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Ziel dieser Untersuchung war ein Vergleich von Cisatracurium und Pancuronium hinsichtlich Hamodynamik und neuromuskularer Wirkungen bei der Narkoseeinleitung β-blockierter Koronarbypasspatienten (ASA III, gute bis masig eingeschrankte LV-Funktion). Doppelblind prospektive Untersuchung an 60 Patienten: Jeweils 20 Patienten erhielten bei Einleitung einer Sufentanil/Midazolam/Etomidatanasthesie zur Muskelrelaxation Pancuronium 0,1 mg/kg (Gruppe P) oder Cisatracurium (0,1 mg/kg: Gruppe C2; 0,2 mg/kg: Gruppe C4). Die Hamodynamik wurde mittels EKG, invasiver arterieller Druckmessung und pulmonalarteriellem Katheter, die neuromuskulare Ubertragung mittels Elektromyographie gemessen. Die Herzfrequenz fiel signifikant ab in Gruppe C2 von 62,7±9,3 min−1 vor Einleitung auf 50,2±6,8 min−1 3 min nach Einleitung, in Gruppe C4 von 63,8±9,3 auf 54,3±11 min−1, blieb dagegen in Gruppe P (63±19 und 62,4±13,2 min−1) unverandert. Dieser Unterschied blieb signifikant bis 60 min nach Einleitung. Die Anschlagszeit betrug 5,2±3,4 min in Gruppe P, 6,4±2,1 min in Gruppe C2 und 2,9±1,2 min in Gruppe C4. Schlussfolgerung. Bei Narkoseeinleitung koronarchirurgischer Patienten mit hochdosierten Opioiden muss bei Anwendung von Cisatracurium im Gegensatz zu Pancuronium mit dem Auftreten einer interventionsbedurftigen Bradykardie gerechnet werden.

Objective: The aim of the present study was to evaluate the correlation, accuracy, and precision of transpulmonary thermodilution cardiac output (CO) measurement. For this purpose, this technique was compared with the clinical gold standard, the CO measurement by pulmonary artery catheter in patients after coronary artery bypass grafting (CABG). Design: A prospective clinical study. Setting: A university medical center. Participants: Seventy-five patients in an intensive care unit (ICU) after CABG. Interventions: Standard (SCO) and transpulmonary thermodilution CO measurement (TPCO) measurements were simultaneously performed in triplicate by central venous injection of cooled saline solution. All variables were recorded at five different time points of measurement during weaning from mechanical ventilation. Measurements and Main Results: CO measurements yielded 375 data pairs. SCO ranged from 2.0 to 10.2 L/min, and TPCO from 1.3 to 10.6 L/min. During the entire observation period, TPCO measurements tended to yield relatively high values, whereas SCO measurements resulted in lower values. Correlation between TPCO and SCO measurements was significant (r = 0.73; p < 0.05), accompanied by an accuracy with a bias of 0.456 L/min (7.3%) and a precision of 1.156 L/min (18.5%). Conclusion: In most patients, TPCO measurement will not replace the conventional technique by pulmonary artery catheter, but in some patients it offers an attractive, reliable, and safe method to determine CO.

We evaluated intermittent and continuous thermodilution cardiac output data in 12 patients undergoing orthotopic liver transplantation. Measurements were performed at 16 predefined time points between induction of anaesthesia and 3 h after reperfusion of the liver graft. Cardiac output measurements yielded 192 data pairs (intermittent cardiac output range: 1.8-18.9 l.min-1, continuous cardiac output range: 3.3-20.0 l.min-1). During most of the procedure the correlation between intermittent and continuous cardiac output measurements was significant (r = 0.87, p0.0001), accompanied with a bias of -0.240 l.min-1 and a degree of precision of 1.789 l.min-1 (10.0 l.min-1:1.137 l.min-1,or = 10.0 l.min-1:2.220 l.min-1). However, in the early phases after caval clamping and after reperfusion, accuracy was not acceptable. Only during these phases did the difference between the mean values of pulmonary artery blood temperature and rectal temperature increase (after caval clamping) or decrease (after reperfusion). In conclusion, despite acceptable levels of accuracy and precision between intermittent and continuous cardiac output measurement under stable conditions, both methods showed markedly decreased accuracy and precision in the early phases after caval clamping and after reperfusion, possibly owing to increased thermal noise.

Purpose: Although it is known that weaning from mechanical ventilation is associated with alterations in intrathoracic pressure, lung volume, and venous return, changes in intrathoracic fluid volumes during weaning are not reported. Especially in patients with impaired cardiac function, the development of pulmonary edema during weaning has been described. Thus, we investigated changes in intrathoracic fluid volumes in patients after coronary artery bypass grafting after changing the ventilatory pattern from mechanical to spontaneous ventilation. Materials and methods: Intrathoracic blood volume index (ITBVI), pulmonary blood volume index (PBVI), and extravascular lung water (EVLW) were calculated during mechanical ventilation (T1), Tpiece breathing (T2), and spontaneous breathing after extubation of the trachea (T3) in 72 consecutive patients after coronary artery bypass grafting using a combined dye-thermal dilution method. Results: Changing from mechanical ventilation to T-piece breathing resulted in an increase in ITBVI from 880 ± 22 mL/m2 to 970 ± 22 mL/m2 (P < .01), and in PBVI from 162 ± 6 mL/m2 to 173 ± 6 mL/m2 (P < .01). After extubation of the trachea, both parameters decreased again (ITBVI, 879 ± 20 mL/m2; PBVI, 160 ± 7 mL/m2). EVLW remained unchanged after transition to T-piece breathing (T1, 5.8 ± 0.3 mL/kg; T2, 6.0 ± 0.3 mL/kg), but increased to 6.6 ± 0.5 mL/kg (P < .01) after extubation of the trachea. However, pathological values of EVLW were not observed. Conclusions: In patients after coronary artery bypass grafting, changes in intrathoracic intravascular fluid volumes during weaning are restricted to the period of T-piece breathing and reflect an increased venous return. The maintenance of EVLW in the normal range during weaning indicates that cardiac function was matched to this elevated preload.

Current industrial robots are optimized to “economy of scale” while new business models demand customization, individualization and service-orientation. The next generation of robotic workers will have to cope with more complex tasks, rapidly adapt to new situations and provide high flexibility. Additionally demographic change requires a paradigm shift to put the human workforce in the center of a production system. The LOCOBOT project proposes a toolkit for building customized low cost robot co-workers for a broad spectrum of scenarios. The system approach envisaged keeps the human worker in the loop. So far the approach is user centered design.

Commercially available semi-continuous cardiac output (SCCO) monitoring systems are based on the pulsed warm thermodilution technique. There is evidence that SCCO fails to correlate with standard intermittent bolus cardiac output (ICO) in clinical situations with thermal instability in the pulmonary artery. Furthermore, ventilation may potentially influence thermodilution measurements by enhanced respiratory variations in pulmonary artery blood temperature and by cyclic changes in venous return. Therefore, we evaluated the correlation, accuracy and precision of SCCO versus ICO measurements before and after extubation.Prospective cohort study.Intensive care unit (ICU) of a university hospital.22 cardiac surgical ICU patients.None.SCCO and ICO data were obtained at nine postoperative time points while the patients were on controlled mechanical ventilation. Further sets of measurements were taken during the weaning phase 20 min before extubation, and 5 min, 20 min and 1 h after extubation. SCCO and ICO measurements yielded 286 data pairs with a range of 1.8-9.9 l/min for SCCO and 1.9-9.8 l/min for ICO. The correlation between SCCO and ICO was highly significant (r = 0.92; p0.01), accompanied by a bias of -0.052 l/min and a precision of 0.56 l/min. Correlation, accuracy and precision were not influenced by the mode of respiration.Our results demonstrate excellent correlation, accuracy and precision between SCCO and ICO measurements in postoperative cardiac surgical ICU patients. We conclude that SCCO monitoring offers a reliable clinical method of cardiac output monitoring in ICU patients following cardiac surgery.

AIM The perioperative risk in patients undergoing coronary artery bypass grafting (CABG) might be influenced by premedication procedures. This study was undertaken to evaluate present premedication regimens in CABG patients in Germany. METHODS Using a detailed written questionnaire, each of the 58 German centres of cardioanaesthesia were asked to complete it. RESULTS 37 (64%) of all questionnaires were returned and analysed. All centres used orally administered drugs for premedication in the evening before the operation. Flunitrazepam is the most often administered drug (54%), followed by dipotassium clorazepat (8%), and diazepam (8%). Premedication in the morning on the day of surgery is performed orally in 29 centres (78%), of which 18 centres (49%) prefer flunitrazepam and 6 centres (16%) midazolam as first choice. In contrast, 7 centres (19%) used intramuscularly administered regimens. 5 centres (14%) combined intramuscularly opioids with sedatives for that indication. If anaesthesia was induced late in the morning or in the afternoon, respectively, 11 centres (30%) administered additional benzodiazepines early in the morning. 68% of all centres maintained the administration of chronic treatment with ss-blockers until the morning of the operating day. Chronic treatment with nitrates is continued in 65%, treatment with calcium-channel blockers in 62%. Angiotensin converting enzyme inhibitors are continued in 30%, alpha 2-agonists in 27%, other antihypertensive drugs in 19%, and inotropic glycosids in 11%. 31 of 37 centres (84%) discontinued the administration of acetylsalicylic acid 5 or more days prior to surgery, but 68% tolerate individual exceptions from this principle. CONCLUSIONS The results of our survey indicate that most of the German cardioanaesthesia centres use oral premedication regimens in patients undergoing coronary revascularisation. Anti-anginal medications, with the exception of anti-platelet agents, were continued until the day of surgery in most of the centres.

The aim of this study was to investigate the influence of the platelet-activating factor (PAF) antagonist BN52021 on endotoxin-induced leukocyte-endothelium interactions and on venular microcirculation. The rates of leukocyte adherence and changes in red cell velocity, volumetric blood flow, vessel diameter, and venular shear rate were monitored in rat mesenteric venules following intravenous lipopolysaccharide (LPS) exposure (15 mg/kg body wt). The experiments were performed in LPS-treated control animals and in animals pretreated with the PAF receptor antagonist BN52021. LPS exposure induced a marked increase in adherent leukocytes in the control group compared to the BN52021-pretreated group. Thirty minutes after LPS injection, 6.1 +/- 0.8 leukocytes were adherent to 100 microns of venule in the control group compared to 2.5 +/- 0.5 in BN52021-pretreated animals (P0.01). The increased leukocyte adherence in the control group was accompanied by leukocytopenia. Red cell velocity, volumetric blood flow, vessel diameter, and venular shear rate did not differ between groups, indicating that increased leukocyte adherence in the control group was not due to diminished hydrodynamic dispersal forces. The attenuation of leukocyte adherence by the PAF receptor antagonist BN52021 suggests that PAF is involved in the mediation of the initial process of leukocyte sticking to the endothelium after LPS stimulation.

OBJECTIVES To determine the influence of ketamine on endotoxin-induced leukocyte adherence and venular microhemodynamics. DESIGN Randomized, controlled trial. SETTING Experimental laboratory. SUBJECTS Thirty male Wistar rats. INTERVENTIONS The rats were pretreated with ketamine (10 mg/kg iv) or 0.9% saline, and both groups were given endotoxin (Escherichia coli lipopolysaccharide; 5 mg/kg iv). The control group received two doses of 0.9% saline. MEASUREMENTS AND MAIN RESULTS The rates of leukocyte adherence and changes in microhemodynamics were monitored in rat mesenteric venules, using in vivo video microscopy. The number of adherent leukocytes was determined on-line in 10-min intervals from 60 mins before until 2 hrs after endotoxin administration. Venular diameters, red blood cell velocity, volumetric blood flow, and the venular wall shear rate were monitored before and at 10, 30, and 60 mins after endotoxin exposure. A 6.3-fold increase in the number of adherent leukocytes was observed 10 mins after administration of endotoxin when compared with control animals (5.87 +/- 0.69 vs. 0.93 +/- 0.21 adherent cells/100 microns; p < .001). This increase remained unchanged for 120 mins. In ketamine-pretreated rats, a 2.6-fold increase in leukocyte adherence occurred during the first 20 mins after endotoxin exposure (2.40 +/- 0.46 vs. 0.93 +/- 0.21 adherent cells/100 microns; p < .01). However, no difference in the number of adherent leukocytes between ketamine-pretreated and control animals was found after this 20-min period. In animals of the control group, no increase in leukocyte adherence occurred during the entire observation time. Diameters of mesenteric venules did not change after endotoxin exposure in any of the groups. Red blood cell velocity and venular blood flow in the endotoxin-treated groups decreased 10 mins after the injection of endotoxin when compared with controls, but these values did not show any difference when they were compared between ketamine and saline-pretreated animals. Similarly, venular wall shear rate in the endotoxin-treated groups decreased 10 and 30 mins after injection of endotoxin. However, no significant difference occurred between ketamine and saline-pretreated animals. CONCLUSIONS Pretreatment with ketamine attenuates endotoxin-induced leukocyte adherence by a shear rate-independent mechanism, suggesting reduced expression of adhesion molecules. These results indicate that ketamine exerts an anti-inflammatory effect, which might be beneficial in septic patients.

LOCOBOT (www.locobot.eu) is a European project funded in the first call of the "Factory of the future" in FP 7 (FoF.NMP.2010-1). LOCOBOT addresses strategic objective ― Plug-and-Produce components for adaptive control. The 'Factories of the Future' public-private partnership (PPP) is a joint initiative of the European Commission and the private sector to promote research in advanced manufacturing across Europe. Launched in early 2009, this major European initiative has embarked upon its first 25 research projects which will achieve their final results in 2013 and 2014. 5 of these 25 projects are related to the Topic of robotics and LOCOBOT is one of this 5 projects. LOCOBOT is a system which reaches above and beyond what is currently available for those working in the automotive industry: it incorporates a flexible robotic assistant platform to support and increase manual production processes, as well as the engineering tools required for its setup. Further, this project aims to improve the ergonomics in industrial production processes.

Reactive intramolecularly crosslinked macromolecules (RICM) (reactive micropels) have been synthesized by emulsion copolymerization. Besides 1,4-divinylbenzene (1,4-DVB), self-emulsifying unsaturated polyesters (EUP) were used. In copolymerization of EUP and comonomers the diffusion rate of the latter influences the copolymerization rate of the growing species, if the initiator concentration is high and the water solubility of the difunctional comonomer is low. The compact structure of RICM is indicated by low slopes of log[η]/log M w

Summary Background During cardiopulmonary resuscitation (CPR), thrombolysis can help to stabilise patients with pulmonary embolism and myocardial infarction. Moreover, thrombolysis during CPR has beneficial effects on cerebral reperfusion after cardiac arrest. We investigated this new therapeutic approach in patients in whom conventional CPR had been unsuccessful. Methods We assessed, in a prospective study, patients undergoing CPR after out-of-hospital cardiac arrest for cardiological reasons in whom return of spontaneous circulation was not achieved within 15 min. According to the Ustein criteria, our control group consisted of patients who were assessed during 1 year. After this year patients were treated with a bolus of 5000 U of heparin and 50mg, over 2 min, of tissue-type plasminogen activator (rt-PA treated group). This intervention was repeated if return of spontaneous circulation was not achieved within the following 30 min. For controls only CPR was given. Findings Overall, 90 patients were included; heparin and rt-PA were given to 40 patients. There were no bleeding complications related to the CPR procedures. Of the rt-PA group, 68% (27) had return of spontaneous circulation and 58% (23) were admitted to a cardiac intensive care unit, compared with 44% (22; p=0·026) and 30% (15; p=0·009) of the controls, respectively. At 24 h after cardiac arrest a larger proportion of the rt-PA group than of the controls was alive (35% [14] vs 22% [11], p=0·171), and 15% (six) of rt-PA-treated patients and 8% (four) of controls could be discharged from hospital. Interpretation After initially unsuccessful out-of-hospital CPR, thrombolytic therapy combined with heparin is safe and might improve patient outcome. On the basis of our data a randomised controlled trial might be regarded as ethical.

Outlines the requirements for the various digital signal processing functions of the pan-European digital mobile cellular telephone system in terms of computational power and RAM and ROM capacities, and describes a digital signal processor (DSP) solution which is able to integrate all of these digital baseband functions for a hand-held terminal onto one VLSI chip. The KISS-16V2 processor, a low-power CMOS 16-b DSP, is optimized for digital telecommunications, especially for Groupe Speciale Mobile (GSM). A power-down mode together with the capability of memory and multiplier standby operation make this DSP well suited for handheld devices. A design strategy based on the extensive use of cell compilers and synthesis tools reduces the design of further DSP derivations to a minimum. >

The X-ray powder diffraction data for δ-Na2Si2O5 are reported. The sample was prepared from water glass solution applied to pressed powder tablets of finely ground quartz using a heating program with a maximal temperature of 700 °C. The crystallographic data for δ-disilicate obtained from a Rietveld analysis are: space group P21/n, a=8.3818(4) Å, b=12.0726(5) Å, c=4.8455(2) Å, β=90.303(5)°, V=490.31 Å3, Z=4, and Dcalc.=2.468 g/cm3.

Background While IMRT is widely used in treating complex oncological cases in adults, it is not commonly used in pediatric radiation oncology for a variety of reasons. This report evaluates our 9 year experience using stereotactic-guided, inverse planned intensity-modulated radiotherapy (IMRT) in children and adolescents in the context of the current literature. Methods Between 1999 and 2008 thirty-one children and adolescents with a mean age of 14.2 years (1.5 - 20.5) were treated with IMRT in our department. This heterogeneous group of patients consisted of 20 different tumor entities, with Ewing's sarcoma being the largest (5 patients), followed by juvenile nasopharyngeal fibroma, esthesioneuroblastoma and rhabdomyosarcoma (3 patients each). In addition a review of the available literature reporting on technology, quality, toxicity, outcome and concerns of IMRT was performed. Results With IMRT individualized dose distributions and excellent sparing of organs at risk were obtained in the most challenging cases. This was achieved at the cost of an increased volume of normal tissue receiving low radiation doses. Local control was achieved in 21 patients. 5 patients died due to progressive distant metastases. No severe acute or chronic toxicity was observed. Conclusion IMRT in the treatment of children and adolescents is feasible and was applied safely within the last 9 years at our institution. Several reports in literature show the excellent possibilities of IMRT in selective sparing of organs at risk and achieving local control. In selected cases the quality of IMRT plans increases the therapeutic ratio and outweighs the risk of potentially increased rates of secondary malignancies by the augmented low dose exposure.

Today’s markets and economies are becoming increasingly volatile, unpredictable, they are changing radically and even the innovation speed is accelerating. Manufacturing and production technology and systems must keep pace with this trend. The impact of novel innovative 3D imaging technology to counter these radical changes is exemplarily shown on the robot paint process. One has to keep in mind that investments in automatic painting lines are considerably high and as the painting line often is the bottleneck in production, it is imperative to prevent nonproductive times and maximize the use of the expensive equipment. Highly flexible, scalable and user-friendly production equipment is needed, including robotic systems for painting – a common process in production.

Publisher Summary Building to order implies responding to individual customer requests and not simply producing large numbers of goods for stock and encouraging their sale by promotion and discounting. Adapting state-of-the-art robotized painting lines to new variants is time-consuming and leaves the line in a non-productive state. To overcome the limitations of state-of-the-art robotizes painting systems that are economically not viable at small lot sizes, the Flexpaint project (2000-2002) has developed a new “what you see is what you paint" approach. This approach scans unknown parts being transported to the painting cabinet, reconstructs their geometry and painting-relevant features, and automatically plans the painting strokes and executable—collision free—trajectories. Finally, robot code is automatically generated and executed by the painting robots. The Flexpaint system thus poses a new paradigm in the flame of agile manufacturing. This chapter presents an extension of the “what you see is what you paint” approach by means of dynamic vision and three-dimensional object recognition that is able to complement missing data of scanned parts by use of computer-aided design (CAD) information of recognized and localized parts.

The authors describe the architecture and design of the 1 6-b low-power CMOS fixed-point signal processor KISS-16V1. The 16-b data and instructions are processed in one 50-ns cycle. The KISS-16V1 is a digital-signal processor (DSP) with a multibus Harvard architecture. Its new architectural features and its sophisticated instruction set are optimized for digital telecommunications, especially for GSM. A power-down mode together with the capability of memory and multiplier standby operation make this DSP well suited for hand-held devices. A design strategy based on the extensive use of cell compilers and synthesis tools reduces the design period of further DSP derivations to a minimum. This flexible concept allows adaptation of the device for enhanced requirements of GSM as well as for other signal processing applications. This DSP is a significant step toward an all-digital-on-one-chip solution for the GSM full-rate channel. >

Background —The results of early conventional tests do not correlate with cerebral outcome after cardiac arrest. We investigated the serum levels of astroglial protein S-100 as an early marker of brain damage and outcome after cardiac arrest. Methods and Results —In 66 patients undergoing cardiopulmonary resuscitation after nontraumatic cardiac arrest, blood samples for the evaluation of S-100 were drawn immediately after and 15, 30, 45, and 60 minutes; 2, 8, 24, 48, and 72 hours; and 7 days after initiation of cardiopulmonary resuscitation. Moreover, the serum levels of neuron-specific enolase were determined between 2 hours and 7 days. If patients survived for >48 hours, brain damage was assessed by a combination of neurological, cranial CT, and electrophysiological examinations. Overall, 343 blood samples were taken for the determination of S-100. Maximum S-100 levels within 2 hours after cardiac arrest were significantly higher in patients with documented brain damage (survivors and nonsurvivors, 3.70±0.77 μg/L) than in patients without brain damage (0.90±0.29 μg/L). Significant differences between these 2 groups were observed from 30 minutes until 7 days after cardiac arrest. In addition, the positive predictive value of the S-100 test at 24 hours for fatal outcome within 14 days was 87%, and the negative predictive value was 100% ( P Conclusions —Astroglial protein S-100 is an early and sensitive marker of hypoxic brain damage and short-term outcome after cardiac arrest in humans.

Was haben die Europaische Union, die von Medienkonzernen angestrebte Superliga fur die bekanntesten Fusballvereine und der Untergang der Sowjetunion gemeinsam? Auf den ersten Blick mag diese Frage seltsam anmuten. Die Antwort ist, dass sie Ausdruck der Auflosung alter Strukturen sind. Diese Auflosung ist die Folge der mikroelektronischen Revolution, der Entwicklung der Informationstechnologien (IT). Die enorme Beschleunigung der Datenverarbeitung und der Netze hat ungeahnte okonomische, politische und gesellschaftliche Folgen gezeitigt. Die Virtualitat wird durch die Verdoppelung der Zahl der Transistoren auf einem Chip alle zwei Jahre, nach Andrew Groves von Intel Andrew’s law genannt, erst moglich. In der jungeren Diskussion geht man davon aus, dass im Jahr 2019 Computer den Turing-Test bestehen, das heist, in einem Gesprach nicht mehr als Maschinen erkennbar sind. 2029 konnen Spezialisten das menschliche Gehirn scannen und in einem Computer duplizieren.2

Operation planning in liver surgery depends on the precise understanding of the 3-dimensional (D) relation of the tumor to the intrahepatic vascular trees. To our knowledge, the impact of anatomical 3-D reconstructions on precision in operation planning has not yet been studied.Three-dimensional reconstruction leads to an improvement of the ability to localize the tumor and an increased precision in operation planning in liver surgery.We developed a new interactive computer-based quantitative 3-D operation planning system for liver surgery, which is being introduced to the clinical routine. To evaluate whether 3-D reconstruction leads to improved operation planning, we conducted a clinical trial. The data sets of 7 virtual patients were presented to a total of 81 surgeons in different levels of training. The tumors had to be assigned to a liver segment and subsequently drawn together with the operation proposal into a given liver model. The precision of the assignment to a liver segment according to Couinaud classification and the operation proposal were measured quantitatively for each surgeon and stratified concerning 2-D and different types of 3-D presentations.The ability of correct tumor assignment to a liver segment was significantly correlated to the level of training (P.05). Compared with 2-D computed tomography scans, 3-D reconstruction leads to a significant increase of precision in tumor localization by 37%. The target area of the resection proposal was improved by up to 31%.Three-dimensional reconstruction leads to a significant improvement of tumor localization ability and to an increased precision of operation planning in liver surgery.

Objective: To determine sex hormone-binding globulin (SHBG) and osteocalcin (OC) levels in patients undergoing coronary artery bypass graft surgery to clarify the status of peripheral thyroid metabolism and to correlate SHBG and OC with thyroid hormones and adverse postoperative events. Design: Prospective study. Setting: University medical center. Participants: Fifty randomly selected patients undergoing coronary artery bypass graft surgery. Interventions: On the morning of surgery before induction of anesthesia; 30 minutes after cross-clamping of the aorta; 2 hours and 6 hours after aortic cross-clamp removal; and on the first, second, third, and seventh postoperative mornings, blood samples were drawn and analyzed for OC, SHBG, triiodothyronine (tT3), free T3 (fT3), thyroxine (tT4), free T4 (fT4), thyroid-stimulating hormone, and thyroid-binding globulin. Adverse postoperative events were recorded. Measurements and Main Results: Mean tT3 and fT3 decreased on average by 35% and 18% but remained within the normal range perioperatively. Similarly, mean SHBG and OC remained within the normal range. More than half of the patients investigated (60%) had OC concentrations below the normal range. Patients with pathologically decreased tT3 (n = 6) and tT4 (n = 16) intraoperatively and postoperatively had SHBG and OC concentrations similar to those in patients with normal tT3 and tT4 levels. Patients with postoperative complications had significantly lower OC levels preoperatively and on the first postoperative morning than those with an uneventful postoperative recovery. Conclusion: Despite significant intraoperative and postoperative decreases in levels of thyroid hormones, low T3 syndrome was rare in this patient population. Unchanged concentrations of SHBG and OC in patients with pathologically decreased tT3 or tT4 suggest normal local thyroid exposure at the tissue sites in these patients. OC may act as a predictor for postoperative outcome. Copyright © 2000 by W.B. Saunders Company

OBJECTIVE—To test the effect of a physician staffed advanced cardiac life support (ALS) system on patient outcome following out-of-hospital cardiac arrest. DESIGN—Observational study. SETTING—Two tier basic life support (BLS) and physician staffed ALS services in the midsized urban/suburban area of Heidelberg, Germany. PATIENTS—All patients suffering out-of-hospital cardiac arrest of cardiac aetiology between January 1992 and December 1994 and who were covered by ALS services. INTERVENTIONS—Physician staffed ALS services. MAIN OUTCOME MEASURES—Return of spontaneous circulation, hospital discharge, and one year survival, according to the Utstein style. RESULTS—Of 330 000 inhabitants, 755 suffered from cardiac arrest covered by the Heidelberg ALS services. In 512 patients, cardiopulmonary resuscitation had been initiated. Of 338 patients with cardiac aetiology, return of spontaneous circulation was achieved in 164 patients (49%), 48 (14%) were discharged alive, and 40 (12%) were alive one year later; most of these patients showed good neurological outcome. Thus, 4.85 patients with cardiac aetiology were saved by the ALS services and discharged alive per 100 000 inhabitants a year. Ventricular fibrillation or tachycardia was detected in 106 patients (31%), other cardiac rhythms in 40 (12%), and asystole in 192 (57%). Hospital discharge rates (and one year survival) in these subgroups were 34.0% (29.2%), 12.5% (7.5%), and 3.6% (3.1%), respectively. Discharge rates increased if cardiac arrest was witnessed (bystander, 20.0%; BLS/ALS personnel, 21.4%; non-witnessed arrest, 3.3%; p 8 minutes, 8.1%; p

Background Endotoxin activates leukocyte-endothelial cell adhesion, vascular leakage, and changes in vascular micro-hemodynamics. The aim of this study was to determine whether lidocaine, which inhibits the activation of leukocytes, could attenuate microcirculatory disturbances during endotoxemia. Methods Thirty anesthetized male rats were randomly assigned to receive one of three treatments (n = 10 for each group): infusion of saline (control group), infusion of Escherichia coli endotoxin (LPS group: 2 mg x kg(-1) x h(-1) lipopolysaccharides) without lidocaine treatment, or infusion of endotoxin with lidocaine pretreatment 30 min before baseline measurements (lidocaine group: intravenous bolus of 2 mg/kg and continuous infusion of 2 mg x kg(-1) x h(-1)). Leukocyte adherence, erythrocyte velocity (V(RBC), and vessel diameters (Dv) were determined at baseline and at 60 and 120 min in mesenteric postcapillary venules using in vivo videomicroscopy. Macromolecular leakage was determined by measuring the extravasation of fluorescence-labeled albumin. Venular wall shear rate (tau) was calculated according to the equation tau = 8 x V(RBC) x Dv(-1). Results Lidocaine significantly attenuated the increase of leukocyte adherence during endotoxemia. There were no significant differences of tau within or between the groups. Macromolecular leakage exhibited the greatest increase in the LPS group. In the lidocaine group, it was significantly decreased but still increased compared with the control group. Conclusions These results show that lidocaine attenuates endotoxin-induced alterations in leukocyte-endothelial cell adhesion and macromolecular leakage, which suggests that lidocaine may have a therapeutic role in preventing endothelial damage in sepsis.

Im letzen Jahrzehnt hat die westeuropaische Integration eine Renaissance erlebt. Die Wissenschaft hatte sich Mitte der 70er Jahre von diesem Forschungsfeld abgewandt, zu sehr war die Europaische Gemeinschaft damals in der Krise. Die weitere Beschaftigung schien nicht zu lohnen, Integration als Politikmodell in einer Sackgasse angelangt zu sein. Um so uberraschender, weil nicht erwartet und prognostiziert, waren die Ereignisse in den 80er Jahren. Das Weisbuch der Kommission zum Binnenmarkt, die Einheitliche Europaische Akte und die Regierungskonferenzen von 1991, mit den Maastrichter Vertragen als Abschlus, sind die Meilensteine. Parallel erfolgte die Suderweiterung der EG, jetzt steht die Aufnahme nordeuropaischer Staaten an. Wie weit der Prozes der Vertiefung der Integration im Innern und der weiteren geographischen Ausdehnung gehen wird und kann, ist gegenwartig nicht abzusehen.

Emulsion copolymerization of unsaturated polyesters (UP) with styrene was initiated by potassium peroxodisulfate and by azodiisobutyronitrile (AIBN). The decay rates of both initiators were compared and influences of temperature, electrolyte and concentration of the reaction components studied. Initiation radicals from the persulfate partly add to unsaturated UP units and decarboxylate terminal acid groups of the UP. Initiation by AIBN predominantly occurs in the aqueous phase, and side reactions with this initiator are neglectable.

Die 8-Oxabicyclo[3.2.1]oct-6-en-3-one 1a–c reagieren mit Trimethylsilyltrifluormethansulfonat/Triethylamin (TMSOTf/NEt3) zu Troponen. Aus den an der 6,7-Doppelbindung hydrierten Bicyclen 5 entstehen mit TMSOTf/NEt3 die 1,6-Bis(trimethylsiloxy)-1,3-cycloheptadiene 6 neben Doppelbindungsisomeren 7a, 8e. Durch Methanolyse der Trimethylsilyldienolether lassen sich Cycloheptenone gewinnen. Cleavage of the Oxygen Bridge in 8-Oxabicyclo[3.2.1]octan-3-ones and -oct-6-en-3-ones by Trimethylsilyl Trifluoromethanesulfonate The 8-oxabicyclo[3.2.1]oct-6-en-3-ones 1a–c react with trimethylsilyl trifluoromethanesulfonate/triethylamine (TMSOTf/NEt3) to give tropones. The bicyclic compounds 5, hydrogenated at the 6,7-double bond, are cleaved by TMSOTf/NEt3 to form 1,6-bis(trimethylsiloxy)-1,3-cycloheptadienes 6 and the double bond isomers 7a, 8e. Cycloheptenones are obtained by methanolysis of the trimethylsilyl dienol ethers.