Discovery and Relative Importance of Continuous Arteriovenous HemofIltration Lee W. Henderson Continuous arteriovenous hemofiltration (CAVH) has seen a brisk upswing in popularity in Europe since its introduction by Dr. Kramer and colleagues from Gottingen, West Germany in 1977 [1]. In the United States, the technique re- ceived approval as a clinical tool from the Food and Drug Administration in April 1982. This approval flowed, in no small measure, from the extensive expe- rience reported from Europe and in particular West Germany [e. g. , 2, 3]. Reports of its clinical utility now have begun to appear in the United States [4]. Removal of excess total body water using synthetic membranes in an extracor- poreal circuit dates back to the work of Alwall and the artificial kidney that he designed which permitted utilization of a hydrostatic pressure gradient to moti- vate water flow across the membrane [5]. Kolffs original rotating drum with its unencased membrane required an osmotic driving force [6]. Hemofiltration, the use of the filtration process to remove uremic solutes with the artificial kidney, in analogy with the glomerulus, was reported in 1967 [7]. This was made possible by the availability of synthetic membranes with far higher hydraulic permeability (approximately 10 times higher) than conventionally used cellulosic hemodialysis membrane. Specific applications of these "high flux" membranes to the removal primarily of excess total body water followed shortly thereafter [8].

Archetypal Grief: Slavery's Legacy of Intergenerational Child Loss is a powerful exploration of the intergenerational psychological effects of child loss as experienced by women held in slavery in the Americas and of its ongoing effects in contemporary society. It presents the concept of archetypal grief in African American women: cultural trauma so deeply wounding that it spans generations. Calling on Jungian psychology as well as neuroscience and attachment theory, Fanny Brewster explores the psychological lives of enslaved women using their own narratives and those of their descendants, and discusses the stories of mothering slaves with reference to their physical and emotional experiences. The broader context of slavery and the conditions leading to the development of archetypal grief are examined, with topics including the visibility/invisibility of the African female body, the archetype of the mother, stereotypes about black women, and the significance of rites of passage. The discussion is placed in the context of contemporary America and the economic, educational, spiritual and political legacy of slavery. Archetypal Grief will be an important work for academics and students of Jungian and post-Jungian studies, archetypal and depth psychology, archetypal studies, feminine psychology, women's studies, the history of slavery, African American history, African diaspora studies and sociology. It will also be of interest to analytical psychologists and Jungian psychotherapists in practice and in training.

In spite of all the progress made by modern science and technology in penetrating the mysteries of nature and providing new possibilities for its transformation, we remain largely helpless in the face of such natural phenomena as earthquakes, tsunami, typhoons, floods, and droughts. Natural disasters occur suddenly, but with periodicity, and man has been confronted by their devastating consequences throughout history. The way people deal with these problems is primarily predetermined: by charac ter, by conditions, and by the social and economic development of society. Industri ous efforts to reconstruct nature, and exploitation of her resources, have brought about additional damage, and there is the apparent danger that our interference with the atmosphere and other areas such as climate, soil, and hydrology has initiated devastating processes which may well be irreversible. As a result, the effects of natural disasters, and all the ensuing repercussions, become ever more aggravating. Their scope becomes global, and for the time being we have no effective countermeasures at our disposal with which to fight them. The contemporary world, then, faces the interconnected and interdependent phenomena of ecological crises and natural disasters: the problem of protecting man from the environment, and the concurrent problem of protecting the environment from man."

The existence of a differential block is still part of the theory of regional anaesthesia. In 1980 it was described in detail by Cousins and Bridenbough in their standard work Neural Blockade. The theory of differential sensitivity of fibres in the peripheral nervous system essentially goes back to Gasser and Erlanger, who in 1929 established that when isolated peripheral nerves are electri- cally stimulated in the presence of increasing concentrations of co- caine, the compound action potentials of slow-conducting fibres are blocked before those of fast-conducting fibres show any measur- able changes. In man, regional anaesthesia begins subjectively with a feeling of warmth, objectively with a corresponding increase in skin tem- perature. There is then, in order of occurence, loss of sensation of cold, heat and pain, and pressure and touch, and fmally loss of voluntary motoricity. In recovery from anaesthesia, these return in the reverse order. The theory of differential block is by no means undisputed. In 1981, de Jong, commenting in Anesthesiology on the work pub- lished in that journal by Gissen et al. which showed a new sequence of differential sensitivity in the rabbit, wrote, "There remains plen- ty to be done yet before the book on differential nerve block can be closed".

Pregnancy loss can leave us with many unanswered questions, and knowing where to find answers is not always clear. This book is for you if, like me, you've been affected by any kind of pregnancy loss - currently or in the past. It provides practical advice and self-care strategies to help you cope during or after loss, alongside ideas that will enable you to make sense of what's happened - including understanding your feelings and choices; outlining what you can expect during and after your loss; ways to navigate physical and mental health care (if appropriate); and thinking about how to remember your baby. It's for charities, support groups, therapists, and healthcare professionals who want to provide support and care. We all react - and cope with loss - in different ways, and this book respects diverse needs when it comes to getting information and help. You don't have to feel like you are going through your loss alone. In this book you'll find reflection exercises, self-help resources, and stories and suggestions from other people about how they survived, which should leave you feeling more confident and better able to seek additional support if you need it.

The anesthetist-computer interface tends to be a problem for the utilization of computer systems for anesthesia. Ergonomic interface design with an emphasis on the coherency of the interface's static and dynamic structure may improve this situation. To investigate this proposition we developed an Anesthesia Information System (AIS) with a touch-sensitive monitor as the hardware-user interface. Basic data input and system control techniques were defined and implemented. Record keeping is integrated into the user interface. Ventilator control from the same interface is an additional feature for laboratory simulations. The system is being evaluated using a technique that simulates live operations. References Anthony J (1982) BAS - A major change coming in delivery. IEEE EMB 1 (1): 36-42 Apple HP, Schneider AJL, Fadel J (1982) Design and evaluation of a semiautomatic anesthesia record system. Med lnstrum 16 (1): 69-71 Arnell WJ, Schultz DG (1983) Computers in anesthesiology - a look ahead. Med Instrum 17 (6): 393-395 Bender HJ, Osswald PM, Hartung HJ, Lutz H (1983) On line - Erfassung haemodynamischer und respiratorischer GraBen in der Anaesthesie. Anaesth Intensivther Notfallmed 18: 37-40 Cooper JB et al. (1982) A graphics-tablet for data entry in computer assisted recordkeeping Proc.

The hemodynamic significance of the flow properties of blood was put into perspective only during the past decade. Advances in modern technologies today allow the quantitative analy- sis of the fluidity of blood and its components under conditions approximating the flow in vivo, particularly those in the microcirculation. The hematocrit is the most important of the determinants of blood fluidity (reciprocal value of blood viscosity); acute increases in the hematocrit exert deleterious effects on circulation and oxygen transport owing to impaired fluidity of blood. High viscosity of plasma due to hyper- or dysproteinemias initiates the microcirculatory dysfunctions in hyperviscosity syndromes. Furthermore, the fluidity or deformability of red cells might be critically diminished and therefore cause redistribution of blood elements and adversely affect the resistance to flow within the microvessels. In low- flow states blood fluidity most likely becomes the key determinant for microvessel perfu- sion, overriding the neural and local metabolic control mechanisms operative at physiological conditions to adjust blood supply to tissue demand. Microcirculatory disturbances are there- fore encountered whenever driving pressures are reduced, as in shock or hypotension, and distal to stenoses of macrovessels, but also in hemoconcentration due to plasma volume con- traction, polycythemia, leukemia, and dysproteinemia. Based on experimental studies exploring the possibilities and limitations, with regard to improving the fluidity of blood by reducing the hematocrit, the concept of intentional hemo- dilution has been introduced to clinical medicine.

The significance of a change in Pa02 occuring in a patient with cardiovascular instability cannot be ascertained unless the values for PV0 and CV02 are known. A fall in Pa02 could 2 reflect worsening of pulmonary function or deterioration of cardiac output (with resultant increase in systemic oxygen extraction). PEEP/CPAP would be an appropriate therapy in the former case but frankly deleterious in the latter if applied prior to cardiovascular stabiliza- tion. References 1. Douglas ME, Downs JB, Dannemiller FJ et al (1976) Change in pulmonary venous admixture with varying inspired oxygen. Anesthesia and Analgesia 55:688-695 2. Kelman GR, Nunn JF, Prys-Roberts C et al (1967) The influence of cardiac output on arterial oxygena- tion. A theoretical study. Br J Anaesth 39:450-458 3. Kirby RR (1986) Respiratory vs cardiovascular dysfunction - How can we differentiate? ASA Refresher Course Lectures, 102 4. Nunn JF (1977) Applied respiratory physiology (2nd ed). Butterworth et Co 5. Van Aken H, Lawin P (1981) Der EinfluB des Herzminutenvolumens auf die arterielle Oxygenation.

Based on Dr. Auerbach's renowned Wilderness Medicine text, Field Guide to Wilderness Medicine, 5th Edition, is your portable, authoritative guide to the full range of medical and emergency situations that occur in non-traditional settings. Useful for experienced physicians as well as advanced practice providers, this unique medical guide covers an indispensable range of topics in a well-illustrated, highly condensed format - in print or on any mobile device - for quick access anytime, anywhere. An easy-access presentation ensures rapid retrieval and comprehension of wilderness medical information, with "Signs and Symptoms" and "Treatment" sections, bulleted lists, and quick-reference text boxes in every chapter. All chapters are thoroughly up to date, including new information on travel medicine, medications, immunizations, and field treatment of common conditions. Step-by-step explanations from wilderness medicine experts cover the clinical presentation and treatment of a full range of wilderness emergencies and show you how to improvise with available materials. Comprehensive coverage includes dive medicine and water-related emergencies, mountain medicine and wilderness survival, global humanitarian relief and disaster medicine, high-altitude medicine, pain management, and much more. Line drawings and color plates help you quickly and accurately identify skin manifestations, plants, poisonous mushrooms, snakes, insects, and more. Useful appendices address everything from environment-specific situations to lists of essential supplies, medicines, and many additional topics of care. Expert ConsultT eBook version included with purchase. This enhanced eBook experience allows you to search all of the text, tables and figures from the book on a variety of devices.

Apley & Solomon's Concise System of Orthopaedics and Trauma is firmly established as the leading introductory textbook of orthopaedic practice and the principles of fracture and trauma management. Praised in previous editions for the systematic approach, balanced content and easy-to-read style, this fifth edition has been brought fully up to date under the direction of the new and distinguished authorial team, while remaining true to the teaching principles of Alan Apley and his successor Louis Solomon. Key features: Focused - on diseases and clinical signs with additional detail on anatomy where appropriate International - enhanced coverage of 'global orthopaedics' reflect the changing pattern of musculoskeletal disease and trauma around the world Relevant - provides helpful guidance on simple procedures without unnecessary operative detail Readable - increased emphasis on concise presentation Current - updates reflect developments in molecular biology, genetics and imaging technology This fifth edition remains the first choice for medical students, trainee surgeons and other health professionals seeking a convenient introduction to this large and complex subject and is a natural precursor to the more detailed coverage offered by its larger parent, Apley & Solomon's System of Orthopaedics and Trauma.

The recent development of the use of spinal opiates as a rational therapy for pain rests on clear and certain experimental data. We have long known the spinal cord to be a highly complex structure. Anatomical studies of the substantia gelatinosa have repeatedly demonstrated signs of massive synaptic interaction between primary afferents, descending pathways and intrinsic neurons. Yet, to date that knowledge, insofar as clinical therapy is concerned, has permitted us only to destroy certain connections within the spinal cord in the hopes that the substrate mediating pain could be anatomically differentiated from those which mediate other function. Though cordotomies are clearly effective under certain circumstances, they suffer from the fact the spinal cord is not organized in such an anatomically discrete fashion as is often times drawn in basic medical text. Rather, functions intertwine exquisitely and specific physical interventions are no more likely to produce a specific effect than smashing of the fmgertip with a hammer will produce just a loss of the fingernail. The development of specific therapies of the spinal cord has come about by our growing aware ness of the intricate organization of the pharmacological substrates associated with specific neural function."

This book introduces emotion focused family therapy (EFFT) as an evidence-based intervention for children through the integration of parent trauma treatment and emotion-focused techniques. A team of expert authors, including the founders of EFT and EFFT, contribute to the chapters, in which recent findings from longitudinal clinical trials are woven into a rich and deeply presented overview of using EFFT practically with clients. This immensely practical book also provides illustrative case studies, intervention strategies, and do's and don'ts at the end of each chapter.

bei cardio-chirurgischen EingrifIen U. Brenken, G. Karliczek und H. Oldenziel Einleitung 1 2 Seit einigen Jahren werden an unserer Klinik Etomidate und Piritramid aufgrund der gUn* stigen Mitteilungen in der Literatur [3-9, 12, 13, 15, 17] routinemae,ig zur Narkoseeinlei- tung fill Koronar- und Klappenersatzoperationen eingesetzt. In dieser Untersuchung sollte gezeigt werden, inwieweit auch bei schwerstkranken Herzpatienten Narkosen ohne wesent- liche Veriinderungen der Haemodynamik eingeleitet werden konnen. Entsprechende Unter- suchungen haben sich bisher auf den Vorgang der Schlafinduktion beschrankt. In Wirklich- keit umfae,t die Narkoseeinleitung Muskelerschlaffung, endotracheale Intubation und den Ubergang zur kontrollierten Beatmung mit meist Lachgas-Sauerstoff. Diesen Sachverhalt ha- ben wir in unserer Untersuchung mitberiicksichtigt Methoden Die Messungen erfolgten an 12 Patienten mit ernster Koronarsklerose und an 12 weiteren Patienten mit Herzklappenfehlern im klinischen Stadium III, III bis IV und IV der NYHA- Klassifikation. Die verwendeten Mee,methoden wurden an anderer Stelle eingehend be- schrieben [10]. Praemedikation: 10-15 mg Valium, kein Atropin. Unter Lokalanaesthesie wurde ein 7-F-Swan-Ganz-Katheter (KMA) eingebracht. Nach Messung der Basiswerte: Herzfrequenz, arterieller Blutdruck (Riva-Rocci), zentralvenoser Druck, Pulmonalarteriendmck und Cardiac Output (Thermodilution) wurde die Anaesthesie durch langsame Injektion von Etomidate 0,2-0,3 mg/kg in 30 Sekunden und Piritramid 0,3-0,5 mg/kg eingeleitet. Bis zur Intuba- tion unter Pancuroniumbromid (pavulon) 0,1 mg/kg in der 5. Minute wurden die Patienten tiber eine Maske mit 100% Sauerstoff beatmet. Nach der Intubation erfolgte die Beatmung mit dem Servo-Ventilator mit einem Lachgas/Sauerstoffgemisch (Fi0 = 0,5). Es wurde eine 2 endexpiratorische CO -Konzentration von 5% angestrebt.

W.F. List Unter einer praoperativen Ambulanz soll eine Organisationsform verstanden werden, die eine fruhzeitige praoperative Befunderhebung zur Feststellung der Anasthesiefahigkeit und des Anasthesierisikos durch Anasthesiologen ermoglicht. Chirurgische Patienten mit elektiven Eingriffen sollen entweder noch vor ihrer Spitalsaufnahme oder aber unmittelbar nachher in einer derartigen Ambulanz gesehen werden. Die Untersuchungen werden in eigenen Raum- lichkeiten der Anasthesieabteilung bzw. des Anasthesieinstitutes oder der Anasthesieklinik durchgefuhrt. Dadurch ist die Gewahr gegeben, dass der Anasthesiologe schon fruhzeitig mit dem chirurgischen Patienten in Kontakt kommt und alle notwendigen Befunde zur Feststel- lung der Anasthesiefahigkeit (Narkosetauglichkeit) und des Anasthesierisikos erheben kann. Zwischen 25 und 40 % unserer Patienten zeigen neben der chirurgischen Erkrankung noch medizinische Befunde, die beachtet werden mussen (Kyei Mensah et al. 1974). Das operative Risiko und die Operationsletalitat wird durch medizinische Begleiterkrankungen deutlich er- hoht (Goldman et al. 1977). Bisher war es doch so - jedenfalls in meiner Institution - dass praoperative Befunde vom chirurgischen Patienten selbst in mehreren Ambulanzen und Labors zusammengetragen werden mussten. Dann wurde sehr oft vom Chirurgen ein Internist angefordert, der die Ope- rationstauglichkeit meist bei "schonender Narkose" feststellt. Der Anasthesiologe sah die Pa- tienten erst am Vorabend der Operation. Eine oft sehr lange Liste von Patienten musste in kur- zester Zeit beurteilt und pramediziert werden. Nicht selten musste die Anasthesiefahigkeit auch noch mit unzureichenden Befunden abgeklart werden. Ein Absetzen der Operation fuhrte zu Schwierigkeiten mit dem Patienten, mit dem Operationsprogramm und dem Chirurgen.

In clinical anaesthesiology the inhalation anaesthetics halothane (fluothane), enflurane and - in recent times - forane got a renaissance in clinical application. The reasons are not only the ad vantages of volatile anaesthetics, but also the fact that the investi gations of pharmacodynamics and pharmacokinetics of Lv. narcot ics showed negative aspects. It was the aim of the organizers of the symposium to give a survey of the present state of knowledge on inhalation anaesthetics, which is as up-to-date, critical as well as detailed as possible. Furthermore it was the intention to evaluate the recent advances made in the field of basic research. The first section of the symposium in particular enters into the question of the toxicity of volatile anaesthetics as well as their mechanisms of action. In a second main part the influences on cardiovascular system and on microcirculation are discussed. Apart from the extensive discussion of the advances in knowledge in the field of cardiovascular pathophysiology, the focal point of the contribut ions is made up of those with anaesthesia in coronary heart disease and cardiac insufficieny as well as the contribution on interactions of inhalation anaesthetics with cardiovascular drugs. In the third and fourth section the influences of volatile anaesthetics on cerebral, hepatic, renal and pulmonary function are dealt with as well as questions concerning the clinical application. Particular attention is given to the important problems of indicat ion in patients belonging to the extreme age groups."

I felt highly honoured when I was asked to write about the achievements of my late brother, Dr Frank Wilson, MB, BS(Lond.), FF ARCS, DA, DCH, who was the editor of and a contributor to this book. Frank graduated in Medicine at St Bartholomew's Hospital Medical College in 1949 at the early age of 22. Born in Lancaster, his one wish was to return to the North. He held house appointments at Preston, spent his two years of National Service in the Royal Air Force and attained the rank of Squadron Leader. While on National Service, his interests turned to anesthetics, and as Senior Medical Officer on H.M. Troopship 'Devonshire', he developed a love for the sea. Convinced that anesthesia was his career, Frank came to Liverpool and attended the University course in this speciality. The vast experi ence he gained in anesthesia in the Liverpool Hospitals and on the Thoracic, Cardiac, Neurosurgical and Paediatric units, ensured his continued interest in resuscitation and neonatal anesthesia, which led him to design a new tracheostomy tube when he was at Alder Hey Children's Hospital. He became Lecturer in Anesthesia at the University of Liverpool and later Consultant Anesthetist to Southmead Hospital, Bristol, and then to the Burnley group of hospitals and to Lancaster in 1966."

The VIth World Congress of Anaesthesiology, held in Mexico City in 1976, offered several European participants the opportunity of discovering their community of views. The idea was then launched of establishing a forum for regular exchanges among academic anaesthetists from Europe. After many preliminary discussions, some thirty delegates or observers from the Societies of Anaes thesia of Austria, Belgium, Finland, France, German Federal Re public, Greece, Ireland, Italy, the Netherlands, Norway, Poland, Spain, Switzerland, United Kingdom and Yugoslavia met in Paris on 12 March 1977. They agreed to found a European Academy of Anaesthesiology. After a second meeting in Dublin, the Academy was officially created by a general assembly in Paris on 5 Septem ber 1978. Election of members took place for the first time on that date. Since then, the Academy has been functioning regular ly. Its membership presently stands at 180 from 26 European countries. Associate members will be elected for the first time this year. The total number of full members is limited by the statutes to five hundred. The Academy also has two other categories of members: hon orary and patrons. Five honorary members have so far been elec ted: Mrs. N. du Bouchet (France), Mr. H. Killian (German Federal Republic), Sir Robert Macintosh, Prof. W. W. Mushin (United King dom) and Dr. E. M. Papper (United States)."

This first manuscript on cold injuries was written in the period 1945-1946 as the result of personal experience gained in the winter months of the years 1941-1943 on the Northern Front in Russia and subsequent experimental work at the "Chirurgische Uni versitatsklinik" in Breslau (Wroclav) between 1943 and 1945. The intention at the time of writing was to present a summary of our experiences, so that they might serve as a basis for further scientific and clinical work. The manuscript has continually been revised and brought up to date. For purely external reasons publication has been delayed until today. Our experience of cold preservation and of increased resistance to oxygen deficiency in chilled tissue, acquired during the winter periods of the Second World War in Russia, served as a basis for the development of local cryanaesthesia and hibernation, which retroactively furthered to a considerable degree our knowledge of cold and frost injuries. See my monograph on the biology and clinical treatment of the cold injury and general loss of temperature, which appeared separately in 1966 and discusses all biological changes. A comprehensive report on cold injuries was written in English in 1952 at the instigation of Captain A. R. Behnke jr. USA (M.C.), (not available commercially).

Dieser Band ist die Fortsetzung von Beitragen internationaler Ex perten zur Physiologie und Pathophysiologie der ruckenmarksna hen Leitungsanaesthesien. Nachdem 1978 die Wirkung der Epiduralanaesthesie auf Kreis lauf und Atmung sowie auf die Stressreaktionen bei Operationen behandelt wurde, werden jetzt die Pharmakokinetik der Lokal anaesthetika, der Interaktion der Lokalanaesthetika mit Medika menten, die zusatzlich bei Regionalanaesthesien verabreicht werden und das Thromboembolierisiko bei Epiduralanaesthesie im Ver gleich zur Allgemeinnarkose angesprochen. Dabei wird insbesondere die klinisch wichtige Frage bespro chen, ob ruckenmarksnahe Leitungsanaesthesien bei Low-Dose Heparinisierung der Patienten durchgefiihrt werden durfen. AuEerdem wird der gegenwartige Stand der peripheren und ruckenmarksnahen Leitungsanaesthesien, vor aHem in den USA, aufgezeigt und mogliche neue Entwicklungen diskutiert. Diese Zusammenstellung soH dem Leser nicht das Lehrbuch ersetzen, sondern ihm einen raschen und umfassenden Dberblick uber den neuesten Stand der Entwicklung ermoglichen. Den Erfolg dieses Symposiums danken wir wiederum den in formativen und interessanten Beitragen der Referenten und Dis kussionsteilnehmer, sowie der groEzugigen Unterstutzung durch die Firma Astra Chemicals, Wedel/Holstein. Dusseldorf, im Oktober 1981 H.J. Wlist M. Zindler Inhaltsverzeichnis I. Pharmakokinetik der Lokalaniisthetika Vorsitz: B.G. Covino, Boston, USA und U. Borchard, DUsseldorf H. Stoeckel und P.M. Lauven Grundlagen der Pharmakokinetik . . . . . . . . . . . . . . . . . . . 3 Diskussion . . . . . . . . . . . . . . . . . . . . . . . .. . . . 11 . . . . . . B.G. Covino Pharmacokinetics of Local Anesthetics 12 Discussion . . . . . . . . . . . . . . . . . . . . . . . .. . . . 20 . . . . . . R. Dennhardt Pharmakokinetik und Metabolismus von Bupivacain ...... 21 Diskussion . . . . . . . . . . . . . . . . . . . . . . . .. . . . 30 . . . . . . L. Wiklund und A. Berlin-Wahlen The Influence of Liver Circulation of the Pharmacokinetics of Local Anaesthetics ... . . . . . . . . . . . . . . . . . .. . . 32 . . . . Discussion . . . . . . . . . . . . . . . . . . . . . . . .. . . . 41 . . . . . ."

Selected Figures and Tables from The Practice of Emergency and Critical Care Neurology, 2nd Edition condenses the main conclusions from each chapter of The Practice of Emergency and Critical Care Neurology, 2nd Edition into a concise and handy pocketbook. Designed as a quick reference, the pocketbook pulls together the most important tables and figures, putting hard to find information in one easy reference. This is by no means a replacement for the larger text, but rather, a quick, yet comprehensive volume to keep what is most vital on hand. Along with the tables and figures, the pocketbook includes important formulas and rating scales, guides to verifying a dose, guides to writing an order set and to provide emergency care of critically ill neurologic patients, guideline references, and a section at the back of the book to allow the practitioner to take notes. This is the go-to guide for every physician, staff neurologist, neurointensivist, resident, and fellow in training with managing acutely ill neurologic patients.