Search

Today transplantation of different vital organs is an often and successfully applied clinical method. After organ transplantation the degree of recovery mainly depends on graft function. Besides social, work and school reintegration as well as the development of independence and self-responsibility are decisive for a general recovery. Therefore a rehabilitation should be planned in the scope of the medical care after transplantation. For this reason the rehabilitation center for children and juvenile was founded in Stronach, Austria in 1992. Since then until March 1995 136 kidney- and 54 liver transplanted patients have been treated. There is a significant increase of hemoglobine in all cases and a significant decrease of creatinine as a parameter of graft function in kidney-transplanted patients. By spiroergometric testing the heartrate at the aerobic-anaerobic threshold can be easily estimated in children and juvenile and in consideration of these results the physical endurance can be distinctively increased by an individual training program.

A plastic lung working on the same principles as an iron lung has been developed at the Medical School in Hannover. Functional and practical tests were performed in a representative group of patients. Respirators support following the principles of an iron lung may be provided as a supplement or an alternative to existing artificial respirator therapy. The modern artificial respirators are superior to the plastic lung, which however, has advantages for particular indications: Respiratory therapy performed in a plastic lung is well tolerated by the patients. It requires specific skills which can easily be learned by the medical staff. Routine use certainly cannot be instituted before further technical improvement has been achieved; in particular the noise level should be reduced. The plastic lung is suitable for short-term ventilation (2-10 h); in view of the restricted nursing procedures possible, prolonged artificial respiration cannot be recommended. In conclusion, immediate postoperative ventilation is the area of application for the plastic lung. Several advantages are known: the endotracheal tube can be removed, there is no indication for sedative drugs, cardiac function and organ blood flow are positively influenced, mucolysis and lung expansion are adequate. A patient whose spontaneous respiratory activity is borderline benefits from short-term therapy, which can be repeated as necessary. Protracted artificial ventilation can be avoided. The gradual process of weaning from the ventilator following prolonged artificial respiration is facilitated by the use of a plastic lung. Plastic lung therapy is superior to other common methods of treating persistent atelectasis, because its mucolytic effects lead to expansion of the atelectatic lobe or segment.(ABSTRACT TRUNCATED AT 250 WORDS)

Historically, there are three phases of development: initially, prophylactic operations in transplant candidates were performed frequently, particularly to minimize complications of infection and stress ulceration. As a consequence of advanced experience and reduced immuno-suppression, the need for those operations declined. Today, by extending transplant indications to elderly patients and to more complicated situations, prophylactic surgery-particularly for concomitant cardiovascular disease-plays an increasing role. Indications for prophylactic surgery are also provided in endocrinal, oncologic and immunologic conditions.

Postoperative artificial ventilation by using an endotracheal tube may cause a pulmonary infection. A possibly necessary permanent sedation and relaxation may result in an additional danger for the patient. The principle of the "iron lung" represents an alternative to endotracheal artificial respiration, which applies especially to endangered patients who are under postoperative artificial respiration. After an abdominal operation five patients have been extubated and artificially respirated by using the "iron lung" principle while not being able to breath by themselves. The degree of the sedation was monitored both intraoperatively and postoperatively using an automatic EEG classification. The performance spectrum of the respiratory curve enabled very early detection of the onset of spontaneous respiration.

Intravenous fluid replacement via a peripheral catheter harbours several risks. The study presented emphasizes that about 50% of the patients show complications during the first days after positioning of an intravenous line. Women patients have been affected more often than male patients. Small catheters positioned in a major vessel away from a joint in the forearm, yield the best results. Peripheral lines should be removed within 8 to 12 hours after surgical procedures, when early symptoms are observed. Complications can be avoided by following these recommendations.

In order to prevent symptoms of drug withdrawal during pregnancy, we treated a woman with clonidine, an alpha-2 adrenergic agonist with central and peripheral actions. We saw a good response of the withdrawal symptoms without any period of severe hypotension or bradycardia. Two healthy babies were subsequently delivered by cesarean section.

Total atelectasis of the left lung occurred in a 61-year-old woman after several weeks ventilator-assisted breathing following an operation for ileus, when the tracheal cannula was removed. It was quickly replaced and artificial ventilation resumed. But despite daily bronchoscopic suction for three weeks the patient's state failed to improve (vital capacity 39%, arterial pO2 47 mm Hg, pCO2 37 mm Hg). Mechanical ventilation with an "iron lung" was therefore instituted over a six month period, at first for two hours daily (as an in-patient) and then weekly (as out-patient). During this time her condition and general state clearly improved. On re-hospitalization to remove the tracheal cannula her vital capacity was 75%, pO2 78 mm Hg and pCO2 38 mm Hg.