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Background The European Diploma in Anaesthesiology and Intensive Care (EDAIC) has become a standard of quality among Spanish anaesthesiologists. The aim of this retrospective observational study was to assess the results of Spanish participants for the Part 1 and Part 2 exams over a recent five years period from 2012 to 2016 and 2013 to 2017, respectively. Material and methods After obtaining the authorization from the European Society of Anaesthesiology, the results of both parts of the EDAIC exams were anonymously analysed for five years. We analysed the number of registrations, the pass rates, the cause for failure and the mean scores for basic sciences (paper A of part 1 exam and the two first vivas of part 2 exam) and clinical anaesthesia and intensive care (paper B of part 1 exam and the two last vivas of part 2 exam). Quantitative variables were analysed using the one-way analysis of variance, and qualitative variables using the chi-square test for trends. The level of statistical significance was set at p Results For the written part 1 exam, 1189 of a total of 10,954 candidates (10.85%) were registered in Spanish centres, reflecting the global growth of the exam (p = 0.29). The pass rate was 62.1%, with no significant differences from other countries (p = 0.38). Basic sciences were involved in 84.1% of failing candidates. Mean scores were 71.74 ± 5.98% for basic science (paper A) and 74.48 ± 4.29% for clinical anaesthesiology (paper B). Regarding the part 2 exam, 72.4% of the candidates who had passed the part 1 exam registered for the oral part 2, with a pass rate of 62.7% versus 62.2% in the rest of the world (p = 0.91). Failing in the basic sciences sections of the part 2 resulted in 93.8% of candidates failing the part 2 exam. Bad fails were registered in 56 (31.5%) of failing candidates, of which 71.3% occurred in the basic sciences vivas. Isolated bad fails only occurred in 7 (3.9%) cases. Conclusions The evolution of the EDAIC in Spain has been very similar to evolution of the EDAIC in the rest of the world. Further efforts to improve knowledge in basic sciences and better preparation in the technique of oral examination should improve the pass rate of the EDAIC examinations from an ever-increasing cohort of candidates.

Resumen Antecedentes El Diploma Europeo en Anestesiologia y Cuidados Intensivos (EDAIC) se ha convertido en un estandar de calidad entre los anestesiologos espanoles. El objetivo de este estudio retrospectivo observacional fue valorar los resultados de los participantes espanoles en los dos examenes —parte 1 y parte 2— en un periodo reciente de 5 anos, entre 2012 y 2016 y entre 2013 y 2017, respectivamente. Material y metodos Despues de obtener la autorizacion de la European Society of Anaesthesiology, los resultados de los dos examenes del EDAIC fueron analizados de manera anonima en un periodo de 5 anos. Analizamos el numero de inscripciones, la tasa de aprobados, la causa de suspensos y la nota media en ciencias basicas (cuadernillo A de la parte 1 del examen y las dos primeras mesas de la parte 2 del examen) y en anestesiologia clinica y cuidados intensivos (cuadernillo B de la parte 1 del examen y las dos ultimas mesas de la parte 2 del examen). Las variables cuantitativas fueron analizadas con analisis de varianza y las variables cualitativas con test de chi-cuadrado para tendencias. El nivel de significacion estadistica fue establecido en p Resultados Para la parte 1 del examen escrito, 1.189 de un total de 10.954 candidatos (10,85%) fueron inscritos en centros espanoles, reflejando el crecimiento global del examen (p = 0,29). La tasa de aprobados fue del 62,1%, sin diferencias significativas con los demas paises (p = 0,38). Las ciencias basicas supusieron el 84,1% de los suspensos. La nota media fue de 71,74 ± 5,98% para las ciencias basicas (cuadernillo A) y de 74,48 ± 4,29% para la anestesiologia clinica (cuadernillo B). En relacion con la parte 2 del examen, el 72,4% de los candidatos aprobados en la parte 1 del examen se inscribieron en la parte 2, con una tasa de aprobados del 62,7%, versus el 62,2% en el resto del mundo (p = 0,91). Los suspensos en las mesas de ciencias basicas de la parte 2 del examen supusieron el 93,8% de los candidatos suspensos en la parte 2 del examen. Los suspensos eliminatorios en una mesa fueron registrados en 56 (31,5%) de los candidatos suspensos, de los que el 71,3% se produjeron en las mesas de ciencias basicas. Los suspensos eliminatorios aislados se produjeron solo en 7 (3,9%) de los candidatos. Conclusiones La evolucion del EDAIC en Espana ha sido muy similar a la del resto del mundo. En el futuro, los esfuerzos persistentes de los anestesiologos espanoles para mejorar sus conocimientos en ciencias basicas y preparar mejor la tecnica del examen oral podrian mejorar la tasa de aprobados en el EDAIC en una cohorte de candidatos en constante aumento.

The EDAIC is a diploma of the European Society of Anaesthesiology and Intensive Care (ESAIC). which is obtained after passing two a written MCQ-based (Part1) and a structured oral (part2) examinationIn 2011, a formative On-Line Assessment (OLA) was introduced to help candidates to prepare for EDAIC Part1 examination (EDAIC-I). This retrospective observational study evaluated the results of the OLA and its impact on the EDAIC-1 between 2013 and 2019.After obtaining the authorisation from the ESAIC Examinations Committee, all the results of candidates registered to OLA and/or EDAIC-I between 2013 and 2019 were included. The total number of registrations and the results were analysed and compared for both.Over 17,000 candidates (17,401) sat any of the written exams of the EDAIC. The overall pass-rate for the EDAIC-1 was 68.95%. The OLA score increased significantly with the number of attempts for Paper A (Basic Science) (p=0.006). Overall success of the EDAIC-I was higher in candidates who took the OLA before (72.9% versus 68.3%; OR: 1.25; 95% CI [1.12; 1.39]; p0.001). Candidates who failed in their first attempt for EDAIC-I were more likely to sit the exam again if they had performed the OLA before (OR: 1.396, 95% CI [1.237; 1.574]; p0.001).The OLA was associated with an improvement of the results in basic science and success rate in the EDAIC-I.

The European Diploma in Anaesthesiology and Intensive Care (EDAIC) has become a standard of quality among Spanish anaesthesiologists. The aim of this retrospective observational study was to assess the results of Spanish participants for the Part1 and Part2 exams over a recent five years period from 2012 to 2016 and 2013 to 2017, respectively.After obtaining the authorization from the European Society of Anaesthesiology, the results of both parts of the EDAIC exams were anonymously analysed for five years. We analysed the number of registrations, the pass rates, the cause for failure and the mean scores for basic sciences (paperA of part1 exam and the two first vivas of part2 exam) and clinical anaesthesia and intensive care (paperB of part1 exam and the two last vivas of part2 exam). Quantitative variables were analysed using the one-way analysis of variance, and qualitative variables using the chi-square test for trends. The level of statistical significance was set at P.05.For the written part1 exam, 1,189 of a total of 10,954 candidates (10.85%) were registered in Spanish centres, reflecting the global growth of the exam (P=.29). The pass rate was 62.1%, with no significant differences from other countries (P=.38). Basic sciences were involved in 84.1% of failing candidates. Mean scores were 71.74±5.98% for basic science (paperA) and 74.48±4.29% for clinical anaesthesiology (paperB). Regarding the part2 exam, 72.4% of the candidates who had passed the part1 exam registered for the oral part2, with a pass rate of 62.7% versus 62.2% in the rest of the world (P=.91). Failing in the basic sciences sections of the part2 resulted in 93.8% of candidates failing the part2 exam. Bad fails were registered in 56 (31.5%) of failing candidates, of which 71.3% occurred in the basic sciences vivas. Isolated bad fails only occurred in 7 (3.9%) cases.The evolution of the EDAIC in Spain has been very similar to evolution of the EDAIC in the rest of the world. Further efforts to improve knowledge in basic sciences and better preparation in the technique of oral examination should improve the pass rate of the EDAIC examinations from an ever-increasing cohort of candidates.

Zusammenfassung Die Bedeutung mykologischer Diagnostik bei therapieresistenten Dermatosen, hier der Acne conglobata, wird hervorgehoben. Candida albicans lies sich massenhaft und wiederholt mikroskopisch und kulturell nachweisen. Um die sich hieraus ergebenden erheblichen therapeutischen Konsequenzen eindeutig hervorzuheben, wird die Bezeichnung Acne conglobata candidosa vorgeschlagen. Systemische und lokale 95tagige antimycetische Behandlung mit Bis-phenyl-(2-chlorphenyl)-1-imidazolyl-methan, unterstutzt durch weitere Masnahmen, fuhrt bereits in 36 Tagen zur Eliminierung von Candida albicans und weitgehender klinischer Erscheinungsfreiheit. Bei der Schwere der Erkrankung und der therapeutischen Unbeeinflusbarkeit sollten die Beschwerden seitens des Magen-Darmkanals in Kauf genommen werden, zumal ernstere Veranderungen an anderen Organen nicht beobachtet wurden. Resumen Se hace resaltar la importancia del diagnostico micologico en dermatosis resistentes a todo tratamiento, aqui del acne conglobado. Se pudo demostrar Candida albicans repetidas veces en preparados directos y cultivos. Para llamar la atencion a cerca de las consecuencias terapeuticas que de ello resulta se ha propuesto la denominacion de acne conglobado candidasico. Un tratamiento local sistemico durante 95 dias con Bis-phenyl (2-cloro-phenyl)-1-imidazolyl-methano, apoyado por otras medidas terapeuticas eliminaron ya a los 36 dias a la C. albicans e hizo desaparecer casi totalmente a las manifestaciones clinicas. El cuadro clinico severo de esta enfermedad y la imposibilidad de influenciarla terapeuticamente justifican la aplicacion de este tratamiento a pesar de los trastornos digestives que provoca, ya que no se han observado alteraciones severas en otros organos.

Zusammenfassung Der Gottinger Historiker, Okonom und Philosoph Georg Friedrich Sartorius von Waltershausen hat als grundsatzlicher Befurworter der Lehren Adam Smiths bereits 1820 geschrieben, dass das von Smith unterstutzte „laissez-faire“-Prinzip der Forderung eigennutzigen Strebens der Einzelpersonen politisch allein nicht ausreichend sei. Der deutsche Okonom und praktische Landwirt Johann Heinrich von Thunen (1783–1850), der wahrend seines kurzen Gottinger Studiums diese Lehrmeinung vermutlich aufgenommen hat, beschaftigte sich ab 1819 im Rahmen seiner Untersuchungen zur Lohn- und Kapitaltheorie als einer der ersten auch mit sozialpolitischen Problemen. Auf ihn, der sich intensiv nicht nur mit Adam Smiths, sondern auch mit Immanuel Kants Lehren auseinandergesetzt hatte, gehen seit dieser Zeit die Anfange sowohl wissenschaftlichen Nachdenkens als auch praktischer Unternehmerinitiativen im Sinne einer fruhen empirischen und normativen „Sozial-Okonomik“ zuruck. Thunen glaubte auf Grund praziser Daten zu w...

Background . Failure of the systemic right ventricle after atrial switch operation can be treated by conversion into an arterial switch operation. Methods . Four patients, age 38 to 59 months, presented with right ventricular failure after Senning operation and ventricular septal defect closure. One patient had elevated left ventricular pressure; in the other three patients the left ventricle was retrained to a left ventricular/right ventricular pressure ratio of 0.8 or greater by pulmonary artery banding in 12 to 24 months. Results . Postoperative course after arterial switch operation was prolonged, but clinical condition was good at discharge. Fractional shortening ranged from 20% to 28%. Trace-to-moderate aortic regurgitation was present; only 1 patient had preserved sinus rhythm. After a mean follow-up of 43.5 months 1 patient had died due to left ventricular dysfunction. The survivors are in New York Heart Association functional class I to II. Fractional shortening has improved (29% to 37%); aortic regurgitation has not increased. No patient has undisturbed sinus rhythm. Conclusions . Conversion of an atrial into an arterial switch is an alternative to cardiac transplantation in childhood. However, the procedure is demanding. Long-term morbidity is caused by rhythm disturbances. Aortic valve performance and left ventricular function require close observation.

Tungsten was injected by means of laser ablation in both ohmic and additionally heated plasmas of the ASDEX Upgrade tokamak experiment. Spectroscopic investigations were performed in the extreme ultraviolet (EUV) wavelength region, 4 to 140 nm. Besides the quasi-continuum structure at ? 5 nm emitted by tungsten ions around W27+, isolated lines of tungsten were observed in the same spectral region and also in the range from 12 to 14 nm. By comparison with calculations from the HULLAC and RELAC codes, these lines could be identified as transitions of bromine to nickel-like tungsten ions. The concentration cW of tungsten after laser ablation was determined from comparisons between the total tungsten radiation PW and the calculated radiation losses. Calibration of the quasi-continuum intensity with the help of the PW measurements allows the tungsten concentration to be determined from spectroscopic observations, which are more sensitive. Both concentration measurements (quasi-continuum, PW) agree well in discharges with laser ablation. From a comparison of the intensity of the isolated lines with code results, cW could be estimated in the central region of hot, additionally heated plasmas. The lower detection limit of the spectroscopic method allows the extraction of cW during the tungsten divertor experiment of ASDEX Upgrade.

UNLABELLED The anaesthetic potency of the (S)-ketamine isomer is approximately double that of racemic ketamine. The aim of this study was to compare the recovery of cerebral function after a bolus of 1.3 mg/kg racemic ketamine or 0.65 mg/kg (S)-ketamine followed by continuous application of 4 or 2 mg/kg x h over 15 minutes. METHODS With their informed consent and approval of the local ethics committee 12 healthy volunteers were enrolled in a double-blind, cross-over study. All drugs were dissolved in identical volumes. On three dates with an interval of one week at least ketamine/NaCl, (S)-ketamine/physostigmine or (S)-ketamine/NaCl was administered (table 1). The sequence was randomized. In addition, the unspecific antagonistic potential of the centrally acting, cholinergic agonist physostigmine (0.012 mg/kg) after (S)-ketamine was tested against saline-placebo. Neuropsychological tests (tests 3-5 of the syndrome-short-test [Erzigkeit, see references]) were used to quantify cerebral function before and at 45, 75, 105, 135, 165 and 195 min after anaesthesia. All data are mean values and standard deviation. Comparisons over time and between drugs were carried out using two-dimensional analysis of variance (ANOVA). Wilcoxon-tests were used post-hoc. p < 0.05 was considered significant. RESULTS After (S)-ketamine the subjects were able to carry out the tasks more rapidly than after racemic ketamine (p < 0.05). Mean time to reach preoperative test performance +10% was 117.5 min for (S)-ketamine/physostigmine, 121.3 min for (S)-ketamine/NaCl and 141.6 min for racemic ketamine (p < 0.05 between (S)-ketamine and racemic ketamine). No differences were found between physostigmine and placebo. The incidence of side effects (mainly nausea, vomiting) was not different. DISCUSSION (S)-ketamine offers a shorter recovery time after short anaesthesia compared to racemic ketamine. The investigated dose of physostigmine was probably too low to produce antagonism of (S)-ketamine. An increased dosage of physostigmine has yet to be studied, but is likely to cause a higher rate of side effects such as nausea, vomiting, bradycardia and possibly even tonic-clonic seizures.

An infusion system that is insufficiently equipped with an alarm device in case the syringe pumps are obstructed, may gravely endanger patient safety. In a patient with septic shock, an obstruction of the infusion system led to periodic application of norepinephrine boli. Sudden haemodynamic disturbances in critically ill patients should be evaluated for pathological causes as well as for technical failure in the infusion system. A sensitive alarming system of syringe pumps may help to eliminate inappropriate drug delivery. For safe infusion of vasoactive drugs the following conditions are highly recommended: a singular syringe pump, a high volume delivery at a low drug concentration, a pressure-controlled infusion device and a short and pressure-resistant infusion system.

Ketamin ist ein Razemat, dessen Isomere S-(+)- und R-(−)-Ketamin ein Aquipotenzverhaltnis von etwa 4:1 aufweisen. Fruher wurde spekuliert, das S-(+)-Ketamin die erwunschten anasthetischen und R-(−)-Ketamin die unerwunschten psychomimetischen Wirkungen hervorruft. Daher wurde S-(+)-Ketamin in einigen randomisierten Untersuchungen an Probanden und an Patienten mit razemischem Ketamin verglichen. In dieser Ubersicht wird die Bedeutung von S-(+)-Ketamin fur die Dauer der Aufwachphase, die Inzidenz von Traumerlebnissen, deren Inhalt und fur sonstige Nebenwirkungen dargestellt. Das Dosisverhaltnis von S-(+)-Ketamin zu Ketamin-Razemat war 1:2. Mit einer Ausnahme war die Aufwachphase in allen Untersuchungen nach S-(+)-Ketamin deutlich kurzer als nach Razemat. Dies gilt unabhangig davon, ob die Substanz als intravenoser Einzelbolus, als Bolus mit anschliesender kontinuierlicher Infusion oder als intramuskulare Injektion verabreicht wurde. Demgegenuber war die Inzidenz der psychomimetischen Reaktionen nur in einer Studie nach S-(+)-Ketamin niedriger als nach Ketamin-Razemat. Daher sollte auch S-(+)-Ketamin in der klinischen Anasthesie mit einem Hypnotikum oder Sedativum kombiniert werden.

Tungsten coated tiles, manufactured by plasma spray on graphite, were mounted in the divertor of the ASDEX Upgrade tokamak and cover almost 90% of the surface facing the plasma in the strike zone. Over 500 plasma discharges, among which around 300 were heated with heating powers up to 10 MW, were performed up to now. The tungsten flux in the divertor was monitored by a WI line at 400.8 nm. In the plasma centre an array of spectral lines at 5 nm emitted by ionisation states around W XXX was monitored. Under normal discharge conditions W-concentrations of around 10 −5 or even lower were found. The influence on the main plasma parameters was negligible. In a few low power discharges accumulation of tungsten occurred and the temperature profile was flattened. The concentrations of the intrinsic impurities carbon and oxygen are comparable to the discharges with graphite divertor. Furthermore, the density-limits and the β-limits remained unchanged and no negative influence on the energy confinement as well as on the H-mode threshold was found.

Sixty-three core samples bracketing the Maastrichtian/Danian boundary were collected from wells at Savannah River Site near Aiken, South Carolina for palynological investigation. The samples were collected from the Steel Creek Member of the Peedee Formation (Maastrichtian) and the base of the Ellenton Formation (Danian). Analysis of the Steel Creek Member samples indicates that sedimentation took place in an upper delta-plain to lower delta-plain freshwater environment. The pollen and spores are predominantly terrestrial in origin and no marine dinoflagellates were encountered. The top of the Peedee Formation is heavily oxidized in most areas and underlies deposits of the Ellenton Formation (Danian) with similar lithologies. The base of the Ellenton Formation contains abundant marine dinoflagellates, glauconite, and substantially lower concentrations of pollen and spores along with a decrease in the number of species encountered. There are two distinct groups of pollen and spores in these samples. Danian age species such as Intratriporopollenites stavensis and Subtriporopollenites nanus were encountered with Maastrichtian age species such as Rugubivesiculites reductus and Proteacidites retusus. These Maastrichtian palynomorphs are highly fragmented as a result of a high-energy influence during transport and represent sediments of Maastrichtian age that were reworked and redeposited in the Danian. The presence of marine dinoflagellates and glauconite in these samples is typical of a change from an upper delta-plain to a lower delta-plain or marginal marine depositional environment. The lithology of these units in conjunction with this palynologic study suggests that the paleo-shoreline in the Maastrichtian was located just southeast of Savannah River Site. With the onset of the Danian, a marine transgression migrated the paleo-shoreline to the northwest, partially covering the Savannah River Site with marine waters.

Objecti6e: Arterial switch operation (ASO) is the procedure of choice for the repair of simple d-transposition of the great arteries (TGA) during the neonatal period. Beyond this time such correction is performed in two stages. The first step incorporates banding of the pulmonary artery with or without a Blalock-Taussig shunt to train the left ventricle (LV). The second step consists of the ASO. To find out whether candidates for a two-stage procedure would tolerate a one-stage correction, a trial of pulmonary artery banding was performed. Material and methods: Between February 1986 and December 1995, 224 patients less than 3 months of age with TGA, intact ventricular septum or a small restrictive ventricular septal defect, had an ASO. Seven patients were 4 weeks of age or older (28‐70 days). Two of these had a pulmonary artery to systemic pressure ratio higher than 0.6 and underwent primary ASO without complications. The remaining five patients had low left ventricular pressure with a pulmonary to systemic pressure ratio of 0.2‐0.5; echocardiography showed a banana-shaped LV with left ventricular wall thickness as low as 3 mm. They underwent a trial of pulmonary artery banding to systemic pressure for 15‐30 min. As this increase in workload was tolerated well with an anticipated decrease of oxygen saturation but without hemodynamic disturbances anticipated, the ASO was performed immediately. Results: Postoperative course was uneventful in all five patients, although catecholamine dependence was prolonged and three patients received enoximone. There were no severe complications. Echocardiography showed an increase in posterior wall thickness from 3 to 6 mm after 19 days in one infant. Conclusion: Some of the children, assigned for a ‘two-stage’ ASO may tolerate a primary anatomic repair up to an age of at least three months. This subgroup can be selected by a trial of pulmonary artery banding. Copyright © 1997 Elsevier Science B.V.

Despite the use of broad-spectrum antibiotics, aggressive fluid resuscitation, vasopressor support, the mortality associated with Gram-negative sepsis and septic shock has not decreased significantly in the last two decades. The consequences of host exposure to endotoxin and the relationship of antibiotic administration to endotoxin release have become important areas of intense interest. In vitro studies have demonstrated that there was a difference in endotoxin release between PBP-3 specific antibiotics (β-lactam antibiotics) and PBP-2 specific antibiotics (carbapenems). This is the first clinical report of surgical patients admitted to the surgical and anaesthesiology intensive care unit on the missing endotoxin release after imipenem treatment; however cefotaxime and ceftriaxone showed significantly more positive endotoxin tests in the plasma when compared to imipenem. Ciprofloxacin and vancomycin were intermediate in endotoxin release and tobramycin did not cause endotoxin release. There were also significant differences in endotoxin neutralizing capacity. IL-6 levels were decreased after imipenem faster than after ceftriaxone or cefotaxime; ciprofloxacin seemed to increase IL-6. Endotoxin may be harmful in patients where the immune system has been continuously challenged. Timing, dosage, or combination with other compounds as well as the effect of antibiotics on macrophages need to be tested in larger clinical trials. In this respect a consecutive study was started.

Several experiments were conducted in ASDEX Upgrade to prove the suitability of tungsten as a divertor target material under the conditions of a high density and low temperature divertor. The observed fluxes from a tungsten tile into the plasma are low, in keeping with the extremely low sputtering yields. In addition, the very favourable effect of `prompt redeposition' (redeposition during the first gyration) could be confirmed by the experiments. Cooling of the edge region by neon injection seems permissible, i.e. neon impurity sputtering did not increase the eroded fluxes of tungsten. The transport and accumulation behaviour were investigated by means of the laser blow-off technique. No accumulation effects could be observed in ohmic discharges. In discharges with NBI heating but without ICRH, strong accumulation can occur. High heat flux tests were performed on graphite tiles coated with plasma sprayed tungsten, which withstood a thermal load of 15 MW/m2 lasting 2 s as well as 1000 cycles of 10 MW/m2 for 2 s without disabling damage. Owing to the encouraging results, an experiment using a tungsten divertor is planned in ASDEX Upgrade

Complement activation and leukocyte stimulation were prospectively studied during and after cardiopulmonary bypass in 16 children receiving sodium nitroprusside—a nitrovasodilator releasing nitric oxide—for vasodilation during the cooling and rewarming periods of extracorporeal circulation. Results were compared with those in 29 patients who were not treated with sodium nitroprusside during the operation. Patients treated with sodium nitroprusside had significantly less C3 conversion during cardiopulmonary bypass as measured by the ratio C3d/C3 (p < 0.05) and significantly less C5a liberation immediately after cardiopulmonary bypass (p < 0.005) than patients not treated with sodium nitroprusside. C4 was not overtly consumed in our series. Leukocyte count during the rewarming period of cardiopulmonary bypass, but not leukocyte elastase release during cardiopulmonary bypass, was significantly reduced in patients treated with sodium nitroprusside (p < 0.05). In vitro experiments were conducted to analyze the effect of sodium nitroprusside on complement hemolytic activity initiated by the classic and the alternate pathways and on zymosan-induced C3 conversion by the activation of the alternate pathway. The in vitro experiments clearly demonstrate inhibition of complement hemolytic activity by sodium nitroprusside in the sera tested. The 50% inhibitory concentration of sodium nitroprusside on the available complement hemolytic activity was less through the alternate pathway than through the classic one (4.2 ± 0.8 mmol/L and 14.0 ± 2.88 mmol/L, respectively). The decrease of complement hemolytic activity measured was dose-dependent and was enhanced by the sodium nitroprusside preincubation of the sera tested. This effect was related to the duration of preincubation. Sodium nitroprusside photodegradation (enhancing nitric oxide release) increased the anticomplementary effect of the drug, reducing the 50% inhibitory concentration on complement hemolytic activity to 0.24 to 0.02 mmol/L for the alternate pathway and 2.74 to 0.3 mmol/L for the classic pathway. The zymosan-induced C3 conversion was inhibited by sodium nitroprusside. Nitroglycerin and isosorbide dinitrate (other nitric oxide donors) had in vitro effects on complement hemolytic activity similar to those of nonphotodegraded sodium nitroprusside at similar concentrations (1 mmol/L). Our results suggest that sodium nitroprusside, both in vitro and in vivo, has an inhibiting effect on complement activation initiated by both classic and alternate pathways and that this effect is mediated by nitric oxide release from sodium nitroprusside. This is the first report on the anticomplementary effect of sodium nitroprusside by nitric oxide release. (J THORAC CARDIOVASC SURG 1996;111:882-92)

The completely detached high confinement (CDH) regime established recently in high power ASDEX-Upgrade single null divertor discharges is described. The standard CDH mode scenario with feedback controlled external deuterium and neon puffing is analysed in detail with respect to its divertor detachment and confinement properties. Impurity transport and pumping effects and the density operation windows of the CDH mode are outlined. First results with other impurity radiators (N,Ar) are given. Finally the CDH mode operation space is discussed in terms of main chamber and scrape-off layer plus divertor radiation and possible consequences for future fusion experiments are outlined.

Objective parameters are needed to quantify cerebral dysfunction following cardiac surgery in outcome and comparative studies. In this investigation we assessed the value of the late auditory evoked potentials N100 and P300 to measure the neuropsychological deficit after coronary artery bypass grafting (CABG). N100, an exogenous potential is influenced by the stimulus pattern (frequency, intensity and stimulus presentation rate). P300, an endogenous potential, depends on the cognitive processing invoked by the stimulus. With approval of the Human Investigation Committee and the patients' consents, 52 subjects undergoing elective CABG were enrolled. Operation, extracorporal circulation, anesthesia and postoperative intensive care were standardized. Twenty-channel recordings of N100 and P300 were obtained for off-line analysis. P300 was elicited using an oddball paradigm with rare target tones interspersed among frequent non-target tones. Additionally, neuropsychological tests (syndrome short test SKT and letter cancellation test) were carried out. Neurological examination and all tests were compared preoperatively and one week postoperatively. A significant deterioration in cerebral function was documented by the SKT score (P = 0.04), an increase in P300 latency (P = 0.004) and an increase of mistake rate in counting the P300 target tone (P = 0.02). No differences between preoperative and postoperative testing were found for letter cancellation, P300 amplitude and any N100 parameter. No correlation was found between the preoperative/postoperative changes in SKT score and P300 latency. P300 was proved to be an objective neurophysiological parameter that allows for the quantification of cerebral function after CABG.

ASDEX Upgrade is a poloidal divertor experiment very similar to ITER with respect to magnetic field properties and especially to the plasma boundary geometry. A large part of the programme on ASDEX Upgrade is therefore dedicated to investigating and optimizing reactor-relevant plasma boundary issues. This contribution is concerned with H-mode studies and edge physics in general. The L/H-power threshold, H-mode confinement, details of ELM dynamic and 'dithering' L/H-transitions will be discussed. The edge physics investigations are concerned with model calculations and validations, the characteristic 'approach' to the density limit (DL), target plate sputtering and the influence of hydrocarbons, asymmetries and drifts depending on the direction of the toroidal magnetic field, and finally first results of high-Z material experiments.

A new principle has been developed for the measurement of both profile and position. The sensors are vibrating quartz resonators. The closer they are to a surface the more they are damped due to the air viscosity. This characteristic can be either used for a nontouching profilometer unit or for a very low loaded contact 3D-coordinate measuring process. The principle is detailed as well as the oscillator circuits used and some significant experimental results.

Between January 1985 and March 1989 we retrospectively observed multiple system organ failure (MSOF) in 16 of 460 children (3.5%) who underwent cardiac surgery with cardiopulmonary bypass for congenital heart disease. MSOF was arbitrarily defined as a clinical entity with failure of two or more vital organ systems associated with high fever, thrombocytopenia, and cardiocirculatory insufficiency and occurring within the first postoperative week. In 13 children the first clinical manifestations of MSOF were evident on the first post-operative day and in the other 3 on the second or third post-operative day. All children showed acute renal failure, acute hepatic failure, high fever, and thrombocytopenia. Most of them showed respiratory insufficiency and neurological involvement. Seven of the 16 children died. Four of the 9 surviving patients had neurological sequelae still present 6 months after the operation, and the others recovered completely.

The aim of present study was to characterize the topographical effect of thiopental on the EEG during induction of anesthesia. A multichannel (19 channels) digital EEG was recorded in 10 patients undergoing surgical treatment. The period during induction of anaesthesia before intubation was investigated in regard to peak frequency, amplitude, topography, and amplitude in conventional frequency bands. The main findings were a slowing of the EEG with a simultaneous increase of amplitude in the predominant EEG frequency (peak frequency) during induction. The topographical analysis showed a clear change of localization of the peak frequency in the occipito-frontal direction. Berger described the effect of thiopental on electrical cortical activity as early as 1933. Since then, many studies have investigated its influence on the EEG, but few have tried to characterize the effects of topographical changes in a quantitative way.