Human lung virtual histology by multi-scale x-ray phase-contrast computed tomography

As the central organ of the respiratory system, the human lung is responsible for supplying oxygen to the blood, which reaches the erythrocytes by diffusion through the alveolar walls and is then distributed throughout the body. By exploiting the difference in electron density detected by a phase shift in soft tissue, high-resolution X-ray phase-contrast computed tomography (XPCT) can resolve biological structures in a sub-μm range, shedding new light on the three-dimensional structure of the lungs, physiological functions and pathological mechanisms.

This work presents both synchrotron and laboratory XPCT results of postmortem tissue from autopsies and biopsies embedded with various preparation protocols such as precision-cut lung slices, cryogenically fixed lung tissue, as well as paraffin and alcohol fixed tissue. The selection of pathological abnormalities includes channel of Lambert, bronchus-associated lymphoid tissue, alveolar capillary dysplasia with misalignment of pulmonary veins. Subsequently, quantification and visualization approaches are presented.

The overall high image quality even of in-house XPCT scans for the case of FFPE biopsies can be exploited for a wide range of pulmonary pathologies and translated to dedicated and optimized instrumentation which could be operated in clinical setting. By using synchrotron radiation, contrast can be further increased to resolve sub-μm sized features down to the sub-cellular level. The results demonstrate that a wide range of preparation protocols including sample mounting in liquids can be used. 

With XPCT, poorly understood 3D structures can be identified in larger volume overview and subsequently studied in more detail at higher resolution. With the full 3D structure, the respective physiological functions of airways or vascular networks, and the different pathophysiologic mechanisms can be elucidated or at least underpinned with structural data. Moreover, synchrotron data can be used to validate laboratory protocols and provide ground truth for standardizing the method.
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Coherent Backscattering of Light Off One-Dimensional Atomic Strings

We present the first experimental realization of coherent Bragg scattering off a one-dimensional system-two strings of atoms strongly coupled to a single photonic mode-realized by trapping atoms in the evanescent field of a tapered optical fiber, which also guides the probe light. We report nearly 12% power reflection from strings containing only about 1000 cesium atoms, an enhancement of 2 orders of magnitude compared to reflection from randomly positioned atoms. This result paves the road towards collective strong coupling in 1D atom-photon systems. Our approach also allows for a straightforward fiber connection between several distant 1D atomic crystals.

Computational modelling of mobile bearing TKA anterior-posterior dislocation

Anterior-posterior stability in an unconstrained mobile-bearing total knee arthroplasty (TKA) and one with rotational constraints is compared in a computational model based on an ASTM test. Both TKA designs dislocate at loads greater than reported maximum in vivo forces. The posterior drawer forces (mean: 3027 N vs. 1817 N) needed to induce subluxation increase with a greater anterior jump distance (12 mm vs. 7 mm; refers to the vertical height of the anterior or posterior border of the tibial insert's articulating surface). The posterior jump distance for both tested TKA differed by 1.5 mm and had minimal effect on the magnitude of the anterior drawer forces at dislocation in mid-flexion (unconstrained vs. constrained: 445 N vs. 412 N). The unconstrained insert dislocated by means of spin-out whereas in the constrained TKA the femur dislocated from the bearing during posterior drawer and the bearing from the baseplate during anterior drawer. MCL function is an important consideration during ligament balancing since a ± 10% variation in MCL tension affects dislocation forces by ± 20%. The simulation platform provided the means to investigate TKA designs in terms of anterior-posterior stability as a function of knee flexion, collateral ligament function and mechanical morphology.

Generation and detection of a sub-Poissonian atom number distribution in a one-dimensional optical lattice

We demonstrate preparation and detection of an atom number distribution in a one-dimensional atomic lattice with the variance -14  dB below the Poissonian noise level. A mesoscopic ensemble containing a few thousand atoms is trapped in the evanescent field of a nanofiber. The atom number is measured through dual-color homodyne interferometry with a pW-power shot noise limited probe. Strong coupling of the evanescent probe guided by the nanofiber allows for a real-time measurement with a precision of ±8  atoms on an ensemble of some 10(3)  atoms in a one-dimensional trap. The method is very well suited for generating collective atomic entangled or spin-squeezed states via a quantum nondemolition measurement as well as for tomography of exotic atomic states in a one-dimensional lattice.

Effect of light assisted collisions on matter wave coherence in superradiant Bose-Einstein condensates

We investigate experimentally the effects of light assisted collisions on the coherence between momentum states in Bose-Einstein condensates. The onset of superradiant Rayleigh scattering serves as a sensitive monitor for matter-wave coherence. A subtle interplay of binary and collective effects leads to a profound asymmetry between the two sides of the atomic resonance and provides far bigger coherence loss rates for a condensate bathed in blue detuned light than previously estimated. We present a simplified quantitative model containing the essential physics to explain our experimental data and point at a new experimental route to study strongly coupled light matter systems.

THE ERYTHROPOIETIC ACTION OF GERMANIUM DIOXIDE

Injections were made of a sterile 0.4 per cent solution of germanium dioxide into four lots of mature male and female albino rats. Exact conditions of control were maintained. To two lots there was administered in four doses at intervals of 4 days a total of 6.6 mg. of the oxide per kilo of body weight. To two lots there was given in three doses at like intervals a total of 45 mg. of the compound per kilo of body weight. In each lot there was one rat which served as a control and which did not receive any germanium. A preliminary period of observation was maintained as a further control during which two determinations of the erythrocyte and leucocyte counts of the blood were made 7 days apart on all the rats. Weekly counts were made on all the rats during the progress of the investigation which lasted for 4 weeks, during 3 of which the treated animals were under the influence of germanium. In the first group 11 days elapsed between the last injection and the last count. In the second group the interval was 14 days. It was found that without exception all of the test rats responded to the germanium dioxide by a marked and sustained rise in the number of erythrocytes in the blood which ranged from 1 to nearly 5 millions. These results are statistically valid. There was an apparent tendency for the degree of effect to be related to the initial erythrocyte number, in that with a lower initial count there seemed to take place a greater rise, and vice versa. There was no indication that the larger doses of germanium dioxide exerted a greater stimulating effect on the production of the resultant erythrocythemia than the smaller doses. There is evidence that the effect is quick in making its appearance. The rise in the red cell count was found to occur within a week, and after but two injections of the oxide. Indications were obtained that germanium dioxide tends to increase the coagulability of the blood. Autopsy findings showed color changes in the liver and bone marrow. We believe that germanium dioxide is an erythrocytogenic agent and we hope that fruitful results will come from its therapeutic application.

High quality anti-relaxation coating material for alkali atom vapor cells

We present an experimental investigation of alkali atom vapor cells coated with a high quality anti-relaxation coating material based on alkenes. The prepared cells with single compound alkene based coating showed the longest spin relaxation times which have been measured up to now with room temperature vapor cells. Suggestions are made that chemical binding of a cesium atom and an alkene molecule by attack to the C = C bond plays a crucial role in such improvement of anti-relaxation coating quality.

Nondestructive probing of Rabi oscillations on the cesium clock transition near the standard quantum limit

We report on the nondestructive observation of Rabi oscillations on the Cs clock transition. The internal atomic state evolution of a dipole-trapped ensemble of cold atoms is inferred from the phase shift of a probe laser beam as measured using a Mach-Zehnder interferometer. We describe a single color as well as a two-color probing scheme. Using the latter, measurements of the collective pseudospin projection of atoms in a superposition of the clock states are performed and the observed spin fluctuations are shown to be close to the standard quantum limit.

Gesundheitstelematik und Datenschutz

In the health system, telematics are to be used for the benefit of patients and to make it possible for them to receive better medical care. Telematics must be employed in accordance with the guidelines of data protection and this means in particular that the patient must remain the master of his data. Therefore, he must be able to decide in which situation and to whom he wants to reveal his medical data. For this reason, the exact implementation of the introduction of the electronic medical smart card envisaged by the law requires detailed access authorisations and limitations, which must be reinforced by ample technical security measures. These measures must be transmitted to the patients through co-operation of doctors and health insurance companies in such a transparent way that they recognise the advantages of the new technology. The higher the acceptance is on the patients' side, the more they will be willing to participate voluntarily in telematic projects.

Asymmetric Landau-Zener tunneling in a periodic potential

Using a simple model for nonlinear Landau-Zener tunneling between two energy bands of a Bose-Einstein condensate in a periodic potential, we find that the tunneling rates for the two directions of tunneling are not the same. Tunneling from the ground state to the excited state is enhanced by the nonlinearity, whereas in the opposite direction it is suppressed. These findings are confirmed by numerical simulations of the condensate dynamics. Measuring the tunneling rates for a condensate of rubidium atoms in an optical lattice, we have found experimental evidence for this asymmetry.

Bloch oscillations and mean-field effects of Bose-Einstein condensates in 1D optical lattices

We have loaded Bose-Einstein condensates into one-dimensional, off-resonant optical lattices and accelerated them by chirping the frequency difference between the two lattice beams. For small values of the lattice well depth, Bloch oscillations were observed. Reducing the potential depth further, Landau-Zener tunneling out of the lowest lattice band, leading to a breakdown of the oscillations, was also studied and used as a probe for the effective potential resulting from mean-field interactions as predicted by Choi and Niu [Phys. Rev. Lett. 82, 2022 (1999)]. The effective potential was measured for various condensate densities and trap geometries, yielding good qualitative agreement with theoretical calculations.

Bridging-to-recovery

BACKGROUND

Patients with end-stage heart failure placed on a cardiac assist device show at least some degree of improvement of cardiac function. In a subgroup of selected patients, some hearts recovered considerable function. In these patients the device was removed and cardiac transplantation was no longer necessary. We report our long-term experience with these weaned patients.

METHODS

As of today, 512 cardiac assist devices of various types (Berlin Heart, Berlin, Germany; Novacor, World Heart, Ottawa, Ontario, Canada; TCI, ThermoCardio Systems, Inc, Woburn, MA; DeBakey, Micromed Technology Inc, Houston, TX) were implanted in patients with end-stage heart failure in our institution. Of these, 95 patients belonged to a subgroup of patients with nonischemic, idiopathic, dilated cardiomyopathy who were implanted with a left ventricular support system (Novacor 84, TCI 10, Berlin Heart 1) between 1994 and 2000. All were routinely examined by echocardiography for improvement of cardiac function. The left ventricular diameter in diastole (LVIDd) and left ventricular ejection fraction (LVEF) served as the main parameters to assess changes in cardiac performance. Under the conditions of a running device, an LVIDd below 60 mm and an LVEF above 40% were the criteria to do further echocardiographic studies when the pump was turned off for up to 20 minutes.

RESULTS

Twenty-eight patients (26 men, 2 women; ages 18 to 64 yrs; history of heart failure, 1 to 17 yrs) fulfilled the criteria of improved cardiac performance and were weaned from the device. Since then, 16 patients have continued "normal" heart function with follow-up times ranging from 1 month to 5.5 years (group B). Three patients died of noncardiac causes (group C). Eight patients were transplanted from 1 to 17 months later and one died on the waiting list (group A). Statistically significant differences between groups A and B were calculated for the duration of heart failure (9 versus 2 years, p = 0.0002). Differences in LVIDd before removal of the device (57 versus 51 mm, p = 0.0420), LVEF after 2 months of unloading (30 versus 49%, p = 0.0300), and LVEF preexplantation (43 versus 52%, p = 0.0001) were significant. Overall, 17% of the cohort of 95 patients were weaned successfully.

CONCLUSIONS

Weaning from cardiac assist devices is feasible for selected patients; it saves donor hearts and is preferred to cardiac transplantation. However, as of today no reliable parameter predicts outcome after weaning and none determines the possibility of device removal before implantation in advance.

Midterm follow-up of patients who underwent removal of a left ventricular assist device after cardiac recovery from end-stage dilated cardiomyopathy

OBJECTIVE

Cardiac recovery in end-stage idiopathic dilated cardiomyopathy recently occurred after temporary support with a left ventricular assist device. We report the case histories of patients who underwent removal of the device more than 4 years ago.

METHODS

Since June 1994, 23 patients with end-stage idiopathic dilated cardiomyopathy who were supported by a left ventricular assist device or biventricular assist device for 1 to 26 months (mean, 6 months) underwent removal of the device after complete or extensive cardiac recovery, as revealed by echocardiography.

RESULTS

Seven patients (group A) had recurrent cardiac failure after 4 to 24 months. Transplantation was performed in 6 patients, and one died while on the waiting list. Three patients died of noncardiac causes within a period of 4 months and 3 days after removal of the assist device. Stable cardiac recovery occurred in 13 patients (group B) for 3 to 49 months (mean, 23 months). At the time of implantation, there were no significant differences between the groups with regard to age, hemodynamics, left ventricular ejection fraction, left ventricular internal diameter in diastole, and autoantibody levels. The increase of ejection fraction and the decrease of left ventricular internal diameter in diastole after 2 months were highly significant. The patients in group A had longer histories of heart failure and first cardiac symptoms and duration of assist when compared with group B. Group B demonstrated a quicker cardiac recovery on the assist device, and thus support was shorter. Also, the degree of recovery at assist device explantation was more complete in group B. The age at the time of device placement was the only influencing factor for duration on the assist device. The probability of recurrence of heart failure was influenced by the duration of heart failure.

CONCLUSIONS

In selected patients with idiopathic dilated cardiomyopathy, lasting recovery can be achieved after unloading with a left ventricular assist device. Lasting cardiac recovery seems to be related to functional normalization and a more rapid recovery during the unloading period.

Quantitative determination of F:O ratios in rare earth oxide fluorides by energy dispersive X-ray analysis

The F:O ratio in homogeneous and inhomogeneous rare earth oxide fluoride systems of compositions RO(1+x)F(1-2x) with -0.1</=x</=0.1 can be determined by energy dispersive X-ray (EDX) analysis with an accuracy of +/-0.5% if an appropriate background modelling procedure is applied and if the EDX signals of the light elements are free of overlap from the accompanying rare earth element. The latter condition holds true for R=Tb-Lu and it is shown that the calibration of the method with well-defined samples of YbO(1+x)F(1-2x) can be transferred with only a moderate loss of accuracy to the determination of oxygen and fluorine in DyOF and ErOF. Increasing signal overlap in case of GdOF, EuOF, SmOF and especially PrOF necessitates the choice of different channels for background modelling, and the accuracy of the method is hence decreasing to +/-4% for these systems.

[Follow-up of surgical therapy in patients with threatened and acute myocardial ischemia for an average of 5 years]

Out of a total group of 300 patients after local intracoronary fibrinolysis, systemic ultra-high short-term fibrinolysis and instable angina pectoris 73 (24% out of 300) patients, in whom acutely or in the course of the treatment a surgical therapy of their coronary heart disease was performed, were analysed. Constellations of the findings of the coronary heart disease, when according to this connection with an adequate conservative therapy on the basis of a diagnostic and therapeutic step programme in 44% of the patients an improvement of the load capacity and in 73% an improvement of the subjective well-being is to be stated. In patients with diseases of one vessel compared with patients with diseases of several vessels significantly more frequently an intraindividual increase of the bicycle-ergometric performance develops.

[Obstructive disorders of urine transport in the upper urinary tract--vascular and inflammatory causes]

Vascular and inflammatory causes of ureteral obstruction may be difficult in diagnosis and are recognized often too late. Symptoms, diagnostic approach and therapeutic measures are described in detail.

[Phlebodynamometry studies in patients with chronic venous insufficiency and phlebography verified insufficiency of muscle veins]

23 patients with complaints in the sense of a chronic venous insufficiency were examined by means of phlebodynamometry, who phlebographically did not show any postthrombotic changes of the deep conducting veins, but had clear signs of an insufficiency of the muscle veins stage I-III. Cases with isolated insufficiency of the muscle veins (n = 5) and combination forms with additional insufficiency of the conducting veins and/or superficial varicosis (long and short saphenous veins) were found. Measured at the decrease of pressure (delta-p) after exercise in the combined forms the epifascial varicosis has the greatest haemodynamic effects. The isolated findings of an insufficiency of the muscle veins with or without additional insufficiency of the conducting veins has apparently only smaller haemodynamic effects. For the isolated insufficiency of the muscle veins normal limit values for delta-p could still be measured, which also could only insignificantly be bettered by application of a tourniquet. This knowledge is important for therapy planning.

[Diagnostic value of digital subtraction angiography in chronic venous insufficiency]

The first 117 investigations in chronic venous insufficiency by means of the technique of digital subtraction angiography (DSA) are reported. According to our experiences hitherto made this technique with peripheral intravenous injection of contrast remedies is excellently suited for the phlebography of the pelvic and vena cava regions as well as of the region of upper arm and shoulder, not so much, however, for the phlebography of the leg. By decrease of the concentration of the contrast remedy and the total quantity of the contrast remedy a reduction of the patient's stress and the risk of the examination is the result.

[The significance of a staged diagnostic-therapeutic program for the disease course in patients following unstable angina pectoris during a follow-up period of 3 1/2 years]

Among a group of 160 patients (146 men and 14 women) who had been admitted to our hospital under the picture of an unstable angina pectoris and whom we treated according a standardized diagnostic-therapeutic step programme 8.7% of the patients died of a cardiovascular disease during a period of 3 1/2 years. In 8% of our patients an acute myocardial infarction occurred during the period of observation. A diagnostic-therapeutic step programme was the basis for a differential therapy adapted to the individual course of the disease. We think that this therapy concept first of all corresponds to the individual dynamics of the course of the disease of patients with coronary heart disease.

[Local intra-arterial fibrinolytic therapy in acute vascular occlusions in the area of the internal carotid artery]

Report on the first experiences with the local intraarterial streptokinase therapy in 5 patients with acute obliteration processes of the vascular system of the internal carotid artery. Two peripheral obliterations (occlusions of the main branch of the media) could be completely recanalised, with complete regression of the neurological symptomatology. In one of the three complete occlusions of the internal carotid artery (region of the siphon) a considerable partial recanalisation could be achieved. A fourth patient could be dismissed with an essential clinical improvement 11 days later despite angiographic persistence of the occlusion. Two patients died. As directive value for the dosage from 50,000 to 100,000 units streptokinase are proposed as short-term infusion in 30 to 60 minutes.

[Associated thrombotic processes of the superficial, perforating and intramuscular venous system in patients with acute phlebothrombosis of the lower extremities]

In a retrospective study 100 phlebograms of the legs of patients with definitive acute phlebothrombosis were examined for additional thrombotic processes in the superficial venous system, in the perforating and muscular veins. They could be confirmed in 77% of the cases, whereby preferredly the superficial venous system (long saphenous vein and lateral branches) were affected. A temporary coordination of superficial thrombophlebitis and phlebothrombosis cannot be made. At first it is adhered to the approved strategy of diagnosis that an acute superficial thrombophlebitis is no indication for phlebography. It is demanded the immediate application of invasive and non-invasive examination methods, when there is the least clinical suspicion of a deep venous thrombosis.

The cost and appropriateness of health care technology in South Africa. A plea for the development of a local medical equipment industry

Some of the main reasons for the increase in the cost of health care technology are summarized. Local problems in the health care delivery system are not being solved effectively by imported medical equipment. The expertise required for the local solution of problems is available in the RSA and should be developed further. A private-sector consortium with matching funding from the State should serve as a clearing house for developing and evaluating assessment criteria, promoting the use of existing cost-efficient medical technologies, and identifying obsolete and inappropriate ones. The formation of a local health care technology corporation should be considered seriously.

[Diagnosis of primary hyperparathyroidism by selective determination of parathyroid hormones]

Due to a hypercalcaemia and changeably appearing hypercalciuria 13 patients with relapsing urolithiasis were under suspicion of a primary hyperparathyroidism. After selective sounding and withdrawal of blood from the cervical veins in all cases the determination of parathormones was performed and always an increased activity of parathormones was found. The exploration of the cervical region carried out could in 11 performed operations in 8 cases prove an adenoma and in 3 cases a hyperplasia as cause of hyperparathyroidism. A localization of the suspected adenoma was in 5 cases possible in combination with the angiography of the thyroid gland. By equally high activity in 3 cases no clear evidence was possible. An improvement of the diagnostics of localization might be achieved by supraselective sounding of the veins. On principle the authors recommend to perform a selective determination of parathormones before operation, which in case of need is to be supplemented by a selective angiography of the thyroid gland.

[Results of local intracoronary fibrinolysis in acute myocardial infarct and the effects of reperfusion on the function of the left ventricle]

Out of 46 patients who had undergone acute coronary angiography in 41 a definitive acute myocardial infarction was present. In 31 complete and in 10 cases subtotal obliterations of the infarct-related coronary artery were found. 14 patients had a one-vessel-disease, 8 a two-vessel-disease, but 19 a three-vessel-disease. In these 41 patients with acute myocardial infarction a subsequent intracoronary fibrinolysis therapy with streptokinase or urokinase immediately followed, which was successful in 33 patients (80.5%). Coronarographically neither a recanalization or a marked improvement of luminal patency of the infarct-related coronary artery could be proved. In 4 patients an additional guidewire thrombus perforation was necessary. The intracoronary fibrinolysis lasted maximally 2 hours (average total dosage 121.000 +/- 45.000 U streptokinase) and was essentially well tolerated. Only 3 patients of the treatment group died. 20 patients underwent a repeated angiography on average 8 1/2 months after fibrinolysis therapy, out of this group in 10 successfully treated patients comparable quantitative angiographic investigations are present. Heart index, stroke volume and systolic ejection fraction improved significantly. The percental size of the non-contracting area of the myocardium decreased statistically significantly. The recanalized coronary arteries were still patent at control.

[Phlebographic findings in venous ulcus cruris]

In a retrospective analysis 97 phlebograms of the leg of patients with ulcus cruris were evaluated. According to the phlebographic result a subdivision into Ulcus cruris varicosum (n = 66) and Ulcus cruris postthromboticum (n = 31) was made. The different phlebographic findings are discussed.

[Results of percutaneous kidney cyst sclerosing]

The results of the percutaneous obliteration of the renal cysts in 68 renal cysts (6 cases of recidivation) are discussed. The use of an obliteration remedy is superior to the only submaximal depletion of cysts. The results after the sclerosation treatment with ethoxysclerol 2% were essentially better than after varicocid instillation. The sclerosation therapy may be performed only after a preliminary thorough angiographical clarification including renocystography. The excretion urograms are sufficient for the control examination.

[Diagnosis and therapy of malignant parenchymal kidney tumors]

We think that the present paper insistently demonstrates the fact which is acknowledged by all but followed only by few how important is a unitary classification of the renal tumours in order to perform scientifically proved comparisons and valuations in all branches of the treatment of renal tumours including the results of the therapy. On the basis of the classification of our patients according to the TNM-system we could prove that the best results in the operative removal of the kidney with following irradiation were achieved in the categories T1 and T2, particularly when there were not yet present any metastases distant from the primary tumour.

[Quantitative angiographic studies for the differential diagnosis of early acute kidney failure of ischemic and rejection-damaged grafts]

On 22 auto- or homotransplanted kidneys of dogs a quantitative angiographic evaluation of the corticalis perfusion was carried out. For this purpose four special parameters were evaluated. With the help of the linear discriminance analysis we succeed in a sufficient secure separation between autografts impaired by ischaemia or shock on the one hand and homografts impaired by rejection on the other. It is referred to the prognostic significance of angiography in human graft kidneys with disturbed function.

[Effect of phenoxybenzamine on the renal and general circulation in the hypovolemic hypotonic dog]

For the estimation of the haemodynamic and metabolic effect of 1 mg/kg phenoxybenzamine in a kidney donor with craniocerebral trauma model experiments were performed on dogs with hypovolaemic hypotension. The results show that phenoxybenzamine leads to vasodilatation in a constant aortic pressure of 80 mm Hg in the systemic circulation as well as in the renal circulation with different speed of reaction. Thus the arterial and venous O2 and CO2 partial pressure normalizes and the diuresis increases. On the other hand, the hypotension-conditioned metabolic acidosis and the symptoms of an acute renal failure may not be influenced.

[Coronary reserve, left ventricular function, and coronary risk factors in patients with myocardial infarction, but normal coronary arteries (author's transl)]

In 5 patients with angiographically normal coronary arteries and previous myocardial infarction (left ventricular a- or dyscinesia), measurement of coronary reserve revealed normal values. On average, patients with myocardial infarction and normal coronary arteries were younger than patients with angiographically proven obstructive coronary lesions (p less than 0,001), and did not exhibit a rise in coronary risk factors. These results suggest that in some cases myocardial infarction is due to acute, completely reversible occlusion or severe stenosis of larger coronary arteries without morphological or functional defects of coronary arteries detectable later on.

[Angiographic studies on regional contraction behavior of the left ventricle in the acute phase of myocardial infarction]

Quantitative angiocardiographic examinations concerning the regional contraction of the left ventricle in 16 patients with acute myocardial infarction were performed. In comparison to a control group of 6 healthy male patients the determination of the speed of the medium regional shortening (MVRF) of 12 different ventricle segments resulted in typical findings deviating from the normal. On the second day after beginning of the infarction in the area of the myocardium affected by an acute infarction there existed as a rule severe hypokinetic and akinetic disturbances of the contraction (13 times), only in three cases slight paradoxical movements of the ventricular wall (dyskinesias) could be observed. The average speed of shortening of all segments together (MVRF) excellently represents the momentary global function of the ventricle. It comprises in the same way acutely and chronicly disturbed areas as well as also the function of regions of the myocardium which are not disturbed. MV/RF and systolic ejection fraction (SEF) show statistically a highly significant correlation of r = 0,797 (p less than 0.001). On the basis of the findings got considerations are performed concerning a proved differential therapy in the acute stage of the myocardial infarction.

[Vascular changes in experimental renal ischemia and after renal homotransplantation (experimental angiographic study on animals)]

Which consequences result from these experimental results from practice? In the acute angiography in postoperative functional distrubance after transplantation of a human kidney is at first probably always to be reckoned with a rejection process, though this immunological process by no means must be in the foreground of the causal connection of several pathogenetic factors. Therefore, in our opinion it would then be assumed an ischaemia-conditioned cell damage of the tubulus by a longer lasting prefinal circulatory depression or due to a not optimal preservation, when there is in the angiogramme a clear discrepancy to the severity of the postoperative functional distrubance, i.e. when angiographically exists only a slight cortical ischaemia in an otherwise good arterial filling picture and a widely normal capillary filling phase.

[Late results following palliative vascular embolization in inoperable kidney tumors. (Preliminary report)]

During 18 months in 15 patients with inoperable renal tumours palliative therapeutic vascular embolisations were carried out with the help of an own catheter technique. In contrast to preoperative embolisation (16 patients) in the inoperable cases a non-absorpable polyvinyl alcohol foam substance ("Ivalon") was used, which leads to a secure permanent vascular occlusion. The haematuria occurring in all patients which many times threateningly increased was removed in all cases. There did not appear any essential complications. However, on account of the formation of a symptomatology of renal infarction a clinical after-treatment is necessary. In 12 patients regulary clinical and paraclinical control examinations during an observation period of on an average 11 months were carried out (minimum 6 months, maximum 18 months). 11 of these patients were still alive at the end of the report and had a tolerable or even improved general condition. In angiographical after-controls of 4 patients, and in one case by autopsy, permanent vascular occlusions with formation of necroses of a large area and partly considerable restriction of the tumour kidneys were found. In these cases the therapeutic embolisation led to a provable damage of the tumorous process. An influence of metastases distant from the primary tumour was not observed.

[Complex angiographic diagnosis of space-demanding processes in the kidney including renocystography]

Issuing from the experiences of the complex angiorgraphic diagnostics of space-demanding processes of the kidneys in 400 patients value and sequence of different angiographic methods including renocystography are discussed. The diagnostic certainty in hypo- and avascular tumours by the renal phlebography and in cystic processes is essentially increased by percutaneous puncture. In malignant tumours before operation the judgement of the endovenous extension is always to be demanded, which is most certainly achieved by direct venography. A diagnostic step programme is proposed, to make possible the rational use of the methods.

The influence of the size of acute ischaemic myocardial lesions on coronary reserve and left ventricular function in the dog

Acute ischaemic lesions of 5 and 15% of the left ventricular mass were produced in 10 dogs by ligations of branches of the left anterior descending coronary artery. Under maximal coronary dilatation by Dipyridamole and at constant aortic pressure, an ischaemic lesion of 15% caused reductions of blood flow in the left anterior descending coronary artery of 50% (p less than 0.05), , the R. circumflexus of 36% and of total myocardial blood flow (Argon method) by 44% (p less than 0.02). Parameters of left ventricular function, dp/dtmax and Vmax fell by 26 and 27% respectively (p less than 0.02). Ischaemic lesions of 5% LV mass were detected by 133 Xenon clearance estimations, but had no effect on any of the other variables measured. There was good agreement between estimations of total myocardial blood flow (Argon) and direct measurement of coronary flow with electromagnetic flowmeters (r = 0.957).

[Function of the left ventricle in the acute phase of myocardial infarct]

In the acute phase of myocardial infarction in 22 patients intraventricular pressure measurements (left and right heart catheters) were performed. In addition to this in 17 cases a qualitative and quantitative angiocardiographical judgment of the function of the left ventricle was done. A group of 9 patients with healthy heart served as control group. The group with infarction showed typical findings deviating from the normal. Stroke volume, cardiac output and stroke work of the left ventricle were significantly decreased. The systolic ejection fraction which was highly significantly reduced in contrast to the normal value proved as a particularly sensitive index. The contractility parameters dp/dt max. and VCE(dp/dt max.) were also highly significantly reduced; aortic mean pressure and heart rate did not show any significant changes. A compensation of the decrease of the heart function depending on contractility is achieved in the acute phase of the myocardial infarction by a significant increase of the wall stiffness, in which case apparently the ventricle practically exclusively by this means strives for an optimum filling pressure in order to maintain a sufficiently large stroke volume. The practically unchanged enddiastolic ventricle volume excluded at least for the uncomplicated infarction in the acute stage an essential participation of Frank-Starling's compensation mechanism.

[The place of adrenal angiography (phlebography and arteriography) in the diagnostic stepwise program in arterial hypertension]

Arteriographical and phlebographical methods are distinctly suited for the diagnostics of the adrenal glands in the stop program of the combat against hypertension. Hypervascular tumours of the adrenal medulla, especially phaeochromocytomata may be established arteriographically relatively certainly. Avascular processes of the adrenal cortex, however, are better to be diagnosed by the selective phlebography of the adrenal glands. The phlebography is also suited for the planimetric determination of the size. The following uncorrected normal values were established: on the left m1 = 10.58 +/- 1.17 cm2, on the right m2 = 6.95 +/- 1.39 cm2. The mean value of normal couples of adrenal glands is M = 18.17 +/- 1.96 cm2. The left adrenal gland is statistically significantly larger than the right one (p greater than 0.001). In 214 patients altogether 44 selective arteriographies and 276 selective phlebographies of the adrenal glands were performed. As angiographical basis examination of all patients was at first performed an abdominal aortography or an angiography of the kidneys. The phlebographical diagnostics was successful on the left in 98.7% and on the right in 90.4% of the cases. 72 patients had pathological processes of the adrenal glands, out of them 20 times a solitary adenoma of the adrenal glands was present. 38 patients had a one- or double-sided hyperplasia, and 4 patients had a phaeochromocytoma. In 10 other cases more infrequent changes were found.