[Significance of the E point-septum distance for the evaluation of left ventricular function in coronary disease--a study using M-mode echocardiography]. / Die Bedeutung des E-Punkt-Septum-Abstandes für die Beurteilung der linksventrikulären Funktion bei koronarer Herzerkrankung--eine Studie mittels M-mode-Echokardiographie.

In 121 patients (pts) with angiographically proven coronary artery disease, left ventricular (LV) cineangiograms were quantitatively evaluated. 79 pts showed regional wall abnormalities. In this group the relationship between echocardiographic parameters of global (LV) function (mitral-septal separation, systolic and diastolic diameter, and fractional shortening) and ventriculographic parameters was investigated. Mitral-septal separation showed the best correlation to the angiographic ejection fraction (EF) (r = -0.72). The measurement of this parameter allows the diagnosis of a reduced EF independently of the dilatation of the left ventricle, and is easy to perform and to reproduce. Mitral-septal separation discriminated well between the reference group and all infarction subgroups (posterior wall, anterior wall, and double infarction) with reduced EF. The modification of the mitral-septal separation measurement according to D'Cruz et al. showed no advantage over that proposed by Massie et al. Both are clearly dependent upon septal excursion, which has to be taken into consideration when mitral-septal separation is being evaluated. The sensitivity of mitral-septal separation (greater than 7 mm) for the detection of reduced LV function (less than 55%) was 0.66; the specificity was 0.80. There was greater sensitivity for anterior wall infarctions than for posterior wall infarctions (0.73 vs 0.44). Because of the relatively high number of false negatives, only a pathologic mitral-septal separation is diagnostically useful.

[Qualitative and quantitative analysis of regional contraction disorders using levocardiograms]. / Qualitative und quantitative Analyse regionaler Kontraktionsstörungen im Lävokardiogramm.

In 74 patients with proven myocardial infarction (typical history and enzymes, diagnostic ECG, and stenosis of the vessel supplying the asynergic region of more than 75%) the results of qualitative analysis of left ventricular cineangiograms were compared to those of quantitative analysis using the radial axis method of Mathes. There was a significant difference in interpretation between the two methods if the physiological movements of the heart were not taken into account in the qualitative analysis. After correction for systolic anterior movement and downward movement of the aortic valve during systole, a mean accuracy of 92% resulted. The radial axis method discriminated well between normokinetic and asynergic wall segments. However, this method proved less useful for the detection of asynergies in the apical, anterobasal, and posterobasal regions. A radial axis angle of between 15 degrees and 20 degrees is considered to be optimal. The quantitative analysis seems to be particularly useful for the interpretation of borderline cases, and should be carried out routinely in addition to the qualitative analysis.

[Electrocardiogram and M-mode echocardiography in the diagnosis of chronic transmural infarct. Correlations and determination of the accuracy of both methods based on quantitative levocardiography]. / Elektrokardiogramm und M-mode-Echokardiographie in der Diagnostik des chronischen transmuralen Infarkts. Korrelationen und Bestimmung der Aussagekraft beider Verfahren aufgrund der quantitativen Laevokardiographie.

In a comparative study of 121 consecutive patients who had had coronary angiography for coronary heart disease, the diagnostic informations obtained by M-mode echocardiography and electrocardiography in chronic transmural infarction were compared. Wall excursion by echocardiography did not allow sufficient separation of normal and asynergic segments. Changes in systolic wall thickness, on the other hand, provided satisfactory sensitivity and good specificity in the recognition of segmental contraction disorders: posterior wall thickening of 0.64 and 0.76, respectively, septal thickening of 0.45 and 0.91, respectively. In 53% of patients the ECG and echocardiogram provided findings similar to those by angiography. False-positive findings occurred in 10% of electrocardiograms, 14% of echocardiograms. False-negative findings in the ECG occurred in 13%, in the echocardiogram in 25%. Both methods combined had a specificity of nearly 100% with regard to the diagnosis of posterior-wall and anterior-wall infarction, and a positive predictive value of 0.92 (posterior) and 0.93 (anterior wall infarction). M-mode echocardiography and ECG findings provide reliable diagnosis of both the anterior and posterior wall chronic transmural infarction.

[Electrocardiography and quantitative levocardiography in chronic transmural infarct. A correlative study]. / Elektrokardiogramm und quantitative Laevokardiographie beim chronischen transmuralen Infarkt. Eine Korrelationsstudie.

For evaluation of a connection between the electrocardiographic diagnosis and localisation of chronic infarction and the angiographic results left ventriculography data of 97 patients with coronary heart disease were assessed quantitatively according to the method of Mathes. According to electrocardiographic criteria of infarction six subgroups were distinguished: anteroseptal, anterior, anterolateral, inferior, inferiolateral, and posterolateral. Asynergies were demonstrable in 87% of patients with infarct electrocardiograms, normal ventricular function was seen in 80% of patients without infarct ECG. Asynergies were seen in 75% of electrocardiographically diagnosed anterior wall infarcts and in 92% of posterior wall infarcts. The sensitivity of the ECG in chronic infarction was 83%, the specificity 84%. Pronounced differences in the number of involved segments were found between inferior and inferiolateral infarction. In contrast, no clear-cut differentiation of electrocardiographic findings judged by segmental involvement in the left ventriculography was seen for the anterior wall. The extent of the anterior wall infarction diagnosed by electrocardiography did not correlate with results of left ventriculography. The ECG is a suitable means for detection of segmental disturbances of contraction also in the chronic infarction stage. However, localisation and extent of the lesion can only be assessed within limits.

[Stress-ECG after myocardial infarct. Does myocardial infarct reduce the significance of stress ECG in the diagnosis of severe stenosis of the anterior interventricular ramus, the diagonal ramus and the marginal ramus of the coronary artery]. / Belastungs-EKH nach Hinterwand-Infarkt Schränkt ein abgelaufener Herzhinterwand-Infarkt den Aussagewert des Belastungs-EKG bei der Diagnose höhergradiger Stenosen des R. interventricularis anterior, R. diagonalis und R. marginalis der linken Koronararterie ein?

41 patients with inferior myocardial infarction underwent both exercise stress testing and coronary arteriography. Coronary arteriography of 15 patients showed high-degree stenosis as well as occlusions of the right coronary artery and/or of the R. circumflexus of the left coronary artery alone. In 14 of these 15 cases exercise stress testing showed a normal result, in one case results were abnormal. However, we detected additional high-degree stenosis of R. interventricularis anterior and/or of R. diagonalis and/or of R. marginalis in the other 26 patients. In 22 of these 26 cases exercise stress testing showed an abnormal result, in 4 cases it was normal. Because of a sensitivy of 84,6% and a specificity of 93,3% we can assume, that abnormal results of exercise stress testing suggest additional high-degree stenosis of the RIVA-vessel system in patient after inferior myocardial infarction. Considering an eventual bypass operation it is possible to narrow the indication for coronary arteriography.

[Ventricular arrhythmias and left ventricular function in coronary artery disease. A study by M-mode echocardiography and 24-hour Holter-monitoring (author's transl)]. / Ventrikuläre Arrhythmien und linksventrikuläre Funktion bei koronarer Herzerkrankung. Eine Untersuchung mittels M-Mode-Echokardiographie und 24-Stunden-Bandspeicher-Ekg.

In 82 patients with coronary artery disease, most of them having had transmural myocardial infarction, left ventricular function was studied with M-mode echocardiography. Furthermore 24-hour Holter-monitoring was done to determine the maximal degree of ventricular premature contractions (VPC's) according to the classification of Lown. The degree of VPC's was then plotted against echocardiographic parameters of left ventricular function. Confronting the subgroup of patients with Lown grade 0--II with those of grades III and IV, for all parameters significant differences of the mean values could be demonstrated. Parameter "distance E-point of the anterior mitral leaflet--left ventricular septal wall" shows 84% sensitivity; fractional shortening gives 88% specificity. Combination of all four parameters shows 90% specificity, which makes M-mode echocardiography a valuable diagnostic method in identifying those patients with coronary artery disease and malignant arrhythmias who have an increased risk of sudden death.

[Growth rate of pulmonary metastases (author's transl)]. / Die Wachstumsgeschwindigkeit von Lungenmetastasen.

The growth of 148 untreated metastases to the lung was determined in 47 patients. Pulmonary metastases of squamous-cell carcinomas, sarcomas and malignant melanomas exhibited exponential growth, the doubling times were distributed log-normally, the geometric mean amounted to six weeks. The growth rate of adenocarcinomas decreased with increasing tumor size approximately in accordance with a Gompertzian function.

Radioimmunoassay of carcinoembryonic antigen (CEA) without extraction and dialysis using solid-phase antibody.

A modified radioimmunoassay has been developed for plasma CEA levels. This procedure used immobilized, solid-state antibodies, does not require perchloric acid extraction of the plasma samples and purification of the extract by dialysis. The accuracy, sensitivity and precision are equal to those of the most widely used procedure and the laboratory effort is greatly reduced.

Pitfalls in the application of digoxin determinations.

The radioimmunoassay of digoxin is one of the most important services of the nuclear medicine laboratory. Precision and accuracy in the performance of the test are especially critical. A number of commerical kits are available and reliable. Pitfalls to be avoided includelimited availability or delay in performance of the assay; failure to consider senitizing factors; drawing the blood sample too soon after a digoxin dose; failure to consider desensitizing factors; forgetting that renal function is a major determinant of blood and tissue digoxin levels; assuming patient compliance and uniform intestinal absorption (bioavailiability with all digoxin preparations in all patients; attempting to interpret digoxin levels without the necessary clinical information; and failure to deliver the result to the proper person. If one avoids these pitfalls, and important service will be rendered in the evaluation of the patient requiring digitalis therapy.

The intracellular transport and distribution of cysteamine phosphate derivatives.

Radioautography and extractive techniques were used to analyze the transport of cysteamine phosphate and its derivatives in salamander oocytes. The quantitative relations among the processes involved - membrane permeation, enzymatic dephosphorylation, binding through mixed disulfide formation, and cytoplasmic diffusion - were elucidated. Within the detection limits, all of the intracellular material is present as dephosphorylated derivatives. Cytoplasmic diffusion is effectively slowed by binding (the "chromatographic" effect) and makes an appreciable contribution to cellular flux rates. As a consequence, one can observe by radioautography a cortical diffusion ring which spreads inward as a function of influx time, while also increasing in peak density because of the finite membrane permeability. Good agreement was found between the transport parameters determined by radioautography and those from influx data for the whole oocyte. The ratio of nuclear to cytoplasmic concentrations of the cysteamine phosphate derivatives at equilibrium is about 0.4. The nuclear membrane is, however, a negligible barrier to transport, and the asymmetry appears to arise primarily from the quantity and sulfhydryl content of the binding proteins in the two compartments.