[Low-dose helical CT-dacryocystography in nasolacrimal duct obstruction-a prospective study]. / Low-Dose-Spiral-CT-Dakryozystographie bei Tränenwegsstenosen ­ eine prospektive Studie.

BACKGROUND: In addition to basic ophthalmologic diagnostic workup, different radiologic procedures can be performed for assessment of nasolacrimal duct obstruction. However, no gold standard imaging technique has yet been established. Using the results of the present study, the advantages of helical CT-dacryocystography (CT-DCG) are demonstrated, particularly when performed before endonasal endoscopic dacryocystorhinostomy. MATERIALS AND METHODS: In 21 patients with uni- or bilateral epiphora, 24 low-dose helical CT-DCGs were performed with non-ionic iodine-containing contrast medium and including three-dimensional reconstruction. For 8 patients, digital subtraction angiography (DSA)-DCG results were available for comparison with CT-DCG. RESULTS: Using low-dose helical CT-DCG, either the location of nasolacrimal duct pathology could be exactly identified (n = 19; stenosis presaccal n = 3, intrasaccal n = 11, postsaccal n = 5) or nasolacrimal system block could be definitively excluded as the cause of epiphora (n = 5). For imaging of the perilacrimal and periorbital bony structures, CT-DCG is significantly better than DSA-DCG. CONCLUSION: Low-dose helical CT-DCG with reconstruction of the coronal and sagittal planes represents an ideal imaging technique with low exposure for detection of nasolacrimal duct obstruction. By demonstrating all relevant anatomic landmarks for endoscopic dacryocystorhinostomy, helical CT-DCG enables head and neck surgeons to plan surgery optimally.

Endotoxemia in patients with alcoholic and non-alcoholic cirrhosis and in subjects with no evidence of chronic liver disease following acute alcohol excess.

The presence of endotoxemia in peripheral venous blood was evaluated in 88 patients with alcoholic cirrhosis (AC) and in 42 patients with non-alcoholic cirrhosis (NAC). The two groups did not differ significantly with respect to mean age, liver function tests, and incidence of esophageal varices or ascites. In addition, a group of 24 patients with no evidence of chronic liver disease but with acute exposure to large quantities of alcoholic beverages was investigated. Endotoxin was determined by using the Limulus lysate test. The assays were carried out in the plasma samples by both the dilution technique and the chloroform extraction method. Endotoxemia was found more frequently in patients with AC (67.3%) than in patients with NAC (45.5%, P less than 0.025). The prevalence of endotoxemia was not significantly higher in cirrhotics with ascites or esophageal varices when compared to the subgroup without ascites or esophageal varices. Of the 24 patients with no evidence of chronic liver disease investigated because of acute alcohol excess immediately before admission 11 (45.7%) were found to have endotoxin in the peripheral venous blood. In 7 of these patients a second blood sample was tested 5-8 days later and no endotoxin could be detected. The latter results suggest that heavy alcohol abuse leads to transient endotoxemia even in patients with no signs of chronic liver disease. The findings support the hypothesis that gut-derived endotoxins might play a role in the initiation and aggravation of alcohol-induced liver disease.

[The effect of oxyfedrine on cardiac performance in coronary patients. Tests using electrocardiographic and metabolic parameters in atrial stimulation]. / Die Wirkung von Oxyfedrin auf die kardiale Belastungstoleranz bei Koronarpatienten

In 17 patients with coronary heart disease the effects of the beta-active agent L-3-(beta-hydroxy-alpha-methyl-phenethyl-amino)-3'-methoxy-propiophenone (oxyfedrine, Ildamen) were proved at rest and during atrial pacing by measurements of coronary venous O2-saturation, myocardial lactate extraction, angina threshold and ST-segment depression. In 88% oxyfedrine had antianginal effectivity with rise in angina threshold (+11%), reduction of ST-segment depression (--48%) and reduction of lactate production(--63%). The rise in coronary venous O2-saturation ("35%) and the electrocardiographic and metabolic reduction of hypoxic reaction indicate the improvement of nutritional coronary flow. Therefore improvement of myocardial O2-balance is derived from the reduced energy requirement by decrease of heart size and ventricular wall tension and the rise of myocardial O2-supply by coronary dilation in spite of the increased energy requirement by ascending contractility. Conclusively the application of oxyfedrine is preferred in coronary heart disease with simultaneous congestive heart failure.