[Quantitative two-dimensional echocardiography. Study results in patients with cystic fibrosis]. / Quantitative zweidimensionale Echokardiographie. Untersuchungsergebnisse bei Patienten mit zystischer Fibrose.

15 patients with cystic fibrosis aged 8-19 years were graduated into 3 stages of the cor pulmonale dependent on results of an examination with the microcatheter: stage 0:6, stage I: 4 and stage II: 5 patients. These patients were studied in the period from April 1987 to January 1988 echocardiographically. With this size and contractility of the right ventricle were especially considered. The end-diastolic and end-systolic area of the right ventricle could be measured in the apical 4-chamber-view in 14 of the altogether 15 patients and out of this the fractional area-shortening could be calculated. The end-diastolic area of the right ventricle in the patients with stage 0 was on an average 11.4 cm2/m2 body surface bs (8.7-13.5), in stage I 11.2 cm2/m2 bs (9.2-13.5), and in stage II 9.7 cm2/m2 bs (9.0-10.8). The end-systolic area of the right ventricle in stage 0: 7.2 cm2/m2 bs (6.8-8.4), stage I: 7.1 cm2/m2 bs (6.0-8.5), and stage II: 8.02 cm2/m2 bs (6.4-10.1). The results we found don't differ significantly in the 3 groups. Contrary to this fractional area-shortening of the right ventricle shows a falling tendency: stage 0.35.2% (22-49), stage I 32% (7-56), stage II 17.2% (4-38) with an increasing part of patients with a value under 28% (stage 0:1 patients, stage I 2 patients, stage II 3 patients). Contractility and pump-efficiency of the left ventricle were calculated in the apical 4-chamber-view according of the area-length-method. The findings don't show an increasing size of the right ventricle in the sense of a cor pulmonale but a decreasing contractility and pump-efficiency of the right ventricle as expressions of a cardial manifestation of the basic illness in the sense fo a symptomatic cardiomyopathy. A disturbance of the contractility of the left ventricle could be seen in 7 of the 15 patients (47%).

[Change in cardiopulmonary function following surgery]. / Kardiopulmonale Funktionsänderung nach operativen Eingriffen.

45 patients were subjected to pre- and postoperative radio-cardiographic examinations and 52 patients to respiratory function tests. Vital capacity, one-second capacity, maximum breathing capacity and peak flow decreased significantly, the oscillatory resistance increased significantly. During extra-abdominal interventions, the difference to the initial value appeared to be essentially lower. These findings are to be related to bronchial irritation and concurrent anaesthesia-induced bronchospasm as well to pain-dependent restriction of lung function due to elevation and relieving posture of the diaphragm. Not significant was the change in cardiac function which was determined by age and predigitalization of the test persons rather than by the site of the surgical intervention.

[Experiences with propranolol (Obsidan25) in hypertension therapy in pregnancy]. / Erfahrungen mit Propranolol (Obsidan25) in der Hochdrucktherapie bei Schwangeren.

The treatment of the mentioned forms of hypertension with propranolol during pregnancy either as monotherapy or in combination with dihydralazine and after careful exclusion of the contraindications described represents a further effective therapy. In the control examinations during pregnancy carried out in close cooperation between obstetrician and internist no detrimental side effects could be established for both mother and child. No significant changes of absorption, distribution and elimination of propranolol in pregnant women with hypertension in comparison with normotensive nonpregnant women were found as follows from the pharmacokinetic parameters shown.

[Value of mechanocardiographic parameters in comparison to radiocardiography in cardiologic diagnosis and therapy control]. / Wertigkeit mechanokardiographischer Parameter in Vergleich zur Radiokardiographie in der kardiologischen Diagnostik und Therapiekontrolle.

Two noninvasive methods for diagnosing cardiac function, the determination of systolic time intervals (STI) and radiocardiography-cyclography (RCG), were investigated in parallel on two study groups - patients with healthy heart and patients with myocardial insufficiency - before and after glycoside treatment with regard to their diagnostic validity by inter- and intraindividual comparison. The STI in patients with myocardial insufficiency clearly deviated from the values found in normals, but reached, however, the limit of significance only for the equalized pre-ejection period (PEP) and the quotient according to Weissler (PEP/LVET). A reliable quantitative conclusion about cardiac function by interindividual comparison with the help of STI, therefore, does not seem possible. The intraindividual comparison (before and during glycoside treatment) reveals statistically significant alterations in STI. In patients with myocardial insufficiency, the radiocardiographic findings in part exhibit considerable deviations from the expected values and those of other authors. Methodological and pathophysiological causes of these deviations are discussed. Taking into consideration methodological factors of influence (body position etc.), RCG yields quantitatively significant conclusions about the functional condition of the normal and insufficient heart and is, therefore, in its diagnostic valency superior to the determination of STI.

[Persistent infarct signs--obligate symptoms of heart wall aneurysm?]. / Persistierende Infarktzeichen--obligates Symptom eines Herzwandaneurysmas?

Out of 19 cases the ECG of which on an average during 6.1 years demonstrated persisting signs of an infarction at stage I in 13 cases a comparison between clinical and ECG findings X-ray kymography and scintigraphy of the ventricle was possible. In 7 cases a congruence of the results was found. With regard to the differing findings on account of the clinical treatment, the ECG and the ejection fraction the greater diagnostic valency must be ascribed to the Tc-scintigraphy.

[Psychological and physical performance standards of borderline hypertensive patients before and during treatment with propranolol]. / Psychische und physische Leistungsanforderungen an Borderline-Hypertoniker vor und unter Behandlung mit Propranolol.

On 47 borderline hypertensives discriminative reaction tests (17 test persons) and ergometries (30 test persons) were carried out. It could be proved that both in psychic and in physical demand by beta-blocker therapy heart rate and blood pressure significantly remained below the initial value. The calculation of the interior heart work resulted in an economization of the heart work. By means of the beta-blocker therapy of the borderline hypertensives a more favourable situation in an increased functional demand and a decreased reaction of the blood pressure on psychic stress was achieved.

[The prognostic value of diastolic extra sounds]. / Prognostische Wertigkeit diastolischer Estratöne.

Longitudinal examinations of 110 patient and ergometric loading tests on 300 patients resulted in correlative relations between diastolic extra sounds, increasing, reduction of the activity and decreased load capacity. On the basis of subjective and objective criteria the thesis is confirmed to value diastolic extra sounds as signs of an early insufficiency. It was conspicuous that already in adolescents with diastolic extra sounds a reduced load capacity could be established in comparison to adolescents of the same age.

[Early recognition and long-term control of hypertension in a random study]. / Früherfassung und Langzeitüberwachung der Hypertonie in einer Stichprobenuntersuchung.

6 years after a random hypertension screening of the initially recognized 355 persons 234 ones were after-examined. The measurement of blood pressure with a great expenditure of time proved to be the only secure method to establish the whole number of patients with hypertension, while the X-ray picture and the anamnesis questionnaire take into consideration only one part of the cases. The control examination after 6 years established that the number of the continuously treated patients with hypertension increased, that a decrease of the pressure was achieved in 44% of the cases of hypertension and that it was possible to reduce at the same time a part of the risk factors, particularly the consumption of nicotine. Untreated cases showed a tendency to the increase of blood pressure.

[Cardiopulmonary function after segmental resection of the lung]. / Kardiopulmonale Funktion nach Lungenteilresektion.

By the combination of radiocardiography, ergooxytensiometry and heart probing on 22 lobectomized, cone- and segment-resected patients, respectively could be established in comparison to control groups that also after parenchyma-saving lung resection a pulmonary load parenchyma-saving lung resection a pulmonary load hypertension develops in 15 patients. The sequel of this increase of pressure and resistance in the pulmonary circulation is a functional insufficiency of the heart in 11 cases which is to objectify by reduction of the stroke volume, increase of the end-diastolic and end-systolic volume and by reduction of the contractility of the myocardium.

[Radiocardiographic assessment of the effect of digoxin on heart conduction insufficiency]. / Radiokardiographische Beurteilung der Digoxinwirkung am leistungsinsuffizienten Herzen.

On 29 patients with heart insufficiency radiocardiographical investigations in rest and under stress were carried out before and after treatment with digoxin. Here it was shown that in existing functional insufficiency the determination of the stroke volume and of the minute volume in rest after digitalisation did not result in a remarkable change, but in obstructive insufficiency an improvement of the pump function of the heart began already under conditions of rest. Only in stress also in patients with functional insufficiency a significant increase of the heart-time volume and the stroke volume after application of glycoside was proved. An exacter information about the effect of glycoside was given by the temporary volume function particularly under stress.

[Observations on the disease course of arterial circulatory disorders in the lower extremities under conservative therapy]. / Verlaufsbeobachtung arterieller Durchblutungsstörungen der unteren Extremitäten unter konservativer Therapie

For estimation of the conservative treatment of peripheral arterial disturbances of the blood supply by means of parasympathicomimetics and sympathicolytics as well as body exercises patients in stage I, II and IV according to Fontaine were after-examined after 2-5 years. In the majority of cases a progessing of the arterial obstructions and an extension to proximal vascular regions could be established. Improvements in stage I suggest thinking of a false diagnosis. In stage IV especially with simultaneously existing diabetes mellitus the obliteration process extends to other vascular regions and thus frequently develop complications with exitus letalis.

[Haemodynamic and respiratory changes after lung resection (author's transl)]. / Hämodynamische und respiratorische Veränderungen nach Lungenoperationen.

After lobectomy a slight increase of pulmonary arterial pressure can already be observed in the state of rest. The resistance of the pulmonary vessels reveals a marked dependance on the date of operation, it increases moderately on strain, but more significantly in the state of rest. At the same time cardiac output is decreased due to the exhaustion of the myocard after straining. Cardiac insufficiency developing postoperatively is due to the reduction of pulmonary hypertension. The reduction of VC and a slight increase of resistance do not cause the arterial PO2 pressure to be lowered under conditions of strain or rest.

[Pulmonary artery pressure in the pathophysiology of lung-resections therapy. Part I: standard values, surgical lung diseases, postoperative death rate (author's transl)]. / Der pulmonale Blutdruck in der Pathophysiologie der Lungenresektionsbehandlung. TeilI: Normalwerte, lungenchirurgische Erkrankungen, Operationsletalität

The early death rate after lung-resections is caused mainly by right heart failure. The level of pulmonary blood pressure plays a decisive role in this respect. In patients with surgical lung diseases the blood pressure is significantly higher in several parts of lung circulation than in healthy persons. The early death rate after operation was found to be increased in patients with a higher level of preoperative pulmonary artery pressure.

[Pulmonary artery pressure in the pathophysiology of lung-resections therapy. Part II: bronchial carcinoma and pulmonary tuberculosis (author's transl)]. / Der pulmonale Blutdruck in der Pathophysiologie der Lungenresektionsbehandlung. Teil II: Bronchialkarzinom und Lungentuberkolose

Patients with lung resections due to bronchial carcinoma have a much higher early death rate than patients with lung resections because of pulmonary tuberculosis. Functional failure of the cardiorespiratory system and right heart insufficiency are considered to be the main reasons for this difference. Intracardial pressure values were compared between 530 patients with bronchial carcinoma and 200 patients with pulmonary tuberculosis revealing significantly higher pressure values in the right heart and pulmonary artery for patients with bronchial carcinoma. Predisposing factors of the aged people are fundamental in this respect.

[Pulmonary artery pressure in the pathophysiology of lung-resections therapy. Part III: pre- and postoperative investigations (author's transl)]. / Der pulmonale Blutdruck in der Pathophysiologie der Lungenresektionsbehandlung. Teil III: Prä- und postoperative Untersuchungen

50 patients were investigated by right heart catheterization to determine the range of blood pressure values in lung circulation after lung resection. A comparison between pre- and postoperative blood pressure values was conducted in 29 patients and a significant increase was found. In some patients the blood pressure values after pulmonary lobectomy rose to 50% and after pneumonectomy to 100% above the preoperative values. Changes of the investigated aterial pressure differences proved to be not statistically significant.

[72. Evaluation of the cardiac performance by means of radiocardiographic studies]. / Beurteilung der kardialen Leistung durch radiokardiographische Untersuchungen

In 2 series of investigations could be established that there exist relations between the radiocardiographically determined stroke volume and minute volume in rest and the maximum receptivity of oxygen and that the effect of a digitalisation is to be judged according to the increase of stroke and minute volume in rest and under load. The values obtained by the use of 113m indium allow an evidence concerning the functional capacity of the heart. A clear reduction of the stroke volume correlates with a diminution of the maximum oxygen pulse established during an ergometric examination and the maximum receptivity of oxygen.

[Early diagnosis of cardiovascular diseases in younger patients]. / Früherfassung von Erkrankungen des Herz-Kreislauf-Systems bei jüngeren Personen

In 114 persons with an average age of 30 years who were found out during an X-ray examination on account of pathological findings of the heart clinical examinations were carried out and the findings were compared with those of a control group of the same age which had normal fluorographic findings. Among the patients with radiologically provable enlargement of the heart were 29% of active sportsmen who in the majority of cases had no other findings. Moreover, the enlargement of the heart correlated with overweight, increased values of blood pressure, vitia cordis and with subjective heart complaints. The effectivity of the primary screening is confirmed by the establishment that 66% of patients free of symptoms could be established.