The effect of knee position on the reproducibility of measurements taken from stress films: a comparison of four measurement methods.

We evaluated the accuracy of four different means of radiographic measurement of anteroposterior translation in the knee joint. The tests were performed in normal knees, in knees lacking the anterior cruciate ligament, and in knees lacking both anterior and posterior cruciate ligaments; the knees were obtained from cadavers. It is difficult to define landmarks and to perform exact measurements, and we sought to determine which of the four methods is the most accurate. In particular, we examined the effect of various degrees of rotation and flexion on the positional relationships of the landmarks of the tibia and the femur.

Knee joint simulator: an anatomical reconstruction of the joint surfaces and of the ligamentous structures of the knee joint for teaching purposes.

A knee joint simulator with anatomical reconstruction of the joint surfaces and of the ligamentous structures was built for teaching purposes. With this simulator it is possible to demonstrate the anatomy, physiology and kinematics of knee ligaments, to teach and learn how to conduct ligamentous instability tests and to demonstrate the effect of knee ligament reconstructive surgery.

Regular sauna bathing and the incidence of common colds.

The high morbidity of common colds means that their economic importance is considerable, with colds causing more loss of productivity than any other infection. As no effective prophylaxis is available, this trial was to test the hypothesis that sauna bathing can reduce the incidence of common colds. Twenty-five volunteers were submitted to sauna bathing, with 25 controls abstaining from this or comparable procedures. In both groups the frequency, duration and severity of common colds were recorded for six months. There were significantly fewer episodes of common cold in the sauna group. This was found particularly during the last three months of the study period when the incidence was roughly halved compared to controls. The mean duration and average severity of common colds did not differ significantly between the groups. It is concluded that regular sauna bathing probably reduces the incidence of common colds, but further studies are needed to prove this.

[Early ergometry following acute myocardial infarction?]. / Früh-Ergometrie nach akutem Myokardinfarkt?

One hundred and twenty patients underwent a symptom limited submaximal exercise test (SSET) 8-40 days after acute myocardial infarction. No complications occurred during the exercise test. Sixty-two patients (52%) showed a normal SSET. ST-segment depression (greater than or equal to 1 mm) was detected in 21 (17.5%). Dyspnea, fatigue, inadequate blood pressure response and angina pectoris without changes in ST-segments were the end-point in 33 patients (27.5%). Furthermore, significant premature ventricular contractions occurred in four cases (3%) and limited the SSET. An SSET soon after myocardial infarction can be performed without risk. High specificity of ST-segment depression in lead V5 was confirmed by the coronary angiographic findings. Apart from ST-segment depression there were other, more frequent nonspecific end-points of SSET which require further examination regarding their prognostic value.

[Course and prognosis of primary pulmonary hypertension]. / Verlauf und Prognose der primären pulmonalen Hypertonie.

Between 1967 and 1970 primary pulmonary arterial hypertension was diagnosed in 52 patients. Menocil had been taken by 36 patients. Overall survival rate after 9 years was 0.58. Mortality was particularly high within 2 years after the diagnosis was established (22%). Survival rate was low in the group with pulmonary vascular resistance exceeding 1000 dynes-sec-cm-5 (0.42 after 9 years). Initially slight pulmonary hypertension generally had a good prognosis but even severe pulmonary hypertension can regress or even disappear. With respect to survival rate, there were no significant differences between patients with and without Menocil intake.

[Effect of droperidol on the creatine phosphokinase activity in acute myocardial infarct]. / Beeinflussung der Aktivität des Kreatin-phosphokinase-Isoenzyms durch Droperidol beim akuten Myokardinfarkt.

In 141 patients with acute myocardial infarction, creatine phosphokinase isoenzyme (CPK-MB) was determined by the activation method with dithiothreitol (RAO et al.: Clin. Chim. Acta 21, 1612 [1975]). 15 out of 16 patients with atypical negative CPK-MB values within the first 3 days after infarction had been treated with 5-10 mg droperidol, a neuroleptic drug dispensed for its antiemetic effect. In a prospective study in 7 patients, CPK-MB determined serially showed a decrease or persistently low or negative values within 1 minute after injection of 5 mg droperidol and lasting 24-36 hours after injection. In contrast, CPK-MB determined by immunoprecipitation did not change its typical pattern after use of droperidol. Hence, negative or low values of CPK-MB in acute myocardial infarction must be expected after droperidol if determination is by the activation method with dithiothreitol.

Relationship between duration of systolic upstroke of apexcardiogram and internal indexes of myocardial function in man.

In 11 patients with nonobstructive cardiomyopathy and coronary heart disease and decreased myocardial function of the left ventricle, as well as in nine patients without left heart valvular or myocardial disease, left apexcardiograms were recorded during diagnostic heart catheterization, wherein micromanometers were used; ACG's were registered additionally in 54 healthy volunteers in order to establish the normal range of apexcardiographic parameters. In all cases the apex tracings were recorded by means of a pulse transducer with infinite time constant. The most important finding of this study was the close correlation between the duration of the systolic upstroke (SUT) of the apex tracing and some accepted isovolumic indexes of left heart function (isovolumic contraction time, time interval from the onset to peak of the first derivative of left ventricular pressure, maximal value of the first derivative of left ventricular pressure, and the peak measured velocity of shortening of the contractile elements). Further, the mean value of SUT in patients with impaired left myocardial function was significantly prolonged, compared to the control subjects; an overlap was apparent due to the fact that some of these patients showed a normal left myocardial performance at rest, having an abnormal response only to exercise tests. The apexcardiographic SUT can practically always be measured when the first derivative of apex tracing is simultaneously recorded. It showed itself to be only slightly influenced by the resting heart rate. The mentioned relationship of the systolic upstroke time of the ACG to internal isovolumic indexes of myocardial function makes this noninvasive measurable parameter an additional excellent tool for the evaluation of the left myocardial state, thus supporting a new aspect of the value of quantitative apexcardiography.

Time relation between apex cardiogram and left ventricular events using simultaneous high-fidelity tracings in man.

In 10 patients without left heart valvular disease and having normal function of the left ventricle, the left ventricular apex cardiogram with its first derivative (dA/dt), left ventricular pressure with its first derivative (dP/dt), aortic pressure, electrocardiogram, and phonocardiogram were reocrded simultaneously during cardiac catheterization. The apex cardiographic tracings were obtained by means of a transducer with infinite time constant and very high resonant frequency and the LV and aortic pressures with catheter tip-manometers. The onset of the systolic rise of apex cardiographic and LV pressures were found to occur almost simultaneously with the upstroke of LV pressure, preceding that of the apex cardiogram by only 2 +/- 4 ms (mean +/- 1 SD). The summit of the systolic upstroke of the apex cardiogram (called E-point) occurred 37 +/- 9 ms after opening of the aortic valve and 41 +/- 9 ms after peak dP/dt. The peak of dA/dt preceded peak dP/dt by 10 +/- 4 ms. The protodiastolic nadir of the apex cardiogram (called-O-point) occurred slightly earlier (19 +/- 16 ms) than the nadir of the LV pressure curve, with considerable variation. In conclusion, this study using external and internal transducers with similar characteristics gives a new definition of the time relation between the externally recorded apex cardiogram and the haemodynamic events within the left heart in human subjects with normal left ventricular function.

[Proceedings: Relaxation speed in the apex cardiogram. Comparison with criteria of myocardial function on the simultaneously registered left ventricular pressure]. / Relaxationsgeschwindigkeit im Apexkardiogramm

A new apexcardiographic time parameter is described which is definable as the interval between the beginning of the aortic component of the second heart sound and the protodiastolic negative peak of the first derivative of the apexcardiogram and called A2-min dA/dt. There was a significant inverse correlation between the parameter in question and the simultaneous minimal and maximal rate of rise of the first derivative of left ventricular pressure in 20 patients (r = -0.79, p less than 0.001, r = -0.60, p less than 0.01 respectively).

Abnormal segmental contraction velocity in coronary artery disease produced by isometric exercise and atrial pacing.

Since isometric exercise by sustained handgrip leads to a sizable increase in aortic pressure this maneuver was used in addition to atrial pacing to increase the imbalance between oxygen demand and supply in two groups of patients. Both groups were studied by left heart catheterization and cineangiography in the right anterior oblique projection, at rest, during atrial pacing and during combined pacing and handgrip exercise. Group 1, the control group, consisted of 10 patients without coronary artery disease having an ejection fraction of 0.61 to 0.82. Group 2 was composed of 10 patients with definite obstructive disease of one or more of the three main coronary arteries. At rest, ejection fraction was normal or nearly normal (range 0.54 to 0.78). Regional myocardial contraction performance was assessed by determining mean segmental shortening velocities at the basal (VSB), middle (VSM) and apical (VSA) short ventricular axes. Whereas at rest there was no significant difference between the two groups or any of the three velocities, during pacing, VSM and VSA were significantly smaller in Group 2 than in Group 1 (P smaller than 0.02). During pacing combined with handgrip exercise the difference between the two groups was clearly accentuated, all three velocities being highly significantly decreased in Group 2 (VSB, P smaller than 0.01; VSM and VSA, P smaller than 0.001). When evaluated individually the patients of Group 2 had in 9 segments during pacing values for VSB, VSM and VSA that were below the range of the normal subjects. During pacing combined with handgrip a newly abnormal shortening velocity was observed in 12 segments (VSB abnormal in 3 of 7, VSM in 4 of 7 and VSA in 5 of 7 instances). In conclusion, the combination of atrial pacing and handgrip exercise appears to be a useful stress maneuver to identify temporarily dysfunctioning segments in patients with coronary artery disease in whom atrial pacing alone is not sufficient to induce ischemic contraction disorders.