[Angiography during interventional procedures with carbon dioxide (CO2) (carbo-angiography) in patients with increased contrast media risk]. / Interventionsbegleitende Angiographie mit Kohlendioxid (CO2) (Carboangiographie) bei Patienten mit erhöhtem Kontrastmittelrisiko.

Within the last 18 months we examined 130 patients with known complications or contraindications using iodinated contrast media for angiography by using carbon dioxide as contrast agent in digital subtraction angiography technique. These were diagnostic pelvis-leg angiographies (n = 106) with simultaneous consecutive interventional radiologic therapy in 68 cases. In 19 dialysis access fistulas 11 angioplasties were performed in the same session. In 5 cases of renal allografts no interventional radiologic therapy was necessary. For CO2 application an electronic controlled special injector was used. Carbon dioxide has a number of advantages: no adverse reactions, nonallergenic and can be used several times without increasing risks and is cost-saving. CO2 angiography is a sensitive method, for detection vessel wall processes below the diaphragm. It can replace conventional angiography.

[Rehabilitation from the economic viewpoint--basic geriatric considerations]. / Rehabilitation unter ökonomischen Gesichtspunkten--Grundsätzliche geriatrische Anmerkungen.

Rehabilitation of the elderly on principle uses the same therapeutics as in younger people. But it will only be successful if the target will be realistic, i.e., the indication considers the individual functional capacity as well as psychosocial factors. Still often only partial success will be available. But carried out competently geriatric rehabilitation will be efficient as many reports-also from Germany-verify.

Dysregulation between TH1 and TH2 T cell subpopulations in the elderly.

We investigated the influence of zinc and its binding proteins on the immune system in 21 elderly and 20 young subjects. We detected a deficiency of zinc in the serum of the elderly. Albumin levels were within physiological range, but alpha 2-macroglobulin was significantly increased in the serum of elderly subjects. Using a whole blood assay, we found decreased production of interferon-gamma (IFN-gamma) and soluble interleukin-2 receptors (SIL-2R) in the elderly, whereas interleukin-10 (IL-10) production was greater than in the young controls. To exclude cellular defects, we measured lymphocyte subpopulations. In elderly subjects, we detected lower quantities of CD8+, CD8+/CD45RA+ and CD4+/CD45RO+ cells, but not CD4+ cells, than in young subjects. Other lymphocyte subpopulations were comparable for both groups. These findings suggest a dysregulation between TH1 cells and TH2 cells in the elderly, which may be a result of long-term zinc deficiency. Zinc reconstitution showed no beneficial effects as measured by T cell activity.

[Carbon dioxide as an alternative contrast medium in peripheral angiography]. / Kohlendioxid als alternatives Kontrastmittel für die periphere Angiographie.

A closed gas pressure pistol was used in 50 patient CO2 angiography as a supplementary method to conventional injection with liquid contrast medium. These were diagnostic pelvis-leg angiographies (n = 36), therapeutic angiographies (n = 8), haemodialysis fistulas (n = 3), suspected stenosis of a renal transplant artery (n = 1) and suspected renal artery stenosis (n = 1). 246 renal angiography series were performed with CO2. Dosages varied in accordance with the imaged vascular area between 10 ccm;(shunt imaging) and up to 100 cm3 (pelvis-leg angiography), at pressures between 400 mbar in case of haemodialysis fistulas up to 2000 mbar in the pelvis-leg area. Short-term feeling of fullness and even nausea were accompanying symptoms in 4 patients. The image quality was slightly inferior to that of conventional contrast medium images due to an elevated signal-to-noise ratio. Injector-monitored CO2 angiographies enabled imaging of the distal aorta or of peripheral vascular sections, imaging of the upper extremity and presentation of kidney transplants in patients with a relative or absolute contraindication to iodised contrast media.

[Doppler ultrasound monitoring during vascular interventions]. / Dopplerultraschallmonitoring während Gefässintervention.

Doppler ultrasound examination as diagnostic device in angiology yields only discontinuous information on flow velocities in vessels during insonation with hand-held probes. Continuous insonation and therefore determination of flow velocities in arteries are necessary to evaluate flow disturbances and changes of flow velocities during radiologic invasive interventions, i.e. implantation of stents, during percutaneous transluminal angioplasty therapy or local lysis. This modification of Doppler ultrasound examination is already used in neurosurgery for permanent monitoring of flow velocities in large brain vessels in one or both hemispheres during therapy. In our institute we developed a probe holder device to fix a miniature Doppler ultrasound probe (8-MHZ pulsed-wave probe) on the skin surface. Therefore continuous insonation during the manipulations is easy to realize. Information about complications such as occlusions, thrombi, emboli and changes in flow velocity is immediately present on the screen. We have monitored 40 patients during radiologic interventional therapy in arteries of the lower limb. Complications during the interventions were detected immediately and could be corrected.

[The team of the geriatric day clinic]. / Das Team der geriatrischen Tagesklinik.

Composition of staff and therapeutic offers of day-hospitals principally are identical with those of geriatric hospitals. But there are peculiarities in their working: They offer a well balanced combination of somato-, physio-, psycho- and sociotherapy which individually must be planned, perpetually controlled and if necessary changed corresponding to the given situation of the particular patient. This so called therapeutic milieu is only to be preserved by a close cooperation and interchange of information within the team and an intensive motivation of the patient to cooperate with the therapists.

[DSA with mechanically injected carbon dioxide. Animal experimental results]. / DSA mit maschinell injiziertem Kohlendioxid: Tierexperimentelle Ergebnisse.

Carbon dioxide was used as an intra-arterial contrast medium by mechanical injection in 10 pigs. 127 angiographic examinations of 114 vascular territories were carried out and 93 were successful. A mechanism providing even gas volumes was chosen to obtain reproducible volume and pressures when using a compressible medium such as gas. Gas pressure is exponentially correlated with volume and volumes of 20-50 cm3 at 1000 mbar adequate for filling various infradiaphragmatic vascular areas. In parenchymatous organs, gas filling is seen only as far as third order arteries. The reason for this is escape of gas through preexisting arteriovenous fistulae into the efferent veins.

[Aging and disability. Attempt at determining current status]. / Alter und Behinderung. Versuch einer Standortbestimmung.

Disability must not occur inevitably during ageing though interrelations with age dependent physiological involutive processes and/or psychological factors may exist. But it is possible to prevent genesis or progression of disabilities to a remarkable range by suitable therapy as activating care or rehabilitation. Necessary basic decrees for this exist but are used too scarcely. At time epidemiology only gives insufficient informations concerning both the situation of ageing people with disabilities and of the further development of disability with age. Therefore this contribution mainly is confined to point out deficits resp. trends and to request urgently reactions for starting necessary changes.

[Carbon dioxide as an irrigation medium for percutaneous angioscopy]. / Kohlendioxid als Spülmedium für die perkutane Angioskopie.

Since technical progress has allowed the development of small and flexible endoscopes, percutaneous, transluminal angioscopy promises to be a diagnostic and therapeutic tool. Nevertheless, the main problem is to obtain a satisfactory bloodless visual field. The saline solutions used for this purpose present problems with hypervolaemia, insufficient clearance, and decreased refraction. We investigated a CO2 application system for angioscopy that allows the reproducible injection of variable quantities of gas, pressure, and injection time. In 10 pigs undergoing angioscopy, CO2 was injected through a Swan-Ganz catheter under blockade of the distal aorta. Using a bifemoral approach, the application of gas and the blocking balloon were controlled by an automatic gas injector. The CO2 was injected through the tip of the catheter with a constant flow and a variable pressure and time. The angioscopy procedures were videotaped. With small volumes of carbon dioxide (approximately 50 cm3; 1000 mbar application pressure) a column of gas can be created which, unlike liquids, completely displaces blood from the vessels and allows for several minutes a bloodless inspection of the aorta and the side branches without blood mixture. Carbon dioxide application allows safe and successful percutaneous angioscopy under optimal conditions if the quantities of gas, pressure, and injection time are adjustable. The tested gas injection device fulfills these conditions.

Investigations of the lymphokine system in elderly individuals.

Elderly people are at risk from an increased incidence of infections. Therefore we have studied the correlation between the production of several immunological parameters such as interferon-gamma (IFN-gamma), interferon-alpha-2 (IFN-alpha-2), interleukin-2 (IL-2), soluble interleukin-2 receptors (sIL-2R) and interleukin-6 (IL-6) in young controls of 25-34 years old and old individuals with a minimum age of 65 years. All persons were selected according to the basic concept of the 'Senieur protocol'. Heparinized blood was taken and cultured in the whole-blood assay. The determination of all cytokines in the supernatants of stimulated cultures was done by the ELISA technique. We found significantly decreased levels of sIL-2R and IFN-alpha-2 after stimulation, whereas the values of IFN-gamma and IL-2 showed no significant difference between elderly and young persons. The values of IL-6 showed a distinct trend towards an increased synthesis for the elderly. We also studied the lymphocyte subpopulations T4 and T8 by flow cytometry. Elderly individuals showed a significantly increased T4/T8 ratio, caused by a slightly but not significantly decreased level of T8 cells. These results show that the elderly have decreased values of some immunological parameters such as IFN-alpha-2 and sIL-2R, which might explain an increased susceptibility of elderly individuals to bacterial and viral infections.

[Vascular diseases in the elderly]. / Gefässerkrankungen im Alter.

Obliterary artery diseases are not confined to the elderly but on the other hand a higher rate of acute symptoms in old age is observed because of multiple influences of the hemodynamics. Furthermore in old age only rarely a reversal of these symptoms takes place. In the underlying paper the several regions of the body which may be changed by the obliteration of the arteries are discussed. In addition the question of therapy will be taken into consideration. In general the therapeutic regimes will be the same as in younger age: muscle training of the legs, local lysis by catheter, late fibrinolysis, hemodilution, rheologically acting substances, along with an active interval training or a transluminal dilatation by catheter or a surgical intervention. Relevant concomitant diseases such as diabetes mellitus or hypertension and their relevance for obliterative vessel diseases will especially be stressed.

[Current therapy of peripheral arterial occlusive diseases in the aged]. / Aktuelle Therapie bei peripheren arteriellen Durchblutungsstörungen im Alter.

The following methods have proven to be effective in the treatment of peripheral vascular disorders in the elderly: local low-dose thrombolysis, systemic fibrinolysis, hemodilution, prostaglandins, transluminal angioplasty, vascular surgery. An early diagnosis, elimination or treatment of risk factors, walking-training, and specific treatment in cases of multimorbidity will improve therapeutic effectiveness.