High average power Q-switched 1314-nm two-crystal Nd:YLF laser.

A 1314 nm two-crystal Nd:YLF laser was designed and operated in both CW and actively Q-switched modes. Maximum CW output of 26.5 W resulted from 125 W of combined incident pump power. Active Q-switching was obtained by inserting a Brewster-cut acousto optic modulator. This setup delivered an average power of 18.6 W, with a maximum of 5.6 mJ energy per pulse with a pulse duration of 36 ns at a pulse repetition frequency of 500 Hz.

330 mJ single-frequency Ho:YLF slab amplifier.

We report on a double-pass Ho:YLF slab amplifier which delivered 350 ns long single-frequency pulses of up to 330 mJ at 2064 nm, with a maximum M2 of 1.5 at 50 Hz. It was end pumped with a diode-pumped Tm:YLF slab laser and seeded with up to 50 mJ of single-frequency pulses.

High average power 1314 nm Nd:YLF laser, passively Q-switched with V:YAG.

A 1314 nm Nd:YLF laser was designed and operated both CW and passively Q-switched. Maximum CW output of 10.4 W resulted from 45.2 W of incident pump power. Passive Q-switching was obtained by inserting a V:YAG saturable absorber in the cavity. The oscillator delivered a maximum of 825 µJ energy per pulse, with a pulse duration of 135 ns at a pulse repetition frequency of 6.3 kHz, effectively delivering 5.2 W of average power.

Ho:YLF & Ho:LuLF slab amplifier system delivering 200 mJ, 2 µm single-frequency pulses.

A single-frequency single-pass amplifier based on Ho:YLF and Ho:LuLF in a scalable slab architecture delivering up to 210 mJ at 2064 nm is demonstrated. The amplifier was end-pumped by a 1890 nm Tm:YLF slab laser and was seeded with a 69 mJ single-frequency Ho:YLF ring laser operating at 50 Hz.

[Tracheobronchomegaly--Mounier-Kuhn syndrome--case report and review of the literature]. / Tracheobronchomegalie--Mounier-Kuhn-Syndrom--Kasuistik und Literaturübersicht.

Tracheobronchomegaly is a rare disorder. A marked dilatation of the trachea and the main stem bronchi is the characteristic sign measured as an enlarged transverse diameter (mean +/- 3 SD). Bronchiectasis is usual. In about one third of the published cases a diverticulosis was described as demonstrated in one our cases. For diagnostic modern radiological methods (CT including 3 D reconstruction, MRT) and bronchoscopy are recommended. The number and seize of the diverticula are documented by tracheography or by bronchography. In a part of all cases of tracheobronchomegaly the cause of the disorder is known. Therefore a division into congenital and acquired tracheobronchomegaly is useful.

Identification of depression in a rural general practice.

Major depression is underdiagnosed by general practitioners, but the reasons for this are not clear. This study aimed to establish the prevalence of major depression and coexisting generalised anxiety disorder in a rural general practice in the Orange Free State. It also assessed the predictive value of a screening questionnaire for use by general practitioners. The two practitioners evaluated 858 patients over a 4-week period. Those who met the screening criteria, together with a random sample of 60 patients who did not, were re-evaluated by a registrar in psychiatry who was unaware of the findings of his colleagues. Of the patients studied, 134 (15.6%) had major depression; 59 of these (44.0%) also had coexisting generalised anxiety disorder. The general practitioners had correctly diagnosed major depression in 32 patients (3.7%) before the study started. The screening questionnaire had a 42% chance of correctly identifying a patient with depression and a 97% chance of correctly identifying a patient who did not have major depression. Both practitioners were equally capable at identifying major depression. The study confirmed both the high prevalence of depression in a rural general practice and its low identification rate. It also showed the advantage of using a screening questionnaire to alert practitioners to the possibility of depression in their patients.

Sarcoid heart disease--results of follow-up investigations.

52 patients thought to have sarcoid heart involvement have been followed up. By administration of a standardized glucocorticoid therapy we demonstrated improvement of patients' symptoms, ECG disturbances, thallium scan defects of left heart muscle and there was 60-70% regression of pulmonary sarcoidosis. There was a low death rate. We conclude that our diagnostic measures are reliable, and that glucocorticoid therapy is efficacious in the early stages of the disease.

[Quantifying aortic valve insufficiency using color Doppler echocardiography]. / Quantifizierung von Aortenklappeninsuffizienzen mittels Farb-Doppler-Echokardiographie.

UNLABELLED: 51 consecutive patients with the clinical signs of aortic valve incompetence (AI) were evaluated by color-coded Doppler flow mapping (CDF) before angiography (AG). Quantitation of the severity of AI was performed by measurement of length and width of the extension of regurgitant jet (grade I-IV). After AG results both -AG and CDF- were compared. In 36 patients the results of both methods concurred exactly by use length in CDF. With CDF, the regurgitation was overestimated in 7 cases by one grade and underestimated in 8 patients also by one grade. Width of regurgitant jet relative to size of outflow space is a useful parameter to distinguish between mild and severe A1 (limit 0.50). CONCLUSION: CDF is a suitable method for semiquantitative assessment of AI. In presence of unequivocal CDF signs and in consideration of clinical and other patients findings AG will be dispensable before aortic valve replacement.

[The value of endomyocardial biopsy in verifying the diagnosis of sarcoidosis of the heart]. / Die Wertigkeit der Endomyokardbiopsie bei der Sicherung der Diagnose Herzsarkoidose.

The evaluation of the results of myocardial biopsy specimens of 24 patients highly suspected of having myocardial sarcoidosis revealed a sarcoid granuloma only in one case. In tapering frequency (60-33%) there has been myocardial scarring, generalized fibrosis, pathological count of mononuclear cells, nuclear hypertrophy, and perivascular fibrosis which all yield unspecific results, but because of lack of another cause are related to sarcoidosis. The specimens of 8 patients have been normal. In contrast to communications in the literature, we cannot recommend endomyocardial biopsy as a routine method to establish heart sarcoidosis, but as a method to exclude other myocardial processes.

[Comparative cinematographic, endoscopic and functional studies of the preoperative estimation of the severity of tracheal stenoses]. / Vergleichende kinematographische, endoskopische und funktionsanalytische Untersuchungen zur präoperativen Beurteilung des Schweregrades von Trachealstenosen.

Structural tracheal stenoses have different functional effects according to degree, localization and extent of the stenosis. Further modifications are due to malacic components within the range of the stenosis or tracheal segments abutting on the stenosis. Nineteen patients with mainly cervical tracheal stenoses (12 patients) were investigated in order to examine if a functional X-ray-diagnostic procedure (X-ray-cinetracheobronchography--CTBG--of the central airways in several beam-directions during forced breathing, cough and Valsalva-maneuver after contrasting of the trachea and main-bronchi with powdered tantalum) yields an increase of findings in comparison with a static roentgenologic procedure (chest films p. a. and frontal; tomography) and an endoscopic examination. The judgement of the stenosis is made by measurement of the length and of the diameter compared with the normal trachea. Malacic components reveal themselves by changes of the stenosis-configuration during Valsalva-maneuver, forced breathing and strong coughing. In 11 of 19 patients there was evidence of a malacic stenosis-component and in 5 patients there was a mural weakness of abutting segments. In comparison with the endoscopic examination we found in 8 of 15 patients a diagnostic improvement by demonstration of unfixed stenotic compartments. Besides information about stenotic degree, configuration, localization and length, a CTBG offers the possibility of localizing and grading malacic stenotic components or of adjacent segments--provided that films are made in at least two planes. The application of CTBG in patients with tracheal stenosis is useful if there are signs of tracheomalacia or if the localization and the extent of the stenosis require a difficult reconstructive surgical intervention or if discrepancies between clinical aspect and stenosis-degree make it advisable to extend the field of diagnostic procedures.

[Comparative cinematographic, endoscopic and functional analytic studies of the pre- and postoperative evaluation of the severity of the tracheobronchial collapse syndrome]. / Vergleichende kinematographische, endoskopische und funktionsanalytische Untersuchungen in der prä- und postoperativen Beurteilung des Schweregrades von tracheobronchialen Kollapssyndromen.

Sixty eight adults of both sexes (33 patients with clinically and endoscopically verified tracheobronchial collapse; 35 persons without disease of the central airways) underwent continuous cinetracheographic studies of the wall-movements of the central airways during various respiratory maneuvers. The insufflation of powdered tantalum for a better outlining of the contours of the central airways was preferably done in local anaesthesia via an orotracheally inserted catheter. Studies of wall-movement were made in recumbent position during forced breathing and violent coughing in various obliquities using a 35 mm-camera. The percentage of diameter-shortening during expiration (forced breathing; violent coughing) in relation to the inspiratory diameter during the same breathing-maneuver was measured in 4 or 3 projections respectively at 5 localities (cervical trachea; thoracic outlet; thoracic trachea 1 cm above the bifurcation; right and left main bronchus, 1 cm distant from bifurcation). Out of maximally 17 single numerical values per examination the highest single value was selected as the so-called "maximal relative diameter-shortening" - independent of locality and projection. In healthy persons the mean value amounts to 22.4 +/- 15.44% (means +/- SD) during forced breathing and to 75.5 +/- 11.72% during violent coughing. Patients with a tracheobronchial collapse differ from healthy persons, the former having a value of 100% during violent coughing. This is equivalent to a brief contact of the membranous part to the ventral circumference of the trachea (total cough-collapse) at least at one locality in one projection. Out of a number of 28 patients 17 cases (group H) revealed a normal "maximal relative diameter-shortening" of 29.7 +/- 21.57% during forced breathing. In addition to the total cough-collapse 11 patients (group F) exhibited an increased prolapse-tendency of the membranous part during forced breathing, too; the mean value of the "maximal relative diameter-shortening" amounted to 80.5 +/- 16.15%. Pathological shortening-values are mainly measured at the intrathoracic trachea in the lateral and both oblique projections. The cinetracheobronchographic examination should be used in patients with endoscopic signs of a tracheobronchial collapse-syndrome if an operative procedure with tautening is taken into consideration. In the case of mere clinical suspicion of the presence of a collapse-syndrome the assessment of the wall-motility is non-invasively possible by means of cinetracheography without a contrast-agent.(ABSTRACT TRUNCATED AT 400 WORDS)

[Diagnostic value of lipids and apolipoproteins for assessment of atherogenic risk]. / Zur diagnostischen Wertigkeit von Lipiden und Apolipoproteinen für die Beschreibung des atherogenen Risikos.

In 242 coronarographed male patients (51.7 +/- 7.6 years) with 0-, 1-, 2- or 3-vessel diseases as well as a clinically healthy control group (n = 68, 50.6 +/- 8.5 years) the lipoprotein pattern was investigated: total-, LDL-, HDL-, HDL2-, HDL3-, beta-, pre-beta-alpha-cholesterol, triglycerides, apolipoproteins (Apo) A-I, A-II, B, (A-I)HDL, Lp(a). With regard to the separation of patients with diseases of the coronary vessels and healthy persons out of the individual parameters Apo A-I (turbidimetrically), HDL3 and HDL cholesterol had the greatest significance (maximal diagnostic efficiency: 0.81, 0.76, 0.72). For the assessment of the severity of the change of the coronary vessels the quotient total/HDL cholesterol was most suitable (efficiency: 0.67). Differences in the diagnostic significance were established in the determination of a parameter by means of different methods. The intake of beta-receptor blockers increased the concentration of the triglycerides and pre-beta-cholesterol.

[Lipids and apolipoproteins in relation to the degree of coronary sclerosis]. / Lipide und Apolipoproteine in Abhängigkeit vom Grad der Koronarsklerose.

86 male patients with 0-, 1-, 2- or 3 vascular disease who underwent coronary angiography as well as a control group were examined with regard to their lipoprotein constellation: total (TC-), LDL-, HDL-, beta- and alpha-cholesterol (C); triglycerides; apolipoproteins A, AI and B. Significant differences between the mean values of the control group and the patients with coronary disease were found for the groups with 2- and 3-vascular disease for the following parameters: TC, HDLC, TC/HDLC, LDLC/HDLC, alpha-C, TC/alpha-C, beta-C, alpha-C. The quotients TC/HDLC and TC/alpha-C most closely correlate with the degree of the coronary sclerosis. In the apolipoproteins A, B and the index Apo B/A the patients with coronary disease of the groups 0-3 possess equally lowered or increased serum levels and number values, respectively, in comparison to the control group. The apolipoproteins do not show any relationship to the degree of severity of the coronary sclerosis. By means of the parameters combination (Apo A + TC/alpha-C) with a diagnostic sensitiveness of 0.83 and a specificity of 0.87 a coordination coronary disease--healthy could be performed. The classification according to risks should then be performed by means of a cholesterol quotient (TC/alpha-C or TC/HDLC).

[Behavior of pressure and flow parameters of pulmonary circulation in bronchologic studies in general anesthesia using 2 injectable anesthetics]. / Das Verhalten von Druck- und Flussparametern im kleinen Kreislauf während bronchologischer Untersuchungen in Allgemeinnarkose bei Verwendung zwei verschiedener Injektionsnarkosemittel.

Flow- and pressure-parameters of the pulmonary circulation were measured in the course of bronchologic investigations under general anaesthesia using as narcotics in group I (n = 14) Hexobarbital, in group II (n = 10) Propanidid (Sombrevin). The increase of mean pulmonary artery and mean PCW-pressure in group II is significantly higher than in group I. This seems to be caused by a more reduced myocardial function due to Sombrevin. Heart rate and pulmonary vascular resistance increase in both groups uniformly. The pO2 is markedly reduced up to 4 hours after the investigation accompanied by an increase of pCO2.

[Incidence and clinical symptomatology of coronary heart disease in acquired valvular defects]. / Häufigkeit und klinische Symptomatik der koronaren Herzkrankheit bei erworbenen Herzklappenfehlern.

220 consecutive patients with acquired valvular defects were checked within the preoperative examination by means of heart catheter with regard to significant coronary stenoses. In these cases a relative frequency of typical and atypical angina pectoris troubles of 0.136 and 0.459, respectively, was the result. In contrast to this significant coronary stenoses could relatively infrequently made evident angiographically: 6/220 (= 0.027). In patients with valvular defects angina pectoris cannot be used as the leading symptom of an additionally existing coronary heart disease on account of bad sensitiveness.

[Thallium myocardial scintigraphy, hemodynamics and left ventricular wall kinetics in patients with suspected myocardial sarcoidosis]. / Thallium-Myokardszintigraphie, Hämodynamik und Linkskammerwandkinetik bei Patienten mit Verdacht auf Myokardsarkoidose.

The cardiological examination of 22 patients (pts) with suspected heart sarcoidosis (histologically established lung sarcoidosis, heart rhythm disturbances, cardiomegaly) has revealed thallium scan defects in 20 pts at rest and during exercise. In 19 pts we found pathologic left heart wall motions established by laevocardiography by applying the half axis method. The number of pathologic half axis shortenings correlated with ejection fraction, but not with left ventricular enddiastolic pressure and left ventricular enddiastolic volume index. IHD could not be found in coronarography in any case. Myocardial biopsy did not show myocarditis. Cardiomyopathies, other specific heart muscle diseases or rheumatic myocarditis could not be excluded as causes of the results mentioned above. The follow-up examinations of the patients will give more detailed information on the etiology of the pathologic cardiac findings.

[Chronic fibrosing alveolitis and lung fibrosis--frequency and distribution of radiographic symptoms]. / Chronisch fibrosierende Alveolitis und Lungenfibrose--Häufigkeit und Verteilung radiographischer Symptome.

In 95 patients with histologically or immunologically diagnosed interstitial lung diseases (44 pts. with chronic fibrosing alveolitis, 6 with allergic alveolitis, 11 with chronic diffuse fibrosis, 34 pts. with localized fibrosis) the radiographic symptoms of interstitial and accompanying alveolar and pleural alterations are estimated by a semiquantitative score, with regard to location and intensity. No diagnosis-relevant differences are found. Nodular densities are seen on the radiographs of all patients. In most of the cases (82%) they are accompanied by reticular shadows. Irreversible "honeycomb"-cysts are found in 27% of patients, alveolar and pleural reactions in 22% and 28% respectively. An impressive shrinkage is found in 16%.