[Acute pulmonary embolism: still a diagnostic and therapeutic challenge?] / Akute Lungenembolie: immer noch eine diagnostische und therapeutische Herausforderung?

BACKGROUND: Acute pulmonary embolism (PE) is a cardiovascular emergency with high mortality in which a rapid diagnosis and the early initiation of therapy is vital. In the present study patients with acute PE hospitalized at the Clinic Lippe in Detmold were characterized and their prognosis examined. METHODS: In our department at the hospital Detmold, all patients with acute PE admitted in 2012 and 2013 were documented with respect to the severity of PE, predisposing risk factors and diagnostic and therapeutic steps. RESULTS: A total of 170 patients with acute PE were documented of which 80 patients (47 %) had low, 70 patients an intermediate (41 %) and 20 a high risk (12 %). The main diagnostic tool was thoracic computed tomography (82 %). All patients initially received unfractionated or low-molecular weight heparin; systemic intravenous fibrinolysis was carried out in 3 % of patients (intermediate risk n = 1, high risk n = 4). Nineteen percent (n = 13) of the patients at intermediate and 30 % (n = 6) of patients at high risk received local intrapulmonary fibrinolysis. Overall, the mortality rate in hospital was 10 % (low risk 2.5 %; intermediate risk 7 %; high risk 58 %). All 5 patients who received systemic emergency lysis died. One (5.3 %) of the 19 patients at intermediate risk, undergoing local intrapulmonary fibrinolysis, died. CONCLUSION: In acute PE a rapid diagnosis and the initiation of an adequate therapy remains a big challenge. Further studies are required to evaluate if aggressive treatment options might reduce mortality especially among patients at intermediate or high risk.

[Treatment of coronary three-vessel disease in patients above 75 years]. / Therapie der koronaren Dreigefäßerkrankung bei Patienten über 75 Jahren.

BACKGROUND: Chronic ischemic heart disease take the first place in cause of death in Germany. The proportion of patients aged 75 years or older amounts more than 80 %. Due to their growing part of population the medical care of older patients becomes increasingly important. In this investigation patients aged ≥ 75 years with coronary three-vessel disease were characterized and various treatment strategies were compared. PATIENTS AND METHODS: This analysis was retrospective. The data of patients aged 75 years or older with three-vessel disease diagnosed by coronary angiography at the Klinikum Lippe Detmold between 2005 and 2007 were collected. Depending on the received therapy they were parted in three groups: optimal drug therapy (OMT), interventional - (PCI) and surgical revascularization (CABG). Patient characteristics as well as survival- and MACCE-rates during follow up were ascertained. Subgroup analyzes were performed for acute coronary syndrom (ACS) and stable coronary artery disease( CAD). RESULTS: The data of 434 patients with an average age of 79 years were documented. 139 (32.0 %) were assigned to the OMT- 189 (43.6 %) to the PCI- and 106 (24.4 %) to the CABG-group. Overall there was no significant difference between the three groups regarding mortality. In the subgroup of patients wit ACS (n = 180) mortality significantly increased in the OMT-group compared to the two invasive therapies (PCI (p = 0.029), CABG (p = 0.045)). The subgroup of patients with stable CAD showed no significant differences in mortality between the three types of therapy. CONCLUSIONS: Older patients benefit from an interventional or surgical revascularization in the context of ACS. In contrast, in elderly with stable CAD optimal medical therapy provides a reasonable alternative to invasive therapy without increase in mortality.

Light-emitting diode based on mask- and catalyst-free grown N-polar GaN nanorods.

We report on the fabrication of a light-emitting diode based on GaN nanorods containing InGaN quantum wells. The unique system consists of tilted N-polar nanorods of high crystalline quality. Photoluminescence, electroluminescence, and spatially resolved cathodoluminescence investigations consistently show quantum well emission around 2.6 eV. Scanning transmission electron microscopy and energy-dispersive x-ray spectroscopy measurements reveal a truncated shape of the quantum wells with In contents of (15 ± 5)%.

A structural investigation of highly ordered catalyst- and mask-free GaN nanorods.

GaN nanorods were grown on r-plane sapphire substrates by a two-step approach. Nucleation sites for the nanorods were provided by the formation of AlN islands during nitridation in a metal organic vapor phase system. These islands are a-plane oriented as expected for nitride growth on r-plane sapphire. The nanorods themselves were grown by plasma assisted molecular beam epitaxy. The nanorods show an inclination towards the surface normal of 28.3° and are highly ordered. Studies with high resolution x-ray diffraction polar plots reveal the epitaxial relationship between the substrate and nanorods as a c-direction growth on inclined m-plane facets of the nitridated islands. The determined lattice constants show nanorods which are strain free. The growth direction of the nanorods has been confirmed in a transmission electron microscope by convergent beam electron diffraction patterns to be in the N-polar [Formula: see text] direction.

Highly ordered catalyst-free and mask-free GaN nanorods on r-plane sapphire.

Self-organized and highly ordered GaN nanorods were grown without catalyst on r-plane sapphire using a combination of molecular beam epitaxy and metal-organic vapor-phase epitaxy. AlN nucleation centers for the nanorods were prepared by nitridation of the sapphire in a metal-organic vapor-phase epitaxy reactor, while the nanorods were grown by molecular beam epitaxy. A coalesced two-dimensional GaN layer was observed between the nanorods. The nanorods are inclined by 62 degrees towards the [Formula: see text]-directions of the a-plane GaN layer. The high degree of ordering and the structural perfection were confirmed by micro-photoluminescence measurements.

Scaling-index method as an image processing tool in scanning-probe microscopy.

The scaling-index method (SIM) is a novel tool for image processing in scanning-probe microscopy. Originating from the theory of complex systems, the SIM can be used in order to extract structural information from arbitrary data sets. This method can readily be applied to the analysis of digital atomic-force microscopy (AFM) images. Especially for biomedical diagnostics, where genetic material is investigated by various microscopic methods, a reliable image segmentation based on the SIM algorithm is helpful. As a first application, AFM-images of GTG-banded human metaphase chromosomes (with G bands obtained by Trypsin using Giemsa) are compared with micrographs from conventional light microscopy by means of a scaling-index analysis. While the grey-level distributions of the optical and the AFM-images are largely different from each other, the scaling-index images are remarkably similar. Using this method, a fingerprint of an image can be produced which helps in the classification and interpretation of the measured data.