Determination of free apolipoprotein(a) in serum by immunoassay and its significance for risk assessment in patients with coronary artery disease.

This paper describes a new enzyme-linked ligand sorbent assay (ELLSA) to quantify free apolipoprotein(a) (apo(a)). The new test immobilizes free apo(a) utilizing a specific peptide that carries the amino acid sequence of a non-covalent apo(a) binding site on apoB3375-3405 (ligand-peptide). The ligand-peptide coupled to Sepharose was used in affinity chromatography to separate free apo(a) from whole serum. Isolated free apo(a) consisted of full length apo(a) and smaller apo(a). Additionally, free apo(a) levels determined by ELLSA as well as by electroimmunodiffusion correlated moderately well. Significantly increased serum concentrations of free apo(a) were found in coronary artery disease. The mean value of free apo(a) was three times higher in patients than in controls while the lipoprotein(a) (Lpla)) concentration was doubled. Utilizing receiver operating characteristic diagrams, it was shown that the free apo(a)-ELLSA had a better diagnostic test performance in atherosclerotic risk assessment than the Lp(a)-test: specificity free apo(a)-ELLSA 0.77, Lp(a)-test 0.81 [with (a:a)-enzyme immunoassay (EIA)] to 0.83 [with (a:B)-EIA]; sensitivity free apo(a)-ELLSA 0.57, Lp(a)-test 0.36 to 0.40. In conclusion, the new free apo(a)-ELLSA allows for the specific quantification of free apo(a). This provides an interesting indicator for atherosclerotic risk assessment.

[Results of the complex evaluation of scintigraphy of the intracardiac space in patients with coronary disease]. / Ergebnisse der komplexen Auswertung der Herzbinnenraumszintigraphie bei Patienten mit koronarer Herzkrankheit.

With the help of the comparison of the results of 95 patients with coronary heart disease who were examined by means of the intracardiac space scintigraphy for the purpose of the subjective subdivision according to the NYHA-classification there is no close correlation between the nuclear-medically obtained functional sizes (EF, maximum ejection and filling rate) and the clinical degree of severity of the disease. Only at the degree of severity 3 and 4 a discrimination is possible. In 64 patients laevocardiographic and coronarographic, respectively, findings were present. The trend to the deterioration of the functional parameters and to the increase of the nuclear-medically recognizable disturbances of the kinetics, respectively, with a more intensive expression of the vascular stenoses is distinctly readable. From the examination in rest in the individual case no statement is possible concerning the findings which are to be expected in the invasive diagnostics. When there are discrepancies between the result of the intracardiac space scintigraphy and the clinical and electrocardiographic preliminary investigations in many cases a clarification becomes possible by the immediately following study under submaximal exercise. On the assumption of a close cooperation with experienced cardiologists the relatively little expensive intracardiac space scintigraphy which does not stress the patient provides an essential evidence for the prognosis and estimation of the functional capacity of the patients with coronary heart disease.

[Rare anomalies of the architecture of the bronchial tree]. / Seltene Anomalien der Architektur des Bronchialbaums.

Six cases of rare bronchial anomalies are presented (3 complete right-sided hypo-arterial bronchial distributions, 1 partial right-sided hypo-arterial bronchial supply of the upper lobe, 2 cases of atresia of the left apico-posterior bronchus). Emphasis is placed on the bronchographic elucidation of the changed bronchial segmental topic if additive or subtractive bronchial anomalies are found endoscopically especially with regard to preoperative aspects.

[Causes and x-ray symptomatic types of isolated bronchoceles]. / Ursachen und röntgenologische Erscheinungsformen isolierter Bronchozelen.

A survey is given of the roentgenographic features of isolated bronchoceles (25 cases: 9 men; 16 women). If some roentgenomorphological peculiarities are taken into consideration, identification is possible via plain radiography and topic-related two-dimensional tomography. With regard to preoperative aspects the perception of this disease is very important because the extent of a surgical procedure may not infrequently be limited to a segmental resection.

[Myocardial biopsy in suspected myocardial sarcoidosis]. / Myokardbiopsie beim Verdacht auf Myokardsarkoidose.

24 patients with pulmonary sarcoidosis stage I or II, who above all on account of changes of the ECG roused the suspicion of the presence of a sarcoidosis of the myocardium, finally underwent an invasive examination with laevocardiography, coronarography and biopsy of the endomyocardium. While the unaimed taking of tissue from the left ventricle did not result light-microscopically in a reference to granulomas or other inflammatory changes, the biopsy in a female patient, on purpose taken from a hypokinetic area of the left ventricle, showed epitheloid-cellular granulomas with giant-cells. Evaluating these results and reports in literatur, we came to the conclusion that findings typical for sarcoidosis are promising success only when taken from cardiographically suspicious areas of the myocardium.

Film-screen digital radiography.

The anticipated benefits of digitized projection radiographic data to medical imaging has generated much interest and activity. Numerous methods for capturing the radiographic image data prior to digitization are being evaluated. In this paper the excellent performance of the film-screen system as a receptor for projection radiographic data is discussed. An experimental system for obtaining high quality digital radiographic data by laser scanning radiographic films is described. This system is being used to evaluate the clinical utility of various digital image processing algorithms. Future plans include an investigation of quantitative analysis of projection radiographic data. Digital data obtained by film scanning can be used with digital image archiving and communications systems.

[Diagnostic value of bronchographic study for the detection of bronchial cancer, originating from bronchi of the 3d to 5th order]. / Der diagnostische Wert der bronchographischen Untersuchung für die Erkennung von Bronchialkarzinomen, ausgehend von den Bronchien 3. bis 5. Ordnung.

Lung cancers originating from the bronchi of the fourth and fifth generation (the "intermediate" type according to the definition by Walter and Pryce) and a subdivision of "central" tumours originating from the bronchi of the third generation (segmental bronchi) form a clinical entity the common characteristics of which consists in the fact of being placed in the boundary-zone of endoscopic-macroscopic visibility. The definitive diagnostic confirmation of these tumours often requires the application of the bronchologic and radiographic equipment as a whole. Between 1/70 and 12/82 86 bronchographies were performed in 82 patients suffering from a histologically verified bronchogenic carcinoma of the location mentioned above. Eighty one bronchographies could be submitted to a retrospective analysis. Unequivocal signs of tumour were found in 52 cases (64%) and suspicious signs in 24 cases (30%). Five bronchograms failed to demonstrate tumour-suspicious alterations. The results indicate that up to now the bronchography has an unquestionable though strictly limited field of indication in the diagnostics of selected "topically related" lung cancers.

[Compact costal islands in the differential diagnosis of small coin lesions in chest x-rays]. / Kostale Kompaktainseln in der Differentialdiagnostik kleiner Rundherde auf Thoraxübersichtsaufnahmen.

The radiological characteristics of 13 costal bone-islands in 12 patients (one patient with bilateral bicostal involvement) are described. The bone-island manifests itself as a small dense coin-lesion following fluoroscopically the respirative movements of the host-rib. X-ray-films and a fluoroscopy confined to the interesting area allow an exact diagnosis. Retrospective analyses of X-ray-films generally reveal an unchanged existence over a long time period. No therapeutic consequences are necessary.

[Sound spectrographic studies in the diagnosis of dysfunctions of mechanical heart valve prostheses (Björk-Shiley prostheses)]. / Schallspektrographische Untersuchungen zur Diagnose von Dysfunktionen mechanischer Herzklappenprothesen (Björk-Shiley-Prothesen).

A newly developed real-time sound spectroanalyzer was found to be capable of diagnosing malfunction of prosthetic heart valves (Björk-Shiley prostheses). Sound spectroanalysis was carried out 430 times on 257 patients with a prosthetic heart valve. The valvular click of prosthetic heart valves shows a typical sound spectroanalysis pattern in real time, with a high-frequency peak which diminishes beyond 25 kHz. Thrombosis of the prosthetic heart valve causes loss of the valvular click and reduction in the intensity of the high-frequency components, as shown in 4 patients. Thus the sound spectroanalysis appears to be a noninvasive technique which may allow early diagnosis of a thrombosed prosthetic heart valve. We believe this method to be superior to phonocardiography and echocardiography.

[Aneurysm of the membranous septum of the heart. A diagnostic and therapeutic challenge]. / Aneurysmen des Septum membranaceum des Herzens. Eine diagnostische und therapeutische Aufforderung.

Aneurysms of the membranous portion of the interventricular septum are considered to be rare cardiac lesions. Left ventricular angiography appears to be the only method to establish the specific intravital diagnosis. Rupture, infection, thromboembolism, and obstruction of the right ventricular outflow tract have been documented for complications of this malformation. Early resection should be performed before complications occur. 4 patients underwent successful open heart correction of the aneurysm. In another patient a bundle branch block was present and a pacemaker was implanted.

[Primary benign intramural intracavitary cardiac tumors--clinical, diagnostic and therapeutic aspects]. / Primäre benigne intramural intrakavitäre Tumoren des Herzens--klinische, diagnostische und therapeutische Gesichtspunkte.

10 cases of benign primary tumours of the heart (5 myxomas of the left atrium, 2 myxomas of the right atrium, 1 right-ventricular endothelioma of the endocardium, 1 left-ventricular pseudorhabdomyoma, 1 tumour of the interventricular septum) are described. The diagnostically decisive method was in 5 cases the heart catheterization with angiocardiography, furthermore in one case each the roentgenogram of the thorax, the echocardiography, the histology of embolic material, the operation as well as the autopsy. The echocardiography was available for 4 patients; in one case it was diagnostically decisive, delivered important additional informations in 2 patients and failed in one patient. With increasing propagation of the echocardiography, which in the opinion of the authors at least in all cases should be used before a planned invasive cardiological diagnosis, is to be reckoned with an improvement of the diagnosis of tumours of the heart and with an increase of the chances of a causal, namely the timely cardiosurgical therapy.

[Prophylaxis of pulmonary embolism by inferior vena cava filter (author's transl)]. / Die Prophylaxe der Lungenembolie mit dem Kava-Schirm-Filter. Beitrag zur Studie "Kavasieb".

30 patients underwent implantation of the Mobin-Uppin filter for recurrent life threatening pulmonary embolism. 20 patients could be followed by phlebography. In 11 cases obstruction of the inferior vena cava was observed. Due to the collaterals having developed in the intermediate time there were no significant clinical symptoms below the obstruction.

[Studies of X-ray morphology of the heart contour in ischemic heart disease as seen in dorsoventral X-ray photography of the thorax in the basis of coronarographic findings (author's transl)]. / Untersuchungen zur Rötgenmorphologie der Herzkontur im dorsoventralen Thoraxschirmbild bei der ischämischen Herzkrankheit auf der Grundlage koronarographischer Befunde.

Cardiovascular diseases hold a place of considerable importance in national health schemes and various screening methods have been devised to determine and to control such diseases. One of the methods is based on the use of thorax photofluorographs obtained from regular nation-wide X-ray examinations. The ischemic heart disease is a significant group among cardiovascular diseases and it appears that dorsoventral photofluorography is an insufficient means for its recognition. For 250 subjects examined by intracardial methods for suspected ischemic heart disease, a retrospective study of dorsoventral thorax photofluorographs was performed along the lines of the classification by Richter and Böck. The results show that in about 75 percent of the cases of ischemic heart disease associated with serious lesions of the coronary vessels, no signs of changes in the heart contour were seen in photofluorographs of the thorax. It is concluded that the evaluation of chestfilm is an inadequate approach as far as the ischemic heart disease group is concerned within photofluorographic screening programmes for cardiovascular diseases.