Sympathectomy aggravates subchondral bone changes during osteoarthritis progression in mice without affecting cartilage degeneration or synovial inflammation.

OBJECTIVE: Osteoarthritis (OA) pathogenesis involves the interaction of articular cartilage with surrounding tissues, which are innervated by tyrosine hydroxylase-positive (TH+) sympathetic nerve fibers suggesting a role of the sympathetic nervous system (SNS) during OA progression. We analyzed the effects of sympathectomy (Syx) in a murine OA model. METHODS: Peripheral Syx was generated by 6-hydroxydopamine (6-OHDA) injections in male C57BL/6 mice. OA was induced in wild-type (WT) and Syx mice by destabilization of the medial meniscus (DMM). TH+ fibers and splenic NE were analyzed to evaluate Syx efficiency. OA progression was examined by OARSI and synovitis scores and micro-CT. Expression of TH, α2A- and ß2-adrenergic receptors (AR), and activity of osteoblasts (ALP) and osteoclasts (TRAP) was investigated by stainings. RESULTS: Syx resulted in synovial TH+ fiber elimination and splenic NE decrease. Cartilage degradation and synovitis after DMM were comparably progressive in both WT and Syx mice. Calcified cartilage (CC) and subchondral bone plate (SCBP) thickness and bone volume fraction (BV/TV) increased in Syx mice due to increased ALP and decreased TRAP activities compared to WT 8 weeks after DMMWT and Syx mice developed osteophytes and meniscal ossicles without any differences between the groups. AR numbers decreased in cartilage but increased in synovium and osteophyte regions after DMM in both WT and Syx mice. CONCLUSION: Peripheral dampening of SNS activity aggravated OA-specific cartilage calcification and subchondral bone thickening but did not influence cartilage degradation and synovitis. Therefore, SNS might be an attractive target for the development of novel therapeutic strategies for pathologies of the subchondral bone.

Plasma and soft tissue pharmacokinetics of ceftolozane/tazobactam in healthy volunteers after single and multiple intravenous infusion: a microdialysis study.

OBJECTIVES: To investigate ceftolozane/tazobactam pharmacokinetics (PK) in plasma and interstitial space fluid (ISF) of muscle and subcutaneous tissue and establish a population PK model. METHODS: Eight healthy volunteers received four IV doses of 1000/500 mg ceftolozane/tazobactam q8h in a prospective, open-labelled PK study. ISF concentration-time profiles were determined via in vivo microdialysis up to 8 h post-dose and efficacy of unbound ceftolozane and tazobactam was estimated using the time above MIC (%ƒT>MIC) and time above threshold concentration (%T>CT), respectively. A population PK model was established by merging derived plasma and soft tissue PK data. RESULTS: Ceftolozane reached %ƒT>MIC values of 100% in plasma, muscle and subcutaneous ISF for Enterobacteriaceae and 87%, 89% and 87%, respectively, for Pseudomonas aeruginosa. Tazobactam %T>CT was 21%, 22% and 21% in plasma, muscle and subcutaneous ISF, respectively. Plasma protein binding was 6.3% for ceftolozane and 8.0% for tazobactam. Multiple-dose ceftolozane AUC0-8 ISF/plasma ratios were 0.92 ±â€Š0.17 in muscle and 0.88 ±â€Š0.18 in subcutis, and tazobactam ratios were 0.89 ±â€Š0.25 in muscle and 0.87 ±â€Š0.21 in subcutis, suggesting substantial soft tissue penetration. CONCLUSIONS: Tazobactam %T>CT values were distinctly below proposed target values, indicating that tazobactam might be underdosed in the investigated drug combination. However, ISF/unbound plasma ratios of ceftolozane and tazobactam support their use in soft tissue infections. A plasma and soft tissue PK model adds important information on the PK profile of ceftolozane/tazobactam. Further investigations in patients suffering from wound infections are needed to confirm these findings.

Mantle redox state drives outgassing chemistry and atmospheric composition of rocky planets.

Volcanic degassing of planetary interiors has important implications for their corresponding atmospheres. The oxidation state of rocky interiors affects the volatile partitioning during mantle melting and subsequent volatile speciation near the surface. Here we show that the mantle redox state is central to the chemical composition of atmospheres while factors such as planetary mass, thermal state, and age mainly affect the degassing rate. We further demonstrate that mantle oxygen fugacity has an effect on atmospheric thickness and that volcanic degassing is most efficient for planets between 2 and 4 Earth masses. We show that outgassing of reduced systems is dominated by strongly reduced gases such as [Formula: see text], with only smaller fractions of moderately reduced/oxidised gases ([Formula: see text], [Formula: see text]). Overall, a reducing scenario leads to a lower atmospheric pressure at the surface and to a larger atmospheric thickness compared to an oxidised system. Atmosphere predictions based on interior redox scenarios can be compared to observations of atmospheres of rocky exoplanets, potentially broadening our knowledge on the diversity of exoplanetary redox states.

Risk of target non-attainment in obese compared to non-obese patients in calculated linezolid therapy.

OBJECTIVES: The aim was to characterize linezolid population pharmacokinetics in plasma and interstitial space fluid of subcutaneous adipose tissue (target site) of obese compared with non-obese patients and to determine dosing regimens enabling adequate therapy using Monte Carlo simulations. METHODS: In this prospective, parallel group, open-label, controlled, single-centre trial, 30 surgery patients (15 obese, 15 non-obese) received 600 mg of intravenous linezolid. A population pharmacokinetic analysis characterizing plasma and microdialysis-derived target site pharmacokinetics was followed by Monte Carlo simulations using twice/thrice daily 600-1200 mg short-term and extended infusions of linezolid. Adequacy of therapy was assessed by the probability of pharmacokinetic/pharmacodynamic target attainment for time and exposure-related indices. RESULTS: In the model, lean body weight and obesity status largely explained between-patient variability in linezolid PK parameters (12.0-44.9%). Both factors caused lower area under the concentration-time curve in typical obese patients in plasma (-20.4%, 95% CI -22.0% to -15.9%) and at target-site (-37.7%, 95% CI -47.1% to -24.2%) compared with non-obese patients. Probability of target attainment showed improvement with increasing linezolid doses. Depending on lean body weight, adequate therapy was partially attained for 900- and 1200-mg linezolid doses and minimum inhibitory concentrations (MICs) ≤2 mg/L (probability of target attainment 62.5-100%) but could not be reached for MIC = 4 mg/L (probability of target attainment ≤82.3%). Additionally, lower linezolid distribution into the target site in obese patients as described above might compromise the plasma-based probability of target attainment analysis. DISCUSSION: This analysis revealed risks of linezolid underdosing in empirical antibiotic therapy of most resistant bacteria for obese and non-obese patients. Doubling the standard dose is associated with adequate probability of target attainment throughout most body masses for MIC ≤2 mg/L. Further clinical studies with adjusted dosing regimens in for example intensive care patients are needed.

Measurement of soft tissue drug concentrations in morbidly obese and non-obese patients - A prospective, parallel group, open-labeled, controlled, phase IV, single center clinical trial.

BACKGROUND: Pharmacokinetic (PK) and pharmacodynamic (PD) data on perioperative antibiotic prophylaxis or antibiotic therapy are rare in patients suffering from morbid obesity. Furthermore, dosing regimens should be based on PK/PD models that ensure effective antibiotic exposure not in plasma, but primarily at the site of infection, mostly in the interstitial fluid (ISF). The aim of this trial is to investigate whether current dosing regimens of various antibiotics lead to effective concentrations in the ISF of morbidly obese patients. METHODS: We designed a prospective, parallel group, open-labeled, controlled single center trial to investigate the plasma and tissue pharmacokinetics of the antibiotics linezolid, meropenem, tigecycline, piperacillin/tazobactam, fosfomcyine, cefazolin, metronidazole and as secondary aim the analgesics metamizole and acetaminophen. Inclusion criteria comprise body mass index ≥35 kg/m2 for obese or between 18.5 and 30 kg/m2 for non-obese patients scheduled for elective abdominal surgery. For PK analysis, blood and microdialysate samples of subcutaneous tissue were collected 0-8 h after study drug administration. The primary endpoint is to investigate a possible dependency of the area-under-the-curve (AUC0-8) in the interstitial fluid on body weight and obesity with population based pharmacokinetic analysis. DISCUSSION: Inadequate dosing regimes of antibiotics may be a relevant factor for morbidity and mortality of patients, as well as for the development of bacterial antibiotic resistance. The measurement of plasma and tissue concentrations will provide information necessary for PK/PD-modelling. These data about antibiotic PK/PDcharacteristics in soft tissue and their dependence on weight should help to develop weight-dependent models for calculation of patient's individual doses of different antibiotics. TRIAL REGISTRATION: EU clinical trials register (EudraCT-No. 2012-004383-22) and German Clinical trials Register (DRKS00004776).

Tigecycline in critically ill patients on continuous renal replacement therapy: a population pharmacokinetic study.

BACKGROUND: Tigecycline is a vital antibiotic treatment option for infections caused by multiresistant bacteria in the intensive care unit (ICU). Acute kidney injury (AKI) is a common complication in the ICU requiring continuous renal replacement therapy (CRRT), but pharmacokinetic data for tigecycline in patients receiving CRRT are lacking. METHODS: Eleven patients mainly with intra-abdominal infections receiving either continuous veno-venous hemodialysis (CVVHD, n = 8) or hemodiafiltration (CVVHDF, n = 3) were enrolled, and plasma as well as effluent samples were collected according to a rich sampling schedule. Total and free tigecycline was determined by ultrafiltration and high-performance liquid chromatography (HPLC)-UV. Population pharmacokinetic modeling using NONMEM® 7.4 was used to determine the pharmacokinetic parameters as well as the clearance of CVVHD and CVVHDF. Pharmacokinetic/pharmacodynamic target attainment analyses were performed to explore the potential need for dose adjustments of tigecycline in CRRT. RESULTS: A two-compartment population pharmacokinetic (PK) model was suitable to simultaneously describe the plasma PK and effluent measurements of tigecycline. Tigecycline dialysability was high, as indicated by the high mean saturation coefficients of 0.79 and 0.90 for CVVHD and CVVHDF, respectively, and in range of the concentration-dependent unbound fraction of tigecycline (45-94%). However, the contribution of CRRT to tigecycline clearance (CL) was only moderate (CLCVVHD: 1.69 L/h, CLCVVHDF: 2.71 L/h) in comparison with CLbody (physiological part of the total clearance) of 18.3 L/h. Bilirubin was identified as a covariate on CLbody in our collective, reducing the observed interindividual variability on CLbody from 58.6% to 43.6%. The probability of target attainment under CRRT for abdominal infections was ≥ 0.88 for minimal inhibitory concentration (MIC) values ≤ 0.5 mg/L and similar to patients without AKI. CONCLUSIONS: Despite high dialysability, dialysis clearance displayed only a minor contribution to tigecycline elimination, being in the range of renal elimination in patients without AKI. No dose adjustment of tigecycline seems necessary in CRRT. TRIAL REGISTRATION: EudraCT, 2012-005617-39 . Registered on 7 August 2013.

[Well-being and psychosocial activities in nursing homes : Survey of residents]. / Befinden und psychosoziale Aktivitäten im Pflegeheim : Befragung von Bewohnern.

BACKGROUND: Assessment and self-assessment frequently differ, e. g. in psychosomatic disorders and complaints. At the same time the prevalence of corresponding disorders in old age is high. OBJECTIVE: This study investigated psychosocial factors from the perspective of nursing home residents and compared this self-assessment with data collected in other scientific studies with assessments by nursing home staff. The aim was to develop specific recommendations for the nursing home sector. MATERIAL AND METHODS: In this cross-sectional pilot study 256 nursing home residents (average age 81 ± 10.3 years, 69 % female, 31 % male) were questioned about their physical, psychological and social activities and well-being in semistructured anonymous interviews. Psychological screening tests were simultaneously implemented to assess symptoms of depression and dementia using the short form of the geriatric depression scale (GDS-K) and the mini mental status test (MMST). RESULTS: The results showed that 44.6 % of the residents had symptoms of depression and 76.1 % revealed signs of development of dementia. More than half assessed their physical health as good to very good. According to comparable studies nursing staff assessed persistent pain in 20.7 % of all nursing home residents while personal interviews with the residents showed that persistent pain (39.8 %) was almost twice as frequent. Life satisfaction showed a significant correlation with the following items from the self-assessment: participation in nursing home activities (r = 0.171, p = 0.008), mobility (r = -0.131; p = 0.045), emotional activity (r = 0.136, p = 0.038), subjectively experienced physical health (r = -0.420, p < 0.001) and persistent pain (r = -0.178, p = 0.006). Life satisfaction correlated highly significantly with symptoms of depression (r = -0.617, p < 0.001) and cognitive performance (r = 0.251, p = 0.001). CONCLUSION: The findings of this study encourage further research on the characteristic features of satisfied residents and (psycho)therapeutic support in order to promote factors for well-being and a positive quality of life in nursing homes.

[Allogeneic stem cell transplantation for acute myeloid leukemia and HIV infection--case 3/2012]. / Allogene Stammzelltransplantation bei Akuter Myeloischer Leukämie und HIV-Infektion--Fall 3/2012.

HISTORY AND ADMISSION FINDINGS: A 27-year-old male patient with a past medical history of HIV presented with acute myeloid leukemia for allogeneic hematopoietic stem cell transplantation (HSCT). Highly active anti-retroviral therapy suppressed the viral load below detection threshold. INVESTIGATIONS: There were no contraindications for allogeneic HSCT. TREATMENT AND COURSE: Myeloablative conditioning consisted of total body irradiation and cyclophosphamide. Anti-thymocyte globulin, tacrolimus and mycophenolate mofetil were used for immunosuppression. Combined anti-retroviral therapy (nucleoside and nucleotide analog reverse-transcriptase inhibitor, boostered protease inhibitor, maraviroc and raltegravir) was maintained for allogeneic HSCT and viral load remained below detection threshold. No graft-versus-host disease or serious infectious complications occurred. The patient showed good graft function with stable hematopoiesis. Localized Kaposi's sarcoma was diagnosed six months after allogeneic HSCT and treated successfully with surgical excision and reduction of immunosuppression. Almost one year after allogeneic HSCT, the CD4+ cell count is rising and viral load remains below detection threshold with combined anti-retroviral therapy. CONCLUSION: Allogeneic HSCT can be safely performed in HIV positive patients. Kaposi's sarcoma is a rare event after allogeneic HSCT and linked to strong immunosuppression.

[Prospective comparison of term small-for-gestational-age and appropriate-for-gestational-age neonates during the first month of life]. / Prospektiver Vergleich von reifen hypotrophen und eutrophen Neugeborenen während der ersten Lebensmonate.

Aim of the prospective study was to investigate perinatal parameters and outcome of term SGA neonates. 100 term neonates were enrolled into 2 groups: group 1: 50 SGA neonates with birth weight below tenth percentile, group 2: 50 appropriate-for-gestational-age neonates. Both groups were compared concerning parental anamnesis, perinatal parameters, postnatal adaptation and development during the first days of life. After discharge from the hospital all children were observed during the first 15 weeks. In all infants the gain of weight, length, head circumference and the amount and type of nutrition were recorded. It was observed that only 13% of the SGA neonates were small children of small parents. Most of the SGA neonates had a normal target high. We found a significantly increased number of mothers with disturbed uterine or placental perfusion in the SGA group as well as increased problems in postnatal adaptation. SGA children had a significantly faster increase of gaining weight and a higher amount of nutrition during the first 15 weeks of life. This could be an early sign of catch-up-growth in SGA neonates, which could be regard as a part of the complex risk for developing a metabolic syndrome in formerly SGA children.

Lumbocostovertebral syndrome with associated VACTERL anomalad: a neonatal case report.

We report the first clinical case of a term infant with findings suggestive of lumbocostovertebral syndrome and VACTERL association. Renal agenesis was suspected by prenatal ultrasound, and at birth clinical findings included a large abdominal wall hernia, imperforate anus, vestibular fistula, absent right rib, vertebral anomalies, tethered cord, syringomyelia, and two small sacral dimples.

Three-dimensional power Doppler sonography of the (sub)endometrium and angiogenic cytokine concentrations.

The aim of this study was to determine the correlation between three-dimensional power Doppler sonography (3D-PDS) of the (sub)endometrium and concentrations of angiogenic cytokines in patients attending an IVF programme. A total of 42 patients was included in a prospective, non-randomized clinical study. 3D-PDS of the (sub)endometrium was performed on the day of oocyte aspiration, with and without contrast agent. Quantitative assessment included the following 3D Doppler parameters: vascularization index, flow intensity, and vascularization flow index. On the same day, concentrations of oestradiol (serum only), vascular endothelial growth factor (VEGF), insulin-like growth factor (IGF) 1, IGF-binding protein 3 (IGFBP-3) and leptin were determined in the serum and in the follicular fluid. All 3D-PDS indices were significantly higher with contrast enhancement (P < 0.05). Follicular fluid concentrations of VEGF and IGFBP-3, as well as serum concentrations of leptin, showed significant P-values when correlated with (sub)endometrial Doppler indices. A weak linear dependency appeared between flow intensity and VEGF and leptin. Furthermore, weak dependencies were apparent between 3D Doppler parameters and high follicular fluid concentrations of VEGF and IGFBP-3. It is concluded that there is only little evidence for an association between (sub)endometrial Doppler indices as assessed by 3D-PDS and concentrations of angiogenic cytokines.

Oocyte zona birefringence intensity is associated with embryonic implantation potential in ICSI cycles.

A retrospective study recently showed that oocytes presenting with a high birefringence of the inner zona layer were more often associated with conception cycles. To further investigate these findings, a prospective study was conducted between September 2005 and September 2006 including intracytoplasmic sperm injection (ICSI) cycles presenting with at least two embryos for transfer. Using a polarization imaging system, oocytes were classified prior to ICSI treatment as having either a high zona birefringence (HZB) or a low zona birefringence (LZB) of the zona pellucida. Using zona birefringence as the only selection criterion, two fertilized oocytes, preferably derived from HZB oocytes, were selected for further culture and transfer. The required criteria were met by 135 ICSI cycles (124 patients; 34.9 +/- 4.1 years of age). Embryos for transfer were used in 20 cycles derived from HZB/HZB oocytes, in 50 cycles from HZB/LZB oocytes and in 65 from LZB/LZB oocytes. The corresponding implantation (P < 0.025), pregnancy (P < 0.005) and live birth (P < 0.025) rates were significantly different between HZB/HZB and HZB/LZB versus LZB/LZB group. Embryo development was superior in embryos derived from HZB oocytes. This study concludes that oocyte zona birefringence is a good selection criterion and a good predictive criterion for embryo implantation potential.

[Training methods for regional anaesthesia. Evaluation and comparison]. / Trainingsmethode für Regionalanästhesisten. Evaluierung und Vergleich.

INTRODUCTION: Optimized training facilities are the key to efficient teaching of regional anesthesia. MATERIAL AND METHODS: A combination of Thiel's embalming method, flap dissection and pulse simulation was offered to participants in several workshops on regional anesthesia. Tutors, experienced anesthetists and anatomists, evaluated the workshop and compared Thiel's method to classic formaldehyde conservation. Additionally both embalming methods were assessed with regard to the mechanical properties according to the requirements of regional anesthesia. RESULTS: The evaluation showed high acceptance of the method offered in the workshop. In a comparison of fixation methods Thiel's method was generally preferred as it presented more similar conditions to living patients and almost ideal conditions for regional anesthesia. CONCLUSION: The presented method is an optimized, strongly accepted teaching and training tool for teaching regional anesthesia.

Tocolysis with atosiban: experience in the management of premature labor before 24 weeks of pregnancy.

OBJECTIVE: Atosiban has been shown to be an effective tocolytic agent with a low rate of side effects during 24 to 33 weeks of gestation. Atosiban acts through selective, competitive inhibition of both oxytocin and vasopressin, so that there are reasons to assume that a tocolytic effect can also be achieved earlier in the pregnancy. STUDY DESIGN: In this prospective, randomized pilot study, 20 women in the 18th through 24th week of gestation who presented at our hospital with preterm labor were treated with atosiban. In the control group 20 women received saline infusions. All patients received antibiotic therapy. A cervical cerclage was performed when indicated as was correction of the vaginal pH. RESULTS: The tocolytic effect began after 3-10 min (median: 6.5 min). Treatment time until the complete absence of contractions was 3-12 h (median: 7.5 h). Pregnancies were prolonged between 11.1 and 21.7 weeks (median: 15.6 weeks) in the atosiban group vs. 10.5-19.1 weeks in the control group. If well tolerated, atosiban was continued. There were no significant alterations in the routine laboratory parameters, circulation parameters, and fluid balance. CONCLUSION: In summary, atosiban showed itself to be effective for tocolytic treatment for premature labor, even during 18 and 24 weeks of pregnancy, while exhibiting its known, favorable profile of side effects.

Mayer-von Rokitansky-Küster-Hauser syndrome in association with a hitherto undescribed variant of the Holt-Oram syndrome with an aorto-pulmonary window.

We report on the association of Mayer-von Rokitansky-Küster-Hauser syndrome (MRKHS) with a unique form of Holt-Oram syndrome (HOS) with an aorto-pulmonary window. A 24-year-old Turkish woman was referred to our hospital because of primary amenorrhoea. Both her vagina and uterus were absent, and the diagnosis of MRKHS was established. Laparoscopic creation of a neovagina by the modified Vecchietti technique was performed. A rare congenital malformation of the heart, namely an aorto-pulmonary window, had required cardiac surgery when the patient was a 6-month-old infant. This cardiac malformation plus associated upper limb anomalies led to the clinical diagnosis of HOS. To the best of our knowledge, this is only the second report in the scientific literature on the concurrence of MRKHS and HOS, and the first published case of HOS with an aorto-pulmonary window as the cardiac malformation.

Previous miscarriages influence IVF and intracytoplasmatic sperm injection pregnancy outcome.

Previous conceptions are one predictor for the outcome of assisted reproductive technology procedures. Approximately 18-34% of clinical pregnancies following assisted reproduction procedures result in spontaneous abortion. The risk of such pregnancy loss is believed to increase with women's age, previous miscarriages and use of frozen-thawed embryos. This study analyses German IVF Registry data to examine the impact of previous miscarriages on the outcome of assisted reproduction procedures. The data set consists of a total of 174,909 assisted reproduction procedures performed between January 1998 and December 2000. Multiple logistic regression is used to assess the correlation between women's age, spousal/partner change, and infertility diagnosis. It is demonstrated that any previous miscarriage will increase the treatment-dependent miscarriage rate in assisted reproduction procedures. A significantly higher impact is shown for one previous miscarriage achieved by assisted reproduction procedures compared with spontaneous conception. Partner change is shown to have no specific impact on the treatment dependent miscarriage rate, whereas a statistically significant increase in miscarriages in all assisted reproduction procedures was found among women older than 34 years of age. Overall, the highest rate of treatment-dependent miscarriages was seen in assisted reproduction procedures with cryopreserved embryo transfer.

Three-dimensional power Doppler ultrasound of the subendometrial blood flow under the administration of a contrast agent (Levovist).

METHODS: Based on the results from 42 IVF patients on the day of oocyte aspiration, our study tested the hypothesis that 3-D Doppler ultrasound of the endometrium supported by a contrast agent possesses advantages over a conventional 3-D Doppler ultrasound examination. We also determined whether the subendometrial blood flow indices measured under continuous infusion of Levovist (Schering, Berlin, Germany) were an indicator of a successful implantation. RESULTS: It was demonstrated that, after the administration of Levovist, all subendometrial blood flow parameters (e.g., vascularization index [VI: 8.82+/-16.64], flow index [FI: 35.67+/-9.33], and vascularization flow index [VFI: 3.99+/-8.80]) were significantly higher than without the contrast agent ( p<0.001; VI: 3.09+/-7.11; FI: 29.13+/-14.26; VFI: 1.35+/-3.31). However, no significant differences between blood flow with contrast agent and pregnancy rate were found. CONCLUSION: In summary, quantitative 3-D Doppler ultrasound employing Levovist (Schering, Berlin, Germany) is significantly more sensitive when compared to conventional 3-D Doppler examination. For the first time this was demonstrated on 42 IVF patients on the day of oocyte aspiration. However, no correlation with outcome of the IVF-treatment could be found.

Predialing the number of cinegraphic frames enables an effective patient dose due to coronary angiography of 0.8 mSv.

PURPOSE: To investigate the effect of a new device for predialing the number of cinegraphic frames before each coronary angiogaphy, with the objective of reducing the patient dose area product (DAP) from coronary angiography, which typically requires 1000 to 2350 cinegraphic frames. That DAP is high and stated to be between 15.6 to 106.3 Gy x cm (2). Applying the accepted DAP-to-ED conversion factors, for the thoracic region of approximately 0.20 mSv/Gy x cm (2), this corresponds to a mean effective dose (ED) in the range of 3.1 to 21.3 mSv. MATERIAL AND METHODS: For patients undergoing elective coronary angiography, we compared various parameters of radiation exposure obtained with judicious radiation reducing standard techniques (n = 106) and with an additional new rotary switch for predialing the number of cinegraphic frames (n = 106). RESULTS: The patient radiation dose was significantly lower with the new device, with the mean DAP reduced to 5.5 from 9.1 Gy x cm (2). The corresponding reducation of the mean DAP for left ventriculography and coronary angiography was 1.3 from 1.7, and 4.2 from 7.4 Gy x cm (2), respectively. The number of cinegraphic frames was 98 vs. 184, whereas the number of cinegraphic runs and the fluoroscopy time were comparable. CONCLUSION: Predialing the cinegraphic frame number before each cinegraphic run enables a reduction of the patients effective dose from coronary angiography to 0.8 mSv, i. e. to 57 % of the baseline value and far below typically reported values.