Detection of myocardial viability using stress echocardiography.

Asynergic myocardial regions in patients with coronary artery disease can be viable. They may have the ability to improve their function after restoring coronary blood flow. Asynergic but viable myocardial regions have a positive inotropic reserve which can be stimulated by catecholamines. Because echocardiography is an established method for evaluating regional left ventricular function, it has the potential to detect the inotropic response of asynergic myocardial regions. In the clinical setting, prediction of left ventricular functional improvement after revascularization is particularly important. Dobutamine stress echocardiography is the most frequently used stress echocardiographic test for detection of myocardial viability. Dobutamine is infused at low rates of 2.5 to 20 micrograms.kg-1.min-1 to detect myocardial viability. This paper reports on the sensitivity and specificity of the method for the detection of viability and its usefulness for prediction of left ventricular functional improvement after revascularization.

[Chronic intermittent urokinase therapy: anti-ischemic and hemodynamic effects]. / Chronisch-intermittierende Urokinasetherapie: anti-ischämische und hämodynamische Effekte.

Long-term intermittent urokinase therapy has been developed for patients with severe coronary artery disease and refractory angina pectoris. This therapeutic approach is predominantly effective at the microcirculatory level based on a combination of rheologic and fibrinolytic effects; furthermore, plaque regression seems to be a possible mechanism. Patients with refractory angina pectoris are characterized by severe coronary artery disease without a therapeutic option for conventional revascularization procedures, only slight impairment of left ventricular systolic function and hyperfibrinogenemia, which results in further enhancement of myocardial ischemia due to microcirculatory impairment of blood flow. In this article data on the anti-ischemic effectiveness as well as first results on the impact of this therapeutic approach on hemodynamics are described. A dose-response study, which compared 3 x 50,000 IU with 3 x 500,000 IU urokinase three times a week over a treatment period of 12 weeks demonstrated subjective as well as objective antiischemic effectiveness. Only patients who were treated with 500,000 IU per injection achieved marked increases in exercise capacity, while some patients in the low-dose group presented even with a deterioration of exercise performance. First hemodynamic studies could not show marked changes of systolic parameters, either at rest or during exercise. But a decrease of pulmonary capillary wedge pressure at rest after treatment with 500,000 IU per injection indicates an improvement of diastolic function as a result of enhanced myocardial perfusion. Echocardiographic measurements of transmitral Doppler flow in 21 patients with end-stage coronary artery disease demonstrated normalization of early and late diastolic filling rates in most cases. These changes were accompanied by a reduction of clinical signs of heart failure. Long-term intermittent urokinase therapy is a valuable approach as it not only improves quality of life during the actual treatment period but by the persistence of therapeutic effects following the cessation of therapy.

Long-term intermittent urokinase therapy in patients with end-stage coronary artery disease and refractory angina pectoris: a randomized dose-response trial.

OBJECTIVES: This dose-response study was designed to test two low dose regimens of urokinase administered over a prolonged time period in patients with chronic refractory angina pectoris with respect to effects on clinical symptoms and objective variables of myocardial ischemia. BACKGROUND: Patients with severe and chronic refractory angina pectoris in end-stage coronary artery disease represent an increasing clinical problem. Favorable therapeutic effects on myocardial ischemia have been reported for long-term application of low dose urokinase. METHODS: Ninety-eight patients with chronic refractory and end-stage coronary artery disease were randomly assigned to two treatment groups: group A (49 patients) received 50,000 IU and group B (49 patients) 500,000 IU of urokinase as an intravenous bolus infection three times a week over a period of 12 weeks. Variables evaluated were number of weekly anginal events, data from ergometric exercise testing with simultaneous electrocardiographic registration, semiquantitative evaluation of Tc-99m 2-methoxy isobutyl isonitrile (MIBI) scans and rheologic variables. RESULTS: After 12 weeks of treatment, anginal symptoms (events/week) were reduced significantly in group B by 70% compared with 24% in group A (p < 0.001). Fibrinogen decreased by 3% in group A and by 33% in group B (p < 0.001). Plasma viscosity and red blood cell aggregation were reduced by 6.4% (p < 0.001) and 19.9% (p < 0.001), respectively, in group B. Objective variables of myocardial ischemia were improved significantly in group B only. No cumulation of coronary ischemic events was observed in group B. CONCLUSIONS: Long-term intermittent urokinase therapy in an applied dose of 3 X 500,000 IU/week represents an effective anti-ischemic and antianginal approach for patients with refractory angina pectoris and end-stage coronary artery disease. Apart from rheologic improvement, antithrombotic properties and plaque regression are likely anti-ischemic mechanisms.

Cholecystokinin does not delay gastric emptying of regular meals in healthy humans.

Exogenous CCK can delay gastric emptying of meals in the experimental animal and in humans. Studies using exogenous CCK, however, do not prove that the effects of exogenous peptide are of physiological importance. For this reason, the present study employed the specific CCK-antagonist loxiglumide (Rotta) to investigate the question as to whether CCK plays a physiological role in the regulation of gastric emptying. (1) Sonographic studies: Fourteen healthy subjects received a mixed solid-liquid 1,000 kcal meal made up of regular German food. Gastric emptying was calculated from antral volumes measured at 10-minute intervals. All subjects were studied twice on separate days, either with or without i.v. infusion of 1.0, 5.0 or 10.0 mg/kg h loxiglumide, each different dose being given to 4 or 5 subjects. (2) Scintigraphic studies: Eight subjects received an 800 kcal mixed solid-liquid meal consisting of regular food. Solid and liquid components were labeled with 99m-Tc and 113m-In, respectively. Gastric emptying was monitored using a computerized gamma-camera. All subjects were studied twice on separate days either with or without i.v. infusion of 5 mg/kg h loxiglumide. Both meals significantly increased plasma activity of CCK by 4-8 pM/ml (bioassay). However, loxiglumide did not significantly alter gastric emptying at any postprandial time when compared with the NaCl control. The failure of the CCK-antagonist to affect gastric emptying was seen with both type of meals and both the sonographic and scintigraphic techniques. In the scintigraphic studies, gastric emptying of both liquid and solid components were virtually identical in experiments with or without loxiglumide.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diagnosis of achalasia--comparison of methods for the evaluation of severity]. / Diagnostik bei Achalasie--Methodenvergleich zur Beurteilung des Schweregrades.

To determine the value of endoscopy, manometry, and scintigraphy in predicting the severity of achalasia, 25 patients with primary achalasia of the esophagus were posprectively studied; 17 patients could be examined prior and post pneumatic dilatation. According to the symptoms, the severity was graded from I to IV. While endoscopic findings did not well correlate with the symptom score, the lower esophageal sphincter pressure and the resting pressure in the esophageal body were significantly correlated with the severity of the disease (p less than 0.01). The esophageal retention of radioactivity rose parallel to the symptom score (p = 0.07). Both manometric and scintigraphic findings changed significantly after therapy (p less than 0.01). Manometry and scintigraphy of the esophagus can be used to measure treatment related effects in patients with primary achalasia. Endoscopic findings are not related to subjective complaints, but an endoscopic examination should always be performed to exclude malignancies of the esophago-gastric junction.

[Parametric representation of kidney function using 99mTc-mercaptoacetyltriglycine (MAG3)]. / Parametrische Darstellung der Nierenfunktion mit 99mTC-Merkaptoazetyltriglyzin (MAG3).

99mTc-mercaptoacetyltriglycine (MAG3) has recently been introduced for imaging kidney function. Due to the much lower radiation dose per MBq, the total administered activity can be much higher than in the case of 131I-ortho-iodo-hippurate (OIH). The improved counting statistics make this tracer useful for parametric imaging of the kidneys. To investigate this potential of MAG3, its kinetics was compared with that of the reference tracer OIH in 38 patients. Parameters of extrarenal tracer kinetics such as the distribution volumes, the whole-body elimination times and the clearance rates showed a good correlation; however, the clearance rate of MAG3 was always lower than that of OIH. The intrarenal kinetics was investigated using the transfer function which was calculated by deconvolution analysis of the renographic curves. Parameters of the transfer function such as the amplitude, extraction fraction and mean transport time demonstrated a high correlation between the two tracers. Since MAG3 seems to be suitable for parametric imaging of kidney function, parametric images of perfusion, uptake, extraction and transport times were calculated by deconvolution analysis of the MAG3 pixel-renograms in various renal disorders. The parameters were distributed homogeneously throughout the parenchyma of normal kidneys. In a kidney with a hemodynamically significant renal artery stenosis the perfusion parameter was decreased and the time parameter was prolonged. Further examples of a renal graft acute tubular necrosis, an obstructive uropathy, an obstructive nephropathy and of a horse-shoe kidney demonstrate that the parametric images are useful for quantitative investigation of regional renal function.

Gastric phytobezoar: endoscopic removal using the gallstone lithotripter.

Gastric bezoars are a common late complication of gastric surgery. Their treatment may be difficult. This is the first report on the removal of a very firm gastric phytobezoar by perendoscopic lithotripsy. The bezoar was detected 20 years after an unknown type of operation on the stomach, presumably truncal vagotomy and pyloroplasty. We propose the use of the lithotripter through the endoscope as an alternative treatment of firm and large gastric bezoars.

[Examinations of color vision in the differentiation of retinopathia pigmentosa]. / Farbsinnuntersuchungen zur Differenzierung der Retinopathia pigmentosa.

Quantitative analyses of color vision using the Farns-worth-Munsell 100-hue test confirm that the mode of inheritance is important for the prognosis of retinopathia pigmentosa. Cases involving the autosomal dominant mode of inheritance are characterized by slight functional losses whereas patients with the autosomal-recessive or the X-chromosomal-recessive mode of inheritance show pronounced defects in the photopic system. With time the degeneration affects the blue, the green and finally the red areas of the color spectrum.