[Utilization of video consultation in cardiovascular lipid treatment]. / Anwendung der Videosprechstunde in der kardiovaskulären Lipidbehandlung.

BACKGROUND: Video consultation is a possibility for physician-patient communication independent of the location; however, only limited information is available for the possibility of sole use since 2018. METHODS: After the implementation of video consultation (Viomedi) in lipid consultations at the Medical University Mainz, the patients in the first quarter of 2022 were assessed depending on the possibility, suitability and readiness to participate. Included were patients under lipid management and long COVID patients. After treatment an online survey was carried out on the utilization and appraisal. RESULTS: Of the 134 patients 29.1% were inclusively treated (3 refusals). All subjects (16 replies) reported having managed (very) well. Advantages were seen in counselling and follow-up. Problems were feared with respect to technology and possible disorders. Data protection aspects played a subordinate role. In comparison to telephone calls, a significant improvement in the physician-patient relationship (p-value = 0.00027), the quality of treatment and information (p-value both = 0.00044), the access to care (p-value = 0.0053) and the communication (p-value = 0.021) was assumed. An improvement in access to care (p-value = 0.021) and the quality of information (p-value = 0.034) was seen in comparison to personal contact. The main problems were a lack of experience, technical requirements, technical problems and unpunctuality of the practitioner. The flexibility, low effort and the pleasant consultation were all praised. All subjects wanted to use the video consultation again. CONCLUSION: Video consultation can represent a supplement to treatment of patients under lipid management. The correct use requires exact planning and further research.

Advanced high-performance liquid chromatography method for highly polar nitroaromatic compounds in ground water samples from ammunition waste sites.

An advanced HPLC-photodiode array detection method for the determination of 12 selected highly polar nitroaromatic compounds in ground water samples of ammunition waste sites has been developed and validated. After solid-phase extraction the limits of detection were in the range 0.1-0.5 microg/l. To prove the applicability of the method to other polar nitroaromatic compounds the retention time of another 32 polar compounds under the specified chromatographic conditions were determined and their UV spectra recorded. To review the method, interlaboratory comparisons were performed with a spiked and a real ground water sample.

[Patients as partners. Tumor patients and their participation in medical decisions]. / Patienten als Partner in der letzten Lebensphase. Erste Ergebnisse und Perspektiven eines Modellvorhabens.

Between March 2002 and August 2003 as part of the research project "Patients as partners -- tumour patients and their participation in medical decisions" tumour patients undergoing palliative therapy (n=272) were interviewed and asked about their level of information, their desired place to die and whether they had prepared an advance directive. Furthermore, 72 relatives of deceased patients who had been looked after by the project's palliative care team were given a similar questionnaire including questions concerning their knowledge about disease and prognosis, the actual place of death and the relevance of advance directives. According to patients and relatives, information particularly about prognosis is unsatisfactory. Of the inter-viewed patients, 75% said they wanted to die at home and 15% in a hospital. According to their relatives, 36% of the patients looked after by the palliative care team had an advance directive. The survey of the relatives showed a significant relation between the preparation of an advance directive and dying at the desired place. According to the relatives, medical and health reasons, hope for an improvement up to the very end,acute worsening of the condition and deficits in medical care were important reasons for dying in hospital against the patient'swish. In future, advance directives should be used as an aid for communication and the planning of care. Therefore, cooperation between doctors and patients based on a partnership is necessary. The required competence in communication should be improved.

Prognostic significance of right ventricular extrasystoles.

UNLABELLED: Extrasystoles (RVES) from the right ventricular outflow tract (RVOT) are a common arrhythmia in routine ECGs. METHODS: In this prospective study 56 consecutive patients with RVES (22 males, 34 females) were examined for morphological and/or functional right ventricular (RV) abnormalities by 12-lead, Holter, exercise ECGs, transthoracic echocardiography and signal averaging. The follow-up time was 3.1-15.8 years (arithmetic mean +/- SD = 7.2 +/- 1.6 years; median, 6.9 years). Patients with hyperthyroidism, structural cardiovascular and/or lung diseases were excluded. RESULTS: A total of 57.1% of the patients with RVES presented with echomorphologic abnormalities of the right ventricle (RV). In 26.8% the echomorphologic right ventricular abnormalities progressed in 33.3% of patients with normal RVs at baseline (group I) and in 21.9% of those with abnormal RVs at baseline (group II). No significant differences were found between the 2 patient groups in terms of age at onset, family history, ECG changes, late potentials and malignant right ventricular outflow tract arrhythmias on 24-h and exercise ECGs. While females predominated in group I, males were numerous in group II (p = 0.006). Sustained ventricular tachycardia, syncope or sudden death were absent throughout the follow-up. CONCLUSION: Patients with RVES carry a good prognosis in terms of morbidity and mortality no matter whether echomorphologic abnormalities are present or not.

Conversion of adamsite (phenarsarzin chloride) by fungal manganese peroxidase.

Fungal manganese peroxidase was found to convert the persistent chemical warfare agent adamsite (phenarsarzin chloride) in a cell-free reaction mixture containing sodium malonate, Mn(2+) ions, and reduced glutathione. The organo-arsenical compound disappeared completely within 48 h accompanied by the formation of a more polar metabolite with a clearly modified UV spectrum. Thus, As(III) in the adamsite molecule was oxidized by manganese peroxidase to As(V) which added dioxygen and released chloride.

Tissue-specific neuro-glia interactions determine neurite differentiation in ganglion cells.

Guided formation and extension of axons versus dendrites is considered crucial for structuring the nervous system. In the chick visual system, retinal ganglion cells (RGCs) extend their axons into the tectum opticum, but not into glial somata containing retina layers. We addressed the question whether the different glia of retina and tectum opticum differentially affect axon growth. Glial cells were purified from retina and tectum opticum by complement-mediated cytolysis of non-glial cells. RGCs were purified by enzymatic delayering from flat mounted retina. RGCs were seeded onto retinal versus tectal glia monolayers. Subsequent neuritic differentiation was analysed by immunofluorescence microscopy and scanning electron microscopy. Qualitative and quantitative evaluation revealed that retinal glia somata inhibited axons. Time-lapse video recording indicated that axonal inhibition was based on the collapse of lamellipodia- and filopodia-rich growth cones of axons. In contrast to retinal glia, tectal glia supported axonal extension. Notably, retinal glia were not inhibitory for neurons in general, because in control experiments axon extension of dorsal root ganglia was not hampered. Therefore, the axon inhibition by retinal glia was neuron type-specific. In summary, the data demonstrate that homotopic (retinal) glia somata inhibit axonal outgrowth of RGCs, whereas heterotopic (tectal) glia of the synaptic target area support RGC axon extension. The data underscore the pivotal role of glia in structuring the developing nervous system.

Regulatory cell interactions between retinal ganglion cells and radial glia during axonal and dendritic outgrowth.

Neuronal differentiation and the formation of cell polarity are crucial events during the development of the nervous system. Cell polarity is a prerequisite for directed information flux within neuronal networks. In this article, we focus on neuro-glial cell interactions that influence the establishment of neural cell polarity and the directed outgrowth of axons versus dendrites. The cellular model discussed in detail is the retinal ganglion cell (RGC) of the chick retina, which is investigated by a comprehensive set of in vitro assays. The experiments demonstrate that retinal microenvironment determines axon vs. dendrite formation of RGCs. The instructive differences in different retinal microenvironments are substantially influenced by radial glia. Different glial domains support or inhibit axon vs. dendrite outgrowth. The data support the notion that neuro-glial interactions are crucial for directed neurite outgrowth.

[Pacemaker therapy in Austria: national register as a means of quality assurance]. / Schrittmachertherapie in Osterreich: nationales Register als Mittel zur Qualitätssicherung.

Quality control of special medical interventions is indicated as well because of medical as economical reasons. This claim is only fulfilled in part. In Austria pacemaker treatment can be used as example for quality control: Number of first implantation; quality of data documentation; test indication: sinus node disease, carotis sinus syndrome; use of all stimulation modes, follow-up programme. Quality control requires also an appropriate organisation of pacemaker implanting hospitals. In addition financing of implantation should be reorganised.

Risk evaluation of ventricular tachycardia using wavelet transform irregularity of the high-resolution electrocardiogram.

A new method for analysis of high-resolution ECG signals using a wavelet transform based on a modified Morlet function is presented. A polynomial filter is used to reduce low-frequency, high-amplitude noise components in the analysed signals. The method is tested on test ECG signals with simulated late potentials and finally verified on two post-infarction patient (PP) groups: 62 PPs with ventricular tachycardia and 44 PPs without arrhythmia. A new quantitative parameter, the irregularity factor, is proposed for discrimination between the study groups. The results show a significant difference in the parameter values for tachycardia patients compared with those for patients without arrhythmia. The sensitivity of the proposed method is 85%, and the specificity is 93%.

Effectiveness of high resolution ECG spectral analysis in discrimination of patients prone to ventricular tachycardia and fibrillation.

INTRODUCTION: To improve the diagnostic power of high resolution electrocardiography for discriminating patients at risk of ventricular arrhythmias, new methods based on spectral analysis have been used in recent years. The purpose of this study was to evaluate the effectiveness of these methods for predicting the risk of ventricular tachycardia and ventricular fibrillation in patients after myocardial infarction. MATERIAL AND METHODS: High resolution ECG were recorded in 129 post-infarction patients and 23 healthy volunteers. Of the post-infarction patients: 62 presented with ventricular tachycardia, 23 with ventricular fibrillation, while 44 had no clinically relevant arrhythmias. The ECG signals were recorded in three orthogonal X, Y, Z leads and averaged using cross-correlation method. Spectral analysis was performed by fast Fourier transform and the parametric modeling method with autoregressive model. Spectral analysis data were evaluated quantitatively by computing normality factor for FFT and spectral factor for AR. RESULTS: Both methods were found to be useful for evaluating the risk of arrhythmias. The sensitivity of ventricular tachycardia risk evaluation was higher (81%--FFT, 73%--AR) than that of evaluating the risk of ventricular fibrillation (30%--FFT, 48%--AR). The specificity in post-infarction patients without arrhythmias (93%--FFT, 84%--AR) was as high as that in healthy subjects (96%--FFT, 87%--AR). CONCLUSIONS: Spectral analysis of HRECG is an effective method for evaluating the risk of VT and VF in patients after myocardial infarction.

Remediating the core deficits of developmental reading disability: a double-deficit perspective.

The double-deficit hypothesis (Wolf, 1997; Wolf & Bowers, 1999, this issue) contends that deficits in phonological awareness and deficits in visual naming speed represent two independent causal impediments to reading acquisition for children with developmental reading disabilities (RD). One hundred and sixty-six children with severe RD from 7 to 13 years of age were classified into three deficit subgroups according to a double-deficit framework. A total of 140 children with RD, 84% of the sample, were classified; 54% demonstrated a double deficit (DD), 22% a phonological deficit only (PHON), and 24% a visual-naming speed deficit only (VNS). Diagnostic test profiles highlighted the joint contributions of the two core deficits in depressing written language acquisition. The children in the DD group were more globally impaired than those in the other subgroups, and the VNS group children were the highest achieving and most selectively impaired readers. Following 35 hours of word identification training, sizable gains and significant generalization of training effects were achieved by all subgroups. A metacognitive phonics program resulted in greater generalized effects across the domain of real English words, and a phonological training program produced superior outcomes within the phonological processing domain. The greatest non-word reading gains were achieved by children with only phonological deficits.

[Secondary prevention following coronary intervention. Survey of 13 intervention centers in Austria]. / Sekundärprävention nach Koronarintervention. Vorgangsweise an 13 Interventionellen Zentren in Osterreich.

Risk factor control has been shown to reduce the incidence of coronary events in patients with or without preceding infarction. Secondary prevention should therefore be borne in mind by every cardiologist. In order to test this concept and/or to promote secondary prevention in our country, the following survey was conducted by our working group for epidemiology and prevention. All interventional centres of the country (7 million inhabitants) were asked to report relevant data of 50 consecutive patients with PTCA in a structured questionnaire. Thirteen centres responded and we report the data of 650 patients. The mean proportion of women was 28%, the mean age 61.1 years and the mean stent rate 49.8%. The indications for PTCA varied widely: stable angina 10-74%, unstable angina 10-86%, primary PTCA 0-22%. The risk factor history was distributed as follows: diabetes 12-46% (mean 22.3%), hypertension 32-68% (mean 54.2%), current smoking 6-56% (mean 21.9%), and total cholesterol (TChol) > 200 mg/dl: 30-78% (mean 60.3%). Current lipid values were available for T chol. in 44-100% (mean 84.5%) and for LDL in 4-100% (mean 67.1%). Dietary counselling by a dietician was done in 4-100% of patients (mean 35.6%) Information concerning the hazards of smoking was given to 25-100% (mean 83.6%) of current smokers. Drug treatment at hospital discharge was as follows: 84-100% (mean 93.1%) received ASA, 24-74% (mean 49.8%) ticlopidine, 6-84% (mean 53.3%) nitrates, 34-82% (mean 60.2%) beta blockers, 10-70% (mean 39.5%) ACE inhibitors, 4-74% (mean 4 7.2%) lipid lowering drugs, 7-48% (mean 17.8%) calcium antagonists, 0-12% (mean 6.1%) digitalis and 0-28% (mean 13.6%) diuretics. Follow-up data were collected in 4 centres at 6 months post discharge and were available for 174 patients. Here we found an increase in the prescription of calcium antagonists, digitalis and statins. The following conclusions were drawn at a conference in which all centres participated: lipid values should be available for each patient at PTCA, dietary counselling should be initiated for every patient during hospitalisation (and continued by the family physician) and the national cardiac society should promote guidelines for the use of drugs in which the variation in use is too wide at present. It should be ensured that these guidelines are implemented not only in patients after AMI but also in those after PTCA.

Oxaceprol is as effective as diclofenac in the therapy of osteoarthritis of the knee and hip.

In this multicentre (five centres in Germany), randomised, double-blind, comparative study, 150 patients with painful degenerative joint disease according to EULAR criteria received either oxaceprol (200 mg three times daily) or diclofenac (25 mg three times daily) for 20 days. Joint function, the primary variable, assessed according to Lequesne's indices, improved equally in both treatment groups to a clinically relevant degree. Joint mobility improved by approximately 60% in both groups. By the end of therapy in both groups, the period of pain-free walking time had more than doubled and subjectively evaluated pain perception (VAS) was reduced by almost 50% without any significant differences between the treatments. The incidence of adverse drug reactions was similar in both groups but oxaceprol induced milder symptoms. Oxaceprol is as effective and better tolerated than diclofenac in the treatment of osteoarthritis.

Identification of oxidized TNT metabolites in soil samples of a former ammunition plant.

Water extracts of soil samples of the former ammunition plant "Tanne" near Clausthal-Zellerfeld, Lower Saxony, Germany, were investigated for highly polar oxidized 2,4,6-trinitrotoluene (TNT) metabolites. 0.4 to 9.0 mg/kg dry soil 2,4,6-trinitrobenzoic acid (TNBA) and 5.8 to 544 mg/kg dry soil 2-amino-4,6-dinitrobenzoic acid (2-ADNBA) were found. In addition to the oxidized metabolites, TNT, 4- and 2-aminodinitrotoluene (4- and 2-ADNT), and 2,4-dinitrotoluene (2,4-DNT) were extractable with water. Most interestingly, in one sample, 2-ADNBA represented the main contaminant. The origin of the oxidized nitroaromatics is unknown at this time. They might be generated chemically or photochemically. Furthermore, a biological synthesis seems possible.

[Sub-pectoral implantation of defibrillators: intraoperative data and long-term outcome]. / Subpektorale Implantation von Defibrillatoren: Intraoperative Daten und Langzeitbeobachtung.

UNLABELLED: The present study examined the perioperative mortality and morbidity and lead-related complications in patients who had a defibrillator with a transvenous lead system and subpectoral implantation of the generator. Fifty-four out of 57 consecutive patients (95%) received a transvenous lead system. One patient had an acceptable defibrillation threshold with an additional subcutaneous patch whereas no sufficient defibrillation threshold was found in another 2 patients. Two patients died due to congestive heart failure after implantation. Perioperative complications were observed in 4 patients (7%) including pericardial effusion, pocket hematoma, injury of the plexus brachialis and a pneumothorax. None of these complications required surgical intervention. Fifty-five patients were discharged from the hospital. During 27 +/- 10 months none of these patients died. Lead-related complications were observed in 3 patients (5.5%) including microdislocation in two and a outer conductor fracture in one of the lead. CONCLUSION: Technical advancement such as a non-thoracotomy lead system and smaller devices have made the onc-incision approach and subpectoral implantation of the ICD generator clinical routine. Nevertheless complications related to the lead system can occur. Therefore frequent controls of patients with ICD are necessary.

Highly polar metabolites of nitroaromatic compounds in ammunition wastewater.

Transformation processes of nitroaromatic compounds (NAC) are described that lead to polar and highly hydrophilic metabolites in ammunition waste water. For the identification of proposed metabolites, several analytical methods for the separation and determination of these compounds were developed and applied to the investigation of a former ammunition plant and its surroundings. The compound classes which were investigated include nitro and amino substituted toluenesulfonic acids, nitrobenzoic acids, aminobenzoic acids and nitromethylphenols. Method development was usually done with high performance liquid chromatography and ion pairing or ion suppression techniques. In the leachate water of a disposal site of a former ammunition plant in Stadtallendorf, Germany, 15 compounds from the above-mentioned categories have been found to be present in concentrations up to a few hundred microgram/L. The presence of so many polar compounds suggest that current and future surveying programs should include representative analytes of the investigated categories.

Gas chromatographic determination of aromatic amines in water samples after solid-phase extraction and derivatization with iodine. I. Derivatization.

A new method for the selective determination of aromatic amines is presented, which is based on the solid-phase extraction at pH 9 and subsequent derivatization of the analytes to the corresponding iodobenzenes. These can selectively and sensitively be determined with gas chromatography and electron-capture detection. Separation of at least 30 compounds in a single chromatographic run in 30 min is possible. With this method, 56 aromatic amines were investigated, and only in six cases no derivatives were obtained. Limits of quantitation were between 0.5 and 8 micrograms 1(-1), but may still be lowered with higher sample volumes or different injection techniques. The application to water samples revealed the suitability for the investigation of ground, leachate and wastewater.

Anaerobic degradation and transformation of p-toluidine by the sulfate-reducing bacterium Desulfobacula toluolica.

The ability of the strictly anaerobic sulfate-reducing bacterium Desulfobacula toluolica (strain Tol2) to cometabolically degrade p-toluidine (p-methylaniline) while using toluene as the primary source of carbon and energy has been studied. This organism has been shown to modify and degrade toluidine in dense cell suspensions when no other source of carbon and energy is added. The metabolism led to the formation of a variety of metabolites. From these metabolites a biphenyl-like compound as well as phenylacetic acid have been identified by means of HPLC/MS techniques. The probable conversion of p-toluidine to p-aminophenylacetic acid and phenylacetic acid as dead end products suggested that this organism initiates p-toluidine degradation by the carboxylation of the methyl group. If this could be validated in further experiments, it would be the first time that a toluidine was carboxylated at the methyl moiety by an anaerobic, sulfate-reducing bacterium.

Present and future role of ambulatory Holter monitoring for arrhythmia risk stratification.

Risk stratification for arrhythmogenic events and sudden death in patients with organic heart disease, particularly those with coronary heart disease and a history of MI, continues to be one of the major tasks of clinical cardiologists, although advanced management strategies including thrombolysis, acute PTCA and surgical intervention dramatically reduced the percentage of sudden deaths following acute MIs, Noninvasive studies like resting and exercise ECG, echocardiography, signal averaging, 24-hour ECG, and radionuclide studies, as well as invasive techniques such as electrophysiologically programmed electrostimulation and coronary angiography, are being used routinely. Ambulatory Holter monitoring is an established noninvasive technique for risk stratification. There is evidence showing that its predictive potential for arrhythmogenic risks is enhanced, if more than one parameter is analyzed. Absence of ST segment changes and a normal HRV are the parameters signaling out low-risk patients. The use of additional parameters which escape electrocardiographic recording, like ventricular function and myocardial ischemia, improve the accuracy of predicting arrhythmogenic events. The most predictive combination of risk parameters is, however, still poorly understood. Future research should define normal ranges of parameters recordable by H-ECG, solve technical problems of recording data and analyzing them. In addition, the accuracy of measuring QT duration and documenting late potentials should be improved by more sophisticated methods. But it is unrealistic to expect that the QT interval will become amenable to automatic analysis in all patients. A fully automatic QT analysis without visually checking the measuring points at the tip and the end of the T wave for their consistency is hardly conceivable. The documentation of late potentials, in turn, is limited by artefacts caused by muscle contraction during physical activity. Clinical aspects, e.g., the predictability of arrhythmogenic events in patients with cardiomyopathies and valvular disease should be addressed. This will require studies combining the predictive potentials of rhythmologic and hemodynamic data.

Laser catheter coagulation of atrial myocardium for ablation of atrioventricular nodal reentrant tachycardia. First clinical experience.

A new technique for ablation of atrioventricular nodal reentrant tachycardia, using catheter-directed continuous wave Nd-YAG laser light, 1064 nm, via a novel pin-electrode laser catheter, was applied in 10 patients aged 15-63 years (mean 43 years). A total of 22 laser pulses, 1-5 per patient, at 20 or 30 W, of 10-45 s (mean 27 s) were aimed at the postero-inferior aspect of the tricuspid annulus. In all patients the tachycardia was rendered non-inducible at baseline as well as during orciprenaline administration. The amplitudes of the local atrial potentials diminished from 2.0 +/- 0.5 before to 0.4 +/- 0.4 mV after ablation, atrio-His intervals increased from 73 +/- 7 to 157 +/- 36 ms. Anterograde atrioventricular nodal refractory periods (212 +/- 31 vs 238 +/- 31 ms) and Wenckebach rate (174 +/- 8 vs 167 +/- 8 beats.min-1) did not change significantly (P > 0.05). There were no complications or recurrent arrhythmias in a follow-up of 12-35 (mean 27) months. Anatomically guided laser catheter coagulation of the postero-inferior aspect of the tricuspid valve ring is a safe and effective method for the cure of patients with common atrioventricular reentrant tachycardia.