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Aim: Comparison of two gated SPECT analysis tools -- gated SPECT quantification (GSQ) and emory cardiac toolbox (ECT) -- in patients with coronary artery disease (CAD) and severely impaired left ventricular function (preoperative: EF <35% by cardiac catheter)., Patients, Methods: A total of 56 gated SPECT examinations (one-day hybrid-protocol with (201)Tl-chloride for rest and (99m)Tc-sestamibi for stress applied during low-dose dobutamine stress MR-examination; temporal resolution; 8 phases per cardiac cycle) were performed in 36 patients (31 preoperatively, 25 postoperatively) and compared with MRI in 48 cases. Left ventricular end-diastolic (LV-EDV) and end-systolic (LV-ESV) volumes as well as the left ventricular ejection fraction (LV-EF) were calculated., Results: The total volumetric assessment by both analysis algorithms (n = 56) showed good intraclass correlation coefficients preoperatively (n = 31), but even better postoperatively (n = 25). The mean reconstruction time was approximately 3 minutes ( +/- 2 SD) for GSQ and 15 minutes ( +/- 5 SD) for ECT. In comparison to MRI the results of both analysis tools also correlated well, but the agreement decreased in the presence of scared tissue. The mean LV-EF (MRI) preoperatively was 30.4%, in 6/36 patients above the values calculated from cardiac catheter, postoperatively 34.6%., Conclusion: Both gated SPECT analysis tools showed reliable volumetric assessments in high-risk patients with CAD and severely reduced LV-EF in comparison to MRI, with advantages for GSQ in terms of postprocessing time. However, for the calculation of LV-EF a markedly lower concordance with MR-results was observed for both methods depending on the presence of myocardial scars.

Patients with coronary artery disease (CAD) and diabetes mellitus have an increased risk of mortality when undergoing either interventional or surgical revascularization. However, the rate of necessary reinterventions is significantly lower after surgical revascularization than after percutaneous transluminal coronary angioplasty (PTCA). As yet, no results of long-term follow-up after stent implantation are available. The risk for a patient with diabetes mellitus and CAD of dying of myocardial infarction after a bypass operation is significantly lower than after PTCA. Bypass operation with sternotomy in patients with diabetes mellitus carries, however, an increased risk of postoperative mediastinitis, especially when both internal thoracic arteries are used for "totally arterial" revascularization. For this reason the internal thoracic artery should be used only unilaterally in surgical revascularization in these patients. Preoperative and postoperative stabilization of the blood sugar level is very important. Sclerosis of the vessels in close proximity to the heart (ascending aorta, carotid arteries) must be clarified preoperatively. The operation should be carried out particularly carefully, with the wound area kept as small as possible. Reexploration should definitely be avoided. If these guidelines are followed, surgical revascularization in patients with CAD and diabetes mellitus can achieve very good results.

In 24 human cadaver femora standardized instable pertrochanteric osteotomies were created. The right and left femur of each pair were alternately selected for osteosyntheses with the gamma nail and the dynamic hip screw. Afterwards an examination of stability was performed. Cyclical loads were increased in 500 N increments to the maximum loading capacity, while the deformation rate was continuously measured. Radiographs were taken to prove the results of loading. The mean deformation was much greater in the DHS group than for the gamma nail, the maximum load to failure was significantly lower. Femoral shaft fractures caused by the loading occurred five times as often in the gamma nail osteosyntheses than in the DHS.

In a retrospective analysis the clinical history of 202 geriatric patients with vast morbidity who had received hip prosthesis were reviewed. The age of the patients at the time of operation was calculated to a mean of 82.9 years. Hundred and three cases who had underwent cefazolin application as an antibiotic prophylactic therapy were compared to 99 patients who had not received any antibiotics (control group). In comparison wound infections after surgery were less common among the cefazolin group (13.6%) than in the control group (26.3%). Additionally the incidences of reoperations, decubital ulcers and urinary tract infections were statistically significant lower in the cefazolin group as well.

From 4/1986-12/1990, 177 pts. with endstage coronary artery disease (CAD) and left ventricular ejection fraction 10-30% received coronary artery bypass grafting (CABG). Preoperatively myocardial infarction rate was 1.5 (mean). Presupposition for CABGs was myocardial ischaemia at present demonstrated in myocardial viability test. 66.1% of the pts. had signs of ischaemia at e.c.g. after work. Additionally 97.6% of the pts. had myocardial ischaemia defined as redistribution in myocardial scintigraphy. Angina pectoris was present in 93.8% of the pts. preoperatively. 1-5 (mean 2.9) CABG per pt. were performed. 35 pts. received an internal mammaria bypass to the left coronary artery also. Operative mortality was 11.3% (1986-1990) and in 1990 alone 7.3%. Actuarial survival rate was calculated after one year to 87.4% after two years to 86.1% and after three years to 84.8%. Postoperatively all pts. were free from angina pectoris. 5 months after the operation e.c.g. after work was performed. The physical stress bearing area was increased to 82.7 Watt (mean) compared to 51.7 Watt (mean) preoperatively (p less than 0.001 s.). In conclusion pts. with endstage CAD and left ventricular ejection fraction 10-30% appeared to be good candidates for CABG with good prognosis and significant symptomatic improvement when signs of myocardial ischaemia are present preoperatively.

On the occasion of his 100th birthday the curriculum vitae and the scientific work of the surgeon Johannes Volkmann (1889-1982) are presented. The influence of his teacher Friedrich Voelcker (1872-1955) and the importance of Volkmann to the development of intravenous urography are emphasized.

Lymphography was carried out in 41 patients after arterial reconstruction in the aorto-iliac territory or in the extremities: 13 of these patients had been examined pre-operatively. In addition to lymphography, the circumference of the limbs was measured. Lymphographic changes and oedema could be demonstrated in all patients, the extent depending on the type of surgical intervention. There was correlation between the extent of lymphatic damage and the oedema. The duration of post operative oedema depended on effective regeneration of the lymphatics; according to the severity of the surgical injury, regeneration was largely complete from 12 weeks to six months after surgery.

On the occasion of his 300th birthday it is remind to the important english surgeon William Cheselden, who has influenced markedly the development of vesicolithotomy. The few known biographical data and the methods of lithotomy commonly used in the 18th century are presented.

It is reminded of the outstanding Berlin urologist Leopold Casper (1859-1959), whose work reflects half a century of the history of Berlin urology. As founder of the ureteral catheterisation and the functional renal diagnostics he helped the urology, for the recognition of which as an undependent subject he fought a life-long struggle, to further reputation.

We remember the urologist Eugen Joseph (1879-1933), working in Berlin. After a short description of his life from his extensive scientific work particularly the chromocystoscopy, the chemocoagulation of the tumours of the urinary bladder and the medical technological studies are emphasized, by which he considerably influenced the development of urology in Germany.

On the occasion of his 150th birthday we make mention of the Berlin urologist Ernst Fürstenheim born in Köthen in 1836 who in 1863 set up his practice as first "physician for diseases of the urinary tract" in Berlin and thus indicates the beginning of urology in Berlin. Emphasized are Fürstenheim's efforts for the introduction and popularization of the urological endoscopy in Germany, the practical usability of which he detects as first physician. By his engaged advocacy of the performance of lithotripsy this versatile urological practitioner became a true pioneer of urology in Berlin.

In this article we remember the Berlin urologist Maximilian Nitze (1848-1906) who with his invention of the cystoscope 110 years ago founded a new epoch of the urologic-endoscopic diagnostics and therapy. After a short description of his life the importance of his scientific work for the development of urology as an independent medical special subject in the second half of the 19th century is pointed out.

The fourth case of malakoplakia of the urethra is reported in a 20 year-old female patient. As a rule the malakoplakia is diagnosed pathologic-anatomical like special form of a proliferative inflammation and be reputed to be a local lysosomal macrophage defect with disturbed cellular immune answer. The importance of a differential diagnostical clarification against a granular neuroma and of tumor markers is emphasized.

We remember the Berlin urologist Carl Posner (1854-1928) who by his scientific urological work as well as by his activities as an editor has greatly furthered the development of urology to a scientific subject. After the description of his life particularly his political work in associations is treated, which made him the organizer of the international medical associations in the first half of the 20th century.

Life and work of the Berlin urological surgeon James Israel, one of the most outstanding representatives of renal surgery, which developed in the second half of the 19th century in Germany, is described. Coming out from surgery, Israel developed himself the most outstanding renal surgeon of his time, who by his work essentially contributed to the formation of urology in Germany.

On the occasion of the 175th anniversary of his death we think of the physician Phillipp B. Bozzini (1773-1809), born in Frankfurt/Main, who by his light conductor, constructed in 1806, started the development of the endoscopic diagnostics. After description of his short life and an explanation of the light conductor Bozzini's merit is emphasized, by his invention as first physician to have made accessible to medicine endoscopic diagnostic possibilities.