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The field of nutrition has evolved rapidly over the past century. Nutrition scientists and policy makers in the developed world have shifted the focus of their efforts from dealing with diseases of overt nutrient deficiency to a new paradigm aimed at coping with conditions of excess—calories, sedentary lifestyles and stress. Advances in nutrition science, technology and manufacturing have largely eradicated nutrient deficiency diseases, while simultaneously facing the growing challenges of obesity, non-communicable diseases and aging. Nutrition research has gone through a necessary evolution, starting with a reductionist approach, driven by an ambition to understand the mechanisms responsible for the effects of individual nutrients at the cellular and molecular levels. This approach has appropriately expanded in recent years to become more holistic with the aim of understanding the role of nutrition in the broader context of dietary patterns. Ultimately, this approach will culminate in a full understanding of the dietary landscape—a web of interactions between nutritional, dietary, social, behavioral and environmental factors—and how it impacts health maintenance and promotion.

In order to get a better data management of complications in orthopedic surgery and in order to get comparable statistics a standardisation of nomenclature and classification of complications is demanded since 1.1.1997. The Orthopedic University Clinic of Heidelberg started with a register of all early complications of all inpatients. According to a standardized nomenclature all occured complications the doctors put in the data of complications in a database. These data were controlled, complemented and classified by members of the quality menagement group. This guideline consists of five parts: catalogue of diagnoses, general and special definitions, classification and an allocation table of diagnoses to grades of severity.

Virtual Reality is a new form of human-machine interface. Virtual Reality integrates the human into the virtual world of the computer. Concerning existing Virtual Reality programs and 3D-graphics in medicine this article shows possibilities and perspectives for orthopedic surgery. Using Virtual Reality the orthopedic specialist is able to improve the diagnosis, the planning and supporting of operations just as new ways of teaching and training. Virtual Reality (VR) assists disabled individuals in improving the quality of life an working with computers. Principles will be discussed in respect to the four categories Immersive VR, Desktop VR, Pseudo VR and Inverse VR.

An historical overview is given about the medical photography especially in orthopaedic surgery from the beginning until modern times. Orthopaedic surgeons early found out the advantage of this method for documentation of clinical cases. More and more photography was used from the end of the 19. century until now because of its remarkable advantages. In the last years three dimensional photographic measurement has established and is acknowledged to be useful in diagnosis and follow up of deformities, especially of scoliosis. Cinematographic methods for analysis of human movement are helpful tools for diagnosis and therapy of pathologic movement.

Monometric DNA impulse cytophotometry of ploidism state (diploid or aneuploid tumors with stemmline shift, polyploidism ) and proportion of DNA-synthesized cells (S-phase proportion) were determined on over 500, mostly malignant, tumors of different sites. The results were compared with histopathological findings (TNM stage and degree of differentiation). Large diploid carcinomas of the oral cavity have lower S-phase activity than aneuploid tumors. Carcinomas of the breast, stomach and ovary are frequently diploid. Aneuploid carcinomas of these regions generally have high synthesizing activity. Mucoid signet-ring carcinomas of the stomach have lower S-phase activity than non-mucoid carcinomas. In the colorectal region aneuploid carcinoma predominates, in the colon more than in the rectum. Tumor metastases from colon and rectum into the liver predominantly are from aneuploid primary tumors. For tumors of the breast, corpus uteri and ovary with high and moderate differentiation there is a direct correlation between histological grade of differentiation and the S-phase proportions. Aneuploid tumors vary from low to high synthesizing activity. Diploid meningioma and glioma have a low S-phase proportion, aneuploidism correlates with an increase in growth. Supplementation of histopathological diagnosis by determining ploidism and S-phase activity makes an important contribution in the assessment of the degree of malignancy, as well as for therapeutic purposes.

Das Grundprinzip des Tissue Engineering besteht darin aus korpereigenen (autologen) Zellen funktionsfahige Gewebe herzustellen. Als mogliche autologe Zellquelle bietet sich die Nabelschnur an, aus deren Gefasen vaskulare Zellen gewonnen werden konnen ohne den Patienten mit einem zusatzlichen Eingriff zu belasten. Kryokonservierung der Zellen ist fur das Tissue Engineering von kardiovaskularen Strukturen von besonderer Bedeutung und hat den Vorteil, dass die Zellen jederzeit verfugbar sind und in einer Art „individueller Zellbank“ aufbewahrt werden konnen. Die hier vorgestellte Untersuchung zeigt das Prinzip der Isolierung und Lagerung von Endothelzellen (human umbilical venous endothelial cells, HUVEC) als auch Myofibroblasten aus der Nabelschnur auf. Endothelzellen als auch Myofibroblasten wurden aus frischen sowie aus kryokonservierten humanen Nabelschnuren isoliert. Gruppe A setzte sich aus Zellen aus frischen Nabelschnuren zusammen; Gruppe B bestand aus Zellen, die aus kryokonservierten Nabelschnuren gewonnen wurden; Gruppe C enthielt Zellen aus frischen Nabelschnuren, die anschliesend als Zellkultur kryokonserviert wurden. Alle Endothelzell- und Myofibroblastenkulturen wurden mit dem entsprechenden Standardnahrmedium, in vitro mehrfach passagiert. Die Zellen wurden im Lichtmikroskop morphologisch untersucht. Eine weitergehende Charakterisierung wurde mit Hilfe der Proliferationsrate und mit immunhistologischen Untersuchungen durchgefuhrt. Eine morphologisch vitale Zellschicht, die in den jeweiligen Versuchsgruppen optisch vergleichbar war, konnte beobachtet werden. Endothelzellen sowie Myofibroblasten der Gruppen A und C unterschieden sich nicht signifikant in ihrem Wachstum. Endothelzellen in Gruppe B dagegen wiesen eine deutlich geringere Proliferationsrate auf. Myofibroblasten der Gruppe B sind nicht gewachsen. Die in dieser Studie vorgestellte Versuchsanordnung zeigt verschiedene Moglichkeiten der Kryokonservierung von vaskularen Nabelschnurzellen fur das Tissue Engineering von kardiovaskularen Strukturen. Zellen aus kryokonserviertem Gewebe wiesen eine signifikant geringere Proliferation mit einem fruhen Zelltod als Folge auf. Zellen aus kryokonservierten Zellkulturen zeigten im Vergleich zu frisch isolierten Zellen vergleichbare Charakteristika. Basierend auf diesen Ergebnissen besteht die Moglichkeit kryokonservierte Zellkulturen aus der Nabelschnur als mogliche Zellquelle fur das Tissue Engineering von kardiovaskularen Strukturen zu verwenden. Des Weiteren bietet diese Methode die Moglichkeit eine „individuelle Zellbank“ fur das Tissue Engineering von kardiovaskularen Strukturen einzurichten.

Questions By which criteria can a homepage be evaluated? How is the quality of homepages provided by universities in the field of orthopaedics/traumatology? Methods Based on 37 ranking instruments, an optimized list of criteria has been developed. Homepages of orthopaedic and traumatology departments of medical schools in the G7 Nations have been found with help of university homepages and search engines and afterwards were analysed according to previously defined criteria. Results A list of criteria containing 18 subject areas with 49 questions was developed. 136 homepages were evaluated from October 1998 to April 1999. 15 outstanding homepages were found. The best homepages are from medical schools in the USA and Germany. The most frequent subjects were structure of the department (contained in 85% of the homepages) and education/training (68%). 42 homepages provided medical information, 67% of those homepages provided references (attribution), and 26% provided information about authority and authorship. 46% of all hompages were not updated sufficiently. Out of 125 homepages with an e-mail address 36% responded to an inquiry. Multimedia features such as video, sound or animation were used by 6% of the homepages. Conclusion Apart from few exceptions, homepages of orthopaedic-traumatologic departments of medical schools are still insufficient with regard to quality and quantity, especially regarding medical information for patients and professionals. The developed last of criteria should be helpful in installing a basic standard for homepage quality. The time and effort involved in setting up and servicing a homepage should not be underestimated.

For the judgment of the quality of medical services and for the progress of clinical medicine the comparison of data and informations of the diagnostic and therapeutic process is demanded. Therefore a systematic and concrete system of documentation should be implemented in every clinic, which consists of standard nomenclature, classification, instruments of outcome measure and documentation standards. There are a group of problems and barriers which stand in the way of this goal. It is useful to build a minimum basis data set which includes core criterias of clinical dokumentation in orthopedic surgery and include this in an information system so that all of these parts are considered and that a central and comparable data pool is offered for patient care, quality management and research.

An overview of the 30 years history and developement of documentation and information systems in the Orthopedic University Hospital Heidelberg is presented. Since the foundation in 1967 four developmental phases can be described: first initiatives of medical doctors, establishment of a basic documentation system for scientific purposes, strategic information system planning and realisation of information systems with the possibility of controlling in medical areas and thereby steering of the services. Planning and realisation were accomplished within the framework of the masterplans and concepts of the university clinics of the state of Baden-Württemberg.

A solitary osteochondroma of the metatarsale II of an adolescent is presented which led to a painful Metatarsus primus varus. After resection of the tumor the patient was free of symptoms, the postoperative resulting form of the foot was normal. One should be aware of a tumor as a possible cause of foot deformities.

Deformation behavior of two phase materials with High-Pressure Torsion (HPT) was investigated on the basis of Cu-composites. As second phases Fe, W and yttria were used. The deformation behavior in the HPT-process differs due to their different mechanical properties and the ratio of Cu and the second phase. A large benefit of deforming two-phase materials is the homogenous nanocrystalline microstructure with smaller achievable grain sizes than in single phase materials subjected to HPT. Attention is given to development of hardness as a function of the applied strain, the chemical composition at different radii and the obtained microstructure. Tensile tests provide additional information about strength.

To assess the effects of intravenous isradipine (0.5 mg) on left ventricular function in patients pretreated with the beta-blocker propranolol (0.1 mg/kg i.v.), 10 patients were studied during cardiac catheterization for suspected coronary artery disease (confirmed in 6). All patients had normal ejection fractions at rest. Following propranolol, isradipine significantly reduced mean aortic pressure (baseline: 112 mm Hg; propranolol: 107 mm Hg; isradipine: 92 mm Hg) and left ventricular systolic pressure (149 vs. 144 vs. 117 mm Hg, respectively). Propranolol alone significantly decreased heart rate, which then increased after isradipine (75 vs. 66 vs. 70 beats/min, respectively). Cardiac index was depressed with propranolol but normalized with isradipine (3.8 vs. 3.0 vs. 3.7 L/min/m2, respectively) as was mean pulmonary artery pressure (16 vs. 18 vs. 16 mm Hg, respectively). Left ventricular contractility decreased significantly during beta-blocker infusion and reached baseline values with isradipine (2,270 vs. 2,080 vs. 2,320 mm Hg/s, respectively). Parallel to dP/dtmax, systolic wall tension decreased as a consequence of the reduction of left ventricular volume and afterload (1,223 vs. 1,332 vs. 905 units, respectively). It is concluded that isradipine effectively reduces cardiac afterload with no sign of intrinsic cardiodepression.

Rheumatoid arthritis (RA) is thought to be the result of T-cell-mediated autoimmune phenomena. So far, a critical autoantigen has not been identified. Recently, superantigens have been implied in the pathogenesis of RA. In the present study it was tested whether major histocompatibility complex (MHC) class II-positive synovial fibroblast cells (SFC) function as superantigen-presenting cells. SFC were stimulated with interferon-gamma (IFN-gamma) to express class II antigens; then they were cultivated in the presence of T cells with or without staphylococcal enterotoxins (SE). T-cell activation was measured as proliferation and interleukin-2 (IL-2) production. Depending on the dose and type of SE, activation of T-cell clones and also of peripheral T cells was seen. T-cell activation was inhibited by antibodies to MHC class II antigens and also by antibodies to intracellular adhesion molecule type-1 (ICAM-1). The data suggest that class II-positive SFC have the capacity to serve as accessory cells for superantigen-mediated T-cell activation. Thus SFC may participate in the propagation of a T-cell dependent immune response.

E. coli phages of the T4 family (T4, TuIa, TuIb) recognize their cellular receptors with a C-terminal region of protein 37. This protein, common to all three phages, is present as a dimer located at the distal part of the long tail fibers and possesses a C-terminal domain consisting of 40 to 70 highly conserved C-terminal residues, followed by a variable region of 50 to 80 residues which is again followed by a highly conserved area. Protein 38, not being a component of the mature virion, is required for dimerization of protein 37; this represents a non-covalent association of a structural protein. Seven host range mutants of TuIa or TuIb were analyzed which were able to use proteinaceous receptors other than those recognized by their parents. All had suffered amino acid substitutions within the variable region. It is concluded that in all probability it is this region which interacts directly with the cellular receptors. Conditional mutants of T4 are known which, when propagated at the non-permissive temperature (42 degrees C), yield phage of normal morphology but these are more or less unable to adsorb to cells. The causative amino acid substitutions were found both downstream and upstream from the variable area. Distortion of it in the mutants could suggest a "snap-back" conformation of the tail fiber; the conserved C-terminal region may fold back and expose the variable region as a loop at the tip of the fiber. One of the phage mutants (L93), when grown at the permissive temperature, had lost the ability to use the OmpC porin (a receptor for T4) as a receptor. A secondary mutant, able to do so, was isolated. An additional mutation, leading to one amino acid substitution, had occurred in gene 38. This mutant gene acted in trans and caused a much enhanced temperature-sensitivity of infectivity without conferring temperature-sensitivity per se, i.e. the mutant protein 38 apparently altered the conformation of the receptor-recognizing area of the dimer of protein 37. A gene from phage lambda, about 40% identical to gene 38 of T4, complements gene 38 amber mutants. The corresponding protein also restored the ability of L93 to recognize OmpC but did not cause any such temperature-sensitivity. Hence, protein 38, classifying as a chaperone, appears to act instructively in conveying steric information to the target polypeptide.

To assess the effects of intravenous isradipine (0.5 mg) on left ventricular function in patients pretreated with the beta-blocker propranolol (0.1 mg/kg i.v.), 10 patients were studied during cardiac catheterization for suspected coronary artery disease (confirmed in 6). All patients had normal ejection fractions at rest. Following propranolol, isradipine significantly reduced mean aortic pressure (baseline: 112 mm Hg; propranolol: 107 mm Hg; isradipine: 92 mm Hg) and left ventricular systolic pressure (149 vs. 144 vs. 117 mm Hg, respectively). Propranolol alone significantly decreased heart rate, which then increased after isradipine (75 vs. 66 vs. 70 beats/min, respectively). Cardiac index was depressed with propranolol but normalized with isradipine (3.8 vs. 3.0 vs. 3.7 L/min/m2, respectively) as was mean pulmonary artery pressure (16 vs. 18 vs. 16 mm Hg, respectively). Left ventricular contractility decreased significantly during beta-blocker infusion and reached baseline values with isradipine (2,270 vs. 2,080 vs. 2,320 mm Hg/s, respectively). Parallel to dP/dtmax, systolic wall tension decreased as a consequence of the reduction of left ventricular volume and afterload (1,223 vs. 1,332 vs. 905 units, respectively). It is concluded that isradipine effectively reduces cardiac afterload with no sign of intrinsic cardiodepression.

Diffuse Lymphangiomatose der Brustdruse ist ein seltenes Krankheitsbild, welches keine charakteristischen Krankheitssymptome aufweist. Differentialdiagnostisch sind alle Formen der Mastopathien sowie neoplastische Erkrankungen in Erwagung zu ziehen. Hier soll uber eine diffuse Lymphangiomatose der Brustdruse bei einer 36-jahrigen Frau berichtet werden. Ferner soll anhand der in der Literatur beschriebenen Lymphangiome zur Frage der Atiologie und Pathogenese dieser Erkrankung Stellung genommen werden. Diffuse lymphangiomatosis of the breast is a rare condition which shows no characteristic Symptoms. For differential diagnosis all forms of mastopathy as well as neoplastic diseases are to be considered. This is a report on a diffuse lymphangiomatosis of the breast in a 36-year-old woman. It is also intended to express an opinion on the problem of aetiology and pathogenesis of this disease in connection with the lymphangiomas described in the literature.

Mit mechanischen, kalorimetrischen und dielektrischen Mesmethoden werden Relaxationsprozesse beim Glasubergang des Polyethylenterephthalats untersucht. Anhand der Mesergebnisse werden die WLF-Parameter fur das amorphe Ausgangsmaterial ermittelt und scheinbare Aktivierungsenergien fur verschiedene Temperaturen angegeben. Der Einflus unterschiedlicher Kristallinitatsgrade, die durch Abbruch isothermer Kristallisation bei 105°C erzielt wurden, auf die Glastemperatur wird diskutiert. By mechanical, calorimetric and dielectric methods the relaxation processes in the glass transition region of poly-(ethylene terephthalate) were investigated. Based on the results obtained the WLF parameters of the amorphous initial material and the apparent activation energy at different temperatures were determined. The effect of different degrees of crystallization, established by termination of the isothermal crystallization at 105°C, on the glass transition temperature are discussed.

Unverstrecktes Polyethylenterephthalat wurde im Temperaturbereich von 368 bis 518 K verschidedn lange (4 s bis 90 h) isotherm kristallisiert. An den Proben wurden der thermische (DSC) und dynamische (Torsionspendel) Glasubergang untersucht. Die Ergebnisse lassen sich mit der Uberlagerung von Glasubergangen in zwei verschiedenen amorphen Bereichen, die sich zum einen innerhalb, zum anderen auserhalb der Spharolithe befinden, interpretieren. Die Eigenschaften der amorphen Bereiche innerhalb der Spharolithe wurden in Abhangigkeit von der Kristallisationstemperatur diskutiert. Undrawn poly(ethylene terephthalate) was annealed at different constant temperatures in the range 368 to 518 K for different periods of time (4 s to 90 h). Both the thermic (DSC) and dynamic (torsion pendulum) glass transition of the samples were investigated. The results can be discussed by assuming superposition of glass transitions in two different amorphous regions, one occurring inside the other outside the spherulites. The properties of the amorphous regions within the spherulites were studied with respect to the crystallization temperature.

Though it is not known that physiological concentrations of cortisol directly influence cardiac function corticosteroids may by their multiple interactions with other hormones important for the cardiovascular system have an indirect effect on cardiac performance (Kunos et al. 1980; Bakiri et al. 1983; Whitworth et al. 1985). It was the aim of this study to investigate systolic and diastolic left ventricular function noninvasively by echocardiography in patients with adrenal insufficiency.

Die systolischen Zeitintervalle (STI) und echokardiographisch gewonnenen Parameter zur Beurteilung der Funktion des linken Ventrikels haben sich unter klinischen Bedingungen als ahnlich sensitiv in der Erkennung von Anderungen der linksventrikularen Dynamik, wie etwa nach Gabe positiv-introper Substanzen, erwiesen (Angermann et al. 1983; Boudoulas et al. 1983). Sowohl echokardiographische Grosen (Cooper et al. 1972) als auch die STI (Garrard et al. 1970; Weissler et al. 1961) sind mit invasiv gewonnenen Daten korreliert worden (z. B. Ejektionsfraktion, dp/dt, Schlagvolumen). Andererseits ist bisher wenig untersucht, ob systolische Zeitintervalle und andere nichtinvasive Verfahren miteinander in Beziehung stehen (Cokkinos et al. 1983; Mangschau et al. 1984). Die vorliegende Studie hatte somit zum Ziel, eine etwaige Beziehung zwischen dem Verhalten der STI und der echokar-diographischen Parameter wahrend ergometrischer Belastung im Liegen bei Normalpersonen zu untersuchen.

The aim of our echocardiographic study was to characterize cardiac function and anatomy of 14 acromegalics (A: 9 women, 5 men; mean age: 42.4 yrs) more closely. The duration of acromegaly in 4 of these patients was between 3 and 12 years; the disease was diagnosed for the first time in the other patients. Double M-mode echocardiography was performed in all patients and the results compared with data obtained from a control group of 24 healthy volunteers (N: 22 men, 2 women; mean age: 23 yrs). The mean left ventricular diameter at end-diastole was greater in the acromegalics than in the controls (A: 55 +/- 6 mm, N: 50 +/- 4 mm; p less than 0.005, means +/- SD). After correction for age and body surface area, it, however, was outside the 95% confidence interval in 5 patients. Left ventricular hypertrophy was present in 3 patients, one of whom had coexistent arterial hypertension. A total of 3 patients were hypertensive. Significantly higher values for the maximal velocity of systolic wall thickening (A: 6.1 +/- 0.6 cm/s, N: 4.2 +/- 0.6 cm/s, p less than 0.001) and diameter change (A: 12.4 +/- 2.0 cm/s, N: 10.6 +/- 1.0 cm/s, p less than 0.005) indicate increased contractility with concurrently increased relaxation; fractional shortening did not differ significantly (A: 38 +/- 5%, N: 37 +/- 5%, ns). The isovolumetric relaxation period at diastole was slightly longer in the acromegalics (A: 70 +/- 17 ms, N: 61 +/- 13 ms, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

In 45 patients with carotid sinus syndrome, the heart rate-independent vasodepressor component under ventricular and av-sequential pacing of the heart was investigated both in supine and in standing patients. Under both forms of pacing, the carotid pressure determination has led to a marked lowering of systolic and diastolic arterial blood pressure which is significantly more pronounced under orthostasis. The blood pressure values reached both in supine and in standing patients are significantly higher under av-sequential pacing than under ventricular pacing. Accordingly, the proportion of symptomatic patients is less under av-sequential pacing in the supine position (17% versus 29%) and in standing (65% versus 83%). The heart rate-independent vasodepressor reaction is maximal on average between 11 s and 16 s after the beginning of the carotid pressure test and persists for 3 s to 7 s. The blood pressure reaches initial values again after 14 s to 20 s. To summarize, these data document that a clinically relevant heart rate-independent vasodepressor reaction is to be reckoned with in the majority of patients with carotid sinus syndrome. This shows a different time course than the vagally determined effect of the carotid sinus reflex on heart rate. Orthostasis intensifies the vasodepressor reaction so that the hemodynamically more favorable av-sequential pacing which is actually more favorable in hemodynamic terms cannot guarantee freedom from symptoms in the majority of patients in the upright standing position.

Die Echo-Phono-Mechano-Kardiographie stellt eine nichtinvasive Methode zur Beurteilung der diastolischen Funktion des linken Ventrikels dar (Traill u. Gibson 1979). Wahrend systolische Funktionsparameter unter isometrischer Belastung bereits mehrfach untersucht wurden (Claus et al. 1981; Perez-Gonzales et al. 1981; Stefadouros et al. 1974), liegen solche Daten hinsichtlich diastolischer Funktionsparameter bisher nicht vor. Ziel der vorliegenden Studie war es daher, an einem Kollektiv von Normalpersonen das diastolische Verhalten des linken Ventrikels wahrend isometrischer Belastung mittels Echokardiographie zu charakterisieren und weiterhin zu untersuchen, inwieweit das unter Ausgangsbedingungen beobachtete Verhalten durch belastungsinduzierte Anderungen des Sympathikotonus erklart werden kann.

Das Scheitern lokal-chirurgischer Masnahmen in der Tumortherapie am Auftreten von Fernmetastasen hat zum Einsatz adjuvanter Behandlungsverfahren gefuhrt. Die Aggressivitat der Chemotherapie und das begrenzte Ansprechen last eine bessere Selektion der von dieser Behandlung profitierenden Patienten wunschenswert erscheinen. Insbesondere die biologische Charakterisierung des Tumors scheint neben dem histologischen Staging und Grading vielversprechend. In der vorliegenden Untersuchung wurde die Korrelation zwischen den uber Durchflus-Cytophotometrie ermittelten Proliferationsparametern und den unter standardisierten in vitro-Bedingungen gewonnenen Daten zur Cytostatica-Sensitivitat im Human-TumorColony- Assay untersucht. Dabei sollte die Hypothese, das die proliferative Aktivitat eines Tumors, gemessen an DNS-Synthese und Aneuploidie, eine Empfindlichkeit auf Chemotherapie voraussagt, uberpruft werden (3).

Several authors found a correlation of plasma levels of ANP with the impairment of cardiac function [1–3, 5–8]. In order to assess its diagnostic value in a clinical routine setting we measured plasma levels of ANP in a group of unselected patients referred for cardiac workup.

Korperliches Training genugender Intensitat und Dauer bewirkt beim Menschen und beim Versuchstier eine Hypertrophie des Herzmuskels. Da bereits kurz nach der Geburt die mitotische Aktivitat der Herzmuskelzellen erlischt, ist normales Wachstum und Hypertrophie des Herzens im spateren Leben nur durch Vergroserung der bereits vorhandenen Fasern moglich (Zak 1973). Es stellt sich die Frage, wie das myokardiale Kapillarnetz als Sauerstoffzubringer sich dieser Situation morphologisch anzupassen vermag. Kontraktilitat und Myokarddurchblutung sind im trainingshypertrophierten Herzen nicht eingeschrankt (Schaible u. Scheuer 1981; Starnes et al. 1983). Somit mussen die Kapillaren uber einen Anpassungsmechanismus verfugen, der erfolgreich bewirkt, das trotz Faserverdickung die mittlere Diffusionsstrecke des Sauerstoffs in das Zellinnere nicht zu gros wird, und das die zum Gasaustausch dienende Kapillaroberflache relativ zum erhohten Mitochondrienvolumen nicht abnimmt. Ziel unserer Studie war eine quantitative Untersuchung der myokardialen Synergide bei Trainingshypertrophie. Der Begriff „myokardiale Synergide“ wurde von Doerr eingefuhrt und ist als kleinste (ideelle) Einheit des Myokards aufzufassen (Muskelfaser und zugehorige Kapillare mit mesenchymalen Zellen und Nerven); er bietet damit einen Rahmen fur die Suche nach den Initialvorgangen myokardialer Reaktionen (Doerr 1971; Doerr u. Rosner 1977). Zur quantitativen stereologischen Analyse wurde das neue Modell der Dimroth-Watson-Verteilung verwandt, das aus theoretischen Studien bekannt ist und sich bei der Untersuchung von Skelettmuskelkapillaren bereits bewahrt hat (Weibel 1980; Mathieu et al. 1983; Cruz-Orive et al., im Druck). Es zeigte sich, das dieses Modell auch die geometrische Struktur des Herzmuskels besser als das konventionelle Krogh-Zylindermodell beschreibt und mit nur minimalem Zusatzaufwand Informationen uber die dreidimensionale Gefasarchitektur liefert (Mattfeldt u. Mall 1984).