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Background: Glycemic variability (GV) is an indicator of glycemic control and can be evaluated by calculating the SD of blood glucose measurements. In humans with diabetes mellitus (DM), adding a glucagon-like peptide-1 (GLP-1) analogue to conventional therapy reduces GV. In diabetic cats, the influence of GLP-1 analogues on GV is unknown. Objective: To evaluate GV in diabetic cats receiving the GLP-1 analogue exenatide extended release (EER) and insulin. Animals: Thirty client-owned cats with newly diagnosed spontaneous DM. Methods: Retrospective study. Blood glucose curves from a recent prospective placebo-controlled clinical trial generated 1, 3, 6, 10, and 16 weeks after starting therapy were retrospectively evaluated for GV. Cats received either EER (200 μg/kg) or 0.9% saline SC once weekly, insulin glargine and a low-carbohydrate diet. Mean blood glucose concentrations were calculated and GV was assessed by SD. Data were analyzed using nonparametric tests. Results: In the EER group, GV (mean SD [95% confidence interval]) was lower at weeks 6 (1.69 mmol/L [0.9-2.48]; P = .02), 10 (1.14 mmol/L [0.66-1.62]; P = .002) and 16 (1.66 mmol/L [1.09-2.23]; P = .02) compared to week 1 (4.21 mmol/L [2.48-5.93]) and lower compared to placebo at week 6 (3.29 mmol/L [1.95-4.63]; P = .04) and week 10 (4.34 mmol/L [2.43-6.24]; P < .000). Cats achieving remission (1.21 mmol/L [0.23-2.19]) had lower GV compared to those without remission (2.96 mmol/L [1.97-3.96]; P = .01) at week 6. Conclusions and clinical importance: The combination of EER, insulin, and a low-carbohydrate diet might be advantageous in the treatment of newly diagnosed diabetic cats.

International audience; The composition of asteroids gives crucial insights into the formation and evolution of the Solar System. Although spectral surveys and spacecraft missions provide information on small bodies, many important analyses can only be performed in terrestrial laboratories. Meteorites represent our main source of samples of extraterrestrial material. Determining the source asteroids of these meteorites is crucial to interpret their analyses in the broader context of the inner Solar System. For now, the total number of parent bodies represented in our meteorites collection is estimated to about 150 parent bodies, of which 50 parent bodies represented by the poorly studied ungrouped chondrites. Linking ungrouped meteorites to their parent bodies is thus crucial to significantly increase our knowledge of asteroids. To this end, the petrography of 25 ungrouped chondrites and rare meteorite groups was studied, allowing grouping into 6 petrographic groups based on texture, mineralogy, and aqueous and thermal parent body processing. Then, we acquired visible-near-infrared (VIS-NIR) reflectance spectroscopy data of those 25 meteorites, in order to compare them to ground-based telescopic observations of asteroids. The reflectance spectra of meteorites were obtained on powdered samples, as usually done for such studies, but also on raw samples and polished sections. With asteroids surfaces being more complex than fine-grained regolith (e.g., asteroid (101955) Bennu), in particular near-Earth asteroids, the use of raw samples is a necessary addition for investigating parent bodies. Our results showed that sample preparation influences the shape of the spectra, and thus asteroid spectral matching, especially for carbonaceous chondrites. Overall, the petrographic groups defined initially coincide with reflectance spectral groups, with only few exceptions. The meteorite spectra were then compared with reference end-member spectra of asteroids taxonomy. We matched the 25 studied meteorites to asteroids types, using a qualitative match of the shape of the spectra, as well as a quantitative comparison of spectral parameters (bands positions, bands depths and slopes at 1 and 2 μm). We define links between some of the studied ungrouped chondrites and asteroid types that had no meteorite connection proposed before, such as some very primitive type 3.00 ungrouped chondrites to B-type or Cg-type asteroids. We also matched metamorphosed ungrouped carbonaceous chondrites to S-complex asteroids, suggesting that this complex is not only composed of ordinary chondrites or primitive achondrites, as previously established, but may also host carbonaceous chondrites. Conversely, some ungrouped chondrites could not be matched to any known asteroid type, showing that those are potential samples from yet unidentified asteroid types.

Caleta el Cobre (CeC) 022 is a Martian meteorite of the nakhlite group, showing an unbrecciated cumulate texture, composed mainly of clinopyroxene and olivine. Augite shows irregular core zoning, euhedral rims, and thin overgrowths enriched in Fe relative to the core. Low-Ca pyroxene is found adjacent to olivine. Phenocrysts of Fe-Ti oxides are titanomagnetite with exsolutions of ilmenite/ulvöspinel. Intercumulus material consists of both coarse plagioclase and fine-grained mesostasis, comprising K-feldspars, pyroxene, apatite, ilmenite, Fe-Ti oxides, and silica. CeC 022 shows a high proportion of Martian aqueous alteration products (iddingsite) in olivine (45.1 vol% of olivine) and mesostasis. This meteorite is the youngest nakhlite with a distinct Sm/Nd crystallization age of 1.215 ± 0.067 Ga. Its ejection age of 11.8 ± 1.8 Ma is similar to other nakhlites. CeC 022 reveals contrasted cooling rates with similarities with faster cooled nakhlites, such as Northwest Africa (NWA) 817, NWA 5790, or Miller Range 03346 nakhlites: augite irregular cores, Fe-rich overgrowths, fine-grained K-feldspars, quenched oxides, and high rare earth element content. CeC 022 also shares similarities with slower cooled nakhlites, including Nakhla and NWA 10153: pyroxene modal abundance, pyroxenes crystal size distribution, average pyroxene size, phenocryst mineral compositions, unzoned olivine, and abundant coarse plagioclase. Moreover, CeC 022 is the most magnetic nakhlite and represents an analog source lithology for the strong magnetization of the Martian crust. With its particular features, CeC 022 must originate from a previously unsampled sill or flow in the same volcanic system as the other nakhlites, increasing Martian sample diversity and our knowledge of nakhlites., SCOPUS: ar.j, info:eu-repo/semantics/published

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.

In order to achieve points for the CME certificate of the German Medical Council ("Arztekammer") the reader of a CME article in a medical journal has to fill in an evaluation form that includes knowledge assessment. This article summarizes the data of the first ten CME presentations in the "Deutsche Medizinische Wochenschrift".4481 completed data sets were evaluated by chi-square and binomial tests using SPSS version 10.0.85% of the participants were specialists, mainly in internal medicine or surgery: those working in private practice or a hospital took part. The great majority had received their licence one to 30 years ago. The topics dealt with diseases which were not uniformly often seen in clinical practice. The individually perceived changes in the strategy of diagnosis and therapy, induced by the CME article, was mainly dependent on qualification and specialization of the reader as well as on the frequency, with which the reader had been treating the respective disorder. The articles were appreciated by specialists as well as by non-specialists. Knowledge assessment was largely made on the basis of the article alone and was successfully passed by nearly 90% of the participants.For the first time this article provides detailed data on CME activities in a nation-wide available German medical journal and thus forms the basis for discussing further the definition of quality criteria for CME articles in medical journals.

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.

By which criteria can a homepage be evaluated? How is the quality of homepages provided by universities in the field of orthopaedics/traumatology?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.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.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.

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 occurred complications the doctors put in the data of complications in a database. These data were controlled, complemented and classified by members of the quality management 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.

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 criteria of clinical documentation 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 development 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.

The high complex requirements on information and information flow in todays hospitals can only be accomplished by the use of modern Information Systems (IS). In order to achieve this, the Stiftung Orthopädische Universitätsklinik has carried out first the Project "Strategic Informations System Planning" in 1993. Then realizing the necessary infrastructure (network; client-server) from 1993 to 1997, and finally started the introduction of modern IS (SAP R/3 and IXOS-Archive) in the clinical area. One of the approved goal was the replacement of the paper medical record by an up-to-date electronical medical record. In this article the following three topics will be discussed: the difference between the up-to-date electronical medical record and the electronically archived finished cases, steps performed by our clinic to realize the up-to-date electronical medical record and the problems occurred during this process.

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.

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.

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.