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Thirty channels of EEG data were recorded prior to voluntary right or left hand movements. Event-related desynchronization (ERD) was quantified in the 8–10 Hz and 10–12 Hz bands in single-trial data and used as training input for a neural network comprised of a learning vector quantizer (LVQ). After a training period, the network was able to predict the side of hand movement from single-trial EEG data recorded prior to movement onset.

This study investigated the feasibility, accuracy and clinical potential of creating polymer hard copies of echocardiographic data using stereolithography.Three-dimensional (3D) echocardiography has so far been limited by the need to display reconstructed 3D objects on a two-dimensional screen. Thus, tangible stereolithographic polymer models created from echocardiographic data could enhance our spatial perception of cardiac anatomy and pathology.Hard-copy replicas of water-filled latex balloon phantoms (n = 7) and porcine liver specimens (n = 12) were generated from echocardiographic images using stereolithography (computerized laser polymerization). In addition, we created 24 models of the mitral valve from 12 transesophageal studies (normal = 6, mitral stenosis n = 4, prolapse/flail leaflet n = 8, annular dilation n = 2, leaflet restriction n = 2 and following mitral valve repair n = 2).Excellent agreement was found for comparison of volumes (r = 0.98, SEE = 3.46 mm3, mean difference = 0.25 +/- 3.33 mm3) and maximal dimensions (r = 0.99, SEE = 0.16 cm, mean difference = 0.03 +/- 0.16 cm) between phantoms and their corresponding replicas. Visual and tactile examination of mitral valve models by two blinded observers allowed correct depiction of mitral valve anatomy and pathology in all cases.Stereolithographic modeling of echocardiographic images is feasible and provides tangible polyacrylic models that are true to scale, shape and volume. Such models offer accurate depiction of mitral valve anatomy and pathology in patients studied with transesophageal echocardiography. This technique could have substantial impact on diagnosis, management and preoperative planning in complex cardiovascular disorders.

Diclofenac is an anti-inflammatory analgesic which is widely used in the therapy of inflammatory joint pain. Diclofenac hepatotoxicity ranges from asymptomatic elevation of transaminase activity to significant liver disease. 31 cases of diclofenac-induced hepatitis with five associated deaths have been already reported in the English, French and Spanish literature. We report the case of a 64-year-old patient who was admitted to the hospital with an icteric hepatitis of sudden onset. The only drug that was taken before admission was diclofenac in a daily dose of 150-200 mg because of a spondylodiscitis. Work-up of the patient included ERCP, laparoscopy and liver biopsy and excluded other reasons of a cholestatic hepatitis. Discontinuation of diclofenac resulted in normalization of transaminase activity and bilirubin concentration within four months. The frequent use of diclofenac and the possibility of fatal liver damage highlights the need that diclofenac-toxicity should be considered in the differential diagnosis of acute cholestatic hepatitis.

Event-related desynchronization (ERD) is the short-lasting attenuation or blocking of rhythms within the alpha (beta) band. ERD is found during but also before visual stimulation. Two different types of ERD can be differentiated: one short-lasting, localized to occipital areas and involving upper alpha components; the other longer lasting, more widespread, most prominent over parietal areas and maximal for lower alpha components. The former most likely reflects primary visual processing and feature extraction, the latter is more related to cognitive processing and mechanisms of attention.

A mathematical model is used to represent the vascular bed of the left coronary circulation by an arterial, a capillary and a venous compartment. The model is first adjusted so as to reproduce arterial hemodynamics known from measurements during normal perfusion. Additionally, measurements under coronary sinus occlusion are used to assess the venous section of the model. While the calculated phasic shapes of epicardial flows are seen to agree with measurements, intramyocardial flows, which are inaccessable to measurement, are predicted from the model. The model is run under stepwise changes of coronary perfusion pressure and coronary artery resistance for both the normal state and coronary sinus occlusion. Intramyocardial flow between capillaries and veins, being the main determinant for a possible therapeutic effect of coronary sinus interventions, is estimated.

Event-related desynchronization (ERD) is the amount of event-related decrease in alpha band power. In applying ERD as an index of cortical activation, the way in which attention and expectancy affect hemispheric differences for words and numbers was investigated. Subjects, 12 right-handed males, had to perform a semantic and a numerical classification task under two different counterbalanced expectancy conditions. Whereas under the high expectancy condition words and numbers were presented blockwise, they were presented randomly under the low expectancy condition. In the semantic task subjects had to indicate the category to which a word belonged; in the numerical task they had to judge whether a number was odd or even. Because 48 words and numbers were used in both expectancy conditions, each subject had to perform a total of 192 trials, practice trials not included. During each of the 192 trials, EEG-signals were recorded from 29 electrodes and analyzed in two frequency bands (6-10 Hz and 9-13 Hz). The data, which were also presented in the form of maps, were subjected to a 6-factorial ANOVA. The results reveal a complex pattern of interactions between the two frequency bands, expectancy conditions, stimulus types and the recording sites. The most important results concern the influence of expectancy. A consistent left hemispheric advantage could be observed under the high expectancy condition and in the lower alpha band only. This and other results seem to indicate that the lower alpha band is more sensitive to reflect expectancy and attentional processes.

A patient with short bowel syndrome as a consequence of multiple intestinal resections for Crohn's disease, had a port system implanted to improve her nutritional status. One year later she presented with fever, weakness and nighttime sweating. Metschnikowia pulcherrima Pitt et Miller was grown in blood cultures from the port system. After antifungal chemotherapy using fluconazole and removal of the implant, the patient's condition improved markedly and her fever and sweating disappeared. We conclude that Metschnikowia pulcherrima can turn into a human pathogen in patients with indwelling catheters for parenteral nutrition. Chemotherapy with fluconazole and, whenever possible, removal of the implant, appear to be adequate treatment.

Immediately after open heart operations (extracorporeal circulation) 22 patients were investigated in 2 groups at the intensive care unit. Whereas the control group received Ringer lactate as postoperative infusion (RL-group), the 2nd group was given 50% glucose (0.5 g/kg/h) and insulin (250 U/1,000 cc) (GI-group). In case of need (blood glucose level) additional insulin up to 200 U/h, maximum 800 U/10 h, was supplied. On the 1st postoperative day 500 ml 10% crystalline amino acid solution was added. Before the start of postoperative infusion therapy postoperative serum insulin levels were low in spite of considerably elevated blood glucose levels (glucose utilisation disorder, insulin suppression). In contrast with the RL-group there was in the GI-group a significant decrease of FFA-serum level and cAMP serum level which developed during the infusion. Urine output and urinary glucose excretion was nearly equal in both groups. Urinary potassium excretion in the GI-group remained significantly one third lower than that of the RL-group, in spite of the potassium supply to the GI-group being nearly twice and serum potassium level approximately equal. Urinary sodium excretion of GI-group on the other hand was approximately 15% higher than that of RL-group. In relation to preoperative values postoperative urinary N-excretion of the GI-group was unchanged, whereas in RL-group the postoperative N-excretion was significantly 30% increased; in postoperative alpha-amino-N-excretion there was only a small difference between the groups, which indicates an insulin-modifiable increase in protein breakdown rather than a decreased protein synthesis. According to the obviously improved situation in energetic considerations, cell membrane potential restoration and N-balance resp. protein synthesis in the insulin treated group, the question is discussed whether this therapy (APA) which shifts metabolism to an anabolic state, is of a certain value as a therapeutic measure in the postshock phase.

The early concept of global retroperfusion and arterialisation of the coronary sinus was discarded because of unacceptable damage to the myocardium, although many authors provided evidence on the improvement of cardiac function during ischemia. Furthermore, the exact mechanism of coronary sinus retroperfusion remained poorly understood. The lack of a strong physiological basis for retroperfusion as well as the development of coronary bypass grafting lessened interest in this revascularisation technique. Renewed interest in myocardial protection via the coronary sinus emerged because of a more aggressive therapy of acute myocardial ischemia. We developed a simple retroperfusion system conceptualized as a periodical occlusion of the coronary sinus and as a redistribution of venous flow to compromised areas during acute myocardial ischemia, sweeping out toxic substances and edema during coronary venous drainage. To allow sufficient filling of the infarcted area as well as venous drainage, the occlusion versus release phase is controlled by the coronary sinus pressure. This pressure-controlled intermittent coronary sinus occlusion (P-ICSO) represents a closed loop system and therefore guarantees optimal physiologic function of the system. This report explains the proposed nature of action of enhanced washout of myocardial edema induced by P-ICSO. Moreover, beneficial effects of P-ICSO observed during canine studies are summarized. It is concluded that this new simple retroperfusion technique has the clinical potential to serve as interim support to protect deprived myocardium until definite reperfusion is available.

55 of 59 patients with artial septal defect, who had been operated in adult age, were examined postoperatively. The mean time interval from the operation was 43,8 months. Two patients had died immediately after the operation; there were no late deaths. The majority of the reexamined subjects was free of symptoms, in no case was there congestive heart failure. Persistence of postoperative symptoms increased with increasing age at the time of operation, but only up to the fourth decade of life. In 26 cases hemodynamics were examined. Mean pulmonary arterial pressure was normal at rest and during a slight ergometric load. In 5 patients there was moderate pulmonary hypertension. In 8 subjects there was minimal, in one patient moderate increase of pulmonary vascular resistance. Heartsize in chest roentgenogramm was increased in about 25% of cases, in more than 50% the pulmonary vessels were accentuated. Irregularities of cardiac rhythm were not more frequent postoperatively, than they had been prior to surgery. However, surgery was followed by a marked decrease of right axis deviation and of EKG signs of right ventricular hypertrophy. Pulmonary function studies revealed a slight decrease of vital capacity and of maximal breathing capacity. These results are favourable compaired to medically treated groups of patients as described in the literature. It is concluded, that even in later adult age the atrial septal defect as a rule is an indication for surgery.

31 infants with anterior abdominal wall defects were treated over the past 10 years. Despite the falling birth rate gastroschisis occurred almost twice as often as omphalocele (19 and 12 cases, respectively). The mortality rate of 71% in omphalocele were related to large defects, rupture of the sac and associated cardiac malformations. The 73% incidence of prematurity, additional malformations and sepsis contributed to the mortality rate of 58% in gastroschisis.

The coronary sinus, collecting about 70% of the venous blood draining the myocardium lends itself particularly well to retrograde concepts of cardioplegia. It has been gaining wide acceptance as a safe means of access to the myocardium in the presence of atherosclerotic disease and as an important modality in providing a more homogeneous distribution of cardioplegic delivery. This article attempts to review all knowledge available on the pathophysiology of retroinfusion of cardioplegia as well as the state of the art of the technique involved. A new concept is being presented, which, in the form of antegrade delivery with postcapillary redistribution, this achieved either by pressure elevation of the venous effluent or pressure-controlled intermittent coronary sinus occlusion (PICSO), takes advantage of both antegrade and retrograde concepts. First experimental results suggest great potential for this combined approach in the effective delivery of cardioplegia.

Several dermatoglyphic studies of patients suffering from genetically determined disorders which are not manifest at birth, indicate an early direct or indirect influence of the causative factors on the formation of dermatoglyphics. On the basis of these observations the present study gives an analysis of the quantitative and qualitative dermatoglyphic characteristics of fingers, palms and soles, as well as body and head measurements and morphological traits of the head and face of nine patients with adult polycystic kidney disease (APCD) type III and of their first and second degree relatives. No malformations nor any significant variation of these variables were observed, i.e. no differences were recorded between patients and controls or patients and their healthy relatives. Yet some interesting trends appeared in dermatoglyphic ridge counts when special methods for intrafamilial comparison were applied. Thus, APCD type III ridge counts on fingers and palms were somewhat lower when plotted against their mid-parent values than those of their healthy sibs. Nevertheless, only studies of additional family material may permit the conclusion that such a constellation is due to type III APCD, and not merely a spurious finding.

Based on a series of 44 surgical patients with hamartochondromas proven by histology the x-ray appearance and clinical aspects are shown. The percentage of calcified hamartochondromas is slightly higher than in the literature. Only one hamartochondroma was situated endobronchially.

The usefulness of exercise testing and long term-ECG recording in old age was evaluated in a retrospective study. During a period of 24 months 317 long-term-ECGs in 195 patients greater than 70 years and 208 exercise tests in patients greater than 70 years were performed. The mean age of the patients was 73 +/- 3 years. Long-term ECG revealed a high incidence of supraventricular arrhythmias, while PVCs were found in only 28.7% of patients and PVCs greater than 30/h in only 7.3% of patients. Complex ventricular arrhythmias occurred in 25% of patients. Long-term ECG recording appeared to be of particular value in detecting abnormal regulation of heart rate and bradycardia, although symptom correlation with arrhythmias recorded was rare. Exercise testing revealed a higher incidence of PVCs with PVCs recorded in 67% of patients and PVCs greater than 2/min in 42% of patients. The incidence of complex ventricular arrhythmias was slightly greater compared to long-term recording with 29% of all patients. Exercise testing was particularly useful in detecting complex arrhythmias in patients with additional signs of myocardial ischemia (ST-segment depression and/or angina pectoris during increasing levels of exercise). Thus comparing both exercise testing and long-term ECG both appeared to be useful methods to uncover arrhythmias in symptomic patients older than 70 years and have to be considered as complementary tools. Exercise testing is particularly useful in recovering complex ventricular arrhythmias in patients with signs of myocardial ischemia during exercise. Long-term ECG on the other hand allows better recognition of bradycardias and conduction defects that may also be present and may contribute to the patients symptoms.

The risk of sudden death in our material, is 13.6% of all deaths. 2. In 5 patients (1.6%) death was caused by failure of the pacemaker (PM), or the electrode. 3. Patients with an asynchronous PM have no higher risk for sudden death, than patients with demand PM. 4. In 9 of 44 patients, a dysfunction of the PM or electrode, can not be excluded. Thus, it must be strictly advised in all patients with an implanted PM, that an autopsy and control of the explanted PM and electrode should be performed. 5. Patients who have a higher risk for sudden death (total AV-Block, Adams-Stokes-Attacks) should be kept hospitalized at least 4 weeks after implantation, controlled more frequently than others, and should be labelled as high risk patients in their PM passport. 6. Control of the resistance in the patients circuit can detect impending failure of the electrode and prevent life threatening complications.