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The permeability of a material is described by the amount of substances (gases, liquids, particles) passing through pores and/or interstices of the material in a certain time. In medicine and biotechnology the permeability is given usually as the amount of water (ml x cm(-2) x min(-1)) permeating per area and time unit through the material. Vascular prostheses are described e.g. as high porous prostheses (e.g. Dacron: 1500-4000 (ml x cm(-2) x min(-1)) or as low porous prostheses (e.g. ePTFE: 200-1000 (ml x cm(-2) x min(-1)). The permeability of blood capillaries is characterized by the exchange of nutrients, metabolites and breathing gases. Capillary permeability and the transport of the permeates through tissues are the key processes for the supply of organs and tissues where especially the protein transport through tissues is described by diffusive and/or convective terms. The vascular permeability is governed by the permeability of the intimal endothelial cells. The major influence is exerted by the interendothelial binding which can change drastically in a very short time. This is demonstrated by the fast development of interstitial lung oedema in case of septical shock. The permeability is an integral indicator of tissue and organ function. It is possible to assess the permeability of native and engineered tissues precisely with a recently developed system. First results will be shown.

International audience; This document, supported by both the International Society for Clinical Hemorheology and the European Society for Clinical Hemorheology and Microcirculation, proposes new guidelines for hemorheological methods used in experimental and clinical studies. It is based on a similar document entitled: "Guidelines for measurement of blood viscosity and erythrocyte deformability" published in 1986 by the Expert Panel on Blood Rheology of the International Committee for Standardization in Hematology. Recent methods, techniques and instruments, as well as new approaches to interpretation of results, are added to these new guidelines; wide spread adoption should improve comparability between hemorheological laboratories and increase the reliability of rheological tests.

The degradation behavior of biodegradable multiblock copolymers (PDC) containing poly(p-dioxanone) hard segments (PPDO) and crystallizable poly(epsilon-caprolactone) switching segments (PCL) synthesized via co-condensation of two oligomeric macrodiols with an aliphatic diisocyanate as junction unit was explored in in vivo and in vitro experiments. The in vitro experiments for enzymatic degradation resulted that the poly(epsilon-caprolactone) segments are degraded faster, than the poly(p-dioxanone) segments. During degradation the outer layer of the test specimen becomes porous. Finally non-soluble degradation products in form of particles were found at the surface. This observation is in good agreement with the in vivo studies, where the non-soluble degradation products in the periimplantary tissues showed a diameter of 1 – 3 micron.

A total of 209 diabetic children and adolescents aged 6-17 years (mean, 12.6 +/- 2.3 years) were examined by ophthalmoscopy, video fluorescein angiography and hemoglobin (HbA1c) test. Microaneurysms were found in 26% of the children (ophthalmoscopy, 11%; angiography, 23%). The prevalence of retinopathy was 16% in patients aged 6-10 years, 27% in those aged 11-13 years and 36% in those aged 14-17 years. Only five diabetics aged 11-17 years showed lesions other than microaneurysms (hard exudates, intraretinal hemorrhages or retinal capillar leakage). Retinal blood flow was quantified using video fluorescein angiography. The arm-retina time (ART) and the arteriovenous passage time (AVP) as parameters of the retinal microcirculation were obtained using an image analysing system. The mean value for ART was 9.7 +/- 2.5 s and that for AVP was 1.43 +/- 0.52 s. AVP was significantly shorter in diabetic children and adolescents with good glycemic control (HbA1c, less than 7%; AVP, 1.35 +/- 0.44 s) than in those with bad glycemic control (HbA1c, greater than or equal to 9%; AVP, 1.65 +/- 0.51 s).

The scanning laser technique in combination with digital image analysis allows direct objective measurement of flow velocities in perimacular capillaries. In addition, the complete macular network of capillaries can be observed. By means of digital frame-to-frame picture analysis of digital recordings, blood flow velocities and morphologic data have been measured. The mean flow velocity in perimacular capillaries observed with the scanning laser ophthalmoscope in healthy subjects (n = 21) amounted to 3.28 ± 0.45 mm/second. In patients (n = 13) with diabetes mellitus (no or background retinopathy), the mean flow velocity was significantly reduced (2.89 ± 0.57 mm/seconds) compared with healthy subjects. Morphologic data of the perifoveal capillary bed showed a significant reduction of capillaries in patients with diabetes mellitus when compared with healthy subjects.

Key insights into the role of platelets in acute myocardial infarction (AMI) and unstable angina have led to the development of the polymer-coated stent, Camouflage(R). Coating of stents is an elegant method to minimize interactions between platelets and the stent surface and the vascular response following stent implantation.This single-center prospective registry was performed to estimate the in-hospital, 30-day and 180-day event rate (death, revascularization, reinfarction and pathological stress test at 180 days) in an everyday patient population with AMI with immediate percutaneous coronary intervention. There were 44 males (65.7%) and 23 females (34.3%); 53 patients (79.1%) had hypertension, 11 (16.4%) were diabetic, and 32 (47.8%) had elevated LDL cholesterol. The mean age was 60.7 +/- 11.6 years.Sixty-seven patients with AMI (STEMI: 56.7%, NSTEMI: 43.3%) were included. Clinical data at the 30-day and 180-day follow up were available for all but 1 of the patients. Overall, there were 3 (4.5%) deaths, 1 (1.5%) death at 30 days and 2 (3.0%) at 180 days (1 cardiogenic shock 3, 1 sudden cardiac death and 1 AMI). Three (4.5%) patients experienced subacute closure of the target vessel. At 180 days, 1 (1.5%) patient had a pathological stress test and 5 patients (7.5%) underwent target vessel revascularization.The registry with this passive-coated stent showed good results in patients with AMI, consistent with earlier studies. Data are now available both for the development of hypotheses and for a data-based estimation of the number of cases for a comparative clinical study versus other coronary stents.

In patients with hypertensive fundus changes considerable morphologic changes of the entire vascular system may be assumed. In the present study, the effects of these processes on the partial oxygen pressure of the skeletal musculature were investigated in 62 patients via a macro puncture electrode placed in the tibial muscle. The extent of fundus changes and the reduction in muscular partial oxygen pressure were found to be correlated. With advancing stages of fundus changes, blood flow measured in the common carotid artery decreased. Vascular changes which are clearly recognizable in the hypertensive fundus thus appear to be accompanied by a deterioration in partial oxygen pressure in muscular tissue and restriction of flow in the macrocirculation.

An 10 freiwilligen, klinisch gesunden männlichen Probanden wurden im Cross-Over-Design vor und lh, 3h, 6h und 24 h nach iso- bzw. (3 Monate später) hypervolämischer Hämodüution mit 500 ml Hydroxyäthylstärke 200/0,5 10% der Hämatokrit in der Makro- und Mikrostrombahn untersucht. Dabei zeigt sich nach isovolämischer Hamodüution der größere Verdünnungseffekt. Während der systemische Hämatokrit durch eine isovolämische Hämodüution mit 500 ml mittelmolekularer Hydroxyäthylstärke um 8,5 Volumenprozent erniedrigt wird, nimmt der Kapillarhämatokrit zum Zeitpunkt der größten Verdünnung (1 h nach Hämodüution) in kutanen Kapillaren nur um 1,3 Hämatokritpunkte ab. Nach der hypervolämischen Hämodüution sinkt der systemische Hämatokrit maximal um 5,4 Volumenprozent signifikant, während sich der Kapillarhämatokrit nicht signifikant verändert.

To quantify the fluidity of blood it is not suitable to measure whole blood viscosity as blood is no Newton's fluid. For this reason, it is necessary to measure characteristic blood flow parameters direct. This study presents methods of measurement for plasma viscosity, haematocrit, thrombocyte aggregation, erythrocyte rigidity, erythrocyte aggregation and leukocyte adhesivity.

Error analysis or the evaluation of the precision of microscopic measurements must distinguish between technical errors inherent in the measuring system, and biological variability. The technical error inherent in the overall system in the case of linear measurements is smaller than the lengths to be measured by 1 or 2 orders of magnitude. Thus, the erythrocyte column lengths can be correctly, reproducibly and linearly quantified over the entire measuring range. The biological influencing factors can largely be taken into account or excluded by suitable standardisation of the measuring process. Despite a considerable individual fluctuation in the erythrocyte velocity, there is, on average, no significant dependence of the measuring parameter within the daily profile or from day to day. Differences in capillary perfusion in the presence of diseases associated with microcirculatory disorders or a therapeutic influence on erythrocyte velocity can thus be reliably demonstrated.

Despite the proven clinical efficacy of phosphodiesterase inhibitors in the treatment of erectile dysfunction (ED), some patients do not respond to the medication. By means of nailfold capillary microscopy in patients with concomitant coronary artery disease (CAD) and ED, it was evaluated whether the extent of microvascular dysregulation predicts the responsiveness to tadalafil (TAD) in terms of erectile function. The ED of each patient was assessed by the International Index of Erectile Function (IIEF). Patients presenting both, documented CAD and ED, showed a significantly reduced capillary red blood cell velocity (v(RBC)) at rest and after 3 min of ischemia compared with age-matched controls. At 2 h after intake of 20 mg of TAD, a significant increase of v(RBC) at rest as well as during postischemic hyperemia was found. Patients who reported no improvement of their ED after the use of TAD demonstrated no changes in the duration of postischemic (DpH) hyperemia, or even a reduction of the DpH. The majority of the patients, who reported at least one successful sexual intercourse due to TAD, had a prolongation of DpH. We conclude that assessment of microvascular regulation by nailfold capillary microscopy can predict the probability of a treatment failure with phosphodiesterase inhibitors in patients with ED. Moreover, as endothelial dysfunction is the common underlying pathophysiological process of ED and cardiovascular diseases, the test may help to identify patients at risk for the development of atherosclerosis and following cardiovascular events.

This study was designed to compare the rate of restoration to sinus rhythm in patients with permanent atrial fibrillation (pAF) undergoing endocardial microwave ablation during isolated coronary artery bypass grafting (CABG) or isolated mitral valve surgery.A total of 42 patients who underwent isolated CABG (age, 70.1 +/- 5.8 years) and 68 patients (age, 64.4 +/- 8.7 years) who underwent isolated mitral valve surgery were included in the registry. During the operation, all patients received endocardial microwave ablation. Follow-up examinations were performed 1, 3, 6, and 12 months after discharge.A 1-year follow up was obtained for all patients. In the CABG and the mitral valve surgery groups, sinus rhythm, as determined by a 24-h Holter electrocardiograph, was observed in 72% and 63% of the patients, respectively.The difference in sinus rhythm restoration in the CABG and mitral valve surgery groups did not reach statistical significance. Microwave ablation in combination with CABG or mitral valve surgery can be performed with comparable and acceptable success rates.

AIM: To establish the extent to which contrast enhancement with SonoVue in combination with quantitative evaluation of contrast-medium dynamics facilitates the detection of hepatic tumors. METHODS: One hundred patients with histologically confirmed malignant or benign hepatic tumor (maximum size 5 cm) were analyzed. Contrast-enhanced ultrasound (bolus injection 2.5 mL SonoVue) was carried out with intermittent breath-holding technique using a multifrequency transducer (2.5-4 MHz). Native vascularization was analyzed with power Doppler. The contrast-enhanced dynamic ultrasound investigation was carried out with contrast harmonic imaging in true detection mode during the arterial, portal venous and late phases. Mechanical index was set at 0.15. Perfusion analysis was performed by post-processing of the raw data [time intensity curve (TIC) analysis]. The cut-off of the gray value differences between tumor and normal liver tissue was established using Receiver Operating Characteristic (ROC) analysis 64-line multi-slice computed tomography served as reference method in all cases. Magnetic resonance tomography was used additionally in 19 cases. RESULTS: One hundred patients with 59 malignant (43 colon, 5 breast, 2 endocrine metastases, 7 hepatocellular carcinomas and 2 kidney cancers) and 41 benign (15 hemangiomas, 7 focal nodular hyperplasias, 5 complicated cysts, 2 abscesses and 12 circumscribed fatty changes) tumors were included. The late venous phase proved to be the most sensitive for classification of the tumor type. Fifty-eight of the 59 malignant tumors were classified as true positive, and one as false negative. This resulted in a sensitivity of 98.3%. Of the 41 benign tumors, 37 were classified as true negative and 4 as false negative, which corresponds to a specificity of 90.2%. Altogether, 95.0% of the diagnoses were classified as correct on the basis of the histological classification. No investigator-dependency (P = 0.23) was noted. CONCLUSION: The results show the possibility of accurate prediction of malignancy of hepatic tumors with a positive prognostic value of 93.5% using advanced contrast-enhanced ultrasound. Contrast enhancement with SonoVue in combination with quantitative evaluation of contrast-medium dynamics is a valuable tool to discriminate hepatic tumors.

In 1974, Wu and Hoak described a method for determining circulating platelet aggregates. This method was modified by Grotemeyer in 1983. The platelet reactivity index (PR) is based on the ratio of platelet aggregates in blood samples obtained in different buffer solutions. Platelet aggregates are resolved when blood is sampled in EDTA-buffer, but remain fixed when EDTA-formalin-buffer is used. Generally, the PR is preferred, because in vitro manipulations of platelets are not necessary, and the results are calculated. PR values above 1.05 are suspicious for elevated platelet aggregation. PR values above 1.2 indicate pathological changes in platelet aggregation. The PR is inexpensive (4.0 euro dollars) and rapid to perform. PR values were used successfully to identify nonresponders to secondary prophylaxis with acetylsalicylic acid (ASA), that is, patients suffering from stroke (33%) and patients after cardiac ischemia (18%). Furthermore, elevated PR values correlated significantly with the incidence of arterial thromboembolic complications. The PR correlated well in our prospective study with values received from the retention test Homburg (RT-H) and the platelet function analyzer (PFA-100). The data indicate that the values of the PR seem to be highly predictive for the evaluation of the ASA therapy. However, the PR is not feasible for the determination of the ASA overdosage.

The surgical treatment of atrial fibrillation (AF) by Cox and other ablation methods shows a 50-90% conversion rate to sinus rhythm. However, to date no study has addressed the influence of ablation on the mortality rate.The perioperative and postoperative mortalities of 210 consecutive patients with permanent AF was investigated for up to two years after cardiac surgery with (n = 111) or without (n = 99) endocardial microwave ablation within the framework of a prospective register study. All patients were followed up.In the ablation group, one patient (0.9%) died perioperatively, seven died during the first year of follow up (6.3%), and nine in the second year of follow up (8.1%). In the control group, five patients died perioperatively (5.1%), 12 died in the first year of follow up (12.1%), and 22 in the second year of follow up (22.2%). During the two-year follow up period, significantly more patients died in the control group than in the ablation group (Log-Rank test: p = 0.0051).The results of this register study showed that among patients with permanent AF who underwent cardiac surgery with ablation, mortality was significantly lower than in those who underwent comparable surgery but without ablation. The marked difference in mortality was essentially based on the typical clinical consequences of AF (e.g. thromboembolic complications, cardiac arrhythmias and bleeding complications due to anticoagulation therapy), which occurred less often in the ablation group.

Background: The value of magnetocardiography (MCG) for the detection of cardiac electrical disturbances associated with myocardial ischemia was studied. Methods: Sensitivity and predictivity of admission MCG for the presence of coronary artery disease (CAD) were prospectively evaluated in 264 consecutive patients presenting with acute chest pain and without ST-segment elevation. MCG findings were compared with 12-lead ECG, echocardiography (ECHO), and troponin-I in a head-to-head design. Coronary angiography was used for CAD diagnosis. Results: The visual assessment of magnetocardiograms by the experienced reader (R1) was superior to that by the unexperienced reader (R2) and superior to the automated computer analysis. Specificity and positive predictive value of MCG by R1 were comparable with those of ECG and troponin-I (>90%), while ECHO specificity and ECHO positive predictive value were lower (76.2% and 87.9%, respectively). Sensitivity and negative predictive value of MCG were twice as high as those in the ECG, troponin-I, and ECHO tests. Conclusion: For the prediction of CAD in patients presenting with acute chest pain and without ST-segment elevation, an admission MCG test was superior to an admission ECG, ECHO, and troponin-I. The results of the study, however, are applicable only to a highly selected population comprising patients in whom immediate coronary angiography can be performed based on their clinical course in the hospital.

Introduction: The influence of heart rate on cardiac output, oxygen consumption, and myocardial activity has been widely investigated. However, the influence of heart rate on myocardial oxygen tension ( p O 2 ) remains unclear. Since the introduction of flexible p O 2 micro catheters to measure partial oxygen tension in a working muscle, it is possible to investigate the influence of heart rate on myocardial oxygen tension. Methods: Intraoperatively, a flexible p O 2 micro catheter was positioned in the mid-myocardium of 8 male farm pigs. The heart rate was varied via an external pacer from base rate up to fibrillation and the corresponding myocardial p O 2 was measured. Results: Within 2 min, the myocardial p O 2 adjusted to a change in heart rate. In this animal model, an optimal myocardial p O 2 was observed at 109 bpm. A further increase in heart rate led to a decrease in myocardial p O 2 . When the heart rate was reaching the level of a fibrillation, p O 2 dropped to zero. Conclusion: In young healthy pigs – with a normal blood vessel regulation and the pharmacologic and experimental conditions used in this study – a significant relation between myocardial p O 2 and heart rate was observed. Myocardial oxygen tension increased during cardiac pacing until a heart rate of 109 bpm. Thereafter a decline of p O 2 occurred. Each change in heart rate resulted in a corresponding change of p O 2 within roughly 2 min.

Establishing guidelines towards an assessment of prostheses dysfunction using LDH as a marker is difficult as shown by [M. Suedkamp, A.J. Lercher, F. Mueller-Riemenschneider, K. LaRosee, P. Tossios, U. Mehlhorn, Hemolysis parameters of St Jude Medical hemodynamic valves in aortic position, Int. J. Cardiol (95) (2004) 89-93]. In response to their work we would like to add our data concerning ATS valves (AP) and say a word of caution in interpreting an increase of LDH values.

This study evaluated specially designed perfluorocarbon (PFC) emulsions as blood substitutes in case of induced ischemia of the left heart ventricle in healthy farm pigs. Two hundred ml of perfluorocarbon emulsion were infused while 200 ml of blood were simultaneously drawn. Radiographic contrast media were given to aid placement of balloon catheters in the left coronary artery. Histopathological analysis showed that right heart failure caused the deaths of both pigs. Particles (up to3 micro) of foreign body materials obstructed capillaries of all organs analyzed (heart, lung, liver, kidneys and spleen). Laboratory investigation showed severe interference between the PFC emulsion and radiographic contrast media, resulting in the deterioration of the PFC emulsion. The strongest interference occurred when PFC emulsion and Accupaque interacted; particle size started at an initial 311 nm and went up to3 micro within seconds. Great care must be taken when PFC emulsions are used in combination with x-ray contrast media. None of the described radiographic contrast media should be used within 48 hours prior to the use of this PFC emulsion. Also, the use of these contrast media should be avoided for a certain period of time after using PFC emulsion. The mechanisms of elimination of PFC emulsions from the circulation are not completely understood and has yet to be evaluated.

The number of surgical coronary revascularization procedures is static and even declining. Since the introduction of drug eluting stents the question arose whether this will have an impact on the spectrum of surgical coronary revascularization procedures.Bypass surgery is a routine procedure for the treatment of coronary artery disease with good results. Studies have shown that there is a benefit in favor of surgery compared to interventional cardiologic procedures. DRUG-ELUTING STENTS: In recent studies a new generation of stents, drug-eluting stents, have proven to have a significant better patency rate than common stents. However, to date there are no studies which show a benefit compared to surgery given the same indication for treatment.Therefore, the question whether drug-eluting stents have an impact on the spectrum of bypass surgery cannot be fully answered at present.

Microwave ablation (MW) has been established as a safe and efficient procedure for the treatment of permanent atrial fibrillation (pAF) resulting in conversion to sinus rhythm (SR). For further improvement of clinical results, a new ablation line concept has been introduced. We present the first clinical results using this new concept in comparison with the results of previous ablation line concepts.Ablation lines were performed using microwave energy (Flex 2 and Flex 4 device). We compared two groups, including patients (pts) with mitral valve disease (MVD), coronary artery disease (CAD), and aortic valve disease (AVD). Group A included 137 patients, age 68.4+/-7.8, with ejection fraction 32-80%, left atrial diameter 52.6+/-9.6 mm, suffering from MVD (n=87), CAD (n=59) or AVD (n=36) with pAF for 6.5+/-9.2 years using the original ablation line concept. Group B included 112 patients, age 68.1+/-8.0, ejection fraction 20-83%, left atrial diameter 53.1+/-8.7 mm with pAF for 6.8+/-7.0 years suffering from MVD (n=72), CAD (n=33) or AVD (n=36) performing a modified ablation line.Survival rate of group A was 98.5% and 97.3% in group B. In the 6-month follow-up for group A, 62% of patients with MVD, 68% with CAD and 78% with AVD were in SR. For group B, 88% of patients with MVD, 78% with CAD and 85% with AVD were in SR.MW has become an efficient option with an excellent benefit/risk ratio for the treatment of pAF in patients with other cardio surgical disease. The modified ablation line concept in association with the introduction of a new ablation catheter resulted in a 10% higher success rate. Therefore we have established this new lesion line concept as our standard for microwave ablation.

In future, the capillary microscopy may add to the spectrum of differential diagnosis finding in haemostaseological and angiogical centres as a screening test. Especially the fast and simple observation of the capillary morphology with changes such as capillary dilatations, capillary bleeding (the easiest case, extravasal cells, but also fresh bleeding at the summit of the capillary) and simultaneous findings of torqua-tion of the capillaries seem to be very sensitive for the diagnosis of the von Willebrand-Jürgens syndrome – according to the data collected until now.

The present study deals with the question if rheological properties of erythrocyte concentrates (EC) are altered during the storage duration. As a parameter of erythrocyte function cell deformability was measured by the passage time of single red blood cells through an artificial capillary. EC viscosity (ECV), red blood cell volume and red blood cell rigitidy of n=21 EC were measured on the 1st, 7th, 14th, 21th and 28th days of storage. An increase in ECV could be observed: 5.18 ± 0.64 on the 1st day, and 7.25 ± 1.53 on the 28th day; p=0.0001. This observation was mainly due to a marked deterioration of erythrocyte rigidity (1.03 ± 0.11 on the 1st day, 1.61+0.14 on the 28th day; p=0.0001). A rise in packed cell volume due to erythrocyte swelling (85.3 ± 4.33 on the 1st day;89.8 ± 4.11 on the 28th day;p=0.0001) might as well have caused an increase in ECV. During duration of storage a significant and relevant deterioration in rheological properties of erythrocyte concentrates could be observed.

The aim of the study was to test the feasibility of the new Realtime Position Management mapping system for ablation of typical atrial flutter.The ultrasound multi-transducer catheters of the RPM Mapping System are placed in the coronary sinus and at the right ventricular apex. Position and movement of the ablation catheter can be depicted on the monitor at any time. Several guiding marks are set in the right atria and thus, define the subsequent lesion lines. A total of 15 patients were treated. In 13 patients complete bi-directional block was established after the ablation. In two patients only significant conduction delay was measured after the end of the procedure. A total of 10.2 +/- 6.3 cooled RF-applications were needed to reach the end-point of the procedure. The total energy was 18.76 +/- 13.23 J. The fluoroscopy time for ablation was 22.2 +/- 8.34 min. During a mean follow-up of 8.4 +/- 3.2 months no recurrence of atrial flutter occurred. One patient developed atypical flutter and another patient had atrial fibrillation. Both patients were treated with antiarrhythmic drugs. There was one ablation related complication, a pericardial effusion.The Realtime Position Management system is easy to manage and control. The precision of anatomical linear lesions is improved and fluoroscopic exposure time considerably reduced after learning curve.

Stefan G Spitzer,1 Laszlo Karolyi,1 Thomas Weinmann,1 Frank Scharfe,1 Carola Rämmler,1 Tobias Otto,1 Friedrich Jung,2 Clemens T Kadalie11Praxisklinik Herz und Gefäße, Akademische Lehrpraxisklinik der TU Dresden, Dresden, Germany; 2Saarland University, Homburg, Saar, GermanyPurpose: To provide data on acute and long-term outcomes from pulmonary vein isolation with the pulmonary vein ablation catheter (PVAC) in patients with paroxysmal or persistent atrial fibrillation (AF).Methods: This was a single-center, retrospective, nonrandomized, case control study. Patients with documented symptomatic paroxysmal or persistent AF were treated with PVAC or with point-by-point radiofrequency ablation guided by the NavX™ mapping system. All follow-up visits were conducted in our center at 1 month, 3 months, and 6 months, and then at 6-month intervals. Electrocardiography and 24-hour Holter monitoring were performed at each follow-up visit. The endpoints included procedure times, acute and 24-month outcomes, and complications.Results: Of the 539 patients that were enrolled consecutively, 388 were ablated using PVAC and 151 using radiofrequency ablation. More patients with paroxysmal AF were treated with PVAC than with radiofrequency ablation. Acute success rates were >99% with both methods. Procedure duration and fluoroscopy times were significantly (P

Twenty-four patients with arterial hypertension (WHO class I) received either 4 capsules of an onion-olive oil maceration product, containing essential ingredients of the Mediterranean diet, or placebo daily over a period of one week. In order to investigate the acute effect on arterial blood pressure, measurements were performed before and 5 h after the administration of the first dose of 4 capsules verum or placebo, respectively. For the evaluation of the long term effect further blood pressure measurements were performed after one week's treatment with a daily dose of 4 capsules. After a wash-out phase of 2 weeks followed by a crossover, the second study phase, which was identical in design, was carried out. In addition patients were instructed to measure their blood pressure 4 times daily at home for the whole study period. Haemorheological parameters (platelet aggregation, erythrocyte aggregation, plasma viscosity and haematocrit) were also determined at the measuring points mentioned above. The onion-olive oil maceration product led to a significant decrease in systolic blood pressure. There was also a trend towards a decrease in diastolic blood pressure. The improved blood fluidity observed resulted from a decrease in haematocrit. All effects could be shown immediately and after one week's administration.

• Purpose: The study was carried out to ascertain the role of blood viscosity in patients with branch retinal vein occlusion (BR-VO) with and without risk factors. • Methods: In 292 patients with acute BRVO (mean age 65 ± 10 years) and 292 controls matched for gender, age, and cardiovascular risk factors, haematocrit, plasma viscosity, erythrocyte aggregation and erythrocyte rigidity were measured. A subgroup analysis in patients with and without risk factors was performed. • Results: Haematocrit and plasma viscosity values were significantly higher in BRVO patients than in controls, but erythrocyte rigidity and erythrocyte aggregaton did not differ. Subgroup analysis revealed no differences in haematocrit and plasma viscosity values between patients with and those without cardioavascular risk factors. • Conclusions: This study shows increased plasma viscosity and haematocrit values in patients with BRVO which are not associated with the presence of other cardiovascular risk factors. Thus, changes in blood fluidity appear to be important factors in the pathogenesis of BRVO.

In the case of peripheral obstructive arterial disease stages IIb, III, and IV, an angiography, an arterial DSA, or in the case of obstruction at the pelvic or upper thigh level, a venous DSA should be done in order to take lumen reconstructing measures into consideration if there are no contraindications for these examinations. If these measures are impossible (surgically or respectively radiological interventionally) and a lysis treatment cannot be undertaken, only other conservative measures remain. The basic treatment of stage IV is the local treatment of sores and keeping the affected limb at rest. In stage IIb the basic treatment is walking or special ergometer strain treatment whose intensity is determined by the circulatory reserve in the limb concerned [7, 19, 25]. The training program is described elsewhere [26]. In recent years hemodilution has proven its worth in the case of poorly or not trainable patients as well as an accompanying treatment form [1, 5, 14–17, 21, 23, 24, 29]. In the case of arterial circulatory disorders a reduced blood fluidity is often observed [1,4, 12, 13] in the form of an increased erythrocyte and platelet aggregation with the formation of sludges, hyperviscosity, hyperactivation of granulocytes which get stuck in the microcirculation (“stickers”). Hemodilution can bring about an inhibition of erythrocyte aggregation, the normalization of hyperviscosity and can rinse the microcirculation free of stickers. Yet, hemodilution should only be carried out if the hematocrit is higher than 42%.

In an open study follow-up angiographies were performed independently from the clinical course on altogether 131 consecutive patients (99 men, 32 women) six months after percutaneous transluminal coronary angioplasty (PTCA). During this period patients received at least 320 mg of aspirin daily. Possible factors affecting the restenosis rate included age, sex, diabetes mellitus, arterial hypertension, abnormal lipid metabolism, smoking, dosage of aspirin administered, degree of stenosis shown by affected vessels before dilatation, number of vascular segments dilated and platelet reactivity. Restenosis was defined as a renewed narrowing of the dilated segment by 50% or more, with an increase in stenosis by at least 20%. In the present study the following restenosis rates were found six month after a primarily successful PTCA: 30% for the entire sample (39 out of 131 patients); 25% in patients with normal platelet function, 50% in those with mildly abnormal platelet function, and 60% in those with frankly abnormal platelet function; 24% in non-diabetic patients and 45% in diabetics. Analysis of the findings showed that abnormal platelet function and the presence of diabetes mellitus were the most important factors in the subsequent development of restenosis after angioplasty. The same also applied in a more restricted manner to the degree of stenosis present before angioplasty.

Das Thema ist so umfangreich, das von mir nicht erwartet werden kann, hier den Versuch zu machen, ein vollstandiges Bild zu geben. Vielmehr geht es um den Beitrag eines Praktikers, und zwar eines ehemaligen Angehorigen des Auswartigen Dienstes. Er wird sich nicht einer politikwissenschaftlichen Ter­minologie bedienen. Seine Ausfuhrungen sollen als Anschauungsmaterial, ge­wissermasen als Rohstoff fur die Erorterungen der Sektion „Regierungssy­stem und Regieren in der Bundesrepublik Deutschland“ dienen.

Degenerative Makulaveranderungen treten in jedem Lebensabschnitt auf. Sie haufen sich jedoch mit zunehmendem Alter. Neben Katarakt und Glaukom gehoren sie bei alteren Menschen zu den haufigsten Augenerkrankungen. Bei 80jahrigen fand Kronzweig [24] in ca. 40% der Falle degenerative Makulaveranderungen. Mit steigender Lebenserwartung in den letzten Jahrzehnten wird die Zahl dieser Patienten immer groser. Die degenerativen Veranderungen in den verschiedenen Gewebsschichten des Makulabereichs sind teilweise Folgen eines primaren Kapillarschadens. Ob die Arteriosklerose der Gefase der Choriokapillaris die alleinige Ursache der Makuladegenerationen ist, wird immer wieder kontrovers diskutiert [12, 14, 22, 28]. Favorisiert werden als weitere Ursachen eine Abflusstorung in den Vortexvenen mit der Folge eines subretinalen Odems [10] sowie eine subretinale Neovaskularisation durch die Freisetzung angiogener Faktoren. In der vorliegenden Untersuchung wurde im Rahmen einer offenen Vergleichsprufung bei 10 Patienten uber 24 Wochen die Wirksamkeit von Ginkgo-biloba- Extrakt 761 (Rokan) auf die Progredienz der senilen Makulopathie untersucht. Die folgenden Parameter gingen in die Bewertung ein: Visus, Gesichtsfeld, Arm-Retina-Zeit, arteriovenose Passagezeit, Erythrozytenaggregation, Erythrozytenrigiditat, Plasmaviskositat.

In this issue of Clinical Hemorheology and Microcirculation Norbert Nemeth publishes a well-written analysis of the often strong attraction to arts, and especially to musical arts, of people of medical vocation and possible reasons therefore [1]. The quest to comprehend the human body and soul, to detect our own vital signs and signs of psychosomatic processes materializes especially in the music, the art with the most complex effects on human sensory reception. Some vital signs like appearance, dynamic changes and the seemingly endless movement of blood and blood circulation are used by artists as expression of life and death. The author beautifully describes the analogy between progress and flow of music with the running of blood, the speeding or slowing tempo and even the fatal arrest of circulation. He reminds A.L. Copley who linked scientific work and hemorheology with arts, nicely demonstrated in his design of the Fahraeus Medal [2]. A description of “music in medicine” with the known and scientifically approved effects on biological parameters of circulation and on the nervous system is given as well as a description of “medicine in music”. In a few divisions, physiological and pathological phenomena of circulation and blood, diseases or care taking medical persons are portrayed describing circulation, stream, rhythm, bleeding, and appearance of blood in the more or less brilliant compositions of musical arts. It may be unusual, but we decided that this manuscript should published in this journal because it is worthwhile considering the authors attitude to become one with an artwork can mean a momentary liberation for the mind grown wary of everyday limitations, duties, responsibilities, decisions and questions, contributing to a more balanced life and aiding medical activity.

In spite of equivalent clinical efficacy of various thrombolytic agents for the treatment of acute myocardial infarction there is evidence of different drug-depending influences on the haemostatic and fibrinolytic system. In the present study 40 patients with acute myocardial infarction have been investigated. 20 patients received 750,000 and 1.5 mio U streptokinase (SK), respectively, 10 patients 30 mg anisoylated plasminogen streptokinase activator complex (BRL 26921) and 10 patients a combination of 200,000 U urokinase (UK) and 4.5 mio U pro-urokinase (PUK) as a short-term intravenous treatment. Reperfusion of coronary arteries has been achieved in 70 to 100 percent. Major not fatal bleedings occurred in 2 patients. One patient died within 72 hours after beginning of the myocardial infarction. The longest duration of fibrinolytic activity was observed in the BRL 26921 group (half-disappearance time close to 2 h). It was significantly shorter in the SK groups showing a dose-dependency. Plasma concentration of fibrinogen dropped beyond normal levels following SK and BRL 26921, but not under UK/PUK. Plasma viscosity correlated with fibrinogen decrease and displayed a dose-depending relationship with the presence of SK. Haemorheological effects are suggested to be important for the clinical efficacy of thrombolytic therapy in myocardial infarction.

Sensitivity and predictivity of admission MCG for the presence of coronary artery disease (CAD) were prospectively evaluated in 264 consecutive patients presenting with acute chest pain and without ST-segment elevation. Magnetocardiographic findings were compared with 12-lead electrocardiogram (ECG), echocardiography (ECHO), and troponin I in a headto-head design. Coronary angiography was used for the diagnosis of CAD. Specificity and positive predictive value of MCG were comparable with those of ECG and troponin I (N90%), whereas ECHO specificity and ECHO positive predictive value were lower (76.2% and 87.9%, respectively). Sensitivity and negative predictive value of MCG were twice as high as those in the ECG, troponin I, and ECHO tests. A subgroup of 62 patients presented with bundle-brunch block (BBB) (left BBB [LBBB], n = 32; right BBB [RBBB], n = 30; males, 41; females, 21). Specificity, sensitivity, as well as negative and positive predictive values of the 3 diagnostic tests at admission for the recognition of CAD in patients who have BBB presenting with acute chest pain are shown in the table.