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Durch die Fortschritte bei der Transplantation wird zunehmend ein längeres Überleben der Patienten ermöglicht. Vor diesem Hintergrund gewinnen während der Zeit der chronischen Erkrankung erworbene Störungen sowie die im Verlauf nach der Transplantation auftretenden Nebenwirkungen an Bedeutung. Bei Beschränkung auf Veränderungen an der Lunge konnte bei Patienten mit chronischem Organversagen (Herz, Leber und Niere) gezeigt werden, dass lungenfunktionell messbare Störungen nachweisbar sind. Diese manifestieren sich vorrangig als Veränderungen der Diffusion, gefolgt von restriktiven und obstruktiven Ventilationsstörungen. Es bisher ungeklärt, inwieweit an deren Ausprägung interstitielle Lungenerkrankungen beteiligt sind. Gegenstand der Arbeit war die Analyse der Art, der Häufigkeit und des Umfanges lungenfunktioneller Störungen sowie die Bestimmung des Anteils computertomografisch nachweisbarer interstitieller Lungenveränderungen (ILD) bei transplantierten Patienten. Dazu wurden 79 Patienten nach Nierentransplantation (NTX), 40 Patienten nach Lebertransplantation (LTX), 40 Patienten nach Herztransplantation (HTX) zwischen 45-83 Monaten nach Transplantation mittels kompletter Lungenfunktionsanalyse und hochauflösender Computertomografie untersucht. Für eine vergleichende Betrachtung wurden 75 Patienten mit einer progressiven systemischen Sklerodermie (als ein Krankheitsbild mit Modellcharakter für ILD) ausgewertet. Die lungenfunktionellen Daten von 642 Patienten, eine spiroergometrische Analyse sowie eine autoptische Untersuchung bei Patienten nach HTX ergänzten die Erhebung. Als Ergebnisse konnten restriktive Ventilationsstörungen bei 2,5 - 10 Prozent in den drei Gruppen transplantierter Patienten nachgewiesen werden. Eine Obstruktion fand sich in vergleichbarer Größenordnung mit Werten zwischen 7,5 - 10 Prozent. Störungen der Diffusion konnten bei Verwendung des Transferfaktors der Lunge (TLCO) bzw. des Transferkoeffizienten (KCO) bei Patienten nach HTX mit 65 bzw. 98 Prozent, nach NTX mit 44 bzw. 68 Prozent und nach LTX mit 32 bzw. 68 Prozent ermittelt werden. Damit waren diese Veränderungen signifikant häufiger bei Patienten nach HTX gegenüber den beiden anderen Gruppen transplantierter Patienten nachweisbar. Computertomografisch nachweisbare ILD wurden nach LTX mit 5 Prozent , nach HTX mit 12 Prozent und nach NTX mit 24 Prozent gefunden. Damit konnte eine signifikant unterschiedliche Häufigkeit bei Patienten nach LTX und NTX festgestellt werden. Bei keiner der untersuchten Gruppen konnte eine signifikante Korrelation zwischen den Befunden der Diffusionsstörungen und dem Nachweis der ILD erfasst werden. Bei der Modellerkrankung waren die radiologischen Befunde häufiger nachweisbar, jedoch qualitativ gleich. Die Daten der 642 Patienten nach HTX zeigten eine konstante Häufigkeit von Diffusionsein-schränkungen, die unabhängig von der Zeit nach Transplantation waren. Die spiroergometrische Analyse nach HTX dokumentierte bei 92 Prozent der Patienten eine eingeschränkte kardiopulmonale Leistungsfähigkeit, wobei daran eine ventilatorische Begrenzung ursächlich nicht beteiligt war. Bei der autoptischen Untersuchung nach HTX fanden sich in 56 Prozent der untersuchten Fälle eine Verbreiterung des Interstitiums der Lunge sowie in 94 Prozent der Fälle Veränderungen an den Blutgefäßen. Die vorliegenden Daten erlauben die Aussage, dass bei transplantierten Patienten Diffusionsstörungen in relevantem Umfang nachweisbar waren. Diese stehen in keinem ursächlichem Zusammenhang mit den geringgradig computertomografisch nachweisbaren interstitiellen Veränderungen. Somit wird mit den Daten die hypothetische Annahme einer vorrangig gefäßbedingten Einschränkung der Diffusion bei den transplantierten Patienten gestützt., Progress made in transplantation medicine is increasingly leading to longer survival of patients. This means that impairment acquired during the time of chronic illness and side effects during the postoperative course are increasingly significant. Considering pulmonary changes, it was shown that in patients with chronic organ failure (heart, liver, kidneys) impairment of lung function was measurable. This manifests mainly as changes in diffusion, followed by restrictive and obstructive ventilatory impairment. It is to date unclear to what extent interstitial lung disease is involved. This study analyzes the kind, prevalence and extent of lung impairment and the role of interstitial lung disease (ILD) revealed by computed tomography in transplanted patients. For this purpose we examined 79 patients after kidney transplantation (KTX), 40 patients after liver transplantation (LTX) and 40 patients after heart transplantation (HTX) between 45 and 83 months after transplantation by means of comprehensive lung function analysis and high-resolution computed tomography. For purposes of comparison, 75 patients with progressive systemic sclerodermia (chosen because of its exemplary nature for ILD) were evaluated. The study also includes lung function data for 642 patients, an analysis of exercise testing and an autopsy investigation of 73 patients after HTX. The results showed restrictive ventilatory impairment of 2.5-10% in the three groups of transplanted patients. The values for obstruction were similar at between 7.5 and 10%. Taking into account the lung transfer factor (TLCO) and the transfer coefficient (KCO), diffusion impairment was calculated to be 65 and 98% respectively in HTX patients, 44 and 68 % in KTX patients and 32 and 68% in LTX patients. These changes were therefore shown to be significantly more common in patients after HTX than in the other two patient groups. ILD revealed by computed tomography was 5% after LTX, 12% after HTX and 24% after KTX, i.e. a significantly different occurrence was found in patients after LTX and KTX. In none of the groups was a significant correlation between diffusion impairment data and ILD shown. In the sclerodermia group ILD could be shown more often than in the transplanted patients but corresponded in quality. The data of the 642 patients after HTX showed a constant incidence of diffusion impairment independent of the posttransplant time. The analysis of exercise testing established in patients after HTX restricted cardiopulmonary function, of which ventilatory impairment was not the cause. The autopsy investigation of patients after HTX showed widening of the pulmonary interstitium in 56% and changes in the blood vessels in 94% of the cases investigated. The data studied show that diffusion impairment was present to a relevant extent in transplanted patients. This impairment has no causative correlation with the interstitial changes shown by computed tomography to be minimal. Therefore the data support the hypothesis of diffusion impairment in transplanted patients being caused mainly by vascular changes.

The water acceptance of subsurface, agricultural pipe drains is largely determined by the hydraulic conductivity of the surrounding zone. If this zone consists of soil with a poor structural stability, such drains must be wrapped with an envelope to control the rate of pipe sedimentation while safeguarding easy access of water. The studies were made to elicidate the effects of envelope specifications on these requirements.Envelope response was observed in analogue models, for cohesionless, and weakly cohesive, very fine sandy soils. Cohesionless soils were stabilised best by "thin" envelopes. Water access was easy and was not a factor of importance in design. In weakly-cohesive soils, the capability of envelopes to meet the requirements was quantified using an "Envelope Suitability Index" (ESI). Both soil type and envelope type had a significant effect on ESI. Nevertheless, analogue model tests were of limited value because the findings could not be compared with field observations.A field survey was made of grade lines of 184 drains and of soil invasion and sedimentation patterns, root penetration and other phenomena in these drains. They were wrapped with various envelope types and installed in weakly-cohesive, very fine sandy soils in three experimental fields in The Netherlands. Over 9600 m of drain length were inspected. The rate of pipe sedimentation differed significantly between the experimental fields. The particle retention capability of envelopes was associated with the effective opening size of their pores, "O 90 ". The mechanisms of soil invasion into drains and the observed sedimentation rates differed from those predicted in analogue models. Generally, envelope specification had no significant effect on drainage resistance; only in cases where drains were also used for subirrigation did "voluminous" envelopes have significantly lower drainage resistances than "thin" ones.Cores, containing wrapped drain sections with the surrounding soil were sampled at 45 locations. All sections had been functioning in weakly-cohesive, fine-sandy soils for a period of 5 years. The effect of soil and envelope specification on the flow of soil particles near the drains was investigated by microgranulometric analysis. Generally, the finest soil particles were found to be concentrated near the soil/envelope interface. This tendency was largely accounted for by the particle size distribution of the soil. A "natural soil filter" had only developed in a few instances. The envelopes improve stability through supporting the soils rather than through acting as filters. The cores were also examined by x-ray computerised tomography (CT) through 50 adjacent slices. This yielded three dimensional (3D) mappings of the most permeable areas inside the drain envelopes and surrounding soils that convey most of the water to the drains. A finite element model was used to study the effect of radial soil heterogeneity around a subsurface drain on the water table height. Water flow and envelope clogging were found to be quite heterogeneous and were mainly determined by soil structural features. Soil structural stability is therefore the main determinant of the service life of wrapped drains. The physical effect of an envelope on physical soil/envelope interactions is less important than is generally assumed. On the contrary, soil properties are crucial.

Kaiser, Hermann J. [Hrsg.]: Musikalische Erfahrung: Wahrnehmen, Erkennen, Aneignen. Essen : Die Blaue Eule 1992, S. 295-310. - (Musikpädagogische Forschung; 13), Im Juni 1991 erschienen die beiden führenden musikpädagogischen Zeitschriften eine mit dem Thema Kunstlied, somit belcanto, die andere mit dem Thema Pop, Rock, Jazz. Dabei existiert das Thema, die Polarität beider Singideale in unserer Kultur, schon seit den 60er Jahren, seitdem sich der Einfluß der Massenmedien und der amerikanischen Popmusik durchsetzte. Dagegen ist heute der Popgesang einerseits Ausdruck einer jugendlichen Subkultur in Discos und Beatveranstaltungen. Anderseits aber wird er als eine allgemein verbreitete und damit gültige Art zu singen akzeptiert. Damit ist er ein Produkt unserer heutigen Kultur. Nun existiert menschliche Kultur nur aufgrund einer langen Tradition - man kann Kultur nicht neu erfinden - weshalb das Problem der beiden Singideale nicht nur systematisch, sondern auch historisch zu untersuchen ist. (DIPF/Orig.)

The water acceptance of subsurface, agricultural pipe drains is largely determined by the hydraulic conductivity of the surrounding zone. If this zone consists of soil with a poor structural stability, such drains must be wrapped with an envelope to control the rate of pipe sedimentation while safeguarding easy access of water. The studies were made to elicidate the effects of envelope specifications on these requirements.Envelope response was observed in analogue models, for cohesionless, and weakly cohesive, very fine sandy soils. Cohesionless soils were stabilised best by "thin" envelopes. Water access was easy and was not a factor of importance in design. In weakly-cohesive soils, the capability of envelopes to meet the requirements was quantified using an "Envelope Suitability Index" (ESI). Both soil type and envelope type had a significant effect on ESI. Nevertheless, analogue model tests were of limited value because the findings could not be compared with field observations.A field survey was made of grade lines of 184 drains and of soil invasion and sedimentation patterns, root penetration and other phenomena in these drains. They were wrapped with various envelope types and installed in weakly-cohesive, very fine sandy soils in three experimental fields in The Netherlands. Over 9600 m of drain length were inspected. The rate of pipe sedimentation differed significantly between the experimental fields. The particle retention capability of envelopes was associated with the effective opening size of their pores, "O 90 ". The mechanisms of soil invasion into drains and the observed sedimentation rates differed from those predicted in analogue models. Generally, envelope specification had no significant effect on drainage resistance; only in cases where drains were also used for subirrigation did "voluminous" envelopes have significantly lower drainage resistances than "thin" ones.Cores, containing wrapped drain sections with the surrounding soil were sampled at 45 locations. All sections had been functioning in weakly-cohesive, fine-sandy soils for a period of 5 years. The effect of soil and envelope specification on the flow of soil particles near the drains was investigated by microgranulometric analysis. Generally, the finest soil particles were found to be concentrated near the soil/envelope interface. This tendency was largely accounted for by the particle size distribution of the soil. A "natural soil filter" had only developed in a few instances. The envelopes improve stability through supporting the soils rather than through acting as filters. The cores were also examined by x-ray computerised tomography (CT) through 50 adjacent slices. This yielded three dimensional (3D) mappings of the most permeable areas inside the drain envelopes and surrounding soils that convey most of the water to the drains. A finite element model was used to study the effect of radial soil heterogeneity around a subsurface drain on the water table height. Water flow and envelope clogging were found to be quite heterogeneous and were mainly determined by soil structural features. Soil structural stability is therefore the main determinant of the service life of wrapped drains. The physical effect of an envelope on physical soil/envelope interactions is less important than is generally assumed. On the contrary, soil properties are crucial.

Het was het doel van dit onderzoek om een dergelijke vergelijking te maken, waarbij de resultaten van computertomografie zonder contrastmiddel in de speekselklierbuizen (BCT), computertomografie met contrastmiddel in de speekselklierbuizen (CTS) en conventionele sialografie (CS) met elkaar werden vergeleken. ... Zie: Samenvatting

Het was het doel van dit onderzoek om een dergelijke vergelijking te maken, waarbij de resultaten van computertomografie zonder contrastmiddel in de speekselklierbuizen (BCT), computertomografie met contrastmiddel in de speekselklierbuizen (CTS) en conventionele sialografie (CS) met elkaar werden vergeleken. ... Zie: Samenvatting

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