Coronary heart disease -- significance of coronary intervention]

Coronary revascularization using percutaneous coronary intervention (PCI) has rapidly developed in the past 2 decades and its technical and pharmaceutical improvements may avoid bypass surgery in many situations. The use of drug-eluting stents (DES) challenges the classic indications for bypass surgery and shifts them toward PCI, with the need for a critical appreciation of procedure- and patient-related risks. Furthermore, invasive measures such as intravascular ultrasound or pressure wire allow lesion-specific and immediate therapeutic decisions. This overview summarizes the actual potential of coronary intervention. To be aware of potentials and limitations may help the non-interventionalist to advise his patient and to choose the appropriate treatment.     

Nonparasitic Cysts of the Liver: Results and Options of Surgical Treatment

n = 9) should be regarded as a palliative measure. Within a short period, CT-guided aspiration led to recurrence of symptoms in seven of our patients. Standard treatment of NPHC is fenestration with widest possible excision of the cystic wall, which can be performed laparoscopically ( n = 10) or by the conventional surgical mode ( n = 54). One patient was initially operated by the laparoscopic technique but developed bleeding, which necessitated conversion to the open mode. Three patients underwent synchronous laparoscopic cholecystectomy. Recurrence rates were similar: 11% in the laparoscopically treated group and 13% in the group that underwent conventional open surgery. Conventional surgical treatment was always successful in cases of solitary cysts. However, in cases of multiple cysts measuring more than 5 cm, conventional surgery was followed by recurrence of symptoms in 26% of patients (7/27), who then had to undergo a second operation. Partial resection of the liver ( n = 9) was successfully performed in cases of polycystic disease ( n = 5) with concomitant enlargement of the organ as well as in cases of large solitary cysts of the left lobe of the liver ( n = 4). In patients in whom we found that the cysts communicated with the ductal system ( n = 3), we performed a cystojejunostomy to drain the bile. The complication rate was low. In addition to frequent postoperative ascites, which necessitated no further intervention, we observed infectious complications in four patients. Twenty patients (22%) expired during a mean follow-up period of 6.2 years. Interestingly, deaths were frequently associated with malignancy (11/20). After fenestration of multiple cysts measuring > 5 cm, the patients are at high risk for recurrence. Hence partial resection of the liver is an excellent therapeutic alternative in selected patients with polycystic disease and massive enlargement of the organ in whom the disease could not be controlled by simple fenestration. The results of this study show that laparoscopic fenestration should replace the conventional surgical technique as the gold standard in cases of NPHC because the laparoscopic technique is less stressful for the patient and is associated with a rate of success similar to that of the conventional technique.     

Imaging of shifted stimulated echoes and multiple spin echoes

It is shown that a repetitive pulse sequence consisting of two 90° pulses and gradients in a 1:2 ratio around the second 90° pulse generates interscan shifted stimulated echoes (SSTEs) and intrascan multiple spin echoes (MSEs). Separation of these two types of signals is accomplished using specific gradient crusher schemes. The intensity of the SSTEs is an order of magnitude larger than that of the MSEs and determines the signal contrast if both effects are selected simultaneously. The SSTE sequence generates improved contrast between gray and white matter, even at high field, which is explained in terms of increased inverse T₁-weighting for the interscan echo. The MSE image has low signal to noise and no detectable contrast. The effect of interscan diffusion weighting is also discussed.     

Inversion lateral ankle trauma: differential diagnosis, review of the literature, and prospective study

This study is comprised of 71 patients with inversion injuries. The purpose of this article is to present a logical and orderly approach in evaluating these injuries. A comprehensive review of the literature concerning diagnostic techniques and mechanisms of injury related to inversion ankle trauma is presented. Inversion ankle injuries are frequently misdiagnosed as simple sprains when frequently there are other pathologies present. The standard approach of evaluating inversion ankle injuries is often inadequate.     

Energy metabolism in the whole animal revisited

Dimensional analysis of animals with regard to those structures and functions which affect the rate of energy metabolism can be conducted on the basis of either geometric or elastic similarity. Predictions of the relationships between various structures and functions and body mass are dependent of the type of similarity assumed. Comparison of the relationships between numerous physiological variables and body mass reported in the literature and those predicted from geometric and elastic similarity indicates that the preponderance of predictions from elastic similarity are in better agreement with the observed values than are the predictions from geometric similarity. It appears that the components of the cardiovascular system are scaled in accordance with elastic similarity. For this reason, cardiac output is proportional to body mass raised to the 3/4 power. The biochemical basis for the relationship between cardiac output and the rate of energy metabolism is discussed.     

Non-A Non-B Hepatitis and the Safety of Intravenous Immune Globulin, pH 4.2: A Retrospective Survey:

Abstract. Evidence for transmission of non-A non-B hepatitis (NANB) was sought in 41 patients with primary immune deficiency who were receiving human intravenous immune globulin (IGIV) over periods ranging from 6 to 15 months at a monthly dosage of 400 mg/kg body weight. One lot of a reduced and alkylated IGIV and three lots of a nonmodified preparation stabilized at pH 4.2 were used. No evidence of NANB was found, although transient elevations in serum glutamic pyruvic transaminase (alanine aminotransferase) were found in 6 of the patients. The possible causes of the elevated levels in these 6 patients are discussed.