Prognostic value of supine scintigraphic heart function and simultaneous conventional exercise response in patients after myocardial infarction

A total of 240 survivors of one or more myocardial infarctions were consecutively admitted to perform supine exercise radionuclide ventriculography. Within 3 years after the test, 22 died; this group was compared to an age-matched control group of 22 survivors for left and right ventricular function during rest, exercise, and simultaneously assessed exercise performance as well as ECG variables. Evaluation of 3-year survival by linear discriminant analysis revealed an accuracy of 82% for discriminant models using ECG and exercise performance variables. Implementation of resting left ventricular ejection fraction and change of right ventricular ejection fraction during exercise, as well as scintigraphic presence or absence of dyskinesia, improved the accuracy of the model to 91% of correctly classified patients.     

Radionuclide detection of mild valvular regurgitation: its significance as assessed by Doppler sonography

Radionuclide ventriculography (RNV) indices of regurgitation, Fourier amplitude ratio (FAR) and additional RNV variables were prospectively compared to Doppler echocardiography (DE) in 108 consecutive patients with no or mild left ventricular regurgitation, to assess RNV accuracy in detecting regurgitation in patients with different cardiac disorders. Exclusion of left ventricular or tricuspid regurgitation allowed investigation of the FAR range at rest and during exercise in a sufficiently large appropriate reference group without regurgitation. FAR, as well as other RNV variables, failed to provide more information for the diagnosis of mild (clinically irrelevant) left ventricular regurgitation than the diagnosis upon admission alone. Despite the superiority of DE as a gold standard in the detection of mild regurgitation, at present evaluation of RNV regurgitation indices might be the only method to discover regurgitation arising during dynamic exercise.     

Acute hypoxia due to right to left blood shunting in a patient with atrial septal defect

Acute right to left blood shunt is an unusual cause of acute hypoxia. We describe a case of a patient with an atrial septal defect who developed acute hypoxia due to cardiac tamponade. Acute haemopericardium developed as a complication of temporary transvenous cardiac pacing. Bubble contrast echocardiography confirmed right to left blood shunting at the atrial level. Acute hypoxaemia and the right to left blood shunt resolved when the pericardium was drained. The case underscores the importance of evaluating the presence of an intracardial shunt in patients with otherwise inexplicable hypoxia.     

Brusterhaltende Chirurgie des Mammakarzinoms unter ästhetischen Aspekten

Breast-conserving therapy has become standard in the treatment of breast cancer. However, the greater the amount of tissue removed, the higher the risk of visible deformity leading to an unacceptable aesthetic result. This conflict between oncological safety and aesthetic result is most evident when attempting breast-conserving surgery in patients with small breast/tumour ratios. For this reason, the widespread popularity of breast-conserving surgery has focused attention on new oncoplastic techniques that can avoid unacceptable cosmetic results. The wide spectrum of oncoplastic techniques published in recent years necessitates a systematic structuring of these procedures.     

Maßnahmen durch Ersthelfer am Unfallort Eine prospektive, epidemiologische Studie im Raum Wien

The object of this prospective, epidemiological study was to determine whether bystanders provided necessary first aid measures in the prehospital trauma setting, whether they performed these measures correctly, and whether the level of first aid training affected the quality of first aid measures performed. Data were collected by means of a questionnaire, which was filled out between March and July 2000 for all cases attended to by the Vienna Ambulance Service. A total of 2812 cases were documented. The most frequent causes of trauma were falls from heights less than 1 meter (50%) and traffic accidents (17%). The most frequent injuries were injuries to the extremities (59%) and head and traumatic brain injuries (42%). Most patients were "moderately" or "severely" injured (69% and 29%, respectively), but life-threatening injuries were rare (2%). Bystanders were present in 57% of the cases. The most frequently required first aid measures were "application of a dressing" and "positioning" of the patient. "Control of haemorrhage", "ensuring accident site safety" and "extrication" of the patient were less frequently required. "Clearing of the airway", "precautions against hypothermia" and cardio-pulmonary resuscitation were very rarely required. Bystanders were most frequently policemen, relatives or friends of the patient, and strangers. The vast majority of bystanders had no training in first aid or had only attended the first aid course required to attain a driving license. We found a clear relationship between the level of first aid training and the quality of first aid measures provided. It would be advisable to offer an increased amount of refresher courses in first aid to improve bystander trauma care.     

Myocardial fatty acid metabolism during acute cardiac allograft rejection

Fatty acids are promptly taken up, metabolised and eliminated by healthy cardiomyocytes. Cardiomyopathy, coronary heart disease and chronic rejection are known to be associated with an impaired fatty acid metabolism. It was the aim of this study to investigate fatty acid metabolism in a rat heart transplant model and to correlate scintigraphic findings with histological changes. After right-side nephrectomy of Lewis recipients Brown Norway cardiac allografts were anastomosed to the renal vessels. Animals were given no immunosuppression. The metabolism of carrier-free 17-¹²³ jodo-heptadecanoic acid (¹²³J-HDA) with a specific activity of >2×10¹⁷ Bq/ml was scintigraphically measured between days 1 and 11. An increase in the grade of rejection was observed over time. Fifty-six frames of 30 s duration each were recorded. For the region of interest (native heart, transplanted heart, left kidney) frames 10–56 were superimposed, time-activity curves generated and monoexponentially fitted. Furthermore, elimination half-life and intercepts were calculated. Following scintigraphic evaluation the animals were killed and graft as well as native hearts excised for histological examination. The uptake of the tracer identified severe grades of rejection. Elimination half-life of the tracer was twice as long from hearts with mild rejection and more than 14 times as long in severe rejection compared with no rejection. Elimination half-life and amplitude did not permit discrimination between grades 1, 2 and 3 a, but significantly decreased in groups 3 b and 4. This method therefore seems to be a valuable tool for the noninvasive detection of severe acute cardiac allograft rejection. Since fatty acid metabolism is clearly stress-dependent it remains to be seen whether this method allows detection of earlier rejection in loaded hearts.     

Emergency room management of patients with blunt major trauma: evaluation of the multislice computed tomography protocol exemplified by an urban trauma center

BACKGROUND: The early clinical management of patients with major trauma still represents a challenge. To clinically evaluate the full extent of a patient's injuries is difficult, especially when the patient is unconscious. Before December 2002, trauma patients admitted to our emergency room (ER) underwent a diagnostic protocol including physical examination, conventional radiography (CR), sonography and further procedures if necessary. After the installation of a MSCT scanner, all trauma patients underwent the "MSCT protocol" immediately after admission. The aim of the study was to compare the "MSCT-protocol" as it is performed at our institution, with the "Pre-MSCT-protocol". METHODS: We compared 185 patients undergoing the "Pre MSCT-protocol" with 185 patients undergoing "MSCT protocol". We evaluated the efficacy, speed and accuracy of the "MSCT protocol" using several variables. Time periods from admission to the ER to admission to the intensive care unit were compared as well as outcome parameters such as length of ICU stay, ventilation period and rates of organ. Dichotomous data were analyzed by Chi-square analysis; continuous data were analyzed by Student's t test. Any values of p < 0.05 were considered significant for any test. RESULTS: No significant differences were found regarding demographic data. The full extent of injuries was definitively diagnosed after 12 +/- 9 minutes in 92.4% of the "MSCT protocol" cohort. In only 76.2% of "Pre-MSCT protocol" cohort definitive diagnosis was possible after 41 +/- 27 minutes. Total ER time was 104 +/- 21 minutes with the "Pre-MSCT protocol" and 70 +/- 17 minutes with "MSCT protocol" (p < 0.05). "Pre-MSCT protocol" patients had a significantly longer ICU stay than "MSCT protocol" patients (p < 0.05). "MSCT protocol" patients had significantly fewer ventilation days (14.3 vs. 10.9 days). Furthermore, rates of organ failure were lower in patients undergoing the "MSCT protocol". CONCLUSION: We could demonstrate that immediate MSCT in patients with blunt major trauma leads to more accurate and faster diagnosis, and reduction of early clinical time intervals. We also observed a reduction in ventilation, ICU, and hospital days, and in organ failure rates, though this might have been partly due to small differences in case mix. The "MSCT protocol" algorithm seems to be safe and effective.     

Hepatocellular transplantation into the lung for temporary support of acute liver failure in the rat.

Because hepatocyte transplantation into the spleen or the peritoneal cavity, although successful in rats, is more difficult and less successful in larger animals, the lung was chosen for its accessibility and its high oxygen content as a new site for hepatocyte implantation for treatment of acute hepatic failure. Acute hepatic failure was induced by a combination by a portocaval side-to-side shunt and an 80% liver resection, which was associated with a greater than 90% mortality. Hepatocyte transplantation was performed either by injection of 1 x 10(7) cells via the jugular vein (100% mortality) or 5-7 x 10(7) cells transcutaneously into the right lung (92% survival). After injection of the cell-free supernatant into the lung, 53.3% of the animals survived. If more than 90% of the liver was resected, none of the animals survived despite hepatocyte or supernatant injection. From these findings, it is concluded that the lung is a suitable home for hepatocytes. However, the hepatocytes survived only in cases of acute hepatic failure with some remaining vital liver parenchyma.