Localisation of gene for the naevoid basal-cell carcinoma syndrome.
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Biomedical subjects
Publications and source records attributed to G Linss.
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Strategy for the diagnosis of heart insufficiency is directed to the accomplishment of distinct therapeutic aims. Main factors for diagnostic approaches are pathophysiology and progression of qualitatively and quantitatively different disturbances in cardiac performance. Anamnesis and clinical investigations are irremissible for the evaluation of congestive heart failure. For the detection of noncongestive cardiac insufficiency investigations during exercise are often necessary. Ventriculography ist the standard reference technique for measurement of the systolic and diastolic ventricular functions. For exercise and follow-up investigations non-invasive methods are widely used. Accepted methods are two dimensional and Doppler-echocardiography, quantitative radiocardiography with single-pass bolus technique, and radionuclid-ventriculography. We found a good correlation for the measurement of stroke volume when comparing impedance cardiography with uniplane ventriculography at rest. M-mode echocardiography did not yield sufficiently reliable volumetric data. The new imaging methods, positron emission tomography, magnetic resonance technique, and cine computed tomography are future tools for cardiac output measurements.
The literature review reflects new aspects of pathophysiology and pathogenesis of arterial hypertension with special regard to the role of tissue renin-angiotensin-systems, endothelial and growth factors. The arteriolar wall as well as different organs produce angiotensin, which is of higher regulatory capability than the circulating angiotensin. Natriuretic hormones, endogenous opioids, neuropeptide Y and other vasoactive peptides are accepted as new humoral factors and neuromediators with different influence on the blood volume and the peripheral resistance. The vessel endothelium produces potent vasoconstricting (e.g. endothelin and vasodilating (e.g. EDRF) factors. Finally, growth factors with their potential role in vessel wall and myocardial hyperplasia/hypertrophy are analyzed. Tissue systems, endothelial and growth factors as new elements of arterial hypertension pathogenesis may influence the further development of new antihypertensive drugs.
The diagnostic step-program in arterial hypertension can be divided in a so called basic program and in special differential-diagnostic programs. The basic evaluation for every hypertensive subject contains family and personal history, clinical investigation, blood pressure measurement, electrocardiogram, chest X-ray, blood tests (creatinine and potassium) and urine analysis. The extended basic program enables the evaluation of global cardiovascular risk. Furthermore other blood and urine examinations (including vanilmandelic acid), fundoscopy, echocardiography and sonography of the kidneys are of particular value for determining severity and etiology of the disease. After this program an extension of diagnostics can be renounced in about 90% of hypertensives.
Transesophageal echocardiography (TEE) represents a substantial methodological extension of the transthoracic approach (TTE). Limitations of TTE can be overcome, furthermore cardiac regions - for instance atrial appendages - can be scanned, which are only difficult to valuate by TTE. The introduction of the endoscope succeed in above 95% of the patients without problems. The transducers work with 30, 48 or 60 single elements and frequencies of 3.5 to 7.5 MHz. The clinical indications for this procedure have included severe cardiac pathology, insufficient TTE, thoracic aortic dissection, prosthetic cardiac valve dysfunction, detection of intracardiac and paracardiac masses, structure lesions and complications of endocarditis, intraoperative monitoring and assessment of critical ill patients in an intensive-care unit. Attending to the prerequisitis and contraindications TEE growth up to an important method for cardiac surgery with regard to prae-, intra- and postoperative diagnostic and evaluation of treatment effectiveness.
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In 30 hypertensives with angina pectoris the acute action of beta-blockers Celiprolol and Metoprolol on the global and coronary haemodynamics was tested within cardiac catheter diagnostics. In accordance with no long-term effects Metoprolol acts negatively inotrope, chronotrope as well as pre- and post-load increasing. Celiprolol lowered the pre- and postload, and increased the cardiac output, but did not influence the heart rate. Both medicaments increased coronary flow and myocardiac oxygen consumption. From the mentioned effects important conclusions for therapy with both Beta-blockers can be derived.
Summarizing our experience with noninvasive techniques in arterial hypertension we can establish that a fast development is going on and noninvasive techniques are useful for functional analysis. This holds for older techniques as phonocardiography with estimation of STI and apexcardiography as well as impedance cardiography and radiocardiography. This is valid especially for newer techniques as color coded 2D-Doppler-echocardiography, radionuclideventriculography, thallium scintigraphy and magnetic resonance tomography.
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The aim of the study was to demonstrate the possibility of transfemoral balloon occlusion of the coronary sinus and to detect changes of the left ventricular function during this occlusion in patients with angina pectoris. In 9 of 18 patients a stable occlusion over 15 seconds was performed. There were found only short term negative effects on the left ventricular contraction and relaxation. The coronary sinus pressure increased to 53 +/- 11 mm Hg. Numerous venous anastomoses made it difficult to occlude completely the sinus. The retrograde perfusion of the myocardium reached 20-30% of the antegrade one.
In 3 out of 133 patients suffering from prostatic cancer and treated with depot estrogens a porphyria cutanea tarda was found after a follow-up ranging from few months to 10 years. Therefore, a defect of the uroporphyrinogen decarboxylase has been postulated. The therapy could be continued under small doses of chlorochin diphosphate.
In a prospective study we tested the possibility to differentiate myocardial tissue by means of the quantitative texture analysis of two-dimensional echocardiographic images. 12 patients with a bioptically ascertained myocarditis and 12 healthy patients of a control group were echocardiographically examined. The results demonstrated that the echocardiographic image texture in myocarditis is characterized by an increase of the texture parameters entropy, second difference moment and long-run emphasis as well as by a decrease of the parameters angular second moment, inverse difference moment and run-length nonuniformity as well as by different values of the ring and sector sums of the power spectre. The digital image processing of echocardiography images seems thus to open a new way to the noninvasive diagnostic of myocarditis.
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