Biomedical subjects
Publications and source records attributed to R Höfs.
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By means of the radionuclide ventriculography certain contractility parameters of the right heart are presented in 15 patients with chronic obstructive bronchitis without pulmonary hypertension. The results confirm that also without increase of the pulmonary arterial blood pressure the ejection fraction of the right ventricle in rest is decreased in possible dependence upon the size hypoxaemia. The increase of the ejection fraction of the right ventricle under stress is insufficient in 7 out of 15 patients, in which case a connection with the left-ventricular ejection fraction is observed. A characteristic valuation of the right- and left-ventricular ejection fraction for pathophysiology and prognosis of the pulmonary heart disease is discussed. The necessity of further investigations is emphasized.
With the help of the comparison of the results of 95 patients with coronary heart disease who were examined by means of the intracardiac space scintigraphy for the purpose of the subjective subdivision according to the NYHA-classification there is no close correlation between the nuclear-medically obtained functional sizes (EF, maximum ejection and filling rate) and the clinical degree of severity of the disease. Only at the degree of severity 3 and 4 a discrimination is possible. In 64 patients laevocardiographic and coronarographic, respectively, findings were present. The trend to the deterioration of the functional parameters and to the increase of the nuclear-medically recognizable disturbances of the kinetics, respectively, with a more intensive expression of the vascular stenoses is distinctly readable. From the examination in rest in the individual case no statement is possible concerning the findings which are to be expected in the invasive diagnostics. When there are discrepancies between the result of the intracardiac space scintigraphy and the clinical and electrocardiographic preliminary investigations in many cases a clarification becomes possible by the immediately following study under submaximal exercise. On the assumption of a close cooperation with experienced cardiologists the relatively little expensive intracardiac space scintigraphy which does not stress the patient provides an essential evidence for the prognosis and estimation of the functional capacity of the patients with coronary heart disease.
For the diagnostics of obliterating vascular changes in the supraaortic area the invasive diagnostics of the vessels is not to be renounced now as before. The indication to the angiographic investigation results from clinical, perfusion-scintigraphic and Doppler-sonographic-findings. Of 390 patients 289 pathological angiographic findings in the supraaortic vascular area. In 101 patients normal findings were stated. Altogether 509 individual pathological findings were represented. In the comparison of the results of the investigations in the various diagnostic methods the clinical neurological investigation showed itself as particularly evident method. It should be decisive for the indication to the invasive diagnostics. The correspondence between the angiographic findings and the result of the perfusion-scintigraphic and Doppler-sonographic investigations, respectively, was the greater the more expressed the extracranial vascular findings represented themselves. In 127 patients with multiple obliterating vascular changes the size of the pathological changes and their localization could be established only angiographically.
The results of an evaluation of the perfusion scintigraphy findings of 350 hospitalised neurological patients and 55 more strictly selected neurosurgical patients with cerebrovascular complaints, revealed an accuraty of 83%, a sensitivity of 89%, and a specificity of 83%. The selection of the patients had no influence on the results as a whole. Compared with contrast-medium angiography, incorrect diagnosis must be expected in 17% of the cases. This includes erroneous negative findings in 10% of the cases. Grounds for misinterpretations are suggested, and the biological and methodological limitations of the method are set forth.
A prospective examination of 80 patients with struma nodosa resulted in an approximately equally high reliability of scintigraphy (98.8%) and sonography (97.5%) with regard to the evidence of focal changes. Due to the well-known advantages and the present availability the sonography should above all be used in children, adolescents, pregnant women and iodine-contaminated patients. Since from the scintigram additionally can be reported on the functional condition (autonomous adenoma), this technique cannot generally be replaced by sonography. The advantages and the limits should be known to the physician, in order to avoid unnecessary manifold examinations.
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After injection of the radioactive noble gas Xe133 into the A. carotis interna, the regional blood flow in the brain is determined with a 10-channel measuring unit. From the first clinical evaluation of the findings in 35 patients, the following conclusions can be drawn: 1. In epileptics, a localised hyperaemia very probary indicates a latent increased convulsive activity. 2. The measurement of the cerebral blood flow does not yield a contribution to the diagnosis of the type of cerebral tumours. 3. As a consequence of mass shifting of space occupying processes particularly endangered brain sections, also remote from the focus proper, show a localised pathological hyperaemia (morbid "luxus perfusion"). 4. Of greatest importance is the method for clearing up of pathophysiological relations, the clearing up of questions in connection with the blood/brain barrier function, and for the indications for and estimation of the results of vascular-surgical interventions.
Proof and classification of a space-demanding process of the kidney is most successfully done by means of renovasography. The nuclear-medical investigation methods give only unspecific references to the disease. Investigation results of radionephrography, sequence scintigraphy and renovasography of 130 kidneys with space-demanding processes were comparatively evaluated. Renovasographically the findings of 35 malignant tumours, 58 solitary cysts and 37 polycystic degenerations were correctly classified. The radionephrography is of no importance for the diagnostics of space-demanding processes. The results of the sequence scintigraphy were in demands of space localised defects of parenchyma, reductions of parenchyma and one a non-functioning kidney. These findings gave rise to angiographical clarification. In the polycystic degeneration the irregular distribution of the activity in the parenchyma, multiple parenchymal defects and the enlargement of the organ referred to the disease.
Cardiocomputer tomography and radionuclide assessment of left ventricular function complete each other in postoperative control of patients with coronary artery bypass grafts. 70 patients with 163 coronary artery bypass grafts had 85% or total bypass graft early postoperative period, 77% after one year and 69% after two years. Sensitivity of cardiocomputer tomography was 75% and accuracy was 84%. The left ventricular functions was unchanged postoperatively.