E. Zeitler - Böcker

The number of patients with occlusive peripheral vascular disease of the lower ex- tremities is still growing as rapidly as the number of patients with coronary heart disease and cerebrovascular disease. Due to the increase in average life expectancy during the last few decades, more patients now need surgical vascular reconstruc- tion. This actually means a demand for more centers specializing in vascular surgery and equipped with intensive care facilities, since the number of patients with cardio- vascular and bronchopulmonary complications is increasing as well. In addition, the number of patients needing repeated vascular surgery has been growing. Therefore, the search for simple procedures to recanalize the arterial lumen which could be performed under local anesthesia is no surprise. Unfortunately peripheral vascular disease is still frequently treated by amputations. In 1967, the fIrst report in German on percutaneous recanalization of arteries with thrombotic occlusions and stenoses appeared in Rontgenfortschritte. The meth- od described in this report had been published by Dotter and Judkins in 1964.Today, 10 years after their report, more data have been systematically collected on this method in Europe than in the United States, where it was developed. Possibly an explanation of this state of affairs is that nonsurgical treatment is favored more in Europe than in the United States. The scientifIcally based angiology established by Ratschow served as the foun- dation for the development of diagnostic work-up and therapy in other directions beyond the questions of operability and surgical results.

Cardiac nuclear medicine has grown dramatically over the past decade to the point where it is now an integral part of the routine diagnostic workup in patients with heart disease, particularly coro- nary artery disease. In no small part, this is the result of dramatic improvements in technology and the application of these improve- of diagnostic techniques. ments to the development and refinement In this book, authorities on cardiac imaging techniques provide an up-to-date description of the field, covering the clinical appli- cability, efficacy, and future potential of myocardial perfusion scinti- graphy, quantitation of regional blood flow, assessment of ventricu- lar performance, and detection of acute infarction using radio- tracers. This book provides the physician involved in cardiac diag- nosis with the background necessary to integrate the radiotracer method into his diagnostic armamentarium. Boston, August 1979 B.L. HOLMAN Contents Cardiac Nuclear Medicine: An Overview By B.L. HOLMAN ...1 Assessment of Ventricular Function with First-Pass Angio- cardiography By N. ScHAD and 0. NICKEL With 7 Figures ...9 Equilibrium (Gated) Radionuclide Ventriculography By W.E. ADAM, A.TARKOWSKA, F. BITTER, M. STAUCH, and H. GEFFERS With 15 Figures ...21 ...Myocardial Scintigraphy with Infarct-Avid Tracers By B.L. HOLMAN and J. WYNNE With 3 Figures ...35 ...Quantitative Assessment of Thallium-201 Images By U. BuELL, E. KLEINHANS, M. SEIDERER, and B.E. STRADER With 10 Figures ...43 ...Thallium-201 Myocardial Perfusion Scintigraphy during Rest and Exercise By A. LENAERS ...55 ...

Applications of angiography have expanded to include not only diagnostic proce- dures but also therapeutic interventions. The introduction of regional administra- tion of vasoactive drugs through percutaneously placed angiographic catheters was soon followed by methods of transcatheter vessel occlusion using temporary or permanent embolic materials. At the same time methods of opening up nar- rowed or completely obstructed blood vessels with percutaneously introduced balloon catheters were being perfected. Thus, regional blood flow reduction or regional blood flow increase can now be accomplished with percutaneous angiographic methods in lieu of major surgical interventions. The advantages in terms of reduced morbidity, length of hospital stay and cost are evident. Therapeutic angiography is a rapidly advancing and therefore changing field. This monograph aims at capturing some of the most recent advances and also at presenting some of the controversies. In order to accomplish this task the editors invited a selected group of cardiovascular radiologists, to contribute in their respective fields of therapeutic angiography.For a balanced view other experts - usually nonradiologists - were also asked to present their views, com- ments, and criticisms. Whenever opinions were far apart an opportunity was given for reply or rebuttal. Thus, up-to-date information with supporting or oppos- ing expert views is presented on the topics of transluminal angioplasty, transcath- eter vessel occlusion, regional drug infusions, and radiologic interventions in thromboembolic disease.

It is not surprising that so much investigation has been undertaken to establish the cause of childlessness, especially when the potentia coeundi of the male is not impaired. As long ago as 1957 the German Society for the Study of Fertility and Sterility was founded, embracing gynecology, andrology, and veterinary medicine. After its inception, meetings conducted in the spirit of its foundation were held every 2 years. This interdisciplinary, coordinated scientific work in the field of human reproduction achieved its value as a result of the stimuli provided by the permanent involvement of veterinary scientists. After about 20 years of activity, the Society adopted a highly differentiated pattern of work-directions in the field of human and veterinary medicine. Since 1976 annual meetings have been held on the topic of animal and human reproduction. These meetings have proved of great value, especially in the area of comparative medicine, and have led to excellent interdisciplinary associations. One of the most evident successes was the first extracorporal fertilization in humans with subsequent embryo transfer and full-term pregnancy. Gynecologists have found that in 40% of cases the cause of undesired childlessness rests with the male, and it is therefore no surprise that also in the field of andrology certain factors concerned with infertility have received great attention.

In the past ten years, there have been significant advances in the diagnosis and therapy of arterial vascular disease. While long-term morbidity can only be improved by changing the patient's life-style and removing any risk factors that may be present(hypertension, hyperlipidemia,obesity,diabetesmellitus, nicotine abuse), symptomatic relief may be obtained by various procedures. Besides conservative treatment of arterial occlusive disease (physical therapy, medical treatment) and surgical vascular interventions (thromboendarterectomy, bypass procedures), balloon catheters introduced percutaneously under local anesthesia have found increased application in virtually all areas for the dilatation and recanalization of obstructive lesions in the past few years. The technique of balloon dilatation, as introduced by Griintzig as a further development of the percutaneous interventions by Dotter and Judkins, is no longer the decisive issue. The main objective of present clinical research is to de­ termine the proper indications and patient selection for this procedure, which has found its place between conservative treatment and surgery. The contents of this Symposium should provide some guidelines for the indi­ cations and postprocedural therapy for the referring physician, the angiologist, and for the radiologist and cardiologist performing the dilatation. We owe our thanks to all the specialists involved, who have provided us with the benefits of their experience. Mrs. H. Beilmann and Dr. M. Wojtowycz con­ tributed substantially to the preparation of the text. I would like to thank them and the staff of Springer-Verlag for their conscientious work in the interest of composition and publication quality.

Ziel dieses Buches ist es, den Leser anhand von zahlreichen Tabellen uber die Abhangigkeiten der Strahlenexposition und die Grosse der Strahlenexposition bei der Digitalen Subtraktionsangiographie zu informieren. Die Darstellung hat den Charakter eines Nachschlagewerkes: es ist dem Leser besser als bisher moglich, Nutzen und Strahlenrisiko gegeneinander abzuwagen.

Mit der Einfuhrung der nichtionischen Rontgenkontrastmittel hat ein mehrere Jahrzehnte wahrender Prozess der pharmakologischen Entwicklung zum Erfolg gefuhrt. In dem vorliegenden Buch werden die Ruckwirkungen von Rontgenkontrastmitteln auf die Gefasswand, auf Herz, Kreislauf und Lungenstrombahn, Nieren- und Schilddrusenfunktion sowie ihre Toxikologie und Pharmakologie ubersichtlich dargestellt. Weitere Beitrage befassen sich mit der klinischen Wertigkeit der Rontgenkontrastmittel im Rahmen der Angiographie und Computertomographie sowie mit den nichtvaskularen Applikationen. Die hohe Sicherheit nichtionischer Rontgenkontrastmittel bei Arthrographie, Sialographie, Pankreatikographie und indirekter Lymphographie wird belegt. Ein besonderer Abschnitt ist medikolegalen Fragen im Zusammenhang mit der Patientenaufklarung gewidmet. Forschungsergebnisse der letzten Jahre zur Kontrastmittelvertraglichkeit und zur Vermeidung von Kontrastmittelnebenwirkungen schliessen das Buch ab.

Over the last decade, important advances have been made in the radiological man­ agement of peripheral vascular diseases. In the diagnostic field, the role of con­ ventional angiography has diminished considerably in favor of new, non-invasive diagnostic modalities such as color Doppler imaging and magnetic resonance angiography. Percutaneous radiological treatment of arterial diseases of the limbs has revolu­ tionized therapeutic concepts in this area. Professor E. Zeitler is a renowned international expert in the field of peripheral He was one of the pioneers in investigating and developing per­ vascular diseases. cutaneous catheter treatment of arterial stenosis of peripheral arteries. This volume is based upon his unique lifetime's experience of treating patients presenting with peripheral vascular diseases. Moreover, Professor Zeitler was very successful in engaging a group of excellent authors, all specialists in their field, to contribute individual chapters. Together, they have suceeded in producing one of the most comprehensive books on the modern radiological approach to patients with peripheral vascular diseases. It is my firm belief that this volume will be of great interest to radiologists, angiologists, and vascular surgeons alike by providing them with the latest knowl­ edge and information in the field of radiology. I wish this volume the same success as the many other volumes already published in the book series "Medical Radiology." Any constructive criticism that the reader may wish to affer is welcomed.

Die Möglichkeiten der bildgebenden Systeme für die Diagnostik von Herzerkrankungen werden in diesem Band der Klinischen Radiologie beschrieben. Anhand von typischen Beispielen werden die verschiedenen klinischen Untersuchungsverfahren verglichen und helfen somit dem Leser bei der Diagnosefindung.Neben der konventionellen Röntgenaufnahme werden Nuklearmedizin, Magnetresonanztomographie, Angiographie und die invasiven Verfahren der Herzkatheterisation beschrieben und bewertet.