[System analytical approach of lung function and hemodynamics].

The authors critically analyse the traditional views in physiology and complete them with new statements based on computer model simulations of lung function and of hemodynamics. Conclusions are derived for the clinical practice as follows: the four-dimensional function curves are similar in both systems; there is a "waterfall" zone in the pulmonary blood perfusion; the various time constants of pulmonary regions can modify the blood gas values; pulmonary capillary pressure is equal to pulmonary arterial diastole pressure; heart is not a pressure pump, but a flow source; ventricles are loaded by the input impedance of the arterial systems and not by the total vascular (ohmlike) resistance; optimum heart rate in rest depends on the length of the aorta; this law of heart rate, based on the principle of resonance is valid along the mammalian allometric line; tachycardia decreases the input impedance; using positive end expiratory pressure respirators the blood gas of pulmonary artery should be followed; coronary circulation should be assessed in beat per milliliter, the milliliter per minute may be false. These statements are compared to related references.

Contribution of EFMI to development of medical informatics. European Federation for Medical Informatics.

The European Federation for Medical Informatics has been established in 1976. At the MIE 96 it has celebrated the 20th anniversary of its existence. During these 20 years the number of number of national societies who became a member has been increased from 10 to 26 and nowadays is 29 not mentioning 2-3 applicants.

Enhanced accumulation of pericardial fluid adenosine and inosine in patients with coronary artery disease.

Adenosine and inosine are believed to have cardioprotective effects. However, little is known about their possible role in the metabolic autoregulation of human coronaries and in pathologic conditions with supply/demand imbalance of the heart such as coronary artery disease. Since these low molecular weight nucleosides freely diffuse through the monolayer of the visceral pericardium, adenosine and inosine concentrations in pericardial fluid may well reflect the conditions in cardiac interstitium.

Protocols and guides, tools.

The author describes in the first part of the review the definitions and relations of the occurring concepts. In the second part a short history of the topic is overviewed. The third part is dealing with the electronic patient record based development of guidelines in addition what are the relations among guidelines, protocols, tools, knowledge-based systems, diagnosis supporting systems, expert systems, outcome analysis and artificial intelligence.

Respiratory analogue computer model.

An analogue computer model has been constructed to simulate the dynamic behaviour of the human cardiorespiratory system for studying the effect of changes in different system-variables--as alveolar ventilation, functional residual capacity (FRC) of the human lung and the cardiac output--on the partial pressure of carbon dioxide in the arterial and mixed venous blood (pCO2a, pCO2v). The respiratory analogue computer model (RACM) simulates reliably well-known clinical physiological as well as pathological phenomena. Reducing FRC or breath rate an oscillation of pCO2a has been developed, but the mean value has not been changed.

Patient health record on a smart card.

A validated health questionnaire has been used for the documentation of a patient's history (826 items) and of the findings from physical examination (591 items) in our clinical ward for 25 years. This computerized patient record has been completed in EUCLIDES code (CEN TC/251) for laboratory tests and an ATC and EAN code listing for the names of the drugs permanently required by the patient. In addition, emergency data were also included on an EEPROM chipcard with a 24 kb capacity.

[The use of adenosine in the diagnosis and treatment of cardiac arrhythmias].

The authors investigated the effect of adenosine or ATP on narrow QRS tachycardia in 56 pts, 3 pts with wide QRS tachycardia 9 pts with suspected latent preexcitation and 10 pts with PVC suspected to be ventricular parasystole. After the bolus iv. administration of adenosine or ATP every SVT was stopped related to AV node (44 pts), but in the rest twelve related to atrial origin of SVT only one automatic atrial tachycardia could be stopped.

Computer-models for management of a cardiopulmonary clinic.

To optimize the transition of a cardiopulmonary ward management from a centrally directed (so called "socialist") healthcare system to a free market oriented one, the authors constructed two computer-models: one for the simulation of distribution of the financing and another for the simulation of interventional pathways in an operational flow chart. For parameter estimation specificity, sensitivity, and diagnosis probability, function curves have been defined. After using these models, the effectiveness of ward performance and the quality of care have improved.

Relation between tonic sympathetic and vagal control of human sinus node function.

Background: Clinical conditions, such as heart failure or myocardial infarction are associated with enhanced sympathetic and reduced parasympathetic activity as compared to normal controls. The reciprocal alteration in cardiac autonomic tone likely contributes to the electrical instability of the myocardium. Little information is available on the relation between sympathetic and vagal cardiac control in healthy human subjects.

Relation between baroreflex sensitivity and cardiac vagal tone in humans.

The extent of dependence of cardiac vagal tone on arterial baroreceptor input has been studied in 12 healthy, young adult subjects. Cardiac vagal tone was defined as the chang in R-R interval after complete cholinergic blockade by atropine. Baroreflex sensitivity was determined with the "Oxford-method": R-R interval was regressed against systolic pressure.

Carotid sinus hypersensitivity abolished by aminophylline.

A 56-year-old patient with syncope due to carotid sinus hypersensitivity is presented. Carotid massage-induced sinus arrest was completely abolished by intravenous aminophylline.

[Pathogenic role of a pacemaker in occult infection].

A case of seronegative pacemaker lead infection is presented. The diagnosis based on patient history and echocardiography was proved by removing the infected leads from the beating heart through surgery.

[Rhabdomyoma of unusual manifestation].

According to our knowledge in adult pericardial effusion has never been reported to be present in cases of cardiac rhabdomyoma. We present the history of an adult patient with pericardial effusion due to cardiac rhabdomyoma.

[Prinzmetal angina and syncope].

Authors report an unusual case of variant angina associated with unconsciousness. They were able to prove by coronary angiography the vasospasm of the circumflexus artery which was responsible for the morning attacks of the 35 year old patient with unconsciousness, ST segment elevation and high degree AV block. Unconsciousness was the first and earliest sign of the coronary vasospasm.

Evaluation problems of a long-term study on evolving pulmonary arterial hypertension in chronic non specific lung disease.

After having collected a sufficient number of standardized data checked for reliability from patients with chronic non specific lung disease, the following subgroups of pulmonary arterial mean pressure were defined: A = PAP less than 2.7 kPa [= 20 mmHg]; B = 2.7 less than PAP less than 4 kPa; C = PAP greater than 4 kPa [= 30 mmHg].