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Cardiac toxicity of the new anthracycline antitumour antibiotics violamycin BI (V) and carminomycin (C) was studied in comparison with daunorubicin (D). Rabbits were intravenously given total doses of 0.1-1.5 mg/kg V or C, and 0.64-18 mg/kg D, respectively, twice weekly for one month. When examined two to six days, two and four weeks, respectively, after the last drug administration the gross findings consisted of hydropericard, hydrothorax and ascites in some animals. Histologically, loss of striation and focal necrosis of cardiac muscle cells and subsequently chronic inflammatory reactions and/or proliferation of mesenchyma cells were mostly found. These alterations were somewhat more pronounced in rabbits treated with V than in animals received D or C. At equitoxic doses of the antibiotics tested the ultrastructural lesion in the myocardial cells were altogether less marked after treatment with D than with C or V.

Laparoscopic colorectal resection may induce bladder and sexual dysfunction secondary to injury to the autonomic nervous system. The aim of this study was to evaluate urinary and sexual function in male patients after laparoscopic colorectal resection for diverticular disease.From January 1997 to March 2002, we performed a retrospective analysis of urinary and sexual function in 56 consecutive male patients who had undergone laparoscopic colorectal resection for diverticular disease. Preoperative and 6-month postoperative assessment was carried out using data collected via standardized postal questionnaires.Three patients were excluded (one had a prior prostatectomy, one had Peyronie's disease, and one was treated with neuroleptics). Fifty-three patients with a mean age of 54 A+/- 2 years were included in the study. There were no conversions. The morbidity rate was 9.4%. Mean follow-up was 27 A+/- 2 months. There was no significant difference in preoperative and postoperative urinary function. Fifty-one patients (96%) were sexually active preoperatively and were still sexually active postoperatively. Compared with the preoperative period, postoperative impairment of libido, erection, ejaculation, and orgasm were not significant. Every patient was able to achieve ejaculation after the intervention, and no retrograde ejaculations were reported. One patient was unable to have an erection after the intervention.Laparoscopic colorectal resection for diverticular disease does not significantly impair urinary and sexual function.

The prevalence of GB virus C (GBV-C)/ hepatitis G virus (HGV) RNA and antibodies to the structural E2 protein was investigated in a cohort of HIV-1 infected patients. Of 346 individuals, RNA was detected in 143 and E2 antibodies were detected in 73, for an overall prevalence of 62.4%. Intravenous drug use and homosexuality were identified as major transmission risk factors. GBV-C/HGV RNA prevalence was associated with hepatitis B coinfection, whereas antibodies to E2 were associated with older age and lower CD4+ cell counts. GBV-C/HGV infection was frequent in this group of HIV-infected patients and was associated with older age, lower CD4 + cell counts, and the presence of hepatitis B surface antigen.

Purpose: The purpose of this investigation was to develop methods and software for computing realistic digitally reconstructed electronic portal images with known setup errors for use as benchmark test cases for evaluation and intercomparison of computer-based methods for image matching and detecting setup errors in electronic portal images. Methods and Materials: An existing software tool for computing digitally reconstructed radiographs was modified to compute simulated megavoltage images. An interface was added to allow the user to specify which setup parameter(s) will contain computer-induced random and systematic errors in a reference beam created during virtual simulation. Other software features include options for adding random and structured noise, Gaussian blurring to simulate geometric unsharpness, histogram matching with a "typical" electronic portal image, specifying individual preferences for the appearance of the "gold standard" image, and specifying the number of images generated. The visible male computed tomography data set from the National Library of Medicine was used as the planning image. Results: Digitally reconstructed electronic portal images with known setup errors have been generated and used to evaluate our methods for automatic image matching and error detection. Any number of different sets of test cases can be generated to investigate setup errors involving selected setup parameters and anatomic volumes. This approach has proved to be invaluable for determination of error detection sensitivity under ideal (rigid body) conditions and for guiding further development of image matching and error detection methods. Example images have been successfully exported for similar use at other sites. Conclusions: Because absolute truth is known, digitally reconstructed electronic portal images with known setup errors are well suited for evaluation of computer-aided image matching and error detection methods. High-quality planning images, such as the visible human CT scans from the National Library of Medicine, are essential for producing realistic images. Sets of test cases with systematic and random errors in seelcted setup parameters and anatomic volumes are suitable for use as standard benchmarks by the radiotherapy community. In addition to serving as an aid to research and development, benchmark images may also be useful for evaluation of commercial systems and as part of a quality assurance program for clinical systems. Test cases and software are available upon request.

PURPOSE Portal imaging is the most important quality assurance procedure for monitoring the reproducibility of setup geometry in radiation therapy. The role of portal imaging has become even more critical in recent years due to the migration of three-dimensional (3D) treatment planning technology, including high-precision conformal therapy, from the research setting to routine clinical practice. Unfortunately, traditional methods for acquiring and interpreting portal images suffer from a number of deficiencies that contribute to the well-documented observation that many setup errors go undetected, and some persist for a clinically significant portion of the prescribed dose. Significant improvements in both accuracy and efficiency of detecting setup errors can, in principle, be achieved by using automatic image registration for on-line screening of images obtained from electronic portal imaging devices (EPIDs). METHODS AND MATERIALS This article presents recent developments in a method called core-based image analysis that shows great promise for achieving the desired improvements in error detection. Core-based image analysis is a fundamental computer vision method that is capable of exploiting the full power of EPIDs by providing for on-line detection of setup errors via automatic registration of user-selected anatomical structures. We describe a robust method for automatic portal image registration based on core analysis and demonstrate an approach for assessing both accuracy and precision of registration methods using realistic, digitally reconstructed portal radiographs (DRPRs) where truth is known. RESULTS Automatic core-based analysis of a set of 20 DRPRs containing known, random field positioning errors was performed for a patient undergoing treatment for prostate cancer. In all cases, the reported translation was within 1 mm of the actual translation with mean absolute errors of 0.3 mm and standard deviations of 0.3 mm. In all cases, the reported rotation was within 0.6 degree of the actual rotation with a mean absolute error of 0.18 degree and a standard deviation of 0.23 degree. CONCLUSION Our results, using digitally reconstructed portal radiographs that closely resemble clinical portal images, suggest that automatic core-based registration is suitable as an on-line screening tool for detecting and quantifying patient setup errors.

Background Polymerase chain reaction (PCR) detection of herpesvirus DNA in cerebrospinal fluid (CSF) is an important tool in the diagnosis of central nervous system (CNS) syndromes. The corresponding viral infections present with diverse clinical signs, which are often classical although no sign can be considered as specific. This retrospective study aims to describe atypical symptoms in patients with herpesvirus DNA detected in CSF by PCR. A total of 3452 cerebrospinal fluid samples from patients with suspected herpesvirus infection of the CNS were investigated between 1998 and 2003 in our clinical virology laboratory. “In-house” PCRs for each herpesvirus [herpes simplex virus (HSV), varicella zoster virus (VZV), cytomegalovirus (CMV), Epstein Barr virus (EBV), or human herpes virus 6 (HHV6)] were used until 2001 and a commercially available “Herpes Consensus PCR” was used thereafter. One of the five herpesviruses investigated in this study was found in 71 (2.1%) of CSF samples (37 HSV, 14 VZV, 1 CMV, 9 EBV and 10 HHV6). These samples were obtained from 62 patients whose clinical findings were generally consistent with the PCR data. However, some little known features of herpesvirus-related symptoms, such as partial seizure associated with HSV infection, and unusual VZV or HHV6-related myelitis were also observed.

Esophagectomies have a high morbidity rate, mainly related to pulmonary complications. The aim of this work was to assess whether the thoracoscopic approach could reduce this morbidity. We have made a prospective study of the results of 29 attempts of esophagectomy using a right thoracoscopic approach. There were 20 males and 9 females having an average age of 47. The indication was a squamous cell carcinoma in 22 patients, an adenocarcinoma in 1 patient, a melanoma in 1 patient, and a caustic stenosis in 5. The whole esophagus was mobilized thoracoscopically and the esophagectomy was completed through the abdomen. The reconstruction was achieved using a gastric pull-through and a cervical anastomosis. There were five failures for the following reasons: unresectable carcinoma (one case), large tumor making a thoracoscopic dissection unsafe (two cases), and incomplete lung collapse making the exposure of the posterior mediastinum difficult (two cases). The average time of the thoracoscopic procedure was 135 min. The postoperative course was uneventful in all but five patients who had a pulmonary complication: atelectasis (three cases), right purulent pleural effusion (one case), acute respiratory disease syndrome (one case). The latter complication was lethal. Four out of five respiratory complications occurred in patients for whom the dissection was considered difficult. Among the other complications, there were five anastomotic leakages and three cases of laryngeal nerve palsy. The mortality rate was 3.8%. These initial results do not show a real benefit of the thoracoscopic approach for esophageal dissection, especially with respect to difficult esophagectomies. Further evaluation of the technique is needed.

The presence and the quantity of hepatitis C virus (HCV) RNA were investigated in saliva and serum of patients infected with both HCV and human immunodeficiency virus (HIV). Paired serum and saliva samples were collected from 59 HIV-HCV coinfected patients. HCV RNA was detected by nested-PCR, using primers derived from the 5' non-coding region of HCV, and positive results were quantified using the b-DNA method. HCV RNA was detected in the saliva of 22/59 (37.3%) patients, with a mean level of 1.15 x 10(6) genome equivalents/ml; there was no correlation of salivary positivity with immune status (CD4 cell count), age or HIV risk group, but there was with gender (19/38 [50%] positive results in male, compared to 3/21 [14.3%] in female, P = 0.007). HCV RNA was detected in the serum of 45/59 (76.3%) patients at a higher level (mean of 2.52 x 10(7) genome equivalents/ml) compared to saliva. Positivity was not correlated with age, gender or CD4 + cell count. There was a correlation between qualitative saliva and serum results (P = 0.003), but not between quantifications (P = 0.57). This first study reporting significant amounts of HCV RNA in saliva could have important implications for HCV epidemiology.

A monoclonal antibody was developed for detection of Helicobacter pylori in gastric tissue sections in a direct immunofluorescence test. On a comparison of the immunofluorescence test with standard methods for detection of Helicobacter pylori, i.e. culture, the urease activity test and histological examination of tissue sections, using 158 biopsy specimens, 30 specimens were positive in all methods and 64 negative. In the remaining cases comparison was not possible because either immunofluorescence (29 specimens) or the standard methods (16 specimens) gave ambiguous results. The direct immunofluorescence test may have potential as an alternative to standard methods, but further testing in a defined patient population is necessary.

Prevalence of GBV-C/HGV was determined in a cohort of HIV-infected patients, via a reverse transcription-polymerase chain reaction detection of RNA in serum, amplifying the NS5 region of GBV-C/HGV genome. GBV-C/HGV RNA was detected in 143 (37.7%) of 379 patients, with similar results in the different HIV risk groups: 25/56 (44.6%) in intravenous drug users, 66/161 (41%) in homo- and bisexual men, 35/108 (32.4%) in heterosexual patients, 6/20 (30%) in transfusion recipients (P=0.41). There was no difference according to the presence or absence of hepatitis C virus infection. In univariate analysis, GBV-C/HGV genome prevalence was lower in patients over 50 years old (18.2%), compared to other age groups (20-29 years: 34.2%; 30-39 years: 44.3%; 40-49 years: 36.7%, P=0.03), as well as in patients with normal CD4 cell count (29.2% vs. 45.4% between 200-500/mm3, and 35.3% below 200 CD4/mm3, P=0.012) and individuals with a chronic hepatitis B. However, in the multivariate analysis, the only prognostic factor of GBV-C/HGV RNA positivity was the presence of a chronic hepatitis B, compared to the absence of any HBV marker, or a previous exposition to HBV (presence of anti-HBc and/or anti-HBs, absence of HBsAg), or the presence of anti-HBs alone.

To assess the results and the morbidity of thoracoscopy compared with conventional mediastinoscopy for the approach of mediastinal solid masses and lymph nodes, we have performed a prospective study about the respective yields, complication rates, and the length of hospital stay for patients.We have included 114 patients in the study. The criteria of inclusion were the accessibility of the lymph nodes and/or mass to cervical mediastinoscopy through CT scan view. There were 2 groups: 52 patients underwent a mediastinoscopy (group M) and 62 underwent a thoracoscopy (group T).There were 3 failures in group M (5.7%) and 5 failures in group T (8.1%) (not significant; NS). In group M, the three procedures were converted to anterior mediastinotomy (two cases) and to thoracoscopy (one case). In group T, the five procedures were converted to anterior mediastinotomy (two cases), mediastinoscopy (two cases), and thoracotomy (one case). The diagnostic yield was 94.3% in group M and 91.9% in group T (NS). After conversion, a diagnosis was reached in all patients in group M (100%) and in all but 1 patient in group T (98.3%) (NS). There was no intraoperative complication in group M, while 2 complications occurred in group T (3.2%) (p0.05). The overall morbidity was zero in group M and 4.8% in group T (p0.05).The diagnostic yield of mediastinoscopy is comparable to thoracoscopy. Complication rate and hospital stay of patients undergoing mediastinoscopy are significantly inferior. Thoracoscopy should be indicated only for lesions that are not within the reach of the mediastinoscope or when multiple biopsy specimens are necessary.

Oesophagectomies have a high morbidity rate, mainly related to pulmonary complications. The aim of this work was to assess whether the thoracoscopic approach could reduce this morbidity.We conducted a prospective study of the results of 26 attempts of esophagectomy using a right thoracoscopic approach. There were 17 males and 9 females having an average age of 47. The indication was a squamous cell carcinoma in 19 patients, an adenocarcinoma in 1 patient, a melanoma in 1 patient and a caustic stenosis in 5. The whole oesophagus was mobilized thoracoscopically, and the eosophagectomy was completed through the abdomen. The reconstruction was achieved using a gastric pull-through and a cervical anastomosis.There were 5 failures for the following reasons: unresectable carcinoma (1 case), large tumour making a thoracoscopic dissection unsafe (1 case) and incomplete lung collapse making the exposure of the posterior mediastinum difficult (2 cases). The average time of the thoracoscopic procedure was 135 min. The post-operative course was uneventful in all but 5 patients who had a pulmonary complication: atelectasis (3 cases), right purulent pleural effusion (1 case), acute respiratory distress syndrome (1 case). The latter complication was lethal. Four out of 5 respiratory complications occurred in patients for whom the dissection was considered as difficult. Among the other complications, there were 5 anastomotic leakages and 3 laryngeal nerve palsy. The mortality rate was 3.8%.These initial results do not show a real benefit of the thoracoscopic approach for eosophageal dissection, especially for difficult oesophagectomies. Further evaluation of the technique is needed.

Despite the accuracy of percutaneous biopsy of mediastinal masses under CT scan or sonographic control, there is still a need for surgical biopsy either because of difficult location or because of insufficiency of the percutaneous biopsy, especially for those of the tumors requiring an immunological classification. The thoracoscopic approach of mediastinal masses is an alternative to the usual surgical biopsies performed through thoracotomy, sternotomy or anterior mediastinotomy. The procedure is performed under general anaesthesia and one-lung ventilation. In a series of 44 cases, an histological diagnosis was obtained in 41 cases (93.1%). There was one haemorrhagic complication requiring thoracotomy (2.3%). The mean post-operative duration of stay was 3.2 days. We conclude that thoracoscopy is the method of choice in case of failure or contraindication of percutaneous biopsy. There is still a role for mediastinoscopy for laterotracheal lymph nodes.

Most laparoscopic procedures require the creation of a pneumoperitoneum. In order to evaluate the potential hazards of bacteriemia related to insufflation, we conducted a study in the rat. Two groups of 20 Wistar rats were used for this study. Peritonitis was induced by opening the terminal ileum. Twenty-four hours later, 20 rats were insufflated at a mean pressure of 6 mm Hg (Group I). After one hour of insufflation, an hemoculture was performed via direct intracardiac puncture and in the other group of 20 non-insufflated rats (Group NI). Five of the 18 hemoculture were positive in the Gr. I (27.7%) and 6 out of 20 in the Gr. NI (30%) (chi 2 = 0.238 p = 0.62 non significant difference). These results suggest that insufflation does not facilitate hematogenous dissemination of bacteria from intraperitoneal sepsis in this animal model.

Laparoscopic surgery has gained wide acceptance. However, there is still debate as to its role in assessment and staging of gastrointestinal malignancies(1)since it may promote dissemination of cancer cells.(2)We report the first case of a low-grade mesenteric nodal lymphoma for laparoscopic hernia repair, complicated by distant implants both on the peritoneum and wall mesh.

Two-hundred and ten consecutive patients undergoing routine gastroscopy were additionally investigated for evidence of Campylobacter pylori (C.p.). 106 patients were positive in one or more tests: 99.1% using a rapid urease detecting test (CLO-test), 80.2% histology, 78.3% cytology and 60% culture. We found no difference between the CLO-test results from biopsies taken from different parts of the stomach in individual patients. C.p. was found in 100% of patients with significant chronic antral gastritis, 67.7% with gastric ulcers, 65% with duodenal ulcers and in 12.1% of normal individuals. The C.p. infection was apparently eliminated in 50% of cases treated with bismuth subsalicylate (BSS) for four weeks. The combination of BSS with amoxicillin, tinidazole or an H2-receptor antagonist offered no advantage over BSS alone. Treatment with BSS led to improvement in symptoms and histological findings including healing of ulcers in patients with or without persistent C.p. infection. The recurrence of C.p. infection after apparently successful treatment was, however, 75% in 4 weeks. In conclusion, C.p. infection correlates strongly with the presence of chronic gastritis, and significantly with gastric and duodenal ulceration. The best diagnostic approach is the combination of a rapid urease detecting test and histology. C.p. infection is of long duration and difficult to eliminate. The most effective treatment for C.p. infection remains BSS as single agent.

This pilot study comprises quantitative ultrastructural investigations of the normal, non-leukemic granulopoiesis in the bone marrow of four patients suffering from heart diseases, compared with the granulopoiesis of four patients with different types of CMPD. By evaluation of the morphometric parameters it could be demonstrated that normal granulopoiesis is subject to a strong functional order of organelles in the course of maturation, aiming at the preparation of mitoses of immature cells and the production of functionally capable specific granules. Contrary to this, the studied cases of CMPD exhibited striking differences of morphometric parameters, which may be interpreted as functional deficiencies or defects of organelles involved in the production of specific granules, with the phenomenon of dissociation of nuclear and cytoplasmic maturation.

Since 1981, 77 of 116 patients undergoing heart transplantation (HTx) have survived from 6 months to 8 years. Graft control involved a total of 871 endomyocardial biopsies (EMB) and 141 angiographies. Sixteen patients developed coronary artery disease (CAD) manifesting itself 7-60 months after HTx (20.7%). These patients (15 male, 1 female) experienced multiple rejection episodes (RE) and more than half suffered from hypercholesterolaemia and hypertension (n = 10). A mean rejection score (Billingham grading) of greater than 1 (mean = 1.6 +/- 1.1) was calculated in all patients with CAD at the time of angiography or autopsy. By contrast, the mean rejection score ranked less than 1 in patients with undetectable or resolved CAD (means = 0.4 +/- 0.38). This rate is not remarkably different from the rejection score in patients (n = 61) without CAD (mean = 0.2 +/- 0.4). The 8 patients alive (56 +/- 18 months) showed a low number of RE/year (mean = 1.1 +/- 0.4) compared with means = 1 +/- 0.9 in patients without CAD. Eight patients expired within a short period (mean = 31 +/- 26.9) and had a significantly higher number of RE/year (mean = 4.3 +/- 2.9; P less than 0.01 vs. no CAD, CAD alive). Autopsy (n = 6) and angiographic studies (n = 46) demonstrated diffuse, concentric, obliterative arterial disease in all vessels (type A) in 6 patients (RE/yr: mean = +/- 5.5 +/- 2.3), single stenoses in major coronary vessels (type B) in 7 patients and ordinary atherosclerosis (3-vessel disease) comparable to ischaemic heart disease (type C) in 3 patients.(ABSTRACT TRUNCATED AT 250 WORDS)

The prevalence of Campylobacter pylori in gastric mucosa was investigated prospectively (by histology, cytology, bacterial culture and urease rapid-test) in 302 patients of a routine gastroenterological endoscopy programme. According to the histopathological findings the following prevalence of C. pylori was established: 3 of 35 normals (9%); 116 of 167 with antral gastritis (69%), 28 of 40 with gastric ulcers (70%); 26 of 33 with duodenal ulcers (79%); 5 of 27 with other conditions (19%). The activity degree of the gastritis correlated closely with the presence of C. pylori. In a prospective open trial 110 patients with antral gastritis or gastroduodenal ulcer were treated according to the following schedule: (a) bismuth subsalicylate, 1800 mg/d for four weeks (35 patients); (b) amoxycillin 2250 mg/d for two weeks (6); (c) ranitidine 300 mg/d for four weeks (26); (d) bismuth plus amoxycillin (20); (e) bismuth plus ranitidine (23). Immediately after the end of treatment and four weeks later the elimination rates were: (a) bismuth 51% (18) and 23% (8), respectively; (b) amoxycillin 50% (3) and 17% (1); (c) ranitidine 0% (0); (d) bismuth plus amoxycillin 60% (12) and 25% (5); (e) bismuth plus ranitidine 43% (10) and 17% (4). These data indicate that treatment with bismuth plus amoxycillin will achieve a negative bacterial result in about half the patients. But frequently as early as four weeks later C. pylori can again be demonstrated, so that the long-term elimination rate is only 15-30%.

The effects of two 1,2-substituted 5-bis-(beta-chloroethyl)-amino-benzimidazole derivatives on the course of phagocytosis in murine peritoneal macrophages after intraperitoneal injection of bovine fibrin has been investigated by means of quantitative ultrastructural stereologic methods. One of the compounds, IMET 3164, is a strong immunosuppressive agent with membrane-stabilizing effects while the other one, IMET 3393 (Cytostasan) is an effective cytostatic drug with weak immunological effects. From the results the following conclusions can be drawn. After stimulation by intraperitoneal injection of fibrin, macrophages of untreated animals show a rapid antigen uptake and digestion as well as a formation of new lysosomes. Simultaneously, an immigration into the peritoneal cavity of monocytes and an emigration of strongly storing macrophages takes place. After treatment with either benzimidazole-N-mustard derivative, most pronounced after IMET 3164, a delayed antigen phagocytosis and digestion and an inhibition of formation of new lysosomes can be observed. Likewise, the intraperitoneal cell fluctuation is strongly reduced after IMET 3164. The findings lend support to the hypothesis that immunosuppression may be induced, among other mechanisms, by an inhibition of phagocytosis and antigen processing by means of membrane-stabilizing compounds.

The shrinkage of peritoneal cell during the electron microscopical preparation was investigated by means of a special device. Independently of the procedure of fixation after critical point drying the cells exhibit only 54 to 59% of the original diameter (residual volume about 18%). The reduction of cell diameter after Epon embedding is about 25%, corresponding to a residual volume of 40%.

The cardiotoxic and myelosuppressive effects of the potential antitumor antibiotics violamycin BI (VBI) and violamycin BII (VBII) were studied in rats in comparison with daunorubicin (DAU), doxorubicin (ADR) and carminomycin (CAR). Rats were intravenously given the compounds 10 times for three weeks at total doses of 0.4 to 3 times of the acute LD50. Cardiac toxicity was measured using ECG (widening of the QRS complex), and screening parameters for bone marrow suppression were white blood cell counts, hematocrit and hemoglobin values. Following the drug injections the myocardium and the bone marrow were additionally investigated by light microscopy. With the exception of ADR, all the anthracyclines tested showed a more or less strong dissociation of cardiotoxic and myelotoxic activities. VBI was found to be only toxic on the heart but not on the bone marrow, whereas DAU, VBII and CAR were predominantly toxic on the bone marrow. Only ADR showed strong cardiac toxicity as well as distinct myelosuppression. A final evaluation of VBI and VBII has to include both the antineoplastic and the toxic properties of the compounds.

The aim of the study was to evaluate the influence of a cardiotoxic therapy with Adriamycin (ADM) on left ventricular pump function. In 348 patients with malignant tumors, 606 equilibrium radionuclide ventriculographies (ERNV) were performed. In 90 patients, resting studies (R-ERNV) were followed by studies during exercise (E-ERNV). Results were evaluated statistically to determine whether E-ERNV provides more reliable parameters in the early detection of Adriamycin cardiomyopathy (ADM-CMP) than R-ERNV. The following left ventricular parameters were evaluated: global ejection fraction (gEF); end diastolic, end systolic, stroke volume (EDV, ESV, SV); peak filling rate, peak ejection rate (pFR, pER); time to peak filling rate (TpFR) and heart rate. Increasing ADM doses yielded a significant decrease (p less than 0.05) of resting values of gEF, pER, pFR. In contrast, stress-induced increases of gEF, pER, pFR were found independent of accumulative ADM doses and independent of the resting values of these parameters. An increase of gEF resulted from a significant decrease of ESV. In most cases, pathologic results at rest were detected earlier than subnormal changes of exercise values. Therefore, E-ERNV does not have a significantly higher sensitivity in the early detection of ADM-CMP than R-ERNV and is not required for the surveillance of patients under ADM therapy.