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Extracranial stenosis of the carotid artery may lead to cerebral ischemic events and stroke. For this reason, such symptoms as transient ischemic attacks (TIA), unilateral syndrome or amaurosis fugax, the arteries feeding the brain should be investigated. In addition to bilateral palpation and auscultation of the arteries, modern ultrasonographic methods have an important role to play. The aim of treatment is secondary prevention of ischemic stroke, and possibly even to achieve regression of the vascular lesion. This necessitates the elimination of atherogenic risk factors. Particularly suitable as preventive medication, are platelet aggregation inhibitors, such as, acetylsalicylic acid and clopidogrel, which can also be applied postoperatively and postinterventionally to prevent recurrence.

Angiotensin-converting enzyme insertion/deletion (I/D) gene polymorphism plays a role in determining the inter-individual variability of circulating angiotensin-converting enzyme activity and intracellular angiotensin-converting enzyme levels. Angiotensin-converting enzyme, as a key enzyme in the renin-angiotensin system, catalyzes the activation of the vasoconstricting and proliferation-stimulating angiotensin II and breaks down the vasodilatory peptide bradykinin. It is assumed that the excess supply of angiotensin II (due to the deletion polymorphism of the angiotensin-converting enzyme gene) contributes to endothelial dysfunction and in this way promotes the onset and progression of atherosclerosis. The aim of this study was to test whether the presence of the deletion allele of the angiotensin-converting enzyme gene predisposes a more rapid systemic progression of a preexisting peripheral arterial disease. To this end, the course of disease was surveyed for an average of 5 years in 97 patients who were angiotensin-converting enzyme gene-typed and suffered from a stable stage II peripheral arterial disease according to Fontaine. These patients did not suffer from an additional coronary artery disease, a cerebrovascular disease, or other serious illness. A local progression in the periphery or a systemic progression in the coronary or cerebrovascular areas was regarded as study endpoints. Of the patients, 49.5% showed an atherosclerosis progression during the surveillance period. With II-carriers, a progression was registered in 42.1% and with DD carriers, progression was seen in 59.4%. D/I allele frequencies were seen in patients with progression at a level of 0.60/0.40 vs 0.55/0.45 for patients without progression. The average duration of disease in stable stage II (before progression appeared) amounted to 108 +/- 14 months for II carriers, 88 +/- 8 months for ID carriers, and 92 +/- 11 months for DD carriers (p = 0.21). Based on these findings, the deletion polymorphism of the angiotensin-converting enzyme gene is not an independent risk factor for progression of atherosclerosis in patients with peripheral arterial disease.

Calcium oscillations and waves have been observed not only in several types of living cells but also in less complex systems of isolated cell organelles. Here we report the determination of apparent Ca2+ diffusion coefficients in a novel excitable medium of agarose gel with homogeneously distributed vesicles of skeletal sarcoplasmic reticulum. Spatiotemporal calcium patterns were visualized by confocal laser scanning fluorescence microscopy. To obtain characteristic parameters of the velocity curvature relationship, namely, apparent diffusion coefficient, velocity of plane calcium waves, and critical radius, positively and negatively curved wave fronts were analyzed. It is demonstrated that gel-immobilized cell organelles reveal features of an excitable medium. Apparent Ca2+ diffusion coefficients of the in vitro system, both in the absence or in the presence of mitochondria, were found to be higher than in cardiac myocytes and lower than in unbuffered agarose gel. Plane calcium waves propagated markedly slower in the in vitro system than in rat cardiac myocytes. Whereas mitochondria significantly reduced the apparent Ca2+ diffusion coefficient of the in vitro system, propagation velocity and critical size of calcium waves were found to be nearly unchanged. These results suggest that calcium wave propagation depends on the kinetics of calcium release rather than on diffusion.

Background: It has been suggested that the deletion polymorphism of the angiotensin converting enzyme (ACE) gene is linked to a high risk of cardiovascular disease. The relationship between the insertion/deletion (I/D) polymorphism of the ACE gene and the carotid intima-media thickness in patients with peripheral arterial occlusive disease is unknown. We tested the hypothesis that the early progression of atherosclerosis in the extracranial carotid arteries in patients with peripheral arterial disease is associated with a genetic predisposition., Methods: This prospective trial included 98 patients who only had manifestations of arteriosclerotic disease in peripheral arterial vascular regions of the lower extremities (stable stage II PAOD). Maximal common carotid intima-media thickness (mIMT) was measured using high resolution B-mode ultrasonography. Determinations of ACE gene polymorphism were made using a polymerase chain reaction technique. Multivariate regression analysis was performed to assess the influence of ACE genotypes, ACE activity and vascular risk factors on intima-media thickness., Results: There was no significant association between intima-media thickness and ACE gene polymorphism. History of symptomatic peripheral arterial disease without local or systemic progression exists in subjects with the II-genotype significantly longer than in subjects with the DD genotype (p=0.01). With the presence of an II-genotype, there was also a tendency towards a thinner intima-media thickness. We found significant correlations between intima-media thickness and age (p<0.0001), fasting serum insulin (p=0.001), and lipoprotein (a) (p=0.008)., Conclusions: In the present study involving patients with stage II peripheral arterial occlusive disease, ACE gene polymorphism could not be identified as a determining marker for the development of intima-media thickening in the common carotid artery. However, it can be assumed that there is a reduced risk for the systemic progression of atherosclerosis in patients with the II genotype.

Unlabelled: Congenital vascular malformations occur in 1.5% of the general population. Depending on their localization and morphology, with dysfunction of local and central hemodynamics as well as tissue metabolism, congenital peripheral arteriovenous malformations (AVM) are of particular importance within the larger, heterogeneous group of diseases which comprise vascular malformations., Aim: The aim of this study was to evaluate our ability to quantity peripheral congenital AVM using sonographic, functional-hemodynamic, and morphological parameters., Method: Apart from obtaining a medical history and applying clinical and venous occlusion plethysmographic diagnostics, sonographic examinations of peripheral arteries and veins using cw-Doppler sonography and color-coded duplex sonography were performed on 8 patients with peripheral congenital AVM. For comparative purposes, the results of pre-intervention angiography examinations were also considered., Results: For a sonographic quantification of AVM at the time of diagnosis, during assessments of diseases progress, and postinterventionally, both the resistance index of Pourcelot and measurement of the vascular blood flow velocities appeared to be particularly appropriate as functional-hemodynamic parameters. The sonomorphological parameters reflect the individual vascular pathology, which is determined by hemodynamic changes., Conclusion: Functional-hemodynamic and sonomorphologic parameters allow a quantification of AVM. With knowledge of the clinical picture acquired at the time, they provide the basis for deciding upon a more extensive pre-interventional invasive radiological diagnosis.

Unlabelled: A traumatic lesion of the ulnar artery (Hypothenar Hammer Syndrome, HHS) is a very rare cause of acral ischemia of the upper extremity., Aim: Evaluation of the efficacy of ultrasound techniques in the diagnosis of the HSS., Method: Based on the knowledge of the patient's history and clinical examination we investigated forearm, hand and digital arteries by continuous wave Doppler. By means of colour-coded duplex sonography (CCDS) we demonstrated the course of the radial and ulnar arteries to the palmar arch. For comparison we used the results of preintervention angiography., Results: The diameter of the distal ulnary artery measured in healthy women was 1.8 +/- 0.32 and in men 2.2 +/- 0.46 mm. Among 268 patients with ischemia of the hands we diagnosed HHS in four cases. We identified an aneurysm of the ulnary artery in one case and a thrombotic occlusion in three cases. The thrombotic occlusion of the ulnar artery led to a dilatation of the vascular lumen. The occlusion length could be determined. Vessels diameter and echogenecity gave information about the age of the thrombosis., Conclusion: The continuous wave Doppler is a major diagnostic contribution because of its ability to register hemodynamic changes. Additionally, CCDS with its combination of sonomorphology and hemodynamics enables a distinction between HHS and other causes of digital ischemia. The CCDS more precisely refines the indications for preinterventional angiography in acute ischemia syndromes of the hand.

Background: The deletion polymorphism of the ACE gene is linked to a high risk of cardiovascular disease due to the permanent activation of the local and systemic renin-angiotensin systems (RAS). The aim of this prospective study was 1. to compare the ACE insertion/deletion polymorphism in individuals with a healthy vasculature with that of patients suffering from peripheral arterial occlusive disease (PAOD), and 2. to determine whether associations existed between specific clinical parameters and the ACE genotype which the PAOD patients expressed., Patients and Methods: Determinations of ACE I/D gene polymorphism were made using a polymerase chain reaction (PCR) technique on 98 patients with clinical stage II PAOD according to Fontaine and 240 healthy individuals who served as controls. All patients and controls came from central Germany. Clinical variables which included duration of clinical symptoms, a familial history of the disease, arteriosclerosis score (ASF, providing an estimate of the extent of atheromatosis at femoral artery bifurcation) and plasma ACE activity were correlated with the genotypes taking the cardiovascular disease risk factors which were present into consideration., Results: Differences in ACE genotypes between patients with PAOD (D/I: 0.57/0.43) and control group individuals (D/I: 0.59/0.41) were not observed. In comparison with the II genotype, the DD genotype was associated with a shorter duration of disease (p = 0.01), a positive family medical history (p = 0.022) and a higher plasma ACE activity (p = 0.026). The ASF did not correlate with the ACE I/D gene polymorphism., Conclusion: Evidence that the deletion allele is linked to the manifestation of PAOD could not be found in the patients studied. One can assume, however, that the deletion allele has a progression promoting effect on the disease.

Aspirin has recently been shown to increase endothelial resistance to oxidative damage. However, the mechanism underlying aspirin-induced cytoprotection is still unknown. Using cultured cells, the present study investigates the effect of aspirin on the expression of ferritin, a cytoprotective protein that sequesters free cytosolic iron, the main catalyst of oxygen radical formation. In bovine pulmonary artery endothelial cells, aspirin at low antithrombotic concentrations (0.03 to 0.3 mmol/L) induced the synthesis of ferritin protein in a time- and concentration-dependent fashion up to 5-fold over basal levels, whereas ferritin H (heavy chain) mRNA remained unaltered. Aspirin-induced cytoprotection from hydrogen peroxide toxicity was mimicked by exogenous iron-free apoferritin but not iron-loaded ferritin, demonstrating the antioxidant function of newly synthesized ferritin under these conditions. Ferritin induction by aspirin was specific in that other nonsteroidal anti-inflammatory drugs such as salicylic acid, indomethacin, or diclofenac failed to alter ferritin protein levels. Aspirin-induced ferritin synthesis was abrogated in the presence of the iron chelator desferrioxamine, pointing to an interaction of aspirin with iron-responsive activation of ferritin translation. Together, our results suggest induction of ferritin as a novel mechanism by which aspirin may prevent endothelial injury in cardiovascular disease, eg, during atherogenesis.

A 24-h incubation with hydrogen peroxide (0.65 mM) markedly reduced viability of cultured endothelial cells. Preincubation with aspirin (3-30 microM) protected endothelial cells from hydrogen peroxide-induced toxicity and increased viability in a concentration-dependent fashion by up to 64% of control. A similar protection was observed with D-alpha-tocopherol acetate (vitamin E, 3-30 microM). The cytoprotective effects of aspirin and vitamin E against hydrogen peroxide were overadditive suggesting different mechanisms of antioxidant action. In agreement with this, cytotoxicity induced by iron, the main catalyst of oxygen radical formation, was substantially reduced by aspirin but not vitamin E. These results show that aspirin protects endothelial cells from oxidative stress possibly via binding or chelation of free cytosolic iron. Moreover, a combination of aspirin and vitamin E might be useful for the prevention of endothelial injury in cardiovascular disease, e.g. during atherogenesis.

A 51-year-old diabetic showed symptoms of a hypertensive crisis with a systolic blood pressure above 300 mmHg. The antihypertensive therapy failed and the Doppler-pressure values were also too high for all limb arteries. Duplex-sonography and soft-x-ray examination showed a mediasclerosis of arms and legs. The true pressure, measured at the still compressable arteries of the fingers was relatively low. There was symptomatic improvement after completion of the antihypertensive therapy.

It is necessary to observe the direction of the blood flow for measurement of the ankle pressure by the Dopplermethod. Obliteration of the ankle pressure by the Dopplermethod. Obliteration of the anterior tibial artery can be compensated by collaterals from the posterior tibial artery. Through this the blood flow is reversed in the dorsalis pedis artery. If this possibility is disregarded, the pressure of the anterior tibial artery will yield false data. The situation of the blood flow can be clarified by a compression test of the posterior tibial artery. This also applies to obliterations of the other arteries of the ankle.

In patients with peripheral arterial occlusive disease diagnostics by Doppler-sonography at the toe arteries and by Doppler-pressure measurement at the ankle arteries is often difficult and sometimes impossible. Using the first dorsal metatarsal artery for Doppler-waveform analysis yields exact information on haemodynamically relevant circulatory disturbances. Painful ulcers, gangrene, oedemata, mediasclerosis, burns, plaster casts, posttraumatic or postoperative conditions prevent the application of cuffs at the lower leg or foot. This Doppler-waveform analysis evidently represents the degree and the specialties of a disturbed blood circulation and allows an additional assessment of the vessels distal from the ankle arteries and enables a functional test on the anastomosis of the artery tibialis posterior and the artery dorsalis pedis. Functional and pharmacological influences on the tone of the vessels can be shown. The typical diagnostic features of Doppler-wave-form analysis used at the proximal measuring points are also valid at the dorsal metatarsal artery. The results of own comparative investigations in 69 patients and 44 healthy test persons are demonstrated.

Detection of complete inferior vena cava thrombosis is relatively simple because of the clinical symptoms and the pathological results of cw Doppler sonography in the region of the common femoral vein. Drainage volume detectable by means of venous occlusion plethysmography is considerably reduced during the acute phase, but normalizes with increasing degree of collateralization. In case of incomplete inferior vena cava thrombosis clinical signs, cw. Doppler sonography and venous occlusion plethysmography are not very relevant. Therefore, imaging technique is additionally required. Basing on a case report, the article demonstrates that ultrasound-B-method and echocardiography, or preferable endoechocardiography, may contribute to a more reliable diagnosis. Cavography is still the gold standard if invasive therapy is planned.

Microcirculatory disturbances are important complications in hypertension, arterial occlusive disease (PAVK) and diabetic angiopathies. The special haemorrheological diagnostics for the judgment of the terminal vascular bed tended to the comprehension of the haemorheological risk. Due to the increase of the aggregation of erythrocytes and viscosity of the plasma in peripheral arterial occlusive disease and diabetic angiopathies this risk proved to be distinctly increased, in diabetes mellitus without vascular complications and essential arterial hypertension it proved less distinctly increased. In hypertension the application of diuretic drugs should be done more critically and more controlled, in order to avoid conditions of hyperviscosity with their sequels for the microcirculation. The internal therapy in PAVK and diabetic angiopathies must include the amelioration of the disturbed blood fluidity.

On 29 test persons after clinical angiological and cw-Doppler-sonographic exclusion of an obstruction of the deep veins and an arterial occlusive disease on the upper extremities the capacity of the veins and the drainage volume were determined by means of the venous-occlusion plethysmography. The angiological measuring places Compactus 540 and Periquant 3800, respectively, of the firm Gutmann (group 1) and the 2-channel occlusion plethysmography of the former nationally owned measuring device factory Ballenstedt (VEB Messgerätewerk Ballenstedt) (group 2) were at our disposal. Apart from the obsolute values of the capacity of the veins and of drainage volume on account of the large interindividual dispersions the quotients were determined in the comparison of sides. In the two groups the drainage volume showed significantly larger values on the right arm than on the left one. In group 2 the measuring of the capacity of the veins and the drainage volume resulted in essentially larger values than in group 1. In contrast to the absolute values the quotients of the measuring values did not show any significant differences between the two groups so that it seems that these are better suitable of the judgment of the venous obstruction behaviour.

In 35 patients with healthy vessels, 52 patients with vasospasm and 42 patients with stenoses or obliteration of the finger arteries with the help of the Parks-ultrasound-Doppler device model 806-A and a finger cuff of the size of 3.5 X 5 cm the systolic pressure of the finger arteries was measured before and after the administration of glycerol trinitrate. Since in test persons with healthy vessels no significant differences of the radial and ulnar volar finger artery, of the single fingers of one hand or in the comparison of the sides of the two hands was found, a concentration could be done. The relative and absolute increase of the pressure of the finger artery under glycerol trinitrate was most conspicuous in patients with vasospasm. No essential changes, as we expected, occurred in patients with organic disturbances of the arterial blood supply. Under variation of the lower limits of the norm of the pressure of the finger arteries the high values of the sensitivity, specificity and efficiency which are characteristic for the ultrasound-Doppler pressure measurement, lying over 0.90 particularly after pharmacologic vasodilation.

For the clarification of the genesis of a unilateral dropsy of the legs which had appeared in 16 women after operative and radiologic therapy of a carcinoma of the cervix apparative angiological functional investigations were carried out. A slightly diminished plethysmographic drainage volume in a Doppler-sonographically unhandicapped deep venous flow off corresponded to the clinical picture of the secondary lymphatic oedema. The findings were compared with the behaviour of the parameters in thrombosis of the iliofemoral vein and test persons with healthy vessels. Only in two cases a venous component in form of a stenosis of the pelvic veins and a postthrombotic syndrome, respectively, could be objectified. Since the methodology renders possible a differentiation of lymphatic oedema and phleboedema, it is suitable for non-invasive controls of the course and has practical significance in the after-care of female patients with carcinoma of the cervix.

In order to prove inhibitions of the arterial system in the region of the lower extremities and for the judgement of their haemodynamic efficacy Doppler-sonographic measurements of the systolic pressure in patients in the asymptomatic stage I after Fontaine were performed. With regard to the early recognition and judgment of the function the behaviour of the peripheral blood pressure concerning the standardized work of the muscles of the arterial ischaemia, measured at size and duration of the induced decrease of pressure, proved to be particularly evident. Diagnostic informations going beyond the examination under conditions of rest could be brought so that the functional test is particularly suitable for the recognition of early clinical stages the arterial obturation disease in the region of the extremities.

In order to avoid wrong estimations of the functional capacity of extremities with successfully reconstructed vessels in angioorganopathies, the use of reliable angiological measuring sizes in a broad spectrum is needed. Oscillography and longitudinal rheography as well as determinations of the arterial blood pressure deliver such qualitatively reliable parameters. For the judgment of the postreconstructive functional capacity one must not renounce the occlusion plethysmography of the veins which delivers quantitative measuring sizes. Other disturbances of the organs by the vascular basic disease present and concomitant diseases of middle and older age independent on the basic disease must always be taken into consideration in the general judgment.

From the standpoint of the clinical angiology the ultrasound Doppler method is of great diagnostic evidence. By means of this method depending on physico-technical and apparative prerequisites we succeed in judging the movements of blood in the non-invasive way. Of particular relevance is the sonographic investigation after Doppler of the extracranial part of arteries supplying the brain. In the region of extremities the poststenotic pressure measurings after Doppler give the possibility to establish early clinical stages and to objectify the degree of compensation of arterial circulatory obstructions.

The percutaneous transluminal angioplasty is regarded as valuable enrichment of the therapeutical possibilities in peripheral arterial obstructive disease. Frequently by its application an arterial dilatation of the lumen and thus a local improvement of the blood supply can be achieved. As was shown by our measurements the haemodynamic factors and the quality of the prophylaxis of recidivations by medicaments have a decisive influence on the early results. Apart from clinical and X-ray morphological findings also oscillographic, Doppler-sonographic, plethysmographic and ergometric parameters are used for indication. In the same way angiological examinations of the function were performed within the further control of course and therapy. Changes of the peripheral haemodynamics could be particularly well read at the behaviour of the systolic pressure gradients and indices. When the technical and apparative prerequisites for the performance of the percutaneous transluminal angioplasty are given, the close interdisciplinary cooperation between radiologists and angiologists is important for achievement of optimum results of the treatment.

In order to study the spontaneous rhythmics of the peripheral blood supply under diabetic metabolic onditions with the help of venous occlusion plethysmography quantitative measurings were carried out in 20 long-term diabetics treated with insulin and in an adequate control group with healthy metabolism. The results were significant differences of the sizes of blood flow in rest as well as in the behaviour of the amplitudes and in the course of time of the spontaneous rhythmical varieties of the blood supply. Influences of age and duration of diabetes could not be proved on the basis of the number of patients. As to their evidence the findings are discussed with regard to the pathogenesis and early recognition of the diabetic neuro- and angiopathy.

Diseases of the terminal vascular system are of particular diagnostic and differential-diagnostic importance in clinical angiology. While in the functional microangiopathies of the skin as a rule disturbances of the vasomotor function without an essential value of the disease are concerned, secondary organic changes of the wall of the vessel not infrequently determine the course and the prognosis of the basic disease (rheumatoid arthritis, collagenoses, hypertension and diabetes). Vasomotor trophic disturbances are observed also post-traumatically, post-operatively, after exposition to cold, in a lesion of the central nervous system and vertebra nerve irritations. For the allergic hyperergic vasculitides, which show an extraordinary polymorphism in the clinical picture in characteristic histological findings, an auto-immune pathogenesis is to be supposed. The chronic arterial hypertension leads to arteriolosclerosis and necrosis with adequate organic symptoms. In the diabetic microangiopathy we may demarcate functional pre-stages from irreversible structural changes of the vessels, in which case apart from the peripheral microangiopathy of the skin the retinopathy and nephropathy are to be classified as particularly important clinical manifestations.

The clarification of non-arteriosclerotic inflammatory vascular diseases is based on angiological, angiographical, immunological and immunohistological methods and parameters. As causes of the arterial occlusive disease of younger patients are taken into consideration the obliterating endangiitis and Takayasu's aortoarteriitis. To the clinical manifestations of the giant cell arteriitis belong the temporal arteriitis and the rheumatic polymyalgia. Hypersensitivity and panangiitides are to be delimited from the group of the pathergic granulomatoses. The secondary Raynaud's syndrome on the basis of a digital arteriitis is of differential-diagnostic and prognostic importance in collagenoses and rheumatoid arthritis.

In 23 patients with arterial obstructive disease of type of femoropopliteal localization (stage I and II after Fontaine) comparative oscillographic and doppler-sonographic examinations were performed in rest and after standardized dynamic muscle work. Depending upon the haemodynamic importance of the present obstructions of the arterial system after load a significant increase of the systolic pressure gradient could be proved with decrease of the oscillometric indices. The determination of haemodynamic parameters after ergometric load serves to the objective judgment of the function in vascularly conditioned claudication and it is, moreover, important for the recognition of early changes (asymptomatic stage I). Load tests are indicated always in such cases when the findings under conditions of rest do not allow an unequivocal judgment or discrepancies between subjective functional capacity and ischaemically conditioned restriction of the function are to be supposed.

Arteriopathies of the upper half of the body may lead to considerable functional disturbances of the arm and severe deficits on the part of the central nervous system. Due to good comparison they scarcely cause or do not cause any complaints in a no unconsiderable part. The clinical material consisting of 4,162 patients from five annual courses had in 9.2% occlusion and stenoses localized in the supraaortic and brachial region. The in most cases systemic angiopathy here explains the frequently combined appearance with arterial processes in the pelvic and the leg region. According to the height of the occlusion we clinically differ types of carotis, shoulder girdle, upper arm and peripheral-acral obliteration, which in each case show differences concerning frequency, age of manifestation, etiology, distribution of sex and clinical degree of severity. The angiological basic diagnostics is based on the inspection, palpation of the arteries, auscultation of the vessels, bilateral measuring of the blood pressure after Riva-Rocci and functional examinations, such as fist closure test and Allen test, as well as clinical proofs or exclusions of neurovascular syndromes of the shoulder girdle. The special apparative angiological methods comprise the oscillo-, rheo- and vein occlusion plethysmography, the Doppler ultrasound technique, estimations of the ophthalmic pressure, isotopic methods and angiographic exploration. --The individual angiological examination methods are of different importance according to the height localisation of the angioorganopathy. --The incomplete syndrome of the aortic arch is taken into consideration. In short the author adopts a definite attitude to the demands of therapy.

On 95 patients functional rheographic investigations and pressure measurements of the arteries of the big toes were carried out before and after the administration of glycerol trinitrate. Using the nitrate-induced decrease of the tone of the vessels persons with healthy vessels could more certainly be differed from patients with organic arterial occlusive disease of the lower extremities stage I and IIa. Despite the administration of glycerol trinitrate the rheography, however, does not reach the extraordinarily high reliability of the ultrasound-Doppler-pressure measurement in the early diagnosis of the arterial occlusive disease.

In 61 patients with peripheral arterial obstructive disease (stages I and II after Fontaine) oscillographic, haemodynamic and ergometric functional examinations were performed. The pedal-ergometric charge maximum correlated with haemodynamic parameters. Informations were obtained which transgressed the exclusive pressure and flow measurement, for which reason the pedal ergometry is particularly suitable for the judgement of the function and control of therapy in arterial obstructive disease.

23 patients were examined who in the ultrasound-Doppler-pressure measurement were evident by too large peripheral systolic measuring values. On the X-ray pictures of the soft tissues of these patients more or less expressed linear and longitudinal calcifications of the vascular wall in the sense of a Mönckeberg sclerosis of the media were to be proved. Though these changes of the arteries which are to be established in most cases in diabetics of older age do not cause, as a rule, any disturbances of the peripheral blood supply, they are of clinical interest, since they falsify the results of indirect measurements of the pressure (pseudohypertension). An arterial obstructive disease which is simultaneously present may possibly been overseen and the false diagnosis of a therapy-resistant arterial hypertension may be made.

In indirect measurements of the blood pressure with the help of the ultrasound-Doppler-method important influence factors and sources of errors are to be taken into consideration. In order to estimate the importance of restricted vascular compressibility, changed tissue conditions and different position of the body, pressure measurements in patients with arterial obstructive disease and in test persons with healthy vessels were performed. The mediasclerosis leads to an extensive rigidity of the arterial wall so that falsely high measuring values could be established which were lying significantly above the intravasal pressure. For examination in the femoral region of a cuff of the standard breadth in relation to the volume of the extremity is too narrow to guarantee a lossless transmission of the pressure on the artery. After passive change of the position also in the poststenotic region significant changes of the pressure can be proved. As is shown by the results the desired diagnostic evidence with the help of the Doppler pressure is to be got only in such a case, when relevant influence factors are considered and the measurement is performed under standardized conditions.

The broadly subdivided symptomatology of disturbances of the secondary acral blood supply, in which Raynaud's syndrome with its variants occupies a preferred position, demands solid basic knowledge of the physician, since triggering function or supporting permanent disturbance belong to a great number of basic diseases or primary disturbing factors. Thus the practicing physician has to do with comprehensive differential-diagnostic considerations with the aim of the correct recognition of the primary basic disease or noxa for the purpose of consequent induction of therapy. Angiological basis examinations, simple functional tests, a fundamental general physical examination, X-ray pictures granted for necessary and ECG-records as well as chemical laboratory findings alleviate the finding of the diagnosis like an exactly got anamnesis. In this therapeutic management subspecialists have then certainly only for a smaller part the task of further diagnostic clarification and therapeutic advice.

For the purpose of testing extracardial haemodynamic effects of the calcium antagonist nifedipine (corinfar) in 15 patients with arterial obstructive disease and in a control group plethysmographic and doppler-sonographic measurements before and after oral application of the substance were performed. In these cases after the application of nifedipine a significant increase of the blood flow in the crural region developed. At the same time a slight decrease of the systolic pressure could be established at the upper and lower extremity. In patients with arterial obstructive disease these haemodynamic reactions had a less significant result. They correspond to an arterial vasodilatation with decrease of the peripheral resistance and simultaneously they explain a part of the antianginous effect of the calcium antagonist. The increase of the blood flow which is to be objectified after the application of nifedipine also in poststenotic areas might be of clinical importance particularly in the combined occurrence of atherosclerotically conditioned disturbances of the blood supply of the coronary and peripheral vascular system.

Haemorheological investigations in 73 male patients with chronic disturbances of the arterial blood supply of the lower extremities and 54 male non-insulin-requiring (type-II-) diabetics with and without micro- and macroangiopathy resulted in significant changes of the flow properties of the blood in contrast to 20 comparable clinically healthy males. In all groups of patients a clear increase of the aggregation of erythrocytes and the viscosity of plasma as well as a decrease of the deformability of erythrocytes were to be proved. The size of the deviations of all three parameters from the normal correlated with the degree of severity of the arterial obstructive disease and in diabetics with the occurrence of vascular complications (macroangiopathy, retinopathy) as well as with the situation of metabolism. The decreased fluidity of blood may lead to the development of further enlargement of disturbances of microcirculation. Therefore, haemorheological viewpoints should be included into the total diagnostic and therapeutic concept of the arterial obstructive disease and the diabetes mellitus.

In 37 test persons with healthy vessels and 103 patients with arterial obstructive disease the clinical findings of the pulse palpation were related to the results of the systolic Doppler pressure measurement in the region of the posterior tibial artery. The experience of the investigator, physical influences, local extravascular factors as well as parameters of the central haemodynamics proved to be significant. A palpation of the pulse was successful in peripheral systolic pressure values lying higher than 90 Torr, so that here a judgement of the function alone became possible with the help of the palpatory pressure measurement of the posterior tibial artery. Unfavourable local conditions, however, can be followed by negative tactile findings of the pulse also in higher pressure values.

Nitrates decrease the tonus of the smooth vascular musculature and cause a vasodilation also in the region of the peripheral arterial system. This was shown after sublingual administration of glycerol trinitrate in test persons with a healthy vessel and patients with arterial occlusive disease in stage II. A significant change of the poststenotic systolic pressure and the influence on the parameters of the rheographic volume pulse curve developed. The peripheral effects of nitrate are used in the angiological functional diagnostics. They are of importance for the medicamentous therapy of vasospastically and organically disturbances of the arterial blood supply.

In order to control the valency of Doppler-sonographic parameters for the arterial vascular diagnostics, in patients with arterial obstructive disease apart from the measurement of the blood pressure characteristics of Doppler speed curves were analysed. Proximal obstacles of the vascular system of haemodynamic relevance led to the systolic decrease of pressure in the area of the extremities and to the monophasic configuration of curves with increased diastolic flow velocity and loss of the reflux component. Relations to the degree of severity of the ischaemia were found. The Doppler-sonographic comprehension of a changed local behavior of resistance and blood supply was valuable also for the differential diagnosis.

In 83 test persons with healthy vessels within the Doppler sonography the resistance indices of the internal carotid artery and the supratrochlear artery were established and in the various regressor combinations with the help of the multiple correlation influences of age, pulse rate, systolic blood pressure and diastolic blood pressure as well amplitude of blood pressure were tested. Thereby only the combination of systolic blood pressure and amplitude of blood pressure proved to be relevant. The confidence limits of the PWI of the right internal carotid artery and of the supratrochlear arteries of the two sides were established so that in findings with limit value it is easier to be stated whether the changes are only caused by circulation or they are reference to underlying stenoses. There were no significances as to the sides of the peripheral resistance indices.

Doppler-sonographic and internal angiological findings of 57 patients with extracranial stenosis or obliteration of the internal carotid artery were evaluated. On the basis of the audio-signals and Doppler speed curves derived from the supratrochlear artery, the common and internal carotid arteries haemodynamically relevant extracranial obstructions of the vascular system could be objectified and judged with regard to their collateral compensation. Diagnostically valuable were the comparison of the sides and the additional calculation of the indices of the resistance. The Doppler sonography of the carotid artery should be used within the clarification of a cerebrovascular insufficiency and before every invasive diagnostics.

277 patients at stage I after Fontaine were examined for the control of the capacity for clinical and noninvasive apparative investigation methods for the early diagnostics of the arterial occlusive disease. Taking into consideration the angiographic reference method, calculations of sensitivity, specifity and efficiency as well as multivariate statistical evaluation were carried out for the individual techniques. Haemodynamically relevant obstructions of the vascular system could most certainly be established by means of ultrasound-Doppler-pressure measurements (sensitivity = 96%). Also the bicycleergometry and the oscillography under stress were suitable for the early diagnostics. The results of the angiological functional examination underlie the indication for further diagnostics and control of therapy.

In 34 male patients with peripheral arterial occlusive disease of the lower extremities the individual responsibility to an intraarterial adenosine triphosphate infusion was tested with the help of Doppler-sonographic poststenotic measurements of the systolic blood pressure as well as comparatively to this by determination of the arterial blood-flow in rest in the region of the calf. While the greater part of the patients with occlusive disease reacted with a significant increase of the blood supply, nearly with the same frequency a decrease of pressure or no change could be established concerning the behaviour of the peripheral pressure. For the judgment of the efficacy of an intraarterial infusion treatment in the acute experiment plethysmographic measurements of the blood-flow are, therefore, more suitable and should be preferred to Doppler-sonographic pressure parameters. As to the controls of long-term therapy under conservative treatment as well as for the judgment of the success in the reconstructive surgery of vessels, however, the post-stenotic measurements of the pressure stood the test apart from further methods in clinical practice.

In fourty patients with peripheric atherosclerosis obliterans blood flow was measured by means of venous occlusion plethysmography during an intraarterial and an intravenous infusion of ATP. The intraarterial application showed a significantly higher increase of blood flow than the intravenous in the sick extremities. The "borrowing-lending-phenomenon" happened more seldom than after an intravenous load. This withdrawal of blood occurred most frequently in patients with proximal occlusions, when the infusion reached casually the arteria femoralis profunda only. The "borrowing-lending-phenomenon" can be measured by the poststenotic pressure and by the volume of blood flow in time. Then the patients complain about a begining or an increasing of an ischemic pain at rest.