The CLEAR X-ray emission spectrometer available at the CLAESS beamline of ALBA synchrotron.

The CLEAR X-ray emission spectrometer installed at the CLAESS beamline of the ALBA synchrotron is described. It is an energy-dispersive spectrometer based on Rowland circle geometry with 1 m-diameter circle. The energy dispersion is achieved by the combination of a diced analyzer crystal and a unidimensional detector. A single unconventional dynamically bent analyzer crystal (Si 111) permits a wide energy range to be covered, just by exploiting its different reflections (333, 444, 555, 777, 888): 6-22 keV, with a spectrometer efficiency that decreases above 11 keV because of the Si detector thickness (Mythen, 350 µm), while the relative scattering intensities for the Si 333, 444, 555, 777 and 888 reflections correspond to 36, 40, 21, 13 and 15, respectively. The provided energy resolution is typically below 1-2 eV and depends on the beam size, working Bragg angle and reflection exploited. In most cases the energy dispersion ranges from 10 to 20 eV and can be enlarged by working in the out-of-Rowland geometry up to 40 eV. The spectrometer works in full backscattering geometry with the beam passing through the two halves of the analyzer. The vacuum beam path and the particular geometry allow a typical average noise of only 0.5 counts per second per pixel. The spectrometer is mainly used for measuring emission lines and high-resolution absorption spectra, with a typical scanning time for highly concentrated systems of around half an hour, including several repeats. The intrinsic energy dispersion allows systematic collection of resonant X-ray emission maps by measuring high-resolution absorption spectra. Moreover, it allows spectra to be measured on a single-shot basis. Resonant inelastic X-ray scattering experiments to probe electronic excitations are feasible, although the spectrometer is not optimized for this purpose due to the limited energy resolution and scattering geometry provided. In that case, to minimize the quasi-elastic line, the spectrometer is able to rotate along the beam path. Advantages and disadvantages with respect to other existing spectrometers are highlighted.

Association of Low Ficolin-Lectin Pathway Parameters with Cardiac Syndrome X.

In patients with typical angina pectoris, inducible myocardial ischaemia and macroscopically normal coronaries (cardiac syndrome X (CSX)), a significantly elevated plasma level of terminal complement complex (TCC), the common end product of complement activation, has been observed without accompanying activation of the classical or the alternative pathways. Therefore, our aim was to clarify the role of the ficolin-lectin pathway in CSX. Eighteen patients with CSX, 37 stable angina patients with significant coronary stenosis (CHD) and 54 healthy volunteers (HC) were enrolled. Serum levels of ficolin-2 and ficolin-3, ficolin-3/MASP-2 complex and ficolin-3-mediated TCC deposition (FCN3-TCC) were determined. Plasma level of TCC was significantly higher in the CSX than in the HC or CHD group (5.45 versus 1.30 versus 2.04 AU/ml, P < 0.001). Serum levels of ficolin-2 and ficolin-3 were significantly lower in the CSX compared to the HC or CHD group (3.60 versus 5.80 or 5.20 µg/ml, P < 0.05; 17.80 versus 24.10 or 26.80 µg/ml, P < 0.05). The ficolin-3/MASP-2 complex was significantly lower in the CSX group compared to the HC group (92.90 versus 144.90 AU/ml, P = 0.006). FCN3-TCC deposition was significantly lower in the CSX group compared to the HC and CHD groups (67.8% versus 143.3% or 159.7%, P < 0.05). In the CSX group, a significant correlation was found between TCC and FCN3-TCC level (r = 0.507, P = 0.032) and between ficolin-3/MASP-2 complex level and FCN3-TCC deposition (r = 0.651, P = 0.003). In conclusion, in patients with typical angina and myocardial ischaemia despite macroscopically normal coronary arteries, low levels of several lectin pathway parameters were observed, indicating complement activation and consumption. Complement activation through the ficolin-lectin pathway might play a role in the complex pathomechanism of CSX.

Generalized alterations in the biomechanical properties of large veins in non-thrombotic thrombophilic young patients.

AIM: In young, post-thrombotic patients, venous distensibility is decreased not only in the affected lower limb, but also in the contralateral limb and in the jugular vein when compared to age-matched control subjects. In the present study, we investigated venous wall mechanical properties in young, asymptomatic thrombophilic patients. METHODS: Eleven young (24+/-0.4 years) control subjects and 9 age-matched patients (21.1+/-1.8 years) with proven thrombophilic molecular defects, but without any signs or history of previous deep vein thrombosis, were compared. Anterolateral and mediolateral diameters of the common femoral, axillary and internal jugular veins were measured by ultrasonography in situ. Pressure alterations were induced by altering body positions and by pressure-controlled Valsalva tests. Distensibility was calculated from diameter and pressure changes. RESULTS: In thrombophilic patients, resting diameter of both the common femoral and of internal jugular veins at low transmural pressure was larger than those for the control subjects. Distensibility, however, was significantly less when high pressures were applied. Alterations in diameter of the axillary vein were minimal. CONCLUSION: Our measurements suggest that there are generalized changes in venous mechanical properties in thrombophilic patients even before the appearance of thrombotic processes. These biomechanical alterations of the venous wall and/or surrounding connective tissue are similar to those found in connection with aging and in post-thrombotic patients. The pathological mechanisms behind these processes are unknown.

New body surface isopotential map evaluation method to detect minor potential losses in non-Q-wave myocardial infarction.

BACKGROUND: Potential losses caused by stable non-Q-wave myocardial infarction (MI) are too small to diagnose with the use of standard ECG. The aim of the present study was to obtain accurate diagnostic criteria for this prognostically important disease with the help of body surface mapping. METHODS AND RESULTS: Body surface potentials were recorded with the use of 63 unipolar leads in 45 patients with a non-Q-wave MI (41 to 75 years old); 24 healthy adults, 42 patients with unstable angina, and 70 patients with Q-wave MI served as reference groups. Qualitative pathological features of the isopotential maps, such as onset time and site and magnitude of the first right-anterior/anterior minimum, as well as pathological negativities at that time, were defined in non-Q-wave MI cases. These features, which account for the activation sequence and the body surface projections of specific cardiac regions (Selvester classification), showed a 91% sensitivity and an 88% specificity for the detection of non-Q-wave MI. In comparison, the different departure maps (first third QRS, QRS, and QRST isoarea) resulted in less favorable specificities (50% to 58%). Concordance between the isopotential maps and the acute-phase ECG (90%), hypokinesis (64%), fixed perfusion defects (59%), and significant stenosis of the infarct-related coronary artery (87%) supported the concept that these isopotential map changes correspond to the supposed sites of MI. There were pathological features in 69% of patients with unstable angina, with similar concordances as in non-Q-wave MI. CONCLUSIONS: Isopotential maps revealed characteristic features that were suitable for the detection and localization of non-Q-wave MI in the clinical setting of unstable coronary artery disease.

The Euro Heart Failure Survey of the EUROHEART survey programme. A survey on the quality of care among patients with heart failure in Europe. The Study Group on Diagnosis of the Working Group on Heart Failure of the European Society of Cardiology. The Medicines Evaluation Group Centre for Health Economics University of York.

BACKGROUND: The EUROHEART programme is a rolling programme of cardiovascular surveys among the member nations of the European Society of Cardiology (ESC). These surveys will provide information on the nature of cardiovascular disease and its management. This manuscript describes a survey into the nature and management of heart failure. AIMS: The EuroHeart Failure survey aims to describe the quality of hospital care, diagnostic and therapeutic, for patients with suspected or confirmed heart failure in ESC member countries. Patients will be interviewed subsequent to hospital discharge to assess their understanding of their condition, side effects from and their compliance with therapy and their satisfaction with the management for heart failure. The quality of management will be judged against the recommendations contained in the ESC guidelines on diagnosis and treatment of heart failure. Outcome will be further assessed by repeat interviews in 6-12 months time. A further survey of heart failure in 2001/2002 is also planned. METHODS: A prospective survey of all deaths and discharges from medical (cardiology, internal medicine and geriatric medicine) and cardiac surgical wards to identify patients with heart failure, suspected or confirmed. Approximately 70 hospital clusters, comprising two to six hospitals in each cluster, in 24 member countries of the ESC are conducting the study. At the time of writing, approximately 30000 deaths and discharges have been screened and approximately 4000 patients have been enrolled. CONCLUSIONS: The EuroHeart Survey will allow actual practice to be compared to ESC guidelines on the diagnosis and treatment of heart failure. The surveys and guidelines should prove mutually informative. The main EuroHeart Failure project will be completed by late 2000. However, new centres volunteering to participate in the study (contact corresponding author) may be accepted providing they have the necessary research personnel and provided funding can be agreed for statistical support and administration.

Influence of diabetic state and that of different sulfonylureas on the size of myocardial infarction with and without ischemic preconditioning in rabbits.

The sensitivity of the myocardium to ischemia and the level of protection achieved by ischemic preconditioning is shaped by the joint influence of several mechanisms in diabetes mellitus. In vivo studies were made in alloxan diabetic and non-diabetic control rabbits to assess if the effects of preconditioning and sulfonylurea pretreatment with either glibenclamide or glimepiride (0.05-0.2-0.6 micromol kg (-1)) influence the extent of the infarcted area caused by one hour ligature of the left coronary artery. For our study, we defined preconditioning as 2 minutes of ischemia followed by 2 minutes of reperfusion, which was repeated 3 times. The interrelationship of the diabetic pathophysiological state, and sulfonylurea treatment during ischemic preconditioning were studied by comparing the infarcted areas and the rate of infarction to risk areas in left ventricular slices using computer planimetry. In healthy control rabbits preconditioning reduced infarcted area (29.6 +/- 3.0% vs. 48.8 +/- 2.8% p < 0.0005), while in diabetic rabbits this protection did not occur (53.3 +/- 7.3% vs. 56.6 +/- 4.4% NS). Glibenclamide in all of applied doses prevented the protective effect in control animals (infarction/ risk area: HP: 0.47 +/- 0.04 vs. HP Glib-0.05 : 0.69+/-0.06 p< 0.004 vs. HP Glib-0.2 : 0.72+/-0.09 p< 0.002 vs. HP Glib-0.6 : 0.75 +/- 0.04 p< 0.001). In contrast, in diabetic rabbits low dose of glibenclamide contributed to the same development of preconditioning. However the highest dose of glibenclamide (infarction/risk area: DP Glib-0.6 : 0.77 +/- 0.17 vs. DP Glib-0.05 : 0.55 < 0.03 p < 0.047) and the consequences of the diabetic state blocked the salutary effect. Glimepiride had no considerable influence on the protective effect, either in control nor in diabetic animals. Glibenclamide and glimepiride, presumably due to their different sulfonylurea receptor affinity in the heart, resulted in different influence on preconditioning in healthy control animals. Glibenclamide treatment seemed to be more harmful when less K (+)ATP channels were activated. The accomplishment of myocardial preconditioning in diabetes mellitus is claimed to be determined by the interaction of both metabolically influenced K (+)ATP channel activity and the dose of sulfonylurea.

Anti-ischaemic efficacy and tolerability of trimetazidine administered to patients with angina pectoris: results of three studies.

Several clinical studies have compared the anti-ischaemic properties of trimetazidine used as monotherapy with those of standard anti-anginal therapy. In the treatment of uncontrolled angina pectoris, the addition of a metabolic agent such as trimetazidine to existing therapy with a haemodynamic agent would appear to confer advantages over the addition of a second haemodynamic agent. Here we report the results of three studies conducted in Poland, the Czech Republic and Hungary that provide additional evidence for the beneficial effects of combining trimetazidine with a conventional haemodynamic agent such as beta-blockers, long-acting nitrate or calcium channel blockers. This combination provided significant benefits in terms of improved exercise capacity and decreased number of angina attacks along with a good tolerability profile.

Detection and localization of ventricular preexcitation in Wolff-Parkinson-White syndrome (comparative study with body surface mapping).

21 patients with Wolff-Parkinson-White (WPW) syndrome were investigated through radionuclide imaging and body surface mapping. Ventricular preexcitation was localized by display of identical phase ventricular regions (phase display). In 79% of the cases radioisotope and body surface mapping methods have identical results for the site of preexcitation. In two patients of the control group (10 patients with Lown-Ganong-Levine (LGL) syndrome), false positive outside-of septum ventricular preexcitation was detected, i.e. an 80% specificity. It is concluded that phase display might be a suitable method in the diagnosis of WPW syndrome. The sensitivity of this method can be improved using several views.

Long-term left ventricular pacing.

A 57-year-old female was implanted with a Biotronik Pikos VVI pulse generator. During her follow-up period right bundle-branch block was observed. Therefore further posteroanterior and lateral chest X-ray and echocardiography were performed. Only the transoesophageal echocardiography showed exactly the abnormal pathway of the electrode through the foramen ovale apertum to the left side of the heart. Abnormal electrode position can create serious complications, however, our patient remained free of symptoms throughout her 5 year follow-up.

[Malignant lymphoma associated with angioedema]. / Malignus lymphomákhoz társuló angiooedema.

The incidence of malignant lymphoma cases in constantly growing. Therefore it is worth-while to consider its presence even in cases where the symptoms do not give a clear indication of the disease. Two cases with angiooema being rare and not carachteristic signs for malignant lymphoma are reported. The authors discuss the supposed paraneoplastic patomechanism in malignant lymphoma, i.e. the possible role of C' 1 inhibition. In the view at the cases discussed the authors propose to consider the possible diagnosis of malignant lymphoma if unexplained angiooedema is present.

[Prinzmetal angina pectoris associated with 3rd degree atrioventricular block]. / Teljes atrioventricularis blokkal szövódött Prinzmetal-angina pectoris.

The authors report on the case of a 61 year-old female patient who was repeatedly taken to hospital because of chest pain and temporary loss of consciousness. During her hospitalization there was no ST elevation on the ECG, sinus bradycardia, other times atrial fibrillation was detected. The diagnosis was made by Holter monitoring three years after the onset of complaints. At this time chest pain set in after midnight, which was followed by loss of consciousness. Significant ST elevation and IIIrd degree AV block were detected. The coronarography showed non-significant coronary stenosis. According to the vasospastic patomechanism nitrate, calcium antagonist and acetylsalicylic acid therapy was administered and because of the complete AV block leading to syncope a VVI, M pacemaker was implanted. During the two years passed since the implantation of the pacemaker the patient had chest pain only once and it was not accompanied by syncope.

[Experience with long-term atrial pacing]. / Tartós pitvari pacemaker kezeléssel szerzett tapasztalataink.

The aim of this study was to evaluate the long term results of atrial pacing. There were 27 atrial pacemaker implantations and 26 out of them were followed for an average of 47, 04 months. Lead dislodgement occurred in two cases, which made necessary a ventricular pacing. Three other patients developed chronic atrial fibrillation. The late results of the remaining 21 patients were very good. No AV-block occurred during the follow-up period. The atrial pacing in selected patients is safe and reliable, and financial restraints makes it advantageous for economic reason.

[Amiodarone-induced hyperthyroidism causing progression of arrhythmia]. / Amiodaron okozta hyperthyreosis által kiváltott arrhythmia-progresszió.

A case of a 38-year-old male with supraventricular paroxysmal tachycardia existing for more than a decade is reported. He has received amiodarone in a daily dose of 800 mg for three years and the tachycardia returned in 1992. New antiarrhythmic drugs were added but no beneficial effect has been achieved and moreover, a case of ventricular fibrillation occurred. The 12-lead ECG performed during tachycardia and the electrophysiological study showed orthodromic AV reentry tachycardia. Laboratory tests performed proved hyperthyreotic state. Attacks of paroxysmal tachycardia were returned and aggravated by the hyperthyreosis induced by amiodarone. Finally, antiarrhythmic drugs were discontinued and methimazol was introduced. Gradually, the patient become asymptomatic within two months. The most important conclusion of the case reported, that the amiodarone induced hyperthyreosis can be subclinical or obscure. Consequently, a regular control of serum thyreoid hormone levels at least twice a year on patients with long term amiodarone administration should be advised.

[The role of two-dimensional echocardiography in the detection of pacemaker-induced endocarditis]. / A kétdimenziós echocardiographia szerepe a pacemaker endocarditis kimutatásában.

UNLABELLED: The authors analysed the data of eight patients who had to undergo open heart surgery because of pacemaker endocarditis in the last four years. Repeated surgical interventions on the pacemaker system was the most predisposing factor. The most common causative organisms were Staphylococcus aureus and Staphylococcus epidermidis. Two-dimensional echocardiography (2DE) had a decision making role in the diagnosis beside the clinical picture and blood culture. CONCLUSIONS: 1. Each pacemaker patient with fever must be considered to have a pacemaker endocarditis; 2. All these patients must be examined by two-dimensional echocardiography.

[Cerebral embolism caused by a right ventricular pacemaker electrode perforated into the left atrium]. / Cerebralis emboliát okozó, bal pitvarba áthatoló jobb kamrai pacemaker elektróda.

The authors present a new, unusual side effect due to retained pacemaker lead. The free tip of the lead caused cerebral embolism by perforating the interatrial septum. Transoesophageal echocardiographic study showed the lead crossing the interatrial septum. The total abnormal course of the lead was demonstrated by lateral X-ray picture. Diagnostic and therapeutic approaches regarding retained leads in malposition are also discussed.

[Peripartum cardiomyopathy with fatal outcome]. / Letális kimenetelü peripartum cardiomyopathia.

The authors reported the case of a 26 year-old primipara who had unexplained congestive cardiac failure on the 9th week after delivery. There was no previous disease in her history however her pregnancy endangered because of imminent abortion was preceded by 1 artificial and 2 spontaneous abortions. In the acute phase she had to be resuscitated because of ventricular fibrillation and then she had a pulmonary embolism followed by pneumonia and therefore she was in septic state for 4 weeks. After a 4 month clinical remission she died unexpectedly at home. At autopsy the histological appearance of myocarditis, thymic hyperplasia and hypoplastic vascular system were observed.

[Clinical value of body surface mapping in the diagnosis of ischemic heart disease]. / Terheléses testfelületi potenciál térképezés (surface mapping) klinikai értéke az ischaemiás szívbetegség diagnosztikájában.

A series of 137 patients suffered in clinically documented angina pectoris were analyzed by 12-lead exercise ECG, exercise body surface potential mapping and exercise thallium scintigraphic methods and the results were compared to that of selective coronary angiography and left ventriculography. If coronary artery stenosis were considered to be significant in the presence of more than 70% vessel narrowing, the sensitivity figures were 76, 93 and 88% for exercise 12-lead ECG, exercise body surface potential mapping and exercise thallium scintigraphy, respectively. In considering 50% coronary artery narrowing to be significant, the same figures were 78, 94 and 89%. Specificity figures at the same order were 59, 65 and 80% for more than 70%, and 64, 70 and 88% for more than 50% coronary obstructions. Exercise body surface potential mapping and exercise thallium scintigraphy applied parallelly gave a sensitivity of 100% and specificity of 53%. False-negative and false-positive exercise body surface potential mapping and thallium scintigraphic tests were analysed taking into consideration left ventricular function indices and respective patients. The authors suggest that the outstanding high sensitivity of the above mentioned two tests applied parallelly reveals that they highlights partially different aspects of coronary artery disease, and that is why the overlapping between the methods is relatively small. The majority of false-positive tests characterize a pathological state, and in these cases the exact diagnosis should be cleared up by other noninvasive/invasive methods.

[Prognostic value of exercise parameters and simple non-invasive variables of left ventricular function in dilated cardiomyopathy]. / Terheléses vizsgálati paraméterek és egyszerü, noninvazív bal kamra funkciós változók prognosztikus értéke dilatatív cardiomyopathiában.

Authors assessed the prognostic value of some simple, routinely used non-invasive parameters in dilated cardiomyopathy. Fifty patients, 43 male and 7 female, mean NYHA class 2.3, treated with digitalis, diuretics and vasodilators, were tested. Mean follow up time was 24 months. The evaluated parameters were as follows: maximal exercise capacity, heart rate, systolic blood pressure, as well as rate-pressure product at peak exercise, their increase during the test, fractional shortening measured by M-mode echocardiography, mean pulmonary capillary wedge pressure estimated by apexcardiography and clinical grade of heart failure (NYHA class). Exercise test was multistage, symptom limited, maximal upright bicycle ergometer test. Both one-way and multivariate analysis showed that except of fractional shortening all of the evaluated parameters related significantly to the survival. According to the one-way analysis maximal exercise capacity, rate-pressure product and systolic blood pressure at peak exercise as well as the estimated value of mean pulmonary capillary wedge pressure proved to be the strongest prognosticators. Multivariate analysis showed that the prognostic value of the rate-pressure product at peak exercise and that of the estimated mean pulmonary capillary wedge pressure proved to be additive, their combined consideration resulted in the highest accuracy of prediction.

[Dual-chamber rate responsive cardiac pacing]. / Kétürgü, rate responsive pacemaker kezelés.

The authors describe in this report their first experience with the implantation of a rate responsive, dual chamber pacemaker. They emphasize the advantages of this type of pacemakers: the maintenance of AV-synchrony and the rate increase in response to exercise. Meanwhile they call attention on the complexity of the ECG interpretation.