Effects of fragmentation on genetic diversity in island populations of the Aegean wall lizard Podarcis erhardii (Lacertidae, Reptilia).

Landbridge islands offer unique opportunities for understanding the effects of fragmentation history on genetic variation in island taxa. The formation of islands by rising sea levels can be likened to a population bottleneck whose magnitude and duration is determined by island area and time since isolation, respectively. The Holocene landbridge islands of the Aegean Sea (Greece) were formed since the last glacial maximum and constitute an ideal system for disentangling the effects of island area, age and geographic isolation on genetic variability. Of the many reptile species inhabiting this island system, the Aegean wall lizard Podarcis erhardii is an excellent indicator of fragmentation history due to its widespread distribution and poor over-water dispersal abilities. In this study, we utilize a detailed record of Holocene fragmentation to investigate the effects of island history on wall lizard mitochondrial and nuclear microsatellite diversity. Findings show that the spatial distribution of mitochondrial haplotypes reflects historical patterns of fragmentation rather than geographic proximity per se. In keeping with neutral bottleneck theory, larger and younger islands retain more nuclear genetic variation than smaller, older islands. Conversely, there is no evidence of an effect of isolation by distance or effect of distance to the nearest larger landmass on genetic variability, indicating little gene flow between islands. Lastly, population-specific measures of genetic differentiation are inversely correlated with island area, suggesting that smaller islands exhibit greater divergence due to their greater susceptibility to drift. Taken together, these results suggest that both island area and time since isolation are important predictors of genetic variation and that these patterns likely arose through the progressive fragmentation of ancestral diversity and the ensuing cumulative effects of drift.

[Coronary angioplasty over 70 years of age]. / Koszorúér-angioplasztika 70 éves kor felett.

In the two institutions between January 1992 and December 1998 PTCA-s were done in 196 pts (123 male and 73 female) aged 70 years or more, with the 57 (20.1%) 6 months redo procedures performed out to June 1999, totally 247 interventions. The dilatations were done in 230 vessels (218 natives and 12 grafts) and in 254 stenoses, as of 1996 in 73 cases with stent deployment, too. PTCA was clinically successful in 178 (90.8%) pts, suboptimal result and/or MACE (AMI, emergency PTCA or CABG, fatal outcome) occurred in 18 (9.2%) cases. Due to unsuccessful PTCA-s, 3 (1.5%) pts underwent acute, 3 elective bypass surgery, in 1 (0.5%) case thoracal sympathectomy without revascularisation, in 1 no further intervention was done. The in-hospital as well as the 30 days mortality was 5 (2.6%). Taking into consideration the higher risk of CABG surgery at an old age, in the case of indication for coronary revascularisation the possibility of angioplasty should be considered first.

[Improvement of myocardial perfusion following left ventricular resection]. / A myocardialis perfusio javulása bal kamrai resectiót követóen.

Left ventricular aneurysm had detected at the 55-year-old woman after extensive anterior myocardial infarction in association with progressive ventricular dilatation and symptoms of heart failure. Coronary angiogram revealed a serious lesion in the proximal segment of the left anterior descending coronary branch with a poor run off tract. 18FDG-PET and 99mTc-MIBI-SPECT investigation were performed in order to differentiate the scarred regions from the viable myocardial segments. Taking into consideration the results an aneurysm resection was performed without revascularisation procedure. After the surgery not only the ejection fraction and the left ventricular dilatation had improved but the tissue perfusion in the segments surrounding the resected aneurysm had also showed a significant increase at the follow up MIBI-SPECT imaging.

Postinfarction left ventricular pseudoaneurysm.

Left ventricular wall rupture after myocardial infarction is a mechanical complication that may result in a pseudoaneurysm. Between January 1994 and October 1996, false or pseudoaneurysms were detected in 6 (0.0026%) of 2,600 consecutive patients (4 women, 2 men; mean age 59.4 years) undergoing cardiac catheterization at University Medical School, Debrecen, Hungary. All patients had a history of cardiovascular disease, with diagnosis of pseudoaneurysm confirmed by echocardiography. The average time from the occurrence of acute infarction to diagnosis was 37.0 days (range 3-80 days). All patients were in New York Heart Association functional class IV congestive heart failure; in four patients cardiogenic shock was present. Five patients underwent coronary angiography, which demonstrated multivessel disease and occlusion of the infarct-related artery (TIMIO) without adequate collateral circulation (grade 0-1). Five patients had surgical repair of the false aneurysm, and, in three patients, concomitant coronary bypass grafting was performed. The 2-year mortality rate for all patients was 50%. Early diagnosis of false aneurysm is facilitated by echocardiography, and coronary angiography is required before surgery. Early surgical correction with coronary revascularization is advised.

[Coumarin combined with low-dose acetylsalicylic acid in the prevention of thromboembolic complications in patients with mitral and aortic valve prostheses]. / Kumarin és kis adagú acetilszalicilsav együttes adása mitralis és aorta mechanikus mübillentyüs betegek thromboemboliás szövödményeinek megelözésében.

Authors studied the effect of coumarin, and its combination with low-dose (125 mg/day) acetylsalicylic acid in the prevention of thromboembolic complication during a 10-year period (average 4.7 years) in a randomized trial of 296 patients aged 18-60 year with tilting disc type prosthetic heart valve (159 mitral and 137 aortic) in sinus rhythm. In the group treated with coumarin (152 patients, 743.4 patient-years) 4 cases (2 of them fatal) of valve thrombosis, 12 cases of peripheral embolism and 9 cases (3 intracranial, 3 among them fatal) of major bleeding were observed; in the group treated with coumarin plus acetylsalicylic acid (144 patients, 638.7 patient-years) 2 cases (1 of them fatal) of valve thrombosis, 4 cases of peripheral embolism and 14 cases (3 of them fatal) of major bleeding were observed. In the case of valve thromboses the difference between the two groups was non-significant but still clinically remarkable; peripheral embolism occurred in significantly higher number (p < 0.05). There was no statistically significant difference of bleeding complications between the two groups. The results suggest that the combination of coumarin plus low-dose acetylsalicylic acid is more effective in the prevention of thromboembolic complications in patients with mitral and aortic prosthetic heart valve than coumarin alone; the danger of bleeding complications seems to be acceptable with adequate control.

[Angiographic findings in postinfarction cardiac rupture]. / A posztinfarktusos szívizomrupturák angiographiás jellemzöi.

The hemodynamic and angiographic findings were examined in 16 patients with myocardial rupture following acute myocardial infarction. The patients (9 men, mean age 55.8 years, and 7 women, mean age 64.0 years) had suffered an extensive transmural infarction, all but 2 cases involved first cardiac events. The diagnosis of myocardial rupture was made on clinical grounds, and confirmed by the results of noninvasive (echocardiography) and invasive (left ventriculography) investigations. The average time from the infarction to the appearance of cardiac rupture was 4.6 days (range: 1 hour to 16 days). The patients receiving thrombolytic therapy mainly suffered an early rupture (less than 72 hours following the infarction), while the group receiving conventional therapy mainly had a late rupture (between 4 and 16 days). 7 patients had single-vessel, 3 two-vessel and 6 three-vessel disease. Examination of the infarct-related vessel revealed a total occlusion in the proximal or medial part of the coronary in 75% of the cases. Angiography demonstrated no manifest collateral circulation to the infarct-related artery in 10 cases, and only limited collateral blood flow in 6 patients. It is concluded that cardiac rupture depends on the management of the myocardial infarction, the abrupt cessation of flow in the infarct-related vessel and the absence of adequate collateral circulation supporting the infarcted zone. 15 patients underwent cardiac surgical correction and in 8 cases additional coronary artery bypass grafting was performed. After the operative intervention, 9 patients exhibited a significant improvement, and there was no sign of cardiac failure.(ABSTRACT TRUNCATED AT 250 WORDS)

[Late post-infarction angina]. / A késöi postinfarctusos angina.

The authors survey the clinical features and therapeutic results of 88 patients suffering from late postinfarctional angina. The results of the bicycle ergometer ECG tests were negative only in the case of 8 patients. Exercise-induced silent myocardial ischaemia was registered in 45.4%. Coronary angiography revealed that 54 (61%) of the patients suffered from multivessel disease. Coronary bypass surgery was carried out in 56.8% and the rate of peripheral anastomoses was 3.1/patient. The authors consider it to be essential to detect the ischaemia in the infarct survivors with chest pain. Taking into consideration the clinical feature and the results of exercise tests, the authors propose cardiac catheterization. Myocardial revascularization is recommended if the medical therapy is not successful or the patients suffered from left main, triple-vessels disease and the myocardium is jeopardized to a large extend.

[Successful delivery of a patient with two artificial valves (mitral and aortic)]. / Kettös (mitralis és aorta) mechanikus mübillentyüs beteg sikeres szülése.

The authors report the case of the successful delivery of a 35-year old woman who underwent a double Sorin tilting disc valve replacement because of severe mitral and aortic valve disease in NYHA III-IV. functional class six years ago. Beside reporting on outcome of the case and complications, they mention the possible other complications too, endangering the life prospects of the mother and child that can come about as a result of the diminished pump function of the myocardium, blood coagulation changed during pregnancy and due to the hemmorrhagic and teratogenic consequences of anticoagulant treatment.

[Protein C and apoprotein levels in ischemic heart disease diagnosed by coronarography]. / Protein-C és apolipoprotein-szintek vizsgálata coronarographiával igazolt ischaemiás szívbetegségben.

The levels of protein C and different lipid parameters were measured in 22 patients, younger than 50 years, suffering from coronary heart disease, proved previously by angiography. The severity of coronariasclerosis showed certain correlation with the concentration of apolipoprotein B and triglycerids, while low levels of protein C were also mainly observed in those with severe coronary heart disease.