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

Adenosine and inosine are believed to have cardioprotective effects. However, little is known about their possible role in the metabolic autoregulation of human coronaries and in pathologic conditions with supply/demand imbalance of the heart such as coronary artery disease. Since these low molecular weight nucleosides freely diffuse through the monolayer of the visceral pericardium, adenosine and inosine concentrations in pericardial fluid may well reflect the conditions in cardiac interstitium. The pericardial fluid and systemic venous blood adenosine and inosine concentrations were measured in 98 human subjects undergoing heart surgery for coronary artery disease or valvular heart disease. Adenosine and inosine concentrations were measured by HPLC with UV detection. In subjects with coronary artery disease pericardial fluid nucleoside concentrations were significantly higher than in patients with valvular heart disease (adenosine: 1545 (996-3146) nmol/L [median (25th-75th quartiles)] vs. 738 (390-2527) nmol/L, P<0.01; inosine: 658 (321-1331) nmol/L vs. 347 (159-1037) nmol/L, P<0.05), while in both patient groups pericardial fluid nucleoside concentrations were higher by an order of magnitude than in venous plasma. Our results show the enhanced release of adenosine and inosine by the ischemic myocardium as a marker of supply/demand imbalance and support the hypothesis that these cardiac nucleosides may have an important role in the adaptation of coronary blood flow in human coronary artery disease.

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

The European Federation for Medical Informatics has been established in 1976. At the MIE 96 it has celebrated the 20th anniversary of its existence. During these 20 years the number of number of national societies who became a member has been increased from 10 to 26 and nowadays is 29 not mentioning 2-3 applicants. The objectives of EFMI are: a) to advance international co-operation and dissemination of information, b) to promote research and development, c) to promote high standards in the application, d) to encourage high standards in education in this field. The achieve these goals EFMI organizes yearly European Congresses the MIE-s. Through its working groups contributes very well to the scientific development of medical informatics. The Working Group Chairmen regularly organizes tutorials workshops and many of them participate in teaching medical informatics in their homeland as well as on international courses. EFMI publishes scientific papers from its congresses in the Medical Informatics and in the International Journal of Medical Informatics. The most important meeting, however is the regular Council Meeting--twice a year--where council members can exchange opinions, have opportunity to discuss problems of medical informatics and last but not lease recently medical Inform-ETHICS. This Council is operating as a HUMAN-NET counterbalancing the dysinformations coming from the Internet.

Protocols and guides, tools.

The author describes in the first part of the review the definitions and relations of the occurring concepts. In the second part a short history of the topic is overviewed. The third part is dealing with the electronic patient record based development of guidelines in addition what are the relations among guidelines, protocols, tools, knowledge-based systems, diagnosis supporting systems, expert systems, outcome analysis and artificial intelligence. A short review of what was presented in the MIE '97 in this area is finally described and the Session Chairman's conclusion.

Respiratory analogue computer model.

An analogue computer model has been constructed to simulate the dynamic behaviour of the human cardiorespiratory system for studying the effect of changes in different system-variables--as alveolar ventilation, functional residual capacity (FRC) of the human lung and the cardiac output--on the partial pressure of carbon dioxide in the arterial and mixed venous blood (pCO2a, pCO2v). The respiratory analogue computer model (RACM) simulates reliably well-known clinical physiological as well as pathological phenomena. Reducing FRC or breath rate an oscillation of pCO2a has been developed, but the mean value has not been changed. In alveolar hypoventilation the pCO2 of blood increases in good conformity with the clinical experience. Reducing cardiac output a characteristic dissociation appeared: pCO2v and pCO2a diverged from each other by increasing pCO2v and decreasing pCO2a. Since in general clinical practice of intensive care only arterial blood gas values are checked regularly, the conclusion that the patient's condition is improving by decreasing pCO2a is a serious misinterpretation in this case, because peripheral tissues are in balance with the increasing venous carbon dioxide tension, and consequently cannot get rid of this toxic agent. The computer-model-based conclusion has led to the practice of sampling both arterial and venous carbon dioxide tensions for better state assessment of seriously ill patients.

Patient health record on a smart card.

A validated health questionnaire has been used for the documentation of a patient's history (826 items) and of the findings from physical examination (591 items) in our clinical ward for 25 years. This computerized patient record has been completed in EUCLIDES code (CEN TC/251) for laboratory tests and an ATC and EAN code listing for the names of the drugs permanently required by the patient. In addition, emergency data were also included on an EEPROM chipcard with a 24 kb capacity. The program is written in FOX-PRO language. A group of 5000 chronically ill in-patients received these cards which contain their health data. For security reasons the contents of the smart card is only accessible by a doctor's PIN coded key card. The personalization of each card was carried out in our health center and the depersonalized alphanumeric data were collected for further statistical evaluation. This information served as a basis for a real need assessment of health care and for the calculation of its cost. Code-combined with an optical card, a completely paperless electronic patient record system has been developed containing all three information carriers in medicine: Texts, Curves and Pictures.

[The use of adenosine in the diagnosis and treatment of cardiac arrhythmias]. / Adenozin alkalmazása a szívritmuszavarok diagnosztikájában és kezelésében.

The authors investigated the effect of adenosine or ATP on narrow QRS tachycardia in 56 pts, 3 pts with wide QRS tachycardia 9 pts with suspected latent preexcitation and 10 pts with PVC suspected to be ventricular parasystole. After the bolus iv. administration of adenosine or ATP every SVT was stopped related to AV node (44 pts), but in the rest twelve related to atrial origin of SVT only one automatic atrial tachycardia could be stopped. From the 9 patient suspected to have concealed WPW 2 pts had delta wave during the effect of adenosine, and in four pts parasystole was demonstrated among the pts had varying coupling interval PVC. None of the pts who had wide QRS tachycardia was the tachycardia stopped, but in two cases the supraventricular origin--atrial flutter and tachycardia--was discovered. The authors emphasize the favourable effect of adenosine in narrow complex tachycardia and suggest that it can given safely in wide QRS tachycardia of unknown origin either. The diagnostic effect of adenosine can be used in sinus rhythm too if latent preexcitation or ventricular parasystole is suspected.

Computer-models for management of a cardiopulmonary clinic.

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

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

BACKGROUND: Clinical conditions, such as heart failure or myocardial infarction are associated with enhanced sympathetic and reduced parasympathetic activity as compared to normal controls. The reciprocal alteration in cardiac autonomic tone likely contributes to the electrical instability of the myocardium. Little information is available on the relation between sympathetic and vagal cardiac control in healthy human subjects. METHODS AND RESULTS: Heart period changes in response to autonomic blockades were measured in 16 young, healthy human subjects. Adrenergic and cholinergic blockades were induced by i.v. propranolol (0.2 mg/kg) and atropine (0.04 mg/kg) in two opposite orders on two occasions; interindividual correlations were performed between the R-R interval responses to propranolol and to atropine obtained under the various blockade conditions, and the magnitude of the responses were compared by a drug x order two factorial ANOVA design. It was found, that previous adrenergic blockade did not reduce the extent of cardioacceleration produced by subsequent cholinergic blockade and that the R-R interval responses to atropine and to subsequently given propranolol did not share significant variance across subjects (r = 0.22, P = 0.234). Also, no interindividual correlation was found between the R-R interval responses to propranolol and to atropine, with the influence of the other, respective, autonomic division already blocked (r = 0.42, P = 0.114). CONCLUSIONS: Under resting conditions, activity levels of cardiac vagal and sympathetic outflows are not related across young, healthy human subjects and peripheral interaction is not manifest between the autonomic divisions.

Relation between baroreflex sensitivity and cardiac vagal tone in humans.

The extent of dependence of cardiac vagal tone on arterial baroreceptor input has been studied in 12 healthy, young adult subjects. Cardiac vagal tone was defined as the chang in R-R interval after complete cholinergic blockade by atropine. Baroreflex sensitivity was determined with the "Oxford-method": R-R interval was regressed against systolic pressure. The interindividual correlation between cardiac vagal tone and baroreflex sensitivity for falling pressures was found to be significant, but not close (R = 0.81, P = 0.002). In each subject, the baroreflex regression line for falling pressures was extrapolated to the post-atropine R-R interval level; 50 mmHg was considered as minimum and 80 mmHg as maximum threshold level for the integrated baroreflex. From the relation between the individual regression lines and the minimum and maximum threshold levels, it was concluded that cardiac vagal tone could be generated by both baroreflex-dependent and -independent mechanisms, the ratio of which varies in different individuals, with the baroreflex-dependent mechanism being the dominant factor.

Carotid sinus hypersensitivity abolished by aminophylline.

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

[Pathogenic role of a pacemaker in occult infection]. / Pacemaker kóroki szerepe rejtett infectio létrejöttében.

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

[Rhabdomyoma of unusual manifestation]. / Szokatlan manifesztációjú rhabdomyoma.

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

[Prinzmetal angina and syncope]. / Prinzmetal angina és syncope.

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

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

After having collected a sufficient number of standardized data checked for reliability from patients with chronic non specific lung disease, the following subgroups of pulmonary arterial mean pressure were defined: A = PAP less than 2.7 kPa [= 20 mmHg]; B = 2.7 less than PAP less than 4 kPa; C = PAP greater than 4 kPa [= 30 mmHg]. Within these subgroups a diagnostic classification was also carried out: chronic obstructive lung disease, thrombo-embolic lung disease, diffuse interstitial lung disease. The aims of data processing were: clustering correctly individual cases in one of the I-II-III subgroups based on non-invasive variables only; To define equations predictive of quantitative values of pulmonary arterial mean pressure from non-invasive data; To find regularity of evolution of elevated pulmonary arterial mean pressure in chronic non specific lung disease and detect risk factors and/or beneficial interventions if such exist at all. Two different statistical methods were applied: conditional probability (Bayes theorem) and discriminant analysis. The predictive power of each depends mainly on the seriousness of signs and symptoms denoted by the medical user. Three probability-functions have been defined between severity of single variables and their specificity, sensitivity and probability of pulmonary hypertension. By application of these functions the user can select different quantitative values of variables which determine the proportion of false/true, positive/negative cases. After having chosen the desired values of these proportions, multivariate equations are defined by stepwise regression analysis optimized for predictive power.(ABSTRACT TRUNCATED AT 250 WORDS)