Mitochondrial D-loop analysis reveals low diversity in Mangalica pigs and their relationship to historical specimens.

The genetic relationship between 195 Mangalica and 79 non-Mangalica pigs was studied using mitochondrial D-loop SNP genotyping. Altogether, 35 polymorphic sites and 27 haplotypes were identified. Of the haplotypes, eight and 16 are Mangalica and non-Mangalica specific, respectively, while three contain both Mangalica and non-Mangalica individuals. Genetic distance values and phylogenetic analysis indicate that Mangalica individuals are very closely related, and five haplotypes represent approximately 92% of the Mangalica pigs involved in the study, thus determining the major maternal lineages. In contrast to previous microsatellite studies, individuals of Mangalica could not be distinguished as three separate breeds using mtDNA genotyping. Comparing modern and archaeological mtDNA sequences revealed that present day Mangalica is related to pigs that lived in the Carpathian basin where postulated ancestors of Mangalica also lived. This is the first DNA-based genetic evidence to support the described breeding history of Mangalica.

Calculation of the decision limit (CCalpha) and the detection capability (CCbeta) for banned substances: the imperfect marriage between the quantitative and the qualitative criteria.

Initially in the Decision 2002/657/EC the criteria for the calculation of the decision limit (CCalpha) and the detection capability (CCbeta) have been estimated as purely quantitative (alpha-error is 1% and beta-error is 5%). In 2004, the European Commission has issued a document to provide guidance for the interpretation of the 2002/657/EC. In this document it is mentioned that also qualitative criteria should be fulfilled. Therefore, the calculated CCalpha and CCbeta must be verified by using fortified samples. The method should be able to detect/identify the target component in 50% of the cases at CCalpha and in 95% of the cases at CCbeta. Analytical methods for the analysis of nitroimidazoles, nitrofurans and corticosteroids with LC-MS/MS have been validated by fortifying blank samples below and above the MRPL. CCalpha and CCbeta were calculated using the ISO 11843 approach. In addition, the frequency of methodical compliance for the qualitative criteria was determined at each concentration level. It was observed that at the calculated CCalpha and CCbeta levels the qualitative criteria were not fulfilled. It was concluded that the detection capability of the analytical method should be calculated by using decreasing fortification levels at and below the MRPL. A protocol validating methods for banned substances by limiting the number of samples is presented and the qualitative criteria for the assessment of CCalpha and CCbeta were verified based on the same set of data without the need of performing additional validation experiments.

Surgically treated intraoperative coronary embolism.

We report a case of intraoperative coronary embolism in a 52-year-old male patient undergoing mitral valve replacement. The patient had persistent atrial fibrillation and was treated with oral anticoagulants and, in spite of well controlled anticoagulation, he suffered a transient ischemic attack. No intracardiac thrombus was found by transthoracic echocardiography. Three weeks later open heart surgery was performed. During valve surgery no thrombus was found in the left atrium. When cardiopulmonary bypass was discontinued the heart function rapidly deteriorated and the heart swelled up, became bluish, with left atrial pressure rising to 40 mm Hg. It was noticed that the anterior surface of the left ventricle was not moving. Coronary embolism was considered. Multiple thrombi were found and removed from the left anterior coronary artery. After successful thrombectomy the patient came off the pump easily. Early and late postoperative course were uneventful. Intraoperative coronary embolism should be considered when cardiac function is deteriorating and there is an inability to wean the patient from the pump. Early and correct diagnosis is lifesaving.

Validation of a liquid chromatography-tandem mass spectrometry method for the simultaneous quantification of 11 (fluoro)quinolone antibiotics in swine kidney.

A LC-MS-MS method has been validated for the simultaneous quantification of 11 (fluoro)quinolone antibiotics at the maximum residue level (MRL) in swine kidney. The studied compounds were danofloxacine, cinoxacine, ciprofloxacine, noxacine, enrofloxacine, flumequine, marbofloxacine, nalidixic acid, norfloxacine, ofloxacine and oxolinic acid. The method involves solid-phase extraction of these compounds followed by LC-MS-MS analysis using an electrospray ionisation interface. Limits of quantification < or = 50 microg/kg could be obtained in swine kidney, much lower than every MRL. The validation is discussed. This work was carried out in order to support the European Union policy on consumer health

Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: the Metoprolol CR/XL Randomized Intervention Trial in congestive heart failure (MERIT-HF). MERIT-HF Study Group.

CONTEXT: Results from recent studies on the effects of beta1-blockade in patients with heart failure demonstrated a 34% reduction in total mortality. However, the effect of beta1-blockade on the frequency of hospitalizations, symptoms, and quality of life in patients with heart failure has not been fully explored. OBJECTIVE: To examine the effects of the beta1-blocker controlled-release/extended-release metoprolol succinate (metoprolol CR/XL) on mortality, hospitalization, symptoms, and quality of life in patients with heart failure. DESIGN: Randomized, double-blind controlled trial, preceded by a 2-week single-blind placebo run-in period, conducted from February 14, 1997, to October 31, 1998, with a mean follow-up of 1 year. SETTING: Three hundred thirteen sites in 14 countries. PARTICIPANTS: Patients (n = 3991) with chronic heart failure, New York Heart Association (NYHA) functional class II to IV, and ejection fraction of 0.40 or less who were stabilized with optimum standard therapy. INTERVENTIONS: Patients were randomized to metoprolol CR/XL, 25 mg once per day (NYHA class II), or 12.5 mg once per day (NYHA class III or IV), titrated for 6 to 8 weeks up to a target dosage of 200 mg once per day (n = 1990); or matching placebo (n = 2001). MAIN OUTCOME MEASURES: Total mortality or any hospitalization (time to first event), number of hospitalizations for worsening heart failure, and change in NYHA class, by intervention group; quality of life was assessed in a substudy of 741 patients. RESULTS: The incidence of all predefined end points was lower in the metoprolol CR/XL group than in the placebo group, including total mortality or all-cause hospitalizations (the prespecified second primary end point; 641 vs 767 events; risk reduction, 19%; 95% confidence interval [CI], 10%-27%; P<.001); total mortality or hospitalizations due to worsening heart failure (311 vs 439 events; risk reduction, 31%; 95% CI, 20%-40%; P<.001), number of hospitalizations due to worsening heart failure (317 vs 451; P<.001); and number of days in hospital due to worsening heart failure (3401 vs 5303 days; P<.001). NYHA functional class, assessed by physicians, and McMaster Overall Treatment Evaluation score, assessed by patients, both improved in the metoprolol CR/XL group compared with the placebo group (P = .003 and P = .009, respectively). CONCLUSIONS: In this study of patients with symptomatic heartfailure, metoprolol CR/XL improved survival, reduced the need for hospitalizations due to worsening heart failure, improved NYHA functional class, and had beneficial effects on patient well-being.

[EUROASPIRE: survey conducted by the European Society of Cardiology on secondary prevention of coronary disease. Hungarian results]. / EUROASPIRE: az Európai Kardiológiai Társaság felmérése a coronaria betegek másodlagos prevenciójáról. Magyar adatok.

The European Society of Cardiology, the European Atherosclerosis Society and the European Society of Hypertension published in 1994 a joint statement and recommendation on prevention of coronary heart disease in clinical practice. The EUROASPIRE study intended to investigate the present clinical practice in this respect in 9 European countries. The present paper deals with the Hungarian leg of the collaborative study. Hospital data of 546 patients below the age of 70 were reviewed of whom 29% were women. Consecutive patients were identified retrospectively with the following discharge-diagnoses: coronary bypass grafting, PTCA, acute myocardial infarction and angina pectoris. Minimum 6, in the average 18 month after the index event, patients were interviewed and examined. The participation rate was 77%. During the index hospitalisation an incomplete documentation of the main risk factors was found: blood pressure values were missing in 12%, lipid values in 48%, smoking status in 34%, body weight in 22% and family history in 46% of the cases, with wide variation between diagnostic categories. At follow-up 23% of the patients were obese (BMI > or = 30 kg/m2), 49% had elevated blood pressure (140/90 > or = Hgmm), 46% had total cholesterol above 5.5 mmol/l, 23% smoked and 27% were diabetic. 75% of the patients were on antiplatelet, 14% on anticoagulant, 58% on beta-blocking, 22% on lipid lowering, 32% on ACE-inhibitor and 44% on calcium channel blocking medication. The screening of first degree relatives was recommended in only 18% of the patients. The results speak for a substantial neglect of secondary prevention of coronary patients in the Hungarian clinical practice. However without complex detection, evaluation and management of risk factors it is impossible to reduce the recurrence and high mortality of coronary heart disease.

Predicting severe angiographic coronary artery disease using computerization of clinical and exercise test data.

Currently the standard exercise test is shifting from being a tool for the cardiologist to utilization by the nonspecialist. This change could be facilitated by computerization similar to the interpretation programs available for the resting ECG. Therefore, we sought to determine if computerization of both exercise ECG measurements and prediction equations can substitute for visual analysis performed by cardiologists to predict which patients have severe angiographic coronary artery disease. We performed a retrospective analysis of consecutive patients referred for evaluation of possible or known coronary artery disease who underwent both exercise testing with digital recording of their exercise ECGs and coronary angiography at two university-affiliated Veteran's Affairs medical centers and a Hungarian hospital. There were 2,385 consecutive male patients with complete data who had exercise tests between 1987 and 1997. Measurements included clinical and exercise test data, and visual interpretation of the ECG paper tracings and > 100 computed measurements from the digitized ECG recordings and compilation of angiographic data from clinical reports. The computer measurements had similar diagnostic power compared with visual interpretation. Computerized ECG measurements from maximal exercise or recovery were equivalent or superior to all other measurements. Prediction equations applied by computer were only able to correctly classify two or three more patients out of 100 tested than ECG measurements alone. beta-Blockers had no effect on test characteristics while ST depression on the resting ECG decreased specificity. By setting probability limits using the scores from the equations, the population was divided into high-, intermediate-, and low-probability groups. A strategy using further testing in the intermediate group resulted in 86% sensitivity and 85% specificity for identifying patients with severe coronary disease. We conclude that computerized exercise ST measurements are comparable to visual ST measurements by a cardiologist and computerized scores only minimally improved the discriminatory power of the test. However, using these scores in a stratification algorithm allows the nonspecialist physician to improve the discriminatory characteristics of the standard exercise test even when resting ST depression is present. Computerization permitted accurate identification of patients with severe coronary disease who require referral.

Can computerization of the exercise test replace the cardiologist?

BACKGROUND: The type of practitioners who use the standard exercise test is changing. Once a tool of the cardiologist, the standard exercise test is now being performed by internists and other noncardiologists. Because this change could be facilitated by computerization similar to the computerized interpretation programs available for the resting electrocardiograph (ECG), we performed this analysis. A secondary aim was to demonstrate the effects of medication status and resting ECG abnormalities on test diagnostic characteristics because these factors affect utility of the exercise test by the generalist. METHODS AND RESULTS: A retrospective analysis was performed of consecutive patients referred at 2 university-affiliated Veteran's Affairs Medical Centers and a Hungarian Hospital for evaluation of chest pain and possible ischemic heart disease. There were 1384 consecutive male patients without a prior myocardial infarction with complete data who had exercise tests and coronary angiography between 1987 and 1997. Measurements included clinical, exercise test data, and visual interpretation of the ECG recordings as well as more than 100 computed measurements from the digitized ECG recordings and compilation of angiographic data from clinical reports. The computer measurements had similar diagnostic power compared with visual interpretation. Computerized measurements from maximal exercise or recovery were equivalent or superior to all other measurements. Prediction equations applied by computer were superior to single ECG measurements. Beta-blockers had no effect on test characteristics, whereas resting ST depression was associated with decreased specificity and increased sensitivity. CONCLUSIONS: Computerized exercise ST measurements are comparable to visual ST measurements by a cardiologist; computerized scores that included clinical and exercise test results exhibited the greatest diagnostic power. Applying scores with a computer allows the practicing physician to improve the diagnostic characteristics of the standard exercise test. This approach is successful even when there is resting ST depression, thus lessening the need for more expensive nuclear or imaging studies.

[Myocardial infarct and diabetes mellitus: incidence, management and prognosis]. / Myocardialis infarctus és diabetes mellitus: elöfordulás, kezelés, prognózis.

The authors analyse the data of the Myocardial and Diabetes Register, where 2436 diabetic patients (pts) and 1448 pts with acute myocardial infarction (AMI) were registered between 1st of January, 1992 and 31st of December 1994. In the history of diabetic patients previous AMI was present in 14.4% of the cases. The 21.6% of the AMI pts had diabetes mellitus as well. According to the type of diabetes (IDDM and NIDDM) the prevalence of AMI in the history of the registered persons was significantly different: among pts with NIDDM the previous AMI was found 14.8% of the pts and only 2% of pts with IDDM (p = 0.012). The clinical picture of AMI was also different of AMI pts with and without diabetes: chest pain suggesting AMI was present 10.9% of pts with proved AMI and diabetes mellitus, and 86.2% of pts with AMI without diabetes (p < 0.0001). The Streptokinase treatment was more common among AMI pts without diabetes (18.2% versus 12.5% p = 0.022). The hospital lethality was significantly higher among AMI pts with diabetes (42.8% versus 29.4% (p < 0.0001). The poorer prognosis was independent of age.

[Simultaneous occurrence and treatment of right atrial myxoma and extensive colonic polyposis causing recurrent intestinal hemorrhages]. / Jobb pitvari myxoma és kiterjedt--ismételten vérzést okozó--vastagbél-polyposis együttes elöfordulása és kezelése.

The authors describe the case history of 68 year old man. Right atrial myxoma had been diagnosed two years prior to this present observation, however surgical intervention has been contraindicated due to high operative risk. Later the patient was referred to a cardiological evaluation because of chronic atrial fibrillation before a cataract surgery in a symptom free condition. The right atrial myxoma caused inflow obstruction and tricuspid regurgitation was removed before the eye surgery. In addition, tricuspid valve replacement and revascularization of three coronary arteries has been performed. The patient receiving chronic anticoagulant therapy experienced severe gastrointestinal bleeding the source of which turned out to be a partially malignant colon polyposis. The polyps were successfully removed by coloscopy and intra operative coloscopy. No gastrointestinal bleeding has been observed afterwards in spite of the continued anticoagulation. After review of the literature the authors observed that according to their knowledge the common occurrence of the right atrial myxoma and the colon polyposis had not been described before.

[Intravascular hemolysis caused by intravenous glycerin infusion in a patient with artificial mitral valve]. / Intravénás glycerininfúzió okozta intravascularis haemolysis mitrális mübillentyüvel élö betegben.

The case history of a sixty two years old patient is presented by the authors. The patient with an artificial mitral valve was admitted to the hospital because of sudden onset of left sided hemiparesis. The cerebrovascular accident which occurred because of a cerebral embolus as well as the heart murmurs and intravascular haemolysis were thought to be present because dysfunction of the artificial valve. Transthoracal and transesophageal echocardiography revealed a thrombus in the right atrium and a patent foramen ovale, however did not prove artificial valve dysfunction. A paradox embolus from the right atrium caused the hemiparesis. The intravascular haemolysis was caused by the 10% glycerol infusion used for the treatment of the cerebrovascular accident. The authors discuss the observations on the glycerol induced intravascular haemolysis and it has been pointed out, that all kinds of parenteral glycerol use can cause intravascular haemolysis. No Hungarian publication was found on glycerol induced haemolysis.

[Effect of lovastatin on serum lipids and lipoproteins. Hungarian multicenter, open-label study]. / Lovastatin kezelés hatása a serum lipidekre és lipoproteinekre. Hazai, nyitott, többcentrumos vizsgálat.

The authors studied the effects of lovastatin on the parameters of serum and lipoprotein lipids in an open multicenter trial. 160 patients with hypercholesterolemia participated in the study, 151 of whom completed the trial. After a 4 week period of dietary measures, the patients were treated with lovastatin for 12 weeks while combining standard lipid lowering diet. The initial dose of the drug was 20 mg, this was increased until serum cholesterol level decreased under 5.2 mmol/l, or to a maximal daily dose of 80 mg. By the end of the 12th week, serum cholesterol level was reduced by an average of 33% (p < 0.001), LDL-cholesterol by an average of 45% (p < 0.001), serum triglyceride concentration by an average of 22% (p < 0.001) and HDL-cholesterol increased by an average of 13% (p < 0.001). Lovastatin showed a very good safety profile, therapy had to be cancelled due to the occurrence of adverse events only in 4 cases.

[Constrictive pericarditis following heart surgery]. / Szívmütét után kialakult constrictiv pericarditis.

A case history is presented of a patients with postoperative constrictive pericarditis (PCP) after five months of coronary artery bypass grafting. No previous report was found in Hungary on this subject. The authors summarize the main points of etiology, diagnosis and treatment of PCP according the data found in the literature. They point out that the possibility of PCP should arise in every case when the patient's health deteriorates after open heart surgery especially in the case of serious right heart failure. The diagnosis is very important because the patient can be cured with a subsequent open heart surgery.

[Usefulness of exercise test in combination with ECG]. / A terheléses EKG vizsgálat jelentösége.

The author gives an overview on usefulness of exercise ECG in cardiology. There is a summary of indications and contraindications of the test and of the personal requirements. The exercise ECG do not recommended to screen asymptomatic individuals. The test is very important in the diagnosis and the prognostic evaluation of patients with ischemic heart disease. The exercise ECG and coronary arteriography are equally important prognostic determinants of future cardiac events. The exercise ECG has been proved an objective tool in the evaluation of functional impairment of patients with congenital and acquired heart disease. The author summarizes the work of exercise laboratories in Hungary, points out the necessity of it's technical improvement and suggests to increase their productivity.

Computer probability estimates of angiographic coronary artery disease: transportability and comparison with cardiologists' estimates.

A computer algorithm for estimating probabilities of any significant coronary obstruction and triple vessel/left main obstructions was derived, validated, and compared with the assessments of cardiac clinician angiographers. The algorithm performed at least as well as the clinicians when the latter knew the identity of the patients whose angiograms they had decided to perform. The clinicians were more accurate when they did not know the identity of the subjects but worked from tabulated objective data. Referral and value induced bias may affect physician judgment in assessing disease probability. Application of computer aids or consultation with cardiologists not directly involved with patient management may assist in more rational assessments and decision making.

[Comparison of ST depression and various exercise test indices in the diagnosis of coronary stenosis]. / Az ST depresszió és a különbözö terheléses score értékek összehasonlító vizsgálata a koszorúér-szükület felismerésében.

UNLABELLED: Various modifications and refinements have been proposed to improve the diagnostic accuracy of standard ST-segment criteria for identifying coronary artery disease using exercise testing. To ascertain if the treadmill exercise score (TES), the ST integral, or the ST/HR index are significantly better markers for coronary disease the standard ST analysis, measured visually or by computer, a retrospective study of 173 male patients was performed. Exclusions were clinical or electrocardiographic evidence of prior myocardial infarction, left ventricular hypertrophy, left bundle branch block, or resting ST segment depression on their baseline electrocardiogram, digitalis, previous revascularization procedure or any significant valvular or congenital heart disease. Ninety-six patients (55.5%) had at least one epicardial coronary stenosis (more than 70% diameter stenosis). Cutpoints were chosen for each method, that maximized their best combination of sensitivity and specificity. There were no statistically significant differences between any of the five methods (TES, ST integral, ST/HR index, standard and computer ST analysis) for identifying any coronary disease. CONCLUSION: careful visual or ST-segment analysis continues to be the simplest as well most effective marker for coronary disease during exercise testing.

Usefulness of exercise-induced ST-segment depression in the inferior leads during exercise testing as a marker for coronary artery disease.

Multiple lead systems are shown to have a higher sensitivity than that of single leads for detecting coronary artery disease (CAD) during exercise testing, but the value of ST-segment depression isolated to the inferior leads is questionable. To ascertain the diagnostic accuracy of inferior limb lead II compared with that of precordial lead V5, a retrospective analysis of 173 men was performed (108 in a training population and 65 in a validation cohort). All patients had a standard exercise test and underwent diagnostic coronary angiography within 15 days of the exercise test (range 1 to 65). Sixty-three patients had greater than or equal to 1 coronary stenoses greater than or equal to 70%, or left main lesion greater than or equal to 50%, whereas 45 patients in the training population did not. Exclusion criteria were female sex, left ventricular hypertrophy, left bundle branch block or resting ST-segment depression on the baseline electrocardiogram, previous myocardial infarction or revascularization procedures, and any significant valvular or congenital heart disease. Lead V5 had a better combination of sensitivity (65%) and specificity (84%) (chi-square = 24.11; p less than 0.001) than that of lead II (sensitivity 71%, specificity 44%) (chi-square = 2.25; p = 0.13) at a single cut point, and this improved specificity was substantial (95% confidence interval for observed difference 22 to 58%). Receiver-operating characteristic curve analysis also revealed that lead V5 (area = 0.759) was markedly superior to lead II (area = 0.582) over multiple cut points (z = 3.032; 2p = 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)

[Prinzmetal angina pectoris causing diagnostic and therapeutic problems]. / Diagnosztikus és terápiás problémát okozó Prinzmetal angina pectoris.

A 53 year old patient was hospitalized because of retrosternal oppression which was unrelated to effort and recurred in the early morning hours. An esophageal diverticulum and a hiatal hernia were found. The patient had complaints in spite of medical therapy and an operation was performed because of his oesophageal disorders. After operation the patient had the same pain. A cardiologist was asked, who suggested Prinzmetal variant angina. During arteriography coronary artery disease was found. Coronary bypass surgery was indicated and performed, after that procedure the patient was and remained free of any complaints. This observation reaffirmed Prinzmetal original statement "The key to the diagnosis ... is the taking of a painstaking history".

Exercise-induced ST depression and ST/heart rate index to predict triple-vessel or left main coronary disease: a multicenter analysis.

The aim of this investigation was to determine the difference in accuracy between two frequently published noninvasive indicators of severity of coronary artery disease (exercise-induced ST segment depression and heart rate-adjusted ST depression [ST/HR index]). The study was designed as a survey of consecutive patients undergoing exercise electrocardiography and coronary angiography. There were a total of 2,270 patients without prior myocardial infarction or cardiac valvular disease referred for angiography from eight institutions in three countries; 401 of these patients had triple-vessel or left main coronary artery disease. The sensitivities of ST depression and ST/HR index in detecting triple-vessel or left main coronary artery disease were, respectively, 75% and 78% (p = 0.08) at cut point values where their specificities were equal (64%). This small increase in the accuracy of the ST/HR index was evident only at peak exercise heart rates below the median value of 132 beats/min, where the sensitivities of ST depression and ST/HR index were 73% and 76% (p = 0.03), respectively, at cut point values corresponding to a specificity of 60%. These results were consistent at all eight participating institutions. The increase in accuracy achieved by dividing exercise-induced ST depression by heart rate is small and confined exclusively to a low exercise heart rate. This lack of superiority cannot be generalized to all methods of heart rate adjustment.