Cell-free DNA that originates from cell death, circulates in peripheral blood. There are indications that the infarcted myocardium contributes to an increase of cell-free DNA levels. Our aims were to quantify levels of cell-free DNA in patients with acute myocardial infarction (AMI) and examine their correlation with myocardial markers and with postinfarction (PI) clinical course. Thirteen patients (age 57 +/- 16 year) admitted with AMI and who underwent thrombolysis with reteplase within 6 h from the onset of chest pain were studied. PB samples were collected on admission and for 5 consecutive days. Creatine kinase (CK) and troponin I (TnI) were measured on admission and every 8 h for 3 consecutive days. Clinical events were recorded throughout the hospitalization period. Cell-free DNA levels were also measured in 30 healthy controls. Log-transformed mean (+/-SE) of maximum free DNA values in patients higher than controls (6873 +/- 357 g.e./mL verses 4112 +/- 234 g.e./mL, P < 0.0001). Log-transformed maximum values of CK and TnI were correlated with log-transformed free DNA values of first (r = 0.62, P = 0.02/r = 0.68, P = 0.01) and second (r = 0.57, P = 0.04/r = 0.72, P = 0.0053) PI day. Nine patients (group A) had an uncomplicated PI clinical course and four patients (group B) had recorded events (three with angina and one death). Free DNA levels on the second PI day were higher in group B than group A (1298.0 +/- 796.0 g.e./mL verses 244.6 +/- 257.7 g.e./mL, P = 0.003). In conclusion, free DNA levels are significantly higher in patients with AMI than in controls and may play a role in the prognosis of these patients.

Transvenous insertion of endocardial leads for permanent pacing is accompanied in most patients by "minimal" myocardial damage. In this setting CTNI level kinetics are fast, characterized by early elevation and peak.

No abstract

Compared to the existing literature, the median DAP value of this study is almost identical to the 11.2 Gycm(2) reported from a sample of 627 patients in 17 different x-ray rooms, whereas the fluoroscopy times are within the range of values reported by other authors. Concerning the cardiologist exposure, the estimated values indicate that the implantation of pacemakers is a procedure that does not involve a severe risk, especially if it is taken into account that lead aprons and collars are routinely used.

The implantation of permanent cardiac pacemakers is a quite common and simple procedure where fluoroscopy is employed in the manipulations required for the successful placement of the pacemaker. • According to the EU directives and legislation, fluoroscopy should be used in such a way so that the radiation dose to the patients is as low as reasonably achievable (ALARA principle).

Swallow syncope is usually caused by organic or functional disorders of the esophagus due to abnormal vasovagal reflex. In elderly patients this situation could be confused with postprandial hypotension. We present a case of an elderly patient who presented with swallow syncope that was caused by a waist in the midportion of esophagus induced by an ascending aorta aneurysm.

This article reviews the present status of intervention in hypertrophic obstructive cardiomyopathy. Interventions include pacing, which is best administered by VDD mode with sufficiently short atrioventricular delay as to ussure i>entricular capture. Occasionally, this may require the addition of atrioiventricular (AV) junctional ablation in order to achieve 100% ventricular capture. This approach alters the left ventricular (LV) contraction sequence, thereby reducing the left ventricular ouflow~ obstruction. W I pacing is inadequate because of the necessity for atrial contribution to the hypertrophied ventricle. This contribution may he ineffecthv even with VDD pacing, without the benefit of AV junctional ablation, because of late activation of the leji atrium. Ablation of the left bundle branch may also achieve altered contraction sequence of the LV, but experience with this technique is very limited. Two different methods of reduction of the interventricular septum have been proposed. The first is transaortic laser. which has not gained wide acceptance, and the second is a new and promising method that appears to be less traumatic. This is alcohol delivery to the first septal branch of the left anterior descending coronary arteiy by an angioplasty technique. Surgical approaches include septal myomectomy directly to reduce the obstruction and niitral valve replacement to eliminate the part played in the obstruction by the anterior cusp of the \ialve. In conclusion, younger patients, even those who are asymptomatic, should be considered for surgical myomectomy, there being little place now for niitral valve replacement. In older patients, pacing and septal chemoablation offer the greatest promise, but their places are not yet fully established. (J Interven Cardiol 1996; 91399-403) Address for reprints: Richard Sutton, Dsc Med, FRCP, FACC, FESC, Royal Brompton Hospital, Sydney Street, London SW3 6NP, United Kingdom. Fax: 44-171-351-8625.

Coronary angiography (CA) and percutaneous transluminal coronary angioplasty (PTCA) radiation doses were investigated in a recently founded Interventional Cardiology (IC) department. The study includes 336 procedures (177 CAs and 159 PTCAs) carried out with a Philips digital flat detector monoplane system. Patient dose was measured in terms of kerma-area product (KAP) and cumulative dose. Using appropriate conversion factors, peak skin dose (PSD) and effective dose (E) were estimated. Median values of KAP (Gy cm(2)), PSD (mGy) and E (mSv) were: 34 478 and 6.1, respectively for CA and 80 885 and 14.4 for PTCA, within European and international reference levels. Only 1.5 % of patients received radiation dose over the 2 Gy threshold (PTCA procedures) for deterministic effects and none reported any skin effect. Radiation doses were within international standards and comparable with other radiological examinations. The percentage of the high-risk patients for radiation skin effects is extremely low.