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The European Multicentre Study (EMS) assessed coronary reperfusion, functional outcome and safety of anistreplase (anisoylated plasminogen streptokinase activator complex = APSAC) compared to a control group treated with heparin alone in patients with a clinical diagnosis of acute myocardial infarction (A Ml). In the Belgian subset of data (n = 103) the reperfusion results, based on non-invasive clinical parameters, were significantly better in the APSAC group: 66% versus 18% in the heparin group (P < 0.0001). No significant difference was found between the two treatment groups with respect to left ventricular function and adverse events. The purpose of the present study was to analyse the indicative value of ST-segment changes as a possible predictor of reperfusion in threatened myocardial tissue. Two scoring systems were used: the first was based on the combined evaluation of three clinical non-invasive parameters (course of chest pain, ECG evaluation of ST segment changes, reperfusion arrhythmias); the second was based on the changes of the sum of the ST-segment (σ-ST) elevations on consecutive 12-lead ECGs. There was a good correlation between the combined clinical scoring system and the residual stenosis on coronary angiography (P<0–05) and early CK peak (P<0.0001). Analysis of the ECG data revealed that a decrease of ≧50% of the sum of ST-elevations (σ-ST) at 2 h post-treatment in both limb and precordial leads is a fairly useful predictor of reperfusion (sensitivity= 73%, specificity = 63%, predictive value = 88%). [ABSTRACT FROM PUBLISHER]

The ability of brief periods of ischaemia to protect the heart from subsequent ischaemia has been termed ‘ischaemic preconditioning’. In order to assess the role of adenosine receptor stimulation in this phenomenon we studied the ischaemic preconditioning effect during angioplasty in 10 control patients and in 10 patients pre-treated with 5 mg kg−1 aminophylline, an adenosine receptor antagonist.The ischaemic response was assessed by analysis of the intracoronary electrocardiogram every 10 s during three consecutive inflations of 90 s with a reperfusion time of 180 s. The severity of transmural local ischaemia was expressed as the magnitude of the ST segment shift in relation to the time during each inflation. The control patients showed an improved tolerance to myocardial ischaemia: ST segment shift decreased from 1·42±0·49 mV at the end of the first inflation to 1·03±0·44 mV at the end of the third inflation (P<0·001). However, in patients pre-treated with aminophylline, the ischaemic response was not significantly different during three inflations.Conclusion Aminophylline inhibits ischaemic preconditioning, as assessed by analysis of the intracoronary ST segment changes during angioplasty. This suggests that ischaemic preconditioning is mediated by adenosine receptor stimulation in humans. [ABSTRACT FROM PUBLISHER]

Two patients are described with severe coagulation disturbances, in one instance leading to extensive skin bleeding, secondary to the use of cefamandole. This cefalosporin antibiotic carries the same N-methylthiotetrazole side chain as moxalactam. Pathogenetic mechanisms leading to hypoprothrombinemia, its prevention and treatment are discussed. [ABSTRACT FROM AUTHOR]

A case is presented in which the likely lethal outcome of a massive pulmonary embolism could be prevented by the correct diagnosis of a right ventricular thrombus by two-dimensional echocardiography. [ABSTRACT FROM PUBLISHER]

An abstract of the article "Safety Assessment by Cardiac Troponin I Release of Symptom Limited Exercise and Combined Endurance/Resistance Versus Endurance Training in Patients With Chronic Heart Failure," by V. Conraads and colleagues, is presented.

An abstract of the article "Differential myocardial expression of E3-ubiquitin ligases in patients with recent myocardial infarction versus dilated cardiomyopathy," by V. Conraads and colleagues presented.

An abstract of the article "Apoptosis versus active gene transcription in skeletal muscle of chronic heart failure patients. The effect of exercise training," by V. Conraads and colleagues is presented.

An abstract of the study "Apoptosis Versus Active Gene Transcription in the Skeletal Muscle of Patients With Mild to Moderate Chronic Heart Failure. Relationship With Exercise Capacity," by V. Conraads and colleagues is presented.

An abstract of the study "Endurance Training Potentiates Exercise Capacity in Patients with Chronic Heart Failure Referred for Cardiac Resynchronization Therapy," by V. Conraads and colleagues is presented.

An abstract of the study "Assessment of Chronic Heart Failure Using Gas Exchange: Importance of Treadmill Exercise Versus Bicycle Exercise," by V. Conrads and P. Beckers, is presented.

An abstract of the article "Combined Endurance/Resistance Training Reduces Serum NT-proBNP in Patients With Moderate to Severe Chronic Heart Failure," by V. Conraads and colleagues, is presented.

A letter to the editor is presented in response to the article "Combination therapy with carvedilol and amiodarone in patients with severe heart failure," by H. Nägele and colleagues in the March 2001 issue.