Reproductive performance after hysteroscopic metroplasty in infertile women: complete versus partial uterine septum.

OBJECTIVE: To investigate the impact of hysteroscopic metroplasty on pregnancy outcome in women with complete or incomplete uterine septum (US) accompanying infertility. MATERIALS AND METHODS: Seventy-three patients who had hysteroscopic metroplasty for complete and incomplete US with primary and secondary infertility were reviewed. Obstetric outcomes (number of pregnancies, live births, and miscarriages) up to 36 months follow up period were investigated. RESULTS: Twenty-five patients in complete US and 28 patients in incomplete US became pregnant in 36 months follow up. Postoperative miscarriage rate was significantly lower in patients with complete US (p = 0.0001,p = 0.0001, respectively). The mean gestational week at the time of birth and mean birth weight of the in- fants were significantly lower in patients with complete US compared to the incomplete US cases (p = 0.026, p = 0.049, respectively). Postoperative pregnancy rate was significantly lower in incomplete US patients with primary infertility compared with secondary in- fertility (p = 0.037). CONCLUSION: Hysteroscopic metroplasty improves fertility and pregnancy performance. This improvement is more prominent in patients with complete US, and incomplete US patients with secondary infertility.

Prognostic utility of serum vitronectin levels in acute myocardial infarction.

BACKGROUND: Vitronectin (VN) functions as a regulator of platelet adhesion and aggregation, coagulation, and fibrinolysis. The aim of this study was to assess the prognostic significance of serum VN levels in patients with acute myocardial infarction (MI). METHODS: In this study 62 patients admitted with ST-elevation myocardial infarction (STEMI), or non-ST-elevation myocardial infarction (NSTEMI) were enrolled. Serum VN levels were measured within 6 h after onset of chest pains. RESULTS: The VN serum levels were higher in MI patients with a mean of 2.257 µg/ml (range 1.541-4.493 µg/ml) in the STEMI group, 1.785 µg/ml (range 1.372-4.113 µg/ml) in the NSTEMI group, and 1.222 µg/ml (range 1.033-1.466 µg/ml) in the controls (p = 0.012). Major adverse cardiovascular events could be predicted at 6 months using VN levels independently of other variables [odds ratio (OR) 9.87, 95 % confidence interval (CI) 2.54-47.37, p = 0.001]. There was a significant positive correlation between VN levels and the Gensini score in NSTEMI patients (r = 0.436, p = 0.013). CONCLUSION: The VN level may be relevant as a clinical biomarker for adverse cardiovascular outcomes not only in patients with ischemic heart disease undergoing coronary interventions, as previously reported, but also in coronary artery disease patients presenting with acute MI.

Factors affecting pregnancy outcome of intrauterine insemination cycles in couples with favourable female characteristics.

The aim of the presented study is to determine the effect of different sperm parameters on the pregnancy rate of intrauterine insemination (IUI) cycles in women with favourable fertility characteristics treated for infertility. Medical records of 212 infertile couples who had undergone a total of 253 cycles were reviewed retrospectively. Inclusion criteria for women were age <35 years, antral follicle count >5, FSH <15 IU/ml, and at least one patent tube documented by HSG or laparoscopy. Clinical pregnancy rates were achieved as 15.8% per cycle, and 18.8% per couple. Woman's age, partner's age, total number of motile sperm (TMS) and motility, significantly influenced pregnancy rate. Pregnancy rate was the highest when women were aged <25 and TMS >10 × 10(6). Partner's age significantly affected the pregnancy rate per cycle in women aged <30 years and TMS >10 × 10(6). Woman's age (OR: 5.4 95% CI: 1.2-24.3) and TMS (OR: 0.06 95% CI: 0.003-0.89) were predictor variables as regards to pregnancy. Pregnancy rate was the highest in IUI cycles when woman was <25 years old, TMS was >10 × 10(6), and morphology was >4%. Male age was found to be another determining factor for IUI success, even if they had a normal spermiogram.

Vascular endothelial growth factor +405 G/C,-460 T/C and -2578 A/C polymorphisms are not associated with insulin resistance in polycystic ovary syndrome.

Insulin resistance (IR) and pancreatic beta-cell dysfunction are usual comorbidities in polycystic ovary syndrome (PCOS). Vascular endothelial growth factor (VEGF) is known to play an important role in the pathogenesis of PCOS. This study examined firstly the possible association of common +405 G/C,-460 T/C and -2578 A/C polymorphisms of VEGF gene with fasting glucose, fasting insulin and the indices of IR [glucose/insulin ratio (GIR), homoeostasis model assessment (HOMA) and quantitative insulin sensitivity check index (QUICKI)] in 137 patients with PCOS. None of the studied polymorphisms were found to affect IR indices significantly. However, there was a trend towards higher HOMA in +405 G and -460 T allele carriers in comparison with homozygotes +405 CC and -460 CC, respectively. With regard to -2578 A/C polymorphism, although not significant, in -2578 C carriers HOMA was lower, and GIR was higher in comparison with -2578 AA genotype. Alteration of QUICKI between genotypes was minimal and varied from 4% to 7%. Because of the relatively small sample size, more studies with greater number of cases are necessary to confirm our observations before any statement can be made about the relationship between VEGF gene polymorphism and IR parameters in PCOS.

The combinations of TNFalpha-308 and IL-6 -174 or IL-10 -1082 genes polymorphisms suggest an association with susceptibility to sporadic late-onset Alzheimer's disease.

OBJECTIVE: Single nucleotide polymorphisms in the regulatory regions of the cytokine genes for tumor necrosis factor alpha (TNFalpha), interleukin (IL)-6 and IL-10 have been suggested to influence the risk of Alzheimer's disease (AD) with conflicting results. AIM: To investigate the TNFalpha-308, IL-6 -174 and IL-10 -1082 gene polymorphisms as susceptibility factors for AD. METHODS: We analyzed genotype and allele distributions of these polymorphisms in 101 sporadic AD patients and 138 healthy controls. RESULTS: Heterozygotes (AG) or combined genotype (AG+AA) for IL-10 -1082 were associated with approximately two-fold increase in the risk of AD. Carriers of A alleles of both TNFalpha-308 and IL-10 -1082 had 6.5 times higher risk for AD in comparison with non-carriers. Concomitant presence of both mutant TNFalpha-308 A and IL-6 -174 C alleles raised three-fold the AD risk, whereas there was no notable risk for AD afflicted by IL-6 -174 polymorphism alone. CONCLUSION: Our results suggest that TNFalpha and IL-10 promoter polymorphism might be a risk factor for AD. The combined effects of TNFalpha-308, IL-6 -174 and IL-10 -1082 variant alleles may be more decisive to induce functional differences and modify the risk for AD.

Home ventilation for children with chronic respiratory failure in Istanbul.

BACKGROUND: The number of children on home mechanical ventilation (HMV) has increased markedly in Europe and North America but little is known about the HMV use and outcomes in children in Turkey. OBJECTIVE: To review clinical conditions and outcome of children who were discharged from the hospital on respiratory support. METHODS: Thirty-four patients assessed at the Marmara University Hospital in Istanbul who had been receiving ventilatory support at home for more than 3 months were included in the study. RESULTS: Thirty-four patients with a median age of 5.1 years were discharged home with ventilatory support. HMV was started in 2001 at our institution and the number of children treated has increased substantially since then (2001: n = 1, 2002: n = 3, 2003: n = 3, 2004: n = 2, 2005: n = 14, 2006: n = 11). Ventilatory support was started at a median age of 1.8 years and continued for 13 months. Eleven (32.4%) patients received invasive mechanical ventilation via tracheostomy and 23 (67.6%) patients received noninvasive mechanical ventilation. Sixteen children (47.1%) were on noninvasive mechanical ventilation via nasal mask while 7 (20.6%) used a face mask. Seven (20.6%) patients received ventilatory support for 24 h and 27 (79.4%) patients were supported only during sleep. Twenty-four (70.6%) children received supplemental oxygen in addition to ventilatory support. Three patients successfully came off ventilatory support; 11 patients died during follow-up. None of the patients had home nursing and there were no life-threatening complications. CONCLUSIONS: A rapidly rising trend of HMV use in chronic respiratory failure (CRF) has been observed in this study. HMV can be safely applied in selected children with CRF with close monitoring and proper follow-up in developing countries despite the lack of home nursing.

Withdrawal of inhaled steroids in children with non-cystic fibrosis bronchiectasis.

BACKGROUND: To study the effects of inhaled steroid withdrawal on bronchial hyperreactivity, sputum inflammatory markers and neutrophilic apoptosis in children with non-cystic fibrosis (non-CF) bronchiectasis. OBJECTIVES: To evaluate the role of inhaled steroids in the treatment of children with non-CF bronchiectasis with specific emphasis on the bronchial hyperreactivity and neutrophilic apoptosis. METHODS: Twenty-seven children with steady-state non-CF bronchiectasis were evaluated primarily with metacholine challenge tests and apoptotic neutrophil ratios in induced sputum and secondarily with symptom scores, pulmonary function tests and tumour necrosis factor-alpha (TNF-alpha), interleukin-8 (IL-8) levels and neutrophil ratios in induced sputum before and after 12-week withdrawal of inhaled steroids. RESULTS: There were 16 girls and 11 boys. Median (interquartile range) age was 11.4 (9.5-13.6) years, follow-up duration was 3.5 (2-6.5) years. Symptom scores (4 vs. 3; P = 0.27), oxygen saturation (95% vs. 97%; P = 0.06), pulmonary function tests (FEV1: 82% predicted vs. 83% predicted; P = 0.73), sputum neutrophil ratios (29.9% vs. 46.8%; P = 0.20), TNF-alpha (58 pg/mL vs. 44.5 pg/mL; P = 0.55) and IL-8 (2.7 ng/mL vs. 2.4 ng/mL; P = 0.82) levels in induced sputum were similar before and after 12-week withdrawal of inhaled steroids. However, the number of patients with bronchial hyperreactivity increased (37% vs. 63% of patients; P = 0.016) and neutrophilic apoptosis in induced sputum decreased (42.8% vs. 20.2%; P = 0.03) after withdrawal. CONCLUSION: In this study, 12 week-withdrawal of inhaled steroid treatment resulted in a significant increase in bronchial hyperreactivity and decrease in neutrophil apoptosis, but no change in sputum inflammatory markers in children with non-CF bronchiectasis was observed.

Factors that correlate with sleep oxygenation in children with cystic fibrosis.

OBJECTIVE: Cystic fibrosis (CF) patients may develop hypoxemia during sleep. Limited information is available on nocturnal oxygen saturation in CF children with less severe lung disease. The aim of this study was to investigate the degree of nocturnal oxygen desaturation and factors that correlate with nocturnal oxygenation in CF children with normal pulmonary function tests (PFTs) or mild to moderate lung disease. METHOD: Awake resting and post-exercise SpO2 were measured by pulse oximetry. Each patient had overnight oximetry monitorization at home. Six minutes walk test (6MWT), Shwachman-Kulczycki (S-K), Brasfield and computed tomography (CT) scores, blood gas analysis and nutritional status of patients were evaluated. RESULTS: Twenty-four patients with a median age of 9.5 years were included. Nocturnal mean SpO2 did not differ according to the severity of lung disease based on PFT. However, lowest SpO2 obtained was lower in children with both mild and moderate lung disease compared to normals (87.4% vs. 91.7%, respectively, p = 0.009). 95.8% of CF children with normal PFT or mild to moderate lung disease had desaturation events during sleep. Nocturnal mean SpO2 correlated with S-K (Spearman's rho = 0.64, p < 0.0001), Brasfield (Spearman's rho = 0.31, p = 0.007) and CT scores (Spearman's rho = -0.67, p < 0.0001) as well as PaO2 (Spearman's rho = 0.28, p = 0.021), SaO2 (Spearman's rho = 0.28, p = 0.023), z-score of weight (Spearman's rho = 0.23, p = 0.20) and height (Spearman's rho = 0.20, p = 0.30), there was no correlation with 6MWT. CONCLUSIONS: In CF children with normal PFT or mild-to-moderate lung disease, nocturnal oxygenation may correlate with S-K, Brasfield and CT scores as well as PaO2, SaO2, z-score of weight and height.

Late diagnosis of foreign body aspiration in children with chronic respiratory symptoms.

BACKGROUND: Children with undiagnosed and retained foreign bodies (FBs) may present with persistent respiratory symptoms. Delayed diagnosis is an important problem in developing countries and several factors affect the delay. OBJECTIVES: To investigate, the incidence of clinically unsuspected foreign body aspiration (FBA) in our flexible bronchoscopy procedures, the causes resulting in late diagnosis of FBA, and the incidence of the complications of FBA according to elapsed time between aspiration and diagnosis. METHODS: We reviewed the records of all the patients who underwent flexible bronchoscopy between 1997 and 2004 in our clinic. Patients with FBA were identified and their medical records were reviewed. RESULTS: During the study period, 654 children underwent flexible bronchoscopy; 32 cases (4.8%) of FBA were identified. Median age of patients was 29.5 months at presentation with a median symptomatic period of 3 months. None of the patients had a history of FBA. The most common misdiagnosis was bronchitis. Flexible bronchoscopy was performed to these patients within 1 week following presentation. In 87% of the patients (n=28), FBs were in organic nature. Patients were followed up for 21.0 months after removal of the FBs. Fifty-three percent (n=17) of the patients had a complete remission after bronchoscopic removal of the FBs. However, nine (28.8%) patients had chronic respiratory problems and six patients (18.8%) developed bronchiectasis. CONCLUSIONS: Atypical or prolonged respiratory symptoms should alert the physician and clinical and radiological findings should be carefully evaluated for a possible FBA. Delay in diagnosis and treatment of FBA should be avoided to prevent complications.

Treatment outcome of asthma after one year follow-up in health centres of several developing countries.

SETTING: Seven selected out-patient clinics caring for asthma patients in Algeria, Guinea, Morocco, Syria, Turkey and Vietnam. DESIGN: Evaluation of treatment outcomes after one year of follow-up of a cohort of asthma patients consecutively enrolled in a prospective study evaluating routine practice. RESULTS: Among 310 asthma patients registered, the following outcomes were recorded after one year of follow-up: 95 (31%) successful, 61 (20%) under control, 35 (11%) failed, 116 (37%) defaulted and 3 (1%) transferred. Among the 167 (53.9%) patients still on treatment after one year there was a substantial increase in the proportion of patients classified as intermittent at the end of treatment (from 11% to 53%), with a decrease in all categories of persistent asthma (from 34% to 12% for mild, 45% to 28% for moderate and 10% to 8% for severe asthma). CONCLUSIONS: While patients' quality of life can be improved if they follow regular treatment, the key challenge in providing care is to ensure that patients adhere to their treatment.

Implementation of asthma guidelines in health centres of several developing countries.

SETTING: Nine selected out-patient clinics caring for asthma patients in Algeria, Guinea, Ivory Coast, Kenya, Mali, Morocco, Syria, Turkey and Vietnam. DESIGN: Prospective enrolment of consecutive patients considered by the practitioner to have asthma with evaluation of adherence of the practitioner with recommended standard case management, including proportion of patients confirmed to have asthma, proportion in whom severity was correctly graded and proportion in whom treatment with inhaled corticosteroids corresponded to severity grade. RESULTS: Of 499 consecutive patients, 456 (91%) were enrolled and evaluated. The diagnosis was confirmed in 263 (58%). Agreement between the practitioner and the guidelines in assigning grade of severity was moderate overall (kappa = 0.42). It was higher for assignment of grade using symptoms (K = 0.51), but poor for assignment of grade using peak expiratory flow (PEF) rate (kappa = 0.29), with practitioners tending to underestimate the severity. Agreement between the practitioners' assessment of severity and treatment with inhaled corticosteroids was poor (kappa = 0.18), with underutilisation of inhaled corticosteroids. CONCLUSIONS: Practitioners caring for asthma patients in this study tended to underutilise the PEF rate in assessing their patients and underutilised treatment of patients with inhaled corticosteroids.

Mucoid impaction: an unusual form of allergic bronchopulmonary aspergillosis in a patient with cystic fibrosis.

We reported a child with cystic fibrosis (CF) who developed mucoid impaction related to allergic bronchopulmonary aspergillosis (ABPA). This is the first reported case of mucoid impaction related to ABPA in CF described to date in the literature. The case was successfully treated by corticosteroids and itraconazole therapy, but relapsed 6 months later. During exacerbation therapy, cataract formation complicated the corticosteroid treatment. We want to emphasize that 6-months therapy may be inadequate for the treatment of ABPA, and it is important to monitor for possible complications of corticosteroids therapy.

Comparison of the effects of voluntary termination of pregnancy and uterine evacuation for medical reasons on female sexual function.

OBJECTIVE: A wide spectrum of emotions are experienced during abortion, including anxiety, sadness and grief, guilt, pessimism about future pregnancies, disturbed self-perception and loss of confidence in intimate relationships. This study aimed to compare the short-term effects of legal voluntary termination of pregnancy with uterine evacuation for medical reasons on female sexual function. STUDY DESIGN: The study group was comprised of 50 patients admitted to the Family Planning Clinic for legal voluntary termination of pregnancy <10 weeks of gestation, and the control group was comprised of 50 patients who underwent manual vacuum aspiration of the products of conception for medical reasons (e.g. inevitable abortion, incomplete abortion, fetal abnormality and teratogenic drug use). Female sexual function in the two groups was evaluated using the Golombok-Rust Inventory of Sexual Satisfaction (GRISS). GRISS scores immediately before and 3 months after termination of pregnancy were compared within each group and between the two groups. RESULTS: Mean total GRISS scores before and after termination of pregnancy were 5.33 and 8.12 in the study group, and 6.02 and 6.4 in the control group, respectively (p<0.05). The increase in GRISS scores for both groups indicated deterioration in sexual function (p=0.000 and p=0.016, respectively). Three months after termination of pregnancy, the total GRISS score was significantly higher in the study group compared with the control group (8.12 vs 6.4, p<0.05). CONCLUSION: Female sexual dysfunction is a complicated concept that is affected by multiple factors over a woman's lifetime. It is important to consider female sexual function as a part of reproductive health, with a close relationship with contraception. As such, patients should receive counselling about sexual function and contraception as part of comprehensive abortion care.

Early pulmonary involvement in Niemann-Pick type B disease: lung lavage is not useful.

Niemann-Pick disease (NPD) is a rare, autosomal-recessively inherited lipid storage disease which is characterized by intracellular deposition of sphingomyelin in various body tissues. The disease is heterogeneous and classified into six groups. Pulmonary parenchymal involvement may be a feature of several subtypes of NPD, including type B. Progressive pulmonary involvement in NPD type B is a major cause of morbidity and mortality. It is usually diagnosed at older ages. Only a few cases with early pulmonary involvement have been reported. In this report, a patient with NPD type B, hospitalized with the diagnosis of pneumonia at age 3 months, is presented. Following treatment for pneumonia, she continued to have persistent respiratory symptoms and became oxygen-dependent. High-resolution computed tomography of the chest revealed diffuse interstitial changes. During follow-up, the patient developed hepatosplenomegaly. Lung, liver, and bone marrow biopsies showed characteristic findings for NPD. Biochemical studies also confirmed the diagnosis, and the sphingomyelinase enzyme level of the patient was low. Unilateral lung lavage was performed in order to decrease lipid storage as a treatment modality. However, there was no clinical or radiological improvement. The patient died at age 15 months due to progressive respiratory failure. Pulmonary involvement is a rare entity in early childhood in patients with NPD type B, but should be considered in the differential diagnosis of persistent interstitial lung disease. It may cause progressive respiratory failure, but the treatment options remain limited.

Retroperitoneal fibrosis caused by pergolide in a patient with Parkinson's disease.

Retroperitoneal fibrosis (RPF) is an uncommon disorder that may cause ureteric obstruction with renal damage. Pergolide, a dopaminergic agonist used in the treatment of Parkinson's disease, has rarely been related to the development of RPF. We report on a 78-year-old woman with Parkinson's disease who presented with hydroureteronephrosis and developed RPF and serosal fibrosis during treatment with pergolide. Following discontinuation of pergolide therapy and placement of a double-J stent, her renal function improved. Inflammatory markers returned to normal limits within two months and the retroperitoneal fibrotic mass became smaller.

Related factors of dental caries and molar incisor hypomineralisation in a group of children with cystic fibrosis.

AIM: To investigate dental caries and molar incisor hypomineralisation (MIH)-related factors such as treatment, diet, brushing and salivary factors in children with cystic fibrosis (CF) compared with healthy peers. STUDY DESIGN: A cohort study was performed. METHODS: This study was performed on 30 CF children comprising patients at the Faculty of Medicine and 30 control children recruited from the Dental School. Salivary factors, dental caries, MIH, daily diet, brushing habits were analysed. Statistical analysis was calculated by SPSS for Windows. RESULTS: Decay missing filled teeth (DMF-T) score was 4.6 ± 4.0 in CF and 7.7 ± 2.7 in control (p = 0.001). 43% of CF children with MIH were found to use antibiotics, but no significant difference in the caries experience was found with antibiotic usage (p > 0.05). DMF-T of CF adolescents (23%) who use Tobramycin was 7 ± 3.5. DMF-T of CF children (20%) who take other antibiotics was 2.5 ± 3.5, but no statistical difference was found (p = 0.054). Saliva pH, salivary flow rate, and buffering capacity were not found statistically significant (p > 0.05). STATISTICS: Percentage arithmetic mean value, standard deviation, independent sample t test, Fisher's exact test, Chi-square test and Mann-Whitney U test were used, while a p value of <0.05 was considered statistically significant. CONCLUSIONS: Medication and diet could be considered as a risk factor for dental caries and factors such as salivary pH, good oral hygiene could play a protective role for oral health CF children. MIH frequency and lower caries experience seen in CF children could be due to salivary factors or pharmacological treatment they take. The multidisciplinary approach team would be advantageous in the management of children with CF and oral health should be under control during early years of life by paediatric dentists.

Correlations between sarcopenia and hypertensive target organ damage in a Turkish cohort.

AIMS: To investigate a possible correlation between skeletal muscle mass and hypertensive target organ damage. MATERIALS AND METHODS: A total of 365 hypertensive patients aged > 18 years were included (221 females; 144 males). Exclusion criteria were: diabetes; hypo- or hyperthyroidism; immobilisation; leg amputation; dehydration; cancer diagnosis; renal insufficiency with GFR of <60 ml/ dk/1.73 m2; and hormone replacement therapy. All patients who participated in the study were examined for the presence of hypertensive retinopathy and nephropathy and divided into four groups according to age and sex (group 1 = females aged <60 years; group 2 = females aged >60 years; group 3 = males aged <60 years; and group 4 = males aged > 60 years). The diagnosis of hypertensive nephropathy and retinopathy was based on spot urine microalbuminuria/creatinine ratio and opthalmoscopy, examination respectively. Body composition was evaluated using bioimpedance analysis (BIA). Fullbody skeletal muscle mass (SMM) and SMM index (SMMI) were used as indicators of skeletal muscle mass. RESULTS: As expected, female and elderly subjects showed a decreased skeletal muscle mass and increased fat mass compared to males and younger subjects. In the overall cohort, a negative correlation was found between skeletal muscle mass and both hypertensive retinopathy and nephropathy. Subgroup analysis revealed a linear correlation between increased SMM and a decreased risk of hypertensive retinopathy. Patients with a spot urine microalbuminura/creatinine ratio of > or = 30 had a lower SMM and a lower SMMI than patients with a ratio of <30. CONCLUSION: In the present cohort, sarcopenia mainly due to aging was associated with an increased rate of hypertensive target organ damage in the form of hypertensive retinopathy and nephropathy

Serum high-sensitivity C-reactive protein, amyloid associated protein and N-terminal proBNP levels do not predict reversible myocardial ischaemia.

AIM: The aim of this study was to detect any relationship between serum high-sensitivity C-reactive protein (hs-CRP), serum amyloid-associated protein (SAA) and N-terminal pro B-type natriuretic peptide (NT-proBNP) levels, and reversible myocardial ischaemia during cardiovascular exercise tests and to determine whether these biomarkers could predict transient myocardial ischaemia. METHODS: Ninety-six patients (36 women, 60 men, mean age 57 ± 8.5 years) were included in the study. Venous blood samples were taken from patients before and 15 minutes after exercise testing. SAA and hs-CRP were analysed using immunonephelometric assays (Dade-Behring, BN II, Marburg, Germany). NT-proBNP (pg/ml) was determined using the immulite 1 000 chemiluminescence immunoassay system (Siemens Medical Solution Diagnostics, Deerfiled, USA). Forty-eight patients (18 women, 30 men) with positive exercise tests were allocated to the exercise-positive group and 48 (18 women, 30 men) with negative exercise tests were put in the exercise-negative group. Coronary angiography was performed on all patients in the exercise-positive group. RESULTS: There was no difference between the levels of hs-CRP, SAA and NT-pro-BNP before and after exercise testing in both of the exercise groups. CONCLUSION: Serum levels of hs-CRP, SAA and NT-proBNP could not predict the occurrence of reversible myocardial ischaemia during exercise. Large-scale clinical studies are needed to clarify the status of hs-CRP, SAA and NT-proBNP with exercise.

Post-infarction ventricular septal defect: triggered by Valsalva manoeuvre?

Post-infarction ventricular septal defect (VSD) is a fatal mechanical complication of myocardial infarction. Although the incidence has decreased to less than 1% after the extensive use of reperfusion strategies, post-infarction VSD still carries a high mortality risk. Management is controversial, whether to wait for surgery after a stabilisation period or to perform emergency surgery when diagnosed. We report on a case of post-infarction VSD that was detected with severe haemodynamic instability, beginning immediately after the patient's Valsalva manoeuvre on the sixth day of a non-reperfused inferior myocardial infarction. In the early period, the post-infarction VSD was repaired via a trans-aneurismal approach.

Environmental determinants of atopic eczema phenotypes in relation to asthma and atopic sensitization.

BACKGROUND: There is still uncertainty about the determinants of atopic eczema (AE). To explain the heterogeneity of the disease, different phenotypes of AE have been suggested. METHODS: The cross-sectional PARSIFAL study included 14 893 school-age children of farmers or children attending Steiner schools and their respective reference groups. A detailed questionnaire was completed, and house dust was collected for the measurement of endotoxin and glucans. Atopic sensitization was defined by allergen-specific IgE levels in the serum. RESULTS: In multivariate analyses, helping with haying was the only variable related to a farming environment having a consistent inverse association with both current symptoms and a doctor's diagnosis of AE [aOR = 0.65 (95% CI: 0.46-0.93) and 0.73 (0.51-1.05)], respectively. Severe lower respiratory tract infections (LRTI) in the first 2 years of life and usage of antibiotics ever were found to be positively related only to asthma-associated AE, whereas the effect of LRTI on AE without asthma had an opposite effect. Levels of beta(1-->3)-glucans in mattress dust were inversely related to a doctor's diagnosis of asthma-associated AE [aOR = 0.75 (0.57-0.98)], and endotoxin levels to current symptoms of asthma-associated AE [aOR = 0.73 (0.57-0.94)]. CONCLUSIONS: The analyses of the PARSIFAL study revealed two different phenotypes of AE, depending on the association with asthma and wheezing ever. With regard to the hygiene hypothesis, help with haying, exposure to beta(1-->3)-glucans and endotoxin were found to be inversely associated with the AE phenotype associated with asthma and wheezing.