AimsHeart failure (HF) is common in geriatric patients. Clinicians face diagnostic challenges primarily due to comorbidity and limited access to echocardiography. The purpose of this study was to identify independent determinants of the presence of HF in geriatric outpatients and to determine the optimal diagnostic strategy. Methods and resultsGeriatric outpatients [mean age 82 (+6) years, 30% men] with suspected HF underwent an extensive standardized diagnostic work-up. An expert consensus panel determined the presence of HF. Heart failure was present in 94 of 206 participants (46%). Male sex [odds ratio (OR) 2.0], age per 10 years (OR 1.6), nocturnal dyspnoea (OR 1.7), absence of wheezing (OR 2.1), loss of appetite (OR 1.7), and lower body mass index (BMI; OR 0.9) were independently associated with the presence of HF: the c-statistic of the model containing these items was 0.75. Of all additional tests, N-terminal pro-B-type natriuretic peptide (NT-proBNP) improved the diagnostic accuracy the most (OR ln NT-proBNP 2.8; c-statistic 0.92). A diagnostic rule, consisting of six clinical variables and NT-proBNP, showed good negative and positive predictive values. ConclusionHalf of geriatric patients suspected of HF actually have HF. Apart from age, gender, and nocturnal dyspnoea, absence of wheezing, loss of appetite, and lower BMI were independently associated with the presence of HF. Symptoms and signs in combination with NT-proBNP reliably identified the presence or absence of HF in the vast majority of patients. Additional diagnostic tests, in particular echocardiography, can be targeted at those in whom the presence of HF remains uncertain and to ascertain the cause of HF.--

Background -Improvement of allergic

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Effects of high eosinophil numbers and their state of activation in endobronchial biopsy specimens and peri-dose intravenous pheral blood. In the same patient we have investigated the ability of intravenous im-immunoglobulin in two munoglobulin to modulate the concentration of interleukin 8 (IL-8) and its IgG auto-severe corticosteroid antibodies in the circulation. insensitive asthmatic patients Case reports  1 A 15 year old girl with corticosteroid insensitive asthma was admitted to our hospital. On ad-Bart Vrugt, Susan Wilson, mission she was dyspnoeic at rest with a Cush-Edwin van Velzen, Aad Bron, ingoid appearance. Lung function tests showed an obstructive pattern (FEV 1 57%, forced vital Janis K Shute, Stephen T Holgate, capacity (FVC) 80%, airways resistance (Raw) Ratko Djukanovic, René Aalbers 372% of predicted). Peak expiratory flow (PEF) variability was 65%. Total IgE was 2280 IU/l (normal <80 IU/l) with positive radio allergosorbent tests (RAST) for house dust Abstract mite and other aeroallergens. Preliminary observations of the clinical Despite optimal treatment consisting of efficacy of intravenous immunoglobulin in prednisolone (60 mg/day), inhaled budesonide two patients with severe corticosteroid in-(3000 g/day), theophylline, and nebulised sensitive asthma are reported. In both bronchodilators, her asthma proved difficult to patients treatment with intravenous imcontrol. Increasing the dose of oral predmunoglobulin resulted in clinical imnisolone to 100 mg daily led to a modest provement and enabled a significant decrease in PEF variability to 40%. Additional reduction in the dose of prednisolone. In treatment with methotrexate did not result in one of the patients fibreoptic bronclinical improvement or reduction of the dose choscopy with endobronchial biopsies was of prednisolone, and was associated with conperformed and peripheral blood was anasiderable gastrointestinal side effects. After four lysed by flow cytometry before and after weeks methotrexate was therefore discontinued treatment. Immunohistological analysis of (fig 1). the biopsy samples after treatment showed Treatment with intravenous immunoa decrease in the number of all cell types, globulin (Sandoglobulin, Sandoz, Bern, Switespecially CD3+ T cells, CD4+ T cells, zerland) in a dosage of 84 g once a month (2 g/ and activated CD25+ T lymphocytes, Pathology kg body weight) was commenced five months which was associated with a reduction in Department, after admission. After two months of treatment University Hospital peripheral blood T cell activation. Intra-Utrecht, there was a clear clinical improvement asvenous immunoglobulin may be a valid Heidelberglaan 100, sociated with a reduction in PEF variability to option for the treatment of corticosteroid 3508GA Utrecht, 10%, enabling the dose of prednisolone to be The Netherlands insensitive asthma. To elucidate the role B Vrugt reduced to 10 mg/day. Mean morning PEF and mode of action of intravenous imincreased from 160 to 320 l/min, PEF varimunoglobulin further studies in larger...