STUDY QUESTION Does lower quartile normal range thyroid stimulating hormone (TSH) compared to higher quartile normal range in women without thyroid hormone substitution affect live birth rate after a complete IUI treatment series? SUMMARY ANSWER Lower quartile normal range TSH, in women without thyroid hormone substitution, does not affect live birth rate after a complete intrauterine insemination treatment series compared to higher quartile normal range TSH. WHAT IS KNOWN ALREADY TSH is historically seen as the most sensitive test for thyroid function. Its distribution is right-skewed. Whether the preconceptional upper reference TSH values in subfertile women should be 2.5 or 4.5 mIU/L is under debate. Studies have shown that IUI patients treated with levothyroxine for TSH levels above 2.5 mIU/L show higher pregnancy rates. However, no adverse outcome is associated with untreated high normal TSH levels studied in first IUI cycles. Thyroid peroxidase antibodies have also impaired outcomes in some studies whereas others have shown an effect only in combination with high normal TSH levels. As a subgroup, patients with unexplained infertility showed increased levels of TSH. This article adds to the value of TSH evaluation and fertility outcome in four quartiles and in the context of a completed IUI treatment modus of a maximum of six inseminations. STUDY DESIGN, SIZE, DURATION This is a retrospective cohort study in 909 women undergoing 3588 IUI cycles starting treatment between the first of January 2008 and the first of March 2012. PARTICIPANTS/MATERIALS, SETTING, METHODS Women aged 22–45 years with TSH 0.3–4.5 mIU/L without thyroid hormone substitution were included at Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands, an Iodine-sufficient area. The primary endpoint was live birth. Clinical pregnancy, pregnancy loss and ongoing pregnancy were secondary endpoints. Logistic regression was used with the natural logarithm of TSH as a continuous predictor. Chi-square tests and logistic regression were used to compare groups of patients based on TSH values in four quartile TSH groups (0.3–1.21 mIU/L; 1.22–1.75 mIU/L; 1.76–2.34 mIU/L; 2.35–4.5 mIU/L) on basic characteristics and on the endpoints while adjusting for confounders. MAIN RESULTS AND THE ROLE OF CHANCE Analysis with the natural logarithm of TSH as a continuous variable showed no association with live birth, pregnancy chance or pregnancy loss. There were no differences in any of the outcomes across the quartile TSH level ranges after regression analysis before and after adjusting for age, BMI, use of alcohol, tobacco, use or gonadotrophins, sperm count, diminished ovarian reserve, unexplained infertility and primary or secondary subfertility. The distribution of primary and secondary subfertility and smoking characteristics were remarkably different across th...

Background: A simple technique to measure dynamic hyperinflation (DH) in patients with chronic obstructive pulmonary disease (COPD) is the metronome-paced tachypnea test (MPT). Earlier studies show conflicting results about the accuracy of the MPT compared to cardiopulmonary exercise testing (CPET). Objectives: The focus was to investigate the diagnostic accuracy of MPT to detect DH in a prospective and clinical study. Methods: COPD patients were included; all underwent spirometry, CPET, and MPT. DH (ΔIC) was calculated as the difference in % between inspiratory capacity (IC) at the start and end of the test divided by IC at the start. A subject was identified as a hyperinflator, if ΔIC (% of ICrest) was smaller than –10.2 and –11.1% in CPET and MPT, respectively. With these values, sensitivity and specificity were calculated. Bland-Altman plots were made of ΔIC (% of ICrest). Results: In the prospective and clinical study, 107 and 48 patients were included, respectively. Sensitivity of the MPT was 85% in both studies. The specificities were 33 and 27%, respectively. In the prospective study, B = +2.6%, L = 30.6, and –25.6%. In the clinical study, B = +0.8%, L = 31.0, and –29.1%. Conclusion: MPT seems to be a good replacement for CPET in group studies. The mean amount of DH was not different between CPET and MPT. On an individual level, MPT cannot be used to identify hyperinflators; it should be kept in mind that MPT overdiagnoses DH. The amount of DH should not be interchanged between CPET and MPT.

For a reliable detection of the bone conduction threshold blocking of the contralateral ear can be necessary but then the noise will affect the threshold in the test ear. To resolve this problem the cancellation method is used. The equalization of air and bone conduction sound level in the inner ear is very accurate, the relation between the intensities has been proved to be linear and independent of noise at the contralateral ear. An application for calibration of the bone conduction vibrator to the head phone is discussed. The benefit of the method for measuring an air-bone gap in an accurate way in patients suffering bilaterally from a severe conductive hearing loss is shown.

We questioned how many patients with epistaxis can be treated by cautery without the use of nasal packing, as cautery is more effective and efficient. To investigate this, we performed a retrospective study of a cohort of 418 patients with epistaxis who presented to one ENT consultant at the ENT department of Medisch Centrum Leeuwarden (the Netherlands) between 1997 and 2007. Main outcomes were the treatment modality (cautery and/or nasal packing), recurrence of epistaxis and need for hospitalization. In 98% of all patients the bleeding site could be found and treated by cautery. The incidence of recurrent bleeding was 6%. Two percent of all patients had to be admitted to the hospital. This is considerably lower compared with recurrence rates and hospitalization after treatment by nasal packing known from the literature. Therefore we concluded that nearly all patients can be effectively treated by cautery with a low recurrence rate. In addition, this method of treatment is very cost effective. Because cautery requires skill and appropriate facilities, we recommend special attention for this in ENT training programs.