Summary 1.We present a multivariate model of the post-fledging survival of juvenile great and coal tits ( Parus major L. , P. ater L. ) in relation to chick body condition and timing of breeding. Radio-telemetry and colour marks were used to track tit families during 20 days from fledging, that is, the period of post-fledging dependence. Data on 342 chicks of 68 broods were obtained. 2. Forty-seven per cent of juveniles died during the observation period, predation being the main cause of mortality. In the first 4 days after fledging the mortality rate was 5-10% per day. 3. Survival of juveniles was positively correlated with fledging mass. Furthermore, survival strongly decreased during the season. In the second half of June, mortality was five times the rate of mid-May. The differential survival resulted in selection for both early fledging and high fledging mass. Juvenile condition was less important for survival in birds that had fledged early in the season. Their survival rates exceeded 70% in all weight classes, whereas in late broods only the heaviest individuals survived equally well. The survival of birds fledging both late and in poor condition was below 20%. Thus, selection for high fledging mass was much stronger in the late season than in early broods. 4. We conclude that the impact of predation after leaving the nest results in selection for early breeding and, particularly in the late season, for high fledging mass. This may explain why the earliest broods have been found to produce most recruits into the breeding population even if they did not profit from maximum food availability during the nestling period. On the other hand, energetic limitations may constrain the begin of egg laying in adult birds. Thus, counteracting evolutionary responses to the seasonal development of food availability (the caterpillar peak) and to the risk of post-fledging mortality (the peak in post-fledging mortality) may have focused the period of optimal reproduction to a narrow time-window.

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We describe a postmenopausal women with new onset of variant angina caused by thyrotoxicosis due to Graves' disease. During exercise bicycle ergometry at 50 Watts, the patient developed typical angina with ST segment elevation in the precordial leads. A coronary angiogram revealed normal coronary arteries. Graves' disease with overt hyperthyroidism was diagnosed. After achieving an euthyroid state with administration of propylthiouracil, the symptoms resolved completely and the patient had a normal exercise capacity without electrocardiographic changes. Thus, we conclude that in patients with thyrotoxicosis, variant angina and normal coronary arteries, restoration of normal thyroid function may be curative.

Noncardiac Comorbidities are frequent and may be overlooked during routine CHF management. They have great impact on hospitalisations and mortality. The most important comorbidities in heart failure patients are renal insufficiency, diabetes mellitus, chronic obstructive pulmonary disease, sleeping disorders like obstructive and central apnea syndrom, and anemia. The most powerful predictor for mortality is renal insufficiency. It's important to recognize the different causes of renal failure. Defining the volume status and the cardiac output is crucial for the guidance of therapy. The management of diuretic resistance is of special interest and often challenging. Diabetes mellitus is an independent risk factor for heart failure. The benefit of ACE inhibitors and Angiotensin receptor blockers for HF and DM is accepted. The management of Diabetes in HF depends on side-effect profiles of the numerous anti-diabetic drugs. Metformin is safe even in HF patients. Thiazolidinediones should be avoided in NYHA class III/IV because of fluid retention. In COPD patients there is an underuse of betablockers and the prediction of mortality with this comorbidity could be partially caused by that. The principle goal of treatment of sleeping disorders is to avoid hypoxia during night. CPAP therapy improves live quality and HF symptoms. Anemia is often diagnosed, the best therapy - erythropoetin plus iron or iron alone - remains controversial. Iron supplementation without anemia could be an option for better quality of life. To handle all these comorbidities in heart failure patients becomes more and mor complex. Heart failure nurses can help us to manage these growing population.

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