The anti-asthmatic effects of theophylline may supplement those of inhaled steroids in asthma. The aim of the present trial was to study how the addition of theophylline compares to doubling the dose of inhaled steroid in asthmatics who remain symptomatic on beclomethasone dipropionate (BDP) 400 microg x day(-1). The trial was designed as a randomized, double-blind, parallel-group study in several European countries. Sixty nine patients were treated for 6 weeks with theophylline plus BDP 400 microg x day(-1), compared to 64 patients treated with BDP 800 micro x day(-1). The mean+/-SD serum theophylline concentration was 10.1+/-4.2 mg x L(-1). Lung function measurements were made throughout the study and patients kept daily records of peak expiratory flow (PEF), symptoms and salbutamol usage. Forced expiratory volume in one second and PEF at week 6 were significantly increased by both treatments (p<0.01). PEF variability was reduced by about 30% in both groups. There were significant improvements in asthma symptoms and rescue medication use (p<0.001). There were no significant differences between the treatment groups. The study demonstrated clinical equivalence of theophylline plus beclomethasone dipropionate 400 microg x day(-1) and beclomethasone dipropionate 800 microg x day(-1) in patients whose asthma is not controlled on beclomethasone dipropionate 400 microg x day(-1). The results support the use of theophylline as a steroid-sparing agent. The combination of low-dose inhaled steroid plus theophylline is a suitable treatment for moderate asthma.

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Background and aims: Adenoma detection rate (ADR) has been established as a quality indicator for screening colonoscopy. Because ADR is cumbersome to obtain in routine practice, polyp detection rate (PDR), polypectomy rate (PR) and adenomato-polyp-detection-rate-ratio (APDRR) have been proposed to estimate ADR. This study aimed to evaluate APDRR in order to estimate ADR (ADR est ) in different settings. Methods: Average risk screening and surveillance colonoscopies from a community-based private practice and a tertiary academic hospital setting were retrospectively evaluated. APDRR was calculated as averaged group APDRR for all study procedures (APDRR) and for the first half of study procedures of each gastroenterologist (APDRR ag ) or individually for each gastroenterologist on the basis of his or her first 25, 50 and 100 colonoscopies (APDRR ind ). ADR est was determined from PDR by using APDRR, APDRR ag , and APDRR ind , respectively. Results: A total of 2717 individuals were analyzed. Using APDRR, significant correlations between ADR and ADR est were observed for the entire (0.944, p < 0.001), proximal (0.854, p < 0.001), and distal (0.977, p < 0.001) colon. These correlations were lost when APDRR ag was used to estimate each gastroenterologist's ADR for the second half of his or her included colonoscopies. However, ADR and ADR est correlated significantly with a root-mean-square-error of 6.8% and 5.8% when APDRR ind on the basis of each gastroenterologist's first 50 and 100 colonoscopies was used for subsequent colonoscopies. Conclusions: ADR for subsequent colonoscopies of an individual endoscopist can be reliably estimated from PDR by using an individually calculated APDRR. Prospective studies are needed to verify this promising approach in different practice settings.

Tellurium is one of the rarest elements on earth. Intoxications are rare and almost exclusively occupationally exposed workers are affected. Only a few cases of non-occupational poisoning have been reported so far. Severe poisoning results in respiratory depression and circulatory collapse. After occupational exposure main symptoms and signs include loss of appetite, dryness of the mouth, suppression of sweating, a metallic taste in the mouth, and most notable, a sharp garlic odor of the breath, sweat and urine. We report our findings in a 37 year old, non-occupationally exposed woman with tellurium intoxication.