Objective-To evaluate the role of haemostatic and haemodynamic variables in left atrial thrombosis in non-rheumatic atrial fibrillation. Design-Case-control study. Subjects-One hundred and nine patients with non-rheumatic atrial fibrillation. Interventions-Peak blood velocity measured at three sites in the left atrium. Venous blood sampled for coagulant proteins and markers of haemostatic activation. Conclusions-Haemostatic and haemodynamic abnormalities are associated with left atrial thrombus in nonrheumatic atrial fibrillation, and may help stratify thromboembolic risk.

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Allergic bronchopulmonary aspergillosis is recognised in about 8% of asthmatic patients,' 2and its features are transient opacities seen on the chest radiograph, positive immediate and delayed skin test reactions to Aspergillus fumigatus extract, peripheral blood eosinophilia, and serum precipitins against A fumigatus. Mucus plugs or casts often containing the fungus are expectorated and proximal bronchiectasis may eventually develop.3-8 This condition has been reported in only a few non-asthmatic patients.3 9-11 We describe five non-asthmatic patients who presented over seven years with lobar or complete lung collapse rather than pulmonary infiltrates. The presenting clinical features led to an initial diagnosis of bronchial carcinoma. The correct diagnosis was made only after the unusual bronchoscopic findings had prompted further investigation for allergic bronchopulmonary aspergillosis. Case reports Case 1-A 60-year-old woman presented with a four-month history of dyspnoea, cough, mucoid sputum, malaise, and anorexia, starting after a flu-like illness. Her symptoms did not respond to antibiotics. She was a non-smoker and apart from having had pneumonia and tuberculosis when aged 30 years, she had had no respiratory disease. On examination she was unwell, cyanosed, and dyspnoeic with signs of collapse of the

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Diastolic dysfunction may be the earliest marker of a diabetes-induced heart muscle disease which leads to the progressive development of cardiac failure. Left ventricular diastolic function was indirectly assessed using pulsed wave Doppler ultrasound mitral-flow velocities in 20 normotensive patients with a new diagnosis of type 2 diabetes mellitus, normal cardiac function and no evidence of coronary artery disease and in 16 age-matched normal subjects. Peak velocities of early (E) and late (A) left ventricular filling were measured. The median (interquartile ranges) peak E/A ratio was significantly reduced in the diabetic group 0.96 (0.8-1.2) vs 1.2 (1.1-1.3), P < 0.01. Despite improvements in glycaemic control over 3 months, HbA1c 9.9% (7.6%-10.5%) to 7.4% (6.5%-7.9%), P < 0.001, maintained at 6 months, HbA1c 7.0% (6.4%-7.3%), there were no changes in the E/A ratio, 0.96 (0.83-1.15) and 0.95 (0.83-1.17), respectively. Furthermore, there was no correlation between percentage change in HbA1c and E/A ratio over 6 months. The results of this study suggest that in patients with type 2 diabetes mellitus and normal systolic function, diastolic function was impaired at diagnosis and was not affected by an improvement in the glycaemic control.