[Bronchial asthma--how important is the clarification of the allergy component?]. / Von Prick bis Provokation--welche Tests sind nötig?

Bronchial asthma is a chronic disease underlying which is an inflammatory cascade. Allergic reactions have an important role to play, in particular in the case of children and adolescents. An allergological investigation is of great importance in the initial diagnostic work-up of an atopic diathesis, and for the identification of the allergen. Exhaustive history-taking is the essential first measure in the stepped diagnostic approach. In-vivo and in-vitro tests such as the prick test and total IgE can provide information about the extent of the atopy as well as support for the clinical suspicion, but they are not proof of the presence or absence of a clinically relevant sensitization. Further allergological tests (e.g. provocative test) are usually indicated only in specific problems, and should remain the domain of the allergologist or pneumologist.

Relationship between right ventricular ejection fraction and maximum exercise oxygen consumption: a methodological study in chronic heart failure patients.

BACKGROUND: Peak oxygen consumption at maximum exercise (peak VO(2)) predicts survival in chronic heart failure (CHF) patients. Right ventricular ejection fraction (RVEF) at rest has been reported to correlate with peak VO(2). We evaluated the strength and consistency of the association between peak VO(2) and RVEF measured by different radionuclide ventriculography (RNV) techniques in a prospective cohort study. METHODS AND RESULTS: In 58 consecutive CHF patients (mean age, 53 years; 39 patients with dilated cardiomyopathy; 48 men), upright symptom-limited bicycle ergometry was performed. During exercise, ventilatory and gas exchange data were recorded and peak VO(2) was calculated. RVEF was calculated by use of first-pass (FP) RNV with single and dual region of interest (ROI) acquisition and planar multigated acquisition (MUGA). Irrespective of the method used, RVEF showed no relevant correlation with the corresponding peak VO(2) value (r = 0.11 for FP single ROI, r = 0.06 for FP dual ROI, r = 0.16 for MUGA). Peak VO(2) or changes in peak VO(2) after 6 and 12 months of follow-up were not determined by RVEF measurements. CONCLUSION: In CHF patients no association was found between peak VO(2) at maximum exercise and RVEF at rest with different RNV techniques. Changes in exercise capacity are not reliably reflected by changes in RVEF measurements at rest.

Screening for p53 and K-ras mutations in whole-gut lavage in chronic inflammatory bowel disease.

OBJECTIVES: Molecular screening for frequently mutated genes may increase the likelihood of identifying cancer risk groups, such as patients with longstanding inflammatory bowel disease. This study investigated the prevalence and time course of p53 and K-ras mutations in colonic lavage fluid of patients with inflammatory bowel disease. METHODS: Colonic lavage fluid from 190 patients with ulcerative colitis (73), Crohn's disease (58) or controls (49 non-tumour, 10 colorectal cancer) was studied by oligomer-specific hybridization for K-ras mutations and single-strand conformation polymorphism (SSCP) for p53 mutations. Follow-up investigations were carried out after 1-3 years. RESULTS: Mutations were most frequent in carcinomas (5/10, 50%) and rare in non-tumour controls (1/49, 2.0%). They were found in Crohn's colitis in 15.4%, in extensive ulcerative colitis in 18.6%, in left-sided ulcerative colitis in 13.3%, and in distal ulcerative colitis in 6.7% (P > 0.05). There was a positive association with disease duration (> or =11 years, P < 0.05). Follow-up investigations detected the same mutation in four patients and revealed new mutations in three patients. CONCLUSIONS: In our large series of patients with inflammatory bowel disease, K-ras and p53 mutations could be detected with reasonable frequency and confirmed at follow-up in at least some patients. Our data encourage the use of molecular screening for the detection of malignant precursor lesions in at-risk patients.