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Cholesterol pericarditis is an extremely rare type of pericarditis characterized by a continuous pericardial effusion containing high amounts of cholesterol crystals. This case report of a 51-year-old male with syncopal episodes and a massive, cholesterol-rich pericardial effusion highlights the interdisciplinary approach and rationale in treating this rare condition of largely unknown pathogenesis.

Tricuspid regurgitation (TR) has in recent literature been described as an independently progressive disorder associated with a poor prognosis. Studies have emphasized the importance of a more proactive approach in treating TR in order to prevent progression of right ventricular dysfunction and ultimately right heart failure. These findings have renewed interest in surgical treatment for isolated TR whilst also fueling rapid advancements in transcatheter therapies, as argued in this review.

Cardiac natriuretic peptides, BNP and NT-proBNP can be used to screen for left ventricular systolic dysfunction in patients with symptoms suggestive of heart failure. Using the cut-off values recommended in the article, the sensitivity and negative predictive values are high in patients aged < 75 years, but have lower sensitivity at older age. In addition, natriuretic peptides are prognostic markers for mortality and cardiovascular hospitalization. BNP/NT-proBNP measurement may also be of value in follow-up on heart failure patients.

Introduction: Coronary CT angiography (CTA) is a promising method used for diagnostic evaluation of patients suspected of coronary artery disease (CAD). CTA is increasingly used as an alternative to conventional coronary angiography. Information on the diagnostic and therapeutic consequences of using CTA in the diagnostic work-up of patients suspected of CAD is sparse., Material and Methods: Out-clinic patients (n = 215) with chest pain and an intermediate pre-test probability of CAD were referred to diagnostic evaluation by CTA., Results: CTA was not performed in 5% (11/215) due to extensive coronary calcification or arrhythmia, was non-conclusive in 7% (15/215) and was diagnostic in 88% (189/215) of the patients. CTA excluded CAD in 46% (99/215) of the patients. No further diagnostic or hospital follow-up after CTA was necessary in 73% (156/215) of the patients. CTA identified non-significant CAD in 27% (57/215) and significant CAD (>or= 50% stenosis) in 15% (33/215) of the patients. The proportion of patients with CAD in relevant antithrombotic and lipid-lowering medication increased following CTA. Further diagnostic evaluation with coronary angiography following CTA was indicated in 18% (39/215) of the patients due to obstructive CAD (n = 21), non-diagnostic examination (n = 7), or the presence of extensive coronary calcification or arrhythmia (n = 11)., Conclusion: CTA ruled-out CAD in 46% of the patients. No further diagnostic testing or hospital follow-up after CTA was necessary in 73% of the patients. CTA seems valuable in excluding CAD, and may prevent unnecessary invasive angiography in patients without CAD.

A case of mitral papillary fibroelastoma as a cause of cardiogenic embolic stroke in a young man is presented. This case demonstrates the importance of thorough echocardiographic evaluation in younger patients presenting with possible embolic clinical manifestations. Furthermore, the echocardiographic characteristics of papillary fibroelastoma are discussed.

A case of congenitally corrected transposition presenting for the first time with second-degree AV block in a 76-year-old woman is presented. This case demonstrates that congenitally corrected transposition can remain asymptomatic and undiagnosed, especially when no other cardiac defects are present.

Introduction: The aim of this study was to compare the allergy test with the skin prick test and the specific IgE by Phadiatop test to a purely clinical allergy diagnosis by an allergy specialist in adult patients previously tested in general practice., Materials and Methods: A total of 103 patients suspected of having asthma and/or rhinitis were re-evaluated with a clinical diagnosis and the two allergy tests. Both the patient and the individual general practitioner were asked about existing allergy diagnosis., Results: The two test systems showed large differences in a semiquantitative linear system with an explained variation (r2) of only 8%. In comparison to a purely clinical diagnosis, they were diagnostically equal with both tests, with an additional 15% positive reactions of which 25% were judged clinically active. Both tests resulted in about 33% false-positive tests classified as clinically inactive. In the case of a positive Phadiatop test and clinically active allergy, both the patient and the general practitioner reported identical specialist diagnoses in about 75% of cases, while in 20-50% of the cases an identical diagnosis was reported when the clinical diagnosis was qualitatively different from the result of Phadiatop., Conclusion: The results of the two test systems often differ, and they both detect extra positive tests, in which case they should be used in a serial manner. Both tests often result in a false-positive diagnosis, and identification of clinically relevant positive tests often requires an experienced medical evaluation.

Introduction: The aim of this study was to evaluate adult patients in general practice suspected of having rhinitis., Materials and Methods: A total of 72 patients suspected of having rhinitis underwent a secondary specialist investigation, resulting in 55 final specialist diagnoses of rhinitis. Through interviews of patients and a questionnaire mailed to the primary physician, information on diagnostic strategy, final diagnosis, suggested treatments and patients' knowledge about rhinitis were determined., Results: One third of the 72 patients examined for possible rhinitis would have benefited from a supplementary specialist examination, where one group was made up of patients with negative allergy tests and chronic symptoms of either non-rhinitis disease or vasomotoric rhinitis and the other group was made up of patients with severe seasonal allergic rhinitis, who would benefit from immunotherapy. The suggested medical treatments followed modern treatment principles. Of the patients with a final diagnosis of rhinitis, only one third were informed about treatment principles with inhalation steroids, while half of the patients knew about the basic principles of antihistamine treatment. Of 53 patients with rhinitis, 6 were prepared to change medical treatment without first contacting their physician., Conclusion: Patients with chronic or recurrent symptoms should be referred to specialists more often, and patients who might benefit from allergen-specific treatment, such as immunotherapy or allergen prevention, should be evaluated by an allergy specialist. Patients with rhinitis should be given more information on disease mechanisms and treatment principles.

It has become increasingly evident that elevation of troponins can be demonstrated in other diseases than acute myocardial infarction. In this review we wanted to assess the prevalence and the clinical importance of troponin elevations in patients with mainly extra-cardiac organ manifestations. Only in chronic renal failure there appears to be evidence to support the conclusion that high levels of troponins are associated with an adverse clinical outcome. The mechanisms underlying the rise in troponins in non-cardiac diseases origin are unknown. One explanation could be that the patients involved have ischemic heart disease as co-morbidity. Severe stress caused by an acute non-cardiac clinical event may result in a minor leakage of myocardial markers. It is essential to perform a careful clinical evaluation in the case of patients with unexpected high levels of cardiac troponins.

A case of acute myocardial infarction associated with a mild blunt thoracic trauma in a 60-year-old woman with normal coronary angiography is described. The underlying potential pathophysiological mechanisms are discussed. Lastly, the clinical and practical consequences of the new consensus document for the redefinition of acute myocardial infarction are briefly commented on.

On a random day in 1998 all hospitalized unselected patients on the ward of internal medicine, Silkeborg County Hospital were evaluated in relation to possible tobacco-related disease. A total of 56 (71%) of 79 had a smoking-related main diagnosis and of these 23 (29%) of 79 were statistically diseased as a direct consequence of their present and previous use of tobacco.

The objective of this population-based case-control study has been to investigate whether residence before and after birth near 50 Hz high voltage installations increases a child's risk of cancer and whether risk correlates with the strength of the magnetic field. One thousand seven hundred and seven children under the age of 15 with either leukaemia, a tumour of the central nervous system, or malignant lymphoma diagnosed in 1968-86 were identified in the Danish Cancer Registry and matched with 4788 population controls. Measures of exposure were proximity before and after birth to existing or former 50-400 kV electrical transmission connections and substations and associated historical electromagnetic fields calculated on the basis of current load on line, phase ordering of line, and distance from the dwelling. A significant association was seen between all major types of childhood cancer combined and exposure to magnetic fields from high voltage installations of > or = 0.4 microT (odds ratio 5.6). At > or = 0.25 microT no significant association was seen (odds ratio 1.5). A possible association was also seen with cases of Hodgkin's disease separately at > or = 0.1 microT. On the basis of these results and additional descriptive data on electricity consumption and incidence of childhood cancer in Denmark since the 1940s it was concluded that the proportion of childhood cancer possibly caused by 50 Hz electromagnetic fields must be small.

The concentration of house-dust mites (Der. spp.) was investigated in 96 Danish dwellings and bedroom air-exchange rates, humidity and temperature was measured contemporaneously in all the dwellings. A positive correlation was found between indoor air humidity and mite concentration, and an inverse correlation was found between house-dust mite concentration and indoor air-exchange. Dwellings of mite-allergic persons had a higher concentration of house-dust mites compared with those of the non-mite-allergic group. House-dust mite concentration was above the proposed limit in 76% of the homes of mite allergic persons and in 48% of the homes of non-sensitive persons. The high proportion of dwellings infested with house-dust mites, when compared with previous measurements, suggests an increased prevalence of house-dust mites in Danish dwellings. The results support the concept that reduced ventilation in dwellings involves a risk of increased house-dust mite exposure.