The Nissen fundoplication is currently performed throughout the world, most frequently in a minimally invasive technique. Several randomized trials that have been performed in the past years document that the Nissen fundoplication is an effective procedure for the treatment of pathological gastro-oesophageal reflux disease when a critical indication is used for well-defined patients.

Paroxysmal tachycardia with widened QRS complexes was recorded in an eleven-year old boy who had suffered from brain damage, which had resulted from an episode of ventricular fibrillation. Atrial stimulation produced an increased AV conduction, sudden disappearance of the His bundle deflection and a complete left bundle branch block pattern. Tachycardias of this morphology were initiated by early atrial and ventricular premature beats. The findings suggested the presence of a macro re-entry circuit, utilizing a slow AV node- nodoventricular bypass tract as the anterograde limb and the His-Purkinje system--fast AV node as the retrograde limb. This supposition found further support by serial sectioning of the AV junctional area of the heart, which revealed a nodoventricular tract, which originated from the posterior extension of the compact part of the atrioventricular node and inserted into the crest of the ventricular septum.

Cobas h 232 point-of-care instrument for measurement of NT-proBNP performed satisfactorily with regard to precision, user-friendliness, and lot-variation. A decrease in NT-proBNP levels observed in samples transported to a central laboratory needs further attention and investigation.

Introduction:The currently recommended preanalytical conditions for lupus anticoagulant (LA) analysis require analyzing samples in fresh or freshly frozen platelet-poor plasma. The aim of this study was to evaluate whether alternative and less cumbersome preanalytical procedures for LA testing give significantly different results compared to recommended conditions. Materials and Methods: Citrated blood samples were drawn from 29 study participants, 15 with negative and 14 with positive LA results. The samples were processed according to the ISTH guideline for LA testing and compared to several alternative preanalytical conditions. Measurements were performed using the dilute Russell's viper venom time (DRVVT) and silica clotting time (SCT), both screen and confirm, on a STA-R Evolution analyzer. Stability criteria were based upon biological variation.Results: All DRVVT tests (normalized screen, confirm, and screen/confirm ratio) met the stability criteria for all the preanalytical conditions. The SCT tests (normalized screen, confirm, and screen/confirm ratio) met the stability criteria only when treated according to the ISTH guideline, except for SCT normalized screen/confirm ratio which also met the stability criteria for double-centrifuged aliquoted plasma stored in room temperature for 24 hours and then analyzed "fresh" or after being frozen. One warfarin-treated patient was reclassified from positive to negative for DRVVT after the preanalytical modifications, while 2 of 29 participants became falsely positive for 2 of 8 conditions for SCT. Conclusions:The DRVVT assays met the criteria for stability for all preanalytical conditions tested, while the SCT assays should be interpreted with caution if the preanalytical guidelines from ISTH are not followed. K E Y W O R D S dilute Russell's viper venom time, lupus anticoagulant, preanalytical conditions, silica clotting time, stability

Purpose Exercise‐induced bronchoconstriction (EIB) and exercise‐induced laryngeal obstruction (EILO) are the two disorders commonly considered when athletes complain of exertional dyspnea. They are highly different but often confused. We aimed to address this diagnostic challenge and its consequences in elite athletes. Methods We included all athletes competing at national or international level, referred to our institution for workup for EILO during 2013–2016. We diagnosed EILO from video‐recorded laryngoscopy performed during maximal cardiopulmonary treadmill exercise (CLE test). Symptoms and previous diagnostic evaluations were obtained from referral letters and chart reviews. Results Exercise‐induced laryngeal obstruction was diagnosed in 73/101 referred athletes, of whom 70/73 had moderate/severe supraglottic obstruction and 3/73 had primarily glottic obstruction with only minor supraglottic involvement. Of the 73 athletes with EILO, we were able to identify objective tests for asthma in 55 participants, of whom 22 had findings supporting asthma. However, 58/73 had used asthma therapy at some time previously, with current use in 28. Only three reported that asthma medication had improved their exercise‐related breathing problems, two of whom with tests confirming asthma. Treatment for EILO improved breathing problems in all but four. Conclusions Objective testing verified EILO in most of the referred athletes. EILO coexisting with asthma was common, and large proportions had used asthma medication; however, few reported effect on exercise‐related breathing problems. Unexplained persistent exertional dyspnea must not lead to indiscriminate escalation of asthma treatment, but instead incite investigation for EILO, either as a co‐morbidity or as a differential diagnosis.