National strategy for palliative care of severely ill and dying people and their relatives in pandemics (PallPan) in Germany - study protocol of a mixed-methods project.

BACKGROUND: In the SARS-CoV-2 pandemic, general and specialist Palliative Care (PC) plays an essential role in health care, contributing to symptom control, psycho-social support, and providing support in complex decision making. Numbers of COVID-19 related deaths have recently increased demanding more palliative care input. Also, the pandemic impacts on palliative care for non-COVID-19 patients. Strategies on the care for seriously ill and dying people in pandemic times are lacking. Therefore, the program 'Palliative care in Pandemics' (PallPan) aims to develop and consent a national pandemic plan for the care of seriously ill and dying adults and their informal carers in pandemics including (a) guidance for generalist and specialist palliative care of patients with and without SARS-CoV-2 infections on the micro, meso and macro level, (b) collection and development of information material for an online platform, and (c) identification of variables and research questions on palliative care in pandemics for the national pandemic cohort network (NAPKON). METHODS: Mixed-methods project including ten work packages conducting (online) surveys and qualitative interviews to explore and describe i) experiences and burden of patients (with/without SARS-CoV-2 infection) and their relatives, ii) experiences, challenges and potential solutions of health care professionals, stakeholders and decision makers during the SARS-CoV-2 pandemic. The work package results inform the development of a consensus-based guidance. In addition, best practice examples and relevant literature will be collected and variables for data collection identified. DISCUSSION: For a future "pandemic preparedness" national and international recommendations and concepts for the care of severely ill and dying people are necessary considering both generalist and specialist palliative care in the home care and inpatient setting.

[Career Prospects for Young Physicians in Infectious Diseases]. / Perspektiven für junge Ärztinnen und Ärzte in der Infektiologie.

Infectious Diseases are a cross-sectional area connected to various medical disciplines and offer interested physicians multiple working opportunities. The spectrum of infectious diseases covers both out- and inpatient care as well as basic, clinical and epidemiological research. The need for infectious diseases specialists is increasing, thus career prospects are promising. Working conditions in infectious diseases are comparatively family-friendly. With this article we intend to arouse interest for working in the fascinating fields of infectious diseases and provide information on career opportunities. Data from a recently conducted survey among members of the German Society of Infectious Diseases deliver insight, how infectious disease specialists work today.

[Precision medicine in infectious diseases]. / Präzisionsmedizin in der Infektiologie.

Infectious medicine faces a variety of challenges, such as the increase in antibiotic resistance and the emergence and spread of infectious diseases fueled by climate change and globalization. Precision medicine can provide solutions to many of these challenges. Since an untargeted request for diagnostic tests can lead to test results without clinical relevance, which can increase the use of non-indicated antibiotics, the principle aimed at is: targeted diagnostics (the right test) and consideration of patient characteristics (the right person) to optimize management (the right action). At the same time, one must always decide whether empirical therapy must be immediately initiated, even if the results of the initiated diagnostics are not yet available. In addition, many new diagnostics as well as therapies have recently been developed for the rapid detection and more specific treatment of bacterial infections. Molecular genetic methods, which offer more rapid results than classical bacterial cultures, are gaining ground as new diagnostics. New therapeutics such as bacteriophages, antibodies or antibacterial peptides allow increasingly precise treatment of certain bacterial infections. Precision medicine will also play an increasingly important role in infectious medicine in the future.

Computed tomography and histologic results in the early stages of endotoxin-injured pig lungs as a model for adult respiratory distress syndrome.

RATIONALE AND OBJECTIVES: To determine early radiographic changes in diffuse alveolar injury, the authors correlated computed tomography (CT) and histopathology in pigs with recurrent endotoxinemia. METHODS: Five pigs received recurrent endotoxin over a 17-hour period. Three pigs received physiologic saline and served as controls. Hemodynamic and blood-gas data were analyzed. CT was performed immediately before killing the animals. The lungs were cut into 5-mm-thick slices in the same axis as the CT scans and were investigated by light and electron microscopy. RESULTS: Hemodynamic data, blood-gas analysis, and morphologic changes closely simulated the clinical situation of septic shock in the five pigs that had received endotoxin. Results of histologic examination depicted changes similar to those associated with adult respiratory distress syndrome (ARDS). CT clearly demonstrated both interstitial, and to a minor degree, intra-alveolar lesions in the endotoxin-injected group, which correlated well with dilated lymph vessels, thickened interstitium, and areas of dystelectasis on histologic examination. Although there was a rather uniform clinical picture, CT and histologic findings showed different degrees of involvement. CONCLUSIONS: CT clearly depicts changes in endotoxin-injured pig lungs in an early clinical state, which are similar to changes associated with ARDS on histologic examination.

[Medullary carcinoma of the thyroid and 99mTc(V)-DMSA scintigraphy. Clinical results with a new radiopharmaceutical]. / Medulläres Schilddrüsenkarzinom und 99mTc(V)-DMSA-Szintigraphie. Klinische Ergebnisse mit einem neuen Radiopharmakon.

99mTc(V)-DMSA scintigraphy is a non-invasive diagnostic tool for diagnostic differentiation and localisation of medullary carcinoma of the thyroid. For primary tumours its sensitivity is 77%. This diagnostic means is not only helpful for the diagnosis of primary tumours, but is especially informative for recidives and metastases of the medullary carcinoma of the thyroid. Its sensitivity for recidives and metastases is 66%. The sensitivity obtained in our study, which included four patients, corresponded to that reported in the literature.

[The recording of parenchymal lung changes in smokers by high-resolution computed tomography]. / Erfassung von Parenchymveränderungen der Lunge bei Rauchern durch hochauflösende Computertomographie.

PURPOSE: It has been the aim of the study to assess parenchymal changes in the lung with high-resolution CT in healthy heavy, moderate, and non-smokers. MATERIAL AND METHODS: We prospectively evaluated CT changes in 42 healthy heavy smokers (gr. (group) 2, > or = 30 pack-years), 40 moderate smokers (gr. 1, < 30 pack-years) and 38 non-smokers (gr. 0). For CT-analysis, we used a visual grading and computer-based analysis system (Mipron, Kontron GmbH, Munich, Germany). RESULTS: Productive cough, dyspnoea and chronic bronchitis were more common in smokers than in non-smokers (p < 0.05). Pathological CT-findings were found in 6/38 non-smokers and in 71/82 smokers (p < 0.01). In particular, in smokers (gr. 1 [%], gr. 2 [%]) the following pathological findings were found: dystelectases in dependent lung areas in 50% (62, 38), centrilobular emphysema in 44% (43, 20), pleural thickening in 38% (38, 38), panlobular emphysema in 36% (52, 20), ground-glass pattern in 33% (36, 30), paraseptal emphysema in 21% (31, 10), prominent or thickened interlobular septa in 18% (29, 8) and centrilobular micronodules in 13% (10, 18). Computer-based analysis demonstrated thicker bronchial walls in smokers as compared to non-smokers. CONCLUSION: Although feeling healthy, smokers demonstrate various parenchymal abnormalities in the lung. In smokers, subpleural dystelectases, centrilobular and panlobular emphysema are dependent on cigarette consumption, ground glass pattern, centrilobular micronodules, pleural thickening and bronchial wall thickening are independent on cigarette consumption.

[Pulmonary manifestations in rheumatoid arthritis: high-resolution computed tomography in correlation with the skeletal changes and the laboratory chemical changes]. / Lungenmanifestation bei rheumatoider Arthritis: hochauflösende Computertomographie in Wechselbeziehung zur Skelettmanifestation und zu laborchemischen Veränderungen.

PURPOSE: It has been the aim of the following study to evaluate pulmonary changes in rheumatoid arthritis with high-resolution CT and to assess their correlation with joint manifestation and laboratory parameters. MATERIAL AND METHODS: The authors prospectively performed computed tomography (CT) in 83 patients with rheumatoid arthritis and graded pulmonary changes for frequency and severity. Included were patients with 6-7/7 ARA, BSR > 25/1 min and mean disease duration of 12 years (range, 1-44). Data of medical and drug histories, smoking habits, blood levels of rheumatoid factor (RF), antinuclear antibodies (ANA) and C-reactive protein as well as the degree of joint involvement were taken into account. RESULTS: 58 patients (70%) had pathological CT scans showing the following abnormalities: interlobular thickening (44.5%), intralobular thickening (34%), nonseptal linear attenuation (35%), nodular or linear pleural thickening (32.5%), ground-glass pattern (19%), centrilobular nodules (13%), honeycombing (13%) and bronchiolectasis (9%). Intralobular thickening, honeycombing and pleural thickening were associated with a higher degree of joint manifestation; pleural thickening, honeycombing and ground-glass pattern were associated with a higher level of rheumatoid factor. There was no relationship between pulmonary changes and either the duration of the disease, antinuclear antibodies (ANA) or C-reactive protein. CONCLUSION: CT may be a useful noninvasive tool for recognition of RA-associated lung disease. Interstitial lung changes are frequent and they are independent of the duration of the disease. Pulmonary interstitial changes are more frequent and more severe in RF-positive patients and in case of more severe joint involvement.

[Long iliac artery occlusions: Feasibility, short- and mid-term outcome]. / Perkutane Therapie langstreckiger Beckenarterienverschlüsse: Technische Durchführbarkeit, kurz- und mittelfristige Ergebnisse.

PURPOSE: It was the aim of the following study to determine the feasibility of the recanalization of long occlusions in iliac arteries and to establish its patency rate. MATERIAL AND METHODS: We retrospectively evaluated the data of 23 patients (15 male and 8 female) with occlusions of the iliac arteries with a mean length of 12 cm (range: 9-15 cm). The occlusions were situated either in the common iliac artery (CIA) (n = 3), in the external iliac artery (EIA) (n = 12) or in both CIA and EIA (n = 7). In one patient three vessels, the common femoral artery included, were involved. The recanalization procedure was performed with wire and catheter from retrograde and, in case of a failure, from antegrade in a cross-over technique. RESULTS: Recanalization succeeded in all patients. Technical success defined as residual stenosis < 30 % was seen in 20 of 23 patients. Early reocclusions were seen in four patients, in three of whom, the stent dilatation had been incomplete. Late reocclusions were observed in three patients, one of whom had already had early reocclusion. The reason was stent breakage in one, stent dehiscence in the second and restenosis in the third patient. All of the patients with reocclusion either early or late, had received covered stents. In four patients restenosis developed within 30 months: It was successfully treated by ballon dilatation or stent. Embolism during the recanalization procedure was observed in six patients. Embolism was observed on the ipsilateral side in five, and on the contralateral side in one patient. In each patient who had experienced embolism, balloon dilatation had been performed before stent implantation. CONCLUSION: 1) There is some evidence that the recanalization of long iliac artery occlusions is feasible. 2) The main reason for early and late reocclusions is either rest stenosis or restenosis. 3) Covered stents should only be used in selected cases. 4) Primary stenting is the treatment of choice in order to prevent embolism.

[High-resolution computed tomography (HRCT) of the lung in collagenoses: a prospective study of 73 patients]. / Hochauflösende Computertomographie der Lunge (HRCT) bei Kollagenosen: eine prospektive Untersuchung an 73 Patienten.

To determine pulmonary features of collagenous vascular diseases as assessed by high resolution computed tomography (HRCT) we performed a prospective study of 73 consecutive patients, 44 with rheumatoid arthritis (ra), 11 with progressive systemic sclerosis (pss), 8 with systemic lupus erythematosus (sle), 5 with sjögren's syndrome, 3 with dermato-/polymyositis and 2 with mixed connective-tissue disease. Pathological lung changes were demonstrated in 70% of patients with ra, 91% with pss, 63% with sle and 60% with the rest. HRCT features included: intralobular thickening (48%) with a predominance in posterior lower and middle lung areas, pleural thickening (48%) with a predominance in upper lung areas, prominent interlobular septa (37%), subpleural lines (33%), parenchymal bands (33%) with a predominance in lower and anterior lung areas, honeycombing (33%), ground glass pattern (29%) with a predominance in upper and middle, micronodules (18%) with a predominance in upper lung areas and bronchiectasis (14%). HRCT is an important means for the assessment of lung changes associated with collagenous vascular diseases and a definite diagnosis is possible in most cases.

[Disk displacement of the temporomandibular joint: correlation of magnetic resonance tomography and clinical findings]. / Diskusvorverlagerung des Kiefergelenks: Korrelation von Magnetresonanztomographie und klinischem untersuchungsbefund.

PURPOSE: To evaluate the value of magnetic resonance imaging (MRI) in symptomatic patients with different degrees of internal derangement. MATERIAL AND METHODS: We prospectively investigated 117 temporomandibular joints (TMJ) of 59 symptomatic patients and 31 asymptomatic volunteers and correlated this with clinical parameters. RESULTS: There was a positive correlation between the degree of internal derangement and deformity of the disc, maximal mouth opening, signal intensity of the posterior band, thickness of the bilaminar zone, proliferative bony changes, size of the condyle and reduced translation movement of the condyle, which in addition moved upward and backward. Patients most often complained of pain which was dependent on the degree of disc displacement and condylar changes. Clinical parameters were found to be inaccurate in predicting disc displacement. CONCLUSION: Patients with internal derangement of the temporomandibular joint may be asymptomatic. Patients history may give the only pointer to the disorder.

Anterior disk displacement of the temporomandibular joint. Significance of clinical signs and symptoms in the diagnosis.

In order to examine the diagnostic significance of typical clinical symptoms in temporomandibular joint (TMJ) disorders for diagnosis of anterior disk displacement, clinical findings were compared with the degree of disk displacement in 84 TMJs of 59 patients with TMJ disorders, who were examined clinically and by means of magnetic resonance imaging (MRI). The control group consisted of 31 subjects with no TMJ symptoms. No significant correlation between the degree of anterior disk displacement and palpation pain of the masticatory muscles or clicking/crepitus of the TMJ could be found. Joint clicking was observed in 65% of patients with TMJ symptoms in normal disk position (NDP). The percentage of joint clicking was almost the same in patients with anterior disk displacement with reposition (ADWR) (68%). There were significant correlations between active mouth opening and disk position as well as between a history of pain and disk position. Patients with NDP and ADWR had almost identical mouth opening values: 48 (+/- 5) mm and 46 (+/- 5) mm respectively. In contrast to these groups the mean values decreased significantly to 42 (+/- 6) mm in patients with anterior disk displacement without reposition (ADWOR). There were no significant correlations between occlusal findings (centric relation and habitual relation, early occlusal contacts, abrasion facets) and disk position when viewed either collectively or individually.

[Invagination. The present status of diagnostic imaging and therapy]. / Invagination. Derzeitiger Stand der bildgebenden Diagnostik und Therapie.

The use of ultrasound techniques has brought about considerable changes in the diagnosis and therapy of intussusception in the past few years. (1) Whenever intussusception is suspected ultrasound examination of the abdomen is the diagnostic procedure of choice; a diagnosis of intussusception can be made or excluded with an adequate degree of accuracy. (2) Ultrasound monitoring is also good for the follow-up of cecal edema after reduction of intussusception, making it possible to check that there are no pathological lead points and that complete restoration of function has been achieved. (3) There are only three absolute contraindications for attempting an enema: peritonitis, shock, and perforation. (4) Whenever there are relative contraindications for administration of an enema, e.g., long duration of symptoms, complete small-bowel obstruction, it is of the utmost importance to inform the pediatrician and the surgeon and to discuss with them the potential benefits and risks involved in an attempt at hydrostatic reduction.

[Normal values of thyroid gland volume. Ultrasound measurements in schoolchildren 7 to 20 years of age]. / Schilddrüsenvolumen-Normwerte. Sonographische Messungen an 7- bis 20jährigen Schülern.

Thyroid gland volume was calculated from ultrasound data (using the ellipsoid formula) in 1080 apparently healthy schoolchildren, aged 7-20 years, from Speyer and Neckargemünd in the Federal Republic of Germany. Thyroid volume was found to increase with age: mean of 4.34 ml (single standard deviation [SD] 1.55) in seven-year olds, 13.6 ml (SD 6.2) in 16-year olds. No measurable increase was found from the 16th year onwards. No sex-related differences in size were found before the age of ten years, with a slight size increase in girls at the time of puberty. The right lobe was significantly larger than the left one (mean difference of 0.8 ml) in all age groups. There was a weakly positive correlation between thyroid volume and age, body weight, height and surface area, respectively, the best correlation for both sexes being between thyroid volume and body surface area. Among the 1080 children and juveniles of both ages there were eight with abnormal findings, all of them girls aged 16-18 years old.