[Development and Periodicity of Human Exposures in Suicidal Intention Reported to the Centre Erfurt from 2004-2013]. / Entwicklung und Periodizität humaner Expositionen in suizidaler Absicht im Einzugsbereich des Giftnotrufs Erfurt von 2004­2013.

Aim of the Study: Exposures in suicide attempts are demanding for hospitals and poisons information centres (PICs). Therefore, the time characteristics of their frequency were studied. Methods: A retrospective analysis was undertaken of all human exposures reported to Centre Erfurt from the beginning of 2004 to the end of 2013 according to their frequency in the respective year, season, month, weekday, time of the weekday, circumstances of exposure, age and gender. Results: 59.7% of all exposures (n=137 104) were accidental, 23.4% occurred in suicide attempts and 3.3% in substance abuse. 0.3% of the suicide attempts resulted in death. Their number continuously increased from n=2 422 in 2004 to n=3 458 in 2013, but their relative frequency remained almost constant at 23.4%. Their highest numbers were reached in the spring and summer with maxima in July and August and minima in February and September. During the week, the most suicide attempts were observed between Sunday and Tuesday and the least on Friday. Highest rate of suicide attempts was seen at 10 pm and lowest at 6 am. The median of age was 39 years (first quartile 24 years, third quartile 50 years). The female proportion was almost twice as high as the male. Conclusions: Hospitals the Centre Erfurt is serving should be particularly prepared for exposures in suicide attempts in the spring and summer (especially in July and August), at the beginning of the week and shortly before midnight.

[Human Single Drug Exposures to Non-opioid Analgesics Reported to the Poisons Information Centre Erfurt from 2003 to 2012]. / Humane nichtopioide Analgetika-Monoexpositionen im Einzugsbereich des Giftnotrufes Erfurt von 2003-2012.

AIM OF THE STUDY: Because of their frequency, non-opioid analgesics (NOA) single drug exposures registered by Poisons Information Centre (PIC) Erfurt have been studied over a decade. METHODS: A retrospective analysis of frequencies, circumstances of exposure, symptom severity, and age groups in NOA single drug exposures received by the PIC Erfurt from the beginning of 2003 to the end of 2012 was undertaken. RESULTS: Of all 4749 NOA single drug exposures, the 10 most frequent were caused by paracetamol (n=1 686), ibuprofen (n=1 439), acetylsalicylic acid (n=456), dipyrone (n=274), diclofenac (n=267), flupirtine (n=138), naproxen (n=41), etoricoxib (n=36), indomethacin (n=24), and dexketoprofen (n=19). Paracetamol single drug exposures increased from 158 in 2003 to 216 in 2007 and fell afterwards to 133 in 2012. Ibuprofen single drug exposures continously rose from 57 in 2003 to 258 in 2012. Adults were more often involved in NOA (53.8%) and all single drug exposures (54.1%) than children (45.9% and 45.6%, respectively). Suicidal attempts were more frequent in NOA (43.1%) than in all single drug exposures (34.2%), whereas accidental exposures or exposures in abuse were less often (33.4 and 0.2%, 46.0 and 0.9% respectively). NOA single drug exposures resulted mostly in none to minor symptoms (77.0%) and rarely in moderate (2.1%) or severe symptoms (1.0%). One adult was found dead after probable ingestion of 32 g of acetylsalicylic acid in suicidal intention. CONCLUSIONS: Because many NOA are over-the-counter drugs, it is difficult to obtain data on their use. PIC data could provide information on the NOA use in the population.

[Poisonings due to Substance Abuse Reported to the Poisons Information Centre Erfurt from 2002 to 2011]. / Substanzmissbrauch - Entwicklung des Vergiftungsgeschehens im Einzugsbereich des Giftnotrufes Erfurt 2002-2011.

AIM OF THE STUDY: Because of their importance for clinical toxicology, developments of sub-stance abuse reported to the Poisons Information Centre (PIC) Erfurt were investigated and compared to other reasons of human exposures. METHODS: A retrospective analysis of all human exposures (exposures of humans to substances in abuse, accidental and unknown circumstances, and suicide attempts) (n=125,130) from the beginning of 2002 to the end of 2011 was undertaken according to substance classes, reasons of exposures, symptom severity, age groups, and gender. RESULTS: Cases of substance abuse (3,760, 3.0% of all exposures) continuously increased from 252 (92 with one and 160 with multiple substances) in 2002 to 507 in 2011 (239 with one and 268 with multiple substances). In relation to all exposures, only the abuse of multiple substances rose significantly (p<0.001). In comparison to all substances of exposure, ethanol, amphetamine-type stimulants, benzodiazepines/analogues, and liquid ecstasy abuse significantly (p<0.005) increased while cannabis and Brugmansia/Datura species abuse significantly (p<0.05) decreased. Substance abuse significantly (p<0.001) more often caused moderate (23.7%) and severe symptoms (6.1%) than in suicide attempts (9.6%; 4.4%). First legal highs exposures were registered in 2010 and led significantly (p<0.001) more often to moderate symptoms (50%) than cannabis exposures (19.4%). CONCLUSIONS: The clinical significance of substance abuse is shown by the fact that it resulted more often in moderate and severe symptoms than suicide attempts. Data on substance abuse from PICs could supplement official annual drug reports in aspects of clinical toxicology.

Calcium channel antagonist exposures reported to the Poisons Information Center Erfurt.

BACKGROUND: We investigated the toxicity profile of the three main groups of calcium channel antagonists (CCA) and compared mixed CCA exposures (CCA plus another drug) with mono CCA exposures. METHODS: All CCA exposures reported to the PIC Erfurt from 2000 to 2009 were analyzed retrospectively. RESULTS: In total, 727 (230 mono and 497 mixed) CCA exposures were registered. Although CCA exposures increased almost twofold from 56 in 2000 to 108 in 2009 their relative frequency to all exposures remained constant. The five CCAs most frequently involved in exposures were the five most frequently prescribed ones in Germany over the same period. In mono and mixed CCA exposures, none or minor symptoms were most often seen with dihydropyridines (mono: 84.7%; mixed: 68.0%) followed by diltiazem (mono: 71.4%; mixed: 62.5%) and verapamil (mono: 57.1%; mixed: 50.0%). Highest rates of moderate (mono: 8.6%: mixed: 20.2%) and severe symptoms (mono: 18.6%; mixed: 23.7%) were observed after verapamil ingestions. Death most frequently occurred with diltiazem (mono: 28.6%; mixed: 12.5%). Rates of moderate symptoms were higher in mixed (13.3%) than in mono CCA exposures (4.8%). No distinct differences were seen regarding the relative frequency of none or minor symptoms, severe symptoms, and death between mono and mixed CCA exposures. CONCLUSION: Exposures to verapamil more often resulted in moderate and severe symptoms than with dihydropyridines. Death mainly occurred with diltiazem. Moderate symptoms were more frequent in mixed than in mono CCA exposures. The frequency of CCAs involved in exposure was related to their prescription.

[Epidemiology of predominantly occupationally-induced bronchopulmonary diseases]. / Epidemiologie vorwiegend berufsbedingter bronchopulmonaler Erkrankungen.

During the last years occupational diseases are of increasing interest. This lead to an increased sensibility which results in a continuous increase of the number of announcements of suspicion of an underlying occupational diseases. The rate of cases first remunerated remains nevertheless constant. The number of diseases caused by inorganic and organic dusts and the obstructive airway-diseases increase despite of the continuous decrease of silicosis. Among the diseases first remunerated in 1990, occupational diseases caused by inorganic dusts took up the first place (31.6%). As for the deaths in 1990, 91% are due to diseases caused by inorganic dusts.

[Alveolitis and fibrosis of the lung within the drainage area of a hospital for diseases of the lung (author's transl)]. / Alveolitis und Lungenfibrose im Einzugsbereich einer Lungenklinik.

Within the drainage area of the Central Hospital for Diseases of Heart and Lungs at Bad Berka/ GDR 337 persons (210 male, 127 female) with alveolitis and pulmonary fibrosis were observed during a period of 17 years (1963-1979). The average-age of the patient was 43.5 (11-70) years. The mean duration of the illness was to 9 years. The time elapsing up to the confirmation of the diagnosis amounts to approximately 4.35 years. The yearly incidence of alveolitis and pulmonary fibrosis are estimated at one case among 40,000 people. During the last years more attention has been given to these diseases but there seems to be also a true increase of the frequency of these conditions.

[Therapeutic possibilities in alveolitis and pulmonary fibrosis]. / Therapeutische Möglichkeiten bei Alveolitiden und Lungenfibrosen.

Aetiologically, less than 50% of the alveolitides and pulmonary fibroses are clarified. A successful causal therapy by elimination of the noxae is thus possible only in several acute cases, particularly in forms of the exogenic allergic alveolitis. Usually the clinical pictures are misunderstood for a long time and are diagnosed only in advanced stages. The therapeutically influencible inflammatory changes are in such a case only slightly expressed. The more or less advanced fibrosis is not or only slightly to be influenced. Then the last way out of the difficulty of the lung and the heart-lung transplantation, respectively, the size of which, however, is limited by the small number of suitable donors. In the initial phase of the diseases in toxic and allergic-immunologic the inflammations resulting from this in the pulmonary tissue are partly to be controlled by antiinflammatorily and immunosuppressively, respectively, acting medicaments such as corticosteroids, azathioprin and cyclophosphamide. For the treatment of the lung fibrosis only D-penicillamine is at our disposal. Because of the numerous, partly considerable side effects and due to the effectiveness of the necessary long-term therapy which is only difficult to be measured there are very different opinions about the treatment with penicillamine. The enlargement of the knowledge on the pathogenesis of alveolitides and lung fibroses allows to hope that new beginnings for a therapy are found. No final judgement can be made about the efficacy of cyclosporin A and of antioxidants.

[Interstitial lung diseases caused by long-term neurological-psychiatric drug therapy?]. / Lungengerüsterkrankungen durch neurologisch-psychiatrische Langzeittherapie?

UNLABELLED: The development of alveolitis or lung fibrosis through drugs is wellknown, however rare described in the spectrum of drug side effects. In six cases of patients with neurological diseases were studied the relationship between alveolitis or lung fibrosis and a long-time therapy with especially drugs in a neurological practice. CONCLUSION: By the etiological examination of alveolitis or lung fibrosis it is necessary to pay attention to the possible relationship between drug and disease.

[Evaluation of remaining performance capacity in patients with alveolitis and pulmonary fibrosis]. / Beurteilung des Leistungsrestes bei Patienten mit Alveolitis und Lungenfibrose.

In patients with alveolitis or interstitial fibrosis of the lungs reduction of physical work capacity is the consequence of cardiopulmonary functional impairment. On the basis of the results of the evaluation of investigation in 493 patients with alveolitis and fibrosis a decision matrix for quantifying different degrees of impairment is recommended.

[Cardiopulmonary function disorders in pulmonary fibrosis of various etiology]. / Kardiopulmonale Funktionsstörungen bei Lungenfibrosen unterschiedlicher Genese.

A large number of different pulmonary diseases eventually result in producing the final morphological pattern of pulmonary fibrosis. Basing on essential cardiopulmonary functional parameters, four relatively frequently encountered fibrotic pulmonary diseases are compared with each other. Patients suffering from bird breeder's lung show typical obstructive disturbances of ventilation that are even more marked in collagenoses with lung involvement. Patients suffering from electric welder's lung are notable for enhanced respiratory tract obstructions and increased residual volumes. In patients with sarcoidosis it is recommended to determine, above all, the lung compliance besides measuring the diffusion capacity. The specific compliance should be chosen as criterion to assess the compliance, so that the preliminary extension of the lung by emphysema is taken into consideration. Welder's lungs, bird breeder's lungs and collagenoses show a load-conditioned respiratory partial insufficiency and a latent pulmonary hypertonia. The examined groups of patients showed similar functional patterns, but individual parameters were disease-specifically considerably different from standard values.

[Alveolitis and lung fibroses caused by drugs]. / Alveolitiden und Lungenfibrosen, verursacht durch Medikamente.

The causes for alveolitis and lung fibroses are very multifarious. In the scale of the contaminant factors the medicaments occupy only a small sector. Nevertheless, the knowledge of such a side effect is significant on account of the often unfavourable prognosis of the alveolitis. When medicaments with wellknown ability of impairment are administered (e.g. cytostatic drugs, antiarrhythmic drugs etc.) a narrow-meshed observation with suitable control parameters is to be demanded. Only the timely recognition of a side effect of a medicament in the lung structure can prevent the fatal change into a pulmonary fibrosis. In 801 alveolitis and lung fibrosis diagnosed in our clinic 10 times a medicament was established as cause.

[Pulmonary hypertension following Rickettsia infection?]. / Pulmonaler Hypertonus nach Rickettsieninfektion?

A latent or stable pulmonary hypertension was established in three patients with a Q-Fever-Infection confirmed as occupational disease. According to sparse informations in the literature the development of a pulmonary hypertension in the course of this disease is taken into account. The investigation programme regarding Q-Fever-Infections should be completed by measurement of pulmonary artery pressure.

[Transthoracic lung biopsy in interstitial pulmonary diseases (author's transl)]. / Transthorakale Lungenbiopsie bei interstitiellen Lungenerkrankungen.

Report about transthoracic needle biopsy for histological diagnosis of interstitial pulmonary diseases in 366 patients, 22 of whom had a control biopsy. The histological diagnosis in 306 patients (83.6%) were representative of the clinical findings, in 46 cases (12.6%)--generally in exogenic allergic alveolitis--relatively representative, and not representative in 14 patients (3.8%). In view of the efficiency of the method, the slight expense and the relatively low rate of complications (24%), which mostly are of light character and well to be removed, it is considered to be superior to minor diagnostic thoracotomy.

[Alveolitis and pulmonary fibrosis in chronic diverticulitis and ulcerative colitis]. / Alveolitis und Lungenfibrose bei chronischer Divertikulitis und Colitis ulcerosa.

Associated reactions of the connective tissue of the lungs are by no means rare in several extrapulmonary disorders, for example, with the "so-called" collagenoses. They are less frequent in chronic inflammatory intestinal diseases. The mechanism of this pulmonary reaction is largely unclarified. The situation is complicated further by the fact that a drug side reaction may compete with the underlying disease. The problem of a change in the connective lung tissue within the framework of a chronic inflammatory intestinal disease or as a result of drug therapy of that disease, is described and demonstrated via the cases of two patients.

[Oxygen-therapy by means of a rental-system (author's transl)]. / Sauerstofftherapie im Leihsystem.

16 patients with chronic respiratory insufficiency were submitted to an ambulatory oxygen-therapy. The experiences in the organisation of this kind of therapy are discussed.

[Farmer's lung--a form of exogenous allergic alveolitis]. / Die Farmerlunge--eine Form der exogenen allergischen Alveolitis.

Exogenic allergic alveolitides are caused by organic dusts which contain bacteria, moulds or vegetable and animal antigens. The farmer's lung as a form of the exogenic allergic alveolitis is a rare disease. The uncharacteristic symptomatology in the initial phase and in particular the retarded beginning of the symptom after several hours handicap the timely recognition in an early phase of the disease so that curative therapeutic measures are rarely possible. The cases of the disease are found only at the chronic stage, at the stage of the pulmonary fibrosis. Then the prognosis is unfavourable. In the Central Clinic for Heart and Lung Diseases Bad Berka 1,110 patients with alveolitides and lung fibroses were diagnosed in the period from 1975 to 1988. 306 of them could be clarified as exogenic allergic alveolitis, 61 of them (19.8%) were farmer's lungs.

[Exogenous allergic alveolitis in a fruit refrigeration worker]. / Exogen allergische Alveolitis bei einem Obstkühlhausarbeiter.

The causes for an exogenic allergic alveolitis are very multifarious. On the basis of a casuistics is referred to the development of such a disease by the contact with fruit mould in cold-storage plants.