[Cases of poisoning in Germany. Disease entity, documentation, and aspects of the event]. / Vergiftungen in Deutschland. Krankheitsbegriff, Dokumentation und Einblicke in das Geschehen.

Cases of poisoning account for a distinct share of accidents in Germany, which is particularly high for accidents involving children. Cases of poisoning resulting from suicidal intent or abuse are not counted as accidents. Compared to other cases of disease and accidents, the numerical documentation of cases of poisoning is inadequate. Presently, there is no institution in Germany that could make available representative and meaningful data on the current state of poisoning. Owing to intensive scientific cooperation between the poison information centers (funded by the federal states) and the Poison and Product Documentation Center at the Federal Institute for Risk Assessment (BfR DocCenter) as well as to international cooperation, harmonized and standardized tools have been developed for the appropriate documentation and reporting of procedures to account for poisoning accidents. The first evaluation for 2005-2012 based on published and processed figures for the Federal Republic of Germany yielded the following results: Of approximately 230,000 telephone inquiries received in 2012, about 207,000 involved exposure of humans to different noxae. An annual increase of 3-5 % was recorded. For 2011, analyses of subsets processed by means of standardized methods yielded the following results: Medicines were involved in about 39 % of the cases recorded (of these, medicinal products for humans in 99 %); chemical/physicochemical agents in about 26 % (of these, cleaning and maintenance products in 46 %); products of daily use in about 14 % (of these, cosmetics in 40 %); and plants in about 10 %. More than 90 % of cases were acute poisoning and less than 5 %, chronic poisoning. Regarding the degree of severity of poisoning, an asymptomatic course was reported for 44 % of the cases; minor manifestations were experienced in 30 %, moderate ones in 6 %, and severe manifestations in 2 % of the cases recorded. Fatal cases were rare (< 0.1 %). The majority of cases (67 %) were caused by poisoning accidents, followed by suicidal action (20 %), with abuse and industrial poisoning (4 %) in third position; 1 % of the cases of poisoning were attributed to adverse drug reactions (ADR) and mistaking a medicinal product for another one. Infants aged 1-2 years have the highest risk of poisoning. A panel of the BfR Committee for the Assessment of Poisonings has already developed proposals for a national monitoring scheme of poisoning incidents. The aim is to prepare annual reports similar to the report of the National Poison Data System (NPDS) maintained by the American Association of Poison Control Centers (AAPCC) in the USA.

[Vigilance for veterinary medicinal products: declarations of adverse reactions in the year 2010]. / Vigilance der Tierarzneimittel: Gemeldete unerwünschte Wirkungen im Jahr 2010.

In 2010, we observed again an increase in the number of declarations reported to the vigilance system for veterinary medicinal products up to a total of 160. The species and drug classes reported remained the same as in previous years: the majority of adverse drug reactions (ADRs) concerned either dogs or cats and the most frequently involved drugs were either antiparasitic products or antiinfectives. Adverse reactions following reconversions and 8 cases of suspected allergic reactions following the use of amoxicillin-clavulanic acid combinations in dogs were reported. Additional enquiries were processed by the Swiss Toxicological Information Centre and transmitted to Swiss medic. 11 of these reported accidental ingestions of flavoured tablets in overdose by dogs and some cats. The vaccino vigilance program received 179 declarations following immunization against blue tongue disease as well as 82 declarations following the application of other vaccines. The vigilance system increases the chance to identify rare reactions or interactions and thereby contributes to the security of veterinary medicinal products.

[Vigilance for veterinary medicinal products: declarations of adverse reactions in the year 2009]. / Vigilance der Tierarzneimittel: Gemeldete unerwünschte Wirkungen im Jahr 2009.

During the year 2009, 134 reports of suspected adverse drug reactions (ADRs) to veterinary medicinal products (VMPs) were received (106 in the year 2008). The distribution according to species and drug classes remained in line with previous years. Companion animals were involved in most of the reports (46 % dogs, 19 % cats), followed by cattle or calves (22 %). Antiparasitic drugs made the biggest part with 30 % of the reports, followed by antiinfectives (19 %) and hormones (13 %). Some reactions following their use are specifically discussed. 95 additional enquiries about ADRs of VMPs were received by the Swiss Toxicological Information Centre in Zürich. Most of them concerned dogs or cats and antiparasitics or anti-inflammatory drugs. In the vaccinovigilance program, a total of 1020 reports were received, of which 1000 were related to the vaccination against blue tongue disease. The most frequently reported adverse reactions were aborts, mastitis or alterations of milk quality and they are specifically discussed.

[Vigilance for veterinary medicinal products: declarations of adverse reactions in the year 2008]. / Vigilance der Tierarzneimittel: Gemeldete unerwünschte Wirkungen im Jahr 2008.

With 106 reports of suspected adverse reactions to veterinary medicinal products (VMPs) there was a slight decrease in the year 2008 compared to 2007. However, the distribution according to species and drug classes remained grossly the same: dogs were involved in 45 % of the cases followed in frequency by cats (26 %) and cows or calves (21 %). Most often the reports described reactions following the use of either an antiparasitic drug (46 %) or an antibiotic (22 %). One particular case of off-label use and serious skin reactions are presented. For the vaccinovigilance a total of 310 reports were received, with 250 of them related to adverse events following vaccination against blue tongue disease. In most cases, aborts and elevated cell count in the milk were reported. A detailed evaluation of these cases is presented. Finally, 305 enquiries were received by the Swiss Toxicological Information Center in Zürich (concerning mostly dogs or cats). Most of the cases concerned either preparations for the nervous system or anti-inflammatory drugs (human medicinal products) or antiparasitics (VMPs).

[Vigilance for veterinary medicinal products: declarations of suspected adverse reactions in the year 2007]. / Vigilance der Tierarzneimittel: Gemeldete unerwünschte Wirkungen im Jahr 2007.

163 reports of suspected adverse reactions were received in the year 2007: 111 for veterinary medicinal (VMPs) and 52 for immunologic products. Half of the reported reactions for VMPs concerned either an antiparasitic drug (26%) or an antibiotic (24%). Reconversions (use in another target species or for another indication as registered) made the third most frequently mentioned group with 11 reports. For immunologicals, half of the declarations were related to an adverse reaction in dogs, the most frequently reported reaction in companion animals being allergies. Moreover, 272 enquiries were received by the Swiss Toxicological Information Center in Zürich. Most of these were related to dogs (73%) and the number of enquiries regarding VMPs correlated positively with the most frequently used therapeutic classes like antiparasitics (47%) and anti-inflammatory drugs (23%). The complexity of proscessing reports regarding the detection of residues in milk after prescribed withdrawal times is discussed in detail. In conclusion, the year 2007 is seen as a consolidation of the established system with a tendency towards increase in the number of complex cases.

[Reported adverse reactions due to veterinary drugs in 2006]. / Gemeldete unerwünschte Wirkungen von Tierarzneimitteln im Jahr 2006.

We received 190 reports of suspected adverse events (SARs) following the use of veterinary drugs for the year 2006: 118 declarations for veterinary drugs and 72 declarations following the application of immunolgical medicinal products. Most of the 118 declarations relate to the use of antiparasitic drugs (48%) and every second declaration to drug use in dogs. Other drug classes concerned were, in decreasing order, antiinfectives (20%) and drugs used off-label (12%; other target species or other indication). For the vaccines, most of the reactions occurred in dogs (62%) followed by horses (11%) and cattle (10%). The most frequently reported reactions concerned the use of a vaccine against piroplasmosis. Another 349 requests for information were processed by the Swiss Toxicological Information center. We also present a case of a serious adverse reaction in form of a Stevens-Johnson syndrome in a cat as well as a case of ketamine abuse. We note the growing interest of practicing veterinarians with pleasure and are currently working on further adaptations to the system.

Systematic account of animal poisonings in Germany, 2012-2015.

A systematic retrospective study on animal poisonings in Germany (wildlife excluded) between January 2012 and December 2015 was conducted. Data were collected on animal exposure calls to German poison centres, poisoning cases presenting to the University of Veterinary Medicine, Hannover Small Animal and Equine Clinics, cases involving off-label use of veterinary medicinal products reported to the Federal Office of Consumer Protection and Food Safety and toxicological submissions to the Institute of Pharmacology, Toxicology, and Pharmacy, Faculty of Veterinary Medicine, Ludwig-Maximilians-University, Munich. Descriptive statistics were used to characterise animal type, exposure reason, type and substance, year/month of exposure, case severity and outcome. An evaluation of the data and data sources was also carried out. Variation in poisoning patterns was seen. However, dogs and cats were the most frequently reported species and medicinal products, pesticides and plants were consistently implicated as top causes of poisoning. Advantages and disadvantages were associated with each data source; bias was found to be an important consideration when evaluating poisoning data. This study provided useful information on animal poisonings in Germany and highlights the need for standardised approaches for the collection, evaluation and integration of poisoning data from multiple sources.

[Isolated tuberculosis of the liver coincident with renal cell carcinoma]. / Isolierte Tuberkulose der Leber in Koinzidenz mit einem Nierenzellkarzinom.

The macronodular form of hepatic tuberculosis is a very rare disease characterized by tumor-like tuberculomas or abscesses. Correct diagnosis is hampered by ambiguous clinical and radiological findings. We present a case of solitary tuberculosis of the liver without evidence of extrahepatic tuberculous manifestations. The lesions mimicked metastatic disease of a coincidentally found kidney tumor. Diagnosis could only be made by histologic examination of repeated percutaneous liver biopsies. Antituberculous treatment lead to a complete retrogression of hepatic changes while the kidney tumor (histologically a renal cell carcinoma) was removed surgically. As a liver biopsy provides the only means of diagnosing local nodular tuberculosis, which is treatable, we conclude that it should be performed on every unclear tumorous lesion of the liver.

[A mucocele of the appendix--a case report]. / Mukozele der Appendix--ein Fallbericht.

Mucoceles are rare lesions in the region of the appendix and occur in only 0.4% of all tumours of the appendix. Although their radiological-morphological pattern varies, a correct preoperative diagnosis is nevertheless possible in most cases via imaging methods and taking the pattern of clinical findings into consideration.

Routine extracorporeal circulation with a centrifugal or roller pump.

In a randomized, prospective clinical trial, 50 patients undergoing elective coronary artery bypass grafting (CABG) were divided into two groups of 25 each. Group I had a centrifugal pump (CP, Biomedicus) and Group II a roller pump (RP, Stöckert) as the arterial line. Neither group differed significantly, and variables during surgery were kept to a minimum. The parameters studied included the cellular blood elements and their components, such as PMN-elastase (PMN-E), plasma hemoglobin (pHb), beta-thromboglobulin (beta-TG), and D-dimer (D-D) and thrombin-antithrombin III complex (TAT) as indicators for activated coagulation. Blood and urine samples were taken at induction of anesthesia, every 15 minutes throughout extracorporeal circulation (ECC), at arrival in the ICU, and 1, 3, 6, 12, and 24 hours thereafter. No difference between the groups was found in bypass time, ECC flow or volume, or fluid balance. Significant differences in favor of Group I were found in pHb (p less than 0.05), beta-TG (p less than 0.01), D-D (p less than 0.05), and platelet counts (p less than 0.05). These differences were clearly ECC time dependent, became significant after 90 minutes of bypass, but disappeared within hours after surgery. No difference in patient outcome, ICU time, or need for volume substitution was seen. It is concluded that the RP can be safely used for routine ECC, but should be supplied with a CP in complex and prolonged cardiosurgical procedures to avoid severe postperfusion syndrome.

[Extracorporeal circulatory assistance with centrifugal pumps in postcardiotomy low-output syndrome]. / Extrakorporale Kreislaufassistenz mit Zentrifugalpumpen beim Postkardiotomie-low-output-Syndrom.

From 6/86 to 5/89 seven out of 1700 (0.4%) open heart patients had to be assisted with centrifugal pumps for postcardiotomy low cardiac output syndrome. In 4 cases a left ventricular assist device (LVAD) was used, one case each had a right ventricular assist device (RVAD), an extracorporeal membrane oxygenation (ECMO) and a biventricular assist device (BVAD) with ECMO and ultrafiltration. The last 3 patients were assisted non-pulsatile without intraaortic balloon counterpulsation (IABP) and no impairment of vital organ function was observed. Four out of 7 patients could be weaned from the assist device after a mean of 30 hours (0.5-48). Three patients became long-term survivors with 2 assisted non-pulsatile. Transesophageal echocardiography (TEE) was used to determine the timing for wean off and was found to be an important adjunct to the monitoring of filling--and systemic pressure.