RESUMEN
A 58-year-old patient was admitted to the emergency department due to severe respiratory insufficiency. Anamnesis revealed that the patient had experienced increasing stress dyspnea for a few months. Upon imaging, an acute pulmonary embolism was excluded, but peribronchial and hilar soft tissue proliferation with compression of central parts of the pulmonary circulation was found. The patient had a history of silicosis. The histology report showed tumor-free lymph node particles with prominent anthracotic pigment and dust depositions without evidence of IgG4-associated disease. The patient was administered steroid therapy and underwent simultaneous stenting of the left interlobular pulmonary artery and the upper right pulmonary vein. As a result, a significant improvement in symptoms and physical performance was achieved. The diagnosis of inflammatory or, in particular, fibrosing mediastinal processes can be challenging and important clinical symptoms must be taken into account, especially if the pulmonary vasculature is involved. In such cases, the possibility of interventional procedures should be examined in addition to drug therapy options.
RESUMEN
Kongenitale Pulmonalarterienstenosen sind eine seltene Ursache der pulmonalen Hypertonie (PH). Die Erkrankung wird in ihrer Häufigkeit vermutlich unterschätzt, und sie sollte in der Abklärung einer PH bedacht werden.Die Vorstellung einer 43-jährigen Patientin erfolgte zur Therapieoptimierung und Evaluation einer möglichen Lungentransplantation mit der Arbeitsdiagnose kongenitale Pulmonalarterienstenosen.Die Patientin beklagte eine seit der frühen Kindheit bestehende Belastungsdyspnoe aktuell entsprechend WHO-FC-Klasse II-III.Die Krankengeschichte zeigte die Erstdiagnose einer primären pulmonalarteriellen Hypertonie (IPAH) vor 17 Jahren. Es erfolgte eine PH-spezifische Medikation in wechselnden Kombinationen. Im Rahmen eines Zentrumswechsels erfolgte eine Reevaluation, und bei Nachweis eines typischen Mismatch mit normaler Ventilation, jedoch keilförmig gestörter Perfusion in der Lungenszintigrafie wurde eine chronisch thromboembolische pulmonale Hypertonie (CTEPH) vermutet. Die Pulmonalis-Angiografie zeigte ausschließlich subsegmental gelegene Stenosierungen sowie Gefäßabbrüche mit korrespondierenden Minderperfusionen, passend zu einer CTEPH. Im Rahmen der ersten Intervention erfolgte aufgrund der ungewöhnlichen Morphologie der pulmonalarteriellen Läsionen eine Erweiterung der Diagnostik mittels optischer Kohärenztomografie (OCT). Bei der Patientin fand sich kein endoluminales Material, jedoch eine kräftige Gefäßwand. Damit wurde die Diagnose einer pumonalen Hypertonie bei kongenitalen Pulmonalarterienstenosen mit In-situ-Thrombosierung gestellt.
Asunto(s)
Hipertensión Pulmonar , Estenosis de Arteria Pulmonar , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/etiologíaRESUMEN
OBJECTIVES: The aim of this study was to assess native T1 mapping in patients with inoperable chronic thromboembolic pulmonary hypertension (CTEPH) before and 6 months after balloon pulmonary angioplasty (BPA) and compare the results with right heart function and pulmonary haemodynamics. METHODS: Magnetic resonance imaging at 1.5 T and right heart catheterisation were performed in 21 consecutive inoperable CTEPH patients before and 6 months after BPA. T1 values were measured within the septal myocardium, the upper and lower right ventricular insertion points, and the lateral wall at the basal short-axis section. In addition, the area-adjusted septal native T1 time (AA-T1) was calculated and compared with right ventricular function (RVEF), mean pulmonary arterial pressure (mPAP) and pulmonary vascular resistance (PVR). RESULTS: The mean AA-T1 value decreased significantly after BPA (1,045.8 ± 44.3 ms to 1,012.5 ± 50.4 ms; p < 0.001). Before BPA, native T1 values showed a moderate negative correlation with RVEF (r = -0.61; p = 0.0036) and moderate positive correlations with mPAP (r = 0.59; p < 0.01) and PVR (r = 0.53; p < 0.05); after BPA correlation trends were present (r = -0.21, r = 0.30 and r = 0.35, respectively). CONCLUSIONS: Native T1 values in patients with inoperable CTEPH were significantly lower after BPA and showed significant correlations with RVEF and pulmonary haemodynamics before BPA. Native T1 mapping seems to be indicative of reverse myocardial tissue remodelling after BPA and might therefore have good potential for pre-procedural patient selection, non-invasive therapy monitoring and establishing a prognosis. KEY POINTS: ⢠BPA is a promising treatment option for patients with inoperable CTEPH ⢠Native septal T1 values significantly decrease after BPA and show good correlations with right ventricular function and haemodynamics before BPA ⢠Prognosis and non-invasive therapy monitoring might be supported in the future by native T1 mapping.
Asunto(s)
Angioplastia de Balón , Hemodinámica , Hipertensión Pulmonar/diagnóstico por imagen , Hipertensión Pulmonar/terapia , Imagen por Resonancia Magnética , Función Ventricular Derecha , Anciano , Cateterismo Cardíaco , Enfermedad Crónica , Femenino , Corazón/diagnóstico por imagen , Corazón/fisiopatología , Ventrículos Cardíacos/diagnóstico por imagen , Ventrículos Cardíacos/fisiopatología , Humanos , Hipertensión Pulmonar/complicaciones , Hipertensión Pulmonar/fisiopatología , Masculino , Persona de Mediana Edad , Embolia Pulmonar/complicaciones , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/fisiopatologíaRESUMEN
Isoflavones are secondary plant constituents of certain foods and feeds such as soy, linseeds, and red clover. Furthermore, isoflavone-containing preparations are marketed as food supplements and so-called dietary food for special medical purposes to alleviate health complaints of peri- and postmenopausal women. Based on the bioactivity of isoflavones, especially their hormonal properties, there is an ongoing discussion regarding their potential adverse effects on human health. This review evaluates and summarises the evidence from interventional and observational studies addressing potential unintended effects of isoflavones on the female breast in healthy women as well as in breast cancer patients and on the thyroid hormone system. In addition, evidence from animal and in vitro studies considered relevant in this context was taken into account along with their strengths and limitations. Key factors influencing the biological effects of isoflavones, e.g., bioavailability, plasma and tissue concentrations, metabolism, temporality (pre- vs. postmenopausal women), and duration of isoflavone exposure, were also addressed. Final conclusions on the safety of isoflavones are guided by the aim of precautionary consumer protection.
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Mama/efectos de los fármacos , Isoflavonas/efectos adversos , Isoflavonas/farmacología , Hormonas Tiroideas/metabolismo , Animales , Mama/metabolismo , Densidad de la Mama/efectos de los fármacos , Neoplasias de la Mama/inducido químicamente , Neoplasias de la Mama/epidemiología , Neoplasias de la Mama/prevención & control , Ensayos Clínicos como Asunto , Suplementos Dietéticos , Femenino , Humanos , Isoflavonas/farmacocinética , Glycine max/química , Distribución TisularRESUMEN
The 2015 European Guidelines on Pulmonary Hypertension did not cover only pulmonary arterial hypertension (PAH), but also other significant subgroups of pulmonary hypertension (PH). In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany to discuss open and controversial issues surrounding the practical implementation of the European Guidelines. Several working groups were initiated, one of which was dedicated to the diagnosis and treatment of chronic thromboembolic pulmonary hypertension (CTEPH). In every patient with PH of unknown cause CTEPH should be excluded. The primary treatment option is surgical pulmonary endarterectomy (PEA) in a specialized multidisciplinary CTEPH center. Inoperable patients or patients with persistent or recurrent CTEPH after PEA are candidates for targeted drug therapy. For balloon pulmonary angioplasty (BPA), there is currently only limited experience. This option - as PEA - is reserved to specialized centers with expertise for this treatment method. In addition, a brief overview is given on pulmonary artery sarcoma, since its surgical treatment is often analogous to PEA. The recommendations of this working group are summarized in the present paper.
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Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/terapia , Guías de Práctica Clínica como Asunto , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Neumología/normas , Antihipertensivos/administración & dosificación , Cardiología/normas , Quimioterapia Combinada/normas , Fibrinolíticos/administración & dosificación , Humanos , Hipertensión Pulmonar/etiología , Terapia Molecular Dirigida/normas , Embolia Pulmonar/complicacionesRESUMEN
Acute or chronic right ventricular failure is an often misdiagnosed cause of cardiopulmonary insufficiency. In addition to clinical symptoms or laboratory testing, echocardiography and invasive hemodynamic measurement by means of right-heart catheterization are essential for diagnosis and treatment control. In case of acute right ventricular failure, adequate symptomatic treatment of the life-threatening situation is important. Main issues are maintenance of coronary artery perfusion pressure and myocardial oxygen delivery as well as reduction of right ventricular afterload. In persistent right ventricular failure extracorporeal or intracorporeal assist devices are increasingly used as bridging or destination therapy. On a long-term basis, the targeted therapy of the underlying disease is crucial.
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Cuidados Críticos , Disfunción Ventricular Derecha/terapia , Enfermedad Aguda , Cateterismo Cardíaco , Enfermedad Crónica , Diagnóstico Diferencial , Ecocardiografía , Oxigenación por Membrana Extracorpórea , Corazón Auxiliar , Hemodinámica/fisiología , Imagen por Resonancia Magnética , Disfunción Ventricular Derecha/etiología , Disfunción Ventricular Derecha/fisiopatologíaAsunto(s)
Arteria Pulmonar , Embolia Pulmonar/diagnóstico , Sarcoma/diagnóstico , Neoplasias Vasculares/diagnóstico , Biopsia , Errores Diagnósticos , Endarterectomía , Humanos , Imagen por Resonancia Cinemagnética , Masculino , Persona de Mediana Edad , Tomografía de Emisión de Positrones , Valor Predictivo de las Pruebas , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/patología , Arteria Pulmonar/cirugía , Sarcoma/diagnóstico por imagen , Sarcoma/patología , Sarcoma/cirugía , Resultado del Tratamiento , Neoplasias Vasculares/diagnóstico por imagen , Neoplasias Vasculares/patología , Neoplasias Vasculares/cirugíaRESUMEN
Reduction in the scintillation index of multi-Gaussian Schell-model beams propagating in turbulent air is demonstrated as a function of two source parameters: the r.m.s. coherence width and the summation index. The beams were generated with the help of a nematic phase-only, reflective spatial light modulator at a cycling rate of 333 frames per second and recorded after propagating through a weakly turbulent air channel over a distance of 70 m. Experimental results are in good agreement with theory.
Asunto(s)
Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Angioplastia de Balón , Anticoagulantes/administración & dosificación , Enfermedad Crónica , Endarterectomía , Estudios de Seguimiento , Humanos , Hipertensión Pulmonar/mortalidad , Cuidados a Largo Plazo , Embolia Pulmonar/mortalidad , Tasa de SupervivenciaRESUMEN
This position paper summarises current developments in chronic thromboembolic pulmonary hypertension (CTEPH) including diagnostic approaches and treatment options. Based on the guidelines of the task force of CTEPH experts at the 5th World Symposium on Pulmonary Hypertension in Nice 2013. Open questions arising during the treatment of patients with CTEPH are addressed. Patients with suspected CTEPH should undergo echocardiography and cardiopulmonary exercise testing. A ventilation/perfusion scan is the recommended imaging test for screening in the diagnostic algorithm for the evaluation of CTEPH. CTEPH-patients should be discussed in an expert center with an interdisciplinary team and an experienced PEA surgeon to decide the further treatment. Pulmonary endarterectomy (PEA) is the treatment of choice for patients with CTEPH. Medical therapy with PH-targeted medications for inoperable CTEPH and residual disease after PEA should only be initiated if evaluation reveals that the patient is no candidate for a PEA. Current data suggest that CTEPH patients treated with PEA have a better long-term survival rate and quality of life than patients treated with medical therapy.
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Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Algoritmos , Enfermedad Crónica , Terapia Combinada , Conducta Cooperativa , Ecocardiografía , Endarterectomía , Prueba de Esfuerzo , Humanos , Hipertensión Pulmonar/mortalidad , Hipertensión Pulmonar/fisiopatología , Comunicación Interdisciplinaria , Tamizaje Masivo , Terapia Molecular Dirigida , Guías de Práctica Clínica como Asunto , Pronóstico , Arteria Pulmonar , Embolia Pulmonar/mortalidad , Embolia Pulmonar/fisiopatología , Tasa de Supervivencia , Centros de Atención Terciaria , Relación Ventilacion-Perfusión/fisiologíaRESUMEN
PURPOSE: The benefit of ultrasound in comparison with full-body MRI during a medical checkup in preventive health care was examined with regard to the detection of cardiovascular risk factors, metabolic syndrome, malignant tumors and further relevant findings. MATERIALS AND METHODS: 833 consecutive patients (266 f/567âm, age: 19â-â93ây, mean age: 56.6ây) underwent both ultrasound (extracranial carotid arteries, thyroid, abdominal ultrasound and echocardiography) and whole-body MRI (whole-body MR angiography, head, thorax, abdomen and virtual colonoscopy). For ultrasound examinations, DEGUM level III devices were used (Siemens Acuson Antares, Siemens G60, Siemens, Erlangen). MRI examinations were performed using a 1.5 Tesla MRI device (Siemens Avanto, Siemens, Erlangen). All patients were reviewed retrospectively based on the written reports. RESULTS: Ultrasound was much more sensitive in detecting early atherosclerotic changes than MRI angiography. In 33â% of the patients, manifestations of atherosclerosis were found. Thoracic (3) and abdominal aortic and mesenteric artery aneurysms (3) were diagnosed by both methods. Hepatic steatosis as an important risk factor of metabolic syndrome was only found by ultrasound in 20.4â% of our patients. Malignant tumors were rare in this population (1.4â%): all abdominal tumors except one renal oncocytoma were found using both methods. MRI and ultrasound were equally sensitive with respect to the detection of small liver foci. As expected, MRI was less sensitive than ultrasound in the diagnosis of thyroid nodes. For intracranial diagnoses, malignant intrathoracic findings and colonic polyps, ultrasound is not the method of choice. CONCLUSION: For the detection of lifestyle-dependent diseases such as atherosclerosis and metabolic syndrome, ultrasound examination was more sensitive than MRI, and the same was true for the early detection of thyroid diseases. For the detection of malignant abdominal tumors, both methods were equally sensitive. Whole-body MRI can additionally detect pathological changes in the head, lungs and colon.
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Enfermedades Cardiovasculares/diagnóstico , Interpretación de Imagen Asistida por Computador/métodos , Imagen por Resonancia Magnética/métodos , Tamizaje Masivo , Síndrome Metabólico/diagnóstico , Neoplasias/diagnóstico , Ultrasonografía/métodos , Imagen de Cuerpo Entero/métodos , Neoplasias Abdominales/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Ecocardiografía/métodos , Hígado Graso/diagnóstico , Femenino , Humanos , Angiografía por Resonancia Magnética/métodos , Masculino , Persona de Mediana Edad , Sensibilidad y Especificidad , Ultrasonografía Doppler Dúplex/métodos , Adulto JovenRESUMEN
In the 2009 European Guidelines on pulmonary hypertension one section covers aspects of pathophysiology, diagnosis and treatment of chronic thromboembolic pulmonary hypertension (CTEPH). The practical implementation of the guidelines for this disease is of crucial importance, because CTEPH is a form of pulmonary hypertension which can be surgically cured. It is, however, frequently diagnosed late in the course of disease and often treated not correctly. In the European Guidelines CTEPH is addressed relatively briefly, although it is a common form of PH which is often overlooked. Any patient with unexplained PH should be evaluated for the presence of CTEPH. A ventilation/perfusion lung scan is recommended as the first step to exclude CTEPH. If the ventilation/perfusion lung scan or multislice CT angiography reveals perfusions defects suggesting the diagnosis of CTEPH, the patient should be referred to a centre with expertise in the medical and surgical management of these patients. After diagnosis of CTEPH the case has to be reviewed by an experienced surgeon in a PEA centre for assessment of operability. The recommendations of the European guidelines are summarized in the current manuscript with additional comments regarding diagnosis and treatment according to most recent evidence.
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Hipertensión Pulmonar/fisiopatología , Embolia Pulmonar/fisiopatología , Angiografía , Enfermedad Crónica , Diagnóstico Tardío , Alemania , Hemodinámica/fisiología , Humanos , Hipertensión Pulmonar/diagnóstico , Hipertensión Pulmonar/cirugía , Pronóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/cirugía , Tomografía Computarizada Espiral , Relación Ventilacion-Perfusión/fisiologíaRESUMEN
The Senate Commission on Food Safety (SKLM, Senatskommission zur gesundheitlichen Bewertung von Lebensmitteln) of the German Research Foundation (DFG, Deutschen Forschungsgemeinschaft) is a transdisciplinary expert committee, providing advice on food safety to the government, parliament, and authorities. Consultation is based on a scientific assessment with the aim to give expert advice to authorities, so that they can make appropriate decisions. The SKLM is independent in its scientific deliberations and under no directive in the selection of issues to work on. Topics considered may result from requests of the Federal Ministry of Food, Agriculture, and Consumer Protection (BMELV, Bundesministeriums für Ernährung, Landwirtschaft und Verbraucherschutz). Other issues may be raised by the SKLM, if they are regarded to be of particular importance for consumer health protection. Issues encompass the scientific assessment of safety and nutritional benefit of food ingredients and additives, of novel and functional food, as well as of novel food technologies. The SKLM identifies gaps in knowledge, research needs, and need for action.
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Defensa del Consumidor , Información de Salud al Consumidor/tendencias , Seguridad de Productos para el Consumidor , Inspección de Alimentos/tendencias , Agencias Gubernamentales/organización & administración , Política Pública/tendencias , Administración de la Seguridad/tendencias , Alemania , Política de Salud/tendencias , Salud Pública/tendenciasRESUMEN
Phototoxic and photo-genotoxic furocoumarins occur, e.g., in citrus species, parsnip, parsley, celery, and figs. They exhibit phototoxic and photo-genotoxic properties in combination with UV radiation, while less is known about the phototoxicity of the coumarin derivative limettin mainly found in limes and lemons. Risk assessment of dietary furocoumarins is based on a threshold approach and on estimates of 1.2-1.45 mg for the average daily exposure for adults via the diet in several countries. In these estimates, the major contribution to overall daily exposure has been attributed to citrus-flavored non-alcoholic beverages, in spite of a lack of analytical data for those products. Therefore, we analyzed a number of furocoumarins in a variety of citrus-containing beverages and included limettin in the pattern of analyzed constituents. Our findings provide strong evidence that grapefruit juice and not citrus-flavored non-alcoholic beverages is the major source of furocoumarin exposure in a Western diet. Based on these findings it can be assumed that the average dietary exposure to furocoumarins is about 3-fold lower than previously estimated, i.e. in the range of 548 and 2237 microg/day for the average and high consumer, respectively. The coumarin derivative limettin was mainly found in lime products.
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Bebidas/análisis , Citrus/química , Cumarinas/análisis , Furocumarinas/análisis , Cromatografía Líquida de Alta Presión , Citrus aurantiifolia/química , Citrus paradisi/química , Dieta , Extractos Vegetales/química , Aceites de Plantas/análisisRESUMEN
BACKGROUND: The prevalence of thyroid nodules in a healthy population is high: in the German Papillon study, nationwide ultrasound screening of more than 90 000 people using 7.5 MHz scanners revealed the presence of thyroid nodules in 33% of the normal population. A study employing more sensitive 13 MHz scanners has not been conducted so far. MATERIALS AND METHODS: Six hundred and thirty-five consecutive patients (33% female, 67% male, mean 56.7 years) presenting for a preventive health check up underwent ultrasound screening of the thyroid gland (Siemens Acuson Antares, 13 MHz-linear scanner, B-mode and Power mode) and measurement of the basal TSH (thyroid stimulating hormone) value. Size and degree of vascularization of the thyroid gland and of nodules were determined and analysed retrospectively. RESULTS: In 432 of 635 patients, thyroid nodules could be detected with an increasing incidence with age, in 338 without goiter. Mean thyroid size was 12.3 mL for women and 20.5 mL for men correlating strongly with body weight. Fifty-three percentage of the nodules were smaller than 5 mm. Incidence of thyroid dysfunction was only 4%. No cancerous lesions could be found. CONCLUSIONS: Using the 13 MHz technology, we found a substantially higher prevalence of thyroid nodules (68%) than the Papillon study (33%). Even if our population is older than in Papillon, the difference remains in comparable age groups. This is due to the higher sensitivity of 13 MHz scanning. Our study underlines the clinical significance of iodine deficiency and should renew the discussion on routine iodine supplementation.
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Yodo/deficiencia , Glándula Tiroides/diagnóstico por imagen , Nódulo Tiroideo/diagnóstico por imagen , Tirotropina/deficiencia , Adulto , Distribución por Edad , Anciano , Anciano de 80 o más Años , Femenino , Alemania/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Nódulo Tiroideo/epidemiología , UltrasonografíaRESUMEN
Transcription factors of the Sox family arose around the advent of multicellularity in animals, arguing that their ability to regulate the expression of extracellular matrix, cell adhesion and signaling molecules may have been instrumental in the generation of metazoans. In particular, during vertebrate evolution, the Sox family experienced a phase of expansion that led to the appearance of groups of highly homologous Sox proteins and the division of existing Sox protein functions among group members. It furthermore allowed Sox transcription factors to acquire numerous novel functions. These past events of subfunctionalization and neofunctionalization can still be recognized today in all groups of the Sox family. They have led to partial functional redundancies, but also to interesting species-specific variations in the developmental roles of Sox proteins as shown here for the SoxB and the SoxE groups.
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Factores de Transcripción/metabolismo , Animales , Huesos/embriología , Huesos/fisiología , Sistema Nervioso Central/embriología , Sistema Nervioso Central/crecimiento & desarrollo , Sistema Nervioso Central/fisiología , Desarrollo Embrionario/fisiología , Gónadas/embriología , Gónadas/crecimiento & desarrollo , Gónadas/fisiología , Humanos , Familia de Multigenes , Filogenia , Factores de Transcripción/clasificación , Factores de Transcripción/genéticaRESUMEN
A 45 year old male patient was referred to hospital after syncope during defaecation. Rapid peranal blood loss occurred shortly after admission. Gastroscopy and coloscopy performed as first line diagnostic measures failed to detect the source of haemorrhage. Ultrasound (US) revealed a hypoechoic and hypervascularized tumor mass in the right lower abdomen. A gastrointestinal stromal tumor (GIST) of the jejunum was diagnosed after laparatomy. Collectively US should be among the first line diagnostic procedures in younger patients presenting with lower gastrointestinal haemorrhage.
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Hemorragia Gastrointestinal/etiología , Tumores del Estroma Gastrointestinal/diagnóstico , Neoplasias del Yeyuno/diagnóstico , Hemorragia Gastrointestinal/diagnóstico , Hemorragia Gastrointestinal/cirugía , Tumores del Estroma Gastrointestinal/complicaciones , Tumores del Estroma Gastrointestinal/cirugía , Humanos , Neoplasias del Yeyuno/complicaciones , Neoplasias del Yeyuno/cirugía , Laparotomía , Masculino , Persona de Mediana EdadRESUMEN
The Senate Commission on Food Safety (SKLM) of the German Research Foundation (DFG) advises authorities and the government on food safety. The risk assessment of foodstuffs, including novel and functional foods, covers the evaluation of food ingredients and additives as well as the evaluation of novel processing methods. In carrying out this task the Commission expresses its opinion primarily on those aspects which are concerned with the safety assessment. In addition, questions relating to the technological need and to nutritional or physiological benefits are also considered. The topics considered may originate from enquiries of the Ministry for Consumer Protection, Nutrition and Agriculture (BMVEL). Other topics may be selected by the Commission on its own initiative, if they are considered to be of particular importance for consumer protection. Within the context of this activity the SKLM also organises symposia and expert discussions, their outcome subsequently being published as resolutions, conclusions or opinions.