[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.

[Malignant fibrous histiocytoma of the lung]. / Malignes fibröses Histiozytom der Lunge.

The malignant fibrous histiocytoma of the lung is one of the rarely diagnosed soft tissue sarcomas. With the presented case-history we want to remind of this kind of lung-tumour in particular of the possibility of pre-operative diagnostic and the radiological differential diagnosis.

[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 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.

[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.

[Pearl oyster dust as the cause of exogenous allergic alveolitis]. / Perlmuttstaub als Ursache für eine exogen-allergische Alveolitis.

Many different inhalative substances may cause allergic alveolitis (hypersensitivity pneumonitis). We report on a worker who developed lung fibrosis due to the sensitization to pearl oyster shell dust. High concentrations of IgG antibodies to proteins (conchagens) of the shell which appear to represent the relevant antigens were found in the patient's serum.

[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.

[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.

[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.

[Experiences with long-term oxygen therapy in patients with obstructive and restrictive respiratory disorders]. / Erfahrungen mit der Sauerstoff-Langzeittherapie bei Patienten mit obstruktiver und restriktiver Ventilationsstörung.

Thirteen years' experience with long-term oxygen therapy at home for patients with chronic respiratory distress are reviewed. In the period since 1976 37 patients with chronic obstructive pulmonary disease and 48 patients with restrictive respiratory disorders were treated. During oxygen breathing both groups showed the same results in regard to behaviour of the oxygen partial pressure, the carbon dioxide partial pressure, the hematocrit and the heart rate. The mean survival-time amounted to 26 months. The long-term oxygen therapy is useful in the treatment of patients with respiratory insufficiency caused by chronic obstructive pulmonary disease and by restrictive respiratory disorders as well.

[Swine breeder's lung--a form of exogenous allergic alveolitis]. / Die Schweinezüchterlunge--eine Form der exogenen allergischen Alveolitis (EAA).

It is reported about two pig-breeders with the typical symptoms of an exogen allergic alveolitis after having worked in a pigsty. The diagnosis "Pig-Breeders'-Lung" was confirmed by the prove of precipitating antibodies against pig-epidermis components (scales) and pig-serum.

[Pulmonary alveolar microlithiasis (disease in 2 siblings--case report)]. / Microlithiasis alveolaris pulmonum (Erkrankung bei zwei Geschwistern--Kasuistik).

This article presents case reports on brother and sister suffering from microlithiasis alveolaris pulmonum. Diagnosis was established by means of the course of the disease, the relatively typical x-ray film and the findings on performing scintigraphy of the skeleton and also by computed tomography. Findings confirmed that the course of the disease is symptom-free for a long time; that it occurs in both sexes; and that it becomes manifest with considerable incidence in some families. Pulmonary alveolar microlithiasis is not a generalised metabolic disease, since it affects the lungs only. If the aetiology remains unclear, no causal treatment can be effected.

[Tumor-like courses in lung sarcoidosis (4 observations)]. / Tumorartige Verläufe der Lungensarkoidose (4 Beobachtungen).

Case reports on 4 women operated on for suspected tumour. The diagnosis of sarcoidosis was confirmed histologically. The difficulties associated with the differential diagnosis are discussed and, the need for morphological clarification is emphasized.

[Immunohistology of interstitial lung processes]. / Immunhistologie bei Lungengerüstprozessen.

Immunohistologic investigations were performed in 124 lung tissue test of diffuse pulmonary processes obtained by transthoracic needle biopsy. In 40.3% the unselected material showed a positive immunofluorescence. It appeared in all groups formed by light microscopy. In the exogenic allergic alveolitis with 36.8% it was falling short of the expectations. The investigations allow of the conclusion that the immunohistology in diffuse pulmonary processes shows clearly applicable results neither for the diagnostics nor for the therapy and also not for the prognosis.

[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.