[Different Prevalences of Pneumological Disease Patterns in Outpatient and Inpatient Care]. / Unterschiedliche Häufigkeiten pneumologischer Krankheitsbilder in der ambulanten und stationären Medizin.

BACKGROUND: Evaluating the focus of treatment in pneumological inpatient and outpatient care is of special interest due to its impact on physician, patient and research. This work describes differences and commonalities in the focus of treatment of current pneumological inpatient and outpatient care and discusses their impact on patient, physician and research. METHODS: This study compares the inpatient and outpatient sector based on the prevalence of ICD codes of a pneumological specialist clinic (5.211 cases of 2016) and the most prevalent ICD-10 codes of pneumology practices in the third quarter 2016, published by the Association of Statutory Health Insurance Physicians North Rhine ("Kassenärztliche Vereinigung Nordrhein", 142.431 cases). RESULTS: Whereas the proportion of many pneumological disease patterns treated in physicians' practices and hospitals is similar, the relative frequencies of specific diseases differ considerably between the two. Treatment of allergic conditions such as allergic rhinopathy and bronchial asthma is mostly done on an outpatient basis while respiratory insufficiency and lung carcinoma constitute domains of pneumological inpatient care. CONCLUSION: Despite many commonalities in the focus of treatment in pneumological inpatient and outpatient care, there are also substantial differences between the two. These affect medical training, the conduct of clinical studies, and in particular, patient care. In order to maintain a high level of medical care in all areas of pneumology a close exchange between inpatient and outpatient sector seems crucial. In the end, the availability of medical expertise across both sectors will benefit all: physicians, patients and medical science.

The roadmap for the Allergology specialty and allergy care in Europe and adjacent countries. An EAACI position paper.

The high prevalence of allergic diseases warrants for sufficient health care provisions available to patients with allergic diseases. Allergy care should be delivered by well-trained specialists. However, the current status of allergy care is not well documented. For this reason a survey among European and a few non-European countries was launched by the National Allergy Society Committee from the European Academy of Allergy and Clinical Immunology and the Union Européenne des Médecins Spécialistes section and board of Allergology. The survey shows that in the vast majority of countries allergy care services are available. However, a substantial heterogeneity is reported regarding recognition of the full specialty, the number of practicing specialists or subspecialists, and training aspects. Growth but also decline of specialty and subspecialties is reported. In addition, the survey gives insight in strengths, weaknesses, opportunities and threats in this field. It appears that the recognition of the full specialty determines strength as well as weakness. Aging of specialists combined with a decline in the number of trainees form a major threat. Opportunities are seen in creating awareness for allergy, focus on attracting young physicians. The conclusion is that harmonization of allergy services across Europe is needed. Investment in young doctors, creating new opportunities and lobbying for the full specialty is required.

How to diagnose mould allergy? Comparison of skin prick tests with specific IgE results.

BACKGROUND: Diagnosis of mould allergy is complicated due to the heterogeneity of the test material and the decrease in the number of commercial mould skin test solutions that are currently available. OBJECTIVES: The aim of this study was to compare skin prick tests (SPT) from different manufacturers to one another and concurrently with sIgE tests for Aspergillus fumigatus (Asp f), Cladosporium herbarum (Cla h), Penicillium chrysogenum (Pen ch), Alternaria alternata (Alt a) and Aspergillus versicolor (Asp v) to ascertain a feasible diagnostic procedure for mould sensitization. METHODS: In this multi-centre study, 168 patients with mould exposure and/or mould-induced respiratory symptoms were included. Mould SPT solutions were analysed biochemically and tested in duplicate on patients' arms. Specific IgE (sIgE) concentrations to corresponding mould species and mould mix (mx1) were measured by ImmunoCAP. SPTs in accordance with one another and with sIgE were further considered. The test efficiency was calculated using receiver-operating characteristic (ROC) analysis. RESULTS: Mould sensitization was more frequently detected by the SPT (90 of 168) than by the sIgE tests (56 of 168). Concordances of double SPT positives were only sufficient (≥ 80%) for environmental allergens, two Asp f and three Alt a SPT solutions, whereas all other mould solutions revealed concordances < 80%. The antigen content of SPT solutions was positively associated with concordant SPT double values as well as with sIgE. Taking sIgE as the 'positive standard', all mould SPT solutions revealed test efficiencies > 80%, but varied up to 20% in sensitivity and positive predictive value with the exception of Alt a. CONCLUSIONS: SPT solutions are sensitive and essential diagnostic tools for the detection of mould sensitization. Our recommendation for diagnosis would be to test at least Alt a, Asp f and Pen ch using SPT and additional sIgE test to mx1.

Hypersensitivity reactions to carboplatin. Report of two patients, review of the literature, and discussion of diagnostic procedures and management.

BACKGROUND: Hypersensitivity reactions are rare but sometimes life-threatening complications of cytostatic combinations containing platinum compounds. Only approximately 40 instances of such hypersensitivity have been reported in association with carboplatin treatment. However, the symptoms probably often are misinterpreted. METHOD: Signs and symptoms of two patients with severe hypersensitivity reactions to carboplatin are presented. Intracutaneous tests with carboplatin were performed in these two patients and in five control patients receiving carboplatin therapy without unexpected side effects. RESULTS: Both patients had received several cycles of a carboplatin-containing combination chemotherapy. In both patients, hypersensitivity reactions became manifest for the first time after cumulative doses of 3900 and 5400 mg, respectively. Symptoms included dyspnea, tachycardia, angina pectoris, hypotension, diarrhea, edema, and rash. In both patients, a positive urticarial reaction to intracutaneous carboplatin (diluted 1:10 with normal saline) was observed, whereas five control patients undergoing carboplatin therapy without adverse reaction had negative test results. There were no signs of delayed hypersensitivity. Serum immunoglobulin E levels were normal. Symptoms were ameliorated but not suppressed when one patient was reexposed after premedication with corticosteroids and histamine antagonists. Both patients tolerated high doses of cisplatin without allergic reactions. CONCLUSIONS: Although they are rare, hypersensitivity reactions can be serious complications of carboplatin therapy. Simple intracutaneous tests might help to establish the diagnosis to avoid dangerous reexposures. Although the pathogenetic mechanisms are not fully understood, the clinical and experimental findings suggest an anaphylactic type of hypersensitivity, perhaps aggravated to some extent by nonspecific histamine liberation. There seems to be no general cross-reactivity to cisplatin.

[Calcinosis cutis: cutaneous manifestations of generalized calcinosis in renal hyperparathyroidism]. / Calcinosis cutis: kutane Manifestationen generalisierter Kalzinose bei renalem Hyperparathyreoidismus.

In 2 female patients suffering from chronic renal insufficiency and secondary hyperparathyroidism total parathyroidectomy with autotransplantation was performed, but shortly afterwards tertiary hyperparathyroidism developed. Together with numerous generalized metastatic foci of severe smooth tissue calcification, extensive calcification of the skin occurred. Some of the hard painful areas with papules, nodules and large plaques of calcium deposits were inflamed and ulcerated, and the histological picture was that of severe disseminated calcification of the middle and deep reticular dermis, spreading over into the subcutaneous adipose tissue. Conventional X-ray examinations and computer tomography revealed large asymmetrical areas of bone-dense calcification of the soft tissue. After total excision of the autografts the severe calcifications of the skin diminished or disappeared completely.

[Value of diagnostic procedures in fiberoptic bronchoscopy of pulmonary infections]. / Stellenwert diagnostischer Verfahren bei der Fiberbronchoskopie pulmonaler Infektionen.

Fibreoptic bronchoscopy has become an important means of diagnosing infections of the lower respiratory tract, since it a method with few complications, whereas, on the other hand, the conventional non-invasive methods are hardly reliable in respect of diagnostic relevance. Frequent oropharyngeal contamination severely limits the significant assessment of the pathogenicity of cultured microorganisms. The protected specimen brush (PSB) or quantitative cultures of bronchoalveolar lavage (BAL) might be useful in solving this problem. These methods were studied in two prospective trials comprising 123 patients with suspected bronchopulmonary infection and 54 control patients. Both methods were found to be disappointing in respect of sensitivity; moreover, quantitative cultivation did not yield any differences with regard to specificity.