[Transfusion-related acute lung injury (TRALI)]. / Transfusionsassoziierte akute Lungeninsuffizienz (TRALI).

Transfusion-related acute lung injury (TRALI) is primarily caused by transfusion of fresh frozen plasma or platelet concentrates and occurs by definition within 6 hours after transfusion with acute shortness of breath, hypoxemia and radiographically detectable bilateral infiltrates of the lung. Mostly leucocyte antibodies in the plasma of the blood donor (immunogenic TRALI) are responsible. Apart from antibodies, other substances such as biologically active lipids, mainly arising from the storage of platelet and red blood cell concentrates, can activate neutrophilic granulocytes and trigger a non-immunogenic TRALI. Pathophysiologically, granulocytes in the capillaries of the lung vessels release oxygen radicals and enzymes which damage the endothelial cells and cause pulmonary edema. Therapeutically, nasal oxygen administration may be sufficient. In severe cases, mechanical ventilation, invasive hemodynamic monitoring and fluid intake are required. Diuretics should be avoided. The administration of glucocorticoids is controversial. Antibody-related TRALI reactions occurred mainly after transfusion of fresh frozen plasma, which had been obtained from womenimmunized during pregnancy against leukocyte antigens. Therefore, in Germany, since 2009 only plasma from female donors without a history of prior or current pregnancy or negative testing for antibodies against HLA I, II or HNA has been used with the result that since then no TRALI-related death has been registered.

Docetaxel/gemcitabine or cisplatin/gemcitabine followed by docetaxel in the first-line treatment of patients with metastatic non-small cell lung cancer (NSCLC): results of a multicentre randomized phase II trial.

BACKGROUND: Most patients (pts) with metastatic non-small cell lung cancer (NSCLC) receive either single agents or chemotherapy doublets. Recent studies have demonstrated that triple-agent therapies may improve the response rate, but are associated with significant toxicity, and frequently do not prolong survival. A sequential triple-agent schedule may combine acceptable tolerability and good efficacy. We therefore conducted a multicentre, prospectively randomized study that evaluates a sequential three-drug schedule and a platinum-free doublet regimen. PATIENTS AND METHODS: The pts with union international contre le cancer (UICC) stage IV NSCLC were randomized to one of two schedules: in arm Doc-Gem, they received gemcitabine (900 mg/m(2), 30 min infusion) on days 1 and 8, and docetaxel (75 mg/m(2), 1 h infusion) on day 1, repeated every 3 weeks up to six cycles. In arm Cis-Gem-->Doc, gemcitabine (900 mg/m(2), days 1 and 8) and cisplatin (70 mg/m(2), 1 h infusion, day 1) were given for three cycles, followed by three cycles of docetaxel (100 mg/m(2), day 1, repeated every 3 weeks). RESULTS: One hundred and thirteen pts were randomized to arms Doc-Gem (55 pts) and Cis-Gem-->Doc (58 pts). With Doc-Gem, 20.4% of pts responded to the treatment whereas 31.0% responded in arm Cis-Gem-->Doc (overall response, intent-to-treat, difference not significant). The median time to progression was 3.6 months in arm Doc-Gem [95% confidence interval (CI) 1.4, 5.9] and 5.2 months in arm Cis-Gem-->Doc (95% CI 3.1, 7.3). The median survival was 8.7 months with treatment Doc-Gem (95% CI 5.7, 11.6) and 9.4 months with treatment Cis-Gem-->Doc (95% CI 7.8, 11.0). The 1-year survival rates were 34 and 35%, respectively. Mild to moderate leukopenia was frequently seen with both schedules. Other common adverse events (AE) were nausea/vomiting, thrombocytopenia, anaemia, diarrhoea, and infections. No significant differences in AEs were observed between the schedules except for nausea/vomiting, which occurred more frequently with Cis-Gem-->Doc. CONCLUSION: The sequential therapy comprising cisplatin, gemcitabine, and docetaxel demonstrated promising tumour control whereas the platinum-free combination (docetaxel/gemcitabine) was very well tolerated. However, the schedules resulted in comparable survival to recent large trials in pts with advanced NSCLC. The present results do not justify further phase III investigation.

[How are interstitial lung diseases diagnosed in Germany? Results of the scientific registry for the exploration of interstitial lung diseases ("Fibrosis registry") of the WATL]. / Wie werden interstitielle Lungenerkrankungen in Deutschland diagnostiziert? Ergebnisse des wissenschaftlichen Registers zur Erforschung von interstitiellen Lungenerkrankungen ("Fibroseregister") der WATL.

From 1995 to 1999 we evaluated questionnaires sent by pulmonologists and departments of pulmonology in order to register interstitial lung diseases. On the whole 1142 patients (579 males, 563 females, mean age 51.1 +/- 15.3 years, sarcoidosis, n = 511, extrinsic allergic alveolitis, n = 145, idiopathic pulmonary fibrosis, n = 308, bronchiolitis obliterans organizing pneumonia (BOOP), n = 93, others, n = 85) were recorded in the registry. With reference to the mean age sarcoidosis occurred most frequently in the fourth decade and idiopathic pulmonary fibrosis in the sixth decade. In all these diseases bronchoscopy with bronchoalveolar lavage and transbronchial biopsy was predominantly used for further diagnosis. It was striking that high-resolution computed tomography of the thorax was still rarely used when diagnosing these diseases. Apart from the group with BOOP the number of non-smokers in men and women was decisively higher than the average of the population of Germany.

[Unusual gram positive rods, causing pneumonia]. / Ungewöhnliche grampositive Stäbchenbakterien als Auslöser von Pneumonien.

In the last decade, a growing number of patients with pneumonia, caused by unusual gram positive rods have been observed. Mostly, the patients had been infected as a consequence of impaired immunity. In some cases, bioterrorist activities may also induce pneumonia by gram positive rods (B. anthracis). In order to bring these organisms to the attention of the medical community, we present three clinical cases and describe six species of gram positive rods, known to provoke this kind of pneumonias. Case 1 was a 84 years old patient with impaired lung function. He was suspicious of tuberculosis (Tbc). Nocardia spec. was isolated. Case 2 was an alcoholic of 46 years with pneumonia. Reactivation of Tbc was suspected. Actinomadura madurae has been isolated. Case 3 was a patient of 58 years with myelodysplastic syndrome (MDS) and pneumonia. N. asteroides was isolated. All patients shared impaired immunity (age, alcoholism, MDS) with impaired lung functions; Tbc had been suspected (Case 1 + 2). Infection by A. madurae was contained by Clindamycin. Therapy of Nocardia with Moxifloxacin (Case 1) or Bactrim (Case 3) was only partly effective. In the appendix, six species of gram positive rods which are known to cause pneumonia, are summarized (Nocardia, Actinomyceta, Actinomadura, Rhodococcus, Corynebacterium and Bacillus).

Comparison of two budesonide powder inhalers, Easyhaler and Turbuhaler, in steroid-naïve asthmatic patients.

The objective of this multicenter study was to compare the clinical efficacy, safety, and acceptability of Easyhaler and Turbuhaler for the delivery of budesonide 200 micrograms/dose twice daily in steroid-naïve asthmatic patients. Three hundred and twenty-six newly diagnosed, steroid-naïve adult patients with mild-to-moderate asthma were recruited into this randomized, double-blind, double-dummy, parallel-group study, comprising a 2-week run-in period and 8 weeks of treatment. Patients received budesonide inhalation powder 400 micrograms/day either via Easyhaler (n = 159) or via Turbuhaler (n = 167), plus salbutamol inhalation powder (100 micrograms/dose) via Easyhaler as rescue therapy. The study was completed by 292 patients: 143 in the Easyhaler group and 149 in the Turbuhaler group. The primary outcome variable, mean morning peak expiratory flow (PEF), improved significantly and almost similarly by 36.3 and 30.6 l/min, respectively, from run-in to weeks 7-8. At weeks 7-8, the mean (SE) difference in morning PEF between the two treatments was 7.1 (9.4) l/min (90% CI from -8.4 to 22.6) on per protocol analysis, which was within the defined limits for therapeutic equivalence. There were no significant differences between treatments in terms of secondary efficacy variables or adverse events. However, patients found Easyhaler more acceptable than Turbuhaler. The results show that budesonide via Easyhaler is clinically as effective as Pulmicort Turbuhaler when equal daily doses of budesonide are delivered to steroid-naïve asthmatic patients. Moreover, patients found Easyhaler more acceptable than Turbuhaler, and a majority would prefer Easyhaler if given a choice.

Cost saving with ultrasonography in a developing country district hospital.

OBJECTIVE: To estimate the potential monetary reduction induced by the introduction of an ultrasound unit in a major district hospital in a developing country. DESIGN: Propective study. SUBJECTS: Patients referred with abnominal diseases and pregnancy. SETTING: Wad Medani Teaching Hospital, Central Sudan. RESULTS: Local specialists referring the patients stated that an estimated 792 radiologic procedures would have been carried out to obtain the same amount of information as achieved by ultrasound. Such procedures budgeted approximately 8100 US dollars, in terms of equipment, material and personnel by 1987 rates. Such savings have benefited all departments of the hospital. CONCLUSION: The authors consider this as evidence for the fact that despite its initial high investment (15,000 US dollars), availability of ultrasound virtually reduced expenditure on other radiological diagnostic procedures. This is of special benefit for the limited budgets of hospitals in non-industrialised countries.

[Report by the Scientific Working Group for Therapy of Lung Diseases: German Fibrosis Register with initial results]. / Mitteilung der Wissenschaftlichen Arbeitsgemeinschaft für die Therapie von Lungenkrankheiten (WATL): Deutsches Fibroseregister mit ersten Ergebnissen.

The aim of this study was to evaluate the occurrence of interstitial lung diseases (ILD) in Germany. Therefore members of the WATL developed a questionnaire which was sent to pulmonary and other physicians who may encounter patients with ILD. In 1995 altogether 234 patients (105 males, 129 females, mean age 51 years, minimum 12, maximum 88 years) were referred to the registry. 126 of these patients were non-smoker, 58 ex-smoker, 45 smoker and in 5 patients no information was given. The following ILD were reported: sarcoidosis (n = 83, 36 males, 47 females), idiopathic pulmonary fibrosis (n = 76, 35 males, 41 females), idiopathic pulmonary fibrosis (n = 76, 35 males, 41 females), alveolitis (n = 31, 12 males, 19 females), bronchiolitis obliterans organizing pneumonia (n = 16, 6 males, 10 females) and others (n = 28, 16 males, 12 females). These preliminary data show that sarcoidosis (35%) and idiopathic fibrosis (33%) were the most frequently registered ILD.

[Clinical studies of the incidence of pulmonary and extrapulmonary tuberculosis]. / Klinische Untersuchungen über die Häufigkeit der pulmonalen und extrapulmonalen Tuberkulose.

On the whole 797 patients (mean age 49.5 +/- 18.6 years) with tuberculosis who were hospitalized during 1987 and the first half of the year 1994 were investigated. 148 (18.6%) of these patients were foreigners. Regarding the age, the patients of German origin were mostly above 40 years (70.5%). Within the group of foreigners, 61.5% were below 40 years. 83.3% of the patients suffered from pulmonary and 11.4% from extrapulmonary and 11.4% from extrapulmonary tuberculosis. 5.3% of these patients had both manifestations. The tuberculin tine test was positive in 95.7% and negative in 4.3%. In 63.9% of all patients the tuberculosis was localized in the upper lobe of the lung. The tuberculosis was established bacteriologically in 56.0% and histologically in 16.5%. Both methods were applied in 13.6%. The tuberculosis was deteriorated by chronic alcoholism. Malignant diseases were recorded in 17 (2.1%) of the patients. 22 (2.8%) died during their stay at the hospital.

Absence of the left pulmonary artery in a young man with haemoptysis.

We report the case of a white male aged 21 yrs, who was admitted for acute onset of haemoptysis. His past medical history was normal and he had not previously been hospitalized. He was very active in track and field sports and was trained in scuba-diving. Physical examination revealed a grade 2/6 holosystolic heart murmur. Laboratory parameters, blood gases and pulmonary function tests were within the normal range. Fibreoptic bronchoscopy revealed normal geometry of the bronchi, with blood clots in the left lower lobe. An X-ray of the chest showed that the heart was shifted to the left side. In the perfusion scan, defects of the tracer on the left lung were detected. By ergospirometry, no significantly pathological response to exercise using a bicycle ergometer could be observed. By means of pulmonary artery catheterization, cardioangiography and selective angiography of the aorta the absence of the left pulmonary artery could be established, without any further malformations of the cardiopulmonary system. Because of the spontaneous cessation of haemoptysis, no surgical intervention was necessary.

Acute intoxication of a hydrazine-like gas by 19 workers in a garbage dump.

Nineteen workers (18 males, 1 female) of a garbage dump (mean age 39.9 years, range 19-58 years) were admitted to our hospital because of inhalation of a hydrazine-like gas of unknown origin. They complained of an ammoniacal odor with sweet taste followed by burning of the eyes, rawness in the throat and dyspnea, dizziness and nausea. Ten patients (group A) arrived about 2 h after they had experienced their first symptoms. The nine other patients (group B) were admitted about 70 h later. On the second day the white cell counts were significantly elevated compared to those of the days before and after (P < 0.02-0.005). The lung function showed in two patients a moderate obstruction. The PO2 was significantly reduced within 1 to 12 h after admission (P < 0.02-0.005) compared to the measurement before (P < 0.005) and after 25 (P < 0.02) and 50 (P < 0.01) h. A significantly reduced PCO2 was found after 25 h compared to the time of admission (P < 0.03). These investigations show that workers of a garbage dump had an alarming decrease of oxygen after inhalation of nitrogenous gases released by the trash.

[Chronic pollution with environmental toxins: formaldehyde]. / Chronische Belastung mit Umwelttoxinen: Formaldehyd.

Formaline is a colourless, strongly odoriferous gas. It is a very important basic component in chemical industry. It has become well known as a poison in residential areas due to its appearance in chipboard panels. Formaline causes a variety of acute and chronic toxic stress symptoms. In many cases the relation of formaline exposition and symptoms is difficult to demonstrate. The main keys to diagnosis are a very careful anamnesis and the cumulated appearance of symptoms. We intend to show several possible sources of stress symptoms caused by formaline, as well as diagnostic possibilities. This includes several methods of diagnostic assessing formaline concentration in the air, and several suggestions for the reduction of formaline emission.

Pleural penetration of ciprofloxacin in patients with empyema thoracis.

We evaluated the pharmacokinetics of a single 200-mg dose of ciprofloxacin, administered as a 30-minute infusion, into pleural exudate in five elderly patients with empyema thoracis. Ciprofloxacin was measured by HPLC and the pharmacokinetic parameters were determined by noncompartmental methods. Mean peak serum levels 30 minutes after administration were 1.98 +/- 0.07 mg/L. Terminal serum half-lives ranged from 3.9 to 5.1 h. Mean concentrations of ciprofloxacin in pleural exudate were 1.44 +/- 0.42 mg/L at a mean time of 4.5 +/- 2.5 h. After this time, the pleural exudate level exceeded the corresponding serum twofold to tenfold. The mean percentage penetration into the inflammatory compartment was approximately 210 percent. Our data suggested that ciprofloxacin penetrates well into the pleural fluid of patients with empyema thoracis. The concentrations achieved were well above the MIC90 of most pathogens normally found in patients with empyema thoracis for a period of approximately 12 h.

[Serum theophylline concentrations in patients with chronic obstructive lung diseases: a comparison of 2 methods]. / Serumtheophyllinkonzentrationen bei Patienten mit chronisch obstruktiven Lungenerkrankungen: Ein Vergleich zweier Methoden.

A total of 120 samples of serum were obtained from 8 patients with COPD and submitted to a comparative analysis of serum theophylline levels employing the TDX and the EMIT methods of determination. At the same time, two different slow-release preparations of theophylline were compared, their kinetics investigated, and their effects tested using body plethysmography. For this open, randomized cross-over preliminary investigation, numerous inclusion and exclusion criteria were applied.

[Morbidity of respiratory and cardiovascular diseases in smog conditions. Studies of 1,995 patients]. / Morbidität von respiratorischen und kardiovaskulären Erkrankungen unter Smogbedingungen. Untersuchungen an 1995 Patienten.

On the basis of the five-year study (1984-1988) presented herein, we have been able to demonstrate that, under conditions of smog, an increase in respiratory diseases can occur. Our results also show that cardiovascular diseases decrease simultaneously, an observation that has not so far been reported in the literature. A possible reason for this observation is, perhaps, an information effect, or an influence effect induced by warnings given in the media about the negative health-related consequences for those who leave their homes, in particular those consequences applicable to patients with cardiovascular disorders. The pathological process is traceable to a multifactorial occurrence, the temperature of the air having a decisive influence. To date, the influence of indoor pollution has not yet been clarified.