[30th anniversary of the "Kuratorium Tuberkulose in der Welt"]. / 30 Jahre Kuratorium Tuberkulose in der Welt.

The "Kuratorium Tuberkulose in der Welt" is a non-profit association to fight tuberculosis (TB) in the world. It was founded by a group of idealist physicians 30 years ago. Its tasks are to fight against TB, especially in developing countries, to propagate the knowledge of TB prevention and therapy, and to promote research in the field of TB. The "Kuratorium" has set up projects in Santa Cruz (Bolivia), Kathmandu (Nepal), Lomé (Togo), Kiev (Ukraine), and Stavropol (Russia). In cooperation with the WHO, the International Union against Tuberculosis and Lung Disease (IUATLD), and local anti-tb-organisations microbiologic laboratories were established for case detection and therapeutic monitoring. Local staffs were trained and strategies to combat TB were implemented. For more than 30 years the "Kuratorium Tuberkulose in der Welt" has worked successfully and beneficially, despite of often difficult political situations. It has received great appreciation for its achievements.

[Ambulatory electrocardioversion of atrial fibrillation by means of biphasic versus monophasic shock delivery. A prospective randomized study]. / Ambulante Elektrokardioversion von Vorhofflimmern mittels biphasischer versus monophasischer Schockabgabe. Eine prospektiv randomisierte Studie.

Transthoracic electrical cardioversion using a monophasic waveform is the most common method converting persistent atrial fibrillation into sinus rhythm. Recently, cardioversion with a new biphasic waveform has shown promising results for treatment of atrial fibrillation. We undertook a randomized prospective trial comparing the efficacy and safety of the two waveforms for ambulatory cardioversion of atrial fibrillation. A total of 118 consecutive patients (mean age 62 years [SD 11]) presenting with persistent atrial fibrillation (mean duration 8 months [SD 11]) for ambulatory electrical cardioversion were randomized to receive either monophasic (n = 57) or biphasic shocks (n = 61). We used a standardized step-up protocol with increasing shock energies (100-360 joules) in either group. In all patients an anterior-posterior shock electrode position was used. If sinus rhythm was not achieved with the third (360 joules) shock, cardioversion was repeated with the opposite waveform. The two groups did not differ in demographic or disease-related data. The success rate was 100% for the biphasic and 73.7% for the monophasic waveform (p < 0.001). Biphasic patients required fewer shocks (1.5 versus 2.9) and a lower mean cumulative energy (203 versus 570 joules) (p < 0.001). Twelve out of 15 unsuccessfully treated monophasic patients were converted with biphasic shocks. The success rate for all 118 patients was 97.5%. No major acute complications were observed. For ambulatory transthoracic cardioversion of persistent atrial fibrillation biphasic shocks are of greater efficacy and require less energy than monophasic shocks. The procedure can be performed ambulatory and is safe regardless of shock waveform used.

[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.

Comparison of generic health survey SF-36 and arrhythmia related symptom severity check list in relation to post-therapy AF recurrence.

AIM: The effect of applied therapy on quality of life (QoL) in patients with atrial fibrillation (AF) was investigated in recent studies. However, no information on clinical relevance of QoL assessing instruments in relation to post-ablation recurrence of AF is currently available. The aim of this study was to evaluate the clinical relevance of SF-36 and Arrhythmia Related Symptom Severity Check List (SSCL) to post-procedure AF recurrences in patients with paroxysmal AF undergoing pulmonary vein isolation (PVI). METHODS AND RESULTS: Sixty consecutive patients with AF were enroled in the study. The QoL was measured using SF-36 scale and SSCL. The questionnaires were administered at baseline then 3, 6, 9 and 12 months after the procedure. In order to define statistical power in relation to AF recurrence the scores were dichotomized. Positive and negative predictive accuracy (PPA, NPA) and test efficiency (sum of PPA and NPA) were calculated. Twenty-one out of 60 patients experienced a total of 66 recurrences of AF during follow-up. The parameters of SF-36 provided maximum test efficiency of 1.36, whereas the test efficiency of SSCL was 1.79. CONCLUSION: We conclude that SSCL is more specific instrument for a measurement of PVI success or failure.

Biventricular pacing in patients with ICD: how many patients are possible candidates?

BACKGROUND: About 80 % of patients receiving an implantable cardioverter-defibrillator (ICD) due to life-threatening episodes of ventricular tachycardia (VT) or ventricular fibrillation (VF) have structural heart disease. ICD implantation reduces the risk of sudden cardiac death to less than 2 %. However, the major obstacle in these patients is chronic heart failure (CHF). Biventricular stimulation (BIV) has shown its efficiency as an alternative therapy in drug refractory CHF. METHODS: According to the InSync registry, we predefined possible indications for BIV as follows: complete branch bundle block (> 120 ms), left-ventricular ejection fraction (EF) < 35 % and NYHA class > II. We evaluated the number of patients presenting this indication at time of implant and during follow-up (FU) at our ICD clinic. RESULTS: Between 1992 and 1998, 360 patients were provided with an ICD (mean age 64.6 +/- 5.4 yrs, mean EF 37 +/- 14 % at implant, 82 % of patients with organic heart disease). Mean FU was 34 +/- 21 months. During FU 46 patients (13 %) died, 15 of these (33 %) presenting criteria for BIV. 33 patients died of heart failure, there was 1 sudden death and 12 patients died for non-cardiac reasons. 35 % of the patients who died of heart failure had an indication for BIV. CONCLUSIONS: About 10 % of ICD patients had an indication for BIV at time of implant. Over a mean FU period of 34 months, 16% of all patients presented an indication for BIV. Patients with an indication for BIV had a higher mortality rate and more frequent atrial fibrillation compared to patients without. With this data and the good clinical results after BIV-ICD implantation, we consider the implantation of a BIV-ICD system in every patient with appropriate indications.

[2 year follow-up of 321 patients with an implantable cardioverter/defibrillator: comparison of patients with and without atrial fibrillation]. / Verlaufsbeobachtung von 2 Jahren bei 321 Patienten mit einem implantierbaren Kardioverter/Defibrillator: Vergleich zwischen Patienten mit und ohne Vorhofflimmern.

UNLABELLED: Atrial fibrillation is the most common cause of inappropriate therapy deliveries by implantable cardioverter/defibrillators (ICD). However, the importance of atrial fibrillation for the induction of ventricular arrhythmias and for the prognosis is controversial. We studied 321 ICD patients (pts) over the median follow-up of 25 months. In 92 pts, atrial fibrillation was found to be the underlying rhythm (in 49 pts chronic, in 43 pts paroxysmal), in 229 pts sinus rhythm. Pts with atrial fibrillation were older (67 +/- 9 vs. 63 +/- 9 years, p = 0.001) and were considered to suffer more often from a valvular (14 vs. 4%, p = 0.004) or a dilative cardiomyopathy (29 vs. 19%, p = 0.04). Both groups were similar regarding other baseline characteristics like gender, left ventricular ejection fraction, hypertension, diabetes and in the ICD system (single chamber, dual chamber) used. Pts with atrial fibrillation experienced more appropriate (ventricular fibrillation: 0.33 vs. 0.2/month, p = 0.0049, ventricular tachycardias: 0.05 vs 0/month, p = 0.0033) as well as inappropriate (34 vs. 8%, p < 0.001) therapy deliveries by the ICD. Pts with atrial fibrillation were found to suffer twice as much from a progression of their heart failure (43% vs. 22%, p < 0.001). After multivariate analysis, atrial fibrillation was significantly associated with progressive pump-failure mortality (relative risk (RR) 3.12, confidence interval (CI) 1.30 to 7.48, p = 0.01). There was no difference in the incidence of ICD therapies and mortality rates between the pts with chronic and paroxysmal atrial fibrillation. CONCLUSION: The presence of atrial fibrillation in ICD patients is associated with a progression of heart failure and therefore is an unfavorable factor for pump-failure death. Also, atrial fibrillation is a marker for greater possibility to experience more appropriate as well as inappropriate therapy deliveries by the ICD.

International study comparing cefdinir and cefuroxime axetil in the treatment of patients with acute exacerbation of chronic bronchitis.

OBJECTIVES: To assess the efficacy and tolerability of three antibiotic regimens in patients with acute exacerbation of chronic bronchitis. METHODS: In this double-blind, randomized, multicentered, parallel-group study, patients received once-daily cefdinir 600 mg, twice-daily cefdinir 300 mg, or twice-daily cefuroxime axetil 250 mg for 10 days. Primary efficacy measures were microbiologic eradication rate, by pathogen and by patient, and clinical response rate, by patient. RESULTS: Of 1045 patients, 589 were evaluable for efficacy. At baseline, most patients had moderate or severe cough and sputum production as well as rhonchi, wheezing, and dyspnea. The microbiologic eradication rates by pathogen were 90% with once-daily cefdinir, 85% with twice-daily cefdinir, and 88% with twice-daily cefuroxime. The corresponding values for microbiologic eradication rate by patient were 90% (once-daily cefdinir), 85% (twice-daily cefdinir), and 86% (twice-daily cefuroxime). The respective clinical response rates by patient were 81%, 74%, and 80%. There were no significant differences in the incidence of drug-related adverse events or discontinuations due to adverse events. Diarrhea was the most frequent complaint. CONCLUSIONS: The results indicate that the efficacy and tolerability of cefdinir, once or twice daily, and cefuroxime were comparable with no significant differences between the regimens used.

[Initial experience with an implantable loop recorder in patients with unexplained syncope]. / Erste Erfahrungen über den diagnostischen Nutzen eines implantierbaren Langzeit-Ereignisrekorders (Endless-Loop-Rekorder, REVEAL((R))) bei Patienten mit unklaren Synkopen.

Patients with recurrent syncope undiagnosed after extensive noninvasive and invasive testing pose a diagnostic and therapeutic dilemma. Holter monitoring is non-diagnostic in 90% of cases. Recent developments in loop recorder technology permit longterm ECG monitoring in patients with recurrent unexplained syncope. The implantable loop recorder monitors a single lead electrogram continuously using 2 sensing electrodes on the device shell. The device was implanted in 20 patients (11 male, 9 female) with the history of recurrent syncope. During a mean follow-up of 12+/-6 months after device implantation, 11 patients (55%) experienced syncope (8 pts) or presyncope (3 pts). In the remaining 9 patients, no syncope occurred. In all 11 patients with syncope or presyncope during follow-up, loop recording definitively determined whether an arrhythmia was the cause of symptoms or not. Diagnosis included bradycardia in one patient, tachycardia in two patients, in one patient two rhythm disturbances were revealed: frequent ventricular premature beats with bigemini and atrial flutter. Two patients had a neurocardiogenic syncope. Syncope was nonarrhythmic in 5 patients. An implantable loop recorder is useful for establishing the diagnosis if symptoms are recurrent but too infrequent for conventional monitoring techniques.

[Studies with the fully automated EEG sleep analysis system QUISI]. / Untersuchungen zum vollautomatischen Schlaf-EEG-Analysesystem QUISI.

To judge sleep reliably would be interesting not only for outpatient sleep diagnostics, but also in the inpatient sphere. A step in this direction is the easy-to-apply fully automated sleep-EEG-analysis system QUISI. Nine males patients with obstructive sleep apnoea syndrome were examined simultaneously by polysomnography and the QUISI system. A comparison of the sleep profiles evaluated by polysomnographic recordings using Rechtschaffen and Kales' rules with the automated classification using QUISI recording shows that the difference of the sleep parameters sleep period time (SPT), total sleep time (TST), REM, stage 1, stage 2, slow-wave sleep and the awake stage of maximum five patients ranged between +/- 10 minutes, respectively +/- 5 per cent. Only two of nine sleep profiles could be compared as far as the sequence of the sleep stages was concerned. According to our results it is important to edit the original data and to treat the fully automated sleep profile. We cannot recommend QUISI to establish sleep profiles for the obstructive sleep apnoea syndrome.

[Lead-related complications in 340 patients with an implantable cardiverter/defibrillator]. / Komplikationen mit Sonden bei 340 Patienten mit einem implantierbaren Kardioverter/Defibrillator.

From February 1991 to May 1998, 340 patients had a cardioverter/defibrillator (ICD) implanted. Mean age was 64 +/- 9 years, 278 male and 62 female. 60% of patients had coronary artery disease and 31% dilatative cardiomyopathy. Ejection fraction was 38 +/- 14%. The indication for an implantable cardioverter/defibrillator was in 57% of patients ventricular tachycardia, in 43% ventricular fibrillation. 298 patients had a single-chamber cardioverter/defibrillator implanted, 42 patients a dual-chamber cardioverter/defibrillator. In 25 patients additional subcutaneous patch or array electrodes and in 2 patients additional epicardial patch electrodes were implanted. Implantation site was in 92 patients abdominal and in 248 pectoral. Over a period of 7 years 34 lead-related complications occurred in 33 patients (9.7%), after a median of 2 months after implantation. Diagnosis was made by routine chest x-ray in about 55% of lead-related complications, by clinical presentation (inadequate therapy, pain) in 24%, and by electrical parameters in 21%. In patients with an abdominal implantation site, lead-related complications occurred in 20%, in contrast to 6% in patients with a pectoral implantation site. Regarding patients with pectoral implantation site, lead-related complications were observed in 12% of patients with a dual-chamber ICD vs 4% with a single-chamber ICD (p = 0.05), due to dislocation of atrial electrodes with dual-chamber ICD. There were no differences in clinical parameters between patients with pectoral vs abdominal and between single vs dual-chamber ICD. There were no deaths due to lead-related complications.

[Therapy of malignant pleural mesothelioma--a permanent dilemma]. / Die Therapie des malignen Pleuramesothelioms--ein fortdauerndes Dilemma.

Although still a rare tumour, incidence of malignant pleural mesothelioma (MPM) is increasing. The cause, with the exception of some not clearly identified environmental factors, is asbestos. The prognosis is influenced by the stage of the disease. A new staging system has not modified the fact that staging is still a clinical problem. Tumour volume, histological subtype, sex and performance score are some of the important prognostic factors. Most patients (pts) are diagnosed in advanced stages only. Surgery will only cure or significantly prolong survival in the rare event of an early stage with no survival advantage for pleuropneumonectomy over pleurectomy. In early stages adjuvant immunological treatments (e.g. interferon or interleukin) may be of some value. Adjuvant first generation photodynamic therapy is not superior to operation only. The majority of patients, however, are diagnosed in advanced stages, where neither radiation nor chemotherapy, nor multimodality treatments can significantly alter the poor prognosis. There is no standard therapy, and no advantage to poly- versus monochemotherapy. Chemotherapy, however, seems to have some palliative effect in symptomatic patients, as well as radiotherapy, the latter also as prophylaxis against tumour invasion after puncture and thoracoscopy.

[Euphylong in standard dosage: comparison with an international retard preparation for twice-daily administration in recommended dosage]. / Euphylong in Standarddosierung: Vergleich mit einem internationalen Retardpräparat zur Zweimalgabe in empfohlener Dosierung.

24 patients with COPD and delta FEV1 greater than 15% were included in a double-blind crossover study. 7 dropouts due to deterioration of findings and incomplete data reduced the number of assessable patients to 17. Most of the patients had been pretreated with a slightly higher theophylline dosage before initiation of the study. In the preliminary period a 24-hour profile of the peak flow was set up with a morning and evening theophylline level. During the 5-day treatment intervals a 24-hour profile of the serum theophylline levels and of the peak flow was recorded at two-hour intervals. A complete lung function test was performed in each phase. The pharmacokinetic data of both preparations are comparable. Euphylong showed a bioavailability of 83%, the maximum of the serum level was attained at night. Serum level variations were only slightly higher than those of the reference drug. Euphylong had a night level of 24% above the daily average (reference drug 3%). This was associated in a part of the group, about one-third of the total number of patients, with an improvement of the "morning dip" compared with the preliminary period or the reference drug. Over the entire group of patients there were no differences between both drugs or the preliminary period that could be ascribed to the theophylline premedication. An advantage shown by Euphylong was the better predictability of the serum levels. During the time period of the clinical routine the deviation of the serum level from the actual serum maximum was less than 15%.

Lymphangiomyomatosis: a report of three cases treated with tamoxifen.

Three cases are reported of lymphangiomyomatosis with pulmonary and abdominal manifestations. Two had a chylous pleura effusion, while the third presented a retroperitoneal manifestation, which was completely resectable. Antiestrogen therapy with tamoxifen was administered in all three cases. Two patients died of pulmonary progression after 4 months of therapy. The third is still alive, with stable disease for more than 6 years, and has been receiving tamoxifen for 66 months. These observations indicate that antiestrogen treatment may be as effective as oophorectomy when started at an early stage of the disease.