title: Update: intensivmedizinische Studien: Ergebnisse der vergangenen 12 Monate

text: Intensive care medicine plays an important role in the medical care of patients as well as the economic success of hospitals. Knowledge and implementation of recent relevant scientific evidence are prerequisites for high quality care in intensive care medicine. The aim of this review is to present an overview of the most important publications in intensive care medicine published in 2010 and the first half of the year 2011 and to comment on their attributable clinical relevance for intensive care practitioners. In 2010 and up to June 2011 many studies with high patient numbers have been published. The main topics were the treatment of respiratory failure, sepsis and investigations to improve analgosedation.


title: Pulmonale granulomatöse Erkrankungen und pulmonale Manifestationen systemischer Granulomatosen: Inklusive Tuberkulose und nichttuberkulöse Mykobakteriosen

text: CLINICAL/METHODICAL ISSUE: Granulomas as signs of specific inflammation of the lungs are found in various diseases with pulmonary manifestations and represent an important imaging finding. STANDARD RADIOLOGICAL METHODS: The standard imaging modality for the work-up of granulomatous diseases of the lungs is most often thin-slice computed tomography (CT). There are a few instances, e. g. tuberculosis, sarcoidosis and silicosis, where a chest radiograph still plays an important role. METHODICAL INNOVATIONS: Further radiological modalities are usually not needed in the routine work-up of granulomatous diseases of the chest. In special cases magnetic resonance imaging (MRI) and positron emission tomography (PET)-CT scans play an important role, e. g. detecting cardiac sarcoidosis by cardiac MRI or choline C‑11 PET-CT in diagnosing lung carcinoma in scar tissue after tuberculosis. PERFORMANCE: The accuracy of thin-slice CT is very high for granulomatous diseases. ACHIEVEMENTS: In cases of chronic disease and fibrotic interstitial lung disease it is important to perform thin-slice CT in order to diagnose a specific disease pattern. Thin-slice CT is also highly sensitive in detecting disease complications and comorbidities, such as malignancies. Given these indications thin-slice CT is generally accepted in the routine daily practice. PRACTICAL RECOMMENDATIONS: A thin-slice CT and an interdisciplinary discussion are recommended in many cases with a suspected diagnosis of pulmonary granulomatous disease due to clinical or radiographic findings.


title: Crocin alleviates lipopolysaccharide-induced acute respiratory distress syndrome by protecting against glycocalyx damage and suppressing inflammatory signaling pathways

text: OBJECTIVE: To explore the mechanisms of crocin against glycocalyx damage and inflammatory injury in lipopolysaccharide (LPS)-induced acute respiratory distress syndrome (ARDS) mice and LPS-stimulated human umbilical vein endothelial cells (HUVECs). METHODS: Mice were randomly divided into control, LPS, and crocin + LPS (15, 30, and 60 mg/kg) groups. HUVECs were separated into eight groups: control, crocin, matrix metalloproteinase 9 inhibitor (MMP-9 inhib), cathepsin L inhibitor (CTL inhib), LPS, MMP-9 inhib + LPS, CTL inhib + LPS, and crocin + LPS. The potential cytotoxic effect of crocin on HUVECs was mainly evaluated through methylthiazolyldiphenyl-tetrazolium bromide assay. Histological changes were assessed via hemotoxylin and eosin staining. Lung capillary permeability was detected on the basis of wet–dry ratio and through fluorescein isothiocyanate-albumin assay. Then, protein levels were detected through Western blot analysis, immunohistochemical staining, and immunofluorescence. RESULTS: This study showed that crocin can improve the pulmonary vascular permeability in mice with LPS-induced ARDS and inhibit the inflammatory signaling pathways of high mobility group box, nuclear factor κB, and mitogen-activated protein kinase in vivo and in vitro. Crocin also protected against the degradation of endothelial glycocalyx heparan sulfate and syndecan-4 by inhibiting the expressions of CTL, heparanase, and MMP-9 in vivo and in vitro. Overall, this study revealed the protective effects of crocin on LPS-induced ARDS and elaborated their underlying mechanism. CONCLUSION: Crocin alleviated LPS-induced ARDS by protecting against glycocalyx damage and suppressing inflammatory signaling pathways.


title: ARDS infolge schwerer RSV-Infektion Therapeutische Optionen: Therapeutische Optionen

text: We report on a strikingly frequent referral of former preterm babies with respiratory syncytial virus (RSV) infection and subsequent ARDS in our hospital during the winter 1994/95 with regard to the clinical course under application of alternative treatment modalities. Treatment modalities like inhalational ribavirin, use of bronchodilators and instillation of surfactant had been tried without success. All children (age: 1–43 months) were ventilated for 6.6 (1–17) days with FiO(2) = 1.0 and a mean airway pressure of 16.4 (10–24) cm H(2)O. Mean arterial blood gases were 49 (paO(2)) and 41 (pCO(2)) mm Hg, the OI was 33.4. By inhalational NO in combination with IPPV or HFOV 4 patients could be stabilized, in the other 6 ECMO became necessary. Two of them died in spite of several weeks on ECMO; 8 children survived and could be discharged home after a mean hospital stay of 3 months. Even in very severe cases of RSV infection treatment modalities like NO, HFOV and ECMO can be used successfully. The use of these treatment modalities must be considered before the lung damage is irreversible; in those cases a pre-existing BPD is no contraindication even for extracorporeal lung support.


Beatmungsassoziierte Pneumonien : Diagnostik und Therapie


Malaria: Stellungnahmen des Arbeitskreises Blut des Bundesministeriums für Gesundheit


title: Looking forward 25 years: the future of medicine

text: To celebrate the end of our 25th anniversary year, we asked thought leaders and experts in the field to answer one question: What will shape the next 25 years of medical research?


title: Elektronenoptischer Nachweis des Virus der spitzen Kondylome

text: Electron-microscopic investigations of condyloma acuminatum in the area of female genitals are reported. The identification of virus particles in the cytoplasma of the epithelial cells was possible. Volume, localisation and microscopic morphology of the discovered corpuscles make propable that, the causative organismus of condyloma acuminatum are not identical with those of verruca vulgaris.


Abstracts: 11(th) European Congress of Trauma and Emergency Surgery May 15–18, 2010 Brussels, Belgium


title: Annulling a dangerous liaison: vaccination strategies against AIDS and tuberculosis

text: Human immunodeficiency virus (HIV) and Mycobacterium tuberculosis annually cause 3 million and 2 million deaths, respectively. Last year, 600,000 individuals, doubly infected with HIV and M. tuberculosis, died. Since World War I, approximately 150 million people have succumbed to these two infections—more total deaths than in all wars in the last 2,000 years. Although the perceived threats of new infections such as SARS, new variant Creutzfeldt-Jakob disease and anthrax are real, these outbreaks have caused less than 1,000 deaths globally, a death toll AIDS and tuberculosis exact every 2 h. In 2003, 40 million people were infected with HIV, 2 billion with M. tuberculosis, and 15 million with both. Last year, 5 million and 50 million were newly infected with HIV or M. tuberculosis, respectively, with 2 million new double infections. Better control measures are urgently needed.


title: Infektiöse entzündliche Erkrankungen des Zentralnervensystems aus neurologischer und internistischer Sicht

text: Kopfschmerzen und Fieber sind Kardinalsymptome der eitrigen (bakteriellen) Meningitis, der Herpes-simplex-Virus-Enzephalitis und des Hirnabszesses. Diese 3 Krankheitsbilder gehören zu den wichtigsten behandelbaren Infektionskrankheiten des Zentralnervensystems. Der ärztliche Erstkontakt mit diesen Patienten betrifft sowohl den Neurologen als auch den Internisten. In allen 3 Fällen ist eine rasche Diagnostik und der sofortige Beginn einer adäquaten Behandlung (mit Antibiotika bzw. Aciclovir) erforderlich. Zu den wichtigsten diagnostischen Maßnahmen, die eine Differenzierung dieser Krankheitsbilder erlauben, gehören insbesondere die lumbale Liquoruntersuchung und bildgebende Verfahren wie CT oder MRT. Der vorliegende Beitrag beschreibt ausführlich die klinische Symptomatik, Diagnostik und Therapie dieser 3 wichtigen Krankheitsbilder.


title: Monitoring von Organfunktionen: Dysfunktion von Niere, Leber, Gastrointestinaltrakt und Gerinnung

text: Monitoring of organ function is one of the core tasks of intensive care medicine. Although various monitoring devices and parameters have already been established for some organs, there are no or only few conditionally useful parameters or scores available for the kidneys, liver, gastrointestinal tract, and blood coagulation. Therefore, specific biomarkers and scores as well as combinations of both are currently investigated for better monitoring of these organs. This article gives a critical overview of currently used as well as investigational biomarkers, tests and scores in general, and shows some examples of the implications for common diseases, clinical situations and constellations in the intensive care unit.


title: Exantheme nach Auslandsreisen

text: In view of globalization and the associated transport of goods as well as rising travel activity, imported infections with subtropical and tropical pathogens are increasing in Germany. In returning travelers presenting with fever, general symptoms and skin rash, a number of diseases need to be considered. The clinical appearance of the skin rash, accurate travel history and epidemiological information on country-specific risks are helpful in making the correct diagnosis. In this article we provide an overview of the most common exanthemas in travelers who have returned, associated symptoms, diagnostic methods, therapies, as well as prevention strategies.


Alice im Intensivland: Essay über Unsinn und gesunden Menschenverstand auf der Intensivtherapiestation – im Stil von Lewis Carroll


title: Akutes Leberversagen

text: Acute liver failure (ALF) is a rare condition with fatal outcome. Characteristic is rapid onset of liver damage without preexisting liver diseases, including hepatic encephalopathy and coagulopathy. Early and correct diagnosis is essential for further management of patients, since diagnosis impacts therapy choice. Survival of patients with ALF has improved dramatically due to advances in critical care medicine and the use of liver transplantation.


title: Bioactivation of leukotoxins to their toxic diols by epoxide hydrolase

text: Leukotoxin is a linoleic acic oxide produced by leukocytes and has been associated with the multiple organ failure and adult respiratory distress syndrome seen in some severe burn patients. Leukotoxin has been reported to be toxic when injected into animals intravenously. Herein, we report that this lipid is not directly cytotoxic in at least two in vitro systems. Using a baculovirus expression system we demonstrate that leukotoxin is only cytotoxic in the presence of epoxide hydrolases. In addition, it is the diol metabolite that proves toxic to pulmonary alveolar epithelial cells, suggesting a critical role for the diol in leukotoxin-associated respiratory disease. In vivo data also support the toxicity of leukotoxin diol. For the first time we demonstrate that soluble epoxide hydrolase can bioactivate epoxides to diols that are apparently cytotoxic. Thus leukotoxin should be regarded as a protoxin corresponding to the more toxic diol. This clearly has implications for designing new clinical interventions.


title: News Feature: Bad medicine

text: An untested herbal product in South Africa is being touted as an effective AIDS treatment—with the full support of a local scientist. Natasha Bolognesi investigates.


title: Medikamenteninteraktionen für den Anästhesisten

text: Modern anesthesiology employs the combined administration of several drugs belonging to different pharmacological classes. Additionally, anesthesiologists are facing the challenge of polypharmacy regimens utilized by patients considered for surgical treatment. When drugs are combined, the pharmacological effect may considerably differ from the individually expected properties. This may be beneficial or potentially lead to adverse drug reactions harming the patient. The incidence of drug interaction increases exponentially with the number of drugs administered. Depending on the mechanism involved, drug interactions can be classified as pharmaceutical, pharmacodynamic, or pharmacokinetic. Although there are enormous possibilities for adverse drug reactions and the complexity is hard to identify, prediction of drug interaction is possible. Besides recognizing the general risk factors, fundamental knowledge of basic and clinical pharmacology is important to prevent serious or fatal drug interactions before they occur.


Royal Society urges integration of human and veterinary medicine


title: Das akut-auf-chronische Leberversagen als diagnostische und therapeutische Herausforderung der Intensivmedizin

text: Acute-on-chronic liver failure (ACLF) is an emerging clinical syndrome in patients with underlying liver disease that is usually triggered by one or multiple insults and characterized by progressive hepatic and nonhepatic organ failure, a significant risk of infections, and high short-term mortality rates. Despite our incomplete understanding of the underlying pathophysiology, ACLF requires timely diagnostic and therapeutic measures aiming at the identification and elimination of causative factors as well as the prevention of complications to improve the prognosis of affected patients.


title: Akute Pankreatitis

text: Acute pancreatitis is a potentially fatal disease with individually differing expression of systemic involvement. For this reason early diagnosis with subsequent risk stratification is essential in the clinical management of this frequent gastroenterological disorder. Severe forms of acute pancreatitis occur in approximately 20 % of cases often requiring intensive care monitoring and interdisciplinary therapeutic approaches. In the acute phase adequate fluid replacement and sufficient analgesic therapy is of major therapeutic importance. Concerning the administration of antibiotics and the nutritional support of patients with acute pancreatitis a change in paradigms could be observed in recent years. Furthermore, endoscopic, radiological or surgical interventions can be necessary depending on the severity of the disease and potential complications.


Book of Abstracts: 10th World Congress on Inflammation


title: Psoas:lumbar vertebra index: central sarcopenia independently predicts morbidity in elderly trauma patients

text: INTRODUCTION: Central sarcopenia as a surrogate for frailty has recently been studied as a predictor of outcome in elderly medical patients, but less is known about how this metric relates to outcomes after trauma. We hypothesized that psoas:lumbar vertebral index (PLVI), a measure of central sarcopenia, is associated with increased morbidity and mortality in elderly trauma patients. METHODS: A query of our institutional trauma registry from 2005 to 2010 was performed. Data was collected prospectively for the Pennsylvania Trauma Outcomes Study (PTOS). Inclusion criteria: age >55 years, ISS >15, and ICU LOS >48 h. Using admission CT scans, psoas:vertebral index was computed as the ratio between the mean cross-sectional areas of the psoas muscles and the L4 vertebral body at the level of the L4 pedicles. The 50th percentile of the psoas:L4 vertebral index value was determined, and patients were grouped into high (>0.84) and low (≤0.83) categories based on their relation to the cohort median. Primary endpoints were mortality and morbidity (as a combined endpoint for PTOS-defined complications). Univariate logistic regression was used to test the association between patient factors and mortality. Factors found to be associated with mortality at p < 0.1 were entered into a multivariable model. RESULTS: A total of 180 patients met the study criteria. Median age was 74 years (IQR 63–82), median ISS was 24 (IQR 18–29). Patients were 58 % male and 66 % Caucasian. Mean PLVI was 0.86 (SD 0.25) and was higher in male patients than female patients (0.91 ± 0.26 vs. 0.77 ± 0.21, p < 0.001). PLVI was not associated with mortality in univariate or multivariable modeling. After controlling for comorbidities, ISS, and admission SBP, low PLVI was found to be strongly associated with morbidity (OR 4.91, 95 % CI 2.28–10.60). CONCLUSIONS: Psoas:lumbar vertebral index is independently and negatively associated with posttraumatic morbidity but not mortality in elderly, severely injured trauma patients. PLVI can be calculated quickly and easily and may help identify patients at increased risk of complications.


Intensivmedizinische Studien aus 2016/2017


Solid response to SARS—almost


Abstracts zur 106. Jahrestagung der DGKJ


Nekrotisierende Weichteilinfektionen und „toxic shock syndrome“


Abstracts zum 124. Kongress der Deutschen Gesellschaft für Innere Medizin e.V.


title: Pulmonale Komplikationen in der Chemotherapie

text: Many chemotherapeutic agents have a direct or indirect toxic effect on the lungs and airways which can lead to potentially fatal complications. It is a diagnostic challenge to identify such changes by imaging early as they are often unspecific and can be misinterpreted as pulmonary edema, infections, radiation pneumonitis or progression of an underlying disease. In this review the morphological changes of the lungs and airways are summarized according to anatomical location and some of the most commonly used chemotherapeutic agents and their adverse effects are listed.


title: Necrotizing Fasciitis of the Extremities

text: Necrotizing fasciitis (NF) describes a life threatening soft tissue infection characterized by a rapid spreading infection of the subcutaneous tissue and in particular the fascia. Various synonyms for this type of infection are used, often due to the difficult diagnosis. Necrotizing fasciits of the extremities is found after simple skin lacerations and often in rural, farming or garden setting environments. Many of the infections are found in immunologically healthy people, but persons revealing a compromised wound healing are endangered additionally, e.g., diabetes. In the majority of the microbiological analyses, streptococci alone or a mixture with mainly anaerobic bacteria may be detected. The management of infected extremities requires a rapid diagnosis, dedicated aggressive surgical management as soon as possible, and a wide debridement extending the border of the infected fascia. Timely surgical revisions within the first day or days together with antibiotic treatment are the only measures to stop the infection. Depending on the status of the patient a hyperbaric oxygenation treatment seems to be useful in order to limit the infection. In fulminated cases early amputations, maximal intensive care treatment of the septic patient are required, where all means are warranted to save the patients life. As a consequence, early clinical diagnoses with thorough surgical debridement of the infected liquid necrotic fascia as well as correct antibiotic treatment are needed. Secondary plastic reconstruction of the soft tissue defects will generally be required.


title: Critical-illness-Myopathie und -Polyneuropathie

text: An average of 50–80% of patients treated in the intensive care unit is affected by disturbances of neuromuscular functions due to damage to the nerves and muscles, which has led to the terms critical illness polyneuropathy and myopathy. Both components occur in 30–50% of patients, while the others predominantly show a pure myopathy, while pure neuropathy is rare. Meanwhile, the descriptive term of the concept as intensive care unit-acquired weakness (ICUAW) is preferred. The most significant risk factors for the development of ICUAW are sepsis, multiorgan dysfunction and acute respiratory distress syndrome (ARDS). In at least one third of patients, persistent impairment by paralysis, sensory disturbances and balance problems persist when they leave the ICU. At approximately 10%, these leg-accentuated and highly everyday relevant disorders persist over the first year after ICU therapy. Pure myopathy rarely leads to residual disturbances, while the neuropathic component is responsible for long-term impairments.


title: Nichtinfektiöse Differenzialdiagnosen von Pneumonien

text: BACKGROUND: In patients with a clinical suspicion of pneumonia, typical clinical and laboratory features along with the detection of infiltrates on chest X‑ray are as a rule considered diagnostic and therapy is immediately initiated; however, studies have shown that in up to 5% of patients with an initial suspicion of pneumonia, another noninfectious pulmonary disease was the underlying cause. Early recognition and differentiation of diseases mimicking pneumonia are prerequisites for an adequate therapy. OBJECTIVE: The aim of this review is to present the important noninfectious differential diagnoses of pneumonia and to provide the reader with tools for a systematic diagnostic approach. MATERIAL AND METHOD: A literature search was carried out. RESULTS: As alterations in the lungs often result in similar imaging appearances and a differentiation between transudates, exsudates, blood and cells is not feasible by chest X‑ray or CT, a systematic approach is essential to make an appropriate diagnosis. Hence, consideration of the temporal course, predominant pattern, distribution of findings, additional findings and clinical presentation are indispensable.


title: Profile: Malik Peiris

text: If battling a viral illness for a week can be tiring, being consumed by it for years can be downright exhausting. Still, Malik Peiris labors on in his quest to conquer the elusive infections.


title: Rekombinante Hepatitis-B-Impfstoffe und Verdachtsfälle unerwünschter Reaktionen Eine Bewertung der Spontanerfassungsdaten des Paul-Ehrlich-Instituts 1995 bis 2000: Eine Bewertung der Spontanerfassungsdaten des Paul-Ehrlich-Instituts 1995 bis 2000

text: In October 1995, after realising that the strategy of immunising only individuals at high risk for hepatitis B infections did not influence the incidence, the STIKO (permanent Committee on Vaccination at the Robert Koch-Institute) recommended the general immunisation of all infants and children. The number of paediatric doses of recombinant vaccine sold between1995 and 2000 shows that HBV vaccination is widely accepted by paediatricians. The cases of suspected adverse reactions reported from the German spontaneous pharmacovigilance system are summarised and discussed.


title: Akutes Leberversagen

text: Acute liver failure (ALF) is a rare, but life-threatening disease that is characterized by the acute onset of jaundice, coagulopathy, and hepatic encephalopathy (HE) in patients without pre-existing liver disease. Main causes in Germany are drug toxicity, acetaminophen overdose, and viral hepatitis (A, B, E). For the initial assessment of patients with ALF and the diagnostic algorithm, the early detection of HE, exclusion of liver cirrhosis, immediate diagnosis of the underlying etiology, and evaluation for the necessity of liver transplantation (LT) are critical. Intensive care therapeutic measures aim at preventing or treating complications of ALF. Potentially, plasmapheresis (full plasma exchange) offers a survival benefit for ALF patients who do not undergo LT. The King’s College criteria and the Clichy criteria are used as prognostic tools for the indication for LT.


Abstracts der 37. Jahrestagung der Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin (GNPI)


title: Intensivmedizinische Probleme des hämatoonkologischen Patienten

text: The life expectancy and prevalence of malignant diseases is continuously on the rise, which inevitably leads to an increase of critically ill cancer patients. This article explains why the prognosis of cancer patients in the intensive care unit has markedly improved over the last decades, what the reasons for admission are and which risk factors affect mortality. Furthermore, the importance of correct patient selection and other specific topics will be discussed. Accordingly, acute respiratory failure for example is the most common organ dysfunction in these patients and has specific prognostic, diagnostic and therapeutic characteristics. The successful management of cancer patients in the intensive care unit requires specific knowledge of the intensive care physician and an excellent cooperation with the treating hematologist and oncologist.


title: Der alte Mann und die „I sea U“: Essay über Vertrauen, Schicksal und Evidenz – im Stil von Hemingway

text: Robert Bartlett, emeritus Professor of surgery at the University of Michigan in Ann Arbor, USA, transformed classical works of world literature (Charles Dickens: A Christmas Carol, Lewis Carroll: Alice in Wonderland) into teaching aids for advanced training in intensive care medicine. He recently turned his hand to the well-known work of Ernest Hemingway: the Nobel Prize winning novel The Old Man and the Sea. Subsequent to Robert Bartlett’s essay this article provides background information and comments on the current problems in modern intensive care medicine addressed in his essay.


title: Lungentransplantation: Indikationen, Langzeitergebnisse und die besondere Bedeutung der Nachsorge

text: Lung transplantation has been established as an appropriate ultimate treatment strategy in end-stage lung disease, when all conventional therapeutic options have been exhausted. A successful transplantation should result in an improved quality of life as well as an increase in life-expectancy for certain diseases (cystic fibrosis, pulmonary fibrosis and pulmonary hypertension). There is still a critical need regarding the number of available donor organs. Presently, one out of six patients dies on the waiting list. In order to identify suitable candidates for transplantation a number of criteria require consideration. These include the exact etiology of the pulmonary or cardiac disease, but also patient age, physical mobility, nutritional and muscular status as well as a comprehensive assessment to exclude significant extra-pulmonary co-morbidities. Complications arising after transplantation occur because of general perioperative risks, but also as a result of specific issues such as acute or chronic graft rejection, airway stenoses, infections of the newly immunosuppressed patient as well as a complete spectrum of secondary extra-pulmonary conditions. Comprehensive follow-up care in lung transplantation patients remains a vital issue. Analyses have shown a relevant improvement in long-term outcome, when follow-up care is delivered in cooperation with an established large volume transplant centre.


title: Lung diseases after bone marrow transplantation: Results of a clinical, radiological, histological, immunological and lung function study

text: The case histories of 72 subsequently treated patients — 44 with acute leukemia, 10 with chronic myeloid leukemia, 16 with severe aplastic anemia and 2 with neuroblastoma — were analyzed after bone marrow transplantation (BMT) with respect to pulmonary diseases. Thirty-eight patients suffered from a total of 51 pulmonary complications, which led to death in 20. Of 13 patients, 3 died of bacterial pneumonia, all of them during granulocytopenia; 2 of 6 patients died of fungal pneumonia and 2 out of 3 of a mixed bacterialmycotic infection. Adult respiratory distress syndrome (ARDS) led to death in 2 patients. A granulocyte count under 500/µl correlated significantly (P<0.002) with the fatal outcome of bacterial, fungal and ARDS pneumonia as well as with bronchitis. Viral pneumonia led to death in 8 of 9 patients; in each there was a significant correlation (P<0.05) with graft-versus-host disease (GvHD). Patients with repeated episodes of pulmonary illness had significantly more chronic GvHD (P<0.05); several of these patients displayed a reduction in helper T cells and an increase in suppressor T cells in the peripheral blood. The natural killer (NK) cells were reduced and the percentage of activated NK cell level lay between 6% and 69%. B-cells were absent or deficient. These findings explain in part the absence of specific antibody reactivity. Five of these patients also contracted GvHD-associated obstructive bronchiolitis, which did not respond to therapy. Pulmonary infiltrates of unknown origin (including idiopathic interstitial pneumonia) occurred in 8 of the patients (11.1%), with a fatal outcome in 3 patients. Significant changes (P<0.05) in lung function after BMT appeared in the form of reduced vital capacity (VC) increased residual volume (RV) and an increase in RV expressed as the percentage of total lung capacity. Pulmonary diseases were the most common complication and cause of death in our patients after BMT.


Complement-specific antibodies: Designing novel anti-inflammatories


title: Multiple Sklerose Aktuelle Übersicht zu fehlgeschlagenen und abgebrochenen Therapiestudien: Aktuelle Übersicht zu fehlgeschlagenen und abgebrochenen Therapiestudien

text: Recent immunobiological findings together with advances in biotechnology, ameliorations in clinical trial design, and MRI developments have led to a variety of therapeutical approaches in multiple sclerosis (MS). However, in contrast to successfully introduced new treatments, a number of therapeutical failures exist as well: despite impressive data from animal models, convincing concepts, and promising phase I/II studies, some investigated drugs and strategies showed no positive effects in clinical trials, or trials had to be terminated because of unexpected side effects. This article provides an overview of clinical studies that have failed or been abandoned for other reasons. Tumor necrosis factor (TNF) α-antagonists which have led to negative effects in two studies (Lenercept, Infliximab) are discussed in detail. These results raise critical questions concerning the hypothetical pathogenesis of MS lesions and the value of MRI in the assessment of clinically relevant therapeutic drug effects. In addition to a description of the immunobiological background, studies on the immunosuppressive agents linomide, deoxyspergualin, sulfasalazine and cladribine, trials for the cytokines interleukin-10 and TGF-β2, the studies on remyelination by intravenous immunoglobulins (IVIg), oral tolerance, and extracorporeal photopheresis are discussed.


Abstracts zum 122. Kongress der Deutschen Gesellschaft für Innere Medizin e.V.


title: Bakterielle Pneumonien

text: Die folgende Übersichtsarbeit ist gegliedert nach dem Auftreten der Pneumonien außerhalb oder innerhalb des Krankenhauses. Die wichtigsten bakteriellen Erreger werden im Einzelnen aufgeführt und deren Behandlung beschrieben. Die Lungentuberkulose bleibt außer Betracht.


title: Role of reactive oxygen species in biological processes

text: The steady-state formation of prooxidants in cells and organs is balanced by a similar rate of their consumption by antioxidants that are enzymatic and/or nonenzymatic. “Oxidative stress” results from imbalance in this prooxidantantioxidant equilibrium in favor of the prooxidants. A number of diseases are associated with oxidative stress, being the basis of a potential antioxidant therapy. However, current evidence in clinical research does not show unequivocal distinction between causal or associative relationships of prooxidants to the disease process.


title: Akuter Effekt von inhalativem Stickstoffmonoxid auf die Oxygenation bei Kindern mit Virus-induzierter, hypoxämischer Ateminsuffizienz

text: Background: Inhaled nitric oxide (iNO) has been used to improve oxygenation in adults and children with acute respiratory distress syndrome (ARDS) since several years. Previous studies on the effect of iNO in patients with ARDS were usually lumped together with respect to causation. Methods: We describe the acute effect of iNO in 4 children (age 4–54 months) suffering from acute, virus-induced, hypoxemic respiratory failure. Inhaled NO was administered at a dose of 20 ppm during the first hour and subsequently decreased to a dose of 5 ppm. The effects on oxygenation were assessed by changes in arterial oxygen tension and in the oxygenation index at one and 4 hours after initiating iNO therapy. Results: Inhaled NO dramatically improved oxygenation in 3 of 4 children and reduced the oxygenation index by more than 30%. One patient showed no improvement in oxygenation, but a significant reduction in pulmonary vascular resistance. Discussion: Although previous studies have failed to show any benefit of iNO on the survival rate of children with ARDS, we believe that its use can be justified if the improvement in oxygenation helps to stabilise the patient during the acute stage of hypoxemic respiratory failure.


title: Thrombopenie auf der Intensivstation: Diagnose, Differenzialdiagnose und Therapie

text: Thrombocytopenia is a frequent phenomenon in intensive care medicine. A variety of conditions can be responsible for low platelet counts. As platelets are part of the primary hemostatic system, bleeding is the most important complication of thrombocytopenia. Proper workup of the differential diagnosis to identify the cause of thrombocytopenia is essential because the various underlying disorders require different diagnostic and therapeutic management strategies. A low platelet count is a strong predictor of outcome in critically ill patients. This article summarizes the differential diagnosis and diagnostic workup of thrombocytopenia in the critically ill, describes the most important conditions, and gives an overview on therapeutic options and strategies.


Anforderungen an die Hygiene bei der medizinischen Versorgung von immunsupprimierten Patienten: Empfehlung der Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut (RKI)


Level 3 guideline on the treatment of patients with severe/multiple injuries: AWMF Register-Nr. 012/019


title: Pneumologie

text: Lungenerkrankungen stehen mit 10% in der Mortalitätsstatistik an 3. Stelle und machen 15% aller Arbeitsunfähigkeitsfälle aus; 40% aller Todesfälle auf Intensivstationen sind pulmonaler Genese. Als Todesursache infektiöser Krankheiten führen Pneumonien weltweit, die Tuberkulose steht an 5. Stelle. Diese Zahlen sprechen für sich und unterstreichen die Bedeutung der Pneumologie als wichtiges Teilgebiet der Inneren Medizin, eng verzahnt mit den anderen Teilgebieten. Bahnbrechende Fortschritte konnten in den letzten Jahren bezüglich der Ursachen, der Pathogenese, Diagnostik und Therapie von Lungenerkrankungen gemacht werden. So kann die vorliegende Arbeit trotz ihres Umfangs nur eine tour d’horizon über die Techniken und diagnostischen sowie therapeutischen Möglichkeiten der Pneumologie sein. Anhand der wichtigsten Krankheitsbilder werden in aller Kürze die neuesten Perspektiven des Fachgebiets aufgezeigt. Die Pneumologie hat leider hierzulande Strukturprobleme. Im Gegensatz zu den USA und anderen westeuropäischen Universitäten ist sie deutlich unterrepräsentiert, so daß eigenständige Abteilungen gegenwärtig nur an wenigen deutschen Universitäten bestehen. Es wird angestrebt, nicht zuletzt mit Unterstützung des Wissenschaftsrats, dies zu ändern.


Abstracts der 51. Jahrestagung der Österreichischen Gesellschaft für Kinder- und Jugendheilkunde (ÖGKJ)


title: Menno de Jong

text: He is so soft-spoken you may have to strain to catch his words, but on the topic of recognition for scientists in resource-poor regions, Menno de Jong is ready for a fistfight.


Abstracts der DGIM


The 12th World Congress on Inflammation: 8–12 August, 2015 Seaport Hotel and World Trade Center, Boston, USA


title: Angiotensin-converting enzyme is a GPI-anchored protein releasing factor crucial for fertilization

text: The angiotensin-converting enzyme (ACE) is a key regulator of blood pressure. It is known to cleave small peptides, such as angiotensin I and bradykinin and changes their biological activities, leading to upregulation of blood pressure. Here we describe a new activity for ACE: a glycosylphosphatidylinositol (GPI)-anchored protein releasing activity (GPIase activity). Unlike its peptidase activity, GPIase activity is weakly inhibited by the tightly binding ACE inhibitor and not inactivated by substitutions of core amino acid residues for the peptidase activity, suggesting that the active site elements for GPIase differ from those for peptidase activity. ACE shed various GPI-anchored proteins from the cell surface, and the process was accelerated by the lipid raft disruptor filipin. The released products carried portions of the GPI anchor, indicating cleavage within the GPI moiety. Further analysis by high-performance liquid chromatography–mass spectrometry predicted the cleavage site at the mannose-mannose linkage. GPI-anchored proteins such as TESP5 and PH-20 were released from the sperm membrane of wild-type mice but not in Ace knockout sperm in vivo. Moreover, peptidase-inactivated E414D mutant ACE and also PI-PLC rescued the egg-binding deficiency of Ace knockout sperms, implying that ACE plays a crucial role in fertilization through this activity. SUPPLEMENTARY INFORMATION: The online version of this article (doi:10.1038/nm1179) contains supplementary material, which is available to authorized users.


title: Course correction

text: The international response to the ongoing Ebola epidemic has in many respects been more reactive than proactive. But there are changes that, if made, may shift the balance toward future readiness.


title: Der hämatoonkologische Patient im Intensivmanagement

text: Critically ill cancer patients on intensive units with hematological or oncological underlying diseases are a special situation: the underlying disease may be incurable, acute problems are often therapy associated and immunosuppression is regularly present. Due to evolving knowledge about special aspects of these patients and optimized supportive therapy, the prognosis has substantially improved during the last decades. General reluctance to admit cancer patients to an intensive care unit is therefore no longer justified. Reasons for admission are often infections and/or respiratory failure. Extensive diagnostic measures, causal and supportive therapy of sepsis according to current guidelines has led to improved outcome even in cancer patients. In respiratory failure, non-invasive ventilation is the key to improved prognosis if used early enough and indications, contraindications and break-off criteria are strictly followed. The prognosis of critically ill cancer patients is determined by the severity of the acute problem and not by the underlying disease.


title: Thrombotische Mikroangiopathien: Relevante Neuigkeiten für den Intensivmediziner

text: Thrombotic microangiopathy (TMA) is a clinical syndrome that is characterized by hemolysis, thrombocytopenia, and acute kidney injury, known as atypical hemolytic syndrome (aHUS), thrombotic thrombocytopenic purpura (TTP), and shigatoxin-associated HUS (STEC-HUS) among others. Several diseases, like malignoma, infections, malignant hypertension, or autoimmune disease can result in secondary TMAs. aHUS is caused by a hyperactivated complement system. Identification of the underlying causes of the TMA is the most important issue and directly associated with treatment success. In case of secondary TMAs, treatment of the actual disease is the most important step, while in case of complement-mediated HUS treatment of choice is plasma exchange or anticomplement agents. For the treatment of TTP, rapid initiation of plasma exchange or plasma infusion is the treatment of choice. Patients with STEC-HUS should solely receive supportive treatment.


title: Brain renin angiotensin in disease

text: A brain renin angiotensin system (RAS) and its role in cardiovascular control and fluid homeostasis was at first controversial. This was because a circulating kidney-derived renin angiotensin system was so similar and well established. But, the pursuit of brain RAS has proven to be correct. In the course of accepting brain RAS, high standards of proof attracted state of the art techniques in all the new developments of biolo1gy. Consequently, brain RAS is a robust concept that has enlightened neuroscience as well as cardiovascular physiology and is a model neuropeptide system. Molecular biology confirmed the components of brain RAS and their location in the brain. Transgenic mice and rats bearing renin and extra copies of angiotensinogen genes revealed the importance of brain RAS. Cre-lox delivery in vectors has enabled pinpoint gene deletion of brain RAS in discrete brain nuclei. The new concept of brain RAS includes ACE-2, Ang1–7, and prorenin and Mas receptors. Angiotensin II (ANG II) generated in the brain by brain renin has many neural effects. It activates behavioral effects by selective activation of ANG II receptor subtypes in different locations. It regulates sympathetic activity and baroreflexes and contributes to neurogenic hypertension. New findings implicate brain RAS in a much wider range of neural effects. We review brain RAS involvement in Alzheimer’s disease, stroke memory, and learning alcoholism stress depression. There is growing evidence to consider developing treatment strategies for a variety of neurological disease states based on brain RAS.


title: Beatmung von Neugeborenen und Säuglingen

text: Anaesthesiologists must be familiar with the particularities of the respiratory physiology of newborns and infants when providing perioperative care to these patients. Even brief periods of inadequate respiratory support can cause atelectatrauma and volutrauma which in turn can have deleterious cardiorespiratory consequences and accentuate pre-existing lung disease. A variety of respirators and respiratory support strategies are available and should be selected to meet a patient’s particular needs. Optimal PEEP and normal tidal volumes during conventional ventilation, high volume strategy during high frequency ventilation, and permissive hypercapnia are the corner stones of a lung protective strategy. Using an interdisciplinary approach, surgery in the intensive care unit using total intravenous anaesthesia with the uninterrupted use of the ICU equipment is an attractive option for the most vulnerable patients in this age group.


Durch Staphylococcus aureus verursachtes Toxic-shock-Syndrom


title: Pre-treatment with angiotensin-(1–7) inhibits tumor growth via autophagy by downregulating PI3K/Akt/mTOR signaling in human nasopharyngeal carcinoma xenografts

text: ABSTRACT: The highest incidence of nasopharyngeal carcinoma (NPC) is in southeast China, including Taiwan. Many side effects have been observed following radiation therapy with chemotherapy; hence, exploring new treatment modalities for NPC is an important future direction. Angiotensin-(1–7) [Ang-(1–7)] is an endogenous heptapeptide hormone and important component of the renin–angiotensin system that acts through both the Mas receptor and AT2 receptor, exhibiting anti-proliferative and anti-angiogenic properties in cancer cells. However, the anti-cancer activity of Ang-(1–7) related to autophagy in NPC remains largely debated. The effects and signaling pathway(s) involved in the Ang-(1–7)/Mas receptor axis in NPC were investigated both in vitro and in vivo. Ang-(1–7) inhibited cell proliferation, migration, and invasion in NPC-TW01 cells. Ang-(1–7) induced autophagy by increasing the levels of the autophagy marker LC3-II and by enhancing p62 degradation via activation of the Beclin-1/Bcl-2 signaling pathway with involvement of the PI3K/Akt/mTOR and p38 pathways in vitro study. In addition, pre-treatment with Ang-(1–7) inhibited tumor growth in NPC xenografts by inducing autophagy, suggesting a correlation between PI3K/Akt/mTOR pathway inhibition and the abovementioned anti-cancer activities. However, no autophagy was observed following Ang-(1–7) post-treatment. Taken together, these data indicate that Ang-(1–7) plays a novel role in autophagy downstream signaling pathways in NPC, supporting its potential as a therapeutic agent for alleviation the incidence of NPC and preventive treatment of recurrent NPC. KEY MESSAGES: Ang-(1–7) inhibits cell proliferation, migration, and invasion by activating autophagy. Ang-(1–7)pre-treatment inhibits tumor growth via autophagy by suppressing PI3K/Akt/mTOR pathway. Ang-(1–7) may provide a novel preventative treatment for NPC and recurrent NPC. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (10.1007/s00109-018-1704-z) contains supplementary material, which is available to authorized users.


Mitteilungen der Deutschen Gesellschaft für Innere Medizin


title: Diagnostik und Behandlung akuter psychoorganischer Syndrome

text: Psychiatric disorders due to a medical or neurological condition are the main differential diagnoses in newly admitted psychiatric patients, consultations and outpatient settings. Especially with the growing elderly population delirium occurs more frequently, often due to multiple causes. Although its prognosis is known to be unfavourable, delirium too often remains undiagnosed or untreated. Medications, neurological diseases, infections as well as metabolic and other medical conditions have to be ruled out in the differential diagnosis using the patient’s history, physical examination, laboratory results and imaging procedures. First-time psychiatric symptoms of an unknown medical disease as well as co-occurring psychiatric symptoms in chronic diseases provoke a challenging diagnostic decision, as reactive psychiatric symptoms have to be distinguished which is not always possible. In psychiatric disorders confirmed to be due to a medical condition, therapeutic implications are primarily geared to the causes of the disease. Only in a second step psychiatric medication is warranted with antipsychotic, antidepressant or sedation-inducing properties depending on the patient’s symptoms.


title: Die Lungentuberkulose – aktuelle radiologische Diagnostik einer alten Krankheit

text: Incidence. Decreasing numbers of tuberculosis cases in the western countries have led to diminished attention towards this disease. But worldwide, tuberculosis still is the leading cause of mortality due to any one single infectious agent. In the industrialized countries, immigration, growth of low-income groups and increasing numbers of immunocompromised patients, mainly due to the HIV epidemic, supply a reservoir for tuberculosis. Diagnosis. Because of the option of a specific therapy, early diagnosis of tuberculosis is crucial for the course of the disease. In cases of multidrug resistant strains, further spread has to be prevented. Radiology with chest films and computed tomography has a central role in diagnosing tuberculosis. Findings. However, as the disease produces a broad spectrum of radiographic findings, there are often difficulties in determining the underlying diagnosis. Additionally, there have been reports of atypical presentations of tuberculosis in immunocompromised as well as immunocompetent patients. This article reviews the current state of radiological diagnosis of pulmonary tuberculosis.


title: Respiratorische Insuffizienz verursacht durch nicht-pulmonale Funktionsstörungen

text: Das Spektrum der Erkrankungen, die zu pulmonalen Komplikationen in Form einer respiratorischen Insuffizienz führen können, ist groß und reicht von internistischen Krankheitsbildern wie Herz- oder Niereninsuffizienz über chirurgisch-orthopädische Probleme wie Traumen und Operationsfolgen zu der großen Gruppe der zentralnervös bedingten und neuromuskulären Erkrankungen. Bereits bei Diagnose dieser Erkrankungen sollte eine sorgfältige pneumologische Untersuchung erfolgen, die durch ein verlaufsbegleitendes Monitoring ergänzt werden muss. Dieses Vorgehen stellt die Grundlage für eine adäquate Therapie einer sich entwickelnden respiratorischen Insuffizienz dar, die neben der Behandlung der Grunderkrankung symptomatische Maßnahmen bis hin zur Durchführung der nicht-invasiven und invasiven Beatmung umfassen muss.


title: NOX enzymes: potential target for the treatment of acute lung injury

text: Acute lung injury (ALI) and its more severe form, acute respiratory distress syndrome (ARDS), is characterized by acute inflammation, disruption of the alveolar-capillary barrier, and in the organizing stage by alveolar pneumocytes hyperplasia and extensive lung fibrosis. The cellular and molecular mechanisms leading to the development of ALI/ARDS are not completely understood, but there is evidence that reactive oxygen species (ROS) generated by inflammatory cells as well as epithelial and endothelial cells are responsible for inflammatory response, lung damage, and abnormal repair. Among all ROS-producing enzymes, the members of NADPH oxidases (NOXs), which are widely expressed in different lung cell types, have been shown to participate in cellular processes involved in the maintenance of lung integrity. It is not surprising that change in NOXs’ expression and function is involved in the development of ALI/ARDS. In this context, the use of NOX inhibitors could be a possible therapeutic perspective in the management of this syndrome. In this article, we summarize the current knowledge concerning some cellular aspects of NOXs localization and function in the lungs, consider their contribution in the development of ALI/ARDS and discuss the place of NOX inhibitors as potential therapeutical target.


title: The surfactant system of the adult lung: physiology and clinical perspectives

text: Pulmonary surfactant is synthesized and secreted by alveolar type II cells and constitutes an important component of the alveolar lining fluid. It comprises a unique mixture of phospholipids and surfactant-specific proteins. More than 30 years after its first biochemical characterization, knowledge of the composition and functions of the surfactant complex has grown considerably. Its classically known role is to decrease surface tension in alveolar air spaces to a degree that facilitates adequate ventilation of the peripheral lung. More recently, other important surfactant functions have come into view. Probably most notable among these, surfactant has been demonstrated to enhance local pulmonary defense mechanisms and to modulate immune responses in the alveolar milieu. These findings have prompted interest in the role and the possible alterations of the surfactant system in a variety of lung diseases and in environmental impacts on the lung. However, only a limited number of studies investigating surfactant changes in human lung disease have hitherto been published. Preliminary results suggest that surfactant analyses, e.g., from bronchoalveolar lavage fluids, may reveal quantitative and qualitative abnormalities of the surfactant system in human lung disorders. It is hypothesized that in the future, surfactant studies may become one of our clinical tools to evaluate the activity and severity of peripheral lung diseases. In certain disorders they may also gain diagnostic significance. Further clinical studies will be necessary to investigate the potential therapeutic benefits of surfactant substitution and the usefulness of pharmacologic manipulation of the secretory activity of alveolar type II cells in pulmonary medicine.


title: Unklares Fieber, Kopf- und Muskelschmerzen, Hämoptoe, Hepatosplenomegalie und Ikterus Zwei Fallbeispiele: Zwei Fallbeispiele

text: Die Leptospirose kommt in der Schweiz aufgrund der klimatischen Verhältnisse selten vor, trotzdem wird die Inzidenz dieser Krankheit unterschätzt. Das klinische Bild ist vielfältig. Die Differentialdiagnose reicht von einer grippeähnlichen Erkrankung bis hin zur akut verlaufenden Systemerkrankung. Diese Tatsache erfordert aufgrund der therapeutischen Konsequenz, die Durchführung einer intensiven und häufig auch invasiven Diagnostik, welche letztlich oft unergiebig bleibt. Neue und vor allem schnellere diagnostische Möglichkeiten mittels PCR aus Blut, Liquor und Urin werden diskutiert, sind aber noch nicht etabliert. Eine antibiotische Therapie wird je nach Verlaufsform kontrovers beurteilt.


Research Notes


title: Knochenmarktransplantation bei akuter Leukämie, chronisch myeloischer Leukämie, schwerer aplastischer Anämie und Neuroblastom Stadium IV. Einfluß antiviraler Prophylaxe mit Anti-CMV-Hyperimmunglobulin und Azyklovir

text: Bone marrow transplantation was performed between IV/82 and X/85 in 64 patients with acute leukemia (n=36), chronic myelogenous leukemia (CML;n=13), severe aplastic anemia (n=12), and neuroblastoma stage IV (n=3). Of these patients 57 received allogeneic marrow from HLA-ABCDR identical, MLC-negative sibling donors. Six transplants were performed with syngenic marrow and one with autologous marrow. Of the 64 patients 48 survived 40-1,250 days after transplantation, resulting in a survival rate (SR) of 75% and a survival probability (SP) of 71%. Of the 36 patients suffering from acute leukemia (SR=64%, SP=51%), patients with acute myelogenous leukemia (AML) in first complete remission (n=11; SR=81%, SP=76%), as well as patients with acute lymphatic leukemia (ALL) in 1st to 4th complete remission at the time of transplantation (n=14; SR=81%, SP=76%) show a favorable prognosis. A poor survival rate was seen for patients with AML when transplanted in second or partial remission (1/5; SR=20%), as well as for patients suffering from ALL and transplanted during relapse or partial remission (1/6; SR=16%). Of 13 patients suffering from CML 12 survived the transplantation free of relapse (SR=93%, SP=92%), and one patient died from varicella zoster pneumonia. Of the transplanted patients with severe aplastic anemia, 12 of 13 are surviving with complete hematologic reconstitution; one patient, however, died on day 10 from a sepsis. In our patient group, the SR as well as the SP has been improved through changes in the irradiation protocol concomitant with prophylactic application of anti-CMV hypergammaglobulin, as well as through additional oral medication of Azyklovir. The 41 patients (BMT No. 7–47) with total body irradiation at one time-show an SR of 44% and an SP of 41%. The following 46 patients (BMT No. 48–93) have reached an SR of 83% and an SP of 74% under the regimen of fractionated total body irradiation, plus prophylaxis with anti-CMV hypergammaglobulin and Azyklovir. Within this group, no fatal CMV pneumonia was encountered as opposed to six patients lost from CMV pneumonia in the first group.


title: Perioperative Anämietoleranz: Mechanismen, Einflussfaktoren, Grenzen

text: The expected cost explosion in transfusion medicine increases the socio-economic significance of specific institutional transfusion programs. In this context the estimated use of the patient’s physiologic tolerance represents an integral part of any blood conservation concept. The present article summarizes the mechanisms, influencing factors and limits of this natural tolerance to anemia and deduces the indication for perioperative red blood cell transfusion. The current recommendations coincide to the effect that perioperative transfusion is unnecessary up to a Hb concentration of 10 g/dl (6.21 mmol/l) even in older patients with cardiopulmonary comorbidity and is only recommended in cases of Hb <6 g/dl (<3.72 mmol/l) in otherwise healthy subjects including pregnant women and children. Critically ill patients with multiple trauma and sepsis do not seem to benefit from transfusions up to Hb concentrations >9 g/dl (>5.59 mmol/l). In cases of massive hemorrhaging and diffuse bleeding disorders the maintenance of a Hb concentration of 10 g/dl (6.21 mmol/l) seems to contribute to stabilization of coagulation.


title: Hochauflösende Computertomographie der Lunge: Milchglas und seine Differenzialdiagnosen

text: Ground glass opacity (GGO) is defined as diffuse pulmonary infiltration which does not obscure vessels and bronchial walls and is due to intra-alveolar or interstitial processes of pulmonary parenchyma which only partially replace air. The etiology is variable including edema, airspace and interstitial pneumonia due to different organisms, non-infectious pneumonitis as well as tumor manifestations. Physiological processes, such as poor ventilation of dependent lung areas and effects of expiration can also present as ground glass opacity. This review describes the physiology and pathophysiology of GGO, illustrates different examples of common diseases presenting with GGO and reviews how GGO may be used for diagnosis and differential diagnosis of pulmonary disease.


title: Verbreitung von Hantavirusinfektionen in Deutschland

text: Hantaviruses belong to the group of “emerging” viruses. Pathogenic European hantaviruses can cause a human disease designated “hemorrhagic fever with renal syndrome” of varying severity. In general, diagnostics of hantavirus infections are based on immunofluorescence assays using virus-infected cells or enzyme immunoassays and Western blot tests using recombinant nucleocapsid proteins. For highly sensitive detection of hantavirus-specific antibodies in the enzyme immunoassay, a homologous hantavirus nucleocapsid protein is needed as a diagnostic antigen. Serological typing of hantavirus infections can be obtained by neutralization assays, which in certain cases require the use of late convalescent sera. The seroprevalence in the normal German population is about 1%. In professionally exposed risk groups, e. g., forest workers, a seroprevalence higher than that in the normal population was observed. Endemic regions for hantavirus infections are located mainly in Baden-Württemberg. In the years 2001–2003 an annual number of about 200 clinically apparent hantavirus infections were registered in Germany. Neutralization assays detected almost exclusively human infections caused by Puumala and Dobrava viruses, only very rarely by Tula virus. Until this day in Germany mainly mild to moderate courses of human hantavirus infections have been documented. Besides infections caused by “German” hantaviruses, up to 10% of the clinically apparent hantavirus infections registered annually in Germany are caused by infections imported from other countries, mainly from Europe. So far only very limited molecular genetic data about the circulating hantaviruses in Germany are available. Additional investigations are needed to get a more precise picture about the distribution of hantaviruses in Germany and to calculate the resulting risk for the human population.


title: Akutes Leberversagen: Übersicht zur aktuellen Diagnostik und Therapie

text: Although acute liver failure is a rare disease with a prevalence of 5 per 1 million people, it has a considerablely high mortality rate of 34 %. The main causes in western civilizations are drug overdose (acetaminophen) and viral hepatitis. Patients are affected by the loss of liver synthesis function and are at risk of developing hepatic encephalopathy and possible multiorgan failure. Specific therapies consisting of the administration of N-acetylcysteine (acetaminophen) or of nucleotide/nucleoside analogs (hepatitis B) are possible, but are often not adequate. Orthotopic liver transplantation is, therefore, frequently the only remaining effective therapy for severe acute liver failure. Due to organ shortage, new prognostic tools, e.g., the Acute Liver Failure Study Group (ALFSG) score, have been developed to improve patient selection using sufficiently stringent selection criteria.


Extracellular phospholipase A(2): causative agent in circulatory collapse of septic shock?


Taiwanese scientists brace for second season of SARS


title: Risikofaktoren für die Pneumonieentwicklung beim mehrfachverletzten Patienten : Ergebnisse einer prospektiven klinischen Studie

text: Pneumonia is the most common infectious complication in multiple trauma patients. In a prospective clinical cohort study, 266 multiply injured patients were examined for the development of pneumonia.Various risk factors were tested in uni- and multivariate analyses.Three different definitions of pneumonia were used in order to examine how results depended on definition.The incidence of pneumonia was 41%, but varied with definition (30–50%). Injuries to the thorax, head,and abdomen were associated with a significantly increased risk of pneumonia (adjusted relative risk: 1.77, 1.97,and 1.52, respectively).Furthermore, increasing age led to a higher risk of pneumonia. Although the primary analysis revealed a higher pneumonia risk in male patients (adjusted relative risk: 2.23; 95% CI: 1.43–3.05), this result could not be consistently reproduced when using other definitions of pneumonia. Trunk and head injuries and age are proven risk factors for developing posttraumatic pneumonia.The association between male gender and an increased rate of infectious complications remained questionable.


Abstracts des 114. Internistenkongresses 2008


title: Ulzerierende Herpes-simplex-Infektionen bei intensivpflichtigen Patienten

text: Herpes simplex infections are potentially a life-threatening situation for immunocompromised as well as critically ill patients. The correct diagnosis is made more difficult in comatose patients by the fact that the characteristic symptom of extreme pain cannot be registered. The clinical dermatological findings (polycyclic configuration, easily bleeding ulcers) are thus especially important in patients under intensive care conditions. As examples, the cases of 3 critically ill patients (subarachnoid bleeding or head injury) developing therapy-resistant, flat sacral or perioral skin ulcers with peripheral blisters are presented. Herpes simplex virus was confirmed immunohistologically and in the smear test. All patients subsequently died. These cases emphasize that patients in the intensive care unit are in danger of developing a chronic persistent Herpes simplex infection due to latent immunosuppression. Chronic persistent Herpes infections may be underrated in intensive therapy, and must always be ruled out in case of therapy-resistant erosions or ulcerations.


title: Akutes Leberversagen

text: Das akute Leberversagen ist ein lebensbedrohlicher medizinischer Notfall. Es betrifft häufig jüngere Patienten, stellt erhebliche Anforderungen an die versorgende Intensiveinheit und ist eine der wesentlichen Indikationen für die Lebertransplantation. Die dynamische Weiterentwicklung der gesamten Hepatologie in den letzten Jahren hat auch die Behandlung des akuten Leberversagens erheblich verändert. Ein verbessertes Verständnis der pathophysiologischen Probleme dieses Krankheitsbildes führte dabei zur Entwicklung spezieller Behandlungsstrategien, die über eine allgemeine Intensivunterstützung weit hinausgehen. Das entstehende Gesamtkonzept der intensivmedizinischen Behandlung reicht von der Substitution fehlender Eiweißfaktoren bis zur differenzierten Prognoseabschätzung im Hinblick auf eine Lebertransplantation. Der vorliegende Artikel soll einen Überblick geben über spezifische Ursachen, charakteristische Probleme und therapeutische Ansätze in dieser internistisch-intensivmedizinischen Notfallsituation. Neben einer Reihe intensivmedizinischer Standardprobleme sind vor allem die Behandlung von Enzephalopathie, Hirnödem, Nierenversagen, metabolischen Störungen und des hyperdynamen Kreislaufversagens Gegenstand der Darstellung. Das akute Leberversagen zeigt sich dabei als pathophysiologisch komplexes Multiorganversagen, dessen Prognose entscheidend von entschlossenem und orientiertem Handeln abhängt.


title: Complications of plasma exchange in patients with neurological diseases

text: Plasma exchange has proven to be effective in diseases of established or presumed autoimmune etiology as well as in hyperviscosity syndromes and some rare metabolic disorders. Its application is thought to be relatively safe; nevertheless, severe complications may occur. We therefore analyzed the complications of 291 exchanges in 39 patients with neurological diseases. Minor complications developed in 4.8% and major complications in 2.7% of procedures, including one death. Severe infections and technical problems have been the most serious side effects, sometimes followed by organ failure or even death.


title: Thoraxröntgen in der Abklärung des unteren Respirationstrakts beim ambulanten pädiatrischen Patienten

text: The chest X-ray is frequently used for the evaluation of the lower respiration tract. The knowledge of the pediatric anatomy and physiology is essential for the correct interpretation of the image. Also the accuracy of the examination should be considered. Pneumonia is the most important disease of the lower respiration tract. As there is still a high risk of mortality, specific diagnosis is required to initiate a prompt and efficient therapy. Sensitivity and specificity of the pediatric chest x-ray depend on the experience of the interpreter and the available clinical information. This paper gives a short introduction to the interpretation of pediatric chest X-rays. Specific anatomic and physiologic characteristics in pediatric patients and related pathology are presented.


Die Intensivmedizin ist eine multi- und interdisziplinäre Herausforderung


title: Infektionen mit β-hämolysierenden Streptokokken der Gruppe A (GABS) und Streptokokkenfolgeerkrankungen

text: Group A β-hemolytic streptococci (GABS) are among the most frequent causes of bacterial infections during childhood. In addition to well-known local infections, scarlet fever, and sepsis, streptococcal toxic shock syndrome (STSS) and necrotizing fasciitis (NF) have been noted with increasing frequency.NF can also be induced in children by superinfected varicella, which is associated with a higher mortality rate.Triggering factors include pathogen-specific capsular proteins, virulent factors, and toxins as superantigens. Immunological quick tests display high reliability, and PCR enables analyses of types and toxins.Furthermore, type-specific streptococcal sequelae can be caused by group C streptococci.Rheumatic fever is rather rare in industrialized nations, but cardiac involvement accurs more frequent than previously assumed.Chorea apparently correlates with neuronal antibodies, as do pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS),and a series of cases of acute disseminated encephalomyelitis (ADEM) associated with streptococci have also been reported. No resistance to penicillin exists, but pathogenic persistence remains a problem.A 26-M valent vaccine is in clinical trials, but is still subject to controversy.


Agenda 2010 – wettbewerbsfähig und wissensbasiert: XVI. Internationales Heidelberger Anaesthesie-Symposium, 27.–28. März 2010


title: Outcome of pregnancy after organ transplantation: a retrospective survey in Italy

text: The number of women who decide to have a child after organ transplantation has increased. We determined the outcomes of 67 pregnancies of women who had undergone kidney, liver or heart transplantation. All recipients had been maintained on immunosuppressive therapy before and during pregnancy. Pregnancy complications at term were observed in 17 out of 67 women (25%), hypertension being the most frequent complication (16.17%). Two transplant rejections were reported. Sixty-eight infants were delivered (including one pair of twins); five women had two pregnancies at term. Twenty-eight miscarriages (29.2%) were recorded. Of these 68 babies (including the pair of twins), 40 (58.8%) were born at term and 28 (41.2%) before term. The babies were followed-up for 2 months to 13 years. According to our previous experience, our study shows that patients who have undergone organ transplantation can give birth to healthy infants as long as they are monitored accurately during pregnancy.


title: Sepsis-3: Was ist gesichert in der Therapie?

text: Hugo Schottmüller realized already over 100 years ago that sepsis is a syndrome that occurs as a consequence of an infection defined by a systemic overreaction to a periodic invasion of bacilli. Consistent with this old concept, the term “systemic inflammatory response syndrome” (SIRS) was coined about 25 years ago and has been regularly used ever since. In 2016, a sepsis task force was formed to re-evaluate the current definition on a scientific basis. The task force suggested a third definition (sepsis-3) of the disease that now focuses both on the pathological host response and on organ dysfunction as obligatory key features to diagnose sepsis. In this review article, the definition is explained in detail and we summarize the novel international sepsis guideline from 2017 with personal commentaries.


New York Academy pulmonary meeting — March 22, 1990


title: Hyperferritinämie beim Still-Syndrom des erwachsenen und reaktives hämophgozytisches Syndrom

text: □ This report describes the fatal outcome of a case of adult onset Still’s disease in a 46-year old man. The diagnosis was made according to the 1992 criteria, proposed by Yamaguchi. Nine months after the initial disease manifestations a rapid deterioration with progressive hepatosplenomegaly developed. In parall, pancytopenia and marked hyperferritinemia could be detected. Tranjugular liver biopsy revealed the presence of a hemophagocytic syndrome. The course of the disease was refractory to any form of treatment and the patient died from disseminated intravascular coagulation, hepatic and pulmonary failure. □ Pathogenetic mechanisms and possible associations between Still’s disease and reactive hemophagocytic syndrome are discussed.


title: Denguefieber: Klinik, Epidemiologie, Entomologie, Erregerdiagnostik und Prävention

text: Dengue infections are among the most frequent causes of febrile disease in tropical climates. Infections are caused by a flavivirus transmitted by the Aedes mosquito. Aedes aegypti mosquitos are the main transmitters of Dengue viruses. Since these insects are both diurnal and container breeders, particular prevention and control measures are required. Symptom severity varies and can range from a mild, flu-like clinical picture to severe hemorrhage and shock. The most common symptoms experienced by travelers include fever, muscular pain, headaches and skin rash. Depending on the stage of infection, either rapid point-of-care tests or—during the viraemic phase—direct molecular detection of pathogens can be used as diagnostic methods. Serological diagnosis is challenging in terms of interpretation due to serological cross reactions with other flaviviruses.


Fieber im Wochenbett


Line item cut threatens monitoring of more than West Nile virus


title: Neue Influenza-A/H1N1-2009-Virus-Pandemie: Herausforderung für die Intensivmedizin

text: The novel pandemic influenza A/H1N1v has also led to a rapid increase in the number of new cases in Germany. In the majority of patients the disease has taken a mild clinical course. However, in isolated cases severe complications requiring hospitalization or intensive care treatment have occurred. Most of the current recommendations refer to outpatients or mild diseases and are not always suitable and practicable for the management of a life-threatening influenza A/H1N1v infection in an intensive care setting. The aim of this review is to present a reliable diagnostic and therapeutic approach for critically ill patients, considering the current literature, case-based experiences from our own intensive care unit and including relevant recommendations of public health authorities. Initial measures regarding therapeutic, diagnostic and isolation precautions arise from past medical history, current anamnesis and characteristic symptoms and their progression. Patients suspected of having acquired an influenza A/H1N1v infection should be isolated. Early laboratory diagnosis of A/H1N1v infection ideally utilizes the reverse transcriptase polymerase chain reaction (RT-PCR) as the most sensitive diagnostic method. Emerging evidence suggests that incidence and severity of life-threatening influenza A/H1N1v infection increase with several risk factors (e.g. pregnancy, immunosuppression, obesity). Treatment decisions should not be delayed to await laboratory confirmation in these patients as early initiation of antiviral therapy is recommended. Elements of supportive care depend on the presentation of complications and secondary organ failure. If rapidly progressive lung dysfunction occurs, refractory to routine mechanical ventilation, early reporting to centers experienced in the use of extracorporeal membrane oxygenation (ECMO) should be established.


title: GSH rescue by N-acetylcysteine

text: Reduced glutathione (GSH) is the main intracellular low molecular weight thiol. GSH acts as a nucleophilic scavenger and as an enzyme-catalyzed antioxidant in the event of electrophilic/oxidative tissue injury. Therefore, GSH has a major role as a protector of biological structures and functions. GSH depletion has been recognized as a hazardous condition during paracetamol intoxication. Conversely, GSH rescue, meaning recovery of the protective potential of GSH by early administration of N-acetylcysteine (NAC), has been found to be life-saving. Lack of GSH and electrophilic/oxidative injury have been identified among the causes of the adult respiratory distress syndrome (ARDS), idiopathic pulmonary fibrosis (IPF), and the acquired immunodeficiency syndrome (AIDS). Experimental and early clinical data (in ARDS) point to the role of NAC in the treatment of these conditions. Recently, orally given NAC has been shown to enhance the levels of GSH in the liver, in plasma, and notably in the bronchoalveolar lavage fluid. Rescue of GSH through NAC needs to be appreciated as an independent treatment modality for an array of different diseases, all of which have one feature in common: pathogenetically relevant loss of GSH.


title: The role of transmembrane protein 27 (TMEM27) in islet physiology and its potential use as a beta cell mass biomarker

text: AIMS/HYPOTHESIS: Transmembrane protein 27 (TMEM27) is a membrane protein cleaved and shed by pancreatic beta cells that has been proposed as a beta cell mass biomarker. Despite reports of its possible role in insulin exocytosis and cell proliferation, its function in beta cells remains controversial. We aimed to characterise the function of TMEM27 in islets and its potential use as a beta cell mass biomarker. METHODS: To determine TMEM27 function, we studied TMEM27 gene expression and localisation in human healthy and diabetic islets, the correlation of its expression with cell cycle and insulin secretion genes in human islets, its expression in tungstate-treated rats, and the effects of its overproduction on insulin secretion and proliferation in a beta cell line and islets. To elucidate its utility as a beta cell mass biomarker, we studied TMEM27 cleavage in a beta cell line, islets and primary proximal tubular cells. RESULTS: TMEM27 mRNA levels in islets are lower in diabetic donors than in controls. Its gene expression correlates with that of insulin and SNAPIN in human islets. TMEM27 expression is downregulated in islets of tungstate-treated rats, which exhibit decreased insulin secretion and increased proliferation. TMEM27 overproduction in a beta cell line and islets significantly enhanced glucose-induced insulin secretion, with modest or no effects on proliferation. Finally, TMEM27 is cleaved and shed by renal proximal tubular cells and pancreatic islets. CONCLUSIONS/INTERPRETATION: Our data support a role for TMEM27 in glucose-induced insulin secretion but not in cell proliferation. The finding that its cleavage is not specific to beta cells challenges the current support for its use as a potential beta cell mass biomarker. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1007/s00125-010-1728-6) contains supplementary material, which is available to authorised users.


title: Straight talk with...Donna Ambrosino

text: In the 1890s, a diphtheria epidemic was killing thousands of children across the US, prompting many state health departments to create laboratories to start extracting antiserum from horses' blood. More than a century later, however, only one of these public labs is still in operation: the Massachusetts Biologic Laboratories, known simply as MassBiologics. Established in 1894 as the Massachusetts Public Health Laboratories, it is now the only nonprofit, licensed vaccine and biologics manufacturer and research center in the country—which gives the lab a unique position to tackle diseases that 'big pharma' isn't willing to touch. Leading the charge is Executive Director Donna Ambrosino, who took the helm in 1998 after a 20-year career at the Dana Farber Cancer Institute in Boston. On a snowy day in January, Elie Dolgin sat down to chat with Ambrosino at MassBiologics's brand new research center, opened last summer in the outskirts of Boston.


title: Schockraummanagement: Im Zeitalter von Weißbuch, S3-Leitlinie, „Advanced Trauma Life Support“® und TraumaNetzwerk DGU®

text: The treatment of the severely injured is, just as the injury severity and combinations, often highly complex and leaves little leeway for delay, dissent or even error. In order to reduce this to a minimum, trained emergency room teams in addition to optimal technical and structural prerequisites are necessary. This must function in an interdisciplinary fashion according to fixed consensus algorithms which are known to all team members and have been agreed by all participants. The White Paper on treatment of the severely injured of the German Society of Trauma Surgery (DGU) and the recently published S3 guidelines offer evidence-based recommendations on the structural, technical, organizational and personnel prerequisites.


Alveolitiden, Granulomatosen, Lungenfibrosen


Man versus microbe


title: Neutrophil extracellular traps in cancer progression

text: Neutrophils are being increasingly recognized as an important element in tumor progression. They have been shown to exert important effects at nearly every stage of tumor progression with a number of studies demonstrating that their presence is critical to tumor development. Novel aspects of neutrophil biology have recently been elucidated and its contribution to tumorigenesis is only beginning to be appreciated. Neutrophil extracellular traps (NETs) are neutrophil-derived structures composed of DNA decorated with antimicrobial peptides. They have been shown to trap and kill microorganisms, playing a critical role in host defense. However, their contribution to tumor development and metastasis has recently been demonstrated in a number of studies highlighting NETs as a potentially important therapeutic target. Here, studies implicating NETs as facilitators of tumor progression and metastasis are reviewed. In addition, potential mechanisms by which NETs may exert these effects are explored. Finally, the ability to target NETs therapeutically in human neoplastic disease is highlighted.


Money, manpower missing from Europe's new agency


Bildgebung in der Intensivmedizin Techniken, Indikationen, diagnostische Zeichen–Teil I: Techniken, Indikationen, diagnostische Zeichen–Teil I


Abstracts of the 49th Annual Meeting of the EASD


Yersinia enterocolitica Stellungnahmen des Arbeitskreises Blut des Bundesministeriums für Gesundheit: Stellungnahmen des Arbeitskreises Blut des Bundesministeriums für Gesundheit


title: TIPE2 ameliorates lipopolysaccharide-induced apoptosis and inflammation in acute lung injury

text: OBJECTIVE: Tumour necrosis factor-α-induced protein 8-like 2 (TIPE2) has strong anti-inflammatory properties. However, it is unknown whether increased TIPE2 is protective against lipopolysaccharide (LPS)-induced ALI. In the current study, we aimed to investigate whether increased TIPE2 can exert protective effects in a mouse model of ALI induced by LPS. METHODS: We administered TIPE2 adeno-associated virus (AAV-TIPE2) intratracheally into the lungs of mice. Three weeks later, ALI was induced by intratracheal injection of LPS into BALB/c mice. Twenty-four hours later, lung bronchoalveolar lavage fluid (BALF) was acquired to analyse cells and protein, arterial blood was collected for arterial blood gas analysis and the determination of pro-inflammatory factor levels, and lung issues were collected for histologic examination, transmission electron microscopy (TEM), TUNEL staining, wet/dry (W/D) weight ratio analysis, myeloperoxidase (MPO) activity analysis and blot analysis of protein expression. RESULTS: We found that TIPE2 overexpression markedly mitigated LPS-induced lung injury, which was evaluated by the deterioration of histopathology, histologic scores, the W/D weight ratio, and total protein expression in the BALF. Moreover, TIPE2 overexpression markedly attenuated lung inflammation, as evidenced by the downregulation of polymorphonuclear neutrophils (PMNs) in the BALF, lung MPO activity, and pro-inflammatory cytokine levels in the serum. Moreover, TIPE2 overexpression not only dramatically prevented LPS-induced pulmonary cell apoptosis in mice but also blocked LPS-activated JNK phosphorylation and NF-κB p65 nuclear translocation. CONCLUSIONS: Our study shows that the increased expression of AAV-mediated TIPE2 in the lungs of mice inhibits acute inflammation and apoptosis and suppresses the activation of NF-κB and JNK in a murine model of ALI.


title: Inhaled and exhaled nitric oxide

text: Inhaled nitric oxide (NO) is used to treat various cardiopulmonary disorders associated with pulmonary hypertension. The rationale is based on the fact that NO, given by inhalation, only dilates those pulmonary vessels that perfuse well-ventilated lung units. As a result, pulmonary gas exchange is improved while pulmonary vascular resistance is reduced and pulmonary blood flow is increased. Inhaled NO has been succesfully applied to treat persistent pulmonary hypertension of the newborn, reducing the need for extracorporeal life support. Although pulmonary hypertension and altered vasoreactivity contribute to profound hypoxaemia in adult and paediatric acute respiratory distress syndrome (ARDS), the benefit of inhaled NO still remains to be established in patients with ARDS. ARDS is a complex response of the lung to direct or indirect insults, leading to pulmonary vasoconstriction and various inflammatory responses. Recent randomized trials suggest that inhaled NO only causes a transient improvement in oxygenation. Whether this effect is important in the long-term management of ARDS remains to be established. NO, measured in the exhaled breath, is an elegant and non-invasive means to monitor inflammation of the upper and lower respiratory tract. In the normal upper airways, the bulk of exhaled NO originates from the paranasal sinuses. Exhaled NO is increased in nasal allergy and decreased in cystic fibrosis, nasal polyposis and chronic sinusitis. That NO production is increased in asthmatic airways is also well established. However, several questions still need to be addressed, in particular evaluation of the sensitivity and specificity of the measurement techniques, and assessment of the bronchodilator action of endogenous NO.


title: Das Herz bei viralen Infektionen

text: Between 10 and 20% of patients with histologically proven inflammatory disease of the heart muscle develop a chronic disorder after acute myocarditis which results in dilated cardiomyopathy with increasing cardiac insufficiency. Viral infections are a frequent cause of inflammatory heart muscle diseases and thus also responsible for myocardial damage in the initial phase. In the past, evidence for enterovirus, adenovirus, and cytomegalovirus was in the focus of attention. In the meantime, “new” cardiotropic pathogens such as parvovirus B19, Epstein-Barr virus, and human herpesvirus 6 have been detected in patients with dilated cardiomyopathy with and without inflammation. Their persistence in the myocardium correlates with a decline in pumping capability within 6 months. While the virus is still being eliminated, the second phase of the disease begins, which is characterized by autoimmune phenomena and often a cardiac inflammatory response which likewise correlates with a worsening prognosis. The transition to the third and final phase with development of dilated cardiomyopathy occurs gradually and can take years. The goal of every diagnostic and therapeutic intervention must be to eradicate the virus and eliminate the inflammatory response to prevent the disease from progressing to terminal cardiac insufficiency.


title: Suppression der Synthese des Tumornekrosefaktors

text: Klinische Studien aus den vergangenen 5 Jahren belegen die zentrale Rolle des Tumornekrosefaktors (TNF) im pathophysiologischen Geschehen der rheumatoiden Arthritis und des Morbus Crohn. Die vorliegende Arbeit gibt einen Überblick über die Regulation der Synthese und die vielfältigen Wirkungen dieses Zytokins. So wurden erhöhte TNF-Konzentrationen bei verschiedenen infektiösen und entzündlichen Erkrankungen sowie in Verbindung mit speziellen Therapien nachgewiesen. Darauf aufbauend werden experimentelle therapeutische Strategien zur Hemmung der TNF-Bildung dargestellt.


title: Einsatz der Lungen- und Pleurasonographie in der Notfall- und Intensivmedizin

text: Bedside lung ultrasound (LUS) in emergency rooms and intensive care units can serve as a tool to diagnose common lung pathologies, monitor their course and guide clinical management. LUS requires only a few minutes and is a useful extension of the physical examination. Fractures of the ribs as well as the sternum are seen well on ultrasound. Minute pleural fluids (effusion, hemtothorax) are detectable. LUS is able to detect the sound of lung water and thus to differentiate a cardiogenic pulmonary edema from chronic obstructive lung disease. Inflammatory lung diseases such as pleuritis and pneumonia are better seen than on chest X‑ray. LUS should replace chest X‑ray in the diagnosis of ambulant acquired pneumonia. In ventilator-associated pneumonia and atelectasis, LUS measures the presence of lung consolidation as well as dynamic changes und reventilation. A heart-lung-vessel integrated triple ultrasonography according to clinical findings can help with the diagnosis of pulmonary embolism and should be a necessary weapon for the physicians, especially in emergency departments.


title: Alveolar surfactant and adult respiratory distress syndrome: Pathogenetic role and therapeutic prospects

text: The adult respiratory distress syndrome (ARDS) is characterized by extended inflammatory processes in the lung microvascular, interstitial, and alveolar compartments, resulting in vasomotor disturbances, plasma leakage, cell injury, and complex gas exchange disturbances. Abnormalities in the alveolar surfactant system have long been implicated in the pathogenetic sequelae of this life-threatening syndrome. This hypothesis is supported by similarities in pulmonary failure between patients with ARDS and preterm babies with infant respiratory distress syndrome, known to be triggered primarily by lack of surfactant material. Mechanisms of surfactant alterations in ARDS include: (a) lack of surface-active compounds (phospholipids, apoproteins) due to reduced generation/release by diseased pneumocytes or to increased loss of material (this feature includes changes in the relative composition of the surfactant phospholipid and/or apoprotein profiles); (b) inhibition of surfactant function by plasma protein leakage (inhibitory potencies of different plasma proteins have been defined); (c) “incorporation” of surfactant phospholipids and apoproteins into polymerizing fibrin upon hyaline membrane formation; and (d) damage/inhibition of surfactant compounds by inflammatory mediators (proteases, oxidants, nonsurfactant lipids). Alterations in alveolar surfactant function may well contribute to a variety of pathophysiological key events encountered in ARDS. These include decrease in compliance, ventilation-perfusion mismatch including shunt flow due to altered gas flow distribution (atelectasis, partial alveolar collapse, small airway collapse), and lung edema formation. Moreover, more speculative at the present time, surfactant abnormalities may add to a reduction in alveolar host defense competence and an upregulation of inflammatory events under conditions of ARDS. Persistent atelectasis of surfactant-deficient and in particular fibrin-loaded alveoli may represent a key event to trigger fibroblast proliferation and fibrosis in late ARDS (“collapse induration”). Overall, the presently available data on surfactant abnormalities in ARDS lend credit to therapeutic trials with transbronchial surfactant administration. In addition to the classical goals of replacement therapy defined for preterm infants (rapid improvement in lung compliance and gas exchange), this approach will have to consider its impact on host defense competence and inflammatory and proliferative processes when applied in adults with respiratory failure.


title: Gentherapie zur Behandlung der akuten inflammatorischen Immunantwort

text: Acute inflammation and the innate immune response to severe tissue trauma continue to pose a critical pathophysiological challenge in the intensive care regimen. Advances in the development of improved gene therapeutics and their application in diverse animal models of acute inflammation have shown promising results in reducing both morbidity and mortality. The introduction of inflammatory antagonists, by either viral or non-viral vectors, has thereby proven to play a significant role in determining the overall outcome. Recent findings of utilizing the functional characteristics of immunocompetent cells (e.g. dendritic cells) in combination with the gene therapy-induced overexpression of anti-inflammatory target proteins have significantly expanded this gene therapeutic spectrum. The results from diverse experiments in our own murine model of sepsis, in connection with findings from various other analogous international studies, have demonstrated great potential to revolutionize the clinical treatment concept and prevention of acute inflammatory diseases.


ECTES Abstracts 2016


title: Management der saisonalen Influenza 2017/2018: Erfahrungen an einem deutschen Universitätsklinikum

text: BACKGROUND: There are only few structured reports on inpatient management of a seasonal influenza epidemic. OBJECTIVES: A systematic description of a seasonal influenza patient population at a German university hospital to improve risk stratification and clinical care. METHODS: In this monocentric, retrospective observational study of the 2017/2018 influenza season at the University Medical Center Hamburg-Eppendorf, patients with confirmed influenza infection were included. RESULTS: Of all influenza swabs performed in the emergency department, 24% (n = 162/676) were positive. A total of 255 patients (median age 66 years) had an influenza infection (influenza A n = 79, influenza B n = 176); 27 (15.3%) were nosocomial infections. Of the 179 (70.2%) patients that were hospitalized, 51 (20%) received intensive medical care. Patients with subsequent need for intensive care had an elevated CRP level (69.5 mg/dl [SD 62.8] vs. 141.7 [SD 127.2] mg/dl) at the time of influenza diagnosis and more frequent infiltrates in X‑ray/CT of the thorax (n = 43 [33.6%] vs. n = 43 [84.3%]). Antiviral therapy with oseltamivir was administered for 74 (29.0%) patients and 11 (6.1%) patients were treated with extracorporeal membrane oxygenation (ECMO). Of the 23 (9.0%) patients who died, only four of them had been vaccinated (trivalent). Those four had an influenza B infection. CONCLUSION: The structured use of diagnostic tests (influenza PCR, X‑ray/CT chest and CRP) and antiviral therapy (oseltamivir) as well as targeted management of admission, intensive care capacities, and an increase in vaccination rates are important for improving patient care and optimizing the use of resources during seasonal influenza epidemics.


title: Das Fachgebiet Anästhesie abseits der westlichen Medizin: Unter besonderer Berücksichtigung eigener Erfahrungen in der Demokratischen Republik Kongo und der Mongolei

text: During the last decades anesthesia has developed into a wide ranging speciality in western countries, whereas in most developing and newly industrializing nations it still focuses on its core discipline, the perioperative care of the surgical patient. Poor socioeconomic status and inadequate financing of health systems result in a high burden of disease, a high rate of self-financing of healthcare costs by the patients, as well as insufficient personnel, infrastructural and material equipment of most healthcare facilities. Important limiting factors for anesthesia are low educational standards and a widespread lack of oxygen and medical gas supplies, as well as locally serviceable medical equipment. Studies evaluating the status of anesthesia in developing and newly industrializing nations in detail are urgently needed in order to provide aid on national and international as well as institutional and private levels for the development of anesthesia in poor countries.


title: Entwicklungen der modernen Onkologie: Auswirkungen auf Anästhesie und Intensivmedizin

text: Patients with solid tumors and hematological neoplasia can be a special challenge for anesthetists with their multilayered core competences (induction of anesthesia, intensive care, emergency medicine, pain therapy and palliative medicine) due to the systemic manifestation of the disease especially in metastatic stages, to complex sequelae of toxic oncologic therapy especially in curatively intended treatment concepts, to difficult ethical decision-making especially in acute situations and to the special emotional state of the patient which can extend throughout the complete course of the disease. In addition there are many new developments in modern oncology, which complicate the special characteristics of oncology patients, can have a direct influence on the anesthesiologic approach and will, therefore, be presented in this article.


title: Extralymphatic virus sanctuaries as a consequence of potent T-cell activation

text: T helper cells can support the functions of CD8(+) T cells against persistently infecting viruses such as murine lymphocytic choriomeningitis virus (LCMV), cytomegalovirus, hepatitis C virus and HIV. These viruses often resist complete elimination and remain detectable at sanctuary sites, such as the kidneys and other extralymphatic organs. The mechanisms underlying this persistence are not well understood. Here we show that mice with potent virus-specific T-cell responses have reduced levels and delayed formation of neutralizing antibodies, and these mice fail to clear LCMV from extralymphatic epithelia. Transfer of virus-specific B cells but not virus-specific T cells augmented virus clearance from persistent sites. Virus elimination from the kidneys was associated with the formation of IgG deposits in the interstitial space, presumably from kidney-infiltrating B cells. CD8(+) T cells in the kidneys of mice that did not clear virus from this site were activated but showed evidence of exhaustion. Thus, we conclude that in this model of infection, site-specific virus persistence develops as a consequence of potent immune activation coupled with reductions in virus-specific neutralizing antibodies. Our results suggest that sanctuary-site formation depends both on organ anatomy and on the induction of different adaptive immune effector mechanisms. Boosting T-cell responses alone may not reduce virus persistence. SUPPLEMENTARY INFORMATION: The online version of this article (doi:10.1038/nm1670) contains supplementary material, which is available to authorized users.


Abstracts der 49. Jahrestagung der Österreichischen Gesellschaft für Kinder- und Jugendheilkunde


Abstracts zum 125. Kongress der Deutschen Gesellschaft für Innere Medizin e.V.


Abstracts of 52nd EASD Annual Meeting


title: Intensivtherapie nach Transplantation solider Organe

text: Transplantation medicine is an interdisciplinary task and the priority objective is a fast recovery to patient independence. After kidney transplantation the crucial aims are monitoring of transplant perfusion, maintainance of an adequate volume status and avoidance of nephrotoxic medications. Transplantation for patients with advanced chronic liver failure has become more common since the implementation of the model of end stage liver disease (MELD) allocation system which is associated with more complicated proceedings. The essentials of critical care after liver transplantation are monitoring of transplant function, diagnosis of perfusion or biliary tract problems, specific substitution of coagulation factors and hemodynamic optimation due to avoidance of hepatic congestion. Many patients listed for heart transplantation need preoperative intensive care due to impaired heart function. Postoperatively a specific cardiac support with pulmonary arterial dilatators and inotropics is usually necessary. Lung transplantation aims at an improvement of patient quality of life. Postoperative critical care should provide a limitation of the pulmonary arterial pressure, avoidance of volume overload and rapid weaning from the respirator.


Mitteilungen der deutschen Gesellschaft für innere Medizin


40(th) EASD Annual Meeting of the European Association for the Study of Diabetes: Munich, Germany, 5–9 September 2004


title: Nicht-invasive Beatmung

text: Die nicht-invasive Beatmung (NIV) über eine Maske ermöglicht bei vielen Patienten eine effiziente Beatmung unter Vermeidung der Risiken und Nebenwirkungen der endotrachealen Intubation. Für die chronisch-obstruktive Lungenerkrankung (COPD) sind die Vorteile der Maskenbeatmung im Hinblick auf Beatmungsdauer, Dauer der Intensivbehandlung, Prognose und Behandlungskosten inzwischen relativ gut durch Studien belegt. Bei anderen Indikationen –“Nicht-COPD-Patienten”– erlauben die verfügbaren Daten noch kein gesichertes Urteil, rechtfertigen aber einen Behandlungsversuch auch außerhalb von Studien in klinischer Routine. Nachteilig sind der initial höhere personelle Betreuungsaufwand bei NIV sowie die stark von der Erfahrung abhängige Erfolgsrate. Die wichtigste Voraussetzung für eine erfolgreiche nicht-invasive Beatmung in der Intensivmedizin ist die Bereitschaft von Ärzten und Pflegepersonal, eine ungewohnte Beatmungsphilosophie zu akzeptieren und die relativ einfache Technik der Maskenbeatmung zu erlernen. Bei Beherrschung der Technik kann die NIV aber eine wertvolle Hilfe vom Notarztwagen bis zur Intensivstation sein.


Abstracts der 42. Jahrestagung der Gesellschaft für Neonatologie und Pädiatrische Intensivmedizin (GNPI)