A single-season prospective study of respiratory viral infections in lung transplant recipients.

The frequency and complications of respiratory viral infections (RVI) were studied in 50 ambulatory lung transplant patients during a single winter season, using viral antigens, viral cultures and PCR of nasal washes or bronchoalveolar lavages. Patients' survival, episodes of acute rejection and occurrence of bronchiolitis obliterans (BO) or BO syndrome (BOS) were monitored for 1 yr after the study. Overall, 32 (64%) patients had 49 symptomatic episodes. Documented infections included eight due to respiratory syncytial virus (RSV), one due to parainfluenza virus (PIV) and 10 due to influenza (FLU). Four of the FLU infections were serological rises without symptoms. Overall, 17 (34%) patients had documented viral infection; four patients had lower respiratory involvement and two (one RSV, one PIV) were hospitalised for aerosolised ribavirin treatment. After 1 yr there were three (6%) deaths unrelated to RVI. BO or BOS had occurred in one (6%) out of 17 patients with and three (12%) out of 33 without RVI. Respiratory viruses infected one-third of ambulatory lung transplant recipients in a single season. In conclusion, respiratory viral infection was not associated with subsequent graft dysfunction. Larger prospective studies are required to better define the acute and long-term morbidity of these infections.     

Innovative Sonographie beim Prostatakarzinom

Zusammenfassung Zur Früherkennung und Stadieneinteilung des Prostatakarzinoms wird heutzutage fast ausschließlich die sog. systematische Mehrfachbiopsie eingesetzt. Hierbei tritt das bildgebende Verfahren – der transrektale Ultraschall – als Diagnostikum mehr und mehr in den Hintergrund und dient fast ausschließlich zur Führung der Biopsienadel in spezifische anatomische Regionen. Doch selbst bei multiplen systematischen Biopsien wird eine hohe Zahl klinisch signifikanter Karzinome übersehen. Diese Tatsache hat zu einer drastischen Steigerung der Anzahl von Gewebeproben geführt. So finden sich Zentren, in denen 6, 10, 12, ja bis zu 143 Gewebeproben in einer Sitzung entnommen werden. Diese immer invasivere heterogene Vorgehensweise bestätigt den Bedarf an Verbesserung in der Ultraschalldiagnostik. Neue und innovative bildgebende Verfahren in der Prostatasonographie werden vorgestellt mit dem Ziel, die diagnostische Aussagekraft bei Erstdiagnose sowie in der Stadienvorhersage zu verbessern. Eine verbesserte Bildgebung bei Diagnosestellung und in der Stadieneinteilung würde zu einer erheblichen Verbesserung bei den Therapieentscheidungen führen.Dieser Beitrag ist dem kürzlich verstorbenen Pathologen J. E. McNeal gewidmet, der die zonale Anatomie der Prostata erstbeschrieben hat.     

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Ohne Zusammenfassung     

Differenzialdiagnose schlafbezogener Atmungsstörungen

Zusammenfassung Die Differenzialdiagnose schlafbezogener Atmungsstörungen (SBAS) erfolgt in Anlehnung an die durch die im Jahr 2005 von der American Academy of Sleep Medicine (AASM) neu aufgelegte Internationale Klassifikation von Schlafstörungen (ICSD-2). Die ICSD-2 teilt die derzeit bekannten Schlaf- und Aufwachstörungen in 8 Kategorien ein, die SBAS werden in Kategorie II aufgeführt. Die ICSD-2 ist kompatibel zu den international gebräuchlichen Systemen der Klassifikation von Krankheiten (ICD-9, ICD-10). Grundlage aller differenzialdiagnostischen Erwägungen stellt neben der ausführlichen Anamnese die Polysomnographie dar, ggf. ergänzt durch weiterführende internistische, neurologische, pädiatrische, Hals-Nasen-Ohren-ärztliche, Mund-Kiefer-Gesichts-chirurgische sowie neuropsychologische und neurophysiologische Untersuchungen.     

Interstitielle Zystitis

Interstitial cystitis (IC) is a chronic, debilitating inflammatory disease of the urinary bladder, characterized by chronic pelvic pain, urgency/frequency symptoms, and decrease of the functional bladder capacity. Both the etiology and pathogenesis of the condition that predominantly affects women are still not fully understood. Thus, a causal therapeutic approach still does not exist. IC remains a strict diagnosis of exclusion; distinct histopathological findings within the bladder wall are frequently found, although they are not pathognomonic. The diagnostic criteria elaborated by the NIH are helpful in clinical research; their dogmatic utilization will however lead to an underdiagnosis of IC in 60% of the patients. IC-specific symptom questionnaires and validated symptom scales help the physician to assess the therapeutic response during the follow-up of the patients.     

Infarktbedingter kardiogener Schock

Cardiogenic shock remains the major cause of death among patients with acute myocardial infarction. Besides supportive therapy there is clear evidence that revascularization of the infarct related artery should be performed as soon as possible with percutaneous transluminal coronary angioplasty. Placement of coronary stents and administration of platelet glycoprotein IIb/IIIa antagonists may further improve outcome. Intra-aortic balloon pumping should be integral part of this treatment strategy but is unfortunately underused in clinical practice. Routine bypass surgery for cardiogenic shock patients is deferred and restricted to selected patients.     

Serum interleukin 5 concentrations in atopic and non-atopic patients with glucocorticoid-dependent chronic severe asthma.

BACKGROUND--Interleukin (IL)-5 is thought to play a part in asthmatic bronchial mucosal inflammation and is a potential therapeutic target. Detectable serum IL-5 concentrations have been found previously in a proportion of patients with acute severe asthma, but not in the same patients following oral glucocorticoid therapy or in normal controls. A study was undertaken to investigate whether or not IL-5 is detectable in the serum of patients with glucocorticoid-dependent chronic severe asthma. METHODS--Serum concentrations of IL-5 were measured in 29 patients with stable oral glucocorticoid-dependent chronic severe asthma (mean PEFR 59.7% predicted) and seven normal controls using a specific enzyme-linked immunoassay calibrated with recombinant human IL-5 standards (lower limit of sensitivity 40 pg/ml). RESULTS--Interleukin 5 was detectable in the serum of 15 of the 29 patients at a median concentration of 150 pg/ml (range 40-690), but was undetectable in the serum of all the control subjects. The patients with detectable serum IL-5 concentrations did not differ from those with undetectable concentrations in terms of atopic status, disease severity (percentage predicted PEFR or FEV1), prednisolone dosage, serum IgE concentrations, or peripheral eosinophil count. CONCLUSIONS--Interleukin 5 is detectable in the serum of a proportion of both atopic and non-atopic patients with chronic severe asthma, and concentrations in these patients were higher than in normal controls. These observations are compatible with the hypothesis that IL-5 release occurs in these patients during a period of stable asthma despite systemic glucocorticoid therapy.     

Effect of short-term hormone replacement in the treatment of obstructive sleep apnoea in postmenopausal women.

BACKGROUND--Women appear to be increasingly susceptible to snoring and sleep disordered breathing after the menopause. This observation, coupled with the considerable sex difference in sleep apnoea, may be explained on the basis of a protective effect of female hormones. This study was carried out to determine whether hormone replacement therapy has a role in the management of obstructive sleep apnoea in postmenopausal women. METHODS--The effect of short-term (mean (SE) 50 (3) days) hormone replacement therapy with either oestrogen alone or in combination with progesterone on sleep disordered breathing was investigated in 15 postmenopausal women with moderate obstructive sleep apnoea. The effect of treatment on the ventilatory response to hypoxia and hypercapnia was assessed in 10 patients. RESULTS--There was no reduction in the clinical severity of obstructive sleep apnoea after hormone treatment despite an increase in the serum oestrogen level from 172 (23) to 322 (33) pmol/l. There was a small but clinically insignificant reduction in the apnoea/hypopnoea index during REM sleep from 58 (6) to 47 (7). There was no difference in response between the oestrogen only group and the oestrogen plus progesterone group. Hypercapnic ventilatory responsiveness did not change with hormone treatment, but an change with hormone treatment, but an increase in hypoxic ventilatory responsiveness was observed. CONCLUSIONS--These data indicate that short-term hormone replacement is unlikely to have an effective role in the clinical management of postmenopausal women with obstructive sleep apnoea. The observed reduction in the apnoea/hypopnoea index during REM sleep, however, suggests that longer term treatment, or the use of higher doses, may have an effect.