[Development and Periodicity of Human Exposures in Suicidal Intention Reported to the Centre Erfurt from 2004-2013]

Aim of the Study: Exposures in suicide attempts are demanding for hospitals and poisons information centres (PICs). Therefore, the time characteristics of their frequency were studied. Methods: A retrospective analysis was undertaken of all human exposures reported to Centre Erfurt from the beginning of 2004 to the end of 2013 according to their frequency in the respective year, season, month, weekday, time of the weekday, circumstances of exposure, age and gender. Results: 59.7% of all exposures (n=137 104) were accidental, 23.4% occurred in suicide attempts and 3.3% in substance abuse. 0.3% of the suicide attempts resulted in death. Their number continuously increased from n=2 422 in 2004 to n=3 458 in 2013, but their relative frequency remained almost constant at 23.4%. Their highest numbers were reached in the spring and summer with maxima in July and August and minima in February and September. During the week, the most suicide attempts were observed between Sunday and Tuesday and the least on Friday. Highest rate of suicide attempts was seen at 10 pm and lowest at 6 am. The median of age was 39 years (first quartile 24 years, third quartile 50 years). The female proportion was almost twice as high as the male. Conclusions: Hospitals the Centre Erfurt is serving should be particularly prepared for exposures in suicide attempts in the spring and summer (especially in July and August), at the beginning of the week and shortly before midnight.

[Human Single Drug Exposures to Non-opioid Analgesics Reported to the Poisons Information Centre Erfurt from 2003 to 2012]

AIM OF THE STUDY

Because of their frequency, non-opioid analgesics (NOA) single drug exposures registered by Poisons Information Centre (PIC) Erfurt have been studied over a decade.

METHODS

A retrospective analysis of frequencies, circumstances of exposure, symptom severity, and age groups in NOA single drug exposures received by the PIC Erfurt from the beginning of 2003 to the end of 2012 was undertaken.

RESULTS

Of all 4749 NOA single drug exposures, the 10 most frequent were caused by paracetamol (n=1 686), ibuprofen (n=1 439), acetylsalicylic acid (n=456), dipyrone (n=274), diclofenac (n=267), flupirtine (n=138), naproxen (n=41), etoricoxib (n=36), indomethacin (n=24), and dexketoprofen (n=19). Paracetamol single drug exposures increased from 158 in 2003 to 216 in 2007 and fell afterwards to 133 in 2012. Ibuprofen single drug exposures continously rose from 57 in 2003 to 258 in 2012. Adults were more often involved in NOA (53.8%) and all single drug exposures (54.1%) than children (45.9% and 45.6%, respectively). Suicidal attempts were more frequent in NOA (43.1%) than in all single drug exposures (34.2%), whereas accidental exposures or exposures in abuse were less often (33.4 and 0.2%, 46.0 and 0.9% respectively). NOA single drug exposures resulted mostly in none to minor symptoms (77.0%) and rarely in moderate (2.1%) or severe symptoms (1.0%). One adult was found dead after probable ingestion of 32 g of acetylsalicylic acid in suicidal intention.

CONCLUSIONS

Because many NOA are over-the-counter drugs, it is difficult to obtain data on their use. PIC data could provide information on the NOA use in the population.

[Poisonings due to Substance Abuse Reported to the Poisons Information Centre Erfurt from 2002 to 2011]

AIM OF THE STUDY

Because of their importance for clinical toxicology, developments of sub-stance abuse reported to the Poisons Information Centre (PIC) Erfurt were investigated and compared to other reasons of human exposures.

METHODS

A retrospective analysis of all human exposures (exposures of humans to substances in abuse, accidental and unknown circumstances, and suicide attempts) (n=125,130) from the beginning of 2002 to the end of 2011 was undertaken according to substance classes, reasons of exposures, symptom severity, age groups, and gender.

RESULTS

Cases of substance abuse (3,760, 3.0% of all exposures) continuously increased from 252 (92 with one and 160 with multiple substances) in 2002 to 507 in 2011 (239 with one and 268 with multiple substances). In relation to all exposures, only the abuse of multiple substances rose significantly (p<0.001). In comparison to all substances of exposure, ethanol, amphetamine-type stimulants, benzodiazepines/analogues, and liquid ecstasy abuse significantly (p<0.005) increased while cannabis and Brugmansia/Datura species abuse significantly (p<0.05) decreased. Substance abuse significantly (p<0.001) more often caused moderate (23.7%) and severe symptoms (6.1%) than in suicide attempts (9.6%; 4.4%). First legal highs exposures were registered in 2010 and led significantly (p<0.001) more often to moderate symptoms (50%) than cannabis exposures (19.4%).

CONCLUSIONS

The clinical significance of substance abuse is shown by the fact that it resulted more often in moderate and severe symptoms than suicide attempts. Data on substance abuse from PICs could supplement official annual drug reports in aspects of clinical toxicology.

Calcium channel antagonist exposures reported to the Poisons Information Center Erfurt

BACKGROUND

We investigated the toxicity profile of the three main groups of calcium channel antagonists (CCA) and compared mixed CCA exposures (CCA plus another drug) with mono CCA exposures.

METHODS

All CCA exposures reported to the PIC Erfurt from 2000 to 2009 were analyzed retrospectively.

RESULTS

In total, 727 (230 mono and 497 mixed) CCA exposures were registered. Although CCA exposures increased almost twofold from 56 in 2000 to 108 in 2009 their relative frequency to all exposures remained constant. The five CCAs most frequently involved in exposures were the five most frequently prescribed ones in Germany over the same period. In mono and mixed CCA exposures, none or minor symptoms were most often seen with dihydropyridines (mono: 84.7%; mixed: 68.0%) followed by diltiazem (mono: 71.4%; mixed: 62.5%) and verapamil (mono: 57.1%; mixed: 50.0%). Highest rates of moderate (mono: 8.6%: mixed: 20.2%) and severe symptoms (mono: 18.6%; mixed: 23.7%) were observed after verapamil ingestions. Death most frequently occurred with diltiazem (mono: 28.6%; mixed: 12.5%). Rates of moderate symptoms were higher in mixed (13.3%) than in mono CCA exposures (4.8%). No distinct differences were seen regarding the relative frequency of none or minor symptoms, severe symptoms, and death between mono and mixed CCA exposures.

CONCLUSION

Exposures to verapamil more often resulted in moderate and severe symptoms than with dihydropyridines. Death mainly occurred with diltiazem. Moderate symptoms were more frequent in mixed than in mono CCA exposures. The frequency of CCAs involved in exposure was related to their prescription.

[Malignant fibrous histiocytoma of the lung]

The malignant fibrous histiocytoma of the lung is one of the rarely diagnosed soft tissue sarcomas. With the presented case-history we want to remind of this kind of lung-tumour in particular of the possibility of pre-operative diagnostic and the radiological differential diagnosis.

[Epidemiology of predominantly occupationally-induced bronchopulmonary diseases]

During the last years occupational diseases are of increasing interest. This lead to an increased sensibility which results in a continuous increase of the number of announcements of suspicion of an underlying occupational diseases. The rate of cases first remunerated remains nevertheless constant. The number of diseases caused by inorganic and organic dusts and the obstructive airway-diseases increase despite of the continuous decrease of silicosis. Among the diseases first remunerated in 1990, occupational diseases caused by inorganic dusts took up the first place (31.6%). As for the deaths in 1990, 91% are due to diseases caused by inorganic dusts.

[Alveolitis and pulmonary fibrosis in chronic diverticulitis and ulcerative colitis]

Associated reactions of the connective tissue of the lungs are by no means rare in several extrapulmonary disorders, for example, with the "so-called" collagenoses. They are less frequent in chronic inflammatory intestinal diseases. The mechanism of this pulmonary reaction is largely unclarified. The situation is complicated further by the fact that a drug side reaction may compete with the underlying disease. The problem of a change in the connective lung tissue within the framework of a chronic inflammatory intestinal disease or as a result of drug therapy of that disease, is described and demonstrated via the cases of two patients.

[Cardiopulmonary function disorders in pulmonary fibrosis of various etiology]

A large number of different pulmonary diseases eventually result in producing the final morphological pattern of pulmonary fibrosis. Basing on essential cardiopulmonary functional parameters, four relatively frequently encountered fibrotic pulmonary diseases are compared with each other. Patients suffering from bird breeder's lung show typical obstructive disturbances of ventilation that are even more marked in collagenoses with lung involvement. Patients suffering from electric welder's lung are notable for enhanced respiratory tract obstructions and increased residual volumes. In patients with sarcoidosis it is recommended to determine, above all, the lung compliance besides measuring the diffusion capacity. The specific compliance should be chosen as criterion to assess the compliance, so that the preliminary extension of the lung by emphysema is taken into consideration. Welder's lungs, bird breeder's lungs and collagenoses show a load-conditioned respiratory partial insufficiency and a latent pulmonary hypertonia. The examined groups of patients showed similar functional patterns, but individual parameters were disease-specifically considerably different from standard values.

[Pearl oyster dust as the cause of exogenous allergic alveolitis]

Many different inhalative substances may cause allergic alveolitis (hypersensitivity pneumonitis). We report on a worker who developed lung fibrosis due to the sensitization to pearl oyster shell dust. High concentrations of IgG antibodies to proteins (conchagens) of the shell which appear to represent the relevant antigens were found in the patient's serum.

[Interstitial lung diseases caused by long-term neurological-psychiatric drug therapy?]

The development of alveolitis or lung fibrosis through drugs is wellknown, however rare described in the spectrum of drug side effects. In six cases of patients with neurological diseases were studied the relationship between alveolitis or lung fibrosis and a long-time therapy with especially drugs in a neurological practice.

CONCLUSION

By the etiological examination of alveolitis or lung fibrosis it is necessary to pay attention to the possible relationship between drug and disease.

[Farmer's lung--a form of exogenous allergic alveolitis]

Exogenic allergic alveolitides are caused by organic dusts which contain bacteria, moulds or vegetable and animal antigens. The farmer's lung as a form of the exogenic allergic alveolitis is a rare disease. The uncharacteristic symptomatology in the initial phase and in particular the retarded beginning of the symptom after several hours handicap the timely recognition in an early phase of the disease so that curative therapeutic measures are rarely possible. The cases of the disease are found only at the chronic stage, at the stage of the pulmonary fibrosis. Then the prognosis is unfavourable. In the Central Clinic for Heart and Lung Diseases Bad Berka 1,110 patients with alveolitides and lung fibroses were diagnosed in the period from 1975 to 1988. 306 of them could be clarified as exogenic allergic alveolitis, 61 of them (19.8%) were farmer's lungs.

[Therapeutic possibilities in alveolitis and pulmonary fibrosis]

Aetiologically, less than 50% of the alveolitides and pulmonary fibroses are clarified. A successful causal therapy by elimination of the noxae is thus possible only in several acute cases, particularly in forms of the exogenic allergic alveolitis. Usually the clinical pictures are misunderstood for a long time and are diagnosed only in advanced stages. The therapeutically influencible inflammatory changes are in such a case only slightly expressed. The more or less advanced fibrosis is not or only slightly to be influenced. Then the last way out of the difficulty of the lung and the heart-lung transplantation, respectively, the size of which, however, is limited by the small number of suitable donors. In the initial phase of the diseases in toxic and allergic-immunologic the inflammations resulting from this in the pulmonary tissue are partly to be controlled by antiinflammatorily and immunosuppressively, respectively, acting medicaments such as corticosteroids, azathioprin and cyclophosphamide. For the treatment of the lung fibrosis only D-penicillamine is at our disposal. Because of the numerous, partly considerable side effects and due to the effectiveness of the necessary long-term therapy which is only difficult to be measured there are very different opinions about the treatment with penicillamine. The enlargement of the knowledge on the pathogenesis of alveolitides and lung fibroses allows to hope that new beginnings for a therapy are found. No final judgement can be made about the efficacy of cyclosporin A and of antioxidants.

[Experiences with long-term oxygen therapy in patients with obstructive and restrictive respiratory disorders]

Thirteen years' experience with long-term oxygen therapy at home for patients with chronic respiratory distress are reviewed. In the period since 1976 37 patients with chronic obstructive pulmonary disease and 48 patients with restrictive respiratory disorders were treated. During oxygen breathing both groups showed the same results in regard to behaviour of the oxygen partial pressure, the carbon dioxide partial pressure, the hematocrit and the heart rate. The mean survival-time amounted to 26 months. The long-term oxygen therapy is useful in the treatment of patients with respiratory insufficiency caused by chronic obstructive pulmonary disease and by restrictive respiratory disorders as well.

[Pulmonary alveolar microlithiasis (disease in 2 siblings--case report)]

This article presents case reports on brother and sister suffering from microlithiasis alveolaris pulmonum. Diagnosis was established by means of the course of the disease, the relatively typical x-ray film and the findings on performing scintigraphy of the skeleton and also by computed tomography. Findings confirmed that the course of the disease is symptom-free for a long time; that it occurs in both sexes; and that it becomes manifest with considerable incidence in some families. Pulmonary alveolar microlithiasis is not a generalised metabolic disease, since it affects the lungs only. If the aetiology remains unclear, no causal treatment can be effected.

[Immunohistology of interstitial lung processes]

Immunohistologic investigations were performed in 124 lung tissue test of diffuse pulmonary processes obtained by transthoracic needle biopsy. In 40.3% the unselected material showed a positive immunofluorescence. It appeared in all groups formed by light microscopy. In the exogenic allergic alveolitis with 36.8% it was falling short of the expectations. The investigations allow of the conclusion that the immunohistology in diffuse pulmonary processes shows clearly applicable results neither for the diagnostics nor for the therapy and also not for the prognosis.

[Tumor-like courses in lung sarcoidosis (4 observations)]

Case reports on 4 women operated on for suspected tumour. The diagnosis of sarcoidosis was confirmed histologically. The difficulties associated with the differential diagnosis are discussed and, the need for morphological clarification is emphasized.

[Exogenous allergic alveolitis in a fruit refrigeration worker]

The causes for an exogenic allergic alveolitis are very multifarious. On the basis of a casuistics is referred to the development of such a disease by the contact with fruit mould in cold-storage plants.

[Incidence of collagenoses in patients with lung fibrosis]

In 63 out of 887 patients with alveolitis and pulmonary fibroses was causally found a so-called "collagenosis". A participation of the lung in such diseases is prognostically unfavourable. The changes in the framework of the lungs radiographically, functionally and morphologically cannot be separated from fibroses of other origin. The diagnosis is to be made after exclusion of other noxae and taking into consideration the appearances of the primary disease (clinic, spectrum of organs, special laboratory parameters etc.).

[Lymphomatoid granulomatosis--a case report]

On the basis of a casuistics the clinical picture of the lymphomatoid granulomatosis is demonstrated and the connection to other granulomatosis and lymphomas is shown.

[Differential diagnosis and evaluation of multiple allergic reactions]

On the basis of a casuistics the diagnosis, the differential diagnosis and the expert opinion of allergic multiple reactions (bronchial asthma, allergic alveolitis, sarcoidosis) are discussed.

[Obstruction parameters and pulmonary artery pressure in asthmatics after administration of aminophylline]

In 30 asthmatics after the application of aminophylline the measurement of the pressure of the pulmonary arteries as well as of the parameters of the respiratory function FEV1.0 and Rt was performed. It is proved a significant decrease of pressure in the lesser circulatory system. The reduction of the bronchial obstruction cannot be proved by means of the respiratory impulse test (FEV1.0), but by the determination of the resistance to respiration (Rt).

[Primary benign intramural intracavitary cardiac tumors--clinical, diagnostic and therapeutic aspects]

10 cases of benign primary tumours of the heart (5 myxomas of the left atrium, 2 myxomas of the right atrium, 1 right-ventricular endothelioma of the endocardium, 1 left-ventricular pseudorhabdomyoma, 1 tumour of the interventricular septum) are described. The diagnostically decisive method was in 5 cases the heart catheterization with angiocardiography, furthermore in one case each the roentgenogram of the thorax, the echocardiography, the histology of embolic material, the operation as well as the autopsy. The echocardiography was available for 4 patients; in one case it was diagnostically decisive, delivered important additional informations in 2 patients and failed in one patient. With increasing propagation of the echocardiography, which in the opinion of the authors at least in all cases should be used before a planned invasive cardiological diagnosis, is to be reckoned with an improvement of the diagnosis of tumours of the heart and with an increase of the chances of a causal, namely the timely cardiosurgical therapy.

[Pituitary gland extract insufflation lung]

In two patients with diabetes insipidus the development of an allergic alveolitis with transition into pulmonary fibrosis could be observed. The alveolitis is evoked by snuffing of posterior pituitary extracts. The pathomechanism of this side effect (disease) is similar to those of other allergic alveolitides (e.g. farmer's lung, bird-fancier's lung, malt-worker's lung etc). This disease can be avoided by changing the therapy of diabetes insipidus to fully synthetic preparations free of protein. When irreversible changes are already present at the stroma of the lung (X-ray picture, function of the lung, histology), then the therapeutic possibilities are restricted and the prognosis is unfavourable.

[Alveolitis--its effect on lung circulation]

29 patients with exogenous allergic alveolitis and 57 patients with chronic fibrosing alveolitis were examined. Lung function and blood gas analytical parameters and the pressure of the pulmonary artery in rest and during load were investigated in all persons. The measured results of the two groups of patients were compared. In all patients a restrictive disturbance of ventilation and a hypoxemia were established. 34 patients showed an increased pressure of the pulmonary artery in rest, in 22 patients an elevated pressure in the pulmonary circulation on loading conditions was measured. By reason of different loading pressures all 85 patients were divided into 3 groups, where their function patterns were discussed. The special importance of evidence of loading investigations in pressure measurements in the pulmonary circulation is discussed.

[Transthoracic lung-biopsy in diffuse lung diseases (author's transl)]

A report is given about 360 percutaneous transthoracic lung biopsies in diffuse affections of the lung framework. By means of a good cooperation between skilled lung physician and experienced lung pathologist it was able to get a definitive diagnosis in 88.3% of the cases. The expense concerning this diagnostic procedure is small. As for complications there occurred pneumothoraces (15.8%), lung haemorrhage (5.3%) and haemothorax (1 case).

[Oxygen-therapy by means of a rental-system (author's transl)]

16 patients with chronic respiratory insufficiency were submitted to an ambulatory oxygen-therapy. The experiences in the organisation of this kind of therapy are discussed.

[The treatment of lung fibrosis (author's transl)]

D-Penicillamine is increasingly used for the treatment of lung fibrosis. The case-histories of 46 patients from 4 chest hospitals were analysed. All parameters being taken in consideration 13 patients showed an improvement, 17 patients no change and 16 patients a deterioration of their state of health. Side effects were observed in 22 patients.