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Bronchoalveolar lavage [BAL] is an important procedure in the diagnosis of a variety of lung diseases. While it has enormous value in the diagnostics of inflammatory parenchymal diseases, its significance in lung cancer is unclear. Keeping in mind that immune therapy (e. g. application of checkpoint inhibitors) is gaining importance in the management of lung carcinoma, it is important to know if there are typical cellular patterns in BAL of lung cancer patients.

In recent years several studies in children and adults have shown an increase in prevalence of atopic diseases in East and West Germany. The observed frequency of allergic diseases, however, was significantly lower in the East compared to the West. Using data of the German National Health Interview and Examination Survey 1998 and of National Surveys from 1990/92 it was examined, whether the reported increase in prevalence could be confirmed for the total population and whether the differences between East and West are still present. In a self-administered questionnaire, study participants were asked whether they have ever had hay fever. Additionally, in a physician's interview, subjects were asked whether a physician had ever diagnosed hay fever. The questionnaire data were used in comparison with the previous national surveys for the calculation of time trends. A total of 6974 persons filled in the questionnaire and 7099 persons took part in the interview. Physician-diagnosed hay fever was reported by 15% of the total study population. Clear differences in the prevalence rates between East and West Germany are still existing; 11% in the East and 17% in the West suffer from hay fever. In both parts of the country prevalence decreases with increasing age. The highest rates were found among those aged 20-29 and 30-39 years. Based on the questionnaire data the morbidity rose from about 10% in 1990/92 to 17% in 1998. The overall relative increase is quite comparable in East and West Germany. Stratification by age and gender shows considerable differences. In young women from East Germany the increase in prevalence is substantially higher and in women aged 40 years or older much lower than in West German women. In men this pattern has not been observed.

Using data of the German National Health Interview and Examination Survey 1998, a remarkable difference in the prevalence of hay fever between East and West Germany has been observed. Several studies in children and adults have also shown a considerable East-West divergence in other allergic diseases and in sensitisation rates. The aim of this investigation was to examine whether in a representative sample of the adult German population East-West differences in the frequency of asthma, atopic dermatitis, food allergy, urticaria, contact dermatitis and "other allergies" can be found. The calculations base on data of a physician's interview in which study participants were asked whether a physician had ever diagnosed one of the above mentioned diseases. A higher prevalence of all allergic diseases has been observed in West compared to East Germany and women from both parts of the country have higher morbidity rates than men. At least one physician-diagnosed allergy was reported by 40% of the study participants, whereas in East Germany about 30% and in the West 43% suffer from an allergic disease. The prevalence in women is 47% and in men 33%. Extremely high allergy rates were found among West German women at the age of 30-39 years (62%). Although the frequency of allergies decreases with increasing age, considerably high morbidity rates were ascertained even in the oldest age groups. The prevalence in participants aged 70-79 years amounts to 25%. Clear differences between East and West could be demonstrated in this age group, too (West 27% and East 14%).

In the differential diagnosis of infection-related arthritis (infectious arthritis, viral arthritis, reactive arthritis or Reiter's syndrome, Lyme disease) various laboratory methods are applied for the detection of the inciting antigen, specific antibodies or microbe-specific T-lymphocytes. In infectious (septic) bacterial or fungal arthritis, the definitive diagnosis can be made only by recovering the organism from the synovial fluid or membrane. Also, in reactive arthritis following extraarticular infection with Yersinia, Salmonella, Shigella, Campylobacter, or Chlamydia, one of the major shifts in perception of disease pathogenesis has been the detection of bacterial determinants by immunological methods and polymerase chain reaction (PCR) actually within the joint. In sexually acquired reactive arthritis, the etiologic diagnosis should be based on the direct detection of the pathogen (mainly C. trachomatis) from the urogenital smear specimen. For clinical routine, serological tests for bacteria specific antibodies (IgM and IgA class) are often necessary to show recent or persistent infection with the triggering pathogen. However, a cautionary note regarding the diagnostic significance of antibacterial antibody profiles has been sounded in several studies because of the high prevalence of bacteria-specific antibodies in the healthy population. The same problem may arise in the interpretation of virus-specific antibodies in the differential diagnosis of acute polyarthritis. Antigen-specific proliferation of synovial fluid lymphocytes can confirm the clinical diagnosis in patients with reactive arthritis and Lyme disease, although unspecific proliferation to several bacteria can also be observed in reactive arthritis as well as in many other arthritis.

In the dietetic treatment of phenylketonuric patients phenylalanine free amino acid mixtures are given to meet the protein requirement of the patient. In four healthy probands we tested the metabolic effects of four different PKU-preparations given in variable amounts ingested with carbohydrate and fat containing meals. We determined glucose, insulin, amino acids, and urea in blood. Following the amino acid load we saw an increased insulin output with a hypoglycemic reaction or, with smaller amounts a lack of the normal postprandial blood glucose increase. Hyperaminoacidemias depended on the amount of amino acids ingested. The increase of blood urea found suggests that part of the amino acids were degraded. To compare the results we studied a PKU-patient. He showed corresponding but milder effects.

Despite recent improvements of hemodialysis (HD) techniques, symptoms due to secondary hyperparathyroidism (HPT) contribute to longtime complications of HD patients. The aim of the present retrospective study was to determine the incidence and localization of radiological joint and bone lesions in 175 patients on chronic HD. In 108 patients the diagnosis of HPT was made by radiologic criteria. 56% had radiomorphologic lesions of the hands, 45% of the acromio-clavicular (AC) joint, 31% of the shoulder, and 27% of the pelvis. No sex difference was found for prevalence of HPT in these patients, nor was one found for any of the underlying renal diseases. There was a negative correlation between elevated serum parathyroid hormone and serum aluminum concentrations. In 111 patients the history of bone and joint pain was evaluated. 54% of these patients suffered from bone pain, arthralgia, and morning stiffness. Radiological lesions of AC-joint correlated with shoulder pain in 38%. Our data show that even in the predialytic phase of renal insufficiency x-rays of the shoulder are helpful in early diagnosis of HPT. Skeletal manifestations specific for one of the underlying renal diseases do not exist. Elevated PTH levels are a good indicator of HPT in these patients, whereas low levels of PTH do not exclude radiological manifestations. In contrast to beta 2-microglobulin amyloidosis, pain does not occur during rest and is not worsened during HD. Treatment with non-steroidal antiinflammatory drugs led to pain relief in the majority of patients. Pain history in patients on chronic HD provides important information concerning the differential diagnosis of HPT/beta 2-microglobulin amyloidosis.

beta 2-microglobulin amyloidosis is a major complication in chronic hemodialysis patients. Destructive arthropathy, spondylarthropathy, and carpal tunnel syndrome are clinical manifestations of beta 2M amyloid depositions within the joints, intervertebral discs, and tendon sheets. We have investigated the prevalence of beta 2M amyloidosis associated radiological joint lesions in a population of 175 patients on chronic hemodialysis. In 32 of 175 patients the diagnosis of amyloidosis arthropathy and spondylarthropathy was made by radiomorphological criteria. These 32 patients were asked about rheumatic symptoms (localisation and character of pain, synovitis, carpal tunnel syndrome, influence of dialysis membrane on pain) and examined clinically. Bilateral pain of the shoulders or wrists was complained by most of the patients. 24 of the 32 patients had signs of secondary hyperparathyroidism besides beta 2M-amyloidosis. 29 patients had a carpal tunnel syndrome, 23 of whom had to be operated. beta 2M-amyloid was histochemically demonstrated in all of these 23 cases. Renal transplantation led to immediate pain relief in 3 out of 3 patients, a change of the dialysis membrane (high-flux membrane) improved chronic pain in the majority of patients.

Certain gastrointestinal tract infections can trigger reactive arthritis. The best known triggering agents are yersinia, salmonella, shigella, campylobacter jejuni, and possibly clostridium difficile. The clinical findings show a subacute onset of mono- or oligoarthritis, less often of asymmetric polyarthritis with predominance of the lower limbs. The clinical picture is somewhat modified by the genetic constitution (HLA type) of the patient. HLA-B27-positive patients appear to have more severe symptoms, extraarticular features and incomplete or complete Reiter's syndrome than HLA-B27-negative patients. Diagnosis of postenteritic reactive arthritis is based on bacteriological stool analysis and/or examination of serumantibodies to the corresponding agents. Reactive arthritis is usually self-limiting and therefore treatment of the disease has to be mainly symptomatic. Only more severe chronic or destroying arthritis is thought to be treated locally (i.e. by synoviorthesis) or by immunoregulatory drugs.

Osteocalcin, a major noncollagenous protein component of bone matrix which reflects the level of new bone formation, was measured in serum by radioimmunoassay, in 45 patients with rheumatoid arthritis (RA) (Steinbrocker stage III) and in 45 age- and sex-matched healthy subjects. According to the literature, serum osteocalcin concentrations were slightly decreased in the RA group but this was not statistically significant. Only RA patients on corticosteroid therapy had statistically significant decreased osteocalcin levels, compared with normal controls. No correlation was determined in the RA patients between serum osteocalcin levels and levels of C-reactive protein, erythrocyte sedimentation rate, circulating immune complexes (Clq binding assay) and rheumatoid factors of the IgA, IgG or IgM class.

A 47-year old woman patient suffering from chronic delayed sleep phase insomnia and low-dose benzodiazepine dependence was treated as an inpatient under close polygraphic control using DSIP (delta sleep inducing peptide) on an intensive-care basis for one week. This treatment resulted in advancing the main sleep phase by 5 hours, in an abrupt and complete withdrawal of flunitrazepam and restitution of a normal sleep profile. Actographic control during an after treatment week confirmed that the success was maintained.

Microbiological examinations were performed in 247 women complaining of vaginal discharge. An average of 3.9 different organisms was isolated from each patient. Gardnerella vaginalis was found in 62.8% of all women. Candida spp. were seen in 22.7%. Trichomonas vaginalis occurred in 6.5%, Neisseria gonorrhoeae in 1.2%, Chlamydia trachomatis in 10.1%, Mycoplasmata in 13.8%, Cytomegalovirus in 2.8%, and Herpes simplex Type 2-virus in 1.1%. None of the above was found in 17.4% of the patients. Statistic evaluation revealed correlation between different pathogens and between pathogens and normal vaginal bacteria, e.g. a higher prevalence of Trichomonas vaginalis, Mycoplasmata and Bacteroides spp. in association with Gardnerella vaginalis, and a lower prevalence of Candida spp. and lactobacilli. A pathogenic role of the Mycoplasmata in connection with vaginal discharge cannot be supported by this study. The results of antimicrobial therapy are reported and discussed.

We describe an 42 year old patient suffering from chronic pancreatitis for 7 years who additionally developed subcutaneous fat necrosis, acute arthritis and erythema nodosum--like skin lesions. These symptoms associated with acute or chronic pancreatic disease represent a rare clinical entity. In this case the clinical course was rapidly progressive, resistant to therapy and further complicated by a vasculitic process.

Routine laboratory tests (Rose-Waaler test, latex fixation test) for the detection of rheumatoid factor (RF) measure IgM RF by its ability to agglutinate sheep red blood cells or latex particles coated with IgG. Recently, solid-phase RIA and ELISA have been developed to detect RF of all major immunoglobulin classes in a sensitive and reproducible manner. In the literature the pathogenetic, diagnostic and prognostic significance of IgA, IgG and IgM RF is discussed. Using a micro-ELISA with human IgG-Fc-fragments as antigens, we have detected IgA RF and/or IgG RF not only in sera from seropositive rheumatoid arthritis (RA) (n = 48), but also in 13 of 22 sera from seronegative RA, which was statistically significant compared with a group of 50 normal controls. There was a good correlation between IgM RF in ELISA and Rose-Waaler titres for agglutinating RF (r = 0.70). No RF were found in patients with psoriatic arthritis (n = 16).

During a nine-year treatment by haemodialysis for renal failure a now 57-year-old woman developed multiple complications of the skeletal system. Acute calcific periarthritis of the right shoulder became manifest one year after the start of the haemodialysis, followed the next years by progressive arthropathy with subchondral amyloid cysts of both shoulders, effusions in the knee-joint and destructive spondylarthropathy of the middle vertebrae. Carpal-tunnel syndrome also occurred, caused by a beta 2-microglobulin amyloidosis (beta 2-microglobulin concentration in serum 42.6 ng/l) and an aluminium osteopathy. These multiple complications, observed here in one patient, are each of them typical long-term complications of chronic haemodialysis.

The characterization of synovial tissue in rheumatoid arthritis (proliferative or exsudative synovitis), which is important in deciding between local therapies of arthritis, was examined by arthrosonography, computerized axial tomography and arthroscopy. The arthroscopic examination yields the highest significance in characterizing rheumatoid synovial tissue. Compared to arthroscopy, arthrosonographic diagnosis was correct in 70% of our cases. The arthrosonographic results were much influenced by the different concentrations of fibrin in the synovial effusions.

Activated monocytes/macrophages secrete monokines, regulatory proteins which are capable of initiating and maintaining immune processes as well as having an effect on other non immunocompetent cells. In rheumatoid arthritis the monokine Interleukin-1 (IL-1) was detected in the synovial fluid. IL-1 activates immunocompetent cells in the synovial membrane. It also stimulates rheumatoid synovial cells to markedly increase the collagenase-production and release of prostaglandin E2 and lysosomal acid hydrolase. The proliferation of fibroblasts is enhanced by IL-1. IL-1 has also been shown to be responsible for stimulating the production of cartilage-degrading enzymes and to lead to degradation of the cartilage matrix. It can enhance the rate of Ca++-release in the bone, but may also stimulate the production of collagen and glycosaminoglycans by osteocytes. Drug-induced inhibition of secretion, release or function of IL-1 may have an immune-modulating, antiinflammatory and antiproliferative effects.

Concentrations of interleukin-1 (IL-1), C3a des Arg and immune complexes (IC) were investigated in knee effusions of patients with rheumatoid arthritis (RA; n = 36), psoriatic arthritis (Ps.A., n = 19) and osteoarthritis (n = 7). Maximal concentrations of IC and C3a des Arg were found in RA patients, high IL-1-activities could be demonstrated in patients with Ps.A. and seropositive RA. We found significant correlations between IL-1 and C3a des Arg, IL-1 and IC and C3a des Arg, and IC in Ps.A. patients, but not in RA or osteoarthritis patients. The role of IL-1 in the chronic inflammatory response and joint destruction in inflammatory joint diseases is discussed.

Patients with reactive arthritis, sacroiliitis, spondylitis or Reiter's syndrome following intestinal infection from Yersinia, Salmonella, Shigella or Campylobacter organisms have been reported from endemic areas and after epidemic dysenteries. Possession of the antigen HLA B27 affects severity and prognosis of the arthritis and is more often associated with spondylitis and Reiter's syndrome. Articular manifestations are also quite common systemic complications of chronic inflammatory bowel disease. The clinical picture, pathogenetical aspects and treatment of arthritis associated with Crohn's disease, ulcerative colitis and Whipple's disease are reviewed. In only few cases, coeliac disease can be complicated by arthritis. In patients undergoing intestinal bypass surgery systemically absorption of intestinal bacterial antigens and immune complex formation may contribute to the development of bypass-arthropathy and dermatologic manifestations.

The neonatal lupus erythematosus syndrome, first described by McCuistion and Schoch in 1954, is associated with characteristic skin lesions and congenital heart block in the new-born, and the presence of Ro-(SSA), La-(SSB), or RNP antibodies in mothers and infants. A transplacental transference of maternal autoantibodies is discussed as possible pathophysiologic mechanism in neonatal lupus. The symptoms, the onset, and recently published pathogenetic concepts are reviewed.