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Background: Anaphylaxis is the most severe manifestation of a mast cell-dependent immediate reaction and may be fatal. According to data from the Berlin region, its incidence is 2-3 cases per 100 000 persons per year. Methods: We evaluated data from the anaphylaxis registry of the German-speaking countries for 2006-2013 and data from the protocols of the ADAC air rescue service for 2010-2011 to study the triggers, clinical manifestations, and treatment of anaphylaxis. Results: The registry contained data on 4141 patients, and the ADAC air rescue protocols concerned 1123 patients. In the registry, the most common triggers for anaphylaxis were insect venom (n = 2074; 50.1%), foods (n = 1039; 25.1%), and drugs (n = 627; 15.1%). Within these groups, the most common triggers were wasp (n = 1460) and bee stings (n = 412), legumes (n = 241), animal proteins (n = 225), and analgesic drugs (n = 277). Food anaphylaxis was most frequently induced by peanuts, cow milk, and hen's egg in children and by wheat and shellfish in adults. An analysis of the medical emergency cases revealed that epinephrine was given for grade 3 or 4 anaphylaxis to 14.5% and 43.9% (respectively) of the patients in the anaphylaxis registry and to 19% and 78% of the patients in the air rescue protocols. Conclusion: Wasp and bee venom, legumes, animal proteins, and analgesic drugs were the commonest triggers of anaphylaxis. Their relative frequency was agedependent. Epinephrine was given too rarely, as it is recommended in the guidelines for all cases of grade 2 and above. [ABSTRACT FROM AUTHOR]

Introduction. The aim of this retrospective study was to examine effect of erlotinib in patients with advanced non-small cell lung cancer (NSCLC) in second-line and further therapy in daily clinical practice. Methods. Patients with histologically or cytologically proven NSCLC (n = 84) treated with erlotinib in second-line (n = 34), third-line (n = 36), and more-line therapy (n = 14) were examined for progression-free survival (PFS), overall survival (OS), disease control rate (DCR), duration of therapy, and adverse effects. Results. Median PFS of all lines was 83 days (CI 70.0-96.0), OS was 7months (CI 4.7-9.3), DCR was 66.2% (CI 55-77%), and 1-year survival rate was 33% (CI 22-43%), with no significant difference between therapy lines. Median duration of treatment was 76 days (IQR 39-139.5). Patients with epidermal growth factor receptor mutation (EGFR-M) reached the highest PFS (204 days), as did patients with good performance status (ECOG 0-1: 94 versus ECOG 2-3: 65 days, P = 0.035). Patients with EGFR-M also revealed a DCR of 100%. The most frequent side effects were rash (69%) and diarrhoea (41%), without any significant difference between therapy lines. In 24 patients, the treatment dose was reduced and in 18, the therapy was paused. Conclusion. Erlotinibworks in all therapy lines without any significant differences in efficacy and side effects. [ABSTRACT FROM AUTHOR]

Abstract: CAP may be diagnosed and followed up by lung sonography (LUS), a technique that shows excellent sensitivity and specificity that is at least comparable with that of chest X-ray in two planes. LUS may be performed with any abdomen-sonography device. Therefore, LUS is a readily available diagnostic tool that does not involve radiation exposure and has wide applications especially in situations where X-ray is not available and/or not applicable. An X-ray or CT of the chest should be performed in cases of negative lung sonography and if other differential diagnoses or complications are suspected. [Copyright &y& Elsevier]

The article discusses the role of emergency chest sonography. Emergency ultrasound of the chest is a non-invasive and portable diagnostic technique which can be performed any time, anywhere. Chest sonography allows immediate diagnosis of diseases and injuries such as pulmonary embolism, pneumonia, rib fracture and pneumothorax.

A letter to the editor is presented in response to the article "Lung Ultrasound in the Diagnosis and Follow-Up of Community-Acquired Pneumonia: A Prospective, Multicenter, Diagnostic Accuracy Study" by A. Reissig and colleagues in the October 2012 issue.

Abstract: A 74-year old woman suffering from increasing dyspnea was admitted to the university clinic hospital. She had been diagnosed with asthma for a period of ten years prior to admission. Fiberoptic bronchoscopy revealed a circumscript tumour occluding the left main bronchus immediately above the left upper lobe. The diagnosis of endobronchial hamartoma was established by forceps biopsies during fiberoptic bronchoscopy. [Copyright &y& Elsevier]

Abstract: A rapid identification of the causes of hemodynamic instability or cardiac arrest is crucial for correct treatment. In a critical care setting, ultrasound seems to be an ideal tool for a rapid diagnosis. A multiple-goal problem-based approach represents the main peculiarity of emergency ultrasound and may be considered an extension of physical examination. The integration of data that can rapidly be obtained from the heart, lung, inferior vena cava, abdomen and leg vein examination are often essential for the diagnosis and treatment in critically ill patients. The role and potentiality of integrated ultrasound in cardiac arrest, shock/hypotension and severe dyspnea are considered in this article. [Copyright &y& Elsevier]

In a prospective uncontrolled observational study we investigated the influence of gender, resilience, and marital satisfaction on mental distress of patients suffering from lung cancer and their partners. Female patients and partners report-ed impaired physical and mental health as well as lower resilience and marital satisfaction than males. Mental distress was negatively associated with resilience and marital satisfaction, both, in patients and their partners. We found a partial mediation effect of resilience and marital satisfaction on the relationship between gender and mental distress. Taking these results into account, particularly female patients and partners should preferably receive psychooncological support., (© Georg Thieme Verlag KG Stuttgart · New York.)

We report herein the therapeutic effect of interferon (IFN)-alphacon in three patients with severe persistent asthma and long-term oral glucocorticoid treatment. IFN-alphacon (9 microg) administered subcutaneously thrice a week over a period of more than 24 months led to a substantial clinical improvement with regard to the number of daily asthma attacks, nighttime disturbance, emergency visits and hospitalizations. In addition, lung function and exercise capacity improved. At the same time, treatment with IFN allowed discontinuation of the daily glucocorticoid dose in all patients for the first time in more than 8 years. Our findings suggest that IFN-alphacon leads to a significant clinical improvement while at the same time allowing reduction and discontinuation of the glucocorticoid treatment in severe persistent glucocorticoid-dependent asthma.

Purpose: A phase III study to determine whether a weekly docetaxel schedule improves the therapeutic index compared with the classic 3-weekly schedule., Patients and Methods: Patients with stage IIIB-IV non-small-cell lung cancer (NSCLC) were randomly assigned to docetaxel 75 mg/m2 on day 1 every 3 weeks (3-weekly) and 35 mg/m2 on days 1, 8, and 15 (weekly) for < or = eight cycles. End points included survival (primary), toxicity, and response., Results: Of 215 patients enrolled, 208 (103 in the 3-weekly arm and 105 in the weekly arm) were assessable for response. At baseline, 24.5% of patients (51 out of 208) had received prior paclitaxel therapy and 43.3% of patients (90 out of 208) had been progression-free for more than 3 months after first-line therapy. After 12 months' follow-up, median survival was 6.3 months (95% CI, 4.68 to 7.84 months) with 3-weekly docetaxel and 9.2 months (95% CI, 5.83 to 12.59 months) with weekly docetaxel (P = .07) after a median of four (range, one to eight) and two (range, one to eight) treatment cycles, respectively. Overall, response rates were 12.6% v 10.5% with 3-weekly versus weekly docetaxel. Significantly fewer patients reported grade 3 to 4 toxicities with weekly docetaxel versus 3-weekly docetaxel (P < or = .05). There were significantly lower rates of grade 3 to 4 anemia (P < or = .05), leucopenia (P < .0001), and neutropenia (P < or = .001) with weekly versus 3-weekly treatment. No grade 3 to 4 thrombocytopenia or mucositis was reported., Conclusion: Weekly docetaxel 35 mg/m2 demonstrated similar efficacy and better tolerability than standard 3-weekly docetaxel 75 mg/m2 and can be recommended as a feasible alternative second-line treatment option for patients with advanced NSCLC.

Objective: Transthoracic sonography (TS) has evolved as an important imaging technique for diagnosing pleural and pulmonary conditions. However, the value of TS in either excluding or diagnosing pneumothorax is still under debate. This study was conducted to examine whether TS could replace chest radiography for the diagnosis of post-interventional pneumothorax and hydropneumothorax., Methods: 53 patients (21 females, 32 males; median age 64 years, range 37-94 years), 35 of whom underwent transbronchial biopsy (TBB) and 18 patients who had an ultrasound-guided chest tube placement (U-GCTP) were enrolled in the study. TS was performed three hours after either TBB or removal of a chest tube, followed by postero-anterior chest radiograph (CRX). If any discrepancy between TS, the clinical presentation and the CRX became apparent, either a lateral CRX or a computed tomography (CT) of the thorax was performed. TS was assessed according to the presence of the following criteria: (1) "gliding sign" of the pleural line, (2) comet tail artifacts, (3) reverberation artifacts, (4) air/fluid mirror, (5) hyperechoic reflectors within the pleural effusion and (6) "lung point"., Results: In four out of the 53 patients (7.5%) a post-interventional pneumothorax or hydropneumothorax occurred. One out of the 35 patients (2.9%) developed a pneumothorax after TBB, requiring chest tube placement. Three patients (16.7%) developed a hydropneumothorax due to U-GCTP which was detected by sonography but was missed by postero-anterior CRX in one patient. The sensitivity, specificity and accuracy of TS were 100% in excluding post-interventional pneumothorax/hydropneumothorax., Conclusion: TS is a cost-effective and safe bed-side-method, allowing for an immediate exclusion or diagnosis of post-interventional pneumothorax/hydropneumothorax in patients who have undergone TBB or U-GCTP. Thus, these preliminary results suggest that CXR may only be required in patients with pneumothorax diagnosed by TS in order to assess its extension or to exclude any discrepancy between the TS-result and the clinical presentation.

Introduction/objective: The aim of the study was to compare findings of transthoracic sonography (TS) and of spiral computed tomography (sCT) in patients with suspected pulmonary embolism (PE)., Methods and Patients: Peripheral parenchymal and pleural findings of TS and sCT were compared in 62 patients (25 females, 37 males; mean age 62.2 years) with suspected PE., Results: In 39 patients PE was established, of whose pleura-based lesions could be detected by TS in 30 patients and by sCT in 31 patients. Whilst in three of the patients parenchymal lesions were exclusively detected by sonography, no peripheral abnormalities could be discovered with either technique in five patients. Among the nine patients lacking peripheral abnormalities on sonography, four revealed peripheral lesions in sCT. In 23 patients without PE, peripheral consolidations at CT were detected in six patients whereas two showed lesions on TS. With respect to the appearance, pleura-based wedge-shaped consolidations were the main parenchymal alterations (82.4% at TS, 66.1% at sCT) as compared with non-wedge-shaped consolidations (17.6% at TS, 33.9% at sCT). Peripheral lesions were located preferentially within the lower lobes. In addition, both localised and basal pleural effusion associated with PE could be demonstrated in 58.9% at TS and in 23.1% by sCT., Discussions and Conclusion: The study shows that in PE parenchymal and pleural changes are detectable by TS and sCT. If parenchymal findings are present at sCT, peripheral PE should be considered, even in the absence of directly visible emboli.

Objective: The value of transthoracic sonography in diffuse parenchymal lung disease is not established. This prospective study was conducted to analyze pleural and parenchymal alterations in patients with diffuse parenchymal lung disease by transthoracic sonography and to compare the results with the findings of a control group., Methods: Fifty-three patients with diffuse parenchymal lung disease and 35 control subjects underwent transthoracic sonography for assessment of (1) basal pleural effusion, (2) the presence and number of comet tail artifacts, (3) thickening, (4) an irregular, fragmented pleural line, and (5) subpleural alterations., Results: Basal pleural effusion was revealed in 37.7% of the patients with diffuse parenchymal lung disease (0% of the control subjects; P < .001), and 98.1% had multiple (>6 per scan) comet tail artifacts (14.3% of the control subjects; P < .001). Only a few artifacts (< or = 6 per scan; P < .001) were shown in 85.7% of the control subjects. All the control subjects had strongly localized comet tail artifacts and no thickened pleural line (84.9% of patients; P < .001). In 98.1 % of the patients, an irregular, fragmented pleural surface could be detected (82.8% of the control subjects; P < .05). Subpleural alterations were found in 37.7% of the patients and in 8.6% of the control subjects (P < .001)., Conclusions: Diffuse parenchymal lung disease should be considered if multiple comet tail artifacts distributed over the whole surface of the lung together with a thickened and irregular, fragmented pleural line are visible. Transthoracic sonography may reflect the distribution of pleural involvement and may show subpleural alterations.