[Update Sarcoidosis]. / Update Sarkoidose.

Sarcoidosis is a systemic granulomatous disease whose etiology has not yet been clarified. Generally, sarcoidosis is a benign disease, but recent studies have shown that the number of chronic progressive diseases is greater than previously thought. Diagnosis is based on the clinical picture and radiological imaging. In recent years, FDG-PET has become more and more important for the determination of activity and, together with MRI of the heart, for the diagnosis of cardiac manifestation. Furthermore, the indication for immunosuppressive treatment must be determined individually for each patient and depends on the severity of the symptoms and organ disorders. In addition to corticosteroids as the first choice, other immunosuppressants such as methotrexate and TNFalpha blockers have been established as stepwise approach.

[Clinical Characteristics and Course of Infections by Influenza A- and Respiratory Syncytial Virus (RSV) in Hospitalized Adults]. / Symptomatologie und klinischer Verlauf bei hospitalisierten Erwachsenen mit Virusinfektionen durch Influenza A und Respiratory Syncytial-Virus (RSV).

There is little evidence on the clinical characteristics and the course of complicated infections with respiratory syncytial virus (RSV) compared to influenza A in adults. Therefore, the present monocenter study aims to compare infections with RSV and influenza A with regard to potential predisposing factors, clinical profile, course and outcome in hospitalized patient. MATERIAL AND METHODS: the study was performed between Jan 1th and March 31 this year and included all hospitalized patients with a Polymerase chain-reaction-(PCR) confirmed infection of influenza A and RSV. Patients were characterized by clinical symptoms at the time of diagnosis, laboratory parameters of inflammation and potential predisposing factors like chronical diseases of heart, lung, kidney, metabolism and tumors. Data on the length of hospital stay, origin of infection (nosocomial), rate of pneumonia, antimicrobial use, need of mechanical ventilation and hospital mortality were obtained to evaluate clinical severity and outcome. RESULTS: A total of 190 patients with Influenza A and 98 patients with RSV were included. Both patient groups did not differ with regard to anthropometric data and clinical symptoms: it was surprising to see that only 2/3 oft all patients exert symptoms of a respiratory infection. 15.3 % of influenza A and 13.3 % RSV infections were defined as being nosocomial. Comparing the clinical course and outcome, patients with RSV infections and chronical disease of the lung had an increased rate of mechanical ventilations (odds ratio 10.55 [95 % CI 1.18 - 507.1] p = 0.014). CONCLUSIONS: The present data clearly show that RSV is a frequent pathogen in hospitalized adults with complicated infections in the winter season. RSV infections seems to be more severe compared to influenza A particular in patients with chronic lung disease, but were as frequent as influenza A of nosocomial origin. In this context, an early diagnosis seems to be helpful for a successful infections prevention management under hospital conditions.

Treatment of Acute Hemoptysis by Bronchial Artery Embolization with the Liquid Embolic Agent Ethylene Vinyl Alcohol Copolymer.

PURPOSE: To determine the technical and clinical success of bronchial artery embolization (BAE) with the liquid embolic agent ethylene vinyl alcohol (EVOH) copolymer in patients with acute hemoptysis. MATERIALS AND METHODS: Thirty-four patients (25 male; mean age, 58 y; range, 13-78 y) who underwent BAE with EVOH were retrospectively reviewed. Reasons for acute hemoptysis included lung cancer (44%), pulmonary metastases (12%), bronchiectasis (21%), arteriovenous malformation (5%), tuberculosis (6%), aspergilloma (3%), acute respiratory distress syndrome (3%), anticoagulant overdose (3%), and scar tissue (3%). Technical and clinical success of BAE were retrospectively assessed. RESULTS: Embolization was technically successful in 94% of patients. Additional embolization material was needed in 4 patients (12%). The immediate clinical success rate was 94% (32 of 34); in 2 patients (6%), hemoptysis recurred immediately after the intervention or could not be stopped. Periinterventional minor complications included headache (n = 1), fever (n = 1), and acute renal failure (n = 1). During follow-up (mean, 8.8 mo), 5 patients had a recurrence of hemoptysis (15%). CONCLUSIONS: The use of EVOH copolymer for BAE in patients with acute hemoptysis is technically successful and safe and has a good clinical outcome with a low number of recurrences.

Immediate but not long-term intranasal administration of insulin raises blood pressure in human beings.

Intranasal administration of insulin has been shown to influence neuroendocrine functions via an effect on central nervous mechanisms. Because insulin, in particular when infused into cerebral arteries, induces blood pressure (BP) elevation by an unknown mechanism, we investigated whether insulin exerts similar effects on BP after intranasal administration. To evaluate the immediate effects of insulin on BP, 20 IU of human insulin was intranasally administered every 10 minutes over a 2-hour period. Blood pressure, heart rate, and muscular sympathetic nervous activity (MSNA) were continuously monitored. For evaluating the effects of subchronic administration of insulin, changes during and after 8 weeks of treatment with 160 IU insulin/d on BP were monitored. Compared with placebo, the immediate nasal administration of insulin raised diastolic BP (12.21% +/- 5.10%; P < .05), mean arterial BP (10.81% +/- 4.32%; P < .04), and systolic BP (9.53% +/- 4.66%; P < .08), whereas MSNA and heart rate were unaffected. In contrast, prolonged intranasal insulin administration did not affect BP (P > .62 for all comparisons). The immediate increase in BP in the face of an unsuppressed MSNA after insulin suggests that intranasal insulin transiently changes the baroreflex set point. Thus, data suggest that intranasal insulin administration affects BP regulatory centers in the brain. However, the effect is not observed with prolonged administration of the hormone, suggesting the emergence of counterregulatory processes.