Treatment responses in multidrug-resistant tuberculosis in Germany.

BACKGROUND: Excellent treatment outcomes have recently been reported for patients with multi/extensively drug-resistant tuberculosis (M/XDR-TB) in settings where optimal resources for individualised therapy are available. OBJECTIVE: To ascertain whether differences remain in treatment responses between patients with M/XDR-TB and those with non-M/XDR-TB. METHOD: Patients with TB were prospectively enrolled between March 2013 and March 2016 at five hospitals in Germany. Treatment was conducted following current guidelines and individualised on the basis of drug susceptibility testing. Two-month and 6-month sputum smear and sputum culture conversion rates were assessed. A clinical and radiological score were used to assess response to anti-tuberculosis treatment. RESULTS: Non-M/XDR-TB (n = 29) and M/XDR-TB (n = 46) patients showed similar rates of microbiological conversion: 2-month smear conversion rate, 90% vs. 78%; culture conversion rate, 67% vs. 61%; time to smear conversion, 19 days (IQR 10-32) vs. 31 days (IQR 14-56) (P = 0.066); time to culture conversion, 39 days (IQR 17-67) vs. 39 days (IQR 6-85) (P = 0.191). Both clinical and radiological scores decreased after the introduction of anti-tuberculosis treatment. CONCLUSION: There were no significant differences in scores between the two groups until 6 months of treatment. Under optimal clinical conditions, with the availability of novel diagnostics and a wide range of therapeutic options for individualised treatment, patients with M/XDR-TB achieved 6-month culture conversion rates that were compatible with those in patients with non-M/XDR-TB.

[Hepatopulmonary syndrome]. / Hepatopulmonales Syndrom.

ANAMNESIS: We report about a 60-year-old woman with hepatopulmonary syndrome. The patient suffered from progressive dyspnea and liver cirrhosis following viral hepatitis C, acquired through blood transfusion 30 years ago. EXAMINATION RESULTS: Remarkable were clinical signs of chronic liver disease (cutaneous spider naevi, palmar erythema) and signs of chronic respiratory failure (clubbing) with platypnea. Arterial pO2 was 33 mm Hg under 41 O2/min nasal oxygen supplement and improved to 74 mm Hg under 81 O2/min. Arterial pO2 deteriorated in upright position (orthodeoxia). Contrast enhanced two-dimensional transthoracic echocardiography showed a delayed microbubble opacification in the left heart chambers (without atrial or ventricular septal defect), suggesting pulmonary vascular dilatations. Perfusion scan with macroaggregated albumin labelled with technetium-99m showed uptake over thyroid, kidneys, liver, and spleen suggesting an abnormal passage through the pulmonary vascular bed. The radiological examination with chest radiography and high resolution computer tomography revealed no signs of interstitial lung disease. The pulmonary artery angiography showed neither anatomical shunts nor malformations. DIAGNOSIS: The final diagnosis was hepatopulmonary syndrome Type 1. TREATMENT/FOLLOW-UP: The patient underwent liver transplantation with following good function of the liver graft. After 6 months the patient presented in a much better general condition, but with persisting severe hypoxemia whereas the spider naevi disappeared completely. One year after the liver transplantation in the perfusion scan the uptake over thyroid, kidneys, liver, and spleen was absent. The orthodeoxia and hypoxemia improved evidently. From that we conclude that the pulmonary vascular dilatations diminished after liver transplantation.

[Comparison of stress echocardiography and radionuclide ventriculography in the diagnosis of cardiomyopathy in patients receiving chemotherapy for malignant diseases]. / Vergleich von Belastungsechokardiographie und Radionuklidventrikulographie in der Diagnostik der Kardiomyopathie bei Patienten mit malignen Erkrankungen unter Chemotherapie.

BACKGROUND AND OBJECTIVE: Early evidence of drug-induced cardiomyopathy (CMP) is of great importance in haematological treatment, especially with anthracyclines. Stress echocardiography (SEC) has proved of value in determining left ventricular function at rest and under stress in patients with heart disease. The study was undertaken to assess the value of SEC in comparison with radionuclide ventriculography (RNV). PATIENTS AND METHODS: 63 unselected patients with malignant tumour (20 women, 43 men; mean age 49 +/- 15 years) underwent SEC and RNV. No chemotherapy had yet been started in 17 of them, 43 had received anthracyclines as main component of the chemotherapy (mean anthracycline dose 339 +/- 251 mg/m2). Left ventricular ejection fraction (LVEF) was measured by both SEC and RNV at rest and during standardized stress (recumbent ergometry). Both methods were applied and results measured independently by two examiners. RESULTS: The time interval between the two tests averaged 1 = 2 days. EC could be performed at rest in 62 of 63 and under stress in 59 of 63 patients (RNV: 63 of 63 and 54 of 63, respectively). Resting LVEF was 61 +/- 8% by SEC and 64 +/- 9% by RNV (P < 0.05). LVEF during stress, measured by SEC, was 71 +/- 11% and 73 +/- 10% by RNV (not significant). Mean LVEF increase between rest and stress was 9 +/- 10% by SEC and 9 +/- 8% by RNV (not significant). CONCLUSION: SEC is a satisfactory alternative to RNV in the assessment of ventricular function in patients receiving chemotherapy. It is less involved and more cost-effective than RNV, avoids radiation exposure and provides additional information on heart size and segmental contraction abnormalities.