During the last 1.5 years an update of the guideline on silicosis was made by an interdisciplinary working group. New medical and scientific knowledge and the experience in expert opinion practice were taken into account.By preparing the initial guideline in 2010 standardization of diagnostics and adaption of the "Moers convention" which was not based on medical knowledge was in the focus, whereas the current update deals with fine emendation and extension, especially of the compensation rate (adaption with the Reichenhall recommendation).The diagnosis of silicosis (including mixed dust pneumoconiosis) is based on a detailed occupational history, and predominantly on the typical radiological findings. However, at initial diagnosis the standardized LD-HRCT takes an important role because of its high sensitivity and specificity. Exceptional cases are those with characteristic findings in chest X-ray follow-up. Correspondingly, it is mentioned in the guideline: "The standardized appraisal of the Low-Dose-Volume HRCT requires application of the CT classification (ICOERD, International Classification of Occupational and Environmental Respiratory diseases). In order to diagnose silicosis in CT scan opacities with sharp borders in both central upper lung fields and their circumferencies have to be documented. By comparing with ILO standard radiographs at least profusion category 1 in the right and left upper lung fields has to be reached (total profusion category 2)."The pathologic minimal requirement for the diagnosis of silicosis which has undergone controversial discussion has now also been defined. Corresponding to Hnizdo et al. 2000 it is now mentioned: "Finding of less than 5 silicotic granuloma per lung lobe by palpation is regarded as insignificant." This is a convention and not a threshold based on detailed medical scientific and statistical studies; it is based on extended experience in the South African gold mines.This guideline also deals with silicotic hilar (and sometimes mediastinial) lymph nodes; according to the guideline working group they do not closely correlate with the degree of pulmonary involvement. Extended conglomerating and enduring lymph-node processes may lead to dislocation of the hili with impairment of large bronchi and vessels. Shell-like calcifications dominating in the periphery of lymph nodes produce so-called egg-shell hili.The paragraph on exercise testing is now extended: if neither ergometry nor spiroergometry can be performed a 6 minute walking test by measuring oxygen saturation should be done.Furthermore, in individual expert opinion examinations right heart catheterization (the patient is not obliged to give informed consent) may be recommended, if echo cardiography gives evidence for pulmonary hypertension or if it is difficult to differentiate between right and left heart failure. The presence of pulmonary hypertension which is of prognostic relevance has to be considered when grading reduction in earning capacity.For interpretation of spirometry values the new GLI reference values has to be applied. Grading of impairment is due to the recommendation of the DGP.According to current medical scientific knowledge it is unclear, whether certain disorders of the rheumatic group such is scleroderma or Caplan syndrome which are sometimes associated with silicosis (or coal workers' pneumoconiosis) belong in toto to the occupational disease number 4101 (silicosis). Within this context, additional studies are needed to clarify the role of occupational quartz exposure and other risk factors.The guideline working group hopes that this update will help to optimize diagnostics and expert opinion of silicotic patients.

Einleitung ▼ Beryllium ist ein hartes, sprödes Leichtmetall mit einem hohen Schmelzund Siedepunkt. Es wird überwiegend als Legierungszusatz z. B. zum Härten von Kupfer und Nickel verwendet. Die Legierungen besitzen eine gute elektrische Leitfähigkeit, Formtreue und große Haltbarkeit gegenüber mechanischen Belastungen. Erkrankungen, die durch Beryllium und berylliumhaltige Materialien ausgelöst werden, sind in Deutschland seit 1942 eine anerkannte Berufskrankheit (BKNr. 1110). In der Arbeitsmedizin ist heute von den berylliumassoziierten Krankheitsbildern hauptsächlich die chronische Berylliose („chronic beryllium disease“, CBD) von Bedeutung. Die CBD ist eine granulomatöse Systemerkrankung, die fast immer eine Lungenbeteiligung aufweist und differenzialdiagnostisch nur schwer von der Sarkoidose zu unterscheiden ist. Fehldiagnosen sind deshalb leicht möglich. Der einzige durch einen Bioassay nachweisbare Unterschied ist eine Sensibilisierung gegenüber Beryllium bei der CBD. Über den Krankheitswert einer BerylliumSensibilisierung besteht derzeit noch Unklarheit. In einer Überprüfung der Diagnose in einer Fallsammlung von Sarkoidose-Patienten konnten z. B. bei Zahntechnikern eine berufliche Exposition gegenüber berylliumhaltigen Legierungen und eine Beryllium-Sensibilisierung (BeS) nachgewiesen werden [9].

During the last 1.5 years an update of the guideline on silicosis was made by an interdisciplinary working group. New medical and scientific knowledge and the experience in expert opinion practice were taken into account.By preparing the initial guideline in 2010 standardization of diagnostics and adaption of the "Moers convention" which was not based on medical knowledge was in the focus, whereas the current update deals with fine emendation and extension, especially of the compensation rate (adaption with the Reichenhall recommendation).The diagnosis of silicosis (including mixed dust pneumoconiosis) is based on a detailed occupational history, and predominantly on the typical radiological findings. However, at initial diagnosis the standardized LD-HRCT takes an important role because of its high sensitivity and specificity. Exceptional cases are those with characteristic findings in chest X-ray follow-up. Correspondingly, it is mentioned in the guideline: "The standardized appraisal of the Low-Dose-Volume HRCT requires application of the CT classification (ICOERD, International Classification of Occupational and Environmental Respiratory diseases). In order to diagnose silicosis in CT scan opacities with sharp borders in both central upper lung fields and their circumferencies have to be documented. By comparing with ILO standard radiographs at least profusion category 1 in the right and left upper lung fields has to be reached (total profusion category 2)."The pathologic minimal requirement for the diagnosis of silicosis which has undergone controversial discussion has now also been defined. Corresponding to Hnizdo et al. 2000 it is now mentioned: "Finding of less than 5 silicotic granuloma per lung lobe by palpation is regarded as insignificant." This is a convention and not a threshold based on detailed medical scientific and statistical studies; it is based on extended experience in the South African gold mines.This guideline also deals with silicotic hilar (and sometimes mediastinial) lymph nodes; according to the guideline working group they do not closely correlate with the degree of pulmonary involvement. Extended conglomerating and enduring lymph-node processes may lead to dislocation of the hili with impairment of large bronchi and vessels. Shell-like calcifications dominating in the periphery of lymph nodes produce so-called egg-shell hili.The paragraph on exercise testing is now extended: if neither ergometry nor spiroergometry can be performed a 6 minute walking test by measuring oxygen saturation should be done.Furthermore, in individual expert opinion examinations right heart catheterization (the patient is not obliged to give informed consent) may be recommended, if echo cardiography gives evidence for pulmonary hypertension or if it is difficult to differentiate between right and left heart failure. The presence of pulmonary hypertension which is of prognostic relevance has to be considered when grading reduction in earning capacity.For interpretation of spirometry values the new GLI reference values has to be applied. Grading of impairment is due to the recommendation of the DGP.According to current medical scientific knowledge it is unclear, whether certain disorders of the rheumatic group such is scleroderma or Caplan syndrome which are sometimes associated with silicosis (or coal workers' pneumoconiosis) belong in toto to the occupational disease number 4101 (silicosis). Within this context, additional studies are needed to clarify the role of occupational quartz exposure and other risk factors.The guideline working group hopes that this update will help to optimize diagnostics and expert opinion of silicotic patients.

Quarzstaublungenerkrankung (Silikose)1 S2-Leitlinie nach AWMF-Schema der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Gesellschaft für Arbeitsmedizin und Umweltmedizin Diagnostics and Expert Opinion in the Occupational Disease No. 4101 Silicosis (Including Coal Worker’s Pneumoconiosis) Guideline (S2; AWMF) of the Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin and the Deutsche Gesellschaft für Arbeitsmedizin und Umweltmedizin

Quarzstaublungenerkrankung (Silikose)1 S2-Leitlinie nach AWMF-Schema der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Gesellschaft für Arbeitsmedizin und Umweltmedizin Diagnostics and Expert Opinion in the Occupational Disease No. 4101 Silicosis (Including Coal Worker’s Pneumoconiosis) Guideline (S2; AWMF) of the Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin and the Deutsche Gesellschaft für Arbeitsmedizin und Umweltmedizin

Objective: The objective of this study was to examine the efficacy and safety of a herbal drug preparation from the roots of Pelargonium sidoides (EPs* 7630) in the treatment of acute bronchitis in adults outside the very restricted indication for an antibiotic therapy.Research design and methods: This was a randomised, double-blind, placebo-controlled, multicentre study with 217 patients aged between 18 and 66 years with acute bronchitis. One hundred and eight patients were given 30 drops of EPs 7630-solution three times daily and 109 patients 30 drops of placebo three times daily for a period of 7 days.Main outcome measures: Individual change in bronchitis symptom score (BSS) over 7 days, individual symptoms, patient satisfaction and adverse events.Results: After 7 days of treatment, the BSS decreased by 7.6 +/- 2.2 points in the EPs 7630 group and by 5.3 +/- 3.2 points in the placebo group. The 95% confidence interval for the difference between the effects was calculated as 1.6-3.1, showing highly significant superiority for the EPs 7630 treatment (p < 0.0001).There were also marked improvements in the individual symptoms, which are the components of BSS - cough, chest pain on coughing, sputum, rales/rhonchi and dyspnoea - in the treatment group, relative to placebo. Patient satisfaction was very good. Only minor and transitory adverse events were recorded. No serious adverse events occurred during the trial.Conclusion: EPs 7630-solution is a well tolerated and effective treatment for acute bronchitis in adults outside the very restricted indication for an antibiotic therapy.

Background Clinical trial data suggest that antibiotics are not indicated for the treatment of acute non-group A beta hemolytic strep(non-GABHS) tonsillopharyngitis. Nevertheless patients are symptomatic and effective alternatives for its treatment are needed that have been evaluated in clinical trials.Objective To confirm that treatment with an extract of Pelargonium sidoides (EPs 7630) is superior to placebo for the treatment of non-GABHS tonsillopharyngitis in children.Design Randomized, double-blind, placebo-controlled trial.Setting Six study sites in 4 pediatric and ENT primary care outpatient clinics.Patients One hundred forty-three children aged 6-10 years with non-GABHS tonsillopharyngitis present less than or equal to 48h, a negative rapid strep screen, a Tonsillopharyngitis Severity Score (TSS) greater than or equal to 8 points, and informed consent.Intervention EPs 7630 or placebo (20 drops tid)for 6 days.Measurement The primary outcome criterion was the decrease of the TSS from baseline (day 0) to day 4.Results The decrease of the TSS from baseline (day 0) to day 4 was 71 +/- 2.1 points under EPs 7630 (n= 73), and 2.5 +/- 3.6 points under placebo (n=70). The covariate adjusted decrease was 70 +/- 2.4 points under EPs 7630, and 2.9 +/- 2.4 points under placebo. The 95% RCI for the difference between the groups was [2.7 +/-; 4.9] demonstrating a significant difference in efficacy of EPs 7630 compared to placebo (P<0.0001). Adverse events (AEs) occurred in 15/143 patients (EPs 7630: 4/73 patient, placebo: 44/70) and were not related to the investigational medication.Conclusions EPs 7630 was superior compared to placebo for the treatment of acute non-GABHS tonsillopharyngitis in children. Treatment with EPs 7630 reduced the severity of symptoms and shortened the duration of illness by at least 2 days.

Under the primary utilisation of phytosanitary production factors such as selection of variety, crop rotation and N fertilisation according to plant requirements, the IPM Wheat Model comprises the elements diagnosis (qualitative = type of pathogen, quantitative = disease severity), scientifically grounded treatment thresholds which, as critical values in pathogen development, can be applied to define the optimum time of fungicide application, and pathogen-specific effective fungicides and application amounts. This leads to the location and year-specific optimised control of the pathogen and of the associated yield performance. After several years of development in Bavaria (from 1985 on) and Schleswig-Holstein (1993-1999), the model was tested as part of a project involving the Universities of Bonn and Kiel and the plant protection services of the German states of Lower Saxony, North Rhine-Westphalia and Schleswig-Holstein in a three-year study (1999-2001) in interregional locations (usually nine per state) with the winter wheat variety Ritmo (interregional indicator variety) and a further variety of regional importance in different variations (untreated control, three to four times growth stage-oriented variants for the determination of the absolute damage potential, IPM-variant). In exact records (approx. 12 dates per vegetation period), the disease epidemics were recorded weekly. With the genetically uniform indicator variety Ritmo, the results documented substantially differing year- and location-specific disease and yield patterns. Interregionally, a broad wheat pathogen spectrum (Puccinia striiformis, P. recondita, Septoria tritici, Stagonospora (syn. Septoria) nodorum, Blumeria (syn. Erysiphe) graminis, Pseudocercosporella herpotrichoides, Drechslera tritici-repentis) in differing composition, disease severity and damage effect was demonstrated. The heterogeneity of the infection and damage patterns was increased in the case of the second variety, in association with the genetic variability. The epidemiologically-orientated indications (average two, reduced application amounts) according to the IPM Wheat Model in association with time-diverging progressions led, on an interregional basis, with minimum input and in association with the diverging dynamics, to a biologically and economically optimised fungicide application. In the context of economic and ecological performance, the comprehensive results of the project demonstrated the valuable functionality of the IPM Wheat Model.

Under the specific agricultural and climatic conditions of Rheinland (DE), 48 field trials in three years demonstrated the practicability of the action threshold‐based fungicide strategy of the IPM wheat model. The underlying data for action thresholds and dosage of fungicides applied are outlined. The cereal pathogens concerned, predominantly Mycosphaerella graminicola and Puccinia recondita, were controlled in the early stages of epidemic development using reduced rates of fungicides. The IPM wheat model gave a high efficacy of control, in terms of disease incidence and disease severity, under both low and high disease pressure conditions. The yield levels resulting from this effective reduction in diseases were nearly the same as those of the disease‐free variant. Total yield increase varied between 15% and 30% with an overall average of around 20%, and resulted in monetary benefits of 50–100 EUR ha−1 in the years considered.

The results of field trials at nine locations with two wheat cultivars in each case demonstrated the practicability of the action threshold-based fungicide strategy of the IPM Wheat Model under the intensive wheat production conditions in the Rhineland. Action thresholds used and dosage of fungicides applied are outlined. Despite using reduced rates of fungicides the epidemic development of relevant pathogens--mainly Septoria tritici and Puccinia recondita--was controlled in early stages of disease development. In plots treated according to the IPM Wheat Model disease incidence and disease severity were reduced effectively compared to untreated plots with low and high disease incidence, respectively. The effective control of pathogens using pathogen-specific action thresholds resulted in yield levels very similar to those of disease-free plots simultaneously minimising the total amount of fungicides applied. Disease control according to the IPM Wheat Model raised yields by up to 25% with monetary benefits averaging more than [symbol: see text] 100 ha-1 in 2001.

History and clinical findings: Two men and one woman developed typical symptoms of a thrombosis in the arms after unusual physical effort at their work place (a coal miner after a bad fall, a radiographer after having to catch a patient, a painter after jerkily moving a heavy piece of furniture).Investigations and diagnosis: In all three patients a thrombosis of the subclavian vein was demonstrated by duplex scans or phlebography. In two patients tests for hypercoagulability were unremarkable. None of the patients had a thoracic outlet syndrome.Treatment and course: After initial local thrombolytic or heparin therapy alone, phenprocoumon treatment over several months was given in two cases, and in one case low-molecular-weight heparin was administered over several months. All three patients complained of strain-related residual symptoms in the affected arm (pain, swelling, easy fatiguability), In all three cases, the accident insurer recognized the incident to be a work-related accident.Conclusion: Patients with a Paget-Schroetter syndrome resulting from a sudden and unusual physical effort at work, which is covered by statutory accident insurance, must be reported to the accident insurer as a work-related accident in order to safeguard individual medical claims of the patient and for general medical and epidemiological reasons.

BACKGROUND:Recent meta-analyses of randomized controlled trials in homeopathy have suggested that homeopathy is more than a placebo response.OBJECTIVE:Comparison of the effectiveness of homeopathy in primary care with conventional medicine in primary care for three commonly encountered clinical conditions.DESIGN:An international multicenter, prospective, observational study in a real world medical setting comparing the effectiveness of homeopathy with conventional medicine.PARTICIPANTS:Thirty (30) investigators with conventional medical licenses at six clinical sites in four countries enrolled 500 consecutive patients with at least one of the following three complaints: (1) upper respiratory tract complaints including allergies; (2) lower respiratory tract complaints including allergies; or (3) ear complaints.MAIN OUTCOME MEASURES:The primary outcomes criterion was the response to treatment, defined as cured or major improvement after 14 days of treatment. Secondary outcomes criteria were: (1) rate of recovery; (2) occurrence of adverse events; (3) patient satisfaction; and (4) length of consultation.RESULTS:Four hundred and fifty-six (456) patient visits were compared: 281 received homeopathy, 175 received conventional medicine. The response to treatment as measured by the primary outcomes criterion for patients receiving homeopathy was 82.6%, for conventional medicine it was 68%. Improvement in less than 1 day and in 1 to 3 days was noted in 67.3% of the group receiving homeopathy and in 56.6% of those receiving conventional medicine. The adverse events for those treated with conventional medicine was 22.3% versus 7.8% for those treated with homeopathy. Seventy-nine percent (79.0%) of patients treated with homeopathy were very satisfied and 65.1% of patients treated with conventional, medicine were very satisfied. In both treatment groups 60% of cases had consultations lasting between 5 and 15 minutes.CONCLUSIONS:Homeopathy appeared to be at least as effective as conventional medical care in the treatment of patients with the three conditions studied.

INTRODUCTION:Primary thrombosis of the upper extremity (Paget-Schroetter syndrome, effort thrombosis) is usually not accepted either as a work-related accident or an occupational disease by the industrial injuries insurance authorities. This study aims to look at the circumstances under which this kind of thrombosis may be recognised as an occupational hazard. MATERIALS AND METHODS:After thoroughly studying the clinical records of 82 patients with thrombosis of the upper extremity in the outpatient department for angiology during a 10-year period, we found that in 51 cases the thrombosis was caused by secondary reasons (i.e., central venous catheterisation, malignoma, hypercoagulability, postoperative). In the remaining 31 patients, we painstakingly conducted a general and occupational history and further clinical, laboratory or technical investigations to differentiate the aetiology. RESULTS:Twenty-eight of 31 patients with suspected primary thrombosis of the axillary or subclavian vein (Paget-Schroetter syndrome) showed unusual private or occupational physical exercise as the underlying cause. Sixteen patients reported only short physical exercise up to several hours or acute trauma. Longer physical exercise periods (several days, months or even more) were found in 12 patients. Ten of the 28 patients who acquired the thrombosis doing occupational tasks covered by the industrial insurance, may be eligible for compensation. In 4 of these 10 insured cases, we found strong hints for work accidents, 6 patients of this group apparently revealed criteria of occupational diseases. Four of the 28 patients had a combination of physical effort and additional thrombogenic risk factors (cardiac pacemaker, hypercoagulability). CONCLUSION:Primary thrombosis of the upper extremity (Paget-Schroetter syndrome) should be announced to and compensated by the industrial injuries insurance either as work-related accident or occupational disease if the patient's occupational history shows close relationship between thrombosis manifestation and extraordinary physical efforts or exercises during occupational strains. For this reason, we recommend the recognition of the Paget-Schroetter syndrome in the national list of occupational diseases.

Das Paget-von Schroetter-Syndrom ist eine tiefe Venenthrombose der Vena axillaris und/oder der Vena subclavia. Sie ist verbunden mit den typischen Zeichen einer tiefen Venenthrombose, wie Schmerz, Schwellung, Zyanose und evtl. erkennbare Kollateralvenenzeichnung. Neben iatrogenen Ursachen, Malignomen, Hyperkoagulabilitat und anatomischer Pradisposition kommt eine Auslosung durch ruckartige Krafteinwirkung in Frage. Hat die Belastungseinwirkung nachweislich wahrend einer versicherten Tatigkeit stattgefunden, ist diese Erkrankung beim zustandigen gesetzlichen Unfallversicherungstrager als Arbeitsunfall zu melden.

Objective: The primary objective is to evaluate the effectiveness of homeopathic treatment compared to conventional treatment for respiratory and ear complaints commonly seen in the primary care setting: runny nose, sore throat, ear pain, sinus pain, and cough.

Only a few attempts have been made to date to collect data of homeopathic treatment results under the conditions of everyday practice. The purpose of the Integrative Medicine Data Collection Network (IMDCN) is to evaluate the effectiveness, safety and cost±bene®t of homeopathy compared to conventional medicine. It should also provide a scienti®c rationale for the design of further randomized controlled trials in homeopathy.

It was the aim of this study to assess the diagnostic value of bronchial challenge tests using flour dust inhalation from capsules by a Spinhaler, and to compare this method quantitatively with bronchial challenge tests using a commercially available wheat flour extract for the diagnosis of bakers' asthma. 34 bakers with work-related symptoms of rhinitis or asthma, as well as 10 atopic controls were examined. Subjects were randomized to inhale either 0.01, 0.1, 1, 10 and 100 mg/ml of an aqueous wheat flour extract by tidal volume breathing for 10 minutes, or wheat flour dust filled in capsules, respectively One, two, and four capsules of flour dust were given by a Spinhaler (Fisons Inc, UK). 15 (11) bakers demonstrated a greater than or equal to 50% fall of specific airway conductance (sGaw) after the inhalation of the wheat flour extract (dust). 3 controls had a positive reaction with the extract, whereas dust inhalation did not cause positive bronchial reactions in controls. 17 bakers, but also 2 controls demonstrated a positive skin test to wheat flour (wheal greater than or equal to 3 mm). Using a 50% fall of sGaw as criterion for a positive bronchial provocation test, sensitivity for the extract or dust inhalation was 0.44 and 0.32, and specificity was 0.7 and 1.0. If only subjects with a positive skin test with wheat flour were considered, sensitivity of both tests was 0.65. ROC plots using different definitions of the gold standard revealed a similar validity of both methods. If a 30% fall of sGaw was used as positivity criterion, the sensitivity of the Spinhaler method increased to 0.76, and the validity was higher than that of the extract inhalation. We conclude that the validity of bronchial challenge tests using wheat flour dust inhaled from Spinhaler capsules was superior to tests using a commercially available aqueous wheat flour extract. The higher specificity of the Spinhaler method might be an advantage if bronchial challenge tests are used as confirmation tests.