Ruediger Stephan Goertz

Zusammenfassung: Ziel der Studie Das Masernschutzgesetz und aktualisierte Empfehlungen der Ständigen Impfkommission (STIKO) machen den Nachweis der zweimaligen Impfung gegen Masern für ab 1971 geborene Beschäftigte in der Kinderbetreuung zur Pflicht. Weiterhin sollten die allgemeinen Standard- und beruflichen STIKO-Empfehlungen umgesetzt sein. Es erfolgte daher eine retrolektive Evaluation von Impflücken von Beschäftigten in Einrichtungen der vorschulischen Kinderbetreuung. Methodik Durch eine Datenbank-Abfrage der Jahre 2018 und 2019 des B·A·D-Gesundheitszentrums Erlangen wurden insgesamt 1300 arbeitsmedizinische Vorsorgen im Bereich der vorschulischen Kinderbetreuung erfasst. Ausgeschlossen wurden Doppelvorsorgen und Vorsorgen mit unzureichenden Daten: 1016 Akten wurden hinsichtlich der Impflücken bezüglich Masern, Mumps, Röteln, Varizellen, Pertussis, Hepatitis A+B und FSME analysiert. Die Beurteilung erfolgte primär anhand des Impfpasses. Impflücken wurden bei fehlendem, begonnenem bzw. unvollständigem Impfschutz angenommen. Ergebnisse In der Kohorte der 1016 Beschäftigten stieg durch die aktualisierte STIKO-Empfehlung und die damit verbundene Änderung der Definition eines vollständigen Masern-Impfschutzes die Masern-Impflücke von 16,2% auf 20,6%. Weitere Impflücken lagen bei: für Mumps 22,7%, für Röteln 18,9%, für Windpocken 2,3%, für Pertussis 27,8%, für Hepatitis A 61,1% und für FSME 60,5%. Die Altersgruppe <30 Jahre zeigte geringere Impflücken als die Altersgruppe ≥30 Jahre. Schlussfolgerung Es bestehen altersabhängig teils erhebliche Impflücken in der Beschäftigtenkohorte vom Erlanger Gesundheitszentrum bezüglich der untersuchten (teils impfpräventablen) Infektionskrankheiten. Das Masernschutzgesetz erscheint daher als eine sinnvolle Maßnahme, um die Masernimpflücken zu schließen. Es wird deutlich, dass im Rahmen arbeitsmedizinischer Vorsorgen großer Beratungs- und Handlungsbedarf hinsichtlich der Infektionsprävention durch Impfungen besteht.

Purpose: We evaluated ileal bowel wall thickness and semiquantitative vascularization by ultrasound in correlation with the presence or absence of histopathological inflammation in patients with Crohn’s disease (CD). Methods: We conducted a retrospective analysis of 221 ultrasound examinations of the terminal ileum or neoterminal ileum in CD patients with biopsies of the ileum during colonoscopies within 8 weeks of the ultrasound. Ultrasound data were obtained from an inflammatory bowel disease ultrasound register from 2011 to 2017. Bowel wall ultrasound was performed by a high-frequency, linear transducer (7–12 MHz). Presence of bowel wall thickening (> 3 mm), vascularization by the Limberg score, and presence of ileal histopathological inflammation were analyzed. Results: In 221 bowel wall ultrasound examinations of CD patients (128 female, 93 male, mean age 37.5 years), a thickened bowel wall was found in 140 (63.3%) and hypervascularization (corresponding to a Limberg score ≥ 2) in 96 (43.4%) cases. In 187 (84.6%) cases, ileal inflammation was confirmed by histopathology and in 34 (15.4%) cases no inflammation was shown. Bowel wall thickening showed a sensitivity of 70.1%, a negative predictive value (NPV) of 30.9%, a specificity of 73.5% and a positive predictive value (PPV) of 93.6% for the detection of histopathological ileal inflammation. Hypervasularization had a low sensitivity (49.7%) and NPV (24.8%), but high specificity (91.2%) and PPV (96.9%). Conclusion: In this CD subcohort of an ultrasound register, pathologic ultrasound findings were quite common. Bowel wall thickening (> 3 mm) and hypervascularization are good predictors of histopathological inflammation within the terminal ileum or neoterminal ileum. Normal ultrasound findings without bowel wall thickening and without hypervascularization do not rule out histopathological inflammation.

Objective: The clinical presentation of pulmonary embolism (PE) can be various and misleading. We analyzed patients with suspicion of PE and subsequently performed computed tomography pulmonary angiography (CTPA) in an emergency department of Internal Medicine, focusing on patient groups in which PE might be underestimated in the emergency setting, such as young patients and patients with low clinical probability. Material and Methods: In 2016 and 2017, all patients receiving a CTPA for investigation of PE were retrospectively evaluated for clinical parameters (age, symptoms, and vital parameters) and D-dimers. The Wells score was calculated. Results: CTPA was performed in 323 patients (158 female and 165 male; mean age 62 years). The leading symptoms for admission were dyspnea or chest pain; 62% showed intermediate or high risk for PE, calculated by applying the Wells score. In 123 (38%) of all patients, a PE was proved and pathologic age-adjusted D-dimers were found in 97.6%. Thirty of 121 (25%) patients with low risk according to Wells score had a PE. Deep vein thrombosis was verified in 67/123 (55%) patients; 43% (15/35) of all suspicions for PE in patients Conclusion: CTPA frequently proves a PE in patients with suspicion of PE in an emergency department of Internal Medicine. If PE is suspected and CTPA performed accordingly, the presence of PE is quite common even in low-risk patient groups (Wells score) or in young patients <40 years with chest pain or dyspnea.

Acoustic radiation force impulse (ARFI) elastography is a non-invasive, ultrasound-based approach of evaluation of tissue elasticity. It has not yet been systematically applied to the bowel wall. To perform ARFI elastography of the bowel wall in healthy volunteers and patients with ulcerative colitis (UC). A high-frequency ultrasound (with bowel wall thickness and vascularization score) and an ARFI elastography of the bowel wall were performed in 20 patients with UC and 13 healthy volunteers. At least 10 ARFI measurements were obtained within the terminal ileum and the ascending, transverse, descending, and sigmoid colon and correlated with results of high-frequency ultrasound. The UC group had mostly moderate disease activity. All patients had signs of inflammation upon B-mode ultrasound. Eight patients showed an ulcerative (ileo)pancolitis. Overall, ARFI elastography values and wall thickness were higher in the UC group than in the group of healthy volunteers (P = 0.021 and P < 0.001, respectively). ARFI velocities of the separate segments were significantly higher in the transverse (P = 0.045) and sigmoid colon (P = 0.032) in case of UC. ARFI elastography of the bowel wall of the colonic frame and the terminal ileum is feasible but shows high standard deviation. ARFI shear wave velocities appear to be slightly higher in patients with UC than in healthy volunteers, particularly in the sigmoid and transverse colon. Further studies are needed.

Introduction: Influenza infection is a viral disease with significant morbidity and mortality during the cold months. Clinical presentation typically includes cough, fever, and pain. Influenza disease is hardly diagnosed only on the basis of clinical symptoms due to similar clinical presentation of other diseases such as a typical cold or other flu-like diseases. We evaluated patients with proven influenza who presented at an emergency department of internal medicine in a university hospital according to the clinical presentation and different age groups. Materials and Methods: From October 2017 to April 2018, 723 reverse transcription-polymerase chain reaction (RT-PCR) tests for influenza were performed in the emergency department on patients with suspected influenza diagnosed clinically. A total of 240 influenza-positive patients were retrospectively assessed for documented main symptoms, vital parameters, risk factors for an unfavorable course, hospitalization, and death. Results: The mean age of influenza patients was 65 years. Overall, 30 patients were aged 18 to 39 years, 48 patients 40 to 59 years, and 162 patients ⩾60 years. Influenza B in 168 (70%) was predominant to 72 influenza A (mostly H1N1). In only 30% of the patients all three typical symptoms (cough, fever, and headache/myalgia) were documented. Headache or myalgia (with 34%) was rather uncommon in influenza B. Sudden onset was cited in only 5.4%; 57% of all influenza patients were in hospital for a mean of 7.1 days, and 5.8% of all influenza patients died. Patients aged above 60 years had more risk factors, showed typical symptoms less frequently, and were hospitalized longer than younger patients (<60 and <40 years). Conclusions: At an emergency department of internal medicine, influenza-diseased patients are of higher age, show an increased number of comorbidities, and are more likely to have milder symptoms documented. Elderly patients with influenza have a higher hospitalization rate with a longer hospital stay as compared with younger patients.

Die nichtinvasiven ultraschallbasierten Methoden zur Darstellung und Messung der Gewebeelastizität halten zunehmend Einzug in den klinischen Alltag. Bei der Scherwellenelastographie der Leber geben Grenzwerte Hinweise auf eine Fibrose (F ≥ 2, diagnostische Genauigkeit [„area under the reader operating characteristic“, AUROC 87 %]) oder auf eine Zirrhose (F = 4, AUROC 93 %). Normwerte schließen eine Leberzirrhose nahezu aus (negativ prädiktiver Wert bis 97 %). Hohe Scherwellengeschwindigkeiten deuten auf einen komplikativen Verlauf einer primär sklerosierenden Cholangitis, Leberzirrhose oder chronischen Hepatitis B oder C hin. Leberläsionen lassen sich elastographisch hinsichtlich ihrer Dignität nicht unterscheiden. Bei den Schilddrüsen- und Brustläsionen deuten niedrige Scherwellengeschwindigkeiten auf Benignität bzw. hohe auf eine maligne Läsion. Eine Unterscheidung benigner und maligner Schilddrüsenknoten gelingt mithilfe der Kompressionselastographie mit Sensitivitäten um 89 % und Spezifitäten um 82 %. Bei Brustläsionen hilft die Elastographie, Knoten besser als mit dem B-Bild allein zu differenzieren (Sensitivität 97 %, Spezifität 83 %). Invasive Punktionen können dadurch zielgerichteter eingesetzt oder ganz vermieden werden. Wegen zahlreicher Einflussfaktoren insbesondere bei der Leberelastographie müssen die Messungen im klinischen Kontext interpretiert werden. Insgesamt bietet die ultraschallbasierte Elastographie zusätzlich zu den klassischen Techniken mit B-Bild und Farbdoppler hilfreiche Informationen zur Detektion einer Leberfibrose und weiteren Charakterisierung von Schilddrüsen- und Brustknoten.