Showing papers in "Pneumologie in 1996"

Cystic fibrosis airway epithelia fail to kill bacteria because of abnormal airway surface fluid

Abstract: Despite an increased understanding of the cellular and molecular biology of the CFTR Cl- channel, it is not known how defective Cl- transport across airway epithelia causes chronic bacterial infections in cystic fibrosis (CF) airways. Here, we show that common CF pathogens were killed when added to the apical surface of normal airway epithelia. In contrast, these bacteria multiplied on CF epithelia. We found that bactericidal activity was present in airway surface fluid of both normal and CF epithelia. However, because bacterial killing required a low NaCl concentration and because CF surface fluid has a high NaCl concentration, CF epithelia failed to kill bacteria. This defect was corrected by reducing the NaCl concentration on CF epithelia. These data explain how the loss of CFTR Cl- channels may lead to lung disease and suggest new approaches to therapy.

Identification of a brazil-nut allergen in transgenic soybeans

Abstract: BACKGROUND The nutritional quality of soybeans (Glycine max) is compromised by a relative deficiency of methionine in the protein fraction of the seeds. To improve the nutritional quality, methionine-rich 2S albumin from the Brazil nut (Betholletia excelsa) has been introduced into transgenic soybeans. Since the Brazil nut is a known allergenic food, we assessed the allergenicity of the 2S albumin. METHODS The ability of proteins in transgenic and non-transgenic soybeans, Brazil nuts, and purified 2S albumin to bind to IgE in serum from subjects allergic to Brazil nuts was determined by radioallergosorbent tests (4 subjects) and sodium dodecyl sulfate-polyacrylamide-gel electrophoresis (9 subjects) with immunoblotting and autoradiography. Three subjects also underwent skin-prick testing with extracts of soybean, transgenic soybean, and Brazil nut. RESULTS On radioallergosorbent testing of pooled serum from four subjects allergic to Brazil nuts, protein extracts of transgenic soybean inhibited binding of IgE to Brazil-nut proteins. On immunoblotting, serum IgE from eight of nine subjects bound to purified 2S albumin from the Brazil nut and the transgenic soybean. On skin-prick testing, three subjects had positive reactions to extracts of Brazil nut and transgenic soybean and negative reactions to soybean extract. CONCLUSIONS The 2S albumin is probably a major Brazil-nut allergen, and the transgenic soybeans analyzed in this study contain this protein. Our study show that an allergen from a food known to be allergenic can be transferred into another food by genetic engineering.

Bronchoalveolar lavage findings in cystic fibrosis patients with stable, clinically mild lung disease suggest ongoing infection and inflammation

Abstract: To determine the extent of airway infection and inflammation in adolescents and adults with cystic fibrosis (CF) who have mild lung disease and are without symptoms of active infection, we performed bronchoalveolar lavage (BAL) on 18 CF patients > or = 12 yr of age who were stable, appeared clinically well, and had mean (+/- SEM) FEV1 of 79 +/- 4% of predicted. We quantitated the bacteria, inflammatory cells, immunoglobulins, and mediators of inflammatory tissue damage in the epithelial lining fluid (ELF) of these patients and in 23 healthy control subjects. All CF patients were found to be infected with Pseudomonas aeruginosa, Staphylococcus aureus, and/or Haemophilus influenzae; no organisms were isolated from the control subjects. The mean number of cells in the ELF was 14 times greater in the CF patients than in the control subjects. Neutrophils constituted 57% of the recovered cells in the CF patients versus 3% in the control subjects, and their concentration was 380 times greater in the CF patients versus the control subjects. IgG, IgA, and IgM were 2.5 to 6 times greater in CF ELF versus that of control subjects. Abundant active elastase was present in the ELF of the CF patients (2.3 +/- 0.9 microM) despite threefold elevated levels of alpha 1-protease inhibitor (alpha 1-PI). No active elastase was detectable in the control subjects. alpha 1-PI was functional in CF as demonstrated by elevated elastase:alpha 1-PI complex (0.045 microM in CF versus 0.002 microM in control subjects). This active elastase caused proteolytic destruction of surface complement receptors on airway neutrophils in situ.(ABSTRACT TRUNCATED AT 250 WORDS)

Risk factors for nosocomial pneumonia comparing adult critical-care populations

Abstract: The purpose of the study was to examine risk factors for nosocomial pneumonia in the surgical and medical/respiratory intensive care unit (ICU) populations. In a public teaching hospital, all cases of nosocomial pneumonia in the surgical and medical/respiratory ICUs (n = 20, respectively) were identified by prospective surveillance during a 5-yr period from 1987-1991. Each group of ICU cases was compared with 40 ICU control patients who did not acquire pneumonia, and analyzed for 25 potential risk factors. Surgical ICU patients were found to have consistently higher rates of nosocomial pneumonia than medical ICU patients (RR = 2.2). The strongest predictor for nosocomial pneumonia in both the surgical and medical/respiratory ICU groups was found to be prolonged mechanical ventilation (> 1 d) resulting in a 12-fold increase in risk over nonventilated patients. APACHE III score was found to be predictive of nosocomial pneumonia in the surgical ICU population, but not in the medical/respiratory ICU population. We conclude that certain groups deserve special attention for infection control intervention. Surgical ICU patients with high APACHE scores and receiving prolonged mechanical ventilation may be at the greatest risk of acquiring nosocomial pneumonia of all hospitalized patients.

Linkage of high-affinity IgE receptor gene with bronchial hyperreactivity, even in absence of atopy. (Kopplung zwischen dem high-affinity IgE-Rezeptor-Gen und bronchialer Hyperreaktivität, auch in Abwesenheit von Atopie.)

Abstract: Asthma is a manifestation of bronchial hyperreactivity (BHR) and forms part of the spectrum of atopic disease. Some pedigree studies of atopy have suggested linkage with the high-affinity IgE receptor (Fc epsilon RI beta) gene on chromosome 11q13, but others find no linkage. The molecular genetics of asthma and BHR have not been studied in the general population. We examined the genetic linkage of the Fc epsilon RI beta gene with clinical asthma and the underlying phenotypes of BHR (to methacholine) and atopy (defined by skinprick testing) in 123 affected sibling-pairs recruited from the general population. We found evidence of significant linkage of a highly polymorphic microsatellite marker in the fifth intron of the Fc epsilon RI beta gene to a diagnosis of asthma (18.0% excess of shared alleles, p = 0.002) and to BHR (21.7% excess of shared alleles, p = 0.001). Significant linkage was also observed in siblings sharing BHR when those with atopy were excluded (32.8% excess of shared alleles, p = 0.004). Atopy in the absence of BHR did not show significant linkage to the Fc epsilon RI beta gene (7.2% excess of shared alleles, p = 0.124). These findings suggest that mutations in the Fc epsilon RI beta gene or a closely linked gene influence the BHR underlying asthma, even in the absence of atopy.

S-nitrosohaemoglobin: A dynamic activity of blood involved in vascular control

Abstract: A dynamic cycle exists in which haemoglobin is S-nitrosylated in the lung when red blood cells are oxygenated, and the NO group is released during arterial-venous transit. The vasoactivity of S-nitrosohaemoglobin is promoted by the erythrocytic export of S-nitrosothiols. These findings highlight newly discovered allosteric and electronic properties of haemoglobin that appear to be involved in the control of blood pressure and which may facilitate efficient delivery of oxygen to tissues. The role of S-nitrosohaemoglobin in the transduction of NO-related activities may have therapeutic applications.

Reduced vital capacity in elderly persons with hypertension, coronary heart disease, or left ventricular hypertrophy. the Cardiovascular Health Study

Abstract: The Cardiovascular Health Study provided the opportunity to determine the association of subclinical and clinical cardiovascular disease with pulmonary function in a population sample of elderly adults. Included were 2,955 women and 2,246 men over age 64 years who were recruited for this observational study from four communities and completed extensive examinations that included spirometry, echocardiograms, and blood pressure. Current smokers, past smokers with >20 pack-years of smoking, and persons with a history of asthma, chronic bronchitis, or emphysema were excluded from this analysis, leaving 2,784 (55%) of the cohort. Systolic hypertension or coronary artery disease was associated with 40- to 100-mL decrements in FEV 1 and 50- to 150-mL decrements in FVC, while a history of congestive heart failure was associated with 200 to 300 mL lower FEV 1 and FVC values (p 1 and FVC in multivariate models. This relationship was strongest with the end-diastolic LV posterior wall thickness component of LV mass. In summary, FEV 1 and FVC are reduced in elderly persons with hypertension, ischemic heart disease, higher LV mass, and congestive heart failure, though the magnitude of these associations is relatively small unless heart failure supervenes. Substantial decrements in percent predicted FEV 1 and FVC should not be attributed to the presence of uncomplicated ischemic heart disease or hypertension alone.

Tuberculosis outbreak among healthcare workers in a community hospital

Abstract: Twenty-nine healthcare workers (HCW) were exposed to an active case of unrecognized drug-susceptible pulmonary tuberculosis in a community hospital for as long as 2 h in the emergency room and 10 h in a medical intensive care unit. Twelve of the 29 exposed HCW could not be evaluated for tuberculosis infection because 10 of them had a previously positive tuberculin skin test and two were lost to follow-up. Of the remaining 17 tuberculin skin test negative HCW, 13 (76%) either converted their skin test to positive (10 HCW) or developed active disease (three HCW) after exposure to the index case. The Mycobacterium tuberculosis isolates from the three HCW had identical DNA restriction fragment length polymorphism (RFLP) patterns when studied by pulsed field gel electrophoresis. This case of drug-susceptible tuberculosis was associated with unusually high rates of tuberculosis infection and disease in HCW. Prevention of similar occurrences in HCW may be difficult because of the short exposure time required for...

Lung involvement in systemic sclerosis (scleroderma): Relation to classification based on extent of skin involvement or autoantibody status

Abstract: Lung involvement accounts for significant morbidity and is a leading cause of mortality in patients with systemic sclerosis (SSc). It has been shown that different patterns of pulmonary involvement are seen in different subtypes of SSc. This paper reports a retrospective review of 72 patients with SSc to determine whether disease classification according to the extent of skin involvement alone (diffuse vs. limited) or autoantibody status was predictive of pulmonary parenchymal involvement. The diagnosis of interstitial lung disease was based on pulmonary function tests and chest radiographs. Restrictive lung disease was common in both limited SSc (lSSc) and diffuse SSc (dSSc), occurring in 30% and 50% of these patients respectively (P = 0.16). Radiographic evidence of significant interstitial disease was also comparable between the groups [nine of 32 lSSc patients (28%) vs. six of 17 dSSc patients (32%), P = n.s.]. No significant difference in mean lung function was found between patients with anti-Scl 70 antibody (n = 12) compared to those without (n = 60) (TLC 79.0 +/- SE 5.1% predicted vs. 82.8 +/- 2.2, P = n.s.; DLCO 63.0 +/- 5.1 vs. 59.7 +/- 2.5, P = n.s.). By contrast, statistically significant differences in mean lung function were found between patients with anticentromere antibody (ACA) (n = 24) and those without ACA (n = 48) (TLC 98.6 +/- SE 3.9% predicted vs. 79.7 +/- 3.1%, P < 0.001); and less frequent radiographic evidence of severe interstitial disease (0 of 17 with significant interstitial changes on chest radiograph vs. 15 of 32 (47%), P = 0.002). It is concluded that classification of SSc patients on the basis of the distribution of skin involvement poorly predicts the occurrence of interstitial lung disease. On the other hand, ACA is highly associated with the absence of interstitial lung disease.

Nitric oxide increases cellular glutathione levels in rat lung fibroblasts

Abstract: Nitric oxide (NO) has been demonstrated to play a protective role in cell injury. In this study, we have explored the effect of NO and two NO donors (sodium nitroprusside [SNP] and isosorbide dinitrate [ISDN]) on cellular glutathione (GSH) levels in a rat lung fibroblast cell line (RFL6 cells). SNP and ISDN significantly increased cellular GSH in RFL6 cells (5 x 10(-4) M SNP: 21.9 +/- 3.6 nmol/10(6) cells and 5 x 10(-3) M ISDN: 27.6 +/- 1.7 nmol/10(6) cells versus control: 13.2 +/- 0.4 nmol/10(6) cells; P < 0.05). The stimulatory effect of SNP and ISDN on GSH was first seen at 6 h and peaked at 12 to 24 h. A similar increase in GSH was observed in RFL6 cells exposed to 400 ppm NO for 7.5 h (NO: 20.5 +/- 3.4 nmol/10(6) cells versus control: 11.9 +/- 2.4; P < 0.05). SNP and ISDN also increased cellular GSH in bovine pulmonary artery smooth muscle cells (BPSMC) and bovine pulmonary artery endothelial cells (BPAEC). Buthionine sulfoximine (BSO) (0.01 mM), an inhibitor of the GSH synthetic enzyme gamma-glutamyl cysteine synthetase, blocked the increase in GSH in RFL6 cells seen with both SNP and ISDN. In BPAEC, exposure to NO donors for 24 h stimulated glutamate uptake (SNP: 441 +/- 19 pmol/10 min/10(6) cells and ISDN: 677 +/- 48 pmol/10 min/10(6) min/10(6) cells versus control: 222 +/- 9 pmol/10 min/10(6); P < 0.05). This effect paralleled the increase in GSH. In RFL6 cells, only SNP increased glutamate uptake after 24 h of incubation. In summary, NO and NO donors increase cellular GSH in RFL6 cells, BPAEC, and BPSMC. The mechanism of this effect is unclear but may involve upregulation of the normal GSH synthetic pathways. This observation may explain in part the protective effect of NO seen in some cell culture systems and may contribute to a protective effect against oxidant injury in vivo.

[Report by the Scientific Working Group for Therapy of Lung Diseases: German Fibrosis Register with initial results].

Abstract: The aim of this study was to evaluate the occurrence of interstitial lung diseases (ILD) in Germany. Therefore members of the WATL developed a questionnaire which was sent to pulmonary and other physicians who may encounter patients with ILD. In 1995 altogether 234 patients (105 males, 129 females, mean age 51 years, minimum 12, maximum 88 years) were referred to the registry. 126 of these patients were non-smoker, 58 ex-smoker, 45 smoker and in 5 patients no information was given. The following ILD were reported: sarcoidosis (n = 83, 36 males, 47 females), idiopathic pulmonary fibrosis (n = 76, 35 males, 41 females), idiopathic pulmonary fibrosis (n = 76, 35 males, 41 females), alveolitis (n = 31, 12 males, 19 females), bronchiolitis obliterans organizing pneumonia (n = 16, 6 males, 10 females) and others (n = 28, 16 males, 12 females). These preliminary data show that sarcoidosis (35%) and idiopathic fibrosis (33%) were the most frequently registered ILD.

Rates of decline in lung function among subjects who restart cigarette smoking

Abstract: Several studies have demonstrated that smokers who are able to break the habit generally experience reductions in respiratory symptoms and improvement in pulmonary function; however, far less attention has been given to smokers who are unsuccessful in their attempts at quitting. Recent reports have suggested that these subjects (restarters) may have steeper rates of decline in pulmonary function than subjects never attempting to quit smoking. In this study, we compared rates of decline in FEV 1 between restarters and subjects who remained current, ex-smokers, or never-smokers throughout the observation period. The resuits showed that, in both sexes, subjects who attempt to quit the habit and then restart have significantly steeper rates of decline in their FEV 1 than subjects who continue smoking uninterrupted. Female restarters also have significantly steeper rates of decline in FEV 1 than ex-smokers. These effects were independent of the amount smoked and respiratory diseases.

Outcome of structured asthma education in childhood and adolescence

Abstract: From 1988 onwards inpatient asthma training courses have been conducted in Berlin and Osnabruck. A controlled study on asthma training was carried out from 1990 to 1992 at both centres with the support of the Robert Bosch Foundation. In the first intervention group a subsequent training course of 6 months' duration was conducted with the inclusion and participation of the relevant family doctors in addition to the main training course. Scrutiny of the result was done before (T1), directly after (T2) and 12 months subsequent to the training course (T3). Improvements are seen in somatic data or cost-relevant data (emergency referral to the hospital or family physician, inpatient hospital periods, referral because of mild obstruction, days of non-attendance in school due to illness, severity of asthma, incidence of symptoms, stress endurance in sports). There is also a marked improvement in the self-assessment ability of the children and in the management of asthma, as well as a decrease in the asthma-specific feeling of anxiety. Self-reliance and independence, as well as early intervention, are improved as seen by the parents, whereas on the other hand unfavourable factors such as arguments on the proper asthma therapy are diminished. Especially with regard to confidence in controls on the state of health or disease there are significant changes that are more marked in the group subjected to subsequent training than in the group without such additional training, compared with the control group. Structured asthma training exercises a strongly positive effect on the daily management of asthma bronchiale by the families on different planes of coping with the disease. These effects are enhanced by subsequent aftercare by the family physician. Intensive care in the asthma outpatient wards alone does not sufficiently modify the factors contributing to good coping with the disease.

Dangerous complication of transtracheal oxygen therapy with the SCOOP(R) system

Abstract: A portable oxygen system in combination with transtracheal O2 delivery (SCOOP(R)) permits patients with respiratory failure optimal mobility and facilitates longterm oxygen therapy. This report describes a 70 year old female with COPD that developed acute respiratory distress 18 days after inserting PRESCOOP(R) and 11 days after changing to SCOOP 1 catheter. Catheter stripping had not revealed any pathology. Flexible bronchoscopy showed a mucus ball at the catheter tip leading to a 80% stenosis of the trachea. Trials to remove the ball with forceps and a loop were not successful until a rigid bronchoscop was inserted. Up to 10% of patients develop mucus ball formation with SCOOP 1 catheter which remains in situ for 6 weeks. In patients with high risk of mucus formation (high O2 flow, viscous mucus, low FEV1) the manufacturers of SCOOP recommend catheter stripping. We consider a control bronchoscopy being safer 1 week after changing from PRESCOOP to SCOOP because one patient has been reported to have died of this complication and our patient has developed a near fatal situation.

[Bronchial asthma--a cost of illness analysis]

Abstract: We performed an economic evaluation of the costs of asthma in Germany. Estimates of direct medical expenditures and indirect costs were derived from official health statistics of 1992. Adding up direct and indirect costs, the total sum is approximately 2.66 billions ECU which is equivalent to 5.13 billions DM or 3.11 billions US-$, respectively, for a total population of 80.3 millions. Direct costs make up 61.5% of this sum and comprise of outpatient medical care, drugs, hospital treatment, rehabilitation and compensation for occupational asthma as well as sickness benefits. Indirect costs of 38.5% are caused by payments for days off work, premature retirement and premature death due to asthma. Based on these figures, we speculate that an optimised treatment according to published recommendations should be accompanied by a reduction of the high amount of indirect costs.

[Experiences with fluorescence diagnosis and photodynamic therapy in a multimodality therapy concept of operated, recurrent bronchial carcinoma].

Abstract: Even of those few patients who are operated because of bronchial cancer up to a quarter develop a recurrence. One reason is certainly that tumor-cells already present at the time of surgery are bronchoscopically invisible. Fluorescence methods might be able to detect these malignant cells. For patients with post-surgical recurrences the therapeutical choices are limited due to the loss of parenchyma. Photodynamic therapy (PDT) with the hematoporphyrine derivative Photofrin is one laborious but promising option. Based on an argon-dye laser we have developed a combined system for the diagnostical measurement of autofluorescence and Photofrin-induced fluorescence at 488 nm and the therapeutical PDT at 630 nm. Under the excitation with blue light from the argon laser, differences in the autofluorescence of malignant and benign cells can be distinguished. Following the injection of Photofrin a spectrum peak at 628 nm clearly delineates tumor cells. In six out of twelve patients with post-surgical recurrences a single PDT course resulted in tumor eradication. With additional PDT courses and brachytherapies local tumor control could be achieved in all cases. The general photosensitivity and the necessary light protection were tolerated by all patients. In order to avoid severer complications such as asphyxia, obstruction of bronchi and pneumotharaces resulting from fibrin-plugs and necrotic tissue following PDT must be considered. Especially in patients with pneumonectomy a careful surveillance and debridement is mandatory.

[Chronic persistent cough in general practice: diagnosis and therapy in 329 patients over the course of 2 years].

Abstract: Chronic Cough: Chronic persistent cough (CPC) lasting from several months to years - without radiographic or spirometric evidence of its cause - was a surprisingly frequent reason (5,7% of all new referrals) to consult our practice. Sophisticated diagnostic evaluation and therapeutic regimen are necessary. We performed a prospective study on 329 consecutive patients (106 male, 223 female) over a two-year period. 65% of the patients had cough as a consequence of bronchial hyperresponsiveness; 27% due to upper airways disease, i.e. often very common rhinitis or pharyngitis; 14% chronic bronchitis; 5% gastrooesophageal reflux (GER); 3% drug induced cough; 4% other causes. 10% of the patients discontinued the diagnostic evaluation prematurely. In 14% the cause for CPC remained unclear and no relief could be achieved. Furthermore, there is a need for consecutive studies to address the following questions: 1. The cause of the striking difference in gender (male : female = 1 : 2) remains unclear. 2. Wether a cough recorder - as occasionally reported in the literature - is needed for an objective evaluation of cough [9]. 3. A standardised methodology of 24 h pH monitoring for the diagnosis of CPC as a consequence of GER has yet to be established.

[Resistant lung tuberculosis in Berlin 1987-1993].

Abstract: Resistance of Mycobacterium tuberculosis (M. tb) strains is an increasing problem worldwide. Since no public health data are available for urban populations in Germany, we investigated resistance in our hospitalized patients (n = 1011) during the last seven years. We evaluated clinical data and results of susceptibility tests (break-point technique/proportion method) for isoniazid, streptomycin, rifampin, pyrazinamide, protionamide, and ethambutol. Since 1987 there has been a relatively constant rate of 5.9% (3.9-7.8%) for single-drug resistance (SDR) but an increasing rate of multidrug-resistant (MDR) strains (> or = 2 first-line drugs) from 1.7% in 1987 to 5.8% in 1993. 69% of patients with MDR strains showed resistance to two drugs and 31% to three or more drugs. Risk factors for SDR and MDR tuberculosis revealed previous therapy (odds ratio (OR) [CI95%] SDR: 2.2 [1.7-4.0]; MDR: 4.5 [2.3-8.8]) and foreign-born status (SDR: 2.2 [1.3-3.6]; MDR: 3.5 [1.8-6.8]) to be the most important factors associated with resistance (p < 0.006-0.0001). Both primary and acquired resistance was higher in foreign-born than in German-born patients (p < 0.005). There was a considerable increase in multidrug-resistant tuberculosis in our hospital during 1987 and 1993. Since previously treated patients and patients born in countries with a high level of primary resistance had an increased risk of drug-resistant tuberculosis, we would advise a four-drug regimen as initial therapy in those patients.

[A Q-fever pneumonia epidemic in Dusseldorf].

Abstract: There was an unusually high incidence of atypical pneumonias in the catchment area of the Rhine river near the university of Dusseldorf in July 1994 during a long period of hot and dry weather. The 18 patients described in this paper (5 women and 13 men) complained of sudden onset of fever up to over 40 degrees C, often associated with severe headache and dry cough. Almost all of these patients had previously been healthy and active and of young to middle age (average 38 years) without any bronchopulmonary anamnesis. Radiology revealed that all the patients had in most cases defined pulmonary infiltrates without any specific preference for a particular site. Serology was initially negative, but four weeks later the complement fixation reaction titre was positive for Coxiella burnetii antibodies in 14 patients (78%). All patients became symptom-free within a few days'time when treated with a combination of antibiotics which included doxycycline, whereas the infiltrates receded completely only after several weeks. The occurrence of pulmonary Q-fever in a large northern German conurbation had been rare at that time. Such epidemics, however, were also noted in Berlin (1992) and in Dortmund (1993). The epidemic reported in this article probably originated from one of the frequent flocks of sheep grazing along the banks of the Rhine river near Dusseldorf. The infections were probably acquired by inhalation of airborne organisms in infected aerosols derived from infected sheep, promoted by the long-term very hot and dry weather which was at the same time very windy, leading to an unusually extensive spreading of the pathogens throughout a very large infected aerosol area.

Virtual bronchoscopy - relationships of virtual reality endobronchial simulations to actual bronchoscopic findings

Abstract: Advances in computer technology have permitted development of virtual reality images of the tracheobronchial tree using data sets derived from helical CT of the chest. To determine the relevance of these images to actual bronchoscopic findings, we compared "virtual bronchoscopy" images with videotaped bronchoscopy results in 20 patients who had undergone both helical chest CT and fiberoptic bronchoscopy during clinical evaluation of their thoracic problems. Suboptimal endobronchial simulations in ten patients identified important, readily-addressed technical requirements for this imaging procedure. In the ten patients with technically suitable renderings of the airway, virtual bronchoscopy simulations accurately demonstrated endobronchial obstructions by tumor in five, airway distortion and/or ectasia in four, and accessory bronchi in another. These preliminary observations suggest that virtual bronchoscopy simulations accurately represent major endobronchial anatomic findings. This technique may have a role in prebronchoscopy planning, endoscopy training, and/or endobronchial therapy, and merits further study.

[Different threshold concentrations for sensitization by cattle hair allergen Bos d 2 in atopic and non-atopic farmers].

Abstract: Several threshold values for indoor allergens leading to IgE sensitization were proposed. Currently such values exists for allergens of house dust mite, cat, dog, and cockroach and cattle. A high sensitization is known as an important risk factor in the development of asthma. This study was undertaken to examine threshold values of major cow hair allergen Bos d 2 in the house dust of atopic and nonatopic cow hair asthmatic farmers. 45 patients with cow hair asthma were visited at their homes. House dust samples were taken from corridor, living room, and bedroom. The concentration of Bos d 2 was determined by means of rocket immunoelectrophoresis. Additionally, samples of venous blood were taken to demonstrate specific IgE towards cow epithelia by CAP-RAST. Five patients were excluded from further investigations because they have given up their cattle for less than 6 months. In 21 patients occurred typical atopic stigmata like infantil history of atopic eczema, hay fever or milk crust, while the other 19 subjects did not show an atopic diathesis. High sensitization towards cow epithelia (specific IgE > 0.7 kU/l in CAP-RAST) occurred significantly more often in atopics than in nonatopics. In atopic subjects the allergen concentrations leading to IgE sensitization amounted to 1-20 micrograms Bos d 2/g dust, whereas in nonatopics were found higher Bos d 2 threshold values (25-50 micrograms/g dust). The present study suggests that in nonatopic cow hair asthmatics high indoor Bos d 2 levels lead to IgE sensitization as well as the close contact to cattle.

Paraneoplastic IgA nephritis as the initial symptom of bronchial carcinoma

Abstract: We report on a 45-year old patient who was treated for IgA-Nephritis for 9 months. During treatment he developed coughing and dyspnoea which led to diagnose a central stenosing NSCLC at the tracheobronchial angle. Cancer treatment by x-ray showed a good response, e.g. significant reduction of cancer volume and a remarkably improved renal function. In the course of tumour progression (3 months after initial treatment) retention parameter deteriorated again and the patient needed to be dialysed. Palliative laser therapy had no influence on renal function. The close linkage between tumour regression and the extent of IgA nephritis suggest that the preceding IgA nephritis was paraneoplastic and hence a primary symptom of the NSCLC.

[Cost-effectiveness studies of ambulatory educational programs for children with asthma and their families].

Abstract: Increasingly, economic aspects become important in public health which makes necessary the quantification to economical and operational efficiency. One of the instruments applied in this process is cost-benefit-analysis, comparing preventive, curative and rehabilitative services under the aspect of cost and benefit and effectiveness. In this context, we have evaluated a project of ambulant training of asthmatic children and of their parents. We included 142 affected children and their parents, who were trained in the offices of 24 physicians. Evaluation was done with a questionnaire in which data were collected on asthma-management, on quality of life, and on cost-effectiveness. We looked at the year before starting the training and on the year after completion of the training. Treatment costs were decreased by training, life quality improved. Thus, ambulant training of asthmatic children and of their family is a useful and efficient part of preventive rehabilitation.

[MRSA (methicillin-resistant Staphylococcus aureus) infections in patients with pulmonary diseases].

Abstract: Methicillin-resistant Staphylococcus aureus (MRSA) has become a major nosocomial pathogen. We investigated MRSA-infections in patients with pulmonary diseases referring to epidemiological aspects. Between 9/92 and 2/92 we found MRSA-infections in our hospital in 24 patients (11 female, 13 male, average age 54.6 years). Clinical presentation, main and accompanying disorders and previous antibiotic therapy regimens were registered. Strains were typed using DNA-RFLP and lysotyping. MRSA detection were done in specimen from sputum (12/24) and from the bronchial secret (9/24). In 18/24 cases the MRSA-colonisation was associated with infection. In 15/24 cases the first acquisition of MRSA happened in our hospital, 6/24 times the germ was carried off other institutions and in 3/24 cases it was possibly community acquired. Most frequently patients suffered from bronchial cancer (6/24), from chronical bronchitis (5/24), from pneumonia (4/24) or Cystic fibrosis (4/24). Usually the patients showed other severe comorbidity. 13/24 patients had an antibiotic course before detecting MRSA. Typing revealed a strain already known in different hospitals of Berlin, another known strain of northern Germany and two so far unknown strains. Of interest was a different behaviour of resistance and the lost of resistance of strains in the course. MRSA-infection in pulmonary medicine emerged as a problem mostly in patients with multimorbidity and severe underlying diseases. Change of resistance in strains and new strains were observed.