Showing papers in "Pneumologie in 2000"

[Argon plasma coagulation in bronchology: a new method--alternative or complementary?].

Abstract: Argon plasma coagulation (APC) is a thermal coagulation technique that uses ionized argon to transmit high-frequency electrical current, contact free, to tissue. APC has been used in surgery for more than 20 years, particularly for the hemostasis of superficial bleeding. Although APC has become well established in gastrointestinal endoscopy since its introduction in 1991, very few reports of its use in bronchoscopy exist to date. From June 1994 to June 1998, 364 patients (80 women, 284 men), 88% with a confirmed malignant tumor, were treated prospectively in a total of 482 sessions. The single most common indication was recanalization of malignant airway stenoses (186 patients). The defined therapy objective was achieved with good results in 67% of patients. More than 90% of interventions were performed with rigid bronchoscopy. Despite less penetration compared with Nd:YAG laser, extensive bronchial tumors were treatable, in which coagulated tumor fractions were removed either with forceps or bronchoscope tip. The second indication was bleeding in the central airways (119 patients). Acute hemostasis was achieved in 118 patients, 20% in whom the flexible technique under local anesthesia was used. In 34 patients, APC was successfully used to recanalize occluded stents. Rare indications included benign endobronchial tumor, fistula conditioning before fibrin adhesion, and the treatment of scar tissue stenosis. Summarizing all complications, a rate of 3.7% "per treatment" was recorded. Two patients died within 24 hours; their deaths were not directly related to APC. APC is an effective and safe technique for the treatment of bronchologic tumor ablation and hemostasis and can be used with local anaesthetic with flexible bronchoscopy or rigid bronchoscopy with general anesthesia. Compared with Nd:YAG laser, APC is an economic alternative technique offering more effective hemostasis. Furthermore, APC is of particular value as a compliment to well-known techniques, increasing the options in interventional bronchoscopy.

Inhaled prostacyclin and iloprost in severe pulmonary hypertension secondary to pulmonary fibrosis

Abstract: Pulmonary hypertension is a life-threatening complication of lung fibrosis. Vasodilator therapy is difficult owing to systemic side effects and pulmonary ventilation-perfusion mismatch. We compared the effects of intravenous prostacyclin and inhaled NO and aerosolized prostacyclin in randomized order and, in addition, tested for effects of oxygen and systemic calcium antagonists (CAAs) in eight patients with lung fibrosis and pulmonary hypertension. Aerosolized prostaglandin (PG)I2 caused preferential pulmonary vasodilatation with a decrease in mean pulmonary arterial pressure from 44.1 +/- 4.2 to 31.6 +/- 3.1 mmHg, and pulmonary vascular resistance (RL) from 810 +/- 226 to 386 +/- 69 dyn.s.cm-5 (p < 0.005, respectively). Systemic arterial pressure, arterial oxygen saturation, and pulmonary right-to-left-shunt flow, measured by multiple inert gas analysis, were not significantly changed. Inhaled NO similarly resulted in selective pulmonary vasodilatation, with RL decreasing from 726 +/- 217 to 458 +/- 81 dyn.s.cm-5. In contrast, both intravenous PGI2 and CAAs were not pulmonary selective, resulting in a significant drop in arterial pressure. In addition PGI2 infusion caused a marked increase in shunt flow. Long-term therapy with aerosolized iloprost (long-acting PGI2 analog) resulted in unequivocal clinical improvement from a state of immobilization and severe resting dyspnea in a patient with decompensated right heart failure. We concluded that, in pulmonary hypertension secondary to lung fibrosis, aerosolization of PGI2 or iloprost causes marked pulmonary vasodilatation with maintenance of gas exchange and systemic arterial pressure. Long-term therapy with inhaled iloprost may be life saving in decompensated right heart failure from pulmonary hypertension secondary to lung fibrosis.

Die Mediastinoskopie beim Staging des Bronchialkarzinoms - eine kritische Bewertung

Abstract: Hintergrund: Die Mediastinoskopie hat eine hohe Sensitivitat fur das Lymphknotenstaging und eine Spezifitat von 100 %. Der Nachteil der Invasivitat ist damit gegenuber bildgebenden Methoden wie CT oder PET gerechtfertigt. Obwohl in vielen Studien Sensitivitat, Komplikationen und Kosten erfasst wurden, sind uber interindividuelle Abweichungen, bezogen auf den Operateur, keine Daten publiziert. Methode: Zwischen 6/98 und 12/99 wurden in einer prospektiven Untersuchung die biopsierten Lymphknotenstationen erfasst und die histopathologischen Ergebnisse der Mediastinoskopie und nachfolgenden Operation, bezogen auf 6 Operateure, korreliert. Aus den Daten wurde die Sensitivitat der Mediastinoskopie fur das praoperative Lymphknotenstaging ermittelt. Ergebnisse: Bei 165 Mediastinoskopien betrug die Sensitivitat 80,6 %. Pro Patient wurden 4,1 Lymphknoten biopsiert. Ein erheblicher Unterschied des individuellen Biopsiemusters zwischen Chirurgen wurde bei gleicher operateurspezifischer Sensitivitat beobachtet. Die Station 7 wurde in 15,2 % - 90,9 % und die Station 2 links in 39,4 % - 84,4 % erreicht, wahrend die Station 4 von allen Operateuren einheitlich biopsiert wurde. Schlussfolgerungen: Der Faktor „Operateur” ist zu vernachlassigen, wenn eine ausreichend grose Anzahl von Lymphknotenstationen biopsiert wird. Trotz individueller Biopsietechnik hat die Mediastinoskopie im Vergleich zum CT eine hohere Sensitivitat und bleibt Methode der Wahl des praoperativen Stagings. Eine interne Qualitatskontrolle in thoraxchirurgischen Abteilungen ist wunschenswert. Background: Mediastinoscopy has a high sensitivity for lymph node staging with a specificity of 100 %. This compensates the disadvantage of being an invasive procedure compared to CT and PET scan. Although many studies examined the sensitivity, rate of complications and costs no data have been published concerning interindividual differences in relation to the surgeon performing the operation. Methods: From 6/98 to 12/99 in a prospective study all biopsied lymph nodes were documented. Histopathologic results of mediastinoscopy and the following operation were correlated with the 6 participating surgeons. From these data the sensitivity of mediastinoscopy for preoperative lymph node staging was analysed. Results: Analysis of 165 mediastinoscopies showed an overall sensitivity of 80.6 %. 4.1 lymph nodes were biopsied per patient. Substantial differences were noted for individual biopsy patterns between surgeons, but surgeon-related sensitivity was similar. Lymph nodes 7 were reached in 15.2 % to 90.9 % and 2 left in 39.4 % to 84.4 %, whereas lymph nodes 4 were biopsied at similar rates by all surgeons. Conclusion: The variable “surgeon” can be neglected if a sufficient number of lymph nodes is biopsied. Despite individual biopsy patter mediastinoscopy has a higher sensitivity than CT scan and is still the method for choice of preoperative staging. Internal quality control in thoracic surgery departments is desirable.

Individualisiertes, modular strukturiertes Patienten-verhaltenstraining bei obstruktiven Atemwegserkrankungen in der stationären Rehabilitation

Abstract: Patientenschulungsmaßnahmen [1] bilden einen zentralen Bestandteil ambulanter wie stationärer medizinischer Rehabilitation. Speziell im Rahmen der pneumologischen Rehabilitationsmedizin ist das Patientenverhaltenstraining als wichtige Komponente inzwischen fest etabliert und Bestandteil der aktuellen nationalen und internationalen Therapieempfehlungen. Dies gilt insbesondere für das Asthma bronchiale [2– 6], aber auch für die COPD [7–9]. Während der letzten 15 Jahre ist eine Reihe von entsprechenden Patientenschulungsbzw. Patientenverhaltenstrainingsprogrammen für Erwachsene wie Kinder entwickelt und evaluiert worden. Zahlreiche empirische Arbeiten zeigen, dass insbesondere beim Asthma bronchiale sowohl verschiedene Verlaufsparameter der Erkrankung wie Notfallaufnahmen, Krankenhaustage, Arbeitsunfähigkeitsund Schulfehltage als auch die Lebensqualität der Patienten günstig zu beeinflussen sind [10–19]. Wie in mehreren nationalen und internationalen Studien nachgewiesen, lassen sich dadurch zudem langfristig deutliche finanzielle Einsparungen erzielen [20,21]. Daher gilt Patientenedukation als essenzieller Bestandteil einer rationalen Therapie chronisch obstruktiver Atemwegserkrankungen. Die Effektivität ist für das Asthma bronchiale gesichert [22], für die chronisch obstruktive Bronchitis als wahrscheinlich anzunehmen [23,24].

Graduierung von Sideropneumokoniosen

Abstract: Pathological-anatomical analyses of biopsy and autopsy samples of 43 men with anamnestically established occupational exposure to welding fumes showed in 38 specimens (88%) characteristic alterations of varying degrees of sidero pneumokonioses. Based on recurrent histological findings of increase and activation of iron storing macrophages (siderophages) and varying degrees of fibrosis, sidero pneumokonioses are classified into three grades. Intraindividually and also toporegionally different degrees may well be present. Based on morphological criteria of the three grades, seven samples were classified as grade I, 21 specimens as grade II, and 10 samples as grade III. The results show that exposure to welding fumes may well cause pulmonary alterations reaching an impairment level, depending on length, extent and special circumstances of the respective exposure. In cases of so-called welders lungs, an obliging statement in an expert's opinion on the degree of functional impairment, however, can only be given when histological findings, detailed information on the occupational history and clinical functional parameters are combined.

Prävalenz von Schlaganfall und transitorischer ischämischer Attacke (TIA) bei obstruktiver Schlaf-Apnoe: eine retrospektive Erhebung an 187 konsekutiven Patienten

Abstract: Background Obstructive sleep apnea (OSA) is presumed to be significantly associated with cerebrovascular disease; however, there are no consistent epidemiological data providing proof of such a link. Hence, the aim of the present study was to determine the prevalence of stroke and transient ischemic attack (TIA) in patients with OSA. Patients and methods 187 consecutive patients with a polysomnographically verified diagnosis of OSA who had been admitted to our sleep laboratory during 1/98-3/00 were retrospectively analysed. Results The prevalence of stroke and TIA was 7%. This rate was lower if compared with those for coronary artery disease and arterial hypertension in the same study cohort (14% and 53% respectively). The 13 OSA patients with stroke were elderly overweight men (age: 64 +/- 1.7 years, BMI: 31.4 +/- 1.1 kg/m2). They had quite severe OSA (AHI: 43 +/- 5/h) and almost all of them suffered from arterial hypertension. In all cases, the insult was caused by cerebral or brain stem ischemia. None of the patients presented with persistent neurological deficits. The mean latency period between the occurrence of stroke or TIA and the diagnosis of OSA was 41.9 +/- 11.3 months. Conclusion In summary, the prevalence of stroke or TIA in our series of 187 consecutive OSA patients was 7%. Further prospective studies controlling for confounding factors such as age, body weight and arterial hypertension are needed to clarify the risk potential of OSA for the development of cerebrovascular disorders.

Effekt von Ambroxol auf die Surfactantsekretion und -synthese von isolierten, alveolären Typ-II-Zellen

Abstract: The effect of ambroxol is attributed in part to an effect on surfactant synthesis and secretion. Evidence supporting this hypothesis is largely indirect; a direct effect of ambroxol on surfactant synthesis and secretion remains to be demonstrated. In this study a direct effect of ambroxol was evaluated using isolated alveolar type II cells. Secretion of labelled phosphatidylcholine was measured following the addition of increasing concentrations (10(-8) M to 10(-4) M) of ambroxol to the culture medium for increasing time intervals. There was no significant increase in surfactant secretion with increased ambroxol concentration or prolonged exposure time. Uptake of 3H-choline and synthesis into 3H-phosphatidylcholine was analyzed as an indicator of surfactant synthesis. Again, increasing concentrations of ambroxol (10(-7) M to 10(-5) M) were followed for 1, 2, 4, 8 and 24 h. There was no significant effect on synthesis at any time point. Concentrations higher than those mentioned here resulted in LDH release from cultured cells. Ambroxol which also has anti-oxidative and anti-inflammatory effects does not exhibit direct stimulatory effects on surfactant synthesis and secretion in isolated (rat) alveolar type II cells as has been demonstrated e.g. for beta 2-adrenergic stimulation. A specific pharmacologic way to stimulate the surfactant system remains to be developed.

Vorschläge für eine rationale und rationelle Diagnostik des Hustens

Abstract: Cough is probably the most frequent symptom in chest diseases. Hence, a rational and economical diagnostic procedure is essential to prevent unnecessary costs to the health services, i.e. acute bronchitis, a self-limiting disease, which is the most frequent cause for cough should not involve extensive per case costs. History, physical examination, chest X-ray and lung function testing--which constitute both the first and second, i.e. the basic level of a stepwise approach--allows to diagnose causes in most patients with cough. Without evidence of the cause after completing this basic diagnostic procedure patients with acute cough may require blood gases analysis, electrocardiography, echocardiography, lung perfusion study, spiral CT angiography, bronchoscopy or laboratory examinations for diagnosis of pulmonary embolism, aspiration or (seldom) pleuritis sicca. Chronic persistent cough (CPC) is diagnosed if the basic standard approach to chronic cough fails to lead to final diagnosis. Patients will then need further subtle diagnostic management, i.e. bronchial provocation testing, 24 hour pH probe, ENT- or neurological examination, high resolution CT of the thorax and bronchoscopy. We present two algorithms for the rational diagnostic approach to acute (figure 1) and chronic (figure 2) cough. Each algorithm considers spectrum and frequency of causes on the one hand, the positive predictive value, costs and patient discomfort due to the examination on the other. Nonetheless, despite extensive examination up to 20% of patients suffering from CPC the cause remains unclear [11]. Frequently, the capsaicin cough challenge test can reveal an idiopathic upregulation of the cough reflex as the hypothesised underlying condition. Psychogenic cough however, a rare condition in adults should not coincide with hypersensitivity of the cough reflex. Inconsistency and low reproducibility of results of the capsaicin challenge in patients with psychogenic cough preclude his routine clinical use. In conclusion, the very common acute bronchitis and the ACE inhibitor-induced cough do not require any other diagnostic procedure except patient history and physical examination. A simple basic diagnostic approach will usually allow to evaluate acute and chronic cough. In the remaining cases the proposed algorithm should be used for best results and to prevent excessive costs.

Stellenwert der Positronen-Emissions-Tomographie mit 18-Fluor-Desoxyglukose (FDG-PET) in der Rezidivdiagnostik des Bronchialkarzinoms

Abstract: Das Ziel der vorliegenden Untersuchung bestand darin, die diagnostische Aussagekraft der Positronen-Emissions-Tomographie (PET) mit F-18-Desoxyglukose (FDG) im Rahmen der Rezidivdiagnostik von Patienten mit Bronchialkarzinomen zu bestimmen. Nach Injektion von 220 ± 50 MBq F-18-Desoxyglukose wurde die Ganzkorper-PET (ECAT ART Scanner, Siemens CTI) durchgefuhrt. Die PET-Befundung durch visuelle Interpretation transversaler, koronaler und sagittaler Schnitte erfolgte im Konsens zweier erfahrener Nuklearmediziner ohne Kenntnis klinischer Daten oder anderer bildgebender Verfahren. 40 Patienten (= 41 Falle) mit primar kurativ therapierten Bronchialkarzinomen wurden untersucht. In 29 der 35 Falle mit Tumorrezidiv erfolgte eine pathologische Diagnosesicherung. Die FDG-PET-Untersuchung ergab einen richtig positiven Befund in 34/35 Fallen mit Tumorrezidiv. In 5/6 Fallen ohne Nachweis eines Tumorrezidivs ergab die PET-Untersuchung einen richtig negativen Befund. Die diagnostische Genauigkeit der FDG-PET lag insgesamt bei 39/41 = 95 % (95 %-Vertrauensintervall 83 - 99 %). Die FDG-PET weist eine hohe diagnostische Aussagekraft bei Rezidivverdacht von kurativ vorbehandelten Bronchialkarzinomen, kann jedoch die pathologische Diagnosesicherung nicht substituieren. The aim of the present investigation was to evaluate the diagnostic accuracy of positron emission tomography with 18-fluoro-2-deoxyglucose (FDG-PET) in the detection of recurrent lung cancer. PET was performed using an ECAT ART scanner (Siemens CTI) after i. v. injection of 220 ± 50 MBq 18FDG. PET data were analysed by visual interpretation of coronal, sagittal and transversal slices. PET scans were interpreted independently by two experienced nuclear medicine physicians without prior knowledge of the results of other imaging studies or clinical data. 40 patients (= 41 cases) who had undergone primarily curative tumour treatment, were evaluated. In 29 of 35 cases with recurrent tumour, diagnosis was verified by pathologic means. FDG-PET correctly identified tumour recurrence in 34/35 cases. In 5/6 cases without provent tumour recurrence PET gave true negative results. The overall accuracy of FDG-PET was 39/41 = 95 % (95 %-confidence interval 83 - 99 %). FDG-PET shows high diagnostic accuracy in detecting recurrent lung cancer in patients with prior curative tumour treatment, but cannot substitute the need for pathological diagnosis.

Wertigkeit der retrospektiven Einschätzung der Epworth-Schläfrigkeitsskala nach länger dauernder CPAP-Therapie bei obstruktiver, schlafbezogener Atmungsstörung

Abstract: BACKGROUND Daytime-sleepiness is the main symptom of the obstructive sleep apnoea syndrome. Standarized questionnaires (e.g. the Epworth sleepiness scale = ESS) have become useful diagnostic tools. In this study we investigated wether there is a difference between the estimation of initial "pre-treatment" daytime sleepiness (by ESS) compared to the retrospective ESS score after implementation of CPAP therapy. PATIENTS AND METHODS We included 46 patients (RDI 39/h +/- 20.2, CPAP pressure 8 cm/H2O +/- 1.7, daily use of 5.8 h +/- 1.8, RDI with CPAP 7.6/h +/- 5.3). We examined the ESS score before CPAP-therapy (ESS-base) in comparison to the retrospective estimation of the initial conditions after one year of CPAP-therapy (ESS-retro). RESULTS There was no statistical significant difference between ESS base (11.7 +/- 4.6) and ESS-retro (12.7 +/- 5.2). ESS decreased to 5.4 +/- 3.7 by CPAP-therapy (p < 0.01). CONCLUSION From a chronological point of view ESS is a consistent parameter of daytime sleepiness. Hence, the retrospective estimation of pre-CPAP ESS can be considered as a useful diagnostic tool.

[Increase in perforin-positive peripheral blood lymphocytes in extrinsic and intrinsic asthma].

Abstract: The cause of asthma which has been linked to a chronic, T-cell-mediated bronchial inflammation, remains unclear. A number of other T-lymphocyte-mediated, chronic inflammatory disorders have been associated with autoimmunity and there are data indicating that autoimmune phenomena might also be present in asthma. Expression of perforin, a cytotoxic molecule produced by lymphocytes, has been implicated in the pathogenesis of autoimmune disease. We therefore tested the hypothesis that allergic and intrinsic asthma might be associated with an increase in lymphocytes producing perforin by comparing the expression of intracellular perforin in peripheral blood lymphocytes of patients with extrinsic asthma (n = 13), intrinsic asthma (n = 7), and healthy (control subjects (n = 18). Lymphocytes were identified using flow cytometry and subdivided into CD3(+), CD4(+), CD8(+), CD16(+), and CD56(+) subpopulations after staining with appropriate monoclonal antibodies. The percentage of perforin-positive total lymphocytes as significantly elevated in patients with allergic as well as intrinsic asthma when compared with normal control subjects. Analysis of lymphocyte subpopulations also revealed a significant increase in the percentage of CD3(+), CD4(+), CD8(+), and CD56(+) cells expressing perforin in allergic asthma and a significant increase in the percentage of CD4(+), and CD56(+) cells in intrinsic asthma when compare with healthy control subjects. Perforin expression in CD4(+) cells in intrinsic asthma was also significantly elevated compared with allergic asthma. We conclude that allergic and intrinsic asthma is associated with increased expression of perforin in T-lymphocyte subsets.

Allergic bronchopulmonary aspergillosis (ABPA)

Abstract: Allergic bronchopulmonary aspergillosis (ABPA) is the most common allergic bronchopulmonary mycosis in humans. The diagnosis of the complex disease is based on defined criteria. Five clinical stages of ABPA were proposed. The extent of the defined criteria varies in the different stages, thus making diagnosis difficult. Particularly the discrimination of ABPA in remission stage (stage II) and allergic asthma with A. fumigatus-sensitisation may be an important problem. Early diagnosis in stages without persistent changes of bronchial wall and lung parenchyma is needed to prevent severe end stages of ABPA. The up to now widely used commercial (crude) allergen extracts for in vitro and in vivo diagnosis show batch to batch variation, insufficient standardization and lack of reproducibility. Potentials and limitations of routine diagnostic procedures in ABPA are described. The production of a panel of recombinant allergens of A. fumigatus and their evaluation for in vivo and particularly in vitro use has brought an important step forward in the early and precise diagnosis of ABPA. A panel of recombinant allergens is now available for routine assay in CAP-System. Glucocorticosteroids play a central role in therapy of ABPA. The approach in exacerbation phase and the long term therapy are described and also the indication for antimycotic drugs.

Zielorientierte Messung von kurz-, mittel- und langfristigen Effekten in der pneumologischen Rehabilitation

Abstract: UNLABELLED Assessment of goal-oriented short-, mean-, and long-term effects in pneumological rehabilitation: Despite of increasing quality in rehabilitation, the amount of treatment in pneumological rehabilitation has decreased by 40% in the last few years. A typical mark of quality is determination of individual objectives to reach a goal of therapy. METHODS In 566 patients (381 male, 185 female, mean age 47.0 year, body mass index 27.5 kg/m2) goals have been assessed by a questionnaire given at the beginning, the end, 6, and 12 months after rehabilitation. The effect size (ES) of single symptoms, defined as difference between initial and following score values, divided by their standard deviation was used as mild (ES = 0.8) effect. Only those patients were considered, who initially rated for "often" and "very often" in a single symptom. RESULTS At the end of rehabilitation the effect size was strong in 22 of 24 symptoms, mainly nocturnal symptoms. After 12 months 9 symptoms still revealed strong, and 12 mean effect sizes. These mainly again concerned nocturnal symptoms as palpation of the heart, breathlessness, cough, sweating, and headache, but even diurnal tiredness, spontaneously falling asleep, and lack of concentration revealed ES > 0.8. Additionally in 46 patients, who were incapable for work in more than 6 weeks the year before rehabilitation, a reduction of 81 days off job was measured in the year after rehabilitation. DISCUSSION The definition of aims of therapy is a mark of quality, and ES proves as a sensitive instrument of assessment, giving remarkable effects even one year after medical rehabilitation.

[High-dose, stereotactic, one-time radiotherapy with curative intent for peripheral lung cancer].

Abstract: In peripheral non small cell lung cancer without metastasis, surgical resection achieves 5-year survival rates of at least 65%. In functionally inoperable patients radiation therapy offers the second best changes. However, in cases of severe emphysema with severely limited lung function even conventional radiation therapy is prohibited because of possible fibrotic reactions of the lung parenchyma. For such patients high dose rate stereotactic one-time radiation therapy may be an option. According to the study protocol of the DKFZ Heidelberg a dose rate of 24 Gy at the iso-center is applied with the linear accelerator in a single session. The recognisable tumour is irradiated with 22 Gy (90% isodose included). 20 Gy are applied to the tumour plus 6 millimeters safety margin. Prerequisites of such a therapy are a detailed computer-based planning using CT scans and an exact positioning with immobilisation of the patient. The irradiation is ideally performed under general anesthesia with high-frequency jetventilation to avoid movements due to breathing. We report on this new therapeutic modality in a patient with lung emphysema having a T2 tumour.

Kortisonangst: In der pneumologischen Rehabilitation geringer als erwartet. Ergebnisse einer Patientenbefragung

Abstract: BACKGROUND The treatment of diseases of the upper and lower respiratory tracts can't be imagined without corticoids, applied systemically of locally. In specialist literature one can find indications of a certain reservation towards this kind of medication on the part of many patients. Sometimes, this reservation is so strong that it can be referred to as a regular fear of cortison. Bad compliance and with it, frequently, a deterioration of the symptoms, are inevitable consequences. The aim of the study was to find out how distinct the fear of cortison is with patients in pneumological rehabilitation and wether there are any relations with other spheres of attitude. METHOD Patients with COPD and asthma with inhalative and/or systemic corticoid medication received an extensive questionnaire during their rehabilitation as in-patients for four weeks. 102 questionnaires were evaluated. RESULTS The statements of the patients indicated high compliance regarding corticoid medication. As to the fear of such preparation, only 5/102 (4.9%) of those questioned produced results which suggest strong fear of cortison. Fear of cortison is, among other things, slightly related to general psychic-stress and a general negative attitude towards medicine. There is a negative correlation between compliance at the taking of medicine and fear of cortison. CONCLUSIONS Contrary to statements in specialist literature of wide-spread reservations and fear towards cortison, we have found out that these play only a minor part, at least with the mostly elderly clientele of pneumological rehabilitation. Different explanations are discussed.

Linksseitige Lungenagenesie in Kombination mit linkspersistenter oberer Hohlvene und Cor triatriatum sinister bei einem 77-jährigen Mann

Abstract: We report the case of a 77 year old man, who was hospitalized in the final stadium of his congenital disease. Following a pneumonia in the right lung the respirator therapy was needed. Later the patient died by a chronic right heart failure.

Sensibilisierung gegenüber Chinchilla bei Exposition im Haushalt

Abstract: The contact to chinchilla in households may lead to sensibilization and allergic rhinitis in children and adults. In nasal provocation tests on 6 sensibilized patients suffering on perennial rhinitis and/or asthma one child and three adults showed positive reactions with chinchilla hair extract. Allergen avoidance is recommended.

Photodynamische Therapie in der Pneumologie

Abstract: Die photodynamische Therapie (PDT) ist ein endoskopisches Behandlungsverfahren, das in den letzten 20 Jahren in spezialisierten Zentren zunehmend zur kurativen Therapie des oberflächlich wachsenden Bronchialkarzinoms eingesetzt wird. Sie basiert auf der Anwendung einer tumoraffinen Substanz, die durch Licht einer spezifischen Wellenlänge aktiviert wird [1]. Die dadurch ausgelöste photooxidative Reaktion führt zum Zelltod durch Gefäßverschlüsse mit Hypoxie und sekundärer Tumornekrose, während normales Gewebe nicht oder nur geringfügig reagiert [1,2].

Chloroquin-induzierte arzneimitteltoxische Alveolitis

Abstract: This case history presents a 41-years-old man with chronic discoid erythematosus who was treated with chloroquine. After 2 weeks of treatment he developed dyspnea, purulent sputum, high fever, diffuse papular rash, and diffuse peripheral homogeneous infiltrates on chest x-ray. Rapid recovery occurred after discontinuing chloroquine. Subsequent peroral provocation with chloroquine caused symptoms suggestive of hypersensitivity pneumonitis. Analysis of bronchoalveolar lavage fluid showed eosinophilia and a reduced CD4/CD8 ratio. Although treatment with chloroquine is often complicated by side effects, in a literature search we could not find any report on acute pneumonitis.

Measurement of mask leakage during CPAP in patients with obstructive sleep apnea

Abstract: UNLABELLED To improve the compliance of patients with obstructive sleep apnoea tight fitting nasal masks are necessary. It would be very useful to to measure the mask leakage during the recommended pressure for the treatment at home. We studied therefore the influence of different sizes and types of masks on the air leaks during the adaptation procedure. We investigated 20 patients, mean age 60.8 +/- 11.9 years, AHI 31 +/- 17, lowest oxygen saturation 81 +/- 10.3% mean CPAP-9.9 +/- 1.6. Randomized cross over we applied CPAP with different masks during wakefulness. The pressure was increased from 6 to 13 mbar by steps of 1 mbar. The mask leak was measured by Autoset. RESULTS Using the best mask (selected from different sizes and different brands) the mask leak was 0.11 +/- 0.9 L/sec. If the patient used a mask (only one brand but selected from different sizes) or one standard mask the mask leak doubled respectively tripled. To reduce side effects and improve compliance we recommend therefore quantification of the mask leak to find the best fitting mask.