[Tracheobronchial stents: a retrospective analysis of indications, results and in particular complications]. / Tracheobronchiale Stents: Eine retrospektive Analyse zu Indikationen und Ergebnissen unter besonderer Berücksichtigung der Komplikationen.

BACKGROUND: Tracheobronchial stents are inserted mainly in cases of malignant and benign airway stenosis. Further indications are esophago-tracheal fistulas, mediastinal fistulas and tracheomalacia. METHODS: A retrospective analysis was conducted on patients' records, information provided by the general practitioners and relatives of the patients from July 1993 to December 2006 in the Department of Pneumology of the Heidehaus Hospital Hannover (since 6/05 Department of Pneumology and Internal Intensive Care Medicine, Oststadt-Heidehaus Hospital). RESULTS: During the observation period of 13 years a total of 269 stents (177 permanent, 92 temporary) were implanted in 207 patients (1.3 stents per patient). The vast majority of patients (173/207) suffered from an underlying malignancy. About half of the stents were deployed in the trachea. The median length of placement was 116 days in patients with malignancies and 313 days in patients with benign diseases. In about 40 % of the patients notable complications were observed which were directly or indirectly associated with the stents. These findings show the importance of a critical indication for stent implantation. In benign diseases a stent can remain for years inside the tracheobronchial system, if it is well tolerated in the beginning. In malignant diseases the result depends decisively on the stage of the tumour: has the stent been implanted before any other tumour therapy is started or is it an end-stage tumor with no other therapeutic option? In general, complications of stents occur quite frequently. CONCLUSIONS: The analysis of stent data leads to some aspects for the prevention of stent-related complications. There should be a strict indication and appropriate choice of stent material. Nevertheless, there remains an ethical dilemma in patients with end-stage disease as to whether to implant a stent or to do nothing against the tumor, because the benefit immediately after stent insertion vanishes with progression of the tumour, so causing extra complications.

[100 years Heidehaus--from sanatorium for tuberculosis to a modern chest hospital]. / 100 Jahre Heidehaus--vom Tuberkuloseheim zum modernen Lungenzentrum.

When the sanatorium "Heidehaus" was founded on June 1, 1907 in the northern countryside of Hannover with Dr. Otto Ziegler as head about 120 beds for patients with tuberculosis were available. By 1914 about 200 patients were being treated by 4 physicians and 10 nurses. An operating theatre and a modern radiology unit were added in 1927. Shortly after the 2nd World War 400 patients with tuberculosis were hospitalised simultaneously. With the introduction of antituberculous triple drug treatment the number of patients dropped significantly. During this period many traditional facilities, used to care for patients with tuberculosis lost their financial basis and closed. However in the 1960s Prof. Schindler, the head of Heidehaus, widened the spectrum of the hospital into a modern chest hospital, focused on lung and airway diseases. In particular in the 1980s and 1990s this trend continued and 2 independent departments, i. e., pneumology and thoracic surgery were founded. In 2005 due to restructuring by the community of Hannover the "Heidehaus" moved completely and merged with another traditional hospital to become the new "Oststadt-Heidehaus". In its new surroundings both departments for pulmonary medicine and thoracic surgery offer a broad spectrum of modern thoracic medicine in cooperation with other disciplines.

[The diagnosis and treatment of malignant haemangiopericytomas (author's transl)]. / Zur Diagnose und Therapie des malignen Hämangioperizytoms.

Two cases of malignant haemangiopericytomas are described; one was a multiple tumour, the other arose from the mediastinum. The difficulties of diagnosis, and particularly differentiation from lymphangiopericytoma, are stressed. Irradiation of the tumour is a useful addition to the forms of treatment.

[Current status and analysis of diagnostic and therapeutic guidelines in the area of chronic obstructive respiratory tract diseases in adulthood]. / Bestandsaufnahme und Analyse von Diagnose- und Therapieleitlinien im Bereich der chronisch obstruktiven Atemwegserkrankungen im Erwachsenenalter.

UNLABELLED: GOAL OF THE INVESTIGATION: It was investigated (1) whether guidelines for the treatment of bronchial asthma and chronic obstructive pulmonary diseases (chronic obstructive bronchitis and lung emphysema) are distributed in Germany, (2) whether they are accepted by general practitioners and physicians for internal medicine without subspecialty, and (3) how much they are used. METHODS: (1) The mostly read medical journals have been screened. (2) 1200 physicians have been questioned with regard to the main criteria of these guidelines. (3) 600 physicians were asked to write a documentation for two patients each with bronchial asthma and chronic obstructive pulmonary disease. 344 of the questionnaires (28.7%) and 544 of the documentations could be analyzed (22.7%). RESULTS: Guidelines for the treatment of bronchial asthma are published in all leading journals. Substantially less references were found for the therapy of chronic obstructive bronchitis. The main concepts of training, diagnosis of the disease's severity, and physical therapy are all known by the practitioners. The training plays a sufficient role in only half of the questioned physicians. The self-measurement of the patient is not every where accepted. The treatment according to a stage by stage pharmacological therapy cannot be seen in one third of the questioned physicians. CONCLUSIONS: Differential diagnosis and therapy are not sufficiently emphasized in the current guidelines. Practitioners should participate in the development of guidelines, to include the aspects of realization.

[Psychomotor delay and psychiatric diagnoses in special education students]. / Motorische Entwicklungsstörungen und psychiatrische Diagnosen bei Sonderschülern.

76 first grade children of a special school for learning disabled were tested for specific developmental disorders of motor functions (SDDM). 15 children (19.7%), boys and girls proportionately, had a SDDM. This is a substantial increase compared to the unselected population. 8 children (15.5%) suffered from a specific disorder of body coordination and low finger-eye coordination. 4 children (5.3%) were found to have specific disorders of motor functions and specific language retardations. Isolated disorders of hand coordination were not found. 31% of the children with SDDM suffered from psychiatric disorders. Roughly the same percentage of psychiatric diagnosis was found in children without disorders of motor functions. A total of 24 children (33%) had impaired physical coordination: these children had significantly higher total scores in the Child Behavior Checklist (CBCL). Though this questionnaire was not sensitive for detection of disorders of motor functions.

[Specific delays of language development in special education students]. / Umschriebene Sprachentwicklungsrückstände bei Sonderschülern.

The frequencies of specific language retardation and deficits in short term memory span are the subject of this epidemiological investigation of children attending the first grade of a special school for educationally subnormal children in Erlangen and München/Rosenheim. The children at the mean age of seven were examined according to the "Multi-axial Classification of Child Psychiatric Disorders". The following prevalences were found: 16 children (21%) of the sample from Erlangen and 24 children (33%) of the sample from München/Rosenheim had an specific language retardation, in both sample the most frequent disorders were retardations of the expressive language (11% and 21%). In both sample most children had substantially deficits in the acoustic short term memory span, while they were better on visual short term memory span. Significant correlations between acoustic short term memory span and specific language retardations were found.

Transbronchoscopic lung biopsy in sarcoidosis.

In a prospective study in our department, 63 consecutive patients with suspected sarcoidosis underwent combined bronchial and transbronchial biopsy during bronchoscopy with rigid instruments under general anaesthesia. Lung tissue was obtained in all cases. In 19 cases noncaseous granulomas were found only by transbronchial lung biopsy. In 9 cases they were found only by bronchial biopsy. In 30 patients noncaseating granulomas were found by both technics, that is, the lesions were found in both lung parenchyma and bronchial wall. In 5 patients, diagnosis of sarcoidosis could not be confirmed by bronchological methods, but was obtained by other biopsy procedures. From our findings, we conclude that the combination of bronchial and transbronchial biopsies during bronchoscopy with rigid instruments is a valuable procedure for establishing the diagnosis of sarcoidosis and that the bronchological methods could replace mediastinoscopy in most cases of sarcoidosis.

[Thoracoscopic pericardial fenestration--diagnostic and therapeutic aspects]. / Thorakoskopische Perikardfensterung--diagnostische und therapeutische Aspekte.

This article reports on four tumour patients with extensive, but cytologically innocuous pericardial effusion. In three cases, a tumour-cell-negative pleural effusion, on the left, was also present. Thoracoscopy showed that the pleura were unremarkable, whereupon, with the aid of the biopsy forceps--in one case the Nd:YAG laser--the pericardium was opened. The procedure provided diagnostically high-yielding material; in addition, pericardial tamponade was "permanently" eliminated (period of observation up to 4 years). This shows that, in addition to its diagnostic value, thoracoscopic pericardial fenestration also can be therapeutic. It represents an alternative to the surgical approach.

Topical application of epinephrine during bronchoscopy in barbiturate-halothane-anaesthesia and its influence on cardiac action.

Since the introduction of halothane as an anaesthetic there have been several reports about cardiac arrhythmias during application of epinephrine in combination with halothane. This complication was also reported when epinephrine was used as local haemostyptic. We describe the effect of topical epinephrine upon cardiac action during bronchoscopy in barbiturate-halothane-anaesthesia. 21 patients with an average age of 66.4 years underwent bronchoscopy mainly because of suspect bronchial carcinoma, they were monitored by lead I ECG and blood gas analysis was carried out repeatedly. Immediately following biopsies, sponses with epinephrine solution 1:1000 were applied to the bronchial mucosa - the average epinephrine dose of these sponges was 0.12 mgs as calculated before by weighting. During this procedure we could not observe significant cardiac arrhythmias following epinephrine application. We conclude this to be the result of limited dosage and maintenance of adequate ventilation and oxygenation. Thus, epinephrine can be used as a local haemostyptic during bronchoscopy in halothane anaesthesia without significant risk when the above described precautions are observed.

Chondrosarcoma of the pulmonary artery.

Primary sarcomas of the large vessels are rare. They are observed most commonly in the pulmonary artery. Up to now 28 cases of primary sarcoma of the pulmonary artery have been described in the literature. The clinical features of this disease which presents considerable diagnostic difficulties are dominated by signs of cor pulmonale. In the present paper a primary chondrosarcoma of the pulmonary artery is presented.

[Tracheobronchopathia osteochondroplastica--a rare condition in lower respiratory tract (author's transl)]. / Tracheobronchopathia osteochondroplastica.

In a 55 years old male patient bronchoscopy was carried out because of suspected bronchial carcinoma. Chest X-ray showed a lesion in the periphery of left lung, an episode of hemoptysis was reported 4 weeks prior to the examination. During bronchoscopy we found numerous small tumours on the mucosa of distal trachea and left main bronchus. The findings suggested a widespread malignant process, whereas histological examination of biopsies showed tracheobronchopathia osteochondroplastica. In the case described we could not find amyloidosis of tracheal wall or disorders in somatotropine secretion. Pathogenesis and clinical features of the disease, which is in a high percentage detected by chance or post mortem, are discussed.

[Abnormalities of the lung]. / Fehlbildungen der Lunge.

Inborn abnormalities of the lung are rarely seen by clinicians. This paper reports about the cases obeyed within a ten-years-space in a lung-clinic. Symptoms, diagnostic procedure, and treatment are described.

Pulmonary metastasis from a basal-cell carcinoma of the retroauricular region.

Basal-cell carcinoma of the skin is a common facial neoplasm, usually regarded as benign. It is also called basalioma. Distant metastasis is very rare and may involve the brain, lung, and bones. We report a 74-year-old white male who was admitted to our hospital with cough and fever. Chest radiograph revealed an opacity of 2 x 1 cm in diameter in the upper lobe of the right lung. Bronchoscopy and thoracic fine-needle aspiration could not establish a diagnosis. Therefore the patient underwent right thoracotomy and wedge excision of the lesion. Histologic evaluation was consistent with pulmonary metastasis of a facial basal-cell carcinoma. The patient recovered uneventfully from surgery and is well 5 years after the operation. According to the English literature the median survival of patients with metastatic basal-cell carcinoma is 10 months. The clinical features, pathology, and treatment of this rare entity are discussed.

[Reliability of the Child Behavior Checklist in a population of 6 to 8-year-old special education students]. / Untersuchung zur Anwendbarkeit der CBCL an einer Population von sechs- bis achtjährigen Sonderschülern.

66 children attending first grade at a special school for educationally subnormal children were examined medically and psychologically. Classification was done according to ICD-10. In addition, the parents were asked to rate their children's behavior with the "Child Behavior Checklist" by Achenbach and Edelbrock. The most common symptoms rated in this group of 6- to 8-year-old children were lack of concentration, speech and language problems, hyperactivity, demand for attention and arguing. The mean total score (cut-off score: 30) and the number of crucial items (cut-off score: at least two crucial items) differed significantly between the children with and those without psychiatric disorders. No significant correlation was found between the mean total score or the number of crucial items and the sex of the children or the other axes of the Multi-axial Classification of Child Psychiatric Disorders.

Long-term survival of a patient with small-cell lung cancer (SCLC) following treatment with thalidomide and combination chemotherapy.

Thalidomide, an angiogenesis inhibitor is currently used in clinical trials in the US and Europe in combination with chemotherapy for the treatment of various solid tumors. The prognosis of patients suffering from small-cell lung cancer (SCLC) is poor. A 73-year-old female with extensive disease of SCLC was given six courses of chemotherapy with adriamycine, cyclophasphamide and oncovine, which led to complete remission of the disease. Following written informed consent, the patient has been treated with thalidomide 200 mg orally on a daily basis for 2 years and 5 months. There has been no sign of tumor recurrence during the follow-up. This case underlines the possible role of additional treatment with angiogenesis inhibitors in combination with traditional chemotherapy in the therapy of SCLC. Although there is no proof that thalidomide contributed to this good outcome and no conclusions can be drawn from this treatment in a single patient, further studies may determine the role of thalidomide as an adjuvant antiangiogenic agent in the therapy of SCLC.

[Castleman's lymphoma (author's transl)]. / Das Castleman-Lymphom. Angiofolikuläre Lymphknotenhyperplasie als diagnostisches und therapeutisches Problem.

Intrathoracic angiofollicular lymph node hyperplasia (Castleman's lymphoma) was found in a 32-year-old woman. The diagnosis could be established already preoperatively by endoscopic biopsy. It was a coincidental discovery as there were no clinical symptoms. Histologically the tumour was of the hyaline-vascular type. After uncomplicated surgical removal follow-up at 6 weeks was unremarkable. Aetiology and pathology of this rare disease are unknown.

[Multiple diagnoses and stresses in children of primary school age]. / Mehrfachdiagnosen und -belastungen bei Kindern im Grundschulalter.

The study was conducted to assess the consequences of multiple diagnoses and handicaps in children aged 6 to 8 years. Children were considered to be "multiply handicapped" if they suffered from two or more disorders or impairments included in the Multi-axial Classification Scheme. To this end children in special schools were compared with a random sample of children from three communities in Bavaria. As expected, all prevalences found in the population of children from special schools were substantially higher than those found in the random sample. Furthermore, the proportion of children with multiple handicaps in the special schools far exceeded what one would have expected based on the findings for the random sample. Most of the disturbances did not differ in respect to their comorbidity. But the mentally retarded children in the special schools were all "multiply handicapped". The importance of "multiple handicaps" for the assignment to special schools is discussed, as are the implications for the planning of services.

[Adjuvant therapy of non-small cell bronchial cancer with mopidamol]. / Adjuvante Therapie des nicht-kleinzelligen Bronchialkarzinoms mit Mopidamol.

Between January 1982 and April 1986 a double-blind randomized placebo controlled study of mopidamol, employed as adjunct therapy to surgery in patients with non-small cell bronchial carcinoma, was performed at 7 hospitals. The main criteria were occurrence of metastases and survival. Mopidamol was given perioperatively at a dose of 2 x mg i.v. daily, and postoperatively orally at a dose of 3 x 500 mg daily. The treatment period was scheduled to at least 2 years and in some of the patients was prolonged to 3 years. The standard therapy of each individual center was given as basic therapy. A total of 270 patients were included in the study, 147 in the placebo and 123 in the mopidamol group. By the end of the study 52 deaths from metastases had occurred in the placebo group (35%) compared with only 32 (26%) in the mopidamol group. This difference is statistically significant at p less than 0.05 with the one-sided test. A comparison of life-tables according to Kaplan-Meier shows a statistically significant difference in favour of the group treated with mopidamol (savage p less than 0.05). Cox's multivariate analysis confirmed the statistically significant difference in favour of the group treated with mopidamol, the inclusion of the risk factors tumour stage and histology in the evaluation results in a p-value of 0.02. With respect to the incidence of metastases there were no appreciable differences between the treatment groups. The incidence of side effects or undesired events was equal in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)