[Interventional bronchoscopy-an overview]. / Interventionelle Bronchoskopie ­ ein Überblick.

In addition to lung function testing and radiological imaging, bronchoscopy is the most important diagnostic tool in patients with bronchial and pulmonary diseases. Through the combined use of flexible and rigid bronchoscopes, nowadays bronchoscopy can be increasingly used as an endoscopic treatment procedure for pulmonary diseases. In cases of thoracic tumors interventional bronchoscopy provides palliative and curative treatment modalities. Apart from bronchoscopic tumor treatment, techniques for endoscopic lung volume reduction have increasingly come into focus in recent years. Furthermore, treatment options for asthma and chronic bronchitis as well as airway stenosis and fistulas are available.

[Respiratory therapy with Ez-PAP for treatment of dynamic hyperinflation in patients with severe COPD and emphysema]. / Atemtherapie mit Ez-PAP zur Behandlung der dynamischen Überblähung bei Patienten mit schwerer COPD und Lungenemphysem.

BACKGROUND: Non-pharmacological respiratory physiotherapy in treatment of COPD with severe emphysema is achieving increasing importance. Ez-PAP, a compact CPAP- or flow-PEP system, supports inspiration by using the Coanda effect in addition to a PE(E)P-effect during expiration. METHODS AND PATIENTS: 30 patients with severe COPD and emphysema and hypercapnic respiratory failure under non-(NIV) (n = 28) and invasive ventilation (n = 2) were treated in ventilator-free intervals with Ez-PAP and analyzed retrospectively. Clinical courses such as ventilator-dependency, dyspnea by visual CR-10 Borg scale, results of six-minute walk tests (6MWT), lung function tests and recordings of transcutaneous CO2 measurements were evaluated where possible. RESULTS: Analyzed patients showed less ventilator dependancy (n = 9), reported a median decrease of shortness of breath by 3,3 points (n = 10) and improved by 50,4 m in the 6MWT (n = 5). A median increase of vital capacity by 544 ml (n = 5) was shown by spirometry. Combined with manual techniques for reducing air-trapping, treatment success was documented by a median reduction of pCO2 by 7,3 mmHg (n = 6) using transcutaneous pCO2 measurement. CONCLUSION: Ez-PAP is a simple mechanical method to reduce dynamic hyperinflation in severe COPD, thus achieving relief of respiratory muscles and more effective breathing. Prospective studies of this promising method are urgently required.

Successful treatment of murine listeriosis and salmonellosis with levofloxacin.

Levofloxacin (L-ofloxacin) is a fluoroquinolone derivative. It is the active substance contained in ofloxacin with a broad spectrum of antibacterial activity against both Gram-negative and Gram-positive bacteria. In this work we examined the activity of levofloxacin against the facultative intracellular bacteria Listeria monocytogenes and Salmonella typhimurium in vitro, in tissue culture and in animal models of infection. The minimum inhibitory concentrations (MICs) MIC90 for Salmonella enterica and L. monocytogenes were 0.078 mg/l and 4 mg/l, respectively. Levofloxacin was bactericidal against L. monocytogenes and S. typhimurium because 8 x MIC killed 90% of the initial inoculum of L. monocytogenes EGD and S. typhimurium LT2 within 4 hours and 3 hours, respectively. Levofloxacin was more effective than ampicillin against L. monocytogenes EGD infecting tissue culture cells. Also in tissue culture cells infected with S. typhimurium LT2, levofloxacin was slightly more effective than ciprofloxacin. In animal models of infection, levofloxacin was as potent as the reference substances. In conclusion, levofloxacin is a candidate for the treatment of infections caused by facultative intracellular Gram-positive and Gram-negative bacteria.

Clinafloxacin (CL 960) is superior to standard therapeutics in the treatment of murine listeriosis and salmonellosis.

Clinafloxacin is a novel fluoroquinolone with a broad spectrum of antibacterial activity against both gramnegative and grampositive bacteria. In this work, the activity against the facultatively intracellular bacteria Listeria monocytogenes and Salmonella typhimurium was examined in vitro, in tissue culture and in animal models of infection. All strains of L. monocytogenes and S. enterica were highly susceptible against clinafloxacin, with minimal inhibitory concentrations (MICs) that were consistently lower than those for ampicillin and ciprofloxacin, respectively. Clinafloxacin was rapidly bactericidal against L. monocytogenes and S. typhimurium since 8 times the MIC killed the bacteria within 2 hours. In contrast to ampicillin and ciprofloxacin, there was a postantibiotic effect (PAE) of 2 hours with 8 x MIC on L. monocytogenes. Clinafloxacin was more effective than ampicillin and ciprofloxacin in tissue culture cells infected with S. typhimurium or L. monocytogenes. In animal models of infection, clinafloxacin was also more potent than the reference substances. In conclusion, clinafloxacin is an excellent candidate substance for the treatment of infections caused by facultatively intracellular grampositive and gramnegative bacteria.