[Implementation of the German Guideline for the Prevention, Diagnosis, Treatment, and Follow-up of Lung Cancer in the Federal State of Berlin]. / Umsetzung der S3-Leitlinie zur Prävention, Diagnostik, Therapie und Nachsorge des Lungenkarzinoms im Land Berlin.

BACKGROUND: In February 2010, the German guideline for the Prevention, Diagnosis and Treatment of Lung Cancer has been published. For the first time in Germany, the implementation of relevant guideline recommendations has been assessed in the federal state of Berlin. METHODS: Based on the quality indicators of the guideline, a questionnaire was designed which aimed at the application of selected diagnostic and therapeutic concepts. This questionnaire was sent out to all outpatient and inpatient units in the federal state of Berlin being presumably involved in lung cancer care. RESULTS: Overall response rate was good (39.8 %), especially from the addressed inpatient units. Inpatient pneumology units showed the highest application rates of guideline recommendations, followed by oncology units. CONCLUSIONS: Taking the methodologically reduced significance of a survey design into account, this study determined a negative trend of decreasing guideline implementation in units with a lesser grade of specialisation in terms of lung cancer care.

[Lung cancer - historical development, current status, future prospects]. / Lungenkrebs - Geschichtliche Entwicklung, derzeitiger Stand und Ausblick.

One hundred years ago lung cancer was a rare disease. In the meantime, as a result of the sharp increase of tobacco smoking, in Germany and worldwide it is the most common cause of cancer death. Since lung cancer is largely asymptomatic in its early stages, the diagnosis is usually first made in the advanced stages IIIB or IV. The development of diagnostic imaging and minimally invasive procedures as well as the refinement of the staging classification allow a better allocation to the tumor stages. The surgical mortality has declined significantly since the 1950s, yet the 5-year survival rates are low. For locally advanced, unresectable non-small cell lung carcinoma a moderate improvement of the prognosis could be achieved by newer methods of radiotherapy and the combination of radiotherapy with chemotherapy. As a result of chemotherapy in patients with non-small cell lung cancer a moderate life extension has been reached, while the new agents are better tolerated and allow for an improved quality of life. The survival of small cell lung cancer has been significantly prolonged by chemotherapy since the 1970s, however, little progress was made in the last 15 - 20 years. The most important and effective preventive measure against lung cancer is to avoid tobacco smoke. Screening tests using annual chest X-ray images and sputum cytology have shown no improvement in overall mortality compared with the control groups in extensive studies. Whether or not an improvement of prognosis is possible by a screening using low-dose CT is being tested by the ongoing studies. For patients with lung cancer more effective agents and therapies are still needed.

[Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD)]. / Respiratorische Bronchiolitis mit interstitieller Lungenerkrankung (RB-ILD).

Respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) designates interstitial lung changes in smokers, characterized histologically by bronchiolocentric accumulation of pigmented alveolar macrophages and fibrotic or cellular inflammatory changes of pulmonary interstitium. The definition is nearly identical to that of condensate pneumopathy, smoker's pneumopathy or smoker's lung, defined by accumulation of pigmented alveolar macrophages with bland alveoloseptal or peribronchial fibrosis and cellular inflammation of the bronchial wall. In addition to respiratory bronchiolitis, which is found in nearly all smokers, RB-ILD comprises a broad spectrum of varying degrees of the interstitial reaction to the exogenous injury of inhalation smoking with gradual transition to desquamative interstitial pneumonia (DIP). In most cases RB-ILD manifestations are subclinical and detected coincidentally. Radiographic features are reticulonodular and ground glass opacities of the lung. The high resolution computed tomography reveals centrilobular nodules, ground glass opacities, thickening of bronchial walls, and in some cases a reticular pattern. Mild emphysema is frequent. Lung function analysis reveals only minor restrictive or obstructive defects in most cases, often combined with hyperinflation. CO diffusing capacity is slightly to moderately impaired. Pronounced interstitial lung diseases with serious restrictive defects and arterial hypoxemia have been reported infrequently. In differential diagnosis smoking related interstitial lung diseases (DIP, Langerhans cell histiocytosis, idiopathic pulmonary fibrosis) and other interstitial lung diseases have to be excluded. In most cases diagnosis can be achieved by bronchoalveolar lavage and transbronchial lung biopsy. In cases of pronounced interstitial lung disease or assumption of an additional interstitial lung disease besides RB-ILD a thoracoscopic or open lung biopsy can be necessary. RB-ILD has a favourable prognosis. After smoking cessation lung changes are reversible. Corticosteroid therapy is not necessary. A fatal outcome of RB-ILD has not been reported. Follow-up examinations are advisable in order to preclude other interstitial lung diseases. RB-ILD seems to be more frequent than it is assumed at present. The clinical picture is masked in most cases by the concomitant smoking induced chronic bronchitis. Thus only pronounced cases with structural changes and resulting differential diagnostic problems are diagnosed.

Expression of p16 and lack of pRB in primary small cell lung cancer.

The retinoblastoma protein (pRB), p16, and cyclin D1 are major components of the RB pathway, which controls the G1 checkpoint of the cell cycle. Proper regulation of this pathway is crucial for normal cell proliferation. Abnormal forms of these proteins have been found in various types of malignant tumours. In the present report, immunohistochemical techniques were applied to study the expression of pRB, p16, and cyclin D1 in 161 samples of primary small cell lung cancer (SCLC) and 20 samples of non-small cell lung cancer (NSCLC). While pRB and cyclin D1 staining was negative in 161 specimens of SCLC, expression of p16 was observed in 153 samples. In contrast to SCLC, 16 out of 20 NSCLC cases exhibited pRB expression and 15 showed cyclin D1 expression, but only very weak p16 staining was found in five samples. These observations could provide additional criteria for the distinction between SCLC and NSCLC. Furthermore, these findings, based on primary tissues, implicate different mechanisms in the tumourigenesis of SCLC and NSCLC.

Cellular autofluorescent pigment and interstitial fibrosis in smoker's lung.

The mechanisms by which cigarette smoking lead to bronchopulmonary diseases are incompletely understood. The most characteristic lesion is a chronic macrophage-alveolitis accompanied by slight fibrosis and emphysema. The macrophages contain a ceroid-like granular autofluorescent pigment in their lysosomes. Using immunohistochemical methods, open lung-, transbronchial biopsies and cells obtained by broncho-alveolar lavage from cigarette smokers were studied: anti-human macrophage serum and anti-human elastase, immune sera against type I, type III collagens and fibronectin were used in the demonstration of the cellular components of alveolitis and the connective tissue constituents of fibrosis. The characteristic red-brown autofluorescent pigment of the macrophages was also found in an extra-alveolar location mainly in peribronchial, septal and pleural scars. Similar emission colour occurred focally in the elastic laminae of fibrotic alveoli and sclerotic arteries. Granular fluorescent pigment was found in many bronchial epithelial cells. The epithelial pigmentation was associated with increased transcription of nucleic acid proteins, revealed by colloid silver (AgNOR) reaction. The results suggest that the autofluorescent pigment substances in macrophages may indicate or also play a role in the development of pathological connective tissue and epithelial changes of smoker's lung, in addition to the known mediators and enzymes.

[Electromyographic determination of the fatigability of respiratory and leg muscles before and after aortocoronary bypass operation]. / Elektromyographische Bestimmung der Ermüdbarkeit von Atem- und Beinmuskeln vor und nach aortokoronarer Bypass-Operation.

To study the effect of postoperative confinement to bed on respiratory muscle fatigue, 31 male subjects (age, 34-66 years) undergoing coronary artery revascularization were examined. Fatigue of both respiratory muscles (musculi intercostales externi) and leg muscles (musculus gastrocnemius) was determined by electromyography prior to and 7 and 12 days after operation. Additionally, oscillatory resistance to breathing and phase angle were measured. Pre- and postoperative routine lung function tests were performed. A comparison between preoperative and postoperative measurements reveals that respiratory as well as leg muscle fatigue occurred at higher loads during the preoperative and the second postoperative than during the first postoperative determination. After surgery vital capacity, total lung capacity, 1-second capacity, and, to a lower extent, thoracic gas volume were diminished, while specific airway conductance, oscillatory resistance to breathing, phase angle, residual volume, and relative 1-second capacity remained unchanged. The constancy of the latter parameters indicates that neither airway obstruction nor a significant restriction of the lung and/or thorax occurred due to surgery. Therefore, the increase of respiratory muscle fatigue after surgery may more probably be attributed to a lack of training of respiratory muscles which may contribute to limitation of ventilation in bedridden patients.

[Effects of long-term ventilation on the bronchial system. Bronchoscopic, cytologic and microbiological findings]. / Auswirkungen der Langzeitbeatmung auf das Bronchialsystem. Bronchoskopische, zytologische und mikrobiologische verlaufsuntersuchungen.

UNLABELLED: The effects of longterm ventilation were evaluated in 50 patients from a medical intensive care unit. The bronchial tract was investigated using repeated bronchoscopy and assessed by semiquantitative scoring. Prior to each endoscopy tracheal secretions were obtained for microbiological and cytological evaluation, in 20 patients histological analysis of the bronchial mucosa was done in addition. RESULTS: 1. Within 24-48 hours after initiation of respirator ventilation alterations of the bronchial mucosa occur. The extent progresses rapidly, however no further increase of progression is to be observed after ventilation of approximately 150-200 hours. 2. Endoscopic assessment of the severity of mucosal changes correlates well with cytological and histologic results. 3. In 34 patients microbial agents could be demonstrated. In 8 of them mucosal changes preceded demonstration of microbial organisms. The extent of mucosal changes is independent of category or count of pathogen. Endoscopic follow-up investigations of the bronchial tract affected by long-term ventilation serve both direct bronchial clearing and control of position of the intubation tube as well as assessment of mucosal alterations and control of treatment of bronchial infection.

The monitoring of adult intensive care patients by transcutaneous PO2 measurements.

In intensive care medicine the tcPO2 measurement can be used efficiently if the problems discussed are taken into consideration. The advantages of the method follow. 1) The trend of the arterial PO2 can be monitored continuously. 2) A large fall in tcPO2 can be a sign of arterial PO2 decrease or of circulatory insufficiency.