Screening of pulmonary hypertension in chronic obstructive pulmonary disease and silicosis by discriminant functions.

The aim of our prospective multicentric study was to develop a screening method for pulmonary hypertension in patients with chronic lung diseases. We investigated 710 patients in 10 hospitals: 315 males and 109 females with chronic obstructive pulmonary disease, and 286 males with silicosis. Manifest pulmonary hypertension was defined as pulmonary artery pressure greater than 20 mmHg (2.7 kPa) at rest. The multivariate statistical method used was a stepwise discriminant analysis. In males with chronic obstructive pulmonary disease, the diameter of the right descending pulmonary artery, forced expiratory volume in one second (FEV1) arterial oxygen tension (PaO2) at rest, and age turned out to be relevant for discrimination of groups with and without manifest pulmonary hypertension. For females the FEV1/FVC (forced vital capacity) ratio replaced the absolute value of FEV1 in the calculated discriminant function. In females, sensitivity and specificity were below 80%. In males, both were distinctly above 80%. In silicosis, the diameter of the right descending pulmonary artery was much less important, since it could frequently not be measured precisely. In these cases, precision of the prediction of about 80% could only be obtained by combined evaluation of spirometry, PaO2 during exercise, and body plethysmography. The calculated discriminant functions are appropriate for screening patients with risk of pulmonary hypertension. For different chronic lung diseases, and for both sexes, different combinations of parameters are relevant. The method is recommended to select patients who should undergo an invasive examination of pulmonary haemodynamics.

[Monitoring respiratory and circulatory parameters in comparing various jet ventilation procedures]. / Monitoring von Atem- und Kreislaufparametern zum Vergleich verschiedener Jet-Beatmungsverfahren.

Reported is a system of apparatures to control characteristic changes of cardiorespiratory function during different methods of endoscopic ventilation. The aim of the study is to measure and record simultaneously and continuously ECG, thoracic movement, tracheal pressure, pulmonary artery pressure and arterial oxygen pressure using transcutaneous technique. Measurements of arterial blood pressure and blood gas analysis (PaO2, PaCO2, BE, HCO3-, pH) are carried out in intervals. Four different methods of injector-ventilation are compared with the conventional laryngoscopic ventilation on the basis of a test program. Laryngoscopic ventilation as well as injectorventilation by CARDEN-Tubus make it possible to achieve a hyperoxaemic situation by normofrequent ventilation. Despite of hyperventilation it is not possible in every case to achieve an increased capillary oxygen pressure of 200 to 300 mm Hg by injector-ventilation with Venturi effect because of a smaller oxygen proportion. In jet-ventilation with N2O/O2-mixture (3:1) there is no appreciable hyperoxia, but a small reduction of systemic arterial blood pressure. With all techniques of mechanical respiration usual middle intratracheal pressure of respiration was not exceeded. Traumatic pressure of jets was only indirectly shown in steep rises of pressure by the applied technique of measurement.

[Pulmonary alveolar microlithiasis (disease in 2 siblings--case report)]. / Microlithiasis alveolaris pulmonum (Erkrankung bei zwei Geschwistern--Kasuistik).

This article presents case reports on brother and sister suffering from microlithiasis alveolaris pulmonum. Diagnosis was established by means of the course of the disease, the relatively typical x-ray film and the findings on performing scintigraphy of the skeleton and also by computed tomography. Findings confirmed that the course of the disease is symptom-free for a long time; that it occurs in both sexes; and that it becomes manifest with considerable incidence in some families. Pulmonary alveolar microlithiasis is not a generalised metabolic disease, since it affects the lungs only. If the aetiology remains unclear, no causal treatment can be effected.

[Follow-up in patients with chronic obstructive lung diseases with special reference to the pressure behavior in the pulmonary artery]. / Verlaufsuntersuchungen bei Patienten mit chronisch obstruktiven Lungenkrankheiten unter besonderer Berücksichtigung des Druckverhaltens in der Arteria pulmonalis.

The study demonstrates the results of 203 patients with COLD in a follow-up of 4-6 years. The investigations include the clinical state, lung function tests, blood gas analyses and measurements of pulmonary arterial pressure (PAP). One hundred and six of these 203 patients were investigated 3 times within 4-6 years. Clinical state, oxygen partial pressure and airways' resistance showed the best correlation with the PAP at rest and under exercise. In 54 patients (= 51%) the pulmonary arterial pressure increased up to a pulmonary hypertension. In 37 patients (= 35%) it decreased, out of them in 13 to normal values. Only in 15 patients (= 14%) the PAP did not change. We conclude, that a single measurement of the pulmonary arterial pressure can only be a marker of the general prognosis in COLD, but not of the individual prognosis. So we need further follow-up studies for the correct assessment of the individual prognosis dependent on the clinical state in each case.

[Chronic fibrosing alveolitis and lung fibrosis--frequency and distribution of radiographic symptoms]. / Chronisch fibrosierende Alveolitis und Lungenfibrose--Häufigkeit und Verteilung radiographischer Symptome.

In 95 patients with histologically or immunologically diagnosed interstitial lung diseases (44 pts. with chronic fibrosing alveolitis, 6 with allergic alveolitis, 11 with chronic diffuse fibrosis, 34 pts. with localized fibrosis) the radiographic symptoms of interstitial and accompanying alveolar and pleural alterations are estimated by a semiquantitative score, with regard to location and intensity. No diagnosis-relevant differences are found. Nodular densities are seen on the radiographs of all patients. In most of the cases (82%) they are accompanied by reticular shadows. Irreversible "honeycomb"-cysts are found in 27% of patients, alveolar and pleural reactions in 22% and 28% respectively. An impressive shrinkage is found in 16%.

[Measurement of blood pressure in the pulmonary artery during an attack of asthma]. / Druckmessungen in der A. pulmonalis im Asthma-Anfall.

22 patients with asthma attacks were examined by microcatheter and the pressure in the pulmonary artery (PAP) was measured. The bronchial obstruction is characterized by decrease of FEV 1.0 (average mean 44% of the vital capacity). The average pressures in the pulmonary artery change from 12 to 32 Torr (1.5 kPa to 4.2 kPa) during asthma attacks. Average of the PAP mean 20 Torr (2.7 kPa). The examination was completed by application of 0.24 g aminophylline via the catheter. Decrease of the PAP of 4.1 Torr (0.5 kPa) led also to a decrease of wheezing. In 9 patients an additional decrease of the PAP was effected by the application of 0.8 mg nitroglycerin.

[Postural drainage and breathing gymnastics--conditiones sine qua non-before lung resections for bronchiectasis (author's transl)]. / Lagerungsdrainage und Atemgymnastik-Conditiones sine qua non--vor Lungenresektion wegen Bronchiektasen.

Report on 150 lung resections in 143 patients with bronchiectasis in the period of 1958-1974. The intensive preparation of the patients before surgery is of highest importance for a small risk and rare complications after operation. Postural drainage and breathing gymnastics are able to increase significantly FEV1 and VC and to reduce RV in the preoperative phase. The complication rate amounted to 8%, lethality after surgery to 1.3%.

[The effects of preoperative treatment and physical training to operability in patients with bronchial carcinomas (author's transl)]. / Die Bedeutung einer funktionellen Vorbehandlung für die Operationsfähigkeit von Bronchialkarzinomkranken

Training effects of preoperative treatment, especially of breathing exercises in 52 patients with bronchial carcinoma were controlled by bodyplethysmography, measurements of the thoracic and abdominal circumferences in inspiration and expiration before and after the training program. In patients with obstructive ventilation disorders the expiratory resistance came to be reduced significantly. The mobility of the thoracic wall and of diaphragm increased in all patient-groups, but not in patients with restrictive ventilation disorders. After introducing the complex program the complication rate seems to drop to half of the previous rate.