[Therapeutic experiences in a pneumologic specialty clinic of the former East Germany]. / Therapeutische Erfahrungen in der pneumologischen Fachklinik der ehemaligen DDR.

From the viewpoint of a special clinic for pulmonary diseases in the former German Democratic Republic (GDR), problems and experiences are discussed that have been coming up in connection with the treatment of patients before and after the unification of the two Germanys. In view of the large variety of pneumologic diseases, the differences in therapy and their changes are outlined only for the sociomedically most important diseases such as tuberculosis, chronic obstructive diseases of the lungs, pneumonias and cancer of the lung. There were no significant differences in respect of the fundamental principles of therapy; however, differences did exist with regard to the availability of drugs and technical equipment. Attention is drawn to the difficulties that beset both the special hospital and the patient in the course of the present reorganization of outpatient medical care.

[Incidence of hypogammaglobulinemia in patients with nonspecific lung diseases]. / Zur Häufigkeit von Hypogammaglobulinämien bei Patienten mit unspezifischen Lungenkrankheiten.

Patients with hypogammaglobulinemia frequently show complications of the respiratory tract system. We analyzed electrophoresises in 1087 patients with acute and chronic non-specific lung diseases. It were found 14 cases (1,3%) of reproducible hypogammaglobulinemias with pathologic decrease of immunoglobulinfractions in immunoelectrophoresis. All cases could be confirmed as genetically determined by anamnesis and examinations of relatives. The frequency of primary immunodefects and in adults manifesting cases of "common variable immunodeficiency (CVID)" is given in literature with 10:10(6) for the whole population. We found in our patients with non-specific disorders an 1000 x increased incidence.

[Reference values for spirometry exemplified by FVC and FEV1 parameters--comparison of normal values of the Pathophysiology of Respiration Section and the European Society for Coal and Steel]. / Referenzwerte für die Spirometrie am Beispiel der Parameter FVC und FEV1--Vergleich der Normwerte der Sektion Pathophysiologie der Atmung und der Europäischen Gemeinschaft für Kohle und Stahl.

Reference values published by the Section Pathophysiology of Breathing in the Society for Pulmology and Tuberculosis of the GDR and reference values of European Community for Coal and Steel (EGKS) were compared on example of FVC and FEV1. It was found a relative well accordance of reference values of FVC and FEV1 in younger and middle-aged men of a height from 160-200 cm (between -5 to +15%). In women with a body height of 150 to 200 cm a well correlation for FVC and FEV1 is also given (-10 to +10%). Reference values are showing a more important difference with increasing age and independent of sex. There are problems concerning the reference values in male and female lower than 155 cm body height.

[Transitory bacteremia in bronchologic-biopsy procedures]. / Untersuchungen über die transitorische Bakteriämie bei bronchologisch-bioptischen Massnahmen.

In 105 patients, the incidence of transitory bacteraemia seen following bronchological-bioptic interventions was investigated. In three patients (2.9%), the identical pathogens were detected both in the bronchial secretion and in venous blood culture following bronchoscopy.

[Complications in endoscopic and endoscopic biopsy studies--analysis of a 1-year patient sample]. / Komplikationen bei endoskopischen und endoskopisch-bioptischen Untersuchungen--Analyse des Krankengutes eines Jahres.

We report on a prospective study of complications in 2,133 bronchoscopies, 61 transthoracic lung biopsies, 32 mediastinoscopies and 6 thoracoscopies, performed between 1985 and 1986. There were no deaths or life threatening complications. The total rate of essential complications, e.g. pneumothorax, haemorrhage, laryngospasm, and bronchospasm of all patients with bronchoscopies was 10.5%. Excluding small endobronchial haemorrhages, without influence on the patients state or endoscopic procedures the final rate of complications was 1.9%.

[Effects of the argon laser on bronchial tumor tissue]. / Argonlaserwirkungen auf bronchiales Tumørgewebe.

Argon-ion lasers emit blue-green light, transmittable via fiber for endoscopic tumour therapy and coagulation of small vessels. Effective tumour vaporization could be performed in native biopsy specimens using cw-Argon laser with adjusted power and application time. Tissue colour and vascularity influence the laser effect.

[Expanded thoracic use of the laser]. / Erweiterter thorakaler Lasereinsatz.

Using conventional lasers authors create diagnostic and therapeutic thoracoscopic procedures for improvement of present spectrum of pulmonary therapy. Transthoracal punction for insertion of laser fibre and integral photoradiation therapy of pleural tumors are described as new therapeutic laser methods.

[Experimental and clinical experiences with bronchologic lasers]. / Experimentelle und klinische Erfahrungen mit Bronchologielasern.

Bronchological application of lasers is based on differences of their biophysical effects, which were confirmed in experimental investigations. There were early reepithelizations and rapid healing after laser tracheotomy and lung resections without signs secondary stenoses by hypergranulation. Argon laser is of limited use in bronchology for HpD-coupled tumor fluorescence diagnostic. Nd-YAG-laser is the "classic" laser for palliative bronchial tumor therapy. Improvements of laser applications (laser thoracoscopy, perthoracic laser punction therapy) are new therapeutic laser methods.

[Experiences with bronchoalveolar lavage in disseminated and other lung diseases]. / Erfahrungen mit der bronchoalveolären Lavage bei disseminierten und anderen Lungenkrankheiten.

In 860 patients 980 bronchoalveolar lavages were performed. The repeated BAL allows conclusions of the effect of treatment and the prognosis of the disease. BAL is together with other clinical findings an important new method in pulmology. Its value in diagnosis of interstitial pulmonary diseases and other pulmonary diseases is described with special view to occupational expositions.

[Case report of the problem of diagnosis and therapy of mediastinal tumors with anterior venous obstruction]. / Kasuistischer Beitrag zum Problem der Diagnostik und Therapie von Mediastinaltumoren mit venöser oberer Einflussstauung.

At the instance of a patient with upper venous affluence blocking due to a space occupying process in the dorsal and medial mediastinum, the problems of differential diagnostics and therapy of this disease are discussed. In spite of intensive diagnostic efforts, the final diagnosis was only obtained at autopsy. A T-lymphoblastic non-Hodgkin-lymphoma was found.

Experimental pulmonary embolism with electrically activated autologous blood.

Pulmonary thromboembolism is one of the most frequent causes of death in our days. Notwithstanding the great efforts made in clinical and experimental medicine there has been no success as yet in filling the existing gaps in the understanding of pathophysiology of this disease. The blood electrically activated in vitro by direct current reacts like an endogenic thrombogenic substance. On the condition that such a substance is injected into the inferior vena cava, the clot is introduced into the pulmonary circulation and gives rise to pulmonary thromboembolism of a varying degree, each depending on the electrically activated blood injected. In the animal experiment it has thus become feasible, under standardized and reproducible conditions, to produce severe thromboembolism or chronic microembolism with subsequent hypertrophy of the right ventricle. The object of this contribution is a demonstration of a new, easy, and effective method for the induction of pulmonary embolism, which can be treated by thrombolysis.

[Bacteriological findings in selected inflammatory bronchopulmonary diseases]. / Bakteriologische Befunde bei ausgewählten entzündlichen bronchopulmonalen Erkrankungen.

Actual bacterial flora was bronchologically examined in 561 patients with inflammatory bronchopulmonary diseases, 291 out of them with acute pictures. Facultative pathogenic organisms were found in 70 per cent of bronchiectases, in 24.4 per cent of pneumonia and in 17 per cent of acute bronchitis. In the first place of infections were Haemophilus influenzae and gram-negative bacteria; in contrast to that pneumococci and staphylococci were less frequent. Sensitivity tests showed that especially in the case of gram-negative organisms and staphylococci a well-directed antibiotic treatment should be carried out.

[Behavior of pressure and flow parameters of pulmonary circulation in bronchologic studies in general anesthesia using 2 injectable anesthetics]. / Das Verhalten von Druck- und Flussparametern im kleinen Kreislauf während bronchologischer Untersuchungen in Allgemeinnarkose bei Verwendung zwei verschiedener Injektionsnarkosemittel.

Flow- and pressure-parameters of the pulmonary circulation were measured in the course of bronchologic investigations under general anaesthesia using as narcotics in group I (n = 14) Hexobarbital, in group II (n = 10) Propanidid (Sombrevin). The increase of mean pulmonary artery and mean PCW-pressure in group II is significantly higher than in group I. This seems to be caused by a more reduced myocardial function due to Sombrevin. Heart rate and pulmonary vascular resistance increase in both groups uniformly. The pO2 is markedly reduced up to 4 hours after the investigation accompanied by an increase of pCO2.

[Combination of transbronchial lung biopsy and bronchoalveolar lavage in disseminated lung diseases]. / Die Kombination von transbronchialer Lungenbiopsie und bronchoalveolärer Lavage bei disseminierten Lungenkrankheiten.

The effectiveness of transbronchoscopic lung biopsy (TBLB) in combination with bronchoalveolar lavage (BAL) is presented in 487 patients with disseminated lung diseases. The techniques of both methods are described and the results discussed. Comparison of both methods shows that they supply each other. Therefore they should be used in combination in suspected case of disseminated lung disease. Beyond that BAL is important for the control of the disease's course. In the described technique of TBLB we found complications in 7,8%, while with BAL no essential complication was registered.

[Complex diagnosis of bronchial cancer]. / Komplexe Diagnostik des Bronchialkarzinoms.

The necessity and the value of early complex diagnostics of the bronchial carcinoma as a supposition for an optimal treatment is discussed. To avoid any delay, an immediate admission to a high specialized clinic, where all necessary diagnostic methods are available, must be desired. Our own investigations show the importance of several symptoms often neglected. A view of the diagnostic methods in use since many years and their results are given. Endoscopy and endoscopic biopsies are further indispensable methods with a high diagnostic yield in the diagnosis of bronchial carcinoma. The use and the efficiency of different methods depend on an exact clinical and radiological localization of the tumor.

[Effectiveness of photofluorography screening studies in the early detection of bronchial carcinoma]. / Effektivität der Schirmbildreihenuntersuchung zur frühen Erfassung des Bronchialkarzinoms.

Report on results of a prospective study for earlier detection of peripheral and central bronchial carcinoma by fluorography performed for 6 years. In 1972 41,532 men of the age groups 1907 to 1937 were enrolled in the study group examined every 6 months. They were compared statistically and clinically to a control group of 102,348 persons of about the same sex and age distribution examined every two years by mass-x-ray. 1. By fluorographic screening the detection and resection rate in the study group was significantly increased. The percentage of resections was double as high as in the control group. 2. The higher detection rate especially in the younger age groups (40 to 54 years) of the study group caused an increase of the resection rate being three times higher than in the corresponding age group of the control population. 3. 67.5% of the persons with resection in the study group and 49.5% in the control group came to a life expectancy of more than three years. A 5 years healing after resection was attained by 23 of 42 resected patients of the study group and by 15 among 46 of the control group (55% to 32%). 4. Fluorography in 6 months intervals led to an increase of lower tumor stages. 5. At present fluorographic examinations showed to be the only mode of detection with good chances of resection as well in the study as in the control group, case-finding with clinical methods offering only small chances. 6. Among the patients resected in the study group the histological type of adenocarcinoma was rather frequent in 26.0%, parvicellular carcinoma amounting to 13.5%, on the other hand in the control group these types could be found with the same frequency in 16.8%. 7. The own results are reviewed with national and international investigations. Fluorographic examinations of selected risk groups (males between 40 and 70 years) in short intervals have proved to be at present the only method of finding bronchial carcinoma in time with some effectivity. 8. The effectivity of mass-x-ray-examinations must be improved a) by aimed examinations of risk groups, b) by improving the operational approach of fluorography using a special data bank of inhabitants, c) by reducing the medical protraction still high up to diagnosing bronchial cancer, d) by using the computer controlled risk aimed x-ray-examination for a complex screening programme.