[Daily ultrashort chemotherapy and intermittent short-term chemotherapy with 4 drugs of communicable pulmonary tuberculosis treated for the first time. Results of a cooperative multicenter study]. / Tägliche ultrakurze Chemotherapie und intermittierende Kurzzeit-Chemotherapie mit 4 Medikamenten bei erstbehandelten ansteckenden Lungentuberkulosen. Ergebnisse einer multizentrischen kooperativen Studie.

Three short-course regimens, all comprising isoniazide (H), rifampicine (R), streptomycine (S) and pyrazinamide (Z), are compared in a randomized prospective cooperative clinical trial. The drugs are given daily in a 3-month regimen (3-HRSZ), twice a week in a 6-month regimen (6-HRSZ2), and in a further two-phase 6-month regimen the 4 drugs are administered 3 times a week for the first 3 months followed by the administration of HSZ twice a week (without R) for further 3 months (3-HRSZ3/3-HSZ2). The number of patients admitted to study is 80, 144 and 139 respectively. The 3-month regimen has been stopped because of a high rate of relapses. 17 p.c. of the patients admitted have to be excluded from analysis for various reasons, out of these 5.8 p.c. because of adverse reactions. Two thirds of the patients had heavily positive sputum cultures at the start. 300 patients completed therapy. At the end of therapy cultures were negative in 94 p.c., 100 p.c. and 99 p.c. respectively. The rate of bacteriological relapses is 19 p.c. in 3-HRSZ, 9 p.c. in 3-HRSZ3/3-HSZ2 and 3 p.c. in 6-HRSZ2, during a follow-up period of 3-4 years after completing therapy. The acceptability was good in all treatment groups. Adverse reactions like "flu" were rarely observed. Increased blood urea was common but in general without clinical symptoms. Elevation of ALAT and ASAT was relatively frequent but mostly transient and without clinical importance. The results served as basis for the new "Recommendation for Treatment of Tuberculosis" and are interpreted with regard to practical consequences and possibilities for further rationalisation of treatment.

[The pharmacokinetics of rifampicin in the intermittent treatment of patients with pulmonary tuberculosis. 1. Excretion of rifampicin in the urine]. / Zur Pharmakokinetik des Rifampicins (RMP) bei intermittierender Behandlung von Patienten mit Lungentuberkulose. 1. Mitteilung: Zur Ausscheidung von RMP im Harn.

With a rifampicin (RMP) range of 600 to 1800 mg, 12.5% of the administered dose are on an average secreted in urine. In spite of this minimal portion the course of pharmacokinetic processes can distinctly be learned from its alterations. Analyses in 84 patients revealed that the age will influence the induction and the sex-specific differences of the pharmacokinetics. Compared to male subjects, an increased RMP secretion in urine can be recorded in young female subjects, whereas in older male ones an induction-reduced RMP elimination in urine becomes more obviously. Considering these multiform processes, the determination of the bioavailability of RMP preparations by means of the RMP secretion in urine is taken to be manipulatable and uncertainly. More evident results can be gained by the determination of the RMP concentration in serum or by the calculation of the AUC.

[Prognosis and indications of corticosteroid treatment of intrathoracic sarcoidosis--conclusions from a prospective study]. / Prognose und Indikation der Kortikosteroidbehandlung der intrathorakalen Sarkoidose--Schlussfolgerungen aus einer prospektiven Studie.

Preliminary results of a prospective clinical trial to evaluate the value of corticosteroid therapy of intrathoracic sarcoidosis had demonstrated that there were no differences between treated and untreated patients with regard to the clinical, radiological and functional outcome after several years. In one hundred and seventy two patients we could check the former results by identical tests after a longer follow-up period (mean 8,9 years) and by additional physiological assessments, i.e. Cstat, DLCO, DM, VC, which seem to be more significant for early detection of functional disorders in sarcoidosis. Again the findings showed no significant differences neither between patients treated with prednisolone for 12 or 6 months respectively nor when compared to the untreated group. In conclusion we do not treat patients with asymptomatic intrathoracic sarcoidosis and without extrapulmonary manifestations before the disease shows no regressive course within one year or when a progressive course is observed.

[Surgical treatment of small-cell bronchial carcinoma]. / Die chirurgische Behandlung des kleinzelligen Bronchialkarzinoms.

The analysis of 284 resected small-cell bronchial cancers from 4 Lung clinics has shown that these represent 11% of all resected lung cancers. The 5-year survival rate was 24%. The male-to-female ratio was 9.5: 1. Two-thirds were detected by X-ray mass screening. The majority of them (60%) were peripheral tumors. 50% of the patients had a stage Ia cancer and showed a 5-year survival of 40%! This result speaks for the primary surgical therapy even for stage I small-cell bronchial cancers, and for a 6-month screening interval of the respective risk groups. Patients with stage II or III cancers showed a 5-year survival rate of only 10%. In such cases postoperative adjuvant chemotherapy should be carried out. But such a therapy seems to be little effective in stage Ia patients.

[Increase in serum aldolase caused by bronchial carcinoma]. / Serumaldolaseerhöhungen durch Bronchialkarzinome.

13 patients were undergone a resection of their lung tumours. Under operation aldolase were determined in V. pulmonalis, A. pulmonalis and V. basilica. First time it is demonstrated: Human bronchial carcinomas give aldolase in circulating blood. Aldolase-level in V. pulmonalis of carcinoma increases with size and dedifferentiation of tumours.

[Histiocytosis X--a comparative 2-country study of East Germany and Yugoslavia]. / Histiozytosis X--eine vergleichende Zweiländerstudie aus der DDR und SFR Jugoslawien.

In a retrospective study 25 patients with histologically confirmed histiocytosis X were investigated in the GDR and in Yugoslavia. No differences between the clinical course was observed in the two countries. The disease was found somewhat more frequent in men, and relative to age groups the age group 18-39 prevailed. Only one fourth of the patients were detected by radiophotography. Lung function was impaired in 2/3 of the patients. In the lung radiogramm reticular and micronodular changes predominated at the beginning of the disease while cystic lesions appeared in late stages of the disease. The diagnosis was established on the basis of biopsy (most often transthoracic lung biopsy) and pathohistologic examination. The course of the disease was unfavourable because of the 18 observed patients 3 died and in 6 progression of the disease was noted on average within several years.

[Lung resection for carcinoma in old age--effect of cardiopulmonary risk factors on surgical indications]. / Lungenresektion wegen Karzinom im höheren Lebensalter--Einfluss kardiopulmonaler Risikofaktoren auf die Operationsindikation.

Advanced age will only play a limited role in determining the indication for lung resection in elderly patients. Our results demonstrate that the overall state of health and the stage of the tumour are the decisive criteria whether a lung resection can still be performed successfully or not.

[Resection therapy of bronchogenic carcinoma in old age]. / Resektionsbehandlung des Bronchialkarzinoms bei Patienten im höheren Lebensalter.

In a 20 year period from 1959 to 1979, 218 resections were performed for primary cancer of the lung in patients aged 70 and more. The postoperative mortality was 5% (11 cases). Long-term results could be evaluated for 160 cases operated before 1975. A 5 years survival rate could be established after pneumonectomy for 10.7%, after lobectomy for 39.6% and after wedge lobe resection for 25%. Staging by TNM-system 5 years survival rate in St.I/T 1 was 45.1%, St.II/T1/T2 33.3% and St.III/T1-T3 15.5%. Before opening the chest, the histological diagnosis of bronchial carcinoma could be defined by bronchoscopic findings in 81.8%. In cases of primary cancer of the lung without clinical symptoms, resections were done successfully at an age of 70 years and more.

[The effect of Robert Koch's discovery and investigations on the development of the therapy of tuberculosis]. / Die Auswirkung der Entdeckung und der Arbeiten Robert Kochs auf die Entwicklung der Therapie der Tuberkulose.

The discovery of the tuberculous bacillus and the methods of cultivation have been fundamental prerequisite for the development of the therapy of tuberculosis. Substances with antimycobacterial activity in vitro even in low concentrations have been found out already by Robert Koch, however not any effective ones in vivo. The cultural demonstration of tubercle bacilli is not only important for diagnosis but the essential criterion of efficacy of the drugs and for the success of treatment. Experiments with cultures of tuberculous mycobacteria represented the basis for detection of new antituberculous drugs, for the elucidation of the mechanism of their effect, for the inquiry of the type of antituberculous activity and the basic mechanism of the development of resistance. Out of these the principles for avoiding of that has been built up. Cultures are also used for the principal and individual determination of the concentration of antituberculous drugs in blood and organs. By the excellent efficacy of the causal antituberculous therapy it is possible to cure all kind of tuberculosis without any surgical interventions which are now needless. The results of in vitro-experiments on cultures represented also the starting point for the further development of antituberculous treatment. One-phasic or two-phasic intermittent treatment and short-course therapy have simplified treatment and marked it easier, which is supervised under ambulatory conditions, too. They lowered the costs for drugs and staff considerably. The causes of relapses, which have become now the main problem instead of resistance, could been investigated by means of tuberculous cultures. The possibilities of the realisation in practice of the obtained knowledge in the scale of a country are demonstrated on the example of the GDR and referred to the social and economical conditions, of which Robert Koch already had drawn the attention.

[Correlative studies comparing the value of transthoracic needle biopsy and open lung biopsy in disseminated lung diseases]. / Vergleichende Untersuchungen zum Stellenwert von transthorakaler Lungenpunktion und diagnostischer Kleinstthorakotomie bei disseminierten Lungenerkrankungen.

To compare the values of transthoracic needle biopsy and open lung biopsy on 130 patients with disseminated lung diseases transthoracic needle biopsies were carried out immediately before open lung biopsies (including the punction area). A conclusive diagnosis was obtained in 98% by open lung biopsy but only in 42% by transthoracic needle biopsy. In cases of pulmonary fibrosis and sarcoidosis needle biopsies gave a positive result in 50% whereas in other diseases like tuberculosis and silicosis in not more than one third a correct diagnosis has been achieved. The results of the direct comparisons demonstrate the superiority of open lung biopsy in diagnostics of disseminated lung alterations.

[Laboratory staged-programme in diseases of the lung. Aspects and recommendation. (author's transl)]. / Labordiagnostisches Stufenprogramm bei Lungenkrankheiten. Aspekte und Empfehlungen.

The dynamic of biochemical processes opened recently an enlarged arsenal of new diagnostic possibilities for the physician. The exponential increase of scientific knowledge led to a progressive increase in the frequency of laboratory analyses. First the laboratories attempted to confront this development by means of rationalization of the structure, organization and analytic factors. Today the laboratories are confronted with a wide-spread polypragmasy, the demand of redundant parameters and irrelevant analyses increases. This contradiction can be solved only by a process of interdisciplinary responsibility. Very important is a change with the result of an improvement of the parameterpalettes leading to a rationalization of the diagnosis. Up to now there is a loch of systematical scientific investigations for the objectiveness and improvement of laboratory parameterpalettes concerning basis diagnosis, differential diagnosis and control of therapy effects in lung diseases. Obviously the cause for this problem in the structure and function of the organ "lung". In this special cases laboratory diagnosis possesses inbordinale relevance. As for the diagnostical process parameters of the function as well as X-ray diagnosis and morphological findings possesses priority. In this study an attempt is made to classify the diagnostically relevant parameters and to force them in a staged system of the medical supervision. With this conception the physician has the possibility to demand laboratory investigations on a scientifically founded basis.

[Therapy of tuberculosis]. / Therapie der Tuberkulose.

The accomplishment of the principles for the prevention of a germ resistance and the development of new principles of treatment and highly effective antituberculotics has led to the fact that nowadays actually each case of tuberculosis may be treated and cured purely internally. This progress in the individual treatment were achieved by recommendations of therapy which are actualized from time to time. The modern treatment consists of a daily application of three effective antituberculotics for two to three months, fellowed by an intermittent application twice a week. The duration of the initial intensive period and the whole time of therapy is determined by the clinical and social state before the beginning and by the combination of drugs. INH, rifampizine, streptomycin and ethambutol form the components of the therapy combinations which at present are to be used no longer than twelve months. The redetection of the special microbiological qualities of the pyrazineamide and their importance for the prevention of relapses introduces the last phase of the development of the therapy of tuberculosis. By its means it is possible to shorten the duration of the treatment to 9 months and less and thus to increase the acceptability and cooperation, to decrease the toxicity and costs.

Corticosteroid therapy of intrathoracic sarcoidosis stages I and II--results of a controlled clinical trial.

It is difficult to evaluate the efficacy of sarcoidosis therapy. There are high rates of spontaneous remission, frequently pushing course and tendency to relapses after treatment. 280 patients with histologically confirmed mediastino-pulmonary sarcoidosis in stage I and II without extrapulmonary manifestations have been admitted until now in a controlled clinical trial. More than 150 of them have been analysed after a follow-up of 3 to 5 years, in 40 cases already to 7 years. The patients have been treated by prednisolone and isoniazide for six and 12 months respectively and compared with a non-treated control group. 6 and 12 months after the start of observation X-ray regression has been more often observed in the treated than in the non-treated patients. However, the results after 3 and 5 years were nearly similar in all groups: improvement in 75% and complete resolution in 60% respectively. It seems to us therefore that prednisolone shows only an effect on the early stage of sarcoidosis but is without any influence on the late X-ray results. In consequence corticosteroid therapy is clearly indicated only in patients with progressive course of the disease.