[Determination of macrophage activity in bronchoalveolar lavage fluid in patients with lung diseases]. / Bestimmung der Makrophagenaktivität in der bronchoalveolären Lavageflüssigkeit bei Patienten mit Lungenkrankheiten.

In order to investigate the metabolic activity of alveolar macrophages in the bronchoalveolar lavage fluid from patients with extrinsic allergic alveolitis, pulmonary sarcoidosis, bronchogenic carcinoma, chronic bronchitis, tuberculosis, bronchial asthma and from sensitized asymptomatic persons, the quantitative and qualitative Nitroblue-tetrazolium test was used. There was observed a significant increase of the alveolar macrophage activity in patients with bronchogenic carcinoma, chronic bronchitis, sarcoidosis and extrinsic allergic alveolitis. The results of the investigation emphasize the central role of the alveolar macrophages in the triggering and regulation of the inflammatory reaction in the lung and consequently play an important role in the elucidation of pathogenic mechanisms in lung diseases.

[Chemiluminescent measurements of alveolar macrophages in sarcoidosis patients]. / Chemilumineszenz-Messungen an Alveolarmakrophagen bei Sarkoidose-Patienten.

The phagocytic activity of alveolar macrophages (AM) in a group of patients with stage I, stage II and stage III pulmonary sarcoidosis (gradation according to Wurm) has been investigated. Additionally a classification in different forms of the course of sarcoidosis was made (acute = Loefgren's syndrome, latent = primary-chronic, and relapses). Patients with other lung diseases and healthy subjects were recruited as control group. The phagocytic activity (stimulation with opsonized yeast cell wall particles) of AM, which were isolated by bronchoalveolar lavage, was determined by means of chemiluminescence (CL)-measuring using lucigenin and luminol, respectively, as amplifiers. The investigations showed that the lucigenin-dependent yeast cell wall-induced CL of AM in patients with sarcoidosis is significantly increased in comparison to the control group. No significant changes of the luminol-dependent CL of AM from sarcoidosis patients could be detected. The lucigenin-dependent CL-response of AM is obviously an indicator of the intensity of the alveolitis and thus of the activity of the pathological process in sarcoidosis. The results suggest that in pulmonary sarcoidosis there is a hyperreactive AM/lymphocytes-system.

[Effect of antioxidants on the production of reactive oxygen metabolites by stimulated alveolar macrophages]. / Einfluss von Antioxidanzien auf die Erzeugung von reaktiven Sauerstoffmetaboliten durch stimulierte Alveolarmakrophagen.

Reactive oxygen metabolites (ROM) (O2-, H2O2, 1O2, .OH, OX-) which are produced by stimulated alveolar macrophages (AM), neutrophils and eosinophils, play an important role in the pathogenesis of many acute and chronic lung diseases. With regard to a therapeutic application the influence of the antioxidants ascorbic acid (Vitamin C) and alpha-tocopheryl acetate (Vitamin E acetate) on the production of ROM by AM was investigated. The AM were isolated by bronchoalveolar lavage from patients with different lung disorders. The ROM were determined by means of chemiluminescence-measuring. alpha-Tocopheryl acetate solved in peanut oil causes a little increase of the yeast cell wall-induced chemiluminescence. Pure alpha-Tocopheryl acetate has no effect on the chemiluminescence. In contrast to alpha-Tocopheryl acetate the addition Vitamin C to the stimulated AM results in a strong diminution of the chemiluminescence signal. This result suggests that Vitamin C reduces the generation of ROM by AM. Therefore Vitamin C could be a suitable scavenger of radicals and oxidants in different lung diseases.

[The effect of ambroxol and bromhexine on the "respiratory burst" of alveolar macrophages]. / Einfluss von Ambroxol und Bromhexin auf den "Respiratory Burst" von Alveolarmakrophagen.

The effect of ambroxol and bromhexine on the yeast cell wall- and arachidonic acid (AA)-induced luminol-respectively lucigenin-dependent chemiluminescence (CL) of alveolar macrophages (AM) of patients with lung diseases has been investigated. Both drugs cause a suppression of the induced CL. These results suggest that ambroxol and bromhexine reduce the generation of reactive oxygen metabolites (ROM) by AM. The mechanism of action is thought to involve the activation of the acyl-CoA: lysophosphatide acyltransferase. The increase of this enzyme activity lowers probably the intracellular concentration of free AA and consequently also the production of ROM. The investigations show a new possibility for the influence of biosynthesis of ROM and likely of eicosanoids, which play an important role as pathogenetic mediators in different lung diseases.

[Value of bronchoalveolar lavage in the diagnosis and follow-up of lung diseases]. / Zum Stellenwert der bronchoalveolären Lavage in der Diagnostik und Verlaufsbeurteilung von Lungenkrankheiten.

In a group of 100 patients with different lung diseases the diagnostic value of BAL was estimated comparing with conventional broncho-bioptical methods. Final diagnosis was obtained by BAL only in 3% of all cases in contrast to conventional broncho-bioptical methods with 49% positive findings. In a further group of 77 patients with acute and chronic forms of sarcoidosis in stage I and II a significant difference in BAL-lymphocytosis between acute and chronic forms was observed. Our findings demonstrate the limited value of BAL for diagnostic purpose but its valuability in estimation of the activity and the course of different lung diseases especially of granulomatous and fibrotic origin.

[Modulation of alveolar macrophage activity by ambroxol, bromhexine and exogenous arachidonic acid]. / Modulation der Alveolarmakrophagenaktivität durch Ambroxol, Bromhexin und exogene Arachidonsäure.

The increased generation of reactive oxygen metabolites (ROM) (O2-, H2O2, 1O2, X OH, OX-) by alveolar macrophages (AM) and neutrophils has been proposed as an important step in the pathogenesis of many acute and chronic lung disorders. With regard to a possible therapeutic application in this context the effect of bromhexine and ambroxol on the activity of AM of of guinea-pigs and of patients with lung diseases was investigated. The activity of AM, which were isolated by bronchoalveolar lavage, was determined by means of chemiluminescence (CL)-measuring. Ambroxol and bromhexine cause a depression of the spontaneous as well as of the induced CL [yeast cell walls, yeast glucan, exogenous arachidonic acid (AA)] of AM. AM from guinea-pigs and in some cases also from patients show primarily an increase of the CL-signal under the influence of bromhexine. These results suggest that ambroxol and bromhexine reduce the production of ROM by AM. The mechanism is possibly due to the activation of acyl-CoA-lysophosphatide acyltransferase. The increase of this enzyme activity lowers the intracellular concentration of the free AA, whereby the generation of ROM is diminished too. The investigations exhibit a new possibility of influence of respiratory burst and thus indirectly of AA-liberation from phospholipids. The probable reduction of AA-liberation by these drugs could also be of importance for other lung cells especially concerning the biosynthesis of eicosanoids (AA-metabolites), which play an important part as pathogenetic mediators in different lung diseases.

[Bronchoalveolar lavage]. / Bronchoalveolärre Lavage.

The incidence of interstitial lung diseases is increased during the last years. A possibility for improvement the diagnosis of these lung diseases is the bronchoalveolar lavage (BAL). In a critical review the performance of the BAL, same properties of the isolated macrophages and the determination of biochemical parameters in lavage fluid are described. In this context especially problems of diagnosis of sarcoidosis are discussed. There are new fields of application of BAL (diagnosis of occupational lung diseases, control of therapy). In order to improve the comparability of different results a standardization of BAL is necessary.

[Lymphocyte populations in bronchoalveolar lavage fluid in various interstitial lung diseases]. / Lymphozytenpopulationen in der broncho-alveolären Spülflüssigkeit bei einigen interstitiellen Lungenkrankheiten.

Differential cell counts, T-, Tactive-, Tstable-, and B-lymphocytes were studied in bronchoalveolar lavage (BAL) fluid and in peripheral blood from patients with thoracic sarcoidosis (S), extrinsic allergic alveolitis (EAA) and idiopathic pulmonary fibrosis (IPF). In patients with S and EAA the total number of lymphocytes, the percentage of T-, Tactive-, and Tstable-lymphocytes were increased in BAL-fluid, especially in cases of active S and of acute EAA. Contrary to the BAL-fluid the peripheral blood values for T-lymphocytes were decreased in S and in the range of the control group (healthy volunteers) in EAA. The BAL-fluid of patients with IPF is characterized by a high number of polymorphonuclear cells, especially neutrophils. Current concepts of pathogenesis of interstitial lung diseases are discussed and the possible key role of alveolitis in this process is elucidated.

[The treatment of lung fibrosis (author's transl)]. / Die Behandlung von Lungenfibrosen.

D-Penicillamine is increasingly used for the treatment of lung fibrosis. The case-histories of 46 patients from 4 chest hospitals were analysed. All parameters being taken in consideration 13 patients showed an improvement, 17 patients no change and 16 patients a deterioration of their state of health. Side effects were observed in 22 patients.

[Morphological investigations of bronchial biopsy material in chronic bronchitis and asthma bronchiale (author's transl)]. / Morphologische Untersuchungen an Bronchusschleimhautbiopsien bei Asthma bronchiale und chronischer Bronchitis.

Morphological investigations (light microscopy, enzyme histochemistry, immunopathology) were carried out in cases with asthma bronchiale and chronic bronchitis. According to the histological picture no additional parameters were found with enzyme histochemical and immunopathological methods to specify the diagnosis asthma bronchiale and chronic bronchitis. The most important diagnostic factors in chronic bronchitis are hyperplasy of mucous bronchial glands and atrophy of serous bronchial glands with a loss of activity of acid phosphatase. Diffuse thickenings of basal membrane were more often in asthma bronchiale, localized thickenings more often in chronic bronchitis. Hypertrophy of goblet cells, infiltrations with round cells and metaplasia are found both in asthma bronchiale and chronic bronchitis in different degree. Correlations exist between the activity of leucine aminopeptidase in the stroma of the bronchus and degree of cellular infiltration with lymphocytes and plasma cells.

[Tracheobronchopathia chondro-osteoplastica (author's transl)]. / Tracheobronchopathia chondro-osteoplastica.

Clinical, roentgenological and histological findings in two cases of tracheobronchopathia chondroosteoplastica are described in detail. Characteristic features of this rare disorder are calcificated, cartilaginous and osseous deposits in superficially parts of tracheobronchial mucosa. The clinical picture and x-ray changes are not very characteristic. Final diagnosis is possible by bronchoscopy with histologic examination of bioptic material (excision from tracheobronchial mucosa).

[Statement of the bioptic diagnostic in intrathoracic sarcoidosis--team work of 6 lung hospitals of the GDR (author's transl)]. / Stand der bioptischen Diagnostik bei intrathorakaler Sarkoidose--Erfahrungen von 6 Lungenkliniken der DDR.

A nearly nation-wide team-work of six chest hospitals was made with 4284 patients to analyse all performed diagnostic procedures up to the present. Its frequency and diagnostic importance in relation to the radiographic stages of the disease were examined. Especially the procedure of bronchologic examination, having been partly underrated with the morphological ascertainment of sarcoidosis, are now purposefully analysed. This showed that also with perbronchic punction-biopsy and bronchoscopic excision morphologically confirming of the diagnosis was possible at a high percentage. On the other side the right diagnosis was made clinically before bioptic procedures in the majority of the patients. The overall conclusion is that, according to the experiences made in our hospitals, the relatively harmless bronchologic procedures are in general sufficient to obtain bioptic verfication of the diagnosis "sarcoidosis". Other bioptic operations like mediastinoscopy or lung biopsy can be restricted to cases with reasonable doube of the diagnosis.

[Diagnosis of disseminated and localized lung diseases by means of transbronchial lung biopsy (author's transl)]. / Zur Diagnostik disseminierter und herdförmiger Lungenerkrankungen mittels transbronchialer Lungenbiopsie

In 61 patients with mostly diffuse lung diseases 64 transbronchial lung biopsies have been performed by means of rigid biopsy forceps in general anesthesia. 31 of the 36 pathological bioply specimens were diagnostically helpful or represented the clinical diagnosis. Complications were moderate bleeding in three cases and pneumothorax (3 cases). One patient died after myocardial reinfarction occuring under general anesthesia. Transbronchial lung biopsy is indicated when routine methods fail to establish the diagnosis of pulmonary lesions, particularly in patients having higher operative risks. More use of the transbronchial forceps biopsy is expected to improve the diagnostic yield, especially in patients with miliary pulmonary lesions.