Zeitschrift fur Erkrankungen der Atmungsorgane最新文献

The early recognition of obstructive lung diseases plays an important role in the subsequent therapy; the closing volume, determined by means of single-breath oxygen test has been established as a suitable parameter. This technique, however, has not succeeded as a routine method due to prohibitive costs. In a clinical study the closing volume and the easier estimatable so-called flow-resistance elevation volume (Ros-volume-curve parameter obtained from oscilloresistometry/volumetry) were compared and a correlation sought. It could be concluded, that for characterization of small airways diseases the closing volume is a more suitable parameter than the flow-resistance elevation volume.

A modern therapy for the respiratory distress syndrome in neonates is the substitution of alveolar surfactant. Supplementary surfactant has to be applied to the lung via an aqueous emulsion. To estimate the effects of fluids instilled into the lungs a total of 144 premature newborn rabbits were used. They were delivered by hysterotomy after 27, 28 or 29 gestational days (term = 31 +/- 1 days; mean +/- SD), anaesthetized (0.5 mg ethylurethane/kg b.w.), paralyzed (1 mg pancuronium bromide/kg b.w.) and ventilated by positive pressure (P = 25 hPa; f = 40/min; I:E = 1:1) with 100% oxygen. By means of body-plethysmography the tidal volume (VT) was recorded before and regularly during 90 min after the application of 0 (controls), 5, 10 or 20 ml saline (0.9% NaCl solution) per kg b.w. intratracheally. Dynamic lung-thorax compliance (Crs) was calculated as VT/P and related to the body weight. The initial Crs values (mean +/- SD) were 0.06 +/- 0.02 (27 days), 0.62 +/- 0.52 (28 days) and 1.08 +/- 0.21 (29 days) ml/hPa/kg, respectively (p less than 0.001). Intratracheal saline application had no detectable effect on Crs in rabbit neonates on day 27 of gestation. On day 28 or 29 of gestation there was a transient (approximately 15 min) Crs reduction, increasing with the volume of applied liquid. At a given saline quantity the severity of Crs reduction depended more on the magnitude of the initial Crs values than on the gestational day.(ABSTRACT TRUNCATED AT 250 WORDS)

The aim of the study was to determine the bronchoalveolar lavage (BAL) cell differentiation and the activity of beta-glucuronidase and N-acetyl-beta-D-glucosaminidase in alveolar macrophages. In 12 patients with systemic sclerosis (SS), 4 with systemic lupus erythematosus and 4 healthy controls BAL was performed. The activity of beta-glucuronidase and N-acetyl-beta-D-glucosaminidase was measured semiquantitative by means of cytochemical methods. Lymphocytes and neutrophils in BAL cell differentiation are increased, also the activity of beta-glucuronidase. The activity of N-acetyl-beta-D-glucosaminidase is decreased in SS and SLE in comparison with controls. The activity of beta-glucuronidase seems to be a marker of activity of alveolar macrophages in SS and SLE.

A retrospective descriptive analysis of 140 asthmatic patients, classified in our hospital as corticosteroid dependent and treated in outpatients departments showed, that 63% received slow release theophylline (SRT). 33% of them were within the therapeutic dose range, 44% did tolerate a further dose increase of SRT and 23% showed signs of intoxication which could be reduced by decreasing the dose. 12% of all patients were not on oral or inhaled corticosteroids at all. Only 52% received a combined antiasthmatic treatment including corticosteroids and both slow release theophylline and beta-agonists. This percentage was reduced to 18% if secretolytics are counted as a part of combination therapy. During hospital treatment it became evident that actually only 3% of all patients did not tolerate Theophylline retard due to side effects. In hospital 94% of all 140 patients received combined treatment (SRT, beta-agonists and corticosteroids). All of them showed a clear-cut improvement of major asthma symptoms (PEF monitoring, symptom scores, consumption of additional bronchodilators). It is concluded, that steroid dependent asthmatic out-patients are often undertreated: a minor part does not receive steroids at all; about one half does not receive drug therapy combined with bronchodilators; 67 per cent of the patients, who receive SRT (about 2/3 of the total number) is not under optimal theophylline dose regimen.

With a view of the pathogenesis of chronic bronchopulmonary diseases the interrelations between infections and evolving defense system are of interest, they are perhaps detectable by means of diagnostic bronchoalveolar lavage. We carried out cytodifferentiation, investigated adenosine deaminase activities and interleukin 1 formation of macrophages, determined immunoglobulin concentrations (secretory IgA), lysozyme, alpha 2-macroglobulin, alpha 1-antitrypsin, albumin. Because the cytodifferentiation yields insight into topical inflammatory reactions, shows diagnostic useful informations in single cases and because it is simple to carry out we can recommend it for each bronchological examination. There were no results specific for any disease group for parameters mentioned above.

In connection with studies on the pathogenesis of sarcoidosis antigen fractions were isolated from 8 mycobacteria species, three out of each strain. These fractions were tested for their reactivity to serum antibodies by means of RIA-technique, using 40 selected sera from controls, and patients with sarcoidosis, tuberculosis and asthma. Comparing the results (average titer steps) sera from asthmatics showed the lowest and those from sarcoidosis patients the highest reactivities to the mycobacterial antigen fractions. The reactivities clearly differed in dependence on the mycobacteria species. The highest mean reactivity in sarcoidosis patients was found with the HIP-antigen fraction of M. xenopi. It was 8 times higher compared to the control sera as well as the tuberculosis sera and 32 times higher than that of the asthma sera. There were also clear differences in the reactivities within the sarcoidosis sera tested. In sera from patients with clinically inactive sarcoidosis there were found nearly the same or only slightly higher titer steps than in control sera as well as tuberculosis sera, however in clinically active sarcoidosis the titer steps were clearly elevated. The findings are seen in connection with the role of atypical mycobacteria (MOTT) in the pathogenesis of sarcoidosis. The potential applications of the HIP- and Triton X-100 antigen fractions for in vitro diagnostics are discussed.

The Wegener's granulomatosis is a rare primary systemic vasculitis. It is diagnosed more frequently in the last years. Because of various manifestations (rhinitis, sinusitis, otitis, arthralgie, "red eye", neuritis, carditis) and different symptomatics the disease is misjudged over month and years. Clinical findings, problems of bronchopulmonary and histomorphological diagnostics and differential diagnosis are discussed. The prognosis is favourable in cases of early and timely diagnosis and therapy.

Pressurized bronchodilators (PB) play an important role in the treatment of obstructive lung diseases. Therefore, the correct use of PB is a decisive factor for a successful therapy. In our study 207 patients were tested concerning their ability to use PB correctly. Nearly half of the patients (47%) used their PB inadequately, women more frequently then men. Most frequent errors had been an insufficient expiration before the use of PB (33%) and a lack of synchronization between inspiration and the ventilation of the drug. The value of demonstration and role of a medical employee in teaching the correct use of PB is underlined because of the frequency of errors using PB in untaught patients.