Zeitschrift fur Erkrankungen der Atmungsorgane最新文献

Since the beginning of the eightieth the combined heart lung transplantation and two years later the single lung transplantation were established as therapeutical techniques in the treatment of patients with severe heart diseases and lung hypertension as well as patients with end-stage lung diseases. After numerous experimental studies clinical success was reached, but a real progress in the operation technique concerning long term effects was attained only after experimental investigations in primates. The introduction of Cyclosporin in the clinical practice was important for the control of immunological reactions. Especially the single lung transplantation and the "domino"-principle are to stress concerning an increase of availability of donor organs. The lung transplantation opened besides the therapeutical value new aspects in the investigation of physiology and biology of the respiration and lung.

Chronic obstructive airway diseases have only slight demand on lung function diagnostics according to the number of methods and technical level. But we have the demand of a high rate of lung function, more than in all other lung diseases. The expiratory peak flow (PEF) seems to be a suitable parameter for daily control.

Electronic spirometry on the basis of forced expiration and flow-volume-curve possess many advantages for the detection of ventilatory alterations in human lung.

Since 1980 an increase of the frequency of osteomyelitis after BCG vaccination has been described by some european countries. In the GDR osseous impairments as BCG complication are rarely. The authors report on an 18 months old boy with lesions of the distal tibia and the ankle-joint. He was vaccinated with BCG in the neonatal period. In contrast to the local findings general symptoms were unimportant. The surgical treatment was completed by antituberculotic chemotherapy. This treatment was successful.

The efficacy of a newly developed polyvalent bacterial lysat vaccine "Infectvac" was tested in experimental studies in animals. It was shown that a local application (oral, aerogenic) prevent the animals from a lethal bacterial (S. pneumoniae) or viral (A/PR/8/34) infection. In first clinical trials a good compatibility of the drug was demonstrated.

In the GDR annually repeated indiscriminate mass miniature radiographies (MMR) of all persons in the age of 16 years and over were performed during 3 decades. The aim was, beside finding cases of pulmonary tuberculosis, the early detection of bronchogenic carcinoma. The decrease of tuberculosis incidence and the shift of nearly all new cases to higher age groups lead to a change of this policy. The new regulation, in force since 1986, provides mass X-ray examinations of all persons in the age of 40 years and over with 2 years interval, and X-ray examinations of the lung of persons in several risk groups with shorter, mainly annual intervals. The latter became a task of the chest clinics. The experience of 2 chest clinics with the organization of these examinations and the yield of new cases of pulmonary tuberculosis and bronchogenic carcinoma are reported. It is necessary to improve the organization and to reduce the number of risk-groups to those with an acceptable balance of input and result. Otherwise, the staff of the chest clinics is impeded to fulfill more rewarding tasks in the care of patients. The results of the attempts of early detection of bronchogenic carcinoma and improvement of life expectancy by X-ray examination of risk groups and early resection were disappointing. Thus, other ways must be found. A revision of the regulation of 1986, concerning risk groups, is proposed with the aim to rationalize their surveillance.

The comparison of the results of culture and animal test for finding of mycobacteria in selected specimens, obtained in two laboratories between 1981 and 1988 shows a superiority of the animal test. Taking into account adequate literature recommendations are given as well for a possible improvement of culture methods as for the indication of animal tests.

To determine the primary test parameters pH, pCO2 and pO2 one blood sample smaller than 250 microliters is necessary. In general the computer aided check of analyser's functions ensures a high quality of analytic. Nevertheless measurements can be erroneous. Therefore a control independent of the analyser's one is necessary. Blood equilibrated with defined test gases is recommended as control material for pCO2 and pO2 measurement. For control of pH measurement buffer solutions are to be used. The comparison of several analysers is an alternative method of quality control. The approximated validity of computed parameters is explained by the way of the examples oxygen saturation (O2sat) and oxygen concentration (cO2). To calculate them exactly some complemental informations (P0.5, cHb) would be needed. These informations can not be estimated by blood gas analysis. It is pointed to the different importance of the parameters pO2, O2sat and cO2 for evaluation of lung function and oxygen supply in tissue.

There are closed relations between progressive systemic sclerosis (PSS) and exposure to quartz dust in the GDR. The recognition of PSS as an occupational disease is regulated by law. By analysis of the dust exposed working places a limit for silica concentrations were fixed. It is unlikely, that silica concentrations below 10% in the respirable dust induce a PSS. There are no significant differences in lung function of PSS-patients with and without quartz exposure.

The influence of different lung resection methods on pulmonary function was studied in 34 patients suffering from bronchial carcinoma. Daily measurements from the 1st to 10th postoperative day reveal the greatest losses of function after right upper lobectomy. Lower lobectomies or left upper lobectomy resulted in a less extensive loss of function. Recovery of function mainly occurs in the first 4 days after operation. Centrally acting analgetics are followed by a loss in pulmonary function whereas locally applied analgetics improve early postoperative function.