[Initial experience with the treatment of endobronchial lesions using the Nd:YAG laser]. / První zkusenosti s lécbou endobronchiálních lézí Nd:YAG laserem.

Endobronchial treatment by means of a laser acquired during the past ten years a firm place in bronchology. In the submitted paper the authors present their initial experience with this treatment in patients of the Pneumological Clinic in Prague-Veleslavín. In the course of 12 months since when there is a Nd:YAG laser, Sharplan Co. at the clinic, 52 patients were treated by this method. Forty of them suffered from lung cancer. Three had other types of tumours. Eight patients suffered from benign cicatricial stenoses and one female patient aspirated a foreign body. A total of 124 bronchoscopies, using a laser, were performed, on average 2.4 per patient. In 75% of patients with lung cancer recanalization was achieved, the trachea was dilated in all patients with cicatricial stenoses, however, only in one quarter of them complete restitution of the lumen was achieved. Hitherto assembled experience confirms the value of laser treatment for improving the life and its prolongation in patients with lung cancer and its importance for treatment of other endotracheobronchial processes. Three serious haemorrhages during operation were recorded, one female patient died. The use of the laser is simple, its operation smooth.

[Results of surgical and conservative therapy of tracheal and tracheoesophageal lesions]. / Výsledky chirurgické a konzervativní terapie tracheálních a tracheoezofageálních lézí.

The paper deals with 10 years of experience a multispecialty team has reached in the therapy of tracheal stenoses and acquired tracheoesophageal fistulas. In 38 surgical patients the authors performed 50 reconstruction operations. The best results were reached in stenoses and tumours of trachea provided the patient had not died after the operation. In the group of 13 patients with surgery for tracheoesophageal fistula there were seven who died in the postoperation period. The problem of reoperation is discussed as well as the technique of the intervention with the use of Rehn's grafts and microsurgery occlusions of the fistulas by way of a tracheostoma. Two previously published cases are briefly described, the first being a complete resection of tracheal bifurcation, the other one being a rare mucosa form of epidermolysis bullosa, localized and surgically treated in the region of cervical oesophagus.

[Cell and fluid permeability of the alveolar wall in sarcoidosis]. / Zellen und Flüssigkeitspermeabilität der Alveolarwand bei Sarkoidose.

The value of BAL in three groups of diseases (sarcoidosis, lung fibrosis, inflammatory diseases of the bronchi) compared with a control group is described. The cellular components and total protein and glycoprotein as well as electrolyts and angiotension-converting enzyme were examined. In patients with sarcoidosis a higher retention of sodium ions was stated. ACE in BAL was without any hint to the activity of the disease. But for glycoproteins a higher permeability was proved. In several fractions of the BAL fluid were differences according to all examined parameters.

Fibrocapnography in the control of the respiratory airways passage.

With the authors' method of a fibrobronchoscopic investigation using a translucent catheter in the fibrinoscope Olympus with an operational channel of 1.9 mm there were determined in 8 patients in the sitting position possibilities of estimating the degree of free passage in the respiratory tract. Patients with relapsing bronchial inflammations were examined before and after the aspiration of bronchial secretions that was restricting the passage in the respiratory tract prior to the investigation. The measurement was done with apparatus URAS of the firm Jäger using recorder Hellige . Investigation after the aspiration of the bronchial secretions was supplemented by the inhalation of a highly concentrated O2 in two inspirations. In a well ventilated region there took place even regionally changes in the amplitude of the shape and slope of the end of the expiration curve of the capnographic record. The investigation is non-invasive and technically not very demanding. According to the results obtained in our conditions of investigation a further verification of the validity of the results attained can be recommended; also a modification of the capnographic devices in anaesthesiological apparatus is recommended for possible measurements to be done regionally at the level of the primary bronchi.

Regional response of lymphatic tissue in bronchogenic cancer.

The limiting factors in the treatment of bronchogenic cancer consist, from the bronchological point of view, in the possibility to estimate the advanced macromorphological stage of the disease with the determination of the degree of the affection of regional intrathoracic nodes. By the perbronchial route it is possible to obtain also a sufficient amount of material from unaffected nodes for purposes of testing their function. The testing of the spontaneous E-rosette formation is shortened, with the use of this method, by three quarters of an hour, but the possibility of obtaining a sufficient quantity of lymphocytes by the perbronchial puncture with the use of a fine needle is on average smaller than 50% in all types of bronchogenic cancer. It will be probably possible to introduce gradually also other immunological and biochemical methods of testing the function of the regional lymphatic tissue, as confirmed by the authors' experiences with immunological and biochemical investigations of bronchial washings with the use of 4 ml of the saline washing liquid. Experiences are thus far only preliminary and not unequivocal. Different alkaline under study, with better treatment results in patients treated with Cis-Platine, indicate phosphatase levels in patients with Penberol and Cis-Platine monotherapy in the series under study, with better treatment results in patients treated with Cis-Platine, indicate the possibility of using a further limiting aspect of cytostatic therapy.

The influence of endobronchial fluid on the ventilation.

We evaluated the influence of 2 0ml contrast substance Dionosil aq. on the ventilatory function of lung 21 patients who suffered from relapsing bronchial inflammations. The spirographic examination before the local anaesthesia was accomplished with Vitalograph apparatus, the same examination after local anaesthesia of 3 ml 3% cocaine and 60 mg lidocaine and after the bronchoscopy and bronchography and simultaneously was made the bronchocinematographic recording. We verified that the presence of 20 ml contrast substance decreased significantly the values of VC, FVC, FEV1,0 and FEF25--75 and a little even the values of FEV%. The local anaesthesia of the bronchial three did not influence the ventilation values. The bronchocinematography indicated even in contour bronchographs of great bronchi that the intial lumina of peripheral bronchial branches were dispersely fullfilled with contrast media. Because of small flow speed in his section the contrast substance has stopped and it did not move neither at forced breathing nor at coughing. The ventilation secured probably only minor nonfilled branches. Our discoveries contribute to the clearance of failure causes of inhalatory medical treatment with patients having a mild higher viscosity of bronchial secretions.

Uridine diphosphate xylosyltransferase activity in cartilage from manganese-deficient chicks.

The glycosaminoglycan content of cartilage is decreased in manganese deficiency in the chick (perosis). The activity of xylosyltransferase, the first enzyme in the biosynthetic pathway of sulphated glycosaminoglycans, was studied in the epiphysial cartilage of 4-week-old chicks which had been maintained since hatching on a manganese-deficient diet. Enzymic activity was measured by the incorporation of [14C]xylose from UDP-[14C]xylose into trichloroacetic acid precipitates. Optimal conditions for the xylosyltransferase assay were established and shown to be the same for both control and manganese-deficient cartilage. Assay of the enzyme by using an exogenous xylose acceptor showed no difference in xylosyltransferase activity between control and manganese-deficient tissue. Further, the extent of xylose incorporation was greater in manganese-deficient than in control cartilage preparations, suggesting an increase in xylose-acceptor sites on the endogenous acceptor protein in the deficient cartilage. 35S turnover in the manganese-deficient cartilage was also increased. The data suggest that the decreased glycosaminoglycan content in manganese-deficient cartilage is due to decreased xylosylation of the acceptor protein plus increased degradation of glycosaminoglycan.