[Bronchoscopic resection of an endobronchial hamartochondroma]. / Bronchologische Therapie eines endobronchialen Hamartochondroms.

The endobronchial hamartochondroma is a very rare, slowly growing benign tumor. We report a case of hamartochondroma conglomerate located in the left main bronchus. The resection via rigid endoscopy with ND-YAG laser and forceps was successful, and no complications occured. The rigid endoscopy with laser-application in such case is a safe and effective procedure in endobronchial hamartochondroma.

[Right heart failure due to pulmonary tumor microembolism -- a rare differential diagnosis]. / Fulminantes Rechtsherzversagen bei pulmonaler mikroskopischer Tumorzellembolie -- eine seltene Differenzialdiagnose.

A 69-year-old man presented with progressive dyspnea, hemoptysis and fatigue for the previous 4 weeks. Chest radiograph and CT-scan were suggestive of lung cancer. The patient's condition worsened and within in few days he developed respiratory failure and acute cor pulmonale. Despite intensive care measures directed at suspected lung thromboembolism, the patient died on day 12. Autopsy revealed disseminated obstruction of small pulmonary arteries by microscopic tumor emboli. No signs of venous thromboembolism were found. Pulmonary tumor microembolism should be considered whenever a patient with malignancy presents with unexplained progressive dyspnea or pulmonary hypertension.

Short term effect of methotrexate in severe steroid-dependent asthma.

The steroid-sparing capacity of methotrexate in asthmatics is still being debated. The present study was undertaken to evaluate the effect of low-dose methotrexate on steroid consumption in patients with severe asthma, who require very high doses of systemic corticosteroids. We conducted a randomized, double-blind, parallel clinical trial in 24 patients with long-standing asthma. After a 3-week run-in period, patients received a 16-week course of either 15 mg of oral methotrexate weekly or matched placebo in addition to their previous asthma therapy. The daily steroid dose (at run-in 30 +/- 14 mg/day in the methotrexate group; 25 +/- 9 mg/day in the placebo group (NS)) decreased by 24% in the methotrexate group (p < 0.01) and by 5% in the placebo group (NS) during weeks 9-16 of the treatment period when compared with run-in values. However, there was no difference in steroid consumption between the two groups at any time. We conclude that in patients with severe asthma who require very high doses of systemic corticosteroids, short-term treatment with methotrexate allows only a marginal steroid reduction. Our study does not support the use of methotrexate as a steroid-sparing agent in asthmatics.

[The importance of thoracic CT in the diagnosis of pulmonary sarcoidosis]. / Zur Bedeutung der Thorax-CT für die Diagnose der Lungensarkoidose.

The CT findings in the lungs of 52 patients with histologically confirmed sarcoidosis are described. In addition to a nodular pattern, reticulo-nodular, reticular, diffuse infiltrative and streaky shadowing due to fibrosis could be recognised. Pleural lesions, bronchial ectasis and mediastinal and hilar lymph node changes could be diagnosed. The high sensitivity of CT contrasted with its relatively low specificity. At present CT is useful for analysing the pulmonary pattern when planning lung biopsy or lavage. In some cases, the diagnosis of pulmonary sarcoidosis can be made by CT, but the exact criteria for diagnosis and differential diagnosis must be borne in mind.

[Patients with sarcoidosis frequently have bronchial hyperreactivity]. / Patienten mit Sarkoidose haben gehäuft eine bronchiale Hyperreaktivität.

Histamine provocation challenges were performed in 60 patients with pulmonary sarcoidosis. Bronchial hyperreactivity was present in 14 (23%) of them, have an increased prevalence of 8 (13%) patients with hyperreactive airways had an additional history of bronchial asthma. Our findings thus suggest an increased prevalence of bronchial hyperreactivity in patients with sarcoidosis, which may be due to bronchial asthma in some of them.

Microphotometric determination of hematocrit in small vessels.

Evaluation and calibration of a microphotometric method for hematocrit determination in microvessels of transilluminated tissues is described. This method is based on the relation of the optical density (OD) of a microvessel to its hematocrit (Hct). The following requirements of the microphotometric system appear essential: narrow-band monochromatic light source with efficient false light suppression, high numerical aperture of the objective and low numerical aperture of the condensor. We used a video system to measure the intensities of incident (Io) and transmitted (I) light. For converting of Io and I into OD values, correcting procedures were evaluated to eliminate the influence of glare, shading, and fading. The calibration procedure was performed with glass tubes of inner diameter (ID) between 13 and 68 microns perfused with red cell suspensions. A function was fitted to the data, correlating OD to ID and Hct. The standard deviation of the original data from this function is +/- 0.02 units of fractional hematocrit. The presented method allows the continuous determination of the hematocrit in a microvessel as well as the off-line evaluation of the hematocrit distribution within a microvessel network.

Analysis of the hematocrit distribution in the mesenteric microcirculation.

The hematocrit in the microcirculation of the rat's mesentery was determined either by using measurements of optical density (in 56 arterioles and 52 venules) or by counting the number of red cells per unit vessel length (in 63 capillaries) from photographs. The systemic hematocrit (Hsys) averaged 0.42 +/- 0.025. The mean microvessel hematocrit (Hmicro) decreased and its standard deviation increased with decreasing vessel diameter; in capillaries, Hmicro/Hsys ranged between almost zero and 0.86 with an average of 0.36 +/- 0.23. In order to correct Hmicro for the Fahraeus effect, additional experiments were carried out in vitro, in which the tube hematocrit was obtained by centrifugation of glass tubes (I.D. 13-95 micron) perfused with rat's blood of different feed hematocrit. Even after correction for the Fahraeus effect the in vivo data seem to suggest a 'loss of red cells' in the microcirculation. To reconcile the observed hematocrit distribution with the law of mass conservation, model calculations were performed, in which the presence of shunt vessels was assumed on the one hand, and a proportionality between single vessel hematocrit and flow rate on the other. The experimental data are best described by a model which combines the flow dependence of hematocrit and a small shunt component. The positive correlation between single vessel flow rate and Hmicro which is contained in this model also explains an increase of average capillary hematocrit resulting from a more homogeneous flow distribution associated with vasodilatation.

[Mucin accumulation in the dermis and REM syndrome]. / Muzinablagerungen in der Dermis and REM-Syndrom.

Mucus, glucosaminoglycans, and proteoglycans, are produced by fibroblasts. Qualitative and quantitative differences in the dermal mucus are to be seen in mucinoses, partly due to factors in the blood serum. A survey of patients with REM-syndrome--our own patients and those described in other studies--is given, together with cases of the plaque-like form of cutaneous mucinosis. Both conditions are closely related but, in our opinion, not identical. Our findings suggest that the mucous compounds are eliminated from the tissue by the blood vessels and the lymphatics. As a result an increase of mucin may be found in the blood serum.