[Pleural mesothelioma. I: History, epidemiology, clinical aspects (symptoms, diagnosis)]. / Pleuramesotheliom. Teil I: Geschichte, Epidemiologie, Klinik (Erscheinungsbild, Diagnostik).

EPIDEMIOLOGY: Although production and processing of asbestos have been prohibited for years, the incidence of mesothelioma of the pleura will rise in Western Europe. The incidence of mesothelioma will peak between the years 2010 and 2020. It will cause an estimated 250,000 deaths within the next 35 years. PATHOGENESIS: The fact that exposure to asbestos fibers may result in mesothelioma was first described in 1960. The risk of developing mesothelioma depends mainly on the type of asbestos fibers and the way asbestos is manufactured. Environmental eronite fibers in Central Turkey are the cause of endemic mesothelioma. The pathogenetic role of infection with simian virus 40 is still not determined. Thoracic radiation is of minor importance in the etiology of pleural mesothelioma. DIAGNOSIS: Between first symptoms of disease and diagnosis of mesothelioma often more than 6 months pass as clinical symptoms are rarely typical. Detection of early stages by invasive procedures and imaging is often very difficult. Histopathological distinction between adenocarcinoma and mesothelioma requires experienced pathologists. This implies that management of mesothelioma should only be performed in multidisciplinary cooperation in specialized centers.

[Blood gas analysis in bronchiolo-alveolar carcinoma]. / Blutgasanalyse bei bronchiolo-alveolärem Karzinom.

A 44-year old patient is presented with bronchiolo-alveolar carcinoma which had set multiple metastases into the lung. Basic lung function was normal. It is of interest that only blood gases were borderline. There was a huge discrepancy between the extension of the pulmonary tumour and the impairment of lung function. Hence, blood gas analysis at rest and under exercise is a necessary tool in such cases.

[Effect of acupuncture on quality of life, mouth occlusion pressures and lung function in COPD]. / Einfluss der Akupunktur auf Lebensqualität, inspiratorische Mundverschlussdrücke und Standard-lungenfunktion bei chronisch obstruktiven Atemwegserkrankungen (COPD).

BACKGROUND: There are few data concerning the effect of acupuncture in patients suffering from COPD. We conducted a prospective randomized and placebo-controlled pilot study to analyze the effect of acupuncture according to the rules of traditional chinese medicine on quality of life, pulmonary function testing and inspiratory mouth occlusion pressures (MOP). PATIENTS AND METHODS: We randomised 10 patients with stable COPD to a 2-week treatment of 7 verum acupuncture or placebo acupuncture sessions. Before and after treatment we performed pulmonary function tests as well as an interview with the chronic respiratory disease questionnaire. MOP were taken on day 1, 5 and 7 before and after punction to assess function of the respiratory pump. RESULTS: Patients receiving verum acupuncture improved significantly with FEV1 and RV/TLC. There was an improvement of large magnitude in quality of life and a trend of lower demand of the respiratory pump. In the placebo group we saw only a slight improvement of quality of life, a deterioration of lung function parameters and a trend of higher demand of the respiratory pump. CONCLUSION: Although the small number of subjects allows no further conclusions this pilot study proves feasibility of acupuncture in COPD and shows that acupuncture is worthy for further investigation in patients suffering from COPD.

[Stress test blood gas analysis in chronic obstructive lung diseases]. / Die Belastungs-Blutgasanalyse bei chronisch obstruktiven Lungenerkrankungen.

This study was conducted to investigate the clinical value of blood gas analysis during exercise in patients with COPD and healthy controls using the new criteria of the Deutsche Gesellschaft für Pneumologie (DGP) for performance and interpretation of blood gas analysis during exercise. A total of 64 patients with COPD (age: 63.7 +/- 10.1 years) and 35 healthy controls (age: 35.0 +/- 14.3 years) exercised on a bicycle ergometer to their submaximal capacity under steady state conditions (patients: 44.4 +/- 24.6 watt vs. 102.4 +/- 32.1 watt; p < 0.01). A pathological response for PaO2 occurred in 3 of 35 controls (8.6%) and 14 of 64 patients (21.9%; p < 0.01). A decrease in PaO2 yielded a sensitivity of 28% and a specificity of 92% in respect of patients with emphysema. Significant associations of lung function parameters at rest and blood gases under exercise were found by linear regression analysis (airway resistance (Rt): beta = -0.48; p < 0.001) and PaCO2 (FEV1: beta = -0.27; p < 0.05). This study demonstrates that in patients with COPD parameters of lung function and blood gas analysis at rest are already good predictors of gas exchange under exercise conditions. In individual cases, however, prediction may not be possible. This underlines the importance of the exercise test to investigate gas exchange under diagnostic (i.e. dyspnoea, medical opinion) and therapeutic aspects (i.e. therapy control). For COPD patients, the rule of the DGP yielded a poor sensitivity, but an excellent specificity in the diagnosis of emphysema, which yields confirmation of the diagnosis only in conjunction with, and complementary to, other methods.

[Reproducibility of inspiratory mouth occlusion pressure with a mobile computer-assisted measuring system]. / Reproduzierbarkeit inspiratorischer Mundverschlussdrücke mit einem mobilen computergestützten Messsystem.

BACKGROUND: The measurement of mouth occlusion pressure is an easy method to assess respiratory drive and muscle function. In addition to a variety of stationary systems, recently a mobile computer assisted system became available. In this study the repeatability of inspiratory mouth occlusion pressures with such a mobile system was examined. METHOD: Maximal inspiratory mouth occlusion pressure (PImax), mouth occlusion pressure 100 ms after onset of normal inspiration (P0,1), and PImax after 100 ms (P0,1max) were investigated 4 times in 12 healthy subjects. Measurements were performed with a mobile system (resPImax). Criteria of repeatability were analysis of variance, intraindividual standard deviation, variation coefficient and intraclass correlation coefficient. RESULTS: Of all analyzed parameters PImax was most reproducible with a 5.3% share of variance due to measurement methods of the total variance. P0,1 was least reproducible. There was no statistically significant difference between the results of each day. The variance due to measurement methods varied between 5.3% and 30%. CONCLUSION: The repeatability of mouth occlusion pressures with this mobile device was good and partly superior to stationary systems. The concept of a mobile measuring unit simplifies getting results of bed-bound and mechanically ventilated patients.

[Reproducibility of computer-assisted mouth occlusion pressure measurements]. / Reproduzierbarkeit computergestützter Mundverschlussdruckmessungen.

BACKGROUND: The measurement of mouth occlusion pressure is an easy method to assess respiratory drive and muscle function. Lately there is a variety of computer assisted programmes, but their precision is discussed controversially. In this study we analysed the repeatability of measurements of mouth occlusion pressures performed by a computer assisted measurement unit. PATIENTS AND METHODS: We examined maximal inspiratory mouth occlusion pressure (PI(max)), mouth occlusion pressure 100 ms after onset of inspiration (PO.1) and PI(max) after 100 ms (PO.1(max)) of 32 patients with COPD. Subjects were divided into group A (normal blood gas pressures) and group B (hypercapnia due to alveolar hypoventilation). Controls (K) consisted of 22 healthy men. Criteria for repeatability were analysis of variance, intraindividual standard deviation of the mean and the variation coefficient of 5 consecutive measurements. RESULTS: Controls produced the highest values for PI(max) and the lowest ones for PO, 1. Intraindividual standard deviation was small as well as the variation coefficient; we found no statistically significant differences. Compared with controls in group A PI(max) values were markedly reduced with elevated PO.1 values. Intraindividual standard deviation and variation coefficient were low, differences not significant. We observed similar results for group B, variance analysis showed no significant differences, deviation around the mean was small. CONCLUSION: Our data suggest a high repeatability of measurements of mouth occlusion pressures. Especially patients with severe COPD and alveolar hyperventilation are able to produce valid and reliable test results.