[Palliative intrabronchial laser treatment of malignant bronchial stenosis using the fiberbronchoscope]. / Palliative intrabronchiale Laser-Behandlung maligner Bronchusstenosen mit dem Fiberbronchoskop.

During a period of 15 months we performed a laser therapy of bronchi stenosis due to malignant tumors in 28 patients. We used a Neodym-YAG-Laser (MBB-AT, Munich), guided through a fiberbronchoscope (Olympus BF-1 TR). 59% of total-stenoses and 83% of the partly occluded bronchi could be opened sufficiently. During a follow-up period of 12 months (mean 4.7 m) 83% of the bronchi remained open. According to our experience, fractional tissue removal is the method of choice rather than all-at-once coagulation since tissue edema may cause bronchial occlusion 1 to 3 days after treatment. We think, if surgical treatment is ruled out, intrabronchial laser coagulation is an alternative with little impairment of the patient to prevent hypoventilation and repair functional conditions.

[Continuous transcutaneous blood gas monitoring during fiberbronchoscopy]. / Kontinuierliche transkutane Blutgasüberwachung während der Fiberbronchoskopie.

In 28 patients PO2 and PCO2 were measured continuously during diagnostic fiberbronchoscopy by means of transcutaneous electrodes (PtcO2 and Ptc CO2 System TCM Radiometer Copenhagen). A mean decrease in PtcO2 of 31% (s +/- 16.5%) was found. This effect can be prohibited by using oxygen insufflation at a rate of 0.5 liters per minute by nasal tube. The positive effect of fiberbronchoscopic lavage in cases of severe dyscrinism is documented. A mean increase in PtcO2 of 42% was found after the procedure, but there is a time lag of 20-30 minutes until the maximal increase is reached. In patients with known but not acute bronchial asthma the irritation of the bronchial system by fiberbronchoscopy induces a histamine release. There is no relation between the release of histamine and the decrease in arterial oxygen tension.

Early tumor and leukemia response to alkyllysophospholipids in a phase I study.

In a phase I study on the toxicity and toleration of alkyllysophospholipids, tumor and leukemia responses have been noted in the first treated patients. Six patients with solid malignomas of different histologic types and one patient with acute myeloid leukemia are evaluable so far. All of them suffered from metastatic or wide-spread disease, were refractory to adequate polychemotherapy or other treatment modalities, or have been found untreatable because of poor general condition. Four cases revealed objective tumor and leukemia response with a minor response in a hypernephroma, two partial remissions in nonsmall cell bronchogenic carcinomas and reduction of leukemic blasts to less than 10% in acute myeloid leukemia. Limiting toxicity started with doses of 20 mg/kg given daily showing transient injury of renal and liver functions.

[The mucoid impaction and the "mucous bronchogram" (author's transl)]. / Die mucoid impaction und das "Schleimbronchogramm".

Intrabronchial retention of large plugs of inspissated mucous in cases of disturbed bronchial secretion and impaired clearing mechanism leads often to chronic inflammation and to formation of "proximal" bronchiectasis. Mucoid impaction may occur in many bronchial diseases and is radiologically characterized by the so-called "mucous bronchogram".

[Unilateral pulmonary artery aplasia with special reference to lung scintigraphy (author's transl)]. / Die einseitige Lungenarterienaplasie unter besonderer Berücksichtigung der nuklearmedizinischen Lungendiagnostik.

In a case of unilateral aplasia of one Arteria pulmonalis, i.e. proximal interruption, the diagnostic value of perfusion and ventilation scintigraphy is shown to be simple and non-invasive, exposing the patient to a lower radiation dose than other diagnostic screening methods. When an interruption of a main pulmonary artery is radiologically suspected the scintigraphic examination allows to distinguish between vascular and/or parenchymatous pulmonary diseases, thus clarifying the diagnosis of primary pulmonary malperfusion. The results of other examinations, the relevant literature, the pathogenesis and pathophysiology of unilateral pulmonary artery aplasia as well as therapeutical and prognostic aspects are reviewed.

Effect of isosorbide dinitrate on hemodynamics and respiration of patients with coronary artery disease and of patients with chronic cor pulmonale.

The influence of isosorbide dinitrate on hemodynamics and gas exchange was studied in 10 patients with coronary artery disease and 10 patients with chronic cor pulmonale. A significant decrease in total pulmonary vascular resistance was found in both groups. This effect seemed mainly to be due to improved conditions for the left ventricle in the patients with coronary heart disease, while it could be explained by vasodilatation of the precapillary pulmonary resistive vessels in the patients with cor pulmonale. In the latter group, there was also a significant increase in the alveolo-arterial PO-2 gradient.