[Spontaneous pneumothorax in chronic obstructive lung disease]. / Der Spontanpneumothorax bei chronisch obstruktiver Lungenkrankheit.

In the present study the aims were to analyse the difference in various treatment, complications and recurrence rates between patients with spontaneous pneumothorax and those associated with chronic obstructive lung disease (COLD). We made a retrospective analysis with regard to the therapy of all patients with spontaneous pneumothorax who were treated in the district lung hospital Lostau from 1. Jan 1986 to 31. Dec 1988 (171 patients, men: 136, women: 35). 45 patients suffered from a COLD (men: 42, women: 3). 3 methods of the treatment were set in: 1. conservative management by expectant observation, 2. the aspiration once or repeatedly with the pneumothorax apparatus and 3. the rubber-tube drainage. We consider the aspiration of spontaneous pneumothorax with pneumothorax apparatus as an effective method, which is not very burdensome for the patients. It is our opinion that the practice in patients with a COLD is more active than this in other patients, in form of the rubber-tube drainage.

[Reexpansion edema of the lung as a complication of the treatment of a spontaneous pneumothorax]. / Das Reexpansions-Odem der Lunge als Komplikation der Therapie eines Spontanpneumothorax.

It is reported on a 51-year-old patient in whom a reexpansion edema of the lung occurred after treatment of a pneumothorax. As a cause of the development of this complication, a high negative intrathoracic pressure is of high importance. Further pathogenetic factors are discussed.

Asbestos-induced pleural diseases--thoracoscopic aspects.

The endoscopic morphology of asbestos-induced pleural disease is demonstrated by typical thoracoscopic findings. Among 627 thoracoscopies, lesions induced by exposure to asbestos were found in 9.9% (50 malignant mesotheliomas of the pleura, 10 pleural hyalinoses, 2 asbestos pleurisies). This comparatively high percentage is indicative of the pathogenic relevance of asbestos in the pleuropulmonary region. In addition to describing the diffuse malignant mesotheliomas of the pleura, reference is made in the discussion to the possible occurrence of benign localized fibromatous mesotheliomas that are not clearly related to asbestos exposure.

[Pulmonary and pleural metastases in malignant melanoma]. / Pulmonale und pleurale Metastasen beim malignen Melanom.

Clinical reports on first metastases of a malignant melanoma in lung or pleura or of such metastases which are observed before detection of the primary tumor are relatively rare. That is especially typical for metastases of intraocular melanomas. In the time from 1970 till 1984 we have observed in our hospital five cases of pulmonary or pleural metastases of malignant melanomas. We demonstrate a summary of these including two case reports. Differential diagnostic aspects and conclusions from the pulmological view for the follow-up of patients with melanomas are also given.

[Diagnosis of tuberculous pleurisy with special reference to thoracoscopic biopsy findings]. / Zur Diagnostik der tuberkulösen Pleuritis unter besonderer Berücksichtigung thorakoskopisch-bioptischer Befunde.

132 tuberculous pleurisies were diagnosed between 578 thoracoscopies from 1970 to June 1985. A histological confirmation of diagnosis was achieved in 51.5% of the specific pleurisies, whereas in 15.2% typical endoscopic findings were present. 33.3% of the diseases were diagnosed based on the clinical and roentgenological appearance or ex juvantibus after antituberculous therapy. An increase of histologically negative biopsies was noted after a pretreatment of more than 4 weeks before thoracoscopy. This fact is interpreted as caused by an increasing exudation of fibrin, which permits to perform a probe-excision only without optical control. If there were macroscopic findings suspicious for pleural tuberculosis a histological confirmation succeeded in 68.8%. In cases with the uncharacteristic picture of "fibrinous pleurisies" the diagnosis of tuberculosis was confirmed morphologically in 33.9%. These investigations support the diagnostic value of the macroscopic criteria in case of pleural tuberculosis which are reported by Sattler.

[Indications for diagnostic thoracoscopy, based on biopsy results of 400 studies]. / Indikationen der diagnostischen Thorakoskopie, abgeleitet aus den bioptischen Resultaten von 400 Untersuchungen.

It is reported on the results of 401 thoracoscopies. The main indication for thoracoscopic examination was the differential diagnosis of pleural effusions (262 cases = 65.3%). A morphological confirmation was achieved in 88.0% of all malignant and in 43.0% of tuberculous pleural and lung diseases. A histopathological diagnosis was also found in 94.3% of diffuse lung diseases. For diagnosis of non-specific pleurisy it is necessary to exclude all other etiologic factors. Lympho-plasmacellular infiltrates were found in all cases of non-specific pleurisies. Thoracoscopic biopsy is also of great importance for accurate diagnosis of rheumatic pleuro-pulmonary manifestations. All other clinical methods are uncertain for rheumatic diseases affecting the pleura and lung. In cases of spontaneous pneumothorax it is possible to get valuable additional informations by thoracoscopic investigation. Indications of thoracoscopy are represented as a result of the review of literature and of the present material. Variations of thoracoscopy are discussed.

[Hemodynamics of microcirculation during thoracoscopy under anesthesia]. / Untersuchungen zur Hämodynamik im kleinen Kreislauf unter den Bedingungen der Narkose-Thorakoskopie.

Under the conditions of the thoracoscopy under anaesthesia the behaviour of the haemodynamic measuring values is investigated in 10 patients of either sex. The time of intubation and the phase of the open thorax represent the most remarkable periods of examination which are parallel to the alterations of the arterial oxygen partial pressure and the pressure parameters of the circulations within the lesser an the systemic circulatory system. The investigation results obtained from the behaviour of the oxygen partial pressure will prove to be decisive, whether treatment with thorax opening under simultaneously carried out analytic blood-gas measurements should be recommendable.

[Sarcoidosis of the parietal pleura--a contribution to the pathogenesis of intrathoracic sarcoidosis]. / Die Sarkoidose der Pleura parietalis--ein Beitrag zur Pathogenese der intrathorakalen Sarkoidose.

Sarcoidosis is a frequent systemic disease with various appearances and unknown etiology. The diagnosis of intrathoracical sarcoidosis can be made with considerable accuracy by means of X-rays and endoscopic and bioptic methods. In the international literature there exist very great differences concerning the pleural involvement in sarcoidosis. Potential causes and hypotheses of the modality of the involvement of the parietal pleura with noncaseating epitheloid granulomas are discussed.

[Transthoracic puncture biopsy (author's transl)]. / Perthorakale Lungenpunktionsbiopsie.

917 patients with intrapulmonary lesions were studied by transthoracic needle biopsy. 460 cases in which both the puncture technique (general anaesthesia with artificial ventilation using a CARLENS' doublelumen catheter, puncture under X-ray amplifier-TV-guidance) and the control measures (fluoroscopy immediately performed after the puncture biopsy X-ray film 24 hours later) in accordance were analysed. The diagnostic yield was 72.5% in disseminated lung lesions using HAUSSER'S split needle. In localized coinlike lesions there was a positive diagnostic rate of 72.6%. The complication rate in these two groups was 63% and 54.8% respectively (p > 0.05). The authors use the transthoracic puncture biopsy in relation to the roentgenologic appearance and to the localization of the pathologic structures. They decline to perform the transthoracic puncture biopsy as a bed side method.

[Biochemical and immunological examinations in patients with lung diseases under particular consideration of bronchial carcinoma (author's transl)]. / Biochemische und immunologische Untersuchungen bei Lungenpatienten unter besonderer Berücksichtigung des Bronchialkarzinoms.

The diagnosis, judgment of stages and check of the course especially malignant lung diseases are further problematic. Tumourspecific laboratory tests don't exist absolutely, however the content of information of methods with a relatively high statement should be fully used. In serum of tumour patients was determined the enzymes LDH, Alpha-HBDH, ALD and AP; LDH and HBDH showed pathological activities most frequently with the highest share of abnormal values by small-cell carcinoma. Aldolase and AP values was preferential increased at late tumour stages. The mean concentrations of the immunoglobulins G, A and M were exclusive in the normal range, the decreased IgM-level found in 15% of tumour patients is remarkable. --Above all the common determination of LDH, AP and ALD is considered as useful.

[Thoracoscopic lung biopsy (author's transl)]. / Die thorakoskopische Lungaenbiopsie.

The authors start from the fact that till now was a declining attitude in face of the thoracoscopic lung biopsy. Under local anaesthesia any air embolism were happened with it. Moreover there was no optimal instrument for thoracoscopic lung biopsy. Beginning with pressure measurements of the intrathoracic cavity systems the authors research the conditions which can result in air embolism. They found that air embolism is excluded only by unilateral ventilation of the non-biopsied lung of the patient via a channel of Carlens' double-lumen catheter. The other channel of the cathetaer which is connected with the thoracoscopically biopsied lung must be aggreed with the atmosphere in the same way as the pleural space via the open thoracoscope tube. Further it was developed the suction punch, a special instrument for thoracoscopic lung biopsy. In this instrument the proceedings of catch and detache the tissue from the parenchyma are divided contrarily to the forcepslike devices. With this new instrument 63 patients were examined. The thoracoscopic lung biopsy was performed under general anaesthesia with side-separated ventilation through Carlens' catheter. The histologically verified diagnostic yielded was 89 per cent. There aren't serious complications.

[Present state and further development of bronchology in the GDR (author's transl)]. / Stand und Entwicklungstendenzen der Bronchologie in der DDR.

Bronchoscopy and bronchography are further important diagnostic methods in lung diseases. Their development to a high level was influenced by the construction of Friedel's bronchoscope. In the future it will be necessary to extend these methods to general hospitals under special pressuppositions.

[Spontaneous pneumothorax as an urgent internal problem]. / Der Spontanpneumothorax als dringliches internistisches Problem

92 cases of pneumothorax of the clinic for lung diseases Lostau and 35 cases from 9 county hospitals of the district Magdeburg were analysed. In the two groups a vast correspondence of the following data was found: average age of the patients (40.0 or 46.2 years), duration of stay in the ward (25.3/23.5 days), as urgent cases 11 or 8 patients, respectively, were hospitalised. Only in 5% of all cases a treatment on the conditions of an intensive therapy unit was necessary. Apart from the clinical and radiological basal diagnostics a measurement of the interpleural pressure by means of the pneumothorax apparatus is demanded. These values form the basis for a differentiated therapy of the pneumothorax: conservative attitude with sedation of cough of the patient in minimal pneumothoraces; withdrawal by means of the pneumothorax apparatus in more severe lung collapse, appearances of tension, lacking tendency to re-expansion of the lung after 3 days' conservative-medicamentous therapy; rubber-tube drainage when the withdrawal by means of the pneumothorax apparatus was ineffective for three times; surgical therapy when a 7 to 10 days' rubber-tube drainage was without success.