Treatment of acute bacterial exacerbations of chronic obstructive pulmonary disease in hospitalised patients--a comparison of meropenem and imipenem/cilastatin. COPD Study Group.

Meropenem and imipenem/cilastatin were compared in an open, randomised prospective multicentre study in the treatment of acute exacerbations of severe chronic obstructive pulmonary disease in hospitalised patients. One-hundred-and-seventy-three patients were enrolled; 164 were evaluable for clinical efficacy and 98 for bacteriological efficacy, with 144 pathogens isolated. The predominant pathogens were Haemophilus influenzae (n = 30), Streptococcus pneumoniae (18), Staphylococcus aureus (12), Pseudomonas aeruginosa (11), Moraxella catarrhalis (8), other Gram-negative bacteria (Neisseria, Klebsiella, Proteus, and Enterobacter spp.) (53) and other Gram-positive bacteria (12). A single bacterial pathogen was identified in 61 patients, whereas two bacterial pathogens were isolated in 31 patients and three in six patients. The clinical response at the end of treatment was very high in both groups with a satisfactory outcome (cured or improved) in 97.6% of the meropenem patients and in 96.3% of the imipenem/cilastatin patients; at follow-up the rates were 89.1% and 89.8%, respectively. The bacterial success (eradication or presumed eradication) was 88.2% in the meropenem group and 89.4% in the comparator group. Nausea or vomiting were reported more frequently in patients treated with imipenem/cilastatin, whereas in the meropenem group an increase in aminotransferases was reported. One patient treated with imipenem/cilastatin was withdrawn from the study due to seizures. Meropenem and imipenem/cilastatin were highly effective for the treatment of severe bacterial exacerbations of chronic bronchitis but meropenem was better tolerated.

[Determination of individual lipid parameters in non-chylous pleural effusions]. / Bestimmungen einzelner Lipidparameter in nichtchylösen Pleuraergüssen.

Levels of total cholesterol, triglycerides, HDL-cholesterol and LDL-cholesterol were measured in the pleural effusions and the corresponding serum from 52 patients suffering from non-chylous pleural effusions with different genesis. Significantly higher concentrations of lipids were found in exudates in comparison to transudates. The highest levels of total cholesterol and triglycerides were found in effusions with malignant and pneumonia genesis. It was additionally observed that higher than average values were found for HDL-cholesterol in patients with malignant diseases and for LDL-cholesterol in patients with pneumonia. Transudate effusions from patients with heart insufficiency and nephrotic syndrome had significantly lower levels of cholesterol and triglycerides. We were unable to establish a relationship between levels in pleural fluid and serum.

[Cell distribution and macrophage function in bronchoalveolar lavage of patients with sarcoidosis and lung tumors]. / Untersuchungen zur Zellverteilung und Makrophagenfunktion in der Bronchoalveolären Lavage (BAL) von Patienten mit Sarkoidose und Lungentumoren.

BAL was performed to differentiate cases of sarcoidosis and bronchial carcinoma. Significant differences in the cell differentiation are stated. An increase of spontaneous interleukin production seems to be another sign of activity of sarcoidosis.

[Value of modern study methods in the early diagnosis and assessment of asbestosis]. / Zum Wert moderner Untersuchungsmethoden für Frühdiagnostik und Begutachtung der Asbestose.

Results of examinations among 31 asbestos-workers with pleural hyalinosis are presented. The hyalinosis was ascertained by means of pleuroscopy and computed tomography. The value of both methods and special function tests in asbestosis is discussed. Diagnostic and expertising of early signs in asbestosis should not rely on x-ray of thorax but include selected and suitable function tests.

[Anesthesiologic problems in endoscopic interventions of the respiratory organs]. / Anästhesiologische Probleme bei endoskopischen Eingriffen an den Atmungsorganen.

In 28 patients--16 normotensive and 12 hypertensive patients--anaesthetized with hexobarbitone, halothane, nitrous oxide/oxygen and intermittent doses of suxamethonium we examined the influence of diagnostic bronchoscopy on arterial blood pressure, heart frequency, rate pressure product as well as acid-base balance and arterial oxygen partial pressure. Both groups of patients showed a remarkable and highly significant increase in these hemodynamic parameters during intubation, extubation and bronchial lavage. Clinically relevant changes of acid-base balance and arterial oxygen partial pressure which could be responsible for these hemodynamic reactions did not occur. Sympathicotonic reflexes caused by the bronchoscopy are considered to be the main causes for the increase in blood pressure, heart frequency and rate pressure product. They can only be prevented by a sufficient narcosis depth.

[Rational diagnosis in pneumonology]. / Rationale Diagnostik in der Pneumonologie.

A survey is given of the rational use of diagnostic measures in pneumonology. Of the investigations following the anamnesis and the clinical findings (radiology, bacteriology, clinical chemistry, clinical immunology, electrocardiography, functional diagnostics, computed tomography) the radiological ones are most significant. Endoscopy is used in certain questions, in case that a diagnostic clarification could not be performed with the help of the simpler investigations. Rational diagnostics are always case-related, generalizations are only conditionally possible.

[Results, complications and controlled after-care in thoracoscopic pleural and lung biopsy]. / Ergebnisse, Komplikationen und kontrollierte Nachsorge bei thorakoskopischer Pleura- und Lungenbiopsie.

Report on 546 transthoracic forceps biopsies from pleura and lung, selected under thoracoscopic observation. After inducing a diagnostic pneumothorax the biopsy is performed in general anaesthesia with a forceps introduced beside the thoracoscope. In 60%, the endoscopic-bioptic examination resulted in a definitive diagnosis. In the remaining cases too, the results of biopsy were usefull for further diagnostic and clinical conclusions. The number of complications is small. Main risks are bleeding, tension pneumothorax, and cutaneous emphysema. In diseases of pleura and in cases of disseminated small-size lung processes, the method permits in a high proportion a corroborated diagnosis.

[Indications for the use of a wound adhesive in pneumothorax treatment]. / Zur Indikation der Anwendung von Wundklebstoff in der Pneumothoraxbehandlung.

With the aim to improve the results of treatment of pneumothorax, experience has been gathered using tissue glues (Akutol-Spofa, Ankerplast-Spray). Using these preparations, it is possible to tighten small defects and porous regions of the pleura, and to induce circumscribed obliterations of the pleural fissure. The technique is simple (intubation, thoracoscopy, circumscribed application of glue to visceral pleura, insufflation of the lung, drainage of the thorax, permanent suction if necessary). The method is used only, if spontaneous resolution of pneumothorax is failing. Using this method, the relapse rate is significantly reduced as compared with the results of pure drainage with suction. Late results of pulmonary function are good.

[Carcinoid of the distal trachea]. / Karzinoid der distalen Trachea.

We have reported on a 43 years old woman patient, who had fallen ill with an extremely seldom carcinoid tumor arising in the trachea histologically confirmed. Our observations of this woman-patient had been compared with those of 14 patients known from the Anglo-American literature upto 1978. In regard to one French and one Russian collective statistics altogether we come to 24 cases of trachea carcinoids documented in the literature. These are the main symptoms: dyspnea, wheezing, hemoptysis and stridor. Radiation tried at the inoperable patient has proved as ineffective. Today operation seems to be the chosen therapy.

[Experiences with the transthoracal pleura and lung biopsy under thoracoscopic control (author's transl)]. / Erfahrungen mit der transthorakalen Pleura- und Lungenbiopsie unter thorakoskopischer Kontrolle.

We used the so-called sharp nose forceps for the transthoracal pleura and lung biopsy under thoraco scopeic control. This utensil was introduced by a second puncture besides the thoracoscop. The results are demonstrated in statistics about the achievements of 200 pleuroscopic-bioptical forceps-biopsies. There weren't any serious complications.

[Pleural asbestosis in dock workers]. / Pleuraasbestose bei Werftangehörigen.

During the last three years 29 patients with asbestosis of the pleura were examined. 21 of them were exposed to dust on wharfs as joiners, locksmiths, transport workers, isolators and in other trades. The beginning of the exposition was at least 15 years age, the duration of the exposition was 5 to 25 years. Two bronchial carcinomas and one mesothelioma of the pleura among our patients emphasize the increased risk for malignoma of the patients with asbestosis. For this reasons an early recognition and a regular medical control of the patients as well as a reducthe long time of latency between the beginning of the exposition and the appearance of morphologic changes it is recommended to employ older colleagues in the working places with dust exposition.

[Benign and semimalignant intrabronchial lung tumors]. / Benigne und semimaligne intrabronchiale Lungentumoren.

From 1961 to 1977 we observed 14 patients with semimalignant and benign intrabronchial tumours. In our own patients only a proportion of 0.8% of all bronchial tumours was of non-malignant or semimalignant origin. It is referred to the symptomatology, diagnostics and therapy of these tumours (7 carcinoids, 1 malignant degenerated carcinoid, 1 metastasizing cylindrome, 2 adenomas, 1 intrabronchial chondroma, 2 neurofibromas). The authors especially deal with the possibility of an endobronchial removal of tumours.

[Contribution to the differential diagnosis of lung infarct, pulmonary tuberculosis and lung neoplasms]. / Beitrag zur Differentialdiagnose zwischen Lungeninfarkt, Lungentuberkulose und Lungenkrebs.

It is reported on the rare case of a symptom-free, atypically localised haemorrhagic pulmonary infarction without provable cause in a 52-year-old male. The patient became conspicuous on account of a plum-sized focal shadow in the right lateral upper field detected during a mass examination. The state was regarded as bronchial. carcinoma. Operation and following histological investigation of the resection preparation finally resulted in the diagnosis.

[Clinical studies on the paraneoplastic syndrome in intrathoracic neoplastic diseases]. / Klinische Beobachtungen zum paraneoplastischen Syndrom bei intrathorakalen Tumorerkrankungen.

Two own clinical observations concerning the paraneoplastic syndrome are reported: Gynecomastia and hypertrophic osteoarthropathy. The two symptoms appeared as primary manifestation of a bronchial carcinoma and an intrathoracically situated teratoma. The gynecomastia in an estrogen-producing teratoma of this localisation hitherto has not been described; its classification as paraneoplastic syndrome is established. The value of such individual observations may be that the knowledge of these syndromes should be deepened and thus should be indirectly contribute to the diagnostics of tumours, or even to the early recognition of the tumour.

[Intra-and postoperative complications in pulmonary surgery (author's transl)]. / Intra- und postoperative Komplikationen durch Eingriffe an den Lungen.

The age of the patients, the causative diseases, and the extent of the surgical operation are decisive for the development of intraoperative and postoperative complications in pulmonary surgery. Restrictive and obstructive pulmonary changes of the older-age group involve the danger of postoperative complications. By our experience the critical age for pulmonary surgery is about 50 years.

[Rare thoracic injuries (biomechanics, diagnosis and therapy) (author's transl)]. / Seltene Thoraxverletzungen (Biomechanik, Diagnose und Therapie).

Thoracic injuries caused by direct or indirect power action involve various injury effects. The extent of injury depends on the force and the direction of the acting power, on the biomechanical properties of the partial structures of the thorax, and on genetically determined variations of form and structure. These correlations are demonstrated by special examples of rare thoracic injuries. The motto for the diagnostic and the choice of the therapeutical procedure is: "Inter vulnerationem thoracis diagnosis incipiat".