[Pathology of cor pulmonale. Idea and reality (author's transl)]. / Pathologie des Cor pulmonale. Vorstellung und Wirklichkeit.

The diagnosis of chronic cor pulmonale is made by the pathologist, but not by the clinician. Chest x-ray, ECG and lung function tests are not conclusive for the diagnosis. Considering the different pathogenetic possibilities it is evident that more than one factor is involved in the development of cor pulmonale. Explanations for the different reactions in similar anatomical and functional situations may be the influence of genetic factors, a different sensitivity to alveolar hypoxia, a difference in developing of muscular hypertrophy and a difference in the development of bronchopulmonary anastomoses in inflammatory or degenerative lung disease. In this regard it is suggested to omit the term chronic cor pulmonale in clinical diagnosis and to refer instead to pulmonary hypertension, or radiological or electrocardiographical signs of right ventricular hypertrophy. It seems more important, to define the status, the changes or the actual disease of the lungs.

[Pulmonary embolism in the elderly patient (author's transl)]. / Die Lungenembolie im Alter.

Pulmonary embolism has a high incidence in old patients and is often not recognized. In most cases the embolism is of unknown origin, although the deep venous system of the lower extremities is involved in almost 95%. The diagnostic procedure consists of evaluation of clinical symptoms and findings. ECG and chest X-ray are often not conclusive. Confirmation of the diagnosis is possible by ventilation-perfusion scanning of the lung. Pulmonary angiography is of no value in the elderly patient, because of the lack of consequences. Besides local therapy of a thrombosis, therapy consists of administration of heparin, while oral anticoagulation should be used only with precaution. The efficacy of platelet aggregation inhibiting substances remains to be determined. The main point are prophylactic measures in patients with risk factors or in high risk situation.

Miliary mycoplasmal pneumonia: a report of six cases.

Six cases of miliary pneumonia are reported, in which the marked increase in antibody titers showed that Mycoplasma pneumoniae was the probable cause. The clinical picture of these patients showed an acute and severe onset, with the appearance of diffuse alveolitis. The outcome of the disease depended on the time of initiation of treatment in relationship to the onset of symptoms. One case was seen to progress to fibrosing alveolitis with persistent impairment of diffusion. This observation suggests the possibility that some cases of pulmonary fibrosis of unknown aetiology may be due to previous mycoplasmal infection.