Screening of pulmonary hypertension in chronic obstructive pulmonary disease and silicosis by discriminant functions.

The aim of our prospective multicentric study was to develop a screening method for pulmonary hypertension in patients with chronic lung diseases. We investigated 710 patients in 10 hospitals: 315 males and 109 females with chronic obstructive pulmonary disease, and 286 males with silicosis. Manifest pulmonary hypertension was defined as pulmonary artery pressure greater than 20 mmHg (2.7 kPa) at rest. The multivariate statistical method used was a stepwise discriminant analysis. In males with chronic obstructive pulmonary disease, the diameter of the right descending pulmonary artery, forced expiratory volume in one second (FEV1) arterial oxygen tension (PaO2) at rest, and age turned out to be relevant for discrimination of groups with and without manifest pulmonary hypertension. For females the FEV1/FVC (forced vital capacity) ratio replaced the absolute value of FEV1 in the calculated discriminant function. In females, sensitivity and specificity were below 80%. In males, both were distinctly above 80%. In silicosis, the diameter of the right descending pulmonary artery was much less important, since it could frequently not be measured precisely. In these cases, precision of the prediction of about 80% could only be obtained by combined evaluation of spirometry, PaO2 during exercise, and body plethysmography. The calculated discriminant functions are appropriate for screening patients with risk of pulmonary hypertension. For different chronic lung diseases, and for both sexes, different combinations of parameters are relevant. The method is recommended to select patients who should undergo an invasive examination of pulmonary haemodynamics.

[Cardiopulmonary function disorders in pulmonary fibrosis of various etiology]. / Kardiopulmonale Funktionsstörungen bei Lungenfibrosen unterschiedlicher Genese.

A large number of different pulmonary diseases eventually result in producing the final morphological pattern of pulmonary fibrosis. Basing on essential cardiopulmonary functional parameters, four relatively frequently encountered fibrotic pulmonary diseases are compared with each other. Patients suffering from bird breeder's lung show typical obstructive disturbances of ventilation that are even more marked in collagenoses with lung involvement. Patients suffering from electric welder's lung are notable for enhanced respiratory tract obstructions and increased residual volumes. In patients with sarcoidosis it is recommended to determine, above all, the lung compliance besides measuring the diffusion capacity. The specific compliance should be chosen as criterion to assess the compliance, so that the preliminary extension of the lung by emphysema is taken into consideration. Welder's lungs, bird breeder's lungs and collagenoses show a load-conditioned respiratory partial insufficiency and a latent pulmonary hypertonia. The examined groups of patients showed similar functional patterns, but individual parameters were disease-specifically considerably different from standard values.

[Pearl oyster dust as the cause of exogenous allergic alveolitis]. / Perlmuttstaub als Ursache für eine exogen-allergische Alveolitis.

Many different inhalative substances may cause allergic alveolitis (hypersensitivity pneumonitis). We report on a worker who developed lung fibrosis due to the sensitization to pearl oyster shell dust. High concentrations of IgG antibodies to proteins (conchagens) of the shell which appear to represent the relevant antigens were found in the patient's serum.

[Interstitial lung diseases caused by long-term neurological-psychiatric drug therapy?]. / Lungengerüsterkrankungen durch neurologisch-psychiatrische Langzeittherapie?

UNLABELLED: The development of alveolitis or lung fibrosis through drugs is wellknown, however rare described in the spectrum of drug side effects. In six cases of patients with neurological diseases were studied the relationship between alveolitis or lung fibrosis and a long-time therapy with especially drugs in a neurological practice. CONCLUSION: By the etiological examination of alveolitis or lung fibrosis it is necessary to pay attention to the possible relationship between drug and disease.

[Monitoring respiratory and circulatory parameters in comparing various jet ventilation procedures]. / Monitoring von Atem- und Kreislaufparametern zum Vergleich verschiedener Jet-Beatmungsverfahren.

Reported is a system of apparatures to control characteristic changes of cardiorespiratory function during different methods of endoscopic ventilation. The aim of the study is to measure and record simultaneously and continuously ECG, thoracic movement, tracheal pressure, pulmonary artery pressure and arterial oxygen pressure using transcutaneous technique. Measurements of arterial blood pressure and blood gas analysis (PaO2, PaCO2, BE, HCO3-, pH) are carried out in intervals. Four different methods of injector-ventilation are compared with the conventional laryngoscopic ventilation on the basis of a test program. Laryngoscopic ventilation as well as injectorventilation by CARDEN-Tubus make it possible to achieve a hyperoxaemic situation by normofrequent ventilation. Despite of hyperventilation it is not possible in every case to achieve an increased capillary oxygen pressure of 200 to 300 mm Hg by injector-ventilation with Venturi effect because of a smaller oxygen proportion. In jet-ventilation with N2O/O2-mixture (3:1) there is no appreciable hyperoxia, but a small reduction of systemic arterial blood pressure. With all techniques of mechanical respiration usual middle intratracheal pressure of respiration was not exceeded. Traumatic pressure of jets was only indirectly shown in steep rises of pressure by the applied technique of measurement.

[Pulmonary alveolar microlithiasis (disease in 2 siblings--case report)]. / Microlithiasis alveolaris pulmonum (Erkrankung bei zwei Geschwistern--Kasuistik).

This article presents case reports on brother and sister suffering from microlithiasis alveolaris pulmonum. Diagnosis was established by means of the course of the disease, the relatively typical x-ray film and the findings on performing scintigraphy of the skeleton and also by computed tomography. Findings confirmed that the course of the disease is symptom-free for a long time; that it occurs in both sexes; and that it becomes manifest with considerable incidence in some families. Pulmonary alveolar microlithiasis is not a generalised metabolic disease, since it affects the lungs only. If the aetiology remains unclear, no causal treatment can be effected.

[Pulmonary hypertension following Rickettsia infection?]. / Pulmonaler Hypertonus nach Rickettsieninfektion?

A latent or stable pulmonary hypertension was established in three patients with a Q-Fever-Infection confirmed as occupational disease. According to sparse informations in the literature the development of a pulmonary hypertension in the course of this disease is taken into account. The investigation programme regarding Q-Fever-Infections should be completed by measurement of pulmonary artery pressure.

[Reference values for the maximal expiratory flow volume curve for adults. Results of a cooperative study]. / Referenzwerte der maximalen exspiratorischen Fluss-Volumen-Kurve für Erwachsene. Ergebnisse einer kooperativen Studie.

Reference values of the maximal expiratory flow-volume curve for the adult GDR's population have been ascertained by a co-operative study of 5 lung function laboratories. We analysed measurements in 1,004 healthy subjects aged 16 to 69 years (728 males and 276 females). Prediction equations for the maximal expiratory flow rates, several time constants of lung mechanics and screening parameters of ventilatory inhomogeneity have been calculated by means of the multiple linear regression analysis. Our reference values are in good accordance with SEPCR summary equations. It is recommended to subtract from or add to the predicted values 1.64 standard deviations and to consider abnormal all values beyond this limit.

[Bronchospasmolytic tests with and without a nebulizer]. / Bronchospasmolyseteste mit und ohne Nebulator-Vorsatz.

Bronchospasmolytic tests with Terbutaline (Arubendol-Aerosol) were performed in 23 pts without or with an additional nebulizer. The use of a nebulizer in pts with a perfect handling of inhalers seems to be not better than the inhalation without nebulizer. The most reliable parameter of bronchospasmolytic effects is the airway resistance (Rt).

[Alveolitis and lung fibroses caused by drugs]. / Alveolitiden und Lungenfibrosen, verursacht durch Medikamente.

The causes for alveolitis and lung fibroses are very multifarious. In the scale of the contaminant factors the medicaments occupy only a small sector. Nevertheless, the knowledge of such a side effect is significant on account of the often unfavourable prognosis of the alveolitis. When medicaments with wellknown ability of impairment are administered (e.g. cytostatic drugs, antiarrhythmic drugs etc.) a narrow-meshed observation with suitable control parameters is to be demanded. Only the timely recognition of a side effect of a medicament in the lung structure can prevent the fatal change into a pulmonary fibrosis. In 801 alveolitis and lung fibrosis diagnosed in our clinic 10 times a medicament was established as cause.

[Echocardiography in clinically suspected chronic cor pulmonale]. / Echokardiographie bei klinischem Verdacht auf Cor pulmonale chronicum.

UNLABELLED: In a prospective study the echocardiography (M-mode-and two dimensional methodology) as well as the electrocardiography were tested in 40 patients with chronic bronchopulmonary diseases and suspicion of chronic cor pulmonale concerning their statements about right-ventricular hypertrophy and dilatation of the right-sided cavities of the heart. RESULTS: In the question of right-ventricular hypertrophy the electrocardiography showed only a slight sensitiveness of 0.125. However, the echocardiographic criteria of the right-ventricular hypertrophy and of the dilatation of the right-sided cavities of the heart a sensitiveness of 0.809 and a specificity of 0.750. With only 3 out of 40 echocardiograms which could not be evaluated for reasons of the image quality the rate of the success of the echocardiographic investigation of 0.925 was significantly high in the group of patients who are difficult to be examined in this respect.

[Follow-up in patients with chronic obstructive lung diseases with special reference to the pressure behavior in the pulmonary artery]. / Verlaufsuntersuchungen bei Patienten mit chronisch obstruktiven Lungenkrankheiten unter besonderer Berücksichtigung des Druckverhaltens in der Arteria pulmonalis.

The study demonstrates the results of 203 patients with COLD in a follow-up of 4-6 years. The investigations include the clinical state, lung function tests, blood gas analyses and measurements of pulmonary arterial pressure (PAP). One hundred and six of these 203 patients were investigated 3 times within 4-6 years. Clinical state, oxygen partial pressure and airways' resistance showed the best correlation with the PAP at rest and under exercise. In 54 patients (= 51%) the pulmonary arterial pressure increased up to a pulmonary hypertension. In 37 patients (= 35%) it decreased, out of them in 13 to normal values. Only in 15 patients (= 14%) the PAP did not change. We conclude, that a single measurement of the pulmonary arterial pressure can only be a marker of the general prognosis in COLD, but not of the individual prognosis. So we need further follow-up studies for the correct assessment of the individual prognosis dependent on the clinical state in each case.

[Clinico-functional studies in patients with bird fancier's lung]. / Klinisch-funktionelle Untersuchungen bei Patienten mit Vogelhalter-Lunge.

Bird fancier's lung is a typical manifestation of extrinsic allergic alveolitis. In 107 cases with etiologically and histologically verified diagnosis tests of pulmonary function and hemodynamics were performed at admission to hospital and after 2-3 years of allergen abstinence and therapy. Acute forms of disease show distinct functional improvement, while chronic forms lead to increasing impairment.

[Evaluation of remaining performance capacity in patients with alveolitis and pulmonary fibrosis]. / Beurteilung des Leistungsrestes bei Patienten mit Alveolitis und Lungenfibrose.

In patients with alveolitis or interstitial fibrosis of the lungs reduction of physical work capacity is the consequence of cardiopulmonary functional impairment. On the basis of the results of the evaluation of investigation in 493 patients with alveolitis and fibrosis a decision matrix for quantifying different degrees of impairment is recommended.

[Does halothane, in subnarcotic dosage, have a detectable broncholytic effect?]. / Hat Halothan in subnarkotischer Dosierung einen nachweisbaren broncholytischen Effekt?

The reaction of halothane in subnarcotic dosage (0.25-0.5 Vol.-%) e.g. with the cooperative patient, was tested at 32 patients with chronic obstructive pulmonary affection (from them 26 patients with pathological increased resistance of the respiratory system) concerning bronchial obstruction. The significant decrease of the respiratory rate and of the resistance of the respiratory system as well as the significant increase of the volume of the breath inspiration unambiguously prove, beside the influence on the subjective health and on the auscultatory findings, a bronchial-enlarging effect of halothane. At 10 patients with serious acute bronchial obstruction, which could not be cured by means of conventional medicamentous therapy, halothane was employed in subnarcotic dosage. In spite of the difficulties in the assessment of the halothane effect by pretreatment we relate the impressive, subjective and objective improvement in these patients to its bronchospasmolytic effect because of the immediate temporal association with the halothane inhalation. In case that there are missing contraindications and an insufficient effect of the conventional medicamentous therapy the use of halothane in subnarcotic dosage with acute serious bronchial obstruction is indicated.

[Chronic fibrosing alveolitis and lung fibrosis--frequency and distribution of radiographic symptoms]. / Chronisch fibrosierende Alveolitis und Lungenfibrose--Häufigkeit und Verteilung radiographischer Symptome.

In 95 patients with histologically or immunologically diagnosed interstitial lung diseases (44 pts. with chronic fibrosing alveolitis, 6 with allergic alveolitis, 11 with chronic diffuse fibrosis, 34 pts. with localized fibrosis) the radiographic symptoms of interstitial and accompanying alveolar and pleural alterations are estimated by a semiquantitative score, with regard to location and intensity. No diagnosis-relevant differences are found. Nodular densities are seen on the radiographs of all patients. In most of the cases (82%) they are accompanied by reticular shadows. Irreversible "honeycomb"-cysts are found in 27% of patients, alveolar and pleural reactions in 22% and 28% respectively. An impressive shrinkage is found in 16%.

[Calculation of normal values in lung compliance]. / Beitrag zur Normwertberechnung bei der Lungencompliance.

Within a study of standard values, investigations of the static and dynamic lung compliance were performed in 162 test persons in a good state of health of heart and lungs. Age, size, constitution, and intrathoracical gas volume are necessary parameters for calculation of an individual standard value of the dynamic compliance, whereas age and intrathoracical gas volume only are needed for calculation of a standard value of the static compliance. The new standard values are compared with the values known from the literature.

[Value of the vectorcardiogram in the evaluation of right heart hypertrophy in chronic obstructive lung diseases]. / Untersuchungen zur Wertigkeit des Vektorkardiogramms bei der Beurteilung der Rechtsherzhypertrophie bei chronisch-obstruktiven Lungenkrankheiten.

In 41 patients with severe chronic obstructive lung disease vector cardiographic and electrocardiographic results and the level of pulmonary arterial pressure (pap) are compared. We observed a positive correlation between normal results from vector cardiography, electrocardiography, and pulmonary arterial pressure. In cases of hypertrophy of the right heart, type I and type II according the method of Lichtlen, pulmonary arterial hypertension was found in 72% of the cases.