[Acute disorder of ventilation-perfusion of the lung caused by inhalative smoking of 20 cigarettes]. / Akute Ventilations-Perfusionsstörung der Lunge durch inhalatives Rauchen von 20 Zigaretten.

What are the acute bronchopulmonary reactions which occur in smokers when 20 cigarettes are smoked over 10 hours during the day after a 12-hour interruption of smoking at night? Nineteen healthy chronic smokers with normal lung function aged from 22 to 39 years were investigated. The inhalative smoking characteristics were documented by alterations (p < 0.0005) of nicotine, cotinine and COHb in the blood. In body plethysmography, the subjects investigated showed a fall (p < 0.0025) of the airway resistances by 0.51 (cm H2O/l/s), a decrease (p < 0.005) of the trapped air and a rise (p < 0.01) of the thoracic gas volume by 0.58 (1) and (p < 0.01) of the specific conductance by 0.04 (cm H2O x s)-1 after smoking. The frequency-dependent compliance (40 breaths per minute) did not show any change. As a result of smoking, there was a fall (p < 0.025) of the arterial partial pressure of oxygen by 3.1 (mmHg) and carbon dioxide (p < 0.025) by 1.0 (mmHg) in ergometric exercise (women 75 Watts, men 100 Watts) as well as of the partial pressure of CO2 (p < 0.05) by 0.9 (mmHg) at rest. At the same time, the alveolo-arterial CO2 difference increased (p < 0.025) by 2.5 (mmHg). The results are interpreted as acute ventilation perfusion disorders which are reversible in the nocturnal resting phase.

[Importance of echocardiography in general clinical routine practice]. / Bedeutung der Echokardiographie in der allgemeinen klinischen Routine.

Echocardiography was carried out in 526 patients on a general internal medical ward, 54.8% with a clinical indication and 45.2% in screening. The results were compared with the data from the scout view chest x-ray and from the ECG. Enlargement of the cardiac cavities detected in echocardiography (UCG) can only be found in 43% in the x-rays (left atrium 27%, left ventricle 64%, right ventricle 42%). Left ventricular hypertrophy was shown in the UCG in 43% of patients with arterial hypertension: of these, 28% had a pathologic ECG. On the other hand, only 14% of all hypertensive patients show signs of left ventricular hypertrophy on x-ray. The differentiation of systolic (44%) and diastolic (38%) dysfunction was only possible by means of UCG in congestive heart failure. A chronic pulmonary hypertension detected by x-ray correlated with an enlargement of the right ventricle in the UCG. UCG is indicated when there are clinical, ECG, chest x-ray signs of heart disease, arterial hypertension or chronic pulmonary hypertension. UCG is not a screening method.

Acute ventilation-perfusion mismatching resulting from inhalative smoking of the first cigarette in the morning.

The effect of the first cigarette in the morning on the airway resistance (Raw) which can be measured by body-plethysmography was investigated in 70 inhaling cigarette smokers. The test population showed a significant (P less than 0.0005) fall in Raw 8 min after smoking. A further study (n = 16) showed that the fall in Raw was most likely to be attributable to a decrease in the trapped air. The effect of the first cigarette in the morning on the arterial blood gases and on the alveolar-arterial oxygen difference P(A-a)O2 and carbon dioxide difference P(A-a)CO2 was investigated in 12 inhaling cigarette smokers. Smoking gave rise to a significant (P less than 0.0005) fall in the partial pressure of oxygen (PaO2) with compensatory overventilation. At the same time, the P(A-a)O2 and the P(A-a)CO2 increased significantly (P less than 0.01 and P less than 0.05, respectively). This effect could be observed for up to 24 min after smoking. In addition, the flow of blood in the pulmonary capillaries was measured in 28 test subjects with the nitrous oxide method (QN2O) before, and 18-22 min after, smoking the first cigarette in the morning. After smoking, there was a significant (P less than 0.0005) fall in the QN2O by an average of 11.3%. The decrease in the Raw, the fall in the PaO2 with compensatory overventilation, the increase in P(A-a)O2 and P(A-a)CO2 and the decrease in the QN2O are interpreted as manifestations of pronounced acute ventilation-perfusion mismatching induced by smoking.

Smoking behaviour and increase in nicotine and carboxyhaemoglobin in venous blood.

The connection between smoking behaviour (number of puffs, puff volume, depth of inhalation, duration of inhalation) and the increase in both nicotine and carboxyhaemoglobin (COHb) in venous blood was investigated with methods developed especially for measurement of the puff volume, the depth of inhalation, and the duration of inhalation in 28 inhaling cigarette smokers. A significant correlation could be demonstrated between the smoking parameters and the nicotine and carboxyhaemoglobin increase. The weighting obtained shows that the number of puffs is the most important parameter affecting the increase in nicotine, whereas the depth of inhalation and the puff volume are of much less relevance. The duration of inhalation does not affect the nicotine level. A significant increase in nicotine cannot be attained in non-inhalative smoking of cigarettes with an acid mainstream smoke (n = 14). The increase in COHb is most affected by the puff volume, and slightly less by the number of puffs and the depth of inhalation. The duration of inhalation does not affect the COHb level.

[Rhinosinusitis polyposa and intolerance to analgesics (aspirin intolerance)]. / Rhinosinusitis polyposa und Analgetikaintoleranz (Aspirinintoleranz).

Although the signs or symptoms of rhinitis, bronchial asthma, urticaria and hypersensitivity to non-steroidal antiphlogistics, antirheumatics and analgesics as well as to some foods, seem to point towards an anaphylactic reaction, this intolerance--known in the U.S.A. as "aspirin intolerance"--is of non-allergic aetiology. In most cases the disease begins in the upper airways. Hence, early diagnosis by the ENT specialist is essential. The medical examinations and case histories of 20 patients suffering from rhinosinusitis complicated by aspirin intolerance, are discussed.

[A comparison of airway resistance in oral-endotracheal tubes, tracheotomy tubes and in normal noses (author's transl)]. / Vergleichende Untersuchung der Atemwegswiderstände bei Nasenatmung und Atmung über Trachealkanülen bzw. Intubationsrohre.

Not only a decrease, but also an increase of airway resistance by spontaneous regulation in the larynx, nose, or mouth will improve lung function in some diseases. Therefore, pressure and airflow in oral-endotracheal tubes, tracheotomy tubes and in normal noses are analysed. Double-logarithmic divided diagrams, valid for the comparison of laminar, turbulent and unstable turbulent-laminar flows, are used. The airway resistance and therefore the work of breathing generally is lowered after tracheotomy, increased after intubation, if the tubes are not of unusual size. The possible influence of these test results toward the indication (tracheotomy or intubation) is discussed.

[Acute renal failure due to diffuse cholesterol crystal embolisation during streptokinase treatment (author's transl)]. / Akutes Nierenversagen als Folge diffuser Cholesterinkristall-Embolisation unter Streptokinasetherapie.

In a 65-year-old man livedo reticularis occurred in the lower half of the body two days after beginning lysis with streptokinase. This was followed by skin and toe necrosis as well as acute renal failure. Autopsy showed a severe ulcerative atherosclerosis of the aorta with cholesterol crystal embolisation in numerous organs, particularly in both kidneys. The coincidence in time leads one to assume that the streptokinase treatment encouraged acute diffuse embolisation by dissolving the protective thrombi over the ulcerative atheromatous plaques.

[Paralysis in hypophosphataemia (author's transl)]. / Lähmungen bei Hypophosphatämie.

Neuromuscular syndromes and respiratory insufficiency may be caused by hypophosphataemia. This complication may occur particularly in patients with malnutrition who receive parenteral glucose, as two examples show.