[Experiences with cytostatic treatment of small cell bronchial cancer]. / Erfahrungen mit der zytostatischen Behandlung kleinzelliger Bronchialkarzinome.

Reported are the results of cytostatic treatment in 32 patients with inoperable metastasized small cell bronchogenic carcinoma. With regard to the therapeutic effects 3 groups (A: limited disease, stage I-IIIa; B: extensive disease, stage IIIb; C: extensive disease II, stage IV) are compared. The application of a combined chemo-radiotherapy depends on the age, the general state and the stage of extension of the tumor. The polychemotherapy followed by the radiotherapy should be preferably applied to patients with tumors of the disease group A, because in this group the best results were obtained with an average survival time of 21.3 months, a remission length of 13.4 months, an improvement of life quality for 12.5 months and a high remission rate. The above mentioned therapy scheme is justifiable and practicable.

[Compression syndrome of the left main bronchus]. / Das Kompressionsyndrom des linken Hauptbronchus.

Case report of the findings of a pulmonary atelectasis as the result from a compression of the left main bronchus by an enlarged left atrium with preconsisting double mitral valve disease and aortic insufficiency (King-Landau-Rivero-Syndrome). The diagnosis was confirmed clinically, by x-ray and by endoscopy.

[A case report of actinomycosis of the lung]. / Kasuistischer Beitrag zur Aktinomykose der Lunge.

This is the report about a case of the infrequently observed actinomycosis of the lung from the clinical-surgical and pathological-anatomical standpoint. Considering existing publications the picture of the disease is described with this case. In consequence of misinterpretation of clinical-cytological and histological findings and of the picture of the disease during seven months of the postoperative phase a progressive generalized actinomycosis developed. The problems and causes of the error are discussed, also the possibilities to recognize this disease. The difficulties in giving a diagnosis are shown. The protracted illness could be cured in spite of the late start of appropriate therapy.

[Case report of tracheal stenosis]. / Kasuistik zur Tracheastenose.

This is the report on one case of tracheo-stenosis after aspiration of a foreign body which has been diagnosed only after 7 years and successfully treated by surgery. Based on this case, the symptoms of stenosis of trachea or main bronchus are described and it is referred to the difficulties of diagnosis. Anamnesis, therapy-resistant cough and dyspnea, inspiratoric stridor, isolated stenotic murmur in central bronchial sections or a weakened respiratory sound give a hint to the existence of a stenotic process which is to be confirmed by tomography and bronchoscopy. Problems of misinterpretation of such symptoms are discussed.

[Case history contributions to the current symptomatic picture of tuberculous diseases]. / Kasuistische Beiträge zum gegenwärtigen Erscheinungsbild tuberkulöser Erkrankungen.

The problem of quick and early detection of tuberculosis in old persons deserving increasingly special attention is discussed by the hand of eight observations. Differential diagnosis of generalized forms and isolated extrapulmonary organ tuberculosis is particularly difficult. Incorrect interpretation of signs and symptoms, default of examinations crucial for right diagnosis and above all, not considering tuberculosis in the diagnostic process explain error and often subsequent death due to failing the diagnosis of tuberculosis. In the examples represented the difficulties in making the right diagnosis, the change of the clinical features and course of disease, and the reasons for misinterpretation of these forms are shown. Relevant conditions and diagnostic procedures referring to the diagnosis of tuberculosis in old people are reviewed as chronic disabling ailments, drugs reducing resistance, pulmonary fibrotic lesions all sometimes followed by exacerbation of pulmonary or lymph node tuberculosis and subsequent haematogenous generalization, and as the tuberculin testing and repeated examinations for tubercle bacilli.

[Clinical course of Wegener's granulomatosis]. / Ein Beitrag zur Klinik der Wegenerschen Granulomatose.

Granulomatous necrosing ulcerations in the upper respiratory tract, a generalized arteritis developing lung infarcts, and a focal glomerulonephritis in this sequence characterize the classic progression of Wegener's granulomatosis (WG). Two cases of this rarely observed disease are being reviewed, comparing the typical course of illness with a non-typical form hard to diagnose. On the basis of these cases, considering the available publications, the clinical-roentgenological peculiarities, autoptical findings, and therapeutical possibilities of this usually fatal WG are set forth. Ulcerations of the mucous membrane of the nose and oral cavity or chronic sinusitis, haemoptysis with melted round foci of the lung, which can be roentgenologically proved, as well as increasing pulmonary insufficiency, proteinuria, and haematuria with subsequent renal failure are signs and symptoms of WG. Problems of diagnosis are discussed and difficulties in diagnosing are put forward. Histological confirmation in the early phase of the illness is desirable.

[Results of the conservative treatment of spontaneous pneumothorax]. / Ergebnisse der konservativen Behandlung des Spontanpneumothorax.

This work presents the results of the conservative treatment of spontaneous pneumothorax. 315 cases hospitalized between 1965 and 1976 were analysed. The study was carried out regarding results, number of relapses, kind of diagnosis, symptoms and other parameters in dependence on form of therapy. In 18 cases serious complications were observed. The fractionated suction of air by means of the pneumothoracic apparatus the most frequent procedure, was applied in 199 cases, having relapses in 33%. In 57% of all cases this treatment led to a permanent reinflation of the lungs. With suction only and without any activities the relapse quotients were 33% and 53.5% respectively; with continued lung drainage it was as low as 20%. Only 12 patients needed a thoracotomy. Cases wanting long term primary lung drainage were very rare (3.45%). The results showed that the conservative internal treatment of spontaneous pneumothorax is justified in the most cases.

[Diagnostic problems of tuberculosis in old age]. / Diagnostische Probleme der Alterstuberkulose.

Among the present epidemiologic conditions postprimary tuberculoses gain importance due to the exazerbation of latent foci. The particularly concerns the generalised senile tuberculosis. The clinical picture of a generalisation tuberculosis deviates in comparison with the course which was formerly regarded as typical. It shows a protracted, at first undramatic phase with slowly progressing development, appears intermittently, is characterized by rich, variants with regard to form, course and localisation, withdraws from radiological demonstration for a long time and thus progresses occult in general. The 35 cases should remind of diagnostic basic patterns and should take into consideration the peculiarities of exacerbated generalised tuberculoses at old age. The observation of symptomatology and paraclinical findings, bioptic examinations of the liver, bacteriologic or histologic findings of the adequate substrate, the exclusion of other organic diseases and an experiment of an antituberculotic treatment when tuberculosis is supposed may become successful measures of making the diagnosis. Even nowadays tuberculosis must be included in the differential diagnosis of several organic diseases.

[Contribution on the chronic fibrinous bronchitis (author's transl)]. / Beitrag zur chronischen fibrinösen Bronchitis

The present report deals with an actual case of the rare chronic fibrinous bronchitis. With references to previous publications on this subject the picture of the disease is described on the basis of an actual case. A review of the literature available and the investigation of the actual case have led to parameters of the disease mentioned, which are typical and indicative of this disease. It has been found out that chronic fibrinous bronchitis is diagnosable by clinical means. Problems concerning the therapy, prognosis and etiology are discussed.

[A contribution to the symptomatology of diffuse interstitial pulmonary fibrosis (DIPF) (author's transl)]. / Beitrag zur Klinik der diffusen interstitiellen Lungenfibrose (diLF)

Diffuse interstitial pulmonary fibrosis was detected in 64 patients (33 males and 31 females). The diagnosis was obtained in each case from the anamnesis, the clinical findings, the chest X-ray, disturbances of the respiratory function, and from the progress of the disease. The analysis of the material produced the following parameters ranging from indicative to typical: Dry cough was reported by 70% of the patients as being trouble-some. Dyspnoea on exertion and at rest existed in 95%, and gradually increased during the progress of the disease in 76,5% of these cases. On auscultation ear-near crepitant rale was heard in 78% above the affected pulmonary parts. In 62 patients (96,5%) the radiogram showed disseminated streaky-reticular as well as finely to coarsely mottled infiltrations. In more than half of these cases (53%) an increase in severity was observed during the follow-up. A predominantly restrictive disturbance of ventilation existed in 85,5%. Exclusive restriction was found in 65,5%. Effort hypoxemia was detected in 92% of our cases which was especially impressive when the arterial oxygen pressure at rest was within the normal range. The electrocardiographic findings seemed to be less unequivocal. All in all it can be stated that in the synopsis of its manifestation DIPF can be positively identified by clinical means. This fact as well as therapeutical problems are discussed taking available publications into consideration, and respective conclusions are drawn for the clinician.