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.

[Determination of individual lipid parameters in non-chylous pleural effusions].

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.

[Value of modern study methods in the early diagnosis and assessment of asbestosis].

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.

[Cell distribution and macrophage function in bronchoalveolar lavage of patients with sarcoidosis and lung tumors].

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.

[Anesthesiologic problems in endoscopic interventions of the respiratory organs].

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.

[Rational diagnosis in pneumonology].

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.

[Indications for the use of a wound adhesive in pneumothorax treatment].

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).

[Results, complications and controlled after-care in thoracoscopic pleural and lung biopsy].

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.

[Carcinoid of the distal 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.

[Experiences with the transthoracal pleura and lung biopsy under thoracoscopic control (author's transl)].

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.

[Pleural asbestosis in dock workers].

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.

[Benign and semimalignant intrabronchial lung tumors].

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.

[Contribution to the differential diagnosis of lung infarct, pulmonary tuberculosis and lung neoplasms].

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.

[Clinical studies on the paraneoplastic syndrome in intrathoracic neoplastic diseases].

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.

[Rare thoracic injuries (biomechanics, diagnosis and therapy) (author's transl)].

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.

[Intra-and postoperative complications in pulmonary surgery (author's transl)].

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.

[The management of bronchial hemoptysis - case study (author's transl)].

Two case reports exemplify, that in patients with massive hemoptysis occuring in the bronchial system and owing to known or unknown causes, the emergency surgery must not to be delayed. In the case of minor relapsing hemoptysis, especially in old-age patients or borderline operability, the minimum surgical procedure is indicated after diagnosing and finding the localization of the hemorrhage.

[Complications in bilateral large lung cysts (author's transl)].

Complications in bilateral, congenital or acquired large cystic lesions in the lungs are a diagnostic and therapeutic problem. Early diagnosis and treatment is emphasized. When surgical treatment is necessary, decisions about the surgical procedures should be made knowing the in situ condition.