[High-resolution magnetic resonance tomography (HR-MRT) of the pleura and thoracic wall: normal findings and pathological changes].

Aim: To determine the value of high-resolution MRI in pleural and chest wall diseases, the normal and pathologic costal pleura and adjacent chest wall between paravertebral and the axillary region were examined with contrast enhanced high-resolution T1-weighted MRI images using a surface coil.

Material And Methods: Normal anatomy was evaluated in 5 healthy volunteers and a normal specimen of the thoracic wall, and correlation was made with corresponding HR-CT and histologic sections. CT-proved focal and diffuse changes of the pleura and the chest wall in 36 patients underwent HR-MRI, and visual comparison of MRI and CT was done retrospectively.

[Pleural diseases in magnetic resonance tomography (MRT)].

MR images of 48 patients with histologically confirmed benign and malignant diseases of the pleura were retrospectively compared with CT and bioptically/surgically obtained findings. In 47/48 patients pathological changes of the pleura were visualized by increased signal intensities on T2-weighted and contrast enhanced T1-weighted MR images. This lead to a slightly improved sensitivity compared to CT, where pathological pleura findings were confirmed in 45/48 patients.

[Preventive operations of the lung and bronchial system].

There are four major prophylactic indications in thoracic surgery: (1) Intra-pulmonary coin lesions with malignancy up to 50% and other potentially malignant tumors (carcinoid tumor, cylindroma, mucoepidermoid tumor, papilloma); (2) mediastinal tumors with potentially malignant growth (teratoma); (3) chronic lung infections including tuberculosis (bronchiectasis, abscess, chronic pneumonia, persistent tuberculoma, tuberculous cavity, destroyed lobe/lung); (4) cystic pulmonary disease followed by frequent complications (infection, bleeding, pneumothorax).

[Laser and afterloading therapy of bronchial cancer].

Endobronchial afterloading irradiation by remote control was administered to 304 patients with lung cancer. The use of a highly active 192-Iridium source (740 GBq) is possible; irradiation time lasts only a few minutes. A combined treatment modality with laser was employed in 24%, with chemotherapy in 2%.

[Dangers and errors in pleural puncture and placing suction drainage].

Mistakes during puncture and drainage of the pleural space can result in serious complications. A few case reports are presented. Injuries of intrathoracic and intraabdominal organs can occur-, the latter mainly due to underestimating the elevated level of the diaphragm.

[The so-called pituitary snuff-taker's lung. A case contribution].

A 37-year-old woman who had developed diabetes insipidus after an abortion, requiring nasal substitution treatment with desmopressin (Minirin), began to suffer from fatigue, nocturnal sweating, cough and dyspnoea on exertion. Exogenous-allergic alveolitis was demonstrated by chest x-ray, lung function tests, blood gas analysis, broncho-alveolar lavage and transbronchial lung biopsy. After changing the treatment to an intramuscularly administered preparation and starting steroid therapy the clinical, radiological and lung function findings rapidly improved.

[Therapy of spontaneous pneumothorax--surgical therapy].

Spontaneous pneumothorax was treated by primary thoracotomy in 225 patients (1974-1988) in the Thoracic Unit Havelhöhe (Berlin-West). The patients' average age was 25 years (11-60 y.) and the male/female ratio was 169/56.

New technique for treating occlusive and stenosing tumours of the trachea and main bronchi: endobronchial irradiation by high dose iridium-192 combined with laser canalisation.

A new technique is described for treating patients with inoperable malignant tumours causing occlusion or stenosis of the trachea or main bronchi. High dose iridium-192 (20 Ci) was introduced by an afterloading device under computer control via a 4 mm delivery tube into the tumour mass. In 29 of the 56 patients the tumour mass was canalised by a neodymium-YAG laser immediately before the afterloading delivery tube was introduced.

[New methods in the radiotherapy of bronchial carcinoma. Endobronchial small-field irradiation using the iridium-129 high-dose afterloading technic in combination with the neodymium-YAG laser].

106 patients with inoperable malignant tumours constricting the central bronchial tree underwent endobronchial small-field radiotherapy with iridium-192 at high dose between June 1983 and September 1985. Treatment was performed using the computer-guided after-loading technique and a flexible bronchoscope under local anaesthesia. In complete occlusion of a bronchus by the tumour, a neodymium YAG-laser was applied (57 patients) to allow insertion of the after-loading probe.

[New possibilities in radiotherapy of endobronchial tumors using the afterloading method in combination with laser technics].

New possibilities for radiotherapy of bronchial carcinomas are provided by the combined application of the recently introduced afterloading method used hitherto in the treatment of stenosing processes of bronchial carcinomas and the neodyme-YAG laser which opens the stenosis in such a manner that the afterloading probe can be inserted. This new method allows to perform without complications or disadvantages further combined therapies such as percutaneous irradiation (telecobalt, linear accelerator or betatron). An irradiation scheme leading to a decisive tumor regression can be established due to the fast reventilation of the lung obtained by both methods.

Follow-up study of 100 malignant pleural mesotheliomas.

One hundred malignant pleural mesotheliomas have been treated in our hospital since 1955. Clinical and autopsy findings are analyzed and compared to X-ray changes. The most common symptoms were dyspnea (49%), pain (40%) and cough (36%).

[Malignant pleural mesotheliomas. Comparison of roentgenologic and autopsy findings].

In 100 pleural mesotheliomas follow up x-ray studies were compared to autopsy findings. Initially x-ray examinations show effusions in 62%, diffuse pleural thickening in 29% and solitary pleural nodules in 6%, prior to death effusions and pleural thickening are usually combined. In 17 tumor nodules doubling times ranged from 0.

[Localised aspergillosis and oxalosis of the lung caused by aspergillus niger: soil of ornamental plants as a reservoir of aspergilli (case report) (author's transl)].

Haemoptysis occurred in a 64-year-old man with a history of pulmonary tuberculosis, negative for M. tuberculosis. Precipitating antibodies to Aspergillus niger were found in serum and the fungus found in sputum.

[A case of extremely severe chest injury with fracture of several ribs (author's transl)].

A 72-years old man was severely injured when a lorry rolled back and pinned him down, causing contusion of the chest, fractures of ribs 3-10 on the right and haemothorax. Treatment of the chest injuries was by drainage and by positive end-expiratory pressure ventilation because of the development of severe pneumonia with wet lung. Persistent renal insufficiency, a gastro-intestinal haemorrhage and diabetes also required treatment.

[Survival of 51cr-tagged red blood cells in patients with artificial heart valves (author's transl)].

Survival of 51Cr-tagged erythrocytes is determined in 10 patients approximately 1 week after insertion of an artificial heart valve ("early hemolysis") and in 9 patients approximately 2 years after heart valve replacement ("late hemolysis"). Red blood cell survival is found to be significantly reduced in all patients following insertion of an artificial heart valve as compared to a group of control patients. Hemolysis is significantly more pronounced in the early postoperative phase than two years postoperatively.

[Aspergillus serum precipitins in patients of a lung clinic].

The incidence and distribution of aspergillosis among patients of a lung clinic in West Berlin were recorded. The immunodiffusion test (IDT) was used on sera of 228 patients seen during one day to test for precipitins against A. fumigatus, A.

[Experimental demonstration of hemogenous growth of various collateral nets in chronic iliac av-fistulas].

A 2 cm long iliac av-fistula is established in 13 dogs. Flow and pressure measurements are performed in the distal fistula artery and the adjacent arteries before and immediately (stage I) as well as 3 months (stage II) and 6 to 12 months (stage III) post shunt. The development of extensive collaterals adjacent to the chronic iliac av-fistula is demonstrated angiographically and by post-mortem vascular casts.

Quantitative evaluation of retrograde arterial flow in chronic experimental arteriovenous fistulas.

A 2 cm long iliac av. fistula is established in 13 dogs. Flow measurements are performed in the fistula limbs and the adjacent arteries immediately (stage I), as well as 3 months (stage II) and 6 to 12 months (stage III) post-shunt.