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Biomedical subjects

F Trendelenburg

Publications and source records attributed to F Trendelenburg.

At least 19 recordsLinked to original sources

Six years' experience with perthoracic core needle biopsy in pulmonary lesions.

Six years' experience of percutaneous core needle biopsy using the Hausser needle in 502 patients, aged 20-89 years, is reported. A biopsy was carried out when sputum and bronchoscopic methods had failed to establish a definitive histological diagnosis. Over 60% of the lesions were peripheral and about 40% were 2-4 cm in diameter. A correct diagnosis was made by this means in 312 of the 339 patients shown eventually to have a malignant lesion (92%) and in 130 of 146 patients with a benign lesion (89%). A definitive diagnosis was never established in 17 patients. Complications arose in 15% of cases. Pneumothorax occurred in 43 patients (7%), of whom 12 required a chest drain. Further complications included a small haemoptysis (less than 30 ml) in 27 patients (5%), haemothorax necessitating a chest drain in three patients, and an intrapulmonary haematoma in five patients. There were no fatal or permanent complications. Percutaneous core needle biopsy is a valuable procedure with a high diagnostic accuracy in these patients and a low rate of complications.

Adult

Drug-resistant bronchial asthma successfully treated with plasma exchange.

Two patients suffering from allergic bronchial asthma who showed no improvement despite six and four weeks, respectively, of drug therapy were successfully treated with therapeutic plasma exchange. The first patient had no attacks over a period of five months, and the other patient had none for over one year. Although this report only deals with single observations, we believe that therapeutic plasma exchange is of particular value for patients with severe allergic bronchial asthma because it eliminates in addition to immunocomplexes other substances, including antigens, rapidly from the blood. This means that it is possible to directly intervene in the pathomechanism. However, further investigations are necessary in order to corroborate this successful therapy.

Adult

Palliative therapy of tumor-induced pleural effusions with 90Yttrium-silicate.

In 20 patients with rapidly recurring malignant pleural effusion, 90Yttrium-silicate was intrapleurally instilled after the puncture. In all patients this treatment resulted in marked reduction, or even interruption, of exudate formation. Eleven patients died with an average survival of 166 days. Nine patients are still alive and have been followed up for a mean of 140 days without the pleural effusion recurring. Side effects were not observed, either subjectively or in relation to hematological and other laboratory findings.

Adult

[Diagnosis of sarcoidosis by bronchial biopsy and transbronchial pulmonary biopsy].

The presence of non-caseating epitheloid cell granulomas in biopsy material is still one of the most important factors in establishing the diagnosis of sarcoidosis. Since Carlens introduced mediastinoscopy as a diagnostic procedure in these cases the use of liver biopsy or bronchoscopic biopsy has decreased because of the better results obtained by mediastinoscopy. In 148 of 163 persons with sarcoidosis the diagnosis could be verified by the finding of epitheloid cell granuloma without central necrosis in biopsies taken from the lungs and/or bronchial wall. In 15 patients the diagnosis could not be confirmed by bronchological methods, but the presence of epitheloid cell granulomas was established by other biopsy procedures. The conclusions drawn from the observations are that the combination of bronchial and transbronchial biopsies during bronchoscopy with rigid instruments is a valuable technique for establishing the diagnosis of sarcoidosis and that bronchological methods could replace mediastinoscopy in most cases.

Biopsy

Double-blind co-operative trial to compare trimethoprim-sulfalene and co-trimoxazole in the treatment of lower respiratory tract infections.

Two fixed trimethoprim-sulfonamide combinations were compared in a clinical trial for their effectiveness and safety in the treatment of patients with acute lower respiratory tract infections (pneumonia, bronchopenumonia, purulent tracheobronchitis, ect.). 46 in-patients were randomly allocated to Kelfiprim (trimethoprim 250 mg + sulfalene (sulfamethopyrazine) 200 mg) or to co-trimoxazole (trimethoprim 320 mg + sulfamethoxazole 1600 mg) and were treated for 1-2 weeks under double-blind conditions. Assessment of effectiveness was based on daily follow-up of subjective and objective signs and symptoms, on changes in X-ray picture, and on microbiological and laboratory findings. Response to therapy was excellent or good in 86% of patients receiving Kelfiprim and in 79% of those given cotrimoxazole. Transient side-effects were observed in three patients under Kelfiprim (two allergic reactions and one G.I. complaint) and in one under co-trimoxazole (altered kidney function).

Adult

[Mass radiography. The "pros and cons" of a classic method of preventive medicine (author's transl)].

The relation of expense to benefit of mass radiography (RRU) can no longer be referred to the tuberculosis discovery rate. Far more frequently other thoracic diseases are detected, e.g. tumors, cardiovascular diseases, pneumoconiosis, sarcoidosis, etc. The prerequisite and therefore the immediate objective is the limitation to the defined and detectable group of risks so as to increase the detection rate. In combination with other prophylactic investigations the benefit of RRU can still be increased -- it provides a valuable insight into the epidemiology of different social diseases.

Heart Diseases

[New aspects in the treatment of allergic asthma (author's transl)].

Preventive measures in atopic persons comprise genetic advice, identification of, and prevention of contact with, the more common antigens in infancy and, later on, avoidance of exposure to antigens during the flowering season. In view of the complexity of the asthmatic attack the diagnosis must include all relevant parameters as otherwise consistent treatment is impossible. The only causal therapy is avoidance of exposure to antigens and also to unspecific (physicochemical) noxae which are nearly always superimposed. The value of specific immunotherapy varies according to the antigen or combination of antigens. The final verdict has to await the results of controlled studies in carefully classified and analysed groups, including investigations of immune parameters and uninterrupted registration of exposure to antigens. Until the efficiency, indications and mode of application of immunotherapy have been clearly established desensitization is preferable, provided the allergen has been identified and proved to be active, and exposure to the antigen cannot be avoided. The relatively high success rate obtained with placebos is presumably attributable to concurrent symptomatic treatment and avoidance of contact with the antigen. The already broad spectrum of adjuvent therapy is being constantly and successfully enlarged. Attempts to stimulate the production of antigen-specific suppressor T-cells by denatured antigens, and thereby prevent IgE production, are promising. Until a causal anti-allergy therapy has been developed a carefully and individually planned somatic and psychic polytherapy must remain the rule.

Adult