Biomedical subjects
Publications and source records attributed to G Liebetrau.
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The malignant fibrous histiocytoma of the lung is one of the rarely diagnosed soft tissue sarcomas. With the presented case-history we want to remind of this kind of lung-tumour in particular of the possibility of pre-operative diagnostic and the radiological differential diagnosis.
Associated reactions of the connective tissue of the lungs are by no means rare in several extrapulmonary disorders, for example, with the "so-called" collagenoses. They are less frequent in chronic inflammatory intestinal diseases. The mechanism of this pulmonary reaction is largely unclarified. The situation is complicated further by the fact that a drug side reaction may compete with the underlying disease. The problem of a change in the connective lung tissue within the framework of a chronic inflammatory intestinal disease or as a result of drug therapy of that disease, is described and demonstrated via the cases of two patients.
During the last years occupational diseases are of increasing interest. This lead to an increased sensibility which results in a continuous increase of the number of announcements of suspicion of an underlying occupational diseases. The rate of cases first remunerated remains nevertheless constant. The number of diseases caused by inorganic and organic dusts and the obstructive airway-diseases increase despite of the continuous decrease of silicosis. Among the diseases first remunerated in 1990, occupational diseases caused by inorganic dusts took up the first place (31.6%). As for the deaths in 1990, 91% are due to diseases caused by inorganic dusts.
A large number of different pulmonary diseases eventually result in producing the final morphological pattern of pulmonary fibrosis. Basing on essential cardiopulmonary functional parameters, four relatively frequently encountered fibrotic pulmonary diseases are compared with each other. Patients suffering from bird breeder's lung show typical obstructive disturbances of ventilation that are even more marked in collagenoses with lung involvement. Patients suffering from electric welder's lung are notable for enhanced respiratory tract obstructions and increased residual volumes. In patients with sarcoidosis it is recommended to determine, above all, the lung compliance besides measuring the diffusion capacity. The specific compliance should be chosen as criterion to assess the compliance, so that the preliminary extension of the lung by emphysema is taken into consideration. Welder's lungs, bird breeder's lungs and collagenoses show a load-conditioned respiratory partial insufficiency and a latent pulmonary hypertonia. The examined groups of patients showed similar functional patterns, but individual parameters were disease-specifically considerably different from standard values.
Many different inhalative substances may cause allergic alveolitis (hypersensitivity pneumonitis). We report on a worker who developed lung fibrosis due to the sensitization to pearl oyster shell dust. High concentrations of IgG antibodies to proteins (conchagens) of the shell which appear to represent the relevant antigens were found in the patient's serum.
UNLABELLED: The development of alveolitis or lung fibrosis through drugs is wellknown, however rare described in the spectrum of drug side effects. In six cases of patients with neurological diseases were studied the relationship between alveolitis or lung fibrosis and a long-time therapy with especially drugs in a neurological practice. CONCLUSION: By the etiological examination of alveolitis or lung fibrosis it is necessary to pay attention to the possible relationship between drug and disease.
Exogenic allergic alveolitides are caused by organic dusts which contain bacteria, moulds or vegetable and animal antigens. The farmer's lung as a form of the exogenic allergic alveolitis is a rare disease. The uncharacteristic symptomatology in the initial phase and in particular the retarded beginning of the symptom after several hours handicap the timely recognition in an early phase of the disease so that curative therapeutic measures are rarely possible. The cases of the disease are found only at the chronic stage, at the stage of the pulmonary fibrosis. Then the prognosis is unfavourable. In the Central Clinic for Heart and Lung Diseases Bad Berka 1,110 patients with alveolitides and lung fibroses were diagnosed in the period from 1975 to 1988. 306 of them could be clarified as exogenic allergic alveolitis, 61 of them (19.8%) were farmer's lungs.
Aetiologically, less than 50% of the alveolitides and pulmonary fibroses are clarified. A successful causal therapy by elimination of the noxae is thus possible only in several acute cases, particularly in forms of the exogenic allergic alveolitis. Usually the clinical pictures are misunderstood for a long time and are diagnosed only in advanced stages. The therapeutically influencible inflammatory changes are in such a case only slightly expressed. The more or less advanced fibrosis is not or only slightly to be influenced. Then the last way out of the difficulty of the lung and the heart-lung transplantation, respectively, the size of which, however, is limited by the small number of suitable donors. In the initial phase of the diseases in toxic and allergic-immunologic the inflammations resulting from this in the pulmonary tissue are partly to be controlled by antiinflammatorily and immunosuppressively, respectively, acting medicaments such as corticosteroids, azathioprin and cyclophosphamide. For the treatment of the lung fibrosis only D-penicillamine is at our disposal. Because of the numerous, partly considerable side effects and due to the effectiveness of the necessary long-term therapy which is only difficult to be measured there are very different opinions about the treatment with penicillamine. The enlargement of the knowledge on the pathogenesis of alveolitides and lung fibroses allows to hope that new beginnings for a therapy are found. No final judgement can be made about the efficacy of cyclosporin A and of antioxidants.
Thirteen years' experience with long-term oxygen therapy at home for patients with chronic respiratory distress are reviewed. In the period since 1976 37 patients with chronic obstructive pulmonary disease and 48 patients with restrictive respiratory disorders were treated. During oxygen breathing both groups showed the same results in regard to behaviour of the oxygen partial pressure, the carbon dioxide partial pressure, the hematocrit and the heart rate. The mean survival-time amounted to 26 months. The long-term oxygen therapy is useful in the treatment of patients with respiratory insufficiency caused by chronic obstructive pulmonary disease and by restrictive respiratory disorders as well.
It is reported about two pig-breeders with the typical symptoms of an exogen allergic alveolitis after having worked in a pigsty. The diagnosis "Pig-Breeders'-Lung" was confirmed by the prove of precipitating antibodies against pig-epidermis components (scales) and pig-serum.
Immunohistologic investigations were performed in 124 lung tissue test of diffuse pulmonary processes obtained by transthoracic needle biopsy. In 40.3% the unselected material showed a positive immunofluorescence. It appeared in all groups formed by light microscopy. In the exogenic allergic alveolitis with 36.8% it was falling short of the expectations. The investigations allow of the conclusion that the immunohistology in diffuse pulmonary processes shows clearly applicable results neither for the diagnostics nor for the therapy and also not for the prognosis.
A latent or stable pulmonary hypertension was established in three patients with a Q-Fever-Infection confirmed as occupational disease. According to sparse informations in the literature the development of a pulmonary hypertension in the course of this disease is taken into account. The investigation programme regarding Q-Fever-Infections should be completed by measurement of pulmonary artery pressure.
Case reports on 4 women operated on for suspected tumour. The diagnosis of sarcoidosis was confirmed histologically. The difficulties associated with the differential diagnosis are discussed and, the need for morphological clarification is emphasized.
This article presents case reports on brother and sister suffering from microlithiasis alveolaris pulmonum. Diagnosis was established by means of the course of the disease, the relatively typical x-ray film and the findings on performing scintigraphy of the skeleton and also by computed tomography. Findings confirmed that the course of the disease is symptom-free for a long time; that it occurs in both sexes; and that it becomes manifest with considerable incidence in some families. Pulmonary alveolar microlithiasis is not a generalised metabolic disease, since it affects the lungs only. If the aetiology remains unclear, no causal treatment can be effected.
The causes for an exogenic allergic alveolitis are very multifarious. On the basis of a casuistics is referred to the development of such a disease by the contact with fruit mould in cold-storage plants.
In 63 out of 887 patients with alveolitis and pulmonary fibroses was causally found a so-called "collagenosis". A participation of the lung in such diseases is prognostically unfavourable. The changes in the framework of the lungs radiographically, functionally and morphologically cannot be separated from fibroses of other origin. The diagnosis is to be made after exclusion of other noxae and taking into consideration the appearances of the primary disease (clinic, spectrum of organs, special laboratory parameters etc.).
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