Biomedical subjects
Publications and source records attributed to B Wiesner.
Alterations in the small airway tests (flow volume diagram, single breath test, frequence dependence of compliance, nitrogen washout) on 9 asthmatics were measured by the treatment with Atrovent. We found no influences on the peripher obstruction and on the unequal ventilation.
It is reported on the different forms of the interstitial pulmonary diseases. Apart from the clinical examination the establishment of the professional and hobby anamnesis play an important part for the differential diagnosis. Allergologic and immunologic examination methods may contribute to the etiologic clarification. In unclear findings a bioptic ascertainment is necessary, though histologically not all cases are to be clarified. The author enters the most important clinical pictures and refers to the difficulties of the radiological differential diagnostics. Questions of therapy are briefly discussed.
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Morphological investigations (light microscopy, enzyme histochemistry, immunopathology) were carried out in cases with asthma bronchiale and chronic bronchitis. According to the histological picture no additional parameters were found with enzyme histochemical and immunopathological methods to specify the diagnosis asthma bronchiale and chronic bronchitis. The most important diagnostic factors in chronic bronchitis are hyperplasy of mucous bronchial glands and atrophy of serous bronchial glands with a loss of activity of acid phosphatase. Diffuse thickenings of basal membrane were more often in asthma bronchiale, localized thickenings more often in chronic bronchitis. Hypertrophy of goblet cells, infiltrations with round cells and metaplasia are found both in asthma bronchiale and chronic bronchitis in different degree. Correlations exist between the activity of leucine aminopeptidase in the stroma of the bronchus and degree of cellular infiltration with lymphocytes and plasma cells.
Bronchoscopy and bronchography are further important diagnostic methods in lung diseases. Their development to a high level was influenced by the construction of Friedel's bronchoscope. In the future it will be necessary to extend these methods to general hospitals under special pressuppositions.
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A nearly nation-wide team-work of six chest hospitals was made with 4284 patients to analyse all performed diagnostic procedures up to the present. Its frequency and diagnostic importance in relation to the radiographic stages of the disease were examined. Especially the procedure of bronchologic examination, having been partly underrated with the morphological ascertainment of sarcoidosis, are now purposefully analysed. This showed that also with perbronchic punction-biopsy and bronchoscopic excision morphologically confirming of the diagnosis was possible at a high percentage. On the other side the right diagnosis was made clinically before bioptic procedures in the majority of the patients. The overall conclusion is that, according to the experiences made in our hospitals, the relatively harmless bronchologic procedures are in general sufficient to obtain bioptic verfication of the diagnosis "sarcoidosis". Other bioptic operations like mediastinoscopy or lung biopsy can be restricted to cases with reasonable doube of the diagnosis.
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In 61 patients with mostly diffuse lung diseases 64 transbronchial lung biopsies have been performed by means of rigid biopsy forceps in general anesthesia. 31 of the 36 pathological bioply specimens were diagnostically helpful or represented the clinical diagnosis. Complications were moderate bleeding in three cases and pneumothorax (3 cases). One patient died after myocardial reinfarction occuring under general anesthesia. Transbronchial lung biopsy is indicated when routine methods fail to establish the diagnosis of pulmonary lesions, particularly in patients having higher operative risks. More use of the transbronchial forceps biopsy is expected to improve the diagnostic yield, especially in patients with miliary pulmonary lesions.
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Within the frame of intensive care we do no longer use the conventional tracheostomy but the so called "sewed-up tracheostomy". Between January 1971 until November 1973 31 children of all age-groups were treated by that method. Special care for patients with sewed-up tracheostoma is obviously facilitated. The replacement of cannulas has become easy. Plastic closure after decannulation offers good functional and cosmetic results. Surgical techniques, indications and criteria for institution and closure of the tracheostomas are described and 31 cases are evaluated. Complications occuring during the period of tracheostoma and subsequent to the plastic closure as well as the general fate of the children are reported.
13 children of all age groups, suffering from a respiratory insufficiency, and treated with a sewed-up-tracheostoma, were examined by tracheoscopies in regular intervals. The patients were followed up for at least two years and six months. 46 bronchoscopies were performed. Very quick epithelization of the transplantate with two typical forms of the transplantate could be found: development of a pad, and a prolaps of the transplantate. The development of a pad could be considered as the more favourable form with regard to the pulmonary function. The bronchological and roentgenological follow-up-examinations revealed good functional results in all cases except one.
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