Biomedical subjects
Publications and source records attributed to C Engelmann.
9 cases of thoracic actinomycosis are analysed with regard to their antibiotic therapy. On account of sensibility of the bacteria and the pharmaco-kinetics of the antibiotics the therapy with Ampicillin in high doses is recommended for relatively short time. This therapy should be performed in any case before surgical measures.
84 patients with bronchial carcinoid tumors were analysed on during of 28 years. 26 of them were detected by radiography and 58 by symptoms. The bronchoscopy with biopsy is the most important diagnostic procedure. The preoperative histological or cytological diagnosis was correct in 25 cases. The suspicion was given only in 39 patients. The surgical therapy was carried out in all cases with conventional resection of lung as well as parenchyma preserving methods. We used atypical or typical segmental lung resections, bronchotomy with direct suture, sleeve or wedge resection of the bronchus and fenestration of bronchus with closure of the window with free skin graft. The prognosis after surgical treatment is very good. The 5-year-survival was 89%.
A simple test for demonstration of smoker cells was verified on bronchoalveolar lavage (BAL) and cytological smears of lung tissue. Alveolar macrophages exhibit in 81% (BAL) respectively 86% (surgical material) of the smokers with Fettrot 7B a red colouring of the cytoplasm. Only few non-smokers show a positive reaction for smoker cells. In ex-smokers this positive reaction disappears after 7 month. We conclude, that this method is very sensitive but not absolutely specific for detecting smokers with a simple cytological test.
The cause of traumatic tracheobronchial lesions are ruptures as result of blunt trauma, penetrating injuries, iatrogenic manipulations and aspirated fixed foreign bodies. Such lesions are relatively rare. Tracheobronchial lesions with clinical relevance were detected in an acceptable time after the trauma. Emergency tracheobronchoscopy is of great importance for the diagnosis. In the most of patients with bronchial ruptures we have been able to avoid a lung resection by the early operation with direct suture.
"Reconstructive bronchial surgery" and "parenchyma-preserving operation" are terms which define the surgical purpose of restoring patency of the bronchial system or avoiding non-patency. This is beyond the limits of bronchoplasty. Inflammatory lesions are rare as reasons for reconstructive surgery. This indication applied to merely 13 of 120 of the author's patients who underwent reconstructive operations on their tracheobronchial system. Tuberculous aetiology was predominant. Bronchoplastic measures, therefore, were associated with lobectomy in almost all cases. Parenchyma-preserving operations may yield lasting success with minor complications even in cases of inflammatory processes, provided that indications were carefully established and operations performed with subtle techniques.
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Radiological changes in the lung, in the mediastinum and in the pleura should always be clarified. The thoracic surgery realizes methods, which have a minimal risk and a low rate of complications but have a high degree of efficacy. Those methods are biopsy of lymphatic nodes, mediastinoscopy and open chest pleuro-pulmonary biopsy. The methods are described and their indications and also their value is discussed in the scope of the diagnostic system of the lung clinic.
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Dehiscence of bronchial trunk after lung resection is a severe complication. Beside early re-thoracotomy, in certain cases endoscopic (bronchoscopic) treatment of the bronchial fistula may be applied. In a series of patients, we used this method successfully with the help of a fibrin glue of domestic production. The method is most appropriate for fistulas of small and medium size.
Surgical operations for metastases are palliative. If no effective alternative treatment is available, excision of metastases may be the treatment of choice also for extrapulmonary metastases in the thoracic region and for multiple pulmonary metastases. Experience has shown that, in some cases, the course of a patient markedly improved by resection. However, the success is dependent on an effective chemotherapy, not on surgical enthusiasm. A case selection based on favourable prognostic criteria is not justifiable today. More experience is needed before a therapeutic algorithm may be developed.
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Parenchyma-preserving resection techniques with broncho- and angioplastic methods contribute to avoid palliative pneumonectomy in cases of extended bronchial carcinoma (greater than T2; greater than N1). 18 cases are analysed.
We obtained important informations in respect of tumor extent according to the TNM-classification by computed tomography in 99 patients with bronchogenic carcinomas. This method shows high accuracy in assessment of tumor extent and of mediastinal lymphatic metastases. The detection of metastases in the upper abdomen is possible too. In spite of some limitations computed tomography is definitely superior to all roentgenological methods in assessing the stage of bronchogenic carcinoma. It is of value in exploration of local operability and in planning radiation therapy.
Left-sided homologous lung transplantations (LTP) were carried out in 18 mongrel dogs. Exhalation and perfusion scannings took place for interpreting the ventilation and perfusion in the postoperative course. The per cent Xe133 storage and the exhalation per minute show the significant reduction of the ventilation in the transplants dependent on the duration of the postoperative interval. The compensation behaviour of the ventilation of the non-operated lung shows the compartment analysis. The perfusion index QL/QR with Tc99m decreased progressively in the postoperative course.--These investigation methods are slightly invasive. They allow the synoptic recording of the relationships between ventilation and perfusion. A differential diagnosis of complications after lung transplantations is not possible, however.
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