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Bronchoalveolar lavage [BAL] is an important procedure in the diagnosis of a variety of lung diseases. While it has enormous value in the diagnostics of inflammatory parenchymal diseases, its significance in lung cancer is unclear. Keeping in mind that immune therapy (e. g. application of checkpoint inhibitors) is gaining importance in the management of lung carcinoma, it is important to know if there are typical cellular patterns in BAL of lung cancer patients.

There are no European Guidelines on issues specifically related to travel for people with cystic fibrosis (CF). The contributors to these recommendations included 30 members of the ECORN-CF project. The document is endorsed by the European Cystic Fibrosis Society and sponsored by the Executive Agency of Health and Consumers of the European Union and the Christiane Herzog Foundation.The main goal of this paper is to provide patient-oriented advice that complements medical aspects by offering practical suggestions for all aspects involved in planning and taking a trip. The report consists of three main sections, preparation for travel, important considerations during travel and at the destination, and issues specific to immunocompromised travellers. People with CF should be encouraged to consult with their CF centre prior to travel to another country. The CF centre can advise on the necessary preparation for travel, the need for vaccinations, essential medications that should be brought on the trip and also provide information relating to CF care in the region and plan of action in case of an emergency.

185 patients with hyperprolactinaemia and prolactinoma were evaluated in a retrospective investigation. 128 patients were treated surgically whereby the prolactin serum level in 47% of the macroprolactinoma and 60% of the microprolactinoma patients was normalised (prolactin less than 25 ng/ml, no radiological evidence of tumor). Of those patients in whom the operation was less successful, a normal prolactin level could be achieved in 77% by additional therapy with dopamine agonists. Of 57 patients handled exclusively with drugs, the prolactin level was normalised by dopamine agonists in 78%. A small number of patients from both groups did not show a satisfactory fall in the prolactin level despite the use of markedly higher doses of dopamine agonists. During dopamine agonist therapy progressive tumor enlargement was detected radiologically in a previously operated patient.

Granulomatous lung diseases are frequently occurring pulmonary diseases.Important granulomatous lung diseases are sarcoidosis and pulmonary tuberculosis. Furthermore, granulomas can be caused by foreign body reactions like berylliosis or silicosis as well as by other infections (e. g. by nocardia spp.).Granulomatous systemic inflammatory diseases such as the Churg Strauss syndrome or the Wegener's granulomatosis can harm the lung as well.In this case report, we describe a patient who visited our emergency room because of apparent refractory pneumonia. First histologic specimens showed sarcoid-like lesions. Subsequent investigation showed invasive mucinous adenocarcinoma of the lung.

Until recently "mechanical ventilation" meant "intensive care unit (ICU)". Important arguments for more flexibility concerning the locality where patients are mechanically ventilated are the increase in number of patients, costs and reduced resources. The pulmonary centre for mechanical ventilation, where ICU, respiratory intermediate care unit (RICU) and the specialized normal ward are complementary, is an attractive option for the future. The RICU is the key player in this concept, since as a step down unit it represents a cost-effective approach to the care of substantial numbers of selected patients requiring specialized respiratory care, e. g. intensive respiratory monitoring and therapy, particularly those requiring prolonged mechanical ventilation and non-invasive mechanical ventilation. Success of the RICU requires an experienced team, adequate location and high quality of technical equipment, experienced team, adequate location and high quality of technical equipment.

Autoimmune paraneoplastic processes are investigated in detail concerning the Lambert-Eaton-Myasthenic-Syndrome for bronchial carcinomas. For the cutaneous leukocytoclastic vasculitis as a non-ANCA-associated vasculitis the paraneoplastic genesis is described. Litttle is known about ANCA-associated vasculitis as a paraneoplastic autoimmune phenomenon. We present the case of a 62 year old woman referred to our hospital presenting air-space shadows mainly in both upper lobes, skin rash with petechial bleeding and a highly positive pANCA-titer. A bronchioloalveolar carcinoma was diagnosed by surgical biopsy. The patient developed renal failure postsurgically and died a few weeks after the diagnosis was established. This is the 5 (th) case in literature of the temporal concurrence of a bronchial carcinoma and an ANCA-associated vasculitis. So far only 24 cases of a solid tumor occuring simultaneously with an ANCA-positive vasculitis are reported in literature.

The value of ultrasound examination of the pleura and lungs remains highly underestimated to this day. While the ventilated lungs and the osseous skeleton of the thorax represent potent obstacles for ultrasound, a multitude of pathological processes of the chest wall, pleura, and lungs results in altered tissue composition, providing markedly increased access and visibility for sonographic examination. These conditions support the sonographic diagnosis of pleural and pulmonary disorders. However, the main value of pleura and lung ultrasonography is not the primary diagnosis of chest lesions but the follow up, differential diagnosis, detection of complications, such as abscesses and post embolic lung infarction, and guidance of diagnostic and therapeutic interventions in patients with pathological pleural and pulmonary findings. Punctures and drainages of fluids, e. g., haematothorax, empyema, chylothorax as well as biopsies of solid lesions can safely be performed under ultrasound-guidance. It is of special importance that pleura and lung ultrasonography, as a non-invasive method, can be repeated without discomfort or radiation exposure for the patient and is therefore valuable in the follow-up of pathological findings. Adequate interpretation of sonographic pleura and lung findings has to consider the patient's history, physical examination, chest X-ray and other results obtained by complementary imaging technologies (e. g. thoracic computed tomography).

Approximately 4 million patients with a rare disease live in Germany. The medical care of these patients is problematic because of the rarity and heterogeneity of different clinical pictures. The Federal Ministry of Health has therefore published a research report on "Measures to improve the health situation of people with rare diseases in Germany" in 2009.The aim of this paper is to present the main recommendations of this research report and relate it to current developments in the field of medical care for people with rare diseases.The care situation of patients with rare diseases was determined using questionnaires, expert interviews and focus group discussions with representatives of patients, service providers and stakeholders from the health institutions.The main range of actions that have been identified in the research report were centre and network formation, specialized forms of medical care, diagnosis and treatment, information and experience exchange, performance fees and reimbursement of the costs, guidelines and patient pathways, the research, the implementation of a National Action Alliance and the development of a National Action Plan.In March 2010 a National Action League for People with Rare Diseases (NAMSE) was founded. The NAMSE created a national plan of action for people with rare diseases for improving medical care in the field of rare diseases which was approved by the Federal Government in August 2013. Thus, two important areas of the research report have already been implemented. In a comparison of the areas of activity of the research report with those of the National Action Plan it becomes clear that priorities will be in the context of health services research in rare diseases, for example the introduction of centres of reference for rare diseases, measures to accelerate the diagnostic process and the promotion of research and information management in the future.

Anxiety occurs frequently in patients who are on the waiting-list for a lung-transplantation or have already been transplanted. In this context anxiety is a theme of every interaction of doctor and patient but often remains unrecognized because it hides behind bodily symptoms and mechanisms of defense. Anxiety affects patients' behavior and compliance and may afflict - especially if not recognized - doctors' decisions and thus patients' health and survival. It is therefore necessary to recognize and to openly handle anxiety in the interaction of doctor and patient.

Background While defensins have received great attention for their role in bronchial innate immune defence, little is known about the expression levels of the four human epithelial defensins (HD5, HD6, hBD1 and hBD2) in the digestive tract. In this study we quantified the α- and β-defensins mRNA in biopsies obtained from the gastrointestinal mucosa and identified the cells expressing the β-defensin hBD1 mRNA in ileal mucosa. Material and methods Biopsies from human stomach (corpus and antrum), duodenum, jejunum, ileum and colon were analysed for their expression of α- and β-defensins. The mRNA of defensins was quantified by semiquantitative reverse transcription–polymerase chain reaction. Cells expressing β-defensin hBD1 mRNA were identified by in situ hybridization with 35S-labelled RNA probes in tissue sections of human ileum. Results The hBD1 mRNA was expressed at low levels with little variability throughout the gastrointestinal tract and was detected in all epithelial cells of ileal mucosa. HD5 and HD6 mRNA expression was restricted to the intestine and displayed high interindividual variability. The highest expression levels were observed in jejunum and ileum. Biopsies obtained from duodenum displayed low levels or no expression of HD5 and HD6. The expression level increased considerably in a biopsy obtained from a patient with acute coeliac sprue. In contrast, low levels were observed in a biopsy from a patient with coeliac sprue in remission. Conclusions The expression levels of hBD1, HD5 and HD6 throughout the gastrointestinal tract are tissue and peptide specific and these defensins are expressed with high interindividual variability.

Im Rahmen einer Fragebogenaktion wurde der Stand der Intensiv-Versorgung an Kliniken mit in der Deutschen Gesellschaft fur Pneumologie (DGP) organisierten Pneumologen untersucht. Dazu wurden samtliche eingetragenen Mitglieder der DGP zur Situation an der Klinik, an der sie arbeiten, befragt. Von mehr als 1600 angeschriebenen Arzten antworteten 240, die 145 verschiedene Kliniken reprasentieren (Rucklaufquote: 14,4%). Analysiert wurden die Anzahl und Art der Einrichtungen, die pneumologische Gesamt- und Intensivbettenzahl und das pneumologisch-intensivmedizinische Leistungsspektrum. Auch wenn der Anteil pneumologischer Intensivbetten an der Gesamtzahl pneumologischer Betten an Universitatskliniken genau so hoch liegt wie an Lungenkliniken, finden sich weder an Universitatskliniken (8%) noch an Versorgungskrankenhausern (2%) eine akzeptable Anzahl pneumologisch verantworteter Intensivbetten, und selbst an Lungenkliniken (50%) wird nur ein Teil der Intensivstationen durch Pneumologen geleitet. Pneumologen haben in Deutschland bezogen auf die Gesamtzahl der internistischen Intensivbetten so gut wie nichts mit der Intensiv-Versorgung zu tun. Das in Deutschland bestehende Defizit in der Prasenz von Pneumologie an Universitatsklinika und an den anderen Krankenhausern spiegelt sich – im Gegensatz zu anderen Landern – in besonderer Weise in der internistischen Intensivmedizin wider.

Background: Multiple organ failure is regarded to be the major complication of trauma victims treated in the intensive care unit. Long-term rehabilitation results of this special group of patients have not been analyzed so far. Methods: Fifty patients with multiple injuries and multiple organ failure (Injury Severity Score < 36.8) were followed-up 4.9 ± 0.3 years after the trauma. To show any organotopic sequelae, laboratory tests for the function of lungs, liver, kidney, and the hematologic system were performed. Additionally their functional (locomotion and neurologic system) and occupational rehabilitation results were investigated. Results: The laboratory tests showed entirely normal results. The only pathologic values could be found in the lung function tests. Nineteen percent of the patients showed nonphysiologic results in either spirometry, body plethysmography, or diffusion capacity of carbon monoxide. In more than 25% of the patients, permanently decreased range of motion (limitation of more than 30% of the entire range of motion) of the elbow, hip, knee, or ankle joint were found. In 40% of the patients, permanent motoric nerve lesions were identified; in 50% of the patients, permanent sensoric nerve lesions could be verified. The return to work rate was 60%. Conclusions: Patients with multiple injuries, who survived multiple organ failure during their long-term intensive care treatment, show an excellent functional and occupational rehabilitation result. They show no major sequelae in their organ function even years after the trauma. Although often these patients suffer from permanent central or peripheral paralysis and decreased range of motion, this finding does not correlate with the patients' ability to return to work.

Cystic fibrosis is an inherited autosomal recessive metabolic disease caused by mutations on the CFTR gene. This leads to defective chloride channels on epithelial cell membranes and causes various disorders of the respiratory, gastrointestinal, and urogenital tracts.As a result, all exocrine glands produce a viscous secretion, leading to pulmonary symptoms such as chronic cough, secretion retention, recurring infections as well as bronchiectasis and obstructive lung emphysema. Gastrointestinal effects include exocrine and often also endocrine pancreatic insufficiency with chronic diarrhea and maldigestion syndrome as well as pancreoprivic diabetes mellitus; biliary cirrhosis occurs in 10% of cases. Additional effects include reduced fertility in women and infertility in men.Life-threatening complications include bleeding from the bronchial arteries, pneumothorax, and distal intestinal obstruction syndrome (DIOS), previously known as meconium ileus equivalent. Treatment requires rapid diagnosis and should be carried out in experienced centres, since the mortality rate can otherwise be up to 50%.

Catecholamines have been suggested to be responsible for altered cellular immunity after stress. This study was performed to determine the effects of adrenaline and noradrenaline on lymphocyte subpopulations and NK cell functions. Subjects were given a subcutaneous injection of either NaCl, adrenaline (5 micrograms/kg), or noradrenaline (10 micrograms/kg). Catecholamine concentrations, subsets of peripheral blood lymphocytes, NK activity, and antibody-dependent cellular cytotoxicity (ADCC) were analyzed before (baseline) and 5, 15, 30, 60, and 120 min after injection. There were no differences between groups in the distribution of CD2+ and CD8+ lymphocytes over time. However, CD3+ and CD4+ T cells decreased significantly 5 to 60 min after injection of adrenaline. In contrast, NK cell numbers (CD16+, CD56+) increased significantly 5 min after injection of adrenaline and noradrenaline, reached the highest values 15 to 30 min postinjection, and subsequently declined to baseline values 60 (noradrenaline) and 120 (adrenaline) min, respectively, after injection. Similar alterations for NK activity and ADCC were observed after administration of both catecholamines. These data suggest that both sympathetic-adrenal hormones are similarly potent modulators of natural immunity and provide further evidence that catecholamines might be responsible for the observed alterations in immune functions after phases of acute stress.

Emotional stress is often followed by increased susceptibility to infections. One major role in the immediate immune response to infection is played by natural killer (NK) cells. This study was designed to establish whether acute psychological stress influences cellular immune functions and to elucidate the role of endocrine parameters as potent mediators of stress induced alterations of the immune system. Forty-five first-time tandem parachutists were examined continuously for their plasma concentrations of cortisol and catecholamines from 120 min before to 60 min after jumping. Lymphocyte subsets, NK activity, and ADCC were determined 2 hr before, immediately after, and 1 hr after jumping. There was a significant increase in sympathetic-adrenal hormones during (adrenaline, noradrenaline) and shortly after jumping (cortisol). Lymphocyte subsets and the functional capacity of NK cells revealed an increase immediately after jumping followed by a decrease significantly below starting values 1 hr later. These changes were significantly correlated to plasma concentrations of noradrenaline. Thus, quick mobilization of NK cells is suggested as one major mechanism for this effective adaptation of the immune system to stress situations.

The circadian and pulsatile TSH secretion profiles were investigated in 5 females at the time of menstruation and 21 healthy males by sampling blood every 10 min for 24 h. Computer-assisted analysis, i.e. the Cluster and Desade programs, revealed means of 9.9 +/- 1.7 (Cluster) and 11.4 +/- 3.9 (Desade) pulses/24 h. More than 50% of the TSH pulses were detected between 2000-0400 h. Male and female subjects showed no significant difference in the basal mean and pulsatile secretion of TSH or in the TSH response to TRH (200 micrograms). Repetition of the TSH secretion analysis in 4 healthy subjects after 1, 2, and 6 months (2 subjects) revealed a significantly better cross-correlation within than between individuals (P less than 0.0001). We modulate the circadian TSH secretion pattern by acute sleep withdrawal or prolonged sleep after a night of sleep withdrawal in six healthy male volunteers. Sleep withdrawal augmented the nightly TSH secretion (mean serum TSH, 2.1 +/- 1.3 mU/L; mean TSH in sleep, 1.3 +/- 0.5 mU/L; P less than 0.05), whereas sleep after sleep withdrawal almost completely suppressed the circadian variation (mean TSH, 1.1 +/- 0.7 mU/L; P less than 0.01). This modulation is due to a significant decrease in pulse amplitude, but not to an alteration in the frequency or temporal distribution of TSH pulses.

We describe the rare case of a high-grade chemical irritating-toxic damage to the larynx, the trachea and the bronchial system due to the aspiration of the bisphosphonate alendronate. The aspiration of alendronate was caused by oropharyngeal dysphagia. The 68-year-old female patient was sent to hospital with increasing hoarseness and a tormenting continuous cough of high intensity. X-Ray pictures of the thorax showed dystelectasis of the right middle lobe. Severe damage to the bronchial system caused by the aspirated alendronate was demonstrated by flexible bronchoscopy. Anti-obstructive, antiphlogistic and antibiotic treatment led to a gradual improvement of the symptoms. The administration of alendronate should be avoided in cases of dysphagia. Besides the danger of oesophageal injury, there is also the risk of aspiration that can be associated with severe damage to the bronchial system as this case study demonstrates.

For staging, follow-up and even screening (www.screening.info) an "all-in-one" imaging examination is desirable. In the concept of whole body MRI, lung imaging prevails as the weakest link. The purpose of our study was to determine the optimal MRI sequences for the detection of malignant lung nodules.On the basis of 6 lung cancer, 46 metastases and one tuberculoma in 13 patients eight MRI sequences--HASTE, IR-HASTE, fat saturated TrueFISP, STIR, VIBEipat = 2, and contrast-enhanced (CE) VIBE (with ipat = 2, 0, 4) performed with parallel imaging and 12 matrix coil elements--were compared in terms of contrast-to-noise ratio (CNR) and quality in the visualization of the lung nodules using multidetector CT as standard of reference. The parameters of the sequences were pragmatically selected to minimize the imaging time to allow for imaging the entire lung within one breathold interval.The STIR sequence was found to be the best for detecting malignant lung nodules (p0.01) followed by the FS TrueFISP, CE VIBE subsetipat = 0, CE VIBE subsetipat = 2, IR-HASTE, HASTE, CE VIBE subsetipat = 4, and VIBE. The STIR sequence visualized malignant nodules down to 2 mm in size and did not display the 19 mm tuberculoma.The STIR sequence should be included in future studies investigating if MRI can compete with CT in the early identification (detection and classification) of malignant lung nodules.

Until recently "mechanical ventilation" meant "intensive care unit (ICU)". Important arguments for more flexibility concerning the locality where patients are mechanically ventilated are the increase in number of patients, costs and reduced resources. The pulmonary centre for mechanical ventilation, where ICU, respiratory intermediate care unit (RICU) and the specialized normal ward are complementary, is an attractive option for the future. The RICU is the key player in this concept, since as a step down unit it represents a cost-effective approach to the care of substantial numbers of selected patients requiring specialized respiratory care, e. g. intensive respiratory monitoring and therapy, particularly those requiring prolonged mechanical ventilation and non-invasive mechanical ventilation. Success of the RICU requires an experienced team, adequate location and high quality of technical equipment, experienced team, adequate location and high quality of technical equipment.

Today, the majority of cystic fibrosis (CF) patients treated in Germany have reached adulthood. However, with increasing age the morbidity and frequency of severe pulmonary complications continues to rise. Further optimization of conventional therapy alone will be insufficient to compensate for this development. In recent years, there has been impressive progress in our understanding of the molecular basis of the CF gene and its product, the cystic fibrosis transmembrane conductance regulator (CFTR). This knowledge can now be applied to develop new therapeutic strategies. However, important questions remain to be solved, i. e., little is known about the pathways that link the malfunctioning of the CFTR protein with the observed clinical phenotype. This review briefly touches on CF genetics as it applies to lung disease and will focus on the current hypotheses of CFTR (dys)function and its impact on pulmonary fluid homeostasis. New treatment options that target the molecular basis of the disease will be discussed.

The liver is central to the metabolic response to exercise but measurements of effects of reduced liver function on the physiological adaptation to exercise are scarce. We investigated metabolic, endocrine, pulmonary and haemodynamic responses to exercise in 15 healthy untrained controls (Co) and in 30 subjects with reduced liver function (i.e. liver cirrhosis, Ci). The following protocols were used: protocol 1 maximal oxygen uptake \(\dot V{\text{O}}_{{\text{2max}}}\) and anaerobic threshold (AT), protocol 2 stepwise increases in exercise intensity from 0 to 40% \(\dot V{\text{O}}_{{\text{2max}}}\) giving steady-stage conditions, protocol 3 1 h exercise at 20% \(\dot V{\text{O}}_{{\text{2max}}}\). Muscle glycogen content was determined in 15 Ci. Spirometry was essentially normal in Ci. Result: protocol 1 Ci had impaired \(\dot V{\text{O}}_{{\text{2max}}}\) and reduced AT (P < 0.05). Basal plasma concentrations of insulin, glucagon, growth hormone and adrenaline were increased in Ci (P < 0.05); cortisol was normal. During exercise, only glucagon remained different between groups. In protocol 2 Ci had decreased resting respiratory exchange ratio (RQ: p < 0.05) associated with increased plasma concentrations of free fatty acids and glycerol. They had disproportionately enhanced lipolysis and RQ. heart rate (+ 24%), ventilation (+ 28%), thermal effects of exercise (+ 31%) and intrapulmonary shunt volume (+ 76%), which accounted for 11.7 (SD 3.0) or 7.4 (SD 0.9%) of cardiac output during exercise in Ci and Co, respectively (P < 0.05 for all the differences reported). The metabolic effects of Ci were independent of the clinical and nutritional state of the patients. In protocol 3 muscle glycogen content was highly variable in Ci, but mean values were normal [16.9 (SD 8.9) μmol·g−1 wet mass]. Glycogen content positively correlated with resting and exercise-induced RQ, but negatively correlated with the exercise-induced alterations in plasma glucose concentration. From these results we concluded that with reduced liver function \(\dot V{\text{O}}_{{\text{2max}}}\), and AT are reduced, but metabolic, pulmonary and haemodynamic reponses per unit power output are enhanced. Muscle glycogen content would seem to contribute to the metabolic response, but its mobilization to be limited in individuals with reduced liver function.

Type A natriuretic peptide (CDD/ANP-99-126) in its circulating form was analyzed with respect to the localization of its bronchodilating effects in asthmatic subjects in vivo. The intravenous infusion of 5.7, 11.4, and 17.1 pmol kg-1 min-1 CDD/ANP-99-126 caused a significant bronchodilation of both central and peripheral airways. While the localization of the bronchodilating effects was similar to beta 2-agonists, an improvement in lung function parameters comparable to these substances was not observed. But other members of the natriuretic peptide family may reveal a stronger bronchodilating potency.

Emotional stress is often followed by increased susceptibility to infections. Natural killer (NK) cells play a major role in the immediate immune response controlling this susceptibility. In this study on 45 first-time parachutists, it is demonstrated that highly controlled psychological stress increased psychophysiological variables, enhanced the secretion of sympathetic-adrenal hormones and also led to a significant increase of NK cells and their cytotoxic activity followed by a decrease below starting values. This immunological alteration is correlated with the secretion of noradrenaline during the emotional strain. Quick mobilization of these cytotoxic effector cells is suggested as a major mechanism for the effective adaptation of the immune system to stress situations.

People are becoming increasingly aware of environmental health hazards. Air pollutants have long been at the center of interest for both the public and the scientific community. Scientific interest has concentrated mainly on acute effects of high concentrations of pollutants. This has led to relatively strict governmental regulations and, for example, maximum allowable workplace concentrations, on the one hand, and decreasing mean and peak concentrations of some of the classical pollutants such as sulfur dioxide and nitrogen dioxide, on the other (von Boehmer and Fabel 1987). This must not lead to neglect of the specific problems arising from chronic exposure to the same pollutants or the health hazard of low concentrations for groups of patients at high risk. As long as we and our volunteers or patients do not live in an ideal (“synthetic” = well-defined) atmosphere, all studies must consider the fact that only rough approximations of effects can be obtained and must be seen against the background of the atmosphere and the ambient pollutant load at the facility where the studies are performed. Nevertheless, our knowledge of the health effects of pollutants at concentrations commonly found in the ambient air is insufficient, and particularly the effects of such pollutants on the respiratory or other body functions of patients with lung or other diseases must be studied. This is true not only from the aspect of prophylaxis and prevention of disease caused by chronic exposure to pollutants but also to help in early detection of symptoms indicative of deterioration of lung or other functions due to pollutants and to provide patients with the information of the specific risks that air pollutants carry for their body.

Die Fruhdiagnose und Therapie der Cytomegalovirus (CMV) Pneumonie in lungentransplantierten Patienten ist ein schwieriges Problem im spaten postoperativen Verlauf (1, 2). Die Therapie mit DHPG (CYMEVEN) eroffnet die Moglichkeit einer effizienten und spezifischen antiviralen Behandlung. Neuere Ergebnisse der CMV-Behandlung von knochenmarkstransplantierten Patienten haben gezeigt, das eine sehr fruhzeitige Therapie mit DHPG die Mortalitat der CMV-Erkrankung beeinflussen kann (3). Der Einsatz von monoklonalen Antikorpern gegen Fruhantigene des CMV-Virus (immediate early antigen:IEA) ermoglicht eine schnelle und fruhe Diagnose der Virusinfektion in einer Fruhphase der Replikation (4). In dieser Arbeit wurde das Konzept einer fruhen Diagnose der CMV-Aktivierung in der bronchoalveolaren Lavage (BAL) sowie Leukocyten im peripheren Blut (PBL) und einer fruhzeitigen Therapie mit DHPG in Patienten nach Herz-Lungen und Lungentransplantation untersucht. Elf Patienten wurden regelmasig auf die cellulare Expression von CMV-IEA nach Lungentransplantation untersucht.

Aufgrund der insgesamt noch geringen Erfahrung mit der Herz-Lungen-Transplantation (wenige hundert Eingriffe) — und noch geringerer Erfahrung mit der isolierten Lungentransplantation (ca. 150 Eingriffe weltweit) — konnen verbindliche und insbesondere als richtig erwiesene Indikationskriterien nicht aufgestellt werden. Alle Angaben zu Indikationen und Kontraindikationen unterliegen einer standigen Entwicklung durch aktuelle klinische Erfahrungen. Trotzdem mus im praktischen Umfang mit Patienten ein nachvollziehbares Konzept befolgt werden, nach welchem auch zuweisende Kollegen die Frage entscheiden konnen, ob bzw. wann sie mit ihrem Patienten uber das Thema der Lungen- oder Herz-Lungen-Transplantation sprechen sollen, um ihn ggf. bei einem geeigneten Zentrum vorzustellen.

Changes in blood composition, renal function, aldosterone and antidiuretic hormone (ADH) concentrations were investigated in 10 untrained male subjects when swimming (60 min at a heart rate of about 155 beats.min-1, water temperature 28 degrees C) and during the subsequent 3 h in a sitting position. Many specific effects of either exercise or immersion were abolished or attenuated; no significant changes in plasma aldosterone, [ADH], [K+], [Cl-], or of urinary volume, glomerular filtration rate, free water or osmolar clearance were observed. The urine was diluted resulting in lowered [Na+]. In blood some quantities which are only slightly influenced by immersion increased during swimming ([Na+], [Lac-], [H+], osmolality, [creatinine]). Exercise induced plasma volume loss, calculated from increasing [Hb], was small (110 ml), probably because interstitial fluid enters the vascular space during the initial phase of immersion. One might anticipate that the training effects on fluid and electrolyte metabolism and circulation are different when swimming and when performing endurance sports on land.

Publisher Summary This chapter describes the application of the CBA (cytochemical bioassay) segment assay and CBA section assay for the determination of human thyroid-stimulating hormone (TSH) in health and disease. TSH is a glycoprotein hormone, produced by, and released from, the anterior pituitary gland. Classic bioassays were not sensitive enough to determine TSH levels in plasma of normal euthyroid or of hyperthyroid patients. The TRH test is one of the most important tests for the study of pituitary–thyroid function. The chapter presents a study in which CBA technique is used to investigate patients with euthyroid goiter and a negative TRH test. By the use of CBA, it is determined that the circulating basal levels of biologically active TSH are low and the pituitary gland in these patients is unresponsive to TRH. The chapter also discusses that the lysosomal response in thyroid follicle cells not only occurs after stimulation by TSH, but also after activation by other thyroid stimulators.

Publisher Summary This chapter describes the episodic hormone secretion in the regulation and pathophysiology of the reproductive system in man. The reproductive system has been extensively analyzed with respect to episodic hormone secretion, its underlying mechanisms of regulation, and pathophysiology. Infusions of testosterone and dihydrotestosterone at twice the daily production rate of testosterone in normal men significantly reduce LH pulse frequency and mean LH concentrations. As this approach may seem pharmacologic instead of physiologic, the use of anti-estrogens and anti-androgens may be preferred. Dopamine infusion reduces the mean LH level but does not influence LH pulse frequency. When gonadotropins are substituted, a continuous or a slow release from a depot of injection is sufficiently effective to normalize spermatogenesis in the same percentage of patients as with pulsatile LHRH infusion.

Idiopathic delayed male puberty is defined as a delay of puberty beyond the age of 16, with prepubertal testosterone levels, normal gonadotropin responses to GnRH (excluding pituitary failure), and normal androgen responses to a single hCG injection (excluding testicular Leydig cell dysfunction), in absence of serious disease. Ten boys with this condition were evaluated as to their spontaneous LH, FSH, and PRL secretory patterns during a 24-h sampling period (20-min intervals). After this all patients were treated with pulsatile infusions of GnRH (25 ng/kg . pulse every 90 min for 10 days. Two groups could be distinguished by means of their pretreatment LH secretory pattern. Five patients had nighttime pulsatile elevation of LH levels, as usually occurs in early puberty. The other five patients did not have such a pattern (prepubertal type). The GnRH treatment resulted in increased LH and testosterone levels in both groups. All patients with pretreatment nighttime pulsatile LH secretion had steady pubertal development during the post-GnRH treatment observation period, whereas the other patients did not. In conclusion, among a number of tests, including chronic pulsatile GnRH treatment for 10 days, only the nocturnal LH secretory pattern differentiated delayed puberty from permanent hypothalamic hypogonadism in boys.