Search

Introduction: An infection with SARS-CoV-2 is relevant especially in high-performance sport due to possible organ damage and reduced performance which occurs in individual cases. Various recommendations are found in the literature concerning when safe return to sports is possible and what examinations are suitable to support this decision. The dominance of other virus variants than those at the start of the pandemic makes revision of earlier recommendations necessary. Methods and Analysis: The recommended actions are based on the currently-available scientific knowledge of the pathogenicity of the virus and on clinical experiences in general and elite athletes. Twenty-one recommended actions were proposed by the Scientific Council of the DGSP, discussed and agreed on in consensus with experts from German-language sports-medical facilities and evaluated by an independent co-author. The resultant position paper was subsequently released by mutual agreement. Results: The recommendations are oriented to the severity of the course and the symptoms. The required medical diagnostic is deduced therefrom. During persistent symptoms, sports should be paused and training only begun again at low intensity after a three-day symptom-free period. If COVID-19-associated complaints recur, physical exertion should be stopped and a doctor consulted. After moderate and serious course, medical diagnostics are required prior to the start of training. Summary: To prevent a health risk due to sports and thereby resultant organ damage after a SARS-CoV-2 infection, a procedure adapted to the symptoms and course before return to training and finally to competitive sports is recommended.

Background: Tobacco smoke, containing more than 4800 chemical substances with a large number of mutagenic and carcinogenic compounds, is the most important indoor pollution. Aim of the study was to analyse the relationship between exposure of children (2-15 years) to environmental tobacco smoke (ETS) with the amount of respiratory diseases, the occurrence of atopic diseases and the risk for genotoxic damage., Patients and Methods: Within the last 1.5 years 216 children were included in the study. Smoking habits of the family, environmental settings, housing, nutrition, social and economic factors were assessed by a detailed questionnaire. Two different effect markers were used to assess molecular and genetic damage. Biochemical effect of ETS was quantified by 4-aminobiphenyl-hemoglobin (4-ABP-Hb) adducts and the genotoxic damage was determined by chromosomal damage as seen in the micro nucleus test in lymphocytes., Results: Chronic rhinosinusitis and allergic rhinitis are accumulated in the ETS-exposed children. In the ETS-group atopic diseases (allergic rhinitis, extrinsic asthma or neurodermatitis) were significantly more frequent (39.5 %, p = 0.01) than in the non-exposed group (23 %). In addition the genetic predisposition was significantly decreased in the ETS-group (20.8 %, p = 0.048) compared to the non-exposed group (45 %). Until now, blood samples of 63 individuals were analysed for Hb adducts and 92 for micro nuclei. Hemoglobin adducts of 4-ABP, a human carcinogenic aromatic amine, were significantly elevated in children with smoking parents (mean: 82.2pg/g Hb, p = 0.003) compared to children with non-smoking parents (mean: 60.6 pg/g Hb). ETS-exposed children showed significantly higher micro nucleus frequencies (mean ETS: 8.0/1000 binucleate (BN) cells, p = 0.001) than non-ETS exposed children (mean: 6.2/1000 BN cells)., Conclusion: Our data underline the thesis, that ETS plays an important role for the development of atopic diseases. The significantly increased effect markers of tobacco smoke in exposed children give evidence, that ETS causes elevated molecular and genotoxic damage in children.

Objectives: The study investigates associations between socio-demographic or lifestyle factors and the progression of HIV., Methods: We recruited a Swiss cohort (n = 56) of long-term survivors and conducted a cross-sectional study of laboratory data as well as factors concerning socio-demography, life-style, and psychology. On the basis of laboratory results, the cohort was divided into 2 subgroups, non-progressors (n = 31) and slow progressors (n = 25), which were subsequently compared., Results: The comparison of socio-demographic factors showed that non-progressors were younger and had a higher income than slow progressors. Our data do not show an association between lifestyle and disease progression., Discussion: Younger age as a cofactor of non-progression confirms various other studies. The association between income and disease progression, also found in another cohort, cannot be explained by unequal access to therapies since, in accordance with the inclusion criteria, no one in our cohort had received antiretroviral therapies. Further research in this field seems important to determine possible links between socio-economic status and disease progression. The lack of association between disease progression and lifestyle factors such as drug use, physical activity or nutrition is in contrast to a common view of HIV in our study population, but is confirmed by a majority of the research in this field.

Mononuclear cells are the component of blood responsible for allograft recognition, rejection and acceptance. Shifts in the patterns of various mononuclear cell subpopulations were often used as a diagnostic tool in detection of heart rejection. The specificity of mononuclear cell monitoring has remained a controversial point until today, because infections led to similar changes as organ rejection. In this study we investigated whether mononuclear cells taken from coronary sinus blood give more information about the immunological status of the transplanted heart than those taken from central verous blood. After endomyocardial biopsy, coronary sinus blood was sampled by catheterization under X-ray control. Blood from the right atrium was taken for control measurement. Mononuclear cells obtained by density gradient cytocentrifugation were stained with monoclonal fluorescein conjugated antibodies detecting CD4- (T helper)-, CD8- (T suppressor)-, CD25- (Interleukin-2 receptor), and the CD71- (Transferrin receptor) antigens. Endomyocardial biopsies were graded according to the Billingham scheme. In the absence of rejection, the phenotypes of mononuclear cells from the coronary sinus did not differ from those of right atrial cells. Mild rejection led to a statistically insignificant increase of CD4- CD25- and CD7-antigen bearing cells in the coronary sinus blood, whereas the CD8 positive cells remained stable as compared to mononuclear cells from the right atrium. However, patients with moderate rejection showed a significant elevation of CD4 positive cells and activated T-cells (CD15-, CD71-positive cells) in the coronary sinus as compared with cells from the right atrium. The T helper/suppressor ratio (Th/s-ratio) shifted towards the T-helper population.(ABSTRACT TRUNCATED AT 250 WORDS)

90 out of 202 lung cancer patients hospitalized for preoperative investigations were scheduled for radical surgery. 15 patients were not operated on because of insufficient lung function data. The operation was performed in 75 patients. The complication rate was 11% and mortality 8%. 7 out of 8 patients who subsequently developed severe complications had fulfilled the criteria for lung resection only after intensive antibronchitic treatment. Nearly all the survivors showed the predicted preoperative minimal lung function values after the operation. The limit of 1000 ml for postoperative FEV1 is justified, since patients with these or larger functional reserves nearly all had a favourable early and late postoperative course, and also because lung function values continuously deteriorate in chronic obstructive lung disease.

Thoracoscopy is a method involving little discomfort for the patient but of high diagnostic effectiveness for pleural alterations. A histological diagnosis was established in 56 cases out of a total of 60 pleural effusions of unknown origin. In 10 pleural or pleuropulmonary diseases, anatomical classification was possible in all cases. In cases of pneumothorax (21 patients) the bronchopleural fistula could very often be seen and closure by detaching of pleural adhesions or cauterization was possible. These manipulations are usually followed by insufflation of sterile talcum powder through the thoracoscope. Suspicion of ruptured diaphragm due to accident was easily and quickly verified. No complications occurred in our 100 thoracoscopic examinations.

The treatment of spontaneous pneumothorax is still controversial. To evaluate pleural drainage with a chest tube the therapeutic results in 73 patients with benign pneumothorax were reviewed. Benign spontaneous pneumothorax treated with a thick chest tube size Charrière 18-22 disappeared within an average of only 6.6 days. On the other hand, the high recurrence rate of 24% after the initial pneumothorax and 37% after the first recurrence is comparable with the results of conservative management in other pneumothorax series in the literature. Small pneumothorax without severe symptoms should therefore be supervised conservatively on an outpatient basis. The more extended forms of pneumothorax should be treated with thick chest tubes. Failure of therapeutic effect, second ipsilateral relapse or the first contralateral pneumothorax are indications for parietal pleurectomy.

Pulmonary emphysema is regularly complicated by pulmonary hypertension which is, however, mostly of minor degree. As long as pulmonary capillary pressure and cardiac output remain within normal limits, the elevated pressure in the pulmonary artery is due to an increase of vascular resistance for which hypoxia is responsible in the first place, while rarefaction of vascular ramifications due to the emphysematic destructive process in the pulmonary parenchyma plays only a secondary role. Breathing of oxygen decreases pulmonary hypertension, an effect which is reinforced by combination of oxygen with IPPB. Phentolamine lowers both vascular resistance and pressure in the pulmonary artery in short-term administration. The effect of hemodilution on pulmonary hypertension in emphysematic patients with hypoxic polycythemia is, however, somewhat disappointing if the hematocrit value remains below 60%. Some rheological causes for this therapeutic failure are discussed.

31 patients with severe chronic obstructive lung disease (FEV1 less than 45% VC) were included in a rehabilitation program with IPPB home care. The frequency and duration of hospitalizations in the three years before and the three years following institution of the program were compared. During the rehabilitation period the incidence of hospitalizations fell from 87 to 46 (p less than 0.001), and the number of days spent in hospital decreased from 2896 to 1099 (p less than 0.001). The high cost of the rehabilitation program requires careful selection and competent instruction of candidates. If these basic requirements are observed, a surprising reduction in the total cost of treatment can be achieved by shortening the expensive hospital stay.

13 cases of deep candidiasis (two or more positive blood cultures or histological evidence) are reported. The patients were hospitalized because of respiratory problems (pneumonia, neuromuscular respiratory failure, bronchial carcinoma, brochiectasis, chronic bronchitis and acute laryngitis). Frequency, clinical signs and symptoms and therapy are discussed. The importance of early diagnosis is stressed.