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Hintergrund: Raucher konnen in Akutkliniken zu einer Verhaltensanderung motiviert werden. Dennoch bieten nur wenige Kliniken Masnahmen zur Tabakentwohnung an. Vor der Implementierung solcher Masnahmen im Krankenhaus, sollten die Charakteristika der Zielgruppe bekannt sein. Patienten und Methoden: Wir untersuchten uber 3 Monate das Rauchverhalten stationarer Patienten. Raucher wurden mittels eines umfangreichen Fragebogeninstruments evaluiert. Ergebnisse: 25% der stationaren Aufnahmen waren Raucher. 76 Patienten wurden befragt (62% Manner, Alter im Mittel 55 Jahre). 13% hatten die Hochschulreife, 5% einen Hochschulabschluss. 50% waren berentet oder arbeitslos. Die mittlere stationare Verweildauer betrug 6,9 Tage. Haufigste Hauptdiagnosen waren obstruktive Atemwegserkrankungen und maligne Lungenerkrankungen. Der Rauchbeginn war im Mittel im Alter von 17 Jahren, die mittlere Zahl der Packungsjahre lag bei 41. 2/3 zeigten im Fagerstrom-Test eine mindestens mittelschwere Abhangigkeit. 75% hatten mindestens einen Rauchstoppversuch unternommen. Unterstutzungsangebote wurden dabei kaum in Anspruch genommen. Stress und Arger war fur 50% der Ruckfalle verantwortlich. Pulmonale Symptome waren bei 37–50% der Patienten regelmasig vorhanden. Fast 75% hatten mindestens einen auffalligen Wert in den Subskalen der Hospital Anxiety and Depression Scale. Diskussion: Die befragten Raucher sind einer Intervention gegenuber sehr offen. Die Ergebnisse geben Hinweise auf die besonderen Anforderungen, denen ein Angebot zur Tabakentwohnung in der Klinik gerecht werden muss. Langjahriger Tabakkonsum und hohe Abhangigkeit ebenso wie das hohe Mas an Angst und Depressivitat konnen den Erfolg von Masnahmen zur Tabakentwohnung gefahrden. Bei der kurzen Liegezeit und den soziodemographischen Charakteristika mussen Masnahmen zur Tabakentwohnung an Akutkliniken einfach durchfuhrbar sein.

Tobacco smoking is the main preventable risk factor resulting in multiple diseases and premature death. In particular, the airways and the lungs are affected by the effects of smoking. Hospitals have considerable potential to advance smoking cessation. However, so far there have only been a few data on availability and effectiveness of smoking cessation programs in hospitals. This study aimed to assess such programs in general hospitals with a special department for lung disease in South West Germany.40 hospitals with at least one pulmonary specialist were identified. This doctor was subsequently interviewed by a telephone call. 39 hospitals participated, one could not be reached by telephone.Although most of the interviewed specialists confirmed the importance of smoking cessation in the field of pneumology only 3 hospitals had own activities for promoting smoking cessation. Another 7 hospitals cooperated with other institutions. Accompanying pharmacotherapy was not practised regularly. The main reasons for a lack of smoking cessation activities in the hospitals were due to the lack of personnel, time and money.Our study highlights the tremendous difficulties facing general hospitals when trying to implement a smoking cessation program. Changes in the economic frameworks, and further examination of appropriate measures for brief interventions in the hospital setting are necessary.

CT scans of 474 patients with suspected chronic obstructive pulmonary disease (COPD) were retrospectively evaluated by automated software. There was a correlation between the total lung capacity (TLC) and the total lung volume (TLV) (r=.675, P.001), between the TLC and the total emphysema volume (r=.571, P.001), as well as between the TLC and the emphysema index (r=.532, P.001), respectively. The correlation between the TLC and the TLV was dependent on the COPD severity according to the Global Initiative for Chronic Obstructive Lung Disease classification (chi(2)=6.3079, P=.043). The TLC allows a prediction of clinical illness severity.

In this prospective study, reliability of integrated (18)F-FDG PET/CT for staging of NSCLC was evaluated and compared to MDCT or PET alone.240 patients (pts) with suspected NSCLC were examined using PET/CT. Of those patients 112 underwent surgery comprising 80 patients with NSCLC (T1 n = 26, T2 n = 37, T3 n = 11, T4 n = 6). Imaging modalities were evaluated independently.MDCT, PET and PET/CT diagnosed the correct T-stage in 40/80 pts (50%; CI: 0.39-0.61), 40/80 pts (50%; CI: 0.39-0.61) and 51/80 pts (64%; CI: 0.52-0.74), respectively, whereas equivocal T-stage was found in 15/80 pts (19%; CI: 0.11-0.19), 12/80 pts (15%; CI: 0.08-0.25) and 4/80 pts (5%; CI: 0.01-0.12), respectively. With PET/CT, T-stage was more frequently correct compared to MDCT (p = 0.003) or PET (p = 0.019). Pooling stages T1/T2, T-stage was correctly diagnosed with MDCT, PET and PET/CT in 54/80 pts (68%; CI: 0.56-0.78), 56/80 pts (70%; CI: 0.59-0.80) and 65/80 pts (81%; CI: 0.71-0.89). T3 stage was most difficult to diagnose. T3 tumors were correctly diagnosed with MDCT in 2/11 pts (18%; CI: 0.02-0.52) versus 0/11 pts (0%; CI: 0.00-0.28) with PET and 5/11 pts (45%; CI: 0.17-0.77) with PET/CT. In all imaging modalities, there were no equivocal findings for T4 tumors. Of these, MDCT found the correct tumor stage in 4/6 pts (67%; CI: 0.22-0.95), PET in 3/6 pts (50%; CI: 0.12-0.88) and PET/CT in 5/6 pts (83%; CI: 0.36-0.99).Integrated PET/CT was significantly more accurate for T-staging of NSCLC compared to MDCT or PET alone. The advantages of PET/CT are especially pronounced combining T1- and T2-stage as well as in advanced tumors.

Previous studies have shown that vertebral bone metastases (BM) not seen on planar bone scintigraphy (BS) might be present on (18)F-fluoride PET scans or at MRI. Therefore, we evaluated the effect of SPECT or (18)F-labeled NaF PET ((18)F PET) imaging on the management of patients with newly diagnosed lung cancer.Fifty-three patients with small cell lung cancer or locally advanced non-small cell lung cancer were prospectively examined with planar BS, SPECT of the vertebral column, and (18)F PET. MRI and all available imaging methods, as well as the clinical course, were used as reference methods. BS with and without SPECT and (18)F PET were compared using a 5-point scale for receiver operating characteristic (ROC) curve analysis.Twelve patients had BM. BS produced 6 false-negatives, SPECT produced 1 false-negative, and (18)F PET produced no false-negatives. The area under the ROC curve was 0.779 for BS, 0.944 for SPECT, and 0.993 for (18)F PET. The areas under the ROC curve of (18)F PET and BS complemented by SPECT were not significantly different, and both tomographic methods were significantly more accurate than planar BS. As a result of SPECT or (18)F PET imaging, clinical management was changed in 5 patients (9%) or 6 patients (11%), respectively.As indicated by the area under the ROC curve analysis, (18)F PET is the most accurate whole-body imaging modality for screening for BM. Routinely performed SPECT imaging is practicable, is cost-effective, and improves the accuracy of BS.

The cases of four children who presented with respiratory distress unresponsive to bronchodilator treatment and who were subsequently diagnosed with severe anemia were retrospectively reviewed from charts at a children's hospital with 110 beds and an emergency department census of 32,000 per year. The four children, age range 11 months to 2 years, each initially presented with tachypnea. Three had wheezing, three were pale, and each received outpatient bronchodilator treatment. Three to 4 days later, each patient was hospitalized for continued respiratory distress. Each child was pale, and hemoglobin levels ranged from 2.5 to 5.2 g/dL. In three children, respiratory distress resolved with blood transfusions. Final diagnoses were transient erythroblastopenia of childhood in 2, acute lymphoblastic leukemia in 1, and iron deficiency anemia in 1. Severe anemia is a known cause of respiratory distress. These cases remind the clinician to consider severe anemia in children who are tachypneic, pale, and unresponsive to treatment of respiratory disorders.

Background To further evaluate the mechanism of β-blocker–induced benefits in heart failure, the relationships between bisoprolol-induced hemodynamic effects and survival were studied during the Cardiac Insufficiency BIsoprolol Study (CIBIS). Methods and Results In 557 patients studied, bisoprolol significantly reduced heart rate (−16.3±15.3 versus −1.6±13.4 bpm, respectively; P P P P P Conclusions Preservation of left ventricular function appears to play a key role in the bisoprolol-induced beneficial effects on prognosis in heart failure. Short-term β-blocker–induced cardiac effects could provide a means to identify those patients who will experience improved survival over the long term.

Endobronchial therapy is commonly used in the palliative management of malignant disease, but the optimal combinations of treatment modalities (laser, brachytherapy, external beam radiotherapy) have not been defined. We have undertaken a prospective analysis of symptom response, duration of response, and prognostic factors for 117 patients treated with brachytherapy at a single centre, to identify hypotheses suitable for prospective randomised studies. All but one patient had received previous treatment. The percentage of patients with scores of 0 or 1 (none or mild) for each symptom pre-treatment and at 3 months were as follows: cough 62% to 77% (43% improving by at least one grade, N.S.); dyspnoea 32% to 56% (50% improvement by at least one grade, P = 0.0063); haemoptysis 78% to 97%; performance status 65% to 84% (54% by at least one grade, P = 0.0417). An actuarial risk of fatal haemoptysis at 2 years of 20% was associated with prior laser resection (P = 0.048). Death before 2 months was associated with dyspnoea scores of 3 or 4. Suggestions for randomised studies are made to address some of the uncertainties revealed by the analysis.

In the last years many therapeutic attempts were made to improve the poor prognosis of primary cerebral non Hodgkin's lymphoma. The aim of this study was to report on own experiences concerning this rare disease.In 1986 to 1994 26 patients were treated for primary cerebral non Hodgkin's lymphoma. 15% were HIV-positive. High-grade non-Hodgkin's lymphomas were diagnosed in 62%. 46% of all cases showed multiple lesions. 23% of our patients received a dose less than 25.5 Gy, 27% received 37.5 Gy (whole brain) and 39% were treated with 51 Gy (37.5 Gy whole brain and 13.5 Gy boost dose). Radiation technique included regular and irregular fields (single dose: 1.5 Gy).62% of patients achieved a complete or partial remission directly after irradiation, in 4% no change or progression was seen. 31% could not be examined due to their bad status or death. The mean follow-up time for all patients was 19.6 months, the median survival was 3.6 months. The 1-year-survival rate was 41%, 3-year survival rate was 28%. Patients who received a tumor dose of 51 Gy had better survival times in comparison to patients who received less (p = 0.01). Prognostic parameters (Cox regression analysis) were: tumor dose, grading and local result after irradiation. The Karnofsky performance status was not an independent parameter (p = 0.12). Side effects were low. Long-term survivors had relatively good quality of life.Taking into consideration the small numbers of patients in all studies all results or conclusions have to be made with great reservations. Despite the high proportion of HIV-positive patients our results are in compliance with other authors using similar therapy protocols. Reports dealing with combined radio-chemotherapy have published good results concerning survival time. But long-term morbidity due to these protocols needs further investigation and has to be awaited.

13 patients with obstructive sleep apnea syndrome treated with CPAP-therapy and complicating affections of the nasal and pharyngeal mucosa were enrolled in a randomized cross-over study comparing therapy with a heated humidifier (HC 100, company FisherPaykel) and treatment with a heat and moisture exchanger (Typ I, company Dahlhausen). We assessed the bacterial and fungal colonisation of the nasal masks of all patients. Samples of mask rinses were taken after the two treatment periods (2 weeks each) and the period without humidification in between. All microbes were found to have pathological potency. There was no significant difference in the total concentration of the microbes in the different treatment modalities. In a few cases however, gram negative bacteria were detected on the masks during humidification with a heated humidifier, but not with heat and moisture exchangers. Legionella spec. were not detectable in any of the samples. Candida albicans was the only fungus detectable. No patient had any infection of the upper or lower respiratory system associated with humidification therapy.

7508 Background: This phase III study tested the hypothesis whether 3 preoperative cycles of gemcitabine-cisplatin followed by radical surgery provides a reduction in the risk of progression compared with surgery alone in patients (pts) with stage IB- IIIA NSCLC. Methods: Chemotherapy naive pts with clinical stage T2N0, T1–2N1, or T3N0–1 received either preoperatively cisplatin (75 mg/m2, day 1) and gemcitabine (1,250 mg/m2, days 1&8), q3week followed by surgery (C+S) or surgery alone (S). In 2004 the enrollment was closed early after the inclusion of 270 out of 700 planned pts because investigators felt it unethical to complete the study treating patients with surgery alone due to positive adjuvant studies. Results: From September 2000 to December 2004, 141 pts were randomized to S and 129 to C+S. Median age was 63/61 years, and most of pts were male (89%/78%). Stage IB/IIA disease was reported in 55% and 46%, respectively. The commonest histology was squamous cell carcinoma (45%/37%) followed by adenoca...

To evaluate the acute and chronic effects of diuretic monotherapy with 3 mg piretanide bid, 46 patients (pts) with congestive heart failure (NYHA II-III) secondary to coronary artery disease were studied. Within 3 weeks of therapy, the patients lost 1.6 kg body weight. Forty-four patients reported a subjective feeling of improvement. Echocardiographically, a highly significant (p less than 0.001) reduction of diastolic and systolic diameters was found, as well as an increase of fraction shortening. Chest x-ray indicated a reduction of heart volume from 1012 +/- 263 ml to 936 +/- 233 ml (p less than 0.001). The serum potassium level remained unchanged. A subgroup of 26 pts underwent invasive hemodynamic examinations. IV injection of 6 mg piretanide resulted in an acute reduction of pulmonary wedge pressure (pc) from 20.2 +/- 5.3 mmHg to 11.9 +/- 5.0 mmHg (p less than 0.001); simultaneously a slight decrease of cardiac index from 3.2 +/- 0.6 l/min/m2 to 3.0 +/- 0.4 l/min/m2 was observed. Invasive control after 3 weeks of oral therapy showed no decline of the piretanide effect. The exercise tolerance increased clearly from 135 +/- 161 Wmin to 249 +/- 268 Wmin (p less than 0.05). A control group of further 14 pts was treated with placebo only and did not show any significant changes of pc (20.0 +/- 6.4 mmHg vs. 22.8 +/- 19.2 mmHg), exercise tolerance, or other clinical parameters. Thus, the diuretic monotherapy of congestive heart failure with piretanide is highly effective and shows a significant improvement in all clinical and hemodynamic parameters in the absence of any remarkable side effects.

The morphology and structure of 3C-SiC(001) surfaces, grown on Si(001) and prepared via hydrogen etching, are studied using atomic force microscopy (AFM), low-energy electron diffraction (LEED), and Auger electron spectroscopy (AES). On the etched samples, flat surfaces with large terraces and atomic steps are revealed by AFM. In ultrahigh vacuum a sharp LEED pattern with an approximate (5×1) periodicity is observed. AES studies reveal a “bulklike” composition up to the near surface region and indicate that an overlayer consisting of a weakly bound silicon oxide monolayer is present.

Between July 84 and December 93 we irradiated 8 patients (median age 20 years) with histologically confirmed germinoma with a uniform protocol. The aim was the reduction of late sequelae by use of a low dose per fraction. Whole brain and neuroaxis received 30 Gy, the tumor region was boosted to 45 Gy (single dose 1.5 Gy). No additional treatment was given. Median follow-up is > 6 years. In each case a complete remission was achieved. No local or distant relapse occurred. Overall median survival is 77 months. One patient died after 68 mo. from progressive brain atrophy (without evidence of disease, another one developed a moderate mental retardation. The intellectual function of 6 patients remained unchanged. No growth retardation occurred. Fertility was not assessed definitely in most of the cases. Conclusion Local control and survival were excellent, but even the use of low single doses might result in late radiation injury.

Debrisoquine hydroxylation exhibits wide inter-individual variation in Caucasian populations. After similar doses of the drug, extensive metabolizers excrete up to several hundred times more of the urinary metabolite 4-hydroxy-debrisoquine than do poor metabolizers. The phenotypes have traditionally been defined by the metabolic ratio (MR), or the molar ratio of debrisoquine to its chief metabolite recovered in an aliquot of an eight hour urine sample, after a test dose of the drug. Deficient metabolism is inherited as an autosomal recessive condition. We have reanalyzed previously published data from a study of lung cancer patients and controls using a computerized optimization method to more accurately estimate the parameters describing the three phenotypic distributions. Using these new distributions to categorize controls, we show that Hardy-Weinberg conditions are now fulfilled. When the newly defined phenotype parameters are employed to assign the phenotypes of cases and controls, a highly significant difference in phenotype distribution between cases and controls is still observed. This result supports the hypothesis that the debrisoquine metabolic phenotype may be associated with lung cancer susceptibility.

The risk of lung cancer in smokers was examined based on the debrisoquine metabolic phenotype and on exposure to occupational lung carcinogens, specifically asbestos and polycyclic aromatic hydrocarbons. Extensive metabolizers of debrisoquine are at a 4-fold increased risk for lung cancer compared to poor metabolizers, after adjustment for age, sex, and smoking (pack-years), when only occupationally unexposed subjects are considered. Increased risk related to the debrisoquine metabolic phenotype was greatest for squamous and small cell histologies, and least for the adenocarcinoma subtype. Men with a history of exposure to occupational carcinogens had significantly increased risk of lung cancer (relative risk = 2.8), after adjustment for age and smoking. Considering the combined effect of the high risk extensive metabolizers debrisoquine metabolic phenotype and likely occupational exposure to asbestos, the relative excess risk for lung cancer was 18-fold. This finding is consistent with a synergism in risk between the ability to extensively metabolize debrisoquine and occupational exposure to lung carcinogens in male smokers. Debrisoquine phenotyping has potential for identifying carcinogen-exposed workers at high risk of lung cancer.

A-plane (11-20) and diagonal cut (1-102) and (-110-2) surfaces of 4H-SiC have been investigated using atomic force microscopy (AFM), low-energy electron diffraction (LEED), Auger electron spectroscopy (AES), X-ray photoemission spectroscopy (XPS) and scanning tunneling microscopy (STM). After hydrogen etching the surfaces show large, flat terraces. On SiC(11-20) steps down to single atomic heights are observed. On the diagonal cut surfaces steps run parallel and perpendicular to the [-1101] direction, yet drastically different morphologies for the two isomorphic orientations are found. All surfaces immediately display a sharp LEED pattern. For SiC(1-102) and SiC(-110-2) the additional significant presence of oxygen in the AES spectra indicates the development of an ordered oxide. All three surfaces show an oxygen free, well ordered surface after Si deposition and annealing. A transformation between different surface phases is observed upon annealing.

The surface of 3C-SiC(001) single-crystal epilayers grown on Si(001) substrates is well known to be inhomogeneous and defective. Therefore, the control and understanding at the atomic scale of 3C-SiC surfaces is a key issue. We study the effect of hydrogen etching at different temperatures on the morphology of 3C-SiC(001) surfaces by using Nomarksi optical microscopy, atomic force microscopy (AFM) and scanning electron microscopy (SEM). As-grown 3C-SiC(001) samples have been hydrogen etched in a horizontal hot-wall chemical vapor deposition (CVD) reactor at atmospheric pressure for different times and temperatures. Flat, high-quality surfaces presenting defined atomic terraces were observed within the 3C-SiC grain boundaries after etching at 1200°C for 30 minutes. Higher etching temperatures resulted in surfaces with step bunching and enlarged surface defects. Samples etched under the best conditions have been studied using low-energy electron diffraction (LEED) and Auger electron spectroscopy (AES).

The family performs many functions that are directly relevant to population dynamics. It is the primary institution into which children are born and prepared for adult life. It is the only social grouping that man usually takes with him when he moves. Because of the importance of this basic institution in shaping the growth and distribution of our population, statistics on family formation and dissolution are essential to an adequate understanding of the nature, determinants, and consequences of population dynamics. However, data now available are not sufficient to measure trends on differentials in various phenomena associated with the family. ...