Praxis und Klinik der Pneumologie
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When in 1965 Liebow first described desquamative interstitial pneumonia (DIP) and differentiated it from other types of interstitial pneumonia he believed it to be a separate disease entity. The fact that the observed cases were of a relatively benign nature seemed to confirm this view. However, during the past years there have been reports of cases which took a less benign course; it was also observed that disorders with features similar to DIP could be produced by various exogenous noxae. The question, therefore, arises, whether DIP is, in fact, a separate disease entity or a specific pulmonary reaction to a variety of similarly acting noxae.
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The improvement of mechanical respiration by surgical stabilization of the chest wall is an important measure to reduce disadvantages and complications of long time respiratory treatment. Indications are: (1) Chest wall instability with indication for emergency thoracotomy; (2) Respiratory insufficiency mainly caused by chest wall instability; (3) Respiratory insufficiency due to severe laceration of intrathoracical organs with additional chest wall instability as an obstacle for sufficient respirator treatment.
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The mortality rate of chest injuries sustained during work or in road accidents stands now at 15-20%. The considerable force of the impact in road accidents is, in 60-80% of the cases, responsible for chest injuries which involve not only the chest wall but also the lungs. The extent and course of the lung damage must be assessed by repeated X-ray examinations, blood gas analyses and clinical observations. ⋯ Plate osteosynthesis, screw-less rib plates, self-gripping steel plates and steel splints are being used (Brunner, Hofmeister, Koncz). Primary osteosynthetic stabilization of the chest wall is indicated only if artificial ventilation has proved inadequate and there are other reasons for performing a thoracotomy. In these circumstances surgical intervention ensures that prolonged artificial ventilation and its attendent risks and complications and the demands made on the nursing staff are reduced to a minimum.