Pneumologie

Publications in this journal

• Article: [Diagnostic and predictive analyses of cytological specimens of non-small cell lung cancer: strategies and challenges].

  F J F Herth, L Bubendorf, S Gütz, A Morresi-Hauf, M Hummel, K Junker, U Lehmann, I Petersen, P A Schnabel, A Warth
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  ABSTRACT: Personalised medicine is becoming the standard care for advanced non-small cell lung cancer. Tumour-specific therapies based on biomarker analyses, e. g., EGFR mutations or translocations of the ALK gene locus, result in a superior patient outcome compared to unselected therapy approaches. However, predictive molecular analyses can be challenging and require significant experience with cell- and tissue-based diagnostic methods. The major challenge relates to the sometimes low amount of available tumour material for both diagnostic and predictive analyses. As yet, there are no standardised or evidence-based recommendations concerning biopsies, specimen processing, and analyses. Respective guidelines require combined interdisciplinary actions to consider both clinical and pathological aspects. In order to establish a basis for high quality procedures, different approaches, methods, and protocols were interdisciplinary discussed with an emphasis on cytological specimens. Detailed evaluation of the parameters and consented recommendations might contribute to optimised strategies in the interdisciplinary, more and more complex care of non-small cell lung cancer patients.
  Pneumologie 04/2013; 67(4):198-204.
• Article: [Omalizumab therapy in adolescents with severe allergic asthma - results of a post-marketing surveillance].

  M Klyucheva, A von Berg, M Gappa, C Suerbaum, D Berdel
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  ABSTRACT: Background: Omalizumab has been successfully established as add-on therapy to improve asthma control in adults and children aged 6 years and older with uncontrolled severe persistent allergic asthma (GINA 2009 step 5). Patients and Methods: 15 patients between 12 and 20 years of age with severe allergic asthma, which was inadequately controlled despite intensive antiasthmatic therapy according to NVL step 4 /5, received treatment with omalizumab for 6 - 69 months. After 12 months of treatment the effect was evaluated by means of objective parameters.Results: Significant improvements were found for the asthma-exacerbation rate and emergency treatment as well as for most of the lung function parameters. Systemic steroids could be discontinued in 10 of 11 patients. Asthma control has improved in all patients according to the ACT. Omalizumab was well tolerated by 13 patients. Adverse effects occurred in two patients in the first two and after 5 months, respectively. Only in one of them omalizumab had to be discontinued after 6 months due to the development of serum disease.Conclusions: Omalizumab can be considered a valuable add-on therapy in adolescent patients with severe allergic asthma that is inadequately controlled despite GINA step 5 treatment. A significant effect on clinical and functional parameters was shown over 12 months.
  Pneumologie 04/2013; 67(4):233-7.
• Article: [New diagnostic and therapeutic strategies in thoracic oncology].

  N Reinmuth, C Grohé
  Pneumologie 04/2013; 67(4):197.
• Article: [Epidemiological and occupational medicine aspects of pleural mesothelioma].

  B Karabin-Kehl, V Harth, A M Preisser
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  ABSTRACT: Malignant mesothelioma of the pleura represents a signal tumour for (occupational) exposure to asbestos. Almost 20 years after the ban of asbestos in Germany, incident cases are still occurring due to the long latency period between the initial exposure to asbestos and the onset of the tumour. Of particular interest is the development of mesothelioma epidemiology. In Germany, it is extensively discussed whether the incidence of malignant pleura mesothelioma continues to rise, has already reached a plateau or is expected to decline in the next few years. The development is predominantly caused by the total asbestos use, its application and the gradual substitution of asbestos. The prevention of asbestos-related diseases due to former exposures, but also due to existing asbestos contaminations and their restoration is still a hot topic in occupational medicine. It is thus of major importance to ensure an adequate occupational safety and to care for asbestos-exposed workers - even after cessation of their exposure - with effective and efficient measures of early detection. New technologies, such as nanotechnology with carbon nanotubes, represent new potential health hazards.
  Pneumologie 04/2013; 67(4):209-18.
• Article: [Crizotinib - molecular therapy for lung cancer].

  A Gröschel, A Warth, N Reinmuth
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  ABSTRACT: The anaplastic lymphoma kinase (ALK) can act as a key oncogenic driver after activation by means of processes such as gene rearrangement. In approximately 5 % of patients with advanced non-small cell lung cancer (NSCLC), an oncogenic fusion gene of echinoderm microtubule-associated protein-like 4 (EML4) and ALK has been detected using fluorescence in situ hybridisation (FISH). Moreover, various methods including immunohistochemistry and PCR-based assays can be used for analysing ALK expression. Clinical data have been generated for crizotinib, a small molecule inhibitor of the ALK receptor tyrosine kinase, demonstrating a substantial improvement of objective response rate and prolonged progression-free survival (PFS) compared to standard chemotherapy in pretreated NSCLC patients harbouring EML4-ALK fusion genes. In the current review, recent data on the detection and inhibition of ALK in advanced NSCLC are summarised.
  Pneumologie 04/2013; 67(4):205-8.
• Article: [A Combined Mediastinal and Retroperitoneal Cystic Lymphangioma as a Rare Cause of Recurrent Pleural Effusion.]

  P J Wagenhäuser, C Mölleken, J W Walter, C M Heyer, V Nicolas
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  ABSTRACT: We report on a 71-year-old female patient with spontaneous unilateral recurrent chylothoraces - at first glance with no apparent cause. After performing CT, MRI, lymphatic scintigraphy, and CT-guided biopsy, we were able to establish the diagnosis of a combined mediastinal and retroperitoneal cystic lymphangioma. Together with a review of the literature concerning cystic lymphangioma, we also discuss possible differential diagnoses of chylothoraces.
  Pneumologie 03/2013;
• Article: [Occupational Allergies against Pepsin, Chymosin and Microbial Rennet.]

  V van Kampen, H Lessmann, T Brüning, R Merget
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  ABSTRACT: Rennet is a mixture of the proteolytic enzymes pepsin and chymosin (rennin), which is usually obtained from the fourth stomach of young ruminants. While pepsin is also used in the pharmaceutical industry, both enzymes (pepsin and chymosin) are used for the coagulation of milk protein in the manufacture of cheese. Additionally, microbial rennet, which is naturally produced by certain microorganisms, has been used as a substitute for natural rennet in the cheese production for decades. Exposure to enzyme dusts has long been known to cause occupational immediate hypersensitivities. The present paper reviews the results of an evaluation of the literature data concerning occupational airway sensitisation due to natural and microbial rennet. Cases of specific airway sensitisation caused by rennet could be shown clearly by several studies. Positive skin prick and challenge tests as well as specific IgE antibodies have been described, thus suggesting an immunological mechanism.
  Pneumologie 03/2013;
• Article: Life-threatening Events in Respiratory Medicine: Misconnections of Invasive and Non-invasive Ventilators and Interfaces.

  S Stieglitz, S George, C Priegnitz, L Hagmeyer, W Randerath
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  ABSTRACT: Purpose: Both the parallel use of intensive care unit (ICU)-ventilators and ventilators dedicated to non-invasive ventilation (NIV), as well as the construction of some expiratory valves in single circuit breathing tubes may lead to misconnections which are potentially fatal for the patient. Methods: We demonstrate first a case of a misconnected expiratory valve in a patient with invasive home ventilation. In a second case, the mistaken connection of a non-invasive ventilator to an endotracheal tube leading to carbon dioxide (CO2)-rebreathing is demonstrated. A third case describes a patient with home non-invasive ventilation who had been delivered a non-vented mask out-of-hospital, likewise leading to CO2-rebreathing.Conclusion: Human error is the main reason for critical incidents in medicine and the most serious unintended events often involve mechanical ventilation. A regular instruction of medical staff and patients is necessary. The demonstrated misconnections are examples of latent errors "waiting to happen". To prevent these errors from being made in the future, technological solutions similar to the aviation effort to improve safety are needed.
  Pneumologie 03/2013;
• Article: [The Effects of Tobacco Smoke on Alveolar Macrophages - An In Vivo Mouse Lung Model for Short-Term Smoking.]

  N T Veith, J Hellberg, C Beisswenger, M W Laschke, T Tschernig
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  ABSTRACT: Background: The effect of cigarette smoke (CS) on the phagocytosis of alveolar macrophages is discussed controversially on the basis of in vitro experiments. In this short report we describe the in vivo observations that we have performed.Methods: For this purpose mice were exposed to CS for three consecutive days. One day later the fluorescent microspheres were administered intratracheally and the lung surface was investigated using long-distance fluorescence microscopy.Results: We found that the numbers of neutrophils which engulfed particles was increased in the CS group as compared to controls. The overall phagocytic activity was not significantly different after CS exposure. Conclusions: In conclusion the phagocytosis of alveolar macrophages and neutrophils after short time CS exposure was not affected. Further investigations will need to look for the effects of long-term CS exposure and the phagocytosis of living bacteria.
  Pneumologie 03/2013;
• Article: [Broncho-pulmonary Salmonellosis - A Case Series and Review of the Literature.]

  M Jüch, E Grabert, W Rabsch, H J Achenbach
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  ABSTRACT: Broncho-pulmonary salmonelloses are rare manifestations of extraintestinal focal infections in adults caused by different subspecies of Salmonella. They may appear without previous gastroenteritic symptoms especially in patients older than 60 years, as well as in patients who are immunocompromised or suffer from chronic pulmonary diseases. The transmission route is hematogenous or via aspiration of contaminated gastric fluid. Complications are acute respiratory distress syndrome, lung abscesses and pleural empyemas. Complicated und lethal courses have been described frequently. Therefore, antibiotic therapy should be initiated in every case with sufficient duration of treatment and in accordance to antibiotic resistance. Recommended antibiotics are third generation cephalosporins, trimethoprim-sulfamethoxazole, ampicillin or fluoro-quinolones. In this review 4 different clinical courses of broncho-pulmonary salmonellosis caused by Salmonella enterica subsp. enterica serovar Brandenburg, Salmonella groups B (O4), C (O6) and O11 to O67 are presented and discussed in the context of the current literature.
  Pneumologie 03/2013; 67(3):174-178.
• Article: [Correct Inhalation Therapy: Instructions Provided by Internet-based Video Screens].

  V Knipel, C P Criée, W Windisch
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  ABSTRACT: Background: Inhalation therapy is well recognized as a cornerstone treatment of airway diseases. In daily practice, however, high failure rates of inhalation technique are evident, which substantially attenuates the treatment success. Methods: In 2011 the German Airway League has initiated the production of video screens for correct inhalation aimed at providing an efficient and globally available platform for information. All devices regularly used have been filmed and published via internet and DVD; thereby, video screens, spoken text passages, and visual insertion of information have been combined. Here, all important steps of inhalation therapy like preparation, performance, and termination have been covered.Results: Video screens of 20 different devices lasting between 1:42 and 3:11 min:sec have been produced between July 2011 and January 2013 and published on the YouTube channel of the German Airway League with more than 70.000 clicks so far (27. February 2013). Conclusions: Pragmatic, internet-based video screens on the correct inhalation therapy are available and are cost-free. Further studies aimed at evaluating the benefits of these screens are necessary.
  Pneumologie 03/2013; 67(3):157-61.
• Article: [New Spirometric Reference Values for Children and Adolescents in Germany Considering Height and Non-Linear Age Effects: The LUNOKID-Study].

  A Hüls, U Krämer, M Gappa, C Müller-Brandes, G Seitner-Sorge, A von Berg, A Schuster, C Beckmann, S Illi, M Wisbauer, D Berdel
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  ABSTRACT: Background: Comparing children's lung function with reference values is important for diagnosing respiratory diseases. The values by Zapletal et al., commonly used nowadays, are not appropriate for the current stage of children's development. We have now developed new reference values and a lower limit of normal (LLN) for children in Germany, divided into small-range age and height categories. Material and Methods: We examined 4- to 18-year-old children in 3 German communities under field conditions. 1943 children were healthy and had a visually acceptable lung function which also fulfilled international quality criteria. We used the regression model LMS, which was introduced by Stanojevic and Quanjer in this context. Results: There were significant differences between the measured lung function and the predicted values according to Zapletal et al. The lung function did not only depend on the child's height, but also in a non-linear way on the age. The variation coefficient did not depend on age.Conclusions: To avoid diagnostic errors, the currently often used reference values according to Zapletal et al. should no longer be used. The non-linear dependence on age corresponds to the recently published results by Stanojevic and Quanjer.
  Pneumologie 03/2013; 67(3):141-9.
• Article: [Sleep-disordered breathing in patients with chronic heart failure: epiphenomenon or bidirectional relationship].

  J Zeller, A Hetzenecker, M Arzt
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  ABSTRACT: Sleep-disordered breathing (SDB) constitutes a highly prevalent comorbidity in patients with chronic heart failure (HF, approximately 45 %). Both diseases are related in a bidirectional way: Obstructive sleep apnoea (OSA) can contribute to the development of HF via multiple mechanisms. Apnoea-related acute rise of cardiac afterload as well as manifest hypertension may contribute to the development of myocardial hypertrophy and thus HF. In addition, OSA increases the risk for myocardial infarction and impaired recovery of cardiac function after the event. Impaired cardiac function itself may contribute to the development of obstructive and central sleep apnoea (SA). Therefore, optimal medical management of HF is part of the therapy of SDB in such patients. Treatment of SDB with different modes of positive airway pressure suppresses apnoeas and hypopnoeas, improves sleep and may improve related symptoms and cardiac function of affected patients. Considering the high coincidence of SDB and HF, the adequate diagnosis of SDB and evaluation of indication for therapy of SDB performed in a specialised centre is advised.
  Pneumologie 03/2013; 67(3):150-6.
• Article: [Chronic rhinosinusitis - a common piece in pneumological puzzles].

  H Knoop, U Knoop, S Dazert, S Ewig, C M Heyer, A Tannapfel, A Gurr
  Pneumologie 03/2013; 67(3):162-73.
• Article: Syndrome of Inadequate Antidiuretic Hormone Secretion in Pulmonary Tuberculosis - a Therapeutic Challenge.

  H Knoop, U Knoop, J Behr, C M Heyer, S Kuert, D Roggenland, M Suermann, J W Dietrich
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  ABSTRACT: A forty-nine-year-old female patient with pulmonary tuberculosis developed syndrome of inadequate antidiuretic hormone secretion. Consequent restriction of fluid intake as a therapeutic measure was just as ineffective as a medication with tolvaptan which was performed later on. A probable explanation for the inefficacy of the aquaretic drug is an interaction of rifampicine and tolvaptan. This case report gives a short summary of SIADH in pulmonary TB and discusses possible reasons for the difficult antituberculotic treatment in this patient.
  Pneumologie 02/2013;
• Article: [In Process Citation].

  M Spyra
  Pneumologie 02/2013; 67(2):123.
• Article: [The German IPF Guideline: national vs. international].

  U Costabel, J Behr
  Pneumologie 02/2013; 67(2):79-80.
• Article: [In Process Citation].

  R Ewert
  Pneumologie 02/2013; 67(2):123-4.
• Article: [German Guideline for Diagnosis and Management of Idiopathic Pulmonary Fibrosis.]

  J Behr, A Günther, W Ammenwerth, I Bittmann, R Bonnet, R Buhl, O Eickelberg, R Ewert, S Gläser, J Gottlieb, [......], H Sitter, D Theegarten, A Theile, A Wilke, H Wirtz, C Witt, H Worth, P Zabel, J Müller-Quernheim, U Costabel
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  ABSTRACT: Idiopathic pulmonary fibrosis is a fatal lung disease with a variable and unpredictable natural history and limited treatment options. Since publication of the ATS-ERS statement on IPF in the year 2000 diagnostic standards have improved and a considerable number of randomized controlled treatment trials have been published necessitating a revision. In the years 2006 - 2010 an international panel of IPF experts produced an evidence-based guideline on diagnosis and treatment of IPF, which was published in 2011. In order to implement this evidence-based guideline into the German Health System a group of German IPF experts translated and commented the international guideline, also including new publications in the field. A consensus conference was held in Bochum on December 3rd 2011 under the protectorate of the "Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP)" and supervised by the "Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften" (AWMF). Most recommendations of the international guideline were found to be appropriate for the german situation. Based on recent clinical studies "weak negative" treatment recommendations for pirfenidone and anticoagulation were changed into "weak positive" for pirfenidone and "strong negative" for anticoagulation. Based on negative results from the PANTHER-trial the recommendation for the combination therapy of prednisone plus azathiorpine plus N-acetlycsteine was also changed into strong negative für patients with definite IPF. This document summarizes essential parts of the international IPF guideline and the comments and recommendations of the German IPF consensus conference.
  Pneumologie 01/2013;
• Article: [Exercise testing in respiratory medicine].

  F J Meyer, M M Borst, H C Buschmann, R Ewert, B Friedmann-Bette, U Ochmann, W Petermann, A M Preisser, D Rohde, K-H Rühle, S Sorichter, G Stähler, M Westhoff, H Worth
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  ABSTRACT: This document replaces the DGP recommendations published in 1998. Based on recent studies and a consensus conference, the indications, choice and performance of the adequate exercise testing method in its necessary technical and staffing setting are discussed. Detailed recommendations are provided: for arterial blood gas analysis and right heart catherterization during exercise, 6-minute walk test, spiroergometry, and stress echocardiography. The correct use of different exercise tests is discussed for specific situations in respiratory medicine: exercise induced asthma, monitoring of physical training or therapeutical interventions, preoperative risk stratification, and evaluation in occupational medicine.
  Pneumologie 01/2013; 67(1):16-34.