Publisher: Georg Thieme Verlag

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ISSN 1438-8790
OCLC 163410099
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Document type Internet Resource, Computer File, Journal / Magazine / Newspaper

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Georg Thieme Verlag

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Publications in this journal

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    ABSTRACT: Introduction: Inhaled drugs can only be effective if they reach the middle and small airways. This study introduces a system that combines a trans-nasal application of aerosols with noninvasive pressure support ventilation. Methods: In a pilot study, 7 COPD patients with GOLD stages II and III inhaled a radiolabeled marker dissolved in water via a trans-nasal route. The mean aerosol particle size was 5.5 µm. Each patient took part in two inhalation sessions that included two application methods and were at least 70 hours apart. During the first session ("passive method"), the patient inhaled the aerosol through an open tube system. The second session ("active method") included pressure support ventilation during the inhalation process. A gamma camera and planar scintigraphy was used to determine the distribution of aerosol particles in the patient's body and lung. Results: The pressure supported inhalation ("active method") results in an increased aerosol lung deposition compared to the passive method. Above all, we could demonstrate deposition in the lung periphery with relatively large aerosol particles (5.5 µm). Discussion: The results prove that the combination of trans-nasal inhalation with noninvasive pressure support ventilation leads to significantly increased particle deposition in the lung. © Georg Thieme Verlag KG Stuttgart · New York.
    Pneumologie 08/2015; 69(8):469-476. DOI:10.1055/s-0034-1392444
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    ABSTRACT: Pleural empyema in a post-pneumonectomy cavity (PEC) occurs with a frequency of 2 % - 15 % and a mortality of more than 10 %. It can occur with or without bronchopleural fistula (BPF). The treatment of empyema in the PEC requires a strict algorithm: drainage, bronchoscopy, closure of the fistula, thorough cleaning of the PEC, filling the cavity, thoracoplasty. 39 cases with an empyema in the PEC were analysed retrospectively (men: n = 38; women: n = 1; mean age: 60.3 ± 7.6 years). In 32 (82.1 %) of the patients, a BPF was detected (right: n = 26, left: n = 6). The average length of stay in hospital was 125 days (22 - 293 days). Cleaning of the PEC was achieved in all surviving patients (n = 23, 65.1 %). All patients (n = 39) underwent bronchoscopy with placement of a chest tube for drainage. The BPF was closed in three cases (7.7 %) with a stent while in 12 cases (30.8 %) a vascularized flap was used. In 14 patients (35.9 %) the bronchial stump was either reclosed with sutures or resected. In three cases (7.7 %) a re-anastomosis was performed. The PEC became sterile by regular flushing with antibiotic solution in three patients (7.7 %). In 35.9 % of the patients (n = 14), aggressive surgical debridement (Weder procedure) was necessary. A thoracic window was applied in 22 patients (56.4 %), followed by negative pressure wound therapy (NPWT) and change of dressing every three to four days or a tamponade of the thoracic cavity with simple dressings. In 19 patients (48.7 %) the thoracic cavity was sealed with an antibiotic solution. In 5 cases an Alexander thoracoplasty took place. Pleural empyema after pneumonectomy still poses a serious postoperative complication. A bronchopleural fistula is often detected. Thus, two problems arise at the same time - fistula and infection in the pleural cavity. Through a strict algorithm, both problems can be dealt with in stages. After sealing the fistula, the thoracic cavity is thoroughly cleaned and finally the thorax is closed. Only in a small number of patients (1.3 %) in whom these measures remain ineffective (persistent MRSA, aspergillus colonization) should the cavity be obliterated by thoracoplasty. © Georg Thieme Verlag KG Stuttgart · New York.
    Pneumologie 08/2015; 69(8):463-8. DOI:10.1055/s-0034-1392330
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    ABSTRACT: More research is needed to elucidate natural history and underlying pathomechanisms of the most common airway diseases, Asthma and COPD. In the last decade risk factors affecting the natural history of lung function, defined by the decline of lung function over time, have been evaluated. Moreover, scientific methods have been extended and novel biomarkers, genetics, metabolomics, and epidemiology are dominant tools for investigating the natural history of lung function and potential risk factors. Evidence shows that lung function in childhood is a predictor for lung function in adulthood and risk factors starting in utero contribute to lung function decline during life. Therefore, recently it has been hypothesized that COPD begins in childhood. Thus, prospective investigation of lung function changes including novel scientific methodology has been advocated. The Austrian LEAD study has been initiated in the general population 2012 to investigate the natural history of obstructive airway diseases. © Georg Thieme Verlag KG Stuttgart · New York.
    Pneumologie 08/2015; 69(8):459-462. DOI:10.1055/s-0034-1392516
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    ABSTRACT: Spirometry is a highly standardized method which allows to measure the forced vital capacity (FVC) with high precision and reproducibility. In patients with IPF FVC is directly linked to the disease process which is characterized by scaring of alveoli and shrinkage of the lungs. Consequently, there is ample evidence form clinical studies that the decline of FVC over time is consistently associated with mortality in IPF. As for the first time effective drugs for the treatment of IPF are available it becomes obvious that in studies which could demonstrate that the drug reduces FVC decline, a numerical effect on mortality was also observed, while in one study where a significant effect on FVC decline was missed, there was also no change in mortality. Based on these studies FVC decline is a validated surrogate of mortality in IPF. It is concluded that FVC decline is not only accepted as an endpoint of clinical treatment trials in IPF but is also valid as a patient related outcome parameter which should be considered for the assessment of the efficacy of an IPF drug. © Georg Thieme Verlag KG Stuttgart · New York.
    Pneumologie 07/2015; DOI:10.1055/s-0034-1392602
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    ABSTRACT: Pulmonary hypertension (PH) is classified into five distinct groups according to the fifth world conference in Nice 2013. Pulmonary arterial hypertension (PAH) comprises idiopathic PAH, hereditary PAH, drug-induced and associated PAH. Right heart catheterization is essential for the diagnosis of PH and should precede initiation of a targeted PAH therapy. Besides general measures and supportive therapy, four different classes of targeted drugs have been approved for the treatment of PAH. Combination therapy, either sequential or initial (up-front), is increasingly gaining recognition. Risk stratification and treatment goals have been defined to guide therapeutic decisions. However, cure is still far from reach and lung transplantation is an important treatment option for patients with end-stage disease under optimal supportive and targeted drug therapy. © Georg Thieme Verlag KG Stuttgart · New York.
    Pneumologie 07/2015; DOI:10.1055/s-0034-1392103
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    ABSTRACT: In two patients with bilateral micronodular pulmonary changes a diffuse pulmonary meningotheliomatosis was found. A 73-year-old woman presented with bilateral disseminated miliary pulmonary nodules as a radiological incidental finding. The surgical lung biopsy showed multiple tiny nodular proliferations meningothelial-like cells, corresponding "minute pulmonary meningothelial-like nodules", MPMN. A 60-year-old lady with similar radiological findings showed also proliferations of meningothelial-like cells in a transbronchial cryo-biopsy. These lesions are well known to pathologists as curious isolated incidental findings on histological examination of lung specimens. The here described diffuse form of these changes is very rare; its knowledge is important for the differential diagnosis with neoplastic proliferations and other diffuse parenchymal diseases of the lung. This rare diagnosis is made on histological grounds and is also possible in transbronchial biopsies when careful correlation with clinical and radiological data, knowledge of the entity and adequate specimens are provided. © Georg Thieme Verlag KG Stuttgart · New York.
    Pneumologie 07/2015; DOI:10.1055/s-0034-1392437
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    ABSTRACT: Adolescents and young adults with cystic fibrosis (CF) are increasingly having difficulties to take over the complete responsibility for their daily treatment. Particularly inhalative therapy poses special problems. In order to overcome this unsatisfactory situation typically occurring during this vulnerable period, the German Airway League has now created a poster "Correct Inhalation Therapy For Patients With Cystic Fibrosis", according to the model presented by this League already in 2013 for correct inhalation under certain disease conditions. This give an opportunity to adolescents and young adults with CF to obtain anonymously, independently of time and location, autonomously and in a time-saving manner information on correct inhalative treatment. Adolescents and young adults with CF can thus be actively supported on their way to independence. Furthermore, the video clips and the poster offer support physicians, nurses and physiotherapists and can be employed in training of all involved persons in inhalation techniques. © Georg Thieme Verlag KG Stuttgart · New York.
    Pneumologie 07/2015; DOI:10.1055/s-0034-1392490
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    ABSTRACT: COPD is a heterogeneous disease with a wide range of clinical phenotypes and breath-functional dysfunctions. Cardiopulmonary exercise testing (CPET) allows describing all component parts of breathing and determining exercise capacity and the mechanisms of exercise limitation. From these aspects 64 COPD patient stages II, III and IV according to the conventional GOLD classification were examined by means of CPET to evaluate whether CPET can provide a better functional characterization of COPD than the standard investigation procedures in pulmonary practice.We could show that in pulmonary practice CPET is safely and effectively practicable in stable COPD patients of all GOLD stages. This method allowed a clinical and prognostic disease severity assessment of all patients, proving important differences of peak oxygen uptake in each GOLD stage, so that patients in spite of identical GOLD disease severity were to be assigned to different prognostic groups according CPET criteria. Furthermore, we found relevant differences of individual breath-functional patterns in exercise, which can neither be objectified nor be prognosticated by standard investigation procedures at rest.Therefore CPET allows, aside from an objective clinical and prognostic disease severity assessment, also a breath-functional evaluation in a subtly way in COPD patients reflecting the multidimensional background of the disease with variable dysfunctions in pulmonary ventilation, gas exchange, circulation and muscular function as well as associated cardio vascular comorbidities. The breath-functional phenotyping of the COPD patient seems to be meaningful in particular for an individualised therapy management. © Georg Thieme Verlag KG Stuttgart · New York.
    Pneumologie 07/2015; DOI:10.1055/s-0034-1392576
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    ABSTRACT: Smoking cessation as a therapeutic intervention has largely not the significance that it should have according to its potential influence on diseases in the pulmonary practice. Barriers against smoking cessation apart from the addiction character of tobacco dependence are mainly the almost complete absence of reimbursement as well as concerns regarding low achievable long-term abstinence. The presented study shows that despite these barriers smoking cessation in pulmonology practice is successful if carried out by using a 2-step motivation of the participants. The long-term abstinence success of 46 % after 12 months (point prevalence) presented here was achieved with the use of behavioral therapy and medical support. Success factors are doctor's office setting and consequent information and encouragement for medical support (mostly varenicline). © Georg Thieme Verlag KG Stuttgart · New York.
    Pneumologie 07/2015; DOI:10.1055/s-0034-1392470
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    ABSTRACT: Bronchiectasis not due to cystic fibrosis (Non-CF bronchiectasis) represents a heterogeneous disorder with many different underlying diseases. Reliable and mature data referring to prevalence and incidence of Non-CF bronchiectasis in Germany are lacking. Bronchiectasis is often mentioned as rare or orphan disease, although it might be more often than supposed to be. Up to now (May 2015) there is no approved therapy for this disease in Germany. After some preliminary work the German bronchiectasis registry PROGNOSIS (The PROspective German NOn-CF bronchiectaSIS patient registry) will start recruiting patients by the beginning of July. The goals of PROGNOSIS are to build up a national, representative, prospective, observing (non-interventional) and longitudinal patient registry with at least 750 patients within three years in 25-35 centers, to evaluate important epidemiological questions. In addition a German-language guideline for diagnostic and management of Non-CF bronchiectasis will be developed in cooperation with the German respiratory society (DGP). © Georg Thieme Verlag KG Stuttgart · New York.
    Pneumologie 07/2015; 69(7):391-3. DOI:10.1055/s-0034-1392254
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    ABSTRACT: Title: Effects of respiratory therapy (bagging) on respiratory function, swallowing frequency and vigilance in tracheotomized patients in early neurorehabilitation Objective: Tracheotomized patients often suffer from impairments in mucociliary clearance and limited capacities for active expectoration of secretions. We investigated the effects of a specific respiratory intervention method (bagging) for tracheotomized patients on respiratory parameters (pO2, pCO2, SpO2, respiratory rates), swallowing frequency, vigilance and secretion viscosity. Methods: The bagging method supports enforced mobilization and expectoration of secretions by application of a series of manual hyperinflations with a resuscitation bag during active inspiration and manual cough support on the chest. 30 tracheotomized neurological patients participated in a multiple-baseline study including a three-weeks intervention period and a follow-up measurement three weeks after termination of the treatment. Results: Most outcome parameters improved significantly during the intervention period: pO2 (p= .000), SpO2 (p= .000), respiratory rates (p= .000), swallowing rates (p= .000), and vigilance scores (p= .000). The quality of bronchial secretions improved in all participants. All effects were sustained up to the follow-up measurements. Conclusion: This preliminary data indicates positive effects for a respiratory intervention method (bagging) on respiratory function and additional respiration-related functions in tracheotomized neurological patients. This easy-to-learn and inexpensive method might expand the range of treatment options for tracheotomized and non-responsive patients. Titel: Effekte einer spezifischen Atemtherapie (Bagging) auf die Atemfunktion, Schluckfrequenz und Vigilanz bei tracheotomierten Patienten in der neurologischen Frührehabilitation Ziel: Bei tracheotomierten Patienten sind die mucociliäre Clearance und die Möglichkeiten zur aktiven Sekretexpektoration eingeschränkt. Wir untersuchten Effekte einer spezifischen atemtherapeutischen Methode (Bagging) für tracheotomierte Patienten auf respiratorische Funktionsparameter (PCO2, PO2, SPO2, Atemfrequenz, bronchiale Sekretqualität), die Schluckfrequenz und die Vigilanz. Methoden: Die Bagging-Methode unterstützt die Mobilisation und Expektoration von Bronchialsekret durch Anwendung von manueller Hyperinflation und nachfolgender thorakaler Hustenunterstützung. In einer Multiple Baseline Studie mit Follow-up Messung erhielten 30 tracheotomierte neurologische Patienten über einen Zeitraum von 3 Wochen täglich eine Bagging Anwendung. Ergebnisse: In fast allen Parametern zeigten sich nach der Intervention signifikante Verbesserungen: pO2 (p=.000), SpO2 (p=.000), Atemfrequenz (p=.000), Schluckfrequenz (p=.000) und Vigilanz (p=.000). Die Viskosität des Bronchialsekrets veränderte sich bei allen Patienten positiv. Alle Therapieeffekte waren zur Follow-up Messung stabil. Schlussfolgerung: Diese ersten Daten zeigen positive Effekte einer spezifischen Atemtherapie für tracheotomierte neurologische Patienten auf Atemfunktion und weitere Funktionsbereiche. Durch diese kostengünstige und leicht zu erlernende Methode kann das Spektrum atemtherapeutischer Behandlungsmöglichkeiten für tracheotomierte Patienten effektiv ergänzt werden.
    Pneumologie 07/2015; 69:394-399.
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    ABSTRACT: Sleeve resection comprises 3.1 % to 27.7 % of all anatomic lung resections performed in Germany. Anastomotic insufficiency is a feared complication that should be avoided. When anastomotic insufficiency does lead to secondary pneumonectomy, postoperative morbidity and mortality is high (30 % to 80 %). It is therefore very important to standardize the technique of sleeve resection as well as postoperative care. The time-point of postoperative follow-up and the interpretation of endobronchial healing have not yet been defined. In this paper anastomotic healing is described and interpreted with the help of a 5-step classification that allows bronchoscopic evaluation and classification of the anastomosis. The aim is to provide a standardized algorithm for postoperative care after sleeve resection. The basis of this classification and postoperative care measures derived from it are described and illustrated with the help of clinical examples. © Georg Thieme Verlag KG Stuttgart · New York.
    Pneumologie 07/2015; 69(7):403-8. DOI:10.1055/s-0034-1392313
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    ABSTRACT: Though tobacco smoking is the leading cause of lung cancer, during the last decades the prevalence increased in never smoking patients, especially in women. Sex steroid hormones and particularly the estrogen receptors (ERs) seem to play an important but still underestimated role in non-small cell lung cancer (NSCLC). Beside long existing hints that hormone replacement therapy (HRT) increases the risk of lung tumors recent analyses on cell lines, xenografts and human tumors of both sexes gave clear evidence of ER expression and proliferation in NSCLC. Most recently, the expression of ERs apparently has prognostic and predictive value. Recently, an intracellular "cross-talk" between the ER and the epithelial growth factor receptor (EGFR) could be demonstrated. EGFR are important targets of approved tyrosinkinases (TKIs), like gefitinib, erlotinib or afatinib. Currently, clinical studies are enrolling lung tumor patients for combination treatment with EGFR TKI and antihormonal drugs, e. g. fulvestrant. © Georg Thieme Verlag KG Stuttgart · New York.
    Pneumologie 06/2015; 69(6):350-360. DOI:10.1055/s-0034-1392081
  • Pneumologie 05/2015; 69(5):299-300. DOI:10.1055/s-0034-1391933
  • Pneumologie 05/2015; 69(5):295-8. DOI:10.1055/s-0034-1391843
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    ABSTRACT: In addition to malaria and HIV/AIDS, tuberculosis (TB) is one of the world's most important infectious diseases. Also in Germany tuberculosis still remains a relevant public health problem that needs special attention. This article provides an overview of the tuberculosis epidemiology in Germany with emphasis on drug resistance and population groups that are predominantly affected. Based on surveillance data provided in the notification system, the TB-situation in Germany is presented - particularly with respect to drug resistance, origin of patients (country of birth and nationality) and treatment outcome. Since 2009, the continuous decline in case numbers has slowed down and is now stagnating as observed in several other industrialized nations. Since 2007, the proportion of foreign-born patients has continuously increased and accounts for over half of all cases registered in Germany. Special attention deserves the current drug resistance situation: With a proportion of 3.4 % in 2013, multidrug-resistant tuberculosis (MDR-TB) has increased significantly compared to the previous year (2.1 %) and the rate is therefore higher than in many other European low-incidence countries. Particularly high levels of MDR-TB were observed among foreign-born patients originating from a former Soviet Union country. On average, treatment success was observed in 79 % of the cases. Thus, Germany does not reach the WHO target of 85 % treatment success. Stagnating case numbers together with the observed drug resistance trend clearly indicate the need for continued efforts in tuberculosis control in Germany including focused strategies for the most affected population groups. © Georg Thieme Verlag KG Stuttgart · New York.
    Pneumologie 05/2015; 69(5):263-70. DOI:10.1055/s-0034-1391922
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    ABSTRACT: This article summarizes the state of development of new drugs for the treatment of multidrug-resistant tuberculosis. We focused on delamanid, bedaquiline, pretomanid, SQ 109 and sutezolid. © Georg Thieme Verlag KG Stuttgart · New York.
    Pneumologie 05/2015; 69(5):282-6. DOI:10.1055/s-0034-1391920