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ABSTRACT: ZielSchlafbezogene Atmungsstörungen (SBAS) sind eine obligate Komplikation von progredienten neuromuskulären Erkrankungen (NME).
Ziel der Studie war die prospektive Untersuchung des Einflusses von drei Monaten nichtinvasiver Beatmung (NIB) auf den Schlaf
und die mit SBAS assoziierten Symptome von Kindern und Jugendlichen mit fortgeschrittenen NME.
MethodeZweiundzwanzig Patienten mit symptomatischen SBAS (11,1±4,3 Jahre) wurden in die Studie eingeschlossen und mit einer Polysomnographie
und einem Symptomfragebogen untersucht. 20 Patienten wurden während des Nachtschlafes mit druckgesteuerten Beatmungsgeräten
über Masken beatmet, die Evaluation wurde nach drei Monaten Behandlung wiederholt.
ErgebnisseBei zwei Patienten waren nach Adenotomie keine SBAS mehr nachweisbar. Bei den übrigen 20 Patienten normalisierte die NIB die
Atmung und den Gasaustausch im Schlaf (Respiratory Disturbance Index 1,8±1,6 vs. 9,2±4,5/h und minimale SpO2 91±3 vs. 79±12%). Nach drei Monaten wurde während der Beatmung eine kürzere Einschlaflatenz (17±13 vs. 42±38 Minuten), eine
höhere Schlafeffizienz (95±3 vs. 89±9%) und weniger EEG-Arousals (11±5 vs. 22±9/h) gemessen (alle p<0,001). Die Schlafstadienverteilung
änderte sich nicht. Die subjektive Schlafqualität, morgendlichen Kopfschmerzen, Stimmung, Konzentrationsfähigkeit und Tagesmüdigkeit
wurden als signifikant gebessert beurteilt (alle p<0,001).
SchlussfolgerungDie intermittierende nächtliche NIB führt mittelfristig zu einer objektiven und subjektiven Verbesserung der Schlafqualität
sowie der mit SBAS assoziierten Tagessymptome.
AimSleep disordered breathing (SDB) is an inevitable complication of progressive neuromuscular disorders (NMD). Aim of the study
was to prospectively investigate the impact of three months of non-invasive ventilation (NIV) on sleep and SDB-associated
symptoms in children and adolescents with advanced NMD.
MethodsTwenty-two patients (11.1±4.3 years) with symptomatic SDB were enrolled in the study and evaluated with polysomnography and
a symptom questionnaire. Twenty patients were treated with pressure assisted ventilation during sleep. The impact of NIV on
SDB, sleep and symptoms was re-evaluated after 3 months of NIV.
ResultsIn 2/22 patients, after adenotomy, SDB was no longer demonstrable. In the remaining 20 patients NIV improved SDB (Respiratory
Disturbance Index 1.8±1.6 vs. 9.2±4.5/h; minimal SpO2 91±3 vs. 79±12%). Three months of treatment resulted in shortened sleep latency (17±13 vs. 42±38 minutes), improved sleep
efficiency (95±3 vs. 89±9%) and less EEG-arousals (11±5 vs. 22±9/h, p<0.001 for all). Sleep-stage proportion did not change.
Patients reported significant improvements of sleep quality, morning headaches, mood, concentration and daytime sleepiness
(p<0.001 for all).
ConclusionsIn children with NMD intermittent nocturnal NIV results in objective and subjective improvements of sleep quality and symptoms
associated with SDB.
Wiener klinische Wochenschrift 04/2012; 115(24):855-859. · 0.81 Impact Factor
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Arnoldus J.R. van Gestel,,
Malcolm Kohler,,
Jörg Steier,,
Urte Sommerwerck,,
Sebastian Teschler,,
Erich W. Russi,, Helmut Teschler,
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ABSTRACT: Background: Chronic obstructive pulmonary disease (COPD) is associated with impaired exercise tolerance, but it has not been established to what extent cardiac autonomic function impacts on exercise capacity. Objective: To evaluate whether there is an association between airflow limitation and cardiac autonomic function and whether cardiac autonomic function plays a role in exercise intolerance and daily physical activity (PA) in patients with COPD. Methods: Univariate and multivariate analyses were performed to evaluate the association between both 6-minute walking test (6MWT) and PA (steps per day) and pulmonary function, cardiac autonomic function (HR at rest, HRR and heart rate variability, HRV) in patients with COPD. Results: In 154 COPD patients (87 females, mean [SD]: age 62.5 [10.7] years, FEV1%predicted (43.0 [19.2]%), mean HR at rest was elevated (86.4 [16.4] beats/min) and HRV was reduced (33.69 [28.96] ms) compared to published control data. There was a significant correlation between FEV1 and HR at rest (r = -0.32, p < 0.001), between HR at rest and 6MWD (r = -0.26, p = 0.001) and between HR at rest and PA (r = -0.29, p = 0.010). No correlation was found between HRV and 6MWD (r = 0.089, p = 0.262) and PA (r = 0.075, p = 0.322). In multivariate analysis both HR and FEV1 were independent predictors of exercise capacity in patients with COPD. Conclusions: In patients with COPD the degree of airflow limitation is associated with HR at rest. The degree of airflow limitation and cardiac autonomic function, as quantified by HR at rest, are independently associated with exercise capacity in patients with COPD.
03/2012; 9(2):160-165.
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ABSTRACT: Chronic obstructive pulmonary disease (COPD) is associated with impaired exercise tolerance, but it has not been established to what extent cardiac autonomic function impacts on exercise capacity.
To evaluate whether there is an association between airflow limitation and cardiac autonomic function and whether cardiac autonomic function plays a role in exercise intolerance and daily physical activity (PA) in patients with COPD.
Univariate and multivariate analyses were performed to evaluate the association between both 6-minute walking test (6MWT) and PA (steps per day) and pulmonary function, cardiac autonomic function (HR at rest, HRR and heart rate variability, HRV) in patients with COPD. Results: In 154 COPD patients (87 females, mean [SD]: age 62.5 [10.7] years, FEV(1) %predicted (43.0 [19.2]%), mean HR at rest was elevated (86.4 [16.4] beats/min) and HRV was reduced (33.69 [28.96] ms) compared to published control data. There was a significant correlation between FEV(1) and HR at rest (r = -0.32, p < 0.001), between HR at rest and 6MWD (r = -0.26, p = 0.001) and between HR at rest and PA (r = -0.29, p = 0.010). No correlation was found between HRV and 6MWD (r = 0.089, p = 0.262) and PA (r = 0.075, p = 0.322). In multivariate analysis both HR and FEV(1) were independent predictors of exercise capacity in patients with COPD.
In patients with COPD the degree of airflow limitation is associated with HR at rest. The degree of airflow limitation and cardiac autonomic function, as quantified by HR at rest, are independently associated with exercise capacity in patients with COPD.
COPD Journal of Chronic Obstructive Pulmonary Disease 01/2012; 9(2):160-5. · 1.79 Impact Factor
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ABSTRACT: The exhaled breath of lung cancer patients contains volatile organic compounds (VOCs) that differ from those in healthy individuals. These VOCs can be detected with methods such as ion mobility spectrometry (IMS); their origin remains unknown.
In 19 patients with lung cancer, exhaled breath was aspirated via the working channel of a flexible bronchoscope from both the tumor-bearing and the opposite lung and analyzed with IMS.
IMS measurement through the working channel of a bronchoscope was feasible and safe. In comparison to the opposite lung, we found two peaks that were significantly higher and three peaks that were significantly lower on the IMS of the tumor-bearing site. VOCs differ in concentration depending on the histologic subtype.
Our results indicate that VOCs in lung cancer patients are produced locally in or around the tumor, and it is most likely that these VOCs represent underlying metabolic processes of the tumor.
Beiträge zur Klinik der Tuberkulose 12/2011; 189(6):445-52. · 1.90 Impact Factor
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ABSTRACT: Bronchiolitis obliterans syndrome (BOS) is a life-threatening complication after lung transplantation that is characterized by progressive fibrosis in the small airways. However, little is known about sensitive markers for detecting BOS. Our study compared the clinical utility of serum KL-6 level, a marker for pulmonary fibrosis, with that of neutrophilia in bronchoalveolar lavage fluid (BALF) for detecting BOS.
Levels of serum KL-6 were evaluated in 152 samples from 53 lung transplant recipients (BOS, 15; non-BOS, 38) and in 27 samples from age- and sex-matched healthy individuals. Pulmonary function tests, arterial blood gas analysis, and BALF cell differentials were simultaneously evaluated.
Serum KL-6 levels were significantly increased in the BOS group compared with the non-BOS group and the healthy individuals (p < 0.0001). Receiver operating characteristic curve analysis for detecting BOS showed the largest area under the curve for KL-6 compared with lactate dehydrogenase, C-reactive protein, or neutrophils percentage in BALF. Serum KL-6 correlated with the decline in forced expiratory volume in 1 second (FEV(1)) from post-lung transplant baseline (r = 0.43; p = 0.0001).
Serum KL-6 levels are increased and correlate with the decline from baseline in FEV(1) in lung transplant recipients. The diagnostic accuracy of serum KL-6 level is better than that of BALF neutrophilia for detecting BOS.
The Journal of heart and lung transplantation: the official publication of the International Society for Heart Transplantation 08/2011; 30(12):1374-80. · 3.54 Impact Factor
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ABSTRACT: COPD is associated with impaired health-related quality of life (HRQL) and cardiac autonomic dysfunction. Data describing the association between these factors in patients with COPD are mostly lacking. The objective of this study was to evaluate whether there is an association between cardiac autonomic dysfunction and HRQL in COPD.
We studied 60 patients with COPD (37 women, mean (SD) age 65.20 (7.73) years, FEV(1) % pred. 46.58 (18.53) %) and measured HRQL, as assessed by the Chronic Respiratory Disease Questionnaire, and cardiac autonomic dysfunction, as assessed by heart rate variability (HRV). Analysis of HRV was performed using a Holter-ECG device during a recording period of 5 min. To evaluate a possible association between these factors, univariate and multivariate analyses were used.
There was a significant correlation between Chronic Respiratory Disease Questionnaire total score and both variables of HRV reflecting parasympathetic tone; root mean square successive difference of RR intervals (rMSSD) (r = 0.34, P = 0.012) and the density of the beat-to-beat oscillation in the N-N interval of HRV in the high-frequency band (HF power) (r = 0.35, P = 0.01). In a multivariate analysis rMSSD was found to be independently associated with HRQL after correcting for FEV(1), carbon monoxide transfer coefficient (DL(CO)), 6MWD and CRP.
Resting parasympathetic tone, as measured by HRV, is independently associated with HRQL, which emphasizes the role of cardiac autonomic dysfunction on HRQL in patients with COPD.
Respirology 05/2011; 16(6):939-46. · 2.42 Impact Factor
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ABSTRACT: Conventional pulmonary rehabilitation programs improve exercise tolerance but have no effect on pulmonary function in patients with chronic obstructive pulmonary disease (COPD). The role of controlled breathing using respiratory biofeedback during rehabilitation of patients with COPD remains unclear.
To compare the effects of a conventional 4-week pulmonary rehabilitation program with those of rehabilitation plus controlled breathing interventions.
A randomized controlled trial was performed. Pulmonary function (FEV1), exercise capacity (6-min walking distance, 6 MWD), health-related quality of life (chronic respiratory questionnaire, CRQ) and cardiac autonomic function (rMSSD) were evaluated.
Forty COPD patients (mean±SD age 66.1±6.4, FEV1 45.9±17.4% predicted) were randomized to rehabilitation (n=20) or rehabilitation plus controlled breathing (n=20). There were no statistically significant differences between the two groups regarding the change in FEV1 (mean difference -0.8% predicted, 95% CI -4.4 to 2.9% predicted, p=0.33), 6 MWD (mean difference 12.2 m, 95% CI -37.4 to 12.2 m, p=0.16), CRQ (mean difference in total score 0.2, 95% CI -0.1 to 0.4, p=0.11) and rMSSD (mean difference 2.2 ms, 95% CI -20.8 to 25.1 ms, p=0.51).
In patients with COPD undergoing a pulmonary rehabilitation program, controlled breathing using respiratory biofeedback has no effect on exercise capacity, pulmonary function, quality of life or cardiac autonomic function.
Respiration 04/2011; 83(2):115-24. · 2.26 Impact Factor
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ABSTRACT: COPD is a disease characterised by a chronic inflammation of the airways and a not fully reversible airway obstruction. The spirometry is considered as gold-std. to diagnose the disease and to grade its severity. In this study we used the methodol. of Ion Mobility Spectrometry in order to detect Volatile Org. Compds. (VOCs) in exhaled breath of patients with COPD. The purpose of this study was to investigate if the VOCs detected in patients with COPD were different from the VOCs detected in exhaled breath of healthy controls. 13 COPD patients and 33 healthy controls were included in the study. Breath samples were collected via a side-steam Teflon tube and directly measured by an ion mobility spectrometer coupled to a multi capillary column (MCC/IMS). One peak was identified only in the patients group compared to the healthy control group. Consequently, the anal. of exhaled breath could be a useful tool to diagnose COPD. [on SciFinder(R)]
Int. J. Ion Mobility Spectrom. 01/2011; 14(Copyright (C) 2011 American Chemical Society (ACS). All Rights Reserved.):7-13.
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ABSTRACT: Die Atmung ist die einzige Vitalfunktion, die willkürlich beeinflussbar ist. Für die Sauerstoffversorgung der peripheren Gewebe und die pH-Regulation des arteriellen Blutes ist nicht
nur der Zustand von Lunge und Kreislauf entscheidend, sondern auch die Leistung der Atempumpe. Der Gesamtapparat der Atempumpe besteht aus den in ▸ Übersicht 6.1 zusammengefassten Facetten. Die Atempumpe erfordert eine koordinierte Zusammenarbeit aller Einzelfacetten, und sie spielt
eine wesentliche Rolle bei der Aufrechterhaltung der körpereigenen Homöostase.
12/2009: pages 41-49;
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ABSTRACT: Krankheiten der Atemwege und Lunge gewinnen eine zunehmende Bedeutung. Im Gegensatz zu vielen anderen Krankheiten treten einige
Atemwegs- und Lungenerkrankungen nicht erst im fortgeschrittenen Alter auf, sondern betreffen bereits Kinder. Schon 10% der Kinder haben Asthma bronchiale
oder ein nachweislich überempfindliches Bronchialsystem. Etwa 10–15% der Erwachsenen leiden an Asthma oder an chronischer
Bronchitis. Schätzungen zufolge ist damit zu rechnen, dass diese Erkrankungen bis zum Jahr 2010 um 25% zunehmen werden [1]. Aktuell wird etwa ein Drittel aller Arbeitsunfähigkeitstage durch Atemwegs- und Lungenerkrankungen ausgelöst. In der 10.
Revision der „Internationalen Klassifikation der Krankheiten und verwandter Gesundheitsprobleme“ (ICD/ICF, International Statistical
Classification of Diseases and Related Health Problems, 10. Revision, herausgegeben von der World Health Organisation [WHO]
2001) werden die Krankheitsbilder des Atmungssystems unter verschiedenen Blickwinkeln betrachtet (▸ Übersicht 1.1).
12/2009: pages 3-13;
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ABSTRACT: Die Atmung ist die einzige Vitalfunktion, die willkürlich beeinflussbar ist. Sie erfordert eine genau aufeinander abgestimmte Zusammenarbeit zwischen den verschiedenen Facetten der
Atempumpe und spielt eine herausragende Rolle bei der Aufrechterhaltung der körpereigenen Homöostase. Aus pathophysiologischer Sicht ist die COPD durch eine chronisch-progressive exspiratorische Flussbehinderung charakterisiert, die durch chronische endo-
und exobronchiale Atemwegsobstruktion verursacht ist. Im fortgeschrittenen Stadium kommt es durch
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die periphere Atemwegsobstruktion,
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die Parenchym veränderungen und
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die Umbauprozesse im pulmonalen Gefäßsystem
12/2009: pages 86-91;
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ABSTRACT: ApneaLink is a novel single-channel screening device for sleep apnea detection which is based on pressure-transduced measurement of oronasal airflow, summarised as respiratory disturbance index per hour of recording time (RDI(ApneaLink)). We tested ApneaLink's diagnostic performance in a patient population with high prevalence of sleep apnea.
ApneaLink was applied simultaneously with in-laboratory polysomnography (PSG) (n = 102, 24 female, age 54.7 years) and sequentially with PSG in the unattended home setting (n = 131, 37 female, age 59.1 years). Predictive values were computed for apnea-defining thresholds of apnea-hypopnea index (AHI) >or= 5/h, >or=10/h, >or=15/h. Night-to-night variability (NNV) was assessed over three consecutive nights (n = 55, 10 female, age 48.9 years).
RDI(ApneaLink) correlated well with apnea-hypopnea index on PSG (PSG(AHI)) on simultaneous (r = 0.98, bias -0.7) and unattended home application (r = 0.95, bias -0.6). Predictive values were highest at AHI >or= 10/h (in-laboratory: sensitivity 91.1%, specificity 87.5%, LR+ (positive likelihood ratio) 7.4, LR- 0.1; home: sensitivity 80%, specificity 85.5%, LR+5.5, LR- 0.2). NNV was low (V = 0.58 +/- 0.44, range 0-1.69).
ApneaLink is an accurate screening tool for sleep apnea in a population with high prevalence of the disorder.
Sleep And Breathing 09/2009; 14(2):109-14. · 1.84 Impact Factor
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ABSTRACT: To analyze the toxicity profile of an intensified definitive chemoradiotherapy (CRT) schedule in patients with locally advanced non-small-cell lung cancer (Stage IIIA N2/selected IIIB) treated within a prospective multicenter trial.
After mediastinoscopy and routine staging procedures, three cycles of induction chemotherapy (cisplatin 50 mg/m(2), Days 1 and 8; paclitaxel 175 mg/m(2) Day 1, every 21 days) were planned, followed by concurrent CRT (accelerated-hyperfractionated regimen, 45 Gy, 2 x 1.5 Gy/d, cisplatin 50 mg/m(2), Days 64 and 71, vinorelbine 20 mg/m(2), Days 64 and 71). At 45 Gy, a multidisciplinary panel decision was made regarding operability. Inoperable patients received definitive radiotherapy (total dose 65 or 71 Gy, depending on the mean lung dose) with additional concurrent chemotherapy (cisplatin 40 mg/m(2), Day 85; vinorelbine 15 mg/m(2), Days 85 and 92).
A total of 28 patients (23 men and 5 women; median age, 58 years; range 41-73; Stage IIIA in 3 and Stage IIIB in 25) were judged ineligible for surgery by the multidisciplinary panel and underwent definitive CRT (75% of the patients received 71 Gy). The maximum toxicity (Grade 3 or greater) during induction chemotherapy included leukopenia (11%) and anemia (4%). During concurrent CRT, leukopenia (Grade 3 or greater) was observed in 39% of the patients. The maximal nonhematologic toxicity during concurrent CRT included esophagitis (Grade 3 or greater) in 18% and pneumonitis (Grade 3 or greater) in 4% of the patients. At 3 years, the locoregional control rate was 52% (95% confidence interval, 29-75%) and the overall survival rate was 31% (95% confidence interval, 12-50%).
This intensified treatment protocol with induction chemotherapy and concurrent CRT, including hyperfractionated-accelerated RT, showed only moderate toxicity and proved feasible. This treatment represents the definitive CRT arm of our ongoing multicenter randomized trial comparing definitive CRT and trimodality treatment.
International journal of radiation oncology, biology, physics 06/2009; 76(3):809-15. · 4.59 Impact Factor
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ABSTRACT: Polysomnography (PSG) is the gold standard in diagnosing sleep disordered breathing (SDB). Diagnostic analysis of SDB is time-consuming and labor-intensive and entails long waiting lists for patients. The aim of this study was to assess the validity of a flow-based screening classifier as an automated diagnostic test for Cheyne-Stokes respiration (CSR).
Sleep laboratory.
70 study subjects (28 with obstructive sleep apnea [OSA], 20 with CSR, 11 with CSR+OSA and 11 without SDB).
The nasal cannula flow signal was analyzed by ApneaLink (ResMed, Sydney, Australia), based on a classifier algorithm using pattern recognition. In a simultaneous PSG, results were compared with manual scoring of respiratory events by certified sleep experts.
For detecting CSR we obtained a sensitivity of 87.1% (95% confidence interval 75.3% to 98.9%), a specificity of 94.9% (95% confidence interval 87.9% to 100%), a positive likelihood ratio of 17.0, and a negative likelihood ratio of 0.14. The area under the curve (AUC) of the according receiver operating characteristic (ROC) curve was 93.4%. This resulted in an accuracy of 91.4% for identifying CSR.
In this study we demonstrated that the screening classifier was able to detect CSR with high diagnostic accuracy. Hence, ApneaLink equipped with CSR classifier is an appropriate screening tool which may help to prioritize patients with CSR for PSG.
Sleep 05/2009; 32(4):553-7. · 5.05 Impact Factor
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ABSTRACT: The aim of this study was to assess the validity of an artificial neural network based on flow-related spectral entropy as a diagnostic test for obstructive sleep apnoea and Cheyne-Stokes respiration. A data set of 37 subjects was used for spectral analysis of the airflow by performing a fast Fourier transform. The examined intervals were divided into epochs of 3 min. Spectral entropy S was applied as a measure for the spread of the related power spectrum. The spectrum was divided into several frequency areas with various subsets of spectral entropy. We studied 11 subjects with obstructive apnoeas (n = 267 epochs), 10 subjects with obstructive hypopnoeas (n = 80 epochs), 11 subjects with Cheyne-Stokes respiration (n = 253 epochs) and 5 subjects with normal breathing in non-REM sleep (n = 174 epochs). Based on spectral entropy an artificial neural network was built, and we obtained a sensitivity of 90.2% and a specificity of 90.9% for distinguishing between obstructive apnoeas and Cheyne-Stokes respiration, and a sensitivity of 91.3% and a specificity of 94.6% for discriminating between obstructive hypopnoeas and normal breathing in non-REM sleep. This resulted in an accuracy of 91.5% for identifying flow patterns of obstructive sleep apnoea, Cheyne-Stokes respiration and normal breathing in non-REM sleep. It is concluded that the use of an artificial neural network relying on spectral analysis of the airflow could be a useful method as a diagnostic test for obstructive sleep apnoea and Cheyne-Stokes respiration.
Physiological Measurement 08/2008; 29(8):869-78. · 1.68 Impact Factor
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ABSTRACT: Human brucellosis is a worldwide re-emerging zoonosis. However, its histological appearance has only been occasionally described. We report the case of a young girl who had been suffering from a spontaneous fracture of the eighth thoracic vertebra at the age of 7. At the age of 15, X-ray showed a translucence of the seventh and ninth thoracic vertebra, and additionally, a bi-lateral episcleritis was detected. Three months later, she was admitted to the hospital because of perspiration at night and moderate fever. Computer tomography revealed coarsely spotted infiltrates in the lower fields of both lungs. Serology for rheumatic diseases was negative. Thoracoscopical wedge resection was done for histological clarification of pulmonary changes. Microscopically, a granulomatous inflammation with central necrosis was seen. A Ziehl-Neelsen stain did not demonstrate acid-fast bacteria. In spite of negative serology, real-time polymerase chain reaction detected Brucella melitensis deoxyribonucleic acid in the formalin-fixed tissue samples of the lung. Interrogation of the patient revealed visits in different Arabian countries during childhood as a presumable source of infection. In conclusion, granulomatous inflammation negative for Ziehl-Neelsen and Grocott stains presenting together with other localized lesions should lead to specific investigations on brucellosis.
Archiv für Pathologische Anatomie und Physiologie und für Klinische Medicin 02/2008; 452(1):97-101. · 2.49 Impact Factor
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Christoph Pöttgen,
Wilfried Eberhardt,
Andreas Grannass,
Soenke Korfee,
Georg Stüben, Helmut Teschler,
Georgios Stamatis,
Horst Wagner,
Bernward Passlick,
Volker Petersen,
Volker Budach,
Hans Wilhelm,
Isabel Wanke,
Herbert Hirche,
Hans-Jochen Wilke,
Martin Stuschke
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ABSTRACT: To investigate the role of prophylactic cranial irradiation (PCI) within a trimodality protocol (chemotherapy, chemoradiotherapy, surgery) for patients with operable stage IIIA non-small-cell lung cancer (NSCLC).
After mediastinoscopic staging, patients with operable stage IIIA NSCLC were enrolled to a German multicenter trial and randomly assigned to receive either primary resection followed by adjuvant thoracic radiation therapy (50 to 60 Gy; arm A) or preoperative chemotherapy (cisplatin/etoposide [PE]; three cycles) followed by concurrent chemoradiotherapy (PE plus 45 Gy; 1.5 Gy twice per day) and definitive surgery (arm B), respectively. Patients in arm B were scheduled to receive PCI (30 Gy; 2 Gy daily fractions).
One hundred twelve patients were randomly assigned between November 1994 and July 2001. One hundred six patients were eligible (arm A: 51, arm B: 55), 90 males and 16 females, 50 with squamous cell, 16 with large cell, five with adenosquamous, and 35 with adenocarcenoma (median age, 57 years; range, 37 to 71 years). Forty-three patients received PCI as scheduled in arm B. Eleven long-term survivors (arm A: four; arm B: seven) underwent a comprehensive neuropsychological examination. PCI significantly reduced the probability of brain metastases as first site of failure (7.8% at 5 years v 34.7%; P = .02), the overall brain relapse rate was reduced comparably (9.1% at 5 years v 27.2%; P = .04). A slightly reduced neurocognitive performance in comparison with the age-matched normal population was found for patients in both treatment groups. No significant difference between patients who were treated with or without PCI could be noted.
PCI is effective in preventing brain metastases following this aggressive trimodality approach. Neurocognitive late effects are not significantly different between patients treated with or without PCI.
Journal of Clinical Oncology 12/2007; 25(31):4987-92. · 18.37 Impact Factor
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ABSTRACT: Evaluation of the prevalence and nature of sleep-disordered breathing (SDB) in patients with symptomatic chronic heart failure (CHF) receiving therapy according to current guidelines.
We prospectively screened 700 patients with CHF (NYHA class> or =II, LV-EF< or =40%) for SDB using cardiorespiratory polygraphy (Embletta). Furthermore, echocardiography, cardiopulmonary exercise and 6-min walk testing were performed. Medication included ACE-inhibitors and/or AT1-receptor blockers in at least 94%, diuretics in 87%, beta-blockers in 85%, digitalis in 61% and spironolactone in 62% of patients. SDB was present in 76% of patients (40% central (CSA), 36% obstructive sleep apnoea (OSA)). CSA patients were more symptomatic (NYHA class 2.9+/-0.5 vs. no SDB 2.57+/-0.5 or OSA 2.57+/-0.5; p<0.05) and had a lower LV-EF (27.4+/-6.6% vs. 29.3+/-2.6%, p<0.05) than OSA patients. Oxygen uptake (VO(2)) was lowest in CSA patients: predicted peak VO(2) 57+/-16% vs. 64+/-18% in OSA and 63+/-17% in no SDB, p<0.05. 6-min walking distances were 331+/-111 m in CSA, 373+/-108 m in OSA and 377+/-118 m in no SDB (p<0.05).
This study confirms the high prevalence of SDB, particularly CSA in CHF patients. CSA seems to be a marker of heart failure severity.
European Journal of Heart Failure 03/2007; 9(3):251-7. · 4.90 Impact Factor
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Christoph Poettgen,
Dirk Theegarten,
Wilfried Eberhardt,
Sabine Levegruen,
Thomas Gauler,
Thomas Krbek,
Georgios Stamatis, Helmut Teschler,
Hilmar Kuehl,
Andreas Bockisch,
Martin Stuschke
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ABSTRACT: Prediction of histopathological response with PET/CT scans after neoadjuvant chemoradiotherapy is limited by confounding factors which have been evaluated in this analysis.
(18)F-2-fluoro-2-deoxy-D-glucose (FDG)-PET/CT findings [standard uptake value (SUV), residual tumor volume] were correlated with histopathological parameters of the resection specimens (tumor cell density, necrosis, scar, macrophage infiltration) in patients with locally advanced non-small cell lung cancer (stage IIIA/IIIB) after neoadjuvant induction chemotherapy (platinum-based doublet) and concurrent chemoradiotherapy (cisplatin/vinorelbine/45 Gy).
Sixty patients [40 male/20 female, median age 56 years (34-78)] completed induction therapy, 46 patients (stage IIIA/IIIB: 16/30; squamous cell carcinoma 41%, adenocarcinoma 48%, large cell carcinoma 11%) were resected. Pathologic complete response of the primary tumor was observed in 19 patients (41%) with a broad range of SUV(mean) (0.4-9.8, mean 3.0) after neoadjuvant therapy. A high rate of histopathological complete remissions (44%) was observed in tumors with a postinduction SUV >2.5 and volumes larger than the median (7.9 cm(3)) before resection. SUV(mean) was positively correlated with the macrophage score (r = 0.39, p = 0.007) and tumor cell density (r = 0.32, p = 0.03).
These observations suggest that postinduction FDG uptake should be interpreted with caution in larger residual tumor volumes, since high SUV levels may be due to macrophage infiltration and not viable tumor tissue.
Oncology 01/2007; 73(5-6):316-23. · 2.27 Impact Factor
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ABSTRACT: In neuromuscular disorders, reduced peak cough flows (PCFs) are considered to increase the risk of respiratory complications such as pneumonia or chronic atelectasis. Different methods were described to improve PCF. However, these studies were primarily carried out in adults, and there is limited information regarding the use and efficacy of these methods in children with respiratory muscle weakness. The aim of this study was to investigate whether hyperinsufflation with an intermittent positive-pressure breathing (IPPB) device is effective in cough augmentation in pediatric patients. Spirometry (forced inspiratory vital capacity, FIVC; forced expiratory volume in 1 sec, FEV1), respiratory muscle pressures (peak inspiratory pressure, PIP; peak expiratory pressure, PEP), and PCF were measured in 29 schoolchildren with various neuromuscular disorders. IPPB-assisted hyperinsufflation was taught individually to increase lung volumes (maximum insufflation capacity, MIC) above FIVC. The impact of hyperinsufflation on peak cough flow was documented. In 28/29 patients, IPPB-assisted hyperinsufflation enhanced FIVC from 0.68 +/- 0.40 l to an MIC of 1.05 +/- 0.47 l (P < 0.001). Unassisted PCF was 119.0 +/- 57.7 l/min, and increased to 194.5 +/- 74.9 l/min (P < 0.001) in 27/29 patients. This effect was similar in young patients (ages 6-10 years) and older patients (aged >10 years). Augmentation of lung volumes from FIVC to MIC correlated with an increase of PCF (R = 0.42, P < 0.05). IPPB-assisted hyperinsufflation improves PCF in pediatric neuromuscular disorders. The results suggest that this technique can be used to improve clearance of airway secretions and therefore reduce respiratory morbidity in children with NMD.
Pediatric Pulmonology 07/2006; 41(6):551-7. · 2.53 Impact Factor
