Pneumologie

Publisher: Georg Thieme Verlag

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

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Georg Thieme Verlag

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Publications in this journal

  • [Show abstract] [Hide abstract]
    ABSTRACT: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has become essential for the workup of patients with lung cancer and other pulmonary diseases. The emphasis of currently available literature is related to the diagnostic yield of EBUS-TBNA which was found to be high. Complications seem to be rare but such data are scant. We report three cases of complications including mediastinitis, pneumothorax and bleeding and provide a review on the existing literature.
    No preview · Article · Jan 2016 · Pneumologie
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    ABSTRACT: The therapy of choice in hypoxemic respiratory failure (type 1) is the application of supplemental oxygen at flow rates of 1 to 15 l/min via nasal prongs or mask. Non-invasive or invasive positive pressure ventilation will be initiated when the oxygen therapy effects are not sufficient or if hypercapnic respiratory failure (type 2) is the underlying problem. Recently, an alternative therapy option is available, from the pathophysiology it can be classified between oxygen therapy and positive pressure ventilation. The therapy called Nasal High Flow (NHF) is based on the nasal application of a heated and humidified air oxygen mixture with a flow range of up to 60 l/min. The precise pathophysiological principles of NHF are only partly understood, yet various aspects are well studied already: it is possible to deliver high oxygen concentrations, airway dryness can be avoided, dead space ventilation reduced and clearance of nasal dead space is achieved. Additionally, an end expiratory positive pressure is built up, which helps to prevent airway collapse, thus resulting in an improvement of respiratory efficiency and reduction of breathing work. Current studies demonstrate improvement in gas exchange and reduction of reintubation rate when applying the NHF treatment in acute respiratory failure. Thus the NHF therapy attracts attention in intensive care medicine. The application in other fields like chronic respiratory insufficiency is less well clarified. The objectives of this review are to present the pathophysiological effects and mechanisms of NHF, as far as understood, and to give an overview over the current state of relevant studies.
    No preview · Article · Jan 2016 · Pneumologie

  • No preview · Article · Jan 2016 · Pneumologie
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    ABSTRACT: Aims and scope: Sarcoidosis continues to be an underestimated disease that can cause severe morbidity and mortality in individuals. There has, however, been an increasing awareness of this disease as shown by the increasing number of publications since the 1990 s. The large number of available publications makes it challenging for a single scientist to provide an overview of the topic. To quantify the global research activity in this field, a scientometric investigation was conducted. Material and methods: The total number of publications on sarcoidosis was determined in the Web of Science to obtain their bibliometric data for the period 1900 - 2008. According to the NewQIS-protocol, different visualisation techniques and scientometric methods were applied. Results: A total of 14,190 published items were evaluated. The U.S. takes a leading position in terms of the overall number of publications and collaborations. Prolific institutions and authors are of U.S. origin. Only a relatively small number of international co-operations were identified. The most intensive network is between the "University of Colorado" and the "National Jewish Medical Research Center". "Semenzato, G" has the highest citation rate of all authors. The most productive co-operative author is "du Bois, RM". Conclusion: The scientific interest in the topic sarcoidosis is growing steadily. The influence of international co-operation on scientific progress in this area is of increasing importance.
    No preview · Article · Jan 2016 · Pneumologie
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    ABSTRACT: Worldwide there are annually about 9.6 million new cases and 1.5 million deaths due to tuberculosis (TB). Smoking is an independent risk factor causing approximately a twofold increase not only in active Tb disease but also in latent TB infection and mortality. In a mathematical model it is estimated that smoking would produce until 2050 an excess of 18 million tuberculosis cases from TB which would challenge the TB elimination goal of the WHO. Smoking cessation methods during and after TB treatment, which at present are insufficiently included into TB programmes, are urgently needed.
    No preview · Article · Jan 2016 · Pneumologie

  • No preview · Article · Dec 2015 · Pneumologie
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    ABSTRACT: The non-invasive ventilation (NIV) is widespread in the clinical medicine and has attained meanwhile a high value in the clinical daily routine. The application of NIV reduces the length of ICU stay and hospitalization as well as mortality of patients with hypercapnic acute respiratory failure. Patients with acute respiratory failure in context of a cardiopulmonary edema should be treated in addition to necessary cardiological interventions with continuous positive airway pressure (CPAP) or NIV. In case of other forms of acute hypoxaemic respiratory failure it is recommended the application of NIV to be limited to mild forms of ARDS as the application of NIV in severe forms of ARDS is associated with higher rates of treatment failure and mortality. In weaning process from invasive ventilation the NIV reduces the risk of reintubation essentially in hypercapnic patients. A delayed intubation of patients with NIV failure leads to an increase of mortality and should therefore be avoided. With appropriate monitoring in intensive care NIV can also be successfully applied in pediatric patients with acute respiratory insufficiency. Furthermore NIV can be useful within palliative care for reduction of dyspnea and improving quality of life. The aim of the guideline update is, taking into account the growing scientific evidence, to outline the advantages as well as the limitations of NIV in the treatment of acute respiratory failure in daily clinical practice and in different indications.
    No preview · Article · Dec 2015 · Pneumologie
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    ABSTRACT: The COPD is a very common, chronic, non-contagious disease causing high mortality as well as high socio-economical costs worldwide. Its clinical assessment progressively becomes more comprehensive including the lung function, the rate of exacerbations, the physical capacity, the sensation of dyspnoea, and comorbidities. On the other hand, our therapeutic options are very limited: Although there are several well-tolerated and effective combinable bronchodilators of the group of long-acting beta2-mimetics and anticholinergics, drugs causally affecting pathophysiology are barely available. As anti-inflammatory principles only inhaled glucocorticoids as well as one orally available inhibitor of phosphodiesterase 4 are approved, each improving the course of disease in a subgroup of patients. This lack of effective causative therapeutic principles on the one hand and of biomarkers clearly stratifying patients on the other hand to a large extend are caused by our limited understanding of the pathophysiology. Therefore, this review presents the current progress in clinical and experimental research on COPD with regard to clinical practice.
    No preview · Article · Dec 2015 · Pneumologie
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    ABSTRACT: Acute lung injury secondary to pneumonia results from inadequate activation of the innate immune system with hyperinflammation and alveolar-capillary barrier dysfunction. To date, effective strategies for prevention or treatment of acute lung injury in pneumonia besides antibiotics are lacking. In preclinical studies, promising therapeutic targets have been identified and novel strategies demonstrated to protect against lung failure in pneumonia. This review highlights some adjuvant therapeutic strategies for modulation of inflammation and stabilization of lung barrier function in pneumonia.
    No preview · Article · Dec 2015 · Pneumologie
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    ABSTRACT: COPD patients under shared treatment of general practitioners and pulmonologists were grouped in GOLD classification I-IV and A-D, respectively to find out whether the new A-D classification showed advantages concerning therapy decisions. As a result of CAT separation at 10 points (GOLD A-D rule) group C with higher risk and low symptoms was very small. It is described how CAT threshold values of 15 and 20 points would affect the size of the groups A-D in pulmonary practice. The new A-D classification showed better signals for exacerbations. Regardless of the classification I-IV or A-D respectively patients received a considerable amount of overtreatment (low degrees of severity) or undertreatment (higher degrees of severity). Only the application of prednisolone and of roflumilast, respectively, showed a noticeable relation to increased exacerbations in system A-D. A variety of reasons might cause that obviously the principles of both classifications are followed poorly. Higher attention for exacerbations may be considered as a progress resulting from the new a-d classification. Possible abrupt short term intraindividual changes of severity, inadequate to the global course of disease, are a possible disadvantage of the new A-D classification.
    No preview · Article · Oct 2015 · Pneumologie
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    ABSTRACT: The underdiagnosed feather duvet lung, an extrinsic allergic alveolitis (hypersensitivity pneumonitis) caused by duck and goose feathers, can be more frequently diagnosed, if duck and goose feather antibodies are included in the panel of the routinely applied IgG antibody screening test. This does not necessarily require extending the screening test to include duck and goose feather antigens. By analysing 100 sera with duck and goose antibodies we found that the commonly used pigeon and budgerigar antibodies can also screen for feather duvet antibodies. All examined sera lacking pigeon and budgerigar antibodies also lacked clear-cut duck and goose feather antibodies. The examined sera with strong pigeon or budgerigar antibodies always also contained feather duvet antibodies. However, sera with medium or low concentrated pigeon or budgerigar antibodies are not always associated with feather duvet antibodies. In the light of these observations, we find that 71 % of the duck and goose antibody analyses would be dispensable without essential loss of quality, if the results of screening for pigeon and budgerigar antibodies were incorporated into the procedure of a step-by- step diagnostics.
    No preview · Article · Oct 2015 · Pneumologie
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    ABSTRACT: Previous studies showed a reduced hypercapnic ventilatory response (HCVR) in patients with COPD. However, the association between HCVR and COPD GOLD stages is unknown. The measurement of the HCVR is a methodological option to test the function of the breathing feedback cycle. The aim of this feasibility study was to present a new automatic and standardized device (MATAM) to measure and interpret the HCVR. This device determines if exposure to CO2 leads to an adequate increase in breathing frequency and tidal volume. Recordings are performed in a closed system that allows selective changes of each gas component. The minute ventilation (AMV) under hypercapnic stimulation is plotted against the end-tidal CO2 (ETCO2). The HCVR is defined as the linear regression line.28 patients (18 male; 10 female) with COPD GOLD stages 0 to IV were studied. The patients had a mean age of 57 ± 14 (standard deviation) years and a mean BMI of 32 ± 9 kg/m(2). We could show that the HCVR measurement in patients with COPD using MATAM was feasible. Patients with more severe COPD stages had a significantly more reduced HCVR. This could be an indication of reduced chemosensitivity due to a worsening of blood values (pH and pCO2) which affect the central chemoreceptors in the long term. Further studies will be needed to validate the MATAM device for healthy individuals and other patient groups, and for the investigation of standard values.
    No preview · Article · Oct 2015 · Pneumologie
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    ABSTRACT: Within the last years there has been significant progress in the field of chronic cough. So far, the analysis and evaluation of chronic cough was done mainly on the basis of subjective methods such as manual counts of cough events, questionnaires and diaries. Testing cough hypersensitivity and monitoring 24 h cough represent objective criteria. Validated questionnaires on cough frequency and quality of life represent the impact of chronic cough. Cough frequency monitoring, the preferred tool to objectively assess cough, should be used as primary end-point in clinical trials. It will also be possible to discriminate between productive and non-productive cough. The relationship with subjective measures of cough is weak. In the future, cough and its therapy should therefore be assessed with a combination of subjective and objective tools.
    No preview · Article · Oct 2015 · Pneumologie
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    ABSTRACT: Idiopathic pulmonary fibrosis (IPF) is the most common idiopathic interstitial pneumonia and a disease of the elderly. Cigarette smoking and longterm exposure to substances harming alveolar epithelial cells are risk factors for the development of IPF. There is also evidence for a genetic susceptibility. IPF is defined as the idiopathic variant of Usual Interstitial Pneumonitis (UIP). Diagnosis of IPF is complex and based on the exclusion of other diseases associated with an UIP pattern. The only cure is lung transplantation. In the last years there was a breakthrough in the treatment of IPF. With pirfenidone and nintedanib there are now two compounds approved for the treatment of IPF.
    No preview · Article · Oct 2015 · Pneumologie
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    ABSTRACT: Lung cancer is the most preventable neoplastic disease for men and women. The incidence rate per year is 14.000 in Germany. Smoking is the main risk factor for the onset of lung cancer and for a share of 90 % of cases, lung cancer is associated with smoking. Recent studies have shown that the time slot of diagnosing lung cancer is a teachable moment for tobacco cessation interventions. The therapy that was rated most effective was a combination of cognitive behavioral therapy and pharmacotherapy (e. g. NRT, Bupropion, Varenicline). We examined the smoking status of all patients undergoing lung cancer surgery in 2011, 2012 and 2013 in this study. A retrospective semi structured interview via telephone was conducted regarding smoking habits and current quality of life. 131 patients (36.6 % female, average age of 68.7 years) of an urban German hospital were included.Results showed a relapse rate of 22.3 %, while 86.2 % used to be highly addicted smokers; A multivariate analysis of covariance (MANCOVA) indicated a significant overall impact of smoking status on quality of life with a medium effect size, controlled for age, gender, living conditions, tumor stage, duration of smoking abstinence, type of cancer therapy, type of resection method, and the time period between the date of surgery and of the survey. Two thirds of all smokers did not see an association between their habit and their disease.So far motivation to quit and long term abstinence rates are not sufficiently established even among seriously sick patients in Germany; further initiatives should focus on new and more intense interventions and educational strategies.
    No preview · Article · Sep 2015 · Pneumologie
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    ABSTRACT: 8 to 15 % of lung cancer cases and nearly all mesothelioma cases are caused by asbestos. Problems in compensation issues refer to high legal as well as insurance barriers in attesting the occupational diseases. Claiming of certain numbers of asbestos bodies or fibers in lung tissue is of special relevance in substantiating legal medical cases. Such evidence, which is disproved by a sound science, is also used by an influential US pathology department. Frequently, also epidemiological evidence with its causal relationships and exposure histories are ignored. Similar misleading arguments are currently found in industrializing countries where white asbestos which is carcinogenic and fibrogenic like other asbestos types, is efficiently promoted as less harm. As a result, the asbestos consumption is increasing in some of these countries. Beyond the worldwide asbestos tragedy a well-designed strategy of certain transnational or global acting industrial interest groups can be recognized. Their plan, hidden from the public eyes, follows rigorously sole economic interests, while leaving the resulting health harm to the public health systems.
    No preview · Article · Sep 2015 · Pneumologie