Search

Die Etablierung der unterstutzten Spontanatmung gilt allgemein als eine vorteilhafte und wenig gefahrdende Phase der Beatmungstherapie. Allerdings geben neuere Erkenntnisse Hinweise auf eine potenzielle Schadigung durch exzessive Spontanatembemuhungen vor allem bei akuter Lungenschadigung. Das Syndrom wird unter dem Begriff „patient self-inflicted lung injury“ zusammengefasst. Arzte, Pflegepersonen und Atmungstherapeuten sollten fur diese Thematik sensibilisiert werden. Parameter, die mittels Osophagusdruckmessung oder einfacher Manover am Respirator bestimmt werden konnen, sind bei der Entscheidung zur Durchfuhrung und zur Uberwachung von Spontanatmung auch in den akuten Phasen der Lungenschadigung hilfreich. Weiterhin gibt es im Umgang mit hohem Atemantrieb oder erhohter Atemanstrengung therapeutische Moglichkeiten, diesen zu begegnen.

Aufgrund der Neuartigkeit der COVID‑19-Erkrankung existieren keine evidenzbasierten Empfehlungen fur die Beatmung dieser Patienten. Darstellung von Parametern, die eine individualisierte lungen- und diaphragmaprotektive Beatmung ermoglichen. Selektive Literaturrecherche und Diskussion von Expertenempfehlungen. In der aktuellen Literatur wird der Unterschied des ARDS bei COVID‑19 zum klassischen ARDS beschrieben. Evidenzbasierte Empfehlungen zum Umgang mit dieser Diskrepanz gibt es nicht. In der Vergangenheit wurden bereits Parameter und Ansatze fur eine personalisierte Beatmungsstrategie eingefuhrt und erprobt. Unter Verwendung der dargestellten Parameter ist es moglich, die Beatmung von COVID‑19-Patienten zu individualisieren, um so dem heterogenen klinischen Bild des COVID‑19-ARDS gerecht zu werden.

Purpose Anchored electromagnetic transponders for tumor motion monitoring during lung radiotherapy were clinically evaluated. First, intrafractional motion patterns were analyzed as well as their interfractional variations. Second, intra- and interfractional changes of the geometric transponder positions were investigated. Materials and methodsIntrafractional motion data from 7 patients with an upper or middle lobe tumor and three implanted transponders each was used to calculate breathing amplitudes, overall motion amount and motion midlines in three mutual perpendicular directions and three-dimensionally (3D) for 162 fractions. For 6 patients intra-and interfractional variations in transponder distances and in the size of the triangle defined by the transponder locations over the treatment course were determined. Results Mean 3D values of all fractions were up to 4.0, 4.6 and 3.4 mm per patient for amplitude, overall motion amount and midline deviation, respectively. Intrafractional transponder distances varied with standard deviations up to 3.2 mm, while a maximal triangle shrinkage of 36.5% over 39 days was observed. Conclusions Electromagnetic real-time motion monitoring was feasible for all patients. Detected respiratory motion was on average modest in this small cohort without lower lobe tumors, but changes in motion midline were of the same size as the amplitudes and greater midline motion can be observed in some fractions. Intra-and interfractional variations of the geometric transponder positions can be large, so for reliable motion management correlation between transponder and tumor motion needs to be evaluated per patient.

The purpose of this study was to evaluate prognostic factors associated with overall survival (OS) and neurological progression free survival (nPFS) in small-cell lung cancer (SCLC) patients with brain metastases who received whole-brain radiotherapy (WBRT). From 2003 to 2015, 229 SCLC patients diagnosed with brain metastases who received WBRT were analyzed retrospectively. In this cohort 219 patients (95%) received a total photon dose of 30 Gy in 10 fractions. The prognostic factors evaluated for OS and nPFS were: age, Karnofsky Performance Status (KPS), number of brain metastases, synchronous versus metachronous disease, initial response to chemotherapy, the Radiation Therapy Oncology Group recursive partitioning analysis (RPA) class and thoracic radiation. Median OS after WBRT was 6 months and the median nPFS after WBRT was 11 months. Patients with synchronous cerebral metastases had a significantly better median OS with 8 months compared to patients with metachronous metastases with a median survival of 3 months (p

Bei einem Patienten wurde funf Monate nach Operation und adjuvanter Chemotherapie eines NSCLC eine Raumforderung der Thoraxwand mit ossarer Destruktion der Rippen und pulmonalen Rundherden festgestellt. Wie wichtig eine aktuelle histologische Sicherung ist, zeigt der Fallbericht.

Die Bronchoskopie hat einen bedeutenden Stellenwert in der Diagnostik als auch in der Therapie von pneumologischen Krankheitsbildern. Hamoptysen oder zentrale Atemwegsstenosen sind haufige Indikationen fur die interventionelle Bronchoskopie. Auch die Therapie von Lungenfruhkarzinomen ist eine Domane der Bronchoskopie bei inoperablen Patienten. In den vergangenen Jahren haben sich zudem endoskopische Techniken als neue Therapieoptionen bei der fortgeschrittenen chronisch obstruktiven Lungenerkrankung oder dem unkontrollierten Asthma bronchiale etabliert.

To evaluate lung T2 mapping for quantitative characterization and differentiation of ground-glass opacity (GGO), reticulation (RE) and honeycombing (HC) in usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP). Twelve patients with stable UIP or NSIP underwent thin-section multislice CT and 1.5-T MRI of the lung. A total of 188 regions were classified at CT into normal (n = 29) and pathological areas, including GGO (n = 48), RE (n = 60) and HC (n = 51) predominant lesions. Entire lung T2 maps based on multi-echo single shot TSE sequence (TE: 20, 40, 79, 140, 179 ms) were generated from each subject with breath-holds at end-expiration and ECG-triggering. The median T2 relaxation of GGO was 67 ms (range 60-72 ms). RE predominant lesions had a median relaxation of 74 ms (range 69-79 ms), while for HC pattern this was 79 ms (range 74-89 ms). The median T2 relaxation for normal lung areas was 41 ms (ranged 38-49 ms), and showed significant difference to pathological areas (p

Background Benign central airway tumors are very rare diseases. Their unspecific symptoms are responsible for late diagnosis. Endoscopic interventions with different techniques and tools are widely used for their treatment. However, in certain cases interventional endoscopy might be unsuccessful and therefore other methods such as high-dose-rate brachytherapy could be a therapeutic option. Case presentation A 76-year-old white German woman was referred to our clinic for an endoscopic treatment of a recurrent granulation polyp in her left main bronchus. She had dyspnea, coughing, and mucus retention. Three times resections via bronchoscopy were performed within less than a year. After each intervention the polyp regrew inside her left main bronchus causing a repeat of the initial symptoms. She presented to our clinic less than 1 month since the last intervention. Twice we performed a rigid bronchoscopy in total anesthesia where we resected the granulation polyp with a snare wire loop and did an argon plasma coagulation of its base. Due to the recurrent growing of the granuloma, we performed a high-dose-rate brachytherapy in conscious sedation after another interventional bronchoscopy with a resection of the polyp and argon plasma coagulation of the base. Three months after brachytherapy our patient came to our clinic for a follow-up with none of the initial symptoms. Only a small remnant of the polyp without a significant occlusion of her bronchus was visualized by bronchoscopy. Furthermore, 6 months after brachytherapy she was not presenting any of the initial symptoms. Conclusions This case report shows that high-dose-rate brachytherapy is a therapeutic option for the treatment of benign airway stenosis when other interventional treatments are not or are less than successful. However, further investigations are needed to prove the effectiveness and reliability of the method.

Background The INSIGHTS-IPF registry provides one of the largest data sets of clinical data and self-reported patient related outcomes including health related quality of life (QoL) on patients with idiopathic pulmonary fibrosis (IPF). We aimed to describe associations of various QoL instruments between each other and with patient characteristics at baseline. Methods Six hundred twenty-three IPF patients with available QoL data (St George’s Respiratory Questionnaire SGRQ, UCSD Shortness-of-Breath Questionnaire SoB, EuroQol visual analogue scale and index EQ-5D, Well-being Index WHO-5) were analysed. Mean age was 69.6 ± 8.7 years, 77% were males, mean disease duration 2.0 ± 3.3 years, FVC pred was 67.5 ± 17.8%, DLCO pred 35.6 ± 17%. Results Mean points were SGRQ total 48.3, UCSD SoB 47.8, EQ-5D VAS 66.8, and WHO-5 13.9. These instruments had a high or very high correlation (exception WHO-5 to EQ-5D VAS with moderate correlation). On bivariate analysis, QoL by SGRQ total was statistically significantly associated with clinical symptoms (NYHA; p

Distinct morphological emphysema phenotypes were assessed by CT to show characteristic perfusion defect patterns.Forty-one patients with severe emphysema (GOLD III/IV) underwent three-dimensional high resolution computed tomography (3D-HRCT) and contrast-enhanced magnetic resonance (MR) perfusion. 3D-HRCT data was visually analyzed for emphysema phenotyping and quantification by consensus of three experts in chest-radiology. The predominant phenotype per segment was categorized as normal, centrilobular, panlobular or paraseptal. Segmental lung perfusion was visually analyzed using six patterns of pulmonary perfusion (1-normal; 2-mild homogeneous reduction in perfusion; 3-heterogeneous perfusion without focal defects; 4-heterogeneous perfusion with focal defects; 5-heterogeneous absence of perfusion; 6-homogeneous absence of perfusion), with the extent of the defect given as a percentage.730 segments were evaluated. CT categorized 566 (78%) as centrilobular, 159 (22%) as panlobular and 5 (1%) as paraseptal with no normals. Scores with regards to MR perfusion patterns were: 1-0; 2-0; 3-28 (4%); 4-425 (58%); 5-169 (23%); 6-108 (15%). The predominant perfusion pattern matched as follows: 70 % centrilobular emphysema - heterogeneous perfusion with focal defects (score 4); 42% panlobular--homogeneous absence of perfusion (score 5); and 43% panlobular--heterogeneous absence of perfusion (score 6).MR pulmonary perfusion patterns correlate with the CT phenotype at a segmental level in patients with severe emphysema.• MR perfusion patterns correlate with the CT phenotype in emphysema. • Reduction of MR perfusion is associated with loss of lung parenchyma on CT • Centrilobular emphysema shows heterogeneous perfusion reduction while panlobular emphysema shows loss of perfusion.

Background: Uncontrolled proliferation is a hallmark of malignant tumour growth. Its prognostic role in non-small cell lung cancer (NSCLC) has been investigated in numerous studies with controversial results. We aimed to resolve these controversies by assessing the Ki-67 proliferation index (PI) in three large, independent NSCLC cohorts. Methods: Proliferation index was retrospectively analysed by immunohistochemistry in a cohort of 1065 NSCLC and correlated with clinicopathological data including outcome and therapy. Results were validated in two independent cohorts of 233 squamous cell carcinomas (SQCC) and 184 adenocarcinomas (ADC). Results: Proliferation index (overall mean: 40.7%) differed significantly according to histologic subtypes with SQCC showing a mean PI (52.8%) twice as high as ADC (25.8%). In ADC PI was tightly linked to growth patterns. In SQCC and ADC opposing effects of PI on overall (OS), disease-specific and disease-free survival were evident, in ADC high PI (optimised validated cut-off: 25%) was a stage-independent negative prognosticator (hazard ratio, HR OS: 1.56, P=0.004). This prognostic effect was largely attenuated by adjuvant radio-/chemotherapy. In SQCC high PI (optimised validated cut-off: 50%) was associated with better survival (HR OS: 0.65, P=0.007). Conclusions: Our data demonstrate that PI is a clinically meaningful biomarker in NSCLC with entity-dependent cut-off values that allow reliable estimation of prognosis and may potentially stratify ADC patients for the need of adjuvant therapy.

Pulmonary adenocarcinoma patients harboring EGFR mutations can benefit from tyrosine kinase inhibitor therapy. Reliable molecular analyses and precise pathological reporting of the EGFR mutational status are factors essential for patient treatment and outcome. More than 70 % of all EGFR mutation analyses are performed on non-small cell lung cancer (NSCLC) biopsies. However, biopsies may not be sufficient for mutation analysis due to low tumor content and admixture with non-neoplastic cells. To define the minimal concentration of tumor cells required for reliable EGFR mutational diagnostics by Sanger sequencing and to develop an algorithm for routine diagnostics on biopsy material, we determined total numbers of tumor and non-tumor cells, calculated the tumor cell concentration and serially diluted DNA from EGFR-mutated NSCLC by adding DNA of non-tumor cells from the same section. A counted tumor cell concentration of 30 %, which refers to a histologically estimated concentration of 40 %, is necessary for reliable detection of all mutations. Based on these data, we developed an algorithm for evidence-based EGFR mutation analysis by Sanger sequencing in biopsy specimens, which was subsequently applied to 461 diagnostic cases. Optimized diagnostic testing results in 80 % reliable EGFR mutation analyses of biopsy specimens, while in 20 % of cases re-biopsies had to be recommended.

Lung cancer remains a common cancer worldwide. The normal mediastinum on imaging often requires further clarification prior to potentially curative surgery. In this article we review the indications for endobronchial ultrasound (EBUS) and compare it with radiological imaging. We evaluate recent publications on EBUS as a means to evaluate CT and PET negative mediastinal lymph nodes. We also discuss the role of a combined approach of oesophageal ultrasound (EUS) with EBUS for staging of the mediastinum and evaluate the future of EBUS in lung cancer. Transbronchial needle forceps biopsy is a new approach to obtain a larger histological specimen under ultrasound guidance and may be used for immunohistochemistry analysis. In the future EBUS may also offer treatment options as outlined in this article.

Das Bronchialkarzinom ist die vierthaufigste Todesursache in Deutschland. Symptome sind oft unspezifisch und treten haufig erst spat auf. An erster Stelle der Diagnostik stehen die Anamnese und klinische Untersuchung. Die Thoraxrontgenaufnahme ist die Grundlage der bildgebenden Diagnostik und wird durch die Computertomographie des Thorax erganzt, ublicherweise mit Kontrastmittelverstarkung. Anschliesend sollte eine Probe zur histologischen bzw. zytologischen Diagnostik durch die am wenigsten invasive Methode durchgefuhrt werden, zumeist die Bronchoskopie. Erganzt durch neuere Techniken wie Narrow-Band-Imaging, endobronchialen Ultraschall und elektromagnetische Navigation nimmt sie in der gesamten Diagnostik einen wichtigen Stellenwert ein. In Abhangigkeit von den individuellen Therapieoptionen erfolgt das weitere Staging. Die Positronenemissionstomographie besitzt in der Diagnostik des Bronchialkarzinoms eine gesicherte Evidenz. Sie dient einerseits der Abklarung mediastinaler Lymphknoten und andererseits dem extrathorakalen Staging. Dieses sollte die haufigen Metastasenorte Nebennieren, Leber und Skelett umfassen. Insbesondere sollte eine Magnetresonanztomographie des Gehirns erfolgen.

Eine Lungenfibrose als erste symptomatische Manifestation einer mikroskopischen Polyangiitis (MPA) stellt eine Raritat dar. Sie ist durch eine progrediente Belastungsdyspnoe, einen radiologischen Nachweis einer interstitiellen Zeichnungsvermehrung sowie durch einen laborchemischen Nachweis der fur die MPA typischen Autoantikorper gekennzeichnet. Mit diesem Fallbericht soll an die seltene, einer Therapie zugangliche Ursache einer Lungenfibrose erinnert werden. Berichtet wird uber einen 78-jahrigen Patienten mit bereits lange bestehender Belastungsdyspnoe bei radiologisch nachgewiesenen charakteristischen Zeichen einer fortgeschrittenen Lungenfibrose. Der Nachweis der fur eine MPA typischen Autoantikorper war schlieslich zur Diagnosebestatigung ausschlaggebend, und es konnte eine stadiengerechte Therapie eingeleitet werden. Eine fruhzeitige Diagnosestellung einer MPA mit folglich rascher Therapieeinleitung ist wichtig, da die Beeinflussung einer bereits ausgebildeten interstitiellen Lungenerkrankung ungewiss ist.

Many pathologies of the airway involve the bronchial wall and the parabronchial structures. The view of the endoscopist, however, is limited to the lumen and the internal surface of the airway. Processes within the airway wall and outside the airway can only be assessed by indirect signs. Especially in malignancies, this can be of decisive importance for the fate of the patient. Therefore, expanding the endoscopist's view beyond the airway is essential. Endobronchial ultrasound (EBUS) and endobronchial ultrasound-transbronchial needle aspiration (EBUS-TBNA) are new diagnostic tools that are available on the market. They have great potential for diagnosis of mediastinal processes and staging of lung cancer. After discovering a lung cancer without extrathoracic metastases, the preoperative mediastinal check-up is of great importance in determining operability. The investigation of a suspected malignant adenopathy justifies a complete examination by mediastinoscopy or mediastinotomy, which are considered gold standards. EBUS-TBNA constitutes the recent evolution of TBNA, a method known for 20 years now but underused. The aim of this review is to highlight to the different techniques and to discuss the results of published trials.

Dynamic PET studies with(68)Ga-DOTATOC were performed in patients with non-small cell lung cancer (NSCLC) to assess the somatostatin receptor 2 (SSTR2) expression. Furthermore, dynamic(18)F-fluorodeoxyglucose (FDG) studies were performed in the same patients to compare the SSTR2 expression with the tumour viability.The study population comprised nine patients, examined with both tracers on two different days within 1 week. Standardised uptake values (SUVs) were calculated and a two-tissue compartment model was applied to the data. Furthermore, a non-compartment model based on the fractal dimension (FD) was applied to the data.The DOTATOC uptake was generally lower than the FDG uptake. Moderately enhanced DOTATOC uptake was noted in seven of the nine tumours. All kinetic parameters except k (4) were lower for DOTATOC than for FDG. The mean SUV was 2.018 for DOTATOC, in comparison to 5.683 for FDG. In particular, k (3) was highly variable for DOTATOC and showed an overlap with the normal lung tissue. The fractional blood volume V (B) was relatively low for both tracers, not exceeding 0.3. The highest significant logarithmic correlation was found for the FD of the two tracers (r=0.764, p=0.017). The logarithmic correlation for SUVs was also significant (r=0.646, p=0.060), as was that forV (B) (r=0.629, p=0.069). In contrast, none of the eight metastases which were positive on FDG PET showed any DOTATOC uptake.The results demonstrated moderate (68)Ga-DOTATOC uptake in primary NSCLC but did not provide any evidence for SSTR2 expression in metastases. This may be caused by loss of the gene expression in metastases as compared with the primary tumours.

To assess effect and toxicity of high-dose-rate afterloading (HDR) alone or in combination with external beam radiotherapy (EBRT) in centrally located tumors of the upper respiratory tract.From 1987 to 1996, 55 patients were treated. Twenty-one patients (group A1: 17 non-small-cell lung cancer [NSCLC], A2: 4 metastases from other malignancies) were treated using HDR alone due to a relapse after external beam irradiation. In 34 previously untreated and inoperable patients (group B1: 27 NSCLC, B2: 7 metastases from other malignancies) HDR was given as a boost after EBRT (30 to 60 Gy, median 50). HDR was carried out with a 192Ir source (370 GBq). The brachytherapy dose (group A: 5 to 27 Gy, median 20; B: 10 to 20 Gy, median 15) was prescribed to 1 cm distance from the source axis. A distanciable applicator was used in 39/55 patients.In group A1, a response rate (CR, PR) of 53% (group B1: 77%) was reached. The median survival (Kaplan-Meier) was 5 months in group A1 (B1: 20 months). The 1-, 3- and 5-year local progression free survival rates (Kaplan-Meier) were 66% (15%), 52% (0%), and 37% (0%) in group B1 (group A1). Prognostic favorable factors in group B1 were a tumor diameter20 mm, the lack of radiological mediastinal involvement, a complete remission, and a Karnofsky performance status70. Grade-1 or 2 toxicity (RTOG/EORTC) occurred in 0% in group A and in 6% in group B. We observed no Grade-3 or 4 toxicity. Complications caused by persistent or progressive local disease occurred in 3 patients in group A (fatal hemorrhage, tracheomediastinal fistula, hemoptysis) and in 2 patients in group B (fatal hemorrhage, hemoptysis).HDR brachytherapy is an effective treatment with moderate side effects. In combination with external beam irradiation long-term remissions can be reached in one third of the patients.

In a retrospective study the role of radiation therapy for the treatment of primary tracheal carcinoma was investigated.

Background Most patients with metastatic non-small cell lung cancer (NSCLC) will face treatment with systemic therapy. Current clinical studies are demonstrating improvements in chemotherapy and overall survival. However, it remains unclear whether these results are translated into clinical practice. Methods We reviewed all stage IV NSCLC patients without second malignancies that were diagnosed from 2004 to 2006 at our institution. 493 consecutive patients were included into this retrospective analysis and were followed-up until end of 2011. Results 352 patients (71.4%) received systemic therapy for up to 7 lines. For most patients, adjustments of dosages or applications had to be made at some point of the treatment, but the total applied dose remained generally close to the intended dose. The best disease control (BDC) rate decreased with increasing therapy lines from 59.7% to about 35%. Patients with palliative local therapy but no systemic treatment demonstrated inferior survival (median 2.9 versus 8.7 months, p 70 years were associated with improved survival performing third-line therapy. Conclusions Stage IV NSCLC patients may receive substantial systemic therapy resulting in response and median survival rates that are comparable to data from clinical studies. However, preselection factors are increasingly important to improve therapy outcome and life quality.