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Non-invasive risk prediction based on right ventricular function in patients with pulmonary arterial hypertension. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.1960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Individual risk assessment in patients with pulmonary arterial hypertension (PAH) is fundamental to improve their outcome. Although right ventricular (RV) dysfunction is a major determinant of outcome in PAH, echocardiographic measures of RV function are poorly represented by current risk models.
Objective
The objective of this study was to identify echocardiographic measures of RV function, which are associated with adverse outcome and to develop a non-invasive, echocardiography-based risk score for PAH patients.
Methods
In 254 patients with PAH we analyzed functional status, laboratory results, pulmonary function and echocardiographic measures. Echocardiographic measures comprised RV chamber diameters, right atrial area, fractional area change (FAC), tricuspid annular plane systolic excursion (TAPSE), 2D RV strain and pericardial effusion. We used Cox regression models to assess the association with the composite endpoint of 5-year all-cause death or lung transplantation. The analyses included a conventional model using only guideline-recommended variables and a model adding significant echocardiographic measures. Based on the final multivariable model a point risk score was derived, indicating the association with the primary outcome.
Results
Median age was 65.5 years, 33.9% were females. During a median follow-up time of 4.18 years 74 patients died (n=63) or underwent lung transplantation (n=11). In univariable analyses low systolic blood pressure (Hazard ratio [HR] 0.99, 95% Confidence Interval [CI] 0.98,1.00), NYHA functional class IV (HR 3.23, 95% CI 1.48,7.07), 6-minute walk distance (HR 1.00, 95% CI 1.00,1.00), NT-proBNP concentrations (HR 1.00, 95% CI 1.00,1.00), renal impairment (HR 0.99, 95% CI 0.98,1.00), reduced diffusion capacity for carbon monoxide (HR 0.99, 95% CI 0.98,1.00), reduced TAPSE (HR 0.90, 95% CI 0.85,0.96) and reduced FAC (HR 0.97, 95% CI 0.94,1.00) were associated with the endpoint. A multivariable, conventional risk model, including NYHA functional class, 6-minute walk distance, NT-proBNP concentrations, pericardial effusion and right atrial area, resulted in a C-Index of 0.539. Adding TAPSE and FAC to this model improved the performance significantly (C-index 0.639, p-value 0.017). This model was translated to a 12-point score with the highest weighting assigned to TAPSE, FAC, pericardial effusion and 6-minute walk distance (Figure).
Conclusion
An easily applicable score integrating non-invasive, echocardiographic parameters of RV function improves prediction of adverse outcome in PAH patients.
Funding Acknowledgement
Type of funding sources: None. Risk prediction chart
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[Puzzling B symptoms in a 61-year-old patient under treatment for rheumatoid arthritis]. Internist (Berl) 2021; 62:1231-1236. [PMID: 34251468 PMCID: PMC8556203 DOI: 10.1007/s00108-021-01090-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2021] [Indexed: 11/26/2022]
Abstract
Ein Patient mit rheumatoider Arthritis sowie B‑Symptomatik, Polyneuropathie und einschmelzenden Lungenveränderungen unter Immunsuppression entwickelte nach zunächst subakutem Verlauf rasch progrediente zentrale neurologische Symptome und ein letales Multiorganversagen. Als ursächlich erwies sich eine disseminierte Infektion mit Histoplasma capsulatum unter Beteiligung des zentralen Nervensystems. Die Erstinfektion hatte sich fünf Jahre zuvor bei einem Karibikurlaub ereignet. Die Kombination aus Reiseaktivität und Immunsuppression erfordert die Berücksichtigung sonst in Deutschland sehr seltener infektiologischer Diagnosen.
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[Differential Diagnosis of Pulmonary Hypertension Using the Example of Collagenosis-associated PAH in the Context of Chronic Lung and Left Heart Disease]. Pneumologie 2021; 75:122-137. [PMID: 33578434 DOI: 10.1055/a-1204-3248] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Pulmonary hypertension (PH) can be diagnosed in the context of connective tissue diseases (CTD) as well as in elderly patients with multiple comorbidities. A correct clinical differential diagnosis and classification is essential before adequate therapeutic decisions can be made. Differential diagnosis of PH in CTD comprises associated pulmonary arterial hypertension (APAH), group 2 or 3 PH (PH arising from left heart or chronic lung disease), chronic thromboembolic PH (PH) and group 5 (e. g. in the context of terminal renal insufficiency). This is also true of elderly patients in whom the decision has to be made if the increasing number of coincident diseases lead to PH or have to be interpreted as comorbidities. In this manuscript, the differential diagnosis of PH is elucidated, focusing on CTD, in the context of left heart disease and chronic lung disease. Furthermore, criteria are presented facilitating an objective approach in this context.
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Abstract
At the 6th World Symposium on Pulmonary Hypertension (WSPH), which took place from February 27 until March 1, 2018 in Nice, scientific progress over the past 5 years in the field of pulmonary hypertension (PH) was presented by 13 working groups. The results of the discussion were published as proceedings towards the end of 2018. One of the major changes suggested by the WSPH was the lowering of the diagnostic threshold for PH from ≥ 25 to > 20 mmHg mean pulmonary arterial pressure, measured by right heart catheterization at rest. In addition, the pulmonary vascular resistance was introduced into the definition of PH, which underlines the importance of cardiac output determination at the diagnostic right heart catheterization.In this article, we discuss the rationale and possible consequences of a changed PH definition in the context of the current literature. Further, we provide a current overview on non-invasive and invasive methods for diagnosis, differential diagnosis, and prognosis of PH, including exercise tests.
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[Current Aspects of Definition and Diagnosis of Pulmonary Hypertension]. Pneumologie 2020. [PMID: 32707587 DOI: 10.1055/a-1221-5775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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6
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Safety, Tolerability and Pharmacokinetics Study in Patients with Pulmonary Arterial Hypertension (PAH) Temporarily Switching from Oral to IV Selexipag. J Heart Lung Transplant 2019. [DOI: 10.1016/j.healun.2019.01.1247] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
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7
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Synergien zwischen OrganoCat-Vorbehandlung und pflanzlicher Biomasse. CHEM-ING-TECH 2018. [DOI: 10.1002/cite.201855037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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8
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PEGASUS – Fliegen mit Pulmonaler Hypertonie, ein prospektive Beobachtungsstudie. Pneumologie 2018. [DOI: 10.1055/s-0037-1619317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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9
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Pulmonale Hypertonie bei Lungenkrankheiten: Empfehlungen der Kölner Konsensus-Konferenz 2016. Dtsch Med Wochenschr 2016; 141:S57-S61. [DOI: 10.1055/s-0042-114528] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Allgemeine und supportive Therapie der pulmonal arteriellen Hypertonie: Empfehlungen der Kölner Konsensus Konferenz 2016. Dtsch Med Wochenschr 2016; 141:S26-S32. [DOI: 10.1055/s-0042-114525] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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11
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[Targeted therapy of pulmonary arterial hypertension: Recommendations of the Cologne Consensus Conference 2016]. Dtsch Med Wochenschr 2016; 141:S33-S41. [PMID: 27760448 DOI: 10.1055/s-0042-114526] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
The 2015 European Guidelines on Diagnosis and Treatment of Pulmonary Hypertension are also valid for Germany. The guidelines contain detailed recommendations for the targeted treatment of pulmonary arterial hypertension (PAH). However, the practical implementation of the European Guidelines in Germany requires the consideration of several country-specific issues and already existing novel data. This requires a detailed commentary to the guidelines, and in some aspects an update already appears necessary. In June 2016, a Consensus Conference organized by the PH working groups of the German Society of Cardiology (DGK), the German Society of Respiratory Medicine (DGP) and the German Society of Pediatric Cardiology (DGPK) was held in Cologne, Germany. This conference aimed to solve practical and controversial issues surrounding the implementation of the European Guidelines in Germany. To this end, a number of working groups was initiated, one of which was specifically dedicated to the targeted therapy of PAH. This article summarizes the results and recommendations of the working group on targeted treatment of PAH.
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Kölner Konsensus Konferenz zur pulmonalen Hypertonie 2016. Dtsch Med Wochenschr 2016. [DOI: 10.1055/s-0042-115441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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13
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Plasma drug-concentrations in patients with pulmonary arterial hypertension on combination treatment. Pneumologie 2016. [DOI: 10.1055/s-0036-1584623] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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14
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Up to Six Years Experience of Lobar Lung Transplantation. J Heart Lung Transplant 2016. [DOI: 10.1016/j.healun.2016.01.885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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15
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Up to Six Years Experience of Lobar Lung Transplantation. Thorac Cardiovasc Surg 2016. [DOI: 10.1055/s-0036-1571690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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16
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Right heart failure in pregnant women with cyanotic congenital heart disease — The good, the bad and the ugly. Int J Cardiol 2016; 202:773-5. [DOI: 10.1016/j.ijcard.2015.10.036] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2015] [Accepted: 10/04/2015] [Indexed: 11/16/2022]
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17
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Therapie der pulmonal arteriellen Hypertonie. Pneumologie 2015. [DOI: 10.1055/s-0034-1392103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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18
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[Dyspnoea in Patients with Pulmonary Hypertension (PH) - a Survey in Spezialized German PH Centres]. Pneumologie 2015; 69:361-5. [PMID: 25962567 DOI: 10.1055/s-0034-1391893] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Dyspnoea is the predominant symptom in patients with pulmonary hypertension (PH) at diagnosis. However, since dyspnoea is nonspecific and often occurs in a number of common diseases, the presence of PH can easily be underdiagnosed.In addition, this symptom underlies a high variability in the subjective perception, therefore further diagnostic procedures are often delayed by the patients.A survey of the incidence and severity of dyspnoea in 372 patients with PAH was conducted by questionnaire in German centres. Age, sex distribution and the range of comorbidities corresponded to the findings of national and international registries.Approximately 99 % of patients reported the presence of dyspnoea on exertion, even at low loads.Remarkably, in 13 % of patients dyspnoea occurs as a paroxysmal symptom, which may lead to the differential diagnosis of bronchial asthma. In addition, the patients who were being followed in specialized PH centres reported an increase in dyspnoea during the last year.The results of the survey on the incidence of dyspnoea in patients with PAH are consistent with the findings of international studies.
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[Riociguat: stimulator of soluble guanylate-cyclase. New mode of action for the treatment of pulmonary arterial and non operable chronic thromboembolic pulmonary hypertension]. Pneumologie 2015; 69:135-43. [PMID: 25750094 DOI: 10.1055/s-0034-1391435] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Riociguat is the first clinically available soluble Guanylate-cyclase stimulator (sGC) and representative of a completely new class of drugs. Riociguat is approved for pulmonary arterial hypertension (PAH) and non-operable or recurrent/persistent chronic thromboembolic pulmonary hypertension (CTEPH). Moreover, Riociguat is currently under investigation for a wider spectrum of diseases. This article focusses on its mode of action and clinical trial data. Finally, based on these data, the status of approval, as well as the costs a proposal is given how Riociguat can be integrated in the current treatment of PAH and CTEPH.
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21
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[Imatinib for pulmonary arterial hypertension]. Dtsch Med Wochenschr 2014; 139 Suppl 4:S151-4. [PMID: 25489685 DOI: 10.1055/s-0034-1387457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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22
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[DACH Conference for pulmonary hypertension 2014]. Dtsch Med Wochenschr 2014; 139 Suppl 4:S109-10. [PMID: 25489678 DOI: 10.1055/s-0034-1387492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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23
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Epigenetik und Genetik der pulmonal arteriellen Hypertonie – neue Erkenntnisse der letzten Jahre. Dtsch Med Wochenschr 2014; 139 Suppl 4:S111-5. [DOI: 10.1055/s-0034-1387454] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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24
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25
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55-jährige Patientin, Raucherin, mit deutlicher Abgeschlagenheit, Fieber und Hämoptysen. Dtsch Med Wochenschr 2014. [DOI: 10.1055/s-0034-1374727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Radiologic management of haemoptysis: diagnostic and interventional bronchial arterial embolisation. ROFO-FORTSCHR RONTG 2014; 187:248-59. [PMID: 25372159 DOI: 10.1055/s-0034-1385457] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
UNLABELLED Hemoptysis can be a life-threatening pulmonary emergency with high mortality, is symptomatic of an underlying severe pulmonary disease and requires immediate diagnosis and treatment. Diagnostically, bronchoscopy, conventional chest x-ray and contrast-enhanced multislice computed tomography (MSCT) with CT angiography (CTA) provide information regarding the underlying pulmonary disease, bleeding site, the vascular anatomy of the bronchial arteries (BA) and extrabronchial branches, as well a basis for planning of endovascular intervention. Therapeutically, bronchial artery embolization (BAE) is a safe and effective technique in the hands of an experienced interventionist with profound knowledge of the BA anatomy and possible pitfalls as well as experience with first-line therapy of recurrent and massive hemoptysis or as an intervention prior to elective surgery. Recurrent episodes of hemoptysis are not uncommon and require a prompt repeat BAE after exclusion of extrabronchial systemic and pulmonary artery bleeding sources. This review article should give an overview of the history, anatomical and pathophysiological basics and the clinical context of hemoptysis and diagnosis, as well as a survey of management, treatment and results of BAE. KEY POINTS Hemoptyses are life threatening and require urgent diagnostic and therapy. Chest x-ray, bronchoscopy, and contrast-enhanced MSCT with CTA should be carried out before therapeutic bronchial artery embolization (BAE). BAE for the treatment of massive and recurrent hemoptysis is safe and effective. False embolization in spinal branches of BA are the most serious complication of a BAE. Repeatedly BAE refractory cases should undergo elective surgery.
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55-jährige Patientin, Raucherin, mit deutlicher Abgeschlagenheit, Fieber und Hämoptysen. Dtsch Med Wochenschr 2014; 139:2073-4. [DOI: 10.1055/s-0034-1387326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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28
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Endoskopische Lungenvolumenreduktion bei schwerem Lungenemphysem mittels Coilimplantation (LVRC) – multizentrische, norddeutsche Ergebnisse. Pneumologie 2014. [DOI: 10.1055/s-0034-1368026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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29
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Chronic and chronic intermittent hypobaric hypoxia in rats leads to a mismatch in the endothelial ADMA/NO pathway. Pneumologie 2014. [DOI: 10.1055/s-0034-1367746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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30
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[40-year-old patient with dyspnoe one year after lung transplantation]. Dtsch Med Wochenschr 2013; 138:1107-8. [PMID: 23677505 DOI: 10.1055/s-0032-1332944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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31
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Cost-effectiveness analysis of rehabilitation with exercise and respiratory therapy in pulmonary hypertension. Pneumologie 2013. [DOI: 10.1055/s-0033-1334502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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32
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Nutzen der routinemäßigen Kultur der bronchoalveolären Lavage auf Tuberkulose in einem Niedrigprävalenz-Gebiet. Pneumologie 2013. [DOI: 10.1055/s-0033-1334555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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33
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Was Medizinstudenten vom Gesundheitswesen wissen. GESUNDHEITSOEKONOMIE UND QUALITAETSMANAGEMENT 2012. [DOI: 10.1055/s-0032-1312905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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34
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[Tracheal metastasis of a cutaneous malignant melanoma]. ROFO-FORTSCHR RONTG 2012; 184:742-3. [PMID: 22618475 DOI: 10.1055/s-0032-1312779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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35
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43-jähriger Patient mit perakuter schwerer respiratorischer Insuffizienz und Volumenmangelschock durch ein massives Re-Expansionsödem. Pneumologie 2012. [DOI: 10.1055/s-0032-1302575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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36
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Atem- und Bewegungstherapie bei Patienten mit assoziierter pulmonal-arterieller Hypertonie bei angeborenem Herzfehler. Pneumologie 2012. [DOI: 10.1055/s-0032-1302572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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37
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Der G-Protein gekoppelte Rezeptor GPRC5A ist ein prognostischer Faktor bei nicht-kleinzelligen Bronchialkarzinomen. Pneumologie 2012. [DOI: 10.1055/s-0032-1302887] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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38
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Sicherheit der Bronchoskopie bei Patienten mit akuter respiratorischer Insuffizienz und notwendiger nicht-invasiver Beatmung. Pneumologie 2011. [DOI: 10.1055/s-0031-1272272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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39
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Einfluss von Atem- und Bewegungstherapie auf die Lebensqualität von Patienten mit schwerer chronischer pulmonaler Hypertonie. Pneumologie 2011. [DOI: 10.1055/s-0031-1271982] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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40
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Charakteristika von Enterobacter cloacae Pneumonien auf Intensivstationen. Pneumologie 2011. [DOI: 10.1055/s-0031-1272273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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41
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Fibrinogen-Plasmakonzentrationen bei pulmonaler Hypertonie. Pneumologie 2011. [DOI: 10.1055/s-0031-1272213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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42
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43
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[Utility of invasive diagnostics in acute lung injury]. Pneumologie 2010; 64:488-95. [PMID: 20387196 DOI: 10.1055/s-0029-1244047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Acute lung injury/acute respiratory distress syndrome (ARDS) may be induced by a variety of disease entities. Apart from supportive treatment including lung protective ventilation, identification of the underlying process is of crucial importance for optimal therapeutic results. Usually the cause of ARDS can be identified by history, laboratory and radiologicial tests. In some cases a diagnosis cannot be made in spite of an extensive, less invasive diagnostic work-up. In these situations the risks of empirical treatment have to be balanced against the procedural risk of invasive diagnostics, namely open lung biopsy. Today, reports on more than 500 lung biopsies performed in selected ARDS patients are available showing a relevant diagnostic yield at an acceptable procedure-associated risk. Intensive care physicians should be aware of this diagnostic instrument, which can represent the decisive diagnostic step in patients with ARDS of unknown origin.
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In-vitro-Synthese der UDP-Glucuronsäure und des Glycan-Epitopes HNK1 mit einem hochflexiblen Enzym-Modul-System. CHEM-ING-TECH 2009. [DOI: 10.1002/cite.200950235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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45
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Erster Ergebnisbericht der Arbeitsgemeinschaft „Qualitätsmanagement“ der Deutschen Gesellschaft für Plastische und Wiederherstellungschirurgie. Zentralbl Chir 2009. [DOI: 10.1055/s-0029-1238142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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46
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Diffusionsgewichtete MRT und FDG-PET des nicht kleinzelligen Bronchialkarzinoms (NSCLC): Korreliert der Apparent Diffusion Coefficient (ADC) mit der Stoffwechselaktivität (SUV)? ROFO-FORTSCHR RONTG 2009. [DOI: 10.1055/s-0029-1221584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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47
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Schwere PAH unter der Therapie mit zwei Multityrosinkinase-Inhibitoren Imatinib und Dasatinib – Fallbericht. Pneumologie 2009. [DOI: 10.1055/s-0029-1213888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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48
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[Heart rate measurement for determination of training intensity in outpatient pulmonary sport groups]. Pneumologie 2008; 63:72-7. [PMID: 19031371 DOI: 10.1055/s-2008-1038288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Exercise training is an integral component of the management of patients with asthma and COPD. A training intensity of 60-80% of maximum oxygen uptake (VO(2)max) has been recommended. Instead of ergospirometry measurement of heart rate can be used for training guidance. It is unknown whether the given target can be reached in outpatient training groups with substantial heterogeneity concerning diagnosis, disease severity, and age. METHODS AND PATIENTS 61 adult patients (m = 15, w = 46; 63 +/- 9 years) with asthma (n = 50) or COPD (n = 11) exercised in groups of ambulant lung sports. An individualized target heart rate was calculated corresponding to an intensity of 60% to 80% of calculated VO(2)max which was equivalent to a heart rate from 97 to 137 beats per minute in the population studied. Heart rate, as a measure of the intensity of charge, was measured continuously with pulse frequency meters. RESULTS All but one asthma patient exercised in the targeted heart rate range. Patients reached 81 +/- 9% of the training goal of calculated 80% VO(2)max (asthma patients: 79 +/- 9% vs. COPD patients: 88 +/- 9%, p < 0.005) No significant differences regarding training intensities were observed in relation to severity of illness or age. CONCLUSIONS In outpatient lung sport groups of considerable heterogeneity regarding diagnosis, severity of illness and age, participants reach their individualized heart rate target range. COPD patients were training at a significantly higher relative training intensity. Heart rate is an easy to use parameter for training guidance.
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Gegenwärtiger Stand der Tracheotomie auf der Intensivstation – Eine Umfrage auf deutschen Intensivstationen. Pneumologie 2008. [DOI: 10.1055/s-2008-1074213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Diffusionsgewichtete MRT mit Unterdrückung des Hintergrundsignals (DWIBS) zur Detektion von Lungenrundherden bei 1,5 Tesla: Erste Ergebnisse. ROFO-FORTSCHR RONTG 2008. [DOI: 10.1055/s-2008-1073590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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