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Linschoten M, Uijl A, Schut A, Jakob CEM, Romão LR, Bell RM, McFarlane E, Stecher M, Zondag AGM, van Iperen EPA, Hermans-van Ast W, Lea NC, Schaap J, Jewbali LS, Smits PC, Patel RS, Aujayeb A, van der Harst P, Siebelink HJ, van Smeden M, Williams S, Pilgram L, van Gilst WH, Tieleman RG, Williams B, Asselbergs FW, Al-Ali AK, Al-Muhanna FA, Al-Rubaish AM, Al-Windy NYY, Alkhalil M, Almubarak YA, Alnafie AN, Alshahrani M, Alshehri AM, Anning C, Anthonio RL, Badings EA, Ball C, van Beek EA, ten Berg JM, von Bergwelt-Baildon M, Bianco M, Blagova OV, Bleijendaal H, Bor WL, Borgmann S, van Boxem AJM, van den Brink FS, Bucciarelli-Ducci C, van Bussel BCT, Byrom-Goulthorp R, Captur G, Caputo M, Charlotte N, vom Dahl J, Dark P, De Sutter J, Degenhardt C, Delsing CE, Dolff S, Dorman HGR, Drost JT, Eberwein L, Emans ME, Er AG, Ferreira JB, Forner MJ, Friedrichs A, Gabriel L, Groenemeijer BE, Groenendijk AL, Grüner B, Guggemos W, Haerkens-Arends HE, Hanses F, Hedayat B, Heigener D, van der Heijden DJ, Hellou E, Hellwig K, Henkens MTHM, Hermanides RS, Hermans WRM, van Hessen MWJ, Heymans SRB, Hilt AD, van der Horst ICC, Hower M, van Ierssel SH, Isberner N, Jensen B, Kearney MT, van Kesteren HAM, Kielstein JT, Kietselaer BLJH, Kochanek M, Kolk MZH, Koning AMH, Kopylov PY, Kuijper AFM, Kwakkel-van Erp JM, Lanznaster J, van der Linden MMJM, van der Lingen ACJ, Linssen GCM, Lomas D, Maarse M, Macías Ruiz R, Magdelijns FJH, Magro M, Markart P, Martens FMAC, Mazzilli SG, McCann GP, van der Meer P, Meijs MFL, Merle U, Messiaen P, Milovanovic M, Monraats PS, Montagna L, Moriarty A, Moss AJ, Mosterd A, Nadalin S, Nattermann J, Neufang M, Nierop PR, Offerhaus JA, van Ofwegen-Hanekamp CEE, Parker E, Persoon AM, Piepel C, Pinto YM, Poorhosseini H, Prasad S, Raafs AG, Raichle C, Rauschning D, Redón J, Reidinga AC, Ribeiro MIA, Riedel C, Rieg S, Ripley DP, Römmele C, Rothfuss K, Rüddel J, Rüthrich MM, Salah R, Saneei E, Saxena M, Schellings DAAM, Scholte NTB, Schubert J, Seelig J, Shafiee A, Shore AC, Spinner C, Stieglitz S, Strauss R, Sturkenboom NH, Tessitore E, Thomson RJ, Timmermans P, Tio RA, Tjong FVY, Tometten L, Trauth J, den Uil CA, Van Craenenbroeck EM, van Veen HPAA, Vehreschild MJGT, Veldhuis LI, Veneman T, Verschure DO, Voigt I, de Vries JK, van de Wal RMA, Walter L, van de Watering DJ, Westendorp ICD, Westendorp PHM, Westhoff T, Weytjens C, Wierda E, Wille K, de With K, Worm M, Woudstra P, Wu KW, Zaal R, Zaman AG, van der Zee PM, Zijlstra LE, Alling TE, Ahmed R, van Aken K, Bayraktar-Verver ECE, Bermúdez Jiménes FJ, Biolé CA, den Boer-Penning P, Bontje M, Bos M, Bosch L, Broekman M, Broeyer FJF, de Bruijn EAW, Bruinsma S, Cardoso NM, Cosyns B, van Dalen DH, Dekimpe E, Domange J, van Doorn JL, van Doorn P, Dormal F, Drost IMJ, Dunnink A, van Eck JWM, Elshinawy K, Gevers RMM, Gognieva DG, van der Graaf M, Grangeon S, Guclu A, Habib A, Haenen NA, Hamilton K, Handgraaf S, Heidbuchel H, Hendriks-van Woerden M, Hessels-Linnemeijer BM, Hosseini K, Huisman J, Jacobs TC, Jansen SE, Janssen A, Jourdan K, ten Kate GL, van Kempen MJ, Kievit CM, Kleikers P, Knufman N, van der Kooi SE, Koole BAS, Koole MAC, Kui KK, Kuipers-Elferink L, Lemoine I, Lensink E, van Marrewijk V, van Meerbeeck JP, Meijer EJ, Melein AJ, Mesitskaya DF, van Nes CPM, Paris FMA, Perrelli MG, Pieterse-Rots A, Pisters R, Pölkerman BC, van Poppel A, Reinders S, Reitsma MJ, Ruiter AH, Selder JL, van der Sluis A, Sousa AIC, Tajdini M, Tercedor Sánchez L, Van De Heyning CM, Vial H, Vlieghe E, Vonkeman HE, Vreugdenhil P, de Vries TAC, Willems AM, Wils AM, Zoet-Nugteren SK. Clinical presentation, disease course, and outcome of COVID-19 in hospitalized patients with and without pre-existing cardiac disease: a cohort study across 18 countries. Eur Heart J 2022; 43:1104-1120. [PMID: 34734634 DOI: 10.1093/eurheartj/ehab656] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 06/22/2021] [Accepted: 09/01/2021] [Indexed: 12/25/2022] Open
Abstract
AIMS Patients with cardiac disease are considered high risk for poor outcomes following hospitalization with COVID-19. The primary aim of this study was to evaluate heterogeneity in associations between various heart disease subtypes and in-hospital mortality. METHODS AND RESULTS We used data from the CAPACITY-COVID registry and LEOSS study. Multivariable Poisson regression models were fitted to assess the association between different types of pre-existing heart disease and in-hospital mortality. A total of 16 511 patients with COVID-19 were included (21.1% aged 66-75 years; 40.2% female) and 31.5% had a history of heart disease. Patients with heart disease were older, predominantly male, and often had other comorbid conditions when compared with those without. Mortality was higher in patients with cardiac disease (29.7%; n = 1545 vs. 15.9%; n = 1797). However, following multivariable adjustment, this difference was not significant [adjusted risk ratio (aRR) 1.08, 95% confidence interval (CI) 1.02-1.15; P = 0.12 (corrected for multiple testing)]. Associations with in-hospital mortality by heart disease subtypes differed considerably, with the strongest association for heart failure (aRR 1.19, 95% CI 1.10-1.30; P < 0.018) particularly for severe (New York Heart Association class III/IV) heart failure (aRR 1.41, 95% CI 1.20-1.64; P < 0.018). None of the other heart disease subtypes, including ischaemic heart disease, remained significant after multivariable adjustment. Serious cardiac complications were diagnosed in <1% of patients. CONCLUSION Considerable heterogeneity exists in the strength of association between heart disease subtypes and in-hospital mortality. Of all patients with heart disease, those with heart failure are at greatest risk of death when hospitalized with COVID-19. Serious cardiac complications are rare during hospitalization.
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Maris I, Dölle‐Bierke S, Renaudin J, Lange L, Koehli A, Spindler T, Hourihane J, Scherer K, Nemat K, Kemen C, Neustädter I, Vogelberg C, Reese T, Yildiz I, Szepfalusi Z, Ott H, Straube H, Papadopoulos NG, Hämmerling S, Staden U, Polz M, Mustakov T, Cichocka‐Jarosz E, Cocco R, Fiocchi AG, Fernandez‐Rivas M, Worm M, Grünhagen J, Wittenberg M, Beyer K, Henschel A, Küper S, Möser A, Fuchs T, Ruëff F, Wedi B, Hansen G, Buck T, Büsselberg J, Drägerdt R, Pfeffer L, Dickel H, Körner‐Rettberg C, Merk H, Lehmann S, Bauer A, Nordwig A, Zeil S, Hannapp C, Wagner N, Rietschel E, Hunzelmann N, Huseynow I, Treudler R, Aurich S, Prenzel F, Klimek L, Pfaar O, Reider N, Aberer W, Varga E, Bogatu B, Schmid‐Grendelmeier P, Guggenheim R, Riffelmann F, Kreft B, Kinaciyan K, Hartl L, Ebner C, Horak F, Brehler R, Witte J, Buss M, Hompes S, Bieber T, Gernert S, Bücheler M, Rabe U, Brosi W, Nestoris S, Hawranek T, Lang R, Bruns R, Pföhler C, Eng P, Schweitzer‐Krantz S, Meller S, Rebmann H, Fischer J, Stichtenoth G, Thies S, Gerstlauer M, Utz P, Neustädter I, Klinge J, Volkmuth S, Plank‐Habibi S, Schilling B, Kleinheinz A, Brückner A, Schäkel K, Manolaraki I, Kowalski M, Solarewicz‐Madajek K, Tscheiller S, Seidenberg J, Cardona V, Garcia B, Bilo M, Cabañes Higuero N, Vega Castro A, Poziomkowska‐Gęsicka I, Büsing S, Virchow C, Christoff G, Jappe U, Müller S, Knöpfel F, Correard A, Rogala B, Montoro A, Brandes A, Muraro A, Zimmermann N, Hernandez D, Minale P, Niederwimmer J, Zahel B, Dahdah L, Arasi S, Reissig A, Eitelberger F, Asero R, Hermann F, Zeidler S, Pistauer S, Geißler M, Ensina L, Plaza Martin A, Meister J, Stieglitz S, Hamelmann E. Peanut-induced anaphylaxis in children and adolescents: Data from the European Anaphylaxis Registry. Allergy 2021; 76:1517-1527. [PMID: 33274436 DOI: 10.1111/all.14683] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/26/2020] [Accepted: 11/10/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Peanut allergy has a rising prevalence in high-income countries, affecting 0.5%-1.4% of children. This study aimed to better understand peanut anaphylaxis in comparison to anaphylaxis to other food triggers in European children and adolescents. METHODS Data was sourced from the European Anaphylaxis Registry via an online questionnaire, after in-depth review of food-induced anaphylaxis cases in a tertiary paediatric allergy centre. RESULTS 3514 cases of food anaphylaxis were reported between July 2007 - March 2018, 56% in patients younger than 18 years. Peanut anaphylaxis was recorded in 459 children and adolescents (85% of all peanut anaphylaxis cases). Previous reactions (42% vs. 38%; p = .001), asthma comorbidity (47% vs. 35%; p < .001), relevant cofactors (29% vs. 22%; p = .004) and biphasic reactions (10% vs. 4%; p = .001) were more commonly reported in peanut anaphylaxis. Most cases were labelled as severe anaphylaxis (Ring&Messmer grade III 65% vs. 56% and grade IV 1.1% vs. 0.9%; p = .001). Self-administration of intramuscular adrenaline was low (17% vs. 15%), professional adrenaline administration was higher in non-peanut food anaphylaxis (34% vs. 26%; p = .003). Hospitalization was higher for peanut anaphylaxis (67% vs. 54%; p = .004). CONCLUSIONS The European Anaphylaxis Registry data confirmed peanut as one of the major causes of severe, potentially life-threatening allergic reactions in European children, with some characteristic features e.g., presence of asthma comorbidity and increased rate of biphasic reactions. Usage of intramuscular adrenaline as first-line treatment is low and needs to be improved. The Registry, designed as the largest database on anaphylaxis, allows continuous assessment of this condition.
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Affiliation(s)
- Ioana Maris
- Bon Secours Hospital Cork/Paediatrics and Child HealthUniversity College Cork Cork Ireland
| | - Sabine Dölle‐Bierke
- Division of Allergy and Immunology Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | | | - Lars Lange
- Department of Paediatrics St. Marien‐Hospital Bonn Germany
| | - Alice Koehli
- Division of Allergology University Children’s Hospital Zurich Zürich Switzerland
| | - Thomas Spindler
- Department of Paediatrics Medical Campus Hochgebirgsklinik Davos Davos Switzerland
| | - Jonathan Hourihane
- Paediatrics and Child Health Royal College of Surgeons in Ireland Dublin Ireland
- Children’s Health Ireland Dublin Ireland
| | | | - Katja Nemat
- Practice for paediatric pneumology and allergology Kinderzentrum Dresden‐Friedrichstadt Dresden Germany
| | - C. Kemen
- Department of Paediatrics Children’s Hospital WILHELMSTIFT Hamburg Germany
| | - Irena Neustädter
- Department of Paediatrics Hallerwiese Cnopfsche Kinderklinik Nuremberg Germany
| | - Christian Vogelberg
- Department of Paediatrics Universitätsklinikum Carl Gustav CarusTechnical University Dresden Germany
| | - Thomas Reese
- Department of Paediatrics Mathias‐Spital Rheine Rheine Germany
| | - Ismail Yildiz
- Department of Paediatrics Friedrich‐Ebert‐Krankenhaus Neumuenster Germany
| | - Zsolt Szepfalusi
- Division of Paediatric Pulmonology, Allergology and Endocrinology Department of Paediatrics and Adolescent Medicine Competence Center Paediatrics Medical University of Vienna Vienna Austria
| | - Hagen Ott
- Division of Paediatric Dermatology and Allergology Epidermolysis bullosa‐Centre HannoverChildren’s Hospital AUF DER BULT Hanover Germany
| | - Helen Straube
- Division of Allergology Darmstädter Kinderkliniken Prinzessin Margaret Darmstadt Germany
| | - Nikolaos G. Papadopoulos
- Allergy Department 2nd Paediatric Clinic National and Kapodistrian University of Athens Athens Greece
- Division of Infection Immunity& Respiratory Medicine University of Manchester Manchester UK
| | - Susanne Hämmerling
- Division of Paediatric Pulmonology and Allergology University Children`s Hospital Heidelberg Heidelberg Germany
| | - Ute Staden
- Paediatric Pneumology & Allergology Medical practice Klettke/Staden Berlin Germany
| | - Michael Polz
- Department of Paediatrics GPR Klinikum Rüsselsheim Germany
| | - Tihomir Mustakov
- Chair of Allergy University Hospital Alexandrovska Sofia Bulgaria
| | - Ewa Cichocka‐Jarosz
- Department of Paediatrics Jagiellonian University Medical College Krakow Poland
| | - Renata Cocco
- Division of Allergy Clinical Immunology and Rheumatology Department of Paediatrics Federal University of São Paulo São Paulo Brazil
| | | | | | - Margitta Worm
- Division of Allergy and Immunology Department of Dermatology, Venereology and Allergology Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt‐Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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Unnewehr M, Schlesinger A, Stieglitz S, Köhler D. Greulich T, Fähndrich S, Clarenbach C et al. Alpha-1-Antitrypsin-Mangel (AATM) – Ein Expertenstatement. Pneumologie 2020; 74: 436-442, doi:10.1055/a-1143-8186. Pneumologie 2021; 75:69-71. [PMID: 33461236 DOI: 10.1055/a-1251-6424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- M Unnewehr
- Innere Medizin V - Pneumologie, Infektiologie, Schlafmedizin, Allergologie St. Barbara-Klinik Hamm
| | - A Schlesinger
- Lungenklinik Köln-Nord, Betriebsteil St. Marien Hospital Köln
| | - S Stieglitz
- Medizinische Klinik I - Pneumologie, Allergologie, Schlaf- und Intensivmedizin Petrus Krankenhaus Wuppertal
| | - D Köhler
- Ehem. Krankenhaus Kloster Grafschaft, Schmallenberg
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Stieglitz S, Frohnhofen H, Netzer N, Haidl P, Orth M, Schlesinger A. [Recommendations for the Treatment of Elderly Patients with COVID-19 from the Taskforce for Gerontopneumology]. Pneumologie 2020; 74:505-508. [PMID: 32434253 PMCID: PMC7534603 DOI: 10.1055/a-1177-3588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- S Stieglitz
- Medizinische Klinik I - Pneumologie, Allergologie, Schlaf- und Intensivmedizin, Wuppertaler Lungenzentrum, Petrus-Krankenhaus, Wuppertal
| | - H Frohnhofen
- Alfried Krupp Krankenhaus Rüttenscheid, Altersmedizin am Alfried Krupp von Bohlen und Halbach Krankenhaus gemeinnützige GmbH, Essen
| | - N Netzer
- Hermann Buhl Institut für Hypoxie und Schlafmedizinforschung der Universität Innsbruck, Bad Aibling und Eurac Research, Institut für alpine Notfallmedizin, Bozen
| | - P Haidl
- Fachkrankenhaus Kloster Grafschaft GmbH, Pneumologie II, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg
| | - M Orth
- Pneumologie, Pneumologische Onkologie, Allergologie, Schlaf- und Beatmungsmedizin, Theresienkrankenhaus, Mannheim
| | - A Schlesinger
- Klinik für Innere Medizin/ Pneumologie und Beatmungsmedizin, Lungenklinik Köln-Nord, Betriebsteil St. Marien Hospital, Köln
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Stieglitz S, Heppner HJ, Netzer N. Abnormal things happening during sleep: parasomnias. Z Gerontol Geriatr 2020; 53:119-122. [PMID: 32140765 DOI: 10.1007/s00391-020-01714-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2019] [Accepted: 12/27/2019] [Indexed: 11/25/2022]
Abstract
Parasomnias are characterized by abnormal experiences, dreams, movements and behavior during sleep. They may occur in the middle of the sleep during REM (rapid eye movement) or NREM (non-rapid eye movement), during falling asleep or waking up. Characteristically for REM behavior disorder is an increased muscle tone although usually REM is defined by an absence of muscle tone. For these forms aggressive dreams may lead to violating bed partners or self-injury of the sleeping person. Even killing bed partners has been described. Many of the patients develop a kind of Parkinson's disease (synucleinopathies). The rate of phenoconversion is more than 30% in 5 years and nearly 100% after 15 years. There are several recommendations regarding a safe sleeping environment. Medicinal treatment consists of either melatonin or clonazepam.
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Affiliation(s)
- S Stieglitz
- Department of Pneumology, Allergy, Sleep and Intensive Care Medicine, Petrus Hospital Wuppertal, Carnaper Str. 48, 42283, Wuppertal, Germany. .,University of Witten-Herdecke, Witten-Herdecke, Germany.
| | - H J Heppner
- Department of Geriatrics, Helios Clinic Schwelm, Schwelm, Germany
| | - N Netzer
- Hermann Buhl Institute for Hypoxia and Sleep Medicine Research, Bad Aibling, Germany
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Wells AU, Flaherty KR, Brown KK, Inoue Y, Devaraj A, Richeldi L, Moua T, Crestani B, Wuyts WA, Stowasser S, Quaresma M, Goeldner RG, Schlenker-Herceg R, Kolb M, Aburto M, Acosta O, Andrews C, Antin-Ozerkis D, Arce G, Arias M, Avdeev S, Barczyk A, Bascom R, Bazdyrev E, Beirne P, Belloli E, Bergna M, Bergot E, Bhatt N, Blaas S, Bondue B, Bonella F, Britt E, Buch K, Burk J, Cai H, Cantin A, Castillo Villegas D, Cazaux A, Cerri S, Chaaban S, Chaudhuri N, Cottin V, Crestani B, Criner G, Dahlqvist C, Danoff S, Dematte D'Amico J, Dilling D, Elias P, Ettinger N, Falk J, Fernández Pérez E, Gamez-Dubuis A, Giessel G, Gifford A, Glassberg M, Glazer C, Golden J, Gómez Carrera L, Guiot J, Hallowell R, Hayashi H, Hetzel J, Hirani N, Homik L, Hope-Gill B, Hotchkin D, Ichikado K, Ilkovich M, Inoue Y, Izumi S, Jassem E, Jones L, Jouneau S, Kaner R, Kang J, Kawamura T, Kessler R, Kim Y, Kishi K, Kitamura H, Kolb M, Kondoh Y, Kono C, Koschel D, Kreuter M, Kulkarni T, Kus J, Lebargy F, León Jiménez A, Luo Q, Mageto Y, Maher T, Makino S, Marchand-Adam S, Marquette C, Martinez R, Martínez M, Maturana Rozas R, Miyazaki Y, Moiseev S, Molina-Molina M, Morrison L, Morrow L, Moua T, Nambiar A, Nishioka Y, Nunes H, Okamoto M, Oldham J, Otaola M, Padilla M, Park J, Patel N, Pesci A, Piotrowski W, Pitts L, Poonyagariyagorn H, Prasse A, Quadrelli S, Randerath W, Refini R, Reynaud-Gaubert M, Riviere F, Rodríguez Portal J, Rosas I, Rossman M, Safdar Z, Saito T, Sakamoto N, Salinas Fénero M, Sauleda J, Schmidt S, Scholand M, Schwartz M, Shapera S, Shlobin O, Sigal B, Silva Orellana A, Skowasch D, Song J, Stieglitz S, Stone H, Strek M, Suda T, Sugiura H, Takahashi H, Takaya H, Takeuchi T, Thavarajah K, Tolle L, Tomassetti S, Tomii K, Valenzuela C, Vancheri C, Varone F, Veeraraghavan S, Villar A, Weigt S, Wemeau L, Wuyts W, Xu Z, Yakusevich V, Yamada Y, Yamauchi H, Ziora D. Nintedanib in patients with progressive fibrosing interstitial lung diseases-subgroup analyses by interstitial lung disease diagnosis in the INBUILD trial: a randomised, double-blind, placebo-controlled, parallel-group trial. Lancet Respir Med 2020; 8:453-460. [PMID: 32145830 DOI: 10.1016/s2213-2600(20)30036-9] [Citation(s) in RCA: 263] [Impact Index Per Article: 65.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 01/06/2020] [Accepted: 01/16/2020] [Indexed: 12/20/2022]
Abstract
BACKGROUND The INBUILD trial investigated the efficacy and safety of nintedanib versus placebo in patients with progressive fibrosing interstitial lung diseases (ILDs) other than idiopathic pulmonary fibrosis (IPF). We aimed to establish the effects of nintedanib in subgroups based on ILD diagnosis. METHODS The INBUILD trial was a randomised, double-blind, placebo-controlled, parallel group trial done at 153 sites in 15 countries. Participants had an investigator-diagnosed fibrosing ILD other than IPF, with chest imaging features of fibrosis of more than 10% extent on high resolution CT (HRCT), forced vital capacity (FVC) of 45% or more predicted, and diffusing capacity of the lung for carbon monoxide (DLco) of at least 30% and less than 80% predicted. Participants fulfilled protocol-defined criteria for ILD progression in the 24 months before screening, despite management considered appropriate in clinical practice for the individual ILD. Participants were randomly assigned 1:1 by means of a pseudo-random number generator to receive nintedanib 150 mg twice daily or placebo for at least 52 weeks. Participants, investigators, and other personnel involved in the trial and analysis were masked to treatment assignment until after database lock. In this subgroup analysis, we assessed the rate of decline in FVC (mL/year) over 52 weeks in patients who received at least one dose of nintedanib or placebo in five prespecified subgroups based on the ILD diagnoses documented by the investigators: hypersensitivity pneumonitis, autoimmune ILDs, idiopathic non-specific interstitial pneumonia, unclassifiable idiopathic interstitial pneumonia, and other ILDs. The trial has been completed and is registered with ClinicalTrials.gov, number NCT02999178. FINDINGS Participants were recruited between Feb 23, 2017, and April 27, 2018. Of 663 participants who received at least one dose of nintedanib or placebo, 173 (26%) had chronic hypersensitivity pneumonitis, 170 (26%) an autoimmune ILD, 125 (19%) idiopathic non-specific interstitial pneumonia, 114 (17%) unclassifiable idiopathic interstitial pneumonia, and 81 (12%) other ILDs. The effect of nintedanib versus placebo on reducing the rate of FVC decline (mL/year) was consistent across the five subgroups by ILD diagnosis in the overall population (hypersensitivity pneumonitis 73·1 [95% CI -8·6 to 154·8]; autoimmune ILDs 104·0 [21·1 to 186·9]; idiopathic non-specific interstitial pneumonia 141·6 [46·0 to 237·2]; unclassifiable idiopathic interstitial pneumonia 68·3 [-31·4 to 168·1]; and other ILDs 197·1 [77·6 to 316·7]; p=0·41 for treatment by subgroup by time interaction). Adverse events reported in the subgroups were consistent with those reported in the overall population. INTERPRETATION The INBUILD trial was not designed or powered to provide evidence for a benefit of nintedanib in specific diagnostic subgroups. However, its results suggest that nintedanib reduces the rate of ILD progression, as measured by FVC decline, in patients who have a chronic fibrosing ILD and progressive phenotype, irrespective of the underlying ILD diagnosis. FUNDING Boehringer Ingelheim.
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Affiliation(s)
- Athol U Wells
- National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Kevin R Flaherty
- Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Kevin K Brown
- Department of Medicine, National Jewish Health, Denver, CO, USA
| | - Yoshikazu Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Sakai City, Osaka, Japan
| | - Anand Devaraj
- Department of Radiology, Royal Brompton and Harefield NHS Foundation Trust, London, UK; National Heart and Lung Institute, Imperial College, London, UK
| | - Luca Richeldi
- Fondazione Policlinico A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic Rochester, Rochester, MN, USA
| | - Bruno Crestani
- Université de Paris, Inserm U1152, APHP, Hôpital Bichat, Centre de reference constitutif pour les maladies pulmonaires rares, Paris, France
| | - Wim A Wuyts
- Unit for Interstitial Lung Diseases, Department of Pulmonary Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | - Manuel Quaresma
- Boehringer Ingelheim International, Ingelheim am Rhein, Germany
| | | | | | - Martin Kolb
- McMaster University and St Joseph's Healthcare, Hamilton, Ontario, Canada
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Stieglitz S, LaForce C, Derom E, Bothner U, Loaiza L, Trampisch M, Buhl R. Long-Term Safety of Tiotropium/Olodaterol Respimat in Patients with Moderate-to-Very Severe COPD and Renal Impairment in the TONADO Studies. Pneumologie 2018. [DOI: 10.1055/s-0037-1619340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- S Stieglitz
- Pneumologie, Allergologie, Schlaf- und Intensivmedizin, Petrus-Krankenhaus Wuppertal
| | | | - E Derom
- Ghent University Hospital, Belgium
| | - U Bothner
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein
| | - L Loaiza
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein
| | - M Trampisch
- Boehringer Ingelheim Pharma GmbH & Co. KG, Ingelheim am Rhein
| | - R Buhl
- Johannes Gutenberg University Mainz
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Windisch W, Dreher M, Geiseler J, Siemon K, Brambring J, Dellweg D, Grolle B, Hirschfeld S, Köhnlein T, Mellies U, Rosseau S, Schönhofer B, Schucher B, Schütz A, Sitter H, Stieglitz S, Storre J, Winterholler M, Young P, Walterspacher S. [Guidelines for Non-Invasive and Invasive Home Mechanical Ventilation for Treatment of Chronic Respiratory Failure - Update 2017]. Pneumologie 2017; 71:722-795. [PMID: 29139100 DOI: 10.1055/s-0043-118040] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Today, invasive and non-invasive home mechanical ventilation have become a well-established treatment option. Consequently, in 2010 the German Society of Pneumology and Mechanical Ventilation (DGP) has leadingly published the guidelines on "Non-Invasive and Invasive Mechanical Ventilation for Treatment of Chronic Respiratory Failure". However, continuing technical evolutions, new scientific insights, and health care developments require an extensive revision of the guidelines.For this reason, the updated guidelines are now published. Thereby, the existing chapters, namely technical issues, organizational structures in Germany, qualification criteria, disease specific recommendations including special features in pediatrics as well as ethical aspects and palliative care, have been updated according to the current literature and the health care developments in Germany. New chapters added to the guidelines include the topics of home mechanical ventilation in paraplegic patients and in those with failure of prolonged weaning.In the current guidelines different societies as well as professional and expert associations have been involved when compared to the 2010 guidelines. Importantly, disease-specific aspects are now covered by the German Interdisciplinary Society of Home Mechanical Ventilation (DIGAB). In addition, societies and associations directly involved in the care of patients receiving home mechanical ventilation have been included in the current process. Importantly, associations responsible for decisions on costs in the health care system and patient organizations have now been involved.The currently updated guidelines are valid for the next three years, following their first online publication on the home page of the Association of the Scientific Medical Societies in German (AWMF) in the beginning of July 2017. A subsequent revision of the guidelines remains the aim for the future.
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Affiliation(s)
- W Windisch
- Lungenklinik, Kliniken der Stadt Köln gGmbH, Köln.,Universität Witten/Herdecke, Fakultät für Gesundheit/Department für Humanmedizin
| | - M Dreher
- Medizinische Klinik I - Sektion Pneumologie, Universitätsklinikum Aachen, Aachen
| | - J Geiseler
- Medizinische Klinik IV, Paracelsus-Klinik Marl, Marl
| | - K Siemon
- Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg
| | - J Brambring
- Heimbeatmungsservice Brambring Jaschke GmbH, Unterhaching
| | - D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Schmallenberg
| | - B Grolle
- Lufthafen, AKK Altonaer Kinderkrankenhaus gGmbH, Hamburg
| | - S Hirschfeld
- Querschnittgelähmtenzentrum, Berufsgenossenschaftliches Unfallkrankenhaus Hamburg, Hamburg
| | - T Köhnlein
- Klinik für Pneumologie und Intensivmedizin, Klinikum St. Georg, Leipzig
| | - U Mellies
- Klinik für Kinderheilkunde III, Universitätsklinikum Essen, Essen
| | - S Rosseau
- Pneumologisches Beatmungszentrum, Ernst von Bergmann Klinik gGmbH, Bad Belzig
| | - B Schönhofer
- Klinik für Pneumologie, KRH Klinikum Siloah-Oststadt-Heidehaus, Hannover
| | - B Schucher
- Zentrum für Pneumologie und Thoraxchirurgie, Krankenhaus Großhansdorf, Großhansdorf
| | | | - H Sitter
- Institut für theoretische Chirurgie, Universitätsklinikum Giessen und Marburg GmbH, Marburg
| | - S Stieglitz
- Medizinische Klinik I, Petrus Krankenhaus, Wuppertal
| | - J Storre
- Intensiv-, Schlaf- und Beatmungsmedizin, Asklepios Fachkliniken München-Gauting, Gauting.,Klinik für Pneumologie, Universitätsklinikum Freiburg, Freiburg i. Br
| | - M Winterholler
- Klinik für Neurologie, Krankenhaus Rummelsberg gGmbH, Schwarzenbruck
| | - P Young
- Klinik für Schlafmedizin und neuromuskuläre Erkrankungen, Universitätsklinikum Münster, Münster.,Klinik für Beatmungs- und Schlafmedizin, Clemenshospital Münster, Münster
| | - S Walterspacher
- Universität Witten/Herdecke, Fakultät für Gesundheit/Department für Humanmedizin.,II. Medizinische Klinik, Klinikum Konstanz, Konstanz
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Stieglitz S, Budihardjo-Welim H, Welsner M, Kempchen J. Lymphozytäre Alveolitis als seltene Komplikation bei Psoriasis. Pneumologie 2017. [DOI: 10.1055/s-0037-1598531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S Stieglitz
- Wuppertaler Lungenzentrum am Petrus Krankenhaus Wuppertal
| | | | - M Welsner
- Wuppertaler Lungenzentrum am Petrus Krankenhaus Wuppertal
| | - J Kempchen
- Wuppertaler Lungenzentrum am Petrus Krankenhaus Wuppertal
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Stieglitz S, Welsner M, Kempchen J, Schaper R, Sandmann M. Lymphozytäre Alveolitis mit erhöhtem CD4-/CD8-Quotienten – Diagnosen jenseits der Sarkoidose. Pneumologie 2017. [DOI: 10.1055/s-0037-1598570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S Stieglitz
- Klinik I, Kardiologie und Pneumologie, Petrus Krankenhaus Wuppertal – Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf, Wuppertaler Lungenzentrum
| | - M Welsner
- Wuppertaler Lungenzentrum am Petrus Krankenhaus
| | - J Kempchen
- Wuppertaler Lungenzentrum am Petrus Krankenhaus
| | - R Schaper
- Klinik für Innere Medizin III am Petrus Krankenhaus Wuppertal
| | - M Sandmann
- Klinik für Innere Medizin III am Petrus Krankenhaus Wuppertal
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Stieglitz S, Schlesinger A. Technische Lösung standortübergreifender Vernetzung am Beispiel des Köln-Wuppertaler Projekts NiLS (ILD-Netzwerk). Pneumologie 2017. [DOI: 10.1055/s-0037-1598296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- S Stieglitz
- Wuppertaler Lungenzentrum am Petrus Krankenhaus Wuppertal
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Schlesinger A, Buhr M, Strunk J, Schäfer S, Welsner M, Kempchen J, Boldt A, Thiele A, Stieglitz S, Sahebdjami S. Vorteil durch Vernetzung – Retrospektive 1 Jahres Analyse nach der Gründung eines standortübergreifenden Netzwerks für interstitielle Lungengerüsterkrankung (NilS) in Nordrhein Westfalen. Pneumologie 2017. [DOI: 10.1055/s-0037-1598297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- A Schlesinger
- Abtl. Innere Medizin/Pneumologie, St. Marien Hospital Köln, Lungenklinik Köln Nord
| | - M Buhr
- Radiologie, St. Marien Hospital Köln, Lungenklinik Köln Nord
| | - J Strunk
- Abteilung für Rheumatologie, Krankenhaus Porz am Rhein
| | - S Schäfer
- Institut für Pathologie, Universität Köln
| | - M Welsner
- Wuppertaler Lungenzentrum am Petrus Krankenhaus
| | - J Kempchen
- Wuppertaler Lungenzentrum am Petrus Krankenhaus
| | | | - A Thiele
- Zentrum für Rheumatologie und Immunologie, St. Josef Krankenhaus
| | - S Stieglitz
- Klinik I, Kardiologie und Pneumologie, Petrus Krankenhaus Wuppertal – Akademisches Lehrkrankenhaus der Heinrich-Heine-Universität Düsseldorf, Wuppertaler Lungenzentrum
| | - S Sahebdjami
- Abtl. Innere Medizin/Pneumologie, St. Marien Hospital Köln, Lungenklinik Köln Nord
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Stieglitz S, Kempchen J, Lehnerdt G, Mandrakas N. Adaptive Servoventilation: Relevanz der geänderten Indikationsstellung. Pneumologie 2016. [DOI: 10.1055/s-0036-1572112] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Stieglitz S, Kempchen J, Sandmann M, Schaper R. Sarkoidose-Lymphom-Syndrom. Pneumologie 2016. [DOI: 10.1055/s-0036-1572206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Göhl O, Walker DJ, Walterspacher S, Langer D, Spengler CM, Wanke T, Petrovic M, Zwick RH, Stieglitz S, Glöckl R, Dellweg D, Kabitz HJ. [Respiratory Muscle Training: State of the Art]. Pneumologie 2016; 70:37-48. [PMID: 26789431 DOI: 10.1055/s-0041-109312] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Specific respiratory muscle training (IMT) improves the function of the inspiratory muscles. According to literature and clinical experience, there are 3 established methods: 1.) resistive load 2.) threshold load and 3.) normocapnic hyperpnea. Each training method and the associated devices have specific characteristics. Setting up an IMT should start with specific diagnostics of respiratory muscle function and be followed by detailed individual introduction to training. The aim of this review is to take a closer look at the different training methods for the most relevant indications and to discuss these results in the context of current literature. The group of neuromuscular diseases includes muscular dystrophy, spinal muscular atrophy, amyotrophic lateral sclerosis, paralysis of the phrenic nerve, and injuries to the spinal cord. Furthermore, interstitial lung diseases, sarcoidosis, left ventricular heart failure, pulmonary arterial hypertension (PAH), kyphoscoliosis and obesity are also discussed in this context. COPD, asthma, cystic fibrosis (CF) and non-CF-bronchiectasis are among the group of obstructive lung diseases. Last but not least, we summarize current knowledge on weaning from respirator in the context of physical activity.
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Affiliation(s)
- O Göhl
- Rehaklinik Heidelberg-Königstuhl, Heidelberg
| | - D J Walker
- II. Medizinische Klinik, Pneumologie, Kardiologie und Intensivmedizin, Klinikum Konstanz
| | - S Walterspacher
- II. Medizinische Klinik, Pneumologie, Kardiologie und Intensivmedizin, Klinikum Konstanz
| | - D Langer
- KU Leuven - University of Leuven, Department of Rehabilitation Sciences, Leuven, Belgien
| | - C M Spengler
- Exercise Physiology Lab, Institut für Bewegungswissenschaften und Sport, ETH Zürich, und Zentrum für Integrative Humanphysiologie, Universität Zürich, Schweiz
| | - T Wanke
- Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel und Karl Landsteiner Institut, Abteilung für Atmungs- und Lungenerkrankungen, Wien, Österreich
| | - M Petrovic
- Krankenhaus Hietzing mit Neurologischem Zentrum Rosenhügel und Karl Landsteiner Institut, Abteilung für Atmungs- und Lungenerkrankungen, Wien, Österreich
| | - R-H Zwick
- Univ. Klinik für Innere Medizin, Univ. Klinikum Tulln, Karl Landsteiner Privatuniversität, Ambulante Pneumologische Rehabilitation, Therme Wien Med, Wien, Österreich
| | - S Stieglitz
- Medizinische Klinik I - Pneumologie und Kardiologie, Petrus Krankenhaus Wuppertal
| | - R Glöckl
- Schön Klinik Berchtesgadener Land, Fachzentrum Pneumologie, Schönau am Königssee
| | - D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Lehrkrankenhaus der Universität Marburg, Schmallenberg
| | - H-J Kabitz
- II. Medizinische Klinik, Pneumologie, Kardiologie und Intensivmedizin, Klinikum Konstanz
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Stieglitz S, Priegnitz C, Anduleit N, Randerath WJ. Akute hämodynamische Effekte eines Atemmuskeltrainings (IMT). Pneumologie 2015. [DOI: 10.1055/s-0035-1544897] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Stieglitz S, Kietzmann I, Anduleit N, Randerath WJ. Notfälle in invasiver außerklinischer Beatmung: Beobachtungsstudie über 1 Jahr. Pneumologie 2014. [DOI: 10.1055/s-0034-1367805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stieglitz S, Kietzmann I, Richter K, Randerath WJ. Lebensqualität hochgradig respiratorabhängiger Patienten mit invasiver außerklinischer Beatmung. Pneumologie 2014. [DOI: 10.1055/s-0034-1367804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Stieglitz S, George S, Priegnitz C, Hagmeyer L, Randerath W. Life-threatening events in respiratory medicine: misconnections of invasive and non-invasive ventilators and interfaces. Pneumologie 2013; 67:228-32. [PMID: 23479399 DOI: 10.1055/s-0032-1326230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
PURPOSE Both the parallel use of intensive care unit (ICU)-ventilators and ventilators dedicated to non-invasive ventilation (NIV), as well as the construction of some expiratory valves in single circuit breathing tubes may lead to misconnections which are potentially fatal for the patient. METHODS We demonstrate first a case of a misconnected expiratory valve in a patient with invasive home ventilation. In a second case, the mistaken connection of a non-invasive ventilator to an endotracheal tube leading to carbon dioxide (CO2)-rebreathing is demonstrated. A third case describes a patient with home non-invasive ventilation who had been delivered a non-vented mask out-of-hospital, likewise leading to CO2-rebreathing. CONCLUSION Human error is the main reason for critical incidents in medicine and the most serious unintended events often involve mechanical ventilation. A regular instruction of medical staff and patients is necessary. The demonstrated misconnections are examples of latent errors "waiting to happen". To prevent these errors from being made in the future, technological solutions similar to the aviation effort to improve safety are needed.
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Affiliation(s)
- S Stieglitz
- Clinic for Pneumology and Allergology, Centre for Sleep and Ventilation Medicine, Germany.
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Affiliation(s)
- L. Hagmeyer
- Krankenhaus Bethanien gGmbH, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Solingen
| | - S. Stieglitz
- Krankenhaus Bethanien gGmbH, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Solingen
| | - C. Röcken
- Institut für Pathologie, Christian-Albrechts-Universität, Kiel
| | - W. Randerath
- Krankenhaus Bethanien gGmbH, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Solingen
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Hagmeyer L, Priegnitz C, Stieglitz S, Randerath WJ. Weaningverlauf nach interventioneller Entfernung von Trachealstenosen. Pneumologie 2012. [DOI: 10.1055/s-0032-1302554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Abstract
BACKGROUND At present health-care at home for the majority of patients with invasive ventilation is mainly provided by nursing personnel. The reason for this unsatisfying condition is the lack of a basic medical supply for patients with invasive ventilation outside of hospitals. In contrast, current guidelines recommend a follow-up care by the weaning centres that applies for patients with invasive ventilation at home. In an case the practical implementation of the follow-up care is not specified. MATERIAL AND METHODS In this paper we attempt to balance the reasons for the need of follow-up care for ventilated patients by the weaning centre on the basis of 6 cases. Furthermore, we want to report our experience with a weekly visitation of these patients as a basic structure of the follow-up care. RESULTS AND CONCLUSIONS The necessity for a regular consultation by a pneumologist that can be established by weekly rounds has been demonstrated. In addition, it can be expected to reduce the costs of public health markedly if one takes data from ventilated patients living in specialised institutions into account. Nevertheless prospective studies are necessary to objectify the financial and medical benefits arising from this form of medical supply. These studies should be designed as multicentre studies because of the heterogenous population of ventilated patients and the fact that home ventilation is in general a seldom occurrence.
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Affiliation(s)
- S Stieglitz
- Krankenhaus Bethanien, Klinik für Pneumologie und Allergologie, Zentrum für Beatmungs- und Schlafmedizin, Solingen.
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Stieglitz S, Randerath WJ. Zwischenfälle in der Beatmungsmedizin durch Kompatibiliätsprobleme von Beatmungssystemen. Pneumologie 2011. [DOI: 10.1055/s-0031-1272268] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Stieglitz S. Compliance-beeinflussende Faktoren der adaptiven Servoventilation im Vergleich zur CPAP-Therapie. Pneumologie 2010. [DOI: 10.1055/s-0030-1267755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Galetke W, Kostovic L, Stieglitz S, Anduleit N, Funke N, Richter K, Treml M, Randerath W. Prävalenz von Mangelernährung und Adipositas in einer pneumologischen Akutklinik. Pneumologie 2010. [DOI: 10.1055/s-0030-1251229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stieglitz S, Galetke W, Randerath W. Biokalibrierung transkutaner CO2-Messung (TOSCA). Pneumologie 2010. [DOI: 10.1055/s-0030-1251396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stieglitz S, Galetke W, Randerath W. Outcome von Patienten mit invasiver Dauerbeatmung. Pneumologie 2009. [DOI: 10.1055/s-0029-1213817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Galetke W, Stieglitz S, Anduleit N, Osagie-Paech R, Richter K, Randerath W. Prävalenz schlafbezogener Atmungsstörungen in der allgemeinmedizinischen, HNO-ärztlichen und kardiologischen Praxis. Pneumologie 2009. [DOI: 10.1055/s-0029-1214076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stieglitz S, Galetke W, Randerath W. Respiratorische Zwischenfälle bei Patienten mit invasiver Heimbeatmung. Pneumologie 2009. [DOI: 10.1055/s-0029-1213818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Galetke W, Stieglitz S, Anduleit N, Kühnel J, Funke N, Osagie-Paech R, Richter K, Randerath W. Einfluss einer integrierten Schlauchheizung auf die Compliance und Nebenwirkungsrate der CPAP-Therapie. Pneumologie 2009. [DOI: 10.1055/s-0029-1214072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Galetke W, Stieglitz S, Anduleit N, Kenter M, Kühnel J, Osagie-Paech R, Richter K, Randerath W. [Evaluation of a new automatic CPAP algorithm in the treatment of obstructive sleep apnoea syndrome]. Pneumologie 2009; 63:261-5. [PMID: 19229797 DOI: 10.1055/s-0028-1119519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Automatic continuous positive airway pressure (automatic CPAP, APAP) is an effective treatment option in the obstructive sleep apnoea syndrome (OSAS). The differentiation of obstructive and central respiratory events is crucial in adjusting the optimal pressure in this treatment mode. In this pilot study we evaluated a new automatic CPAP algorithm in OSAS patients. METHODS 14 patients with newly diagnosed obstructive sleep apnoea syndrome were enrolled. After a diagnostic polysomnography, patients were treated for one night with a new APAP device based on flow, snoring, relative minute volume and the obstructive pressure peak signal. RESULTS The total apnoea/hypopnoea index (AHI) was 30.0 +/- 21.4/h at baseline and 3.7 +/- 5.3/h with APAP ( P < 0.005). Both obstructive AHI (22.7 +/- 20.5/h at baseline, 1.5 +/- 3.5/h with APAP, P < 0.005) and central AHI (7.3 +/- 4.9/h and 2.2 +/- 2.5/h, respectively, P < 0.01) as well as the arousal index (25.4 +/- 18.1/h and 5.1 +/- 3.8/h, respectively, P < 0.005) were reduced significantly with the new algorithm. CONCLUSIONS The new algorithm of an automatic CPAP device is effective in the treatment of obstructive sleep apnoea syndrome.
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Affiliation(s)
- W Galetke
- Krankenhaus Bethanien Solingen, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Universität Witten/Herdecke, 42699 Solingen.
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Abstract
The obesity hypoventilation syndrome (OHS) is defined by extreme overweight (BMI 30 kg/m2), daytime hypoventilation (PaCO2 > 45 mm Hg, the absence of other known causes of hypoventilation) and sleep-related breathing disorders. Obesity impairs breathing due to a restrictive ventilatory disorder, reduction of the capacity of respiratory muscles and diminishment of the ventilatory response. The restriction cannot serve as the only explanation of OHS because body weight or compliance on the one hand and hypoventilation on the other hand only correlate weakly. Obesity increases the work of breathing by greater body mass with its increased oxygen demand, impaired diaphragmatic mobility, upper airway obstruction, and oxygen desaturation which result in an inadequacy of oxygen demand and supply. The adjustment of the chemoreceptors can avoid the overload on the capacity of the respiratory muscles, at least in a number of patients or in the course of the disease. This disproportion results in hypercapnia. Furthermore, the level of leptin is an important factor in the pathophysiology of OHS. The blood level of leptin correlates with the body fat mass in humans. However, there seems to be a relative leptin deficiency in the brain in overweight humans. Therefore, in contrast to animals, leptin cannot sufficiently increase ventilation in man to avoid hypercapnia.
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Affiliation(s)
- W J Randerath
- Institut für Pneumologie an der Universität Witten/Herdecke, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien.
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Priegnitz C, Stieglitz S, Randerath W. Elastinfaserdegeneration als seltene Ursache einer chronisch ventilatorischen Insuffizienz. Pneumologie 2008. [DOI: 10.1055/s-2008-1074382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Stieglitz S, Galetke W, Anduleit N, Randerath W. Biokalibrierung transkutaner CO2-Messung. Pneumologie 2008. [DOI: 10.1055/s-2008-1074170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Galetke W, Stieglitz S, Laumanns C, Priegnitz C, Randerath W. Evaluation eines neuen Therapiealgorithmus für Patienten mit obstruktivem Schlafapnoe-Syndrom und Cheyne-Stokes-Atmung. Pneumologie 2008. [DOI: 10.1055/s-2008-1074171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Galetke W, Laumanns C, Priegnitz C, Stieglitz S, Randerath W. Therapie-Compliance bei schlafbezogenen Atmungsstörungen – gibt es den typischen Problempatienten? Pneumologie 2008. [DOI: 10.1055/s-2008-1074104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Siemon K, Barchfeld T, Haidl P, Stieglitz S, Herling S, Köhler D. Hat die Lokalanästhesie mit Acoin® Einfluss auf das bronchoskopisch gewonnene Keimspektrum? Pneumologie 2006. [DOI: 10.1055/s-2006-933853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Galetke W, Anduleit N, Assmus C, Richter K, Stieglitz S, Randerath W. Prospektive randomisierte Studie zur Validierung eines Algorhithmus zur automatischen Titration in der Therapie des obstruktiven Schlafapnoe-Syndromes. Pneumologie 2006. [DOI: 10.1055/s-2006-933923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stieglitz S, Galetke W, Randerath W. Chronisch ventilatorische Insuffizienz – Formen der CO2-Retention in der transkutanen Langzeitkapnometrie. Pneumologie 2006. [DOI: 10.1055/s-2006-933879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Galetke W, Feier C, Muth T, Stieglitz S, Randerath W. Vergleich zwischen Ösophagusdruckmethode und Impulsoszillometrie bei der Bestimmung der Lungencompliance. Pneumologie 2006. [DOI: 10.1055/s-2006-933978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Stieglitz S, Haidl P, Köhler D. Anti-Jo1-Ak assoziierte Lungenfibrose bei Myositis. Pneumologie 2005. [DOI: 10.1055/s-2005-864593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Affiliation(s)
- S Stieglitz
- Abteilung für Anästhesiologie und Intensivmedizin, Universität Essen, Germany
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Drake L, Hordinsky M, Fiedler V, Swinehart J, Unger WP, Cotterill PC, Thiboutot DM, Lowe N, Jacobson C, Whiting D, Stieglitz S, Kraus SJ, Griffin EI, Weiss D, Carrington P, Gencheff C, Cole GW, Pariser DM, Epstein ES, Tanaka W, Dallob A, Vandormael K, Geissler L, Waldstreicher J. The effects of finasteride on scalp skin and serum androgen levels in men with androgenetic alopecia. J Am Acad Dermatol 1999; 41:550-4. [PMID: 10495374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
BACKGROUND Data suggest that androgenetic alopecia is a process dependent on dihydrotestosterone (DHT) and type 2 5alpha-reductase. Finasteride is a type 2 5alpha-reductase inhibitor that has been shown to slow further hair loss and improve hair growth in men with androgenetic alopecia. OBJECTIVE We attempted to determine the effect of finasteride on scalp skin and serum androgens. METHODS Men with androgenetic alopecia (N = 249) underwent scalp biopsies before and after receiving 0.01, 0.05, 0.2, 1, or 5 mg daily of finasteride or placebo for 42 days. RESULTS Scalp skin DHT levels declined significantly by 13.0% with placebo and by 14.9%, 61.6%, 56. 5%, 64.1%, and 69.4% with 0.01, 0.05, 0.2, 1, and 5 mg doses of finasteride, respectively. Serum DHT levels declined significantly (P <.001) by 49.5%, 68.6%, 71.4%, and 72.2% in the 0.05, 0.2, 1, and 5 mg finasteride treatment groups, respectively. CONCLUSION In this study, doses of finasteride as low as 0.2 mg per day maximally decreased both scalp skin and serum DHT levels. These data support the rationale used to conduct clinical trials in men with male pattern hair loss at doses of finasteride between 0.2 and 5 mg.
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Affiliation(s)
- L Drake
- University of Oklahoma Health Sciences, Oklahoma City, USA
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Groeben H, Schwalen A, Irsfeld S, Stieglitz S, Lipfert P, Hopf HB. Intravenous lidocaine and bupivacaine dose-dependently attenuate bronchial hyperreactivity in awake volunteers. Anesthesiology 1996; 84:533-9. [PMID: 8659780 DOI: 10.1097/00000542-199603000-00007] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND In standard textbooks, intravenous lidocaine is recommended for intubation of patients with bronchial hyperreactivity. However, whether and to what extent intravenous local anesthetics attenuate bronchial hyperreactivity in humans is unknown. Accordingly, nine awake volunteers with known bronchial hyperreactivity were subjected to an inhalational challenge with acetylcholine before and during intravenous infusion of lidocaine, bupivacaine, or placebo in a randomized, double-blinded fashion. METHODS Baseline acetylcholine threshold concentrations were determined 3-5 days before initiation of the investigation. The response to the acetylcholine challenge was defined as hyperreactive, if forced expiratory volume in 1 s decreased by at least 20%. In addition, the acetylcholine threshold for a 100% increase in airway resistance was obtained by body plethysmography. On seven different days, the acetylcholine challenge was repeated at the end of a 30-min intravenous infusion period of three doses of lidocaine (1, 3, and 6 mg.min(-1)) or bupivacaine (0.25, 0.75, and 1.5 mg.min(-1)), during saline placebo infusion, respectively. Acetylcholine-threshold concentrations were presented with the respective plasma concentrations of the local anesthetic. RESULTS The infusion of lidocaine and bupivacaine resulted in plasma concentrations (means +/- SD) of 0.29 +/- 0.11, 1.14 +/- 0.39, and 2.02 +/- 0.5 microg.ml(-1) for lidocaine and 0.11 +/- 0.04, 0.31 +/- 0.09, and 0.80 +/- 0.18 microg.ml(-1) for bupivacaine, respectively. Compared to baseline, the acetylcholine threshold for a 20% decrease of forced expiratory volume in 1 s as well as the threshold for a 100% increase in total airway resistance increased significantly with increasing plasma concentrations of both local anesthetics. Compared to placebo, acetylcholine threshold was almost quadrupled for lidocaine and tripled for bupivacaine with the highest plasma concentration of each local anesthetic. CONCLUSIONS In awake humans, intravenous lidocaine and bupivacaine both dose-dependently attenuated the hyperreactive response to a nonspecific inhalational challenge with acetylcholine.
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Affiliation(s)
- H Groeben
- Department of Anesthesiology and Critical Care Medicine, University of Düsseldorf, Germany
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Stieglitz S. [Blunt trauma and acute strain injuries in pediatrics. Treatment with Dolo-menthoneurin gel]. ZFA (Stuttgart) 1980; 56:1160-2. [PMID: 7415483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
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Vesper J, Stieglitz S. [Holiday organization for children with chronic recurring attacks]. Z Arztl Fortbild (Jena) 1973; 67:575-8. [PMID: 4198905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
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Adamczyk B, Klier G, Lingelbach R, Stieglitz S. [ECHO virus 8(1) as cause of a group disease in a children's unit]. Arch Hyg Bakteriol 1968; 152:547-50. [PMID: 5754323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
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