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Klose MA, Becker A, Blank V, Eisenmann S, Rosendahl J, Walldorf J. Role of patient and staff mobility in scope 3 emissions in GI endoscopy. Gut 2024:gutjnl-2024-332041. [PMID: 38418211 DOI: 10.1136/gutjnl-2024-332041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 02/14/2024] [Indexed: 03/01/2024]
Affiliation(s)
- Michelle A Klose
- Department of Internal Medicine I, University Medicine Halle (Saale), Halle, Germany
| | - Antonia Becker
- Department of Internal Medicine I, University Medicine Halle (Saale), Halle, Germany
| | - Valentin Blank
- Department of Internal Medicine I, University Medicine Halle (Saale), Halle, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, University Medicine Halle (Saale), Halle, Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, University Medicine Halle (Saale), Halle, Germany
| | - Jens Walldorf
- Department of Internal Medicine I, University Medicine Halle (Saale), Halle, Germany
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Quiroga TN, Bachar N, Voigt W, Danino N, Shafran I, Shtrichman R, Shuster G, Lambrecht N, Eisenmann S. Changes in tidal breathing biomarkers as indicators of treatment response in AECOPD patients in an acute care setting. Adv Med Sci 2023; 68:176-185. [PMID: 37146372 DOI: 10.1016/j.advms.2023.04.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Revised: 03/01/2023] [Accepted: 04/26/2023] [Indexed: 05/07/2023]
Abstract
PURPOSE Acute exacerbation of chronic obstructive pulmonary disease (AECOPD) is a complication of COPD that typically necessitates intensified treatment and hospitalization. It is linked to higher morbidity, mortality and healthcare spending. Assessment of therapy response for AECOPD is difficult due to the variability of symptoms and limitations in current measures. Hence, there is a need for new biomarkers to aid in the management of AECOPD in acute care settings. MATERIALS AND METHODS Fifteen hospitalized AECOPD patients (GOLD 3-4) were enrolled in this study. Treatment response was assessed daily through clinical evaluations and by monitoring tidal breathing biomarkers (respiratory rate [RR], expiratory time [Tex], inspiratory time [Tin], expiratory pause [Trst], total breath time [Ttot]), using a novel, wearable nanosensor-based device (SenseGuard™). RESULTS Patients who showed significant clinical improvement had substantial changes in ΔTex/Ttot (+14%), ΔTrst/Ttot (-18%), and ΔTin/Tex (+0.09), whereas patients who showed mild or no clinical improvement had smaller changes (+5%, +3%, and -0.03, respectively). Linear regression between change in physician's assessment score and the median change in tidal breathing parameters was significant for Tin/Tex (R2 = 0.449, ∗p = 0.017), Tex/Ttot (R2 = 0.556, ∗p = 0.005) and Trst/Ttot (R2 = 0.446, ∗p = 0.018), while no significant regression was observed for RR, Tin/(Trst + Tex) and Tin/Ttot. CONCLUSIONS Our study demonstrates the potential of the SenseGuard™ to monitor treatment response in AECOPD patients by measuring changes in tidal breathing biomarkers, which were shown to be associated with significant changes in the patients' respiratory condition as evaluated by physicians. However, further large-scale clinical studies are needed to confirm these findings.
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Affiliation(s)
- Tess Nuñez Quiroga
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Halle, Germany
| | | | - Wieland Voigt
- NanoVation-GS LTD, Haifa, Israel; Medical Innovation and Management, Steinbeis University Berlin, Berlin, Germany
| | | | | | | | | | - Nina Lambrecht
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Halle, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Halle, Germany
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Pappe E, Hammerich R, Saccomanno J, Sgarbossa T, Pohrt A, Schmidt B, Grah C, Eisenmann S, Holland A, Eggeling S, Stanzel F, Witzenrath M, Hübner RH. Impact of Coronavirus Disease 2019 on Hospital Admissions, Health Status, and Behavioral Changes of Patients with COPD. Chronic Obstr Pulm Dis 2023; 10:211-223. [PMID: 37140947 PMCID: PMC10484494 DOI: 10.15326/jcopdf.2022.0383] [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] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/20/2023] [Indexed: 05/05/2023]
Abstract
Introduction Patients with chronic obstructive pulmonary disease (COPD) have an increased risk of acquiring severe coronavirus disease 2019 (COVID-19), which is why self-isolation was recommended. However, long periods of social isolation, accompanied by limited access to health care systems, might influence the outcome of patients with severe COPD negatively. Methods Data from COPD and pneumonia patients at Charité-Universitätsmedizin Berlin and the volume of endoscopic lung volume reduction (ELVR) surgeries from the German Lung Emphysema Registry (Lungenemphysem Register e.V.) were analyzed from pre-pandemic (2012 to 2019) to the pandemic period (2020 and 2021). In addition, 52 patients with COPD Global initiative for chronic Obstructive Lung Disease (GOLD) stage 4 status included in the lung emphysema registry received questionnaires during lockdowns from June 2020 to April 2021. Results Admissions and ventilation therapies administered to COPD patients significantly decreased during the COVID-19 pandemic. Likewise, there was a reduction in ELVR treatments and follow-ups registered in German emphysema centers. Mortality was slightly higher among patients hospitalized with COPD during the pandemic. Increasing proportions of COPD patients with GOLD stage 3 and GOLD stage 4 status reported behavioral changes and subjective feelings of increasing COPD symptoms the longer the lockdown lasted. However, COPD symptom questionnaires revealed stable COPD symptoms over the pandemic time period. Summary This study reveals reduced COPD admissions and elective treatment procedures of COPD patients during the pandemic, but a slight increase in mortality among patients hospitalized with COPD, irrespective of COVID-19. Correspondingly, patients with severe COPD reported subjective deterioration of their health status, probably caused by their very strict compliance with lockdown measures.
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Affiliation(s)
- Eva Pappe
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ralf Hammerich
- Administrative Office for Clinical Quality and Risk Management, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Jacopo Saccomanno
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Thomas Sgarbossa
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Anne Pohrt
- Institute of Biometry and Clinical Epidemiology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Bernd Schmidt
- Department of Respiratory Medicine, DRK Kliniken Berlin Mitte, Berlin, Germany
| | - Christian Grah
- Department of Internal Medicine and Respiratory Medicine, Clinic Havelhöhe Berlin, Berlin, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, Pulmonary Medicine, University Hospital Halle (Saale), Germany
| | - Angelique Holland
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
| | - Stephan Eggeling
- Department of Thoracic Surgery, Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Berlin, Germany
| | | | - Martin Witzenrath
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Ralf-Harto Hübner
- Department of Infectious Diseases and Respiratory Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
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Sgarbossa T, Lenga P, Stanzel F, Holland A, Grah C, Gesierich W, Gebhardt A, Ficker J, Eggeling S, Andreas S, Schmidt B, Eisenmann S, Schwick B, Franke KJ, Fertl A, Witzenrath M, Hübner RH. Assessment of efficacy and safety of endoscopic lung volume reduction with one-way valves in patients with a very low FEV 1. ERJ Open Res 2023; 9:00190-2023. [PMID: 37609599 PMCID: PMC10440652 DOI: 10.1183/23120541.00190-2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/31/2023] [Indexed: 08/24/2023] Open
Abstract
Introduction Endoscopic lung volume reduction (ELVR) with one-way valves produces beneficial outcomes in patients with severe emphysema. Evidence on the efficacy remains unclear in patients with a very low forced expiratory volume in 1 s (FEV1) (≤20% predicted). We aim to compare clinical outcomes of ELVR, in relation to the FEV1 restriction. Methods All data originated from the German Lung Emphysema Registry (Lungenemphysem Register), which is a prospective multicentric observational study for patients with severe emphysema after lung volume reduction. Two groups were formed at baseline: FEV1 ≤20% pred and FEV1 21-45% pred. Pulmonary function tests (FEV1, residual volume, partial pressure of carbon dioxide), training capacity (6-min walk distance (6MWD)), quality of life (modified Medical Research Council dyspnoea scale (mMRC), COPD Assessment Test (CAT), St George's Respiratory Questionnaire (SGRQ)) and adverse events were assessed and compared at baseline and after 3 and 6 months. Results 33 patients with FEV1 ≤20% pred and 265 patients with FEV1 21-45% pred were analysed. After ELVR, an increase in FEV1 was observed in both groups (both p<0.001). The mMRC and CAT scores, and 6MWD improved in both groups (all p<0.05). The SGRQ score improved significantly in the FEV1 21-45% pred group, and by trend in the FEV1 ≤20% pred group. Pneumothorax was the most frequent complication within the first 90 days in both groups (FEV1 ≤20% pred: 7.7% versus FEV1 21-45% pred: 22.1%; p=0.624). No deaths occurred in the FEV1 ≤20% pred group up to 6 months. Conclusion Our study highlights the potential efficacy of one-way valves, even in patients with very low FEV1, as these patients experienced significant improvements in FEV1, 6MWD and quality of life. No death was reported, suggesting a good safety profile, even in these high-risk patients.
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Affiliation(s)
- Thomas Sgarbossa
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- These authors contributed equally
| | - Pavlina Lenga
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- These authors contributed equally
| | - Franz Stanzel
- Klinik für Pneumologie, Lungenklinik Hemer, Hemer, Germany
| | - Angelique Holland
- Klinik für Pneumologie, Universitätsklinikum Gießen und Marburg GmbH, Marburg, Germany
| | - Christian Grah
- Klinik für Innere Medizin und Pneumologie, Klinik Havelhöhe Berlin, Berlin, Germany
| | - Wolfgang Gesierich
- Klinik für Pneumologie, Asklepios Fachkliniken München-Gauting, Gautingen, Germany
| | - Andreas Gebhardt
- Klinik für Pneumologie, Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Joachim Ficker
- Department of Respiratory Medicine, Paracelsus Medical University, Nuremberg General Hospital, Nuremberg, Germany
| | - Stephan Eggeling
- Klinik für Thoraxchirurgie, Vivantes-Klinikum Neukölln, Berlin, Germany
| | - Stefan Andreas
- Zentrum für Pneumologie, Lungenfachklinik Immenhausen, Immenhausen, Germany, Member of the German Center for Lung Research (DZL)
| | - Bernd Schmidt
- Klinik für Innere Medizin – Pneumologie und Schlafmedizin, DRK Kliniken Berlin Mitte, Berlin, Germany
| | - Stephan Eisenmann
- Klinik für Innere Medizin I, Abteilung Pneumologie, Universitätsklinikum Halle, Halle, Germany
| | - Björn Schwick
- Klinik für Pneumologie, Luisenhospital Aachen, Aachen, Germany
| | - Karl-Josef Franke
- Klinik für Pneumologie und Internistische Intensivmedizin, Klinikum Lüdenscheid, Lüdenscheid, Germany
| | - Andreas Fertl
- Klinik für Innere Medizin und Pneumologie, Krankenhaus Martha-Maria München, Munich, Germany
| | - Martin Witzenrath
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Capnetz Stiftung, Hannover, Germany
- DZL associated partner site Berlin, Berlin, Germany
| | - Ralf-Harto Hübner
- Department of Infectious Diseases, Respiratory Medicine and Critical Care, Charité – Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Sieber S, Garbe J, Böhm S, Eisenmann S. Pneumothorax detection with thoracic ultrasound as the method of choice in interventional pulmonology - A retrospective single-center analysis and experience. BMC Pulm Med 2023; 23:227. [PMID: 37365532 DOI: 10.1186/s12890-023-02511-7] [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: 02/15/2023] [Accepted: 06/06/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Recent studies have shown that thoracic ultrasound (TUS) is not inferior to chest radiography (CR) in detecting pneumothorax (PTX). It is unclear if adopting TUS can reduce the number of CR in the daily clinical routine. This retrospective study investigates the utilization of post-interventional CR and TUS for PTX detection after the introduction of TUS as the method of choice in an interventional pulmonology unit. METHODS All interventions with CR or TUS for ruling out PTX performed in the Pneumology Department of the University Hospital Halle (Germany) 2014 to 2020 were included. The documented TUS and CR performed before (period A) and after the introduction of TUS as the method of choice (period B), as well as the number of diagnosed and missed PTX were recorded. RESULTS The study included 754 interventions (110 in period A and 644 in period B). The proportion of CR decreased from 98.2% (n = 108) to 25.8% (n = 166) (p < 0.001). During period B, a total of 29 (4.5%) PTX were diagnosed. Of these, 28 (96.6%) were detected on initial imaging (14 by CR, 14 by TUS ). One PTX (0.2%) was initially missed by TUS, none by CR. Confirmatory investigations were ordered more frequently after TUS (21 of 478, 4.4%) than after CR (3 of 166, 1.8%). CONCLUSION The use of TUS in interventional pulmonology can effectively reduce the number of CR and thus save resources. However, CR may still be favored in specific circumstances or if pre-existing conditions limit sonographic findings.
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Affiliation(s)
- Sonja Sieber
- Department of Internal Medicine, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Germany.
| | - Jakob Garbe
- Department of Internal Medicine, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Germany
| | - Sebastian Böhm
- Department of Internal Medicine, University Hospital Tübingen, Otfried-Müller-Straße 10, 72076, Tübingen, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine, University Hospital Halle (Saale), Ernst-Grube-Straße 40, 06120, Halle, Germany
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Eisenmann S, Lambrecht N, Dießel L, Busse C, Nuding S, Vogt A. Transbronchial cryobiopsy in unexplained, severe ARDS: a single center retrospective case series. BMC Pulm Med 2023; 23:5. [PMID: 36604710 PMCID: PMC9815052 DOI: 10.1186/s12890-022-02296-1] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2022] [Accepted: 12/23/2022] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Acute respiratory distress syndrome (ARDS) deptics an acute form of lung infjury with often severe respiratory impairment that requires invasive mechanical ventilation. Since ARDS can be caused by several distinct etiologies, correct characterization is desired and frequently challenging. Surgical lung biopsy was previously reported to be of additive value. We describe our institutional experience using transbronchial cryobiopsy (TBCB) for further characterization of severe and unexplained ARDS cases. CASE PRESENTATION We retrospectively collected data of TBCB in patients with unexplained ARDS, whether with or without ECMO-support. Between 2019 and 2020 TBCB was performed in eight patients. Decision for the intervention was decided in multidisciplinary discussion. Five patients were treated with ECMO. The median duration of invasive ventilation before TBCB was 24 days. TBCB was performed in one segment, that was prophylactically occluded by Watanabe spigot or swab after the procedure. Histology results and their contribution to further therapeutic decisions were analyzed. Histology revealed five diffuses alveolar damage, one acute fibrinoid organizing pneumonia, one cryptogenic organizing pneumonia and one lung cancer. All results contributed to the decision of further management. While no pneumothorax or severe endobronchial bleeding occurred, two delayed hematothoraces needed surgical treatment. No patients died due to TBCB. CONCLUSION TBCB is feasible in ARDS even during ECMO treatment. Histologic results can play a significant role in therapeutic and ethic discussion to guide the patients' care. Side effects should be considered and monitored.
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Affiliation(s)
- Stephan Eisenmann
- grid.461820.90000 0004 0390 1701Department of Internal Medicine I, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Nina Lambrecht
- grid.461820.90000 0004 0390 1701Department of Internal Medicine I, University Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Linda Dießel
- grid.461820.90000 0004 0390 1701Department of Pathology, University Hospital Halle, Magdeburger Strasse 2, 06112 Halle, Germany
| | - Christin Busse
- grid.461820.90000 0004 0390 1701Department of Pathology, University Hospital Halle, Magdeburger Strasse 2, 06112 Halle, Germany
| | - Sebastian Nuding
- Department of Internal Medicine, IIIUniversity Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
| | - Alexander Vogt
- Department of Internal Medicine, IIIUniversity Hospital Halle, Ernst-Grube-Strasse 40, 06120 Halle, Germany
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Hoeper MM, Dwivedi K, Pausch C, Lewis RA, Olsson KM, Huscher D, Pittrow D, Grünig E, Staehler G, Vizza CD, Gall H, Distler O, Opitz C, Gibbs JSR, Delcroix M, Park DH, Ghofrani HA, Ewert R, Kaemmerer H, Kabitz HJ, Skowasch D, Behr J, Milger K, Lange TJ, Wilkens H, Seyfarth HJ, Held M, Dumitrescu D, Tsangaris I, Vonk-Noordegraaf A, Ulrich S, Klose H, Claussen M, Eisenmann S, Schmidt KH, Swift AJ, Thompson AAR, Elliot CA, Rosenkranz S, Condliffe R, Kiely DG, Halank M. Phenotyping of idiopathic pulmonary arterial hypertension: a registry analysis. Lancet Respir Med 2022; 10:937-948. [PMID: 35777416 PMCID: PMC9514996 DOI: 10.1016/s2213-2600(22)00097-2] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 03/02/2022] [Accepted: 03/08/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Among patients meeting diagnostic criteria for idiopathic pulmonary arterial hypertension (IPAH), there is an emerging lung phenotype characterised by a low diffusion capacity for carbon monoxide (DLCO) and a smoking history. The present study aimed at a detailed characterisation of these patients. METHODS We analysed data from two European pulmonary hypertension registries, COMPERA (launched in 2007) and ASPIRE (from 2001 onwards), to identify patients diagnosed with IPAH and a lung phenotype defined by a DLCO of less than 45% predicted and a smoking history. We compared patient characteristics, response to therapy, and survival of these patients to patients with classical IPAH (defined by the absence of cardiopulmonary comorbidities and a DLCO of 45% or more predicted) and patients with pulmonary hypertension due to lung disease (group 3 pulmonary hypertension). FINDINGS The analysis included 128 (COMPERA) and 185 (ASPIRE) patients with classical IPAH, 268 (COMPERA) and 139 (ASPIRE) patients with IPAH and a lung phenotype, and 910 (COMPERA) and 375 (ASPIRE) patients with pulmonary hypertension due to lung disease. Most patients with IPAH and a lung phenotype had normal or near normal spirometry, a severe reduction in DLCO, with the majority having no or a mild degree of parenchymal lung involvement on chest computed tomography. Patients with IPAH and a lung phenotype (median age, 72 years [IQR 65-78] in COMPERA and 71 years [65-76] in ASPIRE) and patients with group 3 pulmonary hypertension (median age 71 years [65-77] in COMPERA and 69 years [63-74] in ASPIRE) were older than those with classical IPAH (median age, 45 years [32-60] in COMPERA and 52 years [38-64] in ASPIRE; p<0·0001 for IPAH with a lung phenotype vs classical IPAH in both registries). While 99 (77%) patients in COMPERA and 133 (72%) patients in ASPIRE with classical IPAH were female, there was a lower proportion of female patients in the IPAH and a lung phenotype cohort (95 [35%] COMPERA; 75 [54%] ASPIRE), which was similar to group 3 pulmonary hypertension (336 [37%] COMPERA; 148 [39%] ASPIRE]). Response to pulmonary arterial hypertension therapies at first follow-up was available from COMPERA. Improvements in WHO functional class were observed in 54% of patients with classical IPAH, 26% of patients with IPAH with a lung phenotype, and 22% of patients with group 3 pulmonary hypertension (p<0·0001 for classical IPAH vs IPAH and a lung phenotype, and p=0·194 for IPAH and a lung phenotype vs group 3 pulmonary hypertension); median improvements in 6 min walking distance were 63 m, 25 m, and 23 m for these cohorts respectively (p=0·0015 for classical IPAH vs IPAH and a lung phenotype, and p=0·64 for IPAH and a lung phenotype vs group 3 pulmonary hypertension), and median reductions in N-terminal-pro-brain-natriuretic-peptide were 58%, 27%, and 16% respectively (p=0·0043 for classical IPAH vs IPAH and a lung phenotype, and p=0·14 for IPAH and a lung phenotype vs group 3 pulmonary hypertension). In both registries, survival of patients with IPAH and a lung phenotype (1 year, 89% in COMPERA and 79% in ASPIRE; 5 years, 31% in COMPERA and 21% in ASPIRE) and group 3 pulmonary hypertension (1 year, 78% in COMPERA and 64% in ASPIRE; 5 years, 26% in COMPERA and 18% in ASPIRE) was worse than survival of patients with classical IPAH (1 year, 95% in COMPERA and 98% in ASPIRE; 5 years, 84% in COMPERA and 80% in ASPIRE; p<0·0001 for IPAH with a lung phenotype vs classical IPAH in both registries). INTERPRETATION A cohort of patients meeting diagnostic criteria for IPAH with a distinct, presumably smoking-related form of pulmonary hypertension accompanied by a low DLCO, resemble patients with pulmonary hypertension due to lung disease rather than classical IPAH. These observations have pathogenetic, diagnostic, and therapeutic implications, which require further exploration. FUNDING COMPERA is funded by unrestricted grants from Acceleron, Bayer, GlaxoSmithKline, Janssen, and OMT. The ASPIRE Registry is supported by Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
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Affiliation(s)
- Marius M Hoeper
- Clinic of Respiratory Medicine, Hannover Medical School, member of the German Center of Lung Research (DZL), Germany.
| | - Krit Dwivedi
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital and Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Christine Pausch
- GWT-TUD, Epidemiological Centre, Technical University Dresden, Dresden, Germany
| | - Robert A Lewis
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital and Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Karen M Olsson
- Clinic of Respiratory Medicine, Hannover Medical School, member of the German Center of Lung Research (DZL), Germany
| | - Doerte Huscher
- Institute of Biometry and Clinical Epidemiology, and Berlin Insitute of Health, Charité-Universitätsmedizin, Berlin, Germany
| | - David Pittrow
- GWT-TUD, Epidemiological Centre, Technical University Dresden, Dresden, Germany; Institute for Clinical Pharmacology, Medical Faculty, Technical University Dresden, Dresden, Germany
| | - Ekkehard Grünig
- Center for Pulmonary Hypertension, Thoraxklinik at Heidelberg University Hospital, Translational Lung Research Center Heidelberg, member of the German Center for Lung Research (DZL), Germany
| | | | - Carmine Dario Vizza
- Dipartimento di Scienze Cliniche Internistiche, Anestiologiche e Cardiolohiche, Sapienza, University of Rome, Rome, Italy
| | - Henning Gall
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center, Giessen, Germany
| | - Oliver Distler
- Department of Rheumatology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian Opitz
- Department of Cardiology, DRK Kliniken Berlin Westend, Berlin, Germany
| | - John Simon R Gibbs
- Department of Cardiology, National Heart & Lung Institute, Imperial College London, London, UK
| | - Marion Delcroix
- Clinical Department of Respiratory Diseases, University Hospitals of Leuven and Laboratory of Respiratory Diseases and Thoracic Surgery, Department of Chronic Diseases and Metabolism, Katholieke Universiteit Leuven University of Leuven, Leuven, Belgium
| | - Da-Hee Park
- Clinic of Respiratory Medicine, Hannover Medical School, member of the German Center of Lung Research (DZL), Germany
| | - Hossein Ardeschir Ghofrani
- Department of Internal Medicine, Justus-Liebig-University Giessen, Universities of Giessen and Marburg Lung Center, Giessen, Germany; Department of Medicine, Imperial College London, London, UK
| | - Ralf Ewert
- Clinic of Internal Medicine, Department of Respiratory Medicine, Universitätsmedizin Greifswald, Greifswald, Germany
| | - Harald Kaemmerer
- Deutsches Herzzentrum München, Klinik für angeborene Herzfehler und Kinderkardiologie; TU München, Munich, Germany
| | - Hans-Joachim Kabitz
- Gemeinnützige Krankenhausbetriebsgesellschaft Konstanz, Medizinische Klinik II, Konstanz, Germany
| | - Dirk Skowasch
- Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II, Innere Medizin - Kardiologie/Pneumologie, Bonn, Germany
| | - Juergen Behr
- Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich, member of the German Center for Lung Research (DZL), Germany
| | - Katrin Milger
- Department of Medicine V, University Hospital, LMU Munich, Comprehensive Pneumology Center Munich, member of the German Center for Lung Research (DZL), Germany
| | - Tobias J Lange
- University Medical Center Regensburg, Department of Internal Medicine II, Regensburg, Germany
| | - Heinrike Wilkens
- Klinik für Innere Medizin V, Pneumologie, Universitätsklinikum des Saarlandes, Homburg, Germany
| | - Hans-Jürgen Seyfarth
- Universitätsklinikum Leipzig, Medizinische Klinik und Poliklinik II, Abteilung für Pneumologie, Leipzig, Germany
| | - Matthias Held
- Department of Internal Medicine, Respiratory Medicine and Ventilatory Support, Medical Mission Hospital, Central Clinic Würzburg, Germany
| | - Daniel Dumitrescu
- Clinic for General and Interventional Cardiology and Angiology, Herz- und Diabeteszentrum NRW, Ruhr-Universität Bochum, Bad Oeynhausen, Germany
| | - Iraklis Tsangaris
- Attikon University Hospital, 2nd Critical Care Department, National and Kapodistrian University of Athens, Athens, Greece
| | - Anton Vonk-Noordegraaf
- Amsterdam UMC, Vrije Universiteit Amsterdam, dept of Pulmonary Medicine, Amsterdam Cardiovascular Sciences, Amsterdam, Netherlands
| | - Silvia Ulrich
- Clinic of Pulmonology, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Hans Klose
- Department of Respiratory Medicine, Eppendorf University Hospital, Hamburg, Germany
| | - Martin Claussen
- LungenClinic Grosshansdorf, Fachabteilung Pneumologie, Großhansdorf, Germany
| | - Stephan Eisenmann
- Universitätsklinikum Halle, Klinik für Innere Medizin I, Department of Respiratory Medicine, Halle, Germany
| | - Kai-Helge Schmidt
- Department of Cardiology and Center of Thrombosis and Hemostasis, University Medical Center Mainz, Mainz, Germany
| | - Andrew J Swift
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital and Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Alfred A Roger Thompson
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital and Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Charlie A Elliot
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital and Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Stephan Rosenkranz
- Clinic III for Internal Medicine (Cardiology) and Center for Molecular Medicine, and the Cologne Cardiovascular Research Center, University of Cologne, Germany
| | - Robin Condliffe
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital and Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - David G Kiely
- Sheffield Pulmonary Vascular Disease Unit, Royal Hallamshire Hospital and Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield, Sheffield, UK
| | - Michael Halank
- Universitätsklinikum Carl Gustav Carus der Technischen Universität Dresden, Medizinische Klinik und Poliklinik I, Dresden, Germany
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8
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Lenga P, Grah C, Ruwwe-Glösenkamp C, Saccomanno J, Rückert J, Eggeling S, Gläser S, Kurz S, Eisenmann S, Krüger M, Schmidt B, Schneider P, Andreas S, Hinterthaner M, Pfannschmidt J, Gebhardt A, Stanzel F, Holland A, Kirschbaum A, Becke B, Hübner RH. Endoscopic Lung Volume Reduction with One-Way Valves in Patients with Severe Chronic Obstructive Pulmonary Disease with Hypercapnia. Respiration 2022; 101:823-832. [PMID: 35785772 DOI: 10.1159/000524996] [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: 09/23/2021] [Accepted: 04/19/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Robust clinical evidence on the efficacy and safety of endoscopic lung volume reduction (ELVR) with one-way valves in patients with severe lung emphysema with chronic hypercapnic respiratory failure is lacking. OBJECTIVE The aim of this study was to compare patient characteristics, clinical outcome measures, and incidences of adverse events between patients with severe COPD undergoing ELVR with one-way valves and with either a partial pressure of carbon dioxide (pCO2) of ≤45 mm Hg or with pCO2 >45 mm Hg. METHODS This was a multicentre prospective study of patients with severe lung disease who were evaluated based on lung function, exercise capacity (6-min walk test [6-MWT]), and quality-of-life tests. RESULTS Patients with pCO2 ≤45 mm Hg (n = 157) and pCO2 >45 mm Hg (n = 40) showed similar baseline characteristics. Patients with pCO2 ≤45 mm Hg demonstrated a significant increase in forced expiratory volume in 1 s (p < 0.001), a significant decrease in residual volume (RV) (p < 0.001), and significant improvements in the quality of life and 6-MWT at the 3-month follow-up. Patients with pCO2 >45 mm Hg had significant improvements in RV only (p < 0.05). There was a significant decrease in pCO2 between baseline and follow-up in hypercapnic patients, relative to the decrease in patients with pCO2 ≤45 mm Hg (p = 0.008). Patients who were more hypercapnic at baseline showed a greater reduction in pCO2 after valve placement (r = -0.38, p < 0.001). Pneumothorax was the most common adverse event in both groups. CONCLUSIONS ELVR with one-way valves seems clinically beneficial with a remarkably good safety profile for patients with chronic hypercapnic respiratory failure.
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Affiliation(s)
- Pavlina Lenga
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany,
| | - Christian Grah
- Department of Internal Medicine and Respiratory Medicine, Clinic Havelhöhe Berlin, Berlin, Germany
| | - Christoph Ruwwe-Glösenkamp
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jacopo Saccomanno
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jens Rückert
- Department of Surgery, Competence Center of Thoracic Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Eggeling
- Department of Thoracic Surgery, Vivantes Netzwerk für Gesundheit, Klinikum Neukölln, Berlin, Germany
| | - Sven Gläser
- Department of Pulmonary Medicine and Infectious Diseases, Vivantes-Klinikum Neukölln, Berlin, Germany
| | - Sylke Kurz
- Department of Respiratory Medicine, ELK Berlin Chest Hospital, Berlin, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, University Hospital Halle, Saale, Germany
| | - Marcus Krüger
- Department of Thoracic Surgery, Martha-Maria Clinic, Halle, Germany
| | - Bernd Schmidt
- Department of Respiratory Medicine, DRK Kliniken Berlin Mitte, Berlin, Germany
| | - Paul Schneider
- Department of Respiratory Medicine, DRK Kliniken Berlin Mitte, Berlin, Germany
| | - Stefan Andreas
- Department of Thoracic Surgery, DRK Kliniken Berlin Mitte, Berlin, Germany
| | | | - Joachim Pfannschmidt
- Department of Thoracic Surgery, Heckeshorn Lung Clinic, Helios Klinikum Emil von Behring, Berlin, Germany
| | - Andreas Gebhardt
- Department of Internal Medicine and Respiratory Medicine, Helios Hospital Emil von Behring, Berlin, Germany
| | | | - Angélique Holland
- Department of Medicine, Pulmonary and Critical Care Medicine, University Medical Center Giessen and Marburg, Philipps-University Marburg, Marburg, Germany
| | - Andreas Kirschbaum
- Department of Visceral, Thoracic and Vascular Surgery, Philipp University, Marburg, Germany
| | - Birgit Becke
- Department of Internal Medicine and Respiratory Medicine, Johanniter-Krankenhaus, Treuenbrietzen, Germany
| | - Ralf-Harto Hübner
- Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany
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9
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Dreher M, Grohè C, Hartmann NU, Kanzler S, Kraft K, Sarrazin C, Doll M, Spiesshöfer J, Steiner S, Wöhrle J, Seeger J, Röschmann-Doose K, Thomsen J, Wittig T, Marx N, Eisenmann S. Efficacy and Safety of ELOM-080 as Add-On Therapy in COVID-19 Patients with Acute Respiratory Insufficiency: Exploratory Data from the Prospective Placebo-Controlled COVARI Trial. Adv Ther 2022; 39:3011-3018. [PMID: 35419650 PMCID: PMC9007397 DOI: 10.1007/s12325-022-02135-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/16/2022] [Indexed: 11/24/2022]
Abstract
Introduction Enhancement of mucociliary clearance (MCC) might be a potential target in treating COVID-19. The phytomedicine ELOM-080 is an MCC enhancer that is used to treat inflammatory respiratory diseases. Patients/Methods This randomised, double-blind exploratory study (EudraCT number 2020-003779-17) evaluated 14 days’ add-on therapy with ELOM-080 versus placebo in patients with COVID-19 hospitalised with acute respiratory insufficiency. Results The trial was terminated early after enrolment of 47 patients as a result of poor recruitment. Twelve patients discontinued prematurely, leaving 35 in the per-protocol set (PPS). Treatment with ELOM-080 had no significant effect on overall clinical status versus placebo (p = 0.49). However, compared with the placebo group, patients treated with ELOM-080 had less dyspnoea in the second week of hospitalisation (p = 0.0035), required less supplemental oxygen (p = 0.0229), and were more often without dyspnoea when climbing stairs at home (p < 0.0001). Conclusion These exploratory data suggest the potential for ELOM-080 to improve respiratory status during and after hospitalisation in patients with COVID-19. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02135-z.
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10
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Luiken I, Eisenmann S, Garbe J, Sternby H, Verdonk RC, Dimova A, Ignatavicius P, Ilzarbe L, Koiva P, Penttilä AK, Regnér S, Dober J, Wohlgemuth WA, Brill R, Michl P, Rosendahl J, Damm M. Pleuropulmonary pathologies in the early phase of acute pancreatitis correlate with disease severity. PLoS One 2022; 17:e0263739. [PMID: 35130290 PMCID: PMC8820650 DOI: 10.1371/journal.pone.0263739] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/25/2022] [Indexed: 12/12/2022] Open
Abstract
Background
Respiratory failure worsens the outcome of acute pancreatitis (AP) and underlying factors might be early detectable.
Aims
To evaluate the prevalence and prognostic relevance of early pleuropulmonary pathologies and pre-existing chronic lung diseases (CLD) in AP patients.
Methods
Multicentre retrospective cohort study. Caudal sections of the thorax derived from abdominal contrast enhanced computed tomography (CECT) performed in the early phase of AP were assessed. Independent predictors of severe AP were identified by binary logistic regression analysis. A one-year survival analysis using Kaplan-Meier curves and log rank test was performed.
Results
358 patients were analysed, finding pleuropulmonary pathologies in 81%. CECTs were performed with a median of 2 days (IQR 1–3) after admission. Multivariable analysis identified moderate to severe or bilateral pleural effusions (PEs) (OR = 4.16, 95%CI 2.05–8.45, p<0.001) and pre-existing CLD (OR = 2.93, 95%CI 1.17–7.32, p = 0.022) as independent predictors of severe AP. Log rank test showed a significantly worse one-year survival in patients with bilateral compared to unilateral PEs in a subgroup.
Conclusions
Increasing awareness of the prognostic impact of large and bilateral PEs and pre-existing CLD could facilitate the identification of patients at high risk for severe AP in the early phase and thus improve their prognosis.
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Affiliation(s)
- Ina Luiken
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jakob Garbe
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Hanna Sternby
- Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Robert C. Verdonk
- Department of Gastroenterology, St. Antonius Ziekenhuis, Nieuwegein, The Netherlands
| | - Alexandra Dimova
- Department of Surgery, University Hospital for Emergency Medicine “Pirogov”, Sofia, Bulgaria
| | - Povilas Ignatavicius
- Department of Surgery, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Lucas Ilzarbe
- Department of Gastroenterology, Hospital del Mar, Barcelona, Spain
| | - Peeter Koiva
- Department of Gastroenterology, East Tallinn Central Hospital, Tallinn, Estonia
| | - Anne K. Penttilä
- Department of Surgery, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Sara Regnér
- Department of Surgery, Institution of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Johannes Dober
- Department of Radiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Walter A. Wohlgemuth
- Department of Radiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Richard Brill
- Department of Radiology, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Patrick Michl
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Marko Damm
- Department of Internal Medicine I, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
- * E-mail:
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11
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Schlabitz F, Teich N, Riesner-Wehner A, Böhm S, Greinert R, Eisenmann S, Michl P, Walldorf J. Inflammatory Bowel Disease and COVID-19: How Have Patients Coped So Far? J Clin Gastroenterol 2022; 56:e126-e130. [PMID: 33538442 DOI: 10.1097/mcg.0000000000001504] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Accepted: 01/03/2021] [Indexed: 12/13/2022]
Abstract
OBJECTIVE Knowledge about SARS-CoV2 and coronavirus disease 2019 (COVID-19) is growing fast. Massive changes in the health care system imposed by the COVID-19 pandemic clearly impact the overall quality of medical care. In this survey, we aim to explore experiences and concerns of patients with inflammatory bowel disease (IBD) regarding the current pandemic. METHODS A 40-item web-based questionnaire on disease-related experiences and concerns during the COVID-19 pandemic was made available to patients with IBD from 28 April 2020 to 31 July 2020. RESULTS An increased risk of SARS-CoV2 infection was a concern for 56.7% of the 1199 patients (aged 41.3±12.8, women 77%, Crohn's disease 58.8%, ulcerative colitis 38.5%); 61.7% feared an increased risk of severe disease course of COVID-19. Effective preventive measures in either outpatient practices or hospitals were observed by 84.7% of the patients. Appointments with an IBD specialist were canceled in 38.7%, frequently on the patients' initiative. Telecommunication visits were considered an acceptable alternative to personal visits by 71.0%. Medication was reduced or paused in 6.9% because of the pandemic. A swab (SARS-CoV2-PCR) was done in 13.2% of the patients; only 3 patients (0.25%) were tested positive. CONCLUSION The COVID-19 pandemic is a major concern of patients with IBD. However, the cumulative prevalence in our cohort is low. Patients at risk should be identified and counseled individually. When required because of the local COVID-19 situation, telecommunication visits and liberal prescription policies are advisable to reduce in-person contacts, while ensuring continuous therapy and maintaining communication with patients.
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Affiliation(s)
- Franziska Schlabitz
- Department of Internal Medicine I, Martin Luther University of Halle-Wittenberg, Halle
| | - Niels Teich
- IBD Outpatient Practice, Leipzig and Schkeuditz, Germany
| | - Anica Riesner-Wehner
- Department of Internal Medicine I, Martin Luther University of Halle-Wittenberg, Halle
| | - Sebastian Böhm
- Department of Internal Medicine I, Martin Luther University of Halle-Wittenberg, Halle
| | - Robin Greinert
- Department of Internal Medicine I, Martin Luther University of Halle-Wittenberg, Halle
| | - Stephan Eisenmann
- Department of Internal Medicine I, Martin Luther University of Halle-Wittenberg, Halle
| | - Patrick Michl
- Department of Internal Medicine I, Martin Luther University of Halle-Wittenberg, Halle
| | - Jens Walldorf
- Department of Internal Medicine I, Martin Luther University of Halle-Wittenberg, Halle
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12
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Oezkan F, Eisenmann S, Darwiche K, Gassa A, Carbone DP, Merritt RE, Kneuertz PJ. Linear Endobronchial Ultrasound in the Era of Personalized Lung Cancer Diagnostics-A Technical Review. J Clin Med 2021; 10:jcm10235646. [PMID: 34884348 PMCID: PMC8658311 DOI: 10.3390/jcm10235646] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 11/21/2021] [Accepted: 11/24/2021] [Indexed: 11/16/2022] Open
Abstract
Major advances in molecular profiling for available targeted treatments and immunotherapy for lung cancer have significantly increased the complexity of tissue-based diagnostics. Endobronchial ultrasound-guided transbronchial needle aspirations (EBUS-TBNA) are commonly performed for diagnostic biopsies and lymph node staging. EBUS-TBNA has increasingly become one of the main sources of tumor cells for molecular analyses. As a result, there is a growing need for high quality EBUS-TBNA samples with adequate cellularity. This has increased the technical demands of the procedure and has created additional challenges, many of which are not addressed in the current EBUS guidelines. This review provides an overview of current evidence on the technical aspects of EBUS-TBNA in light of comprehensive sample processing for personalized lung cancer management. These include sonographic lymph node characterization, optimal needle choice, suction biopsy technique, and the role of rapid on-site evaluation. Attention to these technical details will be important to maximize the throughput of EBUS-TBNA biopsies for molecular testing.
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Affiliation(s)
- Filiz Oezkan
- Comprehensive Cancer Center, Division of Medical Oncology, The Ohio State University, Columbus, OH 43210, USA;
- Department of Pulmonary Medicine, Section of Interventional Pneumology, Ruhrlandklinik-University Hospital Essen, University of Duisburg-Essen, 45239 Essen, Germany;
- Fifth Department of Internal Medicine, Faculty of University Heidelberg, University Medicine Mannheim, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
- German Cancer Research Center, A420 Research Group, 69120 Heidelberg, Germany
- Correspondence:
| | - Stephan Eisenmann
- Department of Pneumology, University Hospital of Martin Luther University, 06108 Halle, Germany;
| | - Kaid Darwiche
- Department of Pulmonary Medicine, Section of Interventional Pneumology, Ruhrlandklinik-University Hospital Essen, University of Duisburg-Essen, 45239 Essen, Germany;
| | - Asmae Gassa
- Heart Center, Department of Cardiothoracic Surgery, Faculty of Medicine, University Hospital of Cologne, Kerpener Straße 62, 50937 Cologne, Germany;
| | - David P. Carbone
- Comprehensive Cancer Center, Division of Medical Oncology, The Ohio State University, Columbus, OH 43210, USA;
| | - Robert E. Merritt
- Comprehensive Cancer Center, Division of Thoracic Surgery, Department of Surgery, The Ohio State University, Columbus, OH 43210, USA; (R.E.M.); (P.J.K.)
| | - Peter J. Kneuertz
- Comprehensive Cancer Center, Division of Thoracic Surgery, Department of Surgery, The Ohio State University, Columbus, OH 43210, USA; (R.E.M.); (P.J.K.)
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13
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Schultheiß C, Paschold L, Willscher E, Simnica D, Wöstemeier A, Muscate F, Wass M, Eisenmann S, Dutzmann J, Keyßer G, Gagliani N, Binder M. Maturation trajectories and transcriptional landscape of plasmablasts and autoreactive B cells in COVID-19. iScience 2021; 24:103325. [PMID: 34723157 PMCID: PMC8536484 DOI: 10.1016/j.isci.2021.103325] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Revised: 09/03/2021] [Accepted: 10/19/2021] [Indexed: 12/13/2022] Open
Abstract
In parasite and viral infections, aberrant B cell responses can suppress germinal center reactions thereby blunting long-lived memory and may provoke immunopathology including autoimmunity. Using COVID-19 as model, we set out to identify serological, cellular, and transcriptomic imprints of pathological responses linked to autoreactive B cells at single-cell resolution. We show that excessive plasmablast expansions are prognostically adverse and correlate with autoantibody production but do not hinder the formation of neutralizing antibodies. Although plasmablasts followed interleukin-4 (IL-4) and BAFF-driven developmental trajectories, were polyclonal, and not enriched in autoreactive B cells, we identified two memory populations (CD80+/ISG15+ and CD11c+/SOX5+/T-bet+/−) with immunogenetic and transcriptional signs of autoreactivity that may be the cellular source of autoantibodies in COVID-19 and that may persist beyond recovery. Immunomodulatory interventions discouraging such adverse responses may be useful in selected patients to shift the balance from autoreactivity toward long-term memory. Plasmablast expansions correlate with disease severity and autoantibodies in COVID-19 Patients with high plasmablast levels exhibit IGHV4-34 skewing Autoreactive BCRs are enriched in atypical memory, not plasmablast populations
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Affiliation(s)
- Christoph Schultheiß
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
| | - Lisa Paschold
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
| | - Edith Willscher
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
| | - Donjete Simnica
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
| | - Anna Wöstemeier
- I. Department of Medicine and Department for General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Franziska Muscate
- I. Department of Medicine and Department for General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maxi Wass
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Jochen Dutzmann
- Mid-German Heart Center, Department of Cardiology and Intensive Care Medicine, University Hospital, Martin Luther University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Gernot Keyßer
- Department of Internal Medicine II, Martin-Luther-University Halle-Wittenberg, 06120 Halle (Saale), Germany
| | - Nicola Gagliani
- I. Department of Medicine and Department for General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Hamburg Center for Translational Immunology (HCTI), University Medical Center Hamburg-Eppendorf, Hamburg, Germany.,Immunology and Allergy Unit, Department of Medicine, Solna, Karolinska Institute and University Hospital, Stockholm, Sweden
| | - Mascha Binder
- Department of Internal Medicine IV, Oncology/Hematology, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Straße 40, 06120 Halle (Saale), Germany
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14
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Böhm S, Gittinger FS, Garbe J, Darwiche K, Eisenmann S. Transthorakale Ultraschallpunktion – Schritt für Schritt. Pneumologie 2021; 76:225-230. [PMID: 34704239 DOI: 10.1055/a-1275-3045] [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: 10/20/2022]
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15
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Luiken I, Eisenmann S, Garbe J, Dober J, Wohlgemuth WA, Brill R, Michl P, Rosendahl J, Damm M. Prognostic impact of pleuropulmonary pathologies in the early phase of acute pancreatitis. Imaging 2021. [DOI: 10.1183/13993003.congress-2021.pa358] [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: 11/05/2022] Open
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16
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Eisenmann S, Stangl F, Lambrecht N, Wollschläger B, Böhm S, Brill R, Vogt I, Baust H, Bucher M, Wohlgemuth WA. Interventional Radiology and Pulmonology in Life-Threatening Aneurysm of the Left Pulmonary Artery. Am J Respir Crit Care Med 2021; 203:366-367. [PMID: 33058729 DOI: 10.1164/rccm.202008-3263im] [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: 11/16/2022] Open
Affiliation(s)
| | - Franz Stangl
- Department of Diagnostic and Interventional Radiology, and.,Department of Anaesthesiology, University Hospital Halle, Halle, Germany; and
| | | | | | | | - Richard Brill
- Department of Diagnostic and Interventional Radiology, and
| | | | - Henning Baust
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
| | - Michael Bucher
- Department of Diagnostic and Interventional Radiology, University Hospital Augsburg, Augsburg, Germany
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17
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Garbe J, Eisenmann S, Kantelhardt JW, Duenninghaus F, Michl P, Rosendahl J. Capability of processed EEG parameters to monitor conscious sedation in endoscopy is similar to general anaesthesia. United European Gastroenterol J 2021; 9:354-361. [PMID: 32921270 PMCID: PMC8259428 DOI: 10.1177/2050640620959153] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 08/20/2020] [Indexed: 11/23/2022] Open
Abstract
Background Reliable and safe sedation is a prerequisite for endoscopic interventions. The current standard is rather safe, yet, an objective device to measure sedation depth is missing. To date, anaesthesia monitors based on processed electroencephalogram (EEG) have not been utilised in conscious sedation. Objective To investigate EEG parameters to differentiate consciousness in endoscopic propofol sedation. Methods In total, 171 patients aged 21–83 years (ASA I–III) undergoing gastrointestinal and bronchial endoscopy were enrolled. Standard monitoring and a frontotemporal two‐channel EEG were recorded. The state of consciousness was identified by repeated requests to squeeze the investigator's hand. Results In total, 1132 state‐of‐consciousness (SOC) transitions were recorded in procedures ranging from 5 to 69 min. Thirty‐four EEG parameters from the frequency domain, time‐frequency domain and complexity measures were calculated. Area under the curve ranged from 0.51 to 0.82 with complexity and optimised frequency domain parameters yielding the best results. Conclusion Prediction of the SOC with processed EEG parameters is feasible, and the results for sedation in endoscopic procedures are similar to those reported from general anaesthesia. These results are insufficient for a clinical application, but prediction capability may be increased with optimisation and modelling. Electroencephalogram (EEG)‐based anaesthesia monitors, like the Bispectral Index, have been investigated as an adjunct to monitor propofol sedation in the endoscopy ward. These studies showed very limited benefit. Capability of processed EEG parameters to differentiate the state of consciousness (SOC) in endoscopy is similar to general anaesthesia. However, artefacts arising from the less controlled endoscopy environment as compared to anaesthesia limit their use in sedation monitoring. The Bispectral Index and its underlying parameters are ineffective in the determination of the SOC in sedation during endoscopic procedures.
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Affiliation(s)
- Jakob Garbe
- Department of Internal Medicine I, University Hospital Halle, Halle (Saale), Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, University Hospital Halle, Halle (Saale), Germany
| | - Jan W Kantelhardt
- Institute of Physics, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany
| | - Florian Duenninghaus
- Department of Internal Medicine I, University Hospital Halle, Halle (Saale), Germany
| | - Patrick Michl
- Department of Internal Medicine I, University Hospital Halle, Halle (Saale), Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, University Hospital Halle, Halle (Saale), Germany
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18
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Garbe J, Garbe V, Kantelhardt JW, Michl P, Eisenmann S, Rosendahl J, Krug S. Überwachung der Sedierung in der Endoskopie mit künstlicher Intelligenz. Gastroenterologe 2021; 16:17-24. [DOI: 10.1007/s11377-020-00494-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 11/30/2020] [Indexed: 08/30/2023]
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19
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Gesierich WJ, Darwiche K, Döllinger F, Eberhardt R, Eisenmann S, Grah C, Heußel CP, Huebner RH, Ley-Zaporozhan J, Stanzel F, Welter S, Hoffmann H. Joint Statement of the German Respiratory Society and German Society of Thoracic Surgery in Cooperation with the German Radiological Society: Structural Prerequisites of Centres for Interventional Treatment of Emphysema. Respiration 2021; 100:52-58. [PMID: 33412545 DOI: 10.1159/000511599] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [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: 09/02/2020] [Accepted: 09/04/2020] [Indexed: 11/19/2022] Open
Abstract
Interventional treatment of emphysema offers a wide range of surgical and endoscopic options for patients with advanced disease. Multidisciplinary collaboration of pulmonology, thoracic surgery, and imaging disciplines in patient selection, therapy, and follow-up ensures treatment quality. The present joint statement describes the required structural and quality prerequisites of treatment centres. This is a translation of the German article "Positionspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Gesellschaft für Thoraxchirurgie in Kooperation mit der Deutschen Röntgengesellschaft: Strukturvoraussetzungen von Zentren für die interventionelle Emphysemtherapie" Pneumologie. 2020;74:17-23.
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Affiliation(s)
- Wolfgang Johannes Gesierich
- Department of Pulmonology, Asklepios Fachkliniken Munich-Gauting, Center for Pulmonology and Thoracic Surgery, Munich-Gauting, Germany,
| | - Kaid Darwiche
- Department of Interventional Pulmonology, Ruhrlandklinik - University Medicine Essen, Essen, Germany
| | - Felix Döllinger
- Department of Radiology, Charité - University Medicine Berlin, Berlin, Germany
| | - Ralf Eberhardt
- Department of Pulmonology and Respiratory Medicine, Thoraxklinik, Heidelberg University, Heidelberg, Germany.,Lung Research Center (TLRC), Member of German Center for Lung Research (DZL), Heidelberg, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I/Pulmonology, University Hospital, Halle (Saale), Germany
| | - Christian Grah
- Department of Respiratory Medicine and Lung Cancer Center, Gemeinschaftskrankenhaus Havelhöhe, Berlin, Germany
| | - Claus Peter Heußel
- Lung Research Center (TLRC), Member of German Center for Lung Research (DZL), Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology, Heidelberg University, Heidelberg, Germany.,Department of Diagnostic and Interventional Radiology with Nuclear Medicine, Thoraxklinik, Heidelberg University, Heidelberg, Germany
| | - Ralf-Harto Huebner
- Department of Infectious Diseases and Respiratory Medicine, Charité - University Medicine Berlin, Berlin, Germany
| | | | - Franz Stanzel
- Department of Pulmonology - Thoracic Endoscopy, Lung Clinic, Hemer, Germany
| | - Stefan Welter
- Department of Thoracic Surgery, Lung Clinic, Hemer, Germany
| | - Hans Hoffmann
- Division of Thoracic Surgery, Department of Surgery, University Hospital Rechts der Isar, Technical University of Munich, Munich, Germany
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20
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Faehling M, Schumann C, Christopoulos P, Hoffknecht P, Alt J, Horn M, Eisenmann S, Schlenska-Lange A, Schütt P, Steger F, Brückl WM, Christoph DC. Durvalumab after definitive chemoradiotherapy in locally advanced NSCLC: Data of the German EAP. Data Brief 2020; 34:106556. [PMID: 33364266 PMCID: PMC7750486 DOI: 10.1016/j.dib.2020.106556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 11/13/2020] [Accepted: 11/16/2020] [Indexed: 11/28/2022] Open
Abstract
Following the PACIFIC trial, durvalumab has been approved by the European Medicines Agency (EMA) for consolidation of locally advanced PD-L1-positive NSCLC after chemoradiotherapy (CRT). Patients were treated with durvalumab in the EAP from 22.11.2017 to 15.10.2018 allowing analysis of its efficacy and safety. 211 patients were registered by 90 German centres. Data were collected retrospectively by questionnaire and queries. 56 centres reported data on 126 patients who actually received at least one cycle of durvalumab. In contrast to the PACIFIC-trial population, some patients with oligometastatic disease and a history of autoimmune disease are included in the EAP population. Information on PD-L1 status was obtained for 111 patients. Baseline data include age, gender, ECOG, stage (IASLC 8th ed.), and smoking history. Treatment data include mode of chemoradiotherapy, used chemotherapy agent, and duration of durvalumab therapy. Adverse evants were documented according to CTAEC 5.0. Data were analysed for progression-free survival (PFS), overall survival (OS), and adverse events (AE). The results were published in Lung Cancer [1].
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Affiliation(s)
- Martin Faehling
- Klinik für Kardiologie und Pneumologie, Klinikum Esslingen, 73730 Esslingen, Germany
| | - Christian Schumann
- Klinik für Pneumologie, Thoraxonkologie, Schlaf- und Beatmungsmedizin, Klinikum Kempten, 87439 Kempten, Germany
| | | | - Petra Hoffknecht
- Klinik für Thoraxonkologie und Palliativstation, Franziskus-Hospital Harderberg, 49124 Georgsmarienhütte, Germany
| | - Jürgen Alt
- III. Medizinische Klinik und Poliklinik, Johannes Gutenberg-Universität, 55131 Mainz, Germany
| | - Marlitt Horn
- LungenClinic Grosshansdorf, Großhansdorf, Germany
| | - Stephan Eisenmann
- Universitätsklinik und Poliklinik für Innere Medizin I (Gastroenterologie & Pneumologie), Universitätsklinikum Halle (Saale), 06120 Halle, Germany
| | - Anke Schlenska-Lange
- Klinik für Onkologie und Hämatologie, Krankenhaus Barmherzige Brüder Regensburg, 93049 Regensburg, Germany
| | | | - Felix Steger
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Regensburg, 93053 Regensburg, Germany
| | - Wolfgang M Brückl
- Klinik für Innere Medizin 3, Klinikum Nürnberg Nord, 90419 Nürnberg, Germany
| | - Daniel C Christoph
- Klinik für Internistische Onkologie und Hämatologie mit integrierter Palliativmedizin, Evang. Kliniken Essen-Mitte, 45136 Essen, Germany
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21
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Darwiche K, Ross B, Gesierich W, Petermann C, Huebner RH, Grah C, Gompelmann D, Hetzel J, Holland A, Eisenmann S, Stanzel F, Kempa A, Conrad K, Hagmeyer L, Eberhardt R. [Recommendations for Performing Bronchoscopy in Times of the COVID-19 Pandemic - Update 12/2020]. Pneumologie 2020; 75:187-190. [PMID: 33307556 PMCID: PMC8043672 DOI: 10.1055/a-1320-8250] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Die Pandemie ausgelöst durch SARS-CoV-19 geht weltweit unverändert mit einer bedeutsamen Morbidität und Mortalität einher, sodass Schutzmaßnahmen zur Verhinderung der Transmission des Virus weiterhin notwendig sind. Mitarbeiter im Gesundheitswesen sind einem höheren Risiko ausgesetzt, und dies gilt insbesondere im Rahmen sog. Aerosol-generierender Verfahren wie der Bronchoskopie. Seit der Veröffentlichung konsentierter Empfehlungen zur Durchführung einer Bronchoskopie unter diesen Bedingungen vor mehr als einem halben Jahr hat sich die Gefahrenlage nicht wesentlich verändert, aber aufgrund des erheblichen Erkenntnisgewinns in der Zwischenzeit war ein Update der Empfehlungen notwendig. Die erneuerten Empfehlungen umfassen u. a. die Verminderung der Aerosolentstehung, den persönlichen Schutz der beteiligten Personen sowie Maßnahmen zur besseren Organisation der Abläufe in der Endoskopie, um eine sichere Durchführung auch in Zeiten von COVID-19 zu gewährleisten.
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Affiliation(s)
- K Darwiche
- Klinik für Pneumologie, Sektion Interventionelle Bronchologie, Ruhrlandklinik - Universitätsmedizin Essen
| | - B Ross
- Krankenhaushygiene, Universitätsmedizin Essen
| | - W Gesierich
- Klinik für Pneumologie, Asklepios Fachkliniken München-Gauting
| | - C Petermann
- Klinik für Pneumologie, Asklepios Klinikum Harburg, Hamburg
| | - R-H Huebner
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité - Universitätsmedizin Berlin
| | - C Grah
- Klinik für Innere Medizin, Schwerpunkt Pneumologie und Lungenkrebszentrum (DKG), Gemeinschaftskrankenhaus Havelhöhe, Berlin
| | - D Gompelmann
- Klinische Abteilung für Pulmologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Österreich
| | - J Hetzel
- Klinik für medizinische Onkologie und Pneumologie, Universitätsklinikum Tübingen.,Klinik für Innere Medizin, Abteilung Pneumologie, Kantonsspital Winterthur, Schweiz
| | - A Holland
- Klinik für Innere Medizin SP Pneumologie, Universitätsklinikum Gießen und Marburg
| | - S Eisenmann
- Klinik für Innere Medizin I, Universitätsklinikum Halle (Saale)
| | - F Stanzel
- Pneumologie - Thorakale Endoskopie, Lungenklinik Hemer
| | - A Kempa
- Pneumologie, Medizinische Klinik I, Klinik Löwenstein
| | - K Conrad
- Pneumologie, Lungenklinik Ballenstedt/Harz
| | - L Hagmeyer
- Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien, Solingen
| | - R Eberhardt
- Pneumologie und Beatmungsmedizin, Thoraxklinik am Universitätsklinikum Heidelberg.,Translational Lung Research Center Heidelberg (TLRCH), Deutsches Zentrum für Lungenforschung (DZL)
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22
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Faehling M, Schumann C, Christopoulos P, Hoffknecht P, Alt J, Horn M, Eisenmann S, Schlenska-Lange A, Schütt P, Steger F, Brückl WM, Christoph DC. Durvalumab after definitive chemoradiotherapy in locally advanced unresectable non-small cell lung cancer (NSCLC): Real-world data on survival and safety from the German expanded-access program (EAP). Lung Cancer 2020; 150:114-122. [DOI: 10.1016/j.lungcan.2020.10.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 09/26/2020] [Accepted: 10/09/2020] [Indexed: 02/08/2023]
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23
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Kiefl D, Eisenmann S, Michels G, Schmid M, Ludwig C, Pin M, Glöckner E, Petersen PF, Damjanovic D, Schellhaas S, Janssens U, Fandler M, Blaschke S, Geuting M, Müller T, Menzel J, Heinzmann A, Helm M, Dinse-Lambracht A, Bernhard M, Spethmann S, Stock KF, Clevert DA, Breitkreutz R. [German recommendations on lung and thoracic ultrasonography in patients with COVID-19]. Med Klin Intensivmed Notfmed 2020; 115:654-667. [PMID: 33044655 PMCID: PMC7548535 DOI: 10.1007/s00063-020-00740-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 08/25/2020] [Indexed: 02/07/2023]
Abstract
Lung and chest ultrasound are further examination modalities in addition to computed tomography and laboratory diagnostics in patients with COVID-19. It extends the clinical-physical examination because it can examine lung surface sensitively. Lung surface pattern changes have been found in sonograms of patients with COVID-19 pneumonia and during the course of the disease. German specialist societies of clinical acute, emergency and intensive care medicine as well as imaging, which are concerned with the care of patients with SARS-CoV‑2 infection and COVID-19, have coordinated recommendations for lung and thorax sonography. This document has been created within a transparent process, led by the German Society of Interdisciplinary Emergency and Acute Medicine e. V. (DGINA), and worked out by an expert panel and delegates from the societies. Sources of the first 200 cases were summarized. Typical thorax sonographic findings are presented. International sources or standards that were available in PubMed until May 24, 2020 were included. Using case studies and multimedia content, the document is intended to not only support users but also demonstrate quality features and the potential of chest and lung sonography. The German Society for Ultrasound in Medicine (DEGUM) is carrying out a multicenter study (study coordination at the TU Munich).
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Affiliation(s)
- Daniel Kiefl
- Klinik für Interdisziplinäre Notfallmedizin, Sana Klinikum Offenbach GmbH, Starkenburgring 66, 63069, Offenbach am Main, Deutschland.
| | - Stephan Eisenmann
- Schwerpunkt Pneumologie, Universitätsklinikum Halle (Saale), Halle (Saale), Deutschland
| | - Guido Michels
- Klinik für Akut- und Notfallmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Mathias Schmid
- Klinik für Gastroenterologie, Pneumologie, Internistische Akut- und Intensivmedizin, München Klinik Harlaching, München, Deutschland
| | - Corinna Ludwig
- Klinik für Thoraxchirurgie, Florence-Nightingale-Krankenhaus der Kaiserswerther Diakonie, Düsseldorf, Deutschland
| | - Martin Pin
- Zentrale interdisziplinäre Notaufnahme und Aufnahmebereich, Florence-Nightingale-Krankenhaus der Kaiserswerther Diakonie, Düsseldorf, Deutschland
| | - Erika Glöckner
- Klinik für Gastroenterologie, Endokrinologie und Zentrale Notaufnahme Nord, Klinikum Nürnberg Nord, Paracelsus Medizinische Privatuniversität, Nürnberg, Deutschland
| | | | - Domagoj Damjanovic
- Klinik für Herz- und Gefäßchirurgie, Universitäts-Herzzentrum Freiburg - Bad Krozingen, Freiburg, Deutschland
| | | | - Uwe Janssens
- Klinik für Innere Medizin und Internistische Intensivmedizin, St.-Antonius-Hospital gGmbH, Eschweiler, Deutschland
| | - Martin Fandler
- Interdisziplinäre Notaufnahme, Klinikum Bamberg, Bamberg, Deutschland
| | - Sabine Blaschke
- Interdisziplinäre Notaufnahme, Universitätsmedizin Göttingen, Göttingen, Deutschland
| | - Markus Geuting
- Abteilung Anästhesie, Vulpius Klinik, Bad Rappenau, Deutschland
| | - Thomas Müller
- Medizinische Klinik II, St. Josefs-Hospital Wiesbaden GmbH, Wiesbaden, Deutschland
| | - Joseph Menzel
- DEGUM Kursleiter Innere Medizin, Endosonographie, Medizinische Klinik II, Klinikum Ingolstadt, Ingolstadt, Deutschland
| | | | - Matthias Helm
- Abteilung X (Anästhesie), Bundeswehrkrankenhaus, Ulm, Deutschland
| | - Alexander Dinse-Lambracht
- Interdisziplinäres Notfallzentrum, Trägergesellschaft Kliniken Aurich-Emden-Norden, Aurich-Emden-Norden, Deutschland
| | - Michael Bernhard
- Zentrale Notaufnahme, Universitätsklinikum Düsseldorf, Düsseldorf, Deutschland
| | - Sebastian Spethmann
- Medizinische Klinik A, Kardiologie, Angiologie, Nephrologie, internistische Intensivmedizin, Medizinische Hochschule Brandenburg, Campus Ruppiner Kliniken, Neuruppin, Deutschland
| | - Konrad F Stock
- Nephrologisches Ultraschalllabor, TU München, München, Deutschland
| | - Dirk-André Clevert
- Klinik und Poliklinik für Radiologie, Interdisziplinäres Ultraschallzentrum, Universität München, Klinikum Großhadern, München, Deutschland
| | - Raoul Breitkreutz
- Fachbereich/Institut f. Gesundheit & Soziales (IfGS), FOM Hochschule für Ökonomie & Management, Franklinstr. 52, 60486, Frankfurt am Main, Deutschland.
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24
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Damm M, Garbe J, Eisenmann S, Heidemann C, Krug S, Walter S, Lammert F, Michl P, Rosendahl J. [Challenges of the COVID-19 pandemic in gastrointestinal endoscopy: expectations and implementation of recommendations]. Z Gastroenterol 2020; 58:1074-1080. [PMID: 32937675 PMCID: PMC7724582 DOI: 10.1055/a-1246-3455] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Einleitung
Die COVID-19-Pandemie stellt die Gesundheitssysteme weltweit vor eine große Herausforderung. Aktuelle Daten deuten auf ein erhöhtes Risiko für eine SARS-CoV-2-Infektion für das Endoskopiepersonal hin. Für gastrointestinale Endoskopieeinheiten wurden mehrere Empfehlungen für die aktuelle Situation formuliert, jedoch liegen bislang keine Daten zur momentanen Versorgungsrealität vor.
Material und Methodik
Vom 1. bis 7. April 2020 erfolgte eine deutschlandweite, webbasierte Umfrage unter den Mitgliedern der DGVS. Insgesamt wurden 33 Fragen gestellt, die auf Empfehlungen der ESGE (European Society of Gastrointestinal Endoscopy) basierten. Die Umfrage war an die Leiter von Endoskopieeinheiten gerichtet.
Ergebnisse
Von 551 teilnehmenden Endoskopieeinheiten stornierten 37 % (202) weniger als 40 % ihrer Eingriffe. Kleinere Abteilungen (< 4000 Untersuchungen/Jahr) sagten einen signifikant geringeren Anteil ihrer Untersuchungen ab als größere (> 4000). Eine vollständige räumliche Trennung von Hochrisikopatienten war nur in 17 % der Fälle möglich. Prozedurale Maßnahmen wie strukturierte Risikostratifikation (91 %) oder Verwendung persönlicher Schutzausrüstung (PSA, 85 %) wurden meist umgesetzt. Für die Zukunft wurden Engpässe bei PSA (83 %) und Personal (69 %) sowie relevante finanzielle Verluste (80 %) erwartet.
Schlussfolgerungen
Die Empfehlungen zu den strukturellen Maßnahmen waren nur eingeschränkt umsetzbar, und der Umfang von Stornierungen war heterogen. Eindeutige Definitionen notwendiger Endoskopien in der Pandemiesituation und eine Anpassung struktureller Gegebenheiten sowie eine finanzielle Absicherung erscheinen notwendig.
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Affiliation(s)
- Marko Damm
- Universitätsklinikum Halle, Klinik für Innere Medizin I, Halle, Germany
| | - Jakob Garbe
- Universitätsklinikum Halle, Klinik für Innere Medizin I, Halle, Germany
| | - Stephan Eisenmann
- Universitätsklinikum Halle, Klinik für Innere Medizin I, Halle, Germany
| | - Clara Heidemann
- Universitätsklinikum Halle, Klinik für Innere Medizin I, Halle, Germany
| | - Sebastian Krug
- Universitätsklinikum Halle, Klinik für Innere Medizin I, Halle, Germany
| | - Steffen Walter
- Universitätsklinikum Ulm, Klinik für Psychosomatische Medizin und Psychotherapie, Sektion Medizinische Psychologie, Ulm, Germany
| | - Frank Lammert
- Universitätsklinikum des Saarlandes, Klinik für Innere Medizin II, Homburg, Germany.,Für die Deutsche Gesellschaft für Gastroenterologie, Verdauungs- und Stoffwechselkrankheiten (DGVS)
| | - Patrick Michl
- Universitätsklinikum Halle, Klinik für Innere Medizin I, Halle, Germany
| | - Jonas Rosendahl
- Universitätsklinikum Halle, Klinik für Innere Medizin I, Halle, Germany
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Faehling M, Schumann C, Christopoulos P, Hoffknecht P, Alt J, Horn M, Eisenmann S, Schlenska-Lange A, Aries S, Sackmann S, Schuett P, Steger F, Christoph D. 1244P Durvalumab after definitive radiochemotherapy (RCT) in locally advanced unresectable NSCLC: Real-world data on survival and safety from the German expanded access program (EAP). Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Heidemann CS, Garbe J, Damm M, Walter S, Michl P, Rosendahl J, Darwiche K, Eisenmann S. German bronchoscopy unit readiness for the COVID-19 pandemic: a nationwide survey. ERJ Open Res 2020; 6:00396-2020. [PMID: 32904638 PMCID: PMC7456647 DOI: 10.1183/23120541.00396-2020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 12/28/2022] Open
Abstract
Background The worldwide impact of the coronavirus disease 2019 (COVID-19) pandemic is unprecedented. Among the aerosol generating procedures, bronchoscopy in particular is an indispensable diagnostic and therapeutic tool that comes with a high risk of infection. Therefore, national societies have issued guidance statements. However, the individual ability of bronchoscopy units to follow these recommendations is largely unknown. Methods We conducted a nationwide survey from 1 April 2020 to 7 April 2020 to which 218 German endoscopy units, 105 solely bronchoscopy and 113 interdisciplinary, responded. The survey was distributed electronically via the German Respiratory Society. Results While 17% of units did not cancel any interventions, 16% cancelled >80% of their interventions. 73% were unable to completely separate high-risk patients. Most procedural measures, such as risk stratification in patients (95%), training to handle COVID-19 patients and personal protective equipment (PPE) (91%), risk adapted use of PPE (85%) and self-monitoring for staff (84%) were adopted well. Unit managers expected shortages in PPE (74%), staff shortages (68%) and severe financial losses (63%). Conclusion In the short-term, PPE shortages are perceived to be the most imminent threat to bronchoscopic activity as a whole. In this era of uncertainty, sound evidence to guide bronchoscopy units and an international concerted effort are urgently needed to formulate recommendations on facts and adapted to local conditions as described in this study. Bronchoscopy units were partly prepared for the #COVID19 pandemic. However, sound evidence to guide units and an international concerted effort are urgently needed to formulate recommendations for future pandemics.https://bit.ly/2B8WOPe
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Affiliation(s)
- Clara S Heidemann
- Dept of Internal Medicine I, University Hospital Halle, Halle, Germany.,These authors contributed equally
| | - Jakob Garbe
- Dept of Internal Medicine I, University Hospital Halle, Halle, Germany.,These authors contributed equally
| | - Marko Damm
- Dept of Internal Medicine I, University Hospital Halle, Halle, Germany
| | - Steffen Walter
- Dept of Medical Psychology, Clinic for Psychosomatic Medicine and Psychotherapy, University Hospital Ulm, Germany
| | - Patrick Michl
- Dept of Internal Medicine I, University Hospital Halle, Halle, Germany
| | - Jonas Rosendahl
- Dept of Internal Medicine I, University Hospital Halle, Halle, Germany
| | - Kaid Darwiche
- West German Lung Center, Ruhrlandklinik, University Essen-Duisburg, Essen, Germany.,German Respiratory Society (DGP), Berlin, Germany.,These authors contributed equally
| | - Stephan Eisenmann
- Dept of Internal Medicine I, University Hospital Halle, Halle, Germany.,These authors contributed equally
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27
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Garbe J, Eisenmann S, Walter S, Lammert F, Darwiche K, Rosendahl J. German Endoscopy Unit Preparations for the Coronavirus Disease 2019 Pandemic: A Nationwide Survey. Gastroenterology 2020; 159:778-780.e3. [PMID: 32371115 PMCID: PMC7194040 DOI: 10.1053/j.gastro.2020.04.061] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 04/23/2020] [Accepted: 04/26/2020] [Indexed: 12/14/2022]
Affiliation(s)
- Jakob Garbe
- Department of Internal Medicine I, University Hospital Halle, Saale, Germany
| | - Stephan Eisenmann
- Department of Internal Medicine I, University Hospital Halle, Saale, Germany
| | - Steffen Walter
- Department of Medical Psychology, University Hospital Ulm, Ulm, Germany
| | - Frank Lammert
- Department of Internal Medicine II, Saarland University Hospital, Homburg, Germany,German Society of Gastroenterology, Digestive and Metabolic Diseases, Berlin, Germany
| | - Kaid Darwiche
- West German Lung Center, Ruhrlandklinik, University Essen-Duisburg, Essen, Germany,German Respiratory Society, Berlin, Germany
| | - Jonas Rosendahl
- Department of Internal Medicine I, University Hospital Halle, Saale, Germany.
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28
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Eisenmann S, Winantea J, Karpf-Wissel R, Funke F, Stenzel E, Taube C, Darwiche K. Thoracic Ultrasound for Immediate Exclusion of Pneumothorax after Interventional Bronchoscopy. J Clin Med 2020; 9:jcm9051486. [PMID: 32429057 PMCID: PMC7291137 DOI: 10.3390/jcm9051486] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 05/09/2020] [Accepted: 05/12/2020] [Indexed: 11/16/2022] Open
Abstract
Background. Pneumothorax is a common side effect in interventional pulmonology. The ideal moment for detection with chest X-ray or ultrasound has not yet been defined. Earlier studies demonstrated the utility of performing these tests with a certain delay, which always results in a potentially dangerous gap. Methods. We prospectively enrolled patients with pulmonary interventions at increased risk of pneumothorax. Thoracic ultrasound was performed immediately after the intervention and at the moment of chest X-ray with a delay up to two hours. Results: Overall, we detected four pneumothoraxes in 115 procedures. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy were 75%, 100%, 100%, 99%, 99% for ultrasound and 75%, 90%, 21%, 99% und 89% for chest X-ray respectively. All pneumothoraces requiring chest tube were sufficiently detected by both methods. Conclusion. Thoracic ultrasound when performed immediately can more accurately exclude pneumothorax after interventional bronchoscopy when compared to chest X-ray. Further ultrasound examinations are unnecessary.
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Affiliation(s)
- Stephan Eisenmann
- Department of Pulmonary Medicine, University Hospital of Halle-Wittenberg, 06120 Halle, Germany
- University Hospital of Essen, West German Lung Center, Ruhrlandklinik, 45239 Essen, Germany; (J.W.); (R.K.-W.); (F.F.); (C.T.); (K.D.)
- Correspondence: ; Tel.: +49-345-5573238
| | - Jane Winantea
- University Hospital of Essen, West German Lung Center, Ruhrlandklinik, 45239 Essen, Germany; (J.W.); (R.K.-W.); (F.F.); (C.T.); (K.D.)
| | - Rüdiger Karpf-Wissel
- University Hospital of Essen, West German Lung Center, Ruhrlandklinik, 45239 Essen, Germany; (J.W.); (R.K.-W.); (F.F.); (C.T.); (K.D.)
| | - Faustina Funke
- University Hospital of Essen, West German Lung Center, Ruhrlandklinik, 45239 Essen, Germany; (J.W.); (R.K.-W.); (F.F.); (C.T.); (K.D.)
| | - Elena Stenzel
- Department of Diagnostic and Interventional Radiology, University Hospital of Essen, 45147 Essen, Germany;
| | - Christian Taube
- University Hospital of Essen, West German Lung Center, Ruhrlandklinik, 45239 Essen, Germany; (J.W.); (R.K.-W.); (F.F.); (C.T.); (K.D.)
| | - Kaid Darwiche
- University Hospital of Essen, West German Lung Center, Ruhrlandklinik, 45239 Essen, Germany; (J.W.); (R.K.-W.); (F.F.); (C.T.); (K.D.)
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Darwiche K, Ross B, Gesierich W, Petermann C, Huebner RH, Grah C, Gompelmann D, Hetzel J, Holland A, Eisenmann S, Stanzel F, Kempa A, Conrad K, Eberhardt R. [Recommendations for Performing Bronchoscopy in Times of the COVID-19 Pandemic]. Pneumologie 2020; 74:260-262. [PMID: 32289832 PMCID: PMC7295282 DOI: 10.1055/a-1154-1814] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
COVID-19, caused by coronavirus SARS-CoV-2 is a new and ongoing infectious disease affecting healthcare systems worldwide. Healthcare worker are at high risk for COIVD-19 and many have been infected or even died in countries severely affected by COVID-19 like China or Italy. Bronchoscopy causes cough and aerosol production and has to be considered a significant risk for the staff to get infected. Particular recommendations should guide to prevent spreading COVID-19 and to protect healthcare worker when performing a bronchoscopy.
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Affiliation(s)
- K Darwiche
- Klinik für Pneumologie, Sektion Interventionelle Bronchologie, Ruhrlandklinik - Universitätsmedizin Essen
| | - B Ross
- Krankenhaushygiene, Universitätsmedizin Essen
| | - W Gesierich
- Lungenzentrum am Helios Klinikum München West
| | - C Petermann
- Klinik für Pneumologie, Asklepios Klinikum Harburg, Hamburg
| | - R-H Huebner
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité - Universitätsmedizin Berlin
| | - C Grah
- Abteilung für Pneumologie, Gemeinschaftskrankenhaus Havelhöhe, Berlin
| | - D Gompelmann
- Klinische Abteilung für Pulmologie, Universitätsklinik für Innere Medizin II, Medizinische Universität Wien, Österreich
| | - J Hetzel
- Klinik für medizinische Onkologie und Pneumologie, Universitätsklinikum Tübingen
| | - A Holland
- Klinik für Innere Medizin SP Pneumologie, Universitätsklinikum Gießen und Marburg
| | - S Eisenmann
- Klinik für Innere Medizin I, Universitätsklinikum Halle (Saale)
| | - F Stanzel
- Pneumologie - Thorakale Endoskopie, Lungenklinik Hemer
| | - A Kempa
- Pneumologie, Medizinische Klinik I, Klinik Löwenstein
| | - K Conrad
- Pneumologie, Lungenklinik Ballenstedt/Harz
| | - R Eberhardt
- Pneumologie und Beatmungsmedizin, Thoraxklinik am Universitätsklinikum Heidelberg.,Translational Lung Research Center Heidelberg (TLRCH), Deutsches Zentrum für Lungenforschung (DZL)
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Gesierich W, Darwiche K, Döllinger F, Eberhardt R, Eisenmann S, Grah C, Heußel CP, Hübner RH, Ley-Zaporozhan J, Stanzel F, Welter S, Hoffmann H. Positionspapier der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin und der Deutschen Gesellschaft für Thoraxchirurgie in Kooperation mit der Deutschen Röntgengesellschaft: Strukturvoraussetzungen von Zentren für die interventionelle Emphysemtherapie. Pneumologie 2020; 74:17-23. [DOI: 10.1055/a-1069-2474] [Citation(s) in RCA: 1] [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: 10/25/2022]
Abstract
ZusammenfassungDie interventionelle Emphysemtherapie bietet ein breites Spektrum an chirurgischen und endoskopischen Optionen zur Behandlung von Patienten mit fortgeschrittenem Lungenemphysem. Zur Sicherstellung der Behandlungsqualität ist eine interdisziplinäre Zusammenarbeit von Pneumologie, Thoraxchirurgie und bildgebenden Disziplinen in der Auswahl, Therapie und Nachsorge von Emphysem-Patienten erforderlich. Das vorliegende Positionspapier beschreibt erforderliche Struktur- und Qualitätsvoraussetzungen von Behandlungszentren.
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Affiliation(s)
- W. Gesierich
- Lungenzentrum am Helios Klinikum München West, München
| | - K. Darwiche
- Klinik für Pneumologie, Sektion Interventionelle Bronchologie, Ruhrlandklinik – Universitätsmedizin Essen, Essen
| | - F. Döllinger
- Klinik für Radiologie, Charité − Universitätsmedizin Berlin, Berlin
| | - R. Eberhardt
- Klinik für Pneumologie und Beatmungsmedizin, Thoraxklinik an der Universität Heidelberg, Heidelberg
- Translational Lung Research Center Heidelberg (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Universität Heidelberg, Heidelberg
| | - S. Eisenmann
- Klinik für Innere Medizin I, Universitätsklinikum Halle (Saale), Halle
| | - C. Grah
- Abteilung für Pneumologie, Gemeinschaftskrankenhaus Havelhöhe, Berlin
| | - C.-P. Heußel
- Translational Lung Research Center Heidelberg (TLRC), Deutsches Zentrum für Lungenforschung (DZL), Universität Heidelberg, Heidelberg
- Abteilung für diagnostische und interventionelle Radiologie. Universitätsklinikum Heidelberg, Heidelberg
- Diagnostische und interventionelle Radiologie und Nuklearmedizin, Thoraxklinik an der Universität Heidelberg, Heidelberg
| | - R.-H. Hübner
- Medizinische Klinik mit Schwerpunkt Infektiologie und Pneumologie, Charité − Universitätsmedizin Berlin, Berlin
| | - J. Ley-Zaporozhan
- Klinik und Poliklinik für Radiologie, Klinikum der Ludwig-Maximilians-Universität München, München
| | - F. Stanzel
- Pneumologie − Thorakale Endoskopie, Lungenklinik Hemer, Hemer
| | - S. Welter
- Thoraxchirurgie, Lungenklinik Hemer, Hemer
| | - H. Hoffmann
- Sektion Thoraxchirurgie, Klinikum rechts der Isar der Technischen Universität, München
- Lungenzentrum am Helios Klinikum München West, München
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Darwiche K, Becker J, Winantea J, Karpf-Wissel R, Funke F, Stenzel E, Hautzel H, Hager T, Eisenmann S. Integration of Bronchoscopic Transesophageal Ultrasound Examination of the Left Adrenal Gland into Routine Lung Cancer Staging Workup: A Prospective Trial. Respiration 2019; 99:43-49. [PMID: 31618731 DOI: 10.1159/000503396] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [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: 06/18/2019] [Accepted: 09/16/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Endobronchial ultrasound (EBUS) with transbronchial needle aspiration increases the diagnostic yield of lung cancer staging. The left adrenal gland (LAG) is a common site for lung cancer metastasis. The modality of transesophageal examination with an EBUS bronchoscope (EUS-B) routinely for LAG has not been assessed. OBJECTIVE The aim of this study was to prospectively assess if evaluation and tissue sampling of the LAG could routinely be implemented in an EBUS procedure. METHODS Patients referred for EBUS between March and August 2017 had assessment of the LAG via EUS-B. Fine-needle aspiration (FNA) was performed in cases with a suspicious LAG. The detection rate, procedure time, and learning curve of four experienced EBUS-bronchoscopists was assessed, plus the diagnostic accuracy and complication rate of FNA. RESULTS In total, 313 consecutive patients were included. The overall LAG detection rate was 87.5%. After the initial learning curve, the detection rate for all four bronchoscopists was >93%. The detection rate did not correlate with any patient characteristics. EUS-B-FNA revealed nine LAG metastases, with a sensitivity, specificity, and accuracy of 75%, 100%, and 99%, respectively. The mean EUS-B operation time was 194.4 s, with 594.8 s for FNA. There were no FNA-associated complications. CONCLUSIONS Evaluation of the LAG with EUS-B could routinely be included in an EBUS procedure if necessary. A high detection rate can be achieved after an initial learning period. FNA of the LAG was feasible and safe. EUS-B of the LAG could be integrated into the usual EBUS/EUS-B procedure in lung cancer staging workup.
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Affiliation(s)
- Kaid Darwiche
- Division of Interventional Pneumology, Department of Pulmonary Medicine, Ruhrlandklinik, University Medicine Essen, Essen, Germany,
| | - Jonathan Becker
- Division of Interventional Pneumology, Department of Pulmonary Medicine, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Jane Winantea
- Division of Interventional Pneumology, Department of Pulmonary Medicine, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Ruediger Karpf-Wissel
- Division of Interventional Pneumology, Department of Pulmonary Medicine, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Faustina Funke
- Division of Interventional Pneumology, Department of Pulmonary Medicine, Ruhrlandklinik, University Medicine Essen, Essen, Germany
| | - Elena Stenzel
- Department of Diagnostic and Interventional Radiology and Neuroradiology, University Hospital Essen, Essen, Germany
| | - Hubertus Hautzel
- Department of Nuclear Medicine, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Thomas Hager
- Institute of Pathology, University Hospital Essen, University Duisburg-Essen, Essen, Germany
| | - Stephan Eisenmann
- Division of Interventional Pneumology, Department of Pulmonary Medicine, Ruhrlandklinik, University Medicine Essen, Essen, Germany.,Department of Pneumology, University Hospital of Martin Luther University, Halle (Saale), Germany
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Eisenmann S, Oezkan F, Vogt I, Lambrecht N. EP1.01-43 Immunotherapy and Radiotherapy - A Useful Combination? J Thorac Oncol 2019. [DOI: 10.1016/j.jtho.2019.08.2016] [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: 11/29/2022]
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Schmidt B, Arslan E, Reinicke D, Voss T, Ullius A, Eisenmann S, Fleischhacker M. Abstract 1386: Application of PAXgene® Blood ccfDNA Tubes* as a standardized approach for therapy monitoring in late-stage lung cancer. Cancer Res 2019. [DOI: 10.1158/1538-7445.am2019-1386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Abstract
Introduction In June 2016, the FDA approved the first blood-based genetic test to detect gene mutations of epidermal growth factor receptor (EGFR) in non-small cell lung cancer (NSCLC). With this move, the genetic characterization of cell-free DNA became a routine application for the care of NSCLC patients. Nevertheless, there are many unresolved preanalytical issues. Particularly important is defining the optimal method for blood draw and sample handling before plasma preparation. The aim of this research study is to answer two questions: - Would the PAXgene Blood ccfDNA Tube* (PAXgene Tubes) be a viable alternative to EDTA blood tubes as the current gold standard? - Could a longitudinal analysis of methylated cell-free plasma DNA allow predicting response to NSCLC treatment?
Experimental procedures To date, 45 advanced-stage lung cancer patients were enrolled in this ongoing research study. Blood samples from 17 were used for the first study part to compare the quantity of plasma mPTGER4 and mSHOX2 DNA in both tubes types. At diagnosis, blood from these therapy-naive subjects was drawn into EDTA and PAXgene tubes. The EDTA tubes were processed immediately (within 4 h after blood draw) and spun twice to separate the plasma. The PAXgene tubes were stored for up to 7 days at room temperature (15-25°C) before processing to mimic transport between clinical and laboratory sites. All plasma samples were stored at –80°C before DNA isolation and quantification of the two methylated sequences by real-time PCR. For the longitudinal study, blood was drawn from 28 subjects into PAXgene tubes only in approximately one week intervals, starting before therapy until conventional re-staging. The quantity of mPTGER4 and mSHOX2 plasma DNA was measured as in the comparative research study.
Summary of data The amount of plasma mPTGER4 and mSHOX2 DNA in EDTA and PAXgene tubes was completely congruent for both markers in all 17 samples of the first study part. The analysis of the two methylation markers in the second study part allowed predicting response/non-response to the given therapy in 25/28 subjects (88%), when compared to standard computer tomography-based re-staging. PCR results show that an assessment of therapy success could already be possible within two to three weeks after therapy start.
Conclusions PAXgene tubes stabilize blood cells and thus prevent a dilution of cell-free DNA by genomic DNA from white blood cells. No change in the amount of tumor-derived cell-free DNA was seen. Therefore, PAXgene Blood ccfDNA Tubes* could be a good alternative to EDTA tubes. Therapy monitoring by longitudinal measurements of mPTGER4 and mSHOX2 plasma DNA could be several weeks faster than re-staging by the currently used digital imaging method. *The PAXgene Blood ccfDNA Tube is for Research Use Only in the US.
Citation Format: Bernd Schmidt, Erkan Arslan, Dana Reinicke, Thorsten Voss, Andrea Ullius, Stephan Eisenmann, Michael Fleischhacker. Application of PAXgene® Blood ccfDNA Tubes* as a standardized approach for therapy monitoring in late-stage lung cancer [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2019; 2019 Mar 29-Apr 3; Atlanta, GA. Philadelphia (PA): AACR; Cancer Res 2019;79(13 Suppl):Abstract nr 1386.
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Affiliation(s)
- Bernd Schmidt
- 1Universitätsklinikum Halle/Saale, Med. Klinik I; DRK Kliniken Berlin, Klinik für Innere Medizin, Germany
| | - Erkan Arslan
- 2DRK Kliniken Berlin, Klinik für Innere Medizin – Schwerpunkt Pneumologie, Germany
| | - Dana Reinicke
- 3Universitätsklinikum Halle/Saale, Med. Klinik I, Schwerpunkt Pneumologie, Germany
| | | | | | - Stephan Eisenmann
- 3Universitätsklinikum Halle/Saale, Med. Klinik I, Schwerpunkt Pneumologie, Germany
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Darwiche K, Özkan F, Wolters C, Eisenmann S. [Not Available]. Ultraschall Med 2018; 39:566-567. [PMID: 29972846 DOI: 10.1055/a-0629-5580] [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] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Affiliation(s)
- Kaid Darwiche
- Sektion für Interventionelle Bronchologie, Pneumologische Universitätsklinik, Ruhrlandklinik Essen
| | - Filiz Özkan
- Sektion für Interventionelle Bronchologie, Pneumologische Universitätsklinik, Ruhrlandklinik Essen
- Arthur G. James Cancer Hospital, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Celina Wolters
- Sektion für Interventionelle Bronchologie, Pneumologische Universitätsklinik, Ruhrlandklinik Essen
| | - Stephan Eisenmann
- Abteilung Pneumologie, Klink für Innere Medizin I, Universitätsklinikum Halle, Martin-Luther-Universität, Halle-Wittenberg, Halle
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Schmidt B, Wollschläger B, Reindl I, Lambrecht N, Eisenmann S, Arslan E, Reinicke D, Fleischhacker M. Liquid Biopsy bei Lungenkarzinom-Patienten – Untersuchungen zur Standardisierung der Präanalytik. Pneumologie 2018. [DOI: 10.1055/s-0037-1619212] [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)
- B Schmidt
- Pneumologie, DRK Kliniken Berlin
- Mitte
| | | | - I Reindl
- Pneumologie, Universitätsklinikum Halle (Saale)
| | - N Lambrecht
- Pneumologie, Universitätsklinikum Halle (Saale)
| | - S Eisenmann
- Pneumologie, Universitätsklinikum Halle (Saale)
| | - E Arslan
- Schwerpunkt Pneumologie und Schlafmedizin, Klinik für Innere Medizin, DRK-Kliniken Berlin
- Mitte
| | - D Reinicke
- Pneumologie, Universitätsklinikum Halle (Saale)
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Eisenmann S, Funke F, Darwiche K. Therapieffekte auch bei fehlender direkter Behandlung – Bronchiale Thermoplastie nach modifiziertem Protokoll (MOABIT-Studie). Pneumologie 2018. [DOI: 10.1055/s-0037-1619280] [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 Eisenmann
- Klinik für Innere Medizin I, Universitätsklinik Halle
| | - F Funke
- Ruhrlandklinik Essen, Westdeutsches Lungenzentrum der Universität Essen-Duisburg
| | - K Darwiche
- Ruhrlandklinik Essen, Westdeutsches Lungenzentrum der Universität Essen-Duisburg
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Schmidt U, Zimmermann T, Grabitz R, Haase R, Eisenmann S. EBUS in der Pädiatrie – Ein hilfreiches Zusatztool. Pneumologie 2018. [DOI: 10.1055/s-0037-1619229] [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)
- U Schmidt
- Department für Operative und Konservative Kinder- und Jugendmedizin, Universitätsklinik Halle
| | - T Zimmermann
- Department für Operative und Konservative Kinder- und Jugendmedizin, Universitätsklinik Halle
| | - R Grabitz
- Department für Operative und Konservative Kinder- und Jugendmedizin, Universitätsklinik Halle
| | - R Haase
- Department für Operative und Konservative Kinder- und Jugendmedizin, Universitätsklinik Halle
| | - S Eisenmann
- Klinik für Innere Medizin I, Universitätsklinik Halle
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Schotten L, Darwiche K, Taube C, Aigner C, Welter S, Eisenmann S, Schlegel A, König T, Eberhardt WEE, Hager T, Freitag L, He K, Özkan F. DNA-Methylierungsmarker PTGER4 und SHOX2 erleichtern die Diagnose von Lungenkrebs bei Patienten mit auffälligem CT-Thorax Befund. Pneumologie 2018. [DOI: 10.1055/s-0037-1619258] [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)
- L Schotten
- Abteilung für Interventionelle Pneumologie, Universitätsmedizin-Essen, Ruhrlandklinik, Westdeutsches Lungenzentrum, Universität Duisburg-Essen
| | - K Darwiche
- Abteilung für Interventionelle Pneumologie, Universitätsmedizin-Essen, Ruhrlandklinik, Westdeutsches Lungenzentrum, Universität Duisburg-Essen
| | - C Taube
- Abteilung für Pneumologie, Universitätsmedizin-Essen, Ruhrlandklinik
| | - C Aigner
- Abteilung für Thoraxchirurgie, Universitätsmedizin-Essen, Ruhrlandklinik
| | - S Welter
- Abteilung für Thoraxchirurgie, Zentrum für Pneumologie und Thoraxchirurgie, Lungenklinik Hemer
| | - S Eisenmann
- Pneumologie, Universitätsklinik und Poliklinik für Innere Medizin I, Universitätsklinikum Halle (Saale)
| | | | | | - WEE Eberhardt
- Universitätsklinikum Essen, Westdeutsches Tumorzentrum, Universität Duisburg-Essen, Essen
| | - T Hager
- Institut für Pathologie und Neuropathologie, Universitätsklinikum Essen, Universität Duisburg-Essen
| | - L Freitag
- Abteilung für Interventionelle Pneumologie, Universitätsmedizin-Essen, Ruhrlandklinik, Westdeutsches Lungenzentrum, Universität Duisburg-Essen
| | - K He
- Arthur G. James Thoracic Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - F Özkan
- Abteilung für Interventionelle Pneumologie, Universitätsmedizin-Essen, Ruhrlandklinik, Westdeutsches Lungenzentrum, Universität Duisburg-Essen, Essen; Arthur G. James Thoracic Cancer Center, The Ohio State University, Columbus, Ohio, USA
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Becker J, Darwiche K, Winantea J, Karpf-Wissel R, Funke F, Eisenmann S. Prospektive Machbarkeitsstudie zur regelhaften Integration der linken Nebenniere bei Durchführung eines EBUS zur Abklärung von Lungentumoren. Pneumologie 2018. [DOI: 10.1055/s-0037-1619281] [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)
- J Becker
- Ruhrlandklinik Essen, Westdeutsches Lungenzentrum der Universität Essen-Duisburg
| | - K Darwiche
- Ruhrlandklinik Essen, Westdeutsches Lungenzentrum der Universität Essen-Duisburg
| | - J Winantea
- Ruhrlandklinik Essen, Westdeutsches Lungenzentrum der Universität Essen-Duisburg
| | - R Karpf-Wissel
- Ruhrlandklinik Essen, Westdeutsches Lungenzentrum der Universität Essen-Duisburg
| | - F Funke
- Ruhrlandklinik Essen, Westdeutsches Lungenzentrum der Universität Essen-Duisburg
| | - S Eisenmann
- Klinik für Innere Medizin I, Universitätsklinik Halle
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Darwiche K, Özkan F, Wolters C, Eisenmann S. Endobronchial Ultrasound (EBUS) - Update 2017. Ultraschall Med 2018; 39:14-38. [PMID: 29415301 DOI: 10.1055/s-0043-125092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Endobronchial ultrasound (EBUS) has revolutionized the diagnosis of lung cancer over the last decade. This minimally invasive diagnostic method has also become increasingly important in the case of other diseases such as sarcoidosis, thereby helping to avoid unnecessary diagnostic interventions. This review article provides an update regarding EBUS and discusses current and future developments of this method.
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Schotten L, Darwiche K, Taube C, Aigner C, Welter S, Eisenmann S, Schlegel A, Koenig T, Hager T, Freitag L, He K, Oezkan F. P3.13-033 DNA Methylation of PTGER4 and SHOX2 in Liquid Biopsies Facilitates the Diagnosis of Lung Malignancy After Chest CT-Scan. J Thorac Oncol 2017. [DOI: 10.1016/j.jtho.2017.09.1768] [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: 11/25/2022]
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Al-Towayti HZ, Oster N, Preziosi A, Bukowski I, Eisenmann S, Albert M, Schäfer P. Ein Jahr Untersuchungen nach §62 Asylverfahrensgesetz durch das Gesundheitsamt Mannheim: Ergebnisse des Tuberkulosescreenings bei 13.327 erwachsenen Flüchtlingen. Gesundheitswesen 2017. [DOI: 10.1055/s-0037-1601950] [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: 10/19/2022]
Affiliation(s)
| | - N Oster
- Stadt Mannheim, Fachbereich Gesundheit, Mannheim
| | - A Preziosi
- Stadt Mannheim, Fachbereich Gesundheit, Mannheim
| | - I Bukowski
- Stadt Mannheim, Fachbereich Gesundheit, Mannheim
| | - S Eisenmann
- Stadt Mannheim, Fachbereich Gesundheit, Mannheim
| | - M Albert
- Stadt Mannheim, Fachbereich Gesundheit, Mannheim
| | - P Schäfer
- Stadt Mannheim, Fachbereich Gesundheit, Mannheim
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Eisenmann S, Schütte W, Funke F, Özkan F, Busch C, Darwiche K. Bronchiale Thermoplastie bei symptomatischem Asthma unter Einbeziehung des Mittellappenbronchus ist sicher und verbessert signifikant Lungenfunktion und Lebensqualität. Pneumologie 2017. [DOI: 10.1055/s-0037-1598425] [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 Eisenmann
- Ruhrlandklinik – Westdeutsches Lungenzentrum
| | - W Schütte
- Martha-Maria Krankenhaus Halle-Dölau
| | - F Funke
- Ruhrlandklinik – Westdeutsches Lungenzentrum
| | - F Özkan
- Ruhrlandklinik – Westdeutsches Lungenzentrum
| | - C Busch
- Martha-Maria Krankenhaus Halle-Dölau
| | - K Darwiche
- Ruhrlandklinik – Westdeutsches Lungenzentrum
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Funke F, Eisenmann S, Winantea J, Karpf-Wissel R, Freitag L, Darwiche K. Biodegradierbare Stents: Senkung der Interventionsfrequenz in der Behandlung narbiger Stenosen der zentralen Atemwege. Pneumologie 2017. [DOI: 10.1055/s-0037-1598345] [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)
- F Funke
- Abteilung Interventionelle Pneumologie, Ruhrlandklinik, Westdeutsches Lungenzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen
| | - S Eisenmann
- Abteilung Interventionelle Pneumologie, Ruhrlandklinik, Westdeutsches Lungenzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen
| | - J Winantea
- Abteilung Interventionelle Pneumologie, Ruhrlandklinik, Westdeutsches Lungenzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen
| | - R Karpf-Wissel
- Abteilung Interventionelle Pneumologie, Ruhrlandklinik, Westdeutsches Lungenzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen
| | - L Freitag
- Pneumologie, Universitätsspital Zürich
| | - K Darwiche
- Abteilung Interventionelle Pneumologie, Ruhrlandklinik, Westdeutsches Lungenzentrum, Universitätsklinikum Essen, Universität Duisburg-Essen
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Pieper L, Winantea J, Karpf-Wissel R, Darwiche K, Eisenmann S. Spigot – Ein effektives Verfahren bei peripherer pulmonaler Blutung. Pneumologie 2017. [DOI: 10.1055/s-0037-1598346] [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)
- L Pieper
- Ruhrlandklinik, Westdeutsches Lungenzentrum
| | - J Winantea
- Ruhrlandklinik, Westdeutsches Lungenzentrum
| | | | - K Darwiche
- Ruhrlandklinik, Westdeutsches Lungenzentrum
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Darwiche K, Karpf-Wissel R, Eisenmann S, Aigner C, Welter S, Zarogoulidis P, Hohenforst-Schmidt W, Freitag L, Oezkan F. Bronchoscopic Lung Volume Reduction with Endobronchial Valves in Low-FEV1 Patients. Respiration 2016; 92:414-419. [PMID: 27838695 DOI: 10.1159/000452629] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Accepted: 10/13/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Bronchoscopic lung volume reduction (BLVR) with valves has been shown to improve lung function, exercise capacity, and quality of life in patients with emphysema, but only few patients with forced expiratory volume in 1 s (FEV1) ≤20% predicted have been included in former studies. Although the procedure can be performed safely, pneumothorax is a frequent complication, which can be critical for these very severely diseased patients. OBJECTIVES The aim of the study was to assess the safety of BLVR in patients with a very advanced stage of emphysema, as indicated by FEV1 ≤20% predicted. PATIENTS AND METHODS Patients in whom BLVR was performed between January 2013 and August 2015 were included in this analysis if their baseline predicted FEV1 was ≤20%. BLVR, performed only if collateral ventilation was absent, achieved complete occlusion of the target lobe. All patients were closely monitored and were not discharged before the fourth day after BLVR. RESULTS Twenty patients with FEV1 ≤20% predicted were included in the analysis. Lung volume reduction was achieved in 65% of the cases. Pneumothorax occurred in 4 cases (20%). No patient died. Lung function and exercise tolerance improved after 1 and 3 months, respectively. CONCLUSIONS BLVR with valves can be safely performed in patients with FEV1 ≤20% predicted when close postprocedural monitoring is provided. Improvement in lung function and exercise capacity can be achieved.
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Affiliation(s)
- Kaid Darwiche
- Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Funke F, Eisenmann S, Karpf-Wissel R, Darwiche K. Biodegradierbare Stents: Eine Therapieoption für narbige Stenosen der zentralen Atemwege. Pneumologie 2016. [DOI: 10.1055/s-0036-1572194] [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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Eisenmann S, Busch C, Schädlich S, Schütte W. Bronchiale Thermoplastie – Eigene Erfahrungen der Methodik, Patientenselektion und erste Ergebnisse. Pneumologie 2015. [DOI: 10.1055/s-0034-1396572] [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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Zigler A, Palchan T, Bruner N, Schleifer E, Eisenmann S, Botton M, Henis Z, Pikuz SA, Faenov AY, Gordon D, Sprangle P. 5.5-7.5 MeV proton generation by a moderate-intensity ultrashort-pulse laser interaction with H2O nanowire targets. Phys Rev Lett 2011; 106:134801. [PMID: 21517389 DOI: 10.1103/physrevlett.106.134801] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2010] [Indexed: 05/30/2023]
Abstract
We report on the first generation of 5.5-7.5 MeV protons by a moderate-intensity short-pulse laser (∼5×10(17) W/cm(2), 40 fsec) interacting with frozen H(2)O nanometer-size structure droplets (snow nanowires) deposited on a sapphire substrate. In this setup, the laser intensity is locally enhanced by the snow nanowire, leading to high spatial gradients. Accordingly, the nanoplasma is subject to enhanced ponderomotive potential, and confined charge separation is obtained. Electrostatic fields of extremely high intensities are produced over the short scale length, and protons are accelerated to MeV-level energies.
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Affiliation(s)
- A Zigler
- Racah Institute of Physics, Hebrew University, Jerusalem 91904, Israel
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