Pneumologie最新文献

Objective: To show the importance of hypoglossal nerve stimulation (HGNS) as a treatment method for obstructive sleep apnea (OSA) in the German healthcare context and to better assess the way patients who do not receive adequate care could benefit from HGNS.

Methods: A systematic literature review in the Medline and Cochrane Library literature database was conducted, including publications using different stimulation technologies for HGNS. The efficacy of HGNS was assessed based on patient-relevant outcomes (daytime sleepiness, quality of life), treatment adherence and the apnea-hypopnea index (AHI) and oxygen desaturation index (ODI). The safety of the treatment method was assessed based on adverse events (AEs).

Results: Inclusion and analysis of 33 publications: 2 randomized controlled trials (RCTs, level Ib), 1 level IIb trial (n = 1) and 30 level IV trials with a study duration of up to 60 months. The RCTs showed better values for daytime sleepiness and quality of life when using HGNS than in the control group. AHI and ODI showed a deterioration under placebo stimulation or therapy withdrawal in the RCTs. Consistently high adherence was also reported in the long-term course. Severe AEs under HGNS were rare and could usually be resolved by repositioning electrodes or replacing device components. Other AEs were mostly transient or could be resolved by non-invasive measures. All investigated parameters showed similar results in the evaluated studies. The results of different stimulation systems are comparable in type and extent.

Conclusion: The comprehensive review of the literature shows consistent data that highlight the importance of HGNS as an effective and safe treatment for OSA after unsuccessful CPAP treatment. The evaluation also shows that the different stimulation systems make it possible to better tailor the therapy to the patient's individual requirements. A future systematic evaluation of real-world data on the use of HGNS would help gain additional insights into the relevance of the method in routine clinical practice.

Although OSA is rarely mentioned as a clinically relevant differential diagnosis of hemoptysis in the literature, we report on a patient with chronic hemoptysis, which was caused by repetitive intrathoracic negative pressures due to severe upper airway obstruction.A 56-year-old overweight patient (BMI 32 kg/m²), with a long history of smoking (40 PY) and who complained of pronounced daytime sleepiness, was referred 2 years ago in March and last year in the summer to our emergency room because of long lasting mild hemoptysis.Sedation during bronchoscopies induced hypopharyngeal collapse accompanied by severe obstructive apneas and massive inspiratory negative pressure. Simultaneously, multiple petechial and larger flat mucosal bleeding as fresh blood coverings occurred on the bronchial mucosa. At the first presentation, the patient wished no further diagnosis. During the second presentation, polysomnography including transcutaneous CO₂ measurement showed a severe OSA in combination with hypoventilation (AHI of 76/h, desaturation index: 128/h; medium PCO₂ value of 56 mmHg). OSA was treated effectively with oronasal positive pressure.With this case report we underline the generally underestimated implication of strong intrathoracic negative pressures in severe OSA as a clinically relevant differential diagnosis of hemoptysis.

Background: High-frequency jet ventilation (HFJV) is used in pneumological endoscopy for rigid, diagnostic, and therapeutic bronchoscopies. It is unclear to what extent the unobstructed flow of respiratory gas from the patient's lungs causes microbial contamination of the surrounding air.

Material and methods: After the start of the HFJV (15 min) in 16 rigid bronchoscopies, airborne pathogen measurements were taken directly at the distal endoscope outlet, at examiner height (40 cm above the endoscope outlet), at a 2 m distance from the endoscope in the room and at the supply air outlet of the examination room using an RCS air sampler. The number and type of pathogens isolated in the air samples were then determined, as well as germs in the bronchoalveolar lavage fluid (BALF) from the patient's lungs.

Results: An increased bacterial density (136 and 114 CFU/m³) was detected directly at the distal end of the endoscope and at examiner height at a distance of 40 cm, which decreased significantly with increasing distance from the bronchoscope (98 CFU/m³ at a distance of 2 m and 82 CFU/m³ at the supply air outlet). The most frequently detected bacteria were Staphylococcus spp., Micrococcus spp. and Bacillus spp. In the BALF, pathogens could only be cultivated in four of 16 samples, but the same pathogens were detected in the BALF and the ambient air.

Conclusion: When performing a rigid bronchoscopy, in which patients are mechanically ventilated in a controlled manner using an open HFJV system, there is an increased pathogen load in the ambient air and therefore a potential risk for the examiner.

Parasitic infections by Echinococcus granulosus are rare in Germany, and predominantly affect individuals with a migration background. Liver and lungs are the most commonly affected organs. Pulmonary cysts often remain asymptomatic until rupture, at which point symptoms may manifest. The diagnostic approach typically involves a combination of imaging modalities and serological tests, occasionally supplemented by molecular genetic methods. Given the global movements of migration, considerations of the epidemiology of common diseases in the country of origin should also be taken into account in the differential diagnosis. We present the unusual case of a pneumogenic sepsis in a young man from Syria, where the combination of medical history alongside radiological, serological, and molecular genetic investigations ultimately led to the diagnosis of a severe pulmonary echinococcosis with rupture.

The number of adults with congenital heart defects (CHD) is steadily rising and amounts to approximately 360,000 in Germany. CHD is often associated with pulmonary hypertension (PH), which may develop early in untreated CHD. Despite timely treatment of CHD, PH not infrequently persists or recurs in older age and is associated with significant morbidity and mortality.The revised European Society of Cardiology/European Respiratory Society 2022 guidelines for the diagnosis and treatment of PH represent a significant contribution to the optimized care of those affected. However, the topic of "adults with congenital heart disease" is addressed only relatively superficial in these guidelines. Therefore, in the present article, this topic is commented in detail from the perspective of congenital cardiology.

E-cigarettes are used in clinical trials to facilitate smoking cessation. Due to the health risks associated with the use of e-cigarettes, the results of clinical trials should be fully reported, including continued exclusive use and dual use of tobacco and e-cigarettes. Nicotine cessation outcomes should be reported as the primary endpoint as well as the analysis of tobacco cessation alone. As there is currently no robust evidence that reducing cigarette consumption provides substantial health benefits, cigarette consumption reduction should not be used as a health outcome in clinical trials. Continued nicotine dependence should be included as an "adverse event" in the reporting of trial results.

Ungewöhnliche klinische Fälle wecken bei praktizierenden Ärzten immer wieder Interesse und ermöglichen es ihnen, ihre Wissensbasis zu erweitern und ihre Fähigkeiten zum klinischen Denken zu verbessern. Der Zweck dieser Studie besteht darin, einen klinischen Fall von Stimmresonanz beim Singen bei einem schwindsüchtigen Teenager aus dem Roman "Der Landarzt" von Honoré de Balzac unter Verwendung induktiver und deduktiver Methoden des klinischen Denkens zu analysieren. Stimmresonanzen beim Singen in Schwindsucht können als pathognomonisches Zeichen für eine kavernöse Tuberkulose gewertet werden, da nur mit dem Bronchus verbundene Hohlräume als Helmholtz-Resonator wirken. Trotz der Einzigartigkeit ist das Gehäuse durchaus realistisch, da es nicht im Widerspruch zu den Gesetzen der Akustik steht. Praktizierende Ärzte verfügen über die Kenntnisse der medizinischen Physik, Morphologie und Physiologie, die zum Verständnis der Pathogenese der klinischen Manifestation einer Lungenhöhle erforderlich sind. Dieser Fall zeigt deutlich die Vor- und Nachteile klinischer Denkmethoden, die in der Praxis eingesetzt werden. Dank der Kombination aus Originalität und Realismus kann der Fall von Stimmresonanz aus Balzacs Roman "Der Landarzt" seinen rechtmäßigen Platz in der persönlichen Sammlung klinischer Fälle eines jeden Lungenarztes einnehmen.