{"title":"7 Fragen an den Träger des «Promotionspreises der Deutschen Gesellschaft für Thoraxchirurgie (DGT)» 2022","authors":"D. Strohleit","doi":"10.1159/000530534","DOIUrl":"https://doi.org/10.1159/000530534","url":null,"abstract":"","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"26 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"129876754","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
information@karger.com www.karger.com des Statistischen Bundesamtes (Stand 2020) [2] stünden bösartige Erkrankungen der Bronchien und Lunge an dritter Stelle, noch vor dem Myokardinfarkt und der Herzinsuffizienz, erläuterte Gütz. Ein Problem sei, dass die meisten Patient*innen mit NSCLC im fortgeschrittenen Stadium diag nostiziert werden. Oft führten erst die Metastasen zur Diagnose und nicht die frühen, meist noch unspezifischen Symptome des Primärtumors, ergänzte PD Dr. med. Florian Fuchs, Universitätsklinikum Erlangen.
{"title":"NSCLC: Cemiplimab plus platinbasierte Chemotherapie","authors":"","doi":"10.1159/000531227","DOIUrl":"https://doi.org/10.1159/000531227","url":null,"abstract":"information@karger.com www.karger.com des Statistischen Bundesamtes (Stand 2020) [2] stünden bösartige Erkrankungen der Bronchien und Lunge an dritter Stelle, noch vor dem Myokardinfarkt und der Herzinsuffizienz, erläuterte Gütz. Ein Problem sei, dass die meisten Patient*innen mit NSCLC im fortgeschrittenen Stadium diag nostiziert werden. Oft führten erst die Metastasen zur Diagnose und nicht die frühen, meist noch unspezifischen Symptome des Primärtumors, ergänzte PD Dr. med. Florian Fuchs, Universitätsklinikum Erlangen.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"31 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"122361118","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2023-06-05DOI: 10.1093/oso/9780197503133.001.0001
E. Perakslis, M. Stanley, Erin Brodwin
Digital health has been touted as a true transformation of health care, but all medical interventions have associated risks that must be understood and quantified. The Internet has brought many advancements, which quickly jumped from our computers into our pockets via powerful and completely connected mobile devices that are now being envisioned as devices for medical diagnostics and care delivery. As health care struggles with cost, inequity, value, and rapid virtualization, solid models of benefit-risk determination, new regulatory approaches for biomedical products, and clear risk-based conversations with all stakeholders are essential. Detailed examination of emerging digital health technologies has revealed 10 categories of digital side effects or “toxicities” that must be understood, prevented when possible, and managed when not. These toxicities include cyberthreat, loss of privacy, cyberchondria and cyber addiction, threats to physical security, charlatanism, overdiagnosis and overtreatment, medical/user error, and the plague of medical misinformation. For digital health to realize its promise, these toxicities must be understood, measured, warned against, and managed as concurrent side effects, in the same fashion as any other medical side effect.
{"title":"Digital Health","authors":"E. Perakslis, M. Stanley, Erin Brodwin","doi":"10.1093/oso/9780197503133.001.0001","DOIUrl":"https://doi.org/10.1093/oso/9780197503133.001.0001","url":null,"abstract":"Digital health has been touted as a true transformation of health care, but all medical interventions have associated risks that must be understood and quantified. The Internet has brought many advancements, which quickly jumped from our computers into our pockets via powerful and completely connected mobile devices that are now being envisioned as devices for medical diagnostics and care delivery. As health care struggles with cost, inequity, value, and rapid virtualization, solid models of benefit-risk determination, new regulatory approaches for biomedical products, and clear risk-based conversations with all stakeholders are essential. Detailed examination of emerging digital health technologies has revealed 10 categories of digital side effects or “toxicities” that must be understood, prevented when possible, and managed when not. These toxicities include cyberthreat, loss of privacy, cyberchondria and cyber addiction, threats to physical security, charlatanism, overdiagnosis and overtreatment, medical/user error, and the plague of medical misinformation. For digital health to realize its promise, these toxicities must be understood, measured, warned against, and managed as concurrent side effects, in the same fashion as any other medical side effect.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114073470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
der Onkologie und der Rheumatologie, an der Kooperation beteiligt. «Die Interdisziplinarität ist eine große Stärke des neuen Lungenzentrums. Sie gewährleistet eine optimale Diag-nostik und Therapie der Lungenerkrankungen unserer Patientinnen und Patienten», betont Kreuter.
{"title":"Spektrum Pneumologie – wissenswert, kompakt, anregend","authors":"","doi":"10.1159/000530886","DOIUrl":"https://doi.org/10.1159/000530886","url":null,"abstract":"der Onkologie und der Rheumatologie, an der Kooperation beteiligt. «Die Interdisziplinarität ist eine große Stärke des neuen Lungenzentrums. Sie gewährleistet eine optimale Diag-nostik und Therapie der Lungenerkrankungen unserer Patientinnen und Patienten», betont Kreuter.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"14 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116538143","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Die Therapielandschaft beim Lungenkarzinom ist in den letzten Jahren deut lich umfassender, individueller und damit auch komplexer geworden. Das ist das Ergebnis einer Reihe neuer Erkenntnisse zu Diagnostik und Therapiemög lichkeiten. In der Folge sollen die aktualisierten Leitlinien es den Therapeut*in nen erleichtern, fundierte Entscheidungen zu treffen: Die Einführung der Krebsimmuntherapie beim primär operablen nichtkleinzelligen Lungenkar zinom (NSCLC) sowie beim fortgeschrittenen kleinzelligen Lungenkarzinom (ESSCLC), eine umfassendere und frühzeitige BiomarkerTestung beim NSCLC – die kürzlich aktualisierten S3 [1] und OnkopediaLeitlinien [2, 3] hal ten einige praxisrelevante Neuerungen bereit. So empfehlen die Leitlinien nun beim primär operablen NSCLC die adjuvante Krebsimmuntherapie (KIT) mit dem PDL1Inhibitor Tecentriq. Diese Neue rung ist gleichzeitig mit einer Empfehlung zur frühzeitigen Bestimmung des PDL1Status mittels Immunhistochemie verbunden: Die adjuvante Krebs immuntherapie mit Tecentriq soll allen Patient*innen vom Stadium II bis IIIA mit einer PDL1Expression von ≥ 50% auf Tumorzellen (ohne EGFR oder ALKAlteration) nach vollständiger Resektion und durchgeführter postopera tiver Chemotherapie angeboten werden [1, 2].
{"title":"PharmaNews","authors":"W. Schütte","doi":"10.1159/000531223","DOIUrl":"https://doi.org/10.1159/000531223","url":null,"abstract":"Die Therapielandschaft beim Lungenkarzinom ist in den letzten Jahren deut lich umfassender, individueller und damit auch komplexer geworden. Das ist das Ergebnis einer Reihe neuer Erkenntnisse zu Diagnostik und Therapiemög lichkeiten. In der Folge sollen die aktualisierten Leitlinien es den Therapeut*in nen erleichtern, fundierte Entscheidungen zu treffen: Die Einführung der Krebsimmuntherapie beim primär operablen nichtkleinzelligen Lungenkar zinom (NSCLC) sowie beim fortgeschrittenen kleinzelligen Lungenkarzinom (ESSCLC), eine umfassendere und frühzeitige BiomarkerTestung beim NSCLC – die kürzlich aktualisierten S3 [1] und OnkopediaLeitlinien [2, 3] hal ten einige praxisrelevante Neuerungen bereit. So empfehlen die Leitlinien nun beim primär operablen NSCLC die adjuvante Krebsimmuntherapie (KIT) mit dem PDL1Inhibitor Tecentriq. Diese Neue rung ist gleichzeitig mit einer Empfehlung zur frühzeitigen Bestimmung des PDL1Status mittels Immunhistochemie verbunden: Die adjuvante Krebs immuntherapie mit Tecentriq soll allen Patient*innen vom Stadium II bis IIIA mit einer PDL1Expression von ≥ 50% auf Tumorzellen (ohne EGFR oder ALKAlteration) nach vollständiger Resektion und durchgeführter postopera tiver Chemotherapie angeboten werden [1, 2].","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"53 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-06-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115984127","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Interstitial lung disease (ILD) is a significant complication associated with microscopic polyangiitis (MPA) that has a poor prognosis. However, the longterm clinical course, outcomes, and prognostic factors of MPA-ILD are not well defined. Hence, this study aimed to investigate the long-term clinical course, outcomes, and prognostic factors in patients with MPA-ILD. Methods: Clinical data of 39 patients with MPA-ILD (biopsy proven cases, n = 6) were retrospectively analyzed. High resolution computed tomography (HRCT) patterns were assessed based on the 2018 idiopathic pulmonary fibrosis diagnostic criteria. Acute exacerbation (AE) was defined as the worsening of dyspnea within 30 days, with new bilateral lung infiltration that is not fully explained by heart failure or fluid overload and that does not have identified extra-parenchymal causes (pneumothorax, pleural effusion, or pulmonary embolism). Results: The median follow-up period was 72.0 months (interquartile range: 44–117 months). The mean age of the patients was 62.7 years and 59.0% were male. Usual interstitial pneumonia (UIP) and probable usual interstitial pneumonia patterns on high resolution computed tomography were identified in 61.5 and 17.9% of the patients, respectively. During the follow-up, 51.3% of patients died, and the 5- and 10-year overall survival rates were 73.5% and 42.0%, respectively. Acute exacerbation occurred in 17.9% of the patients. The non-survivors had higher neutrophil counts in bronchoalveolar lavage (BAL) fluid and more frequent acute exacerbation than the survivors. In the multivariable Cox analysis, older age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.01–1.14; p = 0.028) and higher BAL counts (HR, 1.09; 95% CI, 1.01–1.17; p = 0.015) were found to be the independent prognostic factors associated with mortality in patients with MPA-ILD. Conclusion: During the 6 years-follow-up, about half of patients with MPA-ILD died and approximately one-fifth experienced acute exacerbation. Our results suggest that older age and higher BAL neutrophil counts mean poor prognosis in patients with MPA-ILD.
{"title":"MPA-ILD: Eine seltene Manifestation mit schwieriger Diagnose","authors":"F. Drakopanagiotakis, A. Günther","doi":"10.1159/000530755","DOIUrl":"https://doi.org/10.1159/000530755","url":null,"abstract":"Background: Interstitial lung disease (ILD) is a significant complication associated with microscopic polyangiitis (MPA) that has a poor prognosis. However, the longterm clinical course, outcomes, and prognostic factors of MPA-ILD are not well defined. Hence, this study aimed to investigate the long-term clinical course, outcomes, and prognostic factors in patients with MPA-ILD. Methods: Clinical data of 39 patients with MPA-ILD (biopsy proven cases, n = 6) were retrospectively analyzed. High resolution computed tomography (HRCT) patterns were assessed based on the 2018 idiopathic pulmonary fibrosis diagnostic criteria. Acute exacerbation (AE) was defined as the worsening of dyspnea within 30 days, with new bilateral lung infiltration that is not fully explained by heart failure or fluid overload and that does not have identified extra-parenchymal causes (pneumothorax, pleural effusion, or pulmonary embolism). Results: The median follow-up period was 72.0 months (interquartile range: 44–117 months). The mean age of the patients was 62.7 years and 59.0% were male. Usual interstitial pneumonia (UIP) and probable usual interstitial pneumonia patterns on high resolution computed tomography were identified in 61.5 and 17.9% of the patients, respectively. During the follow-up, 51.3% of patients died, and the 5- and 10-year overall survival rates were 73.5% and 42.0%, respectively. Acute exacerbation occurred in 17.9% of the patients. The non-survivors had higher neutrophil counts in bronchoalveolar lavage (BAL) fluid and more frequent acute exacerbation than the survivors. In the multivariable Cox analysis, older age (hazard ratio [HR], 1.07; 95% confidence interval [CI], 1.01–1.14; p = 0.028) and higher BAL counts (HR, 1.09; 95% CI, 1.01–1.17; p = 0.015) were found to be the independent prognostic factors associated with mortality in patients with MPA-ILD. Conclusion: During the 6 years-follow-up, about half of patients with MPA-ILD died and approximately one-fifth experienced acute exacerbation. Our results suggest that older age and higher BAL neutrophil counts mean poor prognosis in patients with MPA-ILD.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"64 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-05-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133311403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: A well-recognized therapy to improve the symptoms of patients with malignant pleural effusion (MPE), indwelling pleural catheters (IPCs) can also achieve spontaneous pleurodesis. Chemical pleurodesis is associated with a significant pro-coagulation and fibrinolytic environment. Hence, anticoagulation could theoretically interfere with this process. Objective: The aim of this study was to evaluate if anticoagulation can interfere with successful spontaneous pleurodesis in patients treated with IPC. Methods: This was a cohort study of all patients with MPE treated with IPC. The primary objective was to determine if anticoagulant use after IPC placement decreased the rate of spontaneous pleurodesis. The secondary objective was to identify other factors associated with spontaneous pleurodesis. We used a Fine-Gray subdistribution hazard model and a direct acyclic graph to identify variables associated with time to spontaneous pleurodesis. Results: Of the included 410 patients, 210 patients (51.2%) achieved pleurodesis and had their IPC removed. We found no association between anticoagulation and likelihood of pleurodesis. Multivariate analyses revealed that prior chemotherapy, ECOG score of 2–4 were associated with unsuccessful pleurodesis, while chemotherapy or radiotherapy after IPC placement remained associated with increased likelihood of spontaneous pleurodesis. Conclusions: We failed to demonstrate an association between anticoagulation and pleurodesis. We found that better performance status and chemotherapy or radiotherapy after IPC placement can increase the rate of pleurodesis and catheter removal.
{"title":"Pleurodese durch getunnelten Pleurakatheter: Können wir den Erfolg vorhersagen?","authors":"S. Keymel","doi":"10.1159/000530735","DOIUrl":"https://doi.org/10.1159/000530735","url":null,"abstract":"Background: A well-recognized therapy to improve the symptoms of patients with malignant pleural effusion (MPE), indwelling pleural catheters (IPCs) can also achieve spontaneous pleurodesis. Chemical pleurodesis is associated with a significant pro-coagulation and fibrinolytic environment. Hence, anticoagulation could theoretically interfere with this process. Objective: The aim of this study was to evaluate if anticoagulation can interfere with successful spontaneous pleurodesis in patients treated with IPC. Methods: This was a cohort study of all patients with MPE treated with IPC. The primary objective was to determine if anticoagulant use after IPC placement decreased the rate of spontaneous pleurodesis. The secondary objective was to identify other factors associated with spontaneous pleurodesis. We used a Fine-Gray subdistribution hazard model and a direct acyclic graph to identify variables associated with time to spontaneous pleurodesis. Results: Of the included 410 patients, 210 patients (51.2%) achieved pleurodesis and had their IPC removed. We found no association between anticoagulation and likelihood of pleurodesis. Multivariate analyses revealed that prior chemotherapy, ECOG score of 2–4 were associated with unsuccessful pleurodesis, while chemotherapy or radiotherapy after IPC placement remained associated with increased likelihood of spontaneous pleurodesis. Conclusions: We failed to demonstrate an association between anticoagulation and pleurodesis. We found that better performance status and chemotherapy or radiotherapy after IPC placement can increase the rate of pleurodesis and catheter removal.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"19 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-04-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130252883","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}