{"title":"Long COVID: Wachsendes Verständnis der Pathomechanismen gibt Hoffnung auf zielgerichtete und direkte Diagnostik sowie effektive Therapien","authors":"A. Steinmetz","doi":"10.1159/000530061","DOIUrl":"https://doi.org/10.1159/000530061","url":null,"abstract":"","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"11 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123786585","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}
C. Nagel, H. Olschewski, S. Sorichter, Gordana Uezgoer, C. Diehm, P. Huppert, T. Iber, F. Herth, S. Harutyunova, A. Marra, N. Benjamin, Amina Salkić, E. Grünig, B. Egenlauf
Hintergrund: Anhaltende Symptome nach akuter Coronavirus-Krankheit-2019 (COVID-19) sind häufig und es besteht kein signifikanter Zusammenhang mit der Schwere der akuten Erkrankung. Bei Long COVID (anhaltende Symptome > 4 Wochen nach akuter COVID-19) treten häufig respiratorische Symptome auf, aber Lungenfunktionstests zeigen nur leichte Veränderungen, die die Symptome nicht erklären. Obwohl COVID-19 zu einer Beeinträchtigung des peripheren Nervensystems und der Skelettmuskulatur führen kann, wurde die Funktion der Atemmuskulatur in diesem Zusammenhang nicht untersucht. Methoden: In dieser Studie haben wir den Schweregrad der Dyspnoe (NYHA-Funktionsklasse) bei Long-COVID-Patienten untersucht und analysierten dessen Zusammenhang mit dem Body-Mass-Index (BMI), der Einsekundenkapazität (FEV1), der forcierten Vitalkapazität, anderen Parametern der Bodyplethysmographie, der Diffusionskapazität für Kohlenmonoxid (DLCO), den arteriellen Blutgasen und der Funktion der Atemmuskulatur, die anhand des Atemwegsokklusionsdrucks (P0,1) und des maximalen Inspirationsdrucks (PImax) in 2 Atemwegskliniken in Deutschland zwischen Oktober 2020 und August 2021 gemessen wurde. Ergebnisse: Insgesamt wurden 116 Patienten in die Studie aufgenommen. Das Durchschnittsalter betrug 50,2 ± 14,5 Jahre, BMI 26,7 ± 5,87 kg/m2, NYHA-Klasse I 19%, II 27%, III 41% und IV 14%. Während die Lungenfunktionswerte und die Computertomografie oder die konventionelle Röntgenaufnahme des Brustkorbs im normalen Bereich lagen, war die Funktion der Atemmuskulatur deutlich beeinträchtigt. Der P0,1 war auf 154 ± 83% des Sollwerts erhöht und der PImax war auf 41 ± 25% des Sollwerts reduziert. Die PImax-Reduktion war stark mit dem Schweregrad der Dyspnoe verbunden, aber nicht abhängig vom BMI, der Zeit nach der akuten COVID-19 und den meisten anderen Parametern. Schlussfolgerungen: Diese Studie zeigt, dass die Atemwegssymptome bei Patienten mit Long COVID hauptsächlich durch eine verminderte Inspirationsmuskelkraft verursacht sein können. Die Bewertung von PImax und P0,1 könnte eine Dyspnoe besser erklären als klassische Lungenfunktionstests und die DLCO. Eine prospektive Studie ist erforderlich, um diese Ergebnisse zu bestätigen.
{"title":"Beeinträchtigung der inspiratorischen Muskelfunktion nach COVID-19","authors":"C. Nagel, H. Olschewski, S. Sorichter, Gordana Uezgoer, C. Diehm, P. Huppert, T. Iber, F. Herth, S. Harutyunova, A. Marra, N. Benjamin, Amina Salkić, E. Grünig, B. Egenlauf","doi":"10.1159/000529940","DOIUrl":"https://doi.org/10.1159/000529940","url":null,"abstract":"Hintergrund: Anhaltende Symptome nach akuter Coronavirus-Krankheit-2019 (COVID-19) sind häufig und es besteht kein signifikanter Zusammenhang mit der Schwere der akuten Erkrankung. Bei Long COVID (anhaltende Symptome > 4 Wochen nach akuter COVID-19) treten häufig respiratorische Symptome auf, aber Lungenfunktionstests zeigen nur leichte Veränderungen, die die Symptome nicht erklären. Obwohl COVID-19 zu einer Beeinträchtigung des peripheren Nervensystems und der Skelettmuskulatur führen kann, wurde die Funktion der Atemmuskulatur in diesem Zusammenhang nicht untersucht. Methoden: In dieser Studie haben wir den Schweregrad der Dyspnoe (NYHA-Funktionsklasse) bei Long-COVID-Patienten untersucht und analysierten dessen Zusammenhang mit dem Body-Mass-Index (BMI), der Einsekundenkapazität (FEV1), der forcierten Vitalkapazität, anderen Parametern der Bodyplethysmographie, der Diffusionskapazität für Kohlenmonoxid (DLCO), den arteriellen Blutgasen und der Funktion der Atemmuskulatur, die anhand des Atemwegsokklusionsdrucks (P0,1) und des maximalen Inspirationsdrucks (PImax) in 2 Atemwegskliniken in Deutschland zwischen Oktober 2020 und August 2021 gemessen wurde. Ergebnisse: Insgesamt wurden 116 Patienten in die Studie aufgenommen. Das Durchschnittsalter betrug 50,2 ± 14,5 Jahre, BMI 26,7 ± 5,87 kg/m2, NYHA-Klasse I 19%, II 27%, III 41% und IV 14%. Während die Lungenfunktionswerte und die Computertomografie oder die konventionelle Röntgenaufnahme des Brustkorbs im normalen Bereich lagen, war die Funktion der Atemmuskulatur deutlich beeinträchtigt. Der P0,1 war auf 154 ± 83% des Sollwerts erhöht und der PImax war auf 41 ± 25% des Sollwerts reduziert. Die PImax-Reduktion war stark mit dem Schweregrad der Dyspnoe verbunden, aber nicht abhängig vom BMI, der Zeit nach der akuten COVID-19 und den meisten anderen Parametern. Schlussfolgerungen: Diese Studie zeigt, dass die Atemwegssymptome bei Patienten mit Long COVID hauptsächlich durch eine verminderte Inspirationsmuskelkraft verursacht sein können. Die Bewertung von PImax und P0,1 könnte eine Dyspnoe besser erklären als klassische Lungenfunktionstests und die DLCO. Eine prospektive Studie ist erforderlich, um diese Ergebnisse zu bestätigen.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132784153","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}
Long COVID is a complex condition affecting quality of life, with limited therapeutic options. We investigated the occurrence of long COVID in subjects receiving early therapy with monoclonal antibodies (mAbs) or antivirals to reduce the risk of COVID-19 progression. In this retrospective study we enrolled 737 adult patients (aged 65.16 ± 13.46; 361F), who experienced COVID-19 between January 2021 and March 2022. Antiviral or mAbs were administered to symptomatic patients who did not require oxygen therapy or hospital admission for SARS-CoV-2 infection, and who were at high risk of progression to severe disease, as identified by age > 65 years or the presence of comorbidities. Long COVID, defined as newly or persistent long-term symptoms 4 weeks after the onset of the acute illness, was reported in 204 cases (28%). Age (OR 1.03; p < 0.001), gender (OR 1.88; p < 0.001) and at least three comorbidities (OR 3.49; p = 0.049) were directly associated with long COVID; conversely, vaccination (OR 0.59; p = 0.005) and mAbs/antivirals (OR 0.44; p = 0.002) were independently associated with a reduced risk of long COVID. At a propensity-score-matched analysis, the mAbs/antivirals group had a significantly lower occurrence of long COVID in comparison with untreated controls (11% vs. 34%; p= 0.001). In conclusion, mAbs and antivirals administered against the progression of COVID-19 were associated with a reduced risk of long COVID.
{"title":"Long-COVID: Impfung und frühe antivirale Therapie senken das Risiko","authors":"S. Krüger","doi":"10.1159/000530014","DOIUrl":"https://doi.org/10.1159/000530014","url":null,"abstract":"Long COVID is a complex condition affecting quality of life, with limited therapeutic options. We investigated the occurrence of long COVID in subjects receiving early therapy with monoclonal antibodies (mAbs) or antivirals to reduce the risk of COVID-19 progression. In this retrospective study we enrolled 737 adult patients (aged 65.16 ± 13.46; 361F), who experienced COVID-19 between January 2021 and March 2022. Antiviral or mAbs were administered to symptomatic patients who did not require oxygen therapy or hospital admission for SARS-CoV-2 infection, and who were at high risk of progression to severe disease, as identified by age > 65 years or the presence of comorbidities. Long COVID, defined as newly or persistent long-term symptoms 4 weeks after the onset of the acute illness, was reported in 204 cases (28%). Age (OR 1.03; p < 0.001), gender (OR 1.88; p < 0.001) and at least three comorbidities (OR 3.49; p = 0.049) were directly associated with long COVID; conversely, vaccination (OR 0.59; p = 0.005) and mAbs/antivirals (OR 0.44; p = 0.002) were independently associated with a reduced risk of long COVID. At a propensity-score-matched analysis, the mAbs/antivirals group had a significantly lower occurrence of long COVID in comparison with untreated controls (11% vs. 34%; p= 0.001). In conclusion, mAbs and antivirals administered against the progression of COVID-19 were associated with a reduced risk of long COVID.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124017477","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}
The usage of bevacizumab for malignant pleural effusion (MPE) or malignant pericardial effusion (MPCE) has attracted increasing interest from researchers, but the precise ways of bevacizumab administration remain unknown. Patients with histologically or cytologically confirmed non-small-cell lung cancer (NSCLC) with MPE or MPCE were enrolled in the study and treated with a low dose of single bevacizumab (100 mg) intrapleurally or intrapericardially injected after the drainage of the effusions. The Lung Cancer Symptom Scale (LCSS), efficacy, and safety of drug administration were used as evaluation parameters in this study. The results indicated that lung cancer-related symptoms were significantly improved following treatment, compared with symptoms before the treatment (LCSS, score 494 ± 78 vs. score 377 ± 77, mean ± SD) (P < 0.001). Malignant effusions were well controlled, and the median time to progression (TTP) was 91 days and 111 days in MPE and MPCE, respectively. In addition, no severe side effects were observed, except in one patient with mild dizziness. In summary, the low dose of single bevacizumab (100 mg) with intrapleural or intrapericardial injection is effective and safe in the treatment of lung cancer-mediated malignant effusion, rapidly improving the malignant effusion-related symptoms and quality of life in patients with NSCLC.
{"title":"Lungenkarzinom-assoziierte maligne Ergüsse: Neue Therapie könnte mit Einzeldosis Bevacizumab etabliert werden","authors":"F. Stanzel","doi":"10.1159/000529517","DOIUrl":"https://doi.org/10.1159/000529517","url":null,"abstract":"The usage of bevacizumab for malignant pleural effusion (MPE) or malignant pericardial effusion (MPCE) has attracted increasing interest from researchers, but the precise ways of bevacizumab administration remain unknown. Patients with histologically or cytologically confirmed non-small-cell lung cancer (NSCLC) with MPE or MPCE were enrolled in the study and treated with a low dose of single bevacizumab (100 mg) intrapleurally or intrapericardially injected after the drainage of the effusions. The Lung Cancer Symptom Scale (LCSS), efficacy, and safety of drug administration were used as evaluation parameters in this study. The results indicated that lung cancer-related symptoms were significantly improved following treatment, compared with symptoms before the treatment (LCSS, score 494 ± 78 vs. score 377 ± 77, mean ± SD) (P < 0.001). Malignant effusions were well controlled, and the median time to progression (TTP) was 91 days and 111 days in MPE and MPCE, respectively. In addition, no severe side effects were observed, except in one patient with mild dizziness. In summary, the low dose of single bevacizumab (100 mg) with intrapleural or intrapericardial injection is effective and safe in the treatment of lung cancer-mediated malignant effusion, rapidly improving the malignant effusion-related symptoms and quality of life in patients with NSCLC.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"1063 ","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-03-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"133843411","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: Endobronchial ultrasound-guided transbronchial needle aspiration is a minimally invasive and effective sampling approach for patients with mediastinal or hilar lymphadenopathy. Increased recognition of the ultrasonographic features revealed the value of its images in predicting mediastinal lymph node malignancy. However, its diagnostic validity and the predictive value of its ultrasonographic features have not been demonstrated well in patients after systemic anti-tumor therapy. This study aimed to evaluate the efficiency of endobronchial ultrasound-guided transbronchial needle aspiration in patients with suspicious lymph nodes after anti-tumor therapy. Method: We retrospectively reviewed cases of endobronchial ultrasound-guided transbronchial needle aspiration performed between January 2019 and August 2021 at a single tertiary hospital center. Patients with suspected mediastinal or hilar lymph nodes within 5 years of systemic anti-tumor therapy were enrolled. Final diagnoses were determined by pathologic diagnoses of samples from transbronchial needle aspiration, surgery, or follow-up for at least 6 months. Ultrasonographic features were analyzed to assess the predictive value of malignant lymph nodes after treatment. Results: Overall, 168 lymph nodes of 138 patients were analyzed. Among 110 (65.5%) malignant lymph nodes, 75 originated from lung cancers; the other 35 were from other malignancies. No complications related to endobronchial ultrasound-guided transbronchial needle aspiration were observed. Of 58 negative results of transbronchial needle aspiration, 51 were proven to be true negatives; 7 were false. The overall sensitivity and the negative predictive value were 94.02% and 87.93%, respectively. Univariate and multivariate analysis revealed the absence of central hilar structure and short axis > 10 mm as independent predictive factors for malignancy. Conclusions: Endobronchial ultrasound-guided transbronchial needle aspiration performs satisfactorily in diagnosing mediastinal and hilar lymphadenopathy even after anti-tumor treatment.
{"title":"Tumorpatienten mit mediastinaler Lymphadenopathie: Bronchoskopie und Rebiopsie mittels EBUS-TBNA zur Sicherheit und Optimierung der Patientenversorgung","authors":"M. Wagner","doi":"10.1159/000529455","DOIUrl":"https://doi.org/10.1159/000529455","url":null,"abstract":"Background: Endobronchial ultrasound-guided transbronchial needle aspiration is a minimally invasive and effective sampling approach for patients with mediastinal or hilar lymphadenopathy. Increased recognition of the ultrasonographic features revealed the value of its images in predicting mediastinal lymph node malignancy. However, its diagnostic validity and the predictive value of its ultrasonographic features have not been demonstrated well in patients after systemic anti-tumor therapy. This study aimed to evaluate the efficiency of endobronchial ultrasound-guided transbronchial needle aspiration in patients with suspicious lymph nodes after anti-tumor therapy. Method: We retrospectively reviewed cases of endobronchial ultrasound-guided transbronchial needle aspiration performed between January 2019 and August 2021 at a single tertiary hospital center. Patients with suspected mediastinal or hilar lymph nodes within 5 years of systemic anti-tumor therapy were enrolled. Final diagnoses were determined by pathologic diagnoses of samples from transbronchial needle aspiration, surgery, or follow-up for at least 6 months. Ultrasonographic features were analyzed to assess the predictive value of malignant lymph nodes after treatment. Results: Overall, 168 lymph nodes of 138 patients were analyzed. Among 110 (65.5%) malignant lymph nodes, 75 originated from lung cancers; the other 35 were from other malignancies. No complications related to endobronchial ultrasound-guided transbronchial needle aspiration were observed. Of 58 negative results of transbronchial needle aspiration, 51 were proven to be true negatives; 7 were false. The overall sensitivity and the negative predictive value were 94.02% and 87.93%, respectively. Univariate and multivariate analysis revealed the absence of central hilar structure and short axis > 10 mm as independent predictive factors for malignancy. Conclusions: Endobronchial ultrasound-guided transbronchial needle aspiration performs satisfactorily in diagnosing mediastinal and hilar lymphadenopathy even after anti-tumor treatment.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"132241366","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: There is limited information on the patient’s perspective of how biologic treatments impact their lives. We conducted a qualitative study to explore the patient’s experience of being considered a super-responder from a quality of life perspective. Methods: Patients with severe asthma identified as super-responders were invited to semi-structured interviews conducted online. Participants could bring a family member/friend to the interview. The interviews explored experiences of biologic treatment, were transcribed and underwent thematic analysis. Results: Twenty-five participants took part in this study. Themes emerged on the impact of biologic treatment for participants and for their friends/family: (i) Words used to describe their often life-changing experiences and (ii) the positive changes noted. Biologic treatment stopped the disruption of family life and social life caused by exacerbations. Improvements in mental health were also noted. Marked individual variations in the way it affected their lives were noted. Most participants noticed improvements 2–3 months after starting their biologic, but some noticed improvement within a few days and others after 6 months. Conclusion: Super-responders reported profound but heterogeneous improvements following biologic treatment beyond asthma symptoms and exacerbations including important benefits to social and family life. Improvements may be underestimated as social and family benefits are not reliably measured in current studies with implications for health economic evaluations. Not all patients are super-responders, and excellent responses may be lost in group mean data in trials. Individual time course and response patterns need further elucidation to identify who will respond best to biologics.
{"title":"Schweres Asthma: Lebensverändernde Erfahrungen von Super-Respondern auf Biologika","authors":"S. Lang","doi":"10.1159/000529554","DOIUrl":"https://doi.org/10.1159/000529554","url":null,"abstract":"Background: There is limited information on the patient’s perspective of how biologic treatments impact their lives. We conducted a qualitative study to explore the patient’s experience of being considered a super-responder from a quality of life perspective. Methods: Patients with severe asthma identified as super-responders were invited to semi-structured interviews conducted online. Participants could bring a family member/friend to the interview. The interviews explored experiences of biologic treatment, were transcribed and underwent thematic analysis. Results: Twenty-five participants took part in this study. Themes emerged on the impact of biologic treatment for participants and for their friends/family: (i) Words used to describe their often life-changing experiences and (ii) the positive changes noted. Biologic treatment stopped the disruption of family life and social life caused by exacerbations. Improvements in mental health were also noted. Marked individual variations in the way it affected their lives were noted. Most participants noticed improvements 2–3 months after starting their biologic, but some noticed improvement within a few days and others after 6 months. Conclusion: Super-responders reported profound but heterogeneous improvements following biologic treatment beyond asthma symptoms and exacerbations including important benefits to social and family life. Improvements may be underestimated as social and family benefits are not reliably measured in current studies with implications for health economic evaluations. Not all patients are super-responders, and excellent responses may be lost in group mean data in trials. Individual time course and response patterns need further elucidation to identify who will respond best to biologics.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"54 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115174341","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}
Introduction: Minimally invasive surgery has become the standard for the early-stage non-small cell lung cancer (NSCLC). The appropriateness of the kind of lung resection for the elderly patients is still debated. Methods: We retrospectively reviewed patients with older than 75 years who underwent robotic lobectomy between May 2016 to June 2022. We selected 103 patients who met the inclusion criteria of the study. The preoperative cardiorespiratory functional evaluations were collected, and the risk of postoperative complications was calculated according to the Charlson Comorbidity Index, the American College of Surgery surgical risk calculator (ACS-NSQIP), EVAD score, and American Society of Anesthesiology (ASA) score. The patients were divided in two groups according to the presence of postoperative complications. Results: Forty-three patients were female, and 72.8% of the total population were former or active smokers. Thirty-five patients reported postoperative complications. The analysis of the two groups showed that the predicted postoperative forced expiratory volumes in the first second (FEV1) and forced vital capacity (FVC) were significantly lower in patients presenting postoperative complications (p = 0.04). Moreover, the upstaging rate and the unexpected nodal metastases were higher in the postoperative complication groups. Conclusion: Robotic-assisted lobectomy for early-stage lung cancer is a safe and feasible approach in selected elderly patients. The factors that could predict the complication rate was the predicted postoperative FEV1 and the nodal disease.
{"title":"Robotergestützte Lobektomie beim NSCLC: Eine moderne und vielversprechende Methode zur Behandlung – auch von älteren Patienten","authors":"K. Hekmat","doi":"10.1159/000529564","DOIUrl":"https://doi.org/10.1159/000529564","url":null,"abstract":"Introduction: Minimally invasive surgery has become the standard for the early-stage non-small cell lung cancer (NSCLC). The appropriateness of the kind of lung resection for the elderly patients is still debated. Methods: We retrospectively reviewed patients with older than 75 years who underwent robotic lobectomy between May 2016 to June 2022. We selected 103 patients who met the inclusion criteria of the study. The preoperative cardiorespiratory functional evaluations were collected, and the risk of postoperative complications was calculated according to the Charlson Comorbidity Index, the American College of Surgery surgical risk calculator (ACS-NSQIP), EVAD score, and American Society of Anesthesiology (ASA) score. The patients were divided in two groups according to the presence of postoperative complications. Results: Forty-three patients were female, and 72.8% of the total population were former or active smokers. Thirty-five patients reported postoperative complications. The analysis of the two groups showed that the predicted postoperative forced expiratory volumes in the first second (FEV1) and forced vital capacity (FVC) were significantly lower in patients presenting postoperative complications (p = 0.04). Moreover, the upstaging rate and the unexpected nodal metastases were higher in the postoperative complication groups. Conclusion: Robotic-assisted lobectomy for early-stage lung cancer is a safe and feasible approach in selected elderly patients. The factors that could predict the complication rate was the predicted postoperative FEV1 and the nodal disease.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124167310","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}
Objectives: Severe acute respiratory syndrome coronavirus 2, the novel coronavirus responsible for coronavirus disease (COVID-19), has been a major cause of morbidity and mortality worldwide. Gastrointestinal and hepatic manifestations during acute disease have been reported extensively in the literature. Post-COVID-19 cholangiopathy has been increasingly reported in adults. In children, data are sparse. Our aim was to describe pediatric patients who recovered from COVID-19 and later presented with liver injury. Methods: This is a retrospective case series study of pediatric patients with post-COVID-19 liver manifestations. We collected data on demographics, medical history, clinical presentation, laboratory results, imaging, histology, treatment, and outcome. Results: We report 5 pediatric patients who recovered from COVID-19 and later presented with liver injury. Two types of clinical presentation were distinguishable. Two infants aged 3 and 5 months, previously healthy, presented with acute liver failure that rapidly progressed to liver transplantation. Their liver explant showed massive necrosis with cholangiolar proliferation and lymphocytic infiltrate. Three children, 2 aged 8 years and 1 aged 13 years, presented with hepatitis with cholestasis. Two children had a liver biopsy significant for lymphocytic portal and parenchyma inflammation, along with bile duct proliferations. All 3 were started on steroid treatment; liver enzymes improved, and they were weaned successfully from treatment. For all 5 patients, extensive etiology workup for infectious and metabolic etiologies was negative. Conclusions: We report 2 distinct patterns of potentially long COVID-19 liver manifestations in children with common clinical, radiological, and histopathological characteristics after a thorough workup excluded other known etiologies.
{"title":"Ungewöhnliche akute Hepatitisfälle bei Kindern 2022 – Evidenz für eine immunvermittelte Erkrankung – ein Fall von Long-COVID?","authors":"B. Bengsch","doi":"10.1159/000529476","DOIUrl":"https://doi.org/10.1159/000529476","url":null,"abstract":"Objectives: Severe acute respiratory syndrome coronavirus 2, the novel coronavirus responsible for coronavirus disease (COVID-19), has been a major cause of morbidity and mortality worldwide. Gastrointestinal and hepatic manifestations during acute disease have been reported extensively in the literature. Post-COVID-19 cholangiopathy has been increasingly reported in adults. In children, data are sparse. Our aim was to describe pediatric patients who recovered from COVID-19 and later presented with liver injury. Methods: This is a retrospective case series study of pediatric patients with post-COVID-19 liver manifestations. We collected data on demographics, medical history, clinical presentation, laboratory results, imaging, histology, treatment, and outcome. Results: We report 5 pediatric patients who recovered from COVID-19 and later presented with liver injury. Two types of clinical presentation were distinguishable. Two infants aged 3 and 5 months, previously healthy, presented with acute liver failure that rapidly progressed to liver transplantation. Their liver explant showed massive necrosis with cholangiolar proliferation and lymphocytic infiltrate. Three children, 2 aged 8 years and 1 aged 13 years, presented with hepatitis with cholestasis. Two children had a liver biopsy significant for lymphocytic portal and parenchyma inflammation, along with bile duct proliferations. All 3 were started on steroid treatment; liver enzymes improved, and they were weaned successfully from treatment. For all 5 patients, extensive etiology workup for infectious and metabolic etiologies was negative. Conclusions: We report 2 distinct patterns of potentially long COVID-19 liver manifestations in children with common clinical, radiological, and histopathological characteristics after a thorough workup excluded other known etiologies.","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"1 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130102966","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}
{"title":"Pneumologie zwischen Patientenzentrierung und Digitalisierung","authors":"C. Taube","doi":"10.1159/000529489","DOIUrl":"https://doi.org/10.1159/000529489","url":null,"abstract":"","PeriodicalId":402207,"journal":{"name":"Kompass Pneumologie","volume":"91 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"131919343","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}
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