Pneumologie最新文献

{"title":"[From vibration trauma to pharyngeal muscle instability: A self-sustaining pathophysiological process (circulus vitiosus) in obstructive sleep apnea].","authors":"Ulrich Koehler, Olaf Hildebrandt, Mikail Aykut Degerli, Christian Viniol, Wulf Hildebrandt, Regina Conradt, Richard Birk, Boris Stuck, Janine Sambale, Heike Korbmacher-Steiner","doi":"10.1055/a-2438-0479","DOIUrl":"10.1055/a-2438-0479","url":null,"abstract":"<p><p>Pharyngeal stability is ensured by both anatomical and non-anatomical factors. In addition to the anatomical width, functional factors are also significant in determining the degree of obstruction of the upper airway. The functionality of the pharyngeal muscles depends on an undisturbed sensorimotor system. In patients with rhonchopathy or obstructive sleep apnea (OSA), sensorimotor function and muscle morphology change progressively. It is hypothesised that long-term snoring leads to vibration-induced sensorimotor neuropathy, resulting in the loss of function and structure of the pharyngeal muscles. Pharyngeal mechanoreceptors lose their sensitivity, and due to neural damage, information can no longer be adequately translated into motor responses. This raises the question of the timeframe within which irreversible vibration-induced receptor damage occurs due to snoring.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"297-301"},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780761","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":"[Dysphagia and obstructive sleep apnea (OSA): What is the pathophysiological bridge?]","authors":"Ulrich Koehler, Mikail Aykut Degerli, Christian Viniol, Olaf Hildebrandt, Wulf Hildebrandt, Keywan Sohrabi, Janine Sambale, Heike Korbmacher-Steiner","doi":"10.1055/a-2561-9333","DOIUrl":"https://doi.org/10.1055/a-2561-9333","url":null,"abstract":"<p><p>There is a high prevalence of dysphagia among patients with obstructive sleep apnea (OSA) and snoring. Swallowing is a complex process requiring fine-tuned neuromuscular coordination. Breathing and swallowing share a common passage in the pharynx. Swallowing process can be divided into an oral, pharyngeal and esophageal phase. When the swallowing reflex starts, hyoid and larynx are pulled up and the glottis covers the entrance to larynx. During swallowing apnea, which is a respiration pause for about 0.5-1.0 seconds, the bolus passes pharyngeal airway. Dysphagia is associated with severe complications such as aspiration and pneumonia. Although the pathophysiology of dysphagia in OSA-patients is not clearly understood, we assume that dysphagia is also a result of sensory and motor changes in the oropharynx caused by snoring vibrations.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764936","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":"[Physiotherapy in Primary Ciliary Dyskinesia].","authors":"Christina Krämer, Jasmin Flock, Birgit Borges-Lüke, Johanna Raidt, Felix C Ringshausen","doi":"10.1055/a-2502-8151","DOIUrl":"https://doi.org/10.1055/a-2502-8151","url":null,"abstract":"<p><p>Primary ciliary dyskinesia (PCD) is a multisystem disease caused by dysfunction of motile cilia. It is characterized by chronic mucus retention of the upper and lower airways. This results in a destructive lung disease with the development of bronchiectasis. There are a very few evidence-based therapies for patients with PCD. Most treatment concepts are based on other respiratory diseases or expert opinion. This article is about the physiotherapy care of patients with PCD and provides an overview of recommendations from the current literature as well as many years of experience in the physiotherapy treatment of patients with PCD. Currently, no curative therapy for PCD exists. Symptomatic treatment with a focus on mucus management is relevant. This includes inhalation, mobilization of mucus, physical activity and the targeted use of medical aids for chest clearance as well as rehabilitation. Whenever possible, specialized therapists should provide guidance for physiotherapy.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764850","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":"[Representation of respiratory medicine in medical curricula in Germany: an online survey among final-year medical students and chief physicians].","authors":"Erik Büscher, Espen Elias Groth, Julia Wälscher, Thomas Bahmer, Matthias Raspe, Nina Sicker, Katharina Buschulte, Christoph Fisser","doi":"10.1055/a-2533-1546","DOIUrl":"https://doi.org/10.1055/a-2533-1546","url":null,"abstract":"<p><p>Students' experiences in medical school may have a significant influence on their later choice of medical specialty, but so far, there has been a lack of objective data on how the subject of pneumology is perceived at German medical schools and where there may be potential for improvement.From July to November 2022, we conducted an online survey among final-year students at German medical schools, as well as chief physicians in the field of pneumology. Students were invited to participate by e-mail via their faculties and the survey was further advertised by the Federal Representation of Medical Students in Germany (BVMD). Chief physicians were contacted via the mailing list of the German Respiratory Society (DGP).We received n=279 responses from students (from 95% of German medical faculties) and n=53 responses from chief physicians in pneumology. Both groups considered pneumology to be rather underrepresented or underrepresented compared to other specialties in the medical curricula (62% of students, 89% of chief physicians). Students attributed the greatest influence on their career aspirations by far to theoretical knowledge, practical experience during internships, clinical traineeships and the final (practical) year of medical school (89% of responses), with value being attributed to good and appreciative supervision and the opportunity to work independently. In a regression analysis, practical learning experience in the field of pneumology during the final year of medical school was particularly associated with students' later career choice for pneumology. From the students' perspective, practical teaching (91% of responses) as well as other courses requiring personal attendance (51%) should be strengthened. Chief physicians described difficulties recruiting junior staff into the field of pneumology and highlighted the need to stress the importance of the subject and the financing of teaching at medical schools.Implementation of a more comprehensive, practice-oriented training in respiratory medicine seems essential for promoting the recruitment of the next generation of physicians into the field of pneumology. The results presented in this paper form a basis for giving more weight to pneumology in medical school curricula and serve as an aid for decision-makers at medical faculties and teaching hospitals in Germany.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143764851","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":"[Prognostic parameters in patients with prolonged weaning from mechanical ventilation: a retrospective analysis].","authors":"Tobias Müller, Jan Mannschreck, Pascal Lennemann, Ingmar Bergs, Benedikt Jörn, Gernot Marx, Tim Philip Simon, Michael Dreher","doi":"10.1055/a-2549-0754","DOIUrl":"https://doi.org/10.1055/a-2549-0754","url":null,"abstract":"<p><p>Weaning from mechanical ventilation of patients treated in an intensive care unit can be difficult and requires transfer to a specialised weaning unit. So far, only limited data are available on parameters associated with survival and successful weaning in this patient group.A retrospective analysis of patients (n=659) treated in the specialised weaning unit at the University Hospital RWTH Aachen during a time period of 8 years was conducted.Multivariate analysis showed an inverse association of patient survival with age (OR 0.958; p<0.001), underlying malignancy (OR 0.422; p=0.008) or chronic renal failure (OR 0.509; p=0.035), cumulative fluid balance (OR 0.948; p<0.001) and lactate levels (OR 0.528; p=0.032). Moreover, age (OR 0.975; p=0.021), chronic renal failure (OR 0.382; p=0.001), cumulative fluid balance (OR 0.953; p<0.001) and lactate levels (OR 0.349; p<0.001) were also associated with weaning failure. In addition, an association of weaning failure was found for underlying neuromuscular disorder (OR 0.212; p=0.01), ventilator days on ICU (OR 0.98; p=0.015) and bicarbonate levels (OR 0.947; p=0.049).Taken together, we were able to identify several parameters associated with survival and successful weaning in a large cohort of patients treated in a specialized weaning unit.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143743451","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":"[The Lung Emphysema Registry: Improving quality of care in interventional emphysema therapy and health management for patients with advanced COPD and lung emphysema].","authors":"Monika Rummenholl, Thomas Sgarbossa, Christian Grah, Angelique Holland, Ralf-Harto Huebner","doi":"10.1055/a-2532-4885","DOIUrl":"https://doi.org/10.1055/a-2532-4885","url":null,"abstract":"<p><p>The Lungenemphysemregister e.V. (LE-Register) offers a specialized platform for the exchange of knowledge, the promotion of research and the improvement of the quality of care in interventional endoscopic and surgical therapies as well as the consideration of other socio-economic and health aspects of pulmonary emphysema. The current focus is primarily on endoscopic and surgical treatment approaches for patients. Through the networking of experts, the development of specific quality standards and the certification of centers, the LE Registry contributes to the evidence-based further development and optimization of these highly specialized therapies and with a focus on other aspects of health promotion in the future.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":""},"PeriodicalIF":1.2,"publicationDate":"2025-03-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143542947","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":"[A rare cause of multiple cavitary lung lesions].","authors":"Melika Piric, Bora Kosan, Christoph Manke, Fadi Khreish, Ludger Fink, Gabriele Koehler, Christoph Lange, Sven Gläser, Detlef Litzlbauer, Philipp Markart","doi":"10.1055/a-2486-6503","DOIUrl":"10.1055/a-2486-6503","url":null,"abstract":"<p><p>We report on a 32-year-old woman with multiple, progressive cavitary lung lesions. Lung cavities may occur in the context of various diseases and, thus, represent a huge diagnostic challenge. The spectrum of diseases comprises infections, systemic autoimmune rheumatic diseases, and malignancies. Several microorganisms may cause lung cavities such as common bacteria (e.g. <i>Haemophilus influenzae, Klebsiella pneumoniae</i>), <i>Mycobacterium tuberculosis</i>, non-tuberculous mycobacteria, uncommon bacteria such as <i>Nocardia species</i>, fungi (e.g. <i>Aspergillus species</i>), and parasites such as <i>Echinococcus species</i>. In respect of systemic autoimmune rheumatic diseases, granulomatosis with polyangiitis is frequently associated with cavitary lung lesions. Malignancies such as lung carcinomas and pulmonary metastasis may also manifest with cavern formation. In our case, we primarily assumed infection as the cause of the cavitary lung lesions - in fact, an infection with <i>Actinomyces species</i>. However, despite antibiotic therapy according to the resistance test results and the removal of the supposed focus of infection (tonsillectomy with proof of <i>Actinomyces</i> colonization of the tonsils), there was clear progression of lung cavities. Therefore, diagnostics were expanded and enhanced including FDG-PET-CT, bone marrow puncture, VATS pulmonary wedge resection, as well as EBUS- and CT-guided lymph node puncture. Finally, a rare clinical manifestation of Hodgkin lymphoma was diagnosed as the underlying cause of the multiple cavitary lung lesions.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"236-243"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142780722","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":"[Artificial intelligence and machine learning in auscultation: prospects of the project DigitaLung].","authors":"Luca Hilberink, Pia Wehage, Milad Pashai Fakhri, Svenja Gaedcke, David DeLuca, Patricia Mattis, Jessica Rademacher","doi":"10.1055/a-2507-1486","DOIUrl":"10.1055/a-2507-1486","url":null,"abstract":"<p><p>Auscultation is one of the key medical skills in physical examination. The main problem with auscultation is the lack of objectivity of the findings and great dependence on the experience of the examiner. Auscultation using machine learning and neural networks promises great potential for solving these problems in clinical practice.A selective search for studies in PubMed was carried out, which revealed the possibilities of machine learning in medical diagnostics.In all the studies identified, significant differences were shown between the respective test groups in favour of artificial intelligence (AI). In addition to the positive study results, the limitations of AI could also be analysed and critically scrutinised.Medical research in the field of artificial intelligence is still in its infancy. The prospects and limitations of AI must be further investigated and require close attention in the collaboration between clinicians, scientists and AI experts. Publicly funded projects such as DigitaLung (a digital auscultation system for the differential diagnosis of lung diseases using machine learning), which aims to improve lung auscultation using AI, will help to unlock the diagnostic benefits of AI for patient care and could improve care in the future.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"229-235"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143441789","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":"[The reality of bronchoscopy care in Germany: a survey by the German Respiratory Society].","authors":"Kyrill Boschung, Jürgen Hetzel, Ralf-Harto Hübner, Frank Pohl, Marcel Treml, Kaid Darwiche, Ralf Eberhardt, Angelique Holland, Torsten Bauer, Winfried Randerath, Wolfram Windisch, Lars Hagmeyer","doi":"10.1055/a-2491-1609","DOIUrl":"10.1055/a-2491-1609","url":null,"abstract":"<p><p>Bronchoscopy has changed considerably in recent years as a result of technical innovations and health economic pressure. There is little current information available on the reality of bronchoscopy care in Germany.</p><p><strong>Methodology: </strong>In September 2022, sites where bronchoscopy was carried out were systematically surveyed regarding structural and process quality features in an anonymized DGP survey with 33 questions. The data collected were analyzed descriptively.</p><p><strong>Results: </strong>Of the 196 participating sites, bronchoscopies were performed regularly at 180 sites. The majority were standard secondary care (n=51) and tertiary care (n=43) hospitals (range of services: diagnostic bronchoscopy, predominantly (80%) including endobronchial ultrasound-guided transbronchial needle aspiration, EBUS-TBNA). Extended treatment options were guaranteed for acute cases at >90% of these locations. University hospitals (n=24) and specialist pulmonary hospitals (n=35) also offered more complex diagnostic procedures and therapeutic-interventional techniques. The performance figures were significantly higher in the specialist pulmonary hospital (specialist pulmonary hospitals: 62%: >2000 bronchoscopies/year; university hospitals: 25%: >2000 bronchoscopies/year; p<0.001). In the practice setting (n=21, partly in co-operation with hospitals) , <500 bronchoscopies/year were performed.Intensive care units were available in 97% of the hospitals; 88% of the hospitals had fluoroscopy facilities in the bronchoscopy room. Propofol (91%) and/or midazolam (62%) were the preferred drugs for sedation. At 21% of the sites, >200 bronchoscopies under ventilation/year were performed. BAL and transbronchial forceps biopsies were mainly performed via the nasal or oral approach, EBUS-TBNA via a bronchoscopy tube or the oral approach, the EBUS mini-probe/navigation, cryotechnique or more complex interventions via the rigid tube or a bronchoscopy tube. ASA >2 led to involvement of a second physician at 46% of clinical sites, at 47% of sites at an ASA classification >3.</p><p><strong>Conclusion: </strong>The majority of bronchoscopic examinations are performed in respiratory departments at secondary care centres as well as maximum care hospitals. For more complex procedures, cooperation with hospitals specialized in bronchoscopy (e.g. university hospital or a specialist lung clinic) is advisable.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"206-215"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142786506","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":"[Task Force Dyspnoe unit (DU)].","authors":"Dominic Dellweg, Georg Nilius, Achim Grünewaldt, Andreas Günther, Matthias Held, Martin Hetzel, Andreas Schlesinger, Robin Schlott, Georgios Sofianos, Markus Unnewehr, Thomas Voshaar, Winfried Randerath","doi":"10.1055/a-2238-4253","DOIUrl":"10.1055/a-2238-4253","url":null,"abstract":"<p><p>Acute dyspnoea is one of the most common internal medicine symptoms in the emergency department. It arises from an acute illness or from the exacerbation of a chronic illness. Symptom-related emergency structures and corresponding structural guidelines already exist in the stroke and chest pain units for dealing with the leading symptoms of acute stroke and acute chest pain. These are lacking in Germany for the key symptom of dyspnoea, although the benefits of these structures have already been proven in other countries. The German Society for Pneumology and Respiratory Medicine (DGP) has now set up a task force together with the Association of Pneumology Clinics (VPK), in order to deal with the topic and develop appropriate structural guidelines for such \"dyspnoea units\" in Germany. At the end of the process, the certification of such units at German hospitals is optional.</p>","PeriodicalId":20197,"journal":{"name":"Pneumologie","volume":" ","pages":"216-220"},"PeriodicalIF":1.2,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139932489","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}