{"title":"Atemnot, Therapiemaßnahmen und Problemlösungen","authors":"M. Raspe","doi":"10.1159/000501411","DOIUrl":"https://doi.org/10.1159/000501411","url":null,"abstract":"Ein Patient mit akutem Atemnotsyndrom, dessen Röntgenund CT-Thorax deutliche Auffälligkeiten zeigen, beschäftigt die Blickdiagnosen dieser Ausgabe. Ob Sie mit Ihrer Diagnose richtig liegen, können Sie wie immer auf der KARGER-KOMPASS-PNEUMOLOGIE -Webseite überprüfen. Wie angekündigt setzen wir unsere kleine Serie zu den aktuellen Therapiemaßnahmen beim nicht kleinzelligen Lungenkarzinom (NSCLC) fort – in diesem Heft widmet sich der Steckbrief dem Tumorstadium III. Wer Ihre erste Anlaufstelle bei Problemen in der Weiterbildung sein könnte, verrät Ihnen ein neuer «Überlebenstipp für die Weiterbildung». Karger Kompass Pneumol 2019;7:205–208 DOI: 10.1159/000501411","PeriodicalId":306175,"journal":{"name":"Karger Kompass Pneumologie","volume":"3 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"115346205","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":"Prospektive Analyse des Vorhersagewertes der sonographischen Pleuraerguss-Echogenität für die Diagnose eines Exsudats","authors":"F. Stanzel","doi":"10.1159/000501322","DOIUrl":"https://doi.org/10.1159/000501322","url":null,"abstract":"Background: Pleural effusion echogenicity on ultrasound has previously been suggested to allow identification of exudates. A case series suggested that homogenously echogenic effusions are always exudates. With modern imaging techniques and more advanced ultrasound technology, this may no longer be true. Objectives: This study aims to prospectively assess the predictive value of echogenicity in the identification of exudates. Method: Patients undergoing thoracic ultrasound before pleural fluid sampling were analysed prospectively (n = 140). Pleural fluid was classified as an exudate if both fluid total protein (TP) > 29 g/L and fluid lactate dehydrogenase (LDH) > 2/3 upper limit of normal serum LDH (which is 255 IU/L in females and 235 IU/L in males) were present. If only one of these criteria was met, the effusion was considered to have discordant biochemistry. Results: Fifty-five (39%) patients had non-echogenic and 85 (61%) had echogenic effusions. Six (7.1%) patients with echogenic effusions had transudates; the median fluid TP for this group was 18.5 g/L (IQR 9.75) and median LDH 63.0 IU/L (IQR 40.3). The specificity of echogenicity identifying exudates from transudates, excluding patients with discordant biochemistry, was 57.1%, positive predictive value (PPV) 90.3%, sensitivity 65.1%, and negative predictive value (NPV) 21.0%. The specificity of echogenicity identifying exudates (including discordant biochemistry) from transudates was 57.1%, PPV 92.9%, sensitivity 62.7%, and NPV 14.5%. Conclusions: Echogenicity of a pleural effusion has a low specificity for identifying an underlying exudate, and the echogenic qualities of the fluid should not influence clinical decisionmaking.","PeriodicalId":306175,"journal":{"name":"Karger Kompass Pneumologie","volume":"7 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"130688634","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":"Verdachtsmomente, Therapiesteckbriefe und Eigenverantwortung","authors":"M. Raspe","doi":"10.1159/000500302","DOIUrl":"https://doi.org/10.1159/000500302","url":null,"abstract":"LOGIE -Webseite. Dieses Heft bildet den Auftakt zu einer kleinen Serie, die sich steckbriefartig den aktuellen Therapiemaßnahmen beim nicht kleinzelligen Lungenkarzinom (NSCLC) widmet. Sie wird in den noch ausstehenden Ausgaben des aktuellen Jahrgangs unserer Zeitschrift fortgeführt und beginnt mit den Tumorstadien I und II. Als Abschluss der Rubrik finden Sie wieder einen «Überlebenstipp für die Weiterbildung». Karger Kompass Pneumol 2019;7:156–158 DOI: 10.1159/000500302","PeriodicalId":306175,"journal":{"name":"Karger Kompass Pneumologie","volume":"60 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"124377062","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}
Ilektra Voulgareli, Alexandra Chronaiou, D. Tsoukalas, George Tsoukalas
{"title":"Ein seltener Fall von Lipidpneumonie durch Amiodaron","authors":"Ilektra Voulgareli, Alexandra Chronaiou, D. Tsoukalas, George Tsoukalas","doi":"10.1159/000499747","DOIUrl":"https://doi.org/10.1159/000499747","url":null,"abstract":"Wir berichten über einen Fall endogener Lipidpneumonie infolge Langzeitanwendung (≥ 30 Jahre) von Amiodaron zur Behandlung von Vorhofflimmern bei einer 76-jährigen Patientin kaukasischer Abstammung, die sich mit Husten und Dyspnoe bei uns vorstellte. Die endogene Lipidpneumonie ist eine seltene und unterdiagnostizierte Krankheit, die häufiger bei Erwachsenen auftritt. Sie verläuft normalerweise asymptomatisch und wird meist bei Patienten diagnostiziert, die klinisch instabil geworden sind, oder wenn im Thoraxröntgenbild eine abnorme Verschattung der Lunge erkennbar ist. In dem hier vorgestellten Fall erfolgte die Diagnosestellung durch fiberoptische Bronchoskopie mit Gewinnung von Flüssigkeit nach bronchoalveolärer Lavage (BALF), in der fettbeladene Makrophagen (Oil-Red-O-Färbung) zu finden waren. Da die Anwendung ölhaltiger Produkte anamnestisch ausgeschlossen worden war, wurde Amiodaron für die wahrscheinlichste Ursache der Lipidpneumonie gehalten. Die Behandlung wurde von Amiodaron auf Digoxin umgestellt und die Patientin erhielt oral Prednisolon. Während der 2-jährigen Nachbeobachtungsdauer blieb die Patientin klinisch stabil und die radiologischen Zeichen gingen zurück.","PeriodicalId":306175,"journal":{"name":"Karger Kompass Pneumologie","volume":"186 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"116421126","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":"Teilen durch Null","authors":"H. Walach","doi":"10.1159/000500386","DOIUrl":"https://doi.org/10.1159/000500386","url":null,"abstract":"seinen Organen, seinen Zellen, deren Organellen und Makromolekülen, und reicht mit allen möglichen Proben bereits in den Nanobereich der Materie. Betrachten wir also mal diese Materie. Eigentlich sind 99,999999999999% davon «Nichts», Leere. Ein Atomkern ist so ähnlich wie ein Basketball in einem Spielfeld und in etwa 3 km Entfernung kommt dann das Elektron. Es hat nur deswegen die gefühlte «Dichte» und Widerständigkeit eines Körpers, weil die Elektronen dazwischen ausgeschmiert sind und mit einer Frequenz von ungefähr 10 12","PeriodicalId":306175,"journal":{"name":"Karger Kompass Pneumologie","volume":"31 4","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"114119759","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":"Hämoptysen: Wann ist die Bronchoskopie besonders wertvoll?","authors":"M. Wagner","doi":"10.1159/000499953","DOIUrl":"https://doi.org/10.1159/000499953","url":null,"abstract":"Background: Bronchoscopy plays a key role to diagnose the etiology, to localize the site, and to identify the sources of the bleeding in patients with hemoptysis, but the ideal timing of an endoscopic examination is still unclear. Methods: We performed a secondary analysis of an observational and multicenter study, aimed at evaluating the epidemiology of hemoptysis in Italy and the diagnostic yield of the most frequently prescribed examinations. The aim of the study was to evaluate whether an early bronchoscopy (i.e., performed during active bleeding/≤48 h after hemoptysis stopped) helps localize bleeding (i.e., site, lobe, lung) and increase diagnostic yield in comparison with a delayed examination. Results: Four hundred eighty-six consecutive adult patients (69.2% males; median [IQR] age: 67 [53-76] years) with hemoptysis requiring an etiological diagnosis and undergoing bronchoscopy were recruited. Bleeding focus could be located more frequently in case of moderate-severe bleedings than in cases of mild hemoptysis (site: 70/154, 45.4%, VS. 73/330, 22.1%; p-value < 0.0001; lobe: 95/155, 61.3%, VS. 95/331, 28.7%; p-value < 0.0001; lung: 101/155, 65.1%, VS. 111/331, 33.5%; p-value < 0.0001). Early bronchoscopy showed a higher detection rate of bleeding source in comparison with delayed examination (site: 76/214, 35.5%, VS. 67/272, 24.6%; p-value = 0.01; lobe: 98/214, 45.8%, VS. 92/272, 33.8%; p-value = 0.007; lung: 110/214, 51.4%, VS. 102/272, 37.5%; p-value = 0.002). Early bronchoscopy did not provide any advantages in terms of increased diagnostic yield, in the total cohort (113/214, 52.8%, VS. 123/272, 45.2%; p-value = 0.10) and in the severity subtypes (mild: 56/128, 43.8%, VS. 88/203, 43.4%; p-value = 0.94; moderate-severe: 57/86, 66.2%, VS. 35/69, 50.7%; p-value = 0.051). Conclusions: Early bronchoscopy helps detect bleeding sources, particularly in cases of moderate-severe hemoptysis, without increasing diagnostic accuracy. Trial registration: ClinicalTrials.gov (identifier: NCT02045394).","PeriodicalId":306175,"journal":{"name":"Karger Kompass Pneumologie","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2019-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"123144369","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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