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Despite advances in chemotherapy treatment, the prognosis for patients with advanced lung cancer still remains serious accompanied by devastating effects on physical well-being, psychological health and psychosocial care. Although chemotherapy is accepted as an effective treatment, the high prevalence of disease-specific symptoms, depressed mood and aggressive end-of-life care highlight the need for palliative care to minimise symptom distress and promote quality of life. In this context, a randomised palliative intervention trial performed by Temel et al. in Boston, USA (N Engl J Med 2010) was remarkable comparing standard oncological chemotherapy alone with an early palliative concept integrated into standard chemotherapy in patients with newly diagnosed metastatic non-small cell lung cancer (NSCLC). The results show that those patients receiving additional palliative care had a better quality of life and less depressive symptoms than did patients assigned to the standard therapy alone. In addition, median survival of patients in the palliative care group was significantly prolonged for 2.7 months compared to standard therapy alone. Data support the incorporation of early palliative care into the therapeutic concept for metastatic NSCLC. © Springer-Verlag 2012. Source

Zabeck H.,Thoraxklinik Am Universitatsklinikum Heidelberg
The Thoracic and cardiovascular surgeon

The aim of this retrospective study was to analyze the etiology, management and outcome of patients with chylothorax and identify clinical parameters for appropriate treatment decisions. We analyzed 82 cases of chylothorax in 75 patients. In 37 cases (45 %) the cause of chylothorax was surgery, in 45 cases (55 %), the etiology was nonsurgical (malignancy n = 17 [21 %], lymphatic disorders n = 5 [6 %], hepatic cirrhosis, n = 4 [5 %], trauma n = 1 and other causes n = 18 [22 %]). Conservative treatment was successful in 13 (16 %) cases. In 25 cases (total 31 %, postsurgical n = 19 [51 %], nonsurgical n = 6 [13 %]) a (redo) thoracotomy with ligation of the thoracic duct or repeat surgical procedure was performed. The quantity of chyle drained per 24 hours appeared to be the best indicator to guide management decisions. Chylothoraces that occur postoperatively following thoracic procedures require redo operations in approximately 50 % of cases, whereas nonsurgical causes rarely require surgical intervention. In postoperative chylothoraces with a high flow leak > 900 mL/24 h revision should be performed early on, since conservative management is likely to be unsuccessful. © Georg Thieme Verlag KG Stuttgart · New York. Source

Herth F.J.F.,Thoraxklinik Am Universitatsklinikum Heidelberg
Frontiers of Radiation Therapy and Oncology

Endobronchial ultrasound (EBUS) has emerged as a new diagnostic tool that allows the bronchoscopist to see beyond the airway. The radial probe EBUS was first introduced to evaluate the airway structure, which has been shown to be useful for identifying the extent of tumor invasion in the central airway. The newest development is the convex EBUS-TBNA scope with a curvilinear electronic transducer on the tip of a flexible videoscope. Linear EBUS allows a real-time EBUS-guided TBNA. Although the main indication for EBUS-TBNA is lymph node staging, it can also be used for diagnosis of intrapulmonary tumors, of unknown hilar and/or mediastinal lymphadenopathy, and of mediastinal tumors. To date, there are no reports of complications related to EBUS-guided TBNA. It is a novel approach that has a good diagnostic yield with excellent potential in assisting safe and accurate diagnostic interventional bronchoscopy. The aim of this review is to highlight the current status of the EBUS-TBNA technique and to discuss the future direction of EBUS. © 2010 S. Karger AG. Source

Steins M.B.,Thoraxklinik Am Universitatsklinikum Heidelberg
Atemwegs- und Lungenkrankheiten

In metastasized lung cancer palliative care is of particular importance for patients. This includes besides the control of dyspnea, pain and further encumbering symptoms like tiredness, fatigue and nausea also psychological and psychosocial components. Frequent contact through consultations with patients and their relatives, support for coping with the disease and decision making at the end of life should be offered to the affected patients as a comprehensive concept of care early after diagnosis. Studies and surveys have shown that such an early palliative care concept results in improved quality of life and mental conditions in patients and their families. © 2015 Dustri-Verlag Dr. Karl Feistle. Source

Ley S.,University of Heidelberg | Grunig E.,Thoraxklinik Am Universitatsklinikum Heidelberg | Kiely D.G.,Pulmonary Vascular Disease Unit | Van Beek E.,University of Edinburgh | Wild J.,University of Sheffield
Journal of Magnetic Resonance Imaging

Pulmonary hypertension (PH) is very heterogeneous and the classification identifies five major groups including many associated disease processes. The treatment of PH depends on the underlying cause and accurate classification is paramount. A comprehensive assessment to identify the cause and severity of PH is therefore needed. Furthermore, follow-up assessments are required to monitor changes in disease status and response to therapy. Traditionally, the diagnostic imaging work-up of PH comprised mainly echocardiography, invasive right heart catheterization, and ventilation/perfusion scintigraphy. Due to technical advances, multidetector row computed tomography (CT) and magnetic resonance imaging (MRI) have become important and complementary investigations in the evaluation of patients with suspected PH. Both modalities are reviewed and recommendations for clinical use are given. © 2010 Wiley-Liss, Inc. Source

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