Thoraxklinik Am Universitatsklinikum Heidelberg

Schönau am Königssee, Germany

Thoraxklinik Am Universitatsklinikum Heidelberg

Schönau am Königssee, Germany
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Magnussen H.,Hospital Grosshansdorf | Kramer M.R.,Beilinson Hospital | Kirsten A.-M.,Hospital Grosshansdorf | Marquette C.,Center Hospitalier University | And 8 more authors.
Thorax | Year: 2012

Rationale: Interlobar fissure integrity has previously correlated with responsiveness to endobronchial lung volume reduction therapy in patients with advanced emphysema. Objective: This report summarises the effect of interlobar fissure integrity on responses to treatment with a novel endoscopic tissue sealant (AeriSeal emphysematous lung sealant (ELS)) that collapses hyperinflated lung. Methods: Fissure status, lung volumes, tissue density and disease heterogeneity were assessed radiographically in 28 patients (age 63.4±6.1 years, 20 men) with advanced upper lobe predominant emphysema (density=888.0±18.2 HU; upper lobe tissue density <-950=2.62±1. 74). Post-treatment changes in lobar volume, pulmonary function, exercise capacity, symptoms and quality of life were compared in patients with complete fissures (CFs) and incomplete fissures (ICFs). Results: ELS therapy reduced lung volumes independent of interlobar fissure integrity. In patients with upper lobe emphysema and CFs, lobar volume reduction was 214±127 ml/treatment compared with 256±175 ml/ treatment in those with ICFs (p=0.453). Reductions in gas trapping and improvements in spirometry, functional capacity and quality of life were similar in patients with CFs and ICFs. Stepwise multiple regression modelling confirmed that fissure integrity did not contribute to post-treatment changes in forced expiratory volume in 1 s, residual volume/total lung capacity ratio or lobar volume measured by CT analysis. Conclusions: Interlobar fissure integrity, an important determinant of responsiveness to endobronchial lung volume reduction therapy in prior studies, had minimal impact on physiological and functional responses to ELS therapy in patients with severe upper lobe predominant emphysema. Clinical trial registration number Registration: numbers for trials contributing to datasets in this report: NCT00884962, NCT01051258 and NCT01181466.

Warth A.,University of Heidelberg | Muley T.,Thoraxklinik am Universitatsklinikum Heidelberg | Muley T.,Translational Lung Research Center Heidelberg H | Dienemann H.,Translational Lung Research Center Heidelberg H | And 8 more authors.
Histopathology | Year: 2014

Aims: Molecular characterization of non-small-cell lung cancer (NSCLC) has revealed multiple druggable mutations for targeted therapies. Recently, chromosomal rearrangements involving c-ros oncogene 1, receptor tyrosine kinase (ROS1) were identified, and patients seem to benefit from crizotinib treatment. The aim of this study was to identify the clinicopathological characteristics of NSCLC with ROS1 expression and translocation. Methods and results: We screened 1478 NSCLCs with a ROS1-specific antibody, and tested positive cases with FISH. All positive cases were analysed for associated clinicopathological characteristics, including survival and molecular tumour composition. Sixty-eight cases (4.6%) showed ROS1 immunoreactivity, and ROS1 translocations were confirmed in nine cases (0.6%). ROS1 expression was predominantly found in female adenocarcinoma patients, in patients with low T stages, and in association with TTF1 and napsin expression, and certain histomorphological adenocarcinoma patterns (lepidic, acinar, and solid). ROS1 translocations occurred in conjunction with other driver mutations (EGFR, KRAS, and BRAF). ROS1 expression was found to be a stage-independent predictor of favourable survival. Conclusions: ROS1 translocations are rare events in resected NSCLCs from Caucasian patients. Immunohistochemical screening for ROS1 expression and clinicopathological parameters, including female sex, early tumour stages, adenocarcinomas with TTF1 and/or napsin expression, and a distinct histomorphological growth pattern, strongly facilitate case enrichment. Molecularly driven multistep concepts might not be optimal for case selection. © 2014 John Wiley & Sons Ltd.

Ley S.,University of Heidelberg | Grunig E.,Thoraxklinik Am Universitatsklinikum Heidelberg | Kiely D.G.,Royal Hallamshire Hospital | Van Beek E.,University of Edinburgh | Wild J.,University of Sheffield
Journal of Magnetic Resonance Imaging | Year: 2010

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.

Burki N.K.,University of Connecticut Health Center | Mani R.K.,Artemis Health | Herth F.J.F.,Thoraxklinik Am Universitatsklinikum Heidelberg | Schmidt W.,Thoraxklinik Am Universitatsklinikum Heidelberg | And 13 more authors.
Chest | Year: 2013

Background : Hypercapnic respiratory failure in patients with COPD frequently requires mechanical ventilatory support. Extracorporeal CO 2removal (ECCO2R) techniques have not been systematically evaluated in these patients. Methods : This is a pilot study of a novel ECCO2R device that utilizes a single venous catheter with high CO2removal rates at low blood flows. Twenty hypercapnic patients with COPD received ECCO2R. Group 1 (n = 7) consisted of patients receiving noninvasive ventilation with a high likelihood of requiring invasive ventilation, group 2 (n = 2) consisted of patients who could not be weaned from noninvasive ventilation, and group 3 (n = 11) consisted of patients on invasive ventilation who had failed attempts to wean. Results: The device was well tolerated, with complications and rates similar to those seen with central venous catheterization. Blood flow through the system was 430.5 ± 73.7 mL/min, and ECCO2R was 82.5 ± 15.6 mL/min and did not change significantly with time. Invasive ventilation was avoided in all patients in group 1 and both patients in group 2 were weaned; Pa CO2decreased significantly (P < .003) with application of the device from 78.9 ± 16.8 mm Hg to 65.9 ± 11.5 mm Hg. In group 3, three patients were weaned, while the level of invasive ventilatory support was reduced in three patients. One patient in group 3 died due to a retroperitoneal bleed following catheterization. Conclusions: This single-catheter, low-flow EC CO2R system provided clinically useful levels of CO2removal in these patients with COPD. The system appears to be a potentially valuable additional modality for the treatment of hypercapnic respiratory failure. © 2013 American College of Chest Physicians.

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.

Kreuter M.,Thoraxklinik Am Universitatsklinikum Heidelberg | Herth F.J.F.,Thoraxklinik Am Universitatsklinikum Heidelberg
Klinikarzt | Year: 2011

COPD is characterized by a not fully reversible airflow obstruction. Recent data have shown that, besides the pulmonary limitations in COPD, specific diseases also may contribute to the clinical appearance of COPD. In this context, cardiovascular diseases, kachexia, muscle atrophy und weakness as well as osteoporosis, metabolic syndrome, lung cancer, depression and anxiety are more frequent in COPD patients than in smokers without airflow limitations. Furthermore, COPD might be an inflammatory disease which rises hope to establish new targets in COPD treatment in future. © Georg Thieme Verlag KG Stuttgart · New York.

Herth F.J.F.,Thoraxklinik Am Universitatsklinikum Heidelberg
Frontiers of Radiation Therapy and Oncology | Year: 2010

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.

Zabeck H.,Thoraxklinik am Universitatsklinikum Heidelberg
The Thoracic and cardiovascular surgeon | Year: 2011

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.

Steins M.B.,Thoraxklinik Am Universitatsklinikum Heidelberg
Atemwegs- und Lungenkrankheiten | Year: 2015

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.

Steins M.B.,Thoraxklinik am Universitatsklinikum Heidelberg
Atemwegs- und Lungenkrankheiten | Year: 2013

A consequent pain management together with treatment of dyspnoea belongs to the main issues in symptom control of palliative patients with thoracic oncology malignancies. The therapeutic fundament according to the WHO guidelines for cancer pain is the opiate-based medicamentous adjustment combined with non-opioides. In principle, this should be performed preferably orally, as simple as possible, according to a fix drug schedule and individually adjusted to the needed dosage. The typical adverse reaction profile for opiates, like constipation and initial nausea, should be considered prophylactically by applying concurrent medication. © 2013 Dustri-Verlag Dr. Karl Feistle.

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