1
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Rath A, Kieninger B, Fritsch J, Caplunik-Pratsch A, Blaas S, Ochmann M, Pfeifer M, Hartl J, Holzmann T, Schneider-Brachert W. Whole-genome sequencing reveals two prolonged simultaneous outbreaks involving Pseudomonas aeruginosa high-risk strains ST111 and ST235 with resistance to quaternary ammonium compounds. J Hosp Infect 2024; 145:155-164. [PMID: 38286239 DOI: 10.1016/j.jhin.2024.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 01/09/2024] [Accepted: 01/15/2024] [Indexed: 01/31/2024]
Abstract
OBJECTIVE Water-bearing systems are known as frequent Pseudomonas aeruginosa (PA) outbreak sources. However, many older buildings continue to have sanitary facilities in high-risk departments such as the ICU. We present two simultaneous prolonged multi-drug-resistant (MDR) PA outbreaks detected at the ICU of a pulmonology hospital, which were resolved by whole-genome sequencing (WGS). METHODS Outbreak management and investigations were initiated in August 2019 after detecting two patients with nosocomial VIM-2-positive MDR PA. The investigations involved weekly patient screenings for four months and extensive environmental sampling for 15 months. All patient and environmental isolates were collected and analysed by WGS. RESULTS From April to September 2019, we identified 10 patients with nosocomial MDR PA, including five VIM-2-positive strains. VIM-2-positive strains were also detected in nine sink drains, two toilets, and a cleaning bucket. WGS revealed that of 16 VIM-2-positive isolates, 14 were ST111 that carried qacE, or qacEΔ1 genes, whereas 13 isolates clustered (difference of ≤11 alleles by cgMLST). OXA-2 (two toilets), and OXA-2, OXA-74, PER-1 (two patients, three toilets) qacEΔ1-positive ST235 isolates dominated among VIM-2-negative isolates. The remaining seven PA strains were ST17, ST233, ST273, ST309 and ST446. Outbreak containment was achieved by replacing U-bends, and cleaning buckets, and switching from quaternary ammonium compounds (QUATs) to oxygen-releasing disinfectant products. CONCLUSION Comprehension and management of two simultaneous MDR PA outbreaks involving the high-risk strains ST111 and ST235 were facilitated by precise control due to identification of different outbreak sources per strain, and by the in-silico detection of high-level QUATs resistance in all isolates.
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Affiliation(s)
- A Rath
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany.
| | - B Kieninger
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - J Fritsch
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - A Caplunik-Pratsch
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - S Blaas
- Donaustauf Hospital, Centre for Pneumology, Donaustauf, Germany
| | - M Ochmann
- Donaustauf Hospital, Centre for Pneumology, Donaustauf, Germany
| | - M Pfeifer
- Donaustauf Hospital, Centre for Pneumology, Donaustauf, Germany; Department of Internal Medicine II, University Hospital Regensburg, Regensburg, Germany; Hospital of the Merciful Brother Regensburg, Regensburg, Germany
| | - J Hartl
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany; Hospital of the Merciful Brother "St. Barbara", Schwandorf, Germany
| | - T Holzmann
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
| | - W Schneider-Brachert
- Department of Infection Prevention and Infectious Diseases, University Hospital Regensburg, Regensburg, Germany
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2
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Hartmann B, Tittel SR, Femerling M, Pfeifer M, Meyhöfer S, Lange K, Milek S, Stemler L, Best F, Holl RW. COVID-19 Lockdown Periods in 2020: Good Maintenance of Metabolic Control in Adults with Type 1 and Type 2 Diabetes. Exp Clin Endocrinol Diabetes 2022; 130:621-626. [PMID: 35181878 DOI: 10.1055/a-1743-2537] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
During the COVID-19 pandemic, there were increased concerns about glycemic control in patients with diabetes. Therefore, we aimed to assess changes in diabetes management during the COVID-19 lockdown for patients with type 1 or type 2 diabetes mellitus (T1DM, T2DM) in Germany. We included data from 24,623 patients (age>18 years) with T1DM (N=6,975) or T2DM (N=17,648) with documented data in 2019 and 2020 from the multicenter Diabetes-Prospective Follow-up registry (DPV). We conducted a groupwise comparison of identical patients in 2019 and 2020 for different time periods of pandemia. Pairwise differences of continuous parameters of treatment modalities and metabolic outcome between 2019 and 2020 were adjusted for seasonality, age, and diabetes duration. We presented these outcomes as adjusted medians with 95% confidence intervals. Rates were compared using negative-binomial models, dichotomous outcomes were compared using logistic models. Models were additionally adjusted for age and diabetes duration. These outcomes were presented as least-square means with 95% confidence intervals, p-values of<.05 were considered significant.In participants with T1DM, CGI (combined glucose indicator) increased only by 0.11-0.12% in all time periods of 2020 compared to 2019 (all p<0.001) while BMI decreased slightly by -(0.09-0.10) kg/m² (p<0.0001). In participants with T2DM, HbA1c increased by 0.12%, while BMI decreased slightly by -(0.05-0.06) kg/m² (p<0.0001).During the COVID-19 lockdown period, patients with T1DM and T2DM experienced only clinically insignificant changes in glucose control or body weight. Despite lockdown restrictions, patients were able to maintain metabolic control.
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Affiliation(s)
- B Hartmann
- Heilig-Geist Hospital, Department of Gastroenterology and Diabetology, Bensheim, Germany
| | - S R Tittel
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
| | | | - M Pfeifer
- Klinik Tettnang GmbH, Tettnang, Germany
| | - S Meyhöfer
- German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany.,University of Lübeck, Institute for Endocrinology and Diabetes, Lübeck, Germany.,Department of Internal Medicine 1, Endocrinology & Diabetes, University of Lübeck, Lübeck, Germany
| | - K Lange
- Hanover Medical School, Department of Medical Psychology, Hanover, Germany
| | - S Milek
- Diabetes-Schwerpunkt und Schulungspraxis, Hohenmölsen, Germany
| | - L Stemler
- Diabetologikum DDG Ludwigshafen, Ludwigshafen, Germany
| | - F Best
- Specialized diabetes practice, Essen, Germany
| | - R W Holl
- Institute for Epidemiology and Medical Biometry, ZIBMT, Ulm University, Ulm, Germany.,German Centre for Diabetes Research (DZD), Munich-Neuherberg, Germany
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3
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Koczulla AR, Ankermann T, Behrends U, Berlit P, Böing S, Brinkmann F, Franke C, Glöckl R, Gogoll C, Hummel T, Kronsbein J, Maibaum T, Peters EMJ, Pfeifer M, Platz T, Pletz M, Pongratz G, Powitz F, Rabe KF, Scheibenbogen C, Stallmach A, Stegbauer M, Wagner HO, Waller C, Wirtz H, Zeiher A, Zwick R. [S1 Guideline "Post-COVID/Long-COVID"]. Chirurg 2022. [PMID: 35041036 DOI: 10.1007/s00104-021-01543-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
- A R Koczulla
- LL-Sekretariat Anja Flender, Schön Klinik Berchtesgadener Land, Malterhöh 1, 83471, Schönau am Königssee, Deutschland.
| | - T Ankermann
- Gesellschaft für Pädiatrische Pneumologie (DGPP), Berlin, Deutschland
| | - U Behrends
- Chronisches Fatigue Centrum, Klinikum rechts der Isar der Technischen Universität München, München, Deutschland
| | - P Berlit
- Deutsche Gesellschaft f. Neurologie (DGN), Berlin, Deutschland
| | - S Böing
- Berufsverband der Pneumologen (BdP), Heidenheim, Deutschland
| | - F Brinkmann
- Gesellschaft für Pädiatrische Pneumologie (DGPP), Berlin, Deutschland
| | - C Franke
- Berufsverband der Pneumologen (BdP), Heidenheim, Deutschland
| | - R Glöckl
- Deutsche Gesellschaft f. Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - C Gogoll
- Deutsche Gesellschaft f. Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - T Hummel
- Deutsche Gesellschaft für Hals-Nasen-Ohren-Heilkunde, Kopf- und Hals-Chirurgie e.V., Bonn, Deutschland
| | - J Kronsbein
- Deutsche gesetzliche Unfallversicherung (DGUV), Berlin, Deutschland
| | - T Maibaum
- Deutsche Gesellschaft f. Neurologie (DGN), Berlin, Deutschland
| | - E M J Peters
- Deutsche Gesellschaft f. Psychosomatische Medizin und Ärztliche Psychotherapie (DGPM), Stuttgart, Deutschland
| | - M Pfeifer
- Deutsche Gesellschaft f. Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - T Platz
- Deutsche Gesellschaft für Neurorehabilitation (DGNR), Rheinbach, Deutschland
| | - M Pletz
- Sektion Infektiologie, Paul Ehrlich Gesellschaft für Chemotherapie e.V. (PEG), Köln, Deutschland
| | - G Pongratz
- Deutsche Schmerzgesellschaft der Deutschen Migräne und Kopfschmerzgesellschaft, Königstein im Taunus, Deutschland.,Deutsche Gesellschaft für Rheumatologie, Berlin, Deutschland
| | - F Powitz
- Berufsverband der Pneumologen (BdP), Heidenheim, Deutschland
| | - K F Rabe
- Deutsche Gesellschaft f. Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | | | - A Stallmach
- Deutsche Gesellschaft f. Gastroenterologie, Verdauungs- und Stoffwechselerkrankungen (DGVS), Berlin, Deutschland.,Deutsche Gesellschaft f. Infektiologie (DGI), Berlin, Deutschland
| | - M Stegbauer
- Deutsche gesetzliche Unfallversicherung (DGUV), Berlin, Deutschland
| | - H O Wagner
- Deutsche Gesellschaft f. Allgemeinmedizin und Familienmedizin (DEGAM), Berlin, Deutschland
| | - C Waller
- Deutsches Kollegium für Psychosomatische Medizin (DKPM), Berlin, Deutschland
| | - H Wirtz
- Deutsche Gesellschaft f. Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - A Zeiher
- Deutsche Gesellschaft f. Kardiologie - Herz- und Kreislaufforschung (DGK), Düsseldorf, Deutschland
| | - R Zwick
- Österreichische Gesellschaft für Pneumologie (ÖGP), Wien, Österreich
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4
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Kluge S, Janssens U, Welte T, Weber-Carstens S, Schälte G, Salzberger B, Gastmeier P, Langer F, Welper M, Westhoff M, Pfeifer M, Hoffmann F, Böttiger BW, Marx G, Karagiannidis C. Recommendations for treatment of critically ill patients with COVID-19 : Version 3 S1 guideline. Anaesthesist 2021; 70:19-29. [PMID: 33245382 PMCID: PMC7694585 DOI: 10.1007/s00101-020-00879-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Since December 2019 a novel coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2) has rapidly spread around the world resulting in an acute respiratory illness pandemic. The immense challenges for clinicians and hospitals as well as the strain on many healthcare systems has been unprecedented.The majority of patients present with mild symptoms of coronavirus disease 2019 (COVID-19); however, 5-8% become critically ill and require intensive care treatment. Acute hypoxemic respiratory failure with severe dyspnea and an increased respiratory rate (>30/min) usually leads to intensive care unit (ICU) admission. At this point bilateral pulmonary infiltrates are typically seen. Patients often develop a severe acute respiratory distress syndrome (ARDS).So far, remdesivir and dexamethasone have shown clinical effectiveness in severe COVID-19 in hospitalized patients. The main goal of supportive treatment is to ascertain adequate oxygenation. Invasive mechanical ventilation and repeated prone positioning are key elements in treating severely hypoxemic COVID-19 patients.Strict adherence to basic infection control measures (including hand hygiene) and correct use of personal protection equipment (PPE) are essential in the care of patients. Procedures that lead to formation of aerosols should be carried out with utmost precaution and preparation.
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Affiliation(s)
- S Kluge
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Germany.
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Germany.
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Germany.
- ARDS Netzwerk Deutschland, Berlin, Germany.
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
| | - U Janssens
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Germany
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Germany
- ARDS Netzwerk Deutschland, Berlin, Germany
| | - T Welte
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Germany
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Germany
- ARDS Netzwerk Deutschland, Berlin, Germany
| | - S Weber-Carstens
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Germany
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Germany
- ARDS Netzwerk Deutschland, Berlin, Germany
| | - G Schälte
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Germany
| | - B Salzberger
- Deutsche Gesellschaft für Infektiologie (DGI), Munich, Germany
| | - P Gastmeier
- Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM), Münster, Germany
| | - F Langer
- Gesellschaft für Thrombose und Hämostaseforschung (GTH), Cologne, Germany
| | - M Welper
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Germany
| | - M Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Germany
| | - M Pfeifer
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Germany
| | - F Hoffmann
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Germany
- Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ), Berlin, Germany
| | - B W Böttiger
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Germany
- Deutscher Rat für Wiederbelebung (German Resuscitation Council, GRC), Ulm, Germany
| | - G Marx
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Germany
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Germany
- ARDS Netzwerk Deutschland, Berlin, Germany
| | - C Karagiannidis
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Germany
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Germany
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Germany
- ARDS Netzwerk Deutschland, Berlin, Germany
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5
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Dellweg D, Lepper PM, Nowak D, Köhnlein T, Olgemöller U, Pfeifer M. [Statement of the German Society for Pulmonology and Respiratory Medicine Regarding the Regulation to Use FFP and Surgical Masks in the General Population]. Pneumologie 2021; 75:181-186. [PMID: 33598902 DOI: 10.1055/a-1375-6717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
On January 19, 2021, a new regulation on the mask requirement was issued in an initiative by the federal and state governments. This regulation obliges citizens to wear medical masks on public transport and in shops. In its statement, the German Society for Pneumology and Respiratory Medicine (DGP) describes the technical background of the various medical masks and explains their functionality using the associated standards. The DGP comes to the conclusion that FFP masks of the EN 149 standard were designed for the self-protection of the wearer and ensure this if the mask is worn properly and closes tightly to the face. Incorrect use must be avoided at all costs. Surgical masks in accordance with the EN 14683 standard were designed to protect against bacteria-carrying aerosols and, due to their design, have a rather low self-protection component. Community masks are not yet subject to any official standard. Community masks with electrostatic properties and high filtration performance could represent a reusable alternative in the future. Depending on the severity of their illness, patients with heart and/or lung diseases require a stress test with a mask to minimize medical risks.
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Affiliation(s)
- D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg Grafschaft
| | - P M Lepper
- Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - D Nowak
- Klinikum der Universität München, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München, Mitglied des Deutschen Zentrums für Lungenforschung (DZL), München
| | - T Köhnlein
- Pneumologisches Facharztzentrum Teuchern, Teuchern
| | - U Olgemöller
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen
| | - M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg.,Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf.,Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg
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6
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Gehlen M, Schwarz-Eywill M, Hinz C, Pfeifer M, Siebers-Renelt U, Ratanski M, Maier A. [Rehabilitation of orphan diseases in adulthood: osteogenesis imperfecta]. Z Rheumatol 2021; 80:29-42. [PMID: 33259008 DOI: 10.1007/s00393-020-00927-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Osteogenesis imperfecta (brittle bone disease) is an orphan disease caused by a genetic mutation in collagen metabolism. Bone fractures are the most common symptoms; however, the clinical manifestation can vary widely. Additional features can include blue sclera, dwarfism, bone deformities, muscular weakness, scoliosis, hearing loss and hypermobility of joints. Most patients show a reduction of skeletal function. This leads to an increased risk of being unable to continue their former work and to participate in social life. A comprehensive treatment includes drug therapy, surgery and rehabilitation. This article gives an overview of the current status of rehabilitation in adult patients with osteogenesis imperfecta.
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Affiliation(s)
- M Gehlen
- Fachklinik für Rheumatologie, Orthopädie und Osteologie, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland.
| | - M Schwarz-Eywill
- Fachklinik für Rheumatologie, Orthopädie und Osteologie, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland
| | - C Hinz
- Fachklinik für Rheumatologie, Orthopädie und Osteologie, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland
| | - M Pfeifer
- Fachklinik für Rheumatologie, Orthopädie und Osteologie, Osteologisches Schwerpunkt- und Forschungszentrum DVO, Klinik Der FÜRSTENHOF, Am Hylligen Born 7, 31812, Bad Pyrmont, Deutschland
| | - U Siebers-Renelt
- Institut für Humangenetik, Universitätsklinikum Münster, Münster, Deutschland
| | - M Ratanski
- St. Josef Stift, Abteilung für Rheumatologie, Nordwestdeutsches Rheumazentrum, Sendenhorst, Deutschland
| | - A Maier
- St. Josef Stift, Abteilung für Rheumatologie, Nordwestdeutsches Rheumazentrum, Sendenhorst, Deutschland
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7
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Abstract
The logistical and infectious peculiarities and requirements challenge the intensive care treatment teams aiming at a successful liberation of patients from long-term mechanical ventilation. Especially in the pandemic, it is therefore important to use all potentials for weaning and decannulation, respectively, in patients with prolonged weaning.Weaning centers represent units of intensive medical care with a particular specialization in prolonged weaning. They are an integral part of a continuous care concept for these patients. A systematic weaning concept in the pandemic includes structural, personnel, equipment, infectiological and hygienic issues. In addition to the S2k guideline "Prolonged weaning" this position paper hightlights a new classification in prolonged weaning and organizational structures required in the future for the challenging pandemic situation. Category A patients with high weaning potential require a structured respiratory weaning in specialized weaning units, so as to get the greatest possible chance to realize successful weaning. Patients in category B with low or currently nonexistent weaning potential should receive a weaning attempt after an intermediate phase of further stabilization in an out-of-hospital ventilator unit. Category C patients with no weaning potential require a permanent out-of-hospital care, alternatively finishing mechanical ventilation with palliative support.Finally, under perspective in the position paper the following conceivable networks and registers in the future are presented: 1. locally organized regional networks of certified weaning centers, 2. a central, nationwide register of weaning capacities accordingly the already existing DIVI register and 3. registration of patients in difficult or prolonged weaning.
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Affiliation(s)
- M Westhoff
- Klinik für Pneumologie, Schlaf- und Beatmungsmedizin, Lungenklinik Hemer, Zentrum für Pneumologie und Thoraxchirurgie, Hemer
- Universität Witten-Herdecke, Witten
| | - J Geiseler
- Medizinische Klinik IV: Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Klinikum Vest GmbH, Paracelsus-Klinik, Marl
| | - B Schönhofer
- Pneumologische Praxis und pneumologischer Konsildienst im Klinikum Agnes Karll Laatzen, Klinikum Region Hannover, Laatzen, Germany
| | - M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
- Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg
| | - D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg
| | - M Bachmann
- Klinik für Intensiv- und Beatmungsmedizin, Asklepios-Klinik Harburg, Hamburg
| | - W Randerath
- Institut für Pneumologie an der Universität zu Köln, Köln
- Klinik für Pneumologie, Krankenhaus Bethanien, Solingen
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8
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Kluge S, Janssens U, Welte T, Weber-Carstens S, Schälte G, Spinner CD, Malin JJ, Gastmeier P, Langer F, Wepler M, Westhoff M, Pfeifer M, Rabe KF, Hoffmann F, Böttiger BW, Weinmann-Menke J, Kersten A, Berlit P, Haase R, Marx G, Karagiannidis C. [S2k Guideline - Recommendations for Inpatient Therapy of Patients with COVID-19]. Pneumologie 2021; 75:88-112. [PMID: 33450783 DOI: 10.1055/a-1334-1925] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Since December 2019, the novel coronavirus SARS-CoV-2 (Severe Acute Respiratory Syndrome - Corona Virus-2) has been spreading rapidly in the sense of a global pandemic. This poses significant challenges for clinicians and hospitals and is placing unprecedented strain on the healthcare systems of many countries. The majority of patients with Coronavirus Disease 2019 (COVID-19) present with only mild symptoms such as cough and fever. However, about 6 % require hospitalization. Early clarification of whether inpatient and, if necessary, intensive care treatment is medically appropriate and desired by the patient is of particular importance in the pandemic. Acute hypoxemic respiratory insufficiency with dyspnea and high respiratory rate (> 30/min) usually leads to admission to the intensive care unit. Often, bilateral pulmonary infiltrates/consolidations or even pulmonary emboli are already found on imaging. As the disease progresses, some of these patients develop acute respiratory distress syndrome (ARDS). Mortality reduction of available drug therapy in severe COVID-19 disease has only been demonstrated for dexamethasone in randomized controlled trials. The main goal of supportive therapy is to ensure adequate oxygenation. In this regard, invasive ventilation and repeated prone positioning are important elements in the treatment of severely hypoxemic COVID-19 patients. Strict adherence to basic hygiene, including hand hygiene, and the correct wearing of adequate personal protective equipment are essential when handling patients. Medically necessary actions on patients that could result in aerosol formation should be performed with extreme care and preparation.
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Affiliation(s)
- S Kluge
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin.,Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin.,ARDS Netzwerk Deutschland, Berlin
| | - U Janssens
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin.,Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,ARDS Netzwerk Deutschland, Berlin
| | - T Welte
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin.,Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin.,ARDS Netzwerk Deutschland, Berlin
| | - S Weber-Carstens
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg.,ARDS Netzwerk Deutschland, Berlin
| | - G Schälte
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg
| | - C D Spinner
- Deutsche Gesellschaft für Infektiologie (DGI), Berlin
| | - J J Malin
- Deutsche Gesellschaft für Infektiologie (DGI), Berlin
| | - P Gastmeier
- Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM), Münster
| | - F Langer
- Gesellschaft für Thrombose und Hämostaseforschung (GTH), Köln
| | - M Wepler
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg
| | - M Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin
| | - M Pfeifer
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin
| | - K F Rabe
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin
| | - F Hoffmann
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ), Berlin
| | - B W Böttiger
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutscher Rat für Wiederbelebung (German Resuscitation Council; GRC), Ulm
| | | | - A Kersten
- Deutsche Gesellschaft für Kardiologie (DGK)
| | - P Berlit
- Deutsche Gesellschaft für Neurologie (DGN)
| | - R Haase
- Patientenvertretung (individueller Betroffener)
| | - G Marx
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg.,ARDS Netzwerk Deutschland, Berlin
| | - C Karagiannidis
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN); Berlin.,Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin.,Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin.,ARDS Netzwerk Deutschland, Berlin
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9
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Pankow W, Andreas S, Rupp A, Pfeifer M. [Smoking Cessation with E-Cigarettes? - Ad Hoc Statement of the German Respiratory Society (DGP)]. Pneumologie 2020; 75:31-32. [PMID: 33285598 DOI: 10.1055/a-1323-6045] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
The German Respiratory Society (DGP) turns against the e-cigarette as a means for harm reduction because of potential health risk and dangers to young people. The aerosol of e-cigarettes contains toxic ingredients that have been shown to be damaging to the lungs, the cardiovascular system and the immune system and are potentially carcinogenic. Studies on e-cigarettes as a means of smoking cessation are not very convincing, in order to favor e-cigarettes over nicotine replacement therapy, which have been tried and tested for many years, or other drugs that reduce the desire to smoke.
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Affiliation(s)
- W Pankow
- Vertreter der DGP im Aktionsbündnis Nichtrauchen e. V., Berlin
| | - S Andreas
- Vertreter der Deutschen Lungenstiftung e. V., Lungenfachklinik Immenhausen
| | - A Rupp
- Sprecher der Arbeitsgruppe Tabakprävention und -entwöhnung e. V., Pneumologische Praxis im Zentrum, Stuttgart
| | - M Pfeifer
- Präsident der DGP, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg
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10
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Loddenkemper R, Konietzko N, Seehausen V, Bauer T, Pfeifer M. [125 Years German Central Committee for the Fight against Tuberculosis (DZK)]. Pneumologie 2020; 74:719-741. [PMID: 33202436 DOI: 10.1055/a-1234-7581] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
The German Central Committee for the Fight against Tuberculosis (DZK) celebrates this year its 125th birthday. On this occasion, the DZK as one of the oldest TB organizations worldwide is looking back on the development during its history and records the results in a comprehensive book, summarized in this article. In the book, the various political changes with their impact on the DZK are mirrored, starting with the German Empire, the Weimar Republic, the so-called "Third Reich", the two German states separated after the Second World War and the current FRG. Tuberculosis (TB) was the dominant widespread disease in the 19th century, today it is the leading infectious disease worldwide. As a consequence of migration, this affects also Germany. After meanwhile - in particular in 2015/16 - risen numbers of new cases (especially of those not born in Germany, which in 2019 accounted for 72 % of all cases), the impact of drug-resistant tuberculosis (in 2019, 11.4 % of all new cases had some resistance (384 cases), including 87 cases of MDR-TB, and of these 8 cases of XDR-TB and 27 cases of pre-XDR-TB), as well as the high proportion (81,5 %) - in 2019 - of open and thus very infectious pulmonary TB among new TB cases in Germany, impressively show that TB continues to be a health problem that should not be underestimated and that is increasingly concentrated in risk groups (socially disadvantaged persons, people from high-prevalence countries, homeless people, drug addicts, alcoholics, HIV-infected persons). The DZK therefore continues to play an important role in TB control as a link between the national and international organizations responsible for combating TB.
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Affiliation(s)
- R Loddenkemper
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin
| | - N Konietzko
- vormals Ruhrlandklinik, Universitätsmedizin Essen, Essen
| | - V Seehausen
- Institut für Geschichte der Medizin und Ethik in der Medizin, Charité - Universitätsmedizin Berlin
| | - T Bauer
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin.,Helios Klinikum Emil von Behring, Lungenklinik Heckeshorn, Berlin
| | - M Pfeifer
- Deutsches Zentralkomitee zur Bekämpfung der Tuberkulose e. V. (DZK), Berlin.,Klinik Donaustauf, Universitätsklinikum Regensburg, Regensburg
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11
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Abstract
The prognosis of patients with the coronavirus disease 2019 (COVID-19) is determined by the severity of lower respiratory infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The majority of patients demonstrate mild symptoms only. However, development of pneumonia is associated with the risk of severe respiratory insufficiency. Reverse transcriptase polymerase chain reaction (RT-PCR) of specimens from the upper and/or lower respiratory tract is the gold standard for the diagnosis of COVID-19. Radiology and especially high-resolution computed tomography (HRCT) are important for diagnosis and follow-up. This narrative review provides an overview of clinical signs and the complex and unique pathophysiology of COVID-19 pneumonia. Radiological features are addressed. Therapy is mainly supportive with the most important task being management of respiratory insufficiency. Recently, promising data were presented regarding effectiveness of antiviral and anti-inflammatory drugs.
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Affiliation(s)
- M. Pfeifer
- Klinik II für Innere Medizin, Pneumologie, Universitätsklinikum Regensburg, Franz-Josef-Strauss-Allee 11, 93053 Regensburg, Deutschland
- Klinikum Donaustauf, Donaustauf, Deutschland
- Klinikum Barmherzige Brüder, Regensburg, Deutschland
| | - O. W. Hamer
- Klinikum Donaustauf, Donaustauf, Deutschland
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland
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12
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Fisser C, Wiest C, Hamer OW, Müller T, Lubnow M, Pfeifer M, Lerzer C, Dvorak I. Die Diagnose liegt auf der Hand. Pneumologie 2020; 74:780-786. [DOI: 10.1055/a-1177-4209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
ZusammenfassungEine seltene Form der Dermatomyositis ist die klinische amyopathische Dermatomyositis (CADM). Charakterisiert ist sie durch das Fehlen einer bzw. durch eine nur sehr gering ausgeprägte Muskelbeteiligung. Dementsprechend sind die Kreatinkinase-Werte meist im Normalbereich. Typische Hautmanifestationen sind Gottron-Papeln und Mechanikerhände. Bei Nachweis eines MDa5 (Melanoma-differentiation-associated gene 5 intracellular pathogen sensor)-Antikörpers ist die CADM häufig mit einer rasch progredienten und schweren Verlaufsform einer interstitiellen Lungenerkrankung assoziiert. In der Lungenfunktion lässt sich eine Restriktion und eine Hypoxämie unterschiedlichen Ausmaßes nachweisen. Die HRCT-Bildgebung ist nicht spezifisch. Es lassen sich u. a. Milchglas, Retikulationen und Konsolidierungen beobachten. In der bronchioloalveolären Lavage zeigen sich gelegentlich vermehrt Lymphozyten. Histologisch ähnelt das Bild einer nicht-spezifischen interstitiellen Pneumonie oder einer organisierenden Pneumonie. Die Therapie richtet sich nach der Schwere der Ausprägung der klinischen Manifestation. Im Allgemeinen ist eine ausgeprägte immunsuppressive Therapie notwendig. Meist müssen verschiedene Immunsuppressiva kombiniert werden. Ein neuer Therapieansatz stellt die Verwendung des Januskinase-Inhibitors Tofacitinib dar. Zur Therapiekontrolle können der Ferritinspiegel und der MDa5-Antikörper-Titer verwendet werden. Es besteht eine hohe Mortalität von bis zu 84 %.
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Affiliation(s)
- C. Fisser
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
| | - C. Wiest
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
| | - O. W. Hamer
- Institut für Röntgendiagnostik, Universitätsklinik Regensburg, Regensburg
- Abteilung für Radiologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
| | - T. Müller
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
| | - M. Lubnow
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
| | - M. Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
- Abteilung für Pneumologie, Krankenhaus der Barmherzigen Brüder Regensburg, Regensburg
| | - C. Lerzer
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
| | - I. Dvorak
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
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13
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Kluge S, Janssens U, Welte T, Weber-Carstens S, Schälte G, Salzberger B, Gastmeier P, Langer F, Wepler M, Westhoff M, Pfeifer M, Hoffmann F, Böttiger BW, Marx G, Karagiannidis C. [German recommendations for treatment of critically ill patients with COVID-19-version 3]. Pneumologe (Berl) 2020; 17:406-425. [PMID: 33110402 PMCID: PMC7581953 DOI: 10.1007/s10405-020-00359-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/28/2023]
Abstract
Seit Dezember 2019 verbreitet sich das neuartige Coronavirus SARS-CoV‑2 (Severe Acute Respiratory Syndrome – Corona Virus-2) rasch im Sinne einer weltweiten Pandemie. Dies stellt Kliniker und Krankenhäuser vor große Herausforderungen und belastet die Gesundheitssysteme vieler Länder in einem nie dagewesenen Ausmaß. Die Mehrheit der Patienten zeigt lediglich milde Symptome der sogenannten Coronavirus Disease 2019 (COVID-19). Dennoch benötigen etwa 5–8 % eine intensivmedizinische Behandlung. Die akute hypoxämische respiratorische Insuffizienz mit Dyspnoe und hoher Atemfrequenz (>30/Min) führt in der Regel zur Aufnahme auf die Intensivstation. Oft finden sich dann bereits bilaterale pulmonale Infiltrate/Konsolidierungen oder auch Lungenembolien in der Bildgebung. Im weiteren Verlauf entwickeln viele Patienten ein Acute Respiratory Distress Syndrome (ARDS). Eine klinische Wirksamkeit einer medikamentösen Therapie bei schwerer COVID-Erkrankung (hospitalisierte Patienten) ist bisher für Remdesivir und Dexamethason nachgewiesen. Das Hauptziel der supportiven Therapie ist es eine ausreichende Oxygenierung sicherzustellen. Die invasive Beatmung und wiederholte Bauchlagerung sind dabei wichtige Elemente in der Behandlung von schwer hypoxämischen COVID-19 Patienten. Die strikte Einhaltung der Basishygiene, einschließlich der Händehygiene, sowie das korrekte Tragen von adäquater persönlicher Schutzausrüstung sind im Umgang mit den Patienten unabdingbar. Prozeduren, die zur Aerosolbildung führen könnten, sollten falls nötig, mit äußerster Sorgfalt und Vorbereitung durchgeführt werden.
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Affiliation(s)
- S. Kluge
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Deutschland
| | - U. Janssens
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - T. Welte
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - S. Weber-Carstens
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - G. Schälte
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - B. Salzberger
- Deutsche Gesellschaft für Infektiologie (DGI), München, Deutschland
| | - P. Gastmeier
- Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM), Münster, Deutschland
| | - F. Langer
- Gesellschaft für Thrombose und Hämostaseforschung (GTH), Köln, Deutschland
| | - M. Wepler
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - M. Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - M. Pfeifer
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - F. Hoffmann
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ), Berlin, Deutschland
| | - B. W. Böttiger
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutscher Rat für Wiederbelebung (German Resuscitation Council; GRC), Ulm, Deutschland
| | - G. Marx
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - C. Karagiannidis
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
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14
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Kluge S, Janssens U, Welte T, Weber-Carstens S, Schälte G, Salzberger B, Gastmeier P, Langer F, Wepler M, Westhoff M, Pfeifer M, Hoffmann F, Böttiger BW, Marx G, Karagiannidis C. [German recommendations for treatment of critically ill patients with COVID-19-version 3 : S1-guideline]. Anaesthesist 2020; 69:653-664. [PMID: 32833080 PMCID: PMC7444177 DOI: 10.1007/s00101-020-00833-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Seit Dezember 2019 verbreitet sich das neuartige Coronavirus SARS-CoV‑2 (Severe Acute Respiratory Syndrome – Corona Virus-2) rasch im Sinne einer weltweiten Pandemie. Dies stellt Kliniker und Krankenhäuser vor große Herausforderungen und belastet die Gesundheitssysteme vieler Länder in einem nie dagewesenen Ausmaß. Die Mehrheit der Patienten zeigt lediglich milde Symptome der sogenannten Coronavirus Disease 2019 (COVID-19). Dennoch benötigen etwa 5–8 % eine intensivmedizinische Behandlung. Die akute hypoxämische respiratorische Insuffizienz mit Dyspnoe und hoher Atemfrequenz (>30/Min) führt in der Regel zur Aufnahme auf die Intensivstation. Oft finden sich dann bereits bilaterale pulmonale Infiltrate/Konsolidierungen oder auch Lungenembolien in der Bildgebung. Im weiteren Verlauf entwickeln viele Patienten ein Acute Respiratory Distress Syndrome (ARDS). Eine klinische Wirksamkeit einer medikamentösen Therapie bei schwerer COVID-Erkrankung (hospitalisierte Patienten) ist bisher für Remdesivir und Dexamethason nachgewiesen. Das Hauptziel der supportiven Therapie ist es eine ausreichende Oxygenierung sicherzustellen. Die invasive Beatmung und wiederholte Bauchlagerung sind dabei wichtige Elemente in der Behandlung von schwer hypoxämischen COVID-19 Patienten. Die strikte Einhaltung der Basishygiene, einschließlich der Händehygiene, sowie das korrekte Tragen von adäquater persönlicher Schutzausrüstung sind im Umgang mit den Patienten unabdingbar. Prozeduren, die zur Aerosolbildung führen könnten, sollten falls nötig, mit äußerster Sorgfalt und Vorbereitung durchgeführt werden.
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Affiliation(s)
- S Kluge
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland.
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland.
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland.
- ARDS Netzwerk Deutschland, Berlin, Deutschland.
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Deutschland.
| | - U Janssens
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - T Welte
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - S Weber-Carstens
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - G Schälte
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - B Salzberger
- Deutsche Gesellschaft für Infektiologie (DGI), München, Deutschland
| | - P Gastmeier
- Deutsche Gesellschaft für Hygiene und Mikrobiologie (DGHM), Münster, Deutschland
| | - F Langer
- Gesellschaft für Thrombose und Hämostaseforschung (GTH), Köln, Deutschland
| | - M Wepler
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
| | - M Westhoff
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - M Pfeifer
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
| | - F Hoffmann
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Kinder- und Jugendmedizin (DGKJ), Berlin, Deutschland
| | - B W Böttiger
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutscher Rat für Wiederbelebung (German Resuscitation Council; GRC), Ulm, Deutschland
| | - G Marx
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin (DGAI), Nürnberg, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
| | - C Karagiannidis
- Deutsche Gesellschaft für Internistische Intensivmedizin und Notfallmedizin (DGIIN), Berlin, Deutschland
- Deutsche Interdisziplinäre Vereinigung für Intensiv- und Notfallmedizin (DIVI), Berlin, Deutschland
- Deutsche Gesellschaft für Pneumologie und Beatmungsmedizin (DGP), Berlin, Deutschland
- ARDS Netzwerk Deutschland, Berlin, Deutschland
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15
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Abstract
Coronavirus disease 2019 (COVID-19) continues to pose a major global threat. Although a wide range of organ manifestations have now been described, the respiratory system remains in the forefront in terms of the course of infection. Severe pneumonia can develop and is generally prognostically relevant. The following article discusses currently known features of these pulmonary manifestations from a pathophysiological, symptomatological, and radiological perspective. With regard to pathophysiology, the complex nature of the acute pulmonary disease involving severe injury to the alveolar epithelium and pulmonary vascular endothelium resulting in severe respiratory failure in a proportion of patients is discussed. The differences from "classic" acute respiratory distress syndrome and the major effects these have on the treatment of COVID-19 are elucidated. Following a brief description of PCR-based pathogen identification and information on typical laboratory findings, imaging of COVID-19 pneumonia is described in greater details (typical findings, differential diagnoses, grading of the likelihood of COVID-19 pneumonia). This is followed by a description of symptoms, which develop in three phases. With regard to treatment, supportive and intensive care approaches are discussed, including O2 administration and (non-)invasive ventilation. The article concludes with a summary of the insights gained into pharmacological therapies: thrombosis prevention on the one hand, and specific antiviral and immunomodulatory therapies (remdesivir, tocilizumab, anakinra, dexamethasone) on the other.
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Affiliation(s)
- M Pfeifer
- Pneumologie, Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg, Franz-Josef-Strauß-Allee 11, 93053, Regensburg, Deutschland.
- Klinikum Donaustauf, Donaustauf, Deutschland.
- Krankenhaus Barmherzige Brüder Regensburg, Regensburg, Deutschland.
| | - O W Hamer
- Klinikum Donaustauf, Donaustauf, Deutschland
- Institut für Röntgendiagnostik, Universitätsklinikum Regensburg, Regensburg, Deutschland
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16
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Kolditz M, Dellweg D, Geerdes-Fenge H, Lepper PM, Schaberg T, Ewig S, Pfeifer M, Bauer T. [Treatment with Dexamethasone in Patients with COVID-19 - A Position Paper of the German Respiratory Society (DGP)]. Pneumologie 2020; 74:493-495. [PMID: 32674177 PMCID: PMC7516361 DOI: 10.1055/a-1216-5739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Affiliation(s)
- M Kolditz
- Universitätsklinikum Carl Gustav Carus an der Technischen Universität Dresden, Klinik und Poliklinik für Innere Medizin I, Dresden
| | - D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg Grafschaft
| | - H Geerdes-Fenge
- Universitätsmedizin Rostock, Zentrum für Innere Medizin, Abteilung für Infektionskrankheiten und Tropenmedizin, Rostock
| | - P M Lepper
- Universitätsklinikum des Saarlandes, Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Homburg/Saar
| | | | - S Ewig
- Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Krankenanstalt Bochum, Bochum
| | - M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg.,Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf.,Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg
| | - T Bauer
- Helios Klinikum Emil von Behring GmbH, Lungenklinik Heckeshorn, Berlin
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17
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Dellweg D, Pfeifer M. Stellungnahme zum Leserbrief „Die maskierte Gesellschaft“ von Prof. Santiago Ewig, Prof. Sören Gatermann und Prof. Sebastian Lemmen. Pneumologie 2020; 74:409-411. [PMID: 32583379 PMCID: PMC7416200 DOI: 10.1055/a-1199-4557] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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18
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Dellweg D, Lepper PM, Nowak D, Köhnlein T, Olgemöller U, Pfeifer M. [Position Paper of the German Respiratory Society (DGP) on the Impact of Community Masks on Self-Protection and Protection of Others in Regard to Aerogen Transmitted Diseases]. Pneumologie 2020. [PMID: 32455450 DOI: 10.1055/a-1184-7263] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg Grafschaft
| | - P M Lepper
- Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - D Nowak
- Klinikum der Universität München, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München, Mitglied des Deutschen Zentrums für Lungenforschung (DZL), München
| | | | - U Olgemöller
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen
| | - M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg.,Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf.,Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg
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19
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Pfeifer M, Ewig S, Voshaar T, Randerath W, Bauer T, Geiseler J, Dellweg D, Westhoff M, Windisch W, Schönhofer B, Kluge S, Lepper PM. [Position Paper for the State of the Art Application of Respiratory Support in Patients with COVID-19 - German Respiratory Society]. Pneumologie 2020; 74:337-357. [PMID: 32323287 PMCID: PMC7378547 DOI: 10.1055/a-1157-9976] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Against the background of the pandemic caused by infection with the SARS-CoV-2, the German Society for Pneumology and Respiratory Medicine (DGP e.V.), in cooperation with other associations, has designated a team of experts in order to answer the currently pressing questions about therapy strategies in dealing with COVID-19 patients suffering from acute respiratory insufficiency (ARI).The position paper is based on the current knowledge that is evolving daily. Many of the published and cited studies require further review, also because many of them did not undergo standard review processes.Therefore, this position paper is also subject to a continuous review process and will be further developed in cooperation with the other professional societies.This position paper is structured into the following five topics:1. Pathophysiology of acute respiratory insufficiency in patients without immunity infected with SARS-CoV-22. Temporal course and prognosis of acute respiratory insufficiency during the course of the disease3. Oxygen insufflation, high-flow oxygen, non-invasive ventilation and invasive ventilation with special consideration of infectious aerosol formation4. Non-invasive ventilation in ARI5. Supply continuum for the treatment of ARIKey points have been highlighted as core statements and significant observations. Regarding the pathophysiological aspects of acute respiratory insufficiency (ARI), the pulmonary infection with SARS-CoV-2 COVID-19 runs through three phases: early infection, pulmonary manifestation and severe hyperinflammatory phase.There are differences between advanced COVID-19-induced lung damage and those changes seen in Acute Respiratory Distress Syndromes (ARDS) as defined by the Berlin criteria. In a pathophysiologically plausible - but currently not yet histopathologically substantiated - model, two types (L-type and H-type) are distinguished, which correspond to an early and late phase. This distinction can be taken into consideration in the differential instrumentation in the therapy of ARI.The assessment of the extent of ARI should be carried out by an arterial or capillary blood gas analysis under room air conditions and must include the calculation of the oxygen supply (measured from the variables of oxygen saturation, the Hb value, the corrected values of the Hüfner number and the cardiac output). In principle, aerosols can cause transmission of infectious viral particles. Open systems or leakage systems (so-called vented masks) can prevent the release of respirable particles. Procedures in which the invasive ventilation system must be opened, and endotracheal intubation must be carried out are associated with an increased risk of infection.The protection of personnel with personal protective equipment should have very high priority because fear of contagion must not be a primary reason for intubation. If the specifications for protective equipment (eye protection, FFP2 or FFP-3 mask, gown) are adhered to, inhalation therapy, nasal high-flow (NHF) therapy, CPAP therapy or NIV can be carried out according to the current state of knowledge without increased risk of infection to the staff. A significant proportion of patients with respiratory failure presents with relevant hypoxemia, often also caused by a high inspiratory oxygen fraction (FiO2) including NHF, and this hypoxemia cannot be not completely corrected. In this situation, CPAP/NIV therapy can be administered under use of a mouth and nose mask or a respiratory helmet as therapy escalation, as long as the criteria for endotracheal intubation are not fulfilled.In acute hypoxemic respiratory insufficiency, NIV should be performed in an intensive care unit or in a comparable unit by personnel with appropriate expertise. Under CPAP/NIV, a patient can deteriorate rapidly. For this reason, continuous monitoring with readiness to carry out intubation must be ensured at all times. If CPAP/NIV leads to further progression of ARI, intubation and subsequent invasive ventilation should be carried out without delay if no DNI order is in place.In the case of patients in whom invasive ventilation, after exhausting all guideline-based measures, is not sufficient, extracorporeal membrane oxygenation procedure (ECMO) should be considered to ensure sufficient oxygen supply and to remove CO2.
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Affiliation(s)
- M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf
- Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg
| | - S Ewig
- Thoraxzentrum Ruhrgebiet, Department of Respiratory and Infectious Diseases, EVK Herne and Augusta-Krankenanstalt Bochum, Bochum
| | - T Voshaar
- Schwerpunkt Pneumologie, Allergologie, Klinische Immunologie, Zentrum für Schlaf- und Beatmungsmedizin, Krankenhaus Bethanien, Moers
| | - W Randerath
- Institut für Pneumologie an der Universität zu Köln, Köln
- Klinik für Pneumologie, Krankenhaus Bethanien, Solingen
| | - T Bauer
- Lungenklinik Heckeshorn, Helios Klinikum Emil von Behring GmbH, Berlin
| | - J Geiseler
- Medizinische Klinik IV: Klinik für Pneumologie, Beatmungs- und Schlafmedizin, Klinikum Vest GmbH, Paracelsus-Klinik, Marl
| | - D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg Grafschaft
| | - M Westhoff
- Klinik für Pneumologie, Lungenklinik Hemer, Hemer
- Universität Witten-Herdecke, Witten
| | - W Windisch
- Universität Witten-Herdecke, Witten
- Klinik für Pneumologie, Klinikum Köln-Merheim, Kliniken der Stadt Köln, Lehrstuhl für Pneumologie der Universität Witten-Herdecke, Köln
| | - B Schönhofer
- Pneumologische Praxis und pneumologischer Konsildienst im Klinikum Agnes Karll Laatzen, Klinikum Region Hannover, Laatzen
| | - S Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Hamburg-Eppendorf, Hamburg
| | - P M Lepper
- Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
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20
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Dellweg D, Lepper PM, Nowak D, Köhnlein T, Olgemöller U, Pfeifer M. [Position Paper of the German Respiratory Society (DGP) on the Impact of Community Masks on Self-Protection and Protection of Others in Regard to Aerogen Transmitted Diseases]. Pneumologie 2020; 74:331-336. [PMID: 32434252 PMCID: PMC7362397 DOI: 10.1055/a-1175-8578] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Affiliation(s)
- D Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Akademisches Lehrkrankenhaus der Philipps-Universität Marburg, Schmallenberg Grafschaft
| | - P M Lepper
- Innere Medizin V - Pneumologie, Allergologie, Beatmungs- und Umweltmedizin, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - D Nowak
- Klinikum der Universität München, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin, LMU München, Mitglied des Deutschen Zentrums für Lungenforschung (DZL), München
| | | | - U Olgemöller
- Klinik für Kardiologie und Pneumologie, Universitätsmedizin Göttingen, Georg-August-Universität, Göttingen
| | - M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
- Krankenhaus Barmherzige Brüder, Klinik für Pneumologie und konservative Intensivmedizin, Regensburg
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21
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Skowasch D, Gaertner F, Marx N, Meder B, Müller-Quernheim J, Pfeifer M, Schrickel JW, Yilmaz A, Grohé C. [Diagnostics and Treatment of Cardiac Sarcoidosis - Consensus Paper of the German Respiratory Society (DGP) and the German Cardiac Society (DGK)]. Pneumologie 2019; 74:24-34. [PMID: 31863422 DOI: 10.1055/a-1031-4588] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Sarcoidosis is a multisystemic granulomatous disorder which affects the respiratory system in the majority of the cases. Symptomatic cardiac manifestations are found in less than 10 % of the affected cohorts and show a large heterogeneity based on the ethnic background. Cardiac sarcoidosis is not only found in patients with rhythmogenic heart disease, such as atrial and ventricular fibrillation but also in all phenotypes of cardiomyopathy. The overall morbidity and mortality caused by cardiac sarcoidosis in Germany remains unclear and large prospective international observational studies.underline the importance of this disease entity. This consensus paper on diagnostic and therapeutic algorithms for cardiac sarcoidosis is based on a current literature search and forms an expert opinion statement under the auspices of the German Respiratory Society and the German Cardiac Society. The rationale of this statement is to provide algorithms to facilitate clinical decision-making based on the individual case situation.
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Affiliation(s)
- D Skowasch
- Universitätsklinikum Bonn, Medizinische Klinik und Poliklinik II, Sektion Pneumologie, Bonn
| | - F Gaertner
- Universitätsklinikum Bonn, Klinik und Poliklinik für Nuklearmedizin, Bonn
| | - N Marx
- Universitätsklinikum Aachen, AöR, Klinik für Kardiologie, Angiologie und Internistische Intensivmedizin (Med. Klinik I), Aachen
| | - B Meder
- Universitätsklinikum Heidelberg, Institut für Cardiomyopathien Heidelberg Abteilung für Kardiologie, Angiologie und Pulmologie, Heidelberg
| | - J Müller-Quernheim
- Universitätsklinikum Freiburg, Abteilung Pneumologie, Freiburg im Breisgau
| | - M Pfeifer
- Klinik Donaustauf, Zentrum für Pneumologie, Psychosomatische Medizin und Psychotherapie, Donaustauf
| | - J W Schrickel
- Medizinische Klinik und Poliklinik II, Sektion Elektrophysiologie, Universitätsklinikum Bonn
| | - A Yilmaz
- Universitätsklinikum Münster, Klinik für Kardiologie I, Sektion für Herzbildgebung, Münster
| | - C Grohé
- Ev. Lungenklinik Berlin, Klinik für Pneumologie, Berlin
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22
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Geiseler J, Westhoff M, Dellweg D, Voshaar T, Hetzel M, Pfeifer M. Positionspapier zu Ursachen und Diagnostik der Beatmungsabhängigkeit sowie zu praktischer Durchführung und Abrechnung des Weaning-Prozesses. Pneumologie 2019; 73:716-722. [DOI: 10.1055/a-1039-7143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- J. Geiseler
- Klinikum Vest, Medizinische Klinik IV, Pneumologie, Beatmungs- und Schlafmedizin, Marl
| | | | - D. Dellweg
- Fachkrankenhaus Kloster Grafschaft GmbH, Abteilung für Pneumologie II, Schmallenberg
| | - T. Voshaar
- Stiftung Krankenhaus Bethanien für die Grafschaft Moers, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Moers
| | - M. Hetzel
- Klinik für Pneumologie, Internistische Intensivmedizin, Beatmungsmedizin und Allgemeine Innere Medizin, Krankenhaus vom Roten Kreuz Bad Cannstatt GmbH, Stuttgart
| | - M. Pfeifer
- Zentrum für Pneumologie, Klinik Donaustauf, Donaustauf
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23
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Herth FJF, Reinmuth N, Wormanns D, Antoch G, Biederer J, Vogel-Claussen J, Kauczor HU, Pfeifer M. [Joint Statement of the German Radiological Society and the German Respiratory Society on a Quality-Assured Early Detection Program for Lung Cancer with Low-dose CT]. Pneumologie 2019; 73:573-577. [PMID: 31537020 DOI: 10.1055/a-0984-8367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Substantial new data on early detection of lung cancer with low-dose CT has become available since the last joint statement of the German Roentgenological Society and the German Respiratory Society was published in 2011. The German S3 guideline on lung cancer was revised in 2018 and now contains a weak recommendation towards early detection of lung cancer with low-dose CT in a quality-assured early detection program. These new developments required a repositioning of the involved professional societies. This present joint statement describes main features of a quality-assured program for early detection of lung cancer with low-dose CT in Germany.
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Affiliation(s)
- F J F Herth
- Thoraxklinik Universitätsklinikum Heidelberg, Abteilung Innere Medizin - Pneumologie, Heidelberg
| | - N Reinmuth
- Asklepios Fachkliniken München-Gauting, Abteilung für Onkologie, Gauting
| | - D Wormanns
- Evangelische Lungenklinik Berlin, Radiologisches Institut, Berlin.,Universitätsklinikum Münster, Institut für Klinische Radiologie, Münster
| | - G Antoch
- Universitätsklinikum Düsseldorf, Institut für Diagnostische und Interventionelle Radiologie, Düsseldorf
| | - J Biederer
- Universitätsklinikum Heidelberg, Klinik für Diagnostische und Interventionelle Radiologie, Heidelberg
| | - J Vogel-Claussen
- Medizinische Hochschule Hannover, Institut für Diagnostische und Interventionelle Radiologie, Hannover
| | - H-U Kauczor
- Universitätsklinikum Heidelberg, Klinik für Diagnostische und Interventionelle Radiologie, Heidelberg
| | - M Pfeifer
- Universitätsklinikum Regensburg, Pneumologische Klinik, Regensburg
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24
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Jany B, Bals R, Dreher M, Held M, Jany L, Rembert Koczulla A, Pfeifer M, Randerath W, Watz H, Wilkens H, Steinkamp G. [Expert Workshop COPD: Lungs and Heart - Quite Often Ill Together]. Pneumologie 2019; 73:651-669. [PMID: 31499562 DOI: 10.1055/a-0914-9566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
When caring for patients with respiratory diseases, always think of the heart! This is especially important for COPD patients, but also for a variety of other disorders of the respiratory system. At the workshop "Luftschlösser", held once more at Wiesbaden, Germany in February 2019 the many and important interactions of the lungs and the heart as well as the therapeutic implications were discussed. Based on pathophysiology, the psycho-social consequences of dyspnea, the leading symptom in patients with lung and heart disease became apparent. A particularly demanding diagnostic and therapeutic situation occurs in patients suffering simultaneously of lung and heart disease. It has been shown how frequently the diagnosis myocardial infarction is missed in COPD patients - and vice versa. Surprisingly, this is also the case in asthmatics with coronary heart disease or heart failure, a fact not readily known in clinical practice. In patients with emphysema and no apparent heart disease, hyperinflation leads to significantly restricted heart function. Reducing hyperinflation by inhaling broncholytics thus improves heart function. Biomarkers are increasingly being used for diagnostic purposes. Their role is being investigated in the large German COPD cohort COSYCONET. Lung patients suffering from more severe heart diseases pose a challenge for therapy in intensive care, especially when ventilated, and weaning from the ventilator is prolonged. Lung vessel diseases are "classic" examples of the intimate interaction of the lungs and the heart. In pulmonary arterial hypertension as well as in chronic thrombo-embolic pulmonary hypertension the lag time between the first symptoms and the definite diagnosis is often unacceptably long. For both diseases of the lung vessels therapeutic options have improved significantly over the last years. Pulmonologists should take care of this increasingly important patient group. Sleep-related breathing disorders and heart function are closely intertwined. Both conditions need special attention after the results of the SERVE-HF trial have been published. But there is no doubt that obstructive sleep apnea represents an independent and important risk factor for cardiovascular disease and needs to be treated according to existing guidelines.This workshop demonstrated impressively the multiple interactions of the respiratory system with cardiac function, resulting diagnostic and therapeutic problems, and means to overcome these problems. Guidelines for respiratory diseases should appropriately address cardiac comorbidity.
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Affiliation(s)
- B Jany
- ehem. Medizinische Klinik, Klinik für Pneumologie und Beatmungsmedizin, Klinikum Würzburg Mitte, Würzburg
| | - R Bals
- Pneumologie, Allergologie, Beatmungsmedizin, Universitätsklinikum des Saarlandes
| | - M Dreher
- Klinik für Pneumologie und Internistische Intensivmedizin, Medizinische Klinik V, Universitätsklinikum Aachen
| | - M Held
- Missioklinik, Klinikum Würzburg Mitte, Zentrum für Thoraxmedizin Würzburg, Medizinische Klinik mit Schwerpunkt Pneumologie und Beatmungsmedizin
| | - L Jany
- Psychologische Praxis, Würzburg
| | - A Rembert Koczulla
- Fachzentrum für Pneumologie, Schön Klinik Berchtesgadener Land, und Universitätsklinikum Marburg
| | - M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinikum Regensburg und Zentrum für Pneumologie, Klinik Donaustauf
| | - W Randerath
- Klinik für Pneumologie und Allergologie, Krankenhaus Bethanien, Solingen
| | - H Watz
- Pneumologisches Forschungsinstitut an der LungenClinic Großhansdorf
| | - H Wilkens
- Klinik für Innere Medizin V, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - G Steinkamp
- Medizinisch-wissenschaftliches Publizieren, Schwerin
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25
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Diamanti-Kandarakis E, Duntas L, Kanakis GA, Kandaraki E, Karavitaki N, Kassi E, Livadas S, Mastorakos G, Migdalis I, Miras AD, Nader S, Papalou O, Poladian R, Popovic V, Rachoń D, Tigas S, Tsigos C, Tsilchorozidou T, Tzotzas T, Bargiota A, Pfeifer M. DIAGNOSIS OF ENDOCRINE DISEASE: Drug-induced endocrinopathies and diabetes: a combo-endocrinology overview. Eur J Endocrinol 2019; 181:R73-R105. [PMID: 31242462 DOI: 10.1530/eje-19-0154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Accepted: 06/03/2019] [Indexed: 11/08/2022]
Abstract
In the currently overwhelming era of polypharmacy, the balance of the dynamic and delicate endocrine system can easily be disturbed by interfering pharmaceutical agents like medications. Drugs can cause endocrine abnormalities via different mechanisms, including direct alteration of hormone production, changes in the regulation of the feedback axis, on hormonal transport, binding and signaling, as well as similar changes to counter-regulatory hormone systems. Furthermore, drugs can interfere with the hormonal assays, leading to erroneous laboratory results that disorientate clinicians from the right diagnosis. The purpose of this review is to cover a contemporary topic, the drug-induced endocrinopathies, which was presented in the monothematic annual Combo Endo Course 2018. This challenging part of endocrinology is constantly expanding particularly during the last decade, with the new oncological therapeutic agents, targeting novel molecular pathways in the process of malignancies. In this new context of drug-induced endocrine disease, clinicians should be aware that drugs can cause endocrine abnormalities via different mechanisms and mimic a variety of clinical scenarios. Therefore, it is extremely important for clinicians not only to promptly recognize drug-induced hormonal and metabolic abnormalities, but also to address the therapeutic issues for timely intervention.
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Affiliation(s)
| | - L Duntas
- Endocrine Clinic Evgenidion Hospital, University of Athens
| | - G A Kanakis
- Department of Endocrinology, Athens Naval & VA Hospital, Athens, Unit of Reproductive Endocrinology, Athens, Greece
| | - E Kandaraki
- Department of Endocrinology, Diabetes and Metabolism, Hygeia Hospital
| | - N Karavitaki
- Centre for Endocrinology, Diabetes and Metabolism, Birmingham Health Partners
- Institute of Metabolism and Systems Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - E Kassi
- Department of Biological Chemistry, First Department of Internal Medicine, Laikon Hospital Medical School, NKUA
| | - S Livadas
- Endocrine Unit, Metropolitan Hospital
| | - G Mastorakos
- Endocrine Unit, 2nd Department of Obstetrics and Gynecology, National and Kapodistrian University of Athens, 'Aretaieion' University Hospital
| | - I Migdalis
- Second Medical Department and Diabetes Centre, NIMTS Hospital, Athens, Greece
| | - A D Miras
- Division of Endocrinology Diabetes and Metabolic Medicine, Imperial College London, London, UK
| | - S Nader
- Department of Internal Medicine-Endocrine Division, McGovern Medical School, Houston, Texas, USA
| | - O Papalou
- Department of Endocrinology, Diabetes and Metabolism, Hygeia Hospital
| | - R Poladian
- Department of Endocrinology, MLH University Hospital, Beirut, Lebanon
| | - V Popovic
- School of Medicine, University of Belgrade, Belgrade, Serbia
| | - D Rachoń
- Department of Clinical and Experimental Endocrinology, Medical University of Gdańsk, Gdańsk, Poland
| | - S Tigas
- Department of Endocrinology, Ioannina University Hospital, Ioannina, Greece
| | - C Tsigos
- Harokopio University of Athens and HYGEIA Hospital, Athens, Greece
| | | | - T Tzotzas
- St. Luke's Hospital, Panorama, Thessaloniki, Greece
| | - A Bargiota
- Department of Internal Medicine - Endocrinology, University of Thessaly, Larissa, Greece
| | - M Pfeifer
- Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
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26
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Pisarczyk T, Gus'kov SY, Zaras-Szydłowska A, Dudzak R, Renner O, Chodukowski T, Dostal J, Rusiniak Z, Burian T, Borisenko N, Rosinski M, Krupka M, Parys P, Klir D, Cikhardt J, Rezac K, Krasa J, Rhee YJ, Kubes P, Singh S, Borodziuk S, Krus M, Juha L, Jungwirth K, Hrebicek J, Medrik T, Golasowski J, Pfeifer M, Skala J, Pisarczyk P, Korneev P. Magnetized plasma implosion in a snail target driven by a moderate-intensity laser pulse. Sci Rep 2018; 8:17895. [PMID: 30559388 PMCID: PMC6297252 DOI: 10.1038/s41598-018-36176-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2018] [Accepted: 11/16/2018] [Indexed: 12/04/2022] Open
Abstract
Optical generation of compact magnetized plasma structures is studied in the moderate intensity domain. A sub-ns laser beam irradiated snail-shaped targets with the intensity of about 1016 W/cm2. With a neat optical diagnostics, a sub-megagauss magnetized plasmoid is traced inside the target. On the observed hydrodynamic time scale, the hot plasma formation achieves a theta-pinch-like density and magnetic field distribution, which implodes into the target interior. This simple and elegant plasma magnetization scheme in the moderate-intensity domain is of particular interest for fundamental astrophysical-related studies and for development of future technologies.
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Affiliation(s)
- T Pisarczyk
- Institute of Plasma Physics and Laser Microfusion, Warsaw, Poland.
| | - S Yu Gus'kov
- P.N. Lebedev Physical Institute of RAS, Moscow, Russian Federation.,National Research Nuclear University MEPhI, Moscow, Russian Federation
| | | | - R Dudzak
- Institute of Physics, Czech Academy of Sciences, 182 21, Prague, Czech Republic.,Insitute of Plasma Physics, Czech Academy of Sciences, 182 00, Prague, Czech Republic
| | - O Renner
- Institute of Physics, Czech Academy of Sciences, 182 21, Prague, Czech Republic.,Insitute of Plasma Physics, Czech Academy of Sciences, 182 00, Prague, Czech Republic
| | - T Chodukowski
- Institute of Plasma Physics and Laser Microfusion, Warsaw, Poland
| | - J Dostal
- Institute of Physics, Czech Academy of Sciences, 182 21, Prague, Czech Republic.,Insitute of Plasma Physics, Czech Academy of Sciences, 182 00, Prague, Czech Republic
| | - Z Rusiniak
- Institute of Plasma Physics and Laser Microfusion, Warsaw, Poland
| | - T Burian
- Institute of Physics, Czech Academy of Sciences, 182 21, Prague, Czech Republic.,Insitute of Plasma Physics, Czech Academy of Sciences, 182 00, Prague, Czech Republic
| | - N Borisenko
- P.N. Lebedev Physical Institute of RAS, Moscow, Russian Federation
| | - M Rosinski
- Institute of Plasma Physics and Laser Microfusion, Warsaw, Poland
| | - M Krupka
- Insitute of Plasma Physics, Czech Academy of Sciences, 182 00, Prague, Czech Republic
| | - P Parys
- Institute of Plasma Physics and Laser Microfusion, Warsaw, Poland
| | - D Klir
- Insitute of Plasma Physics, Czech Academy of Sciences, 182 00, Prague, Czech Republic.,Faculty of Electrical Engineering, Czech Technical University, 166 27, Prague, Czech Republic
| | - J Cikhardt
- Insitute of Plasma Physics, Czech Academy of Sciences, 182 00, Prague, Czech Republic.,Faculty of Electrical Engineering, Czech Technical University, 166 27, Prague, Czech Republic
| | - K Rezac
- Insitute of Plasma Physics, Czech Academy of Sciences, 182 00, Prague, Czech Republic.,Faculty of Electrical Engineering, Czech Technical University, 166 27, Prague, Czech Republic
| | - J Krasa
- Institute of Physics, Czech Academy of Sciences, 182 21, Prague, Czech Republic
| | - Y-J Rhee
- Center for Relativistic Laser Science, IBS, Gwang-Ju, 61005, Korea
| | - P Kubes
- Faculty of Electrical Engineering, Czech Technical University, 166 27, Prague, Czech Republic
| | - S Singh
- Institute of Physics, Czech Academy of Sciences, 182 21, Prague, Czech Republic
| | - S Borodziuk
- Institute of Plasma Physics and Laser Microfusion, Warsaw, Poland
| | - M Krus
- Institute of Physics, Czech Academy of Sciences, 182 21, Prague, Czech Republic.,Insitute of Plasma Physics, Czech Academy of Sciences, 182 00, Prague, Czech Republic
| | - L Juha
- Institute of Physics, Czech Academy of Sciences, 182 21, Prague, Czech Republic.,Insitute of Plasma Physics, Czech Academy of Sciences, 182 00, Prague, Czech Republic
| | - K Jungwirth
- Institute of Physics, Czech Academy of Sciences, 182 21, Prague, Czech Republic
| | - J Hrebicek
- Institute of Physics, Czech Academy of Sciences, 182 21, Prague, Czech Republic.,Insitute of Plasma Physics, Czech Academy of Sciences, 182 00, Prague, Czech Republic
| | - T Medrik
- Institute of Physics, Czech Academy of Sciences, 182 21, Prague, Czech Republic.,Insitute of Plasma Physics, Czech Academy of Sciences, 182 00, Prague, Czech Republic
| | - J Golasowski
- Institute of Physics, Czech Academy of Sciences, 182 21, Prague, Czech Republic.,Insitute of Plasma Physics, Czech Academy of Sciences, 182 00, Prague, Czech Republic
| | - M Pfeifer
- Institute of Physics, Czech Academy of Sciences, 182 21, Prague, Czech Republic.,Insitute of Plasma Physics, Czech Academy of Sciences, 182 00, Prague, Czech Republic
| | - J Skala
- Institute of Physics, Czech Academy of Sciences, 182 21, Prague, Czech Republic.,Insitute of Plasma Physics, Czech Academy of Sciences, 182 00, Prague, Czech Republic
| | - P Pisarczyk
- Warsaw University of Technology, ICS, Warsaw, Poland
| | - Ph Korneev
- P.N. Lebedev Physical Institute of RAS, Moscow, Russian Federation.,National Research Nuclear University MEPhI, Moscow, Russian Federation
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Fisser C, Hamer OW, Eiber R, Pfeifer M, Lerzer C. [Crazy Paving Pattern of the Lung]. Pneumologie 2018; 73:49-53. [PMID: 30536247 DOI: 10.1055/a-0767-7960] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Pulmonary alveolar proteinosis (PAP) is a rare pulmonary disease. PAP results from impaired surfactant clearance. In adults, autoimmune pulmonary alveolar proteinosis is present in 90 - 95 % of the cases. In 5 - 10 %, other etiologies such as toxins and dust exposure, hematological disorders and infections have to be considered. Men between 30 - 60 years are commonly affected. Typical symptoms are cough, dyspnea and alteration in ventilatory function. CT scan of the lung is characterised by a crazy paving pattern. In serological testing, granulocyte macrophage colony-stimulation factor can be identified in most patients with autoimmune pulmonary alveolar proteinosis. Whole-lung lavage remains the therapy of choice. In the current case, treatment with whole-lung lavage resulted in clinical and functional improvement.
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Affiliation(s)
- C Fisser
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg.,Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
| | - O W Hamer
- Institut für Röntgendiagnostik, Universitätsklinik Regensburg, Regensburg.,Abteilung für Radiologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
| | - R Eiber
- Abteilung für Anästhesiologie, Sana Kliniken des Landkreises Cham, Cham
| | - M Pfeifer
- Klinik und Poliklinik für Innere Medizin II, Universitätsklinik Regensburg, Regensburg.,Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
| | - C Lerzer
- Abteilung für Pneumologie, Fachklinik für Lungenerkrankungen Donaustauf, Donaustauf
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28
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Randerath W, Hetzel M, Pfeifer M, Voshaar T, Rabe K. Stellungnahme der Deutschen Gesellschaft für Pneumologie und Beatmungsmedizin (DGP) und des Verbandes Pneumologischer Kliniken (VPK) zur Rolle der Pneumologie in der gestuften Notfallversorgung. Pneumologie 2018; 72:817-819. [DOI: 10.1055/a-0775-3517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- W. Randerath
- Krankenhaus Bethanien, Klinik für Pneumologie und Allergologie, Zentrum für Schlaf- und Beatmungsmedizin, Institut für Pneumologie an der Universität zu Köln, Solingen
| | - M. Hetzel
- Krankenhaus vom Roten Kreuz Bad Cannstatt GmbH, Stuttgart
| | - M. Pfeifer
- Klinik Donaustauf, Zentrum für Pneumologie, Donaustauf, Krankenhaus Barmherzige Brüder Regensburg, Universitätsklinikum Regensburg
| | - T. Voshaar
- Stiftung Krankenhaus Bethanien für die Grafschaft Moers, Akademisches Lehrkrankenhaus der Universität Duisburg-Essen, Moers
| | - K. Rabe
- LungenClinic Grosshansdorf, Großhansdorf
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Thomasius F, Baum E, Bernecker P, Böcker W, Brabant T, Clarenz P, Demary W, Dimai HP, Engelbrecht M, Engelke K, Fratermann U, Grieser T, Gulich M, Hadji P, Henning J, Jehle PM, Kern PM, Ketteler M, Klatt G, Kraenzlin M, Maus U, Meier C, Moser U, Müller D, Peichl P, Pfeifer M, Rintelen B, Rueger JM, Schober HC, Schöffel D, Schwarz H, Siggelkow H, Suhm N, Wiese KG, Wörtler K, Kurth AA. DVO Leitlinie 2017 zur Prophylaxe, Diagnostik und Therapie der Osteoporose bei postmenopausalen Frauen und Männern. ACTA ACUST UNITED AC 2018. [DOI: 10.1055/s-0038-1673537] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
ZusammenfassungDiese DVO Leitlinien, die in erster Linie für Allgemeinmediziner und Spezialisten für Knochenerkrankungen bestimmt sind, sollten von allen im klinischen und ambulanten Bereich tätigen medizinischen Fachkräften angewendet werden. Ziel der Leitlinie ist die Verbesserung der Diagnose, Prävention und Behandlung von Osteoporose und der Folgen der Erkrankung auf der Grundlage evidenzbasierter Medizin.Klare Empfehlungen, welche Patienten zu diagnostizieren und behandeln sind (basierend auf Risikofaktoren [einschließlich sekundärer Osteoporose]) sowie Primär-, Sekundär- oder Tertiärprävention werden dargestellt, mit dem Schwerpunkt auf der postmenopausalen Osteoporose und der Osteoporose bei Männern.Die Identifizierung von Patienten mit einem hohen Risiko für Frakturen wird hervorgehoben, und spezifische Schwellenwerte für die Intervention sind definiert (20 % Hüftfrakturrisiko innerhalb von 10 Jahren diagnostischer Schwellenwert, 30 % Hüftfrakturrisiko innerhalb von 10 Jahren therapeutische Schwelle). Die Diagnose von Osteoporose basiert auf der Anamnese des Patienten, der körperlichen Untersuchung, dem Funktionstest (z. B. Timed Up and Go Test), konventionellen Röntgenaufnahmen der Brust- und Lendenwirbelsäule und der Bestimmung der Knochenmineraldichte (BMD) durch das DXA Verfahren.Die Anamnese ist entscheidend für die Abschätzung des Frakturrisikos auf der Grundlage von 40 wissenschaftlich überprüften Risikofaktoren, die das Frakturrisiko mindestens verdoppeln (z. B. Begleiterkrankungen, Hüftfrakturen in der Familie, prävalente Frakturen an jedem Ort, Lebensstil, Anwendung von Medikamenten, körperliche Aktivität und Stürze). Röntgenaufnahmen der Brust- und Lendenwirbelsäule sind wichtig, um prävalente Wirbelkörperfrakturen zu erkennen. Beim Fehlen eines großen Traumas kann jede Fraktur bei Erwachsenen über dem Alter von 50 Jahren eine Diagnose von Osteoporose nahelegen, mit dem höchsten Risiko für eine nachfolgende Fraktur innerhalb einer kurzen Zeit nach der ersten Fraktur. BMD-Messungen mit DXA sind wichtig, um das individuelle Frakturrisiko besser abschätzen zu können. Eine grundlegende Laboruntersuchung ist obligatorisch, um verschiedene Formen der sekundären Osteoporose ausschließen zu können.Der DVO-Patientenfindungs-Algorithmus basiert auf dem Geschlecht, Alter, Knochenmineraldichte und vorbestehenden Frakturen als wichtigste Informationen. Die Indikation für eine aktive anti-osteoporotische Therapie kann durch multiple Risikofaktoren modifiziert und verfeinert werden. Dieser Algorithmus wurde seit dem Richtlinien-Update 2006 verwendet und wurde entsprechend der internationalen Literatur zu Risikofaktoren für Osteoporose und osteoporotische Frakturen aktualisiert und angepasst.Die Behandlung der Osteoporose enthält viele Therapiepfeiler. Zusammen mit Empfehlungen für Bewegung, Physiotherapie und Sturzprävention sowie Ernährung (z. B. Calcium, Vit. D), werden pharmakologische Behandlungen basierend auf evidenzbasierter Medizin empfohlen. Die aktiven Anti-Osteoporose-Medikamente müssen für die Indikation postmenopausale Osteoporose und männliche Osteoporose in Deutschland, Österreich und der Schweiz zugelassen sein. Das Management und die Vorbeugung von häufigen oder seltenen Nebenwirkungen aufgrund von Anti-Osteoporose-Behandlungen, die in der klinischen Praxis angewendet werden, werden ebenfalls detailliert behandelt.
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Pfeifer M, Schwarz T, Stöwe K. Kombinatorisches Hochdurchsatz-Screening von quaternären Katalysatorsystemen als mikrostrukturierte Wandkatalysatoren. CHEM-ING-TECH 2018. [DOI: 10.1002/cite.201855053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- M. Pfeifer
- Technische Universität Chemnitz; Professur Chemische Technologie; Straße der Nationen 62 09111 Chemnitz Deutschland
| | - T. Schwarz
- Technische Universität Chemnitz; Professur Chemische Technologie; Straße der Nationen 62 09111 Chemnitz Deutschland
| | - K. Stöwe
- Technische Universität Chemnitz; Professur Chemische Technologie; Straße der Nationen 62 09111 Chemnitz Deutschland
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Redondo MJ, Geyer S, Steck AK, Sharp S, Wentworth JM, Weedon MN, Antinozzi P, Sosenko J, Atkinson M, Pugliese A, Oram RA, Antinozzi P, Atkinson M, Battaglia M, Becker D, Bingley P, Bosi E, Buckner J, Colman P, Gottlieb P, Herold K, Insel R, Kay T, Knip M, Marks J, Moran A, Palmer J, Peakman M, Philipson L, Pugliese A, Raskin P, Rodriguez H, Roep B, Russell W, Schatz D, Wherrett D, Wilson D, Winter W, Ziegler A, Benoist C, Blum J, Chase P, Clare-Salzler M, Clynes R, Eisenbarth G, Fathman C, Grave G, Hering B, Kaufman F, Leschek E, Mahon J, Nanto-Salonen K, Nepom G, Orban T, Parkman R, Pescovitz M, Peyman J, Roncarolo M, Simell O, Sherwin R, Siegelman M, Steck A, Thomas J, Trucco M, Wagner J, Greenbaum ,CJ, Bourcier K, Insel R, Krischer JP, Leschek E, Rafkin L, Spain L, Cowie C, Foulkes M, Krause-Steinrauf H, Lachin JM, Malozowski S, Peyman J, Ridge J, Savage P, Skyler JS, Zafonte SJ, Kenyon NS, Santiago I, Sosenko JM, Bundy B, Abbondondolo M, Adams T, Amado D, Asif I, Boonstra M, Bundy B, Burroughs C, Cuthbertson D, Deemer M, Eberhard C, Fiske S, Ford J, Garmeson J, Guillette H, Browning G, Coughenour T, Sulk M, Tsalikan E, Tansey M, Cabbage J, Dixit N, Pasha S, King M, Adcock K, Geyer S, Atterberry H, Fox L, Englert K, Mauras N, Permuy J, Sikes K, Berhe T, Guendling B, McLennan L, Paganessi L, Hays B, Murphy C, Draznin M, Kamboj M, Sheppard S, Lewis V, Coates L, Moore W, Babar G, Bedard J, Brenson-Hughes D, Henderson C, Cernich J, Clements M, Duprau R, Goodman S, Hester L, Huerta-Saenz L, Karmazin A, Letjen T, Raman S, Morin D, Henry M, Bestermann W, Morawski E, White J, Brockmyer A, Bays R, Campbell S, Stapleton A, Stone N, Donoho A, Everett H, Heyman K, Hensley H, Johnson M, Marshall C, Skirvin N, Taylor P, Williams R, Ray L, Wolverton C, Nickels D, Dothard C, Hsiao B, Speiser P, Pellizzari M, Bokor L, Izuora K, Abdelnour S, Cummings P, Paynor S, Leahy M, Riedl M, Shockley S, Karges C, Saad R, Briones T, Casella S, Herz C, Walsh K, Greening J, Hay F, Hunt S, Sikotra N, Simons L, Keaton N, Karounos D, Oremus R, Dye L, Myers L, Ballard D, Miers W, Sparks R, Thraikill K, Edwards K, Fowlkes J, Kinderman A, Kemp S, Morales A, Holland L, Johnson L, Paul P, Ghatak A, Phelen K, Leyland H, Henderson T, Brenner D, Law P, Oppenheimer E, Mamkin I, Moniz C, Clarson C, Lovell M, Peters A, Ruelas V, Borut D, Burt D, Jordan M, Leinbach A, Castilla S, Flores P, Ruiz M, Hanson L, Green-Blair J, Sheridan R, Wintergerst K, Pierce G, Omoruyi A, Foster M, Linton C, Kingery S, Lunsford A, Cervantes I, Parker T, Price P, Urben J, Doughty I, Haydock H, Parker V, Bergman P, Liu S, Duncum S, Rodda C, Thomas A, Ferry R, McCommon D, Cockroft J, Perelman A, Calendo R, Barrera C, Arce-Nunez E, Lloyd J, Martinez Y, De la Portilla M, Cardenas I, Garrido L, Villar M, Lorini R, Calandra E, D’Annuzio G, Perri K, Minuto N, Malloy J, Rebora C, Callegari R, Ali O, Kramer J, Auble B, Cabrera S, Donohoue P, Fiallo-Scharer R, Hessner M, Wolfgram P, Maddox K, Kansra A, Bettin N, McCuller R, Miller A, Accacha S, Corrigan J, Fiore E, Levine R, Mahoney T, Polychronakos C, Martin J, Gagne V, Starkman H, Fox M, Chin D, Melchionne F, Silverman L, Marshall I, Cerracchio L, Cruz J, Viswanathan A, Miller J, Wilson J, Chalew S, Valley S, Layburn S, Lala A, Clesi P, Genet M, Uwaifo G, Charron A, Allerton T, Milliot E, Cefalu W, Melendez-Ramirez L, Richards R, Alleyn C, Gustafson E, Lizanna M, Wahlen J, Aleiwe S, Hansen M, Wahlen H, Moore M, Levy C, Bonaccorso A, Rapaport R, Tomer Y, Chia D, Goldis M, Iazzetti L, Klein M, Levister C, Waldman L, Muller S, Wallach E, Regelmann M, Antal Z, Aranda M, Reynholds C, Leech N, Wake D, Owens C, Burns M, Wotherspoon J, Nguyen T, Murray A, Short K, Curry G, Kelsey S, Lawson J, Porter J, Stevens S, Thomson E, Winship S, Wynn L, O’Donnell R, Wiltshire E, Krebs J, Cresswell P, Faherty H, Ross C, Vinik A, Barlow P, Bourcier M, Nevoret M, Couper J, Oduah V, Beresford S, Thalagne N, Roper H, Gibbons J, Hill J, Balleaut S, Brennan C, Ellis-Gage J, Fear L, Gray T, Pilger J, Jones L, McNerney C, Pointer L, Price N, Few K, Tomlinson D, Denvir L, Drew J, Randell T, Mansell P, Roberts A, Bell S, Butler S, Hooton Y, Navarra H, Roper A, Babington G, Crate L, Cripps H, Ledlie A, Moulds C, Sadler K, Norton R, Petrova B, Silkstone O, Smith C, Ghai K, Murray M, Viswanathan V, Henegan M, Kawadry O, Olson J, Stavros T, Patterson L, Ahmad T, Flores B, Domek D, Domek S, Copeland K, George M, Less J, Davis T, Short M, Tamura R, Dwarakanathan A, O’Donnell P, Boerner B, Larson L, Phillips M, Rendell M, Larson K, Smith C, Zebrowski K, Kuechenmeister L, Wood K, Thevarayapillai M, Daniels M, Speer H, Forghani N, Quintana R, Reh C, Bhangoo A, Desrosiers P, Ireland L, Misla T, Xu P, Torres C, Wells S, Villar J, Yu M, Berry D, Cook D, Soder J, Powell A, Ng M, Morrison M, Young K, Haslam Z, Lawson M, Bradley B, Courtney J, Richardson C, Watson C, Keely E, DeCurtis D, Vaccarcello-Cruz M, Torres Z, Alies P, Sandberg K, Hsiang H, Joy B, McCormick D, Powell A, Jones H, Bell J, Hargadon S, Hudson S, Kummer M, Badias F, Sauder S, Sutton E, Gensel K, Aguirre-Castaneda R, Benavides Lopez V, Hemp D, Allen S, Stear J, Davis E, Jones T, Baker A, Roberts A, Dart J, Paramalingam N, Levitt Katz L, Chaudhary N, Murphy K, Willi S, Schwartzman B, Kapadia C, Larson D, Bassi M, McClellan D, Shaibai G, Kelley L, Villa G, Kelley C, Diamond R, Kabbani M, Dajani T, Hoekstra F, Magorno M, Beam C, Holst J, Chauhan V, Wilson N, Bononi P, Sperl M, Millward A, Eaton M, Dean L, Olshan J, Renna H, Boulware D, Milliard C, Snyder D, Beaman S, Burch K, Chester J, Ahmann A, Wollam B, DeFrang D, Fitch R, Jahnke K, Bounmananh L, Hanavan K, Klopfenstein B, Nicol L, Bergstrom R, Noland T, Brodksy J, Bacon L, Quintos J, Topor L, Bialo S, Bream S, Bancroft B, Soto A, Lagarde W, Lockemer H, Vanderploeg T, Ibrahim M, Huie M, Sanchez V, Edelen R, Marchiando R, Freeman D, Palmer J, Repas T, Wasson M, Auker P, Culbertson J, Kieffer T, Voorhees D, Borgwardt T, DeRaad L, Eckert K, Gough J, Isaacson E, Kuhn H, Carroll A, Schubert M, Francis G, Hagan S, Le T, Penn M, Wickham E, Leyva C, Ginem J, Rivera K, Padilla J, Rodriguez I, Jospe N, Czyzyk J, Johnson B, Nadgir U, Marlen N, Prakasam G, Rieger C, Granger M, Glaser N, Heiser E, Harris B, Foster C, Slater H, Wheeler K, Donaldson D, Murray M, Hale D, Tragus R, Holloway M, Word D, Lynch J, Pankratz L, Rogers W, Newfield R, Holland S, Hashiguchi M, Gottschalk M, Philis-Tsimikas A, Rosal R, Kieffer M, Franklin S, Guardado S, Bohannon N, Garcia M, Aguinaldo T, Phan J, Barraza V, Cohen D, Pinsker J, Khan U, Lane P, Wiley J, Jovanovic L, Misra P, Wright M, Cohen D, Huang K, Skiles M, Maxcy S, Pihoker C, Cochrane K, Nallamshetty L, Fosse J, Kearns S, Klingsheim M, Wright N, Viles L, Smith H, Heller S, Cunningham M, Daniels A, Zeiden L, Parrimon Y, Field J, Walker R, Griffin K, Bartholow L, Erickson C, Howard J, Krabbenhoft B, Sandman C, Vanveldhuizen A, Wurlger J, Paulus K, Zimmerman A, Hanisch K, Davis-Keppen L, Cotterill A, Kirby J, Harris M, Schmidt A, Kishiyama C, Flores C, Milton J, Ramiro J, Martin W, Whysham C, Yerka A, Freels T, Hassing J, Webster J, Green R, Carter P, Galloway J, Hoelzer D, Ritzie AQL, Roberts S, Said S, Sullivan P, Allen H, Reiter E, Feinberg E, Johnson C, Newhook L, Hagerty D, White N, Sharma A, Levandoski L, Kyllo J, Johnson M, Benoit C, Iyer P, Diamond F, Hosono H, Jackman S, Barette L, Jones P, Shor A, Sills I, Bzdick S, Bulger J, Weinstock R, Douek I, Andrews R, Modgill G, Gyorffy G, Robin L, Vaidya N, Song X, Crouch S, O’Brien K, Thompson C, Thorne N, Blumer J, Kalic J, Klepek L, Paulett J, Rosolowski B, Horner J, Terry A, Watkins M, Casey J, Carpenter K, Burns C, Horton J, Pritchard C, Soetaert D, Wynne A, Kaiserman K, Halvorson M, Weinberger J, Chin C, Molina O, Patel C, Senguttuvan R, Wheeler M, Furet O, Steuhm C, Jelley D, Goudeau S, Chalmers L, Wootten M, Greer D, Panagiotopoulos C, Metzger D, Nguyen D, Horowitz M, Christiansen M, Glades E, Morimoto C, Macarewich M, Norman R, Harding P, Patin K, Vargas C, Barbanica A, Yu A, Vaidyanathan P, Osborne W, Mehra R, Kaster S, Neace S, Horner J, McDonough S, Reeves G, Cordrey C, Marrs L, Miller T, Dowshen S, Doyle D, Walker S, Catte D, Dean H, Drury-Brown M, McGee PF, Hackman B, Lee M, Malkani S, Cullen K, Johnson K, Hampton P, McCarrell M, Curtis C, Paul E, Zambrano Y, Hess KO, Phoebus D, Quinlan S, Raiden E, Batts E, Buddy C, Kirpatrick K, Ramey M, Shultz A, Webb C, Romesco M, Fradkin J, Blumberg E, Beck G, Brillon D, Gubitosi-Klug R, Laffel L, Veatch R, Wallace D, Braun J, Lernmark A, Lo B, Mitchell H, Naji A, Nerup J, Orchard T, Steffes M, Tsiatis A, Zinman B, Loechelt B, Baden L, Green M, Weinberg A, Marcovina S, Palmer JP, Weinberg A, Yu L, Babu S, Winter W, Eisenbarth GS, Bingley P, Clynes R, DiMeglio L, Eisenbarth G, Hays B, Marks J, Matheson D, Rodriguez H, Wilson D, Redondo MJ, Gomez D, Zheng X, Pena S, Pietropaolo M, Batts E, Brown T, Buckner J, Dove A, Hammond M, Hefty D, Klein J, Kuhns K, Letlau M, Lord S, McCulloch-Olson M, Miller L, Nepom G, Odegard J, Ramey M, Sachter E, St. Marie M, Stickney K, VanBuecken D, Vellek B, Webber C, Allen L, Bollyk J, Hilderman N, Ismail H, Lamola S, Sanda S, Vendettuoli H, Tridgell D, Monzavi R, Bock M, Fisher L, Halvorson M, Jeandron D, Kim M, Wood J, Geffner M, Kaufman F, Parkman R, Salazar C, Goland R, Clynes R, Cook S, Freeby M, Gallagher MP, Gandica R, Greenberg E, Kurland A, Pollak S, Wolk A, Chan M, Koplimae L, Levine E, Smith K, Trast J, DiMeglio L, Blum J, Evans-Molina C, Hufferd R, Jagielo B, Kruse C, Patrick V, Rigby M, Spall M, Swinney K, Terrell J, Christner L, Ford L, Lynch S, Menendez M, Merrill P, Pescovitz M, Rodriguez H, Alleyn C, Baidal D, Fay S, Gaglia J, Resnick B, Szubowicz S, Weir G, Benjamin R, Conboy D, deManbey A, Jackson R, Jalahej H, Orban T, Ricker A, Wolfsdorf J, Zhang HH, Wilson D, Aye T, Baker B, Barahona K, Buckingham B, Esrey K, Esrey T, Fathman G, Snyder R, Aneja B, Chatav M, Espinoza O, Frank E, Liu J, Perry J, Pyle R, Rigby A, Riley K, Soto A, Gitelman S, Adi S, Anderson M, Berhel A, Breen K, Fraser K, Gerard-Gonzalez A, Jossan P, Lustig R, Moassesfar S, Mugg A, Ng D, Prahalod P, Rangel-Lugo M, Sanda S, Tarkoff J, Torok C, Wesch R, Aslan I, Buchanan J, Cordier J, Hamilton C, Hawkins L, Ho T, Jain A, Ko K, Lee T, Phelps S, Rosenthal S, Sahakitrungruang T, Stehl L, Taylor L, Wertz M, Wong J, Philipson L, Briars R, Devine N, Littlejohn E, Grant T, Gottlieb P, Klingensmith G, Steck A, Alkanani A, Bautista K, Bedoy R, Blau A, Burke B, Cory L, Dang M, Fitzgerald-Miller L, Fouts A, Gage V, Garg S, Gesauldo P, Gutin R, Hayes C, Hoffman M, Ketchum K, Logsden-Sackett N, Maahs D, Messer L, Meyers L, Michels A, Peacock S, Rewers M, Rodriguez P, Sepulbeda F, Sippl R, Steck A, Taki I, Tran BK, Tran T, Wadwa RP, Zeitler P, Barker J, Barry S, Birks L, Bomsburger L, Bookert T, Briggs L, Burdick P, Cabrera R, Chase P, Cobry E, Conley A, Cook G, Daniels J, DiDomenico D, Eckert J, Ehler A, Eisenbarth G, Fain P, Fiallo-Scharer R, Frank N, Goettle H, Haarhues M, Harris S, Horton L, Hutton J, Jeffrrey J, Jenison R, Jones K, Kastelic W, King MA, Lehr D, Lungaro J, Mason K, Maurer H, Nguyen L, Proto A, Realsen J, Schmitt K, Schwartz M, Skovgaard S, Smith J, Vanderwel B, Voelmle M, Wagner R, Wallace A, Walravens P, Weiner L, Westerhoff B, Westfall E, Widmer K, Wright H, Schatz D, Abraham A, Atkinson M, Cintron M, Clare-Salzler M, Ferguson J, Haller M, Hosford J, Mancini D, Rohrs H, Silverstein J, Thomas J, Winter W, Cole G, Cook R, Coy R, Hicks E, Lewis N, Marks J, Pugliese A, Blaschke C, Matheson D, Sanders-Branca N, Sosenko J, Arazo L, Arce R, Cisneros M, Sabbag S, Moran A, Gibson C, Fife B, Hering B, Kwong C, Leschyshyn J, Nathan B, Pappenfus B, Street A, Boes MA, Eck SP, Finney L, Fischer TA, Martin A, Muzamhindo CJ, Rhodes M, Smith J, Wagner J, Wood B, Becker D, Delallo K, Diaz A, Elnyczky B, Libman I, Pasek B, Riley K, Trucco M, Copemen B, Gwynn D, Toledo F, Rodriguez H, Bollepalli S, Diamond F, Eyth E, Henson D, Lenz A, Shulman D, Raskin P, Adhikari S, Dickson B, Dunnigan E, Lingvay I, Pruneda L, Ramos-Roman M, Raskin P, Rhee C, Richard J, Siegelman M, Sturges D, Sumpter K, White P, Alford M, Arthur J, Aviles-Santa ML, Cordova E, Davis R, Fernandez S, Fordan S, Hardin T, Jacobs A, Kaloyanova P, Lukacova-Zib I, Mirfakhraee S, Mohan A, Noto H, Smith O, Torres N, Wherrett D, Balmer D, Eisel L, Kovalakovska R, Mehan M, Sultan F, Ahenkorah B, Cevallos J, Razack N, Ricci MJ, Rhode A, Srikandarajah M, Steger R, Russell WE, Black M, Brendle F, Brown A, Moore D, Pittel E, Robertson A, Shannon A, Thomas JW, Herold K, Feldman L, Sherwin R, Tamborlane W, Weinzimer S, Toppari J, Kallio T, Kärkkäinen M, Mäntymäki E, Niininen T, Nurmi B, Rajala P, Romo M, Suomenrinne S, Näntö-Salonen K, Simell O, Simell T, Bosi E, Battaglia M, Bianconi E, Bonfanti R, Grogan P, Laurenzi A, Martinenghi S, Meschi F, Pastore M, Falqui L, Muscato MT, Viscardi M, Castleden H, Farthing N, Loud S, Matthews C, McGhee J, Morgan A, Pollitt J, Elliot-Jones R, Wheaton C, Knip M, Siljander H, Suomalainen H, Colman P, Healy F, Mesfin S, Redl L, Wentworth J, Willis J, Farley M, Harrison L, Perry C, Williams F, Mayo A, Paxton J, Thompson V, Volin L, Fenton C, Carr L, Lemon E, Swank M, Luidens M, Salgam M, Sharma V, Schade D, King C, Carano R, Heiden J, Means N, Holman L, Thomas I, Madrigal D, Muth T, Martin C, Plunkett C, Ramm C, Auchus R, Lane W, Avots E, Buford M, Hale C, Hoyle J, Lane B, Muir A, Shuler S, Raviele N, Ivie E, Jenkins M, Lindsley K, Hansen I, Fadoju D, Felner E, Bode B, Hosey R, Sax J, Jefferies C, Mannering S, Prentis R, She J, Stachura M, Hopkins D, Williams J, Steed L, Asatapova E, Nunez S, Knight S, Dixon P, Ching J, Donner T, Longnecker S, Abel K, Arcara K, Blackman S, Clark L, Cooke D, Plotnick L, Levin P, Bromberger L, Klein K, Sadurska K, Allen C, Michaud D, Snodgrass H, Burghen G, Chatha S, Clark C, Silverberg J, Wittmer C, Gardner J, LeBoeuf C, Bell P, McGlore O, Tennet H, Alba N, Carroll M, Baert L, Beaton H, Cordell E, Haynes A, Reed C, Lichter K, McCarthy P, McCarthy S, Monchamp T, Roach J, Manies S, Gunville F, Marosok L, Nelson T, Ackerman K, Rudolph J, Stewart M, McCormick K, May S, Falls T, Barrett T, Dale K, Makusha L, McTernana C, Penny-Thomas K, Sullivan K, Narendran P, Robbie J, Smith D, Christensen R, Koehler B, Royal C, Arthur T, Houser H, Renaldi J, Watsen S, Wu P, Lyons L, House B, Yu J, Holt H, Nation M, Vickers C, Watling R, Heptulla R, Trast J, Agarwal C, Newell D, Katikaneni R, Gardner C, Del Rio A, Logan A, Collier H, Rishton C, Whalley G, Ali A, Ramtoola S, Quattrin T, Mastrandea L, House A, Ecker M, Huang C, Gougeon C, Ho J, Pacuad D, Dunger D, May J, O’Brien C, Acerini C, Salgin B, Thankamony A, Williams R, Buse J, Fuller G, Duclos M, Tricome J, Brown H, Pittard D, Bowlby D, Blue A, Headley T, Bendre S, Lewis K, Sutphin K, Soloranzo C, Puskaric J, Madison H, Rincon M, Carlucci M, Shridharani R, Rusk B, Tessman E, Huffman D, Abrams H, Biederman B, Jones M, Leathers V, Brickman W, Petrie P, Zimmerman D, Howard J, Miller L, Alemzadeh R, Mihailescu D, Melgozza-Walker R, Abdulla N, Boucher-Berry C, Ize-Ludlow D, Levy R, Swenson Brousell C, Scott R, Heenan H, Lunt H, Kendall D, Willis J, Darlow B, Crimmins N, Edler D, Weis T, Schultz C, Rogers D, Latham D, Mawhorter C, Switzer C, Spencer W, Konstantnopoulus P, Broder S, Klein J, Bachrach B, Gardner M, Eichelberger D, Knight L, Szadek L, Welnick G, Thompson B, Hoffman R, Revell A, Cherko J, Carter K, Gilson E, Haines J, Arthur G, Bowen B, Zipf W, Graves P, Lozano R, Seiple D, Spicer K, Chang A, Fregosi J, Harbinson J, Paulson C, Stalters S, Wright P, Zlock D, Freeth A, Victory J, Maheshwari H, Maheshwari A, Holmstrom T, Bueno J, Arguello R, Ahern J, Noreika L, Watson V, Hourse S, Breyer P, Kissel C, Nicholson Y, Pfeifer M, Almazan S, Bajaj J, Quinn M, Funk K, McCance J, Moreno E, Veintimilla R, Wells A, Cook J, Trunnel S, Transue D, Surhigh J, Bezzaire D, Moltz K, Zacharski E, Henske J, Desai S, Frizelis K, Khan F, Sjoberg R, Allen K, Manning P, Hendry G, Taylor B, Jones S, Couch R, Danchak R, Lieberman D, Strader W, Bencomo M, Bailey T, Bedolla L, Roldan C, Moudiotis C, Vaidya B, Anning C, Bunce S, Estcourt S, Folland E, Gordon E, Harrill C, Ireland J, Piper J, Scaife L, Sutton K, Wilkins S, Costelloe M, Palmer J, Casas L, Miller C, Burgard M, Erickson C, Hallanger-Johnson J, Clark P, Taylor W, Galgani J, Banerjee S, Banda C, McEowen D, Kinman R, Lafferty A, Gillett S, Nolan C, Pathak M, Sondrol L, Hjelle T, Hafner S, Kotrba J, Hendrickson R, Cemeroglu A, Symington T, Daniel M, Appiagyei-Dankah Y, Postellon D, Racine M, Kleis L, Barnes K, Godwin S, McCullough H, Shaheen K, Buck G, Noel L, Warren M, Weber S, Parker S, Gillespie I, Nelson B, Frost C, Amrhein J, Moreland E, Hayes A, Peggram J, Aisenberg J, Riordan M, Zasa J, Cummings E, Scott K, Pinto T, Mokashi A, McAssey K, Helden E, Hammond P, Dinning L, Rahman S, Ray S, Dimicri C, Guppy S, Nielsen H, Vogel C, Ariza C, Morales L, Chang Y, Gabbay R, Ambrocio L, Manley L, Nemery R, Charlton W, Smith P, Kerr L, Steindel-Kopp B, Alamaguer M, Tabisola-Nuesca E, Pendersen A, Larson N, Cooper-Olviver H, Chan D, Fitz-Patrick D, Carreira T, Park Y, Ruhaak R, Liljenquist D. A Type 1 Diabetes Genetic Risk Score Predicts Progression of Islet Autoimmunity and Development of Type 1 Diabetes in Individuals at Risk. Diabetes Care 2018; 41:1887-1894. [PMID: 30002199 PMCID: PMC6105323 DOI: 10.2337/dc18-0087] [Citation(s) in RCA: 86] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 06/06/2018] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We tested the ability of a type 1 diabetes (T1D) genetic risk score (GRS) to predict progression of islet autoimmunity and T1D in at-risk individuals. RESEARCH DESIGN AND METHODS We studied the 1,244 TrialNet Pathway to Prevention study participants (T1D patients' relatives without diabetes and with one or more positive autoantibodies) who were genotyped with Illumina ImmunoChip (median [range] age at initial autoantibody determination 11.1 years [1.2-51.8], 48% male, 80.5% non-Hispanic white, median follow-up 5.4 years). Of 291 participants with a single positive autoantibody at screening, 157 converted to multiple autoantibody positivity and 55 developed diabetes. Of 953 participants with multiple positive autoantibodies at screening, 419 developed diabetes. We calculated the T1D GRS from 30 T1D-associated single nucleotide polymorphisms. We used multivariable Cox regression models, time-dependent receiver operating characteristic curves, and area under the curve (AUC) measures to evaluate prognostic utility of T1D GRS, age, sex, Diabetes Prevention Trial-Type 1 (DPT-1) Risk Score, positive autoantibody number or type, HLA DR3/DR4-DQ8 status, and race/ethnicity. We used recursive partitioning analyses to identify cut points in continuous variables. RESULTS Higher T1D GRS significantly increased the rate of progression to T1D adjusting for DPT-1 Risk Score, age, number of positive autoantibodies, sex, and ethnicity (hazard ratio [HR] 1.29 for a 0.05 increase, 95% CI 1.06-1.6; P = 0.011). Progression to T1D was best predicted by a combined model with GRS, number of positive autoantibodies, DPT-1 Risk Score, and age (7-year time-integrated AUC = 0.79, 5-year AUC = 0.73). Higher GRS was significantly associated with increased progression rate from single to multiple positive autoantibodies after adjusting for age, autoantibody type, ethnicity, and sex (HR 2.27 for GRS >0.295, 95% CI 1.47-3.51; P = 0.0002). CONCLUSIONS The T1D GRS independently predicts progression to T1D and improves prediction along T1D stages in autoantibody-positive relatives.
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Affiliation(s)
- Maria J. Redondo
- Texas Children’s Hospital, Baylor College of Medicine, Houston, TX
| | | | - Andrea K. Steck
- Barbara Davis Center for Childhood Diabetes, University of Colorado School of Medicine, Aurora, CO
| | - Seth Sharp
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | - John M. Wentworth
- Walter and Eliza Hall Institute of Medical Research and Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Michael N. Weedon
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
| | | | | | | | | | - Richard A. Oram
- Institute of Biomedical and Clinical Science, University of Exeter, Exeter, U.K
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Kreuter M, Ochmann U, Koschel D, Behr J, Bonella F, Claussen M, Costabel U, Jungmann S, Kolb M, Nowak D, Petermann F, Pfeifer M, Prasse A, Schreiber J, Wälscher J, Wirtz H, Kirsten D. Fragebogen der Sektion 7 der DGP zur Erfassung der Ursachen interstitieller und seltener Lungenerkrankungen. Pneumologie 2018. [DOI: 10.1055/s-0037-1619188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Kreuter
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik; Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (TLRC); Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - U Ochmann
- Institut für Arbeits-, Sozial- und Umweltmedizin; Klinikum der LMU-Universität München
| | - D Koschel
- Zentrum für Pneumologie-, Thorax- und Gefäßchirurgie, Fachkrankenhaus Coswig
| | | | | | | | | | | | - M Kolb
- Mcmaster University, Hamilton, Canada
| | - D Nowak
- Comprehensive Pneumology Center, Institut und Poliklinik für Arbeits-, Sozial- und Umweltmedizin; Klinikum der LMU München
| | - F Petermann
- Zentrum für Klinische Psychologie und Rehabilitation der Universität Bremen
| | - M Pfeifer
- Klinik Donaustauf und Universitätsklinikum Regensburg
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule, Hannover
| | - J Schreiber
- Fachbereich Pneumologie, Universitätsklinikum Magedeburg A. ö. R
| | - J Wälscher
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Thoraxklinik, Uniklinikum Heidelberg
| | - H Wirtz
- Pneumologie, Universitätsklinikum der Universität Leipzig
| | - D Kirsten
- Airway Research Center North (Arcn), Lungenclinic Grosshansdorf; Member of the German Center for Lung Research (DZL)
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Kreuter M, Herth FJF, Wacker M, Witt S, Kabitz HJ, Hagmeyer L, Hammerl P, Esselmann A, Wiederholf C, Skowasch D, Stolpe C, Joest M, Veitshans S, Leidl R, Hellmann A, Pfeifer M, Behr J, Kauschka D, Mall M, Günther A, Markart P. Diagnostik und Therapie von Patienten mit interstitiellen Lungenerkrankungen in Deutschland – das EXCITING ILD Register. Pneumologie 2018. [DOI: 10.1055/s-0037-1619191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- M Kreuter
- Zentrum für Interstitielle und Seltene Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik; Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (TLRC); Mitglied des Deutschen Zentrums für Lungenforschung (DZL)
| | - FJF Herth
- Centre for Interstitial and Rare Lung Diseases, Pneumology and Respiratory Critical Care Medicine, Thoraxklinik, University of Heidelberg
| | - M Wacker
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, Member of the German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPC-M)
| | - S Witt
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, Member of the German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPC-M)
| | | | - L Hagmeyer
- Clinic of Pneumology and Allergology, Center of Sleep Medicine and Respiratory Care, Hospital Bethanien Solingen
| | | | - A Esselmann
- Outpatient Center for Pulmonology, Warendorf
| | | | - D Skowasch
- Medical Clinic II, University Hospital Bonn
| | - C Stolpe
- Outpatient Center for Pulmonology, Ibbenbüren
| | - M Joest
- Malteser Center for Pulmonology and Allergology, Bonn
| | - S Veitshans
- Outpatient Center for Pulmonology, Böblingen
| | - R Leidl
- Institute of Health Economics and Healthcare Management, Helmholtz Centre Munich GmbH, German Research Centre for Environmental Health, Member of the German Centre for Lung Research (DZL), Comprehensive Pneumology Centre Munich (CPC-M)
| | - A Hellmann
- Outpatient Center for Pulmonology, Augsburg
| | - M Pfeifer
- Klinik Donaustauf und Universitätsklinikum Regensburg
| | | | | | - M Mall
- Translational Pulmonology, University of Heidelberg, Germany, Member of the German Center for Lung Research (TLRC)
| | - A Günther
- Universitätsklinikum Gießen und Marburg
| | - P Markart
- Medical Clinic II, University Hospital Gießen, Universities of Gießen and Marburg Lung Centre (Ugmlc), Member and Medical Clinic V (Pneumology), Cardiothoracic Centre, Campus Fulda, University Medicine Marburg
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Andreas S, Jany B, Hering T, Rustler C, Grah C, Pfeifer M. OPS „Tabakentwöhnung“ im DRG-System – eine lohnende Perspektive für Patienten und Klinik. Pneumologie 2018; 72:103-105. [PMID: 29462831 DOI: 10.1055/s-0044-101117] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- S Andreas
- Lungenfachklinik Immenhausen.,Abteilung Kardiologie und Pneumologie, Universitätsmedizin Göttingen
| | - B Jany
- Missionsärztliche Klinik Würzburg
| | | | | | - C Grah
- Abteilung für Pneumologie, Gemeinschafts-krankenhaus Havelhöhe
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Behr J, Günther A, Kreuter M, Koschel D, Prasse A, Pfeifer M, Costabel U. [Expert Knowledge and Supporting Advice for the Clinical Use of Nintedanib in Patients with Idiopathic Pulmonary Fibrosis]. Pneumologie 2017; 71:567-579. [PMID: 28772332 DOI: 10.1055/s-0043-109856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
In October 2016, a group of German IPF experts were invited by Boehringer Ingelheim to meet in Frankfurt with the aim, (a) to discuss relevant aspects of the management and treatment of idiopathic pulmonary fibrosis (IPF) using nintedanib; and, (b) to provide supportive advice for daily clinical practice with nintedanib. The resulting information compiled in this document is confined to practical issues regarding the use of nintedanib in patients with IPF. Where different therapeutic options were available, the choice of IPF medication was not discussed and the experts alluded to current guidelines for the diagnosis and treatment of IPF.The participants discussed a comprehensive spectrum of clinical questions related to 10 different topics, including patient-related aspects at initiation of IPF therapy, the treatment of anticoagulated IPF patients, and the handling of nintedanib-related adverse events such as gastrointestinal side effects and elevated liver enzymes. In addition, the experts evaluated therapeutic options for IPF patients with continuous disease progression, clinical scenarios that justify discontinuation of nintedanib treatment, and therapeutic options for IPF patients with an acute exacerbation or severe infection. Finally, the participants discussed the handling of nintendanib before/after elective surgical intervention (e. g. lung transplantation) and the current evidence for antifibrotic combination therapy in patients with IPF.For each topic discussed, the resulting information incorporates published evidence from clinical trials. In case of insufficient or lacking evidence, the experts have formulated recommendations based on their personal clinical experience and evaluation.
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Affiliation(s)
- J Behr
- Asklepios Fachkliniken München-Gauting und Medizinische Klinik V, Klinikum der Ludwig-Maximilians-Universität München
| | - A Günther
- Med. Klinik II, Klinische Forschergruppe "Lungenfibrose", Universitätsklinikum Gießen und Marburg.,Lungenfachklinik Waldhof-Elgershausen, Greifenstein
| | - M Kreuter
- Zentrum für seltene und interstitielle Lungenerkrankungen, Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg, Mitglied des Deutschen Zentrums für Lungenforschung
| | - D Koschel
- Abteilung Pneumologie, Fachkrankenhaus Coswig, Zentrum für Pneumologie, Allergologie, Beatmungsmedizin und Thoraxchirurgie
| | - A Prasse
- Klinik für Pneumologie, Medizinische Hochschule Hannover und Deutsches Zentrum für Lungenforschung BREATH.,Fraunhofer Institut ITEM Hannover
| | - M Pfeifer
- Zentrum für Pneumologie, Klinik Donaustauf
| | - U Costabel
- Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum Essen, Essen
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Abstract
A young patient presented himself to the emergency department with sudden-onset, breathing-dependent right-sided thoracic pain. The auscultation revealed diminished breath sounds on the right. The radiograph showed a pneumothorax which was immediately dealt with chest tube drainage. The CT scan of the thorax showed minuscule subpleural bullae. Video-assisted thoracoscopic surgery (VATS) was performed due to persistent fistulae formation through the drain. The subpleural, bullous and emphysematous changes were histologically confirmed. Investigations into the cause showed evidence of alpha-1-antitrypsin deficiency (AATD). The patient is a Pi MZ type. Few cases of spontaneous pneumothorax as the first manifestation of alpha-1-antitrypsin deficiency have been described. Conclusion: When diagnosing primary spontaneous pneumothorax, alpha-1-antitrypsin deficiency should be considered.
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Affiliation(s)
- M Lepiorz
- Klinik für Pneumologie und konservative Intensivmedizin - Krankenhaus Barmherzige Brüder, Regensburg
| | - C Großer
- Klinik für Thoraxchirurgie - Krankenhaus Barmherzige Brüder, Regensburg
| | - H-S Hofmann
- Klinik für Thoraxchirurgie - Krankenhaus Barmherzige Brüder, Regensburg
| | - M Pfeifer
- Klinik für Pneumologie und konservative Intensivmedizin - Krankenhaus Barmherzige Brüder, Regensburg
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Lorenz J, Bals R, Dreher M, Jany B, Koczulla R, Pfeifer M, Randerath W, Steinkamp G, Taube C, Watz H, Windisch W. [Exacerbation of COPD]. Pneumologie 2017; 71:269-289. [PMID: 28505687 DOI: 10.1055/s-0043-106559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Acute worsenings of chronic obstructive pulmonary disease (COPD) were for a long time regarded as transient deteriorations, although occasionally life-threatening. No connection to disease progression was recognized. Data emerging during the last decade showed that patients had a considerably worse survival outcome after severe exacerbations. This insight was consolidated in 2012 by a large population-based cohort analysis. At present, severe exacerbations are regarded as key risk factors for COPD disease progression. The present article summarises the current knowledge on exacerbations of COPD, as delineated during an expert workshop in February 2017. It comprises pathogenic mechanisms, exacerbation triggers, the characteristics of frequent exacerbators, and the predictors of worse survival outcome. The role of comorbidities is considered more closely. The presentation of the pharmacotherapy of acute exacerbation is supplemented by an overview of ventilatory support. Finally, pharmacological and nonpharmacological preventive measures are summarised.
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Affiliation(s)
- J Lorenz
- Klinik für Pneumologie und Internistische Intensivmedizin, Klinikum Lüdenscheid
| | - R Bals
- Pneumologie, Allergologie, Beatmungsmedizin, Universitätsklinikum des Saarlandes
| | - M Dreher
- Sektion Pneumologie, Medizinische Klinik I, Universitätsklinikum Aachen
| | - B Jany
- Innere Medizin, Missionsärztliche Klinik Würzburg
| | - R Koczulla
- Klinik für Innere Medizin, Schwerpunkt Pneumologie, Universitätsklinikum Marburg
| | - M Pfeifer
- Pneumologie, Klinik Donaustauf und Universitätsklinikum Regensburg
| | - W Randerath
- Klinik für Pneumologie und Allergologie, Krankenhaus Bethanien, Solingen
| | - G Steinkamp
- Medizinisch-wissenschaftliches Publizieren, Schwerin
| | - C Taube
- Department of Pulmonology, Leiden University Medical Center
| | - H Watz
- Pneumologisches Forschungsinstitut an der LungenClinic Grosshansdorf, Airway Research Center North (ARCN), Deutsches Zentrum für Lungenforschung (DZL)
| | - W Windisch
- Abteilung Pneumologie - Lungenklinik, Krankenhaus Merheim - Kliniken Köln, Universität Witten/Herdecke
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Schwandt A, Denkinger M, Fasching P, Pfeifer M, Wagner C, Weiland J, Zeyfang A, Holl RW. Welche der Formeln Cockcroft-Gault, MDRD und CKD-EPI schätzt die gemessene glomeruläre Funktion am besten? Ergebnisse einer multizentrischen Studie mit 36.507 erwachsenen Patienten mit Typ 1 oder Typ 2 Diabetes aus der DPV-Datenbank. DIABETOL STOFFWECHS 2017. [DOI: 10.1055/s-0037-1601602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- A Schwandt
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Ulm, Germany
| | - M Denkinger
- AGAPLESION Bethesda Klinik, Geriatrie der Universität Ulm, Ulm, Germany
| | - P Fasching
- Wilhelminenspital, 5. Medizinischen Abteilung, Wien, Austria
| | - M Pfeifer
- Klinik Tettnang, Diabeteszentrum, Tettnang, Germany
| | - C Wagner
- Diabeteszentrum, Saaldorf-Surheim, Germany
| | - J Weiland
- Klinik Bad Reichenhall, Insitut für Innere Medizin, Bad Reichenhall, Germany
| | - A Zeyfang
- Sana Klinik Bethesda, Stuttgart, Germany
| | - RW Holl
- Universität Ulm, Institut für Epidemiologie und Medizinische Biometrie, ZIBMT, Ulm, Germany
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Dostal J, Dudzak R, Pisarczyk T, Pfeifer M, Huynh J, Chodukowski T, Kalinowska Z, Krousky E, Skala J, Hrebicek J, Medrik T, Golasowski J, Juha L, Ullschmied J. Synchronizing single-shot high-energy iodine photodissociation laser PALS and high-repetition-rate femtosecond Ti:sapphire laser system. Rev Sci Instrum 2017; 88:045109. [PMID: 28456257 DOI: 10.1063/1.4979810] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
A system of precise pulse synchronization between a single-shot large-scale laser exploiting an acousto-optical modulator and a femtosecond high repetition rate laser is reported in this article. This opto-electronical system has been developed for synchronization of the sub-nanosecond kJ-class iodine photodissociation laser system (Prague Asterix Laser System-PALS) with the femtosecond 25-TW Ti:sapphire (Ti:Sa) laser operating at a repetition rate 1 kHz or 10 Hz depending on the required energy level of output pulses. At 1 kHz synchronization regime, a single femtosecond pulse of duration about 45 fs and a small energy less than 1 mJ are exploited as a probe beam for irradiation of a three-frame interferometer, while at 10 Hz repetition rate a single femtosecond pulse with higher energy about 7-10 mJ is exploited as a probe beam for irradiation of a two-channel polaro-interferometer. The synchronization accuracy ±100 ps between the PALS and the Ti:Sa laser pulses has been achieved in both regimes of synchronization. The femtosecond interferograms of laser-produced plasmas obtained by the three-frame interferometer and the femtosecond polarimetric images obtained by the two-frame polaro-interferometer confirm the full usefulness and correct functionality of the proposed method of synchronization.
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Affiliation(s)
- J Dostal
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - R Dudzak
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - T Pisarczyk
- Institute of Plasma Physics and Laser Microfusion, Ul. Hery 23, 01-497 Warsaw, Poland
| | - M Pfeifer
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - J Huynh
- Institute of Physics of the Czech Academy of Sciences, Na Slovance 2, 182 21 Prague, Czech Republic
| | - T Chodukowski
- Institute of Plasma Physics and Laser Microfusion, Ul. Hery 23, 01-497 Warsaw, Poland
| | - Z Kalinowska
- Institute of Plasma Physics and Laser Microfusion, Ul. Hery 23, 01-497 Warsaw, Poland
| | - E Krousky
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - J Skala
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - J Hrebicek
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - T Medrik
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - J Golasowski
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - L Juha
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
| | - J Ullschmied
- Institute of Plasma Physics of the Czech Academy of Sciences, Za Slovankou 3, 182 00 Prague, Czech Republic
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Pfeifer M, Maher TM, Flaherty KR, Inoue Y, Richeldi L, Selman M, Stansen W, Stowasser S, Wells A. No effect of baseline diffusing capacity of lung for carbon monoxide on benefit of nintedanib. Pneumologie 2017. [DOI: 10.1055/s-0037-1598509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M Pfeifer
- Donaustauf Hospital, Donaustauf, Germany
| | - TM Maher
- National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, and National Heart and Lung Institute, Imperial College, London, UK
| | - KR Flaherty
- University of Michigan Health System, Ann Arbor, Michigan, USA
| | - Y Inoue
- Clinical Research Center, National Hospital Organization Kinki-Chuo Chest Medical Center, Osaka, Japan
| | - L Richeldi
- National Institute for Health Research Southampton Respiratory Biomedical Research Unit and Clinical and Experimental Sciences, University of Southampton, Southampton, UK
| | - M Selman
- Instituto Nacional de Enfermedades Respiratorias, Mexico City, Mexico
| | - W Stansen
- Boehringer Ingelheim Pharma GmbH & Co. Kg, Ingelheim am Rhein, Germany
| | - S Stowasser
- Boehringer Ingelheim Pharma GmbH & Co. Kg, Ingelheim am Rhein, Germany
| | - A Wells
- National Institute for Health Research Respiratory Biomedical Research Unit, Royal Brompton and Harefield NHS Foundation Trust, and National Heart and Lung Institute, Imperial College, London, UK
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Kreuter M, Wacker M, Hammerl P, Wiederhold C, Kabitz HJ, Hagmeyer L, Skowasch D, Leidl R, Hellmann A, Pfeifer M, Behr J, Witt S, Kauschka D, Mall M, Günther A, Herth FJF, Markart P. Interims Analyse des EXCITING-ILD Registers (Registry for Exploring Clinical and Epidemiological Characteristics of Interstitial Lung Diseases). Pneumologie 2017. [DOI: 10.1055/s-0037-1598497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- M Kreuter
- Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (Tlrc), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - M Wacker
- Helmholtz Zentrum München, Institut für Gesundheitsökonomie und Management Im Gesundheitswesen, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | | | | | - HJ Kabitz
- II. Medizinische Klinik, Klinikum Konstanz
| | - L Hagmeyer
- Klinik für Pneumologie und Allergologie, Krankenhaus Bethanien gGmbH
| | - D Skowasch
- Medizinische Klinik II, Kardiologie, Pneumologie, Uniklinikum Bonn
| | - R Leidl
- Institut für Gesundheitsökonomie und Management Im Gesundheitswesen, Helmholtz Zentrum München, Comprehensive Pneumology Center Munich (Cpc-M), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | | | - M Pfeifer
- Krankenhaus Donaustauf; Universität Regensburg
| | - J Behr
- Zentrum für Pneumologie und Thoraxchirurgie, Asklepios Fachkliniken München-Gauting; Med. Klinik V, LMU, München, Mitglied des Dzl
| | - S Witt
- Institut für Gesundheitsökonomie und Management Im Gesundheitswesen, Helmholtz Zentrum München
| | - D Kauschka
- C/O Dagmar Kauschka, 1. Vorsitzende, Lungenfibrose e.V
| | - M Mall
- Zentrum für Kinder- und Jugendmedizin, Sektion Pädiatrische Pneumologie & Allergologie und Mukoviszidose-Zentrum, Universitätsklinikum Heidelberg
| | - A Günther
- Med. Klinik II, Schwerpunkt Pneumologie, Univ.-Klinikum Gießen
| | - FJF Herth
- Pneumologie und Beatmungsmedizin, Thoraxklinik, Universitätsklinikum Heidelberg und Translationales Zentrum für Lungenforschung Heidelberg (Tlrc), Mitglied des Deutschen Zentrums für Lungenforschung (Dzl)
| | - P Markart
- Medizinische Klinik V, Klinikum Fulda
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Brandl M, Böhmer M, Brandstetter S, Finger T, Fischer W, Pfeifer M, Apfelbacher C. Factors associated with health-related quality of life (HRQOL) in adults with chronic obstructive pulmonary disease (COPD). Gesundheitswesen 2016. [DOI: 10.1055/s-0036-1586635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Rodbard HW, Seufert J, Aggarwal N, Cao A, Fung A, Pfeifer M, Alba M. Efficacy and safety of titrated canagliflozin in patients with type 2 diabetes mellitus inadequately controlled on metformin and sitagliptin. Diabetes Obes Metab 2016; 18:812-9. [PMID: 27160639 PMCID: PMC5089595 DOI: 10.1111/dom.12684] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 04/11/2016] [Accepted: 05/01/2016] [Indexed: 01/14/2023]
Abstract
AIMS To evaluate the efficacy and safety of titrated canagliflozin, a sodium glucose co-transporter 2 inhibitor, in patients with type 2 diabetes mellitus (T2DM) inadequately controlled on metformin and sitagliptin. METHODS In this randomized, double-blind study, patients with T2DM (N = 218) on metformin ≥1500 mg/day and sitagliptin 100 mg received canagliflozin 100 mg or placebo. After 6 weeks, the canagliflozin dose was increased from 100 to 300 mg (or from placebo to matching placebo) if all of the following criteria were met: baseline estimated glomerular filtration rate ≥70 ml/min/1.73 m(2) ; fasting self-monitored blood glucose ≥5.6 mmol/l (≥100 mg/dl); and no volume depletion-related adverse events (AEs) within 2 weeks before dose increase. Endpoints included change in glycated haemoglobin (HbA1c) at week 26 (primary); proportion of patients achieving HbA1c <7.0%; and changes in fasting plasma glucose (FPG), body weight and systolic blood pressure (SBP). Safety was assessed using AE reports. RESULTS Overall, 85.4% of patients were titrated to canagliflozin 300 mg or matching placebo (mean ± standard deviation time to titration 6.2 ± 0.8 weeks). At week 26, canagliflozin (pooled 100 and 300 mg) demonstrated superiority in HbA1c reduction versus placebo (-0.91% vs. -0.01%; p < 0.001). Canagliflozin provided significant reductions in FPG, body weight and SBP compared with placebo (p < 0.001). The overall AE incidence was 39.8 and 44.4% for canagliflozin and placebo, respectively. Canagliflozin was associated with an increased incidence of genital mycotic infections. CONCLUSIONS Titrated canagliflozin significantly improved HbA1c, FPG, body weight and SBP, and was generally well tolerated over 26 weeks in patients with T2DM as add-on to metformin and sitagliptin.
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Affiliation(s)
- H W Rodbard
- Endocrine and Metabolic Consultants, Rockville, MD, USA
| | - J Seufert
- Department of Endocrinology and Diabetology, Clinic for Internal Medicine II, University Medical Center, Freiburg, Germany
| | - N Aggarwal
- Aggarwal and Associates Ltd, Brampton, ON, Canada
| | - A Cao
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - A Fung
- Janssen Research & Development, LLC, Raritan, NJ, USA
| | - M Pfeifer
- Janssen Scientific Affairs, LLC, Raritan, NJ, USA
| | - M Alba
- Janssen Research & Development, LLC, Raritan, NJ, USA
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Pfeifer M, Kolb M, Kimura T, Stowasser S, Hallmann C, Richeldi L. Effect of baseline FVC on decline in lung function with nintedanib in patients with idiopathic pulmonary fibrosis (IPF): results from the INPULSIS® trials. Pneumologie 2016. [DOI: 10.1055/s-0036-1572000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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45
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Kreuter M, Herth FJF, Wacker M, Leidl R, Hellmann A, Pfeifer M, Behr J, Witt S, Kauschka D, Mall M, Günther A, Markart P. Interims Analyse des EXCITING-ILD Registers (Registry for Exploring Clinical and Epidemiological Characteristics of Interstitial Lung Diseases). Pneumologie 2016. [DOI: 10.1055/s-0036-1572075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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46
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Prieschenk C, Arzt M, Pfeifer M, Lange TJ. Umstellung von Bosentan auf Macitentan bei Patienten mit pulmonal arterieller Hypertonie. Pneumologie 2016. [DOI: 10.1055/s-0036-1572061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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47
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Pfeifer M, Raghu G, Wells A, Nicholson AG, Richeldi L, Flaherty KR, Le Maulf F, Stowasser S, Schlenker-Herceg R, Hansell DM. Consistent effect of nintedanib on decline in FVC in patients across subgroups based on HRCT diagnostic criteria: results from the INPULSIS® trials in idiopathic pulmonary fibrosis (IPF). Pneumologie 2016. [DOI: 10.1055/s-0036-1572001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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48
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Affiliation(s)
- M Pfeifer
- Institute of Clinical Osteology and German Osteology Foundation, Am Hylligen Born 7, 31812, Bad Pyrmont, Germany.
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49
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Malfertheiner M, Malfertheiner P, Costa SD, Pfeifer M, Ernst W, Seelbach-Göbel B, Fill Malfertheiner S. Extraesophageal symptoms of gastroesophageal reflux disease during pregnancy. Z Gastroenterol 2015; 53:1080-3. [PMID: 26367023 DOI: 10.1055/s-0034-1399453] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
AIM Typical symptoms of gastroesophageal reflux disease (GERD) are known to be frequent in pregnancy. The aim of this study was to gain a first estimation of the occurrence of extraesophageal symptoms in this context. METHODS A prospective longitudinal study was performed on 166 pregnant women and in a control group of 285 women. The diagnosis of GERD was based on the Montreal classification using the reflux disease questionnaire (RDQ). Extraesophageal symptoms were recorded with a self-administered questionnaire. Typical GERD symptoms and extraesophageal GERD symptoms were recorded in each trimester of pregnancy. RESULTS The prevalence of GERD during pregnancy was 16.9% in the first, 25.3% in the second and 51.2% in the third trimester. The prevalence of GERD in the control group was 6.3%. Asthma was reported by 3.5% of controls and by 6% of pregnant women during pregnancy. Chest pain occurred in 6% of the controls and in 1.8%, 2.4% and 2.4% during the trimesters of pregnancy, chronic cough was reported by 1.1% of controls and 1.2% of pregnant women. With the diagnosis of GERD the odds ratios and 95% confidence intervals for asthma, chronic cough and chest pain in the third trimester of pregnancy were as follows: 1.56 (0.58-4.22) for asthma, 0.91 (0.08-10.28) for chronic cough and 2.04 (0.49-8.46) for chest pain. CONCLUSION GERD is very frequent during pregnancy with progressive incidence during the course of pregnancy. Extraesophageal symptoms of GERD have an unexpected low prevalence during pregnancy.
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Affiliation(s)
| | - P Malfertheiner
- Klinik für Gastroenterologie, Hepatologie und Infektiologie, Universitätsklinikum Magdeburg, Germany
| | - S D Costa
- Gynäkologie und Geburtshilfe, Universitätsklinikum Magdeburg, Germany
| | - M Pfeifer
- Pneumologie, Barmherzige Brüder, Regensburg, Germany
| | - W Ernst
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Regensburg, Germany
| | - B Seelbach-Göbel
- Frauenheilkunde und Geburtshilfe, Universitätsklinikum, Regensburg, Germany
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Behr J, Bonella F, Bonnet R, Gläser S, Grohé C, Günther A, Koschel D, Kreuter M, Kirsten D, Krögel C, Markart P, Müller-Quernheim J, Neurohr C, Pfeifer M, Prasse A, Schönfeld N, Schreiber J, Wirtz H, Witt C, Costabel U. [Position Paper: Significance of the Forced Vital Capacity in Idiopathic Pulmonary Fibrosis]. Pneumologie 2015; 69:455-8. [PMID: 26227628 DOI: 10.1055/s-0034-1392602] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Spirometry is a highly standardized method which allows to measure the forced vital capacity (FVC) with high precision and reproducibility. In patients with IPF FVC is directly linked to the disease process which is characterized by scaring of alveoli and shrinkage of the lungs. Consequently, there is ample evidence form clinical studies that the decline of FVC over time is consistently associated with mortality in IPF. As for the first time effective drugs for the treatment of IPF are available it becomes obvious that in studies which could demonstrate that the drug reduces FVC decline, a numerical effect on mortality was also observed, while in one study where a significant effect on FVC decline was missed, there was also no change in mortality. Based on these studies FVC decline is a validated surrogate of mortality in IPF. It is concluded that FVC decline is not only accepted as an endpoint of clinical treatment trials in IPF but is also valid as a patient related outcome parameter which should be considered for the assessment of the efficacy of an IPF drug.
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Affiliation(s)
- J Behr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München und Asklepios Fachkliniken München-Gauting, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung
| | - F Bonella
- Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum Essen gGmbH
| | - R Bonnet
- Abteilung Pneumologie, Zentralklinik Bad Berka GmbH
| | - S Gläser
- Klinik für Innere Medizin B - Bereich Pneumologie, Infektiologie und Weaningzentrum Forschungsbereich Pneumologie und Pneumologische Epidemiologie Universitätsmedizin Greifswald
| | - C Grohé
- Pneumologische Klinik Evangelische Lungenklinik Berlin - Krankenhausbetriebs gGmbH
| | - A Günther
- Medizinische Klinik III, Pneumologie und Internistische Intensivmedizin Agaplesion Evangelisches Krankenhaus Mittelhessen und Schwerpunkt "Fibrosierende Lungenerkrankungen", Universitätsklinikum Gießen Marburg GmbH, Mitglied des Deutschen Zentrums für Lungenforschung
| | - D Koschel
- Abteilung Innere Medizin/Pneumologie, Fachkrankenhaus Coswig GmbH Zentrum für Pneumologie, Allergologie, Beatmungsmedizin, Thorax- und Gefäßchirurgie
| | - M Kreuter
- Pneumologie und Beatmungsmedizin, Zentrum für seltene und interstitielle Lungenerkrankungen Thoraxklinik, Universitätsklinikum Heidelberg, Mitglied des Deutschen Zentrums für Lungenforschung
| | | | - C Krögel
- Abteilung Pneumologie & Allergologie/Immunologie, Medizinische Klinik I, Klinikum der Universität Jena
| | - P Markart
- Medizinische Klinik und Poliklinik II, Universitätsklinikum Gießen und Marburg GmbH, Standort Gießen und Medizinische Klinik V (Pneumologie), Herz-Thorax-Zentrum, Klinikum Fulda gAG
| | | | - C Neurohr
- Medizinische Klinik und Poliklinik V, Klinikum der Universität München, Comprehensive Pneumology Center, Mitglied des Deutschen Zentrums für Lungenforschung
| | - M Pfeifer
- Klinik Donaustauf, Klinik für Pneumologie und konservative Intensivmedizin Krankenhaus Barmherzige Brüder, Regensburg, Klinik und Poliklinik für Innere Medizin II Universität Regensburg
| | - A Prasse
- Abteilung Pneumologie, Medizinische Hochschule Hannover
| | - N Schönfeld
- Klinik für Pneumologie, Lungenklinik Heckeshorn, HELIOS Klinikum Emil von Behring, Berlin
| | - J Schreiber
- Klinik für Pneumologie, Universitätsklinikum der Otto-von-Guericke-Universität, Magdeburg
| | - H Wirtz
- Abteilung Pneumologie, Universitätsklinikum Leipzig
| | - C Witt
- Abteilung Pneumologie und Transplantation, Universitätsklinikum Charité, Berlin
| | - U Costabel
- Senior Consultant, Interstitielle und Seltene Lungenkrankheiten, Ruhrlandklinik, Westdeutsches Lungenzentrum am Universitätsklinikum Essen gGmbH
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