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  • 11
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    Online Resource
    Thermal Vapor Ablation for Lung Lesions in a Porcine Model
    S. Karger AG ; 2015
    In:  Respiration Vol. 90, No. 2 ( 2015), p. 146-154
    Details
    In: Respiration, S. Karger AG, Vol. 90, No. 2 ( 2015), p. 146-154
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Various methods for ablating peripheral lung lesions are being investigated; however, none have been successfully adapted for delivery via bronchoscopy. Vapor ablation is currently being used to bronchoscopically create lung volume reduction in emphysema patients. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 In this study, an adaptation of that technology is evaluated for potential treatment of lung lesions in a live pig model. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 In 5 anesthetized healthy pigs, vapor of varying energy levels was delivered bronchoscopically to 66 different lung subsegments with airway diameters of 2-5 mm. Two hours after treatment, a necropsy was performed and the ablated regions were assessed for ablation and tissue structure disruption. In 6 additional pigs, vapor was applied to 3 subsegments each. To evaluate the progression of the response to treatment, 2 were kept alive for 10 days, 2 for 21 days, and 2 for 32 days. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Histopathological evaluation of the sections demonstrated that vapor is capable of creating a uniform field of necrosis following the subsegment anatomical boundary. The reliability of a uniform field is dependent on the level of energy delivered. An energy level that reliably creates a uniform field of necrosis was applied in chronic animals. The animals tolerated the procedure and posttreatment care. No cardiac arrhythmias, hemorrhage, stroke, respiratory distress, or pneumothorax occurred during or after treatment. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Vapor ablation is a potentially safe and efficient means of ablating a targeted region of the lung. We hypothesize that vapor may be useful in treating lesions of the lung in humans.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000433558
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
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  • 12
    Online Resource
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    Bullectomy: A Waste of Space or Room for Improvement?
    S. Karger AG ; 2016
    In:  Respiration Vol. 92, No. 4 ( 2016), p. 218-219
    Details
    In: Respiration, S. Karger AG, Vol. 92, No. 4 ( 2016), p. 218-219
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000448762
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2016
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  • 13
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    How Journals Treat Scientific Misconduct Allegations: Should Articles Be Retracted?
    S. Karger AG ; 2018
    In:  Respiration Vol. 96, No. 1 ( 2018), p. 98-110
    Details
    In: Respiration, S. Karger AG, Vol. 96, No. 1 ( 2018), p. 98-110
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000489981
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
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  • 14
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    Endoscopic Valve Removal 〉180 Days since Implantation in Patients with Severe Emphysema
    S. Karger AG ; 2018
    In:  Respiration Vol. 96, No. 4 ( 2018), p. 348-354
    Details
    In: Respiration, S. Karger AG, Vol. 96, No. 4 ( 2018), p. 348-354
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Valve implantation provides a reversible effective therapy in a selected group of emphysema patients. Knowing predictors for successful therapy, the rate of treatment failure has decreased. Some patients, however, do not benefit, so that the valves may have to be removed. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 To assess implant-related events, complications during valve removal, and clinical outcome after endoscopic procedure. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 The data of 76 consecutive emphysema patients who underwent valve removal & #x3e; 6 months since implantation were collected. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 Seventy-six patients (mean age 62 years, 54% male) underwent removal of all valves after a mean time of 624 days (193–3,043 days) since implantation. Granulation tissue was observed in 39.5% (30/76) and significant secretion in 34.2% (26/76). In 5.3% (4/76), valve removal was complicated requiring another bronchoscopy in 2 of them. In 5.3% (4/76) of the patients, one valve could not be removed and remained in situ. Bleeding requiring intervention occurred in 3.9% (3/76) during valve removal. Following bronchoscopy, there was a need for antibiotics in 34.2% (26/76), glucocorticosteroids in 1.3% (1/76), and both in 6.6% (5/76) due to productive cough or chronic obstructive pulmonary disease (COPD) exacerbation. Due to respiratory failure, invasive ventilation or noninvasive ventilation was necessary in 2.6% (2/76) and 6.6% (5/76), respectively, following procedure. No statistical significant change in lung function was observed following valve removal. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Valve removal after & #x3e; 6 months since implantation is feasible and associated with an acceptable safety profile. However, close monitoring of these patients with limited pulmonary reserve is recommended with particular attention to COPD exacerbations and respiratory failure.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000489887
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
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  • 15
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    Management of Significant Airway Bleeding during Robotic Assisted Bronchoscopy: A Tailored Approach
    S. Karger AG ; 2021
    In:  Respiration Vol. 100, No. 6 ( 2021), p. 547-550
    Details
    In: Respiration, S. Karger AG, Vol. 100, No. 6 ( 2021), p. 547-550
    Abstract: Robotic assisted bronchoscopy represents a major turning point in bronchoscopic history. The management strategies to address significant airway bleeding in this “robotic era” are not well documented, and further guidance is required. We present a case report that exemplifies our approach and management strategy using a combined and simultaneous flexible/robotic bronchoscopy if this complication is encountered.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000514830
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2021
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  • 16
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    Endoscopic Valve Therapy in COPD Patients with Hypercapnia
    S. Karger AG ; 2022
    In:  Respiration Vol. 101, No. 10 ( 2022), p. 918-924
    Details
    In: Respiration, S. Karger AG, Vol. 101, No. 10 ( 2022), p. 918-924
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Endoscopic valve therapy has been established as a therapeutic option for patients with severe emphysema. Several randomized controlled trials confirmed the efficacy of this therapeutic approach in COPD patients without significant collateral ventilation. However, patients with clinical relevant hypercapnia were excluded from these trials. 〈 b 〉 〈 i 〉 Aims and Objectives: 〈 /i 〉 〈 /b 〉 Patients with hypercapnia who underwent endoscopic valve treatment were enrolled in this retrospective analysis. The efficacy of valve treatment and its impact on blood gases were analysed. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 COPD patients with mild to severe hypercapnia (pCO 〈 sub 〉 2 〈 /sub 〉 ≥45 mm Hg) who were treated by endoscopic valve placement at the Thoraxklinik, University of Heidelberg, were enrolled in this retrospective trial. Lung function test (vital capacity [VC], forced expiratory volume in 1 s [FEV 〈 sub 〉 1 〈 /sub 〉 ], residual volume [RV] ), blood gases (pO 〈 sub 〉 2 〈 /sub 〉 , pCO 〈 sub 〉 2 〈 /sub 〉 ), and 6-minute-walk test (6-MWT) were assessed prior to intervention and at 3 and 6 months following valve implantation. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 129 patients (mean age 64 ± 7 years) with severe COPD (mean FEV 〈 sub 〉 1 〈 /sub 〉 26 ± 12% of predicted, mean RV 285 ± 22% of predicted) with hypercapnia (pCO 〈 sub 〉 2 〈 /sub 〉 ≥45 mm Hg, mean pCO 〈 sub 〉 2 〈 /sub 〉 50 ± 5 mm Hg) underwent endoscopic valve treatment. 3 and 6 months following intervention, statistical significant improvement was observed in VC, FEV 〈 sub 〉 1 〈 /sub 〉 , RV, and 6-MWT (all 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). Blood gas analysis revealed a significant improvement of mean pCO 〈 sub 〉 2 〈 /sub 〉 at 3- and 6-month follow-up (both 〈 i 〉 p 〈 /i 〉 & #x3c; 0.001). 40% of the patients had normal pCO 〈 sub 〉 2 〈 /sub 〉 values 3 and 6 months following intervention. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 COPD patients with hypercapnia should not be excluded from valve treatment, as the hyperinflation reduction improves the respiratory mechanics and thus leading to improvement of hypercapnia.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000525729
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2022
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  • 17
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    Preparation of Cell Blocks for Lung Cancer Diagnosis and Prediction: Protocol and Experience of a High-Volume Center
    S. Karger AG ; 2014
    In:  Respiration Vol. 87, No. 5 ( 2014), p. 432-438
    Details
    In: Respiration, S. Karger AG, Vol. 87, No. 5 ( 2014), p. 432-438
    Abstract: Minimally invasive diagnostic techniques are increasingly being used to obtain specimens for pathological diagnosis and prediction. Referring to lung cancer, both endobronchial and endoesophageal ultrasound are used worldwide as diagnostic routine methods. Consequently, an increasing number of pathological samples are cytological and fewer are histological. On the other hand, the requirements for specific and sensitive tumor subtyping complemented by predictive analyses are steadily increasing and are an essential basis for evidence-based treatment decisions. In this article we focus on the cell block method as a helpful tool for diagnostic and predictive analyses in lung cancer and point out its advantages and disadvantages in comparison to conventional cytological and biopsy specimens. Furthermore, we retrospectively analyze the diagnostic results of the cell block method in a high-volume center over 5 years. The main advantages of cell blocks are the availability of established and validated protocols, archiving and the opportunity to have serial sections from the same specimens to provide or repeat molecular analyses. Actually, in case of tumor progression, even additional biomarkers can be tested using the original cell block when re-biopsies are not feasible. The cell block method should be considered as a reliable, complimentary approach to conventional cytological or biopsy procedures, which is helpful to fulfill the increasing requirements of high-quality diagnostics and prediction.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000357068
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
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  • 18
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    Multiple Breath Washout Becoming Feasible for the Assessment of Lung Function in Infants and Young Children with Cystic Fibrosis in a Clinical Setting
    S. Karger AG ; 2014
    In:  Respiration Vol. 87, No. 5 ( 2014), p. 353-354
    Details
    In: Respiration, S. Karger AG, Vol. 87, No. 5 ( 2014), p. 353-354
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000360580
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
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  • 19
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    Effectiveness of Endobronchial Coil Treatment for Lung Volume Reduction in Patients with Severe Heterogeneous Emphysema and Bilateral Incomplete Fissures: A Six-Month Follow-Up
    S. Karger AG ; 2014
    In:  Respiration Vol. 88, No. 1 ( 2014), p. 52-60
    Details
    In: Respiration, S. Karger AG, Vol. 88, No. 1 ( 2014), p. 52-60
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Treatment with lung volume reduction coils (LVRC) may be effective in patients with severe heterogeneous emphysema and incomplete fissures. 〈 b 〉 〈 i 〉 Objective: 〈 /i 〉 〈 /b 〉 We hypothesized that LVRC placement improves pulmonary function, exercise tolerance and quality of life in these patients. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Twenty-six patients with chronic obstructive pulmonary disease (COPD), 13 males and 13 females, aged 66 ± 8 years with heterogeneous emphysema and incomplete fissures were included in this retrospective analysis. The coils were implanted unilaterally in the upper or lower lobe. Patients were followed up at 30, 90 and 180 days after treatment and changes in pulmonary function test and 6-minute-walk-test (6MWT) values as well as scores for the modified Medical Research Council (mMRC) dyspnea scale and the St. George's Respiratory Questionnaire (SGRQ) were recorded. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 FEV 〈 sub 〉 1 〈 /sub 〉 improved significantly at 90 days and tended to decrease at the 180-day follow-up (0.67 ± 0.17 vs. 0.78 ± 0.25 vs. 0.73 ± 0.21 liters, respectively, p 〈 0.001). The 6MWT score had improved significantly at 90 days and had tended to decrease at the 180-day follow-up (216 ± 107 vs. 262 ± 97 vs. 262 ± 112 m, respectively, p = 0.001). SGRQ was significantly improved at 90 days. Multivariate analysis showed that worse 6MWT performance at baseline was independently associated with a greater improvement in 6MWT at the 90-day follow-up. The total complication rate was 54% (n = 14) and included light hemorrhage in 6 patients, COPD exacerbation in 6, pneumothorax in 1 and both COPD exacerbation and pneumothorax in 1 patient. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 This is the first study to show that LVRC in patients with heterogeneous emphysema and incomplete fissures improves exercise capacity, quality of life and lung function up to 90 days after the intervention. Further studies are needed to assess the long-term effects of LVRC in these patients.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000358441
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
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  • 20
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    Expert Statement: Pneumothorax Associated with Endoscopic Valve Therapy for Emphysema - Potential Mechanisms, Treatment Algorithm, and Case Examples
    S. Karger AG ; 2014
    In:  Respiration Vol. 87, No. 6 ( 2014), p. 513-521
    Details
    In: Respiration, S. Karger AG, Vol. 87, No. 6 ( 2014), p. 513-521
    Abstract: The use of endoscopically placed unidirectional valves for the treatment of emphysema is increasing. With better patient selection, there is also an increased likelihood of complications associated with the procedure, such as postprocedural pneumothorax. There is, however, little evidence of pneumothorax management in patients with severe COPD and emphysema. This report describes an expert recommendation that has been developed to outline pneumothorax management after valve placement to inform physicians and patients of the risk-benefit profile and to assist them in decision making. Skilled and aggressive pneumothorax management is necessary in this patient population, and by following these recommendations traumatic scenarios, prolonged drainage, extended hospitalizations, and/or surgery might be avoided in many cases.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000360642
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2014
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