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  • 1
    Online Resource
    Online Resource
    Predictors of Response to Endobronchial Coil Therapy in Patients With Advanced Emphysema
    Elsevier BV ; 2019
    In:  Chest Vol. 155, No. 5 ( 2019-05), p. 928-937
    Details
    In: Chest, Elsevier BV, Vol. 155, No. 5 ( 2019-05), p. 928-937
    Type of Medium: Online Resource
    ISSN: 0012-3692
    URL: Article
    DOI: 10.1016/j.chest.2019.02.012
    RVK:
    XA 36340
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2019
    detail.hit.zdb_id: 2007244-2
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  • 2
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    Computed tomographic airway morphology after targeted lung denervation treatment in COPD
    Elsevier BV ; 2023
    In:  Respiratory Medicine Vol. 206 ( 2023-01), p. 107059-
    Details
    In: Respiratory Medicine, Elsevier BV, Vol. 206 ( 2023-01), p. 107059-
    Type of Medium: Online Resource
    ISSN: 0954-6111
    URL: Article
    DOI: 10.1016/j.rmed.2022.107059
    Language: English
    Publisher: Elsevier BV
    Publication Date: 2023
    detail.hit.zdb_id: 2002557-9
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  • 3
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    The Modern Art of Reading Computed Tomography Images of the Lungs: Quantitative CT
    S. Karger AG ; 2018
    In:  Respiration Vol. 95, No. 1 ( 2018), p. 8-17
    Details
    In: Respiration, S. Karger AG, Vol. 95, No. 1 ( 2018), p. 8-17
    Abstract: Lung diseases are increasing in prevalence and overall burden worldwide. To stem the tide, more and more national and international guidelines are recommending the use of various diagnostic algorithms that are disease specific. There is growing consensus among the respiratory community that although patient histories and lung function testing are the minimum required for clinical examinations, these tests alone are not sufficient for disease characterization. Therefore, the use of computed tomography (CT) imaging is increasing used in clinical decision making for lung diseases. Lung diseases affect various components of lung, including the small airways, lung parenchyma, the interstitial space and the pulmonary vasculature. Quantitative CT (QCT) methods are emerging and are increasingly available using commercial software to quantify the underlying disease components, and a growing body of evidence suggests that QCT is an important tool in the clinical setting to help accurately and reproducibly detect where the disease is located in the lung, and to quantify the extent and overall severity for several lung diseases. Furthermore, this growing body of evidence has promoted the use of thoracic QCT to the point that it is now considered by many as an indispensable technology for longitudinal analysis and intervention trials. Many QCT imaging measurements are available to the respiratory physician, and the aim of this review is to introduce and describe pulmonary QCT imaging measurements and methodologies.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000480435
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2018
    detail.hit.zdb_id: 1464419-8
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  • 4
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    Predicting Lung Volume Reduction after Endobronchial Valve Therapy Is Maximized Using a Combination of Diagnostic Tools
    S. Karger AG ; 2016
    In:  Respiration Vol. 92, No. 3 ( 2016), p. 150-157
    Details
    In: Respiration, S. Karger AG, Vol. 92, No. 3 ( 2016), p. 150-157
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Bronchoscopic lung volume reduction using one-way endobronchial valves (EBVs) has been proven to be effective in patients with severe emphysema. However, the selection of patients without collateral ventilation prior to treatment is critical for procedural success. Collateral ventilation can be assessed directly with the Chartis system or indirectly using computed tomography (CT) fissure analysis. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 We retrospectively evaluated the diagnostic value of a combination of the quantitative CT interlobar fissure completeness score (FCS) and Chartis in predicting responders to EBV therapy. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 CT data from four prospective studies were pooled and analyzed using semiautomated software to quantify the completeness of interlobar fissures. These FCSs were compared to a reference standard of achieving ≥350 ml of target lobe volume reduction after EBV treatment. Using a receiver operating characteristic curve, optimal thresholds predictive of complete fissures (responders) and incomplete fissures (non-responders) were determined. A subgroup of patients with partially complete fissures was identified, where software had lower accuracy. The complementary value of Chartis was investigated in this group. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A fissure was defined as complete (FCS 〉 95%), incomplete (FCS 〈 80%), or partially complete (80% 〈 FCS 〈 95%). The positive predictive value (PPV) of complete fissures is 88.1%, and the negative predictive value (NPV) is 92.9%, with an overall accuracy of 89.2%. Chartis was utilized in patients with partially complete fissures, with a PPV of 82.3%, an NPV of 84.6%, and an accuracy of 83.3%. 〈 b 〉 〈 i 〉 Conclusion: 〈 /i 〉 〈 /b 〉 Combining diagnostic tools could reduce the burden on patients and the healthcare system while providing clinicians with a better means for patient selection for EBV therapy.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000448849
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2016
    detail.hit.zdb_id: 1464419-8
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  • 5
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    Transbronchial Cryobiopsies for Diagnosing Interstitial Lung Disease: Real-Life Experience from a Tertiary Referral Center for Interstitial Lung Disease
    S. Karger AG ; 2019
    In:  Respiration Vol. 97, No. 4 ( 2019), p. 348-354
    Details
    In: Respiration, S. Karger AG, Vol. 97, No. 4 ( 2019), p. 348-354
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Transbronchial cryobiopsy (cTBB) may offer an alternative to surgical lung biopsy (SLB) for histopathological diagnosis of interstitial lung diseases (ILDs). However, real-life experience is limited, although case series are increasingly reported. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 We aimed to evaluate the value of cTBB performed under real-life conditions in a tertiary care center for ILDs. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Data on all patients undergoing a cTBB for evaluation of suspected ILD between October 2015 and January 2017 were included in this retrospective case series. Procedure details, complication rates, histopathological results, and diagnostic consensus reached by a multidisciplinary team (MDT) discussion were collated and evaluated. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total of 109 patients (mean age 64 years, range 19–85; 66% male, 38% never smokers) referred to our center with features suggestive of ILD underwent cTBB. The mean FVC% predicted was 77% (range 41–131), with a mean DLCO of 51% (range 20–86), and a 6-min walking test (6MWT) of 402 m (range 100–642). On average, 4 samples were taken from each patient (range 1–8), with a mean biopsy diameter of 5 mm (range 2–12). Complications included pneumothorax (11.9%), all treated with chest drain. Moderate bleeding occurred in 28.4% (all resolved without active measures). No acute disease exacerbations and no deaths occurred. A histopathological pattern diagnosis was possible in 80 cases (73.4%), and 26.6% of cases were considered nonspecific. An MDT consensus diagnosis was reached in 83.5% of cases. Subsequent SLB was proposed in 13 cases and performed in 8 cases. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 In the real-world setting, cTBB has a meaningful diagnostic value in the context of a MDT approach and may enable histopathological assessment even in patients with more advanced disease unsuitable for SLB.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000493428
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2019
    detail.hit.zdb_id: 1464419-8
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  • 6
    Online Resource
    Online Resource
    Endobronchial Ultrasound With Transbronchial Needle Aspiration for Restaging the Mediastinum in Lung Cancer
    American Society of Clinical Oncology (ASCO) ; 2008
    In:  Journal of Clinical Oncology Vol. 26, No. 20 ( 2008-07-10), p. 3346-3350
    Details
    In: Journal of Clinical Oncology, American Society of Clinical Oncology (ASCO), Vol. 26, No. 20 ( 2008-07-10), p. 3346-3350
    Abstract: To investigate the sensitivity and accuracy of endobronchial ultrasound–guided transbronchial needle aspiration (EBUS-TBNA) for restaging the mediastinum after induction chemotherapy in patients with non–small-cell lung cancer (NSCLC). Patients and Methods One hundred twenty-four consecutive patients with tissue-proven stage IIIA-N2 disease who were treated with induction chemotherapy and who had undergone mediastinal restaging by EBUS-TBNA were reviewed. On the basis of computed tomography, 58 patients were classified as having stable disease and 66 were judged to have had a partial response. All patients subsequently underwent thoracotomy with attempted curative resection and a lymph node dissection regardless of EBUS-TBNA findings. Results Persistent nodal metastases were detected by using EBUS-TBNA in 89 patients (72%). Of the 35 patients in whom no metastases were assessed by EBUS-TBNA, 28 were found to have residual stage IIIA-N2 disease at thoracotomy. The majority (91%) of these false negative results were due to nodal sampling error rather than detection error. Overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of EBUS-TBNA for mediastinal restaging after induction chemotherapy were 76%, 100%, 100%, 20%, and 77%, respectively. Conclusion EBUS-TBNA is a sensitive, specific, accurate, and minimally invasive test for mediastinal restaging of patients with NSCLC. However, because of the low negative predictive value, tumor-negative findings should be confirmed by surgical staging before thoracotomy.
    Type of Medium: Online Resource
    ISSN: 0732-183X , 1527-7755
    URL: Article
    DOI: 10.1200/JCO.2007.14.9229
    RVK:
    XA 52760
    RVK:
    XA 10000
    Language: English
    Publisher: American Society of Clinical Oncology (ASCO)
    Publication Date: 2008
    detail.hit.zdb_id: 2005181-5
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  • 7
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    Lung Sequestration: A Rare Cause for Pulmonary Symptoms in Adulthood
    S. Karger AG ; 2011
    In:  Respiration Vol. 82, No. 5 ( 2011), p. 445-450
    Details
    In: Respiration, S. Karger AG, Vol. 82, No. 5 ( 2011), p. 445-450
    Abstract: 〈 i 〉 Background: 〈 /i 〉 Lung sequestration is a rare congenital pulmonary disorder and is usually diagnosed in children with recurrent pulmonary infections. Lung sequestrations are not commonly found to be a cause of respiratory symptoms in adults. 〈 i 〉 Objectives: 〈 /i 〉 It was the aim of this study to show that pulmonary sequestration is rare in advanced age and can be accompanied by severe pulmonary symptoms. 〈 i 〉 Methods: 〈 /i 〉 We conducted a case series analysis of patient characteristics, symptoms, diagnosis and treatment of 11 adults with a lung sequestration at the Thoraxklinik Heidelberg between 2001 and 2009. 〈 i 〉 Results: 〈 /i 〉 From 2001 to 2009, intralobar lung sequestration was diagnosed and treated in 11 adults aged 19 to 58 years with an average age of 39.9 ± 11.3 years and a male:female distribution of 5:6. In 3 patients (27.3%), the predominant symptom was hemoptysis. Recurrent pulmonary infections occurred in 1 patient (9.1%); pneumonia and lung abscess were detected in 2 patients (18.2%). In 3 cases (27.3%), dry cough was the predominant symptom, and in only 2 cases (18.2%), lung sequestration was asymptomatic. Eight patients (72.7%) were diagnosed by imaging techniques prior to surgery. In 3 cases (27.3%), diagnosis was made intraoperatively and by pathological examination. Surgical intervention included 7 lobectomies (63.6%), 3 wedge resections (27.3%) and 1 (9.1%) segmentectomy. 〈 i 〉 Conclusion: 〈 /i 〉 Lung sequestration in adults is rare, but it can cause severe pulmonary symptoms. In cases of recurrent pulmonary infections of identical localization or recurrent hemoptysis, lung sequestration should be considered in order for the diagnosis to be made rapidly. Surgical resection is the treatment of choice.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000323562
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
    detail.hit.zdb_id: 1464419-8
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  • 8
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    Supportive and Palliative Care of Advanced Nonmalignant Lung Disease
    S. Karger AG ; 2011
    In:  Respiration Vol. 82, No. 4 ( 2011), p. 307-316
    Details
    In: Respiration, S. Karger AG, Vol. 82, No. 4 ( 2011), p. 307-316
    Abstract: Supportive and palliative care is an interdisciplinary challenge with the aims of symptom relief and improvement of quality of life in end-stage patients. Main complaints of patients with advanced nonmalignant lung disease are depression and anxiety, dyspnea, pain, and coughing. The discomfort of many physicians, caregivers, and family members with discussions about end-of-life care is one obstacle for the timely initiation of palliative care and the uncertainty of the short-term prognosis in most advanced nonmalignant respiratory diseases. Early dialog about supportive care already at the onset of the patient’s first symptoms and contemporaneous to life-prolonging therapy may overcome these barriers. Furthermore, continuing education for health professionals in palliative care ensures adequate palliative support. Here, we review insights into symptom control and palliative care in patients with advanced nonmalignant respiratory disease.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000330730
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2011
    detail.hit.zdb_id: 1464419-8
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  • 9
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    Online Resource
    Efficacy of Bronchoscopic Thermal Vapor Ablation and Lobar Fissure Completeness in Patients with Heterogeneous Emphysema
    S. Karger AG ; 2012
    In:  Respiration Vol. 83, No. 5 ( 2012), p. 400-406
    Details
    In: Respiration, S. Karger AG, Vol. 83, No. 5 ( 2012), p. 400-406
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Bronchoscopic thermal vapor ablation (BTVA) ablates emphysematous tissue through a localized inflammatory response followed by contractive fibrosis and tissue shrinkage leading to lung volume reduction that should not be influenced by collateral ventilation. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 To determine the correlation of clinical data from a trial of BTVA with fissure integrity visually assessed by computed tomography (CT). 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 We conducted a single-arm study of patients with upper lobe-predominant emphysema (n = 44). Patients received BTVA either to the right upper lobe or left upper lobe, excluding the lingula. Primary efficacy outcomes were forced expiratory volume in 1 s (FEV 〈 sub 〉 1 〈 /sub 〉 ) and St. George’s Respiratory Questionnaire (SGRQ) at 6 months. Lobar volume reduction from CT was another efficacy outcome measurement. The fissure of the treated lobe was analyzed visually on preinterventional CT. Incompleteness of the small fissure, the upper half of the right large fissure and the whole left large fissure were estimated visually in 5% increments, and the relative amount of fissure incompleteness was calculated. Pearson correlation coefficients were calculated for the association between fissure incompleteness and change in efficacy outcomes (baseline to 6 months) of BTVA. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total of 38 out of 44 patients (86%) had incompleteness in the relevant fissure. Calculated relevant fissure incompleteness was a mean of 13% of fissure integrity (range 0–63). Correlation coefficients for the association of incompleteness with outcomes were as follows: FEV 〈 sub 〉 1 〈 /sub 〉 = 0.17; lung volume reduction = –0.27; SGRQ score = –0.10; 6-min walk distance = 0.0; residual volume (RV) = –0.18, and RV/total lung capacity = –0.14. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Lobar fissure integrity has no or minimal influence on BTVA-induced lung volume reduction and improvements in clinical outcomes.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000336239
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2012
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  • 10
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    Bronchoscopic Coil Treatment for Patients with Severe Emphysema: A Meta-Analysis
    S. Karger AG ; 2015
    In:  Respiration Vol. 90, No. 2 ( 2015), p. 136-145
    Details
    In: Respiration, S. Karger AG, Vol. 90, No. 2 ( 2015), p. 136-145
    Abstract: 〈 b 〉 〈 i 〉 Background: 〈 /i 〉 〈 /b 〉 Bronchoscopic coil treatment has been shown to improve pulmonary function, exercise capacity, and quality of life in patients with severe emphysema. 〈 b 〉 〈 i 〉 Objectives: 〈 /i 〉 〈 /b 〉 To perform a meta-analysis of the results of four independent European clinical trials investigating this coil therapy for emphysema. 〈 b 〉 〈 i 〉 Methods: 〈 /i 〉 〈 /b 〉 Data on all patients included in the four European clinical trials were analyzed for efficacy and safety outcomes. 〈 b 〉 〈 i 〉 Results: 〈 /i 〉 〈 /b 〉 A total of 2,536 coils were placed during 259 procedures in 140 patients. A total of 37 chronic obstructive pulmonary disease exacerbations and 27 pneumonias were recorded as serious adverse events up to 1 year after treatment. The pneumothorax rate was 6.4%. Both 6 and 12 months after treatment, significant (all p 〈 0.001) improvements were observed for: forced expiratory volume in 1 s [+0.08 liters (±0.19) and +0.08 liters (±0.21)], residual volume [RV; -510 ml (±850) and -430 ml (±720)] , 6-min walking distance [6MWD; +44.1 m (±69.8) and +38.1 m (±71.9)], and St. George's Respiratory Questionnaire score [SGRQ; -9.5 points (±14.3) and -7.7 points (±14.2)] . No differences in any outcome measures were observed between heterogeneous and homogeneous emphysema patients. Only a high baseline RV was found to be an independent predictor of successful treatment. 〈 b 〉 〈 i 〉 Conclusions: 〈 /i 〉 〈 /b 〉 Bronchoscopic coil treatment improves pulmonary function, 6MWD, and quality of life in patients with severe emphysema up to 1 year after treatment, independent of the distribution of the disease.
    Type of Medium: Online Resource
    ISSN: 0025-7931 , 1423-0356
    URL: Article
    DOI: 10.1159/000431384
    Language: English
    Publisher: S. Karger AG
    Publication Date: 2015
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