Pneumologie
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The Epworth Sleepiness Scale (ESS) describes the likelihood of falling asleep in 8 specific situations. Pathological sleepiness (TS) of patients with obstructive sleep apnea (OSA) is most often diagnosed with an ESS score≥11 (TS-ESS). In an epidemiological study on the prevalence of sleep apnea syndrome (OSAS), only three questions with yes-no answers were used for the characterization of pathological daytime sleepiness (TS-Young): Due to the different construction of the ESS and the Young's questionnaire, we asked whether with the combination of the two questionnaires a larger number of patients with OSA and TS compared to the ESS can be identified. In addition, we examined the sleepiness questionnaires (FB) using objective vigilance in defined groups of OSA patients. ⋯ As a single test both questionnaires can be used to detect daytime sleepiness with equal incidence. Combining both questionnaires a higher percentage of daytime sleepiness can be found in comparison to the ESS-questionnaire alone especially in patients without disturbance of vigilance.
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Case Reports
[A leak in the lung: endobronchial one-way valve placement as treatment for a persistent bronchopleural fistula].
Patients with bronchopleural fistula are at an increased risk of morbidity and mortality. Treatment of the air leak includes intrathoracic drainage, antibiotic therapy and closure of the fistula, which conventionally has been performed via surgical means. ⋯ Here we report on a 62-year-old patient with underlying severe COPD, who was admitted with a lung abscess and consecutively developed a persistent bronchopleural fistula. Treatment involved antibiotic therapy and endobronchial one-way valve placement, which resulted in termination of the air leak and full recovery.
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Bronchial fistulas occurring either spontaneously in the course of malignant diseases of the chest or following pulmonary resections (lobectomy, pneumonectomy) are rare, but feared complications associated with high morbidity and mortality. In many cases a surgical approach to fistula closure is not possible. Numerous endoscopic procedures for fistula closure have been reported, mostly in the form of isolated case reports with until now no satisfying results. ⋯ Between June and October 2010 five patients with oesophagobronchial or bronchopleural fistulas were successfully treated in our hospitals, using Amplatzer Vascular Plugs II® and 4® (AGA Medical) for fistula closure. These devices were originally developed for transcatheter embolisation procedures in angiology. Three of our patients suffered from bronchial fistulas after lobectomy or pneumonectomy with consecutive empyemas, the other two of bronchooesophageal fistulas caused by carcinomas of the oesophagus.