Pneumologie
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Peripheral pulmonary nodules are difficult to reach bronchoscopically, so for a long time it has been tried, by the use of imaging techniques like X-ray, ultrasound and computed tomography, to aspirate these nodules for exact histological diagnosis. The computed tomography offers the best spatial orientation for methodical reasons, thus this technique is performed increasingly and with great accuracy in pulmonary lesions. Complications like bleeding into lung parenchyma or small pneumothorax after aspiration can be detected easier by computed tomography. ⋯ In another 4 of 30 (13 %) cases pneumothorax occurred, requiring chest tube placement. The ct-guided lung biopsy with the AUTOVAC(R) needle represents a safe, low resilient diagnostic tool to obtain large tissue samples of specimen in good quality. Even in patients with compromised lung function because of severe chronic obstructive lung disease and/or emphysema, the described aspiration technique can be performed, if at the moment of aspiration procedure a pneumologist with corresponding equipment and trained medical staff is present, in order to place a chest tube in case of pneumothorax.
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Pulmonary hypertension (PH), i. e. an increase of mean pulmonary artery pressure above 20 mm Hg under resting conditions, can be observed in different forms of sleep-disordered breathing (SDB). In obstructive sleep apnea (OSA) the apnea-associated triggers of hypoxia and intrathoracic pressure swings lead to repetitive rises of pulmonary artery pressure during sleep. In 20 - 30 % of these patients daytime PH occurs. ⋯ Possible pathogenetic factors of the nocturnal periodic breathing occurring in end-stage IPAH are prolonged circulation times and hypocapnia. In conclusion, SDB might cause PH (OSA-associated PH). On the other hand, PH might lead to the development of SDB (CSR in congestive heart failure, periodic breathing in IPAH).
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In order to promote the care of patients with COPD in Germany a national guideline clearing project was initiated jointly by autonomous corporate bodies of the German health care system. Following a systematic search of literature data bases between 1992 and 2002, 20 guidelines were identified that met the inclusion criteria and were evaluated with the German Checklist for Methodological Guideline Appraisal. Following this, a multidisciplinary expert group appointed by the German Guideline Clearinghouse (Leitlinien-Clearingstelle im Arztlichen Zentrum fur Qualitat in der Medizin, AZQ) reviewed the suitability of these guidelines for the use in the German health care system. ⋯ Among others these strengthened the role of a precise definition of COPD based primarily on the pathogenesis, of a subtle description of all diagnostic and therapeutic tools and of a detailed description of quality assurance and quality management. The feasability of recommendations were demonstrated by examples chosen from the evaluated guidelines. Additionally the presented findings may be used as steering tools in the German Health care system.
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Randomized Controlled Trial Multicenter Study Clinical Trial
[Multicenter study on "non-invasive ventilation in patients with severe chronic obstructive pulmonary disease and emphysema(COPD)"].
Non-invasive ventilation is applied with increasing frequency in patients with chronic hypercapnic COPD and insufficiency of the ventilatory pump. In the few existing clinical trials on long-term use of NIV, no significant improvement on survival could be proven, mainly due to methodical reasons. The "National Task Force for Non-invasive ventilation and weaning" plans to study patients with severe COPD and hypercapnic ventilatory pump insufficiency in a prospective, randomised, multicentre clinical trial over one year. ⋯ The main outcome parameter is all-cause mortality, secondary outcome parameters are course of the disease, exercise capacity, quality of life and consumption of medical resources. The sample size is estimated on 300 patients (150 control group, 150 intervention group). The whole study will take approximately three years.