Pneumologie
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Functional capacity (dyspnea) and quality of life are important criteria for the assessment of disease impact and treatment outcome in patients with chronic obstructive pulmonary disease (COPD). We will review measures for dyspnea and quality of life with particular emphasis on their methodological properties. Because asthma and COPD exhibit important differences and are therefore not comparable, we discuss only those measures which have been verified methodologically in patients with COPD. ⋯ Nowadays we can rely on several measures for dyspnea and HRQOL which have been thoroughly verified methodologically in COPD patients. However, some disease-specific and generic instruments exhibit substantial flaws, so that they need to be revised and it seems better not to use them at present. Many methodological and conceptual questions remain unanswered in the field indicating a strong need for more research.
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Based on a review of the background of MRI using inhaled hyperpolarized noble gases first experiences and perspectives for functional imaging in emphysema patients are presented. ⋯ MRI using inhaled hyperpolarized noble gases is a functional imaging modality with high spatial and/or temporal resolution. First studies for early detection of obstructive lung diseases and disorders of distribution of ventilation in emphysema are promising.
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Comparative Study Clinical Trial Controlled Clinical Trial
[Comparison of the efficacy of the BiPAP-S/T and the VPAP-S/T ventilators in patients with stable chronic respiratory insufficiency].
This study compares the performance characteristics and clinical effectiveness of the BiPAP-S/T (Respironics, USA) and VPAP-S/T (ResMed, Australia) pressure support ventilator during two weeks of nasal ventilation in 15 patients with stable chronic respiratory insufficiency. All patients were previously stabilised using nasal BiPAP ventilation for at least three months. Subjects had a maximum inspiratory pressure of 20 cm H2O and highest breathing rate of 24 per minute. ⋯ Sleep quality and number of respiratory arousals were very similar at the end of the two weeks' test period with BiPAP-S/T and VPAP-S/T. Synchronisation of VPAP-S/T during REM was probably better than with BiPAP-S/T, because in the presence of mouth leak BiPAP-S/T occasionally jammed in IPAP, but VPAP-S/T did not. In conclusion, in the tested settings VPAP-S/T is as effective as BiPAP-S/T in maintaining ventilation and controlling blood gases during sleep in patients with stable respiratory insufficiency.
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Endobronchial chondromas as a rare form of benign tumors of the bronchial tree lead not only to diagnostic problems because of the unspecific often latent pattern of symptoms, but also to therapeutic difficulties because of the macroscopic findings and the poststenotic changes of the bronchial tree and the lung parenchyma. In case of a 75-year old female patient the various therapeutic possibilities are discussed. The therapy must be individual and consider the extent of simultaneous lung changes and the general criteria of operability in thoracic surgery.