[Closure of bronchial fistulas using amplatzer vascular plugs]. / Verschluss von Bronchusfisteln mittels Amplatzer Vascular Plugs.

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. No guidelines or consensus have been established as yet. Since 2006 several cases of successful fistula closure by using Amplatzer Septal Occluders have been reported. 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.

[Tracheobronchial stents: a retrospective analysis of indications, results and in particular complications]. / Tracheobronchiale Stents: Eine retrospektive Analyse zu Indikationen und Ergebnissen unter besonderer Berücksichtigung der Komplikationen.

BACKGROUND: Tracheobronchial stents are inserted mainly in cases of malignant and benign airway stenosis. Further indications are esophago-tracheal fistulas, mediastinal fistulas and tracheomalacia. METHODS: A retrospective analysis was conducted on patients' records, information provided by the general practitioners and relatives of the patients from July 1993 to December 2006 in the Department of Pneumology of the Heidehaus Hospital Hannover (since 6/05 Department of Pneumology and Internal Intensive Care Medicine, Oststadt-Heidehaus Hospital). RESULTS: During the observation period of 13 years a total of 269 stents (177 permanent, 92 temporary) were implanted in 207 patients (1.3 stents per patient). The vast majority of patients (173/207) suffered from an underlying malignancy. About half of the stents were deployed in the trachea. The median length of placement was 116 days in patients with malignancies and 313 days in patients with benign diseases. In about 40 % of the patients notable complications were observed which were directly or indirectly associated with the stents. These findings show the importance of a critical indication for stent implantation. In benign diseases a stent can remain for years inside the tracheobronchial system, if it is well tolerated in the beginning. In malignant diseases the result depends decisively on the stage of the tumour: has the stent been implanted before any other tumour therapy is started or is it an end-stage tumor with no other therapeutic option? In general, complications of stents occur quite frequently. CONCLUSIONS: The analysis of stent data leads to some aspects for the prevention of stent-related complications. There should be a strict indication and appropriate choice of stent material. Nevertheless, there remains an ethical dilemma in patients with end-stage disease as to whether to implant a stent or to do nothing against the tumor, because the benefit immediately after stent insertion vanishes with progression of the tumour, so causing extra complications.

[100 years Heidehaus--from sanatorium for tuberculosis to a modern chest hospital]. / 100 Jahre Heidehaus--vom Tuberkuloseheim zum modernen Lungenzentrum.

When the sanatorium "Heidehaus" was founded on June 1, 1907 in the northern countryside of Hannover with Dr. Otto Ziegler as head about 120 beds for patients with tuberculosis were available. By 1914 about 200 patients were being treated by 4 physicians and 10 nurses. An operating theatre and a modern radiology unit were added in 1927. Shortly after the 2nd World War 400 patients with tuberculosis were hospitalised simultaneously. With the introduction of antituberculous triple drug treatment the number of patients dropped significantly. During this period many traditional facilities, used to care for patients with tuberculosis lost their financial basis and closed. However in the 1960s Prof. Schindler, the head of Heidehaus, widened the spectrum of the hospital into a modern chest hospital, focused on lung and airway diseases. In particular in the 1980s and 1990s this trend continued and 2 independent departments, i. e., pneumology and thoracic surgery were founded. In 2005 due to restructuring by the community of Hannover the "Heidehaus" moved completely and merged with another traditional hospital to become the new "Oststadt-Heidehaus". In its new surroundings both departments for pulmonary medicine and thoracic surgery offer a broad spectrum of modern thoracic medicine in cooperation with other disciplines.

[Stridor due to bolus obstruction of the esophagus]. / Stridor durch Bolusobstruktion des Osophagus.

Obstruction of the oesophagus by a piece of goulash meat resulted in tracheal stenosis in an 18-year-old girl. Because of the history of the illness and information supplied by others, as well as the marked stridor, it was first thought that the tracheal stenosis was at the level of a previous tracheostomy with aspiration, but bronchoscopy revealed marked bulging of the posterior wall of the trachea. Subsequent oesophagoscopy then detected the foreign body, which was removed whole.

[Benign and semi-malignant lung tumors--Review of a ten-year period]. / Benigne und semimaligne Lungentumoren--Ubersicht über einen Zehnjahreszeitraum.

Benign tumors of the lung are infrequent diseases. Their symptoms depend on their localisation in the periphery of the lung or in the central airways. Cough, hemoptysis, and dyspnoea are the most frequent symptoms, they should cause further diagnostic investigations (X-ray in two directions, bronchoscopy). This paper shows the frequency, symptoms, diagnostic procedure and findings, and the treatment of benign lung tumors, giving a survey of the patients of a pneumologic clinic during ten years.

[Splenic rupture. Diagnosis, clinical aspects and therapy]. / Die Milzruptur. Diagnose, Klinik und Therapie.

It is reported about 73 traumatic ruptures of the spleen in a period of 19 years. The most frequent cause for rupturing were traffic accidents. The most important diagnostic procedure was peritoneal lavage, a rapid and well-aimed method. Therapy of choice is splenectomy. Prognosis depends on the time from accident to operation as well as on the severity of accompanying injuries. The course and cause of lethal courses are summarized. Ten patients who died in the postoperative phase, had polytraumatic injuries with three of more injured organs.