[Massive Morgagni Hernia as a Reason for Lung Function Impairment]. / Morgagni-Hernie als Ursache einer restriktiven Ventilationsstörung.

Hernia of Morgagni is the most rare of the four types of congenital diaphragmatic hernia (2 % - 3 % of all cases). In adults, it commonly presents with non-specific symptoms. In severe cases patients complain about shortness of breath and in lung function analysis a restrictive pattern can be observed. This paper presents a rare case of a massive diaphragmatic hernia of the right thorax which remained undiagnosed over many years and gives an up-to-date overview of the literature. The transabdominal approach using laparoscopic repair is favored in adults especially in non-acute cases. In our patient, the lung expanded postoperatively in most parts resulting in improvement of lung function and blood gas analysis.

[Inhaled Triple Therapy in Severe Chronic Obstructive Pulmonary Disease (COPD)]. / Dreifachfixkombinationen (LAMA/LABA/ICS) zur inhalativen Dauertherapie der schwergradigen COPD.

COPD (chronic obstructive pulmonary disease) is characterised by persistent airflow obstruction caused by exposure to irritants including cigarette smoke dust, and fumes. Long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) in fixed-dose combination inhalers are the pillars of modern COPD therapy. LABA/inhaled corticosteroids (ICS) inhalers have been proved to be particularly efficient in patients with ≥ 2 exacerbations per year. Until recently, although recommended in guidelines for severe and unstable COPD patients, the clinical usefulness of the LABA/LAMA/ICS combination was a matter of debate. Recent trials with fixed-dose combination inhalers containing fluticasonfuroate/vilanterol/umeclidinium or beclometasone/formoterol/glycopyrronium significantly reduced exacerbation rates and dyspnea scores and improved lung function as well as quality of life better than the LABA/ICS, LABA/LAMA comparators or the single compounds in selected COPD trial patients. Beclometasone/formoterol/glycolpyrronium and fluticasonfuroate/umeclidinium/vilanterol are the first triple combination therapies approved in a fixed-dose inhaler for COPD patients. The domains of triple fixed-dose formulations are COPD patients in groups C and D.

Elevated soluble urokinase receptor values in CSF, age and bacterial meningitis infection are independent and additive risk factors of fatal outcome.

The aim of the present study was to evaluate the potential role of cerebrospinal fluid soluble urokinase receptor (suPAR) level, infection and age as risk factors for fatal outcome in patients suspected of having meningitis and/or bacteraemia on admission to hospital. A total of 545 cerebrospinal fluid samples from patients with clinically suspected meningitis were sent to the Hellenic National Meningitis Reference Laboratory. Ten of 545 (1.83%) patients died. Analysis by receiver operating characteristics (ROC) curve revealed that both suPAR and age were significant for prediction of fatal outcome. Patients with levels of suPAR above the cut-off values and age ≥ 51 years, or patients in which either Neisseria meningitis or Streptococcus pneumoniae were detected were categorized as high risk patients. The combination of the above three predictors (suPAR, age and infectious agent) in a logistic regression model with outcome of infection as the dependent variable yielded an overall odds ratio (OR = 85.7, 95% CI 10.6-690.2) with both sensitivity and specificity being equal to the value of 0.9. In conclusion, suPAR, age and type of infection have an additive effect in predicting mortality among patients suspected of meningitis.

[Necrotizing esophagitis by stress-cardiomyopathy with right ventricular insufficiency]. / Nekrotisierende Ösophagitis bei Stresskardiomyopathie mit Rechtsherzversagen.

Acute necrotizing esophagitis ("black esophagus") is defined as complete necrosis of the esophageal mucosa, which typically affects the entire circumference. We report a case of a healthy 62-year-old woman, who became hemodynamically unstable due to stress cardiomyopathy with acute right heart failure. Transfusion-dependent anemia occurred 24 h later and an upper gastrointestinal endoscopy revealed a black discoloured mucosa of the distal esophagus. After hemodynamic stabilization and treatment with proton pump inhibitors and sucralfate, complete healing of the esophageal mucosa was achieved.