Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 103
Filtrar
Mais filtros










Base de dados
Intervalo de ano de publicação
2.
Chirurg ; 90(9): 697-703, 2019 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-31161248

RESUMO

BACKGROUND: Interventional bronchoscopy is an indispensable option to manage bronchopleural and tracheopleural fistulas in patients in a poor general condition and at high risk for developing postoperative complications. METHODS: This article is based on a search in the PubMed database for relevant publications and own experiences as surgeons and pneumologists. RESULTS: Various interventional techniques can be used for the treatment of bronchopleural and tracheopleural fistulas. Currently, the insertion of stents or endobronchial valves is the most frequently used treatment. Ideally, the attending anesthesiologist will have experience with high frequency jet ventilation and the attending surgeon will have experience with rigid bronchoscopy, flexible bronchoscopy, and interventional bronchoscopy. DISCUSSION: Due to a lack of standardized treatment recommendations, individual treatment plans must be decided according to the location of the bronchopleural or tracheopleural fistula and taking existing comorbidities into account.


Assuntos
Fístula Brônquica , Doenças Pleurais , Fístula Brônquica/cirurgia , Broncoscopia , Humanos , Doenças Pleurais/cirurgia , Pneumonectomia , Complicações Pós-Operatórias , Stents , Resultado do Tratamento
3.
Pneumologie ; 72(9): 617-623, 2018 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-30071539

RESUMO

Performing rebiopsies for primary lung cancer and/or their metastases is becoming more and more prominent in daily practice, as the therapeutical spectrum increases and some newer strategies are dependent on immunohistochemical and/or molecular factors. In general, nearly all recurrent lesions or metastases can be reached. However, frequently invasive procedures are necessary with the need to carefully weigh risks and benefits of rebiopsies for the patient in each case. In this review indications for recurrent and progressive disease as well as risks are discussed and alternatives to rebiopsies are shown. This work is the joint opinion from both the endoscopic and thoracic oncology sections of the German Society of Pneumology (DGP).


Assuntos
Biópsia , Neoplasias Pulmonares/patologia , Pneumologia , Alemanha , Humanos , Sociedades Médicas
4.
Artigo em Inglês | MEDLINE | ID: mdl-29440884

RESUMO

Objective: Endoscopic valve therapy aims at target lobe volume reduction (TLVR) that is associated with improved lung function, exercise tolerance and quality of life in emphysema patients. So far, a TLVR of >350 mL was considered to be indicative of a positive response to treatment. However, it is not really known what amount of TLVR is crucial following valve implantation. Patients and methods: TLVR, forced expiratory volume in 1 second (FEV1), residual volume (RV) and 6-minute walk distance (6-MWD) were assessed before and 3 months after valve implantation in 119 patients. TLVR was calculated based on computed tomography (CT) scan analysis using imaging software (Apollo; VIDA Diagnostics). Minimal important difference estimates were calculated by anchor-based and distribution-based methods. Results: Patients treated with valves experienced a mean change of 0.11 L in FEV1, -0.51 L in RV, 44 m in 6-MWD and a TLVR of 945 mL. Using a linear regression and receiver operating characteristic analysis based on two of three anchors (ΔFEV1, ΔRV), the estimated minimal important difference for TLVR was between 890 and 1,070 mL (ie, 49%-54% of the baseline TLV). Conclusion: In future, a TLVR between 49% and 54% of the baseline TLV, should be used when interpreting the clinical relevance.


Assuntos
Broncoscopia/métodos , Pulmão/cirurgia , Enfisema Pulmonar/cirurgia , Broncoscopia/efeitos adversos , Tolerância ao Exercício , Feminino , Volume Expiratório Forçado , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Tomografia Computadorizada Multidetectores , Enfisema Pulmonar/diagnóstico , Enfisema Pulmonar/fisiopatologia , Enfisema Pulmonar/psicologia , Qualidade de Vida , Recuperação de Função Fisiológica , Volume Residual , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Teste de Caminhada
5.
Opt Express ; 26(25): 32417-32432, 2018 Dec 10.
Artigo em Inglês | MEDLINE | ID: mdl-30645409

RESUMO

We present the application of a confocal fluorescence microscope to the analysis of Yb-doped solid-state laser materials, with examples of Yb-doped crystals, photonic crystal fibers and fiber preforms made with different manufacturing processes. Beside the fluorescence lifetime image itself, a microscopic spectral fluorescence emission analysis is presented and spatially resolved emission cross sections are obtained. Doping concentration and its distributions and other laser optical parameters are measured, which help to analyze manufacturing steps. Further properties like photodarkening and saturation are addressed.

6.
Pulmonology ; 2017 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-29242047

RESUMO

The endobronchial ultrasound (EBUS) scope has been increasingly used in the gastrointestinal tract (EUS-B). Scientific data proves its efficacy and safety to provide a complete lung cancer staging, when combined with EBUS-TBNA, and in the diagnosis of para-esophageal lesions. There are multiple barriers to start performing EUS-B but probably the most important ones are related to knowledge and training, so new operators should follow a structured training curriculum. This review aims to reflect the best current knowledge regarding EUS-B and provide a road map to assist those who are incorporating the technique into their clinical practice.

7.
J Med Case Rep ; 11(1): 289, 2017 Oct 18.
Artigo em Inglês | MEDLINE | ID: mdl-29047403

RESUMO

BACKGROUND: Benign central airway tumors are very rare diseases. Their unspecific symptoms are responsible for late diagnosis. Endoscopic interventions with different techniques and tools are widely used for their treatment. However, in certain cases interventional endoscopy might be unsuccessful and therefore other methods such as high-dose-rate brachytherapy could be a therapeutic option. CASE PRESENTATION: A 76-year-old white German woman was referred to our clinic for an endoscopic treatment of a recurrent granulation polyp in her left main bronchus. She had dyspnea, coughing, and mucus retention. Three times resections via bronchoscopy were performed within less than a year. After each intervention the polyp regrew inside her left main bronchus causing a repeat of the initial symptoms. She presented to our clinic less than 1 month since the last intervention. Twice we performed a rigid bronchoscopy in total anesthesia where we resected the granulation polyp with a snare wire loop and did an argon plasma coagulation of its base. Due to the recurrent growing of the granuloma, we performed a high-dose-rate brachytherapy in conscious sedation after another interventional bronchoscopy with a resection of the polyp and argon plasma coagulation of the base. Three months after brachytherapy our patient came to our clinic for a follow-up with none of the initial symptoms. Only a small remnant of the polyp without a significant occlusion of her bronchus was visualized by bronchoscopy. Furthermore, 6 months after brachytherapy she was not presenting any of the initial symptoms. CONCLUSIONS: This case report shows that high-dose-rate brachytherapy is a therapeutic option for the treatment of benign airway stenosis when other interventional treatments are not or are less than successful. However, further investigations are needed to prove the effectiveness and reliability of the method.


Assuntos
Braquiterapia/métodos , Broncopatias/radioterapia , Granuloma/radioterapia , Pólipos/radioterapia , Idoso , Obstrução das Vias Respiratórias/etiologia , Broncopatias/complicações , Feminino , Granuloma/complicações , Humanos , Pólipos/complicações , Recidiva , Resultado do Tratamento
8.
Opt Express ; 25(13): 14892-14899, 2017 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-28789071

RESUMO

We investigate the average power scaling of two diode-pumped Yb-doped fiber amplifiers emitting a diffraction-limited beam. The first fiber under investigation with a core diameter of 30 µm was able to amplify a 10 W narrow linewidth seed laser up to 2.8 kW average output power before the onset of transverse mode instabilities (TMI). A further power scaling was achieved using a second fiber with a smaller core size (23µm), which allowed for a narrow linewidth output power of 3.5 kW limited by stimulated Brillouin scattering (SBS). We mitigated SBS using a spectral broadening mechanism, which allowed us to further increase the output power to 4.3 kW only limited by the available pump power. Up to this power level, a high slope efficiency of 90% with diffraction-limited beam quality and without any sign of TMI or stimulated Raman scattering for a spectral dynamic range of higher than -80 dB was obtained.

9.
Opt Express ; 25(4): 3006-3012, 2017 Feb 20.
Artigo em Inglês | MEDLINE | ID: mdl-28241518

RESUMO

We present modal content measurements (S2) of two different negative curvature hollow-core photonic crystal fibers: a kagome fiber and an ice cream cone fiber. Their sensitivity towards mode matching, bending and polarization is analyzed. For the kagome fiber, a higher order mode suppression of 17dB under optimal conditions was achieved, and for the ice cream cone fiber there was a suppression of up to 42dB. Polarization turned out to be a critical parameter for good higher order mode suppression in both fibers.

10.
Int J Chron Obstruct Pulmon Dis ; 11: 3093-3099, 2016.
Artigo em Inglês | MEDLINE | ID: mdl-27994448

RESUMO

INTRODUCTION: Valve implantation has evolved as a therapy for patients with advanced emphysema. Although it is a minimally invasive treatment, it is associated with complications, the most common being pneumothorax. Pneumothorax occurs due to the rapid target lobe volume reduction and may be a predictor of clinical benefit despite this complication. OBJECTIVE: The objective of this study was to conduct an exploratory data analysis of patients who developed a pneumothorax following endoscopic valve therapy for emphysema. MATERIALS AND METHODS: This study performed a retrospective evaluation of pneumothorax management and the impact of pneumothorax on clinical outcomes in 70 patients following valve therapy in 381 consecutive patients. RESULTS: Pneumothorax rate following valve therapy was 18%. Pneumothorax management consisted of chest tube insertion, valve removal, and surgical intervention in 87% (61/70), 44% (31/70), and 19% (13/70) of the patients, respectively. Despite pneumothorax, patients experienced modest but significant improvements in lung function parameters (forced expiratory volume in 1 second: 55±148 mL, residual volume: -390±964 mL, total lung capacity: -348±876; all P<0.05). Persistent lobar atelectasis 3 months after recovering from pneumothorax, which was associated with relevant clinical improvement, was observed in only 21% (15/70) of the patients. CONCLUSION: Pneumothorax is a frequent severe complication following valve therapy that requires further intervention. Nevertheless, the pneumothorax does not impair the clinical status in the majority of patients. Patients with lobar atelectasis benefit after recovering from pneumothorax in terms of lung function parameters.


Assuntos
Broncoscopia/efeitos adversos , Broncoscopia/instrumentação , Pulmão/cirurgia , Tomografia Computadorizada Multidetectores , Pneumotórax/etiologia , Enfisema Pulmonar/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Tubos Torácicos , Remoção de Dispositivo , Feminino , Volume Expiratório Forçado , Nível de Saúde , Humanos , Pulmão/diagnóstico por imagem , Pulmão/fisiopatologia , Medidas de Volume Pulmonar , Masculino , Pessoa de Meia-Idade , Pneumotórax/diagnóstico por imagem , Pneumotórax/terapia , Valor Preditivo dos Testes , Desenho de Prótese , Enfisema Pulmonar/diagnóstico por imagem , Enfisema Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Reoperação , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
11.
Anaesthesist ; 65(9): 696-702, 2016 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-27596367

RESUMO

Here, we present a case of a tracheal fistula due to an anastomotic insufficiency following abdominothoracic esophageal resection. Despite immediate discontinuity resection, the tracheal fistula could not be surgically closed, resulting in incomplete control of the source of infection and an alternative treatment concept in the form of interventional fistula closure using a Y-tracheal stent. However, owing to existing severe acute respiratory distress syndrome (ARDS), which is associated with a considerable risk of peri-interventional hypoxia, a temporary bridging concept using venovenous extracorporeal membrane oxygenation (ECMO) was implemented successfully.


Assuntos
Oxigenação por Membrana Extracorpórea/métodos , Fístula/cirurgia , Controle de Infecções/métodos , Síndrome do Desconforto Respiratório do Adulto/terapia , Sepse/prevenção & controle , Doenças da Traqueia/cirurgia , Anastomose Cirúrgica/métodos , Broncoscopia , Humanos , Masculino , Pessoa de Meia-Idade , Síndrome do Desconforto Respiratório do Adulto/diagnóstico por imagem , Síndrome do Desconforto Respiratório do Adulto/etiologia , Sepse/diagnóstico por imagem , Stents , Tomografia Computadorizada por Raios X
12.
Zentralbl Chir ; 141 Suppl 1: S35-42, 2016 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-27607887

RESUMO

Patients with diffuse airway instability due to tracheobronchomalacia or excessive dynamic airway collapse are typically highly symptomatic, with marked dyspnoea, recurrent bronchopulmonary infections and excruciating intractable cough. Silicone stents achieve immediate symptom control, but are - due to the typical complications associated with stent treatment - usually not an option for long-term treatment. The aim of surgical intervention is definitive stabilisation of the trachea and of both main bronchi by posterior splinting of the Paries membranaceus with a polypropylene mesh. This operation is an appropriate treatment option for patients with documented severe tracheobronchomalacia or excessive dynamic airway collapse and is ultimately the only therapy that can achieve permanent symptom control. The success of the operation, however, depends on many factors and requires close interdisciplinary collaboration.


Assuntos
Brônquios/cirurgia , Traqueia/cirurgia , Traqueobroncomalácia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Anastomose Cirúrgica , Broncoscopia , Feminino , Seguimentos , Humanos , Masculino , Pessoa de Meia-Idade , Tireoidectomia , Tomografia Computadorizada por Raios X , Traqueobroncomalácia/diagnóstico , Traqueobroncomegalia/diagnóstico , Traqueobroncomegalia/cirurgia
13.
Opt Express ; 24(6): 6011-20, 2016 Mar 21.
Artigo em Inglês | MEDLINE | ID: mdl-27136795

RESUMO

We report on a newly designed and fabricated ytterbium-doped large mode area fiber with an extremely low NA (~0.04) and related systematic investigations on fiber parameters that crucially influence the mode instability threshold. The fiber is used to demonstrate a narrow linewidth, continuous wave, single mode fiber laser amplifier emitting a maximum output power of 3 kW at a wavelength of 1070 nm without reaching the mode-instability threshold. A high slope efficiency of 90 %, excellent beam quality, high temporal stability, and an ASE suppression of 70 dB could be reached with a signal linewidth of only 170 pm.

14.
Pneumologie ; 70(2): 110-6, 2016 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-26894392

RESUMO

OBJECTIVES: Bronchoscopy is an integral part of pulmonary medicine. In recent years, a series of new technologies have evolved. It is to assume that significant changes have also occurred in clinical practice. We conducted a nationwide survey to evaluate the current status of care and to compare it with earlier reports. METHODS: A standard questionnaire was sent to 1875 institutions to assess the clinical practice of bronchoscopy in Germany with respect to general issues, education, sedation/anaesthesia and technical aspects. RESULTS: The returned questionnaires cover 301,965 bronchoscopies, performed by 2158 physicians over 12 months, making it the largest survey to date. The proportion of rigid bronchoscopies has decreased and amounts to 7.3% at present. Atropine as a premedication is hardly used any more. Sedation is routinely applied in 88% of flexible bronchoscopies, for which a combination of propofol and midazolam is preferred by most institutions (41.3%), followed by propofol monotherapy (28.3%). 74.4% of institutions accept aspirin for transbronchial biopsy, 8.1% dual platelet inhibition. 62.4% of all institutions perform airway recanalisation, favouring cryotherapy and argon plasma coagulation. 9.1% of bronchoscopies are supported by endobronchial ultrasound. CONCLUSION: Compared to preceding surveys, the experience of bronchoscopists, especially regarding interventional procedures, has increased. Endobronchial ultrasound has become a standard of care, as has patient sedation with propofol.


Assuntos
Broncoscopia/estatística & dados numéricos , Pneumopatias/patologia , Pneumopatias/cirurgia , Padrões de Prática Médica/estatística & dados numéricos , Pneumologia/estatística & dados numéricos , Revisão da Utilização de Recursos de Saúde , Estudos Transversais , Endossonografia/estatística & dados numéricos , Alemanha/epidemiologia , Pesquisas sobre Serviços de Saúde , Humanos , Pneumopatias/epidemiologia , Prevalência , Carga de Trabalho/estatística & dados numéricos
15.
Semin Respir Crit Care Med ; 36(4): 609-15, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26238645

RESUMO

Chronic obstructive pulmonary disease (COPD) is a widespread disease associated with high morbidity and mortality. The principal aim of therapy is preventing disease progression. Besides rehabilitation and pharmacological treatment, different endoscopic approaches were developed in the past decade extending the therapeutic spectrum. Various endoscopic lung volume reduction (ELVR) techniques are available that differ in the implementation, mechanism of action, complication spectrum, and reversibility. So far, the data on efficacy and safety are variable and still very limited. The most comprehensive data are available for endoscopic valve therapy. This reversible technique leads to lobar atelectasis and thus significant lobar volume reduction in patients with severe emphysema and low collateral ventilation. Implantation of coils leading to parenchymal compression and bronchoscopic thermal vapor ablation inducing an inflammatory reaction are nonblocking ELVR techniques and thus independent of collateral ventilation. Besides ELVR techniques, targeted lung denervation has evolved as the latest development in the field of endoscopic therapy in COPD. The aim of this endoscopic method is sustainable bronchodilation by minimizing the influence of parasympathetic pulmonary nerves on smooth muscles of the airways. This review summarizes the different endoscopic procedures, their mechanism of action, and the results of the clinical trials including efficacy and safety.


Assuntos
Broncoscopia/métodos , Pneumonectomia/métodos , Doença Pulmonar Obstrutiva Crônica/cirurgia , Enfisema Pulmonar/cirurgia , Ventilação Pulmonar/fisiologia , Humanos , Doença Pulmonar Obstrutiva Crônica/complicações , Doença Pulmonar Obstrutiva Crônica/fisiopatologia , Enfisema Pulmonar/etiologia , Enfisema Pulmonar/fisiopatologia , Resultado do Tratamento
16.
Internist (Berl) ; 55(9): 1039-44, 2014 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-25146679

RESUMO

Inflexible and flexible bronchoscopy represents a standard diagnostic procedure in pneumology. Besides lung carcinomas, which is the most frequent indication for diagnostic bronchoscopy, a plethora of clinical symptoms such as chronic persistent cough, hoarseness, unexplained dyspnea, hemoptysis, and suspicious findings on auscultation require further endoscopic evaluation. Moreover, bronchoscopy plays a central role in the diagnostic work-up of interstitial lung diseases and persistent lung infiltrates, in particular those of infectious origin (e.g., fungal, viral, tuberculous, and Pneumocystis jiroveci infections). In addition, diagnostic bronchoscopy has more recently been complemented by endobronchial ultrasound (EBUS). EBUS is predominantly employed for the accurate diagnosis and mediastinal staging of lung carcinomas, and the assessment of lympadenopathy-associated diseases such as sarcoidosis.Since endoscopic evaluation is typically preceded by computed tomography (CT) of the chest, genuine incidental findings occur relatively seldom and usually account for pathological findings that have been missed on conventional imaging approaches. For instance, characteristic incidental findings include benign and malignant tumors in the area of the endoscopic access and central airways, anatomical variations and (vascular) malformations, tracheal and bronchial airway alterations, and aspirated objects. This review focuses on bronchoscopic findings that have either been completely missed by conventional imaging or differently interpreted due to its radiologic morphology.


Assuntos
Broncoscopia/métodos , Corpos Estranhos/patologia , Achados Incidentais , Pneumopatias/patologia , Lesão Pulmonar/patologia , Diagnóstico Diferencial , Humanos
17.
Opt Lett ; 39(13): 3725-7, 2014 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-24978721

RESUMO

In this Letter, we demonstrate a single-mode continuous-wave fiber laser amplifier emitting 146 W of average output power at a wavelength of 1009 nm. The wavelength and bandwidth of the seed oscillator are defined by a pair of fiber Bragg gratings. The seed is amplified in a two-stage ytterbium-doped rod-type amplifier to 146 W with a high slope efficiency of 64%, showing excellent beam quality and stability throughout the experiment. The ASE suppression is as high as 63 dB.

18.
Panminerva Med ; 55(2): 121-9, 2013 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-23676954

RESUMO

Bronchoscopy is the most important tool in diagnosis of respiratory diseases, but also provides therapeutic options in various disorders. Besides hemoptysis, airway stenoses are a frequent indication for therapeutic bronchoscopy interventions. Thereby, a broad spectrum of endoscopic techniques including electrocautery, argon plasma coagulation, laser treatment, cryosurgery and stent implantation is available. In the last decade, development of new endoscopic modalities provides also treatment of patients with chronic obstructive pulmonary disease and uncontrolled asthma.


Assuntos
Broncoscopia , Doenças Respiratórias/cirurgia , Obstrução das Vias Respiratórias/cirurgia , Animais , Coagulação com Plasma de Argônio , Asma/cirurgia , Fístula Brônquica/cirurgia , Broncoscopia/instrumentação , Broncoscopia/métodos , Criocirurgia , Eletrocoagulação , Fístula Esofágica/cirurgia , Hemoptise/cirurgia , Humanos , Terapia a Laser , Doença Pulmonar Obstrutiva Crônica/cirurgia , Doenças Respiratórias/diagnóstico , Stents , Fístula Traqueoesofágica/cirurgia , Resultado do Tratamento
19.
Rev Sci Instrum ; 84(4): 045105, 2013 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-23635230

RESUMO

A new setup for high precision, automated secondary pH measurements together with a reference measurement procedure has been developed and tested in interlaboratory comparisons using buffers pH 4.005, pH 7.000, and pH 10.012 at 25 °C and 37 °C. Using primary buffers as standards, a standard uncertainty in pH better than 0.005 can be reached. The central measuring device is a one piece, thermostatted cell of PFA (perfluoroalkoxy) with a built-in Hamilton(®) Single Pore™ Glass electrode. Due to its flow-through principle this device allows pH measurements with low consumption of measurement solutions. The very hydrophobic and smooth PFA as construction material facilitates complete emptying of the cell. Furthermore, the tempering unit affords very precise temperature control and hence contributes to the low target uncertainty of the produced secondary buffer solutions. Use of a symmetric measurement sequence and the two point calibration was sufficient to reach high precision and accuracy.

20.
Respiration ; 85(6): 515-20, 2013.
Artigo em Inglês | MEDLINE | ID: mdl-23485627

RESUMO

Although known for more than 80 years, 'collateral ventilation' (CV) became a focus of endoscopic research in the recent decade. Implantation of one-way valves presents an effective treatment option for patients with advanced heterogeneous emphysema optimizing symptoms and quality of life. However, this treatment modality is only successful in case of low interlobar CV. Based on this evidence, attempts to develop different approaches for the quantification of CV have been initiated. In this regard, it is crucial to illuminate the meaning and different aspects of CV.


Assuntos
Enfisema/cirurgia , Pulmão/fisiologia , Pneumonectomia , Animais , Broncoscopia , Humanos , Ventilação Pulmonar
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA