Qutayba Hamid

Experten-Beirat / Impressum

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Entsättigung unter Belastung als Prädiktor einer raschen Abnahme der Lungenfunktion bei COPD

Background: to date, no clinical parameter has been associated with the decline in lung function other than emphysema severity in COPD. Objectives: the main purpose of this study was to explore whether the rate of lung function decline differs between COPD patients with and without exertional desaturation. Methods: a total of 224 subjects were selected from the Korean Obstructive Lung Disease cohort. exertional desaturation was assessed using the 6-min walk test (6MWt), and defined as a post-exercise oxygen saturation (spO2) of !90% or a 64% decrease. the cohort was divided into desaturator (n = 47) and non-desaturator (n = 177) groups. exertional Desaturation as a Predictor of rapid Lung function Decline in COPD Changhwan Kima,d Joon Beom Seob Sang Min Leeb Jae Seung Leec,d Jin Won Huhc,d Jin Hwa Leed,e Seung Won Rad,j Ji-Hyun Leed,k Eun-Kyung Kimd,k Tae-Hyung Kimd,m Woo Jin Kimd,n Sang-Min Leed,f Sang Yeub Leed,g Seong Yong Limd,h Tae Rim Shind,i Ho Il Yoond,l Seung Soo Sheend,o Yeon-Mok Ohc,d Yong Bum Parka,d Sang-Do Leec,d aDepartment of Pulmonary and Critical Care Medicine, Hallym University Kangdong sacred Heart Hospital, bDepartment of radiology and research institute of radiology, and cDepartment of Pulmonary and Critical Care Medicine, asan Medical Center, University of Ulsan College of Medicine, dClinical research Center for Chronic Obstructive airway Diseases, eDepartment of internal Medicine, ewha Womans University Mokdong Hospital, College of Medicine, ewha Womans University, fDivision of Pulmonary and Critical Care Medicine, Department of internal Medicine and Lung institute of Medical research Center, seoul national University College of Medicine, gDivision of respiratory and Critical Care Medicine, Department of internal Medicine, College of Medicine, Korea University anam Hospital, hDivision of Pulmonary and Critical Care Medicine, Department of Medicine, Kangbuk samsung Hospital, sungkyunkwan University school of Medicine, and iDepartment of internal Medicine, Kangnam sacred Heart Hospital, Hallym University College of Medicine, seoul, jDepartment of Pulmonary and Critical Care Medicine, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, kDepartment of internal Medicine, CHa Bundang Medical Center, CHa University, and lDepartment of internal Medicine, seoul national University Bundang Hospital, seoul national University College of Medicine, seongnam, mDivision of Pulmonology, Department of internal Medicine, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, nDepartment of internal Medicine, College of Medicine, Kangwon national University, Chuncheon, and oDepartment of Pulmonary and Critical Care Medicine, ajou University school of Medicine, suwon, republic of Korea Results: there was a significant difference between the desaturator and non-desaturator groups in terms of the change in prebronchodilator forced expiratory volume in 1 s (feV1) over a 3-year period of follow-up (p = 0.006). the mean rate of decline in feV1 was greater in the desaturator group (33.8 ml/year) than in the non-desaturator group (11.6 ml/year). a statistically significant difference was also observed between the two groups in terms of the change in the st. George’s respiratory Questionnaire (sGrQ) total score over 3 years (p = 0.001). Conclusions: this study suggests, for the first time, that exertional desaturation may be a predictor of rapid decline in lung function in patients with COPD. the 6MWt may be a useful test to predict a rapid lung function decline in COPD. ORIgInaLaRTIKEL zuM vORzugSPREIS unTER [KLICKEn SIE HIER]

Biopsie und Radiofrequenzablation von solitären Lungentumoren bei Hochrisiko-Patienten

Background: in recent years experience has been accumulated in percutaneous radiofrequency ablation (rfa) of lung malignancies in nonsurgical patients. Objectives: in this study, we retrospectively evaluated a simultaneous diagnostic and therapeutic approach including Ctguided biopsy followed immediately by rfa of solitary malignant pulmonary lesions. Methods: Ct-guided transthoracic core needle biopsy of solitary pulmonary lesions suspicious for malignancy was performed and histology was proven based on immediate frozen sections. rfa probes were placed into the pulmonary tumors under Ct guidance and the ablation was performed subsequently. the procedure-related morbidity was analyzed. followup included a Ct scan and pulmonary function parameters. Results: a total of 33 Ct-guided biopsies and subsequent rfa within a single procedure were performed. Morbidity of Ctsimultaneous Computed tomography-Guided Biopsy and radiofrequency ablation of solitary Pulmonary Malignancy in High-risk Patients T. Schneidera M. Puderbachb J. Kunzb A. Bischofb F.L. Giesele H. Dienemanna F.J.F. Herthc P.A. Schnabeld S. Safia H. Hoffmanna C.P. Heusselb athoracic surgery, bDiagnostic and interventional radiology with nuclear Medicine, and cPulmonology and Critical Care Medicine, thoraxklinik, dDepartment of General Pathology, institute of Pathology, and eDepartment of nuclear Medicine, Heidelberg University, Heidelberg, Germany oriGinALArTiKeL zuM vorzuGSPreiS unTer [KLiCKen Sie Hier] guided biopsy included pulmonary hemorrhage (24%) and a mild pneumothorax (12%) without need for further interventions. the rfa procedure was not aggravated by the previous biopsy. the rate of pneumothorax requiring chest tube following rfa was 21%. Local tumor control was achieved in 77% with a median follow-up of 12 months. the morbidity of the Ct-guided biopsy had no statistical impact on the local recurrence rate. Conclusions: the simultaneous diagnostic and therapeutic approach including Ct-guided biopsy followed immediately by rfa of solitary malignant pulmonary lesions is a safe procedure. the potential of this combined approach is to avoid unnecessary therapies and to perform adequate therapies based on histology. taking the local control rate into account, this approach should only be performed in those patients who are unable to undergo or who refuse surgery.

«Out of proportion» pulmonale Hypertonie und Herzinsuffizienz bei erhaltener Ejektionsfraktion

Background: a subset of patients with heart failure with preserved ejection fraction (Hfpef) will have a marked increase in pulmonary artery pressure (PaP). Objective: to evaluate the clinical and hemodynamic characteristics of these patients in comparison to patients with idiopathic pulmonary arterial hypertension (iPaH). Methods: We reviewed the clinical and hemodynamic data of patients with Hfpef with out-of-proportion pulmonary hypertension (Hfpef-PH) and compared it to the corresponding data of age-matched patients with iPaH. Results: twenty consecutive patients with Hfpef-PH and 20 patients with iPaH were included in the study. the mean age (±sD) was 71.3 ± 7.8 and 70.2 ± 6.7 years, respectively. the majority of the Hfpef-PH patients were postmenopausal females with at Out-of-Proportion Pulmonary Hypertension and Heart failure with Preserved ejection fraction Yochai Adira Marc Humbertc–e Olivier Sitbonc–e Rafael Wolfb Frédéric Ladorc–e Xavier Jaïsc–e Gérald Simonneauc–e Offer Amirb aPulmonary Division and bDepartment of Cardiology, Lady Davis Carmel Medical Center, faculty of Medicine, technionisrael institute of technology, Haifa, israel; cfaculté de Médecine, Université Paris-sud, Kremlin-Bicêtre, daP-HP, service de Pneumalogie, DHU thorax innovation, Hôpital Bicêtre, Le Kremlin-Bicêtre, and einserM U999, Labex LerMit, Centre Chirurgical Marie-Lannelongue, Le Plessis-robinson, france least two features of the metabolic syndrome and atrial fibrillation. although Hfpef-PH patients fulfilled the criteria for out-ofproportion PH, with transpulmonary gradient (tPG) 112 mm Hg, the difference between the diastolic PaP and the pulmonary capillary wedge pressure (PCWP) was significantly lower compared to iPaH (6.3 ± 6.2 vs. 27.5 ± 4.8, p < 0.00001). Conclusions: Our results suggest that a diagnosis of Hfpef-PH should be suspected when severe PH occurs in an elderly postmenopausal female with one or more features of the metabolic syndrome and atrial fibrillation. interestingly, these patients had significantly lower differences between diastolic PaP and PCWP, suggesting that the increase in tPG is mainly caused by an elevated systolic PaP, possibly as a result of increased pulmonary vascular stiffness, and not pulmonary vascular remodeling. ORiGinALARtikeL zuM vORzuGSpReiS unteR [kLicken Sie HieR]

Patientenzufriedenheit nach Lungenresektion bei Lungenkrebs

Background: Patient satisfaction reflects the perception of the customer about the level of quality of care received during the episode of hospitalization. Objective: to compare the levels of satisfaction of patients submitted to lung resection in two different thoracic surgical units. Methods: Prospective analysis of 280 consecutive patients submitted to pulmonary resection for neoplastic disease in two centers (center a: 139 patients; center B: 141 patients; 2009– 2010). Patients’ satisfaction was assessed at discharge through the eOrtC-inPatsat32 module, a 32-item, multi-scale self-administered anonymous questionnaire. each scale (ranging from 0 to 100 in score) was compared between the two units. Multivariable regression and bootstrap were used to verify factors associated with the patients’ general satisfaction (dependent variable). Patient satisfaction after Pulmonary resection for Lung Cancer: a Multicenter Comparative analysis Cecilia Pompilia Alessandro Brunellia Gaetano Roccob Rosario Salvib Francesco Xiuméa Antonello La Roccab Armando Sabbatinia Nicola Martuccib Divisions of thoracic surgery, aOspedali riuniti, ancona, and bnational Cancer Center, Pascale foundation, naples, italy ORiGiNALARtikeL zuM vORzuGSPReiS uNteR [kLiCkeN Sie hieR] Results: Patients from unit B reported a higher general satisfaction (91.5 vs. 88.3, p = 0.04), mainly due to a significantly higher satisfaction in the doctor-related scales (doctors’ technical skill: p = 0.001; doctors’ interpersonal skill: p = 0.008; doctors’ availability: p = 0.005, and doctors information provision: p = 0.0006). Multivariable regression analysis and bootstrap confirmed that level of care in unit B (p = 0.006, bootstrap frequency 60%) along with lower level of education of the patient population (p = 0.02, bootstrap frequency 62%) were independent factors associated with a higher general patient satisfaction. Conclusion: We were able to show a different level of patient satisfaction in patients operated on in two different thoracic surgery units. a reduced level of patient satisfaction may trigger changes in the management policy of individual units in order to meet patients’ expectations and improve organizational efficiency.

Anämie und Überleben bei chronisch-obstruktiver Lungenerkrankung

Background: Chronic obstructive pulmonary disease (COPD) is a disorder characterized by high mortality. Hemoglobin (Hb) concentration has a prognostic impact on COPD patients receiving long-term oxygen treatment, but its value as an independent predictor of survival among stable COPD outpatients has not been fully clarified by previous studies. Objectives: to investigate the potential association between anemia and survival in a cohort of stable COPD outpatients. Methods: a cohort of stable COPD patients, who had had their first spirometry, blood count and serum chemistry profile done between October 1999 and november 2010 were retrospectively analyzed. Patients with heart failure, renal impairment, malignancy, recent hemorrhage and other causes of anemia were excluded. Variables that were found to be univariately associated with survival entered a multivariate stepwise Cox regression analysis model, to allow independent predictors of survival to be identified. anemia and survival in Chronic Obstructive Pulmonary Disease: a Dichotomous rather than a Continuous Predictor Afroditi K. Boutoua,b Sarah Karrara Nicholas S. Hopkinsona Michael I. Polkeya aniHr respiratory Disease Biomedical research Unit at the royal Brompton and Harefield nHs foundation trust and imperial College, London, UK, brespiratory failure Unit, aristotle University of thessaloniki, thessaloniki, Greece Results: Of 294 patients (67.9 ± 9.8 years old, 64.6% male) 15.6% were anemic (Hb < 13 g/dl). the median survival differed significantly between anemic (68.7 (18.1–91.5) months) and nonanemic (79.8 (57.5–98.4) months, p = 0.035) individuals. independ ent predictors of mortality in the total population were anemia (hazard ratio (Hr) 1.87, 95% confidence interval (Ci) 1.06–3.29), age (Hr 1.08, 95% Ci 1.04–1.12) and forced expiratory volume in 1 s (feV1) % predicted (Hr 0.94, 95% Ci 0.92–0.97); the Hb concentration was neither univariately nor multivariately associated with mortality. Conclusion: this is the first study to indicate that anemia (but not the Hb value) is independently associated with survival in stable COPD outpatients. it would be better to treat this as a categorical variable in future scoring systems. OrIgINAlArtIKel zuM vOrzugSPreIS uNter [KlIcKeN SIe HIer]