We are killing people by not acting

Worldwide, lung cancer killed about 1·5 million people in 2010. Lung cancer has an extremely poor prognosis, with an overall 5 year survival of 16% in the USA and less than 10% in the UK. To achieve a substantial reduction in lung cancer mortality, global action and progress in prevention, early detection, and treatment are crucial. Mehr

Pulmonary Sequestration

A 9-year-old boy with a history of a lung lesion suspected to be a pulmonary sequestration or a congenital cystic adenomatoid malformation presented to the emergency department with fever and chest pain.
A chest radiograph (Panel A) showed a large opacity in the right lung, abutting the minor fissure and displacing it downward. Mehr

Selection Criteria for Lung-Cancer Screening

The National Lung Screening Trial (NLST) showed that lung-cancer screening with the use of low-dose computed tomography (CT) resulted in a 20% reduction in mortality from lung cancer.1  Some organizations now recommend adoption of lung-cancer screening in clinical practice for high-risk persons if high-quality imaging, diagnostic methods, and treatment are available.2-4 Most of these recommendations identify persons to be screened by applying the NLST criteria, which include an age between 55 and 74 years,
a history of smoking of at least 30 pack-years, a period of less than 15 years since cessation of smoking, or some variant of these criteria. Mehr

Women who smoke like men, die like men

Smoking has become substantially riskier for women during the past 50 years, say researchers. Analyses from two historical and five contemporary US cohorts suggest that the risks for women are now about the same as they are for men. Smokers of both sexes are now about 25 times more likely than never smokers to die of lung cancer, between 22 and 25 times more likely to die of chronic obstructive pulmonary disease (COPD), and nearly three times more likely to die of ischaemic heart disease. Mehr

Ventilator-associated Pneumonia

Attributable Mortality of Ventilator-Associated Pneumonia by Prof Dr Dr Ernst Hanisch

Tobacco control: when economics trumps health

Tobacco makes a lot of people a lot of money. This mantra should be repeated often during any discussion of the epidemic of tobacco use. Mehr

A Lobectomy by Any Other Name

There is growing recognition that not all lobectomies for lung cancer are the same. The components of the lobectomy treatment process are numerous, making it difficult to study lobectomy as a single treatment modality. Each of the lobectomy components must be viewed as having a potentially important influence on quality of life and survival. Aspects that are important include patient selection, particularly, finding a patient who is medically fit to withstand the surgical procedure and who has been thoroughly assessed by noninvasive or minimally invasive means to rule out metastatic disease. In addition, patients and their support system should be emotionally preparedfor the procedure and the postoperative issues that arise. The surgeon must be thoroughly trained, educated, skilled, and focused to perform themost appropriate procedure to provide the best outcome: the best short- and long-term survival with the least probability of morbidity and debility. Mehr

10. Tagung der Rhein-Main AG. Minimal-Invasive Chirurgie. 21./22. Februar 2013, Asklepios-Klinik Langen.Photographiert von Marc Strohfeldt - www.nachelf.de

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Woran wir sterben

Unter dem Titel "Global Burden of Disease" wurden erstmals 1992 alle Menschen erfasst, die innerhalb des Jahres gestorben waren. Außerdem beschrieb die Studie die wichtigsten Risikofaktoren für die Gesundheit. Im Dezember 2012 wurde nun, zwanzig Jahre später, eine Folgestudie veröffentlicht, basierend auf den knapp 53 Millionen Todesfällen des Jahres 2010. Das Fazit: Die Bevölkerung ist in der Zwischenzeit deutlich gesünder geworden. Infektionskrankheiten wurden zurückgedrängt, dafür sterben mehr Menschen an Altersgebrechen und Zivilisationsleiden. Mehr

10. Tagung der Rhein-Main-AG Minimal Invasive Chirurgie

http://de.scribd.com/doc/120036394/Einladung-zur-10-Tagung-der-Rhein-Main-AG-Minimal-Invasive-Chirurgie

Zwerchfelldefekt

A 76-year-old man was referred to our hospital because of hemoptysis. He had had pulmonary tuberculosis six years before his current admission, and he had had an abnormal chest radiograph during adolescence. A chest radiograph showed an opacity in the right hemithorax that was accompanied by numerous masses, each surrounded by an air crescent (Panel A). Bowel sounds were heard over the right chest, and a barium enema showed that the colon filled the right hemithorax (Panel B). Computed tomography suggested hypoplasia of the right lung and herniation of the bowel through the posterior diaphragm (Panel C). Bronchoscopic examination showed no bleeding in any of the bronchial lumina or orifices. Examination of the sputum yielded no specific pathogens or malignant cells, and the hemoptysis ceased spontaneously. Follow-up on an outpatient basis without specific therapy was planned. Since the patient's history did not include a traumatic accident, the radiographic findings were compatible with a diagnosis of congenital diaphragmatic hernia.

Benefits and Harms of CT-Screening for Lung Cancer

Lung cancer is the leading cause of cancer death. Most patients are diagnosed with advanced disease, resulting in a very low 5-year survival. Screening may reduce the risk of death from lung cancer. Mehr

Editorial - Untertainty exists

Handreichungen zur Selbstheilung

...Hatte man lange geglaubt, dass man nur etwas "wollen" muss, um eine Verhaltensänderung zu erzielen, so hat uns die moderne Hirnforschung eines Besseren belehrt. Zu mehr als neunzig Prozent sind es Gefühle und unbewusste Prozesse, die unseren Körper steuern...
Rober Jütte
FAZ 24. Januar 2012, Nr 20 Seite 30

Stalking the diagnosis

...This case illustrates an unusual presentation of breast cancer — that is, metastasis to the pituitary gland. In retrospect, the patient presented with a number of typical symptoms and signs of hypopituitarism, including weakness, intermittent nausea, orthostasis, polydipsia, and polyuria. Her fever and positive urine culture, as well as her dysphagia and dry mouth, initially distracted the clinicians from a consideration of the primary disease process. The recognition of the hormonal deficiencies caused by a lesion on the pituitary stalk and the reconciliation of these developments with the diffuse lymphadenopathy led to the definitive diagnosis that unified this seemingly incongruent set of clinical findings.
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Einladung zur 9. Tagung der Rhein-Main-AG Minimal Invasive Chirurgie

Einladung zur 9. Tagung der Rhein-Main-AG Minimal Invasive Chirurgie

Rauchen als Risikofaktor an Tuberkulose zu sterben

Smoking could lead to 40 million excess tuberculosis deaths by 2050
(Research: Projected effects of tobacco smoking on worldwide tuberculosis control: mathematical modelling analysis) http://www.bmj.com/cgi/doi/10.1136/bmj.d5506
Between 2010 and 2050, smoking could be responsible for 40 million excess deaths from tuberculosis (TB), according to research published on bmj.com today.
The study, led Dr Sanjay Basu from the University of California, used a mathematical model to determine the effect of smoking on future tuberculosis rates. The research finds that because smoking increases the risk of contracting TB, there will be 18 million more cases worldwide between 2010 and 2050.
Once smokers develop the disease, they are more likely to die from it, meaning that smoking can single-handedly undermine the Millennium Development Goal to reduce TB mortality by half between 1990 and 2015, say the authors. They add, however, that "aggressive tobacco control could avert millions of deaths from tuberculosis."
It is established, say the authors, that smoking tobacco is a TB risk factor. They add that nearly one fifth of the world's population smokes and that most cigarettes are smoked in countries with high TB prevalence and where the tobacco industry has expanded its market. Given this, the authors wanted to predict how much impact smoking will have on future TB rates.
The research team developed a mathematical model to investigate the issue. Similar models have previously been used for HIV, TB detection systems and drug resistance, but not smoking.
In their analysis, the authors found that smoking may have a substantial impact on future TB rates because a moderate increase in individual risk translates into a large population-level risk because so many people smoke.
The results show that from 2010 to 2050 worldwide smoking could lead to 40 million excess TB deaths (from 61 to 101 million). They also conclude that if current smoking trends continue, the number of excess TB cases could rise from 256 to 274 million - 18 million new cases in total.
Furthermore, the authors found that the number of people with current TB infections may be falsely reduced by smoking. This is because smoking can kill so many people with TB that the number of people living with TB is reduced by smoking, even though smoking also causes a rise in new cases.
According to Basu's model the African, Eastern Mediterranean and Southeast Asian regions would experience the greatest increase in new TB cases attributable to smoking.
The authors argue that "aggressively lowering the prevalence of tobacco smoking could reduce smoking attributable deaths from tuberculosis by 27 million by 2050".
Contact:
Sanjay Basu, Department of Medicine, University of California, San Francisco, USA
Email: sanjay.basu@ucsf.edu

Nichtraucher in sechs Wochen

Raucherentwöhnungsprogramm "Nichtraucher in 6 Wochen"

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Differentialdiagnose des Asthmas

A 10-year-old previously healthy girl presented with episodic wheezing, dyspnea, and progressive exercise intolerance, which had developed during the preceding 9 months. On physical examination, the patient had moderate bilateral expiratory wheezing. She was treated for presumed asthma with multiple courses of inhaled bronchodilators, inhaled corticosteroids, montelukast, and oral corticosteroids. Though the patient reported that her condition had improved somewhat, there was no demonstrable objective improvement. Further evaluation by spirometry revealed severe expiratory obstruction (Panel A). The patient underwent flexible fiberoptic bronchoscopy, which revealed nearly complete (>90%) occlusion of the distal trachea by a vascular mass. Computed tomographic angiography showed that the mass did not extend beyond the trachea (Panel B, arrow). The mass was ablated endoscopically with the use of a potassium titanyl phosphate laser. Pathological analysis revealed an inflammatory pseudotumor, a benign tumor composed of a proliferation of inflammatory cells. Rarely invasive, this type of tumor is usually cured by local excision. One month after surgery, the patient was free of symptoms and had normal results on spirometry (Panel C). Pulmonary pseudotumors are rarely the cause of wheezing. However, a lack of response to first-line therapies warrants further investigation, including spirographic analysis.

NEJM Volume 363:e1 July 1, 2020 Number 1

Kurs Tabakentwöhnung

Tabakentwöhnung I

Tabakentwöhnung II

Tabakentwöhnung III

Tabakentwöhnung IV

Tabakentwöhnung V

Hydropneumothorax

A 47-year-old man with a history of cirrhosis associated with alcohol abuse presented with a 2-day history of shortness of breath. Before this symptom developed, he had been treated with repeated thoracentesis of the right side for cirrhosis-associated hydrothorax. On pulmonary examination, breath sounds were absent on the right side, and a succussion splash was audible in the right upper chest when the patient was gently shaken. Chest radiography showed hydropneumothorax with a collapsed right lung and an adjacent thoracic air–liquid level, which was probably the result of repeated thoracentesis. The patient was treated with chest-tube placement and diuretics. An analysis of the pleural effusion revealed transudative fluid without evidence of infection or cancer. The chest drain was removed 1 week later, after reexpansion of the lung.

NEJM Volume 362:e9 January 21, 2010 Number 3