Towards Individualized Tracheobronchial Stents: Technical, Practical and Legal Considerations

Stent placement has been established as a standard procedure for treating airway obstructions. Other indications are localized malacias and fistulas. Though many different stents with various diameters and lengths are available, the shapes are hardly ever ideal because of the distorted anatomy in patients with diseased airways. There are technical and legal limitations for customizing purchased airway stents. Individually tailored stents would be preferable. New techniques of additive manufacturing such as 3D printing make it possible to produce optimized stents for a particular patient. Using CT data and bronchoscopic images, stents can be constructed that match a particular anatomical situation and apply the optimized expansion force. We give an overview of the currently available manufacturing techniques for polymeric stents and report about our own experience. Direct on-site printing of polyurethane stents in a hospital and printing individual extrusion molds for silicone stents in a certified cleanroom are both feasible. Furthermore, there are promising attempts of combining mechanically customized stents with surface modifications, drug-eluting features, biodegradability, and time-dependent adaptation (4D printing). Truly optimized airway stents with the potential of solving the well-known stent problems such as granulation tissue formation, remodeling, mucostasis, and infections are in reach. The technical hurdles are probably easier to overcome than the legal constraints. The legal situations are discussed from a physician's and a manufacturer's perspective

Present Topics and Discussions of Research about Social Capital

Das Ziel unseres Beitrages ist es, den Leserinnen und Lesern dieses Sonderhefts eine kurze Einleitung und einen Überblick über den Stand der Forschung zum Thema Sozialkapital zu geben. Wir verweisen zunächst auf einige Klassiker der Soziologie und der Politikwissenschaft, die schon früh die Bedeutung der sozialen Eingebundenheit für das Handeln von Individuen betont haben. Seit Beginn der 1990er Jahre hat sich dann immer mehr der Begriff Sozialkapital als Bezeichnung für diesen Sachverhalt durchgesetzt. In der modernen empirischen Sozialforschung befassen sich mittlerweile viele Studien mit den Fragen, wie Sozialkapital in Gesellschaften verteilt ist, wie es entsteht und welche Auswirkungen mit einer unterschiedlichen Ausstattung verbunden sind. Dies wird durch die Beiträge in diesem Sonderheft demonstriert, die wir in dieser Einleitung zusammenfassen und vorstellen

Arbeitsmarktungleichheiten und die Verfügbarkeit von Sozialkapital. Die Rolle von Gratifikationen und Belastungen

Diewald M. Arbeitsmarktungleichheiten und die Verfügbarkeit von Sozialkapital. Die Rolle von Gratifikationen und Belastungen. In: Franzen A, Freitag M, eds. Sozialkapital. Theoretische Grundlagen und empirische Befunde. Kölner Zeitschrift für Soziologie und Sozialpsychologie. Sonderhefte. Vol 47. Wiesbaden: VS, Verl. für Sozialwiss.; 2007: 183-210

Bronchoskopie in therapeutischer Mission – interventionelle Bronchologie

Die interventionelle Bronchologie ist eine verhältnismässig junge Subspezialisierung der Pneumologie und Thoraxchirurgie. Die Bronchoskopie hat sich in der Vergangenheit vor allem auf die Diagnostik von pulmonalen Infektionen und Malignomen beschränkt. Durch ein ständig wachsendes Armamentarium an therapeutischen Möglichkeiten wachsen jedoch die Indikationen für endobronchiale Eingriffe zusehends. Das heutige Arsenal an therapeutischen Möglichkeiten der interventionellen Bronchologie wird in diesem Artikel vorgestellt. Interventional bronchology is a relatively young discipline of chest medicine. Conventional bronchoscopy has been focused on diagnoses of pulmonary infections or malignancies. However, due to recently established and upcoming therapeutic techniques, indications of interventional bronchoscopic procedures are increasingly used. The modern arsenal of these techniques is discussed in this article

Complications after bronchoscopic lung volume reduction

Bronchoscopic lung volume reduction (BLVR) has been demonstrated an efficient and safe alternative to surgery in multiple randomized trials and retrospective cohort studies. However, despite its minimal invasiveness BLVR is not without potential harm. Complications and their incidents differ significantly between the individual BLVR techniques (valves, coils, vapour or sealant) which are bearing varying device- and intervention-dependent risks. Interventional pulmonologists must be aware of potential side effects and their management to anticipate and ensure highest quality treatment of the severely ill emphysema patient

Target-controlled versus fractionated propofol sedation in flexible bronchoscopy: A randomized noninferiority trial

BACKGROUND AND OBJECTIVE: Fractionated propofol administration (FPA) in flexible bronchoscopy (FB) may lead to oversedation and an increased risk of adverse events, because a stable plasma concentration of propofol is not maintainable. The purpose of this randomized noninferiority trial was to evaluate whether target-controlled infusion (TCI) of propofol is noninferior to FPA in terms of safety in FB. METHODS: Coprimary outcomes were the mean lowest arterial oxygen saturation (SpO2 ) during FB and the number of propofol dose adjustments in relation to procedure duration. Secondary outcomes were the number of occasions with SpO2  4% from baseline, number of occasions with systolic blood pressure < 90 mm Hg, cough frequency, cumulative propofol dose, recovery time, maximum transcutaneous CO2 , mean SpO2 and O2 delivery during FB. RESULTS: Seventy-seven patients were included. TCI was noninferior to FPA in terms of mean (standard deviation) lowest SpO2 during the procedure (88.3% (5.4%) vs 86.9% (7.3%)) and required fewer dose adjustments (0.04/min vs 0.28/min, P < 0.001) but a higher cumulative propofol dose (264 vs 194 mg, P = 0.003). All other secondary outcomes were comparable between the groups. CONCLUSION: We suggest that TCI of propofol is a favourable sedation technique for FB with equal safety issues and fewer dose adjustments compared with FPA

Evaluation of Nickel Release from Endobronchial Valves as a Possible Cause of Hypersensitivity Pneumonitis in a Patient Treated with Bronchoscopic Lung Volume Reduction

BACKGROUND:Endobronchial valve (EBV) placement is an established lung volume reduction procedure aiming to improve lung function and exercise capacity in patients with severe emphysema. As EBVs consist of silicone and nitinol (a metal alloy of nickel and titanium), there are concerns that nickel ions might be released and could have a clinical impact in patients with a contact allergy to nickel. Based on a case with hypersensitivity pneumonitis (HP) after treatment with EBVs, we aimed to evaluate the in vitro nickel release from EBVs using inductively coupled plasma mass spectrometry (ICP-MS) and scanning electron microscopy (SEM). METHODS:Six EBVs were immersed in artificial saliva for a period of 7 days. At 24-h intervals, the nickel ion concentration was measured using ICP-MS. RESULTS:There was evidence of a significant nickel release from EBV during the first 48 h, which is possibly due to an incomplete silicone layer detected by SEM. The concentration of released nickel was below the toxic limit. CONCLUSIONS:To the best of our knowledge, we report the first case of HP after EBV treatment. Our finding of in vitro release of nickel ions from EBVs may contribute to the current understanding on hypersensitivity reactions after nitinol implants in patients with nickel contact allergy. However, it did not confirm a causative relationship

Therapiemöglichkeit des fortgeschrittenen Lungenemphysems

• Nach Ausschöpfen der konservativen/medikamentösen Therapiemassnahmen bei fortgeschrittenem Lungenemphysem kann in vielen Fällen eine chirurgische oder bronchoskopische Behandlung angeboten werden. • Durch die chirurgische oder bronchoskopische Emphysembehandlung können eine Verbesserung der Dyspnoe, Zunahme der Leistungsfähigkeit und Verbesserung der Einsekundenkapazität erreicht werden. • Das Ziel jedweder Emphysembehandlung ist die Abnahme der Lungenüberblähung und die Wiederherstellung der elastischen Rückstellkräfte der Lunge («elastic recoil»). • Die Auswahl der für den Patienten individuell adäquaten Behandlungsmethode sollte interdisziplinär getroffen werden