Asklepios Klinik Barmbek

The S2K guideline, organized by the German Respiratory Society, is aimed at physicians in Germany, Switzerland, and Austria who perform outpatient or inpatient diagnostic flexible bronchoscopy in adult patients. Its goal is to standardize the procedure, minimize complications, and improve diagnostic safety. The guideline specifically addresses specialists in pulmonology, thoracic surgery, and hospital hygiene, as well as nursing and technical staff. It provides evidence- and consensus-based recommendations on indications, preparation, execution, hygiene measures, and aftercare. Additionally, it serves as an information resource for physicians from other specialties, payers, professional societies, and can support quality management. It applies to medical care in Germany, Austria, and Switzerland and incorporates the latest scientific findings up to the date of publication.

To evaluate the effect of intraoperative administration of 1g of tranexamic acid (TXA) on perioperative and postoperative outcomes in patients receiving antithrombotic therapy undergoing endoscopic enucleation of the prostate (EEP). This multicenter, prospective, observational study included 932 patients across 30 centers (December 2024-June 2025). Patients were divided into four groups based on TXA use and continuation or discontinuation of blood thinners during EEP. The primary endpoint was bleeding complications within 30 days, defined as a composite of transfusion, clot retention, bleeding requiring restart of continuous bladder washout (CBWO), or surgical reintervention to control hemostasis. Multivariable Logistic regression analysis identified independent predictors of bleeding complications. There were 534 patients in Group 1 (stopped blood thinners, no TXA given), 316 in Group 2 (on blood thinners, no TXA given), 69 in Group 3 (stopped blood thinners, TXA given), and 13 in Group 4 (on blood thinners, TXA given). Median total operative time was longest in Group 2 (88min [IQR 70-127]) and shortest in Group 3 (55min [IQR 39-69]). Hemostasis time was shortest in TXA groups (p < 0.001). Transfusions occurred in 0.6-7.7% and surgical reinterventions in 0.6-7.7% across groups (p < 0.001). At 3 months, urinary symptoms and continence were comparable. On multivariable analysis, TXA reduced the odds of bleeding complications (OR 0.17, p < 0.001), while ongoing anticoagulant therapy (OR 2.93, p = 0.01), dual therapy (OR 4.31, p < 0.001), and longer operative time (OR 1.01, p < 0.001) increased the odds. Intraoperative TXA might mitigate perioperative bleeding and potentially protect patients at higher hemorrhagic risk.

Zusammenfassung Die extrakranielle Carotisstenose (Verengung der Halsschlagader) gilt mit weltweit über einer Milliarde Betroffenen als Volkskrankheit, wobei in Deutschland etwa 30 % der Erwachsenen zwischen 45 und 74 Jahren eine krankhafte Wandverdickung der Halsschlagader aufweisen. Da circa 15 % der jährlich 250.000 Schlaganfälle in Deutschland auf diese Erkrankung zurückzuführen sind, ist eine frühzeitige Diagnostik mittels farbcodierter Duplexsonografie (Ultraschalluntersuchung) sowie eine konsequente Prävention entscheidend. Die Behandlung basiert auf einer engen Verzahnung von Lebensstilmodifikationen, medikamentöser Therapie und invasiven Verfahren. Als wichtigster veränderbarer Risikofaktor gilt das Tabakrauchen, weshalb eine strikte Entwöhnung neben mediterraner Ernährung und körperlicher Aktivität das Fundament der Therapie bildet. Die medikamentöse Behandlung umfasst zwingend hochpotente Statine zur Senkung des Low-Density-Lipoprotein(LDL)-Cholesterins auf Zielwerte unter 70 mg/dl oder 55 mg/dl sowie den Einsatz von Thrombozytenaggregationshemmern wie ASS oder Clopidogrel. Bei der Entscheidung über invasive Eingriffe wie die operative Endarteriektomie oder das Stenting wird strikt zwischen symptomatischen und asymptomatischen Patienten unterschieden. Während bei symptomatischen Stenosen ab einem Grad von 50 % eine starke Empfehlung zur Operation besteht, wird die Indikation bei beschwerdefreien Patienten zunehmend zurückhaltender und individuell in interdisziplinären Fallkonferenzen gestellt. Aktuelle Versorgungsdaten verdeutlichen jedoch, dass das schlaganfallfreie Gesamtüberleben in der Praxis oft hinter den Ergebnissen klinischer Studien zurückbleibt, was die Bedeutung einer lebenslangen optimalen konservativen Therapie und regelmäßiger jährlicher Ultraschallkontrollen nach einem Eingriff unterstreicht.

A virtual endoscopy simulator with a 3D-printed endoscope handle ("Endonix®") that can be used without dedicated equipment ("plug and play") to train endoscope handling has yet not been tested. We prospectively evaluated the simulator's validity, feasibility, and usability in novices, beginners, and experienced endoscopists. Delegates at two congresses (DGVS and ENDOCLUBNORD, both 2024 in Germany) were invited. 310 complete datasets (146 DGVS, 164 ENDOCLUBNORD) were analyzed. Each participant performed two different simulation modules and completed a survey comprising questions on endoscopy experience, simulator evaluation, as well as the System Usability Scale (SUS) and the National Aeronautics and Space Administration Task Load Index (NASA-TLX). The simulator demonstrated good face validity, but only merely sufficient content validity as 67.8% of all participants favored its implementation into endoscopy training. Construct validity was also favorable as experienced endoscopists completed both modules faster than novices or beginners (P < 0.001). In line, criterion validity was given as performance correlated with self-assessed experience. The SUS yielded 75 out of 100 points (corresponding to good usability) with no discernible difference between novices, beginners, and experienced endoscopists. The NASA-TLX, ranging from 0 to 600 points, reflecting level of exhaustion, exhibited a higher score in novices and beginners than experienced endoscopists (285 vs. 210 vs. 225 points, respectively, P < 0.001). Only 16.1% of participants had access to a simulator at their respective institutions, while 79.4% wished for the incorporation of simulators into endoscopy training. The first validation of a novel virtual simulator demonstrated its feasibility and usability, with mostly sufficient validity. Many participants favored its implementation in endoscopy training, particularly for novice and beginner endoscopists, who were identified as the most suitable target learners.

Urinary tract infections are among the most common reasons for consulting aurologist, although the indication and choice of urinary diversion using acatheter vary greatly. Catheter-associated infections are also among the most significant nosocomial complications and are associated with considerable morbidity, mortality, and high costs. The evidence base for the use of transurethral or suprapubic catheters in various urological infectious diseases is currently limited and somewhat contradictory. The aim of this article is therefore to present the current literature and to highlight practice-oriented decision-making processes for the differentiated use of catheters in urological infectious diseases.

<bold>Background:</bold> Chest quantitative computed tomography (QCT) has been used in clinical trials to monitor patients with alpha-1 antitrypsin deficiency (AATD). There is limited data on the use of QCT to phenotype emphysema in AATD. <bold>Methods:</bold> Data from patients with a reduced AATD serum level and/or at least one deficiency mutation, who underwent a chest CT scan at the Thoraxklinik Heidelberg, between 03/2012 and 02/2024, were retrospectively analyzed. The patients were categorized into three groups based on their AAT serum levels: reduced to normal (>70 mg/dl), moderate (41-70 mg/dl), and severe (≤40 mg/dl). The QCT analyses were performed using a fully automated QCT software package (YACTA v2.9.4.98). <bold>Results:</bold> In this retrospective cohort study, 75 AATD patients were analysed, including 13 with reduced-to-normal AATD, 16 with moderate and 46 with severe AATD. The mean age was 54.3±14.7 years with no differences between groups. Significant differences in pack-years were found: reduced to normal 14.9±17.2, moderate 39.4±31.9 and severe 15.1±14.6 (p<0.001). There were no differences in predicted FEV1% (54.1±28.9%). QCT emphysema parameters showed a decrease in mean lung density and 15th percentile with lower serum levels (p<0.05 for each), but no differences in global emphysema index. Lobe-specific analysis showed that the reduced to normal and moderate groups had upper lobe-predominant emphysema, whereas the severe group had basal-predominant emphysema with maxima in the middle lobe and lingula. <bold>Conclusion:</bold> The study provides new insights into the distribution of emphysema, with lobar-specific quantitative analysis challenging the existing paradigm that emphysema in severe AATD is most pronounced in the lower lobes.

<bold>Introduction:</bold> Endoscopic lung volume reduction (ELVR) with one-way valves has been established as an effective and safe treatment for severe lung emphysema. But clinical studies often exclude or underrepresent older patients from their analysis. <bold>Methods:</bold> Data for this study originates from the Lungenemphysemregister e.V., which is a prospective, multicenter and national clinical study with a focus on the treatment of severe lung emphysema. Data on lung function, exercise capacity (6-MWD), quality of life and adverse events were collected at Baseline und at follow up from three to six months after intervention. Two groups were compared: age<70 and age≥70. <bold>Results:</bold> In total 360 patients were included. At baseline the younger cohort presented with less cardiovascular disease and a better lung function (FEV1 32.27 vs 27.2%, p<0.001; RV 242.8 vs. 262.8%, p=0.001). Table 1 shows no significant differences between both groups in the delta between baseline and follow-up. Older patients presented with a higher rate of pneumothorax after intervention (14.2 vs. 7.5%, p=0.04). Mortality did not differ significantly. <fig><object-id>erj;66/suppl_69/PA940/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig> Conclusions: In conclusion, ELVR is effective in a real clinical setting, regardless of age. A higher rate of pneumothorax did not lead to higher mortality or worse outcomes for the older group.