[Differential Therapy NIV - NHF]. / Differenzialtherapie nicht-invasive Beatmung ­ nasale High-Flow-Therapie.

Nasal high-flow provides a stable oxygenation in acute hypoxemic respiratory failure, modifies breathing patterns, reduces work of breathing and can decrease hypercapnia. Thereby NHF provides more features than low-flow oxygen and acts as a ventilatory support device. Different studies show benefits of NHF compared to NIV. For these reasons we will discuss the capabilities of NHF and NIV in selected settings.

[Nasal Highflow (NHF): A New Therapeutic Option for the Treatment of Respiratory Failure]. / Nasaler Highflow (NHF): Eine neue Therapiealternative zur Behandlung der respiratorischen Insuffizienz.

The therapy of choice in hypoxemic respiratory failure (type 1) is the application of supplemental oxygen at flow rates of 1 to 15 l/min via nasal prongs or mask. Non-invasive or invasive positive pressure ventilation will be initiated when the oxygen therapy effects are not sufficient or if hypercapnic respiratory failure (type 2) is the underlying problem. Recently, an alternative therapy option is available, from the pathophysiology it can be classified between oxygen therapy and positive pressure ventilation. The therapy called Nasal High Flow (NHF) is based on the nasal application of a heated and humidified air oxygen mixture with a flow range of up to 60 l/min. The precise pathophysiological principles of NHF are only partly understood, yet various aspects are well studied already: it is possible to deliver high oxygen concentrations, airway dryness can be avoided, dead space ventilation reduced and clearance of nasal dead space is achieved. Additionally, an end expiratory positive pressure is built up, which helps to prevent airway collapse, thus resulting in an improvement of respiratory efficiency and reduction of breathing work. Current studies demonstrate improvement in gas exchange and reduction of reintubation rate when applying the NHF treatment in acute respiratory failure. Thus the NHF therapy attracts attention in intensive care medicine. The application in other fields like chronic respiratory insufficiency is less well clarified. The objectives of this review are to present the pathophysiological effects and mechanisms of NHF, as far as understood, and to give an overview over the current state of relevant studies.

[Bilateral pneumothorax following acupuncture]. / Bilateraler Pneumothorax nach Akupunktur.

Acupuncture, a subsection of traditional Chinese medicine, plays an important role as an alternative healing method. Even though there is little proof of its efficacy, acupuncture is becoming more and more popular in the Western world, especially because it is considered almost free of side effects. However, severe complications may occur and have previously been described.We will present a patient who suffered from bilateral pneumothoraces after acupuncture into the paravertebral area. This complication was not considered as a differential diagnosis thus even worsening the patient's life-threatening condition.

[Lymphomatoid granulomatosis--a short description of an unusual case of the disease]. / Lymphomatoide Granulomatose--eine kurze Darstellung der Erkrankung anhand eines aussergewöhnlichen Falles.

Lymphomatoid granulomatosis (LYG) is a rare disease with an unknown pathogenesis. It is considered as a B-cell disorder with an uncertain malignant potential. The disease is classified as an angiocentric and angiodestructive lymphoproliferative disorder. EBV-association (LMP1) and the detection of the surface antigens CD20 and CD30 are the characteristic pathological findings. The lung, the nervous system, the kidneys and the liver are affected most frequently. In the present report the case of a 79-year-old man is described, who showed a cavity in the upper right lobe which was opened out into the trachea. The initial CXR and CT scan demonstrated a large nodular air space opacity (reversed halo sign) on the upper right area and a smaller one on the left side. In addition to CT and bronchoscopy, a surgical biopsy was performed to confirm the diagnosis of lymphomatoid granulomatosis. Treatment consisted in chemotherapy with rituximab, cyclophosphamide, vincristine and prednisolone (R-CVP). Three months after confirmation of diagnosis the patient died of an abscess-forming pneumonia.