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Zusammenfassung. Unspezifische Symptome, wie z.B. (Ober-)Bauchschmerzen, sind bei Personen mit chronischen Erkrankungen, insbesondere Adipositas, Typ-2-Diabetes, Hypertonie oder ischämischer Herzerkrankung, manchmal schwierig zu beurteilen. Hier beschreiben wir zwei Fälle von grossen Nebennierentumoren, die erst mehrere Jahre nach dem Auftreten unspezifischer Symptome entdeckt wurden.

Background Noninvasive ventilation (NIV) is standard of care for chronic hypercapnic respiratory failure, but indications, devices, and ventilatory modes are in constant evolution. Research Question To describe changes in prevalence and indications for NIV over a 15-year period; to provide a comprehensive report of characteristics of the population treated (age, comorbidities, and anthropometric data), mode of implementation and follow-up, devices, modes and settings used, physiological data, compliance, and data from ventilator software. Study Design and Methods Cross-sectional observational study designed to include all subjects under NIV followed by all structures involved in NIV in the Cantons of Geneva and Vaud (1,288,378 inhabitants). Results A total of 489 patients under NIV were included. Prevalence increased 2.5-fold since 2000 reaching 38 per 100,000 inhabitants. Median age was 71 years, with 31% being > 75 years of age. Patients had been under NIV for a median of 39 months and had an average of 3 ± 1.8 comorbidities; 55% were obese. COPD (including overlap syndrome) was the most important patient group, followed by obesity hypoventilation syndrome (OHS) (26%). Daytime Pa co 2 was most often normalized. Adherence to treatment was satisfactory, with 8% only using their device Interpretation Use of NIV is increasing rapidly in this area, and the population treated is aging, comorbid, and frequently obese. COPD is presently the leading indication followed by OHS. Trial Registry ClinicalTrials.gov; No.: NCT04054570; URL: www.clinicaltrials.gov

Immune checkpoint inhibitors (ICIs) have been shown to improve overall and progression-free survival in various cancers but have been associated with various immune-related adverse events (IRAEs), including interstitial lung disease, especially organizing pneumonia. We report 2 cases of isolated severe airway disease attributable to ICIs, a rarely reported pattern of lung toxicity. The first patient received nivolumab with or without ipilimumab in a randomized double-blind trial for locoregional metastatic melanoma. The second patient was treated with nivolumab for lung adenocarcinoma. An IRAE was suspected in both cases due to a temporal relationship between ICI initiation and symptom onset. ICIs were stopped, and high-dose prednisone, inhaled corticosteroids, and bronchodilators were administered, allowing a rapid clinical and functional improvement in Patient 1. In Patient 2, despite prolonged high-dose prednisone, only a stabilization of forced expiratory volume in 1 s could be achieved, and the disease course was complicated by respiratory infections resulting in further loss of lung function. The patient died 1 year later due to progression of metastatic disease. These 2 cases suggest that pulmonary IRAEs secondary to ICIs may present as isolated bronchitis or bronchiolitis, with variable outcomes following ICI withdrawal and systemic corticosteroids.

Introduction: Noninvasive ventilation (NIV) is standard of care for chronic hypercapnic respiratory failure. Use of NIV has increased over the past years. However, little is known regarding the use of NIV on a long-term basis in the very old. Methods: Cross-sectional observational study, including all subjects under NIV followed between 2016 and 2018 by structures involved in NIV in the Cantons of Geneva and Vaud (192889378 inhabitants). Comparisons were performed between patients ≥75 and Results: 151 patients aged ≥75 were under NIV (out of 489). Patients aged ≥75, chronic obstructive pulmonary disease (COPD) was more frequent and neuromuscular diseases (NMD) less frequent. Male gender and number of comorbidities were more frequent in older subjects. Correction of ABG and NPO was similar in both groups. Use of bi-level positive pressure ventilators in a spontaneous/timed mode was the most frequent modality of NIV in both groups. No significant difference was noted in pressure settings, back-up respiratory rate, residual respiratory events or compliance. Leaks were more frequent in older subjects. Choice of interfaces was similar and use of supplemental oxygen was more frequent in the older group. Conclusions: One third of the population under NIV is ≥75 years old with a higher proportion of COPD in the older group, and a lower representation of NMD. Indices of efficacy of NIV (daytime ABG, NPO, residual respiratory events) and compliance were similar in both groups. Leaks were more frequent in older subjects.

Background: Use of adaptive servo-ventilation (ASV) has been questioned in patients with central sleep apnea (CSA) and chronic heart failure (CHF). This study aims to detail the present use of ASV in clinical practice. Methods: Descriptive, cross-sectional, multicentric study of patients undergoing long term (≥3 months) ASV in the Cantons of Geneva or Vaud (1,288,378 inhabitants) followed by public or private hospitals, private practitioners and/or home care providers. Results: Patients included (458) were mostly male (392; 85.6%), overweight [BMI (median, IQR): 29 kg/m2 (26; 33)], comorbid, with a median age of 71 years (59-77); 84% had been treated by CPAP before starting ASV. Indications for ASV were: emergent sleep apnea (ESA; 337; 73.6%), central sleep apnea (CSA; 108; 23.6%), obstructive sleep apnea (7; 1.5%), and overlap syndrome (6; 1.3%). Origin of CSA was cardiac (n = 30), neurological (n = 26), idiopathic (n = 28), or drug-related (n = 22). Among CSA cases, 60 (56%) patients had an echocardiography within the preceding 12 months; median left ventricular ejection fraction (LVEF) was 62.5% (54-65); 11 (18%) had a LVEF ≤45%. Average daily use of ASV was [mean (SD)] 368 (140) min; 13% used their device

Noninvasive ventilation (NIV) is standard of care for chronic hypercapnic respiratory failure, but indications, devices, and ventilatory modes are in constant evolution.To describe changes in prevalence and indications for NIV over a 15-year period; to provide a comprehensive report of characteristics of the population treated (age, comorbidities, and anthropometric data), mode of implementation and follow-up, devices, modes and settings used, physiological data, compliance, and data from ventilator software.Cross-sectional observational study designed to include all subjects under NIV followed by all structures involved in NIV in the Cantons of Geneva and Vaud (1,288,378 inhabitants).A total of 489 patients under NIV were included. Prevalence increased 2.5-fold since 2000 reaching 38 per 100,000 inhabitants. Median age was 71 years, with 31% being 75 years of age. Patients had been under NIV for a median of 39 months and had an average of 3 ± 1.8 comorbidities; 55% were obese. COPD (including overlap syndrome) was the most important patient group, followed by obesity hypoventilation syndrome (OHS) (26%). Daytime PacoUse of NIV is increasing rapidly in this area, and the population treated is aging, comorbid, and frequently obese. COPD is presently the leading indication followed by OHS.ClinicalTrials.gov; No.: NCT04054570; URL: www.clinicaltrials.gov.

Pulmonary embolism is a frequent disease with well known acquired or hereditary risk factors. The first diagnostic step is to determine a pre-test probability of the disease based on the revised Geneva score. Further work up with D-Dimers, blood gases and ECG, will ascertain the diagnostic of the condition. The prognosis will be better evaluated with BNP and troponine. Negative D-Dimers can rule out pulmonary embolism when pre test probability of the disease is low or intermediate. Radiological work-up includes computed tomographic pulmonary angiography when D-Dimers are positive and when the pre test probability is high, or ventilation/perfusion scan in case of iodine allergy or renal failure. Finally, guidelines will help choosing which patients suffering of pulmonary embolism have to undergo a hematological assessment or oncologic screening.

Emphysema is one of the components of chronic obstructive pulmonary disease beside the bronchial, vascular and systemic parts. The pathogenesis involves an inflammatory process (macrophages, neutrophiles and lymphocytes), but also an imbalance between proteases-anti-proteases and the oxidative stress by the formation of oxygen radicals. On the therapeutic level, these physiopathological pathways are the rational basis to the progressive use of antioxidants (mainly N-acetylcysteine) or, for the moment at an experimental level, of anti-proteases (inhibitors of serine proteases, cysteine proteases and the matrix metalloproteases). To reach the secondary lobule, site of the emphysema, the inhaled future treatments will have to be constituted of small particles, as in cigarette smoke, in order to distribute into the most homogeneous way the affected lung.

Introduction: recent data on idiopathic pulmonary fibrosis treatment options suggest that old established treatments are either ineffective or deleterious. One novel treatment is pirfenidone, an oral anti-fibrotic agent. this treatment is often limited by skin toxicity. this case report provided a daily photographic guide of the eruption and recovery of pirfenidone skin toxicity, along with the prescribed treatment and alternative diagnoses to be ruled out. case report: A 59-year-old caucasian male patient was admitted for Pirfenidone treatment titration and rehabilitation after an idiopathic pulmonary fibrosis exacerbation. the patient did not experience any gastrointestinal toxicity but a facial skin pruritic and tender rash developed 48 h after drug’s target dose reached. the patient had only one hour limited sun exposure during his transfer to our unit. Due to skin eruption topography corresponding to the concomitant continuous positive airway pressure treatment pressure points a differential diagnosis was to

Megastigma-5,8-dien-4-one, an aroma constituent of the yellow passion fruit and Virginia tobacco Preparative gas chromatography allowed isolation of megastigma-5, 8 (E)-dien-4-one (3) from small subfractions of both yellow passion fruit and Virginia tobacco condensates. Along with 3, the Z-isomer 4 occurs in the aroma of the yellow passion fruit. Both these novel flavor compounds were synthesized by a two-step, non-biomimetic route starting from 2, 6, 6-trimethylcyclohex-2-en-1-one. The E-isomer 3 was also formed by acid-catalyzed dehydration/rearrangements of ionol- and damascol monoepoxides 5, 6, 7, 8 and hydroxy-ionols and -damascol 9, 10 and 11. Such a biomimetic conversion indirectly supports the assumption that 3 and 4 might originate from the oxidative degradation of carotenoid precursors possibly related to canthaxanthine.