ObjectiveThis study analysed whether the persistence of both reversible airway obstruction (RAO) ... more ObjectiveThis study analysed whether the persistence of both reversible airway obstruction (RAO) and elevated BE counts was associated to reduced asthma control and accelerated lung function decline in treated severe asthmatics.MethodsAbout 202 severe asthmatics were studied after 12–120 months of step‐5 treatment associated to anti‐IgE therapy. Following treatments, reversibility tests, after inhaling 400 mcg of Salbutamol, were performed. FEV1 > 12% or ≤12% changes differentiated RAO+ from RAO− subjects. Blood eosinophil (BE) counts after treatment were considered.ResultsPre‐/post‐treatment bronchodilator FEV1% and ACT were lower (61% [50–71], 74.4% [62.5–83.7] and 20[18–22]), whereas BE were higher (380 cells/µl [170–590]) in RAO+ compared to RAO− subjects (77% [64–88], p = 0.0001, 81.8% [66.1–94.3], p = 0.0001, 21[18–23], p = 0.045 and 230 cells/µl [80–360], p = 0.003). A negative relationship between SABA‐induced FEV1% changes and pre‐bronchodilator FEV1% (β = −0.551%; p = 0...
INTRODUCTION The fluoroscopy-guided transbronchial lung biopsy (TBLB) is an useful technique for ... more INTRODUCTION The fluoroscopy-guided transbronchial lung biopsy (TBLB) is an useful technique for diagnosis of peripheral lung lesion (PLL). The diagnostic yield of TBLB is limited and variable, ranging in literature from 16-80%. Nowadays the specimens collected must be suitable for tumor genotyping and the published data for this issue are not conclusive. Aim of the study was to evaluate the diagnostic yield of fluoroscopy guided TBLB and the adequacy of sample for molecular testing in adenocarcinoma subtype. METHODS The pts. referred to our Unit in the period 2013-2015 due to peripheral lung opacities with diameter ≥ 2 cm were included in the study. We excluded pts with uncontrolled coagulopathy, pregnancy, emodinamic instability. All the pts underwent bronchoscopy and fluoroscopy-guided TBLB and TB needle aspiration (TBNA). We performed 4-6 TBLB and 4-6 TBNA for each patient. In case of histopathologic diagnosis of adenocarcinoma, genotyping for EGFR, ALK, K-RAS was done. RESULTS 263 patients have been included, 164 males, age 68.8±11, range 33-88 yrs. TBNA and TBLB allow a diagnosis in 167 patients (diagnostic yield 68%)(table 1); the false negative were 48 (18.2%). The adenocarcinoma represented the 40% of malignant lesions: in this group the sample was adequate for genotyping examination in the majority of cases (> 90%). CONCLUSIONS The fluoroscopy-guided TBLB allowed a correct diagnosis in about 70% of cases with very few adverse events. The specimen resulted adequate for genotyping of adenocarcinoma in the majority of patients.
International Archives of Allergy and Immunology, 2020
Background: It is not clear whether mepolizumab is differently effective in allergic and nonaller... more Background: It is not clear whether mepolizumab is differently effective in allergic and nonallergic severe eosinophilic asthmatics (SEA) in real life. Objective: We tested mepolizumab effectiveness in allergic/nonallergic SEA in real life. A strict criterion to identify the 2 phenotypes was used. Method: We retrospectively considered 134 consecutive patients divided into allergic, with a positivity to at least 1 allergen to prick tests and/or IgE values ≥100 UI/mL (severe allergic eosinophilic asthma [SAEA]; n: 97–72.4%), and nonallergic, with no prick test results and normal IgE levels <100 UI/mL (severe nonallergic eosinophilic asthma [SNAEA]; n: 37–27.6%). They had taken mepolizumab for at least 6 months. Results: After 10.9 ± 3.7 months, improvements in FEV1%, FEF25–75%, exacerbation numbers, blood eosinophil (BE) counts, fractional exhaled nitric oxide (FENO) (ppb), percentages of patients that stopped/reduced short-acting β2-agonists (SABAs) or oral corticosteroid (OC), ob...
Introduzione: la diagnostica delle lesioni polmonari periferiche si avvale di varie metodiche di ... more Introduzione: la diagnostica delle lesioni polmonari periferiche si avvale di varie metodiche di prelievo, tra cui la fibrobroncoscopia affiancata all'utilizzo di un sistema di guida delle biopsie; tra le varie metodiche endoscopiche, la più diffusa è tuttora la biopsia transbronchiale (BTB) sotto guida fluoroscopica, la cui sensibilità per lesioni periferiche di diametro < 2 o > 2 cm è rispettivamente del 34% e 63%. La biopsia transtoracica TC guidata, molto diffusa e caratterizzata da elevata sensibilità e specificità, presenta una percentuale non irrilevante di complicanze , in particolare lo pneumotorace (circa il 20%) con necessità di drenaggio toracico nel 3-5% dei casi. La percentuale di pneumotorace è più elevata per le lesioni distanti dalla pleura, in presenza di enfisema polmonare e in rapporto al numero di passaggi dell'ago. Scopo dello studio: valutare la sensibilità e la specificità della biopsia transbronchiale (BTB)e dell'agoaspirato transbronchiale...
The diagnosis of lung coin lesions (peripheral lesions with a diameter of no more than 6 cm) is o... more The diagnosis of lung coin lesions (peripheral lesions with a diameter of no more than 6 cm) is one of the most important problems in pneumology. Among the numerous causes of coin lesions, the presence of malignancies must always be excluded. The Authors describe an unusual case of lung arteriovenous fistula in a patient suffering from Rendu-Osler-Weber disease. The importance of a multi-step diagnosis, starting with non-invasive procedures is stressed; this is to avoid life threatening complications which may occur after lung trans-thoracic biopsies of previously undiagnosed vascular abnormalities.
A double-blind study versus placebo was performed to assess the effect of bamiphylline, a new xan... more A double-blind study versus placebo was performed to assess the effect of bamiphylline, a new xanthylic derivative, on tracheobronchial mucus clearance (TBMC) in smokers with simple chronic bronchitis and impaired mucus clearance as compared to normal controls. Twenty patients were enrolled and divided into two randomized groups. The first group was treated with bamiphylline (600 mg b.d.) for 15 days, while the second group received placebo with the same oral dosage regimen. Complete clinical-functional examinations were made before and after the test period to establish the effects of treatment. At the end of the study, only the group treated with bamiphylline showed a net increase in mucus clearance (mean radioaerosol elimination 28 +/- 7% before treatment and 38 +/- 11% after treatment; p &lt; 0.01) and an improvement in the clinical score and pulmonary function parameters, in particular the residual volume (RV = 3.41 +/- 0.75 liters before treatment and 2.7 +/- 0.6 after treatment; p &lt; 0.01) and the forced expiratory volume at 1 s (FEV1 = 2.37 +/- 0.7 liters before treatment and 2.88 +/- 0.5 after treatment; p &lt; 0.05). No side effects or adverse reactions that could be attributed to the study drug were observed.
Myasthenic vocal cord dysfunction (VCD), presenting with severe inspiratory stridor, was successf... more Myasthenic vocal cord dysfunction (VCD), presenting with severe inspiratory stridor, was successfully treated with nasal continuous positive airway pressure (nCPAP), thus giving the medical staff time to make the diagnosis and avoiding intubation or tracheostomy. An important sign leading to diagnosis was the very high MEF50/MIF50 ratio calculated from the flow-volume loop. nCPAP treatment induced prompt remission of stridor and a sharp reduction in the MEF50/MIF50 ratio from 9.90 to 1.36. A review of the literature has shown that VCD with inspiratory stridor is an unusual onset symptom of myasthenia gravis and that nCPAP treatment may avoid emergency oral/tracheal intubation and tracheostomy. After diagnosis, the patient underwent thymectomy, and today, 3 years later, he is well without any further therapy.
The aim of this study was to evaluate the efficacy and tolerability of thiamphenicol glycinate hy... more The aim of this study was to evaluate the efficacy and tolerability of thiamphenicol glycinate hydrochloride (TGH) i.m. versus clarithromycin in acute lower respiratory infections due to Chlamydia pneumonia. 113 patients with suspected pneumonia were screened. 40 patients with IgM and/or IgA titers &gt; or = 1:16 and/or IgG titers &gt; or = 1:512 were assigned to 10 days of treatment with TGH 1500 mg daily or clarithromycin 1000 mg daily. 34 patients were considered a clinical success. 33 patients were a radiological success. 22 patients showed a decrease in IgG values. 3 patients had an increase in IgG values. Blood/urine values presented no clinically significant variations. Clinical efficacy was similar in both treatment groups. These are the first results confirming in vivo the recent in vitro evidence that TGH is effective against acute lower respiratory tract infections due to C. pneumoniae, thus representing an alternative therapy to clarithromycin.
PURPOSE: An important aspect that can influence the efficacy of NIV is the choice of interface (n... more PURPOSE: An important aspect that can influence the efficacy of NIV is the choice of interface (nasal, oronasal, nasal pillows); sometimes the interface can be not tolerated (facial skill lesion, ocular and nasal irritation) or ineffective (mouth leak, difficult to fit the ...
Girolamo Adiletta,1 Stefano Baglioni,2 Germano Bettoncelli,3 Pierluigi Bracciale,4 Mario Cazzola,... more Girolamo Adiletta,1 Stefano Baglioni,2 Germano Bettoncelli,3 Pierluigi Bracciale,4 Mario Cazzola,5 Enrico M. Clini,6 Renato Cutrera,7 Franco D’Adduzio,8 Francesco de Blasio,9,10 Fausto Ferraro,11 Roberto Fumagalli,12 Cosimo Lequaglie,13 Maria Gabriella Matera,14 Fabio Numis,15 Paolo Palange,16 Stefano Picciolo,17 Alfredo Potena,18 Francesco Romano,19 Eugenio Sabato,20 Antonio Sacchetta,21 Mario Spatafora,22 Francesco Stefanelli,23 Carlo Zottola24 1General Medicine, “Villa Malta” Hospital, Salerno 2Pneumology Department, Perugia Hospital 3General Practitioner, Brescia 4Pneumology Department, "Ninetto Melli" Hospital, San Pietro V.co (BR) 5Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome 6Respiratory Disease Unit, University Hospital of Modena and University of Modena Reggio Emilia 7Respiratory Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome 8UO Territorial Pneumology ASL BT, ...
ObjectiveThis study analysed whether the persistence of both reversible airway obstruction (RAO) ... more ObjectiveThis study analysed whether the persistence of both reversible airway obstruction (RAO) and elevated BE counts was associated to reduced asthma control and accelerated lung function decline in treated severe asthmatics.MethodsAbout 202 severe asthmatics were studied after 12–120 months of step‐5 treatment associated to anti‐IgE therapy. Following treatments, reversibility tests, after inhaling 400 mcg of Salbutamol, were performed. FEV1 > 12% or ≤12% changes differentiated RAO+ from RAO− subjects. Blood eosinophil (BE) counts after treatment were considered.ResultsPre‐/post‐treatment bronchodilator FEV1% and ACT were lower (61% [50–71], 74.4% [62.5–83.7] and 20[18–22]), whereas BE were higher (380 cells/µl [170–590]) in RAO+ compared to RAO− subjects (77% [64–88], p = 0.0001, 81.8% [66.1–94.3], p = 0.0001, 21[18–23], p = 0.045 and 230 cells/µl [80–360], p = 0.003). A negative relationship between SABA‐induced FEV1% changes and pre‐bronchodilator FEV1% (β = −0.551%; p = 0...
INTRODUCTION The fluoroscopy-guided transbronchial lung biopsy (TBLB) is an useful technique for ... more INTRODUCTION The fluoroscopy-guided transbronchial lung biopsy (TBLB) is an useful technique for diagnosis of peripheral lung lesion (PLL). The diagnostic yield of TBLB is limited and variable, ranging in literature from 16-80%. Nowadays the specimens collected must be suitable for tumor genotyping and the published data for this issue are not conclusive. Aim of the study was to evaluate the diagnostic yield of fluoroscopy guided TBLB and the adequacy of sample for molecular testing in adenocarcinoma subtype. METHODS The pts. referred to our Unit in the period 2013-2015 due to peripheral lung opacities with diameter ≥ 2 cm were included in the study. We excluded pts with uncontrolled coagulopathy, pregnancy, emodinamic instability. All the pts underwent bronchoscopy and fluoroscopy-guided TBLB and TB needle aspiration (TBNA). We performed 4-6 TBLB and 4-6 TBNA for each patient. In case of histopathologic diagnosis of adenocarcinoma, genotyping for EGFR, ALK, K-RAS was done. RESULTS 263 patients have been included, 164 males, age 68.8±11, range 33-88 yrs. TBNA and TBLB allow a diagnosis in 167 patients (diagnostic yield 68%)(table 1); the false negative were 48 (18.2%). The adenocarcinoma represented the 40% of malignant lesions: in this group the sample was adequate for genotyping examination in the majority of cases (> 90%). CONCLUSIONS The fluoroscopy-guided TBLB allowed a correct diagnosis in about 70% of cases with very few adverse events. The specimen resulted adequate for genotyping of adenocarcinoma in the majority of patients.
International Archives of Allergy and Immunology, 2020
Background: It is not clear whether mepolizumab is differently effective in allergic and nonaller... more Background: It is not clear whether mepolizumab is differently effective in allergic and nonallergic severe eosinophilic asthmatics (SEA) in real life. Objective: We tested mepolizumab effectiveness in allergic/nonallergic SEA in real life. A strict criterion to identify the 2 phenotypes was used. Method: We retrospectively considered 134 consecutive patients divided into allergic, with a positivity to at least 1 allergen to prick tests and/or IgE values ≥100 UI/mL (severe allergic eosinophilic asthma [SAEA]; n: 97–72.4%), and nonallergic, with no prick test results and normal IgE levels <100 UI/mL (severe nonallergic eosinophilic asthma [SNAEA]; n: 37–27.6%). They had taken mepolizumab for at least 6 months. Results: After 10.9 ± 3.7 months, improvements in FEV1%, FEF25–75%, exacerbation numbers, blood eosinophil (BE) counts, fractional exhaled nitric oxide (FENO) (ppb), percentages of patients that stopped/reduced short-acting β2-agonists (SABAs) or oral corticosteroid (OC), ob...
Introduzione: la diagnostica delle lesioni polmonari periferiche si avvale di varie metodiche di ... more Introduzione: la diagnostica delle lesioni polmonari periferiche si avvale di varie metodiche di prelievo, tra cui la fibrobroncoscopia affiancata all'utilizzo di un sistema di guida delle biopsie; tra le varie metodiche endoscopiche, la più diffusa è tuttora la biopsia transbronchiale (BTB) sotto guida fluoroscopica, la cui sensibilità per lesioni periferiche di diametro < 2 o > 2 cm è rispettivamente del 34% e 63%. La biopsia transtoracica TC guidata, molto diffusa e caratterizzata da elevata sensibilità e specificità, presenta una percentuale non irrilevante di complicanze , in particolare lo pneumotorace (circa il 20%) con necessità di drenaggio toracico nel 3-5% dei casi. La percentuale di pneumotorace è più elevata per le lesioni distanti dalla pleura, in presenza di enfisema polmonare e in rapporto al numero di passaggi dell'ago. Scopo dello studio: valutare la sensibilità e la specificità della biopsia transbronchiale (BTB)e dell'agoaspirato transbronchiale...
The diagnosis of lung coin lesions (peripheral lesions with a diameter of no more than 6 cm) is o... more The diagnosis of lung coin lesions (peripheral lesions with a diameter of no more than 6 cm) is one of the most important problems in pneumology. Among the numerous causes of coin lesions, the presence of malignancies must always be excluded. The Authors describe an unusual case of lung arteriovenous fistula in a patient suffering from Rendu-Osler-Weber disease. The importance of a multi-step diagnosis, starting with non-invasive procedures is stressed; this is to avoid life threatening complications which may occur after lung trans-thoracic biopsies of previously undiagnosed vascular abnormalities.
A double-blind study versus placebo was performed to assess the effect of bamiphylline, a new xan... more A double-blind study versus placebo was performed to assess the effect of bamiphylline, a new xanthylic derivative, on tracheobronchial mucus clearance (TBMC) in smokers with simple chronic bronchitis and impaired mucus clearance as compared to normal controls. Twenty patients were enrolled and divided into two randomized groups. The first group was treated with bamiphylline (600 mg b.d.) for 15 days, while the second group received placebo with the same oral dosage regimen. Complete clinical-functional examinations were made before and after the test period to establish the effects of treatment. At the end of the study, only the group treated with bamiphylline showed a net increase in mucus clearance (mean radioaerosol elimination 28 +/- 7% before treatment and 38 +/- 11% after treatment; p &lt; 0.01) and an improvement in the clinical score and pulmonary function parameters, in particular the residual volume (RV = 3.41 +/- 0.75 liters before treatment and 2.7 +/- 0.6 after treatment; p &lt; 0.01) and the forced expiratory volume at 1 s (FEV1 = 2.37 +/- 0.7 liters before treatment and 2.88 +/- 0.5 after treatment; p &lt; 0.05). No side effects or adverse reactions that could be attributed to the study drug were observed.
Myasthenic vocal cord dysfunction (VCD), presenting with severe inspiratory stridor, was successf... more Myasthenic vocal cord dysfunction (VCD), presenting with severe inspiratory stridor, was successfully treated with nasal continuous positive airway pressure (nCPAP), thus giving the medical staff time to make the diagnosis and avoiding intubation or tracheostomy. An important sign leading to diagnosis was the very high MEF50/MIF50 ratio calculated from the flow-volume loop. nCPAP treatment induced prompt remission of stridor and a sharp reduction in the MEF50/MIF50 ratio from 9.90 to 1.36. A review of the literature has shown that VCD with inspiratory stridor is an unusual onset symptom of myasthenia gravis and that nCPAP treatment may avoid emergency oral/tracheal intubation and tracheostomy. After diagnosis, the patient underwent thymectomy, and today, 3 years later, he is well without any further therapy.
The aim of this study was to evaluate the efficacy and tolerability of thiamphenicol glycinate hy... more The aim of this study was to evaluate the efficacy and tolerability of thiamphenicol glycinate hydrochloride (TGH) i.m. versus clarithromycin in acute lower respiratory infections due to Chlamydia pneumonia. 113 patients with suspected pneumonia were screened. 40 patients with IgM and/or IgA titers &gt; or = 1:16 and/or IgG titers &gt; or = 1:512 were assigned to 10 days of treatment with TGH 1500 mg daily or clarithromycin 1000 mg daily. 34 patients were considered a clinical success. 33 patients were a radiological success. 22 patients showed a decrease in IgG values. 3 patients had an increase in IgG values. Blood/urine values presented no clinically significant variations. Clinical efficacy was similar in both treatment groups. These are the first results confirming in vivo the recent in vitro evidence that TGH is effective against acute lower respiratory tract infections due to C. pneumoniae, thus representing an alternative therapy to clarithromycin.
PURPOSE: An important aspect that can influence the efficacy of NIV is the choice of interface (n... more PURPOSE: An important aspect that can influence the efficacy of NIV is the choice of interface (nasal, oronasal, nasal pillows); sometimes the interface can be not tolerated (facial skill lesion, ocular and nasal irritation) or ineffective (mouth leak, difficult to fit the ...
Girolamo Adiletta,1 Stefano Baglioni,2 Germano Bettoncelli,3 Pierluigi Bracciale,4 Mario Cazzola,... more Girolamo Adiletta,1 Stefano Baglioni,2 Germano Bettoncelli,3 Pierluigi Bracciale,4 Mario Cazzola,5 Enrico M. Clini,6 Renato Cutrera,7 Franco D’Adduzio,8 Francesco de Blasio,9,10 Fausto Ferraro,11 Roberto Fumagalli,12 Cosimo Lequaglie,13 Maria Gabriella Matera,14 Fabio Numis,15 Paolo Palange,16 Stefano Picciolo,17 Alfredo Potena,18 Francesco Romano,19 Eugenio Sabato,20 Antonio Sacchetta,21 Mario Spatafora,22 Francesco Stefanelli,23 Carlo Zottola24 1General Medicine, “Villa Malta” Hospital, Salerno 2Pneumology Department, Perugia Hospital 3General Practitioner, Brescia 4Pneumology Department, "Ninetto Melli" Hospital, San Pietro V.co (BR) 5Unit of Respiratory Medicine, Department of Experimental Medicine, University of Rome “Tor Vergata”, Rome 6Respiratory Disease Unit, University Hospital of Modena and University of Modena Reggio Emilia 7Respiratory Unit, Academic Department of Pediatrics, Bambino Gesù Children's Hospital, IRCCS, Rome 8UO Territorial Pneumology ASL BT, ...
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