Emergency Laser Treatment of a Tracheobronchial Carcinoid during ECMO

Early diagnosis of endobronchial carcinoids is challenging, as they often mimic other common acute respiratory conditions at first presentation. Increasing consensus favours surgical resection over endoscopic management of bronchial carcinoids whenever possible. ECMO has been reported to be an effective supportive strategy in many cases of elective and urgent surgical or endoscopic airway procedures. However, it has never been described as a supportive technique for the emergency endoscopic management of an endobronchial carcinoid. Herein we report the case of a 17 year-old girl presenting with spontaneous pneumomediastinum and an almost complete endotracheal obstruction at the level of the main carina, due to a typical carcinoid that was treated successfully by endoscopic laser disruption under veno-venous extracorporeal circulation in an emergency scenario

Il supporto decisionale nei processi di acquisto dei broncoscopi monouso

Questo libro non \ue8 un manuale di broncoscopia e neppure una guida alla scelta del miglior broncoscopio per un determinato paziente. Questo libro vuole essere, invece, un aiuto per motivare quando, come e perch\ue8 acquistare e utilizzare broncoscopi monouso. E' stato scritto per pneumologi che fanno uso quotidiano della broncoscopia e hanno vissuto l'esperienza della pandemia COVID-19 in prima linea. Il libro pu\uf2 essere utilizzato da chiunque sia coinvolto sul tema. vengono trattati nello specifico i temi dell'uso dei broncoscopi durante la pandemia COVID-19, la problematica delle infezioni ospedalieri e correlate all'assistenza (ICA), il Piano PNCAR del Ministero della salute, l'utilizzo del monouso nella pratica clinica, il reprocessing, le evidenze economiche (es. costo-efficacia) e l'impatto ambientale e le considerazioni della green economy

A bilateral pneumonia following Thai herbal inhaler compulsive use

Traditional herbal therapy is often underestimated as a possible cause of drug-induced lung diseases. We report the case of a 51 years old man who developed acute respiratory failure after abuse and misuse of a traditional Thai herbal inhaler. The composition of the herbal therapy was only partially known. However, we supposed that the menthol balm may have been responsible of the pulmonary lipoid inclusions and trans-anethole may have caused diffuse alveolar lung damage

Limited role for bronchoalveolar lavage to exclude Covid-19 after negative upper respiratory tract swabs: a multicenter study

Given the strong agreement between negative upper respiratory swabs and BAL, we suggest that BAL has a limited role in the diagnosis of Covid-19 if thoracic imaging and upper respiratory swabs are concordantly negative

The Treatment of Lung Involvement in Systemic Sclerosis

Systemic sclerosis (SSc) patients are often affected by interstitial lung disease (ILD) and, although there have been recent treatment advances, it remains the leading cause of death among SSc, with a 10-year mortality up to 40%. African Americans and subjects with diffuse cutaneous SSc or anti-topoisomerase 1 antibodies are most commonly affected. Currently, early ILD diagnosis can be made, and it is pivotal to improve the prognosis. The diagnostic mainstay test for SSc-ILD is high-resolution computed tomography for the morphology and pulmonary function tests for the functional aspects. Treatment planning and intensity are guided by the disease severity and risk of progression. Traditionally, therapy has depended on combinations of immunosuppressants, particularly cyclophosphamide and mycophenolate mofetil, which can be supplemented by targeted biological and antifibrotic therapies. Benefits have been observed in trials on hematopoietic autologous stem cell transplantation for patients with progressive SSc, whilst lung transplantation is reserved for refractory SSc-ILD cases. Herein, recent advances in SSc-ILD treatment will be explored

Exercise training for patients with pulmonary arterial hypertension

In spite of evidence-based consensus recommendations on exercise training for patients with pulmonary arterial hypertension (PAH) its use outside specialized rehabilitation Centers has been accounted a handful of reports. Dyspnoea and fatigue are common symptoms reducing the exercise tolerance of subjects with PAH even when specific drug are correctly administered. Moreover, the mechanisms of exercise limitation in subjects with PAH are known and thandful of reports. There is evidence of impaired signaling between the periphery and central hemodynamic performance. Exercise training has recently been proven to be effective and safe to enhance physical performance in patients with PAH already treated with specific drug therapy. The rationale of training in PAH has been specifically proven also in experimental animal models of PAH. Moreover, repeated positive results in randomized controlled trials and observational studies in humans gave convincing evidence on the beneficial effects of exercise training as a routine treatment for patients with PAH. To date only 3 small randomized controlled trials and several non-randomized experiences were published in the last decade. Nevertheless, there is a full concordance among all studies, unrespective of the design, training protocol and any possible bias. Exercise training showed to improve physical performance and daily activity, reducing dyspnoea and fatigue, and enhancing the quality of life and muscle strength. So, the final message from the available literature reports is a strong recommendation to adopt exercise training and cardiopulmonary rehabilitation programs for any patient suffering from exertional dyspnoea and fatigue. Many questions remain unanswered regarding the optimization of the exercise training and rehabilitation programs. Ongoing rehabilitative trials in patients with PAH will help answer some of the remaining questions

Correlation between Potential Risk Factors and Pulmonary Embolism in Sarcoidosis Patients Timely Treated

Background. Some studies with inconclusive results have reported a link between sarcoidosis and an increased risk of pulmonary embolism (PE). This study aimed at assessing a possible correlation between potential risk factors and PE in sarcoidosis patients. Methods. A total of 256 sarcoidosis patients (84 males and 172 females; mean age at diagnosis 49 \ub1 13) were enrolled after giving written informed consent. Clinical evaluations, laboratory and radiology tests were performed to evaluate the presence of pulmonary embolism. Results. Fifteen sarcoidosis patients with PE (4 males and 11 females; mean age at diagnosis 50 \ub1 11), diagnosed by lung scintigraphy and 241 sarcoidosis patients without PE (80 males and 161 females; mean age at diagnosis 47 \ub1 13), were observed. There was a statistically significant increase of the presence of antiphospholipid antibodies in the sarcoidosis group with pulmonary embolism. There was no statistically significant difference between the two groups as to smoking habit, obesity or hereditary thrombophilia frequency (p > 0.05, respectively). Conclusions. This study demonstrates a significant correlation between the presence of antiphospholipid antibody positivity and the pulmonary embolism events in our sarcoidosis patients. Furthermore, we propose screening for these antibodies and monitoring, aimed at timely treatment

Epidemiology of Tuberculosis and the Rise of XDR-TB

The global spread of multidrug-resistant strains of tuberculosis (TB) mycobacteria was one of the main reasons leading the World Health Organisation to launch the Stop TB program worldwide. In spite of a slow decline of TB incidence and mortality worldwide, multidrug-resistant TB (MDR-TB) has increased in several countries. MDR-TB is caused by organisms that are resistant to at least isoniazid and rifampicin. The most drug-resistant forms of TB are the extensively drug-resistant TB (XDR-TB) strains caused by organisms that are resistant also to fluoroquinolones and any of the second-line anti-TB injectable drugs. XDR-TB can take 2 years or more to treat with drugs that are less effective, more toxic, and more expensive. Mortality for XDR-TB is very high, and the risk of the transmission between persons of XDR-TB strains is a matter of concern for health systems. Major issues associated with enhanced XDR-TB are non-implementation of DOT (directly observed therapy) and DOT expansion strategies, the insufficient supply or the poor quality of the anti-tuberculosis drugs, and the inadequate intake of the anti-tuberculosis medicines. Nevertheless, prior treatment of MDR-TB with second-line drugs is the strongest associated factor increasing the risk for XDR tuberculosis more than fourfold. Specialized rapid, effective diagnostic methods, including drug-sensitivity testing, are essential for a precise diagnosis of XDR-TB, and subsequent proper treatment. The global rise and spread of XDR-TB have serious effects on TB-control programs, and urge effective health policy responses. National TB control programmes working with all health services can prevent XDR-TB by ensuring that all the physicians and professionals caring for people with TB adhere to the International Standards for TB Care. Specialized centres at regional and national levels should be dedicated to care for difficult-to-treat and untreatable patients with XDR-TB

Evaluation of Correlations between Genetic Variants and High\u2010Resolution Computed Tomography Patterns in Idiopathic Pulmonary Fibrosis

Background. Idiopathic pulmonary fibrosis (IPF) is a progressive fibrosing interstitial lung disease (ILD). This prospective observational study aimed at the evaluation of any correlation between genetic variants associated with IPF susceptibility and high\u2010resolution computed tomography (HRCT) patterns. It also aimed at evidencing any differences in the HRTC pattern between the familial and sporadic form at diagnosis and after two years. Methods. A total of 65 IPF patients (mean age at diagnosis 65 \ub1 10) were enrolled after having given written informed consent. HRCT and genetic evaluations were performed. Results. A total of 19 familial (mean age 62 \ub1 15) and 46 sporadic (mean age 70 \ub1 9) IPF patients were enrolled. A statistically significant difference was evidenced in the HRTC pattern at diagnosis between the two groups. Sporadic IPF patients had a predominantly usual interstitial pneumonia (UIP) pattern compared with those patients with familial IPF (60.0% vs. 21.1%, respectively). Moreover, familial IPF patients had more alternative diagnoses than those with sporadic IPF (31.6% vs. 2.2%, respectively). Furthermore, there was a slight increase in the typical UIP pattern in the familial IPF group at two years from diagnosis. Conclusions. Genetic factors play a pivotal role in the risk of developing IPF. However, further studies are required to clarify how these genetic factors may guide clinical treatment decisions

Optimization and Characterization of Bleomycin mice to better study the Idiopathic Pulmonary Fibrosis

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