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Zarogoulidis P, Tsakiridis K, Vagionas A, Hohenforst-Schmidt W, Zaric B, Tryfon S, Saroglou M, Drevelegas K, Hatzibougias D, Michalopoulou-Manoloutsiou E, Paliouras D, Barbetakis N, Huang H, Bai C. Bronchogenic cyst or lung cancer. Only biopsy can tell. Respir Med Case Rep 2020; 32:101328. [PMID: 33457198 PMCID: PMC7797910 DOI: 10.1016/j.rmcr.2020.101328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 12/27/2020] [Indexed: 11/29/2022] Open
Abstract
Bronchogenic cysts are rare congenital malformations which derive from primitive ventral foregut. They are usually observed in intrathoracically. A fifty year old male was admitted for the investigation of a three month chest pain. Computed tomography scan of the thorax revealed a lesion around the esophagus and left stem bronchus. Endobronchial ultrasound with convex probe and a 19G needle biopsy revealed a bronchogenic cystic which was removed with video assisted thoracic surgery. Initial radiologic assessment although was thought to be lung cancer because of the smoking habit it turned out to be benignancy. EBUS-TBNAB with 10G needle is safe and absolutely necessary for these lesions, as they take large samples.
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Zarogoulidis P, Hohenforst-Schmidt W, Huang H, Sapalidis K, Kosmidis C, Tryfon S, Vagionas A, Tsakiridis K, Drevelegas K, Romanidis K, Freitag L. Vapor for lung volume reduction; pros and cons. Expert Rev Respir Med 2020; 14:1189-1195. [PMID: 32870725 DOI: 10.1080/17476348.2020.1816467] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Bronchoscopic lung volume reduction (BLVR) is a novel approach for treatment of emphysema. Several techniques are available to accomplish BLVR including Bronchoscopic Vapor Thermal Ablation (BVTA). This technique is easy to perform and considered safe due to its gradual effect. We discuss BTVA in detail in this editorial. AREAS COVERED We discuss our experience with BTVA in detail including patient selection, equipment, procedure, post-procedural care and complications. We also review the literature to determine the pros and cons for its use. Other modalities such as endobronchial valves, coils and lung sealants are also briefly discussed. EXPERT OPINION Vapor ablation is a novel and safe approach in inducing lung volume reduction in emphysema patients. The effects are gradual, and therefore potentially making it safer than other minimally invasive modalities. Pneumonitis and infection are common side effects. Just as in other BLVR techniques, a case by case evaluation is needed to determine the right candidate for BTVA. Further larger studies are needed before BTVA becomes standard of care in treatment of patients with emphysema.
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Papadopoulou E, Tryfon S, Saroglou M, Vlachopoulos D, Georgopoulou A, Serasli E. Valproic Acid Induced Pleural Effusion: A Rare Clinical and Pathophysiological Entity. ACTA ACUST UNITED AC 2020. [DOI: 10.15344/2456-8007/2020/150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Zarogoulidis P, Sapalidis K, Kosmidis C, Tsakiridis K, Huang H, Bai C, Hohenforst-Schmidt W, Tryfon S, Vagionas A, Drevelegas K, Perdikouri EI, Freitag L. Stents for small airways: current practice. Expert Rev Respir Med 2020; 14:969-972. [PMID: 32597256 DOI: 10.1080/17476348.2020.1788941] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
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Zarogoulidis P, Tryfon S, Sapalidis K, Tsakiridis K, Baka S, Huang H, Bai C, Hohenforst-Schmidt W, Hatzibougias D, Athanasiou E, Vagionas A, Saroglou M, Kosmidis C. Bronchial HPV; the good the bad and the unknown. Respir Med Case Rep 2020; 30:101053. [PMID: 32309132 PMCID: PMC7155231 DOI: 10.1016/j.rmcr.2020.101053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/04/2020] [Accepted: 04/04/2020] [Indexed: 01/10/2023] Open
Abstract
Background Solitary tracheobronchial papilloma (STBP) is a rare benign tumor. Human papilloma virus (HPV) infection is associated with dysplasia and a high risk of carcinoma. Case 1 Sixty five year old male with hemoptysis and with coilocytic atypia, indicating the presence of HPV. Case 2 Thirty two year old female with a polypoid villoglandular bronchial structure and no cytoplasmic or nuclear atypia but prominent microvilli. Discussion Tissue sample is the best sample in order to determine and distinguish the two entities, local treatment should be considered as first option when possible.
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Tsiouda T, Sardeli C, Porpodis K, Pilikidou M, Apostolidis G, Kyrka K, Miziou A, Kyrka K, Tsingerlioti Z, Papadopoulou S, Heva A, Koulouris C, Giannakidis D, Boniou K, Kesisoglou I, Vagionas A, Kosmidis C, Sevva C, Papazisis G, Goganau AM, Sapalidis K, Tsakiridis K, Tryfon S, Platanas M, Baka S, Zaric B, Perin B, Petanidis S, Zarogoulidis P. Sex Differences and Adverse Effects between Chemotherapy and Immunotherapy for Non-Small Cell Lung Cancer. J Cancer 2020; 11:3407-3415. [PMID: 32231747 PMCID: PMC7097940 DOI: 10.7150/jca.40196] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Accepted: 01/20/2020] [Indexed: 12/16/2022] Open
Abstract
Introduction: Lung cancer remains the leading cause of cancer mortality in men and women and around the world. Approximately 90% of cases of lung cancer are caused by smoking and the use of tobacco products. However, other factors such as asbestos, air pollution and chronic infections can contribute to pulmonary carcinogenesis. Lung cancer is divided into two broad histological categories, which develop and spread different small cell lung carcinomas and non-small cell lung carcinomas. The treatment options for lung cancer include surgery, radiotherapy, chemotherapy and targeted treatments. Tumor induced immune suppression is vital for malignant progression. Immunotherapies act by strengthening the patient's innate tendency for an immune response and give positive promise to patients with non-small cell lung cancer and small cell lung cancer. Immune checkpoint inhibitors are a new approach to cancer therapies. Just as immune therapies include a new approach to cancer biology, the toxicities associated with these factors have created new challenges in clinical practice. Materials & Methods: Patients (218) aged 40-80 years were treated with either chemotherapy or immunotherapy. Their response to treatment and any subsequent adverse drug reactions were studied. Results: 69% of patients were treated with chemotherapy and 31% were treated with immunotherapy. The type of treatment had a statistically significant effect on the undesirable effects of the treatment. Conclusions: The type of treatment was statistically significant in responding to the treatment and treatment side effects but not in the rate of death.
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Filippou D, Kleontas A, Tentzeris V, Emmanouilides C, Tryfon S, Baka S, Filippou I, Papagiannopoulos K. Extended resections for the treatment of patients with T4 stage IIIA non-small cell lung cancer (NSCLC) (T 4N 0-1M 0) with or without cardiopulmonary bypass: a 15-year two-center experience. J Thorac Dis 2020; 11:5489-5501. [PMID: 32030268 DOI: 10.21037/jtd.2019.11.33] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Background Stage IIIA non-small cell lung cancer (NSCLC) is a heterogeneous group of patients, often requiring variable and individualized approaches. The dilemma to operate or not frequently arises, since more than 75% of the cases of NSCLC are diagnosed in advanced stages (IIIA). The main objective of this study was to assess whether the benefits outweigh surgical risks for the T4N0-1M0 subgroup. Methods Data from 857 patients with locally advanced T4 NSCLC were retrospectively collected from two different institutions, between 2002 and 2017. Clinical data that were retrieved and analyzed, included demographics, comorbidities, surgical details, neoadjuvant or/and adjuvant therapy and postoperative complications. Results Twelve patients were in the cardiopulmonary bypass (CPB) group and thirty in the non-CPB. The most common types of lung cancer were squamous cell carcinoma (50.0%) and adenocarcinoma (35.7%). The most frequent invasion of the tumor was seen in main pulmonary artery and the superior vena cava. Significantly more patients of the CPB group underwent pneumonectomy as their primary lung resection (P=0.006). In all patients R0 resection was achieved according to histological reports. The overall 5-year survival was 60%, while the median overall survival was 22.5 months. Analysis revealed that patient age (P=0.027), preoperative chronic obstructive pulmonary disease (COPD) (P=0.001), tumor size (4.0 vs. 6.0 cm) (P=0.001), postoperative respiratory dysfunction (P=0.001) and postoperative atelectasis (P=0.036) are possible independent variables that are significantly correlated with patient outcome. Conclusions We suggest that in patients with stage IIIA/T4 NSCLC, complete resection of the T4 tumor, although challenging, can be performed in highly selected patients. Such an approach seems to result in improved long-term survival. More specific studies on this area of NSCLC probably will further enlighten this field, and may result in even better outcomes, as advanced systemic perioperative approaches such as modern chemotherapy, immunotherapy and improvements in radiation therapy have been incorporated in daily practice.
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Agrafiotis M, Papathanassiou M, Karachristos C, Kerezidou E, Tryfon S, Serasli E, Chloros D. A simplified quantitative acid–base approach for patients with acute respiratory diseases. J Clin Monit Comput 2020; 34:21-28. [DOI: 10.1007/s10877-019-00302-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Accepted: 03/19/2019] [Indexed: 10/27/2022]
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Antoniou K, Markopoulou K, Tzouvelekis A, Trachalaki A, Vasarmidi E, Organtzis J, Tzilas V, Bouros E, Kounti G, Rampiadou C, Kotoulas SC, Bardaka F, Bibaki E, Fouka E, Meletis G, Tryfon S, Daniil Z, Papakosta D, Bouros D. Efficacy and safety of nintedanib in a Greek multicentre idiopathic pulmonary fibrosis registry: a retrospective, observational, cohort study. ERJ Open Res 2020; 6:00172-2019. [PMID: 32010718 PMCID: PMC6983495 DOI: 10.1183/23120541.00172-2019] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Accepted: 11/13/2019] [Indexed: 11/09/2022] Open
Abstract
Nintedanib is a tyrosine kinase inhibitor approved for the treatment of idiopathic pulmonary fibrosis (IPF). In a retrospective, real-world study across seven Greek hospitals, we evaluated the effectiveness and safety of nintedanib in routine clinical practice. Patients diagnosed with IPF, as per guideline criteria or multidisciplinary diagnosis, received nintedanib between January 2013 and January 2018. We evaluated 244 patients: mean±sd age 71.8±7.5 years, 79.1% male, 45.1% current smokers and 33.1% ex-smokers at treatment initiation. At baseline, predicted forced vital capacity (FVC) was 73.3±20.7% and predicted diffusing capacity of the lungs for carbon monoxide (DLCO) was 42.6±16.7%. On average, patients spent 23.6±15.0 months on nintedanib. At 3 years, 78 patients had died, equating to a 3-year survival rate of 59.4% (unaffected by treatment discontinuation or dose reduction). FVC% pred and DLCO% pred were largely stable at 3 years, with no significant difference from baseline (FVC 73.3±20.7% pred versus 78±20.1% pred, p=0.074; DLCO 42.6±16.7% pred versus 40.4±18.1% pred, p=0.334). Of the 244 patients, 55.7% reported an adverse event. Gastrointestinal events were the most common (173 (77.2%) out of 224 total events) and 45.0% of patients experienced diarrhoea. Only 32 (13.1%) patients had to permanently discontinue nintedanib due to an adverse event. This real-world study shows a 3-year survival rate of 59.4% and a low discontinuation rate due to adverse events. Our experience is consistent with previous findings in clinical trials of nintedanib in IPF. Findings from the largest registry of Greek patients with IPF receiving nintedanib in routine clinical practice show, over a 3-year period, a low discontinuation rate and efficacy data that support the results of the INPULSIS clinical trialshttp://bit.ly/35a2CS5
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Antoniadou M, Siopi D, Nena E, Galanou A, Tsara V, Tryfon S, Voudrislis G, Steiropoulos P. Sleep-disordered breathing in patients with inherited neuromuscular diseases. Effect of non-invasive ventilation during sleep: a single center experience. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Serasli E, Papathanasiou M, Tryfon S, Nikolaou K, Stavrati A, Zarifis I, Galanou A, Markopoulou A, Chloros D. AB029. Hospital outcome of patients with pulmonary embolism (2006–2016)—correlation with clinical severity indexes. ANNALS OF TRANSLATIONAL MEDICINE 2016. [DOI: 10.21037/atm.2016.ab029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Cheva A, Kilmpasani M, Karafoulidou I, Pastelli N, Rampiadou C, Tryfon S, Papaemmanouil S. AB046. The limitations in the diagnosis of mesenchymal neoplasms in bronchoscopy biopsy material—a case report. ANNALS OF TRANSLATIONAL MEDICINE 2016. [DOI: 10.21037/atm.2016.ab046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Meristoudis G, Tryfon S, Notopoulos A. Sarcoidosis with muscular involvement demonstrated on gallium-67 scintigraphy. Hippokratia 2016; 20:318. [PMID: 29416310 PMCID: PMC5788236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
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Angomachalelis I, Tryfon S, Angomachalelis N. Clinical Understanding of Inflammation, Inducing Thrombogenesis, Respiratory Impairment, and Cardiorenal Syndrome in Patients With Pulmonary and Coincident Cardiac Dyspnea. Chest 2016. [DOI: 10.1016/j.chest.2016.08.1275] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Cartin-Ceba R, Diaz-Caballero L, Al-Qadi MO, Tryfon S, Fervenza FC, Ytterberg SR, Specks U. Diffuse Alveolar Hemorrhage Secondary to Antineutrophil Cytoplasmic Antibody-Associated Vasculitis: Predictors of Respiratory Failure and Clinical Outcomes. Arthritis Rheumatol 2016; 68:1467-76. [DOI: 10.1002/art.39562] [Citation(s) in RCA: 69] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 12/17/2015] [Indexed: 01/31/2023]
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Vlahopoulos D, Saroglou M, Aggelis N, Kostakis E, Lykogiannis S, Tryfon S. Differences Between the Two Types of Pleural Effusion Related to Taking Valproic Acid; Unknown Origin Pleuritis Versus Drug Induced Lupus Pleural Effusion. Chest 2015. [DOI: 10.1378/chest.2277808] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Tryfon S, Zarogoulidis P, Tsavlis D, Tsirgogianni K, Zissimopoulos A, Kioumis I, Emmanouilides C, Baka S, Titopoulos H, Dager A, Filippou D. Ex situ reimplantation technique, in central lung tumors. ANNALS OF TRANSLATIONAL MEDICINE 2015; 3:178. [PMID: 26366395 DOI: 10.3978/j.issn.2305-5839.2015.08.03] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Accepted: 08/04/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND The parenchyma-sparing resection is most often performed in patients with impaired preoperative lung or cardiovascular function who would not be able to tolerate a pneumonectomy. METHODS Our experience on the ex situ reimplantation procedure and the outcome of patients with lung malignancies, who underwent upper or upper-middle lobectomy, with reimplantation of the lower lobe was reported. RESULTS We present 9 patients mean age 62.6+16.2 years (7 males/2 females) underwent ex situ reimplantation due to extensive lung tumor of upper lobes. The surgical technique precludes IV heparinization and then radical pneumonectomy. The entire lung was immersed in Ringer's solution (temperature 4 degrees centigrade) and bench surgery was performed. The involved upper (or upper-middle) lobes with involved lymph nodes were resected, thus leaving the healthy lower lobe of the lung. Pneumoplegia solution, named "Papworth pneumoplegia", was administered (1,473 mL) through catheterization of the pulmonary artery and vein stumps (ante grade and retrograde) along with 250 mL of prostaglandin E1. Re-implantation of the lower lobe was performed (I) on the right side, implantation involved the anastomosis of lower pulmonary vein in the site of the cuff of left atrium, followed by suturing the stump of the intermedius pulmonary artery to the right main pulmonary artery and finally the bronchial stumps-intermedius bronchus to the right main bronchus; (II) on the left side the pulmonary vein was anastomosed first, followed by the bronchial stumps and finally by the pulmonary artery. The graft ischemia time was 70.2+8.4 minutes ranged between 55 and 80 minutes. CONCLUSIONS Re-implantation or auto-transplantation should be considered as a safe option for the appropriate patient with lung cancer. The ex situ separation of the cancerous lobes is technically feasible and allows extensive pulmonary resection while minimizing the loss of pulmonary reserve. Based on our work, the major factors that play a role for the survival of initially resected and then re-implanted lung graft, are: (I) the ischemia time of the re-implanted lobe; (II) the proper use of pneumoplegia solutions, along with prostaglandin E1 and heparin; (III) the occurrence of pulmonary vein thrombosis; and (IV) the bronchial anastomosis.
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Emmanouilides C, Tryfon S, Baka S, Titopoulos H, Dager A, Filippou D. Operation for preservation of lung parenchyma in central lung cancer--in vivo and ex situ reimplantation techniques. Anticancer Res 2015; 35:1675-1681. [PMID: 25750327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
BACKGROUND/AIM Lobar reimplantation techniques enable the safe resection of lung cancer when pneumonectomy is not desirable or not feasible. We report our experience with this procedure. PATIENTS AND METHODS Patients with difficult to resect upper/middle lobe non-small cell lung cancer were included. In situ reimplantation technique requires the reanastomosis of the pulmonary vein of the healthy lower lobe to the upper lobe stump; bench surgery reimplantation involves the ex vivo surgical treatment of the whole excised lung and subsequent reimplantation of the healthy remnant. RESULTS Nine patients with upper-middle lobe lung cancer underwent in situ reimplantation, mean age=70.7±4.2 years; 6 patients underwent ex situ resection, mean age=64.3±18.4 years. One obese patient succumbed due to thrombosis of the anastomosed pulmonary vein. One patient developed a stroke. CONCLUSION The procedure was in general well-tolerated and enables for curative resection of otherwise unresectable lung cancer.
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Agrafiotis M, Tryfon S, Siopi D, Chassapidou G, Galanou A, Tsara V. Successful management of drug-induced hypercapnic acidosis with naloxone and noninvasive positive pressure ventilation. Am J Emerg Med 2014; 33:312.e3-4. [PMID: 25176564 DOI: 10.1016/j.ajem.2014.08.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 08/01/2014] [Indexed: 10/24/2022] Open
Abstract
A 74-year-old man was referred to our hospital due to deteriorating level of consciousness and desaturation. His Glasgow Coma Scale was 6, and his pupils were constricted but responded to light. Chest radiograph was negative for significant findings. Arterial blood gas evaluation on supplemental oxygen revealed severe acute on chronic respiratory acidosis: pH 7.15; PCO2, 133 mm Hg; PO2,64 mm Hg; and HCO3, 31 mmol/L. He regained full consciousness (Glasgow Coma Scale, 15) after receiving a 0.4 mg dose of naloxone, but because of persistent severe respiratory acidosis (pH 7.21; PCO2, 105 mm Hg), he was immediately commenced on noninvasive positive pressure ventilation (NIV) displaying a remarkable improvement in arterial blood gas values within the next few hours. However, in the days that followed, he remained dependent on NIV, and he was finally discharged on a home mechanical ventilation prescription. In cases of drug-induced respiratory depression, NIV should be regarded as an acceptable treatment, as it can provide ventilatory support without the increased risks associated with invasive mechanical ventilation.
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Angomachalelis I, Kyriazis G, Tryfon S, Angomachalelis N. Distinction of Cardiac From Pulmonary Dyspnea in Chronic Obstructive Pulmonary Disease and Coincident Atrial Fibrillation. Biomarker Serum Evaluation of Inflammation, Latent Ischemia, Dysfunction, Thrombogenesis, Apoptosis, and Cardiovascular Remodeling. Chest 2012. [DOI: 10.1378/chest.1389075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
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Tryfon S, Parisis V, Ioannis K, Saroglou M, Leonidas S, Despina D, Asterios K, Alexandros G. Excessive muscle paralysis due to pulmonary carcinoid -a case report. CLINICAL MEDICINE INSIGHTS-CASE REPORTS 2012; 5:43-8. [PMID: 22563250 PMCID: PMC3342021 DOI: 10.4137/ccrep.s9227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
We present the case of a 58-year-old woman with a renin secreting typical bronchopulmonary carcinoid. This patient showed hypotension, constipation and fatigue due to extensive hypokaliemia (K =1.9 meq/L). Aldosterone (102.7 ng/100 mL) and renin (46 ng/mL) were excessively elevated at that time, but cortisol level was normal. Routine chest roentgenography and computed tomography revealed a nodular lesion in the upper left lung lobe, which was suspicious for a neurosecretory pulmonary tumor. The final diagnosis was made by using bronchoscopic procedures and the histologically diagnosis was compatible as a typical pulmonary carcinoid. The tumor was resected curatively, and the renin and aldosterone level became normal. A year after the patient looks healthy.
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Zarogoulidis P, Porpodis K, Konoglou M, Saroglou M, Mitrakas A, Matthaios D, Touzopoulos P, Archontogeorgis K, Koulelidis A, Zarogoulidis K, Tryfon S. Serratia pneumonia presenting as hemoptysis in a patient with sarcoidosis: a case report. Int J Gen Med 2011; 4:661-4. [PMID: 21941452 PMCID: PMC3177592 DOI: 10.2147/ijgm.s24706] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Serratia marcescens is a Gram-negative bacillus which belongs to the family Enterobacteriaceae. It is a facultative anaerobe and produces red pigment at room temperature. It naturally occurs in soil and water as well as the intestines, and it is responsible for nosocomial infections. There have been few reports about community acquired pneumonia of Serratia. Case presentation This report presents a 37-year-old man with hemoptysis, fever, and shortness of breath. The clinical and laboratory examinations revealed that the patient had pseudohemoptysis due to S. marcescens pneumonia, on an immunocompromised pattern, because of the coexistence of sarcoidosis (stage 1). Conclusion Appropriate antibiotic therapy for Serratia was administered, and the patient’s symptoms regressed. The patient is healthy and asymptomatic after 1-year follow-up. To the best of the authors’ knowledge, this is the first reported case of a pseudohemoptysis in a patient with pulmonary sarcoidosis.
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Papakosta D, Pitsiou G, Daniil Z, Dimadi M, Stagaki E, Rapti A, Antoniou K, Tzouvelekis A, Kontakiotis T, Tryfon S, Polychronopoulos V, Bouros D. Prevalence of pulmonary hypertension in patients with idiopathic pulmonary fibrosis: correlation with physiological parameters. Lung 2011; 189:391-9. [PMID: 21660584 DOI: 10.1007/s00408-011-9304-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2011] [Accepted: 05/20/2011] [Indexed: 10/18/2022]
Abstract
The aim of this study was to prospectively evaluate the prevalence of pulmonary hypertension (PH) in patients with idiopathic pulmonary fibrosis (IPF). One hundred thirty-nine patients (101 male, mean age = 68.6 ± 9 years), with confirmed IPF and who were admitted to eight Pulmonary Departments in Greece between November 2005 and December 2006 were included in the study. Pulmonary artery systolic pressure (PASP) was estimated by echocardiography, and PH was defined as PASP > 36 mmHg. We compared demographics, pulmonary function tests, NYHA functional status, 6-min walk distance (6MWD), B-type natriuretic peptide (BNP), PaO(2), and P(A-a)O(2) at rest data between patients with PH and without PH (PASP ≤ 36 mmHg). Increased estimated right ventricular systolic pressure was present in 55% of patients (mean PASP = 47.1 ± 11.2 mmHg vs. 30.3 ± 3.8 mmHg, respectively). Patients with PH had a lower but not statistically significant DL(CO) (47.1 ± 18.8 vs. 52.5 ± 20.1), lower PaO(2) at rest (64.6 ± 12.2 vs. 71.1 ± 11.3, P = 0.004), and lower mean 6MWD (282 ± 118 vs. 338 ± 91, P = 0.007). Significant differences were also observed in the NYHA functional status between the two groups (P = 0.02). Statistically significant correlations were observed between PASP and PaO(2) at rest (r = -0.331, P = 0.00), P(A-a)O(2) at rest (r = 0.494, P = 0.00)(,) 6MWD (r = -0.264, P = 0.01), SpO(2) at rest (r = -0.293, P = 0.00), SpO(2) at the end of exercise (r = -0.364, P = 0.00), and also BNP values (r = 0.319, P = 0.01). Moreover, PaO(2) (P = 0.02), P(A-a)O(2) (P = 0.005), and SpO(2) at the end of exercise (P = 0.023) were independent predictors of the presence of estimated PH. Using Doppler echocardiography as a screening tool for the estimation of PH, we found that PH is common in patients with IPF. Gas exchange parameters at rest and exercise desaturation might indicate underlying PH in IPF.
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Saroglou M, Tryfon S, Ismailos G, Liapakis I, Tzatzarakis M, Tsatsakis A, Papalois A, Bouros D. Pharmacokinetics of Linezolid and Ertapenem in experimental parapneumonic pleural effusion. JOURNAL OF INFLAMMATION-LONDON 2010; 7:22. [PMID: 20482752 PMCID: PMC2890630 DOI: 10.1186/1476-9255-7-22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2009] [Accepted: 05/18/2010] [Indexed: 11/11/2022]
Abstract
Objective To determine the extent of linezolid and ertapenem penetration into the empyemic fluid using a rabbit model of empyema. Methods An empyema was created via the intrapleural injection of Escherichia coli bacteria (ATCC 35218) into the pleural space of New Zealand white rabbits. After an empyema was verified by thoracocentesis, 24 hours post inoculation, linezolid (10 mg/kg) and ertapenem (60 mg/kg) were administered intravenously into 10 and 8 infected empyemic rabbits, respectively. Antibiotic levels were determined in samples of pleural fluid and blood serum, collected serially at 1, 2, 4, 6 and 8 hours, after administration each of the two antibiotics. Results Linezolid as well as ertapenem penetrate well into the empyemic pleural fluid, exhibiting a slower onset and decline compared to the corresponding blood serum levels. Equilibration between blood serum and pleural fluid compartments seems to occur at 1.5 hours for both linezolid and ertapenem, with peak pleural fluid levels (Cmaxpf of 2.02 ± 0.73 «mu»g/ml and Cmaxpf of 3.74 ± 1.39 «mu»g/ml, correspondingly) occurring 2 hours post antibiotics administration and decreasing very slowly thereafter. The serum concentrations for both antibiotics were significantly lower from the corresponding pleural fluid ones during the 8 hours collecting data, with the exception of samples collected at the 1st hour (Cmaxserum of 2.1 ± 1.2 «mu»g/ml for linezolid and Cmaxserum of 6.26 ± 2.98 «mu»g/ml for ertapenem). Conclusion Pleural fluid levels of both antibiotics are inhibitory for common specified pathogens causing empyema.
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Boutou AK, Abatzidou F, Tryfon S, Nakou C, Pitsiou G, Argyropoulou P, Stanopoulos I. Diagnostic accuracy of the rapid shallow breathing index to predict a successful spontaneous breathing trial outcome in mechanically ventilated patients with chronic obstructive pulmonary disease. Heart Lung 2010; 40:105-10. [PMID: 20561873 DOI: 10.1016/j.hrtlng.2010.02.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2008] [Revised: 01/09/2010] [Accepted: 02/09/2010] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To evaluate the diagnostic accuracy of 2 threshold values (105 breaths per minute [bpm]/L and 130 bpm/L) of the rapid shallow breathing index (RSBI) to predict a successful weaning trial outcome in a homogenous group of patients with chronic obstructive pulmonary disease (COPD). METHODS A consecutive population of patients with COPD who were intubated for hypercapnic respiratory failure during a 2-year period were studied prospectively. RSBI was measured by 2 investigators at minute 5 of the T-piece trial, whereas 2 other physicians evaluated the 30 minute T-piece trial as successful or unsuccessful, according to clinical criteria. RESULTS Of 64 patients with COPD (53 male, 11 female) who constituted the study population, 42 patients (35 male, 7 female; aged 70 ± 9.2 years) completed the spontaneous breathing trial (SBT) and remained clinically stable (group 1). The remaining 22 patients (18 male, 4 female; aged 71.9 ± 4.7 years) had to return to ventilatory support by the end of the SBT because of clinical deterioration (group 2). The 2 threshold values that were evaluated had low specificity (38.1% for < 105 bpm/L and 66.7% for < 130 bpm/L), low sensitivity (63.6% for < 105 bpm/L and 54.5% for < 130 bpm/L), and low diagnostic accuracy (46.8% for < 105 bpm/L and 65.6% for < 130 bpm/L) in predicting a successful T-piece trial outcome. CONCLUSION RSBI measured early during an SBT cannot accurately predict the successful outcome of a T-piece trial in a homogenous population of patients with COPD.
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