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Sonaglioni A, Caminati A, Grasso E, Colleoni M, Nicolosi GL, Lombardo M, Harari S. TAPSE/SPAP ratio stratifies mortality risk in mild-to-moderate idiopathic pulmonary fibrosis. Int J Tuberc Lung Dis 2024; 28:183-188. [PMID: 38563341 DOI: 10.5588/ijtld.23.0474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2024] Open
Abstract
BACKGROUND: Due to paucity of literature data, we aimed at evaluating the prognostic role of the ratio of tricuspid annular plane systolic excursion (TAPSE) to systolic pulmonary artery pressure (SPAP) in idiopathic pulmonary fibrosis (IPF) patients without severe pulmonary hypertension and at assessing its correlation with effective arterial elastance index (EaI). METHODS: Multi-instrumental data obtained in 60 IPF patients (73.2 ± 6.8 years) and 60 matched controls were retrospectively analysed. Primary endpoint was all-cause mortality, while secondary endpoint was the composite of all-cause mortality and re-hospitalisations for all-causes over medium-term follow-up. RESULTS: ;At baseline, TAPSE/SPAP was significantly lower in patients with IPF than in controls (0.36 ± 0.25 vs. 0.77 ± 0.18 mm/mmHg; P < 0.001). TAPSE/SPAP was inversely correlated with EaI (r = -0.96) in IPF patients. During follow-up (3.5 ± 1.5 years), 21 patients died and 25 were re-hospitalised due to cardiopulmonary causes. TAPSE/SPAP was independently associated with both primary (HR 0.79, 95%CI 0.65-0.97) and secondary (HR 0.94, 95%CI 0.92-0.97) endpoints. A TAPSE/SPAP ratio of <0.20 and <0.44 mm/mmHg showed the greatest sensitivity and specificity for predicting primary (AUC 0.98) and secondary (AUC 0.99) endpoints, respectively. CONCLUSIONS: TAPSE/SPAP is a strong predictor of adverse outcomes in mild-to-moderate IPF. The strong correlation between TAPSE/SPAP and EaI might be an expression of a systemic fibrotic process which involves the heart, lungs and circulation.
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Affiliation(s)
- A Sonaglioni
- Division of Cardiology, MultiMedica IRCCS, Milan, Italy
| | - A Caminati
- Division of Pneumology, Semi-Intensive Care Unit, MultiMedica IRCCS, Milan, Italy
| | - E Grasso
- Division of Cardiology, MultiMedica IRCCS, Milan, Italy
| | - M Colleoni
- Division of Pneumology, Semi-Intensive Care Unit, MultiMedica IRCCS, Milan, Italy
| | - G L Nicolosi
- Division of Cardiology, Policlinico San Giorgio, Pordenone, Italy
| | - M Lombardo
- Division of Cardiology, MultiMedica IRCCS, Milan, Italy
| | - S Harari
- Division of Pneumology, Semi-Intensive Care Unit, MultiMedica IRCCS, Milan, Italy
- Department of Clinical Sciences and Community Health, Università di Milano, Milan, Italy
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Harari S, Annesi-Maesano I. The war in Ukraine is an environmental catastrophe. Int J Tuberc Lung Dis 2023; 27:94-95. [PMID: 36853110 DOI: 10.5588/ijtld.22.0603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Affiliation(s)
- S Harari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy, Unità operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, MultiMedica IRCCS, Milan, Italy
| | - I Annesi-Maesano
- Unità operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, MultiMedica IRCCS, Milan, Italy
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3
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Affiliation(s)
- S Harari
- Department of Clinical Sciences and Community Health, University of Milan and Department of Medicine, IRCCS Ospedale San Giuseppe MultiMedica, Milan, Italy
| | | | | | - P M Mannucci
- Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Angelo Bianchi Bonomi Hemophilia and Thrombosis Center, Milan, Italy.
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Orlandi M, Landini N, Sambataro G, Nardi C, Bruni C, Bellando-Randone S, Denton C, Luppi F, Ruaro B, Tomassetti S, Cavigli E, Melchiorre F, Palmucci S, Guiducci S, Moggi Pignone A, Allanore Y, Bartoloni A, Confalonieri M, Cortese G, Dagna L, De Cobelli F, De Paulis A, Harari S, Khanna D, Kuwana M, Miele V, Taliani G, Hughes M, Vanchieri C, Colagrande S, Matucci-Cerinic M. POS1228 THE ROLE OF CHEST CT IN UNDERSTANDING INTERSTITIAL LUNG DISEASE (ILD): SYSTEMIC SCLEROSIS (SSc). VERSUS COVID-19. Ann Rheum Dis 2021. [DOI: 10.1136/annrheumdis-2021-eular.2967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:COVID-19 pandemic is a global emergency which may overlap on the clinical and radiological scenario of ILD in SSc. In clinical practice, the striking similarities observed at computed tomography (CT) between the diseases make it difficult to distinguish a COVID-19 superinfection from a progression of SSc-ILD.Objectives:The aim of our study was to identify the main CT features that may help distinguishing SSc-ILD from COVID-19 pneumonia.Methods:22 international readers were included and divided in the radiologist group (RAD) and non-radiologist group (nRAD). The RAD group included non-chest RAD and chest-RAD. A total of 99 patients, 52 with COVID-19 and 47 with SSc-ILD, were included in the study.Results:Fibrosis inside focal ground glass opacities (GGO) in the upper lobes; fibrosis in the lower lobe GGO; reticulations in lower lobes (especially if bilateral and symmetrical or associated with signs of fibrosis) were the CT parameters most frequently associated with SSc-ILD. The CT parameters most frequently associated with COVID- 19 pneumonia were: consolidation (CONS) in the lower lobes, CONS with peripheral (both central/peripheral or patchy distributions), anterior and posterior CONS and rounded-shaped GGOs in the lower lobes. After multivariate analysis, the presence of CONS in the lower lobes (p <0.0001) and signs of fibrosis in GGO in the lower lobes (p <0.0001) remained independently associated with COVID-19 pneumonia or SSc-ILD, respectively. These two variables were combined in a predictive score which resulted positively associated with the COVID-19 diagnosis, with 96.1% sensitivity and 83.3% specificity: 3 different risk class for COVID-19 pneumonia may be identified: high risk for COVID-19 pneumonia (5-9 points); probable overlap COVID-19 pneumonia in SSc-ILD (4 points); low risk for COVID-19 pneumonia (0-3 points).Conclusion:The CT differential diagnosis between COVID-19 Pneumonia and SSc-ILD is possible and may be fostered in practice by the use of a radiological score. In the case where an overlap of both diseases is suspected, the presence of consolidation in the lower lobes may suggest a COVID-19 pneumonia while the presence of fibrosis inside GGO may indicate a SSc-ILD.References:[1]Orlandi M, Landini N, Bruni C, et al. Infection or autoimmunity? The clinical challenge of interstitial lung disease in systemic sclerosis during COVID 19 pandemic. J Rheumatol. 2020 Dec 1: jrheum.200832[2]Simpson S, Kay FU, Abbara S, et al. Radiological Society of North America Expert Consensus Statement on Reporting Chest CT Findings Related to COVID-19. Endorsed by the Society of Thoracic Radiology, the American College of Radiology, and RSNA [published online ahead of print, 2020 Apr 28]. J Thorac Imaging. 2020;10.1097/RTI.0000000000000524.[3]Cheng C, Li C, Zhao T, et al. COVID-19 with rheumatic diseases: a report of 5 cases. Clin Rheumatol. 2020;39(7):2025-2029.[4]Mariano RZ, Rio APTD, Reis F. Covid-19 overlapping with systemic sclerosis. Rev Soc Bras Med Trop. 2020 Sep 21;53:e20200450.Disclosure of Interests:None declared
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Romiti GF, Corica B, Pipitone E, Vitolo M, Raparelli V, Basili S, Boriani G, Harari S, Lip GYH, Proietti M. Prevalence, management and impact of chronic obstructive pulmonary disease in atrial fibrillation: a systematic review and meta-analysis of 4,200,000 patients. Europace 2021. [DOI: 10.1093/europace/euab116.143] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
OnBehalf
AF-COMET Collaborative Group
Background
Multimorbidity is a major concern in patients with atrial fibrillation (AF). Among other diseases, the prevalence of chronic obstructive pulmonary disease (COPD) in these patients is unclear, and its association with adverse outcomes is often overlooked. Moreover, uncertainties on the treatment of patients with both AF and COPD still exist, and may lead to undertreatment.
Purpose
The aim of this study is to estimate the prevalence of COPD, and its impact on management and outcomes in patients with AF.
Methods
A systematic review and meta-analysis was conducted according to PRISMA guidelines. All studies reporting the prevalence of COPD in AF patients were included and pooled. Data on comorbidities, beta-blockers (BBs) and oral anticoagulant (OAC) prescription, and outcomes (all-cause death, cardiovascular death, ischemic stroke, major bleeding) were pooled and compared according to COPD status; the impact of BBs on outcomes in patients with COPD was also investigated. All analyses were performed using random-effect models; subgroup analysis and meta-regressions were also performed to account for heterogeneity.
Results
Among 46 studies, the pooled prevalence of COPD was 13% (95% Confidence Intervals (CI): 10-16%), with high heterogeneity between studies; significant differences were found according to geographical locations and definition of COPD. A multivariable meta-regression model which included age, female sex, history of hypertension, diabetes and chronic heart failure (CHF) was able to explain a significant proportion of the heterogeneity (R2 = 69.8%). COPD was associated with a higher prevalence of diabetes, coronary artery disease, CHF and stroke (Fig. 1, panel A), as well as higher CHA2DS2-VASc scores and age (Fig. 1, panel B), and lower probability of BB prescription (Odds Ratio (OR): 0.77, 95%CI: 0.61-0.98). Patients with COPD showed higher risk of all-cause death (OR: 2.22, 95%CI: 1.93-2.55), cardiovascular death (OR: 1.84, 95%CI: 1.39-2.43) and major bleeding (OR: 1.45, 95%CI: 1.17-1.80) (Fig.1, Panel C); no significant differences in outcomes were observed according to BBs use in AF patients with COPD (Fig. 1, panel D).
Conclusion
COPD is common in AF, being found in 1 every 8 patients, and is associated with an increased burden of comorbidities, differential management and worse outcomes, with more than two-fold higher risk of all-cause death and increased risk of CV death and major bleeding. Therapy with BBs does not increase the risk of adverse outcomes in these patients. Abstract Figure.
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Affiliation(s)
- GF Romiti
- Sapienza University of Rome, Department of Translational and Precision Medicine, Rome, Italy
| | - B Corica
- Sapienza University of Rome, Department of Translational and Precision Medicine, Rome, Italy
| | - E Pipitone
- Ospedale Regionale “Beata Vergine”, Mendrisio, Switzerland
| | - M Vitolo
- University of Modena & Reggio Emilia, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - V Raparelli
- University of Ferrara, Department of Translational Medicine, Ferrara, Italy
| | - S Basili
- Sapienza University of Rome, Department of Translational and Precision Medicine, Rome, Italy
| | - G Boriani
- University of Modena & Reggio Emilia, Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Modena, Italy
| | - S Harari
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
| | - GYH Lip
- University of Liverpool, Liverpool Centre for Cardiovascular Sciences, Liverpool, United Kingdom of Great Britain & Northern Ireland
| | - M Proietti
- University of Milan, Department of Clinical Sciences and Community Health, Milan, Italy
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Poletti V, Vancheri C, Albera C, Harari S, Pesci A, Metella RR, Campolo B, Crespi G, Rizzoli S. Clinical course of IPF in Italian patients during 12 months of observation: results from the FIBRONET observational study. Respir Res 2021; 22:66. [PMID: 33627105 PMCID: PMC7903602 DOI: 10.1186/s12931-021-01643-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 01/29/2021] [Indexed: 01/20/2023] Open
Abstract
Background FIBRONET was an observational, multicentre, prospective cohort study investigating the baseline characteristics, clinical course of disease and use of antifibrotic treatment in Italian patients with idiopathic pulmonary fibrosis (IPF).
Methods Patients aged ≥ 40 years diagnosed with IPF within the previous 3 months at 20 Italian centres were consecutively enrolled and followed up for 12 months, with evaluations at 3, 6, 9 and 12 months. The primary objective was to describe the clinical course of IPF over 12 months of follow-up, including changes in lung function measured by % predicted forced vital capacity (FVC% predicted). Results 209 patients (82.3% male, mean age 69.54 ± 7.43 years) were enrolled. Mean FVC% predicted was relatively preserved at baseline (80.01%). The mean time between IPF diagnosis and initiation of antifibrotic therapy was 6.38 weeks; 72.3% of patients received antifibrotic therapy within the first 3 months of follow-up, and 83.9% within 12 months of follow-up. Mean FVC% predicted was 80.0% at baseline and 82.2% at 12 months, and 47.4% of patients remained stable (i.e. had no disease progression) in terms of FVC% predicted during the study. Conclusions FIBRONET is the first prospective, real-life, observational study of patients with IPF in Italy. The short time between diagnosis and initiation of antifibrotic therapy, and the stable lung function between baseline and 12 months, suggest that early diagnosis and prompt initiation of antifibrotic therapy may preserve lung function in patients with IPF. Trial registration: NCT02803580
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Affiliation(s)
- V Poletti
- Department of Diseases of the Thorax, Ospedale GB Morgagni, Forlì, Italy.,Department of Respiratory Diseases & Allergy, Aarhus University Hospital, Aarhus, Denmark
| | - C Vancheri
- Regional Referral Centre for Rare Lung Diseases-University Hospital "Policlinico G. Rodolico", Department of Clinical and Experimental Medicine, University of Catania, Catania, Italy.
| | - C Albera
- S.C. Pneumologia U., A.O.U. Città Della Scienza E Della Salute (Molinette), University of Torino, Torino, Italy
| | - S Harari
- Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.,Department of Medicine, Ospedale San Giuseppe MultiMedica IRCCS, Milan, Italy
| | - A Pesci
- Ospedale San Gerardo, ASST Monza, Monza, Italy
| | - R R Metella
- Dipartimento di Scienze Mediche Chirurgiche e Neuroscienze, Università degli Studi di Siena, Siena, Italy
| | | | - G Crespi
- Boehringer Ingelheim, Milan, Italy
| | - S Rizzoli
- MediNeos Observational Research, Modena, Italy
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Carlicchi E, Caminati A, Fughelli P, Pelosi G, Harari S, Zompatori M. High-resolution CT in smoking-related interstitial lung diseases. Int J Tuberc Lung Dis 2021; 25:106-112. [PMID: 33656421 DOI: 10.5588/ijtld.20.0622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
In addition to chronic obstructive pulmonary disease (COPD) and bronchogenic carcinoma, smoking can also cause interstitial lung diseases (ILDs) such as respiratory bronchiolitis (RB), RB with ILD (RB-ILD), desquamative interstitial pneumonia (DIP), Langerhans cell granulomatosis (LCG) and idiopathic pulmonary fibrosis-usual interstitial pneumonia (IPF-UIP). However, smoking seems to have a protective effect against hypersensitivity pneumonitis (HP), sarcoidosis and organising pneumonia (OP). High-resolution computed tomography (HRCT) has a pivotal role in the differential diagnosis. RB is extremely frequent in smokers, and is considered a marker for smoking exposure. It has no clinical relevance in itself since most patients with RB are asymptomatic. It is frequent to observe the association of RB with other smoking-related diseases, such as LCG or pulmonary neoplasms. In RB-ILD, HRCT features are more conspicuous and diffuse than in RB, but there is no definite cut-off between the two entities and any distinction can only be made by integrating imaging and clinical data. RB, RB-ILD and DIP may represent different degrees of the same pathological process, consisting in a bronchiolar and alveolar inflammatory reaction to smoking. Smoking is also a well-known risk factor for pulmonary fibrosis. Multidisciplinary discussion and follow-up can generally solve even the most difficult cases.
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Affiliation(s)
- E Carlicchi
- Postgraduated School in Radiodiagnostic, Università degli Studi di Milano, Milan
| | - A Caminati
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare. Ospedale San Giuseppe, MultiMedica Istituto di Ricovero e Cura a Carattere scientifico (IRCCS), Milan
| | - P Fughelli
- Alma Mater Studiorum, Università di Bologna, Bologna
| | - G Pelosi
- Servizio Interaziendale di Anatomia Patologica, Polo Scientifico e Tecnologico, IRCCS MultiMedica, Milan, Dipartimento di Oncologia ed Onco-ematologia, Università degli Studi di Milano, Milan
| | - S Harari
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare. Ospedale San Giuseppe, MultiMedica Istituto di Ricovero e Cura a Carattere scientifico (IRCCS), Milan, Department of Medical Sciences, San Giuseppe Hospital MultiMedica IRCCS and Community Health, Università degli Studi di Milano, Milan
| | - M Zompatori
- Diagnostica per Immagini, Ospedale San Giuseppe, IRCCS Multimedica, Milan, Italy
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Carlicchi E, Harari S, Caminati A, Fughelli P, Zompatori M. Radiological diagnosis of fibrosing interstitial lung diseases: innovations and controversies. Int J Tuberc Lung Dis 2020; 24:1156-1164. [PMID: 33172523 DOI: 10.5588/ijtld.19.0743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Following the introduction of new effective antifibrotic drugs, interest in fibrosing interstitial lung diseases (FILD) has been renewed. In this context, radiological evaluation of FILD plays a cardinal role. Radiological diagnosis is possible in about 50% of the cases, which allows the initiation of effective therapy, thereby avoiding invasive procedures such as surgical lung biopsy. Usual interstitial pneumonia (UIP) pattern may be diagnosed based on clinical, radiological, and pathological data. High-resolution computed tomography features of UIP have been widely described in literature; however, interpreting them remains challenging, even with specific expertise on the subject. Diagnostic difficulties are understandable given the continuous evolution of FILD classifications and their complexity. Both early-stage diseases and advanced or combined patterns are not easily classifiable, and many end up being labelled 'indeterminate´ or 'unclassifiable´. Especially in these cases, optimal patient management involves collaboration and communication between different specialists. Here, we discuss the most critical aspects of radiological interpretation in FILD diagnosis based on the most recent classifications. We believe that the clinicians´ awareness of radiological diagnostic issues of FILD would improve comprehension and dialogue between physicians and radiologists, leading to better clinical practice.
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Affiliation(s)
- E Carlicchi
- Postgraduated School in Radiodiagnostic, Università degli Studi di Milano, Milan
| | - S Harari
- Pneumologia, Ospedale San Giuseppe, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, Milan
| | - A Caminati
- Pneumologia, Ospedale San Giuseppe, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Multimedica, Milan
| | - P Fughelli
- Alma Mater Studiorum, Università di Bologna, Bologna
| | - M Zompatori
- Diagnostica per Immagini, Ospedale San Giuseppe, IRCCS Multimedica, Milan, Italy
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Cassandro R, Harari S, Caminati A, Elia D, Specchia C. BASELINE CHARACTERISTICS OF ALL PATIENTS ENROLLED IN A PHASE II CLINICAL TRIAL ASSESSING THE EFFICACY AND SAFETY OF NINTEDANIB IN LYMPHANGIOLEIOMYOMATOSIS. Chest 2020. [DOI: 10.1016/j.chest.2020.05.181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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Affiliation(s)
- S Harari
- Dept of Medical Sciences San Giuseppe Hospital MultiMedica IRCCS and Dept of Clinical Sciences and Community Health, Università degli Studi di Milano, Via San Vittore 12, 20123 Milan, Italy.
| | - M Vitacca
- ICS Maugeri IRCCS, Respiratory Rehabilitation Unit Lumezzane, Brescia, Italy
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Cerrina J, Le Roy Ladurie F, Herve PH, Parquin F, Harari S, Chapelier A, Simoneau G, Vouhe P, Dartevelle PH. Role of CMV pneumonia in the development of obliterative bronchiolitis in heart-lung and double-lung transplant recipients. Transpl Int 2018. [DOI: 10.1111/tri.1992.5.s1.242] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Montefusco L, Harari S, Elia D, Rossi A, Specchia C, Torre O, Adda G, Arosio M. Endocrine and metabolic assessment in adults with Langerhans cell histiocytosis. Eur J Intern Med 2018; 51:61-67. [PMID: 29198444 DOI: 10.1016/j.ejim.2017.11.011] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 11/26/2017] [Accepted: 11/27/2017] [Indexed: 12/22/2022]
Abstract
CONTEXT Diabetes insipidus (DI) is one of most common complications of Langerhans cell histiocytosis (LCH) but prevalence of anterior pituitary deficiencies and metabolic alterations have not been clearly defined yet. OBJECTIVES Evaluate prevalence of endocrine and metabolic manifestations in a cohort of patients affected by Pulmonary LCH. METHODS Observational cross-sectional study on 18 adults (7 M/11 F, 42±12years) studied for complete basal and dynamic endocrine lab tests and glucose metabolism. RESULTS Hypothalamic-pituitary endocrine alterations were found in 9 patients: 9 had DI, 5 Growth Hormone Deficiency (GHD), 5 central hypogonadism, 3 central hypothyroidism and 1 central hypoadrenalism. Hyperprolactinemia and hypothalamic syndrome were found in 2 patients each. All these central endocrine alterations were always associated to DI. Five of the 10 MRI performed showed abnormalities. Prevalence of obesity and glucose alterations (either DM or IFG/IGT) were respectively 39% and 33%, higher than expected basing on epidemiological data on general Italian population. Multi-system-LCH without risk-organ involvement (LCH MS-RO-) seems to have slightly higher prevalence of insulin resistance, glucose alterations and metabolic syndrome than LCH with isolated lung involvement (LCH SS lung+). A papillary BRAFV600E positive thyroid carcinoma was diagnosed in one patient. CONCLUSIONS The presence of anterior pituitary deficiencies should be systematically sought in all LCH patients with DI both at diagnosis and during the follow-up by basal and dynamic hormonal assessment. Patients with pulmonary LCH, particularly those with MS disease, have a worse metabolic profile than general population. Occurrence of papillary thyroid carcinoma has been reported.
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Affiliation(s)
- L Montefusco
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - S Harari
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy.
| | - D Elia
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy
| | - A Rossi
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - C Specchia
- MultiMedica IRCCS, Milan, Italy; Dipartimento di Medicina Molecolare e Traslazionale, Università di Brescia, Italy
| | - O Torre
- MultiMedica IRCCS, Milan, Italy; U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria - Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe Multimedica, Milan, Italy
| | - G Adda
- U.O. di Malattie Endocrine e Diabetologia, Ospedale San Giuseppe Multimedica, Milan, Italy; MultiMedica IRCCS, Milan, Italy
| | - M Arosio
- U.O. di Endocrinologia, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Dipartimento di Scienze Cliniche e di Comunità, Università di Milano, Milan, Italy
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Abstract
The goal of this pilot study was to verify the efficacy of the association of cisplatin plus radiotherapy in the treatment of lung cancer. Thirty-seven consecutive patients entered the study. They were treated with radiotherapy (four weekly doses of 2.5 Gy for a total of 50 Gy) and cisplatin once weekly (12 mg/m2). Partial remission was obtained in 15 patients, and 1 patient had a complete remission. Three patients previously inoperable underwent surgical treatment. The actuarial survival curve of the 29 evaluable patients showed a mean survival of 8.5 months. The mean survival of the latter is not evaluable because half of the patients are still alive after 12 to 30 months. No hematologic or renal toxicity was observed with the above schedule.
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Affiliation(s)
- E Soresi
- Divisione Pneumologica, Ospedale Niguarda, Milano, Italy
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Abstract
Idiopathic pulmonary fibrosis (IPF) is a devastating progressive disease associated with a high mortality rate. Novel antifibrotic therapies have been recently demonstrated to slow disease progression and improve survival. However, the management of IPF remains a difficult challenge, since lung complications can still occur, particularly in patients with advanced-stage disease. This paper highlights the most common complications and difficult tasks related to severe IPF such as acute exacerbation of the disease, development of lung cancer, rapid disease progression, and indication for lung transplantation.
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Affiliation(s)
- R Lipsi
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy
| | - D Mazzola
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy
| | - A Caminati
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy
| | - D Elia
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy
| | - C Lonati
- U.O. di Medicina Generale, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy
| | - S Harari
- U.O. di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy; U.O. di Medicina Generale, Ospedale San Giuseppe-MultiMedica IRCCS, Via San Vittore, 12, 20123 Milan, Italy.
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Conti S, Madotto F, Caminati A, Cesana G, Harari S. Epidemiology and clinical course of idiopathic pulmonary fibrosis in Northern Italy, in 2005–2010. Eur J Public Health 2015. [DOI: 10.1093/eurpub/ckv175.116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Harari S, Humbert M, Cottin V. Future perspectives on rare pulmonary diseases and rare presentations of common disorders. Eur Respir Rev 2013; 22:199-201. [DOI: 10.1183/09059180.00004613] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Cottin V, Harari S, Jais X, Mal H, Reynaud-Gaubert M, Prévot G, Lazor R, Taillé C, Zeghmar S, Dorfmüller P, Simonneau G, Humbert H, Cordier JF. Hypertension pulmonaire au cours de la lymphangioléiomyomatose : caractéristiques hémodynamiques et pronostic. Rev Mal Respir 2012. [DOI: 10.1016/j.rmr.2011.10.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Harari S. Drug-induced and Iatrogenic Respiratory Disease. Eur Respir Rev 2011. [DOI: 10.1183/09059180.10021411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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Abstract
Lymphangioleiomyomatosis (LAM) is a rare disease characterised by proliferation of abnormal smooth muscle-like cells (LAM cells) leading to progressive cystic destruction of the lung, lymphatic abnormalities and abdominal tumours. It affects predominantly females and can occur sporadically or in patients with tuberous sclerosis complex. This review describes the recent progress in our understanding of the molecular pathogenesis of the disease and LAM cell biology. It also summarises current therapeutic approaches and the most promising areas of research for future therapeutic strategies.
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Affiliation(s)
- S. Harari
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria – Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare Ospedale San Giuseppe, Milan, Italy. Translational Medicine Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA.,S. Harari, Unità di Pneumologia e Terapia Semi-Intensiva Respiratoria, Ospedale San Giuseppe, via San Vittore 12, 20123 Milan, Italy. E-mail:
| | - O. Torre
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria – Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare Ospedale San Giuseppe, Milan, Italy. Translational Medicine Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
| | - J. Moss
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria – Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare Ospedale San Giuseppe, Milan, Italy. Translational Medicine Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD, USA
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Affiliation(s)
- S Harari
- Unità Operativa di Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare Ospedale San Giuseppe, Via San Vittore 12, Milan, Italy.
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Caminati A, Graziano P, Sverzellati N, Harari S. Smoking-related interstitial lung diseases. Pathologica 2010; 102:525-536. [PMID: 21428116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
In pulmonary pathology, a wide spectrum of morphological changes is related to the consequences of smoking, and recognizing them on surgical specimens and on small transbronchial biopsies represents a challenge for the pathologist. Respiratory bronchiolitis, also referred to as smoker's bronchiolitis, is a common histologic feature found in the lung tissue of cigarette smokers. When identified as the sole histopathologic finding in the clinical setting of symptomatic interstitial lung disease, a diagnosis of respiratory bronchiolitis-interstitial lung disease is made. Since smoking is recognized to cause a variety of histologic patterns encompassing respiratory bronchiolitis, respiratory bronchiolitis-interstitial lung disease, desquamative interstitial pneumonia and pulmonary Langerhans cell hystiocytosis, smoking-related interstitial lung disease may be a useful concept to keep in mind for the pathologists. The relationship of smoking with each of these entities has been largely established on the basis of epidemiologic evidence. Although they have been retained as distinct and separate conditions in various classifications of interstitial lung diseases, these entities share a number of clinical, radiologic, and pathologic features suggesting that they represent a spectrum of patterns of interstitial lung disease occurring in predisposed individuals who smoke. Evaluation of histologic features, particularly in surgical lung biopsy samples, is important in making the distinction between these disorders. However, even after tissue biopsy, it may sometimes be difficult to clearly separate these entities. Recently, respiratory bronchiolitis-interstitial lung disease with fibrosis has been described and postulated that this is a smoking-related condition distinct from fibrotic non-specific interstitial pneumonia.
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Affiliation(s)
- A Caminati
- U.O. Pneumologia e Terapia Semi-Intensiva Respiratoria, Servizio di Fisiopatologia Respiratoria ed Emodinamica Polmonare, Ospedale San Giuseppe - Fatebenefratelli Milano, Italy
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Abstract
Recent years have seen a robust influx of exciting new observations regarding the mechanisms that regulate the initiation and progression of pulmonary fibrosis but the pathogenesis remains poorly understood. The search for an alternative hypothesis to unremitting, chronic inflammation as the primary explanation for the pathophysiology of idiopathic pulmonary fibrosis (IPF) derives, in part, from the lack of therapeutic efficacy of high-dose immunosuppressive therapy in patients with IPF. The inflammatory hypothesis of IPF has since been challenged by the epithelial injury hypothesis, in which fibrosis is believed to result from epithelial injury, activation, and/or apoptosis with abnormal wound healing. This hypothesis suggests that recurrent unknown injury to distal pulmonary parenchyma causes repeated epithelial injury and apoptosis. The resultant loss of alveolar epithelium exposes the underlying basement membrane to oxidative damage and degradation. Emerging concepts suggest that IPF is the result of epithelial-mesenchymal interaction. The initiation of this fibrotic response may depend upon genetic factors and environmental triggers; the role of Th1 or Th2 cell-derived cytokines may also be important. This process appears to be unique to usual interstitial pneumonia/IPF. It is clear that IPF is a heterogeneous disease with variations in pathology, high-resolution computed tomography findings, and patterns of progression. Idiopathic pulmonary fibrosis is a complex disorder, and no unifying hypothesis has been identified at present that explains all the abnormalities.
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Johnson SR, Cordier JF, Lazor R, Cottin V, Costabel U, Harari S, Reynaud-Gaubert M, Boehler A, Brauner M, Popper H, Bonetti F, Kingswood C. European Respiratory Society guidelines for the diagnosis and management of lymphangioleiomyomatosis. Eur Respir J 2010; 35:14-26. [PMID: 20044458 DOI: 10.1183/09031936.00076209] [Citation(s) in RCA: 316] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- S R Johnson
- Division of Therapeutics and Molecular Medicine and Respiratory Biomedical Research Unit, University of Nottingham, Nottingham, UK.
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Calabrò E, Randi G, La Vecchia C, Sverzellati N, Marchianò A, Villani M, Zompatori M, Cassandro R, Harari S, Pastorino U. Lung function predicts lung cancer risk in smokers: a tool for targeting screening programmes. Eur Respir J 2009; 35:146-51. [PMID: 19679603 DOI: 10.1183/09031936.00049909] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The relationship between smoking, lung cancer and airflow obstruction is recognised but it is unclear whether the presence of minimal lung function damage constitutes an independent risk factor for the development of lung cancer. In order to identify those individuals at higher risk of lung cancer on the basis of functional impairment, we evaluated baseline pulmonary function tests of 3,806 heavy smokers undergoing annual chest computed tomography screening, and compared the forced expiratory volume in 1 s (FEV(1)) % predicted of 57 lung cancer cases and that of 3,749 subjects without cancer. We obtained odds ratios (ORs) of lung cancer and the corresponding 95% confidence intervals (CIs) using unconditional logistic regression, adjusting for age, sex, study and smoking variables. Compared with subjects with FEV(1) >or=90% pred, the OR of lung cancer was 2.45 (95% CI 1.39-4.33) for subjects with FEV(1) <90% pred and 2.90 (95% CI 1.34-6.27) for subjects with FEV(1) <70% pred. These data show that even a relatively small reduction in FEV(1) % pred is a significant predictor of increased lung cancer risk. Test screening for lung cancer using airflow obstruction with FEV(1) <90% is a strategy worth future consideration.
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Affiliation(s)
- E Calabrò
- Division of Thoracic Surgery, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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Affiliation(s)
- S Harari
- U.O. di Pneumologia, Ospedale S. Giuseppe, AFAR, Milan, Italy
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Cerrina J, Le Roy Ladurie F, Herve PH, Parquin F, Harari S, Chapelier A, Simoneau G, Vouhe P, Dartevelle PH. Role of CMV pneumonia in the development of obliterative bronchiolitis in heart-lung and double-lung transplant recipients. Transpl Int 2003; 5 Suppl 1:S242-5. [PMID: 14621790 DOI: 10.1007/978-3-642-77423-2_77] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
Obliterative bronchiolitis (OB) is the main cause of late mortality after lung transplantation. Cytomegalovirus infection has been associated with late graft failure. The aim of this study was to determine whether the development of OB was related to CMV pretransplant serological status and to CMV infections. The study group comprised 36 lung transplant recipients (27 HLT and 9 DLT) who survived more than 4 months, of whom 47% developed OB (defined by the persistence of an unexplained obstructive disease: FEV1/VC < 0.7). OB occurred more frequently: (1) in seronegative recipients with seropositive donors (8/9) than in seropositive recipients (7/19) or seronegative well-matched recipients (2/8); and (2) in patients who experienced CMV pneumonia (11/16) and CMV recurrence (11/16). Since matching seronegative recipients is the best way to prevent CMV infection, we believe that seronegative grafts must be reserved for seronegative recipients.
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Affiliation(s)
- J Cerrina
- Centre Chirurgical Marie Lannelongue, Plessis Robinson, France
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30
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Torres MC, Ramos ME, Coelho TL, Harari S. Salivary Streptococcus mutans and Lactobacillus sp levels in cardiac children. J Clin Pediatr Dent 2002; 26:103-9. [PMID: 11688806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023] Open
Abstract
This study assesses salivary conditions of 20 children with cardiac disease comparing with a control group of 15 healthy children. The results showed that there was no difference between the groups on salivary flow, buffer capacity and the level of Streptococcus mutans (Sm). The test group i.e., children with cardiac disease, showed a lower level of Lactobacillus sp. The association between the usage of antibiotics and the risk of developing caries, measuring the level of Streptococcus mutans and Lactobacillus sp., showed that children taking antibiotics frequently had a significant lower level of Lactobacillus sp (p<0.05) than healthy children. This association was not found on relation to the levels of Streptococcus mutans.
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Affiliation(s)
- M C Torres
- Department of Periodontology, Estacio de Sa University, UNESA-RJ, Brazil
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Harari S, Comel A. Pulmonary Langerhans cell Histiocytosis. Sarcoidosis Vasc Diffuse Lung Dis 2001; 18:253-62. [PMID: 11587096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Pulmonary Langerhans cell Histiocytosis is a rare granulomatous disease affecting both sexes, with greater incidence in the second and third decades of life; smoking appears to be the most important risk factor. Its etiology is unknown, although there are data indicating an uncontrolled immune response as possible cause, sustained by the Langerhans cells, antigen presenting cells for T lymphocytes, and their accumulation in the distal bronchioles; these cells express on their surface the CD1a and CD1c antigens, and the B7 molecule, essential for activating quiescent T lymphocytes. In its evolution the granuloma is characterized by the progressive reduction in the LC number, with the increase of fibrosis, surrounding and destroying the bronchiolar lumen; the remaining of the lumen, or the traction exerted by fibrous tissue on the adjacent alveolar spaces leads to the cyst development. Vascular involvement occurs frequently, and may explain the onset of pulmonary hypertension in advanced cases of the disease. The disease may be asymptomatic, or it may present with aspecific respiratory signs and symptoms, and has characteristic radiological findings, being included in the group of cysticaerial parenchymal alterations. The diagnosis could be suggested by the finding of a number of LC in BAL greater than 5%. Different therapies have been proposed, but it seems that the most important measure is smoking cessation.
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Affiliation(s)
- S Harari
- Department of Chest Medicine, San Giuseppe Hospital, Milan, Italy
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Agostini C, Albera C, Bariffi F, De Palma M, Harari S, Lusuardi M, Pesci A, Poletti V, Richeldi L, Rizzato G, Rossi A, Schiavina M, Semenzato G, Tinelli C. First report of the Italian register for diffuse infiltrative lung disorders (RIPID). Monaldi Arch Chest Dis 2001; 56:364-8. [PMID: 11770220] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Abstract
RIPID was established in 1998 as a joint project of the major Italian scientific societies for Respiratory Medicine, with the aim to create an Italian Register on diffuse infiltrative lung disorders that can provide the basis for epidemiological and clinical studies of adequate sample size. In the period from May 1998 to December 2000, 1,382 cases were submitted from 54 Centers in 15 regions of Italy, 54.2% males (mean age +/- SD 50.5 +/- 16.8 years) and 45.8% females (50.2 +/- 15.3 years). A current smoking habit emerges in 18% of subjects; former smokers and never-smokers represent 26% and 56% of the total case series, respectively. The most frequent disease registered is idiopathic pulmonary fibrosis (37.6%), followed in decreasing order by sarcoidosis (29.2%), and Langherans' cell hystiocytosis (6.6%). High resolution computed tomography (HRCT) was considered as the most important tool for final diagnosis in the majority of cases (74.4%); 39.4% of patients underwent transbronchial biopsies, 39.2% bronchoalveolar lavage (BAL). A surgical biopsy was performed in 20.5% of patients. A web site has been activated from December 2000 (www.pneumonet.it/ripid), allowing prompt access to all information and scientific material concerning the project and to an electronic form for data collection that can be completed on-line.
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Harari S, Paciocco G, Aramu S. Ear and nose involvement in systemic diseases. Monaldi Arch Chest Dis 2000; 55:466-70. [PMID: 11272632] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023] Open
Abstract
A whole range of otolaryngeal manifestations may occur as complications or represent the first symptom and sign of a variety of systemic diseases. Otolaryngologists are often the first physicians to recognize that otolaryngeal abnormalities are symptomatic of a broader disease and mandate a systemic approach to the problem. In the present study, the authors focus primarily on ear, nose and throat manifestations that may occur in the context of systemic diseases, discussing clinical manifestations and reviewing the salient histologic, laboratory, and serologic features.
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Affiliation(s)
- S Harari
- Unità Operativa di Pneumologia, Ospedale San Giuseppe, 20123 Milano, Italy
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Abstract
Aspergillus infections have a very high mortality rate. Their incidence is growing because of the increasing number of immunocompromised patients. Treatment of Aspergillus infection is difficult, and the agents used have numerous adverse effects and toxicities. Recently, new and less nephrotoxic formulations of amphotericin B have come onto the market and other new drugs, such as voriconazole and terbinafine, are under evaluation for this infection. Restoration of host immune defences by tapering of immunosuppressive therapy in transplant patients or correction of granulocytopenia in haematological disease is the cornerstone of modern treatment of aspergillosis in immunocompromised patients. In patients with invasive aspergillosis it is very important to achieve therapeutic concentrations of antimycotic drugs as quickly as possible. Patients at high risk of developing aspergillosis (e.g. those with granulocytopenia) should be treated on the basis of clinical or radiological criteria alone if microbiological or histological diagnosis would significantly delay treatment. Conventional amphotericin B is still the first-line treatment for patients with invasive aspergillosis. In transplant patients receiving other nephrotoxic drugs, particularly cyclosporin, first-line therapy with one of the new amphotericin B formulations should be considered. If the emergence of renal toxicity in any patient precludes aggressive treatment, the patient should be switched to one of the new formulations of amphotericin B. For patients cured with amphotericin B, secondary prophylaxis is needed at the end of the intravenous therapy. Amphotericin B by aerosol or itraconazole are possible solutions. In non-invasive forms of aspergillosis, such as suppurative bronchitis, patients could be treated either with amphotericin B or itraconazole as first-line therapy.
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Affiliation(s)
- S Harari
- U.O. di Pneumologia, Ospedale San Giuseppe, Milan, Italy.
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Harari S, Simonneau G, De Juli E, Brenot F, Cerrina J, Colombo P, Gronda E, Micallef E, Parent F, Dartevelle P. Prognostic value of pulmonary hypertension in patients with chronic interstitial lung disease referred for lung or heart-lung transplantation. J Heart Lung Transplant 1997; 16:460-3. [PMID: 9154958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND The purpose of this study was to identify precise and reliable prognostic parameters in patients affected by serious chronic interstitial lung disease, who were undergoing screening for lung or heart-lung transplantation. METHODS Hemodynamic and respiratory function parameters of 67 patients (43 with idiopathic pulmonary fibrosis, 18 with histiocytosis X, and 6 with lymphangioleiomyomatosis) undergoing clinical screening for lung transplantation. RESULTS Statistical analysis showed that hemodynamic and respiratory function parameters in patients affected by histiocytosis X and idiopathic pulmonary fibrosis were not related to survival time. Moreover, the degree of pulmonary hypertension showed no correlation between respiratory function parameters in all the groups of diseases examined. Patients affected with histiocytosis X, even with higher degrees of pulmonary hypertension, had a better survival rate (p < 0.0005) compared with patients with idiopathic pulmonary fibrosis. CONCLUSIONS Hemodynamic and respiratory parameters obtained during the clinical screening for lung transplantation do not predict survival and cannot be used as prognostic indicators.
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Affiliation(s)
- S Harari
- Pneumology Department, Niguarda Hospital, Milan, Italy
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Harari S, Schiraldi G, de Juli E, Gronda E. Relapsing Aspergillus bronchitis in a double lung transplant patient, successfully treated with a new oral antimycotic agent. Chest 1997; 111:835-6. [PMID: 9118736 DOI: 10.1378/chest.111.3.835] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
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Zighetti ML, Cattaneo M, Falcon CR, Lombardi R, Harari S, Savoritto S, Mannucci PM. Absence of hyperhomocysteinemia in ten patients with primary pulmonary hypertension. Thromb Res 1997; 85:279-82. [PMID: 9058503 DOI: 10.1016/s0049-3848(97)00013-3] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- M L Zighetti
- A. Bianchi Bonomi Hemophilia and Thrombosis Center, IRCCS Maggiore Hospital, Milano, Italy
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Schiraldi GF, Colombo MD, Harari S, Lo Cicero S, Ziglio G, Ferrarese M, Rossato D, Soresi E. Terbinafine in the treatment of non-immunocompromised compassionate cases of bronchopulmonary aspergillosis. Mycoses 1996; 39:5-12. [PMID: 8786758 DOI: 10.1111/j.1439-0507.1996.tb00077.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Conventional treatments of broncho-pulmonary aspergillosis are often ineffective and result in associated side-effects. Terbinafine (a new allylamine derivative), although as active against Aspergillus in vitro as amphotericin B and itraconazole, is less effective in rodent models because of a rapid hepatic first-pass effect. As terbinafine is metabolized differently in humans, the aim of this work was to evaluate this drug, for the first time, in the treatment of seven immunocompetent patients with lower respiratory tract mycotic infections unresponsive to the usual antimycotic drugs. Diagnosis was based on identification of fungal isolates, worsening of respiratory function tests, chest radiographs and computerized tomographic (CT) scan changes, positive skin test, aspergillin precipitins and clinical history. Terbinafine was administered at doses ranging from 5 to 15 mg kg-1 day-1 depending on the clinical severity of the disease, and was given for 90-270 days depending on clinical progress and compliance. In three patients A. fumigatus was suppressed with resolution of signs and symptoms; four patients showed transitory A. fumigatus suppression with marked clinical and radiological improvement. During relapses no resistance to terbinafine was observed. No significant side-effects were detected. Terbinafine appeared to be as effective as amphotericin B and itraconazole in the treatment of bronchopulmonary aspergillosis in nonimmunocompromised patients. These preliminary results suggest that controlled studies are warranted.
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Affiliation(s)
- G F Schiraldi
- Department of Pneumology, Niguarda General Hospital, Milano, Italy
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Barberis M, Harari S, Bramerio M, Minola E, Bonacina E, Gambacorta M. Rejection and nonrejection related forms of bronchiolitis obliterans: morphologic terms or clinico-pathological entities? Transplant Proc 1995; 27:2004-5. [PMID: 7792867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Affiliation(s)
- M Barberis
- Institute of Pathological Anatomy, Ospedale Niguarda Ca'Granda, Milano, Italy
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41
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Barberis MC, Veronese S, Bauer D, De Juli E, Harari S. Immunocytochemical detection of progesterone receptors. A study in a patient with primary pulmonary hypertension. Chest 1995; 107:869-72. [PMID: 7874968 DOI: 10.1378/chest.107.3.869] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
Primary pulmonary plexogenic arteriopathy (PPPA) is one of the principal conditions in which pulmonary hypertension may be clinically unexpected. It occurs in the lung vessels in the absence of any demonstrable cause. Its high incidence in women of childbearing age combined with reports of disease following delivery of a child or assumption of oral contraceptives suggest that hormonal factors may play a role in the pathogenesis of PPPA. The suspicion that the pulmonary vascular lesions occurring in PPPA could represent the effect of a hormonal mediated vascular hyperreactivity prompted the evaluation of the steroid hormone receptor status on lung tissue obtained from a women suffering from this disease who had a double-lung transplantation. By the immunocytochemical method performed on formalin fixed, paraffin-embedded lung tissue, we showed the presence of progesterone receptors (PR) in the nuclei of the myofibroblasts forming the arterial obstructive intimal proliferations and of the spindle cells present in the walls of the plexiform lesions. To enhance the staining and to facilitate the observation, we used a microwave-based antigen unmasking technique. The lack of estrogen receptors and the presence of PR could have increased, in the case, the sensitivity of the pulmonary muscular arteries to vasoconstrictory compounds. We hypothesize that on this substrate of a presumptive steroid-mediated vasoconstriction the sequence of the histologic lesions characteristic of pulmonary vascular hypertensive disease could have developed.
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Affiliation(s)
- M C Barberis
- Servizio di Anatomia Patologica, Ospedale Niguarda Ca'Granda, Milan, Italy
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Harari S, Ziglio G, Ioli F, de Juli E, Donner CF, Gronda E, Micallef E, Ravini M, Scoccia S. Selection and evaluation of recipients for heart-lung and lung transplantation: the Niguarda Hospital experience. Monaldi Arch Chest Dis 1994; 49:131-7. [PMID: 8049697] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Between January 1989 and February 1993, 52 patients were evaluated at Niguarda Hospital for lung or heart and lung transplantation. Of the 35 that entered the waiting list, a total of 19 were transplanted (14 at other institutes before our surgical programme became operative, and 5 at our hospital). Recipient selection and evaluation criteria, and timing of transplantation in the different diseases are discussed.
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Affiliation(s)
- S Harari
- Pneumological Dept, Niguarda Hospital, Milan, Italy
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Barberis M, Harari S, Tironi A, Lampertico P. Recurrence of primary disease in a single lung transplant recipient. Transplant Proc 1992; 24:2660-2. [PMID: 1465892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- M Barberis
- Postgraduate School of Pathological Anatomy, University of Milan, Italy
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Barberis M, Harari S. Proliferating cell nuclear antigen immunostaining of the endothelial cells in lung transplantation. Transplant Proc 1992; 24:2667-9. [PMID: 1361264] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023]
Affiliation(s)
- M Barberis
- Postgraduate School of Pathological Anatomy, University of Milano, Italy
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Barberis M, Bauer D, Harari S, Belloni PA, Masini T, Baisi A. Early infections and bronchiolitis obliterans-organizing pneumonia in single lung transplant recipients. J Heart Lung Transplant 1992; 11:1012-4. [PMID: 1420231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
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Schiraldi GF, Soresi E, Locicero S, Harari S, Scoccia S. Salmon calcitonin in cancer pain: comparison between two different treatment schedules. Int J Clin Pharmacol Ther Toxicol 1987; 25:229-32. [PMID: 3583473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The analgesic effect of salmon calcitonin (Calcitonina-Sandoz) was evaluated in an open study of thirty-four patients with bone metastases of a lung cancer. Two different administration protocols were used: eighteen subjects received sCT 400 IU/day for three consecutive days, while the remaining sixteen were given sCT 200 IU/day for six consecutive days. In both protocols salmon calcitonin was diluted in saline and infused intravenously in one hour. Bone, visceral and neuritic pain were evaluated by means of Huskisson's visual analog scale and Keele's pain scale. The analgesic efficacy of salmon calcitonin was also evaluated on the basis of daily consumption of analgesic drugs. Salmon calcitonin proved of extreme efficacy in the treatment of intractable pain from advanced malignancy. A higher and earlier analgesic activity was observed with sCT at the 400 IU daily dosage.
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