Pirfenidone in Idiopathic Pulmonary Fibrosis: Real-World Observation on Efficacy and Safety, Focus on Patients Undergoing Antithrombotic and Anticoagulant.

Idiopathic pulmonary fibrosis (IPF) is a rare and progressive interstitial lung disease characterized by irreversible distortion of lung architecture and subsequent loss of pulmonary function. Pirfenidone is an antifibrotic agent associated with increased progression-free survival and overall survival rates, but it carries multiple side effects. The aim of the study was to examine the efficacy and safety profile of pirfenidone in a real-life context, with a focus on the concomitant use of antithrombotic and/or anticoagulant treatments.

Functional Progression after Dose Suspension or Discontinuation of Nintedanib in Idiopathic Pulmonary Fibrosis: A Real-Life Multicentre Study.

Background: Idiopathic pulmonary fibrosis (IPF) is a chronic interstitial lung disease with rapidly progressive evolution and an unfavorable outcome. Nintedanib (NTD) is an antifibrotic drug that has been shown to be effective in slowing down the progression of the disease. The aim of our study was to examine the efficacy, especially in terms of the functional decline, and the safety profile of NTD in patients treated with the recommended dose and subjects who reduced or suspended the therapy due to the occurrence of adverse reactions.

Medical thoracoscopy without pleural fluid: How I do it.

Thoracoscopy is a commonly used minimally invasive procedure in the field of interventional pulmonology. While medical thoracoscopy is the widely preferred modality, modifications to the technique and expansion in the scope of its utility have always challenged the conventional approach. We describe a modified technique of medical thoracoscopy in absence of pleural effusion also known as dry thoracoscopy under sedation and local anaesthesia.

Predictors of Worse Prognosis in Young and Middle-Aged Adults Hospitalized with COVID-19 Pneumonia: A Multi-Center Italian Study (COVID-UNDER50).

Obesity as well as metabolic and cardiovascular comorbidities are established, significant predictors of worse prognosis in the overall COVID-19 population, but limited information is available on their roles in young and middle-aged adults (aged ≤ 50 years). The main objectives of the present Italian multi-center study were to describe clinical characteristics and role of selected prognostic predictors in a large cohort of young and middle-aged hospitalized patients. Nine pulmonology units, across north and center of Italy, were involved in this retrospective study.

The Medical Concrete Cancer of the Lung: A Unique Case Report.

A 53-year-old 10 pack year smoker and concrete worker for 12 years presented to us with a lung mass proven to be small cell lung cancer on lung biopsy. An industrial terminology of concrete cancer already exists defining the wear and tear in concrete due to various interactions. The interactions of concrete and smoke on lung, predisposed and increased the risk of lung cancer probably as an additive effect which we label as the medical concrete cancer of the lung.

Radical Hemithoracic Radiotherapy Versus Palliative Radiotherapy in Non-metastatic Malignant Pleural Mesothelioma: Results from a Phase 3 Randomized Clinical Trial.

Purpose: We conducted a phase 3 randomized clinical trial to assess whether radical hemithoracic radiation therapy (RHR) compared with palliative radiation therapy (PR) can achieve overall survival (OS) advantages in patients with malignant pleural mesothelioma (MPM).

Methods And Materials: From August 2014 to May 2018, patients with histologically diagnosed nonmetastatic MPM, who underwent nonradical lung-sparing surgery and chemotherapy (CHT), were randomly assigned (1:1) to receive RHR or PR. RHR total dose to the involved pleural cavity was 50 Gy in 25 fractions, and the gross residual disease received a simultaneous integrated boost of 60 Gy.

Diagnostic Accuracy of Pleural Fluid Cytology, Carcinoembryonic Antigen and C-Reactive Protein Together in Patients With Pulmonary Metastases and Malignant Pleural Effusion.

Background/aim: Pleural effusion (PE) has a heterogeneous aetiology, and differential diagnosis between benign and malignant disease may require invasive procedures in up to 60% of cases. The sensitivity of pleural cytology is limited, and several strategies have been tested to reduce the need of invasive diagnostic approaches. The aim of this study was to evaluate the usefulness of pleural fluid cytology, compared to, and combined with, carcinoembryonic antigen (CEA), C reactive protein (CRP), and lactate dehydrogenase (LDH) assay of pleural fluid (PF) in patients with a history of cancer, exudative non-purulent PE, and suspicion of malignant PE on imaging studies.

Limited role for bronchoalveolar lavage to exclude COVID-19 after negative upper respiratory tract swabs: a multicentre study.

https://bit.ly/3gpBC75

A case report on expanding horizon of endobronchial ultrasound through esophagus.

Endobronchial ultrasound has revolutionized the field of bronchoscopy and has become one of the most important tools for the diagnosis of intrathoracic lymphadenopathy and para-bronchial structures. The reach of this technique has not been limited to these structures and pleural lesions have been at times accessible. To our knowledge, pleural fluid collections have not been accessed with endobronchial ultrasound (EBUS) through oesophageal approach and rationale behind using this approach.

Convex probe endobronchial ultrasound guided transbronchial/transoesophageal fine needle aspiration (C-EBUS-TBNA/EUS-B FNA) of pleural lesions: A single center experience and review of literature.

The evaluation of pleural diseases has been well established. If pleurocentensis is non-diagnostic, the second investigation depending upon availability could be either closed pleural biopsy or image guided pleural biopsy or thoracoscopic pleural biopsy (medical or surgical). Pleural disease presenting as thickness/mass/nodule in the mediastinum is difficult to access through ultrasound or computed tomography and will need thoracoscopy.

Novel use of the endobronchial ultrasound through esophagus (EUS-B): Diagnosis of thyroid lesions.

There is paucity in literature on the use of endobronchial ultrasound through esophagus (EUS-B) for the diagnosing thyroid gland lesions. We report the first case of colloid goiter diagnosed using EUS-B- FNA technique. A 77-year-old man presented with ophthalmic symptoms and an incidental finding of lung nodule on chest x-ray.

Percutaneous lung abscess drainage: revisiting the old gold standard.

Lung abscess is defined as the necrosis of lung tissue with cavity formation due to varied etiology. The treatment of lung abscesses is medical involving antibiotics and chest physiotherapy. The failure of medical line of management requires an invasive surgical or percutaneous approach for drainage and control of infection.

A novel procedure of endobronchial ultrasound-guided transbronchial needle aspiration for pulmonary parenchymal lesions: The ZUTAM technique.

Convex probe-endobronchial ultrasound (CP-EBUS) has been proven to be safe and accurate for identifying malignancy and granulomatous disease affecting the mediastinum and hilum. CP-EBUS can be used for intraparenchymal lesions also and has been shown to be efficacious. A subset of lesions particularly suited for CP-EBUS are those completely surrounded by lung parenchyma, centrally located, and typically close to but without an airway leading directly to them.

Multivitamin pill aspiration leading to hemorrhagic bronchial necrosis.

This article highlights the serious but reversible effects of multivitamin pill aspiration into the lungs. If diagnosed early and treated promptly the harmful effects of the pill constituents on the lungs and airways can be attenuated. An early bronchoscopy and a high index of suspicion is required in order not to miss these events.

Esophageal ultrasound with ultrasound bronchoscope (EUS-B) guided transvascular needle aspiration (TVNA).

We have described a 67-year-old man, diagnosed to have adenocarcinoma of lung by transvascular approach with esophageal ultrasound using ultrasound bronchoscope (EUS-B). To the best of our knowledge this is the first case where EUS-B has been used for transvascular fine needle aspiration cytology to diagnose lung carcinoma.

Esophageal ultrasound with ultrasound bronchoscope (EUS-B) guided left adrenal biopsy: Case report with review of literature.

A 45-year old man, chronic smoker with a pancoast tumor due to squamous cell carcinoma has been described. The initial diagnosis of lung carcinoma was based on a scant tissue so the exact cell typing was not possible. The initial treatment consisted of platinum based chemotherapy and radiotherapy.

Asthma management in a specialist setting: Results of an Italian Respiratory Society survey.

Background: Asthma considerably impairs patients' quality of life and increases healthcare costs. Severity, morbidity, and degree of disease control are the major drivers of its clinical and economic impact. National scientific societies are required to monitor the application of international guidelines and to adopt strategies to improve disease control and better allocate resources.