Publications by authors named "Mario Tamburrini"

14 Publications

  • Page 1 of 1

Medical thoracoscopy without pleural fluid: How I do it.

Monaldi Arch Chest Dis 2021 Jul 22. Epub 2021 Jul 22.

Respiratory Medicine University of Ferrara.

Thoracoscopy is 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.
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http://dx.doi.org/10.4081/monaldi.2021.1331DOI Listing
July 2021

Classification and analysis of outcome predictors in non-critically ill COVID-19 patients.

Intern Med J 2021 04 9;51(4):506-514. Epub 2021 Apr 9.

Department of Medicine, University of Udine, Udine, Italy.

Background: Early detection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-infected patients who could develop a severe form of COVID-19 must be considered of great importance to carry out adequate care and optimise the use of limited resources.

Aims: To use several machine learning classification models to analyse a series of non-critically ill COVID-19 patients admitted to a general medicine ward to verify if any clinical variables recorded could predict the clinical outcome.

Methods: We retrospectively analysed non-critically ill patients with COVID-19 admitted to the general ward of the hospital in Pordenone from 1 March 2020 to 30 April 2020. Patients' characteristics were compared based on clinical outcomes. Through several machine learning classification models, some predictors for clinical outcome were detected.

Results: In the considered period, we analysed 176 consecutive patients admitted: 119 (67.6%) were discharged, 35 (19.9%) dead and 22 (12.5%) were transferred to intensive care unit. The most accurate models were a random forest model (M2) and a conditional inference tree model (M5) (accuracy = 0.79; 95% confidence interval 0.64-0.90, for both). For M2, glomerular filtration rate and creatinine were the most accurate predictors for the outcome, followed by age and fraction-inspired oxygen. For M5, serum sodium, body temperature and arterial pressure of oxygen and inspiratory fraction of oxygen ratio were the most reliable predictors.

Conclusions: In non-critically ill COVID-19 patients admitted to a medical ward, glomerular filtration rate, creatinine and serum sodium were promising predictors for the clinical outcome. Some factors not determined by COVID-19, such as age or dementia, influence clinical outcomes.
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http://dx.doi.org/10.1111/imj.15140DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8250466PMC
April 2021

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

J Clin Med 2021 Mar 15;10(6). Epub 2021 Mar 15.

Center of Epidemiology, Biostatistics and Information Technology, Department of Biomedical Sciences and Public Health, Marche Polytechnic University, 60020 Ancona, Italy.

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. Comorbidities were classified according to their known or potential association with COVID-19. A total of 263 subjects were included. The prevalence of obesity was 25.9%, mechanical ventilation (MV) was needed in 27.7%, and 28 in-hospital deaths occurred (10.6%). Obesity and older age were the only independent, significant predictors for MV. Comorbidities, such as hypertension, diabetes, asthma, and increased D-dimer levels were significantly associated with higher mortality risk, regardless of age, body mass index, and MV. Obesity in young and middle-aged adults is a strong predictor of a more complicated COVID-19, without, however, evidence of a significant effect on in-hospital mortality. Selected comorbidities, including hypertension, diabetes and asthma, significantly impact survival even in a younger population, suggesting the need for prompt recognition of these conditions.
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http://dx.doi.org/10.3390/jcm10061218DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7999047PMC
March 2021

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

Indian J Occup Environ Med 2020 Sep-Dec;24(3):203-205. Epub 2020 Dec 14.

Azienda per l' Assistenza Sanitaria n. 5 "Friuli Occidentale", Struttura Complessa di Pneumologia, Pordenone, Italy.

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.
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http://dx.doi.org/10.4103/ijoem.IJOEM_94_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7962503PMC
December 2020

Prolonged Low-Dose Methylprednisolone in Patients With Severe COVID-19 Pneumonia.

Open Forum Infect Dis 2020 Oct 12;7(10):ofaa421. Epub 2020 Sep 12.

Pulmonology Department, S. Maria della Misericordia University Hospital, Udine, Italy.

Background: In hospitalized patients with coronavirus disease 2019 (COVID-19) pneumonia, progression to acute respiratory failure requiring invasive mechanical ventilation (MV) is associated with significant morbidity and mortality. Severe dysregulated systemic inflammation is the putative mechanism. We hypothesize that early prolonged methylprednisolone (MP) treatment could accelerate disease resolution, decreasing the need for intensive care unit (ICU) admission and mortality.

Methods: We conducted a multicenter observational study to explore the association between exposure to prolonged, low-dose MP treatment and need for ICU referral, intubation, or death within 28 days (composite primary end point) in patients with severe COVID-19 pneumonia admitted to Italian respiratory high-dependency units. Secondary outcomes were invasive MV-free days and changes in C-reactive protein (CRP) levels.

Results: Findings are reported as MP (n = 83) vs control (n = 90). The composite primary end point was met by 19 vs 40 (adjusted hazard ratio [aHR], 0.41; 95% CI, 0.24-0.72). Transfer to ICU and invasive MV were necessary in 15 vs 27 ( = .07) and 14 vs 26 ( = .10), respectively. By day 28, the MP group had fewer deaths (6 vs 21; aHR, 0.29; 95% CI, 0.12-0.73) and more days off invasive MV (24.0 ± 9.0 vs 17.5 ± 12.8;  = .001). Study treatment was associated with rapid improvement in PaO:FiO and CRP levels. The complication rate was similar for the 2 groups ( = .84).

Conclusion: In patients with severe COVID-19 pneumonia, early administration of prolonged MP treatment was associated with a significantly lower hazard of death (71%) and decreased ventilator dependence. Treatment was safe and did not impact viral clearance. A large randomized controlled trial (RECOVERY trial) has been performed that validates these findings. ClinicalTrials.gov NCT04323592.
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http://dx.doi.org/10.1093/ofid/ofaa421DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7543560PMC
October 2020

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

Monaldi Arch Chest Dis 2020 Jul 21;90(3). Epub 2020 Jul 21.

Department of Internal and Specialist Medicine, Pneumology Unit, Friuli Venezia Giulia Health Authority Hospital of Pordenone.

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. We report a case of 70 years old man who has been referred from physician for the EBUS in view of hilar mass with mediastinal lymphadenopathy with pleural effusion. The endobronchial ultrasound through oesophagus (EUS-B) was done for thoracocentesis and lymph node cytology evaluation and ultimately endobronchial biopsy of hilar mass was done as rapid on-site (ROSE) analysis of lymph node was suggestive of necrotic tissue. The cytology report of lymph node and pleural effusion was positive for malignant cells. The final diagnosis was metastatic poorly differentiating adeno-squamous carcinoma.
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http://dx.doi.org/10.4081/monaldi.2020.1274DOI Listing
July 2020

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.

Monaldi Arch Chest Dis 2020 Jul 10;90(3). Epub 2020 Jul 10.

Anatomopathologist, AAS5 Friuli Occidentale, Pordenone.

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. Thoracoscopy is an invasive procedure which can be difficult to perform in localized mediastinal pleural disease without effusion or poor health condition not suitable for general anesthesia. An alternative method that can be utilized is sampling of pleural lesion through convex probe endobronchial ultrasound (CEBUS) either through the central large airways or from esophagus if the lesions are in proximity. We present our center's experience in diagnosing pleural lesion using C-EBUS in 4 patients along with review of the literature.
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http://dx.doi.org/10.4081/monaldi.2020.1207DOI Listing
July 2020

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

Monaldi Arch Chest Dis 2020 May 21;90(2). Epub 2020 May 21.

Department of Internal and Specialist Medicine, Unit of Pneumology, Friuli Venezia Giulia Health Authority Hospital, Pordenone.

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. The computed tomography of thorax revealed a left upper lobe nodule and an oval shaped left paratracheal lesion near left pole of thyroid gland. EUS-B- FNAC was performed which lead to the diagnosis of colloid goiter.
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http://dx.doi.org/10.4081/monaldi.2020.1275DOI Listing
May 2020

Percutaneous lung abscess drainage: revisiting the old gold standard.

Monaldi Arch Chest Dis 2020 Mar 6;90(1). Epub 2020 Mar 6.

Department of Clinical Medicine and Surgery, Section of Respiratory Disease, University Federico II, Monaldi Hospital, Naples.

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. While the literature is ample regarding the surgical approach, it is rather scarce on the percutaneous approach. The percutaneous drainage has been most studied with computed tomography guidance. With our case series we describe to the treatment of lung abscesses non-responsive to medical management, by a bedside minimally invasive ultrasound or fluoroscopy guided percutaneous drainage approach.
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http://dx.doi.org/10.4081/monaldi.2020.1214DOI Listing
March 2020

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

Lung India 2020 Jan-Feb;37(1):63-65

Consultant Pulmonologist, Department of Pulmonary Medicine, Santa Maria degli Angeli di Pordenone, Italy.

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. We report a case of transbronchial needle aspiration (TBNA) done from a nodule of size 11 mm in the superior segment of the right lower lobe. EBUS-TBNA was done from this lesion, which was 5 mm away from the bronchus in the lung parenchyma with intervening normal lung tissue in between. TBNA was performed by compressing the abutting normal lung tissue, thus causing compression collapse of the intervening normal lung. We labeled this Zealous Unique Trans Arterial Maneuver as the "ZUTAM" technique.
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http://dx.doi.org/10.4103/lungindia.lungindia_187_19DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6961091PMC
January 2020

Multivitamin pill aspiration leading to hemorrhagic bronchial necrosis.

Respir Med Case Rep 2019 14;28:100944. Epub 2019 Oct 14.

AAS5 Friuli occidentale, Pordenone, Italy.

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. We have described a case of multivitamin pill aspiration in a young healthy male and the good response to early intervention.
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http://dx.doi.org/10.1016/j.rmcr.2019.100944DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6818337PMC
October 2019

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

Respir Med Case Rep 2019 31;28:100864. Epub 2019 May 31.

Azienda per l'Assistenza Sanitaria 5 "Friuli Occidentale", Santa Maria degli Angeli di Pordenone, Italy.

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.
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http://dx.doi.org/10.1016/j.rmcr.2019.100864DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6554485PMC
May 2019

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

Respir Med Case Rep 2019 20;26:154-156. Epub 2018 Dec 20.

Department of Pulmonary Medicine, Santa Maria degli Angeli di Pordenone, Italy.

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. He developed a left adrenal lesion on treatment. There was a possibility of metachronous primary. Also, a large tissue sample was required for tumor markers. The lung mass was difficult to access and was static on treatment. A left adrenal biopsy was considered to be more appropriate. A novel approach for left adrenal lesion with esophageal ultrasound using ultrasound bronchoscope (EUS-B) was successfully performed. This article is aimed at describing the use of EUS-B for transdiaphragmatic structures.
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http://dx.doi.org/10.1016/j.rmcr.2018.12.012DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6310773PMC
December 2018
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