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1. Outcome of treatment of MDR-TB or drug-resistant patients treated with bedaquiline and delamanid: Results from a large global cohort

Author

Koirala, S., Borisov, S., Danila, E., Mariandyshev, A., Shrestha, B., Lukhele, N., Dalcolmo, M., Shakya, S.R., Miliauskas, S., Kuksa, L., Manga, S., Aleksa, A., Denholm, J.T., Khadka, H.B., Skrahina, A., Diktanas, S., Ferrarese, M., Bruchfeld, J., Koleva, A., Piubello, A., Koirala, G.S., Udwadia, Z.F., Palmero, D.J., Munoz-Torrico, M., GC, R., Gualano, G., Grecu, V.I., Motta, I., Papavasileiou, A., Li, Y., Hoefsloot, W., Kunst, H., Mazza-Stalder, J., Payen, M.-C., Akkerman, O.W., Bernal, E., Manfrin, V., Matteelli, A., Mustafa Hamdan, H., Nieto Marcos, M., Cadiñanos Loidi, J., Cebrian Gallardo, J.J., Duarte, R., Escobar Salinas, N., Gomez Rosso, R., Laniado-Laborín, R., Martínez Robles, E., Quirós Fernandez, S., Rendon, A., Solovic, I., Tadolini, M., Viggiani, P., Belilovski, E., Boeree, M.J., Cai, Q., Davidavičienė, E., Forsman, L.D., De Los Rios, J., Drakšienė, J., Duga, A., Elamin, S.E., Filippov, A., Garcia, A., Gaudiesiute, I., Gavazova, B., Gayoso, R., Gruslys, V., Jonsson, J., Khimova, E., Madonsela, G., Magis-Escurra, C., Marchese, V., Matei, M., Moschos, C., Nakčerienė, B., Nicod, L., Palmieri, F., Pontarelli, A., Šmite, A., Souleymane, M.B., Vescovo, M., Zablockis, R., Zhurkin, D., Alffenaar, J.-W., Caminero, J.A., Codecasa, L.R., García-García, J.-M., Esposito, S., Saderi, L., Spanevello, A., Visca, D., Tiberi, S., Pontali, E., Centis, R., D'Ambrosio, L., van den Boom, M., Sotgiu, G., and Migliori, G.B.

Published
2021
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2. Outcome of treatment of MDR-TB or drug-resistant patients treated with bedaquiline and delamanid: Results from a large global cohort

Author

Koirala, S, Borisov, S, Danila, E, Mariandyshev, A, Shrestha, B, Lukhele, N, Dalcolmo, M, Shakya, SR, Miliauskas, S, Kuksa, L, Manga, S, Aleksa, A, Denholm, JT, Khadka, HB, Skrahina, A, Diktanas, S, Ferrarese, M, Bruchfeld, J, Koleva, A, Piubello, A, Koirala, GS, Udwadia, ZF, Palmero, DJ, Munoz-Torrico, M, Gc, R, Gualano, G, Grecu, V, Motta, I, Papavasileiou, A, Li, Y, Hoefsloot, W, Kunst, H, Mazza-Stalder, J, Payen, M-C, Akkerman, OW, Bernal, E, Manfrin, V, Matteelli, A, Hamdan, HM, Marcos, MN, Cadinanos Loidi, J, Cebrian Gallardo, JJ, Duarte, R, Escobar Salinas, N, Gomez Rosso, R, Laniado-Laborin, R, Martinez Robles, E, Quiros Fernandez, S, Rendon, A, Solovic, I, Tadolini, M, Viggiani, P, Belilovski, E, Boeree, MJ, Cai, Q, Davidaviciene, E, Forsman, LD, De Los Rios, J, Draksiene, J, Duga, A, Elamin, SE, Filippov, A, Garcia, A, Gaudiesiute, I, Gavazova, B, Gayoso, R, Gruslys, V, Jonsson, J, Khimova, E, Madonsela, G, Magis-Escurra, C, Marchese, V, Matei, M, Moschos, C, Nakceriene, B, Nicod, L, Palmieri, F, Pontarelli, A, Smite, A, Souleymane, MB, Vescovo, M, Zablockis, R, Zhurkin, D, Alffenaar, J-W, Caminero, JA, Codecasa, LR, Garcia-Garcia, J-M, Esposito, S, Saderi, L, Spanevello, A, Visca, D, Tiberi, S, Pontali, E, Centis, R, D'Ambrosio, L, van den Boom, M, Sotgiuw, G, Migliori, GB, Koirala, S, Borisov, S, Danila, E, Mariandyshev, A, Shrestha, B, Lukhele, N, Dalcolmo, M, Shakya, SR, Miliauskas, S, Kuksa, L, Manga, S, Aleksa, A, Denholm, JT, Khadka, HB, Skrahina, A, Diktanas, S, Ferrarese, M, Bruchfeld, J, Koleva, A, Piubello, A, Koirala, GS, Udwadia, ZF, Palmero, DJ, Munoz-Torrico, M, Gc, R, Gualano, G, Grecu, V, Motta, I, Papavasileiou, A, Li, Y, Hoefsloot, W, Kunst, H, Mazza-Stalder, J, Payen, M-C, Akkerman, OW, Bernal, E, Manfrin, V, Matteelli, A, Hamdan, HM, Marcos, MN, Cadinanos Loidi, J, Cebrian Gallardo, JJ, Duarte, R, Escobar Salinas, N, Gomez Rosso, R, Laniado-Laborin, R, Martinez Robles, E, Quiros Fernandez, S, Rendon, A, Solovic, I, Tadolini, M, Viggiani, P, Belilovski, E, Boeree, MJ, Cai, Q, Davidaviciene, E, Forsman, LD, De Los Rios, J, Draksiene, J, Duga, A, Elamin, SE, Filippov, A, Garcia, A, Gaudiesiute, I, Gavazova, B, Gayoso, R, Gruslys, V, Jonsson, J, Khimova, E, Madonsela, G, Magis-Escurra, C, Marchese, V, Matei, M, Moschos, C, Nakceriene, B, Nicod, L, Palmieri, F, Pontarelli, A, Smite, A, Souleymane, MB, Vescovo, M, Zablockis, R, Zhurkin, D, Alffenaar, J-W, Caminero, JA, Codecasa, LR, Garcia-Garcia, J-M, Esposito, S, Saderi, L, Spanevello, A, Visca, D, Tiberi, S, Pontali, E, Centis, R, D'Ambrosio, L, van den Boom, M, Sotgiuw, G, and Migliori, GB

Abstract

The World Health Organization (WHO) recommends countries introduce new anti-TB drugs in the treatment of multidrug-resistant tuberculosis. The aim of the study is to prospectively evaluate the effectiveness of bedaquiline (and/or delamanid)- containing regimens in a large cohort of consecutive TB patients treated globally. This observational, prospective study is based on data collected and provided by Global Tuberculosis Network (GTN) centres and analysed twice a year. All consecutive patients (including children/adolescents) treated with bedaquiline and/or delamanid were enrolled, and managed according to WHO and national guidelines. Overall, 52 centres from 29 countries/regions in all continents reported 883 patients as of January 31st 2021, 24/29 countries/regions providing data on 100% of their consecutive patients (10-80% in the remaining 5 countries). The drug-resistance pattern of the patients was severe (>30% with extensively drug-resistant -TB; median number of resistant drugs 5 (3-7) in the overall cohort and 6 (4-8) among patients with a final outcome). For the patients with a final outcome (477/883, 54.0%) the median (IQR) number of months of anti-TB treatment was 18 (13-23) (in days 553 (385-678)). The proportion of patients achieving sputum smear and culture conversion ranged from 93.4% and 92.8% respectively (whole cohort) to 89.3% and 88.8% respectively (patients with a final outcome), a median (IQR) time to sputum smear and culture conversion of 58 (30-90) days for the whole cohort and 60 (30-100) for patients with a final outcome and, respectively, of 55 (30-90) and 60 (30-90) days for culture conversion. Of 383 patients treated with bedaquiline but not delamanid, 284 (74.2%) achieved treatment success, while 25 (6.5%) died, 11 (2.9%) failed and 63 (16.5%) were lost to follow-up.

Published
2021

3. Surveillance of adverse events in the treatment of drug-resistant tuberculosis: first global report

Author

Borisov, S., Danila, E., Maryandyshev, A., Dalcolmo, M., Miliauskas, S., Kuksa, L., Manga, S., Skrahina, A., Diktanas, S., Codecasa, L.R., Aleksa, A., Bruchfeld, J., Koleva, A., Piubello, A., Udwadia, Z.F., Akkerman, O.W., Belilovski, E., Bernal, E., Boeree, M.J., Loidi, J., Cai, Q., Gallardo, J.J. Cebrian, Dara, M., Davidaviciene, E., Forsman, L.D., Rios, J. De Los, Denholm, J., Draksiene, J., Duarte, R., Elamin, S.E., Salinas, N. Escobar, Ferrarese, M., Filippov, A., Garcia, A., Garcia-Garcia, J.M., Gaudiesiute, I., Gavazova, B., Gayoso, R., Rosso, R., Gruslys, V., Gualano, G., Hoefsloot, W., Jonsson, J., Khimova, E., Kunst, H., Laniado-Laborin, R., Li, Y, Magis-Escurra, C., Manfrin, V., Marchese, V., Robles, E. Martinez, Matteelli, A., Mazza-Stalder, J., Moschos, C., Munoz-Torrico, M., Hamdan, H. Mustafa, Nakceriene, B., Nicod, L., Marcos, M., Palmero, D.J., Palmieri, F., Papavasileiou, A., Payen, M.C., Pontarelli, A., Quiros, S., Rendon, A., Saderi, L., Smite, A., Solovic, I., Souleymane, M.B., Tadolini, M., Boom, M. van den, Vescovo, M., Viggiani, P., Yedilbayev, A., Zablockis, R., Zhurkin, D., Zignol, M., Visca, D., Spanevello, A., Caminero, J.A., Alffenaar, J.W.C., Tiberi, S., Centis, R., D'Ambrosio, L., Pontali, E., Sotgiu, G., Migliori, G.B., Borisov, S., Danila, E., Maryandyshev, A., Dalcolmo, M., Miliauskas, S., Kuksa, L., Manga, S., Skrahina, A., Diktanas, S., Codecasa, L.R., Aleksa, A., Bruchfeld, J., Koleva, A., Piubello, A., Udwadia, Z.F., Akkerman, O.W., Belilovski, E., Bernal, E., Boeree, M.J., Loidi, J., Cai, Q., Gallardo, J.J. Cebrian, Dara, M., Davidaviciene, E., Forsman, L.D., Rios, J. De Los, Denholm, J., Draksiene, J., Duarte, R., Elamin, S.E., Salinas, N. Escobar, Ferrarese, M., Filippov, A., Garcia, A., Garcia-Garcia, J.M., Gaudiesiute, I., Gavazova, B., Gayoso, R., Rosso, R., Gruslys, V., Gualano, G., Hoefsloot, W., Jonsson, J., Khimova, E., Kunst, H., Laniado-Laborin, R., Li, Y, Magis-Escurra, C., Manfrin, V., Marchese, V., Robles, E. Martinez, Matteelli, A., Mazza-Stalder, J., Moschos, C., Munoz-Torrico, M., Hamdan, H. Mustafa, Nakceriene, B., Nicod, L., Marcos, M., Palmero, D.J., Palmieri, F., Papavasileiou, A., Payen, M.C., Pontarelli, A., Quiros, S., Rendon, A., Saderi, L., Smite, A., Solovic, I., Souleymane, M.B., Tadolini, M., Boom, M. van den, Vescovo, M., Viggiani, P., Yedilbayev, A., Zablockis, R., Zhurkin, D., Zignol, M., Visca, D., Spanevello, A., Caminero, J.A., Alffenaar, J.W.C., Tiberi, S., Centis, R., D'Ambrosio, L., Pontali, E., Sotgiu, G., and Migliori, G.B.

Abstract

Item does not contain fulltext, The World Health Organization (WHO) recommends that countries implement pharmacovigilance and collect information on active drug safety monitoring (aDSM) and management of adverse events.The aim of this prospective study was to evaluate the frequency and severity of adverse events to anti-tuberculosis (TB) drugs in a cohort of consecutive TB patients treated with new (i.e. bedaquiline, delamanid) and repurposed (i.e. clofazimine, linezolid) drugs, based on the WHO aDSM project. Adverse events were collected prospectively after attribution to a specific drug together with demographic, bacteriological, radiological and clinical information at diagnosis and during therapy. This interim analysis included patients who completed or were still on treatment at time of data collection.Globally, 45 centres from 26 countries/regions reported 658 patients (68.7% male, 4.4% HIV co-infected) treated as follows: 87.7% with bedaquiline, 18.4% with delamanid (6.1% with both), 81.5% with linezolid and 32.4% with clofazimine. Overall, 504 adverse event episodes were reported: 447 (88.7%) were classified as minor (grade 1-2) and 57 (11.3%) as serious (grade 3-5). The majority of the 57 serious adverse events reported by 55 patients (51 out of 57, 89.5%) ultimately resolved. Among patients reporting serious adverse events, some drugs held responsible were discontinued: bedaquiline in 0.35% (two out of 577), delamanid in 0.8% (one out of 121), linezolid in 1.9% (10 out of 536) and clofazimine in 1.4% (three out of 213) of patients. Serious adverse events were reported in 6.9% (nine out of 131) of patients treated with amikacin, 0.4% (one out of 221) with ethionamide/prothionamide, 2.8% (15 out of 536) with linezolid and 1.8% (eight out of 498) with cycloserine/terizidone.The aDSM study provided valuable information, but implementation needs scaling-up to support patient-centred care.

Published
2019

4. Surveillance of adverse events in the treatment of drug-resistant tuberculosis: first global report

Author

José-María García-García, Jerker Jonsson, Fabrizio Palmieri, Luigi Codecasa, Matteo Zignol, Andrei Maryandyshev, Qingshan Cai, Domingo Palmero, Magnolia Nieto Marcos, Seifeldin Eltaeb Elamin, Enrique Bernal, Simon Tiberi, Alberto Matteelli, Marisa Vescovo, Judith Bruchfeld, Edita Davidavičienė, Saulius Diktanas, Skaidrius Miliauskas, Rolandas Zablockis, Raquel Duarte, R. Rosso, Martin J. Boeree, Marcela Muñoz-Torrico, Valentina Marchese, Adrian Rendon, Evgeny Belilovski, Sergey Borisov, Zarir F Udwadia, Antoniya Koleva, Jorge De Los Rios, Giovanni Battista Migliori, Ana Garcia, Elena Martínez Robles, Hamdan Mustafa Hamdan, Vygantas Gruslys, Marina Tadolini, Laurent P. Nicod, Laura Saderi, Alena Aleksa, Mahamadou Bassirou Souleymane, Rafael Laniado-Laborín, Vinicio Manfrin, Jesica Mazza-Stalder, Alberto Piubello, Charalampos Moschos, Liga Kuksa, Alexey Filippov, Giovanni Sotgiu, Lia D'Ambrosio, Agostina Pontarelli, Heinke Kunst, Pietro Viggiani, Jan-Willem C. Alffenaar, Emanuele Pontali, Maurizio Ferrarese, Regina Gayoso, Ieva Gaudiesiute, Onno W. Akkerman, Agnese Šmite, Edvardas Danila, Marie-Christine Payen, Justin T Denholm, Jacinta Drakšienė, Blagovesta Gavazova, Wouter Hoefsloot, Elena Khimova, Dina Visca, Askar Yedilbayev, Nadia Escobar Salinas, Julen Cadiñanos Loidi, Sarai Quirós, Ivan Solovic, Jose A. Caminero, Margareth Pretti Dalcolmo, Apostolos Papavasileiou, Gina Gualano, Birutė Nakčerienė, Martin van den Boom, Lina Davies Forsman, Dmitry Zhurkin, Yang Li, Alena Skrahina, Antonio Spanevello, Cecile Magis-Escurra, Masoud Dara, Selene Manga, Jose Joaquin Cebrian Gallardo, Rosella Centis, Microbes in Health and Disease (MHD), Borisov S., Danila E., Maryandyshev A., Dalcolmo M., Miliauskas S., Kuksa L., Manga S., Skrahina A., Diktanas S., Codecasa L.R., Aleksa A., Bruchfeld J., Koleva A., Piubello A., Udwadia Z.F., Akkerman O.W., Belilovski E., Bernal E., Boeree M.J., Loidi J.C., Cai Q., Gallardo J.J.C., Dara M., Davidaviciene E., Forsman L.D., de Los Rios J., Denholm J., Draksiene J., Duarte R., Elamin S.E., Salinas N.E., Ferrarese M., Filippov A., Garcia A., Garcia-Garcia J.-M., Gaudiesiute I., Gavazova B., Gayoso R., Rosso R.G., Gruslys V., Gualano G., Hoefsloot W., Jonsson J., Khimova E., Kunst H., Laniado-Laborin R., Li Y., Magis-Escurra C., Manfrin V., Marchese V., Robles E.M., Matteelli A., Mazza-Stalder J., Moschos C., Munoz-Torrico M., Hamdan H.M., Nakceriene B., Nicod L., Marcos M.N., Palmero D.J., Palmieri F., Papavasileiou A., Payen M.-C., Pontarelli A., Quiros S., Rendon A., Saderi L., Smite A., Solovic I., Souleymane M.B., Tadolini M., Boom M.V.D., Vescovo M., Viggiani P., Yedilbayev A., Zablockis R., Zhurkin D., Zignol M., Visca D., Spanevello A., Caminero J.A., Alffenaar J.-W., Tiberi S., Centis R., D'Ambrosio L., Pontali E., Sotgiu G., and Migliori G.B.

Subjects
Adult, Male, Pulmonary and Respiratory Medicine, medicine.medical_specialty, Tuberculosis, Drug-Related Side Effects and Adverse Reactions, Antitubercular Agents, Terizidone, Clofazimine, Antitubercular Agent, Pharmacovigilance, chemistry.chemical_compound, Internal medicine, Tuberculosis, Multidrug-Resistant, medicine, Humans, Prospective Studies, Adverse effect, Aged, business.industry, Middle Aged, medicine.disease, Prospective Studie, lnfectious Diseases and Global Health Radboud Institute for Health Sciences [Radboudumc 4], chemistry, Tolerability, Female, Delamanid, Bedaquiline, Drug-Related Side Effects and Adverse Reaction, business, Human, medicine.drug
Abstract

The World Health Organization (WHO) recommends that countries implement pharmacovigilance and collect information on active drug safety monitoring (aDSM) and management of adverse events.The aim of this prospective study was to evaluate the frequency and severity of adverse events to anti-tuberculosis (TB) drugs in a cohort of consecutive TB patients treated with new (i.e. bedaquiline, delamanid) and repurposed (i.e. clofazimine, linezolid) drugs, based on the WHO aDSM project. Adverse events were collected prospectively after attribution to a specific drug together with demographic, bacteriological, radiological and clinical information at diagnosis and during therapy. This interim analysis included patients who completed or were still on treatment at time of data collection.Globally, 45 centres from 26 countries/regions reported 658 patients (68.7% male, 4.4% HIV co-infected) treated as follows: 87.7% with bedaquiline, 18.4% with delamanid (6.1% with both), 81.5% with linezolid and 32.4% with clofazimine. Overall, 504 adverse event episodes were reported: 447 (88.7%) were classified as minor (grade 1–2) and 57 (11.3%) as serious (grade 3–5). The majority of the 57 serious adverse events reported by 55 patients (51 out of 57, 89.5%) ultimately resolved. Among patients reporting serious adverse events, some drugs held responsible were discontinued: bedaquiline in 0.35% (two out of 577), delamanid in 0.8% (one out of 121), linezolid in 1.9% (10 out of 536) and clofazimine in 1.4% (three out of 213) of patients. Serious adverse events were reported in 6.9% (nine out of 131) of patients treated with amikacin, 0.4% (one out of 221) with ethionamide/prothionamide, 2.8% (15 out of 536) with linezolid and 1.8% (eight out of 498) with cycloserine/terizidone.The aDSM study provided valuable information, but implementation needs scaling-up to support patient-centred care.

Published
2019

5. New evidence of the presence of micro- and nanoplastic particles in bronchioalveolar lavage samples of clinical trial subjects.

Author

Uogintė I, Vailionytė A, Skapas M, Bolanos D, Bagurskienė E, Gruslys V, Aldonytė R, and Byčenkienė S

Abstract

This is the first study reporting the presence of airborne nano-sized plastic particles in the bronchoalveolar lavage fluid (BALF) samples of patients undergoing diagnostic bronchoscopy. The results represent the plastic pollution content in the lower airways of the residents of Northern Europe. Airborne micro- and nanoplastic particles (MP/NPs) are widely dispersed worldwide and intrude on human organisms to various extents, with the respiratory tract being the first line of exposure. The amounts of inhaled MP/NPs, their fate in the human respiratory tract, and the effects on the health of human airways and other exposed organs remain largely unknown. In this clinical study, human BALF samples were assessed by means of optical and transmission electron microscopy coupled with energy-dispersive X-ray spectroscopy (TEM-EDX). Results show that MP/NPs levels vary in the interval of 0.14-12.8 particles per 100 ml of BALF and are present in all samples tested, mainly in a fragmented form. External pollution by MP/NPs was excluded by carefully choosing methodology and equipment. This finding is a timely addition of valuable information and stimulates further research into the biological effects of inhaled MP/NPs., Competing Interests: The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (© 2023 The Authors.)

Published
2023
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6. Lymphocyte Subsets and Pulmonary Nodules to Predict the Progression of Sarcoidosis.

Author

Danila E, Aleksonienė R, Besusparis J, Gruslys V, Jurgauskienė L, Laurinavičienė A, Laurinavičius A, Mainelis A, Zablockis R, Zeleckienė I, Žurauskas E, and Malickaitė R

Abstract

The search for biological markers, which allow a relatively accurate assessment of the individual course of pulmonary sarcoidosis at the time of diagnosis, remains one of the research priorities in this field of pulmonary medicine. The aim of our study was to investigate possible prognostic factors for pulmonary sarcoidosis with a special focus on cellular immune inflammation markers. A 2-year follow-up of the study population after the initial prospective and simultaneous analysis of lymphocyte activation markers expression in the blood, as well as bronchoalveolar lavage fluid (BALF) and lung biopsy tissue of patients with newly diagnosed pulmonary sarcoidosis, was performed. We found that some blood and BAL fluid immunological markers and lung computed tomography (CT) patterns have been associated with a different course of sarcoidosis. We revealed five markers that had a significant negative association with the course of sarcoidosis (worsening pulmonary function tests and/or the chest CT changes)-blood CD4+CD31+ and CD4+CD44+ T lymphocytes, BALF CD8+CD31+ and CD8+CD103+ T lymphocytes and a number of lung nodules on chest CT at the time of the diagnosis. Cut-off values, sensitivity, specificity and odds ratio for predictors of sarcoidosis progression were calculated. These markers may be reasonable predictors of sarcoidosis progression.

Published
2023
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7. Age as a Risk Factor in the Occurrence of Complications during or after Bronchoscopic Lung Biopsy.

Author

Pocienė I, Gauronskaitė R, Galkauskas D, Mainelis A, Gruslys V, and Danila E

Abstract

Introduction: Bronchoscopic lung biopsy (BLB) is a widely used procedure. As the world's population is ageing, more BLBs are performed for older people with comorbidities. The aim of the study was to investigate if an older age is a risk factor for BLB related complications., Materials and Methods: A prospective study at the Centre of Pulmonology and Allergology of Vilnius University Hospital Santaros klinikos was conducted. Seven hundred and eighty-six patients (male 60.6%), mean age 57 ± 16, who underwent BLB, were included. The complications that occurred due to BLB were evaluated. Bleeding and pneumothorax were classified into I° or II° grades depending on their severity. Potential determinants, which may increase the risk of complications, emphasizing on age, were analyzed., Results: Fifty-seven (7.2%) BLB-related complications occurred. There were 27 (3.4%) pneumothoraxes, and 19 (70%) of them required thoracic drainage. Thirty (3.8%) bleeding complications occurred, and four (16%) of them were severe. Higher rates of bleeding were found in the age group ≥65 years, p = 0.001. The risk of bleeding in older patients was 3.2 times higher (95% CI 1.51-6.87)., Conclusions: Older age is related to a higher incidence of mild bleeding during BLB. However, the risk of life-threatening complications is low despite the age, and older age should not be considered as a contraindication for the procedure if needed.

Published
2022
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8. Systemic Inflammatory Response to Different Sclerosing Agents as a Predictor of Pleurodesis Outcome.

Author

Zablockis R, Danila E, Gruslys V, and Cincilevičiūtė G

Subjects
Humans, Retrospective Studies, Systemic Inflammatory Response Syndrome, Talc, Treatment Outcome, Pleurodesis, Sclerosing Solutions
Abstract

Background/aim: The objectives of this study were to evaluate systemic inflammation using different sclerosing agents and to estimate the prediction of systemic inflammation for the efficacy of pleurodesis., Patients and Methods: Ninety-six patients with recurrent and symptomatic malignant pleural effusion were enrolled in this retrospective study. We used serum C-reactive protein (CRP) levels, serum leukocyte counts and neutrophil-to-lymphocyte ratios (NLRs) as parameters of systemic inflammatory reactions. Evaluations of these parameters were performed before and 24 h after pleurodesis., Results: Pleurodesis was successful in 81 (84.4%) patients. The non-graded talc induced the highest changes in serum CRP levels, total white blood cell and neutrophil counts compared to other agents, while mitoxantrone induced the lowest. Graded talc and bleomycin induced the same levels of changes in serum CRP levels and serum leukocyte counts. The change in serum NLR was the same for all agent groups. Logistic regression confirmed that a change in serum CRP levels [odds ratio (OR)=0.92, p=0.002] and previous chemotherapy (OR=3.31, p=0.012) were independent predictors of pleurodesis efficacy., Conclusion: Pleurodesis agents induced a systemic inflammatory response at different levels. The change in serum CRP levels could be useful for predicting the success of pleurodesis., (Copyright © 2021 International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Published
2021
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9. Follow-Up Analysis of Pulmonary Function, Exercise Capacity, Radiological Changes, and Quality of Life Two Months after Recovery from SARS-CoV-2 Pneumonia.

Author

Strumiliene E, Zeleckiene I, Bliudzius R, Samuilis A, Zvirblis T, Zablockiene B, Strumila A, Gruslys V, Malinauskiene L, Kasiulevicius V, and Jancoriene L

Subjects
Exercise Tolerance, Female, Follow-Up Studies, Humans, Lung diagnostic imaging, Male, Middle Aged, Quality of Life, SARS-CoV-2, COVID-19, Pneumonia
Abstract

Background and objective : According to the World Health Organization (WHO), more than 100 million people have already recovered from SARS-CoV-2 infection. Therefore, it is imperative to understand the possible outcomes of COVID-19. The aim of our study was to evaluate pulmonary function, exercise capacity, residual radiological changes, and health-related quality of life (HRQoL) at follow-up in a cohort of SARS-CoV-2 pneumonia survivors. Materials and Methods : Patients with SARS-CoV-2 infection and radiologically confirmed lung injury, with no chronic lung disease prior to this infection, were included in the study. Patients' evaluation 2 months after their discharge from hospital included spirometry (FVC, FEV1, FEV1/FVC), determination of lung volume (TLC, VC, RV) and diffusing capacity of lung for carbon monoxide (DLCO, adjusted for hemoglobin), 6-Minute Walk Test (6MWT), chest CT scan, and 36-Item Short Form General Health Survey (SF-36). Results: Fifty-one patients (25 men, 26 women) were included. The mean age was 56 years (SD-11,72). Eighteen patients (35.3%) had experienced moderate COVID-19, 21 (41.2%) severe COVID-19, and 12 (23.5%) were critically ill. The mean follow-up visit time after the discharge from hospital was 60 days (SD-17). Pulmonary function at follow-up was impaired in 24 (47.2%) patients. Reduced lung volume was observed in 15 (29.4%) patients, DLCO reduction in 15 (29.4%) patients, and only one patient displayed obstruction. Twelve patients out of 51 (12/51, 27.3%) showed reduced physical capacity in the 6 MWT, and 3/51 (9.1%) showed desaturation, with SO2 < 90%. Different levels of abnormality were found in 49/51 (96,1%) patients on follow-up chest CT; the median radiological score was 10.9 (SD ± 8.87, possible maximal score, 25). Ground-glass opacity was the most common radiological feature, found in 45 (88.2%) patients. The SF-36 scores demonstrated a reduction in health status across all domains, with the lowest scores for limitations in social activities because of physical problems, vitality, and general health. Conclusion: In the group of COVID-19 pneumonia survivors 2 months after hospital discharge, residual changes in the lungs on chest CT and in lung function and reduced physical and HRQoL status were found in a significant number of patients. To evaluate COVID-19 long-term consequences, a longer follow-up period is needed.

Published
2021
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10. CD31 + , CD38 + , CD44 + , and CD103 + lymphocytes in peripheral blood, bronchoalveolar lavage fluid and lung biopsy tissue in sarcoid patients and controls.

Author

Aleksonienė R, Besusparis J, Gruslys V, Jurgauskienė L, Laurinavičienė A, Laurinavičius A, Malickaitė R, Norkūnienė J, Zablockis R, Žurauskas E, and Danila E

Abstract

Background: The mechanisms driving the transition from inflammation to fibrosis in sarcoidosis patients are poorly understood; prognostic features are lacking. Immune cell profiling may provide insights into pathogenesis and prognostic factors of the disease. This study aimed to establish associations in simultaneous of lymphocyte subset profiles in the blood, bronchoalveolar lavage fluid (BALF), and lung biopsy tissue in the patients with newly diagnosed sarcoidosis., Methods: A total of 71 sarcoid patients (SPs) and 20 healthy controls (HCs) were enrolled into the study. CD31, CD38, CD44, CD103 positive T lymphocytes in blood and BALF were analysed. Additionally, the densities of CD4, CD8, CD38, CD44, CD103 positive cells in lung tissue biopsies were estimated by digital image analysis., Results: Main findings: (I) increase of percentage of CD3 + CD4 + CD38 + in BALF and blood, and increase of percentage of CD3 + CD4 + CD44 + in BALF in Löfgren syndrome patients comparing with patients without Löfgren syndrome, (II) increase of percentage of CD3 + CD4 + 103 + in BALF and in blood in patients without Löfgren syndrome (comparing with Löfgren syndrome patients) and increase of percentage of CD3 + CD4 + 103 + in BALF and in blood in more advanced sarcoidosis stage. (III) Increasing percentage of BALF CD3 + CD4 + CD31 + in sarcoidosis patients when comparing with controls independently of presence of Löfgren syndrome, smoking status or stage of sarcoidosis. Several significant correlations were found., Conclusions: Lymphocyte subpopulations in blood, BALF, and lung tissue were substantially different in SPs at the time of diagnosis compared to HCs. CD3 + CD4 + CD31 + in BALF might be a potential supporting marker for the diagnosis of sarcoidosis. CD3 + CD4 + CD38 + in BALF and blood and CD3 + CD4 + CD44 + in BALF may be markers of the acute immune response in sarcoidosis patients. CD4 + CD103 + T-cells in BALF and in blood are markers of the persistent immune response in sarcoidosis patients and are potential prognostic features of the chronic course of this disease., Competing Interests: Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/jtd-20-2396). The authors have no conflicts of interest to declare., (2021 Journal of Thoracic Disease. All rights reserved.)

Published
2021
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11. Case of Severe Treatment-Resistant Cryptogenic Organizing Pneumonia.

Author

Grigoravičius D, Žurauskas E, Gruslys V, Zablockis R, and Danila E

Abstract

Cryptogenic organizing pneumonia is a rare interstitial lung disease with different onset of symptoms, which responds rapidly to glucocorticoid treatment. We present a case of cryptogenic organizing pneumonia which manifested as a progressive 3-year dyspnea that ultimately has led to acute respiratory failure. Moreover, treatment with prednisone for this patient exhibited slow onset of the effect., (Copyright © 2021 Domas Grigoravičius, Edvardas Žurauskas, Vygantas Gruslys, Rolandas Zablockis, Edvardas Danila.)

Published
2021
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12. A Cohort Study of Exposure to Antihyperglycemic Therapy and Survival in Patients with Lung Cancer.

Author

Danila E, Linkevičiūtė-Ulinskienė D, Zablockis R, Gruslys V, Cicėnas S, and Smailytė G

Subjects
Cohort Studies, Female, Humans, Male, Diabetes Mellitus, Type 2, Hypoglycemic Agents, Lung Neoplasms epidemiology, Metformin
Abstract

We evaluated the effect of antihyperglycemic therapy on the survival of patients with lung cancer (LC). The analysis included patients with LC and concomitant type 2 diabetes. 15,929 patients were classified into five groups: metformin users, insulin users, metformin and insulin users, sulphonylurea users and non-diabetic group. A multivariate analysis showed that exposure to either metformin or to insulin was associated with a lower risk of LC-specific mortality, and this approached statistical significance (HR 0.82, 95% CI 0.72-92 for metformin and HR 0.65, 95% CI 0.44-95 for insulin). When deaths from all causes were considered, only metformin exposure was associated with a significantly lower risk of death (HR 0.82, 95% CI 0.73-0.92). Users of sulphonylurea were at a higher risk of LC-specific and overall mortality (HRs 1.19, 95% CI 0.99-1.43 and 1.22, 95% CI 1.03-1.45). Our study shows a positive effect of metformin on the survival of patients with LC. Moreover, our results show that exposure to insulin was associated with a lower risk of LC-specific mortality, but not with deaths from all causes. The study results suggested that users of sulphonylurea may be at a higher risk of LC-specific and overall mortality.

Published
2020
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13. Surveillance of adverse events in the treatment of drug-resistant tuberculosis: first global report.

Author

Borisov S, Danila E, Maryandyshev A, Dalcolmo M, Miliauskas S, Kuksa L, Manga S, Skrahina A, Diktanas S, Codecasa LR, Aleksa A, Bruchfeld J, Koleva A, Piubello A, Udwadia ZF, Akkerman OW, Belilovski E, Bernal E, Boeree MJ, Cadiñanos Loidi J, Cai Q, Cebrian Gallardo JJ, Dara M, Davidavičienė E, Forsman LD, De Los Rios J, Denholm J, Drakšienė J, Duarte R, Elamin SE, Escobar Salinas N, Ferrarese M, Filippov A, Garcia A, García-García JM, Gaudiesiute I, Gavazova B, Gayoso R, Gomez Rosso R, Gruslys V, Gualano G, Hoefsloot W, Jonsson J, Khimova E, Kunst H, Laniado-Laborín R, Li Y, Magis-Escurra C, Manfrin V, Marchese V, Martínez Robles E, Matteelli A, Mazza-Stalder J, Moschos C, Muñoz-Torrico M, Mustafa Hamdan H, Nakčerienė B, Nicod L, Nieto Marcos M, Palmero DJ, Palmieri F, Papavasileiou A, Payen MC, Pontarelli A, Quirós S, Rendon A, Saderi L, Šmite A, Solovic I, Souleymane MB, Tadolini M, van den Boom M, Vescovo M, Viggiani P, Yedilbayev A, Zablockis R, Zhurkin D, Zignol M, Visca D, Spanevello A, Caminero JA, Alffenaar JW, Tiberi S, Centis R, D'Ambrosio L, Pontali E, Sotgiu G, and Migliori GB

Subjects
Adult, Aged, Female, Humans, Male, Middle Aged, Pharmacovigilance, Prospective Studies, Antitubercular Agents adverse effects, Drug-Related Side Effects and Adverse Reactions diagnosis, Drug-Related Side Effects and Adverse Reactions epidemiology, Tuberculosis, Multidrug-Resistant drug therapy
Abstract

The World Health Organization (WHO) recommends that countries implement pharmacovigilance and collect information on active drug safety monitoring (aDSM) and management of adverse events.The aim of this prospective study was to evaluate the frequency and severity of adverse events to anti-tuberculosis (TB) drugs in a cohort of consecutive TB patients treated with new ( i.e. bedaquiline, delamanid) and repurposed ( i.e. clofazimine, linezolid) drugs, based on the WHO aDSM project. Adverse events were collected prospectively after attribution to a specific drug together with demographic, bacteriological, radiological and clinical information at diagnosis and during therapy. This interim analysis included patients who completed or were still on treatment at time of data collection.Globally, 45 centres from 26 countries/regions reported 658 patients (68.7% male, 4.4% HIV co-infected) treated as follows: 87.7% with bedaquiline, 18.4% with delamanid (6.1% with both), 81.5% with linezolid and 32.4% with clofazimine. Overall, 504 adverse event episodes were reported: 447 (88.7%) were classified as minor (grade 1-2) and 57 (11.3%) as serious (grade 3-5). The majority of the 57 serious adverse events reported by 55 patients (51 out of 57, 89.5%) ultimately resolved. Among patients reporting serious adverse events, some drugs held responsible were discontinued: bedaquiline in 0.35% (two out of 577), delamanid in 0.8% (one out of 121), linezolid in 1.9% (10 out of 536) and clofazimine in 1.4% (three out of 213) of patients. Serious adverse events were reported in 6.9% (nine out of 131) of patients treated with amikacin, 0.4% (one out of 221) with ethionamide/prothionamide, 2.8% (15 out of 536) with linezolid and 1.8% (eight out of 498) with cycloserine/terizidone.The aDSM study provided valuable information, but implementation needs scaling-up to support patient-centred care., Competing Interests: Conflict of interest: S. Borisov has nothing to disclose. Conflict of interest: E. Danila has nothing to disclose. Conflict of interest: A. Maryandyshev has nothing to disclose. Conflict of interest: M. Dalcolmo has nothing to disclose. Conflict of interest: S. Miliauskas has nothing to disclose. Conflict of interest: L. Kuksa reports personal fees for trial participation from Otsuka and Tibotec, personal fees for lectures from Johnson and Johnson Services Inc., outside the submitted work. Conflict of interest: S. Manga has nothing to disclose. Conflict of interest: A. Skrahina has nothing to disclose. Conflict of interest: S. Diktanas reports personal fees for trial participation from Otsuka, grants for meeting attendance from Janssen (Sirturo), outside the submitted work. Conflict of interest: L.R. Codecasa has nothing to disclose. Conflict of interest: A. Aleksa has nothing to disclose. Conflict of interest: J. Bruchfeld has nothing to disclose. Conflict of interest: A. Koleva has nothing to disclose. Conflict of interest: A. Piubello has nothing to disclose. Conflict of interest: Z.F. Udwadia has nothing to disclose. Conflict of interest: O.W. Akkerman has nothing to disclose. Conflict of interest: E. Belilovski has nothing to disclose. Conflict of interest: E. Bernal has nothing to disclose. Conflict of interest: M.J. Boeree has nothing to disclose. Conflict of interest: J. Cadiñanos Loidi has nothing to disclose. Conflict of interest: Q. Cai has nothing to disclose. Conflict of interest: J.J. Cebrian Gallardo has nothing to disclose. Conflict of interest: M. Dara has nothing to disclose. Conflict of interest: E. Davidavičienė has nothing to disclose. Conflict of interest: L. Davies Forsman has nothing to disclose. Conflict of interest: J. De Los Rios has nothing to disclose. Conflict of interest: J. Denholm has nothing to disclose. Conflict of interest: J. Drakšienė has nothing to disclose. Conflict of interest: R. Duarte has nothing to disclose. Conflict of interest: S.E. Elamin has nothing to disclose. Conflict of interest: N. Escobar Salinas has nothing to disclose. Conflict of interest: M. Ferrarese has nothing to disclose. Conflict of interest: A. Filippov has nothing to disclose. Conflict of interest: A. Garcia has nothing to disclose. Conflict of interest: J.M. García-García has nothing to disclose. Conflict of interest: I. Gaudiesiute has nothing to disclose. Conflict of interest: B. Gavazova has nothing to disclose. Conflict of interest: R. Gayoso has nothing to disclose. Conflict of interest: R. Gomez Rosso has nothing to disclose. Conflict of interest: V. Gruslys has nothing to disclose. Conflict of interest: G. Gualano has nothing to disclose. Conflict of interest: W. Hoefsloot has nothing to disclose. Conflict of interest: J. Jonsson has nothing to disclose. Conflict of interest: E. Khimova has nothing to disclose. Conflict of interest: H. Kunst has nothing to disclose. Conflict of interest: R. Laniado-Laborín has nothing to disclose. Conflict of interest: Y. Li has nothing to disclose. Conflict of interest: C. Magis-Escurra has nothing to disclose. Conflict of interest: V. Manfrin has nothing to disclose. Conflict of interest: V. Marchese has nothing to disclose. Conflict of interest: E. Martínez Robles has nothing to disclose. Conflict of interest: A. Matteelli has nothing to disclose. Conflict of interest: J. Mazza-Stalder has nothing to disclose. Conflict of interest: C. Moschos has nothing to disclose. Conflict of interest: M. Muñoz-Torrico has nothing to disclose. Conflict of interest: H. Mustafa Hamdan has nothing to disclose. Conflict of interest: B. Nakčerienė has nothing to disclose. Conflict of interest: L. Nicod has nothing to disclose. Conflict of interest: M. Nieto Marcos has nothing to disclose. Conflict of interest: D.J. Palmero has nothing to disclose. Conflict of interest: F. Palmieri has nothing to disclose. Conflict of interest: A. Papavasileiou has nothing to disclose. Conflict of interest: M-C. Payen has nothing to disclose. Conflict of interest: A. Pontarelli has nothing to disclose. Conflict of interest: S. Quirós has nothing to disclose. Conflict of interest: A. Rendon has nothing to disclose. Conflict of interest: L. Saderi has nothing to disclose. Conflict of interest: A. Šmite has nothing to disclose. Conflict of interest: I. Solovic has nothing to disclose. Conflict of interest: M.B. Souleymane has nothing to disclose. Conflict of interest: M. Tadolini has nothing to disclose. Conflict of interest: M. van den Boom has nothing to disclose. Conflict of interest: M. Vescovo has nothing to disclose. Conflict of interest: P. Viggiani has nothing to disclose. Conflict of interest: A. Yedilbayev has nothing to disclose. Conflict of interest: R. Zablockis has nothing to disclose. Conflict of interest: D. Zhurkin has nothing to disclose. Conflict of interest: M. Zignol has nothing to disclose. Conflict of interest: D. Visca has nothing to disclose. Conflict of interest: A. Spanevello has nothing to disclose. Conflict of interest: J.A. Caminero has nothing to disclose. Conflict of interest: J-W. Alffenaar has nothing to disclose. Conflict of interest: S. Tiberi has nothing to disclose. Conflict of interest: R. Centis has nothing to disclose. Conflict of interest: L. D'Ambrosio has nothing to disclose. Conflict of interest: E. Pontali has nothing to disclose. Conflict of interest: G. Sotgiu has nothing to disclose. Conflict of interest: G.B. Migliori has nothing to disclose., (Copyright ©ERS 2019.)

Published
2019
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14. Prognostic Value of Thyroid Transcription Factor-1 Expression in Patients with Advanced Lung Adenocarcinoma.

Author

Zablockis R, Žurauskas E, Danila E, and Gruslys V

Subjects
Adenocarcinoma of Lung epidemiology, Adenocarcinoma of Lung genetics, Adenocarcinoma of Lung pathology, Adult, Aged, Aged, 80 and over, Disease-Free Survival, ErbB Receptors genetics, Female, Gene Expression Regulation, Neoplastic drug effects, Humans, Male, Middle Aged, Mutation, Neoplasm Staging, Protein Kinase Inhibitors administration & dosage, Adenocarcinoma of Lung drug therapy, DNA-Binding Proteins genetics, Prognosis, Transcription Factors genetics
Abstract

Background/aim: The prognostic role of thyroid transcription factor-1 (TTF1) in advanced lung cancer is not clearly established. The present study aimed to evaluate the associations between clinicopathological characteristics, TTF1 expression, and overall survival (OS) of patients with advanced lung adenocarcinoma., Materials and Methods: One hundred and seventy-two patients were enrolled in this retrospective study. OS was assessed according to immunohistochemical TTF1 expression in lung adenocarcinoma tissue, age, gender, performance status (PS), smoking history and status, disease stage, tumor differentiation, epidermal growth factor receptor (EGFR) mutation and EGFR tyrosine kinase inhibitor (TKI) treatment status., Results: The OS time was longer (p<0.001) for patients with TTF1 expression than for patients without TTF1 expression (13.0 vs. 5.0 months, respectively). A multivariate analysis confirmed that worse PS [hazard ratio (HR)=2.13, p<0.001], poor histological differentiation (HR=2.02, p=0.001), wild-type EGFR status (HR=3.08, p<0.001) and negative TTF1 expression (HR=1.97, p=0.001) were independent predictors of worse prognosis., Conclusion: TTF1 expression is an independent predictor of survival of patients with advanced lung adenocarcinoma., (Copyright© 2018, International Institute of Anticancer Research (Dr. George J. Delinasios), All rights reserved.)

Published
2018
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15. Relationship between radiologic patterns, pulmonary function values and bronchoalveolar lavage fluid cells in newly diagnosed sarcoidosis.

Author

Aleksonienė R, Zeleckienė I, Matačiūnas M, Puronaitė R, Jurgauskienė L, Malickaitė R, Strumilienė E, Gruslys V, Zablockis R, and Danila E

Abstract

Background: The aim of the present study was to identify specious radiologic and/or physiologic prognostic marker(s), which lead to optimize of the patient follow-up frequency., Methods: Eighty consecutive patients with newly diagnosed pulmonary sarcoidosis. Patients underwent chest radiography, high-resolution computed tomography (HRCT) examination, pulmonary function tests (PFT), bronchoscopy with bronchoalveolar lavage (BAL) and lung biopsy, and bronchoalveolar lavage fluid (BALF) cell examination., Results: The reduction in PFT values seen in radiological sarcoidosis stage III was greater than that seen in stages I and II. The percentage of neutrophils in the lungs was found to increase in stages II and III. PFT indices were correlated negatively with the consolidation and ground glass opacities CT scores, but not with the micronodule or macronodule scores. The rise in the percentage of BALF lymphocytes was associated with the restriction pattern of PFT. The diagnostic value of BALF for sarcoidosis was higher when the typical radiologic patterns of stage I disease were found and that smoking decreased the diagnostic value of CD4/CD8 ratio., Conclusions: This study supports the opinion that the staging of the pulmonary sarcoidosis with chest X-rays is still valuable from the prognostic point of view, because significant correlations between the radiologic stages of sarcoidosis and PFT parameters were found. Chest HRCT was significantly superior to chest X-ray in detecting mediastinal and pulmonary parenchymal changes. However, the prognostic role of HRCT needs to be better investigated evaluating serial examinations. Only consolidation and ground glass scores (neither of which are frequently found in sarcoidosis) hold prognostic value, since these were negatively correlated with PFT parameters., Competing Interests: Conflicts of Interest: The authors have no conflicts of interest to declare.

Published
2017
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16. Fatal pulmonary complication during induction therapy in a patient with ANCA-associated vasculitis.

Author

Jonaitytė B, Kibarskytė R, Danila E, Miglinas M, Šeinin D, Stulpinas R, Mitrikevičienė J, Gruslys V, Šileikienė V, and Zablockis R

Abstract

ANCA-associated vasculitis (AAV) is an inflammatory systemic disorder affecting small to medium sized vessels and likely leading to any organ dysfunction. Adequate treatment is important to avoid mortality or severe organ damage. In most cases initial treatment (induction therapy) allows to achieve remission. Induction therapy leads to immunosuppression and may cause severe infections. However, in vasculitis patients even an intensive immunosuppressive therapy is rarely complicated by an invasive fungal infection. We present a case in a 29-year old male patient with newly diagnosed AAV. He suffered a fatal pulmonary complication of the induction immunosuppressive treatment. Pathological (infectious) changes in the lungs were misinterpreted as progression of the vasculitis and he died due to disseminated angioinvasive aspergillosis. A clinical course, imaging and histopathology of this case are described and discussed.

Published
2016
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17. A fast and fatal course of bronchiectasis: an unusual rare expression of chronic graft versus host disease. A case report.

Author

Labžentytė V, Zemnickienė S, Danila E, Šileikienė V, Zablockis R, and Gruslys V

Abstract

Introduction. We report a case of a patient with acute myeloid leukaemia whose treatment with bone marrow transplantation (BMT) was followed by chronic graft versus host disease (GVHD) with lung involvement and bronchiectasis. This report illustrates an unusual course of a fast progression of the bronchiectasis due to BMT. Case description. A 33-year-old female was diagnosed with acute myeloid leukaemia. An allogeneic BMT was performed. One month after the transplantation, acute GVHD with skin involvement occurred. Treatment with prednisolone and mycophenolate mofetil (MMF) has been started. Nine months later, the patient was examined by a pulmonologist due to progressive dyspnoea. A pulmonary computed tomography (CT) scan showed normal parenchyma of the lungs and no changes to the bronchi. A CT scan performed 7 months later revealed bronchiectasis for the first time. No clinical response was associated with the treatment and the patient's respiratory status progressively deteriorated. During the final hospitalization, a CT scan performed 1 year later revealed huge cystic bronchiectasis in both lungs. Despite the prophylaxis and treatment of GVHD and aggressive antimicrobial therapy, the patient died one year after the diagnosis of bronchiectasis. Conclusions. This case demonstrates that a fast and fatal course of bronchiectasis, that occurs after BMT, should always be considered as a possible manifestation of chronic graft versus host disease (cGVHD) following allogeneic BMT.

Published
2016
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18. [Esophageal achalasia].

Author

Zilinskas A, Janilionis R, Sucila A, Gruslys V, and Nekrasas V

Subjects
Esophageal Achalasia diagnostic imaging, Esophageal Achalasia surgery, Female, Humans, Male, Radiography, Recurrence, Treatment Outcome, Catheterization, Esophageal Achalasia therapy
Abstract

Unlabelled: The purpose of this study was to analyze results of pneumatic dilatation due to esophageal achalasia at the Clinic of General Thoracic Surgery of Vilnius University., Material and Methods: During 25-year period (1973-1998) we have treated 133 achalasia patients. On 125 patients pneumatic dilatation was performed. One hundred five (84%) patients recovered fully. Single course of pneumatic dilatations was sufficient. Recurrence rate was 16% - 3 courses of pneumatic dilatations were performed on 2 (1.6%), 2 - on 18 (14.4%) patients. Complications. The major complication of pneumatic dilatation is esophageal perforation. Most series report its incidence at about 2%. In our study 2 cases (1.6%) of esophageal perforation occurred. Both patients were operated immediately. One (0.8%) died because of purulent complications., Conclusion: Pneumatic dilatation is safe and effective method of treatment. In our opinion, it would be the best initial approach. If it failed, then myotomy would be treatment of choice.

Published
2002

19. [Odontogenic mediastinitis. Diagnostics and treatment].

Author

Kiskis G, Gruslys V, Jovaisas V, Kybartas A, Liubertiene I, Narbutas J, Zilinskas A, Sucila A, and Janilionis R

Subjects
Adult, Aged, Cellulitis complications, Drainage, Empyema, Pleural surgery, Female, Humans, Male, Mediastinitis diagnosis, Mediastinitis diagnostic imaging, Mediastinitis mortality, Mediastinitis surgery, Middle Aged, Radiography, Thoracic, Thoracotomy, Tomography, X-Ray Computed, Mediastinitis etiology, Periodontal Abscess complications
Abstract

Unlabelled: The aim of our work was to evaluate the diagnostic and treatment of patients with odontogenic mediastinitis., Methods: The last 10 years (1991-2001) 13 males and 4 females, mean age 43 years, with odontogenic mediastinitis were submitted to surgical treatment. Primary odontogenic abscess occurred in all. Before admission to our clinic, 14 patients were treated at stomatological department. Diagnosis was made by clinical manifestation, roentgenographical features and confirmed by findings at mediastinum tissues during operation., Results: All patients at the admission day underwent broad cervicotomies with transcervical mediastinal drainage. In 5 cases this management was associated with mediastinal drainage by transthoracic approach. For another 5 patients thoracotomies were performed late, the last 7 survived without thoracotomy. Six patient died, mortality rate was 35.2%. The reason of the high mortality rate-delay of transthoracic mediastinal drainage in 5 cases, when transcervical was inadequate., Conclusion: Ample cervicotomy, associated with transcervical and transthoracic mediastinal drainage can significantly reduce the mortality rate for odontogenic mediastinitis.

Published
2002

20. [Stent placement in patients with benign esophageal strictures].

Author

Gruslys V

Subjects
Adult, Aged, Esophageal Stenosis surgery, Esophagoscopy, Humans, Middle Aged, Esophageal Stenosis therapy, Stents adverse effects
Abstract

The aim of the study was to evaluate results of esophageal stenting for non-neoplastic strictures. A lot of studies proved esophageal stenting for neoplastic strictures to be a safe and effective method of palliative treatment. However, esophageal stenting for non-neoplastic diseases is a matter of controversion. At the Clinic of Thoracic Surgery of Vilnius University during period of 4 years esophageal stenting for non-neoplastic reasons was performed in 12 patients. After the evolution of the results, it was concluded that self-expanding stents were not suitable for the treatment of non-neoplastic esophageal stenosis. Best results have been achieved implanting into esophagus salivary bypass tubs.

Published
2002

21. [Empyemectomy-treatment of pleural empyema].

Author

Kybartas A, Gruslys V, Kiskis G, Zilinskas A, Narbutas J, Jovaisas V, Liubertiene I, and Janilionis R

Subjects
Adult, Aged, Chest Tubes, Drainage, Humans, Hydropneumothorax etiology, Length of Stay, Middle Aged, Postoperative Complications, Reoperation, Thoracostomy, Time Factors, Empyema, Pleural surgery
Abstract

Empyema thoracis has been recognized as a disease entity since the time of Hippocrates and historically has been associated with high mortality. Over 30 years ago, the American Thoracic Society described three stages in the natural course of empyema, namely the exudative, fibrinopurulent, and organizing phases. Decortication and suction drainage usually result in lung re-expansion, otherwise pleurocutaneous window, intrathoracic transposition of skeletal muscle, or thoracoplasty remain life-saving but now uncommon options for treating a closed-space infection. During last 9 years (1993-2001) 50 patients underwent empyemectomy due to pleural empyema. Three patients died (6%). In 4 cases we had complications-hydropneumothorax. They received punction (3 patients) and 1 received tube toracostomy. In one case urgent retoracotomy was performed due to acute intrapleural bleeding. After successful empyemectomy 47 patients stay at hospital 14 days approximately.

Published
2002

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