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CURRICULUM VITAE
Personal data
First Name: Dionisios
Last Name: Spyratos
Date of birth: 15/08/1973
Place of birth: Athens, Greece
Specialty: Pulmonologist
Residence: Thessaloniki, Greece
Address: Filikis Eterias 26
Kalamaria, Greece (55132)
Work address: Pulmonary Department, Aritotle
University of Thessaloniki, “G. Papanikolaou”
Hospital, Exohi, Thessaloniki,57010
Phone: 00302310410876
Mobile: 00306979490052
E-mail: [email protected]
Marital state: Married and one child
Academic qualifications
Medical Degree: Medical School, University of
Patras, Greece (7.3/10)
PhD: Pathogenetic mechanisms of orthopnea in
patients with congestive heart failure. Studying
respiratory mechanics with impulse oscillometry
system, Thessaloniki 2008
Medical School, Aristotle University of
Thessaloniki, Greece
Medical Specialty
Postgraduate education
Pulmonary Medicine
Pulmonary Department, Medical School, Aristotle
University of Thessaloniki, Greece (19/3/2007)
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Professional activities
Publications (PubMed) / Citations
Hufeland Clinic, Bad Ems (Taunusallee
5, Bad Ems, Germany) on pulmonary
rehabilitation for 3 months
St. Elisabeth und St. Barbara Clinic of
Martin-Luther-Universitat
HalleWittenberg (Mauerstraβe 5, Halle Saale,
Germany) on medical thoracoscopy for 2
months
Lecturer of Pulmonary Medicine, Medical School,
Aristotle University of Thessaloniki, Greece since
04/02/2011
25 / 166
Research programs
As sub-investigator in the following international, multicenter clinical studies accepted by Research
Committee of Aristotle University of Thessaloniki, Greece:
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INSPIRE, code D5125C00288: comparing formoterol as inhaler and turbuhaler in asthmatic
patients
Uplift, code bi205235: 4-year study investigating the effect of tiotropium on the rate of lung
function decline in patients with COPD
Smile, code SD-039-074: comparing formoterol/budesonide, formoterol and terbutaline
administered in an as-needed basis in asthmatic patients who receive standard doses of
formoterol/budesonide
SUN, code D5899C00001: comparing efficacy and safety of the combination
formoterol/budesonide as pMDI with formoterol as turbuhaler in patients with COPD
REACT, code RO-2455-404RD (phase 3/4): investigating the effect of roflumilast on the frequency of
COPD exacerbations versus placebo in patients with COPD who receive fixed combination of LABA/ICS
DB2114930: comparing the efficacy and safety of the combination umeclidinium/vilanderol with
fluticasone propionate / salmeterol in patients with COPD
CQMF149F2202 (phase ΙΙ): comparing the efficacy and safety of the combination QMF149 (indacaterol
150 μg/ Mometasone furoate 160 μg o.d.) with salmeterol hydroxynaphthoate / fluticasone propionate (50
μg / 500 μg b.i.d.) in patients with COPD
Clinical study investigating the effects of fluticasone furoate / vilanterol (100/25mcg) compared
with placebo for the survival of patients with moderate COPD and medical history or
increased risk for cardiovascular diseases.
Table of publications
Type of
Number of 1st
publication publications author
Full articles
in peer
25
6
reviewed
journals
(PubMed)
Full articles
in journals
4
1
not
included in
PubMed
Abstracts in
21
5
journals
included in
PubMed
Full articles
9
in Greek
medical
journals
2nd
3rd
4
>3
Corresp.
author
6
9
4
8
4
3
3
3
2
3
2
Abstracts in
Greek
medical
journals
Chapters in
Greek
medical
educational
books
PhD
31
5
4
9
13
10
1
Table of full publications in peer reviewed journals according to
their impact factor
Journals
Impact factor
Total
3.486
Number of
articles
1
Drug Design,
Development
and Therapy
Onco Targets
Ther
Int J Pharm
Subst Abuse
Treat Prev
Policy
Arch Environ
Occup Health
Virol J
J Aerosol Med
Pulm Drug
Deliv
Prim Care
Respir J
Am J Clin
Oncol
Heart Lung
Am J Ind Med
Ther Adv
Respir Dis
Int J Environ
Res Public
2.073
1
2.073
3.458
1.56
1
1
3.458
1.56
1.194
1
1.194
2.09
2.894
1
1
2.09
2.894
2.19
2
2Χ2.19=4,38
2.552
2
2Χ2.552=5,104
1.404
1.973
0.795
1
2
1
1.404
2Χ1.973=3,946
0.795
2.197
1
2.197
3.486
3
Health
Respiration
Int J Tuberc
Lung Dis
Allergol
Immunopathol
(Madr)
2.615
2.731
2
1
2Χ2.615=5,23
2.731
1.229
1
1.229
Total
43,771
Hirsh index (H-index ή H-factor): 7
Citations: 166
Table of medical congresses
International Congresses
18
Greek Congresses
9
Workshops (ERS)
4
EDUCATION – CAREER – TITLES
I was born in Athens, Greece the 15th of August in 1973. I finished
High School in Mytilene, Greece (degree: 197/11/20) in 1991. I passed the
examination for the Certificate of Proficiency in English (University of
Michigan).
In 1991 I successfully passed the National Examinations and
enrolled in Medical School, University of Patras, Greece. I graduated
from the Medical School in July 1997 with a degree “Very Well (7.3/10).
I worked as a doctor in a Primary Care Center in Mytilene, Greece
from September 1997 to March 1999. I served my military service as a
doctor from March 1999 to September 2000.
4
Then I worked as a primary care doctor in two Nursing Homes
(“St. Dimitrios” and “12 Apostles”) in Thessaloniki from October 2000 to
November 2011.
I worked as a resident in the Pulmonary Department, Medical
School, Aristotle University of Thessaloniki from January 2002 to
January 2007. I successfully passed the examinations for Pulmonary
Medicine and I was awarded the title of Pulmonologist on March 2007
(Identity Number: Γ2/1812, 19-3-2007, Section of Public Health,
Prefecture of Thessaloniki, Greece). From May 2007 to January 2011 I
worked as collaborator of the Pulmonary Department, Aristotle
University of Thessaloniki (AUTh) on research programs of the clinic
and paid through the Research Committee of AUTh. I was teaching for
some months (16/1/08 to 29/02/08 and 01/04/08 to 30/04/08) the topic of
Pulmonary Medicine for the medical students of the 5th year of AUTh. On
the 17th of March in 2008 I was entitled Doctor (PhD) of Aristotle
University of Thessaloniki with the degree of “Excellent”. My PhD
Thesis was “Pathogenesis of orthopnea in patients with congestive heart
failure. Studying the mechanics of respiratory system with impulse
oscillometry system”.
During the time period 16/06/2008 to 15/09/2008 I was trained at
Hufeland Clinic, Bad Ems (Taunusallee 5, Bad Ems, Germany) on
pulmonary rehabilitation. On the 12th of September 2009 I successfully
passed the examinations for the European Diploma in Adult Respiratory
Medicine.
I was elected as a Lecturer of Pulmonary Medicine by the General
Meeting of Medical School, Aristotle University of Thessaloniki on the
08/07/2009 and I undertook my duties on 04/02/2011 in Pulmonary
Department. Since then I have been working as a clinical doctor in
5
Pulmonary Department while taking part in theoretical and practical
education of medical students and residents on Pulmonology.
During the time period 14/05/2012 to 13/07/2012 I was trained at
St. Elisabeth und St. Barbara Clinic of Martin-Luther-Universitat HalleWittenberg (Mauerstraβe 5, Halle Saale, Germany) on medical
thoracoscopy.
Regarding my research activity I am author in 23 studies already
published in PubMed while two additional papers have been accepted for
publication (Citation index: 166, H index:7). My main research interest is
COPD in the primary care setting and Occupational related pulmonary
diseases.
6
Full text publications in peer reviewed journals that are included in
PubMed
Intratumoral chemotherapy for lung cancer: rechallenge current targeted therapies.
Hohenforst-Schmidt W, Zarogoulidis P, Darwiche K, Vogl T, Goldberg
EP, Huang H, Simoff M, Li Q, Browning R, Turner FJ, Pivert P, Spyratos
D, Zarogoulidis K, Celikoglu SI, Celikoglu F.
Drug Des Devel Ther 2013:7 571–583 (In Press)
1.
Abstract: Strategies to enhance the already established doublet chemotherapy
regimen for lung cancer have been investigated for more than 20 years. Initially, the
concept was to administer chemotherapy drugs locally to the tumor site for efficient
diffusion through passive transport within the tumor. Recent advances have enhanced
the diffusion of pharmaceuticals through active transport by using pharmaceuticals
designed to target the genome of tumors. In the present study, five patients with nonsmall cell lung cancer epidermal growth factor receptor (EGFR) negative stage IIIa–
IV International Union Against Cancer 7 (UICC-7), and with Eastern Cooperative
Oncology Group (ECOG) 2 scores were administered platinum-based doublet
chemotherapy using combined intratumoral-regional and intravenous route of
administration. Cisplatin analogues were injected at 0.5%–1% concentration within
the tumor lesion and proven malignant lymph nodes according to pretreatment
histological/cytological results and the concentration of systemic infusion was
decreased to 70% of a standard protocol. This combined intravenous plus
intratumoral-regional chemotherapy is used as a first line therapy on this short series
of patients. To the best of our knowledge this is the first report of direct treatment of
involved lymph nodes with cisplatin by endobronchial ultrasound drug delivery with a
needle without any adverse effects. The initial overall survival and local response are
suggestive of a better efficacy compared to established doublet cisplatin–based
systemic chemotherapy in (higher) standard concentrations alone according to the
UICC 7 database expected survival. An extensive search of the literature was
performed to gather information of previously published literature of intratumoral
chemo-drug administration and formulation for this treatment modality. Our study
shows a favorable local response, more than a 50% reduction, for a massive tumor
mass after administration of five sessions of intratumoral chemotherapy plus two
cycles of low-dose intravenous chemotherapy according to our protocol. These
encouraging results (even in very sick ECOG 2 patients with central obstructive nonsmall cell lung cancer having a worse prognosis and quality of life than a non-small
cell lung cancer in ECOG 0 of the same tumor node metastasis [TNM]-stage without
central obstruction) for a chemotherapy-only protocol that differs from conventional
cisplatin-based doublet chemotherapy by the route, target site, and dose paves the way
for broader applications of this technique. Finally, future perspectives of this
treatment and pharmaceutical design for intratumoral administration are presented.
2.
Measurement of exhaled alveolar nitrogen oxide in
patients with lung cancer: a friend from the past still
precious today.
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Kallianos A, Tsimpoukis S, Zarogoulidis P, Darwiche K, Charpidou A,
Tsioulis I, Trakada G, Porpodis K, Spyratos D, Panoutsopoulos A,
Veletza L, Kostopoulos K, Kostopoulos C, Karapantzos I, Tsakiridis K,
Hohenforst-Schmidt W, Zarogoulidis K, Rapti A, Syrigos K.
Onco Targets Ther 2013 May 31;6:609-13
Abstract: Nitric oxide (NO) is a marker of airway inflammation and indirectly a
general indicator of inflammation and oxidative stress. NO is a contributing factor in
lung cancer at an early stage and also after chemotherapy treatment of lung cancer.
We studied whether exhaled NO levels were altered by three cycles of chemotherapy
at diagnosis and after chemotherapy, and whether, directly or indirectly, these changes
were related to the course of disease. Also, a correlation of NO levels with other
markers of inflammation was performed. We studied 42 patients diagnosed early: 26
men and 16 women with lung cancer. We analyzed blood tests for control of
inflammatory markers, functional pulmonary tests, and alveolar exhaled NO. We
recorded a decrease in exhaled NO after three cycles of chemotherapy in all patients,
regardless of histological type and stage: there were 42 patients with mean 9.8 NO
after three cycles (average 7.7). Also, a strong correlation appeared between NO
measurements before and after chemotherapy and C-reactive protein (P , 0.05, r =
0.42, before) and (P , 0.045, r = 0.64, after). NO alveolar measurement as an indicator
of airway inflammation indicates response to chemotherapy in lung cancer. Also, the
inflammatory process in lung cancer was confirmed and indicated response to
chemotherapy through an index that is sensitive to inflammatory disease of the
airways.
Establishing the optimal nebulization system for
paclitaxel, docetaxel, cisplatin, carboplatin and gemcitabine:
Back to drawing the residual cup.
Zarogoulidis P, Petridis D, Ritzoulis C, Darwiche K, Spyratos D, Huang
H, Goldberg EP, Yarmus L, Li Q, Freitag L, Zarogoulidis K.
Int J Pharm 2013 Jun 14. doi:10.1016/j.ijpharm.2013.06.011. [Epub
ahead of print]
3.
Background: Chemotherapy drugs have still the major disadvantage of non-specific
cytotoxic effects. Although, new drugs targeting the genome of the tumor are already
in the market, doublet chemotherapy regimens still remain the cornerstone of lung
cancer treatment. Novel modalities of administration are under investigation such as;
aerosol, intratumoral and intravascular. Materials and methods: In the present study
five chemotherapy drugs; paclitaxel, docetaxel, gemc-itabine, carboplatin and
cisplatin were nebulized with three different jet nebulizers (Maxineb®, Sunmist®,
Invacare®) and six different residual cups at different concentrations. The purpose of
the study was to identify the “ideal” combination of nebulizer-residual cup designdrug–drug loading for a future concept of aerosol chemotherapy in lung cancer
patients. The Mastersizer® 2000 was used to evaluate the aerosol droplet mass
median aerodynamic diameter. Results: The drug, nebulizer and residual cup design
greatly influences the producing droplet size (p < 0.005, in each case). However; the
design of the residual cup is the most important factor affect-ing the produced droplet
size (F = 834.6, p < 0.001). The drug loading plays a vital role in the production of the
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desired droplet size (F = 10.42, p < 0.001). The smallest droplet size was produced at
8 ml loading (1.26 _m), while it remained the same at 2, 4 and 6 mls of drug loading.
Conclusion: The ideal nebulizer would be Maxineb®, with a large residual cup (10 ml
maximum loading capacity) and 8 mls loading and the drug with efficient pulmonary
deposition would be docetaxel.
Smoking among adolescents in Northern Greece: a
large cross-sectional study about risk and preventive
factors.
Spyratos DG, Pelagidou DT, Chloros D, Haidich AB, Karetsi E,
Koubaniou C, Konstantopoulos S, Gourgoulianis K, Sichletidis LT.
Subst Abuse Treat Prev Policy 2012 Sep 10;7:38
4.
Abstract
Background: The aim of the present study was to investigate epidemiological data
about cigarette smoking in relation with risk and preventive factors among Greek
adolescents.
Methods: We randomly selected 10% of the whole number of schools in Northern
Greece (133 schools, 18,904 participants were included). Two anonymous
questionnaires (smoker's and non-smoker's) were both distributed to all students so
they selected and filled in only one. A parental signed informed consent was obtained
using an informative leaflet about adolescent smoking.
Results: The main findings of the study were: a) 14.2% of the adolescents (mean
age+/−SD: 15.3+/−1.7 years) reported regular smoking (24.1% in the age group 16–
18 years), b) 84.2% of the current smokers reported daily use, c) students who live in
urban and semirural areas smoke more frequently than those in rural areas, d) students
in technically oriented schools smoke twice as frequent compared to those in general
education, e) risk factors for smoking: male gender, low educational level of parents,
friends who smoke (OR: 10.01, 95%CI: 8.53-11.74, p<0.001), frequent visits to
internet cafes (OR:1.53, 95%CI: 1.35-1.74, p<0.001), parents, siblings (OR:2.24,
95%CI: 1.99-2.51, p<0.001) and favorite artist (OR:1.18, 95%CI: 1.04-1.33, p=0.009)
who smoke, f) protective factors against smoking:participation in sports (OR:0.59,
95%CI: 0.53-0.67, p<0.001), watching television (OR:0.74, 95%CI 0.66-0.84,
p<0.001) and influence by health warning messages on cigarette packets (OR:0.42,
95%CI: 0.37, 0.48, p<0.001).
Conclusions: Even though prevalence of cigarette smoking is not too high among
Greek adolescents, frequency of everyday cigarette use is alarming. We identified
many social and lifestyle risk and preventive factors that should be incorporated in a
national smoking prevention program among Greek adolescents.
Chest imaging and lung function impairment after
long-term occupational exposure to low concentrations of
chrysotile.
Spyratos D, Chloros D, Haidich B, Dagdilelis L, Markou S, Sichletidis L.
Arch Environ Occup Health. 2012;67(2):84-90
5.
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ABSTRACT. The aim of the present study was the investigation of radiographic
findings in relation to lung function after occupational exposure to permissible levels
of relatively pure chrysotile (0.5–3% amphiboles).We studied 266 out of the total 317
employees who have worked in an asbestos cement factory during the period 1968–
2004 with chest x-ray, high-resolution computed tomography (HRCT) and lung
function tests. Sensitivity of chest x-ray was 43% compared to HRCT. Abnormal
HRCT findings were found in 75 subjects (67%) and were related to age, occupational
exposure duration, and spirometric data. The presence of parenchymal or visceral
pleural lesions (exclusively or as the predominant abnormality) was being
accompanied by lower total lung capacity and diffusion capacity. HRCT was much
more sensitive than chest x-ray for occupational chrysotile exposure. Lung function
impairment was related with parenchymal but not with pleural HRCT abnormalities.
Diagnosis of chronic obstructive pulmonary disease
in the primary care setting
Spyratos D, Chloros D, Sichletidis L.
Hippokratia 2012;16(1):402-7 (In Press)
6.
Abstract
Chronic obstructive pulmonary disease (COPD) remains a major cause of morbidity
and mortality with increasing rates during the last decades. Due to the progressive
nature of the disease, underestimation of symptoms by the patients, lack of knowledge
and underuse of spirometry by the Primary Care providers the disease remains underdiagnosed in about half of the cases. Patients with a smoking history of ≥20 packyears and relevant symptoms (e.g. dyspnea, chronic cough and sputum production)
are considered a high risk group. Measurement of spirometric parameters after
administration of a short acting bronchodilator confirms the presence of irreversible
airflow obstruction and establishes the diagnosis. However in the primary care
spirometry is usually not available and differential diagnosis with other obstructive
pulmonary diseases (e.g. asthma, bronchiectasis) is not always easy. General
Practitioners (GPs) need simple screening tools to decide if a patient belong to a high
risk group and pulmonary consultation is necessary. Early and accurate diagnosis of
COPD in the primary care setting allowing for a timely and effective management
which reduces the rate of decline in lung function improves survival of patients, their
quality of life and reduces health-care utilization. The aim of the present review is to
provide the existing information about COPD diagnosis and the related problems in
the Primary Care. Also we reviewed numerous simple COPD diagnosis
questionnaires as well as the use of hand-held flow meters which could be used as
effective screening tools.
Long-term respiratory follow-up of H1N1 infection.
Zarogoulidis P, Kouliatsis G, Papanas N, Spyratos D, Constantinidis TC,
Kouroumichakis I, Steiropoulos P, Mabroudi M, Matthaios D, Kerenidi
T, Courcoutsakis N, Zarogoulidis K, Maltezos E.
Virol J 2011 Jun 25;8:319
7.
Background: The first case of 2009 pandemic influenza A (H1N1) virus infection was
documented in our Hospital on 10th August 2009.
10
Metdods and findings: Real-time reverse-transcriptase-polymerase-chain-reaction
(RT-PCR) testing was used to confirm the diagnosis. All patients were treated with
oseltamivir from the first day of hospitalization. Upon admission 12/44 had local
patchy shadowing in their chest x-ray and additionally antibiotic regimen was added
to these patients as pneumonia was suspected based on clinical evidence. In total 44
patients were hospitalized 15/44 had asthma, 6/44 COPD, 5/44 leukemia. Lung
function was evaluated with forced vital capacity, forced expiratory volume in 1 sec
and diffused carbon monoxide upon discharge and every 3 months, until 6 months of
observation was completed after discharge. The purpose of this retrospective cohort
study was to evaluate whether influenza A (H1N1) had an impact on the respiratory
capacity of the infected patients.
Conclusions: An improvement of pulmonary function tests was observed between the
first two measurements, implicating an inflammatory pathogenesis of influenza A
(H1N1) to the respiratory tract. This inflammation was not associated with the
severity or clinical outcome of the patients. All patients had a mild clinical course and
their respiratory capacity was stable between the second and third measurement,
suggesting that the duration of respiratory inflammation was two months. Early
treatment with antiviral agents and vaccination represent the mainstay of
management.
Inhaled insulin: too soon to be forgotten?
Zarogoulidis P, Papanas N, Kouliatsis G, Spyratos D, Zarogoulidis K,
Maltezos E.
J Aerosol Med Pulm Drug Deliv 2011;24(5):213-23
8.
Inhalation is a potentially viable route of administration for numerous agents. In
diabetes mellitus, the need for frequent injections to achieve ideal glycemic control
remains a significant limitation for initiating and complying with insulin therapy in a
large number of patients. To overcome this barrier, inhaled insulin was developed.
The inhalation form of regular human insulin has been tested and administered in a
large number of trials. Respiratory capacity was evaluated in patients with normal
lung parenchyma in whom inhaled insulin was administered without complications.
However, issues like cost, bulky device, fear for lung safety, and the small number of
studies in subjects with underlying respiratory disease prevented widespread use of
this new mode of delivery. In the present review, we will suggest a number of
methods that could be applied in this form of administration to maximize drug
absorption and fully exploit the advantages of this route of administration.
A combination of the IPAG questionnaire and PiKo6® flow meter is a valuable screening tool for COPD in the
primary care setting.
Sichletidis L, Spyratos D, Papaioannou M, Chloros D, Tsiotsios A,
Tsagaraki V, Haidich AB.
Prim Care Respir J 2011;20:184-9
9.
Aims: To investigate the validity of the International Primary Care Airways
Guidelines (IPAG) questionnaire and PiKo-6R (Ferraris Respiratory Europe Ltd.)
11
flow meter as screening tools for diagnosing chronic obstructive pulmonary disease
(COPD) in the primary care setting.
Methods: The first 50 patients in 25 general practice offices completed the IPAG
questionnaire and underwent spirometry with the handheld PiKo-6R flow meter. The
results were compared with official spirometry parameters after bronchodilation. All
participants had no previous medical diagnosis of respiratory diseases.
Results: Data from 1,078 out of 1,250 subjects (462 males, mean age 65.3•}11.4
years) were analysed. The percentage of smokers was 48.4% (38•}29 pack-years).
COPD was diagnosed in 111 (10.3%) patients. In the subgroup of smokers the
sensitivity and specificity for COPD diagnosis were 91% and 49%, respectively, for
the IPAG questionnaire; 80% and 95% respectively for the PiKo-6R spirometer; and
72% and 97% for their combination. The negative predictive value of the
questionnaire was 97%, whereas the positive predictive value of the questionnaire/
PiKo-6R combination was 82%. Using a cut-off score of 19 points for the IPAG
questionnaire, we calculated the best combination of sensitivity (75%) and specificity
(72%).
Conclusions: The IPAG questionnaire and the hand-held PiKo-6R spirometer can be
used in combination to increase the possibility of an early and accurate diagnosis of
COPD in the primary care setting.
Pulmonary rehabilitation in non-small cell lung
cancer patients after completion of treatment.
Glattki GP, Manika K, Sichletidis L, Alexe G, Brenke R, Spyratos D.
Am J Clin Oncol. 2012;35(2):120-5
10.
Objectives: The functional status of patients with non-small cell lungcancer
(NSCLC) is often limited not only by cancer itself, but also by the different types of
treatment and by comorbidities [eg, chronic obstructive pulmonary disease (COPD),
congestive heart failure]. The aim of this study was to investigate the utility of an
inpatient multidisciplinary pulmonary rehabilitation (PR) program on pulmonary
function and exercise capacity of patients with NSCLC after completion of their
treatment.
Methods: Forty-seven patients with NSCLC underwent a PR program after
completing cancer treatment. Pulmonary function tests, arterial blood gases, 6-minute
walk test, and dyspnea severity before and after PR were retrospectively analyzed.
Results: After undergoing PR, patients exhibited significantly higher forced
expiratory volume in the first second (mean increase, 110±240 mL; P = 0.007), forced
vital capacity (mean increase, 130±290 mL; P = 0.001), and 6-minute walk test
distance (mean increase, 41 m; P < 0.001). A statistically significant improvement in
the severity of dyspnea (mean decrease in the Modified Medical Research Council
dyspnea scale: 0.26±0.61; P = 0.007) was observed. We observed that improvement
in pulmonary function and exercise capacity was similar among patients with and
without COPD and among patients who underwent thoracic surgery or not.
Conclusions: Patients with NSCLC who could accomplish PR program, after
multidisciplinary treatment for the main disease, seem to benefit in terms of exercise
capacity and pulmonary function. These benefits are independent of concurrent
COPD and surgical treatment for lung cancer.
12
Therapeutic pneumoperitoneum in a patient with
pulmonary tuberculosis and persistent fever.
Antoniou M, Chloros D, Spyratos D, Giouleka P, Sichletidis L.
BMJ Case Rep. 2011 Feb 2;2011
11.
Artificial pneumoperitoneum represents a therapeutic technique fi rst applied in the
treatment of pulmonary tuberculosis (TB) in prechemotherapy antimycobacterial era.
A 25-year-old patient presented with pulmonary TB diagnosed during the 8th month
of her pregnancy. She was febrile and in severe clinical condition. An antituberculous
regimen of four primary drugs was initiated immediately after the caesarean section.
There was no clinical improvement after 3 months despite full drug sensitivity of
Mycobacterium tuberculosis isolates. An artificial pneumoperitoneum was applied
along with the drug treatment for 6 months. Soon the patient became afebrile, her
body weight increased and sputum smears gave negative results. The combination of
the old technique of therapeutic pneumoperitoneum along with the current
antituberculosis treatment proved to be effective in this advanced case of pulmonary
TB initially unresponsive to drug therapy alone.
Interferon α-induced sarcoidosis to a patient with
polycythemia vera.
Sionidou M, Spyratos D, Chloros D, Sichletidis L.
BMJ Case Rep. 2011 May 10;2011
12.
Treatment with interferon (IFN) can precipitate a variety of inflammatory conditions,
including sarcoidosis. Although many other systems can be affected, the clinical
picture in this case mostly includes cutaneous and pulmonary symptoms. The
prognosis is better than the idiopathic form of the disease, and the most effective
treatment is considered the discontinuation of antivirus therapy alone or in
combination with corticosteroid administration. The authors present the case of a 36year-old man who developed sarcoidosis stage I after 2 years of IFNα therapy for
polycythemia vera.
An unusual cause of spontaneous pneumothorax.
Spyratos D, Kalpakidis V, Giouleka P, Chloros D, Sichletidis L.
BMJ Case Rep. 2011 May 3;2011
13.
Bronchopulmonary sequestration is a congenital pulmonary malformation consisting
of a non-functioning region of lung parenchyma that receives systemic arterial blood
supply. The authors present the case of a 31-year-old male who presented with
spontaneous pneumothorax as the initial clinical manifestation of an intralobar
bronchopulmonary sequestration. There was a persistent air leak through the chest
tube which remained in the pleural cavity for 12 days. CT revealed an area of
increased opacity, with focal calcifi cations and a small eccentric cavity in the
posterior basal region of the left lower lobe. Aortography established the fi nal
diagnosis.
14.
Iliopsoas tuberculous abscess associated
cervical and axillary tuberculous lymphadenopathy.
with
13
Latsios D, Chloros D, Spyratos D, Dagdilelis L, Sichletidis L.
BMJ Case Rep. 2011 Jun 30;2011
The authors report a case of iliopsoas tuberculous abscess without obvious spinal
column involvement. Cervical and axillary tuberculous lymphadenopathy were also
presented. Despite appropriate antituberculous treatment, patient required
percutaneous drainage with CT-guided catheter insertion.
Assessment of respiratory mechanics by impulse
oscillometry in orthopneic patients with acute left
ventricular failure.
Spyratos DG, Glattki GP, Sichletidis LT, Patakas D.
Heart Lung 2011;40(2):97-104
15.
Backround: This study investigated the respiratory function and mechanics of patients
with orthopnea caused by acute left ventricular failure (ALVF).
Methods: The study comprised 40 patients with ALVF and 15 control subjects. All
patients underwent lung function tests and impulse oscillometry in both sitting and
supine positions. In a subgroup of 22 patients, isosorbide dinitrate was administered
and impulse oscillometry was performed 15 minutes later in the supine position.
Results: No patient reported dyspnea while seated, and the orthopnea score was
2.9±1.4. Left ventricular ejection fraction was 43±10%. Patients demonstrated
restrictive spirometric pattern in the sitting position, whereas functional residual
capacity was comparable to that of the control group. In the supine position, all
pulmonary volumes decreased, except inspiratory capacity which increased.
Respiratory reactance (Xrs5) was higher in patients in both sitting and supine
positions. Respiratory resistance (Rrs5) and Xrs5 improved after nitrates
administration. Orthopnea was better correlated with Xrs5%pred in the supine
position. Ejection fraction was positively correlated with inspiratory capacity %pred
in the sitting position.
Conclusion: Patients with ALVF demonstrated increased respiratory reactance that
correlated with orthopnea severity and improved after nitrates administration
Pleural plaques in dentists from occupational
asbestos exposure: a report of three cases.
Sichletidis L, Spyratos D, Chloros D, Michailidis K, Fourkiotou I.
Am J Ind Med 2009;52:926-30
16.
Background White asbestos (chrysotile) has been used in dentistry since 1930 when it
was introduced as a lining material for casting rings.
Methods All three patients presented with pleural plaques on chest X-rays as well as
on CT-scans. They were working as dentists for 35–45 years. Under the instructions
of the first dentist we represented precisely the whole process of manipulating a kind
of paper that contained asbestos. In order to measure asbestos fibers concentration we
used the membrane filter method and phase contrast optical microscopy. Dry asbestos
sheets were scanned with x-ray diffraction and electron microscope.
14
Results Analysis of the filter demonstrated 0.008 fibers/cm3 during the sampling
period. X-ray diffraction analysis revealed that the material consisted of chrysotile
exclusively. Electron microscope pictures confirmed the presence of chrysotile.
Conclusion Everyday occupational exposure for many years even to low asbestos
levels, under poor ventilation conditions in a closed space, could cause pleural
lesions.
17.
Sarcoidosis-associated pulmonary hypertension: a
role for endothelin receptor antagonists?
Pitsiou GG, Spyratos D, Kioumis I, Boutou AK, Nakou C, Stanopoulos I.
Ther Adv Respir Dis 2009;3(3):99-101
Abstract: Data on the treatment of sarcoidosis-associated pulmonary hypertension are
scarce, while the variety of underlying pathophysiologic mechanisms are a major
limitation in the implementation of a universal therapy. We report a 47-year-old male
patient who presented with stage II sarcoidosis and associated severe pulmonary
hypertension. Corticosteroid treatment resolved parenchymal lesions of the lung while
vascular involvement did not respond, with the patient remaining in poor functional
status. Addition of bosentan, a dual endothelin receptor antagonist, resulted in marked
improvement in functional class and exercise capacity of the patient, allowing gradual
tapering of steroids.
Prevalence and risk factors for initiation of smoking
in Greek high-school students.
Sichletidis LT, Chloros DA, Tsiotsios AI, Spyratos DG.
Int J Environ Res Public Health 2009;6:971-9
18.
Abstract: The smoking habits of 9,276 high-school students (15-18 years old) in six
cities of Northern Greece were studied using a questionnaire in order to determine the
prevalence and possible risk factors for initiation of smoking. We observed that
29.6% of high-school students (32.6% of boys and 26.7% of girls) were current
smokers. A percentage of 43.3% had started smoking before the age of 14. Reactive
behaviour towards parents’ and teachers’ advice (40.2%) and the existence of
smoking friends (40.1%) were the main reasons of initiation. A well-planned
integrated anti-smoking campaign is urgently required, especially among students and
teachers.
Efficacy and safety of erythromycin as sclerosing
agent in patients with recurrent malignant pleural effusion.
Balassoulis G, Sichletidis L, Spyratos D, Chloros D, Zarogoulidis K,
Kontakiotis T, Bagalas V, Porpodis K, Manika K, Patakas D.
Am J Clin Oncol 2008;31(4):384-9
19.
Objectives: The aim of pleurodesis in malignant pleural effusions is to prevent
reaccumulation of the fluid, symptoms, and avoid the need for repeated
hospitalization for thoracentesis. The purpose of this study was to evaluate the
efficacy and safety of erythromycin as a pleural sclerosing agent.
Methods: Over a 2-year period, 34 patients with a symptomatic, recurrent, malignant
pleural effusion who referred for chest tube drainage and pleurodesis were included.
15
They had not received prior intrapleural therapy and had predicted survival of at least
1 month. All underwent pleural drainage and chemical pleurodesis with erythromycin.
Complications and response to pleurodesis, according to clinical and radiographic
criteria after 90 days, were recorded.
Results: The overall response was 88.2%. Complete response (no reaccumulation of
pleural fluid after 90 days) was observed in 27 patients (79.4%). Partial response
(reaccumulation of fluid but without symptoms, not requiring drainage) was observed
in 3 (8.8%). No response (symptomatic reaccumulation of fluid that required
drainage) was observed in 4 (11.8%). All patients experienced pleurodynia that was
treated with administration of paracetamol and/or dextropropoxyphene. Sinus
tachycardia and concurrent mild systemic hypertension were observed 2 and 4 hours
after pleurodesis. Both of them were attributed to pleurodynia as there
was remission with analgesics.
Conclusions: This study suggests that erythromycin is effective and safe as a
sclerosing agent for pleurodesis in patients with recurrent malignant pleural effusions.
Mortality from occupational exposure to relatively
pure chrysotile: a 39-year study.
Sichletidis L, Chloros D, Spyratos D, Haidich AB, Fourkiotou I, Kakoura
M, Patakas D.
Respiration 2009;78:63-8
20.
Background: Asbestos exposure is related to serious adverse health effects.
However, there is disagreement about the relationship between chrysotile exposure
and mesothelioma or lung cancer.
Objectives: Our aim was to investigate the mortality rate among workers exposed to
relatively pure chrysotile in an asbestos cement factory.
Patients and Methods: In an asbestos cement plant opened in 1968, we prospectively
studied all 317 workers. A quantity of 2,000 tons of chrysotile, with minimal
amphibole contamination, was used annually until 1 January 2005. Asbestos fiber
concentration was measured regularly. Date and cause of death were recorded among
active and retired workers.
Results: Asbestos fiber concentration was always below permissible levels. Fifty-two
workers died during the study. The cause was cancer in 28 subjects; lung cancer was
diagnosed in 16 of them. No case of mesothelioma was reported. Death was attributed
to cardiovascular diseases in 23 subjects and to liver cirrhosis in 1. Overall mortality
rate was significantly lower than that of the Greek general population, standardized
mortality ratio (SMR) was 0.71 (95% CI 0.53–0.93). Mortality due to cancer was
increased (SMR 1.15, 95% CI 0.77– 1.67), mainly due to lung cancer mortality (SMR
1.71, 95% CI 0.98–2.78), but not significantly.
Conclusions: Occupational exposure to relatively pure chrysotile within permissible
levels was not associated with a significant increase in lung cancer or with
mesothelioma. Decreased overall mortality of workers indicates a healthy worker
effect, which – together with the relatively small cohort size – could have prevented
small risks to be detected.
21.
Expiratory flow limitation in patients with pleural
effusion.
16
Spyratos D, Sichletidis L, Manika K, Kontakiotis T, Chloros D, Patakas
D.
Respiration 2007;74:572-8
Background: Expiratory flow limitation (EFL) is one of the main mechanisms
contributing to dyspnea in patients with chronic obstructive pulmonary disease but
has not been explored in patients with pleural effusion.
Objectives: It was the aim of this study to determine whether patients with pleural
effusion exhibit EFL and to investigate the effect of therapeutic thoracentesis on EFL.
Patients and Methods: The study was performed on 21 patients with pleural effusion
who were subjected to thoracentesis and measurement of pleural pressure (PP).
Spirometry and estimation of flow limitation by the negative expiratory pressure
technique were performed before and after thoracentesis.
Results: Statistically significant differences were observed in all spirometric
parameters. No correlation between the increase in lung volumes and flows and any of
the aspirated fluid parameters was observed. Before thoracentesis, 14 out of 21
patients were flow limited, compared with 7 patients after thoracentesis (x 2= 6.151, p
= 0.013). Mean values of flow limitation before and after thoracentesis differed
significantly. The decrease in flow limitation did not correlate with the increase in the
spirometric parameters, the aspirated fluid volume or PP decrease.
Conclusions: In the majority of patients with pleural effusion, flow limitation
improves after thoracentesis. Flow limitation may be a contributing factor to the
sensation of dyspnea in these patients.
The validity of the diagnosis of chronic obstructive
pulmonary disease in general practice.
Sichletidis L, Chloros D, Spyratos D, Chatzidimitriou N, Chatziiliadis P,
Protopappas N, Charalambidou O, Pelagidou D, Zarvalis E, Patakas D.
Prim Care Respir J 2007;16:82-8
22.
AIM: To determine the validity of the diagnosis of chronic obstructive pulmonary
disease (COPD) in general practice in patients given a diagnosis of COPD and treated
with bronchodilators.
METHODS: From the medical records of eight Health Centres in Northern Greece,
319 subjects aged over 40 years and diagnosed as "COPD" were entered into the
study. All filled in a special questionnaire and were subjected to spirometry,
rhinomanometry and chest X-ray.
RESULTS: One hundred and sixty patients (50.2%) met the GOLD criteria for
COPD. Twenty-six of them were non-smokers and underwent further evaluation:
blood eosinophil count, serum IgE assay, high resolution computed tomography
(HRCT) scan of the chest, and echocardiography; 16 were given a different diagnosis.
One hundred and fifty-nine subjects (49.8%) with an FEV1/ FVC ratio >0.7 did not
meet the GOLD criteria for COPD; 71 suffered from nasal obstruction, 13 from
asthma, six had restrictive pulmonary disease and 69 had no respiratory disease.
CONCLUSION: Diagnostic errors in patients with respiratory symptoms in the
primary healthcare setting are frequent. Patients suspected to have COPD should
undergo spirometry testing after bronchodilation. An alternative diagnosis must be
sought for non-smoking patients with irreversible airway obstruction.
17
Tuberculosis in patients receiving anti-TNF agents
despite chemoprophylaxis.
Sichletidis L, Settas L, Spyratos D, Chloros D, Patakas D.
Int J Tuberc Lung Dis 2006;10:1127-32
23.
SETTING: A major concern surrounding the use of tumor necrosis factor-alpha
(TNF-α) inhibitors is their potential to increase the risk of opportunistic infections,
particularly tuberculosis (TB).
OBJECTIVE: To estimate the incidence of active TB in patients with rheumatic
diseases receiving anti-TNF drug therapy and to evaluate the effectiveness of an
antituberculosis chemoprophylaxis regimen.
DESIGN: Retrospective study of the files of 613 patients with rheumatic diseases who
had received anti-TNF agent (etanercept, infliximab and adalimumab) therapy from
July 2000 to June 2004 at the Aristotle University of Thessaloniki, Greece. All
patients had a tuberculin skin test (TST) and a postero-anterior chest radiograph
(CXR) prior to anti-TNF therapy. When indicated (TST≥10 mm and/or fibrotic
lesions on CXR), treatment for latent TB was established (6 months isoniazid [INH]
or 3 months INH and rifampicin [RMP]). Anti-TNF agent therapy was started again 2
months later.
RESULTS: Of 45 patients who fulfilled the criteria for chemoprophylaxis, only 36
were treated correctly. Eleven patients developed active TB 2–35 months after the
beginning of anti-TNF therapy. Six patients developed pulmonary and five extrapulmonary TB. Eight of these had received infliximab and three adalimumab.
CONCLUSION: The incidence of active TB in this study population was estimated at
449 cases per 100 000 population annually. Anti-tuberculosis chemoprophylaxis was
only of partial preventive success in these patients.
Diachronic study of pleural plaques in rural
population with environmental exposure to asbestos.
Sichletidis L, Chloros D, Chatzidimitriou N, Tsiotsios I, Spyratos D,
Patakas D.
Am J Ind Med 2006;49:634-41
24.
Background: The progress of pleural plaques in persons exposed to environmental
asbestos in Almopia, Greece were studied prospectively.
Methods: During a 15-year period, 198 individuals, in whom pleural plaques had been
observed during the period 1988–1990 were followed. Respiratory function was
initially evaluated in 23. All were inhabitants of seven villages of Northern Greece,
where rocks with high concentration in asbestos fibers were used for whitewashing
until 1935.
Results: Out of this population, 126 survived and underwent chest X-ray in 2003
while respiratory function was retested in 18. New radiological findings were
compared to previous ones using digital technology. Furthermore, the cause of death
of the remaining 72 was recorded. Deterioration of X-ray findings was observed in all
survivors. Not only did the surface area of previous plaques increase (8.66±12.6 cm2,
mean value_SD) but new ones also appeared. Total lung capacity decreased from
95.6±14.8 in 1998 to 76.5±9.3% predicted in 2003. It was found that out of 72 deaths,
11 people died of malignant lung neoplasm, and 4 of mesothelioma.
18
Conclusions: Radiological appearance of pleural plaques and respiratory function of
people previously exposed to asbestos environmental pollution worsens over the
years.Prevalence of mesothelioma was found to be higher than expected.
The prevalence of allergic asthma and rhinitis in
children of Polichni, Thessaloniki.
Sichletidis L, Chloros D, Tsiotsios I, Gioulekas D, Kyriazis G, Spyratos
D, Charalambidou O, Goutsikas S.
Allergol Immunopathol (Madr) 2004;32:59-63
25.
Aim: To define the prevalence of asthma and rhinitis in primary school children in the
Polichni Municipality of the city of Thessaloniki.
Methods and results: The parents of 2005 students living in the area of
Polichni completed a questionnaire for the detection of pulmonary disease in
childhood. Of 493 children who gave positive answers to the questions about
allergies, asthma and rhinitis, 203 were excluded after an interview with the parents,
because they suffered from either atopic dermatitis or drug allergy or had normal lgE
levels. Of the remaining children, 290 were further examined: methacholine test was
positive in 109, exercise test was positive in 67, nasal provocation test with histamine
was positive in 244, and rhinodilation test with tramazoline was positive in 206. Skin
prick tests were positive in 142 children (90 to grass-cereal pollen, 66 to acarea and
59 to Parietaria officinalis).
19