Reference values for lung function tests: I. Static volumes

Static lung volume (LV) measurements have a number of clinical and research applications; however, no previous studies have provided reference values for such tests using a healthy sample of the adult Brazilian population. With this as our main purpose, we prospectively evaluated 100 non-smoking subjects (50 males and 50 females), 20 to 80 years old, randomly selected from more than 8,000 individuals. Gender-specific linear prediction equations were developed by multiple regression analysis with total lung capacity (TLC), functional residual capacity (FRC), residual volume (RV), RV/TLC ratio and inspiratory capacity (IC) as dependent variables, and with age, height, weight, lean body mass and indexes of physical fitness as independent ones. Simpler demographic and anthropometric variables were as useful as more complex measurements in predicting LV values, independent of gender and age (R2 values ranging from 0.49 to 0.78, P<0.001). Interestingly, prediction equations from North American and European studies overestimated the LV at low volumes and underestimated them at high volumes (P<0.05). Our results, therefore, provide a more appropriate frame of reference to evaluate the normalcy of static lung volume values in Brazilian males and females aged 20 to 80 years.

Ventilation with high tidal volume induces inflammatory lung injury

Mechanical ventilation with high tidal volumes (V T) has been shown to induce lung injury. We examined the hypothesis that this procedure induces lung injury with inflammatory features. Anesthetized male Wistar rats were randomized into three groups: group 1 (N = 12): V T = 7 ml/kg, respiratory rate (RR) = 50 breaths/min; group 2 (N = 10): V T = 21 ml/kg, RR = 16 breaths/min; group 3 (N = 11): V T = 42 ml/kg, RR = 8 breaths/min. The animals were ventilated with fraction of inspired oxygen of 1 and positive end-expiratory pressure of 2 cmH2O. After 4 h of ventilation, group 3, compared to groups 1 and 2, had lower PaO2 [280 (range 73-458) vs 517 (range 307-596), and 547 mmHg (range 330-662), respectively, P<0.05], higher wet lung weight [3.62 ± 0.91 vs 1.69 ± 0.48 and 1.44 ± 0.20 g, respectively, P<0.05], and higher wet lung weight/dry lung weight ratio [18.14 (range 11.55-26.31) vs 7.80 (range 4.79-12.18), and 6.34 (range 5.92-7.04), respectively, P<0.05]. Total cell and neutrophil counts were higher in group 3 compared to groups 1 and 2 (P<0.05), as were baseline TNF-alpha concentrations [134 (range <10-386) vs 16 (range <10-24), and 17 pg/ml (range <10-23), respectively, P<0.05]. Serum TNF-alpha concentrations reached a higher level in group 3, but without statistical significance. These results suggest that mechanical ventilation with high V T induces lung injury with inflammatory characteristics. This ventilatory strategy can affect the release of TNF-alpha in the lungs and can reach the systemic circulation, a finding that may have relevance for the development of a systemic inflammatory response.

Volumes nasais de adultos aferidos por rinometria acústica

A rinometria acústica permite aferir a geometria nasal de forma objetiva e não-invasiva. OBJETIVO: O presente estudo teve por finalidade determinar os volumes de segmentos específicos da cavidade nasal, incluindo a nasofaringe, de adultos sadios por rinometria acústica. Forma de Estudo: Clínico prospectivo. CASUÍSTICA E MÉTODO: Foram analisados 30 voluntários sem evidências de obstrução nasal com idade entre 18 e 30 anos, sendo 14 homens e 16 mulheres. Os volumes foram medidos nos segmentos correspondentes à região da válvula nasal (V1), cornetos (V2) e nasofaringe (V3), antes e após a aplicação tópica de vasoconstritor nasal. RESULTADOS: Os volumes médios aferidos em 60 cavidades, antes da vasoconstrição nasal foram os seguintes: 1,81±0,35cm³ (V1), 4,02±1,41cm³ (V2) e 17,52±4,44cm3 (V3) no grupo masculino, e, 1,58±0,25cm³ (V1), 3,94±1,03cm³ (V2) e 17,80±2,73cm³ (V3) no grupo feminino. As diferenças entre os sexos foram significantes apenas para V1 (p<0,05). Após a vasoconstrição nasal, os volumes de todos os segmentos analisados foram significantemente maiores (p<0,05), sendo as diferenças entre os sexos significantes para V1 e V2. CONCLUSÃO: Os volumes dos três segmentos da cavidade nasal determinados em adultos sem evidências de obstrução nasal podem ser utilizados como valores de referência para outros estudos.

Volumes de substratos comerciais, solo e composto orgânico afetando a formação de mudas de maracujazeiro-amarelo em diferentes ambientes de cultivo

Este trabalho teve como objetivo avaliar o crescimento de mudas de maracujazeiro- amarelo em três diferentes tamanhos de recipientes, em três condições de cultivo protegido, utilizando seis diferentes substratos. Foram empregados três ambientes de cultivo: (A1) estufa em arco, coberta de filme de polietileno de 150 μm, abertura zenital e tela termorrefletora de 50% sob o filme; (A2) viveiro agrícola de tela de monofilamento, com 50% de sombra; e (A3) viveiro agrícola de tela termorrefletora, com 50% de sombra. Foram testados três volumes (V1 = xx cm³ -sacolas de polietileno de 7,5 x 11,5 cm; V2 = xx cm33 - sacolas de polietileno 10,0 x 16,5 cm; e V3 = xx cm33 -sacolas de polietileno de 15,0 x 21,5 cm) e seis substratos (S1 = solo; S2 = Plantmax®; S3 = vermiculita; S4 = fibra de coco; S5 = fibra de coco chips; e S6 = Organosuper®, composto orgânico comercial). O delineamento experimental foi inteiramente casualizado, em esquema de parcelas subsubdivididas, em que os ambientes foram as parcelas, os recipientes de diferentes volumes as subparcelas e os substratos as subsubparcelas. Aos 50 dias após a semeadura, foram medidos a altura das plantas, o comprimento da raiz, a massa de matéria seca da parte aérea e das raízes. A partir das massas de matéria seca determinaram-se a relação massa de matéria seca de parte aérea e raiz e massa de matéria seca total. A estufa foi o melhor ambiente quando se utilizou o recipiente de XX cm33 o qual proporcionou mudas maiores, com maior biomassa seca aérea, radicular e total. A vermiculita foi o melhor substrato, porém o solo adubado é uma alternativa menos dispendiosa para a região.

Aclimatização de mudas micropropagadas de Bastão do Imperador em diferentes volumes de recipientes

É crescente o mercado de flores tropicais no Brasil. No nordeste, por causa do clima, torna-se difícil a aclimatização dessas plantas. Portanto, este trabalho tem por objetivo determinar o recipiente mais adequado para aclimatizar mudas micropropagadas de bastão do imperador cv. Porcelana, em ambiente protegido. O experimento foi realizado em estufa e as mudas utilizadas foram obtidas por micropropagação. O delineamento experimental utilizado foi de blocos ao acaso, com quatro tratamentos (volumes) e cinco repetições. Os volumes dos recipientes testados foram: V1 - 50 cm³ (Copo pequeno - CP); V2 - 150 cm³ (Tubete pequeno - TP); V3 - 300 cm³ (Tubete grande - TG); V4 - 450 cm³(Vaso pequeno - VP). Foram coletados dados correspondentes ao número de folhas (NF), altura da muda (AM), diâmetro do pseudocaule (DP), massa fresca da parte aérea (MFPA), massa fresca do sistema radicular (MFSR), massa seca da parte aérea (MSPA) e massa seca do sistema radicular (MSSR). Foi realizada a análise de variância e os resultados de natureza qualitativa foram submetidos ao teste de média. O vaso de 450 cm³ é o recipiente mais adequado para aclimatização de bastão do imperador, pois proporcionou melhor desenvolvimento das mudas.

Micropropagação da bananeira 'Maçã', cultivada in vitro em diferentes volumes de meio líquido

Objetivou-se, neste trabalho, avaliar o efeito de diferentes volumes de meio MS líquido estacionário, na taxa de multiplicação e desenvolvimento, in vitro, de explantes da bananeira 'Maçã'. Na etapa de multiplicação, utilizaram-se microrrizomas do cultivar Maçã (AAB), oriundos de plantas pré-estabelecidas em meio sólido, em estádio de multiplicação, que foram uniformizados quanto ao tamanho. O delineamento utilizado foi inteiramente casualizado, com sete tratamentos e dez repetições, sendo a parcela composta por quatro explantes. Os tratamentos foram diferentes volumes de meio líquido estacionário (5, 10, 15, 20, 25, 30 mL) e 30 mL de meio semissólido (padrão). Mudas obtidas ao final do terceiro subcultivo foram transferidas para um meio de alongamento e enraizamento. O experimento foi composto pelos mesmos tratamentos e delineamento, sendo cada parcela composta por quatro explantes. Os diferentes volumes do meio líquido e semissólido não alteraram a taxa de multiplicação dos explantes. É possível produzir mudas de bananeira 'Maçã', in vitro, em meio líquido estacionário, sendo o volume ideal de 25 mL por frasco.

Budget impact from the incorporation of positron emission tomography – computed tomography for staging lung cancers

OBJECTIVE To estimate the budget impact from the incorporation of positron emission tomography (PET) in mediastinal and distant staging of non-small cell lung cancer.METHODS The estimates were calculated by the epidemiological method for years 2014 to 2018. Nation-wide data were used about the incidence; data on distribution of the disease´s prevalence and on the technologies’ accuracy were from the literature; data regarding involved costs were taken from a micro-costing study and from Brazilian Unified Health System (SUS) database. Two strategies for using PET were analyzed: the offer to all newly-diagnosed patients, and the restricted offer to the ones who had negative results in previous computed tomography (CT) exams. Univariate and extreme scenarios sensitivity analyses were conducted to evaluate the influence from sources of uncertainties in the parameters used.RESULTS The incorporation of PET-CT in SUS would imply the need for additional resources of 158.1 BRL (98.2 USD) million for the restricted offer and 202.7 BRL (125.9 USD) million for the inclusive offer in five years, with a difference of 44.6 BRL (27.7 USD) million between the two offer strategies within that period. In absolute terms, the total budget impact from its incorporation in SUS, in five years, would be 555 BRL (345 USD) and 600 BRL (372.8 USD) million, respectively. The costs from the PET-CT procedure were the most influential parameter in the results. In the most optimistic scenario, the additional budget impact would be reduced to 86.9 BRL (54 USD) and 103.8 BRL (64.5 USD) million, considering PET-CT for negative CT and PET-CT for all, respectively.CONCLUSIONS The incorporation of PET in the clinical staging of non-small cell lung cancer seems to be financially feasible considering the high budget of the Brazilian Ministry of Health. The potential reduction in the number of unnecessary surgeries may cause the available resources to be more efficiently allocated.

Inapparent lung involvement in patients with the subacute juvenile type of paracoccidioidomycosis

Three patients with the diagnosis of subacute juvenile paracoccidioidomycosis who, at the time of their first visit, had no signs or symptoms of lung involvement, were studied. Initially the diagnosis was confirmed by the observation of P. brasiliensis in biopsy material obtained from clinically involved lymphadenopathies. The lung X-rays done in all patients, did not reveal pathologic changes, although it was possible to observe and isolate the fungus from sputum samples obtained from the three patients. This fact reinforces the pulmonary genesis of the mycosis and proofs the existence of a pulmonary primary infection, even in patients with the juvenile manifestations, in whom the lung component is obscured by the predominant lymph node involvement.

Cryptococcus gattii fungemia: report of a case with lung and brain lesions mimicking radiological features of malignancy

A 64-year-old apparently immunocompetent white man developed lung and brain lesions of disseminated cryptococcosis. The radiologic features mimicked those of lung cancer metastatic to the central nervous system. C. gattii was recovered from cultures of bronchoalveolar lavage fluid, brain biopsy, and blood. The same fungus was recovered from pulmonary and brain specimens at autopsy. Serum and cerebrospinal fluid cryptococcal antigen tests were diagnostic in our case and should be included in the diagnostic evaluation of unexplained pulmonary and cerebral lesions. A literature search showed few reports of fungemia by this species of Cryptococcus, contrasting to C. neoformans.

Aspergillus niger causing tracheobronchitis and invasive pulmonary aspergillosis in a lung transplant recipient: case report

A case of invasive aspergillosis caused by Aspergillus niger in a lung transplant recipient is described. The patient presented hyperglycemia starting postoperatively, with other complications such as cytomegalovirus infection. The associated predisposing factors and other implications are discussed. Aspergillus niger seems to be a fungal species of low virulence that requires the presence of a severely immunosuppressed host to cause invasive disease.

Chemotherapy versus best supportive care in stage IV non-small cell lung cancer, non metastatic to the brain

Stage IV non-small cell lung cancer is a fatal disease, with a median survival of 14 months. Systemic chemotherapy is the most common approach. However the impact in overall survival and quality of life still a controversy. OBJECTIVES: To determine differences in overall survival and quality of life among patients with stage IV non-small cell lung cancer non-metastatic to the brain treated with best supportive care versus systemic chemotherapy. PATIENTS: From February 1990 through December 1995, 78 eligible patients were admitted with the diagnosis of stage IV non-small cell lung cancer . Patients were divided in 2 groups: Group A (n=31 -- treated with best supportive care ), and Group B (n=47 -- treated with systemic chemotherapy). RESULTS: The median survival time was 23 weeks (range 5 -- 153 weeks) in Group A and 55 weeks (range 7.4 -- 213 weeks) in Group B (p=0.0018). In both groups, the incidence of admission for IV antibiotics and need of blood transfusions were similar. Patients receiving systemic chemotherapy were also stratified into those receiving mytomycin, vinblastin, and cisplatinum, n=25 and those receiving other combination regimens (platinum derivatives associated with other drugs, n=22). Patients receiving mytomycin, vinblastin, and cisplatinum, n=25 had a higher incidence of febrile neutropenia and had their cycles delayed for longer periods of time than the other group. These patients also had a shorter median survival time (51 versus 66 weeks, p=0.005). CONCLUSION: In patients with stage IV non-small cell lung cancer, non-metastatic to the brain, chemotherapy significantly increases survival compared with best supportive care.

Thumb metastasis from small cell lung cancer treated with radiation

A rare case of thumb metastasis from small cell lung cancer is presented. The patient underwent local radiotherapy with complete palliation of symptoms. She died 4 months later with disseminated disease. Considerations about incidence, treatment, and physiopathology of this kind of dissemination are made. Conservative treatment of finger metastasis with radiation may be considered due to the poor outcome of these patients.