Compensatory lung growth in autologous lobar implant: Experimental study in dogs

Background. The best way to study compensatory lung growth (CLG) is in a transplant without rejection. Since immunosuppressive drugs may influence CLG, it is better to not use them. Therefore we studied CLG in a reimplant of only one lobe after its removal. The objective was to compare lobar transplant CLG with CLG after lobectomy.Methods. Forty eight dogs were distributed in three groups: G1 = control, G2 = left cranial lobectomy, and G3 = left pneumonectomy with reimplantation of the caudal lobe. Five months after surgery the animals underwent lung scintigraphy and were sacrificed for morphometric study.Results. There was no correlation between scintigraphy and lung mass or lung volume. There was both mass and residual volume CLG in the operated groups, both contralateral and ipsilateral to surgery. There was no compensation for total lung capacity or compliance in the remaining caudal lobe (G2) or the reimplanted caudal lobe (G3) at 5 months after surgery. There was more damage in the reimplanted lobe. As previous studies have shown that CLG starts with increased mass and residual volume and compliance is compensated later. This study seemed to document the beginning of CLG, with lung compliance being the limiting factor of CLG at 5 months.Conclusion. There was CLG in both the reimplanted lobe and the contralateral lung, but compliance was still reduced. CLG was similar in both groups, but in the implanted lobe compliance was more prejudiced.

Prevalence of deep vein thrombosis and pulmonary embolism in superficial thrombophlebitis of the lower limbs: prospective study of 60 cases

Aim. Superficial thrombophlebitis (ST) ascending the lower limbs is a common disease, which may be associated with deep vein thrombosis (DVT) and pulmonary embolism (PE). The aim of this study was to investigate the prevalence of DVT and PE as complications of ascending ST of the lower limbs in the great saphenous vein (GSV) or SSV (SSV) and probable risk factors.Methods. For this study 60 consecutive patients were enrolled with ascending ST of the GSV or SSV, seen between 2000 and 2003 at a public hospital in Botucatu, SP, Brazil. All patients were assessed clinically, by venous Duplex scanning of the lower limbs to confirm ST and test for DVT, and by means of pulmonary scintigraphy to test for PE.Results. In 13 ST cases (21.67%) there was concomitant DVT and 17 ST patients (28.33%) also had PE. Eleven patients had a clinical status suggestive of DVT, but only in eight of these (61.5%), this clinical diagnosis was confirmed. Fourteen patients had a clinical status suggestive of PE, and this diagnosis was confirmed in six cases (35.30%). ST patients who also had DVT and/or PE were given anticoagulant treatment with heparin and warfarin. None of the variables studied was predictive of DVT or PE (P>0.05). However, the presence of varicose veins reduced the risk of patients having DVT (relative risk=9.09; 95%CI:1.75 - 50.00 and P=0.023).Conclusion. The prevalence rates of PE (28.3%) and DVT (21.6%) were elevated in this sample of ascending ST cases, indicating a need for detailed assessment of patients for signs of these complications, including for therapeutic management decision making. [Int Angiol 2009;28:400-8]

Scintigraphic validation of AC Biosusceptometry to study the gastric motor activity and the intragastric distribution of food in humans

Abnormal intragastric distribution of food (IDF) and a phasic contractility in the proximal stomach have been related to dyspeptic symptoms. Thus, the behaviour of the stomach and the proximal region, in particular, continues to attract attention and demand for reliable and comfortable techniques. The aims of this study were to employ AC Biosus-ceptometry (ACB) and scintigraphy to evaluate IDF and gastric motor activity in humans. Fifteen healthy volunteers ingested 60 mL of yogurt containing 2 mCi of Tc-99m and 4 g of ferrite. Each volunteer had gastric motility and IDF evaluated twice on separate days; on one occasion by ACB and another by scintigraphy. Digital signal processing was performed in MatLab (Mathworks Inc., Natick, MA, USA). Results were expressed as mean +/- SD. Similar results of distal accumulation time (P < 0.001) were obtained for scintigraphy (6.93 +/- 3.25 min) and for ACB (7.04 +/- 3.65 min). Fast Fourier Transform revealed two dominant frequencies (P > 0.9). Besides the well-know frequency of 3 cpm, our results showed identical frequencies in proximal stomach recordings (P < 0.001) for scintigraphic (1.01 +/- 0.01 cpm) and ACB (0.98 +/- 0.06 cpm). In summary, our data showed that scintigraphy and ACB are promising techniques to evaluate several aspects of gastric motility. Moreover, ACB is non-invasive, radiation-free and deserves the same importance as conventional methods for this kind of analysis.

Clinical presentation and salivary gland histopathology of paediatric primary Sjogren's syndrome

ObjectiveExplore the presentation, diagnostic criteria and exocrine gland histopathology of paediatric primary Sjogren's syndrome (PPSjS).MethodsA case series of 8 children is reported and American-European Consensus Group (AECG-2002) criteria were examined, as well as minor labial salivary and lachrymal gland biopsies, which were scored by a pathologist blinded to outcome. For all cases, connective tissue diseases and parotid-related infectious disease were excluded.ResultsAge at onset varied from 5-13 years old; 6 were females, all followed from diagnosis up to the last visit (1-10 years). The main features at presentation were recurrent tender parotid swelling and sialectasis imaging, with decreased salivary function assessed by Tc-99 scintigraphy. Mild sicca symptoms were observed in 4/8 cases. Systemic features, including fatigue, myalgia, arthritis, tenosynovitis, joint contractures, transient Raynaud's and high ESR, were recorded at onset. Autoantibody profile was unremarkable for diagnosis, while lymphocytic infiltration of labial salivary glands and sialectasis were observed in all biopsies (8/8). In lachrymal glands, massive lymphocytic infiltration and lymphocytic gastritis were observed during complementary assessment. Flares were treated with low dose steroids and long-term use of hydroxychloroquine (5/8), although only 318 fulfilled AECG-2002 diagnostic criteria, throughout the disease course.ConclusionPPSjS is rare, slowly progressive and its early presentation is variable. Standardised diagnostic algorithms should include recurrent parotid swelling and early diagnosis should rely mostly on salivary and lachrymal gland histopathology in this age group.

Hiperplasia nodular focal do fígado: apresentação de um caso e revisão da literatura

Neste trabalho apresentamos um caso de hiperplasia nodular focal que foi diagnosticado aos seis anos de idade e que está sendo acompanhado até o momento presente. Para o diagnóstico foram imprescindíveis as técnicas de imagem, tendo importância de realce a cintilografia hepatoesplênica e a tomografia computadorizada. Apresentamos, também, revisão da literatura sobre o assunto.

Fatores associados à recorrência da infecção do trato urinário em crianças

OBJETIVOS: verificar a freqüência de infecção urinária recorrente (ITU) e avaliar os fatores associados à recorrência da ITU em crianças. MÉTODOS: estudo retrospectivo de 95 pacientes com seguimento de um ano (68 meninas e 27 meninos, mediana de idade três anos). As variáveis estudadas foram: sexo, idade, febre, constipação, tipo de bactéria, refluxo vésico-ureteral (RVU), anormalidades na cintilografia renal com ácido dimercaptosuccínico (DMSA). RESULTADOS: infecção urinária recorrente ocorreu em 49,5% crianças (19 com trato urinário normal, 19 com RVU e 9 com estenose da junção pielocalicial). Comparando o grupo com ITU recorrente com o grupo sem ITU recorrente não se encontrou diferença significativa entre sexos, presença de febre, constipação e anormalidades na cintilografia renal com DMSA. A ITU recorrente foi significativamente maior nas crianças com um ano ou menos, naquelas menores de dois anos com RVU, nas com bactéria diferente da Escherichia coli e sem profilaxia antibacteriana. Os fatores de risco significativos para a recorrência ITU foram idade < 2 anos (OR = 3,83) e refluxo vésico-ureteral (OR = 4,95). CONCLUSÕES: por causa da elevada freqüência de ITU recorrente é importante o seguimento regular de grupo de crianças com fatores de risco para ITU recorrente.

A physiological manoeuvre to improve the positivity of the gastro-oesophageal reflux scintigraphic test

One of the best examinations used routinely to detect gastro-oesophageal reflux (GOR) is scintigraphy and attempts are continuously being made to improve the performance of the test. We have tested a new manoeuvre to improve the results. Three hundred and twenty eight patients (190 males and 138 females, aged 1 month to 84 years, average 4.47 years) were studied after a 12 h fast period with 100 MBq of Tc-99(m)-Phytate, 50 ml volume, directly delivered into the stomach in a mixture of orange juice. All patients were strongly suspected of having GOR. Conventional acquisition was done for 20 min, at a rate of one frame every 20 s. in the middle of the examination, small children were put in the upright position and held there for a few seconds or released in a way that allowed movement; adults were asked to stand up and walk a few metres. The test was then continued for the remaining 10 min. The global index of positivity was 64.6% (76 positive cases in the first half of the examination and 134 positive cases only after the manoeuvre). The mean of GOR episodes observed in the positive cases without the manoeuvre was 0.5 per patient, significantly different from the mean of 1.59 noted after the manoeuvre (P<0.01). In 28 cases the manoeuvre increased either the intensity or the frequency of reflux previously detected without it. We believe that this manoeuvre should be performed in all scintigraphic tests aiming to detect GOR. In the present series, the manoeuvre increased the frequency of GOR episodes. ((C) 2001 Lippincott Williams & Wilkins)].

Effects of meal size and proximal-distal segmentation on gastric activity

Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)

Biomagnetic Methods: Technologies Applied to Pharmaceutical Research

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Implante lobar autólogo pós pneumonectomia: modelo experimental em cães

OBJETIVO: Estudar no implante lobar autólogo a eficiência da anastomose brônquica simples, a perfusão pulmonar e as complicações devido a desproporção doador/receptor. MÉTODOS: Estudou-se 15 cães submetidos à pneumonectomia esquerda, e reimplante do lobo caudal. Estudou-se a perfusão pulmonar e a anastomose brônquica, respectivamente, por cintilografia e por broncografia. O sacrifício ocorreu aproximadamente 200 dias após a cirurgia para o estudo das anastomoses e medidas de volumes e pesos pulmonares. RESULTADOS: Quatro cães foram a óbito, um por deiscência precoce de anastomose brônquica, 1 com infecção e outros 2 por infarto pulmonar devido a oclusão da veia pulmonar no local da anastomose. A perfusão relativa do pulmão direito e esquerdo foram em média respectivamente 72,7% e 27,3%. A broncografia não mostrou nem estenose nem outras alterações na anastomose brônquica. No momento do sacrifício o lobo caudal ocupava totalmente a cavidade pleural sem que houvesse evidentes desvios do mediastino. CONCLUSÕES: O estudo mostrou que a sutura brônquica término-terminal desprotegida não levou a complicações anastomóticas. Não houve complicações pelo fato do lobo implantado ter ocupado somente metade da cavidade pleural. As complicações mais importantes foram o infarto pulmonar e deiscência total da parede torácica. Tanto a broncografia como a cintilografia se mostraram eficientes respectivamente, para o estudo da anastomose brônquica e da perfusão relativa do pulmão funcionante in vivo.

Compensatory lung growth in autologus lobar implant after pneumonectomy in dogs

OBJETIVO: Avaliar se existe crescimento compensatório pulmonar em transplante lobar e verificar se este crescimento é semelhante ao que ocorre após lobectomia. MÉTODOS: Foram utilizados 48 cães, distribuídos em 3 grupos (G1=controle, G2=lobectomia cranial esquerda e G3=pneumonectomia com reimplante do lobo caudal esquerdo). Após 5 meses da cirurgia, os animais foram submetidos à cintilografia pulmonar e a seguir sacrificados para estudo morfométrico pulmonar. RESULTADOS: Os resultados mostraram que não existe correlação da cintilografia nem com a massa nem com o volume do pulmão. Houve crescimento compensatório em massa e volume residual nos dois grupos operados, tanto no pulmão contralateral como no ipsilateral à cirurgia, não existindo até os 5 meses de estudo compensação em capacidade pulmonar total, nem em complacência pulmonar no lobo caudal remanescente do G2 e no lobo caudal reimplantado do G3, havendo maior prejuízo para o lobo reimplantado. Como estudos prévios mostram que o crescimento compensatório pulmonar se inicia com aumento da massa e do volume residual, e que a complacência é compensada posteriormente, este estudo parece ter documentado o início do crescimento compensatório, sendo a complacência pulmonar o fator limitante do crescimento compensatório após 5 meses de estudo. CONCLUSÃO: Conclui-se que existe crescimento compensatório tanto no lobo reimplantado como no pulmão contralateral, mas a complacência ainda encontra-se reduzida. O crescimento compensatório foi semelhante nos dois grupos, mas a complacência do lobo implantado está mais prejudicada.

Molecular analysis of the Von Hippel-Lindau (VHL) gene in a family with non-syndromic pheochromocytoma: the importance of genetic testing

Dois pacientes índices da família analisada neste estudo foram submetidos a adrenalectomia bilateral devido a feocromocitoma. Foi, então, realizado o estudo genético dos pacientes e de sete parentes de primeiro grau. Os dois pacientes com feocromocitoma e dois outros membros assintomáticos da família apresentaram a mutação c496G>T no exon 3 do gene VHL. A família perdeu seguimento médico. Três anos após a realização da avaliação genética, a irmã dos pacientes, portadora da mutação, foi encaminhada para o nosso serviço após uma gestação complicada por pré-eclampsia. Ela referia paroxismos sugestivos de feocromocitoma, mas as metanefrinas urinárias eram negativas. Entretanto, a tomografia computadorizada de abdômen evidenciou uma massa adrenal que também se contrastou na cintilografia com metaiodobenzilguanidina (MIBG). Esse estudo mostra que a análise molecular do paciente índice pode levar à identificação de parentes assintomáticos portadores da mutação. Além disso, mesmo com as metanefrinas urinárias negativas, a identificação de uma mutação específica levou a um aumento da suspeita e detecção de feocromocitoma na irmã dos afetados pela doença.

Pharyngeal clearance and pharyngeal transit time determined by a biomagnetic method in normal humans

Clearance and transit time are parameters of great value in studies of digestive transit. Such parameters are nowadays obtained by means of scintigraphy and videofluoroscopy, with each technique having advantages and disadvantages. In this study we present a new, noninvasive method to study swallowing pharyngeal clearance (PC) and pharyngeal transit time (PTT). This new method is based on variations of magnetic flux produced by a magnetic bolus passing through the pharynx and detected by an AC biosusceptometer (ACB). These measurements may be performed in a simple way. cause no discomfort. and do not use radiation. We measured PC in 8 volunteers (7 males and I female. 23-33 years old) and PTT in 8 other volunteers (7 males and I female. 21-29 years old). PC was 0.82 +/- 0.10 s (mean +/- SD) and PTT was 0.75 +/- 0.03 s. The results were similar for PC but longer for PTT than those determined by means of other techniques. We conclude that the biomagnetic method can be used to evaluate PC and PTT.

A novel biomagnetic method to study gastric antral contractions

A novel non-invasive method to study the motion associated with gastric antral contractions is discussed. The method is based on magnetic flux changes detected by an a.c. biosusceptometer, produced by a magnetic test meal within the stomach. Measurements are made at the surface of the torso and are easy to perform. Simultaneous measurements were made with electrogastrography and scintigraphy showing remarkable coincidence. The effect of a drug on the amplitude of antral contractions was also assayed with the new method.