Paracoccidioidomicose: estudo radiológico e pulmonar de 58 casos

Spirometric and haemogasimetric tests were performed in 52 patients with unifocal and multifocal progressive Paracoccidioidomycosis pulmonary diseases, in 5 patients with juvenile and 1 female internal genital forms. The age ranged from 20 to 74 years old and the duration of disease from 3 to 25 years. Dyspnea, cough, tegumentary and lymphatic manifestations were the most predominant signs observed. Fourteen of them was developed Cor pulmonale. Impaired renal function was recorded in 19 patients, cardiac symptoms were described in 7 and hyporeactor adrenal activity was showed in 13 patients. Radiological studies demonstrated mild in 16, moderate in 24 and severe pulmonary lesions types in 18 patients. The pulmonary function revealed: normal spyrographic findings in 17, pure obstructive type in 32 and mixed form in 9 of them. Hyperventilation was described in 54 individuals and all of them showed an increasing of the alveolo-arterial difference. PaO2 less than 80 mm/Hg observed in 36 of them. Statistical analysis demonstrated significative association between clinical evolution and radiological interpretation. Similar data were obtained in radiology evaluations, clinical evolutive studies and pulmonary functions described in these patients. The granulomatous reaction due to Paracoccidioidomycosis, in heavy smokers patients, gave origin to the alterations in small airways predisposing the interalveolar dissemination an impaired alveolo-arterial diffusion.

Agents that inhibit histamine release: A review

It is well known that histamine is found in high concentration in mast cell granules(1). The histamine content of these granules may be released to the extracellular space if an appropriate stimulus is provided(2). Besides histamine, other preformed active substances like enzymes, chemotatic factors and proteoglycans, as well as newly generated mediators like eicosanoids, platelet activating factor and adenosine are released during the secretion process of mast cells(3). The activation of mast cell degranulation has been associated with a number of pathologic disorders, most frequently, diseases derived from the atopic state(4). It is now evident that mast cells are the primary effector cells in the early reaction in both allergic and non-allergic asthma(5,6), although some authors doubt that the late reaction of asthma is a mast cell dependent event(6). Other studies point towards basophils as cellular elements involved in the secondary phase of inflammation in allergic diseases(7). Secretion would depend on a histamine releasing factor, and on the presence of IgE on the basophil's surface(8). There is also evidence suggesting involvement of mast cells in some non-allergic inflammatory processes like arthritis(9). The pharmacological management of these diseases basically consists in the use of methylxantines, beta 2-adrenergic agonists, glucocorticoids, sodium cromoglycate-like drugs, anticholinergic and antihistaminic H 1 antagonists(10). Their therapeutic effects include bronchodilatation, receptor and physiological antagonism, prevention of inflammatory responses induced by secondary cells, and finally, inhibition of mast cell activation(11). This review is concerned with compounds having inhibitory action on mast cell activation, and their possible importance on the pathophysiology of mast cell-related diseases.

Reação metabólica à infecção no hospedeiro.

At the site of local reaction to infection the interleukin-1 (1L-1) is released signaling to distant tissues the presence of infection and attempting to strengthen the host's defenses and inhibit the bacterial growth. This phenomenon is accompanied by anorexia and fever. The muscle-protein breakdown is sustained and the released amino acids are taken up by the liver and other RE structures where they are used as substrates for energy and for synthesis of defense-related proteins. The metabolic adaptations to sepsis include hyperthermia, increased synthesis of hepatic globulins, development of granulopoiesis and neutrophilia and redistribution of serum iron and trace minerals.

Influência da elevaçáo transitória e da elevaçáo sustentada da pressáo arterial sobre a primeira derivada temporal da pressáo ventricular.

PURPOSE--To analyze the influence of transient and sustained elevations of arterial pressure (AP) on the rate of rise of the left ventricular pressure (dp/dt). METHODS--Thirteen anesthetized, thoracotomized and mechanically ventilated dogs, submitted to pharmacological autonomic block (oxprenolol-3 mg/kg plus atropine-0.5 mg/kg). The AP elevation was obtained by mechanical constriction of the descending thoracic aorta. Two protocols were applied to all animals: Transient Arterial Hypertension (TAH) and Sustained Arterial Hypertension (SAH) and the following variables were evaluated: heart rate (HR), systolic (LVSP) and end diastolic (LVEDP) left ventricular pressure and dp/dt. In TAH the variables were analyzed in the basal condition (To) and at the maximal value of AP attained during the transient pressure elevation (TM). In the protocol SAH the variables were evaluated in the conditions: Control (Ho), hypertension 1 (H1) and hypertension 2 (H2). RESULTS--Considering all conditions, there were no significant differences among the values of HR. In the protocol TAH, the LVSP varied from 133 +/- 22 mmHg to 180 +/- 27 mmHg, whereas in SAH the values of LVSP were as follow: HO = 129 +/- 25 mmHg; H1 = 152 = 23 mmHg; H2 = 182 +/- 24 mmHg. LVEDP changed in both protocols: To = 7 +/- 2 mmHg; TM = 13 +/- 2 mmHg (p < 0.05); Ho = 7 +/- 2 mmHg; H1 = 10 +/- 2 mmHg; H2 = 14 +/- 3 mmHg (p < 0.05). During TAH there was no difference between the values of dp/dt (To = 3.303 +/- 598 mmHg/s; TM = 3.350 +/- 653 mmHg/s; p > 0.05), however, there were increases of the dp/dt during SAH (Ho = 3.233 +/- 576 mmHg/s; H1 = 3.831 +/- 667 mmHg/s; H1 = 4.594 +/- 833 mmHg/2; p < 0.05). CONCLUSION--The values of dp/dt are not influenced by transient elevation of AP. Sustained increase of AP activates cardiac adjustments, which results in elevation of dp/dt, by stimulation of contractile state. Probably, the inotropic intervention mechanism is the length dependent activation due to the Frank-Starling mechanism.

Influence of age on the febrile response to E. coli and S. typhimurium endotoxins in growing pullets.

1. The effect of bacterial endotoxin injection was studied in growing pullets of different ages. Commercial chicks were divided into 5 groups according to age. Bacterial endotoxins (E. coli and S. typhimurium) were injected intravenously and rectal temperature was measured over a period of 300 min. 2. The results showed no significant effect of age on the febrile response induced by bacterial endotoxins, but a slight tendency towards a reduced fever peak was observed with increasing age. The response latency also increased with age.

Características clínicas e implicações prognósticas do acometimento renal no mieloma múltiplo.

The renal involvement in patients with multiple myeloma has been described as a sign of poor prognosis. The influence of renal insufficiency in the clinical patterns and in the prognosis of patients with multiple myeloma was studied retrospectively in 45 patients. Patients with renal insufficiency, at first visit, more often presented weight loss, proteinuria, hypercalcemia. The means of uricemia, ESR, were higher and the hematocritic mean was lower in patients with renal insufficiency. There was no difference in edema, arterial hypertension, fractures and bone pain. The reversibility of renal insufficiency occurred in 47% of the cases, which happened more often in the first months of the follow up. The creatinine mean was lower in patients with reversible renal insufficiency. The median survival was: patients with renal insufficiency: 11 months; patients with normal renal function: 50 months. Among patients with renal insufficiency those with recuperation of renal function showed a higher median survival (24 months) than those with irreversible renal insufficiency (1 month). The renal involvement then is frequent and often reversible. Patients with impaired renal function showed a worse prognosis; normalization of the renal function was associated with a better outcome.

Psychological evaluation of patients scheduled for orthognathic surgery.

Using a questionnaire, 41 patients scheduled for orthognathic surgery were evaluated pre- and postoperatively to determine some of their psychological characteristics and treatment outcome from the patient's standpoint. Among other conclusions, the results showed that some patients may not fully understand the details of their deformity, despite a full explanation by the orthodontist and surgeon. Expectations regarding treatment outcome may be unrealistic even in patients with valid self-motivation for surgery. Social adjustment usually improves after treatment. Functional changes were noticed by over 80% of the patients and esthetic changes in over 90%.

Incontinentia pigmenti (Bloch-Sulzberger syndrome): a case report.

A syndrome--incontinentia pigmenti--of probable genetic etiology, is discussed and a new case report presented. The syndrome presents systemic and dental manifestations, which are separate although similar to those found in other disease entities, i.e., congenital syphilis, hereditary ectodermal dysplasia.

Tosse, uma visão do otorrinolaringologista.

Persistent cough leads individuals to seek for medical assistance. Clinical investigation, however, may not reveal any alteration within the clinic's sphere of action. Often enough, some professionals treat the symptom as a disease, introducing several medicines, unsuccessfully. The author's experience, as an otolaryngologist, allows to state that many of these professionals ignore the upper aerodigestive tract as a cough-generator site. The present work discusses the alterations on the mentioned tract, which may provoke the cough reflex, reviewing, initially, the cough mechanism and the localization of the specific receptors. Cough is produce by stimulus at the receptor level or far from it. In upper and lower parts of the aerodigestive tract secretions may run to several directions. Secretion from the paranasal sinus is a frequent cause of cough. Acute sinusitis may occur insidiously bringing about the chronification of the inflammation with cough being the only great apparent symptom. Nasal and dental alterations favor sinusal infection. Signs and symptoms, even if minimum, may be detected through an accurate anamnesis. Nasal allergy, laryngitis, post nasal dripping and septal deviation may also produce cough. The ORL examination is, therefore, imperative, and no radiologic examination can substitute for it. An inadequate treatment, particularly of the sinusitis, may bring about a worsening and extension of the initial condition.

INFLUENCIA DO ACRESCIMO DE MANITOL A SOLUCAO NUTRIENTE NO DESEMPENHO MECANICO E NO GRAU DE EDEMA MIOCARDICO DE CORACOES ISOLADOS DE RATOS

Purpose - To analyse the influence of mannitol added to Krebs-Henseleit (KH) solution on the myocardium edema and myocardial function. Methods - Isolated rat heart under isovolumetric contractions studied according to Langendorff's technique were perfused with KH solution at constant flow during 90 min. The coronary perfusion pressure, diastolic and systolic pressures were recorded at every 15 min. At the end of the experiment, myocardium water content was measured in hearts perfused with KH solution (group I, n = 9) and in hearts perfused with KH solution plus 8 mM mannitol (group II, n = 8). These results were compared to non-perfused control heart (n = 9). Results - Myocardial water content was statistically higher in group I (80.8 ± 1.3%) compared to group II (78.1 ± 0.7%) and control group (75.5 ± 0.5%). Systolic arterial pressure was statistically higher in group I (86.2 ± 11.5 mmHg) compared to group II (72.7 ± 21.1 mmHg). There was no difference in the diastolic pressure between the two groups. Coronary perfusion pressure (Pp) increased progressively during the experiment in both groups. However, Pp was lower in group II than in group I. Conclusion - Mannitol added to KH solution significantly attenuates the myocardium edema in the isolated perfused rat heart.

Pulpal and periodontal reactions of immature permanent teeth in the dog to intrusive trauma.

Pulpal and periodontal tissues of immature incisors of 10 dogs were radiographically and histopathologically evaluated immediately, 7, 15, 30 and 60 days after experimental intrusion induced by mechanical blows. Forty upper central and mesial lateral incisors showing incomplete root formation on radiographs were submitted to intrusive force. After the observation periods, the dogs were killed, two at a time. The hemi-maxilas were removed and processed for histopathologic examination. The traumatized teeth showed accelerated apical formation with reduced radicular length. Pulpal vitality was maintained and the subjacent tissues did not present irreversible changes. All traumatized teeth re-erupted spontaneously.

Ação do diclofenaco de sódio, após a interrupção da peritonite estercorácea, no cólon de ratos. Estudo da resistência mecânica e do colágeno tecidual.

The objective of the present study was to investigate changes in colon wall in rats with fecal peritonitis (Per) associated with sodium diclofenac (SD) by studying breaking strength and tissue collagen concentration. The rats were divided into the following experimental groups: GROUP 1-SD: 60 animals injected intramuscularly with sodium diclofenac at the dose of 2 mg/kg body weight; GROUP 2-Per: 60 animals injected intraperitoneally with a suspension of human feces. Peritonitis was interrupted after six hours of evolution; GROUP 3-Per+SD: 60 animals injected intraperitoneally with a suspension of human feces and receiving SD according to the schedule used for Groups 1 and 2; CONTROL GROUP: 12 animals injected intramuscularly with physiological saline. The animals of Group 1, 2 and 3 were successively sacrificed 2, 4, 7, 14 and 21 days after interruption of peritonitis an/or the beginning of treatment. Under conditions of the experimental model and of the methods used, we conclude that sodium diclofenac, peritonitis and the peritonitis-sodium diclofenac association decrease the breaking strength and the concentration of tissue collagen in the colon segment.