Linfonodo pulmonar na paracoccidioidomicose aguda infantil (relato de um caso).

The primary complex like Ghon was observed in a child's clinical roentgenographic study. C.S., white, male, 6 years old, was born in Curitiba (PR), Brazil and living in Guaratingueta (SP), Brazil, developed common cold, bimodal diary fever, chills, shake and sweats. Dyspnea, cough with general lymphadenopathy. Foot and right shoulder arthralgias. Six months ago visited a cave, equitation practice, dog and cat contacts and no transfusion, frontal sweats, fever (38.4 degrees C). T.A. was 8/6, tachycardia in generalized lymphadenopathy. Cardiopulmonary system was normal, mesogastric tumoral mass, hepatosplenomegaly and no ascites. Bone marrow with eosinophilia; nodule demonstrated presence of P. brasiliensis, hypoalbuminemia; hyperglobulinemia; anemia; leukocytosis with eosinophilia. Immunodiffusion with exoantigen 43 kd of P. brasiliensis was 1/32. Primary complex like Ghon was observed in interstitial pneumonia followed by mediastinal and mesogastric mass (35 to 40 days). Clavicular osteolytic lesions (45 to 60 days) appeared during paracoccidioidomycosis therapy. Recovery was observed 2 months after treatment of acute infantile paracoccidioidomycosis.

Fístula arteriovenosa pulmonar maciça. Causa rara, potencialmente curável de hipóxia neonatal.

The case of a six-day-old neonate admitted in an emergency situation because of dyspnea and increasing cyanosis is reported. Despite abnormal opacification on the chest X-ray and left ventricular overload on the electrocardiogram and echocardiogram, features compatible with the disease, the diagnosis of massive pulmonary arteriovenous fistula affecting the whole left superior lobe, was made possible only after necroscopic examination.

Situacao atual da quimioterapia contra a tuberculose

Actions to overcome a disease are dependant, essentially, on what is known about it. Procedures followed in the past were sometimes bizarre, but justified because of how little was known about the disease. The tuberculosis prechemotherapeutic age was somber due to the high levels of fatalities and morbidity. With the arrival of the chemotherapeutic treatment its prognosis has changed. Tuberculosis declined in the 50's and stabilized in the 80's. Nevertheless, it is back increasing alarming its numbers more than ever; probably because of some factors, among them, the public health system lack of attention and the government's policies, increasing in the migration to and from the endemic areas, development of drug multi-resistant cepa and also to the HIV infection. An universal antimycobacteria chemotherapy treatment is not accepted, maybe because of the number of drugs that are available. Modern chemotherapy, however, has an attack and a maintenance phases with the aim to eliminate the bacillus of fast and slow multiplication, respectively. The treatment period is long, when compared with other infectious diseases, that leads to the lack of compliance. In spite of the available resources in the fight against tuberculosis they seem insufficient to restrain the disease. This has forced the search for new chemotherapy alternatives to avoid strong come back of tuberculosis to the point of being called the 'white plague' well into the 21'st century.

Doença pulmonar obstrutiva crônica

In this review the definition of COPD is presented and the epidemiology and risk factors for disease development are briefly discussed. Characteristics clinical features, pulmonary functions indices, radiologics signs and arterial blood gases alterations are presented and discussed. Classification of disease severity and components of COPD management are also described.

Doença pulmonar obstrutiva crônica

The chronic obstructive lung disease is reviewed with emphasys on its epidemiology and risk factors. The diagnosis, clinical aspects pulmonary, functional alterations and laboratorial findings are discussed. The treatment is also reviewed, based on the actual consensus, considering the following classes of approaches: bronchodilators, inhaled β-agonists, corticoids, methilxanthines, prolonged domiciliar-orygen therapy.

Análise comparativa de métodos de avaliação da composição corporal em homens sadios e em pacientes com doença pulmonar obstrutiva crônica: antropometria, impedância bioelétrica e absortiometria de raios-X de dupla energia

The aim of this study was to examine the agreement between the results of body fat (BF and BF%), fat-free mass (FFM) and FFM index (FFMI= FFM/height2) as estimated by skinfold anthropometry (ANT), bioelectrical impedance (BIA) and dual-energy X-ray absorptiometry (DXA) in two groups of men (> or = 50 y), one comprising healthy individuals (n=23) and the other, patients with chronic obstructive pulmonary disease (COPD) (n=24). Comparisons between body composition techniques were done by repeated measures ANOVA; the Bland & Altman procedure was used to analyse agreement. RESULTS AND CONCLUSIONS: 1) comparison between healthy and COPD groups showed significant differences between all studied variables; 2) in the healthy group, values for BF, BF%, FFM and FFMI were not significantly different when BIA or ANT was compared to DXA; however, in COPD, values for BF and BF% were significantly higher and for FFM and FFMI significantly lower when BIA was compared to DXA; in contrast, no differences were shown between values for these variables when ANT was compared with DXA; 3) Bland & Altman test, in both groups, showed no agreement between BIA and DXA and between ANT and DXA; it was also shown that body fat was overestimated and fat free mass underestimated by BIA in relation to DXA.

Manifestações sistêmicas na doença pulmonar obstrutiva crônica

Chronic obstructive pulmonary disease is progressive and is characterized by abnormal inflammation of the lungs in response to inhalation of noxious particles or toxic gases, especially cigarette smoke. Although this infirmity primarily affects the lungs, diverse extrapulmonary manifestations have been described. The likely mechanisms involved in the local and systemic inflammation seen in this disease include an increase in the number of inflammatory cells (resulting in abnormal production of inflammatory cytokines) and an imbalance between the formation of reactive oxygen species and antioxidant capacity (leading to oxidative stress). Weakened physical condition secondary to airflow limitation can also lead to the development of altered muscle function. Chronic obstructive pulmonary disease presents diverse systemic effects including nutritional depletion and musculoskeletal dysfunction (causing a reduction in exercise tolerance), as well as other effects related to the comorbidities generally observed in these patients. These manifestations have been correlated with survival and overall health status in chronic obstructive pulmonary disease patients. In view of these facts, the aim of this review was to discuss findings in the literature related to the systemic manifestations of chronic obstructive pulmonary disease, emphasizing the role played by systemic inflammation and evaluating various therapeutic strategies.

Ocorrência de tuberculose em um hospital psiquiátrico do interior de Goiás

Objective: To investigate the prevalence of infection, disease and eventual institutional outbreak of tuberculosis in a psychiatric hospital using the PPD test, as well as testing for mycobacteria in material collected from the respiratory tree and using molecular tracking technique based on insertion sequence 6110 (IS6110). Methods: Between February and August of 2002, PPD tests were given to 74 inpatients and 31 staff members at a psychiatric hospital in the city of Rio Verde, located in the state of Goiás, Brazil. In addition, respiratory tree material collected from the inpatients was submitted to testing for Mycobacterium tuberculosis. Results: Among the patients analyzed, mycobacteria were isolated from five (6.8%): four identified as M. tuberculosis and one as M. chelonae. The M. tuberculosis isolates were sensitive to isoniazid and rifampicin, and, when submitted to the restriction fragment length polymorphism/IS6110 technique, presented unique genetic profiles, totally distinct from one another, suggesting that all of the tuberculosis cases were due to endogenous reactivation. It was not possible to characterize this group of cases as an institutional outbreak. Performing the two-step tuberculin test in the patients, the infection rates were 23% and 31%, compared with 42% among staff members, who were submitted to the one-step test. Conclusion: The results indicate a high incidence of tuberculosis infection among inpatients and hospital staff, as well as a high occurrence of the disease among inpatients.

Tuberculose e o estudo molecular da sua epidemiologia

Systems that can distinguish epidemiologically-related Mycobacterium tuberculosis strains from unrelated ones are extremely valuable. Molecular biology techniques have allowed a great deal of information to be acquired about the infectious disease tuberculosis (TB) that was very hard or impossible to obtain by conventional epidemiology. A typing method based on bacterial DNA genome differences, known as RFLP (restriction fragment length polymorphism), is widely used to discriminate strains in the epidemiologic study of TB. However, RFLP is laborious and there is a tendency to replace it by other methods. Thus, other DNA sequences have been employed as epidemiological markers, as in Spoligotyping, a fast technique based on PCR followed by differential hybridization of amplified products. The polymorphism observed among different isolates is probably the product of strain-dependent recombination. MIRU (mycobacterial interspersed repetitive unit) typing is a reproducible and fast assay, involving the generation of genotypes based on the study of 12 loci containing VNTRs (variable-number tandem repeats) in strains of the M. tuberculosis complex. It compares strains from different geographic areas and allows the movement of individual lineages to be tracked, as in RFLP. This approach enables a greater number of isolates to be analyzed, leading to the identification of a larger number of foci of transmission within the population and thus to improved ways of slowing the progress of the disease.

Doença pulmonar obstrutiva crônica

Chronic obstructive pulmonary disease (COPD) is considered the forth cause of death in the world. The present review summarizes the epidemiologic and risk factors to the disease. Emphasizing the diagnostic, pulmonary function, radiological alterations and blood gases. According to the current guideline recommendations, the authors reviewed the classification and treatment. © Copyright Moreira Jr. Editora. Todos os direitos reservados.

Edema agudo pulmonar associado à obstrução das vias aéreas. Relato de caso

BAKGROUND AND OBJECTIVES: Negative pressure pulmonary edema has been defined as non-cardiogenic edema, with transudation of fluid to the interstitial space of the lungs due to an increase in negative intrathoracic pressure secondary to obstruction of the upper airways. This is the case of a healthy patient who underwent general anesthesia and developed acute pulmonary edema after extubation. CASE REPORT: A 23-year old female patient, physical status ASA II, underwent gynecologic videolaparoscopy under general anesthesia. The procedure lasted 3 hours without intercurrence. After extubation the patient developed laryngeal spasm and reduction in oxygen saturation. The patient improved after placement of an oral cannula and administration of oxygen under positive pressure with a face mask. Once the patient was stable she was transferred to the recovery room where, shortly after her arrival, she developed acute pulmonary edema with elimination of bloody serous secretion. Treatment consisted of elevation of the head, administration of oxygen via a face mask, furosemide and fluid restriction. Chest X-ray was compatible with acute pulmonary edema and normal cardiac area. Electrocardiogram (ECG), echocardiogram and cardiac enzymes were normal. The condition of the patient improved and she was discharged from the hospital the following day, asymptomatic. CONCLUSIONS: Acute pulmonary edema associated with obstruction of the upper airways can aggravate surgical procedures with low morbidity, affecting mainly young patients. Early treatment should be instituted because it has a fast evolution and, in most cases, resolves without lasting damages. © Sociedade Brasileira de Anestesiologia, 2008.

Doença pulmonar obstrutiva crônica

The present review summarizes the clinical aspects, diagnostics criteria and treatment of Chronic Obstructive Pulmonary Disease (COPD). Besides, will be reviewed the systemic manifestations associated with COPD and its clinical relevance in the patient's follow up. © Copyright Moreira Jr. Editora.

Efeito de treinamentos resistidos sobre marcadores inflamatórios, força e massa magra corporal de pacientes com doença pulmonar obstrutiva crônica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

A corda elástica como instrumento de treinamento resistido em paciêntes com doença pulmonar obstrutiva crônica

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)