Tunnel excavation triggering pulmonary sarcoidosis.

CONTEXT: A definite cause of sarcoidosis has not been identified, however past research suggests that environmental factors may be triggers of the granulomatous response in genetically susceptible individuals. CASE PRESENTATION: A 22-year-old male non-smoker, presented with progressive exertional dyspnea and cough of 3 months duration. One year before, when he started working in tunnel excavation, he had a normal chest radiograph. Chest imaging revealed bilateral nodules and masses of peribronchovascular distribution plus mediastinal lymphadenomegaly. Histologic lymph node analysis revealed non-caseating confluent granulomas. Sarcoidosis was diagnosed. The patient was treated with corticosteroids and advised to change jobs. Complete remission of the disease was achieved and persisted for at least one year without steroid treatment. DISCUSSION: Sarcoidosis is believed to have environmental triggers. The timing of the onset of sarcoidosis in this patient following intensive exposure to tunnel dust suggests an environmental contribution. The recognition that sarcoidosis may have occupational triggers have medical, employment, and legal implications.

Factor analysis of sarcoidosis phenotypes at two referral centers in Brazil.

BACKGROUND: In sarcoidosis, clinical presentations and outcomes vary widely. OBJECTIVE: To characterize the clinical phenotypes of sarcoidosis, by factor analysis, in a series of cases with long-term follow-up. METHODS: We conducted a retrospective study involving 137 patients with biopsy-confirmed sarcoidosis, recruited from two referral centers in São Paulo, Brazil. Organ involvement was evaluated in accordance with a previously established protocol. Sarcoidosis phenotypes were characterized by factor analysis. RESULTS: Follow-up ranged from 6 to 144 months. Four factors (phenotypes) were identified: relevant residual pulmonary fibrosis; relapse; residual airflow limitation; and acute disease. The four factors collectively accounted for 66% of the total variance. Patients with relevant residual pulmonary fibrosis were older and presented with the following: greater symptom duration; skin involvement; low forced vital capacity; low forced expiratory volume in one second/forced vital capacity ratio; and more advanced radiographic stages at baseline. The relapse phenotype was associated with chronic disease, greater dyspnea severity, neurologic involvement, and cardiac involvement. Patients with residual airflow limitation more often had airflow obstruction at baseline, chronic disease, and relevant residual pulmonary fibrosis. Acute disease was associated with being younger, weight loss, scoring lower for dyspnea, and having extensive involvement. Abnormal calcium metabolism was associated with acute disease and with relapse. CONCLUSIONS: Sarcoidosis can be categorized into four different clinical phenotypes: three that are chronic; and one that is acute and self-limiting. In many cases, these phenotypes can be easily recognized.

Methacholine vs adenosine on intra and extrathoracic airway hyperresponsiveness in patients with cough variant asthma.

BACKGROUND: Airway hyperresponsiveness (AHR) can be studied by bronchoprovocation test (BPT) using direct (methacholine - MCh) or indirect (adenosine 5'-monophosphate - AMP) stimuli. These two substances have not been compared in cough variant asthma (CVA). OBJECTIVE: We designed a randomized, single-blind, cross-over study to compare AMP and MCh in the detection of CVA. Additionally, we examined whether assessment of extrathoracic airway hyperresponsiveness (EAHR) during MCh and AMP helped in the evaluation of CVA. METHODS: Patients with CVA with previous positive MCh BPT performed challenges with AMP and MCh. The variables were: (i) a provocative dose producing a 20% fall in forced expiratory volume in 1 s (FEV(1)) value (PD(20)MCh); (ii) a provocative dose producing a 25% fall in the maximal mid-inspiratory flow (FIF(50)) from baseline (PD(25)MCh) for MCh; (iii) a provocative concentration producing a 20% fall in FEV(1) value (PC(20)AMP) and (iv) a provocative concentration producing a 25% fall in the FIF(50) from baseline (PC(25)AMP) for AMP. RESULTS: All 113 patients with CVA responded to PD(20)MCh and 96% and 69% responded to PC(20)AMP, if we used PC(20)

Gatifloxacina oral no tratamento da exacerbaçäo aguda da bronquite crônica. Um estudo aberto, multicêntrico, näo comparativo, Fase III b / Oral gatifloxacin in the treatment of acute exacerbation of chronic bronchitis (AECB). An open-label multicenter noncomparative phase IIIb study

Avaliar a eficácia e a segurança da gatifloxacina, uma nova 8-metoxi-fluoroquinolona com amplo espectro de atividade, em pacientes com exacerbaçäo aguda de DPOC. Foram incluídos 50 pacientes näo internados com exacerbaçäo aguda de DPOC, em um estudo aberto, näo comparativo, multicêntrico. Quarenta e três tinham exacerbaçäo aguda do tipo I, de acordo com critérios propostos por Anthonisen. Gatifloxacina foi dada por via oral, 400 mg/dia, por 7-10 dias. O sucesso clínico entre os pacientes avaliáveis foi de 94 por cento. H. influenzae, S. pneumoniae e M. catarrhalis foram isolados 28 vezes em 21 pacientes, e foram erradicados em todos, exceto em um caso. Efeitos adversos ocorreram em 19 pacientes, mas resultaram em interrupçäo do tratamento em apenas dois casos. A gatifloxacina é eficaz e segura em exacerbaçöes agudas da bronquite crônica.

Ciprofloxacina em exacerbaçoes da doença pulmonar obstrutiva crônica-estudo multicêntrico / Ciprofloxacin in exarcebations of chronic obstrutive pulmonary disease(COPD)

O efeito da ciprofloxacina em pacientes com exacerbaçaoda doença pulmonar obstrutiva crônica (DPOC) foi estudado num ensaio aberto, prospectivo, conduzido em oito centros do Brasil. Setenta e seis pacientes com exacerbaçao aguda purulenta, associada a piora da dispnéia, foram tratados com ciprofloxacina 500 mg, duas vezes ao dia, por sete a dez dias(x=8,2). O VEF1 era de 1,20 / + - 0,50 /. O escarro de 51 pacientes revelou um número significativo de bactérias e polimorfonucleares. Pelo gram, os patógenos predominantes sugeridos foram S.pneumoniae(33 por cento), bacilos gram negativos(22 por cento), M. catarrhalis(18 por cento) e H. influenzae(16 por cento). Avaliaçao clínica e bacteriológica foi repetidaapós 7, 10 e 21 dias da avaliaçao inicial. Sucesso clínico (desaparecimento ou melhora acentuada dos sintomas e sinais) foi observada em 80 por cento dos pacientes. O número de bactérias foi reduzido no escarro em 86 por cento dos casos. Efeitos adversos relacionados ao tratamento foram relatados por 17 por cento dos pacientes. A ciprofloxacina oral é um tratamento efetivo para exacerbaçoes agudasde DPOC.