Skin aging in patients with acquired immunodeficiency syndrome.

To evaluate the histomorphometric skin changes over aging patients with autopsied acquired immunodeficiency syndrome (AIDS). In 29 skin fragments of autopsied elderly (older than 50 years) and nonelderly patients with AIDS, epidermal thickness, the number of layers, the diameter of cells, the percentage of collagen and elastic fibers in the dermis, and the number and morphology of Langerhans cells were assessed. Statistical analysis was performed by SigmaStat 2.03 program. The thickness of the epidermis (92.55 × 158.94 µm), the number of layers (7 × 9 layers), and the diameter of the cells (13.27 × 17.6 µm) were statistically lower among the elderly. The quantity of collagen fibers (9.68 × 14.11%) and elastic fibers (11.89 × 15.31%) was also significantly lower in the elderly. There was a decrease in total (10.61 × 12.38 cel/mm(2)) and an increase in immature Langerhans cells (6.31 × 4.98 cel/mm(2)) in elderly patients with AIDS. The aging of the skin of patients with AIDS is amended in different histomorphometric aspects, the epidermis constituents suffer less pronounced changes in normal aging, and the dermis has more intense changes in elastic fibers and collagen.

Influence of AIDS in collagen deposition and thickness of the bone marrow.

Bone marrow abnormalities are frequently observed in individuals with AIDS. Dysplasia, the most common abnormality, is found in more than 50% of patients infected with the HIV. The aim of this study was to assess trabecular thickness and collagen content as well as cellularity in the bone marrow of patients with AIDS. Sixty bone marrow samples were collected from the sternum of autopsied patients with or without AIDS (n = 30, each). Cellularity and trabecular thickness was assessed by performing hematoxylin-eosin staining; picrosirius staining was used to evaluate collagen content. Morphometric analyses were performed by using a Zeiss KS300 system (Kontron-Zeiss). Patients with AIDS showed a significant reduction in trabecular bone thickness and an increase in collagen deposition. No statistically significant differences were observed in cellularity between the 2 groups. Therefore, reduced thickness and increased collagen deposition were observed in the trabeculae of the bone marrow of patients with AIDS due to possible interaction between cytokines and bone marrow components.

Analysis of the scalp of women with AIDS subjected to autopsy: epithelial, follicular, and immunologic aspects.

Hair keeps the scalp warmer and slightly moister than the rest of the skin, which contributes to a favorable environment for mycotic, bacterial, and parasitic infections. It is well established that AIDS makes the patient more susceptible to opportunistic infections and cutaneous manifestations. Because of this, the aim of this study was to analyze scalp fragments of autopsied women with AIDS. Twenty-eight scalp samples of women aged between 18 and 46 years were observed. These women were divided into 2 groups: with AIDS (n = 14) and without AIDS (n = 14). We conducted histochemical (hematoxylin-eosin, Picrosirius, and Verhoeff), morphometric (Image J; National Institutes of Health, Hamilton, ON, Canada and KS-300 Kontron-Zeiss; Kontron Elektronik, Carl-Zeiss, Germany), and immunohistochemical (S-100) analyses of the scalp. In patients with AIDS, epithelial thickness, number of epithelial cell layers, number of immature Langerhans cells in the epidermis, and percentages of elastic fibers in the dermis were significantly lower, whereas telogen hair follicles were significantly higher. The percentage of collagen fibers in the dermis and the diameter of the epithelial cells were smaller in patients with AIDS, without significant difference. AIDS possibly causes immunologic and morphologic alterations in the scalp. This study may establish parameters for better clinical and morphologic diagnostic in patients with AIDS.

Role of mast cell chymase and tryptase in the progression of atherosclerosis: study in 44 autopsied cases.

The aim of this study was to describe the role of mast cell chymase and tryptase in the progression of atherosclerosis. Forty-four sections of aortas were obtained from autopsies. We assessed the macroscopic degree of atherosclerosis, microscopic intensity of lipid deposition in the tunica intima, percentage of collagen in the tunica intima, and density of immunostained mast cells. There was no significant difference between the density of mast cell tryptase and chymase concerning ethnicity, sex, cause of death, or degree of atherosclerosis. The density of mast cell chymase was significantly higher in the nonelderly group. The percentage of collagen was significantly higher in elderly patients. There was a positive and significant correlation between the degree of macroscopic atherosclerosis and lipidosis, the density of mast cell chymase and the percentage of collagen, the density of mast cell tryptase and the percentage of collagen, and lipidosis and the density of mast cell tryptase. The degree of macroscopic lesion of atherosclerosis increased proportionally with the increase in the density of mast cell chymase and tryptase and in the intensity of lipid deposition and with the percentage of collagen in the atherosclerotic plaques. Thus, mast cells may play a crucial role in aggravating atherosclerotic lesions.

Association between cysticercosis and neoplasia: a study based on autopsy findings.

Chronic infections including the cysticercosis induce inflammatory cells to produce free radicals and synthesize carcinogenic toxins. The cells with genetic mutations proliferate in a disorganized manner, leading to the development of neoplasia. The aim of the present study was to demonstrate the relation between cysticercosis and neoplasia. Patients autopsied were divided into 4 groups: patients with neoplasia and cysticercosis (NC), patients with neoplasia only (NN), patients with cysticercosis only (CC), and patients without neoplasia or cysticercosis (WW). Of 2012 autopsy reports analyzed, 0.4 showed NC. In groups CC and NC, the most common location of the parasite was the brain. There was a predominance of three or more cysticerci in groups NC and CC. In the NC group, all had malignant neoplasms, and was predominance of benign neoplasm in NN group. The digestive system was the most frequent neoplasia. By calculating odds ratio, rate of neoplasia in patients with cysticercosis was 0.74. In conclusion, the demographic profile of patients with cysticercosis and neoplasia is similar to that of patients with cysticercosis alone. The incidence of cysticercosis and neoplasia was greater in older patients suggesting that immunosenescence may contribute to development of neoplasia promoted by cysticercosis.

Kocher-Debré-Sémélaigne syndrome diagnosed by autopsy associated with disseminated intravascular coagulation.

Kocher-Debré-Sémélaigne syndrome is a rare disease with little literature, which develops with myopathy in infancy associated with neuromuscular alterations, polymyositis with symmetrical proximal muscle weakness, pseudohypertrophy, muscular rigidity and spasms, exercise intolerance, myxoedema, short stature, and cretinism. Male patient aged 18 years old, 1.52 m in height, admitted in the General Hospital of Triângulo Mineiro Federal University on November 11, 2003, complaining of intense diffuse abdominal pain like severe cramps, without triggering factors, associated with asthenia and hyporexia. This seems to be one of the few reports of KDS syndrome diagnoses by autopsy, where alterations in the thyroid gland connected with hypotrophy and probable congenital hypothyroidism were described and resulted in complications such as disseminated intravascular coagulation and hemophagocytic syndrome with fast progression to death of an 18-year-old patient.

Liver morphologic analysis in perinatal autopsies with intrauterine stress liver morphology in perinatal autopsies.

Quantify steatosis, fibrosis, and focuses of extramedullary erythropoiesis (ER) in the liver and report it to the causes of death in the perinatal. Morphologic analysis of steatosis', percentage of fibrosis, and ER of 467 perinatal autopsies. Cases with hypoxia/perinatal anoxia and ascending infection showed higher percentage of fibrosis. The number of ER was significantly higher among premature infants and in cases with infection. Our results contribute to a better quality of perinatal care through clinical demonstration of which injuries are associated with them, what may help in early diagnosis of these alterations in children who survive.

Morphologic analysis of fetal stress organsin different causes of perinatal death.

Complications act as stress-inducers during pregnancy so the fetus can develop functional compensatory mechanisms or morphologic changes. The cases analyzed are with congenital malformations or acute stress; chronic included cases with ascending infection (AI) and perinatal hypoxia/anoxia (PHA). The hematoxylin-eosin (H&E) was done to analyze the vacuolization, and the immunohistochemistry to the phagocytosis. The discreet standard of vacuolization was observed in 52.6% of the cases, 22.1% moderate, and 25.3% severe. The number of macrophages was higher in PHA. Changes in these organs are closely related to the cause of death and to the period during which the harmful agent.

Chagas disease and gynecologic neoplasias.

The inflammation caused by Trypanosoma cruzi produces irritation and cell proliferation and may contribute to the development of cancer. The objective was to determine the occurrence of gynecologic neoplasia (GN) and demographic characteristics in patients with Chagas disease (CD). We used protocols of 671 autopsies between 1976 and 2008. The patients were divided into 3 groups: with GN and CD, only with CD, and only with GN. The 2 diseases were observed in 4.5% of patients with a mean age of 47.6 years and who were predominantly white. The megaesophagus and megacolon were more frequent in the group with only CD. The most common benign neoplasm was uterine leiomyoma, and malignant, carcinoma of the cervix. We conclude that the epidemiological profile of patients with CD and GN was similar to the other groups, and the CD was found not to be a risk factor or protective against the development of GN.

Analysis of mast cells and myocardial fibrosis in autopsied patients with hypertensive heart disease.

OBJECTIVE: To analyze the percentage of collagen fibers and mast cell density in the left ventricular myocardium of autopsied patients with and without hypertensive heart disease. METHODS: Thirty fragments of left ventricular myocardium were obtained from individuals autopsied at the Clinical Hospital of the Federal University of Triângulo Mineiro (UFTM) in the period from 1987 to 2017. Individuals were divided into two groups: those with hypertensive heart disease (HD) and those with no heart disease (ND). Subjects were also assessed according to age, gender and race (white and non-white). Collagen fibers were quantified by computed morphometry and mast cell density was assessed by immunohistochemical methods. RESULTS: There were significantly more collagen fibers in the left ventricle in the HD group than in the ND group (p<0.001). Mast cell density was significantly higher in the left ventricle of individuals with HD immunolabeled with anti-chymase and anti-tryptase antibodies (p=0.02) and also of those immunolabeled only with anti-tryptase antibodies (p=0.03). Analyzing the HD group, there was a significant positive correlation between the percentage of collagen fibers in the left ventricle and mast cell density immunolabeled by anti-chymase and anti-tryptase antibodies (p=0.04) and also mast cell density immunolabeled only with anti-tryptase antibodies (p=0.02). CONCLUSIONS: Mast cells are involved in the development of hypertensive heart disease, contributing to the remodeling of collagen fibers in this disease.

Implications of alcoholic cirrhosis in atherosclerosis of autopsied patients.

INTRODUCTION:: Alcoholism is a major public health problem, which has a high social cost and affects many aspects of human activity. Liver disease is one of the first consequences of alcohol abuse, and steatosis, liver cirrhosis and hepatitis may occur. Other organs are also affected with pathological changes, such as pancreatitis, cardiomyopathies, dyslipidemias and atherosclerosis. OBJECTIVE:: To identify the occurrence and degree of atherosclerosis in alcohol-dependent individuals with liver cirrhosis, observing macroscopic and microscopic changes in lipid and collagen deposits and in the liver. We also aimed to verify the association of lipid and collagen fiber deposits with gender, age and body mass index, and to relate alcoholism, liver cirrhosis and atherosclerosis. METHOD:: We performed a study based on autopsy reports of patients with alcoholic liver cirrhosis, with analysis of aorta and liver fragments to verify the occurrence and degree of atherosclerosis, as well as collagen contents. RESULTS:: Microscopic atherosclerosis was higher in young subjects (early injury) and in patients with alcoholic liver cirrhosis. The macroscopic analysis of atherosclerosis in aortas showed that patients in more advanced age groups presented more severe classifications. Atherosclerosis, both micro and macroscopically, and the percentage of fibrosis in the liver and aorta were more expressive in females. CONCLUSION:: Cirrhotic patients presented a higher percentage of fibrosis and lipidosis, and may represent a group susceptible to the accelerated progression of cardiovascular diseases. Investigative studies contribute to targeting health-promoting interventions, reducing the mortality and costs of treating cardiovascular disease.

Rupture of the myocardium in autopsied MI hearts.

Although myocardial rupture occurs in only 2% to 4% of cases of acute myocardial infarction (AMI), there is a high mortality rate due to acute cardiogenic shock. We present the anatomopathological findings of three cases of myocardial rupture in autopsied hearts in the last 30 years, with a diagnosis of cardiac rupture in acute myocardial infarction. In these 30 years the percentage of AMI with myocardial rupture was 0.2%. Risk factors for post-AMI myocardial rupture include older age, atherosclerosis, diabetes mellitus and systemic arterial hypertension.

Morphometric evaluation of the aortic root in stillborns.

OBJECTIVE: To describe the dimensions and amount of collagen in the aortic root of autopsied fetuses at different gestational ages. MATERIAL AND METHODS: 40 samples of aortic roots were selected from autopsied fetuses with gestational ages ranging between 20 and 40 weeks. The thickness and the area of the aortic wall were analyzed on slides stained with Hematoxylin and Eosin, and the collagen was quantified on slides stained with Picrosirius, by using an image analyzing system. RESULTS: A positive correlation was observed between the thickness of the media layer of the aortic wall and the gestational age. There was a positive and significant correlation between the percentage of collagen in the aortic wall with gestational age and fetal weight. The correlation between gestational age and the area of the aortic root circumference was positive and significant. And the correlation between the aortic diameter and the gestational age as well as fetal length was positive and significant. CONCLUSION: The thickness of the media layer, the amount of collagen in the aortic wall, the area of the aortic root circumference and the aortic diameter rose with the increase of the gestational age. Thus, the morphological analysis of the aortic root may help as a parameter during the follow-up of inter-uterine growth and fetal development.

Morphological and inflammatory changes in the skin of autopsied fetuses according to the type of stress.

INTRODUCTION: The fetal skin acts on the development and activation of the immune response via immune-neuroendocrine communication coordinated by corticotropin-releasing hormone. OBJECTIVE: This study aimed to evaluate the morphological and inflammatory changes in the skin due to acute stress and chronic stress, associated with perinatal asphyxia, ascending infection and congenital malformation. METHODS: We measured dermal and epidermal thickness, the diameter of keratinocytes, and the percentage of collagen and elastic fibers. Immunohistochemistry was used to evaluate both Langerhans cell and mast cell density, and corticotropin-releasing hormone expression in the epidermis, sebaceous gland, sebaceous duct, sudoriparous gland and in the hair follicle. RESULTS: The epidermis was thinner in the cases with perinatal asphyxia, ascending infection and chronic stress. The diameter of keratinocytes was smaller in ascending infection and chronic stress. Mast cell density showed an indirect correlation with gestational age. Corticotropin-releasing hormone expression was significantly higher in ascending infection and chronic stress. CONCLUSIONS: Chronic stress is associated with immunological and morphological changes in the skin of fetuses with perinatal asphyxia and ascending infection. Thus, corticotropin-releasing hormone seems to play a vital role in the differentiation and activation of innate and adaptive immune cells of the skin of fetuses.

Alterações na Epiderme de Pacientes com Aids Autopsiados em Uso da Terapia Antirretroviral / Changes in the Epidermis of Autopsied AIDS Patients Using Antiretroviral Therapy

Objetivo: Avaliar a influência da terapia na morfologia da epiderme de pacientes com Síndrome da Imunodeficiência Adquirida - AIDS. Metodologia: Estudo transversal desenvolvido na Universidade Federal do Triângulo Mineiro, Brasil. Foram selecionados pacientes com AIDS de ambos os sexos, que foram agrupados de acordo com o tratamento com Terapia antir-retroviral de alta eficiência: pacientes em uso de HAART (n = 14) e pacientes sem uso de HAART (n = 14). Outras informações foram coletadas do prontuário clínico. Resultados: A idade média dos pacientes em tratamento foi de 49,07 ± 7,89 anos e dos pacientes sem TARV foi de 55,11 ± 10,17 anos. A maioria dos pacientes na terapia utilizada pertencia ao sexo feminino, 9 (64,28%). Estes apresentaram espessamento epidérmico (150,04 x 86,09µm), número de camadas celulares (8,0 x 5,5 camadas) e densidade de células de Langerhans superiores àquelas que não utilizaram a terapia, com diferença significativa. Conclusão: Nossos achados sugerem que o HAART propor-ciona a recuperação dos constituintes da epiderme alterados pela doença, melhorando sua função como barreira chave na proteção do corpo contra microorganismos ambientais. (AU)

Objective: To evaluate the influence of therapy in the morphology of the epidermis of patients with Acquired Immunodeficiency Syndrome. Methodology: Cross-sectional study developed at the Triangulo Mineiro Federal University, Brazil. This study has been approved by Triângulo Mineiro Federal University Research Ethics Committee on protocol number 1780/2010. Patients with AIDS, of both genders were selected and arranged according to treatment with Highly Active Antiretroviral Therapy: patients in use of HAART (n = 14), and patients without use of HAART (n = 14). Other information was collected from the clinical record. Results: The mean age of the patients undergoing therapy was 49.07±7.89 years, and of the patients without HAART was 55.11±10.17 years. The majority of the patients using the therapy, belonged to the female gender, 9 (64.28%). These showed epidermal thickness (150.04 x 86.09µm), number of cell layers (8.0 x 5.5 layers) and density of Langerhans cells higher than those who did not use the therapy, with a significant difference. Conclusion: Our findings suggest that the HAART provides recovery of epidermis constituents altered by the disease, improving its function as a key barrier in protecting the body against environmental microorganisms. (AU)

Mucosal immunity in the female genital tract, HIV/AIDS.

Mucosal immunity consists of innate and adaptive immune responses which can be influenced by systemic immunity. Despite having been the subject of intensive studies, it is not fully elucidated what exactly occurs after HIV contact with the female genital tract mucosa. The sexual route is the main route of HIV transmission, with an increased risk of infection in women compared to men. Several characteristics of the female genital tract make it suitable for inoculation, establishment of infection, and systemic spread of the virus, which causes local changes that may favor the development of infections by other pathogens, often called sexually transmitted diseases (STDs). The relationship of these STDs with HIV infection has been widely studied. Here we review the characteristics of mucosal immunity of the female genital tract, its alterations due to HIV/AIDS, and the characteristics of coinfections between HIV/AIDS and the most prevalent STDs.

The influence of age, smoking, antiretroviral therapy, and esophagitis on the local immunity of the esophagus in patients with AIDS.

Studies have shown immunological and morphological alterations in the esophagus during the course of AIDS. Esophageal postmortem samples of 22 men with AIDS autopsied in a teaching hospital between 1982 and 2009 were collected. We carried out revision of the autopsy reports and medical records, morphometric analysis (Image J and KS-300 Kontron-Zeiss), and immunohistochemical (anti-S100, anti-IgA, anti-IgG, and anti-IgM) analysis of the esophagus. In accordance with most of the parameters evaluated, age and the smoking habit harmed the esophageal local immunity, whereas the use of antiretroviral therapy improved the immune characteristics of this organ. Patients with esophagitis also presented immunological fragility of the esophagus. This leads to the conclusion that alterations in the esophageal epithelium of patients with AIDS are not only caused by direct action of HIV but also the clinical and behavioral characteristics of the patient.

Alterações do Baço no Envelhecimento de Acordo com Diferentes Causas de Morte / Age-Related Spleen Changes According to Different Causes of Death

Objetivo: Avaliar as alterações esplênicas de idosos autopsiados de acordo com diferentes causas de morte. Material e Métodos: Foram selecionados 38 idosos autopsiados no Hospital de Clínicas da Universidade Federal do Triângulo Mineiro entre 1996 e 2012. As causas de morte foram agrupadas em cardiovascular (n=13), infecciosa (n=15) e neoplásica (n=10). Os fragmentos de baço foram analisados para determinação da densidade dos folículos linfoides, da área das arteríolas centro foliculares e da porcentagem de fibras colágenas e elásticas. Resultados: Os idosos acometidos pela causa de morte neoplásica apresentaram maior peso esplênico (234,00 vs 126,23g) e menor densidade folicular (0,16 vs 0,36 folículos/mm2) quando comparado aos acometidos pela causa cardiovascular. O grupo de causa neoplásica apresentou maior área das arteríolas centro foliculares quando comparado ao de causa infecciosa (817,00 vs 701,10µm2). Houve uma correlação negativa e significativa entre o peso do baço e a densidade folicular nos grupos com causa cardiovascular e neoplásica (rS=-0,382; p=0,018). Os idosos acometidos pela causa de morte cardiovascular apresentaram significativamente maior porcentagem de fibras colágenas que os idosos com causa infecciosa (0,81 vs 0,65%, p=0,002). O grupo acometido pela causa de morte infecciosa apresentou significativamente maior porcentagem de fibras elásticas quando comparado ao da causa neoplásica (6,01 vs 3,47%, p=0,001). Conclusão: As diferentes causas de mortes influenciam de modo distinto as alterações histomorfométricas do baço durante o envelhecimento. As doenças neoplásicas estiveram associadas ao aumento da área das arteríolas centro foliculares e a diminuição da densidade folicular, enquanto as doenças cardiovasculares contribuíram para o aumento da fibrose esplênica. (/AU)

Objective: To evaluate the changes in the spleens of elderly autopsied according to different causes of death. Material and Methods: We selected 38 elderly autopsied between 1996 and 2012 at the Clinical Hospital of the Federal University of Triangulo Mineiro. The causes of death were grouped into cardiovascular (n=13), infectious (n=15) and neoplastic (n=10). Spleen fragments were analyzed to determine the lymphoid follicle density, follicular arteriole area, and the percentage of collagen and elastic fibers. Results: The elderly affected by neoplastic causes had a higher splenic weight (234.00 vs 126.23g) and a lower follicular density (0.16 vs 0.36 follicles/mm2) than those affected by cardiovascular death. The neoplastic cause group presented greater area of central follicular arterioles when compared to that of infectious death (817.00 vs 701.10ìm2). There was a significant negative correlation between spleen weight and follicular density in the groups with cardiovascular and neoplastic causes (rS=- 0.382; p=0.018). The elderly affected by cardiovascular death presented had a significantly higher percentage of collagen fibers than the elderly with infectious death (0.81 vs 0.65%, p=0.002). The group affected by infectious death had a significantly higher percentage of elastic fibers when compared to the neoplastic death group (6.01 vs 3.47%, p=0.001). Conclusion: The different causes of death influence differentially histomorphometric changes of the spleen during aging. Neoplastic diseases were associated with an increase in the area of central follicular arterioles and decreased follicular density, while cardiovascular diseases contributed to the increase of splenic fibrosis. (AU)

Analysis of the collagen fibers on autopsied patients' uterus with the Acquired Immunodeficiency Syndrome / Análise das fibras colágenas do útero de pacientes autopsiadas com a Síndrome da Imunodeficiência Adquirida

Abstract Objectives: to compare the percentage of collagen fibers in the autopsied women's uterine body and cervix with and without the Acquired Immunodeficiency Syndrome (Aids). Methods: 30 autopsied women's medical files were selected from 1988 to 2013. 30 fragments of the uterine body and 30 cervix were collected and then divided into two groups, 15 with Aids and 15 without, The quantification of the collagen fibers of the uterine body and cervix was performed on slides stained with picrosirius, using the KS-300® system. Results: the percentage of collagen fibers was lower for cervix (U=336544; p=0.001) and higher for the uterine body (U=308726,5; p=0.004) in the retroviral group when compared to the group without the disease. The percentage was higher for cervix than the uterine body in the group with Aids (t=0,4793; p=0.0031). the same result was found in the group without Aids (t=2,397; p=0.0637). Conclusions: the increase in the percentage of collagen fibers in the uterine body of women with Aids' indicates an immune response for viral infection and reveals a failure in keeping the infection restricted to the cervix. The interpretation of the histochemical and morphometric parameters can be useful in the diagnosis associated to HIV infection, contributing for clinical improvement and life expectancy.

Resumo Objetivos: comparar a porcentagem de fibras colágenas no corpo e colo uterino de mulheres autopsiadas com e sem a Síndrome da Imunodeficiência Adquirida (Aids). Métodos: foram selecionados 30 prontuários de mulheres autopsiadas no período de 1988 a 2013. Foram coletados 30 fragmentos do corpo uterino e 30 do colo uterino, dividido em dois grupos, 15 com Aids e 15 sem. A quantificação das fibras colágenas do corpo e colo uterino foi feita nas lâminas coradas por picrosirius, utilizando-se o sistema KS-300®. Resultados: a porcentagem de fibras colágenas foi menor no colo (U=336544; p=0,001) e maior no corpo uterino (U=308 726,5; p=0,004) no grupo com a retrovirose quando comparado ao grupo sem a doença. A porcentagem no grupo com Aids foi maior no colo uterino do que no corpo (t=0,4793; p=0,0031). Sendo o mesmo resultado encontrado para o grupo sem Aids (t=2.397; p=0,0637). Conclusões: um aumento da porcentagem de fibras colágenas no corpo uterino das mulheres com Aids indica uma resposta imune frente a infecção viral e revela uma falha em manter a infecção restrita ao colo. A interpretação dos parâmetros histoquímicos e morfométricos podem ser úteis no diagnóstico das condições associadas à infecção pelo HIV, contribuindo para a melhora clínica e expectativa de vida.

Assessment of endotracheal tube cuff pressure: results obtained by the technique of digital palpation and anesthesiologist experience / Avaliação da pressão do balonete das sondas de intubação traqueal: resultados obtidos pela técnica da palpação digital e experiência do anestesiologista

INTRODUÇÃO: Uma das funções do balonete do tubo endotraqueal é selar a via aérea, ou seja, ocupar o espaço entre o tubo e a parede da traqueia, impedindo a ocorrência de broncoaspiração e permitindo o funcionamento dos ventiladores. Considera-se adequada a pressão do balonete entre 25 a 30 cmH2O. OBJETIVO: Avaliar o método da palpação digital como técnica para determinar a insuflação adequada do balonete dos tubos traqueais de pacientes submetidos à anestesia geral. MÉTODOS: Foi conduzido um estudo prospectivo no Centro Cirúrgico do Hospital de Clínicas da Universidade Federal do Triângulo Mineiro. Após a intubação orotraqueal, o balonete foi insuflado com ar ambiente e o volume injetado determinado pela sensibilidade tátil. A insuflação foi realizada pelo residente em anestesiologia ou pelo Staff. Em qualquer momento da cirurgia foi anotada a pressão do balonete através do cufômetro. (AU)

Introduction: One of the functions of the endotracheal tube cuff is to seal the airway, that is, to occlude the space between the tube and the tracheal wall, thus preventing pulmonary aspiration and ensuring ventilator function. Cuff pressure must be maintained within the recommended range of 25-30 cmH2O. Objective: To evaluate digital palpation as a method to determine the appropriate inflation of endotracheal tube cuff of patients undergoing general anesthesia. Methods: A prospective study was performed at the Surgical Center of Hospital de Clínicas da Universidade Federal do Triângulo Mineiro, in Uberaba, Brazil. After orotracheal intubation, the cuff was inflated with air and the injected volume was determined by tactile sensitivity. Inflation was performed by an anesthesiology resident or by anesthesiology staff, and the cuff pressure was measured by a cuff manometer at any time during the surgery. Results: 15.65% of the cases had adequate insufflation pressure, 21.2% had inadequate pressure, and 63.15% had high pressure. Statistical analysis showed that the R1 group had a mean cuff pressure of 61.7 cmH2O; R2 had 62.7; R3 had 55.4; and the Staff group had 55.6. Measurement of the degree of accuracy was appropriate in 27.3% of R1 cases, in 25.5% of R2 cases, in 7.2% of R3 cases, and in 8.9% of Staff cases. Conclusion: 84.34% were not in accordance with the appropriate limits, so digital palpation and professional experience were shown to be inappropriate methods for estimating the inflated pressure. Therefore, it is recommended that cuff pressure be measured by a specific device, the cuff manometer. (AU)