RÉSUMÉ
ABSTRACT OBJECTIVE: To evaluate the impact that the distribution of emphysema has on clinical and functional severity in patients with COPD. METHODS: The distribution of the emphysema was analyzed in COPD patients, who were classified according to a 5-point visual classification system of lung CT findings. We assessed the influence of emphysema distribution type on the clinical and functional presentation of COPD. We also evaluated hypoxemia after the six-minute walk test (6MWT) and determined the six-minute walk distance (6MWD). RESULTS: Eighty-six patients were included. The mean age was 65.2 ± 12.2 years, 91.9% were male, and all but one were smokers (mean smoking history, 62.7 ± 38.4 pack-years). The emphysema distribution was categorized as obviously upper lung-predominant (type 1), in 36.0% of the patients; slightly upper lung-predominant (type 2), in 25.6%; homogeneous between the upper and lower lung (type 3), in 16.3%; and slightly lower lung-predominant (type 4), in 22.1%. Type 2 emphysema distribution was associated with lower FEV1, FVC, FEV1/FVC ratio, and DLCO. In comparison with the type 1 patients, the type 4 patients were more likely to have an FEV1 < 65% of the predicted value (OR = 6.91, 95% CI: 1.43-33.45; p = 0.016), a 6MWD < 350 m (OR = 6.36, 95% CI: 1.26-32.18; p = 0.025), and post-6MWT hypoxemia (OR = 32.66, 95% CI: 3.26-326.84; p = 0.003). The type 3 patients had a higher RV/TLC ratio, although the difference was not significant. CONCLUSIONS: The severity of COPD appears to be greater in type 4 patients, and type 3 patients tend to have greater hyperinflation. The distribution of emphysema could have a major impact on functional parameters and should be considered in the evaluation of COPD patients.
RESUMO OBJETIVO: Avaliar o impacto que a distribuição do enfisema tem na gravidade clínica e funcional em pacientes com DPOC. MÉTODOS: A distribuição do enfisema foi analisada em pacientes com DPOC, que foram classificados de acordo com um sistema de classificação visual de cinco pontos a partir de achados de TC de tórax. Avaliou-se a influência do tipo de distribuição do enfisema na apresentação funcional e clínica da DPOC. Hipoxemia após o teste da caminhada de seis minutos (TC6) foi também avaliada e a distância percorrida (DTC6) foi determinada. RESULTADOS: Foram incluídos 86 pacientes. A média de idade foi de 65,2 ± 12,2 anos, 91,9% eram homens, e todos menos um eram fumantes (média de carga tabágica, 62,7 ± 38,4 anos-maço). A distribuição do enfisema foi categorizada como obviamente predominante no pulmão superior (tipo 1), em 36,0% dos pacientes; levemente predominante no pulmão superior (tipo 2), em 25,6%; homogêneo entre o pulmão superior e inferior (tipo 3), em 16,3%; e levemente predominante no pulmão inferior (tipo 4), em 22,1%. A distribuição do enfisema do tipo 2 foi associada a menores valores de VEF1, CVF, relação VEF1/CVF e DLCO. Em comparação com os pacientes do tipo 1, os do tipo 4 apresentaram maior probabilidade de ter VEF1 < 65% do previsto (OR = 6,91, IC95%: 1,43-33,45; p = 0,016), DTC6 < 350 m (OR = 6,36, IC95%: 1,26-32,18; p = 0,025),e hipoxemia após o TC6 (OR = 32,66, IC95%: 3,26-326,84; p = 0,003). Os pacientes do tipo 3 tiveram uma relação VR/CPT maior, embora sem diferença significativa. CONCLUSÕES: A gravidade da DPOC parece ser maior nos pacientes do tipo 4, e os do tipo 3 tendem a apresentar maior hiperinsuflação. A distribuição do enfisema pode ter um impacto importante nos parâmetros funcionais e deve ser considerada na avaliação de pacientes com DPOC.
Sujet(s)
Sujet âgé , Femelle , Humains , Mâle , Poumon/physiopathologie , Broncho-pneumopathie chronique obstructive/physiopathologie , Emphysème pulmonaire/physiopathologie , Études transversales , Poumon/anatomopathologie , Broncho-pneumopathie chronique obstructive/diagnostic , Broncho-pneumopathie chronique obstructive/anatomopathologie , Emphysème pulmonaire/diagnostic , Emphysème pulmonaire/anatomopathologie , Tests de la fonction respiratoire , Indice de gravité de la maladie , TomodensitométrieRÉSUMÉ
OBJECTIVE: To evaluate the technical feasibility, performance, and interobserver agreement of a computer-aided classification (CAC) system for regional ventilation at two-phase xenon-enhanced CT in patients with chronic obstructive pulmonary disease (COPD). MATERIALS AND METHODS: Thirty-eight patients with COPD underwent two-phase xenon ventilation CT with resulting wash-in (WI) and wash-out (WO) xenon images. The regional ventilation in structural abnormalities was visually categorized into four patterns by consensus of two experienced radiologists who compared the xenon attenuation of structural abnormalities with that of adjacent normal parenchyma in the WI and WO images, and it served as the reference. Two series of image datasets of structural abnormalities were randomly extracted for optimization and validation. The proportion of agreement on a per-lesion basis and receiver operating characteristics on a per-pixel basis between CAC and reference were analyzed for optimization. Thereafter, six readers independently categorized the regional ventilation in structural abnormalities in the validation set without and with a CAC map. Interobserver agreement was also compared between assessments without and with CAC maps using multirater kappa statistics. RESULTS: Computer-aided classification maps were successfully generated in 31 patients (81.5%). The proportion of agreement and the average area under the curve of optimized CAC maps were 94% (75/80) and 0.994, respectively. Multirater kappa value was improved from moderate (kappa = 0.59; 95% confidence interval [CI], 0.56-0.62) at the initial assessment to excellent (kappa = 0.82; 95% CI, 0.79-0.85) with the CAC map. CONCLUSION: Our proposed CAC system demonstrated the potential for regional ventilation pattern analysis and enhanced interobserver agreement on visual classification of regional ventilation.
Sujet(s)
Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Aire sous la courbe , Études de faisabilité , Biais de l'observateur , Broncho-pneumopathie chronique obstructive/physiopathologie , Emphysème pulmonaire/physiopathologie , Respiration , Études rétrospectives , Tomodensitométrie/méthodes , XénonRÉSUMÉ
OBJECTIVE: To investigate the impact of a pulmonary rehabilitation program on the functional capacity and on the quality of life of patients on waiting lists for lung transplantation. METHODS: Patients on lung transplant waiting lists were referred to a pulmonary rehabilitation program consisting of 36 sessions. Before and after the program, participating patients were evaluated with the six-minute walk test and the Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). The pulmonary rehabilitation program involved muscle strengthening exercises, aerobic training, clinical evaluation, psychiatric evaluation, nutritional counseling, social assistance, and educational lectures. RESULTS: Of the 112 patients initially referred to the program, 58 completed it. The mean age of the participants was 46 ± 14 years, and females accounted for 52%. Of those 58 patients, 37 (47%) had pulmonary fibrosis, 13 (22%) had pulmonary emphysema, and 18 (31%) had other types of advanced lung disease. The six-minute walk distance was significantly greater after the program than before (439 ± 114 m vs. 367 ± 136 m, p = 0.001), the mean increase being 72 m. There were significant point increases in the scores on the following SF-36 domains: physical functioning, up 22 (p = 0.001), role-physical, up 10 (p = 0.045); vitality, up 10 (p < 0.001); social functioning, up 15 (p = 0.001); and mental health, up 8 (p = 0.001). CONCLUSIONS: Pulmonary rehabilitation had a positive impact on exercise capacity and quality of life in patients on lung transplant waiting lists. .
OBJETIVO: Avaliar o impacto de um programa de reabilitação pulmonar na capacidade funcional e na qualidade de vida de pacientes em lista de espera para transplante pulmonar. MÉTODOS: Pacientes em lista de espera para transplante pulmonar encaminhados a um programa de reabilitação pulmonar de 36 sessões. Os participantes foram avaliados no início e no final desse com o teste de caminhada de seis minutos (TC6) e com o questionário de qualidade de vida Medical Outcomes Study 36-item Short-Form Health Survey (SF-36). O programa de reabilitação pulmonar foi composto por exercícios de fortalecimento muscular, treinamento aeróbico, acompanhamento clínico e psiquiátrico, acompanhamento nutricional, assistência social e palestras educacionais. RESULTADOS: Dos 112 pacientes encaminhados, 58 completaram o programa. A média de idade dos participantes foi de 46 ± 14 anos; sendo 52% do sexo feminino. Entre esses pacientes, 37 (47%) eram portadores de fibrose pulmonar, 13 (22%) tinham enfisema pulmonar, e 18 (31%), tinham outras doenças pulmonares em fase avançada. Houve uma melhora significativa na distância percorrida no TC6 ao final do programa (367 ± 136 m vs. 439 ± 114 m; p = 0,001), com um aumento médio de 72 m. Houve aumentos significativos nas pontuações dos seguintes domínios do SF-36: capacidade funcional, 22 pontos (p = 0,001); aspectos físicos, 10 (p = 0,045); vitalidade, 10 (p < 0,001); aspectos sociais, 15 (p = 0,001); e saúde mental, 8 (p = 0,001). CONCLUSÕES: O programa de reabilitação pulmonar teve um impacto positivo na capacidade de exercício e na qualidade de vida nos pacientes em lista de espera para transplante pulmonar. .
Sujet(s)
Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Transplantation pulmonaire , Maladies pulmonaires/rééducation et réadaptation , Qualité de vie , Listes d'attente , Exercices respiratoires , Tolérance à l'effort , Traitement par les exercices physiques/méthodes , Fibrose pulmonaire idiopathique/physiopathologie , Fibrose pulmonaire idiopathique/rééducation et réadaptation , Maladies pulmonaires/physiopathologie , Études prospectives , Emphysème pulmonaire/physiopathologie , Emphysème pulmonaire/rééducation et réadaptation , Tests de la fonction respiratoire , Statistique non paramétriqueRÉSUMÉ
Background: Ozone therapy may stimulate antioxidant systems and protect against free radicals. It has not been used formerly in patients with pulmonary emphysema. Aim: To assess the effects of rectal ozone therapy in patients with pul-monary emphysema. Material and Methods: Sixty four patients with pulmonary emphysema, aged between 40 and 69 years, were randomly assigned to receive rectal ozone in 20 daily sessions, rectal medicinal oxygen or no treatment. Treatments were repeated three months later in the frst two groups. At baseline and at the end of the study, spirometry and a clinical assessment were performed. Results: fifty patients completed the protocol, 20 receiving ozone therapy, 20 receiving rectal oxygen and 10 not receiving any therapy. At baseline, patients on ozone therapy had significantly lower values of forced expiratory volume in the frst second (fEV1) and fEV1/forced vital capacity. At the end of the treatment period, these parameters were similar in the three treatment groups, therefore they only improved significantly in the group on ozone therapy. No differences were observed in other spirometric parameters. Conclusions: Rectal ozone therapy may be useful in patients with pulmonary emphysema.
Sujet(s)
Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Oxydants photochimiques/administration et posologie , Oxygène/administration et posologie , Ozone/administration et posologie , Emphysème pulmonaire/thérapie , Administration par voie rectale , Méthode en double aveugle , Emphysème pulmonaire/physiopathologie , Tests de la fonction respiratoire , Indice de gravité de la maladie , Résultat thérapeutiqueRÉSUMÉ
OBJECTIVE: To verify the accordance of functional and morphometric parameters during the development of emphysema. METHODS: BALB/c mice received a nasal drop of either papain or saline solution and were studied after 1, 3, 15, 28, and 40 days. Functional parameters, such as airway resistance, tissue damping, and tissue elastance, were analyzed. To evaluate the structural changes and possible mechanisms involved in this disease, we measured the mean linear intercept, the volume proportions of elastic and collagen fibers, the number of macrophages, the numbers of cells expressing metalloprotease 12 and 8-isoprostane in lung parenchyma. RESULTS: We only observed decreases in tissue elastance and tissue damping on the 28th day, with a concomitant increase in the mean linear intercept, indicating the presence of emphysema. However, only the mean linear intercept values remained increased until the 40th day. The volume proportion of collagen fibers was increased from the 15th day to the 40th day, whereas the volume proportion of elastic fibers was only increased on the 40th day. The number of macrophages increased beginning on the 1st day. The expression of metalloproteinase 12 was increased from the 3rd day until the 40th day. However, 8-isoprostane expression was only increased on the 1st and 3rd days. CONCLUSIONS: In this study, morphometric parameters were found to be more reliable for detecting the presence of emphysema than the functional parameters measured by respiratory mechanics. Further investigations are necessary to understand how the extracellular matrix remodeling observed in the lung parenchyma could be involved in this process.
Sujet(s)
Animaux , Mâle , Souris , Emphysème pulmonaire/anatomopathologie , Emphysème pulmonaire/physiopathologie , Mécanique respiratoire/physiologie , Collagène/métabolisme , Modèles animaux de maladie humaine , Évolution de la maladie , Tissu élastique/métabolisme , Immunohistochimie , Poumon/anatomopathologie , Poumon/physiopathologie , Souris de lignée BALB C , Macrophages/métabolisme , /métabolisme , Papaïne , Emphysème pulmonaire/induit chimiquement , Facteurs tempsRÉSUMÉ
La combinación de enfisema y fibrosis pulmonar es una condición frecuentemente subdiagnosticada. Los estudios funcionales aislados pueden generar interpretaciones inadecuadas. No hemos hallado comunicaciones de casos que documenten la evolución espirométrica de estos pacientes. Se presentan dos casos de fibrosis y enfisema combinados que permiten observar la evolución funcional a largo plazo y comprender los valores espirométricos actuales en forma más precisa. Los hallazgos más relevantes son: 1) espirometría con discretas alteraciones funcionales en presencia de disnea marcada y, en un paciente, necesidad de oxigenoterapia crónica, 2) evolución funcional con seudonormalización del patrón espirométrico obstructivo inicial, posiblemente como consecuencia del desarrollo de fibrosis. Un defecto obstructivo leve en un paciente con diagnóstico de obstrucción crónica al flujo aéreo y marcado deterioro de su condición clínica y clase funcional debería alertar sobre la posibilidad de fibrosis pulmonar asociada. La tomografía y la disponibilidad de estudios funcionales previos permiten comprender esta condición.
Combined pulmonary fibrosis and emphysema (CPFE) is a frequently under-diagnosed condition. Isolated pulmonary function tests (PFT) can give rise to misinterpretations. We have found no reports on these patients spirometric progression. We describe two cases of CPFE, showing long-term functional evolution to have a more accurate understanding of current spirometric values. The most relevant findings are: 1) spirometry with discrete functional alterations in the presence of a marked dyspnea and the need, in one patient, for chronic oxygen therapy; and 2) functional evolution reflecting "pseudonormalisation" of the initial obstructive spirometric pattern, possibly as a result of fibrosis development. A mild obstructive defect in a patient with chronic airflow limitation and marked impairment of his/her clinical status and functional class should alert on the possibility of associated pulmonary fibrosis. A computed tomography (CT) and previous PFTs will allow a better understanding of this condition.
Sujet(s)
Humains , Mâle , Adulte d'âge moyen , Dyspnée/étiologie , Emphysème pulmonaire/physiopathologie , Fibrose pulmonaire/physiopathologie , Dyspnée/physiopathologie , Dyspnée/thérapie , Oxygénothérapie/méthodes , Emphysème pulmonaire/complications , Emphysème pulmonaire/thérapie , Fibrose pulmonaire/complications , Fibrose pulmonaire/thérapie , Spirométrie , TomodensitométrieRÉSUMÉ
OBJETIVO: Relatar os resultados obtidos no pré- e pós-operatório de três pacientes portadores de enfisema pulmonar difuso grave, empregando uma nova técnica: ventilação colateral com drenagem do parênquima pulmonar. MÉTODOS: Para a avaliação da drenagem pulmonar, foram selecionados pacientes que já haviam sido submetidos à terapêutica clínica máxima, incluindo a reabilitação pulmonar, e que ainda assim sofriam de falência respiratória com dispnéia incapacitante. Os pacientes foram submetidos, no pré- e no pós operatório, à pletismografia e ao teste da caminhada de seis minutos, assim como responderam aos seguintes questionários de qualidade de vida: Medical Outcomes Study 36-item Short-Form Health Survey, Saint George's Respiratory Questionnaire, Eastern Cooperative Oncology Group Performance Status e Medical Research Council Scale. Todos os pacientes tiveram seguimento de no mínimo 300 dias de pós-operatório. Os testes foram realizados no pré-operatório, entre 30 e 40 dias de pós-operatório e após 300 dias de pós-operatório. Os dados foram analisados pelo método de gráficos de perfis de médias. RESULTADOS: Quando comparados os resultados do pré-operatório com os do pós-operatório nos dois momentos, verificou-se que houve melhora em todos os parâmetros estudados. CONCLUSÕES: Os resultados sugerem que a técnica operatória proposta para o tratamento de doentes portadores de enfisema pulmonar difuso grave foi capaz de diminuir os sintomas debilitantes destes pacientes, tornando sua qualidade de vida muito melhor.
OBJECTIVE: To report the results obtained in three patients with diffuse pulmonary emphysema during the pre- and post-operative periods following a new surgical technique: collateral ventilation with lung parenchyma drainage. METHODS: Patients suffering from pulmonary failure and disabling dyspnea, despite having received the gold standard treatment, including pulmonary rehabilitation, were selected for the evaluation of pulmonary drainage. During the pre- and post-operative periods, patients were submitted to plethysmography and six-minute walk tests, as well as completing the following quality of life questionnaires: Medical Outcomes Study 36-item Short-Form Health Survey, Saint George's Respiratory Questionnaire, Eastern Cooperative Oncology Group Performance Status and Medical Research Council Scale. In all three cases, the postoperative follow-up period was at least 300 days. The tests were performed at the following time points: during the pre-operative period; between post-operative days 30 and 40; and on post-operative day 300. Data were analyzed using profile plots of the means. RESULTS: When the results obtained in the pre-operative period were compared to those obtained at the two post-operative time points evaluated, improvements were observed in all parameters studied. CONCLUSIONS: The results suggest that the surgical technique proposed for the treatment of patients suffering from severe diffuse emphysema successfully reduces the debilitating symptoms of these patients, improving their quality of life considerably.
Sujet(s)
Femelle , Humains , Mâle , Adulte d'âge moyen , Drainage/méthodes , Emphysème pulmonaire/chirurgie , Épreuve d'effort , Études de suivi , Pléthysmographie du corps entier , Période postopératoire , Soins préopératoires , Emphysème pulmonaire/physiopathologie , Emphysème pulmonaire/psychologie , Ventilation pulmonaire/physiologie , Qualité de vie , Capacité pulmonaire totale/physiologie , Marche à piedRÉSUMÉ
OBJETIVO: Descrever os achados clínicos e funcionais de pacientes com enfisema em lobos superiores e fibrose pulmonar idiopática (FPI) em lobos inferiores, recentemente descrita na literatura. MÉTODOS: Um grupo de 11 pacientes com a presença simultânea de enfisema e FPI foi identificado retrospectivamente. Todos os pacientes realizaram tomografia computadorizada de tórax com alta resolução e provas de função pulmonar. RESULTADOS: Entre os 11 pacientes identificados, havia 8 homens e 3 mulheres, com média de idade de 70,7 ± 7,2 anos (variação, 61-86 anos). Todos os pacientes eram tabagistas (carga tabágica, 61,5 ± 43,5 anos-maço). As médias da capacidade vital forçada (CVF), do volume expiratório forçado no primeiro segundo (VEF1) e da relação VEF1/CVF foram 72,1 por cento ± 12,7 por cento, 68,2 por cento ± 11,9 por cento e 74,4 ± 10,8, respectivamente. Os volumes pulmonares foram normais em 7 pacientes. Um padrão restritivo foi observado em 3 pacientes e hiperinsuflação estava presente em um. A capacidade de difusão pulmonar apresentou redução moderada a grave em todos os pacientes (média, 27,7 por cento ± 12,9 por cento do previsto). No teste da caminhada de seis minutos, realizado por 10 pacientes, a distância caminhada média foi de 358,4 ± 143,1 m, ocorrendo dessaturação >4 por cento em 9 pacientes. Achados ecocardiográficos sugestivos de hipertensão pulmonar estavam presentes em 4 pacientes (média da pressão sistólica da artéria pulmonar, 61,8 mmHg; variação, 36-84 mmHg). CONCLUSÕES: A presença simultânea de enfisema e FPI causa alterações características nas provas de função pulmonar. O achado mais importante é a discrepância entre a capacidade de difusão e a espirometria.
OBJECTIVE: To describe the clinical and functional findings recently reported in the medical literature for patients diagnosed with emphysema involving the upper lobes and idiopathic pulmonary fibrosis (IPF) involving the lower lobes. METHODS: Eleven patients with emphysema and IPF were identified retrospectively. All of the patients underwent high-resolution computed tomography of the lung and pulmonary function tests. RESULTS: Of the 11 patients, 8 were male and 3 were female. The mean age was 70.7 ± 7.2 years (range, 61-86 years). All of the patients were smokers (mean smoking history, 61.5 ± 43.5 pack-years). The mean values of forced vital capacity (FVC), forced expiratory volume in one second (FEV1) and FEV1/FVC were 72.1 percent ± 12.7 percent, 68.2 percent ± 11.9 percent and 74.4 ± 10.8, respectively. Lung volumes were normal in 7 patients. A restrictive pattern was observed in 3 patients, and hyperinflation was present in one. The diffusing capacity was moderately-to-severely reduced in all of the patients (mean, 27.7 percent ± 12.9 percent of predicted). Ten of the 11 patients performed the six-minute walk test. The mean distance covered was 358.4 ± 143.1 m, and 9 of the 10 patients presented desaturation > 4 percent. Echocardiographic findings suggestive of pulmonary hypertension were present in 4 patients (mean systolic pulmonary artery pressure, 61.8 mmHg; range, 36-84 mmHg). CONCLUSIONS: The concomitant presence of emphysema and IPF causes characteristic changes on pulmonary function tests. The most significant finding is a discrepancy between diffusing capacity and spirometry results.
Sujet(s)
Sujet âgé , Sujet âgé de 80 ans ou plus , Femelle , Humains , Mâle , Adulte d'âge moyen , Fibrose pulmonaire idiopathique/physiopathologie , Emphysème pulmonaire/physiopathologie , Fumer/effets indésirables , Volume expiratoire maximal par seconde , Fibrose pulmonaire idiopathique/étiologie , Capacité de diffusion pulmonaire , Emphysème pulmonaire/étiologie , Études rétrospectives , Spirométrie , Capacité vitaleRÉSUMÉ
La fibrosis pulmonar idiopática (FPI) es una enfermedad que se caracteriza por presentar un compromiso pulmonar de tipo restrictivo, resultante de una reducción en la complacencia pulmonar secundaria a fibrosis difusa. En el enfisema, la pérdida de elasticidad pulmonar y el colapso de las vías aéreas periféricas generan obstrucción e hiperinflación. El efecto simultáneo que ambas enfermedades producen sobre la fisiología pulmonar no es del todo claro y se han descripto volúmenes pulmonares normales o casi normales. Presentamos 4 pacientes de sexo masculino de 64, 60, 73 y 70 años, con antecedentes de tabaquismo e historia de disnea progresiva, tres de ellos con grave limitación en su calidad de vida al momento de la consulta. En la tomografía de tórax de alta resolución todos los pacientes presentaban signos de enfermedad intersticial pulmonar avanzada, con cambios de tipo fibrótico con predominio basal y subpleural, que coexistían con enfisema centroacinar con predominio en lóbulos superiores. Uno de ellos tuvo confirmación diagnóstica de ambas condicioes por biopsia pulmonar a cielo abierto. En los cuatro pacientes la espirometría y volúmenes pulmonares fueron normales, pero tenían importante compromiso del intercambio gaseoso evaluado mediante el test de caminata de 6 minutos. Tres de los pacientes tenían hipertensión pulmonar grave diagnosticado por ecocardiograma. La presencia de volúmenes pulmonares normales no excluye un diagnóstico de fibrosis pulmonar idiopática en pacientes fumadores si coexisten evidencias tomográficas de enfisema. En estos pacientes el grado de compromiso funcional, determinado por la reducción de los volúmenes pulmonares, no debería ser considerado en la evaluación de la gravedad.
Pulmonary function tests in idiopathic pulmonary fibrosis characteristically show a restrictive pattern, resulting from reduction of pulmonary compliance due to diffuse fibrosis. Conversely, an obstructive pattern with hyperinflation results in emphysema by loss of elastic recoil, expiratory collapse of the peripheral airways and air trapping. Previous reports suggest that when both diseases coexist, pulmonary volumes are compensated and a smaller than expected reduction or even normal lung volumes can be found. We report 4 male patients of 64, 60, 73 and 70 years, all with heavy cigarette smoking history and progressive breathlessness. Three of them had severe limitation in their quality of life. All four showed advanced lung interstitial involvement, at high resolution CT scan, fibrotic changes predominantly in the subpleural areas of lower lung fields and concomitant emphysema in the upper lobes. Emphysema and pulmonary fibrosis was confirmed by open lung biopsy in one patient. The four patients showed normal spirometry and lung volumes with severe compromise of gas exchange and poor exercise tolerance evaluated by 6 minute walk test. Severe pulmonary arterial hypertension was also confirmed in three patients. Normal lung volumes does not exclude diagnosis of idiopathic pulmonary fibrosis in patients with concomitant emphysema. The relatively preserved lung volumes may underestimate the severity of idiopathic pulmonary fibrosis and attenuate its effects on lung function parameters.
Sujet(s)
Sujet âgé , Humains , Mâle , Adulte d'âge moyen , Fibrose pulmonaire idiopathique/anatomopathologie , Poumon/physiologie , Emphysème pulmonaire/anatomopathologie , Biopsie , Fibrose pulmonaire idiopathique/physiopathologie , Poumon , Emphysème pulmonaire/physiopathologie , Tests de la fonction respiratoire , Fumer/effets indésirables , TomodensitométrieRÉSUMÉ
Neste estudo investigamos os efeitos da exposição crônica a níveis ambientais de material particulado (PM) no desenvolvimento de enfisema pulmonar. Camundongos receberam instilação de solução de papaína ou de salina e permaneceram em duas câmaras: uma que recebia ar ambiente e outra que possuía filtros em sua entrada de ar para PM. O grupo instilado com solução de papaína e exposto a níveis ambientais de PM apresentou aumento do intercepto linear médio, da densidade de fibras de colágeno e da expressão de isoprostano-8 no tecido pulmonar comparado ao grupo instilado com solução de papaína e que foi mantido na câmara com filtros (p=0,002; p<0,05 e p=0,002, respectivamente). A exposição ao PM piorou o enfisema e o estresse oxidativo pode ser um dos mecanismos envolvidos nesta resposta.
We investigated the effects of chronic exposure to ambient levels of particulate matter (PM) on the development of emphysema in mice. Mice received either papain or normal saline and were kept in two chambers: one received ambient air and the other had filters for PM. Lungs from papain-treated mice exposed to ambient air presented greater values of mean linear intercept than papain-treated mice kept in the chamber with filtered air (p=0.002). There was an increase in the density of collagen fibers and in the expression of 8-isoprostane in pulmonary tissue of papain-treated mice that remained in the chamber with ambient air (p<0.05 and p=0.002, respectively). Exposure to urban levels of PM worsens protease-induced emphysema and an increase in oxidative stress may be involved in this response.
Sujet(s)
Animaux , Souris , Emphysème pulmonaire/physiopathologie , Exposition environnementale/effets indésirables , Pollution de l'environnement/effets indésirables , Emphysème pulmonaire/induit chimiquement , Souris de lignée BALB C , Stress oxydatifRÉSUMÉ
Analisamos as alterações cardíacas pós-indução de enfisema por instilação de papaína. Foram avaliados 75 ratos (grupos papaína e controle), sacrificados 30, 60, 90, 120 ou 180 dias pós-instilação. Foram realizados: gasometria do sangue arterial, avaliação morfométrica cardíaca e pulmonar. A papaína produziu destruição alveolar compatível com enfisema, sem repercussão nas trocas gasosas. Ventrículo direito e septo interventricular não apresentaram alterações significativas. Houve redução da área do ventrículo esquerdo, 90 dias pós-indução, e discreto espessamento de sua parede / Evaluation of the cardiac anatomical alterations secondary to the pulmonary emphysema: experimental study in rats. Cardiac alterations post-induction emphysema by instillation of papain were analyzed. Seventy-five rats (groups papain and control), sacrificed 30, 60, 90, 120 or 180 days post-instillation were evaluated. Arterial blood gases, cardiac and pulmonary morphometrical analysis were performed. Papain administration produced alveolar destruction compatible with emphysema, without arterial blood gases changes. Right ventricle and interventricular septum didn't show alterations. There were left ventricular area decrease (90 days post-induction) and light thickness increase of its wall...
Sujet(s)
Animaux , Mâle , Adulte , Modèles animaux de maladie humaine , Emphysème pulmonaire/induit chimiquement , Papaïne/pharmacologie , Emphysème pulmonaire/physiopathologie , Rat Wistar , Ventricules cardiaques/anatomie et histologieRÉSUMÉ
La limitación del flujo aéreo en los fumadores es la característica funcional más importante que además condiciona su pronóstico. En términos generales, el enfisema y la enfermedad de la vía aérea pequeña son los eventos anatomopatológicos responsables de dicha obstrucción. En este trabajo se hizo una revisión detallada de la participación de la vía aérea pequeña en la patogénesis de la disminución del flujo aéreo en los pacientes con EPOC.
Sujet(s)
Humains , Résistance des voies aériennes , Épithélium/physiologie , Épithélium/physiopathologie , Débits expiratoires forcés , Inflammation/physiopathologie , Bronchopneumopathies obstructives , Poumon/physiologie , Poumon/physiopathologie , Emphysème pulmonaire/étiologie , Emphysème pulmonaire/physiopathologie , Fumer/effets indésirablesSujet(s)
Humains , Maladies pulmonaires/chirurgie , Emphysème pulmonaire/complications , Emphysème pulmonaire/diagnostic , Emphysème pulmonaire/traitement médicamenteux , Emphysème pulmonaire/étiologie , Emphysème pulmonaire/mortalité , Emphysème pulmonaire/physiopathologie , Emphysème pulmonaire/chirurgie , Emphysème pulmonaire/thérapieRÉSUMÉ
El déficit de alfa-1 antitripsina (a-1 AT), también llamado inhibidor de proteasa, es un defecto genético asociado al desarrollo de enfisema pulmonar precoz y menos frecuentemente a cirrosis hepática. Los fenotipos asociados son PiZZ y PiZNulo, caracterizados por un nivel de a-1 AT plasmático menor de 40 mg/dl. La enfermedad pulmonar se presenta habitualmente antes de los 40 años y su progresón es lenta pero puede ser acelerada marcadamente por el hábito tabáquico. La hipótesis del desbalance elastasa-antielastasa postula que la a-1 AT protege al pulmón del daño elastolítico producido por la elastada del neutrófilo. Su déficit lo dejaría altamente vulnerable a una destrucción progresiva que culmina en el enfisema clínico. Como la terapia de aumentar la producción endógena de a-1 AT o disminuir la elastasa no han tenido éxito, su enfoque actual se ha centrado en aumentar la a-1 AT en forma exógena con infusiones iv mensuales, lo que se está probando en un estudio multicéntrico europeo. La terapia genética se encuentra aún en fase experimental
Sujet(s)
Humains , alpha-1-Antitrypsine/déficit , Emphysème pulmonaire/étiologie , alpha-1-Antitrypsine/administration et posologie , alpha-1-Antitrypsine/usage thérapeutique , Pancreatic elastase/métabolisme , Phénotype , Emphysème pulmonaire/diagnostic , Emphysème pulmonaire/traitement médicamenteux , Emphysème pulmonaire/physiopathologie , Fumer/effets indésirablesRÉSUMÉ
La matriz extracelular (ME) del tejido conectivo pulmonar se diferencia en membranas basales y matriz intersticial. Esta última se constituye por un armazón de proteínas colagénicas fibrosas y de fibras elásticas amorfas, que están embebidas dentro de una sustancia basal viscoelástica compuesta por proteoglicanos y glicoproteínas. La ME le proporciona al pulmón sus propiedad mecánicas. Las colágenas proveen tensión, mientras que las fibras elásticas permiten el desarrollo de la expansión elástica, con la subsecuente recuperación característica de este órgano. Las fibras elásticas se constituyen por fibras amorfas de elastina polimérica combinada con ciertas glicoproteínas conocidas como microfibrillas, con proporciones variables según su estadio ontogénico. Este material amorfo constituye toda una malla que comprende un armazón continuo, por todo el pulmón, y en conexión estrecha con las fibras de colágena permite la actividad mecánica del pulmón. La elastina es una molécula altamente hidrofóbica, con una relación intron: exón de 15:1, sintetizada junto con un receptor que guía su polimerización en sitios determinados por las microfibrillas previamente depositadas
Sujet(s)
Chiens , Humains , Animaux , alpha-1-Antitrypsine/déficit , Élastine/composition chimique , Élastine/métabolisme , Structure moléculaire , Emphysème pulmonaire/physiopathologie , Tissu élastique/composition chimique , Tissu élastique/ultrastructure , Tropoélastine/synthèse chimiqueRÉSUMÉ
Los adenocarcinomas de la corteza suprarrenal son entidades clínicas muy poco comunes que alcanzan una frecuencia de 0.2 por ciento entre todas las neoplasias. Por lo regular, la mayoría de ellas son de tipo funcionante y tienen una presentación clínica que va a depender del exceso circulante de la hormona producida por cualquiera de las tres capas que componen la estructura cortical. Sin embargo, un mínimo porcentaje de estas neoplasias se consideran no funcionantes siendo, por su forma de presentación, todo un reto diagnóstico para el clínico. El objetivo del presente trabajo es informar el caso de un paciente masculino en la séptima década de la vida con pérdida de peso, masa suprarrenal derecha y otra en mesogastrio con determinación de 17 cetoesteroides, cortisol plasmático y ácido vainillilmandélico normales y en quien la necropsia mostró adenocarcinoma de corteza suprarrenal. Se realiza revisión de la literatura enfocada al diagnóstico y tratamiento
Sujet(s)
Adulte d'âge moyen , Humains , Mâle , Pneumonie à pneumocoques/physiopathologie , Emphysème pulmonaire/physiopathologie , Sclérose/physiopathologie , Hydrocortisone/métabolisme , Adénocarcinome/physiopathologie , Tumeurs corticosurrénaliennes/physiopathologie , Aminoglutéthimide/usage thérapeutique , Kétoconazole/usage thérapeutique , Mitotane/usage thérapeutique , Androgènes/métabolisme , Oestrogènes/métabolismeRÉSUMÉ
O enfisema pulmonar e uma das doencas mais incapacitantes da especie humana. Embora o agente causal mais frequente do enfisema seja bastante conhecido - o habito de fumar - os mecanismos moleculares envolvidos na destruicao progressiva do parenquima pulmonar ainda nao estao totalmente esclarecidos. Este fato tem impedido o desenvolvimento de estrategias terapeuticas, para o tratamento do enfisema, confinando o ato preventivo aos limites do impedimento de fumar. Mais recentemente, os radicais livres tem sido considerados como importantes medidores na patogenia do enfisema. Dada a importancia deste assunto, a presente monografia foi concebida de forma a apresentar de maneira concisa os mecanismos da producao e homeostase dos radicais livres, bem como seu papel no enfisema pulmonar.
Sujet(s)
Humains , Emphysème pulmonaire/physiopathologie , Nicotiana/effets indésirables , Radicaux libres , Emphysème pulmonaire/classification , Emphysème pulmonaire/enzymologie , Emphysème pulmonaire/étiologie , Pollution de l'air/effets indésirables , Pollution par la fumée de tabac/effets indésirablesRÉSUMÉ
Durante el transcurso de un año, 214 recién nacidos necesitaron ventilación mecánica (VM), de ellos 30 (14 por ciento) presentaron fuga de aire pulmonar, éstos neonatos fueron comparados con otros 31 neonatos (grupo testigo) del mismo peso y edad gestacional, pero sin fuga de aire. De los 30 casos con fuga de aire pulmonar (FAP) 21 fueron neumotórax y 9 enfisema intersticial pulmonar (EIP) lo que le da una incidencia en relación a 214 pacientes ventilados, de 9.8 por ciento y 4.2 por ciento respectivamente. La incidencia de fuga de aire por peso y edad gestacional fue de 25 por ciento para menores de 32 semanas y 8.4 por ciento para mayores de 32 semanas; 35.7 por ciento para los menores de 1500 g y 6.3 por ciento para los mayores de 1500 g. No hubo diferencia en la edad gestacional, peso al nacer y Apgar entre ambos grupos. El número de defunciones aunque fue mayor en el grupo con fuga aérea, 18/30 vs 12/31, la diferencia no fue significativa. Entre los diagnósticos que presentaron los niños de ambos grupos, hubo mayor porcentaje de persistencia de conducto arterioso en el grupo con fuga aérea, con respecto al grupo testigo, (p=0.034), en el resto de los padecimientos no hubo diferencia. En los parámetros de ventilación, hubo una diferencia significativa (p < 0.05), en el tiempo inspiratorio, el cual fue más prolongado en el grupo con fuga aérea, mientras la presión inspiratoria pico fue más elevada en el grupo testigo (p < 0.05). La presión media de las vías aéreas (Pmva) y la presión positiva al final de la espiración no mostraron diferencia entre grupos