High frequency and severity of pleural changes in former workers exposed to anthophyllite associated with other contaminating amphibole asbestos in Brazil.

OBJECTIVE: To evaluate the frequency and severity of pleuropulmonary alterations in anthophyllite-exposed former workers in Itapira, São Paulo, Brazil. The amphibole anthophyllite, a magnesium-iron silicate, had its mining, marketing, and use forbidden in Brazil in 1995. METHODS: Former workers were followed from 1999 to 2011. All completed chest X-ray interpreted using the International Labour Office (ILO) classification. High-resolution computed tomography was used at the final evaluation. Spirometry assessed forced vital capacity (FVC), forced expiratory volume in the first second (FEV1), and FEV1/FVC throughout the follow-up period. Samples from the mined ore were analyzed by X-ray diffraction (XRD) and scanning electron microscopy coupled to energy dispersive spectroscopy (SEM-EDS). RESULTS: XRD and SEM-EDS confirmed the presence in ore of anthophyllite at a concentration of 75%, in addition to tremolite and other amphiboles in lower concentrations. Twenty-eight subjects were evaluated. Median time of exposure was 3 years (minimum = 1; maximum = 18; interquartile interval = 1-4). Twenty cases of pleural abnormalities were diagnosed in 26 evaluated (77%). The average latency time was 25.6 ± 7.4 years. Two individuals (7.7%) showed progressive worsening of diffuse pleural thickening (DPT) and exhibited an annual FVC decrease of 85 mL and 150 mL, respectively. CONCLUSION: This small sample showed a very high index of nonmalignant pleural abnormalities in anthophyllite-exposed workers compared with workers exposed to other kinds of fibers. Rapidly progressive DPT, defined by the severity of pleural compromise, was possibly secondary to the presence of other amphibole types in the inhaled dust. No significant loss of FVC was found in the studied group as a whole. No cases of asbestosis, lung carcinoma, and mesothelioma were diagnosed in this cohort.

Seleção de potência de medicamentos homeopáticos: parâmetros mais frequentemente valorizados entre diversos autores / Selection of potency of homeopathic medicines: parameters most frequently valued among different authors

Dinamização é um assunto polêmico em homeopatia e há grande divergência entre os praticantes desta terapêutica quanto ā seleção medicamentosa. O objetivo deste trabalho é identificar os parâmetros mais frequentemente valorizados para a seleção da potência medicamentosa no início da terapêutica homeopática entre diversos autores. Foi realizada pesquisa bibliográfica nas bases de dados PubMed e LILACS e no site de busca Google. A dinâmica das doenças considera em seu caráter agudo ou crônico, o grau de certeza quanto ā similitude do medicamento, idade, o plano de atuação (mental, funcional, físico), a existência e a gravidade da doença estrutural, e a hipersensibilidade foram os parâmetros que mais frequentemente influenciaram a seleção da potência medicamentosa entre os autores estudados. (AU)

Dynamization is a controversial subject in homeopathy and there is great divergence among the practitioners of this therapeutics regarding the drug selection. The objective of this work is to identify the parameters most frequently valued for the selection of drug potency at the beginning of homeopathic therapy among several authors. A bibliographic search was performed in the PubMed and LILACS databases and in the Google search site. The dynamics of diseases considers the degree of certainty as to the similarity of the medication, age, the plan of action (mental, functional, physical), the existence and severity of the structural disease, and hypersensitivity were the acute or chronic characteristics. Parameters that most frequently influenced the selection of drug potency among the studied authors. (AU)

Rheumatoid pneumoconiosis (Caplan's syndrome) with a classical presentation.

Although rare, rheumatoid pneumoconiosis, also known as Caplan's syndrome, can occur in workers exposed to silica, as well as in patients with silicosis, coal workers' pneumoconiosis or asbestosis. Prevalence is higher among patients with silicosis, despite the fact that it was originally described in coal workers with pneumoconiosis. The classical finding that defines this syndrome is that of rheumatoid nodules in the lungs, regardless of whether there are small rounded opacities suggestive of pneumoconiosis or large opacities consistent with massive pulmonary fibrosis, with or without clinical rheumatoid arthritis. We describe the case of a female patient with rheumatoid arthritis, diagnosed 34 years after 7 years of occupational exposure to silica at a porcelain plant. A chest X-ray showed circular opacities of 1-5 cm in diameter, bilaterally distributed at the periphery of the lungs. A CT-guided thoracic punch biopsy of one of those nodules revealed that it was rheumatoid nodule surrounded by a palisade of macrophages, which is typical of Caplan's syndrome. Aspects of diagnosis, classification and occurrence of this syndrome are discussed, emphasizing the importance of the occupational anamnesis of patients with rheumatoid arthritis and lung opacities on chest X-rays.

Pneumoconiose reumatoide (síndrome de Caplan) com apresentação clássica / Rheumatoid pneumoconiosis (Caplan's syndrome) with a classical presentation

Apesar de rara, a pneumoconiose reumatoide, também chamada de síndrome de Caplan, pode ser diagnosticada entre trabalhadores expostos à sílica e entre pacientes com silicose, pneumoconiose dos mineiros de carvão e asbestose. A maior prevalência ocorre entre os silicóticos, apesar de ter sido descrita inicialmente em mineiros de carvão com pneumoconiose. O achado que define o tipo clássico da síndrome é a presença de nódulos reumatoides nos pulmões, independente da presença ou não de pequenas opacidades pneumoconióticas, ou de grandes opacidades de fibrose pulmonar maciça, associada ou não a um quadro de artrite reumatoide em atividade. Relatamos o caso de uma mulher com quadro de artrite reumatoide, diagnosticada 34 anos após exposição à sílica livre em uma indústria de porcelana por 7 anos, apresentando radiograma de tórax com opacidades arredondadas de 1 a 5 cm de diâmetro, distribuídas na periferia de ambos os pulmões. A biópsia transtorácica guiada por TC de um dos nódulos revelou tratar-se de nódulo reumatoide com macrófagos em paliçada, típico da síndrome de Caplan. São discutidos aspectos de diagnóstico da síndrome, classificação e ocorrência, ressaltando a importância da anamnese ocupacional em casos de artrite reumatoide com opacidades radiológicas pulmonares.

Although rare, rheumatoid pneumoconiosis, also known as Caplan's syndrome, can occur in workers exposed to silica, as well as in patients with silicosis, coal workers' pneumoconiosis or asbestosis. Prevalence is higher among patients with silicosis, despite the fact that it was originally described in coal workers with pneumoconiosis. The classical finding that defines this syndrome is that of rheumatoid nodules in the lungs, regardless of whether there are small rounded opacities suggestive of pneumoconiosis or large opacities consistent with massive pulmonary fibrosis, with or without clinical rheumatoid arthritis. We describe the case of a female patient with rheumatoid arthritis, diagnosed 34 years after 7 years of occupational exposure to silica at a porcelain plant. A chest X-ray showed circular opacities of 1-5 cm in diameter, bilaterally distributed at the periphery of the lungs. A CT-guided thoracic punch biopsy of one of those nodules revealed that it was rheumatoid nodule surrounded by a palisade of macrophages, which is typical of Caplan's syndrome. Aspects of diagnosis, classification and occurrence of this syndrome are discussed, emphasizing the importance of the occupational anamnesis of patients with rheumatoid arthritis and lung opacities on chest X-rays.

Apresentações da esquistossomose no sistema nervoso central: correlação clínica e radiológica / Schistosomiasis of the central nervous system: clinical and radiologic correlation

São relatados quatro casos de esquistossomose do sistema nervoso central, descrevendo-se os achados radiológicos e sua correlação com a clínica. Em um caso o envolvimento cerebral foi caracterizado por lesão pseudotumoral única, com confirmação anatomopatológica, e três casos de esquistossomose medular foram caracterizados por tumefação medular e impregnação leptomeníngea e radicular do meio de contraste paramagnético. Os achados deste trabalho enfatizam a importância de se considerar a esquistossomose no diagnóstico diferencial de lesões encefálicas ou medulares em pacientes procedentes de áreas endêmicas para a esquistossomose.