Computed tomography measurement of lung volume in preoperative assessment for living donor lung transplantation: volume calculation using 3D surface rendering in the determination of size compatibility.

The objective of this study was to describe the use of CT volume quantification assessment of candidates for LLDLT. Six pediatric candidates for LDLLT and their donors were investigated with helical chest CT, as part of the preoperative assessment. The CT images were analyzed as per routine and additional post-processing with CT volume quantification (CT densitovolumetry) was performed to assess volume matching between the lower lobes of the donors and respective lungs of the receptors. CT images were segmented by density and region of interest, using post-processing software. Size matching was also assessed using the FVC formula. Compatible volumes were found in three cases. The other three cases were considered incompatible. All three recipients with compatible sizes survived the procedure and are alive and well. One patient with incompatible size was submitted to the procedure and died because of complications attributed to the incompatible volumes. One patient with incompatible size has subsequently grown and new measurements are to be taken to check the current volumes. Different donors are being sought for the remaining patient whose lung volumes were considered too big for the prospective transplant donor lobes. Under FVC formula criteria, all cases were considered compatible. CT volume quantification is an easy to perform, non-invasive technique that uses CT images for the preassessment of candidates for LDLLT, to compare the volume of the lower lobes from the donors with volume of each lung in the prospective recipients. Size matching based on CT densitovolumetry and FVC may differ.

Clubbed fingers: radiological evaluation of the nail bed thickness.

It is established that there is an increase in soft tissue of the clubbed digits as demonstrated on previous histopathological examinations. In the present study, the nail bed thickness was assessed and measured on plain radiographs of index fingers in two groups of patients: one group with lung disease and fingers clubbing and one group of normal controls. A vertical x-ray beam was used with a focus-film distance of 1.0 m, with the index finger placed in lateral view directly over the film, without anti-diffusion grid. Three investigators, blinded to prevent bias measured the thickness of soft tissues between the nail root and the terminal phalanx on the radiographs. This method was used to evaluate a group of 85 clinically clubbed (hyponychial angle > 192.0 degrees) adult patients with lung disease and a control group of a 100 normal adult individuals with no clubbing (hyponychial angle < 188.0 degrees). The mean nail bed thickness in the patients with clubbing (n = 85) was 3.88 +/- 0.55 mm (3.00-5.50 mm). In comparison, in the normal subjects (n = 100), the mean was 2.38 +/- 0.27 mm (1.75-3.10 mm), revealing a significant difference (P < 0.001). Only two normal individuals presented nail bed thickness >or=3.0 mm. A good interobserver agreement on the measurements was found (P > 0.900). The radiographic evaluation of the nail bed thickness was easily performed, with good interobserver concordance. It is possible to distinguish between clubbed from nonclubbed fingers, in vivo, using plain radiograph.

Nocardial infections: report of 22 cases.

Twenty-two cases of nocardial infections were diagnosed in our city between 1977- 1998. All patients whose clinical specimens showed Nocardia spp. at Gram stain, which were further confirmed by culture, were selected to be included in the study. Data from patients who were cured were compared with those from patients who died by statistical tests using EPIINFO version 6.04 software. Six isolates were identified as Nocardia asteroides complex, one as Nocardia asteroides sensu stricto and other as Nocardia brasiliensis. We had 17 cases of lung nocardiosis, being one out of them also a systemic disease. Other four cases of systemic nocardiosis were diagnosed: nocardial brain abscesses (one); nocardiosis of the jejunum (one); multiple cutaneous abscesses (one); and a case of infective nocardial endocarditis of prosthetic aortic valve. One patient had a mycetoma by N. brasiliensis. Fifteen (68.2%) out of 22 patients were immunosuppressed, being most (93.3%) by high-doses corticotherapy. Mortality by nocardial infection was 41%; mortality of systemic nocardiosis was 60%. Nocardiosis has a bad prognosis in immunosuppressed patients and also in non-immunosuppressed patients if the diagnosis is delayed. We propose that the delay in diagnosis should be examined in larger series to document its influence in the prognosis of the disease.

Nocardial infections: report of 22 cases

Twenty-two cases of nocardial infections were diagnosed in our city between 1977- 1998. All patients whose clinical specimens showed Nocardia spp. at Gram stain, which were further confirmed by culture, were selected to be included in the study. Data from patients who were cured were compared with those from patients who died by statistical tests using EPIINFO version 6.04 software. Six isolates were identified as Nocardia asteroides complex, one as Nocardia asteroides sensu stricto and other as Nocardia brasiliensis. We had 17 cases of lung nocardiosis, being one out of them also a systemic disease. Other four cases of systemic nocardiosis were diagnosed: nocardial brain abscesses (one); nocardiosis of the jejunum (one); multiple cutaneous abscesses (one); and a case of infective nocardial endocarditis of prosthetic aortic valve. One patient had a mycetoma by N. brasiliensis. Fifteen (68.2 percent) out of 22 patients were immunosuppressed, being most (93.3 percent) by high-doses corticotherapy. Mortality by nocardial infection was 41 percent; mortality of systemic nocardiosis was 60 percent. Nocardiosis has a bad prognosis in immunosuppressed patients and also in non-immunosuppressed patients if the diagnosis is delayed. We propose that the delay in diagnosis should be examined in larger series to document its influence in the prognosis of the disease.

São apresentados 22 casos de infecção por Nocardia species entre 1977 e 1998, apresentando-se seu quadro clínico e evolução. Todos os pacientes cujos espécimes clínicos mostraram microorganismos sugestivos de Nocardia spp. à coloração de Gram, confirmados posteriormente por cultura, foram incluídos no estudo. Os dados dos pacientes que obtiveram cura foram comparados com aqueles dos pacientes que foram a óbito pelo programa EPIINFO versão 6.04; nível de significância menor que 5 por cento foi considerado estatisticamente significativo. Foram obtidos 22 casos de infecção por Nocardia spp.: seis isolamentos identificados como Nocardia asteroides complex, um como Nocardia asteroides sensu stricto e outro como Nocardia brasiliensis, enquanto os restantes foram identificados como Nocardia spp. Tivemos 17 casos de nocardiose pulmonar (um com disseminação). Tivemos outros quatro casos de nocardiose sistêmica: múltiplos abscessos cerebrais (um); endocardite infecciosa de prótese valvular aórtica (um); nocardiose de intestino delgado (um); abscessos cutâneos múltiplos por Nocardia spp (um). Um paciente apresentou micetoma por Nocardia brasiliensis. Imunossupressão esteve presente em 15 pacientes (68,2 por cento), predominantemente por corticoterapia (93,3 por cento). Nossa mortalidade foi 41 por cento; a mortalidade dos pacientes com nocardiose sistêmica foi de 60 por cento. A nocardiose tem pior prognóstico em pacientes imunossuprimidos e em pacientes com nocardiose sistêmica.

Bronquiectasias / Bronchiectasis

Säo revisados de modo sumário dados históricos, epidemiológicos, patogenia e achados anatomopatológicos das bronquiectasias. Discutem-se os métodos diagnósticos e, com mais detalhe, o tratamento, destacando-se o papel atual da cirurgia no manejo dessa afecçäo

Doença broncopulmonar obstrutiva crônica (DBPOC): estudo de 255 pacientes (395 internaçöes) / Chronic obstructive pulmonary disease: study of 255 patients

Analisam-se os casos de 255 pacientes portadores de DBPOC (enfisema pulmonar e/ou bronquite crônica) que tiveram a primeira internaçäo no serviço no período 1977-1984; 219(86,0%) eram homens com média de idade de 60,7 anos. Havia 229 fumantes (89,40%) - em média 26,7 cigarros/dia, e durante 41 anos. Dos 255 pacientes, 187 (Grupo I) tiveram somente uma internaçäo no serviço, e 68 (Grupo II) hospitalizaram-se de duas a dez vezes, até o ano de 1987. A soma das primeiras internaçöes com as reinternaçöes totalizou 395 hospitalizaçöes. A causa mais comum desencadeante das internaçöes foi infecçäo respiratória (41,0%), ocorrendo especialmente durante o inverno ou início da primavera. Verificou-se o padräo "enfisematoso" da DBPOC em 32,5% dos pacientes, o "bronquítico" em 10,0% e 57,5% eram casos "mistos". Tosse, expectoraçäo e dispnéia foram os sintomas mais freqüentes (em torno de 85,0%); sibilância ocorreu em 47,5% dos pacientes, e em 12,0% cianose. Evidências de insuficiência cardíaca, esquerda associada a DBPOC foram detectadas em 50 pacientes (19,6%), e 28(11,0%) tinham "cor pulmonale". O VEF1 foi inferior a 1,2 litros em 58,0% dos pacientes, já na primeira internaçäo. Metade dos pacientes tinha PaO2 abaixo de 60 mmHg (um terço dos quais com hipercapnia). Achado radiográfico sugestivo de pneumonia esteve presente em 57,5% dos pacientes na primeira internaçäo, e em 34,0% das reinternaçöes. Oito pacientes (3,0%) tiveram pneumotórax. Pneumococo e/ou Haemophoilus influenzae foram encontrados na escarro de 88,5% dos pacientes infectados. Todos os pacientes receberam tratamento clínico, e sete também cirúrgico (drenagem de pneumotórax, em geral)...