RESUMO
BACKGROUND: Pulmonary involvement is the leading cause of systemic sclerosis (SSc)-related deaths. A simple test to evaluate exercise capacity is the 6-min walk test (6MWT), and the walk distance is used as a primary outcome in clinical trials. Hemoglobin desaturation during a 6MWT is predictive of mortality in patients with primary pulmonary hypertension. Our objectives were to evaluate the walk distance and resting oxygen saturation - oxygen saturation after the 6-min period (DeltaSat) during the 6MWT in patients with SSc, and to establish correlations between the 6MWT results and other clinical variables. METHODS: We analyzed 110 SSc patients. DeltaSat was defined as a fall of end-of-test saturation >or= 4%. Clinical and demographic data were collected. All the patients were submitted to chest radiographs and high-resolution CT (HRCT) and underwent pulmonary function testing and echocardiography, and the presence of autoantibodies was determined. RESULTS: The variables associated with a walk distance < 400 m (p < 0.05) were age, dyspnea index, fibrosis on radiography, pulmonary arterial systolic pressure (PASP) >or= 30 mm Hg, and desaturation. The variables associated with DeltaSat (p < 0.05) were age, positive anti-Scl-70 autoantibody, dyspnea index, fibrosis on radiography, FVC < 80% of predicted, PASP >or= 30 mm Hg, and ground-glass or reticular opacities on HRCT. In the multivariate logistic regression analysis, three variables were significant when tested with walk distance: age, race, and dyspnea index; four variables were significant when tested with DeltaSat: age, dyspnea index, positive anti-Scl-70 autoantibody, and FVC < 80% of predicted. CONCLUSIONS: Desaturation during a 6MWT provides additional information regarding severity of disease in scleroderma patients with pulmonary manifestations.
Assuntos
Tolerância ao Exercício , Pneumopatias/fisiopatologia , Escleroderma Sistêmico/fisiopatologia , Adulto , Ecocardiografia , Teste de Esforço , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Oximetria , Radiografia Torácica , Testes de Função Respiratória , Índice de Gravidade de Doença , Estatísticas não Paramétricas , Tomografia Computadorizada por Raios XRESUMO
Os autores relatam um caso de botriomicose com tumoração da parede abdominal anterior. Ela é de origem bacteriana e acomete tanto o tecido cutâneo quanto o visceral, e a áreas expostas como mãos e pés são as mais atingidas. No caso em questão se estendia por toda a parede abdominal anterior, com trajetos fistulosos, comprometendo o tecido subcutâneo, músculos, gordura pré-peritoneal, não havendo planos de clivagem com alças instestinais, atingindo região pancreática e bexiga. O diagnóstico final foi feito por exame histopatológico e bacteriológico da lesão.
