Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Year 1999 - Volume 25  - Number 2  (March/April)






Original Article

1 - Experimental lobar transplantation in swine: proportional graft in the discrepancy between donor and recipient

Transplante lobar experimental em suínos: enxerto proporcional na disparidade entre receptor e doador

Nuno Ferreira de Lima, Oliver A. Binns, Scott A. Buchanan, Kimberly S. Shochey, Curtis G. Tribble, Irving L. Kron

J Bras Pneumol.1999;25(2):63-69

Abstract PDF PT Portuguese Text

Background - The critical donor shortage in pediatric pulmonary transplantation has prompted lobar transplantation from living-related. However, in the case of great size discrepancy between the adult donor and the small child recipient, a pulmonary segment or medium lobe represents grafts with restricted vascular bed. The authors hypothesized that this type of graft may develop pulmonary hypertension in the recipient by the end of the growth period. Methods - This hypothesis was investigated in a porcine survival model of lung transplantation in piglets. There were three groups for comparison purposes: I (n = 4) - transplantation of the upper lobe from an adult donor, graft being proportional to the recipient but irrigated by two arterial rami only; II (n = 5) - transplantation of the lower lobe from an adult donor, graft being oversized to the recipient and having adequate vascular bed; III (n = 6) - transplantation of immature lung, from matched-sized donor. Graft function was studied three months after the transplantation, when the growth period was completed. Results - The pulmonary artery pressure of grafts in group I (51.8 ± 2.1 mmHg) was increased compared to that of group II (40.4 ± 2.5 mmHg) and of group III (34.8 ± 1.5 mmHg), reaching statistical significance (p = 0.0003). Conclusions - The lobar graft proportional to the recipient, with restricted vascular bed, had hampered hemodynamic performance in the growing animal. These results suggest that graft proportionality should be secondary to an adequate vascular bed.

 


Keywords: Lung transplantation. Lobar transplantation, experimental. Swine.

 

2 - Outcomes of multidrug resistant tuberculosis (MDR TB) treatment in Brasil - Partial results - As of April, 1998

Estudo de efetividade de esquemas alternativos para o tratamento da tuberculose multirresistente no Brasil

Margareth Pretti Dalcolmo, Andrea Fortes, Fernando Fiuza de Melo, Rita Motta, Jorge Ide Netto, Ninarosa Cardoso, Monica Andrade, Angela Werneck Barreto, Germano Gerhardt

J Bras Pneumol.1999;25(2):70-77

Abstract PDF PT Portuguese Text

Purpose: To determine the effectiveness of alternative regimens for treating confirmed MDR TB cases in outpatient units: Methods: MDR TB cases were defined as culture isolation of M. tuberculosis resistant in vitro to at least rifampin/isoniazide and a third drug of standard regimens in Brazil, according to both the conventional method and the BACTEC system. Design: Multicentric non-randomized controlled clinical trial. From April 95 to December 97 187 patients were enrolled. As of April 98, there were 36 patients under treatment. The authors analyzed 149 patients that had an average 14 months of treatment duration. The regimens used were chosen according to sensitivity tests: 1) streptomycin (S)/ofloxacin (OFX)/terizidon (TZ)/ethambutol (E)/clofazimine (CZ) or capreomycin (CM)/OFX/TZ/CZ/E or amicacyn/OFX/TZ/E/CZ. Demography: Male, 68.4%; female, 31.5%; mean age-36.9 years; HIV prevalence 1.9%; primary resistance rate - 8%. Outcomes: cured-treated for 12 months with six months after two consecutive negative culture; abandoned-discontinued treatment and consultations; died - deaths due to TB after two months of treatment; failed - remained positive in culture throughout the 12 months. Results: 120 (79.5%) patients converted to negative culture within 3 months. Cured: 53%, failed 31%, died 6%, abandoned 10%. Conclusions: The major predictor to MDR TB in Brazil is previous irregular and/or incomplete treatment. Sputum conversion rate was high and favorable overall response was 53%. Clinical implications: Because TB is endemic in Brazil and the number of MDR cases due to acquired resistance is increasing, greater efforts are needed to implement supervised treatment in tuberculosis particularly for non compliant patients.

 


Keywords: Tuberculosis, treatment. Multidrug resistant tuberculosis.

 

3 - Antegrade versus retrograde lung perfusion in pulmonary preservation for transplantation in a canine model of post-mortem lung viability

Perfusão pulmonar anterógrada "versus" retrógrada na preservação pulmonar para transplante em modelo canino de viabilidade pulmonar pós-morte

Jean Carlo Kohmann, Ubirajara Lima e Silva, Gabriel Madke, Eduardo Sperb Pilla, José Carlos Felicetti, José de Jesus Peixoto Camargo, Paulo Ivo Homem de Bittencourt, Paulo Francisco Guerreiro Cardoso

J Bras Pneumol.1999;25(2):78-83

Abstract PDF PT Portuguese Text

Lung retrieval following cardio-circulatory arrest has been studied experimentally, however severe ischemia/reperfusion injury requires improved methods of graft preservation. Allograft perfusion with crystalloid solution delivered via pulmonary artery (antegrade perfusion) remains the standard procedure, however it does not provide adequate washout of the blood retained within the bronchial circulation which may trigger reperfusion injury. This has led the authors to test the impact of antegrade versus retrograde (via left atrium) perfusion of lung grafts submitted to 3 hours of warm ischemia after cardio-circulatory arrest in a dog model of left lung allotransplantation. Twelve donor dogs were sacrificed with thiopental sodium and kept under mechanical ventilation at room temperature for 3 hours. They were randomized and the heart-lung blocks harvested after being perfused in a retrograde (group I, n = 6) or antegrade (group II, n = 6) fashion with modified Euro-Collins solution. Twelve recipient animals were submitted to a left lung transplant receiving the grafts from both groups and the assessment was performed during 6 hours. Hemodynamic parameters were similar for animals in both groups. The gas exchange (arterial PaO2 and PaCO2) in recipients of group I (retrograde perfusion) was significantly better when compared to recipients of grafts perfused via pulmonary artery. Intracellular ATP did not show difference between the groups, however there was a measurable drop in its values when samples obtained upon extraction were compared to those measured after reperfusion and at the end of the assessment. The authors concluded that retrograde perfusion yields better pulmonary function after 6 hours of reperfusion in this animal model of left lung allotransplantation following 3 hours of normothermic ischemia under mechanical ventilation.

 


Keywords: Lung. Ischemia. Preservation. Retrograde perfusion. ATP.

 

5 - Resolução nº 196 - De 10 de outubro de 1996

Adib D. Jatene

J Bras Pneumol.1999;25(2):94-98

PDF PT


6 - Resolução nº 251 - De 5 de agosto de 1997

Carlos César S. de Albuquerque

J Bras Pneumol.1999;25(2):99-101

PDF PT


7 - Curso de diagnóstico por imagem do tórax - Capítulo II - Imagenologia da pleura

Arthur Soares de Souza Junior

J Bras Pneumol.1999;25(2):102-113

PDF PT


Case Report

8 - Fat embolism syndrome: report of a case associated to liposuction

Síndrome de embolia gordurosa: relato de caso associado à lipoaspiração

Jõao Carlos Folador, Gabriela Elisete Bier, Renata Ferreira de Camargo, Mônicca Sperandio

J Bras Pneumol.1999;25(2):114-117

Abstract PDF PT Portuguese Text

A forty year old woman, 72 hours after liposuction, complained of sudden dyspnea, fever and tachycardia. Thoracic radiography and duplex-scan of deep veins were normal. Pulmonary scintigraphy suggested thromboembolism. The patient had hypoxia, anemia and mental confusion after three days of systemic heparin. Once fat embolism syndrome was suspected, heparin infusion was stopped and corticosteroid therapy was started. After that, the patient was much better and discharged from hospital.

 


Keywords: Fat embolism syndrome. Pulmonary thromboembolism. Liposuction.

 

9 - Tracheobronchial rupture by blunt chest trauma: evaluation and management

Ruptura traqueobrônquica por trauma torácico fechado: avaliação e manuseio

Wilson de Souza Stori Junior, Marlos de Souza Coelho, José Antônio Zampier, Gilberto Melnick

J Bras Pneumol.1999;25(2):118-123

Abstract PDF PT Portuguese Text

Two cases of complete bronchial rupture and one case of tracheobronchial rupture by blunt chest trauma were treated at the Thoracic Surgical and Respiratory Endoscopy Department of the Hospital Universitário Cajuru in a period of 2 years. The surgical technique used was end-to-end anastomosis with interrupt absorbable suture after either resection of the stenotic edges or debridement of the lacerated edges. All three patients have had good recovery. The mean period to remove the chest tubes was 3.6 days, and the mean period of discharge from the Thoracic Surgical Department was 5.6 days. The follow-up was made using chest X-ray (PA and lateral projections), lung function tests, and bronchoscopy.

 


Keywords: Tracheobronchial rupture. Blunt chest trauma. Evaluation. Treatment.

 

Review Article

10 - Perfusion lung injury

Lesão pulmonar de reperfusão

Bruno do Valle Pinheiro, Marcelo Alcântara Holanda, Fernando Gomes Araújo, Hélio Romaldini

J Bras Pneumol.1999;25(2):124-136

Abstract PDF PT Portuguese Text

The ischemia-reperfusion injury is a common pathophysiologic phenomenon in many diseases seen in daily clinical practice. The lung can be affected both directly, as in pulmonary edema after lung transplant or after resolution of pulmonary thromboembolism, and indirectly, as in shock states or after reperfusion injury in distant organs as intestine or lower extremities. The latter situation can occur secondary to aortic occlusion for surgical procedures. Many mediators have been implicated in the ischemia-reperfusion injury: oxygen free radicals, lipid products as thromboxane, adhesion molecules involved in leukocyte-endothelial interaction, tumor necrosis factor, among others. Therapeutic strategies for the reperfusion injury are used only at the experimental level and in very few clinical studies. Antioxidants, inhibitors of lipid mediators and of the leukocyte-endothelial interaction and promoters of blood flow in post-ischemic vessels have been used.

 


Keywords: Lung. Injury. Reperfusion. Ischemia.

 

Letters to the Editor

11 - Avaliação propedêutica da dispnéia crônica de etiologia indefinida: desafios atuais

Carlos Alberto de Castro Pereira

J Bras Pneumol.1999;25(2):137-140

PDF PT


 


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