Identification of rounded atelectasis in workers exposed to asbestos by contrast helical computed tomography

Rounded atelectasis (RA) is a benign and unusual form of subpleural lung collapse that has been described mostly in asbestos-exposed workers. This form of atelectasis manifests as a lung nodule and can be confused with bronchogenic carcinoma upon conventional radiologic examination. the objective of the present study was to evaluate the variation in contrast uptake in computed tomography for the identification of asbestos-related RA in Brazil. Between January 1998 and December 2000, high-resolution computed tomography (HRCT) was performed in 1658 asbestos-exposed workers. the diagnosis was made in nine patients based on a history of prior asbestos exposure, the presence of characteristic (HRCT) findings and lesions unchanged in size over 2 years or more. in three of them the diagnosis was confirmed during surgery. the dynamic contrast enhancement study was modified to evaluate nodules and pulmonary masses. All nine patients with RA received iodide contrast according to weight. the average enhancement after iodide contrast was infused, reported as Hounsfield units (HU), increased from 62.5 +/- 9.7 to 125.4 +/- 20.7 (P < 0.05), with a mean enhancement of 62.5 +/- 19.7 (range 40 to 89) and with a uniform dense opacification. in conclusion, in this study all patients with RA showed contrast enhancement with uniform dense opacification. the main clinical implication of this finding is that this procedure does not permit differentiation between RA and malignant pulmonary neoplasm.Grp Interinst Estudos Doencas Relacionadas Amiant, São Paulo, BrazilUniv São Paulo, Fac Med, Hosp Clin, Inst Corcao,Disciplina Pneumol, São Paulo, BrazilUniv São Paulo, Fac Med, Disciplinas Radiol, São Paulo, BrazilUniv São Paulo, Fac Med, Disciplinas Patol, São Paulo, BrazilUniv Estadual Campinas, Fac Med, Area Med Ocupac, Campinas, SP, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Disciplinas Pneumol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Disciplinas Radiol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Disciplinas Pneumol, São Paulo, BrazilUniversidade Federal de São Paulo, Escola Paulista Med, Disciplinas Radiol, São Paulo, BrazilWeb of Scienc

Clinical and haemodynamic evaluation of chronic thromboembolic pulmonary hypertension patients scheduled for pulmonary thromboendarterectomy. Is schistosomiasis hypertension an important confounding factor?

INTRODUCTION: Chronic thromboembolic pulmonary hypertension is a disease affecting approximately 4,000 people per year in the United States. The incidence rate in Brazil, however, is unknown. The estimated survival for patients with chronic thromboembolic pulmonary hypertension without treatment is approximately three years. Pulmonary thromboendarterectomy for select patients is a potentially curative procedure when correctly applied. In Brazil, the clinical and hemodynamic profiles of chronic thromboembolic pulmonary hypertension patients have yet to be described. OBJECTIVES: To evaluate the clinical and hemodynamic characteristics of chronic thromboembolic pulmonary hypertension patients scheduled for pulmonary thromboendarterectomy in a referral center for chronic thromboembolic pulmonary hypertension treatment in Brazil. METHODS: From December 2006 to November 2009, patients were evaluated and scheduled for pulmonary thromboendarterectomy. The subjects were classified according to gender, age and functional class and were tested for thrombofilia and brain natriuretic peptide levels. RESULTS: Thirty-five consecutive chronic thromboembolic pulmonary hypertension patients were evaluated. Two patients tested positive for schistosomiasis, and 31 were enrolled in the study (19 female, 12 male). The majority of patients were categorized in functional classes III and IV. Hemodynamic data showed a mean pulmonary vascular resistance (PVR) of 970.8 ± 494.36 dynas·s·cm-5 and a low cardiac output of 3.378 ± 1.13 L/min. Linear regression revealed a direct relation between cardiac output and pulmonary vascular resistance. Paradoxical septal movement was strongly correlated with pulmonary vascular resistance and cardiac output (p=0.001). Brain natriuretic peptide serum levels were elevated in 19 of 27 patients. CONCLUSIONS: In a referral center for pulmonary hypertension in Brazil, chronic thromboembolic pulmonary hypertension patients evaluated for pulmonary thromboendarterectomy had a hemodynamically severe status and had elevated brain natriuretic peptide serum levels. There was a predominance of females in our cohort, and the prevalence of hematological disorders and schistosomiasis was low (less than 10%)

Cirurgia de revascularização do miocárdio: complicações pleuro-pulmonares agudas caracterizadas por tomografia computadorizada de tórax

INTRODUCTION: Pleuropulmonary changes are common following coronary artery bypass grafting surgery performed with a saphenous vein graft, with or without an internal mammary artery. The presence of atelectasis or pleural effusions reflects the thoracic trauma. PURPOSE: To define the postoperative incidence of changes in the lung and in the pleural space and to evaluate the influence of the trauma. METHODS: Thirty patients underwent elective coronary artery bypass grafting surgery (8 saphenous vein grafts and 22 saphenous vein grafts and internal mammary artery grafts with pleurotomy). Chest tubes in the left pleural space were used in all internal mammary artery patients. On the second (day 2) and seventh (day 7) postoperative day, patients underwent a computed tomography, and pleural effusions were rated as follows: grade 0 = no fluid to grade 4 = fluid in more than 75% of the hemithorax. Atelectasis was rated as follows: laminar = 1, segmental = 3, and lobar = 10 points. RESULTS: All patients had pleural effusion or atelectasis. Between day 2 and day 7, the number of patients with effusions or atelectasis on the right side decreased (P < 0.05). The incidence of effusions on day 2 in the saphenous vein graft group (87.5%) was higher (P < 0.05) than in the internal mammary artery group (52.3%). The incidence of atelectasis in the lower right lobe decreased (P < 0.05) from 86.7% (day 2) to 26.7% (day 7). The degree of atelectasis in both sides did not differ on day 2 (P = 0.42) but did on day 7 (P < 0.0001). There was a decrease in the atelectasis from day 2 to day 7 on the right side (P < 0.001), but not on the left (P = 0.21). On day 2 there was a relationship between atelectasis and effusion on the right (P = 0.04), but not on the left (P = 0.113). CONCLUSION: The present series demonstrates that there is a high incidence of both minimal pleural effusion and atelectasis after coronary artery bypass grafting surgery, which drops on the right side from day 2 to day 7 post surgery. Factors that contribute to the persistence of changes on the left side include the thoracic trauma and the presence of chest tubes and pericardial effusion.INTRODUÇÃO: O comprometimento pleuro-pulmonar é freqüente após cirurgia de revascularização do miocárdio independente do uso de veia safena ou de artéria mamária interna. A presença de atelectasias e derrame pleural tem sido atribuída ao trauma torácico. OBJETIVOS: Definir a incidência do comprometimento pleuro-pulmonar observado através de tomografia computadorizada, analisando a influência do trauma no desenvolvimento destas complicações. MÉTODOS: Trinta pacientes foram submetidos a cirurgia eletiva de revascularização do miocárdio (8 safena e 22 também mamária com pleurotomia). Foi drenada a cavidade pleural esquerda de todos os pacientes do grupo mamária. Realizada Tomografia Computadorizada do tórax no 2º e 7º dias pós-op, avaliando-se o derrame pleural (0: sem líquido e 4: derrame em mais de 75% do hemitórax) e atelectasias (laminar: 1, segmentar: 3 e lobar: 10 pontos). RESULTADOS: Todos os pacientes apresentaram derrame pleural ou atelectasia. Entre o 2º e o 7º dia, o número de pacientes com derrame ou com atelectasia, no lado direito, diminuiu (p < 0.05). A prevalência de derrames, no 2º dia, no grupo safena, (87.5%) foi maior (p < 0.05) do que no grupo mamária (52.3%). A prevalência de atelectasias no lobo inferior direito diminuiu (p < 0.05) de 86.7% (2º dia) para 26.7% (7º dia). O grau de atelectasias, em ambos os lados, não diferiu no dia 2 (p = 0,42) mas sim no dia 7 (p < 0.0001). Houve diminuição das atelectasias do dia 2 para o 7, à direita (p < 0.001), mas não à esquerda (p = 0.21). Houve correlação (dia 2) entre as atelectasias e os derrames à direita (p = 0.04), mas não à esquerda (p = 0.113). CONCLUSÃO: Este estudo evidencia alta prevalência de derrame pleural e atelectasias após cirurgia de revascularização do miocárdio, que se reduz à direita no 7º dia de pós-operatório. Os fatores envolvidos na persis-tência das alterações à esquerda incluem o maior trauma torácico, ressaltando-se a drenagem e a presença de derrame pericárdico

INTERSPECIFIC INTERACTIONS OF TREES WITH THE REGENERATION OF Ocotea odorifera (Vell.) Rohwer IN MIXED OMBROPHYLOUS FOREST

This paper has the purpose to describe spatial interactions among predominant community tree species and seedlings and juveniles of Ocotea odorifera. The raised hypothesis is that some stablished species might attract or repulse Ocotea odorifera seedlings and juveniles in certain distances due to competition, allelopathy, resources sharing or other forms of mutualism or ecological processes. For acquiring spatial data and for floristic and structural characterization we used three nearby sampling units in the same Mixed Ombrophylous Forest (Araucaria Forest) patch. Each plot has 100 x 100 meters. We used the O-ring function (O12), a null model for heterogeneous data, to the bivariate analysis and a test for the spatial independence hypothesis. All tested species presented a significant pattern, indicating that spatial interactions are frequent amongst mature and juvenile plants. Positive and negative interactions occurred in several scales and species. Although the significances were predominant in intervals up to 10 meters, where the negative interactions (repulsion or inhibition) were more frequent. For Araucaria angustifolia, a species that stood out in the community’s horizontal structure, the negative interaction was present up to three meters. We found positive interactions in intervals from six to ten meters. The results showed strong inhibition of seedlings and juveniles by the same family species, suggesting that influences from negative spatial interaction, mainly from parental and with dominant community’s species, may contribute to the processes and generating mechanisms of Ocotea odorifera spatial distribution in local scale

Lung Cavities in Chronic Thromboembolic Pulmonary Hypertension

OBJECTIVES: Chronic thromboembolic pulmonary hypertension (CTEPH) is a unique form of pulmonary hypertension (PH) that arises from obstruction of the pulmonary vessels by recanalized thromboembolic material. CTEPH has a wide range of radiologic presentations. Commonly, it presents as main pulmonary artery enlargement, peripheral vascular obstructions, bronchial artery dilations, and mosaic attenuation patterns. Nevertheless, other uncommon presentations have been described, such as lung cavities. These lesions may be solely related to chronic lung parenchyma ischemia but may also be a consequence of concomitant chronic infectious conditions. The objective of this study was to evaluate the different etiologies that cause lung cavities in CTEPH patients. METHODS: A retrospective data analysis of the medical records of CTEPH patients in a single reference PH center that contained or mentioned lung cavities was conducted between 2013 and 2016. RESULTS: Seven CTEPH patients with lung cavities were identified. The cavities had different sizes, locations, and wall thicknesses. In two patients, the cavities were attributed to pulmonary infarction; in 5 patients, an infectious etiology was identified. CONCLUSION: Despite the possibility of being solely associated with chronic lung parenchyma ischemia, most cases of lung cavities in CTEPH patients were associated with chronic granulomatous diseases, reinforcing the need for active investigation of infectious agents in this setting

Use of direct oral anticoagulants for chronic thromboembolic pulmonary hypertension

OBJECTIVES: Chronic thromboembolic pulmonary hypertension is one of the most prevalent forms of pulmonary hypertension and is a major complication of acute pulmonary embolism. One mainstay of chronic thromboembolic pulmonary hypertension treatment is lifelong anticoagulation. The recent advent of direct oral anticoagulants for acute pulmonary embolism treatment has provided a viable and effective alternative for treating this condition. However, little is known about the efficacy of this new class of drugs for treating chronic thromboembolic pulmonary hypertension. We aimed to evaluate the safety and efficacy of direct oral anticoagulants in the treatment of chronic thromboembolic pulmonary hypertension. METHODS: A cohort of chronic thromboembolic pulmonary hypertension patients who initiated treatment with direct oral anticoagulants between June 2015 and November 2016 were enrolled in this study. RESULTS: Sixteen patients used rivaroxaban, three used dabigatran and one used apixaban for a mean follow-up of 20.9 months. The mean age was 51 years, and eighteen patients were classified as functional class II/III. Eight patients underwent a pulmonary endarterectomy and exhibited clinical, hemodynamic and functional improvement and currently continue to use direct oral anticoagulants. No episode of venous thromboembolism recurrence was identified during the follow-up period, but there was one episode of major bleeding after a traumatic fall. CONCLUSIONS: Although direct oral anticoagulants appear to be a safe and effective alternative for treating chronic thromboembolic pulmonary hypertension, larger studies are needed to support their routine use

Screening Of Miners And Millers At Decreasing Levels Of Asbestos Exposure: Comparison Of Chest Radiography And Thin-section Computed Tomography.

Chest radiography (CXR) is inferior to Thin-section computed tomography in the detection of asbestos related interstitial and pleural abnormalities. It remains unclear, however, whether these limitations are large enough to impair CXR´s ability in detecting the expected reduction in the frequency of these asbestos-related abnormalities (ARA) as exposure decreases. Clinical evaluation, CXR, Thin-section CT and spirometry were obtained in 1418 miners and millers who were exposed to progressively lower airborne concentrations of asbestos. They were separated into four groups according to the type, period and measurements of exposure and/or procedures for controlling exposure: Group I (1940-1966/tremolite and chrysotile, without measurements of exposure and procedures for controlling exposure); Group II (1967-1976/chrysotile only, without measurements of exposure and procedures for controlling exposure); Group III (1977-1980/chrysotile only, initiated measurements of exposure and procedures for controlling exposure) and Group IV (after 1981/chrysotile only, implemented measurements of exposure and a comprehensive procedures for controlling exposure). In all groups, CXR suggested more frequently interstitial abnormalities and less frequently pleural plaques than observed on Thin-section CT (p<0.050). The odds for asbestosis in groups of decreasing exposure diminished to greater extent at Thin-section CT than on CXR. Lung function was reduced in subjects who had pleural plaques evident only on Thin-section CT (p<0.050). In a longitudinal evaluation of 301 subjects without interstitial and pleural abnormalities on CXR and Thin-section CT in a previous evaluation, only Thin-section CT indicated that these ARA reduced as exposure decreased. CXR compared to Thin-section CT was associated with false-positives for interstitial abnormalities and false-negatives for pleural plaques, regardless of the intensity of asbestos exposure. Also, CXR led to a substantial misinformation of the effects of the progressively lower asbestos concentrations in the occurrence of asbestos-related diseases in miners and millers.10e011858

The effect of an extract from Ganoderma lucidum (reishi) on the labeling of blood constituents with technetium-99m and on the survival of Escherichia coli

This study evaluated effects of an aqueous extract of Ganoderma lucidum (reishi) on the labeling of blood constituents with technetium-99m (99mTc) and on the survival of cultures of Escherichia coli treated with stannous chloride. Blood samples from Wistar rats were treated with reishi extract, radiolabeling procedure was performed, plasma (P), blood cells (BC) and insoluble (IF) and soluble (SF) fractions of P and BC were separated. The radioactivity was counted for the determination of the percentages of radioactivity (%ATI). Cultures of Escherichia coli AB1157 were treated with stannous chloride in the presence and absence of reishi extract. Blood samples and bacterial cultures treated with NaCl 0.9% were used as controls. Data indicated that reishi extract altered significantly (p99mTc and protecting bacterial cultures against oxidative damage induced by stannous chloride

Burnt sugarcane harvesting: cardiovascular effects on a group of healthy workers, Brazil

Background: Brazil is the world's largest producer of sugarcane. Harvest is predominantly manual, exposing workers to health risks: intense physical exertion, heat, pollutants from sugarcane burning. Design: Panel study to evaluate the effects of burnt sugarcane harvesting on blood markers and on cardiovascular system. Methods: Twenty-eight healthy male workers, living in the countryside of Brazil were submitted to blood markers, blood pressure, heart rate variability, cardiopulmonary exercise testing, sympathetic nerve activity evaluation and forearm blood flow measures (venous occlusion plethysmography) during burnt sugarcane harvesting and four months later while they performed other activities in sugar cane culture. Results: Mean participant age was 31 +/- 6.3 years, and had worked for 9.8 +/- 8.4 years on sugarcane work. Work during the harvest period was associated with higher serum levels of Creatine Kinase - 136.5 U/L (IQR: 108.5-216.0) vs. 104.5 U/L (IQR: 77.5-170.5), (p = 0.001); plasma Malondialdehyde-7.5 +/- 1.4 mu M/dl vs. 6.9 +/- 1.0 mu M/dl, (p = 0.058); Glutathione Peroxidase - 55.1 +/- 11.8 Ug/Hb vs. 39.5 +/- 9.5 Ug/Hb, (p &lt; 0.001); Glutathione Transferase- 3.4 +/- 1.3 Ug/Hb vs. 3.0 +/- 1.3 Ug/Hb, (p = 0.001); and 24-hour systolic blood pressure - 120.1 +/- 10.3 mmHg vs. 117.0 +/- 10.0 mmHg, (p = 0.034). In cardiopulmonary exercise testing, rest-to-peak diastolic blood pressure increased by 11.12 mmHg and 5.13 mmHg in the harvest and non-harvest period, respectively. A 10 miliseconds reduction in rMSSD and a 10 burst/min increase in sympathetic nerve activity were associated to 2.2 and 1.8 mmHg rises in systolic arterial pressure, respectively. Conclusion: Work in burnt sugarcane harvesting was associated with changes in blood markers and higher blood pressure, which may be related to autonomic imbalance