Pulmonary Alveolar Microlithiasis: A Case Report with Emphasis on Imaging Findings

Pulmonary alveolar microlithiasis (PAM) is a rare disease characterized by the presence of small calculi in the alveolar space. The authors report a case of a 21-year-old man with a 2-year history of shortness of breath on exertion and dry cough. Physical examination was altered only for crackles at auscultation. Pulmonary function revealed a mild restrictive ventilatory defect and the chest radiograph demonstrated paracardiac confluence of dense micronodular infiltrate. High-resolution CT scan revealed diffuse ground glass attenuation and septal thickening, more pronounced in lower pulmonary regions, with calcifications along the interlobar septa and subpleural regions. A transbronchial lung biopsy confirmed the diagnosis of PAM

Cavitated Conglomerate Mass in Silicosis Indicating Associated Tuberculosis

Silicosis is the most common occupational lung disease worldwide. It leads to respiratory impairment and may have associated infections that decrease pulmonary function. We describe the case of a 55-year-old man with chronic silicosis who presented with hemoptysis and a cavitated conglomerate mass. The final diagnosis was silicotuberculosis

Spontaneous Pneumothorax as an Atypical Presentation of Pulmonary Paracoccidioidomycosis: A Case Report with Emphasis on the Imaging Findings

We describe the case of a 45-year-old male with pulmonary paracoccidioidomycosis and spontaneous pneumothorax. The patient presented to the hospital with sudden and intense chest pain accompanied by dyspnea and had a six-month history of dry cough, weight loss, and progressive dyspnea on exertion. Chest X-ray showed a small right pneumothorax, bilateral nonhomogeneous opacities, and emphysematous areas in the lung base. Chest computed tomography showed consolidation in both lungs, with architectural distortion, nodules, interlobular septal thickening, and emphysema, in addition to the right pneumothorax. A lung biopsy revealed yeast consistent with Paracoccidioides brasiliensis. No drainage was needed, and the lung was re-expanded. The patient was treated with antifungal drugs, showed mild improvement, and was referred to outpatient care

Anastomose esofagogástrica cervical em dois tempos: 5 anos de experiência do Hospital de Clínicas de Porto Alegre

OBJECTIVE: Cervical esophagogastric anastomosis (CEA) is a common procedure used to restore the continuity of the digestive tract following curative or palliative surgery for esophageal cancer. At the HCPA, we carry out CEA procedures in two steps: first, we carry out a lateral cervical esophagostomy and position the esophageal substitute in the neck; second, after one week, the esophageal remnant is sutured to the esophageal substitute. The choice of esophageal substitute is made according to gastric pull-up (GP) or greater curvature gastric tube (GCGT), depending on the possibility of resection of the lesion. The objective of this paper is to describe the early results (up to 30 days) of delayed cervical esophagogastric anastomosis after resection or esophageal bypass procedures due to esophageal neoplasia. MATERIAL AND METHODS: Fifty-nine patients fulfilled the criteria for inclusion in our study, out of which there were 49 male and 55 white patients; the age average was of 51.5 years. Twenty-two patients were submitted to gastric pull-up. The risk factors for postoperative complications were similar for both groups. Tumor staging was the only difference between the two groups in preoperative examination; this difference was expected according to the criteria used for choosing the procedure. RESULTS: Seven patients (31.8%) of the GP group and in 9 patients (34.3%) from the GCGT group (RR 1.3; CI 95%: 0.5-3.0, P = 0.54) presented leakage. Two patients (9.1%) from the GP group and 1 (2.7%) from the GCGT group died (RR 3.4; CI 95%: 0.3-34.9, P = 0.54). One patient (4.5%) from the GP group and 7 (18.9%) patients from the GCGT group (RR 0.2; CI 95%: 0.1-1.8, P = 0.23) presented infections. There were no differences between the groups regarding occurrence of leakage, short-term postoperative death (until 30 days after surgery), and infections. CONCLUSIONS: Our results are similar to those of other services of reference for the treatment of esophageal cancer. In this study, we did not find any differences between the GP and GCGT groups regarding short-term postoperative complications.OBJETIVO: A anastomose esofagogástrica cervical é um procedimento utilizado para restaurar a continuidade do trato digestivo após cirurgias curativas ou paliativas para o câncer esofágico. O Grupo de Cirurgia do Esôfago, Estômago e Intestino Delgado do Hospital de Clínicas de Porto Alegre realiza o procedimento em 2 tempos cirúrgicos. No primeiro tempo, realiza-se uma esofagostomia cervical lateral e posiciona-se o substituto esofágico no pescoço. O segundo tempo é realizado uma semana após, com a sutura do esôfago remanescente no substituto elevado ao pescoço. Este substituto é escolhido entre os procedimentos de levantamento gástrico (LG) e tubo gástrico de grande curvatura (TGC), conforme a possibilidade ou não de ressecção da lesão esofágica. O objetivo do presente trabalho é de descrever os resultados precoces (até 30 dias) obtidos com a realização de anastomose esôfago-gástrica cervical retardada (postergada) após procedimento cirúrgico de ressecção ou bypass esofágico por neoplasia de esôfago. MATERIAIS E MÉTODOS: Cinqüenta e nove pacientes preencheram os critérios de inclusão, sendo 49 homens, 55 brancos, com uma média de idade de 51,5 anos. Vinte e dois pacientes realizaram cirurgia de levantamento gástrico. Os fatores de risco conhecidos para complicações pós-operatórias foram similares entre os dois grupos. A única diferença entre os grupos na avaliação pré-operatória foi o estágio do tumor, o que era esperado, tendo em vista os critérios usados para a escolha do procedimento. RESULTADOS: A fístula cervical foi detectada em sete pacientes (31,8%) do grupo LG e em nove pacientes (34,3%) do grupo TGC (RR 1,3; IC 95%: 0,5-3,0, P = 0.54). Dois pacientes (9,1%) do grupo LG e um paciente (2,7%) do grupo TGC foram a óbito (RR 3,4; IC 95%: 0,3-34,9, P = 0,54). As complicações infecciosas ocorreram em um paciente (4,5%) do grupo LG e 7 pacientes (18,9%) do grupo TGC (RR 0,2; IC 95%: 0,1-1,8, P = 0,23). Não houve diferenças entre os grupos, levando em conta a ocorrência de fístula cervical no pós-operatório, mortalidade hospitalar precoce (30 dias após a cirurgia) e infecções. CONCLUSÕES: Os dados apresentados nesta série são semelhantes a outros serviços de referência para o tratamento do câncer de esôfago, e nessa série não houve diferença entre os LG e TGC em relação às complicações no pós-operatório precoce

Experimental analysis of vertical and flexible cylinder in water: response to top motion excitation and parametric resonance

Experiments with a flexible and submerged cylinder were carried out to investigate fundamental aspects of risers dynamics subjected to harmonic excitation at the top. The flexible model was designed aiming a high level of dynamic similarity with a real riser. Vertical motion, with amplitude of 1% of the unstretched length, was imposed with a device driven by a servomotor. Four values of the ratio between the exciting frequencies and the first eigenfrequency were investigated, namely ft: fN,1 = 1 : 3; 1 : 1; 2 : 1 and 3 : 1. Cartesian coordinates of 43 monitored points positioned all along the span were experimentally acquired by using an optical tracking system. A simple Galerkin’s scheme applied for modal decomposition, combined with standard Mathieu chart analysis, led to the idenfication of parametric resonances. A curious finding of this paper is that the Mathieu instability may simultaneously occur in more than one mode, leading to interesting dynamic behaviors, also revealed through standard power spectra analysis and displacement scalograms.This work has been carried out after a research project sponsored by Petrobras. The first author acknowledges FAPESP for his post-doctoral scholarship, process no. 2013/09802-2. The second and third authors ackowledge CNPQ, for the research grant 30.3838/2008-6 and the graduate scholarship 131549/2013-8. Special thanks to the IPT technical staff for helping with the experiments