Dissociação clínico-radiológica nas manifestações pulmonares da paracoccidioidomicose Clinical-radiological dissociation in lung manifestations of paracoccidioidomycosis

Os pulmões estão entre os principais sítios acometidos pela paracoccidioidomicose, contudo as alterações nem sempre são fáceis de serem diferenciadas de outros distúrbios respiratórios. O objetivo deste estudo foi verificar a freqüência do comprometimento pulmonar na paracoccidioidomicose e se existe associação clínico-radiológica. Foi realizado um estudo retrospectivo de março de 1996 a novembro de 2006, em pacientes com paracoccidioidomicose no Hospital Universitário Regional de Maringá, PR. No período foram confirmados 45 casos, dos quais 79,5% apresentavam alterações radiológicas em Raios-X de tórax e quatro deles tinham também tuberculose pulmonar. De 40 pacientes com paracoccidioidomicose exclusivamente, 57,5% apresentavam manifestações clínicas respiratórias e 77,5% alterações radiológicas, ficando evidente uma dissociação clínico-radiológica, o tabagismo foi declarado por 80,6% dos pacientes que apresentavam alterações radiológicas. Concluímos que as alterações morfológicas no pulmão, embora freqüentes, nem sempre correspondem a sinais e sintomas respiratórios e são difíceis de serem atribuídas exclusivamente à paracoccidioidomicose.<br>Lungs are among the main sites affected by paracoccidioidomycosis. However, the alterations are not always easy to differentiate from other respiratory disorders. The objectives of the present study were to investigate the frequency of lung impairment in paracoccidioidomycosis cases and to investigate whether any clinical-radiological association exists. A retrospective study was carried out from March 1996 to November 2006, among patients with paracoccidioidomycosis at the Regional University Hospital of Maringá, Paraná, Brazil. Over this period, 45 cases were confirmed, of which 79.5% presented radiological abnormalities on chest X-rays, and four of them also presented pulmonary tuberculosis. Out of the total of 40 patients with paracoccidioidomycosis alone, 57.5% presented respiratory clinical manifestations, whereas 77.5% presented radiological abnormalities, thus demonstrating clinical-radiological dissociation. On the other hand, 80.6% of the patients who presented radiological abnormalities said that they smoked. We concluded that although morphological abnormalities in the lungs are frequent, they do not always correspond to respiratory signs and symptoms and cannot easily be attributed exclusively to paracoccidioidomycosis

Paracoccidioidomycosis in the state of Maranhão, Brazil: geographical and clinical aspects

INTRODUCTION: The study aimed to show the situation of paracoccidioidomycosis in the state of Maranhão, Brazil. METHODS: This study is a descriptive case series developed in two stages. First, a survey of cases originating from the state of Maranhão at the Instituto de Doenças Tropicais Natan Portela, Piauí (IDTNP) from 1997 to 2007, and second, the clinical description of 29 cases diagnosed in the Centro de Referências em Doenças Infecciosas e Parasitárias, Maranhão (CREDIP) from 2004 to 2010. RESULTS: Two hundred and sixteen cases have been cataloged at the IDTNP. West, east, and central regions of the state of Maranhão recorded 90.3% of cases proving to be important areas for study. The western region, with a prevalence of 10.8/100,000 inhabitants, has a significantly higher proportion of cases than the northern, southern, and eastern regions (p < 0.05). The occurrence was higher in men with 89.3% of cases, and the male-to-female ratio was 8.4:1. The majority of patients were older than 20 years, lived in rural areas, and had farming or soil management as main occupation (73.8%). At CREDIP, 29 cases were diagnosed, of which 26 (89.6%) had multifocal manifestations. Mucous tissues were involved more (75.8%) frequently, followed by lymph nodes, skin, and lungs with 65.5%, 39% and 37.9 %, respectively. The diagnosis was made by combining direct examination, culture, and histopathology. CONCLUSIONS: The study shows the geographical distribution and the epidemiological and clinical aspects of paracoccidioidomycosis, revealing the significance of the disease to the state of Maranhão

Pulmonary paracoccidoidomycosis: radiology and clinical-epidemiological evaluation Paracoccidioidomicose pulmonar: radiologia e avaliação clínico-epidemiológica

INTRODUCTION: The purpose of this study was to compare respiratory signs and symptoms between patients with and without chest X-ray abnormalities in order to establish the meaning of radiographic findings in pulmonary PCM diagnosis. METHODS: The epidemiological, clinical and radiological lung findings of 44 patients with paracoccidiodomycosis (PCM) were evaluated. Patients were divided into two groups of 23 and 21 individuals according to the presence (group 1) or absence (group 2) of chest X-ray abnormalities, respectively, and their clinical data was analyzed with the aid of statistical tools. RESULTS: As a general rule, patients were rural workers, young adult males and smokers - group 1 and 2, respectively: males (91.3% and 66.7%); mean age (44.4 and 27.9 year-old); smoking (34.7% and 71.4 %); acute/subacute presentation (38.1% and 21.7%); chronic presentation (61.9% and 78.3%). The most frequent respiratory manifestations were - group 1 and 2, respectively: cough (25% and 11.4%) and dyspnea (22.7% and 6.8%). No statistical difference was observed in pulmonary signs and symptoms between patients with or without radiographic abnormalities. The most frequent radiological finding was nodular (23.8%) or nodular-fibrous (19%), bilateral (90.5%) and diffuse infiltrates (85.7%). CONCLUSIONS: Absence of statistical difference in pulmonary signs and symptoms between these two groups of patients with PCM indicates clinical-radiological dissociation. A simplified classification of radiological lung PCM findings is suggested, based on correlation of these data and current literature review.<br>INTRODUÇÃO: Comparar sinais e sintomas respiratórios entre pacientes com e sem alterações à radiografia de tórax para se estabelecer o significado dos achados radiográficos no diagnóstico da paracoccidioidomicose pulmonar. MÉTODOS: Os achados epidemiológicos, clínicos e radiológicos de 44 pacientes com paracoccidioidomicose (PCM) foram avaliados. Os pacientes foram divididos em dois grupos de 23 e 21 indivíduos de acordo com a presença (grupo 1) ou ausência (grupo 2) de anormalidades à radiografia de tórax, respectivamente, e seus dados clínicos foram analisados com auxílio de ferramentas estatísticas. RESULTADOS: Como regra geral, os pacientes eram trabalhadores rurais do sexo masculino, tabagistas e em idade adulta jovem - grupo 1 e 2, respectivamente: homens (91,3% e 66,7%); média de idade (44,4 e 27,9 anos); tabagismo (34,7% e 71,4 %); forma aguda/subaguda (38,1% e 21,7%); forma crônica (61,9% e 78,3%). As manifestações respiratórias mais frequentes foram - grupo 1 e 2, respectivamente: tosse (25% e 11,4%) e dispnéia (22,7% e 6,8%). Nenhuma diferença estatística foi observada nos sinais e sintomas respiratórios entre pacientes com ou sem anormalidades radiográficas. Os achados radiológicos mais frequentes foram o padrão nodular (23,8%) ou nodular-fibrótico (19%), bilateral (90,5%) e infiltrado difuso (85,7%). CONCLUSÕES: A ausência de diferença estatística nos sinais e sintomas pulmonares entre estes dois grupos de pacientes com PCM sugere dissociação clínico-radiológica. Uma classificação simplificada dos achados radiológicos pulmonares da PCM é sugerida, com base na correlação destes dados e revisão da literatura atual

Scanning Electron Microscopy of Blood Vascular Corrosion Casts in Mammals

In this chapter, we will describe the standard technical protocols used to obtain blood vascular cast for the study with SEM, as well as we will briefly review the recent advances in the observation of vascular network through the use of this tool, and its application in the study of angiogenesis mainly according to our experience in the mammalian ovary

Compound ex vivo and in silico method for hemodynamic analysis of stented arteries

Hemodynamic factors such as low wall shear stress have been shown to influence endothelial healing and atherogenesis in stent-free vessels. However, in stented vessels, a reliable quantitative analysis of such relations has not been possible due to the lack of a suitable method for the accurate acquisition of blood flow. The objective of this work was to develop a method for the precise reconstruction of hemodynamics and quantification of wall shear stress in stented vessels. We have developed such a method that can be applied to vessels stented in or ex vivo and processed ex vivo. Here we stented the coronary arteries of ex vivo porcine hearts, performed vascular corrosion casting, acquired the vessel geometry using micro-computed tomography and reconstructed blood flow and shear stress using computational fluid dynamics. The method yields accurate local flow information through anatomic fidelity, capturing in detail the stent geometry, arterial tissue prolapse, radial and axial arterial deformation as well as strut malapposition. This novel compound method may serve as a unique tool for spatially resolved analysis of the relationship between hemodynamic factors and vascular biology. It can further be employed to optimize stent design and stenting strategies