Douglas Zaione Nascimento

Functional improvement in patients with idiopathic pulmonary fibrosis undergoing single lung transplantation.

Abstract Objective: To evaluate the changes in lung function in the first year after single lung transplantation in patients with idiopathic pulmonary fibrosis (IPF). Methods: We retrospectively evaluated patients with IPF who underwent single lung transplantation between January of 2006 and December of 2012, reviewing the changes in the lung function occurring during the first year after the procedure. Results: Of the 218 patients undergoing lung transplantation during the study period, 79 (36.2%) had IPF. Of those 79 patients, 24 (30%) died, and 11 (14%) did not undergo spirometry at the end of the first year. Of the 44 patients included in the study, 29 (66%) were men. The mean age of the patients was 57 years. Before transplantation, mean FVC, FEV1, and FEV1/FVC ratio were 1.78 L (50% of predicted), 1.48 L (52% of predicted), and 83%, respectively. In the first month after transplantation, there was a mean increase of 12% in FVC (400 mL) and FEV1 (350 mL). In the third month after transplantation, there were additional increases, of 5% (170 mL) in FVC and 1% (50 mL) in FEV1. At the end of the first year, the functional improvement persisted, with a mean gain of 19% (620 mL) in FVC and 16% (430 mL) in FEV1. Conclusions: Single lung transplantation in IPF patients who survive for at least one year provides significant and progressive benefits in lung function during the first year. This procedure is an important therapeutic alternative in the management of IPF.

Oxigenação por membrana extracorpórea em paciente acordado como ponte para o transplante pulmonar

O transplante pulmonar (TxP) é uma terapêutica estabelecida para o tratamento das doenças pulmonares avançadas. Embora o número de transplantes esteja aumentando em todo mundo,(1) durante a espera por um transplante pode haver agravamento da doença de base, especialmente nos pacientes com diagnóstico de doenças intersticiais, que eventualmente evoluem para insuficiência ventilatória com necessidade de suporte ventilatório. O suporte por ventilação mecânica invasiva (VMI) é a forma mais comum de manter esses pacientes vivos até o transplante, mas tem como inconveniente o risco aumentado de infecções e a falência muscular relacionada à sua imobilização e ao uso de drogas para a sedação. Nesse sentido, a utilização de algum suporte que mantenha o paciente fora da VMI aumenta as chances de sucesso do transplante futuro.

An Atypical Type-II Monteggia Fracture Equivalent Lesion

Forearm fractures are common childhood injuries, accounting for about 45% of all fractures and 62% of upper-limb fractures1-3. Approximately 75% to 84% of fractures occur in the distal third of the forearm, 15% to 18% occur in the middle third, and 1% to 7% occur in the proximal third4. Monteggia lesions account for 5% of all forearm fractures5,6. The Monteggia lesion is a radial head fracture or dislocation in association with a concomitant fracture of the metaphysis or diaphysis of the ulna2,6-11. It was first described in 1814 by Giovanni Battista Monteggia12. In 1967, Bado5 introduced a classification system for Monteggia lesions that is well established in clinical orthopaedic practice13. Bado’s classification subdivided Monteggia fracture-dislocations into four types of true Monteggia lesions; he also introduced equivalent lesions of this fracture pattern (Table I). The equivalent lesions are rare and usually occur in children14-19. Equivalent lesions are fractures that have the same mechanism of injury, with a similar radiographic pattern and method of treatment20. In 1991, Jupiter et al. provided the subclassification of a posterior Monteggia lesion based on anatomic location of the ulnar fracture and the pattern of radial head injury9. View this table: TABLE I Bado Classification for Monteggia Lesions5 The type-II Monteggia fracture is well described and has an incidence of 15% to 70%21,22. In his original classification, Bado stated that there were no equivalents to type-II Monteggia lesions other than epiphyseal fracture of the radial head or fracture of the radial neck5,20. In the orthopaedic literature, there are reports of type-II Monteggia fractures and equivalent type-II lesions (which occur mostly in adults)9, …