Jorge Nakatani

Pneumonia adquirida na comunidade em pacientes tratados ambulatorialmente: aspectos epidemiológicos, clínicos e radiológicos das pneumonias atípicas e não atípicas

Objetivo: Avaliar o percentual etiologico das pneumonias atipicas tratadas ambulatorialmente. Identificar os fatores epidemiologicos, clinicos e radiologicos que permitam diferenciar pneumonia atipica de nao atipica. Metodos: Os pacientes foram submetidos a avaliacao clinica, radiologica, coleta de escarro para estudo pelo metodo de Gram e sangue para testes sorologicos, incluindo Legionella pneumophila, Chlamydia sp, Mycoplasma pneumoniae, virus Influenza A e Influenza B, no primeiro dia e 21 dias apos inclusao. As radiografias de torax foram revistas por tres observadores independentes que desconheciam o quadro clinico. Resultados: Avaliados inicialmente 129 pacientes durante 22 meses. A amostra final para estudo comparativo entre os grupos consistiu de 69 pacientes que tinham em media 37 anos, sendo 46 (67%) homens e 23 (33%) mulheres. O diagnostico etiologico foi definido em 34 (50%) dos pacientes. Chlamydia sp foi o agente atipico mais frequente, com 11 (16%) casos, seguido por M. pneumoniae com 7 (10%). Influenza A respondeu por 4 (6%) dos casos e Legionella em 4 (6%) pacientes. Infeccoes mistas foram evidenciadas, com associacao de Chlamydia sp e M. pneumoniae em 5 (7%) casos, Chlamydia sp e Influenza B em um caso e M. pneumoniae e Influenza A em outro. A presenca de sintomas respiratorios e achados gerais sugestivos de pneumonia atipica foram comparados entre os grupos e nao foram observadas diferencas significantes. A avaliacao radiologica realizada por tres observadores independentes mostrou discordância entre eles para os tipos de pneumonia. O diagnostico radiografico de cada observador comparado com o diagnostico clinico nao mostrou associacao significante. Conclusoes: A pneumonia causada por agente atipico ocorre em 50% dos pacientes com pneumonia adquirida na comunidade em tratamento ambulatorial. Nao e possivel distinguir pacientes com pneumonia atipica de pneumonia nao atipica. A apresentacao clinica e a radiologica sao similares nos dois grupos.

Ossificação pulmonar dendriforme

Diffuse pulmonary ossification is a rare condition of unknown pathogenesis in which mature bone is found in the pulmonary parenchyma. It is almost invariably discovered as an incidental finding at autopsy. Most commonly, it affects middle-aged men and is asymptomatic. We present the case of a 75-year-old man in which the chest X-ray showed diffuse interstitial infiltrate. Diagnosis was based on histopathological examination by open-lung biopsy, which revealed interstitial fibrosis with pulmonary ossification.

Dendriform pulmonary ossification

Diffuse pulmonary ossification is a rare condition of unknown pathogenesis in which mature bone is found in the pulmonary parenchyma. It is almost invariably discovered as an incidental finding at autopsy. Most commonly, it affects middle-aged men and is asymptomatic. We present the case of a 75-year-old man in which the chest X-ray showed diffuse interstitial infiltrate. Diagnosis was based on histopathological examination by open-lung biopsy, which revealed interstitial fibrosis with pulmonary ossification.

Ensaio clínico, aberto, controlado sobre a adição de brometo de ipratrópio ao fenoterol no tratamento da crise de asma em adultos

Repeated dosis of inhaled b2-agonists have been used in the treatment of acute asthma. The effect of added ipratropium bromide (IB) to b2-agonist is controversial in adults. OBJECTIVE: To evaluate if addition of IB to fenoterol, in repeated doses, induces a greater bronchodilation, a greater reversion of the attack, and discharge from emergency unit in adults with acute severe asthma. SETTING: Pneumology Emergency Department, Unifesp-Hospital Sao Paulo, in the period from July 1995 to February 1997. TYPE OF STUDY: Open, randomized and parallel study. Discharge from the hospital: FEV1 and PEF > 60% of the predicted value. METHODS: 120 patients with FEV1 and PEF < 50% of the predicted value were divided into two groups (N = 60): fenoterol (F) and ipratropium bromide + fenoterol (IBF). Each group received inhalation treatment through a metered-dose inhaler (MDI) attached to a holding chamber, administered at 30-minute interval, for a total of three treatments. In the group F four puffs of fenoterol (400 mg) were administered, and in the IBF group, 160 mg of BI and 400 mg of fenoterol (four puffs). RESULTS: The patients did not differ from basal PEF (F = 36 ± 7% vs IBF = 35 ± 9% predicted) and basal FEV1 (F = 33 ± 9% vs IBF = 32 ± 9% predicted). Thirty-two patients of group F and 33 of group IBF were discharged from hospital after the inhalation treatment. The final FEV1 and PEF after inhalation treatments were F = 60 ± 13% vs IBF = 61 ± 11% e F = 74 ± 18% vs IBF = 77 ± 13% (NS). CONCLUSION: The addition of ipratropium bromide to fenoterol results in insignificant functional effect and without clinical impact in the treatment of acute asthma in adults.