José Agostinho Marques

Pneumonia aguda fibrinosa e organizante

The term Acute Fibrinous and Organizing Pneumonia (AFOP) has been proposed by Beasley et al for cases that not fit into the histopathologic criteria of the recognized entities described as acute or subacute clinical presentations. The presence of intra-alveolar fibrin in the form of fibrin ‘balls’ and organizing pneumonia with patchy distribution are the main histological features of this entity. We describe the case of a male patient with the diagnostic of AFOP made by surgical lung biopsy. He had a subacute presentation of symptoms consisting of productive cough, chest pain and fever. Bilateral infiltrates with patchy and diffuse distribution were the predominant features in his chest HRCT scan. The patient had a good clinical course after a treatment with prednisone and cyclophosphamide. Our hope in reporting this case study is to add some more data to the discussion of this new entity. Rev Port Pneumol 2006; XII (5): 615-620

Autoadjusting-CPAP effect on serum Leptin concentrations in Obstructive Sleep Apnoea patients

BackgroundLeptin is an hormone that regulates body weight. Studies have shown increasing leptin concentrations according to body mass index (BMI) and intermittent hypoxia.Our aim is to evaluate the basal leptin levels in OSA patients and its possible relation to OSA severity, independently of confounders and investigate the Autoadjusting-CPAP effect on leptin values.MethodsIn ninety eight male patients with moderate to severe OSA leptin serum levels were evaluated before therapy, 9 days and 6 months after therapy.ResultsIn this group mean age was 55.3 years, mean BMI was 33.2 Kg/m2 and mean Apnoea- Hypopnea Index (AHI) was 51.7/h. Mean basal serum leptin value was 12.1 ug/L. Univariate analysis showed a significant correlation between serum leptin values and BMI (R = 0.68; p < 0.001), waist-hip ratio (R = 0.283; p = 0.004) and AHI (R = 0.198; p = 0.048); in stepwise multiple regression analysis only BMI (p < 0.001) was a predictor of serum leptin values.One week after therapy, mean leptin serum level decreased to 11.0 ug/L and 6 months after it was 11.4 ug/L. (p = 0.56 and p = 0.387, respectively)ConclusionBaseline leptin serum levels positively correlate with BMI, fat distributioand OSA severity.BMI is the only predictor of basal leptin levels.Treatment with Autoadjusting-CPAP has a small effect on leptin levels.

Heated humidification during nasal continuous positive airway pressure for obstructive sleep apnea syndrome: objective evaluation of efficacy with nasal peak inspiratory flow measurements.

Background Nasal obstruction is one of the most frequent and sometimes troublesome side effects of nasal continuous positive airway pressure (nCPAP) therapy for obstructive sleep apnea syndrome (OSAS). Methods We describe a 60-year-old man with allergic seasonal rhinitis and OSAS, with worsening nasal symptoms 1 week after beginning home nCPAP, making nCPAP use difficult (nasal peak inspiratory flow [nPIF], 80 L/minute [57% of his best]). Results No significant improvement was obtained with topical steroids or cold humidification. Heated humidification was then considered, achieving an improvement in mean nPIF and symptom scores. An acceptable compliance with CPAP could be obtained during the heated humidification period (3.9 hours of mean daily use). Conclusion In this patient with moderately severe OSAS and allergic rhinitis, monitoring nasal symptoms and nasal PIF objectively showed the benefit of heated humidification to overcome nasal intolerance and increase compliance to nCPAP treatment.

Air travel and hypoxaemia in real life

To the Editors: We read with great interest the paper by Coker et al. 1 in an issue of the European Respiratory Journal . The authors conducted the largest prospective study into the outcomes of flights in patients with various respiratory diseases, showing that 18% suffered respiratory symptoms. They concluded that, although air travel seems generally safe in this population of patients under specialist respiratory care, more detailed studies with oximetry monitoring during flight should be performed to determine which patients are most at risk. The evaluation of the risk of in-flight hypoxaemia has been determined by studies performed in altitude chambers or by hypoxic gas mixture challenge 2. However, extrapolating the findings to real flights may be misleading, due to the higher altitudes attained by newer aircraft, longer duration of altitude exposure and passengers’ activity inside the aircraft 3. We have evaluated transcutaneous arterial oxygen saturation ( S a,O2) using Pulsox 3iA (Minolta, Tokyo, Japan), a finger pulse oximeter with a 24-h internal memory and dedicated software (Pulsox DS-3; Minolta) for viewing and …