Manuel Lopes dos Santos

Increased exhalation of hydrogen peroxide in healthy subjects following cigarette consumption

CONTEXT Increased hydrogen peroxide has been described in the expired breath condensate (H2O2-E) of several lung conditions, such as acute respiratory distress syndrome, chronic obstructive pulmonary disease and asthma. This technique has been advocated as being a simple method for documenting airway inflammation. OBJECTIVE To evaluate H2O2-E in healthy cigarette smokers, and to determine the acute effects of the consumption of one cigarette on H2O2-E levels. TYPE OF STUDY Prospective, controlled trial. SETTING A pulmonary function laboratory in a University Hospital. PARTICIPANTS Two groups of healthy volunteers: individuals who had never smoked (NS; n=10; 4 men; age = 30.6 +/- 6.2 years) and current cigarette smokers (S; n=12; 7 men; age = 38.7 +/- 9.8). None of the volunteers had respiratory symptoms and all showed normal spirometric tests. INTERVENTION Expired air was collected from all volunteers through a face mask and a plastic collecting system leading into a flask with dry ice and pure ethanol. Samples from the group S were collected twice, before and half an hour after the combustion of one cigarette. MAIN MEASUREMENTS Expired hydrogen peroxide using the Gallati and Pracht method. RESULTS The S and NS groups showed comparable levels of H2O2-E at basal conditions [NS = 0.74 microM (DP 0.24) vs. S = 0.75 microM (DP 0.31)]. The smokers showed a significant increase in H2O2-E levels half an hour after the consumption of only one cigarette [0.75 microM (DP 0.31) vs. 0. 95 microM (DP 0.22)]. CONCLUSION The present results are consistent with the concept that smokers increase oxidative stress with elevated production of reactive oxygen species, contributing to the development of smoking-related disorders.

Transplante isolado de pulmão: experiência da Escola Paulista de Medicina

Two cases of left single lung transplantation for pulmonary fibrosis are reported, one of a 50 years old white male who is alive and well 8 months after the transplantation and the other of a 36 years old female weighing 45 kg who received an upper lobe transplantation from a 85 kg donor. This patient died of multiple organ failure in the 8th postoperative day due to complications related to an unexplained cardiac tamponade and also possible rejection but was able to maintain good ventilatory and hemodynamic conditions in the first 3 days following transplantation; radiographic studies showed adequate expansion of the transplanted lobe. Autopsy revealed no problems in the anastomotic sites and signs of difuse bronchopneumonia. In the two cases a flap of pericardial fat was utilized instead of omental flap to protect the bronchial anastomosis and in the first case a telescoping anastomotic technique was done. Both patients received corticoids since the begining and the immunossupression protocol consisted of cyclosporin, prednisone and azathioprine and had no airways complications. In spite of being an initial experience, the authors express their hope in single lung and lobe transplantation for selected terminal lung diseases and in the near future also as an alternative in the surgical treatment of complex congenital cardiac anomalies.