Nobukazu Takada

Hepatopulmonary syndrome associated with autoimmune liver cirrhosis.

A 46‐year‐old woman presented for evaluation of liver dysfunction and dyspnoea. Laboratory examination showed high levels of γ‐globulin, immunoglobulin (Ig)G, and antinuclear antibodies. Laparoscopy demonstrated hepatic cirrhosis. Despite normal spirometry, hypoxaemia (which was worse in standing position) and a low diffusing capacity were present. The shunt ratio calculated using arterial blood gas was 6.4%, but was 40% when measured using 99mTc‐macroaggregated albumin scanning. The discrepancy between the ratios indicated that hypoxaemia was caused by intrapulmonary vascular dilatation. The patient was diagnosed with hepatopulmonary syndrome associated with autoimmune liver cirrhosis.

Valor Diagnóstico do Aumento dos Eosinóftlos e Linfocitos no Lavado Bronco-Alveolar em Doentes com Insuficiência Respiratória Aguda e Infiltrados Pulmonares Difusos

RESUMO Os autores analisaram de 1983 a 199 1, a utilidade da contagem diferencial de celulas no Lavado Bronco-Alveolar (LBA) em doentes com Insuficiencia Respiratoria Aguda (IRA) e Infiltrados Pulmonares Difusos (IPD) , com particular interesse nos que apresentavam niveis elevados de eosinoflos ou de linfocitos no LBA . Foram estudados 118 doentes com insuficiencia respiratoria para aguda e com PaO 2 2 /FiO 2 Infiltrados Pulmonares Difusos (IPD) na radiografia de torax. A doenca pulmonar foi avaliada em bases clinicas, resultados dos exames Bacteriologicos das Secrecoes Bronquicas recolhidas por Broncofibroscopia, por Biopsia Pulmonar Transbronquica c eventualmente. outros exames. O aumemo da percentagem dos eosinoflos no LBA foi encontrado em detcnninadas doencs especificas como: Pneumonia Eosinofila e Bronquiolite Obliterante com Pneumoniu. Por outro lado os autores, constataram que outras doencas como a Tuberculose Miliar, a Pneumonia de Hipersensibilidadc e a Pneumonia a Pneumocystis carinii tem uma percentagern muito elevada de linfocitos no LBA. COMENTARIO A identificoo das causas da Insuficiencia Respiratoria Aguda (IRA) acompanhada por Infiltrados Pulmonares Difusos (IPD) e a maior parte das vezes difficil. O LBA tem sido utilizado como meio de diagnostico nas mais variadus situacooes clinicas. Os autores neste estudo so chegaram a djagnostico definitivo quando isolaram no LBA o Mycobacterium tuberculosis , a Legionella pneumofila eo Pneumocyslis carinii , sendo os outros diagnosticos de suspeicao. Os autores constataram Eosinofilia e Linfocitose no LBA em 2% e 30% dos casas respectivamente. Relacionando estes dados com diagnosticos referidos, verificaram que 50% das eosinofilias constatadas no LBA estavam relacionadas com a Pneumonia eosinofila e como BOOP,que 76% dos casas com linfocitose no LBA estavam relacionados com a Tuberculose Miliar, a Pneumonia de Hipersensibilidade e a Pneumonia a Pneumocystis carinii .

Erythropoietin and base excess levels in patients with chronic pulmonary diseases

Factors which could influence serum erythropoietin (s-EPO) levels in patients with chronic pulmonary diseases were investigated, paying special attention to the role of changes in acid-base balance (PaCO2, HCO3- and base excess levels) in EPO production. Data from 30 patients with chronic pulmonary diseases (chronic pulmonary emphysema, chronic bronchitis and post-tuberculosis status) were obtained in the morning and were analyzed with a stepwise forward multiple regression analysis, evaluating the statistical significance of seven factors which may potentially influence s-EPO levels: arterial pH, PaCO2, PaO2, HCO3-, base excess (BE), SaO2 and hemoglobin (Hb). Significant simple correlations (P < 0.01) of log(s-EPO) were obtained with PaO2 (r = -0.66), PaCO2 (r = 0.59), HCO3- (r = 0.67), BE (r = 0.71) and SaO2 (r = -0.77). The stepwise forward multiple regression analysis revealed that significant correlate variables for the outcome variable of log(s-EPO) were SaO2 and BE, with r = 0.823 (P < 0.0001). In patients with chronic pulmonary diseases it was shown that SaO2 was a negative correlate and BE was a positive correlate of s-EPO levels. It was speculated that s-EPO levels in the morning reflected daytime hypoxemia (SaO2) and nocturnal desaturation evoked by hypopnea during sleep (indicated as BE) in these patients.