Paula Monteiro

Systemic markers of the redox balance in chronic obstructive pulmonary disease

Chronic obstructive pulmonary disease (COPD) is highly prevalent and its pathogenesis is still not completely clarified. Clinically stable patients (n=21) and healthy subjects (n=24) were studied for blood markers of oxidative injury and antioxidant status. The plasma concentration of protein carbonyls was significantly increased in COPD patients, both ex-smokers (0.76±0.28 nmol mg−1) and smokers (0.99±0.20 nmol mg−1) versus controls (0.49±0.14 nmol mg−1). The concentration of total thiols was slightly enhanced in plasma of the COPD patients (ex-smokers 492±23 μmol l−1 and smokers 505±36 μmol l–1 versus controls 450±67 μmol l−1; p<0.05). The activity of the antioxidant enzyme superoxide dismutase was increased in erythrocytes (activity in U g−1 haemoglobin: ex-smokers 4460±763 and smokers 4114±1060 versus 3015±851 in controls; p<0.01), while glutathione peroxidase activity was decreased in total blood (activity in U g−1 haemoglobin: ex-smokers 27±9 and smokers 23±9 versus 47±25; p<0.01). Lower levels of selenium in plasma were also found for COPD patients (concentration in mg l–1: ex-smokers 0.030±0.019 and smokers 0.032±0.024 versus 0.058±0.023 in controls; p<0.01), being more evident in those with very low levels of arterial oxygen pressure. In addition, the levels of potassium and rubidium were increased in blood cells of the patient group. All these changes might reflect oxidant damage and an altered electrolytic homeostasis and can be interpreted as markers of COPD rather than as indicators of smoking habits.

Lavagem pulmonar total – A propósito de quatro casos de proteinose alveolar

Resumo A lavagem pulmonar e uma tecnica desenvolvida na decada de 60 do seculo xx com o intuito de remocao fisica de material proteinaceo dos bronquios, em doentes com proteinose alveolar, levando a uma melhoria clinica e funcional. A tecnica foi evoluindo e o que era inicialmente realizado com anestesia local a um segmento do pulmao e actualmente realizado sob anestesia geral, sequencialmente, a ambos os pulmoes. A presente revisao descreve a tecnica de lavagem pulmonar total, a sua principal indicacao, a proteinose alveolar e, a proposito, relatamos alguns dados relativos a experiencia do nosso servico, onde a realizam com regularidade desde 2002.

BIOLOGICAL MONITORING OF TOXIC METALS - STEEL WORKERS RESPIRATORY HEALTH SURVEY

The aim of this work is to search for respiratory system aggressors to which workers are submitted in their labouring activity. Workers from one sector of a steel plant in Portugal, Siderurgia Nacional (SN), were selected according to the number of years of exposure and labouring characteristics. The work reports on blood elemental content alterations and lung function tests to determine an eventual bronchial hyper-reactivity. Aerosol samples collected permit an estimate of indoor air quality and airborne particulate matter characterisation to further check whether the elemental associations and alterations found in blood may derive from exposure. Blood and aerosol elemental composition was determined by PIXE and INAA. Respiratory affections were verified for 24% of the workers monitored. There are indications that the occurrence of affections can be associated with the total working years. The influence of long-term exposure, health status parameters, and lifestyle factors in blood elemental variations found was investigated.

Role of bronchoscopy in foreign body aspiration management in adults: A seven year retrospective study

Foreign body aspiration (FBA), although more frequent in children, is a potentially life-threatening emergency that can occur at any age. Patients may be asymptomatic, have a choking event, cough attacks with inspiratory stridor, or symptoms may vary from trivial or chronic nonspecific symptoms (dyspnea, cough, sputum, wheezing) and mimic other lung diseases. Hence, in sub-acute and chronic respiratory infections, pulmonary abscesses, haemoptysis, asthmatiform syndrome, localized bronchiectasis or when a lung neoplasia is suspected FBA must be considered. Although it has little diagnostic value (sensitivity of 28--60%; specificity of 68%), chest radiography (CXR) is the initial test for FBA. Unless patients remember an aspiration event, diagnosis of FBA can be delayed for months even years, which increases the rate of complications. When FBA is suspected, a bronchoscopy must be performed to remove the FB (foreign body). In order to evaluate the role of bronchoscopy in FBA, we retrospectively collected data of all suspected FBA that were treated by bronchoscopy in our unit from November 2008 to October 2015 and analyzed those performed in adults aged over 18 years-old. A total of 135 bronchoscopies for FBA suspicion were performed, 69 (51.1%) in adults. The majority of adult patients were male (n = 44; 63.8%) and had a mean age of 63 ± 17 years-old. In 12 (17.3%) cases, clinical manifestations were unavailable since patients were referred to our unit from another hospital. The remaining patients reported a choking episode (n = 34; 49.3%), pneumonia (n = 10; 14.5%), dyspnea (n = 4; 5.8%), trauma (n = 3; 4.3%) or a cardiorespiratory arrest (n = 1; 1.4%). Five patients (7.2%) were asymptomatic. Mean time between aspiration and bronchoscopy was 77.7 ± 173.1 h (not known/available in 36 cases). In the 53 cases (76.8%) with an available CXR, 33 (62.3%) were abnormal, in which a condensation (n = 13), atelectasis (n = 10), visible FB (n = 9) or hyperinflation (n = 1) was identified.

Foreign body aspiration: A 7-year restrospective review

Background: Foreign body aspiration (FBA) is a potentially life threatening emergency. A correct diagnosis is essential to avoid complications. Aim: Compare FBA in children and adults. Methods: We retrospectively collected data of all suspected FBA in patients who undergone a bronchoscopy in our unit from November 2008 to October 2015. We analysed age, imaging, time between aspiration and bronchoscopy, type and location of foreign body (FB). Results: We performed 135 bronchoscopies for suspected FBA (66 children and 69 adults). The majority of the children were under 3 years old (mean age: 3,3 ± 3,3years) and adults over 55 years (mean age: 63 ± 17 years). In children, the mean aspiration time was of 299 hours (unknown in 21,2%), while it was of 77,7 hours for adults (unknown in 52,2%). When performed, chest radiography presented changes for 69,2% of children and 62,3% of adults. Most observed changes were hyperinflation (36,1% of children and 3% of adults) and hypotransparency (36,1% of children and 69,7% of adults). We removed 103 FB (75,8% of children and 76,8% of adults), most of them were organic in children (62%) and inorganic in adults (62,3%). The majority of the FB were found in the left side for children (42%) and in the right side for adults (60,4%). For 25% of children and 33,9% of adults, chest radiography was not in line with bronchoscopy result: 15,4% of children and 22,6% of adults had a FB without any radiographic change. Discussion: We didn9t find a significant difference between FBA suspicion in adults and children but there were differences regarding nature and location of FB. As radiographic changes are not always present, we recommend a bronchoscopy to be performed in all cases of suspected FBA.

Tracheobronchial injuries: Our personal experience on 19 cases

Purpose: To describe our experience in the Management of tracheobronchial injuries Introduction: Tracheobronchial injuries may be iatrogenic, low impact, longitudinal tears (laceration) or high impact, horizontal sections (rupture) caused by penetrating or blunt chest trauma. Methods and Results: Between 2001 and 2012, we have treated 19 tracheobronchial injuries. Six patients presented with tracheobronchial ruptures: two penetrating/stab wounds, two gunshot wounds and two complete sections of the main bronchus; and 13 iatrogenic lacerations: ten post-intubation and three lacerations related to bronchoscopic procedures. The extension of the lesions was 2-12 cm. The iatrogenic bronchial lacerations were all secondary to bronchoscope procedures. All tracheal iatrogenic lacerations and the four cases related to stab or gunshot wounds ruptures underwent conservative treatment. Only two patients underwent surgery (the two traumatic complete sections of the main bronchus). In the conservative treatment group, a silicon stent was inserted in four patients, in order to allow efficient mechanical ventilation and early weaning. Conclusion: In our series, conservative treatment was a safe and effective approach regardless of type of injury, location and size with no mortality related.

Bronchoscopic management of post intubation tracheal stenoses

Post intubation tracheal stenosis (PiTS) is a rare (1/1000 ICU patients) but life-threatening condition. The optimal management of PiTS is not well defined. Between 2010 and 2014 all new patients with PiTS for initial treatment were eligible for this study. All patients were submitted to diagnostic flexible bronchoscopy. Patients asymptomatic or with no criteria for “true” PiTS were excluded. Forty-four patients (25 F; 19 M; with a mean age of 55, 74 years-old) were identified: 28 complex (63,63%) and 16 (36,36%) web-like stenoses. All web-ring stenoses were successfully treated with dilation or Blade Assisted Mechanical Dilation (BAMD). In the group of complex stenoses, 2 (7,15%) required only BAMD and 26 (92,85%) required BAMD/LAMD (Laser Assisted Mechanical Dilation) and silicon stent placement: fourteen (53,84%) had the stent removed in this time period. As we think that PiTS retractile cicatricial fibrosis is time dependent, we tend to maintain the stents in place for a period of 36 months. A mean value of 2,17 per patient, bronchoscopic procedures were performed. No serious complications were observed and no patients were referred to surgery.

Thoracoscopy: Diagnostic and therapeutic applications

Introduction: The technique and clinical applications of medical thoracoscopy (MT) have substantially evolved over the last decades. Aim: We sought to evaluate the diagnostic and therapeutic yield and safety of MT at our unit. Methods: The reports of all MT undergone from 2010 to 2014 were reviewed and analysed as regards to indication, side, endoscopic findings, procedures and immediate complications. Results: In our study, 268 patients underwent MT, 8 of which were excluded because of lost data. One hundred fifty-one patients were male (58,08%) and 109 female (41,92%) with a mean age of 55,76 ± 20,4 years. Sixty of the MT (23,08%) were diagnostic, 140 (53,84%) therapeutic and 60 (23,08%) simultaneously diagnostic and therapeutic. Undiagnosed or malignant pleural effusions were the main indications (66,92%), followed by pneumothorax (26,92%), nodules and masses (4,23%), hydropneumothorax (1,15%), abscess (0,39%) and pleural thickening (0,39%). Thoracoscopic pleural biopsies were performed in 113 patients. One hundred twenty-one (69,54%) of the pleural effusions and 68 (97,14%) of the pneumothorax were submitted to talc poudrage. No death related to thoracoscopy was registered. Conclusions: The role of medical thoracoscopy in the diagnosis and treatment of pleural disease is as relevant today as it was when Jacobeus pioneered this important procedure.