Ricardo Kalaf Mussi

Exercise training reduces pulmonary ischaemia–reperfusion-induced inflammatory responses

Physical exercise reduces the deleterious effects of cardiovascular and inflammatory disorders. The purpose of the present study was to evaluate the beneficial effects of physical training on the inflammatory responses following lung ischaemia–reperfusion (IR) in rats. Male Wistar rats were divided into sham-operated animals and sedentary and trained animals submitted to lung IR. The run training programme consisted of 5 sessions·week−1, each lasting 60 min·day−1, at 66% of maximal oxygen consumption for 8 weeks. The left pulmonary artery, bronchus and pulmonary vein were occluded for 90 min and reperfused for 2 h. Lung protein extravasation was measured as 125I-human albumin accumulation, whereas lung neutrophil infiltration was measured as myeloperoxidase activity. Lung IR in sedentary rats resulted in marked increases in protein extravasation and neutrophil influx, and in significant elevations of serum tumour necrosis factor (TNF)-α and interleukin (IL)-1β levels. Physical preconditioning attenuated the increased IR-induced protein leakage without affecting neutrophil influx. It also reduced serum TNF-α (and IL-1β) levels, but had no effect on IL-10 levels. Plasma superoxide dismutase activity was significantly increased in trained IR rats. The present data show that physical preconditioning protects the rat lung from ischaemia–reperfusion injury by attenuating the pulmonary vascular permeability that may be a consequence of reduced levels of tumour necrosis factor-α and interleukin-1β and elevated superoxide dismutase activity.

Characterization of Pulmonary and Systemic Inflammatory Responses Produced by Lung Re-expansion After One-Lung Ventilation

OBJECTIVES To characterize the pulmonary and systemic inflammatory responses of rats undergoing 1-hour or 3-hour one-lung ventilation (OLV) with subsequent 1-hour lung re-expansion. DESIGN A prospective, randomized, controlled animal experiment. SETTING University laboratory. PARTICIPANTS Thirty male Wistar rats were used. INTERVENTIONS Rats were subjected to 1- or 3-hour OLV followed or not by 1-hour lung re-expansion. Control rats received no ventilation. MEASUREMENTS AND MAIN RESULTS Pulmonary protein extravasation, pulmonary myeloperoxidase (MPO) activity, cytokine levels in serum and bronchoalveolar lavage (BAL), counts of total and differential cells in BAL fluid, gasometric data, and mean arterial blood pressure (MABP) were all evaluated. Bronchial occlusion for 1 or 3 hours with no lung re-expansion did not significantly change the protein extravasation in the right and left lungs compared with the control group. However, rats submitted to 1- or 3-hour OLV followed by lung re-expansion exhibited pulmonary edema formation and neutrophil recruitment as well as a higher MPO activity in comparison with control rats. Increased levels of interleukin (IL)-6, IL-1β, and tumor necrosis factor-α in BAL fluid were observed. Increased levels of IL-6 and IL-10 in serum also were detected. Blood gas and MABP did not differ between groups. CONCLUSIONS Lung re-expansion after bronchial occlusion evokes an acute lung inflammatory response, which has been shown to be more pronounced in long periods of bronchial occlusion in terms of cytokine inflammatory response. In addition, the magnitude of this inflammatory response also can be detected systemically.

Simvastatin attenuates neutrophil recruitment in one-lung ventilation model in rats

PURPOSE To investigate the anti-inflammatory effects of simvastatin in rats undergoing one-lung ventilation (OLV) followed by lung re-expansion. METHODS Male Wistar rats (n=30) were submitted to 1-h OLV followed by 1-h lung re-expansion. Treated group received simvastatin (40 mg/kg for 21 days) previous to OLV protocol. Control group received no treatment or surgical/ventilation interventions. Measurements of pulmonary myeloperoxidase (MPO) activity, pulmonary protein extravasation, and serum levels of cytokines and C-reactive protein (CRP) were performed. RESULTS OLV significantly increased the MPO activity in the collapsed and continuously ventilated lungs (31% and 52% increase, respectively) compared with control (p<0.05). Treatment with simvastatin significantly reduced the MPO activity in the continuously ventilated lung but had no effect on lung edema after OLV. The serum IL-6 and CRP levels were markedly higher in OLV group, but simvastatin treatment failed to affect the production of these inflammatory markers. Serum levels of IL-1β, TNF-α and IL-10 remained below the detection limit in all groups. CONCLUSIONS In an experimental one-lung ventilation model pre-operative treatment with simvastatin reduces remote neutrophil infiltration in the continuously ventilated lung. Our findings suggest that simvastatin may be of therapeutic value in OLV-induced pulmonary inflammation deserving clinical investigations.

Standardization of a method of prolonged thoracic surgery and mechanical ventilation in rats to evaluate local and systemic inflammation

PURPOSE To evaluate the immediate pulmonary and systemic inflammatory response after a long-term operative period. METHODS Wistar rats in the experimental group were anaesthetized and submitted to tracheostomy, thoracotomy and remained on mechanical ventilation during three hours. Control animals were not submitted to the operative protocol. The following parameters have been evaluated: pulmonary myeloperoxidase activity, pulmonary serum protein extravasation, lung wet/dry weight ratio and measurement of levels of cytokines in serum. RESULTS Operated animals exhibited significantly lower serum protein extravasation in lungs compared with control animals. The lung wet/dry weight ratio and myeloperoxidase activity did not differ between groups. Serum cytokines IL-1ß, TNF-α, and IL-10 levels were not detected in groups, whereas IL-6 was detected only in operated animals. CONCLUSION The experimental mechanical ventilation in rats with a prolonged surgical time did not produce significant local and systemic inflammatory changes and permit to evaluate others procedures in thoracic surgery.

Carcinoma mucoepidermoide da traqueia mimetizando asma brônquica

In cases of recent asthma in which clinical control with the usual treatment (corticosteroids and bronchodilator) is unsatisfactory, it is important to consider other diagnoses, such as congestive heart failure, gastroesophageal reflux or other forms of airway obstruction. We report the case of a female patient with mucoepidermoid carcinoma of the trachea mimicking asthma. The patient presented cough and wheezing, as well as abnormal spirometry results with an obstructive pattern that was responsive to bronchodilators. One year later, the patient presented clinical and spirometric worsening. The chest X-ray revealed no abnormalities. A CT scan showed a vegetative lesion obstructing the tracheal lumen and located 1 cm from the carina. Fiberoptic bronchoscopy showed a finding similar to a bronchial carcinoid tumor. The anatomopathological diagnosis made after surgical resection was low-grade mucoepidermoid carcinoma, without lymph node involvement. Although the flow-volume curve was not suggestive of upper airway obstruction, the spirometry performed after the surgery showed a significant reduction in the degree of obstruction and greater reversibility after bronchodilator use. There was no evidence of recurrence of the disease or of the symptoms after a two-year follow-up period.

Edema e hemorragia pulmonar por pressão negativa associados à obstrução das vias aéreas superiores

Negative-pressure pulmonary edema accompanied by hemorrhage as a manifestation of upper airway obstruction is an uncommon problem that is potentially life-threatening. The principal pathophysiological mechanism involved is the generation of markedly negative intrathoracic pressure, which leads to an increase in pulmonary vascular volume and pulmonary capillary transmural pressure, creating a risk of disruption of the alveolar-capillary membrane. We report the case of an adult male with diffuse alveolar hemorrhage following acute upper airway obstruction caused by the formation of a cervical and mediastinal abscess resulting from the insertion of a metallic tracheal stent. The patient was treated through drainage of the abscess, antibiotic therapy, and positive pressure mechanical ventilation. This article emphasizes the importance of including this entity in the differential diagnosis of acute lung injury after procedures involving upper airway instrumentation.

A influência do uso do "clamp" ou braçadeira no acúmulo de coágulos em drenos pleurais tubulares

OBJETIVO: Conduziu-se este estudo prospectivo a fim de avaliar-se a influencia do uso da bracadeira sobre o acumulo de coagulos dentro dos drenos pleurais. METODO: Os drenos pleurais foram pesados logo apos sua retirada, lavados e secados e pesados novamente. A diferenca entre a primeira e a segunda pesagem foi admitida como a quantidade de coagulos acumulada. RESULTADOS: Houve maior acumulo de coagulo nos drenos temporariamente obstruidos por bracadeira em relacao aqueles nao obstruidos. CONCLUSAO: Notou-se, neste estudo, maior acumulo de coagulo dentro de drenos pleurais obstruidos, mesmo que intermitentemente, o que pode levar ao mau funcionamento de todo o sistema de drenagem. A discussao sobre o correto uso dos drenos pleurais deve ser constante e fazer parte de programas de educacao continuada para medicos e enfermagem, a fim de que este sistema, amplamente utilizado e altamente eficiente, seja otimizado.

Derrame pleural parapneumônico e empiema

The infectious effusion, one of the most frequent causes of pleural effusions in the clinical practice, is a sign of complication of the pneumonic disease. The early recognition of the parapneumonic effusion is crucial to determine the best treatment form and reduce the risk of morbidity and mortality. The evolution in the diagnostic methods and the contribution of several studies published in the literature allowed to establish evidence-based guidelines that are used to guide the treatment of the parapneumonic pleural effusion and empyema.

Descriptive analysis of and overall survival after surgical treatment of lung metastases

OBJECTIVE: To describe demographic characteristics, surgical results, postoperative complications, and overall survival rates in surgically treated patients with lung metastases. METHODS: This was a retrospective analysis of 119 patients who underwent a total of 154 lung metastasis resections between 1997 and 2011. RESULTS: Among the 119 patients, 68 (57.1%) were male and 108 (90.8%) were White. The median age was 52 years (range, 15-75 years). In this sample, 63 patients (52.9%) presented with comorbidities, the most common being systemic arterial hypertension (69.8%) and diabetes (19.0%). Primary colorectal tumors (47.9%) and musculoskeletal tumors (21.8%) were the main sites of origin of the metastases. Approximately 24% of the patients underwent more than one resection of the lesions, and 71% had adjuvant treatment prior to metastasectomy. The rate of lung metastasis recurrence was 19.3%, and the median disease-free interval was 23 months. The main surgical access used was thoracotomy (78%), and the most common approach was wedge resection with segmentectomy (51%). The rate of postoperative complications was 22%, and perioperative mortality was 1.9%. The overall survival rates at 12, 36, 60, and 120 months were 96%, 77%, 56%, and 39%, respectively. A Cox analysis confirmed that complications within the first 30 postoperative days were associated with poor prognosis (hazard ratio = 1.81; 95% CI: 1.09-3.06; p = 0.02). CONCLUSIONS: Surgical treatment of lung metastases is safe and effective, with good overall survival, especially in patients with fewer metastases.

A influência do uso do clamp ou braçadeira no acúmulo de coágulos em drenos pleurais tubulares

OBJETIVO: Conduziu-se este estudo prospectivo a fim de avaliar-se a influencia do uso da bracadeira sobre o acumulo de coagulos dentro dos drenos pleurais. METODO: Os drenos pleurais foram pesados logo apos sua retirada, lavados e secados e pesados novamente. A diferenca entre a primeira e a segunda pesagem foi admitida como a quantidade de coagulos acumulada. RESULTADOS: Houve maior acumulo de coagulo nos drenos temporariamente obstruidos por bracadeira em relacao aqueles nao obstruidos. CONCLUSAO: Notou-se, neste estudo, maior acumulo de coagulo dentro de drenos pleurais obstruidos, mesmo que intermitentemente, o que pode levar ao mau funcionamento de todo o sistema de drenagem. A discussao sobre o correto uso dos drenos pleurais deve ser constante e fazer parte de programas de educacao continuada para medicos e enfermagem, a fim de que este sistema, amplamente utilizado e altamente eficiente, seja otimizado.