Saulo Maia Davila Melo

Effects of progressive increase in body weight on lung function in six groups of body mass index

OBJECTIVE To evaluate the effects of the progressive increase in body weight on lung function by oxygen peripheral saturation, spirometry and maximal respiratory pressures in different degrees of obesity. METHODS Cross-sectional study including 140 patients in clinical and surgical evaluation for obesity treatment. The selected patients were divided into six groups of body mass index (BMI), including a control group of non-obese and a subdivision for the morbidly obese into three subgroups. RESULTS Significant differences were demonstrated between the groups regarding oxygen peripheral saturation (SpO2) (p < 0.001), forced vital capacity (FVC) (p < 0.002, p < 0.02) and forced expiratory volume in one second (FEV1) (p < 0.001, p < 0.03) in relative and absolute values, respectively. Group VI (BMI > 50.9 kg/m²) showed significant differences (SpO2, FVC and FEV1) when compared with the other groups (except group V) and group V (BMI > 45 to 49.9 kg/m²) with the group control. The other variables (FEV1/FVC ratio, forced expiratory flow 25-75 [FEF25-75] and maximal respiratory pressure) did not show any statistical differences. CONCLUSION Lung function is influenced by the progressive increase in BMI, with changes in lung function better demonstrated when BMI > 45 kg/m²; these changes are more evident when BMI > 50.9 kg/m².

Pulmonary Histoplasmosis Presenting With the Reversed Halo Sign on High-Resolution CT Scan

We describe the case of a 23-year-old man with pulmonary histoplasmosis whose high-resolution CT scan demonstrated the reversed halo sign. We also extensively review the literature about this CT scan sign. The reversed halo sign has been described in a number of diseases, both infectious and noninfectious. However, to our knowledge, this is the first reported case of pulmonary histoplasmosis presenting with this radiologic finding.

Efeitos do aumento progressivo do peso corporal na função pulmonar em seis grupos de índice de massa corpórea

OBJECTIVE: To evaluate the effects of the progressive increase in body weight on lung function by oxygen peripheral saturation, spirometry and maximal respiratory pressures in different degrees of obesity. METHODS: Cross-sectional study including 140 patients in clinical and surgical evaluation for obesity treatment. The selected patients were divided into six groups of body mass index (BMI), including a control group of non-obese and a subdivision for the morbidly obese into three subgroups. RESULTS: Significant differences were demonstrated between the groups regarding oxygen peripheral saturation (SpO2) (p 50.9 kg/m2) showed significant differences (SpO2, FVC and FEV1) when compared with the other groups (except group V) and group V (BMI > 45 to 49.9 kg/m2) with the group control. The other variables (FEV1/FVC ratio, forced expiratory flow 25-75 [FEF25-75] and maximal respiratory pressure) did not show any statistical differences. CONCLUSION: Lung function is influen- ced by the progressive increase in BMI, with changes in lung function better demonstrated when BMI > 45 kg/m2; these changes are more evident when BMI > 50.9 kg/m2.

Cirurgia bariátrica: existe necessidade de internação em unidade de terapia intensiva?

OBJETIVOS: Determinar o local de internacao no pos-operatorio de cirurgia bariatrica primaria e verificar as complicacoes clinicas-cirurgicas que justificassem internacao em unidade de terapia intensiva, inclusive morte. METODOS: Estudo transversal, prospectivo, aberto, sendo avaliados 120 pacientes submetidos a cirurgia bariatrica primaria por videolaparoscopia no periodo de maio de 2007 a abril de 2008 em um hospital terciario. Utilizou-se o indice de Aldrete e Kroulik para liberacao da sala de recuperacao pos-anestesica e definicao do local de encaminhamento no pos-operatorio. RESULTADOS: Entre os 120 pacientes, havia 83 mulheres e 37 homens, com media de idade 35,4 ± 10,5 anos (18 a 66 anos), indice de massa corporea medio 45,6 ± 10,5. O tempo entre admissao hospitalar e inicio da cirurgia foi de 140,7 ± 81,8 minutos, o tempo cirurgico 105,0 ± 28,6 minutos, o tempo de permanencia na sala de recuperacao pos-anestesica foi 125,0 ± 38,0 minutos e tempo de internacao hospitalar 47,7 ± 12,4 horas, com 100% dos pacientes deambulando em 24 horas. O indice de Aldrete e Kroulik da sala de recuperacao pos-anestesica alcancou pontuacao de 10 com 120 minutos em todos os pacientes, com sobrevida de 100%. CONCLUSAO: Com o uso do indice Aldrete e Kroulik na sala de recuperacao pos-anestesica de bypass gastrico por videolaparoscopia em cirurgia bariatrica primaria, nenhum paciente foi internado em unidade de terapia intensiva e nenhuma complicacao maior foi observada.

Prevalência e gravidade de asma brônquica em adultos obesos com indicação de cirurgia bariátrica

OBJECTIVE To determine the prevalence of asthma in a group of obese adult candidates for bariatric surgery and to evaluate the severity of asthma in this group of patients. METHODS This was a cross-sectional study involving 363 obese adults (body mass index > 35 kg/m²) evaluated by a pulmonologist, using clinical evaluation as a diagnostic tool for asthma. All patients underwent clinical evaluation and spirometry and were divided into two groups (asthma and control). The patients with asthma were stratified by the severity of asthma. RESULTS The prevalence of asthma in the obese population studied was 18.5% (95% CI: 14.5-22.4). That prevalence was 20.4% (95% CI: 16.2-24.5) and 13.7% (95% CI: 10.1-17.2) in the women and the men, respectively. Asthma symptoms in the last twelve months were present in 8.0% (95% CI: 5.2-10.7), and the initial manifestation of asthma symptoms occurred during childhood/adolescence in 17.4% (95% CI: 13.5-21.3). In the asthma group, intermittent asthma was present in 29 patients (43.3%), mild persistent asthma in 7 (10.4%), moderate asthma in 25 patients (37.3%), and severe persistent asthma in 6 (9.0%). CONCLUSIONS Using clinical evaluation as the diagnostic criterion, we found the prevalence of asthma to be high in this group of obese adults. Asthma was more common in females, and the initial manifestation of asthma symptoms more commonly occurred during childhood/adolescence. The severity of asthma in this group of obese adults was within the range of mean values predicted for the general population. Intermittent asthma, mild persistent asthma, and moderate persistent asthma predominated.

Functional lung rejuvenation in obese patients after bariatric surgery

OBJECTIVE To determine the lung age (LA) in obese people before and after bariatric surgery, compare the LA with the chronological age (CA) before and after the peration, and verify whether there was a functional pulmonary rejuvenation after it. METHODS A prospective longitudinal study including 43 morbidly obese patients who underwent bariatric surgery. The patients underwent clinical and spirometric evaluation in two stages, before and after the surgery. In both stages, LA, CA and spirometric variables were measured. RESULTS A significant improvement in the spirometric variables (FVC; FEV1; and FEV1/FVC ratio) was found after the operation (p≤ 0.0001). Comparing the LA before (50.93±13.36 years) and after the surgery (39.02±12.95 years), there was an important reduction of 11.90±9.12 years (95CI:9.10-14.71; p≤0.0001) in LA after surgery. The difference between LA and CA before surgery was 12.20± 11.71 years (95CI:8.60-15.81) with significant difference (p≤0.0001), and the difference between LA and CA after surgery was -1.95±11.83 years (95CI: -5.59-1.69) with no significant difference (p≤0.28). Regarding LA, we observed a pulmonary aging of 12.20±11.71 years before the surgery and a pulmonary rejuvenation of 11.90±9.12 years after it. CONCLUSION Morbid obesity is responsible for early damage and functional accelerated pulmonary aging. After the correction of the body weight by surgery, there is a functional pulmonary rejuvenation demonstrated by the normalization of LA in relation to CA.

Tumor fantasma de pulmão

S.B.E., masculino, 79 anos, negro, viuvo, metalurgi-co aposentado, natural do Espirito Santo, residente em Nova Iguacu – RJ, Brasil ha 40 anos, hipertenso e diabeti-co nao controlado, foi internado com historia de dispneia progressiva nestes ultimos dois meses e atualmente com dispneia em repouso, ortopneia, dispneia paroxistica no-turna, tosse seca e edema de membros inferiores. Ao exame fisico encontrava-se hidratado, afebril, co-rado, anicterico, acianotico, taquipneico, com turgencia jugular e em anasarca. Aparelho respiratorio: murmurio vesicular reduzido na base pulmonar direita e estertores crepitantes bibasais. Aparelho cardiovascular: RCR com B3, bulhas hipofoneticas e sopro sistolico no foco mitral ++/6+. Abdomen: globoso, com edema de parede e hepatomegalia levemente dolorosa. Membros inferiores: edemaciados com cacifo 4+/4+, panturrilhas livres e pulsos preservados. Exames laboratoriais sem alteracoes, exceto glicemia de jejum 117 mg/dL. Na radiografia de torax em PA e perfil observamos, aumento da area cardiaca, opacidade homogenea volumosa (tipo massa) de limites bem defi-nidos, arredondada, na topografia da cissura horizontal direita e opacidades heterogeneas nos tercos inferiores bilateralmente, com velamento dos seios costofrenicos, principalmente a direita (Figuras 1A e 1B). ECG: sobre-carga atrial esquerda, BRE de 2o grau, BAV de 1o grau e extrassistoles ventriculares. Ecocardiograma: disfuncao sistolica importante, hipocinesia difusa, fracao de ejecao: 28%, insuficiencia mitral moderada, insuficiencia tricus-pide leve e avaliacao da funcao diastolica prejudicada por extrassistoles frequentes. A hipotese diagnostica foi de insuficiencia cardiaca congestiva descompensada com a presenca de tumor fan-tasma de pulmao. O paciente evoluiu de maneira satisfatoria com o uso de diureticos de alca e poupador de potassio, inibidor da enzima conversora da angiotensina e betabloqueador, compensando o quadro de insuficiencia cardiaca con-gestiva (ICC).