RESUMO

OBJECTIVES: To describe the history, mechanisms, and consequences of cystic fibrosis (CF)-related diabetes, from childhood to early adulthood. STUDY DESIGN: Pancreatic beta-cell function was estimated from the plasma insulin/glucose ratios during oral glucose tolerance test (total area under the curve and deltaI(30-0min)/G(30min), homeostasis model assessment [HOMA]%B), insulin sensitivity with the HOMA%S index, in 237 children with CF (109 boys, 128 girls). Progression of glucose metabolism abnormalities was evaluated by analysis for interval censored data; rates of pulmonary transplantation and death by Kaplan-Meier analysis. RESULTS: Impaired glucose tolerance was found in 20% of patients at 10 years, 50% at 15 years, 75% at 20 years, 82% at 30 years; for diabetes, >20% at 15 year, 45% at 20 years, 70% at 30 years; for insulin treatment, 30% at 20 years, 40% at 30 years. Early impairment was associated with lower survival rates and higher rates of lung transplantation. The area under the curve(glucose) correlated with decreased body mass index and height. Decrease in early insulin secretion (deltaI(30-0min)/G(30min)) was associated with impaired glucose tolerance, in all estimates of insulin secretion with diabetes. HOMA%S did not differ between the groups. Increased inflammation correlated with insulin resistance and impaired glucose tolerance. CONCLUSIONS: CF-related diabetes, mainly because of beta-cell deficiency, is frequent early in life and associated with impaired nutritional state and growth, increased rates of terminal respiratory failure, and death.

Assuntos

Fibrose Cística/complicações , Intolerância à Glucose/etiologia , Insulina/metabolismo , Adolescente , Adulto , Criança , Fibrose Cística/metabolismo , Fibrose Cística/mortalidade , Fibrose Cística/cirurgia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/etiologia , Feminino , Seguimentos , Intolerância à Glucose/epidemiologia , Teste de Tolerância a Glucose , Humanos , Incidência , Secreção de Insulina , Transplante de Pulmão/estatística & dados numéricos , Masculino , Distribuição por Sexo , Taxa de Sobrevida

RESUMO

Three children with cartilage-hair hypoplasia presented with chronic obstructive symptoms and bronchiolar wall thickening on high-resolution computed tomography scanning. In all children, surgical lung biopsy demonstrated diffuse dilated lymphoplasmacytic bronchiolitis. The bronchiolar wall was infiltrated by a lymphocyte sheath with plasma cell differentiation and dispersed secondary follicles. Clarithromycin substantially improved respiratory symptoms and pulmonary function, allowing children to return home.

Assuntos

Anormalidades Múltiplas/diagnóstico , Bronquiolite/diagnóstico , Bronquiolite/patologia , Cabelo/anormalidades , Pulmão/patologia , Linfopenia/diagnóstico , Doença Pulmonar Obstrutiva Crônica/diagnóstico , Biópsia por Agulha , Bronquiolite/tratamento farmacológico , Líquido da Lavagem Broncoalveolar/citologia , Broncoscopia/métodos , Pré-Escolar , Condrodisplasia Punctata , Claritromicina/uso terapêutico , Nanismo , Feminino , Seguimentos , Humanos , Hipotricose/diagnóstico , Imuno-Histoquímica , Linfopenia/tratamento farmacológico , Masculino , Plasmócitos/patologia , Troca Gasosa Pulmonar , Testes de Função Respiratória , Medição de Risco , Índice de Gravidade de Doença , Síndrome , Tomografia Computadorizada por Raios X , Resultado do Tratamento

RESUMO

Lung resection may be considered for cystic fibrosis (CF) patients showing localized severe chronic atelectasis and/or bronchiectasis. Nonetheless, literature on survival after surgery is scarce. This study was carried out to assess survival time after partial lung resection. Twenty-one CF patients were operated from 1988 to 2003 and were followed until November 30th, 2004. Survival analysis was performed through Kaplan-Meier method. Mean age at resection was 8.09 years (SD 4.40 years) and two-thirds were females. Z-scores for height, weight, and body mass index as well as FEV1 values showed no statistical significance when comparing values obtained from 2 years before to 2 years after resection. Eleven years after resection, survival probability was 93.8%. Our results suggest that lobectomy or segmentectomy are safe procedures and should be considered in carefully selected patients with unilateral severe symptomatic localized and chronic persistent atelectasis and/or bronchiectasis refractory to conservative management.

Assuntos

Fibrose Cística/cirurgia , Pneumonectomia , Bronquiectasia/etiologia , Bronquiectasia/cirurgia , Criança , Estudos de Coortes , Fibrose Cística/complicações , Feminino , Humanos , Estimativa de Kaplan-Meier , Masculino , Pneumonectomia/mortalidade , Atelectasia Pulmonar/etiologia , Atelectasia Pulmonar/cirurgia , Análise de Sobrevida , Fatores de Tempo

RESUMO

OBJETIVO: Verificar as diferenças nos valores da fração exalada de óxido nítrico (FeNO) em asmáticos atópicos e não-atópicos em uso de tratamento antiinflamatório e comparar a FeNO com a função pulmonar MÉTODOS: Estudo transversal com 45 asmáticos persistentes moderados e graves, de 6 a 17 anos, selecionados consecutivamente, em uso de medicação antiinflamatória há pelo menos 1 ano. Os pacientes foram divididos em dois grupos: atópicos, isto é, com testes cutâneos positivos, e não-atópicos. As avaliações clínico-funcionais e a mensuração da FeNO foram realizadas concomitantemente. RESULTADOS: Houve predomínio do sexo masculino (62,5 por cento),sendo que cerca de 85 por cento pertenciam à faixa etária de 6 até 13 anos (média, 10,4 anos). Não foi encontrada, nos dois grupos, significância estatística para a presença de sintomas associados à asma (p = 0,07), rinite alérgica (p = 0,17), alergia alimentar (p = 0,09), necessidade de corticóide sistêmico (p = 0,10), antileucotrieno (p = 0,20) e anti-histamínico (p = 0,70), nem para os três parâmetros usados para avaliar a função pulmonar (VEF1, VEF1/CVF e FEF25-75 por cento, p > 0,14). A freqüência de eczema (p < 0,005) e a FeNO (p < 0,001) foram mais elevadas entre os atópicos. CONCLUSÃO: Os resultados sugerem que, entre atópicos, a estabilidade clínica e funcional da asma não reflete, necessariamente, o efetivo controle do processo inflamatório, e que haja, talvez, maior chance de recidiva após a suspensão da medicação anti-inflamatória.

Assuntos

Humanos , Masculino , Feminino , Criança , Adolescente , Asma/tratamento farmacológico , Broncodilatadores/administração & dosagem , Óxido Nítrico/administração & dosagem , Respiração , Administração por Inalação , Broncodilatadores/análise , Distribuição de Qui-Quadrado , Estudos Transversais , Óxido Nítrico/análise , Testes de Função Respiratória , Fatores Sexuais

RESUMO

OBJECTIVE: To assess the difference in exhaled nitric oxide levels in atopic and nonatopic asthmatic patients treated with anti-inflammatory drugs, and to compare exhaled nitric oxide measurement with lung function tests. METHODS: Cross-sectional study with 45 consecutively selected patients with moderate and severe persistent asthma, aged between 6 and 17 years, and treated with anti-inflammatory drugs for at least 1 year. The patients were split into two groups: atopic ones (with positive skin tests) and nonatopic ones. The clinical and functional assessments and the measurement of exhaled nitric oxide were carried out concomitantly. RESULTS: There was a male predominance (62.5%), with an age range between 6 and 13 years (mean of 10.4 years) in 85% of the patients. Neither the symptoms associated with asthma (p = 0.07), allergic rhinitis (p = 0.17), food allergy (p = 0.09), necessity of systemic corticosteroids (p = 0.10), antileukotrienes (p = 0.20) and antihistamines (p = 0.70), nor the three parameters used to assess lung function (FEV(1), FEV(1)/FVC and FEF(25-75%), p > or = 0.14) were statistically significant. The frequency of eczema (p < 0.005) and exhaled nitric oxide levels (p < 0.001) were higher among atopic patients. CONCLUSION: Results suggest that clinical and functional stability of asthma among atopic patients does not necessarily reflect an efficient control over the inflammatory process and a higher probability for recurrence after discontinuation of anti-inflammatory therapy.

Assuntos

Asma/tratamento farmacológico , Broncodilatadores/administração & dosagem , Óxido Nítrico/análise , Respiração , Administração por Inalação , Adolescente , Asma/metabolismo , Asma/fisiopatologia , Broncodilatadores/análise , Distribuição de Qui-Quadrado , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Testes de Função Respiratória , Fatores Sexuais

RESUMO

OBJECTIVE: The study was carried out to assess the clinical and radiological findings and factors related to delay in definite diagnosis of foreign body aspiration and its removal. METHODS: Medical charts of 280 bronchoscopic-proven foreign body (FB) inhalators were reviewed. To analyze factors related to late removal, the population studied was divided into two groups according to time elapsed between injury and care-seeking (up to 24h and longer than 24h) followed by FB removal. RESULTS: Most children (69.5%) were under three, most were males (63.1%) and in 47.5%, rigid bronchoscopy was performed 24h after the accident. Organic foreign bodies were found in 63.4% of cases, most frequently peanuts (20.5%). Mortality related to FB aspiration reached 0.7%. In comparison with endoscopic diagnosis, clinical and radiological abnormalities were found in 99.3 and 84.3% (95% CI, 79.5-88.4%) of studied patients, respectively. The number of health services sought until definite diagnosis was the only factor associated with late removal (OR=23.0, 95% CI, 10.7-49.3%, p<0.001). CONCLUSION: The population studied presented a long delay in FB removal, thus demanding actions enhancing parent, physician and health services awareness, aiming at an earlier referral for diagnostic and therapeutic bronchoscopy.

Assuntos

Corpos Estranhos/diagnóstico , Corpos Estranhos/cirurgia , Distribuição por Idade , Obstrução das Vias Respiratórias/etiologia , Broncografia , Broncoscopia , Criança , Pré-Escolar , Feminino , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Humanos , Masculino , Estudos Retrospectivos , Distribuição por Sexo , Fatores de Tempo , Traqueia/diagnóstico por imagem

RESUMO

OBJECTIVE: To review basic concepts, inhalation therapy, classification of asthma and peculiarities of asthma in developing countries. SOURCES: Direct search in the Medline, HighWire and MD Consult databases. SUMMARY OF THE FINDINGS: Inhaled corticosteroids are the drugs of choice for the treatment of asthma. Alternatively, other drugs, such as long-acting beta-agonists and antileukotrienes could be considered. CONCLUSIONS: At an individual level, asthma treatment presents a satisfactory outcome. However, the great challenge for public health professionals and authorities is to provide treatment for asthmatic patients from low-income families living in developing countries.