RESUMO
Various methods are available for preservation of vascular grafts for pulmonary artery (PA) replacement. Lyophilization and cryopreservation reduce antigenicity and prevent thrombosis and calcification in vascular grafts, so both methods can be used to obtain vascular bioprostheses. We evaluated the hemodynamic, gasometric, imaging, and macroscopic and microscopic findings produced by PA reconstruction with lyophilized (LyoPA) grafts and cryopreserved (CryoPA) grafts in dogs. Eighteen healthy crossbred adult dogs of both sexes weighing between 18 and 20 kg were used and divided into three groups of six: group I, PA section and reanastomosis; group II, PA resection and reconstruction with LyoPA allograft; group III, PA resection and reconstruction with CryoPA allograft. Dogs were evaluated 4 weeks after surgery, and the status of the graft and vascular anastomosis were examined macroscopically and microscopically. No clinical, radiologic, or blood-gas abnormalities were observed during the study. The mean pulmonary artery pressure (MPAP) in group III increased significantly at the end of the study compared with baseline (P=0.02) and final [P=0.007, two-way repeat-measures analysis of variance (RM ANOVA)] values. Pulmonary vascular resistance of groups II and III increased immediately after reperfusion and also at the end of the study compared to baseline. The increase shown by group III vs group I was significant only if compared with after surgery and study end (P=0.016 and P=0.005, respectively, two-way RM ANOVA). Microscopically, permeability was reduced by ≤75% in group III. In conclusion, substitution of PAs with LyoPA grafts is technically feasible and clinically promising.
Assuntos
Aloenxertos/fisiologia , Implante de Prótese Vascular/métodos , Prótese Vascular , Criopreservação/métodos , Crioprotetores , Liofilização/métodos , Glutaral , Artéria Pulmonar , Aloenxertos/anatomia & histologia , Aloenxertos/cirurgia , Análise de Variância , Animais , Pressão Sanguínea , Prótese Vascular/efeitos adversos , Cães , Feminino , Masculino , Artéria Pulmonar/patologia , Artéria Pulmonar/fisiologia , Circulação Pulmonar , Transplante Homólogo , Resistência VascularRESUMO
Various methods are available for preservation of vascular grafts for pulmonary artery (PA) replacement. Lyophilization and cryopreservation reduce antigenicity and prevent thrombosis and calcification in vascular grafts, so both methods can be used to obtain vascular bioprostheses. We evaluated the hemodynamic, gasometric, imaging, and macroscopic and microscopic findings produced by PA reconstruction with lyophilized (LyoPA) grafts and cryopreserved (CryoPA) grafts in dogs. Eighteen healthy crossbred adult dogs of both sexes weighing between 18 and 20 kg were used and divided into three groups of six: group I, PA section and reanastomosis; group II, PA resection and reconstruction with LyoPA allograft; group III, PA resection and reconstruction with CryoPA allograft. Dogs were evaluated 4 weeks after surgery, and the status of the graft and vascular anastomosis were examined macroscopically and microscopically. No clinical, radiologic, or blood-gas abnormalities were observed during the study. The mean pulmonary artery pressure (MPAP) in group III increased significantly at the end of the study compared with baseline (P=0.02) and final [P=0.007, two-way repeat-measures analysis of variance (RM ANOVA)] values. Pulmonary vascular resistance of groups II and III increased immediately after reperfusion and also at the end of the study compared to baseline. The increase shown by group III vs group I was significant only if compared with after surgery and study end (P=0.016 and P=0.005, respectively, two-way RM ANOVA). Microscopically, permeability was reduced by ≤75% in group III. In conclusion, substitution of PAs with LyoPA grafts is technically feasible and clinically promising.
Assuntos
Animais , Cães , Feminino , Masculino , Aloenxertos/fisiologia , Prótese Vascular , Implante de Prótese Vascular/métodos , Crioprotetores , Criopreservação/métodos , Liofilização/métodos , Glutaral , Artéria Pulmonar , Análise de Variância , Aloenxertos/anatomia & histologia , Aloenxertos/cirurgia , Pressão Sanguínea , Prótese Vascular/efeitos adversos , Circulação Pulmonar , Artéria Pulmonar/patologia , Artéria Pulmonar/fisiologia , Transplante Homólogo , Resistência VascularRESUMO
Cryopreservation has an immunomodulating effect on tracheal tissue as a result of class II antigen depletion due to epithelium exfoliation. However, not all epithelium is detached. We evaluated the role of apoptosis in the remaining epithelium of 30 cryopreserved tracheal grafts. Caspase-3 immunoreactivity of tracheal epithelium was studied in canine tracheal segments cryopreserved with F12K medium, with or without subsequent storage in liquid nitrogen at -196°C for 15 days. Loss of structural integrity of tracheal mixed glands was observed in all cryopreserved tracheal segments. Caspase-3 immunoreactivity in tracheal mucosa and in mixed glands was significantly decreased, in contrast to the control group and to cryopreserved tracheal segments in which it remained high, due to the effect of storage in liquid nitrogen (P < 0.05, ANOVA and Tukey test). We conclude that apoptosis can be triggered in epithelial cells during tracheal graft harvesting even prior to cryopreservation, and although the epithelial caspase-3 immunoreactivity is reduced in tracheal cryopreservation, this could be explained by increased cell death. Apoptosis cannot be stopped during tracheal cryopreservation.
Assuntos
Animais , Cães , Apoptose/imunologia , /imunologia , Criopreservação/métodos , Traqueia , Epitélio/enzimologia , Imuno-Histoquímica , Traqueia/enzimologiaRESUMO
Cryopreservation has an immunomodulating effect on tracheal tissue as a result of class II antigen depletion due to epithelium exfoliation. However, not all epithelium is detached. We evaluated the role of apoptosis in the remaining epithelium of 30 cryopreserved tracheal grafts. Caspase-3 immunoreactivity of tracheal epithelium was studied in canine tracheal segments cryopreserved with F12K medium, with or without subsequent storage in liquid nitrogen at -196 degrees C for 15 days. Loss of structural integrity of tracheal mixed glands was observed in all cryopreserved tracheal segments. Caspase-3 immunoreactivity in tracheal mucosa and in mixed glands was significantly decreased, in contrast to the control group and to cryopreserved tracheal segments in which it remained high, due to the effect of storage in liquid nitrogen (P < 0.05, ANOVA and Tukey test). We conclude that apoptosis can be triggered in epithelial cells during tracheal graft harvesting even prior to cryopreservation, and although the epithelial caspase-3 immunoreactivity is reduced in tracheal cryopreservation, this could be explained by increased cell death. Apoptosis cannot be stopped during tracheal cryopreservation.
Assuntos
Apoptose/imunologia , Caspase 3/imunologia , Criopreservação/métodos , Traqueia , Animais , Cães , Epitélio/enzimologia , Imuno-Histoquímica , Traqueia/enzimologiaRESUMO
Angiogenesis is an essential process required for growth and tissue repair after injury, but it may also contribute to the pathology of a number of human disorders including neoplasias, atherosclerosis and inflammatory diseases. Vascular endothelial growth factor (VEGF) is a potent angiogenic peptide upregulated by many cytokines and endothelium shear stresses. Lung is a highly vascular tissue with finely organized and regulated microvascular beds, and its inflammation may lead to dysregulated angiogenesis. Hypersensitivity pneumonitis (HP) is a lung disorder characterized by chronic lymphocytic inflammation and endothelial damage. However, neovascularization has not been previously explored. In this study, we examined the expression and localization of VEGF in 38 patients with HP and 14 healthy control subjects (CS). VEGF levels in bronchoalveolar lavage fluid (BALF) were measured by ELISA, and cellular lung localization was determined by immunohistochemistry. In addition, VEGF expression was analyzed in lung tissue by RT-PCR. Our results showed sera levels significantly increased in HP patients compared with CS (209.3 +/- 189.3 vs. 55.3 +/- 31.4 pg/ml; p = 0.004). By contrast, BALF levels of VEGF were significantly decreased in HP patients compared with CS (35.3 +/- 51.5 pg/ml vs. 185.1 +/- 191.4 pg/ml; p < 0.001). VEGF was primary expressed by epithelial cells, smooth muscle cells, and interstitial macrophages in HP tissue. Flt-1 and Flk-1 receptors were highly expressed by endothelial cells from medium and small vessels in HP tissue. By RT-PCR the VEGF RNA was increased compared with those in normal lung. Our results suggest that abnormal expression of VEGF may contribute to impair the lung repair in HP.
Assuntos
Alveolite Alérgica Extrínseca/patologia , Pulmão/patologia , Neovascularização Patológica , Fator A de Crescimento do Endotélio Vascular/sangue , Alveolite Alérgica Extrínseca/metabolismo , Humanos , Imuno-Histoquímica , Fator A de Crescimento do Endotélio Vascular/biossíntese , Fator A de Crescimento do Endotélio Vascular/genéticaRESUMO
The objective of this study was to assess the possible role of vascular endothelial growth factor (VEGF) in the pathogenesis of systemic lupus erythematosus (SLE) and primary antiphospholipid syndrome (PAPS). We studied 28 patients with SLE, 10 patients with PAPS, and 24 healthy controls. VEGF plasma levels were measured by ELISA. Immunolocalization of VEGF was done in renal tissue from SLE patients and cadaveric controls. Our results showed that VEGF plasma levels were increased in SLE patients compared with PAPS and controls. The correlation between clinical manifestations and VEGF levels revealed that SLE patients with renal failure had significantly increased plasma VEGF levels (134.1 + 91.0 pg/ml) compared with SLE patients with normal renal function (42.9 + 19.0 pg/ml), PAPS patients (41.9 + 26.6 pg/ml), and controls (36.2 + 27.0 pg/ml; P < 0.01). Immunostaining showed a strong expression of VEGF in SLE renal tissue samples. Our preliminary results indicate that VEGF is increased in plasma from patients with lupus nephritis and a moderate degree of renal failure and is overexpressed in renal tissue from these patients.
Assuntos
Síndrome Antifosfolipídica/sangue , Fatores de Crescimento Endotelial/sangue , Nefrite Lúpica/sangue , Linfocinas/sangue , Adulto , Síndrome Antifosfolipídica/patologia , Fatores de Crescimento Endotelial/análise , Feminino , Humanos , Rim/química , Rim/patologia , Nefrite Lúpica/patologia , Linfocinas/análise , Masculino , Pessoa de Meia-Idade , Fator A de Crescimento do Endotélio Vascular , Fatores de Crescimento do Endotélio VascularRESUMO
In this study we assessed the usefulness of glutaraldehyde-preserved bovine pericardium (GPBP), preparated in our laboratory, in nonanatomic resection of lung tissue in dogs. A 30% resection of the right cranial lobe of the lung was performed in 18 mongrel dogs. The suture line was reinforced with GPBP strips. For group I (n = 6), the GPBP strips were fixed on the lung with nonabsorbable suture by thoracotomy. In Group II (n = 6), the resection and fixation of the GPBP strips were performed with an endoscopic linear stapler by thoracotomy. In Group III (n = 6), the resection and fixation of the GPBP strips were performed with a linear stapler by thoracoscopy. The animals were evaluated each day during the first week after surgery and every other day during the study time. At the end of the study all animals were euthanized with an overdose of pentobarbital. Macroscopic and microscopic examinations of the bioprosthesis and lung were evaluated. All animals survived the surgical procedure and study time (8 weeks). In the three groups, macroscopic examination of the bioprosthesis showed good adaptation to the lung tissue. Microscopically, all groups of animals presented good healing, with the presence of fibrotic tissue layer on the GPBP and its periphery as well as in the lung. However, in group I we observed the presence of giant cells in the suture line. GPBP proved to be a useful material for reinforcement of the nonanatomic resection suture line of lung tissue in dogs.
Assuntos
Bioprótese , Pulmão/cirurgia , Pericárdio/transplante , Animais , Bovinos , Cães , Feminino , Fixadores , Glutaral , Masculino , Suturas , CicatrizaçãoRESUMO
The P300 ERP component was studied in poor and normal readers, using Sternberg and color discrimination (Spaceships) tasks. During the first one, subjects must decide if a probe item belongs or not to a set of digits previously presented. In the second one, the participants must shoot violet spaceships with one key and other than violet spaceships with another key. There were no significant differences between groups with respect to reaction times, but a larger proportion of errors was observed in poor readers. Longer P300 latencies were recorded for poor readers than controls in both tasks. P300 amplitudes showed topographical differences between the two groups: Poor readers' P300 is larger frontally during the Sternberg task, but smaller at posterior sites during the Spaceships task. These results suggest that poor readers may have deficiencies during the early processing stage, such as visual stimulus evaluation. Poor readers also appear to have deficits for classifying and memorizing visual stimuli.
Assuntos
Testes de Percepção de Cores/psicologia , Discriminação Psicológica/fisiologia , Dislexia/fisiopatologia , Potenciais Evocados P300/fisiologia , Criança , Dislexia/psicologia , Eletroencefalografia , Feminino , Humanos , Masculino , Desempenho Psicomotor/fisiologia , Tempo de Reação/fisiologiaRESUMO
We report the results obtained from a behavioural and electrophysiological study. A synthesised continuum going from labial /ba/ to retroflex /da/ through dental /da/ was tested for category goodness. Native English speakers rated different tokens from each category as good, bad or ambiguous. The results showed that not all of the representatives of each category were ideal and that the categories tested have an internal structure. The electrophysiological study evaluated whether event related potentials (ERPs) mirrored the goodness judgements. During a passive oddball task, the same participants were exposed to native /ba/-/da/, Hindi dental /da/-retroflex /da/ and within-category /ba/-/ba/ contrasts. Results showed that participants pre-attentively perceive the differences in all cases, as shown by mis-match negativities (MMN), late positive deflections (LPD) or greater N1 and/or P2 components for deviant stimuli. Acoustic sensitivities, categorical perception and category goodness all contributed to the waveforms obtained. We attribute the ERP effects to a combination of (1) prototypes built from initial sensitivities, (2) reinforcement with exposure to one's native language and (3) no permanent loss of the initial boundaries explains the effects observed.
Assuntos
Percepção Auditiva , Potenciais Evocados Auditivos , Fonação , Fala/fisiologia , Adulto , Estudos Cross-Over , Feminino , Humanos , Julgamento , MasculinoRESUMO
The present study examined the electrophysiological responses that Native English speakers display during a passive oddball task when they are presented with different types of syllabic contrasts, namely a labial /ba/-dental /d a/, a Hindi dental /d a/-retroflex /da/ and a within-category (two /ba/ tokens) contrasts. The analyses of the event-related potentials obtained showed that subjects pre-attentively perceive the differences in all experimental conditions, despite not showing such detection behaviourally in the Hindi and within-category conditions. These results support the notion that there is no permanent loss of the initial perceptual abilities that humans have as infants, but that there is an important neural reorganisation which allows the system to overcome the differences detected and only be aware of contrasts that are relevant in the language which will become the subjects native tongue. We also report order asymmetries in the ERP responses and suggest that the percepts and not only the physical attributes of the stimuli have to be considered for the evaluation of the responses obtained.
Assuntos
Eletroencefalografia , Multilinguismo , Fonética , Percepção da Fala/fisiologia , Adulto , Mapeamento Encefálico , Potenciais Evocados Auditivos/fisiologia , Feminino , Humanos , Índia , Lactente , Desenvolvimento da Linguagem , Masculino , Pessoa de Meia-Idade , Plasticidade Neuronal/fisiologia , Valores de Referência , Espectrografia do SomRESUMO
Hypersensitivity pneumonitis (HP) is characterized by a T-cell-mediated alveolitis, and the putative role of other inflammatory cells in its pathogenesis remains unclear. In this study we determined whether increased quantities of neutrophils were present in HP lungs, and if they were positive for gelatinase B and collagenase-2. Fifteen nonsmoking patients with subacute/chronic active HP were included. Lung samples were analyzed using myeloperoxidase antibody, and neutrophil/total cell ratio was evaluated by digital processing. All HP tissue samples exhibited variable quantities of neutrophils located inside vessels, and in the interstitial and alveolar spaces. Lung neutrophil percentage ranged from 0.7% to 4.8% (2.1 +/- 1.4%). There was a positive correlation between the percentage of lung neutrophils and the percentage of lung fibrosis (r = 0.6, p < 0.02). Tissue neutrophils showed intense immunoreactive collagenase-2 and gelatinase B staining. Additionally, gelatinolytic activities corresponding to progelatinases A and B and their activated forms, were several-fold increased in the bronchoalveolar lavage fluid (BALF) from patients with HP as compared with control subjects. These findings suggest that in HP lungs there is a persistent traffic of neutrophils loaded with gelatinase B and collagenase-2 that may play a role in the lung damage and in the fibrotic response.
Assuntos
Alveolite Alérgica Extrínseca/patologia , Pulmão/patologia , Neutrófilos/patologia , Adulto , Líquido da Lavagem Broncoalveolar/química , Líquido da Lavagem Broncoalveolar/citologia , Adesão Celular , Endotélio Vascular/patologia , Feminino , Fibrose , Humanos , Imuno-Histoquímica , Contagem de Leucócitos , Pulmão/irrigação sanguínea , Masculino , Metaloproteinase 8 da Matriz/análise , Metaloproteinase 9 da Matriz/análise , Microcirculação/patologia , Neutrófilos/químicaRESUMO
BACKGROUND: A central feature in the pathogenesis of COPD is the inflammation coexisting with an abnormal protease/antiprotease balance. However, the possible role of different serine and metalloproteinases remains controversial. PATIENTS AND MEASUREMENTS: We examined the expression of gelatinases A and B (matrix metalloproteinase [MMP]-2 and MMP-9); collagenases 1, 2, and 3 (MMP-1, MMP-8, and MMP-13); as well as the presence of apoptosis in lung tissues of 10 COPD patients and 5 control subjects. In addition, gelatinase-A and gelatinase-B activities were assessed in BAL obtained from eight COPD patients, and from six healthy nonsmokers and six healthy smoker control subjects. SETTING: Tertiary referral center and university laboratories of biochemistry, and lung cell kinetics. RESULTS: Immunohistochemical analysis of COPD lungs showed a markedly increased expression of collagenases 1 and 2, and gelatinases A and B, while collagenase 3 was not found. Neutrophils exhibited a positive signal for collagenase 2 and gelatinase B, whereas collagenase 1 and gelatinase A were revealed mainly in macrophages and epithelial cells. BAL gelatin zymography showed a moderate increase of progelatinase-A activity and intense bands corresponding to progelatinase B. In situ end labeling of fragmented DNA displayed foci of positive endothelial cells, although some alveolar epithelial, interstitial, and inflammatory cells also revealed intranuclear staining. CONCLUSION: These findings suggest that there is an upregulation of collagenase 1 and 2 and gelatinases A and B, and an increase in endothelial and epithelial cell death, which may contribute to the pathogenesis of COPD through the remodeling of airways and alveolar structures.
Assuntos
Apoptose/fisiologia , Pneumopatias Obstrutivas/patologia , Pulmão/patologia , Metaloproteinase 1 da Matriz/metabolismo , Metaloproteinase 2 da Matriz/metabolismo , Metaloproteinase 8 da Matriz/metabolismo , Metaloproteinase 9 da Matriz/metabolismo , Idoso , Colagenases/metabolismo , Humanos , Técnicas Imunoenzimáticas , Masculino , Metaloproteinase 13 da Matriz , Pessoa de Meia-Idade , Neutrófilos/patologia , Regulação para Cima/fisiologiaRESUMO
Glutaraldehyde-preserved bovine pericardium (GPBP) is evaluated as a bioprosthesis for the reconstruction of surgical defects in the thoracoabdominal wall. The mechanical properties of bovine pericardium preserved at different concentrations of glutaraldehyde were studied. Samples preserved in 0.5% glutaraldehyde showed a significantly higher tensile strength (11.7 +/- 0.8 N/mm2) than samples preserved in 2.5, 5, or 10% (similar to pericardium preserved in normal saline). The percentage of elongation was significantly lower than samples preserved in 1, 2.5, and 5% glutaraldehyde. GPBP at 0.5% was used to repair experimentally induced defects of the abdominal wall (n = 9), chest wall (n = 6), diaphragm (n = 6), and sternum (n = 7). All animals presented adequate tolerance to the material used and no case of infection or rejection of the material was seen in any of the animals. Finally, 0.5% GPBP was used clinically in a series of 40 patients: postincisional abdominal hernia (n = 30), inguinal hernia (n = 8), diaphragmatic hernia (n = 1), and congenital pelvic defect with prolapse of abdominal organs (n = 1). Surgical use showed that GPBP was a very manageable material and long-term results were good in 37 patients with a mean follow up of 18 months (range 5-35 months). Six patients presented seroma formation (all abdominal hernia patients), three of which eventually developed infection and had the GPBP patch removed at 3, 5, and 7 months postoperatively. The rest of the patients presented good scar formation with adequate resistance at the area of implantation. GPBP is a biological material with sufficient resistance to be used surgically in the repair of thoracoabdominal defects. Ideal concentration of glutaraldehyde to be used in the preparation-preservation of the material is 0.5% since higher concentration negatively affect its tensile rupture strength and elongation.
Assuntos
Músculos Abdominais/cirurgia , Pericárdio/transplante , Cirurgia Torácica/métodos , Adolescente , Adulto , Idoso , Animais , Bovinos , Criança , Pré-Escolar , Diafragma/cirurgia , Cães , Feminino , Glutaral , Herniorrafia , Humanos , Masculino , Pessoa de Meia-Idade , Omento/cirurgia , Doenças Peritoneais/etiologia , Resistência à Tração , Aderências Teciduais/etiologia , Preservação de Tecido/métodosRESUMO
The severity of pulmonary fibrosis is the main prognostic factor for survival of patients with interstitial lung diseases (ILD). Unfortunately, lung biopsy, which is the best method to assess fibrosis quantitatively, is done only once during the evolution of the disease. In this study we analyzed the relationship between the degree of fibrosis and the exponential constant k, derived from the lung pressure-volume curve (LPVC) in 33 patients with chronic ILD, 19 with pigeon breeder's disease (PBD), and 14 with idiopathic pulmonary fibrosis (IPF). Pulmonary function tests, including the LPVC, were obtained before biopsy. A semiquantitative histologic assessment of the severity of fibrosis was performed on lung tissues. All patients showed a decrease of total lung capacity, residual volume, compliance, and Pao2. The mean value of the constant k was 0.08 +/- 0.06. When expressed as a percent of normal values, 25 patients exhibited values of k lower than 70% of predicted; of the remaining 8 patients whose values were above 70% of predicted, 7 had PBD and only one IPF. On morphologic analysis, 19 patients displayed more than 50% fibrosis. No significant correlations were found between the extent of the lesion or severity of lung fibrosis and the conventional pulmonary function tests. By contrast, a moderate but significant correlation was found between k and the severity of lung fibrosis (r = -0.38, p < 0.05). These findings show that the shape of the LPVC, represented by the constant k, predicts the degree of lung fibrosis and could be useful in the clinical assessment and follow-up of patients with ILD.
Assuntos
Fibrose Pulmonar/fisiopatologia , Adolescente , Adulto , Idoso , Biópsia , Feminino , Humanos , Complacência Pulmonar/fisiologia , Medidas de Volume Pulmonar , Masculino , Pessoa de Meia-Idade , Fibrose Pulmonar/patologiaRESUMO
OBJECTIVES: To evaluate the in-vitro resistance of a pericardial tissue bioprothesis as well as its use for the reconstruction of surgical defects in the thoracoabdominal wall. MATERIALS AND METHODS: The prosthesis were preserved for 15 days in different concentrations of glutaraldehyde (0.5% to 10%). Normal saline and Hanks solution were used as controls. Tensile strength and percent elongation were measured using an Instrom 1011 automatic equipment; polypropilene (Marlex) and polyester (Mersilene) mesh samples were included. Also, the 0.5% glutaraldehyde-preserved pericardium was used to repair defects experimentally produced in the abdominal wall (n = 12), chest wall (n = 6), diaphragm (n = 6), and sternum (n = 7) of mongrel dogs. RESULTS: The samples preserved in 0.5% glutaraldehyde showed a significantly higher tensile strength (11.7 N/mm2, SEM = 0.8) than samples preserved in other concentrations as well as in the mesh samples. Percent elongation in 0.5% glutaraldehyde was 56% (SEM = 5.8) which was similar to the meshes' elongation but significantly lower than that seen for the 1%, 2.5% and 5% glutaraldehyde-preserved samples. The dogs showed good tolerance to the 0.5% preparation and the histopathology showed formation of a fibroblast layer with collagen deposits and development of scar tissue. There was no case of infection or rejection in the animals, and all the microbiological cultures of the preparations were negative. CONCLUSION: Pericardial bioprothesis is a resistant material which can be used surgically in the repair of thoracoabdominal defects.
Assuntos
Músculos Abdominais/cirurgia , Bioprótese , Cirurgia Torácica/métodos , Animais , Bioprótese/efeitos adversos , Bovinos , Diafragma/cirurgia , Cães , Estudos de Avaliação como Assunto , Feminino , Glutaral , Masculino , Pericárdio , Polipropilenos , Esterno/cirurgia , Telas Cirúrgicas , Resistência à Tração , CicatrizaçãoRESUMO
Our objective was to assess the capacity of clinical and laboratory information to predict findings in the lung biopsy in interstitial lung diseases (ILD). We studied 121 patients with ILD as a cohort recruited in our institute from 1983 to 1987 with the diagnosis of hypersensitivity pneumonitis (HP) and usual interstitial pneumonia (UIP). Histologic diagnosis (HP vs UIP) and degree of fibrosis (< 50% of the biopsy surface vs > or = 50%) were used as the gold standard to compare a series of clinical and laboratory variables in the initial assessment. We used a stepwise logistic regression model to predict the biopsy results. The model was calculated in half of the patients selected by random sampling, and the calculated model was tested in the other half of the patients. Variables found to predict degree of fibrosis were (with relative risk RR and 95% confidence interval): a radiographic pattern of honeycombing (RR 5.0 from 0.9-29), digital clubbing (RR 8 from 1.4-48) and gender (RR 2.9 from 0.4-20). This model classified correctly 72% of the biopsies, with a sensitivity of 0.38, a specificity of 0.85 and a kappa of 0.25 +/- 0.19 (p = 0.17 NS). For histologic diagnosis (NIU vs NH), the model included gender (RR 6.6, 1.3-33), honeycombing (RR 1.6, from 0.4-6.0), digital clubbing (RR 4.6, from 1.2-18), and vital capacity expressed as percent of predicted (RR 0.96, from 0.92-1.00).(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Alveolite Alérgica Extrínseca/patologia , Doenças Pulmonares Intersticiais/patologia , Adolescente , Adulto , Idoso , Alveolite Alérgica Extrínseca/diagnóstico , Alveolite Alérgica Extrínseca/etiologia , Alveolite Alérgica Extrínseca/mortalidade , Biópsia , Pulmão do Criador de Aves/diagnóstico , Pulmão do Criador de Aves/etiologia , Pulmão do Criador de Aves/mortalidade , Pulmão do Criador de Aves/patologia , Estudos de Coortes , Diagnóstico Diferencial , Feminino , Fibrose , Humanos , Recém-Nascido , Modelos Logísticos , Pulmão/patologia , Doenças Pulmonares Intersticiais/diagnóstico , Doenças Pulmonares Intersticiais/etiologia , Doenças Pulmonares Intersticiais/mortalidade , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Risco , Sensibilidade e Especificidade , Capacidade VitalRESUMO
The clinical course of chronic pigeon breeder's lung (CPBL) is unknown, especially in comparison with usual interstitial pneumonia (UIP). We studied a cohort of 125 consecutive patients with interstitial lung diseases, including 78 patients with CPBL (74 biopsied) and 47 patients with UIP in the lung biopsy. Patients with UIP were divided into 17 without bird exposure (UIP) and 30 with bird exposure (UIP + BE). All patients were treated with corticosteroids and followed for 33 +/- 23 months. The best predictors of mortality (Cox proportional hazards model) were age > 44 yr, with a relative risk (RR) of 2.5 and 95% confidence interval (CI) of 1.4 to 4.7, masculine gender (RR 4.0, CI 2.1 to 7.6), x-ray honeycombing (RR 7.0, CI 3.8 to 12.7), and severity of fibrosis in the lung biopsy (RR 4.8, CI 2.3 to 9.7). Survival in CPBL 5 yr after diagnosis was 0.71 (SEM 0.08) and in UIP was 0.23 (SEM 0.08), with no statistical difference between UIP + BE and UIP. After adjusting for severity of fibrosis and honeycombing, however, the correlation of diagnosis with survival disappeared. In conclusion, mortality in CPBL is considerable, but lower than in UIP. Lung fibrosis and honeycombing seem to be a final common pathway for the ILD. Adjusting for them, the effect of diagnosis in survival is not significant.
Assuntos
Pulmão do Criador de Aves/mortalidade , Fibrose Pulmonar/mortalidade , Adulto , Fatores Etários , Idoso , Biópsia , Pulmão do Criador de Aves/diagnóstico por imagem , Pulmão do Criador de Aves/patologia , Doença Crônica , Feminino , Seguimentos , Humanos , Pulmão/diagnóstico por imagem , Pulmão/patologia , Masculino , México/epidemiologia , Pessoa de Meia-Idade , Prognóstico , Modelos de Riscos Proporcionais , Estudos Prospectivos , Fibrose Pulmonar/diagnóstico por imagem , Fibrose Pulmonar/patologia , Radiografia , Fatores Sexuais , Análise de Sobrevida , Fatores de TempoRESUMO
Lung transplantation has been slow to develop due mainly to the association of complications at the bronchial anastomosis secondary to the devascularization incurred during procurement. In the present study we evaluate the importance of the protection of the bronchial anastomoses with an omental pedicle. Mongrel dogs were operated upon forming four study groups: lung allotransplantation with bronchial protection (group T1, n = 9), lung allotransplantation without protection (group T2, n = 6); the two remaining groups did not receive a transplant but instead underwent surgery with extensive dissection and transection with reanastomoses of the left main bronchus with (group B1, n = 5) and without (group B2, n = 5) bronchial protection. All animals survived the surgical procedure. There were 8 complications at the bronchial anastomosis, six of which appeared in group T2 and were directly responsible for the animals death (p less than 0.05 when comparing lethal complications with group T1). Angiographic and dye perfusion studies were performed through the right gastroepiploic artery of the omentum. Bronchial neovascularization was demonstrated macroscopically as well as with light microscopy in all animals receiving protection with omentum (groups T1 and B1). We conclude that adequate bronchial protection is achieved with an omental pedicle flap brought up to the thorax during lung transplantation. It diminishes significantly the incidence of lethal complications at the bronchial anastomosis due to the revascularization that occurs through the omentum.