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Biomedical subjects

C R de Carvalho

Publications and source records attributed to C R de Carvalho.

At least 19 recordsLinked to original sources
PubMed1992

Volume-assured pressure support ventilation (VAPSV). A new approach for reducing muscle workload during acute respiratory failure.

This study reports the preliminary clinical evaluation of a new mode of ventilation--volume-assured pressure support ventilation (VAPSV)--which incorporates inspiratory pressure support (PSV) with conventional volume-assisted cycles (VAV). This combination optimizes the inspiratory flow during assisted/controlled cycles, reducing the patient's respiratory burden commonly observed during VAV. Different from conventional PSV, VAPSV assures precise control of tidal volume (VT) in unstable patients. Eight patients with acute respiratory failure (ARF) were submitted to assisted ventilation under VAV and VAPSV. Patient's ventilatory workload (evaluated through the pressure-time product, mechanical work per liter of ventilation, and work per minute) and patient's ventilatory drive (occlusion pressure--P0.1) were significantly reduced during VAPSV. This "relief" was more evident among the most distressed patients (p < 0.001), allowing a reduction of more than 60 percent in muscle load, without the need of increasing peak tracheal pressure. Mean inspiratory flow (VT/TI), VT, and effective dynamic compliance were significantly increased during VAPSV, whereas the effective inspiratory impedance decreased. These mechanical advantages of VAPSV allowed a reduction of intrinsic PEEP, whenever it was present. Blood gas values were similar in both periods. We concluded that VAPSV is a promising form of ventilatory support. At the same time that it was able to safely assure a minimum preset VT, VAPSV reduced patient workload and improved synchrony between the patient and the ventilator during ARF.

Acute Disease↗
PubMed1990

Respiratory failure caused by adiaspiromycosis.

Adiaspiromycosis is a rare pulmonary disorder caused by the fungus Emmonsia crescens (or Chrysosporium parvum var crescens). According to the amount of inhaled conidia, man may develop symptomatic disease. After reaching the alveoli, the adiaconidia do not multiply or disseminate, but will induce a granulomatous inflammatory reaction that may lead to fatal respiratory failure. Up to now, only five cases of disseminated pulmonary infection have been documented. This work describes the occurrence, in Brazil, of two further cases of symptomatic disease with diffuse interstitial infiltrates and severe functional impairment. Possible massive infestation during activities in closed and stuffy environments is suggested. The specific diagnosis was troublesome and could not be made by cultures, skin tests or bronchoalveolar lavage. Both patients were successfully treated, but a spontaneous resolution of the process is seriously considered.

Brazil↗
PubMed1990

Glucocorticoid receptor in active pulmonary sarcoidosis.

Glucorticoid receptor (GR) content of open-chest lung biopsies of 8 patients with active non treated pulmonary sarcoidosis was compared to 10 normal lungs. Results showed a higher GR level in sarcoid lungs (86.0 +/- 8.0 fMol/mg protein) than in control ones (8.2 +/- 3.1 fMol/mg protein). Our findings suggest that this increase is due to the accumulation of active cells in the sarcoid granuloma, possibly lymphocytes and or macrophages that may express cytosolic GR. The high level of this receptor in sarcoidosis may represent an indicator of the responsiveness of this disease to corticoids.

Adult↗
PubMed1989

Pulmonary histiocytosis X: comparison of radiographic and CT findings.

The authors retrospectively evaluated radiographs, computed tomographic (CT) scans, and results of pulmonary function tests (when available) for 17 patients with biopsy-proved pulmonary histiocytosis X. In 11 patients, high-resolution CT was used. In 12 patients, CT demonstrated cystic air spaces, usually less than 10 mm in diameter. In three of these 12, cysts were the only abnormality, but in six others, nodules (usually less than 5 mm in diameter) were also present. Two patients had only nodules and one, only emphysema. CT showed that many lesions that appeared reticular on plain radiographs were actually cysts. CT showed no central or peripheral concentration of lesions, but it did reveal that many small nodules were distributed in the centers of secondary lobules around small airways. CT findings correlated better with the diffusing capacity (rho = -0.71) than did the plain radiographic findings (rho = -0.57). Thus, CT was better than radiography at showing the morphology and distribution of lung abnormalities.

Adult↗
PubMed1989

Histochemical evaluation of lung collagen content in acute and chronic interstitial diseases.

The collagen content and its aggregational state was histochemically measured in interstitial lung diseases. Open chest biopsies of ten patients with adult respiratory distress syndrome, seven patients with sarcoidosis, and nine patients with fibrosis associated with connective tissue diseases and with idiopathic pulmonary fibrosis (IPF/CTD) were compared with eight samples of normal lungs. The collagen content of diseased lungs was significantly increased when compared to control lungs, but no difference was observed among the pathologic groups. The analysis of collagen aggregational state showed maximal aggregation in IPF/CTD, followed by sarcoidosis, ARDS, and control lungs, in decreasing order. The results suggest that measurement of collagen aggregation coupled with collagen content could be used in the evaluation of interstitial lung disease and encourage the use of new techniques in order to better explain the dramatic histologic and functional alterations observed in many disease-associated lung processes.

Azo Compounds↗
PubMed1989

[Septic pulmonary embolism and endocarditis caused by Staphylococcus aureus in the tricuspid valve after infectious abortion. Report of 2 cases].

We report the cases of two patients with septic pulmonary embolism and respiratory failure after septic abortion. Hysterectomy was performed in both patients after unsuccessful uterine curettage and antibiotic therapy for treatment of the infection. The first patient (27 years-old) remained feverish. The blood cultures yielded Staphylococcus aureus. Tricuspid valve endocarditis was identified as the reason for persistent infection. Antibiotic treatment properly planned was administered and the patient was discharged. The second patient (23 years-old) apparently recovered after hysterectomy. Nevertheless, one month later, infection and septic pulmonary embolism recurred. The diagnosis of Staphylococcus aureus tricuspid valve endocarditis was made. Persistent infection unresponsive to medical treatment led to surgical treatment. The patient died after valve replacement. Thus the persistence or recurrence of infection and septic abortion may be due to tricuspid valve endocarditis.

Abortion, Septic↗
PubMed1988

Association of Sjögren's syndrome and sarcoidosis. Report of a case.

We report a case of a 57 year-old woman with Sjögren's syndrome and pulmonary complaints. After an initial evaluation, a lung biopsy was made and disclosed sarcoid lesions. This association is very rare, and the present case does not fulfill the criteria for TASS (Thyroiditis, Addison's disease, Sjögren, and Sarcoidosis). Sarcoidosis and Sjögren can coexist since both diseases may share the same immunological profile. This case report warrants further research on the overlapping of these diseases.

Female↗
PubMed1985

Changes in the pulmonary glucocorticoid receptor content in the course of interstitial disease.

The level of cytosolic glucocorticoid receptors (GR) was measured in 12 open-chest lung biopsies of interstitial pulmonary diseases. The results showed an increase in the GR content in the diseased lungs correlated to the degree of septal cellularity in nine cases. Two pulmonary sarcoidosis and one end-stage idiopathic pulmonary fibrosis patients presented higher levels of GR than those predicted by the septal cellularity. It was concluded that the GR content of the lungs increases in the course of interstitial diseases, reflecting the number of cells that express cytosolic GR in pulmonary parenchyma.

Adult↗
PubMedDate not supplied

[Kidney failure as a complication of the treatment of pulmonary paracoccidioidomycosis].

Sulfadiazine is one of the drugs of choice in the treatment of paracoccidioidomycosis. Side effects are uncommon. Cutaneous and gastrointestinal reactions and rarely leucopenia and jaundice may occur. A patient on sulfadiazine 6 g daily exhibiting a good response is reported. On the 12th day, he presented an intense abdominal pain and reduced urinary output. An ultrasonography revealed diffuse calculosis in urinary tract. Peritoneal dialysis, urinary alkalinization and rehydration were instituted with complete restoration of renal function. This case illustrates the importance of an adequate hydratation of patients receiving sulfadiazine, a simple measure in the prevention of this uncommon complication which carries a high morbidity.

Acute Kidney Injury↗
PubMedDate not supplied

[Transport of electrolytes in the respiratory epithelium in patients with cystic fibrosis].

In the conducting airway, the epithelial electrolyte transport processes play an important role in determining the composition of the respiratory tract fluid. Apical membrane Cl- and Na+ channels control the secretion and absorption of epithelial cells. Defective regulation of these channels is a prominent characteristic of cystic fibrosis.

Biological Transport, Active↗
PubMedDate not supplied

[Primary lung neoplasm in a patient with breast cancer: report of a case].

A pulmonary nodule in a patient with a previous or concomitant diagnosis of extrathoracic malignancy is not always a synonym of metastasis. When dealing with breast cancer this is very important since the pulmonary lesion is usually not related to the primary tumor. We present a white, 69 years old patient, submitted to mastectomy four years earlier, in which a solitary pulmonary nodule was found, and after resection, the histopathologic examination disclosed a intravascular bronchoalveolar tumor. This is a rare lesion, here represented in an unusual way.

Adenocarcinoma, Bronchiolo-Alveolar↗
PubMedDate not supplied

[Response to the administration of corticosteroids in patients with chronic obstructive lung disease and asthma].

A spirometric study was performed in order to evaluate the response to the administration of 200 mg of salbutamol, just before and after the daily administration of 8 mg of triamcinolone, for an average period of 2 weeks, in 21 patients with chronic obstructive pulmonary disease or asthma. Eleven patients responded with a significant increase of FVC or FEV1 or FEF25-75%, after administration of corticoid. Ten patients did not respond. In average there was a significant increase of the FVC and VEF1 (p < 0.01) and of FEF25-75% (p < 0.05) after the administration of corticoid. There was no significant difference between the responders and not responders when the age, initial FVC, FEV1 and FEF25-75% were taken in consideration. A significantly greater number of responders to corticoid responded also to the bronchodilator with an increase of FEF25-75%. There was a significant negative correlation between the intensity of the response to corticoid versus bronchodilator measured with delta FEF25-75%. The administration of corticoid did not change the response to bronchodilator.

Administration, Inhalation↗
PubMedDate not supplied

[Lymph node tuberculosis in adults].

Tuberculous lymphadenitis is a form of extrapulmonary tuberculosis that was observed in 8.4% of all cases with tuberculosis in our series. In all instances the organism isolated was M. tuberculosis. There was a high rate of PPD positiveness. The chemotherapy yielded good results. The evolution was satisfactory in 75% of the patients treated for six months.

Adolescent↗
PubMedDate not supplied

[Bronchial stenosis of tuberculous etiology: pathogenesis and treatment].

Four cases of bronchial stenosis as an unusual complication of tuberculosis are described. In the first case, a 18-year-old woman, the bronchial stenosis resulted from cicatrization of a primary focus. The X-ray examination showed no pulmonary lesion and she did not receive any specific treatment for tuberculosis. In other three patients the bronchial stenosis was due to active disease, and there were acid-fast bacilli in the sputum. They received treatment for tuberculosis which resulted in resolution of stenosis in one of them while in the other two the fibrotic bronchial stenosis persisted.

Adolescent↗
PubMedDate not supplied

[Alveolar proteinosis: report of 4 cases].

Pulmonary alveolar proteinosis is a rare disease characterized by the filling of the alveolar spaces of the lung by a PAS-positive lipoproteinaceous material. Despite the clear characterization of this material, the etiopathogenesis of the disease remains obscure. We present four patients who were admitted in our Department over the last seven years. The diagnosis was confirmed by lung biopsy in all cases. Three patients improved after bronchoalveolar lavage. Spontaneous remission was observed in one case.

Adult↗