Pulmonary function assessment in children and teenagers before and after surgical treatment for rheumatic valve disease

OBJECTIVE: To assess pulmonary function in children and adolescents subjected to correction of rheumatic valve disease in order to quantify changes caused by factors inherent to surgery and rheumatic heart diseaseMETHODS: This was a longitudinal and quantitative intervention study, undertaken at a children's hospital that is a center of excellence for the state of Pernambuco (Instituto Materno Infantil de Pernambuco), between December 2004 and May 2005. Eighteen children suffering from rheumatic fever and indicated for surgery to repair or replace the mitral valve were assessed preoperatively and again on the first and fifth postoperative days. The parameters recorded were minute volume, rapid shallow breathing index, peak expiratory flow, forced vital capacity and inspiratory capacityRESULTS: All patients were aged 8 to 17 years (mean 12.4±2.1), they had a mean body mass index of 16.1±2.2, and were weaned off invasive mechanical ventilation during the first 10 postoperative hours. All parameters had undergone significant deterioration on the first day (statistically significant, p < 0.01), demonstrating gradual improvement up to the last day of assessment, although, with the exception of minute volume which was no longer significantly different from the fourth day onwards (p > 0.01), without returning to baseline levels.CONCLUSION: We observed that the pulmonary dysfunction that results from this type of heart surgery is maintained until at least the fifth postoperative day. It appears that this dysfunction is influenced by the pain and mechanical alterations caused by sternotomy and reduced pulmonary compliance post surgery.

Prevalência de bactérias potencialmente patogênicas em espécimes respiratórios de fibrocísticos do Recife / Prevalence of potentially pathogenic bacteria in respiratory specimens of cystic fibrosis patients from Recife

Entre 147 espécimes respiratórios (114 escarros e 33 swabs faríngeos) coletados de 36 portadores de fibrose cística durante consultas de rotina ou na exacerbação de seus sintomas respiratórios, no período de dezembro de 2000 a dezembro de 2002, isolaram-se: Pseudomonas aeruginosa (65,3%), Staphylococcus aureus (29,9%), Burkholderia cepacia (29,2%) e Haemophilus influenzae (20,4%). Entre os isolados de S. aureus e H. influenzae, 6,8% foram resistentes à oxacilina e 6,7% foram produtores de beta-lactamase, respectivamente. Das 96 linhagens de P. aeruginosa encontradas, 59,4% foram do fenótipo mucóide. Em 12 espécimes, ambos os biótipos, mucóide e não-mucóide, estiveram presentes. Bactérias gram-negativas emergentes, tais como Stenotrophomonas maltophilia e Achromobacter xylosoxidans, foram isoladas em pequeno número. Com exceção do H. influenzae, mais freqüente nas crianças entre seis e 12 anos, não se encontrou diferença entre espécie bacteriana isolada e grupo etário.

Of 147 respiratory specimens (114 sputum and 33 pharyngeal swabs) collected from 36 cystic fibrosis patients during routine visits or exacerbation of their respiratory symptoms, from December 2000 to December 2002, the following bacterial species were recovered: Pseudomonas aeruginosa (65,3%), Staphylococcus aureus (29,9%), Burkholderia capacia (29,2%), and Haemophilus influenzae (20,4%). Among the S. aureus and H. influenzae isolates, 6,8% were oxacillin resistant and 6,7% were b-lactamase producers, respectively. Of 96 isolates of P. aeruginosa, 59.4% belonged to the mucoid phenotype. Both mucoid and non-mucoid morphotypes were simultaneously found in 12 specimens. Emerging gram-negative bacteria, such as Stenotrophomonas maltophilia and Achromobacter xylosoxidans, were present at a low number. H. influenzae was more prevalent in the cystic fibrosis children between six and 12 years old. Concerning the other bacterial species there was not preference for age groups.