ABSTRACT
PURPOSE: Investigate the morphological effects of chronic exposure to tobacco smoke inhalation and alcohol consumption on the lungs and on the growth of rats. METHODS: Sixty male Wistar rats were divided into four groups: control, tobacco, alcohol, tobacco + alcohol, for a period of study 260 days. Morphological analysis was conducted by optical and electron microscopy. Rat growth was investigated by measuring the snout-anus length, body mass index and body weight. RESULTS: The three groups exposed to the drugs presented lower growth and lower weight than the control group. The percentages of alveolitis, bronchiolitis and the mean alveolar diameter were greater, particularly in the groups exposed to tobacco smoke, but were not significantly different from the control group. Electron microscopy revealed more intense apoptotic and degenerative lesions in the smoking group, while degenerative lesions in the lamellar bodies were more intense with the association of both drugs. CONCLUSIONS: This experimental model showed morphological alterations observed by electron microscopy, principally due to tobacco smoke exposure. Alcohol and tobacco hindered the growth of rats, such that tobacco showed a greater effect on body length and alcohol on body weight.
OBJETIVO: Investigar os efeitos morfológicos da exposição crônica à inalação de fumaça do tabaco e o do consumo de álcool nos pulmões e no crescimento de ratos. MÉTODOS: Sessenta ratos Wistar machos foram distribuídos em quatro grupos: controle, tabaco, álcool e tabaco + álcool, e acompanhados por um período de 260 dias. No final do periodo foi realizada análise morfológica dos pulmões por microscopia óptica e eletrônica. O crescimento dos ratos foi investigado através da medição do comprimento focinho-ânus, peso corporal e índice de massa corporal. RESULTADOS: Os três grupos expostos às drogas apresentaram peso e comprimento significativamente menores que os do grupo controle. As percentagens de bronquiolite e alveolite, e o diâmetro alveolar médio foram maiores nos grupos expostos à fumaça do tabaco, mas sem significancia estatística quando comparadas ao grupo controle. A microscopia eletrônica revelou apoptose mais intensa e lesões degenerativas no grupo de fumantes, enquanto lesões degenerativas nos corpos lamelares foram mais intensas com a associação de ambas as drogas. CONCLUSÕES: Este modelo experimental mostrou alterações morfológicas observadas por microscopia eletrônica, principalmente devido à exposição ao tabaco. Tanto o alcool como o tabaco prejudicaram o crescimento dos animais, o tabaco mostrando um efeito maior sobre o comprimento e o álcool sobre o peso corporal.
Subject(s)
Animals , Male , Rats , Alcoholic Beverages/adverse effects , Lung/pathology , Tobacco Smoke Pollution/adverse effects , Tobacco/toxicity , Body Weights and Measures , Bronchiolitis/chemically induced , Bronchiolitis/pathology , Disease Models, Animal , Microscopy, Electron , Rats, WistarABSTRACT
El presente artículo busca presentar brevemente el perfeccionamiento de los conceptos de asma en la edad preescolar y referir la importancia práctica que tienen las definiciones de bronquiolitis aguda del lactante (definición de consenso) y de asma del niño de dos años, a la hora de facilitar la orientación del manejo diagnóstico y terapéutico desde las primeras expresiones de obstrucción bronquio-bronquiolar. La noción de intervención temprana permitirá minimizar la morbilidad y el riesgo de trastornos obstructivos en edades ulteriores.
The objective of this article was to briefly present the improvement of the concepts of asthma at preschool age and to expose the practical importance of the definitions of acute bronchiolitis of the infant (consensus definition) and of asthma in the two-year-old child at the time of facilitating the guidance of the diagnostic and therapeutic management from the first manifestations of bronchiobronchiolar obstruction. The notion of early intervention will allow to minimize morbidity and the risk for obstructive disorders at further ages.
Subject(s)
Humans , Child, Preschool , Asthma/classification , Asthma/pathology , Bronchiolitis/pathologyABSTRACT
Las infecciones respiratorias agudas de etiología viral ocupan el primer lugar de morbilidad en la población pediátrica a nivel mundial. El propósito de este estudio fue identificar los virus respiratorios como agentes etiológicos de estas infecciones en los niños que consultaron al Servicio de Pediatría del Hospital Universitario de Caracas. Se incluyeron pacientes entre 0 y 11 años que consultaron por infecciones respiratorias agudas. Se realizó encuesta epidemiológica y clínica y se tomaron las muestras (hisopado nasofaríngeo) para identificación y aislamiento de los virus respiratorios (influenza A y B, para influenza 1, 2, y 3, adenovirus y virus sincitial respiratorio) por inmunofluorescencia y cultivo. Durante 7 años se evaluaron 583 niños, el estudio virológico fue positivo en 83 pacientes (14,2 por ciento) correspondiendo 72,3 por ciento al virus para influenza 1,15,7 por ciento virus influenza A, 6 por ciento influenza B, 4,8 por ciento adenovirus y 1,2 por ciento al virus para influenza 3. Los hallazgos coinciden con la epidemiología en el país para el período del estudio. Se demostró la circulación de los virus para influenza 1 y 3,influenza A y B y adenovirus.
Respiratory viral infections are the first cause of morbidity in children worldwide. The purpose of this study was to know the viral etiology of acute respiratory infections in the Pediatric Department of the Hospital Universitario de Caracas. We investigated children 0-11 years with acute respiratory infections for viral etiology. The diagnosis was made by identification of respiratory viruses from nasopharyngeal swab (influenza A and B, parainfluenza 1,2, and 3, adenovirus and respiratory sincitial virus) by inmunofluorescence and culture. 583 patients were investigated. Respiratory viruses were detected in 14,2% cases, with parainfluenza type 1 virus the most commonly detected (72,3%), followed by influenza A 15,7%, influenza B 6%, adenovirus 4,8% and parainfluenza 31,2%. The virology results were similar to the epidemiological reports of the Health Services during the period of the investigation. It was demonstrated the circulation of parainfluenza viruses 1-3, influenza A and B and adenoviruses.
Subject(s)
Humans , Male , Female , Child , Adolescent , Respiratory Tract Diseases/etiology , Influenza, Human/epidemiology , Influenzavirus A/immunology , Influenzavirus B/immunology , Respiratory System/injuries , Respiratory Syncytial Virus, Human/isolation & purification , Bronchiolitis/pathology , Infections/epidemiology , Infections/immunology , Pneumonia/pathologyABSTRACT
The relationship between cigarette smoke and interstitial lung diseases (ILD) is not clear. Respiratory bronchiolitis (RB), usually found as an incidental histologic abnormality in otherwise asymptomatic smokers, is characterized by the accumulation of cytoplasmic golden-brown-pigmented macrophages within respiratory bronchioles. A small proportion of smokers have a more exaggerated response that, in addition to the bronchiole-centered lesions, provokes interstitial and air spaces inflammation and fibrosis extending to the nearby alveoli. This set of histologic changes is called RB-ILD, and it results in clinical symptoms. Desquamative interstitial pneumonia (DIP) is characterized by panlobular involvement, diffuse mild-to-moderate interstitial fibrosis, and massive alveolar filling with macrophages. It is well known that the histopathologic patterns of RB-IID and DIP may overlap, and that the key features for differentiating these disorders are the distribution and the extent of the lesions: bronchiolocentric in RB-IID and diffuse in DIP. It has been proposed that RB, RB-IID and DIP may be different components of the same histopathologic disease spectrum, representing various degrees of severity of the same process caused by chronic smoking, although this is still controversial. To illustrate the problem, we present the clinical case of a heavy-smoker patient with progressive dyspnea and radiographic pulmonary infiltrates suggesting of smoking related interstitial lung disease.
La enfermedad pulmonar difusa asociada al consumo de tabaco no ha sido claramente definida, la bronquiolitis respiratoria (RB) es un hallazgo morfológico frecuente en fumadores asintomáticos, se caracteriza por la acumulación de macrófagos pigmentados en los bronquiolos respiratorios. Sólo una pequeña proporción de los sujetos fumadores presenta una respuesta inflamatoria exagerada que compromete el intersticio y espacio alveolar, lo cual corresponde a la bronquiolitis respiratoria asociada a enfermedad pulmonar difusa (RBIID), que se manifiesta por disnea de esfuerzos y tos. La neumonía intersticial descamativa (DIP) se caracteriza por compromiso panlobular, fibrosis intersticial discreta e infiltración masiva del espacio aéreo por macrófagos. El patrón histopatológico de RBIID y DIP se pueden sobreponer, siendo los principales elementos diferenciadores entre ambas entidades, la distribución y extensión de las lesiones: compromiso bronquiolo-céntrico en RBIID y difuso en DIP. Se ha planteado que la RB, RBIID y DIP pueden constituir diferentes fases de una misma enfermedad asociada al consumo de tabaco, lo cual aún es motivo de controversia. Con el propósito de ilustrar este problema, se presenta el caso clínico de un paciente fumador que consultó por disnea progresiva, tos e infiltrados pulmonares bilaterales sugerentes de enfermedad pulmonar difusa asociada al tabaquismo.
Subject(s)
Humans , Male , Aged , Lung Diseases, Interstitial/etiology , Lung Diseases, Interstitial/pathology , Tobacco Use Disorder/adverse effects , Bronchiolitis/etiology , Bronchiolitis/pathology , Lung Diseases, Interstitial , Radiography, Thoracic , Tomography, X-Ray Computed , Tobacco Use Disorder/pathologyABSTRACT
PURPOSE: Surgical lung biopsy has been studied in distinct populations, mostly going beyond clinical issues to impinge upon routine histopathological diagnostic information in diffuse infiltrates; however, detailed tissue analyses have rarely been performed. The present study was designed to investigate the prognostic contribution provided by detailed tissue analysis in diffuse infiltrates. METHODS: Medical records and surgical lung biopsies from the period of 1982 to 2003 of 63 patients older than 18 years with diffuse infiltrates were retrospectively examined. Lung parenchyma was histologically divided into 4 anatomical compartments: interstitium, airways, vessels, and alveolar spaces. Histological changes throughout these anatomical compartments were then evaluated according to their acute or chronic evolutional character. A semiquantitative scoring system was applied to histologic findings to evaluate the intensity and extent of the pathological process. We applied logistic regression to predict the risk of death associated with acute and chronic histological changes and to estimate the odds ratios for each of the independent variables in the model. RESULTS: Impact on survival was found for male gender (P = 0.03), presence of diffuse alveolar damage (P = 0.001), and chronic histological changes (P = 0.0004) on biopsy. Thus, being male was associated with a slightly lower risk (O.R. = 0.18; P=0.03) of dying than being female. Death risk was increased 17 times in the presence of acute histological changes such as diffuse alveolar damage and 2.5 times in the presence of chronic histological changes. CONCLUSION: Detailed analysis of histological specimens can provide more than a nosological diagnosis: this approach can provide valuable information concerning prognosis.
PROPOSIÇÃO: A biópsia pulmonar cirúrgica tem sido estudada em populações distintas, geralmente abordando aspectos histopatológicos puramente diagnósticos em infiltrados pulmonares difusos, além de dados clínicos. Contudo, análises teciduais detalhadas em tais casos têm sido pouco exploradas. O presente estudo foi delineado com o intuito de se investigar a contribuição prognóstica fornecida pela análise histológica detalhada em infiltrados difusos. MÉTODOS: Foram examinados retrospectivamente os prontuários e biópsias pulmonares cirúrgicas de 63 pacientes maiores de 18 anos, com infiltrados difusos, de 1982 a 2003. O parênquima pulmonar foi dividido em 4 compartimentos histológicos: interstício, vias aéreas, vasos e espaços alveolares. Alterações histológicas de cada compartimento histológico foram então avaliadas de acordo com seu caráter evolutivo agudo ou crônico. Um escore semiquantitativo foi aplicado a achados histopatológicos com o intuito de se avaliar a intensidade e a extensão do processo patológico. Aplicamos regressão logística para predizer o risco de morte para alterações histológicas agudas e crônicas e para estimar a razão de probabilidades para cada uma das variáveis independentes do modelo. RESULTADOS: O impacto sobre a sobrevida foi observado para o gênero masculino (p=0.03), para a presença de dano alveolar difuso (p=0.001) e para alterações histológicas crônicas (p=0.0004) em biópsias. Assim, homens apresentariam menor chance (O.R. = 0.18; P=0.03) de morrer do que mulheres. O risco de morte foi 17 vezes maior na presença de alterações histológicas agudas como dano alveolar difuso e 2,5 vezes na presença de alterações histológicas crônicas. CONCLUSÃO: A análise detalhada de espécimes histológicos pode proporcionar maiores e mais valiosas informações de valor prognóstico do que o simples diagnóstico nosológico.
Subject(s)
Humans , Male , Female , Adolescent , Adult , Middle Aged , Aged, 80 and over , Lung Diseases/pathology , Lung/pathology , Biopsy , Brazil/epidemiology , Bronchiolitis/pathology , Epidemiologic Methods , Length of Stay , Lung Diseases/etiology , Lung Diseases/mortality , Prognosis , Pulmonary Alveoli/pathology , Pulmonary Fibrosis/pathology , Sex Factors , Vasculitis/pathologySubject(s)
Humans , Male , Adult , Female , Child , Bronchiolitis/etiology , Bronchiolitis/pathology , Bronchiolitis/therapy , Respiratory Tract Diseases/etiology , Haemophilus parainfluenzae/pathogenicity , Adenoviridae Infections/epidemiology , Adenoviridae Infections/therapy , Mycoplasma pneumoniae/pathogenicity , Orthomyxoviridae/pathogenicity , Prevalence , Enzyme-Linked Immunosorbent Assay/methods , Serology/methods , Fluorescent Antibody Technique, Direct/methods , Respiratory Syncytial Virus Vaccines/analysisABSTRACT
Bronquilolites ou bronquite obliterante säo termos gerais usados para descrever uma injúria imflamatória inespecífica que afeta primariamente as pequenas vias aéreas, freqüentemente poupando consideráveis porçöes de interstício pulmonar. Em geral, os termos utilizados säo confusos porque descrevem tanto a síndrome clínica quanto constelaçöes de anormalidades histopatológicas que podem acontecer sob variadas circustâncias. Infortunamente, muito do que tem sido descrito sobre bronquiolite na literatura baseia-se em casos isolados ou pequenas séries. Adicionalmente, a confirmaçäo histopatológica do diagnóstico em muitos desses casos näo tem sido descrito. Conseqüentemente, permanecem muitas dúvidas com relaçäo à epidemiologia, patologia, seqüelas e tratamento das bronquiolites. O objetivo desta revisäo é fornecer uma visäo geral sobre o assunto com base nos aspectos histopatológicos na tentativa de melhor compreeder as síndromes clínicas resultantes