Utilidad del plasma rico en plaquetas en neumología / Usefulness of platelet-rich plasma in pneumology

The use of Platelet-rich plasma (PRP) involves a very complex network of molecular effects favoring tissue regeneration, due the presence of multiple mediators and growth factors. There are several communications about its use on the dental implantology field, plastic surgery and orthpedics. Besides, its utility has been suggested on peripheral nerves regeneration after trauma. In this article we present our experience on the use of PRP on acute injury of the respiratory system. We present a clinical series of 8 patients treated with PRP with positive response. Four of them presenting a massive hemoptysis were treated by direct endoscopic instillation of autologous PRP on the site of lesion; an immediate favorable result was obtained in all of them, without recurrence of bleeding on the follow-up period. A fifth case was a HIV seropositive patient with a spontaneous pneumothorax on intersticial pneumonia. He was treated by direct instillation of PRP through a thoracic tube. Full lung reexpansion was achieved within 72 h. Finally two patients with a respiratory fistula and another patient who suffered a traumatic tracheal rupture were treated with PRP endoscopic instillation, all of them with favorable clinical outcome. The use of autologous products as PRP has shown a good performance in all the clinical situations described, proposing it as a potentially very useful technique, particularly when a minimally invasive approach is required.

El uso de plasma rico en plaquetas (PRP) involucra una compleja red de efectos moleculares que favorecerían la regeneración tisular, dada la presencia en él de múltiples mediadores y factores de crecimiento. Se ha comunicado su uso con éxito en implantología odontológica, cirugía plástica y ortopedia como también se ha sugerido su utilidad en la regeneración de nervios periféricos posterior a trauma. No existe difusión acerca de su uso en patología respiratoria. Comunicamos nuestra experiencia en el uso de PRP en daño agudo del aparato respiratorio. En esta serie de casos, se trataron 4 pacientes con hemoptisis masiva mediante preparación de PRP autólogo previo al procedimiento e instilación vía endoscópica en el sitio del defecto, con buen resultado inmediato y sin recidiva del sangrado al seguimiento; 1 caso de neumotórax espontáneo con infiltrados pulmonares con fracaso del manejo con sonda endopleural (SEP), que resultó ser una neumonía intersticial con quistes pulmonares en un paciente VIH sero-positivo, instilándose PRP por SEP, reexpandiendo el pulmón a las 72 h; 2 pacientes portadores de fístula respiratoria y 1 paciente portador de ruptura traqueal traumática, todos con buena respuesta. El uso de productos autólogos como PRP ha logrado un favorable rendimiento en todas las situaciones clínicas planteadas, lo que lo sitúa como una herramienta con notable potencial de desarrollo particularmente en casos que por sus características particulares requieren de un manejo mínimamente invasivo.

Hallazgos endoscópicos en pacientes con hemoptisis y radiografía de tórax normal / Endoscopics findings in patients with hemoptysis and normal chest X-ray

La hemoptisis se define como la emisión de sangre proveniente de la región subglótica, habitualmente por el mecanismo de la tos. Se realizó un estudio observacional descriptivo, de corte transversal y retrospectivo a los pacientes con hemoptisis y radiografía de tórax posteroanterior normal a los cuales se les realizó broncoscopia en el período de tiempo de enero de 1999 a enero del 2009 en el Hospital Neumológico "Benéfico Jurídico", con el objetivo de identificar los hallazgos endoscópicos obtenidos a través de este proceder. Se revisaron los libros de registros de broncoscopias y de los resultados de informes de Microbiología y Anatomía patológica del centro. La población estuvo compuesta por 197 enfermos y la muestra quedó constituida por 67 pacientes. El análisis estadístico se realizó en el programa EPIDAT versión 3.0. Se utilizaron medidas de resúmenes para variables cuantitativas, media y desviación estándar (DE), en todas las variables se usó la frecuencia absoluta y los porcentajes con sus respetivos intervalos de confianza del 95 por ciento. Predominó el sexo masculino con un total de 45 pacientes (67,2 por ciento) y el grupo de edad entre los 40-49 años. En 70,1 por ciento de los casos se observó signos inflamatorios, en 16 enfermos se obtuvo crecimiento de gérmenes patógenos y en 17 (25,3 por ciento) se confirmó el diagnóstico de enfermedad neoplásica por biopsia y/o cepillado bronquial.

Hemoptysis is defined as the outcomming of blood from the subglotic region, habitually by the mechanism of cough. A cross- sectional, retrospective, transverse and descriptive study was carried out in patients with hemoptysis and normal PA thorax's x-ray. To whom were practiced bronchoscopy in the "Benéfico Jurídico" Neumologyc Hospital from January 1999, to January 2009, with the purpose of identifing the endoscopyc discoveries obtained through this procedure. The information was obtained from the bronchoscopy, microbiology and pathological Anatomy records of this center. The population was composed by 197 sick people and the sample was constituted by 67 patients. The statistical analysis was carried out in the program EPIDAT version 3.0. Mediates and standard (SD) were used for quantitative variables and absolute frequency and the percentages with their respective intervals of trust of 95 percent were used in all the variables. The masculine sex prevailed with a total of 45 patients (67.2 percent) and the age group was among 40-49 years old. In 70.1 percent of the cases it was observed inflammatory signs, and it was also obtained growth of pathogenics germs in 16 patients and in 17 (25.3 percent) it was confirmed the diagnosis of neoplasic disease by biopsy and/or bronchial brushing.

Malignant Hypertension with an Unusual Presentation Mimicking the Immune Mediated Pulmonary Renal Syndrome

A 27-year-old man presented at the emergency room with hemoptysis. His blood pressure was 180/100 mm Hg, and he had no history of hypertension. Chest radiographs showed bilateral infiltration, suggestive of alveolar hemorrhage. His laboratory data were consistent with acute kidney injury. His serum creatinine level increased abruptly; therefore, renal biopsy was performed. Steroid pulse therapy was administered because of a strong suspicion of immune-mediated pulmonary renal syndrome. Renal biopsy showed proliferative endarteritis, fibrinoid necrosis, and intraluminal thrombi in the vessels without crescent formation or necrotizing lesions. Steroid pulse therapy rapidly tapered and stopped. His serum creatinine level gradually decreased with strict blood pressure control. Ten months after discharge, his blood pressure was approximately 120/80 mm Hg with a serum creatinine level of 1.98 mg/dL. Pulmonary renal syndrome is generally caused by an immune-mediated mechanism. However, malignant hypertension accompanying renal insufficiency and heart dysfunction causing end-organ damage can create a pulmonary hemorrhage, similar to pulmonary renal syndrome caused by an immune-mediated mechanism. The present case shows that hypertension, a common disease, can possibly cause pulmonary renal syndrome, a rare condition.

Hemoptise em hospital de referência em pneumologia / Hemoptysis in a referral hospital for pulmonology

OBJETIVO: Determinar as principais causas de hemoptise e classificar esse sintoma quanto ao volume de sangue expectorado em pacientes internados em um hospital de referência em pneumologia. MÉTODOS: Foram incluídos 50 pacientes com hemoptise internados na enfermaria de pneumologia de um hospital geral na cidade do Recife (PE) no período entre julho de 2005 e fevereiro de 2006. Os dados de interesse foram analisados e comparados aos da literatura mundial. RESULTADOS: As infecções foram principais causas de hemoptise - em 39 pacientes (78 por cento) - a maioria delas relacionadas a sequelas de tuberculose pulmonar ou secundárias a tuberculose ativa. Em relação ao grau de hemoptise, as hemoptises moderadas, diagnosticadas em 28 pacientes (56 por cento), foram as mais encontradas. CONCLUSÕES: Nossos resultados sugerem que todos os pacientes com hemoptise devam ser investigados quanto a infecções.

OBJECTIVE: To determine the main causes of hemoptysis and to classify this symptom, in terms of the amount of blood expectorated, in patients hospitalized at a referral hospital for pulmonology. METHODS: The study included 50 patients with hemoptysis admitted to the pulmonology ward of a general hospital in the city of Recife, Brazil, between July of 2005 and February of 2006. The data of interest were analyzed and compared with those in the literature. RESULTS: The most common cause of hemoptysis was infection-in 39 patients (78 percent)-mostly related to tuberculosis sequelae or active tuberculosis. Regarding the severity of hemoptysis, moderate hemoptysis, diagnosed in 28 patients (56 percent), was the most common. CONCLUSIONS: Our results suggest that all patients who present with hemoptysis should be investigated for infection.

Pathology and pathophysiology of pulmonary manifestations in leptospirosis

Leptospirosis is a re-emerging zoonosis occurring as large outbreaks throughout the world caused by Leptospira interrogans. The incidence of pulmonary involvement in leptospirosis has been reported to be increasing in the last years, affecting up to 70 percent of the patients. Alveolar hemorrhage presented as dyspnea and hemoptysis is the main pulmonary manifestation. The emergence of massive hemoptysis and acute respiratory distress syndrome has characterized the recent changes reported in the clinical patterns of leptospirosis. The pulmonary involvement has been emerged as a serious life threat, becoming the main cause of death due to leptospirosis in some countries. In this review we present the main clinical and pathological manifestations of pulmonary involvement in leptospirosis, with special focus on recent data concerning the pathophysiological mechanisms underlying lung injury.

Hemoptise/s e síndrome de angústia respiratória do adulto como causas de morte na leptospirose: mudanças de padröes clínicos e anatomopatológicos / Hemoptysis ant the adult respiratory distress syndrome as the causes of death leptospirosis: changes in the clinical and anatomopathological patterns

A leptospirose humana, uma das principais endemias dos centros urbanos no Brasil, vem crescendo de forma dramática nas três últimas décadas, com prevalência após enchentes causadas pelas chuvas de veräo. Säo descritas as recentes modificaçöes de seus padröes clínicos em nossa regiäo, constituídas pelo surgimento de hemoptise/s maciça/s e da síndrome de angústia respiratória do adulto, ou de ambas associadamente. Essas evidentes mudanças situadas nas estruturas respiratórias depontaram como séria ameaça à vida e como mecanismos de morte, passando a representar entre nós, por sua grande freqüência, a principal causa de óbito na leptospirose. A nova face da doença impöe revisäo dos conceitos sobre sua gravidade e especulaçäo sobre a patogenia dessas alteraçöes. A evoluçäo fatal dos seis pacientes descritos, dois deles sem icterícia e sem insuficiência renal, mostra a grandeza do desafio

Bilateral pulmonary aneurysm in Behçet's disease (a case report).

While investigating a chest opacity in Behcet's disease possibility of pulmonary aneurysm should be considered. Contrast enhanced CT is a safe diagnostic method which is useful in confirming or excluding the presence of an aneurysm in such cases. We report here the first case of bilateral pulmonary aneurysms in Behcet's disease.