The effect of smoking cessation on posterior ocular structures / O efeito da suspensão do tabagismo em estruturas oculares posteriores

ABSTRACT Purpose: This study evaluated changes in cho­roidal and macular thickness in healthy volunteers and chronic smokers. Methods: Thirty-three eyes of 33 chronic smokers (study group) and 33 eyes of 33 healthy controls who had never smoked were prospectively evaluated. Comprehensive ophthalmic assessment included slit lamp biomicroscopy, stereoscopic fundus examination, and intraocular pressure measurement. Spectral domain optical coherence tomography was used to measure choroidal and macular thickness 1 month before smoking cessation (smoking period) and after 3 months of smoking cessation (nonsmoking period). Results: The mean age of the participants was 41.88 ± 6.52 years (range, 26-52), and the average smoking duration was 8.6 ± 2.5 years (range, 5-16). The thickness of the paracentral choroid (nasal: 1,500 mm, p=0.001 and temporal: 1,500 mm, p=0.001) had significantly decreased after 3 months of smoking cessation. The thicknesses of the subfoveal choroid in the smoking and nonsmoking periods were not significantly different (p=0.194). The mean central macular thickness was 267.21 ± 18.42 mm in the smoking period and 268.42 ± 18.28 mm in the nonsmoking period (p=0.022). Conclusions: Smoking was associated with statistically significant changes in paracentral choroidal and central macular thickness in healthy volunteers. Pathological studies should be performed to evaluate the effects of smoking on posterior ocular structures.

RESUMO Objetivo: Este estudo avaliou as mudanças na espessura da coroide e da mácula em voluntários saudáveis e fumantes crônicos. Métodos: Trinta e três olhos de 33 fumantes crônicos (grupo estudado) e 33 olhos de 33 controles saudáveis que nunca fumaram foram avaliados prospectivamente. A avaliação oftalmológica abrangente incluiu biomicroscopia de lâmpada de fenda, exame de fundo estereoscópico e medição da pressão intraocular. A tomografia de coerência óptica de domínio espectral foi utilizada para medir a espessura da coroide e da mácula um mês antes da cessação do tabagismo (período de fumar) e após 3 meses da cessação do tabagismo (período de abstinência). Resultados: A idade média dos participantes foi de 41,88 ± 6,52 anos (faixa de 26-52 anos) e a duração média do tabagismo foi de 8,6 ± 2,5 anos (faixa, 5-16 anos). A espessura da coroide paracentral (nasal: 1.500 mm, p=0,001, temporal: 1.500 mm, p=0,001) diminuiu significativamente após 3 meses de cessação do tabagismo. As espessuras de coroide subfoveal nos períodos de tabagismo e não-tabagismo não foram significativamente diferentes (p=0,194). A espessura macular central média foi de 267,21 ± 18,42 mm no períodos de tabagismo e 268,42 ± 18,28 mm no períodos de não-fumantes (p=0,022). Conclusões: O tabagismo foi associado a mudanças estatis­ticamente significativas na espessura paracentral de coroide e macular central em voluntários saudáveis. Estudos patológicos devem ser realizados para avaliar os efeitos do tabagismo nas estruturas oculares posteriores.

Trends in lung cancer incidence in Lebanon by gender and histological type over the period 2005-2008

Introduction: Lung cancer incidence rates, overall and by histologic subtypes, vary substantially by gender and smoking. This study's aim was to review data regarding trends in the number of cases of different lung-cancer histologies and relate these to smoking habits by gender in Lebanon

Materials and methods: Lung cancer data using ICD-0, 3rd edition, from the Lebanese National Cancer Registry from 2005 to 2008 were stratified by gender for histology type for patients aged over 18 years. Results: Lung cancer cases among males were 2.5 times higher than those in females. The most common lung cancer histology type for males and females was adenocarcinoma for all observed years. The proportion of squamous cell carcinoma in incident cases was significantly higher in males than in females for the total period from 2005 to 2008, P = 0.032, but not in individual years. The ratio of adenocarcinoma to squamous cell carcinoma in incident cases between 2005 and 2008 was 2:45 for males and 3:15 for females

Conclusion: Lung cancer histology in Lebanon is following a pattern similar to that found in most countries of North America and in Europe, where adenocarcinoma is the most prevalent subtype among both males and females

Rendimiento diagnóstico de la broncoscopia con biopsia transbronquial en el estudio de lesiones sugerentes de cáncer pulmonar / Bronchoscopy with transbronchial biopsy for the diagnosis of potentially malignant pulmonary lesions: experience in 261 patients

Background: Bronchoscopy is a minimally invasive procedure used for the diagnosis of lung cancer. Aim: To report our experience with bronchoscopy and transbronchial biopsies for the diagnosis of potentially malignant pulmonary lesions. Material and Methods: Revision of electronic records from patients who underwent transbronchial biopsies seeking for lung cancer. The diagnostic yield of the procedure was evaluated using pathology reports or a 24 months follow up. Results: 261 patients were included. Bronchoscopy was diagnostic in 65% of cases. Lesions mean diameter was 51 mm (range 9-120 mm). Diagnostic yield for lesions less than 30 mm was 59%, for lesions less than 35 mm was 61%, and for lesions over 40 mm was 69%. The presence of malignant lesions and their location in the superior or middle lobe were associated with a better predictive value of the procedure. TNM staging was IIIB/IV in 80% of the patient at the time of diagnosis. Conclusions: The diagnostic yield of bronchoscopy is influenced by the etiology and location of lung lesions.

Prevalência de alguns fatores de risco para doenças crônicas não transmissíveis em adultos residentes no município de Alta Floresta / Prevalence of some risk factors for chronic noncommunicable diseases in adults living in the municipality of Alta Floresta

Currently, chronic noncommunicable diseases occupy priority space in healthcare. In 2007, approximately 72% of the deaths occurred in Brazil were attributed to these diseases. This study aims to estimate the prevalence of some risk factors for chronic noncommunicable diseases in adults living in the municipality of Alta Floresta, Mato Grosso state, Brazil. This is a population-based cross-sectional study with 292 adults. Obesity was classified according to the standardization of the World Health Organization (BMI ? 30kg/m2). All individuals with blood pressure ? 140/90mmHg and/or those who reported the use of antihyperten¬sive medication were considered hypertensive; while those who reported having no physical activity during leisure time were considered sedentary. Alcohol consumption was expressed in grams of ethanol, considering consumption above 30g and 15g per day as risk values for men and women, respectively. Individuals who reported smoking cigarettes at the time of the survey were considered smokers. The risk factor with the highest prevalence was sedentary leisure. Men showed higher percentages for smoking and alcohol consumption, while women did for obesity. Hypertension and obesity were the most prevalent risk factors in the older age group.

Actualmente, las enfermedades crónicas no transmisibles ocupan un espacio prioritario en el área de la salud, dado que en el 2007 se les atribuyeron alrededor del 72% de las muertes producidas en Brasil. El objetivo de este estudio es el de estimar la prevalencia de algunos factores de riesgo de las enfermedades crónicas no transmisibles en los adultos que viven en la ciudad de Alta Floresta, MT. Se trata de un estudio transversal con base poblacional de 292 adultos. La obesidad se clasificó según la estandarización de la Organización Mundial de la Salud (IMC ? 30kg/m2). Se consideraron hipertensos todos aquellos pacientes con presión arterial ? 140/90mmHg y/o todos aquellos que utilizaban antihipertensivos, mientras que se consideraron sedentarios aquellos pacientes que no practicaban actividad física durante su tiempo libre. El consumo de alcohol se expresó en gramos de etanol, considerándose como valores de riesgo los situados por encima de 30g de etanol al día para los hombres y 15g/día para las mujeres. Se consideraron fumadores aquellos que declararon fumar cigarrillos en el momento de la investigación. El factor de riesgo que presentó una mayor prevalencia fue el de sedentarismo en su tiempo libre. Los hombres mostraron un porcentaje más elevado en el consumo de tabaco y bebidas alcohólicas, mientras que las mujeres lo hicieron en el de obesidad. La hipertensión arterial y la obesidad fueron los factores de riesgo con mayor prevalencia en el grupo de mayor edad.

Atualmente, as Doenças Crônicas Não Transmissíveis ocupam espaço prioritário na área da saúde, sendo que, em 2007, cerca de 72% das mortes no Brasil foram atribuídas às mesmas. Este estudo tem como objetivo estimar a prevalência de alguns fatores de risco para doenças crônicas não transmissíveis em adultos residentes no município de Alta Floresta-MT. Trata-se de um estudo transversal de base populacional, com 292 adultos. A obesidade foi classificada segundo padronização da Organização Mundial de Saúde (IMC ? 30kg/m2). Foram considerados hipertensos todos os indivíduos com pressão arterial ? 140/90mmHg e/ou aqueles que referiram uso de anti-hipertensivo, e sedentários aqueles que relataram não praticar atividade física no lazer. O consumo de bebida alcoólica foi expresso em gramas de etanol, considerando como risco valores acima de 30g e 15g de etanol por dia, para homens e mulheres, respectivamente. Foram considerados fumantes aqueles que declararam fumar cigarros na ocasião da pesquisa. O fator de risco que apresentou maior prevalência foi o sedentarismo no lazer. Os homens apresentaram percentuais mais elevados para tabagismo e consumo de bebida alcoólica, e as mulheres, para a obesidade. A hipertensão arterial e a obesidade foram os fatores de risco de maior prevalência na faixa etária mais avançada.

Oral leukoplakia manifests differently in smokers and non-smokers

Oral leukoplakias (OL) are potentially malignant lesions that are typically white in color. Smoking is considered a risk factor for developing OL, and dysplastic lesions are more prone to malignant transformation. The aim of this study was to describe the clinical features observed in dysplastic and non-dysplastic OL in both smokers and non-smokers. A total of 315 cases of OL were retrieved and separated into either dysplastic or non-dysplastic lesions, and these cases were further categorized as originating in either smokers or non-smokers. Frequencies of the type of OL lesion, with respect to whether the patients smoked, were established. The results demonstrated that 131 cases of OL were dysplastic (74 smokers and 57 non-smokers), and 184 were non-dysplastic (96 smokers and 88 non-smokers). For OL cases in smokers for which information about alcohol consumption was also available (84 cases), the results revealed no significant difference in the amount of dysplastic and non-dysplastic lesions. Dysplastic lesions were more frequent in male smokers and in non-smoking females. The median age of smokers with cases of OL was significantly lower than in non-smokers; the lowest median ages were observed for female smokers with dysplastic OL. The most frequent anatomical sites of dysplastic lesions were the floor of the mouth in smokers and the tongue in non-smokers. Dysplastic lesions in smokers were significantly smaller than non-dysplastic lesions in non-smokers. Being a male smoker, being female, being younger, and having smaller lesions were associated with dysplastic features in OL. These clinical data may be important for predicting OL malignant transformation.

Quantification of AgNOR expression in exfoliated oral mucosal cells of tobacco chewers with and without lesion.

Background: Nucleolar organizer regions (NOR) are associated with proliferative activity and represent a diagnostic and prognostic marker. Materials and Methods: Smears were taken from smokers, tobacco chewers, oral squamous cell carcinoma patients, and normal subjects and evaluated by 2 silver-staining nucleolar organizer region (AgNOR) counting methods: (1) mean number of AgNORs per nucleus (mAgNOR); and (2) percentage of nuclei with >3 and >5 AgNORs (pAgNOR). Results: A statistically significant difference was observed between normal subjects, smokers, tobacco chewers, and oral cancer patients and between tobacco chewers with and without lesion. No significant difference was observed between tobacco chewers and smokers except in the percentage of >5 criteria. Conclusions: AgNOR enumeration using noninvasive methods, such as the cytobrush appears to be useful technique in distinguishing between normal mucosa, mucosa with and without lesions exposed to carcinogens, such as tobacco and frank oral carcinoma.

Hamartoma condromixoide de pulmón / Hamarthoma condromixoide of lung

El hamartoma pulmonar descrito en 1904, se presenta como una masa de crecimiento lento, y puede estar ubicada dentro del bronquio o en el parénquima pulmonar. Siendo esta presentación la más frecuente en el hombre, diagnosticado en forma casual, consiste en un tumor integrado en su estructura histológica por una combinación de cartílago, tejido conectivo, músculo liso y epitelio respiratorio. Desde el punto de vista radiológico corresponde a un nódulo pulmonar solitario. Se reporta un caso de hamartoma pulmonar de localización parenquimatosa en hombre de 59 años de edad

The pulmonary hamartoma, was described in the year 1904, it is presented like a mass of slow growth, and can be localized on the bronchus or in the pulmonary parenchyma; it presentation is saw frequently in men like a casual diagnosis. Pulmonary hamartoma is a integrate tumor in its histology structure by a combination of cartilage, connective tissue, smooth muscle and the respiratory epithelium. Radiological is a solitaire pulmonary nodule. It is reported a clinical case of solitaire pulmonary nodule located in parenchyma of a man 59 years old

Prevenção e Detecção Precoce do Câncer de Boca: Screening em Populações de Risco / Prevention and Early Detection of Oral Cancer: Screening in Risk Populations

Objetivo: Avaliar a viabilidade de programa de prevenção e diagnóstico precoce do câncer de boca direcionado a grupos considerados de risco para esta enfermidade, como tabagistas e etilistas crônicos.Método: No período entre junho de 2000 e julho de 2002, o programa foi realizado em pacientes do Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo (HCFMUSP) e grupos de apoio comunitários, estruturado em palestras periódicas, exame bucal dos interessados e encaminhamento quando necessário para exames complementares e tratamento.Resultados: Foram examinadas 509 pessoas, das quais 215 pertenciam ao sexo masculino (42,2%), 59,7% eram brancos e com média de idade de 49,8 anos. Destas, 131 apresentaram lesão fundamental na boca, que foram encaminhadas à Faculdade de Odontologia da Universidade de São Paulo (FOUSP), para realização de exame complementar. Dos 48 (38,7%) pacientes que compareceram ao ambulatório, 11 foram submetidos à biópsia. Os achados das biópsias foram de hiperqueratose em 3, hiperplasia papilomatosa em 2, hiperplasia fibrosa em 3, um caso de displasia leve, um adenocarcinoma e um carcinoma epidermóide. À citologia esfoliativa, 5 pacientes tiveram o diagnóstico de classe I e 11 como classe II de Papanicolau.Conclusão: O elevado número de lesões fundamentais diagnosticadas demonstra ser de extrema importância o exame oral periódico de pacientes de risco, entretanto o método proposto, como deslocamento de equipes específicas para o rastreamento dos pacientes, mostrou-se bastante trabalhoso e oneroso para ser efetivamente incorporado em serviços de atenção à saúde. Por outro lado, serviços de atenção permanente em conjunto à atuação periódica de campanhas de esclarecimento a população, foram considerados os métodos de maior resultado para o diagnóstico precoce do câncer de boca

Objective: To evaluate a viability of a program for prevention and early diagnosis of oral cancer directed to groups considered at risk for this disease, such as chronic smokers and alcoholics.Method: The program was conducted between June 2000 and July 2002 with patients of the University Hospital of the Medical School of the University of São Paulo (HCFMUSP) and communitarian support groups, structured in the form of periodic lectures, oral exam for those who had interest, and, if necessary, referral for complementary exams and treatment.Results: 509 people were examined, of which 215 (42.2%) were males and 59.7% were Whites with mean age of 49.8 years. From these, 131 presented a fundamental lesion in the mouth and were referred to School of Dentistry of the University of São Paulo (FOUSP) for a complimentary exam. From the 48 (38.7%) patients that attended the University outpatient service, 11 were subjected to biopsy. Results of the biopsies were hyperkeratosis in 3 cases, papillomatous hyperplasia in 2, fibrous hyperplasia in 3, mild dysplasia in 1, adenocarcinoma in 1 and epidermoid carcinoma in 1. Based on the results of exfoliative cytology, 5 patients had diagnosis of Papanicolau class I and 11 of Papanicolau class II.Conclusion: The large number of fundamental lesions diagnosed demonstrates that periodic oral exam of high-risk patients is of paramount importance. However, the method proposed in this study, involving the transport of specific teams for screening of patients, appeared to be too demanding and costly to be effectively incorporated in public health attention services. On the other hand, permanent attention services together with periodic informative campaigns to the population were considered the methods with better results for the early diagnosis of oral cancer

Atherosclerotic lesions in cigarette smokers and hukka smokers: a comparative human autopsy study

To assess the different morphological types of atherosclerotic lesions in cigarette smokers and Hukka smokers in our population. This descriptive study was conducted at the mortuary of King Edward Medical University Lahore and Department of Pathology Allama Iqbal Medical College Lahore from June 2007 to July 2009. Heart, aorta coronary arteries and renal arteries were collected from dead bodies. One to four areas of tissue were taken from aorta and each artery in all cases. Sections were prepared from paraffin blocks. These were stained with Haematoxylin and Eosin stain. Special stains were also performed to differentiate all the components of atherosclerotic lesions. A total of 130 human autopsies were carried out in this study. Out of these, 84 were smokers [62 cigarette and 22 hukka smokers]. The analysis was carried out on these 84 cases. The mean age of smokers was 48.63 +/- 16.079. Fibrolipid plaques and complicated/ calcified lesions were seen in predominantly more cases in cigarette smokers, than hukka smokers in aorta, coronary arteries and renal arteries. This study shows distribution of different atherosclerotic lesions in cigarette smokers and hukka smokers in our population. The raised atherosclerotic involvement in cigarette smokers as compared to hukka smokers is evident from the results

Tabagismo e doenças periodontais como fatores de risco de perda de implantes

Foi realizada uma revisão da literatura com o objetivo de analisar os riscos da perda de implantes por pacientes tabagistas e doentes periodontal...

Prevalence of micronuclei in exfoliated uterine cervical cells from patients with risk factors for cervical cancer / Prevalência de micronúcleos em células esfoliativas do colo uterino de pacientes com fatores de risco para o câncer de colo uterino

CONTEXT AND OBJECTIVE: Pap smears are the most common and inexpensive screening method for cervical cancer. We analyzed micronucleus prevalence in exfoliated cervical mucosa cells, to investigate associations between increased numbers of micronuclei and risk factors for cervical cancer. DESIGN AND SETTING: Analytical cross-sectional study, at Instituto de Pesquisa em Oncologia (IPON). METHODS: Exfoliated cervical cells were obtained from 101 patients between September 2004 and November 2005. Patients' ages, habits (passive or active smoking, alcoholism and numbers of sexual partners), age at first sexual intercourse, contraceptive methods used, histories of sexually transmitted diseases, use of hormone replacement therapy, numbers of pregnancies and abortions, inflammatory cytology and cervical intraepithelial neoplasia (CIN) were obtained. Cells were collected using Ayre spatulas, transferred to vials containing 0.9 percent saline solution for micronucleus tests and analyzed at 1000x magnification. The number of micronuclei in 1,000 epithelial cells per patient sample was counted. RESULTS: Comparisons between groups with active (7.9 ± 7.8) and passive (7.2 ± 10.6) smoking versus no smoking (3.7 ± 5.1); with/without alcoholism (7.8 ± 1.4 and 6.9 ± 10.1); with/without inflammatory cytology (10.7 ± 10.5 and 1.3 ± 1.7); and with CIN I, II and III and no CIN (respectively 4.3 ± 4.3, 10.6 ± 5.3, 22.7 ± 11.9 and 1.3 ± 1.4) found elevated micronucleus prevalence (P < 0.05). CONCLUSIONS: We concluded that the prevalence of micronuclei in exfoliated uterine cervical cells was greater in patients with one or more risk factors for uterine cervical cancer than in patients without risk factors.

CONTEXTO E OBJETIVO: O câncer do colo uterino é uma das mais freqüentes neoplasias na mulher. O exame de Papanicolaou é o método mais comum e econômico para rastreamento. As células esfoliativas epiteliais podem ser úteis para o monitoramento de pacientes expostas a fatores de risco para o câncer. O objetivo foi analisar a prevalência de micronúcleos em células esfoliativas da mucosa cervical uterina e associar com fatores de risco para o câncer de colo uterino. TIPO DE ESTUDO E LOCAL: Estudo transversal analítico, no Instituto de Pesquisa em Oncologia (IPON). MÉTODOS: Células esfoliativas do colo uterino foram obtidas de 101 pacientes ambulatoriais entre setembro/2004 e novembro/2005. As células foram coletadas usando espátula de Ayre e transferidas para um tubo de ensaio com soro fisiológico 0,9 por cento para o teste do micronúcleo. Informações obtidas das pacientes foram: idade, hábitos (fumo e número de parceiros sexuais), métodos contraceptivos, história de doença sexualmente transmissível e uso de terapia hormonal. Células foram analisadas com magnificação de 1000 X e os micronúcleos contados em 1.000 células epiteliais por paciente. RESULTADOS: A comparação do grupo de pacientes fumantes ativas (7,9 ± 7,8) e passivas (7,2 ± 10,6) versus não fumantes (3,7 ± 5,1); alcoolismo e não alcoolismo (7,8 ± 1,4 e 6,9 ± 10,1); citologia inflamatória e citologia normal (10,7 ± 10,5 e 1,3 ± 1,7); neoplasia intraepitelial cervical (NIC) I, II e III e a ausência de NIC, respectivamente, (4,3 ± 4,3; 10,6 ± 5,3; 22,7 ± 11,9 e 1.3 ± 1.4) mostrou maior prevalência de micronúcleos (P < 0,05). CONCLUSÕES: A prevalência de micronúcleo nas células esfoliativas do colo uterino foi maior no grupo de pacientes com pelo menos um dos fatores de risco para câncer do colo uterino do que no grupo controle (sem fatores de risco).

Diretrizes para cessação do tabagismo: 2008 / Smoking cessation guidelines: 2008

Estas diretrizes constituem uma ferramenta atualizada e abrangente para auxiliar o profissional de saúde na abordagem do tabagista, recomendando atitudes baseadas em evidências clínicas como a melhor forma de conduzir cada caso. De forma reduzida e mais objetiva possível, o texto final foi agrupado em dois grandes itens: Avaliação e Tratamento. Os dois itens apresentam comentários e níveis de recomendação das referências utilizadas, bem como algumas propostas de abordagem, como por exemplo, redução de danos, em situações específicas ainda pouco exploradas, como recaídas, tabagismo passivo, tabagismo na categoria médica e uso de tabaco em ambientes específicos.

These guidelines are an up-to-date and comprehensive tool to aid health professionals in treating smokers, recommending measures and strategies for managing each case based on clinical evidence. Written in a simplified and objective manner, the text is divided into two principal sections: Evaluation and Treatment. The sections both present comments on and levels of evidence represented by the references cited, as well as some proposals for the reduction of damage and for intervening in specific and still poorly explored situations, such as relapse, passive smoking, physician smoking, and tobacco use in specific environments.

Avaliação quantitativa das fibras elásticas na doença pulmonar obstrutiva crônica / Quantitative assessment of elastic fibers in chronic obstructive pulmonary disease

OBJETIVO: Quantificar fibras elásticas (FE), músculo liso (ML) e linfócitos T CD4+ e CD8+ na doença pulmonar obstrutiva crônica (DPOC) estável. MÉTODOS: Biópsias cirúrgicas foram obtidas de 15 pacientes com DPOC, 18 tabagistas sem limitação do fluxo aéreo e 14 não tabagistas. FE, ML e células T CD4+ e CD8+ foram quantificados através de métodos histológicos e imuno-histoquímicos. RESULTADOS: Não foi observada diferença estatisticamente significativa das FE nos três grupos (p > 0,05). Tanto a quantidade de FE por unidade de área pulmonar (mm²), quanto o percentual destas fibras por tecido pulmonar foram semelhantes nos três grupos. Foi encontrado aumento da quantidade de ML em pacientes com DPOC quando comparados a tabagistas (p = 0,003) e não tabagistas (p = 0,009). Houve tendência de aumento das células T CD8+ nos pacientes com DPOC. O total de células T CD4+ estava diminuído nos pacientes com DPOC quando comparados aos tabagistas (p = 0,015) e não tabagistas (p = 0,003). Observou-se fraca correlação entre estas células e a relação entre o volume expiratório forçado no primeiro segundo e a capacidade vital forçada (r² = 0,003). CONCLUSÕES: A quantidade de FE foi semelhante nos três grupos estudados. A hipertrofia/hiperplasia muscular da parede das vias aéreas foi encontrada tanto em pacientes com DPOC quanto em tabagistas, indicando que o remodelamento ocorra também nos tabagistas sem limitação do fluxo aéreo. Houve diminuição da relação CD4/CD8 em pacientes com DPOC.

OBJECTIVE: To quantify elastic fibers (EFs) and smooth muscle (SM) cells, as well as CD4+ and CD8+ T lymphocytes, in stable chronic obstructive pulmonary disease (COPD). METHODS: Surgical specimens were obtained from 15 COPD patients, 18 smokers without airflow limitation, and 14 nonsmokers. Histological and immunohistochemical methods were employed in order to quantify EFs, SM cells, CD4+ T cells, and CD8+ T cells. RESULTS: There was no significant difference in EF numbers among the three groups (p > 0.05). The number of EFs per unit area of lung tissue (mm²) and the percentage of EFs in the lung tissue were similar among the three groups. The numbers of SM cells were found to be higher in the COPD patients than in the smokers (p = 0.003) or in the nonsmokers (p = 0.009). There was a tendency toward an increase in CD8+ T-cell counts in the COPD patients. In specimens collected from the COPD patients, CD4+ T-cell counts were lower than in those collected from the smokers (p = 0.015) or from the nonsmokers (p = 0.003). There was a weak correlation between CD4+ T-cell count and the ratio of forced expiratory volume in one second to forced vital capacity (r² = 0.003). CONCLUSIONS: The EF counts were similar among the three groups. Hypertrophy/hyperplasia of airway wall SM cells was found in the COPD patients and in the smokers, indicating that airway remodeling occurs in smokers. The CD4/CD8 ratio was lower in the COPD patients.

Perfil celular do escarro induzido e sangue periférico na doença pulmonar obstrutiva crônica / Induced sputum and peripheral blood cell profile in chronic obstructive pulmonary disease

OBJETIVO: Determinar o perfil celular e subgrupos linfocitários CD4+ e CD8+ no escarro induzido (EI) e sangue venoso periférico (SVP) de pacientes com doença pulmonar obstrutiva crônica (DPOC). MÉTODOS: Foram quantificadas as celularidades total e específica, incluindo subgrupos linfocitários T CD4+ e CD8+, do EI e SVP de 85 pessoas (38 pacientes com DPOC sem agudização, 29 tabagistas sem obstrução e 18 não-tabagistas). Os testes não-paramétricos de Mann-Whitney e Spearman foram usados na análise estatística, considerando como significante o p < 0,05. RESULTADOS: Os neutrófilos, eosinófilos e linfócitos T CD8+ do EI estavam aumentados (p = 0,005, p < 0,05 e p < 0,05) e o percentual de macrófagos encontrava-se reduzido (p = 0,003) nos pacientes com DPOC, em relação aos não-tabagistas. A correlação linear de cada tipo celular do EI com o volume expiratório forçado no primeiro segundo (VEF1), a capacidade vital forçada (CVF), e VEF1/CVF foi fraca (r² < 0,1). Os eosinófilos e os linfócitos T CD8+ também estavam aumentados no SVP (p = 0,04 e p = 0,02). CONCLUSÕES: Em pacientes com DPOC estável, as células T CD8+ estavam aumentadas no SVP, embora a leucometria total tenha se mantido em valores semelhantes aos dos outros dois grupos estudados, indicando possível envolvimento inflamatório sistêmico. A contagem dos linfócitos T CD8+ no sangue pode ser útil como marcador de inflamação sistêmica e auxiliar na identificação de tabagistas que já possuem padrão inflamatório de DPOC.

OBJECTIVE: To determine cell profiles, as well as to identify CD4+ and CD8+ lymphocyte subgroups, in induced sputum (IS) and peripheral venous blood (PVB) of patients with chronic obstructive pulmonary disease (COPD). METHODS: Total cell counts and counts of individual cell types, including CD4+ and CD8+ T lymphocytes, were determined in the IS and PVB of 85 subjects (38 with COPD without exacerbation, 29 smokers without obstruction and 18 nonsmokers). Mann-Whitney and Spearman non-parametric tests were used in the statistical analysis, and values of p < 0.05 were considered statistically significant. RESULTS: Comparing the IS of subjects with COPD to that of nonsmokers, neutrophil, eosinophil and CD8+ T lymphocyte counts were higher (respectively p = 0.005, p < 0.05 and p < 0.05), whereas the percentage of macrophages was lower (p = 0.003). There were weak linear correlations (r² < 0.1) between each cell type in IS and forced expiratory volume in one second (FEV1), forced vital capacity (FVC) and FEV1/FVC ratio. Eosinophil and CD8+ T lymphocyte counts were also higher in PVB (p = 0.04 and p = 0.02). CONCLUSIONS: In patients with stable COPD, CD8+ T lymphocyte counts were higher in PVB, whereas total leukocyte counts were similar to those of the other two groups analyzed, suggesting systemic inflammatory involvement. The CD8+ T lymphocyte count in blood can be a useful marker of systemic inflammation and can help identify smokers who already present a COPD inflammatory pattern.