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1.
Medicina (B.Aires) ; 83(3): 475-478, ago. 2023. graf
Artigo em Espanhol | LILACS-Express | LILACS | ID: biblio-1506704

RESUMO

Resumen El síndrome de Hamman, o neumomediastino es pontáneo, es la presencia de aire en mediastino en pacientes sin antecedentes de enfermedad pulmonar previa, trauma torácico o iatrogenia. Se ha descrito como una complicación rara en pacientes con neumo nía por COVID-19. Se postula que un aumento en la presión de la vía aérea asociado a daño alveolar difuso generado por el virus, producen una fuga de aire hacia el mediastino. El dolor torácico y disnea, asociado a enfisema subcutáneo, deben hacer sospechar al médico tratante. Presentamos un paciente de 79 años que du rante su internación por neumonía secundaria al virus SARS-CoV-2 evolucionó súbitamente con disnea, dolor torácico, accesos de tos y broncoespasmo con hallaz go de neumomediastino espontáneo en la tomografía de tórax. Evolucionó favorablemente con tratamiento broncodilatador y oxigenoterapia. El síndrome de Ham man es una causa poco frecuente de progresión de insuficiencia respiratoria en pacientes con neumonía por COVID-19. Su identificación es crucial para imple mentar el tratamiento adecuado.


Abstract Hamman's syndrome, or spontaneous pneumome diastinum, is the presence of air in the mediastinum without a history of previous pulmonary pathology, chest trauma or iatrogenesis. It has been described as a rare complication in patients with COVID-19 pneu monia. It is postulated that an increase in airway pres sure associated with diffuse alveolar damage caused by the virus produces an air leak into the mediastinum. Chest pain and dyspnea associated with subcutaneous emphysema should make the treating physician suspi cious. We introduce a 79-year-old patient who, during hospitalization for pneumonia secondary to COVID-19, suddenly developed dyspnea, chest pain, coughing spells and bronchospasm with the discovery of spontaneous pneumomediastinum on chest tomography. He evolved favorably with bronchodilator treatment and temporary oxygen therapy. Hamman's syndrome is a rare cause of respiratory failure progression in patients with COVID-19 pneumonia. Its recognition is crucial to implement the appropriate treatment.

2.
Medicina (B Aires) ; 83(3): 475-478, 2023.
Artigo em Espanhol | MEDLINE | ID: mdl-37379547

RESUMO

Hamman's syndrome, or spontaneous pneumomediastinum, is the presence of air in the mediastinum without a history of previous pulmonary pathology, chest trauma or iatrogenesis. It has been described as a rare complication in patients with COVID-19 pneumonia. It is postulated that an increase in airway pressure associated with diffuse alveolar damage caused by the virus produces an air leak into the mediastinum. Chest pain and dyspnea associated with subcutaneous emphysema should make the treating physician suspicious. We introduce a 79-year-old patient who, during hospitalization for pneumonia secondary to COVID-19, suddenly developed dyspnea, chest pain, coughing spells and bronchospasm with the discovery of spontaneous pneumomediastinum on chest tomography. He evolved favorably with bronchodilator treatment and temporary oxygen therapy. Hamman's syndrome is a rare cause of respiratory failure progression in patients with COVID-19 pneumonia. Its recognition is crucial to implement the appropriate treatment.


El síndrome de Hamman, o neumomediastino espontáneo, es la presencia de aire en mediastino en pacientes sin antecedentes de enfermedad pulmonar previa, trauma torácico o iatrogenia. Se ha descrito como una complicación rara en pacientes con neumonía por COVID-19. Se postula que un aumento en la presión de la vía aérea asociado a daño alveolar difuso generado por el virus, producen una fuga de aire hacia el mediastino. El dolor torácico y disnea, asociado a enfisema subcutáneo, deben hacer sospechar al médico tratante. Presentamos un paciente de 79 años que durante su internación por neumonía secundaria al virus SARS-CoV-2 evolucionó súbitamente con disnea, dolor torácico, accesos de tos y broncoespasmo con hallazgo de neumomediastino espontáneo en la tomografía de tórax. Evolucionó favorablemente con tratamiento broncodilatador y oxigenoterapia. El síndrome de Hamman es una causa poco frecuente de progresión de insuficiencia respiratoria en pacientes con neumonía por COVID-19. Su identificación es crucial para implementar el tratamiento adecuado.


Assuntos
COVID-19 , Enfisema Mediastínico , Masculino , Humanos , Idoso , SARS-CoV-2 , Enfisema Mediastínico/etiologia , Enfisema Mediastínico/complicações , COVID-19/complicações , Dispneia/etiologia , Dor no Peito/complicações , Síndrome
3.
Medicina (B.Aires) ; 81(2): 301-303, June 2021. graf
Artigo em Espanhol | LILACS | ID: biblio-1287286

RESUMO

Resumen La proteinosis alveolar pulmonar (PAP) es una enfermedad pulmonar difusa, infrecuente, secundaria a una alteración en la homeostasis del surfactante. Se presenta el caso de una mujer de 69 años que ingresó a sala de internación por disnea progresiva hasta clase funcional III, de tres meses de evolución, asociada a tos no productiva. Se constató insuficiencia respiratoria tipo I. Como hallazgos en tomografía de tórax se evidenció engrosamiento del intersticio pulmonar intra e interlobulillar, opacidades en vidrio esmerilado y áreas con tendencia a la consolidación bilateral. Se realizó biopsia pulmonar con diagnóstico histológico de PAP y se efectuó tratamiento con lavado pulmonar total, logrando mejoría clínica. Se destaca la necesidad de tener presente diagnósticos diferenciales de insuficiencia respiratoria e infiltrados pulmonares en el contexto de la pandemia por COVID-19, incluidas las entidades muy poco prevalentes como lo es la PAP.


Abstract Pulmonary alveolar proteinosis (PAP) is a rare, diffuse pulmonary disease due to abnormal surfactant homeostasis. We present the case of a 69-year-old woman who was admitted to the hospital for progressive dyspnea with marked limitation in activity, and non-productive cough, of three months of evolution. Type I respiratory failure was confirmed. Chest tomography findings were interlobular and intralobular septal thickening, ground glass opacities and bilateral consolidation. Histological diagnosis was made and whole-lung lavage was performed with clinical improvement. We highlight the need to keep in mind differential diagnoses of respiratory failure and pulmonary infiltrates during COVID-19 pandemic, even rare entities such as PAP.


Assuntos
Humanos , Feminino , Idoso , Proteinose Alveolar Pulmonar/terapia , Proteinose Alveolar Pulmonar/diagnóstico por imagem , COVID-19 , Pandemias , SARS-CoV-2 , Pulmão
4.
Medicina (B Aires) ; 81(2): 301-303, 2021.
Artigo em Espanhol | MEDLINE | ID: mdl-33906153

RESUMO

Pulmonary alveolar proteinosis (PAP) is a rare, diffuse pulmonary disease due to abnormal surfactant homeostasis. We present the case of a 69-year-old woman who was admitted to the hospital for progressive dyspnea with marked limitation in activity, and non-productive cough, of three months of evolution. Type I respiratory failure was confirmed. Chest tomography findings were interlobular and intralobular septal thickening, ground glass opacities and bilateral consolidation. Histological diagnosis was made and whole-lung lavage was performed with clinical improvement. We highlight the need to keep in mind differential diagnoses of respiratory failure and pulmonary infiltrates during COVID-19 pandemic, even rare entities such as PAP.


La proteinosis alveolar pulmonar (PAP) es una enfermedad pulmonar difusa, infrecuente, secundaria a una alteración en la homeostasis del surfactante. Se presenta el caso de una mujer de 69 años que ingresó a sala de internación por disnea progresiva hasta clase funcional III, de tres meses de evolución, asociada a tos no productiva. Se constató insuficiencia respiratoria tipo I. Como hallazgos en tomografía de tórax se evidenció engrosamiento del intersticio pulmonar intra e interlobulillar, opacidades en vidrio esmerilado y áreas con tendencia a la consolidación bilateral. Se realizó biopsia pulmonar con diagnóstico histológico de PAP y se efectuó tratamiento con lavado pulmonar total, logrando mejoría clínica. Se destaca la necesidad de tener presente diagnósticos diferenciales de insuficiencia respiratoria e infiltrados pulmonares en el contexto de la pandemia por COVID-19, incluidas las entidades muy poco prevalentes como lo es la PAP.


Assuntos
COVID-19 , Proteinose Alveolar Pulmonar , Idoso , Feminino , Humanos , Pulmão , Pandemias , Proteinose Alveolar Pulmonar/diagnóstico por imagem , Proteinose Alveolar Pulmonar/terapia , SARS-CoV-2
5.
Respir Care ; 61(7): 930-5, 2016 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-27006351

RESUMO

BACKGROUND: Patients with late-onset Pompe disease develop progressive hypercapnic respiratory failure that can be disproportionate to the respiratory muscle compromise and/or thoracic restriction. Although recent studies have reported the presence of a blunted hypercapnic respiratory response in some subjects with neuromuscular disorders and chronic hypercapnia, no study has evaluated the integrity of the respiratory drive in subjects with late-onset Pompe disease. Thus, we endeavor to determine the CO2 rebreathing response in subjects with late-onset Pompe disease. METHODS: Respiratory muscle strength was assessed by measuring the maximum inspiratory pressure, and the maximum expiratory pressure. The maximum inspiratory pressure reflects the strength of the diaphragm and other inspiratory muscles, whereas the maximum expiratory pressure reflects the strength of the abdominal muscles and other expiratory muscles. We studied the hypercapnic drive response (measured as the ratio of the change in airway-occlusion pressure 0.1 s after the start of inspiration and end-tidal PCO2 in 13 subjects with late-onset Pompe disease and 51 healthy controls. RESULTS: Overall inspiratory muscle strength was within normal limits or slightly diminished in the late-onset Pompe disease group. Five subjects (38.5%) were chronically hypercapnic, and 9 (69.2%) had an increased breath-holding time. Compared with controls, the change in airway-occlusion pressure 0.1 s/change in end-tidal CO2 pressure slope (hypercapnic respiratory drive) was lower in the late-onset Pompe disease group (median 0.050 [interquartile range 0.027-0.118] vs 0.183 [0.153-0.233], P < .001). Nine subjects (69.2%) had a blunted change in airway-occlusion pressure 0.1 s/change in end-tidal carbon dioxide pressure slope. CONCLUSIONS: Subjects with late-onset Pompe disease had an impaired hypercapnic respiratory drive response. The clinical impact of this phenomenon in this subject subset deserves further investigation.


Assuntos
Doença de Depósito de Glicogênio Tipo II/fisiopatologia , Hipercapnia/fisiopatologia , Transtornos de Início Tardio/fisiopatologia , Insuficiência Respiratória/fisiopatologia , Mecânica Respiratória/fisiologia , Adolescente , Adulto , Dióxido de Carbono/fisiologia , Estudos de Casos e Controles , Feminino , Doença de Depósito de Glicogênio Tipo II/complicações , Humanos , Hipercapnia/etiologia , Transtornos de Início Tardio/complicações , Masculino , Pressões Respiratórias Máximas , Pessoa de Meia-Idade , Força Muscular , Insuficiência Respiratória/etiologia , Músculos Respiratórios/fisiopatologia , Adulto Jovem
6.
Medicina (B Aires) ; 75(5): 315-8, 2015.
Artigo em Espanhol | MEDLINE | ID: mdl-26502468

RESUMO

Pompe disease (glycogenosis type II) is an inherited autosomal recessive lysosomal storage disease caused by a deficiency of acid alpha-glucosidase. Thymic neuroendocrine tumors, are primary thymic neoplasms with neuroendocrine differentiation that generally present as a mass within the anterior mediastinum. Both diseases are considered rare. To our knowledge the co-existence of Pompe disease and thymic neuroendocrine tumor in the same patient has not been previously reported. We could not find biological plausibility between both diseases. Further studies are needed to confirm the finding and to further increase our understanding of this association. Clinical data from epidemiological studies, case reports, case series and small formal open or controlled clinical trials may define both clinical plausibility and causality between the two conditions.


Assuntos
Carcinoma Neuroendócrino/complicações , Doença de Depósito de Glicogênio Tipo II/complicações , Neoplasias do Timo/complicações , Adulto , Carcinoma Neuroendócrino/diagnóstico , Doença de Depósito de Glicogênio Tipo II/diagnóstico , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Raras/diagnóstico , Neoplasias do Timo/diagnóstico , Tomógrafos Computadorizados
7.
Medicina (B.Aires) ; 75(5): 315-318, Oct. 2015. ilus
Artigo em Espanhol | LILACS | ID: biblio-841520

RESUMO

La enfermedad de Pompe (glucogenosis tipo II) es una enfermedad de depósito lisosomal, autosómica recesiva causada por una deficiencia de ácido alfa-glucosidasa. Los tumores neuroendocrinos tímicos son neoplasias primarias con diferenciación neuroendocrina que generalmente se presentan como una masa en el mediastino anterior. Ambas enfermedades se consideran raras en sí mismas. En nuestro conocimiento, la enfermedad de Pompe y un tumor neuroendocrino del timo en el mismo paciente no ha sido antes comunicada. No pudimos encontrar la plausibilidad biológica entre ambas enfermedades. Se necesitan más estudios para confirmar el hallazgo y para aumentar aún más nuestra comprensión de esta asociación. Los datos clínicos de los estudios epidemiológicos, los informes de casos, las series de casos y los pequeños ensayos clínicos abiertos o controlados pueden definir tanto la plausibilidad clínica como la causalidad entre las dos enfermedades.


Pompe disease (glycogenosis type II) is an inherited autosomal recessive lysosomal storage disease caused by a deficiency of acid alpha-glucosidase. Thymic neuroendocrine tumors, are primary thymic neoplasms with neuroendocrine differentiation that generally present as a mass within the anterior mediastinum. Both diseases are considered rare. To our knowledge the co-existence of Pompe disease and thymic neuroendocrine tumor in the same patient has not been previously reported. We could not find biological plausibility between both diseases. Further studies are needed to confirm the finding and to further increase our understanding of this association. Clinical data from epidemiological studies, case reports, case series and small formal open or controlled clinical trials may define both clinical plausibility and causality between the two conditions.


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Neoplasias do Timo/complicações , Doença de Depósito de Glicogênio Tipo II/complicações , Carcinoma Neuroendócrino/complicações , Neoplasias do Timo/diagnóstico , Doença de Depósito de Glicogênio Tipo II/diagnóstico , Tomógrafos Computadorizados , Carcinoma Neuroendócrino/diagnóstico , Doenças Raras/diagnóstico
8.
Medicina (B Aires) ; 74(3): 225-6, 2014.
Artigo em Espanhol | MEDLINE | ID: mdl-24918672

RESUMO

The schwannoma (neurilemmoma) is a slow-growing benign tumor originating from Schwann sheath whose location in the chest cavity is exceptional. It is generally asymptomatic and is discovered incidentally but can cause symptoms when the lesion grows or invade underlying structures. Its importance lies in the possibility of confusion with malignant tumors. We present a patient who complains of chest pain caused by a prolonged course schwannoma. The tomographic image is suggestive of extrapulmonary tumor, so the schwannoma in this location should be considered in the differential diagnosis of metastatic or primary pleural tumors such as lipoma, solitary fibrous tumor and mesothelioma.


Assuntos
Neurilemoma/patologia , Neoplasias Torácicas/patologia , Idoso , Dor no Peito/etiologia , Diagnóstico Diferencial , Feminino , Humanos , Neurilemoma/complicações , Proteínas S100/análise , Neoplasias Torácicas/complicações , Tomografia
9.
Medicina (B.Aires) ; 74(3): 225-226, jun. 2014. ilus
Artigo em Espanhol | LILACS | ID: lil-734370

RESUMO

El schwannoma (neurilemoma) es un tumor benigno de lento crecimiento originado en la vaina de Schwann, cuya localización en la cavidad torácica es excepcional. En general es asintomático y se descubre en forma incidental, aunque puede ocasionar síntomas cuando la lesión crece o invade estructuras subyacentes. Su importancia radica en la posibilidad de confusión con tumores malignos. Presentamos una paciente con dolor torácico de evolución prolongada causado por un schwannoma. La imagen tomográfica es sugestiva de tumor extrapulmonar, por ello el schwannoma en esta localización debe ser considerado en el diagnóstico diferencial de tumores pleurales metastásicos o primarios como el lipoma, el tumor fibroso solitario y el mesotelioma.


The schwannoma (neurilemmoma) is a slow-growing benign tumor originating from Schwann sheath whose location in the chest cavity is exceptional. It is generally asymptomatic and is discovered incidentally but can cause symptoms when the lesion grows or invade underlying structures. Its importance lies in the possibility of confusion with malignant tumors. We present a patient who complains of chest pain caused by a prolonged course schwannoma. The tomographic image is suggestive of extrapulmonary tumor, so the schwannoma in this location should be considered in the differential diagnosis of metastatic or primary pleural tumors such as lipoma, solitary fibrous tumor and mesothelioma.


Assuntos
Humanos , Feminino , Idoso , Neoplasias Torácicas/patologia , Neurilemoma/patologia , Neoplasias Torácicas/complicações , Dor no Peito/etiologia , Tomografia , Proteínas S100/análise , Diagnóstico Diferencial , Neurilemoma/complicações
10.
Medicina (B.Aires) ; 74(3): 225-226, jun. 2014. ilus
Artigo em Espanhol | BINACIS | ID: bin-131457

RESUMO

El schwannoma (neurilemoma) es un tumor benigno de lento crecimiento originado en la vaina de Schwann, cuya localización en la cavidad torácica es excepcional. En general es asintomático y se descubre en forma incidental, aunque puede ocasionar síntomas cuando la lesión crece o invade estructuras subyacentes. Su importancia radica en la posibilidad de confusión con tumores malignos. Presentamos una paciente con dolor torácico de evolución prolongada causado por un schwannoma. La imagen tomográfica es sugestiva de tumor extrapulmonar, por ello el schwannoma en esta localización debe ser considerado en el diagnóstico diferencial de tumores pleurales metastásicos o primarios como el lipoma, el tumor fibroso solitario y el mesotelioma.(AU)


The schwannoma (neurilemmoma) is a slow-growing benign tumor originating from Schwann sheath whose location in the chest cavity is exceptional. It is generally asymptomatic and is discovered incidentally but can cause symptoms when the lesion grows or invade underlying structures. Its importance lies in the possibility of confusion with malignant tumors. We present a patient who complains of chest pain caused by a prolonged course schwannoma. The tomographic image is suggestive of extrapulmonary tumor, so the schwannoma in this location should be considered in the differential diagnosis of metastatic or primary pleural tumors such as lipoma, solitary fibrous tumor and mesothelioma.(AU)

11.
Medicina (B Aires) ; 74(3): 225-6, 2014.
Artigo em Espanhol | BINACIS | ID: bin-133547

RESUMO

The schwannoma (neurilemmoma) is a slow-growing benign tumor originating from Schwann sheath whose location in the chest cavity is exceptional. It is generally asymptomatic and is discovered incidentally but can cause symptoms when the lesion grows or invade underlying structures. Its importance lies in the possibility of confusion with malignant tumors. We present a patient who complains of chest pain caused by a prolonged course schwannoma. The tomographic image is suggestive of extrapulmonary tumor, so the schwannoma in this location should be considered in the differential diagnosis of metastatic or primary pleural tumors such as lipoma, solitary fibrous tumor and mesothelioma.

12.
Medicina (B Aires) ; 73(6): 529-34, 2013.
Artigo em Espanhol | MEDLINE | ID: mdl-24356261

RESUMO

Myotonic dystrophy (DM) is the most common dystrophy in adults. Several factors may explain the chronic CO2 retention. The selection of patients, different clinical stages and evaluation forms may explain the differing results obtained. Our objectives were to characterize respiratory function and to evaluate factors associated with chronic retention of CO2 in DM. We included 27 consecutive ambulatory and stable patients who were allocated into normocapnic and hypercapnic groups (PaCO2 ≥ 43 mmHg). Forced vital capacity (FVC), maximum static pressure, voluntary apnea time, Epworth scale and arterial blood gases were measured. The CO2 chemosensitivity was assessed using CO2 rebreathing (Read method). The slope ΔP0.1/ΔPCO2 expressed the CO2 chemosensitivity. A 59.3% (16/27) presented hypercapnia. FVC and respiratory muscle strength were normal or showed mild to moderate decrease. No significant differences in these variables were found in both groups. Inadequate response to CO2 (slope ΔP0.1/ΔPCO2 low (< 0.1 cm H2O/mmHg) or flat) was associated with hypercapnia (p < 0.005). Chronic retention of CO2 represented 11.56 times higher risk of inadequate response to CO2. The group with low-flat slope ΔP0.1/ΔPCO2 showed higher PaCO2 (p = 0.0017) and more prolonged voluntary apnea time (p = 0.002). We conclude that in our patients with DM, chronic CO2 retention was associated with the presence of abnormalities of the central control of breathing. Our results allow explaining previous reports describing the striking frequency of postoperative respiratory failure and difficulties in the process of weaning from mechanical ventilation.


Assuntos
Dióxido de Carbono/sangue , Hipercapnia/complicações , Distrofia Miotônica/complicações , Adulto , Apneia/patologia , Doença Crônica , Distúrbios do Sono por Sonolência Excessiva/complicações , Feminino , Volume Expiratório Forçado , Humanos , Hipercapnia/sangue , Masculino , Pessoa de Meia-Idade , Transtornos Respiratórios/sangue , Transtornos Respiratórios/complicações , Testes de Função Respiratória , Espirometria/métodos , Capacidade Vital , Adulto Jovem
13.
Medicina (B.Aires) ; 73(6): 529-534, Dec. 2013. graf, tab
Artigo em Espanhol | LILACS | ID: lil-708573

RESUMO

La distrofia miotónica (DM) es la distrofia muscular más común en adultos. Diversos factores pueden explicar la retención crónica de CO2. La selección de pacientes, diferentes estadios evolutivos y formas de evaluación, pueden explicar los resultados disímiles al respecto. Nuestros objetivos fueron caracterizar la función respiratoria y analizar los factores relacionados con la retención crónica de CO2 en la DM. Se incluyeron 27 pacientes ambulatorios consecutivos, estables clínicamente y se los agrupó como normocápnicos e hipercápnicos (PaCO2 ≥ 43 mm Hg). Se determinaron capacidad vital forzada (FVC), presiones estáticas máximas, tiempo de apnea voluntaria, escala de Epworth y gases arteriales. La quimiosensibilidad al CO2 se evaluó mediante la reinhalación de CO2 (método de Read). La pendiente ∆P0.1/∆PCO2 expresa la quimiosensibilidad al CO2. El 59.3% tenían hipercapnia. La FVC y la fuerza muscular respiratoria fueron normales o mostraron disminución leve a moderada, sin diferencias significativas en ambos grupos. La inadecuada respuesta al CO2 (pendientes ∆P0.1/∆PCO2 bajas (< 0.1 cmH2O/mm Hg) o planas) se asoció con hipercapnia (p < 0.005) y ésta significó un riesgo 11.6 veces mayor de inadecuada respuesta al CO2. El grupo con pendiente ∆P0.1/∆PCO2 baja-plana mostró mayor PaCO2 (p = 0.0017) y tiempo de apnea voluntaria más prolongado (p = 0.002). Concluimos que, en nuestros pacientes con DM, la hipercapnia crónica se asoció a la presencia de anomalías del control central de la respiración. Estos resultados permiten explicar los informes previos que describen la llamativa ocurrencia de insuficiencia respiratoria postoperatoria y las dificultades en el proceso de desvinculación de asistencia ventilatoria mecánica en estos pacientes.


Myotonic dystrophy (DM) is the most common dystrophy in adults. Several factors may explain the chronic CO2 retention. The selection of patients, different clinical stages and evaluation forms may explain the differing results obtained. Our objectives were to characterize respiratory function and to evaluate factors associated with chronic retention of CO2 in DM. We included 27 consecutive ambulatory and stable patients who were allocated into normocapnic and hypercapnic groups (PaCO2 ≥ 43 mmHg). Forced vital capacity (FVC), maximum static pressure, voluntary apnea time, Epworth scale and arterial blood gases were measured. The CO2 chemosensitivity was assessed using CO2 rebreathing (Read method). The slope ΔP0.1/ΔPCO2 expressed the CO2 chemosensitivity. A 59.3% (16/27) presented hypercapnia. FVC and respiratory muscle strength were normal or showed mild to moderate decrease. No significant differences in these variables were found in both groups. Inadequate response to CO2 (slope ΔP0.1/ΔPCO2 low (< 0.1 cm H2O/mmHg) or flat) was associated with hypercapnia (p < 0.005). Chronic retention of CO2 represented 11.56 times higher risk of inadequate response to CO2. The group with low-flat slope ΔP0.1/ΔPCO2 showed higher PaCO2 (p = 0.0017) and more prolonged voluntary apnea time (p = 0.002). We conclude that in our patients with DM, chronic CO2 retention was associated with the presence of abnormalities of the central control of breathing. Our results allow explaining previous reports describing the striking frequency of postoperative respiratory failure and difficulties in the process of weaning from mechanical ventilation.


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Dióxido de Carbono/sangue , Hipercapnia/complicações , Distrofia Miotônica/complicações , Apneia/patologia , Doença Crônica , Distúrbios do Sono por Sonolência Excessiva/complicações , Volume Expiratório Forçado , Hipercapnia/sangue , Testes de Função Respiratória , Transtornos Respiratórios/sangue , Transtornos Respiratórios/complicações , Espirometria/métodos , Capacidade Vital
14.
Medicina (B.Aires) ; 73(6): 529-534, dic. 2013. graf, tab
Artigo em Espanhol | BINACIS | ID: bin-130294

RESUMO

La distrofia miotónica (DM) es la distrofia muscular más común en adultos. Diversos factores pueden explicar la retención crónica de CO2. La selección de pacientes, diferentes estadios evolutivos y formas de evaluación, pueden explicar los resultados disímiles al respecto. Nuestros objetivos fueron caracterizar la función respiratoria y analizar los factores relacionados con la retención crónica de CO2 en la DM. Se incluyeron 27 pacientes ambulatorios consecutivos, estables clínicamente y se los agrupó como normocápnicos e hipercápnicos (PaCO2 ≥ 43 mm Hg). Se determinaron capacidad vital forzada (FVC), presiones estáticas máximas, tiempo de apnea voluntaria, escala de Epworth y gases arteriales. La quimiosensibilidad al CO2 se evaluó mediante la reinhalación de CO2 (método de Read). La pendiente ∆P0.1/∆PCO2 expresa la quimiosensibilidad al CO2. El 59.3% tenían hipercapnia. La FVC y la fuerza muscular respiratoria fueron normales o mostraron disminución leve a moderada, sin diferencias significativas en ambos grupos. La inadecuada respuesta al CO2 (pendientes ∆P0.1/∆PCO2 bajas (< 0.1 cmH2O/mm Hg) o planas) se asoció con hipercapnia (p < 0.005) y ésta significó un riesgo 11.6 veces mayor de inadecuada respuesta al CO2. El grupo con pendiente ∆P0.1/∆PCO2 baja-plana mostró mayor PaCO2 (p = 0.0017) y tiempo de apnea voluntaria más prolongado (p = 0.002). Concluimos que, en nuestros pacientes con DM, la hipercapnia crónica se asoció a la presencia de anomalías del control central de la respiración. Estos resultados permiten explicar los informes previos que describen la llamativa ocurrencia de insuficiencia respiratoria postoperatoria y las dificultades en el proceso de desvinculación de asistencia ventilatoria mecánica en estos pacientes.(AU)


Myotonic dystrophy (DM) is the most common dystrophy in adults. Several factors may explain the chronic CO2 retention. The selection of patients, different clinical stages and evaluation forms may explain the differing results obtained. Our objectives were to characterize respiratory function and to evaluate factors associated with chronic retention of CO2 in DM. We included 27 consecutive ambulatory and stable patients who were allocated into normocapnic and hypercapnic groups (PaCO2 ≥ 43 mmHg). Forced vital capacity (FVC), maximum static pressure, voluntary apnea time, Epworth scale and arterial blood gases were measured. The CO2 chemosensitivity was assessed using CO2 rebreathing (Read method). The slope ΔP0.1/ΔPCO2 expressed the CO2 chemosensitivity. A 59.3% (16/27) presented hypercapnia. FVC and respiratory muscle strength were normal or showed mild to moderate decrease. No significant differences in these variables were found in both groups. Inadequate response to CO2 (slope ΔP0.1/ΔPCO2 low (< 0.1 cm H2O/mmHg) or flat) was associated with hypercapnia (p < 0.005). Chronic retention of CO2 represented 11.56 times higher risk of inadequate response to CO2. The group with low-flat slope ΔP0.1/ΔPCO2 showed higher PaCO2 (p = 0.0017) and more prolonged voluntary apnea time (p = 0.002). We conclude that in our patients with DM, chronic CO2 retention was associated with the presence of abnormalities of the central control of breathing. Our results allow explaining previous reports describing the striking frequency of postoperative respiratory failure and difficulties in the process of weaning from mechanical ventilation.(AU)


Assuntos
Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Dióxido de Carbono/sangue , Hipercapnia/complicações , Distrofia Miotônica/complicações , Apneia/patologia , Doença Crônica , Distúrbios do Sono por Sonolência Excessiva/complicações , Volume Expiratório Forçado , Hipercapnia/sangue , Transtornos Respiratórios/sangue , Transtornos Respiratórios/complicações , Testes de Função Respiratória , Espirometria/métodos , Capacidade Vital
15.
Medicina (B Aires) ; 73(6): 529-34, 2013.
Artigo em Espanhol | BINACIS | ID: bin-132784

RESUMO

Myotonic dystrophy (DM) is the most common dystrophy in adults. Several factors may explain the chronic CO2 retention. The selection of patients, different clinical stages and evaluation forms may explain the differing results obtained. Our objectives were to characterize respiratory function and to evaluate factors associated with chronic retention of CO2 in DM. We included 27 consecutive ambulatory and stable patients who were allocated into normocapnic and hypercapnic groups (PaCO2 ÔëÑ 43 mmHg). Forced vital capacity (FVC), maximum static pressure, voluntary apnea time, Epworth scale and arterial blood gases were measured. The CO2 chemosensitivity was assessed using CO2 rebreathing (Read method). The slope ÎöP0.1/ÎöPCO2 expressed the CO2 chemosensitivity. A 59.3


(16/27) presented hypercapnia. FVC and respiratory muscle strength were normal or showed mild to moderate decrease. No significant differences in these variables were found in both groups. Inadequate response to CO2 (slope ÎöP0.1/ÎöPCO2 low (< 0.1 cm H2O/mmHg) or flat) was associated with hypercapnia (p < 0.005). Chronic retention of CO2 represented 11.56 times higher risk of inadequate response to CO2. The group with low-flat slope ÎöP0.1/ÎöPCO2 showed higher PaCO2 (p = 0.0017) and more prolonged voluntary apnea time (p = 0.002). We conclude that in our patients with DM, chronic CO2 retention was associated with the presence of abnormalities of the central control of breathing. Our results allow explaining previous reports describing the striking frequency of postoperative respiratory failure and difficulties in the process of weaning from mechanical ventilation.


Assuntos
Dióxido de Carbono/sangue , Hipercapnia/complicações , Distrofia Miotônica/complicações , Adulto , Apneia/patologia , Doença Crônica , Distúrbios do Sono por Sonolência Excessiva/complicações , Feminino , Volume Expiratório Forçado , Humanos , Hipercapnia/sangue , Masculino , Pessoa de Meia-Idade , Transtornos Respiratórios/sangue , Transtornos Respiratórios/complicações , Testes de Função Respiratória , Espirometria/métodos , Capacidade Vital , Adulto Jovem
18.
Rev Med Virol ; 21(2): 89-109, 2011 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-21384462

RESUMO

The efficacy of licensed rotavirus vaccines has only been shown against certain rotavirus group A (RV-A) types. It is critical to understand the burden of rotavirus gastroenteritis (RVGE) and its prevalent types to assess the potential impact of these vaccines in Latin America and the Caribbean (LA&C). We performed a systematic review and meta-analyses of all the available evidence reported from 1990 to 2009 on the burden of rotavirus disease and strains circulating in LA&C. Eligible studies--185 country-level reports, 174 951 faecal samples--were selected from MEDLINE, Cochrane Library, EMBASE, LILACS, regional Ministries of Health, PAHO, regional proceedings, doctoral theses, reference lists of included studies and consulting experts. Arc-sine transformations and DerSimonian-Laird random-effects model were used for meta-analyses. The proportion of gastroenteritis cases due to rotavirus was 24.3% (95%CI 22.3-26.4) and the incidence of RVGE was 170 per 1000 children-years (95%CI 130-210). We estimated a global annual mortality for 22 countries of 88.2 (95%CI 79.3-97.1) deaths per 100 000 under 5 years (47 000 deaths).The most common G type detected was G1 (34.2%), followed by G9 (14.6%), and G2 (14.4%). The most common P types detected were P[8] (56.2%), P[4] (22.1%) and P[1] 5.4%, and the most prevalent P-G type associations were P[8]G1 17.9%, P[4]G2 9.1% and P[8]G9 8.8%. In the last 10 years, G9 circulation increased remarkably and G5 almost disappeared. More recently, G12 appeared and P[4]G2 re-emerged. To our knowledge, this is the first meta-analysis of rotavirus infection and burden of disease in LA&C.


Assuntos
Infecções por Rotavirus/epidemiologia , Infecções por Rotavirus/virologia , Rotavirus/classificação , Rotavirus/isolamento & purificação , Região do Caribe/epidemiologia , Surtos de Doenças , Gastroenterite/epidemiologia , Gastroenterite/mortalidade , Gastroenterite/prevenção & controle , Gastroenterite/virologia , Genótipo , Humanos , Incidência , América Latina/epidemiologia , Prevalência , Rotavirus/genética , Infecções por Rotavirus/mortalidade , Infecções por Rotavirus/prevenção & controle , Vacinas contra Rotavirus/administração & dosagem , Vacinas contra Rotavirus/imunologia , Análise de Sobrevida
19.
Respirology ; 12(6): 787-91, 2007 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-17986104

RESUMO

Acinetobacter spp. (A. baumannii is the prevalent genomic species, but others may cause infection) has become an increasingly important cause of nosocomial pneumonia, particularly in mechanically ventilated patients (VAP). This organism has intrinsic resistance to some antimicrobials but easily acquires resistance to many others; Acinetobacter spp. can survive for long periods of time in the environment. All of these characteristics have contributed to protracted outbreaks associated with significant morbidity and mortality. High rates of colonization are found in debilitated hospitalized patients. Infecting or colonizing organisms in nosocomial infections are more likely to be from cross-transmission or from the hospital environment than from endogenous sources. VAP caused by Acinetobacter spp. is emerging as a prominent hospital complication. The incidence of this microorganism varies from site to site, but it is the second commonest aetiological agent among the gram-negative bacteria. Longer periods of hospitalization, longer time on mechanical ventilation and prior use of antibiotics are the recognized factors increasing the risk of VAP due to Acinetobacter spp. Treatment needs to clearly differentiate infection from colonization, and the agents with the most antimicrobial activity are imipenem/cilastatin, amikacin, colistin, ampicillin/sulbactam and tigecycline. Monotherapy can be adequate if the patient does not have significant comorbidities. Infection control procedures have a major role to play in preventing transmission of this microorganism. Emphasis on initial control measures should, however, be on strict isolation of infected or colonized patients to limit dissemination of outbreak strains in the environment. The variety of potential sources of contamination with Acinetobacter spp. in the hospital environment makes control of these outbreaks one of the more difficult challenges. Persistence of Acinetobacter spp. in the environment provides ample opportunities for contamination of patients and staff and may explain continuing long-term outbreaks.


Assuntos
Infecções por Acinetobacter , Acinetobacter baumannii , Pneumonia Bacteriana , Pneumonia Associada à Ventilação Mecânica , Infecções por Acinetobacter/epidemiologia , Infecções por Acinetobacter/microbiologia , Infecções por Acinetobacter/terapia , Comorbidade , Resistência Microbiana a Medicamentos , Quimioterapia Combinada , Humanos , Tempo de Internação , Pneumonia Bacteriana/epidemiologia , Pneumonia Bacteriana/microbiologia , Pneumonia Bacteriana/terapia , Pneumonia Associada à Ventilação Mecânica/epidemiologia , Pneumonia Associada à Ventilação Mecânica/microbiologia , Pneumonia Associada à Ventilação Mecânica/terapia , Fatores de Risco
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