Evaluation of bronchoalveolar cells in pulmonary paracoccidioidomycosis.

To investigate the local immune response, the cellular infiltrate and cytokine levels were analysed in bronchoalveolar lavage (BAL) from patients with pulmonary paracoccidioidomycosis. The group consisted of 19 patients aged 34-65 yrs. The diagnosis was confirmed by demonstration of the fungus in the sputum or BAL fluid and by serological tests. Cytospin preparations showed an increased number of lymphocytes and neutrophils in BAL. A higher number of CD8+ lymphocytes were observed in BAL compared with peripheral blood. Alveolar macrophages (AM) expressed approximately three-fold more major histocompatibility class II, intercellular adhesion molecule-1 and B7-2 molecules on their surfaces than their circulating counterparts, indicating that they had differentiated into activated macrophages inside the lungs. Cultured AM produced higher levels of interleukin (IL)-6, tumour necrosis factor (TNF)-alpha and macrophage inflammatory protein (MIP)-1alpha than peripheral blood monocytes. BAL fluid contained low but detectable amounts of IL-6, TNF-alpha and MIP-1alpha, and specific antibodies to Paracoccidioides brasiliensis, mainly of the immunoglobulin G2 isotype. As macrophage inflammatory protein-1alpha was shown to selectively attract CD8+ T-cells and this population was elevated in bronchoalveolar lavage, the data suggest that, besides macrophages, CD8+ T-cells may have an important role in the pathogenesis of pulmonary paracoccidioidomycosis.

Diagnostic investigation of ventilator-associated pneumonia using bronchoalveolar lavage: comparative study with a postmortem lung biopsy

The purpose of the present study was to validate the quantitative culture and cellularity of bronchoalveolar lavage (BAL) for the diagnosis of ventilator-associated pneumonia (VAP). A prospective validation test trial was carried out between 1992 and 1997 in a general adult intensive care unit of a teaching hospital. Thirty-seven patients on mechanical ventilation with suspected VAP who died at most three days after a BAL diagnostic procedure were submitted to a postmortem lung biopsy. BAL effluent was submitted to Gram staining, quantitative culture and cellularity count. Postmortem lung tissue quantitative culture and histopathological findings were considered to be the gold standard exams for VAP diagnosis. According to these criteria, 20 patients (54 percent) were diagnosed as having VAP and 17 (46 percent) as not having the condition. Quantitative culture of BAL effluent showed 90 percent sensitivity (18/20), 94.1 percent specificity (16/17), 94.7 percent positive predictive value and 88.8 percent negative predictive value. Fever and leukocytosis were useless for VAP diagnosis. Gram staining of BAL effluent was negative in 94.1 percent of the patients without VAP (16/17). Regarding the total cellularity of BAL, a cut-off point of 400,000 cells/ml showed a specificity of 94.1 percent (16/17), and a cut-off point of 50 percent of BAL neutrophils showed a sensitivity of 90 percent (19/20). In conclusion, BAL quantitative culture, Gram staining and cellularity might be useful in the diagnostic investigation of VAP

Diagnostic investigation of ventilator-associated pneumonia using bronchoalveolar lavage: comparative study with a postmortem lung biopsy.

The purpose of the present study was to validate the quantitative culture and cellularity of bronchoalveolar lavage (BAL) for the diagnosis of ventilator-associated pneumonia (VAP). A prospective validation test trial was carried out between 1992 and 1997 in a general adult intensive care unit of a teaching hospital. Thirty-seven patients on mechanical ventilation with suspected VAP who died at most three days after a BAL diagnostic procedure were submitted to a postmortem lung biopsy. BAL effluent was submitted to Gram staining, quantitative culture and cellularity count. Postmortem lung tissue quantitative culture and histopathological findings were considered to be the gold standard exams for VAP diagnosis. According to these criteria, 20 patients (54%) were diagnosed as having VAP and 17 (46%) as not having the condition. Quantitative culture of BAL effluent showed 90% sensitivity (18/20), 94.1% specificity (16/17), 94.7% positive predictive value and 88.8% negative predictive value. Fever and leukocytosis were useless for VAP diagnosis. Gram staining of BAL effluent was negative in 94.1% of the patients without VAP (16/17). Regarding the total cellularity of BAL, a cut-off point of 400,000 cells/ml showed a specificity of 94.1% (16/17), and a cut-off point of 50% of BAL neutrophils showed a sensitivity of 90% (19/20). In conclusion, BAL quantitative culture, Gram staining and cellularity might be useful in the diagnostic investigation of VAP.

Imersão no Laboratório do Estado Vibracional do CEAEC / Immersion in the Vibrational State Laboratory of the CEAEC

Neste artigo encontram-se registrados os resultados de uma investigação desenvolvida no laboratório do estado vibracional (EV), do centro de altos estudos da consciência (CEAEC). Participaram deste estudo 16 pesquisadores, durante quatro semanas consecutivas de auto-experimentos no laboratório alvo e debates técnicos. Esta imersão gerou hipóteses relevantes quanto à importância da contextualização dos experimentos realizados no cotidiano dos pesquisadores participantes (AU)

Proexologia: Antiproéxis grupal (laboratório da proéxis - CEAEC)

Ao agendar um horário para realizar meu primeiro experimento no laboratório da proéxis, já se iniciava uma expectativa de estudar metas a curto, médio e longo prazo (AU)

Moradias conscienciais: quebra de paradigmas / Consciential residences: break of paradigms

Este artigo analisa a necessidade da mudança de paradigma referente às estruturas das moradias, quando se considera não só as necessidades físicas da consciência, mas também sua realidade holossomática e multidimensional. Considera-se as propostas iniciais para a estruturação de um ambiente com base orgânica, arredondada e adaptada a um estilo de vida focado na evolução consciencial (AU)

"Adult only" esterase/phospholipase A of the small-intestine brush border membrane: isolation, identification of the catalytic site, and biosynthesis.

We have isolated and investigated an esterase/phospholipase A (EC 3.1.1) which is an intrinsic protein of the small-intestine brush border membrane of adult but not of preweaning rabbits. This enzyme had been referred to previously as AdRabB [Boll, W., Schmid-Chanda, T., Semenza, G., & Mantei, N. (1993) J. Biol. Chem. 268, 12901-12911]. Its amino acid sequence shows four extensive, homologous repeats between the signal sequence and a hydrophobic stretch in the C-terminal region. We have identified a serine residue (Ser400) in the (unexpectedly) single catalytic site and indicate that this esterase is likely to operate by way of a Ser-His-Asp/Glu triad. This esterase/phospholipase A is synthesized as a single polypeptide chain of 170-180 kDa, agreeing well with the size deduced from its cognate cDNA sequence [Boll, W., et al. (1993) J. Biol. Chem. 268, 12901-12911], and it undergoes (at least) N-glycosylation. Once it has reached the brush border membrane, it is subjected in vivo to two types of proteolytic processing, presumably by pancreatic protease(s): a split after Arg263, with loss of the first N-terminal repeat, and two or more cleavages much farther downstream but still located in the luminal bulk of the protein; these splits lead to multiple bands of approximately 140, 125, 100, and 90 kDa.

Pituitary-adrenocortical function in chronic renal failure: studies of episodic secretion of cortisol and dexamethasone suppressibility.

Pituitary-adrenocortical function was studied in patients with chronic renal failure (CRF) and compared with that in normal subjects. All CRF patients were on chronic hemodialysis. The mean morning plasma total and free (nonprotein bound) cortisol levels were higher in patients with CRF. Episodic secretion of cortisol was studied in plasma sampled every 20 min for 24 h. CRF patients demonstrated normal circadian rhythmicity, as evidence by times of peak secretory activity and number of peaks per 24 h. Mean 24-h plasma total cortixol levels were twice the normal levels in CRF patients. Nine of 10 patients with CRF did not suppress plasma total cortisol levels with 1 mg dexamethasone. Four of 10 patients with CRF suppressed with 2 mg dexamethasone orally for 2 days, 5 patients suppressed after 8 mg dexamethasone administration, and 1 patient with CRF resisted suppression. Hemodialysis did not alter mean 24-h cortisol levels or numbers of secretory episodes but produced a shift of secretory activity into the dialysis time period. These studies show alterations in cortisol dynamics in which increased plasma cortisol levels and dexamethasone resistance coexist with normal circadian rhythmicity.