Increased lung inflammation with oxygen supplementation in tracheotomized spontaneously breathing rabbits: an experimental prospective randomized study.

BACKGROUND: Mechanical ventilation is a well-known trigger for lung inflammation. Research focuses on tidal volume reduction to prevent ventilator-induced lung injury. Mechanical ventilation is usually applied with higher than physiological oxygen fractions. The purpose of this study was to investigate the after effect of oxygen supplementation during a spontaneous ventilation set up, in order to avoid the inflammatory response linked to mechanical ventilation. METHODS: A prospective randomised study using New Zealand rabbits in a university research laboratory was carried out. Rabbits (n = 20) were randomly assigned to 4 groups (n = 5 each group). Groups 1 and 2 were submitted to 0.5 L/min oxygen supplementation, for 20 or 75 minutes, respectively; groups 3 and 4 were left at room air for 20 or 75 minutes. Ketamine/xylazine was administered for induction and maintenance of anaesthesia. Lungs were obtained for histological examination in light microscopy. RESULTS: All animals survived the complete experiment. Procedure duration did not influence the degree of inflammatory response. The hyperoxic environment was confirmed by blood gas analyses in animals that were subjected to oxygen supplementation, and was accompanied with lower mean respiratory rates. The non-oxygen supplemented group had lower mean oxygen arterial partial pressures and higher mean respiratory rates during the procedure. All animals showed some inflammatory lung response. However, rabbits submitted to oxygen supplementation showed significant more lung inflammation (Odds ratio = 16), characterized by more infiltrates and with higher cell counts; the acute inflammatory response cells was mainly constituted by eosinophils and neutrophils, with a relative proportion of 80 to 20% respectively. This cellular observation in lung tissue did not correlate with a similar increase in peripheral blood analysis. CONCLUSIONS: Oxygen supplementation in spontaneous breathing is associated with an increased inflammatory response when compared to breathing normal room air. This inflammatory response was mainly constituted with polymorphonuclear cells (eosinophils and neutrophils). As confirmed in all animals by peripheral blood analyses, the eosinophilic inflammatory response was a local organ event.

Circumscribed morphea and breast asymmetry in an adolescent.

Morphea is a rare fibrosing disorder of the skin and underlying tissues. Circumscribed morphea presents with less than three discrete indurated plaques and breasts are commonly affected in women. We report the case of a 12-year-old female with a right infra-areolar, nontender, brownish patch and asymmetry of the right breast with 2 years of evolution. Skin biopsy showing thickening of the dermal collagen bundles confirmed the clinical diagnosis of morphea. After a 3-year follow-up period without progression of disease, reconstructive surgery is scheduled. Plaque morphea can involve all layers of the skin but associated breast deformity is rare. It can mimic benign and malignant breast disorders justifying the benefit for early tissue biopsy. Breast morphea generally has a good prognosis but hyperpigmentation and breast deformity in young girls have been rarely described. An early diagnosis can possibly lead to a therapeutic intervention with a different outcome, as it can be the source of severe psychological and social issues in a delicate period of development such as adolescence.

[Whipple's Disease: retrospective analysis of twelve cases and review of the literature]. / Doença de Whipple: análisis retrospectivo de doce casos e revisión de la literature.

BACKGROUND: Whipple's disease is a rare and chronic bacterial disease with multiorganic involvement. Although there is no valid estimate of its actual prevalence, only about 1,000 cases have been reported. OBJECTIVE: To describe the demographic, clinical, laboratory, endoscopic and pathologic features, type of treatment used, its duration and response. METHODS: Based on the duodenal histology, we identified twelve cases of Whipple's disease in the Hospital Centre of Vila Nova de Gaia, between 1997 and 2010. RESULTS. Nine patients (75%) were male and the mean age at diagnosis was 58 years. All patients experienced at least one gastrointestinal and general symptom. Arthralgia were reported in four patients (33%) and occurred on average six years before the onset of gastrointestinal and general symptoms. In 10 patients the initial treatment was trimethoprim-sulfamethoxazole. The initial treatment duration was one year in 8 cases (80%). Seven patients (70%) had a symptomatic resolution between the third and sixth months of antibiotic therapy, as well as an endoscopic and histological improvement. Even in these patients, there was maintenance of periodic acid-Schiff positive macrophages, although in small number and with a more diffuse distribution. Gastrointestinal symptoms predominated in cases of clinical relapse. CONCLUSIONS: The gastrointestinal and general symptoms as well as the arthralgia were the predominant manifestations. The majority of patients showed clinical and endoscopic improvement in response to treatment with trimethoprim-sulfamethoxazole. However, in these cases periodic acid-Schiff positive macrophages can remain for years. Thus, in the absence of clinical deterioration, the presence of these structures is not indicative ofactive disease.

Chromoblastomycosis associated with Fonsecaea pedrosoi in a carpenter handling exotic woods.

Chromoblastomycosis is a rare, hard to diagnose disease that arises mostly in the tropics, especially in humid areas, affecting mainly males and rural workers. It is characterized by verrucous plaques or nodules that are slow growing and attributed to infection by different pigmented (dematiaceous) fungi. Usually the infection develops after injury, being primarily located on the lower extremities. The authors present the case of a healthy, 60-year-old man observed with a one year history of an erythematous violaceous 5cm tumor located on the right thigh. A biopsy specimen for histopathology revealed single or clustered brown pigmented cells, with a single or double septum and thick cell walls. Cultural smears showed growth of Fonsecaea Pedrosoi. The patient was treated with oral itraconazole (200mg per day), with a good response and clinical cure in 6 months that left only an atrophic scar.

[Review of breast pathology: diagnosed by fine needle aspiration and correlation between cytological and histological findings]. / Estudo retrospectivo da patologia mamária: diagnóstico por biópsia aspirativa e correlação cito-histológica.

The 980 exams concerning breast pathology performed in an 18-month period, including 626 fine needle aspiration biopsies, were reviewed. A diagnosis was made in 78.2% of fine needle aspiration biopsies, and in the remaining 21.8% they were considered insufficient for diagnosis. It was possible to establish a correlation with histological findings in 109 cases. There was accordance in 87.2% of the cases, a discrepancy in 6.4% of the cases neither with false positives nor false negatives, and in the remaining cases fine needle aspiration biopsy was considered insufficient for diagnosis despite the presence of a lesion in histological sections. The advantages and pitfalls of fine needle aspiration are discussed, and we consider this technique important in the initial approach to patients with breast disorders.

Bronchopulmonary sequestration--a 12-year experience.

Bronchopulmonary sequestration (BPS) is a rare malformation of the lower respiratory tract. It consists of a non-functioning mass of lung tissue that lacks normal communication with the tracheobronchial tree and that receives arterial blood supply from the systemic circulation. It is classified as intralobar (ILS) or extralobar (ELS) according to its location within or outside the normal lung. Most sequestrations are intralobar (75%) and occur predominantly in the left lower lobe.

[Endobronchial granular cell tumor - what approach to take]. / Tumor de células granulares endobrônquico - Como abordamos?

Granular cell tumor is a mesenchymal neoplasm almost always benign, with tendency to recurrence. Although it is more frequent in in the head and neck it has been described in almost all areas of the body. Its occurrence in the lung is extremely rare. The authors describe two cases of endobronchial granular cell tumours, discuss the particularities of this pathology as well as the treatment options, with particular attention to the use of endobronchial excision and criotherapy.

A proposito do diagnostico diferencial da lepra nervosa

Os AA. relatam a observação documentada de dois doentes enviados à Secção de Elucidação de Diagnóstico do Serviço de Profilaxia da Lepra, doentes cuja sintomatologia, idêntica am ambos os casos, lembrava em alguns pontos a da lepra nervosa "pura": amiotrofias, mãos Aran-Duchenne, graves perturbações da sensibilidade têrmo-dolorosa, etc... O exame neurológico revelou tratar-se de um síndromo clínico essencialmente caracterizado por perturbações radiculares e meníngeas. O exame anátomo-patológico do sistema nervoso veio demonstrar, no segundo caso, o perfeito acôrdo entre o quadro clínico (amiotrofias, arreflexia, hipotonia, perturbações da sensibilidade, distúrbios esfinctéricos e da esfera sexual) e o quadro patológico (reação inflamatória crônica dos nervos examinados, degeneração primária das raízes medulares, leptomenningite crônica hipertrófica cérvico-dorso-lombar, acompanhada, na região cervical, de paquimeningite). A natureza do processo não ficou esclarecida. A lepra, entretanto, foi, em ambos os casos, rejeitada como possibilidade etiológica.