Transbronchial biopsy in chronic hypersensitivity pneumonitis.

INTRODUCTION: The diagnosis of chronic hypersensitivity pneumonitis (CHP) is based on relevant exposure, tomographic findings and, in some cases, pathological data. The role of bronchoscopy is uncertain, especially in the fibrotic form of CHP. AIM: To analyze the yield of transbronchial biopsy (TBBx) in patients with CHP according to tomographic findings and to evaluate the importance of bronchoalveolar lavage (BAL) in the diagnostic approach. METHODS: This retrospective study analyzed patients with CHP who underwent TBBx in São Paulo, Brazil. The TBBx findings were classified as characteristic (granulomas and/or multinucleated giant cells, associated or not with peribronchiolar infiltration of lymphocytes and plasma cells and bronchiolocentric distribution) and supportive (data indicative of small airway injury: peribronchiolar metaplasia, organizing pneumonia, and intra-alveolar foamy macrophages). RESULTS: One hundred nine patients were included. The presence of characteristic findings of HP was seen in 16 patients (14.7%), and supportive findings were seen in 32 patients (29.4%), with a total yield of 44%. Pathological characteristic findings were more common in cases without fibrosis on high-resolution computed tomography (HRCT) (27.3% vs. 9.2%, p= 0.014), whereas the presence of supportive findings was more common in fibrotic HP (38.1% vs. 9.1%, p= 0.002). Fifty-two patients had differential cytology in BAL fluid. Lymphocytosis (> 20%) was present in 51.9% of the patients. There was no difference in the median lymphocyte count according to nonfibrotic and fibrotic tomographic findings on HRCT. CONCLUSION: TBBx and BAL fluid cytology have a role in CHP diagnosis.

Effect of polidocanol foam administration into rat peripheral veins on pulmonary parenchyma.

Background Sclerotherapy has been gaining increased acceptance and popularity as an effective therapy for the treatment of varicose veins. This attention has fed growing interest into the safety and potential complications of this procedure. There is no evidence of pulmonary complications from foam sclerotherapy in humans; however, animal studies have shown possible damage. The aim of this study is to show the changes in rat pulmonary parenchyma after the injection of 1% polidocanol Tessari foam into the peripheral vein using histological analysis of the inflammatory and fibrosis processes. Methods Twenty-four Wistar rats were divided into the following four groups: 24 h polidocanol, seven-day polidocanol, 28-day polidocanol, and control group. After the foam was injected into the lateral saphenous vein, the lungs of the rats were removed for histological analysis. Results Alveolar edema was observed in only the 24 h group (P < 0.005). Vessel thickening was observed in the seven-and 28-day groups (P < 0.001). Interstitial fibrosis was found in only the 28-day group (P = 0.006). There was no evidence of venous or arterial thrombosis in either group. Conclusion Polidocanol Tessari foam injection into rat peripheral veins causes alveolar edema, vessel thickening, and interstitial fibrosis.

Subacute and chronic hypersensitivity pneumonitis: histopathological patterns and survival.

BACKGROUND: In hypersensitivity pneumonitis (HP), survival can be predicted on the basis of the severity of fibrosis in surgical lung biopsy, but few data are available on the influence of clinical, functional, tomographic and histologic findings on prognosis. OBJECTIVES: To describe the impact on survival of clinical data, histological patterns, and HRCT findings in subacute/chronic HP. METHODS: A retrospective analysis of 103 patients diagnosed with HP submitted to surgical lung biopsy. Chronic HP was characterized by HRCT findings indicative of fibrosis (n=76). RESULTS: The most relevant exposures were to molds and birds. Lung biopsies revealed typical HP with granulomas in 46 patients, bronchiolocentric interstitial pneumonia in 27, and non-specific interstitial pneumonia (NSIP) in 16. By univariate analysis, several findings were predictors of mortality: older age, male sex, velcro crackles, higher FEV(1)/FVC ratio, lower oxygen saturation during exercise, and absence of mosaic pattern/air trapping and presence of fibrosis on HRCT. By multivariate analysis, remained significant: age (p=0.007), oxygen saturation during exercise (p=0.003), and mosaic pattern/air trapping on HRCT (p=0.004). Patients with NSIP had a greater survival than did those with typical histology and those with bronchiolocentric pneumonia (p=0.033). CONCLUSIONS: A wide range of histological features are found in HP. Typical findings are seen in 45% of cases. Other common patterns are NSIP and centriacinar lesions. Survival is better in patients with NSIP and worse in those with older age, desaturation during exercise, and absence of mosaic pattern/air trapping on HRCT.

Survival in idiopathic pulmonary fibrosis-cytotoxic agents compared to corticosteroids.

STUDY OBJECTIVE: To compare the survival of patients with IPF treated retrospectively with corticosteroids alone, to survival of patients treated with immunosuppressive and corticosteroids combined. DESIGN: Non-randomized retrospective cohort study. SETTING: Three tertiary centers in Brazil. PATIENTS: Eighty-two IPF patients were included. The diagnosis was confirmed by open lung biopsy in 48. Patients received either corticosteroids alone (group I) or cytotoxic agents in addition to corticosteroids (group II). MEASUREMENTS AND RESULTS: The primary end-point was mortality. Secondary outcome included longitudinal changes in FVC. Mean age was 66+/-8 years. FVC was 71+/-17% of predicted. There were 48 deaths during the study period (59%), 44 secondary to respiratory causes. From preliminary univariate analysis, for the group as a whole, worse survival was found to be associated with FVC% <70% of predicted (P=0.004), evidence of disease progression by follow-up FVC measurements (P=0.01), and pharmacologic treatment (P=0.014). Median survival was 25 months for the group I, and 45 months for the group II (Log-Rank=6.45, P=0.01). After adjusting for FVC > or =70% and<70% of predicted, there was evidence to indicate that survival was associated with recommended pharmacologic treatment only in patients with FVC> or =70% (Log Rank=6.84, P=0.009). CONCLUSIONS: The combination of immunosuppressive agents and prednisone results in better survival when compared to prednisone alone in patients with IPF. The benefit seems to occur only in patients with less severe disease, as reflected by FVC> or =70%.

Irrigação intranasal: avaliação dos efeitos do uso de soluções hidroeletrolíticas na mucosa de ratos / Nasal irrigation: effects of hydroelectrolytic solutions on rats mucosa

A irrrigação intranasal tem grande importância como terapia adjuvante de doenças nasossinusais. Entretanto, faltam estudos que avaliem as alteraçöes histológicas que as diferentes soluçöes utilizadas podem causar na mucosa do nariz. OBJETIVO: Analisar os aspectos histológicos da mucosa nasal de ratos após irrigaçäo local com diferentes soluçöes hidroeletrolíticas. FORMA DE ESTUDO: Experimental. MATERIAL E MÉTODO: 120 ratos Wistar foram divididos igualmente em 4 grupos. O grupo número 1 recebeu soluçäo salina a 0,9 por cento. Os grupos 2 e 3 receberam soluçöes contendo Cloreto de Sódio associado a Cloreto de Potássio e Glicose, em diferentes concentraçöes. O grupo 4 foi o grupo controle. Duas vezes ao dia, 0,1ml (2 gotas) das soluçöes foram aplicados na narina esquerda dos ratos, através de uma seringa. Metade dos animais de cada grupo foi sacrificado após a primeira semana e a metade restante após a quarta semana de tratamento. Os fragmentos de mucosa obtidos foram processados e estudados em microscopia óptica, utilizando a hematoxilina e eosina. RESULTADOS: Pôde-se observar que a infiltraçäo de células inflamatórias foi estatisticamente mais intensa no grupo 2, em 1 e 4 semanas de administraçäo das soluçöes (p<0,05), quando comparada ao grupo controle. A formaçäo de glândulas intraepiteliais foi estatisticamente mais evidente no grupo 1, quando comparada aos grupos 3 e 4 (p<0,05). CONCLUSÄO: A soluçäo salina hipertônica testada causou a menor reaçäo tecidual na mucosa nasal de ratos quando comparada ao grupo controle. Näo foram encontradas vantagens na utilizaçäo da soluçäo salina a 0,9 por cento em comparaçäo com o uso das demais soluçöes em estudo

Bronquiolite obliterante com pneumonia em organizaçäo e aspergiloma em paciente com linfoma-leucemia de células T / Bronchiolitis obliterans with organizing pneumonia and aspergilloma in patient with T cell leukemia-lymphoma

Há pouco relato na literatura médica referente à associaçäo de bronquiolite obliterante com pneumonia em organizaçäo (BOPO) e aspergiloma. Apresenta-se uma associaçäo de BOPO e aspergiloma pulmonar em uma paciente com linfoma-leucemia de células T do adulto. Sugere-se que os achados deste caso representam uma associaçäo fortuita e näo a expressäo de unidade nosológica