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- Envolvimento pulmonar subclínico em sarcoidose cutâneaPublication . Robalo-Cordeiro, C; Gonçalo, Margarida; Lima, MA; Mesquita, L; Teixeira, L; Santos-Rosa, M; Azevedo-Bernarda, R; Poiares-Baptista, A; Robalo-Codeiro, AJ
- The transbonchial lung biopsy for diagnosis of diffuse parenchymal lung disease; ProPublication . Casoni, GL; Robalo-Cordeiro, C; Tomassetti, S; Romagnoli, M; Chilosi, M; Cancellieri, A; Gurioli, C; Poletti, VThe diagnosis of diffuse parenchymal lung disease (DPLD) may require invasive procedures after all noninvasive tools have failed. The clinical context in which these diseases develop and the radiological patterns are crucial for defining the timing and the methods to be used. After the introduction in clinical practice of HRCT scan, the evaluation of imaging patterns, along with the immunological status of the patient and the clinical course of the disease (acute vs. chronic) seem to be crucial to choose the best diagnostic procedure.
- Granulomatose de Wegener: forma limitadaPublication . Gil, I; Porto, J; Fernandes, B; Gonçalo, Margarida; Carvalho, L; Vieira, JD; Moura, JA
- Aeroallergens sensitization in an allergic paediatric population of Cova da Beira, Portugal.Publication . Loureiro, G; Rabaça, MA; Blanco, B; Andrade, S; Chieira, C; Pereira, CCova da Beira is an interior central region of Portugal, with a population of 93,000 inhabitants. The first pollen counts performed in Portugal revealed the highest values of the country in this area. The aim of this study was to assess the aeroallergens sensitization in an allergic population, according to the age groups. In a 5 year period (1995-2000) 1790 consecutive outpatients were observed for suspected allergic symptoms. We included in this study all the 557 paediatric (< or = 15 years old) observed patients (317 male (57%) and 240 female (43%) with an average age of 7.6 < or = 4.2 years old). They were divided in three age groups (Group I: < or = 5 yr; Group II: 6-10 yr; Group III: 11-15 yr). 371 patients were submitted to skin prick tests to aeroallergens. 86.5% of these patients were sensitised to at least one allergen extract. The most representative aeroallergens sensitization were grasses mixture (44.9%), D. pteronyssinus (32.5%), D. farinae (29.1%), Olea europea (27.5%), Parietaria judaica (23.4%), cat dander (16.1%), Artemisia vulgaris (17.6%), Robinia pseudoacacia (12.2%), Platanus acerifolia (11.4%), Tilia cordata (11.4%) moulds mixture (11.2%), Plantago lanceolata (10.6%), dog dander (10.4%), and Pinus radiata (7.5%). The sensitisation to indoor aeroallergens, was similar in all age groups and it was less important than that of pollens. The prevalence of sensitisation to grasses was the greatest in all ages and the house dust mites sensitization was the second most prevalent. The highest pollens counts in this region could explain the early sensitisation even in young children.
- Doseamento das granzimas A e B na sarcoidose pulmonar (estudo experimental)Publication . Dourado, M; Bento, J; Mesquita, L; Marques, A; Vale-Pereira, S; Ribeiro, AB; Mota-Pinto, ASarcoidosis is a systemic disease of unknown aetiology, morphologically characterized by well-formed epithelioid granulomas, which show little or no central necrosis. These may be present in any organ or tissue. The lung is the most frequently and prominently involved target. The granuloma is often very sharply demarcated from the adjacent tissue and is surrounded by a mantle of lymphocytes, which mediate lysis of target cells by various mechanisms, including exocytosis of lytic proteins, perforins and granzymes. Sarcoidosis laboratorial diagnosis is usually made by SACE and Lisozyme dosages. The granzymes A and B could be two other markers of the disease, since the sarcoidosis granuloma is rich in cytotoxic and NK cells. An ELISA Kit was used to measure Granzyme A and B in serum of a normal control group (NC) (n=30), and in two groups with lung pathology: one without sarcoidosis, disease control (DC) (n=21) and other with sarcoidosis (S) (n=11). Our results showed that SACE activity is significantly augmented in S group comparing with NC and DC, respectively: 82,6+/-32,7/31,9+/-17,8 - p=0,00017 and 82,6+/-32,7/31,9+/-17,8 - p=0,00024. Lisozyme activity is significantly augmented in S and DC groups comparing with NC. Granzyme B showed a significant decrease in DC and S groups comparing with NC. Granzyme A showed a significant decrease between S/NC groups. Our results suggest that the decrease of Granzyme A and B in sarcoidotic patients could be related to an ineffective inflammatory local response related to the formation of sarcoidosis granulomas. More studies are needed, particularly in BAL.
- Airway involvement in interstitial lung diseasePublication . Robalo-Cordeiro, CPURPOSE OF REVIEW: After briefly discussing several ways to approach airway involvement in interstitial lung diseases - by diagnostic methodologies used to assess it, considering different topographical involvement, related to its presence in the diffuse lung diseases with higher prevalence, or from a causal point of view - the author describes in more detail, taking into account recent literature, new proposed entities combining airways (at different levels) and interstitial damage, like airway-centered interstitial fibrosis and acute fibrinous organizing pneumonia. RECENT FINDINGS: These proposed patterns are being discussed, as possible autonomic interstitial lung disease disorders, and also from the perspective of its relationship with the main differential diagnosis, within known interstitial pictures. SUMMARY: Thus, airway-centered interstitial fibrosis and acute fibrinous organizing pneumonia may widen the spectrum of the yet described long list of interstitial lung diseases, and its diagnosis may be considered, under specific circumstances, when there is airway involvement associated with interstitial damage.
- Bronchoalveolar lavage in occupational lung diseasesPublication . Robalo-Cordeiro, C; Cemlyn-Jones, J; Alfaro, TM; Ferreira, AJOccupational lung diseases (OLDs) are related to the exposure and inhalation of organic, inorganic, and synthetic particles, fumes, gases, or infectious agents. From the long list of OLDs this article focuses the discussion on bronchoalveolar lavage (BAL) in parenchymal immunoinflammatory conditions, such as hypersensitivity pneumonitis (HP) and pneumoconiosis. Several antigens may cause HP, including products of plant or animal origin, aerosolized microorganisms, and organic chemicals. BAL is used not only to assess the pathogenesis of these diseases but also to identify the typical pattern of intense lymphocytic alveolitis, usually with a CD4:CD8 ratio below normal and frequently with the presence of mast cells, plasma cells, and foamy macrophages. Pneumoconioses are chronic interstitial lung diseases caused by the inhalation of mineral and metallic inorganic particles/dusts in an occupational setting, showing a decreasing prevalence in recent years. BAL is a useful tool not only to express the complex pathogenic mechanisms of these entities but also in excluding other diagnoses and causes of alveolitis, and to document specific exposures, such as the identification of asbestos bodies (ABs) in asbestosis or the proliferative response of BAL lymphocytes to beryllium in chronic beryllium disease (CBD).
- Quilotórax no contexto de cirrose hepática etílicaPublication . Freitas, R; Cemlyn-Jones, J; Aragão, A; Saldanha, MH
- Avaliação da densidade mineral óssea em doentes com fibrose quísticaPublication . Cemlyn-Jones, J; Gamboa, F; Loureiro, M; Baganha, MFPatients with cystic fibrosis (CF) have an increasing life span and osteoporosis has become a more recognised problem in these patients. The pathogenesis of low bone mineral density (BMD) in CF seems to be multifactorial and the aim of this study was to assess the prevalence of low BMD in a group of CF outpatients and to relate the findings with the variables studied. The study included 22 patients aged between 14 and 45 years (mean age 26.3). Two of the subjects were lung transplant patients. BMD was assessed by dual-energy X-ray absorptiometry (DEXA) at the lumbar spine (LS) and femoral neck (FN). This data was correlated with serum 25-hydroxy vitamin D (25-OHD) levels, BMI and the forced expiratory volume in one second (FEV1). BMD (Z-score and T-score) ranged from 0.6 to -6 and from 0.5 to -6.7 at LS; at FN the scores ranged from 0.6 to -3.9 and from 0.6 to -4.1. The mean serum 25-OHD concentration (12,57 ng/ml) was at the low end of the normal range (10-60 ng/ml). On average patients did not present with malnutrition, however BMI ranged from 15.2 to 33.7 kg/m2. Lung function status was assessed by FEV1; 64% of patients had FEV1 below 80% and within this group four patients had a FEV1 under 40%. There was a positive correlation between low BMD and 25-OHD concentrations and also between BMD and FEV1. There was no linear correlation between BMD and BMI.
- Pneumonia eosinofílica crónica idiopática: A propósito de um caso clínicoPublication . Valente, C; André, S; Catarino, A; Loureiro, M; Baganha, MFThe eosinophilic pneumonias are a heterogeneous group of pulmonary disorders, which may compromise only the air ways, the pulmonary parenchyma, or both, characterised by alveolar eosinophils and infiltration of pulmonary tissue, with or without peripheral blood eosinophilia. Idiopathic Chronic Eosinophilic Pneumonia (ICEP), detailed description was by Carrington in 1969, is a rare eosinophilic lung disease, of unknown aetiology, characterised by peripheral blood eosinophilia, chest radiograph infiltrates and prompt response to corticosteroid therapy. ICEP most commonly affects women of middle age and usual symptoms are cough, dyspnea, fever and weight loss. The authors present a case of ICEP in a young woman, 21 years old, non-smoker and previously healthy.