Thoracic injuries caused by blunt trauma are commonly encountered emergencies in veterinary medicine. However, no literature exists comparing radiography to computed tomography (CT) in blunt thoracic trauma caused by motor vehicle accidents in canine patients. The aim of this prospective case series was to estimate the sensitivity (Se) and specificity (Sp) of thoracic radiography relative to CT for detecting lung contusions, pneumothorax, pleural effusion and rib fractures. The study further aimed to establish a severity scoring system for radiography and CT and to compare the findings between the two modalities. The hypothesis was that radiography would be less sensitive than CT at detecting these injuries and that radiography would underestimate the severity of lung contusions compared to CT. Fifty-nine patients met the inclusion criteria. Radiography underestimated the presence of lung contusions (Se = 69%, 95% Confidence interval (CI)) and overestimated the severity of the contusions relative to CT. There was also high interobserver variability in evaluating lung contusion severity (coefficient of variation = 91%). Both the three-view thoracic and horizontal beam radiography had poor sensitivities for the detection of pneumothorax (Se = 19% and 63% respectively) and pleural effusions (Se = 43% and 71% respectively). Similarly, the sensitivity (56%) of three-view thoracic radiographs for the detection of rib fractures was poor relative to CT. To conclude, three-view thoracic radiography had low sensitivity for pathology related to blunt thoracic trauma caused by motor vehicle accidents and CT could be considered as an additional diagnostic imaging modality in these patients. / Dissertation (MMedVet (Diagnostic Imaging))--University of Pretoria, 2019. / Companion Animal Clinical Studies / MMedVet (Diagnostic Imaging) / Unrestricted

A prospective study was undertaken to assess the diagnostic value of various rapid diagnostic tests for tuberculosis in pleural fluid, and to assess the sensitivity and speed of a radiometric mycobacterial culture system (BACTEC, Johnson Laboratories). Patients presenting to the Department of Medicine at Groote Schuur Hospital with pleural effusions for diagnostic pleural aspiration and biopsy over a 6 month period were entered into the study. Because the incidence of tuberculous effusions was observed to be high in this population (65% of 94 patients), patients from the Department of Radiotherapy with proven malignant disease and the development of new pleural effusions requiring diagnostic or therapeutic aspiration were included in the study in order to increase the number of control patients without tuberculosis. The 111 patients (17 of whom were recruited from the Department of Radiotherapy) were divided into 4 diagnostic categories: tuberculosis - 62 patients, malignant - 28 patients, miscellaneous conditions - 10 patients, and undiagnosed - 11 patients (3 of whom probably had tuberculosis). There were 59 male patients. The racial distribution was 11 whites, 51 of mixed race, and 49 blacks. Exudative pleural effusions were present in 109 patients. Closed pleural biopsies with the Abrams needle were performed on 100 patients using a modified version of the standard technique whereby larger specimens were obtained by stripping pleura off the chest wall. Seven pleural biopsies were reported as inadequate by the pathologist and the diagnostic yield of the procedure was 63%. Tuberculosis was confirmed histologically or by culture in 62 patients. The age distribution of these patients was bimodal, with most cases occuring in the third decade. The presentation was usually acute, with 60% of patients being symptomatic for less than 4 weeks. Granulomata were found on initial pleural biopsy in 52 cases (84%). Pleural biopsy culture was positive in 44 cases (71%). The radiometric culture system tested (12B BACTEC) yielded the same number (14) of positive cultures as conventional mycobacterial culture media in pleural fluid, but was almost twice as fast. Bedside inoculation of pleural fluid into 13A BACTEC bottles more than doubled the yield in the 24 patients tested (11 positive cultures compared with 4 each for conventional and 12B BACTEC media, p=0.046). The rapid diagnostic tests assessed on pleural fluid were adenosine deaminase (ADA), an antigen (BCG) capture enzymelinked immunosorbent assay (ELISA), and a specific DNA probe after amplification with the polymerase chain reaction. ADA was found to have a sensitivity of 0.77 and a specificity of 0.83 in the 109 patients tested, and values were significantly higher in tuberculosis patients compared with the other three diagnostic categories (p< 0.001 ). The ELISA test was performed on 103 patients and showed a sensitivity of only 0.26 and a specificity of 0.72. The DNA probe was performed on 43 patients, and had a sensitivity of 0.93 with a specificity of 0.43. Contamination of samples or latent tuberculous infection may have been responsible for the poor specificity of the DNA probe.

Introdução: A pleurodese com talco é o método mais popular para controle sintomático do derrame pleural maligno recidivante. A administração intrapleural do talco pode ser por videotoracoscopia ou dreno de tórax e qual o melhor método é uma questão controversa. Ainda que a expansão pulmonar seja um dos principais critérios de sucesso do procedimento, suas características pós-pleurodese ainda são pouco estudadas. Objetivo: Avaliar a expansão pulmonar após dois diferentes métodos de pleurodese com talco (dreno de tórax ou videotoracoscopia) em pacientes com derrame pleural maligno recidivante, considerando a evolução radiológica, diferença entre os métodos e correlação com desfecho clínico. O objetivo secundário foi comparar ambos os métodos quanto a: efetividade clínica, segurança, qualidade de vida e sobrevivência. Método: Estudo prospectivo randomizado que incluiu 60 pacientes (45 Mulheres, 15 Homens, idade média: 55,2 anos) com derrame pleural maligno recidivante entre janeiro de 2005 e janeiro de 2008. Os pacientes foram alocados em dois grupos: videotoracoscopia com insuflação de talco (VT) ou instilação de talco por dreno de tórax (DT). A expansão pulmonar imediata e a evolução da expansão pulmonar foram avaliadas através de tomografias de tórax obtidas nos primeiros 7 dias, 1, 3 e 6 meses após a pleurodese, as quais foram analisadas por dois observadores independentes. Efetividade clínica (considerada como ausência de necessidade de novos procedimentos pleurais durante o seguimento), complicações, tempo de drenagem e de internação hospitalar e qualidade de vida (questionários gerais e específicos) foram também analisados. A análise estatística foi realizada através dos testes de Qui-quadrado e Fisher para as variáveis categóricas e Mann-Whitney para variáveis contínuas não paramétricas. A sobrevivência foi analisada através do método de Kaplan- Meier e o teste de log-Rank para foi usado para identificar fatores que interferissem na sobrevida. Os resultados dos questionários de qualidade de vida foram avaliados através de ANOVA de duplo-fator. Resultados: Não houve diferença significativa entre os grupos nas variáveis clínicas préoperatórias. A expansão imediata total (>90%) foi observada em 27 (45%) pacientes e foi mais freqüente no grupo VT (60 vs. 30%, p=0.027). Durante o seguimento, 71% dos pacientes estudados tiveram melhora ou ao menos mantiveram a expansão pulmonar observada na 1ª tomografia, fato que ocorreu de forma semelhante entre os grupos (p=0,58). Novos procedimentos pleurais foram necessários em 9(15%) pacientes (5 recidivas no grupo VT e 4 no grupo DT, p=0.999). Não foram encontradas diferenças entre os grupos quanto a: complicações, tempo e de internação. A análise dos questionários de qualidade de vida revelou resultados semelhantes para ambos os grupos. A expansão pulmonar imediata não se correlacionou com recidiva radiológica, recidiva clínica ou complicações (p= 0.60, 0.15 e 0.20, respectivamente). A sobrevida após ambos os procedimentos foi semelhante, porém a ocorrência de recidivas foi um fator relacionado a sobrevida mais curta (p=0,02). Conclusão: Expansão pulmonar imediata parcial foi freqüente, particularmente no grupo DT. Contudo, manutenção do quadro radiológico e até melhora radiológica ocorreram na maioria dos casos. Não foi encontrada correlação entre expansão pulmonar imediata e desfecho clínico neste estudo. / Introduction: Talc pleurodesis is the most popular method to control recurrent malignant pleural effusion symptoms. Two methods may be used to deliver talc into the pleural space: videothoracoscopy or talc slurry through a chest tube ; which is the best method is still controversial. Although lung expansion is the most accepted pleurodesis outcome variable, its features are poorly studied. Objective: To analyze and compare radiological lung expansion after talc pleurodesis performed either by videothoracoscopy or chest tube and correlate it with clinical outcome. Secondary endpoints evaluated were: clinical efficacy, safety, quality of life and survival. Methods: Prospective randomized study that included 60 patients (45 Female, 15 Male, mean age: 55,2 years) with recurrent malignant pleural effusion, between January, 2005 and January, 2008. They were enrolled into two groups: videothoracoscopic talc poudrage (VT) and talc slurry through a chest tube (TS). Lung expansion was evaluated through chest CT scans obtained in the first 7 days and 1, 3 and 6 months after pleurodesis. All examinations were revised by two independent observers. Clinical efficacy (considered as lack of new procedures during follow up), complications, drainage duration, hospital stay and quality of life (general and specific questionnaires) were also analyzed. Categorical variables were compared with the Chi-Square test or Fisher´s exact test for small samples. Mann-Whitney test was used to compare continuous non parametric variables. Survival curves were calculated according to the Kaplan-Meier method and Log-rank test was used to identify factors that could interfere with survival. Double factor ANOVA was used to compare quality of life questionnaires results. Results: No significant difference in pre-procedure clinical variables was observed between groups. Postoperative lung expansion was total (>90%) in 27 (45%) patients and was more frequent in VT group (60% vs. 30%, p=0.027). During follow-up 71% of the patients showed unaltered or improved lung expansion and lung expansion evolution was similar in both groups (p=0.58). Nine (15%) patients needed new pleural procedures (5 recurrences in VT group and 4 in DT group, p=0.999). No statistical difference was found between groups regarding complications, drainage time and hospital stay. Quality of life questionnaires were evaluated but no difference between study arms was observed. There was no correlation between initial lung expansion and clinical recurrence, radiological recurrence or complications (p = 0.60, 0.15 and 0.20, respectively). No difference in survival between study arms was observed, but a shorter survival was observed in patients that developed clinical recurrence (p=0.02). Conclusion: Immediate partial lung expansion was a frequent finding and was more frequent in TS group. However, maintenance of the radiological image and even radiological improvement occurred in most cases. No correlation between immediate lung expansion and clinical outcome was found in this study

Introdução: O derrame pleural, reduzindo a capacidade funcional pulmonar, torna os pacientes incapacitados para o desenvolvimento de suas atividades habituais. A retirada do líquido pleural através da toracocentese pode reverter este quadro, porém seu impacto especialmente na capacidade ao exercício não foi totalmente estabelecido. Objetivos: Avaliar o impacto da toracocentese de alívio na capacidade funcional ao exercício, no comportamento da função pulmonar e na força dos músculos respiratórios 48 horas pós toracocentese. Casuística e Método: Foram incluídos no estudo 25 pacientes com derrame pleural unilateral, documentado por radiografia de tórax. O teste de caminhada de seis minutos (TC6M), a escala modificada de dispnéia de Borg, as variáveis espirométricas: Capacidade Vital Forçada (CVF), Volume Expiratório Forçado no Primeiro Segundo (VEF1) e as medidas de Pressão Inspiratória Máxima (Pimax) e Pressão Expiratória Máxima (Pemax) foram analisados antes e 48 horas após a retirada de volumes superiores a 600 mL. Resultados: Foram removidos 1564 + 695 mL de líquido pleural. Os valores da distância percorrida, da CVF, do VEF1, da Pimax e da Pemax aumentaram (p < 0,001) enquanto o escore de dispnéia diminuiu (p < 0,001) após o procedimento. Observaram-se correlações estatísticas (p < 0.001) entre a distância percorrida e a CVF (r = 0.725) e VEF1 (r = 0.661) avaliadas 48 horas pós toracocentese e entre a variação da distância percorrida e a variação porcentual da CVF (r = 0,450) e do VEF1 (r = 0,472), corrigidos pelo volume de líquido retirado (p < 0,05). Conclusão: Embora ocorra melhora da função pulmonar após a toracocentese, os benefícios observados são mais evidentes em situações de esforço, o que possibilita melhor readaptação dos pacientes às suas atividades rotineiras. / Introduction: Pleural effusion reducing pulmonary functional capacity hinders patients in carrying out their habitual activities. Pleural fluid removal by thoracentesis reverts the clinical situation but its impact especially on exercise capacity has not yet been determined. Objectives: To evaluate the impact of thoracentesis in functional exercise capacity on pulmonary function and on muscle strength 48 hours after thoracentesis. Methods: Twenty five patients with unilateral pleural effusion documented by chest X-ray were included. The 6 minute walk test (TC6M), Borg\'s modified dyspnea scale, spirometric variables: CVF (forced vital capacity), VEF1 (forced expiratory volume in the first second), Maximum Inspiratory Pressure (Pimax) and Maximum Expiratory Pressure (Pemax) were analyzed before and 48 hours after the removal of volumes greater than 600 mL. Results: The mean of pleural effusion removed was 1564 + 695 mL. After the procedure values of walked distance, CVF, VEF1, Pimax and Pemax covered increased (p < 0.001) while dyspnea decreased (p < 0.001). Statistical correlations (p < 0.001) between the walked distance and FVC (r = 0.725) and VEF1 (r = 0.661) were established noted measured 48 hours post thoracentesis and between the variation of the distance walked and the percentage of variation of CVF (r = 0.450) and VEF1 (r = 0.472), corrected by the volume of fluid removed (p < 0.05). Conclusions: Despite an improvement in lung function after thoracentesis, the benefits noted are more evident in effort situations of exertion, allowing a better readaptation of patients to their routine activities.

Introdução: O derrame pleural, reduzindo a capacidade funcional pulmonar, torna os pacientes incapacitados para o desenvolvimento de suas atividades habituais. A retirada do líquido pleural através da toracocentese pode reverter este quadro, porém seu impacto especialmente na capacidade ao exercício não foi totalmente estabelecido. Objetivos: Avaliar o impacto da toracocentese de alívio na capacidade funcional ao exercício, no comportamento da função pulmonar e na força dos músculos respiratórios 48 horas pós toracocentese. Casuística e Método: Foram incluídos no estudo 25 pacientes com derrame pleural unilateral, documentado por radiografia de tórax. O teste de caminhada de seis minutos (TC6M), a escala modificada de dispnéia de Borg, as variáveis espirométricas: Capacidade Vital Forçada (CVF), Volume Expiratório Forçado no Primeiro Segundo (VEF1) e as medidas de Pressão Inspiratória Máxima (Pimax) e Pressão Expiratória Máxima (Pemax) foram analisados antes e 48 horas após a retirada de volumes superiores a 600 mL. Resultados: Foram removidos 1564 + 695 mL de líquido pleural. Os valores da distância percorrida, da CVF, do VEF1, da Pimax e da Pemax aumentaram (p < 0,001) enquanto o escore de dispnéia diminuiu (p < 0,001) após o procedimento. Observaram-se correlações estatísticas (p < 0.001) entre a distância percorrida e a CVF (r = 0.725) e VEF1 (r = 0.661) avaliadas 48 horas pós toracocentese e entre a variação da distância percorrida e a variação porcentual da CVF (r = 0,450) e do VEF1 (r = 0,472), corrigidos pelo volume de líquido retirado (p < 0,05). Conclusão: Embora ocorra melhora da função pulmonar após a toracocentese, os benefícios observados são mais evidentes em situações de esforço, o que possibilita melhor readaptação dos pacientes às suas atividades rotineiras. / Introduction: Pleural effusion reducing pulmonary functional capacity hinders patients in carrying out their habitual activities. Pleural fluid removal by thoracentesis reverts the clinical situation but its impact especially on exercise capacity has not yet been determined. Objectives: To evaluate the impact of thoracentesis in functional exercise capacity on pulmonary function and on muscle strength 48 hours after thoracentesis. Methods: Twenty five patients with unilateral pleural effusion documented by chest X-ray were included. The 6 minute walk test (TC6M), Borg\'s modified dyspnea scale, spirometric variables: CVF (forced vital capacity), VEF1 (forced expiratory volume in the first second), Maximum Inspiratory Pressure (Pimax) and Maximum Expiratory Pressure (Pemax) were analyzed before and 48 hours after the removal of volumes greater than 600 mL. Results: The mean of pleural effusion removed was 1564 + 695 mL. After the procedure values of walked distance, CVF, VEF1, Pimax and Pemax covered increased (p < 0.001) while dyspnea decreased (p < 0.001). Statistical correlations (p < 0.001) between the walked distance and FVC (r = 0.725) and VEF1 (r = 0.661) were established noted measured 48 hours post thoracentesis and between the variation of the distance walked and the percentage of variation of CVF (r = 0.450) and VEF1 (r = 0.472), corrected by the volume of fluid removed (p < 0.05). Conclusions: Despite an improvement in lung function after thoracentesis, the benefits noted are more evident in effort situations of exertion, allowing a better readaptation of patients to their routine activities.

Η κακοήθης υπεζωκοτική συλλογή (ΚΥΣ), προκαλούμενη από μεταστατικά αδενοκαρκινώματα είτε από πρωτοπαθή μεσοθηλιώματα, αποτελεί μείζον κλινικό πρόβλημα καθώς σηματοδοτεί συστηματική νεοπλασματική διασπορά και χαμηλό προσδόκιμο επιβίωσης. Η τρέχουσα αντιμετώπισή της είναι μη αιτιολογική και συχνά αναποτελεσματική. Ενώ τα νεοπλάσματα που προκαλούν ΚΥΣ φέρουν καλά χαρακτηρισμένες μεταλλάξεις και ο υπεζωκότας θεωρείται προνομιακή ανατομική θέση γονιδιακής θεραπείας, οι μέχρι τώρα μελέτες της αποτελεσματικότητας της υπεζωκοτικής διαγονιδιακής μεταφοράς υπήρξαν αποσπασματικές. ΣΚΟΠΟΣ: Σκοπός της παρούσας μελέτης είναι ο χαρακτηρισμός της έκτασης, της αποτελεσματικότητας και της λειτουργικότητας της διαγονιδιακής μεταφοράς τόσο στο φυσιολογικό υπεζωκοτικό μεσοθήλιο, όσο και και στον πάσχοντα υπεζωκότα με πρωτοπαθείς ή μεταστατικούς όγκους. ΥΛΙΚΑ ΚΑΙ ΜΕΘΟΔΟΙ: Υγιείς ποντικοί φυσικού τύπου C57BL/6 και διαγονιδιακοί ποντικοί-ιχνηλάτες mT.mG έλαβαν ενδοϋπεζωκοτικές εγχύσεις 5 x 108 μολυσματικών μονάδων αδενοϊών τύπου 5 (Ad) που κωδικοποιούν τα γονίδια της λουσιφεράσης (Luc), της πράσινης φθορίζουσας πρωτεΐνης (GFP) και της Cre ρεκομπινάσης. Η αποτελεσματικότητα της διαγονιδιακής μεταφοράς μελετήθηκε με απεικόνιση βιοφωταύγειας/βιοφθορισμού, καθώς και με φθορίζουσα μικροσκοπία. Τα πειράματα επαναλήφθηκαν σε ποντικούς με ΚΥΣ, οι οποίες προκλήθηκαν μέσω υπεζωκοτικής έγχυσης 150.000 κυττάρων συγγενικού μεσοθηλιώματος υπεζωκότα (ΑΕ17) και αδενοκαρκινώματος πνεύμονα (LLC). Προκειμένου να μελετηθεί αν οι αδενοϊοί σε ποιο βαθμό μπορούν να διαμολύνουν κύτταρα in vitro , ανθρώπινες και ποντικίσιες κυτταρικές σειρές , φυσιολογικές και καρκινικές , διαμολύνθηκαν με 10ng/μl Ad-luc και Ad-GFP. AΠΟΤΕΛΕΣΜΑΤΑ: Η θωρακική φωτεινή εκπομπή ποντικών C57BL/6 κορυφώθηκε την πρώτη και υποχώρησε τη δεύτερη εβδομάδα μετά ενδοϋπεζωκοτική έγχυση Ad-Luc . Δύο εβδομάδες μετά από ενδοϋπεζωκοτική χορήγηση Ad-Cre σε ποντικούς mT.mG παρατηρήθηκε διάχυτη εξάλειψη του ερυθρού και εμφάνιση πράσινου φθορίζοντος σήματος σε όλες τις υπεζωκοτικές επιφάνειες, το οποίο εντοπιζόταν κατ’ αποκλειστικότητα στο μεσοθήλιο. Δύο εβδομάδες μετά από έγχυση Ad-Cre σε ποντικούς mT.mG που είχαν αναπτύξει όγκους παρατηρήθηκε πράσινος φθορισμός μαζί με τον κόκκκινο μέσα στους όγκους. Στατιστικώς σημαντική διαμόλυνση παρατηρήθηκε in vitro στα κύτταρα φυσιολογικού μεσοθηλίου, μεσοθηλιώματος ανθρώπου και ποντικού , αδενοκαρκινώματος πνεύμονα και παγκρέατος ποντικού. ΣΥΜΠΕΡΑΣΜΑΤΑ: Η ενδοϋπεζωκοτική έγχυση ανασυνδυασμένων αδενοιών αποτελεί αποτελεσματική μέθοδο διαγονιδιακής μεταφοράς στο φυσιολογικό και παθολογικό υπεζωκοτικό μεσοθήλιο. Ο βαθμός της διαγονιδιακής μεταφοράς επιβεβαιώνεται με τη διαμόλυνση φυσιολογικών και καρκινικών κυτταρικών σειρών in vitro. / --

Pagrindinis baigiamojo darbo tikslas buvo nustatyti kaip dažnai katės serga pleuritu, kokie yra pagrindiniai klinikiniai simptomai, nustatyti ir įvertinti rizikos veiksnius , išanalizuoti, kurie diagnostikos ir gydymo metodai yra efektyviausi. Norint pasiekti šį tikslą buvo suformuluoti darbo uždaviniai ir pasirinkta tyrimo atlikimo vieta. Tyrimas buvo atliekamas smulkių gyvūnų veterinarijos klinikoje " X" Kauno mieste nuo 2011 metų sausio 1 dienos iki 2013 metų sausio 1 dienos. Per šį laikotarpį kiekviena katė serganti kvėpavimo takų ligomis buvo registruojama klinikos duomenų bazėje. Kiekvienai katei buvo atliktas klinikinis tyrimas ir jei buvo įtariamas pleuritas, buvo atlikti kiti tyrimo metodai kaip rentgeninis ar ultragarsinis tyrimas. Torakocentezė buvo atliekama diagnostiniu ir gydomuoju pagrindu prieš ar po rentgeninio tyrimo. Torakocentezės metu buvo paimti mėginiai citologiniam ir bakteriologiniam tyrimams. Pagrindiniai taikyti gydymo metodai pleurito metu buvo pleuros ertmės drenažas ir antimikrobinė terapija. Atlikus tyrimą nustatyta,kad kvėpavimo takų ligomis sirgo 130 katės. Pleuritas buvo diagnozuota 19 proc. pacientų. Pastebėta, kad katės tarp 1 ir 5 metų amžiaus sirgo pleuritu dažniau(50 proc.). Dažniau sirgo mišrios veislės katės (67 proc.). Nustatyta, kad patelės dažniau sirgo nei patinai (67 proc). Sergant pleuritu pacientams dažniausiai pasireiškė anoreksija (100 proc.), dyspnėja (66,7 proc.) ir letargija (50 proc.). Atlikus kraujo morfologinius... [toliau žr. visą tekstą] / The main goal of this thesis was to determine how often cats suffer from pleural effusion and what are the main clinical symptoms, determine and evaluate the risk factors, analyze which diagnostic and treatment methods are most effective. To achieve this goal was formulated work tasks and choose the location and period of research. Research was carried out in a small animal veterinary clinic “X” in Kaunas from 1st January 2011 to 1st January 2013. Every cat who had the respiratory system disease was brought to the clinic during this period was registred in the clinic database. The clinical exam was carried out to all cats and if pleural effusion was suspected, further diagnostic methods as x-ray or ultrasound was performed. Thoracocentesis was performed as a diagnostic and therapeutic technique, before or after radiographic confirmation of pleural effusion. To confirm inflammatory conditions of pleura were taken samples of liquid for cytology and bacteriology analysis. The mainstay of pyothorax management was thoracic drainage and appropriate antibiotic therapy. During research period, respiratory system disease was diagnosed to 130 cats. Pleuritis was diagnosed to 19 % of patient. The largest number of pleuritis was observed in cats that were between the age of 1 to 5 years (50%). 67 % of the cats diagnosed with pleuritis were mixed bread. Females more frequently than males suffer from pleural effusion (67%). The most expressed clinical symptoms for patients with pleuritis... [to full text]

Diss. (sammanfattning) Stockholm : Karol. inst., 2004. / Härtill 5 uppsatser.

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2012-10-23T17:32:31Z No. of bitstreams: 1 Juliana Rebouças de Oliveira Etiologia da pneumonia adquirida....pdf: 2505145 bytes, checksum: d0d9c1cc48dc6e014855686844968a82 (MD5) / Made available in DSpace on 2012-10-23T17:32:31Z (GMT). No. of bitstreams: 1 Juliana Rebouças de Oliveira Etiologia da pneumonia adquirida....pdf: 2505145 bytes, checksum: d0d9c1cc48dc6e014855686844968a82 (MD5) Previous issue date: 2012 / Universidade Federal da Bahia. Centro de Pesquisas Gonçalo Moniz. Salvador, Bahia, Brasil / Pneumonia adquirida na comunidade (PAC) é uma das principais causas de hospitalização e óbito em crianças menores de cinco anos, na maioria dos países em desenvolvimento. O controle da PAC depende do entendimento adequado da importância dos agentes etiológicos, o quê tem sido dificultado pela ausência de métodos sensíveis, específicos e disponíveis, para estabelecer a etiologia dos casos. Derrame pleural (DP) é a complicação mais frequente da PAC. A atual compreensão é de que DP ocorre em infecções bacterianas piogênicas, informação essa decorrente do uso restrito de métodos tradicionais e pouco sensíveis que investigam apenas etiologia bacteriana em crianças com PAC e DP. Objetivo principal deste estudo foi determinar a etiologia da PAC em crianças hospitalizadas com DP utilizando métodos abrangentes para investigação etiológica. Desenho do estudo: realizado estudo observacional prospectivo do tipo corte transversal realizado em um hospital público, Centro Pediátrico Professor Hosannah de Oliveira (Salvador-Bahia). Material e métodos: a coleta de dados ocorreu entre setembro de 2003 a maio de 2005. Crianças previamente saudáveis com idade inferior a cinco anos, hospitalizadas com PAC, foram incluídas neste estudo. Resultados: das 277 crianças selecionadas, 206 (74%) tiveram o diagnóstico de pneumonia confirmado pela radiografia de tórax avaliada por um especialista em radiologia pediátrica. A etiologia foi estabelecida em 165 (80%) crianças; nas quais foram encontrados, infecção bacteriana em 20%, viral 48,5% e co-infecção vírus-bactéria em 31,5%. Derrame pleural (DP) foi descrito em 25 casos (12%). Entre as crianças com DP, a etiologia foi estabelecida em 18 casos (72%) sendo infecção bacteriana 28%, viral 50% e viral-bacteriana 22%. Entre todos os 25 casos com DP, a frequência por grupos etiológicos foram: bacteriana 20%, viral 36%, viral-bacteriana 16% e não identificado 28%. Conclusão: infecção exclusivamente viral foi identificada em um terço das crianças internadas com PAC e DP, portanto, quando se faz ampla investigação etiológica para vírus e bactérias, DP não está associado a apenas infecções bacterianas. Estes resultados levantam a necessidade de investigar a etiologia do DP de forma abrangente, procurando agentes virais e bactérianos, pelo uso de métodos moleculares / Community-acquired pneumonia (CAP) is a major cause of hospitalization and death among children under five years old in most developing countries. The control of CAP depends on the appropriate understanding of the matter of etiologic agents, what has been impaired by the lack of sensitive, specific and available diagnostic methods to establish the etiology. Pleural effusion (PE) is the most frequent complication of CAP. The current understanding is that SD occurs mainly in pyogenic bacterial infections. Such idea is probably due to limited use of diagnostic methods that are traditional and less sensitive, and merely investigate bacterial etiology in children with CAP and PE. The main objective of this study was to determine the etiology of CAP in hospitalized children with PE using comprehensive methods for investigating the etiology. We conducted a prospective cross-sectional observational study, performed at a public hospital, the Professor Hosannah de Oliveira Pediatric Center (Salvador-Bahia-Brazil). Data collection occurred between September 2003 and May 2005.Previously healthy children younger than five years, hospitalized with CAP were included in this study. Results: among 277 children selected, 206 (74%) had diagnosis of pneumonia confirmed by chest radiographs evaluated by a specialist in pediatric radiology. The etiology was confirmed in 80% children, in which we found: bacterial infection in 20%, viral infection in 48.5% and co-infection viral-bacterial in 31.5%. Pleural effusion (PE) was reported in 25 cases (12%). Among children with PE, the etiology was established in 18 cases (72%), being bacterial infection in 28%, viral infection in 50% and viral-bacterial infection in 22%. Among all 25 cases with PE, the frequencies by etiological groups were: 20% bacterial, 36% viral, 16% bacterial-viral and 28% unidentified. Conclusion: Viral infection was identified in only one third of children hospitalized with CAP and PE; so when extensive etiologic investigation for viruses and bacteria is performed, PE is not associated exclusively with bacterial infections. These results raise the need to investigate the etiology of PE in a comprehensive way, looking for viral and bacterial agents, including the use of molecular methods.

Introdução: A pleurodese com talco é o método mais popular para controle sintomático do derrame pleural maligno recidivante. A administração intrapleural do talco pode ser por videotoracoscopia ou dreno de tórax e qual o melhor método é uma questão controversa. Ainda que a expansão pulmonar seja um dos principais critérios de sucesso do procedimento, suas características pós-pleurodese ainda são pouco estudadas. Objetivo: Avaliar a expansão pulmonar após dois diferentes métodos de pleurodese com talco (dreno de tórax ou videotoracoscopia) em pacientes com derrame pleural maligno recidivante, considerando a evolução radiológica, diferença entre os métodos e correlação com desfecho clínico. O objetivo secundário foi comparar ambos os métodos quanto a: efetividade clínica, segurança, qualidade de vida e sobrevivência. Método: Estudo prospectivo randomizado que incluiu 60 pacientes (45 Mulheres, 15 Homens, idade média: 55,2 anos) com derrame pleural maligno recidivante entre janeiro de 2005 e janeiro de 2008. Os pacientes foram alocados em dois grupos: videotoracoscopia com insuflação de talco (VT) ou instilação de talco por dreno de tórax (DT). A expansão pulmonar imediata e a evolução da expansão pulmonar foram avaliadas através de tomografias de tórax obtidas nos primeiros 7 dias, 1, 3 e 6 meses após a pleurodese, as quais foram analisadas por dois observadores independentes. Efetividade clínica (considerada como ausência de necessidade de novos procedimentos pleurais durante o seguimento), complicações, tempo de drenagem e de internação hospitalar e qualidade de vida (questionários gerais e específicos) foram também analisados. A análise estatística foi realizada através dos testes de Qui-quadrado e Fisher para as variáveis categóricas e Mann-Whitney para variáveis contínuas não paramétricas. A sobrevivência foi analisada através do método de Kaplan- Meier e o teste de log-Rank para foi usado para identificar fatores que interferissem na sobrevida. Os resultados dos questionários de qualidade de vida foram avaliados através de ANOVA de duplo-fator. Resultados: Não houve diferença significativa entre os grupos nas variáveis clínicas préoperatórias. A expansão imediata total (>90%) foi observada em 27 (45%) pacientes e foi mais freqüente no grupo VT (60 vs. 30%, p=0.027). Durante o seguimento, 71% dos pacientes estudados tiveram melhora ou ao menos mantiveram a expansão pulmonar observada na 1ª tomografia, fato que ocorreu de forma semelhante entre os grupos (p=0,58). Novos procedimentos pleurais foram necessários em 9(15%) pacientes (5 recidivas no grupo VT e 4 no grupo DT, p=0.999). Não foram encontradas diferenças entre os grupos quanto a: complicações, tempo e de internação. A análise dos questionários de qualidade de vida revelou resultados semelhantes para ambos os grupos. A expansão pulmonar imediata não se correlacionou com recidiva radiológica, recidiva clínica ou complicações (p= 0.60, 0.15 e 0.20, respectivamente). A sobrevida após ambos os procedimentos foi semelhante, porém a ocorrência de recidivas foi um fator relacionado a sobrevida mais curta (p=0,02). Conclusão: Expansão pulmonar imediata parcial foi freqüente, particularmente no grupo DT. Contudo, manutenção do quadro radiológico e até melhora radiológica ocorreram na maioria dos casos. Não foi encontrada correlação entre expansão pulmonar imediata e desfecho clínico neste estudo. / Introduction: Talc pleurodesis is the most popular method to control recurrent malignant pleural effusion symptoms. Two methods may be used to deliver talc into the pleural space: videothoracoscopy or talc slurry through a chest tube ; which is the best method is still controversial. Although lung expansion is the most accepted pleurodesis outcome variable, its features are poorly studied. Objective: To analyze and compare radiological lung expansion after talc pleurodesis performed either by videothoracoscopy or chest tube and correlate it with clinical outcome. Secondary endpoints evaluated were: clinical efficacy, safety, quality of life and survival. Methods: Prospective randomized study that included 60 patients (45 Female, 15 Male, mean age: 55,2 years) with recurrent malignant pleural effusion, between January, 2005 and January, 2008. They were enrolled into two groups: videothoracoscopic talc poudrage (VT) and talc slurry through a chest tube (TS). Lung expansion was evaluated through chest CT scans obtained in the first 7 days and 1, 3 and 6 months after pleurodesis. All examinations were revised by two independent observers. Clinical efficacy (considered as lack of new procedures during follow up), complications, drainage duration, hospital stay and quality of life (general and specific questionnaires) were also analyzed. Categorical variables were compared with the Chi-Square test or Fisher´s exact test for small samples. Mann-Whitney test was used to compare continuous non parametric variables. Survival curves were calculated according to the Kaplan-Meier method and Log-rank test was used to identify factors that could interfere with survival. Double factor ANOVA was used to compare quality of life questionnaires results. Results: No significant difference in pre-procedure clinical variables was observed between groups. Postoperative lung expansion was total (>90%) in 27 (45%) patients and was more frequent in VT group (60% vs. 30%, p=0.027). During follow-up 71% of the patients showed unaltered or improved lung expansion and lung expansion evolution was similar in both groups (p=0.58). Nine (15%) patients needed new pleural procedures (5 recurrences in VT group and 4 in DT group, p=0.999). No statistical difference was found between groups regarding complications, drainage time and hospital stay. Quality of life questionnaires were evaluated but no difference between study arms was observed. There was no correlation between initial lung expansion and clinical recurrence, radiological recurrence or complications (p = 0.60, 0.15 and 0.20, respectively). No difference in survival between study arms was observed, but a shorter survival was observed in patients that developed clinical recurrence (p=0.02). Conclusion: Immediate partial lung expansion was a frequent finding and was more frequent in TS group. However, maintenance of the radiological image and even radiological improvement occurred in most cases. No correlation between immediate lung expansion and clinical outcome was found in this study