[A pulmonary mycotic sequestrum during invasive aspergillosis]

2 cases of mycetomas are presented as exceptional manifestations of invasive aspergillosis. Both patients had diagnosis of leukemia and neutropenia, secondary to chemotherapy. The clinical features were subacute and mainly fever, cough, dyspnea and multiple infiltrates with cavitations and balls of hyphae within cysts shown in chest x-ray. The precipitin tests were positive for A. fumigatus and A. flavus, and were correlated with the specimens of the bronchial brushing. One of the patients improved with antimycotics and normalization of neutropenia.

[Spontaneous pneumomediastinum in adults]

Pneumomediastinum cases admitted to our Respiratory Intensive Care Unit during the past 15 years are reviewed. After excluding secondary and iatrogenic pneumomediastinum, spontaneous pneumomediastinum was diagnosed in seven patients being all of them males. The causative conditions were status asthmaticus in four patients, intense cough in two and Valsalva manoeuver in one patient. The most frequent symptoms were dyspnea, chest pain and odynophagia. Subcutaneous emphysema appeared in six patients and there was associated pneumothorax in two cases. ECG was normal in six patients. All cases of spontaneous pneumomediastinum had a satisfactory evolution with conservative treatment resolving in four to eight days.

[Spontaneous pneumothorax in pregnancy: description of a case and review of the literature]

A case of pneumothorax during the 8th week of pregnancy is described. The literature is reviewed. We highlight the rareness of the case and discuss of possible relationship with protector hormonal factors.

Trichosporon beigelii pneumonia in a neutropenic patient

A case of pulmonary infection caused by Trichosporon beigelii is reported in an asthmatic patient undergoing steroid treatment who developed fever and lung infiltrates. Arthroconidia and blastoconidia were isolated from repeated sputum, bronchial aspirate and telescopic catheter samples. The infection coincided with neutropenia resulting from pyrazolone treatment. The response to amphotericin B treatment was favourable.

[Evaluation of transcutaneous oxygen pressure in adults with respiratory pathology]

The usefulness of the transcutaneous oxygen tension (tcPO2) in adults is under controversy. In a varied group of respiratory patients, results of the application of this method were compared with those from the arterial blood sampling method. Thirty-eight arterial oxygen tension (PaO2) and tcPO2 simultaneous determinations were made in a group of 22 patients, while in a sitting position; the tcPO2 measurements obtained (68 +/- 12.36 Torr) were significantly lower (p less than 0.05) than the PaO2 values (74 +/- 13.07 Torr). The correlation coefficient was 0.51 (p less than 0.01) with a regression line, tcPO2 = 31.58 + 0.48 PaO2. It is concluded that tcPO2 measurement does not correlate well with PaO2 and that this method cannot be always be safely applied and used in adults with respiratory diseases.

[Primary spontaneous pneumothorax in 4 siblings]

4 cases of spontaneous pneumothorax in 4 brothers, previously healthy with similar morphometric features and normal levels of alpha-1-antitrypsin, are presented. They all showed a tendency to relapse. The thoracoscopy carried out on one patient did show bullae and pleurodesis with tetracycline was non-effective. There were no functional alterations. We highlight the extremely rare occurrence of familial spontaneous pneumothorax. The literature is reviewed and genetic transmission mechanics is proposed, concluding that difficulties exist in identifying the non-symptomatic genetic carrier. We insist on the need to study family backgrounds in epidemiologic research.

[Pleural tuberculosis: yield of thoracoscopy]

34 tuberculosis with pleural affectation were diagnosed after examining 292 pleural effusions. 19 cases studied were diagnosed by pleuroscopy. The mean age of patients was 38 years old. The cytology, being mainly limphocytes, cultures and bacyloscopy, were all negative. The cultures of the biopsies was positive in 36.7% of the cases. The pathology report was positive in 88% of them. There was macroscopic suspicion of the disease in 73.6% with good macro-microscopic correlation this being the reason of the early treatment applied. We concluded that pleuroscopy is a good technique to diagnose pleural tuberculosis, reducing the hospital admission time.