Entendendo a classificação, a fisiopatologia e o diagnóstico radiológico das bronquiectasias

Surgical treatment of non-cystic fibrosis bronchiectasis in Brazilian children

PURPOSE

To determine the clinical characteristics of patients submitted to surgical treatment for non-cystic fibrosis (CF) bronchiectasis, the indications for surgery, and the results obtained at a referral facility for pediatric thoracic surgery.

METHODS

Between January 1998 and December 2009, we retrospectively reviewed the medical charts of 109 pediatric patients with non-CF bronchiectasis who underwent surgical treatment. These findings were subsequently analyzed by focusing on postoperative complications and long-term results.

RESULTS

Of the 109 patients undergoing pulmonary resection, the mean age was 7.6 years (ranging from 1 to 15.5 y-o) with male predominance (59 %). The most common procedure was segmentectomy (43 %) followed by left lower lobectomy (38 %). Minor postoperative complications occurred in 36 % of the patients; the most common was transient atelectasis (26 %), followed by air leak (6 %), and postoperative pain (4 %). There was one death within the 30-day postoperative period, but it was unrelated to the procedure. Eighty-three children were followed after discharge, with a mean follow-up period of 667 days. Sixty-five (76 %) patients showed improvement of clinical symptoms after surgery.

CONCLUSIONS

Lung resection for the treatment of non-CF bronchiectasis in children is a safe procedure, with no life-treating morbidity and low mortality. This procedure also leads to significant improvements in symptoms and quality of life.

Detection of Y chromosome microdeletions and mitochondrial DNA mutations in male infertility patients

Infertility affects about 10-15% of all couples attempting pregnancy with infertility attributed to the male partner in approximately half of the cases. Proposed causes of male infertility include sperm motility disturbances, Y chromosome microdeletions, chromosomal abnormalities, single gene mutations, and sperm mitochondrial DNA (mtDNA) rearrangements. To investigate the etiology of decreased sperm fertility and motility of sperm and to develop an appropriate therapeutic strategy, the molecular basis of these defects must be elucidated. In this study, we aimed to reveal the relationships between the genetic factors including sperm mtDNA mutations, Y chromosome microdeletions, and sperm parameters that can be regarded as candidate factors for male infertility. Thirty men with a history of infertility and 30 fertile men were recruited to the study. Y chromosome microdeletions were analyzed by multiplex PCR. Mitochondrial genes ATPase6, Cytb, and ND1, were amplified by PCR and then analyzed by direct sequencing. No Y chromosome microdeletions were detected in either group. However, a total of 38 different nucleotide substitutions were identified in the examined mitochondrial genes in both groups, all of which are statistically non-significant. Fifteen substitutions caused an amino acid change and 12 were considered novel mutations. As a conclusion, mtDNA mutations and Y chromosome microdeletions in male infertility should be examined in larger numbers in order to clarify the effect of genetic factors.

[Etiology and evolution of bronchiectasis in women]

INTRODUCTION

Although considered as an orphan disease in the developed countries, bronchiectasis are frequent in our country as in all emerging ones. They are most common in women and they represent a frequent cause for consultation and hospitalization in pulmonology departments.

PATIENTS AND METHODS

To determine the etiology and prognosis of the bronchectasies in women, a retrospective study was performed including 200 patients.

RESULTS

The mean age was 55.60 years. The diagnosis of bronchiectasis was confirmed in all patients. Bronchiectasis were post-tuberculosis in 56.5% of cases and primitive in 29.5% of cases. The systemic diseases, in particular the rheumatoid polyarthritis represented 3% of cases. The infectious complications and the chronic respiratory failure were more frequent in patients with primitive bronchiectasis than those with secondary bronchiectasis. However this difference was statistically significant only for the chronic respiratory failure.

CONCLUSION

The bronchiectasis remains frequent in women in our country, as a sequel of pulmonary tuberculosis more than primitive forms. Bronchiectasis secondary to systemic diseases, although rare, must be known.