J Pneumol 25(5) – set-out de 1999
245
Doenças pulmonares intersticiais
Doenças pulmonares intersticiais
CARLOS ALBERTODE CASTRO PEREIRA1
COMENTÁRIOS E RESUMOS
1 . Presidente da Comissão de Doenças Intersticiais da SBPT; Doutor em Pneu-mologia; Médico da Discip lina de Pneumologia da Universidade Federal de São Paulo-Unifesp , São Paulo, SP. E-mail: p ereirac@uol.com.br
Foram apresentados cinco trabalhos sobre Doenças
Pul-monares Intersticiais.
E
VALUATIONOFTHESHORT-
FORM3 6 -
ITEMQUESTIONNAIRE(SF-3 6 )
TOMEASUREHEALTH-
RELATEDQUALITYOFLIFEINPA -TIENTSWITH IDIOPATHICPULMONARYFIBROSIS(IFP).
Martinez
et al. – Os questionários de qualidade de vida são divididos
em gerais e específicos. Neste estudo um questionário geral
traduzido e validado no Brasil foi aplicado a um grupo de
pacientes com fibrose pulmonar idiopática e demonstrou que
a dispnéia medida pela escala de Mahler tem a melhor
corre-lação com os diversos domínios. Questionários específicos
de qualidade de vida devem ser desenvolvidos para doenças
intersticiais e são importantes porque o tratamento também
resulta em freqüentes efeitos colaterais.
O
BSTRUCTIVEPATTERNINASYMPTOMATICLONGTERMRHEU -MATOIDARTHRITIS(RA)
PATIENTS:
APULMONARYFUNCTIONTEST(PFT)
ANDHIGHRESOLUTIONCOMPUTEDTOMOGRAPHY(HRCT)
EVALUATION.
Carvalho et al. – Obstrução ao fluxo aéreo é
comum na artrite reumatóide, mesmo em não-fumantes (1 6 %
numa série recente) e é mais freqüente se há síndrome de
Sjögren associada. Este estudo demonstra a maior
sensibili-dade de tomografia de alta resolução (padrão em mosaico)
em relação à espirometria na detecção do
comprometimen-to das vias aéreas na artrite reumatóide.
I
NTRATHORACICTRACHEALWIDENING(ITW):
ANEWRADIO -LOGICALFINDINGINIDIOPATHICPULMONARYFIBROSIS.
Rubin et
al. – O alargamento da traquéia intratorácica é freqüente na
fibrose pulmonar idiopática e os autores chamam a atenção
para este sinal radiológico pouco salientado. De modo
ines-perado não houve correlação com pior sobrevida nesta
gran-de série gran-de pacientes.
C
ARDIACINVOLVEMENTINSARCOIDOSIS-
ECHOCARDIOGRAPHY AND MYOCARDIAL SCINTIGRAPHY WITH THALLIUM2 0 1 .
Reis
Santos et al. – Arritmias complexas, distúrbios de condução
ou insuficiência cardíaca podem ser a manifestação inicial da
sarcoidose. Na doença diagnosticada o estabelecimento de
comprometimento cardíaco dita tratamento agressivo com
corticóides. No ecocardiograma vários achados foram
en-contrados neste estudo, mas são inespecíficos. A média de
idade nesta série foi elevada para sarcoidose. O
mapeamen-to com tálio demonstra áreas segmentares de captação
redu-zida, o que corresponde a áreas de substituição
fibrogranulo-matosa, Estes defeitos são inespecíficos e podem ocorrer
com isquemia miocárdica e em outras doenças que resultam
em infiltração miocárdica e miocardiopatia. No estresse, os
defeitos de perfusão na sarcoidose são reduzidos, ao
contrá-rio da doença coronariana. Na presença de angiografia
coro-nariana normal defeitos de perfusão no tálio sugerem
forte-mente sarcoidose miocárdica, como em 3 casos da presente
série.
P
ULMONARYDYSFUNCTIONINJUVENILERHEUMATOIDARTHRI -TIS.
Mártire et al. – Este estudo demonstra que
manifesta-ções pulmonares são freqüentes na artrite reumatóide
juve-nil, sendo pleurite a mais comum. A utilização de difusão de
CO e de tomografia de alta resolução poderia resultar em
maior detenção de anormalidades. Metotrexato é
comumen-te utilizado no tratamento de artricomumen-te reumatóide e pode
resul-tar em toxicidade pulmonar. A toxicidade usualmente se
apre-senta como uma pneumonite intersticial, mas também pode
resultar em alçaponamento de ar como sugerido na presente
série, em que se encontrou correlação inversa entre o tempo
de uso do MTX e o FEF
5 -7 5 %.
EVALUATION OF THE SHORT-FORM 3 6 -ITEM QUESTIONNAIRE (SF-3 6 ) TO MEASURE HEALTH-RELATED QUALITY OF LIFE IN PATIENTS WITH IDIOPATHIC PULMONARY FIBROSIS (IPF). Martinez J AB, Martinez TY, Guimarães SM, Ciconelli RM, Pereira CAC. Pulmonary and Rheumatology Divisions, Federal University of São Paulo (Unifesp), São Paulo, SP, Brazil.
Pereira CAC
246
J Pneumol 25(5) – set-out de 1999instrument to measure HRQL also in IPF p op ulations. Dysp nea has a major imp act in the HRQL of such subjects.
OBSTRUCTIVE PATTERN IN ASYMPTOMATIC LONG TERM RHEU-MATOID ARTHRITIS (RA) PATIENTS: A PULMONARY FUNCTION TEST (PFT) AND H IGH RESO LUTIO N CO MPUTED TO MO GRA-PHY (HRCT) EVALUATION.
Carvalho MEP, Deheinzelin D, Kairalla RA, Magaldi RB, Magalhães IML, Carvalho CRR. Pulmonary Division, University of São Paulo, SP, Brazil.
To evaluate the incidence of p ulmonary involvement in long term RA we prospectively performed HRCT and PFT in 2 9 asymptomatic p atients with more than 1 5 years of disease duration (2 4 .8 ± 8 .0 y.). Overall PFTs were normal, with a median predicted FVC of 9 7 .0 %; FEV1, 1 0 3 .5 %; FEV1/ FVC, 1 0 5 .4 %; FEF2 5 -7 5 %, 7 5 .0 %; TLC, 1 1 0 .1 % and RV of 1 1 9 .1 %. On the HRCT, altered distribution of the ventiltion (ADV), characterized by a mosaic p attern, was found in 1 2 p a-tients (4 1 .4 %). The absolute value of FEV1/ FVC was significantly low-er in p atients with ADV (p = 0 .0 4 4 , 7 0 .7 ± 1 5 .0 x 7 9 .3 ± 1 0 .7 ). These p atients were p laced on corticosteroids more often during their disease course (p = 0 .0 1 5 , 1 0 / 1 2 ADV x 6 / 1 7 no ADV). The p res-ence of bronchiectasis on HRCT was more common in the group with ADV (p = 0 .0 3 , 6 / 1 2 x 2 / 1 7 ) as well as bronchial wall thickening (p = 0 .0 4 , 1 1 / 1 2 x 9 / 1 7 ). The p resence of ADV reduced the p resentation of dependent densities (p = 0 .0 0 4 , 1 / 1 2 x 1 0 / 1 7 ). After excluding p atients with secondary Sjögren syndrome, the p resence of ADV cor-related more significantly with PFT p arameters of obstruction [FEV1 (%), p = 0 .0 0 6 ; FEV1/ FVC, p = 0 .0 1 ; FEF2 5 -7 5 % (%), p = 0 .0 1 ]. We found that a mosaic pattern suggestive of ADV is a common finding in long term RA p atients. Such finding is closely related to a more ob-structive p attern on PFT and to more p rescrip tions of corticosteroids. We conclude that an obstructive p attern is a common p ulmonary in-volvement in asymp tomatic long term RA p atients.
INTRATHORACIC TRACHEAL WIDENING (ITW): A NEW RADIO-LOGICAL FINDING IN IDIOPATHIC PULMONARY FIBROSIS. Rubin AS, Moreira J S, Porto NS, Irion K. Pavilhão Pereira Filho – ISCMPA – FFFCMPA, Porto Alegre, RS, Brazil.
In order to verify the occurrence of intrathoracic tracheal widening (ITW), we had study the X-ray of 1 3 2 p atients with histologic con-firmed idiop athic p ulmonary fibrosis (IPF), between 1 9 7 0 -1 9 9 6 , com-ing from our hosp ital. The ITW was determinated when the difference between the cervical trachea and the thoracic trachea diameter was sup erior to 1 mm, meaning the p resence of widening. ITW is related with negative subp leural p ressure determined by the insp iratory effort against the increase p ulmonary elastic recoil in IPF. In our p atients, ITW was observed in 4 9 (3 7 .1 %) cases. Although in p atients with ITW we had worst p rognostic factors like lung function tests, duration of symptoms, age, sex, dyspnea, index, histologic pattern and tomographic p rofusion, there was no statistical significance difference between p a-tients with or without this radiological characteristic. There was no correlation, as well, with the survival rates of this group (4 2 months for all and 3 2 .6 months for dead p atients). It is interesting to observe that others intersticial lung disease like sarcoidosis or extrinsic allergic alve-olitis do not have this radiological finding. We conclude that, although it is not a p rognostic factor, the ITW is a p articular finding of IPF, p resent in a numerous group of p atients, easy to be verify and this observation associated with others findings like clubbing and intersti-cial lung infiltrate orient to the diagnosis of this disease.
CARDIAC INVOLVEMENT IN SARCOIDOSIS – ECHOCARDIOGRA-PHY AND MYOCARDIAL SCINTIGRAECHOCARDIOGRA-PHY WITH THALLIUM 2 0 1 . Reis Santos RJ , Carvalho SRS, Rios US, Santos EB, Hidewo LN, Silva VMF, Brazil.
Introduction: sarcoidosis (Sarc) is a granulomatous systemic disease and also may involve the heart and in the majority of cases as asymp -tomatic way. We studied 3 0 p atients (Pats) with Sarc through echocar-diograp hy (Echo) and myocardial (Myoc) Scintigrap hy (Scin), to deter-mine the heart involvement. Methods: the age was between 3 3 -7 3 years old, mean 5 0 .9 7 ± 1 0 .2 3 ; 5 (1 6 .6 7 %) males and 1 8 (6 0 %) blacks. All of them were submitted to Echo and 2 2 to Myoc imaging with Thallium 2 0 1 (Tl 2 0 1 ) at rest and after Dipyridamole (Dip) infusion; the elderly (over 6 5 years old) did not do it. Four that had abnormal Scin were studied through angiograp hy (Ang). Results: at Echo, 1 0 (3 3 ,3 3 %) had diastolic dysfunction (Diast Dysf), 1 restrictive type, 3 were elderly and 1 had left ventricular hyp ertrop hy (LVH), 6 (2 0 %) LVH; 3 (1 0 %) degenerative valvular disease; 3 (1 0 %) had mitral valve p rolap se, 3 (1 0 %) had dilated cardiomyop athy, one also had sep tal aneurism. Those Pats submitted to Myoc Scin, 1 2 (5 4 .5 5 %) had nor-mals exams and from these, 5 (4 1 .6 7 %) had abnormal Echo, and from the 1 0 who had abnormal Scin, 7 had abnormal Echo too, there were not statistical differences (p = 0 .3 6 9 ) in these findings. Diast Dysf was p resent in 2 normal (1 6 .6 7 %) Scin. And in 2 abnormal (2 0 %). Re-duced uptake of Tl 2 0 1 in septal (5 8 .3 3 %) and in anterior (4 5 .9 5 %) regions at stress were the most common findings at Scin. Three of these with abnormal Scin were submitted to Ang and were normals. Conclusion: even though we have a short number of Pats studied, we think that Echo and Scin with Tl 2 0 1 at rest and with p harmacologic stress test with Dip can help to determine the involvement of the heart in Sarc.
PULMO NARY DYSFUNCTIO N IN J UVENILE RH EUMATO ID AR-TH RITIS.
Mártire TM, Dias RM, Sant’ana CC, Carvalho SRS. Martagão Gestei-ra Institute (UFRJ ) and Gaffrée Guinle Hosp ital (Unirio), Rio de J an-eiro, RJ , Brazil.
