Papers by Carlos Roberto Ribeiro Carvalho
Jornal Brasileiro de Pneumologia, 2012
OBJETIVO: Analisar a prevalência de sintomas asmáticos e de obstrução ao fluxo aéreo em nadadores... more OBJETIVO: Analisar a prevalência de sintomas asmáticos e de obstrução ao fluxo aéreo em nadadores amadores de 8-17 anos de idade e avaliar a conscientização sobre asma e tratamento de asma entre nadadores, seus pais e treinadores. MÉTODOS: Uma amostra com 1.116 nadadores amadores respondeu a uma versão modificada do questionário escrito do International Study of Asthma and Allergies in Childhood, ao qual questões sobre as razões de início da natação e sobre gerenciamento de asma foram adicionadas. Os participantes realizaram espirometria antes de uma prova de natação. RESULTADOS: A prevalência de sintomas de asma nos últimos 12 meses foi de 11,5%, e 327 participantes (29,4%) relataram sibilos no passado. Dos 223 nadadores que relataram asma ou bronquite na vida, somente 102 (45,7%) relataram algum tipo de tratamento: natação foi o "tratamento" mais frequente (37,3%), e somente 12,7% utilizavam corticosteroides inalatórios. Dos 254 participantes (22,7%) com obstrução ao flu...
Brazilian Journal of Infectious Diseases, 2007
Leptospirosis is a re-emerging zoonosis occurring as large outbreaks throughout the world caused ... more Leptospirosis is a re-emerging zoonosis occurring as large outbreaks throughout the world caused by Leptospira interrogans. The incidence of pulmonary involvement in leptospirosis has been reported to be increasing in the last years, affecting up to 70% of the patients. Alveolar hemorrhage presented as dyspnea and hemoptysis is the main pulmonary manifestation. The emergence of massive hemoptysis and acute respiratory distress syndrome has characterized the recent changes reported in the clinical patterns of leptospirosis. The pulmonary involvement has been emerged as a serious life threat, becoming the main cause of death due to leptospirosis in some countries. In this review we present the main clinical and pathological manifestations of pulmonary involvement in leptospirosis, with special focus on recent data concerning the pathophysiological mechanisms underlying lung injury.
D23. CASE REPORTS: INTERSTITIAL LUNG DISEASE, 2012
Castleman disease is a rare lymphoproliferative disorder presenting frequently with constitutiona... more Castleman disease is a rare lymphoproliferative disorder presenting frequently with constitutional symptoms. Although pleural effusion is common, there is only one case report of an adult patient with chylous pleural effusion. We present the first case report of a hypervascular variant of Castleman disease presenting as a chylous pleural effusion and successfully treated with a combination of anti-interleukin-6 agent and steroids.
Jornal Brasileiro de Pneumologia, 2008
A embolia gordurosa é definida como a ocorrência de bloqueio mecânico da luz vascular por gotícul... more A embolia gordurosa é definida como a ocorrência de bloqueio mecânico da luz vascular por gotículas circulantes de gordura. Acomete principalmente o pulmão, podendo afetar também o sistema nervoso central, a retina e a pele. A síndrome da embolia gordurosa é uma disfunção desses órgãos causada pelos êmbolos gordurosos. As causas mais comuns de embolia gordurosa e síndrome da embolia gordurosa são as fraturas de ossos longos, mas há relatos de sua ocorrência após procedimentos estéticos. O diagnóstico é clínico, e o tratamento ainda se restringe a medidas de suporte. Apresentamos o caso de uma paciente que evoluiu com síndrome da angústia respiratória do adulto por embolia gordurosa no período pós-operatório de lipoaspiração e lipoenxertia e respondeu bem às manobras de recrutamento alveolar e à ventilação mecânica protetora.Apresentamos também uma análise epidemiológica e fisiopatológica da síndrome da embolia gordurosa após procedimentos estéticos.
Jornal Brasileiro de Pneumologia, 2004
O primeiro surto no Brasil da síndrome pulmonar e cardiovascular por hantavírus foi descrito em J... more O primeiro surto no Brasil da síndrome pulmonar e cardiovascular por hantavírus foi descrito em Juquitiba (SP), em 1993. Desde então têm sido descritos novos casos, especialmente nos estados do sul e sudeste do país. Em 2002 ocorreu a observação dos primeiros três casos em São Carlos (SP). Um dos pacientes recebeu suporte respiratório sem intubação traqueal, utilizando-se pressão positiva contínua nas vias aéreas (CPAP) através de máscara facial. Este é o primeiro caso grave descrito de insuficiência respiratória por hantavírus em que houve sucesso com essa terapêutica ventilatória.
Jornal Brasileiro de Pneumologia, 2007
Princípios da ventilação mecânica Definição A ventilação mecânica (VM) ou, como seria mais adequa... more Princípios da ventilação mecânica Definição A ventilação mecânica (VM) ou, como seria mais adequado chamarmos, o suporte ventilatório, consiste em um método de suporte para o tratamento de pacientes com insuficiência respiratória aguda ou crônica agudizada.
Jornal Brasileiro de Pneumologia, 2012
OBJETIVO: Investigar o significado de marcadores de imunidade celular e de componentes elásticos/... more OBJETIVO: Investigar o significado de marcadores de imunidade celular e de componentes elásticos/colágeno da matriz extracelular em estruturas granulomatosas em biópsias de pacientes com sarcoidose pulmonar ou extrapulmonar. MÉTODOS: Determinações qualitativas e quantitativas de células inflamatórias, de fibras de colágeno e de fibras elásticas em estruturas granulomatosas em biópsias cirúrgicas de 40 pacientes com sarcoidose pulmonar e extrapulmonar foram realizadas por histomorfometria, imuno-histoquímica, e técnicas de coloração com picrosirius e resorcina-fucsina de Weigert. RESULTADOS: A densidade de linfócitos, macrófagos e neutrófilos nas biópsias extrapulmonares foi significativamente maior do que nas biópsias pulmonares. Os granulomas pulmonares apresentaram uma quantidade significativamente maior de fibras de colágeno e menor densidade de fibras elásticas que os granulomas extrapulmonares. A quantidade de macrófagos nos granulomas pulmonares correlacionou-se com CVF (p <...
Pathology, research and practice, 2002
The classification of idiopathic interstitial pneumonias (IIP) is still under debate. In this con... more The classification of idiopathic interstitial pneumonias (IIP) is still under debate. In this context, we observed in some of our patients with a clinical and radiological diagnosis of IIP a different histological picture with an aggressive centrilobular scarring centered in the bronchiolar epithelia, but involving the surrounding parenchyma, which underwent extensive remodeling. We hypothesized that this pattern is a form of IIP that could be separated out histologically from the previously described patterns, in particular from usual interstitial pneumonia (UIP) and non-specific interstitial pneumonia (NSIP). Forty-nine patients with clinical and radiological diagnosis of IIP and open-lung biopsies were retrospectively selected from 1982 to 1998. The biopsies were reviewed according to the following criteria: derangement of lobular architecture, temporal homogeneity and subpleural or bronchocentric distribution of the lesions, fibroblast foci, bronchial epithelium necrosis and reg...
Respiratory care, 2005
When endotracheal intubation is required during ventilatory support, the physiologic mechanisms o... more When endotracheal intubation is required during ventilatory support, the physiologic mechanisms of heating and humidifying the inspired air related to the upper airways are bypassed. The task of conditioning the air can be partially accomplished by heat-and-moisture exchangers (HMEs). To evaluate and compare with respect to imposed resistance, different types/models of HME: (1) dry versus saturated, (2) changing inspiratory flow rates. Eight different HMEs were studied using a lung model system. The study was conducted initially by simulating spontaneous breathing, followed by connecting the system directly to a mechanical ventilator to provide pressure-support ventilation. None of the encountered values of resistance (0.5\N3.6 cm H(2)O/L/s) exceeded the limits stipulated by the previously described international standard for HMEs (International Standards Organization Draft International Standard 9360-2) (not to exceed 5.0 cm H(2)O with a flow of 1.0 L/s, even when saturated). The h...
Human pathology, 2010
Idiopathic pulmonary fibrosis is a distinctive, usually fatal, type of chronic fibrosing intersti... more Idiopathic pulmonary fibrosis is a distinctive, usually fatal, type of chronic fibrosing interstitial pneumonia of unknown cause that increases in prevalence with advanced age, characterized by failure of alveolar re-epithelization and progressive scar formation. Recently, limitation of the replicative capacity of tissues determined by telomerase/apoptosis balance has been implicated in pathogenesis of age-related diseases. In this study, we validated the importance of the expression of type 2 alveolar epithelial cells telomerase protein and studied the relationships between telomerase and apoptosis in early remodeling of usual interstitial pneumonia. We determined type 2 alveolar epithelial cells density, telomerase expression, and apoptosis in surgical lung biopsies from 24 patients with usual interstitial pneumonia, and in normal lung tissues from 18 subjects. We used immunohistochemistry, deoxynucleotidyl transferase method of end labeling, electron microscopy, and histomorphome...
World Journal of Cardiovascular Diseases, 2013
To improve the identification of cardiac regions in Electrical impedance tomography (EIT) pulmona... more To improve the identification of cardiac regions in Electrical impedance tomography (EIT) pulmonary perfusion images, a model of wavelet transform was developed. The main goal was to generate maps of the heart using EIT images in a controlled animal experiment using a healthy pig and in two human volunteers. The model was capable of identifying the heart regions, demonstrated robustness and generated satisfactory results. The pig images were compared to perfusion images obtained using injection of a hypertonic solution and achieved an average area of the ROC curve of 0.88. The human images were qualitatively compared with Computerized Tomography scan (CT-scan) images.
Clinical Pulmonary Medicine, 1998
Revista Brasileira de Terapia Intensiva, 2014
Conflicts of interest: With the help of the Brazilian Thoracic Society, the AMIB Division of Scie... more Conflicts of interest: With the help of the Brazilian Thoracic Society, the AMIB Division of Scientific Issues procured financial support from industrial companies and laboratories, distributed as sponsorship quotas, to cover part of the event costs (participants' air tickets, food and lodging). None of those companies participated in the drafting of the present document, nor had access to its content until it was disclosed (after its final format was approved) as brochures distributed at the Brazilian Congress of Intensive Care Medicine in Rio de Janeiro in 2013. The companies that collaborated with the present project are:
Revista da Sociedade Brasileira de Medicina Tropical, 2009
A síndrome pulmonar e cardiovascular por hantavírus é doença causada pela aspiração de aerossóis ... more A síndrome pulmonar e cardiovascular por hantavírus é doença causada pela aspiração de aerossóis dos dejetos de roedores silvestres contaminados por vírus da família Bunyaviridae. Estudamos manifestações clínicas e laboratoriais de 70 casos ocorridos de 1998 a 2007 na região de Ribeirão Preto, SP. A freqüência de sintomas foi dispnéia (87%), febre (81%), tosse (44%), cefaléia (34%), taquicardia (81%), hipotensão arterial (56%), hipóxia (49%), acidose metabólica (57%), linfocitopenia (51%), hematócrito >45% (70%), leucocitose com desvio à esquerda (67%), creatinina (51%) e uréia (42%) séricas elevadas. A letalidade (54,3%) ocorreu principalmente no 4o dia. Insuficiência respiratória, hipotensão arterial e choque ocorreu 24-48 horas; o hematócrito elevado e a plaquetopenia são sinais fortemente sugestivos da doença. A hipótese diagnóstica de pneumonia atípica associada a bom prognóstico (p:0,0136); a infusão hídrica >2.000ml e hipotensão arterial associadas a mau prognóstico (p:...
Lung, 2006
Epithelial remodeling probably contributes to parenchymal deterioration in usual interstitial pne... more Epithelial remodeling probably contributes to parenchymal deterioration in usual interstitial pneumonia/idiopathic pulmonary fibrosis (UIP/IPF), but understanding its mechanisms is still a challenge. The aim of our study was to examine apoptosis and the epithelial changes in the histologic pattern of UIP. After immunohistochemical staining we quantified the content of type I cells, type II cells, surfactant-A protein, bcl-2, and Fas-ligand (Fas-L) in control and alveolar collapse, fibroblastic foci, and honeycomb in UIP areas of 23 open lung biopsies. A significant association was found between epithelial changes and parenchymal deterioration (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Type I epithelial cell density was similar between control (1.7 +/- 0.7%) and UIP alveolar collapse areas (1.8 +/- 0.6%) but decreased progressively in fibroblastic foci zones (0.8 +/- 0.4%) and honeycomb changes (0.4 +/- 0.3%). Type II cell density increased from control (25.6 +/- 8.3%) to areas of alveolar collapse (34.5 +/- 11.4%), then decreased toward fibroblastic foci (15.4 +/- 6.0%) and honeycomb change areas (23.1 +/- 8.6%). The surfactant-A protein increased from control (6.7 +/- 3.2%) to areas of alveolar collapse (31.1 +/- 9.5%) and decreased toward fibroblastic foci (14.5 +/- 4.9%) and honeycomb change areas (21.1 +/- 8.9%). Fas-L positive epithelial cell density presented a progressive decline from control (48.5 +/- 9.5%), alveolar collapse (37.9 +/- 12.4%), fibroblastic foci (27.4 +/- 6.8%), and honeycomb change areas (21.9 +/- 6.5%). A similar decline in density was found for bcl-2 positive epithelial cells from control (20.4 +/- 2.7%), alveolar collapse (18.9 +/- 5.1%), and fibroblastic foci areas (13.8 +/-2.9%), then increased honeycomb change areas (16.3 +/- 2.8%). We conclude that loss of the nuclear (bcl-2) and membrane (Fas-L) regulation of normal cell population density and suppression of cell death by apoptosis in UIP may be a determinant of the abnormal epithelial/parenchymal remodeling in UIP.
Journal of Critical Care, 2013
Recent studies suggest a role for distal airway injury in acute respiratory distress syndrome (AR... more Recent studies suggest a role for distal airway injury in acute respiratory distress syndrome (ARDS). The epithelium lining the small airways secretes a large number of molecules such as surfactant components and inflammatory mediators. There is little information on how these small airway secretory functions are altered in ARDS. Materials and Methods: We studied the lungs of 31 patients with ARDS (PaO 2 /fraction of inspired oxygen ≤200, 45 ± 14 years, 16 men) and 11 controls (52 ± 16 years, 7 men) submitted to autopsy and quantified the expression of interleukin (IL) 6, IL-8, surfactant proteins (SP) A and SP-B in the epithelium of small airways using immunohistochemistry and image analysis. In addition, an index of airway epithelial apoptosis was determined by the terminal deoxynucleotidyl transferase-mediated deoxyuridinetriphosphatase nick-end labeling assay, caspase 3, and Fas/Fas ligand expression. The density of inflammatory cells expressing IL-6 and IL-8 within the small airway walls was also quantified. Results: Acute respiratory distress syndrome airways showed an increase in the epithelial expression of IL-8 (P = .006) and an increased density of inflammatory cells expressing IL-6 (P = .004) and IL-8 (P b .001) compared with controls. There were no differences in SPA and SP-B epithelium expression or in epithelial apoptosis index between ARDS and controls. Conclusion: Distal airways are involved in ARDS lung inflammation and show a high expression of proinflammatory interleukins in both airway epithelial and inflammatory cells. Apoptosis may not be a major mechanism of airway epithelial cell death in ARDS.
Intensive Care Medicine, 2001
Clinics in Chest Medicine, 2002
Artificial Organs, 2001
Among the possible techniques to obtain the pressure-volume (P × V) curve at the bedside the low ... more Among the possible techniques to obtain the pressure-volume (P × V) curve at the bedside the low constant flow (CF) is the easiest and quickest one. However, the best value for CF to perform a good semistatic P × V curve is still to be determined. The purpose of this study was to evaluate the influence of 4 different CFs (1, 2, 5, and 10 L/min) on determination of lower inflection point of the P × V curve (L-Pflex) and upper inflection point of the P × V curve (U-Pflex) on the maximum slope and on the inspiratory work of breathing (up to volume of 1.35 L; inspiratory work L/cm H 2 O), comparing the volume estimated from the CF with the measured volume obtained by the respiratory inductive plethysmograph. The design was a prospective study, and the setting was an adult medical intensive care unit of a university hospital. There were 7 acute respiratory distress syndrome (ARDS) patients, less than 5 days of installation, after the standardization of lung volume history received sequentially from 4 different low inspiratory CFs in 2 trials. The P × V curve
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Papers by Carlos Roberto Ribeiro Carvalho