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Background: The impressive association of lung involvement and gastroesophageal reflux in scleroderma raises the possibility of a cause-effect relationship. Objectives: To determine clinical, radiological and histopathological features of systemic sclerosis (SSc) patients according the presence or absence of centrilobular fibrosis (CLF). Methods: Twenty-eight SSc patients with lung involvement were submitted to open lung biopsy and the specimens classified for the presence of CLF (bronchocentric distribution of the lesions and intraluminal matter according to the classification of idiopathic interstitial pneumonia). HRCT, pulmonary function tests and esophageal analysis were also performed. Subsequently, cyclophosphamide was introduced for the nonspecific interstitial pneumonia subgroup and antireflux treatment was intensified for isolated CLF patients. Results: Isolated CLF was found in 21% of the biopsies and also found associated to nonspecific interstitial pneumonia in 84% of these patients. The other 3 cases had usual interstitial pneumonia, pulmonary hypertension and respiratory bronchiolitis-associated interstitial lung disease. The histopathological analysis revealed that all 6 patients with isolated CLF had the bronchocentric distribution and intraluminal basophilic content, with foreign bodies detected in one third of them. The central distribution of lung involvement on HRCT was found in 67% of these patients with a consistent patchy distribution (100%). Ground glass (67%) and consolidation (33%) were the predominant patterns found. The constant clinical finding in all isolated CLF cases was dyspnea, esophageal abnormalities and a moderate lung impairment (FVC: 63.83 ± 16.31%; DLCO: 61.66 ± 18.84%). Lung function parameters in isolated CLF patients remained stable after 1 year of exclusively intensive antireflux treatment (FVC, p = 0.23; DLCO, p = 0.59). Conclusions: The novel description of CLF pattern in SSc lung disease with peculiar histological, tomographic and clinical features will certainly contribute to a more appropriate therapeutic approach.

During the anhepatic phase of conventional liver transplantation (LT), the inferior vena cava (IVC) is crossclamped and venovenous bypass (VVB) is usually indicated for diversion of IVC and portal blood flow. VVB can theoretically lead to pulmonary complications due to the contact of the blood with the surfaces of the circuit. In the piggyback method, preservation of the IVC avoids VVB. The aim of this study is to compare pulmonary alterations after conventional with VVB versus piggyback LT. Sixtyseven patients were randomized for conventional VVB (n ‫؍‬ 34) or piggyback (n ‫؍‬ 33) LT. Pulmonary static compliance (C st ) and Pa O2 /F IO2 ratio were measured preand post-LT. Chest X-rays were obtained daily from the 1st to the 5th postoperative day. Pre-and post-LT C st were 73.4 ؎ 36.0 mL/cm H 2 O and 59.7 ؎ 22.0 mL/cm H 2 O in the conventional group and 69.1 ؎ 20.0 mL/cm H 2 O and 58.7 ؎ 27.1 mL/cmH 2 O in the piggyback group. The difference between the two groups was not significant (P ‫؍‬ .702). C st significantly decreased after LT (P ‫؍‬ .008). The pre-and post-LT Pa O2 /F IO2 were 455.6 ؎ 126.6 mm Hg and 463.1 ؎ 105.9 mm Hg in the conventional group and 468.9 ؎ 114.1 mm Hg and 483.3 ؎ 119.8 mm Hg in the piggyback group. The difference among the two groups was not significant (P ‫؍‬ 0.331). There was no significant difference after LT (P ‫؍‬ .382). Upon the radiological evaluation, piggyback group presented a higher frequency of pulmonary infiltrates (80.6% vs. 50.0%; P ‫؍‬ .025). In conclusion, piggyback LT recipients have a higher rate of pulmonary infiltrates when compared to those operated upon using the conventional VVB method. (Liver Transpl 2004;10:425-433.) C urrently, 2 main methods of liver transplantation (LT) are employed. 1 In the conventional method, the retrohepatic portion of the inferior vena cava (IVC) is cross-clamped and resected in block with the native liver. This maneuver can lead to pulmonary complications secondary to the temporary reduction of the venous blood return of the lower extremities and splanchnic bed. 2 Patients with poor hemodynamic tolerance to IVC and portal vein clamping will require fluid infusion during the anhepatic phase. 2 After graft reperfusion, the restoration of the venous return results in a sudden central volume overload that can cause pulmonary edema. 2 A concurrent mechanism is the release into the systemic circulation of proinflammatory substances produced in the graft itself during the ischemia-reperfusion injury, and in the obstructed venous beds during blood stagnation. 3 These substances may produce left ventricle dysfunction, increase pulmonary capillary pressure, and alter capillary permeability. 3 All these actions can contribute to pulmonary dysfunction.To overcome these disorders, venovenous bypass (VVB) is usually indicated, allowing the diversion of the IVC and portal blood flow to the superior vena cava. 2 Despite these advantages, VVB can also cause pulmonary complications. Although rare, some can be fatal, like air or thrombotic pulmonary em...

Although we were not able to prove a causal relationship between esophageal and pulmonary involvement, our series revealed a strong association between esophageal motor dysfunction and interstitial lung disease in patients with mixed connective tissue disease.

125Souza Jr AS et al. INTRODUÇÃOUma das grandes preocupações da ciência sempre foi estabelecer uma linguagem universal, a fim de facilitar a comunicação entre pessoas de diferentes nacionalidades e culturas. Isto permite, entre outras coisas, a comparação de resultados de trabalhos científicos e a troca de informações sobre um determinado assunto.No Brasil, de proporções continentais, com uma cultura rica e variada, há a necessidade de se estabelecer um consenso de terminologia para se descrever os exames de imagem.Especialmente em relação aos exames de imagem, isto não é tarefa fácil, pois na formação do radiologista em geral não há a preocupação de saber como se deve descrever uma lesão pulmonar. Esta situação se deve a vários fatores, como existir uma literatura muito variada, aprender "ouvindo" os radiologistas mais experientes, existir vícios de linguagem, que foram passados de geração em geração, as próprias características regionais, que influenciam no linguajar médico, e o uso indiscriminado de termos em inglês, sem uma real preocupação com a sua adequada tradução.Além disso, ao se fazer um relatório, este passa a ser um documento, que será lido, no mínimo, por outro médico, que muitas vezes não entende o que está escrito, acarretando conseqüências ruins para todos os envolvidos neste processo, especialmente para a figura central do processo, o paciente.Foi com essa preocupação que o Grupo de Tórax do Colé-gio Brasileiro de Radiologia, em conjunto com a Sociedade Paulista de Pneumologia e Tisiologia, resolveram fazer uma primeira proposta para um consenso brasileiro de terminologia em tó-rax, com base em consensos internacionais já existentes. Nesta primeira fase, é abordada a terminologia usada para os exames de tomografia computadorizada de alta resolução do tórax.É muito importante que todos participem com sugestões e críticas, para que num futuro próximo possamos estabelecer um consenso que seja referendado por todas as sociedades representantes afins, as escolas médicas, os congressos, as universidades, as residências médicas e seja utilizado pela maioria dos radiologistas, para que se use uma linguagem em comum, compreensível tanto para o radiologista como para o pneumologista.A partir desta publicação, durante um prazo de dois meses aguardaremos idéias e sugestões dos colegas radiologistas e pneumologistas de todo o País, para posteriormente divulgarmos o Consenso Brasileiro em TCAR do Tórax, que, esperamos, passe a ser usado no Brasil. As sugestões devem ser enviadas para o Dr. Arthur Soares Souza Jr (e-mail: asouzajr@terra.com.br). GLOSSÁRIO EM TOMOGRAFIA COMPUTADORIZADA DE ALTA RESOLUÇÃO DO TÓRAXAprisionamento (seqüestro) aéreo. S. m. 1. (Fisiopatol.) Retenção de excesso de gás ("ar") em todo ou em parte do pulmão, especialmente durante a expiração, tanto como resultado de obstrução parcial ou completa de vias aéreas, como também resultante de anormalidades focais da complacência pulmonar. Apesar de não ser de uso habitual, o termo "aprisionamento gasoso" é mais preciso. 2. (TC) Diminuição da a...

Aims: To investigate the consequences of improvement in the workplace environment over six decades in asbestos miners and millers from a developing country (Brazil). Methods: A total of 3634 Brazilian workers with at least one year of exposure completed a respiratory symptoms questionnaire, chest radiography, and a spirometric evaluation. The study population was separated into three groups whose working conditions improved over time: group I (1940-66, n = 180), group II (1967-76, n = 1317), and group III (1977-96, n = 2137. Results: Respiratory symptoms were significantly related to spirometric abnormalities, smoking, and latency time. Breathlessness, in particular, was also associated with age, pleural abnormality and increased cumulative exposure to asbestos fibres. The odds ratios (OR) for parenchymal and/or nonmalignant pleural disease were significantly lower in groups II and III compared to group I subjects (0.29 (0.12-0.69) and 0.19 (0.08-0.45), respectively), independent of age and smoking status. Similar results were found when groups were compared at equivalent latency times (groups I v II: 30-45 years; groups II v III: 20-25 years). Ageing, dyspnoea, past and current smoking, and radiographic abnormalities were associated with ventilatory impairment. Lower spirometric values were found in groups I and II compared to group III: lung function values were also lower in higher quartiles of latency and of cumulative exposure in these subjects. Conclusions: Progressive improvement in occupational hygiene in a developing country is likely to reduce the risk of non-malignant consequences of dust inhalation in asbestos miners and millers.

Exposure to high levels of silica dust was associated with an increased prevalence of silicosis among stone carvers. Am. J. Ind. Med. 45:194-201, 2004.

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