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        "titulo" => "Resumo"
        "resumen" => "<span id="as0005" class="elsevierStyleSection elsevierViewall"><p id="sp0005" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Introdu&#231;&#227;o&#58;</span> A pneumonia organizativa&#44; anteriormente designada como BOOP&#44; &#233; uma entidade individualizada desde h&#225; duas d&#233;cadas&#44; que apresenta caracter&#237;sticas cl&#237;nicas&#44; radiol&#243;gicas e crit&#233;rios histol&#243;gicos de diagn&#243;stico espec&#237;ficos&#46; Caracteriz&#225;mos os doentes com pneumonia organizativa seguidos em consulta de Pneumologia&#47;Doen&#231;as do Interst&#237;cio do nosso hospital&#44; no per&#237;odo de Janeiro de 1997 a Dezembro de 2006&#44; e compar&#225;mos os resultados com os da literatura&#46; <span class="elsevierStyleBold">Materiais e m&#233;todos&#58;</span> Foram consultados retrospectivamente os processos dos doentes com o diagn&#243;stico de pneumonia organizativa &#40;OP&#41; e avaliados os seguintes par&#226;metros&#58; idade&#44; sexo&#44; cl&#237;nica&#44; caracter&#237;sticas imagiol&#243;gicas&#44; tempo at&#233; ao diagn&#243;stico&#44; etiologia&#44; altera&#231;&#245;es laboratoriais e histol&#243;gicas&#44; tratamento e recidivas&#46; <span class="elsevierStyleBold">Resultados&#58;</span> Foram estudados 13 doentes&#44; 12 dos quais do sexo feminino &#40;92&#37;&#41;&#44; idade m&#233;dia de apresenta&#231;&#227;o 55&#44;6 anos &#40;&#43;-15&#44;3&#41;&#59; 10 eram n&#227;o fumadores e dois ex-fumadores&#46; O tempo m&#233;dio desde o in&#237;cio da sintomatologia at&#233; ao diagn&#243;stico foi de 77&#44;2 semanas &#40;m&#225;ximo 432 e m&#237;nimo 3 semanas&#41; e o tempo m&#233;dio do acompanhamento de 171&#44;6 semanas &#40;m&#225;ximo 334 e m&#237;nimo 28 semanas&#41;&#46; No grupo de OP prim&#225;ria &#40;pneumonia organizativa criptog&#233;nica &#8211; COP&#41; inclu&#237;ram-se nove doentes e quatro no secund&#225;rio &#40;pneumonia organizativa secund&#225;ria &#8211; SOP&#41;&#44; sendo dois com artrite reumat&#243;ide &#40;AR&#41;&#44; um com dermatomiosite e um submetido a radioterapia por neoplasia da mama&#46; Os principais sintomas na altura do diagn&#243;stico foram fadiga &#40;92&#37;&#41;&#44; tosse &#40;85&#37;&#41;&#44; febre &#40;65&#37;&#41;&#44; dispneia &#40;54&#37;&#41;&#44; dor tor&#225;cica &#40;23&#37;&#41;&#44; perda ponderal &#40;23&#37;&#41; e mialgias &#40;17&#37;&#41;&#46; Laboratorialmente apresentavam velocidade de sedimenta&#231;&#227;o m&#233;dia de 70<span class="elsevierStyleHsp" style=""></span>mm&#59; &#40;m&#225;ximo de 127<span class="elsevierStyleHsp" style=""></span>mm e m&#237;nimo de 16<span class="elsevierStyleHsp" style=""></span>mm&#41;&#44; prote&#237;na C reactiva elevada em oito doentes&#44; e aus&#234;ncia de leucocitose&#46; A radiografia de t&#243;rax e TC tor&#225;cica mostravam doen&#231;a bilateral em doze doentes &#40;92&#37;&#41;&#44; imagem de consolida&#231;&#227;o com broncograma a&#233;reo presente tamb&#233;m em doze doentes&#44; quatro dos quais com les&#245;es migrat&#243;rias&#46; Quatro realizaram bi&#243;psia pulmonar transbr&#244;nquica&#44; todas incaracter&#237;sticas&#44; e oito fizeram bi&#243;psia pulmonar cir&#250;rgica&#44; quatro das quais diagn&#243;sticas de OP&#46; Onze fizeram terap&#234;utica com corticoterapia com uma dura&#231;&#227;o m&#233;dia de 61&#44;6 semanas &#40;m&#225;ximo 288 e m&#237;nimo 16&#41;&#46; Dois doentes mant&#234;m doses baixas de corticoterapia&#44; um pela sua patologia de base e outro por m&#250;ltiplas recidivas&#46; Houve recidiva em quatro doentes &#40;30&#44;8&#37;&#41;&#44; um dos quais por cinco vezes&#46; <span class="elsevierStyleBold">Discuss&#227;o e conclus&#227;o&#58;</span> De salientar&#44; nesta s&#233;rie&#44; a elevada incid&#234;ncia desta patologia no sexo feminino&#46; &#201; preconizada a confirma&#231;&#227;o histol&#243;gica&#44; mas&#44; na presente s&#233;rie&#44; foi poss&#237;vel estabelecer o diagn&#243;stico em nove doentes&#44; com base apenas em par&#226;metros cl&#237;nicos&#44; imagiol&#243;gicos e de resposta &#224; terap&#234;utica&#46; O tempo m&#233;diode diagn&#243;stico foi muito vari&#225;vel&#44; o que sugere que a doen&#231;a por vezes n&#227;o &#233; diagnosticada e os doentes s&#227;o tratados como apresentando pneumonias ou outras doen&#231;as do interst&#237;cio&#46; A maioria apresentou uma evolu&#231;&#227;o cl&#237;nica favor&#225;vel com recidiva francamente inferior &#224; descrita na literatura&#46; Perante quadros cl&#237;nicos de &#8220;pneumonia arrastada&#8221; que n&#227;o resolvem com antibioticoterapia em 3-4 semanas&#44; imp&#245;e-se a realiza&#231;&#227;o de exames complementares subsequentes no sentido de despistar outras patologias&#44; nomeadamente a pneumonia organizativa&#46; Apenas em centros com experi&#234;ncia nesta &#225;rea se dever&#225; aceitar um diagn&#243;stico exclusivamente com crit&#233;rios cl&#237;nicos e radiol&#243;gicos&#46;</p><p id="sp0015" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010&#59; XVI &#40;3&#41;&#58; 369-389</span></p></span>"
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        "resumen" => "<span id="as0010" class="elsevierStyleSection elsevierViewall"><p id="sp0020" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Aim&#58;</span> to characterise outpatients of a Portuguese central hospital diagnosed with organising pneumonia &#40;OP&#41; and compare results with current literature&#46; <span class="elsevierStyleBold">Methods&#58;</span> medical processes with diagnosis of OP were retrospectively studied as to demographics&#44; aetiology&#44; clinical and radiological features&#44; average time until and date of diagnosis&#44; laboratory and histological changes&#44; treatment and relapse&#46; Results &#8211; thirteen patients with a mean follow-up of 171&#46;6<span class="elsevierStyleHsp" style=""></span>weeks &#40;max 334 and min 28 weeks&#41; were evaluated&#46; Nine of these patients &#40;70&#37;&#41; had cryptogenic OP &#40;COP&#41; while 30&#37; had secondary OP &#40;SOP&#41;&#44; two with rheumatoid arthritis&#44; one with dermatomyositis and another undergoing radiotherapy for breast cancer&#46; Mean age was 55&#46;6 &#40;&#43;-15&#46;3<span class="elsevierStyleHsp" style=""></span>years&#41;&#44; 92&#37; female&#44; 77&#37; were non-smokers&#46; Average time until diagnosis was 77&#46;2<span class="elsevierStyleHsp" style=""></span>weeks &#40;min 3 and max 432 weeks&#41;&#46; Symptoms at presentation were tiredness &#40;92&#37;&#41;&#44; cough &#40;85&#37;&#41;&#44; fever &#40;65&#37;&#41;&#44; shortness of breath &#40;54&#37;&#41;&#44; thoracic pain &#40;23&#37;&#41; and weight loss &#40;23&#37;&#41;&#46; At the time of diagnosis&#44; the mean erythrocyte sedimentation rate was 70<span class="elsevierStyleHsp" style=""></span>mm &#40;max 170<span class="elsevierStyleHsp" style=""></span>mm and min 16<span class="elsevierStyleHsp" style=""></span>mm&#41;&#46; C-reactive protein level was increased in eight patients&#46; Significant leucocytosis was absent&#46; Chest X-ray and chest CT scan showed bilateral distribution in 12 patients &#40;92&#37;&#41;&#46; Consolidation with an air bronchogram was present in 12 patients and in four &#40;31&#37;&#41;&#44; consolidation was migratory&#46; Four patients &#40;30&#37;&#41; underwent transbronchial pulmonary biopsy&#44; all uncharacteristic and eight patients surgical pulmonary biopsy&#44; four showed histological confirmation of SOP&#46; Corticosteroids were started in 11 patients and average treatment was 61&#46;6<span class="elsevierStyleHsp" style=""></span>weeks &#40;16-288 weeks&#41;&#46; 15&#37; &#40;2&#47;13&#41; had spontaneous resolution&#46; Four patients &#40;31&#37;&#41; relapsed&#44; one of them five times&#46; Two patients are dependent on a low dose of corticosteroids&#44; one due to underlying disease and another due to multiple relapses&#46; Therapy of relapse was corticosteroids alone in minimum effective dosage or associated to azathioprine or ciclosporin&#46; <span class="elsevierStyleBold">Discussion and conclusion&#58;</span> such a high incidence in females &#40;92&#37;&#41; may be explained by the limited sample of patients&#46; In 70&#37; of the patients diagnosis were established by clinical and radiology criteria&#46; Mean time to diagnosis was very variable which suggests that in some cases the disease was not diagnosed and treated as another interstitial lung disease or as recurrent pneumonia&#46; Most patients &#40;53&#46;8&#37;&#41; had a favourable clinical course after treatment with corticosteroids with a very low number of relapses &#40;30&#46;8&#37;&#41;&#44; much lower than described by other authors &#40;60&#37;&#41;&#46; Only in experienced centres should the diagnosis of OP established by clinical and radiological criteria&#46;</p><p id="sp0025" class="elsevierStyleSimplePara elsevierViewall"><span class="elsevierStyleBold">Rev Port Pneumol 2010&#59; XVI &#40;3&#41;&#58; 369-389</span></p></span>"
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Vol. 16. Issue 3.
Pages 369-389 (May - June 2010)
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Vol. 16. Issue 3.
Pages 369-389 (May - June 2010)
Artigo Original/Original Article
Open Access
Pneumonia organizativa – Experiência da consulta de um hospital central
Organising pneumonia – the experience of an outpatient clinic of a central hospital
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6632
M. Aguiar1,
Corresponding author
m_aguiar@netcabo.pt

Correspondência/Correspondence to: Margarida Aguiar, Serviço de Pneumologia I, Hospital de Santa Maria, CHLN, Av. Egas Moniz, 1500 Lisboa.
, M. Felizardo1, A.C. Mendes2, D. Moniz2, R. Sotto-Mayor3, A. Bugalho de Almeida4
1 Interna do Complementar de Pneumologia/Resident, Pulmonology
2 Assistente Hospitalar Graduada de Pneumologia/Consultant, Pulmonology Specialist
3 Chefe de Serviço de Pneumologia/Head, Pulmonology Unit
4 Director de Serviço do Serviço de Pneumologia I/Head, Pulmonology Unit I
This item has received

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Article information
Resumo

Introdução: A pneumonia organizativa, anteriormente designada como BOOP, é uma entidade individualizada desde há duas décadas, que apresenta características clínicas, radiológicas e critérios histológicos de diagnóstico específicos. Caracterizámos os doentes com pneumonia organizativa seguidos em consulta de Pneumologia/Doenças do Interstício do nosso hospital, no período de Janeiro de 1997 a Dezembro de 2006, e comparámos os resultados com os da literatura. Materiais e métodos: Foram consultados retrospectivamente os processos dos doentes com o diagnóstico de pneumonia organizativa (OP) e avaliados os seguintes parâmetros: idade, sexo, clínica, características imagiológicas, tempo até ao diagnóstico, etiologia, alterações laboratoriais e histológicas, tratamento e recidivas. Resultados: Foram estudados 13 doentes, 12 dos quais do sexo feminino (92%), idade média de apresentação 55,6 anos (+-15,3); 10 eram não fumadores e dois ex-fumadores. O tempo médio desde o início da sintomatologia até ao diagnóstico foi de 77,2 semanas (máximo 432 e mínimo 3 semanas) e o tempo médio do acompanhamento de 171,6 semanas (máximo 334 e mínimo 28 semanas). No grupo de OP primária (pneumonia organizativa criptogénica – COP) incluíram-se nove doentes e quatro no secundário (pneumonia organizativa secundária – SOP), sendo dois com artrite reumatóide (AR), um com dermatomiosite e um submetido a radioterapia por neoplasia da mama. Os principais sintomas na altura do diagnóstico foram fadiga (92%), tosse (85%), febre (65%), dispneia (54%), dor torácica (23%), perda ponderal (23%) e mialgias (17%). Laboratorialmente apresentavam velocidade de sedimentação média de 70mm; (máximo de 127mm e mínimo de 16mm), proteína C reactiva elevada em oito doentes, e ausência de leucocitose. A radiografia de tórax e TC torácica mostravam doença bilateral em doze doentes (92%), imagem de consolidação com broncograma aéreo presente também em doze doentes, quatro dos quais com lesões migratórias. Quatro realizaram biópsia pulmonar transbrônquica, todas incaracterísticas, e oito fizeram biópsia pulmonar cirúrgica, quatro das quais diagnósticas de OP. Onze fizeram terapêutica com corticoterapia com uma duração média de 61,6 semanas (máximo 288 e mínimo 16). Dois doentes mantêm doses baixas de corticoterapia, um pela sua patologia de base e outro por múltiplas recidivas. Houve recidiva em quatro doentes (30,8%), um dos quais por cinco vezes. Discussão e conclusão: De salientar, nesta série, a elevada incidência desta patologia no sexo feminino. É preconizada a confirmação histológica, mas, na presente série, foi possível estabelecer o diagnóstico em nove doentes, com base apenas em parâmetros clínicos, imagiológicos e de resposta à terapêutica. O tempo médiode diagnóstico foi muito variável, o que sugere que a doença por vezes não é diagnosticada e os doentes são tratados como apresentando pneumonias ou outras doenças do interstício. A maioria apresentou uma evolução clínica favorável com recidiva francamente inferior à descrita na literatura. Perante quadros clínicos de “pneumonia arrastada” que não resolvem com antibioticoterapia em 3-4 semanas, impõe-se a realização de exames complementares subsequentes no sentido de despistar outras patologias, nomeadamente a pneumonia organizativa. Apenas em centros com experiência nesta área se deverá aceitar um diagnóstico exclusivamente com critérios clínicos e radiológicos.

Rev Port Pneumol 2010; XVI (3): 369-389

Palavras-chave:
Pneumonia organizativa criptogénica
pneumonia organizativa secundária
Abstract

Aim: to characterise outpatients of a Portuguese central hospital diagnosed with organising pneumonia (OP) and compare results with current literature. Methods: medical processes with diagnosis of OP were retrospectively studied as to demographics, aetiology, clinical and radiological features, average time until and date of diagnosis, laboratory and histological changes, treatment and relapse. Results – thirteen patients with a mean follow-up of 171.6weeks (max 334 and min 28 weeks) were evaluated. Nine of these patients (70%) had cryptogenic OP (COP) while 30% had secondary OP (SOP), two with rheumatoid arthritis, one with dermatomyositis and another undergoing radiotherapy for breast cancer. Mean age was 55.6 (+-15.3years), 92% female, 77% were non-smokers. Average time until diagnosis was 77.2weeks (min 3 and max 432 weeks). Symptoms at presentation were tiredness (92%), cough (85%), fever (65%), shortness of breath (54%), thoracic pain (23%) and weight loss (23%). At the time of diagnosis, the mean erythrocyte sedimentation rate was 70mm (max 170mm and min 16mm). C-reactive protein level was increased in eight patients. Significant leucocytosis was absent. Chest X-ray and chest CT scan showed bilateral distribution in 12 patients (92%). Consolidation with an air bronchogram was present in 12 patients and in four (31%), consolidation was migratory. Four patients (30%) underwent transbronchial pulmonary biopsy, all uncharacteristic and eight patients surgical pulmonary biopsy, four showed histological confirmation of SOP. Corticosteroids were started in 11 patients and average treatment was 61.6weeks (16-288 weeks). 15% (2/13) had spontaneous resolution. Four patients (31%) relapsed, one of them five times. Two patients are dependent on a low dose of corticosteroids, one due to underlying disease and another due to multiple relapses. Therapy of relapse was corticosteroids alone in minimum effective dosage or associated to azathioprine or ciclosporin. Discussion and conclusion: such a high incidence in females (92%) may be explained by the limited sample of patients. In 70% of the patients diagnosis were established by clinical and radiology criteria. Mean time to diagnosis was very variable which suggests that in some cases the disease was not diagnosed and treated as another interstitial lung disease or as recurrent pneumonia. Most patients (53.8%) had a favourable clinical course after treatment with corticosteroids with a very low number of relapses (30.8%), much lower than described by other authors (60%). Only in experienced centres should the diagnosis of OP established by clinical and radiological criteria.

Rev Port Pneumol 2010; XVI (3): 369-389

Key-words:
Cryptogenic organising pneumonia
secondary organising pneumonia
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Copyright © 2010. Sociedade Portuguesa de Pneumologia/SPP
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