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M Freitas e Costa

Publications and source records attributed to M Freitas e Costa.

16 recordsLinked to original sources
PubMed1997

Role of bronchoalveolar lavage in predicting survival of patients with human immunodeficiency virus infection.

In this multicenter study, we investigated the prognostic factors that influence the risk of death in patients with human immunodeficiency virus (HIV) infection. Clinical and laboratory indices obtained from 161 HIV-seropositive patients who underwent a detailed morphologic and immunophenotypic evaluation of bronchoalveolar lavage (BAL) and peripheral blood cell populations were retrospectively analyzed. In 155 patients, death occurred within the 48-mo follow-up (mean follow-up: 14.8 mo; range: 1 to 48 mo). In the univariate analysis, the patient's age (> 30 yr), HIV disease status, HIV transmission category, number of opportunistic pathogens isolated from the BAL, percentage of BAL neutrophils, and low number of BAL CD4 T cells were predictive of increased mortality. In contrast, the presence of an alveolitis or an increase in the numbers of alveolar macrophages and CD3 T cells was associated with a decreased mortality. In the multivariate analysis, significant independent predictors were age, risk factor for HIV, and presence of an alveolitis. Furthermore, patients with a low number of BAL CD4 T cells had a particularly poor prognosis while the CD4 T-cell count in the peripheral blood (< 50 cells/mm3 in the majority of our patients) had a negligible effect on predicting survival. Our findings suggest the clinical utility of BAL analysis in patients infected with HIV.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Pleural effusion of non-neoplastic etiology in a patient with a rare form of myeloma].

Pleural effusions can be a manifestation of several nosological entities. Etiologic diagnosis involves a good clinical history, followed by thoracocentesis with pleural biopsy and eventually bronchoscopy or thoracoscopy. The differentiation between transudates and exudates, by the biochemical characteristics of the pleural effusions, can orientate the underlying disorder. It is known that there are more than 35 different etiological entities of exudative pleural effusions. However, pneumonia, malignancies, pulmonary embolism, abdominal disease and tuberculosis are the major causes (around 90%). Transudative effusions are more frequently due to congestive heart failure, renal or hepatic failure. The AA present a clinical situation of pleural effusion, the etiology of which was initially attributed to congestive heart failure, with a good response, clinical and radiological response to the treatment established. However the laboratory alteration persisted (anaemia, renal failure, acute inflammation). The subsequent study showed the existence of a rare syndrome, a Myeloma Ig M lambda that can lead to differential diagnosis with Waldenström's Macroglobulinemia, about which the authors make some theoretical considerations showing the difficulty in etiologic diagnosis of some pleural effusions.

Aged↗
PubMed1994

[The microbiological profile of nosocomial infection in a respiratory intensive care unit].

In 1987, in the Respiratory Intensive Care Unit of Santa Maria Hospital we developed a nosocomial surveillance program with specially created software that provides knowledge of NI in the ICU at any moment. The information gathered along the time is particularly useful in the correlation of the risk factors, the most frequent microorganisms and in the institution of empiric antibiotic therapy. Out of 2528 patients admitted in our ICU for the last 6 years (87/92), 10% had bacteriologically identified NI. Almost (93%) of them had occurred in mechanically ventilated patients, which corresponds to 20.7% NI in those patients. The gram-negative appeared in 63.37%, with the predominance of Enterobacteriaceae. From the gram-positives the most frequent were Staphylococcus spp. Their meticiline resistance was worrisome. NI patients had significantly higher severity and therapeutic intervention scores. Mechanical ventilation period was 4 fold higher and mortality 2.5 times higher in the patients with this complication.

Cross Infection↗
PubMed1993

[Pulmonary sequestration. Report of a clinical case].

Concerning a clinical situation of intralobar pulmonary sequestration, in a seventeen year old young man, the authors review this nosological entity. They emphasize the importance of the complementary examens of diagnosis, namely of thoracic scan and aortography, for the establishment of the said diagnosis.

Adolescent↗
PubMed1992

[Benign pleural effusion caused by asbestos exposure].

The Authors present the first case described among us of benign pleural effusion of an asbestotic origin. They stress the importance of thoracoscopy (pleuroscopy) in the diagnosis of this situation. Attention is drawn to the fact that asbestotic lesions and asbestotic bodies have been found in the lung and, in particular, in the parietal pleura as well. They emphasize the fact that exposure to asbestos was not realized by the patient, which made the clarification of the situation more difficult. It was a CT scan that showed the signs suggestive of exposure to asbestos which raised the diagnostic suspicion. They conclude that every patient with a pleural effusion must be thoroughly questioned about exposure to asbestos. Even if the exposure is accepted, they consider that one should proceed to a pleuro-pulmonar biopsy by thoracoscopy. This biopsy allows demonstration of the characteristic histopathological lesions and rule out other etiologies, namely malignancy and tuberculosis. They suggest that these patients must be highly motivated to stop any smoking and kept under periodic surveillance.

Adult↗
PubMed1974

Thoracic kidney.

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Adult↗
PubMedDate not supplied

[Diffuse tracheo-bronchial amyloidosis].

The case of a 52 year old man, whose initial clinical manifestations were dyspnea, bloodstained sputum and malaise is reported. After the initial cancer hypothesis, a diagnosis of diffuse primary tracheo-bronchial amyloidosis was made. The amyloid substance present was not of A A type and the plasma cells next to the deposits were polyclonal. The piece-meal removal of the masses by bronchoscopy led to profuse bleeding. The patient died with sepsis. The clinical, pathological and therapeutical aspects of lower respiratory tract amyloidosis are reviewed.

Amyloidosis↗
PubMedDate not supplied

Thomé George villar.

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History of Medicine↗