We performed a prospective observational study to define the clinical course and the prognostic factors of 31 patients with postinfectious bronchiolitis obliterans. All patients presented with an episode of acute bronchiolitis in the first 2 years of life, and respiratory symptoms and signs persisted since then. Other diseases which may cause chronic airflow obstruction were excluded. The patients were followed after their inclusion in the study and the clinical findings were recorded in a standardized questionnaire and form. Repeated chest radiographs and lung perfusion scans were obtained in all 31 patients and semiannual spirometry was performed in 8 older patients. Eight patients had lung biospies. The clinical course varied in the 31 patients during a mean of 3.5 years of follow‐up. The outcome of the patients included clinical remission (22.6%), persistence of respiratory symptoms and signs (67.7%), and death (9.7%). An older age at onset of illness and presence of atopy as suggested by an elevated serum IgE appeared to predispose to a poor prognosis. Pediatr Pulmonol. 2000; 29:341–350. © 2000 Wiley‐Liss, Inc.

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Objective: To review the literature on general aspects of bronchiolitis obliterans, with emphasis on childhood postinfectious bronchiolitis obliterans.Methods: The most important publications on bronchiolitis obliterans were selected, using basically the Medline database (January of 1966 to September of 1999.Results: This review is organized as follows: introduction, general aspects of bronchiolitis obliterans (terminology, histopathology and classification), and postinfectious bronchiolitis obliterans (etiological agents, clinical and radiological aspects, diagnosis and investigation, and treatment).Comments: Bronchiolitis obliterans is a clinical syndrome wich is more common than previously believed in the pediatric population, thus deserving pediatricians' attention.J. pediatr. (Rio J.). 2000; 76(3): 185-192: bronchiolitis obliterans, organizing pneumonia. ResumoObjetivos: Apresentar uma revisão sobre os aspectos gerais da bronquiolite obliterante, com ênfase na bronquiolite obliterante pós-infecciosa em crianças.Métodos: Foram selecionadas as publicações mais relevantes sobre a bronquiolite obliterante, utilizando basicamente o banco de dados do Medline (janeiro de 1966 a setembro de 1999).Resultados: A presente revisão inclui os seguintes tópicos: introdução, aspectos gerais da bronquiolite obliterante (terminologia, histopatologia e classificação) e bronquiolite obliterante pós-infecciosa (agentes etiológicos, aspectos clínico-radiológicos, diagnóstico e investigação, e tratamento).Comentários: A bronquiolite obliterante é uma síndrome clíni-ca mais comum do que se imaginava na população pediátrica, merecendo atenção dos pediatras. J. pediatr. (Rio J. IntroduçãoBronquiolite obliterante (BO), no sentido clínico, refere-se a uma síndrome de obstrução crônica do fluxo aéreo associada a lesão inflamatória das pequenas vias aéreas 1 . Patologicamente, o termo BO tem sido usado para descrever dois tipos de lesão bronquiolar, ou seja, bronquiolite proliferativa e bronquiolite constritiva 1-3 . Embora a descrição inicial de BO tenha ocorrido já há um século 4 , os aspectos da sua epidemiologia, patogenia, tratamento efetivo e prognóstico permanecem desconhecidos ou duvidosos.A BO, tanto em adultos quanto em crianças, até recentemente, foi considerada uma doença rara [5][6][7] . Em 1941, LaDue descobriu só um caso em 42.038 autópsias realizadas na Universidade de Minnesota, num período de 42 anos 8 . Em 1988, Hardy e cols. confirmaram 19 casos pediátricos, após revisarem todos os casos de autópsia (n = 2.897) e biópsia pulmonar (n = 244) realizadas no Hospital Infantil Saint Christopher, na Filadélfia, durante um período de 25 anos 9 . No entanto, nas últimas décadas, surgiu um interesse crescente a respeito dessa doença em adultos (Figura 1), devido ao reconhecimento de novos fatores causais, principalmente transplante de órgãos [10][11][12][13][14][15][16] .Em crianças, na maioria das vezes, a BO é precedida por uma infecção das vias aéreas inferiores, principalmente causada por adenovírus [17][18][19][2...

The combination of factors, such as abnormal viscosity of the paranasal sinus secretions, decreased sinus drainage, and impaired mucociliary clearance may account for the establishment of a suitable and opportune environment for the colonization of bacteria in the paranasal sinuses of patients with cystic fibrosis. Aim: The goal of the present study was to assess the bacteriology of the middle meatus aspirate in patients diagnosed whit cystic fibrosis. Material and Methods: Through a cross-sectional prospective study, a sample consisting of 23 patients evaluated for 2 years, was assessed. Firstly, we established the relationship between the middle meatus culture and the maxillary sinus x-ray. In second, we studied the relationship between the middle meatus aspirate bacteriology and the sputum bacteriology. Results: In total, 42 aspirates of the middle meatus were carried out. In 17 (73.91%) of the 23 patients, the aspirates were negative; and in 6 (26.08%) they were positive. Out of the 42 aspirates,31 (78.8%) were negative, and 11 (26.2%) were positive. The presence of Pseudomonas aeruginosa was observed in 18.18% of the positive cultures, and Staphylococcus aureus was observed in 27.28%. Conclusion:The great majority of the middle meatus aspirates of the patients with cystic fibrosis were negative.

Objective: To identify the predictive factors of oxygen desaturation during the six-minute walk test (6MWT) in patients with cystic fibrosis (CF). Methods: Prospective cross-sectional study involving clinically stable patients with CF aged ≥ 10 years. The patients were submitted to nutritional evaluations, oral glucose tolerance tests, pulmonary function tests, chest X-rays and 6MWTs. Results: The study included 88 patients (43 females and 45 males; mean age, 19.9 ± 7.2 years; mean FEV 1 , 65.4 ± 28.4%). We observed oxygen desaturation in 13 patients (OD+ group) and no oxygen desaturation in 75 (OD− group). In comparison with OD− group patients, OD+ group patients presented higher mean age (p = 0.004), worse clinical score (p < 0.001), worse radiological score (p < 0.001), higher incidence of glucose intolerance (p = 0.004), lower incidence of methicillin-sensitive Staphylococcus aureus infection (p < 0.001), higher incidence of methicillin-resistant S. aureus infection (p = 0.016), higher incidence of Pseudomonas aeruginosa infection (p = 0.008), lower mean resting SpO 2 (p < 0.001) and lower mean FEV 1 (p < 0.001). In the logistic regression analysis, oxygen desaturation during the 6MWT correlated with resting SpO 2 (OR = 0.305, p < 0.001) and FEV 1 (OR = 0.882, p = 0.025). The parameters maximizing the predictive value for oxygen desaturation were resting SpO 2 < 96% and FEV 1 < 40%. In this sample, 15% of the patients with CF aged ≥ 10 years presented oxygen desaturation during the 6MWT. Conclusions: Resting SpO 2 < 96% and FEV 1 < 40% can predict oxygen desaturation during the 6MWT. Keywords: Cystic fibrosis; Respiratory function tests; Exercise tolerance. ResumoObjetivo: Identificar os fatores preditores de dessaturação de oxigênio durante o teste de caminhada de seis minutos (TC6) em pacientes com fibrose cística (FC). Métodos: Estudo transversal e prospectivo em pacientes com FC clinicamente estáveis com idade superior a 10 anos. Os pacientes foram submetidos à avaliação nutricional, teste oral de tolerância à glicose, testes de função pulmonar, exame radiológico do tórax e TC6. Resultados: Foram incluídos 88 pacientes (43 femininos e 45 masculinos) com média de idade de 19,9 ± 7,2 anos e média de VEF 1 de 65,4 ± 28,4%. Observamos que 75 pacientes apresentaram-se sem dessaturação de oxigênio (SD) e 13 com dessaturação (CD). Os pacientes do grupo CD apresentaram maior média de idade (p = 0,004), pior escore clínico (p < 0,001), pior escore radiológico (p < 0,001), maior frequência de intolerância à glicose (p = 0,004), menor frequência de infecção bacteriana por Staphylococcus aureus sensível à meticilina (p < 0,001), maior frequência de infecção por S. aureus resistente à meticilina (p = 0,016) e por Pseudomonas aeruginosa (p = 0,008) e menor valor médio de SpO 2 em repouso (p < 0,001) e de VEF 1 (p < 0,001) do que os pacientes do grupo SD. Na análise de regressão logística, SpO 2 em repouso (OR = 0,305, p < 0,001) e VEF 1 (OR = 0,882, p = 0,025) se associaram com a dessaturação de oxigênio no TC...