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CONTEXT: Pulmonary thromboembolism is the third most frequent cause of morbidity and mortality among acute cardiovascular diseases. The incidence of pulmonary embolism in necropsies has remained unchanged over the last few decades. Cardiac diseases, neoplasia, trauma, recent surgery and systemic diseases are important predisposing clinical conditions. The relationship between male and female sexes is estimated at 1.24. Various studies have shown an increase in morbidity in spring and autumn. There is great difficulty in precise anatomopathological diagnosis in relation to the localization of the emboli in the pulmonary vessels, although they are preferentially located in the right lung and lower lobes. OBJECTIVE: To study the incidence of lethal and non-lethal pulmonary thromboembolism in relation to epidemiological and anatomical variables. DESIGN: Retrospective study performed via reports on the necropsy findings. SETTING: University hospital providing tertiary-level attendance. SAMPLE: 16,466 consecutive necropsies performed from January 1972 to December 1995. MAIN MEASUREMENTS: Frequency of lethal and non-lethal pulmonary thromboembolism, predisposing diseases, occurrence in relation to the seasons of the year, and location where the embolus is lodged. RESULTS: Pulmonary thromboembolism was found in 4.7% of all the necropsies performed. There was a predominance of lethal cases (68.2%). There was no difference in relation to sex or seasons of the year for the occurrence of this disease. Cardiovascular diseases were more frequently associated with thromboembolic phenomena. With regard to the location where the embolus was lodged, various lung segments showed greater incidence of being bilaterally compromised. CONCLUSION: Over the period of this study, it was observed that there was a reduction in the incidence of pulmonary thromboembolism, which was probably due to the increase in prophylactic measures over the last few decades. Nonetheless, lethal thromboembolism predominated in frequency, probably because of the abrupt onset of a condition of attack across a large area of the lung, lack of clinical suspicions and consequently a lack of early diagnosis, and delay in instituting fibrinolytic therapy in the cases with hemodynamic repercussions or a large number of lung segments affected.

UNITERMOS. SIRS. Sepse. Síndrome da resposta inflamatória sistêmica. Terminologia. Fisiopatologia. Citoquinas.KEYWORDS. SIRS. Sepsis. Systemic inflammatory response syndrome. Terminology. Pathophysiology. Cytokines. INTRODUÇÃOO progresso da ciência médica, que avança no sentido do entendimento das doenças e suas conseqüências, nos tem levado à novas técnicas diagnósticas e terapêuticas e, assim nos obriga a reavaliações de conceitos e terminologias. Várias dessas terminologias deixaram de existir, não em decorrência de medidas terapêuticas ou preventivas, mas graças aos avanços da compreensão da fisiopatologia, de tal modo que suas denominações tornaram-se obsoletas 1 . Na antiga Grécia usava-se o termo Pepse para designar o processo de fermentação do vinho ou digestão da comida que indicava vida e boa saúde e o termo Sepse para descrever casos onde havia putrefação e estava associado com doença e morte 2 . Sepse tornou-se então uma condição clínica resultante de infecção bacteriana e a septicemia a presença desses microrganismos na corrente sangüínea. Há 50 anos, pacientes com falência de múltiplos órgãos não podiam ser mantidos vivos. Aqueles com infecções graves morriam rapidamente, já que os antimicrobianos estavam apenas começando a ser usados 3 . "Falência sistêmica seqüencial" foi descrita primeiramente por Tilney et al 4 em 1973, abrangendo três pacientes que evoluíram para óbito por falên-cia orgânica após rutura de aneurisma aórtico. Baue em 1975 descreveu três pacientes com "falên-cia orgânica sistêmica progressiva, múltipla, ou sequencial" 5 . Na realidade essas diferentes terminologias caracterizam condições que tornaram-se cada vez mais freqüentes em serviços de emergên-cia e unidades de terapia intensiva (UTI). Inúme-ros quadros clínicos denominados de "Sepse ou Síndrome Séptica" 6 , "Falência de múltiplos ór-gãos" 7 , "Falência de múltiplos órgãos e sistemas" 8 são responsáveis por aproximadamente 80% de todos os óbitos em UTI 9 . Essas denominações descrevem, na realidade, grupos altamente heterogê-neos de doenças, com diferentes causas e prognós-ticos.Nos últimos 10 anos, progressos em biologia celular e molecular mostraram que a agressão bacteriana ou de seus subprodutos (endotoxinas, LPS), não são os únicos responsáveis pela deterioração clínica dos pacientes em choque e que a resposta do hospedeiro desempenha papel importante nos diferentes tipos de agressões, quer infecciosas ou não, como pancreatite ou trauma. A identificação de mediadores e dos mecanismos envolvidos na produção das alterações fisiológicas, metabólicas e celulares 10 , o papel das células endoteliais, das moléculas de interação célula-endotélio, do endotélio do trato intestinal 11 são de grande interesse, porque estão envolvidos na perda da capacidade de homeostase do organismo. O presente estudo tem por objetivo apresentar a terminologia atualmente aceita e as principais características fisiopatológicas envolvidas na Sín-drome da Resposta Inflamatória Sistêmica e da Sepse. TerminologiaAtualmente acredita-se que doenças re...

Community-Acquired Pneumonia (CAP) is a major public health problem. In Brazil it has been estimated that 2,000,000 people are affected by CAP every year. Of those, 780,000 are admitted to hospital, and 30,000 have death as the outcome. This is an open-label, non-comparative study with the purpose of evaluating efficacy, safety, and tolerability levels of IV azithromycin (IVA) and IV ceftriaxone (IVC), followed by oral azithromycin (OA) for the treatment of inpatients with mild to severe CAP. Eighty-six patients (mean age 56.6 +/- 19.8) were administered IVA (500 mg/day) and IVC (1g/day) for 2 to 5 days, followed by AO (500 mg/day) to complete a total of 10 days. At the end of treatment (EOT) and after 30 days (End of Study--EOS) the medication was evaluated clinically, microbiologically and for tolerability levels. Out of the total 86-patient population, 62 (72.1%) completed the study. At the end of treatment, 95.2% (CI95: 88.9% - 100%) reported cure or clinical improvement; at the end of the study, that figure was 88.9% (CI95: 74.1% - 91.7%). Out of the 86 patients enrolled in the study, 15 were microbiologically evaluable for bacteriological response. Of those, 6 reported pathogen eradication at the end of therapy (40%), and 8 reported presumed eradication (53.3%). At end of study evaluation, 9 patients showed pathogen eradication (50%), and 7 showed presumed eradication (38.89%). Therefore, negative cultures were obtained from 93.3% of the patients at EOT, and from 88.9% at the end of the study. One patient (6.67% of patient population) reported presumed microbiological resistance. At study end, 2 patients (11.11%) still reported undetermined culture. Uncontrollable vomiting and worsening pneumonia condition were reported by 2.3% of patients. Discussion and Conclusion Treatment based on the administration of IV azithromycin associated to ceftriaxone and followed by oral azithromycin proved to be efficacious and well-tolerated in the treatment of Brazilian inpatients with CAP.

The authors report an unusual case involving a 38 year-old man who developed a intracranial abscess caused by Aspergillus of the parietal lobe. Cerebral aspergilloma of an initial pulmonary origin developed in a patient with "Fungus Ball" secondary to tuberculosis sequelae. The diagnosis was made through the isolation of Aspergillus from the secretion of the brain abscesses. The patient was treated with drainage of the abscesses and Amphotericin B. He presented a progressive regression of the radiological images (brain and pulmonary) over a period of 55 days. This report emphasizes the importance of combined anti-fungal therapy and surgical resection as a treatment for cerebral aspergilloma. Furthermore, an early initiation of therapy should improve the prognosis in such cases.UNITERMS: Aspergillus. Brain abscesses. Amphotericin B.