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Vol. 12. Issue 2.
Pages 93-105 (March - April 2006)
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Vol. 12. Issue 2.
Pages 93-105 (March - April 2006)
Prémio Thomé Villar/Boehringer Ingelheim 2004**

Trabalho vencedor ex-aequo (Secção A)

\Thomé Villar/Boehringer Ingelheim Award 2004*
Open Access
Participação das vias aéreas centrais na doença vibroacústica
Involvement of central airways in vibroacoustic disease patients
Visits
4790
José Reis Ferreira1, Miguel B. Monteiro2, Fernanda Tavares3, Isabel Serrano4, Emanuel Monteiro5, Carla P. Mendes6, Mariana Alves-Pereira7, Nuno A. A. Castelo Branco8
1 Médico pneumologista/Pulmonologist. Unidade de Estudo Funcional Respiratório, Hospital da Força Aérea, Lisboa
2 Médico pneumologista/Pulmonologist. Unidade de Pneumologia, Centro Hospitalar de Cascais
3 Médica anatomopatologista/Anatomo-pathologist. Centro de Patologia Humana, Oeiras
4 Médica anatomopatologista/Anatomo-pathologist. Centro Hospitalar de Cascais
5 Técnico de anatomia/Anatomy technician. Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto
6 Médico pneumologista/Pulmonologist. Unidade de Estudo Funcional Respiratório, Hospital da Força Aérea, Lisboa
7 Mestre em engenharia biomédica/M.A.in Biomedical engeneering. Departamento de Ciências e Engenharia do Ambiente, Universidade Nova de Lisboa
8 Médico anatomopatologista/Anatomo-pathologist. Presidente do Conselho Científico/President of the Scientific Board, Centro da Performance Humana
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Resumo

Nos últimos vinte cinco anos constatou-se que o aparelho respiratório constitui um alvo do ruído de baixa frequência (RFB <500Hz, incluindo infra-sons). Denomina-se doença vibroacústica (VAD) a patologia sistémica causada pela exposição excessiva a RBF. Em ratos Wistar expostos a RBF, as alterações morfológicas observadas nos tecidos das vias aéreas centrais explicam, parcialmente, os sintomas apresentados pelos doentes com a VAD. Apesar disso, muitas perguntas permanecem por responder. Recentemente, voluntários com a doença vibroacústica submeteram-se a exames broncos cópicos para esclarecer e, se possível, demonstrar possíveis lesões das vias aéreas centrais que estariam associadas com as queixas respiratórias. Treze doentes voluntários, exaustivamente esclarecidos sobre este exame, submeteram-se a broncoscopias, durante as quais se colheram fragmentos para exame histológico e ultra-estrutural. Em todos os indivíduos se observaram lesões de tipo vascular na submucosa próximas das bifurcações das vias aéreas. Estas lesões caracterizavam-se por numerosos pequenos vasos com paredes espessadas, mergulhados em feixes de colagénio e algumas fibras de elastina. Em cinco indivíduos as lesões evidenciavam degenerescência e ruptura do colagénio. Histologicamente, na mucosa normal observaram-se alterações ciliares, hiperplasia da membrana basal e espessamento dos vasos sanguíneos. Em nenhum caso se observaram infiltrados celulares de natureza inflamatória. O estudo da ultra-estrutura revelou numerosos axonemas (de dois a oito) contidos numa membrana ciliar comum, algumas vesículas emanando dos cílios, imagens de apoptose com reforço do citosqueleto celular e das ligações intercelulares. Não se observaram diferenças entre fumadores e não fumadores. Estes dados estão de acordo com o que já fora observado nas vias aéreas centrais de oito doentes com carcinoma pavimento-celular do pulmão e também com as imagens observadas em ratos expostos a RBF. Em broncoscopias efectuadas em doentes sem a doença vibroacústica, não é normal observar-se este tipo de lesões vasculares. Assim, estas lesões vasculares das vias aéreas centrais podem ser específicas da doença vibroacústica.

Rev Port Pneumol 2006; XII (2): 93-105

Palavras-chave:
Ruído de baixa frequência
doença vibroacústica
lesões vasculares
displasia
doença auto-imune
doença do colagénio
estrutura ciliar
apoptose
mecano-transdução
Abstract

Introduction. Vibroacoustic disease (VAD) is the whole-body pathology caused by excessive exposure to LFN. For the past 25 years, it has been know that low frequency noise (LFN, <500Hz, including infrasound) targets the respiratory system. In LFN-exposed rodents, the morphological changes of respiratory tract tissue partially explained some respiratory symptoms reported by VAD patients. However, many questions remain unanswered. Recently, some volunteer VAD patients underwent bronchoscopy in order to ascertain possible damage that could be associated with their respiratory complaints. Methods. Fourteen fully-informed and volunteer VAD patients were submitted to bronchoscopy, and biopsies were removed for analysis. Results. All patients exhibited small submucosal vascular-like lesions near the spurs, consisting of increased collagen and elastin fibres. Histology disclosed cilliary abnormalities, basal membrane hyperplasia, and thickening of vessel walls. In five patients, collagen bundles appeared degenerative and disrupted. No inflammatory process was ever identified, and no differences were seen between smokers and non-smo-kers. Discussion. Data is in accordance with what was observed in LFN-exposed animal models and also in 8 VAD patients who developed lung tumours. Collagen disruption and degeneration was also observed in electron microscopy images of the respiratory tract of LFN-exposed rodents. Thickened blood and lymphatic vessel walls have been consistently seen in images of VAD patients and of LFN-exposed rodents. During bronchoscopy performed by other reasons, this sort of structural aspects is not frequently seen. Taken together, it is strongly suggested that these findings could be VAD-specific.

Rev Port Pneumol 2006; XII (2): 93-105

Key-words:
Low frequency noise
vibroacoustic disease
vascular lesions
displasia
auto-imune disorders
collagen disease
ciliar structure
apoptosis
mecano-transduction
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Trabalho vencedor ex-aequo (Secção A)

Copyright © 2006. Sociedade Portuguesa de Pneumologia/SPP
Pulmonology
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