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Thaís Ferrari da Cruz, Rogerio Rufino, Agnaldo José Lopes, Arnaldo Noronha, Fernando Medeiros Anselmo, Cláudia Henrique da Costa Pneumology Department, Pedro Ernesto Hospital of State University of Rio de Janeiro, Rio de Janeiro, PR, BrazilCorrespondence: Thaís Ferrari da Cruz Av João Gualberto, 253 Ap 241, Cep: 80030-000, Curitiba, PR, Brazil Tel +55 41 99911-4487Email thais.ferrari2110@gmail.comIntroduction: Small airways are not evaluated with traditional pulmonary function tests. The aim of this study was to evaluate the small airways in patients with chronic obstructive pulmonary disease (COPD) with a nitrogen washout test and to verify whether there is a difference between patients with COPD due to smoking and those with COPD due to alpha-1 antitrypsin mutation.Methods: Sixteen patients with mutation in the SERPINA1 gene and 45 patients with no mutation were included in this cross-sectional study. All pulmonary function tests, including the single breath nitrogen washout test, were performed for all patients and alpha-1 antitrypsin dosage was assessed with immunonephelometry.Results: A comparison of patients with COPD due to smoking and those with COPD due to smoking and mutation revealed a significant difference in closure volume (%), which was the poorest in the mutation group. In the group with COPD and mutation, there was an inverse correlation between smoking and closure volume (%). We also verified that similar to forced expiratory volume in the first second (FEV1), the phase III slope (%) and ΔN2 750– 1250 mL (%) could be used to differentiate the severity of airflow limitation.Conclusion: Our results suggest that both variables, phase III slope and the ΔN2 750– 1250 mL (%), could be related to COPD severity. Therefore, alterations at the distribution of the location of the emphysema could alter the results of closer volume and that the nitrogen washout test is more sensitive when compared to traditional pulmonary function test in evaluating COPD patients.Keywords: serine proteinase inhibitors mutation, chronic obstructive pulmonary disease, alpha-1 antitrypsin deficiency, respiratory function tests, nitrogen washout test

Introduction: Optic nerve sheath meningiomas (ONSM) are rare tumors of the anterior visual pathway. Without treatment, tumor growth leads to progressive loss of visual acuity and blindness due to optic nerve compression. Case report: Patient, female, 42 years without other morbility, begins in 1992 with decreased visual acuity of the left eye, magnetic resonance imaging (MRI) showed enlargement of the left optic nerve sheath, suggestive of ONSM. On that occasion, orbit exploration failed, so it was decided to follow up with annual clinical and imaging controls. About ten years later, begins with progressive deterioration of visual acuity and visual field, with ptosis and ocular motor palsy of the left eye, confirmed with neuro-ophtalmological examinations. MRI shows tumor progression. A new surgical approach was discarded by the risk of visual worsening. A conformal radiotherapy was performed with a fractionated 54 Gy dose. Today, at age 65, after 24 years of follow up, 13 post radiation therapy. clinical and radiological stability of ONSM is confirmed. Discussion: Conformal radiotherapy has been shown as an effective therapy, with fewer complications and better outcomes in the preservation of visual function in the long term follow up. Key words: Optic sheath meningioma, Conformal Radiotherapy, Radiosurgery. Introduccion: Los meningiomas de la vaina del nervio optico (MVNO) son tumores inusuales de la via visual anterior. Sin tratamiento, el crecimiento del tumor lleva a perdida visual progresiva hasta la ceguera debido a la compresion que ejerce sobre el nervio optico. Presentacion del caso: Paciente, sexo femenino, 42 anos, sin antecedentes morbidos, que en 1992, inicia cuadro de disminucion de la agudeza visual del ojo izquierdo. La resonancia magnetica (RM) cerebral informa una lesion expansiva fusiforme en relacion a la vaina del nervio optico izquierdo que lo engloba, altamente sugerente de MVNO. En esa ocasion se realiza exploracion de orbita la cual resulta frustra, por lo que se decide observacion con controles clinicos e imagenologicos anuales, permaneciendo estable. Aproximadamente diez anos mas tarde, en el lapso de un ano, inicia agravacion progresiva de la agudeza y campo visual, ptosis palpebral y alteraciones de la oculo-motilidad del ojo izquierdo, objetivadas por examen neuro-oftalmologico, por lo que se sospecha progresion de MVNO. Se solicita nueva RM que confirma crecimiento significativo del tumor. Se descarta nuevo abordaje quirurgico por riesgo de mayor deterioro visual y se efectua radioterapia conformacional con una dosis de 54 Gy. Actualmente, a la edad de 65 anos, se cumplen 24 anos de evolucion, 13 post radioterapia, confirmandose estabilidad clinica y radiologica de MVNO. Discusion: La radioterapia, cuando se observa progresion de la enfermedad, ha demostrado ser una terapia eficaz para los MVNO, con menos complicaciones y con mejores resultados en la preservacion de la funcion visual a largo plazo. Palabras clave: Meningioma de la vaina del nervio optico, radioterapia conformacional, radiocirugia., Introduccion Los meningiomas de la vaina del nervio optico (MVNO) son tumores inusuales de la via visual anterior, correspondiendo al 2% de los tumores orbitarios y del 1-2% del total [...]

The traumatic spinal cord injury (TSCI) involves all traumatic injuries that harm the bones, ligaments, muscles, cartilage, vascular, radicular or meningeal structures, at any level of the spinal cord. The personal, family, social and economic consequences of this disease, make it an important issue today. The purpose of this review is to provide the reader, the basic tools of the TRM, and it is mainly aimed at the treatment, which it approaches closely related to the pathophysiology, to understand the molecular and biomechanical mechanisms of trauma, including its complications and his management. Regarding treatment of TSCI, the evidence offered by currently validated and controversial therapies is discussed, including glucocorticoids, closed reduction and early surgery. Also emerging therapies such as therapeutic hypothermia, new neuroprotective agents currently in preclinical and clinical phases as riluzole, minocycline, lithium, opioid antagonists, among others, and neuroregenerative agents like Cethrin and Anti- Nogo that have shown good results in neurological recovery. Current recommendations for therapy with stem cells and subtype stem cell, is that only should be carried out in the context of clinical trials. Although there are not still therapies that allow full neurological recovery in all or most patients, emerging therapies provide a promising future in the clinical outcomes of patients with TRM. Key words: Traumatic spinal cord injury, pathophysiology, treatment, emerging therapies. El Traumatismo Raquimedular (TRM) implica todas las lesiones traumaticas que danan los huesos, ligamentos, musculos, cartilagos, estructuras vasculares, radiculares o meningeas a cualquier nivel de la medula espinal. Las consecuencias personales, familiares, sociales y economicas de esta enfermedad, hacen que sea un tema relevante en la actualidad. El proposito de esta revision es entregar al lector las herramientas elementales sobre el TRM, y esta principalmente enfocada en el tratamiento, el cual se aborda estrechamente relacionado con la fisiopatologia para comprender los mecanismos moleculares y biomecanicos de trauma, incluyendo sus complicaciones y el manejo de estas. Respecto al tratamiento del TRM, se aborda la evidencia que ofrecen las terapias actualmente validadas y las aun controversiales, incluyendo los glucocorticoides, la reduccion cerrada y la cirugia precoz. Ademas las terapias emergentes como la hipotermia terapeutica, los nuevos agentes neuroprotectores que se encuentran en fases preclinicas y clinicas de estudio como el riluzol, la minociclina, el litio, los antagonistas opioides, entre otros, y los agentes neurorregenerativos como el Cethrin y el Anti-Nogo que han mostrado buenos resultados en la recuperacion neurologica. Las recomendaciones actuales respecto a la terapia con celulas madre y subtipos de celulas madre en la actualidad, es que deben llevarse a cabo solo en el contexto de ensayos clinicos. Aunque aun no existen terapias que permitan la recuperacion neurologica completa en todos o la mayoria de los pacientes, las terapias emergentes preven un futuro promisorio en los resultados clinicos de los pacientes con TRM. Palabras clave: Traumatismo raquimedular, fisiopatologia, tratamiento, terapias emergentes., Introduccion El Traumatismo Raquimedular (TRM) implica todas las lesiones traumaticas que danan los huesos, ligamentos, musculos, cartilagos, estructuras vasculares, radiculares o meningeas a cualquier nivel de la medula espinal. Frecuentemente [...]