title: Pulmonary alveolar proteinosis: four cases.
abstract: OBJECTIVE
  The aim of this study was to present the evolution of four patients presenting pulmonary alveolar proteinosis and treated at the State University of Londrina School of Medicine. We focus on the importance of whole-lung lavage as the treatment of choice.
  
  
  METHODS
  A retrospective study of four patients, three females and one male, 22 to 34 years old, presenting similar histories of progressive dyspnea and dry cough. The final diagnosis was established through open-lung biopsy. Three of the patients underwent whole-lung lavage in the Department of Surgery. The procedures were performed under general anesthesia and using a double-lumen endotracheal tube.
  
  
  RESULTS
  One patient presented spontaneous regression of the pulmonary alveolar proteinosis without the need for whole-lung lavage. In the other three cases, the number of lavages varied: in one patient, a single unilateral lavage resulted in complete remission of the bilateral process; in another patient, three lavages yielded no significant improvement; in the remaining patient, four lavages provided intervening periods of transient improvement.
  
  
  CONCLUSIONS
  In the cases evaluated, whole-lung lavage proved an efficient treatment for pulmonary alveolar proteinosis. Although some patients presented a certain resistance to the procedure, it might lead to complete remission of the disease in others.
authors.affiliation: Royal Brompton Hospital, London, England. zthomson@sercomtel.com.br
authors.forename: João Carlos
authors.initials: JC
authors.lastname: Thompson
authors.forename: Marina
authors.initials: M
authors.lastname: Kishima
authors.forename: Mariana Ulbricht
authors.initials: MU
authors.lastname: Gomes
authors.forename: Mariano de Almeida
authors.initials: Mde A
authors.lastname: Menezes
authors.forename: José
authors.initials: J
authors.lastname: Perandré Neto
authors.forename: Paula Tapia Gomes
authors.initials: PT
authors.lastname: Pereira
mesh_terms: D000328:Adult; D018893:Bronchoalveolar Lavage / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D011649:Pulmonary Alveolar Proteinosis / Q000175:diagnosis* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome