Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713

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Year 1998 - Volume 24  - Number 1  (January/February)

Editorial

1 - O novo estadiamento do câncer do pulmão

Mauro Musa Zamboni

J Bras Pneumol.1998;24(1):1-2

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Original Article

2 - Relationship between aerobic fitness and clinical indicators of asthma severity in children

Relação entre capacidade aeróbia e indicadores clínicos da gravidade da asma em crianças

José Alberto Neder, Ana Luíza Godoy Fernandes, Antônio Carlos Silva, Anna Lúcia de Barros Cabral, Luiz Eduardo Nery

J Bras Pneumol.1998;24(1):3-10

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In order to assess the relationship between the physical fitness of asthmatics and the clinical expression of the underlying disease, the authors studied 39 physically active children with moderate to severe but stable asthma. The patients (25 boys and 14 girls, aged between 9 and 16 years) were submitted to clinical evaluation; spirometry before and after bronchodilator (BD); maximal cardiopulmonary exercise test in cycle ergometer with breath-by-breath analysis of ventilatory and gas exchange variables; and, on a separate day, an exercise challenge test. As expected by the clinical stability, FEV1 post-BD was in the normal range in most of the children (mean ± SD = 93.8 ± 13.7% predicted). Maximal oxygen uptake (VO2max) was higher than the lower 95% confidence interval in 31/39 children; and in 29/39, the oxygen uptake at the anaerobic threshold (VO2AT) showed values above the lower limit of normality. Seven patients with low tolerance to exercise (reduced VO2max) presented suggestions of circulatory limitation (cardiovascular and/or peripheral) and only 1 had ventilatory limitation. There was no association or correlation between the lower ventilatory reserve (VEmax/MVV% ratio > 80%) and the decreased VO2max. Reduction in VO2AT, but not VO2max, was associated with some clinical indicators of asthma severity, e.g. (i) higher daily inhaled beclomethasone and frequent courses of oral steroids (p < 0.05) and (ii) higher exercise-induced bronchospasm occurrence (p < 0.01). The results show that (i) most patients with moderate to severe asthma, when clinically stable and physically active, present an adequate level of exercise tolerance; (ii) in estimation of the clinical severity of bronchial asthma in children, VO2AT is a better aerobic index than VO2max.

 


Keywords: Asthma in children. Exercise tolerance. Maximal oxygen uptake. Anaerobic threshold. Physical fitness. Exercise-induced

 

3 - Bronchiectasis: a study of 314 cases tuberculosis x non-tuberculosis

Bronquiectasias: estudo de 314 casos tuberculose x não-tuberculose

Miguel Bogossian, Ilka Lopes Santoro, Sérgio Jamnik, Hélio Ramaldini

J Bras Pneumol.1998;24(1):11-16

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The authors studied 314 patients with bronchiectasis. An elevated percentage of sequelae of tuberculosis (42.7%) was found, and other causes of bronchiectasis represented 57.3%. Mean age was similar in both groups, around 50 years old, with predominance of females (65.0%). As to symptoms and signs, hemoptysis was sharply predominant in the tuberculosis group (37.3% x 22.8%; p < 0.05). Association between asthma and infections during childhood was similar in both groups, but sinusitis was more frequent in the non-tuberculosis group (45.0% x 23.9%; p < 0.05). The most frequent site for bronchiectasis secondary tuberculosis was the right upper lobe; in the other group, the most frequent sites were lower left lobe and lingula. The most frequent morphologic type in greater groups was cylindrical (more than 50% of patients). Lung function tests were abnormal, with reduction in both FEV 1 and FVC in the tuberculosis group. Forty-four percent of the patients in the first group and 37.2% in the second one were smokers. The authors make comments about the high number of patients with tuberculosis scars that have secondary bronchiectasis and the greater impairment of lung function in this group of patients.

 


4 - Mediastinal evaluation in lung cancer staging

Avaliação mediastinal no estadiamento do câncer do pulmão

Angelo Fernandez, Aldo Rodrigues Junqueira Jr., Ricardo H. Bammann, Ricardo Beyruti, Fábio B. Jatene

J Bras Pneumol.1998;24(1):17-22

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The presence of mediastinal lymph node metastasis in lung cancer has a great influence on treatment selection and prognosis, and the diagnosis of lymphatic metastasis must be accurate. CT chest scans and mediastinoscopy are the diagnostic tools available to detect mediastinal lymph node metastases and to establish preoperative staging. Lymph node size evaluated by CT scans is not an acceptable criterion in the patients studied here. The aim of this study was to find out a representative pattern of size to indicate the possibility of neoplastic invasion in the population studied. Fifty consecutive patients were operated on and were submitted to pulmonary resection and mediastinal dissection to treat lung cancer. Seventy-four percent of the lymph nodes with transverse section of more than 3 cm had no neoplastic invasion. CT scans and mediastinoscopy have similar sensitivity (close to 65%), but mediastinoscopy has higher specificity (100%). This means that the authors must have histologic confirmation of any suspected lymph node to achieve a correct staging.

 


Keywords: Carcinoma, non-small cell. Lung neoplasias. Lymph nodes. Lymphatic metastasis. Mediatinoscopy. Neoplasm, staging. CT scanning.

 

5 - Non-invasive positive pressure ventilation in patients with acute respiratory failure

Ventilação não-invasiva com pressão positiva em pacientes com insuficiência respiratória aguda

Bruno do Valle Pinheiro, Alessandra Ferreira Pinheiro, Diane Michela Nery Henrique, Júlio César Abreu de Oliveira, Jorge Baldi

J Bras Pneumol.1998;24(1):23-29

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Recent studies suggest that non-invasive positive pressure ventilation (NPPV) improves clinical signs and gas exchange, apart from avoiding the need for endotracheal intubation in selected patients with acute respiratory failure. In this prospective, open trial in the Intensive Care Unit (Hospital Universitário da Universidade Federal de Juiz de Fora), the authors evaluated the efficacy and security of using NPPV in patients with acute respiratory failure. Twenty-five patients with clinical or gasometric diagnosis of acute respiratory failure (respiratory rate > 25 breaths/min, accessory muscle use, PaO2 < 60 mmHg, PaCO2 > 50 mmHg after supplemental oxygen) received NPPV. Fifteen patients (60%) were successfully ventilated with NPPV, avoiding the tracheal intubation. After two hours with NPPV, the respiratory rate was reduced (from 36 ± 2 breaths/min to 26 ± 1 breaths/min, p < 0.01) and the PaO2 increased (from 76 ± 6 mmHg to 100 ± 12 mmHg, p < 0.05). Among the patients with hypercapnia, after two hours, the PaCO2 decreased (from 60 ± 2 mmHg to 49 ± 3 mmHg, p < 0.05). Four patients (16%) presented complications with facial skin necrosis, but only one had the NPPV stopped. Among the patients who did not respond to the method, three did not adapt to the NPPV and seven had it interrupted because of clinical deterioration. The authors conclude that NPPV is a safe option that can be used to treat selected patients with acute respiratory failure.

 


Review Article

6 - Difficulties to interpret biopsies in diffuse lung diseases

Dificuldades na interpretação de biópsias em doenças pulmonares difusas

Vera Luiza Capelozzi

J Bras Pneumol.1998;24(1):30-42

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The approach described below is an attempt to make order out of chaos for the pathologists dealing with diffuse lung disease and to provide radiologists some information about the histology of interstitial lung disease as it applies to HRCT. Obviously, the approach outlined is not applicable to all situations and many cases remain insoluble. Nevertheless, it does give the pathologist a framework within which interstitial lung disease can be assessed, and helps to develop a differential diagnosis histologically. The author thinks this approach also shows good correlation with many of the changes observed by the chest radiologist with HRCT of the lung. Recognizing an anatomic distribution may not necessarily be correlated with how a lesion is clinically viewed. For example, bronchiolocentricity is an important and prominent feature in hypersensitivity pneumonitis and respiratory bronchiolitis associated with interstitial lung disease, but neither is clinically considered an airway disease. The authors also make comments about transbronchial biopsy in opposition to open-lung biopsy in the pathologic assessment of difuse lung disease, although HRCT does provide information to the clinician to help select the most appropriate biopsy modality. Obviously, open-lung biopsy (and those retrieved by thoracoscopic techniques) offer more tissue and make it easier to observe anatomic distribution and reaction patterns. Nevertheless, transbronchial biopsies often include sufficient tissue (although fragmented) and the pathologist is able to mentally reconstruct the distribution and reaction pattern. Obviously, the changes assessed in transbronchial biopsy have to be individualized on a case-by-case basis, but it is surprising how often they are useful when carefully correlated with the clinical and radiological features in a given case.

 


Keywords: Pulmonary interstitial disorders. Pathology. Pulmonary fibrosis. Pulmonary biopsy.

 

Case Report

7 - Hérnia diafragmática encarcerada com boa evolução após duas intervenções cirúrgicas: relato de caso

Célia Mallart Llarges, Lieselotte Von Ameli Roesler, Andrea Fátima de Souza Gomes, Carlos Eduardo P. Barreto

J Bras Pneumol.1998;24(1):43-46

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8 - Bronchiolitis obliterans organizing migratory pneumonia (BOOP) after unilateral radiotherapy for breast carcinoma treatment

Bronquiolite obliterante com pneumonia organizante (BOOP) migratória após radioterapia unilateral para tratamento de carcinoma de mama

Renata Tristão Rodrigues, Ricardo Togashi, Hugo H Bok Yoo, Júlio Defaveri, Irma de Godoy, Thais Helena A. Thomaz Queluz

J Bras Pneumol.1998;24(1):47-50

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The authors describe a case of a woman submitted to radiation therapy for breast carcinoma who presented, 40 days after the end of the treatment, fever, dry cough, dyspnea on exertion, and weight loss. Chest imaging revealed migratory opacities. The histopathological examination of transbronchial biopsy specimens showed characteristic findings of BOOP. Corticosteroid therapy resulted in dramatic clinical improvement, together with complete clearing of the pulmonary opacities on chest imaging. The authors present a brief review of the literature concerning radiation-induced lung injury, emphasizing the importance of including BOOP in the differential diagnosis in these complications. The present case, as well as the two other reports from the literature, provide further evidence for the role of irradiation injury as a cause of clinicopathological syndrome identical to idiopathic BOOP, i.e., radiation-induced BOOP.

 


Keywords: Bronchiolitis obliterans organizing pneumonia. BOOP. Radiation pneumonitis. Radiotherapy. Breast carcinoma.

 

9 - Pulmonary siderosis

Siderose pulmonar

Márcia Beatriz de Souza, Guilherme Freire Garcia, Renato Maciel

J Bras Pneumol.1998;24(1):51-53

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Pulmonary siderosis is a rare cause of diffuse lung infiltration. This report describes the investigation of a patient with a micronodular pattern, where open-lung biopsy confirmed the diagnosis of pulmonary siderosis in a welder.

 


Keywords: Pulmonary siderosis. Micronodular pattern.

 

10 - Endobronchial tuberculosis. Case report

Tuberculose endobrônquica

A.A. Arantes, P.C. Ribeiro, F.S. Lima, C.A.B. Franco

J Bras Pneumol.1998;24(1):54-56

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A case of exuberant endobronchial tuberculosis is presented in a 29-year-old male patient, HIV negative, under endoscopic aspects before and after the institution of a specific therapy. Considering the high tuberculosis infection/disease prevalence in our environment and the potential sequelae of this kind of tuberculosis, the authors emphasize the importance of the respiratory endoscopic examination for the diagnosis, treatment, and follow-up of endobronchial lesions.

 


Keywords: Bacilo álcool-acidorresistente

 

11 - Dores articulares, pleurite, dispnéia, nódulos broncovasculares, centrolobulares e padrão em mosaico em paciente de 47 anos

Veronica Moreira Amado, Roseli Rocha Brito, Jaquelina Sonoe Ota, Rimarcs G. Ferreira, Carlos Alberto de Castro Pereira

J Bras Pneumol.1998;24(1):57-60

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Year 1998 - Volume 24  - Number 2  (March/April)

1 - I Consenso Brasileiro sobre Pneumonias

João Carlos Corrêa

J Bras Pneumol.1998;24(2):63-65

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2 - Pneumonias adquiridas na comunidade

Alexandre Pinto Cardoso, Arnaldo Noronha, Jorge Nakatani, Lucy Gomes Viana, Margareth Pretti Dalcolmo

J Bras Pneumol.1998;24(2):66-72

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3 - Pneumonias adquiridas em ambiente hospitalar

Carlos Alberto de Barros Franco, Jorge Pereira, Blancard Torres

J Bras Pneumol.1998;24(2):73-86

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4 - Pneumonias em pacientes imunocomprometidos

João Carlos Corrêa, Rodney Luiz Frare e Silva, Sérgio Menna Barreto

J Bras Pneumol.1998;24(2):87-88

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5 - Pneumonia no paciente imunocomprometido HIV negativo

João Carlos Corrêa, Rodney Luiz Frare e Silva, Sérgio Menna Barreto

J Bras Pneumol.1998;24(2):89-94


6 - Pneumonias em portadores da síndrome de imunodeficiência adquirida (sida/aids)

Sérgio Menna Barreto, Jussara Fiterman Molinari

J Bras Pneumol.1998;24(2):95-100

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7 - Pneumonias na criança

Maria Aparecida de Souza Paiva, Francisco José Caldeira Reis, Gilberto Bueno Fisher, Tatiana Rozov

J Bras Pneumol.1998;24(2):101-108

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Year 1998 - Volume 24  - Number 3  (May/June)

In Memoriam

1 - Presença de Newton Bethlem

Margareth Pretti Dalcolmo

J Bras Pneumol.1998;24(3):5-

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2 - Mozart Tavares de Lima Filho - 1916-1998

Fernando Augusto Fiuza de Melo

J Bras Pneumol.1998;24(3):6-

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Editorial

3 - A cirurgia redutora do volume pulmonar no Brasil

Ricardo Beyruti

J Bras Pneumol.1998;24(3):109-111

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Original Article

4 - Bronchoalveolar lavage versus transbronchial biopsy in patients infected with the human immunodeficiency virus: comparative analysis of 287 examinations

Lavado broncoalveolar "versus" biópsia transbrônquica em pacientes HIV-positivos: análise comparativa de 287 exames

Ricardo H. Bammann, Angelo Fernandez, Carla M.P. Vázquez, Altamiro R. Dias

J Bras Pneumol.1998;24(3):112-118

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A total of 287 bronchoscopies were performed in 267 patients infected with the human immunodeficiency virus (HIV). Bronchoalveolar lavage (BAL) and transbronchial biopsies (TBB) were sequentially performed in the same lung, in all cases. Specimens were examined after routine laboratory procedures for microbiologic and histologic analysis. Age ranged from 16 to 78 (median 37.2); 228 were men (85.4%) and 39 were women. Dyspnea was the main symptom in 198 cases (69.0%) and interstitial infiltrates (diffuse or localized) were the most common findings at chest radiographs (179 patients, 62.4%). Endoscopic view was normal in 246 patients (85.7%). Mucosal lesions suggestive of Kaposi's sarcoma (KS) were visible in 12 cases (4.2%). BAL detected 97 infectious agents, simultaneous co-infection occurred in 3 cases. TBB identified 165 pathogens (9 of them in association), anticipating a better yield than BAL in the diagnosis of P. carinii (84 versus 51, respectively) and cytomegalovirus (35 v. 0). Biopsies were unique in establishing the appropriate diagnosis of extrabronchial cancer and describing inespecific pneumonitis. Altogether, a definite diagnosis was obtained by bronchoscopic examination (including endoscopic view, BAL and TBB) in 271 of 287 cases (94.4%). Infections were caused by P. carinii in 105 patients (36.6%), Mycobacterium sp in 40 (13.9%), cytomegalovirus in 35 (12.2%), C. neoformans in 13 (4.5%) etc. Malignancies (including KS) were found in 16 patients (5.6%). More than one pathologic process was present in 28 (9.8%). Nonspecific pneumonitis was diagnosed in 56 cases (19.5%) and normal lung in 20 (7.0%). Complications related to bronchoscopy were pneumothorax (8 patients, 2.8%), haemorrhage (8), thoracic pain (2) and distal pneumonia (2). Chest tubes were required in 4 patients, including one fatal case (mortality rate of 0.3%). Combining BAL and TBB results increases the diagnostic yield of bronchoscopy in AIDS, with a low complication rate. If both techniques are performed, a higher number of infectious agents and more multiple causes of pulmonary disease may be identified.

 


Keywords: Bronchoscopy/methods. Acquired Immunodeficiency Syndrome/complications. Opportunistic infections related to AIDS/diagnosis.

 

5 - Weaning from mechanical ventilation: comparison of three methods

Desmame da ventilação mecânica: comparação de três métodos

José Raimundo A. de Azevedo, Cecilma Miranda de S. Teixeira, Kivania Carla Pessoa

J Bras Pneumol.1998;24(3):119-124

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Studies published by Brochard et al. and by Esteban et al. came to different conclusions about the best technique of weaning from mechanical ventilation. Although the association of synchronized intermittent mandatory ventilation (SIMV) with pressure support ventilation (PSV) is frequently used and considered as a physiologic form of weaning, no prospective randomized study compared this technique to synchronized intermittent mandatory ventilation or to pressure support ventilation used singly. The authors compared these three weaning methods to determine the one that is associated with the shortest weaning time and the smallest frequency of unfavorable outcome. Methods: The authors analyzed prospectively 72 consecutive patients submitted to mechanical ventilation for at least 24 hours and that had clinical, gasometric, and respiratory criteria for weaning. The patients were randomized in three groups (SIMV, PSV, SIMV+PSV). Stringent criteria were used in the application of each technique to define success or failure of the procedure. Results: The groups (SIMV = 21, PSV = 25 and SIMV+PSV = 26 patients) were similar with respect to age, score APACHE III and diseases. Mean duration of weaning was 1.7 ± 1.2 days with SIMV, 2.5 ± 1.6 days with PSV, and 2.1 ± 1.5 days with SIMV+PSV. Four (19.0 %) patients failled to wean in the SIMV group, nine (36.0%) in PSV and two (7.7%) in SIMV+PSV. Conclusions: This study shows a good performance of SIMV+PSV for weaning patients from mechanical ventilation and unfavorable results with support ventilation that can not be attributed to homogeneity between the groups, nor to the methodologies or equipments used.

 


Keywords: Weaning. Synchronized intermittent mandatory ventilation. Pressure support ventilation.

 

6 - Brazilian Society of Tisiology and Pulmonary Medicine Board Examination: factors related to approval

Prova do título de especialista em Pneumologia: fatores associados à aprovação

Daniel Deheinzelin, Luís Fernando Pereira, Jorge Nakatani

J Bras Pneumol.1998;24(3):125-128

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Objectives: Evaluate the results of the Brazilian Society of Tisiology and Pulmonary Medicine Board Examination and verify the factors related to acceptance. Planning: Retrospective analysis comparing scores obtained in practical and written examinations and acceptance to gender, years since graduation, years of pulmonary medicine practice, regional and national meetings attendance, place, and duration, as well as having or not attended residence or training programs. Population: Between 1992 and 1996, 199 candidates - 81 females and 108 males - took the board examination. Results: In this period, 54.3% of the candidates were approved. Mean written score was 6.27 ± 0.95 for the approved candidates and 4.30 ± 0.76 for those who were not approved (p = 0.0001, t test). Mean practical score was 7.18 ± 0.92 versus 5.17 ± 1.38 (p = 0.001). The overall mean of the written score was significantly lower than that of the practical score (53.78 ± 13.16 x 62.62 ± 15.32, p < 0.001). Univariate analysis showed that the approved group had fewer years since graduation (p = 0.001), fewer years of pulmonary medicine practice (p = 0.01); lower training attendance for a shorter period (p = 0.01), and a higher frequency of residence attendance for a longer period (p < 0.001) in the approved group. Logistic regression showed that residence (p = 0.002) and place of residence (p = 0.006) were the only predictive factors for approval. Multiple linear regression showed that only residence (coefficient 2.26, p = 0.016), place of residence (4.43, p = 0.002), and training (-1.97, p = 0.047) predicted the overall board score. Conclusion: The efficacy of the board exmination is hereby proven, since it accepts candidates with better medical background (residence). Some medical education methods, such as years of practice, meeting and training attendance need to be revised, since they do not determine approval.

 


Keywords: Medical education. Residence. Board certificate.

 

7 - The confusing Brazilian pulmonary auscultation nomenclature

A confusa nomenclatura da ausculta pulmonar brasileira

Mariam Patrícia Auada, Gisele Laguna Vitória, João Adriano de Barros

J Bras Pneumol.1998;24(3):129-132

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After the invention of the stethoscope by Laënnec in 1816, the nomenclature for lung sounds was spread without following a specific structure, becoming confusing and lacking precision. Since 1985 a great effort has been made to reach a terminology standardization, based on physical patterns such as frequency, duration, and amplitude. The evaluation of the terminology employed by Brazilian pneumologists in reported cases is the object of this study. A retrospective study of reported cases published in Jornal de Pneumologia has been performed between 1985 and 1997, regarding the pulmonary auscultation described. The data were compared to those proposed by the Symposium on Lung Sounds, in 1985. Out of 131 cases, 72 reported altered pulmonary auscultation, presenting 30 distinctive denominations for lung sounds. It is, therefore, easy to notice that pneumologists are not yet familiar with the current nomenclature. It is important to highlight that 31 cases did not report pulmonary auscultation even in a pneumology publication, which serves to show the underestimation of the method. Pulmonary auscultation is a quick, non-invasive, low-cost, and great clinical guiding means which must be recognized among other techniques applied for diagnosis.

 


Keywords: Auscultation. Stethoscope. Respiratory sounds. Nomenclature.

 

Review Article

8 - Como administrar drogas por via inalatória na asma

Luiz Fernando F. Pereira

J Bras Pneumol.1998;24(3):133-144

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Case Report

10 - Dispnéia crônica, distúrbio restritivo e tomografia computadorizada de tórax de alta resolução normal em paciente de 74 anos

Alessandra Sandrini Lopes de Souza, Georgino Henderson Pereira Lemos, Raquel Hermes Rosa Oliveira, Carlos Alberto de C. Pereira, Ester N.A.M. Coletta

J Bras Pneumol.1998;24(3):153-156

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12 - Spontaneous diaphragm rupture to the right

Ruptura espontânea do diafragma à direita

Adilson Casemiro Pires, Wladmir Faustino Saporito

J Bras Pneumol.1998;24(3):157-158

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Diaphragm rupture is generally associated with severe trauma. Spontaneous diaphragm rupture is rare, seldom reported, and does not have a clear etiology. In this report the authors show a case of spontaneous diaphragm rupture which took place during hospitalization.

 


Keywords: Diaphragm rupture. Spontaneous diaphragm rupture.

 

13 - Interstitial lung disease after idiopathic diffuse proliferation of neuroendocrine cells (tumorlets carcinoids)

Pneumopatia intersticial secundária à proliferação difusa idiopática de células neuroendócrinas ("tumorlets carcinoids)

Marcelo Cunha Fatureto, Marcus Aurelho de Lima, Gesner Pereira Lopes, Wilson Carneiro Silva Junior, Maysa Silva Arruda, Ricardo Frota Boggio

J Bras Pneumol.1998;24(3):159-162

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A 35 year-old black woman, previously healthy, who complained about chronic cough and shortness of breath was investigated after non-response of symptoms. Her chest X-ray and high resolution chest CT-scan were normal. She presented with abnormal spirometry, a mild restrictive disturbance. After a negative initial clinical investigation, an open lung biopsy was indicated. Multiple microscopic peribronchiolar tumorlets carcinoids - neuroendocrine cell hyperplasia was revealed. The authors emphasize the importance of an early diagnosis of this unusual entity and discuss its possible pathophysiological mechanisms.

 


Keywords: Lung diseases. Neuroendocrine cell. Bronchiolitis. Carcinoid. Tumorlets.

 

14 - Fibrosing mediastinitis

Mediastinite fibrosante

Jefferson Lessa Soares de Macedo, Manoel Ximenes Netto

J Bras Pneumol.1998;24(3):163-166

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Fibrosing mediastinitis is an uncommon disease associated with a multiplicity of clinical syndromes. The pathophysiology of this disease is predicated on the encasement of the mediastinal vital organ structures within a dense fibrotic tumor. This tumor appears to emanate from an invasive chronic inflammatory process causing erosion and external compression of these structures. Two cases of this disease are reported: one case of superior vena cava syndrome and one case of esophageal obstruction which evolved satisfactorily with conservative treatment.

 


Keywords: Sclerosing mediastinitis. Fibrosing mediastinitis. Superior vena cava syndrome.

 

15 - Non-surgical treatment of descending necrotizing mediastinitis

Tratamento conservador de mediastinite necrotizante descendente

Jefferson Lessa Soares de Macedo, Manoel Ximenes Netto

J Bras Pneumol.1998;24(3):167-170

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A rare case of descending necrotizing mediastinitis secondary to a non-traumatic submandibular abscess is reported. Although most reports emphasize surgical treatment as indispensable in this disease, this case had an excellent outcome using only intensive care. Thus, even complicated descending necrotizing mediastinitis can be treated by non-surgical procedures.

 


Keywords: Mediastinitis. Sepsis.

 

Year 1998 - Volume 24  - Number 5  (September/October)

Original Article

1 - Influence of gastroesophageal reflux levels in the treatment of patients with chronic cough

Influência dos níveis de refluxo gastroesofágico (RGE) na escolha do tratamento de pacientes com tosse crônica

Otávio Leite Gastal, Bruno Carlos Palombini, Tom Ryan DeMeester, Carmen Palombini Gastal, Marta Mascarenhas Corrêa da Silva, Silvia Macedo

J Bras Pneumol.1998;24(5):277-282

Abstract PDF PT

Gastroesophageal reflux (GER) is a common cause of chest affections and symptoms, such as chronic cough, asthma, respiratory infections, pulmonary fibrosis and chest pain. Relief after medical or surgical antireflux therapy is variable. Twenty-four hour pH monitoring has been considered the gold standard for the diagnosis of gastroesophageal reflux disease (GERD). The use of 2 or more pH sensors in different locations within the esophagus is a reliable method for the diagnosis of more severe GER and enables aspiration of the airways and lungs. The purpose of this study was to determine whether the height at which reflux is detected within the esophagus is an indicator of surgical, as opposed to medical, antireflux therapy. In a series of 35 patients with cough as a sole presentation of GER the levels of reflux within the esophagus were correlated to the outcome after medical or surgical antireflux therapy. The studies and surgical procedures were performed in the affiliated hospitals of the Federal and Catholic Universities of Pelotas - RS. Chi-square and Mann-Whitney-U test were used to perform statistical analysis. The present study showed that gastroesophageal reflux into either the distal or the proximal esophagus can cause chronic cough. The height of reflux is an important predictor of response to antireflux therapy. Patients with proximal reflux treated medically do poorly. Surgical therapy is consistently associated with a good outcome, regardless of the height to which reflux occurs, particularly in patients with proximal reflux. Overall, surgical therapy provides the best outcome in all patients with chronic cough due to gastroesophageal reflux.

 


Keywords: Chronic cough. Gastroesophageal reflux disease. Esophageal pH monitoring.

 

2 - Chronic dyspnea with unexplained cause: evaluation of an investigation protocol with 90 patients

Dispnéia crônica de causa indeterminada: avaliação de um protocolo de investigação em 90 pacientes

Sílvia Helena Bersácola, Carlos Alberto de Castro Pereira, Rita de Cássia Cruz da Silva, Ricardo M. Ladeira

J Bras Pneumol.1998;24(5):283-297

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Chronic dyspnea has a wide range of causes. The aim of the authors was to evaluate a diagnostic approach applied to patients with unexplained chronic (> 30 days) dyspnea, or when multiple causes were present. Methods: An algorithm for the work-up was applied: 1) complete history and physical examination; 2) bronchoprovocation test (BPT) and serial measurements of echocardiography; 3) cardiopulmonary exercise testing (CPET) and doppler echocardiography; 4) special tests: FRCT, V/Q scan, DCO, lung volumes, MIP, and others, as indicated. Results: Ninety patients were included, mean age of 51 ± 16 yr. Hyperventilation symptoms were present in 48, but associated with BHR or asthma in 19. Obstructive defect was present in 24 (asthma, 11; COPD, 8). Reduced FVC with normal FEV1/FVC was found in 10; explanations were asthma in 4, heart disease in 4. BPT was performed in 71 and was verified to be normal in 20; PEF variation was evaluated in 71, and was abnormal in 28, isolated in 16, and in 7 with asthma as final diagnosis. Echocardiography was performed in 44, and showed diastolic dysfunction in 11 out of 16 patients with final diagnosis of heart disease. CPET showed cardiovascular limitation in 19, hyperventilation in 19, and ventilatory defect in 12. CPET was decisive in 33 (38%), specially for heart diseases and to exclude causes suspected by clinical data. Respiratory disease was the explanation for dyspnea in 51 (59%): asthma (31), BHR (8), COPD (8), interstitial lung disease (4); other causes found were: heart disease (16), primary hyperventilation syndrome (8), obesity (5), neuromuscular disease (6), psychogenic dyspnea (2), and others (7). Multiple causes were found in 13 patients. Eight patients had non-recognizable etiology. Conclusion: An algorithm approach to chronic dyspnea resulted in diagnosis of 91% of the cases; spirometry, tests for BHR including PEF measurements, echocardiography, and CPET are essential for the investigation.

 


Keywords: Chronic dyspnea. Exercise test. Spirometry. Respiratory function tests. Bronchoprovocation tests. Peak expiratory flow. Echocardiography. Chest X-ray. Heart failure, congestive.

 

3 - Classification of risk and prophylaxis for venous thromboembolism in university hospital patients

Estratificação de risco e profilaxia para tromboembolia venosa em pacientes internados em hospital geral universitário

Sérgio Saldanha Menna Barreto, Carlo Sasso Faccin, Paula Mallman da Silva, Larissa Pretto Centeno, Marcelo Basso Gazzana

J Bras Pneumol.1998;24(5):299-302

Abstract PDF PT

Objectives: To identify the frequency of risk factors, classification of degree of risk and the practice of prophylaxis to venous thromboembolism (VTE) in a general hospital. Methods: Randomly selected cases were included. Patients were excluded if they were on anticoagulant treatment. Determination of risk factors and classification of degree of risk were done according to international consensus. Results: Most patients (96%) had at least one recognized risk factor, 81% of them fulfilled the criteria to be classified as moderate/high risk. Prophylactic measures were prescribed to 221 (63%) patients. There was a significant association between the higher risk level for VTE and increased use of heparin (p < 0.001). Contraindications to the use of heparin were noticed in 7% of the cases. Conclusion: Risk factors for VTE are usually seen and prophylaxis is unsatisfactory. Contraindications to the use of heparin are uncommon; prophylaxis should be considered for a higher number of patients.

 


Keywords: Pulmonary embolism. Deep venous thrombosis. Prevention.

 

4 - Pulmonary and mediastinal malformations with respiratory symptoms

Malformações pulmonares e mediastinais com repercussões respiratórias

Carlos A. Riedi, Nelson A. Rosário Filho, Isabelle V. Trevisan, José E. Carreiro, Dante L. Escuissato

J Bras Pneumol.1998;24(5):303-310

Abstract PDF PT

Objective: To evaluate clinical features of malformations of lung and mediastinum. Methods: Retrospective analysis of 51 patients with malformations identified in the author's division between 1982 and 1997. They verified the clinical manifestations, diagnostic procedures, and treatment. Results: The most frequent anomaly was esophageal atresia/tracheoesophageal fistula (12), followed by vascular ring (11), congenital lobar emphysema (7), diaphragmatic hernia/eventration (7), bronchogenic cyst (5), pulmonary hypoplasia (4), pulmonary sequestration (3), and arterial-venous fistula (2). Age at diagnosis varied from birth to 10 years. Most of them exhibited symptoms at first month, some even at birth. The main respiratory symptoms were tachypnea, coughing, retractions, dyspnea, wheezing, pneumonia and rales. Chest X-rays with barium swallow were most important for diagnosis. When chest radiology was inconclusive, CT scans were next in achieving diagnosis. Surgical intervention was the effective treatment in 86% of cases. Conclusions: Lung and mediastinal congenital malformations with respiratory symptoms require adequate diagnostic evaluation and immediate intervention. The most frequent respiratory symptoms were coughing and tachypnea and chest X-rays with barium swallow was the main diagnostic method. Survival is good and mortality is secondary to associated malformations.

 


Keywords: Bronchopulmonary malformations. Respiratory distress. Retrospective studies.

 

Review Article

5 - Complicações cardiovasculares da síndrome da apnéia do sono obstrutiva

Lia Rita Azeredo Bittencourt, Odair Marson, Luiz E. Nery, Sérgio Tufik

J Bras Pneumol.1998;24(5):311-316

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6 - Manifestações pulmonares causadas pelo uso do "crack"

Maria do Rosário da Silva Ramos Costa, Rosemary Farias Alves, Marciel Dourado Franca

J Bras Pneumol.1998;24(5):317-321

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Case Report

7 - Bronchiolitis obliterans with organizing pneumonia (BOOP)

Bronquiolite obliterante com pneumonia em organização (BOOP) aguda

José Eduardo Delfini Cançado, Carlos Alberto de Castro Pereira, Ester N.A.M. Coletta

J Bras Pneumol.1998;24(5):331-334

Abstract PDF PT

Most interstitial lung diseases (ILD) are indolent in nature, producing subacute or chronic symptoms that progress at various rates and are usually present for months to years before a diagnosis is established. This report describes a case of a fulminating and life-threatening variant of idiopathic bronchiolitis obliterans with organizing pneumonia (BOOP). Early suspicion, histologic diagnosis, and prompt initiation of corticosteroid therapy is important to prevent mortality.

 


Keywords: Bronchiolitis obliterans with organizing pneumonia (BOOP). Interstitial lung disease.

 

8 - Cystic adenomatoid malformation of the lung: report on four cases

Malformação congênita adenomatóide cística do pulmão: relato de quatro casos

Gisele A. Nai1, Carlos Zelandi Filho, Rosa M. Viero, Julio Defaveri

J Bras Pneumol.1998;24(5):335-338

Abstract PDF PT

Cystic adenomatoid malformation of the lung is a rare form of congenital pulmonary disease. It has been found in all lobes, it is rarely bilateral, and is associated to hydramnion, placental edema, and fetal hydrops. It is divided into three types, with different clinical and histologic characteristics. Intrauterine diagnosis is possible by means of ultrasound examination, and the treatment of choice is lobectomy. The authors describe four cases seen at their hospital and review the literature.

 


Keywords: Cystic adenomatoid malformation. Congenital malformation. Lung.

 

9 - Human pulmonary adiaspiromycosis: a new case diagnosed by transbronchial biopsy

Novo caso de adiaspiromicose humana diagnosticado por biópsia transbrônquica

Terezinha do Socorro M. Lima, Mário A.P. Moraes, Hebe Quezado Magalhães, Norma Suely G. Athayde

J Bras Pneumol.1998;24(5):339-341

Abstract PDF PT

A case of human pulmonary adiaspiromycosis - the 18th from Brazil - is reported for two purposes: to contribute to the knowledge of the clinical course of the disease and to discuss the basis for using the transbronchial biopsy in demonstrating the causative organism. The patient, an 18 year old male, lived in the Paranoa village, near Brasilia, DF, where he worked in a joinery, making straw-brooms. In February 1997, he was admitted to the Brasilia University Hospital, with severe respiratory manifestations. The main symptom was a ventilatory-dependent thoracic pain. A chest roentgenogram showed a diffuse interstitial infiltrate, in both lungs, with micronodular pattern suggestive of a miliary process. No bacterial or fungal organisms could be found in the sputum or bronchial lavages of the patient. A transbronchial biopsy was then performed and the microscopic examination of the lung tissue revealed several large adioconidia. Adiaspiromycosis is believed to be a self-healing condition, since in the great majority of the so far known cases spontaneous remission of the pulmonary lesions has been the rule. Transbronchial biopsy, due to its simplicity, is indicated as the procedure of choice to demonstrate the adiaconidia of the agent in tissue sections - the only way to definitely establish the diagnosis of adiaspiromycosis.

 


Keywords: Adiaspiromycosis. Pulmonary mycosis. Emmonsia crescens. Emmonsia parva var crescens. Chrysosporium parvum var crescens.

 

10 - Derrame pleural com elevado teor de amilase

Célia Mallart Llarges, Jaqueline Maria Lima, Luís Felipe F. da Silva, Carlos Eduardo P. Barreto

J Bras Pneumol.1998;24(5):342-344

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Year 1998 - Volume 24  - Number 6  (November/December)

Original Article

2 - Nutritional evaluation in patients with lung cancer

Avaliação nutricional em pacientes portadores de câncer de pulmão

Sérgio Jamnik, Cesar Uehara, Ilka Lopes Santoro

J Bras Pneumol.1998;24(6):347-353

Abstract PDF PT

The authors analyze the nutritional status of patients with lung cancer. 131 patients, 96 (73.3%) male and 35 (26.7%) female, were classified into three groups: I - malnourished patients; II - eutrophic patients and III - obese patients. Most of the malnourished had anorexia (59.7%), which was not seen in the eutrophic (25%) and obese patients (26.1%). More than 70% of patients reported some degree of previous weight loss at the initial evaluation, weight loss being higher among malnourished patients. Weight loss was observed in more than 60% of the patients during the follow-up period of 3 months after the first evaluation. Patients with squamous carcinoma neoplasms prevailed in the malnourished group whereas adenocarcinoma was more prevalent in the other two groups. Most patients had advanced stages of the disease.

 


Keywords: Lung cancer. Nutritional status.

 

3 - Risk factors for a positive tuberculin skin test among employees of a Brazilian university hospital

Fatores de risco para um teste cutâneo tuberculínico positivo entre funcionários de um hospital universitário brasileiro

Rafael Dias da Costa e Silva, Marcelo Simão Ferreira, Paulo Pinto Gontijo Filho

J Bras Pneumol.1998;24(6):353-356

Abstract PDF PT

The authors conducted a cross-sectional survey to estimate the prevalence of tuberculosis infection in employees at the Uberlândia University Hospital, Minas Gerais. The participants (167) were classified according to exposure to tuberculosis into three groups: A) clinical medicine ward, frequent; B) admission unit, limited; and C) administration area, none, and underwent a two-step tuberculin testing. Factors associated with positive results were: level of exposure (44.70%; OR, 1.45; IC, 1.13-2.15; p = 0.013), age over 40 years (52.60%; OR, 1.66; IC, 1.20-2.30; p = 0.004) and employed for more than 10 years (59.30%; OR, 1.63; IC, 1.13-2.22; p = 0.011). Among clinical personnel at the Uberlândia University Hospital the prevalence of significant tuberculin reaction was high.

 


Keywords: Tuberculosis. Tuberculin skin test. Health care personnel.

 

Review Article

4 - Pathology concepts of the mediastinum. An anatomicoradiological correlation

Conceitos em patologia do mediastino. Uma correlação anátomo-radiológica

Vera Luiza Capelozzi

J Bras Pneumol.1998;24(6):357-370

Abstract PDF PT

The mediastinum, made up by many organs and structures, comprises a wide range of affections, from simple cysts to low differentiated neoplasias and lymphomas. In their day-to-day activities, the diagnosis of these affections represent a real challenge to the pathologists. Furthermore, one of the main approaches to diagnosis includes mediastinoscopy. Therefore, the representation of the specimen for studies, as well as some artifacts to obtain the specimen, may pose some difficulty for a final diagnosis. This article will focus mainly on the problems faced to diagnose entities from the specimens obtained by mediatinoscopy in the surgical room, during the extraction of the material and at examination by freezing. The article will also update current criteria used to classify the tumors and the use of the immunohistochemistry to complement the diagnosis, criteria of invasion, and metastases. The purposes of this article are: recognize the main affections of the mediastinum, classify the main tumors, apply malignancy criteria, identify prognostic markers, and evaluate when there is need to establish a clinical, radiological and morphological correlation.

 


Keywords: Mediastinum. Mediastinum pathology. Prognostic markers.

 

Case Report

5 - Bronchoesophageal fistula in AIDS patient: report of a case

Fístula broncoesofágica em portador de SIDA: relato de caso

Claudio Ricardo Frison, Verônica Amado, Renata T. Rodrigues, Lilian S.B. Caetano

J Bras Pneumol.1998;24(6):371-374

Abstract PDF PT

The authors report a case of bronchoesophageal fistula found unsuspectedly in bronchoscopy. The radiological findings were compatible and etiologic confirmation was established by histopathological studies.

 


Keywords: Bronchoesophageal fistula. AIDS.

 

6 - Primary pulmonary hypertension in an HIV+ patient

Hipertensão pulmonar primária em um paciente HIV+

Aline Elisa Goulart, Agnaldo José Lopes, José Manoel Jansen, Eduardo X. Pozobon, Mara Negreiros Carvalho, Dirce Bonfim de Lima

J Bras Pneumol.1998;24(6):375-378

Abstract PDF PT

Primary pulmonary hypertension (PPH) is a disease of rare, unclear etiology, leading to elevations in pulmonary artery pressure and pulmonary vascular resistance. The vascular lesions range from mild - consisting of neo-intimal proliferation - to severe - characterized by concentric intimal fibrosis, plexiform lesions, and necrotizing arteritis. There have been since 1987 reports describing the association between human immunodeficiency virus (HIV) and PPH, with as many as 60 patients in 1997. The role of HIV in the pathogenesis remains unclear. It is reported a case of a woman in whom this association was observed.

 


Keywords: Primary pulmonary hypertension. Human immunodeficiency virus.

 

7 - Nodular measles pneumonia: a case report

Pneumonia nodular por sarampo: relato de caso

Eduardo Walker Zettler, Jussara Fiterman Molinari

J Bras Pneumol.1998;24(6):379-381

Abstract PDF PT

The authors report the case of an adolescent with bilateral interstitial bronchopneumonia caused by measles. They discuss this rare presentation and the usefulness of thorax CT scan for the diagnosis of this disease.

 


Keywords: Measles. Pneumonia. CT scan.

 

8 - Internal thoracic artery injury caused by chest tube: a case report

Lesão da artéria torácica interna por dreno torácico: relato de caso

Fernando Luiz Westphal1, Luiz Carlos de Lima1, Marcelo Augusto Teixeira Fadul2

J Bras Pneumol.1998;24(6):382-384

Abstract PDF PT

The authors report a rare case of internal thoracic artery lesion caused by a chest tube in a patient under open drainage system treatment for empyema. The vessel rupture, leading the patient to hypovolemic shock and massive hemoptysis, was the indication for surgical intervention. They also emphasize the care with a thoracic drainage and the need for radiologic control.

 


Keywords: Thoracostomy. Internal thoracic artery. Chest tube.

 

 


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