Brazilian Journal of Pulmonology

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

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Year 1999 - Volume 25  - Number 1  (January/February)

Editorial

2 - Que sejamos cientificamente prósperos

Thais Helena A. Thomaz Queluz

J Bras Pneumol.1999;25(1):3-4

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Original Article

3 - Silicosis among PIT diggers in the region of Ibiapaba, State of Ceará, Brazil: from detection to control

Silicose em cavadores de poços da região de Ibiapaba (CE): da descoberta ao controle

Márcia Alcântara Holanda, Ana Carolina Peixoto do Rego Barros, Alexandre Alcântara Holanda, Cristina Gomes do Monte, Elias Bezerra Leite, Luiz Ximenes Junior, Maria Zélia Maia Holanda, Pedro Henrique Felismino

J Bras Pneumol.1999;25(1):1-11

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Silicosis among pit diggers was first described in 1984. Two years later, a focus of the disease was detected in the region of Ibiapaba, State of Ceará, Brazil. The aims of this study were: 1) to present the educational program to which these workers and their families were submitted; 2) to study, in this population, the impact of the educational program on the knowledge about silicosis and on the behavior changes in the pit digging activity. First, a primary preventing educational intervention (PPEI) was created as per the critical awareness-raising method by Paulo Freire, and applied to this population. Subsequently, the role of PPEI on silicosis control among the pit diggers was studied. In the region there were 1202 pit diggers, and 687 from 5 selected towns were submitted to PPEI. Out of these, 287 workers participated of the second part of the study. All of them were male, ages from 18 to 78 years, 115 were silicotic, 122 non-silicotic, and 46 did not know their health status. Results show that PPEI brought to silicotic and non-silicotic workers a deep knowledge about the relationship between pit digging and silicosis, and induced most of them (85.8%) to quit this activity. PPEI itself promoted an awareness of this population about silicosis, interrupting the epidemiological cycle of the disease in the region of Ibiapaba.

 


Keywords: Silicosis. Epidemiology. Occupational lung diseases.

 

4 - Asthma morbidity and mortality in the State of Parana and in city of Curitiba from 1984 to 1995

Morbimortalidade por asma no Estado do Paraná e município de Curitiba no período entre 1984 e 1995

Sônia Zulato, Denise Carvalho, Anne-Claire Ribeiro, Nelson Augusto Rosário Filho

J Bras Pneumol.1999;25(1):12-16

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There has been an increase in hospital admissions and mortality rates for asthma in several countries. The objectives of this study were to assess hospital morbidity for asthma in Curitiba and mortality rates for asthma in Curitiba and in the State of Paraná. Hospital admissions for asthma in 1994 and 1995 were analyzed among users of SUS-Sistema Único de Saúde (Public health care system) in Curitiba. The authors verified asthma deaths that occurred from 1984 to 1995 in Curitiba and in the State of Paraná. Specific mortality rates for asthma were obtained through a mortality information system (SIM) of the State and City Departments of Health. Population data were obtained from IPARDES (Institute for Demographic and Statistical Information of the State of Paraná). Hospital admissions for asthma represented 0.8% of total admissions and remained unchanged in 1994 and 1995. Mean mortality rates for asthma was 0.24 ± 0.08/100,000 inhabitants aged 5 to 34 years. In 1989, the mortality rate was greater than the positive standard deviation, but was stable in the remaining years. In Curitiba, the mean mortality rate was 0.39 ± 0.28/100,000. Two peaks occurred in 1984 and 1989, respectively 1.04 and 0.81/100,000. Despite an increase in prevalence of asthma and increasing mortality rates in the past years, Curitiba and the State of Paraná remained with stable rates for ages 5 to 34.

 


Keywords: Asthma. Mortality rates. Morbidity.

 

5 - Pulmonary diseases in HIV positive patients. Evaluation of diagnostic techniques

Pneumopatias em pacientes positivos ao vírus da imunodeficiência humana. Avaliação de técnicas diagnósticas

Rosemeri Maurici da Silva, Mário Sérgio Soares de Azeredo Coutinho, Márcia Margaret Menezes Pizzichinni

J Bras Pneumol.1999;25(1):17-24

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Bronchoscopy with bronchoalveolar lavage, bronchial brush, and transbronchial biopsy are useful methods for the diagnosis of pulmonary diseases in patients infected with the human immunodeficiency virus (HIV). However, data on the accuracy of these techniques are conflicting. In order to estimate the sensitivity of the bronchoalveolar lavage, bronchial and transbronchial biopsy in pulmonary disease diagnosis in patients infected with HIV, the authors studied 71 consecutive patients, most of them with respiratory symptoms up to 15 days (58%) and radiologic signs of interstitial infiltrates (62%). The sensitivity was calculated taking as reference a constructed gold-standard, represented by the sum of all three techniques combined. Sensitivities for bronchoalveolar lavage, transbronchial biopsy, and bronchial brush were 86%, 43% and 5%, respectively. The association of bronchoalveolar lavage and transbronchial biopsy reached the sensitivity to 100%, reflecting how the gold-standard was constructed. The complication rate of the procedures was 3%. These results suggest that, in this population: (1) bronchoscopy with bronchoalveolar lavage, bronchial brush, and transbronchial biopsy are secure procedures with good diagnostic performance; (2) bronchoalveolar lavage alone has reached the highest sensitivity, whereas both bronchoalveolar lavage and transbronchial biopsy can be considered complementary techniques; (3) the association of bronchoalveolar lavage and transbronchial biopsy performed better than bronchoalveolar lavage alone; and (4) the use of bronchial brush in the sequence used in this protocol did not have any influence on the performance of diagnosis.

 


Keywords: Human immunodeficiency virus. Lung diseases. Diagnostic techniques. HIV. Lung infections.

 

7 - Curso de diagnóstico por imagem do tórax

Arthur Soares Souza Junior

J Bras Pneumol.1999;25(1):35-49

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Case Report

8 - Malignant pulmonary hemangiopericytoma: report of a case

Hemangiopericitoma pulmonar maligno: relato de caso

Mônica Flores Rick, Sonia Catarina de Abreu Figueiredo

J Bras Pneumol.1999;25(1):50-52

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The hemangiopericytoma is a rare malignant neoplasia that involves the lungs in about 10% of the cases. It usually presents as a great encapsulated mass in asymptomatic patients. The treatment of choice is surgical resection. The authors present a case of malignant lung hemangiopericytoma in a 62 year-old woman, followed by discussion and review of literature.

 


Keywords: Hemangiopericytoma. Lung neoplasms.

 

9 - Pulmonary microsporidiosis in AIDS: report of a case

Microsporidiose disseminada na AIDS: relato de caso

Aline Elisa Goulart, Agnaldo José Lopes, José Manoel Jansen, Daurita D. Paiva, Márcio Neves Bóia, José Mauro Peralta

J Bras Pneumol.1999;25(1):53-56

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Microsporidiosis is a rapidly emerging protozoon infection that has been reported predominantly in severely immunosuppressed persons with acquired immunodeficiency syndrome (AIDS). Since the first case of human microsporidian infection was reported in 1956, over 400 cases have been documented. The initial description of microsporidian infection in AIDS patients occurred in 1985. Five genera have been identified as the agents of microsporidiosis in immunocompromised persons (Enterocytozoon, Encephalitozoon, Septata, Pleistophora and Nosema). Respiratory tract infection due to microsporidia is associated almost exclusively with disseminated disease produced by members of the genera Encephalitozoon and Septata. Metronidazole and albendazole were recently reported to be responsible for clinical improvement of patients. The authors reported a case of a woman with AIDS and respiratory symptoms related to two pulmonary pathogens: Mycobacterium tuberculosis and Encephalitozoon cuniculi, identified by polymerase chain reaction (PCR) using diagnostic primers targeting the small subunit ribosomal RNA.

 


Keywords: Microsporidiosis. Respiratory tract infection. Acquired immunodeficiency syndrome.

 

10 - Swyer-James-MacLeod's syndrome

Síndrome de Swyer-James-MacLeod

Nelson Perelman Rosenberg, Daniel Augusto Pavan, Leandro Almeida Streher, Alessandro Comarú Pasqualotto

J Bras Pneumol.1999;25(1):57-60

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The hyperlucent lung syndrome, first described by Swyer and James, is considered a post-infectious complication related to bronchiolitis in infancy. The authors report a case of Swyer-James-MacLeod syndrome which was diagnosed in an adult male, and make a brief review of pertinent literature.

 


Keywords: Swyer-James-MacLeod. Syndrome. Bronchiolitis. Lung disease.

 

Year 1999 - Volume 25  - Number 2  (March/April)

Original Article

1 - Experimental lobar transplantation in swine: proportional graft in the discrepancy between donor and recipient

Transplante lobar experimental em suínos: enxerto proporcional na disparidade entre receptor e doador

Nuno Ferreira de Lima, Oliver A. Binns, Scott A. Buchanan, Kimberly S. Shochey, Curtis G. Tribble, Irving L. Kron

J Bras Pneumol.1999;25(2):63-69

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Background - The critical donor shortage in pediatric pulmonary transplantation has prompted lobar transplantation from living-related. However, in the case of great size discrepancy between the adult donor and the small child recipient, a pulmonary segment or medium lobe represents grafts with restricted vascular bed. The authors hypothesized that this type of graft may develop pulmonary hypertension in the recipient by the end of the growth period. Methods - This hypothesis was investigated in a porcine survival model of lung transplantation in piglets. There were three groups for comparison purposes: I (n = 4) - transplantation of the upper lobe from an adult donor, graft being proportional to the recipient but irrigated by two arterial rami only; II (n = 5) - transplantation of the lower lobe from an adult donor, graft being oversized to the recipient and having adequate vascular bed; III (n = 6) - transplantation of immature lung, from matched-sized donor. Graft function was studied three months after the transplantation, when the growth period was completed. Results - The pulmonary artery pressure of grafts in group I (51.8 ± 2.1 mmHg) was increased compared to that of group II (40.4 ± 2.5 mmHg) and of group III (34.8 ± 1.5 mmHg), reaching statistical significance (p = 0.0003). Conclusions - The lobar graft proportional to the recipient, with restricted vascular bed, had hampered hemodynamic performance in the growing animal. These results suggest that graft proportionality should be secondary to an adequate vascular bed.

 


Keywords: Lung transplantation. Lobar transplantation, experimental. Swine.

 

2 - Outcomes of multidrug resistant tuberculosis (MDR TB) treatment in Brasil - Partial results - As of April, 1998

Estudo de efetividade de esquemas alternativos para o tratamento da tuberculose multirresistente no Brasil

Margareth Pretti Dalcolmo, Andrea Fortes, Fernando Fiuza de Melo, Rita Motta, Jorge Ide Netto, Ninarosa Cardoso, Monica Andrade, Angela Werneck Barreto, Germano Gerhardt

J Bras Pneumol.1999;25(2):70-77

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Purpose: To determine the effectiveness of alternative regimens for treating confirmed MDR TB cases in outpatient units: Methods: MDR TB cases were defined as culture isolation of M. tuberculosis resistant in vitro to at least rifampin/isoniazide and a third drug of standard regimens in Brazil, according to both the conventional method and the BACTEC system. Design: Multicentric non-randomized controlled clinical trial. From April 95 to December 97 187 patients were enrolled. As of April 98, there were 36 patients under treatment. The authors analyzed 149 patients that had an average 14 months of treatment duration. The regimens used were chosen according to sensitivity tests: 1) streptomycin (S)/ofloxacin (OFX)/terizidon (TZ)/ethambutol (E)/clofazimine (CZ) or capreomycin (CM)/OFX/TZ/CZ/E or amicacyn/OFX/TZ/E/CZ. Demography: Male, 68.4%; female, 31.5%; mean age-36.9 years; HIV prevalence 1.9%; primary resistance rate - 8%. Outcomes: cured-treated for 12 months with six months after two consecutive negative culture; abandoned-discontinued treatment and consultations; died - deaths due to TB after two months of treatment; failed - remained positive in culture throughout the 12 months. Results: 120 (79.5%) patients converted to negative culture within 3 months. Cured: 53%, failed 31%, died 6%, abandoned 10%. Conclusions: The major predictor to MDR TB in Brazil is previous irregular and/or incomplete treatment. Sputum conversion rate was high and favorable overall response was 53%. Clinical implications: Because TB is endemic in Brazil and the number of MDR cases due to acquired resistance is increasing, greater efforts are needed to implement supervised treatment in tuberculosis particularly for non compliant patients.

 


Keywords: Tuberculosis, treatment. Multidrug resistant tuberculosis.

 

3 - Antegrade versus retrograde lung perfusion in pulmonary preservation for transplantation in a canine model of post-mortem lung viability

Perfusão pulmonar anterógrada "versus" retrógrada na preservação pulmonar para transplante em modelo canino de viabilidade pulmonar pós-morte

Jean Carlo Kohmann, Ubirajara Lima e Silva, Gabriel Madke, Eduardo Sperb Pilla, José Carlos Felicetti, José de Jesus Peixoto Camargo, Paulo Ivo Homem de Bittencourt, Paulo Francisco Guerreiro Cardoso

J Bras Pneumol.1999;25(2):78-83

Abstract PDF PT

Lung retrieval following cardio-circulatory arrest has been studied experimentally, however severe ischemia/reperfusion injury requires improved methods of graft preservation. Allograft perfusion with crystalloid solution delivered via pulmonary artery (antegrade perfusion) remains the standard procedure, however it does not provide adequate washout of the blood retained within the bronchial circulation which may trigger reperfusion injury. This has led the authors to test the impact of antegrade versus retrograde (via left atrium) perfusion of lung grafts submitted to 3 hours of warm ischemia after cardio-circulatory arrest in a dog model of left lung allotransplantation. Twelve donor dogs were sacrificed with thiopental sodium and kept under mechanical ventilation at room temperature for 3 hours. They were randomized and the heart-lung blocks harvested after being perfused in a retrograde (group I, n = 6) or antegrade (group II, n = 6) fashion with modified Euro-Collins solution. Twelve recipient animals were submitted to a left lung transplant receiving the grafts from both groups and the assessment was performed during 6 hours. Hemodynamic parameters were similar for animals in both groups. The gas exchange (arterial PaO2 and PaCO2) in recipients of group I (retrograde perfusion) was significantly better when compared to recipients of grafts perfused via pulmonary artery. Intracellular ATP did not show difference between the groups, however there was a measurable drop in its values when samples obtained upon extraction were compared to those measured after reperfusion and at the end of the assessment. The authors concluded that retrograde perfusion yields better pulmonary function after 6 hours of reperfusion in this animal model of left lung allotransplantation following 3 hours of normothermic ischemia under mechanical ventilation.

 


Keywords: Lung. Ischemia. Preservation. Retrograde perfusion. ATP.

 

5 - Resolução nº 196 - De 10 de outubro de 1996

Adib D. Jatene

J Bras Pneumol.1999;25(2):94-98

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6 - Resolução nº 251 - De 5 de agosto de 1997

Carlos César S. de Albuquerque

J Bras Pneumol.1999;25(2):99-101

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7 - Curso de diagnóstico por imagem do tórax - Capítulo II - Imagenologia da pleura

Arthur Soares de Souza Junior

J Bras Pneumol.1999;25(2):102-113

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Case Report

8 - Fat embolism syndrome: report of a case associated to liposuction

Síndrome de embolia gordurosa: relato de caso associado à lipoaspiração

Jõao Carlos Folador, Gabriela Elisete Bier, Renata Ferreira de Camargo, Mônicca Sperandio

J Bras Pneumol.1999;25(2):114-117

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A forty year old woman, 72 hours after liposuction, complained of sudden dyspnea, fever and tachycardia. Thoracic radiography and duplex-scan of deep veins were normal. Pulmonary scintigraphy suggested thromboembolism. The patient had hypoxia, anemia and mental confusion after three days of systemic heparin. Once fat embolism syndrome was suspected, heparin infusion was stopped and corticosteroid therapy was started. After that, the patient was much better and discharged from hospital.

 


Keywords: Fat embolism syndrome. Pulmonary thromboembolism. Liposuction.

 

9 - Tracheobronchial rupture by blunt chest trauma: evaluation and management

Ruptura traqueobrônquica por trauma torácico fechado: avaliação e manuseio

Wilson de Souza Stori Junior, Marlos de Souza Coelho, José Antônio Zampier, Gilberto Melnick

J Bras Pneumol.1999;25(2):118-123

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Two cases of complete bronchial rupture and one case of tracheobronchial rupture by blunt chest trauma were treated at the Thoracic Surgical and Respiratory Endoscopy Department of the Hospital Universitário Cajuru in a period of 2 years. The surgical technique used was end-to-end anastomosis with interrupt absorbable suture after either resection of the stenotic edges or debridement of the lacerated edges. All three patients have had good recovery. The mean period to remove the chest tubes was 3.6 days, and the mean period of discharge from the Thoracic Surgical Department was 5.6 days. The follow-up was made using chest X-ray (PA and lateral projections), lung function tests, and bronchoscopy.

 


Keywords: Tracheobronchial rupture. Blunt chest trauma. Evaluation. Treatment.

 

Review Article

10 - Perfusion lung injury

Lesão pulmonar de reperfusão

Bruno do Valle Pinheiro, Marcelo Alcântara Holanda, Fernando Gomes Araújo, Hélio Romaldini

J Bras Pneumol.1999;25(2):124-136

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The ischemia-reperfusion injury is a common pathophysiologic phenomenon in many diseases seen in daily clinical practice. The lung can be affected both directly, as in pulmonary edema after lung transplant or after resolution of pulmonary thromboembolism, and indirectly, as in shock states or after reperfusion injury in distant organs as intestine or lower extremities. The latter situation can occur secondary to aortic occlusion for surgical procedures. Many mediators have been implicated in the ischemia-reperfusion injury: oxygen free radicals, lipid products as thromboxane, adhesion molecules involved in leukocyte-endothelial interaction, tumor necrosis factor, among others. Therapeutic strategies for the reperfusion injury are used only at the experimental level and in very few clinical studies. Antioxidants, inhibitors of lipid mediators and of the leukocyte-endothelial interaction and promoters of blood flow in post-ischemic vessels have been used.

 


Keywords: Lung. Injury. Reperfusion. Ischemia.

 

Letters to the Editor

11 - Avaliação propedêutica da dispnéia crônica de etiologia indefinida: desafios atuais

Carlos Alberto de Castro Pereira

J Bras Pneumol.1999;25(2):137-140

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Year 1999 - Volume 25  - Number 3  (May/June)

Editorial

1 - A importância da crítica na ciência

José Roberto Lapa e Silva

J Bras Pneumol.1999;25(3):3-4

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Original Article

2 - Analysis of dry pleural biopsy in 107 patients

Análise da biópsia pleural em 107 pacientes sem líquido pleural

Marcelo Chalhoub, Sérgio Arruda, Ronald Fidélis, Ana Paula Barreto, Manoel Barral Netto

J Bras Pneumol.1999;25(3):141-146

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The clinical-radiographic presentation and tuberculosis prediction in patients that have undergone dry pleural biopsy, as well as its usefulness and complications, have been evaluated in this retrospective study, conducted in the Octávio Mangabeira Hospital (Salvador, Bahia, Brazil), where 107 patients consecutively submitted to this exam have been analyzed. Altogether 108 biopsies have been performed using Cope's needle (biopsies of both hemithoraxes were performed in one patient). The following diagnoses were obtained: a) tuberculosis (n = 66); b) probable tuberculosis (n = 4); c) neoplasm (n = 2); d) parapneumonic (n = 3), and e) not determined (32). Sixty-seven (62.6%) of the patients were male, and mean age was 34.5 ± 15.4 years. Analyses carried out compare patients diagnosed with tuberculosis (whether confirmed or probable) to those with different diagnoses (miscellaneous). Tuberculosis patients were younger (p < 0.01), expectoration was less frequent (p < 0.01), previous tuberculosis was less often reported (p = 0.04) and PPD reactivity was more frequent (p < 0.01). No significant differences were found between the two groups as to the extent of pleural commitment and its variation in the period observed. Presence of acinar infiltrations in the upper lobes was correlated with tuberculosis diagnosis in the 13 patients in which this feature was observed. Pleural fragments were present in 100 out of 108 cases (92.6%) and the diagnosis was made in the first biopsy in 64 out of 108 cases (59.3%). Ten minor complications have occurred (9.3%) in the 108 biopsies: 6 bloody sputums, 3 small pneumothoraxes, and one moderate subcutaneous emphysema. The authors conclude that for the various predictive indicators of tuberculosis analyzed, except for the presence of acinar infiltrations in the upper lobes, there is broad overlap between the two groups compared, meaning that a safe clinical diagnosis cannot be provided and thus reinforcing the need of performing biopsies. Dry pleural biopsy offers a satisfactory diagnostic yield in areas with high prevalence of tuberculosis and proved safe, when performed by experienced personnel.

 


Keywords: Pleural tuberculosis. Pleural thickening. Pleural biopsy. Diagnosis.

 

3 - Experimental pleural empyema in rats: effect of the intrapleural administration of dextran 40 during the fibrinopurulent stage

Empiema pleural experimental em ratos: avaliação dos efeitos do uso intrapleural de dextran-40 na fase fibrinopurulenta

Tulio Tonietto, Eduardo Sperb Pilla, Gabriel Ribeiro Madke, Ubirajara de Lima e Silva, José Carlos Felicetti, José de Jesus Peixoto Camargo, Marisa Ribeiro de Itapema Cardoso, Ricardo Bettiol Nonnig, Paulo Francisco Guerreiro Cardoso

J Bras Pneumol.1999;25(3):

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Pleural empyema carries high morbidity and mortality rates. Therapy focuses on the control of the infectious process in its initial phase when parenteral antibiotics and chest drainage are likely to be most effective. The ability of dextrans in preventing peritoneal adhesions leads one to test their potential effectiveness in reducing fibrinous proliferation in a rat model of pleural empyema. Twenty-four Wistar rats weighing 250-400 grams were anesthetized, submitted to a right thoracotomy and then randomized into 3 groups (n = 8 each). Animals in group I were given intrapleural dextran 40 (1 ml/kg) + 1 ml/kg of Staphylococcus aureus extract (1010 cells/ml) in heart-brain culture media obtained from oropharyngeal swabs of the animals. Animals in group II received saline solution (1 ml/kg) +1 ml/kg of Staphylococcus aureus extract (1010 cells/ml) in heart-brain culture media. Animals in group III (controls) were given the culture media without bacteria (1 ml/kg) in addition to saline (1 ml/kg). Upon completion, the chest was deaired, the thoracotomy wound was closed, the animals recovered, observed for 4 days, and sacrificed. Only the animals in groups I and II developed pleural effusion and empyema (average volume of 9.7 ml and 8.1 ml respectively, p > 0.05, NS). There was a significant weight loss in groups I and II compared to control animals (p = 0.004). There were no significant differences in blood work-up tests between groups. The pleural fluid of all animals in groups I and II had positive cultures for Staphylococcus aureus. The biochemical analysis of the pleural fluid in animals from groups I and II did not show any significant differences. The authors concluded that in this novel and reliable model of pleural empyema in rats, the intrapleural administration of dextran 40 at time of inoculation of bacteria did not result in any measurable reduction of the pleural reaction after 96 hours of observation.

 


Keywords: Empyema. Pleura. Rat. Dextrans. Staphylococcus.

 

4 - A prospective study of pleural effusions through analysis of DNA ploidy by flow cytometry

Estudo prospectivo de derrames pleurais através da análise de ploidia do DNA por citometria de fluxo

Giuliano Borile, Luciano da Silva Selistre, Samir Abu El Haje, Luiz Jaime Tellez, João Carlos Prolla, Jorge Neumann, Heloisa Sporleder, José de Jesus Peixoto Camargo, José Carlos Felicetti, Paulo Francisco Guerreiro Cardoso

J Bras Pneumol.1999;25(3):153-158

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This is a prospective study of benign and malignant pleural effusions carried out to determine the diagnostic yield of standard cytopathology compared to findings of DNA ploidy obtained by flow cytometry. Twenty-six samples of pleural effusion obtained by thoracocentesis were analyzed by cytopathology and flow cytometry. Final diagnosis was confirmed in all instances by histopathology of pleural biopsies. Ten samples were excluded from the analysis due to technical reasons, and the remaining 16 were used in the study. There were 13 malignant and 3 benign pleural effusions. Cytopathology revealed 9 malignant effusions and 7 benign effusions (4 false negatives). Flow cytometry findings have shown euploid DNA content in all 3 benign effusions (positive predictive value and specificity of 100%) and in 8 malignant effusions (positive value and specificity of 100%) and in 8 malignant effusions (sensitivity of 38.4% and negative predictive value of 27.2%). Cytopathology showed specificity of 100%, sensitivity of 69.2%, and positive and negative predictive values of 100% and 42.8%, respectively. The authors concluded that in this study the low sensitivity and negative value of flow cytometry in comparison to conventional cytopathology have limited the usefulness of flow cytometry to the finding of euploid DNA contents in benign pleural effusions.

 


Keywords: Flow cytometry. Cytopathology. DNA ploidy. Pleural effusion.

 

Upgrading

5 - Autoria e co-autoria: justificativa e desvios

Mario R. Montenegro

J Bras Pneumol.1999;25(3):159-162

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6 - Curso de epidemiologia básica para pneumologistas

Ana M.B. Menezes, Iná da S. dos Santos

J Bras Pneumol.1999;25(3):163-166

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Case Report

8 - Pulmonary artery aneurysms in Behçet's disease: regression after immunosuppressive treatment

Aneurismas das artérias pulmonares na doença de Behçet: regressão após tratamento imunossupressor

Isabela Fernandes de Magalhães, Iugiro R. Kuroki, Agnaldo José Lopes, Elisa M.N. Albuquerque, Evandro Mendes Klumb, Aline Elisa Goulart

J Bras Pneumol.1999;25(3):176-180

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Behçet's disease is a systemic disease with clinical manifestations, whose underlying histopathologic lesion is a non-specific vasculitis. Pulmonary artery aneurysms and, more rarely, pleuropulmonary manifestations may be found. Some reports are available in the literature about the use of immunosuppressive agents in these conditions. The authors describe a case in whom clinical remission and radiologic resolution were observed after corticosteroid and cyclophophamide therapy.

 


Keywords: Behçet's disease. Pulmonary artery aneurysms.

 

Review Article

9 - Diagnostic sequence in pulmonary thromboembolism

Seqüência diagnóstica no tromboembolismo pulmonar

Thais Helena A. Thomaz Queluz, Hugo Hyung Bok Yoo

J Bras Pneumol.1999;25(3):181-186

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Pulmonary thromboembolism (PTE) should be suspected in patients with risk factors for deep venous thrombosis (DVP) who present, either isolated or in association, malaise, dyspnea/tachypnea, sudden collapse or pulmonary hemorrhage syndrome. The diagnostic approach starts with basic tests (chest X-rays electrocardiographs, and arterial blood gas tensions) the results of which associated to medical history and to physical examination allow the classification of clinical suspicion as high, intermediate or low probability. This phase is important, both to support clinical suspicion of PTE and to exclude alternative diagnoses. In order to confirm or exclude PTE, one or several sophisticated imaging exams (lung isotope scanning, leg imaging, and pulmonary angiography) should be performed next, according to the findings of the chest X-ray. If there is undue delay in arranging investigations for patients with high clinical probability, heparin should be started, unless high risk to anticoagulation is present. In this review the diagnostic methods are discussed and some strategies for rapid investigation of PTE are shown with the main purpose of adapting them to Brazilian reality.

 


Keywords: Pulmonary thromboembolism. Diagnosis. Management strategy.

 

Year 1999 - Volume 25  - Number 4  (July/August)

Editorial

1 - Pesquisar é inerente ao ser humano

Thais Helena A; Yhomaz Queluz

J Bras Pneumol.1999;25(4):3-4

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Original Article

2 - High resolution CT scan in the evaluation of alterations in small airways of patients with chronic bronchial suppuration

Tomografia computadorizada de alta resolução (TCAR) na avaliação de alterações nas pequenas vias aéreas de pacientes com supuração brônquica crônica

Mônica Corso Pereira, Ilma Aparecida Pascoal, José Ribeiro Menezes Netto

J Bras Pneumol.1999;25(4):189-197

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Imaging the airways has always been a difficult task. Since the introduction of high resolution computed tomography a lot has been achieved in this area, specially in the visualization of the small airways. With the fine details provided by this technique, morphological changes related to the bronchioles can now be detected in a way hitherto impossible. This study was aimed at the description of the CT scan signs of airway disease that were present in a group of 36 patients suffering from chronic respiratory symptoms of cough and great amount of sputum production (bronchial suppuration) attending the outpatient clinics of the Pulmonary Disease Service of the State University of Campinas School of Medicine. Among these patients, 12 were diagnosed as having cystic fibrosis, and 24, other diseases with chronic sputum production. The authors looked for the direct signs of airway disease, such as thickening of the wall and dilatation of the lumen of large airways and these same abnormalities, appearing as micronodules at the center of the lobule and branching linear opacities, or a combination of the two (the so-called "tree in bud" pattern), when the disease is predominantly located in the small airways, in the films obtained from all the patients. The indirect signs of small airway disease, like mosaic perfusion and air-trapping, were also analyzed. Imaging of the airways has come of age with the use of high-resolution computed tomography and there is little doubt that this technique is now the most sensitive radiographic method for imaging the small airways, this previously hidden area of the lungs.

 


Keywords: Computed tomography. High resolution computed tomography. Airway diseases. Bronchiolar diseases. Bronchiectasis.

 

3 - Tuberculosis: directly-observed treatment x autoadministered treatment. Outpatient experience in a philanthropic health center and review of the literature

Tuberculose: tratamento supervisionado "vs." tratamento auto-administrado. Experiência ambulatorial em instituição filantrópica e revisão da literatura

Nelson Morrone, Maria do Socorro Sandes Solha, Maria do Carmo Cruvinel, Nelson Morrone Jr., José Antonio dos Santos Freire, Zelita Lelis de Moraes Barbosa

J Bras Pneumol.1999;25(4):198-206

Abstract PDF PT

Setting: Philanthropic health center specialized in lung diseases, including tuberculosis. Background: Directly-observed treatment (DOT) is the chief measure to insure improvement in cure levels and to reduce acquired resistance. This unit adopted DOT in the past, but financial difficulties prevent its maintenance. Objectives: Compare abandon levels in DOT and auto-administered treatment (AT) and identify predictive factors associated to abandonment. Type of study: Retrospective; patients observed in different years and selected at random. Material and methods: 1,226 patients were selected (613 patients in DOT and 613 in AT). Abandonment was compared in DOT and TA; in each group, abandonment was compared to sex, age, alcoholism, previous treatment, direction of symptoms, sputum and extension of the disease. Main results: Patients in DOT and in AT differ in some aspects. In AT, males, older age, positive sputum and more extensive disease were detected, previous treatment predominantly DOT. No difference was detected in relation to duration of symptoms, race, alcoholism and call up. Abandon was more frequent in AT (5.0% vs. 17.0%), p < 0.01, OR 3.90, CI 95% (2.50-5.88); one abandom in AT may be prevented by treating 8.4 patients in DOT. In AT, abandonment was related to male, black race, previous treatment, duration of symptoms, alcoholism and to age; duration of symptoms in DOT. Conclusion and proposal: 1) As abandonment is more common in AT, it is necessary to begin DOT immediately in structured units. 2) Cooperation with company medical facilities, community leaders and pharmacist will make it easier DOT adoption. 3) Punitive measures must be adopted for uncooperative patients.

 


Keywords: Tuberculosis. Abandonment. Directly-observed treatment (DOT).

 

4 - Bronchoscopy in the diagnosis of tuberculosis: their role of transbronchial biopsy in HIV-infected and in immunocompetent patients

Broncoscopia no diagnóstico de tuberculose: papel da biópsia transbrônquica em imunocompetentes e em HIV-positivos

Ricardo H. Bammann, Angelo Fernandez, Carla M.P. Vázquez, Maria Rita E. Araújo, Kátia R.M. Leite

J Bras Pneumol.1999;25(4):207-212

Abstract PDF PT

Introduction: Bronchoscopy is useful in the diagnosis of tuberculosis suspects with a "negative" sputum smear. The objectives of this study were: to assess yield of bronchoalveolar lavage (BAL) and of transbronchial biopsy (TBB) both in HIV-positive patients (group 1) and immunocompetent individuals (group 2), based on simple and most available laboratory techniques in clinical practice. Patients and methods: The authors performed 319 bronchoscopies in 302 patients. BAL and TBB were sequentially performed in the same lung in all cases. Tuberculosis was diagnosed based on the results of acid-fast stains (AFS) from the lavage (ZN), culture for mycobacteria (LJ), and histological examination of biopsies (HE and ZN). Results: Tuberculosis was the final diagnosis in 28 exams of group 1 (n = 214) and in 35 of group 2 (n = 105). There were abnormal endoscopic findings respectively in 3 and 10 patients. In group 1, AFS were positive in 7 cases, culture of BAL in 14, and TBB in 19. In group 2, AFS were positive in 13 cases, culture in 17, and biopsies in 31. TBB results compared to BAL were in concordance for group 1 (p = 0.823) and different for group 2 (p = 0.022). Immediate results (AFS and TBB) compared to later positive results of culture were similar for group 1 (p = 0.066) but not for group 2 (p = 0.001). There were eight episodes of pneumothorax (2.5%) and one death (0.36%). Conclusions: Both BAL and TBB should be performed whenever possible, aiming towards a higher yield of bronchoscopy in the diagnosis of tuberculosis. Both methods complement each other in immunocompetent patients, whereas TBB establishes a faster diagnosis for HIV-infected patients if associated to AFS.

 


Keywords: Bronchoscopy/methods. Smear-negative tuberculosis/diagnosis. Opportunistic infections related to AIDS/diagnosis.

 

Case Report

6 - Carcinoid tumor: bronchotomy as a technical alternative

Tumor carcinóide: broncotomia como alternativa técnica

Paulo M. Pêgo Fernandes, Luís Gustavo S.I. Castilho, Marcelo G. Gregório, Fábio B. Jatene

J Bras Pneumol.1999;25(4):225-228

Abstract PDF PT

The treatment of typical carcinoid tumors in bronchus is usually done by a small pulmonary resection with or without bronchoplasty. The authors report the case of a patient with typical carcinoid tumor in the left lower lobar bronchus, next to the lobar carina. They performed a longitudinal bronchotomy, tumor resection, and suture of the bronchus, preserving the lung tissue. The patient is currently well, three years after surgery, without any evidence of recurrence in the bronchoscopic control.

 


Keywords: Bronchial carcinoid tumor. Bronchoplasty. Bronchotomy. Lung tissue. Surgery.

 

7 - Pulmonary tuberculosis and optical neuritis: a new association or a variation of Devic's syndrome?

Tuberculose pulmonar e neurite óptica: uma nova associação ou uma variante da síndrome de Devic?

Lucélia de Azevedo Henn, Carlos Henrique François, Ângela Beatriz John

J Bras Pneumol.1999;25(4):229-231

Abstract PDF PT

Sporadic cases of patients with neuromyelitis (Devic's syndrome) in association with tuberculosis restricted to the lungs have come out in recent years. The case of a patient with sudden visual loss and a further diagnosis of optic neuritis and pulmonary tuberculosis is reported. Based on the description of this case, the possible relationship between these two pathologies and their implications are discussed.

 


Keywords: Tuberculosis. Optical neuritis. Devic's syndrome.

 

Upgrading

8 - Bronchiole pathology

Patologia bronquiolar

Vera Luiza Capelozzi

J Bras Pneumol.1999;25(4):232-239

Abstract PDF PT

Bronchiolitis or bronchiolitis obliterans are general terms used to describe a non-specific inflammatory injury that affects primarily the small airways, frequently not involving the pulmonary interstitium. Usually the terms utilized to categorize bronchiolitis are confused because they describe the clinical syndrome and also the histopathologic abnormalities. Unfortunately, most of the literature about bronchiolitis is based on isolated or small series. Additionally, there are many questions about epidemiology, pathophysiology, and treatment of bronchiolitis. The aim of this paper is to give a general view about the issue based on histopathologic features with the purpose of better understanding the clinical syndrome.

 


Year 1999 - Volume 25  - Number 5  (September/October)

Editorial

1 - Pesquisa brasileira no Congresso da American Thoracic Society

Thais Helena A. Thomaz Queluz

J Bras Pneumol.1999;25(5):3-

PDF PT


2 - Pesquisar é um ato de coragem!

Jussara Fiterman Molinari

J Bras Pneumol.1999;25(5):5-

PDF PT


Reviews and Abstracts

3 - Poluição e doenças ocupacionais pulmonares

Eduardo Algranti

J Bras Pneumol.1999;25(5):241-244

PDF PT


4 - Doenças pulmonares intersticiais

Carlos Alberto de Casro Pereira

J Bras Pneumol.1999;25(5):245-246

PDF PT


5 - Pleura

Lisete Ribeiro Teixeira

J Bras Pneumol.1999;25(5):247-250

PDF PT


6 - SDRA e ventilação

Guilherme P.P. Schettino, João Batista Borges Sobrinho

J Bras Pneumol.1999;25(5):251-262

PDF PT


7 - Medicina do sono

Carlos Alberto de Assis Viegas, Paulo Tavares

J Bras Pneumol.1999;25(5):263-264

PDF PT


8 - Tuberculose

MIiguel Aiub Hijjar

J Bras Pneumol.1999;25(5):265-266

PDF PT


9 - Fisiopatologia

Carmem Silvia Valente Barbas

J Bras Pneumol.1999;25(5):267-270

PDF PT


10 - Doenças pulmonares obstrutivas crônicas

Rogério Lopes Rufino Alves

J Bras Pneumol.1999;25(5):271-276

PDF PT


11 - Infecção

J Bras Pneumol.1999;25(5):277-278

PDF PT


13 - Asma

J Bras Pneumol.1999;25(5):279-284

PDF PT


Upgrading

14 - Curso de diagnóstico por imagem do tórax - Capítulo V - Imagem da embolia pulmonar

Arthur Soares de Souza Júnior

J Bras Pneumol.1999;25(5):287-293

PDF PT


Review Article

15 - Computerized tomography in acute respiratory failure

Tomografia computadorizada na insuficiência respiratória aguda

Silvia Regina Rios Vieira

J Bras Pneumol.1999;25(5):294-298

Abstract PDF PT

The goal of this paper is to review the use of CT scan in acute respiratory failure (ARF), acute lung injury (ALI) and acute respiratory distress syndrome (ARDS). The most important papers studying CT in ARF, published in English language literature, were found in Medline. The use of CT in patients with ARF let allowed the authors to proceed to a qualitative evaluation of lung morphology looking for diffuse an/or localized hyperdensities, and for other concomitant abnormalities (pleural effusion, pneumothorax). It is also possible to evaluate lung density histograms and calculate the gas-tissue ratio within the lungs. Likewise, one can also calculate total and regional lung volumes (aerated, poorly-aerated, non-aerated, and overdistension volumes). Knowing those volumes it is possible to quantify alveolar recruitment and overdistension due to ventilatory strategies as the use of different positive end expiratory pressure (PEEP) levels.

 


Keywords: Acute lung injury. Acute respiratory distress syndrome.

 

Letters to the Editor

16 - "Que fazer"

Alexandre Pinto Cardoso

J Bras Pneumol.1999;25(5):300-

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Year 1999 - Volume 25  - Number 6  (November/December)

Editorial

1 - O redescobrimento luso-brasileiro

Maria João Marques Gomes, Francisco Elmano Marques de Souza, Renato Soto-Mayor, Luiz Carlos Corrêa da Silva, Antônio Ramalho de Almeida, Bruno Carlos Palombini

J Bras Pneumol.1999;25(6):5-

PDF PT


Original Article

2 - Open, controlled clinical assay of the addition of ipratropium bromide to fenoterol in the treatment of acute asthma crisis in adults

Ensaio clínico, aberto, controlado sobre a adição de brometo de ipratrópio ao fenoterol no tratamento da crise de asma em adultos

Solange Diccini, Clystenes Odyr Soares Silva, Jorge Nakatani, Carlos Alberto de Castro Pereira

J Bras Pneumol.1999;25(6):301-308

Abstract PDF PT

Repeated dosis of inhaled β2-agonists have been used in the treatment of acute asthma. The effect of added ipratropium bromide (IB) to β2-agonist is controversial in adults. Objective: To evaluate if addition of IB to fenoterol, in repeated doses, induces a greater bronchodilation, a greater reversion of the attack, and discharge from emergency unit in adults with acute severe asthma. Setting: Pneumology Emergency Department, Unifesp-Hospital São Paulo, in the period from July 1995 to February 1997. Type of study: Open, randomized and parallel study. Discharge from the hospital: FEV1 and PEF ≥ 60% of the predicted value. Methods: 120 patients with FEV1 and PEF ≤ 50% of the predicted value were divided into two groups (N = 60): fenoterol (F) and ipratropium bromide + fenoterol (IBF). Each group received inhalation treatment through a metered-dose inhaler (MDI) attached to a holding chamber, administered at 30-minute interval, for a total of three treatments. In the group F four puffs of fenoterol (400 μg) were administered, and in the IBF group, 160 μg of BI and 400 μg of fenoterol (four puffs). Results: The patients did not differ from basal PEF (F = 36 ± 7% vs IBF = 35 ± 9% predicted) and basal FEV1 (F = 33 ± 9% vs IBF = 32 ± 9% predicted). Thirty-two patients of group F and 33 of group IBF were discharged from hospital after the inhalation treatment. The final FEV1 and PEF after inhalation treatments were F = 60 ± 13% vs IBF = 61 ± 11% e F = 74 ± 18% vs IBF = 77 ± 13% (NS). Conclusion: The addition of ipratropium bromide to fenoterol results in insignificant functional effect and without clinical impact in the treatment of acute asthma in adults.

 


Keywords: Fenoterol. Ipratropium. Status asthmaticus. Respiratory therapy.

 

Upgrading

3 - Suitability of Health Science key words for indexing master's degree theses and dissertations in the area of respiratory diseases

Adequação dos descritores em Ciências da Saúde para a indexação de dissertações acadêmicas, na área de doenças respiratórias

J Bras Pneumol.1999;25(6):

Abstract PDF PT

Introduction: The process of indexing consisted of two phases: firstly, to identify and represent the intellectual contents of a document; and secondly, the translation of the subject analysis into a specified language, with the aid of key words. At the Instituto de Doenças do Tórax da UFRJ medical library, the indexing was performed through a controlled vocabulary - the MeSH (Medical Subject Headings). The purpose of this study was to identify if the authors' subject headings were adequate for indexing Master's degree theses and dissertations on respiratory diseases. Method: The key words of 29 Master theses and dissertations, from 1990 through 1996, were studied. Results: The data collection showed that 29 authors employed 101 key words (3.48 headings/author). Among the 101 key words, 47 (47%) were adequate. Conclusion: Forty-seven per cent of the key words employed, on Master's degree theses and dissertations on respiratory diseases (IDT-UFRJ, 1990-1996), were adequate.

 


Keywords: Abstracting and indexing. Key words. Dissertations, academic.

 

Original Article

4 - Smoking and alcohol drinking practices among employees of Universidade Estadual do Ceará

Tabagismo e etilismo em funcionários da Universidade Estadual do Ceará

Maria Olganê Dantas Sabry, Helena Alves de Carvalho Sampaio, Marcelo Gurgel Carlos da Silva

J Bras Pneumol.1999;25(6):313-320

Abstract PDF PT

The aim of the present study was to identify smoking and alcohol drinking practices among Universidade Estadual do Ceará employees in the city of Fortaleza. The study used 317 employees as subjects. An interview questionnaire containing personal, socioeconomic, tobacco and alcohol consumption data was applied. The tabulation and analysis were made by Epi-Info 6.0. 157 of the interviewed subjects were male and 160 were female, the most prevalent age bracket being 30-49 years of age, and high level of instruction. 146 workers showed a family income starting from 10 minimal living wages per month. 83 workers were considered smokers, and a higher prevalence was detected among males (56). Mean tobacco consumption was 12.3 cigarettes a day, a practice that took place in the last 23.2 years. Alcohol was ingested by 183 employees and the prevalence was also higher among males. The consumption occurred mainly on weekends or rarely. The most ingested drink was beer - 96, followed by Brazilian white rum - 20 employees. The mean daily consumption of ethanol was 29.9 g. The ones who were both smokers and drinkers were mainly males. The instruction and income level were higher among smoking females and the income level was higher among drinking females. Although the prevalence of tobacco and alcohol consumption was low, it is a risk of chronicdegenerative diseases, specially in relation to the ethanol ingested by males. It is necessary to continue this study to provide a deeper association among the different environmental variables.

 


Keywords: Smoking. Alcoholism. Employees. Universities.

 

Upgrading

5 - Curso de epidemiologia básica para pneumologistas - 4ª parte - Epidemiologia clínica

Ana M.B. Menezes, Iná da S. dos Santos

J Bras Pneumol.1999;25(6):321-326

PDF PT


Review Article

7 - Compliance curves or pressure-volume curves in acute respiratory failure

Curvas de complacência ou curvas pressão-volume na insuficiência respiratória aguda

Silvia Regina Rios Vieira

J Bras Pneumol.1999;25(6):335-339

Abstract PDF PT

The goal of this paper is to review the use of pressure-volume (P-V) curves or compliance curves in patients with acute respiratory failure (ARF) - acute lung injury (ALI), and acute respiratory distress syndrome (ARDS). The most important papers published in English language literature concerning P-V curves in ARF were found in Medline and reviewed. Ideally, recommendation is made to calculate P-V curves in all patients with ARF in order to achieve adequate monitoring and management considering data obtained from the curves, such as lower inflexion point, upper inflexion point, and static compliance. The methods used to obtain P-V curves are supersyringe, multiple inspiratory occlusions and continuous flow. All of them are similar if low continuous flow is used and if care is taken to allow lung emptying and to avoid intrinsic PEEP (positive end expiratory pressure) before accomplishing the curves. In this way continuous flow can be a simple, inexpensive, secure and reliable method to be carried out at bedside in order to obtain P-V curves that allow for a better monitoring and management of patients with ARF.

 


Keywords: Acute lung injury. Acute respiratory distress syndrome. Pressure-volume curves.

 

Case Report

8 - Pulmonary embolism resulting from metastatic choriocarcinoma with atypical presentation: report of a case

Embolia pulmonar decorrente de coriocarcinoma metastático com apresentação atípica

Teresa de Jesus Jhayya, Andreia Luisa Simões Francisco, Clystenes Odyr Soares Silva, Rimarcs G. Ferreira

J Bras Pneumol.1999;25(6):340-342

Abstract PDF PT

A case is presented of a 36 year-old woman, with metastatic lung choriocarcinoma with atypical clinical and radiological presentation. The finding of pulmonary hypertension indicated the possibility of pulmonary thromboembolism, still, the definitive diagnosis and cause of pulmonary embolism were done in the autopsy. The authors discuss the manners of choriocarcinoma metastasis presentation, its repercussions and the latent period which may exist until it presents evidence of neoplasm.

 


Keywords: Choriocarcinoma. Pulmonary embolism.

 

9 - Adenoid cystic carcinoma of the trachea: treatment by removing the larynx, trachea, and esophagus, and mediastinal tracheostomy

Carcinoma adenóide cístico de traquéia: tratamento pela laringotráqueo-esofagectomia e traqueostomia mediastinal

Manoel Ximenes Netto, Gutemberg F. Rego, André L.a. Carvalho, Hélcio L. Miziara

J Bras Pneumol.1999;25(6):343-346

Abstract PDF PT

The authors describe the case of a 54 year-old female with adenoid cystic carcinoma of the trachea at the cricoid level upon whom extensive surgical resection was performed, including the larynx, part of the trachea and esophagus. Reconstruction of the digestive tract was done by means of a gastric tube and the airway with a mediastinal tracheostomy. Five years after the original procedure there was a local cutaneous recurrence which was removed. Seven years later the disease recurred in the mediastinum, which responded to irradiation. The patient is alive and well eight years and five months after the operation.

 


Keywords: Trachea. Neoplasm. Carcinoma, adenoid cystic. Tracheostomy.

 

10 - Pseudohemoptysis caused by leishmaniasis

Pseudo-hemoptise por leishmaniose

Saulo Maia D'Avila Melo, João Carlos Todt Neto, Leila Caroline Faria de Andrade

J Bras Pneumol.1999;25(6):347-350

Abstract PDF PT

A case of larynx mucosa leishmaniasis was initially misdiagnosed with lung tuberculosis, because the first symptom was pseudohemoptysis. The histologic appearance confirmed the diagnosis. The primary location in the larynx is exceptional. It is very important for bronchoscopists to have a broad experience in upper airways to make an exact diagnosis.

 


Keywords: Leishmaniasis. Hemoptysis.

 

 


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