Brazilian Journal of Pulmonology

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


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Year 2000 - Volume 26  - Number 1  (January/February)


1 - O "bug" do ano 2000: foi melhor prevenir do que remediar

Thais Helena A. Thomaz Queluz

J Bras Pneumol.2000;26(1):1-2


Original Article

2 - Surgical treatment of necrotizing pneumonia: analysis of four cases

Tratamento cirúrgico de pneumonia necrosante: análise de quatro casos

Fernando Luiz Westphal, Luiz Carlos de Lima, Cyntia Almeida Ferreira, Maria Auxiliadora de Carvalho

J Bras Pneumol.2000;26(1):1-4

Abstract PDF PT

Necrotizing pneumonia is a serious complication of lobar pneumonia. Four children aged between ten months and three years were admitted with acute bacteremic pneumonia and developed sepsis, pleural effusion, and respiratory distress despite adequate antibiotic treatment and chest tube drainage. Decortication and pulmonary resection were performed in all of them. The observed complications were bronchopleural fistula and one death. The emergency pulmonary resection is indicated when pulmonary necrosis is associated to sepsis and massive bronchopleural fistula. In such circumstances, morbidity and mortality are higher than in other conditions.


Keywords: staphylococcal pneumonia; thoracotomy; lung, surgery


3 - Community-acquired pneumonia in outpatients: epidemiological, clinical and radiographic features between atypical and non-atypical pneumonia

Pneumonia adquirida na comunidade em pacientes tratados ambulatorialmente: aspectos epidemiológicos, clínicos e radiológicos das pneumonias atípicas e não atípicas

Rosali Teixeira Rocha, Anna Cristina Vital, Clystenes Odyr Santos Silva, Carlos Alberto de Castro Pereira, Jorge Nakatani

J Bras Pneumol.2000;26(1):5-14

Abstract PDF PT

Aim: To evaluated the etiologic percentage of the atypical pneumoniae in outpatients and to identify the epidemiologic, clinical and radiographic features that permit to distinguish between atypical and non-atypical pneumonia. Methods: All patients underwent clinical and radiographic evaluation. Serum and sputum samples were obtained to serological tests including Legionella sp, Chlamydia sp, M. pneumoniae, Influenza A and Influenza B virus, and Gram stain, respectively. These procedures were performed on the first and 21 days after inclusion. Three independent observers reviewed chest X-rays. Results: During 22 months, 129 patients were evaluated. The final population under study comprised 69 patients (46 men - 23 women) with a mean age of 37 years. The etiologic diagnosis was defined in 34 (50%) of the patients. Etiologic agents included Chlamydia sp, 11 (16%) isolated cases; M. pneumoniae 7 (10%) cases. Influenza A was the third more frequent agent in 4 (6%) patients, and Legionella sp in 4 (6%). Mixed infections were observed with association of Chlamydia sp and M. pneumoniae in 5 (7.3%) cases, Chlamydia sp and Influenza B one (1.5%) case, and another of M. pneumoniae and Influenza A. The atypical pneumonia and non-atypical pneumonia groups were compared to respiratory symptoms and signs. There were no differences between them. The three independent observers' radiographic evaluation showed disagreement among them as to the type of pneumonia. Radiographic diagnoses of individual observers were compared to the clinical diagnoses, and no significant association was obtained for any observer. Conclusion: Pneumonia caused by "atypical" agents occurs in 50% of the outpatients with community acquired pneumonia. It is not possible to distinguish atypical pneumonia from non-atypical pneumonia. The clinical and radiographic presentations are similar in both groups.


Keywords: pneumonia; etiology; diagnosis; epidemiology


4 - Venous thromboembolism prophylaxis in an intensive care unit

Profilaxia para tromboembolia venosa em uma unidade de tratamento intensivo

Sérgio Saldanha Menna Barreto, Paula Mallman da Silva, Carlo Sasso Faccin, Alexandro de Lucena Theil, Alice Hoefel Nunes, Cleovaldo T. S. Pinheiro

J Bras Pneumol.2000;26(1):

Abstract PDF PT

Objectives: To identify the degree of risk and the practice of prophylaxis to venous thromboembolism (VTE) in an intensive care unit (ICU). Methods: The subjects were patients admitted to the ICU between December 1997 and February 1998. Patients were excluded if they were in anticoagulant therapy or presented contra-indication to heparin. Determination of risk factors and classification of the degree of risk for VTE were done according to international consensus. The ICU medical staff did not know about the study. Results: The authors evaluated one hundred and eighty patients with a mean age of 58 years (±16.5). Risk factors more frequently found were: age ³ 40 years (85.0%), surgery (47.8%), thoracic or abdominal infection (22.8%). Two or more risk factors were present in 146 (81%) cases. In the evaluation of VTE risk, 142 (79%) patients were classified as moderate/high risk. Prophylactic measures were prescribed to 102 patients (57%), and heparin was used in 60% of moderate/high risk cases. There was a significant association between risk level and the number of risk factors with the use of prophylaxis (p < 0.05). Conclusion: VTE risk factors were frequent in the sample analyzed. However, 40% of patients considered moderate/high risk did not receive pharmacological prophylaxis for VTE.


Keywords: thromboembolism, prevention & control


5 - Sequelae of foreign body aspiration in the respiratory tract of children

Aspiração de corpo estranho na árvore traqueobrônquica em crianças: avaliação de seqüelas através de exame cintilográfico

João Antônio Bonfadini Lima, Gilberto Bueno Fischer, José Carlos Felicetti, José Antônio Flores, Christina N. Penna, Eduardo Ludwig

J Bras Pneumol.2000;26(1):20-24

Abstract PDF PT

Objective: The aim of this study was to detect late sequelae of foreign body aspiration in the respiratory tract of children. Methods: This study included children admitted from 1987 to 1999 to Hospital da Criança Santo Antônio, of Porto Alegre, with clinical symptoms of foreign body aspiration to the respiratory tract confirmed by chest X-ray and bronchoscopy. Thirty days after the extraction of the foreign body a perfusion lung scan with technetium was performed. Results: 77% of the foreign bodies were organic materials. In 65% of children the aspiration event occurred at least 7 days before referral. The main location of foreign body was in the right lower lobe bronchus. Perfusion lung scans were performed in 24 patients. In 67% of them reduction in lung perfusion was detected. A chance of sequelae was 3.8 times greater in those patients who had the foreign body removed after 7 days from the aspiration event. Conclusion: This study showed that children that have had foreign body aspiration may have perfusion sequelae in their lungs even after removal of the foreign body. These sequelae were more frequent if the removal was delayed in 7 days of aspiration. Pediatricians must keep this in mind at the follow-up of children that have had foreign body aspiration.


Keywords: foreign bodies; aspiration; bronchi; prognosis


6 - M. tuberculosis resistance profile in HIV/AIDS patients in a reference hospital

Perfil de resistência de "M. tuberculosis" isolados de pacientes portadores do HIV/AIDS atendidos em um hospital de referência

Cid Gomes, Darcita Buerger Rovaris, João Laus Severino, Mônica Ferreira Gruner

J Bras Pneumol.2000;26(1):25-29

Abstract PDF PT

This study was performed in 117 patients infected by HIV, admitted to a reference hospital, in a period of one year (from 10/1/95 to 9/30/1996). All patients were 15 years old or more and had their sputum collected for AFB research, by clinical indication. All the 117 collected samples were submitted to bacilloscopic examination and 116 to culture (due to contamination in one sample) and also drug susceptibility test in all the 39 isolated strains. The strains were evaluated by PNB and TCH tests, and sent to a reference laboratory to typify the specimens. The bacilloscopic examination was positive in 34.2% (40/117) of the samples. From the 39 isolated strains, three did not belong to the M. tuberculosis complex (M. avium intracellulare in two, and one not identified strain). The resistance rate attributed separately to the M. tuberculosis was 13.90% (5/36). Resistance was not found that could be attributed to a single drug and the combination responsible for the highest resistance rate was that of rifampicin and isoniazid. The primary and secondary resistance was 20% (4/20) and 9.1% (1/10), respectively. Among social-demographic and clinical aspects, drug resistance was just significantly associated to a larger number of previous hospitalization (p < 0.03). These data suggest an intrahospital possible transmission of MDR (multi drug resistant) strains, among patients infected by HIV.


Keywords: mycobacterium tuberculosis; tuberculosis, pulmonary; drug resistance; acquired immunodeficiency syndrome



7 - Redação de trabalho científico

Álvaro Oscar Campana

J Bras Pneumol.2000;26(1):30-35


Review Article

8 - Exhaled nitric oxide for the diagnosis and monitoring of respiratory diseases

Óxido nítrico exalado no diagnóstico e acompanhamento das doenças respiratórias

José Miguel Chatkin, Per Djupesland, Wei Qian, James Haight, Noe Zamel

J Bras Pneumol.2000;26(1):36-43

Abstract PDF PT

This paper reviews in brief the role of nitric oxide in the respiratory physiology and in the pathology of some pulmonary diseases. The potential diagnostic and monitoring uses in several clinical situations are also discussed.


Keywords: respiratory tract diseases; lung diseases, obstructive; asthma; smoking; cystic fibrosis; bronchiectasis lung; lung transplantation


9 - Acquired immunodeficiency syndrome and the lung

A síndrome da imunodeficiência adquirida e o pulmão

Rosemeri Maurici da Silva

J Bras Pneumol.2000;26(1):44-48

Abstract PDF PT

The greatest causes of morbidity and mortality in patients infected with human immunodeficiency virus are opportunistic infections and neoplastic diseases. Most of them are lung diseases. Its correct diagnosis and proper treatment improve the quality of life as well as the survival in this group of patients.


Keywords: lung disease; acquired immunodeficiency syndrome; bronchoscopy


Case Report

10 - Granular cell tumor of the trachea: case report

Tumor de células granulares da traquéia

Jefferson Luiz Gross, Riad Naim Younes, Fabio José Haddad, Clóvis Antonio Lopes Pinto

J Bras Pneumol.2000;26(1):49-51

Abstract PDF PT

Granular cell tumors are uncommon neoplasm arising from Schwann cell. They are uncommon in the respiratory tract and there are only 32 cases described with primary tracheal involvement. A case is described of a 28 year-old woman with granular cell tumor located primarily in the trachea. The tumor was treated surgically with good result.


Keywords: granular cell tumor; trachea


In Memoriam

11 - Saudação a Mario Rigatto

Carlos Antônio Mascia Gottschall

J Bras Pneumol.2000;26(1):1-3


Case Report

11 - Bronchiolitis obliterans with organizing pneumonia and aspergilloma in patient with T cell leukemia-lymphoma

Bronquiolite obliterante com pneumonia em organização e aspergiloma em paciente com linfoma-leucemia de células T

Teresa S. Jhayya, Domingo B. Perez, Celia Mallart Llarges, Rimarcs G. Ferreira

J Bras Pneumol.2000;26(1):52-54

Abstract PDF PT

There are few reports in the medical literature about association between bronchiolitis obliterans with organizing pneumonia (BOOP) and aspergilloma. This report shows the presence of both BOOP and pulmonary aspergilloma in a patient with adult T cell leukemia-lymphoma. It is suggested that these findings represent a random association rather than the expression of a nosologic unity.


Keywords: bronchiolitis obliterans; aspergillosis; T cell lymphoma; pneumonia


Letters to the Editor

12 - A história da descoberta da circulação pulmonar

Rubens Bedrikow, Valdir Golin

J Bras Pneumol.2000;26(1):11-


Year 2000 - Volume 26  - Number 2  (March/April)


1 - AIDS e tuberculose: novo problema, velho problema

Margareth Pretti Dalcolmo

J Bras Pneumol.2000;26(2):3-4


Original Article

2 - Impact of multiple biopsies in two different sites of the pleural surface for the diagnosis of tuberculosis

Impacto de múltiplas biópsias em dois pontos distintos da superfície pleural no diagnóstico de tuberculose

Marcelo Chalhoub, Ronald Fidelis, Ana Paula Barreto, Eduardo Ramos, Manoel Barral-Netto, Aryon Almeida Barbosa Jr.

J Bras Pneumol.2000;26(2):55-60

Abstract PDF PT

For diagnostic purposes of pleural tuberculosis, three pleural fragments are routinely obtained from a single site by needle biopsy. The objective of this study is to compare the diagnostic yield of the routine procedure with two different approaches: harvesting five fragments on a single site (A), and collection of fragments at an additional site (B); from the same cutaneous orifice, the needle was partially removed up to the subcutaneous tissue and redirected at a 45o angle. The authors performed a prospective study in 115 patients submitted to pleural biopsy. The first three pleural fragments were placed in a vial (VA1-3), the 5 subsequent fragments obtained at the same site were placed in a second vial (VA4-8), and the five fragments from the second site were placed in a third vial (VB1-5). Analysis of fragments from VA1-3 revealed granuloma in 72/92 tuberculosis cases (78.3%), whereas in fragments VA5-8 and VB1-5, granuloma was observed in 74/92 cases (80.5%). In 6/92 patients the diagnosis at VA1-3 was non-specific pleuritis, but granuloma was found in VA4-8, resulting in a diagnosis increment of 8.3% (adding six to the 72 patients). In 7/92 patients (7.6%) the histopathological examination at site A led to a non-specific result but granuloma was found at site B, leading to a diagnostic increment of 9.0% (7 to 78 patients). Histological concordance of two examinations by the same pathologist had a kappa index of 0.62 (0.54 to 0.7) whereas concordance between two different pathologists had a kappa index of 0.64 (0.56 to 0.72). The performance of multiple biopsies at two different sites at the pleural surface led to an additional diagnosis of 13 patients, i.e., an increase of 18% (13 to 72) relative to the routine procedure. Considering the low cost increase of obtaining the fragments, adoption of this method is recommended in routine pleural tuberculosis diagnosis.


Keywords: Tuberculosis, pleural tuberculosis, biopsy, diagnosis.


3 - Pulmonary idiopathic fibrosis: clinical findings and survival in 132 histologically-proven patients

Fibrose pulmonar idiopática: características clínicas e sobrevida em 132 pacientes com comprovação histológica

Adalberto Sperb Rubin, José da Silva Moreira, Nelson da Silva Porto, Klaus Loureiro Irion, Rafael Franco Moreira, Bruno Scheidt

J Bras Pneumol.2000;26(2):61-68

Abstract PDF PT

In order to evaluate the clinical findings and survival of pulmonary idiopathic fibrosis patients, 132 cases with histologically-proven biopsy were studied, coming from Pavilhão Pereira Filho Hospital, from 1970 to 1996. The diagnosis was made in 120 patients by open lung biopsy and in 12 cases by transbronchial lung biopsy. The average age was 56 years; 78 were male and only 6 were black. Smoking was observed in 61 cases. Mean duration of symptoms before diagnosis was 22.7 months. Digital clubbing was present in 75 patients and teleinspiratory crackles in 100. Dyspnea was observed in all but two patients and cough was present in 89 cases. Lung function test values were: FVC, 62%; FEV1, 70%; DLCO, 43.4%; TLC, 76.7%; PaO2, 67.3 mmHg; PaCO2, 39.1 mmHg and SaO2, 92.3%. Bronchoalveolar cellularity values were: macrophages, 83.8%; neutrophils, 9.1%; lymphocytes, 6.1% and eosinophils, 0.6%. In X-ray, honeycombing was present in 79 cases, reduced total lung capacity in 107 and intrathoracic tracheal widening in 50. In CT, the mean reticular pattern profusion was 42.3% and the mean granular pattern profusion was 43.6%. The usual histologic pattern was found in 128 cases, and the descamative pattern in only 4. Information about survival was found in 121 cases until December 1997. The mean survival rate of all patients was 28 months and for dead patients was 24 months. Patient characteristics in this study were associated with advanced stage of disease, which was confirmed by small survival rates of those cases. The strong predominance of usual pattern and better patient selection may have contributed to these results.


Keywords: Pulmonary fibrosis, interstitial lung disease, clinical symptoms; Survival analysis.


5 - Functional respiratory changes in laparoscopic cholecystectomy

Alterações funcionais respiratórias na colecistectomia por via laparoscópica

Luciana Dias Chiavegato, José Roberto Jardim, Sonia Maria Faresin, Yara Juliano

J Bras Pneumol.2000;26(2):69-76


Objective: The aim of this study was to measure the changes in lung volume, pulmonary ventilation, maximum respiratory muscle strength, and the incidence of pulmonary complications in patients undergoing elective laparoscopic cholecystectomy. Type of study: Prospective study. Material and methods: Twenty patients (7 men and 13 women) with mean age of 42.7 years with normal respiratory function were studied. All patients in the preoperative period answered a long questionnaire, had a physical examination done, and had their lung volumes, respiratory muscle strength, diaphragmatic index and pulse oximetry determined. All measurements were repeated on the 1st, 2nd, 3rd and 6th postoperative days. Results: Patients showed a significant decrease (p < 0.05) on the first postoperative day: 26% ± 13% in tidal volume; 20% ± 14% in minute volume; 36% ± 17% in vital capacity; 47% ± 17% in maximum inspiratory pressure, 39% ± 27% in the maximum expiratory pressure and 36% ± 25% in diaphragmatic index. Tidal volume, minute volume and maximum expiratory pressure returned to their basal values on the third postoperative day; vital capacity, maximum inspiratory pressure and diaphragmatic index returned to their basal values between the 4th and 6th postoperative days. Among the 20 patients pulmonary complication was observed in just one patient (lobar atelectasis); there was a full recovery by the third postoperative day with the use of chest physical therapy techniques. Conclusion: The authors conclude that patients undergoing a laparoscopic cholecystectomy show a significant decrease in lung volume and in respiratory muscle strength on the first postoperative day. But, when these measurements are compared to the literature, return to their basal values is faster (between the 4th and 6th postoperative days) than with conventional surgery.


Keywords: Laparoscopic surgery, preoperative and postoperative care and respiratory muscle strength.



6 - Pesquisa bibliográfica em ciências biomédicas

Enilze de Souza Nogueira Volpato

J Bras Pneumol.2000;26(2):77-80


Review Article

7 - Respiratory health hazards in agricultural activities

Agravos respiratórios decorrentes da atividade agrícola

Carlos A.A. Viegas

J Bras Pneumol.2000;26(2):83-90

Abstract PDF PT

Respiratory diseases are today an important clinical problem for agricultural workers since many studies have demonstrated a significantly increased risk of respiratory morbidity and mortality. This is also important as a public health problem, specially in many developing countries where over half of the work force is involved in agriculture. The rural workers have potential inhalatory exposure to a very wide range of agents like organic and inorganic dust, decomposition gases, pesticides, disinfectants, etc. The impact on the respiratory system varies considerably and may affect all the airways and the pulmonary interstitium and may be associated to rhinitis, asthma, asthma-like syndrome, chronic airway disease, organic dust toxic syndrome, hypersensitivity pneumonitis, and interstitial fibrosis.


Keywords: respiratory tract diseases; occupational diseases; agricultural worker's diseases; environmental exposure.


8 - Bronchial remodeling in asthma

Remodelamento brônquico na asma

Thais Mauad, Alessandra Sandrini Lopes de Souza, Paulo Hilário Nascimento Saldiva, Marisa Dolhnikoff4

J Bras Pneumol.2000;26(2):91-98

Abstract PDF PT

The relationship between structure and function in asthma has been extensively studied. All the compartments of the airway have been shown to have some structural alterations contributing to functional defects. The structural alterations are thought to be a consequence of the chronic inflammation present in asthmatic airways, leading ultimately to remodeling. The decline of the ventilatory function over time in some asthmatic patients may be a consequence of airway remodeling. In this review, the authors describe the phenomena leading to airway remodeling and discuss the role of inflammatory mediators involved in this process. The structural alterations of the asthmatic airways are presented and the possible correlated functional defects are discussed.


Keywords: bronchii; pathology; asthma.


Case Report

9 - Intrabronchial leiomyoma: report of a case with seven years of tumor evolution

Leiomioma intrabrônquico: relato de um caso com sete anos de evolução

Paulo José Lorenzoni, Maria Ilizabeti Donatti, Paulo de Tarso Muller, Eliana Setti A. Aguiar, Pedro Nango Dobashi

J Bras Pneumol.2000;26(2):99-102

Abstract PDF PT

The authors report a rare case of benign lung tumor, the INTRABRONCHIAL LEIOMYOMA, of a 33-year-old male patient. Diagnosis was performed by bronchoscopy with tumor biopsy, the tumor consisted largely of smooth muscle fibers. The option for treatment, after seven years of tumor evolution, was pneumonectomy.


Keywords: Leiomyoma; Bronchi, Lung neoplasm.


10 - Pulmonary and pleural paragonimiasis: report of two cases

Paragonimíase pulmonar e pleural: relato de dois casos

Teresa de Jesus Jhayya S., Miguel Angel Coloma S., Mónica Pérez V., Danilo Montaño E.

J Bras Pneumol.2000;26(2):103-106

Abstract PDF PT

Paragonimiasis is a chronic infection caused by a trematode of the genus Paragonimus, the Paragonimus westermani being the one that most infects man. It is an endemic disease in East Asia, however, it is also seen in America. The authors report two cases of paragonimiasis, in which a patient showed a past history and clinical and radiological characteristics suggestive of this disease, diagnosed by the presence of eggs of P. westermani in the sputum, and another patient, a thoracic post-traumatism empyema whose paragonimiasis diagnosis was a histopathological finding in the pleura after a decortication. This diagnosis was confirmed by the presence of eggs of P. westermani in the sputum.


Keywords: paragonimiasis


Letters to the Editor

11 - O Brasil no "bonde da história da asma"

Márcia Alcântara Holanda

J Bras Pneumol.2000;26(2):19-21


Year 2000 - Volume 26  - Number 3  (May/June)


1 - Asmáticos brasileiros: o tratamento desejado

Márcia Alcântara Holanda

J Bras Pneumol.2000;26(3):7-9


Original Article

2 - Phenotypic characterization of lymphocyte subsets in bronchoalveolar lavage of patients with silicosis

Caracterização imunofenotípica das subpopulações de linfócitos do lavado broncoalveolar de pacientes com silicose

Ângela Ferreira, Jose da Silva Moreira, Regina Caetano, José Manoel Gabetto, Thereza Quirico-Santos

J Bras Pneumol.2000;26(3):107-112

Abstract PDF PT

Bronchoalveolar lavage is a safe and simple technique to evaluate lung disease related to exposure to mineral dusts. The aim of this study was to characterize the lymphocyte subsets in bronchoalveolar lavage of patients with silicosis. Bronchoalveolar lavage was carried out in 26 workers with different forms of silicosis: simple form (n = 12), complicated (n = 13) and 1 patient with acute form of the disease. As a control group, 7 healthy individuals were included. Compared to the control group, silicotic patients showed intense pleocytosis constituted mainly by alveolar macrophages with slight lymphocytosis. Lymphocyte subsets present in the bronchoalveolar fluid (BAL) of normal individuals were mature lymphocytes with phenotype CD2+TCRab (87.3%) and only 2.9% were CD2+TCRgd. CD4/CD8 ratio was 1.8 with few (16%) immature double negative T cells subsets (CD4-CD8-). In contrast, silicotic patients showed reduction of the more mature lymphocyte subset CD2+CD4+, CD2+CD8+ and a great increase (47%) of immature (CD4-CD8-) T cell subsets. No increase in the NK (CD56+) cell population was observed. Biochemical analysis of protein contents and determination of the Ig/albumin ratio characterized local immunoglobulin production within the pulmonary microenvironment. Furthermore, lack of increase of plasma cells, as well as the maintenance of the percentage of B lymphocyte population (CD19+) in the BAL of silicotic patients, favors the hypothesis that the cells responsible for Ig production are possibly located in the interstitial space. Altogether the results suggest development of lymphopoiesis and tertiary lymphoid tissue within the pulmonary microenvironment during the clinical course of silicosis.


Keywords: bronchoalveolar lavage, lymphocyte subsets, silicosis, immunophenotyping


3 - Surgical treatment of bullae for bullous emphysema: a simple drainage

Tratamento operatório de bolhas no enfisema bolhoso: uma simples drenagem

Roberto Saad Jr., Marcelo Domingues Mansano, Márcio Botter, Jacqueline Arantes Giannini, Vicente Dorgan Neto

J Bras Pneumol.2000;26(3):113-118

Abstract PDF PT

Ten surgeries have been performed on 8 patients for the relief of symptoms due to bullous disease. Closed intubation drainage of the bullae was used in all patients under local anesthesia. The technique, initially devised by Monaldi for the treatment of intrapulmonary tuberculous abscesses was modified. Symptomatic improvement and total collapse of the bullae was reported by 9 of the 10 procedures. The technique described provides a simple method for decompressing bullae by means of a minimally invasive surgical procedure. It has proved a suitable approach for all but those with the poorest lung function and is now the author's treatment of choice. Techniques using intracavitary intubation have potential advantages: no lung tissue is removed, in addition, the limited incision and a local anesthesia needed for the procedure are better tolerated by patients with poor lung function.


Keywords: pulmonary emphysema; drainage; lung surgery


4 - Validation of the Saint George's Respiratory Questionnaire in patients with chronic obstructive pulmonary disease in Brazil

Validação do Questionário do Hospital Saint George na Doença Respiratória (SGRQ) em pacientes portadores de doença pulmonar obstrutiva crônica no Brasil

Thais Costa de Sousa, José Roberto Jardim, Paul Jones

J Bras Pneumol.2000;26(3):119-128

Abstract PDF PT

Introduction: The term quality of life has gained increasing importance in the scientific context. This study describes the adaptation of a disease-specific questionnaire developed by Paul Jones et al. in 1991, the St. George's Respiratory Questionnaire (SGRQ), to the Brazilian language and culture. This questionnaire evaluates the quality of life in patients with chronic obstructive pulmonary disease (COPD) and contains three domains (symptoms, activity, and impacts) divided in 76 items. The questionnaire is self-administrated, but it may be read to illiterate persons. Goal: To verify if the St. George's Respiratory Questionnaire is a valid tool to measure quality of life in patients with chronic obstructive pulmonary disease in Brazil. Methods: In order to validate the questionnaire in Brazil, it was initially translated into Portuguese and afterwards a back-translation into English, that was compared to the original version. A final Portuguese version was then written. This final version was, then, answered by 30 clinically stable COPD patients, according to the spirometry and oximetry values. Patients answered the questionnaire twice, within a 15 day interval. The length of time the patients took to answer the questionnaire and their doubts were noted. Wilcoxon test was used for the calculation of r probability between every single question between the two days; interclass correlation ratio was calculated to test the trustworthiness and reliability of the questionnaire. Results: Among the 30 participant patients, 10 were female and 20 were male. Mean age was 65.9 years. Most of the patients were found to be in stage 2 (56.7 %) of COPD, according to the American Thoracic Society classification. The interclass correlation ratio for the total score of the questionnaire was a = 0.79 and Wilcoxon p = 0.2110 (not statistically significant). The mean answering time for the two days of interview was, respectively, 11 minutes and 50 seconds and 10 minutes and 31 seconds. As concerns the doubts about the questions, the patients reported difficulties in answering Sections 4 and 5, each one of these questions written in a negative form. Conclusion: It can be concluded that the Brazilian version of the St. George's Respiratory Questionnaire is a valid and reliable tool to measure quality of life in patients with COPD in Brazil.


Keywords: obstructive lung diseases, questionnaire, quality of life, reproducibility of results, evolution studies


Review Article

5 - Long-acting b2-agonists in chronic obstructive pulmonary disease (COPD)

b2-agonista de longa duração na doença pulmonar obstrutiva crônica (DPOC)

Luiz Eduardo Mendes Campos

J Bras Pneumol.2000;26(3):128-136

Abstract PDF PT

Long-acting b2-agonists can produce the same level of bronchodilation as anticholinergic drugs in patients with COPD, but due to their lipophilicity, the action persists for 12 h after inhalation. Comparative studies between salmeterol and formoterol demonstrate an equivalent potency of salmeterol 50 mcg and formoterol 24 or 12 mcg when administered respectively by a metered dose inhaler or a turbuhaler. One must consider the inhaler in order to establish the equivalent potency between these two agents. Patients with COPD and associated cardiac diseases can use the long-acting b2-agonists safely. In this particular high-risk group of patients, salmeterol, a partial agonist, is considered safer than formoterol. A reassessment of the bronchodilator therapy in COPD might be considered. Tiotropium bromide is a new anticholinergic drug, the action of which prolongs for more than 1-3 days. It is the most promising new bronchodilator for COPD patients.


Keywords: COPD, long-acting b2-agonists, bronchodilators


Case Report

7 - Granulomatous foreign body reaction simulating chest wall tumor over previous thoracotomy site

Reação granulomatosa do tipo corpo estranho simulando tumor de parede torácica em cicatriz de toracotomia prévia

Amarílio Vieira de Macedo Neto, Alexandre Heitor Moreschi, Antonio Azambuja Neto, Daniela Fedrizzi

J Bras Pneumol.2000;26(3):139-141

Abstract PDF PT

A male patient presented with a painless, slowly-growing chest wall mass in the site corresponding to the surgical wound of a previous thoracotomy for correction of aortic coarctation done fifteen years before. Chest CT scan showed tumor-like lesions with well-defined edges and osteolysis of the adjacent ribs. The patient was submitted to a chest wall resection and reconstruction, whose histological examination showed granular histiocytes and granulomatous reaction to necrohemorragic material. This is a rare event on medical practice. A review of the subject has been done in the literature.


Keywords: thoracic neoplasms; foreign body reaction; thoracotomy


8 - Congenital bronchial atresia: report of two cases. Contribution of CT scan to diagnosis

Atresia brônquica congênita: relato de dois casos. Contribuição da tomografia computadorizada ao diagnóstico

Alecsandra Calil Moyses Faure, Ana Paula Andrade Barreto, Carlos Alberto de Castro Pereira, Clystenes Odyr Soares Silva

J Bras Pneumol.2000;26(3):142-144

Abstract PDF PT

Bronchial atresia is a rare, congenital anomaly characterized by the presence of bronchocele with distal hyperinflation. The authors report two cases of segmental bronchial atresia and describe the clinical and roentgenographic findings supporting the diagnosis in the absence of other invasive diagnostic modalities or surgical exploration.


Keywords: pulmonary atresia; bronchi; X-ray computed tomography


9 - Pancoast's syndrome caused by lymphoma

Síndrome de Pancoast causada por linfoma

Alla Dolganova, Ana Luíza Schneider Moreira, Marinês Barra, Jose da Silva Moreira

J Bras Pneumol.2000;26(3):145-148

Abstract PDF PT

A rare case of Pancoast's syndrome caused by non-Hodgkin's lymphoma is reported. The diagnosis was made on the grounds of examination of the tissue obtained by pulmonary needle biopsy. The necessity of accurate histologic diagnosis and immunohistochemical study is emphasized.


Keywords: lymphoma; Pancoast's syndrome; lung neoplasms


10 - "Pneumocystis carinii" pneumonia: tumoral manifestation

Pneumonia por "Pneumocystis carinii": forma tumoral

Luiz Alberto Costa Barra, Eleni Aparecida Bedaque, Fabio Leoncio Bornstein Martinelli, Audrey Egypto Macedo, Renato Curti Jr., Ricardo Hanna

J Bras Pneumol.2000;26(3):149-152

Abstract PDF PT

Pneumocystosis is an opportunistic infection that occurs frequently in immunodeficient patients, mainly in those with the acquired immunological deficiency (AIDS). The authors report the case of a patient with insidious symptoms of fever, cough, and weight loss. Thorax radiography revealed a tumoral image in the right costophrenic angle. Treatment for tuberculosis (therapeutic test) presented no response. An open lung biopsy was performed and the histological examination revealed Pneumocystis carinii pneumonia. The patient presented significant clinical and radiological improvement with specific treatment.


Keywords: pneumocystis carinii pneumonia; AIDS-related opportunistic infections



11 - Recomendações para a prevenção do tromboembolismo venoso

Comissão de Circulação Pulmonar da Sociedade Brasileira de Pneumologia e Tisiologia

J Bras Pneumol.2000;26(3):153-158


Year 2000 - Volume 26  - Number 4  (July/August)

Original Article

1 - Pulmonary reperfusion injury by aortic occlusion: experimental model in rats

Lesão pulmonar de reperfusão por oclusão da aorta abdominal: modelo experimental em ratos

Bruno do Valle Pinheiro, Cândida Maria Moreira Horta, Bruno Guedes Baldi, Leonardo de Lucca Schiavon, Ângela Maria Gollner, Júlio César Abreu de Oliveira

J Bras Pneumol.2000;26(4):163-168

Abstract PDF PT

Introduction: Surgical procedures requiring aortic occlusion have been associated with pulmonary reperfusion injury. The authors studied the pulmonary edema in a reperfusion injury model by aortic occlusion in rats. Material and methods: Thirty-three Wistar rats were anesthetized with intraperitoneal injection of sodium pentobarbital (20 mg/kg). Using a midline abdominal incision, the infra-renal aorta was isolated and the animals were randomized into three groups. Ischemia-reperfusion group (IRG, n = 5): rats that underwent 30 min of aorta occlusion and were followed during 120 min of reperfusion. Ischemia group (IG, n = 5): rats that underwent 30 min of aorta occlusion. Control group (CG, n = 5): rats that underwent sham operations without aorta occlusion and were followed during 150 min. Histopathologic examination of the right lung was performed. The pulmonary edema was studied by morphometric analysis and so was the leukocytes infiltration. Eighteen rats (6 rats in each group) were studied with respect to lung fresh/dry weight ratio. ANOVA was used to analyze the morphometric results and the lung fresh/dry weight ratio, with Bonferroni adjustment for paired multiple comparisons. Animals of the IRG presented more pulmonary edema than those of the IG and CG (0.24 vs. 0.17 and 0.17, p < 0.001). There was no difference between the groups regarding the lung fresh/dry weight ratio. There were more inflammatory cells in the lungs of the rats submitted to ischemia-reperfusion. The authors concluded that infra-renal abdominal aorta cross-clamping and unclamping are associated with pulmonary edema. This edema is not induced by elevation of the hydrostatic pressure due to the aortic occlusion, since it was not seen in animals that were only submitted to ischemia.


Keywords: ischemia, reperfusion, pulmonary edema, inbred strains rats


2 - Diagnosis and treatment of mediastinal tumors by thoracoscopy

Diagnóstico e tratamento dos tumores mediastinais por toracoscopia

José Ribas Milanez de Campos, Luís Marcelo Inaco Cirino, Angelo Fernandez, Marcos Naoyuki Samano, Paulo Pego Fernandez, Luiz Tarcísio Britto Filomeno, Fábio Biscegli Jatene

J Bras Pneumol.2000;26(4):169-174

Abstract PDF PT

Objectives: Thoracoscopic management of mediastinal tumors is still subject to analysis. Seventy-three patients were submitted to thoracoscopy for the treatment of mediastinal masses and were analyzed retrospectively, in order to evaluate the effectiveness and complications of the procedure. Methods: Between 1983 and 1999, 21 conventional thoracoscopies and 52 video-assisted thoracic surgeries were performed (33 for diagnostic purposes and 40 for therapy). Patient ages ranged from two to 81 years (mean 43.8) with a slight predominance of females over males (41 versus 32). All underwent general anesthesia using simple (22) or double lumen (51) intubation. Results: The histological type of tumor was identified in all patients. For therapeutic purposes, conversion to thoracotomy was necessary in nine patients. The reasons were tumor size and invasion of nearby structures, difficulty to continue dissection, to perform an upper lobectomy, and to suture the iatrogenic diaphragm lesion. Four patients died during the first 30 postoperative days as a consequence of their primary pathology. Conclusions: Thoracoscopy was confirmed to be an effective diagnostic and therapeutic alternative for the treatment of mediastinal disorders.


Keywords: Thoracoscopy, thoracic surgery, mediastinal neoplasms, mediastinal cysts.


3 - Clinical application of serum tumor markers in patients with non-small cell lung carcinoma

Aplicação clínica dos marcadores tumorais séricos em carcinoma não-pequenas células do pulmão

Jefferson Luiz Gross, Riad Naim Younes, José Alexandre Marzagão Barbuto, Fabio José Haddad, Daniel Dehenzelin

J Bras Pneumol.2000;26(4):175-182

Abstract PDF PT

The usefulness of serum tumor markers in lung cancer is not well defined. Objective: The aim of this study is to examine the correlation between serum tumor markers and tumor extension and its prognostic value. Patients and method: From February 1995 to September 1997, 103 patients with non-small cell lung carcinoma were evaluated at the Department of Thoracic Surgery. Serum levels of CEA, CYFRA21.1, CA15.3, CA19.9, CA72.4, and NSE were determined before treatment. Results: The serum level of CYFRA21.1 was the most frequent elevated tumor marker (55%). Patients with advanced tumor had higher mean serum level of CEA (90.8 ng/ml), CYFRA21.1 (20.3 ng/ml) and CA15.3 (56.5%) than those with localized carcinoma, respectively 10.2 ng/ml, 12.6 ng/ml and 22.2 ng/ml. Considering all serum tumor markers evaluated in this study, only patients with elevated CEA had greater chance (5.6) of presenting with advanced non-small lung carcinoma than patients with normal CEA. Overall survival was influenced by performance status (p = 0.001), tumor extension (p = 0.006), elevated serum level of CEA (p = 0.043), more than two elevated serum tumor markers (p < 0.001), and type of treatment (p < 0.001). The prognostic value of anatomical tumor extension reached the limit of significance (p = 0.052); however, two or more elevated serum tumor markers and type of treatment had independent prognostic value (respectively, p = 0.035 and p = 0.005). Conclusion: None of these serum tumor markers had clinical value in the management of NSCLC patients.


Keywords: biological tumor markers, neoplasm staging, non-small cell lung carcinoma, prognosis


4 - Thoracic positron emission tomography: preliminary results of a Brazilian experiment

Tomografia por emissão de pósitrons (PET) no tórax: resultados preliminares de uma experiência brasileira

Mário Terra Filho, Sidney Bombarda, José Soares Júnior, José Cláudio Meneghetti

J Bras Pneumol.2000;26(4):183-188

Abstract PDF PT

New non-invasive methods have been developed to detect lung malignancies. One of them is positron emission tomography (PET) using 18F 2-deoxy-D-glucose (FDG) as a radiotracer. Objective: Evaluate the FDG-PET results performed through a hybrid coincidence-gamma camera in patients with pleuropulmonary infectious diseases or lung tumors. Material and methods: Fifteen patients were evaluated, and divided into: group I - five patients with active lung tuberculosis, and group II - ten patients with possible pleuropulmonary neoplasia. Doses of 185 MBq of FDG were given intravenously, and scans were performed with a two-headed ADAC Vertex Plus camera. Results: In group I all scans were positive. In group II after thoracotomy in nine patients and mediastinoscopy in one, the following diagnoses were observed: two adenocarcinomas, two granulomas, one small cell carcinoma, one large cell carcinoma, one hamartoma, one rounded atelectasis, one mesothelioma, and one antracosis. The scans were positive in six patients (five malignant neoplasias and one granuloma) and negative in the other four cases. Conclusion: The FDG-PET performed through a hybrid camera produces images of quality that permit identification of active infectious process. FDG-PET in association with clinical and radiological exams can differentiate malignant from benign lung neoplasias.


Keywords: emission-computed tomography, lung neoplasms, lung diseases


5 - Prevalence of HIV infection in patients hospitalized due to tuberculosis

Prevalência da infecção pelo HIV em pacientes internados por tuberculose

Guilherme Freire Garcia, Paulo César Rodrigues Pinto Corrêa, Márcia Gregory Tavares Melo, Márcia Beatriz de Souza

J Bras Pneumol.2000;26(4):189-193

Abstract PDF PT

Objectives: To verify the prevalence of tuberculosis (TB)/HIV co-infection and the ability of the clinical history to detect the HIV infection in TB inpatients. Setting: Eduardo de Menezes Hospital, reference for both TB and AIDS. Patients and methods: All patients admitted with TB in a pneumology ward were evaluated prospectively from 1/1/1997 to 1/31/1998. The clinical history was directed to the presence of risk factors for AIDS or TB, previous treatments or abandoned treatments for TB, and TB clinical forms. Patients with AIDS defining illnesses, except for TB, and with previous anti-HIV tests were excluded. All patients had an ELISA anti-HIV serology, and when positive, a Western-Blot test was performed to confirm the previous result. X-square test and Fisher test were used for statistical analysis. Results: Sixty-five patients were divided into group I (positive serology for HIV, n = 6) and group II (negative serology for HIV, n = 59). There were no statistical differences between the groups comparing the risk factors for AIDS and TB, previous treatments or abandoned treatments for TB, or TB clinical forms. Conclusions: The high prevalence of TB/HIV co-infection (9.2%) reinforces that: 1) the clinical history was not able to detect a significant number of patients with TB/HIV co-infection and that: 2) anti-HIV serology should be performed in all patients with active TB forms.


Keywords: tuberculosis, acquired immundeficiency syndrome, prevalence


Review Article

6 - Analysis of the ventilatory mechanics by forced oscillations technique: main concepts and clinical applications

Avaliação de mecânica ventilatória por oscilações forçadas: fundamentos e aplicações clínicas

Pedro Lopes de Melo, Marcelo Martins Werneck, Antonio Giannella-Neto

J Bras Pneumol.2000;26(4):194-206

Abstract PDF PT

Requesting passive cooperation from the patient and supplying new parameters for the analysis of the ventilatory mechanics, the forced oscillations technique (FOT) has complementary characteristics to the classical methods of lung evaluation. In this work, a review of the principles of this technique is initially presented together with a discussion about its advantages and present limitations. The performance of the technique is compared to classical methods in the detection of breathing disorders. The main clinical applications reported previously in the literature, including the evaluation of the ventilatory mechanics in children, studies in neonates, monitoring of patients under mechanical ventilation, occupational medicine, and evaluation of respiratory sleep disturbances are reviewed and discussed. Based on this review and on the results obtained in studies made in their laboratory, the authors concluded that FOT could render a more detailed examination and facilitate the accomplishment of lung function tests under conditions in which traditional techniques are not appropriate.


Keywords: respiratory mechanics, oscillometry, respiratory function tests



7 - Quality of life in chronic pulmonary diseases: conceptual and methodological aspects

Qualidade de vida em doenças pulmonares crônicas: aspectos conceituais e metodológicos

Ana Teresa de Abreu Ramos-Cerqueira, André Luiz Crepaldi

J Bras Pneumol.2000;26(4):207-213

Abstract PDF PT

The present article purports to analyze aspects related to the concept of quality of life, taking into account the relevance of setting down parameters that allow for the evaluation of those aspects, especially in patients with chronic diseases. The analysis considered quality of life as one of the essential components of medical care, and pointed out the precautions that should be taken to choose instruments of evaluation, that should be sensitive and reliable to the dimensions they intend to evaluate.


Keywords: quality of life, chronic diseases, asthma, chronic obstructive pulmonary disease


Case Report

8 - Bronchiectasis associated to Sjögren syndrome: case report

Bronquiectasias associadas à síndrome de Sjögren

Simone Aparecida Câmara Tecchio, José Antônio Baddini Martinez, Adriana Inácio de Pádua, João Terra Filho

J Bras Pneumol.2000;26(4):214-217

Abstract PDF PT

Different kinds of pulmonary impairment have been described in Sjögren syndrome, including rare cases of bronchiectasis. The authors report a female patient with a history of episodes of respiratory infections and progressive breathlessness whose high resolution computerized tomography revealed bronchiectasis. A former open lung biopsy showed bronchiolar inflammatory and fibrotic changes. The diagnosis of Sjögren syndrome was made only late in the evolution, although sicca syndrome symptoms had been present for years. The authors discuss the potential pathogenic mechanisms involved in the development of the bronchiectasis and the need for a high degree of clinical medical skill for the early diagnosis of such conditions.


Keywords: Sjögren syndrome; bronchiectasis; bronchiolitis


Year 2000 - Volume 26  - Number 5  (September/October)

Original Article

1 - Comparative study of criteria for the diagnosis of tuberculosis in children seen in a health care center

Estudo comparativo de critérios para o diagnóstico de tuberculose em crianças atendidas em centro de saúde

Márcia Nogueira Carreira, Clemax Couto Sant'Anna

J Bras Pneumol.2000;26(5):219-226

Abstract PDF PT

Setting: Considering the difficulty to establish diagnosis of tuberculosis in childhood, the authors studied three diagnostic criteria published in the literature in the last 20 years, evaluating their sensitivity, specificity, and accuracy. Material and methods: In a prospective study, 94 children at ages ranging from 0 to 15 years having contact with bacillary tuberculous adults were studied in the Municipal Health Center of Duque de Caxias, Rio de Janeiro. The following criteria were studied: Keneth Jones, described by Stegen et al.(1), World Health Organization(2) and Keith Edwards, described by Crofton et al.(3). Results: Among the criteria studied, those of Keith Edwards showed the best sensitivity and specificity, with 84% and 97%, respectively. WHO criterion showed a 100% specificity but zero sensitivity. Keneth Jones criterion showed 56% sensitivity and a 94% specificity. Conclusion: In poor areas, such as that of this study, where easy-to-handle operational methods are required, the criteria studied proved to be adequate to detect tuberculosis cases in children in contact with tuberculous adults. Those of Keith Edwards were the most useful although some changes are necessary for a better adaptation to Brazil.


Keywords: Tuberculosis, diagnosis. Child. Community health care centers.


2 - Prognostic factors in idiopathic pulmonary fibrosis

Fatores prognósticos em fibrose pulmonar idiopática

Adalberto Sperb Rubin, José da Silva Moreira, Nelson da Silva Porto, Klaus Loureiro Irion, Rafael Franco Moreira, Bruno Ssheidt

J Bras Pneumol.2000;26(5):227-234

Abstract PDF PT

In order to evaluate which prognostic factors were significant to the survival of patients with idiopathic pulmonary fibrosis (IPF), 121 histologically confirmed cases of the disease were studied at the Pereira Filho Hospital from 1970 to 1996. All patients were submitted to a standard thorax X-ray and spirometry and answered a standardized questionnaire when admitted to hospital. They also underwent diffusion tests (34 cases), total lung capacity (28), blood gas analysis (106), bronchoalveolar lavage (39), rheumatoid analyses (45), and thoracic CT (24). For further analysis, the patients were classified into two groups: group A (2-year survival) with 55 patients, and group B (more than 5-year survival) with 24 patients; these features were also analyzed according to their significance to survival. Age, increased dyspnea index, long symptomatic period, FVC, DCO, PaO2 and SaO2 reduction, honeycombing intensity, and greater profusion of the reticular pattern on HRCT were considered indicative of worse prognosis. A reduced FEV1 and TLC were also associated with shorter survival. The use of those criteria which had shown statistical significance when evaluated together may determine a more accurate prognostic evaluation of IPF patients resulting in social and therapeutic benefits to patient management.


Keywords: Pulmonary fibrosis. Interstitial lung diseases. Prognosis. Prospective studies. Survival analysis.


3 - Repeated treatment of tuberculosis in the city of Recife, 1997: an epidemiological approach

O retratamento da tuberculose no município do Recife, 1997: uma abordagem epidemiológica

Hermira Maria Amorim Campos, Maria de Fátima Militão de Albuquerque, Antônio Roberto Leite Campelo, Wayner Souza, Ana M. Brito

J Bras Pneumol.2000;26(5):235-240

Abstract PDF PT

Objectives: This study describes the epidemiological profile of cases of repeated treatment of tuberculosis occurring among residents of the city of Recife in the year of 1997. Material and methods: A cross-sectional study was performed and 240 cases of repeated treatment were studied, representing 16.2% of all cases of tuberculosis. Results: Interruption of previous treatment was the principal reason for repeated treatments (55.8%), followed by cases of recurrence of the disease (39.2%). Patients undergoing repeated treatment for tuberculosis are characterized as predominantly male, ages between 30 and 49, with little or no school education, with a significant predominance of pulmonary tuberculosis. It is striking that 42.7% of the cases of repeated treatment had a history of two or more previous courses of treatment. With regard to the outcome of the repeated treatment, 52.5% of the cases showed unfavorable results. Among these, 44.2% of the patients gave up the course of treatment and 39.6% followed it for the first month. The cases that returned for treatment following recurrence showed a higher percentage of successful outcomes (56.7%), in comparison to those that returned after interrupting previous treatment (40.2%), this difference being statistically significant (χ2 = 19,55; p < 0,01). It was found that, among the cases of pulmonary tuberculosis, 27.1% resumed chemotherapy without undergoing the Koch bacillus catarrh test and only 27.1% carried out BK culture with sensitivity test. Conclusions: The results show the need to enhance tuberculosis treatment and follow-up procedures within the sphere of the health care service. An adequate treatment is the cheapest method to avoid drug resistance and should be understood as a strategy to improve the tuberculosis surveillance system.


Keywords: Tuberculosis. Pulmonary tuberculosis. Repeated treatment.


4 - Traumatic late cardiac tamponade: analysis of five cases

Tamponamento cardíaco tardio traumático: análise de cinco casos

Fernando Luiz Westphal, Luiz Carlos de Lima, Badwan Abdel Jaber

J Bras Pneumol.2000;26(5):

Abstract PDF PT

Five traumatic late cardiac tamponade cases were analyzed. All patients were male, mean age was 26.2, victims of thoracic penetrating stabbing wound in the precordial region, Ziedler area, admitted to a trauma reference center. They were classified by the Ivatury physiological index for cardiac trauma. The first treatment approach was intercostal pleurectomy and volemic resuscitation followed by hemodynamic and respiratory recovery. Patients with cardiac tamponade symptoms were re-admitted within an interval from eight to twenty four days (mean 20 days) in a thoracic surgery service of a tertiary reference hospital. Diagnostic exams confirmed thickening and pericardial effusion associated with a left pulmonary base entrapment in four of the cases which were treated by posterolateral thoracotomy, including partial pericardiectomy and pulmonary decortication. One patient was diagnosed with purulent pericarditis by supplementary exams and underwent a subxiphoid pericardial drainage. Postoperative cardiac arrhythmia occurred in one patient but the others did not develop any complications and there were no tamponade recurrent cases.


Keywords: Cardiac tamponade. Penetrating wounds. Thoracic injuries. Diagnosis.


5 - Environmental and epidemiological evaluation of workers of the fertilizer industry of Rio Grande, RS

Avaliação ambiental e epidemiológica do trabalhador da indústria de fertilizantes de Rio Grande, RS

Maura Dumont Hüttner, José da Silva Moreira

J Bras Pneumol.2000;26(5):245-253

Abstract PDF PT

Occupational lung diseases represent an important and serious public health problem. In order to contribute to the knowledge of the risks associated with the exposure to fertilizer production an environmental and epidemiological cross-sectional study was performed among workers of this industry in Rio Grande, RS, Brazil. The ATS-DLD-78 questionnaire was applied, a thoracic radiological study was carried out, and the pulmonary function testing was evaluated through spirometry in 413 employees, 305 being the exposed group and 108 the non-exposed group. The exposed workers were all men, 74.1% had attended elementary school (at least some years), mean age was 38 (± 7.6) and mean time of exposure was 11.8 years (± 6.7). As to cigarette smoking, 126 (41.3%) were smokers, 76 (24.9%) former smokers, and 103 (33.8%) non-smokers. The exposed group was divided into four work sections according to the specific risks of their occupational exposure. The environmental evaluation showed the presence of free silica, gaseous fluorides, and gaseous ammonia in concentrations above the tolerance limits. Results of the exposed workers were: 30.5% of them answered positively to cough, 14.7% to chronic cough, 8.5% to chronic bronchitis, 43.3% to rhinitis, and 35.4% to conjunctivitis. The multivariate analysis, after adjustment for smoking, showed statistically significant association between exposure and cough as a whole, rhinitis and conjunctivitis. The thoracic radiological studies did not point to any considerable abnormality of pneumoconiosis in the exposed workers. Most of them presented normal pulmonary function testing, not different from the controls.


Keywords: Epidemiology. Lung diseases. Respiratory tract diseases. Occupational diseases. Fertilizer industry. Evaluation. Environment.


Review Article

6 - Indoor air quality, Act 3,523 of the Ministry of Health and Brazilian standards for biological indoor air contaminants

Ambientes climatizados, portaria 3.523 de 28/8/98 do Ministério da Saúde e padrões de qualidade do ar de interiores do Brasil

Paulo Pinto Gontijo Filho, Carlos Roberto Menezes Silva, Afrânio Lineu Kritski

J Bras Pneumol.2000;26(5):254-258

Abstract PDF PT

This article reviews Act 3,523 of the Brazilian Ministry of Health which regulates the indoor air quality of air-conditioned environments, focusing mainly on biological standards for contaminant particles. Additionally, a concise analysis on nosocomial air-borne infections is performed, as well as on nosocomial units where air-borne infectious diseases may be important and a special ventilation system is required. Detailed analysis of the most common biological contaminant particles, differences between countries of both Northern and Southern hemispheres, and the aspects of the methodology used to perform their analysis are considered. The authors conclude that there are no established standards for safe levels of air-borne organisms, and that there is no available data in Brazil to set up standards for biological contaminant particles


Keywords: Air pollutants. Air conditioning. Air quality standards. Indoor air pollution. Brazil.


Case Report

7 - Pediatric sarcoidosis: case report

Sarcoidose pediátrica: relato de caso

Fabrício Piccoli Fortuna, Gilberto Bueno Fischer

J Bras Pneumol.2000;26(5):259-262

Abstract PDF PT

The authors report a typical case of pediatric sarcoidosis presenting a granulomatous pulmonary disease with systemic impairment, reviewing clinical, diagnostic, and particular aspects of the disease in this age group, with emphasis on the difficulty to differentiate its diagnosis from that of tuberculosis.


Keywords: Sarcoidosis. Pulmonary sarcoidosis. Lung diseases.


8 - Spontaneous hemopneumothorax: a rare clinical entity

Hemopneumotórax espontâneo: uma rara entidade clínica

Márcia Thomson, Eduardo Sahão, João Carlos Thomson

J Bras Pneumol.2000;26(5):263-265

Abstract PDF PT

Spontaneous hemopneumothorax with massive bleeding is considered a rare complication of spontaneous pneumothorax. The authors describe two patients with acute chest pain and dyspnea; the chest X-ray showed pneumothorax and pleural effusion. The two cases were submitted to thoracic drainage and presented important bleeding; thoracotomy was performed and in the first case an aberrant vessel was found, and in the second case the source of bleeding was rupture of pleural adherence. The post-operative evolution had no incidents in either case.


Keywords: Pneumothorax. Hemopneumothorax. Spontaneous rupture.


9 - Congenital lobar emphysema diagnosed in an adult patient

Enfisema lobar congênito diagnosticado em paciente adulta

Antônio S. Porto, Evandro M.S. Magalhães, Michele M. Coppini, Viviane P. Freitas

J Bras Pneumol.2000;26(5):266-268

Abstract PDF PT

Congenital lobar emphysema is a disease in which symptoms often begin during the first six months of age. In this report, the authors present the case of a twenty-year-old woman whose symptoms started when she had a spontaneous pneumothorax, an exceptional occurrence. The possible etiologies for that congenital lung malformation and the reasons for the performance of a conservative treatment are discussed.


Keywords: Pulmonary emphysema. Pneumothorax. Abnormalities.


10 - Association of bronchogenic carcinoma with Pancoast's syndrome and acquired immunodeficiency syndrome

Associação de carcinoma broncogênico com síndrome de Pancoast e síndrome da imunodeficiência adquirida

A.C. Frohlich, D. Chiesa, M. Ronsani, L.A. Henn, S.S. Menna Barreto

J Bras Pneumol.2000;26(5):269-272

Abstract PDF PT

A case of a patient with Pancoast's syndrome associated with acquired immunodeficiency syndrome is reported. This association is rare and Kaposi's sarcoma and non-Hodgkin lymphoma are the most recurrent tumors in AIDS. The patient was an IV drug user and was admitted to the hospital for diagnosis of apex lung mass with signs of Pancoast's syndrome. HIV serology was positive and pathology of lung mass showed non-small cell lung cancer.


Keywords: Pancoast's syndrome. HIV. Bronchogenic carcinoma. Lung neoplasms. Acquired immunodeficiency syndrome.


Letters to the Editor

13 - Metodologia de pesquisa da pneumonia adquirida na comunidade

Maria Bernadete Fernandes Chedid

J Bras Pneumol.2000;26(5):273-276


Year 2000 - Volume 26  - Number 6  (November/December)

Original Article

1 - Evaluation of the histological parameters in usual interstitial pneumonia (idiopathic pulmonary fibrosis)

Avaliação de parâmetros histológicos na pneumonia intersticial usual (fibrose pulmonar idiopática)

Rimarcs Gomes Ferreira, Ester Nei Aparecida Martins Coletta, Osvaldo Giannotti Filho

J Bras Pneumol.2000;26(6):279-285

Abstract PDF PT

Idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis) is a progressive interstitia pulmonary disease of unknown etiology. Since Hamman's and Rich's (1944) reports, many studies have tried to find a histological marker for the correlation between prognosis and response to therapy. However, there are many doubts regarding pathogenesis. In addition, it is generally accepted that response to therapy is related to the relative degree of cellularity and fibrosis. The purpose of this study is to describe the results of inflammatory/exudative changes, fibrotic/reparative changes, and airway alterations, using a semi-quantitative method by independent evaluation of two pathologists, in 24 open lung biopsies with the diagnosis of idiopathic pulmonary fibrosis. Fourteen histological features were analyzed using the 0 to 5 scale for interstitial alterations and the 0 to 2 scale for the airway changes. There was significant interobserver agreement for all histological features with Kw (Kappa) variations between 0.47 and 0.92. There was significant disagreement only for septal inflammatory intensity analysis, suggesting that these features must be discussed by the pathologists. The semi-quantitative method assessment was effective.


Keywords: Idiopathic pulmonary fibrosis (IPF). Usual interstitial pneumonia (UIP). Semi-quantitative method assessment.


2 - A case-control study about indicators of non-compliance in patients with tuberculosis

Estudo caso-controle de indicadores de abandono em doentes com tuberculose

Sandra A. Ribeiro, Verônica M. Amado, Aquiles A. Camelier, Márcia M.A. Fernandes, Simone Schenkman

J Bras Pneumol.2000;26(6):291-296

Abstract PDF PT

Non-compliance of tuberculosis treatment has social and epidemiological implications. Purpose: To compare characteristics of patients that were compliant (control group) and non-compliant with the treatment at the Health Care Center at the Federal University of São Paulo, Brazil, between 1995 and 1997, and to verify if patients who had joined in educational classes on tuberculosis had enhanced chances to a positive outcome after expiration of the six months of treatment. Method: The authors conducted a retrospective and controlled study with 100 patients (38 non-compliant and 62 compliant) registered for tuberculosis treatment in order to verify the variables related to non-compliance. Sixty patients (16 non-compliant and 44 compliant) had educational classes. Results: The risk factors most related to non-compliance were: male sex, cigarette smoking, alcohol and drug abuse, risk factors for HIV, and previous hospitalization. Patients who had attended educational classes had the same characteristics as all patients, but they had lower frequency of non-compliance (p < 0.05). Conclusion: The authors conclude that, if they had adequate access to means of diagnosis and follow-up for the treatment of tuberculosis, all extra efforts should be concentrated on avoiding non-compliance, mainly in patients with risk factors, as mentioned above. The patients at risk of non-compliance should have educational classes about their disease.


Keywords: Prevalence. Diagnosis-related groups.


Review Article

3 - Acute asthma in adults in the emergency room: clinical management in the first hour

Asma aguda em adultos na sala de emergência: o manejo clínico na primeira hora

Paulo de Tarso Roth Dalcin, Alan Castoldi Medeiros, Marcelo Kurz Siqueira, Felipe Mallmann, Mariane Lacerda, Marcelo Basso Gazzana, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2000;26(6):297-306

Abstract PDF PT

Asthma is a disease with high prevalence in our country and around the world. Although new therapeutic approaches have been recently developed, there appears to be a worldwide increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that the first hour of management of acute asthma in the emergency room entails crucial decisions that could be determinant in the clinical outcome. In this non-systematic review, the authors focus on the first hour assessment and treatment of patients with acute asthma and outline an appropriate strategy for their management. Diagnosis, severity assessment, pharmacological treatment, complications, and the decision regarding the place where additional treatment will take place will be considered. It is reasonable to expect that these recommendations will help physicians make appropriate decisions about the first hour care of acute asthma in the emergency room.


Keywords: Asthma. Emergency medicine. Emergency treatment. Clinical procedures. Emergency medical services.


4 - Pleurodesis: future prospects

Pleurodese: perspectivas futuras

Francisco S. Vargas, Lisete R. Teixeira, Alípio O. Carmo, Evaldo Marchi, Marcelo Costa Vaz, Leila Antonangelo, Fábio B. Jatene

J Bras Pneumol.2000;26(6):307-312

Abstract PDF PT

This article addresses the evolution of pleurodesis since the beginning of the 20th century and defines the characteristics of the ideal sclerosing agent. Emphasis is placed on the current tendency towards minimally invasive procedures where insertion of catheters is usually given priority over certain surgical procedures such as placement of drains or thoracoscopy. Among the sclerosing drugs, talc is the one preferred throughout the world. However, the possible appearance of respiratory distress syndrome, which is sometimes fatal, caused the awakening of interest in other drugs. Anti neoplastic drugs do not induce a very efficient pleurodesis and still have the disadvantage of causing important side effects. Sodium hydroxide and silver nitrate produce effective pleurodesis. Both can be used in humans.


Keywords: Pleurodesis. Sclerosing solutions. Clinical procedures.


Case Report

5 - Diffuse systemic sclerosis with isolated pulmonary hypertension: a case report

Esclerose sistêmica difusa com hipertensão pulmonar isolada: relato de caso

Silméia Garcia Zanati, Katashi Okoshi, Luiz Shiguero Matsubara, Roberto Minoru Tani Inoue, Marina Politi Okoshi

J Bras Pneumol.2000;26(6):313-316

Abstract PDF PT

Systemic sclerosis (SS) is an uncommon disease characterized by small blood vessel vasculopathy and increased connective tissue in the skin and in other organs. The pulmonary involvement is common in SS; however, pulmonary hypertension without interstitial fibrosis is rare. The authors present a case of the diffuse form of SS with isolated pulmonary hypertension. The diagnosis of pulmonary hypertension was suggested by physical examination and confirmed by doppler-echocardiography which allowed for the estimation of the pulmonary artery systolic pressure in 80 mmHg. The authors started treatment with nifedipine; however, as the patient presented side effects, it was not possible to increase the dose beyond 30 mg/day. In this dosage, nifedipine did not decrease the pulmonary arterial pressure.


Keywords: Systemic scleroderma. Nifedipine. Pulmonary hypertension. Vasodilatador agents. Doppler echocardiography.


6 - Traumatic transpericardial diaphragmatic hernia: case report

Hérnia diafragmática traumática transpericárdica: relato de caso

Roberto Ruben Pando-Serrano, Antonio J. Ferreira Leal, Márcio R.A. Gomes, René Crepaldi Filho

J Bras Pneumol.2000;26(6):317-320

Abstract PDF PT

The diagnosis and correction of a rare case of traumatic transpericardial diaphragmatic hernia is presented with spontaneous intraoperative reduction by the verification of the lesions of the left lateral wall of the pericardium, diaphragmatic pericardium, and the central tendon, with intact left hemidiaphragm. Only one such case has been published in the last thirty years.


Keywords: Transpericardial diaphragmatic hernia. Thoracic injuries


7 - Pulmonary hypertension: a report of six cases and updating review

Hipertensão pulmonar: relato de seis casos e atualização do tema

Sérgio Saldanha Menna Barreto, Marcelo Basso Gazzana

J Bras Pneumol.2000;26(6):321-336

Abstract PDF PT

Pulmonary hypertension occurs when the pressure of the pulmonary artery is disproportionally high for a certain level of pulmonary blood flow. Values of mean pulmonary artery pressure of more than 25 mm Hg at rest or 30 mm Hg during exercise allow the diagnosis of pulmonary hypertension. Sustained or chronic pulmonary hypertension may be secondary to known diseases, mainly to those of cardiac or pulmonary nature, or may be a primary abnormality of the pulmonary circulation, with or without identification of associated conditions. Advances in the knowledge of the mechanisms of vasoconstriction and vascular remodeling have brought better prospects for the treatment of the disease. The correct use of vasodilators and anticoagulants, the new vasodilators, as epoprostenol and its analogs, and surgical techniques have increased the survival of many patients. Pneumologists can view cases of pulmonary hypertension as complications of pulmonary diseases or as a result of dyspnea investigation. Despite its etiology, pulmonary hypertension represents a clear abnormality that affects the right ventricle and can be potentially fatal to patients. Image methods have made the diagnosis of pulmonary hypertension more accessible and non-invasive. Six cases of patients with pulmonary hypertension of different causes are presented and discussed. In conclusion, according to new concepts, idiopathic pulmonary hypertension is no longer an irreversible condition, and the identification of associated conditions with potential treatments can be favorable in the management of the patients with pulmonary hypertension.


Keywords: pulmonary hypertension, vascular resistance, lung diseases, vasodilator agents


8 - Scimitar syndrome: case report with false diagnoses and adequate procedure

Síndrome da cimitarra: relato de caso com falsos diagnósticos e conduta adequada

Giesela Fleischer Ferrari, Cristina Costa Parreira, Samuel Marek Reibscheid, Antônio Sérgio Martins

J Bras Pneumol.2000;26(6):337-340

Abstract PDF PT

Scimitar syndrome is rare, but knowledge about it is important to pediatricians and pneumologists. X-ray can suggest diagnosis, but the interpretation can be wrong. If a diagnosis is made, further anomalies must be investigated with echocardiography and angiography, even if he patient is asymptomatic. This child showed evidence of pulmonary hypertension and required surgery. Postoperative evolution was excellent.


Keywords: Scimitar syndrome. Surgery. Pulmonary disease (specialty). Diagnosis.


Guidelines SBPT

9 - Oxigenoterapia domiciliar prolongada (ODP)

Sociedade Brasileira de Pneumologia e Tisiologia

J Bras Pneumol.2000;26(6):341-350


Letters to the Editor

10 - Medicina baseada em evidências: quais os limites?

Edmilson Vieira Gaia Filho

J Bras Pneumol.2000;26(6):351-352



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