Brazilian Journal of Pulmonology

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

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Year 2001 - Volume 27  - Number 1  (January/February)

Editorial

1 - Jornal de Pneumologia: agora também on-line

Thais Helena A. Thomaz Queluz

J Bras Pneumol.2001;27(1):5-7

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Original Article

2 - Localized and multisegmental bronchiectasis: clinical-epidemiological profile and surgical treatment results in 67 cases

Bronquiectasia localizada e multissegmentar: perfil clínico-epidemiológico e resultado do tratamento cirúrgico em 67 casos

Antero Gomes Neto, Marcos Lima de Medeiros, José Mauro Mendes Gifoni

J Bras Pneumol.2001;27(1):1-6

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Bronchiectasis is a disease which is rarely found in developed countries and has a high incidence in developing countries. In Brazil, the most frequent causes are viral or bacterial respiratory infections in childhood, and tuberculosis. Antibiotic therapy considerably reduces morbidity. However, in patients with persistent symptoms, surgical resection offers greater chances of cure or better quality of life. Objectives: Prospectively evaluate the clinical-epidemiological profile of patients with bronchiectasis as well as the results of surgical treatment in patients from two public hospitals in Fortaleza (CE), northeastern Brazil. Patients and method: Sixty-seven patients with bronchiectasis submitted to surgery between August 1989 and March 1999 were evaluated, as well as demographic data, etiology of the disease, complications, and therapeutic success rate. Results: Mean age of patients (39 females e 28 males) was 32.5 ± 14.1 years. The most frequent causes of bronchiectasis were viral or bacterial infection (44.8%) and tuberculosis (31.3%). The disease was localized in 46 patients and multisegmental in 21. In six patients it was bilateral. No surgical death occurred and postoperative complications were more frequent in patients with multisegmental bronchiectasis (9/21 versus 6/46, p = 0.011). From the 62 patients who were followed up, 49 were cured, 10 showed improvement, and 3 did not obtain any benefit. Results were excellent in 39 patients with localized bronchiectasis and in 10 patients with the multisegmental form of the disease (p < 0.001). Conclusion: Results show two distinct groups of patients: those with bronchiectasis, who presented fewer surgical complications and better postoperative results, and those with multisegmental bronchiectasis.

 


Keywords: Bronchiectasis. Epidemiological profiles. Clinical diagnosis. Treatment outcome. Surgical operative procedures.

 

3 - Metered-dose inhaler technique learning after explanation given by pulmonologist

Aprendizado do uso do inalador dosimetrado após explicação por pneumologista

Alessandra Sandrini, Andréia Jacomossi, Sonia Maria Farensin, Ana Luisa Godoy Fernandes, José Roberto Jardim

J Bras Pneumol.2001;27(1):7-10

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Introduction: The use of inhaled drugs through metered-dose inhaler has been advocated for years. Nonetheless, a small number of patients are routinely treated by this technique. Prescriptions of inhaled drugs by healthcare providers are not frequent, usually because they anticipate patients will not be able to perform the technique correctly. In addition, healthcare providers do not usually take their time to appropriately teach patients how to use metered-dose inhalers correctly. Objective: To evaluate the percentage of uninstructed patients that learn how to use a metered-dose inhaler correctly after being taught by a pneumologist. Patients and methods: One hundred and nineteen patients from a private clinic were prospectively studied in São Paulo, southeastern Brazil. Patients were exhaustively taught how to use the metered-dose inhaler at the first consultation and were told to return after 10 days, when they were asked to perform the technique exactly the way they were doing it at home. Their performance was classified as correct, slightly incorrect, intermediately incorrect, and totally incorrect. Results: Twenty-six patients were excluded for not coming to the second appointment. The final sample comprised 93 patients. Age ranged from 9 to 81 years (mean age 42.6 ± 21); 59.2% of the patients were male and 40.8% female. Considering all patients, only 16.25 of them used the metered-dose inhaler totally incorrectly and 19.3% performed the technique intermediately incorrectly. The most frequent mistakes were: metered-dose inhaler device was placed inside the mouth; inspiration before jet was activated; fast aspiration; inspiration through the nose. Thirty-three percent of patients who were under 15 and over 75 years performed the technique correctly. Conclusion: This study has demonstrated that the majority of the patients learned how to use the metered-dose inhaler correctly after being properly and extensively taught.

 


Keywords: Nebulizers and vaporizers. Inhalation administration. Learning.

 

4 - Clinical presentation of cow milk allergy symptoms

Apresentação clínica da alergia ao leite de vaca com sintomatologia respiratória

Fábio Ferreira de Carvalho Junior

J Bras Pneumol.2001;27(1):17-24

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Cow milk allergens are the first antigens children have contact with. The symptoms, which are frequently multi-systemic, may be related to the gastrointestinal tract, to the skin and, more rarely, to the respiratory tract. Objective: To describe some clinic and epidemiological characteristics of children who have cow milk allergy and present respiratory symptoms. Patients and method: This retrospective study included 17 children who presented respiratory problems immediately after ingesting cow milk, showed no symptoms as cow milk was excluded from their diets for a period of 4 to 6 weeks, and presented recurrent symptoms as cow milk was reintroduced into their diet in a hospital environment. Results: No difference was observed between genders. Family atopic antecedents were present in 14 of the 17 children. Mean exclusive breast-feeding period was 2.9 months and the onset of symptoms occurred at an average of 3.6 months. Eight of the ten tests conducted to evaluate immediate cutaneous hypersensitivity to cow milk were positive. Clinical manifestations observed were: wheezing infants (9), asthma (5), repetition otitis (2), selective IgA deficiency related to wheezing and allergic rhinoconjunctivitis (1). Conclusion: Regarding wheezing infants, cow milk allergy should be included as a differential diagnosis and exclusive breast-feeding should be stimulated in cases of atopic family antecedents. However, a precise diagnosis is vital to prevent unnecessary food deprivation.

 


Keywords: Milk hipersensitivity. Milk substitutes. Respiratory signs and symptoms. Respiratory diseases.

 

5 - usceptibility to respiratory tract isolated bacteria to antimicrobial agents in patients with community-acquired respiratory tract infections: 1997 and 1998 Brazilian data of the SENTRY surveillance program of resistance to antimicrobial agents

Sensibilidade a antimicrobianos de bactérias isoladas do trato respiratório de pacientes com infecções respiratórias adquiridas na comunidade: resultados brasileiros do Programa SENTRY de Vigilância de Resistência a Antimicrobianos dos anos de 1997 e 1

Hélio S. Sader, Ana C. Gales, Adriana O. Reis, Cassia Zoccoli, Jorge Sampaio, Ronald N. Jones

J Bras Pneumol.2001;27(1):25-34

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Background: Antimicrobial treatment of community-acquired respiratory tract infections (CARTI) is usually empiric and antibiotics are chosen on the basis of surveillance studies. The SENTRY Program was designed to monitor antimicrobial resistance via a worldwide surveillance network of sentinel laboratories. Three sites in Brazil participated in the 1997 and 1998 SENTRY Program. Methods: A total of 344 bacterial isolates, collected from patients with CARTI in 1997 and 1998, were tested against more than 20 antimicrobial agents by the broth microdilution method. Results: Among S. pneumoniae (176 isolates), 71.6% were susceptible to penicillin. High level resistance to penicillin and resistance to cefotaxime was found in 2.3 and 4.0%, respectively. The newer quinolones, levofloxacin, (MIC90 of 2 mg/mL) and gatifloxacin (MIC90 of 0.5 mg/mL) were active against 100% of the isolates tested. Among the other non-b-lactam drugs tested, the rank order of pneumococci activity was (% susceptible): chloramphenicol (97.5%) > clindamycin (94.0%) > azithromycin (90.3%) > clarithromycin (89.4%) > tetracycline (76.4%) > trimethoprim/sulfamethoxazole (60.2%). The percentage of Haemophilus influenzae (101 isolates) susceptible to amoxicillin was 90.1%, whereas among Moraxella catarrhalis (67 isolates) only 9.0% were susceptible. Clavulanic acid restored the activity of amoxicillin against both H. influenzae and M. catarrhalis. However, H. influenzae showed increased levels of resistance to trimethoprim/sulfametoxazole (55.1% susceptibility), clarithromycin (80.4% susceptibility), and cefaclor (88.2%) susceptibility). All H. influenzae and M. catarrhalis isolates were susceptible to levofloxacin (MIC90, < 0.5 mg/mL for both) and gatifloxacin (MIC90, < 0.06 mg/mL for both) with very low MICs. Conclusion: Results indicate that the rate of S. pneumoniae showing high-level penicillin resistance is still low in Brazil. However, intermediate resistance to penicillin associated with resistance to other classes of antimicrobial agents was relatively high. On the other hand, the new quinolones were highly active against 100% of the respiratory pathogens tested.

 


Keywords: Respiratory tract infections. Bacterial pneumonia. Microbial drug resistance. Program evaluation. Microbial sensibility tests.

 

6 - Spirometric response to bronchodilators: which parameters and values are clinically relevant in obstructive diseases?

Resposta a broncodilatador na espirometria: que parâmetros e valores são clinicamente relevantes em doenças obstrutivas?

Roberto Rodrigues Jr., Carlos Alberto de Castro Pereira

J Bras Pneumol.2001;27(1):35-47

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In lung function laboratories, statistical responses after bronchodilators (Bd) administration are widely used in patients with airflow limitation. However, their clinical relevance is debatable. Objective: To determine which spirometric parameters best reflect improvement in both exercise tolerance and exertional dyspnea in response to bronchodilators in obstructive lung diseases. Methods: Fifty patients with persistent asthma and/or COPD (FEV1/FVC = 41 ± 11%) were submitted to slow and forced vital capacity testing, MVV and a six-minute walking test (6 MW) following practice, before and after a 400 mg dose of salbutamol was given by MDI. Responses to Bd were expressed in absolute values and considered as increments to the initial values and predicted values. Responses to Bd were considered clinically significant if distance was longer than 30 m in the 6 MW test and/or if there was a 2-point decrease in the Borg scale in the walking distance. Results: 32 patients were responsive (R) to Bd and 18 were non-responsive (NR). As DMW correlated with age, (rs = -0.38 - p < 0.01) an analysis on spirometric data, including age as covariant, was performed and expressed as x ± SE. No difference in FEV1 was observed between the groups (R = 255 ± 57 ml; NR = 256 ± 43 ml). The same occurred regarding MVV (R = 11± 2 L/min; NR = 10 ± 2 L/min.). The best separation (p < 0.01) was given by changes in inspiration capacity (IC) followed by changes in slow vital capacity (SVC): IC% of initial R = 23 ± 3% and NR = 3 ± 4%; absolute IC = 411 ± 58 ml and NR = 163 ± 77 ml; predicted IC%: R = 19 ± 3% and NR = 3 ± 4%. For SVC, the values were: % initial - R = 18 ± 2% and NR = 9 ± 3%; absolute changes - R = 448 ± 52 ml and NR = 256 ± 70 ml. Increases in IC > 15% of the initial values and 0.3 L and increases in SVS > 15% of the initial values and 0.4 L determined responsive patients with positive predicted values as approximately 90%. Conclusion: Variations in FEV1, FVC and MVV do not predict improvement in exercise capacity after Bd. This is best reflected by 15% of increases in IC and/or in the SVC initial values.

 


Keywords: Obstructive lung diseases. Spirometry. Predictive value of tests. Bronchodilator agents. Exercise tolerance. Dyspnea.

 

Case Report

7 - Hypersensitivity pneumonitis to tobacco

Pneumonite de hipersensibilidade ao tabaco

Sílvia E.C. Macedo, Elicarlos Zago, Vítor F. Torres, Fabiano Bergamaschi

J Bras Pneumol.2001;27(1):48-51

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Hypersensitivity pneumonitis (HP) derives from the inhalation of organic and/or inorganic antigens by susceptible individuals. The authors report the case of an eighteen-year-old female, who worked as a tobacco planter in Pelotas, southern Brazil. She had been presenting progressive dyspnea, dry cough, and weight loss for 35 days. She had fine thoracic crepitations and X-ray examination revealed diffuse interstitial infiltration. The diagnosis of HP was determined by her history of exposure to tobacco, tomographic findings and anatomopathologic examination of the lung, obtained by open biopsy. Tobacco antigens were found to be the cause. As patient was treated with prednisone and tobacco exposure was discontinued, a good clinic and functional response was observed.

 


Keywords: Therapeutics. Extrinsic allergic alveolitis. Tobacco. Diagnosis.

 

8 - Hepatopulmonary syndrome in a patient with AIDS and virus C cirrhosis (viral cirrhosis type C)

Síndrome hepatopulmonar em paciente com cirrose por vírus C e SIDA

Maria Angélica Pires Ferreira, Marcelo Basso Gazzana, Sérgio Saldanha Menna Barreto, Marli Maria Knorst

J Bras Pneumol.2001;27(1):52-55

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Hepatopulmonary syndrome is characterized by a triad consisting of liver disorder, pulmonary vascular dilatation, and hypoxemia. No case of hepatopulmonary syndrome associated with AIDS has been reported so far. In this study, the authors report the case of a 43-year woman with AIDS and virus C cirrhosis taking prophylactic cotrimoxazole for pneumocystosis and retroviral therapy. Upon admission, the patient presented dyspnea, cyanosis, digital clubbing, vascular spiders, and normal chest examination. Chest X-ray revealed bilateral interstitial infiltration and evidenced increased alveolar-arterial gradient and liver function impairment. Intrapulmonary shunt was evidenced by contrast-enhanced echocardiography and radionuclide perfusion scanning, thus confirming hepatopulmonary syndrome.

 


Keywords: Hepatopulmonary syndrome. Acquired human immunodeficiency syndrome. Human viral hepatitis. Anoxemia. Liver cirrhosis.

 

Letters to the Editor

9 - Manoel de Abreu

Rubens Bedrikow

J Bras Pneumol.2001;27(1):56-58

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Year 2001 - Volume 27  - Number 2  (March/April)

Original Article

1 - Perfil de sensibilidade a antimicrobianos de bactérias isoladas do trato respiratório baixo de pacientes com pneumonia internados em hospitais brasileiros - Resultados do Programa SENTRY, 1997 e 1998

Hélio S. Sader, Rodrigo E. Mendes, Ana C. Gales, Ronald N. Jones, Michael A. Pfaller, Cássia Zoccoli, Jorge Sampaio

J Bras Pneumol.2001;27(2):59-67

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Resumo

Introdução: Pneumonia hospitalar é a mais fatal das infecções hospitalares, com taxas de mortalidade de 30 a 60%. Estima-se que 15% de todas as mortes associadas à hospitalização estejam diretamente relacionadas a pneumonias hospitalares. O SENTRY é um estudo de vigilância de resistência a antimicrobianos envolvendo centros médicos em todo o mundo. Objetivo: Avaliar a sensibilidade a antimicrobianos de bactérias isoladas no trato respiratório baixo de pacientes com pneumonia internados em hospitais brasileiros. Material e métodos: Foram avaliadas 525 amostras bacterianas de 11 hospitais brasileiros, como parte do programa SENTRY. Os isolados foram testados por microdiluição em caldo contra um grande número de antimicrobianos. Resultados: As cinco espécies mais freqüentes foram (n/%): Pseudomonas aeruginosa (158/30,1%), Staphylococcus aureus (103/19,6%), Acinetobacter spp. (68/13,0%), Klebsiella spp. (50/9,5%), e Enterobacter spp. (44/8,4%). Essas cinco espécies representam mais de 80% de toda a amostragem. A P. aeruginosa apresentou altas taxas de resistência à maioria dos antimicrobianos testados. As maiores taxas de sensibilidade foram apresentadas por piperacilina/tazobactam (71,5%) e meropenem (69,0%). Os compostos com maior atividade in vitro contra Acinetobacter spp. foram imipenem e meropenem (80,9% de sensibilidade) seguido pela tetraciclina (63,2%). A sensibilidade das amostras de Klebsiella spp. foi muito baixa. MICs ≥ 2μg/mL para ceftriaxona ou ceftazidima, indicando produção de ESBL, foram encontrados em 36,0% das amostras. Os antimicrobianos mais ativos contra Klebsiella spp. foram os carbapenens (100% de sensibilidade) e as quinolonas (92,0% de sensibilidade). Ceftriaxona foi ativa contra somente 56,8% das amostras de Enterobacter spp. (MIC50, 1μg/mL), enquanto a cefepima foi ativa contra 88,6% destes isolados (MIC50, ≤ 0,12μg/mL). A resistência à oxacilina foi detectada em 43,7% dos isolados de S. aureus. As drogas mais ativas contra essa espécie foram: vancomicina, teicoplanina, quinupristin-dalfopristin e linezolida. Conclusões: Os resultados do presente estudo mostraram alta prevalência de Acinetobacter spp. e altas taxas de resistência entre bacilos gram-negativos quando comparados com resultados de estudos norteamericanos e europeus.

 


2 - Respiratory endoscopy in 89 patients of lung neoplasms

Endoscopia respiratória em 89 pacientes com neoplasia pulmonar

Paulo José Lorenzoni, Maria Ilizabeti Donatti, Paulo de Tarso Muller, Pedro Nango Dobashi

J Bras Pneumol.2001;27(2):

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Objectives: Lung neoplasms are one of the most common causes of mortality in Brazil. The objective of this survey is to evaluate the diagnosis of these neoplasms using fiberoptics bronchoscopy. Methods: 89 patients were analyzed retrospectively in a period of five years. They were divided into two groups: Group 1 (n = 53) - the presence of visible lesion on endoscopy, Group 2 (n = 36) - the absence of visible lesion on endoscopy. Epidemiological elements, endoscopic discoveries, cytopathologic and anatomopathologic examination were performed in the review, as well the examination that provided the final diagnosis. Results: The findings of indirect endoscopies of neoplasms corresponded to 59.5% and the presence of tumor inside bronchi was 48.8%. The most frequent histologic type was the epidermoid carcinoma (59.5%), followed by adenocarcinoma (15.7%), small-cell carcinoma (10.1%), and others (14.7%). In endoscopically visible or not visible tumors, the anatomopathologic study of bronchial biopsy and/preor the cytopathologic examination of the bronchial washing and brushing showed a sensitivity of 83.1% in the diagnosis of lung neoplasms. When the lesion was visible on endoscopy, the sensitivity was 96.2%: positive biopsy was 94.2%, and cytology was 43.75%. When the lesion in the bronchi is not observed, its addition was significantly small (63.8%), namely: biopsy registered 72.7% and cytopathology 38.4%. Not significant complications resulting from the endoscopic examination occurred in 11.2% of patients and there were no serious complications. Conclusion: The fiberoptics bronchoscopy was an excellent method to investigate patients with suspicion of lung neoplasms, with 83.1% of sensitivity. This sensitivity was higher in visible lesions and in non-visible lesions when endobronchial biopsy was used.

 


Keywords: Lung neoplasms. Bronchoscopy. Bronchogenic carcinoma. Diagnostic techniques and procedures.

 

3 - Change in asthma mortality trends in children and adolescents in Rio Grande do Sul: 1970-1998

Mudança da tendência da mortalidade por asma em crianças e adolescentes no Rio Grande do Sul: 1970-1998

José Miguel Chatkin, Jussara Fiterman, Nivalvo Almeida Fonseca, Carlos Cezar Fritscher

J Bras Pneumol.2001;27(2):89-93

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Introduction: During the period from 1970 to 1992, mortality from asthma in children and young adults increased in Rio Grande do Sul. The present study aimed at assessing this phenomenon in patients of the same age group, now extending the time period to 1998. Methods: The death certificates of 157 patients aged between 5 and 19 years in which asthma was reported to be the cause of death during 1970-80 were reviewed. Testing for trends was conducted using the log-linear, S-curve, and quadratic models. Results: Asthma mortality rate ranged from 0.04 to 0.399/100,000. Among the tested models, S curve trend model showed the best accuracy for the adjusted time series: r2=0.59; mean absolute percentage error (MAPE) = 23.48; mean absolute deviation (MAD) = 0.035; mean square deviation (MSD) = 0.0021. These results suggest that a plateau has probably been reached. The quadratic model also showed good accuracy values suggesting that a decrease in the coefficients probably started to occur. In this model, the estimated maximal point value was found in the 25th year (1994). Conclusions: Stabilization of asthma death rates is starting to occur in Rio Grande do Sul and it is likely that a decrease will take place.

 


Keywords: Asthma. Mortality. Brazil.

 

Review Article

4 - Sleepiness and motor vehicle accidents

Sonolência e acidentes automobilísticos

Simone Fagondes Canani, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2001;27(2):94-96

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Objective: The purpose of this article is to present a brief review of the effects of excessive sleepiness on driving performance, and to emphasize the importance of the subject. Methods: Bibliographic review of national and international literature, including original articles and official publications from the American Thoracic Society and the American Sleep Apnea Association. Results: There is growing evidence that excessive sleepiness may be an important factor related to the occurrence of motor vehicle accidents. Difficulties regarding the identification of sleepiness as a preceding factor related to motor vehicle crashes are discussed on the text. There are many causes for excessive sleepiness. Fortunately most of them are easy to recognize and have specific treatment. Conclusions: A better understanding of the problem is fundamental to promote a better approach for patients with excessive sleepiness and perhaps encourage the discussion about the current motor vehicle legislation and the physicians' legal obligations.

 


Keywords: sleepiness; motor vehicle accidents

 

Original Article

4 - Prevalence of mycobacterium tuberculosis infection among medical students of Federal University of Rio de Janeiro

Prevalência de infecção pelo "Mycobacterium tuberculosis" entre alunos da Faculdade de Medicina da Universidade Federal do Rio de Janeiro

Vania Maria Carneiro da Silva, Jaqueline R. Oliveira, Flávia Matos Silva dos Santos, Clarisse Moreira de Araújo, Afrânio Lineu Kritski

J Bras Pneumol.2001;27(2):77-82

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Introduction: The teaching hospital, HUCFF, Southeastern Brazil, annually receives three hundred tuberculosis cases. Medical students have their practice at that hospital. Objective: To determine the prevalence of Mycobacterium tuberculosis (Mtb) infection among the students of the UFRJ School of Medicine. Design: Cross-sectional study of medical students at different levels of their training programs. Information about social and demographic characteristics, BCG vaccination history, and potential exposures to tuberculosis were obtained with a standardized questionnaire. Tuberculin skin testing was used to determine the prevalence of tuberculosis infection. Results: The prevalence of tuberculin skin testing positivity among medical students increased as they advanced to higher training levels (4.6%, 7.8%, 16.2%, respectively; P = 0.002). The risks were greatest during the years of clinical training, when medical students had more contact with patients. Conclusions: Medical students in the HUCFF/UFRJ may be at an increased risk of M. tuberculosis infection. A program of routine tuberculin skin testing, combined with interventions to confirm TST conversion and to reduce the risk of nosocomial transmission in the workplace is needed.

 


Keywords: Nosocomial infection. Medical students. Risk factors. Cross-sectional studies.

 

Review Article

5 - Risk factors and prophylaxis of community-acquired pneumonias

Fatores de risco e medidas profiláticas nas pneumonias adquiridas na comunidade

Lucy Gomes

J Bras Pneumol.2001;27(2):97-114

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This article reviews the effects of aging, tobacco-smoking, chronic bronchitis and emphysema, heart failure, oropharyngeal colonization, aspiration (micro and macro), alcoholism, hepatic cirrhosis, nutritional deficiency, immunosuppression, and environmental factors on the risk of community-acquired pneumonia and its severity. In the second part, the authors review the prophylactic action of anti-influenza and anti-pneumococcus vaccines as well as the role of prevention and treatment of antiviral agents in community-acquired pneumonia.

 


Keywords: Pneumococcal pneumonia. Influenza. Influenza vaccine. Viral vaccines. Risk factors.

 

Case Report

7 - Job's syndrome or hyperimmunoglobulinemia E

Síndrome de Jó ou hiperimunoglobulinemia E

Ricardo Coelho Reis, Marcelo Alcântara Holanda, Juvêncio Paiva Câmara, José Humberto Araújo, Micheline Paiva Aquinos, Laryssa Braga Cavalcante Santana

J Bras Pneumol.2001;27(2):115-118

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Job's syndrome, or hyperimmunoglobulinemia E, is a rare immunodeficiency condition with no established etiology, characterized by recurrent lower and upper respiratory tract and skin infections associated with high levels of immunoglobulin E, eosinophilia, and a characteristic facial alteration. The authors report on a 22-year-old man who carried this disease complicated by pleural empyema and lung cysts, showing a good evolution.

 


Keywords: Job's syndrome. Respiratory tract infections. Recurrence.

 

8 - Tracheoesophageal fistula as a late complication of tracheostomy

Fístula traqueoesofágica como complicação tardia de traqueostomia

Marlos de Souza Coelho, José Antônio Zampier, Sérgio Augusto Zanin, Elisângela de Mattos e Silva, Paulo de Souza Fonseca Guimarães

J Bras Pneumol.2001;27(2):119-122

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Tracheoesophageal fistula as a late complication of tracheostomy is rare and its incidence is less than 1%. Nonetheless, it should be known, diagnosed, and promptly treated in order to prevent an unfavorable evolution. The authors report on a 41-year-old female who had had tracheostomy a long time before, due to a cerebrovascular accident. Following hospital discharge, the patient presented acute respiratory insufficiency and it was observed that some material was secreted through the tracheostomy nasogastric probe. Tracheoesophageal fistula was endoscopically diagnosed, the patient was submitted to a tracheoplasty and showed good evolution.

 


Keywords: Tracheostomy. Tracheal tubes. Intubation. Tracheoesophageal fistula. Intensive care units.

 

Letters to the Editor

9 - Hérnia diafragmática traumática transpericárdica

Antonio Sebastião Porto

J Bras Pneumol.2001;27(2):19-21

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Year 2001 - Volume 27  - Number 3  (May/June)

Editorial

1 - Jornal de Pneumologia

Luiz Carlos Corrêa da Silva

J Bras Pneumol.2001;27(3):5-

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Original Article

2 - Reasons for the admission, length of stay and type of discharge in tuberculosis hospitals in the State of São Paulo, Brazil - 1981 to 1995

Motivos e tempo de internação e o tipo de saída em hospitais de tuberculose do Estado de São Paulo, Brasil - 1981 a 1995

Péricles Alves Nogueira

J Bras Pneumol.2001;27(3):123-129

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Introduction: Since 1981 the State Health Office has taken over the treatment and hospitalization of all tuberculosis cases in the State of São Paulo, southeastern Brazil. A decrease in both the incidence and the percentage of admissions due to tuberculosis has been observed during this period. Objective: To analyze the evolution of the reasons that led tuberculosis patients to hospitalization and correlate these reasons with hospitalization length and the type of discharge. Material and methods: A sample of 1,805 patients' records compiled between 1981 and 1995 at five tuberculosis hospitals in the State of São Paulo was reviewed. Results: The main reason for admission was general poor health, followed by cachexy. Increasing alcoholism was also observed. Among those who stayed in hospital for less than one week, the most frequent reasons for hospitalization were "other pathologies" and "respiratory insufficiency". These cases also showed the shortest average hospitalization length whereas the longest was presented by the patients admitted for social reasons and treatment failure. The patients with respiratory insufficiency presented the highest rate of dropouts and death. The highest rate of requested discharge was observed among the patients admitted due to drug intolerance whereas those admitted due to social reasons and alcoholism showed the highest rate of disciplinary release. The hospital that admitted females was the one with the highest rate of requested release, whereas in the hospitals that admitted males disciplinary release and dropouts were the most frequent types of discharge.

 


Keywords: Pulmonary tuberculosis. Length of stay. Health services research. Specialized hospitals. Patient discharge.

 

3 - Spirometry evolution assessment of cystic fibrosis

Avaliação evolutiva da espirometria na fibrose cística

Elenara da Fonseca Andrade, Deisi Letícia Oliveira da Fonseca, Fernando Antônio de Abreu e Silva, Sérgio Saldanha Menna-Barreto

J Bras Pneumol.2001;27(3):130-136

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Objectives: To evaluate the evolution pattern of dynamic pulmonary flow and volume in cystic fibrosis patients and analyze the relation between the severity of ventilatory attacks and age, gender, genotype and pulmonary colonization. Methods: At the Pediatric Pulmonary Unit and Pulmonary Service of Hospital de Clínicas of Porto Alegre, 243 spirometries performed between 1987 and 1999 in 52 cystic fibrosis patients older than four years of age were reviewed. From the patients' medical records the following informations were extracted: age at diagnosis, genetic data, bronchial colonization and absolute as well as percent values of the flows and volumes of the best annual spirometry. Results: The age of the patients ranged from four to 26 years (mean = 13.04 ± 4.82). Out of the 52 patients, 49 (94%) had at least one sputum culture with P. aeruginosa, 45 (86%) with S. aureus and 13 (25%) with B. cepacia. At initial evaluation, that included patients four to six years old (n = 40), mean values for FVC and FEV1 were 114.24% and 112.25%, respectively. Mean FVC remained above baseline until 18 years of age, when it abruptly dropped to 67.2% (p = 0.0002). Mean FEV1 values dropped to less than 80% at ten years and was 50% at 18 years (p < 0.00001). The FEV1/FVC% relationship, the most obstruction sensitive index, was observed to be reduced as early as initial evaluation. It was 85% between four and six years and gradually decreased to 63% at 18 years. The mean values of FEF50, FEF75 and FMEF were initially normal (94%, 80% and 90%, respectively), showed a greater and earlier statistically significant decline, and reached to 37%, 12.5% and 19%, respectively, at 18 years. Although a tendency to lower terminal flow was seen in the girls, the differences were not statistically significant. Significant correlations between pulmonary function and the airway colonizator or genotype were not detected statistic. Conclusion: The evolution pattern of pulmonary function alterations found in these patients is consistent with those reported in the literature, where obstructive ventilatory disorders with early terminal flow reduction and late FVC onset predominate.

 


Keywords: Spirometry. Cystic fibrosis. Pulmonary ventilatory.

 

4 - Cardiorespiratory response to incremental progressive maximal exercise in asthmatic patients

Resposta cardiorrespiratória na asma induzida pelo exercício máximo com incrementos progressivos

Ruy Amazonas Lamar Filho, Antonio Augusto Soares da Fonseca, Maria Alice Melo Neves, Laércio Moreira Valença

J Bras Pneumol.2001;27(3):137-142

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Objective: To determine the occurrence of exercise-induced bronchoconstriction and analyze cardiorespiratory response during maximal exercise in asthmatic patients. Patients and methods: Fourteen subjects with asthma (FEV1 of 86.3% predicted), as defined by the American Thoracic Society criteria were submitted to a maximal exercise test. Volume-flow curves were performed prior to progressive maximal exercise and seven and 15 minutes after it. Six patients (43%) showed a decline in FEV1 equal or greater than 15% after exercise (group I). The remaining patients constituted group II. Group I showed a FEV1 fall of 40.9% and 26.7%, seven and 15 minutes after exercise, respectively. In group II, there was a decrease of 2.6%, after 7 min and an increase of 1.2% after 15 min. At peak exercise, both groups reached heart rate above 91% of reference values; peak work was 82.7% and 62.5%, VO2max (mL/kg/min) 93.5% and 58,9% and VEmax 91.5% and 63.8%, respectively, in groups I and II. These differences were statistically significant. The correlation between the FEV1 fall rate (7 min post-exercise) and VEmax (% predicted) has showed a coefficient r = 0.8989 in group I and r = 0.3629 in group II. There was no correlation between delta VEF1 and VO2max (% predicted) in both groups. These findings showed that, in exercise-induced asthma patients, the occurrence of bronchoconstriction correlated with the level of maximal ventilation, but not with physical fitness.

 


Keywords: Exercise induced asthma. Bronchoconstriction. Tidal volume. Respiratory function tests.

 

5 - Endoscopic diagnosis of stridor in childhood

Diagnóstico endoscópico de estridor na infância

Vítor Emanuel Cassol

J Bras Pneumol.2001;27(3):143-147

Abstract PDF PT

Objective: To determine the main endoscopic diagnoses identified in children presenting stridor, at the Pediatric Unit of the General University Hospital of Santa Maria, Rio Grande do Sul, Southern Brazil. Methods: This is a cross sectional, uncontrolled, descriptive study. Data were obtained from the records of 56 consecutive patients submitted to bronchoscopy due to stridor; from March/93 to November/99. Results: Fifty-six bronchoscopies were performed and 59 lesions compatible with the diagnosis of stridor were observed. Patients were predominantly males (63%). Congenital anomalies and acquired lesions were observed in 45% and 50% of the cases, respectively. The remaining 5% of the cases were normal. Laryngomalacia, subglottic stenosis, tracheobronchomalacia and laryngeal edema were the most common diagnoses. Conclusions: The investigation of the respiratory tree by endoscopy is important for the correct diagnosis of children with stridor. Congenital or acquired diseases were similarly frequent as the cause of stridor. The endoscopic procedure was very valuable and yielded a high diagnostic rate.

 


Keywords: Thoracoscopy. Diagnosis. Respiratory sounds.

 

6 - Home oxygen therapy in children: seven years experience

Oxigenoterapia domiciliar em crianças: relato de sete anos de experiência

Helena Teresinha Mocelin, Gilberto Bueno Fischer, Lilian Cristine Ranzi, Rosângela Dias Rosa, Maria Regina Philomena

J Bras Pneumol.2001;27(3):148-152

Abstract PDF PT

Objective: To describe the results of a seven years experience using home oxygen therapy in children with hypoxemia and chronic lung disease. Patients and methods: This is a retrospective and descriptive study carried out at Hospital da Criança Santo Antônio - Porto Alegre-RS, Southern Brazil. The characteristics of the children on home oxygen therapy from January/93 to January/00 were analyzed. Results: Out of the 40 patients studied, 29 (72.5%) were males. At the beginning of home oxygen therapy, the age of the patients ranged from two months to 13 years and six months (mean: 24.8; median: 13), and 18 of them (45%) were less than one year old. The most frequent diseases were: obliterative bronchiolitis (31 cases; 77.5%); chronic obstructive lung disease with aspiration pneumonia (three cases); hypogammaglobulinaemia (two cases); suppurative lung disease (two cases), alveolar proteinosis (one case) and tuberculosis (one case). The length of the last hospitalization before home oxygen therapy was started ranged from nine to 240 days (mean: 63.7 days; median: 50 days). Most of the patients (30; 75%) received oxygen from a concentrator and the remainder from a cylinder. Mean oxygen therapy length ranged from 27 to 1,620 days (median: 392.5 days). There were five deaths from complications of the basic disease and one from accidental removal of the tracheostomy tube. Oxygen use could be discontinued in 19 patients - 15 with obliterative bronchiolitis, two with chronic aspiration pneumonia, one with tuberculosis and one with alveolar proteinosis. Conclusion: Although oxygen was needed for long periods, evolution was satisfactory in most children. Home oxygen for oxygen-dependent is an alternative treatment that allows an early discharge and a quick return to home life.

 


Keywords: Oxygen inahalation therapy. Anoxemia. Lung obstructive diseases. Home treatment.

 

7 - Surgical treatment of primary spontaneous pneumothorax on the first episode

Tratamento cirúrgico do pneumotórax espontâneo primário no primeiro episódio

Darcy Ribeiro Pinto Filho, André Germano Leite, Fabíola Délia Perin, Ronaldo Barbieri

J Bras Pneumol.2001;27(3):153-157

Abstract PDF PT

Purpose: To assess the results of the surgical treatment of primary spontaneous pneumothorax (PSP) by means of axillary thoracotomy, blebs resection and abrasive pleurodesis, by comparing the results with the different options of treatment, and to discuss the surgical approach as the best therapeutic option for patient with the first occurrence of PSP. Material and methods: 35 axillary thoracotomy with abrasive pleurodesis for the treatment of PSP were carried out at the Department of Thoracic Surgery of the University of Caxias do Sul between January 1996 and March 1999. Results: 23 patients with their first episode of PSP and 12 patients in their second episode were treated. The pleural drains were kept for in an average period of 2.7 ± 1.6 days. The average time in hospital was about 4.9 ± 2.4 days. Morbidity was 8.5% and mortality rate was zero. There was no relapse in an average period of 22 months of follow-up. Conclusion: The indication of axillary thoracotomy and abrasive pleurodesis to the patients with primary spontaneous pneumothorax (PSP) at the first or recurrent episode showed low rates of morbidity and no relapse, besides short periods of hospitalization and pleural drain permanence. The possibility of indication as the first therapeutic method for the PSP should be considered.

 


Keywords: Pneumothorax. Thoracotomy.

 

Case Report

8 - Renal sarcoidosis

Sarcoidose renal

Maria Enedina Claudino de Aquino, Roberta Karla Barbosa de Sales, José Antônio Freire dos Santos, Ana Lidia Régis, Nelson Morrone

J Bras Pneumol.2001;27(3):163-166

Abstract PDF PT

In a 62-year-old white woman, submitted to preoperative evaluation for facectomy, urinary alterations were detected. The diagnosis established included left-sided kidney stones and homolateral exclusion. At pre-nephrectomy, interstitial widespread lung disease and thoracic adenopathy were evidenced and their investigation was postponed to after surgery. In the removed kidney, non cascous epithelioid granulomas were found. Later, transbronchial biopsy disclosed this same aspect. The patient was treated with methylprednisolone and presented slight pulmonary improvement, though no amelioration in renal function occurred. Final diagnosis was sarcoidosis with lung, thoraco-lymphatic and renal involvement.

 


Keywords: Sarcoidosis. Kidney failure. Pulmonary sarcoidosis.

 

9 - Organized pneumonia secondary to amiodarone use

Pneumonia em organização secundária ao uso de amiodarona

Lia Augusta de Souza Gulmini, Carlos Alberto de Castro Pereira, Ester N.A.M. Coletta

J Bras Pneumol.2001;27(3):167-170

Abstract PDF PT

Organized pneumonia secondary to amiodarone use is rare. Only eight cases have been reported in the literature. It is reported on the case of a 75-year-old female who, after a cumulative dose of 43 g of amiodarone, presented coughing, progressive dyspnea and bilateral infiltrates seen at thoracic radiographs. Transbronchial biopsy confirmed the diagnosis. As the drug was discontinued, there was functional and clinical improvement.

 


Keywords: Bronchiolitis obliterans organizing pneumonia. Amiodarone. Drug therapy. Drug toxicity.

 

10 - Pulmonary Rhodococcus equi infection: report of the first two Brazilian cases

Infecção pulmonar por "Rhodococcus equi": relato dos dois primeiros casos brasileiros

Luiz Carlos Severo, Patricia Ritter, Victor Flávio Petrillo, Cícero Armídio Gomes Dias, Nelson da Silva Porto

J Bras Pneumol.2001;27(3):

Abstract PDF PT

Rhodococcus equi, the principal agent of rhodococcosis, is a pleomorphic, gram-positive, aerobic coccus bacillus that infects humans by inhalation or through a transcutaneous route. It is clinically manifested as a pulmonary abscess. The first two Brazilian cases of rhodococcosis are reported on. Both patients were immunocompromised and showed pulmonary infection. The first patient had AIDS and cavitating pneumonia in the left upper lobe, that was fatal. The second case presented Goodpasture syndrome and was under chronic corticotherapy. He displayed a cavitating nodular lesion in the right upper lobe, that was successfully treated with sulfametoxazol-trimethoprim.

 


Keywords: Actinomycetal infections. Pulmonary tuberculosis. Acquired immunodeficiency syndrome. Goodpasture syndrome. Brazil.

 

Year 2001 - Volume 27  - Number 4  (July/August)

Original Article

2 - Comparative study of high resolution computer-assisted tomography with chest radiograph in the diagnosis of silicosis incipient cases

Estudo comparativo entre tomografia computadorizada de alta resolução e radiografia de tórax no diagnóstico da silicose em casos incipientes

Ana Paula Scalia Carneiro, Arminda Lucia Siqueira, Eduardo Algranti, Cid Sérgio Ferreira, Jorge Issamu Kavakama, Maria Luiza Bernardes, Thaís Abreu de Castro, René Mendes

J Bras Pneumol.2001;27(4):

Abstract PDF PT

Introduction: At present, chest radiography (CR) is the main instrument used in the diagnosis of silicosis, following the International Labor Organization (ILO) recommendations. In incipient cases, the interpretation of radiographs is difficult and disagreement may occur, even among experienced readers. Recently, the possibility of evaluating incipient cases by using high resolution computed tomography (HRCT) has been considered. Objective: To compare CR with HRCT results. Patients and methods: An original group of 135 ex-miners were evaluated by CR, according to ILO recommendations, examined by three readers, from November 1997 to December 1999. HRCT was indicated to 68 patients whose median profusion readings was 1/0 or below. HRCT results were examined by two readers and, in cases of disagreement, a third reader was consulted. HRCT results were classified according to micronodule profusion into categories 0 to 3. CR and HRCT results were compared using McNemar test, weighed Kappa coefficient and log-linear models. Results and conclusion: There was good agreement among the methods in category 0, so it was concluded that both methods are similar in excluding the diagnosis of silicosis. However, in category 1 or greater (diagnosis of the disease) a good agreement among the methods was not observed.

 


Keywords: Silicosis. Thoracic radiography. Tomography X-ray computed. Pneumoconiosis.

 

3 - Airway inflammation in asthmatic patients after methacholine challenge

Avaliação da inflamação de vias aéreas em asmáticos após o teste de broncoprovocação com metacolina

Fabrício Lino de Matos, João Terra Filho, José Antonio Baddini Martinez, Tatiana Furlan Sala, Elcio Oliveira Vianna

J Bras Pneumol.2001;27(4):171-176

Abstract PDF PT

Background: The methacholine challenge test is commonly used to evaluate bronchial responsiveness in diagnosis and follow-up of asthmatic patients. Objective: To investigate late effects of methacholine challenge on induced sputum. Methods: Ten non-smoker patients with mild or moderate stable asthma were recruited. At 12:00 p.m., patients were randomly assigned to inhale either methacholine (challenge) or physiologic saline. At 6:00 p.m., sputum induction was performed. On the second visit, one week apart, patients completed their participation in the study by undergoing another inhalation and sputum induction. Results: After methacholine, 8.6 ± 9 g of sputum were expectorated with 8.6 ± 6 million cells, 78 ± 10% were viable, and 6.8 ± 7% eosinophils. These data were not different from results obtained after saline: sputum amount = 7.6 ± 6 g, total cell count = 12.4 ± 12 million, viability = 82 ± 10%, and eosinophils = 6.6 ± 9%. Expiratory flow (PF) peak fall during sputum induction was not different: 21.4 ± 12% after methacholine and 18.4 ± 15% after saline. The PF fall observed during induction correlated with the amount of expectorated sputum (p = 0.018) and eosinophil relative number (p = 0.003). No other significant correlation between lung function measurements and sputum characteristics was found. Conclusion: A methacholine challenge carried out six hours before sputum induction does not significantly alter the cellular constituents or amount of sputum.

 


Keywords: Asthma. Methacholine chloride. Bronchial provocation tests.

 

4 - Predictive factors for pleural drainage in children with parapneumonic pleural effusion

Fatores preditivos para drenagem de derrames pleurais parapneumônicos em crianças

Helena Teresinha Mocelin, Gilberto Bueno Fischer

J Bras Pneumol.2001;27(4):177-184

Abstract PDF PT

Objective: To evaluate Light's criteria for drainage in children with parapneumonic pleural effusion. Methods: Prospective cross-sectional study on 85 children who were admitted to Hospital da Criança Santo Antônio, State of Rio Grande do Sul, Southern Brazil, presenting pneumonia with pleural effusion confirmed by chest X-ray and/or chest ultrasonography. The exclusion criteria were: previous drainage, pleural effusions associated with other disorders. The pH analysis was performed with a blood gas analyzer. Glucose and LDH were analyzed by spectrophotometry. The decision to perform pleural drainage was made by the attending physician without the participation of the researchers. Results: Pleural fluid in parapneumonic effusion with pH < 7.2 and glucose < 40 mg/dl presented higher drainage rate than LDH > 1,000 UI/l. The pH and glucose had high specificity (89% and 88%) and above the LDH (65%). The same results were observed when non-purulent fluids were analyzed (pH < 7.2 94%, glucose 88%, LDH 68%). In patients with pH < 7.2 LDH > 1,000 UI/l and glucose < 40 mg/dl predominated fluid with cloudy or purulent aspect. In more than 21% of patients who have indication of drainage by the classic criteria, was found limpid aspect. Conclusions: These data indicate that biochemical test support indication of drainage in children presenting with parapneumonic pleural effusion in non-purulent fluid. The specificity for drainage was 89% for pH and 88% for glucose and around 65% for LDH.

 


Keywords: Pleural effusion. Pleural empyema. Postural drainage.

 

5 - Poor perception of airflow limitation in patients with moderate to severe asthma

Má percepção da limitação aos fluxos aéreos em pacientes com asma moderada a grave

Adelmir Souza-Machado, Manuela N. Cavalcanti, Álvaro A. Cruz

J Bras Pneumol.2001;27(4):185-192

Abstract

Background: This study evaluated the perception of airway obstruction in moderate to severely asthmatic outpatients and the efficiency of chest auscultation in identifying airflow limitation. Methods: 33 subjects were evaluated at seven weekly visits by using symptoms scores determined by visual analogue scales (VAS, 0-100 mm), a clinical index of bronchial hyperreactivity (1-10), the clinical classification of asthma severity (GINA, 1-4) and a thoracic auscultation score (TAS, 0-5), spirometry and peak expiratory flow (PEF), which were correlated by the coefficient of Spearman. Patients were classified as perceivers (-1 £ r < 0) or nonperceivers (0 £ r £ 1) by correlations between VAS for dyspnoea and FEV1. A correlation between auscultation and bronchial obstruction was considered accurate when a r £ -0.5 (TAS vs. FEV1) was found. Results: Seventeen asthmatic patients (51.5%) did not accurately perceive the degree of their airways obstruction (nonperceivers). No clinical characteristics distinguished the groups. Only 39.4% of the individual correlations between TAS and FEV1 indicated accurate discrimination by auscultation. Severe asthma was not associated with inaccurate auscultation nor with malperception in this study. Conclusions: A significant proportion of this sample of asthmatic patients did not accurately perceive their own airway obstruction. Moreover, chest examination was shown to be an unsuitable discriminator of airflow limitation in moderate to severe stable asthmatics in an outpatient clinic.

 


Keywords: Asthma. Airway obstruction. Auscultation. Lung obstructive diseases.

 

6 - Hospital admissions caused by respiratory diseases in a tertiary internal medicine service in Northeastern Rio Grande do Sul State

Doenças respiratórias como causa de internações hospitalares de pacientes do Sistema Único de Saúde num serviço terciário de clínica médica na região nordeste do Rio Grande do Sul

Dagoberto Vanoni de Godoy, Crischiman Dal Zotto, Jamila Bellicanta, Rui Fernando Weschenfelder, Samira Barrentin Nacif

J Bras Pneumol.2001;27(4):193-198

Abstract

Objective: Epidemiologic survey of respiratory diseases that cause hospital admissions at the Internal Medicine Service, Hospital Geral de Caxias do Sul (SCM-HG), a tertiary university hospital in the State of Rio Grande do Sul, Southern Brazil. Patients and methods: Retrospective study conducted at SCM-HG between November 1998 and November 1999. Data were obtained from medical records and included: a) major admission cause; b) associated diseases; c) sazonal variability; d) hospitalization length; e) mortality. Results: There were 1,200 admissions at SCM-HG, 228 (19%) caused by a respiratory disease. COPD (41.3%), pneumonias (29.8%) and bronchial asthma (9.6%) were the most prevalent. Fifty subjects (21.9%) presented comorbidity: cardiac failure (7.7%), systemic arterial hypertension (6.4%) and diabetes mellitus (4.4%). Pneumonias predominated between September and November, bronchial asthma frequency raised in October and November, and COPD prevailed from May to November. The admissions had an average duration of 10.4 ± 10 days. Twenty-six (11.4%) patients died. Conclusions: 1) Respiratory diseases were responsible for approximately 1/5 of the admissions. 2) COPD patients represented the biggest quota of admissions. 3) Patients with respiratory diseases stayed for a long time as compared with the others hospitalized patients (10.4 versus 7.7 days). 4) COPD, pneumonias and bronchial asthma behaved as expected regarding sazonal variability.

 


Keywords: Lung diseases. Asthma. Pneumonia. Epidemiology. University hospitals. Patient admission.

 

Review Article

7 - Asbestos, asbestosis and cancer: diagnostic criteria

Asbesto, asbestose e câncer: critérios diagnósticos

Vera Luiza Capelozzi

J Bras Pneumol.2001;27(4):206-218

Abstract PDF PT

Asbestos-induced diseases are still major health problems, as a remarkably large number of workers have been exposed to asbestos over the past 50 years. Personal injury lawsuits against asbestos manufacturers number hundreds of thousands, and new cases are still being filed. Asbestosis is a complex issue, and although the broad outlines of asbestos-related diseases are well set, many important areas, especially pathology, are poorly understood. In Brazil, since 1940, asbestos has been commercially explored, producing around 200,000 tons/year, exposing about 10,000 workers in the mining activity, and an unknown number of workers in asbestos-cement industry. A study, with scientific appropriate investigation, with the purpose to evaluate the effects of asbestos exposure over the health of the mine workers in this country, was done by interinstitution researchers, and untitled "Morbidity and mortality among workers exposed to asbestos in mining activities - 1940/1996". With the experience achieved in the course of this study, the objective of this report is to make an overview of asbestos-related diseases, mainly with respect to difficulties in establishing the histopathologic diagnosis.

 


Keywords: Asbestosis. Pathology. Neoplasms. Diagnosis.

 

Case Report

8 - Severe pneumonia due to Chlamydia psittaci

Pneumonia grave por "Chlamydia psittaci"

Cristiane Moschioni, Henrique Pereira Faria, Marco Antônio Soares Reis, Estevão Urbano Silva

J Bras Pneumol.2001;27(4):219-222

Abstract PDF PT

Psittacosis, also known as ornithosis, is a disease caused by Chlamydia psittaci. The most common clinical presentation is insidious onset, mild symptoms resembling a nonspecific viral illness and preference for the lungs. It is rarely a systemic and fatal disease. It is described a rare case of pneumonia due to Chlamydia psittaci that progressively developed into respiratory failure, requiring mechanical ventilation. It is very important to consider psittacosis in cases of atypical pneumonia whose evolution is unsatisfactory, with no response to antimicrobial therapy and epidemiology is positive for exposure to birds. Prompt recognition is vital as the response to appropriate treatment is excellent. Delayed diagnosis may lead to a severe course and fatal outcome.

 


Keywords: Mycoplasma pneumonia. Ornithosis.

 

9 - Sternal and pectoral musculature hydatidosis

Hidatidose do esterno e musculatura peitoral

NILTON HAERTEL GOMES1, DÉCIO VALENTE RENCK2, DANIEL ENGEL DA CUNHA3, LEANDRO PRETTO ORLANDINI3

J Bras Pneumol.2001;27(4):223-226

Abstract PDF PT

Hydatidosis is a cyclezoonotic infection caused by taenia Echinococcus granulosus, whose larval form accidentally affects men by forming hydatic cysts preferably in the lungs and liver. Osseous hydatidosis is a rare event characterized by slow growth and few symptoms. It is reported on a 36-year-old man who had presented nodes in the anterior thorax for nine years. Imaging diagnostic examinations revealed thick, loculated, expansive masses in the pectoral muscles and sternal lytic lesions. The diagnosis of hydatidosis was established by exploratory surgery. The patient showed good clinical-surgical evolution and was discharged receiving albendazole, 2,400 mg/day, for 28 days.

 


Keywords: Diagnostic techniques and procedures. Pulmonary echinococcosis. Surgery.

 

Letters to the Editor

10 - Hérnia diafragmática traumática transpericárdica (tréplica)

Antônio Sebastião Porto

J Bras Pneumol.2001;27(4):229-

PDF PT


Year 2001 - Volume 27  - Number 5  (September/October)

Original Article

1 - Use of breath carbon monoxide as an indicator of smoking status

Emprego da determinação de monóxido de carbono no ar exalado para a detecção do consumo de tabaco

Ubiratan P. Santos, Silmar Gannam, Julie M. Abe, Patricia B. Esteves, Marco Freitas Filho, Thais B. Wakassa, Jaqueline S. Issa, Mario Terra-Filho, Rafael Stelmach, Alberto Cukier

J Bras Pneumol.2001;27(5):231-236

Abstract PDF PT

Introduction: Smoking is the major preventable risk of morbidity and mortality. However, its prevalence is high in developed countries and increasing in developing countries, even though its effects are now better known. The purpose of this study was to compare the exhaled carbon monoxide concentration (exCO) between smokers and nonsmokers, evaluate the factors that influence this parameter among smokers and the potential influence of passive smoking by measuring exCO in workers and patients of Instituto do Coração HC-FMUSP. Materials and methods: This cross study included 256 volunteers who responded to a questionnaire and were submitted to exCO measuring with the MicroCo meter device. Results: There were 106 males and 150 females. Mean age was 43.4 years (Vmin-max: 15-83). There were 107 smokers, 118 nonsmokers and 31 passive smokers. Mean exCO was 14.01 ppm (Vmin-max: 1-44) among smokers, 2.03 ppm (Vmin-max: 0-5) among passive smokers and 2.50 ppm (Vmin-max: 0-9) among nonsmokers. Significant statistical difference was observed between smokers and the other groups (p < 0.001), but not between nonsmokers and passive smokers. A positive correlation was found between the number of cigarettes smoked per day and exCO values while there was a negative correlation between the exCO values and the timing of the last cigarette. For a reference limit value of 6 ppm, sensitivity was 70% and specificity was 96%. Conclusion: exCO metering is easy to perform, low-cost, noninvasive and allows the obtention of immediate results and the reference limit value of 6 ppm has good specificity to evaluate the smoking habit.

 


Keywords: Smoking. Carbon monoxide. Tobacco smoke pollution. Brazil.

 

2 - Asthma and atopy prevalence in a group of students from Porto Alegre, Rio Grande do Sul

Variação na prevalência de asma e atopia em um grupo de escolares de Porto Alegre, Rio Grande do Sul

Renata Wagner Fiore, Adriana Barbieri Comparsi, Cláudia Loss Reck, Jéferson Krawcyk de Oliveira, Karina Brasco Pampanelli, Carlos Cezar Fritscher

J Bras Pneumol.2001;27(5):237-242

Abstract

Introduction: A considerable increase in asthma and atopy prevalence has been noticed worldwide through the last decades, however, in our country, epidemiological data are still insufficient. Objective: This study was carried out to determine the prevalence of asthma and atopy in a group of students, and compare these data with those found in two previous studies undertaken in Porto Alegre, Rio Grande do Sul. Methods: Asthma prevalence was identified through a questionnaire applied to 855 students from five schools of Porto Alegre. The students submitted to skin tests who presented, at least, one positive reaction were considered atopic. The signature of an informed consent from one of the parents was required for the skin test performance. Results: Prevalence was found to be 42.5% and 22% of cumulative and active asthma, respectively, with predominance in females. Atopy was identified in 50.1% of the sample. These results were significantly higher than the 6.7% (1980) and 16% (1989) of cumulative asthma, 10.9% (1989) of active asthma and 15.8% (1980) of atopy found in the two previous studies. Conclusion: A high prevalence of asthma and atopy was identified in our students. Future studies should be performed to elucidate the phenomenon herein demonstrated.

 


Keywords: Asthma. Epidemiology. Atopy.

 

3 - Smoking cessation with bupropion and nicotine replacement

Tratamento do tabagismo com bupropiona e reposição nicotínica

Fábio Maraschin Haggsträm, José Miguel Chatkin, Daniela Cavalet-Blanco, Vanessa Rodin, Carlos Cezar Fritscher

J Bras Pneumol.2001;27(5):255-261

Abstract

Introduction: Around one third of the world adult population smoke. Due to the recent researches on the smoking addiction and to the use of new drugs, the possibilities to succeed on the attempts to quit smoking have increased remarkably. Purposes: To study the tobacco abstinence in patients under treatment at the Ambulatório de Auxílio ao Abandono do Tabagismo da Pontifícia Universidade Católica do Rio Grande do Sul (AAAT-PUCRS) and to evaluate the role of some variables as risk factors to the chosen outcomes. Patients and methods: In a prospective open clinical trial not randomized we studied all the smokers who attended the AAAT-PUCRS within July 1999 and October 2000. All of them were submitted to the same standard program; the results were analyzed by central tendency measures for quantifying variables, relative risk with a IC95% for the associated factors and the Kaplan Meier's curve for the analyses of the time trend. Results: The study included 169 patients (67.5% women), average age 46 (± 10.4) years old; the most of them smoked 20 cigarettes/day for around 30 years. Even for a very young cohort like this one, it was possible to show that in relation to the outcome success/failure, 49% of the patients quit smoking, 14% remarkably diminished the number of smoked cigarettes and 37% failed completely. For the studied variables, severe dependency to nicotine was the only one associated with an increased risk to failure quitting smoking. Conclusions: It was possible to achieve a reasonable quitting smoking percentage adopting standard procedures described, but adapted for each patient. Pharmacological therapy was associated to a higher percentage of success.

 


Keywords: Smoking. Treatment. Tobacco use cessation. Ambulatory care.

 

4 - A study of community-acquired pneumonia inpatients in a period of a year

Estudo de casos hospitalizados por pneumonia comunitária no período de um ano

Ricardo de Amorim Corrêa, Regina Magalhães Lopes, Luciana Macedo Guedes de Oliveira, Frederico Thadeu Assis Figueiredo Campos, Marco Antônio Soares Reis, Manoel Otávio da Costa Rocha

J Bras Pneumol.2001;27(5):243-248

Abstract PDF PT

Introduction: Besides the improvement we have had in the diagnostic methods, the causative agent in around 50% of the cases of community-acquired pneumonia (CAP) remains unknown, even in inpatients. Despite that, adequate empirical therapy results in low mortality in the majority of the cases. Goals: To describe the epidemiology, the clinical presentation, the utility of diagnostic tests, the duration of hospital stay, the morbidity and mortality rates of 42 consecutive inpatients with CAP. Methods: The inclusion criteria were the presence of a recent pulmonar infiltrate in the CXR and two items out of fever (38ºC), productive cough and leukocytosis (> 10,000/mm3), in the presence of a compatible clinical syndrome. The subsidiary tests were performed as required on individual basis. Results: Forty-two patients, aged 64.7 ± 16.8 years, 27 (64.3%) male, were studied. Twenty-seven (64%) had subjacent illness. Seventeen (40.5%) were on antimicrobial therapy on admission. There were eight cases (19%) of severe pneumonia; the patients aged > 60 or £ 60 years were similar concerning the severity of presentation (p = 0.57) and had similar hospital stay (p = 0.25). The mean global hospital stay was 14.3 ± 7.6 days. Definite etiologic diagnosis were done in three patients: Legionella sp (2), S. aureus (1). In thirty-one cases (73.8%) the antimicrobial therapy wasn't modified; when it happened (11 patients, 26.2%), the main reason was the bad outcome in six cases (54.5%); in five (45.5%), the microbiological result prompted the change in therapy. Blood samples were drawn in 16 cases (38%), being positive in only one (6.3%). There were nine adequate sputum samples for analysis (9/22, 41%). There was only one death (2.4%), due to severe pneumonia in a patient with a neoplastic disease. Conclusion: The etiologic diagnosis in CAP is reached in a minority of cases, even in inpatients. At least partly, this is probably due to the previous use of antimicrobial drugs. Adequate empirical therapy results in low mortality. Diagnostic tests can be performed on individual basis.

 


Keywords: Pneumonia. Community acquired infections. Epidemiology. Therapeutics.

 

5 - The bronchodilatory effect of salbutamol administered through spacers with and without antistatic treatment

Efeito broncodilatador do salbutamol inalado através de espaçadores com e sem tratamento antiestático

Luiz Eduardo Mendes-Campos, Clarissa Marina Biagioni

J Bras Pneumol.2001;27(5):249-254

Abstract PDF PT

Objective: To compare the bronchodilatory effect of salbutamol delivered by metered-dose inhaler connected to spacers with and without previous antistatic treatment. Design: Prospective, randomized, open, crossover study. Setting: Outpatients from The Pulmonary Clinic of Hospital Júlia Kubitschek-FHEMIG, Belo Horizonte, Minas Gerais, Brazil. Patients and methods: Eleven patients, with stable mild to moderate asthma were randomized to four inhalation tests of 100 mg of salbutamol: (A) open mouth, (B) non antistatic small volume spacer (50 ml), (C) antistatic small volume spacer (50 ml) and (D) antistatic Fisonair® (750 ml). The antistatic treatment consisted in soaking the spacer in a solution of water and detergent for ten minutes and letting it to drip dry without rinsing. Main outcome measure: The peak expiratory flow (PEF) variation 15 minutes after each test in absolute, % of predicted and % of baseline values. Results: The median (Min-Max) PEF absolute variation was 25 (5-85), 40 (0-70), 70 (25-83) and 60 (15-90) l/min for tests A, B, C and D, respectively. The median PEF % baseline variation was 7.6, 11.0, 15.0, 13.3, and median PFE % predicted variation was 6.0, 8.7, 12.7 and 10.7 for tests A, B, C and D, respectively. The results of tests C and D were significantly superior to those of tests A and B (p < 0.01) based on the three methods evaluated. There was no significant difference between the results of tests C and D. Conclusion: The antistatic treatment of a small volume spacer device using a solution of water and detergent can improve the antiasthmatic effect of inhaled drugs delivered by metered-dose inhaler, as occurred with the salbutamol in this study. This fact can be more relevant concerning the treatment with inhaled steroids for asthma.

 


Keywords: Asthma. Respiratory therapy. Aerosols. Albuterol.

 

Review Article

6 - Primary ciliary dyskinesia

Discinesia ciliar primária

José Wellington Alves dos Santos, Aland Waldow, Claudius Wladimir Cornelius de Figueiredo, Diego Rossi Kleinubing, Severo Salles de Barros

J Bras Pneumol.2001;27(5):262-268

Abstract PDF PT

Primary ciliary dyskinesia is an autosomal recessive disorder characterized by a history of recurrent upper and lower respiratory tract infections with chronic otitis media, bronchitis and rhinosinusitis, associated with situs inversus in 50% of cases. The diagnosis is established by ciliary ultrastructural analysis of respiratory specimens, after ruling out some disorders as cystic fibrosis, a-1 anti-trypsin deficiency, immune deficiencies (IgG, neutrophils and complement) and Young's syndrome. The purpose of this paper is to review the clinical features, diagnosis and management of primary ciliary dyskinesia, including a diagnostic algorithm.

 


Keywords: Ciliary dyskinesia. Situs inversus. Diagnosis.

 

Case Report

7 - Inflammatory pseudotumor in childhood

Pseudotumor inflamatório em criança pré-escolar

Maura Malcon, Nilton Haertel Gomes, Valéria Jorge, Geraldo Geyer

J Bras Pneumol.2001;27(5):279-281

Abstract PDF PT

The authors described a case of a five year old boy having an inflammatory pseudotumor (fibrohistiocytic granuloma) in the left upper lobe. Surgical excision was undertaken, and the four year outcome was favorable. These tumors are rare and can simulate sarcomas, so that a radical excision is considered the diagnostic procedure and the treatment of choice as well.

 


Keywords: Inflamatory pseudotumor. Childhood. Plasma cell pulmonary granuloma.

 

8 - Pulmonary coccidioidomycosis in a armadillo hunter

Coccidioidomicose pulmonar em caçador de tatus

Fabrício André Martins da Costa, Ricardo Coelho Reis, Fábio Benevides, Geraldo de Sousa Tomé, Marcelo Alcântara Holanda

J Bras Pneumol.2001;27(5):275-278

Abstract PDF PT

Coccidioidomycosis is a disease caused by inhalation of arthrospores of the fungus Coccidioides immitis. It has been recognized as a clinical entity since 1892. It is related to activities that involves dust exposure. It is found in many regions of the western hemisphere with dry and alkaline soil. In Brazil it has been described almost exclusively in the Northeast region where drought periods may favor its growth in its soil. We report a case of fatal coccidioidomycosis, in an immunocompetent host, associated to the activity of armadillo hunting (Dasypus novemcynctus) in a rural area of Ceará state.

 


Keywords: Coccidioidomycosis. Occupational exposure. Armadillos.

 

9 - Necrotizing descending mediastinitis afetr Ludwig angina

Mediastinite descendente necrosante pós-angina de Ludwig

Maricélia Brommelstroet, José Fioravante Tosatti da Rosa, Paulo César Buffara Boscardim, Carlos Augusto Schmidlin, Sérgio Shibata

J Bras Pneumol.2001;27(5):269-271

Abstract PDF PT

Ludwig's angina is an infection of the submandibular space generally caused by an infection of the 2nd or 3rd lower molar. As a consequence, descending necrotizing mediastinitis, a rare and severe form of mediastinal infection, may occur. The descending necrotizing mediastinitis represents a rare form of mediastinal infection. It presents a high mortality and to decrease that rate it is necessary prompt diagnosis and surgical treatment. Two cases of descending necrotizing mediastinitis due to Ludwig's angina were treated with excellent results in our hospital. The transcervical mediastinal drainage is justified in patients with disease limited to the upper mediastinum. Even so, when there is extensive involvement of the whole mediastinum it is suitable the accomplishment of a wide thoracotomy.

 


Keywords: Ludwig's angina. Mediastinitis. Diagnosis. Treatment. Surgery.

 

10 - Metastatic ependymoma of the lung

Ependimoma metastático de pulmão

Paulo Manuel Pêgo-Fernandes, Roger Beltrati Coser, Rosana Seleri Fontes, Fábio B. Jatene

J Bras Pneumol.2001;27(5):282-284

Abstract PDF PT

Ependymomas are rare tumors of the central nervous system that most often occur at the cauda equina. These tumors seldom metastasize. A 35 year-old man, nine years after the resection of an ependymoma of the coccygeal region developed pleuritic pain, dyspnea, cough and night sudoresis. Lung X-ray revealed pleural congestion and metastic nodes in both lungs. Histopathological and immunohistochemical examinations of the tissue obtained through open pulmonary biopsy confirmed the diagnosis of a pendymoma, chemotherapy was administered and after 43 months of follow up the patient's evolution has been good.

 


Keywords: Ependymoma. Lung neoplasms. Neoplasm metastasis.

 

11 - Intrapulmonary teratoma

Teratoma intrapulmonar

Cleverson Winston de Liz Medeiros, William Kondo, Michelli Totti Dyckyj, Nelson Suzuki

J Bras Pneumol.2001;27(5):272-274

Abstract PDF PT

Lung teratoma is a rare disease to date. About 43 cases have been described in the literature. We report on a 28-year-old man who presented fever, cough and hemoptysis for four months. Chest X-ray and computerized tomography showed opacification of the left upper lobe and bronchoscopy revealed the presence of hair at the site. The patient's condition improved with surgical treatment.

 


Keywords: Teratoma. Lung neoplasm.

 

Letters to the Editor

12 - Asma brônquica e a tolerância ao exercício incremental

José Alberto Neder

J Bras Pneumol.2001;27(5):285-286

PDF PT


Year 2001 - Volume 27  - Number 6  (November/December)

Original Article

1 - Thymoma: discussion about treatment and diagnosis

Timoma: discussão sobre tratamento e prognóstico

Paulo Manuel Pêgo-Fernandes, Gustavo Xavier Ebaid, Maurício Stanzione Galizia, Paulo Marchiori, Francisco Vargas Suso, Fábio Biscegli Jatene

J Bras Pneumol.2001;27(6):289-294

Abstract PDF PT

Objectives: To describe a group of patients with thymoma who were submitted to surgica treatment associated or not with therapy, and evaluate their prognosis. Methods: Of the 104 patients with thymic tumors who were operated at Hospital das Clínicas - São Paulo University Medical School between 1965 and 1998, (66.3%) were males. Mean age at diagnosis, was 47.9% ± 16.3 years (ranging from 13 to 76 years). Results: Of the 104 patients, 89 (85.6%) underwent complete thymoma resection, 6 (5.8%) underwent partial resection and, in 9 (8.6%) of them, biopsy was performed. Anatomopathologic diagnosis (thymoma vs malignant thymoma) and the type of surgery (biopsy vs complete resection vs partial resection) were significant predictors of survival mean time (p < 0.02). Conclusions: Complete resection is the treatment of choice for thymomas. These tumors, when not invasive and completely resected, have good immediate and late prognosis.

 


Keywords: Thymoma.

 

2 - Six minute walk test in COPD patients under a rehabilitation program

Teste da caminhada de seis minutos em pacientes com DPOC durante programa de reabilitação

Maria Auxiliadora Carmo Moreira, Maria Rosedália de Moraes, Rogério Tannus

J Bras Pneumol.2001;27(6):295-300

Abstract PDF PT

Objectives: To report the results obtained in six-minute walk tests (6 MWT) performed in a group of patients under a pulmonary rehabilitation program (PRP) as a contribution to a better interpretation and the proper use of this test. Some factors that interfere with physical training during pulmonary rehabilitation were also studied. Methods: Retrospective data on 18 males and 5 females under a PRP were evaluated. During 3 months, the patients had 3 weekly training sessions to exercise the muscles of the lower extremities. The following parameters were analyzed before and after training: the distance walked during the 6 MWT and its relationship with the reference values calculated by the equations of Enright and Sherril; forced expiratory volume in one second, training load, heart rate (HR), respiratory rate (RR), oxygen saturation by pulse oxymeter (SpO2) and body mass index (BMI). Results: The values obtained during pre-training 6 MWT did not differ from the reference values calculated by Enright and Sherril equations (P = 0.777). After training, these values differed significantly (P = 0.001). The mean 6 MWT distance increase was 76 m. However, 3 patients did not reach the minimally significant increase of 54 m. Post-training 6 MWT correlated positively with pre-training FEV1 (P = 0.012), but not with load increase during training (P = 0.693). No significant difference in RR and SpO2 was observed before and after training. HR increased significantly at the end of post-training 6 MWT (P = 0.035). In 9 patients BMI was lower than the inferior limit. Six of them (66%) presented post-training distance increased in 54 m or more. Conclusions: The use of standardized methods for 6 MWT performance is recommended, even when reference values are targeted. The equations of Enright and Sherril for healthy subjects tended to yield underestimated values, with no statistical differences in training values in COPD patients. Differences in the encouragement technique employed could explain these conflicting results. Physical gain after rehabilitation was confirmed regardless of the patient's initial functional status, justifying the indication of rehabilitation even to those with severe respiratory limitations. The heterogeneous responses to load increase suggest the analysis of the predictive factors of the best response to training is necessary to customize load increase and thus obtain the best performance possible.

 


Keywords: Exercise test. Obstructive lung diseases. Rehabilitation. Respiratory function tests. Exercise.

 

3 - Non-invasive positive pressure ventilation in patients with acute respiratory failure: factors associated with failure or success

Ventilação não-invasiva com pressão positiva em pacientes com insuficiência respiratória aguda: fatores associados à falha ou ao sucesso

Marcelo Alcantara Holanda, Carlos Henrique Oliveira, Emília Matos Rocha, Rita Moara Bandeira, Isabel Veras Aguiar, Waltéria Leal, Ana Karina Monte Cunha, Alexandre Medeiros Silva

J Bras Pneumol.2001;27(6):301-309

Abstract PDF PT

Objective: To evaluate the effects of non-invasive positive pressure ventilation (NIPPV) on acute respiratory failure and to identify the factors associated with its failure or success. Patients and methods: This open and prospective study analyzed 60 episodes of NIPPV use in 53 patients with respiratory failure. Results: In 37 occasions (62%), the patients were successfully ventilated with NIPPV (Success Group, SG) whereas in 23 episodes (38%) intubation was necessary (Failure Group, FG). FG patients showed a higher Apache II score (30.4 ± 9 versus 22.2 ± 8, p = 0.001). The use of NIPPV reduced respiratory rate after 2 hs. This reduction was less evident in FG (from 33 ± 9 to 30 ± 8 bpm, p = 0.094) than in SG (from 39 ± 11 to 28 ± 9 bpm, p < 0.001). PaO2 increased from 62 ± 22 to 101 ± 65 mmHg, (p < 0.001) with no differences between groups. Among patients with hypercapnia, PaCO2 level decreased in SG (from 76 ± 20 to 68 ± 21mmHg, p = 0.032) but not in FG (from 89 ± 23 to 93 ± 40mmHg, p = 0.54). Arterial pH increased in SG (from 7.25 ± 0.10 to 7.34 ± 0.11, p = 0.007) and not in FG (from 7.24 ± 0.07 to 7.21 ± 0.12, p = 0.48). NIPPV was used for longer in SG (3.4 ± 2.5 versus 2.3 ± 2 days, p = 0.003). Higher IPAP levels were used in SG (13.2 ± 3 versus 11 ± 4cmH2O, p = 0.02). The 10 patients (17%) who died, all belonged to FG. Skin lesions at the site of mask contact was the most common complication of NIPPV (5, 8%). NIPPV was efficient in treating acute respiratory failure in 2/3 of patients. The factors associated with failure were: greater severity of the illness, smaller reduction in the respiratory rate, no improvement of respiratory acidosis in 2 h and use of lower IPAP levels. The high mortality rate observed in FG (10, 43%) justifies efforts to optimize NIPPV implementation and to recognize its failure, as early as possible, in order to avoid delays in endotracheal intubation.

 


Keywords: Non-invasive positive pressure ventilation. Respiratory failure. Apache II. Hypercapnia.

 

4 - Multidrug-resistant tuberculosis prevalence in Ceará State - Northeastern Brazil, 1990-1999

Prevalência da tuberculose multirresistente no Estado do Ceará, 1990-1999*

Elizabeth Clara Barroso, Jorge Luís Nobre Rodrigues, Valéria Góes Ferreira Pinheiro, Creuza L. Campelo

J Bras Pneumol.2001;27(6):310-314

Abstract PDF PT

Multidrug-resistant tuberculosis (MDR-TB) is a worldwide concern but its magnitude in the state of Ceará - Northeastern Brazil has been so far unknown. Objectives: To determine the prevalence of MDR-TB among us as well as the sesceptibility of Mycobacterium tuberculosis to antituberculosis drugs. Methods: A retrospective study was conducted using 1,500 susceptibility tests (ST) for rifampin (RFM), isoniazid (INH), streptomycin (SM), pyrazinamide (PYZ), ethambutol (ETM) and ethionamide (ETH) that were performed at the Central Laboratory of the State of Ceará (LACEN) between 1990 and 1999. The proportion method test was used. Results: Of the 1,500 stains studied, 404 (27%) were resistant to at least one drug, including both primary and acquired resistance. MDR-TB, defined as resistance to at least rifampin and isoniazid was observed in 266 (17.7%) patients. During the study period, there were 41,073 TB cases and MDR-TB prevalence was 0.65% in our state. Among the patients studied, 62.3% were men and mean age was 40.17 ± 14.62. Overall prevalence for single-drug resistance was 8.1% (INH = 5.7%; SM = 1.5%; and RFP = 0.9%). Resistance to 2, 3, 4, 5 and 6 drugs was, respectively, 10.8%; 3.1%; 0.9%; 1.5%; and 2.9%. HIV testing was performed in all inpatients and some outpatients (total of 86 patients) and revealed that they were all HIV negative. The probability of 5-year survival (138 patients assessed) was greater in the MDR-TB group treated with alternative drugs, including the patients of the failure group. Conclusion: The MDR-TB prevalence rate found in this study is intermediate in comparison with those reported in Brazil and the other parts of the world. Preventive approaches, early diagnosis and the development of effective, safe and relatively inexpensive new drugs should be stimulated.

 


Keywords: Multidrug-resistant tuberculosis. Prevalence. Survival probability.

 

5 - Comparing reference spirometric values obtained from Knudson and Pereira equations - Adults

Comparação entre valores espirométricos de referência obtidos a partir das equações de Knudson e de Pereira - Adultos

Waldemar Ladosky, Rogerson T. Andrade, Noel Guedes Loureiro, Jesus M.B. Gandar, Marcos M. Botelho

J Bras Pneumol.2001;27(6):315-320

Abstract PDF PT

In its 1991revision, the American Thorax Society (ATS) recommended that each region should define its own equations to determine the theoretical, or predicted values of the spirometric parameters that best represent the pulmonary functional reality of the local population. At that time, the United States already had various equations of its own as well as the European Community, specially Poland. In 1992, Pereira et al., analysing 4,200 spirograms on healthy Brazilians, found predicted values (PV) of forced vital capacity (FVC), forced expiratory volume in 1 sec (FEV1) and middle expiratory flow (MEF) different from those reported by American and European authors. The purpose of the present study was to compare the equations developed by Pereira et al., using a Brazilian sample population, with those determined by Knudson et al. for American populations, that are the most used by Brazilian specialists. This study included 1,070 spirograms performed in patients of both genders (389 males and 681 females) who came to our service for routine functional assessment. No pathology was excluded and the smoking status of the patients was not taken into account. For each patient the PV of FVC, FEV1 and MEF were calculated accordingly to the equations of Pereira et al. (PV-P) and Knudsen et al. (PV-K). Subsequently, the means, standard deviations and reports obtained by both methods were compared. Among females, the PV-K of FVC were 4,01% (p < 0.005) greater, leading to a higher rate of restrictive impairment whereas among males there was no significant difference. Regarding FEV1, PV-P were higher in both males (4.76%; p < 0.005) and females (5.04%; p < 0.05) resulting in a greater sensitivity in the identification of respiratory obstructions. No significant difference was observed between PV-P and PV-K as to FEF25-75 regardless of gender.

 


Keywords: Spirometry. Reference values. Forced expiratory flow rates.

 

Review Article

6 - Understanding the role of biological markers in lung cancer

Entendendo o papel de marcadores biológicos no câncer de pulmão

Vera Luiza Capelozzi

J Bras Pneumol.2001;27(6):321-328

Abstract PDF PT

Biological markers are cellular, structural and biochemical components that can define cellular as well as molecular changes in both normal and neoplastic cells. There are two types of biological markers: 1) intermediate markers that evaluate cellular and molecular alterations before malignancy occurs; and 2) diagnostic markers, present in association with malignancy. The identification and validation of biological markers for clinical use are performed in stages: initial identification in cell cultures of the tumor;  testing of the marker in tissues obtained in biopsies of patients with an established diagnosis of the tumor;  testing of biopsies of normal tissues and tissues with an inflammatory process;  sputum, blood or urine tests for validation as a non-invasive test that can be used in high-risk populations. Sorologic and histopathologic biological markers are cellular, structural and biochemical components found in both normal and neoplastic cells that can be quantitatively assessed by biochemical, immunological and molecular methods in the body fluids or tissues, respectively, and may be associated with malignancies and, possibly, with the neoplastic organ. Biological markers are studied in diverse primary neoplasms. However, few of them proved to be clinically valuable. The role of biological markers in lung cancer patients remains unclear because only a small number of markers has been properly identifiassessed. The aim of this paper is to understand the role of sorologic and histologic biological markers in the prognosis and survival of lung cancer patients based on our previous works. Furthermore, we present a future perspective of the early detection of lung cancer on the basis of the role of intermediate biological markers.

 


Keywords: Biologic markers. Lung cancer. Prognosis. Survival. Morphometric method.

 

7 - Pulmonary tuberculosis imaging

Imagem em tuberculose pulmonar

Sidney Bombarda, Cláudia Maria Figueiredo, Marcelo Buarque de Gusmão Funari, José Soares Júnior, Márcia Seiscento, Mário Terra Filho

J Bras Pneumol.2001;27(6):329-340

Abstract PDF PT

Tuberculosis is a disease of high incidence and prevalence in Brazil. Imaging methods can reveal signs suggestive of tuberculosis activity or sequelae. Chest radiographs can reveal active lung tuberculosis through consolidations, cavitations, interstitial patterns (nodular and reticulo-nodular), mediastinal or hilar lymphadenopathy and pleural effusions. Images compatible with the active disease, such as centrilobular nodules segmentarily distributed, thick-walled cavities, thickened bronchial or bronchiolar walls, bronchiectasis and lymphadenopathy can be observed by computerized tomography. Thin-walled cavities, traction bronchiectasis, parenchymal bands, emphysema and mosaic pattern are signs suggestive of inactive disease. Gallium-67 citrate scyntigraphy is a complementary method useful in the detection of infectious diseases, including tuberculosis, especially in immunocompromised patients. Inhalation / perfusion analyses are used in the pre-operative assessment of patients carrying tuberculosis sequelaes and multiresistant tuberculosis. Positron emission tomography with fluorine-18 labeled deoxyglucose allows the detection of the inflammatory process that takes place during the active stage of tuberculosis and may persist, not so intense, after specific treatment is over. Imaging methods are valuable tools to be used in the diagnosis and follow up of pulmonary tuberculosis.

 


Keywords: Tuberculosis. Radiography. Computed tomography. Scintigraphy. Emission-computed tomography.

 

Case Report

8 - Acute breathlessness and sudden death in a patient with blunted perception of the intensity of bronchial obstruction

Dispnéia aguda e morte súbita em paciente com má percepção da intensidade da obstrução brônquica

Adelmir Souza-Machado, Gustavo Alcoforado, Álvaro A. Cruz

J Bras Pneumol.2001;27(6):341-344

Abstract PDF PT

Patients with severe asthma and blunted perception of their bronchial obstruction are likely to have elevated risk of death from asthma. The authors describe the case of a 52-year-old woman with asthma whose test results, in a prospective study for the identification of patients with blunted perception of the intensity of their own bronchial obstruction, showed the minimum score in the analogic visual scale in the presence of reduced morning FEV1 and EFP. After the study, the patient was seen at the outpatient clinic. He had no complaints, seemed normal at physical examination and reported to be using no medication at all. Then, while still in the clinic, he suddenly developed dyspnea, respiratory failure, and non-revertible cardio-respiratory failure. Blunted perception of the bronchial obstruction severity probably contributed to the development of acute respiratory failure and death of the patient.

 


Keywords: Dyspnea. Asthma. Bronchial spasm. Death. Perception.

 

9 - Bilateral benign mainstem bronchus stenosis

Estenose benigna dos brônquios principais

Manoel Ximenes-Netto, Marcos Amorim Piauilino, Ulisses Eduardo Ramiro, Clarice F.G. Santos

J Bras Pneumol.2001;27(6):345-348

Abstract PDF PT

We report on a 37-year-old female patient who was first seen on account of a progressive dyspnea of 18 month's duration. Admission diagnosis was bronchial asthma. Over the past seven years, the patient has had seven pneumonia episodes involving mainly the lingular segment. Seventeen years prior to admission (1982) she was orally intubated for 15 days due to meningococcus meningitis and coma. Fiberoptic bronchoscopy revealed marked widening of the carina and stenosis of the main bronchi, confirmed by virtual bronchoscopy. The stenosis was shorter and more severe to the right side (1 cm) and longer and less severe on the left side (2 cm). The patient was submitted to carina resection and anastomosis of the right mainstem bronchus to the trachea and the left main bronchus to the bronchus intermedius. Fifteen months after surgery the patient shows good clinical, radiological and functional evolution.

 


Keywords: Carinal stenosis. Mainstem bronchus stenosis. Carinal reconstruction.

 

10 - Tracheobronchial cystic disease

Doença cística traqueobrônquica

Hugo Alejandro Vega Ortega, Nelson de Araújo Vega, Jece Comparini, Leonardo Vieira do Carmo, Luciano Penha Pereira

J Bras Pneumol.2001;27(6):349-354

Abstract PDF PT

Air cysts abnormally emerging from the trachea and/or larger bronchi is an extremely rare disease. Only a few isolated cases of paratracheal air cysts associated with chronic lung diseases have been described in the literature. The aim of this communication is to describe two cases of this rare, clinical entity in members of the same family. The father of the patients died from this disease at 43 years of age and his two daughters are currently under treatment. The clinical findings are similar to those of chronic pulmonary suppuration syndrome. The diagnosis was established by bronchovideoscopy, axial CT with 3D reconstitution and virtual bronchoscopy. The patients are under observation and palliative treatment is being administered.

 


Keywords: Lung diseases. Cysts. Trachea. Bronchi. Bronchoscopy. Computed tomography.

 

 


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