Brazilian Journal of Pulmonology

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


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Year 2005 - Volume 31  - Number 1  (January/February)


1 - New times, old challenges

Novos tempos, antigos desafios

José Antônio Baddini Martinez

J Bras Pneumol.2005;31(1):

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2 - Environmental control in asthma - to recommend or not recommend: that is the question!

Controle ambiental na asma: recomendar ou não recomendar, eis a questão!

Luisa Karla Arruda

J Bras Pneumol.2005;31(1):

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Original Article

3 - Relationship between home environmental control and exacerbation of asthma in children and adolescents in the city of Camaragibe in the state of Pernambuco, Brazil

Associação entre controle ambiental domiciliar e exacerbação da asma em crianças e adolescentes do município de Camaragibe, Pernambuco*

Rosane M. Barreto de Melo, Luciane S. de Lima, Emanuel S.Cavalcanti Sarinho

J Bras Pneumol.2005;31(1):5-15

Abstract PDF PT PDF EN Portuguese Text

Background: Hypersensitivity to dust mites, mold and pet dander found in the home is common among patients with asthma. Home environmental control to reduce exposure to allergens is one of various therapeutic measures that can be taken. Objectives: To determine the prevalence of adequate home environmental control among a study population monitored by the Family Health Program and to identify any possible correlation with the exacerbation of asthma among children between the ages of 5 and 14 in the city of Camaragibe, located in the state of Pernambuco, Brazil. Method: A transversal study was carried out involving 210 mothers/guardians of children, to whom International Study of Asthma and Allergies in Children questionnaires were administered in order to characterize the exacerbation of asthma attacks. The Environment Assessment Guide of Allergic Patients was used to assess the bedrooms and living rooms in the home. Results: Among the 210 asthmatic children and adolescents evaluated in 2001, adequate home environmental control was observed in 141 (67.1%), and no correlation was observed between the degree of environmental control and fewer (< 3) asthma attacks (p = 0.39). Regarding the rooms where the asthmatic patients sleep, inappropriate furnishings were found in the homes of 93 patients (44.3%), including rag curtains in 84 cases (40.2%). Passive smoking was reported in 77 cases (36.7%). Conclusion: The level of home environmental control was satisfactory in the great majority of the residences, which may have contributed to the fact that no correlation was found between home environmental control and lower frequency of acute asthma attacks among the population studied.


Keywords: Key Words: Asthma. Environment Control. Frequency of Attacks.


4 - The effect of esophageal acidification on bronchial obstruction in asthmatics with gastroesophageal reflux

Efeito da acidificação esofágica na obstrução brônquica de pacientes asmáticos com refluxo gastroesofágico*

Ana Carla Sousa de Araujo, Lílian Rose Otoboni Aprile, João Terra Filho, Roberto Oliveira Dantas, Milton Arruda Martins, Elcio Oliveira Vianna

J Bras Pneumol.2005;31(1):

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Background: The relationship between asthma and gastroesophageal reflux is, as yet, not completely understood. Among the mechanisms thought to be responsible for gastroesophageal reflux-related worsening of asthma symptoms are the vagovagal reflex and microaspiration. Objective: To assess forced expiratory volume in one second after acid infusion. Method: This study investigated the effect of acid infusion in 13 volunteers with moderate asthma and gastroesophageal reflux. Spirometry was performed before and after insertion of an 8F nasogastric tube and a pH meter. After 15 minutes of saline solution infusion into the midpoint between the upper esophageal sphincter and lower esophageal sphincter, and again after 15 minutes of esophageal acidification (with hydrochloric acid) of the same area, forced expiratory volume in one second was reassessed. Acidification was repeated every 5 minutes until forced expiratory volume in one second values stabilized (variation: < 5%). Results: Mean forced expiratory volume in one second values remained stable during the tube insertion, saline infusion, initial hydrochloric acid infusion and subsequent hydrochloric acid infusion procedures (p = 0.72). Lower forced expiratory volume in one second values were seen resulting from the tube insertion in two patients (drops of 11% and 22%, respectively), after saline infusion in another two (drops of 13% and 14%) and after acid infusion in 1 (a drop of 22%). Conclusion: Esophageal acidification over short periods does not lead to spirometric alterations in a group of asthmatics with gastroesophageal reflux. However, in some cases, simple esophageal procedures or infusions result in bronchospasm.


Keywords: Key words: Asthma. Gastroesophageal reflux. Respiratory function tests. Endoscopy/methods.


5 - Effect of adenosine on pulmonary circulation in patients with primary pulmonary hypertension

Ação da adenosina na circulação pulmonar de pacientes com hipertensão pulmonar primária

Rogerio Souza, Marcelo Britto Passos Amato, Sergio Eduardo Demarzo, Daniel Deheinzelin, Carmen Silvia Valente Barbas, Pedro Caruso, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2005;31(1):

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Background: The nucleoside adenosine is a potent vasodilator. Although its effect on the pulmonary arteries is well known, its influence on capillaries and veins has yet to be described. Objective: To evaluate the pre- and post-administration effects of adenosine on arterial and venous resistance in the pulmonary circulation of patients with primary pulmonary hypertension. Method: The study involved 7 patients with primary pulmonary hypertension and presenting a positive response to adenosine on the acute test. Before and after adenosine administration, arterial and venous resistances were determined by estimating pulmonary capillary pressure through analysis of pulmonary artery pressure decay curves. Results: Following adenosine administration, there was an increase in the cardiac index (from 1.71 ± 0.23 to 2.72 ± 0.74 L/min-1/m-2) and a decrease in pulmonary vascular resistance (from 2924 ± 1060 to 1975 ± 764 dynes/s/cm-5/m-2) with no significant variations in mean pulmonary artery pressure (pre: 75.6 ± 16.8 mmHg; post: 78.1 ± 18.8 mmHg), pulmonary wedge pressure (pre: 15.3 ± 1.5 mmHg; post: 15.4 ± 1.9 mmHg) and pulmonary capillary pressure (pre: 43.8 ± 5.8 mmHg; post: 44.5 ± 4.9 mmHg). The ratio between arterial resistance and total pulmonary vascular resistance also presented a less than significant variation (pre: 50 ± 15%; post: 49 ± 17%). These findings suggest that adenosine affects the capillaries and veins as well as the arteries. Conclusion: We can conclude that the adenosine mechanism is not restricted to the arterial aspect of the pulmonary circulation, and that analysis of pulmonary capillary pressure could prove useful in the study of various drugs that affect the pulmonary circulation.


Keywords: Key Words: Adenosine/pharmacocinetic. Adenosine/uso terapêutico. Blood pressure. Hypertension pulmonary.


6 - Analysis of acute and chronic vascular remodeling in an experimental model of pulmonary ischemia

Análise da remodelação vascular na isquemia pulmonar experimental, nas fases aguda e crônica

Wanderley M. Bernardo, Fabio B. Jatene, Lea Maria M. F. Demarchi, Vera Luiza Capelozzi, Rogério Pazetti, Dolores H. R. F. Rivero¸ Rosangela Monteiro, Sérgio A. de Oliveira

J Bras Pneumol.2005;31(1):

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Background: Structural alterations to the pulmonary circulation characterize the vascular remodeling process and are likely correlated with local variations in flow and ischemia. Objective: To define the histological alterations to the pulmonary circulation seen after experimentally-induced ischemia of the pulmonary artery and to correlate those alterations with known patterns of blood redistribution and vascular remodeling. Method: Wistar rats (n = 48) were randomized into two groups with ligation of the pulmonary artery and without (controls) and were sacrificed on post-ischemia days 1, 7, 30 and 60. Lungs were removed and inspected for signs of parenchymal injury. External diameters, as well as wall thicknesses in the pulmonary, alveolar and bronchial end arterioles, were measured. Internal diameter and wall thickness percentage were calculated. Results: Infarction, necrosis and hemorrhage occurred only in ischemic lungs. In nonischemic lungs, there was a sustained increase in the internal and external arteriolar diameters, with an initial reduction in wall thickness on day 1, and day-60 values were similar to those seen in controls. In ischemic lungs, there was a transitory reduction in the internal and external diameters of the pulmonary and bronchial end arterioles, together with an initial, equally transitory, increase in their wall thickness. The alveolar arterioles presented sustained and progressive increases in external diameter and wall thickness, with concomitant reductions in internal diameter. Conclusion: This model mimics distal arterial disease in patients with chronic pulmonary thromboembolism. The vascular response in nonischemic lungs was consistent with a pattern of flow remodeling, whereas that seen in ischemic lungs was more consistent with flow and ischemia. In the pulmonary and bronchial end arterioles, the response was transitory, in contrast to the sustained and progressive response seen in the alveolar arterioles, which was probably caused by delayed local flow.


Keywords: Key-words: Pulmonary embolism. Pulmonary circulation. Vascular remodelling. Pulmonary artery.


7 - Lung volume reduction surgery in an experimental rat model of emphysema

Cirurgia de redução do volume pulmonar em modelo experimental de enfisema em ratos

Laerte Brasiliense Fusco, Marcelo Heleno Fonseca, Paulo Manuel Pêgo-Fernandes, Rogério Pazetti, Vera Capelozzi, Fabio Biscegli Jatene, Sergio Almeida Oliveira

J Bras Pneumol.2005;31(1):

Abstract PDF PT PDF EN Portuguese Text

Background: Lung volume reduction surgery may be a viable treatment alternative for emphysema patients suffering from severe respiratory insufficiency. Objectives: To evaluate functional and morphological aspects of emphysematous rat lungs, prior to and following lung volume reduction surgery. Method: Wistar rats were divided into two experimental groups (papain without surgery and papain with surgery) and three control groups (saline without surgery, saline with surgery and papain without mechanical ventilation). After approximately 40 days of endotracheal instillation of papain or saline solution, animals in the papain with surgery and saline with surgery groups were submitted to bilobectomy of the middle lobes by right thoracotomy along the posterior border of the superior vena cava. After 1 week, the same animals were submitted to a mechanical ventilation study, which involved measurement of lung elasticity and airway resistance. For all of the animals studied, lung tissue was analyzed in order to determine alveolar diameter and the elastic fiber quantity. Results: Morphometric analysis revealed higher mean alveolar diameter in the lungs of all animals exposed to papain as compared to those exposed to saline. Elastic fiber counts in the alveolar septa of animals treated with papain were lower than those of animals receiving saline. In the animals submitted to bilobectomy and papain, lung elasticity was greater than in those receiving papain without surgery and was statistically equal to that seen in animals receiving saline (with or without surgery). Conclusion: In the respiratory systems of animals with pulmonary emphysema submitted to lung volume reduction by bilobectomy, the capacity for elastic recoil returned to values equivalent to those of the control group animals.


Keywords: Key words: Pulmonary emphysema. Papain/drugs efects. Case-control studies. Disease models, animal. Respiratory mechanics/drugs efects. Lung/sugery. Lung/anatomy & histology.


8 - Postoperative respiratory complications from elective and urgent/emergency surgery performed at a university hospital

Complicações respiratórias no pós-operatório de cirurgias eletivas e de urgência e emergência em um Hospital Universitário

Luiz Joia Neto, João Carlos Thomson, Jefferson Rosa Cardoso

J Bras Pneumol.2005;31(1):

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Background: Respiratory complications have been the focus of studies aiming to identify methods of reducing postoperative morbidity/mortality and controlling the cost of treatment. Objectives: To estimate the incidence of the respiratory complications in patients submitted to elective or urgent/emergency surgical procedures and determine any correlations between respiratory complications and potential risk factors. Method: A retrospective cohort study of patients submitted to elective or urgent/emergency surgery at a university hospital during 2001. The sample was restricted to patients hospitalized for at least 24 hours following surgery. Data were collected from patient charts and according to protocol. Results: Of the 5075 patients submitted to elective or urgent/emergency surgery during the year 2001, 1345 (25.5%) were included in the study. There was no statistically significant difference between elective surgery and urgent/emergency surgery in terms of respiratory complications. The incidence of respiratory complications was 11.7%. The most frequent complication (at 52.5%) was pneumonia. Overall mortality was 7.2% and 27.8% of deaths were related to respiratory complications. Conclusion: The incidence of postoperative respiratory complications was 11.7% (11.3% in elective surgery and 12.3% in urgent/emergency surgery). Pneumonia was the most frequent complication. The risk factors that correlated with respiratory complications were previous lung disease, use of a nasogastric tube, admission to the intensive care unit, endotracheal intubation and tracheostomy.


Keywords: Key words: Postoperative complications. Lung diseases/complications. Risk factors. Cohort studies 


9 - Quality of life before and after pulmonary thromboendarterectomy: Preliminary results

Qualidade de vida antes e após tromboendarterectomia pulmonar. Resultados preliminares

Pedro Rodrigues Genta, Fábio Biscegli Jatene, Mário Terra-Filho

J Bras Pneumol.2005;31(1):

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Background: Pulmonary hypertension secondary to chronic thromboembolism is a severe and debilitating disease and has been associated with high mortality. Pulmonary thromboendarterectomy is the treatment of choice. Objective: To evaluate the impact of pulmonary thromboendarterectomy on the quality of life of patients with pulmonary hypertension secondary to chronic thromboembolism using the SF-36 Health Survey. Method: The SF-36 Health Survey questionnaire was administered to 13 patients prior to and at least 3 months following thromboendarterectomy. Results: Of the 13 patients studied, 7 were female and 6 were male. Mean age was 45.7 ± 18.3. All were submitted to thromboendarterectomy. After surgery, all SF-36 domains, with the exception of the "mental health" domain, improved. Conclusion: Pulmonary thromboendarterectomy provides significant improvement in patient quality of life.


Keywords: Key words: Hypertension pulmonary. Pulmonary embolism. Endarterectomy/methods. Quality of life.


10 - Acute pulmonary histoplasmosis in the state of Rio Grande do Sul, Brazil

Histoplasmose pulmonar aguda no Rio Grande do Sul

Gisela Unis, Eliane Wurdig Roesch, Luiz Carlos Severo

J Bras Pneumol.2005;31(1):

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Background: Acute pulmonary histoplasmosis is a respiratory infection occurring when an otherwise healthy individual inhales a large quantity of fungal propagules. Length of exposure determines disease severity. An epidemic is influenced by factors affecting the growth and transmission of Histoplasma capsulatum var. capsulatum in nature. Objective: To identify epidemiological and clinical aspects of patients with acute pulmonary histoplasmosis in the state of Rio Grande do Sul (RS) and compare these aspects with those of other cluster outbreaks reported in Brazil. Method: The charts of 212 patients diagnosed with histoplasmosis over a 25-year period (1977-2002) were obtained from the archives of the Laboratório de Micologia from Complexo Hospitalar Santa Casa (Santa Casa Hospital Mycology Laboratory), in the city of Porto Alegre (RS). In reviewing these patient charts, we identified and included in the study cases of acute pulmonary histoplasmosis in which there was a positive culture and/or histopathological findings consistent with the diagnosis. Outbreaks were defined as one confirmed case or positive immunodifusion Histoplasma capsulatum with compatible clinical history. All reported Brazilian outbreaks were reviewed. Results: Of the 212 patient charts reviewed, 18 (8.5%) were selected for inclusion in the study. Among those 18 patients, ages ranged from 8 to 63 years (median, 35.4), and 67% were male. Epidemiological histories were suggestive of the disease in 11 patients (61%). The most common disease type, seen in 17 patients (95%), was primary acute pulmonary histoplasmosis, and there was a predominance of isolated cases. Conclusion: The identification of isolated cases and the presence of cluster outbreaks demonstrate the abundance of H. capsulatum in the soil and, together with the occurrence of all forms of the disease, confirms the assumption that Rio Grande do Sul is a hyperendemic region for histoplasmosis.


Keywords: Key words - Histoplasmosis/epidemiology. Histoplasmosis/diagnostic. Histoplasma. Medical records. Retrospective studies.


Review Article

11 - Oxygen free radicals and pulmonary disease

Os radicais livres de oxigênio e as doenças pulmonares

Dahir Ramos de Andrade Júnior, Rodrigo Becco de Souza, Sânia Alves dos Santos, Dahir Ramos de Andrade

J Bras Pneumol.2005;31(1):

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Oxygen free radicals are molecules that present unpaired electrons in their outer orbit and can transform other molecules such as proteins, carbohydrates, lipids and deoxyribonucleic acid. Oxygen free radicals are produced in various clinical conditions in which hypoxic microenvironments are generated and reoxygenation follows. Such situations include clinical shock, septicemia, systemic inflammatory response, fulminant hepatitis, organ transplant and respiratory failure. In this review, we discuss the main concepts related to oxygen free radicals: the principal types and their formation, as well as the way in which they affect cellular structures and cause significant tissue damage. We present also the main antioxidants that guard against oxidative stress, including glutathione, glutathione peroxidase, superoxide dismutase, catalase, and N-acetylcysteine. The influence of oxygen free radicals on the principal pulmonary diseases are also discussed, with special emphasis given to oxygen free radicals in cigarette smoke, chronic obstructive pulmonary disease, asthma, sleep apnea syndrome and acute respiratory distress syndrome.


Keywords: Key words: Oxygen free radicals. Antioxidant substances. Oxidative stress. Lung diseases.


12 - Postpneumonectomy pulmonary edema

Edema pulmonar pós-pneumonectomia

Marcos Naoyuki Samano, Luis Miguel Melero Sancho, Ricardo Beyruti, Fábio Biesegli Jatene

J Bras Pneumol.2005;31(1):

Abstract PDF PT PDF EN Portuguese Text

Although pneumonectomy is a technically simple procedure, it has been associated with a high (60%) incidence of complications. Respiratory complications account for approximately 15% of such complications. Worldwide, the mortality rate among patients subjected to pneumonectomy is 8.6%. However, the rate among patients developing respiratory complications is 30%. Although postpneumonectomy pulmonary edema is rare (occurring in 3% to 5% of cases), it is a serious complication and is almost always fatal. It was first described twenty years ago and, despite these alarming statistics, little is known regarding the physiopathology of postpneumonectomy pulmonary edema. Once it has become entrenched, the condition is difficult to treat, and there is no proven efficient treatment. Various risk factors have been correlated with postpneumonectomy pulmonary edema onset. Fluid overload was the first to be identified as a factor to avoid. However, many studies have shown that there is no direct correlation between fluid overload and the development of edema. Prevention is the best way to avoid postpneumonectomy pulmonary edema and must be performed in a multidisciplinary fashion, involving the entire medical staff - from the initiation of anesthesia through the surgical procedure and extending into the critical care management phase. Equally important is early identification and testing of patients at risk for postpneumonectomy pulmonary edema when there is clinical suspicion of this serious complication.


Keywords: Key Words: Pulmonary edema/complications. Pneumonectomy/adverse effects. Risk factors. Pulmonary edema/prevention & control.


Case Report

13 - Pulmonary metastasis of mediastinal paraganglioma

Paraganglioma de mediastino com metástases pulmonares

Manoel Ximenes Netto, Pedro R. Paniágua, Marcos A. Piauilino, Humberto Alves de Oliveira, Luci Ishii

J Bras Pneumol.2005;31(1):

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Herein, we describe the case of a 27-year-old female presenting with paraganglioma of the anterior and middle mediastinum and bilateral pulmonary nodules. Treatment consisted of pulmonary resection by anterior bilateral thoracotomy and transverse sternotomy, in which the paraganglioma was excised with the aid of extracorporeal circulation. As neoadjuvant treatments, radiotherapy and chemotherapy were applied. Postoperative evolution was uneventful, and the patient was classified as asymptomatic after 14 months.


Keywords: Key words: Mediastinal tumor. Paraganglioma. Lung metastasis


14 - Traumatic pulmonary pseudocyst

Pseudocisto pulmonar traumático

Andreia Salarini Monteiro, Gabriela Addor, David Henrique Nigri, Carlos Alberto de Barros Franco

J Bras Pneumol.2005;31(1):

Abstract PDF PT PDF EN Portuguese Text

Traumatic pulmonary pseudocyst is a rare lesion and is typically seen after blunt chest trauma. Although secondary infection is an uncommon complication, it presents high morbidity and requires immediate treatment. A 28-year-old male motorcycle accident victim was admitted to the hospital with hemoptysis, chest pain, dyspnea and hypoxemia. Computed tomography of the chest revealed pulmonary infiltrate and pseudocysts in the lower lobe of the right lung. The patient developed fever, purulent expectoration and an air-fluid level within the pseudocysts. After culture collection, a course of broad-spectrum antibiotics was started. Clinical improvement was observed, and the patient was discharged 15 days after admission.


Keywords: Key words: Chest trauma. Pseudocyst


15 - Inflammatory pseudotumor of the lung

Pseudotumor inflamatório do pulmão

Jorge Montessi, João Paulo Vieira, Rafael Rabello Lista Mira, Felipe Torres Rabêlo

J Bras Pneumol.2005;31(1):

Abstract PDF PT PDF EN Portuguese Text

Inflammatory pseudotumor of the lung is a rare condition that represents a dilemma because the radiographic, macroscopic and pathological aspects mimic a malignant process. Herein, we report the case of a patient complaining of respiratory difficulty who, after being appropriately assessed, was submitted to exploratory thoracotomy. An initial diagnosis of pseudotumor was subsequently confirmed through immunohistochemistry. In addition to presenting data relating to clinical history, we also discuss radiographic, histopathological and surgical aspects, as well as treatment options.


Keywords: Key Words: Inflammatory pseudotumor of the lung. Toracotomy. Imunohistochemistry


Letters to the Editor

18 - Respiratory physiotherapy in the ICU: Effectiveness and professional certification

Fisioterapia respiratória em UTI: Efetividade e habilitação profissional

Wellington P. S.Yamaguti, Luiz A. Alves, Lucienne T. Q. Cardoso, Carrie C. R. Galvan, Antonio F. Brunetto

J Bras Pneumol.2005;31(1):

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19 - Case management of the patient/family with tuberculosis: a strategy of systematizing home care

Gerenciamento de caso ao doente/família com tuberculose: uma estratégia de sistematização do cuidado no domicílio

Aline Aparecida Monroe, Roxana Isabel Cardozo Gonzales, Cinthia Midori Sassaki, Antônio Ruffino Netto, Tereza Cristina Scatena Villa

J Bras Pneumol.2005;31(1):

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Year 2005 - Volume 31  - Number 2  (March/April)


1 - The International Study of Asthma and Allergies in Childhood (ISAAC): what have we learned?

International Study of Asthma and Allergies in Childhood (ISAAC): o que nos ensinou?

Dirceu Solé

J Bras Pneumol.2005;31(2):93-95

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2 - Pursuing MEDLINE

Perseguindo o MEDLINE

José Antônio Baddini Martinez

J Bras Pneumol.2005;31(2):95-96

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Original Article

3 - Pulmonary function tests in asthmatic children and adolescents: Comparison between a microspirometer and a conventional spirometer

Avaliação funcional pulmonar em crianças e adolescentes asmáticos: comparação entre a micro espirometria e a espirometria convencional

Lúcia Bartmann Wild, Alexandre Simões Dias, Gilberto Bueno Fischer, Daniele Ruzzante Rech

J Bras Pneumol.2005;31(2):97-102

Abstract PDF PT PDF EN Portuguese Text

Background: Spirometry is widely used in the diagnosis and quantification of respiratory disorders such as asthma. A microspirometer is a portable and easily used apparatus that can substitute for a regular spirometer, although there is little evidence of its accuracy. Objective: To compare the microspirometer to a regular spirometer for use in asthmatic children and adolescents. Methods: The instruments used were a Micro Spirometer, manufactured by Micro Medical, and a conventional Cosmed Pony Graphic 3.5 spirometer, both with turbinometers (flow sensors). The study sample consisted of 62 children and adolescents, of both genders, clinically diagnosed with asthma and under treatment at a pulmonology clinic. Ages ranged from 5 and 16 years. All spirometric tests were carried out according to the guidelines established by the American Thoracic Society and by the Associacão Brasileira de Normas Técnicas (Brazilian Technical Standards Association). For each patient, microspirometry was performed first, followed by conventional spirometry. The parameters analyzed in both devices were forced vital capacity, forced expiratory volume in one second and peak expiratory flow. Data were analyzed using the Student's t-test and Pearson's correlation test. Results: Strong correlations were found between the two devices in the parameters analyzed: forced expiratory volume in one second: r = 0.97; forced vital capacity: r = 0.97; and peak expiratory flow: r = 0.91. Conclusion: These results demonstrate that the microspirometer is a useful diagnostic tool that can be used when a conventional spirometer is unavailable.


Keywords: Key words: Asthma. Spirometry. Micro spirometer. Puomonary ventilation.


4 - Prevalence of asthma symptoms and treatment of children and adolescents from 2 to 14 years of age in Porto Alegre, Rio Grande do Sul, Brazil

Prevalência de sintomas de asma e tratamento de crianças e adolescentes de 2 a 14 anos no Campus Aproximado da PUCRS

Brasília Itália C. S. Ache, Fabiane Kahan, Jussara Fiterman

J Bras Pneumol.2005;31(2):103 -110

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Background: In recent decades, the prevalence of asthma has increased. Objectives: To determine the prevalence of asthma symptoms in children and adolescents from 2 to 14 years of age living in Porto Alegre (in the state of Rio Grande do Sul, Brazil) and to determine any potential correlations with socioeconomic profile, treatment and smoking in the home. Methods: A transversal study based on interviews of all families seeking medical attention in June of 2000. Results: The prevalence of asthma symptoms was 49.5%. In 66.8% of families, total income was less than four times the minimum wage, and in more than 50% of homes, the parents had had less than five years of schooling. In 98.5%, prophylactic asthma treatment was not used. In the 174 families studied, 38.7% of mothers and 43.7% of fathers were smokers (32.7% overall). Correlations were found between the following variables: exposure to smoking in the home and number of asthma attacks in the last year (p = 0.02; RR = 2.9; CI: 1.1 - 4.5); maternal level of education and number of attacks in the last year (p = 0.03; RR = 2.03; CI: 1.01 - 4.19); close living quarters and number of attacks in the last year among children exposed to second-hand smoke (p = 0.04; RR = 2.7; CI: 1.4 - 5.1); hospitalization and number of attacks in the last year (p = 0.004; RR = 1.46; CI: 1.15 -1.86); hospitalization and close living quarters (p = 0.03; RR = 1.47; CI: 1.15 -1.86). In children below the age of five, there was correlation between maternal smoking and number of attacks in the last year (p = 0.03; RR = 1.79; CI: 1.04 - 3.08). Conclusion: The prevalence of asthma symptoms was high. The community studied has limited socioeconomic resources, and there is therefore a lack of adequate treatment for asthma. Our results demonstrate the need for prioritized, standardized treatment programs that would give healthcare workers access to the appropriate materials and means of evaluation necessary for asthma control.


Keywords: Key words: Asthma. Prevalence. Smoking in the home. Treatment between episodes of asthma.


5 - Prevalence and severity of asthma symptoms in school-age children in the city of Duque de Caxias, Rio de Janeiro, Brazil

Prevalência e gravidade de sintomas relacionados à asma em escolares e adolescentes no município de Duque de Caxias, Rio de Janeiro

José Laerte Boechat, José Luiz Rios, Clemax Couto Sant'Anna, Alfeu Tavares França

J Bras Pneumol.2005;31(2):111-117

Abstract PDF PT PDF EN Portuguese Text

Background: Asthma is considered the most common chronic childhood disease. However, there have been few studies on the prevalence of asthma in Brazil. Objective: To assess the prevalence and severity of asthma symptoms in school-age children and adolescents living in the city of Duque de Caxias, located in the greater metropolitan area of Rio de Janeiro. Method: Cross-sectional transversal study using the International Study of Asthma and Allergies in Childhood (ISAAC) questionnaire. The sample comprised students of 6, 7, 13 and 14 years of age. Results: One group of 2334 students between the ages of 6 and 7 and another composed of 4040 students between the ages of 13 and 14 were evaluated. The prevalence of wheezing within the last 12 months in the younger children was 27.7%, vs. 19% among the adolescents (p < 0.0001). There was a predominance of males in the 6-7 age group (29.9% vs. 25.6%; p = 0.01) and of females in the 13-14 age group (21.9% vs. 15.8%; p < 0.0001). The proportion of previously diagnosed cases of asthma was similar (approximately 10%) for both age brackets. Wheezing upon physical exertion was more prevalent among the adolescents (21.4% vs. 7.8%; p < 0.0001). Symptom severity was higher among female adolescents (severe asthma: 6.6% vs. 4.4%; p = 0.001), although no differences among genders were seen in the 6-7 age group. Conclusion: Asthma prevalence in Duque de Caxias is high, as it is in other Brazilian and Latin American cities. Values are higher in the 6-7 age group, in which symptoms were seen predominantly in males. Among the adolescents, the prevalence and severity of symptoms were higher in females, a recent observation that seems to be a new epidemiological trend of asthma.


Keywords: Key words: Asthma. Epidemiology. Severity of illness index. Cross-sectional studies.


6 - Efficacy of pulmonary rehabilitation: exercise capacity, respiratory muscle strength and quality of life in patients with chronic obstructive pulmonary disease

A eficácia da reabilitação pulmonar na capacidade de exercício, força da musculatura inspiratória e qualidade de vida de portadores de doença pulmonar obstrutiva crônica

Renata Cláudia Zanchet, Carlos Alberto de Assis Viegas, Terezinha Lima

J Bras Pneumol.2005;31(2):118 -124

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Background: Pulmonary rehabilitation is widely recommended for the treatment of chronic obstructive pulmonary disease. Objective: To evaluate the efficacy of pulmonary rehabilitation in improving exercise capacity, respiratory muscle strength and quality of life of chronic obstructive pulmonary disease patients. Method: This was an open, non-randomized clinical trial involving 27 clinically stable ex-smokers with chronic obstructive pulmonary disease who were enrolled in a pulmonary rehabilitation program. All were evaluated before and after pulmonary rehabilitation. Results: Mean age was 65 ± 5 years, mean body mass index was 25 ± 4 kg/m2, mean forced expiratory volume in one second was 55 ± 25% of predicted, mean ratio between forced expiratory volume in one second and forced vital capacity was 50 ± 12%, and mean arterial oxygen tension was 70 ± 7 mmHg. Comparison of pre- and post-pulmonary rehabilitation values revealed improvement in the distance walked in the 6-minute walk test (513 ± 99 m vs. 570 ± 104 m), maximum upper limb load (2 ± 1 kg vs. 3 ± 1 kg) and maximal inspiratory pressure (-89 ± 23 cmH2O vs. -102 ± 23 cmH2O), as well as in the activity domain, impact domain and total score on the Saint George's Respiratory Questionnaire. Conclusion: Pulmonary rehabilitation, when performed with care and with a focus on physical training, is efficacious in increasing not only the distance walked in the 6-minute walk test but maximum upper limb load, maximal inspiratory pressure and quality of life as well.


Keywords: Key words: Pulmonary rehabilitation. Chronic obstructive pulmonary disease. Quality of life. Respiratory muscles.


7 - Lung volumes, lung capacities and respiratory muscle strength following gastroplasty

Volumes, capacidades pulmonares e força muscular respiratória no pós-operatório de gastroplastia

Denise de Moraes Paisani, Luciana Dias Chiavegato, Sonia Maria Faresin

J Bras Pneumol.2005;31(2):125-132

Abstract PDF PT PDF EN Portuguese Text

Background: Gastroplasty has been increasingly used in the treatment of morbidly obese patients, who typically present pronounced alterations in lung volume and capacity. Objective: To evaluate post-gastroplasty lung volume, lung capacity, respiratory muscle strength and respiratory pattern, as well as any postoperative pulmonary complications. Method: 21 patients (3 of them men), with an average age of 39 ± 9.7 years and an average body mass index of 50.4 kg/m2, all candidates for gastroplasty, were evaluated during the preoperative period and again on the first, third and fifth postoperative days. Tidal volume, vital capacity, minute volume, maximal expiratory pressure and maximal inspiratory pressure, as well as chest and waist circumferences, were measured. Postoperative pulmonary complications and mortality were assessed. Results: On the first and third postoperative days, respectively, there were drops of 47% and 30.5% in vital capacity, 18% and 12.5% in minute volume, 28% and 21% in tidal volume, 47% and 32% in the diaphragmatic index, 51% and 26% in maximal inspiratory pressure, and 39.5% and 26% in maximal expiratory pressure (p < 0.05). On the fifth postoperative day, all variables analyzed were higher than on the first postoperative day, indicating a linear increase, with only tidal volume, minute volume diaphragmatic index returning to preoperative values. The incidence of postoperative pulmonary complications was 4.7%, and there were no deaths. Conclusion: Patients submitted to gastroplasty present reduced pulmonary function, following a pattern quite similar to that previously observed following other types of upper abdominal surgery.


Keywords: Key words: Gastroplasty. Obesity. Respiratory function tests. Postoperative care.


8 - Analysis of treatment outcomes related to the tuberculosis control program in the city of Campinas, in the state of São Paulo, Brazil

Análise do programa de controle da tuberculose em relação ao tratamento, em Campinas - SP

Helenice Bosco de Oliveira, Leticia Marin-León, Jovana Gardinali

J Bras Pneumol.2005;31(2):133-138

Abstract PDF PT PDF EN Portuguese Text

Background: Tuberculosis cure is dependent upon treatment adherence. Objective: To analyze the results of tuberculosis treatment in public health clinics in the city of Campinas, in the state of São Paulo, Brazil, during 2002. Method: From a cohort of 484 patients diagnosed with tuberculosis, we evaluated 436. Treatment outcomes were described for all patients, whether new patients or patients in retreatment, including those presenting the pulmonary form, with or without acquired immunodeficiency syndrome (AIDS) comorbidity. Results: The success rate was 68.6% (72.3% among non-AIDS patients and 57.6% among AIDS patients). Among new cases, the non-AIDS group presented a 2.2-times greater chance of presenting favorable results. In the AIDS group, no differences were observed between new patients and those in retreatment. Among the unfavorable outcomes, only lethality presented a difference (18.9% among AIDS patients and 8.0% among non-AIDS patients). In patients presenting the pulmonary form, the success rate was similar between those who were initially acid-fast bacilli positive and those who were not. Conclusion: The tuberculosis control program in Campinas presented low effectiveness. In comparison to the 2001 national cohort, success rates were higher for non-AIDS patients but lower for AIDS patients. The higher success rate among cases of tuberculosis without AIDS was primarily derived from the treatment of new cases. The unfavorable profile of tuberculosis patients co-infected with AIDS, characterized by the (18.9%) lethality and the (15.3%) noncompliance, were partially responsible for the lower success rate seen among such patients. It is notable that such high proportions of noncompliant patients were seen in a city providing easy access to treatment. In order to improve the program, medical teams should receive further training in supervised treatment, health education and techniques for interacting with patients, all of which will require considerable investment.


Keywords: Key words: Tuberculosis. Treatment Refusal. Retreatment. Acquired Immunodeficiency Syndrome. Comorbidity


9 - Coexistence of intracavitary fungal colonization (fungus ball) and active tuberculosis

Coexistência de colonização fúngica intracavitária (bola fúngica) e tuberculose ativa

Gisela Unis, Pedro Dornelles Picon, Luiz Carlos Severo

J Bras Pneumol.2005;31(2):139-143

Abstract PDF PT PDF EN Portuguese Text

Background: Although pulmonary tuberculosis is the principal predisposing factor for intracavitary fungal colonization, the coexistence of the two diseases is rare. Simultaneity of fungal colonization and active mycobacteriosis in the same cavity (acid-fast bacilli found among hyphal masses) is highly unusual. Objective: To describe clinical findings, diagnostic procedures, radiographic aspects, accompanying conditions and evolution in patients with tuberculosis and fungus ball. Method: We reviewed, retrospectively, the records of 625 patients diagnosed with fungus ball between 1974 and 2002. All of the patients had been diagnosed through immunodiffusion or mycological study, or both. The inclusion criterion was positivity for acid-fast bacilli in sputum smear microscopy or histopathology. Results: The charts of 14 patients were selected. All had presented hemoptysis, followed by productive cough, dyspnea, weight loss, fever, asthenia and chest pain. In one patient colonized by Aspergillus niger and in another colonized by Scedosporium apiospermum (Teleomorph, Pseudallescheria boydii), active tuberculosis was seen concomitant to the fungus ball. In the remaining cases, the mycobacteria were found in the adjacent parenchyma or in the contralateral lung. Conclusion: This study corrobates the assertion that antagonism exists between Mycobacterium tuberculosis and Aspergillus fumigatus. The potential for fungal colonization and mycobacteriosis to occur concomitantly is demonstrated in other fungal agents, S. apiospermum (P. boydii) and A. niger in particular.


Keywords: Key words: Aspergillosis. Aspergillus fumigatus. Aspergillus niger. Pseudallescheria. Mycobacterium tuberculosis. Scedosporium apiospermum.


10 - Influence of vial size on the results of the tuberculin test

Influência do tamanho do frasco de tuberculina nos resultados da prova tuberculínica

Antonio Ruffino-Netto, Afranio Lineu Kritski, Eleny Guimarães Teixeira, Carla Conceição dos Santos Loredo, Danielle Novelo de Souza, Anete Trajman

J Bras Pneumol.2005;31(2):144-148

Abstract PDF PT PDF EN Portuguese Text

Background: Tuberculin purified protein derivative is stored in vials of various sizes. Its adsorption to the vial can influence the results of tuberculin tests. Objective: To evaluate the effect of vial size on the results obtained in tuberculin tests. Methods: Sixty-four inpatients with active tuberculosis were submitted to two simultaneous tuberculin tests using the Mantoux technique. Patients were randomly allocated to receive two 0.1-ml injections, either one in the right forearm from a 1.5-ml vial and one in the left forearm from a 5-ml vial or vice versa. Induration was determined in a blinded fashion by a single, previously trained observer. Right arm-left arm differences of 2 mm or less were considered concordant results. Results: Twenty-one patients presented no induration and were excluded from analysis. Among the 42 remaining patients, mean induration diameters obtained in tuberculin tests using the larger vials were greater than those obtained in tests using the smaller vials. Concordance was achieved in 40.5% (17/42). The difference was negative (large-vial indurations smaller than small-vial indurations) in 16.7% (7/42) and positive in 42.9% (18/42). Conclusions: The size of the vial may influence tuberculin test results. Adsorption to the sides of the vial may explain this phenomenon. The authors caution others to be aware of the impact of these variations in epidemiological and operational studies.


Keywords: Key words: Tuberculin Skin Test. Tuberculin. Adsorption. PPD. Mantoux.


Guidelines SBPT

11 - Brazilian Consensus on Terminology Used to Describe Computed Tomography of the Chest

Consenso Brasileiro sobre a Terminologia dos Descritores de Tomografia Computadorizada do Tórax

Brazilian Society Of Pulmonology and Phthisiology, Department of Diagnostic Imaging 2002-2004 Biennium

J Bras Pneumol.2005;31(2):149-156

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Review Article

12 - Portopulmonary hypertension

Hipertensão portopulmonar

Eduardo Garcia, José Silva Moreira, Ajácio Bandeira de Melo Brandão, Alessandra Isabel Zille, Juliana Cardozo Fernandes

J Bras Pneumol.2005;31(2):157-161

Abstract PDF PT PDF EN Portuguese Text

Portal hypertension and cirrhosis can result in complex changes in the pulmonary vascular bed, the most important among them being the hepatopulmonary syndrome and portopulmonary hypertension. When pulmonary hypertension accompanies cirrhosis and portal hypertension, it is seldom diagnosed. Its prevalence is estimated to range from 1% to 2% in patients with portal hypertension or cirrhosis, regardless of gender, and the condition is predominantly seen in patients in their 40s. Etiologic factors have not been sufficiently well defined to explain the increase in pulmonary artery pressure and pulmonary vascular resistance. Most patients are asymptomatic until developing dyspnea on exertion, which generally occurs when the mean pulmonary artery pressure exceeds 40 mmHg. Concomitant hepatic disease with progressive hypoxemia or right ventricular failure increase mortality rates. Further studies are needed in order to determine the benefits of using oral, inhaled or intravenous vasodilators, as well as to evaluate the outcomes of liver transplant, which may be the sole definitive therapeutic option.


Keywords: Key words: Oxygen free radicals. Antioxidant substances. Oxidative stress. Lung diseases.


13 - Respiratory disturbance during sleep in chronic obstructive pulmonary disease

Perturbação respiratória durante o sono em doença pulmonar obstrutiva crônica

Ana C. Krieger

J Bras Pneumol.2005;31(2):162-172

Abstract PDF PT PDF EN Portuguese Text

Chronic obstructive pulmonary disease is a prevalent condition and is currently the forth leading cause of mortality in the US. The prevalence of respiratory disturbance during sleep, or overlap syndrome as it was commonly known in the past, is still undetermined as conflicting reports have been published. Because of the adverse effects of sleep-related respiratory impairment in patients with underlying pulmonary disease, this condition deserves further investigation. In this report, we will briefly discuss the mechanisms involved in generating respiratory disturbance during sleep in Chronic Obstructive Pulmonary Disease and will guide the reader into distinguishing those patients who would benefit from a more detailed sleep evaluation, discussing management issues and treatment options.


Keywords: Key words: COPD. Sleep disorder breathing. Sleep apnea. Hypoxemia. Hypoventilation


Case Report

14 - Langerhans-cell histiocytosis: rapid resolution after smoking cessation

Histiocitose de células de Langerhans: rápida resolução após cessação do tabagismo

José Miguel Chatkin, Vinicius D. Silva, Carlos C. Fritscher, Jussara Fiterman, Cláudia Reck

J Bras Pneumol.2005;31(2):173-176

Abstract PDF PT PDF EN Portuguese Text

We describe a case of pulmonary Langerhans cell histiocytosis with a close temporal relationship between smoking cessation and radiological improvement. High-resolution computed tomography revealed multiple small nodules located in the upper and middle lobes of both lungs. Microscopy of these lesions showed histiocytic infiltration that reacted strongly to staining for S100 protein. The histiocytes resembling Langerhans cells showed strong reactivity for S100 protein. Smoking cessation was recommended and the patient complied. Chest X-ray and computed tomography performed 6 and 24 months later revealed almost complete resolution of the radiographic abnormalities. Despite the possibility that this evolution was attributable to spontaneous remission, in this case, the lesions did, in fact, disappear rapidly after smoking cessation.


Keywords: Key words: Histiocytosis. Langerhans-Cell. Tabaco use cessation.


15 - Multiple pulmonary metastases of benign meningioma

Múltiplas metástases pulmonares de meningioma benigno

Adalberto Sperb Rubin, Liliana Gomes Pellegrin, Nelson da Silva Porto, Geraldo Geyer.

J Bras Pneumol.2005;31(2):177-180

Abstract PDF PT PDF EN Portuguese Text

Meningiomas account for approximately one-sixth of all primary neoplasms of the central nervous system and rarely present extracranial metastases. A finding of multiple metastases is rare, as is the presence of respiratory symptoms. Herein, we report the case of a 67-year-old female patient presenting subacute onset of respiratory symptoms. The patient had undergone resection of a benign intracranial meningioma six months prior, but had no history of lung disease. Upon examination, multiple pulmonary metastases, originating from the primary tumor, were observed.


Keywords: Key words: Meningioma. Neoplasm Metastasis. Lung Neoplasms..


16 - Thoracic ectopic kidney

Rim intratorácico ectópico

Claudinei Leôncio Beraldo, Eugênio Fernandes de Magalhães, Demétrius Tierno Martins, Douglas Silva Coutinho, Lívia Silva Tiburzio, Mário Ribeiro Neto.

J Bras Pneumol.2005;31(2):181-183

Abstract PDF PT PDF EN Portuguese Text

Thoracic ectopic kidney is a rare anomaly, the rarest of all renal ectopia types (p = 0.005%). Herein, we describe a case of thoracic ectopic kidney in an 83-year-old black man who, upon seeking medical attention, presented a clinical profile consistent with pulmonary emphysema. A chest X-ray was ordered, and the results showed evidence of a mass, which was then diagnosed (through computed tomography) as renal ectopia. The majority of thoracic ectopic kidney cases present as an intrathoracic tumor seen on chest X-rays ordered for reasons other than suspicion of this anomaly and do not require special treatment.


Keywords: Key words: Ectopic. Renal. Thoracic. Lung.


Year 2005 - Volume 31  - Number 3  (May/June)


1 - The Sociedade Brasileira de Pneumologia e Tisiologia (Brazilian Society of Pulmonology and Phthisiology) and its international relationships

A Sociedade Brasileira de Pneumologia e Tisiologia e as suas relações internacionais

Mauro Zamboni

J Bras Pneumol.2005;31(3):187-188

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2 - The utility of molecular biology in the diagnosis of tuberculosis

A utilidade da biologia molecular no diagnóstico da tuberculose

Fernanda Carvalho de Queiroz Mello, Joseane Fonseca-Costa

J Bras Pneumol.2005;31(3):188-190

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Original Article

3 - Prevalence of asthma among adolescents in the city of Santa Maria, in the state of Rio Grande do Sul, Brazil. International Study of Asthma and Allergies in Childhood (ISAAC) Project

Prevalência de asma em adolescentes urbanos de Santa Maria (RS). Projeto ISAAC - International Study of Asthma and Allergies in Childhood

Vitor Emanuel Cassol, Dirceu Solé, Sérgio Saldanha Menna-Barreto, Stefenia Pigatto Teche, Tiago Moraes Rizzato, Martin Maldonado, Diogo Ferrari Centenaro, Eliane Zenir Colpo Moraes

J Bras Pneumol.2005;31(3):191-196

Abstract PDF PT PDF EN Portuguese Text

Background: Asthma is the most common chronic disease among adolescents. Objective: To determine the prevalence of asthma and asthma-related symptoms using the International Study of Asthma and Allergies in Childhood (ISAAC) protocol to evaluate adolescents in the city of Santa Maria, located in the state of Rio Grande do Sul, Brazil. Method: A cross-sectional study evaluating 3066 schoolchildren from 13 to 14 years of age, selected by random sampling, as indicated in the ISAAC protocol. Data were collected from March to June of 2003 using the standardized ISAAC questionnaire, which was completed by the adolescents in the classroom and under the supervision of the researchers. Results: A total of 3066 valid questionnaires (95.5%) were collected. Among the asthma-related symptoms evaluated, the following prevalences were determined: history of wheezing: 42.1%; wheezing within the last 12 months: 16.7%; four or more wheezing attacks within the last 12 months: 1.9%; sleep disturbance on one or more nights a week within the last 12 months: 3.8%; impaired speech within the last 12 months: 3.8%; history of asthma: 14.9%; wheezing after exercise within the last 12 months: 19%; dry cough at night within the last 12 months: 32.4%. Values were significantly higher among females. Conclusion: The prevalence of asthma-related symptoms among adolescents living in the city of Santa Maria was high, predominantly among the females. However, the rate was comparable to the international average and was lower than those observed in larger metropolitan areas in Brazil. These findings underscore the need for regional studies in order to better understand the prevalence of asthma in Brazil.


Keywords: Asthma. Adolescent. Epidemiology.


4 - Radiological profile of the ideal candidate for lung volume reduction surgery to treat emphysema: a systematic review

Perfil radiológico do candidato ideal à cirurgia redutora de volume pulmonar no enfisema: uma revisão sistemática

Paula Antonia Ugalde Figueroa, Martha Silvia Martinez-Silveira, Eduardo Ponte, Aquiles Camelier, Jorge L. Pereira-silva

J Bras Pneumol.2005;31(3):197-204

Abstract PDF PT PDF EN Portuguese Text

Background: Lung volume reduction surgery is an alternative treatment for advanced pulmonary emphysema. Radiological evaluation of the type and distribution of emphysema, together with the results of pulmonary function testing, seem to be the main criteria used in deciding whether or not the procedure is indicated. Objective: To determine the extent of scientific evidence available regarding the radiological profile of the ideal candidate for lung volume reduction surgery. Method: A systematic review of the literature from January 1994 to January 2004 using the following databases: MEDLINE, EMbase, LILACS, The Cochrane Library and EBM Reviews. Results: Of 208 articles identified, 16 met the study criteria. Two were randomized (one multicentric, named the 'National Emphysema Treatment Trial' and including 1218 patients, and the other including only 30 patients). The other 14 articles were observational studies. The National Emphysema Treatment Trial identified a subgroup of patients with favorable prognoses when submitted to lung volume reduction surgery. This group consisted of patients with advanced heterogeneous pulmonary emphysema with upper lobe predominance, diffuse pulmonary distention and low exercise capacity. The pattern of the results obtained in the remainder of the studies was consistent with the individual analyses, despite their heterogeneity. In the observational studies, surgical benefit, mortality rates and quality of life were assessed. Conclusion: The radiological pattern, characterized by the type, heterogeneity, distribution and diffuse distention, together with the degree of emphysema severity, represents the main predictor of a positive surgical outcome. Due to the paucity of studies in the literature, this is a grade B recommendation.


Keywords: Pulmonary emphysema. Lung surgery. Tomography X-ray computed. Review.


5 - Utility of a scoring system and indicative variables for assessing the need for pleural drainage in pediatric patients with parapneumonic pleural effusion

Utilidade de um escore e de variáveis indicativas de drenagem pleural em crianças com derrame pleural parapneumônico

Gláucia de Oliveira Moreira, José Dirceu Ribeiro, Antonia Terezinha Tresoldi

J Bras Pneumol.2005;31(3):205-211

Abstract PDF PT PDF EN Portuguese Text

Background: The decision to drain parapneumonic pleural effusion in children is still controversial. An indicative scoring system to assess the need for chest-tube drainage arose from a partnership between pediatricians and surgeons. Objective: To evaluate the utility of the score in indicating whether drainage should be performed in pediatric patients with parapneumonic effusion. Method: A cross-sectional study involving 250 inpatients with parapneumonic effusion, treated in a tertiary-care hospital between 1994 and 1999. The following variables were analyzed: clinical presentation, chest X-rays, pleural fluid culture and biochemical analysis of the pleural fluid, as well as the score and treatment. The score was based on four categories: general appearance of the pleural fluid, chest X-rays, laboratory findings, and the second thoracentesis. Drainage was recommended for patients scoring higher than 5.5. Results: Of 941 children with pneumonia, parapneumonic effusion occurred in 304 (32.2%), 250 of which were included in the study. Of those, 146 (58.4%) were male, with mean of age of 3 years (median, 2 years). The cutoff points (determined through receiver operating characteristic curve analysis) for suggesting pleural drainage were pH < 7.29 (89.2% sensitivity and 76.5% specificity), score > 5.0 (68.7% sensitivity and 81.7% specificity). These values were more strongly correlated with the need for drainage (p = 0.001), as were those reported in the literature (pH = 7.0 and glucose < 40). The lactate dehydrogenase did not prove to be a good parameter for indicating a need for drainage. Conclusion: In addition to the purulent aspect, pH = 7.29 and score were the best indicators of the need for chest-tube drainage in pediatric patients with parapneumonic effusion. However, we suggest that some score variables be readjusted to improve the usefulness of this particular scoring system.


Keywords: Empyema. Pleural effusion. Pneumonia.


6 - Open lung biopsy in patients on mechanical ventilation and presenting diffuse pulmonary infiltrate

Biópsia pulmonar a céu aberto em pacientes sob ventilação mecânica e com infiltrado pulmonar difuso

Andreia Salarini Monteiro, Gabriela Addor, David Henrique Nigri, Carlos Alberto de Barros Franco

J Bras Pneumol.2005;31(3):212-218

Abstract PDF PT PDF EN Portuguese Text

Background: Open lung biopsy is regarded as the gold standard for the diagnosis of diffuse pulmonary infiltrates. Objective: To determine the diagnostic yield, therapeutic changes, complications and mortality attributed to open lung biopsy in patients with diffuse pulmonary infiltrates and on mechanical ventilation. Method: We reviewed, retrospectively, the charts of 24 patients, ranging from 26 to 89 years of age, admitted to the intensive care units of two private hospitals and submitted to open lung biopsy. Results: Diagnostic positivity was found in 100% of patients, resulting in an alteration in the treatment regimen in 75%. Postoperative complications occurred in five patients (20.8%). There were no biopsy-related deaths, although global mortality was 45.8%. Conclusion: Open lung biopsy is a safe and high yield procedure for diagnosing diffuse pulmonary infiltrate in patients on mechanical ventilation. Despite the fact that no mortality impact factor has been assigned to such patients, data in the literature regarding prognosis must be taken into consideration.


Keywords: Biopsy. Respiratory insufficiency. Respiration artificial.


7 - Evaluation of a genetic probe (Gen-Probe Accuprobe® system) in comparison to traditional methods for identifying members of the Mycobacterium tuberculosis complex

Avaliação de uma sonda genética (Sistema Accuprobe, Gen Probe®) para identificação de organismos do complexo Mycobacterium tuberculosis, em comparação com métodos tradicionais de caracterização

Delurce Tadeu de Araujo Spada, Manoel Armando Azevedo dos Santos, Elisabete A. Almeida, Marcos Augusto, Maria Idemar Pedrosa Albarral, Fernando Augusto Fiuza de Melo

J Bras Pneumol.2005;31(3):219-224

Abstract PDF PT PDF EN Portuguese Text

Background: The appearance of tuberculosis/human immunodeficiency virus co-infection and the growing number of diseases caused by nontuberculous mycobacteria, as well as the confusion that these can cause in relation to emerging multidrug-resistant strains, require more accurate and rapid laboratory results, not only in the isolation of strains but also in their identification. Objective: A comparative study evaluating a new tool of molecular identification, which uses a genetic probe based on the 16S rDNA sequence of the Mycobacterium tuberculosis gene (Gen-Probe Accuprobe® Gen Probe, Inc.), and the classic methodology. Method: Fifty-five Mycobacterium strains, isolated from the sputum of patients treated at a tuberculosis reference clinic, were selected for study. Subcultures were performed in three tubes: one submitted to genetic identification, one analyzed through classical tests (production and accumulation of niacin; growth in the Lowenstein-Jensen medium with the inhibitor agents p-nitrobenzoic acid and thiophene-2-carboxylic acid hydrazide added), and one held in reserve. Results: The probe identified 51 cases as belonging to the M. tuberculosis complex (one associated with M. kansasii) and the other 4 as nontuberculous mycobacteria, later identified as M. kansasii (3) and M. avium (1). Using traditional methods, 47 samples were identified as belonging to the M. tuberculosis complex, 4 were classified as fitting the profile of nontuberculous mycobacteria (in agreement with the genetic probe results), and 4 were unidentified, 1 of which presented the exact characteristics that 2 mycobacterium species have in common. Conclusion: The benefits of the molecular biology technique justify its implementation and routine use, in combination with classical methods, in a high-traffic clinic where complex cases of tuberculosis are treated.


Keywords: Mycobacterium tuberculosis. Molecular probe techniques.


8 - Indicators related to delays in diagnosis and in implementation of measures to control airborne infection among patients with pulmonary tuberculosis in a tertiary-care hospital

Indicadores relacionados ao retardo no diagnóstico e na instituição das precauções para aerossóis entre pacientes com tuberculose pulmonar bacilífera em um hospital terciário

Mariângela Ribeiro Resende, Verônica Maria Sinkoc, Márcia Teixeira Garcia, Eliane Oliveira de Moraes, Afrânio Lineu Kritski, Priscila Maria de Oliveira Papaiordanou

J Bras Pneumol.2005;31(3):225-230

Abstract PDF PT PDF EN Portuguese Text

Background: The risk for nosocomial transmission of tuberculosis exists in health care institutions. Objective: To evaluate indicators of transmission risk among patients with pulmonary tuberculosis treated at a university hospital. Method: A retrospective study covering the January 1997 to September of 1999 period and evaluating patients admitted to the Hospital de Clínicas of the Universidade Estadual de Campinas with pulmonary tuberculosis. Three intervals were determined: from admission to collection of sputum for acid-fast bacilli microscopy; from admission to implementation of airborne infection control measures; from sputum collection to the initiation of treatment. Results: The final sample included 63 cases. Concomitant human immunodeficiency virus-positivity was found in 31.7%. Forty patients (63.5%) were admitted through the emergency room. In 42 (66.7%) patients, TB was suspected at admission. The interval between admission and sputum collection exceeded 12 hours in 27.5% of cases admitted through the emergency room and in 30.4% of those admitted directly to wards (p = 0.803). Delayed respiratory isolation occurred in 31 cases (49.2%). The delay in isolation was correlated to no diagnosis of tuberculosis at admission (p < 0.000) and lower bacillary load in the sputum (p = 0.032). Co-infection with human immunodeficiency virus (p = 0.530), hospitalization ward (p = 0.284) and underlying diseases (p = 0.541) were not correlated with delayed isolation. The interval between sputum collection and initiation of treatment was greater than 24 hours in 15.9% of the cases. Conclusion: Delayed isolation was observed in many cases. Policies of continuing education are called for, especially in high-risk areas.


Keywords: Tuberculosis. Infection Control. Brazil. Delay. Diagnosis.


9 - Sputum culture yield: comparing an automated diagnostic system to Löwenstein-Jensen medium in the diagnosis of pulmonary tuberculosis

Rendimento da cultura de escarro na comparação de um sistema de diagnóstico automatizado com o meio de Lowenstein-Jensen para o diagnóstico da tuberculose pulmonar

Elisabete Aparecida de Almeida, Manoel Armando Azevedo dos Santos, Jorge Barros Afiune, Delurce Tadeu de Araújo Spada, Fernando Augusto Fiuza de Melo

J Bras Pneumol.2005;31(3):231-236

Abstract PDF PT PDF EN Portuguese Text

Background: Tuberculosis continues to be a global health problem. Objective: To evaluate an automated system designed to diagnose tuberculosis, comparing it to sputum microscopy and culture in Löwenstein-Jensen medium. Method: A comparative study using 844 sputum samples, collected between September and December of 1999 at a reference center for tuberculosis in São Paulo, Brazil, to draw distinctions between the results obtained through the use of the automated system and those obtained through sputum microscopy and culture in Löwenstein-Jensen medium. Results: Of the 844 samples evaluated, 27.1% tested positive for acid-fast bacilli, and 72.9% tested negative. In Löwenstein-Jensen culture, 34.7% were positive and 63% were negative, compared with 37.1% positivity and 56.9% negativity using the automated system. Sensitivity was 98.1% for the automated system and 91.9% for Löwenstein-Jensen culture. Specificity and positive predictive value were 100% for both methods. Negative predictive value was 98.9% for the automated system and 95.5% for Löwenstein-Jensen culture. The degree of accuracy was 99.3% for the automated system and 97% for Löwenstein-Jensen culture, and the Kappa was 0.99 for the automated system and 0.94 for Löwenstein-Jensen culture. The difference between the mean time to detection of mycobacteria using the automated system (10.5 days) and that found using Löwenstein-Jensen culture (34.7 days) was statistically significant. Conclusion: The difference between the culture yield obtained using the automated system and that achieved with Löwenstein-Jensen culture was statistically significant. Mean time to detection of mycobacteria was significantly shorter with the automated system. The higher yield provided by this new system justifies its use in a reference center for tuberculosis in São Paulo


Keywords: Mycobacterium tuberculosis. Diagnostic. Automated systems.


10 - Tuberculosis in a medium-sized city in the Southeast of Brazil: morbidity and mortality rates (1985 - 2003)

Tuberculose em município de porte médio do sudeste do Brasil: indicadores de morbidade e mortalidade, de 1985 a 2003

Silvia H. F. Vendramini, Cláudia Eli Gazetta, Francisco Chiaravalotti Netto, Maria R. Cury, Edna B. Meirelles, Fátima G. Kuyumjian, Tereza C. S. Villa

J Bras Pneumol.2005;31(3):237-243

Abstract PDF PT PDF EN Portuguese Text

Background: Tuberculosis is a disease linked to poverty, unequal distribution of wealth, and urbanization, as well as the epidemics of acquired immunodeficiency syndrome epidemic and multidrug resistance. Objective: To analyze indicators of tuberculosis morbidity and mortality in the city of São José do Rio Preto, Brazil from 1985 to 2003, compared with those in the state of São Paulo and in Brazil at large, and to determine the relationship between the risk of occurrence and socioeconomic level. Method: The following official information systems were utilized: the Sistema de Informação de Mortalidade (SIM, Mortality database), the Notificação de Tuberculose (Epi-Tb, Tuberculosis Notification database), the Sistema de Informação de Agravos de Notificação (SINAN, Case-registry database), the Departamento de Informação e Informática do Sistema Único de Saúde (DATASUS, Information Department of the Brazilian Health Ministry) and the Instituto Brasileiro de Geografia e Estatística (IBGE, Brazilian Institute of Geography and Statistics database). New cases reported in 2003 in the urban area were georeferenced and analyzed. A map of the sectors, each classified as representing one of three socioeconomic classes, was drawn up, showing the respective tuberculosis incidence coefficients. Results: Comparing Brazil as a whole to the state of São Paulo, total incidence coefficients and mortality rates were similar, as were gender-related values. In the city of São José do Rio Preto the rates were consistently lower. The proportion of cases presenting tuberculosis/human immunodeficiency virus coinfection varied from 29% to 37%. In 2002, 59% and 65% of tuberculosis-only and coinfected tuberculosis patients, respectively, were under supervised treatment, with a cure rate of 81% and a treatment-abandonment rate of 1%. The risk of developing active tuberculosis was three times higher in the area presenting the lowest socioeconomic levels. Conclusion: Identification of the areas with different levels of risks for tuberculosis enables the Municipal Health Department to deal with the peculiarities of each region and to prioritize those presenting higher incidences of the disease.


Keywords: Tuberculosis. Epidemiology. Socioeconomic class. Supervised Treatment. Infection. HIV.


Review Article

11 - Asthma in children under five years of age: problems in diagnosis and in inhaled corticosteroid treatment

Asma em menores de cinco anos: dificuldades no diagnóstico e na prescrição da corticoterapia inalatória

Maria Jussara Fernandes Fontes, Maria Teresa Mohallem Fonseca, Paulo Augusto Moreira Camargos, Alessandra Gazire Alves Affonso, Geralda Magela Costa Calazans

J Bras Pneumol.2005;31(3):244-253

Abstract PDF PT PDF EN Portuguese Text

The objective of this study was to review the literature, focusing on difficulties encountered in asthma diagnosis and in the establishment of initial inhaled corticosteroid treatment in children under five years of age. The search was limited to studies published between 1991 and 2002 in Portuguese, Spanish, or English and included in the LILACS and MEDLINE databases. Symptoms of asthma, the most common chronic childhood disease, typically appear in the first years of life. There are currently no diagnosis means of making a certain diagnosis of asthma in children under the age of five. Clinical manifestations, when present in toddlers and preschoolers, may require treatment such as that given for asthma, assuming that it is preceded by a critical evaluation. We can conclude that diagnosis of asthma in the first years of life is complex and predominantly clinical. Inhaled corticosteroid treatment is an effective tool, although its risks and benefits must be carefully evaluated.


Keywords: Asthma. Adrenal cortex hormones. Infant. Preschool.


12 - Pulmonary sarcoidosis: high-resolution computed tomography findings

Sarcoidose pulmonar: achados na tomografia computadorizada de alta resolução

Bruno Barcelos da Nóbrega, Gustavo de Souza Portes Meirelles, Gilberto Szarf, Dany Jasinowodolinski, Jorge Issamu Kavakama

J Bras Pneumol.2005;31(3):254-260

Abstract PDF PT PDF EN Portuguese Text

Sarcoidosis is a systemic disease of unknown etiology, characterized by noncaseating granulomas. Although it may affect any organ, morbidity and mortality are most commonly related to pulmonary involvement, which is found in 80-90% of patients. This study illustrates the principal manifestations of sarcoidosis seen in high-resolution computed tomography scans, including typical as well as atypical forms.


Keywords: Sarcoidosis. Lung. High-resolution computed tomography.


Case Report

13 - Tuberculous spondylitis in teenager

Espondilite tuberculosa em adolescente

Marta Maciel Lyra Cabral, Bruno Canto C. de A. Azevedo, Lílian Maria Lapa Montenegro, Rosana de Albuquerque Montenegro, Andrea Santos Lima, Haiana Charifker Schindler

J Bras Pneumol.2005;31(3):261-264

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This article presents a case report of osteoarticular tuberculosis affecting lumbar sacral column non-typical attack. The diagnosis remains a medical challenge because the symptoms and bone lesions are not specific and can be mislead with other morbidity such as inflammatory, circulatory, metabolic, traumatic, congenital and tumoral diseases. The disease is degenerative and the prognosis not satisfactory. Besides the clinical aspects and laboratory, imaging results, including computed tomography and magnetic ressonance, are discussed. A PCR system targeting the IS 6110 of M. tuberculosis was positive, strongly suggesting the presence of this pathogen. This assay would be particularly indicated when quick and sensitive diagnosis of tuberculosis is required.


Keywords: Tuberculosis. Spondylitis. PCR. Diagnostic.


14 - Factitious hemoptysis in Munchhausen syndrome: a differential diagnosis to be considered

Hemoptise fictícia na síndrome de Munchhausen: uma entidade a ser considerada no diagnóstico diferencial

Thamine Lessa Espírito Santo Andrade, Jorge L. Pereira-Silva

J Bras Pneumol.2005;31(3):265-268

Abstract PDF PT PDF EN Portuguese Text

Munchhausen syndrome results from a psychiatric disorder in which patients attempt to demonstrate signs and symptoms of serious organic diseases. In a review of the literature, we found 23 cases of Munchhausen syndrome accompanied by factitious hemoptysis, 2 presenting the same mechanism described herein. We report the case of a 23-year-old male with a recent history of multiple hospital admissions for investigation of bloody sputum, although no conclusive diagnosis had been made. Upon insistent questioning the patient admitted to aspirating his own blood with a syringe, holding it in his mouth and eliminating it in order to simulate hemoptysis. Munchhausen syndrome should be considered in patients presenting hemoptysis of obscure etiology.


Keywords: Munchhausen syndrome. Factitious hemoptysis. Diagnosis


15 - Treatment of bronchial stenosis after lung transplantation using a self-expanding metal endobronchial stent

Utilização de endoprótese metálica no tratamento de estenose brônquica após transplante pulmonar

Marcos Naoyuki Samano, Marlova Luzzi Caramori, Ricardo Henrique de Oliveira Braga Teixeira, Helio Minamoto, Paulo Manuel Pêgo Fernandes, Fabio Biscegli Jatene, Sérgio Almeida de Oliveira

J Bras Pneumol.2005;31(3):269-272

Abstract PDF PT PDF EN Portuguese Text

Although the incidence of bronchial anastomosis as a complication of lung transplantation has decreased in recent years, it remains a significant cause of morbidity and mortality in these patients. Treatment options include balloon dilatation, laser photocoagulation, placement of a stent (silicone or metal), and performing a second operation. We report the case of a patient who presented bronchial stenosis after left lung transplantation and was treated with a self-expanding metal alloy (nitinol) stent (UltraflexÒ). Despite the fact that this was the first case of stenosis treated in this fashion in Brazil, the positive clinical response, in agreement with results reported in the literature, indicates that this treatment is a viable alternative in such cases.


Keywords: Lung transplantation. Tracheal stenosis. Prosthesis and implants. Stents. Postoperative complications.


Book Reviews

18 - Professor Thomas W. Shields' sixth edition

Sexta edição do livro do professor Thomas W. Shields

Manoel Ximenes Netto

J Bras Pneumol.2005;31(3):276

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19 - Asthma: a great challenge

Asma: um grande desafio

Sérgio Saldanha Menna Barreto

J Bras Pneumol.2005;31(3):277

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Year 2005 - Volume 31  - Number 4  (July/August)


1 - Interstitial lung disease in scleroderma

Doença intersticial pulmonar na esclerodermia

Ronaldo Adib Kairalla

J Bras Pneumol.2005;31(4):1-3

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2 - Pneumococcal resistance to penicillin and macrolides: implications for the treatment of respiratory infections

Resistência do pneumococo à penicilina e aos macrolídeos: implicações no tratamento das infecções respiratórias

Roberto Martinez

J Bras Pneumol.2005;31(4):4-5

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Original Article

3 - Evaluation of a four-month program of physical training designed for asthmatic children

Avaliação de um programa de treinamento físico por quatro meses para crianças asmáticas

Cristiane Soncino Silva, Lídia Alice Gomes Monteiro Marins Torres, Abel Rahal, João Terra Filho, Elcio Oliveira Vianna

J Bras Pneumol.2005;31(4):279-285

Abstract PDF PT PDF EN Portuguese Text

Objective: The aim of this study was to evaluate physical conditioning and muscle strength before and after a four-month program of physical training. Methods: Two groups of children, ages 8 to 11 years, with moderate asthma were studied. All subjects were tested before and after a program of physical training, which was conducted in 90-min sessions, twice weekly, for four months and also included exercises performed in the water. Children in both groups received general information about asthma, as well as information about the management and treatment of asthma. Results: In the final evaluation, anthropometric parameters (height and weight) were found to have increased. Children in the exercise group presented significant gains in the distance run in nine minutes (initial 1.333 + 0.03 km vs. final 1.440 + 0.03 km; p < 0.05), number of abdominal crunches (initial 24.3 + 1.4 abdominais vs. final 33.2 + 1.1; p < 0.05), maximal inspiratory pressure (initial 73 + 5 cmH2O vs. final 103 + 5 cmH2O; p < 0.05), maximal expiratory pressure (initial 75 + 4 cmH2O vs. final 102 + 4 cmH2O; p < 0.05) and heart rate at rest (initial 84.3 + 1.6 bpm vs. final 77.1 + 2.7 bpm; p < 0.05). The control group presented no significant changes in any of these parameters. Conclusion: An exercise program involving longer sessions, conducted less frequently, facilitates increased participation by children, thereby leading to better physical conditioning and greater muscle strength.


4 - Bronchial hyperresponsiveness in patients with gastroesophageal reflux disease

Estudo da hiper-responsividade brônquica em pacientes portadores de refluxo gastroesofágico

Mônica Silveira Lapa, Roberto Rodrigues Júnior, Elie Fiss

J Bras Pneumol.2005;31(4):286-291

Abstract PDF PT PDF EN Portuguese Text

Objective: To identify this vagal reflex using bronchial provocation tests in patients with gastroesophageal reflux disease. Methods: The study group was composed of 10 patients presenting endoscopic evidence of hiatal hernia or gastroesophageal reflux disease, and the control group consisted of 11 patients presenting no evidence of either condition. All subjects were submitted to bronchial provocation with carbachol. Results: The provocation test was positive in 5 (50%) of the study group patients and 3 (27%) of the control group patients (p = 0.64). Conclusion: The hypothesis that the airways of patients with gastroesophageal reflux disease (and no history of asthma-like respiratory symptoms) might be more responsive than those of individuals without the disease remains unproven.


Keywords: Asthma/complications; Gastroesophageal reflux/complications; Hernia hiatal; Peak expiratory flow rate; Bronchial hyperreactivity; Forced expiratory volume; Carbachol/diagnostic use


5 - Torrington and Henderson and Epstein risk assessment scales: applicability and effectiveness in lung resection

Escalas de risco de Torrington e Henderson e de Epstein: aplicabilidade e efetividade nas ressecções pulmonares

Fabiana Stanzani, Maria Alenita de Oliveira, Vicente Forte, Sônia Maria Faresin

J Bras Pneumol.2005;31(4):292-299

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Objective: To compare the incidences of pulmonary and cardiopulmonary postoperative complications estimated using, respectively, the scoring systems devised by Torrington and Henderson and by Epstein in a populational sample undergoing lung resection for the treatment of lung cancer. Methods: Prospective data from patients submitted to resection of one or more pulmonary lobes were selected from the databases of two tertiary-care hospitals. The outcome measures were pulmonary complications, cardiac complications and mortality rates. Fisher's exact test was used to evaluate the concordance between the predicted and observed complications. Results: The Torrington and Henderson scoring system was applied to 50 patients, in which the risk was found to be mild in 12, moderate in 32, and high in 6. Although accurately identifying patients at high risk, the Torrington and Henderson scale underestimated the rate of postoperative cardiopulmonary complications in the mild and moderate risk categories (p = 0.0003 and p = 0.0006, respectively). The Epstein scoring system was applied to 38 patients, 4 of which were found to be at high risk, and 34 of which were found to be at mild risk. The Epstein scale also underestimated the risk in the patients (the majority) that were classified as being at mild risk (p < 0.0001) and yet, like the Torrington and Henderson scale, accurately identified those at high risk. Conclusion: Neither of the two scoring systems analyzed were found to be appropriate for predicting the risk of pulmonary and cardiopulmonary complications in most cases.


Keywords: Postoperative complications; Preoperative care; Thoracic surgical procedures/mortality; Lung neoplasms/surgery; Pneumonectomy; Respiratory function tests; Risk factors; Risk assessment


6 - Interstitial lung disease in patients with progressive systemic sclerosis. A study of 58 cases

Comprometimento do interstício pulmonar em portadores de esclerose sistêmica progressiva. Estudo de uma série de 58 casos

Sergio Fernandes de Oliveira Jezler, Mittermayer Barreto Santiago, Thamine Lessa Andrade, César Araujo Neto, Helio Braga, Álvaro Augusto Cruz

J Bras Pneumol.2005;31(4):300-306

Abstract PDF PT PDF EN Portuguese Text

Objective: To estimate the frequency of interstitial lung disease in a group of patients with progressive systemic sclerosis, and to describe the clinical, functional and radiological characteristics of the patients studied. Methods: Fifty-eight patients diagnosed with progressive systemic sclerosis were submitted to high-resolution computed tomography of the chest, pulmonary function tests and a blood test for anti-Scl 70 antibodies. Comparisons were drawn between patients with interstitial lung disease and those without. Logistic regression with multivariate analysis was used to identify factors predictive of interstitial lung disease. Results: Of the 58 patients evaluated, 51.7% presented interstitial lung disease on high-resolution computerized tomography scans. Dyspnea and cough were the most common symptoms (seen in 65.5% and 39.7%, respectively). Bronchiolectasis and honeycombing were the most common tomographic abnormalities (observed in 83.3% and 80%, respectively). When compared to individuals without interstitial lung disease, patients with the condition had a comparable frequency of pulmonary and extrapulmonary symptoms but presented progressive systemic sclerosis of longer duration, a higher frequency of crackling rales, higher rates of anti-Scl 70 positivity, lower vital capacity and reduced total lung capacity. Only forced vital capacity < 80% was found to be a predictor of interstitial lung disease. Conclusion: Interstitial lung disease was common in this group of patients with progressive systemic sclerosis. No correlation with symptoms was found, although interstitial lung disease was found to correlate with crackling rales and with anti-Scl 70 positivity. Nevertheless, only reduced forced vital capacity was found to be predictive of interstitial lung disease.


7 - Acute mediastinitis. Restropective analysis of 21 cases

Mediastinite aguda. Análise retrospectiva de 21 casos

Marcelo Cunha Fatureto, Milton Alves das Neves-Júnior, Thassio Cunha de Santana

J Bras Pneumol.2005;31(4):307-311

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the epidemiological and clinical aspects of acute mediastinitis and to characterize its treatment. Methods: A retrospective study conducted through review of the medical charts of patients diagnosed with acute mediastinitis at the Hospital Escola da Faculdade de Medicina do Triângulo Mineiro (Triângulo Mineiro Medical School Hospital) between 1987 and 2004. Results: A total of 21 patients were studied. Most (76.2%) were male, and the mean age was 52.5 years. Six patients (28.6%) died. The most common cause (in 38.1%) was median sternotomy, followed by esophageal perforation (in 33.3%) and cervical infection (in 14.3%). Staphylococcus aureus and Staphylococcus epidermidis were the causative agents most frequently isolated. In most cases, the treatment of choice was antibiotic therapy accompanied by surgery. The most frequent complications of the acute mediastinitis were pleural effusions (in 23.8%) and osteomyelitis (in 19.0%). The average hospital stay was 26.6 days. Conclusion: Acute mediastinitis is a serious complication of some diseases and procedures. Despite its low incidence, the mortality rate is high. Staphylococcus aureus and Staphylococcus epidermidis are the most common causative agents. The treatment used was antibiotic therapy accompanied by surgery.


8 - Phenotypic and genotypic study of macrolide resistance of Streptococcus pneumoniae strains isolated in hospitals in Porto Alegre, in the state of Rio Grande do Sul, Brazil

Estudo fenotípico e genotípico da resistência aos macrolídeos de "Streptococcus pneumoniae" isolados em hospitais de Porto Alegre - RS

Fabiana Rowe Zettler, Eduardo Walker Zettler, Virginia Minghelli Schmitt, Marina Tagliaro Jahns, Cícero Armídio Gomes Dias, Carlos Cezar Fritscher

J Bras Pneumol.2005;31(4):312-317

Abstract PDF PT PDF EN Portuguese Text

Objective: The aim of this study was to determine the prevalence of macrolide-resistant S. pneumoniae and to identify its phenotypic and genotypic characteristics. Methods: Strains of S. pneumoniae isolated in the city of Porto Alegre between May 2002 and August 2004 from samples collected from different anatomical sites were analyzed. For the agar diffusion test, disks of erythromycin, clarithromycin, azithromycin and clindamycin were used. The minimum inhibitory concentrations of erythromycin were determined for macrolide-resistant isolates by the agar dilution method. Macrolide-resistant isolates were phenotyped by agar diffusion test and genotyped by polymerase chain reaction. Results: A total of 229 pneumococcal strains were evaluated, 12 (5.2%) of which were macrolide-resistant. Among the 12 resistant strains, 9 (75%) presented the MLSB phenotype, and 3 (25%) presented the M phenotype. Polymerase chain reaction testing indicated that 8 MLSB phenotype isolates harbored the ermB gene only, whereas the mefE gene was present in all 3 M phenotype isolates. One MLSB phenotype isolate presented both genes. Conclusion: In Porto Alegre, the S. pneumoniae resistance to macrolides is still low since such resistance is due primarily to the presence of the ermB gene expressing the MLSB phenotype.


9 - Chronic pulmonary histoplasmosis mimicking tuberculosis

Histoplasmose pulmonar cavitária crônica simulando tuberculose

Gisela Unis, Luiz Carlos Severo

J Bras Pneumol.2005;31(4):318-324

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Objective: To evaluate cases of chronic pulmonary histoplasmosis diagnosed in recent years at the Complexo Hospitalar Santa Casa in Porto Alegre, in the state of Rio Grande do Sul, Brazil. Methods: Cases diagnosed at the Santa Casa Hospital Complex within the last 25 years were reviewed. Four cases in which the diagnosis was made through histopathological analysis or culture and confirmed by with serologic testing are described. Cases from the Brazilian literature are also discussed. Results: The principal clinical manifestations were cough, dyspnea, fever, anorexia and weight loss. Among the radiological findings were emphysema, cystic cavities, bronchiectasis and pleural thickening. All patients had an epidemiological history of contact with chicken feces. One of the patients presented Aspergillus fumigatus colonization of cavities. Conclusion: Chronic pulmonary histoplasmosis must be considered in patients with chronic obstructive pulmonary disease presenting cavitary lesions of the lung, sputum smear microscopy negative for acid-fast bacilli and negative tuberculin skin test. Hemoptysis occurring in the presence of cured or fading pulmonary lesions is suggestive of Aspergillus colonization.


Keywords: Histoplasmosis/diagnosis; Histoplasmosis/drug therapy; Histoplasma/isolation & purification; Tuberculosis, pulmonary/diagnosis; Itraconazole/drug therapy; Sputum/microbiology; Diagnosis, Differential


10 - Human immunodeficiency virus seroprevalence in patients with tuberculosis in the city of Londrina, in the state of Paraná, Brazil

Soroprevalência da infecção pelo vírus da imunodeficiência humana em pacientes com tuberculose, em Londrina, Paraná

Arilson Akira Morimoto, Ana Maria Bonametti, Helena Kaminami Monimoto, Tiemi Matsuo

J Bras Pneumol.2005;31(4):325-331

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Objective: To estimate the prevalence of human immunodeficiency virus seropositivity among patients with active tuberculosis residing in the city of Londrina, in the state of Paraná, Brazil and treated at the Pulmonology Clinic of the 17th Regional Health Facility of the State of Paraná, and to compare those coinfected with human immunodeficiency virus to those with active tuberculosis only in terms of the clinical form of tuberculosis, sputum smear microscopy, chest X-ray and tuberculosis treatment regimen. Methods: A transversal study involving 188 active tuberculosis patients was conducted. Tuberculosis and human immunodeficiency virus infection were diagnosed based on criteria established by the Brazilian Ministry of Health. In addition to the data obtained through individual tuberculosis investigation files, clinical and epidemiological information were collected by means of questionnaires, which were completed by all participating patients. Results: The prevalence of human immunodeficiency virus seropositivity among patients with tuberculosis was 14.9%. The rate of positive sputum microscopy results was higher in the tuberculosis-only group (p = 0.0275), and the ratio for patients treatment with alternative scheme was significantly higher in the co-infected group (p = 0.042). In 32.1% of the coinfected patients, the serological diagnosis of human immunodeficiency virus infection was made simultaneously to or following that of the tuberculosis. Conclusion: The results underscore the importance of routinely testing for human immunodeficiency virus antibodies in patients diagnosed with tuberculosis.


Keywords: Tuberculosis/complications; Tuberculosis/diagnosis; Soropositivity; HIV/immunology; HIV infections/complications; HIV infections/epidemiology; HIV infections/ drug therapy; Rifampin/therapeutic use; Disease progression


Review Article

11 - Prone position

Posição prona

Kelly Cristina de Albuquerque Paiva, Osvaldo Shigueomi Beppu

J Bras Pneumol.2005;31(4):332-340

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The prone position is a maneuver used to combat hypoxemia in patients with acute respiratory distress syndrome. Despite the fact that this is currently considered an efficient way to improve oxygenation, the physiological mechanisms that bring about improvements in respiratory function are not yet fully understood. The aim of this review is to discuss the physiological and clinical aspects of the prone position in patients with acute respiratory distress syndrome.


Keywords: Prone position/physiology; Respiratory distress syndrome, adult; Lung/injuries; Posture/physiology; Supine position/physiology; Anoxemia; Pulmonary gas exchange; Hemodynamic processes


12 - Inhaled corticosteroids: effects on growth and adrenal suppression

Corticóide inalatório: efeitos no crescimento e na supressão adrenal

Elisete E. Arend, Gilberto Bueno Fischer, Helena Mocelin, Lídia Medeiros

J Bras Pneumol.2005;31(4):341-349

Abstract PDF PT PDF EN Portuguese Text

This is a review of the medical literature regarding inhaled corticosteroids and their effects on growth and adrenal suppression in children and adolescents. A review of the literature, principally that published over the last five years, was conducted using Medline and searching indexes of articles published in national and international scientific journals. There is considerable controversy regarding the side effects of inhaled corticosteroids. In 21 studies evaluating the effect that inhaled corticosteroids have on growth, a statistically significant reduction (growth retarded by 1-1.5 cm) was observed within the first year of treatment with Beclomethasone or Budesonide inhalers. However, in studies of longer duration, no significant difference was found between final adult height and adult height of the parents. However, in ten studies of the use of inhaled corticosteroids and their effect on adrenal suppression, hypoglycemia and arrested development (no height or weight gains), as well as changes in morning serum levels and 24-h urinary levels of cortisol, were reported, especially when high doses of inhaled corticosteroids were used. Inhaled corticosteroids can reduce growth during the first year of use but do not affect adult height. However, further long-term studies are needed in order to determine the full impact of inhaled corticosteroids on final adult height. Height measures are a means of evaluating the safety and efficacy of the use of inhaled corticosteroids in children. Tests that evaluate the hypothalamic-pituitary-adrenal axis and adrenal insufficiency should be correlated with clinical symptoms and side effects.



13 - Diagnosis of tuberculosis in individuals with respiratory symptoms. Commentary on the II Guidelines of the Brazilian Society of Pulmonology and Phthisiology and the Ministry of Health

Diagnóstico da tuberculose em sintomáticos respiratórios. Comentários a respeito das II Diretrizes da Sociedade Brasileira de Pneumologia e Tisiologia e Ministério da Saúde

Nelson Morrone

J Bras Pneumol.2005;31(4):350-355

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Case Report

14 - Isolated pulmonary chondroma: a case of incomplete Carney triad?

Condroma pulmonar isolado: caso incompleto da tríade de Carney?

Raul Lopes Ruiz Júnior, Júlio Defaveri, Antonio José Maria Cataneo, Rogério Cardoso da Silva, Sérgio Marrone Ribeiro, Cristiano Ventorim de Barros

J Bras Pneumol.2005;31(4):356-359

Abstract PDF PT PDF EN Portuguese Text

A 45-year-old man presented with recurrent pulmonary infection for four years, cough, bloody sputum, yellowish excretion and nonpleuritic chest pain. Tomography of the chest revealed a calcified nodule occluding the right lower lobe bronchus. A right lower and middle lobectomy was performed, and the histopathological examination of the bronchi revealed chondroma, a rare pulmonary tumor usually associated with the Carney triad (pulmonary chondroma, gastric leiomyosarcoma and extra-adrenal paraganglioma), being the less common of the three components. In the present case, the other two components of the triad were not observed. Since these components may appear years later, long-term follow-up care is necessary.


Keywords: Chondroma; Lung neoplasms/radiography; Lung neoplasms/surgery; Leiomyosarcoma;


15 - Pulmonary capillary hemangiomatosis. A rare cause of pulmonary hypertension. The first Brazilian case

Hemangiomatose capilar pulmonar, uma rara causa de hipertensão pulmonar. Primeiro caso brasileiro

Helano Neiva de Castro, Mara Rúbia Fernandes de Figueiredo, Norma Selma Santos, Teresa Neuma Albuquerque Gomes Nogueira, Maria da Penha Uchoa, Marcelo Alcântara Holanda

J Bras Pneumol.2005;31(4):360-364

Abstract PDF PT PDF EN Portuguese Text

Pulmonary capillary hemangiomatosis is a rare disorder characterized by a proliferation of capillaries that invade the pulmonary interstitium and alveolar septae. Herein, we report the first Brazilian case of pulmonary capillary hemangiomatosis. A 21-year-old man presented with severe pulmonary hypertension that eventually resulted in his death. Upon admission, a computed tomography scan of the chest revealed diffuse ill-defined bilateral pulmonary nodules. A postmortem lung biopsy revealed pronounced multifocal proliferation of capillaries in the alveolar walls, interlobular septa and peribronchial connective tissue. A diagnosis of pulmonary capillary hemangiomatosis should be considered in patients presenting pulmonary hypertension and suspicious changes on high-resolution computed tomography scans.


Keywords: Hemangioma, capillary/etiology; Hemangioma capillary/diagnosis; Hypertension, pulmonary/complications; Tomography, Emission-Computed; Case report


16 - Surgical treatment of a paratracheal bronchogenic cyst using cervical mediastinoscopy

Tratamento cirúrgico de cisto broncogênico paratraqueal por mediastinoscopia cervical

Daniel Sammartino Brandão, Carlos Henrique Ribeiro Boasquevisque, Rui Haddad, Eduardo de Souza Ponzio

J Bras Pneumol.2005;31(4):365-364

Abstract PDF PT PDF EN Portuguese Text

Bronchogenic cysts of the mediastinum are benign congenital lesions, usually found in adults. When surgery is indicated, the classical approach is resection of the lesion by thoracotomy or thoracoscopy. Herein, we describe the complete resection of a paratracheal bronchogenic cyst by cervical mediastinoscopy. We also include a brief review and discussion of the literature.


Letters to the Editor

19 - Smoking, health and education

Tabagismo, saúde e educação

Renata Carone Sborgia, Antonio Ruffino-Netto

J Bras Pneumol.2005;31(4):371-372

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Year 2005 - Volume 31  - Number 5  (September/October)


1 - Brazilian Journal of Pulmonology: Thirty years of history

Jornal Brasileiro de Pneumologia: trinta anos de história

Manuel Lopes dos Santos

J Bras Pneumol.2005;31(5):1-

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2 - Sarcoidosis in Brazil

Sarcoidose no Brasil

Eduardo Pamplona Bethlem

J Bras Pneumol.2005;31(5):2-3

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3 - Forced expiratory volume in one second and bronchodilator response in chronic obstructive pulmonary disease - a needless ritual?

Volume expiratório forçado no primeiro segundo e resposta a broncodilatador em doença pulmonar obstrutiva crônica - um ritual inútil?

Carlos Alberto de Castro Pereira

J Bras Pneumol.2005;31(5):4-6

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Original Article

4 - Factors predictive of the development of acute asthma attacks in children

Fatores preditivos da evolução da asma aguda em crianças

Maria Luisa Zocal Paro, Joaquim Carlos Rodrigues

J Bras Pneumol.2005;31(5):373-381

Abstract PDF PT PDF EN Portuguese Text

Objective: To use clinical and functional characteristics observed upon admission to an emergency room to identify factors predictive of the occurrence and course of acute asthma attacks in children. Methods: We prospectively studied 130 asthmatic children, from 1 to 13 years of age, who were treated for acute asthma attacks in an emergency room, evaluating status determined at admission and over the course of the crisis. Clinical scores were determined and arterial oxygen saturation by pulse oximetry was measured, as was peak expiratory flow. Results: The initial clinical score, arterial oxygen saturation by pulse oximetry and peak expiratory flow correlated with the number of inhalations performed, as well as with the need for corticosteroid treatment. Mean initial clinical score and mean arterial oxygen saturation by pulse oximetry of the hospitalized patients were statistically different from those of patients who were not hospitalized. Initial clinical score, arterial oxygen saturation and prior treatment for the same exacerbation were predictive of the need for hospitalization. Conclusion: The measurement of arterial oxygen saturation by pulse oximetry and the clinical score were useful in predicting the occurrence and course of acute asthma attacks in children. The measurement and interpretation of peak expiratory flow is difficult in children and, under these conditions, served no practical application.


Keywords: Asthma; Acute disease; Prospective studies; Predictive value of tests; Child


5 - Incidence of viral infection of the respiratory tract in acute asthma patients treated in the emergency room

Incidência de infecção viral do trato respiratório em asma aguda atendida em sala de emergência

Ivete Terezinha Machado da Rocha, Diego Menegotto, Cristine Feliciati Hoffmann, Sergio Saldanha Menna-Barreto, Paulo de Tarso Roth Dalcin, Selir Maria Straliotto, Suzie Hyona Kang, Lilian Rech Pasin, Josiane Fischer, Fabiane Nieto

J Bras Pneumol.2005;31(5):382-389

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the incidence of viral infection in patients with acute asthma treated in the emergency room. Methods: We conducted a cohort study of patients aged 12 and older presenting to the emergency room of the Hospital de Clínicas de Porto Alegre with acute asthma. Nasopharyngeal aspirate was collected, and antigens were detected through indirect immunofluorescence staining for respiratory syncytial virus, adenovirus and influenza, as well as for parainfluenza types 1, 2, 3 and 4. Data were collected regarding demographic characteristics, medical history, the attack that led to the current emergency room visit, and clinical outcomes. Results: From March to July of 2004, 49 patients were examined for viral infection of the respiratory tract. Respiratory viruses were identified in 6 patients (3 with adenovirus, 2 with influenza A, 1 with parainfluenza type 1). The mean age of the patients with viral infection of the respiratory tract was 61.7 ± 11.5 years, compared with 41.7 ± 20.9 years for the patients without such infection (p = 0.027). There were no other significant differences in clinical characteristics or outcomes. Conclusion: The incidence of viral infection of the respiratory tract in acute asthma patients 12 years and older treated in an emergency room was 12.2%, which confirms that viral infection is a significant precipitant of acute asthma for patients in this age bracket.


Keywords: Emergency Service, Hospital; Vírus diseases/prevention & control; Asthma; Respiratory tract infections; Influenza A virus, human


6 - Asthma prevalence among employees of a university hospital as evaluated using a European Union respiratory health questionnaire

Prevalência de asma em funcionários de hospital universitário avaliada por meio de questionário de saúde respiratória da Comunidade Européia

Antônio Soares Aguiar Filho, Edmundo Pessoa Almeida Lopes Neto, Emanuel Sávio Cavalcanti Sarinho, Maria Magalhães Vasconcelos, Darla Siqueira Tenório Lima, Penélope Matos Wirtsbiki

J Bras Pneumol.2005;31(5):390-397

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of bronchial asthma among university hospital employees between the ages of 20 and 44 based on the criteria established in the European Community Respiratory Health Survey. Methods: A descriptive, prospective, randomized, stratified prevalence study was conducted, in which questionnaires completed between April and October of 2002 by 351 employees of the Universidade Federal de Pernambuco (Federal University at Pernambuco) Hospital das Clínicas were evaluated. For sample characterization, the independent variables used were the signs and symptoms of asthma, and one dependent variable (physician-diagnosed asthma, characterized by data related to attacks occurring within the 12 months preceding the study) was included. Results: The prevalence of asthma was 10.7%. Nocturnal dyspnea, chest tightness and nocturnal cough were the most frequent symptoms, although statistically significant correlations with asthma were found exclusively among females (p = 0.03, p = 0.04 and p = 0.001, respectively). Nocturnal dyspnea, wheezing within the last 12 months, dyspnea with wheezing and the use of asthma medication were more frequent among individuals between 20 and 29 years of age. The last two variables presented statistical significance (p < 0.001). Undertreatment of asthma was identified in 35 (10.7%) of the cases. Conclusions: The results of this pioneering study show that asthma prevalence in a sample composed of employees of a university hospital located in a developing country was slightly higher than that found in the literature and suggest that working in a university hospital does not reduce the frequency of undertreatment.


Keywords: Asthma/diagnosis; Asthma/epidemiology; Hospitals, university; Questionnnaires


7 - Sarcoidosis in the south of Brazil: a study of 92 patients

Sarcoidose no sul do Brasil: estudo de 92 pacientes

Luiz Carlos Corrêa da Silva, Felipe Teixeira Hertz, Dennis Baroni Cruz, Fernanda Caraver, Juliana Cardozo Fernandes, Fabrício Picoli Fortuna, Klaus Irion, Nelson da Silva Porto

J Bras Pneumol.2005;31(5):398-406

Abstract PDF PT PDF EN Portuguese Text

Objective: This case study, conducted in the state of Rio Grande do Sul (RS), Brazil, aims to determine the local profile of sarcoidosis, describing patient characteristics, clinical presentation and pulmonary function, as well as analyzing the results of radiological, histopathological and biochemical tests, at the time of diagnosis in a series of sarcoidosis patients. Methods: A retrospective study of 92 patients with sarcoidosis treated on the Pavilhão Pereira Filho (Pereira Filho [Respiratory Diseases] Ward) of the Hospital Santa Casa, in the city of Porto Alegre, RS, between 1990 and 2003. The protocol included the collection of clinical, biochemical, radiological, spirometric and histological data. Results: There was no significant gender-based difference in frequency (men, 42%; women, 58%). Mean age was 41.8 ± 14.1 years, with 87% of patients being between 20 and 60 years old. Caucasians predominated (84%). Most patients (61%) had never smoked, 29% were former smokers, and 10% were current smokers. The majority (33%) of the diagnoses were made in winter. Among the clinical findings, it is of note that 12% were asymptomatic, 18% presented pulmonary symptoms only, 22% presented extrapulmonary symptoms only, and 48% presented pulmonary and extrapulmonary symptoms. Spirometry was performed in 79% of patients at the time of diagnosis. In 45% of those patients, abnormal results were obtained: a restrictive pattern was seen in 23%, an obstructive pattern in 18% and a mixed pattern in 4%. Classification by radiological type revealed that 30% were stage I, 48% were stage II, and 22% were stage III. Conclusion: The findings of this study are quite similar to those of other studies in the literature, particularly those conducted in Europe.


Keywords: Sarcoidosis, pulmonary/diagnosis; Sarcoidosis, pulmonary/pathology; Lung diseases/pathology; Prognosis; Retrospective studies


8 - Measuring forced expiratory volume in one second alone is not an accurate method of assessing response to bronchodilators in chronic obstructive pulmonary disease

O volume expiratório forçado no primeiro segundo não é suficiente para avaliar resposta broncodilatadora em doença pulmonar obstrutiva crônica

Felícia de Moraes Branco Tavares, Luiz Carlos Corrêa da Silva, Adalberto Sperb Rubin

J Bras Pneumol.2005;31(5):407-414

Abstract PDF PT PDF EN Portuguese Text

Objective: To assess the frequency of variation in forced expiratory volume in one second after bronchodilator use in a sample of patients with chronic obstructive pulmonary disease, correlating such variation with clinical and demographic variables and evaluating the frequency of response presented in forced vital capacity, slow vital capacity, inspiratory capacity, residual volume, airway resistance and specific airway conductance. Methods: A total of 64 patients with chronic obstructive pulmonary disease were submitted to whole body plethysmography, and reversibility of bronchoconstriction after the administration 400 µg of fenoterol was quantified. Results: A response in forced expiratory volume in one second was observed in 31% of the patients. Excluding patients presenting a response in forced expiratory volume in one second, 5% presented responses in 5 of the other 6 parameters, 10% presented responses in 4 parameters, 17.5% in 3 parameters, 27.5% in 2 parameters, and 25% in only 1 parameter. Conclusion: When included in the evaluation of bronchodilator response together with forced expiratory volume in one second, static lung volumes, airway resistance and airway conductance allowed a broader evaluation of those patients presenting a functional pharmacodynamic response. These results are in accordance with the observation that bronchodilator use provides clinical improvement and relief of dyspnea to many patients with chronic obstructive pulmonary disease, even to those in whom such treatment leads to no improvement in forced expiratory volume in one second.


Keywords: Pulmonary disease, chronic obstructive/drug therapy; Bronchodilator agents/therapeutic use; Airway resistance/drug effects; Respiratory function tests; Vital capacity; Forced expiratory volume


8 - Influenza vaccination of individuals over the age of 60: impact on hospital admissions and deaths from respiratory and circulatory diseases in Fortaleza, Brazil

Impacto da vacinação de maiores de 60 anos para influenza sobre as internações e óbitos por doenças respiratórias e circulatórias em Fortaleza - CE - Brasil

Mônica Cardoso Façanha

J Bras Pneumol.2005;31(5):

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9 - Abnormalities on computed tomography scans of the paranasal sinus in adult patients with allergic rhinitis

Alterações tomográficas de seios paranasais em pacientes adultos com rinite alérgica

Eduardo Vieira Ponte, Fabiana Lima, Glauber Ferraz Aguiar, Fabíola Goyana, Marcelo Benício dos Santos, Álvaro Augusto Cruz

J Bras Pneumol.2005;31(5):421-426

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate, using computerized tomography, the frequency of paranasal sinus involvement in patients with allergic rhinitis. Methods: From among outpatients diagnosed with rhinitis and complaining of nasal obstruction, 60 were selected for evaluation. The patients were submitted to anterior rhinoscopy, skin prick test for reactivity to aeroallergens and computed tomography of the paranasal sinuses. In addition, questionnaires designed to evaluate symptom severity were administered. The Lund score was used to evaluate paranasal sinus involvement on computed tomography scans. Results: Computed tomography scans of the paranasal sinuses were abnormal in 31 patients (52%). The sum of the largest diameters of cutaneous reactions to the aeroallergens, symptom severity and anterior rhinoscopy findings did not differ between patients with paranasal sinus involvement and those without. All the patients with paranasal sinus abnormalities also presented osteomeatal complex abnormalities, whereas only 11 patients (38%) without paranasal sinus involvement presented such abnormalities (p < 0.01). Conclusion: In a sample of patients with allergic rhinitis, the frequency of paranasal sinus abnormalities on computed tomography scans was elevated and did not correlate with symptom severity or skin prick test reactivity but was correlated with osteomeatal complex obstruction.


Keywords: Rhinitis; Sinusitis; Tomography, X-ray computed; Paranasal sinuses/radiography


11 - Noncompliance with treatment for pulmonary tuberculosis in Cuiabá, in the State of Mato Grosso - Brazil

Abandono do tratamento da tuberculose pulmonar em Cuiabá - MT - Brasil

Silvana Margarida Benevides Ferreira, Ageo Mário Cândido da Silva, Clóvis Botelho

J Bras Pneumol.2005;31(5):427-435

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze factors predictive of noncompliance with pulmonary tuberculosis treatment. Methods: A historical cohort study involving 481 of the 529 active tuberculosis patients registered with the Tuberculosis Control Program in the city of Cuiabá, located in the state of Mato Grosso, during the 1998-2000 period. Data were obtained by analyzing medical charts and registration records. In the bivariate analysis, the chi-square test was used to calculate noncompliance rate ratios (relative risk), 95% confidence intervals were determined, and Fisher's exact test was used. The choice to estimate the rate of incidence was the method of density and a multivariate logistic regression model was constructed in order to identify the variables that were most predictive of noncompliance, using a level of statistical significance of p < 0.05. Results: The global rate of incidence was 27.3%, equivalent to 5.1 noncompliant patients/100 patients/month, increasing in the second and third months of treatment. In the final logistic regression model, the following were considered predictors of noncompliance: unsupervised treatment (odds ratio: 2.58; 95% confidence interval: 1.64 - 4.06; p < 0.001); having been treated during the 1998-1999 period (odds ratio: 1.43; 95% confidence interval: 1.14 - 1.80; p = 0.002); being male (odds ratio: 1.39; 95% confidence interval: 1.10 - 1.76; p = 0.005) and having been out of compliance with previous treatment regimes (odds ratio: 1.37; 95% confidence interval: 1.06 - 1.78; p < 0.017). Conclusion: The results indicate an elevated incidence of noncompliance and show that unsupervised treatment, year in which treatment was received, male gender and prior noncompliance were predictors of future noncompliance.


Keywords: Tuberculosis, pulmonary/therapy; Treatment refusal; Cohort studies


Review Article

12 - Avian influenza A (H5N1) - the bird flu

Influenza A aviária (H5N1) - a gripe do frango

Cássio da Cunha Ibiapina, Gabriela Araújo Costa, Alessandra Coutinho Faria

J Bras Pneumol.2005;31(5):436-444

Abstract PDF PT PDF EN Portuguese Text

The objective of this study was to review the literature related to avian influenza A (H5N1). The bibliographic research was conducted using the Medline, MD Consult, HighWire, Medscape and Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS, Latin American and Caribbean Health Sciences Literature) databases, as well as through direct research, limiting the scope to articles published within the past 10 years. We selected 31 original articles addressing the recent outbreaks of infection with the H5N1 subtype of avian influenza A in domesticated birds in Asia, which have resulted in significant economic losses and repercussions for public health, as well as some cases of human infection presenting high lethality. In most cases, infection has been associated with direct exposure to infected birds or contact with surfaces infected with bird excrement. However, cases of human-to-human transmission have been confirmed. In those cases, the incubation period varied from 2 to 4 days. The clinical manifestations range from asymptomatic infection to mild upper airway disease, pneumonia and multiple organ failure. Chest X-rays may reveal bilateral interstitial infiltrate, lobar collapse, focal consolidation and air bronchogram without pleural effusion. Lymphopenia is indicative of a poor prognosis. Supportive care appears to be the only acceptable treatment. Risk factors for poor prognosis include advanced age, delayed hospitalization, lower airway involvement, low white blood cell count or lymphopenia upon admission. Controlling outbreaks in domestic fowl and limiting contact between humans and infected birds must be the priorities in the management of this disease at the public health level. In addition, techniques and knowledge regarding the disease should be widely disseminated.


Keywords: Influenza A virus, avian /pathogenicity; Influenza; Disease outbreaks; Disease vectors; Clinical trials


13 - Educational interventions for children with asthma: An analytical review of the literature

Intervenções educativas em asma na infância. Uma revisão analítica da literatura

Lívia Fonseca da Silva Carvalho de Azevedo Santana, Rita de Cássia Santos Bastos, Martha Silvia Martinez-Silveira, Leda Solano de Freitas Souza

J Bras Pneumol.2005;31(5):445-458

Abstract PDF PT PDF EN Portuguese Text

A review of the literature published from 1992 to 2002 was performed in order to evaluate educational interventions for asthmatics from 0 to 18 years of age and to identify characteristics related to the efficacy of such interventions. Various databases were used, and a manual search of the references found in the studies selected was conducted. Thirty-nine studies (including 27 controlled studies) were selected, and, although presenting varying results, these studies provided valuable insights into the validity of education in the control of pediatric asthma. The studies evaluated the following parameters: morbidity, use of health care services, quality of life, pulmonary function, knowledge of the disease and self-care abilities. In 32 studies (82%), a beneficial effect was attributed to one or more of the variables. Among the 27 controlled studies, 85.7% presented evidence of improvement in self-care abilities, 83.3% demonstrated increased knowledge, 80% showed a reduction in diurnal and nocturnal asthma symptoms, 71.4% demonstrated fewer unscheduled medical visits, 66.6% showed that the capacity for physical activity increased, 54.5% reported fewer hospital admissions, 50% demonstrated fewer emergency room visits, 50% presented evidence of improved pulmonary function, 22,2% showed fewer school absences, and 20% found an improvement in quality of life. Among the educational programs reviewed, the number of topics was the only characteristic that was found to correlate with the degree of efficacy. The use of sophisticated educational techniques did not lead to better results. Although asthma education programs for children and adolescents has beneficial effects, further studies with better control of confounding variables are needed in order to evaluate the efficacy of such programs with greater precision.


Keywords: Asthma/prevention & control; Health education; Health knowledge, attitudes, practice; Child; Questionnaires


Case Report

14 - Pleural effusion caused by nontuberculous mycobacteria

Derrame pleural por micobactéria não tuberculosa

Márcia Seiscento, Sidney Bombarda, Adriana Castro de Carvalho, José Ribas Milanez de Campos, Lisete Teixeira

J Bras Pneumol.2005;31(5):459-463

Abstract PDF PT PDF EN Portuguese Text

Mycobacterium kansasii, a nontuberculous mycobacterium, can cause pulmonary disease presenting clinical and radiological similarities to tuberculosis. M. kansasii infection has been associated with risk factors such as bronchiectasis, chronic obstructive pulmonary disease, tuberculosis sequelae, pneumoconiosis and immunosuppression. Herein, we describe a case of pleural effusion in a 67-year-old patient with chronic obstructive pulmonary disease and a history of pulmonary tuberculosis. The histological analysis demonstrated a granulomatous chronic process and acid-fast bacilli positivity, suggesting a diagnosis of pleural tuberculosis. M. kansasii was detected both in pleural fluid cultures and in cultures of tissue samples. We discuss the differential etiologic diagnosis with other infectious agents of granulomatous diseases, and we address treatment options.


Keywords: Mycobacterium kansasii; Mycobacterium infections; Pleural effusion; Case reports


15 - Acute respiratory failure after occupational exposure to food preservatives

Insuficiência respiratória aguda após exposição a conservantes de alimentos

Maria Auxiliadora Carmo Moreira, Luiz Carlos da Cunha, Tereza Yoshie Ikegami, José Laerte Rodrigues da Silva Junior

J Bras Pneumol.2005;31(5):464-469

Abstract PDF PT PDF EN Portuguese Text

Herein, we report an instance of occupational exposure to food preservatives and resultant acute respiratory failure in three workers. The toxicological analysis revealed that mixing the particular food preservatives involved, a procedure that was performed by the three workers involved, produced NO2, the inhalation of which caused the pulmonary edema and respiratory failure. With time, the pulmonary damage was completely reversed in all three individuals. Accompanying this case report is a brief review of the literature regarding acute pulmonary injury resulting from occupational exposure to chemicals. We emphasize the importance of training, as well as of the use of protective gear, for workers who handle chemical substances.


Keywords: Respiratory insufficiency; Occupational exposure; Occupational diseases; Case report


16 - Yellow nail syndrome

Síndrome da unha amarela

Renato Maciel, Andréia Cristina de Melo, Emanuella Braga Carvalho

J Bras Pneumol.2005;31(5):470-473

Abstract PDF PT PDF EN Portuguese Text

Yellow nail syndrome is a rare disorder characterized by three main features: discoloration of the nails, together with dystrophic alterations; lymphedema; and pleural effusion. It is often accompanied by bronchiectasis and chronic rhinosinusitis. Herein, we report a case of the complete syndrome with bilateral pleural effusion in a patient under treatment for pulmonary tuberculosis for nine months. There was a family history of two similar cases in siblings.


Keywords: Nail diseases; Lymphedema; Pleural effusion; Antitubercular; Syndrome; Case report


Year 2005 - Volume 31  - Number 6  (November/December)


1 - The soul of the business!

A alma do negócio!

José Antônio Baddini Martinez

J Bras Pneumol.2005;31(6):

PDF PT PDF EN Portuguese Text

2 - Advances in the treatment of lung cancer

Avanços no tratamento do câncer pulmonar

Teresa Yae Takagaki

J Bras Pneumol.2005;31(6):iii-v

PDF PT PDF EN Portuguese Text

3 - Defining asthma for epidemiologic studies: can this objective be attained?

Definir asma para estudos epidemiológicos: essa meta pode ser alcançada?

Márcia Margaret Menezes Pizzichini

J Bras Pneumol.2005;31(6):vi-viii

PDF PT PDF EN Portuguese Text

Original Article

4 - Determining the score and cut-off point that would identify asthmatic adults in epidemiological studies using the asthma module of the International Study of Asthma and Allergies in Childhood questionnaire

Determinação de escore e nota de corte do módulo de asma do International Study of Asthma and Allergies in Childhood para discriminação de adultos asmáticos em estudos epidemiológicos

Elayne de Fátima Maçãira, Eduardo Algranti, Rafael Stelmach, Marcos Ribeiro, Maria do Patrocínio Tenório Nunes, Elizabete Medina Coeli Mendonça, Marco Antônio Bussacos

J Bras Pneumol.2005;31(6):477-485

Abstract PDF PT PDF EN Portuguese Text

Objective: To validate, for use in asthma prevalence studies, the asthma module of the standardized written questionnaire developed for use in the International Study of Asthma and Allergies in Childhood, establishing the score and cut-off point that would identify asthmatic adults. Methods: We interviewed 78 adult outpatients (40 adult asthmatics and 38 age-matched and gender-matched controls) using the asthma module of the International Study of Asthma and Allergies in Childhood questionnaire, which is composed of questions related to eight dichotomous features of asthma. We determined the score and cut-off point required to accurately identify asthmatic adults, calculating sensitivity, specificity and Youden index. The method was validated against the clinical and functional diagnosis of asthma. The reproducibility of individual questions was evaluated by conducting second interviews with half of the patients some weeks later. Results: The score ranged from 0 to 14 points. A score = 5 allowed patients with asthma to be distinguished from those without (sensitivity = 93%; specificity = 100%; Youden index = 0.93). Most questions presented satisfactory reproducibility in the second interviews conducted after 48.2 ± 11.1 days (kappa and weighted kappa ranging from 0.43 to 1.00 for individual questions). Conclusion: For studies of adult asthma prevalence, the determination/validation of a cut-off point allows an alternative interpretation of the information gathered through the application of the asthma module of the International Study of Asthma and Allergies in Childhood, taking into account the totality of the data rather than responses to individual questions.


Keywords: Asthma/diagnosis; Asthma/epidemiology; International cooperation; Questionnaires


5 - Prevalence of bronchial asthma and related symptoms in schoolchildren in the Federal District of Brazil: correlations with socioeconomic levels

Prevalência de asma brônquica e de sintomas a ela relacionados em escolares do Distrito Federal e sua relação com o nível socioeconômico

Maria Luisa Brangeli Maia Felizola, Carlos Alberto de Assis Viegas, Marcelo Almeida, Fernando Ferreira, Martinho Candido A. Santos

J Bras Pneumol.2005;31(6):486-491

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the asthma prevalence in the Federal District of Brazil, using the questionnaire developed for the International Study of Asthma and Allergies in Childhood to look for correlations with socioeconomic levels. Methods: A total of 6437 children (3183 from six to seven years old and 3254 from thirteen to fourteen years old), attending public or private schools, were evaluated. The data were analyzed by gender and socioeconomic status (chi-square test). Results: The prevalence of asthma in the Federal District was 12.1% among the six- and seven-year-olds and 13.8% among the thirteen- and fourteen-year-olds (p < 0.04). In the six-to-seven age bracket, asthma prevalence was significantly greater, and asthma-related symptoms were more frequent, among males (p < 0.001). In contrast, asthma-related symptoms were more frequent among females in the thirteen-to-fourteen age bracket (p < 0.05). Children belonging to the lowest socioeconomic class, as determined by the responses given on the questionnaire completed by the parents, presented the highest prevalence of asthma, regardless of age bracket (p < 0.001). Among such children, asthma-related symptoms were also more frequent (p < 0.05). In the thirteen-to-fourteen age bracket, the prevalence of asthma was greater among those belonging to the highest socioeconomic class (p = 0.001). Conclusions: Overall, economically disadvantaged children more frequently presented asthma-related symptoms and experienced asthma attacks that were of greater severity. In addition, the prevalence of suspected asthma was higher than that of diagnosed asthma in this group, suggesting that asthma is underdiagnosed in children belonging to the lowest socioeconomic class.


Keywords: Asthma/epidemiology; Asthma/diagnosis; Socioeconomic factors; School health; Questionnaires


6 - Climate variations and health services use for the treatment of asthmatic children under five years of age: an ecological study

Variações climáticas e uso de serviços de saúde em crianças asmáticas menores de cinco anos de idade: um estudo ecológico

Celso Taques Saldanha, Ageo Mário Cândido da Silva, Clovis Botelho

J Bras Pneumol.2005;31(6):492-498

Abstract PDF PT PDF EN Portuguese Text

Objective: To study variations in climate (dry or rainy periods) and health services use for the treatment of asthma in children under five years of age. Methods: An ecological study was conducted and involved analysis of the medical charts of all children under the age of five that were diagnosed with asthma and treated in the Municipal Emergency Room of the city of Cuiabá, located in the state of Mato Grosso, Brazil. In accordance with the geographic location of Cuiabá, two climatic periods were identified: a dry season (from May to October) and a rainy season (from November to April). Results: The percentage of children treated that were diagnosed with asthma was 12.2% (3140/25,802), with no gender-based difference. Children from 3 to 5 years of age were most often affected. The overall asthma hospitalization rate was 1.3% (336/25,802), rising to 10.7% (336/3140) among the asthmatic children treated in the emergency room. In the rainy season, the percentage of outpatients seeking treatment for asthma was higher than in the dry season: 39.1% (1228/3140) versus 60.9% (1912/3140). However, during the dry season, a greater proportion of such patients were hospitalized: 52.3% (176/336) versus 47.7% (160/336). These differences were statistically significant (p < 0.05). Conclusions: The dry season, which was correlated with higher asthma hospitalization rates, seems to be related to more severe cases of asthma in children under five years of age.


Keywords: Asthma/prevention & control; Allergens/adverse effects; Respiratory hypersensitivity; Environmental monitoring;


7 - The effect of psychotherapy provided as part of a pulmonary rehabilitation program for the treatment of patients with chronic obstructive pulmonary disease

O efeito da assistência psicológica em um programa de reabilitação pulmonar para pacientes com doença pulmonar obstrutiva crônica

Dagoberto Vanoni de Godoy, Rossane Frizzo de Godoy, Benno Becker Júnior, Paula Fernanda Vaccari, Maurício Michelli, Paulo José Zimermann Teixeira, Bruno Carlos Palombini

J Bras Pneumol.2005;31(6):499-505

Abstract PDF PT PDF EN Portuguese Text

Objective: To assess the effect of psychotherapy on levels of anxiety and depression, as well as on quality of life and exercise capacity in patients with chronic obstructive pulmonary disease enrolled in a pulmonary rehabilitation program. Methods: A randomized, controlled, blind clinical trial was conducted involving 49 chronic obstructive pulmonary disease patients. Patients were randomized into three groups: those submitted to the complete pulmonary rehabilitation program, which included psychotherapy and an exercise regimen (group 1); those submitted to the program minus physical exercise (group 2); and those submitted to the program minus psychotherapy (group 3). The three groups underwent a 12-week treatment program. All patients were evaluated at baseline and at completion of the pulmonary rehabilitation program through four instruments: The Beck Anxiety Inventory, Beck Depression Inventory and St. George's Respiratory Questionnaire were applied. The distance walked-weight product was also calculated. Results: Statistically significant absolute improvements in exercise capacity were found for groups 1 and 2, although not for group 3 (p = 0.007, p = 0.008 and p = 0.06, respectively). In groups 1 and 2, levels of anxiety and depressions were also significantly reduced (group 1: p = 0.0000 and p < 0.0003; group 2: p = 0.0001 and p = 0.0014), and quality of life was significantly improved (p = 0.0007 and p = 0.002, respectively). Anxiety levels were also reduced in group 3 (p = 0.03), although levels of depression were not, and quality of life was unaffected. Conclusion: Psychotherapy sessions provided as part of a pulmonary rehabilitation program assist patients with chronic obstructive pulmonary disease in coping with disease-related limitations by reducing behavioral symptoms, especially depression, thereby influencing exercise capacity and health-related quality of life.


Keywords: Pulmonary disease, chronic obstructive/rehabilitation; Pullmonary diseases, chronic obstructive/psychology; Anxiety; Depression; Quality of Life; Exercise therapy


8 - Experimental myocardial infarction and increased oxidative stress in the rat diaphragm

Infarto do miocárdio experimental e aumento do estresse oxidativo em diafragma de ratos

Fabiano Leichsering Silva, Nicolle Gollo Mazzotti, Marcus Picoral, Daniella Meirelles Nascimento, Maria Isabel Morgan Martins, Adriane Belló Klein

J Bras Pneumol.2005;31(6):506-510

Abstract PDF PT PDF EN Portuguese Text

Objective: To use an experimental model to evaluate the effect of heart failure on oxidative stress in the rat diaphragm. Methods: The model of myocardial infarction was developed through left coronary artery ligation. On day 42 after coronary artery ligation, the animals were killed, after which the diaphragms were collected and homogenized. Oxidative stress was evaluated in diaphragm homogenates through measurement of lipid peroxidation and assays of the activity of antioxidant enzymes, including catalase and glutathione peroxidase (enzymes that reduce hydrogen peroxide to water), as well as superoxide dismutase (an antioxidant enzyme that reduces superoxide anions to hydrogen peroxide). Results: The coronary artery ligation model was found to be effective in causing heart failure. In the animals submitted to coronary artery ligation, the mean infarcted area of the left ventricle was 39%. Lipid peroxidation was 217% greater in the diaphragms of ligated animals than in those of controls. The activity of catalase and glutathione peroxidase was 77% and 20% lower, respectively, in study rats than in control rats. Infarction did not modify superoxide dismutase activity. Conclusion: The results suggest that left coronary artery ligation results in oxidative stress in the diaphragm.


Keywords: Myocardial infarction; Oxidative stress; Congestive heart failure; Antioxidants; Diaphragm; Rats


9 - Effect of perillyl alcohol on gene expression of human pulmonary adenocarcinoma cells

Efeito do álcool perílico na expressão gênica de células de adenocarcinoma de pulmão humano

Juliana de Saldanha da Gama Fischer, Marcelo Soares da Mota e Silva, Marcos Eduardo Paschoal, Cerli Rocha Gattass, Paulo Costa Carvalho, Maria da Gloria da Costa Carvalho

J Bras Pneumol.2005;31(6):511-515

Abstract PDF PT PDF EN Portuguese Text

Objective: To study the effect of perillyl alcohol on the gene expression of human pulmonary adenocarcinoma cells. Methods: Pulmonary adenocarcinoma cells were incubated with perillyl alcohol in dilutions ranging from 0.03% to 0.0003% for 48 hours. Alterations were observed in the cell morphology, and cell viability was quantified using [3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide] assays. Protein synthesis of samples previously targeted with S35 was analyzed using electrophoresis on a polyacrylamide gel. Expression of the proteins p53 and p44/42 was determined using the Western blot method. Results: After 48 hours of incubation, greater numbers of morphological alterations were observed in cells treated with the 0.03% perillyl alcohol dilution than in those treated with perillyl alcohol diluted to 0.003% or further. Treatment with perillyl alcohol dilutions of 0.03%, 0.003% and 0.0003% inhibited cellular viability by 60.17% (p < 0.001), 15.62% (p < 0.001) and 11.53% (p < 0.05), respectively. The results show that 28-kDa, 42-kDa and 110-kDa proteins were induced. No statistically significant effect on p53 expression was observed. In comparison with the expression of a-tubulin, the 0.003% perillyl alcohol dilution induced an increase in p42 phosphorylation and a marked decrease in p44 phosphorylation. Conclusion: The results suggest that there are other, previously undescribed, metabolic pathways for perillyl alcohol effects in human pulmonary adenocarcinoma cells.


Keywords: Adenocarcinoma; Lung neoplasms; Monoterpenes; Cell culture; Lung/cytology


10 - Smoking among physicians in a specific region of the greater metropolitan area of São Paulo

Tabagismo entre médicos da Região do ABC Paulista

Adriano Cesar Guazzelli, Mário Terra Filho, Elie Fiss

J Bras Pneumol.2005;31(6):516-522

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the prevalence of and describe the methods used to control the smoking habit among a geographically-specific population of physicians. Methods: Questionnaires were distributed to physicians practicing in a region of the greater metropolitan area of São Paulo area known as the "ABC Paulista" (comprising the municipalities of Santo Andre, São Bernardo and São Caetano), and completed questionnaires were received from 678 physicians, all registered with the São Paulo State Regional Council of Medicine. Results: Of the 678 responding physicians, 58 (8.6%) were smokers, 183 (27.0%) were former smokers, and 437 (64.5%) were nonsmokers. No gender-based differences were found. Nor were there any significant differences in prevalence based on medical specialty. Most of the smokers had tried to stop smoking. Among the smokers, cessation methods were used by 7%: nicotine replacement therapy by 4.3%; and acupuncture by 2.7%. Most of the former smokers (88.1%) had successfully quit smoking without using any cessation methods. Conclusion: The prevalence of smoking among physicians in the ABC Paulista region was 8.6%. In this region, the majority of physicians who quit smoking did so without the aid of smoking cessation methods. Among those who did use such methods, nicotine replacement therapy was the method of choice.


Keywords: Prevalence; Smoking; Physicians; Smoking cessation


11 - Spatial and temporal patterns of tuberculosis in the city of Ribeirão Preto, Brazil from 1998 to 2002

Evolução espaço-temporal dos casos de tuberculose em Ribeirão Preto (SP), nos anos de 1998 a 2002

Paula Hino, Claudia Benedita dos Santos, Tereza Cristina Scatena Villa

J Bras Pneumol.2005;31(6):523-527

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the spatial distribution of tuberculosis in the city of Ribeirão Preto, located in the state of São Paulo, Brazil, between 1998 and 2002, with a focus on the potential spatially-dependent nature of its occurrence. Methods: The secondary Epi-Tb database of the Ribeirão Preto Municipal Secretary of Health. Georeferencing of tuberculosis cases was performed using MapInfo 6.5 software, and the Spring program was used for statistical analysis of spatial data. Results: Through analysis of the existing spatial pattern and those of the previous years analyzed, we found a consistent pattern of spatial distribution of tuberculosis in Ribeirão Preto. Although there are areas that were homogeneous in terms of risk, the highest concentrations of cases were found in one zone, consisting of middle- to lower middle-class neighborhoods, located in the northeast part of the city. Conclusion: These results add to the store of knowledge regarding the spatial distribution of tuberculosis in Ribeirão Preto in various periods, emphasizing the importance of space as a methodological alternative to aid the planning, monitoring and evaluation of health care programs, allowing interventions to be more appropriately directed in order to decrease inequalities in the allocation of health care resources.


Keywords: Tuberculosis/epidemiology; Health status indicators; Residence characteristics; Urban health/ statistics & numerical data; Topography, medical


Review Article

12 - The challenge of diagnosing acute pulmonary thromboembolism in patients with chronic obstructive pulmonary disease

O desafio de diagnosticar tromboembolia pulmonar aguda em pacientes com doença pulmonar obstrutiva crônica

Sérgio Saldanha Menna-Barreto

J Bras Pneumol.2005;31(6):528-539

Abstract PDF PT PDF EN Portuguese Text

Pulmonary thromboembolism and exacerbation of chronic obstructive pulmonary disease are common conditions. Chronic obstructive pulmonary disease is a clinical risk factor for pulmonary thromboembolism. The presentation of acute pulmonary thromboembolism and acute exacerbation of chronic obstructive pulmonary disease often mimic each other so closely that they cannot be distinguished clinically. The structural abnormalities of the lungs in chronic obstructive pulmonary disease make also difficult to interpret the results of noninvasive tests like ventilation-perfusion lung scans. Therefore, diagnosing acute pulmonary thromboembolism in patients with underlying chronic obstructive pulmonary disease is a challenging task. In order to update knowledge of the subject and offer suggestions regarding conduct, we evaluated various studies addressing this theme, including case reports and case series. In addition, we reviewed diagnostic approaches to acute pulmonary thromboembolism, and we reflect upon that topic. The clinical probability of pulmonary thromboembolism concomitant to chronic obstructive pulmonary disease is typically intermediate, as is positivity on the ventilation-perfusion lung scan. Diagnostic algorithms should take that into consideration.


Keywords: Pulmonary disease, chronic obstructive/complications; Pulmonary embolism/diagnosis; Pulmonary embolism/epidemiology; Ventilation-perfusion ratio


13 - Treatment of superior vena cava syndrome

Tratamento da síndrome da veia cava superior

Luís Marcelo Inaco Cirino, Rafael Ferreira Coelho, Ivan Dias da Rocha, Bernardo Pinheiro de Senna Nogueira Batista

J Bras Pneumol.2005;31(6):540-550

Abstract PDF PT PDF EN Portuguese Text

The superior vena cava is formed by the union of the right and left brachiocephalic veins. It is located in the middle mediastinum, to the right of the aorta and anterior to the trachea. Superior vena cava syndrome consists of a group of signs (dilation of the veins in the neck, facial swelling, edema of the upper limbs, and cyanosis) and symptoms (headache, dyspnea, cough, orthopnea and dysphagia) caused by the obstruction of blood flow through the superior vena cava to the right atrium. This obstruction can be caused by extrinsic compression, tumor invasion or thrombosis. Such obstruction may also occur as a result of insufficient venous return secondary to intra-atrial or intraluminal diseases. From 73% to 93% of all cases of superior vena cava syndrome occur during the development of an intrathoracic tumor. Most patients presenting superior vena cava syndrome secondary to malignant neoplasms are treated without surgery, through radiotherapy, chemotherapy or the use of intraluminal stents. When the etiology of superior vena cava syndrome is benign, it can be treated with clinical measures (anticoagulation, raising the head, etc.) or, in refractory cases, with angioplasty, stents or surgery.


Keywords: Superior vena cava syndrome/therapy; Superior vena cava syndrome/surgery; Superior vena cava syndrome/etiology; Superior vena cava syndrome /drug therapy; Superior vena cava syndrome /radiotherapy; Superior vena cava


14 - Respiratory therapy in pleural empyema. A systematic review of the literature

Fisioterapia respiratória no empiema pleural. Revisão sistemática da literatura

Murilo Carlos Amorim de Britto, Maria do Carmo Menezes Bezerra Duarte, Silvia Maria Mendes da Conceição Silvestre

J Bras Pneumol.2005;31(6):551-554

Abstract PDF PT PDF EN Portuguese Text

Some techniques used in respiratory therapy are not based on sound scientific evidence. The misuse of such techniques can be harmful in terms of adverse effects and may not be cost-effective. A systematic review of the literature was performed using the Oldmedline, Medline, Cinahl and Lilacs databases, as well as the registry of clinical trials registered by the Cochrane Library and National Institutes of Health. The focus of the review was on trials addressing the efficacy of respiratory therapy in treating pleural empyema in children, adolescents and adults. No such trials were found. We can conclude that there is a lack of data regarding the efficacy of respiratory therapy in pleural empyema. In order to provide such data, clinical trials are warranted.


Keywords: Empyema pleural/rehabilitation; Evidence-based medicine; Physical therapy techniques; Review [Publication Type]; Randomized controlled trials


Case Report

15 - Endobronchial lipoma

Lipoma endobrônquico

Antônio Mauro Bof, Abrão Rapoport, Luiz Carlos Paier, Yara Lopes Diaz, Luiz Carlos Filgueiras Leiro, Roberto Ruben Pando-Serrano, Márcio Rogério Alcalá Gomes, Emílio Scafura Lomonte

J Bras Pneumol.2005;31(6):555-558

Abstract PDF PT PDF EN Portuguese Text

Lipomas are benign neoplasms composed primarily of adipose tissue and may be located in various parts of the body. The case reported is that of a patient who sought medical assistance complaining of recurring pneumonia. After diagnostic procedures, including chest X-ray and computed tomography scan of the chest, endobronchial lesion with fat density was suspected. The diagnostic hypothesis was endobronchial lipoma. This hypothesis was confirmed after surgical intervention. The aim of this study was to report this case of endobronchial lipoma and to review the available literature on the subject.


Keywords: Pneumonia/complications; Recurrence; Bronchial neoplasms/surgery; Lipoma/surgery; Tomography, X-ray computed; Case reports


16 - Mucoepidermoid carcinoma: a rare cause of recurrent pneumonia

Pneumonia recorrente com uma causa rara: carcinoma mucoepidermóide

José Wellington Alves dos Santos, Maurício Licks da Silveira, Cristiano Tonello, Melissa Falster Daubermann

J Bras Pneumol.2005;31(6):559-562

Abstract PDF PT PDF EN Portuguese Text

Recurrent pneumonia is characterized by frequent infection and infiltrates in one or more lung lobes. The localized form of the disease is caused by intraluminal obstruction, extrinsic compression or structural abnormalities. The pattern, frequency and severity of the infections, together with a thorough review of all chest X-rays, inform the diagnosis. Herein, we report a case of recurrent pneumonia due to endobronchial obstruction by mucoepidermoid carcinoma.


Keywords: Pneumonia; Recurrent; Carcinoma, mucoepidermoid/diagnosis; Tomography, X-ray computed; Case reports


16 - Primary effusion lymphoma in an immunocompetent patient

Linfoma primário de cavidade pleural em paciente imunocompetente

Leila Antonangelo, Francisco S Vargas, Lisete Ribeiro Teixeira, Marcelo A C Vaz, Maria Mirtes Sales, Luis C Moreira, Roberta Karla Barbosa de Sales

J Bras Pneumol.2005;31(6):563-566

Abstract PDF PT PDF EN Portuguese Text

Primary effusion lymphoma is an unusual non-Hodgkin's lymphoma rarely seen in immunocompetent patients. Herein, we present clinical and biochemical data obtained from an immunocompetent patient diagnosed with primary effusion lymphoma.


Keywords: Pleural effusion; Lymphoma, non-Hodgkin; HIV seronegativity; Case reports


Letters to the Editor

17 - The avian flu pandemic

Pandemia de gripe aviária

Danilo Cortozi Berton, Paulo Jose Zimermann Teixeira

J Bras Pneumol.2005;31(6):570

PDF PT PDF EN Portuguese Text

18 - Pavilhão Pereira Filho celebrates 40 years in operation

Pavilhão Pereira Filho comemora 40 anos

Paulo José Zimermann Teixeira

J Bras Pneumol.2005;31(6):571

PDF PT PDF EN Portuguese Text

Relationship of Reviewers


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