Brazilian Journal of Pulmonology

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

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Year 2006 - Volume 32  - Number 1  (January/February)

Editorial

1 - Master Rosemberg

Mestre Rosemberg

Affonso Berardinelli Tarantino

J Bras Pneumol.2006;32(1):1

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2 - Brazilian ratification of the Framework Convention on Tobacco Control: a question of public health

A ratificação da Convenção-Quadro para o Controle do Tabaco pelo Brasil: uma questão de saúde pública

Ricardo Henrique Sampaio Meirelles

J Bras Pneumol.2006;32(1):2-3

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3 - Peak expiratory flow. It's better to measure!

Pico de fluxo expiratório. É melhor medir!

Álvaro Augusto Cruz

J Bras Pneumol.2006;32(1):4-6

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Original Article

4 - Early prognosis of acute asthma in the emergency room

Avaliação prognóstica precoce da asma aguda na sala de emergência

Deise Marcela Piovesan, Diego Milan Menegotto, Suzie Kang, Eduardo Franciscatto, Thaís Millan, Cristine Hoffmann, Lílian Rech Pasin, Josiane Fischer, Sérgio Saldanha Menna Barreto, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2006;32(1):1-9

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Objective: To evaluate clinical and pulmonary function measurements taken in the first fifteen minutes of the assessment of acute asthma in the emergency room and used for prognostic purposes. Methods: A prospective cohort study involving consecutive patients with acute asthma. Only patients who were between the ages of 12 and 55 and presented peak expiratory flow rates < or = 50% of predicted were included. Evaluations were performed upon admission, then again at 15 minutes and 4 hours after the initiation of treatment. Treatment included albuterol and ipratropium delivered by metered-dose inhaler with a spacer, together with 100 mg of intravenous hydrocortisone. Favorable outcomes were defined as peak expiratory flow > or = 50% of predicted after 4 hours of treatment, and unfavorable outcomes were defined as peak expiratory flow < 50% after 4 hours of treatment. Results: Favorable outcomes were seen in 27 patients, and unfavorable outcomes were seen in 24 patients. In the multivariate analysis, peak expiratory flow as percentage of predicted was identified as the variable with the highest predictive value. A peak expiratory flow > or = 40% after 15 minutes of treatment showed significant power in predicting a favorable outcome (sensitivity = 0.74, specificity = 1.00, and positive predictive value = 1.00). A peak expiratory flow < 30% after 15 minutes of treatment was predictive of a poor outcome (sensitivity = 0.54, specificity = 0.93, and positive predictive value = 0.87). Conclusion: Our results suggest that measuring peak expiratory flow after 15 minutes of management in the emergency room is a useful tool for predicting outcomes in cases of acute asthma.

 


Keywords: Asthma; Acute disease; Respiratory mechanics; Prognosis; Emergency Service, Hospital; Cohort studies

 

5 - Evaluation of quality of life of patients submitted to pulmonary resection due to neoplasia

Avaliação da qualidade de vida em pacientes submetidos a ressecção pulmonar por neoplasia

Ivete Alonso Bredda Saad, Neury José Botega, Ivan Felizardo Contrera Toro

J Bras Pneumol.2006;32(1):10-15

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Objective: To evaluate the health-related quality of life of patients submitted to resection of the pulmonary parenchyma due to neoplasia. Methods: The Medical Outcomes Study 36-item Short-Form Health Survey was used to evaluate patients in the preoperative period and on postoperative days 30, 90 and 180. We used the GEE statistical model, in which the dependent variable (quality of life) changes for each patient over the course of the evaluation. Independent variables were gender, age, educational level, type of surgery, radiotherapy, chemotherapy, forced vital capacity and 6-minute walk test. The level of significance adopted was 5%. Results: The final study sample comprised 36 patients, 20 of whom were men. Of those 36 patients, 17 were submitted to lobectomy, 10 to pneumonectomy, 6 to segmentectomy, and 3 to bilobectomy. Chemotherapy was used in 15 patients, radiotherapy in 2, and a combination of radiotherapy and chemotherapy in 2. Improved quality of life was seen in the following domains: social (on postoperative day 90); physical/functional (some patients presenting better forced vital capacity and 6-minute walk test performance); and physical (in patients undergoing smaller resections). Lowered quality of life was seen in the following domains: social (for female patients); physical/social (resulting from radiotherapy, chemotherapy or both); and physical/functional (by postoperative day 30). Conclusions: It is important that studies evaluating the various determinants of quality of life, as well as the impact that cancer treatment modalities have on such variables, be conducted. The knowledge provided by such studies can contribute to improving the quality of life of patients undergoing pulmonary resection due to neoplasia.

 


Keywords: Lung neoplasms/surgery; Pneumonectomy; Quality of life; Questionnaires

 

6 - Effects of pneumoperitoneum on the amplitude of diaphragmatic excursion in pigs

Repercussões do pneumoperitônio na amplitude da excursão diafragmática em suínos

Valéria Marques Ferreira Normando, Marcus Vinicius Henriques Brito, Francisco Alves de Araújo Júnior, Breno Costa Maciel Albuquerque

J Bras Pneumol.2006;32(1):16-22

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Objective: To study the effects that pneumoperitoneum achieved through carbon dioxide insufflation has on diaphragmatic excursion in pigs. Methods: A total of 14 male Landrace pigs, 30 to 45 days of age and weighing five to seven kilograms each, were used. The sample was randomly and equally divided into two groups: one (n = 7) in which pneumoperitoneum was maintained at 10 mmHg for 60 minutes; and another (n = 7) in which pneumoperitoneum was maintained at 15 mmHg (also for 60 minutes). After anesthetic induction, the animals were intubated. Flow volume was monitored, and the amplitude of diaphragmatic excursion was analyzed using noninvasive ultrasound imaging of the right hemidiaphragm. Results: In both groups, restricted diaphragmatic excursion was observed only during the procedure. There was no statistical difference between the two pressure levels studied. Conclusion: The amplitude of diaphragmatic excursion was restricted during abdominal insufflation, independent of the pressure level (within the 10-15 mmHg range), during the study period.

 


Keywords: Pneumoperitoneum/chemically induced; Carbon dioxide; Diaphragm; Video-assisted surgery; Swine

 

7 - Prevalence and characteristics of smoking among youth attending the University of Brasília in Brazil

Prevalência e características do tabagismo em jovens da Universidade de Brasília

Ana Paula Alves de Andrade, Ana Cláudia Corsini Bernardo, Carlos Alberto de Assis Viegas, Denise Bastos Lage Ferreira, Thais Cabral Gomes, Mariana Ramos Sales

J Bras Pneumol.2006;32(1):23-28

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Objective: To determine the prevalence of smoking and to describe the profile and smoking habits of students attending the Universidade de Brasília (University of Brasília) in Brasília, Brazil. Methods: A total of 1341 students responded to a smoking questionnaire, adapted from the World Health Organization questionnaire, including questions directed at smokers, former smokers and nonsmokers. Twenty different courses in the areas of health, exact sciences and human sciences were evaluated. The students included in the study were duly enrolled in day courses and were evaluated during the second semester of 2003. Results: The overall prevalence of smoking was 14.7%. Approximately 80.8% of the students were nonsmokers, and 4.5% were former smokers. In the study sample, 57.3% of the students were male. No significant difference (p > 0.05) in the prevalence of smoking was observed in terms of gender or class year. The mean age of the study population was 21.6 ± 3.6 years, and the mean age at which the smoking habit was acquired was 17 ± 2.8 years. The percentage of smokers was higher in the Geology, Communication, and History courses (32.9, 26.3 and 24.4%, respectively). Mean consumption was 7.5 cigarettes per day. The majority (72.6%) of the students used commercial cigarettes rather than other types of tobacco. Conclusion: The high prevalence of smoking observed in the present study is similar to that reported for other universities and indicates the need for smoking control policies in university environments.

 


Keywords: Smoking/epidemiology; Students; Questionnaires

 

8 - Availability and use of noninvasive ventilation in the intensive care units of public, private and teaching hospitals in the greater metropolitan area of São Paulo, Brazil

Conhecimento da disponibilidade e sobre o uso da ventilação não invasiva em unidades de terapia intensiva de hospitais públicos, privados e de ensino da região metropolitana de São Paulo

Lara Maris Nápolis, Leila Mara Jeronimo, Danila Vieira Baldini, Michelle Pinheiro Machado, Virgínia Aparecida de Souza, Pedro Caruso

J Bras Pneumol.2006;32(1):29-34

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Objective: To determine the availability of noninvasive positive-pressure ventilation equipment, as well as the level of expertise and familiarity of physicians, nurses and physiotherapists with noninvasive positive-pressure ventilation in the intensive care units of public, private and teaching hospitals in the greater metropolitan area of São Paulo, Brazil. Methods: On-site administration of questionnaires. Results: Noninvasive positive-pressure ventilation equipment was widely available and was more commonly found in private hospitals than in teaching hospitals. Such equipment was least available in public hospitals, in which the predominant method was the use of mechanical ventilators designed for invasive ventilation and adapted to noninvasive positive-pressure ventilation. In private hospitals, continuous flow ventilators were more common, whereas, in teaching hospitals, ventilators specifically designed for noninvasive ventilation were typically employed. All physiotherapists felt themselves capable of initiating noninvasive positive pressure ventilation, compared with 72.6% of physicians and 33.3% of nurses. Physicians and physiotherapists presented high percentages of correct answers when asked about the indications and contraindications for the use of noninvasive positive-pressure ventilation. Over a one year period, more physiotherapists read articles about noninvasive positive-pressure ventilation and participated in related classes than did physicians, who in turn did so more than did nurses. Conclusion: Noninvasive positive-pressure ventilation equipment is widely available in the greater metropolitan area of São Paulo, although differences exist among public, private and teaching hospitals in terms of the type of equipment used. Physicians and physiotherapists exhibited considerable knowledge regarding the indications and contraindications for the use of noninvasive positive-pressure ventilation. More physiotherapists felt themselves able to initiate noninvasive positive-pressure ventilation, and their knowledge of the subject was more current than was that of physicians or nurses.

 


Keywords: Ventilators, mechanical; Positive-pressure respiration/methods; Respiratory insuficiency; Intensive care units; Hospitals

 

9 - Incidence of acute lung injury and acute respiratory distress syndrome in the intensive care unit of a university hospital: a prospective study

Incidência de lesão pulmonar aguda e síndrome da angústia respiratória aguda no centro de tratamento intensivo de um hospital universitário: um estudo prospectivo

Raquel Hermes Rosa Oliveira, Aníbal Basille Filho

J Bras Pneumol.2006;32(1):35-42

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Objective: To establish the incidence of acute lung injury and acute respiratory distress syndrome, as well as related risk factors and mortality in an intensive care unit. To compare patients developing lung injury with at-risk patients not presenting acute lung injury or acute respiratory distress syndrome. Methods: The study was conducted in the intensive care unit of the Ribeirão Preto Hospital das Clínicas Emergency Room. All patients admitted between May 2001 and April 2002 were monitored prospectively. Clinical data, Acute Physiologic and Chronic Health Evaluation II score, complications, length of stay in the intensive care unit and lung injury data were recorded. Results: Of the 524 patients admitted, 175 (33.4%) presented risk factors for acute lung injury and acute respiratory distress syndrome, 33 (6.3%) developed acute respiratory distress syndrome, and 12 (2.3%) developed acute lung injury. The main risk factors were pneumonia (37.7%), shock (32.0%), multiple trauma (24.6%) and sepsis (21.1%). Patients developing acute lung injury had higher Acute Physiologic and Chronic Health Evaluation II scores (p < 0.05), more frequently presented sepsis (p = 0.001), developed more complications (p = 0.001) and presented greater mortality (p = 0.001). The main cause of death was multiple organ failure (38.5%). Conclusion: The incidence of acute lung injury and acute respiratory distress syndrome was 2.3% and 6.3%, respectively.

 


Keywords: Respiratory distress syndrome, adult/epidemiology; Respiratory distress syndrome, adult/mortality;

 

10 - Functional profile of patients with tuberculosis sequelae in a university hospital

Perfil funcional de pacientes portadores de seqüela de tuberculose de um hospital universitário

Lucia Maria Macedo Ramos, Nara Sulmonett, Cid Sergio Ferreira, Juliana Fulgêncio Henriques, Silvana Spíndola de Miranda

J Bras Pneumol.2006;32(1):43-47

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Objective: To describe data related to the pulmonary function of patients with sequelae of pulmonary tuberculosis, pleural tuberculosis or both. Methods: In the outpatient clinic of a university hospital, 218 patients were evaluated. Of those 218, 56 had sequelae of tuberculosis (pulmonary, pleural or both), and 162 had other types of tuberculosis. All patients were evaluated in the pulmonary function laboratory between February 2000 and July 2004, and 43 were found to be eligible for inclusion in the study. Patients with a history of asthma, chronic pulmonary obstructive disease, cardiac insufficiency, collagen diseases, silicosis or thoracic surgery, as well as those for whom spirometry yielded unacceptable results or was not performed, were excluded. The lung fields were divided into six zones, and radiographic results were classified by degree: I (involvement of only one zone with no cavitation); II (involvement of two or three zones or of one zone with cavitation); or III (extensive involvement of three or more zones with or without cavitation). Results: The final study sample comprised 50 patients, 44 (88%) of whom had pulmonary tuberculosis. The most prevalent form (17/50; 34%) was mixed ventilatory disturbance. Severe disturbances were more significant in degree III radiographs (p = 0.0002) and normal pulmonary function was predominant among patients presenting degree I and II radiographs (p = 0.002). Conclusion: The early discovery and treatment of tuberculosis contribute to reduce the number of cases, as well as the incidence of tuberculosis sequelae, thereby improving the quality of life of tuberculosis patients. Further studies, involving longitudinal, sequential analysis and larger samples of patients with tuberculosis sequelae, should be conducted in referral centers in Brazil.

 


Keywords: Tuberculosis, pulmonary/diagnosis; Tuberculosis, pleural/diagnosis; Respiratory function tests; Spirometry;

 

11 - Prevalence of and factors related to tuberculosis in seropositive human immunodeficiency virus patients at a reference center for treatment of human immunodeficiency virus in the southern region of the state of Rio Grande do Sul, Brazil

Prevalência e fatores associados à tuberculose em pacientes soropositivos para o vírus da imunodeficiência humana em centro de referência para tratamento da síndrome da imunodeficiência adquirida na região sul do Rio Grande do Sul

Jussara Maria Silveira, Raúl Andrés Mendoza Sassi, Isabel Cristina de Oliveira Netto, Jorge Lima Hetzel

J Bras Pneumol.2006;32(1):48-55

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Objective: In view of the relevance of co-infection with tuberculosis and human immunodeficiency virus, this study was designed to determine tuberculosis prevalence and identify factors related to tuberculosis in patients residing in a region in which both infections are highly prevalent. Methods: All patients treated during 1999 at the HIV/AIDS Clinic of the Universidade Federal do Rio Grande (Rio Grande Federal University) University Hospital were evaluated retrospectively, from the time of human immunodeficiency virus diagnosis, in terms of the incidence of tuberculosis and its relationship to sociodemographic, behavioral and immunological factors. Results: The sample included 204 patients, and tuberculosis prevalence was found to be 27%. The multivariate analysis showed a significant correlation between the development of tuberculosis and being of African descent (odds ratio: 4.76; 95% confidence interval: 1.93-11.72) and an inverse correlation between the development of tuberculosis and the TCD4+ lymphocyte count at the time of human immunodeficiency virus diagnosis (odds ratio: 0.995; 95% confidence interval: 0.993-0.997). When analyzed separately, other variables were found to be potential risk factors: being of the male gender (odds ratio: 2.49; 95% confidence interval: 1.15-5.39); and using illicit drugs (odds ratio: 2.1; 95% confidence interval: 1.02-4.31). Conclusion: The factors responsible for the development of tuberculosis among patients who are human immunodeficiency virus seropositive include immunological, socioeconomic and demographic factors. The high rate of tuberculosis prevalence among the seropositive patients underscores the urgent need to implement strategies that combine rapid identification and prompt treatment of individuals with active or latent infection, as well as of those with whom they have been in contact.

 


Keywords: HIV Infections/complications; AIDS-related opportunistic infections/complications; Tuberculosis/etiology; Tuberculosis/epidemiology

 

Review Article

12 - Molecular markers in lung cancer: prognostic role and relationship to smoking

Marcadores moleculares no câncer de pulmão: papel prognóstico e sua relação com o tabagismo

Ricardo Luiz de Menezes Duarte, Marcos Eduardo Machado Paschoal

J Bras Pneumol.2006;32(1):56-65

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Epidemiological studies have demonstrated a causal relationship between smoking and lung cancer. Although most lung cancer cases are linked to smoking, only a minority of heavy smokers develop lung cancer, leading to the notion that genetic factors affect individual susceptibility. The principal molecular changes in lung cancer are seen in tumor suppressor genes, proto-oncogenes, growth factors, telomerase activity, and methylation status of promoters. Well-known agents include angiogenesis-stimulating factors (such as vascular endothelial growth factor), as well as factors related to tumor cell proliferation and apoptosis (epidermal growth factor receptor, p53, K-ras, retinoblastoma and BCL-2). Several of these genetic factors have already been investigated, but no single parameter has yet presented sufficient selectivity regarding prognostic value or therapeutic efficacy. Treatment strategies to cure lung cancer should focus on these early genetic lesions in order to promote their repair or to eliminate these lung cancer cells.

 


Keywords: Smoking; Lung neoplasms; Genetic markers; Prognosis

 

13 - New treatments for chronic obstructive pulmonary disease using ergogenic aids

Novas terapias ergogênicas no tratamento da doença pulmonar obstrutiva crônica

Débora Strose Villaça, Maria Cristina Lerario, Simone Dal Corso, José Alberto Neder

J Bras Pneumol.2006;32(1):66-77

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Chronic obstructive pulmonary disease is currently considered a systemic disease, presenting structural and metabolic alterations that can lead to skeletal muscle dysfunction. This negatively affects the performance of respiratory and peripheral muscles, functional capacity, health-related quality of life and even survival. The decision to prescribe ergogenic aids for patients with chronic obstructive pulmonary disease is based on the fact that these drugs can avert or minimize catabolism and stimulate protein synthesis, thereby reducing the loss of muscle mass and increasing exercise tolerance. This review summarizes the available data regarding the use of anabolic steroids, creatine, L-carnitine, branched-chain amino acids and growth hormones in patients with chronic obstructive pulmonary disease. The advantage of using these ergogenic aids appears to lie in increasing lean muscle mass and inducing bioenergetic modifications. Within this context, most of the data collected deals with anabolic steroids. However, to date, the clinical benefits in terms of increased exercise tolerance and muscle strength, as well as in terms of the effect on morbidity and mortality, have not been consistently demonstrated. Dietary supplementation with substances of ergogenic potential might prove to be a valid adjuvant therapy for treating patients with advanced chronic obstructive pulmonary disease, especially those presenting loss of muscle mass or peripheral muscle weakness.

 


Keywords: Lung diseases, obstructive; Respiratory muscle; Dietary supplements; Anabolic agents/therapeutic use; Exercício; Energy metabolism

 

Case Report

14 - Pulmonary blastoma: treatment through sleeve resection of the right upper lobe

Blastoma pulmonar: tratamento cirúrgico por lobectomia superior direita e broncoplastia

Eduardo Sperb Pilla, Pablo G. Sánchez, Gabriel Ribeiro Madke, Spencer Camargo, José de Jesus Peixoto Camargo

J Bras Pneumol.2006;32(1):75-77

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Pulmonary blastoma is a rare lung tumor that is composed of malignant epithelial and mesenchymal cells. It presents a pattern of rapid growth. Herein, we report the case of a patient with hemoptysis and a mass in the right upper lobe. The patient presented limited pulmonary function, and fiberoptic bronchoscopy revealed invasion of the intermediate bronchus. The patient underwent sleeve resection of right upper lobe, a technique never before described. After 36 months of follow-up, the patient remained asymptomatic. We also review the literature regarding treatment, clinical aspects and pathology.

 


Keywords: Pulmonary blastoma/surgery; Pneumonectomy; Case reports [Publication type]

 

15 - Sclerosing mediastinitis in the differential diagnosis of mediastinal tumors

Mediastinite esclerosante no diagnóstico diferencial de tumores mediastinais

Davi Wen Wei Kang, Mauro Canzian, Ricardo Beyruti, Fábio Biscegli Jatene

J Bras Pneumol.2006;32(1):78-83

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Sclerosing mediastinitis is a rare disorder characterized by an extensive fibrotic reaction involving the mediastinum. Due to the compression or invasion of mediastinal structures, the disorder mimics neoplasia. We present three cases of superior vena cava syndrome in which sclerosing mediastinitis was confirmed. The pathophysiological process is related to enlarged mediastinal lymph nodes, fibroblast proliferation and collagen deposition. The main causes of sclerosing mediastinitis are histoplasmosis and tuberculosis, both of which are prevalent in Brazil. It is difficult to make an accurate histopathological diagnosis using minimally invasive methods, and there is no effective treatment for this condition. In order to make a definitive diagnosis and resolve the aerodigestive tract obstruction, exploratory surgery is indicated.

 


Keywords: Mediastinitis/physiopathology; Mediastinum; Pulmonary fibrosis; Mediastinal neoplasms; Diagnosis, differential; Case reports [Publication type].

 

16 - Pneumothorax and tension pneumopericardium following cardiothoracic surgery

Pneumotorax e pneumopericárdio hipertensivo em cirurgia cardiotorácica

Rui Haddad, Carlos Eduardo Teixeira Lima, Carlos Henrique Boasquevisque, Guilherme Saraiva Haddad, Tadeu Diniz Ferreira

J Bras Pneumol.2006;32(1):84-87

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Herein, we report two cases of pneumothorax and tension pneumopericardium after cardiothoracic surgery. Both patients underwent pericardiotomy during the primary operation and developed pericardial tamponade as a complication. The treatment was tube thoracostomy, and both patients recovered completely.

 


Keywords: Pneumopericardium/etiology; Pneumothorax/etiology; Thoracic surgical procedures/adverse effects; Postoperative complications

 

Year 2006 - Volume 32  - Number 2  (March/April)

Editorial

1 - Evaluating COPD from the perspective of the patient

Avaliando a DPOC pela perspectiva do paciente

Cláudia Adriana Sant'Anna Ferreira, Alberto Cukier

J Bras Pneumol.2006;32(2):7-8

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2 - Obstructive sleep apnea: a contagious disease?

Apnéia obstrutiva do sono: uma doença contagiosa?

Denis Martinez

J Bras Pneumol.2006;32(2):9-10

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Original Article

3 - Using the forced oscillation technique to evaluate bronchodilator response in healthy volunteers and in asthma patients presenting a verified positive response

Técnica de oscilações forçadas na análise da resposta broncodilatadora em voluntários sadios e indivíduos portadores de asma brônquica com resposta positiva

Juliana Veiga Cavalcanti, Agnaldo José Lopes, José Manoel Jansen, Pedro Lopes de Melo

J Bras Pneumol.2006;32(2):91-98

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Objective: To use the forced oscillation technique to evaluate asthma patients presenting positive bronchodilator responses (confirmed through spirometry) and compare the results with those obtained in healthy individuals. Methods: The study sample consisted of 53 non-smoking volunteers: 24 healthy subjects with no history of pulmonary disease and 29 asthmatics presenting positive bronchodilator response, as determined through analysis of spirometry findings. All of the subjects were submitted to forced oscillation technique and spirometry immediately before and 20 minutes after the administration of salbutamol spray (300 g). The parameters derived from the forced oscillation technique were total respiratory resistance, total respiratory reactance, resistance extrapolated to the y axis, the slope of resistance, and dynamic compliance. The parameters measured in the spirometry evaluation tests were forced expiratory volume in one second and forced vital capacity. Results: In the control group, bronchodilator use produced a significant alteration in the resistance extrapolated to the y axis (p < 0.001), although no significant differences were observed in the slope of resistance or in dynamic compliance. Analysis of the asthma patients revealed significant differences between the prebronchodilator and postbronchodilator values for all spirometry and forced oscillation technique parameters. Values of p < 0.001 were obtained for all comparisons between the two groups. Conclusion: The modifications provoked by use of the forced oscillation technique were in direct concordance with the pathophysiology of the bronchodilator response in asthma patients, indicating that the forced oscillation technique could be useful as a complement to spirometry in these patients.

 


Keywords: Asthma; Bronchial hyperreactivity; Spirometry/methods; Bronchial provocation tests; Forced expiratory volume/physiology; Oscillometry

 

4 - Respiratory muscle evaluation in elective thoracotomies and laparotomies of the upper abdomen

Avaliação muscular respiratória nas toracotomias e laparotomias superiores eletivas

Laryssa Milenkovich Bellinetti, João Carlos Thomson

J Bras Pneumol.2006;32(2):99-105

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Objective: To identify any possible relation between lower than predicted preoperative respiratory muscle function and the incidence of postoperative respiratory complications and death in elective thoracotomies and laparotomies of the upper abdomen. Methods: A prospective cohort study was conducted, in which 70 patients over the age of 18 were monitored in two similar hospitals. In the preoperative evaluation performed at admission, patients were classified as presenting respiratory muscle function (as determined by measurement of maximal respiratory pressures) > 75% of the predicted value (n = 50) or < 75% of the predicted value (n = 20). Patients were monitored until discharge. In both groups, the incidence of pneumonia was determined, as was that of acute respiratory failure, bronchospasm, prolonged mechanical ventilation, atelectasis, pleural effusion, pneumothorax and death. A comparative analysis was made between the groups, and relative risk was calculated. Results: In the study sample, the overall incidence of postoperative complications was 22.86% (16/70): 55% (11/20) in the group of patients presenting < 75% of the predicted value; and 10% (5/50) in the group of patients presenting > 75% of the predicted value. Patients in the < 75% of the predicted value group presented a relative risk of 5.5 (95% confidence interval between 2.19 and 13.82). Conclusion: Respiratory muscle function below the predicted value was found to be related with higher relative risk of postoperative complications in the surgical procedures studied.

 


Keywords: Postoperative complications; Thoracotomy; Laparotomy; Respiratory muscles; Respiratory insufficiency

 

5 - Evaluating physical capacity in patients with chronic obstructive pulmonary disease: comparing the shuttle walk test with the encouraged 6-minute walk test

Avaliação da capacidade de exercício em portadores de doença pulmonar obstrutiva crônica: comparação do teste de caminhada com carga progressiva com o teste de caminhada com acompanhamento

Fernanda Warken Rosa, Aquiles Camelier, Anamaria Mayer, José Roberto Jardim

J Bras Pneumol.2006;32(2):106-113

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Objective: To evaluate the applicability of the incremental (shuttle) walk test in patients with chronic obstructive pulmonary disease and compare the performance of those patients on the shuttle walk test to that of the same patients on the encouraged 6-minute walk test. Methods: A cross-sectional study was conducted, in which 24 patients with chronic obstructive pulmonary disease were selected. In random order, patients were, after an initial practice period, submitted to a shuttle walk test and an encouraged 6-minute walk test. Results: The patients obtained a higher heart rate (expressed as a percentage of that predicted based on gender and age) on the encouraged 6-minute walk test (84.1 ± 11.4%) than on the shuttle walk test (76.4 ± 9.7%) (p = 0.003). The post-test sensation of dyspnea (Borg scale) was also higher on the encouraged 6-minute walk test. On average, the patients walked 307.0 ± 89.3 meters on the shuttle walk test and 515.5 ± 102.3 meters on the encouraged 6-minute walk test (p < 0.001). There was a good correlation between the two tests in terms of the distance walked (r = 0.80, p < 0.001). Conclusion: The shuttle walk test is simple and easy to implement in patients with chronic obstructive pulmonary disease. The encouraged 6-minute walk test produced higher post-test heart rate and greater post-test sensation of dyspnea than did the shuttle walk test.

 


Keywords: Pulmonary disease, chronic obstructive/rehabilitation; Exercise test; Motor activity; Reproducibility of results;

 

6 - Using the Saint George's Respiratory Questionnaire to evaluate quality of life in patients with chronic obstructive pulmonary disease: validating a new version for use in Brazil

Avaliação da qualidade de vida pelo Questionário do Hospital Saint George na Doença Respiratória em portadores de doença pulmonar obstrutiva crônica: validação de uma nova versão para o Brasil

Aquiles Camelier, Fernanda Warken Rosa, Christine Salim, Oliver Augusto Nascimento, Fábio Cardoso, José Roberto Jardim

J Bras Pneumol.2006;32(2):114-122

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Objective: The objective of this study was to evaluate the applicability of a modified version of the Saint George's Respiratory Questionnaire. The version evaluated elicits "agree" and "do not agree", rather than "yes" and "no", responses. The intention is to facilitate the comprehension of double-negative questions and to promote better recollection of symptoms by patients by shortening their symptom histories from 12 months to 3 months. Methods: A total of 30 clinically stable patients with chronic obstructive pulmonary disease were evaluated. The Saint George's Respiratory Questionnaire and the modified version of the same were administered 15 days apart. Results: All of the patients presented health-related alterations in their quality of life. Comparing mean scores between the two questionnaires, the greatest difference was seen in the Symptoms domain. No significant differences were found in any of the remaining domains or in the total scores. In a subsequent analysis, significant correlations between the two questionnaires were found in all domains: Symptoms (r = 0.71; p < 0.001); Activity (r = 0.75; p < 0.001); Impact (r = 0.73; p < 0.001) and Total (r = 0.86; p < 0.001). Conclusion: The modified version of the Saint George's Respiratory Questionnaire is as effective as the original in gauging quality of life. However, various symptoms recollection time frames should be investigated in order to determine which would be the best time frame to employ in the analysis.

 


Keywords: Pulmonary disease, chronic obstructive; Quality of life; Reproducibility of results; Cross-cultural comparison; Questionnaires

 

7 - Influence of the technique of re-educating thoracic and abdominal muscles on respiratory muscle strength in patients with cystic fibrosis

Influência do método Reequilíbrio Toracoabdominal sobre a força muscular respiratória de pacientes com fibrose cística

Renata Claudia Zanchet, Aline Mayara Azevedo Chagas, Juliana Sarmento Melo, Patricia Yuki Watanabe, Augusto Simões-Barbosa, Gilvânia Feijó

J Bras Pneumol.2006;32(2):123-129

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the effect that re-education of the thoracic and abdominal muscles has on the respiratory muscle strength of patients with cystic fibrosis evaluated over time at the Cystic Fibrosis Outpatient Clinic of the Universidade Católica de Brasília (Catholic University of Brasília). Methods: The sample consisted of 29 cystic fibrosis patients, characterized based on anthropometric, genetic and bacterial colonization data. The patients were submitted to physical therapy sessions, involving re-education of the respiratory muscles, twice a week for four months. Spirometry, pressure manometry and anthropometry were performed before and after each session. Results: Comparing baselines values to those obtained after physical therapy, increases in maximum inspiratory pressure and maximum expiratory pressure were observed in all patients, those without any obstructive respiratory disease and those with mild obstructive respiratory disease (p < 0.05). A positive correlation between age and maximum expiratory pressure was observed for most of the patients. Maximum inspiratory pressure correlated positively with age only in the group with mild obstructive respiratory disease (p = 0.012; r = 0.817). In female patients and in the group of patients without obstructive respiratory disease, a negative correlation was observed between maximum expiratory pressure and colonization with Pseudomonas aeruginosa (p = 0.036; r = -0.585). Conclusion: Use of the thoracic and abdominal muscle re-education technique increased respiratory muscle strength in the cystic fibrosis patients studied, a finding that underscores the importance of including physical therapy in the treatment of these patients.

 


Keywords: Cystic fibrosis/rehabilitation; Physical therapy technique; Respiratory muscles; Forced expiratory volume; Inspiratory capacity; Vital capacity

 

8 - Yoga versus aerobic activity: effects on spirometry results and maximal inspiratory pressure

Ioga versus atividade aeróbia: efeitos sobre provas espirométricas e pressão inspiratória máxima

Dagoberto Vanoni de Godoy, Raquel Lonchi Bringhenti, Andréi Severa, Ricardo de Gasperi, Leonardo Vieira Poli

J Bras Pneumol.2006;32(2):130-135

Abstract PDF PT PDF EN Portuguese Text

Objective: To clarify whether, in healthy individuals, practicing yoga can modify maximal inspiratory pressure and spirometric indices when compared with the practice of aerobic exercise. Methods: A controlled clinical trial. A total of 31 healthy volunteers were allocated to practice aerobic exercise (n = 15) or to practice yoga (n = 16). Those in the first group served as controls and engaged in aerobic exercise for 45-60 minutes, twice a week for three months. Those in the second group practiced selected yogic techniques, also in sessions of 45-60 minutes, twice a week for three months. Forced vital capacity, forced expiratory volume in one second and maximal inspiratory pressure were measured before and after the three months of training. Results: No significant alterations were seen in the spirometric indices. A slight, although not significant, improvement in maximal inspiratory pressure was seen in both groups. However, there was a significant difference, seen in both genders, between the absolute delta (final value minus baseline value) of maximal inspiratory pressure for the group practicing yoga and that obtained for the group engaging in aerobic exercise (males: 19.5 cm H2O versus 2.8 cm H2O, p = 0.05; females: 20 cm H2O versus 3.9 cm H2O, p = 0.01). Conclusion: Neither yoga nor aerobic exercise provided a statistically significant improvement in maximal inspiratory pressure after three months. However, the absolute variation in maximal inspiratory pressure was greater among those practicing yoga.

 


Keywords: Yoga; Exercise; Respiratory muscles; Respiratory function tests; Maximal voluntary ventilation; Spirometry; Inspiratory capacity/physiology

 

9 - Lung abscess: analysis of 252 consecutive cases diagnosed between 1968 and 2004

Abscesso pulmonar de aspiração: análise de 252 casos consecutivos estudados de 1968 a 2004

José da Silva Moreira, José de Jesus Peixoto Camargo, José Carlos Felicetti, Paulo Roberto Goldenfun, Ana Luiza Schneider Moreira, Nelson da Silva Porto

J Bras Pneumol.2006;32(2):136-143

Abstract PDF PT PDF EN Portuguese Text

Objective: To relate the experience of the staff at a health care facility specializing in the management of patients with aspiration lung abscess. Methods: Diagnostic aspects and therapeutic results of 252 consecutive cases of lung abscess seen in patients hospitalized between 1968 and 2004. Results: Of the 252 patients, 209 were male, and 43 were female. The mean age was 41.4 years, and 70.2% were alcoholic. Cough, expectoration, fever and overall poor health were seen over 97% of patients. Chest pain was reported by 64%, 30.2% presented digital clubbing, 82.5% had dental disease, 78.6% reported having lost consciousness at least once, and 67.5% presented foul smelling sputum. In 85.3% of the patients, the lung lesions were located either in the posterior segments of the upper lobe or in the superior segments of the lower lobe, and 96.8% were unilateral. Concomitant pleural empyema was seen in 24 (9.5%) of the patients. Mixed flora was identified in the bronchopulmonary or pleural secretions of 182 patients (72.2%). All patients were initially treated with antibiotics (mainly penicillin or clindamycin), and postural drainage was performed in 98.4% of cases. Surgical procedures were performed in 52 (20.6%) of the patients (drainage of empyema in 24, pulmonary resection in 22 and drainage of the abscess in 6). Cure was obtained in 242 patients (96.0%), and 10 (4.0%) died. Conclusion: Lung abscess occurred predominantly in male adults presenting dental disease and having a history of loss of consciousness (especially as a result of alcohol abuse). Most of the patients were treated clinically with antibiotics and postural drainage, although some surgical procedure was required in one-fifth of the study sample.

 


Keywords: Lung abscess; Pneumonia, aspiration; Bacteria, anaerobic; Bacterial infections; Drainage, postural

 

10 - Prevalence of risk factors for obstructive sleep apnea syndrome in interstate bus drivers

Prevalência de fatores de risco para a síndrome da apnéia obstrutiva do sono em motoristas de ônibus interestadual

Carlos Alberto de Assis Viegas, Haroldo Willuweit de Oliveira

J Bras Pneumol.2006;32(2):144-149

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of risk factors for obstructive sleep apnea syndrome in interstate bus drivers. Methods: This study involved 262 professional interstate bus drivers employed by a Brazilian company headquartered in the Federal District. The drivers were evaluated using a questionnaire designed to assess respiratory sleep disorders, the Epworth Sleepiness Scale, test of sustained attention, test of divided attention and anthropometric measurements. Results: Body weight was found to be above the ideal in 68% of the drivers evaluated, 34% of which had a neck circumference = 42 cm. During the study period, the drivers reported using tobacco (27%), cola-based soft drinks (55%), alcohol (65%) and coffee (88%). The Epworth Sleepiness Scale score was = 10 points in 28%. Snoring was reported by 36%, sleep apnea by 5%, a sensation of suffocation during sleep by 12%, restless sleep by 29% and drowsiness while driving by 48%. There were 42% who had been involved in transit accidents, 7.6% of which were attributed to hypersomnolence. Those scoring higher than 10 of the Epworth Sleepiness Scale presented lower levels of sustained attention. In addition, a reduction in divided attention was found to correlate with greater daytime sleepiness and larger neck circumference. Conclusion: The rate of stimulant use found in the group of drivers evaluated is alarming. The high prevalence of daytime sleepiness indicates that attentiveness is reduced in this population.

 


Keywords: Automobile driving; Sleep apnea, obstructive; Work schedule tolerance; Psychometrics; Risk factors; Attention; Questionnaires

 

Review Article

11 - Extraesophageal manifestations of gastroesophageal reflux disease

Manifestações extra-esofágicas da doença do refluxo gastroesofágico

Richard Ricachenevski Gurski, André Ricardo Pereira da Rosa, Enio do Valle, Marcelo Antonio de Borba, André Alves Valiati

J Bras Pneumol.2006;32(2):150-160

Abstract PDF PT PDF EN Portuguese Text

Gastroesophageal reflux disease often presents as heartburn and acid reflux, the so-called "typical" symptoms. However, a subgroup of patients presents a collection of signs and symptoms that are not directly related to esophageal damage. These are known collectively as the extraesophageal manifestations of gastroesophageal reflux disease. Principal among such manifestations are bronchospasm, chronic cough and laryngitis, which are classified as atypical symptoms. These manifestations comprise a heterogeneous group. However, some generalizations can be made regarding all of the subgroups. First, although the correlation between gastroesophageal reflux disease and the extraesophageal manifestations has been well established, a cause-and-effect relationship has yet to be definitively elucidated. In addition, the main proposed pathogenic mechanisms of extraesophageal reflux are direct injury of the extraesophageal tissue (caused by contact with gastric acid) and the esophagobronchial reflex, which is mediated by the vagus nerve. Furthermore, gastroesophageal reflux disease might not be considered in the differential diagnosis of patients presenting only the atypical symptoms. In this article, we review the extraesophageal manifestations of gastroesophageal reflux disease, discussing its epidemiology, pathogenesis, diagnosis and treatment. We focus on the most extensively studied and well-established presentations.

 


Keywords: Gastroesophageal reflux/complications; Asthma; Laryngitis; Cough; Fundoplication; Respiration disorders/etiology

 

12 - Systemic manifestations in chronic obstructive pulmonary disease

Manifestações sistêmicas na doença pulmonar obstrutiva crônica

Victor Zuniga Dourado, Suzana Erico Tanni, Simone Alves Vale, Márcia Maria Faganello, Fernanda Figueirôa Sanches, Irma Godoy

J Bras Pneumol.2006;32(2):161-171

Abstract PDF PT PDF EN Portuguese Text

Chronic obstructive pulmonary disease is progressive and is characterized by abnormal inflammation of the lungs in response to inhalation of noxious particles or toxic gases, especially cigarette smoke. Although this infirmity primarily affects the lungs, diverse extrapulmonary manifestations have been described. The likely mechanisms involved in the local and systemic inflammation seen in this disease include an increase in the number of inflammatory cells (resulting in abnormal production of inflammatory cytokines) and an imbalance between the formation of reactive oxygen species and antioxidant capacity (leading to oxidative stress). Weakened physical condition secondary to airflow limitation can also lead to the development of altered muscle function. Chronic obstructive pulmonary disease presents diverse systemic effects including nutritional depletion and musculoskeletal dysfunction (causing a reduction in exercise tolerance), as well as other effects related to the comorbidities generally observed in these patients. These manifestations have been correlated with survival and overall health status in chronic obstructive pulmonary disease patients. In view of these facts, the aim of this review was to discuss findings in the literature related to the systemic manifestations of chronic obstructive pulmonary disease, emphasizing the role played by systemic inflammation and evaluating various therapeutic strategies.

 


Keywords: Pulmonary disease, chronic obstructive/complications; Nutritional status; Exercise tolerance;

 

Case Report

13 - Resection of a mediastinal schwannoma using video-assisted thoracoscopy

Ressecção de schwannoma mediastinal por cirurgia torácica videoassistida

Leonardo Ortigara, Nelson Rosemberg, Rafael Siqueira, Francisco Neto

J Bras Pneumol.2006;32(2):172-175

Abstract PDF PT PDF EN Portuguese Text

Schwannomas are tumors that are typically benign. They are derived from Schwann cells (glial cells of the peripheral nervous system that serve to separate and isolate nerve cells from adjacent structures). The most common type of schwannoma is a benign tumor of cranial nerve VIII and is referred to as an acoustic neuroma. When extradural, such tumors usually present as masses that can invade adjacent structures, thereby becoming symptomatic, as in the case of intrathoracic schwannomas (typically found in the posterior mediastinum). Herein, we present a case of a schwannoma treated through video-assisted thoracoscopy, and we review the literature on the subject.

 


Keywords: Mediastinal neoplasms/surgery; Neurilemmoma; Thoracic surgery, video-assisted; Case reports

 

14 - Claude Bernard-Horner syndrome resulting from pleural empyema

Síndrome de Claude Bernard-Horner associada ao empiema pleural

Fernando Luiz Westphal, Luiz Carlos de Lima, Arteiro Queiroz Menezes, Dirany Leite Sacramento e Silva

J Bras Pneumol.2006;32(2):176-179

Abstract PDF PT PDF EN Portuguese Text

Claude Bernard-Horner syndrome presents various etiologies and occurs as the direct result of interrupted nerve signaling at any point along the nerve trajectory, be it intrathoracic or extrathoracic. Herein, we report a case of Claude Bernard-Horner syndrome caused by loculated pleural empyema located in the paravertebral region of the upper third of the right hemithorax. The patient was submitted to thoracotomy in order to drain the infected fluids. The end result was satisfactory, including resolution of the infection, pulmonary expansion, and remission of the syndrome.

 


Keywords: Pleural empyema/complications; Horner syndrome/etiology; Blepharoptosis; Thoracotomy;

 

15 - Mounier-Kuhn syndrome

Síndrome de Mounier-Kühn

Fabrício Piccoli Fortuna, Klaus Irion, Cesare Wink, Jorge Luis Boemo

J Bras Pneumol.2006;32(2):180-183

Abstract PDF PT PDF EN Portuguese Text

Mounier-Kuhn syndrome, or tracheobronchomegaly, is a rare clinical entity characterized by abnormal dilation of the trachea and main bronchi. The diagnosis can usually be made by measuring the tracheal diameter. We report the case of a 40-year-old black man with refractory lower respiratory tract infection. Tracheobronchomegaly was confirmed through computed tomography.

 


Keywords: Tracheobronchomegaly/diagnosis; Tomography, X-ray computed; Tracheobronchomegaly/rehabilitation;

 

In Memoriam

16 - The parting of Jorge Kavakama, a shining star in Brazilian medicine that has flickered out

A partida de Jorge Kavakama, um pixel que se apaga na medicina brasileira

Mário Terra Filho

J Bras Pneumol.2006;32(2):187-

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Letters to the Editor

17 - Prevalence of asthma in the Federal District of Brasília, Brazil

Prevalência de asma no Distrito Federal Brasília

Murilo Carlos Amorim de Britto

J Bras Pneumol.2006;32(2):188-

PDF PT PDF EN Portuguese Text


Year 2006 - Volume 32  - Number 3  (May/June)

Editorial

1 - Bronchodilator use in asthma: the art of prescribing bronchodilators correctly, taking advantage of their differences and reducing risks

Os broncodilatadores na asma: a arte de prescrever corretamente, aproveitando as qualidades e reduzindo os riscos

Ana Luisa Godoy Fernandes

J Bras Pneumol.2006;32(3):11-12

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2 - Evaluating the efficiency of polymerase chain reaction in diagnosing pulmonary tuberculosis in indigenous and non-indigenous patients

Avaliação da reação em cadeia da polimerase no diagnóstico da tuberculose pulmonar em pacientes indígenas e não indígenas

Afrânio Lineu Kritski

J Bras Pneumol.2006;32(3):13-14

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Original Article

3 - Compliance with environmental control measures in the homes of children and adolescents with asthma

Adesão às medidas de controle ambiental em lares de crianças e adolescentes asmáticos

Nulma Souto Jentzsch, Paulo Augusto Moreira Camargos, Elza Machado de Melo

J Bras Pneumol.2006;32(3):189-194

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine, through home visits, the rate of compliance with environmental control measures in the homes of children with asthma. Methods: This study involved 98 asthma patients between the ages of 4 and 15. The parents of those children and adolescents received instruction in how to carry out environmental control measures and were encouraged to perform such measures continuously for a period of 90 days. Home visits, which included direct inspection of the domicile and administration of a questionnaire, were made before and after this 90-day period. In cases of noncompliance, parents were asked to explain why they did not carry out the control measures. Statistical analysis was performed using the McNemar test. Results: Overall compliance with the various items studied was 11.1%, ranging from -4.1% (for curtain control, p = 0.63) to 22.6% (for stuffed toys, p < 0.001). Passive smoking was reduced to 9.7% (p = 0.02). Among the families studied, the mean monthly income was 2.5 times the national minimum wage. When asked why they had not adopted the recommended measures, noncompliant parents gave, among others, the following explanations: "economic hardship" (60.1%); "the measures were too difficult to carry out" (6.1%); "nonparticipation of the father" (4%); and "lack of time on the part of the mother" (4%). Conclusion: Environmental control measures were carried out sporadically, possibly reflecting the influence of socioeconomic and cultural factors.

 


Keywords: Asthma; Allergens; Environmental exposure; Hypersensivity/prevention & control; Compliance

 

4 - Bronchial hyperresponsiveness to hypertonic saline challenge in children and adolescents

Avaliação da hiperresponsividade brônquica à solução salina hipertônica em crianças e adolescentes

Paulo Kussek, Nelson Augusto Rosário Filho, Mônica Cat

J Bras Pneumol.2006;32(3):195-201

Abstract PDF PT PDF EN Portuguese Text

Objective: To assess airway hyperresponsiveness to 4.5% hypertonic saline solution in comparison to that obtained through challenge with other bronchoconstriction agents and in relation to patient allergic sensitization. Methods: A cross-sectional, experimental study was conducted, initially involving 85 subjects. After exclusions, the final sample consisted of 62 patients, divided into two groups: a study group of those with asthma (n = 45) and a control group of those with no asthma or allergies (n = 17). Hypertonic saline was nebulized using an ultrasonic nebulizer and administered successively for 0.5, 1, 2, 4 and 8 minutes until a drop in forced expiratory volume in one second of = 15% was achieved in relation to the baseline value. The level of specific immunoglobulin E to Dermatophagoides pteronyssinus level was determined by ImmunoCAP assay and was considered positive when > 0.35 kU/L. Results: In the 36 asthma group subjects presenting a response, the mean drop in forced expiratory volume in one second after hypertonic saline nebulization was 27.4%. None of control group subjects (immunoglobulin E < 0.35 kU/L) presented a positive response to hypertonic saline. The mean forced expiratory volume in one second for control group subjects was 9%. The results of a bronchial provocation test were negative in 9 of the asthma group subjects. The frequency of bronchial provocation test positivity was higher in the subjects presenting elevated levels of specific immunoglobulin E, indicating that there is a relationship between bronchial hyperresponsiveness and the level of specific immunoglobulin E. The sensitivity and specificity of the test were 80% and 92%, respectively. Conclusion: Bronchial provocation with hypertonic saline presents satisfactory sensitivity and specificity. Therefore, in addition to being a low cost procedure that requires very little equipment, it is a useful means of assessing hyperresponsiveness in children and adolescents.

 


Keywords: Bronchial provocation tests; Bronchial hyperreactivity; Saline solution, hypertonic; Administration, inhalation;

 

5 - Efficacy of inhaled formoterol in reversing bronchoconstriction

Eficácia do formoterol na reversão imediata do broncoespasmo

Adalberto Sperb Rubin, Christiano Perin, Liliana Pelegrin, Juliana Cardozo Fernandes, Luiz Carlos Corrêa da Silva

J Bras Pneumol.2006;32(3):202-206

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the effectiveness and onset of action of formoterol delivered by dry-powder inhaler in reversing methacholine-induced bronchoconstriction. Methods: Patients presenting a drop in forced expiratory volume in one second > 20% after methacholine inhalation were included. A total of 84 patients were evaluated. All of the participating patients presented respiratory symptoms of unknown origin, which were being investigated. The patients were randomized to receive 200 µg of spray fenoterol (n = 41) or 12 µg of dry-powder inhaler formoterol (n = 43), both administered in order to achieve immediate reversal of methacholine-induced bronchoconstriction. We evaluated the decrease in forced expiratory volume in one second (in relation to the baseline value) after methacholine challenge and the dose of methacholine required to provoke a drop of 20% in forced expiratory volume in one second, as well as the increase in forced expiratory volume in one second (in relation to the baseline value) at five and ten minutes after bronchodilator use. Results: There were no significant differences related to gender, age, weight, height or dose of methacholine required to provoke a drop of 20% in forced expiratory volume in one second. Nor were there any significant differences in terms of baseline or post-methacholine forced expiratory volume in one second. In the fenoterol group, the mean postbronchodilator increase in forced expiratory volume in one second increase was 34% (at five minutes) and 50.1% (at ten minutes), compared with 46.5% (at five minutes) and 53.2% (at ten minutes) in the formoterol group. Conclusion: The bronchodilator effect of formoterol at five and ten minutes after methacholine-induced bronchoconstriction was similar to that of fenoterol. Despite being a long-acting bronchodilator, formoterol also has a rapid onset of action, which suggests that it could be employed as a relief medication in cases of bronchoconstriction occurring during asthma attacks.

 


Keywords: Asthma; Formoterol; Fenoterol; Inhalation therapy; Bronchodilation, Methacoline

 

6 - Nocturnal desaturation: predictors and the effect on sleep patterns in patients with chronic obstructive pulmonary disease and concomitant mild daytime hypoxemia

Dessaturação noturna: preditores e influência no padrão do sono de pacientes portadores de doença pulmonar obstrutiva crônica com hipoxemia leve em vigília

Renata Claudia Zanchet, Carlos Alberto de Assis Viegas

J Bras Pneumol.2006;32(3):207-212

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the nocturnal oximetry pattern in chronic obstructive pulmonary disease patients having no sleep apnea and presenting mild daytime hypoxemia, to identify probable daytime parameters capable of predicting nocturnal desaturation, and to evaluate the influence of nocturnal desaturation on the sleep pattern of these patients. Methods: Twenty-five patients were divided into two groups: those with nocturnal desaturation and those without. Results: Comparing the first group (52%) with the second, we found the following: age, 63 + 5 years versus 63 + 6 years; forced expiratory volume in the first second = 53 + 31% versus 56 + 19% predicted; ratio of forced expiratory volume in the first second to forced vital capacity, 49 + 14% versus 52 + 10%; arterial oxygen tension, 68 + 8 mmHg versus 72 + 68 mmHg; and arterial oxygen saturation, 93 + 2% versus 94 + 1%. Patients in the nocturnal desaturation group presented lower daytime arterial oxygen saturation and nocturnal arterial oxygen saturation by pulse oximetry. There was no difference between the two groups in terms of the sleep patterns observed. The ratio of forced expiratory volume in the first second to forced vital capacity was found to correlate with forced vital capacity, daytime arterial oxygen tension and daytime arterial oxygen saturation. In addition, arterial oxygen saturation by pulse oximetry during exercise was found to correlate with nocturnal arterial oxygen saturation by pulse oximetry. However, only daytime arterial oxygen saturation was predictive of nocturnal desaturation. Conclusion: The only variable capable of predicting nocturnal desaturation was daytime arterial oxygen saturation. Nocturnal desaturation did not influence the sleep patterns of patients with chronic obstructive pulmonary disease accompanied by mild daytime hypoxemia.

 


Keywords: Sleep, REM; Pulmonary disease, chronic obstructive; Anoxemia; Spirometry; Wakefulness

 

7 - Using the forced oscillation technique to evaluate respiratory resistance in individuals with silicosis

Avaliação das características resistivas do sistema respiratório de indivíduos portadores de silicose pela técnica de oscilações forçadas

Jayme Alves de Mesquita Júnior, Agnaldo José Lopes, José Manoel Jansen, Pedro Lopes de Melo

J Bras Pneumol.2006;32(3):213-220

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the resistance values obtained through the use of the forced oscillation technique in patients with varying degrees of airway obstruction resulting from silicosis. Methods: A total of 40 never-smoking volunteers were analyzed: 10 were healthy subjects with no history of pulmonary disease or silica exposure, and 30 had silicosis. The forced oscillation technique was used to examine the subjects, and spirometry was used as a reference in order to classify the obstruction by degree. This classification resulted in five groups: control (n = 10); normal exam, composed of individuals diagnosed clinically and radiologically with silicosis but presenting normal spirometry results (n = 7); mild obstruction (n = 10); moderate obstruction (n = 8); and severe obstruction (n = 5). Results: The reduction observed in the spirometric values corresponded to a significant increase in the total respiratory resistance (p < 0.001), as well as in airway resistance (p < 0.003). A significant reduction in ventilation homogeneity was also observed (p < 0.004). Conclusion: In individuals with silicosis, the additional respiratory resistance-related data obtained through the use of the forced oscillation technique can complement spirometric data. Therefore, the forced oscillation technique presents great potential for the analysis of such patients.

 


Keywords: Pneumoconiosis; Silicosis; Forced expiratory volume; Oscillometry; Respiratory function tests

 

8 - Early diagnosis of lung cancer: the great challenge. Epidemiological variables, clinical variables, staging and treatment

Diagnóstico precoce do câncer de pulmão: o grande desafio. Variáveis epidemiológicas e clínicas, estadiamento e tratamento

João Adriano Barros, Geraldo Valladares, Adriane Reichert Faria, Erika Megumi Fugita, Ana Paula Ruiz, André Gustavo Daher Vianna, Guilherme Luís Trevisan, Fabrício Augusto Martinelli de Oliveira

J Bras Pneumol.2006;32(3):221-227

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate confirmed cases of lung cancer, reviewing epidemiological variables, clinical variables, staging and treatment. Methods: The cases of 263 patients were studied. All of the patients had been treated at the Universidade Federal do Paraná (Federal University of Paraná) Hospital de Clínicas or at the Hospital Erasto Gaertner, two institutions that, together, serve a significant portion of the patients seeking treatment in the city of Curitiba, located in the state of Paraná. This was a retrospective study, involving the administration of questionnaires. The descriptive analysis of the data obtained was performed using the Epi-Info program. Results: There was a predominance of male patients (76%). At the time of diagnosis, the majority of patients (90%) were smokers or former smokers. In 87% of the cases, there was no history of lung disease. The most common initial symptoms were cough (142 cases) and chest pain (92 cases). Non-small cell lung cancer was found in 87% of the patients, and the most common histological type was spinocellular carcinoma, which was found in 49% of all of the patients. Smoking was found to be the most significant predisposing factor. Conclusion: The characteristics of lung cancer progression, such as the nonspecificity of the initial symptoms, the duration of tumor growth and the course of the tumor, together with the lack of tracking programs, are the principal factors that hinder the early detection of lung cancer, making it difficult to treat lung cancer patients and to increase their survival.

 


Keywords: Lung neoplasms/diagnosis; Lung neoplasms/epidemiology; Lung neoplasms/surgery; Early diagnosis; Neoplasms staging

 

9 - Radiographic alterations in patients presenting human immunodeficiency virus/tuberculosis coinfection: correlation with CD4+ T cell counts

Alterações radiográficas em pacientes com a co-infecção vírus da imunodeficiência humana/tuberculose: relação com a contagem de células TCD4+

Rosemeri Maurici da Silva, Lígia da Rosa, Renata Nunes Lemos

J Bras Pneumol.2006;32(3):228-233

Abstract PDF PT PDF EN Portuguese Text

Objective: To look for correlations between radiological patterns and CD4+ T cell counts in patients coinfected with tuberculosis and human immunodeficiency virus. Methods: Patients included were selected from among those presenting human immunodeficiency virus/tuberculosis coinfection and admitted to the Nereu Ramos Hospital, located in Florianópolis, Brazil, between January of 2000 and December of 2003. Results: A total of 87 patients were included. The mean age was 34 + 8 years, and 6.8% were non-Caucasian. The mean CD4+ T cell count was 220.2 cells/mm3 (median, 144 cells/mm3), and 56.4% of the patients presented less than 200 cells/mm3. We identified the following radiographic patterns and related them to the CD4+ T cell counts: the alveolar pattern in 50.6% of the cases (56.8% CD4+ T cells < 200); the interstitial pattern in 32.2% (53.6% CD4+ T cells < 200); pleural effusion in 24.1% (47.6% CD4+ T cells < 200); cavitation in 24.1% (57.1% CD4+ T cells < 200); enlarged mediastinal or hilar lymph nodes in 11.5% (90% CD4+ T cells < 200); and a normal pattern in 11.5% (60% CD4+ T cells < 200). The mean CD4+ T cell counts for the radiologic patterns isolated were as follows: 235.2/mm3 (alveolar consolidation); 208.8/mm3 (interstitial); 243.3/mm3 (pleural effusion); 265/mm3 (cavitation); 115.1/mm3 (enlarged mediastinal or hilar lymph nodes) (p < 0.05); and 205.5/mm3 (presenting no radiological alterations). As noted, mediastinal/hilar lymph node enlargement was the only pattern that correlated with the degree of cell-mediated immunity in a statistically significant way. Conclusion: With the exception of mediastinal/hilar lymph node enlargement, the radiographic patterns were randomly distributed in relation to the CD4+ T cell counts.

 


Keywords: Tuberculosis, pulmonary; HIV infections; Lung/radiography; AIDS-related opportunistic infections; CD4 lymphocyte count; T-lymphocytes, helper-inducer

 

10 - Evaluation of polymerase chain reaction in the diagnosis of pulmonary tuberculosis in indigenous and non-indigenous patients

Avaliação da reação em cadeia da polimerase no diagnóstico da tuberculose pulmonar em pacientes indígenas e não indígenas

Rose Mary Corrêa Santos, Mauricio Morishi Ogusku, José de Moraes Miranda, Maria Cristina Dos-Santos, Julia Ignez Salem

J Bras Pneumol.2006;32(3):234-240

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the accuracy of bacteriological methods and of polymerase chain reaction (with primers specific for IS6110 of the Mycobacterium tuberculosis complex) in testing sputum samples from indigenous (Amerindian) and non-indigenous patients. Methods: A total of 214 sputum samples (154 from indigenous patients and 60 from non-indigenous patients) were analyzed in order to determine the accuracy of smear microscopy (direct and concentrated versions) for acid-fast bacilli, culture, and polymerase chain reaction. Results: Both microscopy methods presented low sensitivity in comparison with culture and polymerase chain reaction. Specificity ranged from 91% to 100%, the concentrated acid-fast smear technique being the least specific. Nontuberculous mycobacteria were isolated three times more frequently in samples from indigenous patients than in those from non-indigenous patients. False-positive and false-negative polymerase chain reaction results were more common in the indigenous population. Conclusion: Positivity and isolation of nontuberculous mycobacteria in the acid-fast smear in conjunction with polymerase chain reaction positivity raise the following hypotheses: nontuberculous mycobacteria species with DNA regions homologous to, or even still possessing, the M. tuberculosis IS6110 exist in the Amazon; colonization of the oropharynx or of a tuberculous lesion accelerates the growth of the nontuberculous mycobacteria present in the sputum samples, making it impossible to isolate M. tuberculosis; A history of tuberculosis results in positivity for M. tuberculosis DNA. The absence of bacteriological positivity in the presence of polymerase chain reaction positivity raises questions regarding the inherent technical characteristics of the bacteriological methods or regarding patient history of tuberculosis.

 


Keywords: Tuberculosis, pulmonary/diagnosis; Mycobacterium tuberculosis, Polymerase chain reaction/methods; Indians, south american

 

Review Article

11 - Cellular and biochemical bases of chronic obstructive pulmonary disease

Bases celulares e bioquímicas da doença pulmonar obstrutiva crônica

Rogério Rufino, José Roberto Lapa e Silva

J Bras Pneumol.2006;32(3):241-248

Abstract PDF PT PDF EN Portuguese Text

Chronic obstructive pulmonary disease is an inflammatory disease. Together with oxidant stimuli, which directly affect lung structures, macrophages, neutrophils and CD8+ lymphocytes actively participate in the pathogenesis of the disease and promote biochemical reactions that result in progressive alteration of the upper airways and irreversible lung remodeling. The release of substances promoted by inflammatory cell recruitment and by oxidative stress lead to a temporary imbalance in the pulmonary defense mechanisms. Understanding the long-term maintenance of this imbalance is key to understanding the current physiopathology of the disease. The present study explores the cellular and molecular alterations seen in chronic obstructive pulmonary disease.

 


Keywords: Pulmonary disease, chronic obstructive/physiopathology; Lung/metabolism; Inflammation; Oxydants; Antioxidants; Oxidative stress

 

12 - Idiopathic pulmonary fibrosis: a decade of progress

Fibrose pulmonar idiopática: uma década de progressos

Jeffrey J. Swigris, Kevin K. Brown

J Bras Pneumol.2006;32(3):249-260

Abstract PDF PT PDF EN Portuguese Text

Although idiopathic pulmonary fibrosis remains a devastating diagnosis, recent advances have improved our understanding of many facets of this disease. These breakthroughs, combined with the increased general availability of therapeutic trials, hold the promise of a brighter future for idiopathic pulmonary fibrosis patients. For example, we now have a more comprehensive understanding of the diagnostic criteria and natural history of the disease. Several studies have shown that simple measurement of pulmonary physiology or gas exchange can be used to predict patient survival. By identifying several molecular pathways that play significant roles in the pathogenesis of idiopathic pulmonary fibrosis, investigators have produced a growing list of novel potential therapeutic targets for the disease. Several prospective, controlled therapeutic trials have been conducted. Others are ongoing or are still in the planning stages. These efforts have advanced our current knowledge of idiopathic pulmonary fibrosis and have raised new important questions, as well as having generated the interest and momentum needed to gain additional ground in the fight against this challenging disease. This article offers the reader a view of the recent advances in idiopathic pulmonary fibrosis research, with a focus on natural history, pathogenesis and treatment.

 


Keywords: Pulmonary fibrosis/diagnosis; Pulmonary fibrosis/drug therapy; Fibroblasts; Transforming growth factor beta; Lung/pathology, Anti-inflammatory agents/therapeutic use

 

Case Series

13 - Pulmonary alveolar proteinosis: four cases

Proteinose alveolar pulmonar: série de quatro casos

João Carlos Thomson, Marina Kishima, Mariana Ulbricht Gomes, Mariano de Almeida Menezes, José Perandré Neto, Paula Tapia Gomes Pereira

J Bras Pneumol.2006;32(3):261-266

Abstract PDF PT PDF EN Portuguese Text

Objective: The aim of this study was to present the evolution of four patients presenting pulmonary alveolar proteinosis and treated at the State University of Londrina School of Medicine. We focus on the importance of whole-lung lavage as the treatment of choice. Methods: A retrospective study of four patients, three females and one male, 22 to 34 years old, presenting similar histories of progressive dyspnea and dry cough. The final diagnosis was established through open-lung biopsy. Three of the patients underwent whole-lung lavage in the Department of Surgery. The procedures were performed under general anesthesia and using a double-lumen endotracheal tube. Results: One patient presented spontaneous regression of the pulmonary alveolar proteinosis without the need for whole-lung lavage. In the other three cases, the number of lavages varied: in one patient, a single unilateral lavage resulted in complete remission of the bilateral process; in another patient, three lavages yielded no significant improvement; in the remaining patient, four lavages provided intervening periods of transient improvement. Conclusion: In the cases evaluated, whole-lung lavage proved an efficient treatment for pulmonary alveolar proteinosis. Although some patients presented a certain resistance to the procedure, it might lead to complete remission of the disease in others.

 


Keywords: Pulmonary alveolar proteinosis /diagnosis; Bronchoalveolar lavage; Macrophages, alveolar;

 

Case Report

14 - Alveolar adenoma

Adenoma alveolar

Eduardo Haruo Saito, Luciana Ribeiro de Araújo, Leonardo Hoehl Carneiro, Antonio Ambrosio de Oliveira Neto, João Carlos Corrêa, Luiz Sérgio Carvalho Teixeira

J Bras Pneumol.2006;32(3):

Abstract PDF PT PDF EN Portuguese Text

Alveolar adenoma is a rare benign neoplasm of the lungs, and very few cases have been described in the literature. Patients with alveolar adenoma are frequently asymptomatic and are diagnosed through the accidental discovery of a singular, well-delineated nodule on a routine chest X-ray. The definitive diagnosis is made histologically, and the treatment consists of surgical resection of the nodule..

 


Keywords: Adenoma; Lung neoplasms; Pulmonary alveoli/pathology; Coin lesion, pulmonary;

 

15 - Dendriform pulmonary ossification

Ossificação pulmonar dendriforme

Andrezza Araújo de Oliveira Duarte, Jorge Nakatani, Moacyr Pezati Rigueiro, Tânia Saad

J Bras Pneumol.2006;32(3):270-273

Abstract PDF PT PDF EN Portuguese Text

Diffuse pulmonary ossification is a rare condition of unknown pathogenesis in which mature bone is found in the pulmonary parenchyma. It is almost invariably discovered as an incidental finding at autopsy. Most commonly, it affects middle-aged men and is asymptomatic. We present the case of a 75-year-old man in which the chest X-ray showed diffuse interstitial infiltrate. Diagnosis was based on histopathological examination by open-lung biopsy, which revealed interstitial fibrosis with pulmonary ossification.

 


Keywords: Ossification, heterotopic; Lung diseases; Lung/radiography; Pulmonary fibrosis/pathology;

 

Year 2006 - Volume 32  - Number 4  (July/August)

Editorial

1 - Scientific production of the Brazilian Society of Pulmonology and Phthisiology: 1979-2006

Produção científica da Sociedade Brasileira de Pneumologia e Tisiologia: 1979 a 2006

Ana Maria Baptista Menezes

J Bras Pneumol.2006;32(4):xv-xvii

PDF PT PDF EN Portuguese Text


2 - Respiratory sleep disorders and fibromyalgia

Transtornos respiratórios do sono e fibromialgia

Suely Roizenblatt

J Bras Pneumol.2006;32(4):18-19

PDF PT PDF EN Portuguese Text


3 - Ventilator-associated pneumonia

Pneumonia associada à ventilação mecânica

Carlos Roberto Ribeiro de Carvalho

J Bras Pneumol.2006;32(4):20-22

PDF PT PDF EN Portuguese Text


Original Article

4 - Compliance with maintenance treatment of asthma (ADERE study)

Adesão ao tratamento de manutenção em asma (estudo ADERE)

José Miguel Chatkin, Daniela Cavalet-Blanco, Nóris Coimbra Scaglia, Roberto Guidotti Tonietto, Mário B. Wagner, Carlos Cezar Fritscher

J Bras Pneumol.2006;32(4):277-283

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the rate of compliance with preventive treatment of moderate and severe persistent asthma. Methods: Physicians at various medical centers across the country were invited to nominate patients for participation in the study. Inclusion criteria were being over the age of 12 and presenting moderate or severe persistent asthma. Participating patients received salmeterol/fluticasone 50/250 µg by dry powder inhaler for 90 days and were instructed to return the empty packages at the end of the study as a means of determining the total quantity used. In order to evaluate compliance, a member of the research team contacted each patient via telephone at the study outset and again at the end of the 90-day study period. Asthma patients were considered compliant with the treatment if they used at least 85% of the prescribed dose. The following variables were studied: gender, age, race, marital status, years of schooling, smoking habits, other atopic conditions, comorbidities, asthma severity, use of other medication and number of hospital admissions for asthma. Results: A total of 131 patients from fifteen states were included. The overall rate of compliance was found to be 51.9%. There was a significant difference in compliance in relation to asthma severity: compliance was greater among patients with severe persistent asthma than among those with moderate persistent asthma (p = 0.02). There were no statistically significant differences among any of the other variables. Conclusion: The overall rate of compliance with maintenance treatment of asthma was low.

 


Keywords: Asthma/drug therapy; Asthma/prevention & control; Patient compliance; Patient education; Physician-patient relations

 

5 - Seasonal variations in emergency room visits for asthma attacks in Gama, Brazil

Variação sazonal nos atendimentos de emergência por asma em Gama, Distrito Federal

Laércio Moreira Valença, Paulo César Nunes Restivo, Mário Sérgio Nunes

J Bras Pneumol.2006;32(4):284-289

Abstract PDF PT PDF EN Portuguese Text

Objective: To quantify the number of asthma attacks treated in the emergency room of a public hospital and to study seasonal fluctuations, taking into consideration the local climate, which is characterized by having only two seasons: a rainy/humid season and a dry season. Methods: A retrospective survey was conducted in a community general hospital. A total of 37,642 emergency room consultations related to asthma, bronchitis, pneumonia, upper-airway infection or other respiratory complaints were registered during a two year period. The data from each patient chart were collected for later analysis. Results: Among the respiratory conditions treated, asthma (24.4%) was the second most common diagnosis. Most of the asthma consultations (56.6%) involved children below the age of fifteen. Regression analysis revealed a seasonal variation in the number of asthma consultations, which was significantly higher in March (p = 0.0109), the low points being in August (p = 0.0485) and September (p = 0.0169). The correlation between climate and asthma was most significant in relation to changes in humidity, although the effect was delayed by one month (p = 0.0026) or two months (p = 0.0002). Conclusion: Visits to the emergency room for the treatment of asthma attacks were more frequent during the rainy season, increasing at one to two months after the annual increase in humidity and decreasing in the dry season. This positive correlation raises the possibility of a causal relationship with proliferation of house dust mites and molds.

 


Keywords: Seasons; Status asthamaticus/etiology; Weather; Pyroglyphidae ; Humidity; Emergency service, hospital

 

6 - Post-pneumonectomy thoracic drainage: to drain or not to drain? A retrospective study

Drenagem torácica pós-pneumonectomia: sim ou não? Estudo retrospectivo

João Carlos Thomson, Olavo Franco Ferreira Filho

J Bras Pneumol.2006;32(4):290-293

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the need for post-pneumonectomy thoracic drainage. Methods: This was a retrospective study of 46 patients having undergone pneumonectomy in the Thoracic Surgery Department of the Londrina University Hospital between January of 1998 and December of 2004. Patients were divided into two groups: those having been submitted to drainage and those not having been. The diseases involved were lung cancer, bronchiectasis and tuberculosis. Results: Drainage was used in 21 patients, whereas no drainage was used in 25. The most common postoperative complication was subcutaneous emphysema (12 cases). Hospital stays were of shorter duration among patients who were not submitted to drainage than among those who were (mean, 6.5 days vs. 10.2 days). No serious postoperative complications were observed in the group of patients not submitted to drainage. Conclusion: The findings that evolutions were more favorable and hospital stays were shorter for the patients not submitted to drainage call into question the need for routine post-pneumonectomy drainage.

 


Keywords: Drainage; Pleural cavity; Pneumonectomy; Postoperative care; Postoperative complications; Retrospective studies

 

7 - The relative frequency of hypomagnesemia in outpatients with chronic airflow limitation treated at a referral center in the north of the state of Paraná, Brazil

Freqüência relativa de hipomagnesemia em pacientes com limitação crônica do fluxo aéreo atendidos em ambulatório de referência do norte do Paraná

Alcindo Cerci Neto, Olavo Franco Ferreira Filho, Johnathan de Sousa Parreira

J Bras Pneumol.2006;32(4):294-300

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the relative frequency of hypomagnesemia among patients with chronic airflow limitation treated as outpatients at a referral center in the northern part of the state of Paraná between 2000 and 2001, as well as to determine whether hypomagnesemia correlates with hypoxia, with other electrolyte disturbances and with the severity of airflow limitation. Methods: This was a descriptive study of the relative frequency of hypomagnesemia in 72 patients with chronic airflow limitation. All of the patients were submitted to blood tests to determine serum levels of magnesium and other electrolytes, as well as to staging of the underlying disease. Results: The prevalence of hypomagnesemia was 27.8%. The mean age was 65 ± 9.9 years, and there was a predominance of males. The mean forced expiratory volume in one second was 1.31 ± 0.52 L. Most of the patients (68.1%) were found to be in the advanced stages of the disease. Hypomagnesemia was not found to correlate with other electrolyte disturbances, hypoxemia or disease stage. Conclusion: The high frequency of patients in the advanced stages is likely attributable to the fact that the outpatient facility is a referral center for the region. Further studies should be conducted in order to determine the probable causes of this high prevalence of hypomagnesemia.

 


Keywords: Magnesium/blood; Pulmonary ventilation; Pulmonary disease, chronic obstructive; Respiratory insufficiency

 

8 - Potential consequences for stable chronic obstructive pulmonary disease patients who do not get the recommended minimum daily amount of physical activity

Possíveis conseqüências de não se atingir a mínima atividade física diária recomendada em pacientes com doença pulmonar obstrutiva cronica estável

Fabio Pitta, Thierry Troosters, Vanessa S. Probst, Sarah Lucas, Marc Decramer, Rik Gosselink

J Bras Pneumol.2006;32(4):301-308

Abstract PDF PT PDF EN Portuguese Text

Objective: The present study attempted to determine whether patients with chronic obstructive pulmonary disease (COPD) get the minimum daily amount of physical activity recommended in the guidelines established by the American College of Sports Medicine (ACSM), as well as to characterize the consequences of noncompliance with those guidelines. Methods: This study involved 23 patients (median age: 61 - range, 59-69 years; FEV1: 39% of predicted - range, 34-53%; BMI: 24 kg/m2 - range, 21-27 kg/m2). The following parameters were evaluated: daily physical activity (DynaPort activity monitor); pulmonary function; muscle force; exercise tolerance; quality of life; functional status; and various indices of disease severity (GOLD, BODE and MRC). Results: Based on compliance with the guidelines (minimum of 30 minutes of walking per day), 12 patients were considered "physically active", and 11 were considered "physically inactive". No significant differences were observed between the two groups in terms of age, gender, BMI, muscle force, ventilatory reserve, hyperinflation or quality of life. The inactive group presented more impaired pulmonary function and lower exercise tolerance, as well as lower MRC and BODE scores (p < 0.05). In their daily life, patients in the inactive group also walked for less time and more slowly than did those in the active group (p < 0.05). The MRC and BODE indices were superior to the GOLD index in predicting compliance with the guidelines, both presenting a specificity of 0.83, compared with 0.50 for the GOLD index. The BODE index score increased significantly with each day of inactivity. Conclusion: A large number of COPD patients do not walk more than 30 minutes per day and are therefore not getting the minimum daily amount of physical activity recommended by the ACSM. Inactivity correlates with a higher mortality rate. The MRC and BODE indices proved superior to the GOLD index in predicting whether patients are physically inactive in their daily lives.

 


Keywords: Pulmonary disease, chronic obstructive; Body mass index; Exercise tolerance; Exercise; Guidelines; Severity of illness index

 

9 - Profile of research published in the annals of the Brazilian Pulmonology and Phthisiology Conferences held over the last twenty years

Perfil da atividade de pesquisa publicada nos anais dos congressos brasileiros de pneumologia e tisiologia nos últimos vinte anos

Alexandre Todorovic Fabro, Hugo Hyung Bok Yoo, Thaís Helena Abrahão Thomaz Queluz

J Bras Pneumol.2006;32(4):309-315

Abstract PDF PT PDF EN Portuguese Text

Objective: To increase the knowledge base regarding pulmonology research in Brazil. Methods: A retrospective, observational study of the abstracts published in the Annals of the Brazilian Pulmonology and Phthisiology Conferences held from 1986 to 2004, quantifying the institutions of origin by geographic distribution and type, as well as categorizing the abstracts by study design and topic. Results: A total of 6467 abstracts were published. The institutions of origin were located, variously, in the Southeast (3870 abstracts), South (1309), Northeast (783), Central-West (267) and North (84). There were 94 abstracts originating from foreign institutions, especially from institutions in Portugal (56.3%) and the United States (13.8%). Most of the studies (5825) were conducted in public Brazilian institutions. There were 4234 clinical studies, 1994 case reports and 239 original research articles. A marked, progressive increase was observed in the number of clinical studies and case reports during the period evaluated. Overall, the most common themes were tuberculosis and other infections diseases (25.2%), following by oncology (11.6%), interstitial lung diseases (8.8%) and thoracic surgery (8.5%). Nevertheless, the number of abstracts on each topic varied widely from year to year. Conclusion: Public Brazilian institutions are the principal sources of pulmonology research in Brazil. Such research activity is concentrated in the southeastern part of the country. Case reports account for one-third of this activity. Although there was great variability in the subjects addressed, diseases that are highly prevalent in Brazil, such as tuberculosis and other infections diseases, were the most common topics.

 


Keywords: Biomedical research/statistics & numerical data; Respiratory tract diseases; Pulmonary disease (Speciality); Bibliometrics; Scientific and technical publications/statistics & numerical data; Brazil

 

10 - Analysis of pulmonary mechanics in an experimental model of sepsis

Análise da mecânica pulmonar em modelo experimental de sepse

Rodrigo Storck Carvalho, André Gustavo Magalhãer de Pinho, Ana Paula Alves de Andrade, César Augusto Melo e Silva, Carlos Eduardo Gaio, Paulo Tavares

J Bras Pneumol.2006;32(4):316-321

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether pulmonary mechanics are altered in mice with sepsis. Methods: A total of 40 Balb/c mice were divided into two groups: survival (n = 21) and pulmonary mechanics (n = 19). The survival group was divided into three subgroups: control (n = 7), sublethal (n = 7) and lethal (n = 7). The pulmonary mechanics group was also divided into three subgroups: control (n = 5), sublethal (n = 7) and lethal (n = 7). Sepsis was induced through cecal ligation and puncture, the latter varying in degree (sublethal or lethal). At eight hours after the intervention, pulmonary mechanics were measured through end-inflation occlusion. In the pulmonary mechanics group, the following variables were studied: total pressure, resistance, viscoelasticity, dynamic compliance and static compliance. The data obtained were analyzed using one-way ANOVA. Results: The data for the survival group indicate the efficacy of the model employed. There were no statistically significant differences among the pulmonary mechanics subgroups in terms of dynamic compliance, static compliance, total pressure, resistance or viscoelasticity. Conclusion: At eight hours after cecal ligation and puncture, there were no changes in the lung parenchyma, nor were any alterations observed in the viscous and viscoelastic components of the lung.

 


Keywords: Sepsis; Respiratory mechanics; Lung/injuries; Punctures/instrumentation; Respiratory distress syndrome, adult; Mice

 

11 - Morphological aspects as prognostic factors in malignant mesothelioma: a study of 58 cases

Marcadores morfológicos de prognóstico no mesotelioma maligno: um estudo de 58 casos

Alexandre Bottrel Motta, Germânia Pinheiro, Leila Antonângelo, Edwin Roger Parra, Maria Margarida Monteiro, José Carlos das Neves Pereira, Tereza Takagaki, Mario Terra Filho, Sandro Martins, Vera Luiza Capelozzi

J Bras Pneumol.2006;32(4):322-332

Abstract PDF PT PDF EN Portuguese Text

Objective: Various markers have shown promise as diagnostic markers and prognostic predictors in malignant mesothelioma (MM). Methods: Through morphometric and immunological studies of markers in stromal components (calretinin, CEA, Leu-M1 and thrombomodulin) and nuclear components (p53 and Ki-67), we evaluated post-diagnosis survival in 58 patients with MM. Results: The histologic pattern of the MM was typical in 50 cases and atypical in 8. Through immunohistochemistry, we confirmed 40 cases of mesothelioma and 11 cases of adenocarcinoma, although we were unable to classify 7 of the 8 cases presenting atypical histologic patterns. Cox multivariate analysis revealed that the risk factor for death was higher (476.2) among patients of advanced age, presenting the biphasic subtype and testing positive for components expressed at the nuclear level. Conclusion: The most useful immunohistochemical markers were was calretinin (for mesothelioma) and CEA (for adenocarcinoma). Immunohistochemical quantification of thrombomodulin facilitated the diagnosis of mesothelioma in patients testing positive for both calretinin and CEA. The most useful prognostic information was that provided by the routine histopathological analysis of the tumor type. It is of note that the combination of a mean age of 55 years and 30.5% immunohistochemical markers in nuclear components created a natural dividing point between patients in which survival was shorter than expected and those in which it was longer than expected. Therefore, histopathological analysis offers a powerful weapon with great potential to inform decisions regarding the use of adjuvant chemotherapy after surgical excision of a mesothelioma.

 


Keywords: Pleural neoplasms; Mesothelioma; Tumor markers, Biological; Carcinoembryonic antigen; Prognosis.

 

12 - Sleep disordered breathing concomitant with fibromyalgia syndrome

Coexistência de transtornos respiratórios do sono e síndrome fibromiálgica

Dienaro Germanowicz, Magali Santos Lumertz, Denis Martinez, Ane Freitas Margaretes

J Bras Pneumol.2006;32(4):333-338

Abstract PDF PT PDF EN Portuguese Text

Objective: To identify fibromyalgia syndrome in patients with sleep disordered breathing. Method: We studied 50 patients seeking treatment at a sleep disorder clinic for snoring, apnea and excessive daytime sleepiness. Sleep disordered breathing was diagnosed through the use of polysomnography. To diagnose fibromyalgia syndrome, patients were evaluated in accordance with the criteria established by the American College of Rheumatology. Results: Of the 50 patients, 32 were male. The mean (± standard deviation) age of the group was 50 ± 12 years. The mean body mass index was 29.7 ± 5.6 kg/m2. The mean apnea-hypopnea index was 36 ± 29 attacks of apnea or hypopnea per hour of sleep. Of the 18 women and 32 men evaluated, 9 and 2, respectively, met the American College of Rheumatology criteria for fibromyalgia syndrome. Conclusion: Considering the fact that the prevalence of fibromyalgia syndrome in the general population is 0.5% for men and 3.4% for women, the more than ten-fold higher proportion of fibromyalgia cases seen in this sample supports the hypothesis that there is an association between sleep disordered breathing and fibromyalgia syndrome.

 


Keywords: Respiration disorders/complications; Fibromyalgia/complications; Sleep apnea, obstructive; Polysomnography

 

13 - Prevalence of ventilator-associated pneumonia in a university hospital and prognosis for the patients affected

Prevalência e prognóstico dos pacientes com pneumonia associada à ventilação mecânica em um hospital universitário

Márcio Martins de Queiroz Guimarães, José Rodolfo Rocco

J Bras Pneumol.2006;32(4):339-346

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of ventilator-associated pneumonia in an intensive care unit, as well as to identify related factors and characterize patient evolution. Methods: This study evaluated 278 patients on mechanical ventilation for more than 24 hours in a university hospital. Results: Ventilator-associated pneumonia developed in 38.1% of the patients, translating to 35.7 cases/1000 ventilator-days: 45.3% were caused by gram-negative agents (Pseudomonas aeruginosa accounting for 22%); and multidrug resistant organisms were identified in 43.4%. In the ventilator-associated pneumonia group, time on mechanical ventilation, time to mechanical ventilation weaning, hospital stays and intensive care unit stays were all longer (p < 0.001). In addition, atelectasis, acute respiratory distress syndrome, pneumothorax, sinusitis, tracheobronchitis and infection with multidrug resistant organisms were more common in the ventilator-associated pneumonia group (p < 0.05). Mortality rates in the intensive care unit were comparable to those observed in the hospital infirmary. Associations between ventilator-associated pneumonia and various factors are expressed as odds ratios and 95% confidence intervals: acute sinusitis (38.8; 3.4-441); > 10 days on mechanical ventilation (7.7; 4.1-14.2); immunosuppression (4.3; 1.3-14.3); acute respiratory distress syndrome (3.5; 1.4-9.0); atelectasis (3.0; 1.2-7.3); cardiac arrest (0.18; 0.05-0.66); and upper gastrointestinal tract bleeding (0.07; 0.009-0.62). The variables found to be associated with in-hospital death were as follows: chronic renal failure (26.1; 1.9-350.7); previous intensive care unit admission (15.6; 1.6-152.0); simplified acute physiologic score II > 50 (11.9; 3.4-42.0); and age > 55 years (4.4; 1.6-12.3). Conclusion: Ventilator-associated pneumonia increased the time on mechanical ventilation and the number of complications, as well as the length of intensive care unit and hospital stays, but did not affect mortality rates.

 


Keywords: Bacterial pneumonia; Hospital infection; Intensive care units; Prognosis; Prospective studies; Intensive care medicine

 

Review Article

14 - Pleurodesis: technique and indications

Pleurodese: técnica e indicações

Marcelo Costa Vaz, Evalo Marchi, Francisco Suso Vargas

J Bras Pneumol.2006;32(4):347-356

Abstract PDF PT PDF EN Portuguese Text

Recurrent pleural effusion, which is commonly seen in clinical practice, compromises patient quality of life, especially in patients with advanced malignant disease. The therapeutic approach to the pleural space involves a wide range of techniques, including aggressive procedures such as pleurectomy. Among such techniques, pleurodesis is the most frequently used. Pleurodesis can be induced through the insertion of pleural catheters, as well as through major surgical procedures (such as thoracotomy). There are various recommended sclerosing agents, including talc (which is the most widely used), silver nitrate and, recently, proliferative cytokines. This article summarizes the principal approaches to the treatment of recurrent pleural effusion, pleurodesis in particular, addressing the indications for, as well as the advantages and disadvantages of, their application in daily pulmonology practice.

 


Keywords: Pleural effusion, malignant/prevention & control; Pleural neoplasms; Pleura/surgery; Pleurodesis/methods; Silver nitrate; Talc; Recurrence

 

15 - Rhinitis, Sinusitis and Asthma: hard to dissociate?

Rinite, sinusite e asma: indissociáveis?

Cássio da Cunha Ibiapina, Emanuel Savio Cavalcantio Sarinho, Álvaro Augusto Souza da Cruz Filho, Paulo Augusto Moreira Camargos

J Bras Pneumol.2006;32(4):357-366

Abstract PDF PT PDF EN Portuguese Text

The objective of this study was to review the literature and to discuss epidemiological and physiopathological aspects and therapeutical implications of an unified approach to allergic rhinosinusitis and asthma. The bibliographic survey was based on the information provided by the following databases: Medline, MD Consult, Highwire, Medscape, LILACS and through direct search over thirty years, using the terms allergic rhinitis and asthma. Fifty-five original articles were selected in the no systematically review addressing the issue of clinical association between allergic rhinusinusitis and asthma. It is noteworthy that in the late years, with the use of specific topical medications for the lower airways or else, to the upper airways, the therapeutical approach has been distinct. However, numerous epidemiological surveys, immunopatological and clinical studies demonstrate the inter-relationship between asthma and allergic rhinossinusitis, characterized by: i) allergic rhinitis is associated to asthma and constitute an independent risk factor for its occurrence; ii) the immunopathological characteristics of allergic rhinitis and asthma are similar; iii) allergic rhinitis and asthma are manifestations of a systemic disease; iv) control of rhinitis favors asthma control. taking into consideration the close inter-relationship between allergic rhinitis and asthma, the approach to diagnosis, treatment and prophylaxis of these illnesses should be integrated. Therapeutical options that allow for the simultaneous control of asthma and allergic rhinitis offer advantages related both to costs and tolerability.

 


Keywords: Asthma/epidemiology; Asthma/physiopathology; Asthma/drug therapy; Sinusitis/epidemiology; Sinusitis/drug therapy; Sinusitis/physiopathology; Rhinitis, allergic, perennial

 

Case Report

16 - Asthma and Churg-Strauss syndrome

Asma e síndrome de Churg-Strauss

Soloni Afra Pires Levy, Alfeu Tavares França, Denise de La Reza, Solange Oliveira Rodrigues Valle, Ana Helena Pereira Correia

J Bras Pneumol.2006;32(4):367-370

Abstract PDF PT PDF EN Portuguese Text

We report the case of a 25-year-old woman with Churg-Strauss syndrome, the symptoms of which had first appeared soon after she began taking oral contraceptive at the age of sixteen. The clinical profile evolved rapidly to severe persistent asthma, nasal polyposis, perennial obstructive rhinitis, eosinophilia (peripheral/tissue) and mononeuritis. Churg-Strauss syndrome is the type of disease that demands early detection, accurate diagnosis, aggressive treatment and periodic monitoring. It should be considered in the differential diagnosis of moderate and severe persistent asthma. The case reported calls attention to possibility that there is a hormonal component and that the disease can present early onset.

 


Keywords: Asthma; Churg-Strauss syndrome; Eosinophilia; Nasal polyps; Vasculitis; Case reports [publication type]

 

17 - Intrathoracic goiter and invasive thymoma: rare concomitant presentation

Bócio de tireóide intratorácico e timoma invasivo: apresentação simultânea incomum

Rodrigo Silva, Jefferson Gross, Fábio Haddad, Riad Younes

J Bras Pneumol.2006;32(4):371-374

Abstract PDF PT PDF EN Portuguese Text

We present a rare situation in which two mediastinal tumors of different topology and histology were found during the resection of an extensive mediastinal tumor in an asymptomatic patient. Different histologies within the same mass have been reported, although, to our knowledge, there have been no reports of different tumors at distinct locations. Thymomas and intrathoracic goiters account for a large proportion of the tumors found in the mediastinum. When feasible, surgical resection plays a fundamental role in effecting a cure. In order to identify concomitant lesions and perform a complete resection, detailed surgical exploration is required.

 


Keywords: Thymoma/complications; Mediastinal neoplasms/complications; Goite, substernal; Mediastinum/pathology; Case reports [publication type]

 

18 - An outbreak of histoplasmosis in the city of Blumenau, Santa Catarina

Microepidemia de histoplasmose em Blumenau, Santa Catarina

Flávio de Mattos Oliveira, Gisela Unis, Luiz Carlos Severo

J Bras Pneumol.2006;32(4):375-378

Abstract PDF PT PDF EN Portuguese Text

Acute pulmonary histoplasmosis is rarely diagnosed and is often confused with tuberculosis. Most knowledge of the disease has been derived from descriptions of epidemics in which a number of individuals were exposed to the same source of infection. Isolation of Histoplasma capsulatum var. capsulatum from soil samples is conclusive evidence of an epidemic focus. This is the first report of an outbreak of histoplasmosis, in which two cases were reported and the fungus was isolated at the focus of the epidemic, in the state of Santa Catarina. Further epidemiological studies are needed in order to determine the prevalence of the infection statewide.

 


Keywords: Histoplasmosis/diagnosis; Histoplasmosis/epidemiology; Histoplasma/isolation & purification; Lung disases, fungal; Disease outbreaks; Case reports [publication type]

 

Letters to the Editor

20 - Pulmonologists, awake!

Acorda pneumologista !

Geraldo Lorenzi Filho, Flávio Magalhães, Carlos Alberto de Assis Viegas

J Bras Pneumol.2006;32(4):382-384

PDF PT PDF EN Portuguese Text


20 - Reply

Réplica

Richard Ricachenevski Gurski, André Ricardo Pereira da Rosa, Enio do Valle, Marcelo Antonio de Borba, André Alves Valiati

J Bras Pneumol.2006;32(4):384-

PDF PT PDF EN Portuguese Text


Year 2006 - Volume 32  - Number 5  (September/October)

Editorial

1 - Pulmonary infiltrates in critically ill patients: the importance of lung biopsy

Infiltrado pulmonar no paciente crítico: a importância da biópsia pulmonar

Bruno do Valle Pinheiro

J Bras Pneumol.2006;32(5):23-24

PDF PT PDF EN Portuguese Text


2 - Pediatric asthma - The impact of hospital admissions

Asma pediátrica - O impacto das internações hospitalares

Renato Tetelbom Stein

J Bras Pneumol.2006;32(5):25-26

PDF PT PDF EN Portuguese Text


Original Article

3 - Asthma management in a public referral center in Porto Alegre in comparison with the guidelines established in the III Brazilian Consensus on Asthma Management

Estudo comparativo entre o manejo da asma em uma unidade de referência da rede pública de Porto Alegre (RS) e as proposições do III Consenso Brasileiro no Manejo da Asma

Waldo Mattos, Luciano Bauer Grohs, Fabíola Roque, Maurício Ferreira, Gabriela Mânica, Ernesto Soares

J Bras Pneumol.2006;32(5):385-390

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether the guidelines put forth in the III Brazilian Consensus on Asthma Management are being applied in a population of asthma patients treated at a public hospital that is a referral center for asthma in the city of Porto Alegre, Brazil. Methods: All adult asthma patients who began their treatment between 1999 and 2002 were evaluated. The treatment given was classified as consistent or inconsistent with the Consensus guidelines. The clinical features of asthma and the frequency of treatment provided by a specialist were compared between the two groups (those receiving guideline-consistent treatment and those receiving guideline-inconsistent treatment). Results: The charts of 357 patients were evaluated. The study sample consisted of 106 males (29.9%) and 251 females (70.3%). The mean age was 41 years, and 33 (9.2%) of the patients were smokers. The treatment was considered inconsistent with the Consensus guidelines in 246 cases (70%). Of those 246, 174 (71%) had presented persistent asthma and were not treated with an inhaled corticosteroid. Normal forced expiratory volume in one second, being from 12 to 18 years of age, and having intermittent asthma were more frequently observed among the patients receiving guideline-consistent treatment (p < 0.01). No correlations were found between guideline-inconsistent treatment and being treated by a pulmonologist, severity of persistent asthma or number of emergency room visits. Conclusion: Most of the asthma patients treated at the public referral center in Porto Alegre did not receive treatment that was consistent with the Consensus guidelines. Undertreatment with inhaled corticosteroids was the principal source of that inconsistency.

 


Keywords: Asthma/therapy; Guidelines; Comparative study

 

4 - Risk factors for multiple hospital admissions among children and adolescents with asthma

Fatores de risco para readmissão hospitalar de crianças e adolescentes asmáticos

Laura Maria de Lima Belizario Facury Lasmar, Paulo Augusto Moreira Camargos, Eugênio Marcos Andrade Goulart, Emília Sakurai

J Bras Pneumol.2006;32(5):391-399

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the influence that hospital admission of suckling infants with asthma has on their risk for future admissions for the same cause. Methods: A retrospective study was conducted, in which the charts of 202 patients, all less than fifteen years of age, were evaluated. All of the patients had been treated as outpatients in a pediatric pulmonology clinic and had been admitted to the hospital on one or more occasions. A multivariate analysis was conducted in order to evaluate the risk factors associated with multiple hospitalizations. Results: Virtually all of the patients evaluated were hospitalized a second time within 18 months of the first hospitalization. Among the patients first hospitalized at = 12 months of age, the second admission occurred sooner than did that recorded for those first hospitalized at > 12 months of age (p = 0.001). The risk factors found to be associated with multiple hospital admissions were as follows: age at first admission = 12 months (odds ratio: 2.55; 95% confidence interval: 1.18-5.48); age at first admission between 13 and 24 months (odds ratio: 3.54; 95% confidence interval: 1.31-9.63); and severity of asthma symptoms (odds ratio: 3.86; 95% confidence interval: 2.02-7.40). Conclusion: After the first hospitalization, children with asthma should be closely monitored, since the risk of subsequent admissions is elevated in the first months following discharge, especially among those of less than two years of age. Health care facilities should be organized to confront this problem appropriately and should dispense prophylactic medication more freely.

 


Keywords: Asthma; Child, hospitalized; Patient readmission; Risk factors

 

5 - Pulmonary auscultation terminology employed in Brazilian medical journals between January of 1980 and December of 2003

Terminologia da ausculta pulmonar utilizada em publicações médicas brasileiras, no período de janeiro de 1980 a dezembro de 2003

Kamila Fernanda Staszko, Carla Lincho, Vivian da Cas Engelke, Nádia Spada Fiori, Karina Cirino Silva, Elisa Iribarren Nunes, Linjie Zhang

J Bras Pneumol.2006;32(5):400-404

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the appropriateness of the use of auscultation terminology in Brazilian respiratory disease-related medical journals published between January of 1980 and December of 2003. Methods: A descriptive study was conducted, evaluating three medical journals: the Jornal de Pneumologia (Journal of Pulmonology), Jornal de Pediatria (Journal of Pediatrics) and Revista Brasileira de Medicina (Brazilian Journal of Medicine). Original articles and case reports about respiratory diseases were selected, and auscultation terminology was extracted from these articles. The appropriateness of terms used to describe adventitious sounds was assessed. Results: We found that the inappropriate use of terms was more frequent when intermittent sounds were described than when continuous sounds were described (87.7% versus 44.0%; p = 0.0000). No significant difference was observed between the inappropriate use of terms by pulmonologists and that observed for other specialists (56.5% versus 62.0%; p = 0.26). In addition, there were no significant differences among the various regions of the country or between the periods prior to and after the dissemination of international nomenclature. Conclusion: Inappropriate use of pulmonary auscultation terms describing adventitious sounds remains common and widespread in Brazilian medical publications.

 


Keywords: Auscultation; Lung/physiopathology; Lung diseases/diagnosis; Respiratory sounds; Terminology

 

6 - Rhodococcus equi infection in acquired immunodeficiency syndrome. Computed tomography aspects

Infecção pulmonar pelo Rhodococcus equi na síndrome da imunodeficiência adquirida. Aspectos na tomografia computadorizada

Edson Marchiori, Renato Gonçalves de Mendonça, Domenico Capone, Elza Maria de Cerqueira, Arthur Soares Souza Júnior, Gláucia Zanetti, Dante Escuissato, Emerson Gasparetto

J Bras Pneumol.2006;32(5):405-409

Abstract PDF PT PDF EN Portuguese Text

Objective: To present the computed tomography aspects of Rhodococcus equi pneumonia in seven patients with acquired immunodeficiency syndrome. Methods: A retrospective study of the computed tomography scans of seven patients with acquired immunodeficiency syndrome and Rhodococcus equi infection. Results: The most common findings were consolidation (n = 7), consolidation with cavitation (n = 6), ground glass opacities (n = 6), peribronchial nodules (n = 4) and centrilobular nodules presenting a "tree-in-bud" pattern (n = 3). Conclusion: The most common finding in patients with Rhodococcus equi pulmonary infection and acquired immunodeficiency syndrome was consolidation with cavitation.

 


Keywords: Acquired immunodeficiency syndrome; Rhodococcus equi; Actimomycetales infections; Lung diseases, fungal; Tomography, emission-computed

 

7 - Outpatient smoking cessation program in the state of Ceará, Brazil: patient profiles and factors associated with treatment success

Ambulatório de apoio ao tabagista no Ceará: perfil dos pacientes e fatores associados ao sucesso terapêutico

Maria Penha Uchoa Sales, Mara Rúbia Fernandes de Figueiredo, Maria Irenilza de Oliveira, Helano Neiva de Castro

J Bras Pneumol.2006;32(5):410-417

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate patient profiles and factors associated with successful treatment. Methods: A retrospective study of patients enrolled in the smoking cessation program at the Hospital de Messejana, located in the state of Ceará, Brazil, from October of 2002 to April of 2005. The treatment was evaluated based on patient profile, type of medication prescribed and time on that medication. Results: Of the 320 patients enrolled, 65.5% were women. The mean age at the outset of treatment was 48 years, and the mean duration of the smoking habit was 33 years. More than 90% of the patients had started smoking before the age of 20. Of the 258 individuals who had enrolled in the program at least one year prior, 50.8% had achieved treatment success; 17.8% had relapsed, and 31.4% had not quit smoking. On average, partial success was achieved in the fifth week of the treatment, and relapse occurred predominantly in the fourth month. Approximately 60% of the patients were treated with medication. Conclusion: Quitting smoking was significantly associated with the use of medication, regardless of the profile of the smoker evaluated. In the second year of the program, quitting smoking was more strongly associated with the use of bupropion and nicotine replacement, resulting in a higher success rate and a trend toward a reduction in the relapse rate.

 


Keywords: Smoking/therapy; Tobacco use cessation; Bupropion; Nicotine

 

8 - Impact of open lung biopsy on refractory acute respiratory failure

Impacto de biópsia pulmonar a céu aberto na insuficiência respiratória aguda refratária

Carmen Silvia Valente Barbas, Vera Luiza Capelozzi, Cristiane Hoelz, Ricardo Borges Magaldi, Rogério de Souza, Maria Laura Sandeville, José Ribas Milanez de Campos, Eduardo Werebe, Laerte O. Andrade Filho, Elias Knobel

J Bras Pneumol.2006;32(5):418-423

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the impact that open lung biopsy findings have on decisions regarding changes in the treatment strategies employed for critically ill patients presenting diffuse pulmonary infiltrates and suffering from refractory acute respiratory failure, as well as on their clinical improvement. Methods: This study involved 12 mechanically ventilated patients with acute respiratory failure who were subjected to open lung biopsy (by thoracotomy) after not presenting a clinical response to standard treatment. Results: The single most common cause of the acute respiratory failure was viral infection, which was identified in 5 patients (40%). The pre-operative evaluation of the cause of respiratory failure was modified in 11 patients (91.6%), and a specific diagnosis was made in 100% of the cases. Regardless of changes in treatment regimen, the mortality rate was 50%. Six patients (50%) survived to be discharged from the hospital. All of the discharged patients survived for at least one year after the open lung biopsy, for an overall one-year survival rate of 50% among the 12 patients studied. For the patients who died in the hospital, the time of survival after open lung biopsy was 14 + 10.8 days. Conclusion: We conclude that open lung biopsy is a useful tool in the management of acute respiratory failure when there is no clinical improvement after standard treatment, since it can lead to a specific diagnosis that requires distinct treatment, which probably lowers the mortality rate among such patients.

 


Keywords: Respiratory distress syndrome, adult; Lung/pathology; Biposy; Acute respiratory syndrome

 

9 - Co-infection with Mycobacterium tuberculosis and human immunodeficiency virus: an epidemiological analysis in the city of Taubaté, Brazil

Co-infecção por Mycobacterium tuberculosis e vírus da imunodeficiência humana: uma análise epidemiológica em Taubaté (SP)

Luiz Gustavo Miranda de Carvalho, Anabelli Zanchetta Buani, Maria Stella Amorim da Costa Zöllner, Alexandre Prado Scherma

J Bras Pneumol.2006;32(5):424-429

Abstract PDF PT PDF EN Portuguese Text

Objective: To discuss the main aspects of co-infection with Mycobacterium tuberculosis and human immunodeficiency virus in the city of Taubaté (located in the state of São Paulo, Brazil) in 2001 and 2002. Methods: This study presents epidemiological data on tuberculosis cases occurring in Taubaté in 2001 and 2002. Results: Of the 250 cases of tuberculosis analyzed, 70 (28%) presented human immunodeficiency virus seropositivity, 95 (38%) presented human immunodeficiency virus seronegativity, and 85 (34%) were patients who had not been submitted to serological testing. In the first group (tuberculosis and human immunodeficiency virus seropositivity), males from 30 to 40 years of age predominated, the most common clinical presentation of tuberculosis was pulmonary (65.71%), and the cure rate was 59.38%. In the group of tuberculosis patients presenting human immunodeficiency virus seronegativity, males from 30 to 40 years of age also predominated, the most common clinical presentation of tuberculosis was also pulmonary (70.55%), and the cure rate was 81.63%. Conclusion: We conclude that the human immunodeficiency virus plays an important role in the epidemiology of tuberculosis. Therefore, serological testing for human immunodeficiency virus should be carried out when a diagnosis of tuberculosis is made.

 


Keywords: Tuberculosis/epidemiology; HIV infections; HIV; Prevalence

 

10 - Multidrug-resistant Mycobacterium tuberculosis at a referral center for infectious diseases in the state of Minas Gerais, Brazil: sensitivity profile and related risk factors

Perfil de sensibilidade e fatores de risco associados à resistência do Mycobacterium tuberculosis, em centro de referência de doenças infecto-contagiosas de Minas Gerais

Márcia Beatriz de Souza, Carlos Maurício de Figueiredo Antunes, Guilherme Freire Garcia

J Bras Pneumol.2006;32(5):430-437

Abstract PDF PT PDF EN Portuguese Text

Objective: To assess the determining factors for Mycobacterium tuberculosis multidrug resistance at a referral center for infectious diseases in the state of Minas Gerais, Brazil. Methods: A retrospective case-control study was conducted using data collected from September of 2000 to January of 2004. During this period, 473 cultures presenting growth of M. tuberculosis, corresponding to 313 patients, were submitted to susceptibility tests at the Central Laboratory of Minas Gerais. Cases presenting resistance to at least rifampin and isoniazid were classified as cases of multidrug resistance and were selected for study. These cases were paired to control group cases of drug-susceptible tuberculosis at a ratio of 1:3. Clinical and demographic data were analyzed using univariate and multivariate analyses. Results: During the study period, 12 (3.83%) cases of multidrug-resistant tuberculosis were identified. In the univariate analysis, multidrug-resistant tuberculosis was found to be more common among male patients, as well as among those testing positive in the sputum smear microscopy, those with cavitations larger than 4 cm in diameter and those having been previously treated for tuberculosis (p = 0.10 for all). After the multivariate analysis, only previous treatment for tuberculosis remained statistically significant (p = 0.0374), with an odds ratio of 14.36 (1.96-176.46). Conclusion: In the present study, previous treatment for tuberculosis was found to be an independent risk factor for multidrug-resistant tuberculosis.

 


Keywords: Mycobacterium tuberculosis; Tuberculosis, multidrug-resistant; Tuberculosis; Microbial sensitivity tests; Risk factors

 

11 - Tuberculin testing of individuals infected with the human immunodeficiency virus: relationship with peripheral T-cell counts and active tuberculosis

Teste tuberculínico em indivíduos com infecção pelo vírus da imunodeficiência humana: relação com número de linfócitos T periféricos e atividade tuberculosa

Lenice do Rosário de Souza, Marli Therezinha Gimenez Galvão, Jussara Marcondes Machado, Domingos Alves Meira, Karlla Cunhas

J Bras Pneumol.2006;32(5):438-443

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate tuberculin test results and relate them to the presence or absence of active tuberculosis, as well as to CD4+ and CD8+ T-lymphocyte counts. Method: The charts of 802 patients with acquired immunodeficiency syndrome treated between August of 1985 and March of 2003 were reviewed. Of the 185 patients submitted to tuberculin tests (23.1%), 107 (57.8%) were male, and 78 (42.2%) were female. Patients were divided into two study groups: tuberculin test reactors (n = 28); and tuberculin test non-reactors (n = 157). Among the reactors, the mean age was 30.60 years, with a standard deviation of 6.62 years, compared with 34.45 years, with a standard deviation of 10.32 years, among the non-reactors. Results: Most of the individuals tested presented only a mild response to the tuberculin test. We found that, at the time of the test, the percentage of individuals with active tuberculosis was greater in the reactor group than in the non-reactor group. During the test period, 10 reactor group patients and 11 non-reactor group patients presented some clinical form of active tuberculosis. In addition, CD4+ T-lymphocyte counts were lower than 200 cells/mm3 in 6 reactor group patients and in 8 non-reactor group patients. Conclusion: Indurations greater than 5 mm were unrelated to higher absolute CD4+ T-cell counts.

 


Keywords: Tuberculin test; Acquired immunodeficiency syndrome; Tuberculosis; CD4-positive T-lymphocytes; CD8-positive T-lymphocytes

 

12 - Tuberculosis as a disease defining acquired immunodeficiency syndrome: ten years of surveillance in Rio de Janeiro, Brazil

Tuberculose como doença definidora de síndrome da imunodeficiência adquirida: dez anos de evolução na Cidade do Rio de Janeiro

Elizabeth Cristina Coelho Soares, Valéria Saraceni, Lilian de Mello Lauria, Antonio Guilherme Pacheco, Betina Durovni, Solange Cesar Cavalcante

J Bras Pneumol.2006;32(5):444-448

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze the frequency of tuberculosis and of the other principal opportunistic infections defining acquired immunodeficiency syndrome at the time such cases were reported in the city of Rio de Janeiro, Brazil. Methods: Analysis of the data compiled in the Rio de Janeiro Municipal Program for the Surveillance of Sexually Transmitted Diseases and Acquired Immunodeficiency Syndrome database from 1993 to 2002. Results: The expanded definition of a case of acquired immunodeficiency syndrome, implemented in 1998, resulted in a substantial increase in the number of reported cases of acquired immunodeficiency syndrome, especially of those defined by immunologic criteria. Among the cases of acquired immunodeficiency syndrome defined only by disease, esophageal candidiasis, in its various forms, remained the most common opportunistic infection present at the time the cases of acquired immunodeficiency syndrome were reported. Although Pneumocystis carinii pneumonia was the second leading opportunistic infection in most of the years evaluated, it was surpassed by tuberculosis in 2001. Conclusion: Despite the decreased numbers of cases of acquired immunodeficiency syndrome defined by disease, tuberculosis remains a significant acquired immunodeficiency syndrome-defining event, currently more common than P. carinii pneumonia and toxoplasmosis. This is probably due to the high rate of tuberculosis prevalence in the city.

 


Keywords: Tuberculosis; Acquired immunodeficiency syndrome; AIDS-related opportunistic infections

 

Review Article

13 - An update on the use of antifungal agents

Atualização no uso de agentes antifúngicos

Roberto Martinez

J Bras Pneumol.2006;32(5):449-460

Abstract PDF PT PDF EN Portuguese Text

We summarize here data regarding the spectrum of action, the pharmacological aspects, the toxicological aspects and the clinical efficacy of liposomal amphotericin B, amphotericin B in colloidal dispersion, amphotericin B lipid complex, voriconazole and caspofungin. We discuss the use of these more recently introduced antifungal agents in terms of their safety, efficiency and cost. We also offer suggestions for the clinical use of these drugs in pulmonary and systemic infections, with an emphasis on the lower toxicity of the lipid formulations of amphotericin B in comparison with conventional medications. In addition, we explore the possibility of using voriconazole as the primary treatment for invasive infections such as aspergillosis, as well as those caused by Scedosporium spp. and Fusarium spp., together with that of using caspofungin to treat disseminated candidiasis and invasive aspergillosis.

 


Keywords: Aspergillosis; Lung diseases, fungal/drug therapy; Amphotericin b/administration & dosage;

 

14 - Nutrition therapy for chronic obstructive pulmonary disease and related nutritional complications

Terapia nutricional na doença pulmonar obstrutiva crônica e suas complicações nutricionais

Amanda Carla Fernandes, Olívia Maria de Paula Alves Bezerra

J Bras Pneumol.2006;32(5):461-471

Abstract PDF PT PDF EN Portuguese Text

Chronic obstructive pulmonary disease is characterized by progressive and partially reversible airway obstruction. The innumerable complications that occur during the progression of the disease can affect the nutritional state of patients suffering from this illness. The objective of this study was to present a brief review of the literature regarding the nutrition therapy used in the treatment of chronic obstructive pulmonary disease. To that end, we performed a bibliographic search for related articles published within the last 18 years and indexed for the Literatura Latinoamericana y del Caribe en Ciencias de la Salud (LILACS, Latin American and Caribbean Health Sciences Literature) and Medline databases. Malnutrition is associated with a poor prognosis for patients with chronic obstructive pulmonary disease, since it predisposes such patients to infections, as well as reducing respiratory muscle force, exercise tolerance and quality of life. Despite the fact that such malnutrition is extremely common in chronic obstructive pulmonary disease patients, it should be recognized as an independent risk factor, since it can be modified through appropriate and efficacious diet therapy and monitoring. For patients with chronic obstructive pulmonary disease, nutrition therapy is initiated after the evaluation of the nutritional state of the patient, which identifies nutritional risk, thereby allowing the proper level of treatment to be established. In this evaluation, anthropometric and biochemical markers, as well as indicators of dietary consumption and body composition, should be used. The prescribed diet should contain appropriate proportions of macronutrients, micronutrients and immunonutrients in order to regain or maintain the proper nutritional state and to avoid complications. The physical characteristics of the diet should be tailored to the individual needs and tolerances of each patient. In the treatment of patients with chronic obstructive pulmonary disease, individualized nutrition therapy is extremely important and has been shown to be fundamental to improving quality of life.

 


Keywords: Pulmonary disease, chronic obstructive; Nutrition assessment; Malnutrition; Nutrition therapy

 

Case Report

15 - Allergic bronchopulmonary aspergillosis presenting a glove-finger shadow in radiographic images

Aspergilose broncopulmonar alérgica com imagem radiológica em "dedo de luva"

Marta Elizabeth Kalil, Ana Luiza Godoy Fernandes, Aline Cristinane da Silva Curzel, Márcio Zamuner Cortez, Gláucia Cristina Godinho Alves Lima

J Bras Pneumol.2006;32(5):472-475

Abstract PDF PT PDF EN Portuguese Text

Allergic bronchopulmonary aspergillosis is a lung disease occurring in patients with asthma or cystic fibrosis, triggered by a hypersensitivity reaction to the presence of Aspergillus fumigatus in the airways. We report herein the case of a patient presenting a clinical profile suggestive of asthma and meeting the clinical, laboratory testing and radiological criteria for a diagnosis of allergic bronchopulmonary aspergillosis. The importance of such findings is that early diagnosis can reduce the risk of respiratory exacerbations and fibrosis.

 


Keywords: Asthma; Bronchiectasis; Aspergillus fumigatus; Aspergillosis, allergic bronchopulmonary

 

16 - Isolated pulmonary cryptococcosis in an immunocompetent patient

Criptococose pulmonar isolada em paciente imunocompetente

Ana Teresa Fernandes Barbosa, Fernando Antônio Colares, Edson da Silva Gusmão, Amanda Araújo Barros, Cristiane Gonçalves Cordeiro, Maria Cecília Tolentino Andrade

J Bras Pneumol.2006;32(5):476-480

Abstract PDF PT PDF EN Portuguese Text

In this study, we report a case of pulmonary cryptococcosis in a patient presenting respiratory symptoms and a lung mass on the chest X-ray. The patient had no concomitant diseases, was seronegative for human immunodeficiency virus and was not receiving immunosuppressive therapy of any kind. The diagnosis was confirmed through transbronchial biopsy and bronchoalveolar lavage. The patient was treated as an outpatient with fluconazole (300 mg/day for six months), evolving to clinical improvement and partial regression of the lung mass, as seen on a second chest X-ray. The current case illustrates an unusual presentation of pulmonary cryptococcosis and raises questions regarding the therapeutic approaches proposed in the literature.

 


Keywords: Cryptococcosis; Lung diseases, fungal; Lung/radiography; Immunocompetence

 

17 - Idiopathic bilateral diaphragmatic paresis

Paresia diafragmática bilateral idiopática

Mônica Corso Pereira, Rodrigo Frange Miziara Mussi, Reinaldo Alexandre de Carvalho Massucio, Ana Maria Camino, Aristóteles de Souza Barbeiro, Wander de Oliveira Villalba, Ilma Aparecida Paschoal

J Bras Pneumol.2006;32(5):481-485

Abstract PDF PT PDF EN Portuguese Text

We report the case of a patient with severe dyspnea upon reclining. Lung disease, neuromuscular disorders and heart disease were ruled out. However, during the course of the investigation, bilateral diaphragmatic paresis was discovered. A key sign leading to the diagnosis was evidence of paradoxical respiration in the dorsal decubitus position. When the patient was moved from the orthostatic position to the dorsal decubitus position, oxygenation and forced vital capacity worsened. The orthostatic fluoroscopy was normal. Maximal inspiratory pressure was severely reduced. The responses to transcutaneous electric stimulation of the diaphragm were normal. However, electric stimulation of the phrenic nerve produced no response, leading to the diagnosis of bilateral diaphragmatic paresis.

 


Keywords: Paresis; Respiratory insufficiency; Diaphragm; Respiration

 

Letters to the Editor

19 - Core biopsy; tru-cut biopsy, lance biopsy or punch biopsy with a tissue-cutting needle (punch cutting - PCut)?

Core biópsia; Tru-cut biópsia, punção lancetante ou biópsia por punção com agulha fragmentante tecidual (punção fragmentante - PFrag)?

Klaus Loureiro Irion, Bruno Hochhegger, Luciane Dreher Irion

J Bras Pneumol.2006;32(5):488-

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Year 2006 - Volume 32  - Number 6  (November/December)

Editorial

1 - The Brazilian Journal of Pulmonology crosses the MEDLINE!

O Jornal Brasileiro de Pneumologia está no MEDLINE !

José Antônio Baddini Martinez

J Bras Pneumol.2006;32(6):27-29

PDF PT PDF EN Portuguese Text


2 - Risk factors involved in performing lobectomy to treat bronchial carcinoma

Fatores de risco nas lobectomias realizadas para tratar o carcinoma brônquico

Vicente Forte

J Bras Pneumol.2006;32(6):30-32

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3 - Silicosis (still) among us

A silicose (ainda) entre nós

Eduardo Mello De Capitani

J Bras Pneumol.2006;32(6):33-35

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Original Article

4 - Prognostic factors for complications following pulmonary resection: pre-albumin analysis, time on mechanical ventilation, and other factors

Fatores prognósticos em complicações pós-operatórias de ressecção pulmonar: análise de pré-albumina, tempo de ventilação mecânica e outros

Renata Cristiane Gennari Bianchi, Juliana Nalin de Souza, Carolina de Almeida Giaciani, Neucy Fenalti Höehr, Ivan Felizardo Contrera Toro

J Bras Pneumol.2006;32(6):489-494

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether pre-operative nutritional status and post-operative time on mechanical ventilation, as well as others factors, are correlated with post-operative complications (general or pulmonary) in patients undergoing elective thoracic surgery. Methods: A prospective study was conducted, involving 71 patients undergoing elective pulmonary resection. The data collected pre-operatively included gender, age, smoking status, pre-albumin level, lymphocyte count, and body mass index. The peri-operative data included type of surgery and surgical time, as well as post-operative time on mechanical ventilation. Results: Post-operative complications were found to correlate with low pre-albumin concentration, type of resection, surgical time, and post-operative time on mechanical ventilation. Surgical time and post-operative time on mechanical ventilation were also implicated in the post-operative pulmonary complications observed in 22 (30.99%) of the patients studied. Conclusion: Our results suggest that pre-albumin concentration, type of surgery and surgical time, as well as post-operative time on mechanical ventilation, serve as predictive indices of post-operative complications in patients undergoing elective pulmonary resection. In the analysis of the post-operative pulmonary complications, statistically significant correlations were found between such complications and increases in surgical time or post-operative time on mechanical ventilation.

 


Keywords: Thoracic surgery; Postoperative complications; Mechanical ventilation; Nutritional status; Prealbumin

 

5 - Lobectomy for treating bronchial carcinoma: analysis of comorbidities and their impact on postoperative morbidity and mortality

Lobectomia por carcinoma brônquico: análise das co-morbidades e seu impacto na morbimortalidade pós-operatória

Pablo Gerardo Sánchez, Giovani Schirmer Vendrame, Gabriel Ribeiro Madke, Eduardo Sperb Pilla, José de Jesus Peixoto Camargo, Cristiano Feijó Andrade, José Carlos Felicetti, Paulo Francisco Guerreiro Cardoso

J Bras Pneumol.2006;32(6):495-504

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze the impact that comorbidities have on the postoperative outcomes in patients submitted to lobectomy for the treatment of bronchial carcinoma. Methods: A retrospective study of 493 patients submitted to lobectomy for the treatment of bronchial carcinoma was conducted, and 305 of those patients met the criteria for inclusion in the final study sample. The surgical technique used was similar in all cases. The Torrington-Henderson scale and the Charlson scale were used to analyze comorbidities and to categorize patients into groups based on degree of risk for postoperative complications or death. Results: The postoperative (30-day) mortality rate was 2.9%, and the postoperative complications index was 44%. Prolonged air leakage was the most common complication (in 20.6%). The univariate analysis revealed that gender, age, smoking, neoadjuvant therapy and diabetes all had a significant impact on the incidence of complications. The factors found to be predictive of complications were body mass index (23.8 ± 4.4), forced expiratory volume in one second (74.1 ± 24%) and the ratio between forced expiratory volume in one second and forced vital capacity (0.65 ± 0.1). The scales employed proved efficacious in the identification of the risk groups, as well as in drawing correlations with morbidity and mortality (p = 0.001 and p < 0.001). In the multivariate analysis, body mass index and the Charlson index were found to be the principal determinants of complications. In addition, prolonged air leakage was found to be the principal factor involved in mortality (p = 0.01). Conclusion: Reductions in forced expiratory volume in one second, in the ratio between forced expiratory volume in one second and forced vital capacity, and in body mass index, as well as a Charlson score of 3 or 4 and a Torrington-Henderson score of 3, were associated with a greater number of postoperative complications in patients submitted to lobectomy for the treatment of bronchial carcinoma. Air leakage was found to be strongly associated with mortality.

 


Keywords: Lung neoplasms/surgery; Postoperative complications; Pneumonectomy; Morbidity

 

6 - Analysis of 39 cases of idiopathic chronic interstitial pneumonia

Análise de 39 casos de pneumonia intersticial crônica idiopática

Rogério Rufino, Leonardo Rizzo, Cláudia Henrique da Costa, Roberto José de Lima, Kalil Madi

J Bras Pneumol.2006;32(6):505-509

Abstract PDF PT PDF EN Portuguese Text

Objective: To make a retrospective analysis of lung biopsy samples obtained from patients diagnosed with chronic idiopathic interstitial pneumonia, as defined in the American Thoracic Society/European Respiratory Society classification system made public in 2000. Methods: Samples from 252 open-lung biopsies of patients with interstitial lung disease, all performed between 1977 and 1999, were reviewed, and 39 cases of idiopathic interstitial lung disease were selected and re-evaluated by two pathologists in accordance with the American Thoracic Society/European Respiratory Society classification system. Results: Among those 39 cases, the diagnoses were maintained in 28 (71.8%). A new pathologic entity, nonspecific interstitial pneumonia, was included in the reclassification, and overlapping patterns were observed in 6 cases. Of the 28 cases in which the diagnosis of chronic idiopathic interstitial pneumonia remained unchanged, idiopathic pulmonary fibrosis was accompanied by cryptogenic organizing pneumonia in 4, cryptogenic organizing pneumonia was accompanied by nonspecific interstitial pneumonia in 1, and desquamative interstitial pneumonia was accompanied by nonspecific interstitial pneumonia in 1. All cases of idiopathic pulmonary fibrosis were confirmed, although 3 of those were found to be accompanied by cryptogenic organizing pneumonia. Virtually all prior diagnoses were maintained in the review of the biopsy samples (p > 0,05). Conclusion: The American Thoracic Society/European Respiratory Society system of classifying interstitial lung disease is a useful tool for pathologists who deal with lung biopsies.

 


Keywords: Pulmonary fibrosis; Lung diseases, interstitial

 

7 - Location of lung carcinoma in relation to the smoking habit and gender

Localização do carcinoma pulmonar em relação ao vício tabágico e ao sexo

Sérgio Jamnik, César Uehara, Vilmer Vieira da Silva

J Bras Pneumol.2006;32(6):510-514

Abstract PDF PT PDF EN Portuguese Text

Objective: To analyze the locations of lung carcinomas in relation to patient gender and smoking status. Methods: In order to test the hypothesis that lung carcinoma location (upper or lower lobe; left or right side) is correlated with smoking status and gender, we conducted a retrospective study of 697 patients with bronchogenic carcinoma treated at the Pulmonology-Oncology Outpatient Clinic of the Federal University of São Paulo. Results: We found that the bronchogenic carcinomas occurring in smokers were more frequently located in the upper lobes, whereas those occurring in nonsmokers were more frequently located in the lower lobes. In women, the neoplasms were more often seen in the lower lobes, especially in nonsmokers. Based on the available data, there were no differences in terms of the side affected (left or right). Conclusion: Overall, bronchogenic carcinomas are predominantly found in the upper lobes. However, in nonsmokers, they occur more frequently in the lower lobes. In females, bronchogenic carcinomas present a tendency to occur more often in the lower lobes.

 


Keywords: Lung neoplasms; Sex factors; Smoking

 

8 - Hydrostatic pulmonary edema: high-resolution computed tomography aspects

Edema pulmonar hidrostático: aspectos na tomografia computadorizada de alta resolução

Cláudia Maria Cunha Ribeiro, Edson Marchiori, Rosana Rodrigues, Emerson Gasparetto, Arthur Soares Souza Júnior, Dante Escuissato, Luiz Felipe Nobre, Gláucia Zanetti, César de Araujo Neto, Klaus Irion

J Bras Pneumol.2006;32(6):515-522

Abstract PDF PT PDF EN Portuguese Text

Objective: This study aimed to use high-resolution computed tomography scans of the chest to characterize the principal alterations occurring in cases of hydrostatic pulmonary edema. Methods: A retrospective analysis was made of the tomography scans of 15 patients presenting clinical profiles of hydrostatic pulmonary edema. The cases were divided into five groups by etiology: congestive heart failure (n = 7); acute mitral valve disease (n = 2); acute myocardial infarction (n = 2); myocarditis (n = 2); and fibrosing mediastinitis (n = 2). Results: The principal findings in the cases of hydrostatic pulmonary edema were ground-glass opacities (in 100%), interlobular septal thickening (in 100%), pleural effusion (in 87%) and peribronchovascular interstitial thickening (in 80%). Other, less common, findings were increased blood vessel diameter, consolidations and air-space nodules. Conclusion: The predominant pattern found in the patients studied was that of ground-glass opacities accompanied by interlobular septal thickening (mosaic attenuation pattern) and bilateral (predominantly right-sided) pleural effusion.

 


Keywords: Pulmonary edema; Tomography, X-ray computed; Lung diseases

 

9 - Progressive massive fibrosis in silica-exposed workers. High-resolution computed tomography findings

Fibrose maciça progressiva em trabalhadores expostos à sílica. Achados na tomografia computadorizada de alta resolução

Ângela Santos Ferreira, Valéria Barbosa Moreira, Hevânia Mara Vaz Ricardo, Renata Coutinho, José Manoel Gabetto, Edson Marchiori

J Bras Pneumol.2006;32(6):523-528

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the radiological characteristics of conglomerate masses using high-resolution computed tomography of the chest. Methods: From among the patients treated between 1986 and 2004 at the Antonio Pedro University Hospital, 75 patients with silicosis and massive fibrosis, most working in the field of sandblasting, were selected for study. These patients were submitted to a clinical evaluation, chest X-ray and high-resolution computed tomography of the chest. Results: In more than half of the patients with accelerated silicosis, the chest X-ray revealed large type B and C opacities, denoting the severity of the disease in those patients. In 1 case, a unilateral mass simulating lung cancer was observed. High-resolution computed tomography scans of the chest were acquired for 44 patients. In most cases (88.6%), the masses were located in the superior and posterior thirds of the lung. Common findings within the masses included air bronchograms (in 70.4%) and calcifications (in 63.6%). A history of tuberculosis was reported by 52% of the patients. Conclusion: In the vast majority of cases, the masses were bilateral, predominantly located in the superior and posterior regions of the lung, featuring air bronchograms and interposed calcifications. Concomitant calcification of the mediastinal and hilar lymph nodes was another common finding. Exposure to high concentrations of dust and having a history of tuberculosis were considered significant risk factors for the development of progressive massive fibrosis.

 


Keywords: Pulmonary fibrosis; Silicosis; Silicon dioxide; Occupational diseases; Environmental exposure;

 

10 - Epidemiological aspects of human immunodeficiency virus/tuberculosis co-infection in Ribeirão Preto, Brazil from 1998 to 2003

Aspectos epidemiológicos da co-infecção tuberculose e vírus da imunodeficiência humana em Ribeirão Preto (SP), de 1998 a 2003

Jordana de Almeida Nogueira, Antônio Ruffino-Netto, Tereza Cristina Scatena Villa, Mellina Yamamura, Ricardo Arcencio, Roxana Isabel Cardozo-Gonzales

J Bras Pneumol.2006;32(6):529-534

Abstract PDF PT PDF EN Portuguese Text

Objective: This study aimed to characterize the epidemiological profile of tuberculosis cases reported in the city of Ribeirão Preto between 1998 and 2003, according to patient HIV status, gender, age bracket and treatment outcome. Methods: This was a descriptive epidemiological study that employed the Brazilian National Tuberculosis Notification Database as an instrument of data collection. The study sample consisted of all cases of human immunodeficiency virus/tuberculosis co-infection occurring in residents of Ribeirão Preto and reported between 1998 and 2003. Results: During this period, 1273 new cases of tuberculosis were reported, 377 of which were in HIV-positive individuals, for a co-infection rate of 30%. Of the cases of co-infection, 76% were in men, and the majority occurred in individuals in the 20-59 age bracket. In terms of treatment outcome, cure was achieved in 52%, treatment abandonment was reported in 11%, and death occurred in 32%. The predominant clinical form of tuberculosis was the pulmonary form, which accounted for 58% of the cases. Conclusion: A high prevalence of co-infection was observed in the community studied. The treatment outcomes seen among the cases in our study sample underscore the need to adopt special strategies to monitor this clientele. Comparing the cases of tuberculosis in isolation with the cases of co-infection, no gender-related or age-related differences were observed.

 


Keywords: Tuberculosis; HIV infections; Comorbidity

 

11 - Characteristics of elderly tuberculosis patients in Recife, Brazil: a contribution to the tuberculosis control program

Características da tuberculose em idosos no Recife (PE): contribuição para o programa de controle

Zilda do Rego Cavalcanti, Maria de Fátima Pessoa Militão de Albuquerque, Antônio Roberto Leite Campelo, Ricardo Ximenes, Ulisses Montarroyos, Marianne Karel Amaral Verçosa

J Bras Pneumol.2006;32(6):535-543

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the demographic characteristics, everyday habits, socio-economic conditions, clinico-epidemiological profiles and access to health care services among the elderly patients with tuberculosis diagnosed and treated in the city of Recife, Brazil, comparing them to those observed in young adults with tuberculosis. Methods: A case-control type strategy was used to evaluate a cohort of patients with tuberculosis, all of whom were treated in public health care facilities in Recife between May of 2001 and July of 2003. Results: The final cohort consisted of 1127 patients: 136 elderly patients (cases) and 991 young adults (controls). In both groups, males predominated, and the most common form of tuberculosis was the pulmonary form. Alcoholism was more common in the control group, whereas illiteracy was more common in the case group. There were fewer complaints of cough, sweats and chest pain among the patients in the case group than among those in the control group. Serological testing for the human immunodeficiency virus was performed in only 29 patients (2.6%). The percentage of positive sputum smear microscopy results, as well as that of positive cultures, was higher in the controls. Prior to being diagnosed with the disease, patients in both groups had sought treatment at more than two health care facilities and had waited more than two months (after first seeking treatment). The elderly patients presented higher indices of cure and were more often compliant with the treatment regimen, yet presented higher mortality rates. Conclusion: In the population studied, the elderly presented less cough, fewer episodes of night sweats and less chest pain, as well as less often presenting positivity on complementary exams. Nevertheless, the mortality rate was higher among the elderly patients than among the young adult patients. Elderly patients with tuberculosis constitute a population that should be given special attention in public health care facilities.

 


Keywords: Tuberculosis; Elderly; Case-control; Brazil

 

12 - Deaths attributed to multiple causes and involving tuberculosis in the state of Rio de Janeiro Brazil between 1999 and 2001

Causas múltiplas de morte relacionadas à tuberculose no Estado do Rio de Janeiro entre 1999 e 2001

Augusto Hasiak Santo

J Bras Pneumol.2006;32(6):544-552

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate deaths attributed to multiple causes in which tuberculosis was one of the causes listed. Methods: All deaths among residents of the state of Rio de Janeiro, Brazil, occurring between 1999 and 2001 and for which the death certificate mentioned tuberculosis, were investigated. The World Health Organization guidelines were used in characterizing the underlying and associated (non-underlying) causes of death. Results: In deaths from tuberculosis, conditions related to its natural history were the principal associated causes, together with alcoholism and diabetes. In approximately three-fifths of all deaths for which tuberculosis was listed as an associated cause, the underlying cause of death was acquired immunodeficiency syndrome. High proportion of ill-defined causes of death, low values found for the number of causes informed per death certificate and for TB as an associated cause point towards a certain degree of underestimation of the actual number of TB-related deaths in Rio de Janeiro State. Conclusion: The study shows that the rates of tuberculosis-related mortality in the state of Rio de Janeiro, calculated based on the number of times tuberculosis was listed as a cause of death (underlying or associated), are the highest in the country. Epidemiological studies of mortality are recommended as a means of guiding the activities of the tuberculosis control program.

 


Keywords: Tuberculosis/mortality; Acquired immunodeficiency syndrome; Multipe cause of death; Brazil

 

13 - Evolution of tuberculosis-related mortality in Fortaleza, Brazil from 1980 to 2001

Evolução da mortalidade por tuberculose em Fortaleza (CE), entre 1980 e 2001

Mônica Cardoso Façanha

J Bras Pneumol.2006;32(6):553-558

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the evolution of tuberculosis-related mortality, as well as gender-related and age-related tendencies, in the city of Fortaleza, Brazil. Methods: A descriptive study, based on secondary data, was conducted. All deaths from tuberculosis occurring among residents of Fortaleza in the 1980-2001 period and reported to the Ministry of Health via the Mortality Database were included. The evolution of tuberculosis-related mortality was compared with that of overall mortality and with that of mortality from all infectious diseases. The tendencies of the coefficients of overall mortality and of tuberculosis-related mortality, adjusted and unadjusted for age and gender, were calculated for the study period. Results: The coefficients of overall mortality and of tuberculosis-related mortality presented decreasing tendencies. The coefficient of tuberculosis-related mortality presented a decreasing tendency in individuals = 19 years of age (y = -0.0906x + 2.5133), from 20 to 59 years of age (y = -0.414x + 12.29) and 60 years of age (y = -1.2494x + 40.289), as well as in males (y = -0.3175x + 10.971) and females (y = -0.1933x + 6.8051). Conclusion: Despite displaying a decreasing tendency, the coefficient of tuberculosis-related mortality remains high.

 


Keywords: Tuberculosis/mortality; Information systems; Prevalence

 

14 - Investigation of tuberculosis contacts in the tuberculosis control program of a medium-sized municipality in the southeast of Brazil in 2002

O controle de comunicantes de tuberculose no programa de controle da tuberculose em um município de médio porte da Região Sudeste do Brasil, em 2002

Cláudia Eli Gazetta, Antônio Ruffino Netto, José Martins Pinto Neto, Maria de Lourdes Sperli Geraldes Santos, Maria Rita de Cássia Oliveira Cury, Silvia Helena Figueiredo Vendramini, Tereza Cristina Scatena Villa

J Bras Pneumol.2006;32(6):559-565

Abstract PDF PT PDF EN Portuguese Text

Objective: This study aimed to describe the investigation of tuberculosis contacts enrolled in the Tuberculosis Control Program of the municipality of São José do Rio Preto, Brazil in 2002. Methods: A descriptive study was conducted using secondary data obtained from the Tuberculosis Notification Database, as well as charts and registries compiled by the São José do Rio Preto Tuberculosis Control Program in 2002. Results: A total of 166 household tuberculosis contacts were enrolled in the Program. Of those, 82 were male, and 84 were females. The incidence of tuberculosis was highest (70%) in the 15 to 59 age bracket: 42 (25.3%) of the cases occurred in individuals from 0 to 19 years of age; 73 (44%) in those from 20 to 49; and 44 (25.5%) in those 50 or over. In terms of their relationship with the index patient, 41 (24.7%) were children; 29 (17.5%) were partners; 22 (13.2%) were siblings, and 15 (9.1%) were mothers. The following tests were requested: (in 12%) sputum smear microscopy, culture or both; (in 100%) chest X-ray, revealing 2 suspected cases of pulmonary tuberculosis and 5 cases of other diseases; (in 7.2%) tuberculin skin test, the results of which showed that 4.2% were nonreactors, and that 1.2% presented an induration of 8 mm. Among the contacts examined, the disease was detected in 3 (1.8%). Conclusion: There is no systematization in the monitoring of individuals who are in contact with tuberculosis patients.

 


Keywords: Tuberculosis/mortality; Information systems; Prevalence

 

15 - Tuberculosis in a Psychiatric Hospital in the state of Goiás, Brazil

Ocorrência de tuberculose em um hospital psiquiátrico do interior de Goiás

Hindenburg Cruvinel Guimarães da Costa, Ana Carolina Malaspina, Fernando Augusto Fiúza de Mello, Clarice Queico Fujimura Leite

J Bras Pneumol.2006;32(6):566-572

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate the prevalence of infection, disease and eventual institutional outbreak of tuberculosis in a psychiatric hospital using the PPD test, as well as testing for mycobacteria in material collected from the respiratory tree and using molecular tracking technique based on insertion sequence 6110 (IS6110). Methods: Between February and August of 2002, PPD tests were given to 74 inpatients and 31 staff members at a psychiatric hospital in the city of Rio Verde, located in the state of Goiás, Brazil. In addition, respiratory tree material collected from the inpatients was submitted to testing for Mycobacterium tuberculosis. Results: Among the patients analyzed, mycobacteria were isolated from five (6.8%): four identified as M. tuberculosis and one as M. chelonae. The M. tuberculosis isolates were sensitive to isoniazid and rifampicin, and, when submitted to the restriction fragment length polymorphism/IS6110 technique, presented unique genetic profiles, totally distinct from one another, suggesting that all of the tuberculosis cases were due to endogenous reactivation. It was not possible to characterize this group of cases as an institutional outbreak. Performing the two-step tuberculin test in the patients, the infection rates were 23% and 31%, compared with 42% among staff members, who were submitted to the one-step test. Conclusion: The results indicate a high incidence of tuberculosis infection among inpatients and hospital staff, as well as a high occurrence of the disease among inpatients.

 


Keywords: Tuberculosis/epidemiology; Hospitals, psychiatric; Mycobacterium tuberculosis; Tuberculin test;

 

Review Article

16 - The influence of genetics on nicotine dependence and the role of pharmacogenetics in treating the smoking habit

A influência da genética na dependência tabágica e o papel da farmacogenética no tratamento do tabagismo

José Miguel Chatkin

J Bras Pneumol.2006;32(6):573-579

Abstract PDF PT PDF EN Portuguese Text

Despite the considerable efforts made in the fight against smoking in the last decades, there are still substantial numbers of people who, in full knowledge of the health hazards, begin smoking or continue smoking. Recent studies have focused on the genetic bases of the nicotine addiction. Various genetic polymorphisms have been associated with smoking. However, environmental factors have also been shown to play a role. In this review, we present some of the principal data collected in genetic studies of smoking behavior. The results obtained through this line of research will eventually aid clinicians in individualizing the type, dosage and duration of treatment for patients with nicotine dependence in accordance with the genotype of each smoker, thereby maximizing the efficacy of the proposed treatment regimen.

 


Keywords: Smoking; Tobacco use cessation; Nicotine; Tobacco use disorder

 

17 - Functionality of patients with chronic obstructive pulmonary disease: energy conservation techniques

Funcionalidade do paciente com doença pulmonar obstrutiva crônica e técnicas de conservação de energia

Marcelo Velloso, José Roberto Jardim

J Bras Pneumol.2006;32(6):580-586

Abstract PDF PT PDF EN Portuguese Text

Chronic obstructive pulmonary disease is a progressive and debilitating disease that is typically diagnosed only after a long period of gradual worsening. Dyspnea is the symptom that most often interferes with the execution of professional, family, social and daily-life activities of patients with chronic obstructive pulmonary disease. Such limitations can lead to a sedentary lifestyle and worsen overall quality of life. This article aims to address the functional limitations these patients deal with in carrying out their daily-life activities, establishing guidelines that health professionals can use to help their patients achieve maximum functionality. Guidelines for the use of energy conservation techniques are widely used in pulmonary rehabilitation programs. However, these guidelines should also be used in outpatient clinics and hospitals. A great number of human activities involve the legs and arms. The arms are involved in virtually all everyday activities - from the most simple to the most complex. Some studies have shown that upper-body exercises in which the arms are not supported cause thoracoabdominal asynchrony and dyspnea in shorter times and with less oxygen consumption than in exercises involving the legs. Even simple tasks can result in high oxygen consumption and minute ventilation, which accounts for the sensation of dyspnea reported by the patients. In view of these facts, it is appropriate to evaluate the impact that such incapacity has on daily life in patients with chronic obstructive pulmonary disease. Techniques of energy conservation that can be used as tools to minimize the discomfort of such patients are herein discussed, and those considered most appropriate are highlighted.

 


Keywords: Pulmonary disease, chronic obstructive/rehabilitation ; Activities of daily living; Energy metabolism;

 

Case Report

18 - Postinfectious bronchiolitis obliterans accompanied by pulmonary hemosiderosis in childhood

Associação de bronquiolite obliterante pós-infecciosa e hemossiderose pulmonar na infância

Leonardo Araújo Pinto, Anick Oliveira, Sintia Collaziol, Paulo Márcio Pitrez, Marcus Jones, João Carlos Prolla, Marisa Dolhnikoff, Renato T. Stein

J Bras Pneumol.2006;32(6):587-591

Abstract PDF PT PDF EN Portuguese Text

In the present report, we describe an unusual presentation of post-infectious bronchiolitis obliterans accompanied by pulmonary hemosiderosis in a nine-year-old boy with persistent respiratory symptoms subsequent to an episode of acute bronchiolitis occurring at the age of seven months. After the episode, the persistent respiratory symptoms worsened significantly, and, by the age of seven, the patient began to have difficulty breathing after minimal exertion. Computed tomography of the chest presented findings consistent with bronchiolitis obliterans. Open lung biopsy revealed numerous hemosiderin-laden macrophages, as well as other findings consistent with bronchiolitis obliterans. Pulmonary hemosiderosis can occasionally be accompanied by bronchiolitis obliterans in children with severe sequelae after an episode of viral infection.

 


Keywords: Bronchoalveolar lavage; Bronchiolitis obliterans; Hemosiderosis; Case reports [Publication type]

 

19 - Pulmonary and cutaneous nocardiosis in a patient treated with corticosteroids

Nocardiose pulmonar e cutânea em paciente usuário de corticosteróide

Bruno Guedes Baldi, Alfredo Nicodemos Cruz Santana, Teresa Yae Takagaki

J Bras Pneumol.2006;32(6):592-595

Abstract PDF PT PDF EN Portuguese Text

Nocardiosis is a localized or disseminated infection caused by gram-positive bacteria of the genus Nocardia. The infection most commonly affects the lungs, skin and central nervous system. Nocardiosis principally occurs in individuals with cellular immunodeficiency and should be considered in the differential diagnosis when such individuals present respiratory, cutaneous or neurological alterations. Herein, we report a case of pulmonary and cutaneous nocardiosis in a patient receiving oral corticosteroids to treat bronchiolitis obliterans accompanied by organizing pneumonia of unknown origin. After long-term treatment with sulfamethoxazole-trimethoprim, the clinical and radiological profile improved.

 


Keywords: Nocardia infections; Lung diseases; Bronchiolitis obliterans; Adrenal cortex hormones; Case reports [Publication type]

 

20 - Exogenous lipoid pneumonia: importance of clinical history to the diagnosis

Pneumonia lipóide exógena: importância da história clínica no diagnóstico

Alfredo Pereira Leite de Albuquerque Filho

J Bras Pneumol.2006;32(6):596-598

Abstract PDF PT PDF EN Portuguese Text

Lipoid pneumonia is a rare disease resulting from the micro-aspiration of lipid formulations. Making a diagnosis of lipoid pneumonia requires a high degree of clinical suspicion. Herein, we report the case of a female patient with a history of breast cancer, presenting progressive dyspnea and cough, together with radiological findings of bilateral pulmonary infiltrate. The working diagnosis of lymphangitic carcinomatosis, for which chemotherapy would be indicated, was called into question based on the high-resolution computed tomography findings and on the fact that the patient had a history of chronic ingestion of laxatives containing mineral oil. A lung biopsy confirmed a diagnosis of lipoid pneumonia, which should always be considered in patients with diffuse lung disease having been exposed to potential causative agents.

 


Keywords: Pneumonia, lipid; Tomography, X-Ray Computed; Mineral oil; Case Reports [Publication type]

 

21 - Spontaneous chylothorax associated with light physical activity

Quilotórax espontâneo associado a atividade física leve

José Carlos Miranda Torrejais, Carolina Borges Rau, João Adriano de Barros, Márcia Miranda Torrejais

J Bras Pneumol.2006;32(6):599-602

Abstract PDF PT PDF EN Portuguese Text

Chylothorax occurs when there is rupture, laceration or obstruction of the thoracic duct, resulting in the release of chyle into the pleural space. Chylothorax can occur in cases of congenital lymphatic malformation, lymphoma, mediastinal tumor and infectious disease, as well as during surgical procedures and after traffic accident-related trauma. It can also be idiopathic. The condition presents clinical signs of dyspnea, hypotension, generalized edema and cyanosis. The diagnosis is usually made through thoracocentesis, and the treatment is conservative. Spontaneous chylothorax is an uncommon form of pleural effusion, and its diagnosis should be hypothesized only after all other causes have been ruled out. Herein, we describe a case of spontaneous chylothorax associated with light physical activity at a fitness center.

 


Keywords: Chylothorax; Pleural effusion; Motor; Case reports [Publication type]

 

Letters to the Editor

22 - Intratracheal stent: prosthesis or orthesis?

Dispositivos intra-traqueais: próteses ou órteses?

Ricardo Mingarini Terra, Helio Minamoto, Fabio Biscegli Jatene

J Bras Pneumol.2006;32(6):606-607

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Index of Issues

Index of Authors

Relationship of Reviewers

26 - Revisores

J Bras Pneumol.2006;32(6):616-618

PDF PT Portuguese Text


 


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