Brazilian Journal of Pulmonology

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


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

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

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

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

Abstract PDF PT PDF EN Portuguese Text

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


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


Pulmonary involvement in Behcet's disease: a positive single-center experience with the use of immunosuppressive therapy

Acometimento pulmonar na doença de Behçet: uma boa experiência com o uso de imunossupressores

Alfredo Nicodemos Cruz Santana, Telma Antunes, Juliana Monteiro de Barros, Ronaldo Adib Kairalla, Carlos Roberto Ribeiro de Carvalho, Carmen Silvia Valente Barbas

J Bras Pneumol.2008;34(6):362-366

Abstract PDF PT PDF EN Portuguese Text

Objective: Behcet's syndrome, or Behcet's disease (BD), is a multisystem pathology, and survival is related to pulmonary involvement. However, it appears that different treatments correlate with different prognoses. The aim of this study was to evaluate clinical and tomographic evolution, as well as the survival, of patients with BD-related pulmonary involvement. Methods: A retrospective review of our experience with pulmonary manifestations in patients with BD treated at our institution between January 1, 1988 and April 30, 2006. The clinical, radiological, treatment and survival data were obtained from medical charts. Results: We identified 9 patients with BD-related pulmonary involvement. The mean age was 34 ± 11.5 years, and 7 of the patients were male. The radiological findings were as follows: pulmonary artery aneurysm (PAA) in 8 patients; pulmonary embolism in 3 (translating to an incidence of 5.11 cases/100 patient-years); alveolar hemorrhage in one; and pulmonary hypertension in one. The treatment consisted of immunosuppression with prednisone plus chlorambucil (or cyclophosphamide or mycophenolate mofetil) in all patients, with partial or complete resolution of the PAAs. One patient with a PAA and pulmonary hypertension also received sildenafil and warfarin, with good clinical and tomographic response (the first report in the English literature). In our sample, the mean duration of the follow-up period was 6.52 years. The three-year survival rate was 88.8%, as was the five-year survival rate. Conclusions: Patients with BD-related pulmonary involvement can present good survival with immunosuppressive therapy, and BD should be borne in mind as a possible cause of pulmonary hypertension and alveolar hemorrhage.


Keywords: Behcet Syndrome; Lung diseases, interstitial; Pulmonary circulation; Hypertension, pulmonary; Pulmonary embolism; Alveolar.


Severe form of hantavirus cardiopulmonary syndrome managed with continuous positive airway plessure through facial mask

Forma grave da síndrome pulmonar e cardiovascular por hantavírus tratada com pressurização positiva através de máscara facial

Mariangela Pimentel Pincelli, Carlos Roberto Ribeiro de Carvalho, Luis Tadeu Moraes Figueiredo, Antônio Delfino de Oliveira Júnior, Ana Lúcia Bernardo Soares, Carmen Sílvia Valente Barbas

J Bras Pneumol.2004;30(3):264-269

Abstract PDF PT

In 1993 the first Brazilian cluster of Hantavirus Cardiopulmonary Syndrome (HCPS) was described in Juquitiba, SP. Since then, there have been descriptions of new cases specially on the southeast and south states of Brazil. Only in 2002 there were observed the first three cases of HCPS in our city: São Carlos. One of our patients was successfully supported with CPAP through facial mask. This is the first severe case of acute respiratory failure induced by Hantavirus that was successfully managed with this kind of respiratory strategy.


Keywords: Noninvasive Ventilation, CPAP, Hantavirus Pulmonary and Cardiovascular Syndrome, Acute Hipoxemic Respiratory Failure.


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


Immunophenotyping and gene rearrangement analysis in lymphoid/lymphoproliferative disorders of the lungs

Imunofenotipagem e rearranjo gênico em doenças pulmonares linfocíticas e linfoproliferativas

Camila Cristina Ishikawa, Alexandre Muxfeldt Ab'Saber, Edwin Roger Parra, Chin Jia Lin, Carmen Silvia Valente Barbas, Vera Luiza Capelozzi

J Bras Pneumol.2007;33(6):625-634

Abstract PDF PT PDF EN Portuguese Text

Incidence of fatal venous thromboembolism in antineutrophil cytoplasmic antibody-associated vasculitis

Incidência de tromboembolismo venoso fatal em vasculite associada a anticorpo anticitoplasma de neutrófilos

Alfredo Nicodemos Cruz Santana, Teresa Yae Takagaki, Carmen Silvia Valente Barbas

J Bras Pneumol.2011;37(3):409-411

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Acute lung injury and acute respiratory distress syndrome: diagnostic hurdles

Lesão pulmonar aguda e síndrome do desconforto respiratório agudo: dificuldades diagnósticas

Carmen Sílvia Valente Barbas

J Bras Pneumol.2007;33(4):25-26

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Predictive parameters for weaning from mechanical ventilation

Parâmetros preditivos para o desmame da ventilação mecânica

Sérgio Nogueira Nemer, Carmen Sílvia Valente Barbas

J Bras Pneumol.2011;37(5):669-679

Abstract PDF PT PDF EN Portuguese Text

The use of predictive parameters for weaning from mechanical ventilation is a rather polemic topic, and the results of studies on this topic are divergent. Regardless of the use of these predictive parameters, the spontaneous breathing trial (SBT) is recommended. The objective of the present study was to review the utility of predictive parameters for weaning in adults. To that end, we searched the Medline, LILACS, and PubMed databases in order to review articles published between 1991 and 2009, in English or in Portuguese, using the following search terms: weaning/desmame, extubation/extubação, and weaning indexes/indices de desmame. The use of clinical impression is an inexact means of predicting weaning outcomes. The most widely used weaning parameter is the RR/tidal volume (VT) ratio, although this parameter presents heterogeneous results in terms of accuracy. Other relevant parameters are MIP, airway occlusion pressure (P0.1), the P0.1/MIP ratio, RR, VT, minute volume, and the index based on compliance, RR, oxygenation, and MIP. An index created in Brazil, the integrative weaning index, has shown high accuracy. Although recommended, the SBT is inaccurate, approximately 15% of extubation failures going unidentified in SBTs. The main limitations of the weaning indexes are related to their use in specific populations, the cut-off points selected, and variations in the types of measurement. Since the SBT and the clinical impression are not 100% accurate, the weaning parameters can be useful, especially in situations in which the decision as to weaning is difficult.


Keywords: Weaning; Intensive care units; Ventilators, mechanical; Respiration, artificial.


Hantavirus pulmonary and cardiovascular syndrome

Síndrome pulmonar e cardiovascular por hantavírus

Mariangela Pimentel Pincelli, Carmen Sílvia Valente Barbas, Carlos Roberto Ribeiro de Carvalho, Luiza Terezinha Madia de Souza, Luís Tadeu Moraes Figueiredo

J Bras Pneumol.2003;29(5):309-324

Abstract PDF PT

Hantavirus pulmonary and cardiovascular syndrome is a recently identified and often fatal disease, which presents as acute respiratory distress syndrome (ARDS). Since the first outbreak, in Nov/Dec 1993, in Juquitiba, Brazil, 226 cases have been registered by FUNASA (National Health Foundation).(4) The disease occurs in previously healthy subjects, presenting with fever and symptoms similar to the common cold, and may rapidly evolve to pulmonary edema, respiratory failure and shock. Hemoconcentration and thrombocytopenia are common features, and the typical radiological finding is a bilateral diffuse interstitial infiltrate that evolves to alveolar consolidations in parallel to the worsening of the clinical condition. Initially, mortality was around 75%, but it declined to approximately 35% in the last few years. Patients who survive usually recover completely, about a week after the onset of the respiratory symptoms. The causal agent is a previously unrecognized hantavirus whose natural reservoirs are rodents of the family Muridae, sub-family Sigmodontinae. Specific antiviral treatment for hantavirus pulmonary and cardiovascular syndrome has not yet been well established, and the efficacy of ribavirin is currently being studied. Intensive care, including mechanical ventilation and invasive hemodynamic monitoring, is required for the more severe presentations of the disease. These measures may improve the prognosis and survival of patients with hantavirus pulmonary and cardiovascular syndrome if started early in the course of the disease.


Keywords: Hantavirus pulmonary syndrome/diagnoses. Hantavirus infections/diagnoses. Brazil.


Tracheobronchomalacia in a patient on invasive mechanical ventilation: the role of electrical impedance tomography in its detection and positive end-expiratory pressure titration

Traqueobroncomalácia em paciente sob ventilação mecânica invasiva: o papel da tomografia de impedância elétrica na sua detecção e na titulação da pressão expiratória final positiva

Olívia Meira Dias1, Eduardo Leite Vieira Costa2, Daniel Antunes Silva Pereira3, Caroline Nappi Chaves3, Samia Zahi Rached3, Carmen Silvia Valente Barbas2

J Bras Pneumol.2015;41(2):203-205

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Thrombosis in small and medium-sized pulmonary arteries in Wegener's granulomatosis: A confocal laser scanning microscopy study

Trombose em artérias pulmonares pequenas e médias em granulomatose de Wegener: Um estudo com microscopia confocal a laser

Alfredo Nicodemos Cruz Santana, Alexandre Muxfeldt Ab`Saber, Walcy Rosolio Teodoro, Vera Luiza Capelozzi, Carmen Silvia Valente Barbas

J Bras Pneumol.2010;36(6):724-730

Abstract PDF PT PDF EN Portuguese Text

Objective: Wegener's granulomatosis (WG) can cause endothelial cell damage and thromboembolic events. Nevertheless, there have been few studies on the pulmonary microcirculation-small and medium-sized pulmonary arteries (SMSPA)-in patients with WG. The objective of this study was to quantify fibrin thrombi in the SMSPA of patients with WG. Methods: We analyzed 24 SMSPA samples collected from six patients with WG and 16 SMSPA samples collected from four patients without WG. In all samples, we used the endothelial cell marker CD34 and confocal laser scanning microscopy in order to detect intravascular fibrin thrombi. We calculated the total vessel area, the free lumen area, and the thrombotic area. Results: The mean total vessel area was similar in the WG and control groups (32,604 µm2 vs. 32,970 µm2, p = 0.8793). Thrombi were present in 22 (91.67%) of the 24 WG group samples and in none of the control group samples (p < 0.0001; OR = 297; 95% CI: 13.34-6,612). The mean thrombotic area was greater in the WG group samples than in the control group samples (10,068 µm2 vs. 0.000 µm2; p < 0.0001). In contrast, the mean free lumen area was smaller in the WG group samples than in the control group samples (6,116 µm2 vs. 24,707 µm2; p < 0.0001). Conclusions: Confocal laser scanning microscopy revealed a significant association between pulmonary microvascular thrombosis and WG. This suggests a possible role of microvascular thrombosis in the pathophysiology of pulmonary WG, evoking the potential benefits of anticoagulation therapy in pulmonary WG. However, further studies are needed in order to confirm our findings, and randomized clinical trials should be conducted in order to test the role of anticoagulation therapy in the treatment of patients with pulmonary WG.


Keywords: Vasculitis; Antibodies, antineutrophil cytoplasmic; Wegener granulomatosis; Thrombosis; Lung; Microscopy, confocal.


A very rare cause of dyspnea with a unique presentation on a computed tomography scan of the chest: macrophage activation syndrome

Uma rara causa de dispnéia com apresentação singular na tomografia computadorizada de tórax: síndrome de ativação macrofágica

Rodrigo Antônio Brandão-Neto, Alfredo Nicodemos Cruz Santana, Debora Lucia Seguro Danilovic, Fabíola Del Carlo Bernardi, Carmen Silvia Valente Barbas, Berenice Bilharinho de Mendonça

J Bras Pneumol.2008;34(2):118-120

Abstract PDF PT PDF EN Portuguese Text

Macrophage activation syndrome is a rare and potentially life-threatening disease. It occurs due to immune dysregulation manifested as excessive macrophage proliferation, typically causing hepatosplenomegaly, pancytopenia and hepatic dysfunction. Here, we report an unusual case of macrophage activation syndrome presenting as dyspnea, as well as (reported here for the first time) high resolution computed tomography findings of an excavated nodule, diffuse ground glass opacities and consolidations (mimicking severe pneumonia or alveolar hemorrhage). The patient was successfully treated with human immunoglobulin. We recommend that macrophage activation syndrome be considered in the differential diagnosis of respiratory failure. Rapid diagnosis and treatment are essential to achieving favorable outcomes in patients with this syndrome.


Keywords: Macrophage activation; Lymphohistiocytosis, hemophagocytic; Tomography, X-ray computed; Lung diseases, interstitial.




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