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.

 


Bronchoscopy for the diagnosis of pulmonary tuberculosis in patients with negative sputum smear microscopy results

Broncoscopia no diagnóstico de tuberculose pulmonar em pacientes com baciloscopia de escarro negativa

Márcia Jacomelli, Priscila Regina Alves Araújo Silva, Ascedio Jose Rodrigues, Sergio Eduardo Demarzo, Márcia Seicento, Viviane Rossi Figueiredo

J Bras Pneumol.2012;38(2):167-173

Abstract PDF PT PDF EN Portuguese Text

Objective: To evaluate the diagnostic accuracy of bronchoscopy in patients with clinical or radiological suspicion of tuberculosis who were unable to produce sputum or with negative sputum smear microscopy results. Methods: A prospective cross-sectional study involving 286 patients under clinical or radiological suspicion of having pulmonary tuberculosis and submitted to bronchoscopy-BAL and transbronchial biopsy (TBB). The BAL specimens were submitted to direct testing and culture for AFB and fungi, whereas the TBB specimens were submitted to histopathological examination. Results: Of the 286 patients studied, 225 (79%) were diagnosed on the basis of bronchoscopic findings, as follows: pulmonary tuberculosis, in 127 (44%); nonspecific chronic inflammation, in 51 (18%); pneumocystis, fungal infections, or nocardiosis, in 20 (7%); bronchiolitis obliterans organizing pneumonia, alveolites, or pneumoconiosis, in 14 (5%); lung or metastatic neoplasms, in 7 (2%); and nontuberculous mycobacterium infections, in 6 (2%). For the diagnosis of tuberculosis, BAL showed a sensitivity and a specificity of 60% and 100%, respectively. Adding the TBB findings significantly increased this sensitivity (to 84%), as did adding the post-bronchoscopy sputum smear microscopy results (total sensitivity, 94%). Minor post-procedure complications occurred in 5.6% of the cases. Conclusions: Bronchoscopy is a reliable method for the diagnosis of pulmonary tuberculosis, with low complication rates. The combination of TBB and BAL increases the sensitivity of the method and facilitates the differential diagnosis with other diseases.

 


Keywords: Bronchoscopy; Tuberculosis, pulmonary; Sputum; Bronchoalveolar lavage; Biopsy.

 


Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions

Ecobroncoscopia radial para o diagnóstico de lesões pulmonares periféricas

Marcia Jacomelli, Sergio Eduardo Demarzo, Paulo Francisco Guerreiro Cardoso, Addy Lidvina Mejia Palomino, Viviane Rossi Figueiredo

J Bras Pneumol.2016;42(4):248-253

Abstract PDF PT PDF EN Portuguese Text

Objective: Conventional bronchoscopy has a low diagnostic yield for peripheral pulmonary lesions. Radial-probe EBUS employs a rotating ultrasound transducer at the end of a probe that is passed through the working channel of the bronchoscope. Radial-probe EBUS facilitates the localization of peripheral pulmonary nodules, thus increasing the diagnostic yield. The objective of this study was to present our initial experience using radial-probe EBUS in the diagnosis of peripheral pulmonary lesions at a tertiary hospital. Methods: We conducted a retrospective analysis of 54 patients who underwent radial-probe EBUS-guided bronchoscopy for the investigation of pulmonary nodules or masses between February of 2012 and September of 2013. Radial-probe EBUS was performed with a flexible 20-MHz probe, which was passed through the working channel of the bronchoscope and advanced through the bronchus to the target lesion. For localization of the lesion and for collection procedures (bronchial brushing, transbronchial needle aspiration, and transbronchial biopsy), we used fluoroscopy. Results: Radial-probe EBUS identified 39 nodules (mean diameter, 1.9 ± 0.7 cm) and 19 masses (mean diameter, 4.1 ± 0.9 cm). The overall sensitivity of the method was 66.7% (79.5% and 25.0%, respectively, for lesions that were visible and not visible by radial-probe EBUS). Among the lesions that were visible by radial-probe EBUS, the sensitivity was 91.7% for masses and 74.1% for nodules. The complications were pneumothorax (in 3.7%) and bronchial bleeding, which was controlled bronchoscopically (in 9.3%). Conclusions: Radial-probe EBUS shows a good safety profile, a low complication rate, and high sensitivity for the diagnosis of peripheral pulmonary lesions.

 


Keywords: Diagnostic techniques, respiratory system; Lung/ultrasonography; Bronchoscopy/methods; Bronchoscopy/instrumentation.

 


Erratum: Radial-probe EBUS for the diagnosis of peripheral pulmonary lesions.

Errata: Ecobroncoscopia radial para o diagnóstico de lesões pulmonares periféricas.

Marcia Jacomelli1, Sergio Eduardo Demarzo1, Paulo Francisco Guerreiro Cardoso2, Addy Lidvina Mejia Palomino1, Viviane Rossi Figueiredo1

J Bras Pneumol.2017;43(1):78-79

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Endobronchial ultrasound-guided transbronchial needle aspiration for lung cancer staging: early experience in Brazil

Punção aspirativa por agulha guiada por ultrassom endobrônquico no estadiamento do câncer de pulmão: experiência inicial no Brasil

Viviane Rossi Figueiredo, Paulo Francisco Guerreiro Cardoso, Márcia Jacomelli, Sérgio Eduardo Demarzo, Addy Lidvina Mejia Palomino, Ascédio José Rodrigues, Ricardo Mingarini Terra, Paulo Manoel Pego-Fernandes, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2015;41(1):23-30

Abstract PDF PT PDF EN Portuguese Text

Objective: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive, safe and accurate method for collecting samples from mediastinal and hilar lymph nodes. This study focused on the initial results obtained with EBUS-TBNA for lung cancer and lymph node staging at three teaching hospitals in Brazil. Methods: This was a retrospective analysis of patients diagnosed with lung cancer and submitted to EBUS-TBNA for mediastinal lymph node staging. The EBUS-TBNA procedures, which involved the use of an EBUS scope, an ultrasound processor, and a compatible, disposable 22 G needle, were performed while the patients were under general anesthesia. Results: Between January of 2011 and January of 2014, 149 patients underwent EBUS-TBNA for lymph node staging. The mean age was 66 ± 12 years, and 58% were male. A total of 407 lymph nodes were sampled by EBUS-TBNA. The most common types of lung neoplasm were adenocarcinoma (in 67%) and squamous cell carcinoma (in 24%). For lung cancer staging, EBUS-TBNA was found to have a sensitivity of 96%, a specificity of 100%, and a negative predictive value of 85%. Conclusions: We found EBUS-TBNA to be a safe and accurate method for lymph node staging in lung cancer patients.

 


Keywords: Lung neoplasms; Neoplasm staging; Bronchoscopy; Endoscopic ultrasound-guided fine needle aspiration; Lymph nodes.

 


Resolution of right-to-left shunt after primary pulmonary hypertension treatment with sildenafil

Resolução do "shunt" direita-esquerda após uso do sildenafil como tratamento de hipertensão pulmonar primária

Sérgio Marques da Silva, Carla Bastos Valeri, Humberto Bassit Bogossian, Carlos Jardim, Sérgio Eduardo Demarzo, Rogério Souza

J Bras Pneumol.2003;29(5):305-308

Abstract PDF PT

Primary pulmonary hypertension is a rare, progressive disease with high mortality rates. The treatment of primary pulmonary hypertension is still based on high-cost drugs, not yet available in developing countries. Recently, the use of sildenafil as an alternative drug for primary pulmonary hypertension treatment has been reported. It is reported a case of a 21 year-old female patient with primary pulmonary hypertension, who presented an acute worsening of symptoms and decrease of oxygen saturation. The investigation revealed the existence of a patent oval foramen not previously seen, with right-to-left shunt. Sildenafil treatment was instituted in escalating doses. After 40 days of treatment, the echocardiogram showed resolution of the shunt, concomitant to oxygenation improvement. The authors believe that sildenafil is a feasible alternative for primary pulmonary hypertension treatment, although larger clinical trials are necessary to determine its clinical safety and efficacy.

 


Keywords: Pulmonary hypertension/therapy. Vasodilator agents/administration & dosage.

 


Authors' reply

Resposta dos autores

Marcia Jacomelli1, Sergio Eduardo Demarzo1, Paulo Francisco Guerreiro Cardoso2, Addy Lidvina Mejia Palomino1, Viviane Rossi Figueiredo1

J Bras Pneumol.2017;43(1):77-77

PDF PT PDF EN Portuguese Text



 

 


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