Brazilian Journal of Pulmonology

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

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Year 1998 - Volume 24  - Number 3  (May/June)






In Memoriam

1 - Presença de Newton Bethlem

Margareth Pretti Dalcolmo

J Bras Pneumol.1998;24(3):5-

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2 - Mozart Tavares de Lima Filho - 1916-1998

Fernando Augusto Fiuza de Melo

J Bras Pneumol.1998;24(3):6-

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Editorial

3 - A cirurgia redutora do volume pulmonar no Brasil

Ricardo Beyruti

J Bras Pneumol.1998;24(3):109-111

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Original Article

4 - Bronchoalveolar lavage versus transbronchial biopsy in patients infected with the human immunodeficiency virus: comparative analysis of 287 examinations

Lavado broncoalveolar "versus" biópsia transbrônquica em pacientes HIV-positivos: análise comparativa de 287 exames

Ricardo H. Bammann, Angelo Fernandez, Carla M.P. Vázquez, Altamiro R. Dias

J Bras Pneumol.1998;24(3):112-118

Abstract PDF PT Portuguese Text

A total of 287 bronchoscopies were performed in 267 patients infected with the human immunodeficiency virus (HIV). Bronchoalveolar lavage (BAL) and transbronchial biopsies (TBB) were sequentially performed in the same lung, in all cases. Specimens were examined after routine laboratory procedures for microbiologic and histologic analysis. Age ranged from 16 to 78 (median 37.2); 228 were men (85.4%) and 39 were women. Dyspnea was the main symptom in 198 cases (69.0%) and interstitial infiltrates (diffuse or localized) were the most common findings at chest radiographs (179 patients, 62.4%). Endoscopic view was normal in 246 patients (85.7%). Mucosal lesions suggestive of Kaposi's sarcoma (KS) were visible in 12 cases (4.2%). BAL detected 97 infectious agents, simultaneous co-infection occurred in 3 cases. TBB identified 165 pathogens (9 of them in association), anticipating a better yield than BAL in the diagnosis of P. carinii (84 versus 51, respectively) and cytomegalovirus (35 v. 0). Biopsies were unique in establishing the appropriate diagnosis of extrabronchial cancer and describing inespecific pneumonitis. Altogether, a definite diagnosis was obtained by bronchoscopic examination (including endoscopic view, BAL and TBB) in 271 of 287 cases (94.4%). Infections were caused by P. carinii in 105 patients (36.6%), Mycobacterium sp in 40 (13.9%), cytomegalovirus in 35 (12.2%), C. neoformans in 13 (4.5%) etc. Malignancies (including KS) were found in 16 patients (5.6%). More than one pathologic process was present in 28 (9.8%). Nonspecific pneumonitis was diagnosed in 56 cases (19.5%) and normal lung in 20 (7.0%). Complications related to bronchoscopy were pneumothorax (8 patients, 2.8%), haemorrhage (8), thoracic pain (2) and distal pneumonia (2). Chest tubes were required in 4 patients, including one fatal case (mortality rate of 0.3%). Combining BAL and TBB results increases the diagnostic yield of bronchoscopy in AIDS, with a low complication rate. If both techniques are performed, a higher number of infectious agents and more multiple causes of pulmonary disease may be identified.

 


Keywords: Bronchoscopy/methods. Acquired Immunodeficiency Syndrome/complications. Opportunistic infections related to AIDS/diagnosis.

 

5 - Weaning from mechanical ventilation: comparison of three methods

Desmame da ventilação mecânica: comparação de três métodos

José Raimundo A. de Azevedo, Cecilma Miranda de S. Teixeira, Kivania Carla Pessoa

J Bras Pneumol.1998;24(3):119-124

Abstract PDF PT Portuguese Text

Studies published by Brochard et al. and by Esteban et al. came to different conclusions about the best technique of weaning from mechanical ventilation. Although the association of synchronized intermittent mandatory ventilation (SIMV) with pressure support ventilation (PSV) is frequently used and considered as a physiologic form of weaning, no prospective randomized study compared this technique to synchronized intermittent mandatory ventilation or to pressure support ventilation used singly. The authors compared these three weaning methods to determine the one that is associated with the shortest weaning time and the smallest frequency of unfavorable outcome. Methods: The authors analyzed prospectively 72 consecutive patients submitted to mechanical ventilation for at least 24 hours and that had clinical, gasometric, and respiratory criteria for weaning. The patients were randomized in three groups (SIMV, PSV, SIMV+PSV). Stringent criteria were used in the application of each technique to define success or failure of the procedure. Results: The groups (SIMV = 21, PSV = 25 and SIMV+PSV = 26 patients) were similar with respect to age, score APACHE III and diseases. Mean duration of weaning was 1.7 ± 1.2 days with SIMV, 2.5 ± 1.6 days with PSV, and 2.1 ± 1.5 days with SIMV+PSV. Four (19.0 %) patients failled to wean in the SIMV group, nine (36.0%) in PSV and two (7.7%) in SIMV+PSV. Conclusions: This study shows a good performance of SIMV+PSV for weaning patients from mechanical ventilation and unfavorable results with support ventilation that can not be attributed to homogeneity between the groups, nor to the methodologies or equipments used.

 


Keywords: Weaning. Synchronized intermittent mandatory ventilation. Pressure support ventilation.

 

6 - Brazilian Society of Tisiology and Pulmonary Medicine Board Examination: factors related to approval

Prova do título de especialista em Pneumologia: fatores associados à aprovação

Daniel Deheinzelin, Luís Fernando Pereira, Jorge Nakatani

J Bras Pneumol.1998;24(3):125-128

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Objectives: Evaluate the results of the Brazilian Society of Tisiology and Pulmonary Medicine Board Examination and verify the factors related to acceptance. Planning: Retrospective analysis comparing scores obtained in practical and written examinations and acceptance to gender, years since graduation, years of pulmonary medicine practice, regional and national meetings attendance, place, and duration, as well as having or not attended residence or training programs. Population: Between 1992 and 1996, 199 candidates - 81 females and 108 males - took the board examination. Results: In this period, 54.3% of the candidates were approved. Mean written score was 6.27 ± 0.95 for the approved candidates and 4.30 ± 0.76 for those who were not approved (p = 0.0001, t test). Mean practical score was 7.18 ± 0.92 versus 5.17 ± 1.38 (p = 0.001). The overall mean of the written score was significantly lower than that of the practical score (53.78 ± 13.16 x 62.62 ± 15.32, p < 0.001). Univariate analysis showed that the approved group had fewer years since graduation (p = 0.001), fewer years of pulmonary medicine practice (p = 0.01); lower training attendance for a shorter period (p = 0.01), and a higher frequency of residence attendance for a longer period (p < 0.001) in the approved group. Logistic regression showed that residence (p = 0.002) and place of residence (p = 0.006) were the only predictive factors for approval. Multiple linear regression showed that only residence (coefficient 2.26, p = 0.016), place of residence (4.43, p = 0.002), and training (-1.97, p = 0.047) predicted the overall board score. Conclusion: The efficacy of the board exmination is hereby proven, since it accepts candidates with better medical background (residence). Some medical education methods, such as years of practice, meeting and training attendance need to be revised, since they do not determine approval.

 


Keywords: Medical education. Residence. Board certificate.

 

7 - The confusing Brazilian pulmonary auscultation nomenclature

A confusa nomenclatura da ausculta pulmonar brasileira

Mariam Patrícia Auada, Gisele Laguna Vitória, João Adriano de Barros

J Bras Pneumol.1998;24(3):129-132

Abstract PDF PT Portuguese Text

After the invention of the stethoscope by Laënnec in 1816, the nomenclature for lung sounds was spread without following a specific structure, becoming confusing and lacking precision. Since 1985 a great effort has been made to reach a terminology standardization, based on physical patterns such as frequency, duration, and amplitude. The evaluation of the terminology employed by Brazilian pneumologists in reported cases is the object of this study. A retrospective study of reported cases published in Jornal de Pneumologia has been performed between 1985 and 1997, regarding the pulmonary auscultation described. The data were compared to those proposed by the Symposium on Lung Sounds, in 1985. Out of 131 cases, 72 reported altered pulmonary auscultation, presenting 30 distinctive denominations for lung sounds. It is, therefore, easy to notice that pneumologists are not yet familiar with the current nomenclature. It is important to highlight that 31 cases did not report pulmonary auscultation even in a pneumology publication, which serves to show the underestimation of the method. Pulmonary auscultation is a quick, non-invasive, low-cost, and great clinical guiding means which must be recognized among other techniques applied for diagnosis.

 


Keywords: Auscultation. Stethoscope. Respiratory sounds. Nomenclature.

 

Review Article

8 - Como administrar drogas por via inalatória na asma

Luiz Fernando F. Pereira

J Bras Pneumol.1998;24(3):133-144

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Case Report

10 - Dispnéia crônica, distúrbio restritivo e tomografia computadorizada de tórax de alta resolução normal em paciente de 74 anos

Alessandra Sandrini Lopes de Souza, Georgino Henderson Pereira Lemos, Raquel Hermes Rosa Oliveira, Carlos Alberto de C. Pereira, Ester N.A.M. Coletta

J Bras Pneumol.1998;24(3):153-156

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12 - Spontaneous diaphragm rupture to the right

Ruptura espontânea do diafragma à direita

Adilson Casemiro Pires, Wladmir Faustino Saporito

J Bras Pneumol.1998;24(3):157-158

Abstract PDF PT Portuguese Text

Diaphragm rupture is generally associated with severe trauma. Spontaneous diaphragm rupture is rare, seldom reported, and does not have a clear etiology. In this report the authors show a case of spontaneous diaphragm rupture which took place during hospitalization.

 


Keywords: Diaphragm rupture. Spontaneous diaphragm rupture.

 

13 - Interstitial lung disease after idiopathic diffuse proliferation of neuroendocrine cells (tumorlets carcinoids)

Pneumopatia intersticial secundária à proliferação difusa idiopática de células neuroendócrinas ("tumorlets carcinoids)

Marcelo Cunha Fatureto, Marcus Aurelho de Lima, Gesner Pereira Lopes, Wilson Carneiro Silva Junior, Maysa Silva Arruda, Ricardo Frota Boggio

J Bras Pneumol.1998;24(3):159-162

Abstract PDF PT Portuguese Text

A 35 year-old black woman, previously healthy, who complained about chronic cough and shortness of breath was investigated after non-response of symptoms. Her chest X-ray and high resolution chest CT-scan were normal. She presented with abnormal spirometry, a mild restrictive disturbance. After a negative initial clinical investigation, an open lung biopsy was indicated. Multiple microscopic peribronchiolar tumorlets carcinoids - neuroendocrine cell hyperplasia was revealed. The authors emphasize the importance of an early diagnosis of this unusual entity and discuss its possible pathophysiological mechanisms.

 


Keywords: Lung diseases. Neuroendocrine cell. Bronchiolitis. Carcinoid. Tumorlets.

 

14 - Fibrosing mediastinitis

Mediastinite fibrosante

Jefferson Lessa Soares de Macedo, Manoel Ximenes Netto

J Bras Pneumol.1998;24(3):163-166

Abstract PDF PT Portuguese Text

Fibrosing mediastinitis is an uncommon disease associated with a multiplicity of clinical syndromes. The pathophysiology of this disease is predicated on the encasement of the mediastinal vital organ structures within a dense fibrotic tumor. This tumor appears to emanate from an invasive chronic inflammatory process causing erosion and external compression of these structures. Two cases of this disease are reported: one case of superior vena cava syndrome and one case of esophageal obstruction which evolved satisfactorily with conservative treatment.

 


Keywords: Sclerosing mediastinitis. Fibrosing mediastinitis. Superior vena cava syndrome.

 

15 - Non-surgical treatment of descending necrotizing mediastinitis

Tratamento conservador de mediastinite necrotizante descendente

Jefferson Lessa Soares de Macedo, Manoel Ximenes Netto

J Bras Pneumol.1998;24(3):167-170

Abstract PDF PT Portuguese Text

A rare case of descending necrotizing mediastinitis secondary to a non-traumatic submandibular abscess is reported. Although most reports emphasize surgical treatment as indispensable in this disease, this case had an excellent outcome using only intensive care. Thus, even complicated descending necrotizing mediastinitis can be treated by non-surgical procedures.

 


Keywords: Mediastinitis. Sepsis.

 

 


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