Brazilian Journal of Pulmonology

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

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Year 1999 - Volume 25  - Number 4  (July/August)






Editorial

1 - Pesquisar é inerente ao ser humano

Thais Helena A; Yhomaz Queluz

J Bras Pneumol.1999;25(4):3-4

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Original Article

2 - High resolution CT scan in the evaluation of alterations in small airways of patients with chronic bronchial suppuration

Tomografia computadorizada de alta resolução (TCAR) na avaliação de alterações nas pequenas vias aéreas de pacientes com supuração brônquica crônica

Mônica Corso Pereira, Ilma Aparecida Pascoal, José Ribeiro Menezes Netto

J Bras Pneumol.1999;25(4):189-197

Abstract PDF PT Portuguese Text

Imaging the airways has always been a difficult task. Since the introduction of high resolution computed tomography a lot has been achieved in this area, specially in the visualization of the small airways. With the fine details provided by this technique, morphological changes related to the bronchioles can now be detected in a way hitherto impossible. This study was aimed at the description of the CT scan signs of airway disease that were present in a group of 36 patients suffering from chronic respiratory symptoms of cough and great amount of sputum production (bronchial suppuration) attending the outpatient clinics of the Pulmonary Disease Service of the State University of Campinas School of Medicine. Among these patients, 12 were diagnosed as having cystic fibrosis, and 24, other diseases with chronic sputum production. The authors looked for the direct signs of airway disease, such as thickening of the wall and dilatation of the lumen of large airways and these same abnormalities, appearing as micronodules at the center of the lobule and branching linear opacities, or a combination of the two (the so-called "tree in bud" pattern), when the disease is predominantly located in the small airways, in the films obtained from all the patients. The indirect signs of small airway disease, like mosaic perfusion and air-trapping, were also analyzed. Imaging of the airways has come of age with the use of high-resolution computed tomography and there is little doubt that this technique is now the most sensitive radiographic method for imaging the small airways, this previously hidden area of the lungs.

 


Keywords: Computed tomography. High resolution computed tomography. Airway diseases. Bronchiolar diseases. Bronchiectasis.

 

3 - Tuberculosis: directly-observed treatment x autoadministered treatment. Outpatient experience in a philanthropic health center and review of the literature

Tuberculose: tratamento supervisionado "vs." tratamento auto-administrado. Experiência ambulatorial em instituição filantrópica e revisão da literatura

Nelson Morrone, Maria do Socorro Sandes Solha, Maria do Carmo Cruvinel, Nelson Morrone Jr., José Antonio dos Santos Freire, Zelita Lelis de Moraes Barbosa

J Bras Pneumol.1999;25(4):198-206

Abstract PDF PT Portuguese Text

Setting: Philanthropic health center specialized in lung diseases, including tuberculosis. Background: Directly-observed treatment (DOT) is the chief measure to insure improvement in cure levels and to reduce acquired resistance. This unit adopted DOT in the past, but financial difficulties prevent its maintenance. Objectives: Compare abandon levels in DOT and auto-administered treatment (AT) and identify predictive factors associated to abandonment. Type of study: Retrospective; patients observed in different years and selected at random. Material and methods: 1,226 patients were selected (613 patients in DOT and 613 in AT). Abandonment was compared in DOT and TA; in each group, abandonment was compared to sex, age, alcoholism, previous treatment, direction of symptoms, sputum and extension of the disease. Main results: Patients in DOT and in AT differ in some aspects. In AT, males, older age, positive sputum and more extensive disease were detected, previous treatment predominantly DOT. No difference was detected in relation to duration of symptoms, race, alcoholism and call up. Abandon was more frequent in AT (5.0% vs. 17.0%), p < 0.01, OR 3.90, CI 95% (2.50-5.88); one abandom in AT may be prevented by treating 8.4 patients in DOT. In AT, abandonment was related to male, black race, previous treatment, duration of symptoms, alcoholism and to age; duration of symptoms in DOT. Conclusion and proposal: 1) As abandonment is more common in AT, it is necessary to begin DOT immediately in structured units. 2) Cooperation with company medical facilities, community leaders and pharmacist will make it easier DOT adoption. 3) Punitive measures must be adopted for uncooperative patients.

 


Keywords: Tuberculosis. Abandonment. Directly-observed treatment (DOT).

 

4 - Bronchoscopy in the diagnosis of tuberculosis: their role of transbronchial biopsy in HIV-infected and in immunocompetent patients

Broncoscopia no diagnóstico de tuberculose: papel da biópsia transbrônquica em imunocompetentes e em HIV-positivos

Ricardo H. Bammann, Angelo Fernandez, Carla M.P. Vázquez, Maria Rita E. Araújo, Kátia R.M. Leite

J Bras Pneumol.1999;25(4):207-212

Abstract PDF PT Portuguese Text

Introduction: Bronchoscopy is useful in the diagnosis of tuberculosis suspects with a "negative" sputum smear. The objectives of this study were: to assess yield of bronchoalveolar lavage (BAL) and of transbronchial biopsy (TBB) both in HIV-positive patients (group 1) and immunocompetent individuals (group 2), based on simple and most available laboratory techniques in clinical practice. Patients and methods: The authors performed 319 bronchoscopies in 302 patients. BAL and TBB were sequentially performed in the same lung in all cases. Tuberculosis was diagnosed based on the results of acid-fast stains (AFS) from the lavage (ZN), culture for mycobacteria (LJ), and histological examination of biopsies (HE and ZN). Results: Tuberculosis was the final diagnosis in 28 exams of group 1 (n = 214) and in 35 of group 2 (n = 105). There were abnormal endoscopic findings respectively in 3 and 10 patients. In group 1, AFS were positive in 7 cases, culture of BAL in 14, and TBB in 19. In group 2, AFS were positive in 13 cases, culture in 17, and biopsies in 31. TBB results compared to BAL were in concordance for group 1 (p = 0.823) and different for group 2 (p = 0.022). Immediate results (AFS and TBB) compared to later positive results of culture were similar for group 1 (p = 0.066) but not for group 2 (p = 0.001). There were eight episodes of pneumothorax (2.5%) and one death (0.36%). Conclusions: Both BAL and TBB should be performed whenever possible, aiming towards a higher yield of bronchoscopy in the diagnosis of tuberculosis. Both methods complement each other in immunocompetent patients, whereas TBB establishes a faster diagnosis for HIV-infected patients if associated to AFS.

 


Keywords: Bronchoscopy/methods. Smear-negative tuberculosis/diagnosis. Opportunistic infections related to AIDS/diagnosis.

 

Case Report

6 - Carcinoid tumor: bronchotomy as a technical alternative

Tumor carcinóide: broncotomia como alternativa técnica

Paulo M. Pêgo Fernandes, Luís Gustavo S.I. Castilho, Marcelo G. Gregório, Fábio B. Jatene

J Bras Pneumol.1999;25(4):225-228

Abstract PDF PT Portuguese Text

The treatment of typical carcinoid tumors in bronchus is usually done by a small pulmonary resection with or without bronchoplasty. The authors report the case of a patient with typical carcinoid tumor in the left lower lobar bronchus, next to the lobar carina. They performed a longitudinal bronchotomy, tumor resection, and suture of the bronchus, preserving the lung tissue. The patient is currently well, three years after surgery, without any evidence of recurrence in the bronchoscopic control.

 


Keywords: Bronchial carcinoid tumor. Bronchoplasty. Bronchotomy. Lung tissue. Surgery.

 

7 - Pulmonary tuberculosis and optical neuritis: a new association or a variation of Devic's syndrome?

Tuberculose pulmonar e neurite óptica: uma nova associação ou uma variante da síndrome de Devic?

Lucélia de Azevedo Henn, Carlos Henrique François, Ângela Beatriz John

J Bras Pneumol.1999;25(4):229-231

Abstract PDF PT Portuguese Text

Sporadic cases of patients with neuromyelitis (Devic's syndrome) in association with tuberculosis restricted to the lungs have come out in recent years. The case of a patient with sudden visual loss and a further diagnosis of optic neuritis and pulmonary tuberculosis is reported. Based on the description of this case, the possible relationship between these two pathologies and their implications are discussed.

 


Keywords: Tuberculosis. Optical neuritis. Devic's syndrome.

 

Upgrading

8 - Bronchiole pathology

Patologia bronquiolar

Vera Luiza Capelozzi

J Bras Pneumol.1999;25(4):232-239

Abstract PDF PT Portuguese Text

Bronchiolitis or bronchiolitis obliterans are general terms used to describe a non-specific inflammatory injury that affects primarily the small airways, frequently not involving the pulmonary interstitium. Usually the terms utilized to categorize bronchiolitis are confused because they describe the clinical syndrome and also the histopathologic abnormalities. Unfortunately, most of the literature about bronchiolitis is based on isolated or small series. Additionally, there are many questions about epidemiology, pathophysiology, and treatment of bronchiolitis. The aim of this paper is to give a general view about the issue based on histopathologic features with the purpose of better understanding the clinical syndrome.

 


 


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