Brazilian Journal of Pulmonology

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

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Year 2000 - Volume 26  - Number 2  (March/April)






Editorial

1 - AIDS e tuberculose: novo problema, velho problema

Margareth Pretti Dalcolmo

J Bras Pneumol.2000;26(2):3-4

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Original Article

2 - Impact of multiple biopsies in two different sites of the pleural surface for the diagnosis of tuberculosis

Impacto de múltiplas biópsias em dois pontos distintos da superfície pleural no diagnóstico de tuberculose

Marcelo Chalhoub, Ronald Fidelis, Ana Paula Barreto, Eduardo Ramos, Manoel Barral-Netto, Aryon Almeida Barbosa Jr.

J Bras Pneumol.2000;26(2):55-60

Abstract PDF PT Portuguese Text

For diagnostic purposes of pleural tuberculosis, three pleural fragments are routinely obtained from a single site by needle biopsy. The objective of this study is to compare the diagnostic yield of the routine procedure with two different approaches: harvesting five fragments on a single site (A), and collection of fragments at an additional site (B); from the same cutaneous orifice, the needle was partially removed up to the subcutaneous tissue and redirected at a 45o angle. The authors performed a prospective study in 115 patients submitted to pleural biopsy. The first three pleural fragments were placed in a vial (VA1-3), the 5 subsequent fragments obtained at the same site were placed in a second vial (VA4-8), and the five fragments from the second site were placed in a third vial (VB1-5). Analysis of fragments from VA1-3 revealed granuloma in 72/92 tuberculosis cases (78.3%), whereas in fragments VA5-8 and VB1-5, granuloma was observed in 74/92 cases (80.5%). In 6/92 patients the diagnosis at VA1-3 was non-specific pleuritis, but granuloma was found in VA4-8, resulting in a diagnosis increment of 8.3% (adding six to the 72 patients). In 7/92 patients (7.6%) the histopathological examination at site A led to a non-specific result but granuloma was found at site B, leading to a diagnostic increment of 9.0% (7 to 78 patients). Histological concordance of two examinations by the same pathologist had a kappa index of 0.62 (0.54 to 0.7) whereas concordance between two different pathologists had a kappa index of 0.64 (0.56 to 0.72). The performance of multiple biopsies at two different sites at the pleural surface led to an additional diagnosis of 13 patients, i.e., an increase of 18% (13 to 72) relative to the routine procedure. Considering the low cost increase of obtaining the fragments, adoption of this method is recommended in routine pleural tuberculosis diagnosis.

 


Keywords: Tuberculosis, pleural tuberculosis, biopsy, diagnosis.

 

3 - Pulmonary idiopathic fibrosis: clinical findings and survival in 132 histologically-proven patients

Fibrose pulmonar idiopática: características clínicas e sobrevida em 132 pacientes com comprovação histológica

Adalberto Sperb Rubin, José da Silva Moreira, Nelson da Silva Porto, Klaus Loureiro Irion, Rafael Franco Moreira, Bruno Scheidt

J Bras Pneumol.2000;26(2):61-68

Abstract PDF PT Portuguese Text

In order to evaluate the clinical findings and survival of pulmonary idiopathic fibrosis patients, 132 cases with histologically-proven biopsy were studied, coming from Pavilhão Pereira Filho Hospital, from 1970 to 1996. The diagnosis was made in 120 patients by open lung biopsy and in 12 cases by transbronchial lung biopsy. The average age was 56 years; 78 were male and only 6 were black. Smoking was observed in 61 cases. Mean duration of symptoms before diagnosis was 22.7 months. Digital clubbing was present in 75 patients and teleinspiratory crackles in 100. Dyspnea was observed in all but two patients and cough was present in 89 cases. Lung function test values were: FVC, 62%; FEV1, 70%; DLCO, 43.4%; TLC, 76.7%; PaO2, 67.3 mmHg; PaCO2, 39.1 mmHg and SaO2, 92.3%. Bronchoalveolar cellularity values were: macrophages, 83.8%; neutrophils, 9.1%; lymphocytes, 6.1% and eosinophils, 0.6%. In X-ray, honeycombing was present in 79 cases, reduced total lung capacity in 107 and intrathoracic tracheal widening in 50. In CT, the mean reticular pattern profusion was 42.3% and the mean granular pattern profusion was 43.6%. The usual histologic pattern was found in 128 cases, and the descamative pattern in only 4. Information about survival was found in 121 cases until December 1997. The mean survival rate of all patients was 28 months and for dead patients was 24 months. Patient characteristics in this study were associated with advanced stage of disease, which was confirmed by small survival rates of those cases. The strong predominance of usual pattern and better patient selection may have contributed to these results.

 


Keywords: Pulmonary fibrosis, interstitial lung disease, clinical symptoms; Survival analysis.

 

5 - Functional respiratory changes in laparoscopic cholecystectomy

Alterações funcionais respiratórias na colecistectomia por via laparoscópica

Luciana Dias Chiavegato, José Roberto Jardim, Sonia Maria Faresin, Yara Juliano

J Bras Pneumol.2000;26(2):69-76

Abstract Portuguese Text

Objective: The aim of this study was to measure the changes in lung volume, pulmonary ventilation, maximum respiratory muscle strength, and the incidence of pulmonary complications in patients undergoing elective laparoscopic cholecystectomy. Type of study: Prospective study. Material and methods: Twenty patients (7 men and 13 women) with mean age of 42.7 years with normal respiratory function were studied. All patients in the preoperative period answered a long questionnaire, had a physical examination done, and had their lung volumes, respiratory muscle strength, diaphragmatic index and pulse oximetry determined. All measurements were repeated on the 1st, 2nd, 3rd and 6th postoperative days. Results: Patients showed a significant decrease (p < 0.05) on the first postoperative day: 26% ± 13% in tidal volume; 20% ± 14% in minute volume; 36% ± 17% in vital capacity; 47% ± 17% in maximum inspiratory pressure, 39% ± 27% in the maximum expiratory pressure and 36% ± 25% in diaphragmatic index. Tidal volume, minute volume and maximum expiratory pressure returned to their basal values on the third postoperative day; vital capacity, maximum inspiratory pressure and diaphragmatic index returned to their basal values between the 4th and 6th postoperative days. Among the 20 patients pulmonary complication was observed in just one patient (lobar atelectasis); there was a full recovery by the third postoperative day with the use of chest physical therapy techniques. Conclusion: The authors conclude that patients undergoing a laparoscopic cholecystectomy show a significant decrease in lung volume and in respiratory muscle strength on the first postoperative day. But, when these measurements are compared to the literature, return to their basal values is faster (between the 4th and 6th postoperative days) than with conventional surgery.

 


Keywords: Laparoscopic surgery, preoperative and postoperative care and respiratory muscle strength.

 

Upgrading

6 - Pesquisa bibliográfica em ciências biomédicas

Enilze de Souza Nogueira Volpato

J Bras Pneumol.2000;26(2):77-80

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Review Article

7 - Respiratory health hazards in agricultural activities

Agravos respiratórios decorrentes da atividade agrícola

Carlos A.A. Viegas

J Bras Pneumol.2000;26(2):83-90

Abstract PDF PT Portuguese Text

Respiratory diseases are today an important clinical problem for agricultural workers since many studies have demonstrated a significantly increased risk of respiratory morbidity and mortality. This is also important as a public health problem, specially in many developing countries where over half of the work force is involved in agriculture. The rural workers have potential inhalatory exposure to a very wide range of agents like organic and inorganic dust, decomposition gases, pesticides, disinfectants, etc. The impact on the respiratory system varies considerably and may affect all the airways and the pulmonary interstitium and may be associated to rhinitis, asthma, asthma-like syndrome, chronic airway disease, organic dust toxic syndrome, hypersensitivity pneumonitis, and interstitial fibrosis.

 


Keywords: respiratory tract diseases; occupational diseases; agricultural worker's diseases; environmental exposure.

 

8 - Bronchial remodeling in asthma

Remodelamento brônquico na asma

Thais Mauad, Alessandra Sandrini Lopes de Souza, Paulo Hilário Nascimento Saldiva, Marisa Dolhnikoff4

J Bras Pneumol.2000;26(2):91-98

Abstract PDF PT Portuguese Text

The relationship between structure and function in asthma has been extensively studied. All the compartments of the airway have been shown to have some structural alterations contributing to functional defects. The structural alterations are thought to be a consequence of the chronic inflammation present in asthmatic airways, leading ultimately to remodeling. The decline of the ventilatory function over time in some asthmatic patients may be a consequence of airway remodeling. In this review, the authors describe the phenomena leading to airway remodeling and discuss the role of inflammatory mediators involved in this process. The structural alterations of the asthmatic airways are presented and the possible correlated functional defects are discussed.

 


Keywords: bronchii; pathology; asthma.

 

Case Report

9 - Intrabronchial leiomyoma: report of a case with seven years of tumor evolution

Leiomioma intrabrônquico: relato de um caso com sete anos de evolução

Paulo José Lorenzoni, Maria Ilizabeti Donatti, Paulo de Tarso Muller, Eliana Setti A. Aguiar, Pedro Nango Dobashi

J Bras Pneumol.2000;26(2):99-102

Abstract PDF PT Portuguese Text

The authors report a rare case of benign lung tumor, the INTRABRONCHIAL LEIOMYOMA, of a 33-year-old male patient. Diagnosis was performed by bronchoscopy with tumor biopsy, the tumor consisted largely of smooth muscle fibers. The option for treatment, after seven years of tumor evolution, was pneumonectomy.

 


Keywords: Leiomyoma; Bronchi, Lung neoplasm.

 

10 - Pulmonary and pleural paragonimiasis: report of two cases

Paragonimíase pulmonar e pleural: relato de dois casos

Teresa de Jesus Jhayya S., Miguel Angel Coloma S., Mónica Pérez V., Danilo Montaño E.

J Bras Pneumol.2000;26(2):103-106

Abstract PDF PT Portuguese Text

Paragonimiasis is a chronic infection caused by a trematode of the genus Paragonimus, the Paragonimus westermani being the one that most infects man. It is an endemic disease in East Asia, however, it is also seen in America. The authors report two cases of paragonimiasis, in which a patient showed a past history and clinical and radiological characteristics suggestive of this disease, diagnosed by the presence of eggs of P. westermani in the sputum, and another patient, a thoracic post-traumatism empyema whose paragonimiasis diagnosis was a histopathological finding in the pleura after a decortication. This diagnosis was confirmed by the presence of eggs of P. westermani in the sputum.

 


Keywords: paragonimiasis

 

Letters to the Editor

11 - O Brasil no "bonde da história da asma"

Márcia Alcântara Holanda

J Bras Pneumol.2000;26(2):19-21

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