Brazilian Journal of Pulmonology

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

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Year 2000 - Volume 26  - Number 3  (May/June)






Editorial

1 - Asmáticos brasileiros: o tratamento desejado

Márcia Alcântara Holanda

J Bras Pneumol.2000;26(3):7-9

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Original Article

2 - Phenotypic characterization of lymphocyte subsets in bronchoalveolar lavage of patients with silicosis

Caracterização imunofenotípica das subpopulações de linfócitos do lavado broncoalveolar de pacientes com silicose

Ângela Ferreira, Jose da Silva Moreira, Regina Caetano, José Manoel Gabetto, Thereza Quirico-Santos

J Bras Pneumol.2000;26(3):107-112

Abstract PDF PT Portuguese Text

Bronchoalveolar lavage is a safe and simple technique to evaluate lung disease related to exposure to mineral dusts. The aim of this study was to characterize the lymphocyte subsets in bronchoalveolar lavage of patients with silicosis. Bronchoalveolar lavage was carried out in 26 workers with different forms of silicosis: simple form (n = 12), complicated (n = 13) and 1 patient with acute form of the disease. As a control group, 7 healthy individuals were included. Compared to the control group, silicotic patients showed intense pleocytosis constituted mainly by alveolar macrophages with slight lymphocytosis. Lymphocyte subsets present in the bronchoalveolar fluid (BAL) of normal individuals were mature lymphocytes with phenotype CD2+TCRab (87.3%) and only 2.9% were CD2+TCRgd. CD4/CD8 ratio was 1.8 with few (16%) immature double negative T cells subsets (CD4-CD8-). In contrast, silicotic patients showed reduction of the more mature lymphocyte subset CD2+CD4+, CD2+CD8+ and a great increase (47%) of immature (CD4-CD8-) T cell subsets. No increase in the NK (CD56+) cell population was observed. Biochemical analysis of protein contents and determination of the Ig/albumin ratio characterized local immunoglobulin production within the pulmonary microenvironment. Furthermore, lack of increase of plasma cells, as well as the maintenance of the percentage of B lymphocyte population (CD19+) in the BAL of silicotic patients, favors the hypothesis that the cells responsible for Ig production are possibly located in the interstitial space. Altogether the results suggest development of lymphopoiesis and tertiary lymphoid tissue within the pulmonary microenvironment during the clinical course of silicosis.

 


Keywords: bronchoalveolar lavage, lymphocyte subsets, silicosis, immunophenotyping

 

3 - Surgical treatment of bullae for bullous emphysema: a simple drainage

Tratamento operatório de bolhas no enfisema bolhoso: uma simples drenagem

Roberto Saad Jr., Marcelo Domingues Mansano, Márcio Botter, Jacqueline Arantes Giannini, Vicente Dorgan Neto

J Bras Pneumol.2000;26(3):113-118

Abstract PDF PT Portuguese Text

Ten surgeries have been performed on 8 patients for the relief of symptoms due to bullous disease. Closed intubation drainage of the bullae was used in all patients under local anesthesia. The technique, initially devised by Monaldi for the treatment of intrapulmonary tuberculous abscesses was modified. Symptomatic improvement and total collapse of the bullae was reported by 9 of the 10 procedures. The technique described provides a simple method for decompressing bullae by means of a minimally invasive surgical procedure. It has proved a suitable approach for all but those with the poorest lung function and is now the author's treatment of choice. Techniques using intracavitary intubation have potential advantages: no lung tissue is removed, in addition, the limited incision and a local anesthesia needed for the procedure are better tolerated by patients with poor lung function.

 


Keywords: pulmonary emphysema; drainage; lung surgery

 

4 - Validation of the Saint George's Respiratory Questionnaire in patients with chronic obstructive pulmonary disease in Brazil

Validação do Questionário do Hospital Saint George na Doença Respiratória (SGRQ) em pacientes portadores de doença pulmonar obstrutiva crônica no Brasil

Thais Costa de Sousa, José Roberto Jardim, Paul Jones

J Bras Pneumol.2000;26(3):119-128

Abstract PDF PT Portuguese Text

Introduction: The term quality of life has gained increasing importance in the scientific context. This study describes the adaptation of a disease-specific questionnaire developed by Paul Jones et al. in 1991, the St. George's Respiratory Questionnaire (SGRQ), to the Brazilian language and culture. This questionnaire evaluates the quality of life in patients with chronic obstructive pulmonary disease (COPD) and contains three domains (symptoms, activity, and impacts) divided in 76 items. The questionnaire is self-administrated, but it may be read to illiterate persons. Goal: To verify if the St. George's Respiratory Questionnaire is a valid tool to measure quality of life in patients with chronic obstructive pulmonary disease in Brazil. Methods: In order to validate the questionnaire in Brazil, it was initially translated into Portuguese and afterwards a back-translation into English, that was compared to the original version. A final Portuguese version was then written. This final version was, then, answered by 30 clinically stable COPD patients, according to the spirometry and oximetry values. Patients answered the questionnaire twice, within a 15 day interval. The length of time the patients took to answer the questionnaire and their doubts were noted. Wilcoxon test was used for the calculation of r probability between every single question between the two days; interclass correlation ratio was calculated to test the trustworthiness and reliability of the questionnaire. Results: Among the 30 participant patients, 10 were female and 20 were male. Mean age was 65.9 years. Most of the patients were found to be in stage 2 (56.7 %) of COPD, according to the American Thoracic Society classification. The interclass correlation ratio for the total score of the questionnaire was a = 0.79 and Wilcoxon p = 0.2110 (not statistically significant). The mean answering time for the two days of interview was, respectively, 11 minutes and 50 seconds and 10 minutes and 31 seconds. As concerns the doubts about the questions, the patients reported difficulties in answering Sections 4 and 5, each one of these questions written in a negative form. Conclusion: It can be concluded that the Brazilian version of the St. George's Respiratory Questionnaire is a valid and reliable tool to measure quality of life in patients with COPD in Brazil.

 


Keywords: obstructive lung diseases, questionnaire, quality of life, reproducibility of results, evolution studies

 

Review Article

5 - Long-acting b2-agonists in chronic obstructive pulmonary disease (COPD)

b2-agonista de longa duração na doença pulmonar obstrutiva crônica (DPOC)

Luiz Eduardo Mendes Campos

J Bras Pneumol.2000;26(3):128-136

Abstract PDF PT Portuguese Text

Long-acting b2-agonists can produce the same level of bronchodilation as anticholinergic drugs in patients with COPD, but due to their lipophilicity, the action persists for 12 h after inhalation. Comparative studies between salmeterol and formoterol demonstrate an equivalent potency of salmeterol 50 mcg and formoterol 24 or 12 mcg when administered respectively by a metered dose inhaler or a turbuhaler. One must consider the inhaler in order to establish the equivalent potency between these two agents. Patients with COPD and associated cardiac diseases can use the long-acting b2-agonists safely. In this particular high-risk group of patients, salmeterol, a partial agonist, is considered safer than formoterol. A reassessment of the bronchodilator therapy in COPD might be considered. Tiotropium bromide is a new anticholinergic drug, the action of which prolongs for more than 1-3 days. It is the most promising new bronchodilator for COPD patients.

 


Keywords: COPD, long-acting b2-agonists, bronchodilators

 

Case Report

7 - Granulomatous foreign body reaction simulating chest wall tumor over previous thoracotomy site

Reação granulomatosa do tipo corpo estranho simulando tumor de parede torácica em cicatriz de toracotomia prévia

Amarílio Vieira de Macedo Neto, Alexandre Heitor Moreschi, Antonio Azambuja Neto, Daniela Fedrizzi

J Bras Pneumol.2000;26(3):139-141

Abstract PDF PT Portuguese Text

A male patient presented with a painless, slowly-growing chest wall mass in the site corresponding to the surgical wound of a previous thoracotomy for correction of aortic coarctation done fifteen years before. Chest CT scan showed tumor-like lesions with well-defined edges and osteolysis of the adjacent ribs. The patient was submitted to a chest wall resection and reconstruction, whose histological examination showed granular histiocytes and granulomatous reaction to necrohemorragic material. This is a rare event on medical practice. A review of the subject has been done in the literature.

 


Keywords: thoracic neoplasms; foreign body reaction; thoracotomy

 

8 - Congenital bronchial atresia: report of two cases. Contribution of CT scan to diagnosis

Atresia brônquica congênita: relato de dois casos. Contribuição da tomografia computadorizada ao diagnóstico

Alecsandra Calil Moyses Faure, Ana Paula Andrade Barreto, Carlos Alberto de Castro Pereira, Clystenes Odyr Soares Silva

J Bras Pneumol.2000;26(3):142-144

Abstract PDF PT Portuguese Text

Bronchial atresia is a rare, congenital anomaly characterized by the presence of bronchocele with distal hyperinflation. The authors report two cases of segmental bronchial atresia and describe the clinical and roentgenographic findings supporting the diagnosis in the absence of other invasive diagnostic modalities or surgical exploration.

 


Keywords: pulmonary atresia; bronchi; X-ray computed tomography

 

9 - Pancoast's syndrome caused by lymphoma

Síndrome de Pancoast causada por linfoma

Alla Dolganova, Ana Luíza Schneider Moreira, Marinês Barra, Jose da Silva Moreira

J Bras Pneumol.2000;26(3):145-148

Abstract PDF PT Portuguese Text

A rare case of Pancoast's syndrome caused by non-Hodgkin's lymphoma is reported. The diagnosis was made on the grounds of examination of the tissue obtained by pulmonary needle biopsy. The necessity of accurate histologic diagnosis and immunohistochemical study is emphasized.

 


Keywords: lymphoma; Pancoast's syndrome; lung neoplasms

 

10 - "Pneumocystis carinii" pneumonia: tumoral manifestation

Pneumonia por "Pneumocystis carinii": forma tumoral

Luiz Alberto Costa Barra, Eleni Aparecida Bedaque, Fabio Leoncio Bornstein Martinelli, Audrey Egypto Macedo, Renato Curti Jr., Ricardo Hanna

J Bras Pneumol.2000;26(3):149-152

Abstract PDF PT Portuguese Text

Pneumocystosis is an opportunistic infection that occurs frequently in immunodeficient patients, mainly in those with the acquired immunological deficiency (AIDS). The authors report the case of a patient with insidious symptoms of fever, cough, and weight loss. Thorax radiography revealed a tumoral image in the right costophrenic angle. Treatment for tuberculosis (therapeutic test) presented no response. An open lung biopsy was performed and the histological examination revealed Pneumocystis carinii pneumonia. The patient presented significant clinical and radiological improvement with specific treatment.

 


Keywords: pneumocystis carinii pneumonia; AIDS-related opportunistic infections

 

Upgrading

11 - Recomendações para a prevenção do tromboembolismo venoso

Comissão de Circulação Pulmonar da Sociedade Brasileira de Pneumologia e Tisiologia

J Bras Pneumol.2000;26(3):153-158

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