Brazilian Journal of Pulmonology

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

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Year 2000 - Volume 26  - Number 5  (September/October)






Original Article

1 - Comparative study of criteria for the diagnosis of tuberculosis in children seen in a health care center

Estudo comparativo de critérios para o diagnóstico de tuberculose em crianças atendidas em centro de saúde

Márcia Nogueira Carreira, Clemax Couto Sant'Anna

J Bras Pneumol.2000;26(5):219-226

Abstract PDF PT Portuguese Text

Setting: Considering the difficulty to establish diagnosis of tuberculosis in childhood, the authors studied three diagnostic criteria published in the literature in the last 20 years, evaluating their sensitivity, specificity, and accuracy. Material and methods: In a prospective study, 94 children at ages ranging from 0 to 15 years having contact with bacillary tuberculous adults were studied in the Municipal Health Center of Duque de Caxias, Rio de Janeiro. The following criteria were studied: Keneth Jones, described by Stegen et al.(1), World Health Organization(2) and Keith Edwards, described by Crofton et al.(3). Results: Among the criteria studied, those of Keith Edwards showed the best sensitivity and specificity, with 84% and 97%, respectively. WHO criterion showed a 100% specificity but zero sensitivity. Keneth Jones criterion showed 56% sensitivity and a 94% specificity. Conclusion: In poor areas, such as that of this study, where easy-to-handle operational methods are required, the criteria studied proved to be adequate to detect tuberculosis cases in children in contact with tuberculous adults. Those of Keith Edwards were the most useful although some changes are necessary for a better adaptation to Brazil.

 


Keywords: Tuberculosis, diagnosis. Child. Community health care centers.

 

2 - Prognostic factors in idiopathic pulmonary fibrosis

Fatores prognósticos em fibrose pulmonar idiopática

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

J Bras Pneumol.2000;26(5):227-234

Abstract PDF PT Portuguese Text

In order to evaluate which prognostic factors were significant to the survival of patients with idiopathic pulmonary fibrosis (IPF), 121 histologically confirmed cases of the disease were studied at the Pereira Filho Hospital from 1970 to 1996. All patients were submitted to a standard thorax X-ray and spirometry and answered a standardized questionnaire when admitted to hospital. They also underwent diffusion tests (34 cases), total lung capacity (28), blood gas analysis (106), bronchoalveolar lavage (39), rheumatoid analyses (45), and thoracic CT (24). For further analysis, the patients were classified into two groups: group A (2-year survival) with 55 patients, and group B (more than 5-year survival) with 24 patients; these features were also analyzed according to their significance to survival. Age, increased dyspnea index, long symptomatic period, FVC, DCO, PaO2 and SaO2 reduction, honeycombing intensity, and greater profusion of the reticular pattern on HRCT were considered indicative of worse prognosis. A reduced FEV1 and TLC were also associated with shorter survival. The use of those criteria which had shown statistical significance when evaluated together may determine a more accurate prognostic evaluation of IPF patients resulting in social and therapeutic benefits to patient management.

 


Keywords: Pulmonary fibrosis. Interstitial lung diseases. Prognosis. Prospective studies. Survival analysis.

 

3 - Repeated treatment of tuberculosis in the city of Recife, 1997: an epidemiological approach

O retratamento da tuberculose no município do Recife, 1997: uma abordagem epidemiológica

Hermira Maria Amorim Campos, Maria de Fátima Militão de Albuquerque, Antônio Roberto Leite Campelo, Wayner Souza, Ana M. Brito

J Bras Pneumol.2000;26(5):235-240

Abstract PDF PT Portuguese Text

Objectives: This study describes the epidemiological profile of cases of repeated treatment of tuberculosis occurring among residents of the city of Recife in the year of 1997. Material and methods: A cross-sectional study was performed and 240 cases of repeated treatment were studied, representing 16.2% of all cases of tuberculosis. Results: Interruption of previous treatment was the principal reason for repeated treatments (55.8%), followed by cases of recurrence of the disease (39.2%). Patients undergoing repeated treatment for tuberculosis are characterized as predominantly male, ages between 30 and 49, with little or no school education, with a significant predominance of pulmonary tuberculosis. It is striking that 42.7% of the cases of repeated treatment had a history of two or more previous courses of treatment. With regard to the outcome of the repeated treatment, 52.5% of the cases showed unfavorable results. Among these, 44.2% of the patients gave up the course of treatment and 39.6% followed it for the first month. The cases that returned for treatment following recurrence showed a higher percentage of successful outcomes (56.7%), in comparison to those that returned after interrupting previous treatment (40.2%), this difference being statistically significant (χ2 = 19,55; p < 0,01). It was found that, among the cases of pulmonary tuberculosis, 27.1% resumed chemotherapy without undergoing the Koch bacillus catarrh test and only 27.1% carried out BK culture with sensitivity test. Conclusions: The results show the need to enhance tuberculosis treatment and follow-up procedures within the sphere of the health care service. An adequate treatment is the cheapest method to avoid drug resistance and should be understood as a strategy to improve the tuberculosis surveillance system.

 


Keywords: Tuberculosis. Pulmonary tuberculosis. Repeated treatment.

 

4 - Traumatic late cardiac tamponade: analysis of five cases

Tamponamento cardíaco tardio traumático: análise de cinco casos

Fernando Luiz Westphal, Luiz Carlos de Lima, Badwan Abdel Jaber

J Bras Pneumol.2000;26(5):

Abstract PDF PT Portuguese Text

Five traumatic late cardiac tamponade cases were analyzed. All patients were male, mean age was 26.2, victims of thoracic penetrating stabbing wound in the precordial region, Ziedler area, admitted to a trauma reference center. They were classified by the Ivatury physiological index for cardiac trauma. The first treatment approach was intercostal pleurectomy and volemic resuscitation followed by hemodynamic and respiratory recovery. Patients with cardiac tamponade symptoms were re-admitted within an interval from eight to twenty four days (mean 20 days) in a thoracic surgery service of a tertiary reference hospital. Diagnostic exams confirmed thickening and pericardial effusion associated with a left pulmonary base entrapment in four of the cases which were treated by posterolateral thoracotomy, including partial pericardiectomy and pulmonary decortication. One patient was diagnosed with purulent pericarditis by supplementary exams and underwent a subxiphoid pericardial drainage. Postoperative cardiac arrhythmia occurred in one patient but the others did not develop any complications and there were no tamponade recurrent cases.

 


Keywords: Cardiac tamponade. Penetrating wounds. Thoracic injuries. Diagnosis.

 

5 - Environmental and epidemiological evaluation of workers of the fertilizer industry of Rio Grande, RS

Avaliação ambiental e epidemiológica do trabalhador da indústria de fertilizantes de Rio Grande, RS

Maura Dumont Hüttner, José da Silva Moreira

J Bras Pneumol.2000;26(5):245-253

Abstract PDF PT Portuguese Text

Occupational lung diseases represent an important and serious public health problem. In order to contribute to the knowledge of the risks associated with the exposure to fertilizer production an environmental and epidemiological cross-sectional study was performed among workers of this industry in Rio Grande, RS, Brazil. The ATS-DLD-78 questionnaire was applied, a thoracic radiological study was carried out, and the pulmonary function testing was evaluated through spirometry in 413 employees, 305 being the exposed group and 108 the non-exposed group. The exposed workers were all men, 74.1% had attended elementary school (at least some years), mean age was 38 (± 7.6) and mean time of exposure was 11.8 years (± 6.7). As to cigarette smoking, 126 (41.3%) were smokers, 76 (24.9%) former smokers, and 103 (33.8%) non-smokers. The exposed group was divided into four work sections according to the specific risks of their occupational exposure. The environmental evaluation showed the presence of free silica, gaseous fluorides, and gaseous ammonia in concentrations above the tolerance limits. Results of the exposed workers were: 30.5% of them answered positively to cough, 14.7% to chronic cough, 8.5% to chronic bronchitis, 43.3% to rhinitis, and 35.4% to conjunctivitis. The multivariate analysis, after adjustment for smoking, showed statistically significant association between exposure and cough as a whole, rhinitis and conjunctivitis. The thoracic radiological studies did not point to any considerable abnormality of pneumoconiosis in the exposed workers. Most of them presented normal pulmonary function testing, not different from the controls.

 


Keywords: Epidemiology. Lung diseases. Respiratory tract diseases. Occupational diseases. Fertilizer industry. Evaluation. Environment.

 

Review Article

6 - Indoor air quality, Act 3,523 of the Ministry of Health and Brazilian standards for biological indoor air contaminants

Ambientes climatizados, portaria 3.523 de 28/8/98 do Ministério da Saúde e padrões de qualidade do ar de interiores do Brasil

Paulo Pinto Gontijo Filho, Carlos Roberto Menezes Silva, Afrânio Lineu Kritski

J Bras Pneumol.2000;26(5):254-258

Abstract PDF PT Portuguese Text

This article reviews Act 3,523 of the Brazilian Ministry of Health which regulates the indoor air quality of air-conditioned environments, focusing mainly on biological standards for contaminant particles. Additionally, a concise analysis on nosocomial air-borne infections is performed, as well as on nosocomial units where air-borne infectious diseases may be important and a special ventilation system is required. Detailed analysis of the most common biological contaminant particles, differences between countries of both Northern and Southern hemispheres, and the aspects of the methodology used to perform their analysis are considered. The authors conclude that there are no established standards for safe levels of air-borne organisms, and that there is no available data in Brazil to set up standards for biological contaminant particles

 


Keywords: Air pollutants. Air conditioning. Air quality standards. Indoor air pollution. Brazil.

 

Case Report

7 - Pediatric sarcoidosis: case report

Sarcoidose pediátrica: relato de caso

Fabrício Piccoli Fortuna, Gilberto Bueno Fischer

J Bras Pneumol.2000;26(5):259-262

Abstract PDF PT Portuguese Text

The authors report a typical case of pediatric sarcoidosis presenting a granulomatous pulmonary disease with systemic impairment, reviewing clinical, diagnostic, and particular aspects of the disease in this age group, with emphasis on the difficulty to differentiate its diagnosis from that of tuberculosis.

 


Keywords: Sarcoidosis. Pulmonary sarcoidosis. Lung diseases.

 

8 - Spontaneous hemopneumothorax: a rare clinical entity

Hemopneumotórax espontâneo: uma rara entidade clínica

Márcia Thomson, Eduardo Sahão, João Carlos Thomson

J Bras Pneumol.2000;26(5):263-265

Abstract PDF PT Portuguese Text

Spontaneous hemopneumothorax with massive bleeding is considered a rare complication of spontaneous pneumothorax. The authors describe two patients with acute chest pain and dyspnea; the chest X-ray showed pneumothorax and pleural effusion. The two cases were submitted to thoracic drainage and presented important bleeding; thoracotomy was performed and in the first case an aberrant vessel was found, and in the second case the source of bleeding was rupture of pleural adherence. The post-operative evolution had no incidents in either case.

 


Keywords: Pneumothorax. Hemopneumothorax. Spontaneous rupture.

 

9 - Congenital lobar emphysema diagnosed in an adult patient

Enfisema lobar congênito diagnosticado em paciente adulta

Antônio S. Porto, Evandro M.S. Magalhães, Michele M. Coppini, Viviane P. Freitas

J Bras Pneumol.2000;26(5):266-268

Abstract PDF PT Portuguese Text

Congenital lobar emphysema is a disease in which symptoms often begin during the first six months of age. In this report, the authors present the case of a twenty-year-old woman whose symptoms started when she had a spontaneous pneumothorax, an exceptional occurrence. The possible etiologies for that congenital lung malformation and the reasons for the performance of a conservative treatment are discussed.

 


Keywords: Pulmonary emphysema. Pneumothorax. Abnormalities.

 

10 - Association of bronchogenic carcinoma with Pancoast's syndrome and acquired immunodeficiency syndrome

Associação de carcinoma broncogênico com síndrome de Pancoast e síndrome da imunodeficiência adquirida

A.C. Frohlich, D. Chiesa, M. Ronsani, L.A. Henn, S.S. Menna Barreto

J Bras Pneumol.2000;26(5):269-272

Abstract PDF PT Portuguese Text

A case of a patient with Pancoast's syndrome associated with acquired immunodeficiency syndrome is reported. This association is rare and Kaposi's sarcoma and non-Hodgkin lymphoma are the most recurrent tumors in AIDS. The patient was an IV drug user and was admitted to the hospital for diagnosis of apex lung mass with signs of Pancoast's syndrome. HIV serology was positive and pathology of lung mass showed non-small cell lung cancer.

 


Keywords: Pancoast's syndrome. HIV. Bronchogenic carcinoma. Lung neoplasms. Acquired immunodeficiency syndrome.

 

Letters to the Editor

13 - Metodologia de pesquisa da pneumonia adquirida na comunidade

Maria Bernadete Fernandes Chedid

J Bras Pneumol.2000;26(5):273-276

PDF PT


 


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