Brazilian Journal of Pulmonology

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


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Year 2000 - Volume 26  - Number 6  (November/December)

Original Article

1 - Evaluation of the histological parameters in usual interstitial pneumonia (idiopathic pulmonary fibrosis)

Avaliação de parâmetros histológicos na pneumonia intersticial usual (fibrose pulmonar idiopática)

Rimarcs Gomes Ferreira, Ester Nei Aparecida Martins Coletta, Osvaldo Giannotti Filho

J Bras Pneumol.2000;26(6):279-285

Abstract PDF PT Portuguese Text

Idiopathic pulmonary fibrosis (cryptogenic fibrosing alveolitis) is a progressive interstitia pulmonary disease of unknown etiology. Since Hamman's and Rich's (1944) reports, many studies have tried to find a histological marker for the correlation between prognosis and response to therapy. However, there are many doubts regarding pathogenesis. In addition, it is generally accepted that response to therapy is related to the relative degree of cellularity and fibrosis. The purpose of this study is to describe the results of inflammatory/exudative changes, fibrotic/reparative changes, and airway alterations, using a semi-quantitative method by independent evaluation of two pathologists, in 24 open lung biopsies with the diagnosis of idiopathic pulmonary fibrosis. Fourteen histological features were analyzed using the 0 to 5 scale for interstitial alterations and the 0 to 2 scale for the airway changes. There was significant interobserver agreement for all histological features with Kw (Kappa) variations between 0.47 and 0.92. There was significant disagreement only for septal inflammatory intensity analysis, suggesting that these features must be discussed by the pathologists. The semi-quantitative method assessment was effective.


Keywords: Idiopathic pulmonary fibrosis (IPF). Usual interstitial pneumonia (UIP). Semi-quantitative method assessment.


2 - A case-control study about indicators of non-compliance in patients with tuberculosis

Estudo caso-controle de indicadores de abandono em doentes com tuberculose

Sandra A. Ribeiro, Verônica M. Amado, Aquiles A. Camelier, Márcia M.A. Fernandes, Simone Schenkman

J Bras Pneumol.2000;26(6):291-296

Abstract PDF PT Portuguese Text

Non-compliance of tuberculosis treatment has social and epidemiological implications. Purpose: To compare characteristics of patients that were compliant (control group) and non-compliant with the treatment at the Health Care Center at the Federal University of São Paulo, Brazil, between 1995 and 1997, and to verify if patients who had joined in educational classes on tuberculosis had enhanced chances to a positive outcome after expiration of the six months of treatment. Method: The authors conducted a retrospective and controlled study with 100 patients (38 non-compliant and 62 compliant) registered for tuberculosis treatment in order to verify the variables related to non-compliance. Sixty patients (16 non-compliant and 44 compliant) had educational classes. Results: The risk factors most related to non-compliance were: male sex, cigarette smoking, alcohol and drug abuse, risk factors for HIV, and previous hospitalization. Patients who had attended educational classes had the same characteristics as all patients, but they had lower frequency of non-compliance (p < 0.05). Conclusion: The authors conclude that, if they had adequate access to means of diagnosis and follow-up for the treatment of tuberculosis, all extra efforts should be concentrated on avoiding non-compliance, mainly in patients with risk factors, as mentioned above. The patients at risk of non-compliance should have educational classes about their disease.


Keywords: Prevalence. Diagnosis-related groups.


Review Article

3 - Acute asthma in adults in the emergency room: clinical management in the first hour

Asma aguda em adultos na sala de emergência: o manejo clínico na primeira hora

Paulo de Tarso Roth Dalcin, Alan Castoldi Medeiros, Marcelo Kurz Siqueira, Felipe Mallmann, Mariane Lacerda, Marcelo Basso Gazzana, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2000;26(6):297-306

Abstract PDF PT Portuguese Text

Asthma is a disease with high prevalence in our country and around the world. Although new therapeutic approaches have been recently developed, there appears to be a worldwide increase in morbidity and mortality from asthma. In many institutions, asthma exacerbation is still a common medical emergency. Clinical evidence demonstrates that the first hour of management of acute asthma in the emergency room entails crucial decisions that could be determinant in the clinical outcome. In this non-systematic review, the authors focus on the first hour assessment and treatment of patients with acute asthma and outline an appropriate strategy for their management. Diagnosis, severity assessment, pharmacological treatment, complications, and the decision regarding the place where additional treatment will take place will be considered. It is reasonable to expect that these recommendations will help physicians make appropriate decisions about the first hour care of acute asthma in the emergency room.


Keywords: Asthma. Emergency medicine. Emergency treatment. Clinical procedures. Emergency medical services.


4 - Pleurodesis: future prospects

Pleurodese: perspectivas futuras

Francisco S. Vargas, Lisete R. Teixeira, Alípio O. Carmo, Evaldo Marchi, Marcelo Costa Vaz, Leila Antonangelo, Fábio B. Jatene

J Bras Pneumol.2000;26(6):307-312

Abstract PDF PT Portuguese Text

This article addresses the evolution of pleurodesis since the beginning of the 20th century and defines the characteristics of the ideal sclerosing agent. Emphasis is placed on the current tendency towards minimally invasive procedures where insertion of catheters is usually given priority over certain surgical procedures such as placement of drains or thoracoscopy. Among the sclerosing drugs, talc is the one preferred throughout the world. However, the possible appearance of respiratory distress syndrome, which is sometimes fatal, caused the awakening of interest in other drugs. Anti neoplastic drugs do not induce a very efficient pleurodesis and still have the disadvantage of causing important side effects. Sodium hydroxide and silver nitrate produce effective pleurodesis. Both can be used in humans.


Keywords: Pleurodesis. Sclerosing solutions. Clinical procedures.


Case Report

5 - Diffuse systemic sclerosis with isolated pulmonary hypertension: a case report

Esclerose sistêmica difusa com hipertensão pulmonar isolada: relato de caso

Silméia Garcia Zanati, Katashi Okoshi, Luiz Shiguero Matsubara, Roberto Minoru Tani Inoue, Marina Politi Okoshi

J Bras Pneumol.2000;26(6):313-316

Abstract PDF PT Portuguese Text

Systemic sclerosis (SS) is an uncommon disease characterized by small blood vessel vasculopathy and increased connective tissue in the skin and in other organs. The pulmonary involvement is common in SS; however, pulmonary hypertension without interstitial fibrosis is rare. The authors present a case of the diffuse form of SS with isolated pulmonary hypertension. The diagnosis of pulmonary hypertension was suggested by physical examination and confirmed by doppler-echocardiography which allowed for the estimation of the pulmonary artery systolic pressure in 80 mmHg. The authors started treatment with nifedipine; however, as the patient presented side effects, it was not possible to increase the dose beyond 30 mg/day. In this dosage, nifedipine did not decrease the pulmonary arterial pressure.


Keywords: Systemic scleroderma. Nifedipine. Pulmonary hypertension. Vasodilatador agents. Doppler echocardiography.


6 - Traumatic transpericardial diaphragmatic hernia: case report

Hérnia diafragmática traumática transpericárdica: relato de caso

Roberto Ruben Pando-Serrano, Antonio J. Ferreira Leal, Márcio R.A. Gomes, René Crepaldi Filho

J Bras Pneumol.2000;26(6):317-320

Abstract PDF PT Portuguese Text

The diagnosis and correction of a rare case of traumatic transpericardial diaphragmatic hernia is presented with spontaneous intraoperative reduction by the verification of the lesions of the left lateral wall of the pericardium, diaphragmatic pericardium, and the central tendon, with intact left hemidiaphragm. Only one such case has been published in the last thirty years.


Keywords: Transpericardial diaphragmatic hernia. Thoracic injuries


7 - Pulmonary hypertension: a report of six cases and updating review

Hipertensão pulmonar: relato de seis casos e atualização do tema

Sérgio Saldanha Menna Barreto, Marcelo Basso Gazzana

J Bras Pneumol.2000;26(6):321-336

Abstract PDF PT Portuguese Text

Pulmonary hypertension occurs when the pressure of the pulmonary artery is disproportionally high for a certain level of pulmonary blood flow. Values of mean pulmonary artery pressure of more than 25 mm Hg at rest or 30 mm Hg during exercise allow the diagnosis of pulmonary hypertension. Sustained or chronic pulmonary hypertension may be secondary to known diseases, mainly to those of cardiac or pulmonary nature, or may be a primary abnormality of the pulmonary circulation, with or without identification of associated conditions. Advances in the knowledge of the mechanisms of vasoconstriction and vascular remodeling have brought better prospects for the treatment of the disease. The correct use of vasodilators and anticoagulants, the new vasodilators, as epoprostenol and its analogs, and surgical techniques have increased the survival of many patients. Pneumologists can view cases of pulmonary hypertension as complications of pulmonary diseases or as a result of dyspnea investigation. Despite its etiology, pulmonary hypertension represents a clear abnormality that affects the right ventricle and can be potentially fatal to patients. Image methods have made the diagnosis of pulmonary hypertension more accessible and non-invasive. Six cases of patients with pulmonary hypertension of different causes are presented and discussed. In conclusion, according to new concepts, idiopathic pulmonary hypertension is no longer an irreversible condition, and the identification of associated conditions with potential treatments can be favorable in the management of the patients with pulmonary hypertension.


Keywords: pulmonary hypertension, vascular resistance, lung diseases, vasodilator agents


8 - Scimitar syndrome: case report with false diagnoses and adequate procedure

Síndrome da cimitarra: relato de caso com falsos diagnósticos e conduta adequada

Giesela Fleischer Ferrari, Cristina Costa Parreira, Samuel Marek Reibscheid, Antônio Sérgio Martins

J Bras Pneumol.2000;26(6):337-340

Abstract PDF PT Portuguese Text

Scimitar syndrome is rare, but knowledge about it is important to pediatricians and pneumologists. X-ray can suggest diagnosis, but the interpretation can be wrong. If a diagnosis is made, further anomalies must be investigated with echocardiography and angiography, even if he patient is asymptomatic. This child showed evidence of pulmonary hypertension and required surgery. Postoperative evolution was excellent.


Keywords: Scimitar syndrome. Surgery. Pulmonary disease (specialty). Diagnosis.


Guidelines SBPT

9 - Oxigenoterapia domiciliar prolongada (ODP)

Sociedade Brasileira de Pneumologia e Tisiologia

J Bras Pneumol.2000;26(6):341-350


Letters to the Editor

10 - Medicina baseada em evidências: quais os limites?

Edmilson Vieira Gaia Filho

J Bras Pneumol.2000;26(6):351-352



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