Brazilian Journal of Pulmonology

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

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Year 2001 - Volume 27  - Number 3  (May/June)






Editorial

1 - Jornal de Pneumologia

Luiz Carlos Corrêa da Silva

J Bras Pneumol.2001;27(3):5-

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Original Article

2 - Reasons for the admission, length of stay and type of discharge in tuberculosis hospitals in the State of São Paulo, Brazil - 1981 to 1995

Motivos e tempo de internação e o tipo de saída em hospitais de tuberculose do Estado de São Paulo, Brasil - 1981 a 1995

Péricles Alves Nogueira

J Bras Pneumol.2001;27(3):123-129

Abstract PDF PT Portuguese Text

Introduction: Since 1981 the State Health Office has taken over the treatment and hospitalization of all tuberculosis cases in the State of São Paulo, southeastern Brazil. A decrease in both the incidence and the percentage of admissions due to tuberculosis has been observed during this period. Objective: To analyze the evolution of the reasons that led tuberculosis patients to hospitalization and correlate these reasons with hospitalization length and the type of discharge. Material and methods: A sample of 1,805 patients' records compiled between 1981 and 1995 at five tuberculosis hospitals in the State of São Paulo was reviewed. Results: The main reason for admission was general poor health, followed by cachexy. Increasing alcoholism was also observed. Among those who stayed in hospital for less than one week, the most frequent reasons for hospitalization were "other pathologies" and "respiratory insufficiency". These cases also showed the shortest average hospitalization length whereas the longest was presented by the patients admitted for social reasons and treatment failure. The patients with respiratory insufficiency presented the highest rate of dropouts and death. The highest rate of requested discharge was observed among the patients admitted due to drug intolerance whereas those admitted due to social reasons and alcoholism showed the highest rate of disciplinary release. The hospital that admitted females was the one with the highest rate of requested release, whereas in the hospitals that admitted males disciplinary release and dropouts were the most frequent types of discharge.

 


Keywords: Pulmonary tuberculosis. Length of stay. Health services research. Specialized hospitals. Patient discharge.

 

3 - Spirometry evolution assessment of cystic fibrosis

Avaliação evolutiva da espirometria na fibrose cística

Elenara da Fonseca Andrade, Deisi Letícia Oliveira da Fonseca, Fernando Antônio de Abreu e Silva, Sérgio Saldanha Menna-Barreto

J Bras Pneumol.2001;27(3):130-136

Abstract PDF PT Portuguese Text

Objectives: To evaluate the evolution pattern of dynamic pulmonary flow and volume in cystic fibrosis patients and analyze the relation between the severity of ventilatory attacks and age, gender, genotype and pulmonary colonization. Methods: At the Pediatric Pulmonary Unit and Pulmonary Service of Hospital de Clínicas of Porto Alegre, 243 spirometries performed between 1987 and 1999 in 52 cystic fibrosis patients older than four years of age were reviewed. From the patients' medical records the following informations were extracted: age at diagnosis, genetic data, bronchial colonization and absolute as well as percent values of the flows and volumes of the best annual spirometry. Results: The age of the patients ranged from four to 26 years (mean = 13.04 ± 4.82). Out of the 52 patients, 49 (94%) had at least one sputum culture with P. aeruginosa, 45 (86%) with S. aureus and 13 (25%) with B. cepacia. At initial evaluation, that included patients four to six years old (n = 40), mean values for FVC and FEV1 were 114.24% and 112.25%, respectively. Mean FVC remained above baseline until 18 years of age, when it abruptly dropped to 67.2% (p = 0.0002). Mean FEV1 values dropped to less than 80% at ten years and was 50% at 18 years (p < 0.00001). The FEV1/FVC% relationship, the most obstruction sensitive index, was observed to be reduced as early as initial evaluation. It was 85% between four and six years and gradually decreased to 63% at 18 years. The mean values of FEF50, FEF75 and FMEF were initially normal (94%, 80% and 90%, respectively), showed a greater and earlier statistically significant decline, and reached to 37%, 12.5% and 19%, respectively, at 18 years. Although a tendency to lower terminal flow was seen in the girls, the differences were not statistically significant. Significant correlations between pulmonary function and the airway colonizator or genotype were not detected statistic. Conclusion: The evolution pattern of pulmonary function alterations found in these patients is consistent with those reported in the literature, where obstructive ventilatory disorders with early terminal flow reduction and late FVC onset predominate.

 


Keywords: Spirometry. Cystic fibrosis. Pulmonary ventilatory.

 

4 - Cardiorespiratory response to incremental progressive maximal exercise in asthmatic patients

Resposta cardiorrespiratória na asma induzida pelo exercício máximo com incrementos progressivos

Ruy Amazonas Lamar Filho, Antonio Augusto Soares da Fonseca, Maria Alice Melo Neves, Laércio Moreira Valença

J Bras Pneumol.2001;27(3):137-142

Abstract PDF PT Portuguese Text

Objective: To determine the occurrence of exercise-induced bronchoconstriction and analyze cardiorespiratory response during maximal exercise in asthmatic patients. Patients and methods: Fourteen subjects with asthma (FEV1 of 86.3% predicted), as defined by the American Thoracic Society criteria were submitted to a maximal exercise test. Volume-flow curves were performed prior to progressive maximal exercise and seven and 15 minutes after it. Six patients (43%) showed a decline in FEV1 equal or greater than 15% after exercise (group I). The remaining patients constituted group II. Group I showed a FEV1 fall of 40.9% and 26.7%, seven and 15 minutes after exercise, respectively. In group II, there was a decrease of 2.6%, after 7 min and an increase of 1.2% after 15 min. At peak exercise, both groups reached heart rate above 91% of reference values; peak work was 82.7% and 62.5%, VO2max (mL/kg/min) 93.5% and 58,9% and VEmax 91.5% and 63.8%, respectively, in groups I and II. These differences were statistically significant. The correlation between the FEV1 fall rate (7 min post-exercise) and VEmax (% predicted) has showed a coefficient r = 0.8989 in group I and r = 0.3629 in group II. There was no correlation between delta VEF1 and VO2max (% predicted) in both groups. These findings showed that, in exercise-induced asthma patients, the occurrence of bronchoconstriction correlated with the level of maximal ventilation, but not with physical fitness.

 


Keywords: Exercise induced asthma. Bronchoconstriction. Tidal volume. Respiratory function tests.

 

5 - Endoscopic diagnosis of stridor in childhood

Diagnóstico endoscópico de estridor na infância

Vítor Emanuel Cassol

J Bras Pneumol.2001;27(3):143-147

Abstract PDF PT Portuguese Text

Objective: To determine the main endoscopic diagnoses identified in children presenting stridor, at the Pediatric Unit of the General University Hospital of Santa Maria, Rio Grande do Sul, Southern Brazil. Methods: This is a cross sectional, uncontrolled, descriptive study. Data were obtained from the records of 56 consecutive patients submitted to bronchoscopy due to stridor; from March/93 to November/99. Results: Fifty-six bronchoscopies were performed and 59 lesions compatible with the diagnosis of stridor were observed. Patients were predominantly males (63%). Congenital anomalies and acquired lesions were observed in 45% and 50% of the cases, respectively. The remaining 5% of the cases were normal. Laryngomalacia, subglottic stenosis, tracheobronchomalacia and laryngeal edema were the most common diagnoses. Conclusions: The investigation of the respiratory tree by endoscopy is important for the correct diagnosis of children with stridor. Congenital or acquired diseases were similarly frequent as the cause of stridor. The endoscopic procedure was very valuable and yielded a high diagnostic rate.

 


Keywords: Thoracoscopy. Diagnosis. Respiratory sounds.

 

6 - Home oxygen therapy in children: seven years experience

Oxigenoterapia domiciliar em crianças: relato de sete anos de experiência

Helena Teresinha Mocelin, Gilberto Bueno Fischer, Lilian Cristine Ranzi, Rosângela Dias Rosa, Maria Regina Philomena

J Bras Pneumol.2001;27(3):148-152

Abstract PDF PT Portuguese Text

Objective: To describe the results of a seven years experience using home oxygen therapy in children with hypoxemia and chronic lung disease. Patients and methods: This is a retrospective and descriptive study carried out at Hospital da Criança Santo Antônio - Porto Alegre-RS, Southern Brazil. The characteristics of the children on home oxygen therapy from January/93 to January/00 were analyzed. Results: Out of the 40 patients studied, 29 (72.5%) were males. At the beginning of home oxygen therapy, the age of the patients ranged from two months to 13 years and six months (mean: 24.8; median: 13), and 18 of them (45%) were less than one year old. The most frequent diseases were: obliterative bronchiolitis (31 cases; 77.5%); chronic obstructive lung disease with aspiration pneumonia (three cases); hypogammaglobulinaemia (two cases); suppurative lung disease (two cases), alveolar proteinosis (one case) and tuberculosis (one case). The length of the last hospitalization before home oxygen therapy was started ranged from nine to 240 days (mean: 63.7 days; median: 50 days). Most of the patients (30; 75%) received oxygen from a concentrator and the remainder from a cylinder. Mean oxygen therapy length ranged from 27 to 1,620 days (median: 392.5 days). There were five deaths from complications of the basic disease and one from accidental removal of the tracheostomy tube. Oxygen use could be discontinued in 19 patients - 15 with obliterative bronchiolitis, two with chronic aspiration pneumonia, one with tuberculosis and one with alveolar proteinosis. Conclusion: Although oxygen was needed for long periods, evolution was satisfactory in most children. Home oxygen for oxygen-dependent is an alternative treatment that allows an early discharge and a quick return to home life.

 


Keywords: Oxygen inahalation therapy. Anoxemia. Lung obstructive diseases. Home treatment.

 

7 - Surgical treatment of primary spontaneous pneumothorax on the first episode

Tratamento cirúrgico do pneumotórax espontâneo primário no primeiro episódio

Darcy Ribeiro Pinto Filho, André Germano Leite, Fabíola Délia Perin, Ronaldo Barbieri

J Bras Pneumol.2001;27(3):153-157

Abstract PDF PT Portuguese Text

Purpose: To assess the results of the surgical treatment of primary spontaneous pneumothorax (PSP) by means of axillary thoracotomy, blebs resection and abrasive pleurodesis, by comparing the results with the different options of treatment, and to discuss the surgical approach as the best therapeutic option for patient with the first occurrence of PSP. Material and methods: 35 axillary thoracotomy with abrasive pleurodesis for the treatment of PSP were carried out at the Department of Thoracic Surgery of the University of Caxias do Sul between January 1996 and March 1999. Results: 23 patients with their first episode of PSP and 12 patients in their second episode were treated. The pleural drains were kept for in an average period of 2.7 ± 1.6 days. The average time in hospital was about 4.9 ± 2.4 days. Morbidity was 8.5% and mortality rate was zero. There was no relapse in an average period of 22 months of follow-up. Conclusion: The indication of axillary thoracotomy and abrasive pleurodesis to the patients with primary spontaneous pneumothorax (PSP) at the first or recurrent episode showed low rates of morbidity and no relapse, besides short periods of hospitalization and pleural drain permanence. The possibility of indication as the first therapeutic method for the PSP should be considered.

 


Keywords: Pneumothorax. Thoracotomy.

 

Case Report

8 - Renal sarcoidosis

Sarcoidose renal

Maria Enedina Claudino de Aquino, Roberta Karla Barbosa de Sales, José Antônio Freire dos Santos, Ana Lidia Régis, Nelson Morrone

J Bras Pneumol.2001;27(3):163-166

Abstract PDF PT Portuguese Text

In a 62-year-old white woman, submitted to preoperative evaluation for facectomy, urinary alterations were detected. The diagnosis established included left-sided kidney stones and homolateral exclusion. At pre-nephrectomy, interstitial widespread lung disease and thoracic adenopathy were evidenced and their investigation was postponed to after surgery. In the removed kidney, non cascous epithelioid granulomas were found. Later, transbronchial biopsy disclosed this same aspect. The patient was treated with methylprednisolone and presented slight pulmonary improvement, though no amelioration in renal function occurred. Final diagnosis was sarcoidosis with lung, thoraco-lymphatic and renal involvement.

 


Keywords: Sarcoidosis. Kidney failure. Pulmonary sarcoidosis.

 

9 - Organized pneumonia secondary to amiodarone use

Pneumonia em organização secundária ao uso de amiodarona

Lia Augusta de Souza Gulmini, Carlos Alberto de Castro Pereira, Ester N.A.M. Coletta

J Bras Pneumol.2001;27(3):167-170

Abstract PDF PT Portuguese Text

Organized pneumonia secondary to amiodarone use is rare. Only eight cases have been reported in the literature. It is reported on the case of a 75-year-old female who, after a cumulative dose of 43 g of amiodarone, presented coughing, progressive dyspnea and bilateral infiltrates seen at thoracic radiographs. Transbronchial biopsy confirmed the diagnosis. As the drug was discontinued, there was functional and clinical improvement.

 


Keywords: Bronchiolitis obliterans organizing pneumonia. Amiodarone. Drug therapy. Drug toxicity.

 

10 - Pulmonary Rhodococcus equi infection: report of the first two Brazilian cases

Infecção pulmonar por "Rhodococcus equi": relato dos dois primeiros casos brasileiros

Luiz Carlos Severo, Patricia Ritter, Victor Flávio Petrillo, Cícero Armídio Gomes Dias, Nelson da Silva Porto

J Bras Pneumol.2001;27(3):

Abstract PDF PT Portuguese Text

Rhodococcus equi, the principal agent of rhodococcosis, is a pleomorphic, gram-positive, aerobic coccus bacillus that infects humans by inhalation or through a transcutaneous route. It is clinically manifested as a pulmonary abscess. The first two Brazilian cases of rhodococcosis are reported on. Both patients were immunocompromised and showed pulmonary infection. The first patient had AIDS and cavitating pneumonia in the left upper lobe, that was fatal. The second case presented Goodpasture syndrome and was under chronic corticotherapy. He displayed a cavitating nodular lesion in the right upper lobe, that was successfully treated with sulfametoxazol-trimethoprim.

 


Keywords: Actinomycetal infections. Pulmonary tuberculosis. Acquired immunodeficiency syndrome. Goodpasture syndrome. Brazil.

 

 


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