Brazilian Journal of Pulmonology

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

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Year 2001 - Volume 27  - Number 5  (September/October)






Original Article

1 - Use of breath carbon monoxide as an indicator of smoking status

Emprego da determinação de monóxido de carbono no ar exalado para a detecção do consumo de tabaco

Ubiratan P. Santos, Silmar Gannam, Julie M. Abe, Patricia B. Esteves, Marco Freitas Filho, Thais B. Wakassa, Jaqueline S. Issa, Mario Terra-Filho, Rafael Stelmach, Alberto Cukier

J Bras Pneumol.2001;27(5):231-236

Abstract PDF PT Portuguese Text

Introduction: Smoking is the major preventable risk of morbidity and mortality. However, its prevalence is high in developed countries and increasing in developing countries, even though its effects are now better known. The purpose of this study was to compare the exhaled carbon monoxide concentration (exCO) between smokers and nonsmokers, evaluate the factors that influence this parameter among smokers and the potential influence of passive smoking by measuring exCO in workers and patients of Instituto do Coração HC-FMUSP. Materials and methods: This cross study included 256 volunteers who responded to a questionnaire and were submitted to exCO measuring with the MicroCo meter device. Results: There were 106 males and 150 females. Mean age was 43.4 years (Vmin-max: 15-83). There were 107 smokers, 118 nonsmokers and 31 passive smokers. Mean exCO was 14.01 ppm (Vmin-max: 1-44) among smokers, 2.03 ppm (Vmin-max: 0-5) among passive smokers and 2.50 ppm (Vmin-max: 0-9) among nonsmokers. Significant statistical difference was observed between smokers and the other groups (p < 0.001), but not between nonsmokers and passive smokers. A positive correlation was found between the number of cigarettes smoked per day and exCO values while there was a negative correlation between the exCO values and the timing of the last cigarette. For a reference limit value of 6 ppm, sensitivity was 70% and specificity was 96%. Conclusion: exCO metering is easy to perform, low-cost, noninvasive and allows the obtention of immediate results and the reference limit value of 6 ppm has good specificity to evaluate the smoking habit.

 


Keywords: Smoking. Carbon monoxide. Tobacco smoke pollution. Brazil.

 

2 - Asthma and atopy prevalence in a group of students from Porto Alegre, Rio Grande do Sul

Variação na prevalência de asma e atopia em um grupo de escolares de Porto Alegre, Rio Grande do Sul

Renata Wagner Fiore, Adriana Barbieri Comparsi, Cláudia Loss Reck, Jéferson Krawcyk de Oliveira, Karina Brasco Pampanelli, Carlos Cezar Fritscher

J Bras Pneumol.2001;27(5):237-242

Abstract Portuguese Text

Introduction: A considerable increase in asthma and atopy prevalence has been noticed worldwide through the last decades, however, in our country, epidemiological data are still insufficient. Objective: This study was carried out to determine the prevalence of asthma and atopy in a group of students, and compare these data with those found in two previous studies undertaken in Porto Alegre, Rio Grande do Sul. Methods: Asthma prevalence was identified through a questionnaire applied to 855 students from five schools of Porto Alegre. The students submitted to skin tests who presented, at least, one positive reaction were considered atopic. The signature of an informed consent from one of the parents was required for the skin test performance. Results: Prevalence was found to be 42.5% and 22% of cumulative and active asthma, respectively, with predominance in females. Atopy was identified in 50.1% of the sample. These results were significantly higher than the 6.7% (1980) and 16% (1989) of cumulative asthma, 10.9% (1989) of active asthma and 15.8% (1980) of atopy found in the two previous studies. Conclusion: A high prevalence of asthma and atopy was identified in our students. Future studies should be performed to elucidate the phenomenon herein demonstrated.

 


Keywords: Asthma. Epidemiology. Atopy.

 

3 - Smoking cessation with bupropion and nicotine replacement

Tratamento do tabagismo com bupropiona e reposição nicotínica

Fábio Maraschin Haggsträm, José Miguel Chatkin, Daniela Cavalet-Blanco, Vanessa Rodin, Carlos Cezar Fritscher

J Bras Pneumol.2001;27(5):255-261

Abstract Portuguese Text

Introduction: Around one third of the world adult population smoke. Due to the recent researches on the smoking addiction and to the use of new drugs, the possibilities to succeed on the attempts to quit smoking have increased remarkably. Purposes: To study the tobacco abstinence in patients under treatment at the Ambulatório de Auxílio ao Abandono do Tabagismo da Pontifícia Universidade Católica do Rio Grande do Sul (AAAT-PUCRS) and to evaluate the role of some variables as risk factors to the chosen outcomes. Patients and methods: In a prospective open clinical trial not randomized we studied all the smokers who attended the AAAT-PUCRS within July 1999 and October 2000. All of them were submitted to the same standard program; the results were analyzed by central tendency measures for quantifying variables, relative risk with a IC95% for the associated factors and the Kaplan Meier's curve for the analyses of the time trend. Results: The study included 169 patients (67.5% women), average age 46 (± 10.4) years old; the most of them smoked 20 cigarettes/day for around 30 years. Even for a very young cohort like this one, it was possible to show that in relation to the outcome success/failure, 49% of the patients quit smoking, 14% remarkably diminished the number of smoked cigarettes and 37% failed completely. For the studied variables, severe dependency to nicotine was the only one associated with an increased risk to failure quitting smoking. Conclusions: It was possible to achieve a reasonable quitting smoking percentage adopting standard procedures described, but adapted for each patient. Pharmacological therapy was associated to a higher percentage of success.

 


Keywords: Smoking. Treatment. Tobacco use cessation. Ambulatory care.

 

4 - A study of community-acquired pneumonia inpatients in a period of a year

Estudo de casos hospitalizados por pneumonia comunitária no período de um ano

Ricardo de Amorim Corrêa, Regina Magalhães Lopes, Luciana Macedo Guedes de Oliveira, Frederico Thadeu Assis Figueiredo Campos, Marco Antônio Soares Reis, Manoel Otávio da Costa Rocha

J Bras Pneumol.2001;27(5):243-248

Abstract PDF PT Portuguese Text

Introduction: Besides the improvement we have had in the diagnostic methods, the causative agent in around 50% of the cases of community-acquired pneumonia (CAP) remains unknown, even in inpatients. Despite that, adequate empirical therapy results in low mortality in the majority of the cases. Goals: To describe the epidemiology, the clinical presentation, the utility of diagnostic tests, the duration of hospital stay, the morbidity and mortality rates of 42 consecutive inpatients with CAP. Methods: The inclusion criteria were the presence of a recent pulmonar infiltrate in the CXR and two items out of fever (38ºC), productive cough and leukocytosis (> 10,000/mm3), in the presence of a compatible clinical syndrome. The subsidiary tests were performed as required on individual basis. Results: Forty-two patients, aged 64.7 ± 16.8 years, 27 (64.3%) male, were studied. Twenty-seven (64%) had subjacent illness. Seventeen (40.5%) were on antimicrobial therapy on admission. There were eight cases (19%) of severe pneumonia; the patients aged > 60 or £ 60 years were similar concerning the severity of presentation (p = 0.57) and had similar hospital stay (p = 0.25). The mean global hospital stay was 14.3 ± 7.6 days. Definite etiologic diagnosis were done in three patients: Legionella sp (2), S. aureus (1). In thirty-one cases (73.8%) the antimicrobial therapy wasn't modified; when it happened (11 patients, 26.2%), the main reason was the bad outcome in six cases (54.5%); in five (45.5%), the microbiological result prompted the change in therapy. Blood samples were drawn in 16 cases (38%), being positive in only one (6.3%). There were nine adequate sputum samples for analysis (9/22, 41%). There was only one death (2.4%), due to severe pneumonia in a patient with a neoplastic disease. Conclusion: The etiologic diagnosis in CAP is reached in a minority of cases, even in inpatients. At least partly, this is probably due to the previous use of antimicrobial drugs. Adequate empirical therapy results in low mortality. Diagnostic tests can be performed on individual basis.

 


Keywords: Pneumonia. Community acquired infections. Epidemiology. Therapeutics.

 

5 - The bronchodilatory effect of salbutamol administered through spacers with and without antistatic treatment

Efeito broncodilatador do salbutamol inalado através de espaçadores com e sem tratamento antiestático

Luiz Eduardo Mendes-Campos, Clarissa Marina Biagioni

J Bras Pneumol.2001;27(5):249-254

Abstract PDF PT Portuguese Text

Objective: To compare the bronchodilatory effect of salbutamol delivered by metered-dose inhaler connected to spacers with and without previous antistatic treatment. Design: Prospective, randomized, open, crossover study. Setting: Outpatients from The Pulmonary Clinic of Hospital Júlia Kubitschek-FHEMIG, Belo Horizonte, Minas Gerais, Brazil. Patients and methods: Eleven patients, with stable mild to moderate asthma were randomized to four inhalation tests of 100 mg of salbutamol: (A) open mouth, (B) non antistatic small volume spacer (50 ml), (C) antistatic small volume spacer (50 ml) and (D) antistatic Fisonair® (750 ml). The antistatic treatment consisted in soaking the spacer in a solution of water and detergent for ten minutes and letting it to drip dry without rinsing. Main outcome measure: The peak expiratory flow (PEF) variation 15 minutes after each test in absolute, % of predicted and % of baseline values. Results: The median (Min-Max) PEF absolute variation was 25 (5-85), 40 (0-70), 70 (25-83) and 60 (15-90) l/min for tests A, B, C and D, respectively. The median PEF % baseline variation was 7.6, 11.0, 15.0, 13.3, and median PFE % predicted variation was 6.0, 8.7, 12.7 and 10.7 for tests A, B, C and D, respectively. The results of tests C and D were significantly superior to those of tests A and B (p < 0.01) based on the three methods evaluated. There was no significant difference between the results of tests C and D. Conclusion: The antistatic treatment of a small volume spacer device using a solution of water and detergent can improve the antiasthmatic effect of inhaled drugs delivered by metered-dose inhaler, as occurred with the salbutamol in this study. This fact can be more relevant concerning the treatment with inhaled steroids for asthma.

 


Keywords: Asthma. Respiratory therapy. Aerosols. Albuterol.

 

Review Article

6 - Primary ciliary dyskinesia

Discinesia ciliar primária

José Wellington Alves dos Santos, Aland Waldow, Claudius Wladimir Cornelius de Figueiredo, Diego Rossi Kleinubing, Severo Salles de Barros

J Bras Pneumol.2001;27(5):262-268

Abstract PDF PT Portuguese Text

Primary ciliary dyskinesia is an autosomal recessive disorder characterized by a history of recurrent upper and lower respiratory tract infections with chronic otitis media, bronchitis and rhinosinusitis, associated with situs inversus in 50% of cases. The diagnosis is established by ciliary ultrastructural analysis of respiratory specimens, after ruling out some disorders as cystic fibrosis, a-1 anti-trypsin deficiency, immune deficiencies (IgG, neutrophils and complement) and Young's syndrome. The purpose of this paper is to review the clinical features, diagnosis and management of primary ciliary dyskinesia, including a diagnostic algorithm.

 


Keywords: Ciliary dyskinesia. Situs inversus. Diagnosis.

 

Case Report

7 - Inflammatory pseudotumor in childhood

Pseudotumor inflamatório em criança pré-escolar

Maura Malcon, Nilton Haertel Gomes, Valéria Jorge, Geraldo Geyer

J Bras Pneumol.2001;27(5):279-281

Abstract PDF PT Portuguese Text

The authors described a case of a five year old boy having an inflammatory pseudotumor (fibrohistiocytic granuloma) in the left upper lobe. Surgical excision was undertaken, and the four year outcome was favorable. These tumors are rare and can simulate sarcomas, so that a radical excision is considered the diagnostic procedure and the treatment of choice as well.

 


Keywords: Inflamatory pseudotumor. Childhood. Plasma cell pulmonary granuloma.

 

8 - Pulmonary coccidioidomycosis in a armadillo hunter

Coccidioidomicose pulmonar em caçador de tatus

Fabrício André Martins da Costa, Ricardo Coelho Reis, Fábio Benevides, Geraldo de Sousa Tomé, Marcelo Alcântara Holanda

J Bras Pneumol.2001;27(5):275-278

Abstract PDF PT Portuguese Text

Coccidioidomycosis is a disease caused by inhalation of arthrospores of the fungus Coccidioides immitis. It has been recognized as a clinical entity since 1892. It is related to activities that involves dust exposure. It is found in many regions of the western hemisphere with dry and alkaline soil. In Brazil it has been described almost exclusively in the Northeast region where drought periods may favor its growth in its soil. We report a case of fatal coccidioidomycosis, in an immunocompetent host, associated to the activity of armadillo hunting (Dasypus novemcynctus) in a rural area of Ceará state.

 


Keywords: Coccidioidomycosis. Occupational exposure. Armadillos.

 

9 - Necrotizing descending mediastinitis afetr Ludwig angina

Mediastinite descendente necrosante pós-angina de Ludwig

Maricélia Brommelstroet, José Fioravante Tosatti da Rosa, Paulo César Buffara Boscardim, Carlos Augusto Schmidlin, Sérgio Shibata

J Bras Pneumol.2001;27(5):269-271

Abstract PDF PT Portuguese Text

Ludwig's angina is an infection of the submandibular space generally caused by an infection of the 2nd or 3rd lower molar. As a consequence, descending necrotizing mediastinitis, a rare and severe form of mediastinal infection, may occur. The descending necrotizing mediastinitis represents a rare form of mediastinal infection. It presents a high mortality and to decrease that rate it is necessary prompt diagnosis and surgical treatment. Two cases of descending necrotizing mediastinitis due to Ludwig's angina were treated with excellent results in our hospital. The transcervical mediastinal drainage is justified in patients with disease limited to the upper mediastinum. Even so, when there is extensive involvement of the whole mediastinum it is suitable the accomplishment of a wide thoracotomy.

 


Keywords: Ludwig's angina. Mediastinitis. Diagnosis. Treatment. Surgery.

 

10 - Metastatic ependymoma of the lung

Ependimoma metastático de pulmão

Paulo Manuel Pêgo-Fernandes, Roger Beltrati Coser, Rosana Seleri Fontes, Fábio B. Jatene

J Bras Pneumol.2001;27(5):282-284

Abstract PDF PT Portuguese Text

Ependymomas are rare tumors of the central nervous system that most often occur at the cauda equina. These tumors seldom metastasize. A 35 year-old man, nine years after the resection of an ependymoma of the coccygeal region developed pleuritic pain, dyspnea, cough and night sudoresis. Lung X-ray revealed pleural congestion and metastic nodes in both lungs. Histopathological and immunohistochemical examinations of the tissue obtained through open pulmonary biopsy confirmed the diagnosis of a pendymoma, chemotherapy was administered and after 43 months of follow up the patient's evolution has been good.

 


Keywords: Ependymoma. Lung neoplasms. Neoplasm metastasis.

 

11 - Intrapulmonary teratoma

Teratoma intrapulmonar

Cleverson Winston de Liz Medeiros, William Kondo, Michelli Totti Dyckyj, Nelson Suzuki

J Bras Pneumol.2001;27(5):272-274

Abstract PDF PT Portuguese Text

Lung teratoma is a rare disease to date. About 43 cases have been described in the literature. We report on a 28-year-old man who presented fever, cough and hemoptysis for four months. Chest X-ray and computerized tomography showed opacification of the left upper lobe and bronchoscopy revealed the presence of hair at the site. The patient's condition improved with surgical treatment.

 


Keywords: Teratoma. Lung neoplasm.

 

Letters to the Editor

12 - Asma brônquica e a tolerância ao exercício incremental

José Alberto Neder

J Bras Pneumol.2001;27(5):285-286

PDF PT


 


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