Brazilian Journal of Pulmonology

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

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Year 2002 - Volume 28  - Number 2  (March/April)






Original Article

1 - Modified crichothyroidotomy: an alternative for tracheobronchial secretions removal

Cricotireoidotomia modificada: opção para remoção das secreções traqueobrônquicas

Wilson Paloschi Spiandorello, Darcy Ribeiro Pinto Filho, Gisele Bassani, Franca Stedile Angeli Spiandorello

J Bras Pneumol.2002;28(2):61-64

Abstract PDF PT Portuguese Text

Introduction: Inhalations, postural drainage and respiratory physiotherapy are not always effective in removing tracheobronchial secretions. Objectives: To evaluate an alternative surgical technique, modified crichothyroidotomy, to aspirate tracheobronchial secretions. Method: Modified crichothyroidotomy is the introduction of a catheter number 8, 10 or 12 into the crichothyroid membrane in order to stimulate coughing and the aspiration of secretions. This is a descriptive study of the benefits as well as immediate and late complications caused by the use of this technique in 45 patients with excessive tracheobronchial secretions inadequately removed by usual methods. Results: Immediate surgical complications were bleeding (10 patients), oropharynx deviation (3), subcutaneous emphysema (1) and difficult introduction (1). Mean catheter permanence was 14 ± 16 days and, in all cases, the catheter provoked coughing and allowed the easy aspiration of secretions. The most frequent occurrence (17 patients) was the expulsion of the catheter by coughing, inadequate catheter handling during aspiration and moving of the patients. Conclusion: This is a simple technique with a low morbidity rate and represents constitutes an effective alternative to be used in the aspiration of tracheobronchial secretions.

 


Keywords: Postural drainage. Aspiration.

 

2 - The effectiveness of the pulmonary rehabilitation program as an ancillary treatment for chronic obstructive pulmonary disease

Efetividade da reabilitação pulmonar como tratamento coadjuvante da doença pulmonar obstrutiva crônica

Sérgio Leite Rodrigues, Carlos Alberto de Assis Viegas, Terezinha Lima

J Bras Pneumol.2002;28(2):65-70

Abstract PDF PT Portuguese Text

Introduction: The patient with COPD has his global physical activity decreased due to a progressive worsening of the lung function resultant from any kind of physical effort he may perform. Pulmonary rehabilitation (PR) is used in the United States and Europe as an alternative therapy in COPD treatment. Objective: To evaluate the effectiveness of PR as an ancillary treatment for COPD. Patients and methods: 30 patients prospectively submitted to the PR program developed in six weeks with three weekly sessions. Evaluation included clinical history and complete physical examination, the six-minute walking distance test, maximum workload test for upper limbs, maximum load test for lower limbs, a questionnaire of effort perception, spirometry and analysis of blood gases. Results: Concerning spirometry and analysis of blood gases, pre and post PR program, no statistically significant change was observed (p > 0.05). Pre and post PR program, statistically significant values (p < 0.05) were observed in the decrease in effort perception and increase in functional physical capacity, maximum workload test for upper limbs and incremental test for lower limbs used to determine the maximum workload. Conclusions: The authors concluded that, in the group studied, the PR program increased the patients' physical capacity and maximum workload for upper limbs whereas no changes were observed in the data regarding spirometry and analysis of blood gases.

 


Keywords: Rehabilitation. Therapeutical approaches. Lung diseases obstructive. Treatment outcome. Exercise therapy.

 

3 - Cost-effectiveness of an education program for asthmatic adults of a public university hospital

Custo-efetividade de programa de educação para adultos asmáticos atendidos em hospital-escola de instituição pública

Maria Alenita de Oliveira, Maria Tereza Muniz, Lucia Ande Santos, Sônia Maria Faresin, Ana Luisa Godoy Fernandes

J Bras Pneumol.2002;28(2):71-76

Abstract PDF PT Portuguese Text

The direct costs incurred in managing patients with poorly controlled asthma are high and educational programs could decrease these costs. Aim: The objectives of this study were to compare the direct cost of the implementation of an educational program for adult asthmatic patients with the cost of the usual care delivered to asthmatics by specialists. Methods: Five years ago, a six-month study demonstrated that an educational program improved clinical outcomes (22 in educational program-E and 20 patients in control group-C). Throughout the educational intervention period all cases of hospitalization, emergency and regular calls involving patients from both groups were recorded. The basis for the values utilized in the calculation of costs was the healthcare database of the Brazilian government (DATASUS). The overall medication cost/patient in both groups was based on the amount of medication taken during the month preceding the last call. The final values were converted into US dollars. Results: The mean direct cost/patient in the educational (E) and control (C) groups and the difference (Δ) between groups were: hospitalizations (C = US$ 183, E = 0, Δ = US$ 183); emergency calls (C = US$ 14, E = US$ 5, Δ = US$ 9); regular calls (C = US$ 10, E = US$ 24, Δ = -US$ 14); medication (C = US$ 124,3, E = US$ 195,6, Δ = -US$ 71,3). The total cost was US$ 33/patient in group C and US$ 224/patient in group E with an average cost saving of US$ 107/patient. Conclusion: The expenses with medication is higher in E group because the regular use of maintenance drugs, however the study suggested that the application of the asthma education program reduced the total direct costs of asthma.

 


Keywords: Asthma. Cost-benefit. Patient education.

 

4 - Cigarette smoking survey among physicians of Rio Grande, Rio Grande do Sul: prevalence and smoker's profile

Pesquisa sobre tabagismo entre médicos de Rio Grande, RS: prevalência e perfil do fumante

Luís Suárez Halty, Maura Dumont Hüttner, Isabel de Oliveira Netto, Thaís Fenker, Tatiana Pasqualini, Berenice Lempek, Adriana Santos, Alessandra Muniz

J Bras Pneumol.2002;28(2):77-83

Abstract PDF PT Portuguese Text

Smoking is a serious public health problem. The campaign against tobacco is largely supported by health professionals, especially doctors. The physician is a model for the community and therefore should give the example avoiding smoking. Objectives: This work seeks to evaluate the magnitude and the distribution of smoking habit among physicians in Rio Grande, state of Rio Grande do Sul, southern Brazil, and characterize the smoking doctor's profile. Method: Data were obtained, in 1999, through application and analysis of a questionnaire, based on the model proposed by WHO, among 333 physicians of whom 213 (64%) were men and 120 (36%) were women. The average age of the sample was 43 (± 10.5) years with 65.1% between 30 and 50 years. Results: Smoking prevalence was 18.3% (15.9% regular smokers and 2.4% occasional smokers). Regular smoking prevalence was 17.8% among males and 12.5% among females, with no significant statistic difference (p > 0.05). The mean number of cigarettes smoked was 24.3 packets/years, being superior among men and increasing with age. It was verified that 86.8% of the smokers began smoking before 20 years of age, due to their desire or friends' influence in 63.2% of the cases. Conclusion: Although smoking prevalence among Rio Grande physicians is lower than in other countries, it is still unacceptable. Since this class has a decisive role in the prevention and fight against smoking, a specific campaign against tobacco among these professionals would greatly justify.

 


Keywords: Smoking. Prevalence. Physicians. Epidemiological

 

Review Article

5 - Therapeutic management of tracheobronchial stenosis with stent application

A correção das estenoses traqueobrônquicas mediante o emprego de órteses

Maurício Guidi Saueressig, Amarílio Vieira de Macedo Neto, Alexandre Heitor Moreschi, Rogério Gastal Xavier, Paulo Roberto Stefani Sanches

J Bras Pneumol.2002;28(2):84-93

Abstract PDF PT Portuguese Text

The surgical treatment of patients with tracheobronchial stenosis requires individualized attention due to the complexity of its origin though tracheoplasty is considered to be the ideal procedure. The most common causes of stenosis are tracheal intubation and the development of neoplasias. These are the very conditions that most benefit from endoscopic treatment when surgical correction is not indicated. Today, endoscopic procedures include the application of different kinds of laser and dilators usually delivered with a rigid bronchoscope, as well as radiotherapy and stents that may be used separately or associated. Basically, there are two types of stents, metal or silicone. The metallic ones are more frequently indicated in cases of tracheomalacia and extrinsic compressive stenosis. Silicone are more applicable in cases of tracheobronchial obstruction resultant from acute inflammation or endoluminal tumor. Although these methods can be used interchangeably in some cases, the best way to correct tracheobronchial stenosis is to correctly decide upon the treatment as early as the preliminary steps.

 


Keywords: Tracheal stenosis. Orthopedics fixation devices. Angioplasty.

 

6 - Lung cancer radiology

Radiologia do câncer de pulmão

Maysa Gomes Barcellos

J Bras Pneumol.2002;28(2):94-99

Abstract PDF PT Portuguese Text

The evaluation of patients with lung cancer involves not only the detection of enlarged mediastinal lymph nodes and the delineation of the relationship between the primary lesion with the mediastinal structures but also the determination of extra thoracic metastases. This article reviews the major imaging techniques that are currently used to stage bronchogenic carcinoma. Radiologic studies have made an important impact on the evaluation of the solitary pulmonary nodule. Mediastinal staging coupled with imaging methods is not accurate. CT and MR imaging of the chest and abdomen are often used to stage a known or suspected lung carcinoma. Despite their limitations, CT and MR prevent unnecessary thoracotomies and invasive procedures. MR can be helpful in the evaluation of parts of the chest not well shown on CT. PET-FDG imaging complements chest CT in the noninvasive evaluation of lung cancer and strategies for its use merit further investigation.

 


Keywords: Radiology. Bronchogenic carcinoma. Lung neoplasms. Diagnostic imaging. Emission-computed tomography. Nuclear magnetic resonance.

 

Case Report

7 - Human pulmonary dirofilariasis: a report of seven cases

Dirofilariose pulmonar humana: relato de sete casos

Rodrigo Silva Cavallazzi, Antônio César Cavallazzi, Irene Vieira Souza, João José de Deus Cardoso

J Bras Pneumol.2002;28(2):100-102

Abstract PDF PT Portuguese Text

Human pulmonary dirofilariasis is a rare disease caused by the parasite Dirofilaria immitis. It is usually seen as a solitary pulmonary nodule that mimics lung cancer. Although this disease is considered benign, its diagnosis often requires an excisional lung biopsy. Herein we report the epidemiological, clinical and radiological features observed in seven cases of human pulmonary dirofilariasis from Florianópolis. Six of our seven patients, showed a radiological finding of pulmonary nodule and underwent excisional lung biopsy for diagnosis. In one case, the radiological image was unavailable for review. Therefore, it was not described in this work, and the diagnosis was established through transbronchial biopsy.

 


Keywords: Dirofilariasis. Dirofilaria immitis. Coin lesion pulmonary.

 

8 - Tracheobronchomegaly

Traqueobroncomegalia em criança: relato de caso e revisão da literatura

Eliana H. Mihara Varella, Patrícia F. Miamoto, Fabíola V. Adde, Cleyde M.A. Nakaie, Joaquim C. Rodrigues

J Bras Pneumol.2002;28(2):103-106

Abstract PDF PT Portuguese Text

Objective: To point out to tracheobronchomegaly as a differential diagnosis in children with chronic respiratory disorders. Methods: The patient's data were obtained from his chart review and bibliographical data were obtained from the Medline System. Results: This is a case report on a 15-year-old, white, male patient who had been followed up in the Pulmonology Unit of the Children's Institute since he was 10 years old. His history included wheezing episodes and recurrent respiratory tract infections since he was 5 months old. The initial diagnosis was asthma, but, since the patient responded only partially to treatment, a chest computerized tomography was performed. It revealed an enlargement of the tracheal and right bronchial dimensions, confirming the diagnosis of tracheobronchomegaly. Conclusions: Tracheobronchomegaly is a rare disease in children. This entity should be thought in children with chronic respiratory diseases of unidentified etiology. To date, no definitive treatment is available.

 


Keywords: Tracheobronchomegaly. Obstructive lung diseases.

 

9 - Osteochondroma

Osteocondroma: relato clínico

Nelson Perelman Rosenberg, Ivo Leuck Jr., Mario de Luca Jr., Miguel Angelo Martins Castro Jr.

J Bras Pneumol.2002;28(2):107-108

Abstract PDF PT Portuguese Text

Osteochondroma is generally found as a small, hard and painless tumor that grows from the outer surface of the costal metaphysis. We herein report the case of a 19-year-old female presenting chest pain with respiratory or hemodynamic involvement. Radiological examination showed a large intrathoracic calcified lesion compressing the mediastinal vessels.

 


Keywords: Osteochondroma. Thoracic injuries.

 

10 - Nephrobronchial fistula due to Pastereula aerogenes infection

Fístula nefrobrônquica em paciente com infecção por "Pasteurella aerogenes"

Renato Della Santa, Cláudio Leo Gelape, Felipe Duborqc, Ricardo Lira, João Cabral

J Bras Pneumol.2002;28(2):109-112

Abstract PDF PT Portuguese Text

The authors report the case of a 58 year-old woman with nephrolithiasis, who after being submitted to percutaneous lithotripsy developed xantogranulomatous pyelonephritis, lung abscess and sepsis. Initially, treatment included open drainage of the retroperitoneum, nephrectomy and tubular drainage of the lung abscess and pleural space, through right lateral thoracotomy. Pastereula aerogenes was isolated from both lung and retroperitoneal secretions. To our knowledge, this is the first case of nephrobronchial fistula related with this bacteria in medical literature.

 


Keywords: Bronchial fistula. Xantogranulomatous pyelonephritis. Lung abscess. Gram-negative bacterial infections. Lithiasis. Kidney.

 

Letters to the Editor

 


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