Brazilian Journal of Pulmonology

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


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Year 2002 - Volume 28  - Number 3  (May/June)

Original Article

1 - Heimlich valve in the treatment of pneumothorax

A válvula de Heimlich no tratamento do pneumotórax

Ricardo Beytuti, Letícia Engber Odilon Villiger, José Ribas Milanez de Campos, Rodrigo Afonso Silva, Angelo Fernandez, Fábio Biscegli Jatene

J Bras Pneumol.2002;28(3):115-119

Abstract PDF PT Portuguese Text

Objective: Heimlich valve has been described as a substitute for water-sealed drainage systems. The objective of this study by the Thoracic Surgery Service of the "Hospital das Clínicas", University of São Paulo Medical Center, is to assess its effectiveness in the treatment of pneumothorax and its ease of operation, safety, and patient toleration. Methods: From June/97 to August/00, 107 patients with pneumotoraxes of different etiologies were analyzed. The majority (76%) were classified radiologically as suffering from moderate or large pneumothorax, three hypertensive pneumothorax, and one was bilateral. The pleural cavity was drained with teflon or polyurethane plastic pig-tail catheters (10.2F, 14F, straight 11F connected to the Heimlich valve or the valve was connected directly to the thoracic drain in post-thoracotomy patients). Results: The valve remained in place for one to 120 days (mean 4 days). Tolerance to the system was good in 89% of cases. There were no serious complication linked to the system. Associated pleural effusion in 20 patients (18.5%) did not prevent the system from functioning well. Only two patients (1.8%) developed subcutaneous emphysema, and therefore, a 36F Tubular drain under water seal was chosen. Thoracotomy for decortication was indicated in one patient (0.9%). Twenty patients (18.5%) were treated on an outpatient basis. Conclusions: The Heimlich valve confirmed its effectiveness in resolving pneumothorax of different etiologies and in postoperative air leaks. Its operation was simpler than that of conventional systems. The good toleration and safety mentioned by the patients was a determining factor in early hospital discharge and a motive for outpatient treatment.


Keywords: Pneumothorax. Pleura. Postural drainage.


2 - Reduction on the levels of anxiety and depression of COPD patients participating in a pulmonary rehabilitation program

Redução nos níveis de ansiedade e depressão de pacientes com doença pulmonar obstrutiva crônica (DPOC) participantes de um programa de reabilitação pulmonar

Dagoberto Vanoni de Godoy, Rossane Frizzo de Godoy

J Bras Pneumol.2002;28(3):120-124

Abstract PDF PT Portuguese Text

Study objectives: Multidisciplinary pulmonary rehabilitation has been the most suitable treatment for chronic obstructive pulmonary disease (COPD). This clinical trial studied the prevalence of anxiety and depression and the effect of a pulmonary rehabilitation program on anxiety and depression levels of 46 COPD patients (mean ± SD age, 62 ± 11 years; 34 men and 12 women). Design: The participants underwent a 12-week treatment program: 24 sessions of physical exercise, 24 sessions of physiotherapy, 12 psychological sessions and three educational sessions. All patients were evaluated at baseline and at completion of the rehabilitation program through three instruments: Beck Anxiety Inventory (BAI), Beck Depression Inventory (BDI) and 6- minute walking distance (Tcam6'). Results: Patients demonstrated significant statistical improvements, including reduced anxiety and depression, and increased endurance: BAI 16.4 ± 6.9 vs. 6.8 ± 5.3 (p < 0.001); BDI: 16.9 ± 8.7 vs. 7.5 ± 6.6 (p < 0.001); Tcam6": 335.7 ± 83.4 vs. 441.6 ± 100.8 (p < 0.05). Conclusions: COPD patients presented high prevalence of anxiety and depression levels. The pulmonary rehabilitation program was able to improve patient exercise performance, and to reduce anxiety and depression levels.


Keywords: COPD. Pulmonary rehabilitation. Physical exercise. Anxiety. Depression.


3 - Comparison between the theoretical values for spirometric data in children determined by Mallozi's and Polgar's equations

Comparação entre os valores teóricos para alguns dados espirométricos em crianças determinados pelas equações de Mallozi e de Polgar

Waldemar Ladosky, Rogerson T. Andrade, Noel Guedes Loureiro, Marcos Alberto Machado Botelho

J Bras Pneumol.2002;28(3):125-130

Abstract PDF PT Portuguese Text

Objective: This paper is a continuation of the study on the validity of equations of predicted value (PV) for the Brazilian population. A comparison was made between the equations proposed by Mallozi and by Polgar for the Brazilian population, which are mainly used in the United States and Europe. Methods: PVs of 185 patients of both sexes (89 boys and 96 girls), ages between 6 and 17 years, were analyzed. For each subject, the PVs for forced vital capacity (FVC), forced expiratory volume at 1 sec. (FEV1), and the medium expiratory flow (MEF) were calculated according to the equations proposed by Mallozi and Polgar. Results were compared. Diagnoses were made according to the Brazilian Consensus of Spirometry. Results: The PV-M for FVC is 0.38% higher for boys and 2.19% higher for girls than that determined by Polgar. The PV-P for FEV1 is 6.67% (p < 0.05) lower for girls, suggesting an underassessment of the obstructive impairment. For boys, a mean lower value of 7.26% as compared to the VT-M is at the limit of significance (0.05 < p < 0.01). No significant difference between the two equations analyzed was found for MEF. Conclusions: The PVs for CVF and VEF1 for Brazilian children, according to Mallozzi, are significantly different when compared to those published by authors like Polgar. As a result, the authors found that Mallozzi's equations are more likely to detect obstructive impairment and less likely to diagnose restrictive ventilatory insufficiency.


Keywords: Spirometry. Vital capacity. Forced expiratory volume. Maximal medium expiratory flow rate. Case-control studies


4 - Use of continuous positive airway pressure (CPAP) during physical activities on an ergometric treadmill performed by individuals with chronic obstructive pulmonary disease (COPD): comparison with the use of oxygen

Utilização da pressão positiva contínua nas vias aéreas (CPAP) durante atividade física em esteira ergométrica em portadores de doença pulmonar obstrutiva crônica (DPOC): comparação com o uso de oxigênio

Flávio Danilo Mungo Pissulin, Alcides Guimarães, Lúcio Benedicto Kroll, Michel Jorge Cecílio

J Bras Pneumol.2002;28(3):131-136

Abstract PDF PT Portuguese Text

Objective: To analyze the effects of the continuous positive airway pressure (CPAP), with 30% of FiO2 and in compressed air, used during the performance of submaximal physical activity on an ergometric treadmill. Materials and methods: Nine male individuals with COPD were submitted to physical activity on the ergometric treadmill using CPAP with 30% FiO2 .The authors evaluated the behavior of the spirometric parameters, the forced vital capacity (FVC), the forced expiratory volume in the first second (FEV1) before and after physical activity, the respiratory frequency (f), the arterial oxygen saturation (SaO2), the cardiac frequency (cf), the systolic arterial pressure (SAP), and the diastolic arterial pressure (DAP) at rest and during physical activity. Results and conclusion: Results have shown that, when using CPAP in both situations analyzed, there has been an increase in the FVC and a decrease in f and in cf with statistically significant difference (α = 0.05). SaO2 has showned a significantly higher mean when CPAP was used with 30% of FiO2 (α = 0.05). The FEV1, the SAP and DAP have maintained the same value in the statistical analyses.


Keywords: Exercise test. Forced expiratory volume. Vital capacity.


Review Article

5 - Low-molecular-weight heparin in the treatment of pulmonary embolism

Heparina de baixo peso molecular no tratamento da tromboembolia pulmonar

Renato Maciel

J Bras Pneumol.2002;28(3):137-142

Abstract PDF PT Portuguese Text

This article reviews the pharmacokinetic properties of low-molecular weight heparins, compares the results of their use to that of unfractioned heparin in a pulmonary embolism treatment, showing they are a safe an effective alternative. The authors suggest that low-molecular-weight heparins administered subcutaneously once or twice-daily and without frequent laboratory monitoring have permitted out-of-hospital or short hospitalization management in some cases of pulmonary embolism, resulting in cost savings and increased patient satisfaction.


Keywords: Pulmonary embolism. Heparin. Low-molecular-weight heparin.


6 - Tumor markers in lung cancer: a pathway to biological therapy

Marcadores tumorais no câncer de pulmão: um caminho para a terapia biológica

Fernando Azevedo Pacheco, Marcos Eduardo Machado Paschoal, Maria da Glória da Costa Carvalho

J Bras Pneumol.2002;28(3):143-149

Abstract PDF PT Portuguese Text

Recent advances in genetics and molecular biology lead to the identification of genes and protein products overexpressed by tumors. Such products, called tumor markers, were previously used only as diagnostic and prognostic tools, but are currently being the target of extensive research, with growing evidence that some of them may have an important role in the development of new treatment modalities, targeting the tumor cell biological cycle. In this article, the authors review the role of some of the traditionally known tumor markers (CEA, p53, NSE, K-ras), and describe the prevalence and the role of the epidermal growth factor receptor (EGFR) overexpression and its protein product, p185neu. New drugs have been developed, aiming at the blockade of the signaling process initiated by the EGFR. Among these, the authors highlight ZD1839 (Iressa), a new orally administered drug that reversibly and selectively inhibits the EGFR tyrosine-kinase activity. This drug has demonstrated good results in the treatment of non-small-cell lung cancer, as an isolated drug or in combination with other chemotherapy agents. Targeting the EGFR could represent a significant contribution to cancer therapy, mainly the non-small-cell lung cancer.


Keywords: Lung neoplasms. Tumor markers. Receptor epidermal growth factor.


Case Report

7 - Pulmonary artery aneurysm as a manifestation of Behçet disease: case report and review

Aneurisma de artéria pulmonar como manifestação da doença de Behçet

Marcos Naoyuki Samano, Renata Teixeira Ladeira, Luiz Pedro Meirelles, Paulo Manuel Pêgo-Fernandes

J Bras Pneumol.2002;28(3):150-154

Abstract PDF PT Portuguese Text

Behçet disease has been associated to pulmonary manifestations and may be lethal if not treated correctly. The authors describe a case of a 53 year-old male with aneurysmatic pulmonary artery dilatation, pulmonary hypertension, and hemoptysis. A review is presented about the diagnosis and the medical and surgical treatment of this disease.


Keywords: Behcet's syndrome. Pulmonary artery. Pulmonary hypertension. Aneurysm. Hemoptysis.


8 - Recurrent pneumonias in patient with antibody deficiency and normal immunoglobulins

Pneumonias de repetição em paciente com deficiência de anticorpos e imunoglobulinas normais

Beatriz Tavares Costa-Carvalho, Renata Rodrigues Cocco, Waldinei M. Rodrigues, Viviane A. Colla, Dirceu Solé, Magda M. Carneiro-Sampaio

J Bras Pneumol.2002;28(3):155-158

Abstract PDF PT Portuguese Text

The authors report the case of a 7-year-old girl, with a history of recurrent respiratory infections since five months of age. Immunological evaluation at four years of age revealed a normal level of total serum immunoglobulins, but a deficient humoral response to Streptococcus pneumoniae. Although having all normal IgG subclasses, the patient had inadequate antibody levels to all serotypes tested (1, 3, 5, 6, 9, and 14). Concurrent radiological evaluation showed diffuse atelectasis and bronchiectasis. Patient was started on IVIG, and subsequent chest CT scan revealed resolution of the above-mentioned lesions. To prevent irreversible damage to lung parenchyma, due to recurrent lower respiratory infections, it is important to identify immunocompromised individuals and treat them accordingly.


Keywords: Immunologic deficiency syndromes. Streptococcus pneumoniae.


9 - Pancreatic pseudocyst associated to massive pleural effusion

Pseudocisto de pâncreas associado a derrame pleural maciço

Evandro Monteiro S. de Magalhães, Joaquim Carlos Ávila Terra, Luciana Borém Pimenta de Figueiredo, Luís Henrique Serra Miranda

J Bras Pneumol.2002;28(3):

Abstract PDF PT Portuguese Text

The authors report a case of pancreatic pseudocyst associated with massive pleural effusion. The patient was submitted to X rays, REED, ultrasonography, thoracoabdominal computerized tomography and amylase dosing in the pleural liquid. Clinical treatment included dietary support and thoracocentesis with drainage of about 3,200 ml. Patient was submitted to laparotomy to remove the pseudocyst, and was discharged in good clinical conditions. Based on this report, the authors analyze and review the literature for the occurrence of pleural effusion associated with pancreatic diseases and diagnoses.


Keywords: Pancreatic pseudocyst. Pleural effusion. Computerized X-ray tomography. Laparotomy.


10 - Benign schwannoma of the posterior mediastinum with a dumbbell-shaped lesion traversing the trachea

Schwannoma benigno do mediastino posterior com desenvolvimento em ampulheta para a traquéia

Fernando Luiz Westhhal, Augusto Castilho, Arteiro Queiroz Menezes

J Bras Pneumol.2002;28(3):

Abstract PDF PT Portuguese Text

Benign schwannoma tumors are the most common primary tumors of the posterior mediastinum. They may develop into a dumbbell-shaped involvement of the medullar channel, but rarely reach the tracheobronchial tree. The authors report a case of a 45-year-old female patient with a benign schwannoma in the posterior mediastinum, with a dumbbell-shaped lesion that traverses the intercartilaginous septa of the trachea. The tumor was resected by endoscopy in the endotracheal portion and afterwards by thoracotomy of the mediastinal tumor. Eight months after the surgery, there has been no recurrence of the lesion.


Keywords: Mediastinal neoplasms. Thoracotomy. Thoracoscopy. Mediastinal cyst.


11 - Chronic hypersensitivity pneumonia: analysis of eight cases and review of the literature

Pneumonia de hipersensibilidade crônica: análise de oito casos e revisão da literatura

Maria de Fátima do Amparo Teixeira, Patrícia Gioia de Assis, Luiz Cláudio Lazzarini-de-Oliveira

J Bras Pneumol.2002;28(3):167-172

Abstract PDF PT Portuguese Text

Hypersensitivity pneumonitis is an immunologic lung disease caused by chronic inhalation of chemicals or organic dusts. Its chronic stage makes diagnosis more difficult because other interstitial diseases share the same clinical and radiological presentation, usually requiring open lung biopsy to confirm the diagnosis. The authors reviewed the confirmed cases in the last 11 years at the Thoracic Diseases Institute [Instituto de Doenças do Tórax] of the Rio de Janeiro Federal University [UFRJ]. In this period, eight cases were confirmed by histopathological studies. Main symptoms were dyspnea and coughing. All cases showed interstitial infiltrates on radiological studies and restrictive functional patterns were found in 70% of the cases. All seven patients treated with corticosteroids responded with improved clinical symptoms, although some did not have radiological or functional response. Once the diagnosis is established, patients must avoid the causative environment because the disease may progress to fibrosis if exposition continues.


Keywords: Extrinsic allergic alveolitis. Case-control studies. Diagnosis.


Letters to the Editor

12 - A tuberculose e o casamento

Rubens Bedrikow

J Bras Pneumol.2002;28(3):173-174



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