Brazilian Journal of Pulmonology

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

SBPT

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Year 2002 - Volume 28  - Number 5  (September/October)






Editorial

1 - A honra de poder servir à Sociedade Brasileira de Pneumologia e Tisiologia (SBPT)

Thaís Helena Abrahão Thomaz Queluz

J Bras Pneumol.2002;28(5):v-

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Original Article

2 - Comparative study of prognostic factors among longer and shorter survival patients with bronchogenic carcinoma

Estudo comparativo dos fatores prognósticos entre os pacientes com maior e menor sobrevida em portadores de carcinoma broncogênico

Sérgio Jamnik, Ilka Lopes Santoro, César Uehara

J Bras Pneumol.2002;28(5):245-249

Abstract PDF PT Portuguese Text

Despite the improvements seen in the treatment of lung cancer, little has improved in the survival of these patients, and a great importance is attributed to the factors that have a role to play in such survival. Purpose: To check for possible prognostic factor differences in two populations of lung cancer patients, one of them with short survival (less than six months), and the other with longer survival (more than 24 months). Methods: From 1997 to 1999, 52 patients with histopathologic diagnosis of homogenous carcinoma were studied, and demographics, clinical parameters, smoking pattern, Karnofsky's index, disease staging, and laboratory dosing of lactic dehydrogenase, alkaline phosphatase, carcinoembryonic antigen, and calcium data were surveyed. Results: 29 patients had less than six month survival, and 23 had more than 24 month survival. The three most important factors for short survival were the low initial Karnofsky's index, loss of appetite, and high serum LDH levels. Conclusion: The three prognosis components are: current physical status, prior physical status, and current status of the disease.

 


3 - Evaluation of the risk of bacterial contamination in the patient submitted to bronchoscopy, after reprocessing the bronchoscope

Avaliação do risco de contaminação por bactérias, no paciente submetido à broncoscopia, após o reprocessamento do broncoscópio

Nancy Spekla Grande, Romilda Aparecida Nakayama, Antonia Maria de Oliveira Machado, Fábio Akio Yamaguti, Cesar Uehara

J Bras Pneumol.2002;28(5):250-260

Abstract PDF PT Portuguese Text

Introduction: Bronchoscopic is a diagnostic and therapeutic procedure performed by introducing a flexible tube in the airways that allows for the visualization even of the smallest airways. In order to prevent or reduce the risk of infection, the bronchoscope must be adequately disinfected with at least high level disinfection. Purpose: Check for the risk of bacterial contamination for patients submitted to bronchoscopy at the Hospital São Paulo of Unifesp University, State of São Paulo. Methods: From 1997 to 1998, bronchoscope reprocessing included cleaning, rinsing with sterile or potable water, followed by rinsing with 2% glutaraldehyde for 20 minutes, rinsing again with sterile or potable water, and rinsing with 70% ethyl alcohol, and forced-air drying through the suction channel. Samples of 65 patients were collected for microbiologic tests by instilling sterile saline solution through the suction channel of the bronchoscope. Results: After reprocessing, the following were found in the samples: Staphylococcus epidermidis, Enterobacter sp, Acinetobacter baumanni, Streptococcus viridans, Staphylococcus aureus, Streptococcus beta hemoliticus A, Staphylococcus coagulase negative, and mycobacterial growth was found in the culture of five samples. Conclusions: Bronchoscope disinfection with 2% glutaraldehyde was not sufficient to assured disinfection of the scope and the presence of Staphylococcus epidermidis shows that there was bronchoscope contamination due to handling after disinfection.

 


4 - Environment and lung

Ambiente e pulmão

Maria João Marques Gomes

J Bras Pneumol.2002;28(5):261-269

Abstract PDF PT Portuguese Text

The human body is exposed to different environmental aggressions; accidents, physical, chemical, and microbiological agents are a permanent risk. The respiratory system is particularly exposed to environmental aggressions and is frequently ground of alterations with greater or lesser intensity and danger. The authors review the consequences of air pollution on the respiratory system. They define air pollution, indoor and outdoor pollution, and primary and secondary pollution. They briefly review respiratory system defense mechanisms and describe harmful actions of different air pollutants to airways: SO2, NO2, CO, O3, aerosols and particles. They point to the consequences of tobacco smoking due to its importance to health. They conclude with comments on the intervention that Pneumology and Pneumologists should have in this matter, drawing the attention of the community and authorities to the risks of pollution to health in general and to the respiratory system in particular.

 


5 - Evaluation of glucose metabolism in active lung tuberculosis by positron-emission tomography (18F-FDG PET)

Estudo do metabolismo da glicose na tuberculose pulmonar ativa utilizando a tomografia por emissão de pósitrons (18F-FDG PET)

Sidney Bombarda, José Soares Júnior, Mário Terra Filho

J Bras Pneumol.2002;28(5):270-276

Abstract PDF PT Portuguese Text

Current methods to evaluate lung tuberculosis include chest radiography and computed tomography. Nuclear medicine imaging techniques are performed after administration of specific radiopharmaceuticals that accumulate in the organs of interest. Alterations of glucose metabolism can be observed by positron-emission tomography, using 18F-fluorodeoxyglucose (18F-FDG PET). These findings are present in the neoplasms, but also in inflammatory and infectious diseases. Tuberculosis is a granulomatous disease caused by Mycobacterium tuberculosis, that uses glucose as an energy source. Purpose: The study of glucose metabolism in lung tuberculosis by PET and the comparison of this results to CT scan findings. Material and methods: Twenty patients with active lung tuberculosis were evaluated. The 18F-FDG PET and computed tomography were performed in all patients, after the diagnosis and until 30 days of treatment. Results of both methods were compared. Results: All patients showed 18F-FDG positive uptake. On the computed tomography, all patients showed signs compatible with tuberculosis. The sensitivity of both methods was of 100%. There was significant concordance between the two methods (K = 0.27). Conclusions: The study concludes that glucose metabolism is modified in lung tuberculosis. There was concordance in the anatomic changes observed on computed tomography.

 


Case Report

6 - Non-conventional therapies to manage refractory acute asthma attack

Uso de terapias não convencionais no manejo da crise aguda de asma refratária

Raquel Hermes Rosa Oliveira, Alexandre de Oliveira Ribeiro, Gustavo Adolpho Junqueira Amarante, Miguel Lia Tedde

J Bras Pneumol.2002;28(5):277-280

Abstract PDF PT Portuguese Text

A patient with an acute asthma attack refractory to inhaled and intravenous b2-agonist, aminophylline and corticosteroids was submitted to mechanical ventilation and treated with non-conventional therapies: bronchoscopy with bronchoalveolar lavage using N-acetylcysteine and halothane inhalation. The ventilatory parameters improved after lavage, however, bronchospasm resolution occurred only after anesthesia which was followed by extubation and discharge from the ICU. A review of the use of these non-conventional therapeutic modalities for the management of acute asthma attack is presented.

 


7 - Chronic eosinophilic pneumonia

Pneumonia eosinofílica crônica

Alessandra Isabel Zille, Christiano Perin, Geraldo Resin Geyer, Jorge Lima Hetzel, Adalberto Sperb Rubin

J Bras Pneumol.2002;28(5):281-284

Abstract PDF PT Portuguese Text

Chronic eosinophilic pneumonia is a rare disease of unknown cause characterized by eosinophilic alveolar and interstitial infiltration. The authors describe the case of a 49-year-old caucasian woman, presenting dyspnea on minimum effort, with insidious beginning and progressive course in the last six months. The main findings were serum eosinophilia and in the sputum, chest radiographs showing multifocal infiltrations of irregular distribution in both lungs and a restrictive functional impairment. The patient was submitted to an open lung biopsy, which demonstrated a chronic eosinophilic pneumonia. There was a dramatic clinical, radiological, and functional response after corticosteroid therapy.

 


8 - Pleural effusion: an extraintestinal complication of Crohn's disease

Derrame pleural: uma complicação extra-intestinal da doença de Crohn

Elie Fiss, Flavio Steinwaurz, Andrea Barranjard Vannucci, Camila de Menezes Succi

J Bras Pneumol.2002;28(5):285-287

Abstract PDF PT Portuguese Text

A 34-year-old patient had had Crohn's disease (CD) for eight years; she was seen for complaints of thoracic pain and fever, without gastrointestinal manifestations. Initial laboratory exams were compatible with the presence of inflammatory activity (VHS = 45 mm for normal value of 20 mm and PCR+). The physical exam revealed signs of pleural effusion in the left hemithorax base, which was confirmed by thoracic RX. The pleural liquid analysis showed that the cells were 100% of lymphocytes, with negative BAAR research. The pleural biopsy evidenced non caseous granuloma. Despite the tuberculosis treatment, the patient only got better when corticotherapy was introduced in high doses, suggesting the activity of CD as the cause of the pleural effusion. This case establishes a connection between activity of CD and manifestations of lung disease.

 


Review Article

9 - Superior vena cava syndrome

Síndrome de veia cava superior

Samuel Zuínglio de Biasi Cordeiro, Paulo de Biasi Cordeiro

J Bras Pneumol.2002;28(5):288-293

Abstract PDF PT Portuguese Text

Lung cancer is now the main cause of blood flow obstruction in the superior vena cava and of its clinical manifestations. History tells that in the 18th Century, syphilis and tuberculosis were responsible for 40% of the known cases. The knowledge of hemodynamic changes seen in this syndrome and the improvement of diagnostic and cytopathologic techniques allow for a safer and more comfortable treatment of the patient than 10 years ago. Contrast CT and MR added to the identification and location of the obstruction, and older techniques such as cavography could be abandoned. SVC obstruction diagnosis and Doppler studies carried out at the bed of the patient contribute to deobstruction procedures such as transluminal percutaneous angioplasty in cases of thrombosis and venous stenosis. In addition, the use of prostheses is of great importance in the management of cases utilization of traumatic lesion to the SVC during lung or mediastinal cancer surgeries. In the realm of radiotherapy, the fractionating technique allows for the administration of high doses of irradiation to cancer patients with benefits to 70% of the cases on the average.

 


10 - Screening for lung cancer: past, present and future

Protocolos de rastreamento para o diagnóstico precoce do câncer de pulmão: passado, presente e futuro

Thamine Lessa E.S. Andrade, Soria Ramos-Barbosa, Jorge L. Pereira-Silva

J Bras Pneumol.2002;28(5):294-301

Abstract PDF PT Portuguese Text

Lung cancer is the leading cause of death from cancer. More people die each year of bronchial carcinoma than of colon, breast, and prostate cancer combined. More than 50% of the patients will have distant metastases at diagnosis and only 20-25% of these will be localized and potentially resectable, with a five-year survival of 14%. Prior chest radiographs and sputum cytology studies lead to clinically meaningful improvements in stage distribution, resectability and survival, but no disease-specific mortality reductions have been demonstrated. More recently, these techniques have evolved to those of screening by low-dose spiral computed tomography and by the use of specific biomarkers for early detection, thus bringing back interest in lung cancer screening. The authors review screening for lung cancer made in the past, analyze more recent prospective studies, and the prospects for the future, and they point to their main limitations, methodological problems in design, major biases, all of which may invalidate the interpretation of results.

 


Letters to the Editor

 


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