Brazilian Journal of Pulmonology

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

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Year 2003 - Volume 29  - Number 2  (March/April)






Editorial

1 - Pleurodese: qual agente deve ser utilizado?

Richard W. Light

J Bras Pneumol.2003;29(2):53-54

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2 - Fatores de risco para tuberculose multirresistente adquirida

Afrânio Lineu Kritski

J Bras Pneumol.2003;29(2):55-56

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Original Article

3 - Pleurodesis induced by intrapleural injection of silver nitrate or talc in rabbits. Can it be used in humans?

Pleurodese induzida pela injeção intrapleural de nitrato de prata ou talco em coelhos: há perspectivas para o uso em humanos?

Francisco S. Vargas, Leila Antonangelo, Marcelo A.C. Vaz, Evaldo Marchi, Vera Luiza Capelozzi, Eduardo H. Genofre, Lisete R. Teixeira

J Bras Pneumol.2003;29(2):57-63

Abstract PDF PT Portuguese Text

Objective: To evaluate the pleurodesis and the lung damage caused by intrapleural silver nitrate or talc in an experimental model in rabbits to consider the use in human beings. Design: 112 rabbits were randomized to receive intrapleural 0.5% silver nitrate or 400 mg/kg talc slurry in 2 ml saline. Eight rabbits in each group were sacrificed 1, 2, 4, 6, 8, 10, or 12 months post injection. The degree of pleurodesis (gross pleural fibrosis and inflammation), lung damage (collapse and edema), and cellular infiltrates were graded on a 0 to 4 scale. Results: The intrapleural injection of silver nitrate produced a better pleurodesis than did the intrapleural injection of talc slurry. The lung damage was moderate 1 month after silver nitrate and greater than after talc. They were similar as from the second month. Conclusions: The better pleurodesis induced by silver nitrate persists for at least one year. The more evident lung damage after silver nitrate was mild with reversible changes which show a clear tendency to normalize with time. For these reasons, the efficacy of silver nitrate as a sclerosing agent in humans should be evaluated.

 


Keywords: Pleurodesis. Talc. Silver nitrate. Pleural effusion.

 

4 - Sleep pattern in patients with COPD and correlation among the gasometric, spirometric, and polysomnographic variants

Padrão do sono em pacientes portadores de doença pulmonar obstrutiva crônica e correlação entre variáveis gasométricas, espirométricas e polissonográficas

Carlos Eduardo Ventura Gaio dos Santos, Carlos Alberto de Assis Viegas

J Bras Pneumol.2003;29(2):69-74

Abstract PDF PT Portuguese Text

Objective: There are few studies on chronic obstructive pulmonary disease (COPD) establishing differences between the functional parameters of the disease and variants of sleep. The aim of the authors is to describe the sleep patterns of these patients and to investigate possible correlations among spirometric, gasometric, and polysomnographic variants. Methods: Transversal study using patients with COPD, submitted to spirometry, arterial gasometry, and polysomnography. Results: 21 male patients were studied with average age = 67 ± 9, 7 ± 4 average points in the Epworth sleep scale, average FEV1/FVC% = 54 ± 13.0, average PaO2 = 68 ± 11 mmHg, average PaCO2 = 37 ± 6 mmHg. Sleep efficiency decreased (65 ± 16%) with the decrease in slow wave sleep (8 ± 9%) and in rapid eye movement (REM) sleep (15 ± 8%). Average T90 = 43 ± 41%. Average apnea-hypopnea index (AHI) = 3 ± 5/h, two patients (9.5%) presented overlap syndrome. In the correlation analysis a correlation was observed between PaO2 and T90 (p < 0.01), PaCO2 and T90 (p < 0.05), and AHI and the cardiac rate in REM (p < 0.01). There was no correlation between spirometric and polysomnographic variants. Conclusion: The low sleep efficiency, the high number of awakenings, and shift in stages show the low quality of sleep. There were no linear correlations between the spirometric and polysomnographic variants.

 


4 - Profile of a Brazilian population with chronic obstructive pulmonary disease

Perfil de uma população brasileira com doença pulmonar obstrutiva crônica grave

Mateo Sainz Yaksic, Mauro Tojo, Alberto Cukier, Rafael Stelmach

J Bras Pneumol.2003;29(2):64-68

Abstract PDF PT Portuguese Text

Chronic obstructive pulmonary disease (COPD) is a public health problem. Tobacco smoking is the major cause, but not the only one. Air pollution, exposure to chemical compounds, environmental smoke exposure, and environmental tobacco smoke are among other contributing causes; viral and bacterial infection are risk factors too. Gender and weight loss are associated to the severity of the disease. Co-morbidity is frequent. Objective: To characterize a population of COPD outpatients followed at a tertiary medical service. Methods: Questionnaires were applied to patients with COPD. The data included gender, age, weight, body mass index (BMI), oxygen delivery users, and FEV1, exposure to tobacco smoke, exposure to wood smoke, tuberculosis antecedent and co-morbid diseases. Results: Of the 70 patients enrolled in the study, 70% (49) were male with an average age of 64 ± 10 years, an average weight of 63 ± 16 kg and an average BMI of 22 ± 5 kg/m2. 45,7% were oxygen dependent and the FEV1 average was 35 ± 14%. Nine (12.8%) patients never smoked, while 78.8% had quit tobacco smoking, (38 ± 11 pack/years was the average). Nine (12.8%) smoked straw cigarettes. Eighteen (25.7%) had environmental exposure to wood smoke. Eleven (15.7%) patients had tuberculosis, 5.7% complained of asthma symptoms, 2.8% had bronchiectasis, 11.4% diabetes mellitus, 51.4% hypertension, and 20% Cor pulmonale. Conclusion: Other possible COPD etiologies must be investigated. Determinants for the pulmonary injury could be environmental smoke exposure associated to former infections. Men with low BMI are typically representative of this severe patient population. Hypertension and Cor Pulmonale are frequent co-morbidity factors.

 


6 - Inhaled medication on asthma management: evaluation of how asthma patients, medical students, and doctors use the different devices

Inalantes no tratamento da asma: avaliação do domínio das técnicas de uso por pacientes, alunos de medicina e médicos residentes

Janaína Barbosa Muniz, Carlos Roberto Padovani, Irma Godoy

J Bras Pneumol.2003;29(2):75-81

Abstract PDF PT Portuguese Text

Asthma is characterized by variable airflow obstruction, hyperresponsiveness of airways to endogenous or exogenous stimuli and inflammation. Inadequacy of the techniques to use different inhalation devices is a cause of no response to treatment. The main purpose of this study was to evaluate how 20 medical students, 36 resident physicians on Internal Medicine/Pediatrics, and 40 asthma patients used three devices for inhalation therapy containing placebo. All patients were followed at the Pulmonary Outpatient Service of Botucatu Medical School and had been using inhaled medication during the last six months. The following devices were evaluated: metered dose inhalers (MDI), dry powder inhalers (DPI), and MDI attached to a spacer device. A single observer applied a protocol containing the main steps necessary to obtain a good inhaler technique to follow and grade the use of different devices. Health care professionals tested all three devices and patients tested only the device being used on their management. MDI was the device best known by doctors and patients. MDI use was associated with errors related to the coordination between inspiration and device activation. Failure do exhale completely before inhalation of the powder was the more frequent error observed with DPI use. In summary, patients have not been receiving repeated instruction on how to use inhaled medication and health care professionals are not well prepared to adequately teach their patients.

 


7 - Mortality due to pneumoconioses in macro regions of Brazil in the 1979-1998 period

Mortalidade por pneumoconioses nas macrorregiões do Brasil no período de 1979-1998

Hermano Albuquerque de Castro, Genésio Vicentin, Kellen Cristina Xavier Pereira

J Bras Pneumol.2003;29(2):82-88

Abstract PDF PT Portuguese Text

Pneumoconioses make up a group of lung diseases related to exposure to mineral dusts in work environments. This is a public health problem as such diseases could have already been eradicated in Brazil with the use of control measures in such environments. The aim in this paper was to map the distribution of deaths due to pneumoconioses in the different Brazilian geographical areas and states through an ecological survey carried out among the working population older than 15 years. The preliminary results of this investigation in the Brazilian macro regions in the period from 1979 to 1998 are presented. This study used mortality data from the Mortality Information System of Datasus - Data Processing Department of the Unified Health System, including codes from International Classification of Diseases (ICD) 9 and ICD 10. The results showed an increase of the coefficient of deaths due to pneumoconioses per 1 million inhabitants per year throughout this period. The shift from ICD 9 to ICD 10 showed an increase in the frequency of deaths, which was twice as high. As a conclusion, the coefficients of deaths due to pneumoconiosis does not describe this problem adequately, thus obscuring the transcendence and magnitude of the disease. To obtain more representative indicators it is necessary to know the population really exposed and the territorial distribution of the disease.

 


8 - Risk factors associated to acquired multidrug resistant tuberculosis

Fatores de risco para tuberculose multirresistente adquirida

Elizabeth Clara Barroso, Rosa Maria Salani Mota, Raimunda Oliveira Santos, Ana Lúcia Oliveira Sousa, Joana Brasileiro Barroso, Jorge Luís Nobre Rodrigues

J Bras Pneumol.2003;29(2):89-97

Abstract PDF PT Portuguese Text

Multidrug resistant tuberculosis (MDR-TB) is a serious, feared, and difficult to control problem, and is showing a growing tendency worldwide. Objective: To make a risk factors analysis for acquired MDR-TB. Methods: A population-based case-control study was conducted in a retrospective way. Multidrug resistance was defined as resistance to at least Rifampin (RFM) + Isoniazid (INH), and susceptible TB was defined as the case that had had the first treatment in a period similar to the first treatment of the MDR-TB cases, but that was cured at the moment of the interview. The selection of cases was made based on the list of Susceptibility Tests (ST) carried out at the Central Laboratory of Public Health of the State of Ceará, in the period 1990 to 1999. The Proportion Method was used to make a survey of resistance to the six antituberculosis drugs (isoniazid, rifampin, pyrazinamide, ethambutol, ethionamide, streptomycin) that represent the standard treatment in Brazil. Controls were selected from the book of registry of TB cases. Univariate and multivariate analysis was performed and statistical significance was considered with a p value < 0.05. Results: Of the 1,500 ST performed in the period, 266 strains were multidrug resistant. Only 153 patients were identified. Of these, 19 were excluded. The Group of Cases comprised 134 patients and the Controls, 185. The following risk factors were found after the multivariate analysis: lack of sewer in the domicile, alcoholism + tobacco smoking, number of previous treatments, irregular treatments and lung cavities. Conclusion: Based on the evidence, conclusion is that these five factors play a role in the development of acquired MDR-TB, and that neutralizing such factors can contribute to the control of tuberculosis.

 


Case Report

9 - Tuberculosis pericarditis in patients with AIDS

Pericardite tuberculosa em portadores da síndrome de imunodeficiência adquirida

Ruggero Bernardo Guidugli, Paul Albert Hamrick, Nancy Figueiroa de Rezende

J Bras Pneumol.2003;29(2):98-100

Abstract PDF PT Portuguese Text

Two quite dyspneic HIV positive patients were admitted to the Emergency Room; they presented with aspects and images suggesting pericardial effusion. The analysis of an initial liquid puncture did not show any specificity and the patients did not register any clinical improvement. Both patients were submitted to a subxiphoid pericardial window, all the effusion liquid was drained, and a biopsy of the pericardium tissue was completed revealing a granulomatous process. Good evolution was the result of specific treatment. Such findings draw attention to a high possibility of pericardial suffusion in AIDS patients being tuberculosis, in particular if one considers the high prevalence of this disease in Brazil. The results also showed that the opening of a subxiphoid pericardial window and the specific triple scheme is a procedure that leads to good therapeutic evolution in this kind of patients.

 


Review Article

10 - Reexpansion pulmonary edema

Edema pulmonar de reexpansão

Eduardo Henrique Genofre, Francisco S. Vargas, Lisete R. Teixeira, Marcelo Alexandre Costa Vaz, Evaldo Marchi

J Bras Pneumol.2003;29(2):101-106

Abstract PDF PT Portuguese Text

Reexpansion pulmonary edema (RPE) is a rare, but frequently lethal, clinical entity. The precise pathophysiologic abnormalities associated with this disorder are still unknown: decreased surfactant levels and a pro-inflammatory status are putative mechanisms. Early diagnosis is crucial, since prognosis depends on early recognition and prompt treatment. Considering the high mortality rates related to RPE, preventive measures are still the best available strategy for patient handling. This review provides a brief overview of the pathophysiology, diagnosis, treatment, and prevention of RPE, with practical recommendations for adequate intervention.

 


11 - Chronic obstructive pulmonary disease and malnutrition: why aren't we winning this battle?

Doença pulmonar obstrutiva crônica e desnutrição: por que não estamos vencendo a batalha?

Ivone Martins Ferreira

J Bras Pneumol.2003;29(2):107-115

Abstract PDF PT Portuguese Text

Objectives: To perform a review of the mechanisms involved in the origin of malnutrition in patients with chronic obstructive pulmonary disease (COPD) and a systematic review of randomized controlled studies to clarify the contribution of nutritional supplementation in patients with stable COPD. Methods: Systematic review of article published in this subject, in all languages from several sources, including Medline, Embase, Cinahl and Cochrane Registry in COPD, as well as studies presented in American and European. Results: Studies with nutritional supplementation longer than two weeks showed that the effect was not big and did not reach statistical significance. A study with linear regression showed that old age, relative anorexia, and high inflammatory response are associated with non-response to nutritional therapy. Conclusion: Currently, there is no evidence of the efficacy of nutritional supplementation in patients with COPD. Factors related to lack of response suggest a relationship with the degree of inflammation, including high levels of TNF alpha. Measuring inflammation markers may be useful to determine prognostic and adequate therapy. Treatment with anti-inflammatory cytokines or cytokine inhibitors are promising for the future.

 


 


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