Brazilian Journal of Pulmonology

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

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Year 2003 - Volume 29  - Number 4  (July/August)






Editorial

1 - Baixa estatura mas alta espirometria

Noé Zamel

J Bras Pneumol.2003;29(4):175-

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2 - Monitoração da inflamação das vias aéreas na asma

Mark D. Inman

J Bras Pneumol.2003;29(4):176-

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Original Article

3 - Questionnaire of quality of life in patients with primary hyperhidrosis

Questionário de qualidade de vida em pacientes com hiperidrose primária

José Ribas Milanez de Campos, Paulo Kauffman, Eduardo de Campos Werebe, Laert Oliveira Andrade Filho, Sergio Kuzniek, Nelson Wolosker, Fábio Biscegli Jatene, Mariane Amir

J Bras Pneumol.2003;29(4):178-181

Abstract PDF PT Portuguese Text

Background: Hyperhidrosis or excessive sudoresis is a chronic disease associated with important subjective distress. Objective: To propose a specific questionnaire to evaluate the quality of life of patients with hyperhidrosis. Methods: From October 1995 to March 2002, 378 patients (234 females), with a mean age of 26.8 years, were evaluated before and after video-assisted thoracic sympathectomy. Results: Therapeutic success was obtained in 90% of the procedures. The recurrence rate was 10% for palmar and 11% for axillary hyperhidrosis; 27% of the patients who had recurrence were re-operated successfully. No serious complications were reported. Of the total number of patients, 91% answered to the quality of life questionnaire, and 86% of them reported improvement after the procedure. Conclusions: Thoracic sympathectomy is a therapeutic method capable of changing the quality of life of patients with hyperhidrosis. The questionnaire applied has shown these changes.

 


Keywords: Thoracic sympathectomy. Quality of life.

 

4 - Spirometric values in children and adolescents with short stature

Valores espirométricos de crianças e adolescentes com baixa estatura

Naiza Alessandra Dorneles, Nelson Augusto Rosário Filho, Carlos Antônio Riedi, Margareth Cristina Boguszewski, João Adriano de Barros

J Bras Pneumol.2003;29(4):182-187

Abstract PDF PT Portuguese Text

Background: Several factors influence the pulmonary function values considered normal. In children of short stature, there are difficulties in interpreting the pulmonary function. Objective: To assess spirometric values in children and adolescents with short stature and to identify a correction factor to adequately predict the expected values for this population. Method: A prospective selection of 77 patients was made, all with short stature and no respiratory disease. These patients were submitted to spirometry, transcutaneous hemoglobin oxygen saturation, chest perimeter measurement, and immediate hypersensitivity testing. Bone age was assessed by wrist X-rays. The data obtained by spirometry (FVC, FEV1, and FEF25-75%) were compared with those of Polgar and Promadhat (1971), predicted in three ways: a) by actual height; b) by height estimated at the 50th percentile for chronological age (CA); c) by height estimated at the 50th percentile for bone age (BA). Results: The mean height was 133.3 ± 13.2 cm, and the deficit in relation to the third percentile was 5.4 ± 6.0 cm. The values obtained for FVC, FEV1, FEF25-75%, were significantly higher than those predicted by actual height. The mean FEV1 obtained was 2.42 ± 0.71 L, and the predicted (actual height) was 2.10 ± 0.64 L; according to the height estimated by BA and CA, the values were 2.27 and 2.86 L, respectively. The mean FVC1 was 2.20 ± 0.6 L, and the predicted was 1.90 ± 0.55 L. With the height estimated for bone age and chronologic age, the predicted values were 2.10 and 2.60 L, respectively. Conclusion: Children and adolescents with short stature have higher spirometric values than predicted for their actual height. These findings suggest that the height estimated at the 50th percentile for bone age can be used to evaluate pulmonary function.

 


Keywords: Lung function. Short stature.

 

5 - Airway inflammation in steroid-naïve asthmatics: characteristics of induced sputum

Inflamação das vias aéreas em asmáticos virgens de tratamento com esteróides: características do escarro induzido

Simone Van de Sande Lee, Marcia Margaret Menezes Pizzichini, Leila John Marques, Samira Cardoso Ferreira, Emilio Pizzichini

J Bras Pneumol.2003;29(4):188-195

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Background: Airway inflammation, acknowledged as an important feature of asthma, can be assessed by the examination of induced sputum. Objective: To determine the pattern of inflammatory cells in induced sputum from stable steroid-naïve asthmatics, in Florianópolis, Santa Catarina. Method: The induced sputum from 34 asthmatics using exclusively inhaled bronchodilators on demand was examined. The patients' clinical characteristics were obtained at visit 1, and sputum was induced at visit 2. Differential cell count was performed on Giemsa-stained cytospins. Sputum was considered to be eosinophilic if there were ³ 3% eosinophils, and neutrophilic if there were ³ 65% neutrophils. Results: Results are expressed by median and interquartile range. The total cell count was 3.4 (3.7) x 106 cells/ml, and cell viability was 80.0 (16.4) %. The proportion of neutrophils was 14.4 (22.1) %, of eosinophils 6.4 (17.2) %, of macrophages 60.3 (37.5) %, and of lymphocytes 1.1 (1.2) %. Eosinophilic sputum was observed in 24 subjects (70.6%); none of them had neutrophilic sputum. There were no significant differences between the eosinophilic and non-eosinophilic groups concerning the measured clinical outcomes, total cell count and proportions of cells in the sputum, except for the proportion of eosinophils (14.4 [19.3] vs 0.4 [1.1], p < 0.001). Conclusions: In our environment, steroid-naïve asthmatics present a higher proportion of sputum eosinophils, as compared to the established reference values. The clinical and physiological parameters analyzed were unable to predict the presence of eosinophilic inflammation of the airways.

 


Keywords: Asthma. Inflammation. Sputum. Eosinophils. Neutrophils.

 

6 - Relationship between functional and X-ray alterations in patients with cystic fibrosis

Relação entre alterações funcionais e radiológicas em pacientes com fibrose cística

Andréia Kist Fernandes, Felipe Mallmann, Ângela Beatriz John, Carlo Sasso Faccin, Paulo de Tarso Roth Dalcin, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2003;29(4):196-201

Abstract PDF PT Portuguese Text

Background: Cystic fibrosis (CF) is a disease marked by airway inflammation and airflow obstruction, resulting in air trapping in the lungs. Objective: To assess the associations between airflow limitation, pulmonary volume and X-ray findings in patients with cystic fibrosis. Method: A cross-sectional retrospective study. Review of spirometric, plethysmographic, and chest X-ray findings of outpatients (age ³ 16 years). The airflow findings were classified as within normal limits or as airflow obstruction: mild, moderate or severe obstructive alteration. Results: A total of 23 patients (15 male and eight female; mean age, 21 ± 5.9 years) were studied. Six of them were within normal limits, four had a mild, five had a moderate, and eight had a severe obstructive alteration. There was an association between airflow limitation and the increase of residual volume (p = 0.006) and also with the Brasfield score (p = 0.001), but not with the total lung capacity (p = 0.33). There was a correlation between residual volume and Brasfield score (r = 0,73, p = 0,002), but not with the total pulmonary capacity. Moreover, according to X-ray criteria, the air trapping was correlated only with the residual volume (p = 0.006). Conclusion: In patients with cystic fibrosis (age ³ 16 years), the progressive airflow limitation is accompanied by an increase in residual volume, while the total pulmonary capacity remains normal or tends to decrease. The X-ray score was associated with airflow limitation and residual volume, but not with total lung capacity.

 


Keywords: Cystic fibrosis. Pulmonary disease. Lung volume measurements. Radiography, thoracic.

 

7 - Mediastinal diseases: clinical and therapeutic aspects

Doenças mediastinais: aspectos clínicos e terapêuticos

Roberto Saad Júnior, Maria Elisa Ruffolo Magliari, Júlio Mott Ancona Lopez

J Bras Pneumol.2003;29(4):202-207

Abstract PDF PT Portuguese Text

Background: Mediastinal affections are common and encompass a great number of different diagnoses. Objective: To analyze the clinical aspects and the therapeutic response of 114 patients with mediastinal diseases treated at the Thoracic Surgery Department of Santa Casa de São Paulo Hospital, from 1979 and 1997. Method: The patients were grouped according to the benign or malignant nature of the disease, and the two groups were compared regarding gender, age bracket, symptomatology, topography of the lesion, mortality, and response to treatment. Results: Sixty-three patients had neoplasia: 31 benign and 32 malignant. Fifty-one cases were not neoplastic. No difference was found between the groups regarding gender or age bracket. Half of the patients were between 20 and 49 years of age. The anterior mediastinum was the most frequently affected compartment (66 patients), followed by the upper mediastinum (18 patients), the posterior mediastinum (16 patients), and the middle mediastinum (14 patients). The most frequent histological types were: benign thymus diseases (N = 40), mesenchymal tumors (N = 17), lymphomas (N = 15), neural tumors (N = 9), and germ cell tumors (N = 8). Malignant tumors were more frequently symptomatic (91%), and benign tumors were more frequent in asymptomatic patients (92%). The most frequent symptoms were related to myastenia gravis, followed by dyspnea and chest pain. Weight loss, anorexia and fever were significantly more frequent in patients with malignant neoplasias. Conclusions: Regarding the clinical aspects we can state that benign lesions were predominant, that mediastinal diseases were more prevalent in young adults, and that benign lesions were more frequent in asymptomatic patients. Treatment (clinical/surgical) was effective in most patients, benefiting approximately 90% of the patients with benign affections and 45% of the patients with malignant tumors. In 73% of the benign affections, surgical treatment was capable of achieving the cure. Mortality resulting from complications was 1.75%.

 


Keywords: Key words - Mediastinum. Mediastinal disease/epidemiology. Mediastinal neoplasms.

 

8 - Comparing peak and sustained values of maximal respiratory pressures in healthy subjects and chronic pulmonary disease patients

Comparação entre os valores de pico e sustentados das pressões respiratórias máximas em indivíduos saudáveis e pacientes portadores de pneumopatia crônica

J Bras Pneumol.2003;29(4):208-212

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Background: The measurement of maximal inspiratory and expiratory pressures is useful for the evaluation of pulmonary function. However, the methods to obtain them are not always properly described. Objective: To identify the difference between the peak pressure values (Ppeak, the highest pressure reached) and the sustained pressure (Pmaxs, the highest pressure sustained for one second) in MIP and MEP evaluation. Method: 55 healthy individuals and 50 patients who were taking part in a pulmonary rehabilitation program, all of them with chronic pulmonary disease, were studied by recording their best maximal inspiratory pressure and maximal expiratory pressure tests. The peak and sustained pressure values were compared and analyzed to determine whether there was a difference between them. Results: The maximum inspiratory pressure records of healthy individuals showed that the maximal peak inspiratory pressure and the maximal inspiratory pressure found were, respectively, 102 ± 33 cmH2O and 92 ± 29 cmH2O (p < 0.001), and those of the patients participating in the pulmonary rehabilitation program were 75 ± 23 cmH2O and 67 ± 22 cmH2O (p < 0.001). The recorded values of maximal expiratory pressure, peak and maximal were 119 ± 42 cmH2O and 110 ± 39 cmH2O (p < 0.001), respectively, for healthy subjects, and 112 ± 40 cmH2O and 103 ± 36 cmH2O (p < 0.001) for the patients. Conclusion: There is a significant difference between Ppeak and Pmaxs, that can lead to different interpretations in the evaluation of the respiratory muscle strength. To minimize interpretation errors, the authors suggest the use of devices which record both values (peak and sustained).

 


Keywords: Pulmonary function tests. Respiratory muscles strength. Maximal respiratory pressures.

 

9 - Development of an experimental model of neutrophilic pulmonary response induction in mice

Desenvolvimento de um modelo experimental de indução de resposta pulmonar neutrofílica em camundongos

Leonardo Araújo Pinto, Camila Camozzato, Monique Avozani, Denise Cantarelli Machado, Marcus Herbert Jones, Renato Tetelbom Stein, Paulo Márcio Condessa Pitrez

J Bras Pneumol.2003;29(4):213-216

Abstract PDF PT Portuguese Text

Background: Several lung diseases are characterized by a predominantly neutrophilic inflammation. A better understanding of the mechanisms of action of some drugs on the airway inflammation of such diseases may bring advances to the treatment. Objective: To develop a method to induce pulmonary neutrophilic response in mice, without active infection. Methods: Eight adult Swiss mice were used. The study group (n = 4) received an intranasal challenge with 1 x 1012 CFU/ml of Pseudomonas aeruginosa (Psa), frozen to death. The control group (n = 4) received an intranasal challenge with saline solution. Two days after the intranasal challenge, a bronchoalveolar lavage (BAL) was performed with total cell and differential cellularity counts. Results: The total cell count was significantly higher in the group with Psa, as compared to the control group (median of 1.17 x 106 and 0.08 x 106, respectively, p = 0.029). In addition to this, an absolute predominance of neutrophils was found in the differential cellularity of the mice that had received the Psa challenge. Conclusion: The model of inducing a neutrophilic pulmonary disease using frost-dead bacteria was successfully developed. This neutrophilic inflammatory response induction model in Swiss mice lungs may be an important tool for testing the anti-inflammatory effect of some antimicrobial drugs on the inflammation of the lower airways.

 


Keywords: Animal experimentation. Lung disesases. Inflammation. Neutrophils. Pseudomonas.

 

Case Report

10 - Diffuse alveolar hemorrhage resulting from pauci-immune pulmonary capillaritis

Hemorragia alveolar difusa por capilarite pulmonar pauci-imune

Andreia Salarini Monteiro, Gabriela Addor, David Henrique Nigri, Wilhermo Torres, Carlos Alberto de Barros Franco

J Bras Pneumol.2003;29(4):217-220

Abstract PDF PT Portuguese Text

A 27 year-old female patient, cocaine user, presenting hemoptysis and progressive dyspnea with onset 48 hours prior to hospital admission, without any other signs or symptoms. Serum tests for infectious diseases, collagen disorders and vasculitis were negative. Urinalysis was type I. Computed tomography of the chest showed diffuse alveolar infiltrate, affecting mainly the lower left lobe. A thoracoscopic lung biopsy was performed to clarify the diagnosis. The histopathological findings showed capillaritis and diffuse intra-alveolar hemorrhage. Treated with steroid and cyclophosphamide pulse therapy, a good clinical and radiographical response was obtained. The recently described pauci-immune pulmonary capillaritis is characterized by the presence of isolated pulmonary capillaritis and negative serum testing for auto-immune diseases.

 


Keywords: Hemorrhage. Pulmonary alveoli/physiopathology.

 

11 - Silicosis associated with systemic lupus erythematosus

Associação de silicose e lúpus eritematoso sistêmico

Shirley Castro Holanda, Maria do Socorro T.M. Almeida, Antônio de Deus Filho

J Bras Pneumol.2003;29(4):221-224

Abstract PDF PT Portuguese Text

The hypothesis that exposure to silica might be associated with a wide range of autoimmune diseases including SLE (systemic lupus erythematosus) has been discussed over the last decade, but only few cases of silicosis and SLE were described in the literature. The authors report the case of a male patient in his fifth decade of life, with previous exposure to silica, who worked as a well digger for ten years. The patient's clinical picture started with articular symptoms, sporadic peaks of fever, anemia, positive antinuclear factor, peripheral (1/10) and homogeneous (1/500) standard, and productive cough. Computed tomography of the chest showed a diffuse interstitial process, bilateral nodules, para-aortic and para-tracheal hilar calcifications, compatible with pulmonary and ganglial silicosis. He developed acute respiratory distress syndrome (ARDS) and died.

 


Keywords: Systemic lupus erythematosus. Silicosis. Autoimmune diseases.

 

Review Article

12 - The value of cytology and pleural biopsy in the differential diagnostic of nonspecific pleural effusions

Valor de citologia e biópsia pleural no diagnóstico diferencial dos derrames pleurais indeterminados

Vera Luiza Capelozzi, Danieli Cheke da Rosa, Aloísio S. Felipe da Silva

J Bras Pneumol.2003;29(4):225-234

Abstract PDF PT Portuguese Text

A significant percentage of pleural effusions remains without a diagnostic explanation. In such circumstances, the anatomical-pathological result of nonspecific chronic pleuritis should be revised. This is an important issue, not only for the pathologist, but mainly for the pneumologist, who usually makes the clinical-pathological correlation during the routine practice. Although the existence of established criteria is accepted, they are certainly subjective and make the communication by means of a common language difficult, mainly among pathologists. The authors recently studied 311 pleural biopsies with histo-pathological diagnoses of chronic nonspecific pleuritis. All specimens were reviewed and the histo-pathological parameters quantified by stereology. The patients were stratified according to the final diagnosis of their disease, including cases of chronic renal failure, vasculitis, pancreatitis, tuberculosis, cancer, and congestive cardiac failure, in this case considering the pleura as normal. This procedure allowed us to obtain a discriminating model, whose morphological subcriteria classified almost 90% of the nonspecific chronic pleuritis biopsies, according to their final clinical diagnoses, which included true nonspecific chronic pleuritis or tuberculosis pleuritis, paraneoplastic pleuritis, or even normal pleura. By adding to this model the biochemistry or differential cytology of the pleural liquid, its classificatory power reaches 99% of correctness. This study represents the result of the experience acquired over several years in the histo-pathological interpretation of pleural biopsies, based on the correlation between morphology and biochemistry and cytology of the pleural fluid.

 


Keywords: Biopsy, needle. Pleura/pathology. Pleura/cytology. Pleural effusion.

 

13 - Lung tissue remodeling in the acute respiratory distress syndrome

Remodelamento do tecido pulmonar na síndrome do desconforto respiratório agudo

Alba Barros de Souza, Flavia Brandão dos Santos, Elnara Marcia Negri, Walter Araujo Zin, Patricia Rieken Macedo Rocco

J Bras Pneumol.2003;29(4):235-245

Abstract PDF PT Portuguese Text

Acute respiratory distress syndrome (ARDS) is characterized by diffuse alveolar damage, and evolves progressively with three phases: exsudative, fibroproliferative, and fibrotic. In the exudative phase, there are interstitial and alveolar edemas with hyaline membrane. The fibroproliferative phase is characterized by exudate organization and fibroelastogenesis. There is proliferation of type II pneumocytes to cover the damaged epithelial surface, followed by differentiation into type I pneumocytes. The fibroproliferative phase starts early, and its severity is related to the patient's prognosis. The alterations observed in the phenotype of the pulmonary parenchyma cells steer the tissue remodeling towards either progressive fibrosis or the restoration of normal alveolar architecture. The fibrotic phase is characterized by abnormal and excessive deposition of extracellular matrix proteins, mainly collagen. The dynamic control of collagen deposition and degradation is regulated by metalloproteinases and their tissular regulators. The deposition of proteoglycans in the extracellular matrix of ARDS patients needs better study. The regulation of extracellular matrix remodeling, in normal conditions or in several pulmonary diseases, such as ARDS, results from a complex mechanism that integrate the transcription of elements that destroy the matrix protein and produce activation/inhibition of several cellular types of lung tissue. This review article will analyze the ECM organization in ARDS, the different pulmonary parenchyma remodeling mechanisms, and the role of cytokines in the regulation of the different matrix components during the remodeling process.

 


Keywords: Respiratory distress syndrome. Pulmonary alveoli/lesions. Extracellular matrix. Cytokines/ultrastructure.

 

Upgrading

14 - Asma grave: uma questão de prescrição ou de diagnóstico?

Afrânio Kritski

J Bras Pneumol.2003;29(4):248-250

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