Brazilian Journal of Pulmonology

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

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Year 2004 - Volume 30  - Number 5  (September/October)






Editorial

1 - Uma realidade

Sérgio Saldanha Menna Barreto

J Bras Pneumol.2004;30(5):411-412

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Original Article

3 - Acceptability, preference, tolerance and clinical efficacy of dipropionate beclomethasone delivered by two inhalation devices in chronic asthma patients: Clenil pulvinal® versus Miflasona Aerolizer®

Avaliação da eficácia clínica, aceitabilidade e preferência de dois sistemas inalatórios de beclometasona no tratamento da asma : Pulvinal versus Aeroliser.

Jussara Fiterman, Waldo Mattos, Alberto Cukier, Márcia Pizzichinni, Rodnei Frare e Silva, Fabiane Kahan, José Roberto Jardim, Armando Brancatelli

J Bras Pneumol.2004;30(5):413-418

Abstract PDF PT PDF EN Portuguese Text

Acceptability, preference, tolerance and clinical efficacy of dipropionate beclomethasone delivered by two inhalation devices in chronic asthma patients: Clenil pulvinal versus Miflasona Aerolizer Background: Approximately half of all asthmatic patients adhere to their prescribed treatment regimen, which makes noncompliance with treatment one of the main problems associated with the disease. It is possible that inhalation devices combining technological advances with comfort and simplicity of use could increase treatment compliance. Objective: To compare the acceptability of and preference for two inhalation devices (Pulvinal and Aerolizer), as well as to evaluate the efficacy of and tolerance for beclomethasone dipropionate when delivered by these two systems. Method: A multicenter, randomized, crossover parallel study was carried out involving 83 patients with stable asthma. Patients received 500-1000 g/day of beclomethasone dipropionate. After a 2-week run in, the patients were randomized to begin a 4-week crossover treatment period with equivalent doses of Clenil Pulvinal (CP) or Miflasona Aerolizer (MA). Results: Both groups showed improvement in dyspnea and FEV1, and acceptability was considered good or excellent in both groups. Of the patients studied, 50.6% preferred CP, and 39% preferred MA. In their future treatment regimes, 54.5% would choose the CP and 37.7% the MA. Conclusion: Clinical efficacy and acceptability were comparable between CP and MA.

 


Keywords: Asthma/therapy. Beclomethasone/ administration & dosage. Randomized controlled trials. Treatment Outcome.

 

4 - Bronchoscopy in Brazil

Broncoscopia no Brasil

Mauro Zamboni, Andréia Salarini Monteiro

J Bras Pneumol.2004;30(5):419-425

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Background: During recent years, bronchoscopy has evolved considerably. Numerous clinical investigations, symposia, congresses and training courses have demonstrated the renewed interest in respiratory endoscopy. However, it is unknown whether this has modified bronchoscopy practice. Objective: Obtain information regarding the opinions and practices of pulmonologists who perform diagnostic and therapeutic bronchoscopy in Brazil. Methods: A survey consisting of 56 questions was mailed to 576 pulmonologists associated with the SBPT-DER. Results: A total of 111 questionnaires (19.2%) were returned and analyzed. All respondents were familiar with flexible fiberoptic bronchoscopy, but only 45% had performed rigid bronchoscopy. Less than 15% of the responders had performed any therapeutic bronchoscopic procedure. Conclusions: The majority of respondents (87.3%) thought that pulmonary societies and specialized training centers should initiate and disseminate informative materials and programs to optimize and perfect the practice of respiratory endoscopy, including therapeutic bronchoscopy, in Brazil.

 


Keywords: Bronchoscopy. Survey. Bronchoscopy practice.

 

5 - Clinicopathological findings in pulmonary thromboembolism: a 24-year autopsy study

Achados clínicopatológicos na tromboembolia pulmonar: estudo de 24 anos de autópsias

Hugo Hyung Bok Yoo, Fabiana Guandalini Mendes, Christine Elisabete Rubio Alem, Alexandre Todorovic Fabro, José Eduardo Corrente, Thaís Thomaz Queluz

J Bras Pneumol.2004;30(5):426-432

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Background: Pulmonary thromboembolism (PTE) is still an enigmatic disorder in many epidemiological and clinical features, remaining one of the most commonly misdiagnosed disorders. Objective: To describe the prevalence and pathological findings of PTE in a series of autopsies, to correlate these findings with underlying diseases, and to verify the frequency of PTE clinically suspected before death. Method: The reports on 5261 consecutive autopsies performed from 1979 to 2002 in a Brazilian tertiary referral medical school were reviewed for a retrospective study. From the medical records and autopsy reports of the patients found with macroscopically and/or microscopically documented PTE, were gathered data on demographics, underlying diseases, antemortem suspicion of PTE, and probable PTE site of origin. Results: The autopsy rate was 42.0% and PTE was found in 544 patients. In 225 cases, PTE was the main cause of death (fatal PTE). Infections (p=0.0003) were associated with nonfatal PTE and trauma (p=0.007) with fatal PTE. The rate of antemortem unsuspected PTE was 84.6% and 40.0% of these patients presented fatal PTE. Diseases of the circulatory system (p=0.0001), infections (p<0.0001), diseases of the digestive system (p=0.0001), neoplasia (p=0.024) and trauma (p=0.005) were associated with unsuspected PTE. The most frequent PTE site of origin was the lower limbs (48.9%). Probable PTE sites of origin such as right-sided cardiac chambers (p=0.012) and pelvic veins (p=0.015) were associated with fatal PTE. Conclusion: A large number of cases do not have antemortem suspicion of PTE. Special attention should be paid to the possibility of PTE in patients with diseases of the circulatory system, infections, diseases of the digestive system, neoplasia, and trauma.

 


Keywords: Autopsy. Epidemiology. Pulmonary Thromboembolism.

 

6 - Comparative study evaluating outcomes of lobectomy and extended segmentectomy used in the treatment of primary non-small cell bronchial carcinoma

Estudo comparativo entre lobectomia e segmentectomia estendida para o tratamento do carcinoma brônquico não de pequenas células em estágios iniciais

Airton Schneider, Paulo Roberto Kriese, Luiz Augusto Lopes da Costa, Tiago José Refosco, Caroline Buzzatti

J Bras Pneumol.2004;30(5):433-438

Abstract PDF PT PDF EN Portuguese Text

Background: Lobectomy is still considered the most effective method of controlling primary lung tumors. Method: During the period from 1995 to 2000, 733 cases of non-small cell bronchial carcinoma. After clinical evaluation and surgical staging, 191 patients were submitted to surgical resection. Of those 191 surgeries, 63 were for locally advanced tumors and 128 (69 segmentectomies and 59 lobectomies) for primary tumors. Post-operative FEV1 of at least 800 ml was used as a measure of surgical success. Extended segmentectomies, in which the resection passes the intersegmental line, including the parenchyma of the adjoining segment, were used. Results: Among the 128 patients with primary tumors, there were 3 deaths and 10 patients fell out of contact. Therefore, 62 segmentectomies and 53 lobectomies were evaluated. There were 72 adenocarcinomas and 43 epidermoid carcinomas. The 5-year survival of lobectomy patients was 80% (T1N0), 72.7% (T2N0), 50% (T1N1) and 31.8% (T2N1), whereas that of segmentectomy patients was 80% (T1N0), 66.6% (T2N0), 41.1% (T1N1) and 30% (T2N1) (p > 0.05). Tumor size and enlarged interlobar lymph nodes were prognostically significant (p < 0.001), although method of resection influenced neither survival nor local or remote recurrence (p > 0.05). Conclusion: Extended segmentectomy represents an alternative treatment for primary tumors in patients with limited lung reserve.

 


Keywords: Lung Neoplasms, surgery. Pulmonary Surgical Procedures. Carcinoma, Non-Small-Cell Lung.

 

7 - Influence of pulmonary rehabilitation on the sleep patterns of patients with chronic obstructive pulmonary disease

Influência da reabilitação pulmonar sobre o padrão de sono de pacientes portadores de doença pulmonar obstrutiva crônica

Renata Cláudia Zanchet, Carlos Alberto de Assis Viegas, Terezinha do Socorro Macêdo Lima

J Bras Pneumol.2004;30(5):439-444

Abstract PDF PT PDF EN Portuguese Text

Background: Pulmonary Rehabilitation (PR) improves the quality of life of chronic obstructive pulmonary disease (COPD) patients. However, the influence of PR on the sleep pattern of these patients is unknown. Objective: To evaluate the influence of PR on the sleep patterns of patients with COPD. Method: A total of 27 patients (22 men/5 women) were submitted to polysomnographic, gasometric and anthropometric studies before and after six weeks of PR and were evaluated using the Epworth Sleepiness Scale. The results were analyzed using paired Student's t-test, ANOVA and Newman-Keuls multiple comparison test. Results: Mean age was 63.3 5.3 years, mean FEV1 was 54.8 25.4% of predicted, mean FEV1/FVC was 49.9 12.0% of predicted, mean resting PaO2 was 69.7 7.3 mmHg, and mean resting SaO2 was 93.7 2.1%. Polysomnography revealed sleep patterns to be fragmented, with frequent waking and reduced slow-wave sleep, as well as oxygen desaturation. The most significant drops in oxygen saturation occurred during rapid eye movement sleep. No significant differences were observed between pre- and post-PR values for the other variables studied (p > 0.05).Conclusion: In the group of patients studied, PR did not alter sleep patterns.

 


Keywords: Sleep. Pulmonary Disease. Chronic Obstructive. Lung Diseases, rehabilitation.

 

9 - Induced sputum for the diagnosis of lung disease in HIV-positive patients

O escarro induzido no diagnóstico das doenças pulmonares em pacientes positivos ao vírus da imunodeficiência humana

Rosemeri Maurice da Silva, Paulo José Zimermann Teixeira, José da Silva Moreira

J Bras Pneumol.2004;30(5):452-458

Abstract PDF PT PDF EN Portuguese Text

Background: Induced sputum is widely used in assessing airway inflammation. However, its utility as a diagnostic tool in the diagnosis of lung disease in immunosuppressed patients merits further investigation. Objectives: To determinate the diagnostic yield of sputum induction in the diagnosis of lung diseases in HIV-positive patients. Method: Subjects were selected from among HIV-positive patients older than 14 years who were evaluated at a reference hospital between January 2001 and September 2002. Those with respiratory symptoms for 7 days or longer with normal or abnormal chest X-rays, as well as those without respiratory symptoms but with abnormal chest X-rays, were included. All subjects were submitted to clinical examination, radiologic evaluation, sputum induction and laboratory testing. Subsequently, flexible fiberoptic bronchoscopy, bronchoalveolar lavage and transbronchial lung biopsy were performed. Samples were processed for Gram and Ziehl-Neelsen staining, quantitative culture for pyogenic bacteria, direct staining for fungi, culture for mycobacteria and fungi, silver stain for Pneumocystis jiroveci, as well as for total and differential cellularity determination. Results: A total of 54 patients were included. Upon testing negative for any etiologic agent, 7 patients were excluded, resulting in a total of 54 patients studied. A total of 60 infectious agents were isolated. Among the etiologic agents isolated, 46.7% were P. jiroveci, 33.5 were pyogenic bacteria and 16.7% were Mycobacterium tuberculosis. Sputum induction presented 57.5% sensitivity, 42.9% specificity, 87.1% predictive positive value, 13% predictive negative value and 55.6% overall accuracy. Conclusions: In this population, sputum induction proved to be a technique that is safe and easily performed, with a good diagnostic yield.

 


Keywords: HIV, Acquired Immunodeficiency Syndrome, Bronchoscopy, Sputum, Lung Disease/diagnosi.

 

10 - Risk for Mycobacterium tuberculosis infection among medical students at the Universidade Federal do Rio de Janeiro Faculdade de Medicina

Risco de infecção pelo Mycobacterium tuberculosis entre alunos da Faculdade de Medicina da Universidade Federal do Rio de Janeiro

Vania Maria Carneiro da Silva, Antônio José Ledo Alves da Cunha, Afrânio Lineu Kritski

J Bras Pneumol.2004;30(5):459-466

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Introduction: There have been few Latin American studies investigating the fact that the rate of tuberculosis (TB) infection among medical students is higher than the 1.3% rate seen in the population at large. Objective: To describe the cumulative incidence and the relative risk for TB infection among medical students. Method: In 1998, a prospective cohort study was conducted involving medical students at the Universidade Federal do Rio de Janeiro Faculdade de Medicina who tested negative (induration <10 mm) on the tuberculin skin test (TST). Students were tested using the two-step TST method and were retested one year later. The students tested were at two different stages in their training: pre-clinical (no contact with patients) and final year (contact with patients). Information about demographic characteristics, BCG vaccination history, and instances of potential exposure to Mycobacterium tuberculosis were obtained using a standardized questionnaire. Of the 575 students initially enrolled, 72% (414) completed the study. Results: The TSTs of 16 (3.9%) of the 414 students converted, representing a cumulative incidence of 3.9% (95% confidence interval = 1.06 to 12.1). Senior medical students were at an almost fourfold higher risk for M. tuberculosis infection than were those in pre-clinical training. Conclusion: The risk for TST conversion is very high in this population.

 


Keywords: PPD. Tuberculosis-infection. Tuberculin conversion. Medical students

 

Upgrading

11 - How to Access the Biomedical Literature and Bridge the "Digital Divide" in Pulmonology

Como acessar a literatura biomédica e cruzar o "divisor de águas digital" em Pneumologia

João Carlos Prolla

J Bras Pneumol.2004;30(5):467-473

Abstract PDF PT PDF EN Portuguese Text

In poor and underdeveloped countries, including Brazil, pulmonologists have great difficulty in maintaining a level of service that keeps pace with advances in current knowledge, in keeping up to date with newly developed techniques, and in pursuing research. Due to the rising costs of scientific journal subscriptions, one of the main problems is lack of access to the scientific literature. The term "digital divide" refers to the gap between those who can and those who cannot effectively use new information technology and tools such as the Internet to communicate within and between countries. In this report, we call attention to some solutions to this situation. In particular, the SciELO Project, the CAPES Periodicals portal and the HINARI project, as well as several others, provide access at little or no cost. These options are explained in detail herein.

 


Keywords: Pulmonary Disease (Specialty), Internet. Bibliography. Resource Guides.

 

Review Article

12 - Imaging of acute pulmonary thromboembolism

Diagnóstico por imagem do tromboembolismo pulmonar agudo

Isabela S. Silva, Nestor L. Müller

J Bras Pneumol.2004;30(5):474-479

Abstract PDF PT PDF EN Portuguese Text

The diagnosis of acute pulmonary thromboembolism is based on the clinical probability, use of D-dimer (when available) and imaging. The main imaging modalities used in the diagnosis are ventilation-perfusion (V/Q), angiography, and computed tomography (CT). In the last decade several studies have demonstrated that spiral CT has a high sensitivity and specificity in the diagnosis of acute pulmonary thromboembolism. The evaluation of the pulmonary arteries has further improved with the recent introduction of multidetector spiral CT scanners. Various investigators have suggested that spiral CT pulmonary angiography should replace scintigraphy in the assessment of patients whose symptoms are suggestive of acute PE. This article discusses the role of the various imaging modalities in the diagnosis of acute pulmonary thromboembolism with emphasis on the role of spiral CT.

 


Keywords: Diagnostic imaging. Pulmonary embolism./diagnosis. Angiography. Lung diseases/radionuclide imaging. Tomography, emission-computed single-photon/methods.

 

13 - Thromboprofilaxis for videolaparoscopic cholecystectomy

Tromboprofilaxia na colecistectomia videolaparoscópica

Renato Maciel, Sérgio Saldanha Menna Barreto

J Bras Pneumol.2004;30(5):480-484

Abstract PDF PT PDF EN Portuguese Text

Based in a case of a patient who developed pulmonary embolism three days after a laparoscopic cholecystectomy in spite of using unfrationated heparin starting before surgery and mantained in the first 24hs postoperatively. The authors have analysed the risk factors and the rate of VTE in laparoscopic cholecystectomy , the use of thromboprofilaxis and suggested procedures that should be adopted

 


Keywords: Cholecystectomy. Video laparoscopy. Pneumoperitoneum

 

Case Report

14 - 80 year old man thromboendarterectomy Pulmonary thromboendarterectomy in an 80-year-old patient

Tromboendarterectomia pulmonar em paciente com 80 anos de idade

Mário Terra-Filho, Sabrina Correia da Costa Ribeiro, Rogério de Souza, Fábio Biscegli Jatene

J Bras Pneumol.2004;30(5):485-487

Abstract PDF PT PDF EN Portuguese Text

Pulmonary hypertension secondary to thromboembolism is a serious and debilitating disease. It occurs in approximately 0.5-1.0% of patients who survive an episode of acute thromboembolism. This is the first reported case of successful thromboendarterectomy performed in an elderly patient in Brazil. The patient, an 80-year-old man, presented favorable postoperative evolution. The authors believe this surgical procedure is a viable option for treatment of this type of pulmonary hypertension even in patients of advanced age, providing that there are no comorbidities.

 


Keywords: Thromboendarterectomy/methods. Hypertension pulmonary/surgery. Clinical evolution.

 

15 - Carcinoid tumor of the skin involving the sternum: Resection and reconstruction

Tumor carcinóide de pele envolvendo o esterno. Ressecção e reconstrução

Samuel Zuínglio de Biase Cordeiro, Paulo Leal, Mauro Zamboni, Emanuel Torquato, Paulo de Biasi Cordeiro

J Bras Pneumol.2004;30(5):488-491

Abstract PDF PT PDF EN Portuguese Text

Carcinoid tumor of the skin, which is a malignant neoplasm originating in the neuroendocrine system and having its pathological substrate in the Merkel cells, is a rare occurrence. It is most frequently seen on the skin around the neck and head and is more common in the elderly. This study relates the case of a 35-year-old woman presenting with a visible and palpable tumor covering the upper third of the sternum. Resection of the tumor was indicated because the patient had experienced two significant episodes of bleeding and osseous invasion had occurred. Penetration of the full thickness of the chest wall at the sternum notch necessitated the implantation of a rigid prosthesis. The definitive histopathological diagnosis was made only through postoperative analysis of the excised section. Reconstruction using a surgical cement plate and interposition of a myocutaneous flap proved its usefulness as an alternative when resection is performed in an area important to the postoperative respiratory dynamic, a situation that typically requires a ventilatory prosthesis for up to 6 days. The stability of the chest wall, together with viability of the flap and the recuperation of pulmonary function, allowed the patient to be discharged after 18 days.

 


Keywords: Carcinoma, Merkel cell/surgery. Carcinoid tumor/ diagnosis. Carcinoid tumor/surgery. Immunohistochemistry. Sternun/surgery. Neoplasm metastasis.

 

16 - Digestive Chagas disease with concomitant lipoid pneumonia

Pneumonia lipoídica associada à forma digestiva da doença de Chagas

Marcelo Fernando Ranzani, Nilson Sebastião Miranda, Ulisses Frederigue Júnior, Sérgio Marrone Ribeiro, Jussara Marcondes Machado

J Bras Pneumol.2004;30(5):492-495

Abstract PDF PT PDF EN Portuguese Text

A 50-year-old woman with chagasic esophageal achalasia and megacolon presented with nonproductive cough, chest pain and dyspnea. A chest X-ray showed bilateral opacity suggestive of lobar pneumonia. Open lung biopsy revealed lipoid pneumonia resulting from aspiration of mineral oil from a mineral oil-based laxative that the patient had been taking regularly for the last three years. The authors discuss concomitance of chagasic megacolon and esophageal achalasia with lipoid pneumonia and make recommendations regarding the use of mineral oil-based products by these patients.

 


Keywords: Pneumonia, aspirtion/etiology. Pneumonia, lipid/etiology. Esophageal achalasia/pathology. Chagas disease/complications.

 

 


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