Brazilian Journal of Pulmonology

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


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Year 2005 - Volume 31  - Number 1  (January/February)


1 - New times, old challenges

Novos tempos, antigos desafios

José Antônio Baddini Martinez

J Bras Pneumol.2005;31(1):

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Original Article

3 - Relationship between home environmental control and exacerbation of asthma in children and adolescents in the city of Camaragibe in the state of Pernambuco, Brazil

Associação entre controle ambiental domiciliar e exacerbação da asma em crianças e adolescentes do município de Camaragibe, Pernambuco*

Rosane M. Barreto de Melo, Luciane S. de Lima, Emanuel S.Cavalcanti Sarinho

J Bras Pneumol.2005;31(1):5-15

Abstract PDF PT PDF EN Portuguese Text

Background: Hypersensitivity to dust mites, mold and pet dander found in the home is common among patients with asthma. Home environmental control to reduce exposure to allergens is one of various therapeutic measures that can be taken. Objectives: To determine the prevalence of adequate home environmental control among a study population monitored by the Family Health Program and to identify any possible correlation with the exacerbation of asthma among children between the ages of 5 and 14 in the city of Camaragibe, located in the state of Pernambuco, Brazil. Method: A transversal study was carried out involving 210 mothers/guardians of children, to whom International Study of Asthma and Allergies in Children questionnaires were administered in order to characterize the exacerbation of asthma attacks. The Environment Assessment Guide of Allergic Patients was used to assess the bedrooms and living rooms in the home. Results: Among the 210 asthmatic children and adolescents evaluated in 2001, adequate home environmental control was observed in 141 (67.1%), and no correlation was observed between the degree of environmental control and fewer (< 3) asthma attacks (p = 0.39). Regarding the rooms where the asthmatic patients sleep, inappropriate furnishings were found in the homes of 93 patients (44.3%), including rag curtains in 84 cases (40.2%). Passive smoking was reported in 77 cases (36.7%). Conclusion: The level of home environmental control was satisfactory in the great majority of the residences, which may have contributed to the fact that no correlation was found between home environmental control and lower frequency of acute asthma attacks among the population studied.


Keywords: Key Words: Asthma. Environment Control. Frequency of Attacks.


4 - The effect of esophageal acidification on bronchial obstruction in asthmatics with gastroesophageal reflux

Efeito da acidificação esofágica na obstrução brônquica de pacientes asmáticos com refluxo gastroesofágico*

Ana Carla Sousa de Araujo, Lílian Rose Otoboni Aprile, João Terra Filho, Roberto Oliveira Dantas, Milton Arruda Martins, Elcio Oliveira Vianna

J Bras Pneumol.2005;31(1):

Abstract PDF PT PDF EN Portuguese Text

Background: The relationship between asthma and gastroesophageal reflux is, as yet, not completely understood. Among the mechanisms thought to be responsible for gastroesophageal reflux-related worsening of asthma symptoms are the vagovagal reflex and microaspiration. Objective: To assess forced expiratory volume in one second after acid infusion. Method: This study investigated the effect of acid infusion in 13 volunteers with moderate asthma and gastroesophageal reflux. Spirometry was performed before and after insertion of an 8F nasogastric tube and a pH meter. After 15 minutes of saline solution infusion into the midpoint between the upper esophageal sphincter and lower esophageal sphincter, and again after 15 minutes of esophageal acidification (with hydrochloric acid) of the same area, forced expiratory volume in one second was reassessed. Acidification was repeated every 5 minutes until forced expiratory volume in one second values stabilized (variation: < 5%). Results: Mean forced expiratory volume in one second values remained stable during the tube insertion, saline infusion, initial hydrochloric acid infusion and subsequent hydrochloric acid infusion procedures (p = 0.72). Lower forced expiratory volume in one second values were seen resulting from the tube insertion in two patients (drops of 11% and 22%, respectively), after saline infusion in another two (drops of 13% and 14%) and after acid infusion in 1 (a drop of 22%). Conclusion: Esophageal acidification over short periods does not lead to spirometric alterations in a group of asthmatics with gastroesophageal reflux. However, in some cases, simple esophageal procedures or infusions result in bronchospasm.


Keywords: Key words: Asthma. Gastroesophageal reflux. Respiratory function tests. Endoscopy/methods.


5 - Effect of adenosine on pulmonary circulation in patients with primary pulmonary hypertension

Ação da adenosina na circulação pulmonar de pacientes com hipertensão pulmonar primária

Rogerio Souza, Marcelo Britto Passos Amato, Sergio Eduardo Demarzo, Daniel Deheinzelin, Carmen Silvia Valente Barbas, Pedro Caruso, Carlos Roberto Ribeiro Carvalho

J Bras Pneumol.2005;31(1):

Abstract PDF PT PDF EN Portuguese Text

Background: The nucleoside adenosine is a potent vasodilator. Although its effect on the pulmonary arteries is well known, its influence on capillaries and veins has yet to be described. Objective: To evaluate the pre- and post-administration effects of adenosine on arterial and venous resistance in the pulmonary circulation of patients with primary pulmonary hypertension. Method: The study involved 7 patients with primary pulmonary hypertension and presenting a positive response to adenosine on the acute test. Before and after adenosine administration, arterial and venous resistances were determined by estimating pulmonary capillary pressure through analysis of pulmonary artery pressure decay curves. Results: Following adenosine administration, there was an increase in the cardiac index (from 1.71 ± 0.23 to 2.72 ± 0.74 L/min-1/m-2) and a decrease in pulmonary vascular resistance (from 2924 ± 1060 to 1975 ± 764 dynes/s/cm-5/m-2) with no significant variations in mean pulmonary artery pressure (pre: 75.6 ± 16.8 mmHg; post: 78.1 ± 18.8 mmHg), pulmonary wedge pressure (pre: 15.3 ± 1.5 mmHg; post: 15.4 ± 1.9 mmHg) and pulmonary capillary pressure (pre: 43.8 ± 5.8 mmHg; post: 44.5 ± 4.9 mmHg). The ratio between arterial resistance and total pulmonary vascular resistance also presented a less than significant variation (pre: 50 ± 15%; post: 49 ± 17%). These findings suggest that adenosine affects the capillaries and veins as well as the arteries. Conclusion: We can conclude that the adenosine mechanism is not restricted to the arterial aspect of the pulmonary circulation, and that analysis of pulmonary capillary pressure could prove useful in the study of various drugs that affect the pulmonary circulation.


Keywords: Key Words: Adenosine/pharmacocinetic. Adenosine/uso terapêutico. Blood pressure. Hypertension pulmonary.


6 - Analysis of acute and chronic vascular remodeling in an experimental model of pulmonary ischemia

Análise da remodelação vascular na isquemia pulmonar experimental, nas fases aguda e crônica

Wanderley M. Bernardo, Fabio B. Jatene, Lea Maria M. F. Demarchi, Vera Luiza Capelozzi, Rogério Pazetti, Dolores H. R. F. Rivero¸ Rosangela Monteiro, Sérgio A. de Oliveira

J Bras Pneumol.2005;31(1):

Abstract PDF PT PDF EN Portuguese Text

Background: Structural alterations to the pulmonary circulation characterize the vascular remodeling process and are likely correlated with local variations in flow and ischemia. Objective: To define the histological alterations to the pulmonary circulation seen after experimentally-induced ischemia of the pulmonary artery and to correlate those alterations with known patterns of blood redistribution and vascular remodeling. Method: Wistar rats (n = 48) were randomized into two groups with ligation of the pulmonary artery and without (controls) and were sacrificed on post-ischemia days 1, 7, 30 and 60. Lungs were removed and inspected for signs of parenchymal injury. External diameters, as well as wall thicknesses in the pulmonary, alveolar and bronchial end arterioles, were measured. Internal diameter and wall thickness percentage were calculated. Results: Infarction, necrosis and hemorrhage occurred only in ischemic lungs. In nonischemic lungs, there was a sustained increase in the internal and external arteriolar diameters, with an initial reduction in wall thickness on day 1, and day-60 values were similar to those seen in controls. In ischemic lungs, there was a transitory reduction in the internal and external diameters of the pulmonary and bronchial end arterioles, together with an initial, equally transitory, increase in their wall thickness. The alveolar arterioles presented sustained and progressive increases in external diameter and wall thickness, with concomitant reductions in internal diameter. Conclusion: This model mimics distal arterial disease in patients with chronic pulmonary thromboembolism. The vascular response in nonischemic lungs was consistent with a pattern of flow remodeling, whereas that seen in ischemic lungs was more consistent with flow and ischemia. In the pulmonary and bronchial end arterioles, the response was transitory, in contrast to the sustained and progressive response seen in the alveolar arterioles, which was probably caused by delayed local flow.


Keywords: Key-words: Pulmonary embolism. Pulmonary circulation. Vascular remodelling. Pulmonary artery.


7 - Lung volume reduction surgery in an experimental rat model of emphysema

Cirurgia de redução do volume pulmonar em modelo experimental de enfisema em ratos

Laerte Brasiliense Fusco, Marcelo Heleno Fonseca, Paulo Manuel Pêgo-Fernandes, Rogério Pazetti, Vera Capelozzi, Fabio Biscegli Jatene, Sergio Almeida Oliveira

J Bras Pneumol.2005;31(1):

Abstract PDF PT PDF EN Portuguese Text

Background: Lung volume reduction surgery may be a viable treatment alternative for emphysema patients suffering from severe respiratory insufficiency. Objectives: To evaluate functional and morphological aspects of emphysematous rat lungs, prior to and following lung volume reduction surgery. Method: Wistar rats were divided into two experimental groups (papain without surgery and papain with surgery) and three control groups (saline without surgery, saline with surgery and papain without mechanical ventilation). After approximately 40 days of endotracheal instillation of papain or saline solution, animals in the papain with surgery and saline with surgery groups were submitted to bilobectomy of the middle lobes by right thoracotomy along the posterior border of the superior vena cava. After 1 week, the same animals were submitted to a mechanical ventilation study, which involved measurement of lung elasticity and airway resistance. For all of the animals studied, lung tissue was analyzed in order to determine alveolar diameter and the elastic fiber quantity. Results: Morphometric analysis revealed higher mean alveolar diameter in the lungs of all animals exposed to papain as compared to those exposed to saline. Elastic fiber counts in the alveolar septa of animals treated with papain were lower than those of animals receiving saline. In the animals submitted to bilobectomy and papain, lung elasticity was greater than in those receiving papain without surgery and was statistically equal to that seen in animals receiving saline (with or without surgery). Conclusion: In the respiratory systems of animals with pulmonary emphysema submitted to lung volume reduction by bilobectomy, the capacity for elastic recoil returned to values equivalent to those of the control group animals.


Keywords: Key words: Pulmonary emphysema. Papain/drugs efects. Case-control studies. Disease models, animal. Respiratory mechanics/drugs efects. Lung/sugery. Lung/anatomy & histology.


8 - Postoperative respiratory complications from elective and urgent/emergency surgery performed at a university hospital

Complicações respiratórias no pós-operatório de cirurgias eletivas e de urgência e emergência em um Hospital Universitário

Luiz Joia Neto, João Carlos Thomson, Jefferson Rosa Cardoso

J Bras Pneumol.2005;31(1):

Abstract PDF PT PDF EN Portuguese Text

Background: Respiratory complications have been the focus of studies aiming to identify methods of reducing postoperative morbidity/mortality and controlling the cost of treatment. Objectives: To estimate the incidence of the respiratory complications in patients submitted to elective or urgent/emergency surgical procedures and determine any correlations between respiratory complications and potential risk factors. Method: A retrospective cohort study of patients submitted to elective or urgent/emergency surgery at a university hospital during 2001. The sample was restricted to patients hospitalized for at least 24 hours following surgery. Data were collected from patient charts and according to protocol. Results: Of the 5075 patients submitted to elective or urgent/emergency surgery during the year 2001, 1345 (25.5%) were included in the study. There was no statistically significant difference between elective surgery and urgent/emergency surgery in terms of respiratory complications. The incidence of respiratory complications was 11.7%. The most frequent complication (at 52.5%) was pneumonia. Overall mortality was 7.2% and 27.8% of deaths were related to respiratory complications. Conclusion: The incidence of postoperative respiratory complications was 11.7% (11.3% in elective surgery and 12.3% in urgent/emergency surgery). Pneumonia was the most frequent complication. The risk factors that correlated with respiratory complications were previous lung disease, use of a nasogastric tube, admission to the intensive care unit, endotracheal intubation and tracheostomy.


Keywords: Key words: Postoperative complications. Lung diseases/complications. Risk factors. Cohort studies 


9 - Quality of life before and after pulmonary thromboendarterectomy: Preliminary results

Qualidade de vida antes e após tromboendarterectomia pulmonar. Resultados preliminares

Pedro Rodrigues Genta, Fábio Biscegli Jatene, Mário Terra-Filho

J Bras Pneumol.2005;31(1):

Abstract PDF PT PDF EN Portuguese Text

Background: Pulmonary hypertension secondary to chronic thromboembolism is a severe and debilitating disease and has been associated with high mortality. Pulmonary thromboendarterectomy is the treatment of choice. Objective: To evaluate the impact of pulmonary thromboendarterectomy on the quality of life of patients with pulmonary hypertension secondary to chronic thromboembolism using the SF-36 Health Survey. Method: The SF-36 Health Survey questionnaire was administered to 13 patients prior to and at least 3 months following thromboendarterectomy. Results: Of the 13 patients studied, 7 were female and 6 were male. Mean age was 45.7 ± 18.3. All were submitted to thromboendarterectomy. After surgery, all SF-36 domains, with the exception of the "mental health" domain, improved. Conclusion: Pulmonary thromboendarterectomy provides significant improvement in patient quality of life.


Keywords: Key words: Hypertension pulmonary. Pulmonary embolism. Endarterectomy/methods. Quality of life.


10 - Acute pulmonary histoplasmosis in the state of Rio Grande do Sul, Brazil

Histoplasmose pulmonar aguda no Rio Grande do Sul

Gisela Unis, Eliane Wurdig Roesch, Luiz Carlos Severo

J Bras Pneumol.2005;31(1):

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Background: Acute pulmonary histoplasmosis is a respiratory infection occurring when an otherwise healthy individual inhales a large quantity of fungal propagules. Length of exposure determines disease severity. An epidemic is influenced by factors affecting the growth and transmission of Histoplasma capsulatum var. capsulatum in nature. Objective: To identify epidemiological and clinical aspects of patients with acute pulmonary histoplasmosis in the state of Rio Grande do Sul (RS) and compare these aspects with those of other cluster outbreaks reported in Brazil. Method: The charts of 212 patients diagnosed with histoplasmosis over a 25-year period (1977-2002) were obtained from the archives of the Laboratório de Micologia from Complexo Hospitalar Santa Casa (Santa Casa Hospital Mycology Laboratory), in the city of Porto Alegre (RS). In reviewing these patient charts, we identified and included in the study cases of acute pulmonary histoplasmosis in which there was a positive culture and/or histopathological findings consistent with the diagnosis. Outbreaks were defined as one confirmed case or positive immunodifusion Histoplasma capsulatum with compatible clinical history. All reported Brazilian outbreaks were reviewed. Results: Of the 212 patient charts reviewed, 18 (8.5%) were selected for inclusion in the study. Among those 18 patients, ages ranged from 8 to 63 years (median, 35.4), and 67% were male. Epidemiological histories were suggestive of the disease in 11 patients (61%). The most common disease type, seen in 17 patients (95%), was primary acute pulmonary histoplasmosis, and there was a predominance of isolated cases. Conclusion: The identification of isolated cases and the presence of cluster outbreaks demonstrate the abundance of H. capsulatum in the soil and, together with the occurrence of all forms of the disease, confirms the assumption that Rio Grande do Sul is a hyperendemic region for histoplasmosis.


Keywords: Key words - Histoplasmosis/epidemiology. Histoplasmosis/diagnostic. Histoplasma. Medical records. Retrospective studies.


Review Article

11 - Oxygen free radicals and pulmonary disease

Os radicais livres de oxigênio e as doenças pulmonares

Dahir Ramos de Andrade Júnior, Rodrigo Becco de Souza, Sânia Alves dos Santos, Dahir Ramos de Andrade

J Bras Pneumol.2005;31(1):

Abstract PDF PT PDF EN Portuguese Text

Oxygen free radicals are molecules that present unpaired electrons in their outer orbit and can transform other molecules such as proteins, carbohydrates, lipids and deoxyribonucleic acid. Oxygen free radicals are produced in various clinical conditions in which hypoxic microenvironments are generated and reoxygenation follows. Such situations include clinical shock, septicemia, systemic inflammatory response, fulminant hepatitis, organ transplant and respiratory failure. In this review, we discuss the main concepts related to oxygen free radicals: the principal types and their formation, as well as the way in which they affect cellular structures and cause significant tissue damage. We present also the main antioxidants that guard against oxidative stress, including glutathione, glutathione peroxidase, superoxide dismutase, catalase, and N-acetylcysteine. The influence of oxygen free radicals on the principal pulmonary diseases are also discussed, with special emphasis given to oxygen free radicals in cigarette smoke, chronic obstructive pulmonary disease, asthma, sleep apnea syndrome and acute respiratory distress syndrome.


Keywords: Key words: Oxygen free radicals. Antioxidant substances. Oxidative stress. Lung diseases.


12 - Postpneumonectomy pulmonary edema

Edema pulmonar pós-pneumonectomia

Marcos Naoyuki Samano, Luis Miguel Melero Sancho, Ricardo Beyruti, Fábio Biesegli Jatene

J Bras Pneumol.2005;31(1):

Abstract PDF PT PDF EN Portuguese Text

Although pneumonectomy is a technically simple procedure, it has been associated with a high (60%) incidence of complications. Respiratory complications account for approximately 15% of such complications. Worldwide, the mortality rate among patients subjected to pneumonectomy is 8.6%. However, the rate among patients developing respiratory complications is 30%. Although postpneumonectomy pulmonary edema is rare (occurring in 3% to 5% of cases), it is a serious complication and is almost always fatal. It was first described twenty years ago and, despite these alarming statistics, little is known regarding the physiopathology of postpneumonectomy pulmonary edema. Once it has become entrenched, the condition is difficult to treat, and there is no proven efficient treatment. Various risk factors have been correlated with postpneumonectomy pulmonary edema onset. Fluid overload was the first to be identified as a factor to avoid. However, many studies have shown that there is no direct correlation between fluid overload and the development of edema. Prevention is the best way to avoid postpneumonectomy pulmonary edema and must be performed in a multidisciplinary fashion, involving the entire medical staff - from the initiation of anesthesia through the surgical procedure and extending into the critical care management phase. Equally important is early identification and testing of patients at risk for postpneumonectomy pulmonary edema when there is clinical suspicion of this serious complication.


Keywords: Key Words: Pulmonary edema/complications. Pneumonectomy/adverse effects. Risk factors. Pulmonary edema/prevention & control.


Case Report

13 - Pulmonary metastasis of mediastinal paraganglioma

Paraganglioma de mediastino com metástases pulmonares

Manoel Ximenes Netto, Pedro R. Paniágua, Marcos A. Piauilino, Humberto Alves de Oliveira, Luci Ishii

J Bras Pneumol.2005;31(1):

Abstract PDF PT PDF EN Portuguese Text

Herein, we describe the case of a 27-year-old female presenting with paraganglioma of the anterior and middle mediastinum and bilateral pulmonary nodules. Treatment consisted of pulmonary resection by anterior bilateral thoracotomy and transverse sternotomy, in which the paraganglioma was excised with the aid of extracorporeal circulation. As neoadjuvant treatments, radiotherapy and chemotherapy were applied. Postoperative evolution was uneventful, and the patient was classified as asymptomatic after 14 months.


Keywords: Key words: Mediastinal tumor. Paraganglioma. Lung metastasis


14 - Traumatic pulmonary pseudocyst

Pseudocisto pulmonar traumático

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

J Bras Pneumol.2005;31(1):

Abstract PDF PT PDF EN Portuguese Text

Traumatic pulmonary pseudocyst is a rare lesion and is typically seen after blunt chest trauma. Although secondary infection is an uncommon complication, it presents high morbidity and requires immediate treatment. A 28-year-old male motorcycle accident victim was admitted to the hospital with hemoptysis, chest pain, dyspnea and hypoxemia. Computed tomography of the chest revealed pulmonary infiltrate and pseudocysts in the lower lobe of the right lung. The patient developed fever, purulent expectoration and an air-fluid level within the pseudocysts. After culture collection, a course of broad-spectrum antibiotics was started. Clinical improvement was observed, and the patient was discharged 15 days after admission.


Keywords: Key words: Chest trauma. Pseudocyst


15 - Inflammatory pseudotumor of the lung

Pseudotumor inflamatório do pulmão

Jorge Montessi, João Paulo Vieira, Rafael Rabello Lista Mira, Felipe Torres Rabêlo

J Bras Pneumol.2005;31(1):

Abstract PDF PT PDF EN Portuguese Text

Inflammatory pseudotumor of the lung is a rare condition that represents a dilemma because the radiographic, macroscopic and pathological aspects mimic a malignant process. Herein, we report the case of a patient complaining of respiratory difficulty who, after being appropriately assessed, was submitted to exploratory thoracotomy. An initial diagnosis of pseudotumor was subsequently confirmed through immunohistochemistry. In addition to presenting data relating to clinical history, we also discuss radiographic, histopathological and surgical aspects, as well as treatment options.


Keywords: Key Words: Inflammatory pseudotumor of the lung. Toracotomy. Imunohistochemistry


Letters to the Editor

18 - Respiratory physiotherapy in the ICU: Effectiveness and professional certification

Fisioterapia respiratória em UTI: Efetividade e habilitação profissional

Wellington P. S.Yamaguti, Luiz A. Alves, Lucienne T. Q. Cardoso, Carrie C. R. Galvan, Antonio F. Brunetto

J Bras Pneumol.2005;31(1):

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