Brazilian Journal of Pulmonology

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

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Year 1997 - Volume 23  - Number 2  (March/April)






Editorial

1 - Pneumonia por "Pneumocystis carinii": tratar ou investigar?

Sérgio Menna Barreto

J Bras Pneumol.1997;23(2):57-60

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Original Article

2 - Management of "Pneumocystis carinii" pneumonia in HIV-infected patients: empiric treatment versus microscopic confirmation

Controle da pneumonia por "Pneumocystis carinii" em pacientes HIV-positivos: tratamento empírico "versus" confirmação microscópica

Carlos Viegas, Rob Roy Macgregor, Ronald G. Collman

J Bras Pneumol.1997;23(2):61-65

Abstract PDF PT Portuguese Text

Com o objetivo de determinar a necessidade de confirmação microscópica do diagnóstico de pneumonia por Pneumocystis carinii (PPC), comparando grupos de pacientes tratados empiricamente com aqueles com confirmação diagnóstica, foram revisados os dados clínicos e laboratoriais de 82 pacientes internados em nossa instituição com infecção respiratória durante o ano de 1994. Estes pacientes formaram um grupo PPC (n = 37), dos quais 17 tiveram diagnóstico confirmado e 20 foram tratados empiricamente; e um grupo não-PPC (n = 45), com infecção respiratória que não PPC. O grupo PPC diferiu significativamente dos pacientes não-PPC por apresentarem maior duração dos sintomas, dispnéia mais freqüente, predomínio de lesões radiológicas bilaterais, menor contagem de células CD4 e menor uso de profilaxia anti-PPC. Quando comparamos os pacientes tratados empiricamente para PPC com os que tiveram confirmação diagnóstica de PPC, não observamos diferença estatisticamente significativa em qualquer das variáveis estudadas, exceto por um maior nível sérico de DHL nos pacientes com diagnóstico confirmado. Portanto, concluímos que confirmação microscópica pode não ser essencial em pacientes infectados pelo HIV com achados típicos de PPC e que tratamento empírico baseado no diagnóstico clínico pode ser uma alternativa razoável neste grupo de pacientes.

 


Keywords: PCP management. Empiric treatment.

 

3 - The saccharin test (ST) in children

Teste de sacarina em crianças

Fabíola Villac Adde, Tatiana Rozov

J Bras Pneumol.1997;23(2):66-70

Abstract PDF PT Portuguese Text

The saccharin test measures nasal mucociliary clearance. It is simple to perform, inexpensive, reproducible and is a screening test for the diagnosis of primary ciliary dyskinesia. Study objective - To establish the normal range of the ST in a group of presumed normal Brazilian children, and compare the results with those from the literature. Setting - The study was conducted in 2 schools in São Paulo, Brazil. Participants - Two hundred and thirty eight schoolchildren, 134 boys and 104 girls, age range 10.8-16.8 years, were studied. Information on respiratory diseases and smoking habits of parents were obtained from a questionnaire completed by the parents. Results - The questionnaires were analyzed and the children were then divided into 5 groups.The mean ST value in the group of normal children was 7.5 ± 2.8 minutes, comparable to the literature. The mean ST value in children with parental smoking, upper respiratory tract infection (URTI) within the preceding week, or allergy and URTI was not significantly different from the normal group. However, there was a significant difference between the normal group and those with allergy. As the standard deviation was greater in the groups with URTI, the population was reorganized into 2 groups, the criteria being the presence or not of URTI within the preceding week. Again, the mean ST values were not significantly different, but the variability was significantly different in the group with URTI. In 99% of the children studied the test took less than 30 minutes. Conclusions - Saccharin test values over 30 minutes should be considered abnormal and retested. We recommend that the test should not be performed during or within one month following an URTI.

 


Keywords: Saccharin test. Nasal mucociliary clearance.

 

4 - Distribution of the Euro-Collins solution in swine lungs, given through different rapid perfusion routes: a comparative study

Distribuição da solução Euro-Collins em pulmões de porcos ministrada por diferentes vias de perfusão rápida: estudo comparativo

José Bitu-Moreno, Ieda Francischetti, Ralph Siemer, Georg Matheis, Rufus Baretti, Francisco Humberto de Abreu Maffei, Friedhelm Beyersdorf

J Bras Pneumol.1997;23(2):71-78

Abstract PDF PT Portuguese Text

Bronchial healing remains one of the dominant issues in lung transplantation. Among other factors, the quality of airway protection during procurement may contribute to improve bronchial healing. In most centers lung preservation is performed using the pulmonary artery (PA) flush perfusion (FP). The present study was performed to investigate the influence of different routes of perfusion on the distribution of Euro-Collins solution (EUC) in lung parenchyma and upper airways in swine. The animals were divided into 4 groups, 1 without FP; Control (n=6), and the others with EUC delivery via: pulmonary artery (PA) (n=6); pulmonary and bronchial arteries simultaneously (PA+BA) (n=8), and pulmonary veins (PV). Lungs and airways were assessed by the following methods: dye-labeled microspheres for total and regional perfusion, tissue water content, and lung temperature. There was no significant difference in total lung flow between PA+BA and PA, both superior to the PV group. Flow in the proximal and distal trachea were significantly increased: PA+BA (0.970 ± 0.4 and 0.380 ± 0.2 mL/min/g, respectively); PA ( 0.023 ± 0.007 and 0.024 ± 0.07 mL/min/g, respectively); PV (0.009 ± 0.003 and 0.021 ± 0.006 mL/min/g respectively) and Control experiments (0.125 ± 0.0018 and 0.105 ±0.012 mL/min/g, respectively). The highest flow rates in the right main bronchus were achieved by PA+BA (1.04 ± 0.4 mL/min/g) as comparison to Control, PA, and PV groups (0.11 ± 0.03, 0.033 ± 0.008, and 0.019 ± 0.005 mL/min/g, respectively). Flows in the left main bronchus were significantly increased by PA+BA (0.97 ± 0.3 mL/min/g), as comparison to control, PA and PV groups (0.09 ± 0.02, 0.045 ± 0.012, and 0.027 ± 0.006 mL/min/g, respectively). In conclusion, these data showed that the distribution of EUC in airways of swine is significantly improved by PA+BA perfusion.

 


Keywords: Lung transplantation. Flush perfusion. Bronchial circulation. Bronchial complications.

 

4 - Functional respiratory changes in laparoscopic cholecystectomy

Alterações funcionais respiratórias na colecistectomia por via laparoscópica

Luciana Dias Chiavegato, José Roberto Jardim, Sonia Maria Faresin, Yara Juliano

J Bras Pneumol.1997;23(2):69-76

Abstract Portuguese Text

Objective: The aim of this study was to measure the changes in lung volume, pulmonary ventilation, maximum respiratory muscle strength, and the incidence of pulmonary complications in patients undergoing elective laparoscopic cholecystectomy. Type of study: Prospective study. Material and methods: Twenty patients (7 men and 13 women) with mean age of 42.7 years with normal respiratory function were studied. All patients in the preoperative period answered a long questionnaire, had a physical examination done, and had their lung volumes, respiratory muscle strength, diaphragmatic index and pulse oximetry determined. All measurements were repeated on the 1st, 2nd, 3rd and 6th postoperative days. Results: Patients showed a significant decrease (p < 0.05) on the first postoperative day: 26% ± 13% in tidal volume; 20% ± 14% in minute volume; 36% ± 17% in vital capacity; 47% ± 17% in maximum inspiratory pressure, 39% ± 27% in the maximum expiratory pressure and 36% ± 25% in diaphragmatic index. Tidal volume, minute volume and maximum expiratory pressure returned to their basal values on the third postoperative day; vital capacity, maximum inspiratory pressure and diaphragmatic index returned to their basal values between the 4th and 6th postoperative days. Among the 20 patients pulmonary complication was observed in just one patient (lobar atelectasis); there was a full recovery by the third postoperative day with the use of chest physical therapy techniques. Conclusion: The authors conclude that patients undergoing a laparoscopic cholecystectomy show a significant decrease in lung volume and in respiratory muscle strength on the first postoperative day. But, when these measurements are compared to the literature, return to their basal values is faster (between the 4th and 6th postoperative days) than with conventional surgery.

 


Keywords: Laparoscopic surgery, preoperative and postoperative care and respiratory muscle strength.

 

5 - Pneumonia por "Pneumocystis carinii" em pacientes com e sem SIDA: reavaliação

"Pneumocystis carinii" pneumonia in patients with and without AIDS: a reappraisal

Carloss Viegas, Ronald FCCP, Collman G

J Bras Pneumol.1997;23(2):79-82

Abstract PDF PT Portuguese Text

A pneumonia por Pneumocystis carinii (PPC), que é a infecção oportunista que mais comumente põe em risco a vida de pacientes com síndrome da imunodeficiência adquirida (SIDA), tem sido há bastante tempo associada a outros estados de imunodeficiência. Os relatos iniciais sugeriram que a apresentação clínica da PPC em SIDA difere de sua apresentação em outras situações, embora ambas tenham sofrido modificações nos últimos anos. O objetivo do presente estudo é comparar os achados clínicos e laboratoriais da PPC em SIDA com os de pacientes portadores de PPC sem SIDA. Foram revisados os prontuários médicos de todos os pacientes em nossa instituição que tiveram o diagnóstico confirmado de PPC e SIDA durante o ano de 1994 (17 pacientes) e sem SIDA no período de 1992-1994 (dez pacientes). Quando da apresentação, os pacientes sem SIDA tinham uma duração de sintomas significativamente menor (8,4 ± 7,7 vs 19,5 ± 10,2 dias, p < 0,05), menor PaO2 média a ar ambiente (47 ± 8,2 vs 63 ± 10mmHg, p < 0,05), e mais freqüente infiltrado unilateral no radiograma do tórax (60 vs 6%, p < 0,05). O índice de mortalidade da PPC foi marcadamente maior nos pacientes sem SIDA (40 vs 6%, p < 0,05), e este fato estava associado com retarde no início do tratamento específico nestes pacientes. Devido a seu curso mais agudo, apresentação radiológica atípica e alto índice de mortalidade, concluímos que o diagnóstico de PPC deve ser afastado em pacientes que recebem terapia imunossupressora e que profilaxia anti-PPC deve ser fortemente considerada em pacientes que serão imunossuprimidos.

 


Keywords: PPC-AIDS. PPC não-AIDS.

 

Endoscopia respiratória

6 - Saber-sheath trachea: clinic-tomographic-endoscopic-functional correlation

Traquéia em bainha de sabre ("saber-sheath trachea"): correlação clínico-tomográfico-endoscópico-funcional

Jorge Luiz Pereira-Silva, Tereza Villas-Bôas Veloso, Márcia Maria Magalhães de Almeida e Marinho, Luiz Eduardo Lago de Castro, Guilherme Sóstenes da Costa Montal

J Bras Pneumol.1997;23(2):83-86

Abstract PDF PT Portuguese Text

Saber-sheath trachea constitutes a morphologic-functional disorder of the intrathoracic segment, characterized by an abnormal configuration of the tracheal cartilages, where the coronal diameter represents less than 2/3 of the sagittal, with narrowing of the front bow and collapse of the side wall during coughing and stressed expiration. Just as it happens in the case of semilunar configuration of the thacheal expiratory collapse syndrome, it is more common in patients with COPD, when the clinicradiologic appearance usually masks the seriousness of the functional disorder. The authors demonstrate the clinic-tomographic-endoscopic-functional correlation in the case of a 43-year-old female patient suffering from severe chronic obstructive respiratory failure whose clinic-radiologic condition masked the seriousness of the dysfunction, emphasizing the need for systematic investigation of the tracheal dynamics in this type of case.

 


Review Article

7 - Radiation therapy alone versus combined chemotherapy and radiation therapy in locally advanced non-small cell lung carcinoma (stages IIIA and IIIB).

Radioterapia exclusiva "versus" radioterapia associada à quimioterapia no carcinoma de pulmão não de pequenas células localmente avançado (estádios IIIA e IIIB)

Heloisa de Andrade Carvalho

J Bras Pneumol.1997;23(2):87-92

Abstract PDF PT Portuguese Text

For patients with stage III (A or B) non-small cell lung cancer, radiation is still the standard treatment. However, long-term survival remains poor and new alternatives and therapeutic associations are being studied. Recently, chemotherapy has been in focus, with several combinations with radiation therapy and/or surgery. An update of the recently published data about the controversies on whether or not one should combine chemotherapy with radiation in locally advanced lung tumors was done. Cisplatin-based chemotherapy regimens combined with radiation are favorable, with a possible increase in survival of 3% in 2 years and 2% in 5 years. Neither the best drug combination nor the ideal association regimen have been defined yet. The indication of a combined treatment must be based on patient's clinical conditions and on a balance between quality of life, toxicity, and cost of chemotherapy.

 


Keywords: Lung neoplasms. Radiation therapy. Chemotherapy.

 

Case Report

9 - Thoracotomy with pulmonary resection in trauma

Toracotomia com ressecção pulmonar no trauma

Roger Normando, Marco Antônio Franco Tavares, Antônio Guilherme Guimarães, Adenard Cunha, Marcello Rickmann Lobato

J Bras Pneumol.1997;23(2):101-104

Abstract PDF PT Portuguese Text

Objective - To verify the incidence of the wounds of the pulmonary hilum in a public hospital Emergency Unit, and the mortality rate. Means of access, operative techniques and tatics of operation used were also evaluated. Patients and methods - One thousand, one hundred and twenty-four patients with chest trauma were registered at the thoracic surgery unit from April, 1992 to October, 1996. A hundred eighty-two thoracotomies (16.19%) were performed and indication for lung resection was present in only four cases (2.20%). Results - The way of access most commonly used was anterolateral, in three cases, and posterolateral in another case. Two lobectomies and one pneumonectomy were performed. In only one patient a clamping of the hilum was utilized, but the patient died due to massive bleeding. Two other patients died in a total of three deaths. There was only one survivor in this series, who did not present any complication. Conclusion - A low incidence of indication for lung resections was observed in trauma, however, mortality was extremely high due to the lesion involving a high life risk. The most commonly used access was the anterolateral because of the short time needed to clamp the pulmonary hilum, and it was used for all cases of success.

 


Keywords: Thoracic trauma. Lobectomy. Pneumonectomy.

 

10 - Giant pneumatoceles: report of a case

Pneumatoceles gigantes: relato de caso

Vivian Kiran Lee, Antônio Carlos Pastorino, Joselina Magalhães Andrade Cardieri, Tatiana Rozov

J Bras Pneumol.1997;23(2):105-109

Abstract PDF PT Portuguese Text

Pneumatoceles usually have a benign presentation. The authors describe an uncommon case of a 3-month-old boy who had a first episode of pneumonia and left pleural effusion. At the age of 2, he had another episode of pneumonia with pneumatoceles formation. He progressed with wheezing and enlargement of the pneumatoceles, chickenpox, urinary infection, liver abscess and toxocariasis. When he was 3 years old, the patient was admitted to hospital with pneumonia, giant bilateral pneumatoceles, status asthmaticus and possible immunodeficiency. Due to a restrictive pulmonary disorder, a chest tube was placed in one of the pneumatoceles, but there was no improvement in his respiratory status. He progressed to sepsis and respiratory failure, needing mechanical ventilation. The patient was submitted to bilateral bullectomy with expansion of the collapsed lung. However, he died soon after the surgery. This was an uncommon case with pneumatoceles that evolved to respiratory failure requiring surgical intervention.

 


Keywords: Pneumatoceles. Bullous lung disease. Cysts. Staphyloccocal pneumonia. Ventilatory insufficiency. Bullectomy.

 

11 - Alterações pulmonares na macroglobulinemia de Waldenström

Renato de Albuquerque Medeiros, Jucineide Araújo, José Kerbauy, Miguel Bogossian

J Bras Pneumol.1997;23(2):110-112

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