Brazilian Journal of Pulmonology

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

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Year 2008 - Volume 34  - Number 2  (/February)






Original Article

2 - Pulmonary histopathological alterations in patients with acute respiratory failure: an autopsy study

Alterações histopatológicas pulmonares em pacientes com insuficiência respiratória aguda: um estudo em autopsias

Alexandre de Matos Soeiro, Edwin Roger Parra, Mauro Canzian, Cecília Farhat, Vera Luiza Capelozzi

J Bras Pneumol.2008;34(2):67-73

Abstract PDF PT PDF EN Portuguese Text

Objective: To present the pulmonary histopathological alterations found in the autopsies of patients with acute respiratory failure (ARF) and determine whether underlying diseases and certain associated risk factors increase the incidence of these histopathological patterns. Methods: Final autopsy reports were reviewed, and 3030 autopsies of patients > 1 year of age with an underlying disease and associated risk factors were selected. All had developed diffuse infiltrates and died of ARF-related pulmonary alterations. Results: The principal pulmonary histopathological alterations resulting in immediate death were diffuse alveolar damage (DAD), pulmonary edema, lymphocytic interstitial pneumonia (LIP) and alveolar hemorrhage. The principal underlying diseases were AIDS, bronchopneumonia, sepsis, liver cirrhosis, pulmonary thromboembolism, acute myocardial infarction (AMI), cerebrovascular accident, tuberculosis, cancer, chronic kidney failure and leukemia. The principal associated risk factors were as follows: age ≥ 50 years; arterial hypertension; congestive heart failure; chronic obstructive pulmonary disease; and diabetes mellitus. These risk factors and AIDS correlated with a high risk of developing LIP; these same risk factors, if concomitant with sepsis or liver cirrhosis, correlated with a risk of developing DAD; thromboembolism and these risk factors correlated with a risk of developing alveolar hemorrhage; these risk factors and AMI correlated with a risk of developing pulmonary edema. Conclusion: Pulmonary findings in patients who died of ARF presented four histopathological patterns: DAD, pulmonary edema, LIP and alveolar hemorrhage. Underlying diseases and certain associated risk factors correlated positively with specific histopathological findings on autopsy.

 


Keywords: Respiratory insufficiency; Autopsy; Lung diseases, interstitial; Pulmonary edema; Hemorrhage.

 

3 - Foreign body aspiration in children: clinical aspects, radiological aspects and bronchoscopic treatment

Aspiração de corpo estranho em crianças: aspectos clínicos, radiológicos e tratamento broncoscópico

Andrea de Melo Alexandre Fraga, Marcelo Conrado dos Reis, Mariana Porto Zambon, Ivan Contrera Toro, José Dirceu Ribeiro, Emilio Carlos Elias Baracat

J Bras Pneumol.2008;34(2):

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the clinical manifestations and bronchoscopic treatment of foreign body aspiration in children under 14 years of age, correlating the clinical aspects with the bronchoscopic findings. Methods: A retrospective, descriptive study analyzing data related to children under 14 years of age undergoing bronchoscopy due to clinical suspicion of foreign body aspiration at the State University at Campinas Hospital das Clinicas from January of 2000 to December of 2005. Results: The sample consisted of 69 patients, ranging in age from 8 months to 12 years/7 months (75.4% under 3 years of age), 62.3% of whom were male. The principal complaint was sudden-onset cough (75.4%), auscultation was abnormal in 74%, and dyspnea was observed in 29%. Radiological abnormalities were seen in 88% of the cases. Aspirations were primarily into the right lung (54.8%), and 30.7% of the foreign bodies were of vegetal origin (principally beans and peanuts). In the follow-up period, 29% presented complications (most commonly pneumonia), which were found to be associated with longer aspiration time (p = 0.03). Mechanical ventilation was required in 7 children (10.1%), and multiple bronchoscopies were performed in 5 (7.2%). Conclusion: A history of sudden-onset choking and cough, plus abnormal auscultation and radiological findings, characterizes the profile of foreign body aspiration. In such cases, bronchoscopy is indicated. Longer aspiration time translates to a higher the risk of complications. The high prevalence of foreign bodies of vegetal origin underscores the relevance of prevention programs aimed at children younger than 3 years of age.

 


Keywords: Foreign bodies; Bronchoscopy; Pediatrics.

 

4 - Prevalence of pulmonary hypertension evaluated by Doppler echocardiography in a population of adolescent and adult patients with cystic fibrosis

Prevalência de hipertensão pulmonar avaliada por ecocardiografia Doppler em uma população de pacientes adolescentes e adultos com fibrose cística

Paula Maria Eidt Rovedder, Bruna Ziegler, Antônio Fernando Furlan Pinotti, Sérgio Saldanha Menna Barreto, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2008;34(2):83-90

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the prevalence of pulmonary hypertension (PH) in patients with cystic fibrosis (CF), to compare clinical characteristics, radiographic scores, pulmonary function, and echocardiographic parameters in patients with and without PH, and to correlate echocardiographic findings with clinical characteristics, radiographic scores, and pulmonary function. Methods: This was a prospective, cross-sectional study involving clinically stable patients (aged 16 or older) enrolled in an adult CF program. The patients were submitted to clinical evaluation, Doppler echocardiography, pulmonary function tests, and chest X-rays. Results: Tricuspid regurgitant jet velocity (TRV) was obtained in 37 of the 40 patients studied. The prevalence of PH was 49% with a TRV cut-off of 2.5 m/s (18 patients) and 30% with a TRV cut-off of 2.8 m/s (11 patients). Peripheral oxygen saturation (SpO2) at rest, clinical score, forced expiratory volume in one second (FEV1), and forced vital capacity (FVC) were significantly lower in the group with PH. The TRV was found to correlate significantly with SpO2 at rest (p < 0.001), clinical score (p < 0.001), radiographic score (p = 0.030), FEV1 in liters (p < 0.001) and in % of predicted (p < 0.001), and FCV in liters (p = 0.008) and in % of predicted (p = 0.001). The single best predictor of TRV was SpO2 at rest (p < 0.001). Conclusion: The high prevalence of PH in the CF patients studied suggests that PH should be considered in the evaluation and follow-up treatment of such patients. The best predictor of PH was SpO2 at rest.

 


Keywords: Cystic fibrosis; Tricuspid valve/physiopathology; Hypertension, pulmonary; Echocardiography, Doppler.

 

5 - Smoking in a small city: an ethnographic study to serve as a base for the creation of a public health program

O tabagismo em um município de pequeno porte: um estudo etnográfico como base para geração de um programa de saúde pública

Thales Jenner de Oliveira Falcão, Iris do Céu Clara Costa

J Bras Pneumol.2008;34(2):91-97

Abstract PDF PT PDF EN Portuguese Text

Objective: To outline the prevalence of smoking in the city of Parazinho, Brazil, with the objective of generating data on which to base a plan of action for smoking control programs in the city. Methods: A questionnaire was applied to 150 people (25.6% of whom were smokers) by community health agents during home visits. The questionnaire comprised 30 objective and subjective questions to collect social and biological information on smokers in urban and rural areas. Results: The data were analyzed using descriptive statistics, and the principal findings were as follows: the prevalence of smoking was higher among males (57.8%); most of the interviewees started smoking at an early age (45% before the age of 12); economic conditions constituted a contributing factor (66% of the smokers interviewed earned less than the minimum wage); most of the interviewees reported difficulty in kicking the habit (44.6% reported living with a smoker, and 80% had a friend who smoked); there was a high prevalence of tobacco-related diseases (56.6% had respiratory problems); and there was concomitant alcohol use in 52% of the smokers. Conclusion: This outline can be used in the generation of a local program of smoking prevention and control. Such a program is, in fact, under development. A team of professionals has received training in a 'minimal, intensive approach to the smoker', and a municipal outpatient clinic for the treatment of nicotine dependence has been inaugurated.

 


Keywords: Smoking/prevention & control; Questionnaires; Smoking/epidemiology.

 

6 - Tuberculous uveitis at a referral center in southeastern Brazil

Uveíte por tuberculose em um centro de referência no Sudeste do Brasil

Wesley Ribeiro Campos, Juliana Fulgêncio Henriques, Afrânio Lineu Kritski, André Curi, Rosita Tomishi Pimentel, Silvana Spindola de Miranda

J Bras Pneumol.2008;34(2):98-102

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the occurrence of tuberculous uveitis (TBU) at a referral center in the state of Minas Gerais, Brazil. Methods: A total of 16 consecutive patients (≥15 years of age) who underwent diagnostic evaluation of uveitis between January of 2001 and July of 2004 at the Minas Gerais State Referral Center were selected for study. Demographic and clinical data, as well as data related to screening for toxoplasmosis, syphilis, and rheumatologic diseases, together with the results of tuberculin skin testing and HIV testing, were collected. Results: Of the16 patients evaluated, 11 (69%) were found to have TBU. A history of contact with pulmonary tuberculosis was reported by 8 (72%) of the 11 patients with TBU and by 1 (20%) of the 5 with non-TBU. Although the odds ratio for this association was 10.67 (95% CI: 0.59-398.66), the p value was borderline significant (p = 0.078). There was no difference between the patients with TBU and those with non-TBU in terms of the status of ocular inflammation or the tuberculin skin testing results. All of the patients were HIV negative and were monitored for two years. Conclusion: In this study, a history of contact with pulmonary tuberculosis proved to be useful in diagnosing TBU.

 


Keywords: Tuberculosis; Uveitis; Diagnosis; Brazil.

 

Brief Communication

7 - Brazilian examples of programs for the control of asthma

Exemplos brasileiros de programas de controle de asma

Alcindo Cerci Neto, Olavo Franco Ferreira Filho, Tatiara Bueno

J Bras Pneumol.2008;34(2):103-106

Abstract PDF PT PDF EN Portuguese Text

The aim of this study was to determine which Brazilian programs demonstrate experience in asthma management. Data on and characteristics of those programs were obtained by electronic mail. The variables studied were related to the program itself, its patients and staff. Descriptive statistics were used in the study, which evaluated 17 programs. All programs received public funding, produced educational/training materials and had specialized physicians on staff. We concluded that the experience accumulated by all the programs can be used as one of the pillars of a national program for the control of asthma in Brazil.

 


Keywords: Programs; Asthma; Public health.

 

Review Article

8 - Cystic fibrosis in adults: diagnostic and therapeutic aspects

Fibrose cística no adulto: aspectos diagnósticos e terapêuticos

Paulo de Tarso Roth Dalcin, Fernando Antônio de Abreu e Silva

J Bras Pneumol.2008;34(2):107-117

Abstract PDF PT PDF EN Portuguese Text

Once considered a childhood disease, cystic fibrosis is now also a disease of adults. Increased longevity has resulted in the aging of the cystic fibrosis population. The consequent age-related medical problems among adults with cystic fibrosis have increased medical care needs. These needs are being met by a growing number of non-pediatric pulmonologists and other non-pediatric specialists. The objective of this review was to summarize the current knowledge about diagnosis and treatment in adult cystic fibrosis. In most cases, the diagnosis is suggested by manifestations of chronic sinopulmonary disease and exocrine pancreatic insufficiency. The diagnosis is confirmed by a positive sweat test result. Adult patients may, however, present pancreatic sufficiency and atypical clinical features, sometimes in combination with normal or borderline sweat test results. In such cases, identifying cystic fibrosis mutations and measuring nasal potential difference can have diagnostic utility. The standard therapeutic approach to pulmonary disease includes the use of antibiotics, airway clearance, exercise, mucolytics, bronchodilators, oxygen therapy, anti-inflammatory agents and nutritional support. Appropriate application of these therapies results in most cystic fibrosis patients surviving into adulthood with an acceptable quality of life.

 


Keywords: Cystic fibrosis; Diagnosis; Therapeutics; Mucoviscidosis.

 

Case Report

9 - A very rare cause of dyspnea with a unique presentation on a computed tomography scan of the chest: macrophage activation syndrome

Uma rara causa de dispnéia com apresentação singular na tomografia computadorizada de tórax: síndrome de ativação macrofágica

Rodrigo Antônio Brandão-Neto, Alfredo Nicodemos Cruz Santana, Debora Lucia Seguro Danilovic, Fabíola Del Carlo Bernardi, Carmen Silvia Valente Barbas, Berenice Bilharinho de Mendonça

J Bras Pneumol.2008;34(2):118-120

Abstract PDF PT PDF EN Portuguese Text

Macrophage activation syndrome is a rare and potentially life-threatening disease. It occurs due to immune dysregulation manifested as excessive macrophage proliferation, typically causing hepatosplenomegaly, pancytopenia and hepatic dysfunction. Here, we report an unusual case of macrophage activation syndrome presenting as dyspnea, as well as (reported here for the first time) high resolution computed tomography findings of an excavated nodule, diffuse ground glass opacities and consolidations (mimicking severe pneumonia or alveolar hemorrhage). The patient was successfully treated with human immunoglobulin. We recommend that macrophage activation syndrome be considered in the differential diagnosis of respiratory failure. Rapid diagnosis and treatment are essential to achieving favorable outcomes in patients with this syndrome.

 


Keywords: Macrophage activation; Lymphohistiocytosis, hemophagocytic; Tomography, X-ray computed; Lung diseases, interstitial.

 

10 - Management of recurrent distal tracheal stenosis using an endoprosthesis: a case report

Manejo da estenose traqueal distal recidivada por meio de endoprótese: relato de caso

André Germano Leite, Douglas Kussler

J Bras Pneumol.2008;34(2):121-125

Abstract PDF PT PDF EN Portuguese Text

The authors report the case of a patient with recurrent distal tracheal stenosis after several tracheal resections. A T-Y tracheobronchial stent was inserted for the management of distal airway obstruction. The prosthesis was adapted based on the specifications obtained through a computed tomography scan of the chest with three-dimensional reconstruction.

 


Keywords: Tracheal stenosis; Prostheses and implants; Trachea/surgery; Case reports [publication type].

 

Letters to the Editor

11 - Bedside tracheostomy: practical considerations

Traqueostomia à beira do leito: considerações práticas

Ricardo Mingarini Terra, Angelo Fernandez, Ricardo Helbert Bammann

J Bras Pneumol.2008;34(2):126-

PDF PT PDF EN Portuguese Text


 


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