Brazilian Journal of Pulmonology

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


Publication continuous and bimonthly

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Castleman's disease: An unusual presentation

Doença de Castleman: Uma apresentação pouco frequente

Nicole Murinello, Cristina Matos, Fernando Nogueira

J Bras Pneumol.2011;37(1):129-132

Abstract PDF PT PDF EN Portuguese Text

Castleman's disease is a rare lymphoproliferative disorder, with focal or systemic lymph node involvement, which rarely affects the lung parenchyma. We report the case of an asymptomatic immunocompetent male patient who had the rarest histological variant of the disease, a nodular parenchymal presentation. The patient underwent lobectomy, and the postoperative evolution was favorable. In the last 10 years, there have been only five reports of Castleman's disease presenting as a solitary pulmonary nodule. This case underscores the fact that Castleman's disease, albeit rare, should be included in the differential diagnosis of pulmonary nodules.


Keywords: Giant lymph node hyperplasia; Lymphoproliferative disorders; Solitary pulmonary nodule.


Effect of a clinical protocol on the management of acute asthma in the emergency room of a university hospital

Efeito da implantação de um protocolo assistencial de asma aguda no serviço de emergência de um hospital universitário

Pérsio Mariano da Rocha, Andréia Kist Fernandes, Fernando Nogueira, Deise Marcela Piovesan, Suzie Kang, Eduardo Franciscatto, Thaís Millan, Cristina Hoffmann, Carísi Anne Polanczyk, Sérgio Saldanha Menna Barreto, Paulo de Tarso Roth Dalcin

J Bras Pneumol.2004;30(2):94-101

Abstract PDF PT

Background: There is a wide variability in clinical practice for treating acute asthma (AA) in the emergency room (ER) interfering in the quality of management. Objective: To evaluate the impact of a clinical protocol for care of acute asthma in the ER of the Hospital de Clínicas de Porto Alegre. Method: In this hospital a cross-sectional study was conducted before and after implementation of the protocol, of consecutive patients presenting with acute asthma in the adult ER (age ³ 12 years). The intention was to measure the effect of recommendations on the objective assessment of severity, utilization of diagnostic tools, proposed therapy, not recommended therapy and on the outcomes. Results: The pre-protocol group comprised 108 patients and the protocol group comprised 96 patients. There was a significant increase in the use of pulse oximetry (8% to 77%, p<0.001) and PEFR (5% to 21%, p<0.001). There was an increase in the utilization of radiology (33% to 66%, p<0.001) and in that of blood tests (11% to 25%, p=0.016). There was also an increase in the number of patients receiving the three recommended nebulizations in the first hour (22% to 36%, p=0.04). Although the overall use of corticosteroids did not change, there was a significant increase in the use of oral steroids (8% to 28%, p<0.001). There was no significant difference in the not recommended therapy, time of stay and outcomes. Conclusion: The acute asthma clinical protocol used in the ER was associated to a positive effect on the objective assessment of severity of asthma and on the use of the recommended therapy. No other significant influence on the treatment or on the outcome was perceived.


Keywords: Clinical protocols. Asthma. Emergency medicine.




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