Brazilian Journal of Pulmonology

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


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Year 2011 - Volume 37  - Number 5  (September/October)

Original Article

3 - Six-minute walk test: reference values for healthy adults in Brazil

Teste de caminhada de seis minutos: valores de referência para adultos saudáveis no Brasil

Maria Raquel Soares, Carlos Alberto de Castro Pereira

J Bras Pneumol.2011;37(5):576-583

Abstract PDF PT PDF EN Portuguese Text

Objective: To develop regression equations for six-minute walk distance (6MWD) in healthy adults (20-80 years of age) in Brazil. Methods: We included 132 volunteers (66 males) without respiratory disease, cardiac disease, or comorbidities that affect ambulation. The volunteers completed three six-minute walk tests. Prior to and at the end of each test, we obtained SpO2 and maximal HR, as well as the Borg scale scores for sensation of dyspnea and lower limb fatigue. The data included in the final analysis were derived from the test with the greatest 6MWD. Results: The mean 6MWD values were 566 ± 87 m and 538 ± 95 m in males and females, respectively (p = 0.08). The 6MWD was greater in taller individuals and decreased in parallel with increases in age or body index mass (BMI). The best adjusted model was the quadratic model. We derived the following equation (valid for both genders): 6MWD = 511 + stature2 (cm) × 0.0066 − age2 × 0.030 − BMI2 × 0.068. This equation explained 55% of the variance in 6MWD. Conclusions: Reference values explaining a high proportion of the variance were derived by a quadratic regression model in healthy adults (of a wide range of ages) in Brazil. Keywords: Reference values; Exercise test; Walking.


Keywords: Reference values; Exercise test; Walking.


4 - Acute asthma management in children: knowledge of the topic among health professionals at teaching hospitals in the city of Recife, Brazil

Manejo de crises asmáticas em crianças: conhecimento de profissionais de saúde quanto ao tópico em hospitais-escola do Recife (PE)*

Giovanna Menezes de Medeiros Lustosa, Murilo Carlos Amorim de Britto, Patrícia Gomes de Matos Bezerra

J Bras Pneumol.2011;37(5):584-588

Abstract PDF PT PDF EN Portuguese Text Appendix

Objective: Knowledge of acute asthma management in children is a subject that has rarely been explored. The objective of this study was to assess the level of such knowledge among health professionals in the city of Recife, Brazil. Methods: This was a cross-sectional survey involving 27 pediatricians and 7 nurses, all with at least two years of professional experience, at two large pediatric teaching hospitals in Recife. The participants completed a self-administered multiple-choice questionnaire. Results: The pediatricians and nurses all possessed insufficient knowledge regarding the use of metered dose inhalers, nebulization, and types/doses of medications, as well as techniques for decontamination and disinfection of the equipment. Conclusions: Insufficient knowledge of acute asthma management in children can lead to less effective treatment in hospitals such as those evaluated here. Educational programs should be developed in order to minimize this problem.


Keywords: Asthma; Health knowledge, attitudes, practice; Nebulizers and vaporizers.


5 - An experimental rat model of ex vivo lung perfusion for the assessment of lungs after prostacyclin administration: inhaled versus parenteral routes

Modelo experimental de perfusão pulmonar ex vivo em ratos: avaliação de desempenho de pulmões submetidos à administração de prostaciclina inalada versus parenteral

Paulo Francisco Guerreiro Cardoso, Rogério Pazetti, Henrique Takachi Moriya, Paulo Manuel Pêgo-Fernandes, Francine Maria de Almeida, Aristides Tadeu Correia, Karina Fechini, Fabio Biscegli Jatene

J Bras Pneumol.2011;37(5):589-597

Abstract PDF PT PDF EN Portuguese Text

Objective: To present a model of prostaglandin I2 (PGI2) administration (inhaled vs. parenteral) and to assess the functional performance of the lungs in an ex vivo lung perfusion system. Methods: Forty Wistar rats were anesthetized and placed on mechanical ventilation followed by median sterno-laparotomy and anticoagulation. The main pulmonary artery was cannulated. All animals were maintained on mechanical ventilation and were randomized into four groups (10 rats/group): inhaled saline (IS); parenteral saline (PS); inhaled PGI2 (IPGI2); and parenteral PGI2 (PPGI2). The dose of PGI2 used in the IPGI2 and PPGI2 groups was 20 and 10 µg/kg, respectively. The heart-lung blocks were submitted to antegrade perfusion with a low potassium and dextran solution via the pulmonary artery, followed by en bloc extraction and storage at 4°C for 6 h. The heart-lung blocks were then ventilated and perfused in an ex vivo lung perfusion system for 50 min. Respiratory mechanics, hemodynamics, and gas exchange were assessed. Results: Mean pulmonary artery pressure following nebulization decreased in all groups (p < 0.001), with no significant differences among the groups. During the ex vivo perfusion, respiratory mechanics did not differ among the groups, although relative oxygenation capacity decreased significantly in the IS and PS groups (p = 0.04), whereas mean pulmonary artery pressure increased significantly in the IS group. Conclusions: The experimental model of inhaled PGI2 administration during lung extraction is feasible and reliable. During reperfusion, hemodynamics and gas exchange trended toward better performance with the use of PGI2 than that with the use of saline.


Keywords: Prostaglandins; Lung transplantation; Reperfusion; Models, animal; Rats.


6 - Hematopoietic stem cell transplantation: pulmonary function tests and post-transplant mortality

Testes de função pulmonar e mortalidade após o transplante de células-tronco hematopoiéticas

Eliane Viana Mancuzo, Nilton Alves de Rezende

J Bras Pneumol.2011;37(5):598-606

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine whether the results of pulmonary function tests carried out in patients subsequently submitted to hematopoietic stem cell transplantation (HSCT) are associated with post-HSCT mortality. Methods: This was a prospective study involving patients older than 15 years of age who were submitted to allogenic HSCT between January of 2007 and March of 2008 at the Hospital das Clínicas da Universidade Federal de Minas Gerais, located in the city of Belo Horizonte, Brazil. Prior to HSCT, all of the patients underwent spirometry, determination of lung volumes, and determination of DLCO. Those same tests were repeated six months, one year, and two years after HSCT. Kaplan-Meier curves and two-tailed log-rank tests were used for survival analysis. The relative risk (RR) and 95% CI were calculated using the Cox proportional hazards model. The Cox regression model was used in the multivariate analysis. Results: The pre-HSCT pulmonary function results were normal in 40 (74.1%) of the 54 patients evaluated, 19 (35.2%) of whom died within the first 100 days after HSCT. By the end of the two-year follow-up period, 23 patients (42.6%) had died, the most common causes of death being septicemia, observed in 11 (47.8%), and septicemia-related respiratory insufficiency, observed in 10 (43.4%). The only variables significantly associated with post-HSCT mortality were alterations in spirometry results prior to HSCT (RR = 3.2; p = 0.016) and unrelated donor (RR = 9.0; p < 0.001). Conclusions: Performing spirometry prior to HSCT provides baseline values for future comparisons. Although alterations in spirometry results reveal a higher risk of post-HSCT mortality, such alterations do not contraindicate the procedure.


Keywords: Hematopoietic stem cell transplantation/mortality; Respiratory function tests; Donor selection.


7 - Reference equations for the performance of healthy adults on field walking tests

Equações de referência para os testes de caminhada de campo em adultos saudáveis

Victor Zuniga Dourado, Milena Carlos Vidotto, Ricardo Luís Fernandes Guerra

J Bras Pneumol.2011;37(5):607-614

Abstract PDF PT PDF EN Portuguese Text

Objective: To develop regression equations for predicting six-minute and incremental shuttle walk distances (6MWD and ISWD, respectively), based on demographic characteristics, anthropometric variables, and grip strength. Methods: We evaluated 6MWD and ISWD in 98 healthy adults. Height, weight, and grip strength were also assessed. Using data from 90 of the participants (40 males; 60 ± 9 years of age), we devised linear equations adjusted for age, gender, height, and weight, and we developed alternate models that included grip strength. We prospectively applied the equations in the 8 remaining participants (4 males; 59 ± 10 years), who had been randomly separated from the initial sample. Results: Age, gender, height, and weight collectively explained 54.5% and 64.9% of the variance in 6MWD and ISWD, respectively, whereas age, height, weight, and grip strength collectively explained 54.4% and 69.0% of the respective variances. There was no significant difference between the measured and predicted 6MWD using equations with and without grip strength (14 ± 57 vs. 13 ± 67 m). Similar results were observed for ISWD (25 ± 104 vs. 25 ± 93 m). Conclusions: Grip strength is a determinant of ISWD and 6MWD; however, it could not improve the power of equations adjusted by demographic and anthropometric variables. The validity of our models including grip strength should be further evaluated in patients with skeletal muscle dysfunction.


Keywords: Walking; Exercise; Reference Values; Exercise test.


8 - Spirometric reference values for healthy adults in the Mazandaran province of Iran

Valores de referência para espirometria em adultos saudáveis na província de Mazandaran, Irã

Siavash Etemadinezhad, Ahmad Alizadeh

J Bras Pneumol.2011;37(5):615-620

Abstract PDF PT PDF EN Portuguese Text

Objective: One of the major issues in the use of spirometry is the evaluation of the values obtained in comparison with standardized reference values. Such reference values should be determined by studying populations similar to the population in which they are intended to be used. Considering the anthropometric differences among races and the effect of regional issues, such as climate and air quality, it is recommended that these standards be set and used regionally. The objective of this study was to measure the spirometric values in residents of the Mazandaran province in Iran, as well as to determine which standardized reference values most closely correlate with the values obtained and to devise predictive equations for the target population. Methods: This was a cross-sectional study of 1,499 volunteers, from whom demographic and anthropometric data were collected. After having been instructed in the correct procedure, each volunteer underwent spirometry. From each volunteer, we obtained three spirometry curves that met the acceptability criteria established by the American Thoracic Society. The test with the highest values of FEV1 and FVC was employed in the analysis. Results: We observed significant correlations between the measured values and the reference values, for both genders. The strongest correlations were with the European Respiratory Society reference values and with the 18-20 year age bracket. The predictive equations devised were based on the regression coefficients obtained and the demographic data collected. Conclusions: Our results show that the European Respiratory Society standard is the most appropriate standard for use in the population studied.


Keywords: Spirometry/statistics  numerical data; Climate effects; Reference values; Iran.


9 - Influenza A (H1N1)-associated pneumonia

Pneumonia associada a influenza A (H1N1)

Antonello Nicolini, Simonassi Claudio, Fabrizio Rao, Lorenzo Ferrera, Michele Isetta, Monica Bonfiglio

J Bras Pneumol.2011;37(5):621-627

Abstract PDF PT PDF EN Portuguese Text

Objective: To describe the characteristics of patients with influenza A (H1N1)-associated pneumonia treated at two hospitals in the region of Liguria, Italy, as well as to describe their treatment and outcomes. Methods: This was a prospective observational study including all patients older than 16 years of age with a confirmed diagnosis of influenza A (H1N1) who were admitted to Villa Scassi Hospital, in the city of Genoa, Italy, or to the Sestri Levante General Hospital, in the city of Sestri Levante, Italy, between September of 2009 and January of 2010. The primary outcome measure was mortality within 60 days after diagnosis. Secondary outcome measures were the need for mechanical ventilation and the length of hospital stay. Results: Of the 40 patients with a confirmed diagnosis of influenza A (H1N1), 27 presented pneumonia during the study period. The mean age of the 27 patients was 42.8 ± 14.8 years, and the mean length of hospital stay was 11.6 ± 8.2 days. Of the 27 patients, 20 had respiratory failure, 4 underwent invasive mechanical ventilation, and 5 underwent noninvasive ventilation. One patient had comorbidities, developed multiple organ failure, and died. Conclusions: During the influenza A (H1N1) pandemic, the associated mortality rate was lower in Italy than in other countries, and cases reported in the country typically had a milder course than did those reported elsewhere. Nevertheless, 9 of our cases (33%) rapidly evolved to respiratory failure, requiring mechanical ventilation.


Keywords: Pneumonia; Influenza A virus, H1N1 subtype; Respiratory insufficiency.


10 - Restriction enzyme analysis of the hsp65 gene in clinical isolates from patients suspected of having pulmonary tuberculosis in Teresina, Brazil

Análise de restrição enzimática do gene hsp65 de isolados clínicos de pacientes com suspeita de tuberculose pulmonar em Teresina, Piauí

Maria das Graças Motta e Bona, Maria José Soares Leal, Liline Maria Soares Martins, Raimundo Nonato da Silva, José Adail Fonseca de Castro, Semiramis Jamil Hadad do Monte

J Bras Pneumol.2011;37(5):628-635

Abstract PDF PT PDF EN Portuguese Text

Objective: To identify mycobacterial species in the sputum of patients suspected of having pulmonary tuberculosis and to determine the impact that the acquisition of this knowledge has on the therapeutic approach. Methods: We evaluated 106 patients suspected of having pulmonary tuberculosis and referred to the pulmonology department of a public hospital in the city of Teresina, Brazil. Morning sputum specimens were evaluated for the presence of mycobacteria by sputum smear microscopy and culture. We used PCR and restriction enzyme analysis of the hsp65 gene (PRA-hsp65) to identify the strains of mycobacteria isolated in culture. Results: A total of 206 sputum samples were analyzed. Patient ages ranged from 15 to 87 years, and 67% were male. There was cough in 100% of the cases. The predominant radiographic pattern was moderate disease, observed in 70%. Smear positivity was 76%, and isolation in culture occurred in 91% of the cultures. Traditional tests identified nontuberculous mycobacteria (NTM) in 9% of the isolates. The PRA-hsp65 method confirmed these data, showing seven band patterns that were able to identify the isolated species of NTM: Mycobacterium kansasii; M. abscessus 1; M. abscessus 2; M. smegmatis; M. flavescens 1; M. gordonae 5; and M. gordonae 7. All of the patients with NTM were over 60 years of age, and bronchiectasis was seen in 88% of the X-rays. There were two cases of reinfection, initially attributed to M. abscessus and M. kansasii. Conclusions: In immunocompetent patients, NTM can infect the lungs. It is important to identify the specific NTM in order to establish the correct diagnosis and choose the most appropriate therapeutic regimen. The PRA-hsp65 method is useful in identifying NTM species and can be implemented in molecular biology laboratories that do not specialize in the identification of mycobacteria. Keywords:


Keywords: Tuberculosis; Mycobacteria, atypical; Polymerase chain reaction; Brazil.


11 - Active tuberculosis among health care workers in Portugal

Tuberculose ativa entre profissionais de saúde em Portugal

José Castela Torres da Costa, Rui Silva, José Ferreira, Albert Nienhaus

J Bras Pneumol.2011;37(5):636-645

Abstract PDF PT PDF EN Portuguese Text

Objective: To determine the incidence of active tuberculosis (TB) in a cohort of health care workers (HCWs). Methods: Descriptive study of active TB cases identified in an occupational health screening of 6,112 HCWs between 2005 and 2010. Cases of active TB were defined as those in which Mycobacterium tuberculosis was identified by direct microscopy or culture; those in which there were symptoms or clinical signs of TB and necrotizing granuloma, as detected by histology; and those in which the radiological findings were consistent with active TB. Results: Among the 6,112 HCWs evaluated, we identified 62 cases of active TB: pulmonary TB (n = 43); pleural TB (n = 15); lymph node TB (n = 2); pericardial TB (n = 1); and cutaneous TB (n = 1). Seven HCWs were asymptomatic at the time of diagnosis. Of the 62 cases of active TB, 48 developed within the first 10 years of occupational exposure in the workplace, 36 of those occurring within the first 5 years. Physicians and nurses accounted for the highest numbers of cases (22 and 21, respectively). Conclusions: In HCWs employed in Portugal, the TB burden is high. Physicians and nurses are the HCWs who are at the highest risk of developing active TB. We found the risk of developing this disease to be highest in the first years of exposure, as has been reported in previous studies. In high-incidence countries, TB screening of HCWs is important for controlling the transmission of this disease.


Keywords: Tuberculosis/diagnosis; Occupational health; Health personnel.


12 - Tuberculin skin test: operational research in the state of Mato Grosso do Sul, Brazil

Teste tuberculínico: pesquisa operacional no Mato Grosso do Sul

Sandra Maria do Valle Leone de Oliveira, Antônio Ruffino-Netto, Anamaria Mello Miranda Paniago, Olcinei Alves de Oliveira, Marli Marques, Rivaldo Venâncio da Cunha, Renato Andreotti

J Bras Pneumol.2011;37(5):646-654

Abstract PDF PT PDF EN Portuguese Text

Objective: To investigate operational aspects of tuberculin skin test (TST) use in tuberculosis control programs and at specialized Brazilian National Sexually Transmitted Diseases/AIDS and Viral Hepatitis Program health care clinics in priority municipalities for tuberculosis control in the state of Mato Grosso do Sul, Brazil. Methods: This was a descriptive, cross-sectional, epidemiological survey. Data on qualifications/training of professionals administering TSTs, timing of the TST, procedures in cases of loss to follow-up (reading), material availability, and material storage were collected through interviews and technical visits. For the 2008-2009 period, we determined the numbers of screenings in vulnerable populations, of TSTs performed, and of patients treated for latent tuberculosis. Results: We interviewed 12 program managers in six municipalities. Some programs/clinics did not perform TSTs. Nursing teams administered the TSTs, results were read by non-specialists, and specialization/refresher courses were scarce. The PPD RT23 was stored in 5-mL flasks under appropriate conditions. Insulin syringes were commonly used. Testing was available during business hours, three times a week. In cases of loss to follow-up, telephone calls or home visits were made. Of the 2,305 TSTs evaluated, 1,053 (46%) were performed in indigenous populations; 831 (36%) were screenings in prisons, performed for training; and only 421 (18%) involved contacts of tuberculosis patients or vulnerable populations. Four vulnerable patients and 126 indigenous subjects were treated for latent tuberculosis. Conclusions: These priority municipalities showed operational difficulties regarding human resources, materials, and data records.


Keywords: Tuberculin test; Health services research; HIV; Latent tuberculosis; Chemoprevention.


Brief Communication

13 - Occurrence of influenza among patients hospitalized for suspicion of influenza A (H1N1) infection in 2010 at a sentinel hospital in São Paulo, Brazil

Ocorrência de influenza em pacientes hospitalizados com suspeita de infecção por influenza A (H1N1) em 2010 em um hospital sentinela na cidade de São Paulo

Thaís Boim Melchior, Sandra Baltazar Guatura, Clarice Neves Camargo, Aripuanã Sakurada Aranha Watanabe, Celso Granato, Nancy Bellei

J Bras Pneumol.2011;37(5):655-658

Abstract PDF PT PDF EN Portuguese Text

In 2010, 96 patients suspected of being infected with the influenza A (H1N1) virus were hospitalized at the Hospital São Paulo, located in the city of São Paulo, Brazil. Of those 96 patients, 4 (4.2%) were found to be infected with influenza A virus-3 with influenza A (H1N1) and 1 with seasonal influenza A-and 2 patients (2.1%) were found to be infected with influenza B virus. Most (63.5%) of the suspected cases occurred in children, as did half of the positive cases. The second wave of influenza A (H1N1) infection was weaker in São Paulo. The decrease in the number of hospitalizations for H1N1 infection in 2010 might be attributable to vaccination.


Keywords: Influenza A virus, H1N1 subtype; Influenza, human; Pneumonia; Pandemics.


14 - Negative expiratory pressure test: a new, simple method to identify patients at risk for obstructive sleep apnea

Teste de pressão negativa expiratória: um novo método simples para identificar pacientes com risco para apneia obstrutiva do sono

Luis Vicente Franco de Oliveira, Salvatore Romano, Raquel Pastréllo Hirata, Newton Santos de Faria Júnior, Lílian Chrystiane Giannasi, Sergio Roberto Nacif, Fernando Sergio Studart Leitão Filho, Giuseppe Insalaco

J Bras Pneumol.2011;37(5):659-663

Abstract PDF PT PDF EN Portuguese Text

The objective of this article was to describe a new method for assessing expiratory flow limitation during spontaneous breathing, using the negative expiratory pressure test to identify patients at risk for obstructive sleep apnea. Upper airway collapsibility is evaluated by measuring decreases in flow and in expired volume in the first 0.2 seconds after negative expiratory pressure application at 10 cmH2O. The negative expiratory pressure test is easily applied and could be adopted for the evaluation of expiratory flow limitation caused by upper airway obstruction in patients with obstructive sleep apnea.


Keywords: Sleep apnea, obstructive/diagnosis; Sleep apnea, obstructive/prevention and control; Airway resistance.


15 - Identification of Mycobacterium bovis among mycobacterial isolates from human clinical specimens at a university hospital in Rio de Janeiro, Brazil

Identificação de Mycobacterium bovis em cepas micobacterianas isoladas de espécimes clínicos humanos em um complexo hospitalar na cidade do Rio de Janeiro

Luciana Fonseca Sobral, Rafael Silva Duarte, Gisele Betzler de Oliveira Vieira, Marlei Gomes da Silva, Neio Boechat, Leila de Souza Fonseca

J Bras Pneumol.2011;37(5):664-668

Abstract PDF PT PDF EN Portuguese Text

In 2005 and 2006, 8,121 clinical specimens submitted to the Mycobacteriology Laboratory of the Clementino Fraga Filho University Hospital/Thoracic Diseases Institute, in the city of Rio de Janeiro, Brazil, were inoculated on Löwenstein-Jensen medium containing glycerol and pyruvate. There were 79 mycobacteria isolates that presented growth only on pyruvate-containing medium, and those isolates were selected for the presumptive identification of Mycobacterium bovis. The selected isolates were screened with biochemical tests, PCR amplification (with the specific primers Rv0577 and Rv1510), and pyrazinamide susceptibility tests. All of the strains isolated showed specific phenotypical and genotypical patterns characteristic of M. tuberculosis, and no M. bovis strains were detected.


Keywords: Tuberculosis; Mycobacterium bovis; Polymerase chain reaction.


Review Article

16 - Predictive parameters for weaning from mechanical ventilation

Parâmetros preditivos para o desmame da ventilação mecânica

Sérgio Nogueira Nemer, Carmen Sílvia Valente Barbas

J Bras Pneumol.2011;37(5):669-679

Abstract PDF PT PDF EN Portuguese Text

The use of predictive parameters for weaning from mechanical ventilation is a rather polemic topic, and the results of studies on this topic are divergent. Regardless of the use of these predictive parameters, the spontaneous breathing trial (SBT) is recommended. The objective of the present study was to review the utility of predictive parameters for weaning in adults. To that end, we searched the Medline, LILACS, and PubMed databases in order to review articles published between 1991 and 2009, in English or in Portuguese, using the following search terms: weaning/desmame, extubation/extubação, and weaning indexes/indices de desmame. The use of clinical impression is an inexact means of predicting weaning outcomes. The most widely used weaning parameter is the RR/tidal volume (VT) ratio, although this parameter presents heterogeneous results in terms of accuracy. Other relevant parameters are MIP, airway occlusion pressure (P0.1), the P0.1/MIP ratio, RR, VT, minute volume, and the index based on compliance, RR, oxygenation, and MIP. An index created in Brazil, the integrative weaning index, has shown high accuracy. Although recommended, the SBT is inaccurate, approximately 15% of extubation failures going unidentified in SBTs. The main limitations of the weaning indexes are related to their use in specific populations, the cut-off points selected, and variations in the types of measurement. Since the SBT and the clinical impression are not 100% accurate, the weaning parameters can be useful, especially in situations in which the decision as to weaning is difficult.


Keywords: Weaning; Intensive care units; Ventilators, mechanical; Respiration, artificial.


17 - Gastroesophageal reflux disease and airway hyperresponsiveness: concomitance beyond the realm of chance?

Doença do refluxo gastroesofágico e hiperresponsividade das vias aéreas: coexistência além da chance?

Jaqueline Cavalcanti de Albuquerque Ratier, Emilio Pizzichini, Marcia Pizzichini

J Bras Pneumol.2011;37(5):680-688

Abstract PDF PT PDF EN Portuguese Text

Gastroesophageal reflux disease and asthma are both quite common the world over, and they can coexist. However, the nature of the relationship between these two diseases remains unclear. In this study, we review controversial aspects of the relationships among asthma, airway hyperresponsiveness, and gastroesophageal reflux disease in adults and in children.


Keywords: Asthma; Bronchial hyperreactivity; Gastroesophageal reflux.


Case Report

18 - Pulmonary actinomycosis as a pseudotumor: A rare presentation

Actinomicose pulmonar na forma pseudotumoral: Uma apresentação rara

Hylas Paiva da Costa Ferreira, Carlos Alberto Almeida de Araújo, Jeancarlo Fernandes Cavalcanti, Roberta Lacerda Almeida de Miranda, Rachel de Alcântara Oliveira Ramalho

J Bras Pneumol.2011;37(5):689-693

Abstract PDF PT PDF EN Portuguese Text

Some lung diseases are true diagnostic challenges due to their various clinical presentations. Actinomycosis is one such disease, potentially affecting various organs and systems. We report the case of a patient with pulmonary actinomycosis as a pseudotumor, which is usually only diagnosed by thoracotomy or thoracoscopy.


Keywords: Actinomycosis; Thoracic neoplasms; Bacterial infections and mycoses.


Letters to the Editor

19 - Robotic thymectomy for myasthenia gravis

Timectomia robótica para miastenia gravis

Rodrigo Afonso da Silva Sardenberg, Ricardo Zugaib Abadalla, Igor Renato Louro Bruno Abreu, Eli Faria Evaristo, Riad Naim Younes

J Bras Pneumol.2011;37(5):694-696

PDF PT PDF EN Portuguese Text

20 - Diaphragmatic pacing: unusual indication with successful application

Marca-passo diafragmático: indicação incomum, aplicação bem-sucedida

Rodrigo Afonso da Silva Sardenberg, Liliana Bahia Pereira Secaf, Adriana Cordeiro Pinotti, Mário Augusto Taricco, Roger Schmidt Brock, Riad Naim Younes

J Bras Pneumol.2011;37(5):697-699

PDF PT PDF EN Portuguese Text

21 - Nonfunctional middle mediastinal paraganglioma: diagnostic and surgical management

Paraganglioma não funcional de mediastino médio: diagnóstico e manejo cirúrgico

Marcelo Cunha Fatureto, João Paulo Vieira dos Santos, Evelyne Gabriela Schmaltz Chaves Marques, Tarcísio Barcelos Evangelista, Wilson Alves Marques da Costa

J Bras Pneumol.2011;37(5):700-702

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