Brazilian Journal of Pulmonology

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


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Year 1998 - Volume 24  - Number 5  (September/October)

Original Article

1 - Influence of gastroesophageal reflux levels in the treatment of patients with chronic cough

Influência dos níveis de refluxo gastroesofágico (RGE) na escolha do tratamento de pacientes com tosse crônica

Otávio Leite Gastal, Bruno Carlos Palombini, Tom Ryan DeMeester, Carmen Palombini Gastal, Marta Mascarenhas Corrêa da Silva, Silvia Macedo

J Bras Pneumol.1998;24(5):277-282

Abstract PDF PT Portuguese Text

Gastroesophageal reflux (GER) is a common cause of chest affections and symptoms, such as chronic cough, asthma, respiratory infections, pulmonary fibrosis and chest pain. Relief after medical or surgical antireflux therapy is variable. Twenty-four hour pH monitoring has been considered the gold standard for the diagnosis of gastroesophageal reflux disease (GERD). The use of 2 or more pH sensors in different locations within the esophagus is a reliable method for the diagnosis of more severe GER and enables aspiration of the airways and lungs. The purpose of this study was to determine whether the height at which reflux is detected within the esophagus is an indicator of surgical, as opposed to medical, antireflux therapy. In a series of 35 patients with cough as a sole presentation of GER the levels of reflux within the esophagus were correlated to the outcome after medical or surgical antireflux therapy. The studies and surgical procedures were performed in the affiliated hospitals of the Federal and Catholic Universities of Pelotas - RS. Chi-square and Mann-Whitney-U test were used to perform statistical analysis. The present study showed that gastroesophageal reflux into either the distal or the proximal esophagus can cause chronic cough. The height of reflux is an important predictor of response to antireflux therapy. Patients with proximal reflux treated medically do poorly. Surgical therapy is consistently associated with a good outcome, regardless of the height to which reflux occurs, particularly in patients with proximal reflux. Overall, surgical therapy provides the best outcome in all patients with chronic cough due to gastroesophageal reflux.


Keywords: Chronic cough. Gastroesophageal reflux disease. Esophageal pH monitoring.


2 - Chronic dyspnea with unexplained cause: evaluation of an investigation protocol with 90 patients

Dispnéia crônica de causa indeterminada: avaliação de um protocolo de investigação em 90 pacientes

Sílvia Helena Bersácola, Carlos Alberto de Castro Pereira, Rita de Cássia Cruz da Silva, Ricardo M. Ladeira

J Bras Pneumol.1998;24(5):283-297

Abstract PDF PT Portuguese Text

Chronic dyspnea has a wide range of causes. The aim of the authors was to evaluate a diagnostic approach applied to patients with unexplained chronic (> 30 days) dyspnea, or when multiple causes were present. Methods: An algorithm for the work-up was applied: 1) complete history and physical examination; 2) bronchoprovocation test (BPT) and serial measurements of echocardiography; 3) cardiopulmonary exercise testing (CPET) and doppler echocardiography; 4) special tests: FRCT, V/Q scan, DCO, lung volumes, MIP, and others, as indicated. Results: Ninety patients were included, mean age of 51 ± 16 yr. Hyperventilation symptoms were present in 48, but associated with BHR or asthma in 19. Obstructive defect was present in 24 (asthma, 11; COPD, 8). Reduced FVC with normal FEV1/FVC was found in 10; explanations were asthma in 4, heart disease in 4. BPT was performed in 71 and was verified to be normal in 20; PEF variation was evaluated in 71, and was abnormal in 28, isolated in 16, and in 7 with asthma as final diagnosis. Echocardiography was performed in 44, and showed diastolic dysfunction in 11 out of 16 patients with final diagnosis of heart disease. CPET showed cardiovascular limitation in 19, hyperventilation in 19, and ventilatory defect in 12. CPET was decisive in 33 (38%), specially for heart diseases and to exclude causes suspected by clinical data. Respiratory disease was the explanation for dyspnea in 51 (59%): asthma (31), BHR (8), COPD (8), interstitial lung disease (4); other causes found were: heart disease (16), primary hyperventilation syndrome (8), obesity (5), neuromuscular disease (6), psychogenic dyspnea (2), and others (7). Multiple causes were found in 13 patients. Eight patients had non-recognizable etiology. Conclusion: An algorithm approach to chronic dyspnea resulted in diagnosis of 91% of the cases; spirometry, tests for BHR including PEF measurements, echocardiography, and CPET are essential for the investigation.


Keywords: Chronic dyspnea. Exercise test. Spirometry. Respiratory function tests. Bronchoprovocation tests. Peak expiratory flow. Echocardiography. Chest X-ray. Heart failure, congestive.


3 - Classification of risk and prophylaxis for venous thromboembolism in university hospital patients

Estratificação de risco e profilaxia para tromboembolia venosa em pacientes internados em hospital geral universitário

Sérgio Saldanha Menna Barreto, Carlo Sasso Faccin, Paula Mallman da Silva, Larissa Pretto Centeno, Marcelo Basso Gazzana

J Bras Pneumol.1998;24(5):299-302

Abstract PDF PT Portuguese Text

Objectives: To identify the frequency of risk factors, classification of degree of risk and the practice of prophylaxis to venous thromboembolism (VTE) in a general hospital. Methods: Randomly selected cases were included. Patients were excluded if they were on anticoagulant treatment. Determination of risk factors and classification of degree of risk were done according to international consensus. Results: Most patients (96%) had at least one recognized risk factor, 81% of them fulfilled the criteria to be classified as moderate/high risk. Prophylactic measures were prescribed to 221 (63%) patients. There was a significant association between the higher risk level for VTE and increased use of heparin (p < 0.001). Contraindications to the use of heparin were noticed in 7% of the cases. Conclusion: Risk factors for VTE are usually seen and prophylaxis is unsatisfactory. Contraindications to the use of heparin are uncommon; prophylaxis should be considered for a higher number of patients.


Keywords: Pulmonary embolism. Deep venous thrombosis. Prevention.


4 - Pulmonary and mediastinal malformations with respiratory symptoms

Malformações pulmonares e mediastinais com repercussões respiratórias

Carlos A. Riedi, Nelson A. Rosário Filho, Isabelle V. Trevisan, José E. Carreiro, Dante L. Escuissato

J Bras Pneumol.1998;24(5):303-310

Abstract PDF PT Portuguese Text

Objective: To evaluate clinical features of malformations of lung and mediastinum. Methods: Retrospective analysis of 51 patients with malformations identified in the author's division between 1982 and 1997. They verified the clinical manifestations, diagnostic procedures, and treatment. Results: The most frequent anomaly was esophageal atresia/tracheoesophageal fistula (12), followed by vascular ring (11), congenital lobar emphysema (7), diaphragmatic hernia/eventration (7), bronchogenic cyst (5), pulmonary hypoplasia (4), pulmonary sequestration (3), and arterial-venous fistula (2). Age at diagnosis varied from birth to 10 years. Most of them exhibited symptoms at first month, some even at birth. The main respiratory symptoms were tachypnea, coughing, retractions, dyspnea, wheezing, pneumonia and rales. Chest X-rays with barium swallow were most important for diagnosis. When chest radiology was inconclusive, CT scans were next in achieving diagnosis. Surgical intervention was the effective treatment in 86% of cases. Conclusions: Lung and mediastinal congenital malformations with respiratory symptoms require adequate diagnostic evaluation and immediate intervention. The most frequent respiratory symptoms were coughing and tachypnea and chest X-rays with barium swallow was the main diagnostic method. Survival is good and mortality is secondary to associated malformations.


Keywords: Bronchopulmonary malformations. Respiratory distress. Retrospective studies.


Review Article

5 - Complicações cardiovasculares da síndrome da apnéia do sono obstrutiva

Lia Rita Azeredo Bittencourt, Odair Marson, Luiz E. Nery, Sérgio Tufik

J Bras Pneumol.1998;24(5):311-316


6 - Manifestações pulmonares causadas pelo uso do "crack"

Maria do Rosário da Silva Ramos Costa, Rosemary Farias Alves, Marciel Dourado Franca

J Bras Pneumol.1998;24(5):317-321


Case Report

7 - Bronchiolitis obliterans with organizing pneumonia (BOOP)

Bronquiolite obliterante com pneumonia em organização (BOOP) aguda

José Eduardo Delfini Cançado, Carlos Alberto de Castro Pereira, Ester N.A.M. Coletta

J Bras Pneumol.1998;24(5):331-334

Abstract PDF PT Portuguese Text

Most interstitial lung diseases (ILD) are indolent in nature, producing subacute or chronic symptoms that progress at various rates and are usually present for months to years before a diagnosis is established. This report describes a case of a fulminating and life-threatening variant of idiopathic bronchiolitis obliterans with organizing pneumonia (BOOP). Early suspicion, histologic diagnosis, and prompt initiation of corticosteroid therapy is important to prevent mortality.


Keywords: Bronchiolitis obliterans with organizing pneumonia (BOOP). Interstitial lung disease.


8 - Cystic adenomatoid malformation of the lung: report on four cases

Malformação congênita adenomatóide cística do pulmão: relato de quatro casos

Gisele A. Nai1, Carlos Zelandi Filho, Rosa M. Viero, Julio Defaveri

J Bras Pneumol.1998;24(5):335-338

Abstract PDF PT Portuguese Text

Cystic adenomatoid malformation of the lung is a rare form of congenital pulmonary disease. It has been found in all lobes, it is rarely bilateral, and is associated to hydramnion, placental edema, and fetal hydrops. It is divided into three types, with different clinical and histologic characteristics. Intrauterine diagnosis is possible by means of ultrasound examination, and the treatment of choice is lobectomy. The authors describe four cases seen at their hospital and review the literature.


Keywords: Cystic adenomatoid malformation. Congenital malformation. Lung.


9 - Human pulmonary adiaspiromycosis: a new case diagnosed by transbronchial biopsy

Novo caso de adiaspiromicose humana diagnosticado por biópsia transbrônquica

Terezinha do Socorro M. Lima, Mário A.P. Moraes, Hebe Quezado Magalhães, Norma Suely G. Athayde

J Bras Pneumol.1998;24(5):339-341

Abstract PDF PT Portuguese Text

A case of human pulmonary adiaspiromycosis - the 18th from Brazil - is reported for two purposes: to contribute to the knowledge of the clinical course of the disease and to discuss the basis for using the transbronchial biopsy in demonstrating the causative organism. The patient, an 18 year old male, lived in the Paranoa village, near Brasilia, DF, where he worked in a joinery, making straw-brooms. In February 1997, he was admitted to the Brasilia University Hospital, with severe respiratory manifestations. The main symptom was a ventilatory-dependent thoracic pain. A chest roentgenogram showed a diffuse interstitial infiltrate, in both lungs, with micronodular pattern suggestive of a miliary process. No bacterial or fungal organisms could be found in the sputum or bronchial lavages of the patient. A transbronchial biopsy was then performed and the microscopic examination of the lung tissue revealed several large adioconidia. Adiaspiromycosis is believed to be a self-healing condition, since in the great majority of the so far known cases spontaneous remission of the pulmonary lesions has been the rule. Transbronchial biopsy, due to its simplicity, is indicated as the procedure of choice to demonstrate the adiaconidia of the agent in tissue sections - the only way to definitely establish the diagnosis of adiaspiromycosis.


Keywords: Adiaspiromycosis. Pulmonary mycosis. Emmonsia crescens. Emmonsia parva var crescens. Chrysosporium parvum var crescens.


10 - Derrame pleural com elevado teor de amilase

Célia Mallart Llarges, Jaqueline Maria Lima, Luís Felipe F. da Silva, Carlos Eduardo P. Barreto

J Bras Pneumol.1998;24(5):342-344



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