Objectives: Evaluate the results of the Brazilian Society of Tisiology and Pulmonary Medicine Board Examination and verify the factors related to acceptance. Planning: Retrospective analysis comparing scores obtained in practical and written examinations and acceptance to gender, years since graduation, years of pulmonary medicine practice, regional and national meetings attendance, place, and duration, as well as having or not attended residence or training programs. Population: Between 1992 and 1996, 199 candidates - 81 females and 108 males - took the board examination. Results: In this period, 54.3% of the candidates were approved. Mean written score was 6.27 ± 0.95 for the approved candidates and 4.30 ± 0.76 for those who were not approved (p = 0.0001, t test). Mean practical score was 7.18 ± 0.92 versus 5.17 ± 1.38 (p = 0.001). The overall mean of the written score was significantly lower than that of the practical score (53.78 ± 13.16 x 62.62 ± 15.32, p < 0.001). Univariate analysis showed that the approved group had fewer years since graduation (p = 0.001), fewer years of pulmonary medicine practice (p = 0.01); lower training attendance for a shorter period (p = 0.01), and a higher frequency of residence attendance for a longer period (p < 0.001) in the approved group. Logistic regression showed that residence (p = 0.002) and place of residence (p = 0.006) were the only predictive factors for approval. Multiple linear regression showed that only residence (coefficient 2.26, p = 0.016), place of residence (4.43, p = 0.002), and training (-1.97, p = 0.047) predicted the overall board score. Conclusion: The efficacy of the board exmination is hereby proven, since it accepts candidates with better medical background (residence). Some medical education methods, such as years of practice, meeting and training attendance need to be revised, since they do not determine approval.

Keywords: Medical education. Residence. Board certificate.

Repeated dosis of inhaled β2-agonists have been used in the treatment of acute asthma. The effect of added ipratropium bromide (IB) to β2-agonist is controversial in adults. Objective: To evaluate if addition of IB to fenoterol, in repeated doses, induces a greater bronchodilation, a greater reversion of the attack, and discharge from emergency unit in adults with acute severe asthma. Setting: Pneumology Emergency Department, Unifesp-Hospital São Paulo, in the period from July 1995 to February 1997. Type of study: Open, randomized and parallel study. Discharge from the hospital: FEV1 and PEF ≥ 60% of the predicted value. Methods: 120 patients with FEV1 and PEF ≤ 50% of the predicted value were divided into two groups (N = 60): fenoterol (F) and ipratropium bromide + fenoterol (IBF). Each group received inhalation treatment through a metered-dose inhaler (MDI) attached to a holding chamber, administered at 30-minute interval, for a total of three treatments. In the group F four puffs of fenoterol (400 μg) were administered, and in the IBF group, 160 μg of BI and 400 μg of fenoterol (four puffs). Results: The patients did not differ from basal PEF (F = 36 ± 7% vs IBF = 35 ± 9% predicted) and basal FEV1 (F = 33 ± 9% vs IBF = 32 ± 9% predicted). Thirty-two patients of group F and 33 of group IBF were discharged from hospital after the inhalation treatment. The final FEV1 and PEF after inhalation treatments were F = 60 ± 13% vs IBF = 61 ± 11% e F = 74 ± 18% vs IBF = 77 ± 13% (NS). Conclusion: The addition of ipratropium bromide to fenoterol results in insignificant functional effect and without clinical impact in the treatment of acute asthma in adults.

Keywords: Fenoterol. Ipratropium. Status asthmaticus. Respiratory therapy.

Diffuse pulmonary ossification is a rare condition of unknown pathogenesis in which mature bone is found in the pulmonary parenchyma. It is almost invariably discovered as an incidental finding at autopsy. Most commonly, it affects middle-aged men and is asymptomatic. We present the case of a 75-year-old man in which the chest X-ray showed diffuse interstitial infiltrate. Diagnosis was based on histopathological examination by open-lung biopsy, which revealed interstitial fibrosis with pulmonary ossification.

Keywords: Ossification, heterotopic; Lung diseases; Lung/radiography; Pulmonary fibrosis/pathology;

Aim: To evaluated the etiologic percentage of the atypical pneumoniae in outpatients and to identify the epidemiologic, clinical and radiographic features that permit to distinguish between atypical and non-atypical pneumonia. Methods: All patients underwent clinical and radiographic evaluation. Serum and sputum samples were obtained to serological tests including Legionella sp, Chlamydia sp, M. pneumoniae, Influenza A and Influenza B virus, and Gram stain, respectively. These procedures were performed on the first and 21 days after inclusion. Three independent observers reviewed chest X-rays. Results: During 22 months, 129 patients were evaluated. The final population under study comprised 69 patients (46 men - 23 women) with a mean age of 37 years. The etiologic diagnosis was defined in 34 (50%) of the patients. Etiologic agents included Chlamydia sp, 11 (16%) isolated cases; M. pneumoniae 7 (10%) cases. Influenza A was the third more frequent agent in 4 (6%) patients, and Legionella sp in 4 (6%). Mixed infections were observed with association of Chlamydia sp and M. pneumoniae in 5 (7.3%) cases, Chlamydia sp and Influenza B one (1.5%) case, and another of M. pneumoniae and Influenza A. The atypical pneumonia and non-atypical pneumonia groups were compared to respiratory symptoms and signs. There were no differences between them. The three independent observers' radiographic evaluation showed disagreement among them as to the type of pneumonia. Radiographic diagnoses of individual observers were compared to the clinical diagnoses, and no significant association was obtained for any observer. Conclusion: Pneumonia caused by "atypical" agents occurs in 50% of the outpatients with community acquired pneumonia. It is not possible to distinguish atypical pneumonia from non-atypical pneumonia. The clinical and radiographic presentations are similar in both groups.

Keywords: pneumonia; etiology; diagnosis; epidemiology