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.

Objective: To evaluate the effects that pulmonary resection has on pulmonary function and quality of life (QoL) in patients with primary or metastatic lung cancer. Methods: This was a prospective cohort study involving all patients submitted to pulmonary resection for cancer between September of 2006 and March of 2007 at the A. C. Camargo Hospital in São Paulo, Brazil. Patients underwent spirometry in the preoperative period and at six months after the surgical procedure. After a postoperative period of six months, the patients completed an overall QoL questionnaire (the Medical Outcomes Study 36-item Short-form Health Survey) and another one, specific for respiratory symptoms (the Saint George's Respiratory Questionnaire). The scores obtained in our study were compared with those previously obtained for a general population and for a population of patients with COPD. Results: We included 33 patients (14 males and 19 females), ranging in age from 39 to 79 years. All of the patients, smokers and nonsmokers alike, presented significant worsening of pulmonary function. The mean scores on the overall QoL questionnaire were approximately 5% lower than those obtained for the general population. The scores of various domains of the symptom-specific QoL questionnaire were 50-60% lower than those obtained for the general population and approximately 20% higher than those obtained for the population with COPD. Conclusions: Pulmonary resection has a direct negative impact on pulmonary function and QoL, especially on the QoL related to aspects directly linked to pulmonary function. We highlight the importance of preoperative assessment of pulmonary function in patients undergoing pulmonary resection, in order to predict their postoperative evolution.

Keywords: Thoracic surgery; Lung neoplasms/surgery; Spirometry; Quality of life; Questionnaires.

Background: The nucleoside adenosine is a potent vasodilator. Although its effect on the pulmonary arteries is well known, its influence on capillaries and veins has yet to be described. Objective: To evaluate the pre- and post-administration effects of adenosine on arterial and venous resistance in the pulmonary circulation of patients with primary pulmonary hypertension. Method: The study involved 7 patients with primary pulmonary hypertension and presenting a positive response to adenosine on the acute test. Before and after adenosine administration, arterial and venous resistances were determined by estimating pulmonary capillary pressure through analysis of pulmonary artery pressure decay curves. Results: Following adenosine administration, there was an increase in the cardiac index (from 1.71 ± 0.23 to 2.72 ± 0.74 L/min-1/m-2) and a decrease in pulmonary vascular resistance (from 2924 ± 1060 to 1975 ± 764 dynes/s/cm-5/m-2) with no significant variations in mean pulmonary artery pressure (pre: 75.6 ± 16.8 mmHg; post: 78.1 ± 18.8 mmHg), pulmonary wedge pressure (pre: 15.3 ± 1.5 mmHg; post: 15.4 ± 1.9 mmHg) and pulmonary capillary pressure (pre: 43.8 ± 5.8 mmHg; post: 44.5 ± 4.9 mmHg). The ratio between arterial resistance and total pulmonary vascular resistance also presented a less than significant variation (pre: 50 ± 15%; post: 49 ± 17%). These findings suggest that adenosine affects the capillaries and veins as well as the arteries. Conclusion: We can conclude that the adenosine mechanism is not restricted to the arterial aspect of the pulmonary circulation, and that analysis of pulmonary capillary pressure could prove useful in the study of various drugs that affect the pulmonary circulation.

Keywords: Key Words: Adenosine/pharmacocinetic. Adenosine/uso terapêutico. Blood pressure. Hypertension pulmonary.