Year 1999 - Volume 25 - Issue 3 (May/June)

Editorial

1 - A importância da crítica na ciência

José Roberto Lapa e Silva

J Bras Pneumol.1999;25(3):3-4

Original Article

2 - Analysis of dry pleural biopsy in 107 patients

Análise da biópsia pleural em 107 pacientes sem líquido pleural

Marcelo Chalhoub, Sérgio Arruda, Ronald Fidélis, Ana Paula Barreto, Manoel Barral Netto

J Bras Pneumol.1999;25(3):141-146

The clinical-radiographic presentation and tuberculosis prediction in patients that have undergone dry pleural biopsy, as well as its usefulness and complications, have been evaluated in this retrospective study, conducted in the Octávio Mangabeira Hospital (Salvador, Bahia, Brazil), where 107 patients consecutively submitted to this exam have been analyzed. Altogether 108 biopsies have been performed using Cope's needle (biopsies of both hemithoraxes were performed in one patient). The following diagnoses were obtained: a) tuberculosis (n = 66); b) probable tuberculosis (n = 4); c) neoplasm (n = 2); d) parapneumonic (n = 3), and e) not determined (32). Sixty-seven (62.6%) of the patients were male, and mean age was 34.5 ± 15.4 years. Analyses carried out compare patients diagnosed with tuberculosis (whether confirmed or probable) to those with different diagnoses (miscellaneous). Tuberculosis patients were younger (p < 0.01), expectoration was less frequent (p < 0.01), previous tuberculosis was less often reported (p = 0.04) and PPD reactivity was more frequent (p < 0.01). No significant differences were found between the two groups as to the extent of pleural commitment and its variation in the period observed. Presence of acinar infiltrations in the upper lobes was correlated with tuberculosis diagnosis in the 13 patients in which this feature was observed. Pleural fragments were present in 100 out of 108 cases (92.6%) and the diagnosis was made in the first biopsy in 64 out of 108 cases (59.3%). Ten minor complications have occurred (9.3%) in the 108 biopsies: 6 bloody sputums, 3 small pneumothoraxes, and one moderate subcutaneous emphysema. The authors conclude that for the various predictive indicators of tuberculosis analyzed, except for the presence of acinar infiltrations in the upper lobes, there is broad overlap between the two groups compared, meaning that a safe clinical diagnosis cannot be provided and thus reinforcing the need of performing biopsies. Dry pleural biopsy offers a satisfactory diagnostic yield in areas with high prevalence of tuberculosis and proved safe, when performed by experienced personnel.

Keywords: Pleural tuberculosis. Pleural thickening. Pleural biopsy. Diagnosis.

3 - Experimental pleural empyema in rats: effect of the intrapleural administration of dextran 40 during the fibrinopurulent stage

Empiema pleural experimental em ratos: avaliação dos efeitos do uso intrapleural de dextran-40 na fase fibrinopurulenta

Tulio Tonietto, Eduardo Sperb Pilla, Gabriel Ribeiro Madke, Ubirajara de Lima e Silva, José Carlos Felicetti, José de Jesus Peixoto Camargo, Marisa Ribeiro de Itapema Cardoso, Ricardo Bettiol Nonnig, Paulo Francisco Guerreiro Cardoso

J Bras Pneumol.1999;25(3):

Pleural empyema carries high morbidity and mortality rates. Therapy focuses on the control of the infectious process in its initial phase when parenteral antibiotics and chest drainage are likely to be most effective. The ability of dextrans in preventing peritoneal adhesions leads one to test their potential effectiveness in reducing fibrinous proliferation in a rat model of pleural empyema. Twenty-four Wistar rats weighing 250-400 grams were anesthetized, submitted to a right thoracotomy and then randomized into 3 groups (n = 8 each). Animals in group I were given intrapleural dextran 40 (1 ml/kg) + 1 ml/kg of Staphylococcus aureus extract (1010 cells/ml) in heart-brain culture media obtained from oropharyngeal swabs of the animals. Animals in group II received saline solution (1 ml/kg) +1 ml/kg of Staphylococcus aureus extract (1010 cells/ml) in heart-brain culture media. Animals in group III (controls) were given the culture media without bacteria (1 ml/kg) in addition to saline (1 ml/kg). Upon completion, the chest was deaired, the thoracotomy wound was closed, the animals recovered, observed for 4 days, and sacrificed. Only the animals in groups I and II developed pleural effusion and empyema (average volume of 9.7 ml and 8.1 ml respectively, p > 0.05, NS). There was a significant weight loss in groups I and II compared to control animals (p = 0.004). There were no significant differences in blood work-up tests between groups. The pleural fluid of all animals in groups I and II had positive cultures for Staphylococcus aureus. The biochemical analysis of the pleural fluid in animals from groups I and II did not show any significant differences. The authors concluded that in this novel and reliable model of pleural empyema in rats, the intrapleural administration of dextran 40 at time of inoculation of bacteria did not result in any measurable reduction of the pleural reaction after 96 hours of observation.

Keywords: Empyema. Pleura. Rat. Dextrans. Staphylococcus.

4 - A prospective study of pleural effusions through analysis of DNA ploidy by flow cytometry

Estudo prospectivo de derrames pleurais através da análise de ploidia do DNA por citometria de fluxo

Giuliano Borile, Luciano da Silva Selistre, Samir Abu El Haje, Luiz Jaime Tellez, João Carlos Prolla, Jorge Neumann, Heloisa Sporleder, José de Jesus Peixoto Camargo, José Carlos Felicetti, Paulo Francisco Guerreiro Cardoso

J Bras Pneumol.1999;25(3):153-158

Upgrading

5 - Autoria e co-autoria: justificativa e desvios

Mario R. Montenegro

J Bras Pneumol.1999;25(3):159-162

6 - Curso de epidemiologia básica para pneumologistas

Ana M.B. Menezes, Iná da S. dos Santos

J Bras Pneumol.1999;25(3):163-166

7 - Curso de diagnóstico por imagem do tórax - Capítulo III - Manifestações radiológicas pulmonares nos portadores da síndrome da imunodeficiência adquirida

Edson Marchiori, Arthur Soares de Souza Junior

J Bras Pneumol.1999;25(3):167-175

Case Report

8 - Pulmonary artery aneurysms in Behçet's disease: regression after immunosuppressive treatment

Aneurismas das artérias pulmonares na doença de Behçet: regressão após tratamento imunossupressor

Isabela Fernandes de Magalhães, Iugiro R. Kuroki, Agnaldo José Lopes, Elisa M.N. Albuquerque, Evandro Mendes Klumb, Aline Elisa Goulart

J Bras Pneumol.1999;25(3):176-180

Review Article

9 - Diagnostic sequence in pulmonary thromboembolism

Seqüência diagnóstica no tromboembolismo pulmonar

Thais Helena A. Thomaz Queluz, Hugo Hyung Bok Yoo

J Bras Pneumol.1999;25(3):181-186

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