Introduction: Surgical procedures requiring aortic occlusion have been associated with pulmonary reperfusion injury. The authors studied the pulmonary edema in a reperfusion injury model by aortic occlusion in rats. Material and methods: Thirty-three Wistar rats were anesthetized with intraperitoneal injection of sodium pentobarbital (20 mg/kg). Using a midline abdominal incision, the infra-renal aorta was isolated and the animals were randomized into three groups. Ischemia-reperfusion group (IRG, n = 5): rats that underwent 30 min of aorta occlusion and were followed during 120 min of reperfusion. Ischemia group (IG, n = 5): rats that underwent 30 min of aorta occlusion. Control group (CG, n = 5): rats that underwent sham operations without aorta occlusion and were followed during 150 min. Histopathologic examination of the right lung was performed. The pulmonary edema was studied by morphometric analysis and so was the leukocytes infiltration. Eighteen rats (6 rats in each group) were studied with respect to lung fresh/dry weight ratio. ANOVA was used to analyze the morphometric results and the lung fresh/dry weight ratio, with Bonferroni adjustment for paired multiple comparisons. Animals of the IRG presented more pulmonary edema than those of the IG and CG (0.24 vs. 0.17 and 0.17, p < 0.001). There was no difference between the groups regarding the lung fresh/dry weight ratio. There were more inflammatory cells in the lungs of the rats submitted to ischemia-reperfusion. The authors concluded that infra-renal abdominal aorta cross-clamping and unclamping are associated with pulmonary edema. This edema is not induced by elevation of the hydrostatic pressure due to the aortic occlusion, since it was not seen in animals that were only submitted to ischemia.

Keywords: ischemia, reperfusion, pulmonary edema, inbred strains rats

Objectives: Thoracoscopic management of mediastinal tumors is still subject to analysis. Seventy-three patients were submitted to thoracoscopy for the treatment of mediastinal masses and were analyzed retrospectively, in order to evaluate the effectiveness and complications of the procedure. Methods: Between 1983 and 1999, 21 conventional thoracoscopies and 52 video-assisted thoracic surgeries were performed (33 for diagnostic purposes and 40 for therapy). Patient ages ranged from two to 81 years (mean 43.8) with a slight predominance of females over males (41 versus 32). All underwent general anesthesia using simple (22) or double lumen (51) intubation. Results: The histological type of tumor was identified in all patients. For therapeutic purposes, conversion to thoracotomy was necessary in nine patients. The reasons were tumor size and invasion of nearby structures, difficulty to continue dissection, to perform an upper lobectomy, and to suture the iatrogenic diaphragm lesion. Four patients died during the first 30 postoperative days as a consequence of their primary pathology. Conclusions: Thoracoscopy was confirmed to be an effective diagnostic and therapeutic alternative for the treatment of mediastinal disorders.

Keywords: Thoracoscopy, thoracic surgery, mediastinal neoplasms, mediastinal cysts.

The usefulness of serum tumor markers in lung cancer is not well defined. Objective: The aim of this study is to examine the correlation between serum tumor markers and tumor extension and its prognostic value. Patients and method: From February 1995 to September 1997, 103 patients with non-small cell lung carcinoma were evaluated at the Department of Thoracic Surgery. Serum levels of CEA, CYFRA21.1, CA15.3, CA19.9, CA72.4, and NSE were determined before treatment. Results: The serum level of CYFRA21.1 was the most frequent elevated tumor marker (55%). Patients with advanced tumor had higher mean serum level of CEA (90.8 ng/ml), CYFRA21.1 (20.3 ng/ml) and CA15.3 (56.5%) than those with localized carcinoma, respectively 10.2 ng/ml, 12.6 ng/ml and 22.2 ng/ml. Considering all serum tumor markers evaluated in this study, only patients with elevated CEA had greater chance (5.6) of presenting with advanced non-small lung carcinoma than patients with normal CEA. Overall survival was influenced by performance status (p = 0.001), tumor extension (p = 0.006), elevated serum level of CEA (p = 0.043), more than two elevated serum tumor markers (p < 0.001), and type of treatment (p < 0.001). The prognostic value of anatomical tumor extension reached the limit of significance (p = 0.052); however, two or more elevated serum tumor markers and type of treatment had independent prognostic value (respectively, p = 0.035 and p = 0.005). Conclusion: None of these serum tumor markers had clinical value in the management of NSCLC patients.

Keywords: biological tumor markers, neoplasm staging, non-small cell lung carcinoma, prognosis

New non-invasive methods have been developed to detect lung malignancies. One of them is positron emission tomography (PET) using 18F 2-deoxy-D-glucose (FDG) as a radiotracer. Objective: Evaluate the FDG-PET results performed through a hybrid coincidence-gamma camera in patients with pleuropulmonary infectious diseases or lung tumors. Material and methods: Fifteen patients were evaluated, and divided into: group I - five patients with active lung tuberculosis, and group II - ten patients with possible pleuropulmonary neoplasia. Doses of 185 MBq of FDG were given intravenously, and scans were performed with a two-headed ADAC Vertex Plus camera. Results: In group I all scans were positive. In group II after thoracotomy in nine patients and mediastinoscopy in one, the following diagnoses were observed: two adenocarcinomas, two granulomas, one small cell carcinoma, one large cell carcinoma, one hamartoma, one rounded atelectasis, one mesothelioma, and one antracosis. The scans were positive in six patients (five malignant neoplasias and one granuloma) and negative in the other four cases. Conclusion: The FDG-PET performed through a hybrid camera produces images of quality that permit identification of active infectious process. FDG-PET in association with clinical and radiological exams can differentiate malignant from benign lung neoplasias.

Keywords: emission-computed tomography, lung neoplasms, lung diseases

Objectives: To verify the prevalence of tuberculosis (TB)/HIV co-infection and the ability of the clinical history to detect the HIV infection in TB inpatients. Setting: Eduardo de Menezes Hospital, reference for both TB and AIDS. Patients and methods: All patients admitted with TB in a pneumology ward were evaluated prospectively from 1/1/1997 to 1/31/1998. The clinical history was directed to the presence of risk factors for AIDS or TB, previous treatments or abandoned treatments for TB, and TB clinical forms. Patients with AIDS defining illnesses, except for TB, and with previous anti-HIV tests were excluded. All patients had an ELISA anti-HIV serology, and when positive, a Western-Blot test was performed to confirm the previous result. X-square test and Fisher test were used for statistical analysis. Results: Sixty-five patients were divided into group I (positive serology for HIV, n = 6) and group II (negative serology for HIV, n = 59). There were no statistical differences between the groups comparing the risk factors for AIDS and TB, previous treatments or abandoned treatments for TB, or TB clinical forms. Conclusions: The high prevalence of TB/HIV co-infection (9.2%) reinforces that: 1) the clinical history was not able to detect a significant number of patients with TB/HIV co-infection and that: 2) anti-HIV serology should be performed in all patients with active TB forms.

Keywords: tuberculosis, acquired immundeficiency syndrome, prevalence

Requesting passive cooperation from the patient and supplying new parameters for the analysis of the ventilatory mechanics, the forced oscillations technique (FOT) has complementary characteristics to the classical methods of lung evaluation. In this work, a review of the principles of this technique is initially presented together with a discussion about its advantages and present limitations. The performance of the technique is compared to classical methods in the detection of breathing disorders. The main clinical applications reported previously in the literature, including the evaluation of the ventilatory mechanics in children, studies in neonates, monitoring of patients under mechanical ventilation, occupational medicine, and evaluation of respiratory sleep disturbances are reviewed and discussed. Based on this review and on the results obtained in studies made in their laboratory, the authors concluded that FOT could render a more detailed examination and facilitate the accomplishment of lung function tests under conditions in which traditional techniques are not appropriate.

Keywords: respiratory mechanics, oscillometry, respiratory function tests

The present article purports to analyze aspects related to the concept of quality of life, taking into account the relevance of setting down parameters that allow for the evaluation of those aspects, especially in patients with chronic diseases. The analysis considered quality of life as one of the essential components of medical care, and pointed out the precautions that should be taken to choose instruments of evaluation, that should be sensitive and reliable to the dimensions they intend to evaluate.

Keywords: quality of life, chronic diseases, asthma, chronic obstructive pulmonary disease

Different kinds of pulmonary impairment have been described in Sjögren syndrome, including rare cases of bronchiectasis. The authors report a female patient with a history of episodes of respiratory infections and progressive breathlessness whose high resolution computerized tomography revealed bronchiectasis. A former open lung biopsy showed bronchiolar inflammatory and fibrotic changes. The diagnosis of Sjögren syndrome was made only late in the evolution, although sicca syndrome symptoms had been present for years. The authors discuss the potential pathogenic mechanisms involved in the development of the bronchiectasis and the need for a high degree of clinical medical skill for the early diagnosis of such conditions.

Keywords: Sjögren syndrome; bronchiectasis; bronchiolitis