Year 2003 - Volume 29 - Issue 5 (September/October)

Editorial

1 - Bom para alguns, ótimo para outros

Sérgio Saldanha Menna Barreto

J Bras Pneumol.2003;29(5):251-

Original Article

2 - Mediastinal tumors in children

Tumores do mediastino em crianças

José Carlos Fraga, Marcia Komlós, Eliziane Takamatu, Luciano Camargo, Fábio Contelli, Algemir Brunetto, Carlos Antunes

J Bras Pneumol.2003;29(5):253-257

3 - Bronchiectasis: diagnostic and therapeutic features A study of 170 patients

Bronquiectasias: aspectos diagnósticos e terapêuticos Estudo de 170 pacientes

José da Silva Moreira, Nelson da Silva Porto, José de Jesus Peixoto Camargo, José Carlos Felicetti, Paulo Francisco Guerreiro Cardoso, Ana Luiza Schneider Moreira, Cristiano Feijó Andrade

J Bras Pneumol.2003;29(5):258-263

4 - Smoking among school adolescents in Salvador (BA)

Tabagismo em amostra de adolescentes escolares de Salvador-Bahia

Adelmo Souza Machado Neto, Álvaro A. Cruz2

J Bras Pneumol.2003;29(5):264-272

5 - Extended thymectomy through video assisted thoracic surgery and cervicotomy in the treatment of myasthenia

Timectomia estendida por cirurgia torácica videoassistida e cervicotomia no tratamento da miastenia

Eduardo Haruo Saito, Cláudio Higa, Rodolfo Acatauassu Nunes, Gérson C. Magalhães, Luiz Carlos Aguiar Vaz, Vicente Faria Cervante

J Bras Pneumol.2003;29(5):273-279

6 - Management of massive hemoptysis with the rigid bronchoscope and cold saline lavage

Controle da hemoptise maciça com broncoscopia rígida e soro fisiológico gelado

Giovanni Antonio Marsico, Carlos Alberto Guimarães, Jorge Montessi, Antonio Miguel Martins da Costa, Levi Madeira

J Bras Pneumol.2003;29(5):280-286

7 - Effects of a physical exercises program designed to increase thoracic mobility in patients with chronic obstructive pulmonary disease

Efeitos de programa de exercícios físicos direcionado ao aumento da mobilidade torácica em pacientes portadores de doença pulmonar obstrutiva crônica

Elaine Paulin, Antonio Fernando Brunetto, Celso Ricardo Fernandes Carvalho

J Bras Pneumol.2003;29(5):287-294

Upgrading

8 - Study about the ability of the pulmonary aerostasia, in animal model, using differents parenchymal pulmonary types of the sutures

Estudo sobre a eficácia da aerostasia pulmonar, em modelo animal, utilizando diferentes tipos de suturas

Darcy Ribeiro Pinto Filho

J Bras Pneumol.2003;29(5):295-301

Background: The search for an ideal procedure to accomplish aerostasis, after partial surgical resection of the lung parenchyma, remains a practical challenge for the thoracic surgeon. Objective: The objective of this study was to compare the ability of four types of parenchymal pulmonary sutures in preventing air leaks, using a porcine model with incremental endobronchial pressures. Method: Ex vivo experimental study in porcine lungs (n = 5) at the Laboratory of Experimental Surgery of the Universidade de Caxias do Sul. Four different parenchymal pulmonary types of suture were analyzed: type 1 (absorbable suture), type 2: (stapled suture), type 3 (stapled suture with bovine pericardium) and type 4 (stapled suture with biologic glue). The surgical sutures (n = 40) were exposed to different intrabronchial pressure levels, varying from 10 cmH2O to 60 cmH2O. The presence of air leaks along the suture line was verified through the water seal maneuver. Results: The mean intrabronchial pressure level needed to cause suture line air leaks for each type were: type 1 (n = 10): 29 cmH2O; type 2 (n = 10): 38.5 cmH2O; type 3 (n = 10): 44 cmH2O; and type 4 (n = 10): 51.4 cmH2O. The comparison between the mean intrabronchial pressure level of type 1 and of types 2 and 3 sutures was statistically significant, respectively: p = 0.04 and p = 0.01. However, the comparison between types 2, 3 and 4 did not show statistic significance (p > 0.05). Conclusions: The pulmonary suture covered by biologic glue demonstrated more resistance to incremental levels of intrabronchial pressure. Parenchymal pulmonary sutures using stapled suture exclusively or stapled with bovine pericardium or biologic glue demonstrated an increased ability to avoid air leaks if compared to absorbable sutures in a model of porcine lung with incremental levels of intrabronchial pressure. There were no differences between stapler exclusively or stapler and bovine pericardium or biologic glue.

Keywords: Experimental study. Thoracic surgery. Biologic glue. Staplers.

Case Report

9 - Sildenafil for treatment of pulmonary hypertension in association with systemic lupus erythematosus and anti-phospholipid syndrome

Sildenafil no tratamento da hipertensão pulmonar associada a lúpus eritematoso sistêmico e síndrome antifosfolipídio

Eduardo José do Rosário e Souza, Junia Rios Garib, Nasim Michel Garib, Paulo Madureira de Pádua

J Bras Pneumol.2003;29(5):302-304

10 - Resolution of right-to-left shunt after primary pulmonary hypertension treatment with sildenafil

Resolução do "shunt" direita-esquerda após uso do sildenafil como tratamento de hipertensão pulmonar primária

Sérgio Marques da Silva, Carla Bastos Valeri, Humberto Bassit Bogossian, Carlos Jardim, Sérgio Eduardo Demarzo, Rogério Souza

J Bras Pneumol.2003;29(5):305-308

Review Article

11 - Hantavirus pulmonary and cardiovascular syndrome

Síndrome pulmonar e cardiovascular por hantavírus

Mariangela Pimentel Pincelli, Carmen Sílvia Valente Barbas, Carlos Roberto Ribeiro de Carvalho, Luiza Terezinha Madia de Souza, Luís Tadeu Moraes Figueiredo

J Bras Pneumol.2003;29(5):309-324

12 - Inhaled nitric oxide: clinical application

Óxido nítrico inalatório: considerações sobre sua aplicação clínica

Gisele Limongeli Gurgueira, Werther Brunow de Carvalho

J Bras Pneumol.2003;29(5):325-331

The objective of this paper is to report some clinical and therapeutic aspects of inhaled nitric oxide in pediatrics. Some references were obtained from Medline® using the keywords: inhaled nitric oxide and pediatrics, and critical care. Other sources were the University library and personal files. Along the last decade, clinical trials with inhaled nitric oxide demonstrated only a few specific areas of proven efficacy and a variety of possible adverse events. Toxicity related to inhaled nitric oxide included metahemoglobinemia, cytotoxic pulmonary effects, excess production of nitrogen dioxide and peroxynitrite, and injury to the pulmonary surfactant system. The administration of inhaled nitric oxide to patients with severe left ventricular dysfunction and pulmonary hypertension should be cautious, since vasodilatation may increase pulmonary blood flow and lead to excessive preload. Some studies showed the clinical effects related to abrupt nitric oxide withdrawal, including rebound pulmonary hypertension. Current literature supports the therapeutic use of inhaled nitric oxide in persistent pulmonary hypertension of the newborn (gestational age ³ 34 weeks) to improve oxygenation and avoid extracorporeal oxygenation; and in congenital cardiopathy accompanied by pulmonary hypertension, especially in the immediate postoperative period. To date, research in pediatrics and multicentre trials in adults with inhaled nitric oxide therapy have failed to show mortality reduction or decrease the amount of time under mechanical ventilation for acute respiratory distress syndrome and acute lung injury. This indication needs further investigations. Persistent pulmonary hypertension is the most important indication for inhaled nitric oxide. The Food and Drug Administration has not approved inhaled nitric oxide in acute respiratory distress syndrome for adults and children.

Keywords: Nitric oxide/therapeutic use. Pediatrics. Pulmonary hypertension. Critical care.

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