Objective: The aim of this study was to evaluate physical conditioning and muscle strength before and after a four-month program of physical training. Methods: Two groups of children, ages 8 to 11 years, with moderate asthma were studied. All subjects were tested before and after a program of physical training, which was conducted in 90-min sessions, twice weekly, for four months and also included exercises performed in the water. Children in both groups received general information about asthma, as well as information about the management and treatment of asthma. Results: In the final evaluation, anthropometric parameters (height and weight) were found to have increased. Children in the exercise group presented significant gains in the distance run in nine minutes (initial 1.333 + 0.03 km vs. final 1.440 + 0.03 km; p < 0.05), number of abdominal crunches (initial 24.3 + 1.4 abdominais vs. final 33.2 + 1.1; p < 0.05), maximal inspiratory pressure (initial 73 + 5 cmH2O vs. final 103 + 5 cmH2O; p < 0.05), maximal expiratory pressure (initial 75 + 4 cmH2O vs. final 102 + 4 cmH2O; p < 0.05) and heart rate at rest (initial 84.3 + 1.6 bpm vs. final 77.1 + 2.7 bpm; p < 0.05). The control group presented no significant changes in any of these parameters. Conclusion: An exercise program involving longer sessions, conducted less frequently, facilitates increased participation by children, thereby leading to better physical conditioning and greater muscle strength.

Objective: To identify this vagal reflex using bronchial provocation tests in patients with gastroesophageal reflux disease. Methods: The study group was composed of 10 patients presenting endoscopic evidence of hiatal hernia or gastroesophageal reflux disease, and the control group consisted of 11 patients presenting no evidence of either condition. All subjects were submitted to bronchial provocation with carbachol. Results: The provocation test was positive in 5 (50%) of the study group patients and 3 (27%) of the control group patients (p = 0.64). Conclusion: The hypothesis that the airways of patients with gastroesophageal reflux disease (and no history of asthma-like respiratory symptoms) might be more responsive than those of individuals without the disease remains unproven.

Keywords: Asthma/complications; Gastroesophageal reflux/complications; Hernia hiatal; Peak expiratory flow rate; Bronchial hyperreactivity; Forced expiratory volume; Carbachol/diagnostic use

Objective: To compare the incidences of pulmonary and cardiopulmonary postoperative complications estimated using, respectively, the scoring systems devised by Torrington and Henderson and by Epstein in a populational sample undergoing lung resection for the treatment of lung cancer. Methods: Prospective data from patients submitted to resection of one or more pulmonary lobes were selected from the databases of two tertiary-care hospitals. The outcome measures were pulmonary complications, cardiac complications and mortality rates. Fisher's exact test was used to evaluate the concordance between the predicted and observed complications. Results: The Torrington and Henderson scoring system was applied to 50 patients, in which the risk was found to be mild in 12, moderate in 32, and high in 6. Although accurately identifying patients at high risk, the Torrington and Henderson scale underestimated the rate of postoperative cardiopulmonary complications in the mild and moderate risk categories (p = 0.0003 and p = 0.0006, respectively). The Epstein scoring system was applied to 38 patients, 4 of which were found to be at high risk, and 34 of which were found to be at mild risk. The Epstein scale also underestimated the risk in the patients (the majority) that were classified as being at mild risk (p < 0.0001) and yet, like the Torrington and Henderson scale, accurately identified those at high risk. Conclusion: Neither of the two scoring systems analyzed were found to be appropriate for predicting the risk of pulmonary and cardiopulmonary complications in most cases.

Keywords: Postoperative complications; Preoperative care; Thoracic surgical procedures/mortality; Lung neoplasms/surgery; Pneumonectomy; Respiratory function tests; Risk factors; Risk assessment

Objective: To estimate the frequency of interstitial lung disease in a group of patients with progressive systemic sclerosis, and to describe the clinical, functional and radiological characteristics of the patients studied. Methods: Fifty-eight patients diagnosed with progressive systemic sclerosis were submitted to high-resolution computed tomography of the chest, pulmonary function tests and a blood test for anti-Scl 70 antibodies. Comparisons were drawn between patients with interstitial lung disease and those without. Logistic regression with multivariate analysis was used to identify factors predictive of interstitial lung disease. Results: Of the 58 patients evaluated, 51.7% presented interstitial lung disease on high-resolution computerized tomography scans. Dyspnea and cough were the most common symptoms (seen in 65.5% and 39.7%, respectively). Bronchiolectasis and honeycombing were the most common tomographic abnormalities (observed in 83.3% and 80%, respectively). When compared to individuals without interstitial lung disease, patients with the condition had a comparable frequency of pulmonary and extrapulmonary symptoms but presented progressive systemic sclerosis of longer duration, a higher frequency of crackling rales, higher rates of anti-Scl 70 positivity, lower vital capacity and reduced total lung capacity. Only forced vital capacity < 80% was found to be a predictor of interstitial lung disease. Conclusion: Interstitial lung disease was common in this group of patients with progressive systemic sclerosis. No correlation with symptoms was found, although interstitial lung disease was found to correlate with crackling rales and with anti-Scl 70 positivity. Nevertheless, only reduced forced vital capacity was found to be predictive of interstitial lung disease.

Objective: To evaluate the epidemiological and clinical aspects of acute mediastinitis and to characterize its treatment. Methods: A retrospective study conducted through review of the medical charts of patients diagnosed with acute mediastinitis at the Hospital Escola da Faculdade de Medicina do Triângulo Mineiro (Triângulo Mineiro Medical School Hospital) between 1987 and 2004. Results: A total of 21 patients were studied. Most (76.2%) were male, and the mean age was 52.5 years. Six patients (28.6%) died. The most common cause (in 38.1%) was median sternotomy, followed by esophageal perforation (in 33.3%) and cervical infection (in 14.3%). Staphylococcus aureus and Staphylococcus epidermidis were the causative agents most frequently isolated. In most cases, the treatment of choice was antibiotic therapy accompanied by surgery. The most frequent complications of the acute mediastinitis were pleural effusions (in 23.8%) and osteomyelitis (in 19.0%). The average hospital stay was 26.6 days. Conclusion: Acute mediastinitis is a serious complication of some diseases and procedures. Despite its low incidence, the mortality rate is high. Staphylococcus aureus and Staphylococcus epidermidis are the most common causative agents. The treatment used was antibiotic therapy accompanied by surgery.

Objective: The aim of this study was to determine the prevalence of macrolide-resistant S. pneumoniae and to identify its phenotypic and genotypic characteristics. Methods: Strains of S. pneumoniae isolated in the city of Porto Alegre between May 2002 and August 2004 from samples collected from different anatomical sites were analyzed. For the agar diffusion test, disks of erythromycin, clarithromycin, azithromycin and clindamycin were used. The minimum inhibitory concentrations of erythromycin were determined for macrolide-resistant isolates by the agar dilution method. Macrolide-resistant isolates were phenotyped by agar diffusion test and genotyped by polymerase chain reaction. Results: A total of 229 pneumococcal strains were evaluated, 12 (5.2%) of which were macrolide-resistant. Among the 12 resistant strains, 9 (75%) presented the MLSB phenotype, and 3 (25%) presented the M phenotype. Polymerase chain reaction testing indicated that 8 MLSB phenotype isolates harbored the ermB gene only, whereas the mefE gene was present in all 3 M phenotype isolates. One MLSB phenotype isolate presented both genes. Conclusion: In Porto Alegre, the S. pneumoniae resistance to macrolides is still low since such resistance is due primarily to the presence of the ermB gene expressing the MLSB phenotype.

Objective: To evaluate cases of chronic pulmonary histoplasmosis diagnosed in recent years at the Complexo Hospitalar Santa Casa in Porto Alegre, in the state of Rio Grande do Sul, Brazil. Methods: Cases diagnosed at the Santa Casa Hospital Complex within the last 25 years were reviewed. Four cases in which the diagnosis was made through histopathological analysis or culture and confirmed by with serologic testing are described. Cases from the Brazilian literature are also discussed. Results: The principal clinical manifestations were cough, dyspnea, fever, anorexia and weight loss. Among the radiological findings were emphysema, cystic cavities, bronchiectasis and pleural thickening. All patients had an epidemiological history of contact with chicken feces. One of the patients presented Aspergillus fumigatus colonization of cavities. Conclusion: Chronic pulmonary histoplasmosis must be considered in patients with chronic obstructive pulmonary disease presenting cavitary lesions of the lung, sputum smear microscopy negative for acid-fast bacilli and negative tuberculin skin test. Hemoptysis occurring in the presence of cured or fading pulmonary lesions is suggestive of Aspergillus colonization.

Keywords: Histoplasmosis/diagnosis; Histoplasmosis/drug therapy; Histoplasma/isolation & purification; Tuberculosis, pulmonary/diagnosis; Itraconazole/drug therapy; Sputum/microbiology; Diagnosis, Differential

Objective: To estimate the prevalence of human immunodeficiency virus seropositivity among patients with active tuberculosis residing in the city of Londrina, in the state of Paraná, Brazil and treated at the Pulmonology Clinic of the 17th Regional Health Facility of the State of Paraná, and to compare those coinfected with human immunodeficiency virus to those with active tuberculosis only in terms of the clinical form of tuberculosis, sputum smear microscopy, chest X-ray and tuberculosis treatment regimen. Methods: A transversal study involving 188 active tuberculosis patients was conducted. Tuberculosis and human immunodeficiency virus infection were diagnosed based on criteria established by the Brazilian Ministry of Health. In addition to the data obtained through individual tuberculosis investigation files, clinical and epidemiological information were collected by means of questionnaires, which were completed by all participating patients. Results: The prevalence of human immunodeficiency virus seropositivity among patients with tuberculosis was 14.9%. The rate of positive sputum microscopy results was higher in the tuberculosis-only group (p = 0.0275), and the ratio for patients treatment with alternative scheme was significantly higher in the co-infected group (p = 0.042). In 32.1% of the coinfected patients, the serological diagnosis of human immunodeficiency virus infection was made simultaneously to or following that of the tuberculosis. Conclusion: The results underscore the importance of routinely testing for human immunodeficiency virus antibodies in patients diagnosed with tuberculosis.

Keywords: Tuberculosis/complications; Tuberculosis/diagnosis; Soropositivity; HIV/immunology; HIV infections/complications; HIV infections/epidemiology; HIV infections/ drug therapy; Rifampin/therapeutic use; Disease progression

The prone position is a maneuver used to combat hypoxemia in patients with acute respiratory distress syndrome. Despite the fact that this is currently considered an efficient way to improve oxygenation, the physiological mechanisms that bring about improvements in respiratory function are not yet fully understood. The aim of this review is to discuss the physiological and clinical aspects of the prone position in patients with acute respiratory distress syndrome.

Keywords: Prone position/physiology; Respiratory distress syndrome, adult; Lung/injuries; Posture/physiology; Supine position/physiology; Anoxemia; Pulmonary gas exchange; Hemodynamic processes

This is a review of the medical literature regarding inhaled corticosteroids and their effects on growth and adrenal suppression in children and adolescents. A review of the literature, principally that published over the last five years, was conducted using Medline and searching indexes of articles published in national and international scientific journals. There is considerable controversy regarding the side effects of inhaled corticosteroids. In 21 studies evaluating the effect that inhaled corticosteroids have on growth, a statistically significant reduction (growth retarded by 1-1.5 cm) was observed within the first year of treatment with Beclomethasone or Budesonide inhalers. However, in studies of longer duration, no significant difference was found between final adult height and adult height of the parents. However, in ten studies of the use of inhaled corticosteroids and their effect on adrenal suppression, hypoglycemia and arrested development (no height or weight gains), as well as changes in morning serum levels and 24-h urinary levels of cortisol, were reported, especially when high doses of inhaled corticosteroids were used. Inhaled corticosteroids can reduce growth during the first year of use but do not affect adult height. However, further long-term studies are needed in order to determine the full impact of inhaled corticosteroids on final adult height. Height measures are a means of evaluating the safety and efficacy of the use of inhaled corticosteroids in children. Tests that evaluate the hypothalamic-pituitary-adrenal axis and adrenal insufficiency should be correlated with clinical symptoms and side effects.

A 45-year-old man presented with recurrent pulmonary infection for four years, cough, bloody sputum, yellowish excretion and nonpleuritic chest pain. Tomography of the chest revealed a calcified nodule occluding the right lower lobe bronchus. A right lower and middle lobectomy was performed, and the histopathological examination of the bronchi revealed chondroma, a rare pulmonary tumor usually associated with the Carney triad (pulmonary chondroma, gastric leiomyosarcoma and extra-adrenal paraganglioma), being the less common of the three components. In the present case, the other two components of the triad were not observed. Since these components may appear years later, long-term follow-up care is necessary.

Keywords: Chondroma; Lung neoplasms/radiography; Lung neoplasms/surgery; Leiomyosarcoma;

Pulmonary capillary hemangiomatosis is a rare disorder characterized by a proliferation of capillaries that invade the pulmonary interstitium and alveolar septae. Herein, we report the first Brazilian case of pulmonary capillary hemangiomatosis. A 21-year-old man presented with severe pulmonary hypertension that eventually resulted in his death. Upon admission, a computed tomography scan of the chest revealed diffuse ill-defined bilateral pulmonary nodules. A postmortem lung biopsy revealed pronounced multifocal proliferation of capillaries in the alveolar walls, interlobular septa and peribronchial connective tissue. A diagnosis of pulmonary capillary hemangiomatosis should be considered in patients presenting pulmonary hypertension and suspicious changes on high-resolution computed tomography scans.

Keywords: Hemangioma, capillary/etiology; Hemangioma capillary/diagnosis; Hypertension, pulmonary/complications; Tomography, Emission-Computed; Case report

Bronchogenic cysts of the mediastinum are benign congenital lesions, usually found in adults. When surgery is indicated, the classical approach is resection of the lesion by thoracotomy or thoracoscopy. Herein, we describe the complete resection of a paratracheal bronchogenic cyst by cervical mediastinoscopy. We also include a brief review and discussion of the literature.