Objective: To evaluate the Polyflex® stent in terms of its efficacy, ease of implantation, and complications in patients with tracheobronchial affections. Methods: This was a prospective study, in which sixteen patients with inoperable tracheal stenosis secondary to orotracheal intubation (n = 12), neoplasia (n = 3), or Wegener's granulomatosis (n = 1) were monitored. Of these patients, eleven were women, and five were men. The mean age was 42.8 years (range, 21-72 years). Patients were submitted to implantation of a total of 21 Polyflex® stents. All procedures were carried out in the operating room under general anesthesia, and the stents were implanted via suspension laryngoscopy using the stent applicator. Results: Stents were implanted and symptoms were resolved in all cases. The stents remained in place for a mean period of 7.45 months, ranging from 2 to 18 months. The complications observed in the immediate postoperative period were dysphonia (in two patients, 12.5%) and odynophagia (in two patients, 12.5%). Late complications were cough (in ten patients, 62.5%), migration (in seven patients, 43.75%), granuloma formation (in two patients, 12.5%), and pneumonia (in one patient, 6.25%). Conclusion: The Polyflex® stent is easily implanted, easily removed, well tolerated by patients and effective in resolving symptoms. However, its use is associated with a high rate of migration, especially in patients with post-orotracheal intubation stenosis.

Keywords: Tracheal stenosis; Intubation, intratracheal; Prostheses and implants; Stents.

Objective: To compare different levels of ablation in terms of the degree of patient satisfaction and extent of postoperative reflex sweating in sympathectomized patients. Methods: A retrospective study involving 521 patients with primary hyperhidrosis, submitted to thoracic sympathectomy at the Monte Sinai Hospital and University Hospital of the Federal University of Juiz de Fora, from January of 2001 to December 2005. All patients were submitted to thermal ablation of the sympathetic stem and were divided into three groups: up to T2 (group I, n = 162); up to T3 (group II, n = 65); and up to T4 (group III, n = 294). Results: Optimal postoperative control of palmar/axillary hyperhidrosis was achieved in, respectively, 94/82% of the patients of group I, 89/89% of those in group II and 80/80% of those in group III. Postoperative reflex sweating was observed in 67% of the patients in groups I and II, compared with 61.29% of those in group III. Severe reflex sweating occurred in 32% of the group I patients, 9% of the group II patients and 4% of the group III patients. Conclusion: Sympathectomy provided excellent patient satisfaction and a low incidence of complications. There was no significant difference between the levels of ablation in terms of reflex sweating, although the intensity of this complication decreased when lower levels of blockage, principally at the T4 level, were employed.

Keywords: Sympathectomy; Thoracoscopy; Hyperhidrosis.

Objective: To create a mechanical model that could be regulated to simulate the conditioning of inspired and expired air with the same normal values of temperature, pressure, and relative humidity as those of the respiratory system of a healthy young man on mechanical ventilation. Methods: Using several types of materials, a mechanical device was built and regulated using normal values of vital capacity, tidal volume, maximal inspiratory pressure, positive end-expiratory pressure, and gas temperature in the system. The device was submitted to mechanical ventilation for a period of 29.8 min. The changes in the temperature of the air circulating in the system were recorded every two seconds. Results: The statistical analysis of the data collected revealed that the device was approximately as efficient in the conditioning of air as is the respiratory system of a human being. Conclusion: By the study endpoint, we had developed a mechanical device capable of simulating the conditioning of air in the respiratory tract. The device mimics the conditions of temperature, pressure, and relative humidity seen in the respiratory system of healthy individuals.

Keywords: Thermodynamics; Respiration, artificial; Temperature.

Objective: To determine the submaximal exercise capacity of patients with cystic fibrosis (CF) by means of the 6-minute walk test (6MWT), correlating the results with clinical score, nutritional status, radiographic score, and pulmonary function tests. Methods: This was a prospective, cross-sectional study involving patients aged 16 or older enrolled in a program for adults with CF. The patients were submitted to clinical evaluation, determination of maximal respiratory pressures, 6MWT, spirometry, and chest X-ray. Results: The study comprised 41 patients. The mean age was 23.7 ± 6.5 years, and the mean forced expiratory volume in one second (FEV1) was 55.1 ± 27.8%. On the 6MWT, 30 (73.2%) of the patients covered a distance (mean, 556.7 ± 76.5 m) that was less than the predicted normal value. The distance walked did not correlate significantly with body mass index, clinical score, radiographic score, maximal respiratory pressures, peripheral oxygen saturation at rest, desaturation during the 6MWT, sensation of dyspnea, or fatigue, although it did so with age at diagnosis, FEV1 in liters, and forced vital capacity in liters. Worsening of pulmonary function was associated with greater desaturation during the 6MWT. Conclusion: This study showed that most patients attending an adult CF program had reduced submaximal exercise capacity. The 6MWT can be valuable for identifying patients who might experience oxygen desaturation and physical impairment in daily activities.

Keywords: Cystic fibrosis; Respiratory function tests; Exercise tolerance.

Objectives: To compare clinical and radiological aspects, as well as aspects regarding the course of the disease, of elderly inpatients clinically diagnosed with community-acquired pneumonia, with or without radiological confirmation. Methods: A total of 141 patients over the age of 60 were retrospectively studied. Results: Radiological findings corroborated the clinical diagnosis in 45 patients, whereas, in 96 patients, radiology did not correlate with the clinical suspicion. The signs, symptoms, treatment, and outcomes of these two groups were compared. The findings of the study suggest that there were no significant differences between the groups according to the criteria analyzed. Conclusion: The prevalence of chest X-rays compatible with pneumonia in patients suspected of the disease was slightly higher than 30%. Having low specificity in the elderly, the clinical diagnosis of community-acquired pneumonia should be used with caution. In view of the small number of patients studied, further studies on this topic are needed in order to confirm the findings.

Keywords: Pneumonia; Aged; Diagnosis; Radiology; Hospitalization.

Objective: To evaluate quality of sleep and pulmonary function in clinically stable adolescents with sickle cell anemia (SCA). Methods: A cross-sectional descriptive study involving 50 patients with SCA submitted to nocturnal polysomnography and spirometry at the Brasília University Hospital. Anthropometric, polysomnographic and pulmonary function data were analyzed. Patients were divided into two groups according to oxygen saturation by pulse oximetry (SpO2) during rapid eye movement (REM) sleep: SpO2 ≤ 93%; and SpO2 > 93%. Descriptive statistics, Student's t-test, chi-square test and Pearson's correlation coefficient were used. Results: Mean age was 13.9 ± 2.5 years. Total sleep time and REM sleep percentage were lower, whereas REM sleep latency, the number of awakenings, movement during sleep, changes in sleep stage, sleep-disordered breathing index and obstructive apnea index were higher. Two patients (4%) did not present REM. There were statistically significant differences between the groups in most of the polysomnographic variables. The SpO2 in REM sleep presented a strong positive correlation with waking SpO2 and with SpO2 in non-REM sleep, whereas it presented a strong negative correlation with the percentage of total sleep time during which SPO2 was < 90%. Mean spirometric values were within normal ranges. Residual volume and the residual volume/total lung capacity/functional residual capacity ratio were elevated. Conclusion: Sleep impairment in clinically stable patients with SCA is probably due to hemoglobin desaturation and not to individual alterations in pulmonary function.

Keywords: Sleep disorders; Polysomnography; Adolescent; Anemia, sickle cell; Spirometry.

Objective: The impact of chronic obstructive pulmonary disease (COPD) is underestimation as a result of underdiagnosis and undertreatment. The objective of this study was to determine whether using spirometry to evaluate smokers enrolled in smoking cessation programs facilitates early diagnosis of COPD. Methods: The medical records of 158 smokers enrolled in the smoking cessation program at the Botucatu School of Medicine (Botucatu, Brazil) between January of 2003 and November of 2005 were evaluated retrospectively. All were over 40 years old (mean age: 55 ± 8.5 years), and 99 (62.6%) were female. We analyzed the clinical data, the previous medical diagnosis, and the spirometry results. Results: The diagnostic criteria for COPD were met by 57 (36.1%) of the 158 individuals evaluated, and 14 individuals (8.9%) were considered to be at risk for the development of the disease. Of those 57 individuals meeting the criteria for a diagnosis of COPD, 39 (68.4%) were receiving their first diagnosis of COPD, whereas 18 (31.6%) were receiving confirmation of a prior diagnosis. Of the 18 individuals previously diagnosed, 10 (56%) presented the mild/moderate form of the disease, and 8 (44%) presented the severe form. Of the 39 newly diagnosed individuals, 38 (97,4%) presented the mild/moderate for of the disease, and only 1 (2,6%) had severe COPD. Seven patients previously diagnosed with COPD presented pulmonary function test results inconsistent with the diagnostic criteria. Conclusion: Using spirometry in the initial evaluation of smokers enrolling in smoking cessation program might be a useful tool for early diagnosis of COPD.

Keywords: Smoking cessation; Spirometry; Pulmonary disease, chronic obstructive.

Objective: To analyze the effectiveness of the Tuberculosis Control Program, in conjunction with the recently incorporated Family Health Program, in the city of Cáceres, Brazil, between 1999 and 2004. Methods: This was a descriptive epidemiological study, based on the registry of tuberculosis cases diagnosed and treated in Cáceres, according to the characteristics of the cases diagnosed, whether or not the protocol for diagnosis, treatment, and monitoring of patients was followed, as well as the type of health care facility involved. Results: The incidence of tuberculosis was reduced from 99.4 to 49.8 (per 100,000 inhabitants) between 1999 and 2004. The patients presented characteristics similar to those of patients from other regions of Brazil, with a predominance of males during their most economically productive years. Among the patients presenting pulmonary forms and treated via the Family Health Program, there was a reduction in the number of sputum smear microscopies performed at the moment of diagnosis (OR = 0.33; 95%CI: 0.16-0.66) and prior to discharge (OR = 0.32; 95%CI: 0.18‑0.59). The patients monitored via the Family Health Program presented a 16.4% lower cure rate than did those treated at the referral center, as well as being more likely to abandon treatment (OR = 2.93; 95%CI: 1.15-7.46) and to die (OR = 5.71; 95%CI: 1.85‑18.1). Conclusion: The decentralization of the treatment services to the family health clinics did not improve the treatment or monitoring of tuberculosis cases in the city of Cáceres.

Keywords: Tuberculosis/epidemiology; Community Health Services; Health care reform/Brazil.

Objective: To evaluate the frequency of the real association between paracoccidioidomycosis (PCM) and tuberculosis (TB) as well as the rate of previous TB misdiagnosis in individuals with PCM among the patients treated in the Pulmonology Division of the State University of Campinas Hospital das Clínicas, Campinas, Brazil. Methods: A retrospective study of 227 adult patients with PCM (chronic form) treated between 1980 and 2005. Results: Of the 227 patients studied, 36 (15.8%) had been previously treated for TB. However, only 18 (7.9%) presented positive sputum smear microscopy results. The remaining 18 (7.9%) neither presented positive sputum smear microscopy nor showed improvement after receiving specific anti-TB treatment. Conclusion: Although the existence of an association between PCM and TB has been documented in the literature, misdiagnosis is common due to the superimposition of and the similarity between their clinical and radiographic presentations, thereby warranting the need for bacteriological diagnosis before initiating specific treatment.

Keywords: Paracoccidioidomycosis; Tuberculosis, pulmonary; Diagnosis, differential.

Objective: To evaluate cases of tuberculosis occurring in the Entorno region of the state of Goiás but reported in the Federal District (FD) and to analyze the influence that this has on the effectiveness of the local tuberculosis control program, as well as on the socioeconomic and demographic data related to tuberculosis incidence rates. Methods: Rates of tuberculosis incidence, cure, noncompliance, treatment failure, mortality and referral, as well as socioeconomic and demographic data, were reviewed for patients from ten cities in Goiás. Results: From 2000 to 2004 in the cities under study, 714 new cases of tuberculosis were reported, 436 (61.0%) of which were treated in the FD, and therefore, were not included in the Goiás database. Among patients treated only in Goiás, the mean incidence of tuberculosis ranged from 4.40 to 10.02/100,000 inhabitants. When those treated in the FD were included, the incidence significantly increased, ranging from 15.16 to 20.54/100,000 inhabitants (p < 0.001). The rate at which contacts of tuberculosis patients were investigated was low, and treatment outcomes were unsatisfactory in Goiás and in the DF. Socioeconomic and demographic data were consistent with the tuberculosis incidence. Conclusion: The number of tuberculosis patients treated in the city in which they reside was lower than expected. Treatment in another city might compromise tuberculosis control. The recalculated tuberculosis incidence is consistent with the socioeconomic and demographic profile of the region. A federal surveillance system can be efficiently optimized, improving the control of this disease.

Keywords: Tuberculosis/epidemiology; Epidemiologic studies; Government programs.

Objective: To identify factors associated with death from TB, evaluating TB cases reported for 2001 in the city of São Paulo (specifically in the neighborhoods of Cidade Tiradentes, Guaianazes, Itaquera and São Mateus) and comparing those evolving to death with those evolving to cure. Methods: We investigated all deaths in which TB was given as the principal cause (n = 48), analyzing medical charts and conducting home visits to interview the caregiver(s). In parallel, we investigated 96 TB cases in which the patient had been discharged after a cure had been achieved. Patients with HIV were excluded from both groups. Results: There were no differences between the two groups in terms of the clinical form of tuberculosis, laboratory test confirmation of the diagnosis and type of treatment. Death from TB was found to be associated, in a statistically significant manner, with being male, being over 50 years of age, having had less than 3 years of schooling, suffering from alcoholism and being unemployed. The logistic regression showed that the variables presenting the strongest associations with death from TB were suffering from alcoholism and being over 50, whereas being a new treatment and being employed were found to be protective. The combination of suffering from alcoholism, being unemployed and being over 50 increased the chance of evolving to death by 25 times (95%CI: 6.43-97.20). Conclusion: Ongoing education of health professionals, prompt epidemiological interventions and efficient patient referral systems could improve the indices related to this disease.

Keywords: Tuberculosis/mortality; Epidemiologic studies; Death certificates.

Objective: To describe the difficulties and peculiarities encountered by health professionals during the treatment and investigation of contacts of tuberculosis (TB) patients in disadvantaged communities. Methods: A qualitative study carried out at health care facilities in Health Programming Area 1.0, located in the city of Rio de Janeiro, Brazil, which has a TB incidence rate of 240/100,000 inhabitants. From among the professionals responsible for visiting and treating TB cases and their contacts, two home visit agents and one clinical nurse were selected to be interviewed for the study. Data were transcribed and structured in the form of quotations, emphasizing the predominant ideas. Results: The central ideas focus on the issue of violence, one significant facet of which is the set of rules imposed by narcotraffickers, and on the barriers to the movement of patients/health professionals for TB treatment, as well as on public safety (police). Conclusion: This study provides public health officials, as well as institutions that graduate health professionals, data for reflection and analysis of the difficulties that urban violence creates for the control of TB in a disadvantaged community.

Keywords: Tuberculosis; Prevention and control; Violence; Directly observed therapy; Community health nursing.

Tuberculosis remains a serious social and public health problem, affecting millions of people annually. The bacille Calmette-Guerin (BCG) vaccine, used prophylactically, does not impede the progression of the disease, which usually manifests as decreased cellular immunity. Early diagnosis, together with polychemotherapy, can control the dissemination of the tuberculosis infection. The current diagnostic methods present certain problems. Such problems include the low sensitivity of sputum smear microscopy, the fact that performing microbiological cultures is quite time-consuming, and the low specificity of the skin test with the purified protein derivative of Mycobacterium tuberculosis. New diagnostic methods, which use specific antigens such as the early secreted antigenic target 6-kDa and culture filtrate protein 10‑kDa, are being evaluated. The genes that encode these antigens are located in the DNA region of difference 1 of M. tuberculosis, M. africanum and M. bovis. However, they are absent from the M. bovis (BCG) and from most environmental mycobacteria. Diagnostic methods such as QuantiFERON-TB® and T SPOT.TB®, which are based on the production of interferon-gamma by T lymphocytes, in response to those antigens, are being tested and have been found to outstrip the purified protein derivative skin test in the following characteristics: greater sensitivity; lower cross-reactivity due to BCG vaccination or infection with environmental mycobacteria; and execution time. The introduction of diagnostic methods that are more specific and sensitive, together with gaining a better understanding of the molecular and cellular mechanisms that regulate the parasite-host interaction, can increase the efficiency of strategies devised to combat tuberculosis.

Keywords: Tuberculosis; Mycobacterium tuberculosis; Diagnosis; Antigens, bacterial/ESAT-6 protein; Immunity.

To describe the principal evidence in the literature regarding the interrelationship among helminth infections, atopy, and asthma, a nonsystematic review of the literature was conducted. Among the publications on the subject, we found a number in which there was controversy regarding the capacity of geohelminth infections to inhibit responsiveness to skin allergy tests and to minimize the symptoms of allergic diseases. However, although small in number, studies of patients infected with Schistosoma spp. suggest that these helminths can inhibit the responsiveness to skin allergy testing and minimize asthma symptoms. Evidence provided by in vitro studies suggests that helminthiases inhibit T helper 1- and T helper 2-type immune responses. This opens new therapeutic possibilities for the treatment of immune system diseases.

Keywords: Asthma; Helminths; Hypersensitivity; Epidemiology.

Pulmonary amyloidosis is a rare disease, characterized by extracellular deposition of fibrillary protein in the lungs. Amyloidosis is a generic term for a heterogeneous group of diseases, including Alzheimer's disease and type 2 diabetes mellitus. In the respiratory system, it appears in various forms: tracheobronchial; nodular pulmonary; and alveolar septal (diffuse parenchymal). We present the case of a woman who was a 20 pack-year smoker and had nodular pulmonary amyloidosis, as diagnosed through tests performed prior to laparoscopic cholecystectomy.

Keywords: Amyloidosis/diagnosis; Lymphoproliferative disorders; Neoplasms; Lung.

Pectus excavatum (PEX) is the most frequent congenital deformity of the anterior chest wall and is defined as the dislocation of the medial or inferior portion of the sternal region toward the spinal column. There are various ways to measure the deformity. In this study, we present an objective method of assessing such deformity, the anthropometric index for PEX (AI-PEX). The AI-PEX was developed in the Thoracic Surgery Department of the Heart Institute - University of São Paulo School of Medicine Hospital das Clínicas. The anthropometric measurements are taken during the physical examination. We herein report two cases involving patients with PEX assessed using the AI-PEX and treated with the minimally invasive Nuss technique. The measurements were always taken at the point of greatest deformity. The patients were assessed on the day of the operation and again at 60 days after the surgery. The AI-PEX allowed us to obtain a satisfactory assessment of the defect. In both patients, the post-operative evolution was favorable.

Keywords: Thoracic wall; Thoracic surgery, Video-assisted; Funnel chest.

Trauma primarily affects young people and is the leading cause of death in the first three decades of life. Flail chest is observed in approximately 10% of all patients with severe chest trauma, and the mortality rate among such patients is 10-15%. We report herein the case of a car accident victim with chest trauma causing hemopneumothorax and multiple rib fractures, intense pain and deformity of the chest wall. Surgical stabilization was performed, with good results. Therapeutic options are also discussed.

Keywords: Thoracic injuries; Flail chest; Thoracoplasty.

Tumors of the anterior mediastinum include several entities with different radiological and clinical manifestations, constituting a heterogeneous group of congenital, inflammatory, and neoplastic conditions. Among these lesions, the most common primary tumor of the mediastinum is thymoma, nearly followed by germ cell tumors and lymphomas. Tuberculosis of the thymus, an extremely rare condition, typically involves the mediastinal lymph nodes. We present, in this study, pathological, radiological, and clinical findings of one case of tuberculosis of the thymus in an 18-year-old patient who presented thoracic pain, dyspnea upon minimal effort, and progressive worsening of the symptoms in one week. The chest X-ray showed a large mass in the mediastinum, and computed tomography scans indicated that it was located anteriorly. The patient was submitted to surgery in order to excise the mass. Microscopy revealed a massive inflammatory response and granulomas in the thymic tissue. Ziehl-Neelsen staining for acid-fast bacilli yielded positive results, and a diagnosis of tuberculosis was made. Surgeons and pathologists should remain alert for this condition and should include it in the differential diagnosis of mediastinal masses.

Keywords: Thymus; Tuberculosis; Thoracic surgery; Pathology.

Objective: To characterize the situation of pulmonology journals published in Latin America. Methods: A survey was conducted in a meeting sponsored by the Latin American Thoracic Society. Each journal editor presented a report and answered a questionnaire. Results: Improving information acquisition is the main motivation for pulmonology societies to edit their own journals, whereas disseminating medical knowledge and reporting experiences are the main motivations for authors to submit papers. The most common failing in the manuscripts submitted is poor compliance with the journal guidelines. Improving author-editor-reviewer relationships would be the best strategy for improving the quality of manuscripts. Suggestions for improving Latin American journals included the following: promoting professionalism in editorial tasks; encouraging manuscript reviewers to be more meticulous; and embracing international norms for editing medical journals. The following major problems were reported: a lack of regular, appropriate periodicity of issues; a shortage of original papers that are considered 'milestones' in the specialty; a low rejection rate for submitted papers; a high turnover of editors. Conclusion: Based on our findings, we can make the following recommendations: although many journals are available in electronic form, they should also be maintained in print form; each journal should divulge its subscription fee, even if it is included in the annual society membership dues; although each Latin American country might decide to publish its own pulmonology journal, the feasibility of publishing a multinational Latin American pulmonology journal should be explored.

Keywords: Periodicals; Manuscripts; Latin America; Respiratory tract diseases.