Ana Luiza Schneider Moreira

Abscesso pulmonar de aspiração: análise de 252 casos consecutivos estudados de 1968 a 2004

OBJECTIVE: To relate the experience of the staff at a health care facility specializing in the management of patients with aspiration lung abscess. METHODS: Diagnostic aspects and therapeutic results of 252 consecutive cases of lung abscess seen in patients hospitalized between 1968 and 2004. RESULTS: Of the 252 patients, 209 were male, and 43 were female. The mean age was 41.4 years, and 70.2% were alcoholic. Cough, expectoration, fever and overall poor health were seen over 97% of patients. Chest pain was reported by 64%, 30.2% presented digital clubbing, 82.5% had dental disease, 78.6% reported having lost consciousness at least once, and 67.5% presented foul smelling sputum. In 85.3% of the patients, the lung lesions were located either in the posterior segments of the upper lobe or in the superior segments of the lower lobe, and 96.8% were unilateral. Concomitant pleural empyema was seen in 24 (9.5%) of the patients. Mixed flora was identified in the bronchopulmonary or pleural secretions of 182 patients (72.2%). All patients were initially treated with antibiotics (mainly penicillin or clindamycin), and postural drainage was performed in 98.4% of cases. Surgical procedures were performed in 52 (20.6%) of the patients (drainage of empyema in 24, pulmonary resection in 22 and drainage of the abscess in 6). Cure was obtained in 242 patients (96.0%), and 10 (4.0%) died. CONCLUSION: Lung abscess occurred predominantly in male adults presenting dental disease and having a history of loss of consciousness (especially as a result of alcohol abuse). Most of the patients were treated clinically with antibiotics and postural drainage, although some surgical procedure was required in one-fifth of the study sample.

Surgical treatment of bronchial carcinoid tumors: a single-center experience.

BACKGROUND Bronchial carcinoid is an infrequent neoplasm with a neuroendocrine differentiation. Surgical treatment is the gold standard therapy, with procedures varying from sublobar resections to complex lung sparing broncoplastic procedures. This study evaluates the results of surgical treatment of bronchial carcinoids and its prognostic factors. PATIENTS AND METHODS Retrospective review of 126 consecutive patients who underwent surgical treatment for bronchial carcinoid tumors between December 1974 and July 2007. RESULTS There were 70 females (55%) and the mean age was 46 years, ranging from 17 to 81 years. Upon clinical presentation, 38 patients (30%) have had recurrent respiratory tract infection, 31 (24%) cough, 16 (12%) chest pain and 25 (20%) were asymptomatic. Preoperative bronchoscopic diagnosis was obtained in 74 cases (58.7%). The procedures performed were: 19 sublobar resections (14,9%), 58 lobectomies (46%), 8 bilobectomies (6.3%), 6 pneumonectomies (4.7%), 2 sleeve segmentectomies (1.5%), 26 sleeve lobectomies (20.6%) and 9 bronchoplastic procedures without lung resection (7.1%). Operative mortality was 1.5% (n = 2) and morbidity was 25.8% (n=32), including 12 respiratory tract infections and 4 reinterventions due to bleeding (3) and pleural empyema (1). Among the 112 patients available for follow-up, the overall survival at 3, 5 and 10 years was 89.2%, 85.5% and 79.8%, respectively. Five and 10-year survival for typical and atypical carcinoids were 91, 89% and 56, 47%, respectively. Overall disease-free survival at 5 years was 91.9% Statistical analysis showed that overall disease-free survival correlated with histology--typical vs. atypical--(p = 0.04) and stage (p = 0.02). CONCLUSION Surgery provides safe and adequate treatment to bronchial carcinoid tumors. Histology and stage were the main prognostic factors.

Bronquiectasias: aspectos diagnósticos e terapêuticos Estudo de 170 pacientes

BACKGROUND: Bronchiectasis is a frequently found disease in medical practice in Brazil leading to significant morbidity and decrease in quality of life of the affected individuals. OBJECTIVES: To study diagnostic and therapeutic aspects in a series of hospitalized patients with bronchiectasis in a department of pulmonary diseases. METHOD: Signs, symptoms, microbiological and radiographic data, and therapeutic results were studied in 170 hospitalized patients between 1978 and 2001 - females 62.4%, males 37.6%, and aged from 12 to 88 years (mean age 36.8 yrs). Previous history of pneumonia in childhood was detected in 52.5% of the patients, tuberculosis in 19.8%; 8.8% had bronchial asthma, and 2 had Kartageners syndrome. RESULTS: The most common symptoms were cough (100.0%), expectoration (96.0%) and pulmonary rales (66.0%). The pulmonary lesions were unilateral in 46.5% of the cases. Pneumococcus, H. influenzae or mixed flora were found in 85.0% of the examined sputa. All 170 patients received antibiotics and postural drainage, and 88 of them (younger and with a higher functional reserve) were also submitted to pulmonary resections (82 unilateral and 6 bilateral). Two deaths occurred, and repetitive hospitalizations were more frequent among the clinically treated patients. The follow up showed that most of the surgically treated patients had significant symptoms improvement and rarely needed to be re-hospitalized. CONCLUSIONS: In the majority of the patients, lung resection surgery improved permanently the prolonged bronchopulmonary symptoms of patients with bronchiectasis, differently from the patients who received only clinical treatment.

Avaliação objetiva do hipocratismo digital em imagens de sombra de dedo indicador: estudo em pacientes pneumopatas e em indivíduos normais

INTRODUCAO: O diagnostico do hipocratismo digital e clinico, mas pode tornar-se mais acurado pelo uso de criterios objetivos de determinacao. OBJETIVO: Mostrar um metodo simples de obtencao de imagens de dedos para estudo do hipocratismo digital. METODO: Em imagens de dedos indicadores em perfil, obtidas praticamente sem distorcao em folha de papel comum, projetadas atraves de lâmina de vidro, determinaram-se os ângulos do perfil e hiponiquial, e a relacao entre as espessuras falangeana distal e interfalangena. Estudaram-se 306 pneumopatas adultos, clinicamente com hipocratismo presente, ausente ou duvidoso, e 452 individuos adultos normais. Eram fumantes 71,0% dos pacientes e 33,4% dos controles. RESULTADOS: Os valores encontrados nos individuos normais e nos pacientes nos quais havia a presenca clinica de hipocratismo foram, respectivamente, 172,8 ± 5,3o e 183,4 ± 5,0o para ângulo de perfil, 181,5 ± 4,8o e 201,4 ± 6,5o para ângulo hiponiquial, e 0,904 ± 0,029 e 1,014 ± 0,062 para a relacao entre as espessuras falangeana distal e interfalangeana. As diferencas foram significativas. Os casos duvidosos tambem tiveram valores maiores que os verificados nos controles. No grupo controle, observou-se que os fumantes masculinos apresentaram os tres valores significativamente superiores aos exibidos pelos nao fumantes, enquanto que nas mulheres fumantes desse grupo apenas a relacao entre as espessuras falangeana distal e interfalangeana se mostrou superior. CONCLUSAO: Imagens nitidas de dedos indicadores foram facilmente obtidas pelo metodo empregado. O ângulo hiponiquial, determinado a partir das imagens, foi a medida que se mostrou com maior capacidade para discriminar casos com e sem hipocratismo (sensibilidade de 76,7%, especificidade de 83,2%, valores preditivos positivo de 95,8% e negativo de 96,9%).

Interobserver agreement between radiologists and radiology residents and emergency physicians in the detection of PE using CTPA

OBJECTIVE To assess interobserver agreement between thoracic radiologists, radiology residents, and emergency physicians in diagnosing pulmonary embolism (PE). MATERIALS AND METHODS Emergency physicians, radiology residents, and thoracic radiologists evaluated 123 computed tomography pulmonary angiography images. Interobserver agreement was analysed using kappa statistics. RESULTS Very good agreements were observed between thoracic radiologists and radiology residents (0.81 and 0.82). Fair and moderate agreements (0.39 and 0.42) were demonstrated between emergency physicians and thoracic radiologists. CONCLUSIONS Important differences in interobserver agreement were found, with emergency physicians tending to overdiagnose PE.

Magnetic Resonance Imaging of Pulmonary Embolism: Diagnostic Accuracy of Unenhanced MR and Influence in Mortality Rates

ObjectivesWe evaluated the diagnostic value for pulmonary embolism (PE) of the True fast imaging with steady-state precession (TrueFISP) MRI, a method that allows the visualization of pulmonary vasculature without breath holding or intravenous contrast.MethodsThis is a prospective investigation including 93 patients with suspected PE. All patients underwent TrueFISP MRI after undergoing CT pulmonary angiography (CTPA). Two independent readers evaluated each MR study, and consensus was obtained. CTPA results were analysed by a third independent reviewer and these results served as the reference standard. A fourth radiologist was responsible for evaluating if lesions found on MRI for both analysis were the same and if these were the correspondent lesions on the CTPA. Sensitivity, specificity, predictive values and accuracy were calculated. Evidence for death from PE within the 1-year follow-up was also assessed.ResultsTwo patients could not undergo the real-time MRI and were excluded from the study. PE prevalence was 22%. During the 1-year follow-up period, eight patients died, whereas PE was responsible for 12.5% of cases. Between patients who developed PE, only 5% died due to this condition. There were no differences between MR and CT embolism detection in these subjects. MR sequences had a sensitivity of 85%, specificity was 98.6% and accuracy was 95.6%. Agreement between readers was high (κ= 0.87).ConclusionsCompared with contrast-enhanced CT, unenhanced MR sequences demonstrate good accuracy and no differences in the mortality rates in 1 year were detected.

Pneumonia tuberculosa: um estudo de 59 casos confirmados microbiologicamente

OBJECTIVE To study the clinical, epidemiological, radiographic and endoscopic features of individuals with tuberculous pneumonia. METHODS We evaluated 2,828 consecutive tuberculosis patients treated at a public health center between December of 2005 and February of 2007. Of those, 59 (2.1%) had pulmonary involvement consistent with fistula between a lymph node and a bronchus. RESULTS Of the 59 patients studied, 43 (73%) were between 20 and 50 years of age, 31 (53%) were male, and 28 (47%) were Black. The most common symptoms were cough (in 100%), fever (in 88%), expectoration (in 81%), and weight loss (in 40%). Comorbidities were reported in 35 cases (59%), the most common being HIV infection (in 20%) and diabetes (in 15%). On chest X-rays, consolidation was observed, predominantly in the upper lobes (in 68%). The diagnostic confirmation (identification of AFB) was made through the sputum smear microscopy in the majority of the cases and by bronchoscopy (BAL examination or bronchial biopsy) in the remainder. Bronchial lesions were clearly indicative or suggestive of fistula in three cases and five cases, respectively. CONCLUSIONS Tuberculous pneumonia presents as acute respiratory infection, initiating with a dry cough that is followed by fever. Chest X-rays show alveolar consolidation. In most cases, tuberculous pneumonia was accompanied by at least one comorbid condition, the most common being HIV infection, and the etiological diagnosis was made through sputum smear microscopy for AFB. Bronchoscopy findings were indicative of bronchial fistula in eight cases (13%).OBJECTIVE: To study the clinical, epidemiological, radiographic and endoscopic features of individuals with tuberculous pneumonia. METHODS: We evaluated 2,828 consecutive tuberculosis patients treated at a public health center between December of 2005 and February of 2007. Of those, 59 (2.1%) had pulmonary involvement consistent with fistula between a lymph node and a bronchus. RESULTS: Of the 59 patients studied, 43 (73%) were between 20 and 50 years of age, 31 (53%) were male, and 28 (47%) were Black. The most common symptoms were cough (in 100%), fever (in 88%), expectoration (in 81%), and weight loss (in 40%). Comorbidities were reported in 35 cases (59%), the most common being HIV infection (in 20%) and diabetes (in 15%). On chest X-rays, consolidation was observed, predominantly in the upper lobes (in 68%). The diagnostic confirmation (identification of AFB) was made through the sputum smear microscopy in the majority of the cases and by bronchoscopy (BAL examination or bronchial biopsy) in the remainder. Bronchial lesions were clearly indicative or suggestive of fistula in three cases and five cases, respectively. CONCLUSIONS: Tuberculous pneumonia presents as acute respiratory infection, initiating with a dry cough that is followed by fever. Chest X-rays show alveolar consolidation. In most cases, tuberculous pneumonia was accompanied by at least one comorbid condition, the most common being HIV infection, and the etiological diagnosis was made through sputum smear microscopy for AFB. Bronchoscopy findings were indicative of bronchial fistula in eight cases (13%).

Síndrome de Pancoast causada por linfoma

A rare case of Pancoasts syndrome caused by non-Hodgkins lymphoma is reported. The diagnosis was made on the grounds of examination of the tissue obtained by pulmonary needle biopsy. The necessity of accurate histologic diagnosis and immunohistochemical study is emphasized.

Regressão do hipocratismo digital em pacientes com câncer de pulmão tratados cirurgicamente

OBJETIVO: Estudar, por meio de avaliacoes objetivas, a ocorrencia de regressao do hipocratismo digital (HD) em pacientes com câncer de pulmao, tratados cirurgicamente, e revisar a literatura sobre o assunto. METODOS: Sessenta e um pacientes com câncer de pulmao nao-pequenas celulas-40 com e 21 sem HD-foram tratados por cirurgia de resseccao pulmonar. Onze deles (18%) tambem receberam radioterapia pos-operatoria. No periodo pre-operatorio e no 7o, no 18o e no 90o dia pos-operatorio, o ângulo hiponiquial (AH) e a relacao entre as espessuras falangeana distal e interfalangeana (EFD/EIF) foram determinados sobre imagens da sombra dos dedos indicadores em perfil. Uma revisao da literatura sobre regressao do HD (1954-2007) tambem foi efetuada. RESULTADOS: Do periodo pre-operatorio ao 90o dia pos-operatorio, o AH diminuiu de 200,5 ± 5,0o para 193,3 ± 6,8o (p < 0,001), e a relacao EFD/EIF, de 1,014 ± 0,051 mm para 0,956 ± 0,045 mm (p < 0,001) no grupo de 40 pacientes com HD. Em 33 (82,5%), o AH e a relacao EFD/EIF diminuiram, mas, em 7 (1,7%), 6 com evolucao desfavoravel, esses valores nao se reduziram. Nos 21 pacientes sem HD, tanto o AH (184,5 ± 5,5o) como a relacao EFD/EIF (0,937 ± 0,046 mm) permaneceram inalterados apos a cirurgia. Na literatura (1954-2007) foram encontrados 52 casos em que a regressao do HD, observada em diversas condicoes clinicas, foi explicitamente referida, 5 dos quais eram casos de câncer de pulmao. CONCLUSOES: O HD em pacientes com câncer de pulmao regride na maioria dos casos apos tratamento cirurgico efetivo do tumor, o que pode tambem ocorrer em pacientes com outras condicoes.

Predictors of noncompliance to pulmonary tuberculosis treatment: An insight from South America

Purpose To investigate the factors associated with a higher risk of noncompliance to tuberculosis (TB) treatment in Porto Alegre, Brazil. Methods We identified 478 adult patients for this case-control study undergoing treatment for confirmed pulmonary TB. Cases (noncompliance) were defined as patients who stopped treatment for more than 30 consecutive days (n = 118). Controls were defined as all patients who completed treatment and were cured (n = 360). Factors associated with noncompliance were calculated with unadjusted and adjusted odds ratio (OR). Results The rate of noncompliance in our study was 25%. The factors of noncompliance after adjustments in the overall population were, in order of magnitude, living in an area of lower income (OR = 4.35, 95%CI: 2.50–7.58), abuse of drugs (OR = 2.73, 95%CI: 1.47–5.09), nonadherence to a previous treatment regimen (OR = 2.1, 95%CI: 1.28–3.45), and history of smoking (OR = 1.72, 95%CI: 1.00–3.00). Age, race, gender, level of education, HIV infection or diabetes status were not associated with a higher risk of noncompliance. In the subgroup of re-treatment cases, poverty (OR = 2.65; 95%CI = 1.06–6.66), smoking history (OR = 2.94; 95%CI = 1.09–7.92), male gender (OR = 3.25; 95%CI = 1.32–8.0), and younger age (OR = 4.3; 95%CI = 1.15–16.07) were also associated with a higher risk of dropout. Conclusion Predictors of poor compliance to TB treatment were low income, abuse of drugs, re-treatment cases and history of smoking.