Nelson Morrone

III Diretrizes para Tuberculose da Sociedade Brasileira de Pneumologia e Tisiologia

New scientific articles about tuberculosis (TB) are published daily worldwide. However, it is difficult for health care workers, overloaded with work, to stay abreast of the latest research findings and to discern which information can and should be used in their daily practice on assisting TB patients. The purpose of the III Brazilian Thoracic Association (BTA) Guidelines on TB is to critically review the most recent national and international scientific information on TB, presenting an updated text with the most current and useful tools against TB to health care workers in our country. The III BTA Guidelines on TB have been developed by the BTA Committee on TB and the TB Work Group, based on the text of the II BTA Guidelines on TB (2004). We reviewed the following databases: LILACS (SciELO) and PubMed (Medline). The level of evidence of the cited articles was determined, and 24 recommendations on TB have been evaluated, discussed by all of the members of the BTA Committee on TB and of the TB Work Group, and highlighted. The first version of the present Guidelines was posted on the BTA website and was available for public consultation for three weeks. Comments and critiques were evaluated. The level of scientific evidence of each reference was evaluated before its acceptance for use in the final text.

Ginecomastia: um efeito colateral raro da isoniazida

We report the case of a patient who twice developed gynecomastia following tuberculosis treatment. An 18-year-old male developed painful bilateral gynecomastia after three months of treatment with the isoniazid-rifampin-pyrazinamide regimen. Partial resolution of gynecomastia was achieved at the end of treatment. The patient was retreated with the same regimen eight years later, and gynecomastia recurred after six months of treatment. Hormone levels were normal, and a mammogram revealed bilateral gynecomastia. The isoniazid was discontinued, and the gynecomastia was partially resolved by the end of treatment. Four years later, gynecomastia was not detected. We conclude that isoniazid-related gynecomastia completely resolves when the medication is discontinued. Therefore, pharmacological and surgical treatment should be avoided.

Hemangioendotelioma epitelióide de pleura

Epithelioid hemangioendothelioma (EHE), a very uncommon pleural tumor, was diagnosed in a 61-year-old man with work-related exposure to asbestos. Serohemorrhagic pleural effusion was diagnosed in the work-up of this patient, whose complaints were chest pain and weight loss. A lymphocytic predominance was present in the effusion, but no malignant cells were seen; pleural needle biopsy disclosed only a non-specific inflammatory process. Video thoracoscopy revealed nodules in parietal and visceral pleurae. A biopsy revealed a mesenchymal neoplasm; vascular markers CD 31, CD 34 and VIII factor were present; therefore, diagnosis of HE was accepted. The tumor was not responsive to cisplatin or etoposide and the patient died 3 months after the diagnosis.

Osteíte por BCG Moreau em uma menina vacinada ao nascer

A female infant (age, 2 years and 4 months) from the city of Sao Paulo, Brazil, had been vaccinated with BCG in the maternity ward and presented with a 15-day history of pain in the right leg and impaired ambulation. The patient was treated with a nonsteroidal anti-inflammatory drug and showed improvement. However, two weeks after the drug had been discontinued, she showed worsening. An X-ray of the knee showed an osteolytic lesion in the right distal femoral epiphysis. Magnetic resonance imaging (Figure 1) revealed a centromedial lesion in the right distal femoral epiphysis, with multiple areas of cortical erosion; there was significant cortical discontinuity, and there was no effusion in the posteroinferior portion of the medial femoral condyle. The patient was treated with ceftriaxone for 14 days, with no improvement. A punch biopsy of the right knee showed a granuloma with no AFB. The patient was started on isoniazid, rifampin, and pyrazinamide. Investigation of her parents, siblings, and nannies showed no exposure to pulmonary or extrapulmonary tuberculosis. At admission to our facility, a few days after treatment initiation, the patient was in good general health. The only abnormality on physical examination was right knee edema (distal and proximal to the tibia). The edema was cold and painful on palpation, being accompanied by functional disability.The following tests were performed: tuberculin skin testing with PPD, the induration being 14 mm; X-ray and magnetic resonance imaging of the right knee; enzyme-linked immunospot (ELISPOT) assay, the results being negative; knee biopsy, revealing very little bone tissue with two epithelioid granulomas (one of which had caseous necrosis) and chronic lymphoplasmacytic inflammatory infiltrate; AFB testing, the results being negative; mycobacterial culture, the results being positive; PCR testing, revealing the presence of insertion sequence 6110 (which is characteristic of mycobacteria) and duplication of spacer 33 in the DR region (172-bp amplicon), present only in the Mycobacterium bovis BCG strain and absent in M. tuberculosis; PCR testing, the results being negative for M. tuberculosis; routine tests (complete blood count, ESR determination, HIV testing, and evaluation of liver and kidney function), the results being normal; humoral and cellular immune response testing, the results being normal (Table 1); and chest CT, the findings being normal.The patient achieved a satisfactory clinical improvement and was discharged after 18 months of treatment, at which point an X-ray of the right femur showed normal findings.The BCG vaccine is used in many countries, and there are no strict rules regarding the age of vaccination, the groups that should be vaccinated, the type of vaccine, the concentration of bacilli, the ratio of live to dead bacilli, or the mode of administration. Many strains are used; however, there is uncertainty regarding the total number of viable and nonviable bacilli (which could potentiate the immunity induced by the former) and the ability of PPD to induce allergy, both of which are factors that can have an impact on the potency and complications of the vaccine.

Jornal Brasileiro de Pneumologia: 40 years of tradition.

398 For humans, turning forty is almost a cause for despair, because it signals the end of youth as well as a less brilliant future. For a medical journal, however, 40 years of existence means that it has had a satisfactory history, and that, more importantly, it will have an increasingly bright future. The Brazilian Journal of Pulmonology (BJP), which is celebrating its 40th anniversary, stands out today for a number of reasons, chief among which is that it disseminates research conducted by Brazilian and international experts. This internationalization reflects the maturity and dissemination power of the Journal. One important contribution to that internationalization, as well as to attracting researchers working in Brazil, was our acceptance for indexing by LILACS, PubMed/MEDLINE, and other databases. The online publication of all articles, in Portuguese and in English (in-house translation by the BJP), in parallel with the publication of a print version, in Portuguese, English, or Spanish, depending on the language of submission, is an invaluable achievement and confers considerable prestige. Changing the name of our Journal from the Jornal de Pneumologia (Journal of Pulmonology) to the Jornal Brasileiro de Pneumologia (Brazilian Journal of Pulmonology) undoubtedly made a considerable contribution to the prestige it currently enjoys. Another truly important aspect of the BJP is that, unlike many publications, its online version is available for free. It therefore differs from other scientific journals in that it is not a source of revenue for the professional society that sponsors it—in our case the Brazilian Thoracic Association. This is clearly an important contribution to medical knowledge, with obvious advantages for patients, distinguishing our Journal from those that charge a fee for viewing an article. The greatness of the BJP reflects the fact that numerous initial difficulties were surmounted, many by progress in general and other by advances in the field of information technology. For example, I remember that the government financed the publication of our Journal by providing an annual stipend, which was constantly devalued by inflation, and that we were prohibited from investing those funds. The reporting of expenditures was an onerous chore, given that even postage stamps had to be accounted for (a point of curiosity: a few years after leaving the BJP, I was fined by the tax authority because R

Opacidade homogênea no hemitórax esquerdo de mulher com 66 anos

3.00, which is currently equivalent to less than US

Bilateral Pleural Effusion due to Mediastinal Fibrosis Induced by Radiotherapy

1.00, had not been accounted for). This nuisance ended when we began to purchase a …

Pleural Biopsy with Cope and Abrams Needles

* Trabalho realizado no Sanatorinhos – Acao Comunitaria de Saude eClinica Pneumologica do Hospital Ipiranga – Sao Paulo, SP.1. Residente de 2o ano em Pneumologia – Hospital Ipiranga.2. Chefe da Clinica Pneumologica do Hospital Ipiranga.3. Medico da Clinica Pneumologica do Hospital Ipiranga e de Sanato-rinhos – Acao Comunitaria de Saude.4. Diretor Clinico de Sanatorinhos – Acao Comunitaria de Saude.Endereco para correspondencia – Nelson Morrone, Rua Ministro deGodoy, 657, apto. 101 – 05015-000 – Sao Paulo, SP.