Rodolfo Fred Behrsin

Avaliação do coeficiente de variação da idade dos pacientes com síndroma de derrame pleural no Hospital Universitário António Pedro, cidade de Niterói, estado do Rio de Janeiro, Brasil

Pleural effusion is a frequent syndrome in Brazil. Tuberculosis is the most prevalent (P) cause. The coeficient of variation (CV) is a useful single measure of variability. The objective of the present work was to evaluate the coeficient of variation in pleural effusion, having as variable the age. 215 patients had appeared after diagnostic physician and for image of syndrome of pleural effusions. Diagnostic thoracentesis, tests on pleural fluid and others invasise surgical procedures to the approach to a patient with pleural effusion. Tuberculosis (P = 56.0%; CV = 39,7%), adenocarcinoma (P = 11.0%; CV = 25.1%), transudates (P = 12.0%; CV = 19.6%), lymphomas (P = 2.0%; CV = 34.6%), systemic lupus erythematosus (P = 2.0%; CV = 38.7%), empyema pleural not tuberculosis (P = 5.0%; CV = 42.2%), pulmonary infarction (P = 4.0 %; CV = 30.1%) and parapneumonic (P = 4.0 %; CV = 38.9%) are the causes more prevalent. The analysis on the date showed that the coefficient of variation of age in pleural effusions was high and very high. The values of the coeficient of variation translate a high degree of dispersion of the age of the patients in each cause of pleural effusion. REV PORT PNEUMOL 2003; IX (5): 389-393

Evaluation of adenosine deaminase activity for the diagnosis of pleural TB in lymphocytic pleural effusions

AIM To evaluate the diagnostic value of pleural adenosine deaminase (P-ADA) as a pleural TB-specific biomarker in lymphocytic pleural effusions. MATERIALS & METHODS Pleural effusions were classified on the basis of definitive diagnosis. RESULTS A total of 218 patients (122 tuberculous and 96 nontuberculous) were included in the study. The optimal cut-off value of P-ADA (receiver operating characteristic curve) for the diagnosis of pleural TB was 40.0 U/l (Giusti method). In lymphocytic pleural effusions P-ADA had a sensitivity of 80.3%, a specificity of 96.0% and an accuracy of 86.2%. The positive predictive value was 97.0% and the negative predictive value was 75.0%. The positive likelihood ratio and negative likelihood ratio were 19.8 and 0.2, respectively (p < 0.0001). CONCLUSION P-ADA activity is recommended for the diagnosis of TB in lymphocytic pleural effusions.

Cirurgia redutora de volume pulmonar: critérios de seleção de pacientes no Hospital Universitário Antônio Pedro, Universidade Federal Fluminense, Niterói, Rio de Janeiro, RJ

BACKGROUND: Chronic Obstructive Pulmonary Disease (CPOD) is an important problem in Brazil and other countries. The clinical treatment of ambulatory patients is now reasonably standardized. Lung volume reduction surgery (LVRS) is an alternative of surgical treatment of emphysema (aside from lung transplantation). OBJECTIVES: The aim of this study was to analyse patient selection criteria for LVRS. METHODS: This study was carried out using a sample of 31 patients referred to and given assistance to at the Smoking and Chronic Obstructive Pulmonary Disease Outpatient Ward Antonio Pedro Hospital, who were evaluated to check whether or not they could be eligible for LVRS. Aiming at evaluating the major criteria for eligibility for LVRS, the patients underwent a protocol including standardized anamnesis and physical examination, spirometry with maximum inspiratory and expiratory flow volume curves associated with post-bronchodilatator test, room air arterial blood gases, a six-minute walking test, plain chest roentgenograms and left lateral chest roentgenograms, high-resolution chest computed tomographic scans and lung perfusion scans. Statistical analysis was conducted with description of data proportions. RESULTS: Contraindications to surgery included chronic bronchitis (29% or nine patients), forced expiratory volume in one second (FEV 1) more than 80 percent predicted (13% or four patients), negative consent for surgery (10% or three patients), fibrosis pattern, severe depression and bronchiectasis (two patients each one), solitary pulmonary nodule, severe obesity, severe bullous emphysema, pulmonary hipertension, pulmonary resection history, current cigarette smoking, diffuse emphysema with alpha-1-antitrypsin deficiency and severe cardiac disease (one patient each). Indication. One selected patient with severe symptoms of emphysema met criteria for LVRS (bilateral superior lobe heterogeneous pattern of emphysema on chest computed tomography and lung perfusion scan). CONCLUSIONS: Chronic bronchitis was the major isolated factor to contraindicate LVRS. Most patients who fit the criteria for the surgery performance refused to undergo the LVRS for fear of the surgery and after pulmonary rehabilitation. The most important criteria for LVRS is bilateral superior lobe heterogeneous pattern of emphysema.