Resumo em Inglês:

Epidemiologic data on idiopathic pulmonary fibrosis are relatively scarce, and its real incidence and prevalence are unknown. Recent studies suggest that mortality due to idiopathic pulmonary fibrosis is rising in developed countries. OBJECTIVE: To describe mortality caused by idiopathic pulmonary fibrosis in the State of Rio Grande do Sul (RS), Brazil, from 1970 to 2000, analyzing its trend and comparing it with that from other countries. METHOD: Prevalence study, using data from the Brazilian Institute of Geography and Statistics (IBGE), analyzing death certificates in which idiopathic pulmonary fibrosis was stated as the ultimate cause of death. RESULTS: Annual mortality rate adjusted to the population was 0.22/100,000 people in the 1970’s, 0.3/100,000 people in the 1980’s, and 0.48/100,000 people in the 1990’s. Total mortality raised 36% from 1970 to 1980, and 73% from 1980 to 1990. The mortality rate adjusted to the population raised 36% and 60% during the same periods. The rise in both total and adjusted mortality from IPF was statistically significant (p < 0.05). The mean mortality rate per 100,000 inhabitants between 1996 and 1998, however, was 0.683, corresponding to a 70% increase when compared to the previous three-year period, which was 0.4 (p = 0.0002), probably reflecting coding practices. CONCLUSION: There was a significant increase in IPF mortality in RS from 1970 to 2000, partly due to changes in coding practices. This increase is in conformity with observations in other countries, although mortality rates in RS are considerably lower.

Resumo em Inglês:

OBJECTIVE: To evaluate the prevalence and the risk factors for tuberculosis (TB) infection and disease among hospitalized cocaine users. METHOD: A cross-sectional study performed on a sample of 440 addicts over 18 years of age, admitted to hospitals of the metropolitan area of the Greater São Paulo city, whose clinical conditions allowed them to answer a standard questionnaire, and who agreed to participate in the study. The prevalence of TB infection was assessed through positive tuberculin testing (PPD), and of TB disease by the finding of M. tuberculosis in the sputum of patients with respiratory symptoms. RESULTS: Respiratory symptoms were present in 21% of the patients, the most frequent being weight loss and cough, which disappeared when cocaine use was discontinued. The general prevalence of TB infection was 28%. The prevalence of TB disease was 0.6%. The factors which were associated with positive PPD were: age, color/race, time spent in prison, and drug use in prison. CONCLUSION: No increased prevalence of TB infection and disease was found in these patients. Older addicts had a higher probability of having TB infection, and so had those who had been in prison.

Resumo em Inglês:

OBJECTIVE: To describe and to compare the incidence of tuberculosis in childhood and adolescence in the Paraíba Valley (State of São Paulo, Brazil) in 1993 and 1997. METHOD: Descriptive study with secondary records obtained from the Tuberculosis Division of the Health Department of the State of São Paulo (Divisão de Tuberculose da Secretaria de Saúde de São Paulo). The variables were the type of case, age, form of detection, diagnosis confirmation, clinical presentation, X-ray results, and anti-HIV test results. RESULTS: The global incidence of tuberculosis in all age ranges was of 97.3 cases/100,000 inhabitants in 1993, and 127.6 cases/100,000 inhabitants in 1997. In the age group up to 15 years old, there were 93 new cases in 1993, and 68 new cases in 1997, representing an incidence of 11.7 cases/100,000 inhabitants in 1993 and 7.9 cases/100,000 inhabitants in 1997. The most common clinical presentation was the pulmonary form; the most important form of detection was by searching communicants; the most frequent diagnosis confirmation was by X-ray, and there was an increasing number of anti-HIV tests between 1993 and 1997. The distribution by age range was similar to the literature data in both years analyzed. CONCLUSION: The values of tuberculosis incidence in childhood and adolescence found in this study are higher than those existing in developed countries.

Resumo em Inglês:

OBJECTIVE: To determine the clinical characteristics and the results of bronchoscopic treatment of children due to foreign body aspiration in a university hospital. METHOD: Time series of children who underwent bronchoscopies for foreign bodies aspirated into the airway between March 1993 and July 2002. Each patient was analyzed for age, sex, initial clinical diagnosis, nature and location of the foreign body, duration of symptoms between aspiration and bronchoscopy, radiological findings, results of bronchoscopic removal, complications of bronchoscopy and presence of foreign bodies in the airways. RESULTS: Thirty-four children, 20 (59%) boys, ages ranging from nine months to nine years (median = 23 months). In 32 (94%) children the foreign body was removed by rigid bronchoscope, and two resulted in thoracotomy. Foreign bodies were more frequent in children under three years of age (66%). A clinical history of foreign body inhalation was obtained in 27 (80%) cases. Most of the foreign bodies removed were organic (65%) and more frequently found in the right bronchial tree (59%). Foreign bodies were removed within 24 hours in 18 (53%) cases. The most frequent radiographic findings were: unilateral air trapping, atelectasis and radiopac foreign body. Major bronchoscopy complications occurred in seven children (22%), and there were no deaths. CONCLUSIONS: More attention is necessary to the respiratory symptoms of aspirations, mainly in boys at early ages, with clinical history and compatible radiological findings. Most foreign bodies removed were of organic nature. In this case series, therapeutic rigid bronchoscopy was effective with few complications.

Resumo em Inglês:

OBJECTIVE: To determine the contribution of percutaneous biopsy with core cutting needle in the diagnosis of mediastinal tumors. METHOD: Retrospective review of 22 patients with mediastinal lesions who were submitted to percutaneous core cutting needle biopsy, oriented, but not guided by computer assisted tomography of the thorax, between 1999 and 2002. RESULTS: Percutaneous biopsy with core cutting needle provided adequate material in 18/22 cases, with a total positive sample rate of 82%. In 4/22 cases, the material was insufficient to define the diagnosis (18%). Percutaneous core cutting needle biopsy established a specific histologic diagnosis in 82% of the patients: 8/22 (36%) lymphoma; 5/22 (28%) thymoma; 2/22 (11%) thymic carcinoma; 1/22 (6%) metastatic adenocarcinoma; 1/22 (6%) neuroectodermic primitive tumor; and 1/22 (6%) plasmocytoma. All the patients were submitted to a thoracic X-ray after the biopsy. No complications were found in these patients. CONCLUSION: Percutaneous core cutting needle biopsy oriented, but not guided by computer assisted tomography of the thorax, is an easy and safe procedure which can provide a precise diagnosis in most mediastinal tumors, and can prevent the exploratory thoracic surgery in inoperable or chemotherapy-treated cases.

Resumo em Inglês:

The bronchogenic cyst is a common congenital malformation, generally located in the mediastinum; however, it can develop in other areas, such as the diaphragm. A rare case of intradiaphragmatic bronchogenic cyst is described here, discovered in a 32 year-old patient, who experienced thoracic pain and dyspnea following thoracic trauma. The pre-operative exams were compatible with left diaphragmatic hernia. The patient was submitted to a left post-lateral thoracotomy with the operative discovery of a cystic lesion enveloped by the diaphragm with mucinous content, and a partial resection of the diaphragm was performed. The histological findings of the operated portion revealed ciliated cylindrical epithelium, compatible with bronchogenic cysts. The post-operative outcome was excellent.

Resumo em Inglês:

Some kinds of interstitial pneumonia present a histopathological pattern dominated by sarcoid - necrotizing or non-necrotizing - granulomas, which can be divided into two main groups: infectious and non-infectious. The infectious causes include tuberculosis, histoplasmosis, fungi in general, paracoccidioidomycosis, ascaridiasis, echinococcosis and dirophilariosis. The non-infectious causes include histiocytosis-X, hipersensitivity pneumonia, vasculitis, lymphomas, sarcoidosis, and pneumoconioses such as silicosis and berylliosis. The purpose of this review is to provide a practical guideline to enable general pathologists to make the differential diagnosis of granulomatous pulmonary diseases. For this purpose, anatomical-clinical-radiological correlations will be presented and targeted to each diagnosis discussed. Whenever a granulomatous inflammatory process is in progress, the search for infective agents by direct observation, by culture, and by histochemical methods should be mandatory. The histological aspects of infectious granulomas to be analyzed should include their random histo-anatomical location, the type of inflammatory reaction, and necrosis. A panel of complementary reactions (immunohistochemistry and PCR) should identify the infectious agent and, whenever their results and the culture are negative, the possibility of non-infectious granulomatous diseases has to be evaluated. In such cases, the histo-anatomical distribution (bronchocentric, lymphangitic, angiocentric, random), the qualitative characteristics of the lesions (type of necrosis and inflammatory reaction), and the correlation with the X-ray findings will help the diagnosis.

Resumo em Inglês:

Focal lung abnormalities are frequent X-ray findings and can have an infectious, inflammatory or neoplastic etiology. In the evaluation of such radiological alterations, it is important to make a distinction between benign and malignant (lung cancer) diseases. Computed tomography characterizes 25% of the lung nodules as indeterminate, requiring thoracotomy with biopsy for diagnostic clarification. FDG-PET has a 94% sensitivity and a 86% specificity in the differentiation of benign and malignant parenchymal lesions, thus reducing by 15% the need for surgery to make a diagnosis. It is useful in the staging of non-small-cell lung carcinoma, having a 91% sensitivity and a 86% specificity in the evaluation of mediastinal lymph nodes. It also seems to be useful in the analysis of liver, adrenal and bone metastases. In this review, the several indications for PET in pulmonary neoplasias are discussed, in addition to details about the examination technique.