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A reality
SÉRGIO SALDANHA MENNA BARRETO (TE SBPT)
In 1977, Kenneth Moser published an article in the American Review of Respiratory Disease1. His article
presented an overview of the state-of-the-art regarding cases of pulmonary embolism. Since then, as an entity of consistency, natural history and doctrine, it seems to have been relegated to the status of a curiosity for pulmonologists. Various prospective epidemiological studies have succeeded the classic Dalen and Alpert estimate2, confirming the impact and importance of
giving serious attention to the problematic issue of venous thromboembolism (VTE) in everyday practice. Subsequent advances in diagnostic techniques and the introduction of low- molecular- weight heparins h a ve d em o n st ra t ed t h e releva n ce o f t h e t o p ic. Proposals for efficacious means of prophylaxis, as well as questions regarding the best course of action in diagnosing and treating VTE, have resulted in extremely strict guidelines that have democratized the approach to this potentially complex condition.
Wit hou t regard for his st an din g wit hin t he ran ks o f t h e a ca d e m ic a n d scie n t if ic co m m u n it ie s, t h ro u g h wh ich h is ad van ce h ad b een rap id an d n o t ewo rt h y, Mo ser p u b lish ed a n o t h er crit iq u e o f t he st at e- of- t he- art in 19903. In t his secon d review,
t h e a u t h o r ca lled a t t en t io n t o t h e fa ct t h a t ra t es of VTE in ciden ce an d mort alit y in t he Un it ed St at es rem a in ed “su b st a n t ia l a n d u n a ccep t a b le”, a n d h e a p p ea led fo r m o re resea rch a n d m o re a ct io n .
In 1996, at the XXVIII Congresso Brasileiro de Pn eu mologia e Tisiologia (Brazilian Con gress on Pulmonology and Phthisiology) in the city of Belo Horizon t e, t he Comissão Cien t ífica de Circu lação Pulmonar da Sociedade Brasileira de Pneumologia e Tisiologia (SBPT, Brazilian Society of Pulmonology and Phthisiology, Scientific Commission on Pulmonary Circulation) was created. The objective of the this commission was to encourage – at scientific events, as well as in continuing education programs sponsored by the SBPT – the study of, and new approaches to, d isea ses t h a t a ffect p u lm o n a ry circu la t io n . Th e
commission has achieved this objective. Interest in the vario u s asp ect s o f t h e p at h o lo g y o f p u lm o n ary circu la t io n h a s in cre a se d co n sid e ra b ly a m o n g pulmonologists. In addition, a condition that, until recen t ly, was alm ost exclusively t he provin ce of cardiologists – pulmonary arterial hypertension – has now fallen under the purview of pulmonologists.
Th i s i s s u e o f t h e Br a z i l i a n J o u r n a l o f Pu lm o n o lo g y is a p erfect exa m p le o f t h e t o p ic a t han d, con t ain in g fou r art icles t hat deal wit h variou s aspect s of abn orm alit ies in pu lm on ary circu lat ion .
Yoo et al.4
presen t an an alysis of clin ical an d p a t h o lo g ica l d a t a re g a rd in g p u lm o n a ry thromboembolism (PTE), collected in autopsies over a 24- year time span. For many decades, postmortem studies were considered the gold standard in diagnosing PTE, being the only means of obtaining a definitive diagn osis. Cu rren t ly, alt hou gh prospect ive st u dies involving objective diagnostic techniques have provided data of considerable exactitude, knowledge gained from clinical and pathological correlations continues to be important to the understanding of the many facets of the disease. Autopsies, when routinely performed, serve as a means of quality control for patient care, as well as enriching the pulmonology milieu. We continue to learn from postmortem data.
Silva et al.5
present a concise review of diagnosis of acute PTE through imaging, with an emphasis on the role of helical computed tomographic angiography. Since the publication of the first article by Remy-Jardim et al.6
, this technique ascended rapidly and sharply to be, initially, a means of diagnostic confirmation and, later, a means of ruling out acute PTE. In health care centers that possess a helical computed tomography d evice wit h m u lt ip le d et ect o rs a n d a t ea m o f conscientious radiologists, the thorny problem of PTE diagnosis seems to be a closed case. Let it be so.
Terra- Filho et al.7
412
REFERENCES
1 . M o s e r KM . P u lm o n a r y e m b o lis m . Am Re v Re s p ir Dis1 9 7 7 ; 11 5 : 8 2 9 - 51 .
2 . Da le n J E, Alp e rt J S. Na t u ra l h is t o ry o f p u lm o n a ry em b o lism . Pro g Ca rd io va sc Dis.1 9 7 5 ; 1 7 : 2 5 9 - 7 0 3 . Mo ser MK. Ven o u s t h ro m b o em b o lism . Am Rev Resp ir
Dis 1 9 9 0 ; 1 41 : 2 3 5 - 4 9 .
4 . Yo o H H B, M e n d e s F G, Al e m CE R. Ac h a d o s c l i n i c o p a t o l ó g i c o s n a t r o m b o e m b o l i a p u l m o n a r : est u d o s d e 2 4 a n o s d e a u t o p sia s. J Bra s Pn eu m o l 2 0 0 2 : 3 0 : 4 2 6 - 3 2 .
5 . Silva IS, M ü lle r NL. Dia g n ó s t ic o p o r im a g e n s d o t ro m b o e m b o lism o p u lm o n a r a g u d o . J Bra s P n e u m o l 2 0 0 4 ; 3 0 : 4 7 4 - 9 .
6 . Re m y- J a rd im M, Re m y J , Wa t t im e L e t a l. Ce n t ra l p u lm o n a ry t h ro m b o e m b o lism : d ia g n o sis w it h sp ira l v o l u m e t r i c CT w i t h s i n g l e - b r e a t j h t e c h n i q u e – co m p a riso n wit h p u lm o n a ry a n g io g ra p h y. Ra d io lo g y 1 9 9 2 , 1 8 5 : 3 81 - 7 .
7 . Te r r a - Filh o M , Rib e ir o SCC, So u z a R, J a t e n e FB. Tro m b o e n d a rt e re ct o m ia p u lm o n a r e m p a cie n t e co m 8 0 a n o s d e id a d e. J Bra s Pn eu m o l 2 0 0 4 ; 3 0 :4 8 5 - 7 . 8 . Ma c ie l R, Me n n a Ba r r e t o SS. Tr o m b o p r o f ila xia n a
co le cist e ct o m ia vid e o la p a ro scó p ica . J Bra s P n e u m o l 2 0 0 4 ; 3 0 : 4 8 0 - 4 .
REFERENCES
1 . Qu elu z, THAT. Ad m issã o d o J o rn a l d e Pn eu m o lo g ia n a Sc iELO Bra s il: u m a vit t ó ria c o m n o vo s d e s a f io s . J Pn e u m o l 2 0 0 2 ; 2 8 : IX- X
2 . Lo ren zi- Filh o , G. O esp írit o d o J o rn a l d e Pn eu m o lo g ia . J Pn e u m o l 2 0 0 3 ; 2 9 : 3 3 5 .
chronic PTE hypertension. Their casuistic analysis and t he resu lt s obt ain ed t herefrom are world class.
Maciel et al.8 presen t an equ ally con cise review
o f VTE p ro p h yla xis in p a t ie n t s su b m it t e d t o videolaparoscopic procedu res, presen t in g a pat ien t under follow- up treatment as a case in point. Advances that have made surgical procedures less invasive, more flexible an d bet t er able t o con t rol bleedin g have n ot e lim in a t e d t h e r is k o f VTE. Th e r e f o r e , t h e corresponding thromboprophylaxis merits evaluation. Pulmonary circulation is now a reality in our midst.
The Brazilian Journal of Pulmonology and the Internet
Over t he cou rse of it s 30 years in prin t , t he Jornal Brasileiro de Pn eu mologia (JBP, Brazilian Jou rn al of Pu lm on ology) has been en gaged in an on goin g process of reinvention. Recent changes are intimately linked to the Internet. The indexing of the JBP in the SciELO dat abase(1) has allowed free an d u n rest rict ed
access t o JBP con t en t – n ot on ly in Port u gu ese bu t also in English (www.jornaldepneumologia.com.br or alt ern at ively www.scielo.br/ jbpn eu ). Cu rren t ly, ou r Associate Editors, both in Brazil and abroad, participate directly in all stages of the revision, from the reviewer com m en t s t o t he fin al decision t o pu blish. This process wou ld have been u n imagin able before t he advent of the Internet. At the same time, the number of art icles su bmit t ed t o t he JBP ju mped from 77 in 2 0 0 2 t o 1 3 4 in 2 0 0 3 . Aid e d b y t h e e a se o f communication, we increased, in parallel, the number of ad hoc reviewers – from 53 in 2002 t o 130 in 2003. We t hereby su cceeded in redu cin g t he mean t ime t o t he first review from 44 ± 32 days t o 29 ± 16
days(2). This degree of agilit y was achieved wit hou t
sacrificin g t he qu alit y of t he edit in g an d wit hou t
lowerin g ou r st an dards. In fact , t he percen t age of art icles reject ed has act u ally in creased.
At the moment, we are in the final phase of implementing a program that will facilitate the submission and review process, which will be carried out entirely via the Internet.
We invite all members of the society, including authors,
reviewers and researchers who are interested in contributing to the JBP, to register online. After navigating to our site, it will take only a few minutes of your time. The registration form is simple and will be essential for updating our database.
Access: www.jornaldepneumologia.com.br/sgp Register today
Geraldo Lorenzi- Filho(TE- SBPT)
Editor
SÉRGIO SALDANHA MENNA BARRETO TE SBPT
