Showing papers in "Revue Des Maladies Respiratoires in 1994"

[Thoracic Surgery: Progression to Surgical Endoscopy]

Abstract: Surgical thoracoscopy is in its first stage of development. However indications are expanding rapidly. This work is a review of the conditions of surgical endoscopy of the chest, the equipment currently available and the main indications. Some of these indications are already accepted. For other indications, further evaluation is needed. Many experimental works as well as clinical studies are required in order to make progress.

Value of individualized rehabilitation at the ventilatory threshold level in moderately severe chronic obstructive pulmonary disease

Abstract: In order to study the efficiency of individual training programs at the ventilatory threshold level, twenty COPD patients were randomized into two groups and studied over a two-month period. At the start, during, and at the end of the study all subjects performed incremental exercise tests. The trained group (59.60 SEM +/- 2.75 years) walked four times a week at the heart rate corresponding to the metabolic level of ventilatory threshold. The other group served as controls (58.2 +/- 1.80 years). A marked increase in the symptom-limited oxygen consumption (+/- 25%) (p 0.05). Moreover, we observed an increase in the oxygen pulse at 50% VO2 sl (p < 0.05). In conclusion, this study demonstrates that individualized training at the ventilatory threshold level increases exercise tolerance and produces better ventilatory comfort in COPD patients.

Diffuse alveolar hemorrhage and myositis in icterohemorrhagic leptospirosis. Rapid control by a single bolus of corticoids

Abstract: La leptospirose est l'une des etiologies les plus frequentes d'hemorragie alveolaire diffuse. En depit d'une bone sensibilite a la penicilline et des techniques de ventilation, elle reste entachee d'une mortalite non negligeable, liee en particulier a l'atteinte pulmonaire intiale. Les auteurs decrivent un nouveau cas de leptospirose grave avec hypoxie severe, hemorragie alveolaire diffuse et myosite, dont l'originalite therapeutique repose sur l'utilisation d'un bolus de corticoides au cours des 24 premieres heures en complement du traitement traditionnel

[Diffuse interstitial pneumonia revealing Erdheim-Chester's disease].

Abstract: La maladie d'Erdheim-Chester est une forme rare de xanthogranulomatose viscerale. Nous rapportons le cas d'une patiente, âgee de 50 ans, presentant une pneumopathie interstitielle diffuse revelant une maladie d'Erdheim-Chester a localisations osseuse, neurologique et periaortique. La pneumopathie interstitielle diffuse d'evolution chronique etait caracterisee par un epaississement diffus des septa, un aspect kystique sous-pleural et un emphyseme apical bilateral avec epaississement de la plevre. L'exploration fonctionnelle objectivait un trouble ventilatoire restrictif avec hypoxemie de repos s'aggravant a l'effort. Le lavage bronchoalveolaire retrouvait une lymphocytose (26%) avec polynucleose neutrophile (11%). Le diagnostic anatomopathologique etait confirme par biopsie pulmonaire transbronchique retrouvant la surcharge interstitielle enhistiocytes spumeux caracteristiques de la maladie. L'evolution de la pneumopathie interstitielle est stable sans therapeutique immunosuppressive

Acute eosinophilic lung after a course of minocycline

Abstract: Chez un patient de 28 ans, un poumon eosinophile aigu a ete observe apres la prise de minocycline. Le tableau clinique est reapparu apres la reintroduction du medicament. Il s'agit d'une complication rare de la prise d'un derive de la tetracycline. L'eosinophilie a ete demontree dans le sang peripherique et le lavage broncho-alveolaire. L'interruption de la prise medicamenteuse sans adjonction de corticoide a permis la guerison

[Anti-influenza vaccine. Bibliographic review].

Abstract: A large number of papers are regularly published about anti-flu vaccine with discordant results regarding their efficacy. Through a recent review the efficacy of the vaccine has been evaluated both in terms of the immune response, the protection against clinical disease, but also as regards the impact from an epidemiological and economic point of view. In the majority of papers in which the immune response was studied before and after vaccination a 60 to 100% case of protection was obtained serologically by measuring the protective antibodies. These levels varied as a function of the type of the vaccination (inactive or living) and also of the immune state of the subject. In subjects of more than 60 years of age the immune response was 1.5 to 2 times less that in the young adult. The protection against clinical disease in children and adults is of the order of 40 to 70%, according to whether the infection is confirmed or not. On the other hand the vaccine is less effective in the elderly subjects, but gives a protection of the order of 75% protection against complications or of mortality linked to influenza. Finally there are a certain number of epidemiological and economic arguments which would justify the vaccine use on a large scale.

[Acute eosinophilic pneumonia and the larva migrans syndrome: apropos of a case in an adult].

Abstract: La toxocarose est une affection frequente chez l'enfant, mais dont les manifestations cliniques graves (pneumopathie infiltrative diffuse hypoxemiante, asthme aigu grave) sont rares dans la litterature. Le diagnostic est fait grâce a la fiabilite des techniques serologiques (ELISA et utilisation des antigenes d'excretion-secretion des larves de Toxocara canis). Les auteurs rapportent une observation de pneumopathie eosinophilique aigue severe dont l'evolution a ete rapidement favorable sous corticotherapie; l'existence d'une serologie positive pour Toxocara canis, avec le risque de contamination de la patiente dans son environnement domestique, nous incite a integrer le tableau clinique dans un syndrome de Larva migrans

Contribution of epidemiology to the study of allergic response in children

Abstract: Allergy is the conjunction of hereditary predisposition and risk factors encountered in the environment, phenomenon which can be observed very early in individual life. The aim of this review is to present the contribution of epidemiology in the study of allergic response in childhood, from sensitization to clinical manifestations as eczema, asthma and rhinitis. The first contribution of epidemiology has consisted in estimating the scatter of the allergic response, the presence of circulating antibodies against allergens (IgE and IgG), the evaluation of immediate hypersensitivity (such as the response to skin prick tests) and the prevalence of clinical manifestations. Then, knowledge of allergic response has been improved by the contribution of aetiological epidemiology. Various risk factors have been described according to the different stages during life in which their effects are observable. In prenatal life, potential risk factors are maternal immunity and smoking during pregnancy. Later in perinatal or neonatal life they are perinatal complications, month of birth and maternal smoking. Lastly, in infancy a role can be played by feeding, immunological deficiencies, infections, parental smoking and early exposure to allergens or pollution. Perceiving these risk factors helps to determine strategies to prevent allergy occurrence.

[Long-term oxygen therapy at home. Compliance with the medical prescription and observance of the daily duration of at least 15 hours].

Abstract: Long-term domiciliary oxygen therapy in patients with chronic respiratory failure significantly improves both survival and quality of life. These therapeutic objetives are only achieved by daily oxygen therapy of more than 15 hours. For a period of 3 months, we have prospectively measured the duration of oxygen therapy in 930 patients with chronic airflow obstruction. This is carried out by reading the meters on the oxygen concentrators, or for liquid oxygen by checking the weight of the cylinders at each delivery, making allowances for the flow rate and also for natural loss from evaporation. The instructions for oxygen therapy and the true therapy of the patient were then gathered using a questionnaire. The practitioners were questioned on the prescription for oxygen therapy which had been made for each patient, and more generally on their usual criteria for prescribing long-term oxygen therapy. The patients (82% male) were aged between 67 +/- 8 years, and were on domiciliary oxygen therapy 36 +/- 24 months, with hypoxaemia (PaO2 = 56 +/- 9 mmHg), hypercapnea (PaCO = 47 +/- 8 mmHG) and suffering from airflow obstruction (FEV1/VC = 42 +/- 14%). The duration of prescribed oxygen therapy was on average 16 +/- 3 hours. The mean duration of oxygen therapy achieved was 14.5 +/- 5 hours, but only 45% of the patients (419/930) managed daily oxygen therapy superior of equal to 15 hours and were categorised as compliant.(ABSTRACT TRUNCATED AT 250 WORDS)

Hémothorax gauche, complication d'une fissuration d'anévrisme de l'aorte thoracique descendante

Abstract: A woman of 93 was admitted to hospital with a left pleural effusion. The presence of an unrecognised aneurysm of the descending thoracic aorta, lying posteriorly, led to an inadvertent puncture of the aorta. The diagnosis of a haemothorax due to dissection of the aneurysm was supported by echocardiography, and confirmed by angio-scanning.

[Associated lipid pneumonia and bronchiolo-alveolar carcinoma].

Abstract: The authors report a new case of bronchio-alveolar carcinoma which developed on a background of iatrogenic exogenous lipid pneumonia; this association is extremely rare (less than 20 cases in the literature) and poses the problem of possible cancer developing in the centre of the lipid pneumonia.

[Iatrogenic diffuse interstitial pneumonia linked to 5-aminosalicylate].

Abstract: Iatrogenic pneumonias to sulphasalazine are most usually seen during the course of a haemorrhagic proctocolitis (RCH). We report a case in which a young woman was treated with 5-aminosalicylate (Pentasa) and prednisolone during an exacerbation of RCH. After 3 months of treatment the steroid therapy was stopped and the Pentasa was continued at the same dose (3 g per day). She presented with increasing dyspnoea on effort. Clinical examination was normal but a CT scan of the chest showed interstitial micro nodules; there was also a restrictive ventilatory disorder, hypoxaemia on effort and an alveolar eosinophilia (1.8%) The clinical progress, respiratory and blood gases all improved rapidly after stopping the Pentasa with the disappearance of the interstitial nodule over 5 months, suggesting that the role of the Pentasa was causal in the genesis of the pneumonia.

Spiral volumetric scanning and its applications in thoracic pathology

Abstract: Spiral scanning (BSV) is a newly acquired scanning technique for all or part of the thoracic volume in a single breath-hold. It offers many advantages when compared to conventional CT scanning. The study of the lungs with a single breath-hold avoids the inconvenience of an anatomical discontinuity while acquiring the information. In a population of patients presenting with multiple, or solitary pulmonary nodules, or the absence of nodule, BSV shows 30 to 40% of supplementary nodules when compared to conventional scanning techniques. BSV enables the optimal use of contrast products in which the iodine is poorly concentrated to study the pulmonary vessels. Certainly this technique will not replace pulmonary angiography for the diagnosis of pulmonary emboli. However, it may be used first in certain situations, dispensing with invasive angiography in patients with an increased risk, or in the initial assessment of patients with pulmonary arterial hypertension of unknown aetiology, or to follow a previously documented pulmonary emboli. The correlation between spiral scanning and conventional angiography for the diagnosis of pulmonary emboli is excellent, to the level of segmental arteries. Finally the continuity, both anatomically and for the lesions obtained by BSV is such that it is now possible to apply to thoracic pathology techniques of multiplanar and three dimensional reconstruction. If all the information is contained in conventional transversal imaging slice by slice, not everything is perceived by the observer because the information is inconveniently presented because the anatomical and lesional picture is deconstructed. The reconstruction of the volume inspected in coronal, sagittal, oblique or three-dimensional viewing, furnishes supplementary information and announces the arrival of trachea-bronchography, and non-invasive angiography three-dimensionally. In parallel to the expected progress in IRM angiography, three-dimensional angio-CT of the thoracic vessels after appropriate evaluation is going to be substituted for more invasive techniques which are currently used.

Pneumopathie interstitielle diffuse iatrogène liée au 5-aminosalycilate

Abstract: Les pneumopathies iatrogenes a la sulfasalasine sont classiques au cours de la rectocolite hemorragique (RCH). Nous rapportons l'observation d'une jeune femme traitee par 5-aminosalicylate (Pentasa®) et prednisolone lors d'une poussee de RCH. Apres 3 mois de traitement, la corticotherapie etait interrompue et le Pentasa® etait poursuivi a la meme dose (3 g/j). Elle presentait alors une dyspnee d'effort croissante. L'examen clinique etait normal, la tomodensitometrie objectivait un syndrome interstitiel micromodulaire; il existait un trouble ventilatoire restrictif, une hypoxemie d'effort et une eosinophilie alveolaire (11,8%). L'evolution clinique, spirometrique et gazometrique etait rapidement favorable a l'arret du Pentasa® avec disparition du syndrome interstitiel a cinq mois, suggerant le role de Pentasa® dans la genese de la pneumopathie

Sleep apnea syndrome in intensive care

Abstract: The aim of this work was to study the existence of special characteristics in the sleep apnoea syndrome (SAS) discovered following a stay on the Intensive Care Unit. This retrospective study of 25 casenotes of SAS patients who were resuscitated has enabled a comparison with 182 SAS patients who have never had acute respiratory failure. The intensive care consisted of controlled ventilation, following intubation, in a clinical context of acute respiratory failure with major problems of conscious level. The diagnosis of SAS was made using conventional or computerised polysomnography, or a computerised study of transcutaneous SaO2 (SaO2TC) which had been validated before. The results show that patients with SAS in an Intensive Care Unit, differs significantly from other patients with SAS by the permanent presence of alveolar hypoventilation in a stable state, associated with a significant decrease in the FEV1 (VEMS) in relation to the group that had not been in intensive care. However, the FEV1/VC ratio did not differ between the two groups which were expressed in absolute values or as a percentage of the theoretical value defined on the basis of their age. There was no difference on the data from the sleep studies and notably the hypoapnoeic indices, nor on age, the index of body mass or the sex ratio. We conclude that there is a need to look for SAS in the presence of acute respiratory failure in the obese without a recognised cause.

[Mechanisms of bronchial hyperreactivity: role of airway inflammation and atopy].

Abstract: The mechanisms of airway hyperresponsiveness are numerous and complex. The inflammatory process is one of the most important. It is characterized by epithelial damage and sloughing, by cellular infiltration of the bronchial mucosa and submucosa and by anatomical modifications of the bronchial wall. The cellular infiltrate is characterized by the presence of eosinophils, lymphocytes, monocytes-macrophages and mast cells. These cells are activated and release bronchoconstrictor and proinflammatory mediators. Eosinophils have toxic effects on the bronchial epithelium through the release of basic proteins, while lymphocytes play a central role through the release of cytokines, which can activate and recruit other cells. Mast cells have an important role of starter of the reaction but may also maintain it. Allergen inhalation in the laboratory, when a late response occurs, is responsible for an inflammatory reaction comprising eosinophil influx and activation and T lymphocyte activation. The intensity of the reaction is related to the transient increase in airway hyperresponsiveness confirming the important role of atopy and allergic reactions in airway hyperresponsiveness. However the same kind of inflammatory reaction can be present without atopy and antiinflammatory treatments, even if they reduce airway hyperresponsiveness, may not completely abolish it. This emphasises the complex mechanisms involved in persistent airway hyperresponsiveness.

[A rare tumor of the thoracic wall: synovial sarcoma].

Abstract: The synovial sarcoma is a tumour of the soft tissues. Its thoracic localisation is unusual. The authors report a case of a recurrent tumour of the scapula, whose excision required major plastic surgery to the dorsal chest wall. The diagnosis was revealed by the biphasic histological nature which was confirmed on immunological studies. Such tumours give rise to discussions on their histogenesis; their subsequent progress is slow and recurrences are common. Healing depends on the radical nature of their excision.

Mechanisms of bronchial hyperreactivity. Role of smooth muscle

Abstract: The understanding of the cellular and molecular mechanisms involved in the contraction of airway smooth muscle has tremendously advanced in the recent years. Extracellular messengers that control the muscle contraction as well as both the membrane transduction processes and the activation of the contractile proteins are known in some details. Sensitization alters the contractility of airway smooth muscle. It increases shortening in the early phase of the contraction when rapidly cycling cross bridges are operative. At the molecular level, the responsible mechanism is an increment in the activity of the processes leading to phosphorylation of the myosin light chain. Such an alteration in the airway smooth muscle contractility may be observed in the early phase of the development of bronchial hyperresponsiveness.

Measure of bronchial hyperreactivity in epidemiology

Abstract: D'abord utilisee dans l'evaluation individuelle de sujets presentant des symptomes respiratoires suggestifs d'asthme, la mesure de l'hyperreactivite bronchique est de plus en plus utilisee en epidemiologie clinique, les methodes de mesure etant bien reproductibles et facilement transportables sur le terrain. Ce chapitre vise a definir comment evaluer l'hyperreactivite bronchique dans des etudes epidemiologiques, quels sont les facteurs qui doivent etre consideres dans l'interpretation des tests, quelle en est la prevalence dans diverses populations et enfin quelles sont les indications de la mesure de l'hyperreactivite bronchique dans les etudes epidemiologiques

Estimation of static lung volumes by nitrogen washout method. Single breath of oxygen

Abstract: Total lung capacity (TLC) and residual volume (RV) estimations were obtained from single-breath nitrogen washouts in 96 male and 77 female healthy never-smokers with normal spirometry from a non-polluted rural area in north-east France. TLC depended on height (both sexes) and diminished slightly with age in males, with the body-mass index (kg/m2) in females. RV increased with age in both sexes and with weight in males. The RV/TLC ratio was related only to age. When compared with values obtained using multiple-breath helium dilution, our results yielded lower predicted values. The test depends heavily on the subject's co-operation, and errors are frequent if a standard procedure is not observed. This method cannot thus be recommended for routine use in patients with respiratory diseases.

[Treatment with clarithromycin of 173 HIV+ patients with disseminated Mycobacterium avium intracellulare infection].

Abstract: No treatment was established for disseminated M. avium intracellulare (MAC) infection, a common disease of end stage of AIDS. An open study was conducted to assess in 173 AIDS patients, the activity of clarithromycin. Initial bacteriologic eradication from blood was observed in 136/147 evaluable patients (93%). Acquired resistance to clarithromycin associated with relapse appeared to develop after 2 to 7 months of drug treatment in 31/136 patients with initial success. Early bacteriological relapse was associated with clinical deterioration. Side effects of drug treatment were elevated liver enzymes (26%) and impaired hearing (4%). Side effects conducted to stop treatment in 14 cases (8%) to modified treatment in 8 cases (5%). Our study gave new argues for activity of clarithromycin in disseminated MAC infection.

Emphysème lobaire géant : cause d'une opacité hémithoracique compressive chez le nouveau-né

Abstract: Les auteurs rapportent un cas d'emphyseme lobaire geant du lobe superieur droit, decouvert a la naissance, qui s'est traduit radiologiquement par un hemithorax opaque et une deviation mediastinale. Le diagnostic est confirme par tomodensitometrie. Une lobectomie est realisee a l'âge de 6 semaines. Les diagnostics evoques devant cette image radiologique, chez un nouveau-ne en detresse respiratoire, et les mecanisms physiopathologiques de l'emphyseme lobaire geant sont discutes

Neuropeptides of the nasal innervation and allergic rhinitis

Abstract: In the last decade, several neuropeptides have been localized in sensory, sympathetic and parasympathetic neurons of the upper and lower airways in animals and man. Tachykinins are sensory neuropeptides: after nasal allergen challenge in patients with allergic rhinitis, substance P is locally released and induces nasal obstruction. Like neurokinin A, another tachykinin of sensory C fibers, substance P induces an increase in vascular permeability and a recruitment of inflammatory cells. Thus, tachykinins partially mimic nasal response to antigen. Calcitonin gene-related peptide (CGRP) is another sensory neuropeptide and vasoactive intestinal peptide (VIP) is a neuropeptide localized to parasympathetic fibers. The distributions of CGRP and VIP fibers and of their binding sites, as well as their physiological effects described in other tissues, are consistent with a vasodilator effect. On the other hand, neuropeptide Y (NPY), a sympathetic neuropeptide, would seem to be a potent vasoconstrictor. Thus, nasal neuropeptides, and above all sensory neuropeptides, could play a role in the pathophysiology of allergic rhinitis.

[Mechanisms of bronchial hyperreactivity. Bronchial edema, mechanical and vascular factors].

Abstract: Hindrance to gas flow in the bronchi is affected not only by airway smooth muscle tone but also by airway circulation. Congestion and oedema increase airway wall thickness and act in series with airway smooth muscle contraction to reduce airway calibre, an effect which is more marked in small and intermediate bronchi. Many mediators, neuromediators, paracrine mediators produced by resident (epithelium) or migrant (inflammatory cells) cells share bronchomotor and vascular effects. In addition, contraction of airway smooth muscle and vascular phenomena are mechanically coupled. Contraction of airway smooth muscle facilitates vascular congestion and oedema because the diameter of the muscle ring is more reduced than the external diameter of the airways. In addition, a negative intrathoracic pressure, e.g. in asthma, increases the mechanical loading of both ventricles, thereby facilitating pulmonary and bronchial oedema. The effects of this mechanical coupling are enhanced by airway inflammation that facilitates both vascular congestion and leakage. Stimuli such as exercise and hyperventilation cause airway vasodilatation which, in turn, facilitates and, possibly, triggers the post-exercise asthma attack. Conversely, congestion and vasodilatation may have a protective effect through an increase in the clearance of bronchoconstrictor substances, or in reducing the amplitude of airway cooling and water loss in exercise-induced asthma. The relative role in bronchial hyperresponsiveness of airway smooth muscle contraction and vascular phenomena probably depends upon individual factors such as, for instance, both intensity and nature of inflammation of the airway walls.

Mechanisms of bronchial hyperreactivity. Role of the epithelium

Abstract: Bronchial epithelial cells are present all along the airways. They play a role of barrier and protect the airways against inhaled pollutants. However it is known to day that they could play an active role, through synthesis and release of mediators which modulate the airway muscles, the epithelium permeability and the vascular tone. Shedding of the epithelium is a constant feature of the asthmatic airways as can be observed directly on the bronchial biopsies and indirectly through and increased number of epithelial cells in the bronchoalveolar lavage fluid. The epithelial shedding is well correlated to the bronchial hyperreactivity. In vitro, bronchial epithelial cells release higher quantities of 15 HETE, endothelin and PGE2 in asthmatics than in normal control subjects. They express HLA-DR and ICAM-1 in higher quantities in asthmatic patients. Bronchial epithelial cells might play an important role in inflammatory lesions which are observed in asthmatic patients. They could be a good target for new therapeutic approaches in asthma.

Bronchial hyperreactivity. Definitions and history

Abstract: The various definitions that are proposed for bronchial hyper-responsiveness (BH) are discussed. The semantic problems related to these definitions are presented: 1) the translation of bronchial hyperresponsiveness into French can vary; 2) BH is not synonymous of abnormal contraction of airway smooth muscle; 3) there is also some confusion of BH with the clinical status of asthma, which is excessive. The authors also review the difficulties related to the purely operational character of the definition itself: 1) BH has a continuous distribution in a general population; 2) BH can be expressed by various indices; 3) stimuli to reveal BH are various; 4) there are various types of BH related to the causal conditions; 5) there are different sites of BH within the airways. The authors also review the historical background of BH with some emphasis on the contribution of French-speaking research workers.

Animal models of bronchial hyperreactivity

Abstract: Airway responsiveness is increased in a variety of airway diseases. To understand the mechanism of enhanced airway responsiveness, in particular as it pertains to asthma, animal models have been developed and extensively explored. The guinea pig and Basenji-greyhound dog are the best characterized animals showing airways hyperresponsiveness and appear to bear substantial resemblances to asthmatic human subjects. Challenge with bronchoconstrictive agonist results in bronchoconstriction and transient vascular leak. Both phenomena contribute to the degree of airway narrowing. Adenosine challenge tests not only the responsiveness of the airways, but also that of the airway effector cells such as the mastocyte. Bradykinin and tachykinin cause indirect airway narrowing, probably by liberation of leukotrienes. Responsiveness can be enhanced by immune and non-immune challenges. Ozone, Sephadex, various contractile agonists (leukotriene D-4, bradykinin, platelet-activating factor), as well as certain cytokines (IL-1, IL-2, TNF-alpha) can enhance airway responsiveness. Cyclooxygenase and lipooxygenase products appear to be involved. Allergen-induced hyperresponsiveness is associated with airway inflammation and appears to involve bradykinin and PAF acutely and growth of airway smooth muscle chronically.