Le Poumon et le coeur最新文献

One case of chylopericardium associated with chylopneumothorax is reported. Published data make it clear that the pathogenesis of effusions of chyle is imperfectly known and still highly hypothetical. With the exception of tamponade, there are few pathognomonic and dramatic signs. TM and cross-sectional echography is of paramount importance, since it provides a qualitative and quantitative diagnosis of effusion, the nature of which is determined by chemical analysis. Effusions of chyle may be idiopathic or may developed after oesophago-cardio-pulmonary surgery, or even after blockade of lymphatic vessels or as a result of increased lymphatic flow rate or pressure. Although the course of the disease is usually favourable, infectious or haemodynamic complications (e.g. tamponade or constriction) may aggravate the prognosis. Treatment is exclusively surgical and consists of partial pericardectomy, which is unquestioned. There is no consensus of opinion about simultaneous ligature of the thoracic duct.

In a co-operative study involving 10 centres, 95 asthmatic patients were treated with Armophylline, a new slow-release theophylline for a period of 1 to 3 months. Eighty per cent of the patients receiving the drug in doses of 11 to 15 mg/kg/day immediately had adequate blood theophylline levels (7-20 mcg/ml). There was a significant decrease in dyspnoea and number of asthmatic attacks and a significant increase in FEV1 and FEV1/VC ratio. The drug was usually well tolerated. Side-effects, such as insomnia, headache or digestive disorders were, as a rule, mild.

Pneumatocele, a special form of lung injury, is characterized by intrathoracic images of cavities detected on X-ray films. These cavities develop immediately after a trauma of the thorax, disappear rapidly and have a relatively favourable outcome.

After seeing 9 cases of digitalis intoxication in patients with acute respiratory decompensation of chronic respiratory failure in one year in an intensive care unit, the authors decided to review the literature on the subject. They set out to: --determine the clinical, laboratory and electrical features of digitalis intoxication in patients with chronic respiratory failure, accounting for the frequency of supraventricular arrhythmias; --evaluate the frequency of this intoxication (20% in this study), introducing a definite risk factor, given the poor haemodynamic effectiveness of digitaloids in this indication; --establish a therapeutic management based on the use of anti-arrhythmics and especially on the prevention of predisposing factors (hypoxaemia--functional renal failure and abuse of diuretics).

Epithelial or mixed mesotheliomas were detected in 38 patients in the region of Marseilles over a period of 9 years. Though an occupational element was involved in 80% of cases, no history of contact with asbestos could be obtained in certain of the patients. Confirmation of diagnosis requires wide pleural biopsies, because of the high level of false negatives and false positives from cytology and pleural needle biopsy. Hyaluronic acid levels are significant only when they are markedly enhanced. Local and regional tumor spread provides an aid to prognosis, but authentic metastases, with further worsening of prognosis, were detected in more than 75% of patients while still alive. Nodules appeared along the course of punctures of drainage tubes or in thoracotomy scars in 56% of cases, and appear to be a very frequent and characteristic feature of mesothelioma. Their therapy involves preventive irradiation.

Drugs induced respiratory disorders include bronchospasm, extrinsic alveolitis, and diffuse interstitial pulmonary fibrosis. Bronchospasm may be due to the action of pharmacodynamic agents on autonomic control of bronchial tone (beta-blockers, beta-agonists...) or to a hypersensitivity reaction (penicillins, sulfonamides, anti-inflammatory compounds...). Extrinsic alveolitis usually follows administration of anti-infective medication but other drugs may be implicated. Prolonged use of a wide variety of drugs, particularly cytotoxic agents, is necessary to provoke the onset of a diffuse interstitial pulmonary fibrosis.

Continuous positive airway pressure ventilation (CPAP) tends to reduce the risk of post-operative pulmonary infection by recruiting poorly ventilated areas. In human renal transplantation, pulmonary infection is a major problem with a high mortality rate in these immuno-depressed patients. The risk is further increased by the need for recipient maximal hydration during surgery to ensure satisfactory graft function. We therefore thought that it would be appropriate to use CPAP preventively during the immediate post-operative period. In a series of 60 successive patients who benefited from CPAP, the incidence of pulmonary infections was only 5%, which compared favourably with a 14.3% incidence in a previous series of 77 patients without preventive CPAP. Moreover, the 3 pulmonary infections that occurred were rapidly cured and the transplanted kidney could be saved in 2 cases; one patient required dialysis. No death was recorded.

Twenty-seven cases of South American blastomycosis are reported. Pulmonary lesions predominate and the diagnosis rests on the findings of Paracoccidioides brasiliensis in sputum and tissues. Serological examinations (complement fixation and immunodiffusion) are also useful. Treatment includes sulphonamides, imidazole derivatives and, in cases resistant to these drugs, Amphotericin B. Surgery is limited to abscesses, bone lesions and bronchial stenoses.

The authors report two cases of Sjögren's syndrome presenting as chronic obstructive bronchopulmonary disease. They stress the need to consider the possibility of Sjögren's syndrome when confronted with chronic obstructive lung disease in a woman in her fifties, without history of bronchopulmonary disease or smoking, unexposed to occupational dust and without ENT infection or gastro-oesophageal reflux.

The authors report 27 cases of severe primary pulmonary infections which resulted in acute respiratory failure and which were treated in a Respiratory Medicine Intensive Care Unit. A bacteriological specimen (blood culture, transtracheal aspiration, fibroscopy, pleural tap) and/or a serological examination permitted the responsible agent to be identified in 20 of the 27 cases (74%). Apart from antibiotics and symptomatic treatments, 13 patients also received oxygen therapy and 14 other patients were intubated and ventilated. In the first group, 3 patients died (24%) and in the second group, the mortality was much higher, with 9 deaths out of 14 patients (64%). The authors present the clinical features, the frequency of the various micro-organisms isolated, the therapeutic modalities and various prognostic factors. Although repeated early specimens usually provide bacteriological diagnosis and therefore appropriate antibiotic therapy, the prognosis of these conditions, at the stage of acute respiratory failure remains serious and is probably related to risk factors linked with predisposition. The exact nature and the relative importance of these risk factors still needs to be determined.