Le Poumon et le coeur最新文献

Among non-chromaffin paragangliomas, the so-called aorticopulmonary or branchiomeric mediastinal chemodectomas are very rare tumors. A case is reported, and 57 similar cases described in the literature are reviewed. As recommended by Olson, a separate group was instituted of 21 cases of the so-called posterior mediastinal or aorticosympathetic group of the costovertebral groove. In principle, aorticopulmonary chemodectomas are non-functional, and in 9 out of 10 cases follow a slow and benign course extending over many, or even tens of years. In contrast to carotid and jugular paragangliomas they are rarely multifocal: when this is the case it is difficult to confirm the presence of metastases, this being however the most reliable criterion of their malignancy. The fortuitous discovery on a radiography of a tumor of the anterior and middle compartments of the upper mediastinum should invoke the presence of an aorticopulmonary chemodectoma, and lead to arteriography of the aortic arch region. Diagnosis is made essentially by pathological examination. Treatment is exclusively by surgical excision, and this was complete in nearly half of the cases treated. Prognosis is not hopeless after partial removal, however, and a relatively comfortable survival can be obtained extending over many years.

Angiotensin-converting enzyme (ACE) levels were measured in the serum of patients with various pulmonary affections (sarcoidosis, tuberculosis, anthracosilicosis, cancer, etc.), with diabetes or renal insufficiency, and in 247 healthy subjects. Mean ACE levels (41.5 U/ml +/- 16) were significantly higher in sarcoidosis than in normal controls (22 U/ml +/- 6), high values (greater than or equal to 34 U/ml) being observed in 62 p. cent of cases. In these patients, the ACE tended to become normal in parallel with clinical and radiological improvement in the disease, and to increase again during relapses. In 75 p. cent of sarcoidosis patients there was concordance between the increase in alveolar lymphocytes and that of serum ACE. Elevated ACE levels were noted in only 3 p. cent of non-sarcoidosis pneumopathies, and in 24 and 18 p. cent of diabetes and renal insufficiency cases respectively. In the absence of these two latter affections, measuring ACE levels is of obvious value for the diagnosis and follow-up surveillance of sarcoidosis.

Based on the technique described by Gabler et al. several years ago, stabilization of the mediastinum after penumonectomy is obtained by introducing a blown up latex balloon into the operated side of the thorax. The balloon is introduced immediately following surgery after being distended by means of Kuss's apparatus, and is removed, after being emptied in the same way, five to seven days later. Good stabilization of the mediastinum during the immediate postoperative period allows rapid effective coughing to take place. The balloon also prevents postoperative emphysema through the mediastinal and parietal walls, especially in enlarged excisions. The method is of undoubted value in the postoperative period following pneumonectomy, particularly in chronic bronchitis cases. No particular complications were observed.

The diagnostic value of different respiratory function tests in the respiratory distress syndrome was compared in 5 groups of subjects: healthy non-smokers, asymptomatic smokers, patients with bronchitis affecting the large bronchi, asthmatic patients between attacks, and patients with emphysema. Indices measured were the forced expiratory volume per second (FEV1), mean expiratory flow between 25 and 75% of vital capacity (MEF 25-75%), maximum instantaneous flow at 25-50-75% of vital capacity, and peak flow (Vmax 25-50-75%, PF), residual volume, expiratory resistance volume, and the curve of the alveolar plateau of expired nitrogen. The Vmax 50% and the MEF 25-75% appear to be sufficiently sensitive indices of bronchial obstruction in current practice, the MEF 25-75% being simple to measure, and presenting the advantage of not requiring complicated equipment. The Vmax 25% and the respiratory resistance volume present wide inter-individual variations, and this, together with their lack of reproducibility, limit their value in exploratory tests in isolated cases.

A case of pulmonary alveolar proteinosis followed-up for eleven years is presented and this poorly recognised affection discussed. It is a rare disease arising from filling of the alveoli by a non-surface-acting surfactant, either as a response to a non-specific aggression, experimentally reproducible, or spontaneously. The mechanism by which this accumulation occurs is still a controversial subject: increased production by the granular pneumocytes, deficiency of alveolar clearance, or loss of phagocytic activity of alveolar macrophages. The diagnosis, suggested by the only slightly specific clinical picture after elimination of more common aetiologies, is confirmed by electron microscopy of alveolar lavage fluid without, as in the past, the need for lung biopsy. The various treatments proposed have lacked efficacy and are not really necessary, except for symptomatic extensive pulmonary lavage, which should be reserved for severe cases and may need to be repeated.

Three cases of mushroom growers lung, responding to the criteria for an extrinsic allergic alveolitis, have been observed in the Hôpital Bichat, Paris. In the first case, a "semi-delayed" hypersensitivity phenomenon of type III was evoked, an "immediate" type I phenomenon in case 2, and an association of the two in the third case. Clinical manifestations may develop very rapidly in subjects working in areas where they are exposed to a high inoculum of fungal products. Multiple antigens are involved: Psalliota, actinomycetes of different varieties, manure substrate, fungal spores, bacteria, cereal dust, etc. A recognized occupational disease, it leads to a change in activity and the right to compensation.

Employed since 1971, contra-immunoelectrophoresis is a microbiological technique now recognised as being of increasing value. Used in 37 cases of pneumococcal lung infections its diagnostic reliability was 81% the technique being of particular interest in that it enabled a positive diagnosis in lung infections previously treated by antibiotics. Though performed in only a small number of cases, this method was able to confirm the frequency of pneumococcal infections. The technique can now be considered to be well established, the production of specific anti-serums, approaching type-specificity, being possible. Fairly simple to perform, and giving rapid results (within hour) it requires a minimum of apparatus and is a standard procedure that should be employed in all microbiological medical laboratories. Of undeniable diagnostic value, it should be associated with conventional bacteriological tests, which though essential sometimes give insufficient data.

On the basis of cytological similarities in chronic obstructive disease (COPD) in human beings and in horses during 1981 a total number of 144 horses with COPD were examined. Bronchial secretions were taken under endoscopic control and stained with a modified Hansel staining procedure. Whereas 26 horses did not exhibit signs of allergic reactions cytologically and 94 horses showed low amounts of eosinocytes and/or mast cells in their secretion; only the secretions of 24 horses (16,67%) were characterized by fairly high contents of these allergy associated cells and low numbers of neutrophilic granulocytes.