Le Poumon et le coeur最新文献

The pulmonary alveolar microlithiasis is an affection characterized by the presence, in the alveolar light, of calcified deposits or "microliths". It is a rare affection as there is now about 200 cases in the world. We report the case of a pulmonary alveolar microlithiasis discovered in a patient of 25 years old and demonstrated histologically by transbronchial lung biopsy under flexible bronchoscope.

Pulmonary biopsies were taken under thoracoscopy from 16 patients presenting with insoluble diagnostic problems. This method enabled the authors to make a diagnosis, which was not contradicted by the course of the disease, in 14 cases of diffuse or circumscribed pathology touching the lung cortex. There was no major incident.

The authors report a case of bilateral hilar lymphoma of sarcoid origin associated with a pleural effusion. With the exception of pneumothorax, the pleural manifestations in the course of sarcoidosis amount to 115 published cases, including 49 with histopathological proof enabling us to speak of a pleural sarcoidosis. When the histopathological diagnosis is missing, it is preferable to speak of sarcoidotic pleurisy: the aetiopathogenesis in this case is venous obstruction and/or lymphatic obstruction by sarcoid involved lymph nodes. Exceptionally, it could be due to heart failure due to the fibrotic stage of sarcoidosis or to an autonomous sarcoidotic myocarditis.

The various studies which have dealt up to the present with a possible relationship between asbestosis and HLA groups have led to differing conclusions. The present study evaluated this relationship by comparison of 57 workers with asbestosis confirmed radiologically (minimum S1 type opacities) and functionally (VC and/or DuaCO less than 88%) with 58 controls from the same population. In a second phase, statistical analysis involved the combination of these cases with those reported in the literature, estimating the mean relative risk and, for each gene, the heterogeneity of the results thus collected. No relation was found between class I (A and B) HLA antigens and asbestosis. The authors suggest extension of this study to class II (DR) and III (components of complement) antigens and to seek possible links between combinations of antigens and the development of asbestosis.

Thoracoscopy examinations in 5 cases of solid tumors of the pleura: 1 case of Pancoast's and Tobias' tumors of neoplastic origin, 1 case of asbestosis-induced fibrohyaline plaques, and 2 cases of benign pleural tumors, 1 neurinoma emphasized the diagnostic value of thoracoscopy for tumors of this type. Direct visualization of the lesion is possible, its precise site and extent can be determined, and biopsy samples obtained for pathology under direct visual guidance.

The authors report 3 cases of endobronchial metastases of visceral carcinomas (kidney, breast, pancreas). With the aid of a review of the 144 cases found in the literature, they analyse the characteristics of this special type of secondary neoplasm and their diagnostic, physiopathological and therapeutic aspects.

The authors report their experience of use of the peritoneal dialysis drain in the evacuation of pleural effusions. After describing the technique used, they report their results in the various indications for pleural drainage and then emphasise the advantages of this effective, relatively atraumatic and well tolerated technique.

The authors report a case of acquired tracheomalacia occurring in an adult with a definitive tracheostomy. They make a review of the clinical, radiological and bronchological features of tracheomalacia. They insist on the pathophysiology and report the first case successfully treated with spontaneous ventilation and end expiratory positive pressure.

A case of large arteriovenous aneurysm in the right upper lobe of a 27-year old man is reported. The pulmonary angioma was responsible for a 30% shunt with hypoxia and polycythaemia but was only discovered while looking for the origin of a cerebral abscess. A few weeks after surgical treatment of the cerebral abscess, the right upper lobe was excised with immediate correction of the hypoxia. This case shows that pulmonary angiomas can sometimes be revealed by neurological complications, and that visceral angiomas should not remain undiagnosed. They should be considered as part of a Rendu-Osler disease, the familial character of which may contribute to an early diagnosis.

The finding, on systemic X-ray examination of a 20-years ol Algerian patient, of an opaque image along the right side of the suprahilar trachea led to the discovery of a rare abnormality of venous return known as azygos continuation of the inferior vena cava. The opacity was ovoid in shape, 4 X 1.7 cm in dimension, well circumscribed and homogeneous. It shrunk during a Valsalva's manoeuvre and increased in size when the patient was lying down. Angiography through the femoral vein showed that the inferior vena cava was interrupted below the liver and continued with the azygos vein. No other cardiovascular abnormality was detected and the situs was normal. Although rare or unrecognized because it is asymptomatic, azygos continuation of the inferior vena cava is the most common of congenital abnormalities of that vessel. It was described initially by Stark in 1835 and remained an anatomical curiosity until 1950. Since the development of vascular opacification techniques, it has been more frequently diagnosed, particularly in children, where it is usually associated with congenital heart disease and/or abnormal situs. Our case is peculiar in that no congenital abnormalities were present.