Le Poumon et le coeur最新文献

The authors report 4 cases of round atelectasis seen over a period of 3 years. They review the very limited literature on this subject. In the light of their experience and according to the work of Hanke, they believe this to be a fairly common disease. This condition was first described during collapsotherapy, but now, it is essentially seen following pleurisy. For Hanke, round atelectasis may occur in almost one quarter of cases of pleural effusion. The authors also believe that this condition is common and that it is usually confused with or grouped together with "pleural sequelae". However, their original mechanism of formation, the reversible parenchymal involvement, and not pleural, and their radiological appearance clearly distinguish them. Round atelectasis is an interesting topic of discussion in terms of diagnosis, in the broad framework of round intrathoracic opacities (especially when the initial pleural episode has not been recognized) and also in terms of treatment, which consists of decortication when they are large.

Re-expansion pulmonary edema (RPE) due to pneumothorax aspiration can lead to a fatal outcome, as in the case reported, the chronic nutritional deficiency and hypoproteinemia that it provokes probably playing a contributing role. Pathogenesis and factors affecting prognosis of RPE are discussed. These include the duration of the pulmonary collapse, though this is not an essential factor, the alterations in alveolar surfactant activity possibly related to the chronicity of the collapse, and the abruptness of aspiration which is, in contrast, a determining mechanical factor. Finally, the hypoproteinemia present in certain cases could facilitate fluid extravasation towards the alveolus. It is concluded that aspiration should be a gentle procedure in all cases, and should be conducted with extreme caution in the presence of hypoproteinemia.

A double-blind trial was conducted to evaluate the capacity of an immunomodulator of bacterial origin (Biostim) to diminish the frequency of infectious episodes in chronic bronchitis. The study duration was 9 months, Biostim being administered orally initially, with follow-up examinations after 2 and 4 months. Of the 73 subjects selected, 38 received Biostim and 35 a placebo (no significant differences between the two groups). By the 9th month, the duration in days of infectious episodes and of antibiotic therapy was 13 +/- 1.3 and 11.5 +/- 1.4 days respectively for the group receiving Biostim, and 33 +/- 5.8 and 41 +/- 9.5 respectively for the placebo group (p less than 0.05). No signs of intolerance and particularly no immunotoxicity were observed: absence of elevation of IgE or anti-Biostim antibody titres. Pre-winter administration of Biostim to subjects at high risk would appear to significantly diminish the frequency of infectious episodes and thus the consumption of antibiotics.

The authors report 4 new cases of bronchial granular cell tumours. The course of these rare tumours is usually slow and benign. They are usually discovered at endoscopy. Surgery is the most radical therapeutic solution and is that most often used. The possibilities of endoscopic resection, use of the laser or therapeutic abstention with endoscopic surveillance must be reserved for cases where surgical operation is contraindicated. In addition, the authors report one case in which multiple chemotherapy appeared to result in disappearance of a granular cell bronchial tumour.

In 1956, LIEBOW and HUBBEL defined pulmonary fibrosing haemangioma as a marked vascular proliferation with a marked tendency to fibrosis, papillary vegetations, extensive histiocytic infiltration and haemorrhages at various stages of organisation. More than 70 cases have been reported since. This lesion occurs most often in the middle aged woman. It is usually asymptomatic or may present as haemoptysis. Radiologically, it takes the form of a well-limited round homogeneous opacity and the prognosis is excellent after excision. The case reported here fell fully within this context and had the special feature of intrascissural tumour development resulting in an unusual radiological appearance which initially suggested a diagnosis of encysted pleural effusion. However the solid nature of the opacity being confirmed by CT scan, it was excised surgically. Its nature was revealed by histological examination. A detailed review of the literature is undertaken and changes in the histopathological concept of this type of lesion discussed. Previously classified amongst inflammatory pseudo-tumours, it is now considered to be a tumour proliferation which, on the basis of current data from electron microscopy and histochemistry, is felt by some to be of vascular origin but by the majority to be of epithelial origin, apparently developing from immature type II pneumocytes. The name "benign fibrosing pneumocytoma" suggested by CHAN would seem now more appropriate.

Thirty cases of allergic bronchopulmonary aspergillosis (ABPA) were treated between 1967 and 1981. Developing in patients with a history of chronic asthma (28 of the 30 cases), the initial manifestations of ABPA developed after long periods (an average of 29 years after the onset of the asthma). Chest radiography demonstrated recurrent labile infiltrates in 28 cases, segmental or lobar atelectasis in 7, and proximal bronchiectasis in 16 cases. A circulating eosinophilia was a constant finding, but this varied with time. Immunologic investigations gave positive skin tests, 19 of the 30 patients only presenting a cutaneous reaction delayed until the 6th hour. Total IgE, determined in 18 cases, varied between 600 and 9400 IU/ml (RIST), with identification of specific IgE for Aspergillus in all cases, though to varying degrees. Serial measurements of total IgE levels showed co-existence of an acute progression of the affection and elevated total IgE in 3 cases, but no correlation was found between serum IgE levels and the severity or chronicity of the disease. Physiopathologic features included immediate and partially delayed hypersensitivity to Aspergillus fumigatus. The frequency of ABPA during the course of mucoviscidosis suggests, by analogy, that a local factor may exist which favorizes Aspergillus fumigatus proliferation in patients with ABPA alone.

The authors report a case of legionnaires' disease with retractile late sequelae affecting the lingula and the dorsal segment of the culmen. They stress the need for appropriate and prolonged treatment because of the possible presence of intracellular Legionella pneumophila. The existence of an associated staphylococcal infection is also one of the hypotheses raised in explaining such sequelae.

A new case of left cervical aorta is described, affecting a 12-year-old girl. Haemodynamic, CT scan and radiological investigations are described. The only associated abnormality in the present case was hypoplasia of the left vertebral artery. There were two spicules on the medial surface of the descending aorta, possibly embryonic rests. A review is made of the literature and there is discussion of the contribution of different diagnostic techniques to determination of the embryological origin or the abnormality and its possible treatment.

Whereas pulmonary fibrosis is a very frequent manifestation of scleroderma, pulmonary hypertension of the precapillary type is a much rarer occurrence in this affection. Two cases of scleroderma with subsequent development of a pulmonary hypertension are reported. Various hypotheses have been advanced to explain the origin of this disorder during the course of scleroderma. Rather than a direct consequence of the sclerodermic pulmonary fibrosis it probably arises secondary to the specific, diffuse, primary pulmonary vascular lesions.

4 856 cases of primary lung carcinoma in the Rhônes-Alpes area have been collected from 1970 to 1980 by cytological examination. The validity of these data rests upon the fact that they come from the same laboratory. The percentage of small cell carcinomas has been calculated per year and per geographical area. An increasing incidence is observed starting from 8% in 1973 and reaching 19% in 1980. These data are correlated with a review of the literature.