Le Poumon et le coeur最新文献

We report the case of a 65 years old woman treated for 20 months with Amiodarone for angina who presented a picture of diffuse interstitial pneumonitis of rapid onset and of marked severity, which totally resolved once the drug was suspended and following the administration of steroid therapy. This raises the problem of the responsibility of Amiodarone in the aetiology of diffuse interstitial pneumonitis. We present 12 cases from the literature which also raise the question of the responsibility of this drug.

Pathologic findings in two patients with no previous history of atopic affections were apical pulmonary infiltration, a marked general syndrome with altered general state and hyperthermia, a productive cough, and a circulating eosinophilia. Clinical manifestations and the particular radiographic images of homogeneous condensation of the two apices in the form of "helmet crests", together with the typical course during corticoid treatment and histopathologic findings in one case, established a diagnosis of chronic eosinophil pneumonia. The principal characteristics of this affection, as exemplified by these two cases, are analyzed.

One case of unilateral pulmonary oedema a vacuo is reported and the 38 cases published in the literature are reviewed. Contributing factors are essential, the main ones being the duration and severity of lung collapse and the rate of reexpansion. The clinical signs and symptoms are described, together with the various possible courses of the disease, and the severity factors are deduced from 8 lethal cases. A therapeutic approach is proposed but not formalised, since pathophysiological data are still scarce.

Amyloidosis of the lower respiratory tract is a rare condition. We report three new cases and we review the literature. Tracheobronchial amyloidosis is the most frequent form. The diagnostic is made by fiberoscopy and biopsies with a risk of bleeding. Our patients were usually treated with intermittent bronchoscopic resections. In one of the three cases reported, desobstruction of the large airway was performed with laser. Nodular pulmonary amyloidosis is usually asymptomatic, and surgical resection results in cure in all cases. Diffuse pulmonary amyloidosis is very unusual and fatal.

A case of Wegener's granulomatosis starting as a localized pseudo-tumoral lung lesion and following a fulminating course is reported. The histological diagnosis required thoracotomy. New pulmonary lesions developed post-operatively, together with severe renal failure which was responsible for the patient's death 5 weeks after the thoracotomy. The authors describe the lesions characteristic of the disease and their pathogenesis and discuss the relationship between Wegener's syndrome and other granulomatous angiitis.

In a 59-year old sand-blaster, histologically proven silicosis was complicated by systemic lupus erythematosus (SLE) and focal glomerulonephritis with IgG, IgA and ClQ deposits. Nothing likely to facilitate SLE was detected by investigating the familial background, the HLA phenotype and the complement system. This type of SLE differs from drug-induced lupus-like syndromes by a high level of anti-double helix DNA antibodies and by the renal lesions observed. The connection between silicosis and SLE lies in changes in humoral immunity, i.e. polyclonal activation and production of antinuclear antibodies. A decrease in the number of suppressor T-cells may also be held responsible.

The hyper IgE syndrome develops in childhood and leads to repeated infectious episodes, usually of staphylococcus aureus origin and affecting mainly the skin and pulmonary parenchyma. It may be associated with a predominantly facial atypical dermatitis and more rarely with allergic manifestations. Biological tests show mainly an eosinophilia and a hypergammaglobulinemia E alone without modifications in other immunoglobulin types. Disorders of neutrophil and monocyte chemotaxis are inconstant findings. The initial mechanism of the affection appears related to a deficit in suppressive T function selectively acting on the IgE isotype.

Over a 2 year period from April 1980 to April 1982, 240 pneumococci isolated from amongst 208 patients during 216 infectious episodes were serotyped. Sensitivity to standard antibiotics was determined for 209 of these strains. Pneumococci are divided into 33 serotypes. The vaccination cover provided by the vaccine currently commercially available is 70%. AUSTRIAN and GESLIN feel that the surveillance of bacteraemias is the most effective method for the choice of vaccine formula in order to eliminate the bias due to healthy carriers. In the present study, pneumococci isolated from 41 bacteraemias came from 14 serotypes and vaccine cover was 90%. Amongst 209 strains of Streptococcus pneumoniae, 25.8% were resistant to tetracyclines, 10.5% to sulphonamides, 6.6% to chloramphenicol, 5.7% to erythromycin, 2.8% to co-trimoxazole and none to penicillin.

Two cases of nitrofurantoin induced acute pneumopathy are reported. The characteristics of the pulmonary reactions to this drug are described, and currently accepted pathogenic mechanisms, and diagnostic and therapeutic means discussed.