Le Poumon et le coeur最新文献

The frequency of associated bronchial dilatation and male sterility is sufficiently high for simple coincidence to be discounted. Initially observed in patients with Kartagener's syndrome, an abnormal frequency of bronchial disorders (with or without ectasia)M was then noted in subjects with azoospermia, especially of the excretory type. Originally proposed by AFZELIUS et al in 1975, an explanation for the association could be the presence of ultrastructural anomalies of the cilia, both in the bronchial mucosa and in the single cilium of the spermatozoid. Other physiopathological explanations for this association, characterized by a motility disorder (mucociliary or spermatic), include secretory anomalies as in mucoviscidosis and acquired anomalies (major role of infection in bronchial affections, role of tobacco). Practical consequences of this association are discussed.

The case of pigeon breeders' disease reported here is peculiar not only because of the large number of birds with which the patient was in contact, but also because the disease developed in a patient presenting with both pulmonary tuberculosis and Crohn's disease. Moreover, 18 months after eviction of the birds and beginning of corticosteroid therapy, the number of lymphocytes in fluid from broncho-alveolar lavage remained high.

Critical analysis of a series of 55 cases of pulmonary metastases of various origins, treated surgically, included successive study of the circumstances of discovery of the pulmonary lesions, the free interval, and the characteristics and mode of therapy of the metastases. Overall survival was 41% at 2 years and 21% at 5 years. The effect of surgery on overall therapeutic strategy of cancer is discussed.

Hypoxic vasoconstriction is one of the main determinants of pulmonary arterial hypertension in C.O.P.D. The authors study in two groups of respiratory insufficiency patients (82 C.O.P.D. and 46 non-C.O.P.D.) correlations between mean pulmonary arterial pressure (PAP) and gasometric values. They show that: --no correlation exists in the patients who suffer from a restrictive syndrome; --in the obstructive patients, correlations are poorer between PAP and PaO2 or PvO2 than between PAP and a factor made up of these two parameters, according to the percentage of their theoretical values.

Two hundred and seventeen patients undergoing digestive tract surgery, either randomly or non-randomly allocated in two separate groups, and presenting postoperative hypoxemia, were studied during intensive care : 77 were ventilated by continuous positive pressure (CPP), 70 by intermittent positive pressure (IPP), and 70 were treated by classical respiratory physiotherapy. Results showed that CPP was the method of choice for ventilatory assistance following digestive tract surgery: hematosis was improved in a prolonged manner without modification of CO2 levels. The other procedures had a beneficial effect on PaO2 but at the price of a hyperventilation. Patients receiving IPP developed hypocapnea and hypoxemia five minutes after the end of the treatment. Physiopathological bases for these differences in gasometric behaviour in patients undergoing digestive tract surgery are analyzed as a function of the characteristics of CPP on the one hand, and IPP and respiratory physiotherapy on the other.

Protective and curative effects of parenterally administered bamifylline and theophylline on bronchospasm induced by standardized house dust inhalation were studied in two series of eight patients with allergic asthma to house dust. Preventive effects were assessed by variations in liminal allergen dose (LAD) required to double resistance of the air passages (Rap), measured by barometric body plethysmography after determining basal LAD levels. Thirty minutes afer a slow i.v. injection of bamifylline, and LAD mean value reached 920 +/- 950 % of control value, and was still at 830 +/- 1 000 % after 60 minutes. After theophylline, mean LAD values were 750 +/- 980 % at 30 minutes and 700 +/- 970 % at 60 minutes, a non-significant difference. Curative activity was evaluated by studying changes in Rap after the provocative inhalation test with house dust, the test being immediately followed by the administration of either bamifylline or theophylline. Similar results were also obtained employing this test : reduction in Rap of 35 +/- 17 % for bamifylline and 48 +/- 13 % for theophylline (non-significant difference) after 30 minutes, and of 38 +/- 25 % for bamifylline and 48 +/- 14 % for theophylline (non-significant difference) after 60 minutes. These findings suggest that these two xanthine derivatives possess comparable protective and curative effects against bronchospasm induced by allergen inhalation.

Asthma, a disease characterized by bronchial hyperreactivity to various physical, chemical, nd pharmacological stimuli, has been extensively studied, and many pathogenic hypotheses have been evoked. Theories attempting to explain the development of the asthmatic syndrome are still fragmentary: the parasympathetic system appears to be the predominant factor involved in changes in nervous system regulatory alterations, this hypothesis being suggested to explain the bronchial hyperreactivity occurring after viral infections or exposure to certain oxidizing agents. The results of morphological and ultrastructural studies of human bronchial muscle suggest the involvement of modifications in a non-adrenergic relaxant system, analogous to the purinergic system in the digestive tract, but supply marked evidence of changes in sympathetic innervation. An alteration in the smooth muscle itself may be implicated: muscle hyperplasia, increase in contractility, and especially modification in pharmacological receptors situated on the membrane of smooth muscle fibres : acquired or spontaneous blocking of beta receptors, activation of alpha receptors, and alteration of cholinergic receptors. The chemical theory suggests that bronchoconstriction is due to local excess of mediators from cells taking part in the allergic and inflammatory reactions, and which are found in the tracheobronchial tree. The possible relationships between repeated secretion of mediators in allergic subjects and the bronchial hyperreactivity to numerous non-specific stimuli appear to be a complex subject. The possibility that a single biochemical anomaly is involved in asthma has been raised, but further basic research is necessary to explain the alterations in biochemical processes involved in such different phenomena as muscle contraction, secretion of anaphylactic mediators, and nerve impulse transmission.

The pharmacological modifications of the airways contraction and of the secretion of mediators of anaphylaxis appear as the main way to therapeutic control of asthma. Calcium antagonists which inhibit calcium influx in the pulmonary smooth muscle have been proposed as antiasthmatic drugs. The pharmacological use of inhibitors of calmodulin, the intracellular target of calcium, requires the development of specific calmodulin inhibitors. The secretion of the mediators of anaphylaxis involves modifications of membranous phospholipids metabolism. The cytoskeleton might control the exocytosis of stored mediators. The multiplicity of putative mediators, of cellular systems and of various interrelationships between mediators of anaphylaxis and neuromediators, suggest multiple potential pharmacological targets in asthma.

Two patients with severe forms of legionnaires' disease presented similar manifestations of a confusional syndrome, a major infectious syndrome resistant to cyclines, beta-lactams, and aminoglycosides, altered hepatic and renal functions, and a fulminating course with the need for assisted ventilation in one case. Indirect immunofluorescence serology gave very positive results in both patients and changes in serum levels were reported 6 and 8 months after the onset of the disease. A serotype I strain of Legionella pneumophila was isolated by direct immunofluorescence from bronchial aspiration products in the second case. These cases are discussed in relation to reports in the published literature.

Two cases of hypoglycemiant pleural fibroma are reported: -- the first case, in a patient with sarcoidosis, was diagnosed following the onset of neuropsychic manifestations due to hypoglycemia; --the second case, much more atypical, was a patient with an enormous pleural tumor affecting cardiorespiratory function to such a degree that almost total incapacity ensued: the hypoglycemia was detected during routine pre-operative investigations. Various extrathoracic manifestations accompany these tumors: osteo-articular (present in 1 patient), and thyroidal (present in both cases). The various mechanisms proposed to explain the development of hypoglycemia in patients with certain extra-pancreatic tumors are reviewed.