Le Poumon et le coeur最新文献

Authors report two new cases of lonely pulmonary varices, raising the number of lonely pulmonary varices to 34 and to 61 the number of pulmonary varices related in literature. In both cases the dilated veins were discovered by chance on a chest roentgenogram. The pulmonary angiogram has brought the diagnosis out. A recall of the clinical symptoms and radiological aspects shown off the importance of the pulmonary angiography and of a regular supervision of those patients. If some complications appear or if some shadows extend on chest roentgenogram, the surgical treatment might become necessary.

The objective of the present study is to gauge mechanical and manual external vibrations for a rational use in chest physiotherapy. The observed frequencies are included between 22 and 100 Hz. The efficacy (significantly) is not yet proved and further studies are necessary to define the practical aspects of these vibrations.

A patient had been operated 4 years ago for a hypoglycemic tumor of the pleura. The lesion could be separated from the lung, and histological examination demonstrated an undifferentiated markedly cellular appearance of the tumor. Ultrastructural features were not in favor of a mesothelial tumor. Prognosis in such cases depends upon the histological type of tumor present, but remains uncertain, particularly in some apparently morphologically benign forms. Th most valid hypothesis to explain the genesis of this syndrome involves the role played by the non-suppressible insulin-like activity of a substance secreted by the tumor. This is a glycoprotein, molecular weight 90 000, which has recently been isolated, and which could play an important role as a non-suppressible insulin-like protein.

Ketotifene is a new preventive treatment for asthma possessing the main advantage of being administered orally. Results were analyzed after treatment of 1 791 patients with allergic paroxysmal asthma, at a daily dose of 2 mg for a minimum duration of 3 months. Ketotifene was found to be effective both against asthma attacks (no further episodes in 30% of cases, and reduction in their frequency by at least a half in 35%), and by the fact that associated anti-asthma medication could be suppressed. Positive effects were noted after two weeks of treatment, with improvement increasing during the observation period (3 months). Tolerance was good, the principal side effect being somnolence (13% of cases), which occurred early in treatment but was reversible in more than one-third of these patients.

A further case of granulomatous hypersensitivity angiitis (syndrome described by Churg and Strauss) is reported. Clinical, biological, and histological features (asthma, blood eosinophilia, necrotizing angiitis lesions, extravascular eosinophilic and granulomatous infiltrates) differentiate this affection from other necrotizing angiitis diseases, particularly from polyarteritis nodosa. Unusual features in this case were its favorable course, and the remission following combined corticoid and cyclophosphamide treatment. Diagnostic, clinical and histological criteria which distinguish Churg and Strauss's angiitis from other necrotizing angiitis affections are described, and current pathogenic hypotheses discussed.

Advances in the therapy of tumors or for the maintenance of grafts have improved survival in a large number of patients, but at the price of repeated complications due to the induced immunodeficiency state. Pulmonary infections are a frequent occurrence, and while some are easily recognized and treated, others must be precisely diagnosed, as only early specific treatment can avoid the often fatal outcome. Various techniques have therefore been developed to obtain specimens for microorganism isolation before having ultimate recourse to a surgical lung biopsy. It is in this field that the most marked progress is currently being made. The different microorganisms responsible for these affections are reviewed, the majority being common to the immunodeficiency state, while others are encountered more frequently as a function of the underlying disorder and of the ecological conditions in each centre.

Five years after a cross-sectional survey concerning the small airways disease within a working population aged 18 to 66 years, the authors carried on a new study within the same sample of population (272 subjects) using the same methodology of research : standard questionnaire and spirometry (VC, FEV1, FEV1/VC, MEF 25-75/VC). The goal of this study was to assess the functional outlook of the individuals depending on the functional status recorded in the frame of the first study, i.e. normal ventilatory status, small airways disease, advanced bronchial obstruction. The results showed that after five years there is a worsening of the ventilatory status, mostly in men and in aged persons at start. This worsening arises from the movement from one category to another towards the advanced bronchial obstruction. This movement was reversible from small airways disease to normal status. Conversely, the movement from small airways disease to advanced bronchial obstruction was irreversible. This study shows that small airways disease is an intermediate condition between normal status and advanced bronchial obstruction. Three risk factors were put in evidence both for small airways disease and for movement towards advanced bronchial obstruction : male sex, aging and tobacco smoking.

Pyoneumopericardium developed secondary to perforation of an iatrogenic hiatus hernia ulcer. Eighteen cases of gastropericardial fistulae have been reported, but only one similar case has been described in the published literature. Currently employed medical and surgical treatment gives disappointing results, whether the site of perforation of the ulcer be thoracic or transdiaphragmatic.

Respiratory function disturbances were evaluated in 34 patients, mostly retired naval shipyard workers, with asbestos-related pleural calcifications. All patients had spirography tests, while 20 of them were studied by CO transfer in steady-state and measurements of arterial gases. Results were correlated with previous clinical history (chronic bronchopathy and/or pleural effusions), smoking habits, and the duration of exposure to asbestos dust. Patients with no previous history had mean spirographic values close to the normal (VC: 96% of lower limits; TC: 113%, mean VEMS/CV: 72.5%). Previous clinical history had a very much more marked effect on spirographic results than on gas exchanges: whereas CO transfer and blood gases were usually fairly normal (97% of normal for TCO and DuCO, mean PaO2 at 78 mmHg, mean PaCO2 at 34,5 mmHg), many patients had markedly altered altered values. A clear correlation was found for TCO, DuCO, Du a and PaCO2 with the duration of exposure. This suggests that in some cases there is a certain degree of pulmonary fibrosis associated with the pleural thickening.