Revue francaise des maladies respiratoires最新文献

The effect of short, medium and long term physiotherapy remain controversial. The theoretical objectives of the method are to reduce dyspnoea and respiratory disability while improving exercise performance and expectation of life. As regards respiratory mechanics, the goals are to reduce bronchial obstruction and the mechanical properties of the chest wall. A rise in expiratory flow might result in an increased drainage of secretions, a reduction in transmural bronchial pressure and a raised level of ventilation at end-tidal volume. The correction of parietal distortions by physiotherapy has as an objective a diminution of thoracic elastance. Muscular training, a new aspect of respiratory physiotherapy, consists of increased both the endurance and the force of contraction of the respiratory muscles. The beneficial effects of these recent methods require confirmation with long term clinical studies. The correct indications for the diverse techniques proposed require a better understanding of the mechanism of action of respiratory physiotherapy, an essential complement to effective treatment of chronic airflow obstruction.

This study of tuberculous treatment in a French department--Les Hautes Pyrenees--was carried out on 539 patients registered on an epidemiological card index from 1973 to 1980. Isoniazid, ethambutol and rifampicin were the drugs most commonly used and were prescribed in 96% of cases by Specialists in thoracic medicine. The mean duration of treatment was a little more than 12 months for the duration of the study. A quarter of the patients were admitted to hospital and this figure did not change during the study from one year to the next although the mean length of stay fell by half between 1973 and 1980, the longest stays in hospital were for social reasons.

The rehabilitation of patients with chronic airflow obstruction consists of a number of complementary treatments, one of which is respiratory physiotherapy (KR). Breathing exercises (RE), bronchial drainage and controlled coughing are all part of current techniques in physiotherapy. As problems with the rhythm of breathing are frequently encountered in patients with chronic pulmonary disease, their correction is attempted with KR. In order to acquire a new, more efficient breathing pattern, training in simple every day measures is used (such as talking, reading watching TV, walking, climbing stairs, etc.) or techniques using mechanical devices, including inventive spirometers and magnetometers. With a few exceptions, most of the studies show an immediate objective benefit on blood gases and alveolar ventilation, due to a reduced respiratory rate and increased tidal volume. Although dynamic ventilatory work increases, neither the pulmonary haemodynamics nor energy expenditure are altered as judged by oxygen consumption during RE. The long term results are contradictory and more difficult to interpret. Many studies have noted a clinical and functional improvement with fewer relapses and hospital admissions; these studies often lack adequate controls and the clinical state is not always precisely defined; nor whether associated therapy has been changed or not. Other studies have given negative results, and lately the causes of these failures have been better defined. There is insufficient theoretical and practical training of KR at all medical levels, an absence of uniformity in the KR rehabilitation teams, and treatment courses which are both too few in number and too short in duration. An appreciation of these points of criticism should make for greater objectivity in the future analysis of pulmonary rehabilitation.

Between the 24 October 1977 and the 31 December 1978 a series of 299 patients were treated with triple therapy--Rifampicin, Ethambutol and Isoniazid; the latter was given in a standard dose of 5 mg/kg. Between the 1 January 1979 and the 31 December 1981 a second series of 448 patients were treated with the same combination, Isoniazid was given in a dose adjusted for acetylator status (Vivien et coll.). In all the patients the serum concentration of Isoniazid at 3, 6 and 12 hours (after a single oral dose of 5 mg/kg) were measured and the two series of patients were comparable. No significant difference was noted between the two groups regarding either efficacy or toxicity. The adjustment of Isoniazid dosage according to acetylator status has not resulted in any statistically significant benefit in those patients studied.

Anomalies of drainage of the superior vena cava (S.V.C.) usually consists of a persistent left S.V.C. draining into the left auricle. Until now there has only been one published case of S.V.C. anastomosis with the left auricle. We describe a second case of a four year old boy who had undergone two operations for a recurrent cerebral abscess. This child presented with cyanosis, polycythaemia and arterial hypoxaemia. This abnormality is associated with a partially anomalous pulmonary venous drainage. Surgical correction using prosthetic and pericardial grafts enabled closure of the right to left shunt.

When a sudden death occurs, a necropsy is of the upmost value, but sometimes it does not yield the anticipated benefit; in this situation histological study of the specimens may help the diagnosis. We describe two decreased "sniffers" with pulmonary lesions that could have explained their sudden deaths. The histological appearance is often not recognised and considerably worsens the prognosis in subjects inhaling certain drugs.

This study describes our experience from 1960 onwards of 222 patients suffering from terminal chronic respiratory failure; we report our results of domiciliary mechanical ventilation for 11-17 hours per day using tracheotomy. The method was easy to use at home at a reasonable cost and was far less than in a medical environment. The results were excellent both for length of survival and quality of life for all cases where respiratory failure was due to chest wall problems (neurological, muscular or restrictive syndromes due to chest deformity). The majority of cases were sequelae of polio, myopathies, kyphoscoliosis or tuberculosis. The results were less good for patients with intrinsic pulmonary disease such as chronic airflow obstruction; for this the superiority of mechanical ventilation compared to long term oxygen therapy is not proven. The results were very poor for patients suffering from bronchial dilatation. However, a positive correlation between the efficacy of the method and the duration of a normal PaO2 during a 24 hour period seemed to exist, both during periods of mechanical ventilation and weaning from the machine.

This study is in two parts. The first is devoted to a brief reminder of those situations in which pathogenic microbes invade the respiratory tract and is concerned with: the rapid elimination of the pathogen, thanks to the intervention of the first line of defence of the lung; a delayed elimination which sets in action complementary mechanisms inducing an inflammatory response; the overflow of the defence system with the development of the infectious illness. The second part is devoted to a review of the causes of failure of the defence mechanisms against the microbes. Two series of events are discussed: first constitutional immune deficiency and secondly acquired deficiencies.

The aim of this study was to establish data which would best demonstrate the variations of different tests using Carbon Monoxide as a tracer gas (total and partial functional uptake coefficient and transfer capacity) to establish mean values and lower limits of normal of these tests. Multivariate statistical analysis was used; in the first stage a connection was sought between the fractional uptake coefficient (partial and total) to other parameters, comparing subjects and data. In the second stage the comparison was refined by eliminating the least useful data, trying, despite a small loss of material, to reveal the most important connections, linear or otherwise. The fractional uptake coefficients varied according to sex, also the variation of the partial alveolar-expired fractional uptake equivalent (DuACO) was largely a function of respiratory rate and tidal volume. The alveolar-arterial partial fractional uptake equivalent (DuaCO) depended more on respiratory frequency and age. Finally the total fractional uptake coefficient (DuCO) and the transfer capacity corrected per liter of ventilation (TLCO/V) were functions of these parameters. The last stage of this work, after taking account of the statistical observations consistent with the facts of these physiological hypotheses led to a search for a better way of approaching the laws linking the collected data to the fractional uptake coefficient. The lower limits of normal were arbitrarily defined, separating those 5% of subjects deviating most strongly from the mean. As a result, the relationship between the lower limit of normal and the theoretical mean value was 90% for the partial and total fractional uptake coefficient and 70% for the transfer capacity corrected per liter of ventilation.

The systematic biopsying of the carina overlying a tumour, the main carina and of a contralateral carina was made a part of the work up in some patients with bronchial carcinoma, to assess operability. Different studies show that despite a normal macroscopic appearance these biopsies often reveal sub-mucous invasion. This microscopic extension might modify the resection planned, and even end in inoperability in the case of tracheal or contralateral tracheal invasion. We have studied the notes of 110 patients with primary bronchial carcinoma who have had systematic biopsies. All had a normal endoscopic appearance in the carinas biopsied and none revealed invasion by tumour. Of 110 patients, 37 had operations. In 1/3 (13/37) there was a discordance between the pre-operative bronchoscopic assessment and the local extension at thoracotomy, since 7 patients were subjected to a more extensive dissection than planned, 4 were exploratory thoracotomies only and in 4 the bronchial stumps were found to be invaded. Thus negative biopsies of healthy carinas overlying a tumour have proved to be false security and did not allow us to confirm the absence of tumour extension at peri-bronchial level in the local lymph nodes or in the mediastinum.