[Diffusion of trimethoprim and sulfamethoxazole into the pleural fluid]. / Diffusion du triméthoprime et du sulfaméthoxazole dans le liquide pleural.

The level of Trimethoprim (TMP) and of Sulfamethoxazole (SMZ) in the fluid of both pleural effusion and plasma was determined in 7 patients on the first day of treatment consisting of two daily doses of 160 mg TMP and 800 mg SMZ. In 4 subjects, the levels were determined again on the third (J3) and fifth day of treatment (J5). Thus with TMP the ratio of pleural/plasma drug levels rose progressively from the first day of treatment to attain by 12 hours a mean value of 0.79 +/- 0.16; subsequently it stayed at about the same level for day 3 (J3) and day 5 (J5). As for SMZ, the ratio of the pleural plasma drug level reached a maximum at 8 hours on the first day of treatment (0.53 +/- 0.12) then rose progressively on day 3 (J3 0.58 +/- 0.06) and on day 5 to 0.71 (+/- 0.08). The levels of TMP in the pleural fluid were below those which are usually described in bronchial secretions. On the other hand those of SMZ are appreciably raised.

[Value of the assay of pleural carcinoembryonic antigen for the diagnosis of neoplastic pleurisy. Correlation with plasma levels and anatomopathological results]. / Intérêt du dosage de l'antigène carcino-embryonnaire pleural pour le diagnostic des pleurésies néoplasiques. Corrélation avec les taux plasmatiques et les résultats anatomopathologiques.

The authors specify the contribution of pleural carcinoembryonic antigen (CEA) assay in the diagnosis of malignant pleuritis by comparing it to plasma concentrations and pathologic findings. 45 patients with pleuritis were studied. Etiology was malignant in 15 and non-malignant in 27. Analysis of results shows that a pleural CEA concentration above 5 ng/ml is very suggestive of malignancy. Determination of the pleural CEA/plasmatic CEA ratio provides no additional information compared to pleural CEA assay alone.

[Spontaneous pneumomediastinum in adults]. / Pneumomédiastin spontané de l'adulte.

Pneumomediastinum is an uncommon, often overlooked, condition resulting from the rupture of perivascular alveoli and the migration of air along the pulmonary vessels. Diagnosis, which is usually difficult, rests on three major signs: cervical subcutaneous emphysema, Hamman's sign and roentgenological findings. Prognosis is good and the course is uneventful. Cervico-mediastinotomy is only rarely reeded.

[Granular cell bronchial tumors. General features, developmental and therapeutic aspects. Apropos of 4 new cases]. / Tumeurs bronchiques à cellules granuleuses. Généralités, aspects évolutif et thérapeutique. A propos de quatre nouveaux cas.

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.

[Legionnaires' disease with late pulmonary sequelae. Apropos of a case]. / Maladie des légionnaires avec séquelles pulmonaires tardives. A propos d'un cas.

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.

[Pulmonary biopsy using thoracoscopy]. / Biopsies pulmonaires par thoracoscopie.

Pulmonary biopsies were taken under thoracoscopy from 16 patients presenting with insoluble diagnostic problems. This method enabled the authors to make a diagnosis, which was not contradicted by the course of the disease, in 14 cases of diffuse or circumscribed pathology touching the lung cortex. There was no major incident.

[Value of the small diameter pleural drain in pneumological practice (author's transl)]. / Place du drain pleural de petit calibre en pratique pneumologique.

The authors propose the use of a drain of small diameter, opaque to X-rays, of the "Pleurocath" type, for draining pleural cavities. Having described the setting technique and the rules for after care, they underline its value in the treatment of pneumothorax and purulent pleurisies. It is a method of easy use, efficient, producing little trauma and well tolerated.

[Pulmonary emphysema and hepatic involvement by alpha-1 antitrypsin deficiency in two adults with a PiZ phenotype (author's transl)]. / Emphysème pulmonaire et atteinte hépatique par déficit en alpha 1-antitrypsine chez deux adultes de phénotype PiZ.

Two unreleated adult males were found to be suffering from an association of pan-lobular severe emphysema and hepatomegally of unknown origin which led to the discovery of a marked deficit in alpha-1 antitrypsin (A1-AT) in relation to a PiZ phenotype. Liver biopsy revealed cirrhosis with portal fibrosis in one case and in both cases fatty infiltration with the accumulation of a glycoprotein antigenically identical to A1-AT. Electron microscopy showed this protein to be situated within the dilated lumina of the endoplasmic reticulum of the hepatocytes. A1-AT deficiency is usually associated with pulmonary involvement only in the adult and liver involvement only in the child. The association of the two remains rare--hence the interest of the two cases reported.