Association between lung function and dyspnoea and its variation in the multinational Burden of Obstructive Lung Disease (BOLD) study.

BACKGROUND: Dyspnoea is a common symptom of respiratory disease. However, data on its prevalence in general populations and its association with lung function are limited and are mainly from high-income countries. The aims of this study were to estimate the prevalence of dyspnoea across several world regions, and to investigate the association of dyspnoea with lung function. METHODS: Dyspnoea was assessed, and lung function measured in 25,806 adult participants of the multinational Burden of Obstructive Lung Disease study. Dyspnoea was defined as ≥2 on the modified Medical Research Council (mMRC) dyspnoea scale. The prevalence of dyspnoea was estimated for each of the study sites and compared across countries and world regions. Multivariable logistic regression was used to assess the association of dyspnoea with lung function in each site. Results were then pooled using random-effects meta-analysis. RESULTS: The prevalence of dyspnoea varied widely across sites without a clear geographical pattern. The mean prevalence of dyspnoea was 13.7 % (SD=8.2 %), ranging from 0 % in Mysore (India) to 28.8 % in Nampicuan-Talugtug (Philippines). Dyspnoea was strongly associated with both spirometry restriction (FVC

A lepidic adenocarcinoma mimicking an eosinophilic lung.

Lepidic adenocarcinoma is a cancer with atypical radiological presentation making its diagnosis difficult and late. Here,we report the case of a 64-year-old man, who presented with respiratory distress his thoracic CT showed ground glass areas and diffuse condensations with blood hypereosinophilia. He was diagnosed to have eosinophilic lung and was placed on corticosteroid therapy but he did not show any improvement. A CT-guided biopsy showed lepidic adenocarcinoma.

Association between chronic airflow obstruction and socio-economic position in Morocco: BOLD results.

BACKGROUND: Chronic obstructive lung disease (COPD) is the third most common cause of death in the world. Factors other than smoking, such as socio-economic status, could be involved in the development of COPD.OBJECTIVE: To investigate the association between chronic airflow obstruction and socio-economic status in Morocco.DESIGN: Questionnaires were administered and spirometry tests performed as part of the BOLD (Burden of Obstructive Lung Disease) Study carried out in Fez, Morocco. Socio-economic status was evaluated using a wealth score (0-10) based on household assets. The ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) was used to measure airflow obstruction.RESULTS: A total of 760 subjects were included in the analysis. The mean age was 55.3 years (standard deviation [SD] 10.2); the average wealth score was 7.54 (SD 1.63). After controlling for other factors and potential confounders, FEV1/FVC increased by 0.4% (95%CI 0.01-0.78; P < 0.04) per unit increase in wealth score. Ageing, tobacco smoking, underweight, history of tuberculosis and asthma were also independently associated with a higher risk of airflow obstruction.CONCLUSION: Our findings suggest that airflow obstruction is associated with poverty in Morocco. Further investigations are needed to better understand the mechanisms of this association.

Prevalence of chronic obstructive pulmonary disease in Fez, Morocco: results from the BOLD study.

OBJECTIVE: To present population-estimated prevalence of spirometrically confirmed chronic obstructive pulmonary disease (COPD) in adults (age ⩾40 years), living in the city of Fez, Morocco. DESIGN: Following the Burden of Lung Disease (BOLD) methodology, population-based sampling plans were used for the recruitment of eligible adults. The study collected questionnaire data on respiratory symptoms, medical history, health status, exposure to risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed and COPD and its stages were defined according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. RESULTS: Among 768 individuals with valid data and acceptable quality post-bronchodilator spirometry results, the overall prevalence of stage 1 or higher COPD was 12.6%. The prevalence of GOLD stage 2 or higher COPD was 7.9%. The population-estimated prevalence of lower limit of normal (LLN) modified stage 1 or higher COPD was 8% among non-smokers, and it increased with number of pack-years (17.8% for >20 pack-years vs. 3.8% for <10 pack-years). The prevalence of physician-diagnosed COPD was 3.2%; this was associated with an increase in smoking pack-years. CONCLUSION: These results emphasise the urgent need to take necessary measures to reduce the prevalence of tobacco smoking.

[Hydatic pulmonary embolism: a rare complication of hepatic hydatid cyst]. / Embolie pulmonaire d'origine hydatique : une complication rare du kyste hydatique du foie.

Hepato-pulmonary hydatidosis is a parasitic disease common in Mediterranean countries. Hydatid pulmonary embolism is extremely rare and is due to rupture of a cardiac hydatid cyst or, more rarely, rupture of a hepatic hydatid cyst. We report three cases of hydatid pulmonary embolism secondary to rupture of a hydatid cyst into the inferior vena cava. Thoracic imaging, mainly CT angiography and MRI, was important for both the diagnosis and decisions on treatment. The prognosis of intra-arterial pulmonary hydatid cyst is poor because of the risk of acute fatal complications such as anaphylactic shock and vascular rupture and also of chronic progression to cor pulmonale and respiratory failure. The therapeutic management is difficult and often only partially effective hence the importance of focusing on preventative treatment.

[Acute pulmonary edema, new complication of sclerosing mediastinitis]. / Œdème aigu du poumon, une nouvelle complication de la médiastinite sclérosante.

Sclerosing mediastinitis is a rare and benign disease, which can cause obstruction of mediastinal structures, this determines the clinical presentation and prognosis. The obstruction of pulmonary venous structures secondary to mediastinal fibrosis has been rarely reported, clinically it mimics mitral stenosis. We describe the clinical case of a young patient with idiopathic sclerosing mediastinitis. The radiologic exams found stenosis of the right pulmonary artery, the right bronchus and pulmonary veins. Through this observation, we discuss this rare entity that although benign, can also be deadly. We study the different etiologies, clinical and therapeutic possibilities.

[Desmoid tumor of mediastinum revealed by superior vena cava syndrome and tamponade]. / Syndrome cave supérieur et tamponnade révélant une tumeur desmoïde du médiastin.

Desmoid tumors are rare forms of low grade malignancies. They are characterized by a strong potential of local invasion. Although they are considered histologically benign they behave aggressive locally. They typically occur in the abdominal wall or within the abdomen. Mediastinal localisation is very rare. The only curative treatment is wide surgical excision but the surgery is difficult and the risk of local recurrence is high.

[Tripe palms and a hypertrophic osteoarthropathy syndrome revealing a neuroendocrine carcinoma of the lung]. / Pachydermatoglyphie associée à une ostéoarthropathie hypertrophique révélant un carcinome neuroendocrine du poumon.

BACKGROUND: Tripe palms is a rare cutaneous paraneoplastic syndrome, primarily evocative of lung and gastric neoplasia. Association of many paraneoplastic diseases has also been reported. PATIENTS AND METHODS: A 49-year-old man with a history of alcoholism and smoking addiction reported haemoptysis and thoracic pains present for one year. The physical examination showed left lung condensation. The skin examination revealed a thickened yellowish keratoderma with exaggerated skin ridges and digital clubbing. A diagnosis of paraneoplastic tripe palms was made, prompting repetition of the biopsy which ultimately revealed a neuroendocrine carcinoma. Skeletal scintigraphy showed periosteal proliferation with hypertrophic osteoarthropathy. COMMENTS: "Tripe palms" or "osteoarthritic acanthosis" is a paraneoplastic syndrome. It involves an acquired keratoderma taking on a yellow velvety appearance with accentuation of dermatoglyphic lines. Malignancy is discovered in over 90% of individuals with tripe palms. If malignancy is isolated, it mostly involves the lung (53%). Gastric cancer is associated in 77% of cases if the condition is associated with acanthosis nigricans. In approximately one third of cases, the keratoderma may resolve, generally after treatment of the tumour. The association of many paraneoplastic syndromes has also been reported, in particular digital clubbing and hypertrophic osteoarthropathy. At least 90% of cases of hypertrophic osteoarthropathy in adults occur in patients who have or will eventually develop a malignancy. It is characterized by periostosis of long bones, joint pain, and clubbing, and it is often seen on bone scintigraphy during staging of lung carcinoma.

[Cardiac hydatidosis with dissemination to the pulmonary parenchyma and the pulmonary artery]. / Hydatidose cardiaque compliquée d'une dissémination parenchymateuse pulmonaire et vasculaire artérielle pulmonaire.

Multiple thoracic hydatic disease involving a cardiac and pulmonary localization is exceptional and prognosis is poor. We report a case in a 21-year-old male who presented repeated episodes of hemoptysis. The chest x-ray showed multiple opacities. The thoracic computed tomography and echocardiography visualized cystic formations in the heart and the pulmonary arteries. Hydatic serology was strongly positive. Medical treatment with albendazole was given but the patient died from massive hemoptysis before the cardiac and pulmonary artery cysts could be removed surgically (a procedure which requires extracorporeal circulation). A hydatic cyst of the pulmonary artery is usually secondary to a cardiac localization. The risk is dissemination into the pulmonary and eventually systemic circulation. An arterial localization must be carefully ruled out in all patients with multiple or cardiac hydatidosis. Treatment is surgical to avoid dissemination.

Variation of T-cell activation in allergic subjects during natural pollen exposure.

BACKGROUND: Allergic inflammation is characterized by a Th2 activation. However, little is known about dynamics of T-cell cytokine production during natural allergen exposure. The aim of this study was to assess the Th1/Th2 balance in cypress allergic patients compared with controls, and variations of this balance over the pollen season. METHODS: Twenty cypress allergic patients and 10 controls were studied, distributed during two consecutive pollen seasons. Cytokine production was assessed by flow cytometry and ELISA. The variation of cytokine production during the pollen season was analyzed among patients in four occasions, and the preseason values were compared with controls. IL-13 and IFN-gamma-containing T cells were assessed among whole blood cells and PBMC. In addition the effect of specific stimulation by Juniperus ashei pollen extract was studied. RESULTS: Compared with controls, IL-13-producing T cells were increased in allergics in any case. By contrast, compared with controls, allergic IFN-gamma-producing T cells were decreased in whole blood, but not in PBMC, and were increased after specific stimulation. During the season, an increase in IFN-gamma- and a decrease in IL-13-producing T cells occurred in patients, whatever the culture conditions. CONCLUSION: These results show that the allergic T-cell activation is not limited to a Th2 profile: allergen-stimulated T cells are able to produce IFN-gamma at baseline, and the Th1/Th2 ratio increases during the pollen season.

[Mediastinal paraganglioma with pleural metastasis. A case report]. / Paragangliome médiastinal avec métastase pleurale. A propos d'un cas.

Paraganglioma is rare tumor arising from chromaffine cells. We report a 39-year-old man who was diagnosed with anterior mediastinal paraganglioma. Computed tomography (CT) revealed a solid mass in the anterior mediastinum. Surgical biopsies obtained by sternotomy confirmed histologic and immunohistochemical features of paraganglioma. Surgical removal of this vascularized and invasive tumor was not possible to. External radiotherapy was performed. Three years later, the patient developed chest pain. CT findings showed right nodular pleural masses. Transparietal biopsy confirmed the same pathological aspect of paraganglioma. Chemotherapy was proposed without significant response. This observation confirmed the rare course of paraganglioma to pleural metastases. Treatment of paraganglioma is mainly surgery if the mass is resectable.

[Amoebic infections of the lung and pleura]. / Les atteintes pleuro-pulmonaires a Entamoeba histolytica.

INTRODUCTION: Pleuropulmonary involvement is the second most common extra-intestinal manifestation of entamoeba histolytica infection after liver abscess. CASE REPORT: We report 2 cases of pleuropulmonary disease occurring in two men aged 32 and 48 years following an episode of dysentery. Purulent pleural infection was noted in one case. In the other both lung and liver abscesses occurred. CONCLUSION: The diagnosis was confirmed by strongly positive serology in both cases. Treatment with metronidazole (1.5 g per day) for 15 days combined with pleural drainage led to a satisfactory outcome in both cases.

Dog factor differences in Can f 1 allergen production.

BACKGROUND: The clinical importance of dog allergy is well known, but it is unknown if all types of dogs represent the same risk for allergic patients. The purpose of this work was to evaluate among 288 healthy dogs if the levels of Can f 1 on fur vary between breeds (German Shepherd, Pyrenean Shepherd, Poodle, Cocker spaniel, Spaniel, Griffon, Labrador retriever and Yorkshire terrier), gender, hormonal status, hair length, and according to the presence of seborrhea. METHODS: Each dog was shaved in a limited area and Can f 1 concentrations were measured in mug/g fur by ELISA. The results (geometric mean values and 95% confidence intervals) were analyzed using analysis of variance and with nonparametric tests. RESULTS: A wide variability in Can f 1 levels was found between dog breeds, from Labradors [1.99 (0.03-129.91)] to Yorkshires [16.72 (3.67-76.16)] and Poodles [17.04 (2.79-103.94)] but only the Labrador levels were significantly different from each other breed. Males produced more Can f 1 than females, 11.75 (1.27-108.40) vs 8.89 (0.91-86.39). No difference was found according to hair length or hormonal status. The seborrheic status highly (P = 0.0019) influenced the presence of Can f 1 on hair: 16.66 (1.59-173.96) vs 9.40 (1.03-85.70). CONCLUSION: Breeds (Labrador retriever), sex and seborrhea seem to influence the levels of Can f 1 on fur.

[Pulmonary actinomycosis. Two cases]. / Actinomycose pulmonaire. A propos de deux cas.

We report two cases of pulmonary actinomycosis in two young men. These observations are an opportunity to review the usual difficulties of diagnosis and the clinical, radiological and therapeutic characteristics in patients with this rare disease. Pulmonary actinomycosis often appears in a debilitated patient with significant disease of the teeth and gingival margins. High-dose penicillin G which is the standard treatment generally provides cure.

Assessment of T lymphocyte cytokine production in induced sputum from asthmatics: a flow cytometry study.

BACKGROUND: Asthma results from a bronchial inflammation in which Th2 lymphocytes play a pivotal role, as shown in invasive bronchial biopsies and broncho-alveolar lavages. Induced sputum (IS) is a non-invasive method of recovery of bronchial cells, which can be repeated in the same patients. However, lymphocyte activation has not been studied in IS to date, because of the low number of T cells recovered. Herein we took advantage of flow cytometry, a method suitable for the study of small cell populations, to assess T cell cytokine production in IS. OBJECTIVES: (1) To assess induced sputum T cell cytokine production by flow cytometry in asthmatic subjects and controls. (2) To compare the T cell cytokine production between symptomatic and non-symptomatic asthmatics. METHODS: Thirteen asthmatics and 19 controls were included. Sputum was induced by a hypertonic saline. Sputum cells were stimulated and intracellular IL-13 and IFN-gamma were detected in T cells by flow cytometry. RESULTS: Stimulation induced an increase of IL-13 and IFN-gamma production by T cells. This increase was higher in asthmatics. IL-13-producing T cells were increased in asthmatics after stimulation. In symptomatic asthma, IFN-gamma-producing T cells were in higher proportion than in controlled asthma. CONCLUSION: IS T cell cytokine production indicates a basic Th2 bias in asthma, accompanied during symptoms by a Th1-like activation. These results open the field for longitudinal studies of the variation of T cell activation in asthma.

T cell activation, from atopy to asthma: more a paradox than a paradigm.

During the last 15 years, it was largely shown that allergic inflammation was orchestrated by activated Th2 lymphocytes, leading to IgE production and eosinophil activation. Indeed, Th2 activation was shown to be necessary to induce allergic sensitization in animal models. In humans, a Th2 skewing was shown in atopic children soon after birth. In asthma, descriptive studies showed that Th2 cells were more numerous in patients than in controls. In addition, during specific allergen stimulation, an increase of Th2 cells was described in most cases. According to this Th2 paradigm, it was proposed that early avoidance of microbial exposure could explain the increase of atopic diseases seen in the last 20 years in developed countries, as the "hygiene hypothesis". Recently, it was proposed that early exposure to lipopolysaccharide (LPS) could be protective against atopic diseases. However, it is well established that exposure to LPS can induce asthma symptoms, both in animals and humans, although it induces a Th1 inflammatory response. In addition, most infections induce asthma exacerbations and Th1 responses. Recently, some studies have showed that some Th1 cells were present in asthmatic patients, which could be related to bronchial hyperreactivity. There is therefore an "infectious paradox" in asthma, which contributes to show that the Th2 paradigm is insufficient to explain the whole inflammatory reaction of this disease. We propose that the Th2paradigm is relevant to atopy and inception of asthma albeit a Th1 activation would account at least in part for bronchial hyperreactivity and asthma symptoms.