[Evaluation of pulmonary function in the elderly. Intergroupe Pneumo Gériatrie SPLF-SFGG]. / Evaluation de la fonction respiratoire chez le sujet âgé. Intergroupe Pneumo Gériatrie SPLF-SFGG.

Aging is associated with a progressive decrease in lung function. As a consequence of aging, individual's reserve is diminished, but this decrease is heterogeneous between individual subjects. Many factors are involved in the overall decline in lung function. The prevalence of asthma in the elderly is estimated between 6 and 10%. Mortality due to COPD is increasing, especially among older subjects. Older subjects are at an increased risk of developing chronic diseases such as Parkinson's disease, which can have consequences for lung function. Under-nutrition is also common in the elderly and can produce sarcopenia and skeletal muscle dysfunction. The presentation of respiratory disorders may differ in the elderly, especially because of a lack of perception of symptoms such as dyspnea. The impact of bronchodilatators or corticosteroids on respiratory function has not been studied in the elderly. Drugs usually used for the treatment of hypertension or arrhythmias, which are often observed with aging, can have pulmonary toxicity. There is no difference between functional evaluation in younger and older subjects but it is more difficult to find predicted values for older patients. Performing pulmonary function tests in older patients is often difficult because of a higher prevalence of cognitive impairment and/or poor coordination. When assessing pulmonary function in the elderly, the choice of tests will be depend on the circumstances, with the use of voluntary manoeuvres dependent on the condition of the patient.

Cisplatin and vindesine for disseminated non-small cell lung cancer. Results of a prospective trial with 81 patients.

Eighty-one patients with disseminated non-small cell lung cancer (stage IV) were treated with 2 monthly cycles of initial chemotherapy combining cisplatin with vindesine. The initial chemotherapy-responding patients (CR, PR, MR) were randomized to 2 cycles or 4 cycles of maintenance chemotherapy. After initial chemotherapy, the response rate was 33% (CR, PR, MR) with 18.5% objective responses. The overall 1-year survival rate was 15% with 37% for responders as opposed to 2% for non-responders. Maintenance chemotherapy did not improve the response rate obtained after initial cycles. The small number of patients does not allow us to reach a definite conclusion on the optimum duration of maintenance chemotherapy. In the absence of large placebo versus chemotherapy randomized trials, no definite conclusion can be made on the benefit of chemotherapy in disseminated non-small cell lung cancer. This study suggests, however, that chemotherapy is associated with a significantly longer survival in responding patients.

[Value of nifedipine in respiratory failure related to obstructive chronic bronchitis during treatment over 6 months]. / Intérêt de la nifédipine dans l'insuffisance respiratoire liée aux bronchites chroniques obstructives au cours d'un traitement de six mois.

We studied the simultaneous effects of nifedipine on the pulmonary circulation and blood gases in 12 patients with pulmonary hypertension secondary to obstructive chronic bronchitis. Measurements were carried out at rest and during stress, initially then one hour after administration of 20 mg of nifedipine sublingually. They were repeated in a similar fashion after a 6-month treatment with 60 mg/day (group II) (30 mg/day in case of intolerance) (group I). The results of the immediate effect of nifedipine are in favor of a passive pulmonary vasodilatation secondary to the systemic vasodilatation. After six months of treatment, the pulmonary vasodilatation persists, but is associated with a decreased motor pressure indicating a more specific and more active pulmonary vasodilating effect of long-term nifedipine, especially during stress; this results in the improvement of the performance of the right ventricle without harmful effect on the blood gases. However, these results should be interpreted with caution on account of the small number of patients, the large interindividual variations and the absence of a reference population.

[Mode of action of corticoids in asthma]. / Mode d'action des corticoïdes dans l'asthme.

Generally speaking, corticosteroids exert their effects on cells through genomic and non genomic mechanisms. They both suppress and enhance numerous biological phenomena. In asthma, corticosteroids act at different levels. They: inhibit chemical mediators, whether these are performed, like histamine, or newly formed, like arachidonic acid metabolites (prostaglandins and leukotrienes) or the platelet-activating factor (PAF); restore the sensitivity of beta-adrenergic receptors to sympathomimetic drugs; exert a powerful anti-inflammatory effect, notably reducing bronchial mucus secretion; reduce bronchial hyperreactivity and modify the bronchial response to bronchoconstrictors; act on respiratory function and gas exchanges. Many effects of corticosteroids in asthma involve the synthesis of proteins, such as lipomodulin (or macrocortin) which inhibits phospholipase A2, a key-enzyme in the synthesis of numerous chemical mediators derived from membrane phospholipids. The multiple effects of corticosteroids account for their broad spectrum of activity and their effectiveness against both acute and chronic manifestations of asthma.

[Auscultation of pulmonary rales, from Laënnec to phonopneumography]. / L'auscultation des râles pulmonaires, de Laënnec à la phonopneumographie.

The invention in 1819 of the stethoscope by Laënnec was followed by the first classification of pulmonary adventitial sounds. A number of new nomenclatures based upon acoustic principles have subsequently been suggested. Phonopneumography consists of the recording of respiratory sounds and their breakdown into different harmonics by frequential analysis. Broadly speaking, a distinction is drawn between continuous sounds, including sibilants and rhonchi, and discontinuous sounds, covering crepitations and coarse rales.

[Bilateral chylothorax after mild trauma: apropos of a case]. / Chylothorax bilatéral après un traumatisme minime: à propos d'un cas.

The authors report a new case of bilateral chylothorax predominant on the left side, which occurred after movements of body trunk hyperextension in a 52-year old woman without any notable history. The clinical signs revealing the lesion were left thoracic pain and dyspnoea. The effusion had been preceded by a painless and transient left cervical tumefaction. The outcome was favourable after two left pleural draining punctures and rest.

[The role of inhalation chambers in the treatment of asthma]. / Place des chambres d'inhalation dans le traitement de l'asthme.

Inhalation chambers (spacers), interposed between the aerosol doser and the patient's mouth take 3 forms: lengthened tubes, large volume plastic sacs and conical chamber in the shape of a pear. Their chief advantages are: A greater proportion of the drug reaches the airways, as the deposition in the oropharynx is reduced. Co-ordination of lung and hand, a major obstacle to the correct use of aerosol-dosers, is no longer necessary.

[Inflammatory polyp: a rare benign endobronchial tumor]. / Le polype inflammatoire: une tumeur endobronchique bénigne rare.

We report a case of inflammatory polyp in a male patient, which was totally obstructing the left main bronchus but could be removed by simple endoscopic traction. The polyp was responsible for an absence of left lung ventilation which in turn produced by reflex an absence of left lung perfusion completely reversible after removal of the polyp. Inflammatory polyp is a rare benign tumour. Its physiopathology is controverted, but it seems to result from local irritation of the bronchial mucosa. Bronchial endoscopy is the essential examination which in most cases make it possible to diagnose and treat the tumour.

[Veno-occlusive disease of the lung]. / La maladie veino-occlusive du poumon.

This paper is a review of current data on a rare pathology which causes primary pulmonary arterial hypertension: pulmonary veno-occlusive disease. The manifestations of the disease consist of dyspnoea of progressive onset, crepitations in the lower pulmonary lobes and diffuse interstitial syndrome with Kerley's B lines. These signs are associated with severe hypoxia and severe pulmonary arterial hypertension with paradoxically normal wedge pressure. Pathological specimens must be obtained to confirm the diagnosis. They show thrombosis of pulmonary veins less than 2 mm in diameter and sometimes of arterioles, presence of connective tissue with few cells and images of recanalization, muscularization of pulmonary arterioles, lesions of interstitial nodular fibrosis and presence of haemosiderin-rich macrophages. The disease is frequently associated with other pathologies, including heart disease, blood disease and pulmonary capillary haemangiomatosis. In recent years, veno-occlusive disease has been found to occur immediately after chemotherapy for cancer and bone marrow or kidney transplantation. Three physiopathological hypotheses have been put forward to explain the disease: infection, autoimmune reaction and toxic reaction.

[Comparative study of 2 assay methods for serum isoniazid in 413 patients: microbiological method and high performance liquid chromatography]. / Etude comparative de 2 méthodes de dosage de l'isoniazide sérique chez 413 patients: méthode microbiologique, chromatographie liquide à haute performance.

Serum INH was assayed by 2 techniques over 4 years in 413 patients following the administration of a single test dose of 300 mg of isoniazid. The microbiological method measures the inhibitory activity of the serum on the growth of mycobacteria. The pharmacological method consists of high performance liquid chromatography with ultra-violet detection (HPLC). The mean difference in the assays performed by the 2 methods in each subject was 0.061 mcg/ml and the global correlation between the 2 assays was 0.76. Liquid chromatography also allows the simultaneous assay of acetyl INH. Thirty-three per cent of the subjects who received a test dose of 300 mg of INH had a serum INH concentration of between 1 and 2 mcg/ml at the third hour. This study therefore confirms the usefulness of a pre-treatment assay of INH and the good correlation of the results obtained with the 2 methods.

Six vs twelve cycles for complete responders to chemotherapy in small cell lung cancer: definitive results of a randomized clinical trial. The "Petites Cellules" Group.

Of 320 patients with small cell lung cancer (SCLC) entered into a clinical trial of chemotherapy between January 1983 and September 1985, 106 patients achieved a complete response. The induction chemotherapy used was lomustine 60 mg.m-2 p.o., cyclophosphamide 1 g.m-2 i.v., doxorubicin 45 mg.m-2 i.v. and etoposide 150 mg.m-2 i.v., every four weeks. Lomustine was only given for the first three cycles. Seventy nine of the 106 patients still in complete response after six chemotherapy cycles were subsequently randomized to receive either six more cycles or no more treatment until relapse. In this group of 79 patients, a difference was shown from the time of inclusion between the 51 patients with limited disease and the 28 patients with disseminated disease, with overall median survivals of 395 and 165 days, respectively, (p = 0.0002). No difference was shown between the two treatment groups: the median survival was 332 days from the time of second randomization with a two year survival rate of 28% for the patients randomized to receive six more cycles and 246 days and 22% for those randomized to receive no more treatment (add 147 days to obtain overall median survival). Continuing chemotherapy for more than six cycles to patients in complete response did not improve survival.

[Scattered arterioveinous fistulae of the lung associated with alcoholic cirrhosis : about one case complicated by neurological involvement (author's transl)]. / Fistules artério-veineuses pulmonaires diffuses associés à une cirrhose : à propos d'un cas avec complication neurologique.

We report case of 49 years old woman suffering from severe alcoholic cirrhosis and presenting arterioveinous fistulae of the lung which evidence was given by selective arteriography. Quantitative analysis of vasoactive intestinal polypeptide show no modification ; mecanism of the opening of fistulae could no be found. This observation is noteworthy in consideration of lung lasting evolution (4 years) and out come of neurological complication (must likely due to cortical phlebitis).

[Interstitial pneumopathies during amiodarone treatment. Determination of serum amiodarone, typing of lymphocytes from bronchiolo-alveolar lavage]. / Contribution à l'étude des pneumopathies interstitielles au cours de traitement par amiodarone. Dosages d'amiodarone sérique, typage des lymphocytes du lavage bronchiolo-alvéolaire.

We report 6 cases of diffuse interstitial pneumonia complicating therapy. The patients' study included the determination of amiodarone plasma level by high performance liquid chromatography (HPLC) and a study of lymphocyte subpopulations in alveolar lavage (wash cut). The mean cumulative dosage of amiodarone was 229 g; clinical symptoms were mainly weight loss, asthenia, dyspnea and dry cough. Bronchiolo-alveolar lavage fluids contained numerous lymphocytes, of which were T cells with a predominance of T8 lymphocytes. This is compatible with an immunoallergic mechanism as suggested in allergic alveolitis and in other drug induced pulmonary diseases. The determination of plasma amiodarone level performed after amiodarone withdrawal consistently showed a level inferior to the toxic one. These data confirm the lack of correlation between the pneumonitis outbreak and the amiodarone plasma level. Study of the red cell concentration of amiodarone and its major metabolites seems to be of greater interest.