Double-blind comparison of tulobuterol and salbutamol in chronic obstructive pulmonary disease.

A double-blind study compared tulobuterol (2 mg BID), a new beta 2-adrenergic agent, with salbutamol (2 mg TID) in 40 hospitalized men with chronic obstructive pulmonary disease. The study evaluated the bronchospasmolytic effects of the two drugs and their selectivity of action. Measurements and observations were made for six hours after the first oral dose, daily during nine days of continuous therapy, and for 12 hours after the final dose on the tenth day. Results show that the tulobuterol regimen produced a significant (P less than 0.01) improvement of the forced expiratory volume in one second equal to an increase of 25% above the pretreatment value, versus 16% with the salbutamol regimen. Cardiovascular effects appeared more rapidly with tulobuterol, but they stabilized to values lower than those observed with salbutamol. No clinically important adverse reactions were reported other than slight tremor, which was not objectionable.

[A case of pulmonary distomiasis (author's transl)]. / Distomatose pulmonaire: une observation.

Pulmonary distomiasis due to Paragonimus westermani was discovered in a young 21-year-old patient from Thailand following several bouts of hemoptysis. The authors review the published literature and outline the principal characteristics of this affection, emphasizing the radiological appearances and the possible value of bronchial arteriography.

[The influence of a new beta agonist: formoterol on mucociliary function]. / Influence sur la fonction muco-ciliaire d'un nouveau bêta-agoniste: formoterol.

The muco-ciliary apparatus has an essential role in the cleansing of the tracheo-bronchial tree of particulate matter. Disturbances linked to muco-ciliary function are well known in respiratory pathology and in cases of chronic bronchitis and asthma and lead to a reduced capacity for cleansing. In addition there are numerous pharmacological agents including sympathomimetics which are capable of altering the ciliary activity and the rheological properties of mucous. The role of Formoterol, administered as an aerosol has been assessed in vivo in 10 bronchitic patients who were in a stable state. After 6 days of treatment using the Formoterol aerosol the muco-ciliary clearance had significantly increased to 46% and was a real gain when compared to the muco-ciliary clearance measured on placebo. This gain was linked to a better function of the muco-ciliary carpet and not due to the bronchodilatation which was induced by Formoterol, because the penetration index did not change. At the same time the airway resistance was slightly reduced in a none significant fashion.

[Pneumopathy induced by pirindopril. A case report]. / Pneumopathie induite par le pirindopril. A propos d'un cas.

Cough is known to be the major respiratory side effect of treatment with angiotensin converting enzyme inhibitors (ACEI). Recently, ACEI have been implicated in drug-induced lung disease. We report a new case of diffuse pneumonitis which occurred during treatment with ACEI. A 73-year-old man was admitted for cough, dyspnea at rest, fever and weight loss. The patient had been treated with the ACEI pirindopril during 6 months for systemic hypertension. Chest radiographs showed reticular infiltrates in the upper lung fields. A CT scan confirmed the infiltrates and showed pleural thickening and airspace opacities. White blood cell counts showed 15,700/mm3 leucocytes with 940 eosinophils/mm3. Transbronchial biopsy was consistent with infiltration of the lung with eosinophils. There was no evidence for another etiology. Once the drug was withdrawn, clinical and radiological abnormalities improved but steroids were required to control symptoms. This report suggests that pirindopril, as captopril, can induce the picture of drug-induced pulmonary disease.

[Post-traumatic pulmonary hematomas. Apropos of 2 cases]. / Hématomes pulmonaires post-traumatiques. A propos de deux observations.

Post-traumatic pulmonary hematoma presents clinically as a hemorrhagic collection within a newly-formed cavity in the lung parenchyma. Its frequency is probably underestimated in view of the importance of the associated lesions. The most frequent clinical sign is hemoptysis. The chest radiograph, as well as the CT scan, shows a clearly defined round image. As a rule, there is a favorable outcome with slow resorption over several weeks, with a restoration of the integrity of the pulmonary parenchyma, which justifies simple observation, with an absence of any therapeutic intervention.

[Immunotherapy of recurrent respiratory infections. Double-blind study of a new immunomodulator in 60 patients]. / Immunothérapie des infections respiratoires récidivantes. Etude en double aveugle d'un nouvel immunomodulateur chez 60 patients.

A new immunomodulator, SLO4 oral drops, was tested for treatment and prevention of recurrent respiratory infections in a double-blind, drug versus placebo trial conducted in 60 adults with chronic bronchitis or asthma. This agent brought about a highly significant reduction in the frequency and duration of infectious episodes, as well as a decrease in antibiotic consumption and lost work time. Well tolerated from the clinical and laboratory points of view, it proved remarkably effective. It has been hypothesized that induction of interferon may account for the excellent clinical results obtained with SLO4, and numerous authors regard this compound as one of the basic keys to regulation of immune reactivity. Pharmacological trials under way with SLO4 should help answer this question.

[Prescription of Theostat 300 as a single evening dose]. / Prescription du Théostat 300 en prise unique le soir.

Sixteen patients with asthma and/or chronic obstructive lung disease were treated for 8 days by scored tablets of sustained-release theophylline. Treatment was administered as a single evening dose per day, 2 hours after dinner, at a daily dosage of 10 mg/kg/day of theophylline. The theophylline curve remained in the theoretical therapeutic zone of 8 to 15 mcg/ml for about 14 hours; the clinical efficacy, evaluated on the basis of the improvement in the signs and symptoms, was satisfactory. The clinical acceptability was good apart from insomnia observed during the first 2 days of treatment.

[Does extrinsic asthma exist?]. / L'asthme extrinsèque existe-t-il?

Asthma cannot be triggered exclusively by external causes, even allergy. For it to develop, the subject must have pathological bronchial hyper-reactivity. On the contrary, however, asthma cannot be explained solely by intrinsic causes, metabolic or endocrine. It persists only in those subjects who have bronchial hyper-reactivity. The authors suggest a new definition of asthma, designed to replace the semi-logical definition of Charpin: Asthma is a dyspnoeic bronchospasmodic crisis that is linked with the existence of pathological bronchial hyper-reactivity.

[Skin tests in the exploration of perianesthetic complications]. / Intérêt du bilan cutané dans l'exploration des accidents per-anesthésiques.

Adverse reactions in anesthesia are more and more frequent. The favoring factors are multiple but the physiopathology of these reactions are not right known: non specific histamine-release, complement activation is anaphylaxis can occur. Skin tests are an very important data for the diagnosis of these accidents. Forty patients and ten healthy subjects were tested with systematic research of a cross-reactivity for curare family; myorelaxants, fluid gelatin, dextran are the tests the most frequently positive. Cross reactivity for curare family is sure and sensibilization by some medicine is possible. Then the behavior of the data is looked at; the research of the favoring factors, the non utilization of some substances and prophylactic treatment are recommended.

[Bronchopulmonary hamartochondroma (apropos of 136 cases, including a homogeneous series of 124 cases). Review of the literature]. / Les hamartochondromes broncho-pulmonaires (à propos de 136 cas, dont une série homogène de 124 cas). Revue de la littérature.

On the basis of a series of 136 hamartochondromas, the largest ever published, the authors review the clinical and paraclinical characteristics of bronchopulmonary hamartochondromas. After describing their pathological study, particular attention is paid to the controversial pathogenesis of these tumors before dealing with therapeutic aspects. Review of the literature.

[Long-term tolerability of formoterol in chronic obstructive bronchopathies]. / Tolérance à long terme du Formotérol chez des bronchopathes chroniques obstructifs.

Formoterol aerosol, a long-acting new beta 2-mimetic was administered over a year at a dose of 12 micrograms twice daily, to 62 chronic obstructive bronchitics of mean age 66 +/- 6 years and of whom the basal VEMS was at 12,801 +/- 0.59. Clinical tolerance of the product was good with undesirable effects in 13 patients, the most frequent being shaking. No untoward effect was seen on systolic or diastolic arterial pressure, or the heart rate over successive visits at 1, 3, 6, 9 months and one year. Electrocardiographic surveillance found in only four patients electrical abnormalities that may be due to Formoterol, these were patients without previous cardiac problems but of advanced mean age. Functionally, a significant improvement of basal VEMS was noticed from the 6th month. The VEMS improved significantly after administration of 12 micrograms on successive visits, without tachyphylactic signs. Well tolerated, with functional benefits, Formoterol is a promising product amongst the long-acting beta 2-mimetics. Its usefulness and limitations in the basic treatment of these chronic bronchopathies remains to be defined.

[Pneumocystis carinii pneumonia radiologically simulating tuberculosis]. / Pneumonie à Pneumocystis carinii simulant radiologiquement une tuberculose.

The authors report a case of Pneumocystis carinii pneumonia simulating tuberculosis. Predominant upper lobes involvement is rarely seen but should be considered in immunocompromised patients.

[Kinetics of action of Vectarion. Ventilatory chemo-stimulant (author's transl)]. / Cinétique d'action du Vectarion, chémo-stimulant ventilatoire.

Vectarion has a powerful respiratory stimulant effect in animals and in man which is manifested by a significant and lasting increase in ventilation, as shown by a marked lowering of arterial P. CO2 and an increase in blood pH. This activity is maintained in dogs with experimental alkalosis or acidosis as well as during morphine or oxygen-induced respiratory depression. This respiratory stimulating action originates at the level of the aortic and carotid chemo-receptors: this explains why Vectarion is devoid of any epileptogenic risk. The aim of the present study was to demonstrate the peak of activity and duration of action of an intravenous perfusion of Vectarion, in such a way as to be able to plan administration all through the day and night.

[Multicenter, double-blind study of oral acetylcysteine vs. placebo]. / Etude multi-centrique en double aveugle avec acétylcystéine oral vs. placébo.

The mucolytic activity of acetylcysteine (NAC) was evaluated in a double-blind, placebo controlled, clinical trial performed in three pneumology centres and involving a total of 215 patients with the following diagnoses: 84 acute bronchitis, 95 superinfections of chronic bronchitis, 36 complicated bronchitis in patients with severe chronic respiratory insufficiency. Treatment consisted of 1 sachet of 200 mg NAC t.i.d. for 10 days. Standard antibiotic therapy (amoxycillin 1.5 g/day) was concurrently administered for 7 days. Statistical analysis comparing sputum volume and viscosity, sedation of cough and improvement of PEFR in 108 NAC and in 107 placebo treated patients, showed that NAC was very significantly more effective than placebo. The effect of NAC was negligible in the 36 patients with complicated bronchitis, whereas it was evident and remarkable in patients with acute and chronic bronchitis.

[Pulmonary metastasis from Vater's ampullomas]. / Les métastases pulmonaires des ampullomes vatériens

The authors report two cases of carcinoma of the ampulla of Vater with numerous pulmonary metastases. This carcinoma is a malignant tumour with a very poor short-term prognosis. This tumour develops at the expense of the ampulla of Vater and may give rise to numerous pulmonary metastases and carcinomato,s lymphangitis. Authors are not unanimous concerning the course and prognosis of these tumours. In fact, one may note two tendencies, one optimistic, which seems to us erroneous, the other pessimistic, which we share.