Pulmonary function assessment during bleomycin therapy.

20 male patients were treated for various tumors, most of them by combination therapy program including Cis-diammino-dichloroplatinum, Methotrexate and Bleomycin, the mean total dose for this last drug being 225 mg in 3 months (75 mg-300 mg). Spirometric tests, carbon monoxide diffusing capacity (DLCO) and its components Dm (membrane diffusing capacity) and Vc (capillary blood volume) were performed before each course and at the end of the chemotherapy, to assess their value in detecting Bleomycin pulmonary toxicity. There was no statistically significant change in any ventilatory nor diffusional test among these 20 patients, carefully selected for the absence of cardiopulmonary history. There was a slight decrease of DLCO for 3 patients having received 300 mg of Bleomycin. The lack of cardiopulmonary history, the mean total dose under the toxic threshold, and perhaps the insufficient delay between the end of the treatment and the last control test, may explain this absence of variability of functional tests.

[Gas exchanges on effort in diffuse pulmonary emphysema (author's transl)]. / Les échanges gazeux à l'effort dans l'emphysème pulmonaire diffus.

With the aim of determining the causes of hypoxia which develops on effort in certain emphysema sufferers, gas exchange at rest and effort were studied in 28 patients with diffuse pulmonary emphysema (including one third with large bullous form), with the exclusion of any clinical evidence of bronchitis or asthma. These patients, selected on the basis of the similarity of their clinical, radiological, mechano-spirographic and diffusion criteria, behaved very differently in terms of their gas exchanges during a moderate effort (mean VO2 = 750 ml/mn). The first group of 12 subjects showed a significant fall in pO2 (- 10.5 mmHg on average). The second group of 16 subjects improved by 4 mmHg hypoxaemia present at rest (though more marked than in the first group). The various parameters studied of ventilation, blood gases, and diffusion appeared to indicate a preponderant role played by distributive problems, and in particular the Qs/Qt ratio (calculated on the Fenn and Rahn pO2 and pCO2 diagram) which worsened on effort in the first group whilst it improved in the second, as well as the greater degree of desaturation of mixed venous blood on effort in the first group. The difficulties of a valid physiopathological interpretation are emphasized.