Forced expirations in normal subjects. Is the shape of the flow rate curve related to existence of a wheeze?

The flow rate curve takes different shapes during forced expirations performed by normal subjects. In some cases a wheeze may exist. In this study, we examine the conditions for appearance of a wheeze, before and after the peak flow, and the relationship between the wheeze and the shape of the flow rate curve. We analyzed ten parameters in 83 forced expirations produced by 32 normal subjects (16 men and 16 women) using multidimensional scaling techniques. Among these expirations, 53 presented a wheeze. The first two axes of the analysis define a plane on which forced expirations are divided into four quadrants. Two opposite quadrants (upper right and bottom left) contain the wheezing expirations, while the two others only have the ones with no wheezing. This distribution corresponds to specific shapes of the flow rate curve. We found that wheezes are associated with two main shapes. One of them consists of a short onset until a sharp peak, followed by a fast exponential decay. The other is about triangular, with a late appearance of the wheeze, and is only produced by women.

Comparison of two oral antibiotics, roxithromycin and amoxicillin plus clavulanic acid, in lower respiratory tract infections.

In a randomized, multicenter, open-label study, 490 ambulatory adult patients with lower respiratory tract infection (LRTI) were randomized to roxithromycin (ROX) 150 mg b.i.d. orally (n = 244) or amoxicillin plus clavulanic acid (AMX + CA) as 500 mg AMX + 125 mg CA t.i.d orally (n = 24). Clinical results were analyzed in 477 patients with acute bronchitis (79%), chronic bronchitis (CB) (14%), and pneumonia (7%). There were significantly more patients with underlying disease (cardiovascular diseases, p = 0.045; and alcoholism, (p less than 0.001), and more patients over the age of 65 years (p = 0.045) in the ROX group. Overall clinical efficacy was similar in both groups: 88% (206:235) in the ROX group and 85% (205:242) in the AMX + CA group. Side effects were reported in 67 cases (28%) in the AMX + CA group and in 21 cases (9%) in the ROX group (p less than 0.0001), causing withdrawal in 21 and three cases, respectively (p less than 0.001). Thus, despite being administered to a significantly older and more ill group of patients with LRTI, roxithromycin was as effective as amoxicillin plus clavulanic acid and better tolerated.

Simultaneous discovery of bilateral intralobar and extralobar pulmonary sequestrations.

We describe the rare case of bilateral bronchopulmonary sequestrations, one intralobar and one extralobar, in a 22-year-old man. The coexistence of two forms of separated sequestrations with a common vascularization support the theory that intralobar as well as extralobar sequestrations are congenital malformations.

[Contribution of flow cytometry in the prognostic evaluation of non-small-cell lung cancers. Review of the literature]. / Apport de la cytométrie en flux dans l'évaluation du pronostic des cancers bronchiques non à petites cellules. Revue de la littérature.

The flow-cytometry (FCM) is a method of quickly determining the desoxyribonucleic acid (DNA) content of tumoral cells. This provides us with two results: the DNA-ploidy which characterizes quantitatively the DNA, and the percentage of cells in DNA synthesis phase (%S). The contribution of FCM in evaluation of the prognosis of non-small cell lung cancer remains disputable. The absence of standardization between laboratories makes it difficult to compare the different studies to define the place of FCM analysis. However, for epidermoid carcinomas, the most actively studied, a DNA diploidy and a weak %S have a favourable impact on survival. No conclusion can be drawn from the studies on adenocarcinomas. Large cell carcinomas have never been studied in an isolated manner, due to the lack of numbers.

[Prognostic value of flow cytometry in squamous cell bronchogenic cancer. A retrospective study of 61 cases]. / Valeur pronostique de la cytométrie en flux dans les cancers bronchiques épidermoïdes. Etude rétrospective à propos de 61 cas.

To assess the prognostic value of flow cytometric analysis, 61 cases of operated squamous cell lung carcinoma were studied in terms of desoxyribonucleic acid (DNA) nuclear content and percentage of cells in DNA synthesis phase (% S). These parameters were determined on a fresh surgical sample. The S % was obtained in 25 cases. DNA index (DI) and % S were compared with survival and usual clinicopathologic characteristics for the prediction of survival. DNA content classified as DNA-diploid and DNA-aneuploid is not a prognostic factor for survival. DI higher than 2 seems to be predictive but needs confirmation. The % S and multiploidy are not predictive factors for survival.

[Prognostic evaluation of small cell lung carcinoma by flow cytometry. A retrospective study from bronchial brushing samples]. / Evaluation pronostique du carcinome bronchique à petites cellules par cytométrie en flux. Etude rétrospective à partir de prélèvements par brossage bronchique.

The authors determined the desoxyribonucleic acid (DNA) content of 45 small-cell lung cancers, by flow-cytometry (FC), from bronchial brushings to asses the prognostic meaning of the DNA index, the percentage of cells in DNA synthesis phase (% S) and the ploidy. Moreover, the value of this tumorous cells brushing was assessed for Flow-cytometric analysis. Bronchial brushing offers some advantages opposite to biopsies, but the low quantity of collected cells reduces the number of tumors analysable by FC. The output is low (39%) for determination of DNA index, and moreover low (22%) for determination of % S. In regard to the flow-cytometry analysis, the DNA content does not show any significant difference of survival where as the % S is related to survival, but it seems to be paradoxical in this study. Indeed, patients with small-cell lung cancer associated to high cells' percentage in DNA synthesis phase have the longest survival.

[Anorexia associated with bronchial cancer]. / Anorexie au cours du cancer bronchique.

Anorexia is a frequent complaint in patients suffering from bronchial cancer. It is linked to multiple factors, organic, biological and psychological. The treatment of anorexia implies an involvement with all these factors. If it persists, it may be improved by corticosteroids or by derivatives of progesterone independently of the control of the tumour process.

[Relieving the obstruction caused by malignant tracheobronchial tumors under flexible endoscopy]. / La désobstruction des tumeurs malignes de l'arbre trachéo-bronchique sous endoscopie souple.

OBJECTIVES: We evaluate the feasibility and the efficiency of electrosurgery in the treatment of the symptomatic malignant tracheobronchial tree obstructions (MTTO) when it is used with flexible fiberoptic bronchoscopy without general anesthesia. METHODS: The aim of electrosurgery was to restore the permeability of the tracheobronchial tree to suppress symptoms. The operation lasted no more than 60 minutes, and a second operation was performed 8 days later if symptoms persisted. The patients received local anesthesia and light sedation (midazolm). PATIENTS: 28 patients have been treated from june 1995 to june 1996 for following symptoms: dyspnea (22 cases), cough (1 case), dyspnea and cough (5 cases). All patients had malignant disease palliatively treated. RESULTS: The protocol has failed in one case, needing general anesthesia. 27 patients have had one session, 6 a second one week later. After the first session, dyspnea was improved in 22/27 cases (81.5%) and cough in 5/6 cases (83%). After the second session, dyspnea was globally improved in 26/27 cases (96%), without change for cough. CONCLUSION: Electrosurgery is a feasible and safe treatment which can implement immediately without general anesthesia, in MTTO. Its result are highly effective on dyspnea but less on cough, with reproducible effects and a well-tolerated procedure. Further investigations need to compare the different techniques.

[Evolvements in the presentation of primary bronchial adenocarcinomas observed in a pneumology service over an 11-year period]. / Evolution de la présentation des adénocarcinomes bronchiques primitifs observés dans un service de pneumologie pendant 11 ans.

The evolution of the clinical presentation, endoscopy and radiology in a consecutive series of 121 cases of primary bronchial adenocarcinoma has been studied in a retrospective manner over a period of 11 years. The mean age was 60 +/- 12 and 16.5% of the patients were women. The frequency of smoking and the quantity smoked in packed years was significantly higher in men than in women. The frequency of the presenting signs and the endoscopic features did not change over the period. On the other hand, the peripheral and mediastinal-hilar forms were more frequent from 1990 in a significant manner so that the hilar form became rarer. The result seems to confirm an increase in the frequency of a new radio-clinical expression of primary bronchial adenocarcinoma. These mediastinal-hilar adenocarcinomas do not have specific characteristics but are associated with a higher mortality.

[Fistulous pulmonary abscess in the bronchi detected by staphylococcal spondylodiscitis, with the presence of bony sequestra in the bronchial secretions]. / Abcès pulmonaire fistulisé dans les bronches révélateur d'une spondylodiscite staphylococcique, avec présence de séquestres osseux dans les sécrétions bronchiques.

The authors report the case of a man aged 70 who was admitted to hospital for staphylococcal pulmonary suppuration which occurred during the long-term follow-up for an osteosynthesis for a fractured humerus. The diagnosis of a pulmonary abscess in contiguity with a staphylococcal spondylodiscitis was only established by computed tomographic examination and the aspiration from a vertebral body. The outcome was fatal, despite appropriate antibiotic treatment, on account of the past medical history of the patient. The diagnosis might have been made by the presence of osseous sequestra in the bronchial secretions, the bronchial fistulae in contiguity with the vertebral column was confirmed at autopsy.

[Endodermal pulmonary tumor resembling a fetal lung]. / Tumeur pulmonaire endodermique ressemblant au poumon foetal.

We report a case of a 56-year-old man who developed a flu-like syndrome associated with weight loss. Chest X-ray revealed a homogeneous round lesion of the lung with sharply defined margins in the central lobe. At pathology, the tumor was found to be an endodermal pulmonary tumor resembling a fetal lung. This uncommon tumor is generally a fortuitous chest X-ray finding seen as a rounded peripheral opacity. Diagnosis is based on pathology examination of the surgical specimen. Complementary investigations are not contributory. Unlike blastoma, a differential diagnosis, prognosis is generally good.

[Severe pneumonia with a pneumococcal aspect during an ornithosis outbreak]. / Pneumopathies sévères d'allure pneumonique, au cours d'une épidémie d'ornithose.

OBJECTIVES: To describe the clinical, radiological and biological features of Chlamydia psittaci pneumonia. METHODS: A pneumonia outbreak occurred in a healthy middle-aged population working in a poultry slaughterhouse. Systematic serology (2 samples at 5 weeks intervals) provided the diagnosis of Chlamydia psittaci pneumonia in 6 patients. Patient files were analyzed retrospectively. RESULTS: The clinical presentations in this series of pneumonia were particularly homogeneous with a pneumococcal profile in all 6 cases: sudden onset, temperature above 39 degrees C, lobar alveolar involvement, hypoxemia, hyperleukocytosis and liver dysfunction. One case of hallucinatory delirium was observed. The patients were given spiramycin (9 million units per day for 3 weeks) and all recovered rapidly with no complications. CONCLUSION: The unusual virulence of the Chlamydia psittaci and very important inoculum were probably involved in this outbreak because of the severity of the pulmonary features and the short exposure of some patients to the bacteria. These cases suggest that the prevention of ornithosis in poultry slaughterhouses should be reinforced.

[Pulmonary lesions after inhalation of nitrous vapors]. / Lésions pulmonairs après inhalation de vapeurs nitreuses.

Nitrous vapours are oxidants and they create fibrosing lesions in the distal bronchioles and alveoli. The degree of oedema in the initial lesion influences the development of acute respiratory failure and the prognosis in the initial term. We have seen a case of acute hypoxic interstitial pneumonia following accidental inhalation of nitrous vapours with lesions of bronchiolitis obliterans. The outcome subsequently followed the usual pattern and there was a complete cure with steroid therapy.

[Multifocal fibrosclerosis (retroperitoneal, mediastinal, mesenteric and pelvic involvement) associated with vasculitis and revealed by a livedo: clinical, histopathological and ultrastructural study in a case (author's transl)]. / Fibrosclérose multifocale (médiastinale, rétropéritonéale, pelvienne, avec mésentérite rétractile) associée a une vascularite et révélée par un livedo. Etude clinique, histopathologique et ultrastructurale.

A 22-year-old male patient was seen with vasculitis and subcutaneous nodules on arms and legs. Discret thoracic venous dilations were noticed and venography demonstrated obstruction of the superior vena cava. Clinical and biological examination, roentgenograms revealed no sign of immunological disease but led to the diagnosis of mediastinal and retroperitoneal idiopathic fibrosis. No drug could be incriminated. Right hydronephrosis obliged to a surgical bilateral ureterolysis combined with systemic steroid therapy. Histological and ultrastructural examinations on retroperitoneal biopsies showed dense collagenous fibrosis, with vasculitis. Perivascular infiltrate was mainly composed of extravased erythrocytes and lymphocytes. Fibrin deposits were seen around implicated vessels. Direct immunofluorescence investigations were negative. These morphological features seem to be in agreement with the physiopathological hypothesis of sclerosis. No retroperitoneal or mediastinal fibrosis extension occurred three years after surgical procedure, and under corticosteroid therapy. Similar vasculitis with mediastinal and retroperitoneal idiopathic fibrosis have previously been reported in only one case by R. W. Carton and R. Wrong. Multifocal fibrosclerosis is the generic term currently used, since Comings et al. (1967), to describe a group of fibrosing conditions which affect separate organ systems. Findings suggest that retroperitoneal fibrois, mediastinal fibrosis, sclerosing cholangitis, Riedel's thyroiditis and pseudotumors of the orbit may be different manifestations of a single disease whose pathogenesis remains obscure.

[Surgical vein reconstruction in patients with tumor invasiveness of the superior caval system. Retrospective study of 7 cases]. / Reconstruction veineuse chirurgicale devant un envahissement tumoral du système cave supérieur. Etude rétrospective de 7 cas.

We studied retrospectively all patients who underwent vascular reconstruction after tumor invasion of the superior vena cava in order to assess the surgical procedure. Seven patients were operated including 5 with compression of the superior vena cava. Compression regressed within 24 hours without recurrence. Reconstruction had no effect on morbidity and mortality. One patient is still alive after a 5 year follow-up. Invasion of the superior vena cava is not a contraindication for resection of a tumor localized in the thorax and may contribute to cure as it improved patient comfort in all cases.

[Can outcome of varicella pneumonia be predicted in a non-immunosuppressed patient?]. / Peut-on prévoir l'évolution d'une pneumopathie varicelleuse chez un sujet non-immunodéprimé?

Varicella rarely occurs in the adult but can cause multi-organ complications. The most frequent (15 to 30% involve varicella pneumonia of unpredictable outcome. In the healthy adult, outcome can be favourable in 5 days or inversely lead to respiratory distress and death in 10 to 20% of the cases. An analysis of the published cases does not reveal any factor predicting unfavourable outcome. A register of varicella pneumonia would help identify potential predictive factors.

[Phase II trial evaluating the effect of megestrol acetate-prednisolone combination in the treatment of anorexia during the palliative-care phase of lung cancer]. / Essai de phase II évaluant l'effet d'une association acétate de mégestrol et prednisolone dans le traitement de l'anorexie au cours du cancer bronchique en phase palliative.

OBJECTIVES: Anorexia is one of the most frequent complaints in patients who have reached the palliative-care phase of lung cancer. Megestrol acetate (or medroxyprogesterone acetate) and corticosteroids have been used with success, but the effect of their combination remains unknown. We conducted a phase II trial to assess the impact of combination therapy. PATIENTS AND METHODS: Patients with lung cancer given palliative care and who developed anorexia with or without weight loss were given 320 mg/d megestrol acetate in 2 doses and 40 mg/d prednisolone in one dose in the morning for 1 month. The principal outcome criterion was anorexia assessed on a visual analog scale prior to treatment and then at day 15 and day 30. Variation in daily calorie intake and weight were also recorded. We used an Armitage sequential plan to determine the number of inclusions necessary and the preference method (closed schema) to evaluate the principal outcome criterion. RESULTS: Inclusions were stopped after the eighth patient (giving p<0.05) as we observed a significant improvement in patient appetite. Daily calorie intake improved significantly (p<0.0001), by 39.18% the first 15 days and 16.57% more the next 15 days. Body weight improved significantly by 5.4% in one month (p=0.5). No treatment-related complication occurred during the study period or during the six consecutive months. CONCLUSIONS: The megestrol acetate-prednisolone combination was found to improve anorexia in patients with lung cancer in the palliative-care phase and allowed a significant improvement in calorie intake and body weight.

[Angiosarcoma of the thoracic wall revealed by hemothorax]. / Angiosarcome de la paroi thoracique révélé par un hémothorax.

Angiosarcoma is an uncommon tumor accounting for approximately 1% of all soft tissue tumors which, themselves account for 0.7% of all malignant tumors. Thoracic parietal localizations are reported exceptionally and prognosis is poor. We report the case of a 79-year-old woman who developed an angiosarcoma of the thoracic wall. The inaugural symptom was a hemothorax. Besides the localization, this case was particularly exceptional since the patient has remained asymptomatic three years after treatment by wide resection followed by radiotherapy.