[Early detection of smoking related chronic obstructive pulmonary disease in Vietnam]. / Détection précoce de la bronchopneumopathie chronique obstructive post-tabagique au Viet Nam.

INTRODUCTION: Epidemiological studies of chronic obstructive pulmonary disease (COPD) are rare in the developing countries, particularly in Viet Nam where the consumption of tobacco continues to increase. The aim of this study was to evaluate the feasibility of early screening of smokers for bronchial obstruction using the Piko-6 apparatus. MATERIALS AND METHODS: Smokers over 40 years of age who had smoked for more than 10 years were included. The subjects were classified into 3 groups according to the degree of bronchial obstruction measured by the Piko-6. (group 1: FEV1/FEV6>0.8; group 2: 0.7-0.8; group 3:<0.7). The smokers in group 3 and a sample of the smokers in groups 1 and 2 were recalled for full spirometric assessment. RESULTS: 2397 smokers were included, comprising 2130 active smokers and 267 ex-smokers. The mean age was 52 +/- 13 years. The mean smoking history was 24 +/- 13 pack years. 267 smokers from the 3 groups responded to the recall for full investigation. The prevalence of COPD detected by the Piko-6 in the study population was 13.5%. For the threshold FEV1/FEV6<0.7 and with the detected prevalence, the Piko-6 had a sensitivity of 97.8%, a specificity of 93.8%, a positive predictive value of 71% and a negative predictive value of 99.6% (confidence interval 95%). CONCLUSIONS: The Piko-6 is a useful tool for the early screening for COPD in smokers in a developing country where the prevalence of this disease appears to be under estimated.

[Aspergillus niger responsible for a tracheo-oesophageal fistula in an immunocompetent patient]. / Aspergillus niger responsable d'une fistule trachéo-oesophagienne chez un sujet immunocompétent.

Tracheal or bronchial aspergillar locations are rare. They are mainly found in patients with general or localised immune deficiency. The authors report the case of a 53-year-old Vietnamese immunocompetent patient without any factors of risk who suddenly came down with a perforation syndrome indicating a tracheo-oesophageal fistula. The bronchial samples helped identify Aspergillus niger as the agent incriminated. Surgical treatment associated with an antifungal treatment provided a cure without any recurrence for 3 years.

Predictive factors for late toxicity after endobronchial brachytherapy: a multivariate analysis.

PURPOSE: To determine the predictive factors associated with hemoptysis and radiation bronchitis after endobronchial brachytherapy by univariate and multivariate analyses METHODS AND MATERIALS: One hundred forty-nine patients underwent endobronchial brachytherapy and were divided into three therapeutic groups: group 1: patients treated with palliative intent (n=47); group 2: patients treated with curative intent (small endobronchial tumors without mediastinal or general dissemination: n=73); group 3: patients also receiving external irradiation (n=29). One hundred twelve patients had previously received external irradiation. Brachytherapy was delivered with a dose per fraction ranging from 4 to 7 Gy and a prescription point between 0.5 and 1.5 cm, usually 1 cm from the source center. Two to six fractions were delivered according to the therapeutic group and clinical situation. The influence of the following variables on the incidence of hemoptysis or radiation bronchitis was studied: age, sex, Karnofsky score, therapeutic group, histologic type, endoscopic tumor length, dose per fraction, total brachytherapy dose, total external beam irradiation dose, total dose (brachytherapy dose plus external irradiation dose), volumes of the 100% and 200% isodoses, and volumes of the 7 and 14 Gy isodoses. RESULTS: We observed 11 hemoptyses (7.4%), 10 were lethal. All but one occurred in patients with progressive disease. Two clinical factors were significantly associated with hemoptysis by univariate analysis: palliative group (p=0.009) and endobronchial tumor length (p=0.004). No technical factors seem to be implicated in the occurrence of hemoptysis. Only endobronchial tumor length remained in the multivariate model (p=0.02). Radiation bronchitis was observed in 13 cases (8.7%). By univariate analysis, a good Karnofsky score (p=0.02), curative treatment (p=0.02), and tumor location on trachea and main stem bronchus (p=0.002) were significantly associated with this complication. Two technical factors were also incriminated: the total dose (p=0.04) and the 100% isodose volume (p=0.02). By multivariate analysis, only the tumor location retained statistical significance (p=0.009). CONCLUSION: Hemoptysis is most likely due to disease progression, with the bleeding being facilitated by brachytherapy. Some rare cases could be a direct complication of brachytherapy itself, particularly when tumors are located in the upper lobes. In contrast, radiation bronchitis occurred more frequently in patients with controlled disease, and was significantly influenced by tumor location and technical factors (dose and volumes treated). Technical improvements should increase the therapeutic ratio.

An uncommon etiology of isolated pleural effusion. The ovarian hyperstimulation syndrome.

We report three cases of pleural effusion in the context of ovarian stimulation for in vitro fertilization. The ovarian hyperstimulation syndrome usually causes pleural effusion and ascites. When the latter is lacking, an isolated pleural effusion in a pregnant patient can be mistaken for pulmonary embolism. Early recognition of the condition should allow for an appropriate diagnostic and therapeutic management. Except for some rare but life-threatening complications, such as major hypovolemia or respiratory distress syndrome, the spontaneous outcome is usually favorable. The pathogenesis of this condition may involve an increase of capillary permeability due to the release of vasoactive mediators.

Prolonged survival after high-dose rate endobronchial radiation for malignant airway obstruction.

STUDY OBJECTIVE: To show that prolonged survival can be observed after high-dose rate (HDR) endobronchial brachytherapy as the sole treatment for some selected patients presenting with an endobronchial malignant obstruction. PATIENTS: Twenty-nine patients (group 1) who presented with an endoluminal localized tumor without metastatic extension were treated by HDR endobronchial brachytherapy and are compared with 22 subjects who presented with extraluminal dissemination and were palliatively treated (group 2). TREATMENT PROTOCOL: Treatment consisted of sessions of two exposures, delivering 7 Grays at a 10-mm radius from the center of the applicator each, and repeated every 15 days, to a maximum of six exposures. Endoscopic response and survival are the main criteria of assessment. RESULTS: Follow-up bronchoscopies, performed 2 months after the end of the procedure, showed tumor regressions: macroscopic complete responses (CR) were observed in 21 of 25 patients evaluable in group 1, and 6 of 22 in group 2, with histologic CR in 18 and 2 patients, respectively. Median overall survival was not reached in group 1 after 23 months of follow-up; it was 5 months for group 2. CONCLUSIONS: These results confirm that HDR brachytherapy can be used as a monotherapy for carefully selected patients who have small tumors to all appearances limited to the bronchial lumen and bronchial wall without adjacent parenchymal extension or metastatic disease.

Bronchoscopic cryotherapy for airway strictures caused by tumors.

This study reports an application of cryosurgery for the treatment of tracheobronchial tumors. Bronchoscopic cryotherapy can be applied in patients who are not candidates for other traditional therapy. The technique utilizes a nitrous oxide cryoprobe, introduced through a rigid bronchoscope. The principal feature of this probe is to be nonrigid. The cryodestruction is controlled by an impedance metric method. The study group consisted of 27 patients ranging in age from 39 to 88 years. The most frequent diagnosis was squamous cell carcinoma (14). For malignant tumors, the objective was obtained in 13 cases out of 21. Cryotherapy successfully destroyed five benign granulomas. Four or six days after cryotherapy, bronchial biopsy specimens usually showed a necrotic substance, and tumoral tissues were entirely destroyed. The time of survival is probably extended and the quality of life bettered. Most visible tumors are now reached with a flexible cryoprobe, inserted in a flexible bronchoscope.

Pleural and lung cryobiopsies during thoracoscopy.

Cryotherapy through rigid bronchoscopy has been used in the past three years in the treatment of endobronchial tumors. We performed pleural and lung cryobiopsies during thoracoscopy. The hemostatic properties and the quality of the histopathologic specimens obtained using this technique offer an innovative approach to the diagnosis of pleural effusion with associated lung disease.

Cryotherapy for tracheobronchial disorders.

Cryotherapy is the therapeutic application of extreme cold for local destruction of living tissue. This technique has been shown to be effective and safe in treating endobronchial lesions, particularly in patients with endobronchial carcinoma and airway obstruction. This article describes cryotherapy and its use in treating tracheobronchial disorders.

[Sequential chemotherapy and radiotherapy modalities in small cell lung carcinoma. Preliminary results]. / Chimiothérapie et radiothérapie séquentielles dans les carcinomes anaplasiques bronchiques à petites cellules. Résultats préliminaires.

Two non randomized therapeutic trials have been conducted in oat cell carcinoma of the lung with limited disease. The first protocol combined chemotherapy (adriamycin, cyclophosphamide, VM 26, procarbazine) with mediastinal and supra-clavicular radiotherapy in classical fractionation (40 grays in 4 weeks). The second combined a more intensive chemotherapy (adriamycin, VP 16, methotrexate, cyclophosphamide) with an alternating radiotherapy (3 series of 15 grays). All patients received prophylactic brain irradiation. Preliminary results show a 9 month survival rate of 34 per cent and 62.5 per cent respectively. In addition, all patients in the second protocol presented a complete response at the end of the induction treatment. These preliminary data encourage proceeding with this kind of combined treatment.

[Postoperative radiotherapy in non-small cell lung cancer. Apropos of a series of 374 cases]. / Radiothérapie postopératoire dans le cancer bronchique non à petites cellules. A propos d'une série de 374 cas.

PURPOSE: Several randomized trials have led us to address the usefulness of post-surgical external beam therapy (EBT) in non-oat cell bronchial carcinoma. Results that were obtained in a group of 374 patients submitted between 1977 and 1994 to identical therapy-the follow-up being done by the same team-and results of six randomized trials are analyzed. PATIENTS AND METHODS: The tumor stages were the following: T1, 13%; T2, 56%; T3, 29%; and T4, 2%; N0, 31%; N1, 34%; and N2, 35%. There were 85% histologically complete resections. EBT was administered according to either the classical irradiation scheme (C) or as an 'equivalent hypofractionated dose' (H) in the case of complete resection. When resection was not complete, 60 to 65 Gy were administered according to a C or an H irradiation scheme. The irradiation scheme was C in 73% of the cases and H in 27%. The EBT technique has been chosen to ensure maximum lung sparing. Following a 45 Gy-irradiation with anteroposterior beams, orthogonal or, when necessary, oblique beams were used. Non homogeneity of the lungs was taken into account in establishing the treatment planning. The treatment file was collectively checked by the medical staff in 75% of the cases. EBT was indicated for N+(N1+N2), T3 and incomplete resections. RESULTS: The overall survival was 42% at 5 years and 27% at 10 years. The 5-year survival was 52% for stage I cancer (T1N0-T2N0), 60% for stage II cancer (T1N1-T2N1), 31% for stage IIIa cancer (T3N0, T1-3N2), 45% for complete resection and 30% when resection was not complete. CONCLUSION: Regarding the benefits of post-surgical radiotherapy, the analysis of the six randomized trials does not allow any conclusion. This might be due to either the insufficient number of cases, a follow-up time not long enough, incorrect radiotherapy, or insufficient available data. Comparison of the results pertaining to the six trials with those of our series shows an advantage for the current series, indicating that survival is likely to be improved if EBT is correctly done with regard to the dose, volume and technique used.

[High-frequency thermocoagulation. Use in bronchial endoscopy]. / Thermocoagulation haute fréquence. Utilisation en endoscopie bronchique.

High frequency thermocoagulation is a relatively recent technique of destroying tracheobronchial tumour mass. It selects the thermal effect of electrical current whilst avoiding the electrolytic and faradic effects of nerve and muscle stimulation. With gentle coagulation which is generally utilised the tissues are heated to between 70 and 100 degrees with the formation of water vapour and immediate destruction of the tissues. The electrodes are usually unipolar and are either rigid or flexible. The HF current which circulates across the tissues is gathered and evacuated by neutral electrodes. A new generation of fiberoptic bronchoscopes which isolate the exit current may optimise the safety of the procedure. New generators delivering a stable voltage controlled by a microprocessor enable the control of the process of coagulation and adapt the thermal energy delivered to the volume and nature of the tissue to be destroyed. The electrode is put in contact with the tissues. The immediate effects is similar to those described with laser. The simplicity, speed of utilization, minimal morbidity and relatively low cost has made this an interesting technique even in developed countries where the investment budgets are becoming more and more limited.

[Primary bronchial carcinoma in elderly subjects in France]. / Le cancer bronchique primitif du sujet âgé en France. Résultats de l'étude KBP-2000 du Collège des Pneumologues des Hôpitaux Généraux (CPHG).

INTRODUCTION: There are few data on primary bronchial carcinoma in France. We report here the results of the study KBP 2000-CPHG in which there were 1868 patients aged 70 or more and 338 aged 80 or more. METHODS: We compared the patients under 70 (Group I) with those aged 70 or more (Group II) as well as with the details of the over 80's. RESULTS: Group II included significantly more women (17.4% vs 15.2%; p=0.04), non-smokers (11.2% vs 5.3%; p<0.0001), patients of poor performance status (24.2% vs 14.5%; p<0.0001) and squamous carcinomas (44.5% vs 37.8%; p<0.001) than Group I, but fewer adenocarcinomas (27.2% vs 31.5%; p=0.009) and as many small cell carcinomas (15.9% vs 16.9%; p=0.32). In Group II there were less stage III and IV tumours (75.1% vs 78.1%; p=0.0005) more symptomatic treatment (23.2% vs 6.1%) and radiotherapy alone (12.8% vs 3.8%; p<0.0001). The results were similar beyond 80 years. On multivariate analysis age, performance status and stage appeared to be independent variables in the choice of curative or symptomatic treatment. CONCLUSIONS: Age alone is not therefore a limiting factor in the choice of treatment.

[Primary lung cancer in elderly subjects in France]. / Le cancer bronchique primitif du sujet âgé en France. Résultats de l'étude KBP-2000 du Collège des Pneumologues des Hôpitaux Généraux (CPHG).

INTRODUCTION: There are few data on primary bronchial carcinoma in France. We report here the results of the study KBP 2000-CPHG in which there were 1868 patients aged 70 or more and 338 aged 80 or more. METHODS: We compared the patients under 70 (Group I) with those aged 70 or more (Group II) as well as with the details of the over 80's. RESULTS: Group II included significantly more women (17.4% vs 15.2%; p = 0.04), non-smokers (11.2% vs 5.3%; p<0.0001), patients of poor performance status (24.2% vs 14.5%; p<0.0001) and squamous carcinomas (44.5% vs 37.8%; p<0.001) than Group I, but fewer adenocarcinomas (27.2% vs 31.5%; p = 0.009) and as many small cell carcinomas (15.9% vs 16.9%; p = 0.32). In Group II there were less stage III and IV tumours (75.1% vs 78.1%; p = 0.0005) more symptomatic treatment (23.2% vs 6.1%) and radiotherapy alone (12.8% vs 3.8%; p < 0.0001). The results were similar beyond 80 years. On multivariate analysis age, performance status and stage appeared to be independent variables in the choice of curative or symptomatic treatment. CONCLUSIONS: Age alone is not therefore a limiting factor in the choice of treatment.

[Malignant non-Hodgkin's lymphoma of tracheo-bronchial sites]. / Lymphome malin non hodgkinien à localisations trachéo-bronchiques.

The case of a 66 years old male patient with multiple tracheal and bronchial lesions of non-Hodgkin lymphoma is reported. This was a disseminated form of low-malignancy lymphoma, as shown by histological findings. The lesions disappeared after 10 courses of chemotherapy, and no sign of recurrence was observed during a 3 years' follow-up. It is concluded that the prognosis of this disease depends on histology rather than on anatomical spread.

[Reevaluation of environmental factors in allergy to mites: bedding not a factor?]. / Réévaluation des facteurs environnementaux de l'allergie aux acariens: la literie innocentée?

Prospective multicentric study was conducted among parents of children referred in three allergy units. Unlike current opinions: carpets are less frequent in bedrooms of mite's allergic children. foam bedding don't play any role, local humidity non significantly increases the mite's allergy risk. the sunlight absence is significantly correlated with this hypersensitivity. These data, mainly inconsistent with general conviction, could be explained by socio economic diversity of patients.

[Lung autofluorescence. Preliminary study of two systems without laser illumination or photosensitization]. / Autofluorescence bronchique. Etude préliminaire portant sur deux systèmes sans illumination laser ni photosensibilisation.

When illuminated with a certain wavelength, lung tissue emits a weak fluorescence. The fluorescence from normal tissue is different from that from diseased tissue. This technique can thus be used for early diagnosis of precancerous lesions. Technical manipulations are required to amplify the fluorescence signal. Numerous studies have used the LIFE (Lung Imaging Fluorescent Endoscope) to study lung diseases. This system of detection uses a laser helium-cadmium excitation source; the principal photosensitizing agents are hematoporphyrin derivatives. The cost, bulkiness and secondary effects have limited diffusion of this type of photodynamic diagnostic system. We have used 2 systems (SAFE 1000 Pentax and D-LIGHT Storz) successively in a prospective study to analyze autofluorescence of lung tissue without laser illumination or photosensitization. Fifty-four patients were selected for their risk factors. We were able to detect one case of severe dysplasia but did not identify any case of carcinoma in situ. Among 18 cases, 16 were evident with white light. Two were detected with autofluorescence used to orient biopsies while white light had only revealed a common inflammatory aspect. Thirty-nine low-grade lesions (metaplasia, dysplasia) were found. The systems are easy to use. Lower cost would allow more widespread use of these systems currently reserved for risk populations. These techniques broaden the scope of interventional endoscopy.

[Inhaled foreign bodies in 50 patients in South Vietnam, mainly caused by naseberry (Sapodilla)]. / Une série de 50 cas d'inhalation de corps étranger au Sud Viêt-nam (cause principale: le noyau de sapotier).

Inhalation of foreign bodies is relatively frequent in children, but exceptional in adults. Various kinds of foreign bodies can be inhaled, the type generally depends on eating habits in adults. We reviewed a series of 50 consecutive cases of inhaled foreign bodies and found that naseberry fruits (Sapodilla plum) was the primary cause, followed by bone debris. This series is typical of Eastern Asia, particularly South Vietnam. Most of the foreign bodies were extracted under local anesthesia using fibroscopy with a foreign body forceps. Most of the foreign bodies were on the right side. The naseberry nut is not radio-opaque, so diagnosis was generally established late after infectious complications. The endoscopic aspect was typical and should be recognized by endoscopists working in Vietnam.

[Evaluation of different fibroscopic sampling techniques for the diagnosis of isolated peripheral pulmonary nodules. A prospective study of 74 cases in Vietnam]. / Evaluation des différentes techniques de prélèvement par fibroscopie pour le diagnostic des nodules pulmonaires isolés périphériques. Etude prospective de 74 cas, réalisée au Viêt-nam.

Isolated pulmonary nodules raise serious diagnostic problems. Combined imaging and endoscopic methods can often avoid exploratory thoracotomy. The situation is different however in developing countries where health facilities and technical availability are quite variable. Bronchial fibroscopy without image guidance can provide the diagnosis is an acceptable number of cases. We conducted a prospective study in 74 patients. After chest x-ray and CT scan of the lesion of interest, bronchial lavage was performed in each patient with brushings samples in 71 and transbronchial biopsy in 68. Riu staining was performed immediately in the endoscopy suite, providing an almost immediate diagnostic approach. The combination of lavage, brushing and biopsy provided a diagnostic yield as good as the brushings and biopsy combination. These endoscopic techniques gave the diagnosis of the specific lesion in 52 cases (70%). Most involved cancer but there were 15 cases of tuberculosis diagnosis, which remains frequent in developing countries.

[Treatment of bronchial tumors with high-frequency thermocoagulation. Preliminary studies]. / Traitement des tumeurs bronchiques par thermocoagulation haute fréquence. Etude préliminaire.

Several techniques are available for endobroncheal tissue destruction. The cost and nature of the effect of the different techniques are determining factors in deciding on which equipment to use. Electrocoagulation is an old method which has practically been abandoned in favour of high frequency coagulation. This technique has an immediate effect, somewhat like the laser. We treated 32 patients with inoperable malignant (17) or benign (5) tumours obstructing the trachea or the bronchi. Response to treatment was evaluated on clinical manifestations and endoscopic findings. Haemostasis was obtained in 11/12 cases and tumour destruction of more than 50% in 27/32 cases. Complications included haemoptysia in 2 patients followed by death due to respiratory failure in 1. The ERBOTOM ACC 450 equipment was piloted with a microcomputer to control the power output automatically. White coagulation was induced by slow heating up to 70-100 degrees C causing tissue vaporization. The cost of this multiple applications of this equipment is competitive.

[Cryotherapy in the treatment of tracheobronchial obstructions of tumor origin]. / La cryothérapie dans le traitement des obstructions trachéo-bronchiques d'origine tumorale.

The effects of cold on tissues result in necrosis through crystallisation and thrombosis. These properties, utilized for many years in certain fields of medicine, can now be applied to bronchial tumours, using semi-rigid or flexible cryodes introduced into bronchoscopes. In our experience the results, evaluated by clinical, radiological, endoscopic or even histological improvement, were good in 7 out of 8 cases of benign tumours and in 16 out of 30 cases of malignant tumours. Complications were minimal. This relatively cheap and very simple method constitutes a good alternative to laser in the same pathologies.