[Aspergillus bronchitis and aspergilloma treated successfully with voriconazole]. / Un cas d'aspergillome associé à une bronchite aspergillaire traités par Voriconazole.

INTRODUCTION: Aspergillus fumigatus is a ubiquitous soil-dwelling organism, which can cause both aspergillomas which develop in a preformed lung cavity, and aspergillus bronchitis. The two pathologies can occasionally co-exist, notably in patients with of cystic fibrosis. CASE REPORT: We describe a 57 year old patient, with diffuse bronchiectasis, who developed aspergillus bronchitis as well as an aspergilloma complicating a cavity caused by an atypical mycobacterial infection. After one month of therapy with voriconazole the aspergilloma had decreased in size and the endobronchial changes had resolved. CONCLUSION: This case report illustrates that in addition to its established role for the treatment of invasive aspergillosis, voriconazole is a promising new therapy for the treatment of aspergilloma and aspergillus bronchitis.

[Neoadjuvant chemoradiotherapy and peroperative radiotherapy for non-small-cell lung cancer of the apex. A study of 5 cases]. / Chimio-radiothérapie néoadjuvante et radiothérapie per-opératoire dans les carcinomes non à petites cellules (CBNPC) de l'apex. Etude dur 5 cas.

The management of superior sulcus tumors with Pancoast 's syndrome is not well defined, especially in view of their low frequency. Even if surgery performed by "en bloc" resection of the tumor and the chest wall is recommended, neoadjuvant treatment could have a potential benefit on the resecability and pain control. We report five cases of Pancoast tumors (NSCLC), treated by radiotherapy and chemotherapy before surgery. Four tumors was on stage IIIb. A regimen with radiotherapy (50 Gy) and chemotherapy (cisplatinum + etoposide) was initially performed. Four tumors were resected, with 2 complete pathologic responses and good control on pain. Three patients received radiotherapy during surgery. No toxic reaction was observed. This regimen may be discussed with locally advanced tumors and poor prognosis.

[Unrecognized occupational risk of pleural mesothelioma. The example of the Rhône-Alps region]. / Méconnaissance du risque professionnel de mésothéliome pleural. Exemple de la région Rhône-Alpes.

A retrospective study of pleural mesothelioma diagnosed between 1980 and 1988 in the Rhône-Alpes région allowed to identify 224 cases. From the 187 patients in which occupational history was available 105 (56%) had been exposed to asbestos at work and 44 had been recognised as occupation disease and compensated. These data illustrate that the real incidence of the disease is largely underestimated and that legal procedure for occupational disease recognition is highly deficient.

[Penetration of antibiotics in alveolar macrophages compared by in vitro and in vivo data in man]. / Pénétration des antibiotiques dans les macrophages alvéolaires comparaison des données in vitro et in vivo chez l'homme.

Optimal therapy of infections caused by intracellular organisms requires an active antibiotic prone to intracellular penetration. This phenomenon has been studied on alveolar macrophages as well in vitro as in vivo for most groups of antibiotics. The comparison of data shows that the values obtained by incubation are not predictive of what happens in situ. These results must be taken in account for the choice of an antibiotic in pulmonary infections as well as its spectrum, pharmacokinetic, and possible side effects.

Spiramycin uptake by alveolar macrophages.

The in-vitro and in-vivo uptake of spiramycin by human and animal alveolar macrophages was studied. In-vitro penetration was studied in guinea pig and human alveolar macrophages incubated in medium 199 at 37 degrees C containing spiramycin at various concentrations. Results were expressed as the cellular/extracellular concentration ratio (C/E). The in-vivo study was performed in patients receiving 500 or 1000 mg spiramycin every 8 h as a 1-h infusion on day 1. A single infusion was given on day 2, 2 h before serum and bronchoalveolar lavage (BAL) sampling. Spiramycin was assayed by HPLC, and by a microbiological assay. In guinea pig alveolar macrophages, the C/E ratio of spiramycin after 60 min at 37 degrees C was 20.3 +/- 6.5 when the concentration was 10 mg/l. In human alveolar macrophages, the C/E ratio was 21.3 +/- 8.7 at 5 mg/l spiramycin and 23.8 +/- 8.7 at 50 mg/l. The accumulated spiramycin was slowly released when the cells (guinea pig alveolar macrophages) were washed and re-incubated in antibiotic free medium. Spiramycin was able to penetrate the alveolar space. In BAL supernatant, spiramycin levels were about 24-fold the serum level (n = 6 patients), when the BAL/serum glucose ratios were used as the dilution estimate. Alveolar macrophage levels ranged from 17 to 210 mg/l (n = 6 patients receiving 500 mg spiramycin infusion). These results are consistent with the in-vitro data.

Determination of rifampicin, desacetylrifampicin, isoniazid and acetylisoniazid by high-performance liquid chromatography: application to human serum extracts, polymorphonucleocytes and alveolar macrophages.

A method for the determination of rifampicin, desacetylrifampicin, isoniazid, and acetylisoniazid by high-performance liquid chromatography and using the same extract of the same sample is reported. After protein precipitation and extraction of these antituberculous drugs, two reversed-phase chromatographies were necessary. The technique was applied to serum extracts, polymorphonucleocytes and alveolar macrophages from patients treated for tuberculosis.

[Is there a pleural involvement in bird-breeder alveolitis? (author's transl)]. / L'atteinte pleurale au cours des alvéolites aviaires existe-t-elle?.

The authors report the observation of a bird-breeder lung in which the first sign was a pleural involvement, as the serosa biopsy revealed lymphoplasmocytic inflammatory infiltrates, lesions compatible with this interpretation. No such observation was found in the literature. The true incidence of these eventual pleural involvements during these allergic diseases remains to be evaluated as well as their etiopathogenic determinism.