[Fatal acute pneumonopathies in disseminated lupus erythematosus]. / Pneumopathies aiguës mortelles au cours du lupus érythémateux disséminé.

Two cases of systemic lupus erythematosus (SLE) complicated by pneumonia which resulted in death are reported. The first patient, a 21-year old woman, died of acute diffuse lupus pneumonia; the initial and unusual radiological image of "multiple balloons" progressed within 2 months to terminal interstitial fibrosis. The second patient, a 60-year old woman, died of infection on an interstitial pneumonia which turned into severe fibrosis within 16 months. Acute or chronic lupus pneumonia is uncommon, but it may follow a very serious course. Clinically, true lupus pneumonia must be distinguished from all other types of lung involvement in SLE, such as infection, pulmonary haemorrhage or oedema, iatrogenic pathology, thromboembolic disease, etc. The pathogenetic mechanism of pulmonary lesions directly related to SLE is obscure, although some lung biopsy specimens have shown positive immunofluorescence. Concerning treatment, the initial response to corticosteroid therapy is usually very good, especially in the acute forms of the disease. However, in severe cases immunosuppressive drugs or even plasma exchanges must be added to steroids. For treatment to be rapidly initiated the diagnostic procedures must be completed in the early stages of the disease, involving, when necessary, surgical lung biopsy.

[A new case of associated sarcoidosis and tuberculosis, or the close relationship between 2 granulomatous diseases...]. / A propos d'un nouveau cas d'association sarcoïdose-tuberculose, ou les rapports intimes de deux maladies granulomateuses...

The case reported here concerns a 30-year old male patient who had both very severe, multivisceral tuberculosis and equally severe sarcoidosis, with repercussions on the respiratory function that required corticosteroid therapy. Prolonged anti-tuberculous therapy and corticosteroids gave favourable results. This case is remindful of an old debate which opposed the two diseases on account of their histological lesions. It offers a new example of the severity of tuberculosis in "immunocompromised" patients, and it raises anew the still unresolved problem of the individuality of sarcoidosis in pulmonary pathology.

Peripheral blood and tumor-infiltrating mononuclear cell analysis in esophagus and head and neck cancer.

We show a significantly decreased number of OKT3+ lymphocytes in the peripheral blood (PB) of cancer patients mainly due to a reduced number of OKT4 cells. OKT8 cells were also somewhat reduced. The numbers of DR+ and interleukin-2 receptor-bearing T-cells were significantly increased in patients. The tumor-infiltrating cells included OKT4+ AND OKT8+ lymphocytes. There was a significant correlation between the proportion of activated T-cells in PB and in tumor, as shown by DR and interleukin-2 receptor expression.

Predictive value of T-cell subset derangements in lung cancer.

The proportions of T-lymphocytes, T-lymphocyte subsets, NK cells, DR determinant and interleukin-2 receptor-bearing T-lymphocytes were enumerated in 39 patients with lung cancer prior to any chemotherapy. T-lymphocytes, suppressor/cytotoxic T-cells and interleukin-2 receptor-bearing T-cells were found to be significantly higher in patients responding than in those not responding to chemotherapy. Such mononuclear cell subset analysis by monoclonal antibodies might be additional information to consider before undertaking treatment.

Preoperative chemotherapy in epidermoid bronchogenic carcinoma.

Palliative chemotherapy in cases of epidermoid bronchogenic carcinoma, initially judged to be inoperable, made it possible to perform operative resection in 50 cases. An association of cis-platinum and bleomycin was used, this combination having previously been considered synergistic. In certain cases the tumour seemed to have disappeared on macroscopic examination of the resected specimen, and in some instances no tumoral cells could be found on histological examination. This series brought out several positive features: chemotherapy made it possible to operate on patients previously judged to be inoperable; it ensured maximum local efficiency of drugs because of the absence of abnormal vascularity; and it made it possible to anticipate the cure of occult metastases. However, three negative aspects were also present: modification of postoperative TNM classification making it difficult to establish a prognosis; difficulty in determining therapeutic strategy for pNo; and inadequate long-term follow-up. On the whole the positive points appeared to outweigh the negative aspects, but a randomized study is necessary to confirm this.

[Current status of Wegener's syndrome. Apropos of 2 cases]. / Actualité du syndrome de Wegener. A propos de 2 observations.

In the context of two recent cases, the authors briefly review the clinical, laboratory and anatomical features of Wegener's granulomatosis and, in particular, its clinical course in response to treatment. These 2 cases include fairly original features: one case presented with abundant haemoptysis with a radiological picture of extensive diffuse bilateral pneumonia; the other case presented with a very large pleural effusion with no E.N.T. involvement whatsoever. The authors then summarise the classical features of this severe form of granulomatous vasculitis, which essentially affects the lungs, the kidneys and the ear, nose and throat. The lesions have a typical histological appearance. The major interest of this disease lies in its treatment. The natural evolution of this disease is very serious with a mean survival of 5 months. However, with immunosuppressant and corticosteroid treatment, a complete remission is obtained and maintained in more than 90% of cases. The therapeutic protocol used, as in one of the present cases, prevents the development of the lesion responsible for the very serious prognosis, irreversible renal failure.

Antiperinuclear activity in lung carcinoma patients.

Antiperinuclear factor (APF) might be a specific serum rheumatoid factor directed towards keratohyaline granules. It was found to be present in 40 of 79 (50.6%) patients with primary and in 21 of 36 (58.3%) patients with metastatic lung cancer, compared with 12 of 95 (12.6%) sex- and age-matched normal controls. Additionally, APF frequency and titer correlated well with tumor dissemination, even though no relationship could be shown with histopathological type.