Detection of cytomegalovirus, Pneumocystis carinii, and aspergillus species in bronchoalveolar lavage fluid. A comparison of techniques.

Cytomegalovirus (CMV), Pneumocystis carinii, and Aspergillus species are common causes of fatal pulmonary infections in immunocompromised hosts. Therefore, rapid and reliable methods of establishing the diagnosis of these types of pneumonia are essential. Bronchoalveolar lavage (BAL) has proved to be a rapid and safe procedure for procuring large numbers of bronchial and alveolar cells from the lung. To assess various methods of detecting CMV, P. carinii, and aspergillosis in lavage specimens, 47 BAL samples from adults at high risk for these infections were evaluated. The visualization of these agents was performed by cytologic examination and in situ hybridization for CMV; cytologic examination, Gomori's methenamine silver (GMS) stain, and immunofluorescence for P. carinii; and cytologic examination, GMS stain, and immunocytologic studies for Aspergillus species. Cytomegalovirus was detected in 2 of 47 specimens (4%) by cytologic examination and 7 of 47 (15%) by in situ hybridization. Cells with nuclear and/or cytoplasmic inclusions invariably were labeled with the CMV DNA probe. The weak diagnostic value of the cytologic examination resulted from the absence of characteristic inclusions in many specimens with positive results by in situ hybridization. P. carinii was the most frequent pathogen isolated from BAL fluid (9 of 47 cases; 19%). It was found in 1 of 47 specimens (2%) by the cytologic examination of Papanicolaou-stained smears, 4 of 47 (8.5%) by the GMS stain, and 8 of 47 (17%) by immunofluorescence. Most P. carinii-positive cases (five of nine cases) were detected by immunofluorescence only. Aspergillus species was diagnosed in 2 of 47 specimens (4%) by cytologic examination and GMS staining. Immunocytologic studies had positive results in these specimens and detected one additional case of Aspergillus infection (3 of 47 cases; 6%). These data show that techniques using CMV DNA probes and anti-P. carinii or anti-Aspergillus antibodies are rapid and more sensitive than conventional diagnostic procedures.

Intestinal permeability to chromium-51 ethylenediamine tetraacetic acid in children with chronic obstructive respiratory disease: relationship with clinical and duodenal biopsy findings.

Intestinal permeability (IP) to 51-Cr ethylenediamine tetraacetic acid was investigated in 47 children with chronic obstructive respiratory disease (CORD). Endoscopic duodenal biopsies were performed in 22 of these patients. IP was significantly increased in CORD patients when compared to either control children or adults (P less than 0.001). Mean +/- 1 SD were 4.3 +/- 1.71%, 2.5 +/- 0.78%, and 2.3 +/- 0.77% in the three groups, respectively. IP was not related to the presence of atopy. Significant differences in IP results were found between CORD children with abdominal pain (4.5 +/- 1.4%) and both control children and CORD patients without abdominal pain (2.5 +/- 0.78% and 3.2 +/- 1.49%, respectively). A significant correlation was found between small bowel injury on the one hand and IP on the other hand (P less than 0.02). Furthermore, small bowel injury was significantly related to the presence of abdominal pain (P less than 0.05). We speculate that in CORD patients with abdominal pain, a factor exists that causes small bowel injury responsible for both abdominal pain and increased small bowel permeability. Food intolerance could, presumably, play a role in the mucosal damage-linked IP increase found in the subset of CORD patients who complain of abdominal pain.

Serum beta 2-microglobulin levels in chronic post-transfusion non A non B liver disease.

Serum beta 2-microglobulin (beta 2 mu), a reliable marker of T-cell activation, was measured in 25 patients with chronic post-transfusion non A non B (NANB) liver disease and in 21 patients with HBsAg positive chronic liver disease. beta 2 mu levels were elevated in NANB patients when compared with controls but not in comparison with the HBsAg carriers. In NANB patients, beta 2 mu concentrations were significantly correlated with serum IgG (P less than 0.001) and with circulating immune complex activity, assessed by the 125IClq binding test (P less than 0.01). These findings suggest that, in addition to T-cells, the B-cells contributed also to the beta 2 mu production. Patients with "active disease" (chronic active hepatitis and active cirrhosis) had significantly higher beta 2 mu levels (P less than 0.001) than did those with "inactive disease" (chronic persistent hepatitis and inactive cirrhosis). This relation of serum beta 2 mu concentrations and histological activity was also observed in the HBsAg carriers and suggests that the course of post-transfusion NANB chronic hepatitis could be determined by host's immune response rather than by a direct effect of the virus.

[Fatal toxic hepatitis associated with administration of dantrolene (author's transl)]. / Hépatite toxique mortelle associée à l'usage du Dantrolène.

A 50 year-old female diabetic patient with disseminated sclerosis presented fatal cholestatic hepatitis about ten weeks after the initiation of dantrolene therapy (600 mg/day). Clinical findings, biochemical results and the appearance of hepatic biopsy are described and compared with other cases reported to date. Hypotheses regarding the hepatotoxicity of dantrolene and essential precautions to be taken when using this medication are deduced.

[Primary pulmonary leiomyosarcoma. Review of the literature apropos of a case]. / Le léiomyosarcome pulmonaire primitif. Revue de la littérature à propos d'une observation.

A 55-year-old patient with primary pulmonary leiomyosarcoma was treated by pneumonectomy. The diagnosis was established by histology of the operative piece. Bronchoscopy and cytology of expectorations were negative. This rare tumor (fewer than 100 cases described) differs from bronchial carcinoma by its method of spread, mainly hematogenic, and its better prognosis. clinical and radiographic data do not provide differential diagnoses. Treatment is essentially surgical since the tumor is only weakly radio-sensitive and responds poorly to chemotherapy.

[Bronchogenic cysts. A clinical and regional lung function study before and after surgery (author's transl)]. / Kystes bronchogéniques. Deux cas avec études cliniques et fonctionnelles régionales avant et après traitement chirurgical.

Studies of regional lung function were performed on two children with bronchogenic cysts before and after surgery. The first patients, aged two, presented with a severe and continuous airflow obstruction leading to significant disturbance of perfusion per unit of alveolar volume; the abnormalities of perfusion were partly reversible when the ventilation was restored after surgery. Patient no 2, aged 10 years, had a voluminous peripheral cyst, which was shown to be ventilated by pulmonary function studies and further confirmed by bronchography. After lobectomy, studies revealed a reduction in the functional pulmonary parenchyma in the right hemithorax. The abnormal distribution of perfusion was still seen two years after the operation.

Intravascular bronchioloalveolar tumour.

We report the clinical and histological characteristics of a case of intravascular bronchioloalveolar tumour, a rare multicentric pulmonary neoplasm of endothelial origin. This tumour affects predominantly women under 40 years of age and causes initially few symptoms. The disease may be found incidentally on a routine chest X ray. This tumour has a low metastasizing capacity and survival rate is quite high.