Cryotherapy in early superficial bronchogenic carcinoma.

BACKGROUND: Treatment of early superficial bronchogenic carcinoma (ESBC) is under debate, and no consensus has been achieved. Different therapeutic methods have been proposed, including surgical resection and endoscopic methods. STUDY OBJECTIVE: To assess the efficacy of cryotherapy in patients with ESBC. PATIENTS AND METHODS: Patients included in the study had histologically proven ESBC after fiberoptic bronchoscopy. Cryotherapy was performed through a rigid bronchoscope. Efficacy was assessed by endoscopy with multiple biopsies 1 month after treatment and during the follow-up period. Parameters studied were response to treatment, adverse effects, and survival. RESULTS: We included 35 patients (34 men and 1 woman). The mean age was 61 +/- 9 years. Multiple locations of ESBC were observed in seven patients (20%). Complete response rate at both 1 month and 1 year was 91% (32 patients). No severe adverse effects were noted. Local recurrence was observed within 4 years in 10 patients (28%). A follow-up period of at least 4 years was available in 22 patients; of them, 11 patients (50%) were long-term survivors. CONCLUSION: Our results suggest that cryotherapy is an effective method of treatment in patients with ESBC. Due to its relative tolerance compared to surgery, cryotherapy could be proposed as a first-line therapy in this population with high carcinogenic risk.

[Mediastinal fibrosis associated with Riedel's thyroiditis. Apropos of a case]. / Fibrose médiastinale associée à une thyroïdite de Riedel. A propos d'un cas.

The authors describe a case of mediastinal fibrosis in a 53 year old woman which presented with a superior venacaval syndrome ten years after the diagnosis of a Riedel's thyroiditis. The clinical and laboratory evidence did not reveal anything to suggest other fibrosing disorders (such as retroperitoneal fibrosis, extra-hepatic biliary fibrosis or orbital fibrosis) which could be associated either simultaneously or successively with this multi-focal fibrosis. The physiology of this disorder currently remains imprecise. A current hypothesis is that there is an immunological reaction in the periarterial area leading to lipid components make atheromatous plaques. The therapeutic means are limited and depend on the localisation of the fibrous tissue and of their functional repercussions. Currently, the benefit of corticosteroids on the mediastinal fibrotic lesions has not been demonstrated.

[Nephrotic syndrome complicating treatment with interferon alpha]. / Syndrome néphrotique compliquant un traitement par interféron alpha.

UNLABELLED: We report two cases of nephrotic syndrome with minimal glomerular change complicating alpha-interferon therapy. CASE REPORTS: The first patient was a 60-year-old man with Waldenström's disease who was given 1 million units of alpha-interferon three times a week for 22 months. Acute renal failure developed when a second protocol was started. Renal biopsy revealed intraglomerular deposits and no cellular proliferation. Total remission could not be achieved with corticosteroids. The second case was a 46-year-old man given high dose alpha-interferon (15 million units 3 times a week) for lymph node metastasis of a malignant melanoma. A nephrotic syndrome without renal failure developed during the third month of treatment. Minimal glomerular involvement was seen. Symptomatic treatment led to resolution of the nephrotic syndrome. DISCUSSION: Nine other cases of nephrotic syndrome complicating alpha-interferon therapy have been reported in the literature.

[Familial medullary thyroid cancer. Contribution of genealogy and genetics to the study of two families]. / Cancer médullaire familial de la thyroïde. Apport de la généalogie et de la génétique à l'étude de deux familles.

A geneological study made it possible to establish a link between two medullary thyroid carcinoma families from Normandy totalling 9 sick subjects, and a probable link with a third family. The study contributed to the diagnosis of multiple endocrine neoplasia type IIa, whereas the condition had been diagnosed for 6 years as familial medullary thyroid carcinoma, without phaechromocytoma. Group in these two families together increased the number of subjects tested, thereby facilitating genetic link analysis and enabling the link with markers of the disease on chromosome 10 to be asserted. The genetic study can now be used to detect individuals at risk, and with regular laboratory tests the diagnosis will be made at the "precancerous" stage. A genealogical study going back to the family-founding couple will increase the population which will benefit from screening in this region north of Rouen.

[Meteorological conditions and spontaneous pneumothorax. Retrospective study of 165 cases in the Rouen area]. / Conditions météorologiques et pneumothorax spontanés. Etude rétrospective sur 165 cas de la région rouennaise.

The occurrence of a spontaneous "idiopathic" pneumothorax in 165 patients admitted to hospital could be precisely dated over a 5-year period. An analysis of the meteorological conditions recorded at these dates (mean atmospheric pressure, mean temperature, relative and absolute humidity) and of their seasonal distribution demonstrated two peaks of frequency, one in the summer, the other in the winter, and a significant correlation between the occurrence of pneumothorax and a low relative humidity. These results, particularly clear during the exceptionally dry summer of 1976, confirm some data in the literature and suggest that bronchoconstriction induced by moistening of air in the airways might play a role in the pathophysiology of pneumothorax.

Evolution of peripheral nerve function in hypoxaemic COPD patients taking almitrine bismesylate: a prospective long-term study.

Almitrine bismesylate has been thought to provoke peripheral neuropathies in patients with chronic obstructive pulmonary disease (COPD). However, there seems to exist alterations of peripheral nerve function in patients with COPD, who have not taken almitrine. We have therefore examined 22 patients with COPD and no other cause of peripheral neuropathy (PN), before and after 6 and 12 months of treatment with almitrine (50 mg bd). Seventy-eight similar patients, who did not take almitrine, were also studied (controls). Sixty-four per cent of controls, and 55% of almitrine patients initially had at least one neurophysiological abnormality. There was no change in the studied parameters after 6 months and one year's treatment with almitrine.

Carbimazole-induced acute cholestatic hepatitis.

A case of carbimazole-induced cholestatic hepatitis is presented. A woman received carbimazole for hyperthyroidism for 3 months. Five months later, she had prompt recurrence of cholestasis parameters after rechallenge (2 days of treatment). Histologic examination showed predominantly centrilobular cholestasis. Only 5 other cases have been published in the literature. An idiosyncratic mechanism seems likely.

Susceptibility of Mycobacterium avium complex to various two-drug combinations of antituberculosis agents.

The drug susceptibility of two untypable strains of Mycobacterium avium complex were studied in 7H10 agar plates containing ethambutol (EMB), isoniazid (INH), rifampicin (RMP), ethionamide (ETH), and streptomycin (SM) alone and in two-drug combinations. The effective dose inhibiting 75% of the mycobacterial population (ED 75) was estimated by a regression analysis on the probit transformed inhibition percentages and plotted on an isobologram for each combination. No major discrepancies were found between strains. Five combinations (RMP plus INH, RMP plus EMB, EMB plus SM, INH plus EMB, and ETH plus INH) showed synergistic effect, whereas five other combinations (ETH plus EMB, ETH plus RMP, ETH plus SM, SM plus RMP, and SM plus INH) showed antagonistic effect. These in vitro results are not in combination with the known results of treatment of the M. avium diseases. We conclude that the effect of drug combinations against M. avium may be strain dependent and that it is important to determine this effect in vitro before setting up a treatment protocol.

Nifedipine in chronic bronchial asthma: a randomized double-blind crossover trial against placebo.

Calcium-channel blockers such as verapamil and nifedipine have been shown to inhibit exercise-induced asthma as well as acutely induced bronchoconstriction, but little is known of their chronic effects, if any, on bronchial asthma. Nifedipine, 60 mg/day for 3 weeks, was compared to placebo in a double-blind randomized crossover study, as an addition to the usual treatment of 11 patients with severe chronic bronchial asthma. Nifedipine decreased the weekly duration of the attacks (102 +/- 34 vs 193 +/- 49 min, p less than 0.05), the number of betamimetic puffs inhaled per week (13 +/- 3 vs 18 +/- 4, p less than 0.05), and the duration of intercritical dyspnoea (7.9 +/- 3.9 vs 15.9 +/- 2.3 h, p less than 0.05) without significantly changing the number of asthma attacks (4.8 +/- 1.2 vs 4.7 +/- 1.7, NS). Nifedipine did not significantly change basal respiratory function, nor did it change heart rate or blood pressure. Side effects were noted in 5 patients taking nifedipine, leading to a decrease in the dosage to 30 mg per day in 3, and in one patient taking placebo. In this study nifedipine had essentially subjective effects, but these warrant a longer-term study of nifedipine or other calcium antagonists in the treatment of bronchial asthma.