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1.
Rev Med Suisse ; 11(495): 2176, 2178-80, 2182-3, 2015 Nov 18.
Artículo en Francés | MEDLINE | ID: mdl-26742239

RESUMEN

Lung abscess occurs in very pleomorphic according to germs initially involved. The mechanism commonly found is an aspiration of the oropharyngeal flora in patients with disorders of consciousness or swallowing. The infection is polymicrobial, with presence of anaerobic germs in 2/3 of the cases. The support consists of a prolonged antibiotic treatment, as well as anaerobic until resolution or stability of the radiological image. In case of prolonged toxic state, drainage of the abscess is to be discussed especially if there is no airways drainage. Surgical sanctions is rarely needed regardless of the size of the abscess, unless underlying carcinoma is present.


Asunto(s)
Absceso Pulmonar/diagnóstico , Absceso Pulmonar/terapia , Antibacterianos/uso terapéutico , Diagnóstico Diferencial , Drenaje , Humanos , Absceso Pulmonar/microbiología , Factores de Riesgo
2.
Rev Med Suisse ; 11(495): 2145-50, 2015 Nov 18.
Artículo en Francés | MEDLINE | ID: mdl-26742234

RESUMEN

Asthma and COPD are often considered mutually exclusive diseases, mainly because of the inclusion of only typical cases of asthma or COPD in therapeutic clinical trials. However, clinicians are unable to distinguish between both conditions in a substantial number of patients, a situation that may be called the "asthma-COPD overlap syndrome". It is important to recognize this entity, as patients suffering from an asthma-COPD overlap syndrome are more symptomatic, have a poorer quality of life and suffer more exacerbations than patients with asthma or COPD alone. In the absence of studies specifically designed to assess the treatment modalities for these patients, it appears wise to prescribe inhaled corticosteroids early in the course of the disease, considering their established efficacy in asthma.


Asunto(s)
Asma/complicaciones , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Asma/diagnóstico , Diagnóstico Diferencial , Humanos , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Síndrome
3.
Rev Med Suisse ; 11(495): 2151-2, 2154-6, 2015 Nov 18.
Artículo en Francés | MEDLINE | ID: mdl-26742235

RESUMEN

Patients with chronic obstructive pulmonary disease (COPD) often also present with one or more cardiovascular risk factors, resulting not only in an increased mortality rate but also in a major impact on the health care system. Aside from common predisposing and environmental factors, the hypothesis of a chronic systemic inflammation linking COPD and cardiovascular co-morbidities is supported by an increasing body of evidence in recent literature. This could in turn pave the way for new developments, both diagnostic and therapeutic, in the future. In this context, the studies CoLaus and PneumoLaus aim to further investigate characteristics of the Lausanne general population, in particular those relating to cardiovascular and respiratory disease.


Asunto(s)
Enfermedades Cardiovasculares/etiología , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Complicaciones de la Diabetes , Humanos , Hipertensión/complicaciones , Isquemia Miocárdica/complicaciones , Obesidad/complicaciones , Factores de Riesgo
4.
Allergy ; 69(10): 1333-42, 2014 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-24961817

RESUMEN

BACKGROUND: Thymic stromal lymphopoietin (TSLP) is a cytokine primarily produced by epithelial cells, which has been shown to be a potent inducer of T-helper 2 (Th2)-type responses. However, TSLP has pleiotropic effects upon immune cells, and although extensively studied in the context of atopic asthma, its relevance as a therapeutic target and its role in the pathogenesis of nonatopic asthma remains unknown. We sought to investigate the role of TSLP in atopic, nonatopic and viral-induced exacerbations of pulmonary inflammation. METHODS: Using stringently defined murine models of atopic, nonatopic and virally exacerbated forms of pulmonary inflammation, we compared inflammatory responses of C57BL/6 wild-type (WT) and TSLP receptor-deficient (TSLPR KO) mice. RESULTS: Thymic stromal lymphopoietin receptor (TSLPR) signaling was crucial for the development of atopic asthma. Specifically, TSLPR signaling to lung recruited CD4+ T cells enhanced eosinophilia, goblet cell hyperplasia, and overall inflammation within the airways. In contrast, the absence of TSLPR signaling was associated with strikingly exaggerated pulmonary neutrophilic inflammation in a nonatopic model of airway inflammation. The inflammation was associated with excessive levels of interleukin (IL)-17A in the lungs, indicating that TSLP negatively regulates IL-17A. In addition, in a model of influenza-induced exacerbation of atopic airway inflammation, the absence of TSLPR signaling also led to exaggerated neutrophilic inflammation. CONCLUSION: Thymic stromal lymphopoietin plays divergent roles in the pathogenesis of atopic and nonatopic asthma phenotypes by either enhancing Th2 responses or curtailing T-helper 17 responses. These findings raise important caveats for the design of therapeutic interventions targeting TSLP in asthma.


Asunto(s)
Asma/inmunología , Citocinas/inmunología , Neumonía/inmunología , Hipersensibilidad Respiratoria/inmunología , Traslado Adoptivo , Animales , Modelos Animales de Enfermedad , Ratones , Ratones Endogámicos C57BL , Ratones Noqueados , Linfopoyetina del Estroma Tímico
5.
Rev Med Suisse ; 10(451): 2208-10, 2212-3, 2014 Nov 19.
Artículo en Francés | MEDLINE | ID: mdl-25603568

RESUMEN

Idiopathic pulmonary fibrosis (IPF) is the most frequent of the idiopathic interstitial pneumonias. It is a progressive disorderwith a poor prognosis. Its diagnosis requires the careful exclusion of potential causes, and a pattern of usual interstitial pneumonia at high-resolution computed tomography or video-assisted surgical lung biopsy. Several recent randomized trials have profoundly modified the therapeutic management of IPF. The combination of prednisone and azathioprine, often prescribed until recently, has been shown to be harmful and is no longer indicated. N-acetylcystein, also used in the past decade, failed to show an efficacy. However, two new antifibrotic drugs, pirfenidone and nintedanib, have for the first time proven effective in slowing disease progression.


Asunto(s)
Fibrosis Pulmonar Idiopática/diagnóstico , Fibrosis Pulmonar Idiopática/terapia , Azatioprina/uso terapéutico , Técnicas de Diagnóstico del Sistema Respiratorio/tendencias , Humanos , Fibrosis Pulmonar Idiopática/clasificación , Fibrosis Pulmonar Idiopática/epidemiología , Prednisona/uso terapéutico , Cirugía Torácica Asistida por Video , Tomografía Computarizada por Rayos X
6.
Rev Med Suisse ; 9(407): 2175-80, 2013 Nov 20.
Artículo en Francés | MEDLINE | ID: mdl-24354253

RESUMEN

Common variable immunodeficiency (CVID) is the most frequent primary immune deficiency. Recurrent infections are classical consequences of CVID, but their impact has been largely reduced by immunoglobulin replacement. CVID is also associated with various inflammatory and autoimmune manifestations resulting from abnormal cellular immunity. The lungs are especially affected by a recently described entity called granulomatous lymphocytic interstitial lung disease (GLILD). GLILD currently constitutes an important cause of morbidity and mortality in these patients. It is distinct from bronchiectasis secondary to recurrent infections, and presents similarities but also striking differences with sarcoidosis.


Asunto(s)
Inmunodeficiencia Variable Común/fisiopatología , Granuloma/patología , Enfermedades Pulmonares Intersticiales/fisiopatología , Bronquiectasia/diagnóstico , Bronquiectasia/fisiopatología , Inmunodeficiencia Variable Común/diagnóstico , Inmunodeficiencia Variable Común/terapia , Granuloma/diagnóstico , Humanos , Inmunoglobulinas/administración & dosificación , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/terapia , Pronóstico , Recurrencia , Sarcoidosis/diagnóstico , Sarcoidosis/fisiopatología
7.
Eur Respir J ; 39(4): 807-19, 2012 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-22467723

RESUMEN

The European Centre for Disease Prevention and Control (ECDC) and the European Respiratory Society (ERS) jointly developed European Union Standards for Tuberculosis Care (ESTC) aimed at providing European Union (EU)-tailored standards for the diagnosis, treatment and prevention of tuberculosis (TB). The International Standards for TB Care (ISTC) were developed in the global context and are not always adapted to the EU setting and practices. The majority of EU countries have the resources and capacity to implement higher standards to further secure quality TB diagnosis, treatment and prevention. On this basis, the ESTC were developed as standards specifically tailored to the EU setting. A panel of 30 international experts, led by a writing group and the ERS and ECDC, identified and developed the 21 ESTC in the areas of diagnosis, treatment, HIV and comorbid conditions, and public health and prevention. The ISTCs formed the basis for the 21 standards, upon which additional EU adaptations and supplements were developed. These patient-centred standards are targeted to clinicians and public health workers, providing an easy-to-use resource, guiding through all required activities to ensure optimal diagnosis, treatment and prevention of TB. These will support EU health programmes to identify and develop optimal procedures for TB care, control and elimination.


Asunto(s)
Antituberculosos/uso terapéutico , Guías de Práctica Clínica como Asunto/normas , Tuberculosis Pulmonar/tratamiento farmacológico , Unión Europea , Humanos
8.
Rev Med Suisse ; 8(363): 2206-11, 2012 Nov 21.
Artículo en Francés | MEDLINE | ID: mdl-23240295

RESUMEN

Lung cancer screening has been the focus of intense interest since the publication in 2011 of the NLST trial (National Lung Screening Trial) showing a mortality reduction in smokers undergoing 3-year screening by chest computed tomography. Although these data appear promising, many issues remain to be resolved, such as high rate of false positive cases, risk of overdiagnosis, optimal intervals between screens, duration of the screening process, feasibility, and cost. Structured screening programs appear crucial to guarantee patient information, technical quality, and multidisciplinary management. Despite these uncertainties, several guidelines already state that screening should be performed in patients at risk, whereas investigators stress that more data are needed. How should the primary care physician deal with individual patients requests? This review provides some clues on this complex issue.


Asunto(s)
Neoplasias Pulmonares/diagnóstico , Tamizaje Masivo/métodos , Tomografía Computarizada por Rayos X/métodos , Reacciones Falso Positivas , Humanos , Neoplasias Pulmonares/patología , Médicos de Atención Primaria , Guías de Práctica Clínica como Asunto , Factores de Riesgo
9.
Rev Med Suisse ; 8(363): 2228-32, 2012 Nov 21.
Artículo en Francés | MEDLINE | ID: mdl-23240299

RESUMEN

The increasing use of chest CT imaging in medical practice rises the likelihood of the general practitioner to be confronted with cases of interstitial lung disease. Respiratory bronchiolitis (RB) and respiratory bronchiolitis-associated interstitial lung disease (RB-ILD) are two smoking-related lung damages that may have important implications for the patient's management. The authors present in this paper a review of current knowledge of the epidemiology, clinical features, prognosis, and treatment options of RB and RB-ILD.


Asunto(s)
Bronquiolitis/patología , Enfermedades Pulmonares Intersticiales/patología , Fumar/efectos adversos , Anciano , Bronquiolitis/etiología , Bronquiolitis/terapia , Humanos , Enfermedades Pulmonares Intersticiales/etiología , Enfermedades Pulmonares Intersticiales/terapia , Masculino , Pronóstico , Tomografía Computarizada por Rayos X/métodos
10.
Rev Med Suisse ; 8(363): 2212-4, 2216-8, 2012 Nov 21.
Artículo en Francés | MEDLINE | ID: mdl-23240296

RESUMEN

Bronchoalveolar lavage (BAL) is a minimally invasive procedure used to characterize the status of the alveolar space. Standardization of the procedure and the analysis of samples taken is essential for their proper interpretation. In nonresolving or ventilator-associated pneumonia, BAL contributes to the detection of resistant pathogens and noninfectious etiologies. In immunocompromised hosts with radiological infiltrates, BAL should be performed early during work-up since outcome is significantly modified in this population group. In cases of interstitial lung disease, BAL can exclude infectious or neoplastic causes. Associated with a clinical and radiological evaluation, it provides valuables additional diagnostic information.


Asunto(s)
Lavado Broncoalveolar/métodos , Huésped Inmunocomprometido , Alveolos Pulmonares/metabolismo , Humanos , Enfermedades Pulmonares Intersticiales/diagnóstico , Enfermedades Pulmonares Intersticiales/etiología , Factores de Tiempo
11.
Nat Med ; 2(9): 1033-5, 1996 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-8782463

RESUMEN

Microsatellite instability is an important characteristic of many tumor types especially those associated with hereditary non-polyposis colorectal carcinoma (HNPCC) syndrome. Microsatellite alterations in 50% of primary small cell lung carcinoma (SCLC) have been found. These alterations were also found in the sputum. Because neoplastic characteristics such as decreased strand stability9 and ras mutations have been found in the plasma DNA of cancer patients, we looked for microsatellite alterations in the plasma of SCLC patients. A microsatellite alteration was present in 16 out of 21 (76%) SCLC tumors and in 15 out of 21 (71%) plasma samples. In one case, the alteration was present only in the plasma DNA. If confirmed in larger studies, microsatellite analysis of plasma DNA might constitute a new tool for tumor staging, management and, possibly, detection.


Asunto(s)
Biomarcadores de Tumor , Carcinoma de Células Pequeñas/genética , ADN de Neoplasias , Neoplasias Pulmonares/genética , Repeticiones de Microsatélite , Adulto , Anciano , Anciano de 80 o más Años , Secuencia de Bases , Biomarcadores de Tumor/sangre , Cartilla de ADN , ADN de Neoplasias/sangre , ADN Satélite/sangre , Femenino , Humanos , Masculino , Persona de Mediana Edad , Datos de Secuencia Molecular , Plásmidos
14.
Eur Respir J ; 31(1): 213-7, 2008 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-18166599

RESUMEN

Polymyositis and interstitial lung diseases, predominantly nonspecific interstitial pneumonia (NSIP), are known to be frequent in antisynthetase syndrome, where anti-aminoacyl-tRNA synthetase antibodies are often identified. An unusual case of acute respiratory distress syndrome, secondary to such proven NSIP of cellular type with predominant CD8 lymphocytes, is described herein. The patient described in the present case study initially had a poor recovery with high dose of steroids, but this was followed by a good improvement after the prescription of tacrolimus and a low dose of prednisone. A precise diagnosis in similar circumstances may be life-saving, allowing the successful application of new immunosuppressants.


Asunto(s)
Autoanticuerpos/análisis , Enfermedades Pulmonares Intersticiales/tratamiento farmacológico , Polimiositis/tratamiento farmacológico , Síndrome de Dificultad Respiratoria/tratamiento farmacológico , Síndrome de Dificultad Respiratoria/etiología , Tacrolimus/uso terapéutico , Anticuerpos Antinucleares/química , Linfocitos T CD8-positivos/metabolismo , Ciclosporina/farmacología , Humanos , Inmunosupresores/uso terapéutico , Masculino , Persona de Mediana Edad , Síndrome , Tacrolimus/farmacología , Tomografía Computarizada por Rayos X/métodos , Resultado del Tratamiento
16.
J Clin Invest ; 96(5): 2304-10, 1995 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-7593617

RESUMEN

Human mononuclear phagocytes can modulate the turnover of extracellular matrix by producing metalloproteinases such as 92-kD gelatinase and interstitial collagenase as well as the tissue inhibitor of metalloproteinases (TIMP). We have previously reported that IL-4 and IFN gamma released by lymphocytes suppress metalloproteinase biosynthesis in macrophages without affecting TIMP production (Lacraz, S., L. Nicod, B. C. de Rochementeix, C. Baumberger, J. Dayer, and H. Welgus. 1992. J. Clin. Invest. 90:382-388.; Shapiro, S. D., E. J. Campbell, D. K. Kobayashi, and H. G. Welgus 1990. J. Clin. Invest. 86:1204-1210). Like IL-4, IL-10 is secreted by Th2 lymphocytes and is inhibitory to several macrophage functions. In the present study, IL-10 was tested and compared to IL-2, IL-4, IL-6, and IFN gamma for its capacity to modulate synthesis of 92-kD gelatinase, interstitial collagenase and TIMP in human macrophages and monocytes. We found that IL-10, just like IL-4, inhibited the production of 92-kD gelatinase and blocked LPS-, as well as killed Staphylococcus aureus-induced, interstitial collagenase production. The principal finding of this study, however, was that IL-10, in distinction to IL-4, produced a dose-dependent stimulation in the biosynthesis of TIMP-1. TIMP-2 production was not affected. IL-10 regulated the expression of 92-kD gelatinase and TIMP-1 at the pretranslational level. Furthermore, IL-10 regulation was cell type-specific, as it had no effect on the production of metalloproteinases or TIMP by human fibroblasts. In summary, IL-10 has a potent and unique effect upon tissue macrophages and blood monocytes by enhancing TIMP-1 production while decreasing metalloproteinase biosynthesis.


Asunto(s)
Gelatinasas/antagonistas & inhibidores , Glicoproteínas/biosíntesis , Interleucina-10/farmacología , Macrófagos Alveolares/metabolismo , Inhibidores de la Metaloproteinasa de la Matriz , Monocitos/metabolismo , Células Cultivadas , Expresión Génica/efectos de los fármacos , Glicoproteínas/genética , Humanos , Interleucina-4/farmacología , Metaloproteinasa 1 de la Matriz , Inhibidores Tisulares de Metaloproteinasas
17.
Rev Med Suisse ; 8(363): 2203-4, 2012 Nov 21.
Artículo en Francés | MEDLINE | ID: mdl-23240294
18.
Respir Med Case Rep ; 22: 215-217, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28884072

RESUMEN

Ochroconis gallopava is an anamorphic mould characterized by slow growth rate and production of a maroon pigment, which has been isolated worldwide from soil, thermal springs, decaying vegetation, and chicken litter. It has been reported to cause localized, mostly pulmonary, and systemic infection in severely immunocompromised patients. We describe the case of a 76-year-old woman known for ulcerative colitis-related bronchiectasis treated with low dose oral steroids, who developed a fungal bronchitis with dark, bloody-like, sputum which was initially misinterpreted as haemoptysis. A filamentary mould grew on sputum culture, and was identified by DNA analysis as Ochroconis gallopava. We observed a significant clinical improvement after 6 weeks of itraconazole therapy.

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