[Lung cancer in the elderly subject]. / Cancer bronchique du sujet âgé.

INTRODUCTION: In France, the average age for the diagnosis of bronchial carcinoma is 64. It is 76 in the population of over 70. In fact, its incidence increases with age linked intrinsic risk of developing a cancer and with general ageing of the population. Diagnosis tools are the same for elderlies than for younger patients, and positive diagnosis mainly depends on fibreoptic bronchoscopy, complications of which being comparable to those observed in younger patients. STATE OF THE ART: The assessment of dissemination has been modified in recent years by the availability of PET scanning which is increasingly becoming the examination of choice for preventing unnecessary surgical intervention, a fortiori in elderly subjects. Cerebral imaging by tomodensitometry and nuclear magnetic resonance should systematically be obtained before proposing chirurgical treatment. An assessment of the general state of health of the elderly subject is an essential step before the therapeutic decision is made. This depends on the concept of geriatric evaluation: Geriatric Multidimensional Assessment, and the Comprehensive Geriatric Assessment which concerns overall competence of the elderly. PERSPECTIVES: This is a global approach that allows precise definition and ranking of the patient's problems and their impact on daily life and social environment. Certain geriatric variables (IADL, BADL, MMSE, IMC etc) may be predictive of survival rates after chemotherapy or the incidence of complications following thoracic surgery. The main therapeutic principles for the management of bronchial carcinoma are applicable to the elderly subject; long term survival without relapse after surgical resection is independent of age. Whether the oncological strategy is curative or palliative, the elderly patient with bronchial carcinoma should receive supportive treatments. They should be integrated into a palliative programme if such is the case. In fact, age alone is not a factor that should detract from optimal oncological management. CONCLUSIONS: The development of an individual management programme for an elderly patient suffering from bronchial carcinoma should be based on the combination of oncological investigation and comprehensive geriatric assessment.

Determination of gadolinium in sodium borate glasses.

A method for the determination of gadolinium in sodium borate glasses is described which utilizes the 312-nm fluorescence of gadolinium under 273-nm excitation. A linear dependence of fluorescence on concentration is found for the concentration range 10-20000 ppm. Quenching of gadolinium fluorescence by samarium is examined.

[Pleural talc administration under thoracoscopy in the treatment of pneumothorax. Study of a series of 109 cases treated over a 3-year period]. / Talcage pleural par thoracoscopie dans le traitement du pneumothorax. Etude d'une série de 109 cas traités en 3 ans.

There has recently been renewed interest in thoracoscopy. Among its indications we consider talc therapy for a pneumothorax particularly worthy of interest. We report the three year results obtained on a series of 109 pneumothoraces. The indication for thoracoscopy were considered either for a chronic pneumothorax (failure of drainage after 8 days) or for a recurrent pneumothorax. We perform this technique under local anaesthetic with talc therapy given direct vision on the macroscopic lesions encountered. Patients were in hospital for a mean of five days. The results were as follows: Lung appearance. Normal 19%-Dystrophic bullae and giant bullae 41%. blebs: 13%-a visible breach 14%-Diverse anomalies 13%. The immediate failures with talc numbered 6 (5%) each time from the chronic pneumothorax group. They were treated surgically. There were 7 recurrences after talc therapy, 5 were partial recurrences requiring no further treatment and two total relapses were surgically treated. The radiological sequelae appeared minimal. On 5 occasions pleural discomfort hindered the diaphragmatic movement, in the other cases the radiological sequelae consisted of discrete pleural thickening. 42 patients had respiratory function testing and no abnormalities were noted. The failures or recurrences in the talc treated patients were all in the recurrent pneumothorax and were only 13 cases (12%). Thus thoracoscopy is a treatment of choice in the treatment of recurrent pneumothorax, and often replaces surgery. In certain cases (pneumothorax in respiratory failure) it is only possible treatment.

[Value of transparietal lung biopsy in the cytological diagnosis of bronchiolo-alveolar carcinomas of the lung. Apropos of 3 cases]. / Apport de la ponction pulmonaire transpariétale au diagnostic cytologique des carcinomes bronchiolo-alvéolaires du poumon. A propos de 3 cas.

Bronchiolo-alveolar carcinoma is a rare primary lung tumour, which is difficult to diagnose by cytological techniques. This peripheral tumour, which develops on pre-existing alveolar walls, is not visible on bronchial endoscopy and brushing is often negative. The cellular material derived from aspiration or expectoration is characterised by numerous papillae, without any cytonuclear criteria of malignancy. The differential diagnosis is very difficult with reactive papillary hyperplasia and various forms of chronic bronchial inflammation. Transparietal aspiration lung biopsy facilitates the diagnosis of glandular carcinoma: the material examined corresponds to pathological tissue, as the biopsy is performed under image intensifier control. An inflammatory lesion is excluded by the rich cellularity and by the presence of architectural features of malignancy: cohesive and three-dimensional clumps of papillary tumour cells. The early cytological diagnosis of bronchiolo-alveolar and primary bronchiolar carcinomas of the lung by transparietal aspiration biopsy can allow the surgical cure of certain localised forms.

Thermoregulated Optical Properties of Peptidic Pseudorotaxanes.

Natural peptide spine and artificial crown ether are blended together to form a hybrid structure. A dicationic benzylammonium guest threads through the crown ether pendants and the resulting noncovalent, self-assembled pseudorotaxane complex, shown schematically in the picture, is both stable and has optical properties dependant on temperature.

[Features of asthma in women: what is the relationship with hormonal status?]. / Particularités de l'asthme de la femme: quelle relation avec le statut hormonal?

INTRODUCTION: The prevalence and control of asthma are modulated by hormonal changes in women, suggesting an influence of sex hormones on the airways. BACKGROUND: The blood levels of both oestrogens and progesterone can modulate airway tone and inflammation. Asthma prevalence changes at puberty and the menopause, events also associated with modifications of adipose tissue and behaviour. Changes in lung function and asthma control are well documented during the menstrual cycle. However, an effect of hormone therapy on asthma control has not been demonstrated. PERSPECTIVE: The effect of a targeted hormonal therapeutic intervention in menopausal asthma, a phenotype, which is frequently particularly severe, or in premenstrual asthma, should be evaluated by randomized trials. CONCLUSION: Involvement of sex hormones and their cyclical variations in the characteristics of asthma in women is probable, despite lack of convincing data. However, no definitive protective or deleterious effect can be assigned. Complex interactions with adipose tissue, airways anatomy and the domestic or working environment must be taken into account to explain these differences.

[Are there specific characteristics of COPD in women?]. / Existe-t-il des spécificités chez les femmes atteintes de BPCO ?

INTRODUCTION: Chronic Obstructive Pulmonary Disease (COPD) is a disorder resulting from an interaction between a genetic predisposition, still poorly understood, and the impact of environmental factors including tobacco smoke or professional or domestic air contaminants. BACKGROUND: The prevalence of COPD in the world concerns women as much as men, but it remains under diagnosed among women smokers. The mortality data show an increase in mortality among women compared to men. It thus seems that COPD in women presents more often a particular phenotype, characterized more by bronchial attacks than by emphysema, and by more marked functional effects on the quality of life. Anxiety and depression seem more marked with further repercussions on the quality of life. The effectiveness of treatment may be different, in particular with regard to nicotine weaning and respiratory rehabilitation. VIEWPOINT AND CONCLUSIONS: In the evaluation of chronic diseases in women little is known about COPD. Further studies, focusing specifically on these differences, are needed in order to improve the diagnosis and management of COPD in women.

[Value of thoracoscopy in the diagnosis of solid tumors extending into the pleural cavity]. / Intérêt de la thoracoscopie dans le diagnostic des tumeurs solides atteignant la cavité pleurale.

Thoracoscopy examinations in 5 cases of solid tumors of the pleura: 1 case of Pancoast's and Tobias' tumors of neoplastic origin, 1 case of asbestosis-induced fibrohyaline plaques, and 2 cases of benign pleural tumors, 1 neurinoma emphasized the diagnostic value of thoracoscopy for tumors of this type. Direct visualization of the lesion is possible, its precise site and extent can be determined, and biopsy samples obtained for pathology under direct visual guidance.

Conformational analysis of biologically active truncated linear analogs of endothelin-1 using NMR and molecular modeling.

Some linear truncated analogs of endothelin-1 display potent agonistic activity at the ET(B) receptor, especially when the side chain of Trp21 is N-formylated. Then, the three-dimensional arrangements of six structurally reduced linear analogs, three formylated and three nonformylated, have been investigated by high resolution NMR spectroscopy and molecular modeling, in order to pinpoint the conformational features related to the biological activity. Two-dimensional double-quantum-filtered correlation spectroscopy (DQFCOSY), total correlation spectroscopy (TOCSY) and nuclear Overhauser enhancement spectroscopy (NOESY) were recorded and analyzed for each molecule. Interspatial distance constraints were derived from the intensity of the NOESY connectivities. The formation of hydrogen bonding was monitored from the temperature dependence of the NH chemical shifts. Molecular models calculated by means of distance geometry, simulated annealing and energy minimization, using the NMR constraints, strongly suggested a global elongated structure for the formylated analogs exhibiting biological activity, and a folded arrangement for the unformylated derivatives. Homology comparisons allowed the identification of a beta-turn-like folding of the C-terminal segment Asp18-Trp21 as a probable key-factor for activity.

[Severe neurological toxicity (coma, convulsions, distal motor neuropathy) secondary to the association of accidental poisoning by isoniazid and a protocol containing high doses of vincristine]. / Toxicité neurologique sévère (coma, convulsions, neuropathie motrice distale) secondaire à l'association d'une intoxication accidentelle à l'isoniazide (INH) et d'un protocole comportant de fortes doses de vincristine (VCR).

Authors report the case of a 19 year old metastatic Ewing's sarcoma, prophylactically treated for suspected tuberculosis by Rifampicin and INH. Hepatic failure was induced by accidental overdose of INH. A high dose containing VCR protocol associated, lead to a coma with convulsions and severe motor peripheral neuropathy partially regressive. Neurological incidents of VCR, INH and their association are reviewed.

Conformational and orientation studies of artificial ion channels incorporated into lipid bilayers.

The conformational and orientation studies in lipid bilayers of 21 amino acid peptides bearing six crown ethers are reported. The compounds were designed to form artificial ion channels by stacking the crown rings, and were shown to be functional in bilayer membranes. We used Fourier transform infrared spectroscopy and CD spectropolarimetry to study the conformation of the peptides in solution and in lipid bilayers. These studies revealed that hexacrown peptides retain their alpha-helical conformation when incorporated in a lipid bilayer environment. Attenuated total reflectance spectroscopy was used to investigate the orientation of the peptides in a lipid bilayer. Results demonstrated that the peptides are not oriented at a fixed angle in membrane, but rather are in incorporation equilibrium between an active state parallel to the lipid chain and an inactive state adsorbed at the surface of the bilayer. From these results, we propose a model for the channel activity and the gating mechanism of these hexacrown peptides in bilayer membranes.