[Allergic bronchopulmonary aspergillosis associated with strongyloidiasis]. / Aspergillose broncho-pulmonaire allergique associée à une anguillulose.

We report the case of a 58-year-old woman who suffered from progressive respiratory distress syndrome. Strongyloides stercoralis was disclosed in tracheal aspirations. A high serum level of antibodies directed to Aspergillus fumigatus was also found. Diagnosis, prevalence, microbiology, clinical consequences and treatment of strongyloidiasis are discussed. We also revisit to the diagnose criteria of allergic bronchopulmonary aspergillosis and his differential diagnosis. The puzzling aspect of this case was the association of two different diseases and the concern about the prevalence of strongyloidiasis in our regions.

[Catamenial pneumothorax : a case report]. / Le cas clinique du mois. Pneumothorax cataménial: a propos d'un cas.

Catamenial pneumothorax is an unusual and rarely recognized entity that belongs to the thoracic endometriosis syndrome. The increase a number of published cases over the last years allows a more frequent diagnosis and understanding. We describe the story of a young woman with a recurrent right sided pneumothorax and discuss the different pathogenic mechanisms and current therapies. The rarity of the disease makes a prospective study very difficult. To this day, there is no consensus on a standardized therapeutic attitude.

[Anatomo-clinical confrontation: idiopathic pulmonary fibrosis]. / Confrontation anatomo-clinique. Dyspnée progressive chez un homme de 58 ans.

Idiopathic pulmonary fibrosis and pulmonary fibrosis associated with systemic diseases are the most frequent diffuse interstitial pulmonary diseases. They slowly but irrevocably progress towards terminal respiratory failure. They can also be complicated by severe acute respiratory failure and admission in the intensive care unit can be discussed. Despite invasive mechanical ventilation, anti-infectious and immunosuppressive treatments, the disease carries a high mortality rate. We report and discuss the case of a patient with idiopathic, pulmonary fibrosis (UIP) who underwent rapid clinical deterioration.

Characterization of the IGF system and analysis of the possible molecular mechanisms leading to IGF-II overexpression in a mesothelioma.

The expression of members of the IGF system in a mesothelioma from a patient suffering from hypoglycemia, in term placenta and HT29 colon adenocarcinoma cells were compared. Very high levels of IGF-II mRNA and protein were detected in the mesothelioma. Moreover, half of the IGF-II protein took the high-molecular-weight form. We also analyzed the parental imprinting status and the promoter usage of the IGF-II gene. Our results showed loss of imprinting (LOI) in the mesothelioma while the imprinting was maintained in HT29 cells, expressing moderate levels of the transcript. Promoter P4 was active in the three tissues we analyzed, whereas IGF-II mRNA transcription from promoter P3 was only detected in the mesothelioma and the placenta, expressing comparably high levels of the transcript. IGF-II gene structure was identical in the analyzed tissues and cells. The type-I receptor mRNA expression was very low in the tumor. IGFBP-2, -4 and -5 mRNAs were detected in the mesothelioma, while IGFBP-2, -3 and -5 transcripts were detected in the placenta. IGFBP-1 and -6 transcripts were not detected.

Unilateral facial pain as the first symptom of lung cancer: are there diagnostic clues?

We describe three patients with unilateral facial pain due to non-metastatic lung cancer and review 11 published cases. Pain, most frequently located on the right side and around the ear, as well as digital clubbing can be clues to an early diagnosis. Compression of the vagus nerve by the tumour or by mediastinal adenopathy is most likely responsible for the facial pain and could play a role in pulmonary osteoarthropathy.

Failure of buserelin-induced medical castration to control pulmonary lymphangiomyomatosis in two patients.

Two women, aged 44 and 29 years, respectively, were admitted to the hospital in early 1987 for recurrent pneumothorax, dyspnea and a diffuse reticulonodular pattern evidenced on the chest x-ray film. Lung biopsy confirmed LAM in both patients. Both were treated sequentially with medroxyprogesterone and a LHRH agonist (buserelin) to achieve reversible medical castration. Neither subjective nor objective improvement was noted after 13 and 5 months, respectively, of buserelin therapy (900 micrograms/day, nasal spray) despite an effective suppression of the pituitary-gonadal axis. Medroxyprogesterone also was ineffective. Buserelin thus failed to control pulmonary LAM in these two patients, in spite of effective medical castration.

Use of PEEP in management of life-threatening status asthmaticus: a method for the recovery of appropriate ventilation-perfusion ratio.

In 15 patients with asthma attack, evidence of the uneven distribution of air flow during controlled ventilation was obtained by detection of ventilatory asynchronism expressed by the incurvated profile of tracheal pressure waves associated with the repetitive interruptions of air flow. It was observed that low values of PEEP (mean: 5 +/- 2.5 cm H 2O) induced an increase in transbronchial pressure able to overcome ventilatory asynchronism. In these conditions, an appropriate ventilation-perfusion ratio was restored and improved gas exchanges as indicated by the mean increase of arterial PO 2 from 66.3 mmHg (+/- 2.57) to 96.89 mmHg (+/- 4.41) (p = 0.0005) associated with a mean decrease in arterial PCO 2 from 53.66 mmHg (+/- 2.71) to 42.07 mmHg (+/- 1.64) (p = 0.0005). Simultaneously hemoglobin oxygen saturation rose from 82.31% (+/- 1.97%) to 95.74% (+/- 0.5%). In our patients, such values of PEEP were not high enough to influence the pulmonary arterial circulation. The means of the pulmonary arterial pressures obtained before (syst.: 32.3; diast.: 15.1; mean: 22.00 mmHg) were quite the same (p greater than 0.2) as with PEEP (syst.: 32.00; diast.: 14.00; mean: 21.1 mmHg). The mean of the wedge pressure was found to be 8.3 (+/- 74 mmHg) prior to and 8.4 (+/- 0.68 mmHg) after PEEP (p greater than 0.3). Mean cardiac output rose slightly from 5.27 l/min (+/- 0.24) to 5.77 l/min (+/- 0.38) during PEEP (p = 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Does mast cell protection plus mediator antagonism surpass the effect of a classic antihistaminic in the treatment of chronic urticaria? A double-blind comparison of oxatomide and mequitazine.

A new type of antiallergic drug, oxatomide (60 mg daily), was compared with the antihistaminic, mequitazine (10 mg daily), in a 5-week double-blind randomized study involving 26 patients with chronic urticaria. In the 13 oxatomide-treated patients, papules, erythema and pruritus were significantly suppressed after 2 weeks, which was markedly more rapid than with mequitazine. Slight somnolence was reported by 3 patients on oxatomide and 1 on mequitazine; in the latter case, severe urine retention was also reported. Another patient on mequitazine had to discontinue treatment because of severe drowsiness.

[Bronchospasm, a sign revealing pulmonary embolism]. / Bronchospasme, signe révélateur de l'embolie pulmonaire

As a clinical feature, and sometimes as a feature of the special mechanical tests of ventilation, bronchospasm has been found by the authors to be associated with pulmonary embolus. Bronchospasm was found to be the commonest feature in the 45 patients studied. The sudden onset of bronchospasm must be regarded as strong evidence for pulmonary embolus, especially in patients with a past history of bronchitis. The mechanism of these asthma-like features is discussed. The authors impugn the adrenergic system both to explain the bronchial overactivity of the patients with pulmonary embolus, and to understand how the attack commences.