A comparison of two long-acting beta-agonists, oral bambuterol and inhaled salmeterol, in the treatment of moderate to severe asthmatic patients with nocturnal symptoms. The French Bambuterol Study Group.

This multicentre study was set up to compare the efficacies of two long-acting beta 2-agonists, oral bambuterol (20 mg nocte) and inhaled salmeterol (50 micrograms b.i.d.), for the treatment of moderate to severe asthmatics who were considered to be on optimal steroid/bronchodilator therapy, but continued to have troublesome nocturnal symptoms. The study was of double-blind, parallel-group design and comprised a 2-week run-in on previous maintenance therapy followed by a 6-week study treatment period. There were 117 randomized asthmatic patients aged 20-70 years (65 women and 52 men with a mean age of 45 and predicted FEV1 of 64%), who had been taking 800-2000 micrograms inhaled steroid and/or up to 20 mg oral steroid per day for at least 4 weeks. They were asked to complete daily diary cards, recording morning and evening PEF, daily symptoms, nocturnal awakenings, rescue medication and subjective tremor. There was a significant increase in both morning and evening PEF respectively, on bambuterol (28 l min-1, 20 l min-1, P < 0.05) and salmeterol (29 l min-1, P < 0.001; 23 l min-1, P < 0.01) when compared with run-in. The mean percentage fall in overnight PEF was reduced by 8.3% (P < 0.001) on bambuterol and by 6.8% (P < 0.001) on salmeterol. Nocturnal awakenings and daytime symptoms due to asthma were significantly lowered by both treatments, as was the consumption of rescue bronchodilator. Tremor scores were very low during both run-in and study treatments. No significant treatment difference between bambuterol and salmeterol was detected for any of the above variables. Once-daily oral bambuterol provides a highly effective alternative to twice-daily inhaled salmeterol for relief of nocturnal symptoms in patients with moderate to severe asthma.

[Small cell lung carcinoma. Value of the evaluation of extension for the therapeutic strategy]. / Cancer bronchique à petites cellules. Intérêt du bilan d'extension dans la stratégie thérapeutique.

Small-cell lung carcinoma can be distinguished from other histological types of lung cancer because of its high metastatic potential. Initial staging procedures divide the patients into two main prognostic groups: the so-called "limited" (to the thorax) and the extensive disease patients. Based on the results of a prospective pilot study involving 182 patients and on a review of the literature, the authors discuss the usefulness of initial staging in increasing the number of detectable metastases, assessing tumour burden, evaluating treatment results and identifying prognostic factors. Complete tumour staging at the time of diagnosis appears to be very helpful for a better knowledge of the disease and better therapeutic decisions.

[Thoracoscopic study of 6 cases of catamenial pneumothorax]. / Etude thoracoscopique de 6 cas de pneumothorax cataménial.

Six new cases seen personally, and 72 cases of catamenial pneumothorax found in the literature have had thoracoscopic talcage. We shall discuss several peculiarities of this syndrome: its relative rarity, symptoms linked to periods, the specific and unique endopleural aspects, confirming certain pathogenetic theories, the first among which is pleural endometriosis. Therapeutic methods are also discussed, stressing the sharing of the association between pleural symphysis surgically and above all by thoracoscopy with antigonadotrophic hormone therapy an association which alone gives good results in 95% of cases.

[Bullous dystrophy and bronchopulmonary cancer in young patients]. / Dystrophie bulleuse et cancers broncho-pulmonaires chez des sujets jeunes.

It is classically admitted that young subjects with bullous dystrophy may develop lung cancer, but this rarely occurs. We report the case of 2 patients under 40 years of age who were found to have bronchial carcinoma. In such cases the clinical signs are not different from those of ordinary bronchial cancer, but the lesions are very often located in the upper lobes, adenocarcinoma is rare in contrast with the usual cancers on scars, the histological diagnosis is difficult and the prognosis usually poor owing to frequent extension to the chest wall. The problem of cancer on bullous dystrophy is essentially that of management of the dystrophy in young subjects: systematic surgery or wait-and-see attitude?

[Resection of bronchial carcinoid tumor with the YAG-Nd laser under local anesthesia]. / Résection d'une tumeur carcinoïde bronchique au laser YAG-Nd sous anesthésie locale.

The YAG-Nd laser has been used for several years in tracheobronchial pathology. The authors report the case of an inoperable female patient with a carcinoid tumour of the left main bronchus. The laser resulted in complete removal of obstruction with an excellent clinical, radiological and isotope scan result.

[Transparietal pulmonary puncture in the diagnosis of excavated pulmonary masses. Apropos of 18 cases]. / Apport de la ponction pulmonaire transpariétale au diagnostic des masses pulmonaires excavées. A propos de 18 cas.

The aetiological diagnosis of excavated pulmonary opacities is sometimes uneasy, hovering between squamous cell carcinoma and abscess. Normal results at bronchoscopy and two weeks of antibiotic therapy do not always provide a definite answer. The authors report 18 cases of such excavated masses and conclude that transparietal needle aspiration can establish the diagnosis provided some technical procedures are followed and the samples obtained are examined by skilled cytologists.

[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.

[Contribution of thoracoscopic brushing to the diagnosis of pleural diseases]. / Apport du brossage par thoracoscopie au diagnostic des affections pleurales.

Pleural brushing can be performed under thoracoscopic examination. The combined use of all three methods of diagnosis (macroscopy, biopsy, cytology) achieved optimal diagnostic results. From September 1980 to October 1981 we have performed 150 thoracoscopies for pleural effusions, while the results of conventional pleural cytology and biopsy were negative. In 108 cases pleural brushing and biopsy were both performed. The diagnosis was in 37 cases non malignant diseases states associated with effusions and in 71 cases tumoral effusions. Among the 37 cases of non malignant diseases states associated with effusions were: 6 mechanical effusions, 27 inflammatory processes, 4 infectious processes. Among the 71 cases of tumoral effusions were 3 benign pleural lipomas, 50 metastatic carcinomas, 18 carcinomatous mesotheliomas. We studied the diagnostic accuracy of pleural brushing: in non malignant diseases, pleural brushing show the non tumoral features of the process, in metastatic tumours, biopsy was positive in 80% of the cases; pleural brushing in 78% of cases; taken together they allowed the diagnosis in 86% of the cases, in carcinomatous mesotheliomas biopsy was positive in 82,3%, pleural brushing in 78%; taken together they allowed the diagnosis in 89% of the cases. Pleural brushing allows a rapid cytological diagnosis, enhances the histological results and may also be used to get cellular material in areas dangerous to biopsy.

[Thoracoscopy with pleural brushing. A new diagnostic method for pleural diseases]. / La thoracoscopie avec brossage pleural. Un nouveau mode diagnostique des affections de la plèvre.

Pleural brushing can be performed under thoracoscopic examination. The combined use of all three methods of diagnosis (macroscopy, biopsy, cytology) achieved optimal diagnostic results. From September 1980 to October 1981 we have performed 150 thoracoscopies for pleural effusions, while the results of conventional pleural cytology and biopsy were negative. In 108 cases pleural brushing and biopsy were both performed. The diagnosis was in 37 cases non malignant disease states associated with effusions and in 71 cases tumoural effusions. Among the 37 cases of non malignant diseases states associated with effusions were 6 mechanical effusions, 27 inflammatory processes, 4 infectious processes. Among the 71 cases of tumoural effusions were 3 benign pleural lipomas, 50 metastatic carcinomas, 18 carcinomatous mesotheliomas. We studied the diagnostic accuracy of pleural brushing: in non malignant diseases pleural brushing show the non tumoural features of the process, in metastatic tumours biopsy was positive in 80% of the cases; pleural brushing in 78% of cases; taken together they allowed the diagnosis in 86% of the cases, in carcinomatous mesotheliomas biopsy was positive in 82.3%, pleural brushing in 78%; taken together they allowed the diagnosis in 89% of the cases. Pleural brushing allows a rapid cytological diagnosis, enhances the histological results and may be used to get cellular material in areas dangerous to biopsy.