[Bronchial laser: techniques, indications, and results]. / Laser bronchique: techniques, indications et résultats.

Laser emits a light characterised by being monochromatic, phased and collimated. Since the beginning of the '80s the fibers ND-YAG laser, whose energy may be transmitted by quartz fibres, is the type principally used for therapeutic bronchoscopy. It may be used to coagulate or to vaporize endoluminal lesions. The effect looked for depends on the level of density of power selected. During rigid bronchoscopy, YAG laser is usually applied in the coagulation mode, with a weak liberation of energy. Further resection is then achieved mechanically with the rigid tube or forceps. For malignant lesions the laser has a palliative action in eliminating endoluminal tumour mass. Its use has overturned the management of progressive tracheal or bronchial asphyxia. Outside emergencies, its action can be combined with radio and chemotherapy. For benign lesions its action may be curative. The laser is however poorly adapted for extrinsic compression and for infiltrating lesions where other more appropriate endoscopic methods should be used.

[Silicone tracheobronchial endoprosthesis]. / Endoprothèses trachéobronchiques en silicone.

Silicone endoprostheses are used to replace loss of support in tracheobronchial cartilage. The main silicone stents are similar to those of the Montgomery T tube, the Westaby, Dumon and Cooper-Hood prostheses. The major indications are malignant tumours and benign stenosis after anastomotic resection or graft. All have in common a degree of narrowing greater than 50%. An initial bronchoscopy enables a precise assessment of the zone to support. The prostheses are then put in place using a rigid bronchoscope. An annual bronchoscopic review is recommended associated with clinical supervision. Their removal is simple even after being in position for a long period. A multicentre study (Marseille, Saint-Etienne, Brescia and Barcelona) report their experience of 1574 prostheses positioned in 1058 patients. The localisation was tracheal (54%), left main bronchus (21%), right main bronchus (18%). The average time in place was 1.2 years for benign tumours(maximum 6.2 years) and four months for malignant tumours (maximum 4.7 years). Complications were rare and included migrations (9.5%), granulomas (7.9%) and obstructions (3.6%). Thanks to their being well tolerated, their simplicity in handling, silicone prostheses are currently an essential choice to re-establish patency of the airways in patients presenting with benign or malignant tracheobronchial pathology.

[A rare case of severe pulmonary artery hypertension. Thrombosing pulmonary microangiopathy due to tumor]. / Une hypertension artérielle pulmonaire sévère de cause rare: la microangiopathie pulmonaire tumorale thrombosante.

We report a case of acute respiratory insufficiency with acute cor pulmonale and a fatal outcome. Right cardiac catheterisation enabled a diagnosis of precapillary pulmonary arterial hypertension to be made with a mean pulmonary arterial pressure of 61 mmHg and a pulmonary capillary pressure of 12 mHg. An autopsy was carried out and this revealed a microscopic pulmonary tumour emboli with lymphangitis carcinomatosis. In particular, it showed an association of fibrocellular proliferation at the level of the intima in the small calibre pulmonary arteries and arterioles permitting the unusual diagnosis of thrombosing pulmonary microangiomathy due to tumour. The physiopathological mechanism of this particular form of pulmonary tumour emboli is discussed; it would be secondary to an activation of the coagulation systems by the embolic tumour cells. Once activated, it is the lesions in the intima and not the carcinoma cells which generate the pulmonary arterial hypertension by vascular obstruction.

Domiciliary nasal intermittent positive pressure ventilation in severe COPD: effects on lung function and quality of life.

The aim of this study was to determine the effect of domiciliary nasal intermittent positive pressure ventilation (NIPPV) on lung function and quality of life in hypercapnic patients with chronic obstructive pulmonary disease (COPD). Fourteen hypercapnic COPD patients in a stable clinical condition were evaluated in a prospective study of domiciliary NIPPV plus long-term oxygen therapy. Baseline data obtained during a 4 week run-in period were compared with measurements at the end of the 6 month study period. Spirometric parameters, arterial blood gas tensions, and quality of life were assessed. Quality of life was measured using the St George's Respiratory Questionnaire (SGRQ) and the French version of the Nottingham Health Profile (FVNHP). All patients completed 6 months of domiciliary NIPPV. Gastro-intestinal inflation was reported by eight patients. Daytime arterial oxygen tension and arterial carbon dioxide tension, improved after therapy. During the NIPPV study period, the total SGRQ score and impacts score both improved significantly; significant improvements were also noted in the total FVNHP score and the physical mobility, emotional reactions, and energy component scores. Domiciliary nasal intermittent positive pressure ventilation combined with long-term oxygen therapy has been found to improve blood gases in spontaneous ventilation, as well as the quality of life of patients with chronic obstructive pulmonary disease.

[Flavonoids and pycnogenols]. / Flavonoides et pycnogenols.

Pycnogenols is the term put forward by the authors to designate flavan-3-ol derivatives, so as to distinguish these substances, upon chemical and pharmacological grounds, from the heterogeneous group of flavonoid compounds.