[Pneumopathy induced by pirindopril. A case report]. / Pneumopathie induite par le pirindopril. A propos d'un cas.

Cough is known to be the major respiratory side effect of treatment with angiotensin converting enzyme inhibitors (ACEI). Recently, ACEI have been implicated in drug-induced lung disease. We report a new case of diffuse pneumonitis which occurred during treatment with ACEI. A 73-year-old man was admitted for cough, dyspnea at rest, fever and weight loss. The patient had been treated with the ACEI pirindopril during 6 months for systemic hypertension. Chest radiographs showed reticular infiltrates in the upper lung fields. A CT scan confirmed the infiltrates and showed pleural thickening and airspace opacities. White blood cell counts showed 15,700/mm3 leucocytes with 940 eosinophils/mm3. Transbronchial biopsy was consistent with infiltration of the lung with eosinophils. There was no evidence for another etiology. Once the drug was withdrawn, clinical and radiological abnormalities improved but steroids were required to control symptoms. This report suggests that pirindopril, as captopril, can induce the picture of drug-induced pulmonary disease.

Prevention of pollen rhinitis symptoms: comparison of fluticasone propionate aqueous nasal spray and disodium cromoglycate aqueous nasal spray. A multicenter, double-blind, double-dummy, parallel-group study.

Fluticasone propionate aqueous spray, a new intranasal corticosteroid preparation, and disodium cromoglycate 2% aqueous nasal spray, an established preventive treatment for seasonal allergic rhinitis, were compared in a double-blind, double-dummy, parallel-group, multicentric study in France. A total of 218 patients with seasonal allergic rhinitis caused by grass pollen (verified by positive skin prick test) were preventively treated before the onset of the grass pollen season with either fluticasone propionate 200 micrograms once daily or disodium cromoglycate 5.2 mg four times daily. Half of these doses was given in each nostril. Treatment started before the onset of the pollen season in most patients (178/218). Diary cards, including symptoms of rhinitis and usage of nasal sprays, were filled in twice daily for 6 weeks. Terfenadine in 60-mg tablets and eye-drops could be used as rescue medications. We treated 110 patients with fluticasone propionate and 108 patients with disodium cromoglycate. Patients treated with fluticasone propionate had significantly more days free of primary efficacy symptoms of sneezing (P < 0.001) and nasal discharge during the day (P = 0.002), as well as free of all the other nasal symptoms (P < 0.01), and significantly lower median scores (P < 0.05) for all nasal symptoms except nasal discharge than patients treated with disodium cromoglycate. There was no difference in eye symptoms or in rescue medication use between the two groups. Compliance with the treatment was assessed.(ABSTRACT TRUNCATED AT 250 WORDS)

[Long-term tolerability of formoterol in chronic obstructive bronchopathies]. / Tolérance à long terme du Formotérol chez des bronchopathes chroniques obstructifs.

Formoterol aerosol, a long-acting new beta 2-mimetic was administered over a year at a dose of 12 micrograms twice daily, to 62 chronic obstructive bronchitics of mean age 66 +/- 6 years and of whom the basal VEMS was at 12,801 +/- 0.59. Clinical tolerance of the product was good with undesirable effects in 13 patients, the most frequent being shaking. No untoward effect was seen on systolic or diastolic arterial pressure, or the heart rate over successive visits at 1, 3, 6, 9 months and one year. Electrocardiographic surveillance found in only four patients electrical abnormalities that may be due to Formoterol, these were patients without previous cardiac problems but of advanced mean age. Functionally, a significant improvement of basal VEMS was noticed from the 6th month. The VEMS improved significantly after administration of 12 micrograms on successive visits, without tachyphylactic signs. Well tolerated, with functional benefits, Formoterol is a promising product amongst the long-acting beta 2-mimetics. Its usefulness and limitations in the basic treatment of these chronic bronchopathies remains to be defined.

[The influence of a new beta agonist: formoterol on mucociliary function]. / Influence sur la fonction muco-ciliaire d'un nouveau bêta-agoniste: formoterol.

The muco-ciliary apparatus has an essential role in the cleansing of the tracheo-bronchial tree of particulate matter. Disturbances linked to muco-ciliary function are well known in respiratory pathology and in cases of chronic bronchitis and asthma and lead to a reduced capacity for cleansing. In addition there are numerous pharmacological agents including sympathomimetics which are capable of altering the ciliary activity and the rheological properties of mucous. The role of Formoterol, administered as an aerosol has been assessed in vivo in 10 bronchitic patients who were in a stable state. After 6 days of treatment using the Formoterol aerosol the muco-ciliary clearance had significantly increased to 46% and was a real gain when compared to the muco-ciliary clearance measured on placebo. This gain was linked to a better function of the muco-ciliary carpet and not due to the bronchodilatation which was induced by Formoterol, because the penetration index did not change. At the same time the airway resistance was slightly reduced in a none significant fashion.

[Clear cell tumor of the lung (sugar tumour). Study of a case]. / Tumeur à cellules claires du poumon ("sugar tumour"). Etude d'un cas.

A case of benign clear cell tumor ("sugar tumor") is reported. Light microscopy showed a proliferation of clear cells with a rich blood supply and endocrinoid pattern. Ultrastructurally, cells were loaded with glycogen both free and membrane-bound. The cellular origin of the benign clear cell tumor of the lung is still uncertain.

Evaluation of the efficacy and safety of loratadine in perennial allergic rhinitis.

Loratadine, a new nonsedating antihistamine, was evaluated for efficacy and safety in 228 patients with perennial allergic rhinitis. Taken at a dose of 10 mg once daily, loratadine was significantly more effective than placebo and comparable to terfenadine, 60 mg taken twice daily, in reducing combined symptom scores in this patient population. Efficacy was maintained throughout the 28-day course of treatment. The overall incidence of side effects with loratadine was low (14%) with few occurrences of sedation (3%) and dry mouth (4%).

[Post-traumatic pulmonary hematomas. Apropos of 2 cases]. / Hématomes pulmonaires post-traumatiques. A propos de deux observations.

Post-traumatic pulmonary hematoma presents clinically as a hemorrhagic collection within a newly-formed cavity in the lung parenchyma. Its frequency is probably underestimated in view of the importance of the associated lesions. The most frequent clinical sign is hemoptysis. The chest radiograph, as well as the CT scan, shows a clearly defined round image. As a rule, there is a favorable outcome with slow resorption over several weeks, with a restoration of the integrity of the pulmonary parenchyma, which justifies simple observation, with an absence of any therapeutic intervention.

[Does extrinsic asthma exist?]. / L'asthme extrinsèque existe-t-il?

Asthma cannot be triggered exclusively by external causes, even allergy. For it to develop, the subject must have pathological bronchial hyper-reactivity. On the contrary, however, asthma cannot be explained solely by intrinsic causes, metabolic or endocrine. It persists only in those subjects who have bronchial hyper-reactivity. The authors suggest a new definition of asthma, designed to replace the semi-logical definition of Charpin: Asthma is a dyspnoeic bronchospasmodic crisis that is linked with the existence of pathological bronchial hyper-reactivity.

Eficácia clínica do ambroxol no tratamento da estase brônquica: ensaio clínico em 120 pacientes com dois diferentes esquemas terapêuticos / Clinical efficacy of ambroxol in the treatment of bronchic stasis: clinical assay in 120 patients with 2 different therapeutic schedules

O ambroxol é um "modificador do muco". O objetivo do nosso estudo foi determinar sua eficácia clínica no tratamento da estase brônquica, através da realizaçäo de dois estudos duplo-cegos sucessivos em dois grupos paralelos de pacientes, comparando o ambroxol com placebo, em tratamento de 10 dias. O primeiro ensaio, envolvendo 60 pacientes tratados com 120 mg de ambroxol diariamente, mostrou diferenças significativas (p<0.05) no volume do esputo, viscosidade do esputo, dificuldade de expectoraçäo e intensidade da tosse, quando comparados com o grupo placebo. Os dois grupos de pacientes estavam inicialmente bem pareados e a droga foi bem tolerada. Em um segundo ensaio envolvendo 60 novos pacientes tratados com 30 mg de ambroxol diariamente, a droga näo mostrou efeitos clínicos claros. Concluímos que o ambroxol é um "modificador do muco" eficaz e é bem tolerado na dose de 120 mg/dia

[Pneumocystis carinii pneumonia radiologically simulating tuberculosis]. / Pneumonie à Pneumocystis carinii simulant radiologiquement une tuberculose.

The authors report a case of Pneumocystis carinii pneumonia simulating tuberculosis. Predominant upper lobes involvement is rarely seen but should be considered in immunocompromised patients.

Clinical efficacy of ambroxol in the treatment of bronchial stasis. Clinical trial in 120 patients at two different doses.

Mucosolvan is a 'mucus-modifier' whose active compound is ambroxol. The aim of our research was to determine its clinical efficacy in the treatment of bronchial stasis by carrying out two successive double-blind studies in two parallel groups of patients and comparing ambroxol with placebo in a treatment lasting 10 days. The first trial involving 60 patients daily treated with 120 mg of ambroxol showed significant differences (p less than 0.05) in sputum volume, sputum viscosity, difficulty of expectoration, and severity of cough when compared with the placebo group. The two groups of patients were initially well matched and the drug was well tolerated. In a second trial involving 60 new patients daily treated with 30 mg of ambroxol, the drug showed no clear clinical effects. We conclude that ambroxol is an effective 'mucus modifier' and is well tolerated at a dose of 120 mg/day.

[Prescription of Theostat 300 as a single evening dose]. / Prescription du Théostat 300 en prise unique le soir.

Sixteen patients with asthma and/or chronic obstructive lung disease were treated for 8 days by scored tablets of sustained-release theophylline. Treatment was administered as a single evening dose per day, 2 hours after dinner, at a daily dosage of 10 mg/kg/day of theophylline. The theophylline curve remained in the theoretical therapeutic zone of 8 to 15 mcg/ml for about 14 hours; the clinical efficacy, evaluated on the basis of the improvement in the signs and symptoms, was satisfactory. The clinical acceptability was good apart from insomnia observed during the first 2 days of treatment.

[Skin tests in the exploration of perianesthetic complications]. / Intérêt du bilan cutané dans l'exploration des accidents per-anesthésiques.

Adverse reactions in anesthesia are more and more frequent. The favoring factors are multiple but the physiopathology of these reactions are not right known: non specific histamine-release, complement activation is anaphylaxis can occur. Skin tests are an very important data for the diagnosis of these accidents. Forty patients and ten healthy subjects were tested with systematic research of a cross-reactivity for curare family; myorelaxants, fluid gelatin, dextran are the tests the most frequently positive. Cross reactivity for curare family is sure and sensibilization by some medicine is possible. Then the behavior of the data is looked at; the research of the favoring factors, the non utilization of some substances and prophylactic treatment are recommended.