Does peripheral blood T-lymphocyte population distribution in sarcoidosis provide a prognostic clue?

In its pulmonary form, sarcoidosis generally resolves spontaneously, but it may lead to fibrosis of the lung. The clinical, radiological and functional tests, as well as activity markers such as the serum angiotensin converting enzyme, intrathoracic uptake of 67Gallium and the cytological data provided by bronchoalveolar lavage are only the expressions at any given time of a disease which is constantly progressing and only partly express its evolutive potential. The authors studied the distribution of T-lymphocyte subsets in the peripheral blood and from bronchoalveolar lavage. 32 patients were included in the study. They were suffering from acute or chronic sarcoidosis of the mediastinum and lungs and were divided into 2 groups according to clinical, radiological and pulmonary function criteria; Group A (n = 19) included regressive forms (minimum follow up 2 years) and group B (n = 13) the progressive untreated forms. Lymphopenia with a decrease in the percentage of CD3 cells was found in both groups. The percentage of CD4 cells is significantly lower in group B (28 +/- 11%) than in group A (45 +/- 8%) (p < 0.01) or in the control population (46 +/- 8%) (p < 0.01). The percentage of CD8 cells is higher in group B (30 +/- 8%) than in group A (18 +/- 6%). This results in a CD4/CD8 ratio which is significantly reduced in group B (1 +/- 0.5) when compared with group A (2.72 +/- 0.8) (p < 0.01) and the control group (2.17 +/- 0.8) (p < 0.01), the difference between group A and the controls being minimal.(ABSTRACT TRUNCATED AT 250 WORDS)

[Post-traumatic pneumatocele and hemato-pneumatocele of the lung. Apropos of 3 cases]. / Pneumatocèles et hémato-pneumatocèles post-traumatiques du poumon. A propos de 3 observations.

Pneumatocele and haemato-pneumatocele are air or air/fluid cavitary lesions which develop in the lung parenchyma after thoracic trauma. The formation of this lesion requires a direct violent impact on the pliable lung wall which explains its frequency in young adults. They are preferentially localised in the lung bases. The importance of associated lesions often marks the pneumatocele. Though rarely described, its frequency is certainly underestimated. If haemoptysis is the most frequent clinical sign it is the chest x-ray which demonstrates the early abnormality in the form of a rounded translucent image with a fine contour and variable diameter. The existence of a fluid level suggests the presence of blood (haemato-pneumatocele). The differential diagnosis with a localised pneumothorax, a diaphragmatic hernia and a pre-existing cystic lesion is easy as a rule but an evacuated pulmonary haematoma may lead to the discussion, especially as the mechanism of their formation may be the same. In isolation their clinical implications are minimal, their evolution favourable and after several weeks with a restitution of the integrity of the pulmonary parenchyma the absence of therapeutic intervention is justified.

[T lymphocyte subsets in alveolar lavage and peripheral blood in sarcoidosis and extrinsic allergic alveolitis]. / Etude des sous-populations lymphocytaires T dans le lavage alvéolaire et le sang périphérique dans la sarcoïdose et les alvéolites allergiques extrinsèques.

Accumulation of inflammatory and immune cells within lung parenchyma would constitute the initial step in producing the alveolar structural abnormalities. It is usually assumed that alveolitis, as assessed by broncho-alveolar lavage (BAL), represents a biological assessment of lung disease activity. The aim of this study, using monoclonal antibodies, is to characterize the T lymphocytes alveolitis in the lung and in peripheral blood in 3 well-defined populations: 1 degree) control subjects (n = 7); 2 degrees) patients with biopsy proven mediastino-pulmonary sarcoidosis (sarc) (n = 73), classified according to their clinical activity as active, inactive, chronic, and treated; 3 degrees) patients with extrinsic alveolar alveolitis (EAA) (n = 19). For the same BAL volume, the % of CD4+ cells and the CD4/CD8 ratio are increased in chronic and active sarc, contrasting with an increase in the % of CD8+ cells and a decrease in the CD4/CD8 ratio in the EAA. In absolute values, there are 2 times as many CD4+ cells and 5 times as many CD8+ cells in EAA than in sarcoidosis. In sarcoidosis, corticotherapy tends to normalize the CD4/CD8 ratio although the intensity of the lymphocytic alveolitis is not affected. In the peripheral blood, lymphopenia is observed only in the active form of sarc. in the CD4+ population, without any significant change in the CD4/CD8 ratio compared to the other groups. The number and distributions of BAL. T lymphocytes subsets may constitute a biological indicator for diagnostic orientation, but they do not distinguish sufficiently between the different groups of sarcoidosis to be of any prognostic value.