Exogenous lipoid pneumonia: HRCT, MR, and pathologic findings.

The objective of this study was to describe high-resolution CT (HRCT) and MR findings of exogenous lipoid pneumonia and to correlate them with pathologic findings. A retrospective review of the medical records of our institution revealed seven patients with a diagnosis of lipoid pneumonia based on clinical data, chest films, bronchoalveolar lavage, and follow-up. Both HRCT and MR imaging were reviewed by two readers. Pathologic examination of the resected specimen or surgical biopsies were also reviewed in the four available cases. The HRCT findings were pulmonary consolidations (n = 6) with fatty (n = 3) or unspecific but low attenuation values (n = 3), areas of ground-glass opacities (n = 5), septal lines, and centrilobular interstitial thickening (n = 5). In five of the seven cases, a crazy-paving pattern of various spread was also present, either isolated (n = 1) or surrounding a pulmonary consolidation. In two cases traction bronchiectasis and cystic changes consistent with fibrosis were seen. At MR imaging (n = 2) a pulmonary consolidation of high signal intensity on T1-weighted image consistent with lipid content was present in one case. Pathologic examination (n = 4) showed the coexistence of lobules with lesions of various ages, sometimes in contiguous lobules, within the same patient. Recent lesions were those with alveolar fill-in by spumous macrophages and almost normal alveolar walls and septae. In more advanced lesions, lobules were filled in with larger vacuoles often surrounded by inflammatory infiltrates of alveolar walls, bronchiolar walls, and septa. The oldest lesions were characterized by fibrosis and parenchymal distortion around large lipid-containing vacuoles. The HRCT findings reflect pathologic findings in exogenous lipoid pneumonia. Although non-specific, consolidation areas of low attenuation values and crazy-paving pattern are frequently associated in exogenous lipoid pneumonia and are indicative of the diagnosis.

Reduction of exercise-induced asthma in children by short, repeated warm ups.

AIM: To study the effect of a warm up schedule on exercise-induced asthma in asthmatic children to enable them to engage in asthmogenic activities. METHOD: In the first study, peak flows during and after three short, repeated warm up schedules (SRWU 1, 2, and 3), identical in form but differing in intensity, were compared in 16 asthmatic children. In the second study the efficiency of the best of these SRWU schedules was tested on 30 young asthmatic children. Children performed on different days a 7 minute run alone (EX1) or the same run after an SRWU (EX2). RESULTS: The second study showed that for most children (24/30) the fall in peak flow after EX2 was less than that after EX1. The percentage fall in peak flow after EX2 was significantly correlated with the percentage change in peak flow induced by SRWU2 (r = 0.68). The children were divided into three subgroups according to the change in peak flow after SRWU2: (G1: increase in peak flow; G2: < 15% fall in peak flow; G3: > 15% fall in peak flow). Only the children in the G3 subgroup did not show any gain in peak flow after EX2 compared with EX1. CONCLUSION: The alteration in peak flow at the end of the SRWU period was a good predictor of the occurrence of bronchoconstriction after EX2. An SRWU reduced the decrease in peak flow for most of the children (24/30) in this series, thus reducing subsequent post-exercise deep bronchoconstriction.

[Treatment of community-acquired pneumonia by pristinamycin (Pyostacine 500). Results of a non comparative open study]. / Traitement des pneumopathies communautaires par la pristinamycine (Pyostacine 500). Résultat d'une étude ouverte non comparative.

UNLABELLED: Activity of natural streptogramin (NSG) appears well adapted to pathogens responsible for CAP. The goal of this multicenter pilot study was to bring first data about efficacy of NSG in treatment of CAP. PATIENTS METHOD: Ten days of a NSG (1 gr b.i.d. or t.i.d.) regimen was administered to 46 hospitalized adult patients for CAP defined with fever > 38 degrees C, respiratory symptoms and X-ray opacity. Severely ill patients were excluded. A broncho-pulmonar sample (expectoration or trantracheal aspiration or protected distal sample) was performed in all patients. RESULTS: two patients were excluded because of pulmonary embolism (n = 1) or tuberculosis (n = 1) and 44 patients were analyzed. 50% of them had associated disease, 20% had failure of prior antibiotherapy. At inclusion, mean fever was 39.2 +/- 0.7 degrees C, respiratory rate was 22 +/- 5/mn, PaO2 was 74 +/- 10 mmHg, chest X-ray showed bilateral opacity in 16%, unilateral in 84% and pleural fluid level in 6 cases. Etiological diagnosis was determined in 70% of cases. Streptococcus pneumoniae (n = 14), Haemophilus influenzae (n = 5), Legionella pneumophila (n = 2), Mycoplasma pneumoniae (n = 2) and Chlamydia psittaci (n = 1) were the most frequent isolated pathogens. 40 patients (91%) were cured with NSG and delay to obtain apyrexia was 4.4 +/- 3.9 days. NSG was stopped in 4 patients: 1 clinical and bacteriological failure (Klebsiella pneumoniae), 2 clinical failures (1 pneumococcus with purulent pleurisy, 1 pneumococcus with worsening of respiratory status), 1 patient with resistant H. influenzae strain in spite of favourable clinical evolution. NSG was well tolerated in 86% of patients. CONCLUSION: these data invite to carry on evaluation of first line therapy of CAP with NSG.

Lung density and lung mass in emphysema.

Mean lung density (dm) and radiologic (VLx) lung volume can be calculated using CT scan data. As many emphysematous patients are overdistended, the analysis of dm alone could be meaningless. However, lung mass (m) can be calculated as the product of dm and VLx. Twenty-four patients suspected of mild or severe emphysema as judged by roentgenographic and physiologic examinations as well as 16 healthy subjects were included in the protocol. They all underwent both a CT scan of the whole lung and functional tests from which the following were derived: airway resistance, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC), total lung capacity (TLC), CO transfer capacity, quasi-static compliance at functional residual capacity (FRC), and blood gases. All CT scans were performed at the FRC of each patient. The dm was lower in emphysema patients than in healthy subjects, as m was greater in patients than in healthy subjects; 1,303 +/- 398 g and 997 +/- 133 g, respectively. Although dm values were significantly correlated to FEV1, FEV1/FVC, and TLC, m values were not correlated to any of these functional indices. Unexpectedly, these results show that most patients (22/24) with emphysema have a normal or increased lung mass. Normal or above normal m values might be due to oversecretion in some patients. Nevertheless, the synthesis of new tissue due to chronic inflammation is the most likely explanation that could account for this finding.

[Community-acquired pneumonia in healthy adults: 188 patients treated with spiramycin in private practice]. / Pneumopathies communautaires de l'adulte sain: 188 patients traités en médecine libérale par la spiramycine.

One hundred and eighty eight outpatients with community acquired pneumonia have been treated by spiramycin in general practice. Community acquired pneumonia was defined by the association of fever > or = 38 degrees C, respiratory symptoms as cough, sputum production, dyspnea or thoracic pain, and pulmonary opacity on the chest X-Ray. The mean age of patients was 44.7 +/- 16.6 and few of them had concomitant chronic illness, as cardiovascular (9%) or bronchopulmonary disease (9%). Twenty one percent of patients have been included after a previous antibiotherapy failure. In 92% on these cases, prior antibiotherapy was a beta lactam. At inclusion, the fever was greater than 39 degrees C in 56% of patients, 58% had localized crepitations at the chest auscultation. The chest X-Ray was performed 1.4 +/- 2.1 days after inclusion and showed a lobar consolidation in 77%. One third of patients presented a clinical picture evoking acute bacterial pneumonia. One hundred and seventy one patients have been reviewed for a second evaluation 4 +/- 1.5 days after inclusion. One hundred and eighty seven patients have visited for the long term follow up 19 +/- 6.5 days after the onset of treatment. Ninety six per cent of them have consulted with a control chest X-ray. At this visit, the antibiotherapy was changed in 2 other patients with of failure. Overall, 83% of patients were clinically and radiologically cured by Spiramycin 3 MU twice a day for 13 +/- 3.5 days. Fourteen percent of patients were improved without necessity of changing the antibiotic regimen. This study confirms the efficacy of spiramycin in the management of community acquired pneumoniae in general practice, either in first line therapy of after the failure of beta lactam.

[A phase II trial of pirarubicin in untreated disseminated small cell lung cancer. A cooperative study of the French Pneumo-Cancerology Group]. / Essai de phase II de la pirarubicine dans les cancers pulmonaires à petites cellules disséminés jamais traités. Etude Coopérative du Groupe Français de Pneumo-Cancérologie (GFPC).

The usual form of chemotherapy of metastatic small cell lung cancer gives a 50% objective response with a mean survival of 7-8 months. We have tested a new antimitotic drug using pirarubicin alone in 26 patients. After the second treatment we noticed a response level of 12% with moderate toxicity. Then, we undertook classical chemotherapy using cisplatin-V16. After 3 doses the response level was 50% with a median survival of 32 weeks. In our study the use of a single drug pirarubicin in metastatic small cell cancer did not appear to worsen the chance of survival in patients if polychemotherapy was carried out immediately in cases which failed on the single drug. Our monotherapy did not appear to induce resistance to affective polychemotherapy. This method applied carefully to patients with metastatic disease with a strict follow up may be utilised in the assessment of the efficacy of the newer antimitotic drugs.

[Bronchial symptoms and respiratory function in the natural gas extraction industry. The role of Pi phenotype and chemical pollution]. / Symptômes bronchiques et fonction respiratoire dans l'industrie d'extraction des gaz naturels. Rôle du phénotype Pi et de la pollution chimique.

The aim of this study was to measure, in workers in the chemical industry, the frequency of symptoms and/or alteration in respiratory function according to the Pi phenotype and the occupational environment of each subject. 188 men (mean age 33) participated in a cross sectional study which included: a questionnaire on the working conditions, smoking habits and respiratory symptoms, a lung function test assessing bronchial flow rates, residual volume and CO lung transfer, laboratory investigations with determination of the Pi phenotype, blood concentration of alpha-1-antitrypsin (alpha-1-AT) and antielastase activity in the serum, a study of outdoor environment in each occupation. The Pi phenotype was divided as MM (75.5%) and non MM (24.5%). Both serum alpha 1AT concentration and antielastase activity were lower in non MM subjects than in MM ones. There was no difference between the 2 groups for age, smoking, working conditions, bronchial symptoms or respiratory function values that were within a normal range. The MM subjects stated that they were more exposed to dust, gas and cold; their absence from work for respiratory disorders was more frequent although in a non significant manner and their flow rates at low lung volumes was paradoxically worse than in non MM subjects. It is concluded that neither the outdoor environment nor the Pi phenotype play a role in the respiratory risk which requires, to be more comprehensively evaluated, a prospective study.

[A new form of mushroom workers' lung]. / Une nouvelle forme du poumon des champignonnistes.

The authors describe a new form of mushroom workers' lung after assessing the clinical situation and also the results of an immunological study. The case was related to the mushroom Poria megalopora. A new antigen has been identified and also its domiciliary origin, thus the ubiquitous nature of the antigen contributes to the interest of the case reported.

Actual usage of medical facilities by asthmatics in two French rural settings: a preliminary study.

Until recently the medical management of asthmatic patients with respect to their socio-cultural environment had only been superficially studied. Four hundred and fifty eight adult asthmatics were identified through a two-stage questionnaire in two rural districts of south west France. The study has mainly demonstrated: 1) the large number of subjects experiencing more than one attack per week (33% in Gironde, 40% in Lot et Garonne); 2) the large number of subjects feeling disabled in their occupational and day-to-day life (52% in Gironde, 54% in Lot et Garonne); 3) the absence of a relationship between the severity of the disease and the use of medical facilities in the community. Despite the frequency of the attacks and the perceived disability, 27% of the patients felt that their asthma did not require any treatment and up to 60% did not seek medical help even during an attack; 4) the role of population density, type of dwelling and social status in the management of asthma. We conclude that under-treatment is widespread in these two rural settings and is closely related with the association of at least two of these three characteristics: 1) living in a low population density area; 2) living in an isolated dwelling; and 3) being a farm owner.

[Left atrial extension of bronchial cancer diagnosed by echocardiography. Report of 2 cases]. / Extension intra-auriculaire gauche du cancer bronchique détectée par échocardiographie. A propos de deux observations.

The authors report 2 cases of left atrial extension of bronchial carcinoma detected by echocardiography. There have only been ten previous reports of echocardiography. There have only been ten previous reports of echocardiography detection of this complication as echocardiography is not requested systematically in patients with bronchial carcinoma. Left atrial metastasis is not uncommon at autopsy and the diagnostic value of echocardiography is excellent : the tumour appears as a hyperdense mass invading the roof of the left atrium through the pulmonary veins. Echocardiographic detection of left atrial extension of bronchial carcinoma is important because it implies a poor prognosis and because it may lead to a different therapeutic approach.

Pirarubicin phase II study in untreated metastatic small-cell lung carcinoma. A cooperative study of the Groupe Français de Pneumo-Cancérologie (GFPC).

Pirarubicin (THP) (Roger Bellon Laboratory, France) is a new anthracycline under clinical development. In order to assess the efficacy and toxicity of the drug in small-cell lung carcinoma (SCLC), we have undertaken this trial in front-line therapy in patients with metastatic disease, PS less than 3 and at least one evaluable lesion. Responses were assessed after two cycles of THP (60 mg/m2 i.v. bolus every 3-4 weeks) and a further cross over to VP16 + CDDP (three cycles) was systematic whatever the response to THP. This crossover was performed after only one cycle in case of obvious progression. From June 1988 to April 1990, 32 patients were enrolled: 6 were ineligible (4 non-SCLC, 2 M0), 26 patients were fully evaluable for THP and 18 patients for VP16-CDDP. The characteristics of the patients were as follows: mean age 57.4 years (38-71); T4: 54%; T3: 27%; T2: 19%; N3: 62%; N2: 35%; No: 4%. The efficacy was as follows 1 complete response and 2 partial responses (confirmed by endoscopy); 12 patients received only one cycle because of obvious progression; the overall response rate is 12% (95% confidence interval 0-24%). The patient who had complete response after pirarubicin remained in CR after VP16-CDDP, whereas the 2 patients who had partial response achieved CR for one and PR for the other; among the 15 who did not respond 1 CR and 7 PR were observed. The only significant toxicity of THP was granulopenia without infection. THP seems to be an effective anthracycline in SCLC, and the study is continuing. A response could be reached in 50% of the nonresponders with standard therapy and 10 of 24 patients (42%) finally responded. Therefore, this schedule for testing new drugs in metastatic SCLC appears ethically acceptable.

[Beta blocking drugs in chronic obstructive bronchopneumopathies]. / Les médicaments bêta-bloqueurs dans les bronchopneumopathies chroniques obstructives.

UNLABELLED: The respiratory tolerance can limit the use of beta-blocker medication (beta-) currently indicated in numerous clinical situations, both cardiovascular and also neurological and ophthalmological. Blockade of beta adrenergic receptors is without risk in subjects free of bronchial pathology, but may destabilize underlying airflow obstruction; either presenting as or sustaining bronchospasm in an asthmatic, and increasing bronchial obstruction, in patients suffering from chronic airflow obstruction (BPCO). Now BPCO, and in particular asthma, are easily associated with diseases for which beta- are indicated. In addition the notion of cardioselectivity is relative and dose dependent. IN PRACTICE: beta- are contraindicated in chronic airflow obstruction with bronchial hyper-reactivity; in other cases, beta- should be used carefully choosing the most cardioselective products at the lowest effective dose. Whatever the route of administration (in particular eye drops), the beta- are reliable to produce the same harmful effects. There should be strict follow up of treatment and a watch kept for signs of a worsening or a provocation of respiratory problems; conversely the occurrence of such symptomatology in a patient with bronchial pathology should call into question the place of beta-. Finally beta- should be avoided in allergic subjects and (a fortiori) in specific immunotherapy where there is a possibility of anaphylactic shock.

[Analysis of 64 second primary cancers of the bronchi]. / Analyse de soixante-quatre cancers métachrones des bronches.

Sixty-four primary lung carcinomas were observed among 1,039 patients operated for bronchial carcinoma between 1975 and 1984. (Statement: July 1987). The second tumor tended to develop at a distance from the first resection performed for a lesion with good prognostic factors. Their site and histology present no unusual features. 64% appeared in the contralateral lung; 78% had the same histological type as the first cancer. Among 28 patients treated by surgery, 26 had a second resection: there were two peri-operative deaths and 4 major complications. Among the 36 patients rejected for surgery, 21 had excessively altered lung function tests. 30 patients were treated with radiotherapy, 7 with chemotherapy first; one had no treatment. The survival rate for the whole group was quite good: 26% at three years; it was significantly better after a second resection: 41% at three years. Overall survival seems comparable with that of the patients operated upon for a single carcinoma.

Portable oxygen therapy: use and benefit in hypoxaemic COPD patients on long-term oxygen therapy.

In 159 chronic obstructive pulmonary disease (COPD) patients (139 males, mean age 62 +/- 8 yrs, arterial oxygen tension (PaO2) 7.2 +/- 0.9 kPa), on long-term oxygen therapy (LTOT), we evaluated the effects of portable oxygen therapy both on the daily duration of oxygen therapy and on daily activities. They were given two types of LTOT at random: group A (n = 75), oxygen concentrators only (OC); group B (n = 84), either small oxygen cylinders plus OC (B1 = 51) or liquid oxygen (B2 = 33). The patients were followed-up for one year by means of: a) medical examination every three months; b) monthly home interviews concerning the daily duration of oxygen therapy, the utilization of the devices and the daily activities of the patients; c) a measurement of the daily oxygen usage. The results show that: 1) there are no significant clinical and functional differences between groups A and B at the onset of and throughout the study; 2) in group B the daily use of oxygen therapy is significantly longer than in group A (17 +/- 3.5 h.day-1 vs 14 +/- 3 h.day-1, p less than 0.01) without any difference between groups B1 and B2; 3) outdoor walking activities are different between groups A and B, at least in those patients using oxygen more than 18 h.day-1. Only 60% of patients in group B (55% of B1; 67% of B2) use their portable devices outdoors and for walking. No strict predictive criterion of this use is found in our study.(ABSTRACT TRUNCATED AT 250 WORDS)

[Calcium antagonists and chronic obstructive bronchopneumopathies]. / Antagonistes calciques et bronchopneumopathies chroniques obstructives.

Calcium ion acts as a second messenger in numerous cellular functions. The increase in its intracellular free concentration, which is brought about by influx from the extracellular source through voltage-dependent or receptor-operated channels and/or by release from intracellular sources, triggers the contraction of smooth muscle. The currently available calcium antagonists inhibit calcium movement through voltage-dependent channels. Tracheobronchial and pulmonary vascular smooth muscles play an important role in the symptomatic expression of chronic airflow obstruction. Whether an alteration in their functioning is involved in the pathogenic mechanism of the disease has not yet been established. The contraction of bronchial smooth muscle participates in bronchial obstruction and that of vascular muscle in pulmonary arterial hypertension, which complicates hypoxemic airflow obstruction. Numerous clinical and experimental studies show that bronchodilator or anti-bronchoconstrictor effects of calcium antagonists are limited. This limitation may be linked to either a low affinity of calcium antagonists for bronchial smooth muscle or a specificity of the mechanism of excitation-contraction coupling in this muscle. Calcium antagonists are powerful inhibitors of hypoxic pulmonary vasoconstriction. This inhibition may lead to a worsening of hypoxemia in relation to redistribution of blood flow towards low ventilation/perfusion ratio areas although the concomitant rise in cardiac output leads to increased oxygen transport. These effects seem to be maintained in the long term.

[Delayed-action theophylline versus placebo on the ventilatory function of stable asthmatic patients. Study in relation to circadian rhythm]. / Essai d'une théophylline longue action contre placebo sur la fonction ventilatoire de l'asthmatique stable. Etude en fonction du rythme nycthéméral.

The aim of this study was to measure the results of a long-acting theophylline (Planphylline) on the flow rates of stable asthmatic patients while taking into account the spontaneous circadian variations of the ventilatory function. 27 patients were involved in this randomized, double-blind, cross-over trial; they received 10 mg/kg/day in two doses at 8.30 a.m. and 8.30 p.m or the placebo. The product was administered over two 4-day periods separated by a 3-day wash-out period. The theophylline concentration and bronchial flows (FEV1; MMEFR 25-75) were measured at 8 a.m., 10.30 a.m., noon, and 3 p.m. on days 1 and 4 of each period; 11 patients measured their hourly PEFR from 8 a.m to 10 p.m those same days. The results can be analysed for 19 patients, including the 11 who measured their PEFR. The first day of treatment (D1), the theophylline concentration rose regularly without going above 10 micrograms/ml. On the fourth day of treatment (D4), the mean maximum concentration was above 10 micrograms/ml and the 8 a.m rate was superior to 8 micrograms/ml for 14 patients out of 19. The bronchodilating effect of Planphylline is significant for all bronchial flow rates (FEV1 less than 0.01; MMEFR 25-75 less than 0.05; PEFR less than 0.01, n = 11). On D1, the FEV1 becomes normal. On D4, the MMEFR 25-75 is still only partially improved, in spite of the theophylline concentration obtained. Because of the spontaneous diurnal improvement of bronchial rates, only the 8 a.m, 10.30 a.m. and 3 p.m. FEV1 obtained with Planphylline are statistically different from those obtained with placebo.(ABSTRACT TRUNCATED AT 250 WORDS)

Respiratory function and bronchial reactivity in mill workers.

Professional exposure to vegetable dusts affect the respiratory function of the exposed subjects. A previous survey conducted in an industrial flour-mill demonstrated a higher frequency of respiratory symptoms in workers compared to a control group. Ten subjects employed in a work site particularly exposed to dust were studied. Each subject answered a questionnaire and performed on Mondays and Fridays, at the beginning and end of his work shift, a flow volume curve and an isocapnic hyperventilation test. The aerobiology of the professional environment was also measured. We noted: 1) in the flow volume curves: a drop in the FEV1 during the Monday morning shift, a significant difference between the FEV1 (p less than 0.05) and the MMEFR 25-75 (p less than 0.05) measured at 6 am on Monday and Friday, and between the MMEFR 25-75 values obtained at 12 noon on Monday and Friday (p less than 0.05). 2) after isocapnic hyperventilation, a significant drop in the MMEFR 25-75 at 6 am on Monday (p less than 0.01) and in the FEV1 and MMEFR 25-75 at 12 noon on Mondays (p less than 0.05), a significant drop in the FEV1 at 1 pm on Monday (p less than 0.01).

Effect of dry warm air on respiratory water loss in children with exercise-induced asthma.

The variation in respiratory water loss (RWL) over time, expressed as the mass of water vapor lost per liter (body temperature and pressure, saturated) of ventilation (MH2O), was investigated in two groups: (1) children with exercise-induced asthma; and (2) healthy children. Children were matched for age and sex and went without medication for at least 12 hours before each experiment. The children breathed dry warm air (TI = 28.4 degrees C +/- 0.3 degree C) for 15 minutes while bicycling at constant and moderate work load (50 W). The MH2O was measured by collecting and weighing the expired water vapor (1) at rest breathing in warm conditions of inspired gas (control values), (2) every five minutes during exercise while breathing dry warm air, and (3) four minutes after the end of exercise. Pulmonary function tests were performed before and six minutes after exercise. The results were abnormal only in children with exercise-induced asthma. During exercise, RWL significantly fell (compared to control value) at the tenth and 15th minute in both groups. Whereas normal subjects recovered their initial values for MH2O four minutes after stopping exercise, asthmatic children still had a reduction in respiratory water loss. During exercise, MH2O decreased a little more in healthy than in asthmatic children. The decrease in MH2O in both groups suggests that the means to fully humidify expired gas are overwhelmed by thermal stress. The lack of increase in MH2O in asthmatic children on stopping exercise suggests that the airway mucosa is unable to produce enough water vapor and is thus dehydrated and probably hyperosmotic.

Respiratory function in flour-mill workers.

The frequency of bronchial symptoms and the alteration of respiratory function parameters were studied in a group of 63 workers of an industrial flour-mill, and in a control group matched according to age, social class, and tobacco intake. In the exposed group the answers to a questionnaire indicated a greater incidence of cough (p less than 0.01) and chronic expectoration (p less than 0.01) as well as clinical airway hyperreactivity (p less than 0.01). No differences were noted for either asthma or allergy. The respiratory function parameters did not differ between the two groups studied. These results suggest that workers exposed to the vegetable dust found in fluor-mills are subject to develop chronic bronchial irritation.