[Tracheobronchial amyloidosis: apropos of 2 cases]. / Amylose trachéobronchique: à propos de deux cas.

INTRODUCTION: Tracheo-bronchial amyloidosis is an uncommon localized form of amyloidosis. We report two new cases. EXEGESIS: Two patients had developed expiratory dyspnea for several months. CT-scan and flexible bronchoscopy confirmed tracheal narrowing and a diagnosis of tracheo-bronchial amyloidosis was made by tissue biopsies. The immunohistochemical type was AL in one case, undetermined in the other case. There was no argument for systemic involvement. The two patients benefited from bronchoscopic dilatation. This treatment improved clinical symptoms and pulmonary function tests with a follow up of 12 and 18 months respectively. CONCLUSION: Tracheo-bronchial amyloidosis is a localised form of amyloidosis with various respiratory symptoms. Diagnosis is made by CT-scan and flexible bronchoscopy that allows biopsies. Immunohistochemical type is more often AL. Recurrence, respiratory insufficiency and tracheo-bronchial metaplasia are the most important complications. Treatment consists of bronchoscopic dilatation or excision, and bronchoscopic laser-YAG. Pulmonary function testing allows precise follow-up.

[Primary pericardial thymoma: an unusual etiology of neoplastic pericarditis]. / Thymome primitif du péricarde: une étiologie inhabituelle de péricardite néoplasique.

We present a case of a primary pericardic thymoma, revealed by a pericardic effusion. This ectopic localisation is very unusual; neoplastic pericarditis are usually due to metastasis of carcinomas or lymphomas. Sometimes, they are secondary to pericardic invasion by mediastinal malignant thymomas or a metastasis of thymomas. Our patient presented a single pericardic localisation of thymoma without any other site. We discuss ectopic localisations of thymic tissue and thymomas and the diagnostic usefulness of the MIC 2 antibody.

[Uncommon aspects of mediastinal teratoma. CT X-ray and MRI study]. / Aspect inhabituel d'un tératome médiastinal. Etude TDM et IRM.

CT and MRI features of a multicystic mediastinal teratoma, which was surgically and pathologically confirmed, are presented. CT found 4 cystic tumors of mediastinum with water density content and thick capsule. One kyste contained a fat density area and peripheric calcifications. MRI showed will defined high signal intensity on Spin-echo T1 weighted images. CT and MRI are not reliables in predicting or excluding adherence to adjacent structures. The particularity of this case was the presence of a communication between the anterior right cyst and the posterior left one. This communication passed by the transverse sinus of pericardium.

[Pleural thymoma. Apropos of a case and review of the literature]. / Thymome pleural. A propos d'une observation et revue de la littérature.

The authors report a case of pleural tumor discovered in case of thoracic pain in a 72 year old woman. This lesion, discovered on chest X-Ray, developed in the left costo-vertebral groove and was seen as a homogeneous opacity, multilobate, well-defined. CT confirmed the pleural origin, showed a thickening of posterior pleural, a polylobate tumor well-defined on its lung side, non-invasive and of tissue density. Histopathological examination of the operative specimen showed it to be a thymoma with an exceptional localization.

[Adult bronchiectasis revealing familial ciliary anomaly]. / Dilatations des bronches localisées de l'adulte révélatrices d'une anomalie ciliaire familiale.

We report a case of bronchiectasis in a 26-year-old man associated with the following congenital abnormalities: deafness, purulent bronchorrhea, nasal polyps, dysmorphic physical pattern and chronic sinusitis. Situs inversus was absent. A sampling was performed on the posterior nasal mucous membrane and displayed structural ciliary abnormality: a deficiency of the intern dynein-arm. The patient's bother was affected and had similar features: congenital bronchiectasis, deafness, mental deficiency and sinusitis. Young's syndrome was relevant in this case. Hereditary ciliary dyskinesia should be considered in adults with bronchiectasis together with rhinologic and alimentary canal disorders. Nasal biopsies are safe and allow cilia examination.

[Intrathoracic cavernous hemangioma. Apropos of a case]. / Hémangiome caverneux intrathoracique. A propos d'un cas.

A cavernous haemangioma of the mediastinum is a rare benign vascular tumour. Generally it is totally asymptomatic and the diagnosis is most often made in a child or young adult. The treatment is surgical. We report a case in a 60 year old man who was a smoker.

[Peripheral bronchopulmonary cancers. Diagnostic efficiency of fibroscopic samples. Prospective study on 561 patients]. / Cancers bronchopulmonaires périphériques. Rendement diagnostique des prélèvements fibroscopiques. Etude prospective sur 561 malades.

The purpose of this french multicentric study was to evaluate the diagnostic accuracy of samples collected by fibroscopy in peripheral lung cancer with normal endoscopy. Five hundred and sixty-one patients entered the study; a tumour had been diagnosed in 350 of them (62 p. 100). Among these 350 patients, 147 were examined with the help of a light-amplifier screen, and a positive diagnosis was made in 97 (66 p. 100). Guided sample collection in the pathological area (biopsy, brushing, transcatheter aspiration) proved much more rewarding than unguided sample collection (biopsy of the bronchus, simple aspiration or cytology of 3-day sputum): 45 p. 100 positive results versus 18 p. 100 (P less than 0.001). However, sputum cytology still had good diagnostic value since it provided by itself the diagnosis in 14 p. 100 of the cases. Results were significantly inferior in tumours less than 3 cm in diameter.

[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.

[Bronchial dilatation and rheumatoid arthritis: a little known association]. / Dilatation des bronches et polyarthrite rhumatoïde: une association méconnue.

Since Ellmann's description in 1948 numerous authors have studied the respiratory manifestations associated with rheumatoid arthritis. Amongst the numerous disorders described, dilatation of the bronchi, although one of the most frequent, remains largely under-estimated. The authors report a series of 21 patients presenting jointly with both rheumatoid arthritis and bronchiectasis which was documented using thoracic computed scanning. All the subjects were female. For 20 of these patients, the appearance of bronchial suppuration preceded that of the articular manifestations by several years. Bronchial dilatation in these cases can, only with difficulty, be considered as a complication of arthritis as has been previously suggested. Rather it appears as a possible pre-disposing factor in the occurrence of the rheumatoid disease. These hypotheses explain the pathophysiological mechanisms implicated in this association are discussed.

[Associated lesions in closed injuries of the thorax: right bronchial rupture, rupture of the right subclavian artery, and bilateral fracture of the 1st rib]. / Associations lésionnelles dans les traumatismes fermés du thorax: rupture bronchique droite, rupture de l'artère sous clavière droite, avec fracture bilatérale de la 1re côte.

A patient presented with rupture of right bronchus associated with rupture of the homolateral subclavian artery (diagnosed secondarily at the false aneurysm stage) and bilateral fracture of the 1st rib. Two stage repair operation provided lasting recovery. This case is used as a basis for emphasizing the diagnostic problems raised by combined endothoracic lesions, the need for systematic investigation of possible presence of a lesion of subclavian artery in patients with fracture of 1st rib, and finally various operative tactics (in the framework of false aneurysms of proximal subclavian vessels).

[Acute respiratory insufficiency after pleural talcage of pneumothorax. Apropos of a case]. / Insuffisance respiratoire aiguë après talcage pleural d'un pneumothorax. A propos d'un cas.

The authors report about one case of respiratory distress occurring after pleural talcage for pneumothorax. Although few cases have been published, this complication is known, and it should lead to carefully consider the indication of this technique and to limit the total amount of talc used.

[Idiopathic pulmonary hemosiderosis and rheumatoid arthritis. Apropos of a case]. / Hémosidérose pulmonaire idiopathique et polyarthrite rhumatoïde. A propos d'une observation.

A 38-year-old woman was known to have had a histologically proven "idiopathic" pulmonary hemosiderosis for 7 years; the authors report the onset in this patient of polyarthralgias with articular swelling and positivity of rheumatoid factor, all features consistent with the diagnosis of rheumatoid arthritis, whose beginning was certainly hidden by steroid therapy. This case, as some others previously published, outlines the possibility of the association of pulmonary hemosiderosis and rheumatoid arthritis: is this a casual association, or may pulmonary hemosiderosis be a rare manifestation of rheumatoid arthritis?

[Mycobacterium chelonei pulmonary infections. Apropos of a case]. / Les infections pulmonaires à Mycobacterium chelonei. A propos d'un cas.

Infections caused by Mycobacterium chelonei are rare. We report a case of pulmonary infection in a 57-year-old non-immunocompromised woman. Most of the abnormalities were observed at radiology which showed bilateral apical excavated opacities. The disease could only be diagnosed on surgical biopsies. Beside diagnostic problems, M. chelonei infections are a source of therapeutic problems.

[X-ray pictures in pneumonia caused by Pneumocystis carinii. Nine cases of immunodepressed patients (author's transl)]. / Aspects radiologiques de la pneumonie à Pneumocystis carinii. A propos de 9 observations de patients immunodéprimés.

The authors analyse the pulmonary symptoms found by X-Ray in nine immunodepressed patients who were hosts to Pneumocystis carinii. The radiological abnormalities do not generally appear early nor are they specific; the syndrome of diffuse alveolar consolidation only appears at a late stage, it is most serious in the base and the peri-hilar regions, but does not affect the apex. It would appear that no prognostic value can be ascribed to the radiological results. The authors therefore suggest bronchial scanning for tracking down the Pneumocystis whenever suspicious clinical symptoms appear.

[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.

Tracheobronchial stenting in patients with esophageal cancer involving the central airways.

BACKGROUND AND STUDY AIMS: Locoregional progression of esophageal cancer can result in respiratory distress aving to tracheoesophageal (T-E) fistula or central airways stenosis. We report our experience of airway stenting in 51 patients with esophageal carcinoma involving the central airways. PATIENTS AND METHODS: All data were recorded retrospectively. Fifty-one patients (44 men and seven women), with a mean age of 58.6 years, were analyzed. All had an esophageal squamous cell carcinoma. Severe respiratory impairment due to tumor invasion or to a tracheobronchial fistula (n= 14) was present in all patients. Nine of the 14 patients with fistula had dysphagia. Among the 37 patients without fistula, 19 had dysphagia. RESULTS: Sixty-six tracheobronchial stents were inserted in 51 patients: 65 Dumon stents and one Wallstent. Forty stents were implanted in the trachea, 16 in the left main bronchus and 10 in the right main bronchus. In 47 patients there was a significant improvement of respiratory symptoms. Esophageal intubation, carried out in nine patients, allowed eating and drinking in all cases. Mean survival was 107.7 days, with the longest follow-up 587 days. There was no difference between mean survival in the patients with fistulae (103.3+/-days) and the others (109.3+/-days). In two cases stent placement was responsible for death (massive hemoptysis and pneumonia). The main complications were migration (n=6), granuloma (n=2), pneumonia (n=2) and pneumothorax (n = 2). In 13 patients tumor progression in the airways was noted from one to 11 months after stenting, inducing a relapse of dyspnea. CONCLUSIONS: Complications are easily detected by the appearance of respiratory symptoms and do not necessitate systematic flexible bronchoscopy, but only preventive measures such as regular aerosol therapy, adapted respiratory physiotherapy and regular clinical follow-up.