Sarcoidosis. Retroperitoneal fibrosis, renal arterial involvement, and unilateral focal glomerulosclerosis.

In one patient with pulmonary sarcoidosis, hypertension occurred during the course of the disease. Aortography showed extensive narrowing of the right renal artery. Surgical exploration disclosed extensive periaortic and perirenal fibrosis. This fibrosis encircled the right renal artery and caused extrinsic compression. Pathological examination disclosed a large amount of histiocyte epithelioid infiltration in various samples of the fibrosis and particularly in the adventitia of the renal artery, highly suggestive of sarcoidal angiitis. Surgical biopsy was performed on both kidneys. The right kidney, protected by arterial stenosis, was little altered, while the left kidney showed extensive interstitial, tubular, and glomerular lesions. The glomerular lesions were focal and segmental hyalinosis.

Preoperative chemotherapy in epidermoid bronchogenic carcinoma.

Palliative chemotherapy in cases of epidermoid bronchogenic carcinoma, initially judged to be inoperable, made it possible to perform operative resection in 50 cases. An association of cis-platinum and bleomycin was used, this combination having previously been considered synergistic. In certain cases the tumour seemed to have disappeared on macroscopic examination of the resected specimen, and in some instances no tumoral cells could be found on histological examination. This series brought out several positive features: chemotherapy made it possible to operate on patients previously judged to be inoperable; it ensured maximum local efficiency of drugs because of the absence of abnormal vascularity; and it made it possible to anticipate the cure of occult metastases. However, three negative aspects were also present: modification of postoperative TNM classification making it difficult to establish a prognosis; difficulty in determining therapeutic strategy for pNo; and inadequate long-term follow-up. On the whole the positive points appeared to outweigh the negative aspects, but a randomized study is necessary to confirm this.

[Therapeutic importance and tolerance of coated 50 mg Vectarion tablets (almitrine bismesylate) at a dosage of 100 mg/day. Study of blood gas, clinical and biological results after a year of long-term treatment]. / Intérêt thérapeutique et acceptabilité du Vectarion 50 mg comprimés enrobés (bismésilate d'almitrine) à la dose de 100 mg/jour. Etude des résultats gazométriques, cliniques et biologiques en traitement prolongé pendant 1 an.

The objectives of this study, in which Almitrine bismesylate was administered for one year in chronic bronchitics with obstructive hypoxia, were to assess its clinical and gasometric efficacy and its clinical, laboratory, spirometric and electrocardiac acceptability. The blood gas results show a significant rise in PaO2 (p less than 0.001) rising by 5.5 mmHg after 6 months (T6) and by 6.0 mmHg after 12 months (T12) in comparison with the value at the study's onset. The PaCO2 fell by 3.3 mmHg at T6 and 2.7 mmHg at T12 (p less than 0.001). The dyspnoea of the patient, scored by the doctor on a scale of severity from 0 to 5 was situated on a mean of 3.3 points at the beginning of the study. It was significantly reduced by 0.8 points at T6 and by 0.9 points at T12 (p less than 0.001). The percentage of patients hospitalised during the course of the study fell significantly in comparison with the previous year, from 68% to 49% (p less than 0.001). The improvement in clinical status and in blood gases bore no relation to changes in respiratory function. The clinical acceptability of the product was good; few side effects were observed and the respiratory, digestive and neurological problems were often pre-existing. They only led to cessation of treatment in three cases. The electrocardiogram was unchanged. The laboratory investigations was unchanged, with the exception of a fall in red blood cells in relation to the correction of the hypoxaemia in polycythaemic patients.

[Possible role of committees concerned with the fight against tuberculosis and respiratory diseases in home ventilatory assistance of severe chronic respiratory insufficient patients (author's transl)]. / Role possible des comités de lutte contre la tuberculose et les maladies respiratoires dans l'assistance aux insuffisants respiratoires chroniques graves par la ventilation à domicile.

It appeared that the departmental committees involved in the fight against tuberculosis and respiratory diseases were qualified to bring assistance to severe chronic respiratory insufficient (C.R.I.) patients. This modified course of action replaces their previous struggle against tuberculosis due to its recession. In Seine-Maritime the committee has signed an agreement with the principal Social Security organizations. This agreement defines the modalities and cost of home care for severe C.R.I. patients who have been tracheostomized permanently and whose condition justifies the continuation of assisted ventilation. Contingent on certain medical and socio-family conditions, the return home of such patients is possible. Thus in 15 years we have been able to benefit 72 patients with assisted endo-tracheal ventilation at home. Thirty-two of them are actually still living.

[Upper and medial alveolar nerves. Study of their frequency and point of origin in 100 cases]. / Nervios alveolares superiores y medios. Estudio de su frecuencia y punto de origen en 100 casos.

The existence, frequency and origin of the middle superior alveolar nerves was studied in 100 cases. 40 dried bones and 40 formaldehyded bones with the nerves in situ, were observed by transilumunation; and 20 hemi sectioned heads were disected with the help of transilumination. The middle superior alveolar nerve was found in 57 cases, in 35 arose from the Maxillary nerve trunk in the infraorbital canal and in 22 arose from the Maxillary nerve trunk in the tuberosity face of the maxillary bone, very near of the beginning of the infraorbital canal. A enlarged review of the literature and the comparison with our findings, was made too.

[Poisoning by diazomethane inhalation]. / Intoxication par inhalation de diazométhane.

A case of Diazomethane intoxication has been reported. Diazomethane is gaz commonly used by pharmacological and industrial chemist. This case of intoxication is rare, since only 15 other cases have been published up to now. A review of the literature leads leads describe the clinical feature of such an intoxication by gaz inhalation. When Diazomethane is inhaled it induces respiratory and general disorders. In some cases, it be fatal, and, in some other cases, when a second exposure happens, bronchial asthma may appear. Post mortem studies show pulmonary oedema lesions with important inflammatory reaction localized in the peribronchia. It must be emphasized that direct aggression is probably responsive of toxical discorders, but increase of the symptoms consecutive to a second exposure are related to allergical mechanisms.

[Tuberculosis or hepatic granulomatosis? (author's transl)]. / Tuberculose ou granulomatose hépatique?

The authors report 43 observations of pulmonary or extra-pulmonary tuberculosis, bacteriologically proved, in which liver biopsies revealed more or less complete granulomatous lesions. The culture of 29 liver fragments on Löwenstein and Colestos medium enabled the identification of the tuberculous bacillum in only one case. In the other cases the hepatic lesion has only been related to the tuberculosis because of the clinical and bacteriological context. Therefore, besides exceptional cases where Koch bacillum is revealed in the liver parenchyma, it seems that granulomatosis can be considered a control for the delayed hypersensitivity reaction to the tuberculous antigens, and not to the tuberculous infection localized to liver.

[Information obtained by liver biopsy in 100 tuberculous patients]. / Renseignements fournis par la biopsie hépatique chez 100 malades tuberculeux

The results of liver biopsy in 100 patients with tuberculosis are reported. In 8 patients, biopsy only occurred secondarily, during liver disease which appeared during antituberculous treatment. In five cases, the association of rifamycin and isoniazid was probably responsible and the mild histological signs noted suggested a favourable course after stopping one of the drugs or simply reducing the dose. The 3 other patients had virus hepatitis and biopsy was of prognostic interest by revealing the onset of post-hepatic cirrhosis. In 92 cases, liver biopsy was carried out before treatment. In 34 cases the liver was normal, in 38 patients there were hisotlogical changes which did not suggest tuberculosis but, probably, alcoholism. These were : steatosis, in 21 cases, cirrhosis in 8 cases, a mixture of steatosis and cirrhosis in 4 cases, and acute alcoholic hepatitis in 5 cases. Finally, in 20 cases, biopsy revealed an appearance of granulomatous hepatitis. Although this lesion is significant in the development of the disease, it is not characteristic of tuberculosis unless there is caseous necrosis, as in 2 cases, and unless culture of the biopsy material is positive, as in one case out of 9, i.e. the diagnostic interest of liver biopsy is not very great compared with prognostic interest. By determining the anatomical condition of the liver, often not obvious when simple liver function tests are carried out, it permits one to forsee to some extent the tolerance of the liver to antituberculous treatment, especially in alcoholics.

[Lung function and gastroesophageal reflux during chronic bronchitis (author's transl)]. / Fonction respiratoire et reflux gastro-oesophagien au cours de la bronchite chronique.

The coexistence of gastroesophageal reflux (GER) and respiratory diseases has led us to raise three questions : 1) how frequent is GER in patients with chronic bronchitis?, 2) is the respiratory function in patients with chronic bronchitis different when they have a GER and when they do not?, 3) is the GER different in patients with chronic bronchitis and in subjects not suffering with chronic bronchitis? The study of esophageal pH after a test meal showed there was a GER in 29 out of the 47 patients studied. The measurements of lung volume, air flow, pulmonary compliance, as well as the alveolo-capillary transfer of carbon monoxide, showed that there was no difference in the lung function of bronchitics whether they had a reflux or not. On the other hand, refluxes are less frequent but longer in patients having bronchitis and a GER, than in those having a GER but not having bronchitis. This must be linked to a low esophageal clearance which could be related to the attack of bronchitis. Only a well carried out prospective study of the treatment of GER in patients will reveal if the reflux increases bronchitic symptoms.

[Study of adult morbidity and mortality from pneumococcus in hospital (author's transl)]. / Etude de la morbidité et de la mortalité par pneumococcie, chez l'adulte, en milieu hospitalier.

The authors report the retrospective study of 333 cases of pneumococcal infection recorded in in-patients at the Rouen CHU (University Hospital Centre) from january 1974 to december 1978. Pneumococcal infection involves mainly the lungs (210 cases) according to different features. Pleural involvement is found in 70 cases only. Extra-respiratory localizations are less frequently encountered; they are represented mainly by meningitis (43 cases). Prognosis depends more on diathesis factors such as age and associated pathology than on the site of infection (cases with isolated respiratory involvement being usually less severe). The authors insist on the necessity of prevention especially by vaccination, of which indication is discussed.

[Respiratory function disorders during hepatopathies with immunity involvement]. / Perturbations de la fonction respiratoire au cours des hépatopathies a participation immunitaire.

A respiratory functional test was done systematically on 24 patients with chronic hepatitis and was found normal in only 2 cases. It showed an alteration of the transfer in 14 patients and a syndrom of hyperinflation in 8 others. Despite the histopathological proof it seems that the transfer alteration could be attributed to diffuse interstitial pulmonary lesions. They have already been noted in chronic hepatitis by several authors. The pathogeny of this interstitial involvement probably implied immunity phenomenons including the participation of the antigen Australia or others. As for the hyperinflation syndrome observed in 4 patients in the absence of any bronchopulmonary history, it could reveal an emphysema, which, so far, had not been seen associated to chronic hepatitis.

[Respiratory function tests in epidermoid cancers of the bronchi]. / A propos de l'exploration fonctionnelle respiratoire au cours du cancer épidermoïde des bronches

The results of functional tests are analyzed in 50 cases of epidermoid bronchial cancers. Severe disorders take place in almost every patient. In one patient out of two, there is an old distension already existing prior to the cancer; in other patients gas exchange disorders can be improved by the intervention. Moreover, from some results a spreading of cancer towards the mediastinum is to be feared.

[Study of P50 and 2,3-diphosphoglycerate in 23 bronchoemphysema patients as a function of hypoxia and hemoglobin concentration]. / Etude de P50 et 2,3-diphosphoglycérate chez 23 broncho-emphysémateux en fonction de l'hypoxie et de la concentration d'hémoglobine.

2,3-DPG and P50 were measured in 23 patients with chronic obstructive lung disease. All patients had a chronic hypercapnia (PaCO2 greater than or equal to 45 Torr). They are shared in 3 groups, according to hemoglobin content [Hb] and hypoxia : group I(PaO2 = 48.0 +/- 2.4 Torr ; [Hb] = 15.9 +/- 0.3 g. 100 ml-1; n = 9), (M +/- 1 SE); group II (PaO2 = 46.4 +/- 5.0 Torr; [Hb] = 11.6 +/- 0.7 g. 100 m[-1; n = 7); group III(PaO2 = 61.4 +/- 2.4 Torr; [Hb] = 13.3 +/- 0.4 g. 100 ml-1; n = 7). 2,3-DPG (group I : 1.05 +/- 0.06 mole.moleHb-1; group II : 1.02 +/- 0.08; group III : 1.11 +/- 0.08) was not significantly different of 2,3-DPG value of 12 control subjects (0.96 +/- 0.04). P50 of group I (26.9 +/- 0.9 Torr) and group III patients (28.1 +/- 1.6 Torr) was not significantly different of control value of P50 (27.4 +/- 0.5 Torr). P50 of group II patients (29.6 +/- 0.8 Torr) was significantly higher than P50 control and group I values (p less than 0.05). All the patients of group II died. These results suggest that in patients with chronic obstructive lung disease : 1) P50 value is different with various clinical conditions; 2) P50 increase is a compensatory mechanism in severe hypoxemia with anemia, but is not sufficient; 3) [Hb] is the best data for clinical prognosis.

[Pulmonary arteriovenous aneurysm]. / Anévrysme artério-veineux pulmonaire.

A case of large arteriovenous aneurysm in the right upper lobe of a 27-year old man is reported. The pulmonary angioma was responsible for a 30% shunt with hypoxia and polycythaemia but was only discovered while looking for the origin of a cerebral abscess. A few weeks after surgical treatment of the cerebral abscess, the right upper lobe was excised with immediate correction of the hypoxia. This case shows that pulmonary angiomas can sometimes be revealed by neurological complications, and that visceral angiomas should not remain undiagnosed. They should be considered as part of a Rendu-Osler disease, the familial character of which may contribute to an early diagnosis.