[Endobronchial ultrasound and PET positive mediastinal lymph nodes]. / Echographie endobronchique et ganglions TEP positifs dans le cancer broncho-pulmonaire.

INTRODUCTION: In bronchial carcinoma when positron emission tomography with 18-fluorodeoxyglucose (FDG-PET) shows increased emission in the mediastinal lymph nodes, confirmation by tissue biopsy is necessary. In this particular situation we have evaluated the use of real time lymph node aspiration under endobronchial ultrasound control. METHODS: Consecutive patients referred for staging and/or diagnosis of PET positive mediastinal nodes in the setting of suspected or confirmed bronchial carcinoma were included. The results of lymph node aspiration, performed under local anaesthesia in out-patients, were collected and if non-diagnostic surgical exploration was performed. RESULTS: 20 patients were studied between December 2004 and September 2005. The average number of ultrasound guided needle aspirations per patient was 4.8 +/- 1.2. Cytological or histological confirmation of malignancy was obtained by needle biopsy in 12 patients. The 8 negative cases were confirmed by surgical biopsy. In this preliminary series the sensitivity, specificity and negative predictive value of ultrasound guided aspiration of PET positive nodes was 100%. CONCLUSION: Endobronchial ultrasound with needle aspiration should be considered a primary method of investigation of PET positive mediastinal lymph nodes.

Acute hepatic injury associated with minocycline.

Minocycline hydrochloride hepatotoxic effect occurred in one patient. Unlike the usual histologic features of tetracycline-induced hepatic injury, fatty metamorphosis was predominantly macrovesicular . The patient recovered when drug therapy was withdrawn. Close observation of liver function variables is recommended in patients treated with high parenteral doses of minocycline, particularly in cases of pregnancy or renal disease.

Acute nonhemodynamic pulmonary edema with nifedipine in primary pulmonary hypertension.

A 34-year-old man with primary pulmonary hypertension developed acute nonhemodynamic pulmonary edema after a loading dose of nifedipine. Changes of the vascular permeability induced by the drug acting on the arteriolar wall of the capillary system could be an explanation.

Perception of dyspnoea during acute changes in lung function in patients with either asthma or COPD.

The aim of the study was to evaluate the relationship between several lung function indices and perceived dyspnoea during bronchoconstriction. Acute changes in lung function were induced by inhaled histamine followed by terbutaline, in 12 asthmatics and 12 subjects with chronic obstructive pulmonary disease (COPD). A bipolar visual analogue scale (VAS), allowing subjects to report either improvement or worsening when moving off from a 'nochange' midpoint, was used to rate shortness of breath. Large swings in ratings were seen in all asthmatics and in seven out of 12 COPD subjects (high perceivers). Using linear regression of VAS rating against parallel change in lung function, on a within-subject basis, the highest degree of correlation between dyspnoea and objective response was found to involve the change in specific inspiratory resistance (sRin) in the asthmatics. In the five low perceivers, the ability to discriminate an increase in airway obstruction, estimated as the VAS/change in lung function slope, was very poor. Using a stepwise multiple regression analysis, the sensation of dyspnoea was found to be significantly related to the FEV1 and the sRin in the asthmatics, to the inspiratory vital capacity and the maximal inspiratory flow at 50% FVC (MIF50) in the COPD subjects with high perception, and to the MIF50 in the COPD subjects with low perception.

[Induced expectoration or endoscopic samples in case of bronchopulmonary infection?]. / Expectorations induites ou prélèvements endoscopiques en cas d'infection bronchopulmonaire?

The aim of this study was to compare induced sputum versus bronchoscopy in a non selected population. An induced sputum and a bronchoscopy with aspiration of secretions and bronchoalveolar lavage (BAL) were proposed to 30 patients with suspected lower respiratory tract infection, including 14 subjects with AIDS. Induced sputum failed in 3 patients, while endoscopy could not be performed (contra-indication, refusal or failure due to lack of cooperation) in 7 patients; a technical failure for BAL was observed in 3/23 cases. Contamination by oral germs was significantly less frequent with BAL (4/20) than with aspiration (15/23) or induced sputum (17/27). A relevant pathogen was cultured from induced sputum in 7/27 cases (3 mycobacteria, 4 usual pathogens) from aspiration in 3/23 cases (one mycobacterium, 2 usual pathogens) and from BAL in 4/20 cases (one mycobacterium, 3 usual pathogens). These results suggest that induced sputum is a promising method when difficulties in performing bronchoscopy are expected (severe respiratory insufficiency, psychiatric disease, lack of cooperation).

[Microbiological and clinical features of urinary tract infections due to Staphylococcus saprophyticus (author's transl)]. / Infection urinaire à Staphylococcus saprophyticus. Aspects microbiologiques et cliniques.

Ninety-one strains of coagulase-negative Staphylococci isolated from urine specimens of patients with urinary tract infection were classified by the kloos and Schleifer method. The study confirmed the pathogenic role played by S. saprophyticus--an organism characterized by its biological properties and its resistance to novobiocin--in UTI of young female out-patients. On the other hand, coagulase-negative Staphylococci sensitive to novobiocin were mostly found in the urine of elderly in-patients who had undergone instrumental procedures or who presented with urinary tract abnormalities. Precise identification of coagulase-negative Staphylococci urinary isolates is needed, since it has epidemiological, clinical and therapeutic applications.

Empyema due to Salmonella dublin.

An alcoholic patient presented with a thoracic empyema secondary to a pancreatic abscess with Salmonella dublin. The absence of an adjacent pulmonary parenchymal infection suggested a transdiaphragmatic passage of organisms.

Lung function, maximum and submaximum exercise testing in COPD patients: reproducibility over a long interval.

This study was designed to investigate the reproducibility and clinical relevance of several lung function and exercise test indices in a sample of patients with stable severe chronic obstructive pulmonary disease (COPD). Twenty subjects (ages 67.8 +/- 2.0 years, forced expiratory volume in 1s, [FEV1] 39.7 +/- 2.8% predicted) receiving conventional medical therapy and pulmonary rehabilitation were tested 4 times at 1 month intervals. Testing procedures included lung function (inspiratory vital capacity [IVC], FEV1, plethysmographic functional residual capacity [FRC], specific conductance of the airways (sGaw), single breath transfer factor divided by the alveolar volume [TL/VA]); incremental, progressive, symptom-limited, cycle exercise (maximum work load [Wmax], maximum heart rate [HRmax], maximum ventilation [VEmax], maximum oxygen uptake [VO2max]); and 2 modes of submaximum exercise (12 min walking test [12 MWD] and endurance cycle test). The mean of the absolute value of the individual patient, session-to-session, variation was found to be 0.131 for FEV1, 102 ml/min for VO2max. The within-subject variability was the smallest for HRmax and IVC (mean intrasubject coefficient of variation, [CV intra] 5.0 and 6.5%) and the greatest for TL/VA, the work performed during the endurance cycle test (EW) and sGaw (CV intra 16.5, 19.4, and 22.7%), while it was reasonably low (8.1-10.2%) for all the other variables studied. Calculation of the F ratio of the intersubject variance to the residual (total minus intersubject) variance, interpreted as a signal-to-noise, ratio, yielded the following, in decreasing order: TL/VA, EW, VEmax, VO2max, IVC, FEV1, HRmax, Wmax, sGaw, 12 MWD, FRC. If we assume that a useful variable should combine a low within-subject variability (CV intra less than or equal to 10%) with a high signal-to-noise ratio, we conclude that, among all the variables studied, IVC, FEV1, VEmax, and VO2max are those with the greatest clinical potential for functional assessment in patients with COPD.

Perceived effect on shortness of breath of an acute inhalation of saline or terbutaline: variability and sensitivity of a visual analogue scale in patients with asthma or COPD.

The purpose of the study was to validate a bipolar visual analogue scale (VAS) to assess the perceived effect on shortness of breath of an acute inhalation and to search for differences in perception between asthmatics and subjects with chronic obstructive pulmonary disease (COPD). Thirty two subjects with airway obstruction and a diagnosis of either asthma (n = 16) or COPD (n = 16) received three consecutive inhalations of isotonic saline, followed by two inhalations of 400 micrograms terbutaline. Saline was perceived by asthmatics as a slight improvement: VAS (median, 95% confidence interval) 9%, 0-18% of line length. COPD subjects could be separated into two subgroups: "high perceivers" (n = 8, VAS 43%, 33-53%) and "low perceivers" (n = 8, VAS 5%, 3-7%). The median intrasubject coefficient of variation of the three post-saline VAS ratings was 19.4% (asthma), 12.5% (COPD high perceivers), and 14.5% (COPD low perceivers). After terbutaline, asthmatics had, by selection, a larger increase in forced expiratory volume in one second (FEV1) than COPD subjects. However, for other indices (expiratory specific resistance, inspiratory vital capacity and maximal inspiratory flow at 50% forced vital capacity) the changes were smaller in COPD low perceivers than in both asthmatics and COPD high perceivers. The parallel improvement in VAS was 24%, 20-39% (asthma), 15%, 6-25% (COPD high perceivers) and 1%, -1-8% (COPD low perceivers). The most sensitive index was FEV1 in asthmatics, vital capacity in COPD subjects, VAS being among the most sensitive indices in the former, but among the least sensitive in the latter. We conclude that the sensitivity of this VAS to bronchodilation is better in asthmatics than in COPD subjects. The latter can however be separated into subgroups with high and low level of perception.

[Pseudomonas cepacia hospital infections; uncertainties and experiences with an epidemiological investigation (author's transl)]. / Infections nosocomiales à Pseudomonas cepacia. Aléas et leçons d'une enquête épidémiologique.

During a hospital outbreak of Pseudomonas cepacia a traditional epidemiological investigation was proved to be misleading. Suppression of the suspected antiseptic did not stop the epidemics. A further investigation proved that it was due to the intravenous injection of contamineted anesthetic vials. Fever, chills, lack of hemodynamic disorders and of metastatic absceses characterize the clinical state of the infected patients. The removal of the catheters for perfusion was sometimes necessary to stop the bacteraemia. A lack of medical information is responsible of the outbreak.

Tracheoesophageal fistula: case report and review of literature.

The case of a 44 year old woman with progressive postoperative dysphagia and food inhalations complicated by recurrent pulmonary infections, due to a tracheoesophageal fistula (TEF) is reported. Some months earlier, this woman had been operated for a cerebral aneurysm with hemiplegia and aphasia. For several months, pulmonary and feeding difficulties had been attributed to neurological status. Wide TEF was diagnosed by bronchoscopy, confirmed with fistulography. Surgical closure was performed: the oesophagus was sutured, and covered with fascia and a segment of the cervical trachea was resected with end-to-end anastomosis. Acquired nonmalignant TEF is an uncommon disorder with a high degree of morbidity and mortality. The etiology of those TEF is still unclear: traumatic intubation, elevated endotracheal tube cuff pressure, nasogastric tube, inflammation, poor general conditions,.... A better knowledge of the predisposing factors and physiopathology could decrease the number of acquired TEF.

How do patients with either asthma or COPD perceive acute bronchodilation?

The purpose of this study was to assess the perception of bronchodilation, as a change in shortness of breath on a bipolar visual analogue scale (VAS), in 16 asthmatics and 20 subjects with COPD. Bronchodilation was gradually induced by five consecutive terbutaline inhalations (cumulated dose 800 micrograms). The subjects were categorized into high and low perceivers, on the basis of a cut-off of 25% VAS line length (after the fifth inhalation). The quality of perception was studied on a within-subject basis by linear regression analysis of VAS ratings against changes in lung function, and was characterized in terms of strength of correlation (squared correlation coefficient, r2), slope, and VAS axis intercept. Fourteen out of 16 asthmatics, and 13 out of 20 COPD subjects, were high perceivers. In the COPD group, the high perceivers had a larger objective response--particularly in inspiratory vital capacity--than the low perceivers. The strongest correlation between subjective and objective response was obtained in asthmatics when the improvement in shortness of breath was evaluated against the decrease in specific inspiratory resistance (median r2 = 0.831). In COPD low perceivers, subjective and objective response were unrelated, while COPD high perceivers differed from the asthmatics by larger intercepts. The perceptual characteristics were unrelated to the degree of baseline obstruction, whilst a modest relationship (r = 0.51) was found between the increase in forced expiratory volume in one second (FEV1) and r2 of the VAS/delta FEV1 analysis.(ABSTRACT TRUNCATED AT 250 WORDS)

Enoxacin in acute exacerbations of chronic bronchitis: a comparison with amoxycillin.

A total of 43 hospitalized adult patients with acute exacerbations of chronic bronchitis or bronchiectasis due to Gram-negative bacteria were randomized to receive either enoxacin (400 mg bd) or amoxycillin (1,000 mg tid) for 7-12 days. Micro-organisms isolated included 24 Haemophilus influenzae (three beta-lactamases positive), 11 Branhamella catarrhalis (six beta-lactamase positive), two Pseudomonas aeruginosa and two Neisseria meningitidis in 37 evaluable patients. In the enoxacin group (23 patients) 82.6% of the patients were clinically cured or improved against 93% of patients in the amoxycillin group (14 patients). In the enoxacin group 76% of the pathogens were eradicated with two failures (P. aeruginosa), one relapse (H. influenzae) and three superinfections (Streptococcus pneumoniae). In the amoxycillin group, 71% of the pathogens were eradicated with 29% relapses. The differences between the two groups were not statistically significant. An increase in theophylline concentration occurred in 15 of 16 patients receiving simultaneous administration of theophylline, without clinical evidence of toxicity when theophylline dosage was reduced and enoxacin continued. Enoxacin appears to be as effective as amoxycillin in the treatment of acute exacerbations of chronic bronchitis due to susceptible Gram-negative bacteria.