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Biomedical subjects

D Valeyre

Publications and source records attributed to D Valeyre.

At least 73 records · Page 4Linked to original sources
PubMed1998

[Hypoxic eosinophilic pneumonia in two patients treated with ACE inhibitors].

Diffuse hypoxic pneumonia was found to be caused by angiotensin converting enzyme (ACE) inhibitors in two patients given enalapril and fosinopril for hypertension. Both patients developed sub-acute respiratory failure and lost weight. Imaging explorations showed multiple areas of alveolar consolidation, moderate pleural effusion and in one case linear opacities. In both cases, peripheral eosinophila was found and the bronchoalveolar lavage fluid contained lymphocytes. Progressive improvement was achieved after withdrawal of the ACE and corticosteroid therapy for three months. Subsequent x-rays and respiratory function tests returned to normal apart from persistently low CO diffusion in one patient. In view of other cases reported in the literature, ACE inhibitors should probably be included in the list of drugs capable of inducing pneumonia, notably eosinophilic pneumonia.

Adrenal Cortex Hormones↗
PubMed1997

Pulmonary Langerhans cell histiocytosis: evolution of lesions on CT scans.

PURPOSE: To document the evolution of pulmonary lesions of Langerhans cell histiocytosis (LCH) with sequential computed tomography (CT). MATERIALS AND METHODS: Initial and final CT scans of 21 patients with LCH and CT evidence of pulmonary disease were compared retrospectively. Histologic confirmation of pulmonary involvement was available in 11 patients. RESULTS: On initial CT images, a nodular pattern (n = 14) was seen more frequently than a cystic pattern (n = 7). On final CT images, a cystic pattern (n = 14) was seen more often than a nodular one (n = 6). There was complete resolution of parenchymal abnormality in one case. Nodular opacities, thick-walled cysts, and ground-glass opacities underwent regression. Thin-walled cysts, linear opacities, and emphysematous lesions remained unchanged or progressed. CONCLUSION: Pulmonary CT allows good assessment of the evolution of LCH lesions. Nodular lesions probably represent active disease and often undergo regression or transform into cysts.

Adult↗
PubMed1997

Malignant melanoma and granulomatosis.

Sarcoidosis or granulomatous reactions have rarely been reported in association with malignant melanoma (MM). We describe seven patients who presented with both granulomatous disease and MM, and discuss the physiopathological and prognostic significance of this association. In three patients, the granulomatosis was diagnosed as true sarcoidosis and in one patient, as tumour-associated granuloma. In three cases, designated here as atypical tumour-associated granulomatoses, the presence of clear-cut pulmonary granulomatous nodules was typical neither for sarcoidosis nor for tumour-associated granuloma and was highly suggestive of melanoma metastases. Mediastinal lymphadenopathy was present in every patient. In all seven patients, the question of mediastinal or pulmonary involvement or relapse of the MM was raised, but could be confirmed in only one patient. MM can be associated with granulomatous disease. Knowledge of this association has implications in the management of patients with MM.

Adult↗
PubMed1995

CT assessment of bronchi in sarcoidosis: endoscopic and pathologic correlations.

PURPOSE: To evaluate the computed tomographic (CT) appearance of bronchi in patients with sarcoidosis and to correlate CT, endoscopy, and bronchial biopsy findings. MATERIALS AND METHODS: Sixty patients with sarcoidosis underwent CT and tracheobronchial endoscopy. CT findings of abnormalities of the bronchial walls and lumina were compared with endoscopic and biopsy findings. RESULTS: CT scans showed bronchial abnormalities in 39 patients (65%). CT and endoscopic findings were concordant in only 35 cases. However, CT showed abnormal lumina in 14 patients and endoscopy showed mucosal thickening in 12 of these 14 patients. CT findings of bronchial abnormalities were associated with the presence of bronchial granulomas (P < .0001). CT scans showed that, of the 37 patients with biopsy results of granulomatosis, 84% had thickened bronchial walls and 35% had luminal abnormalities. Eight CT findings were false-positive, and six were false-negative for the presence of granulomas. CONCLUSION: Bronchial involvement in sarcoidosis was detected at CT in 65% of cases. CT can help predict whether bronchial granulomas will be found in cases of sarcoidosis.

Adult↗
PubMed1995

Migratory bronchiolitis obliterans organizing pneumonia after unilateral radiation therapy for breast carcinoma.

We report the case of a 59 year old woman who developed cough, dyspnoea and fever with patchy migratory airspace infiltrates, 2 months after right breast radiation therapy for breast carcinoma. Lung infiltrates were initially localized in the irradiated area and spread to the contralateral lung. Lung biopsy, performed in an unirradiated area of the contralateral lung 9 months after completion of radiotherapy, revealed a typical histological pattern of bronchiolitis obliterans organizing pneumonia. No cause of bronchiolitis obliterans organizing pneumonia other than radiation was found. Treatment with corticosteroids resulted in rapid clinical improvement and complete resolution of airspace opacities. This case suggests that localized lung irradiation might trigger the development of a bilateral lung disease, with a histological pattern of bronchiolitis obliterans organizing pneumonia.

Biopsy↗
PubMed1995

[Hypersensitivity pneumopathies: x-ray computed tomographic aspects].

Chest radiographs and computed tomographic scans obtained from nineteen patients with hypersensitivity pneumonitis were reviewed retrospectively. Thirteen of them had a subacute form. Six of them had a chronic form. In subacute forms, CT scans were normal in two patients. In the 11 other cases, CT findings were ground glass attenuation (n = 10), nodules (n = 7) and linear opacities (n = 5). Ground glass attenuation was diffuse or patchy. Two patterns are quite suggestive of hypersensitivity pneumonitis: the association of micronodules and ground glass attenuation and the presence of hyperlucent secondary lobules within the ground glass. After cessation of exposure, CT showed a return to normal or improvement. Ground glass opacities, nodules and also linear opacities disappeared. CT scans were always abnormal in chronic forms. CT findings were linear opacities (n = 6), ground glass attenuation (n = 4), micronodules (n = 2) and cysts (n = 3).

Adult↗
PubMed1994

[Thoracic imaging in the diagnosis and surveillance of sarcoidosis].

Imaging is useful at all stages of management of thoracic sarcoidosis. It contributes to diagnosis, prognosis, evaluation of lesions and follow-up in the course of the disease. Chest radiography is essential in initial work-up as well as during the course of well-tolerated forms of the disease. High resolution CT and gallium-67 scintigraphy are useful in severe lung involvement and in chronic forms of sarcoidosis.

Gallium Radioisotopes↗
PubMed1994

[Treatment of sarcoidosis].

The treatment of sarcoidosis remains empirical. In severe cases, it is based on systemic corticosteroid therapy which is highly effective on granulomatous lesions and immune and metabolic disorders. Its limitations are its purely "suspensive" effect, its lack of efficacity on fibrous lesions and its side effects. It is widely accepted in the case of poorly tolerated, recent sarcoidosis and respiratory or extrarespiratory involvement, modification of the general status, or hypercalcaemia. In these cases, its therapeutic effect is spectacular. Corticosteroid treatment is also indicated in most chronic forms having development of fibrosis. Complementary examinations, especially CT scan of the chest, can be useful in treatment decision. Failure or contraindication of corticosteroids suggests the use of synthetic antimalarial drugs or methotrexate. Local corticosteroids are useful in treatment of ophthalmologic or skin localisations.

Adrenal Cortex Hormones↗
PubMed1994

Cisplatin-5-fluorouracil in small cell lung cancer. A phase II study in 109 patients.

One hundred nine previously untreated patients with small cell lung cancer were treated for five consecutive days with 20 mg/m2/day of cisplatin and 600 mg/m2/day of 5-fluorouracil. One cycle of chemotherapy was administered every three weeks. The patients received a median number of three cycles. Then they were transferred to CAE chemotherapy. A 77% overall response rate (95% confidence interval of 0.70-0.85) was observed after initial cisplatin-5FU treatment. Twenty-three complete responses (21%) and 62 partial responses (56%) were obtained. In cerebral metastases the response rate was high at 91% (21 out of 23), with 43% complete responses. In the limited forms, statistical survival at 1 year was 25%. A Grade 3-4 thrombocytopaenia was observed in 10 patients (9%) and a Grade 2-3 leukopaenia in four patients. Three patients suffered from a Grade 2 cardiac toxicity. The cisplatin-5-fluorouracil combination demonstrates promising initial response rate in small cell lung cancers. Its main interest is in its important action on cerebral metastases and its moderate haematological toxicity.

Adult↗
PubMed1994

Pulmonary sarcoidosis with a diffuse ground glass pattern on the chest radiograph.

BACKGROUND: Several chest radiographic abnormalities have been described in pulmonary sarcoidosis, but a diffuse ground glass pattern is extremely rare. METHODS: The chest radiographs of more than 1600 patients with sarcoidosis evaluated in our service between 1976 and 1991 were reviewed to determine the prevalence of this pattern on chest radiography at presentation, and to assess the clinical characteristics of these patients. RESULTS: Ten patients (0.6%) were identified with diffuse ground glass abnormalities on the chest radiography (eight men); all had associated hilar or mediastinal adenopathy. All patients were white and nine were smokers or former smokers. Nine patients were symptomatic and six had inspiratory crackles on physical examination. As a group these patients were remarkable for the frequency and severity of physiological abnormalities and the presence of various findings typically associated with "active" disease. Nine patients were followed for more than three years. All were treated with oral corticosteroids because of significant symptoms or physiological abnormalities, or both. Symptoms and radiological abnormalities disappeared or improved in all patients, but recurred in a high proportion when steroids were tapered or discontinued. By December 1992 only three patients had been withdrawn from treatment. CONCLUSIONS: A diffuse ground glass pattern on the chest radiograph is unusual in patients with sarcoidosis and may occur more commonly in white subjects and cigarette smokers. Its presence suggests the existence of active disease of recent onset likely to require long term treatment with corticosteroids.

Acute Disease↗
PubMed1994

Chronic diffuse infiltrative lung disease: determination of the diagnostic value of clinical data, chest radiography, and CT and Bayesian analysis.

PURPOSE: To assess the value of clinical, chest radiographic, and computed tomographic (CT) findings in classifying chronic diffuse infiltrative lung disease (CDILD) MATERIALS AND METHODS: Two samples from the same population were consecutively studied: the training set (group A, n = 208) for the development of the decision aid and the test set (group B, n = 100) for validation. Computer-aided diagnoses were made with a Bayesian model that assigned to each patient diagnostic probabilities based on clinical, radiographic, or CT variables. RESULTS: In group A, a correct diagnosis based on clinical data was obtained in 29% of cases; radiography, 9%; and CT, 36%. This increased to 54% when clinical and radiographic variables were combined (P < .0001) and to 80% when data from all three were analyzed together (P < .0001). With prior and conditional probabilities determined from group A, the frequency of correct diagnosis in group B was 27% with clinical data, which increased to 53% (P < .0001) with radiographic findings and 61% after including CT data (P = .07). CONCLUSION: CT can help determine the specific diagnosis in patients with CDILD.

Bayes Theorem↗
PubMed1994

T cell receptor repertoire of T lymphocytes recovered from the lung and blood of patients with sarcoidosis.

We evaluated the repertoire of V beta segments used in forming the T-cell receptor of lavage and blood T lymphocytes from 11 sarcoid patients and 10 normal subjects using procedures based on quantitative polymerase chain reaction, permitting analysis of both the abundance of transcripts using each of 20 different V beta families and the diversity of the VDJC beta rearrangements within each V beta family. Blood and lung T cells from sarcoid patients had a very diverse V beta repertoire. For all V beta families but one, the abundance of the V beta transcripts fell within the mean +/- 2 SD of that observed for normal blood lymphocytes; no difference in the overall abundance was observed comparing lavage and blood T cells, and the length of VDJC beta rearrangements for a given V beta family in samples from sarcoid patients was usually quite heterogeneous. Despite the overall polyclonality, evidence for selective expansion of T cells was found, in that an increased abundance of V beta 19 transcripts was observed for sarcoid blood and/or lung T cells in eight out of 11 patients studied, and rearrangements of a single predominant length using certain (e.g., V beta 19, V beta 14), but not all, V beta families were present. Sequencing confirmed the presence of a single predominant VDJC beta rearrangement in these cases. These findings suggest that the alveolitis in sarcoidosis results from two distinct processes, a local clonal expansion of T cells associated with an apparently nonspecific accumulation of T cells with an extremely diverse V beta repertoire.

Adult↗
PubMed1994

Ultrastructural alterations of the air-blood barrier in sarcoidosis and hypersensitivity pneumonitis and their relation to lung histopathology.

To evaluate the incidence of air-blood barrier lesions in the course of chronic interstitial lung diseases, we studied by electron microscopy open lung biopsy specimens from patients with sarcoidosis or chronic hypersensitivity pneumonitis, and compared the distribution of ultrastructural air-blood barrier lesions (including swelling or destruction of epithelial and endothelial cells, type II cell hyperplasia, and basement membrane disruption) with the type of histopathologic abnormalities present (including inflammation, inflammation and fibrosis, or fibrosis alone). Ultrastructural lesions of the air-blood barrier were frequently observed in sarcoidosis as well as hypersensitivity pneumonitis. Their nature and distribution were highly dependent on the histologic pattern of lung tissue in which they were present: epithelial and/or endothelial injury was more frequently observed in inflammatory areas (90 to 100% of all lung specimens displaying inflammation alone), whereas type II cell hyperplasia was mainly identified in fibrotic tissues (83 to 100% of all lung specimens displaying fibrosis alone). Strikingly, in lung tissue considered as normal by light microscopy, air-blood barrier was frequently found to be damaged (50 to 62% of apparently normal lung specimens), suggesting that alveolar lesions may constitute an early phenomenon in the course of pulmonary inflammatory processes. The air-blood barrier alterations observed in this study may provide an anatomic basis for the modifications of alveolar permeability described in pulmonary sarcoidosis and hypersensitivity pneumonitis.

Adult↗
PubMed1994

Myocardial sarcoidosis. Clinical value of technetium-99m sestamibi tomoscintigraphy.

STUDY OBJECTIVE: The presence of defects on rest thallium 201 myocardial scintigraphy, reversible after dipyridamole infusion, was already demonstrated in myocardial localization of sarcoidosis. The present study compared the respective efficiency of a new tracer of myocardial blood flow, 99mTc sestamibi (sestamibi), vs thallium 201 (TI) for the diagnosis and follow-up of myocardial sarcoidosis. METHODS: Quantitative single photon emission computed tomography (SPECT) was performed in 37 consecutive patients with confirmed sarcoidosis and clinical suspicion of myocardial localization. Three successive scans were performed in all patients within the same day: rest TI SPECT, rest sestamibi SPECT, and dipyridamole sestamibi SPECT. Thirteen patients were reinvestigated after 3 months of corticosteroid therapy. The size and intensity of the defects were compared using a computerized quantitative analysis of bull's eye. RESULTS: At rest, sestamibi SPECT is more sensitive than TI, demonstrating significantly larger defects (28.1 +/- 13.2% vs 17.2 +/- 12.8% of bull's eye area, p < 0.001) and detecting abnormalities in seven more patients (24 vs 17). All patients with abnormal TI scans also had sestamibi abnormalities. After dipyridamole infusion, sestamibi defects decreased significantly (28.1 +/- 13.2% vs 15.2 +/- 12.3%, p < 0.001). This improvement correlated with the evolution of sestamibi SPECT performed in the 13 patients reinvestigated after corticosteroid therapy (r = 0.85, p < 0.001). CONCLUSIONS: We conclude that sestamibi SPECT is suitable for the diagnosis of myocardial sarcoidosis and represents an objective tool for the follow-up. The improvement after vasodilatation supports the hypothesis of reversible abnormalities in most of these patients and accurately predicts corticosteroid efficiency.

Adult↗
PubMed1994

Thyroid stimulating antibodies in sarcoidosis.

OBJECTIVES: Thyroid disorders, particularly euthyroid goiters and hyperthyroidism, can be observed in sarcoidosis. The aim of this study was to analyze the presence of thyroid stimulating antibodies (TSAb) in 21 patients with sarcoidosis. 12 patients out of 21 had simultaneous euthyroid goiter. The others were euthyroid and free of goiter. METHODS: The TSAb testing was carried out using the rat thyroid fragment perifusion technique. Thyroid response to IgG was determined by the mean rate of T4 release (R) during a 30-min perifusion and the secretion peak (Imax). Antibodies inhibiting TSH binding to its receptors were also looked for. RESULTS: Ten patients were TSAb+ and eleven were TSAb-. There was no difference between the TSAb+ and TSAb- groups in the clinical parameters for sarcoidosis, nor in the number of goiters found (n = 6 for both groups). In 5 out of the 6 cases where goiter was present in the TSAb+ group it was homogeneous and diagnosed at the same time as or after the first signs of sarcoidosis, whereas in 5 out of the 6 cases of goiter in TSAb- patients, it was nodular, diagnosed before sarcoidosis in 3 of them, endemic in one of them, and familial in another. The search for antibodies inhibiting TSH binding to its receptors was negative in 10 out of 21 patients tested. CONCLUSION: Although the presence of thyroid-stimulating antibodies in the serum of patients with sarcoidosis, found here for the first time, remains to be explained, it pleads in favor of the immunologic nature of the association of sarcoidosis with thyroid disorders.

Adult↗
PubMed1994

Vitamin D metabolism by alveolar immune cells in tuberculosis: correlation with calcium metabolism and clinical manifestations.

The aim of this study was to investigate the relationship between the pulmonary vitamin D metabolism in tuberculosis and the calcium metabolism abnormalities and other clinical characteristics of the disease. The metabolism of 25-hydroxyvitamin D3 (25(OH)D3) by alveolar immune cells recovered by bronchoalveolar lavage (BAL) was evaluated in parallel to the results of calcium metabolism, 25(OH) D and 1,25 dihydroxyvitamin D (1,25(OH)2D) plasma levels and other clinical parameters obtained in 14 tuberculosis patients. Whilst predominant metabolites produced by lavage cells in patients and controls were 5(E)--and 5(Z) -19-nor-10-oxo-25(OH)D3, 1,25(OH)2D3 was produced by cells from all tuberculosis patients but not by cells from controls. Calcium metabolism abnormalities were observed in only some patients, but the production of 1,25 (OH)2D3 by lavage cells was found to correlate both with 1,25(OH)2D levels (r = 0.67) and post-load urinary calcium excretion (r = 0.59). 1,25(OH)2D3 production by lavage cells was increased in patients of black origin, and those presenting with hilar adenopathy without pulmonary infiltrates, and was correlated with the number of lymphocytes recovered by lavage (r = 0.87). We conclude that 1,25(OH)2D3 production by alveolar immune cells makes a major contribution to the abnormalities in calcium metabolism seen in tuberculosis patients, and may be partly dependent on the clinical characteristics evaluated here.

Adult↗