[Recommendations apropos of contraindications and precautions in the use of bronchial cryotherapy with a flexible catheter].
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Biomedical subjects
Publications and source records attributed to F Blanc-Jouvan.
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We report a case of spontaneous bilateral chylothorax appearing in a woman suffering from kyphoscoliosis. A cure was obtained after one pleural tap and three weeks of rest with a special alimentary diet. We discussed as a possible cause the tearing of the thoracic duct secondary to movements resulting from the hyperextension of the vertebral column.
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A distinctive form of sarcoidosis is reported. A young woman, without any past medical history, presented with a cannon-ball radiographic appearance and a fever, suggesting an infection or underlying neoplasm. A lung biopsy gave the diagnosis of sarcoidosis after negative fibreoptic bronchoscopy, bronchial lavage and needle biopsy. This macronodular form of sarcoidosis is known but rarely described. There was a favourable clinical and radiological outcome, which occurred spontaneously.
The relation between bronchial cancer and fibrous scars still remains controversial. We report, with regard to a typical case, the histological arguments for this hypothesis in the knowledge that only a clinical history and above all a radiographic progress will evoke the carcinomatous transformation. We report on the diagnostic peculiarities, the evolution, the therapeutic approach and histogenetics of bronchial cancers developing on a scar. This association and the interest of pursuing these investigations in the presence of evocative clinical or radiographic anomalies enable a better understanding of the natural history of bronchial cancer.
A case of primary malignant fibrous histiocytoma of the lung is reported. The clinical course was divided into 2 periods: slow tumoral growth followed by rapid aggravation. The pathological aspects of the first localization and of the relapse are analyzed and discussed. Data from the literature are reviewed, with special attention to diagnostic and prognostic problems.
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In order to assess the value of nuclear magnetic imagery NMR in the diagnosis of the extent of bronchial cancers, 61 patients with operable bronchial carcinoma had both a CT scan and an NMR scan pre-operatively. Fifty one mediastinoscopies were performed. Twelve times there were mediastinal glandular enlargement. Ten times the thoracotomy was performed straight away. After pathological studies of the biopsy, 24 patients were N2, 25 N1, 12 N0; the sensibility of NMR to foresee lymph node invasions was 83% (specificity 70%), for CT scanning 75% (specificity 81%). Thirteen patients presented with a direct mediastinal or parietal invasion. The sensibility of detecting these invasions was only 38% for NMR (specificity 94.5%) and for CT scanning 54% (specificity 94.5%). There is little difference in the results and no statistical difference. This leads us to conclude that at present, NMR does not give more information than TDM in the diagnosis of operability in bronchial cancers.
We report the results of 82 needle biopsies of pulmonary nodules, using a fine screw needle. Owing to the very small diameter of the needle (0.8 mm), very few complications were observed (minor pneumothorax 13%, major pneumothorax 2.5%). The screw needle provided samples adequate for both cytological and histological examination. Forty-eight out of 53 cancers were diagnosed by this method (sensitivity 83%, specificity 100%).
Primary alveolar hypoventilation is a rare syndrome of unknown origin, characterized by a dysfunction of the automatic respiratory pattern in spite of normal lungs and in the absence of mechanical ventilatory defects. A reduction of the ventilatory response to CO2 is regularly found, and cardiac failure is common. The differential diagnosis mainly concerns the sleep apnoea syndrome. The usual treatments have little effectiveness.
In a prospective study 128 community acquired pneumoniae were treated with a macrolide (josamycin) by oral route. Patients improved in 94 p. 100 (113). Complications were as following: 2 deaths, 2 sequels, 3 failures. Authors discuss macrolides effectiveness in acute pneumoniae, particularly pneumococcal ones. They conclude macrolides are a good choice in first intention in acute pneumoniae of adults.
In 76 patients the diagnosis of the mediastinal extension of a bronchial cancer, assessed by computed tomography (CT), was compared to histological specimens obtained by mediastinoscopy and surgery (58/76). The extension to mediastinal nodes was present in 26 subjects (34.2%) and yet was not recognised 15 times on CT. There were 15 false negatives (FN) and 3 false positives (FP). Sensitivity 43%, specificity 94%, predictive value for positives (VPP) 70%, predictive value for negatives (VPN) 75%. Extension was present in 18 patients. These were recognised 14 times by CT. There were no false positives. (Sensitivity 70%, specificity 100%, VPP 100%, VPN 94%). We conclude That CT is useful for diagnosing direct mediastinal extension and allows the juxta-hilar extension of the cancer to be assessed. CT has no place in the diagnosis of mediastinal gland involvement. Mediastinoscopy (5.2% FN; no FP) is better than TDM for the diagnosis of extension to the mediastinal nodes both for peripheral and central cancers.
We treated 10 patients with bacterial meningitis by 150 mg/kg/day cefmenoxime divided into six intravenous infusions. CSF samples were taken one hour after an IV on the second and fifth days. CSF cefmenoxime determined by microbiologic assay was 8.3 mg/l on days 2 and 5. Every patient recovered without sequelae. In our opinion, these results may support use of cefmenoxime in bacterial meningitis.
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Two new cases of rheumatic pelvispondylitis associated with bilateral fibrosis of the pulmonary apex are reported and published data are reviewed. The clinical, radiological, evolutive and diagnostic features of this probable pulmonary manifestation of rheumatic spondylitis are described, and the pathogenesis is discussed.
Over recent years, several cases have been reported of bronchiolitis obliterans, of very rapid onset and serious clinical course in patients with rheumatoid arthritis being treated with D-Penicillamine. After reporting a new case, the authors stress the unusual features of this bronchiolar condition which is probably of iatrogenic origin and irreversible, with death occurring within a few years. The pathogenesis is poorly understood and many questions still remain concerning the relationships between rheumatoid arthritis, the bronchiolar lesions and D-Penicillamine in this disease of pulmonary collagen. The ultrastructural examination and the morphometric examination of this new case suggest the presence of predominantly type III collagen, which is normally present in the lungs in only small quantities.
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Based on a homogeneous series of 50 cases investigated within less than a week by CT scan and NMR imaging with mediastinoscopic correlation, and in 32 of theses cases with correlation with operative findings, a critical study was carried out of modern imaging methods for detection of mediastinal gland invasion from primary bronchial cancer. Axial mediastinoscopy presented absolute specificity and very high sensitivity (93%) markedly superior to those of CT scan and NMR imaging. The two latter examinations were practically of equal efficacy: sensitivity of NMR (80%) was somewhat higher than that of CT scan (70%) whereas specificity of CT scan was 83% as against 70% for NMR. Lack of efficacy of axial mediastinoscopy was in cases with extra-axial lymphatic extension (anterior mediastinal chains) from primary cancer. These results suggest that, in view of current inconveniences of NMR imaging, the best means for local and regional exploration of primary bronchial cancer preoperatively is combined CT scan and mediastinoscopy. The diagnosis of glandular enlargement of anterior mediastinal lymphatic chains should lead to performance of an anterolateral mediastinoscopy.