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Biomedical subjects

F Lebargy

Publications and source records attributed to F Lebargy.

At least 19 recordsLinked to original sources
PubMed2002

[Toxic dermatitis caused by pseudoephedrine: apropos of a case].

Allergy to pseusoephedrine seems to be rare and has been described as responsible of urticaria, contact dermatitis, fixed non-pigmenting erythema or pseudoscarlatina. We report the case of a male patient who presented a recurrent erythema after administration of different treatments including pseudoephedrine. A cutaneous biopsy was compatible with erythema multiform. Patch tests confirmed the diagnosis of allergy to pseudoephedrine but resulted in a reappearance of symptoms.

Adult↗
PubMed2001

[A "sweet" hydrothorax].

BACKGROUND: Hydrothorax is a rare complication of continuous ambulatory peritoneal dialysis (CAPD). CASE REPORT: A 68-year-old man on CAPD consulted for rapidly progressive dyspnea. An elevated glucose level in the pleural puncture fluid and Tc-99m peritoneoscitigraphy demonstrated pleuroperitoneal communication via Larrey's cleft led to the diagnosis of "sweet" hydrothorax. Resolution was achieved with pleurocentesis and interruption of CAPD. DISCUSSION: Although rare, hydrothorax should be retained as a possible diagnosis in patients who develop dyspnea within the first 2 months after institution of CAPD. Chemistry of the pleural fluid and Tc-99m scintigraphy provide the diagnosis. Conservative treatment by pleural puncture or pleurodesis is indicated. In most cases, CAPD can be resumed without recurrence.

Aged↗
PubMed2000

[Nicotine dependence].

Nicotine is the principle alkaloid in tobacco and is considered to be responsible for tobacco dependence due to its psychoactive properties and its capacity to induce self-administration behavior in animals. Its action affects the brain where it binds to specific nicotinic receptors distributed on the mesolimbic and mesocortial dopaminergic pathways. Dopamine release by the nerve endings on these pathways provokes activation of the cerebral response. Acute stimulation with nicotine provokes a rise in cerebral dopamine levels in the accumbens. Dopamine release is greatly lowered in animals having undergone chronic exposure to nicotine, suggesting desensitization of the nicotinic receptors. In the regular smoker, there is an increase in the number of cerebral nicotinic receptors which would be a neuroadaptation response to desensitization. Reduction in the serum nicotine level favors resensitization of the nicotinic receptors and their vacuity would be the cause of the withdrawal syndrome. In therapeutics, nicotinic substitutes can effectively suppress the withdrawal syndrome and lead to abstinence rates to the order of 20 to 25% at one year. Psychotropes can also be effective to help patients stop smoking. Their mechanism of action is not clearly established but most would act by increasing the level of cerebral dopamine. They are used independently of their antidepressor effect with abstinence rates to the order of 25 to 30% at one year. Their combination with nicotinic substitutes can increase the rate of success.

Animals↗
PubMed2000

[Evaluation of occupational exposures in lung cancer].

Occupational lung cancers are underestimated by the number of cases compensated in the French National Insurance System. Rules of compensation of occupational diseases were recently modified in France. Therefore a study was conducted on incident cases of lung cancer in a general hospital in the Paris area. The aim was to evaluate the exposure to carcinogens using data of a detailed specific occupational questionnaire, and to determine the number of cases who could receive compensation. Two hundred and seven subjects (171 males, 36 females, mean age = 64.5 years) were eligible in 1996, and 122 had an occupational questionnaire. Definite exposure to one or more occupational carcinogens in at least one job was identified in 50 subjects, the most frequent agent was asbestos (42 subjects). Claim for compensation was done in 32 subjects, mainly for asbestos (30 subjects). This study emphasizes the frequency of occupational exposure to carcinogens, and the usefulness of systematic occupational questionnaire in subjects having lung cancer. Social and financial consequences are important for these subjects. Further studies are needed, with recruitement of control subjects to allow calculation of the attributable risk to occupational factors in lung cancer.

Aged↗
PubMed1999

Corticosteroids as adjunctive therapy for severe Pneumocystis carinii pneumonia in non-human immunodeficiency virus-infected patients: retrospective study of 31 patients.

The aim of this retrospective study was to assess whether corticosteroid adjunctive therapy (CAT) could prevent death in immunocompromised patients with severe Pneumocystis carinii pneumonia (PCP) who do not have human immunodeficiency virus (HIV) infection, similarly to what has been demonstrated for HIV-infected patients. The charts of all non-HIV-infected patients who were admitted to two medical intensive care units between 1988 and 1996 because of severe PCP, defined by an arterial oxygen pressure (determined while the patient was breathing room air) of <70 mm Hg, and who were treated with trimethoprim-sulfamethoxazole were analyzed retrospectively. Thirty-one patients met the study criteria, of whom 23 received CAT (within 72 hours of antibiotic therapy) and eight did not receive CAT. The need for mechanical ventilation (10 [43%] of 23 vs. 4 [50%] of 8) and the mortality rate (9 [39%] of 23 vs. 4 [50%] of 8) were similar for the two groups. Although this small study does not have a statistical power high enough to rule out the possibility of a difference, the results suggest that CAT does not improve the survival of non-HIV-infected patients as has been described for HIV-infected patients with severe PCP.

Adolescent↗
PubMed1998

[Pulmonary sarcoid-like granulomatosis associated with Hodgkin's disease and complicated by bleomycin-induced pulmonary nodules].

We report the case of a man in whom multiple lung macronodules developed after chemotherapy containing bleomycin for Hodgkin's disease, which was itself shortly preceded by a pulmonary sarcoid-like granulomatosis. Biopsy of the nodules showed fibrotic and granulomatous lesions. The etiological diagnosis is discussed.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1997

Pulmonary complications in toxic epidermal necrolysis: a prospective clinical study.

OBJECTIVE: To evaluate the incidence, clinical features, and prognosis of pulmonary complications associated with toxic epidermal necrolysis DESIGN: Prospective study. SETTING: Dermatology intensive care unit in Mondor Hospital, France. PATIENTS: 41 consecutive patients. INTERVENTIONS: On admission, then daily, respiratory evaluation was based on clinical examination, chest X-ray, and arterial blood gas analysis. When clinical symptoms, X-ray abnormalities, or hypoxemia [partial pressure of oxygen (PO2) < 80 mm Hg] were present, fiberoptic bronchoscopy was performed. RESULTS: 10 patients presented early manifestations: dyspnea (n = 10), bronchial hypersecretion (n = 7), marked hypoxemia (n = 10) (PO2 = 59 +/- 8 mm Hg). Chest X-ray was normal (n = 8) or showed interstitial infiltrates (n = 2). In these 10 patients, fiberoptic bronchoscopy demonstrated sloughing of bronchial epithelium in proximal airways. Delayed pulmonary complications occurred in 6 of these 10 patients from day 7 to day 15: pulmonary edema (n = 2), atelectasis (n = 1), bacterial pneumonitis (n = 4). Mechanical ventilation was required in 9 patients. A fatal outcome occurred in 7 patients. Seven patients did not develop early pulmonary manifestations (PO2 on admission 87 +/- 6 mm Hg) but only delayed pulmonary symptoms related to atelectasis (n = 1), pulmonary edema (n = 4), and bacterial pneumonitis (n = 3); bronchial epithelial detachment was not observed. None of them required mechanical ventilation and all recovered with appropriate therapy. CONCLUSIONS: "Specific" involvement of bronchial epithelium was noted in 27% of cases and must be suspected when dyspnea, bronchial hypersecretion, normal chest X-ray, and marked hypoxemia are present during the early stages of toxic epidermal necrosis. Bronchial injury seems to indicate a poor prognosis, as mechanical ventilation was required for most of these patients and was associated with a high mortality.

Adolescent↗
PubMed1997

Gelatinases in epithelial lining fluid of patients with adult respiratory distress syndrome.

Gelatinases A and B are matrix metalloproteinases secreted as inactive pro forms and are capable of degrading basement membrane components after activation in the extracellular environment. To determine whether the presence of gelatinases A (noninflammatory cells) and B (inflammatory cells) in epithelial lining fluid (ELF) is associated with the adult respiratory distress syndrome (ARDS), we studied 28 patients divided into four groups based on the presence of ARDS and/or multiple organ failure (MOF). Gelatinase activities were quantified in ELF using zymography. ARDS patients had larger ELF volumes than non-ARDS patients: 9.2 +/- 8.5 ml/100 ml recovered lavage fluid (n = 18) vs. 1.9 +/- 1.7 ml/100 ml (n = 11), respectively (P < 0.001). The presence of activated gelatinase A in ELF was a sensitive (16 out of 18 ARDS patients, 89%) and specific (0 out of 11 non-ARDS patients with or without MOF) marker for ARDS. Activated gelatinase (A + B) activities per microliter ELF were correlated with albumin concentrations in ELF (P < 0.01), and activated gelatinase activities in ELF were correlated with the volume of ELF (P < 0.0005). This could suggest an involvement of these gelatinases in alveolar-capillary permeability increase.

Adult↗
PubMed1996

Expression of matrix metalloproteinase gelatinases A and B by cultured epithelial cells from human bronchial explants.

To investigate the role of human bronchial epithelial cells (HBECs) in the maintenance and remodeling of the extracellular matrix, we evaluated the expression by HBECs of 72- and 92-kDa gelatinases under basal conditions and after exposure to bacterial lipopolysaccharides (LPS). Confluent HBECs from explants were cultured in plastic dishes coated with type I and III collagens. Gelatin zymography of HBEC-conditioned media showed constitutive major 92-kDa and minor 72-kDa gelatinases recognized by specific human antibodies and totally inhibited by the metalloproteinase inhibitor EDTA. The identification of the two matrix metalloproteinases was confirmed by quantitative reverse transcription-polymerase chain reaction. Identical patterns of gelatinase expression were observed with repetitive primary cultures issued from the same explants. Zymography showed that exposure of HBECs to LPS induced 2- and 20-fold increases in 92-kDa gelatinase production and activation, respectively, as well as a smaller increase in activated 68-kDa gelatinase. With [3H]gelatin substrate, elevated metallogelatinolytic activity (138 microgram of hydrolyzed gelatin/48 h/10(6) cells) was also observed, whereas no activity was detected in the absence of LPS. A human epithelial cell line (16HBE14o-) exhibited the same basal profile of gelatinase activity, but this profile remained unchanged after exposure to LPS. Quantitative reverse transcription-polymerase chain reaction demonstrated only minimal changes in 92-kDa mRNA levels in response to LPS, but the half-life of 92-kDa gelatinase mRNA was increased with exposure to LPS. In contrast, concomitant slight increases in 72-kDa gelatinase protein and mRNA were found, suggesting that the control mechanisms regulating the expression of 92- and 72-kDa gelatinases by HBECs in response to LPS are divergent. All these data allowed us to propose that HBECs may be actively involved in the physiological and physiopathological remodeling of the airway basement membrane.

Bronchi↗
PubMed1996

Tobacco smoking induces expression of very-high-affinity nicotine binding sites on blood polymorphonuclear cells.

The targets of nicotine in the central nervous system (CNS) have been identified as nicotinic acetylcholine (ACh) receptors. Because of their localization in the brain, no data are available about their in vivo modifications. However, nonneuronal nicotine binding sites have been identified on peripheral blood cells. The present study was designed to evaluate the effects of tobacco smoking on granulocyte nicotine binding sites. Binding assays were performed on granulocyte membranes using (-)(3H)nicotine and were analyzed by the Scatchard method in nonsmokers (n=10), smokers (n=10), and ex-smokers (n=10). In nonsmokers, a single-affinity binding site was detected with Kd = 1.08 +/- 0.05 x 10 -9 M. In contrast, in smokers, two different classes of binding sites were identified: one with Kd1 = 2.80 +/- 0.81 x 10 -11 M and another with Kd2 = 3.92 +/- 0.58 x 10 -9 M, similar to the binding site in nonsmokers. Moreover, a twofold increase in nicotine binding-site density was observed in smokers. Ex-smokers recovered a single class of binding sites similar to those observed in nonsmokers when they had stopped smoking for more than 1 yr, whereas recent ex-smokers (1 to 8 mo) displayed a pattern similar to that in smokers, as demonstrated by the persistence of two classes of nicotine binding sites. Chronic nicotine exposure induces modifications of nicotine binding sites on granulocytes. It is noteworthy that the persistence of such alterations corresponds to the very high rate of relapse into smoking observed during the early stages of tobacco cessation. Consequently, monitoring of nicotine binding sites could constitute an interesting approach to understanding the pharmacologic mechanisms involved in tobacco dependence.

Adult↗
PubMed1996

Bronchoalveolar lavage in adult sickle cell patients with acute chest syndrome: value for diagnostic assessment of fat embolism.

Fat embolism of necrotic bone marrow could be a frequent cause of acute chest syndrome (ACS) in sickle cell syndromes (SC), as suggested by postmortem findings. To check this hypothesis in living patients, we evaluated the presence of fatty macrophages recovered by bronchoalveolar lavage (BAL) in ACS. We investigated 20 consecutive cases of ACS by BAL, and identification of alveolar cells containing fat droplets was performed using oil red O (ORO), a specific neutral fat stain. The specificity of the method was determined on control groups, including eight SC patients without acute chest syndrome and 15 non-SC patients. A cut-off of > 5% of alveolar macrophages containing fat droplets was determined from the control groups to assess the diagnosis of fat embolism. In 12 ACS episodes, BAL exhibited > 5% of fatty macrophages, ranging from 10% to 100% (median value 46.5%). In 11 cases, fat embolism was associated with proven (n = 8) or probable (n = 3) bone marrow infraction, which mostly predated ACS. Eight ACS episodes were associated with a low percentage (< or = 5%) of fatty alveolar macrophages and could be related to a cause other than fat embolism in six episodes, such as sepsis, in-situ thrombosis, or rib infarcts generating hypoventilation. This study supports the diagnostic yield of BAL for fat embolism, which can be incriminated in 60% of cases of ACS in this adult population.

Adolescent↗
PubMed1995

Ciliary abnormalities in bronchial epithelium of smokers, ex-smokers, and nonsmokers.

Although respiratory changes induced by tobacco smoke have been extensively described, no study has focused on ciliary abnormalities associated with chronic smoking. Ciliary ultrastructure was studied in 37 adults with chronic sputum production (CSP) consisting of 13 current smokers (Group 1), 5 ex-smokers (Group 2), and 19 nonsmokers (Group 3). Five healthy nonsmokers constituted the control group (Group 4). Clinical and radiologic data and respiratory function tests were recorded. Acute respiratory infection was diagnosed by culture of tracheobronchial secretions obtained during bronchoscopy. Bronchial ciliated cells were obtained and processed for transmission electron microscopy. Within each group, the percentages of abnormal cilia were similar in patients with either chronic bronchitis or bronchiectasis and in patients with or without acute infection. The percentage of axonemal ultrastructural abnormalities (AUA) was higher in smokers (16.5% +/- 2.7%) and ex-smokers (17.5% +/- 7%) than in nonsmokers (5.2% +/- 1%) or control subjects (0.7% +/- 0.2%) (p < 0.0002). The AUA were polymorphic, characteristic of acquired ultrastructural changes. These results suggest that chronic smoking may induce an increased number of abnormal cilia which could participate in impairment of tracheobronchial clearance and which appears to be independent of the etiology of CSP.

Adult↗
PubMed1995

[Pulmonary metastases of glioblastoma].

Extracranial metastases arising from primary brain tumors are very unusual. We report a case of glioblastoma with intra-thoracic spread characterized by mediastinal lymph nodes metastasis and bronchial, lung parenchyma and pleura carcinomatous lymphangitis. Pathologic findings are consistent with non-differentiated cell proliferation but Glial Fibrillary Acidic Protein immunodetection can be helpful to relate such a non-differentiated cell proliferation to its glial origin. The mechanisms of extra-cerebral spread are discussed according to autopsic findings and to the data reported in the literature.

Autopsy↗
PubMed1994

Minocycline pneumonitis and eosinophilia. A report on eight patients.

We identified eight patients (six women and two men) who had pulmonary infiltrates during treatment with minocycline hydrochloride between 1989 and 1992 in French referral centers for drug-induced pulmonary diseases. Clinical files, chest roentgenograms, computed tomographic scans, pulmonary function, and bronchoalveolar lavage data were reviewed. Minocycline treatment was given for acne (n = 4), genital infection (n = 3), and Lyme disease (n = 1). The duration of treatment averaged 13 +/- 5 days (mean +/- SE); the total dose, 2060 +/- 540 mg. Patients presented with dyspnea (n = 8), fever (n = 7), dry cough (n = 5), hemoptysis (n = 1), chest pain (n = 2), fatigue (n = 3), and rash (n = 3). Chest roentgenograms showed bilateral infiltrates in all cases. Pulmonary function was measured in five patients; four had airflow obstruction and two had mild restriction. Blood gas tests demonstrated hypoxemia in seven patients (58 +/- 3 mmHg). Seven patients had blood eosinophilia (1.76 +/- 0.2 x 10(9)/L). Bronchoalveolar lavage (performed in seven patients) showed an increased proportion of eosinophils (0.30 +/- 0.07). The Cd4+/CD8+ ratio was determined in four cases and was low in three. Transbronchial lung biopsy, performed in two patients, showed interstitial pneumonitis in both patients, with marked infiltration by eosinophils in one patient. The outcome was favorable in all patients. Because of severe symptoms, steroid therapy was required in three patients. Rechallenge was not attempted. We conclude that minocycline can induce the syndrome of pulmonary infiltrates and eosinophilia, that presenting symptoms may be severe and may culminate in transient respiratory failure, and that the disease has a favorable prognosis.

Adolescent↗
PubMed1994

Prospective study of pulmonary function for cyclomegalovirus infection after renal transplantation.

Pulmonary involvement remains the main complication of cytomegalovirus (CMV) infection in renal transplantation (RT). Early diagnosis is required for the best management of patients, and preemptive therapy could be a successful approach. In order to define the predictive value of lung alveolocapillary abnormalities. We prospectively studied 26 renal transplant recipients for their diffusing capacity of carbon monoxide (DLCO) and their pulmonary clearance of a 99mTc-DTPA aerosol. Patients were studied before transplantation and then every 2 weeks up to the end of the 3rd month following RT. Viral blood cultures and serological determinations were performed every week during these first 3 months. Bronchoalveolar lavage (BAL) was done in case of CMV disease. Statistic analysis was done using Student's t-test and Pearson's chi-square test. During the 3-month follow-up, 13 patients remained free of CMV infection. Three non-infected and 8 infected patients showed DTPA clearance abnormalities (P < 0.05). Six non-infected and 7 infected patients showed DLCO disturbance (P > 0.50). DTPA clearance were significantly modified on days 45 and 60 in the infected group. Serial DTPA scanning, in association with viral blood cultures, could be a useful test to avoid unnecessary BAL in a preemptive therapy strategy.

Bronchoalveolar Lavage↗