[Clinical aspects and treatment of Pneumocystis carinii infections].
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Acquired Immunodeficiency Syndrome↗
Biomedical subjects
G Akoun
Publications and source records attributed to G Akoun.
[Radiologic aspects of acute invasive pulmonary aspergillosis in 18 immunodepressed patients].
A retrospective study of 18 immunodepressed patients with acute invasive pulmonary aspergillosis enabled the radiologic picture of this increasingly frequent opportunist affection to be described, and different manifestations of the disease as a function of underlying conditions to be determined. Two groups could be distinguished: the first of patients with malignant blood diseases (n = 10) when the "aplasia" factor was dominant; the second of patients without blood diseases (n = 8) when the immunodepression was usually induced by a recent increase in corticoid therapy. Neutropenia was not a finding in any of these patients. The most frequent radiologic finding was single or multiple round excavating foci, these corresponding to zones of bronchopneumonia containing aspergillus filaments with central tissue necrosis forming the "target" lesion. The aplasia was distinguished by the multiplicity of lesions and their excavation following aplasia in the shape of a crescent due to sequestrum formation. Prognosis was related to severity of subjacent lesions. In the 2nd group, lesions could be single and nodular; prognosis was improved by the possibility of reducing immunodepression factors.
Acute Disease↗
[Role of thoracic x-ray computed tomography in the pretherapeutic evaluation of bronchial cancer. A prospective study of 60 patients].
The value of computerized tomography (CT) was compared with that of conventional exploratory methods (standard radiology, bronchial tomography and endoscopy) in 60 patients with non-anaplastic bronchial cancer evaluated preoperatively. After CT examination thoracotomy was avoided in 14 (23%) patients with local or distal extension. CT proved more sensitive than conventional methods in the assessment of pleural and/or parietal extension, and of direct or lymph-node mediastinal invasion (67% vs 33%, 50% vs 33%, 64% vs 45% respectively). Similar results (75%) were obtained in cases with hilar lymph-node involvement. However, caution must be exerted before excluding thoracotomy, since CT may give false-positive results.
Adult↗
[Toxoplasma gondii pneumopathy in a patient with the acquired immunodeficiency syndrome: demonstration of the parasite by bronchioloalveolar lavage].
Toxoplasmosis is an infection frequently observed in patients with acquired immunodeficiency syndrome. Its first manifestations usually are cerebromeningal symptoms, but others may occur. A pulmonary lesion is sometimes present; it is discovered at post-mortem examination in most cases. The authors report a case of pulmonary toxoplasmosis diagnosed by bronchoalveolar lavage (BAL). Three points are emphasized: toxoplasmosis of the lung may produce an interstitial pneumonia similar to that of pneumocystosis; diagnosis can be made non-invasively by BAL, and provided an appropriate treatment is administered, the outcome may be favourable.
Acquired Immunodeficiency Syndrome↗
[Endobronchial metastases of cancer. Apropos of 29 cases].
In a retrospective study covering a 3-year period, 29 cases were reviewed. All concerned patients with endoscopic abnormalities resembling those of a primary carcinoma and histologically of the same type as a previously known tumour affecting areas as diverse as the E.N.T. region (31%), the colorectal region (20.6%), the mammary gland (13.7%) or the bladder (10.3%). There was nothing particular in the clinical, radiological or endoscopic signs. In the vast majority of cases (27/29) the histological diagnosis was provided by bronchofibroscopy. Thus, not only does endoscopy frequently visualizes abnormalities in obviously secondary carcinomas, but it also diagnoses cancers with clinical, radiological and endoscopic features of primary cancers from which they are sometimes almost undistinguishable.
Adult↗
A prospective study of detorubicin in malignant mesothelioma.
Between January 1981 and December 1983, a prospective therapeutic trial of detorubicin (14-diethoxyacetoxy-daunorubicin [DTR]) was conducted in 40 patients with histologically proven malignant mesothelioma (MM). DTR was given intravenously at 40 mg/m2 on days 1, 2, and 3 for five 21-day cycles, then 40 mg/m2 once every 21 days. Thirty-five patients (32 with pleural MM, 3 with peritoneal MM) were eligible. The overall median survival from onset of chemotherapy was 17 months. Complete relief from chest pain was observed in 8 of 15 cases (53%). Of 21 patients with measurable disease, there were 2 complete responses (10%) and 7 partial responses (33%). Median duration of response was 30 weeks. Congestive cardiac failure developed in two patients after 1100 and 1600 mg/m2 of DTR, respectively. Hematologic toxicity was moderate. This study demonstrates that DTR is effective against MM.
Adult↗
[Acquired immune deficiencies].
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Acquired Immunodeficiency Syndrome↗
[Pulmonary changes caused by cytostatic drugs].
About 80 drugs are known to cause lung disease. Cytostatic agents are the most common cause of this type of iatrogenic disease. In addition to the "intercalating" type of cytostatic, other groups, especially the alkylating (busulfan) and the antimetabolites groups (methotrexate), have also been incriminated. Cytostatic drug-induced lung disease is a difficult diagnosis based on the results of clinical, radiological, respiratory function, histopathological and biological investigations. The results of bronchoalveolar lavage are vital, especially in lung disease due to a drug hypersensitivity reaction; the diagnosis of drug-induced pulmonary fibrosis due to a toxic mechanism is much more difficult and risky. Early diagnosis of these drug-induced lung diseases is obviously important.
Alkylating Agents↗
[The treatment of tracheobronchial amyloidosis using a bronchial laser. Apropos of a series of 13 cases].
We have encountered and successfully treated thirteen cases of tracheobronchial amyloidosis using a laser. The clinical data, radiology, endoscopic and histological appearance of these patients were similar to that described in the literature (48 published cases). A YAG laser was used, introduced through a rigid bronchoscope. The principal difficulties of this type of resection were related to the oozing of blood which they caused. Only lesions in the trachea, main and lobar bronchi could be destroyed. 8 of the 9 patients followed for sufficiently long were clearly improved but a patient whose lesions were very diffuse did not experience any benefit. The laser seems to us above all to be indicated when there is considerable obstruction by amyloid, limited to the trachea and/or several of the major bronchi.
Adult↗
[Legionnaires' disease: 21 cases observed over 2.5 years in a Parisian respiratory intensive care unit].
The incidence of Legionnaire's disease is probably underestimated in France. Its clinical presentation is very suggestive, especially after the failure of a 48 hour therapeutic trial of beta-lactams, when a pneumococcal infection is initially suspected. This one sign is sufficient to orient the diagnostic survey and constitutes an indication for a therapeutic trial of macrolides for at least 72 hours. In fact, the delay in the diagnosis appears to be the determinant factor in the fatal outcome of the disease.
Adolescent↗
[AIDS and associated syndromes: clinical manifestations].
Numerous clinical and immunological manifestations are commonly observed in AIDS patients. Among these, Kaposi's sarcoma and major opportunistic infections appear today as clinical "markers" of the disease. Other signs and symptoms such as fever, diarrhea, lymphadenopathy and immunological abnormalities are currently recognized as "associated" disorders. One of the main problems faced by clinicians is to evaluate the significance of these "associated" abnormalities, especially when they occur in at risk populations. Much work is still needed to clarify whether they actually imply an individual predisposition to contract the disease, a minor form or some early stage of AIDS.
Acquired Immunodeficiency Syndrome↗
[The amiodarone lung].
During the past 3 years, 51 cases of pulmonary lesions associated with the use of amiodarone, an effective anti-arrhythmic and anti-angina drug, have been reported in 17 publications. Durations of treatment, daily doses and total dosage were extremely varied. Clinical symptoms as well as radiological findings, respiratory function studies and laboratory data suggested hypersensitivity pneumonia. However, the histopathological substrate remains ill-defined, and while some data suggest a toxic effect, others are in favour of an immune reaction ending in diffuse pulmonary fibrosis. Five of the 11 deaths reported seem to be directly related to the drug. It would appear that long-term treatment with amiodarone requires regular periodical examination of the respiratory system.
Amiodarone↗
[Bronchocentric granulomatosis].
Bronchocentric granulomatosis (G.B.C.) is a disorder which was considered rare till recently (67 cases published). The essential histo-pathological lesion is the presence of a necrosing granuloma in the wall of the small bronchi and bronchioles which may extend by contiguity into the adjacent pulmonary arterioles. The origin and exclusive bronchial location of the granuloma and the absence as a rule of extra-pulmonary lesions enable a distinction to be made with pulmonary vasculitis and other granulomas. It occurs in asthmatics (1/3 of cases) with a blood eosinophilia (79% of cases); a mycotic aetiology (essentially aspergillosis) is seen in 68% of cases and a hypersensitivity mechanism is probable. It may equally occur in non-asthmatic patients (2/3 of cases) often older and less frequently symptomatic; a cause is rarely found here and although the pathogenesis remains obscure a hypersensitivity reaction is likely. The radiology is similar in the two groups; typically represented by a round macro-nodular opacity or a single infiltrate in the upper lobes. The outcome is favourable in 90% of cases, either spontaneously or as a result of treatment (surgical excision or steroid therapy). Thus it is important to differentiate other pulmonary granulomas whose prognosis is much more guarded. These particular characteristics suggest that G.B.C. should be removed from the group of pulmonary vasculitides in which they were initially placed by Liebow.
Adolescent↗
[Endobronchial non-Hodgkin's lymphoma. Apropos of a case].
The authors report a case of splenic non-hodgkin's lymphoma which revealed by an endobronchial localisation, causing a respiratory disorder. The biopsy of this lesion led to the diagnosis. They recall the rarity of such cases and stress the fact that this bronchial lesion is always observed in cases of disseminated lymphomas with a poor prognosis.
Aged↗
[Treatment of an asthmatic crisis by acupuncture. Probable role in the onset of pneumothorax with development to status asthmaticus].
The onset of pneumothorax during acupuncture treatment has been reported since 1973. Usually unilateral, it occurs in patients free from any bronchopulmonary disease, and its consequences are therefore relatively benign. However, rare cases of bilateral pneumothorax have been reported since 1978, as well as a pneumothorax developing in asthmatic patients, with often dramatic consequences. A 15-year-old girl with a severe attack of asthma was treated by implantation of needles, and this coincided with the onset of a pneumothorax, and a subsequent state of status asthmaticus. A fatal outcome was only just avoided. The question is raised as to the technical quality of the implantations practised, as well as the validity and dangers of acupuncture in asthmatics, particularly during the acute attack.
Acupuncture Therapy↗
[Emergency treatment of severe hemoptysis by embolization of systemic arteries].
Over a 6-year period 23 patients with massive haemoptysis were treated at the Hôpital Tenon, Paris. Eighteen of these, usually considered "non-surgical" cases, underwent emergency embolization of the bronchial artery (B.A.E.). The immediate outcome was favourable in 14 patients; 4 died of early recurrence. B.A.E. therefore appears to be a valuable treatment of massive haemoptysis in "non-surgical" patients or in patients awaiting transfer to a thoracic surgery unit. However, because of the failure rate, B.A.E. cannot compete with thoracic surgery in its classical indications, and its effectiveness and safety should be compared with those of balloon catheter endobronchial tamponade in "non-surgical" patients.
Bronchial Arteries↗
[Pulmonary infections caused by Pneumocystis carinii].
The following topics are discussed: 1. Pneumocystis carnii: appearance, antigenic structure, pathogenicity...; 2. Human pneumocytosis: clinical, diagnostic, prognostic and therapeutic aspects; 3. Pneumocystis carnii and the pneumocystoses: coexistence, theoretical and practical consequences, difficulties in interpretation of bronchiolo-alveolar lavage.
Adult↗
[Multicenter study of a slow-release theophylline: armophylline].
In a co-operative study involving 10 centres, 95 asthmatic patients were treated with Armophylline, a new slow-release theophylline for a period of 1 to 3 months. Eighty per cent of the patients receiving the drug in doses of 11 to 15 mg/kg/day immediately had adequate blood theophylline levels (7-20 mcg/ml). There was a significant decrease in dyspnoea and number of asthmatic attacks and a significant increase in FEV1 and FEV1/VC ratio. The drug was usually well tolerated. Side-effects, such as insomnia, headache or digestive disorders were, as a rule, mild.
Asthma↗