"Mechanic's hands": a misleading cutaneous sign of the antisynthetase syndrome.
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Adult↗
Biomedical subjects
I Tillie-Leblond
Publications and source records attributed to I Tillie-Leblond.
["EXACO": four year follow-up of exacerbations in a cohort of patients with COPD].
EXACO is a French prospective observational epidemiological study. Chest physicians will enrol 1200 patients who will be followed up for 4 years. The aims of the study are to describe the exacerbations in COPD patients at different levels of severity and to confirm the existence of a sub-group of patients defined as frequent exacerbators. The clinical characteristics associated with this profile and the decline of FEV1 will be evaluated. A validation of the VSRQ scale will be performed. The data will be collected from chest physicians and by phone calls to the patients every three months.
Algorithms↗
[Characteristics of mild asthma: clinical signs and medication use. Position statement of the Mild Asthma Working Group (174)].
OBJECTIVE: To update on the state of knowledge in mild asthma (intermittent and persistent mild asthma, according to the GINA classification) review the literature, and the position statement of the French Mild Asthma Working Group. METHODS: The French Mild Asthma Working Group (11 lung specialists, 4 paediatricians, 1 pharmacologist, and 1 general practitioner) selected, analysed, and summarised the literature on the descriptive epidemiology, physiopathology, clinical signs, and management of mild asthma. The position of the working group on the descriptive epidemiology (causal factors excluded) and the nature of the bronchial inflammation has been presented in a previous article. The present article focuses on the clinical features of mild asthma and the use of medication for it. RESULTS: Mild asthma was more frequent, more symptomatic, and less well controlled in children than in adults. Its generally benign evolution may in some (<10%) cases be complicated by severe episodes. Patients with mild persistent asthma require controller medication every day: permanent low-dose inhaled corticosteroid monotherapy is the reference foundation treatment for persistent mild asthma. CONCLUSIONS: The present findings should help clinicians and guide them in their approach to managing this condition.
Administration, Inhalation↗
[Pulmonary involvement in polymyositis and dermatomyositis].
Polymyositis is characterised by an inflammatory reaction in skeletal muscle with a variable degree of muscular weakness and associated with skin lesions in the case of dermatomyositis. Involvement of the muscles of deglutition and the diaphragm may lead to inhalation pneumonia and acute or chronic respiratory failure, often hypercapnic. The other respiratory manifestations are diffuse interstitial pneumonitis (DIP), usually non-specific, and very occasionally pulmonary arterial hypertension. The development of DIP during polymyositis is a grave prognostic factor, respiratory involvement being one of the main causes of morbidity and mortality. The onset of DIP is acute in between 30 and 47% of cases. Anti-synthetase antibodies (particularly anti-JO-1) are positive in about 75% of cases. Treatment is usually with a combination of immunosuppressants and corticosteroids without any immunosuppressants therapy having shown a superiority.
Adrenal Cortex Hormones↗
[Pulmonary disease in dental laboratory technicians].
INTRODUCTION: The manufacture of dental prostheses exposes the technician to inhalation of various potentially dangerous dusts (silica, hard metals, dental alloys and acrylic resins). BACKGROUND AND VIEWPOINT: Inhalation of dusts produced by the technician in the work place may lead to several respiratory disorders (pneumoconiosis, hypersensitivity pneumonitis, asthma, lung cancer). The continuous development of new materials leads to further manifestations of these disorders and justifies their notification, even in the absence of an accepted occupational disease. This step is taken inconsistently as many dental technicians are not salaried or insured. CONCLUSION: The seriousness of some of these disorders and the absence of effective treatment makes it important to develop effective methods of prevention for the protection of individuals and groups, and for early detection.
Dental Prosthesis↗
[Diffuse infiltrative lung diseases].
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Antigens, Neoplasm↗
[Acute invasive pulmonary aspergillosis in chronic lung disease--a review].
INTRODUCTION: Apart from malignancies and solid organ transplant, chronic lung disease, in particular chronic obstructive pulmonary disease (COPD), is a third important predisposing factor for acute invasive pulmonary aspergillosis. STATE OF THE ART: COPD is present in 2% of patients dying from invasive aspergillosis. This opportunistic infection occurs because of an immunodeficiency linked both to altered local immunity and to systemic factors such as long term steroid treatment and malnutrition. In patients whose sputum and/or endotracheal aspirate specimens contain hyphal forms of filamentous Aspergillus, half will have a clinically significant aspergillus infection. Diagnostic tests include serum galactomannan antigen test, serum antibody titre, thoracic CT scan and bronchoalveolar lavage (BAL). The identification of fungal hyphae in BAL fluid by microscopy and/or on culture is critical for a positive diagnosis. The mortality rate for acute invasive pulmonary aspergillosis in chronic lung diseases reaches almost 100%. Antifungal monotherapy is still recommended as a first line treatment. Combined treatment can be used in refractory aspergillosis as a salvage therapy. The question of maintaining, decreasing or interrupting steroid treatment must be considered. PERSPECTIVES: Prospective studies are needed to evaluate a standardised diagnostic strategy such as exists for patients with haematological disease. Whether this will improve prognosis remains to be seen. CONCLUSION: Acute invasive pulmonary aspergillosis complicating chronic lung disease is not rare. Improved diagnosis procedures and recent therapeutic advances may have a positive impact on patient prognosis.
Antifungal Agents↗
[Characteristics of mild asthma: descriptive epidemiology and nature of bronchial inflammation. Position of the Mild Asthma Working Group].
INTRODUCTION: Update on the state of knowledge in the mild asthma (intermittent and persistent mild asthma, according to the GINA classification) literature, and position of a French Mild Asthma Working Group. STATE OF THE ART: The French Mild Asthma Working Group (11 lung specialists, 4 paediatricians, 1 pharmacologist, and 1 general practitioner) selected, analysed, and summarised the literature on the epidemiology, physiopathology, clinical signs, and management of mild asthma. The present article shows the position of the working group on mild asthma descriptive epidemiology (causal factors excluded) and the nature of the bronchial inflammation. Clinical signs and medicinal treatments will be presented in a second article. PERSPECTIVES: Between 50% and 75% of asthma patients, depending on the study, present mild asthma. Childhood-to-adulthood cohort monitoring found severity to be unchanged over developmental time. Its generally benign evolution may in some (<10%) cases be complicated by severe episodes. Inflammation and airway-wall remodelling were always found, although of variable intensity, and non-specific (except for absence of infiltration by polymorphonuclear neutrophils). Corticosteroid therapy by inhalation reduces bronchial inflammation, but with little impact on airway-wall remodelling. CONCLUSION: The present findings should help clinicians in identifying and understanding mild asthma.
Adrenal Cortex Hormones↗
Inflammatory events in severe acute asthma.
Severe acute asthma can be induced by different triggers, allergens, irritants, viruses, etc., which induce inflammation and provoke acute bronchoconstriction. Inflammatory cells, such as activated eosinophils and neutrophils identified in sputum and bronchial lavages (BL) in severe acute asthma from children and adults are associated with increased levels of IL-5, IL-8, and of proinflammatory mediators. Viruses, but also endotoxin or allergen exposure, are able to recruit neutrophils, via an IL-8 production by activated macrophages or epithelial cells. Together, these inflammatory mediators are responsible for the diffuse bronchial inflammation, which involve large and small airways. Activated T cells may also be related to the pathogenesis of severe asthma. An aberrant CD8+ T lymphocyte response in bronchi, with a cytotoxic activity has been associated with fatal asthma. Moreover, the persistence of inflammatory cells in bronchi, particularly neutrophils, which respond poorly to corticosteroids, could be in part responsible for the epithelial damage, the extensive mucus plugging, and the abnormalities of epithelial and endothelial permeability which are associated with severe acute asthma. Further studies are necessary to better identify the implication of this increased bronchial permeability in the persistence of high levels of airway resistance, particularly in patients with status asthmaticus.
Acute Disease↗
Allergic bronchopulmonary aspergillosis.
Allergic bronchopulmonary aspergillosis (ABPA) occurs in nonimmunocompromised patients and belongs to the hypersensitivity disorders induced by Aspergillus. Genetic factors and activation of bronchial epithelial cells in asthma or cystic fibrosis are responsible for the development of a CD(4)+Th2 lymphocyte activation and IgE, IgG and IgA-AF antibodies production. The diagnosis of ABPA is based on the presence of a combination of clinical, biological and radiological criteria. The severity of the disease is related to corticosteroid-dependant asthma or/and diffuse bronchiectasis with fibrosis. The treatment is based on oral corticosteroids for 6-8 weeks at acute phase or exacerbation and itraconazole is now recommended and validated at a dose of 200 mg/day for a duration of 16 weeks.
Aspergillosis, Allergic Bronchopulmonary↗
Invasive pulmonary aspergillosis in chronic obstructive pulmonary disease: an emerging fungal pathogen.
Acute invasive pulmonary aspergillosis occurs predominantly in immunocompromised hosts, with increasing numbers of cases of invasive aspergillosis among patients with chronic obstructive pulmonary disease (COPD) being reported. Among 13 cases of invasive aspergillosis diagnosed in COPD patients admitted to the intensive care unit with acute respiratory distress, the only risk factor for invasive fungal infection was corticosteroid treatment. Invasive aspergillosis should be suspected in COPD patients receiving steroid treatment who have extensive pulmonary infiltrates. Survival depends on rapid diagnosis and early appropriate treatment. A decrease or interruption of steroid treatment should be considered as part of the overall therapeutic strategy.
Aspergillosis↗
Combined pulmonary fibrosis and emphysema: a distinct underrecognised entity.
The syndrome resulting from combined pulmonary fibrosis and emphysema has not been comprehensively described. The current authors conducted a retrospective study of 61 patients with both emphysema of the upper zones and diffuse parenchymal lung disease with fibrosis of the lower zones of the lungs on chest computed tomography. Patients (all smokers) included 60 males and one female, with a mean age of 65 yrs. Dyspnoea on exertion was present in all patients. Basal crackles were found in 87% and finger clubbing in 43%. Pulmonary function tests were as follows (mean+/-sd): total lung capacity 88%+/-17, forced vital capacity (FVC) 88%+/-18, forced expiratory volume in one second (FEV1) 80%+/-21 (% predicted), FEV1/FVC 69%+/-13, carbon monoxide diffusion capacity of the lung 37%+/-16 (% predicted), carbon monoxide transfer coefficient 46%+/-19. Pulmonary hypertension was present in 47% of patients at diagnosis, and 55% during follow-up. Patients were followed for a mean of 2.1+/-2.8 yrs from diagnosis. Survival was 87.5% at 2 yrs and 54.6% at 5 yrs, with a median of 6.1 yrs. The presence of pulmonary hypertension at diagnosis was a critical determinant of prognosis. The authors hereby individualise the computer tomography-defined syndrome of combined pulmonary fibrosis and emphysema characterised by subnormal spirometry, severe impairment of gas exchange, high prevalence of pulmonary hypertension, and poor survival.
Adult↗
Necrotising sarcoid granulomatosis: clinical, functional, endoscopical and radiographical evaluations.
Necrotising sarcoid granulomatosis (NSG) is a rare disease diagnosed on the basis of pathological features. The present study reports the characteristics of 14 cases of NSG. The mean age at the appearance of first symptoms was 37 yrs and the mean delay between first symptoms and diagnosis was 1 yr. Extrarespiratory symptoms were more common (12 out of 14) than respiratory symptoms (eight out of 14). Seven patients had inflammatory syndrome. Bronchoalveolar lavage was performed in eight patients and found to be normal in three cases. Respiratory function was normal in 13 patients, but carbon monoxide diffusing capacity was slightly decreased in eight of the 11 patients tested. A computed tomography scan showed a solitary nodule in four out of 14 cases, bilateral nodules in three and infiltrates in seven. One patient died from neurological complications despite treatment with corticosteroids and immunosuppressive drugs. Two cases of relapse were observed in patients initially treated with corticosteroids, and there were two cases of relapse after surgery. No relapse occurred in the five untreated patients. During the follow-up, lung cancer was detected at 26 months and 8 yrs, respectively, after NSG diagnosis in two patients. In conclusion, no one treatment is associated with a better outcome than the others, although lung biopsy might be necessary in case of isolated nodule or cavitation. Greater vigilance is required during the follow-up.
Adolescent↗
[Endocrine and pulmonary histiocytosis: a case diagnosed through stereotoxic biopsy].
INTRODUCTION: Despite intensive investigation, the pulmonary lesions of Langerhans cell histiocytosis can sometimes prove difficult to yield a diagnosis of this potentially multi-focal disease. CASE REPORT: We report the case of a sixteen year old woman, who presented with a hypothalamo-hypophyseal mass associated with endocrine clinical signs, dyspnoea, and micro-nodular pulmonary lesions on computerised tomography. A Langerhans cell histiocytosis was initially suspected, but then thought unlikely in the light of negative pulmonary investigations and spontaneous regression of the pulmonary lesions. However, an increase in the size of the cerebral mass prompted a brain biopsy finally confirming the diagnosis of Langerhans cell histiocytosis. CONCLUSIONS: This case report identifies a possible dissociation between the clinical courses of cerebral and pulmonary Langerhans cell histiocytosis, and confirms the usefulness of extra-thoracic biopsies in making a diagnosis on the disseminated form of the disease.
Adolescent↗
[Involvement of dendritic cells in allergic airway diseases].
INTRODUCTION: Dendritic cells (DCs) are able to present antigen to T lymphocytes and to orientate the immune response towards a Th1 or a Th2 type. STATE OF THE ART: The aim of this report is to present different studies comparing DCs from allergic patients with those from healthy subjects using in vivo and in vitro experimental conditions. These studies have demonstrated that cellules dentritiquess from house dust mite allergic patients:i) take up house dust mite allergen more efficiently, ii) after stimulation by house dust mite allergen, secrete a restricted panel of cytokines and chemokines, and express characteristic co-stimulatory molecules, favoring a Th2 profile, iii) after stimulation by house dust mite allergen, induce Th2 cytokines secretion by T lymphocytes, and iv) favor an allergen-specific Th2 airway inflammatory response in an in vivo model of humanized mice. PERSPECTIVES: Functional modulation of DC could be a new therapeutic concept in allergic airway diseases. CONCLUSIONS: These results show phenotypic and functional specificities of DC from house dust mite allergic patients, and suggest a key-role for cellules dentritiques in the pathogenesis of allergen-dependent airway inflammatory response.
Dendritic Cells↗
[Physiopathology of inflammatory events in asthma].
Inflammatory events in asthma include an initiation step dependent on dendritic cells, an effector step which involves the release of a large number of mediators by inflammatory cells, mastocytes, polymorphonuclear neutrophils and eosinophils, alveolar macrophages and monocytes, and lymphocytes; and a repair phase leading to airway remodeling. In addition to classic mediators such as histamine and leucotrienes, it is currently accepted that cytokines and chimokines play an essential role in local cellular trafficking. The bronchial endothelium and epithelium are simultaneously activated. Bronchial inflammation is constant in patients with allergic asthma and persists even in the absence of symptoms. Links between the intensity of the inflammatory response and the occurrence of airway remodeling suggest that therapeutic interventions should take place as early as possible, particularly in children.
Asthma↗
Exposure to methyl methacrylate and hypersensitivity pneumonitis in dental technicians.
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Adult↗