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J Brune

Publications and source records attributed to J Brune.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Alveolar proteinosis. Prolonged favorable course after total pulmonary lavage].

We report the outcome in a case of alveolar proteinosis diagnosed histologically in a 43 year old female. The increase in dyspnoea and the deterioration in the pulmonary function tests have lead to the realisation that a total pulmonary lavage was required under general anaesthesia. This was performed in two stages. A biochemical analysis of the lavage liquid showed an accumulation of phospholipids, proteins, and LDH. A subjective improvement was obtained in a few weeks followed by a slow radiological improvement as well as on CT scanning, and in respiratory function. Radiological and blood gas improvement was noted 19 months after total bilateral pulmonary lavage. Broncho-alveolar lavage is thus able to induce long-term improvement in pulmonary alveolar proteinosis.

Adult↗
PubMed1989

Idiopathic bronchiolitis obliterans organizing pneumonia. Definition of characteristic clinical profiles in a series of 16 patients.

Bronchiolitis obliterans organizing pneumonia (BOOP) is a pathologic finding common to various injuries to the lung of either definite or idiopathic etiology. Since the presentation of patients with idiopathic BOOP varies, we studied 16 patients with BOOP on pulmonary histology to define more distinct and homogeneous clinical and imaging profiles of idiopathic BOOP. We distinguished three groups of patients: group 1 (n = 4), with multiple patchy migratory pulmonary involvement of the pneumonia type. Their clinical course was subacute, with cough, fever, weight loss, mild dyspnea, and increased ESR. Chest x-ray film and CT scan showed multiple alveolar opacities. All patients completely recovered with corticosteroid therapy but relapsed when therapy was stopped too rapidly. Group 2 (n = 5) had solitary pulmonary involvement of the pneumonia type occurring in a similar clinical context. Since carcinoma was suspected, they underwent surgical excision of the pneumonic area and recovered without relapse. Group 3 patients (n = 7) presented with diffuse pulmonary involvement of the interstitial lung disease type. They had more progressive onset of more severe dyspnea, crackles heard over all lung surfaces, and interstitial opacities with or without alveolar opacities on chest imaging. Improvement with corticosteroid therapy was obtained in only three patients. In all three groups, lung function test results showed a restrictive pattern. The obstructive pattern characteristic of pure bronchiolitis obliterans was found in none. BAL showed a mixed pattern (increase of both lymphocytes and polymorphonuclear cells) in the patients of the first two groups. Thus, we distinguished three characteristic clinical and imaging profiles in patients with idiopathic BOOP: multiple patchy pneumonia, solitary pneumonia, and diffuse interstitial lung disease. These profiles are so different that they should be distinguished in clinical studies of idiopathic BOOP.

Adult↗
PubMed1989

[Surgical treatment of 48 primary peripheral, non-small cell lung cancers equal to or greater than 8 cm. Prognostic factors and 5 years' survival].

In a series of 885 resections for lung carcinoma performed between 1976 and 1986, 48 (5.5%) were for large size tumors of 8 cm and over. Pneumonectomy was performed in 28 patients (58.3%), lobectomy in 17 (35.5%) and bilobectomy in 3 (6.2). Histological type of tumor was squamous cell in 27, adenocarcinoma in 9, large cell carcinoma in 10, and adenosquamous carcinoma in 2. The stage of the disease was stage I in 16 cases, stage II in 3 cases, and stage III in 29 cases. Total survival rate including perioperative mortality (3 deaths) was 30.5% at 3 years and 16.3% at 5 years. The best prognostic factors are: age under 60 (23% survival at 5 years, and no survival over 60, (p = 0.01), absence of weight loss (24% survival at 3 years, and 14% at 3 years in case of weight loss (p = 0.02), absence of symptoms (44% at 3 years) but no survival in case of symptoms (p = 0.02), no invasion of mediastinal lymph nodes (N0 and N1), and stage I and II of the disease (50% of survival at 3 years against 20% for stage III (p = 0.04). There was no relation to survival rate between T2 and T3, squamous and adenocarcinoma, and between lobectomy and pneumonectomy. Most of our patients died of post-operative metastasis (52%), related to the large size of the tumor.

Adult↗
PubMed1989

[Pulmonary arteriovenous fistula. Apropos of 12 cases].

Arteriovenous fistula of the lung is a relatively rare lesion with various clinical manifestations. It may be clinically silent and discovered by chance on X-ray films of the chest or during evaluation of Rendu-Osler-Weber disease with which it is associated in about one-half of the cases. It may also have loud manifestations when complicated. The fistula is diagnosed in successive steps, mainly by respiratory function tests and pulmonary angiography. Conservative treatment should be the rule, especially in case with multiple fistulae, but it must begin at an early stage to avoid the dramatic complications of this abnormality, such as acute neurological disorders, haemoptysis, haemothorax, etc. Wide and crippling lung resection must be avoided. Aneurysmorrhaphy or embolization is sufficient to cure most of these multiple angiomas. The results obtained are measured by calculating the blood flow rate in the shunt, as it should theoretically disappear after surgery.

Adult↗
PubMed1989

[Molecular analysis of biopsies of bronchial cancers: feasibility of a systematic approach].

Malignant cells can be distinguished from their normal counterpart at the DNA level: they carry molecular changes which are characteristic of the tumor type or which might have some prognostic value. Amplifications and mutations of oncogenes and loss of alleles have been reported to occur in lung cancers, but their prognostic value has not yet been estimated, mainly for technical reasons: primary fresh biopsies are usually too small for molecular investigation. From 79 biopsies (50 of which were obtained by fiberoptic bronchoscopy), DNA hybridization was performed using the Southern blot technique, with myc family genes probes and a polymorphic probe located on the short arm of chromosome 3. Our study indicates that: 1) in 88% cases, enough DNA can be obtained by 3 or 4 fiberoptic bronchoscopy biopsies: from 5 to 80 micrograms DNA with an average of 25; 2) the quality of DNA is good for analysis by the Southern blot technique; 3) the loss of allele on chromosome 3 (3p 14-23) can be detected both in the small cell and in the non small cell type, but contamination of the specimens by non-tumoral tissue (based on the cytological and histological analysis of each biopsy) remains a problem for this type of study; 4) gene amplifications and rearrangements can be easily evaluated for the genes of the myc family. This pilot study shows that DNA analysis is feasible on perendoscopic biopsies. Collection and analysis of a large series of such biopsies at diagnosis is essential to define the value of DNA markers as prognostic factors in lung cancers.

Alleles↗
PubMed1988

Gallium-67 scanning in the staging of cryptogenetic fibrosing alveolitis and hypersensitivity pneumonitis.

Gallium-67 citrate is known to localize within inflammatory sites. Gallium-67 scanning is used for the evaluation of lung inflammation (i.e. alveolitis) during interstitial lung diseases. We investigated 27 patients with cryptogenetic fibrosing alveolitis (n = 17) and hypersensitivity pneumonitis (n = 10) using gallium-67 lung scanning and lung function tests (forced vital capacity, diffusing capacity, resting and exercise blood gases). Investigations were performed before and after one year of methylprednisolone treatment. None of eight healthy volunteers had any abnormal gallium-67 uptake. In all patients with cryptogenetic fibrosing alveolitis an initial abnormal gallium-67 uptake was observed (mean fixation index: 163 +/- 18). In addition, analysis of lung function tests a year after initial evaluation showed that unchanged or improving patients presented initially with a lower gallium-67 index than patients with evidence of deterioration (153.9 +/- 23.7 vs 251.0 +/- 23.3.; p less than 0.01). Similarly, among patients with hypersensitivity pneumonitis the index was lower in unchanged or improving patients than in those with deterioration (74.9 +/- 22 vs 226.7 +/- 4.9; p less than 0.05). Thus gallium-67 scanning is useful in the management of cryptogenetic fibrosing alveolitis and hypersensitivity pneumonitis.

Alveolitis, Extrinsic Allergic↗
PubMed1987

[Spontaneous recurrent pneumothorax in young patients. Treatment by bilateral one stage apical pleurectomy by axillary approach].

The quality of the surgical and respiratory functional results of one-stage bilateral apical pleurectomy for alternating or successive bilateral pneumothorax was evaluated in 30 patients operated upon from 1970 to 1984. These 4 women and 26 men represented 15% of the 194 patients surgically treated for pneumothorax during the same period. Among early results figure absence of mortality, moderate blood loss (295 +/- 130 ml) and short stay in hospital (11 +/- 3 days). Late results could be assessed in 23 patients with a mean post-operative follow-up of 50 +/- 21 months; 7 patients were lost sight of. No clinical or radiological recurrence of pneumothorax was observed. No dyspnoea associated by post-operative ventilatory restriction was demonstrated in our 23 patients. Among the 12 patients subjected to a total of 16 spirographic examinations, 4 out of 10 examined after 6 months showed slight restriction. These good functional results are confirmed by the literature which only gives the results of unilateral pleurectomy.

Adult↗
PubMed1987

Prevalence of legionellosis among adults: a study of community-acquired pneumonia in France.

Over a 24-month period, 274 patients with community-acquired pneumonia were hospitalized in Departments of Medicine at hospitals in Bordeaux, Lyon, Marseille, and Toulouse. Etiology of the pneumonia was determined either by organism identification or by indirect immunofluorescence in only 139 cases (51%). The most frequently isolated etiological agents were Streptococcus pneumoniae (34 cases), Legionella pneumophila (29 cases) and Mycoplasma pneumoniae (24 cases). The majority of patients with legionellosis were male (79%), middle aged (mean age: 53 years), and living in urban areas (69%). Their clinical features were atypical and did not differ from those of other pneumonias. Four patients with legionellosis (13.8%) died. L. pneumophila was isolated directly in only three instances. The study confirms the high prevalence of legionellosis (20%) among pneumonias of identified etiology. The fact that these cases had an atypical clinical presentation and that isolation of the organism was difficult reinforce the need to apply the CDC criteria for the interpretation of positive serological titers.

Age Factors↗
PubMed1987

[Bronchiolitis caused by graft versus host reaction after bone marrow allograft].

Graft versus host reaction (GVH) is a major complication of allogenic marrow transplants. The GVH present is a pluri-visceral syndrome in which certain pulmonary disorders are recognised. Amongst these respiratory failure by bronchiolitis is not an exceptional presentation. The case reported here is of an 18 year old man who developed, immediately following a marrow graft for acute lymphoblastic leukaemia, a lethal obstructive respiratory failure after progression for 2 1/2 years. The respiratory function data (TVO with elevated residual volume (VR) and VR/Total lung capacity (CT) hypoxia which corrected on exercise with normocapnia then hypoxic hypercapnia; compliance normal at low frequency but fell at high frequency and inspiratory and expiratory resistance was raised: DLCO/VA was normal) allowed the confirmation of obstructive respiratory failure by disease of the small airways. The pathogenesis of CVH is equivocal. Recurring infections seem to play a role, favoured by iatrogenic factors such as chemotherapy and total body irradiation. In the case reported here the first pulmonary signs followed an episode of influenza with sero-conversion.

Adolescent↗
PubMed1987

[Hypereosinophilia in bronchoalveolar lavage. Diagnostic value and correlations with blood eosinophilia].

An eosinophilia of 3% or more was present in 13.3% of a series of 1,084 broncho-alveolar lavages done in our department. An eosinophilia of less than 10% was of no diagnostic value. Idiopathic diffuse interstitial fibrosis, hypersensitivity pneumonitis, and asthma were the principal diagnoses encountered in cases with an eosinophilia of between 10 and 40%. An eosinophilia of greater than 40% was mainly observed in cases of chronic idiopathic eosinophilic pneumonia. A linear correlation (p less than 0.01; r = 0.545) was found between the blood eosinophils and that of the broncho-alveolar lavage; the existence of isolated cases where these two were dissociated raised the possibility of chemotactic factors acting independently on the blood and alveolar compartments.

Bronchoalveolar Lavage Fluid↗
PubMed1987

[Analysis by broncho-alveolar lavage of the pulmonary uptake of gallium 67 in idiopathic diffuse interstitial fibrosis and sarcoidosis].

The pulmonary fixation of Gallium 67 has been studied by broncho-alveolar lavage (LBA) in a group of 10 cases of stage II pulmonary sarcoid, proven histologically, and in a group of 11 cases of idiopathic diffuse interstitial fibrosis (FID). The pulmonary activity of Gallium 67 was measured in vitro in a quantitative manner on a centrifuged clump and a supernatant of LBA as well as on the serum and in vivo in a semi-quantitative manner by the Line index. The alveolar Gallium activity has been correlated with different cytological and biochemical parameters of the lavage liquid. There was a narrow correlation in the serum between the Gallium 67 activity and the level of circulating transferrin. The fixation of Gallium in the cellular clump of LBA depends on the number of macrophages present in the clump and the total available radioactivity. The macrophages of the sarcoid and fibrosis cases picked up the gallium in a similar fashion, with an affinity all the more important as the total available radioactivity was weak. The radioactivity of the supernatant of the lavage liquid was quantitatively important and narrowly tied to the diffusible proteins present in the lavage. There was no correlation between the semi-quantitative Line index and the cytological or biochemical data in the fibrosis cases. In the sarcoid cases there was an inverse correlation with the polymorphonuclear leukocyte count. The semi-quantitative index was only correlated with alveolar gallium fixation level in the fibrosis group.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Amyloidosis of the lower respiratory tract. Clinical and pathologic features in a series of 21 patients.

Twenty one cases of amyloidosis of the lower respiratory tract were seen at a single center. In three patients, multifocal bronchial amyloid plaques led to stenosis and atelectasis, and in two, small pseudotumor masses were an incidental bronchoscopic finding. Two patients had nodular parenchymal amyloidosis, in one of whom the lesions were progressive and in the other static. Fifteen patients had diffuse parenchymal amyloidosis. Two of these had severe interstitial involvement and died in respiratory failure; eight had congestive cardiac failure, and parenchymal amyloidosis was a post-mortem finding; two had senile cardiorespiratory amyloidosis, also found at autopsy; and in three, the amyloidosis was associated with malignancy. The degree of respiratory embarrassment seemed to be related to the amount of amyloid in the gas diffusion zones, irrespective of the etiology of amyloidosis.

Adult↗