[A rare case of thoracoabdominal opacity].
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Adolescent↗
Biomedical subjects
J C Guérin
Publications and source records attributed to J C Guérin.
[Mediastinal adenopathies and presence of anti-cytoplasmic antibodies of diffuse type polynuclear neutrophils].
We report a case of sarcoidosis with mediastinal and pulmonary localizations associated with diffuse antineutrophil cytoplasmic antibodies (c-ANCA). This led to discuss the differential diagnosis with vascularitis and the specificity of c-ANCA in Wegener's granulocytosis.
Antibodies, Antineutrophil Cytoplasmic↗
[Psychological profile of patients with COPD: contribution of Semiometry].
Patients with chronic bronchitis often ignore, or pretend to ignore, their disease and generally consult very late. The physician's advice is often quite vague and centered on smoking. One of the objectives of this study was to better understand the psychological profile of patients with chronic bronchitis in order to better apprehend the patient-physician relationship and therapeutic options. Semiometry was designed to overcome the problem encountered by physicians who would like to understand who their patients are without directly asking them. The concept is based on submitting very ordinary words to these subjects and asking them whether they like the word or not. An analysis of their responses allows a very deep understanding of their psychological profile. Briefly, the patient-physician relationship is quite difficult in COPD. The patient "brings" the disease to the physician, "putting" it in his hands and asking him to cure it without having to do anything concerning himself, his life or his behavior. The physician is called on to answer this challenge that can be expressed as "trying to get the patient to play the game without getting caught".
Adaptation, Psychological↗
Effectiveness of low doses (50 and 100 microg b.i.d) of beclomethasone dipropionate delivered as a CFC-free extrafine aerosol in adults with mild to moderate asthma. Study Group.
The objective of this study was to evaluate the efficacy and safety of low doses (50 and 100 microg b.i.d.) of hydrofluoroalkane-134a (HFA) beclomethasone dipropionate (BDP) extrafine aerosol in improving asthma control. Reformulation of BDP in a new chlorofluorocarbon (CFC)-free propellant (HFA) has produced an extrafine aerosol with increased delivery of the drug to the airways of the lung. The study population comprised 270 steroid-naive patients with mild to moderate asthma (mean baseline forced expiratory volume in 1 sec [FEV1] as a percentage of predicted normal of 65%-85%). This was a 6-week, blinded, placebo-controlled, multicenter study. Patients were randomized to receive 50 or 100 microg b.i.d. HFA-BDP or HFA-placebo. Treatment with either 50 or 100 microg b.i.d. HFA-BDP resulted in a significantly greater improvement compared with placebo in FEV1 (mean change from baseline as percentage of predicted normal of 6.7%, 8.6%, and 0.4%, respectively; p < or = 0.01 active treatment groups vs. placebo), with a significant trend toward increasing improvement with increasing doses (p < or = 0.0001). Treatment also resulted in significantly greater mean changes from baseline in morning peak expiratory flow compared with placebo (29.5, 33.8, and 5.0 L/min, respectively; p < or = 0.01 active treatment groups vs. placebo). All other pulmonary function and asthma symptom measures supported these data. The study treatments were well tolerated. These results show that low doses of HFA-BDP extrafine aerosol effectively improve asthma control in adult patients with mild to moderate asthma. However, it is important that inhaled corticosteroid therapy is still given at a dose high enough to control airway inflammation as well as asthma symptoms.
Administration, Inhalation↗
[Post-cardiac injury syndrome: an rare cause of pleurisy, value of pleural fluid analysis].
The post-cardiac injury syndrome is an inflammatory process concerning the pericardium, the pleura and/or the pulmonary parenchyma, that develops after different kinds of cardiac aggression. The diagnosis can be evoked when some clinical and biological results are present but remains one of exclusion. We report a case of post-cardiac injury syndrome for which we demonstrate an immunologic involvement of the pleura. The antimyocardial antibodies and the low complement index found in the pleura strongly support an immunologic process, and this suggests that the analysis of the pleural fluid could be useful for the diagnosis of the post-cardiac injury syndrome.
Adult↗
[Carcinomatous lymphangitis].
DEFINITION: Carcinomatous lymphangitis is a radioclinical entity accounting for about 8% of all cases of lung metastasis defined as the presence of tumoral cells in lymph vessels and lung interstitium. DIAGNOSIS: Biopsy specimens or bronchial brushings obtained by fibroendoscopy or bronchioalveolar lavage fluid usually reveal adenocarcinoma. PRACTICAL MANAGEMENT: In clinical practice, the patient presents with dyspnea and non-specific infiltration on the chest x-ray. The clinical situation worsens rapidly. Millimetric CT-scan shows highly suggestive polygonal images in the subpleural area. Respiratory function tests may be helpful for the differential diagnosis, particularly in difficult cases, showing a mixed ventilation disorder without altered carbon monoxide diffusion and hypoxemia at rest without hypercapnia. SEARCH FOR THE PRIMARY CANCER: Primary lesions must be identified for specific treatment. Pathology findings help guide the search. Despite the highly unfavorable prognosis (median survival = 3 months), etiological treatment when possible can improve quality of life and possibly survival. Symptomatic treatment is indicated and must be adapted to each individual case.
Adenocarcinoma↗
[Anaphylactic reactions to systemic corticosteroids. Review of the literature concerning 3 cases].
Despite their antiinflammatory and antiallergic properties, corticosteroids can nevertheless cause adverse allergic reactions. This is currently accepted for local corticosteroids and there have also been about a hundred reports of variable pertinence concerning hypersensitivity reactions to systemic corticosteroids. Based on three cases of immediate hypersensitivity reactions after taking methylprednisolone, we propose a critical review of the literature, focusing particularly on methylprednisolone-induced reactions. The means of investigation currently available in drug-induced hypersensitivity reactions are also discussed.
Anaphylaxis↗
[Fortuitous discovery of infiltration of the lung bases].
We report a case of interstitial pneumonia found by a woman who suffered from a gastroesophageal reflux unamenable to usual treatments. The HR-tomographic discovery of a tone esophagus lead to a manometric study. The association of high autoantibodies levels and radiographic and manometric data were characteristic of esophageal and pulmonary scleroderma.
Diagnosis, Differential↗
[Pleuropulmonary endometriosis].
Endometriosis is a condition where endometrial and cytogenic chorion glands lie outside the uterine cavity. The underlying pathophysiological mechanisms remain unclear. Pelvic localizations are common, but more distant localizations in cutaneous, neurological or thoracic sites are exceptional. Symptoms following the menstrual cycle suggest the diagnosis. Bronchopulmonary endometriosis is exceptional. The diagnosis is suggested by the presence of recurrent hemoptysis following the menstrual cycle. Distal lesions are exceptionally visible to the endoscope. Chest x-ray and CT can visualize the lesion as a nodule with variable size depending on the menstrual cycle. Positive diagnosis is obtained at excision. The characteristic feature of catamenial pneumothorax is recurrent pneumothorax in the fourth decade of life, almost always on the right and coincident with menses but with no other signs. The diagnosis is clinical and radiological. Endometriomas appear as hypodense nodules on CT scan if they are larger than one centimeter. A homogeneous hypersignal is seen on the MRI. Thoracoscopy or thoracotomy may be necessary; the endopleural aspect is specific. The hypothesized pathogenic mechanism involves an air passage from the genital tract via breaches in the diaphragm. Treatment is based on medical or surgical pleural synthesis and hormone therapy for several months.
Biopsy↗
[Percutaneous closure of an right-left interatrial shunt acquired after pneumonectomy].
Right to left shunt through a patent foramen ovale after pneumonectomy is a rare complication. Its clinical presentation is a severe dyspnea with posture dependency. The diagnosis is easily confirmed by contrast echocardiography. The purpose of this article is to expose the interest of interventional catheterization and transcatheter closure. This method appears to be a viable alternative to surgery for those patients with precarious respiratory function.
Cardiac Catheterization↗
[Acute diffuse interstitial pneumopathy following docetaxel (Taxotère). Apropos of 2 cases].
Docetaxel, a new chemotherapeutic agent, has demonstrated activity in non-small cell lung cancer and breast cancer. Toxicities associated with treatment using docetaxel include hypersensitivity reactions and fluid retention, which can be prevented by pretreatment with corticosteroids. We describe herein two cases of acute interstitial pneumonitis after administration of docetaxel to patients suffering from metastatic non-small cell lung cancer. A pulmonary toxicity of docetaxel from an hypersensitivity reaction is likely because of symptoms course, radiological demonstration of an interstitial pneumonitis, lack of an infectious etiology and of clinical response to antibiotic treatment, and rapid recovery with corticosteroids. This unusual pulmonary toxicity has been rarely described with docetaxel, as transient pulmonary infiltrates have been observed during treatment with paclitaxel. The possibility of an hypersensitivity pneumonitis must be taken into account when a patient with docetaxel treatment presents pulmonary infiltrates.
Aged↗
[Spontaneous resolution of multiorgan sarcoidosis associated with malignant lymphoma].
We report a case of multisystemic sarcoidosis with adenopathy, skin and respiratory involvements, which have a prolonged evolution. After 3 years with corticosteroid and synthetic antimalarial drugs treatment, the patient have a new skin and pseudo-tumoral pulmonary development, which have a spontaneous regression. Few month later, he developed a malignant lymphoma.
Adrenal Cortex Hormones↗
[Sarcoma of the pulmonary artery].
Two cases of pulmonary artery angiosarcomas are reported. Pulmonary artery tumor was diagnosed during exploratory thoracotomy in the first case. It was suspected on magnetic resonance imaging and confirmed by surgery in the second case. The therapeutic was a right pneumonectomy for the first patient and a tumor resection followed by chemotherapy and radiotherapy on cerebral metastases for the second patient. Both our patients died, 13 and 44 months after surgery. On the basis of histological and immunohistochemical findings both tumors were angiosarcomas. Ultrastructural examination in the second case revealed an endothelial differentiation. The review of 142 previously reported cases of pulmonary artery sarcomas and these ultrastructural findings suggest that pulmonary artery sarcomas may have multiple origins; leiomyosarcomas deriving from arterial smooth muscle; angiosarcomas deriving from the endothelium and undifferentiated sarcomas or "myointimal sarcomas" deriving from myointimal cells.
Brain Neoplasms↗
[Restrictive myocardiopathy and pulmonary Raynaud's syndrome].
Idiopathic restrictive myocardiopathy is an uncommon condition. The differential diagnosis with constrictive pericarditis may require endomyocardial biopsy or surgical exploration. The prognosis of idiopathic restrictive myocardiopathy reported in the literature is to the order of several years. In this case the association with pulmonary Raynaud syndrome appears to be fortuitous and has not been previously reported.
Cardiomyopathy, Restrictive↗
[Larva migrans syndrome: a rare differential asthma diagnosis].
We report a case of sudden-onset bronchospasm which developed in a 68-year-old patient. Peripheral eosinophila suggested several possible diagnoses. Positive serology for Toxocara canis and clinical and radiological regression without treatment were particularly noteworthy.
Aged↗
[Pharmacological perspectives].
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Bacterial Infections↗
[Spontaneous pneumothorax].
Pneumothorax corresponds to the extravasation of air in the pleural cavity. This produces a partial or complete collapse of the adjacent lung. This is a common thorax disease resulting from a leak between the broncho-pulmonary gas compartment and the usually virtual pleural space. Pneumothorax is called spontaneous when no traumatic or iatrogenic factors are present. Spontaneous pneumothorax can be primary (when no radiographic or clinical injuries can be detected) or secondary to an underlying pulmonary disorder. Evolution of spontaneous pneumothorax is usually benign. However, recurrence is frequent. Preventing recurrences is the basis of all the therapeutic controversies which, after drainage, are based on pleurodesia indications. Vital prognosis may be compromised when pneumothorax is compressive, bilateral, or when it results in respiratory failure in patients with chronic respiratory insufficiency.
Humans↗
[Bioclinical interest in the assay of leukotrienes in four cases of sensitization to trophallergens].
New cellular tests as flow cytometry and leukotriene release having been set up for allergy diagnosis, we checked the reliability of the LTC4 release test for 4 patients sensitized to wheat flour, oyster and lobster and to anise. Food allergy diagnosis was based on the clinical history, skin tests (pricks and IDR) and specific IgE. After allergen stimulation, LTC4 released was determined by an RIA method using a monoclonal antibody. The allergen extracts used for skin tests and LTC4 release having the same origin, LTC4 release test showed a good correlation with the clinical history whereas specific IgE determinations were less sensitive. Skin tests were negative in the cases.
Adult↗