Biomedical subjects
Publications and source records attributed to J L Corhay.
We report the case of a patient treated by chemotherapy for a diagnosis of mesothelioma. A quickly progressive dyspnea developed which was due to compression of the right main bronchus by mediastinal extension of the tumor. This obstruction was treated by interventionnal bronchoscopy and stenting.
Exacerbations of chronic obstructive pulmonary disease (COPD) play a very important role. Unfortunately they were neglected a long time in the therapeutic tests. However exacerbations influence the decline of the respiratory function over time, cause important deterioration of the quality of life of the patients, increase morbidity and mortality of COPD, and finally represent a burden for health care. Reducing the number of exacerbations could potentially slow down the progression of the disease. Thus the prevention of exacerbations should be the "corner stone" of the maintenance treatment of the COPD. In this review we propose to recall the importance of exacerbations in COPD and to present the treatment which have been shown to reduce exacerbation rate in COPD.
Tiotropium is a long-acting anticholinergic bronchodilator, inhaled only once a day, which produces relaxation of airway smooth muscle through antagonism of acetylcholine at M3-muscarinic receptors. Its duration of action is at least 24 h with once daily administration of tiotropium. Several studies have shown its efficacy and its good tolerance in the treatment of patients who are suffering from moderate to very severe chronic obstructive pulmonary disease (COPD). Tiotropium improves spirometric measurements and quality of life, and reduces dyspnea and exacerbation rate in COPD patients.
UNLABELLED: The 1997 International staging system (ISS) classification separated stage III non-small cell lung cancer (NSCLC) into stages IIIA and IIIB. In a previous study including unresectable NSCLC initially treated with chemotherapy, we analysed survival according to tumour (T) and node (N) stages and derived a classification into stages IIIbeta (T3-4N3) and IIIalpha (other TN stage III) that had a better discrimination on survival distribution. The aim of this study was to validate these results in a further set of patients. Patients with unresectable stage III NSCLC included in a phase III trial assessing the role of increased dose chemotherapy (SuperMIP: mitomycin 6 mg/m2, ifosfamide 4.5 g/m2, cisplatin 60 mg/m2, carboplatin 200 mg/m2) in comparison to standard chemotherapy MIP (mitomycin 6 mg/m2, ifosfamide 3 g/m2, cisplatin 50 mg/m2), before thoracic irradiation (60 Gy in 30 fractions over 6 weeks) were the subject of this study. Survival distributions were assessed by the method of Kaplan-Meier. Survival comparisons were made by the log-rank test. Multivariate analyses using Cox regression models, included all potential prognostic factors for survival with a P-value <0.2 in univariate analysis. According to the 1997 International staging system classification, 328 eligible patients were included in the study. There was no imbalance between the two arms. Five parameters were significantly associated (P < or = 0.05) with survival in univariate analysis: European lung cancer working party (ELCWP) staging (IIIalpha[n = 294 pts] versus IIIbeta [n = 46]), Karnofsky index, weight loss, platelet count and haemoglobin level. These variables as well as the 1997 ISS staging, white blood cell (WBC) count, LDH and sodium levels were included in a multivariate analysis. Two models were constructed, including either the ELCWP or the 1997 ISS. In model 1 (ISS included), Karnofsky index (HR 0.69; 95% confidence interval (CI) 0.47-1.00; P = 0.05) and haemoglobin (HR 1.49; 95% CI 1.11-1.99; P = 0.007) were found significant. In model 2, including ELCWP staging, two variables were associated with survival: ELCWP staging (HR 1.68; 95% CI 1.20-2.35; P = 0.002) and haemoglobin (HR 1.54; 95% CI 1.15-2.07; P = 0.01). CONCLUSION: In initially unresectable stage III NSCLC treated by chemotherapy and radiotherapy, we validated the results of our previous study. The classification into stages IIIbeta (T3-4N3M0) and IIIalpha (other TN stage III) better discriminates the patients in term of survival than the 1997 ISS classification.
In a healthy individual, a dyspnoea of abrupt onset raises the suspicion of a spontaneous pneumothorax. The clinical examination and standard chest X-ray usually permit the correct diagnosis. The risk of reccurence can be assessed by the clinical history and examination. The functional consequences (which can be lethal) and the risk of recurrence will guide the short- and long-term therapy.
SPIRIVA (tiotropium) is a long-acting anticholinergic bronchodilatator, inhaled once a day, which produces relaxation of airway smooth muscle through antagonism of acetylcholine at M3-muscarinic receptors. Its duration of action is at least 24h with once daily administration of tiotropium. Several studies have shown its efficacy and its good tolerance in the treatment of patients who are suffering from moderate to very severe chronic obstructive pulmonary disease (COPD). SPIRIVA improves spirometric measurements and quality of life, and reduces dyspnea and exacerbation rate in COPD patients.
During recent years the endobronchial prostheses has become an essential part of the therapeutic bronchoscopy in order to remove obstructions from the proximal airways, in malignant diseases, (principally lung cancer) are in benign disorders. In this article we report our last ten year experience in stenting of the tracheo-bronchial tree. We will retrospectively review the indications of the stents, the type of prostheses and their modes of insertion, their complications, the clinical and functional results.
We report a case of bronchiectasis due to primary ciliary dyskinesia.
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PositIon emission tomography using 18-fluorodeoxyglucose (FDG-PET) is an imaging technique based on metabolic criteria rather than morphological criteria. We discuss the contribution of this technique in the field of pulmonary oncology and we summarize our work which has demonstrated the performance capacity of PET: to discriminate the malignant nature of a solitary pulmonary nodule; to improve sensitivity over CT for mediastinal assessment in non-small cell lung cancer; to seRach for distant metastasis in patients with non-small cell lung cancer; to complement CT imaging to better dissociate tumor residue or recurrence from post-therapeutic sequelae in non-small cell lung cancer. Finally, we present different expected progress for the future.
Continuing advances in PET imaging have resulted in an improved ability to evaluate thoracic malignancies. Published reports demonstrate that PET provides accurate noninvasive detection of malignancy that is useful in the characterization of a pulmonary solitary nodule and in the mediastinal or extrathoracic staging of known lung cancer. Preliminary studies suggest that PET may also be able to assess the therapeutic response after surgery or radiation therapy.
In order to evaluate the usefulness of 18-fluorodeoxyglucose (FDG) positron emission tomography (PET) in the assessment of therapeutic effects, a study was performed before and after therapy in 126 patients with non-small cell lung cancer (NSCLC) codified stage I to stage IIIB. Treatment with an early curative result was given in 58 patients, whereas in 68 cases it was limited to palliation. During the treatment follow-up period (8-40 months), each patient was evaluated every 3 months by clinical examination and < or =6 months by imaging techniques (PET and computed tomography (CT)). A diagnosis of persistent or recurrent tumour was established by means of pathological analysis in 31 patients and by clinical evolution and subsequent imaging progression in 29 other patients. PET showed increased FDG uptake in all cases (n = 60) of persistent or recurrent tumour, whereas CT was nonspecific in 17 cases. Conversely, there were five false positive cases via PET imaging and three via CT. In detecting residual or recurrent NSCLC, PET had a sensitivity of 100% and specificity of 92%, whereas CT had a sensitivity and specificity of 71% and 95% respectively. In conclusion, 18-fluorodeoxyglucose positron emission tomography correctly identified response to therapy in 96% (121 of 126) of patients. Positron emission tomography appears to be more accurate (p = 0.05) than conventional imaging in distinguishing persistent or recurrent tumour from fibrotic scar in patients undergoing treatment for non-small cell lung cancer.
We report here the case of a 33-year-old woman admitted in hospital for eclampsia. An infectious course led to the diagnosis of tuberculosis breast abscess with laryngitis and tuberculous bilateral excavated bronchopneumonia. The isolated strain demonstrated resistance to the principals antituberculous agents. However outcome was favorable after cesarean and treatment adapted to sensitivity studies.
Coke-oven workers are exposed to dust and irritant gases. Therefore they are at risk of developing lung diseases including chronic bronchitis. Nonspecific bronchial hyperresponsiveness (BHR) has been advocated as a potential risk factor predisposing to the development of chronic bronchitis. In a previous study, we showed that prevalence of BHR was higher in retired coke-oven workers than in retired blast furnace workers. The present study was carried out to determine the prevalence of BHR in active steelworkers. Thus, 137 coke-oven workers and 150 blast furnace workers underwent clinical examination, a standardized questionnaire for the study of respiratory symptoms, pulmonary function testing and methacholine aerosol challenge. The study demonstrates a higher prevalence and degree of BHR [provocative concentration of methacholine causing a 20% fall in forced expiratory volume in one second (PC20) < or = 8 mg x mL(-1)] in coke-oven workers than in blast furnace workers (31.4 versus 6.7%; p<0.001). Moreover, the frequency of respiratory symptoms and basal bronchial obstruction were greater among coke-oven workers with BHR in nonresponders. The basal maximum expiratory flow from 25-75% of forced vital capacity and the respiratory symptoms were correlated with bronchial responsiveness. The lack of correlation observed between BHR and the intensity of smoking or years spent in coke-oven environment may be explained by the high proportion of smokers, the worker turnover in the steel plant, and the "healthy worker effect". In conclusion, the higher prevalence and degree of bronchial hyperresponsiveness in coke-oven workers suggests that coke-oven pollutants are more intense irritants than those that escape from blast furnaces.
In this study, we analysed the cellular component of induced sputum in healthy control subjects (n = 30), asthmatics (n = 44), patients suffering from COPD (n = 15), pulmonary tuberculosis (PTB) (n = 14) and healthy steel workers (HSW) (n = 14). Sputum was induced by inhalation of hypertonic saline (NaCl 5%) for 20 min. When compared to the healthy control group, all the disease groups as well as the one of healthy steelworkers exhibited significantly higher total sputum cell counts. Analysis of the differential cell counts showed that there was a significant increase in % eosinophils in asthmatics, in % neutrophils in COPD, asthmatics, tuberculosis and healthy steelworkers and in % lymphocytes in pulmonary tuberculosis. Our study illustrates the feasibility and the possible clinical application of induced sputum analysis in several pulmonary diseases and shows how this technique could be useful in assessing airway inflammatory processes in subjects exposed to industrial pollutants.
BACKGROUND: Positron emission tomography (PET) with 18-fluorodeoxyglucose (FDG) is an accurate method for differentiating benign from malignant disease. The use of FDG-PET for the aetiological diagnosis of pleural disease was investigated in 25 patients. METHODS: PET was performed on each subject before invasive procedures were used to determine the aetiological diagnosis. The PET data were analysed by visual interpretation of coronal, sagittal, and transverse slices. RESULTS: Sixteen patients were found to have malignant pleural disease and nine had benign disease. All patients with histologically confirmed malignant disease showed FDG uptake within the pleural thickening which was intense in 14 cases and moderate in two. PET imaging showed the absence of FDG uptake and correctly categorised seven non-malignant lesions. Two patients with infectious pleural diseases showed a localised and moderate FDG uptake. CONCLUSION: Our preliminary results suggest that FDG-PET could be an effective tool for differentiating between benign and malignant pleural diseases.
We have compared the bronchoalveolar lavage fluid (BAL) cellular composition and the BAL cell lysate histamine content (fluorometric assay) in 28 stable mild to moderate asthmatics (atopic n = 18 and intrinsic n = 10) and 11 control subjects. When compared to control subjects, the whole group of asthmatics had a higher proportion of BAL eosinophils (p < 0.01) and metachromatic cells (p < 0.05). The BAL cell lysate histamine was increased in atopic (p < 0.05) and intrinsic asthmatics (p < 0.05) in comparison with control subjects. In the whole group of asthmatics, the BAL cell lysate histamine content correlated with the percentage of BAL eosinophils (r = 0.58, p < 0.01). This relationship was significant in both atopic (r = 0.48, p < 0.05) and intrinsic (r = 0.70, p < 0.05) asthmatics. For the whole group of asthmatics, both the BAL cell lysate histamine and the percentage of BAL eosinophils inversely correlated with the percent predicted FEV1 (r = -0.42, p < 0.05; r = -0.51, p < 0.05). We conclude that an increased BAL cell lysate histamine content correlates with airway eosinophilic infiltration and lung function impairment in mild to moderate atopic and intrinsic asthmatics. This suggests that BAL mast cells play a key role in recruiting eosinophils in the airways of asthmatics irrespective of the presence of an atopic status.
Despite advances in morphological imaging, some patients with lung cancer are found to have nonresectable disease at surgery or die of recurrence within yr of surgery. We performed a prospective study in 109 patients to compare the accuracy of whole-body positron emission tomography (PET) using fluorine-18 deoxyglucose (18FDG) and conventional imaging (CI) methods for the staging of non-small cell lung cancer (NSCLC). When CI or PET study suggested metastatic disease, confirmation was obtained by biopsy or follow-up information. As compared to CI, 18FDG-PET correctly changed the N stage in 22 patients (33%) and the M stage in 15 patients (14%). For the detection of distant metastases, PET study showed five false-positive sites and no false-negative cases. Currently, the accuracy of PET in the detection of M stage is 96%. Our study shows that visual interpretation of whole-body fluorine-18 deoxyglucose-positron emission tomography images can improve the diagnostic accuracy in the staging of non-small cell lung cancer. Further experience is needed to establish if metabolic imaging would be a cost-effective tool in the future management of lung cancer.