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J Rochemaure

Publications and source records attributed to J Rochemaure.

At least 19 recordsLinked to original sources
PubMed1992

[Bronchopulmonary cancer and peripheral neuropathy: diagnostic difficulties. Apropos of a case].

The well-known neurotoxicity of cisplatin may be difficult to diagnose when the neuropathy it produces becomes worse during the weeks or months following the discontinuation of treatment or, exceptionally, appears at the time when cisplatin therapy is withdrawn. In addition, the drug-induced peripheral neuropathy must be distinguished from a paraneoplastic syndrome and in particular from epidural or radicular tumoral invasion. These different diagnoses are discussed in the light of the case reported here.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

[Monitoring of small cell bronchopulmonary cancer by bronchial biopsies].

This retrospective study of 149 patients with small cell lung cancer highlights the value of bronchial endoscopies combined with biopsies for the follow-up of these cases. A control endoscopy performed during the third month showed that macroscopic lesions had completely disappeared in 42 percent of the patients. Each subsequent endoscopy offered a probability rising from 20 to 50 percent of diagnosing a recurrence in the patients explored. Our study particularly demonstrates the usefulness of bronchial biopsy at the initial site of the lesion, even when the bronchial mucosa seems to have returned to normal, since this biopsy is positive in 4.5 percent of the cases.

Adult↗
PubMed1991

Continuous infusion of high-dose metoclopramide: comparison of pharmacokinetically adjusted and standard doses for the control of cisplatin-induced acute emesis.

Metoclopramide was administered by continuous infusion to two groups each of 14 patients on chemotherapy, randomized to receive either doses adjusted to individual pharmacokinetic parameters or doses adjusted as usual to body weight. The mean plasma concentration at the end of the infusion in the adjusted group was 1.01 mg.l-1, close to that aimed for (1.20 mg.l-1). It was significantly different from that in the other group. v 0.54 mg.l-1. Antiemetic efficacy, defined as less than or equal to 2 emetic events in the 24 h following cisplatin, was similar in both groups (being found in 12/14 (86%) and 10/14 patients (71%), respectively). Analysis of the cumulative percentage of responders according to plasma concentration showed a clear plasma concentration-effect relationship. Routine MCP pharmacokinetic dosage adjustment is not indicated, but this therapeutic approach can be used to optimize antiemetic therapy in poor responder patients.

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1991

Computed tomography and magnetic resonance findings in lipoid pneumonia.

A case of exogenous lipoid pneumonia was documented by computed tomography and magnetic resonance imaging. Although strongly suggesting the presence of fat on T1 weighted images, magnetic resonance does not produce images specific for this condition. Computed tomography is the best imaging modality for its diagnosis.

Aged↗
PubMed1991

[Wegener's granulomatosis. Therapeutic indications and follow-up course. Apropos of 5 cases].

Five cases of Wegener's granulomatosis treated with cyclophosphamide (CPM) and prednisolone are reported. Four of these patients received intermittent intravenous boluses of cyclophosphamide with the aim of improving the prognosis and renal function and at the same time to attenuate any haematological or vesical toxicity of CPM. The initial response to treatment by boluses of CPM was favourable in all cases but three patients presented with relapses, which were sometimes repeated and boluses of CPM did not enable a remission to be maintained at the time. Recourse to continuous oral therapy in place of bolus therapy proved viable for the maintenance of remission in two cases. The bladder and haematological tolerance to the bolus was satisfactory but an episode of severe neutropenia led to an adaptation of the dose of CPM. The intermittent administration above all the low cumulative dose of CPM obtained with the boluses will explain the better vesical and haematological tolerance observed depending on the capacity to maintain a prolonged remission. The indications for boluses of CPM in the treatment of Wegener's granulomatosis remain uncertain and do not seem to be totally without inconvenience.

Administration, Oral↗
PubMed1991

[Icterohemorrhagic leptospirosis with acute respiratory distress syndrome and pulmonary hemorrhage].

We report a case of the respiratory distress syndrome occurring in a patient with leptospirosis ictero-haemorrhagica (LIH). The respiratory failure was associated with pulmonary haemorrhage. There was a rapid favourable outcome after treatment with antibiotics and artificial ventilation. The diagnosis of LIH has been confirmed by serological examination. The mechanisms of the pulmonary disorder during the course of LIH were discussed.

Adult↗
PubMed1990

Seizures related to severe hypophosphataemia induced by mechanical ventilation.

A patient with chronic obstructive pulmonary disease and acute respiratory failure developed grand mal seizures in the hours following onset of mechanical ventilation. These seizures were associated with an acute increase in arterial pH and were related to the occurrence of acute severe hypophosphataemia associated with recovery from respiratory acidosis.

Aged↗
PubMed1990

[Respiratory function abnormalities and pneumonia in HIV-positive patients. A prospective study of 112 patients].

Pulmonary function studies are often limited to the alone measurement of transfer lung factor for CO (TLCO) in screening for pneumonia in patients with Human Immunodeficiency Virus (HIV) infection. We prospectively measured pulmonary function tests (PFT) in 112 HIV seropositive patients. The population consisted of two groups: on one hand, a group free of clinical and radiological abnormalities, on the other hand, one with respiratory symptoms and/or abnormal chest X-Ray, with or without overt pneumonitis. For this latter group, a fiberoptic bronchoscopy with bronchoalveolar lavage was routinely performed in addition to PFT. In case of pneumonitis, PFT showed a restrictive disease and a reduced TLCO. The specificity of this functional pattern was however weaker in the subgroup of drug abusers than in the non-drug addicts. This difference was above all linked to a low TLCO value in the subgroup of drug addicts without pulmonary complications. Multivariate statistical analysis, including discriminant analysis, maintained the same sensibility and improved specificity of PFT in diagnosis of pneumonia, especially if the analysis takes the existence of drug abuse into account. Moreover, initial PFT, performed before any lung disease, improved the sensibility of the screening. The results are discussed in relation to new tests proposed for the screening of pneumonitis in HIV positive patients. At the present time, PFT seems to be useful and enables one to understand natural functional evolution.

Adult↗
PubMed1990

[Pleural symphysis with tetracyclines for pneumothorax. The value of thoracic peridural analgesia].

The aim of this study was to assess the value of peridural thoracic analgesia (ATP) to prevent pain observed during pleural symphysis with tetracycline (STP) for pneumothorax (PNO). 12 patients (age 27 +/- 6 years) having a spontaneous PNO benefited from 13 SPT (1 gm, tetracycline diluted in 60 cc of normal saline) under cover of an APT (at the D5-D6 level) with Fentanyl (0.1 mg) and Bupivacaine 0.5% adrenalin (1 mg/kg). The protocol was used on three successive days. Repeated determinations of blood bupivacaine levels were performed in 9 patients on the first day. No patient had an intolerable pain which required injection of parenteral morphine and/or an interruption of the protocol. For two patients (one of them having a right symphysis and then a left symphysis one month later) the treatment sessions to achieve a symphysis were totally painless. 10 patients experienced moderate pain, mainly on the first day, which was relieved by reinjection of peridural bupivacaine (25 mg) (n = 9) or by the parenteral injection of non morphine analgesia (n = 1). No patient had a respiratory depression, collapse or bradycardia. The blood bupivacaine levels were always significantly less than the toxic levels (1.6 mg). The results observed suggest that APT, (Fentanyl and Bupivacaine) is an effective method, non toxic and well tolerated for the prevention of intolerable pain which is seen in SPT for PNO.

Adult↗
PubMed1990

[Fatal hemoptysis during bronchial aspergillosis with multiple pulmonary artery aneurysms].

Aspergillosis with fatal outcome are usually pulmonary invasive aspergillosis with or without dissemination, developed in patients with severe immunosuppression. We report a fatal case of bronchial necrotizing aspergillosis in a young woman with diabetes mellitus, who developed similar lesions to "Semi-invasive Aspergillosis", so-called "Chronic Necrotizing Pulmonary Aspergillosis". This aspergillosis was complicated by large pulmonary artery aneurysms requiring an hemostatic lobectomy. These aneurysms, secondary to the bronchial lesions, contrast with infectious aneurysms (so-called mycotic) secondary to septic embols. They differ from Rasmussen's aneurysms, due to tuberculosis, by their size, fusiform shape and extent. Lesions of vessels' walls and parietal fungal invasion in the vicinity of an endo-bronchial aspergilloma explain the vascular rupture. The multiplicity of these aneurysms, showed on C T Scan, is responsible for death by post-surgical recurrence of hemoptysis.

Adult↗
PubMed1989

Hypophosphatemia induced by mechanical ventilation in patients with chronic obstructive pulmonary disease.

The aim of this study was to assess prospectively the variations of serum phosphorus concentration (P) after onset of mechanical ventilation (MV) in patients with chronic obstructive pulmonary disease (COPD) and acute respiratory acidosis. In 14 COPD patients, we measured P, PaCO2, and pH, immediately before MV (H0), then one hour (H1), 4 (H4), 7 (H7), 12 (H12), and 24 h (H24) after starting MV. P at H0 was in or above the normal range in ten patients and below normal range in four patients. P decreased significantly (p less than .001) after MV at H1, H4, H7, H12, and H24. Hypophosphatemia was present in all patients after MV, but was severe (p less than .3 mmol/L) in only two patients. There was a significant correlation (r = .56 p less than .01) between the decrease of P and the increase of pH after MV. Hypophosphatemia was a constant and early finding after institution of MV in COPD patients and was presumably related to an intracellular shift of P secondary to the correction of respiratory acidosis.

Acidosis, Respiratory↗
PubMed1989

Transbronchial biopsy without fluoroscopy: a five year experience in outpatients.

Transbronchial biopsy is the technique of choice for obtaining tissue for histological diagnosis in many pulmonary disorders. The procedure has usually been carried out as an inpatient procedure with the use of fluoroscopy, though this policy has recently been questioned. This report concerns a five year experience of 174 transbronchial biopsies performed without fluoroscopy as an outpatient procedure in patients with interstitial lung disease or a suspicion of sarcoidosis. Chest radiography was carried out only if the patient developed symptoms. No major complications were encountered and the overall complication rate was low. Pneumothorax occurred in six patients (3.4%), only one of whom required intercostal intubation, and bleeding of more than 30 ml occurred in two patients. Histological diagnosis was obtained in 154 patients (88%). In the experience of this group transbronchial biopsy has been safe when carried out as an outpatient procedure without fluoroscopic guidance.

Ambulatory Care↗
PubMed1989

Detection of pulmonary hypertension by Doppler echocardiography of the inferior vena cava in chronic airflow obstruction.

Pulsed Doppler echocardiography of the inferior vena cava is an accurate method for the diagnosis of tricuspid regurgitation and impaired right ventricular compliance, two features of pulmonary hypertension. The purpose of this study was to assess the value of Doppler echocardiography of the inferior vena cava for the detection of pulmonary arterial hypertension in patients with chronic obstructive lung disease. Pulse Doppler echocardiography of the inferior vena cava and right heart catheterisation were performed in 29 patients with severe chronic obstructive lung disease. The mean pulmonary arterial pressure was 27 (10) mm Hg for the entire group; 62% of patients (18/29) had pulmonary arterial hypertension (mean pulmonary arterial pressure greater than 20 mm Hg). An adequate Doppler signal could be obtained in 25 of the 29 patients (86%). Pulsed Doppler echocardiography of the inferior vena cava gave normal results in 10 patients and disclosed tricuspid regurgitation in seven patients, impaired right ventricular compliance in seven patients, and both of these abnormalities in one patient. An abnormal Doppler echocardiogram of the inferior vena cava (tricuspid regurgitation or impaired right ventricular compliance, or both) predicted the presence of pulmonary arterial hypertension with a sensitivity of 87% and a specificity of 80%. These results suggest that pulsed Doppler echocardiography of the inferior vena cava may be a useful though imperfect method of detecting pulmonary arterial hypertension in patients with chronic obstructive lung disease.

Echocardiography, Doppler↗