[Salvage treatment of multi-resistant pulmonary tuberculosis. Efficacy of pefloxacine].
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Biomedical subjects
Publications and source records attributed to L Jeannin.
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Sudden severe life threatening attack (SSA) may occasionally develop in some patients who have had until that event a mild asthma without detectable baseline airway obstruction. Airway responsiveness (AR) measurement could be a useful mean to characterize or identify them. No data exist regarding the baseline non specific AR of such patients. We studied 5 patients having had a SSA during their past few weeks. Methacholine (MCH) challenges were performed only when standard pulmonary function tests were close to normal (FEV1 greater than or equal to 80% pred.); the patients were off medication at the time of MCH challenges. 3 to 8 evaluations were performed over a time span of 4 to 24 months. The level of AR ranged from moderately increased (PC20 = 24 mg/ml). Mean PC20 was 7,8 mg/ml. This level of AR did not differ significantly from that found in a population of 67 mild asthmatics who also were evaluated in the absence of baseline bronchial obstruction and were off medication (PC20 = 5,5mg/ml). In any individual asthmatic having sustained SSA, AR was strikingly stable. However in two patients we detected a marked decrease in PC20 which was followed within 2 weeks by a SSA. We conclude that: 1. Asthmatics who have had SSA do not demonstrate particularly AR, which is not related to the severity of their asthma. 2. Baseline AR is usually stable. 3. The measurement of AR in these patients is not very useful, specially for substantiating medication needs. 4. A marked increase in AR can be observed before SSA.
Busulfan or Misulban is considered by many the treatment of choice in chronic myeloid leukemia, for which it is used as a single agent. An interstitial fibrosing lung disease occurring after Busulfan was first described in 1961 and to date 56 cases have been published and are the object of this review. The clinical picture of this drug induced disease is well characterised. The disorder has an estimated incidence of 6% and begins gradually, marked by non-specific signs (dyspnoea, cough) and by an alteration in the clinical state, often severe, and is frequently accompanied by skin pigmentation. As a rule it occurs after prolonged treatment (on average 41 months, cumulative dose 2.900 mg). The respiratory function pattern is that of an interstitial fibrosis characterised by reduced volumes and hypoxaemia and hypocapnic respiratory failure. The radiology reveals interstitial and predominantly basal shadows. The histology is often obtained, either by lung biopsy or frequently at necropsy, because the prognosis is poor with an 84% mortality from respiratory failure. As for numerous interstitial pneumopathies, it poses questions as to the pathogenesis and early detection, problems which at present are imperfectly resolved.
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Among the numerous ways by which drug-lung relationships can be discussed we chose to examine three questions: Is the lung capable of directly modulating drug pharmacokinetics? Knowing that the pulmonary circulation can exert very selective and efficient clearance and catabolism of biogenic molecules such as serotonin (5-HT), norepinephrine (N.E.), prostaglandins PGE2 and PGF2 alpha, and bradykinin, as well as activation of angiotensin (A)I to AII, a similar behavior has been sought for drugs. Uptake of circulating drugs occurs clearance of biogenic amines, the significance of which remains to be fully evaluated, and iatrogenic phospholipidosis localization of which in the lung might result from the elevated drug concentration in the tissue. Lung cells contain enzymes, among them mixed function oxidases (MFO), which enables them to metabolize xenobiotics even in the intact organ. Although blood supply to the lung is higher than that to the liver, the comparatively low MFO content of the former organ predicts only a marginal pulmonary metabolic contribution in vivo. On the otherhand, enzymatic activity upon drugs can generate instable reactive metabolites which, even in minute amounts are toxic and can damage cells; furthermore, it is hypothesized that the relatively high bronchiolar Clara cell MFO content explains the striking susceptibility of the long to xenobiotics. Do lung diseases indirectly influence drug pharmacokinetics? Hindrance to blood flow is common in respiratory failure (R.F.), from both reduced area and hypoxic vasoconstriction, resulting in altered flow distribution to the liver and kidney.
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We report the first histologically described case of severe D-penicillamine-induced pneumonitis. It occurred in a 73-year-old woman who suffered from rheumatoid arthritis and had previously demonstrated gold intolerance. Pathologic study disclosed marked interstitial and alveolar damage resembling that described with certain chemotherapeutic agents. We assess the drug's responsibility, discuss possible pathogenetic pathways, and provide suggestions regarding the patient on a D-penicillamine schedule.
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