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Biomedical subjects

P Delaval

Publications and source records attributed to P Delaval.

At least 37 records · Page 2Linked to original sources

[Spontaneous resolution of a giant pulmonary bulla].

There are different causes leading to formation of pulmonary bullae, in particular tuberculosis. There is some debate concerning the pathophysiology of bullae extension although two mechanisms are put forward: partial obstruction of the airways and elastic recoil of adjacent lung parenchyma with a negative pressure in the bullae. Pulmonary function tests are highly perturbed in patients with giant bullae. The natural history of bullae is enlargement although spontaneous regression is rarely described. Bullae should be resected in selected patients, others require careful follow-up. We present the case of a man with tuberculosis who developed a giant pulmonary bulla that regressed spontaneously in a few years.

Adult↗

[Idiopathic diffuse lung diseases with alveolar infiltration].

Diffuse idiopathic pneumonia with alveolar filling gather disorders whose clinical and radiological aspects are varied. It is important to precisely identify them because of the prognostic and therapeutic implications suitable for each one of them. Among these, it is necessary to distinguish the eosinophilic pneumonias, wether acute or chronic, which are characterized by circulating and (or) alveolar hypereosinophilies; the diffuse alveolar haemorrhages whose potential severity requires an early recognition in order to institute a treatment without delay; the pulmonary alveolar phospholipoproteinosis can be easily evoked because of their particular radiological features, associated with a lactescent aspect of bronchoalveolar lavage. Lastly, bronchiolo-alveolar carcinoma and more exceptionally the pulmonary alveolar microlithiasis must be considered.

Acute Disease↗

Reduction of matrix metalloproteinase-9 activity by the selective phosphodiesterase 4 inhibitor, RP 73-401 in sensitized mice.

Matrix metalloproteinases are particularly potent in degrading basement membrane collagen and other extracellular matrix components. We have investigated the effects of a selective phosphodiesterase 4 inhibitor, RP 73-401 [N-(3, 5-dichloropyrid-4-yl)-3-cyclopentyloxy-4-methoxybenzamide], on gelatinase (matrix metalloproteinase-2 and matrix metalloproteinase-9) activity in ovalbumin-sensitized and -challenged mice. Twenty-four hours after the last challenge, matrix metalloproteinase activity was evaluated in the bronchoalveolar lavage fluids by a zymography technique, and a significant increase in matrix metalloproteinase-9, but not matrix metalloproteinase-2, activity was noted. When administered orally (0.3-3 mg/kg) 1 h before each ovalbumin challenge, the selective phosphodiesterase 4 inhibitor, RP 73-401, significantly reduced this increased matrix metalloproteinase-9 activity in bronchoalveolar lavage fluids. Our data suggest that RP 73-401 may modulate tissue remodelling associated with lung inflammatory processes including asthma.

3',5'-Cyclic-AMP Phosphodiesterases↗

[Vertebrate galectins: structure and function, role in tumoral process].

Galectins are proteins structurally related to the lectin family. They share, with lectins, the ability to bind carbohydrate residues. Galectins are suspected to mediate several biological functions such as embryonic development growth, immune response and apoptosis. Their role is similar to that of adhesion molecules in cell to cell or to matrix interactions. Their contribution to human carcinogenesis has been suggested from experimental studies. In clinical research, they could be used as a differentiation marker, particularly in thyroid carcinomas and in certain lymphomas.

Animals↗

Standard combination versus alternating chemotherapy in small cell lung cancer: a randomised clinical trial including 394 patients. 'Petites Cellules' Group.

PURPOSE: to compare standard and alternating administration of chemotherapy combinations in small cell lung cancer (SCLC) patients. MATERIAL AND METHODS: in a multicenter clinical trial, 394 previously untreated SCLC patients were randomised to receive, every 4 weeks, eight courses of either a standard regimen with CCNU, cyclophosphamide, adriamycin (CCA) and VP16 or an alternating regimen (CCA regimen alternating with cisplatin-vindesine-VP16). RESULTS: overall response rate was higher in the standard group (78%) than in the alternating group (64%) (P = 0.0001). Complete response rate was also higher in the standard group (32%) than in the alternating group (18%) (P = 0.004). The median survival in the overall SCLC population was 306 days in the standard group and 272 days in the alternating group (P = 0.08). In limited SCLC patients, median survival was higher in the standard group (421 days) than in the alternating group (328 days) (P = 0.01). Grade III/IV haematological toxicity was lower in patients in the alternating group (25 versus 47%) (P < 0.001). CONCLUSION: the standard regimen was better than the alternating regimen for patients with limited forms of SCLC. The alternating regimen, associated with better haematological safety and ensuring a fairly similar survival, may be considered in patients with extensive SCLC. Pleiomorphic resistance mechanisms to chemotherapy make it difficult to define a non-cross-resistant chemotherapy regimen.

Adult↗

Tracheobronchial stenting in patients with esophageal cancer involving the central airways.

BACKGROUND AND STUDY AIMS: Locoregional progression of esophageal cancer can result in respiratory distress aving to tracheoesophageal (T-E) fistula or central airways stenosis. We report our experience of airway stenting in 51 patients with esophageal carcinoma involving the central airways. PATIENTS AND METHODS: All data were recorded retrospectively. Fifty-one patients (44 men and seven women), with a mean age of 58.6 years, were analyzed. All had an esophageal squamous cell carcinoma. Severe respiratory impairment due to tumor invasion or to a tracheobronchial fistula (n= 14) was present in all patients. Nine of the 14 patients with fistula had dysphagia. Among the 37 patients without fistula, 19 had dysphagia. RESULTS: Sixty-six tracheobronchial stents were inserted in 51 patients: 65 Dumon stents and one Wallstent. Forty stents were implanted in the trachea, 16 in the left main bronchus and 10 in the right main bronchus. In 47 patients there was a significant improvement of respiratory symptoms. Esophageal intubation, carried out in nine patients, allowed eating and drinking in all cases. Mean survival was 107.7 days, with the longest follow-up 587 days. There was no difference between mean survival in the patients with fistulae (103.3+/-days) and the others (109.3+/-days). In two cases stent placement was responsible for death (massive hemoptysis and pneumonia). The main complications were migration (n=6), granuloma (n=2), pneumonia (n=2) and pneumothorax (n = 2). In 13 patients tumor progression in the airways was noted from one to 11 months after stenting, inducing a relapse of dyspnea. CONCLUSIONS: Complications are easily detected by the appearance of respiratory symptoms and do not necessitate systematic flexible bronchoscopy, but only preventive measures such as regular aerosol therapy, adapted respiratory physiotherapy and regular clinical follow-up.

Adult↗

[Fire-eater's lung: report of six cases].

Lung damage due to inhalation of inflammable products, especially Kerdane, is mainly observed in young subjects. Lung damage is rarely severe and the diagnosis is facilitated by the notion of inhalation. These conditions regress favorably in a few days. We report six cases.

Acute Disease↗

[Mature teratoma of the mediastinum: apropos of 2 cases].

Mature teratoma is the most frequent primary germ-cell tumor occurring in the mediastinum. These tumors present characteristic mature cells derived from all three types of embryogenesis tissues. We report two cases. The typical presentation is a cyst-like noninvasive, heterogeneous and calcified formation in the anterior mediastinum, usually in young subjects. Tumor markers, alpha-fetoprotein and beta-gonadotropin, are contributive as they rule out mature tumors if positive. Surgery is the treatment of choice, although adherence to neighboring structures usually makes complete excision difficult. Pathology provides the precise diagnosis, ruling out an immature component.

Adult↗

[Adult bronchiectasis revealing familial ciliary anomaly].

We report a case of bronchiectasis in a 26-year-old man associated with the following congenital abnormalities: deafness, purulent bronchorrhea, nasal polyps, dysmorphic physical pattern and chronic sinusitis. Situs inversus was absent. A sampling was performed on the posterior nasal mucous membrane and displayed structural ciliary abnormality: a deficiency of the intern dynein-arm. The patient's bother was affected and had similar features: congenital bronchiectasis, deafness, mental deficiency and sinusitis. Young's syndrome was relevant in this case. Hereditary ciliary dyskinesia should be considered in adults with bronchiectasis together with rhinologic and alimentary canal disorders. Nasal biopsies are safe and allow cilia examination.

Adult↗

Alveolar haemorrhage revealing epithelioid haemangioendothelioma.

Epithelioid haemangioendothelioma of the pulmonary vessels is a rare neoplasm which usually has a minimal clinical expression. The present case report describes an exceptional case with severe inaugural alveolar haemorrhage which led to death by acute respiratory failure within a few weeks.

Aged↗

[Bronchial dilatation and rheumatoid arthritis: a little known association].

Since Ellmann's description in 1948 numerous authors have studied the respiratory manifestations associated with rheumatoid arthritis. Amongst the numerous disorders described, dilatation of the bronchi, although one of the most frequent, remains largely under-estimated. The authors report a series of 21 patients presenting jointly with both rheumatoid arthritis and bronchiectasis which was documented using thoracic computed scanning. All the subjects were female. For 20 of these patients, the appearance of bronchial suppuration preceded that of the articular manifestations by several years. Bronchial dilatation in these cases can, only with difficulty, be considered as a complication of arthritis as has been previously suggested. Rather it appears as a possible pre-disposing factor in the occurrence of the rheumatoid disease. These hypotheses explain the pathophysiological mechanisms implicated in this association are discussed.

Adult↗

[A rare biphasic pulmonary tumor, carcinosarcoma. A separate entity or differentiation variant of spindle-cell carcinoma?].

We report a case of pulmonary carcinosarcoma. Surgery is required for this rare mixed type, biphasic tumor. It is generally considered to be a malignant formation issuing from a single cell line but with a two-way differentiation into epithelial and conjunctive components. There is a differentiation continuum between spindle-cell carcinomas (also called monophasic sarcomatoid carcinoma) and carcinosarcoma (or biphasic sarcomatoid carcinoma) leading to debate concerning the immunohistochemical and ultrastructural features.

Carcinosarcoma↗

Treatment of human lung carcinoma xenografts with a combination of 131I-labelled monoclonal antibody Po66 and doxorubicin.

Po66, a mouse monoclonal antibody, is directed against an intracytoplasmic antigen present in human lung squamous cell carcinoma cells. In previous work it was found that the co-administration of 125I-radiolabelled Po66 and doxorubicin strongly enhanced the uptake of radioactivity by the tumour. The present-work was designed to evaluate, in a tumour-bearing mouse model of lung carcinoma, the ability of 131I-labelled Po66 to retard tumour growth when injected alone, or in combination with doxorubicin (8 mg kg-1 at 1-week intervals). A single dose of 550 microCi 131I-Po66 alone had no effect on tumour growth, whereas three fractionated doses of 250 microCi 131I-Po66 decreased it over two doubling times from 14.5 +/- 1.5 days for untreated control mice to 24.8 +/- 2.7 days. Mice treated with doxorubicin alone had a double tumour doubling time of 22.6 +/- 4.9 days, compared to 35.2 +/- 2.9 days (1.55-fold increase) in mice treated with doxorubicin and a single dose of 550 microCi 131I-Po66. Doxorubicin combined with three fractionated doses of 250 microCi 131I-Po66 provoked a twofold decrease in tumour growth compared to mice treated with doxorubicin alone. The administration of fractionated doses of 131I-Po66 simultaneously with doxorubicin resulted in a highly delayed mortality, which was not observed when 131I-Po66 was administered after doxorubicin. Thus, in a non-small-cell lung tumour model, a 131I-radiolabelled monoclonal antibody, directed against an intracellular antigen, significantly potentiated the effect of chemotherapy. Such a therapeutic approach could be used as an adjuvant therapy and improve the effect of chemotherapy on distant small metastases.

Animals↗

Necrotizing sarcoid granulomatosis with and without extrapulmonary involvement.

Three cases of necrotizing sarcoid granulomatosis (NSG) are reported. All 3 patients had pulmonary lesions; one of them had additional extrapulmonary lesions which were ophthalmologic (dacryoadenitis) and digestive (ulcerative colitis). This patient was followed for 5 years and developed several respiratory, ophthalmologic and digestive recurrences. In 2 cases the diagnosis of NSG had been initially overlooked and the authors emphasize the difficulties of this histologic diagnosis in terms of the differential diagnosis with other necrotic and granulomatous pulmonary diseases such as tuberculosis and Wegener's granulomatosis. They stress the possibility of extrapulmonary lesions in NSG and discuss the relationship between NSG and sarcoidosis.

Adult↗