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Biomedical subjects

P Delaval

Publications and source records attributed to P Delaval.

At least 55 records · Page 3Linked to original sources
PubMed1996

Long-term nasal intermittent positive pressure ventilation (NIPPV) in sixteen consecutive patients with bronchiectasis: a retrospective study.

Life expectancy and quality of life are poor in patients with chronic respiratory failure due to bronchiectasis. The indication for nocturnal nasal intermittent positive pressure ventilation (NIPPV) remains controversial in chronic obstructive lung disease. The purpose of the present study was to determine whether some of the objectives of home mechanical ventilation, i.e. improvement in blood gas values and reduced length of hospitalization, were fulfilled by NIPPV and oxygen plus medical treatment in patients with chronic respiratory failure due to bronchiectasis. Sixteen consecutive patients (12 females and four males; mean age 57 +/- 11 yrs) with chronic respiratory failure due to bronchiectasis, treated at home with nocturnal NIPPV in addition to oxygen therapy, were retrospectively studied in terms of blood gas values and duration of hospitalization before and after NIPPV. Details of the therapy received by each patient were recorded. Nine patients agreed to complete a questionnaire to determine their perception of the benefits of the treatment. NIPPV was performed using a volumetric respirator and was applied with a customized nasal mask modelled with silicone paste. NIPPV was used for a mean of 26 months (range 0.5-60 months). Eleven patients were alive 12 months after use of NIPPV. No significant improvement in blood gas values was noted on room air during NIPPV, but arterial carbon dioxide tension (Pa,CO2) stabilized after the period of worsening observed before initiation of NIPPV. Duration of hospitalization, the year before and the year after NIPPV, was 19 (3-40) and 16 (8-37) days, respectively (NS). For the 11 patients who were alive 2 yrs after the start of NIPPV, duration of hospitalization the year before NIPPV and between 12 and 24 months after NIPPV were 17 (4-40) and 7 (2-27) days, respectively (p < 0.05). Nine patients who had received NIPPV for at least 12 months at the time of the study reported an improvement in their quality of life. The results suggest that home ventilatory support by nasal intermittent positive pressure ventilation offers an acceptable alternative to tracheotomy, with less discomfort, in the management of severe respiratory failure due to bronchiectasis, in order to allow the patient to return home. These results should be confirmed by controlled studies.

Adult↗
PubMed1996

[Pulmonary metastases with a prolonged development. Two cases of thyroid cancers].

The authors report two cases of differentiated carcinoma of the thyroid with pulmonary involvement showing as miliary shadowing radiologically which preceded the diagnosis of the thyroid neoplasm by 35 and 6 years respectively. The two patients had undergone cervical radiotherapy in infancy for lymphadenopathy whose aetiology had not been determined. The scintigraph with iodine 131 showed tht in two cases there was a bilateral and diffuse pulmonary uptake in keeping with pulmonary lesion of metastatic origin. Our observations recall the possibility of a slow evolution of pulmonary metastases and carcinoma of the thyroid and the role of cervical irradiation in the development of such cancers. With miliary shadowing a metastatic origin, in particular that of the thyroid, should be considered and in the majority of cases the proof could be supported using iodine 131 scintigraphy. The delay in appearance of pulmonary metastases during the course of cancer of the thyroid is variable. They occur most often after the initial diagnosis or more rarely preceding the discovery of a primary thyroid cancer. The pulmonary metastases may be asymptomatic. This neoplasm may benefit from a specific effective therapy and prolonged remissions have been described even with metastases.

Adult↗
PubMed1996

[Pleural amyloidosis. Apropos of a case and review of the literature].

The main respiratory manifestations of amylosis are tracheobronchial involvement and modular or diffuse parenchymal disease. Amyloid deposits in the pleura are exceptional. We observed transsudative pleural effusion and heart failure in a patient with multiple myeloma, leading to the discovery of pleural amylosis. Amyloid deposits in the pleura may be fortuitous discoveries since pleural effusion is not necessarily observed. It is however important to be aware of this possibility since the localization is easily accessible for diagnosis. Specific stains are effective diagnostic tools even for transsudative effusions, particularly in suggestive clinical conditions such as multiple myeloma.

Aged↗
PubMed1996

Exogenous lipoid pneumonia complicated by Mycobacterium fortuitum and Aspergillus fumigatus infections.

We report the case of a nonimmunocompromised female patient, who developed exogenous lipoid pneumonia with Mycobacterium fortuitum infection at diagnosis, later followed by Aspergillus fumigatus infection. The association of exogenous lipoid pneumonia with atypical mycobacterial infection is uncommon but well-recognized, but, to our knowledge, association with A. fumigatus infection has not previously been reported.

Aspergillosis↗
PubMed1995

Biodistribution of monoclonal antibody Po66 in a human lung tumour-bearing mouse model: effect of blood exchange on tumour antibody uptake.

We report a method designed to improve the specificity of tumour uptake after intravenous injection of an anti-tumour monoclonal antibody (MAb). It consists in increasing the blood clearance of the MAb injected in order to diminish its tissue activity, without altering tumour binding. Po66, an MAb directed against lung squamous cell carcinoma, was radiolabelled with 125I and injected i.v. into tumour-bearing nude mice. Radioactivity uptake by the tumour reached a plateau on days 3-5 which persisted up to day 14 after antibody injection. The radiolabelled Po66 remaining in the circulation on day 5 after injection was removed by means of exsanguination and blood transfusion. This blood exchange technique depleted circulating radiolabelled MAb by 60%, whenever mice had been injected with Po66 or an unrelated control IgG1. The proportion of radiolabelled Po66 taken up by the tumour 5 days after blood exchange did not differ substantially from that of non-exsanguinated controls (96.1% of controls). In contrast, there was a significant decrease in blood radioactivity (46% of control values on day 5). Blood exchange provoked a 1.8 fold increase in the tumour/blood and a 1.5-1.8 fold increase of the tumour/organ radioactivity ratios. After injection of unrelated radiolabelled IgG1, blood exchange reduced by 50% both blood and tumour radioactivity, and did not increase the tumour/blood or tumour/organ ratios. Hence, removal of 60% of circulating Po66, 5 days after its injection, did not affect the binding or retention of the antibody by the tumour, but would probably constitute a marked improvement if the antibody is used for two-phase radioimmunotherapy.

Animals↗
PubMed1995

Monoclonal antibody Po66 uptake by human lung tumours implanted in nude mice: effect of co-administration with doxorubicin.

The efficacy of radioimmunotherapy of tumours with radiolabelled monoclonal antibodies (MAbs) depends on the amount of antibody taken up by the tumour and on its intratumoral distribution. In the case of MAbs directed against intracellular antigens, increasing the permeability of the cytoplasmic membrane may augment the bioavailability of the antigen for the antibody. This raises the question whether the induction of tumour necrosis by chemotherapy can enhance the tumour uptake of radiolabelled monoclonal antibodies. In this work, the effect of doxorubicin on the biodistribution of Po66, an MAb directed against an intracellular antigen, was studied in nude mice grafted with the human non-small-cell lung carcinoma cell line SK-MES-1. After injection on day 0 of 125I-labelled Po66, tumour radioactivity increased up to days 3-5, and then remained unchanged to day 14. The combined administration of 125I-labelled Po66 with 8 mg kg-1 doxorubicin, in two doses separated by 7 days, doubled the radioactivity retained by the tumour. Histological and historadiographic analysis showed, however, that the drug induced cellular damage. In the absence of doxorubicin, the accumulation of Po66 was restricted to some necrotic areas, whereas with doxorubicin the necrosis was more extensive and the antibody more evenly distributed. These results suggest that chemotherapy and immunoradiotherapy combined would enhance tumour uptake of radioisotope and promote more homogenous distribution of the radiolabelled MAb. This would promote eradication of the remaining drug-resistant cells in tumours.

Animals↗
PubMed1995

[Pleural fibroma. Contribution of immunohistochemistry].

The authors report a case of pleural fibroma discovered during an examination for thoracic pains in a 65 year old woman. Histochemical studies were positive with vimentin and negative with KL1 antibodies and compatible with the most recent hypotheses concerning the purely fibroblastic origin of these tumours.

Aged↗
PubMed1995

[Severe acute asthma].

Serious acute asthma is a reality. The authors detail the factors that cover the areas usually met, the signs that are portents of a worrying development, regrouped to the threshold of the entirety of the "menacing syndrome", finally the signs of severity or distress, as well as the recommended treatments.

Acute Disease↗
PubMed1995

[Pleural involvement of myeloma. Apropos of 2 cases].

The authors report two cases of myelomatosis localised to the pleura, one of which was associated with an adenocarcinoma. Pleural effusions are relatively rare during the course of multiple myeloma and most often occur with non-specific disorders of the disease. The myelomatous origin of a pleural effusion can only be made by analysis of the pleural fluid and should be recognised early enough to enable aggressive treatment to be instituted even if the prognosis associated with such a localisation is very poor.

Adenocarcinoma↗
PubMed1995

[Diffuse alveolar hemorrhage secondary to oral anticoagulant use].

We report a case of alveolar haemorrhage in all probability, attributable to the use of anti-vitamin K. The favourable outcome of this type of disease has rarely been reported with anticoagulants and fibrinolytics, most frequently in a disturbed haematological setting with disseminated intravascular coagulation or profound thrombocytopaenia. One should not forget this diagnosis in cases of acute respiratory failure in association with an alveolar syndrome in an exposed patient due to the fact that the outcome is generally favourable after correcting the disturbed coagulation.

Administration, Oral↗
PubMed1995

[Intrathoracic cavernous hemangioma. Apropos of a case].

A cavernous haemangioma of the mediastinum is a rare benign vascular tumour. Generally it is totally asymptomatic and the diagnosis is most often made in a child or young adult. The treatment is surgical. We report a case in a 60 year old man who was a smoker.

Hemangioma, Cavernous↗
PubMed1994

Severe diffuse interstitial pneumonitis induced by carmustine (BCNU).

We report a fatal case of acute interstitial pneumonitis in a patient treated with carmustine (BCNU) for a brain tumor. Bronchoalveolar lavage (BAL) revealed lymphocyte alveolitis with a low CD4/CD8 ratio (0.36), consistent with an immunoallergic phenomenon, rather than the most often evoked toxic hypothesis.

Acute Disease↗
PubMed1993

A comparative study of cefepime and ceftazidime in the treatment of community-acquired lower respiratory tract infections.

Antibiotic treatment for community-acquired pneumonia must target Gram-positive pathogens, especially frequently isolated organisms such as Streptococcus pneumoniae. The severity of community-acquired pneumonia is often related to underlying factors. Occasionally it may be complicated by staphylococcal or Gram-negative bacillary infection. We have compared the safety and efficacy of cefepime 1 g bd with ceftazidime 1 g tds as empirical treatment in adults with community-acquired lower respiratory tract infections (LRTIs). One hundred and thirty-one patients with moderate to severe LRTIs were randomized to two treatment groups: 87 received cefepime and 44 received ceftazidime. The treatment groups were comparable with regard to sex, age and treatment duration. Of the 116 pathogens isolated, 57 were Gram-positive (46 strains of S. pneumoniae) and 59 were Gram-negative (33 strains of Haemophilus influenzae). Of the 111 patients evaluated, clinical cure rates were 87% (65/75) in the cefepime group and 86% (31/36) in the ceftazidime group. Pathogen eradication rates were 95% (74/78 and 36/37, respectively) in both groups. Both drugs were well tolerated and the incidence of adverse events in each group was comparable. Cefepime 2 g per day (1 g bd) was as safe and effective as ceftazidime 3 g per day (1 g tds) in the treatment of community-acquired LRTIs.

Adult↗
PubMed1993

[Mediastino-pulmonary sarcoidosis].

Sarcoidosis is diffuse granulomatosis disease. The aetiology and pathogenesis are unknown. Many different localizations have been described together with immunological disturbances. Generally, the prognosis is favourable. Here we describe the pulmonary manifestations and their staging. Extra-pulmonary manifestations are then presented. Finally, the principle elements of the diagnosis and the treatment of sarcoidosis are discussed.

Adult↗
PubMed1993

[Desmoid tumor of the thoracic wall].

Desmoid tumor are rare connective tissue tumors currently considered as sarcoma of low grade malignancy. They are most often encountered in young women of child-bearing years. Abdominal localisation is the most frequent site. The main aim of treatment is to avoid recurrences. We report a case of desmoid tumor developing in the thoracic cage in a patient who had been operated on six years earlier for an epidermoid carcinoma of bronchus.

Adult↗