Biomedical subjects
P Fraisse
Publications and source records attributed to P Fraisse.
Recurrent varicella pneumonia complicating an endogenous reactivation of chickenpox in an HIV-infected adult patient.
We report the case of an adult patient with acquired immune deficiency syndrome (AIDS) presenting with acute dyspnoea and cutaneous disseminated lesions suggestive of an atypical varicella. The chest radiograph and the computed tomography (CT)-scan revealed a miliary pneumonia. On a previous serum sample varicella-zoster (VZV)-specific serum immunoglobulin (Ig)G titre was 1/200. A high dose acyclovir treatment was effective, but recurrences occurred twice when the treatment was discontinued. During the first recurrence the polymerase chain reaction (PCR) detected the presence of VZV in the bronchoalveolar lavage (BAL) sample. These findings confirmed the diagnosis of secondary varicella with pulmonary involvement. Secondary varicella pneumonia has not been reported in a human immunodeficiency virus (HIV)-infected adult until now. The use of PCR on a BAL sample was very useful in this case because viral culture remained negative. Recurrences of the varicella pneumonia suggested that a maintenance treatment was required in this deeply immunocompromised patient.
[Acrosyndromes induced by bleomycin in HIV 1 related Kaposi's disease. 5 cases].
OBJECTIVES: Raynaud's syndromes may be observed in HIV-infected patients, particularly those with Kaposi disease treated with bleomycin. This complication occurs in 10% of patients given bleomycin although only 7 cases have been reported in the literature. The aim of this study was to determine the frequency of certain biological abnormalities observed in HIV patients with Kaposi disease given bleomycin and who develop Raynaud's syndromes. PATIENTS AND METHODS: A survey was conducted from 1989 to 1995 among 1074 patients infected with HIV-1. There were 121 patients with Kaposi disease and 73 of these were treated with bleomycin. The clinical features and laboratory results (cryoglobulinemia, free protein-S, protein-C, anticardiolipin antibodies, von Wille-brand factor (vWF.ag) endothelin-1) were obtained in 5 patients who developed biomycin-induced Raynaud's syndrome. RESULTS: Amont the 73 patients with Kaposi disease treated with bleomycin (total mean dose = 227 mg (120-380 mg)), 5 patients (12.6%) developed a severe Raynaud's synchrome including two who suffered digital necrosis Withdrawal of bleomycin led to improved symptomatology (n = 2) or an aggravation (n = 1) in the 3 patients followed. CONCLUSION: Raynaud's syndromes are frequent (12.6%) in HIV patients with Kaposi disease treated with bleomycin. The vascular toxicity of bleomycin, demonstrated in animals, would appear to be the causal factor among others. Release of endothelial factors (vWF.ag endothelin-1) and perturbed hemostasis related to the HIV infection (protein-S deficiency, anti-cardiolipin antibodies) could be an expression of and aggravate the vascular toxicity of bleomycin.
[Tsukamurella infections. Review of the literature apropos of a case].
The genus Tsukamurella belongs to the family Nocardiaceae, and is an environmental saprophyte. The type species is Tsukamurella paurometabola. Its microbiological identification and differentiation from the other species containing mycolic acids can be difficult. There has been a few cases of human infections reported, usually in patients with special conditions, such as chronic lung pathology, immuno-suppression (leukemia, solid tumors, maybe HIV-infection) or the long-term use of indwelling catheters. The treatment of choice, despite the lack of adequate guidelines, is an antibiotherapy combining a beta-lactam and an aminoglycoside; catheter removal appears to be essential for cure.
[Asymptomatic pulmonary pneumocytosis accidentally discovered in a patient with HIV infection].
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Successful sequential double lung transplantation and cardiac repair for aortopulmonary window: technical and functional advantages over heart-lung transplantation.
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Early alternating chemotherapy and radiotherapy schedule in limited disease stage small cell lung cancer.
44 patients with limited small cell lung cancer were treated with six cycles of chemotherapy (cisplatinum 60 mg/m2 day 1, doxorubicin 40 mg/m2 day 1, etoposide 100 mg/m2 days 1-3) alternating with three courses of mediastinal irradiation, the first one starting 7 days after the first day of chemotherapy. A total dose of 55 Gy was delivered. Prophylactic cranial irradiation (30 Gy after the third cycle of chemotherapy) was left to the physician's discretion. 4 patients had radical surgery before combined modality treatment. 29 patients finished the scheduled program. The complete response rate (bronchoscopically confirmed) was 25.6% after two cycles of chemotherapy and 41% at the end of treatment. Median survival time was 17.2 months, with an estimated survival of 32% at 2 years. Main toxicity was haematological with one early toxic death and six premature interruptions of treatment. We conclude that this treatment modality is feasible and efficacious. Prospective studies comparing chemotherapy with alternating or concurrent early radiotherapy schedules in limited disease small cell lung cancer are needed to determine the best treatment modality.
Tsukamurella and HIV infection.
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[Efficacy of thalidomide in the treatment of esophageal ulcers in human immunodeficiency virus infection].
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[Contribution of an induction treatment in the surgical treatment of locally advanced non-small-cell cancers].
From October 1988 to July 1990, 18 patients with marginally resectable non-small cell cancer (10 stage IIIa and 8 stage IIIb) were entered in a phase-II trial combining induction therapy with a subsequent thoracotomy. Induction therapy included 2 courses of chemotherapy (5-FU and cisplatinum) and radiotherapy (30 Gray in split course). Partial response was observed in 10 patients, and minimal response in 3. Thoracotomy disclosed unresectability in 3 patients. Fifteen complete resections consisted in 1 lobectomy and 14 pneumonectomies. There were no operative deaths (30 days). Postoperative recovery was uneventful in 3 patients with exploratory thoracotomy and in 1 patient with lobectomy. Following pneumonectomy, we observed 2 bronchopleural fistulae and 1 empyema. On pathology, 10 patients were stage IIIa, and 3 were stage I, whereas no residual tumor was found in 2 patients. During follow-up, local recurrence occurred in 2, and metastases in 8. On December 31st, 1993, 3 patients were alive at 44, 52, and 62 months respectively. Nine patients had died from cancer, and 3 from unrelated causes. Estimated survival was 66.7% at 1 year, 33.3% at 3 years, and 20% at 5 years. We conclude that induction therapy allowed satisfactory resection for marginally resectable tumors. Operative morbidity was increased in this group. However, the 5-year survival was similar to resectable stage IIIa cancer.
[High incidence of bullous pulmonary lesions before pentamidine isethionate aerosols. 35 cases].
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Medical treatment of pulmonary hypertension in chronic lung disease.
In chronic respiratory diseases, especially chronic obstructive pulmonary disease (COPD) pulmonary arterial hypertension is generally mild to moderate and the necessity for treating it can, therefore, be questioned. In fact, pulmonary hypertension, even when modest, may worsen markedly during acute episodes, exercise and sleep. These acute increases in mean pulmonary artery pressure (PAP) could contribute to the development of right heart failure. Therefore, the medical treatment of pulmonary hypertension is justified. There are, at the present time, no selective pulmonary vasodilators, with the exception of inhaled nitric oxide. Indeed, vasodilators appear less effective in COPD compared to primary pulmonary hypertension. Thus, there is, at present, no justification for the long-term use of vasodilators in COPD patients. Long-term oxygen therapy (LTOT) attenuates and sometimes reverses the progression of pulmonary hypertension, although the condition rarely returns to normal. We do not know whether the structural changes of the pulmonary vasculature in COPD patients are potentially reversible with LTOT. The longer the daily duration of LTOT the better are the haemodynamic results. At present, LTOT remains the best treatment for pulmonary hypertension in COPD patient. In the future, treatment of this condition in COPD patients could combine LTOT and specific vasodilators.
A life-threatening tracheal localization of lymphoma in a patient with AIDS.
Lymphoma is a frequent complication of HIV infection, but we report a rare localization in the subglottic tracheal area. A case of tracheal stenosis due to lymphoma in an HIV-infected patient is presented. The main complaint was severe dyspnea. Chemotherapy was ineffective but radiotherapy improved the patient's condition and increased the caliber of the tracheal lumen.
[Rhodococcus equi infection causing pulmonary malacoplakia in a patient with acquired immune deficiency syndrome].
Rhodococcus equi is a pathogen for some animal species. It can cause opportunistic pulmonary infections in immunocompromised people. The authors describe such an infection that causes malacoplakia in a patient with acquired immunodeficiency syndrome. The likeness between lesions due to Rhodococcus equi and those due to other opportunistic germs as Mycobacterium avium-intracellulare is emphasized.
Magnetic resonance imaging in the diagnosis of pulmonary infarction.
We report for the first time, to our knowledge, MRI features which could differentiate noninvasively pulmonary infarction from pneumonia. Three subjects with angiographically proven pulmonary infarction showed high T1 weighted MRI signals located in the embolic territory. Three patients with pneumonia and one patient with emboli, but without infarction, did not have these T1 weighted images.
[Prevention of pneumocystosis with pentamidine aerosols].
In patients with human immunodeficiency virus infection primary or secondary prevention of pulmonary pneumocystosis sometimes fails, resulting in atypical or extrarespiratory pneumocystosis. From the series found in the literature and from our own experience, it appears that such failures depend on the way aerosols are administered: they are usually due to low dosage, intervals of more than 2 weeks between aerosols, excessive particle size or poor patient's compliance. We suggest that pentamidine mesylate or isethionate should be administered forthnightly in doses of 4 mg/kg bodyweight, using an inhaler capable of delivering particles of less than 2 micrometers in diameter.
Long-term secondary prophylaxis of Pneumocystis carinii pneumonia by inhaled pentamidine in AIDS.
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