[The lung facing infection].
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Biomedical subjects
Publications and source records attributed to R Pariente.
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Our aim was to study the effects of a chronic exposure to SO2 on the permeability of bronchial epithelium in the rat, in vivo and in vitro, in relation with a marker (ferritin). The anatomical lesions observed in light and electron microscopy considerably increased the passage of ferritin both in vivo and in vitro through the epithelium of trachea and primary bronchi. This increase was still found although more discrete three months after the end of exposure while the histological appearance returned to normal. Those results showed that SO2 induces in upper airways functional abnormalities persisting beyond the necessary lapse of time for the repairing of histological lesions which could therefore intervene in the pathogeny of chronic bronchopathies.
We have compared changes in maximal flows induced by breathing gases of different density in 54 patients suffering from emphysema and chronic bronchitis. We considered as positive responders those subjects displaying an increase by at least 20% of maximal expiratory flows while breathing gases of lower density. Such a response was demonstrated in 21 cases, the remainder (33 cases) being non-responders. Hence, in such patients, airways obstruction may primarily be localised in central or peripheral airways. There was no correlation between the nature of this response and the clinical diagnosis, but non-responders, in general, were those in whom respiratory insufficiency was more severe. There seemed to be no additional information gained by measuring isoflow-volume (iso V vol.) in comparison with measuring differences in maximal flows at 50% of vital capacity.
Extracorporeal circulation with membrane oxygenator (E.C.M.O.) was performed in 6 dogs and 5 baboons during 4 to 57 hours. Examination of pulmonary samples showed progressive lesions in the two species: at the second hour of E.C., alteration of capillary endothelium, at the sixth, extensive lesions of all the lung structures, worsening later on. We discussed whether these lesions are related to the E.C.M.O., their reversibility and the questionable benefit of E.C.M.O. for management of respiratory distress syndrome.
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Pi phenotypes have been studied in a group of 433 patients. Patients with panacinar emphysema and/or bullae were identified from careful analysis of their clinical, physiological, radiological and anatomical characteristics. Twenty-five p.cent of the emphysematous patients were MZ; there was no significant difference in the alpha-1-antitrypsin plasmatic levels between the groups. The HLA antigens were studied in order to try to identify the possible cofactors in the development of emphysema. The role of occupational pollutants and/or of tobacco is discussed. The frequency of the MZ phenotype in our series differs from previous publications. This discrepancy is discussed on the basis of the criterious used to identify the emphysematous patients.
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Using morphologic and ultrastructural criteria, the present study in the rat was undertaken to distinguish lymphoepithelial modules from lymphoid aggregates and lymph modes, and to demonstrate the uptake and transport of ferritin and latex particles, instilled in the trachea, by the lymphoepithelium. Unlike lymph nodes or lymphoid aggregates, lymphoepithelial nodules can be distinguished by the following characteristics of the lymphoepithelium: it is flattened and devoid of goblet cells; it contains intracellular and "intercellular" vacuoles; occasional macrophage-like cells infiltrates and surrounding lymphocytes clusters can be observed. At any time, no latex particle was found inside or under the lymphoepithelium, but until 1 hour after local instillation, ferritin particles were localized close to the cilia, at the luminal surface of the epithelium, within vesicles at the surface of some cells, and in the intercellular space. Moreover, ferritin particles were consistently present on both sides of the basement membrane after 1 hour. These results suggest that lymphoepithelial nodules may be considered as original structures capable of uptake and transport across the basement membrane of certain foreign materials.
Three type of structures can be distinguished among the bronchial lymphoid tissue: lymph nodes, lymphoids cells aggregates and lymphoepithelial nodules. Such structures are encountered in many species and may be characterized by flattened epithelium, devoid of mucus producing cells, infiltrated with lymphocytes and containing of few ciliated cells. The lymphoepithelium surrounds the nodules, characterized by a high cellular density. Original structures may be observed, mainly inter and intracellular vacuoles. Peripheral lymphatic vessels and high endothelium veins contribute to the important lymphocyte transfer. Electron microscope, studies support the view that lymphoepithelium has an uptake function of particulate matter; more direct evidence is however attempted. An hypothesis of capacity for antigenic recognition of the lymphoepithelium nodules is discussed.
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In a previous publication the ultrastructure of pleural effusions in cases of pleural mesothelioma was reported. The same method has now been applied to a study of effusions produced by pleural metastases. The findings are considered sufficiently conclusive to justify the use of electron microscopic cytology in determining the nature and sometimes the origin of such effusions.
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Among the bronchial lymphoid tissue, lympho-epithelial nodules are an original component, easily distinguished from other structures, particularly from lymphoid cell infiltrates. Such structures are encountered in many species and may be characterized by a flattened epithelium, containing a few ciliated cells, devoid of mucus producing cells, and infiltrated with lymphocytes. Inter and intracellular vacuoles are described in the lympho-epithelium and the underlying mucosa. Electron microscope studies support the view that lymphoepithelium has a "trapping" function of particulate matter, more direct evidence is however attempted. Peripheral lymphatic vessels and high endothelium veins contribute to the important lymphocyte transfer. An hypothesis of capacity for antigenic recognition of the lymphoepithelial nodule is discussed.
The results of a study of 90 patients are presented. Intrapulmonary mineral deposits were characterized by electron diffraction and electron probe microanalysis. Using this method, pneumoconioses may be distinguidhed from other pneumopathies. In cases of pneumoconiosis, there exists a specific relationship between the etiology of the dust exposure and the crystallographic characteristics of the intrapulmonary deposits. The nature of the deposits may be indicative of a specific type of pneumoconiosis. This method is particularly useful in differentiating between asbestos bodies and ferruginous bodies. The value of the method in general and its importance in the study of pneumoconiosis are discussed.
The authors made a preliminary study of the damage caused by membrane oxygenators. They suggest nevertheless before a completely definative interpretation to increase the number of observations and above all to check the autopsy findings by an experimental study.