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Biomedical subjects

T Rochat

Publications and source records attributed to T Rochat.

At least 55 records · Page 3Linked to original sources
PubMed1997

Pulmonary fibrosis with predominant CD8 lymphocytic alveolitis and anti-Jo-1 antibodies.

Interstitial lung disease (ILD) is a complication of polymyositis (PM) and dermatomyositis (DM). It often manifests itself in association with myositis-specific antisynthetase autoantibodies, among which anti-Jo-1 antibodies are the most commonly encountered. In contrast, ILD associated with anti-Jo-1 antibodies without muscle involvement is rare and not well characterized. We report four patients presenting with ILD associated with anti-Jo-1 antibodies. Histological findings of transbronchial biopsies disclosed a pattern consistent with nonspecific interstitial pneumonitis, a CD8+ lymphocytosis was found in bronchoalveolar lavage. Only one of these patients developed an "antisynthetase syndrome" with PM, after nearly 2 yrs of severe ILD. The clinical conditions of all four cases showed stabilization or improvement when cyclosporine was added to their immunosuppressive treatment. These cases confirm that a CD8+ lymphocytic interstitial lung disease may be the first, and sole manifestation of autoimmune disease associated with anti-Jo-1 antibodies. Furthermore, they suggest that this form of interstitial lung disease apparently has a poor response to steroids and cytotoxic drugs, but may respond to moderate doses of cyclosporine and azathioprine in addition to low doses of steroids.

Aged↗
PubMed1997

End-stage cystic fibrosis: improved diabetes control 2 years after successful isolated pancreatic cell and double-lung transplantation.

Over a period of years, insulin-dependent diabetes and respiratory insufficiency developed in a 35-year-old patient with end-stage cystic fibrosis. After waiting more than 4 years while receiving maintenance treatment with continuous liquid O2 and nasal ventilation, the patient underwent double-lung and pancreatic islet cell transplantation. Subsequently, the patient has enjoyed a normal life with full employment and much better control of his diabetes. Pancreatic islet cell transplantation is a simple and innocuous technique easily added to the end of lung transplantation. These new pancreatic cells, although locally injected, are still secreting more than 2 years later as assessed by repeated C-peptide measurements.

Acute Disease↗
PubMed1996

Aerosolized rhDNase in cystic fibrosis: effect on leucocyte proteases in sputum.

In cystic fibrosis (CF), large amounts of free leucocyte proteases are present in bronchial secretions, contributing to progressive lung damage. Recombinant, human deoxyribonuclease (rhDNase) is a new therapeutic agent that decreases sputum viscosity. However, deoxyribonuclease has been shown, in vitro, to release cationic enzymes from complexes with deoxyribonucleic acid (DNA). The present study was conducted to assess this effect in vivo. Free human leucocyte elastase (HLE), human leucocyte cathepsin G (HCG), total chemotactic activity, and interleukin-8 (IL-8) were determined in sputum from eight patients before, during and after rhDNase treatment. After 15 days of treatment, HLE activity increased by 81+/-44% (NS), and HCG by 189+/-70% (p<0.05). One week after stopping a 4-6 months treatment, HLE activity decreased by 35+/-18% (p<0.05), and HCG by 43+/-11% (p<0.05). Sputum bacterial density, chemotactic activity, and IL-8 concentration did not change. Thus, treatment with rhDNase can indeed increase the activity of HLE and HCG in the bronchial secretions of CF patients, and this effect is still detectable after several months of treatment. If this can be shown to be clinically relevant, combination therapy of recombinant human deoxyribonuclease with protease inhibitors should be considered as an approach to the problem.

Adult↗
PubMed1996

Osteoporosis in patients undergoing lung transplantation.

The occurrence of osteoporotic fractures may seriously compromise the quality of life of lung transplant recipients. However, at present, the true risk of osteoporosis in such patients is unknown. We therefore prospectively evaluated bone mass changes in patients undergoing pulmonary transplantation. Bone mineral density (BMD) of lumbar spine (LS), femoral neck (FN) and femoral shaft (FS), as well as whole body bone mineral content (WB-BMC) were measured in 21 consecutive candidates for lung transplantation (9 males and 12 females; mean+/-SD age 47+/-11 yrs). Twelve of the patients had their BMD remeasured within 6 months after surgery, and nine again after 1 year. Before transplantation, BMD at all sites as well as WB-BMC were significantly decreased as compared to the values in young healthy adults, FN being the most affected (FN -25+/-2%; LS, -12+/-4%; FS -9+/-2%, WB-BMC -15+/-4% (mean+/-SEM)). Seven out of 20 adult patients (35%) fulfilled World Health Organization (WHO) criteria for osteoporosis, i.e. BMD more than 2.5 SD below peak bone mass, whereas three had previously been diagnosed as having osteoporotic fractures of the spine or femoral neck. Within 6 months after transplantation, significant bone loss occurred, mostly at the LS level (-4.0+/-1.7%; p=0.04), despite calcium and vitamin D supplementation. Furthermore, two patients had new osteoporotic vertebral fractures. After 1 year, no further bone loss or new osteoporotic fractures were observed. In conclusion, evaluation of bone mass and prevention of bone loss should be considered early before lung transplantation. Further studies are needed to determine the efficacy of antiresorptive drugs on the prevention of accelerated bone loss and vertebral fractures after transplantation.

Adult↗
PubMed1996

Combined islet-lung transplantation in a cystic fibrosis patient.

The prevalence of insulin-dependent diabetes mellitus (IDDM) in cystic fibrosis patients ranges from 2 to 8% and glucose intolerance up to 15%. In recent years, lung transplantation has helped to prolong life expectancy of cystic fibrosis patients and represents 10 to 30% of all indications for lung transplantation. The postoperative need for immunosuppressive therapy using diabetogenic agents has decompensatory effects on glucose regulation and will probably increase the number of insulin-dependent cystic fibrosis patients. We report the case of an insulin-dependent cystic fibrosis patient transplanted with a combined islet-lung allograft. The pre-transplantation C-peptide level was below 0.04 nmol/l and preoperative insulin requirement was some 100 U per day. A sequential bipulmonary lung transplantation was performed and, using the pancreas of the same donor, we isolated and purified the islets of Langerhans by a modified automated method. We obtained 232,200 islets equivalent, which were injected into the liver by portal embolization. The postoperative course was uncomplicated, the insulin requirement decreased to 50% of the preoperative need and the C-peptide value increased to normal values and remained with the normal range during a follow-up period of 15 months. In conclusion, we believe that, besides type I diabetic patients, insulin-dependent cystic fibrosis patients with a negative C-peptide value could also be good candidates for combined islet-lung allotransplantation.

Adult↗
PubMed1996

Quality of life of patients under home mechanical ventilation for restrictive lung diseases: a comparative evaluation with COPD patients.

The aim of this study was to compare the quality of life of patients under home mechanical ventilation (HMV) for restrictive lung disease, with the quality of life of patients with chronic obstructive pulmonary disease (COPD), having similar decrease in forced expiratory volume in one second (FEV1), but not receiving HMV. Sixteen patients who were receiving intermittent HMV (six post-tuberculosis, four post-poliomyelitis, two neuromuscular diseases, two kyphoscoliosis, two obesity-hypoventilation syndromes) were compared to 15 COPD patients who were receiving only usual conservative treatment, including long-term oxygen therapy. Dyspnoea scores, anxiety, depression, and psychosocial scores, as well as a panel of functional parameters were measured. The two groups did not differ in terms of functional impairment. However, patients under HMV had much better scores for anxiety, depression, and adjustment to illness than COPD patients. Scores for dyspnoea at rest were also better in the HMV group, but showed no relationship to quality of life. In spite of a cumbersome and intrusive type of treatment, patients under home mechanical ventilation for predominantly restrictive lung disease were found to have a better quality of life than chronic obstructive pulmonary disease patients under conservative therapy. In the first group, a longer history of coping with a chronic disease and the perception that medical intervention is effective may in part account for this difference.

Aged↗
PubMed1996

[Aspergillus lung pathology in transplant patients].

Invasive pulmonary aspergillosis, with or without dissemination to other organs, is a severe complication in patients who have undergone transplantation. The incidence of this disease is conditioned by the type of transplantation, the intensity of immunosuppressive regimens, and local epidemiology. The latter factor underscores the importance of air conditioning systems, and special caution is needed in case of hospital renovation. The clinical picture is frequently characterized by persisting fever, despite antibiotic treatments, but is otherwise non specific. Computerized tomography and magnetic resonance imaging show typical lesions more often than do conventional chest x-ray films. The sensitivity of broncho-alveolar lavage is poor, and DNA amplification techniques for Aspergillus might increase the diagnostic yield in the future. Also, detection of Aspergillus antigens in serum and urine might prove useful, but further studies are needed before a standardized test can be recommended for diagnostic purpose. Intravenous amphotericin B is the treatment of choice. Liposomal and other lipid formulations of this drug represent interesting alternatives, although very expensive. Itraconazole is emerging as a promising drug, because of fewer side effects than amphotericin. However, improvement of its formulation is still necessary.

Air Conditioning↗
PubMed1995

[Should patients with asymptomatic sleep apnea syndrome be treated with CPAP?].

Treatment of sleep apnea patients may be justified even when symptoms are absent. On the one hand, hypersomnia or daytime sleepiness are subjective symptoms and only reflect one aspect of the clinical syndrome of sleep apnea. On the other hand, an apnea index in excess of 5, e.g. the "laboratory diagnosis" of sleep apnea, has been reported as an independent risk factor for myocardial infarction. The main problem is scientific definition of cut-off points for treatment. There is no controversy about whether patients with symptoms should be treated or not. A CPAP trial seems to be justified in asymptomatic patients with an apnea/hypopnea index in excess of 20-30 and in patients with cardiovascular risk factors when the apnea/hypopnea index is in excess of 5. These laboratory cut-off values are not absolute values but represent flexible guidelines for initiating a CPAP trial in asymptomatic patients with apnea. The reasons for uncertainty whether or not to treat patients with asymptomatic sleep apnea are discussed.

Adult↗
PubMed1995

Isoniazid preventive therapy for pulmonary tuberculosis sequelae: which patients up to which age?

SETTING: Preventive therapy with isoniazid (INH) is usually recommended for all patients with pulmonary fibrotic lesions compatible with previous tuberculosis (TB). OBJECTIVE: To determine the optimal strategy between a 6- to 12-month course of prophylactic INH and therapeutic abstention in different age groups and in patients with severe coexisting diseases that limit life expectancy, such as chronic heart failure (CHF) or chronic obstructive pulmonary disease (COPD). DESIGN: A Markov decision analysis model that balances the risk of developing active TB against TB-related mortality, the risk of INH-related hepatitis, and INH-related death. RESULTS: In all groups of patients, prophylactic INH clearly reduced the number of deaths from TB, whereas very few cases died from INH-related toxicity. However, because INH-related deaths occur early, and TB-related deaths occur early or late, the gain in life expectancy was small. Particularly for patients with short survival such as those older than 80 years and those with CHF or COPD, the average gain in life expectancy provided by prophylactic INH did not exceed one week. CONCLUSIONS: Our analysis confirms that prophylactic INH is beneficial to all cohort groups of patients. However, in the case of very old age or severe disease, the gain in life expectancy is minimal. In these cases, the decision to give INH prophylaxis should be tailored on an individual basis with special consideration given to the patient and his environment.

Adult↗
PubMed1994

[Long-acting beta-2-agonists in the treatment of asthma].

The long-acting beta-2-agonist bronchodilators salmeterol and formoterol are relatively new drugs that may significantly improve the treatment of chronic bronchial asthma. Their physical and chemical properties partly explain the long duration of their bronchodilating action and their high affinity for beta-2-receptors. Numerous clinical studies have demonstrated their ability to alleviate the symptoms of asthma. In vitro studies have also revealed interesting effects of these two drugs in some aspects of the bronchial inflammatory process. However, they should not be considered equivalent to antiinflammatory medication from a clinical point of view. National and international consensus conferences insist on the fact that salmeterol or formoterol should always be prescribed in conjunction with inhaled corticosteroids.

Adrenergic beta-Agonists↗
PubMed1994

Quantitative metabolic PET imaging of a plasma cell granuloma.

We report a patient who underwent surgical resection of two lung nodules that proved to be recurrent plasma cell granuloma, also known as inflammatory pseudotumor. Prior to surgery, positron emission tomography (PET) was performed with 18F-labeled fluoro-2-deoxy-D-glucose (18FDG) and rubidium-82 (82Rb). The 18FDG PET scan revealed that the nodules corresponded to two areas of intense uptake. PET imaging with 82Rb, the marker of flow, also showed intense uptake. Thus, PET demonstrated both a high degree of metabolic activity and increased perfusion. These features suggest a lesion with high cellular activity rather than a simple reparative process. The true nature of this lesion remains unknown.

Animals↗
PubMed1994

Chronic destructive lung disease associated with a novel mycobacterium.

A woman born in 1920 has suffered from a chronic destructive lung disease since 1972, with development of a severe combined restrictive and obstructive ventilatory defect. Large quantities of acid-fast microorganisms have been repeatedly observed in her sputum. Multiple courses of antimycobacterial treatment did not stop the progression of the disease. The mycobacterium involved was first identified as Mycobacterium gordonae, and later as Mycobacterium scrofulaceum. Analysis of part of the amplified gene of the 16S rRNA, however, revealed that its sequence differed from that of any established mycobacterial species, although it was observed once before in a German lymph node isolate, for which the name "Mycobacterium interjectum" has been proposed. Retrospective analysis confirmed the presence of this sequence in frozen samples which had been provided by the patient in 1983, 1985, 1989, 1990, and 1993. Our case confirms the value of amplification and sequencing of mycobacterial 16S rRNA for classifying mycobacteria, and suggests that "Mycobacterium interjectum" may be involved in cases of chronic destructive lung disease.

Aged↗
PubMed1994

Body composition analysis by dual-energy x-ray absorptiometry in adults with cystic fibrosis.

Assessment of nutritional status is important in cystic fibrosis (CF). We performed body composition analysis by dual-energy x-ray absorptiometry (DXA) in 12 adults with CF, 7 of them with malnutrition as defined by percentage of ideal body weight (IBW) lower than 90. The DXA allowed for determination of bone body mass (BBM), lean body mass (LBM), and fat body mass (FBM). A deficit in BBM and LBM was found to be present in all seven patients with malnutrition when compared with a group of young normal adults. By contrast, deficit in FBM was inconstant. Deficits in bone and lean were associated with each other. They did not depend on the severity of steatorrhea, but were highly correlated to ventilatory impairment. In conclusion, DXA provides new and potentially useful information on the nutritional status of these patients. In addition, it confirms the close association of malnutrition and lung disease in CF.

Absorptiometry, Photon↗
PubMed1993

[Continuous home oxygen therapy in chronic obstructive bronchopneumopathy].

Long-term oxygen therapy (LTOT) has a significant effect on the survival of patients with chronic obstructive bronchitis and/or emphysema (COPD). The rationale for this therapy is based on prevention of the increase in pulmonary arterial tension resulting from chronic hypoxia. There are several problems in the application of this treatment to individual patients, and they are reviewed in this paper. Indication for LTOT depends on precise criteria. Information to the patients and to the medical community is essential for the success of this therapy.

Clinical Trials as Topic↗
PubMed1993

[Heart-lung transplantation, single lung and both lungs].

Following the improvement in surgical techniques and immunosuppression regimens as well as a better selection of recipients, an increasing number of heart-lung, single lung and double lung transplantations have been performed within the last decade. In the early stages, most candidates had advanced pulmonary hypertension. More recently, patients with end-stage lung disease have been successfully transplanted. Providing the allografts remain free of complications, long-term survivors may benefit of well preserved pulmonary function. However, acute rejection, obliterative bronchiolitis and infections are still a major cause of morbidity and mortality.

Bronchiolitis Obliterans↗