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Biomedical subjects

B J Milleron

Publications and source records attributed to B J Milleron.

At least 19 recordsLinked to original sources
PubMed1994

Assessment of bone marrow involvement by magnetic resonance imaging in small cell lung cancer. No significant change of staging.

STUDY OBJECTIVE: This prospective study was performed in an attempt to evaluate (1) the rate of magnetic resonance imaging (MRI) demonstrating bone marrow (BM) abnormalities, (2) the correlation of these abnormalities with a pathologic malignant BM involvement, and (3) the possible modification of patients' usual disease staging in the light of these abnormalities. METHODS: After extensive staging investigations, patients' diseases were classified as limited or extensive. Dorsal and lumbar spine MRI was performed for second staging. RESULTS: Thirty-two patients were eligible for this study. In ten patients (31.2 percent), MRI showed abnormalities; in four of them, the BM sample from the posterior iliac crest was free from malignancy. Three of these four patients had extensive disease. The last patient, because he had limited disease, had biopsy at the site of MRI abnormalities; the biopsy specimen revealed a malignant involvement and therefore this patient, initially classified as having limited disease, was classified in the extensive disease group. In only 1 of 32 patients, BM-MRI data modified initial staging. CONCLUSIONS: The metastases disclosure yield of the MRI in the detection of medullar involvement is higher than BM biopsy but especially in patients with extensive disease. Therefore, MRI should not be considered in routine practice, in particular in patients with extensive disease.

Biopsy↗
PubMed1992

[Pulmonary pathology of drug origin].

Over the past ten years, there has been an impressively growing number of reports about drug-induced pneumonitis (DIP) due to more than one hundred different drugs. The most troublesome question is how to establish with certainty the diagnosis. Usually, five criteria are necessary. 1) The administration of a drug on a more or less long term basis. 2) Newly occurrence of an interstitial pneumonitis (defined on symptomatology, radiological features, pulmonary function test results). 3) Elimination of all other causes of pneumonitis (haemodynamic, infectious, systemic, environmental diseases). 4) Broncho-alveolar lavage (BAL) cell data showing in most cases a lymphocyte alveolitis with an inverted CD4/CD8 ratio. In a certain number of ambiguous circumstances, coupling a provocation test with a sequentially performed BAL could firmly establish the diagnosis. 5) Rapid resolution within a few days or months of the pneumonitis as early as the incriminated drug administration is stopped. Nevertheless sometimes one or more of these criteria are not met, mainly when the pneumonitis is a fibrosis directly induced by a fibrosing toxic mechanism.

Humans↗
PubMed1992

Severe hypoxemia-associated intrapulmonary shunt in a patient with chronic liver disease: improvement after medical treatment.

A 20-yr-old woman with chronic liver disease and angioimmunoblastic lymphadenopathy presented with marked hypoxemia caused by intrapulmonary shunt. Her respiratory tract showed her to be free of angioimmunoblastic lymphadenopathy manifestations. After 12 months of treatment with cyclophosphamide and corticosteroid, the immunologic disease disappeared. Unexpectedly, hypoxia-associated intrapulmonary shunt was no longer present either. To the best of our knowledge, this is the first case of dramatic improvement, with medical therapy, of severe hypoxemia related to noncirrhotic liver disease. However, the mechanism by which this treatment caused the regression of intrapulmonary shunt is unknown.

Adult↗
PubMed1991

Bronchoalveolar lavage cell data in alveolar proteinosis.

In bronchoalveolar lavage fluid (BAL) from nine patients with alveolar proteinosis (AP), total and differential cell count and T-lymphocyte phenotyping were done and compared with those in 12 healthy volunteers comparable as to age and tobacco consumption. Although total cell count was not significantly different from that in control subjects, the most prominent feature in patients was an increase in the number of CD4 and CD8 T-lymphocytes within the alveoli. Conversely, the macrophage population was significantly reduced. The ratio of CD4/CD8 T-lymphocytes tended to be high, but this increase did not reach statistical significance. The pathophysiologic mechanism and the meaning of these alveolar cell changes in AP remain to be elucidated.

Adult↗
PubMed1991

Bronchoalveolar lavage cell data in 19 patients with drug-associated pneumonitis (except amiodarone)

We examined bronchoalveolar lavage (BAL) cell data from 19 patients with a lung disorder presenting clinical, radiologic, functional, and course characteristics of drug-associated interstitial pneumonitis. In each of them, one of 13 different drugs was incriminated and no other cause was found. In one case due to bleomycin, a neutrophil and eosinophil alveolitis was present. In the other 18, the common denominator was a lymphocyte alveolitis, either pure (n = 6) or associated with neutrophilia (n = 5), eosinophilia (n = 3), or neutrophilia and eosinophilia (n = 4). In addition, in all patients, an inverted CD4/CD8 lymphocyte ratio was observed. In eight patients who underwent another BAL, lymphocyte alveolitis decreased but was persistent in two of them two to four months after cessation of treatment with the drug incriminated, whereas interstitial pneumonitis had resolved clinically. In five patients, after resolution of pneumonitis and after an almost normal BAL cell profile was obtained, resumption of treatment with the suspected drug for two to four weeks induced a rise in lymphocyte population in a third BAL. In conclusion, apart from one case of bleomycin lung, the most striking feature of drug-associated alveolitis in this series was expansion of lymphocyte population and imbalance in lymphocyte subsets. When a provocation test was performed, variations in alveolar lymphocyte levels paralleled withdrawal and readministration of the drug responsible for alveolitis. These data could be of value in diagnosing and understanding drug-induced lung disorders.

Amiodarone↗
PubMed1991

Bronchoalveolar lavage cell data in amiodarone-associated pneumonitis. Evaluation in 22 patients.

To assess the value of bronchoalveolar lavage (BAL) for diagnosis, understanding, and treatment of amiodarone-associated pneumonitis, we examined the results of BAL total and differential cell counts and phenotyping of lymphocytes in 22 patients with this lung disorder and in 33 normal subjects. Overall, the total cell count was found to be almost the same as that seen in control subjects; the macrophage population was significantly reduced, and the lymphocyte, neutrophil, and eosinophil populations were increased in absolute number and percentage. When results were analyzed individually, BAL data appeared to be distributed according to two patterns. In the first pattern, there was no abnormal lymphocytosis. In the second pattern a lymphocyte alveolitis was found in percentage and in absolute number. This lymphocyte alveolitis was present either alone or associated with neutrophil alveolitis or with eosinophil alveolitis. In the first pattern, despite the normal level of the lymphocyte population, the percentage of CD4 T-lymphocytes and the CD4:CD8 T-lymphocyte ratio were significantly lowered. In the second pattern the CD8 T-lymphocyte count was increased in absolute number and percentage, with a low CD4:CD8 ratio. In six patients relavaged two to four months after amiodarone withdrawal, there was a significant fall in alveolar lymphocytosis, but the progressive increase in the neutrophil population over time seemed to be associated with the seriousness and progression of the disease. Finally, these findings closely resembled those obtained in patients with hypersensitivity pneumonitis due to inhalation of organic dust and suggest that an underlying immunologic cell-mediated mechanism may play a role in this iatrogenic pulmonary disease.

Aged↗
PubMed1991

Bronchoalveolar lavage cell data in drug-induced pneumonitis.

In an attempt to evaluate the diagnostic help of bronchoalveolar lavage cell data in drug-induced pneumonitis (D.I.P.), we collected through the world literature 167 cases of D.I.P. In 122 cases, data were available for individual analysis (68 associated with amiodarone prescription and 54 with other drugs). 28 drugs were incriminated. Apart from 13 cases with normal BAL cell profile, the most prominent feature in the other 109 was a lymphocyte alveolitis either pure or associated with neutrophil and/or eosinophil alveolitis along with an imbalance in T-lymphocyte phenotype. These characteristics closely resembled those observed in hypersensitivity pneumonitis due to inhalation of organic dust. Nonetheless, about one third or more of cases displayed no lymphocytosis but neutrophil and/or eosinophil alveolitis. Taken together, these findings are in no way specific for D.I.P. but could be of interest to help diagnosis and understanding of iatrogenic alveolitis, especially when a provocation test coupled with sequential BAL is performed.

Alveolitis, Extrinsic Allergic↗
PubMed1990

Leukocyte migration inhibition in propranolol-induced pneumonitis. Evidence for an immunologic cell-mediated mechanism.

About 20 cases of beta blocker-associated pneumonitis have been published in the mid-70s, and a case of interstitial pneumonitis has been attributed to propranolol. The pathogenesis of these cases of pneumonitis with or without pleural effusion is not clear. A 59-year-old man developed pneumonitis which showed all the characteristics of a drug-associated pneumonitis due to propranolol: BAL demonstrated a lymphocytosis, the variations of which closely correlated with a provocation test. The LIF appeared to be released by the patient's peripheral blood lymphocytes when cultured with optimal doses of propranolol. Production of LIF by the patients' lymphocytes suggests the existence of a drug-specific cellular immune response in propranolol-associated pneumonitis.

Cell Migration Inhibition↗
PubMed1990

Adult-onset Still's disease revealed by a pleuropericarditis.

We report a case of adult-onset Still's disease (AOSD) revealed by pleuropericardial manifestations. A 40 yr old black woman was admitted for flu-like syndrome with pharyngitis, hectic fever, polymorphonuclear hyperleucocytosis and pleuropericarditis. The diagnosis of AOSD was supported by 3 major and 3 minor criteria after exclusion of infectious, haematological and connective tissue diseases. Pulmonary involvement is infrequent in AOSD, and consists of transient pulmonary infiltrates and chronic restrictive pattern. However, pleuritis, like pericarditis, is present in 25% of cases. Initial onset of pleuritis, associated with fever and hyperleucocytosis preceding articular manifestations could be responsible for a delay in diagnosis and a subsequent worsening in the prognosis of the disease. A rapid improvement is usually observed under nonsteroidal anti-inflammatory drug or corticosteroid treatment.

Adult↗
PubMed1989

Provocation test coupled with bronchoalveolar lavage in diagnosis of propranolol-induced hypersensitivity pneumonitis.

A 59-yr-old man was given over a 30-month period a cumulative dose of 36 g of propranolol for treatment of angina pectoris. He then presented with respiratory disease, having all the clinical, radiologic, and functional characteristics of interstitial pneumonitis. No other cause of pneumonitis was found. Bronchoalveolar lavage (BAL) showed a lymphocytic alveolitis with lymphocyte subset inverted ratio. After a 9-wk period of drug withdrawal, clinical and radiologic improvement was observed along with resolution of BAL abnormalities. Propranolol therapy was resumed for 6 wk and induced the recurrence of BAL abnormalities. Propranolol treatment was finally stopped, and 15 wk later, clinical symptoms abated, chest roentgenogram and pulmonary function tests were improved, and BAL data returned to normal. This observation seems to exemplify the possible diagnostic value of coupling provocation test with BAL cell data in some hypersensitivity pneumonitis induced by drugs. In addition, these data support the role of a cell-mediated immunologic mechanism in the pathogenesis of propranolol-induced pneumonitis.

Alveolitis, Extrinsic Allergic↗
PubMed1989

Pleural T-lymphocyte subsets in amiodarone-associated pleuropneumonitis.

Two male patients presented with lung disorders with all the characteristics of amiodarone-related pneumonitis. Bilateral exudative pleural effusions were associated with pneumonitis. High lymphocytosis was present in the pleural fluid with a ratio of T-lymphocyte subsets close to that found in peripheral blood; in the blood T-lymphocyte subset ratio was nearly normal. By contrast, and as is usual in similar cases, lymphocytic alveolitis with T-lymphocyte subset imbalance was found in bronchoalveolar lavage fluid. These findings, never published so far to our knowledge, would favor a compartmentalization of the immune response inside the lung.

Aged↗
PubMed1989

[Unusual thoracic localization of Castleman's tumor. Apropos of a case].

We report a case of angiolymphoid hyperplasia, or Castleman's pseudotumour, located in the chest and most unusually opposite an intercostal space. Pain led to the discovery of the tumour, the nature of which was discovered at surgery, and disappeared after surgical excision. No antigenic stimulus or local haemodynamic disturbance was found, which could have accounted for the very unusual intercostal site of the lesion.

Adult↗
PubMed1988

Leukocyte migration inhibition in amiodarone-associated pneumonitis.

Amiodarone-associated pneumonitis is now a well-known clinical entity, but the mechanism for the induction of the pulmonary disease is ill defined. In four patients with this disorder, evidence was obtained for elaboration of a lymphokine, leukocyte inhibitory factor (LIF), by peripheral blood lymphocytes after incubation with amiodarone in the direct leukocyte migration inhibition test. Control lymphocytes from normal subjects, as well as from patients receiving amiodarone but without pneumonitis, failed to elaborate LIF in the presence of the drug in this test. This production of LIF suggests that pneumonitis associated with amiodarone therapy is also associated with a specific cellular immune response to the drug.

Aged↗
PubMed1988

Late pleuropulmonary metastases of a cerebral ependymoma.

A patient with a 12-year history of occipital ependymoma was found to have late pleuropulmonary metastases without recurrence of the primary tumor. The pleural metastases were diagnosed by histologic, ultrastructural features and finally by glial fibrillary acidic protein (GFAP) labeling positive reaction. This case is unique because of the long interval between occurrence of the initial tumor and the metastases, and because of the apparent quiescence of the cerebral lesion when the pleuropulmonary metastases were discovered.

Adult↗