Biomedical subjects

B Paramelle

Publications and source records attributed to B Paramelle.

At least 37 records · Page 2Linked to original sources

PubMed1990

[Benign pleural fibroma. An anatomo-clinical study of 10 cases].

We present an anatomical-clinical analysis of ten cases of benign pleural fibroma. This tumour was discovered in a systematic fashion in 8 of the 10 cases and fortuitously in one. Recent radiological examinations enabled the diagnosis to be suspected. Computerised tomography most often precisely identified the pleural topography and imagery by nuclear magnetic resonance in one case visualised fibrous tissue (with a zone of low signals on the scale in T2). The final diagnosis was achieved at the same time as the treatment when an exploratory thoracotomy was performed. In all the cases there was a tumour composed of fusiform cells covered by normal epithelium coming from the viscera pleura 8 times out of 10. The ultrastructure examination and immunohistochemistry of the fusiform cells (Vimentin plus, EMA-, KL1-) allowed for a differentiation of these tumours of connective tissue origin from tumours of mesothelial origin. These analyses constitute an argument in favour of the fibroblastic origin of pleural fibromas.

Adult↗

PubMed1990

[Bronchiolitis obliterans with idiopathic organized pneumonia. Anatomoclinical analysis and nosologic discussion apropos of 6 cases].

The clinical, radiological, physiological and pathological features were studied in 6 cases of idiopathic bronchiolitis obliterans organized pneumonia (BOOP). Patients characteristically had a history of exertional dyspnea, cough, fever, weight loss, bilateral radiographic shadowing, elevated ESR and hypoxemia. Corticosteroids were effective; however, one patient died of cytomegalovirus pneumonia. The pathological features, distinguished by the presence of granulation tissue plugs extending from bronchioles into alveolar ducts and alveoli, are described in detail. The place of BOOP within the broad spectrum of bronchiolitis obliterans between small airways disease and usual interstitial pneumonia is discussed.

Aged↗

PubMed1990

[Effect of nebulized salbutamol in 26 patients hospitalized for asthma attack].

Twenty-six asthmatic patients who were hospitalised following an acute asthmatic attack and who had a peak expiratory flow of less than 50% predicted, without hypercapnia, received 5 mg. of salbutamol delivered by a micronebulizer LSA on admission (HO). At H1, 10 mg of additional salbutamol were nebulised in cases where there had been an increase of less than 20% of the PEF. At H2, all the subjects received steroid therapy. Group 1 in which success was defined by an increase of 20% of peak flow judged at H1 and H2, and group II where the increase in peak flow was less than 20%. Group II benefited at H2 by treatment with theophylline or salbutamol intravenously given in a randomised fashion. At H8 the 2 treatments were associated in group II in cases of failures. 15 men, and 11 women aged 40 +/- 17 suffering from severe asthma (65% of Charpin Stage IV) were included. The mean peak flow at HO was 32 +/- 9% of the predicted PEF. 21 subjects, or 81% improved their peak flow by more than 20% at H2. The toleration for salbutamol was very good from the cardiovascular point of view. At HO there was no clinical criteria nor peak flow assessment which would enable one to predict the failures from nebulized salbutamol for a given subject. Nevertheless a level of dyspnoea of greater than 5 on Borg's scale and a peak flow of less than 150 l/min made failure likely.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1990

[Can oximetry contribute to the detection of apnea? The use of a mathematical analysis of the oximetry signal].

The aim of this study was to test the efficacy of nocturnal oximetry as a means of continuous recording of SaO2 in the identification of apnoeic events in the recognition of non-apnoeic desaturation. The oscillations of SaO2 in relation to successive periods of apnoea during the course of the sleep apnoea syndrome (SAS) or with apnoeic episodes in patients with chronic airflow obstruction (BPCO) or restricted disease, were identified using a new delta index quantifying the variations of SaO2 during the night. 26 successive patients in whom there was an indication for nocturnal oximetry were included in a prospective study comparing nocturnal oximetry and polysomnography during 34 nights. In the apnoeic patients we found a strong correlation (r = .85. p. less than .01) between the apnoeic period and the delta index. In BPCO the number of apnoea was correlated with the delta index (r = .96. p. less than .01). A minimal threshold of the delta index fixed at 1.5 was satisfactory for detecting apnoea if the initial SaO2 was less than 93%. The value of the adequate for affected detection ought to be fixed at .8 (95% sensitivity) when the initial SaO2 was greater than 93%. A detection of apnoeic events thus seems possible by this method.

Apnea↗

PubMed1989

Heterotransplantation of small cell lung carcinoma into nude mice. Stability of the phenotypic characters.

In order to validate xenografted small cell lung carcinomas (SCLC) for biological studies, the authors established 12 lung neuroendocrine (NE) tumors (eight typical SCLC and four atypical NE tumors [ANE]) by heterotransplantation onto nude mice. Their characterization was performed using serial ultrastructural, enzymatic, and immunohistochemical methods on primary tumors and after xenografts. These were subclassified into epithelial (one), neuroendocrine (three), and multidifferenciated (eight) types. The phenotypic characters (cytokeratins, neurofilaments, neurone-specific enolase) and the proliferative rate (Ki 67 labelling) of original tumor were maintained until the last passage studied. Although further acquisition of subsets of cytokeratin or neurofilaments was observed in some cases, the authors could not detect any morphologic and/or biological spontaneous change comparable to those described in in vitro cell lines. In addition, ANE are not quite identical to variant subclasses described in vitro. The authors conclude that the stability of heterotransplanted SCLC is an advantage in further biological studies.

Animals↗

PubMed1989

Microangiopathy of endoneurial vessels in hypoxemic chronic obstructive pulmonary disease (COPD). A quantitative ultrastructural study.

A peripheral neuropathy has been reported in patients with chronic respiratory insufficiency due to chronic obstructive pulmonary disease (COPD). It is mainly characterized by axonal degeneration, secondary demyelination and abnormal endoneurial vessels. The pathogenesis of these lesions remains obscure. To investigate whether relationships exist between neuritic and vascular lesions, a qualitative and quantitative ultrastructural study was performed on nerve biopsies in 13 patients with chronic respiratory insufficiency due to COPD, and in 9 normal controls without pulmonary lesions. A computer-assisted multiple regression analysis taking into account clinical, electrophysiological, biological and morphometric parameters was performed. Statistically significant differences in the endoneurial structure of microvessels were: (1) thickening of the basement membrane; (2) narrowing of the lumen; (3) mural pericytic debris deposits, occurring in the COPD group. In the latter, hypercapnia correlated positively with nerve fibers lesions (P = 0.03) and endothelial area (P = 0.03). No correlations were found between age and other parameters. These findings highlight the fact that the microangiopathy in peripheral nerves in patients with COPD may be diffuse and essentially due to hypoxia and reduction in blood flow, as in diabetic neuropathy.

Aged↗

PubMed1989

Sequential combination of 5-fluorouracil, cis-platinum and irradiation in unresectable non-small cell lung cancer.

Twenty patients with unresectable non-small cell lung carcinoma, 15 stage III and 5 stage IV (supraclavicular lymphadenopathy) were treated with a combination of three courses of chemotherapy and hypofractionated irradiation followed after 3 weeks by split-course radiotherapy. Each course was repeated every 3 weeks with the following sequence. Cis-platin (CDDP) (20 mg/m2) was given in a 20-min infusion, followed by a 2-h infusion of 5-fluorouracil (5-FU) (400 mg/m2) on days 1, 2, 5 and 6. Radiation with a dose of 3 Gy on the target volume was given on days 3 and 4, after a 2-h infusion of 5-FU (400 mg/m2). Split course of irradiation consisted of 16 Gy in 5 fractions repeated after 3 weeks interval. The objective response rate was 75%. Median follow-up was 24 months, the median survival was 14 months. The 1-year survival was 53% and the 2-year survival was 16%.

Actuarial Analysis↗

PubMed1989

Clinical value of an amplified electrophoretic determination of enolase isoenzymes in small cell lung carcinoma patients.

Neurone specific enolase (NSE); alpha gamma and gamma gamma isoenzymes of the glycolytic enzyme enolase, is found in considerable quantity in serum of patients with small cell lung cancer (SCLC). The spectrophotometric measurement of serum enolase activity, plus the electrophoretic separation of isoenzymes (alpha alpha, alpha gamma and gamma gamma) using an amplification reaction constitute a simple method, the application of which has not yet been demonstrated. In patients, serum values of higher than 25 U/l of total enolase activity, with more than 10% NSE, were considered to be positive. Seventy patients diagnosed as SCLC were classified before treatment as having either limited (LD) or extensive (ED) disease, and after chemotherapy as being in complete (CR) or partial remission (PR), stable state (SS) or in relapse (R). The levels of enolase activity and NSE (M +/- SE) in these patients (enolase: 67 +/- 7 U/l, NSE 27 +/- 2%) were different from those in a control group of 19 patients with non-small cell lung cancer (enolase: 29 +/- 2 U/l, NSE: 7 +/- 1%) (p less than 0.001) at the time of diagnosis. Mean enolase and NSE levels in patients with SCLC were seen to differ significantly according to the clinical stage. The results of those patients with ED differed from those of patients with LD (p less than 0.001). The results of the group of patients that achieved remission differed from that of patients during relapse (p less than 0.0001). Serial measurements demonstrated a good correlation between enolase and NSE serum levels and the progression of the disease. The usefulness of this method in the early assessment of treatment was also demonstrated. The clinical usefulness of the dosage of NSE with that of two other tumour markers CKBB and mitochondrial CK was compared.

Adult↗

PubMed1989

[Development of nocturnal desaturation in 35 patients with chronic obstructive bronchopneumopathy (COBP). Relation to functional and hemodynamic data].

35 patients with chronic airflow obstruction in a stable state were studied using nocturnal oximetry on two occasions with an interval of 25 +/- 10 months between them. First we studied the predicted value for the pulmonary function factors during the day to compare with nocturnal desaturation. On the second occasion we compared the progress of the desaturation indices and the outcome of the functional and hemodynamic data. The PaO2, the PaCO2 and the VEMS/CV ratio (FEV1/VC) were the only elements during waking which correlated with the degree of nocturnal desaturation. In spite of this correlation and the fact that the confidence intervals were large, the predictable element of these daytime measurements remained weak in daily practice. The progress between the two oximetric measurements of the PaO2 and the PaCO2 as well as the fall in the FEV1 (VEMS) was strongly linked to the evolution of desaturation during sleep. This progressive aspect shows the value of nocturnal oximetry in patients who are evolving towards alveolar hypoventilation. Finally, the outcome of pulmonary arterial pressure appears predictable as a result of the progress of nocturnal desaturation.

Aged↗

PubMed1989

[Chronologic relationship between gastroesophageal reflux and asthma. Simultaneous study of the measured pH and respiratory function].

UNLABELLED: The aim of the study was: 1) to define the frequency of gastroesophageal reflux (GER) in asthmatics; 2) to study a possible relationship between episodes of GER and changes in airflow obstruction while maintaining as far as possible physiological conditions. Nineteen consecutive patients (aged 40.3 +/- 19 years) presenting with severe asthma requiring continuous treatment, were studied in a stable period. All treatments were stopped for 12 hours before the examination, except corticosteroids and sustained theophylline. Esophageal pH was measured continuously one hour before and three hours after a standardized meal. Respiratory function was measured every 30 minutes using a miniaturized spirometer which enabled the measurement of forced vital capacity (FVC), forced expiratory volume in one second (FEV1), and FEV1-VC ratio: 1) the frequency of pathological GER was defined by a Kaye's score greater than 90 and was 32%; 2) there was no significant correlation between the individual changes in FEV1 and different variables for the pH measured in the 30 mn before the measurement of bronchial obstruction (number of GER episodes, duration of GER, duration of the last GER episode, time of the last GER); 3) we have found no significant difference between the variation of FEV1 above or below 10% of the best FEV1 of each patient in relation to the quality (intensity, duration, delay) of GER episodes recorded 10 minutes before the spirometry. IN CONCLUSION: in severe asthmatics these results: 1) confirm the high frequency of pathological GER; 2) do not allow the establishment of a direct causal relationship between GER episodes and occurrence of a bronchial obstruction.

Adult↗

PubMed1988

[A case of pleuropneumopathy due to Eikenella corrodens].

We report the observation of a pleuropneumonia due to Eikenella corrodens in a man of 39 years old suffering from diffuse dilatation of the bronchi. This small micro-aerophilic Gram negative bacillus has rarely been implicated as a cause of pneumonia. It appears that it may often be associated with streptococcal infections and that it becomes a pathogen when the immunity is lowered. Its sensitivity to antibiotics is excellent, particularly vis-à-vis bêta-lactams.

Adult↗

PubMed1987

Isoenzyme pattern of enolase in the diagnosis of neuroendocrine bronchopulmonary tumors.

Electrophoretic separation of enolase isoenzymes and the measurement of enolase activity were performed in 25 lung tumor extracts. In 13 neuroendocrine (NE) tumors (nine small cell lung carcinoma [SCLC], three atypical NE tumors, and one carcinoid tumor), the NE differentiation was assessed by ultrastructural determination of neurosecretory granule (NSG) density. Twelve non-NE lung tumors also were studied (three adenocarcinomas, four epidermoid, two composite, two large cell undifferentiated carcinomas, and one lymphoma). Four normal lung tissues and 1 human brain were used as controls. The gamma gamma isoenzyme was present at a high level (mean +/- SE, 12 +/- 3%) in all NE carcinomas and consistently absent in all non-NE tumors as well as in normal lung. The alpha gamma isoenzyme was found in significantly higher proportion in NE carcinomas (mean +/- SE, 29 +/- 2%) than in non-NE tumors (mean +/- SE, 8 +/- 1%) (P less than 0.0001), despite an equally high level of total enolase activity in both groups of tumor. The separation of alpha gamma and gamma gamma isoenzymes of enolase allows for the accurate diagnosis of NE tumors and NE components of atypical NE carcinomas, and the gamma gamma isoenzyme, in contrast to gamma chain detection by immunoassay, can be considered to be a specific marker in itself of NE differentiation in lung neoplasms.

Adenocarcinoma↗

PubMed1987

[Primary pulmonary malignant fibrohistiocytoma. Apropos of a case].

A case of primary malignant fibrous histiocytoma of the lung is reported. The clinical course was divided into 2 periods: slow tumoral growth followed by rapid aggravation. The pathological aspects of the first localization and of the relapse are analyzed and discussed. Data from the literature are reviewed, with special attention to diagnostic and prognostic problems.

Adult↗

PubMed1987

[Comparative study of magnetic resonance imaging and tomodensitometry in the diagnosis of locoregional extension in 61 patients with bronchial cancers].

In order to assess the value of nuclear magnetic imagery NMR in the diagnosis of the extent of bronchial cancers, 61 patients with operable bronchial carcinoma had both a CT scan and an NMR scan pre-operatively. Fifty one mediastinoscopies were performed. Twelve times there were mediastinal glandular enlargement. Ten times the thoracotomy was performed straight away. After pathological studies of the biopsy, 24 patients were N2, 25 N1, 12 N0; the sensibility of NMR to foresee lymph node invasions was 83% (specificity 70%), for CT scanning 75% (specificity 81%). Thirteen patients presented with a direct mediastinal or parietal invasion. The sensibility of detecting these invasions was only 38% for NMR (specificity 94.5%) and for CT scanning 54% (specificity 94.5%). There is little difference in the results and no statistical difference. This leads us to conclude that at present, NMR does not give more information than TDM in the diagnosis of operability in bronchial cancers.

Bronchial Neoplasms↗

PubMed1987

[Sleep apnea syndrome combined with an anatomical obstruction of the upper airways].

In patients with sleep apnoea syndrome abnormalities of the upper airways may play a major role in the genesis of apnoea. Three cases are presented which illustrate the part played by hypertrophy of the tonsils in a child and by stenosis of the pharynx in an adult and of the larynx in another adult. All three patients were cured by surgical correction of these abnormalities. The physiopathology of alveolar hypoventilation, present in one of the three patients, is discussed in relation to the effects of pure oxygen inhalation on the patient's ventilation.

Adult↗

PubMed1987

[Transparietal needle biopsy of pulmonary lesions with an image intensification system. Apropos of 82 biopsies].

We report the results of 82 needle biopsies of pulmonary nodules, using a fine screw needle. Owing to the very small diameter of the needle (0.8 mm), very few complications were observed (minor pneumothorax 13%, major pneumothorax 2.5%). The screw needle provided samples adequate for both cytological and histological examination. Forty-eight out of 53 cancers were diagnosed by this method (sensitivity 83%, specificity 100%).

Biopsy, Needle↗

PubMed1987

[Severe neurologic complications secondary to poisoning by slow-release theophylline].

Three cases of severe slow-release theophylline toxicity (plasma theophylline levels above 30 mg/l) in patients with severe chronic pulmonary disease are reported. Seizures were noted in all patients, and one had tachyarrhythmia. Two of the patients died. Several factors were present which may have impaired theophylline clearance, leading to toxic plasma levels. The mortality rate of theophylline intoxication being high, the initial doses should be sufficiently low to minimize the risk of adverse affects, and the best way to prevent theophylline toxicity is to monitor plasma concentrations. A management of patients with theophylline overdosage is suggested: oral administration of activated charcoal is the primary therapeutic measure; haemoperfusion or haemodialysis should be considered only in patients in whom conservative measures have failed.

Aged↗

PubMed1987

[Primary alveolar hypoventilation. Clinical aspects and diagnostic problems. Apropos of a case].

Primary alveolar hypoventilation is a rare syndrome of unknown origin, characterized by a dysfunction of the automatic respiratory pattern in spite of normal lungs and in the absence of mechanical ventilatory defects. A reduction of the ventilatory response to CO2 is regularly found, and cardiac failure is common. The differential diagnosis mainly concerns the sleep apnoea syndrome. The usual treatments have little effectiveness.

Blood Gas Analysis↗