Chest pains complicating an artificial therapeutic pneumothorax.
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Chest Pain↗
Biomedical subjects
C Pison
Publications and source records attributed to C Pison.
[Pulmonary inflammatory pseudotumor complicating the course of a community-acquired pneumopathy. A deceptive radio-clinical presentation].
The case of a 46 years old man presenting a chronic history of right upper lobe pneumonia is reported. The clinical presentation associated with nodular pulmonary computed tomographic scan lesions, highly suggested a malignant bronchopulmonary process. A lobectomy was performed. Histological analysis revealed an inflammatory pseudotumor. This inflammatory process may be a particular end stage disease of pulmonary infectious disease.
Biopsy↗
[An unusual case of cardiac insufficiency].
A 70 year old patient with a past history of a left ventricular cardiomyopathy with concentric hypertrophy presented with an exacerbation of cardiac failure; radiology revealed bilateral lung infiltrations, predominantly on the right and a restrictive ventilatory disorder. The broncho-alveolar lavage revealed a lymphocytosis with CD4 prominence. Microbiological examination was negative. With a worsening radiological picture despite increased anti-failure treatment a video-assisted surgical biopsy was performed. The histological examination revealed diffuse interstitial pulmonary amyloidosis. This observation underlined the value of looking for this rare cause of cardiac failure and pulmonary infiltration in a situation where the pulmonary images did not improve on diuretics.
Aged↗
Prevalence of asthma and asthma-like symptoms in three French cities.
BACKGROUND: This study is part of the European Community Respiratory Health Survey (ECRHS), which uses a common methodology in different areas throughout the world. This paper describes the prevalences of reported asthma, asthma-like symptoms and nasal allergies, their relationships to age group and sex, and the relationships of asthma-like symptoms to current asthma, in the general population aged 20-44 years of three French urban areas. METHODS: The study population of 2804 subjects in Grenoble, 3774 in Montpellier and 3152 in Paris (18th district), randomly selected from electoral rolls, answered a postal questionnaire (stage I of ECRHS). The response rates were 77.8%, 68.6% and 74.4%, respectively. RESULTS: The prevalences were approximately 14% for wheezing, 16% for chest tightness and 4.5% for nocturnal shortness of breath in the three areas. Asthma attacks in the last 12 months were reported by 2.7% of subjects in Grenoble, 3.5% of subjects in Montpellier and 4.0% of subjects in Paris (P = 0.02). For nasal allergies, the prevalences were 28.0%, 34.3% and 30.8%, respectively (P < 0.001). Asthma was inversely correlated to age (higher prevalence in the youngest) but was not related to sex. Neither age distribution nor sex ratio explained the differences between areas. Among the asthma-like symptoms, wheezing and nocturnal shortness of breath correlated strongly with asthma, chest tightness correlated moderately and nocturnal coughing correlated poorly. CONCLUSION: The prevalences observed were higher than expected from previous comparable French studies in young adults. These results are consistent with the hypothesis of a recent increase of asthma and allergies.
Adult↗
Successful stenting of a pulmonary arterial stenosis after a single lung transplant.
A 44 year old patient with end stage idiopathic pulmonary fibrosis underwent single left lung transplantation. A perfusion lung scan performed 13 days after transplantation revealed deficient perfusion in the transplanted lung. Pulmonary angiography showed severe pulmonary artery anastomotic stenosis. Percutaneous insertion of a balloon expandable stent improved both pulmonary perfusion and respiratory function.
Adult↗
Benign noninflammatory bronchial stenosis: treatment with balloon dilation.
PURPOSE: To assess the efficacy of balloon dilation in the treatment of acquired, noninflammatory bronchial stenosis of benign origin. MATERIALS AND METHODS: Balloon bronchoplasty was performed with fluoroscopic guidance 36 times in 19 bronchial stenoses in 16 consecutive patients, with use of a local anesthetic. RESULTS: Initial technical success was attained in all cases; clinical success was achieved in 13 (68%) of 19 bronchial stenoses. Six of the 19 stenoses were dilated unsuccessfully because they were caused by localized bronchomalacias. Of these initial successes, seven stenoses recurred but were redilated with success in four cases. At a mean follow-up of 21.6 months (range, 7-60 months), improvement in both fiberoptic bronchoscopy and respiratory status was seen in nine (69%) of 13 patients with fibrous stenoses. CONCLUSION: Balloon bronchial dilation can be proposed as the primary treatment in acquired, noninflammatory bronchial stenoses of various benign origins including stenoses after lung transplantation.
Adolescent↗
[Diffuse pulmonary infiltration at the onset of Waldenström's disease].
The case of an 52 years old female presenting dyspnea and pulmonary infiltration is reported. A transbronchial biopsy showing a lymphomatous infiltrate with immunohistochemistry using anti-IgM antibody on paraffine embedded section helped to diagnose. A monoclonal increase in seric immunoglobin M, led to the diagnosis of Waldrenström's macroglobulinemia. An initial therapeutic response to Chlorambucil was obtained. But a quick recurrence was observed, with an increase of seric IgG.
Female↗
Comparison of epidural analgesia and cryoanalgesia in thoracic surgery.
A prospective study was carried out in 120 patients undergoing elective thoracotomy for parenchymal disease. Patients were randomized into three groups: A (control group), B (epidural analgesia), C (freezing of intercostal nerves). Subjective pain relief was assessed on a linear visual analog scale. Analgesic requirements were evaluated during the 12 days following surgery, or until discharge if earlier. The vital capacity (VC) and forced expiratory volume in 1 s (FEV1) were measured on the day before operation and on the 1st, 2nd, 3rd and 7th postoperative days (POD). Subjective pain relief was significantly better in Group B in comparison with Group A (P < 0.05) or C (P < 0.05). Group C had the lowest score on the 11th and 12th POD but differences were not statistically significant. Requirements for intravenous analgesics were lower in Group B than in the control group (P < 0.05) during the first 3 POD, and in group C than in the control group the day of operation (P < 0.05). Oral analgesic requirements, when compared with controls, were lower in group B during the first 5 POD, and lower in group C on the 3rd and the 4th POD (P < 0.05). Cryoanalgesia led to a slight but not significant increase in VC and FEV1. Epidural analgesia led to a significant increase when compared with controls in FEV1 during the first 3 POD, and in FVC on the 7th POD (P < 0.05). It is concluded that epidural analgesia led to the best pain relief and restoration of pulmonary function after thoracotomy.(ABSTRACT TRUNCATED AT 250 WORDS)
Analgesia, Epidural↗
Double lung transplantation for adult respiratory distress syndrome after recombinant interleukin 2.
Patients suffering from acute respiratory failure are considered poor candidates for lung transplantation (LT). We report a successful double lung transplantation performed in a patient with adult respiratory distress syndrome (ARDS). The 32-year-old woman received recombinant interleukin 2 (rIL-2) three months after an autologous bone marrow transplant for acute myelogenic leukemia as consolidation treatment. After four days of treatment with rIL-2, she developed ARDS which worsened over a three-week period, despite treatment. Lung transplantation was carried out as ultimate treatment. The postoperative course was uneventful. The patient is alive and in a good condition 11 months after LT. This case demonstrates the feasibility of LT in selected patients with ARDS. However, this case is exceptional since lung grafts should be utilized preferably for evaluated and accepted patients in transplant programs.
Adult↗
Double-lung transplantation using donor lungs with a right tracheal bronchus.
A 58-year-old man underwent sequential bilateral lung transplantation. On the donor heart-lung block, it was discovered that the right apical segment was supplied by a tracheal bronchus. After the separate implantation of both lungs, a right apical segmentectomy was performed and the postoperative course was uneventful. The management of this problem is discussed.
Bronchi↗
Endovascular stents for bronchial stenosis after lung transplantation.
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Adult↗
[Diffuse infiltrative lung diseases: histological support of elementary lesions observed on tomodensitometry].
High resolution computed tomography (TDM-HR) is now the technique of choice in the diagnosis and management of diffuse infiltrative lung disease (PID). After a brief review of the technique the authors describe the normal appearance; anatomical observations and the in vivo findings have shown that TDM-HR allow for the exploration of details of structure down to the second pulmonary lobule. Thus, through the alterations that are transmitted in the lobular area, and from its contents and its limits, PID has led to the elaboration of a new semeiology. The authors review the basic computed tomographic images and correlate these in each case with the histological evidence. The spatial distribution and the time sequence of the elementary images are the two other terms in the diagnostic equation of PID. The spatial distribution of several elementary images presents in TDM-HR a superior aetiological pointer to that which is furnished by thoracic radiographs; and the time sequence may furnish a useful indication as to the progress of the treated disease. Sarcoidosis, histiocytosis X, idiopathic interstitial fibrosis and lymphangitis carcinomatosis would serve as examples. Nevertheless, the authors point out that it would be dangerous during the period of evaluation to prematurely extend to all cases of PID conclusions which are only possible to make at present in a restricted number of disorders.
Histiocytosis, Langerhans-Cell↗
[Primary liposarcoma of the mediastinum: contribution of MRI to the diagnosis. Apropos of a case].
An exceptional case of liposarcoma arising in posterior mediastinum is reported in a young woman. CT fails in diagnosis because no area of fatty density was found. MR features were suggestive of this etiology.
Adult↗
[Long-term tolerance of inhaled corticosteroids].
The effect of inhaled steroids on adrenal glands of asthmatic subjects are often difficult to assess because subjects may have received oral steroids before. Moreover, even if the Synacthen test is abnormal, it does not necessarily mean that the adrenals are clinically inefficient. Adrenal insufficiency can certainly occur at high doses of inhaled steroids. Possible long term effects on bone are under study. Ecchymosis has been described. Oropharyngeal candidiasis is frequent but rarely symptomatic and responds well to treatment. Hoarseness is rare but troublesome. In children, inhaled steroids, even taken at low dose, can induce growth impairment. After cessation of inhaled steroids, adrenal insufficiency is only theoretical. Asthmatic flare-ups are more of a threat. Although inhaled steroids are of remarkable efficacy and tolerance, one should not exclude the possibility of long-term negative effects, especially in children.
Administration, Inhalation↗
[Diffuse bronchomalacia after double lung transplantation. Thoughts apropos of a case].
A 40 year old woman suffered from respiratory insufficiency (arterial PaO2 = 47 mmHg) because of a chronic beryllium intoxication. On 6th June 1990, she underwent double lung transplantation with cardio-pulmonary bypass. Each lung was separately implanted via an extra-pericardial approach, and both bronchi were anastomosed at the hilum. On the seventh post operative day, a severe bilateral bronchial ischemia was noticed (black mucosa). Few weeks later, a diffuse bronchomalacia was noticed in the proximal and distal parts of both bronchial trees. To our knowledge, such a bronchial post-ischemic complication has never been reported. The explantation could be several added causes: imperfect preservation of the lung during harvesting, post operative pulmonary oedema, and operative use of an antifibrinolytic agent (aprotinin).
Adult↗
[Value of high resolution tomodensitometry in pulmonary histiocytosis X. Radiological, clinical and functional correlations].
Histiocytosis is a rare cause of diffuse interstitial pneumonia. Its aetiology is not known and the outcome is often unsatisfactory. In 10 subjects in whom the diagnosis of histiocytosis X was established at CHU in Grenoble, 7 could be followed up. We report the clinical, functional, radiological and high resolution tomographic data on these 7 subjects suffering from histiocytosis X and followed up for a period between 3 and 13 years (8 +/- 3 years). All the subjects were symptomatic at the time of diagnosis. The clinical outcome amongst the 10 subjects included 2 patients who died, 2 who stabilised, 1 worsened and there were 4 clinical cures, 1 patient was lost to follow up. The respiratory function tests of the 7 subjects who were followed up was characterised by the appearance of airflow obstruction and a significant fall in the DLCO/VA (KCO) of 68 +/- 17% of the predicted value to 43 +/- 13%. An analysis comparing the initial pulmonary radiography to the current films showed that the reticular nodular lesions tended to progress to a diminution in size, while there was an increase in the reticulation. The high resolution computed tomography was confirmed as better technique than pulmonary radiography in detailing the cystic and nodular lesions. This was the only examination which correlated with DLCO/VA (R: 0.8; p: 0.018). A progressive model for computed tomographic lesions is proposed. Computed tomography appears to be the key examination, orientating the diagnosis based on the association of the nodules and cysts and enabling a better appreciation of the severity of the pulmonary disease taking account of its excellent correlation with diffusion.
Adult↗
[The effect of continuous peri-thoracic negative pressure on nocturnal desaturation of chronic obstructive bronchopneumopathies].
The fall of functional residual capacity (FRC) in the genesis of nocturnal desaturation in chronic airflow obstruction (COPD) continues to be discussed. This hypothesis is being tested by applying a negative continuous thoracic pressure using a cuirass/poncho attached to a pump for one night (night II) after a control night with a cuirass/poncho at atmospheric pressure (night 1). Seven subjects with a mean age of 61 +/- 9, with a mean weight of 108 +/- 21% of their ideal weight, who were suffering from severe airflow obstruction with a mean forced expired volume (FEV1: 39 +/- 20% th., FEV1/FVC: 35 +/- 9%, PaO2: 60 +/- 3 mmHg, PaCO2: 42 +/- 4 mmHg). These seven subjects had two polysomnographies on the two successive nights. During night II, the FRC was increased by 0.33 +/- 0.6 L by applying a continuous negative thoracic pressure of 10 +/- 1 cm of water. A significant decrease in the sleep time was noted (248 +/- 86 min vs 316 +/- 74 min, p less than 0.02) also the efficacy of sleep (54 +/- 9% vs 71 +/- 15% vm p less than 0.02). There was no difference between the two nights as regards the distribution of the sleep stages. In 2 subjects, the hypopnoea-apnoea index passed from 0 to 11 and from 4 to 22 respectively. The principal result was the absence of any significant difference in mean nocturnal oxygen saturation between the two nights.(ABSTRACT TRUNCATED AT 250 WORDS)
Female↗
Transitional hydronephrosis of the newborn and infant.
Between 1986 and 1988, 187 hydronephrotic renal units were discovered antenatally in 134 subjects and confirmed in the neonatal period. Of these cases 119 (64%) were due to anomalies of the ureteropelvic junction. The remainder (36%) were due to various congenital uropathic conditions. Investigation consisted of renal ultrasonography, voiding cystourethrography and diuretic renography with 99mtechnetium-diethylenetriaminepentaacetic acid augmented with furosemide. Of the 119 renal units 36 (30%) underwent pyeloplasty, while 42 (35.7%) were considered normal without obstruction or dilatation. In 41 units (34.3%) diuretic renography showed partial obstruction or dilatation without obstruction that washed out readily with furosemide. Serial renal ultrasonography and renography were performed in these patients. A 12-month followup showed improvement or stabilization in 80% of the renal units and deterioration to significant obstruction in 20%. In attempting to identify the renal units that were most at risk for deterioration, it was realized that the initial ultrasound had a predictive role. None of the mildly hydronephrotic units deteriorated, whereas 14% of the moderately hydronephrotic and 32% of the markedly hydronephrotic units showed further deterioration. However, whether diuretic renography initially demonstrated partial obstruction or dilatation without obstruction, the ultimate outcome could not be predicted. Based on this experience an algorithm is proposed for the evaluation and management of antenatally detected hydronephrosis with currently available imaging techniques.
Female↗