Alveolar microlithiasis and immunological disorders.
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Adult↗
Biomedical subjects
Christophe Pinet
Publications and source records attributed to Christophe Pinet.
Function and bulk of respiratory and limb muscles in patients with cystic fibrosis.
Inspiratory muscle weakness due to lung hyperinflation and muscle wasting may occur in cystic fibrosis. We therefore measured diaphragm function and bulk in 18 stable patients with cystic fibrosis and 15 matched control subjects; the abdominal and quadriceps muscles were studied for comparison. We assessed diaphragm mass, abdominal muscle thickness, twitch transdiaphragmatic and gastric pressures, quadriceps cross-section and isokinetic strength, and lean body mass. Lean body mass, quadriceps strength, and quadriceps cross-section were lower in patients with cystic fibrosis. Twitch transdiaphragmatic pressure was 23% lower and twitch gastric pressure was 22% greater in patients with cystic fibrosis than in control subjects, but diaphragm mass and abdominal muscle thickness were similar in the two groups. For any given lean body mass and quadriceps cross-section, patients with cystic fibrosis had greater diaphragm mass and abdominal muscle thickness. Diaphragm mass had greater intersubject variability in patients with cystic fibrosis than in control subjects. We conclude that diaphragm strength is decreased but abdominal muscle strength is increased in patients with cystic fibrosis. Diaphragm and abdominal muscle bulk are not affected by the general muscle wasting, which suggests that there may be a training effect of cystic fibrosis on respiratory muscles. However, the variability of diaphragm mass indicates that this beneficial response does not occur in all patients with cystic fibrosis.
Abdominal Muscles↗
[Bronchial obstruction in asthmatic patients is underestimated by general practice physicians].
INTRODUCTION: Many asthmatics have few or no symptoms despite severe obstruction of the airways. Physicians confronted with this phenomenon may therefore underrate the severity of the asthma and treatment may be insufficient. We studied the capacity of a group of general practitioners to assess the bronchial obstruction of patients presenting with varying degrees of symptoms and obstruction. METHODS: Ten asthmatics were initially examined by a pneumologist. The patients were classified as: normal (N; no dyspnoea, no wheeze, normal spirometry; n = 2); abnormal (A; dyspnoea and whistling, bronchial obstruction; n = 4); falsely normal (FN; mild or no dyspnoea and no wheeze, bronchial obstruction; n = 4). Ten randomly selected general practitioners, ignoring the protocol and aim of the study, examined 6 patients, 2 from each category. They then had to choose from a list of antiasthma treatments, those that would be appropriate for each patient, and assess on a visual analog scale (VAS) the degree of respiratory tract obstruction at the time of examination. Finally, questions on their knowledge and approach to asthma were asked. RESULTS: The VAS assessments (mm) were of 15.6, 65.2 and 11.0 in the FN, A and N patients, corresponding to a maximum expiratory volume per second of 52, 51 and 98% of the predicted values. Dyspnoea and wheeze were mentioned by each physician as criteria for respiratory tract obstruction. Although they also mentioned the laboured breathing, none noted the signs of thoracic distension, present in the falsely normal patients. None used the paradoxical pulse (inspiratory drop in systolic pressure) and/or spirometric measurements; nobody had noted that dyspnoea and wheeze can be lacking despite substantial obstruction of the airways. Five had prescribed beta 2 agonists alone, without corticosteroid therapy in falsely normal patients. CONCLUSION: General practitioners may underrate the severity of asthma, despite substantial obstruction of the respiratory tract, if there are few symptoms and hence under-treat falsely normal patients.
Adolescent↗
Management of an intrabronchial rupture of right main pulmonary artery: a case report.
We report a case of massive endobronchial hemorrhage following a fistula formation of the right pulmonary artery to the right mainstem bronchus in a 15-year-old girl. The fistula had occurred 39 days after the patient had undergone bilateral lung transplantation for cystic fibrosis. The post-transplantation course was remarkable for bronchial colonization by Aspergillus at the site of right bronchial anastomosis and an episode of spontaneous, self-limited hemoptysis on postoperative day 17. A massive endobronchial hemorrhage during surveillance bronchoscopy occurred 39 days after transplantation. Immediate intervention, including rigid bronchoscopy followed by surgery, was effective in saving the patient. The pathophysiologic hypothesis to explain the fistula of the right pulmonary artery to the right mainstem bronchus probably involves ischemia of the anastomosis with necrosis of the suture zone complicated by endobronchial infection with Aspergillus. Rigid bronchoscopic intervention associated with an excellent medical surgical collaboration was pivotal in successfully rescuing the patient.
Adolescent↗