Biomedical subjects
Publications and source records attributed to F Blanc-Jouvan.
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.
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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.
We have seen four cases of granular cell tumor (Abrikossoff's tumour) and it is recalled that these tumours are most often discovered fortuitously by bronchoscopy in the tracheo-bronchial region because they have a non specific clinical presentation. The cytological and histological characteristics enable an accurate diagnosis but there are problems posed as to the histogenesis of these tumours. With a tumour with a slow progression regular surveillance with regular biopsies seems preferable as in certain cases the tumour regresses spontaneously or disappears after ablation with the forceps. A good alternative approach is destruction of the tumours with a laser in certain complicated forms which enables one to avoid surgical excision.
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%.
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We report a case of spontaneous bilateral chylothorax appearing in a woman suffering from kyphoscoliosis. A cure was obtained after one pleural tap and three weeks of rest with a special alimentary diet. We discussed as a possible cause the tearing of the thoracic duct secondary to movements resulting from the hyperextension of the vertebral column.
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A distinctive form of sarcoidosis is reported. A young woman, without any past medical history, presented with a cannon-ball radiographic appearance and a fever, suggesting an infection or underlying neoplasm. A lung biopsy gave the diagnosis of sarcoidosis after negative fibreoptic bronchoscopy, bronchial lavage and needle biopsy. This macronodular form of sarcoidosis is known but rarely described. There was a favourable clinical and radiological outcome, which occurred spontaneously.
The relation between bronchial cancer and fibrous scars still remains controversial. We report, with regard to a typical case, the histological arguments for this hypothesis in the knowledge that only a clinical history and above all a radiographic progress will evoke the carcinomatous transformation. We report on the diagnostic peculiarities, the evolution, the therapeutic approach and histogenetics of bronchial cancers developing on a scar. This association and the interest of pursuing these investigations in the presence of evocative clinical or radiographic anomalies enable a better understanding of the natural history of bronchial cancer.
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.
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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.
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%).
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.
In a prospective study 128 community acquired pneumoniae were treated with a macrolide (josamycin) by oral route. Patients improved in 94 p. 100 (113). Complications were as following: 2 deaths, 2 sequels, 3 failures. Authors discuss macrolides effectiveness in acute pneumoniae, particularly pneumococcal ones. They conclude macrolides are a good choice in first intention in acute pneumoniae of adults.
In 76 patients the diagnosis of the mediastinal extension of a bronchial cancer, assessed by computed tomography (CT), was compared to histological specimens obtained by mediastinoscopy and surgery (58/76). The extension to mediastinal nodes was present in 26 subjects (34.2%) and yet was not recognised 15 times on CT. There were 15 false negatives (FN) and 3 false positives (FP). Sensitivity 43%, specificity 94%, predictive value for positives (VPP) 70%, predictive value for negatives (VPN) 75%. Extension was present in 18 patients. These were recognised 14 times by CT. There were no false positives. (Sensitivity 70%, specificity 100%, VPP 100%, VPN 94%). We conclude That CT is useful for diagnosing direct mediastinal extension and allows the juxta-hilar extension of the cancer to be assessed. CT has no place in the diagnosis of mediastinal gland involvement. Mediastinoscopy (5.2% FN; no FP) is better than TDM for the diagnosis of extension to the mediastinal nodes both for peripheral and central cancers.