[Rare complication: septic incident during a respiratory function test].
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Biomedical subjects
Publications and source records attributed to F Blanchon.
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The authors report 9 cases of primary pulmonary lymphoma (PPL). With this report, together with the publication of recent and important studies and with the latest advances in immunology, the principal features of this rare entity are emerging from among other lymphoproliferative pathologies of the lung. As a rule, PPL is a histologically well-differentiated tumour with low malignancy and slow course. Treatment is surgical in localized forms. In extensive forms there is no firmly established treatment, but the absence of clinical symptoms permits therapeutic abstention.
The authors report a case of lymphangiomatosis (LAM) proven histologically in a 49 year old female. This case benefitted from very detailed CT-scanning (IDM) with characteristic images obtained from the thorax and bilateral renal tumours suggestive of angiomyolipomas. This association seems to be quasi-pathognomic of the disease. The discovery at CT-scanning of cerebral calcification raises a possible connection of LAM with Bourneville's tuberous sclerosis. This CT-scanning study has several points of interest: the early diagnosis of pulmonary lesions which are under evaluated by standard radiography; a complete inventory of the possible localisations of the disease; it enables a possible diagnosis in very frail patients in whom a lung biopsy would be a risk; an ability to assess further progress as there also exists a good correlation between the extent of the disease assessed by TDM and the disturbance in pulmonary function.
We report the case of a 61-year old man in whom ablation of a hilar tumour enabled us to diagnose a mediastinal plasmacytoma. Plasmacytomas are rarely found in the mediastinum and sometimes evolve towards myelomas. The best treatment seems to be surgery combined with radiotherapy. The effectiveness of chemotherapy against this tumour is questionable.
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Between January 1981 and December 1983, a prospective therapeutic trial of detorubicin (14-diethoxyacetoxy-daunorubicin [DTR]) was conducted in 40 patients with histologically proven malignant mesothelioma (MM). DTR was given intravenously at 40 mg/m2 on days 1, 2, and 3 for five 21-day cycles, then 40 mg/m2 once every 21 days. Thirty-five patients (32 with pleural MM, 3 with peritoneal MM) were eligible. The overall median survival from onset of chemotherapy was 17 months. Complete relief from chest pain was observed in 8 of 15 cases (53%). Of 21 patients with measurable disease, there were 2 complete responses (10%) and 7 partial responses (33%). Median duration of response was 30 weeks. Congestive cardiac failure developed in two patients after 1100 and 1600 mg/m2 of DTR, respectively. Hematologic toxicity was moderate. This study demonstrates that DTR is effective against MM.
A new case of carcinoid tumour of the thymus is reported. Such tumours are extremely rare and of somber prognosis when accompanied by local or regional metastases or metastases in other organs.
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From 5 cases of partial anomalous pulmonary venous drainage of the left lung into the innominate vein, it has been thought of interest to situate this type of venous anomaly among the partial anomalous pulmonary venous drainage classification. It is revealed in 2 different ways. In adults, this malformation sets the problem of the diagnosis of an abnormal chest Xray, without symptom. In children, this vascular abnormality is discovered during the exploration of a congenital cardiopathy which causes the main symptoms. Embryological data are reviewed and statistics of frequency which lead to show that this type of partial anomalous venous drainage is often misunderstood, particularly with regard to anomalous venous drainage of the right lung.
An Algerien patient aged 31 years with a histologically confirmed mediastinopulmonary sarcoidosis had a persistent stable miliary pulmonary x-ray image after cortisone therapy. Eighteen months after stopping the corticotherapy, he developed cryptococcosis which was mainly cutaneous, but associated with subcutaneous abscesses and peripheral adenopathy, and without lesions in the viscera or deep nodes. Cryptococcus antigens were present in the serum and there was a humoral and cellular immunity reaction towards the cryptococcus. Recovery occurred after amphotericin B and 5-fluorocytosine.
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The authors report a case of left-sided abnormal partial pulmonary venous return. This abnormality was discovered following weight loss with a strongly positive tuberculin skin test. A plain chest X-ray showed an externally convex opacity filling the aortico-pulmonary space, suggestive of a lymphadenopathy in that area. Pulmonary angiography and selective opacification of the different afferent branches of this abnormal vein defined the territory of drainage of this A.P.V.R.
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After 3 personal observations of pleural fibromas, 67 analogous cases have been recorded. Clinical, radiological and pathological signs are recalled. The authors stress the 2 points which can turn this benign tumour into a serious disease :--onset of major hypoglycemia,--recurrences happening in a malignant fashion.
Cystic lymphangioma localized only in the mediastinum is a rare type of primitive tumour (less than 1% of the mediastinum primitive tumours). These three new observations concern lymphangiomas with an anterior position ; therir anatomical connections with the lymphatic system are difficult to show. Treated by surgery these benign tumours have a good prognosis and only a few cases of local recurrences have been reported.