[Pulmonary determinations of leptospirosis].
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Diagnosis, Differential↗
Biomedical subjects
G Akoun
Publications and source records attributed to G Akoun.
Vitamin D metabolism by alveolar immune cells in tuberculosis: correlation with calcium metabolism and clinical manifestations.
The aim of this study was to investigate the relationship between the pulmonary vitamin D metabolism in tuberculosis and the calcium metabolism abnormalities and other clinical characteristics of the disease. The metabolism of 25-hydroxyvitamin D3 (25(OH)D3) by alveolar immune cells recovered by bronchoalveolar lavage (BAL) was evaluated in parallel to the results of calcium metabolism, 25(OH) D and 1,25 dihydroxyvitamin D (1,25(OH)2D) plasma levels and other clinical parameters obtained in 14 tuberculosis patients. Whilst predominant metabolites produced by lavage cells in patients and controls were 5(E)--and 5(Z) -19-nor-10-oxo-25(OH)D3, 1,25(OH)2D3 was produced by cells from all tuberculosis patients but not by cells from controls. Calcium metabolism abnormalities were observed in only some patients, but the production of 1,25 (OH)2D3 by lavage cells was found to correlate both with 1,25(OH)2D levels (r = 0.67) and post-load urinary calcium excretion (r = 0.59). 1,25(OH)2D3 production by lavage cells was increased in patients of black origin, and those presenting with hilar adenopathy without pulmonary infiltrates, and was correlated with the number of lymphocytes recovered by lavage (r = 0.87). We conclude that 1,25(OH)2D3 production by alveolar immune cells makes a major contribution to the abnormalities in calcium metabolism seen in tuberculosis patients, and may be partly dependent on the clinical characteristics evaluated here.
Adult↗
[Acute drug-induced lung diseases with hypoxemia, cytotoxic drugs excluded].
Drug-induced acute lung diseases constitute a chapter of pneumology and intensive care that is now in full mutation. In practice, these diseases are still inadequately indexed and little known, the only exception being those caused by cytotoxic drugs observed in onco-haematology. They create for clinicians difficult diagnostic and therapeutic problems. From the cases reported in the literature, recent review papers and 10 personal cases, the authors ask five successive questions concerning hypoxic pneumopathies: 1) which patients?; 2) which clinical features?; 3) which initial diagnostic discussion?; 4) which are the elements likely to support the drug-induced hypothesis?; 5) which outcome?
Acute Disease↗
[Pulmonary and cerebral nocardiosis in a patient infected with HIV].
We report a case of pulmonary and cerebral nocardiosis in a patient infected with HIV. On the basis of this observation, the authors review the frequency of nocardiosis during the course of an HIV infection and the diagnostic problems proposed, and finally the therapeutic difficulties encountered.
AIDS-Related Opportunistic Infections↗
Minocycline-induced cell-mediated hypersensitivity pneumonitis.
OBJECTIVE: To identify the cause of a hypersensitivity pneumonitis and to determine its pathogenesis. DESIGN: Case study. SETTING: Intensive care unit of a referral hospital. PATIENT: A 51-year-old man with chronic bronchitis who developed a hypersensitivity pneumonitis within 1 month after exposure to minocycline, amoxicillin, and erythromycin. INTERVENTION: Sequential bronchoalveolar lavages after reexposure to minocycline and amoxicillin. MEASUREMENTS: Immunologic analysis of the phenotype and function of alveolar lymphocytes. RESULTS: Reexposure to minocycline but not to amoxicillin was followed by an interstitial pneumonitis. Sequential bronchoalveolar lavages showed a transient rise of eosinophils and neutrophils and a persistent alveolar lymphocytosis. Alveolar lymphocytes consisted predominantly of CD8+ but also CD4+ cells. Two CD8+ lymphocyte subsets were identified: CD8+ D44+ cytotoxic T cells that increased rapidly after the drug was resumed and CD8+ CD57+ suppressor T cells that predominated 11 days after the drug's withdrawal. In-vitro assays showed the presence of a lymphocyte-mediated specific cytotoxicity against minocycline-bearing alveolar macrophages. CONCLUSION: These results support the hypothesis of a central role of T lymphocytes in the pathogenesis of drug-related hypersensitivity pneumonitis.
Alveolitis, Extrinsic Allergic↗
Pulmonary Hodgkin's disease in HIV-infected patient. Diagnosis by bronchoalveolar lavage.
We report herein the pulmonary recurrence of Hodgkin's disease coincidental with a marked decrease in the peripheral blood CD4 lymphocyte count in an HIV-seropositive patient with alveolar consolidation on chest roentgenogram. The diagnosis of lung parenchyma involvement was made by bronchoalveolar lavage cell analysis and illustrates the reliability of Reed-Sternberg cell identification in bronchoalveolar lavage for the diagnosis of pulmonary localization of Hodgkin's disease.
Adult↗
[Interstitial pulmonary involvements in polymyositis and dermatopolymyositis. Apropos of 3 cases. Review of the literature].
The authors report 3 cases of myositis associated with pulmonary lesions that preceded or succeeded the muscular disorder. In one of these cases, which was particularly difficult to diagnose, the patient's serum was positive for the anti-Jol antibody. These 3 cases have encouraged the authors to review the literature with particular attention to the diagnostic approach, the latest physiopathological data and the therapeutic basis of the "specific" pulmonary lesions associated with polymyositis and dermatomyositis.
Dermatomyositis↗
[Should the extended evaluation of bronchial adenocarcinoma be different from that of non-small cell lung carcinoma?].
The records of 132 patients explored for initial evaluation of non-small cell lung cancer (NSCLC) were reviewed to find out whether the evaluation of extrathoracic extension could be influenced by anatomicopathological data. Brain, liver and bone metastases were found to be significantly more frequent in adenocarcinomas than in NSCLCs. This relative frequency was observed at all stages, including stages I and II as defined by computerized tomography of the chest, and in asymptomatic patients. We therefore recommend to evaluate fully the tumoral extension in patients with bronchial adenocarcinoma irrespective of its stage, and to do so even in the absence of clinical symptoms.
Aged↗
[Acute respiratory insufficiency caused by hyperinfestation with strongyloides. BALF diagnosis and favourable outcome].
Hyperinfestation with Strongyloides is a severe complication in immunodepressed patients. It may present with various clinical signs, notably acute respiratory failure. Diagnosis may be difficult, particularly when the strongyloidiasis is associated with septicaemia caused by Gram-negative organisms. We report a new case of hyperinfestation with Strongyloides in a patient treated for periarteritis nodosa. This case was remarkable on two scores: the diagnosis problem raised by the presence of intrapulmonary haemorrhages, and the favourable outcome of an acute and initially severe respiratory failure which had required assisted ventilation. The role played in the patient's cure by the doses of thiabendazole given and the duration of their administration is discussed.
Acute Disease↗
[Epidemiology of micro-organisms responsible for community-acquired pneumonia].
Pneumonias occupy a prominent situation among lower respiratory tract infections where they are remarkable for their potential mortality and for our relative knowledge of the responsible micro-organisms. Analysis and synthesis of each series published must answer several questions, such as: what are the lung diseases considered? which investigations have been performed? which criteria of imputability have been used? in which patients has the study been carried out? in which place, which period and which structure? In spite of methodological lacunae and of the inhomogeneous answers to the questions asked, there is some concordance between the series found in the literature. Thus, more than 90% of community-acquired pneumonias with microbiological identification are caused by Streptococcus pneumoniae, Haemophilus influenzae, Mycoplasma pneumoniae, Legionella pneumophila, Chlamydia psittaci (or pneumoniae), or Influenza A virus.
Adolescent↗
Technetium-99m-DTPA aerosol and gallium-67 scanning in pulmonary complications of human immunodeficiency virus infection.
We retrospectively compared the results of 67Ga chest scans and 99mTc-DTPA aerosol clearance measurements with those of fiberoptic bronchoscopy in 88 patients infected with the human immunodeficiency virus. Of 100 investigations, a pulmonary infection was diagnosed in 39, mainly Pneumocystis carinii pneumonia and a noninfectious disorder was found in 42, mainly Kaposi's sarcoma and lymphocytic alveolitis. Gallium scans and DTPA clearance were abnormal respectively in 74% and 92% of infectious complications, and in 12% and 60% of noninfectious disorders. In 10 cases, DTPA clearance was accelerated, while chest x-ray, arterial blood gases and even gallium scanning were normal. A value of DTPA clearance greater than 4.5%.min-1 was both sensitive and specific for the diagnosis of Pneumocystis carinii pneumonia. The gallium scan was always normal in bronchopulmonary Kaposi's sarcoma. We conclude that in symptomatic patients: (1) DTPA clearance measurements are useful for detecting lung disease when chest x-ray and/or PaO2 are normal and (2) a gallium scan is indicated to distinguish progressive Kaposi's sarcoma from a superimposed second process when radiological abnormalities of pulmonary Kaposi's sarcoma are present.
Acquired Immunodeficiency Syndrome↗
[Pleurisy in HIV infected patients].
Thirty-seven records of pleural effusion of known cause which occurred in HIV-seropositive patients hospitalized at the Tenon hospital, Paris, between 1985 and 1990 were analyzed retrospectively and divided into two groups: group 1 (n = 21) made up of kaposian effusions, and group 2 (n = 16) of infectious effusions serving as control. Numerous features distinguished group 1 from group 2 pleural effusions: In group 1 the effusion occurred in patients with cutaneous Kaposi sarcoma in 20/21 cases (P less than 0.001), developed slowly (more than 10 days) in 20/21 patients (P less than 0.001), was associated with a specific fever in only 4/21 cases (P less than 0.001), was bilateral in 20/21 cases (P less than 0.001), was regularly associated with bilateral parenchymatous opacities (P less than 0.001) and was haemorrhagic in 18/21 patients (P less than 0.001). Thus, simple semeiological features are sufficient to predict the cause of pleural effusion occurring in HIV-seropositive patients and to guide the diagnostic approach.
Adult↗
[Pleuropulmonary cryptococcosis disclosing AIDS].
The authors report a case of AIDS revealed by pleuropulmonary cryptococcosis. The infection was diagnosed by culture of the pleural fluid and confirmed by microscopic examination of the cerebrospinal fluid, using Indian ink as stain. Apyrexia and return to normal of chest radiography were obtained with oral fluconazole. Twelve months after this episode the patient is alive and had no relapse under maintenance treatment with this drug.
Acquired Immunodeficiency Syndrome↗
[Respiratory involvement in AIDS].
This review paper is divided into three parts. The first two parts are devoted to an analytical description of the clinical, diagnostic, prognostic and therapeutic aspects of the various bronchopulmonary and pleural lesions observed in AIDS. The third part presents an overall view of the main diagnostic and therapeutic approaches in the main clinical situations covering all respiratory disorders.
Acquired Immunodeficiency Syndrome↗
[Pulmonary carcinomatous lymphangitis of prostatic origin, disclosed by acute respiratory insufficiency, regressing by treatment with an LH-RH agonist].
Carcinomatous lymphangitis of prostatic origin is infrequent and usually carries a poor prognosis. The authors report a case of pulmonary carcinomatous lymphangitis related to a prostatic carcinoma. This case was remarkable for its acute mode of revelation and for its favourable outcome under treatment with LH-RH agonists.
Follow-Up Studies↗
[Radiologic case: multiple macronodular coin lesions in a 27-year-old Algerian woman].
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Adult↗
[Interstitial pulmonary involvement of polymyositis and dermatomyositis. Apropos of 3 cases. Review of the literature].
The authors report 3 new cases of myositis associated with pulmonary lesions that preceded or succeeded the muscular disorder. In one of these cases, which was particularly difficult to diagnose, the patient's serum was positive for the anti-Jo1 antibody. These 3 cases have encouraged the authors to review the literature with particular attention to the diagnostic approach, the latest physiopathological data and the therapeutic basis of the "specific" pulmonary lesions associated with polymyositis and dermatomyositis.
Adult↗
[Cutaneous alternariosis in a patient with metastatic adrenocortical carcinoma].
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Adrenal Cortex Neoplasms↗