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Biomedical subjects

J C Guérin

Publications and source records attributed to J C Guérin.

At least 19 recordsLinked to original sources
PubMed1995

[Diagnostic difficulties in angiosarcoma of the pulmonary artery with hemoptysis].

Intimal sarcomas growing from the pulmonary trunk or branches of the pulmonary artery, are rare tumours in which the diagnosis is most often made at autopsy or during a thoracotomy. Usually the clinical pictures is non specific resembling a severe pulmonary embolus which is resistant of all treatment. With the help of new imaging techniques, a pre-operative diagnosis is made in more than half the cases. When there is a tumour which is relatively localised and without endoluminal invasion, as in the observation reported here, the diagnosis rests on the histology from the operative specimen.

Angiography↗
PubMed1994

[Demonstration of sulfite-group-specific IgE in patients with intolerance to preservatives].

On the basis of the selection of a population of patients intolerant to sulfites by the clinical history, a simple blind oral provocation test and a basophil activation test, we explored the basophil activation reaction induced by sulfites after passive sensitisation of blood donors basophils. We demonstrated that the percentages of activation obtained with a non covalent reagent (MBS-HSA), a covalent reagent (sulfonyl-HSA) and the optimal concentration of an anti-IgE were not significantly different. Human basophil activation was negativated by heating the transferred sera and by competition with a monoclonal human IgE. We also observed mediator release (histamine and LTC4) with a low frequency, histamine release being strictly related to the carrier protein concentration. In two cases, sulfite specific IgE were detected by ELISA. These results are in favour of the specificity and the IgE dependent nature of basophil activation induced by sulfites.

Antibody Specificity↗
PubMed1994

[Analysis of membrane expression of the CD63 human basophil activation marker. Applications to allergologic diagnosis].

On the basis of the CD 63 bi-modal expression on the membrane of activated basophils, we set up a flow cytometric method for the analysis of human basophils activation by an anti-IgE and anti-CD 63 double labelling. We demonstrated that the statistical characteristics of the percentages of activation obtained by an anti-IgE stimulation allowed the use of this method for pharmacological studies. The percentages of activation were of the same order of magnitude than those obtained by histamine release. CD 63 expression was also observed for a low affinity allergen such as the sulfonyl-HSA conjugate used for sulfites hypersensibility diagnosis, healthy donors being negative. This method, which can be automatized may represent an interesting candidate in the field of hapten hypersensitivity which lacks of reliable diagnostical methods.

Alcian Blue↗
PubMed1992

[Use of inhaled beclomethasone dipropionate in adult asthma].

Beclomethasone dipropionate has now been used for more than 10 years during which our knowledge of how to use inhaled corticosteroids has gradually improved: high dose initial treatment followed by progressive reduction down to the minimum effective dosage; administration in 2 daily doses when the asthma is stable and 4 daily doses in case of instability; mild and transient undesirable effects, often minimized by a correct use of the inhaler; effectiveness assessed from bronchial hyper-reactivity and respiratory function tests, reduction or avoidance of oral corticosteroid therapy, or results of association with other treatments, and in particular bronchodilators. When exactly should inhaled corticosteroid therapy should be started and how long should it be pursued are controversial points, but an early and prolonged treatment must probably be recommended.

Administration, Inhalation↗
PubMed1992

[Cystic tumor of the mediastinum of digestive origin. Apropos of a new case. Diagnostic and pathogenic hypotheses].

An incidental discovery of a posterior and inferior mediastinal cyst-like opacity allowed us to diagnose a pulmonary sequestration in a 45-year old woman. The operative findings showed an hour-glass tumor of the inferior mediastinum with an abdominal prolongation attached by a stalk onto the top of the stomach. These findings made us change our diagnosis in favour of an abdomino-thoracic gastric duplication. This new hypothesis was not confirmed by the results of the pathological report which revealed two kinds of tissue; intestinal in the abdomen and broncho-pulmonary in the chest. Two diagnoses where then proposed: complex hamartoma or mediastinal bronchogenic cyst. The pathogenic interpretation in such cases is still very controversial. English authors are prone to classify them as broncho-pulmonary foregut malformations. Macroscopic and microscopic data of the specimen led us to consider our case-report to be a foregut malformation.

Angiography↗
PubMed1992

[Prolonged effect against exercise-induced bronchospasm: salmeterol versus sodium cromoglycate].

Nineteen subjects with isolated exercise-induced asthma (FEV1, FEF25-75%, PEFR, FVC greater than 95% predicted values, fall in FEV1 of at least 15% after exercise, typical recent symptoms of exercise-induced asthma, no other treatment) were entered in a multicenter trial carried out in a double blind, double placebo, cross-over manner. After a one-month baseline period, subjects underwent an exercise after inhaling 100 micrograms of salmeterol (n = 12) or 40 mg of sodium cromoglycate (n = 7). Treatments were alternated before the second exercise which took place at least 2 days after the first. Efficacy was assessed by examining changes in FEV1, FEF25-75% after exercise carried out 30 minutes and 7 hours after administering the treatment by comparison with baseline values (assessments done 1, 10 and 30 minutes after exercise, lowest of three values kept for the analysis of each parameter). FEV1 and FEF25-75% were significantly higher 30 minutes after taking salmeterol. Salmeterol was found to be superior to sodium cromoglycate for all parameters 7 hours after administering the drug. Both treatments were well tolerated. This study confirms that the longer duration of effect of salmeterol and its superiority by comparison with the standard treatments of exercise-induced asthma.

Adrenergic beta-Agonists↗
PubMed1992

[Cytologic examinations during bronchial endoscopy. Bronchial brushing and aspiration].

Bronchial cytology has become an essential diagnostic means in lung pathology for the diagnosis and typing of primary or secondary lung cancers. Bronchial cytology, initially consisting in the study of expectorations, has become increasingly interesting with the development of flexible fiberendoscopes, which allow the visual exploration of areas of the lungs as far down as the subsegmental bronchi. The effectiveness of this type of cytology applied to detected and located lesions accounts for the development of aspiration and brushing. However, the obtention of good cytological results primarily depends on the operator's and nurse's experience, as well as on the quality of the preparation of the slides and of their interpretation in the laboratory.

Biopsy↗
PubMed1992

[Epidemiology of legionnaires' disease. From myth to reality].

Legionella disease is among the leading causes of acute pulmonary infections. Nevertheless, the precise frequency remains difficult to assess because of its clinical aspects, the empirical treatment and the diagnostic requirements. According to the existing literature, the frequency of Legionella infections varies from 1 to 15% of documented pulmonary infections. In a survey carried out in 1990 in the Lyon area, the precise incidence of infections due to Legionella in daily medical practice has been estimated according to various types of practice. In general practice, only one case of Legionella infection was proved among 88 pulmonary infections. This weak incidence is also found in hospital practice: 10 cases among 398 hospitalized pulmonary infections in pneumology; none of 158 cases of severe pulmonary infections hospitalized in intensive care units. On the other hand, of 162 cases of hospitalized AIDS patients in a unit specialized in infections, two cases of Legionella infections were diagnosed. In a multidisciplinary 876 bed hospital, 16 cases of pulmonary infections due to Legionella were seen in 1990 by comparison with 32 cases in 1989 (chlorination of water since 1988). The data of Centre national de référence (Fleurette) report figures of 400 cases per year since 1985, without any change from one year to the other. These data are nevertheless underestimated. Global mortality is of 10%. No acquired resistance during the treatment is observed and infections caused by Legionella are consistently sensitive to macrolides, rifampicin and fluoroquinolones.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1991

[A predominant manifestation of pleural cryptococcosis in acquired immunodeficiency syndrome].

Systemic cryptococcosis occurs in at least 6% patients with human immunodeficiency virus infection (HIV). The lung infection by cryptococcus neoformans, less frequently observed than meningeal involvement, consists usually in focal parenchymal mycosis. Authors report an apparently isolated pleural cryptococcosis in a 41 years old mal with HIV infection. Diagnosis was performed initially by pleural and bronchial alveolar lavage (BAL) fluid culture. Characteristic cryptococcosis pathological and histologic findings from thoracoscopy and open pleural biopsy are described. Cryptococcus capsular polysaccharides stainings and thoracoscopy interests are emphasized.

Adult↗
PubMed1991

[Talc therapy during thoracoscopy of pneumothorax due to rupture of the bullae in emphysema. A study of 71 cases].

The treatment of pneumothorax for large emphysematous bullae is classically surgical. We report a study of 71 patients treated by pleural talc therapy using thoracoscopy with good or excellent long term results in 93% of cases at a cost of some minor side effects. These results were compared with other forms of medical treatment which were always less effective and with surgical techniques which had more severe side effects. These results enable us to stress the value of talc therapy using pleuroscopy in patients with respiratory failure.

Administration, Topical↗
PubMed1990

[Pleurodesis technics].

In patients with recurrent malignant or benign pleural effusion practitioners use specific treatments, but they are then faced with the problem of pleural fluid recurrence. Several techniques of pleurodesis have been used, including drainage, surgery, intrapleural injections and poudrage. From an analysis of the results obtained and from our own experience, we have come to the conclusion that poudrage under thoracoscopy is the best type of pleurodesis.

Antineoplastic Agents↗
PubMed1990

[Small cell lung carcinoma. Value of the evaluation of extension for the therapeutic strategy].

Small-cell lung carcinoma can be distinguished from other histological types of lung cancer because of its high metastatic potential. Initial staging procedures divide the patients into two main prognostic groups: the so-called "limited" (to the thorax) and the extensive disease patients. Based on the results of a prospective pilot study involving 182 patients and on a review of the literature, the authors discuss the usefulness of initial staging in increasing the number of detectable metastases, assessing tumour burden, evaluating treatment results and identifying prognostic factors. Complete tumour staging at the time of diagnosis appears to be very helpful for a better knowledge of the disease and better therapeutic decisions.

Adrenal Gland Neoplasms↗
PubMed1990

[High-dose cisplatin in primary non resecable non small cell lung cancer. Results of a multicenter prospective study of 57 cases].

In a prospective multicentre phase II study conducted on 57 patients suffering from carcinologically inoperable non small-cell lung carcinoma, three courses of CDDP 200 mg/m2 were administered at random in 2 dosage regimens: either 100 mg/m2 on Day 1 and Day 8 (arm A), or 40 mg/m2 per day during 5 consecutive days (arm B), every 28 days, with supportive hydration. All 27 patients were assessable for toxicity: there were 10 cases of major intolerance (grade 4 n = 3, grade 3 n = 7) and 34 cases of minor intolerance (grades 1 and 2). Only 27 of the patients who received the 3 planned courses (19 in arm A, 8 in arm B) were assessable for effectiveness which was poor: 10.5% objective response in arm A and 0 response in arm B. Thus, high-dose CDDP administered alone was poorly tolerated and insufficiently effective; intermittent infusions during 5 days did not improve tolerance and were totally ineffective.

Adult↗
PubMed1990

[Bronchial tuberculosis. Report of 4 cases].

Four cases of bronchial tuberculosis are reported. The first case was revealed by signs of bronchitis; in the second patient M. tuberculosis was found at light microscopy but x-ray films of the chest were normal; the third patient presented with signs of bronchitis and upper lobe infiltration on fibrous sequelae; the fourth patient showed a pseudo-tumoral bronchial image. These cases and those of the literature show that clinical signs are usually those of bronchitis sometimes with the systemic symptoms of tuberculosis. Chest radiography may be normal or may display disorders of ventilation of lung opacities suggestive of recent tuberculosis. Endoscopy reveals granular inflammation with whitish secretion and progressive stenosis. Diagnosis rests on bacteriological and pathological examinations. Medical treatment does not differ from the standard one. Sequelae consisting of bronchial stenosis or bronchiestasis are extremely frequent. Bronchial tuberculosis is now seldom encountered and usually affects elderly women. However, it may now become more frequent due to the greater number of cases of tuberculosis with a slightly atypical course, as found in AIDS patients.

Aged↗
PubMed1990

[Thoracic sympathectomy by thoracoscopy. Apropos of 15 cases].

Thoracic sympathectomy is generally performed by thoracotomy. Apart from the surgical approach, the thoracoscopic technique allows vision and physical or chemical destruction of the thoracic sympathetic system. We studied the possibilities of their technique. Thoracoscopy is performed under local anesthesia after creation of a pneumoserosa. Local anesthesia of the second sympathetic ganglion is performed. The ganglion is destroyed by injection of 8cc of phenol. Fifteen patients have been treated (15 to 70). The first five patients were failures and led to improvement of the technique. We have 8 good results. If we exclude the first five patients, we observe 8 good results and 2 failures. The thoracoscopic approach to the second sympathetic ganglion is not always possible (local pleurodesis). When it is possible, the results of local treatment by phenol are as good as those of surgery.

Adolescent↗
PubMed1990

[A rare cause of pleurisy from subdiaphragmatic origin: epidermoid cyst of the spleen].

Subdiaphragmatic diseases are a classical but uncommon cause of pleural effusion. We report here the case of a woman admitted for a left pleural effusion which led to the discovery of a splenic tumour. Pathological examination of the splenectomy specimen showed that the tumour was an epidermoid cyst of the spleen. Cysts of the spleen are exceptionally revealed by pleurisy. Epidermoid cysts account for 10% of all non-parasitic splenic cysts. They remain silent for a long time and are usually disclosed by such complications as compression of surrounding organs, rupture or superinfection.

Adult↗
PubMed1990

[Thoracic sympathectomy by thoracoscopy. Apropos of 15 cases].

UNLABELLED: Thoracic sympathectomy is achieved using the trans-axillary route during the course of a thoracotomy. The indications are Raynaud's phenomenon, digital arteriopathy, and hyperhidrosis. Alongside the surgical approach in theory it is possible to use a thoracoscopic approach for a thoracic sympathectomy, to achieve a physico-chemical destruction, we have studied this possibility using this technique. MATERIAL AND METHODS: Thoracoscopy is achieved under local anaesthetic after creating a pneumothorax. The approach is through the 2nd intercostal space in the mid-clavicular line. Anaesthesia of the 2nd sympathetic ganglion is achieved, the ganglion is destroyed by injection of 8 c.c's of Phenol. 15 patients were treated (15 to 7). The presented with palmar hyperhidrosis (7), digital arteriopathy (6) or Raynaud's syndrome (2). RESULTS: The first 5 patients were failures which led to a more precise technique. Overall we observed 8 favourable results. If we exclude the first 5 cases we achieved 8 favourable results and 2 failures. The approach to the 2nd sympathetic ganglion using the thoracoscope is not always possible: the vision may be obscured. When it is possible phenolization may yield excellent results comparable to those of surgical sympathectomy. CONCLUSION: Palmar hyperhidrosis for which we have obtained the best results seems to us to be an extra indication of this technique which enables a cure at the price of a relatively simple procedure and a brief period of hospital stay.

Adolescent↗