[Transbronchial needle aspiration. France in the slow lane of Europe!].
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Biopsy, Needle↗
Biomedical subjects
J M Vergnon
Publications and source records attributed to J M Vergnon.
[Medical-surgical treatment of pulmonary infection with Mycobacterium malmoense].
CASE REPORT: We report the case of a patient with chronic obstructive pulmonary disease in whom pulmonary infection due to mycobacterium malmoense was discovered unexpectedly. A diagnostic and therapeutic surgical resection was performed. CONCLUSION: The non-tuberculous mycobacterium was identified by culture of the specimen. Surgery was followed by empirical antibiotic treatment with rifampicin and pyrazinamide for two and a half months. Isoniazid was withdrawn rapidly on account of hepatitis and the treatment was supplemented later with clarithromycin, leading to a total duration of treatment of seven and a half months. This case is unusual because of its medico-surgical management that led to assessment and appropriate treatment of this infection.
Anti-Bacterial Agents↗
Influence of exercise training on cardiac baroreflex sensitivity in patients with COPD.
Decreased spontaneous cardiac baroreflex sensitivity (BRS), which could lead to the onset of cardiovascular events, has been demonstrated in chronic obstructive pulmonary disease patients. This study evaluates the effects of an exercise training programme on BRS. Twenty-one chronic obstructive pulmonary disease patients (mean+/-SD age 62+/-9 yrs; forced expiratory volume in one second 43.6+/-18.1% of the predicted value) with mild hypoxaemia (arterial oxygen tension 8.96+/-1.18 kPa) were compared to 18 healthy age-matched subjects. BRS was calculated as the slope of the baroreflex sequences between spontaneous changes in systolic blood pressure and subsequent consecutive relative risk deviation length, and was measured in the supine position and following head-up tilt for sympathetic stimulation. Pulmonary function test results and blood gas levels, measured only in patients, did not change after the training programme. Exercise training increased the maximal sustained workload (16.5%) and peak oxygen consumption (20.5%). Before training, BRS was lower in patients than in controls (2.7+/-1.5 versus 7.8+/-4.9 ms x mmHg(-1)) and tilting induced a smaller reduction in BRS (13 versus 34%). After training, BRS increased to 3.4+/-2.6 ms x mmHg(-1) in patients but remained lower than in controls. The response to the tilt test remained unchanged after training. It is concluded that, in chronic obstructive pulmonary disease patients, exercise training is associated with a gain in spontaneous baroreflex sensitivity, reflecting cardiovascular benefits.
Baroreflex↗
Summary report of the Standards, Options and Recommendations for the management of patients with non-small-cell lung carcinoma (2000).
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Antineoplastic Combined Chemotherapy Protocols↗
[Positional hypoxaemia complicating a Bochdalek hernia in an adult].
Bochdalek hernias are the result of a congenital defect of the postero-lateral part of the diaphragm, usually discovered in the neonatal period. The diagnosis is rare in adult life and usually follows an acute gastro-intestinal complication. We report the case of a 63 year old man presenting with positional hypoxaemia that could have been related to a left sided Bochdalek hernia.
Hernia, Diaphragmatic↗
[Exercise test and evaluation of exertional dyspnoea in former coal miners].
The decrease in pulmonary function tests (PFTs) in retired coal miners who complain of increased exercise dyspnoea does not precisely reflect exercise tolerance. PFTs and a maximal cardiopulmonary exercise test in order to determine peak were performed in thirty-eight patients (69.7 +/- 6.7 years old). They also completed a six-minute walk test (6MWD) in order to evaluate its sensibility to detect a limitation of peak. Quality of life was assessed by the Saint George's Hospital Respiratory Questionnaire (SGRQ). PFTs were within normal values in 21 patients whereas 8 patients showed an obstructive pattern, 4 a restrictive one and 5 gas exchange abnormalities only. We found a mild decrease in peak at 70.4 +/- 15.9% of reference value. Exercise limitation was explained by a poor ventilatory adaptation in 36.8% of cases, cardiac abnormalities in 23.7% and both in 7.7%. 6MWD was within normal at 83.7 +/- 15.6% of reference value. Neither peak, maximal workload nor 6MWD correlated with the results of PFTs. In patients with normal pulmonary function, the 6MWD had an 80% sensitivity at predicting a decrease in peak. The total SGRQ index of 51% represents the effect of dyspnoea on quality of life. We conclude that there is moderate impairment of maximal exercise capacity in one third of retired coal miners complaining of exercise dyspnoea, irrespective of PFTs results. We suggest that 6MWD could be used to detect a decreased exercise tolerance in these patients with normal PFTs, but should be followed up with a maximal cardiopulmonary exercise test if found to be abnormal.
Aged↗
[Isolated intrapulmonary plasmacytoma; diagnostic and therapeutic difficulties].
Localised intrapulmonary plasmacytoma represents less than 5% of all extramedullary plasmacytomas. Their diagnosis is usually made difficult by a radiological presentation and non specific endoscopic findings as well as non contributory biochemical and cytological data. This often justifies the recourse to more invasive histological investigation aided by immunohistochemical techniques. We report the case of a patient who presented with an isolated plasmacytoma in the form of two parenchymatous pulmonary masses and who was treated by a combination of surgical resection and external radiotherapy. A search for multiple intraosseous myeloma remained negative. Unfortunately a relapse in the form of mediastinal invasion occurred 6 months after the completion of treatment and led to the death of the patient.
Aged↗
Invasive thymoma: a clinical study of 23 cases.
BACKGROUND: Invasive thymoma is a rare mediastinal tumor. Clinicopathological characteristics that influence survival of patients with this tumor are under debate. Treatment is based on tumor resection. The benefice of therapies, such as radiation therapy (RT) and/or chemotherapy (CT) as adjuvant treatments to surgery, or palliative therapy to unresectable or recurrent thymoma are discussed. OBJECTIVES: The aim of this study was to assess patients with invasive thymoma, with specific emphasis on factors predicting survival. METHODS: We studied retrospectively 23 patients with invasive thymoma. Parameters assessed were age, presenting symptoms, histological features, stage at diagnosis, treatment modalities and survival. All patients received primary therapy: 11 patients (48%) had tumor resection associated with CT and/or RT, while 12 patients had palliative therapy including RT and/or CT. Regimens for CT were based on cisplatin. RESULTS: Patients' mean age was 58 years. Three patients had stage II disease at diagnosis (13%), 8 patients had stage III (35%) and 12 patients had stage IV (52%). Median overall survival was 20 months (range: 4-160) and five-year survival rate was 43.5% (10 patients). Surgical resection had a significant impact on survival (p < 0.0001). Survival was also related to stage of the disease at diagnosis (p = 0.006), but not to histology of the tumor (p = 0.12). Salvage treatment was of clinical importance: 5 out of 15 patients (33.3%) who relapsed during a 5-year follow-up responded to a multimodality therapeutic approach that affected survival (p = 0.019). CONCLUSION: Factors determining the outcome of these tumors are the stage of the disease at diagnosis, and the adequacy of surgical removal. Salvage treatment of recurrent thymoma may give a moderate response rate and improve survival.
Combined Modality Therapy↗
Cryotherapy in early superficial bronchogenic carcinoma.
BACKGROUND: Treatment of early superficial bronchogenic carcinoma (ESBC) is under debate, and no consensus has been achieved. Different therapeutic methods have been proposed, including surgical resection and endoscopic methods. STUDY OBJECTIVE: To assess the efficacy of cryotherapy in patients with ESBC. PATIENTS AND METHODS: Patients included in the study had histologically proven ESBC after fiberoptic bronchoscopy. Cryotherapy was performed through a rigid bronchoscope. Efficacy was assessed by endoscopy with multiple biopsies 1 month after treatment and during the follow-up period. Parameters studied were response to treatment, adverse effects, and survival. RESULTS: We included 35 patients (34 men and 1 woman). The mean age was 61 +/- 9 years. Multiple locations of ESBC were observed in seven patients (20%). Complete response rate at both 1 month and 1 year was 91% (32 patients). No severe adverse effects were noted. Local recurrence was observed within 4 years in 10 patients (28%). A follow-up period of at least 4 years was available in 22 patients; of them, 11 patients (50%) were long-term survivors. CONCLUSION: Our results suggest that cryotherapy is an effective method of treatment in patients with ESBC. Due to its relative tolerance compared to surgery, cryotherapy could be proposed as a first-line therapy in this population with high carcinogenic risk.
Adult↗
[Standards, options and recommendations for the management of locally advanced non small cell lung carcinoma].
CONTEXT: The "Standards, Options and Recommendations" (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French Cancer Centres and specialists from French Public Universities, General Hospitals and Private Clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the management of locally advanced non small cell lung carcinoma. METHODS: Data were identified by searching Medline and the personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to independent reviewers and to the medical committees of the 20 French Cancer Centres. RESULTS: The main recommendations are: 1) The management of the locally advanced non small cell lung carcinoma has two main goals: firstly to obtain local control of the disease (or to at least delay local progression in order to improve the survival or relapse free survival), and secondly to prevent the development of metastases. 2) There is a consensus that locally advanced non small cell lung carcinoma should be irradiated. External beam radiotherapy should be of optimal quality and delivered at a minimal dose of 60 Gy by standard fractionation. For patients with a poor life expectancy, this can be delivered as a split-course or hypofractionated scheme. 3) Treatment for patients with a performance status of 0-1 should consist of short duration induction chemotherapy (with a least two drugs one of which must be cisplatin), combined sequentially with conventional radiotherapy. 4) Surgery is contraindicated in extensive N3 disease. Combined radio-chemotherapy (adjuvant or neoadjuvant) is not indicated outside clinical trials. Surgery is justified in stage N2 disease as good local control can be achieved. T4-N0 disease should be treated surgically with curative intent.
Adult↗
[Standards, Options and Recommendations for the management of stage I or II primary bronchial cancers treated exclusively with radiotherapy].
CONTEXT: The 'Standards, Options and Recommendations' (SOR) project, started in 1993, is a collaboration between the Federation of the French Cancer Centres (FNCLCC), the 20 French cancer centres and specialists from French public universities, general hospitals and private clinics. The main objective is the development of clinical practice guidelines to improve the quality of health care and outcome for cancer patients. The methodology is based on literature review and critical appraisal by a multidisciplinary group of experts, with feedback from specialists in cancer care delivery. OBJECTIVES: To develop clinical practice guidelines according to the definitions of the Standards, Options and Recommendations project for the management of stage I and II non small cell lung carcinoma treated by radiotherapy alone. METHODS: Data were identified by searching Medline and personal reference lists of members of the expert groups. Once the guidelines were defined, the document was submitted for review to independent reviewers, and to the medical committees of the 20 French cancer centres. RESULTS: The main recommendations for the management of stage I and II non small cell lung carcinoma treated by radiotherapy alone are: 1) The curative external irradiation with a continual course is an alternative to surgery only in the case of medically inoperable tumors or because the patient refuses surgery; 2) The external irradiation of the primary tumor only without the mediastinum could be proposed in peripheral stage IA. In proximal stage IA and IB, external irradiation should be carried out only as part of prospective randomised controlled trials comparing a localised irradiation of the primary tumor with a large irradiation of the mediastinum and the primary tumor. The treated volume must include the macroscopic tumoral volume with or without the microscopic tumoral volume and with a security margin from 1.5 to 2 cm; 3) There is a benefit to delivering a total dose in the primary tumor higher than 60 Gy in so far as the proposed irradiation, taking into account the respiratory function, does not increase the likelihood of severe adverse events due to radiation; and 4) The change in fractionation, the radiochemotherapy combination, the endobronchial brachytherapy with high dose rate alone or with external irradiation could be proposed only as part of prospective controlled trials for tumors classified as stage IB or II.
Aged↗
Decreased production of local immunoglobulin A to Pneumocystis carinii in bronchoalveolar lavage fluid from human immunodeficiency virus-positive patients.
An enzyme-linked immunosorbent assay and a Western blot analysis were developed to study the antibody response to Pneumocystis carinii in serum and bronchoalveolar lavage fluid from 27 human immunodeficiency virus 27 (HIV)-infected patients with P. carinii pneumonia (Pcp), 32 patients without Pcp, and 51 HIV-negative controls. Urea was used for the correct dilution of epithelial lining fluid, and albumin was used to evaluate transudation from plasma for the assessment of local production of antibodies to P. carinii. By contrast with those of immunoglobulin G (IgG), IgA responses to P. carinii were increased in serum from HIV-positive patients compared to negative controls. Local production of antibodies to P. carinii, especially IgA, was decreased in patients with Pcp. In a study of 10 patients of each group, IgG and IgA responses to gp116 from P. carinii were lower in patients with Pcp than in other groups. These results suggest that, in addition to alveolar macrophages, local antibodies may play a role in host defense against P. carinii.
Animals↗
Efficacy and tolerance of a new silicone stent for the treatment of benign tracheal stenosis: preliminary results.
STUDY OBJECTIVE: In inoperable patients with tracheal stenosis who are treated using silicone stents, stent migration occurs in 18.6% of cases. To decrease the migration rate, we have designed a new silicone stent with narrow central and larger distal parts. This study analyzes the stability and tolerance of this new stent. DESIGN: Preliminary prospective study conducted in two French university hospitals. PATIENTS: Thirteen inoperable patients with benign complex tracheal stenosis due to intubation or tracheotomy. INTERVENTIONS: Tracheal stent insertion was performed under general anesthesia with a rigid bronchoscope. The patients were followed up clinically up to stent removal, which was planned at 18 months. RESULTS: Stent insertion or removal was very simple and did not differ from other silicone stents. No migration occurred after a mean follow-up of 22.8 months. Minimal granuloma formation occurred in only one patient (7.7%). Sputum retention remained similar to that with other silicone stents and could be improved by a smoother internal wall. Stents have been removed in seven patients after a mean duration of 19.6 months, with a complete stenosis cure in four cases. CONCLUSION: This new stent combines the excellent stability of the metallic stents and the tolerance and easy removal of straight silicone stents. This allows a prolonged use in order to obtain curative action.
Adolescent↗
Reduced cardiac sympathetic autonomic tone after long-term nasal continuous positive airway pressure in obstructive sleep apnoea syndrome.
The increased sympathetic activation that occurs in obstructive sleep apnoea (OSA) may play an important role in associated morbidity. We investigated the effect of long-term (3 month) nasal continuous positive airway pressure (CPAP) on the autonomic nervous system assessed by heart rate variability (HRV). Fourteen patients (12 men), mean age 61.4 +/- 8.1 years, with OSA underwent continuous synchronized electrocardiographic and polysomnographic monitoring. The apnoea/hypopnoea index (AHI) decreased from 50.6 +/- 13.7 to 2.2 +/- 2.5 events h-1 after CPAP. HRV analysis showed significant decreases in low frequency (LF; from 7.12 +/- 1.06 to 6.22 +/- 1.18 ln ms2 Hz-1; P < 0.001), high frequency (HF; from 5.91 +/- 0.87 to 5.62 +/- 0.92 ln ms2 Hz-1; P < 0.05) and LF/HF (from 1.21 +/- 0.12 to 1.11 +/- 0.15 ln ms2 Hz-1; P < 0.001) when the patients were asleep. The decrease in LF/HF was prolonged into the daytime (from 1.33 +/- 0.22 to 1.24 +/- 0.21 ln ms2 Hz-1; P < 0.001). Treatment of OSA by CPAP significantly reduced the parameters of cardiac sympathetic tone, a favourable effect.
Adult↗
[Bronchial laser: techniques, indications, and results].
Laser emits a light characterised by being monochromatic, phased and collimated. Since the beginning of the '80s the fibers ND-YAG laser, whose energy may be transmitted by quartz fibres, is the type principally used for therapeutic bronchoscopy. It may be used to coagulate or to vaporize endoluminal lesions. The effect looked for depends on the level of density of power selected. During rigid bronchoscopy, YAG laser is usually applied in the coagulation mode, with a weak liberation of energy. Further resection is then achieved mechanically with the rigid tube or forceps. For malignant lesions the laser has a palliative action in eliminating endoluminal tumour mass. Its use has overturned the management of progressive tracheal or bronchial asphyxia. Outside emergencies, its action can be combined with radio and chemotherapy. For benign lesions its action may be curative. The laser is however poorly adapted for extrinsic compression and for infiltrating lesions where other more appropriate endoscopic methods should be used.
Bronchoscopy↗
[Endobronchial brachytherapy: techniques and indications].
Endobronchial cryotherapy has seen significant developments in France, particularly since 1984. It is a method of relieving obstruction based on the cytotoxicity of low temperatures. Flexible or rigid probes are used with nitrous oxide. Immediate cytotoxicity is doubled up with a delayed but intense vascular effect explaining the haemostatic efficacy of this technique. Tumour destruction is invariable without risk of perforation but necrosis is delayed occurring within 10 or 15 days. The technique is not adaptable to emergency situations but acts perfectly well on very cellular or vascular tumours. Its indications are complementary to laser assisted resection and enable the treatment of infiltrating lesions, local implantation or early neoplasms. Theoretically the histological and vascular effects should potentiate the effects of radiotherapy and chemotherapy. Randomised protocols are underway to establish the clinical relevance of this.
Brachytherapy↗
[Therapeutic endoscopy. Synthesis].
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Bronchoscopy↗
Microsatellite instability and loss of heterozygosity at chromosomes 9 and 17 in non-small cell lung cancer.
BACKGROUND: Microsatellite instability (MI) and loss of heterozygosity (LOH) are described in lung cancer specimens. However, their importance in tumorigenesis remains unknown. The aim of this study was to identify the presence of MI and LOH in human tumor and normal bronchial mucosa DNA. METHODS: We performed biopsies with fiberoptic bronchoscopy and took specimens from the tumor and from the opposite site normal bronchial mucosa in 20 patients with non-small-cell lung cancer (NSCLC). Four patients had an adenocarcinoma, while 16 had a squamous cell carcinoma. Also, 6 patients had an early-stage disease (stages I and II), while 14 patients had an advanced-stage disease (stages III and IV). All paired specimens were studied for MI and LOH on chromosome 17p, 17q, 9p, and 9q, with 10 polymorphic markers. RESULTS: Sixteen of 20 tumors displayed genetic alterations (80%). Six tumors (30%) exhibited MI, five tumors (25%) exhibited LOH, while five tumors exhibited MI and LOH concurrently. The marker HBX had the most frequent incidence of LOH (4/20, 20%), indicating that the hbx gene becomes a strong candidate tumor suppressor gene, whereas of MI it was D17S515 (4/20, 20%). No relationship was observed between the presence of LOH or MI and the histologic subtype of NSCLC or the stage of the disease. CONCLUSION: Results suggest that genetic alterations exist in tumor, compared with the normal mucosa DNA. They may have a role in carcinogenesis as they exist in all stages and in both NSCLC histologic subtypes studied.
Adenocarcinoma↗