Biomedical subjects
J P Homasson
Publications and source records attributed to J P Homasson.
[Cryotherapy in pneumology. Review of basic and clinical data].
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[Horner's syndrome after thoracic drainage].
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[Fulminant hepatitis induced by pyrazinamide].
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[A new use for intrabronchial cryotherapy: extraction of foreign bodies].
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Development of an enzyme immunoassay for the serodiagnostic of tuberculosis and mycobacterioses.
An enzyme-linked immunosorbent assay (ELISA) test has been developed for the serodiagnosis of mycobacterioses. The test is based on an interspecific antigen, antigen 60 (A60). This antigen belongs to the group of thermostable macromolecular antigens and is the principal constituent of tuberculin RT 23. A60 is composed of proteins, polysaccharides and lipids in a ratio that varies with the growth cycle of the mycobacterium. The test detects antibodies against mycobacteria and is most effective in cases of active infections. We found that the best way to cope with the day-to-day variations in the results obtained was to transform the absorbance values into arbitrary IgG units. The variations observed with IgM antisera were, however, too great to allow more than a qualitative test. Healthy individuals are negative in the IgG and IgM tests and tuberculous patients are usually positive in the IgG test. The presence of IgM antibodies was only rarely observed. For IgG antibodies, the best discriminative power at a 1:100 dilution of the analyzed sera seemed to lie at 125 sero-units. It was found that some sera originating from clinically documented tuberculous cases responded in a poor way in this test.
Pleural and lung cryobiopsies during thoracoscopy.
Cryotherapy through rigid bronchoscopy has been used in the past three years in the treatment of endobronchial tumors. We performed pleural and lung cryobiopsies during thoracoscopy. The hemostatic properties and the quality of the histopathologic specimens obtained using this technique offer an innovative approach to the diagnosis of pleural effusion with associated lung disease.
[Recommendations apropos of contraindications and precautions in the use of bronchial cryotherapy with a flexible catheter].
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Cryotherapy in pulmonology today and tomorrow.
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[Malignant non-Hodgkin's lymphoma of tracheo-bronchial sites].
The case of a 66 years old male patient with multiple tracheal and bronchial lesions of non-Hodgkin lymphoma is reported. This was a disseminated form of low-malignancy lymphoma, as shown by histological findings. The lesions disappeared after 10 courses of chemotherapy, and no sign of recurrence was observed during a 3 years' follow-up. It is concluded that the prognosis of this disease depends on histology rather than on anatomical spread.
Unexpectedly normal cilia and spermatozoa in an infertile man with Kartagener's syndrome.
We investigated a 28-year-old, infertile male patient with the characteristic clinical signs of Kartagener's syndrome (i.e. bronchiectasis, recurrent sinusitis, situs inversus). The patient had tried unsuccessfully for 3 years to become a father, and no cause of infertility was detected in his wife. The functional capacities tested in vitro of nasal and tracheal ciliated cells, spermatozoa and neutrophils were found to be normal. The tracheo-bronchial clearance was not impaired. The ultrastructure of ciliary and flagellar axonemes was normal. This case of Kartagener's syndrome without axonemal abnormalities raises the questions of the factors responsible, on the one hand, for the patient's organ asymmetry and respiratory tract diseases and, on the other hand, for the couple's infertility.
[Cryotherapy in the treatment of tracheobronchial obstructions of tumor origin].
The effects of cold on tissues result in necrosis through crystallisation and thrombosis. These properties, utilized for many years in certain fields of medicine, can now be applied to bronchial tumours, using semi-rigid or flexible cryodes introduced into bronchoscopes. In our experience the results, evaluated by clinical, radiological, endoscopic or even histological improvement, were good in 7 out of 8 cases of benign tumours and in 16 out of 30 cases of malignant tumours. Complications were minimal. This relatively cheap and very simple method constitutes a good alternative to laser in the same pathologies.
[Treatment of tracheobronchial granuloma by cryotherapy].
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Bronchoscopic cryotherapy for airway strictures caused by tumors.
This study reports an application of cryosurgery for the treatment of tracheobronchial tumors. Bronchoscopic cryotherapy can be applied in patients who are not candidates for other traditional therapy. The technique utilizes a nitrous oxide cryoprobe, introduced through a rigid bronchoscope. The principal feature of this probe is to be nonrigid. The cryodestruction is controlled by an impedance metric method. The study group consisted of 27 patients ranging in age from 39 to 88 years. The most frequent diagnosis was squamous cell carcinoma (14). For malignant tumors, the objective was obtained in 13 cases out of 21. Cryotherapy successfully destroyed five benign granulomas. Four or six days after cryotherapy, bronchial biopsy specimens usually showed a necrotic substance, and tumoral tissues were entirely destroyed. The time of survival is probably extended and the quality of life bettered. Most visible tumors are now reached with a flexible cryoprobe, inserted in a flexible bronchoscope.
Regression of bronchial epidermoid metaplasia in heavy smokers with etretinate treatment.
Forty heavy-smoker (over 15 packets per year) volunteers were selected for and have completed a 6-month etretinate treatment on the basis of an index of metaplasia (IM) greater than 15% determined according to the following procedure: bronchoscopy with systematic biopsies in ten sites of the bronchial tree. Each biopsy was cut into ten sections and an IM was calculated: IM = number of sections with epidermoid metaplasia/number of sections examined X 100. Etretinate, a retinoid derivative, was given orally at the daily dose of 25 mg, at the end of which patients underwent a second fibroscopy protocol. A highly significant reduction of IM (P = 10(-5)) was observed after 6 months of treatment for those of the patients who maintained their smoking habits during treatment. Besides, the four patients who stopped smoking while under treatment and are excluded from the statistical analysis all had a complete regression of metaplasia at the second fibroscopy. No morbidity was due to etretinate or fibroscopy. Etretinate significantly reduces potentially precancerous bronchial epidermoid metaplasia in heavy smokers. Its association with smoking arrest may induce a rapid restoration of bronchial epithelium to normal.
Correlation of bronchial epidermoid metaplasia with level of tobacco consumption in heavy smokers.
One hundred forty-four heavy-smoker (125 males, 19 females) volunteers with at least 15 packet-year of smoking experience (number of daily packets of cigarettes X number of years of smoking) underwent bronchoscopy with systematic biopsies in ten sites of the bronchial tree. No morbidity was related to the fibroscopy procedure. Each biopsy was cut into ten sections and an index of metaplasia (IM) was calculated: IM = number of sections with epidermoid metaplasia/number of sections examined X 100. A highly significant statistical correlation was observed (P = 10(-4)) between the IM and the amount of cigarettes smoked (slope of the curve: 0.23). Sex appeared to play an important role in the incidence of metaplasia, since 84% of the examined females had an IM less than 15% versus 48% of the males (P adjusted for individual tobacco consumption in packet-years less than 0.01). Early study of HLA phenotype (locus A) failed to detect a link between HLA and risk of tobacco-induced epidermoid metaplasia.
Fluorescence as a guide to bronchial biopsy.
The presence of fluorescence was assessed in 34 unselected patients undergoing bronchoscopy, 11 of whom suffered from bronchial carcinoma. Bronchoscopic inspection was carried out with white light and then repeated with blue light after the injection of 2 ml of 10% sodium fluoresceinate. Fluorescence was graded visually. Seventy six pairs of biopsy specimens were obtained. Of 38 specimens from non fluorescent areas, histological appearances were normal in 34. Slight inflammation was observed in three biopsy specimens, and in one there was evidence of tumour even though the specimen was obtained some distance from the primary tumour. Of 38 biopsy specimens from fluorescent areas, histological examination showed appearances of moderate inflammation in 10, severe inflammation in 10, tuberculosis in one, and carcinoma in 11. In six instances histological appearances were normal. Five normal subjects who were smokers were also examined by the same technique. Appearances of metaplasia were found more often in areas showing fluorescence than in areas not showing fluorescence. Bronchial fluorescence is considered to be related to alteration in vascularity and is not specific for carcinoma. The most fluorescent areas are generally the most pathological and visible tumour is very fluorescent, but moderate degrees of fluorescence are difficult to interpret. Biopsy of every fluorescent area seems excessive.
Regression of bronchial epidermoid metaplasia in heavy smokers with etretinate treatment.
40 voluntary heavy smokers (over 15 packets-years) were selected for and have completed a six months etretinate treatment on the basis of an index of metaplasia (IM) greater than 15% determined according to the following procedure: bronchoscopy with systematic biopsies in 10 sites of the bronchial tree. Each biopsy was cut into 10 sections and an IM was calculated: (Formula: see text). Etretinate, a retinoid derivative, was given orally at the daily dose of 25 mg, at the end of which they underwent a second fibroscopy protocol. A highly significant reduction of IM (p = 10(-5)) was observed after 6 months of treatment for those of the patients who maintained their smoking habits during treatment. Besides, the 4 patients who stopped smoking while under treatment and are excluded from the statistical analysis, all had a complete regression of metaplasia at the second fibroscopy. No morbidity was due to etretinate or fibroscopy. Etretinate significantly reduces potentially precancerous bronchial epidermoid metaplasia in heavy smokers. Its association with smoking arrest may induce a rapid restoration of bronchial epithelium to normal.