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K Atassi

Publications and source records attributed to K Atassi.

15 recordsLinked to original sources
PubMed2003

[Impact of prior biological assessment of coagulation on the hemorrhagic risk of fiberoptic bronchoscopy].

INTRODUCTION: The goals of the study were to test the value of coagulation tests to predict bleeding events during fiberoptic bronchoscopy (FOB) and to identify risk factors. METHODS: A monocentric prospective study of 426 procedures performed by one physician was realized. A standardized questionnaire and coagulation tests including prothrombine time, activated cephaline time and platelets counts were performed before the procedure. Bleeding events, defined by a loss of more than 50 ml of blood, were recorded for all patients. RESULTS: 44 patients (10.3%) had bleeding events, modifying the procedure in 19 cases. No death occurred following FOB during the study. Among the 17 patients with abnormalities on coagulation test before FOB, only one had significant bleeding. Two risk factors were found as predictors of bleeding events: nose or gum bleeding (OR=4.99, CI (95%) [2.6-9.5]; p<0.001) and left cardiac failure (OR=4.53, CI (95%) [1.7-12.1]; p<0.01). CONCLUSION: This study shows that abnormalities on coagulation tests are not predictive for bleeding events. Nose or gum bleeding and left cardiac failure may be risk factors for bleeding events during FOB.

Adolescent↗
PubMed2000

Use of tumor markers for differential diagnosis of mesothelioma and secondary pleural malignancies.

STUDY OBJECTIVE: The aim of the study was to assess diagnosis value of tumor markers for differential diagnosis between mesothelioma and other pleural tumors. DESIGN AND METHODS: Prospective study of 85 patients attending our hospital with malignant pleural effusion. The diagnostic approach involved routine pleurocentesis followed by pleural needle. When precise diagnosis was not achieved, thoracoscopy with pleural biopsies was performed. Carcinoembryonic antigen (CEA), hyaluronic acid, tissue polypeptide antigen and cyfra 21 to 1 were measured in serum and pleural fluid. RESULTS: By using receiver operating characteristics curves and area under curves, the best diagnostic characteristics were obtained with pleural and serum CEA concentrations. The area under the curve was larger for pleural ACE than for serum ACE. The sensitivity and specificity of a pleural CEA level exceeding 3 ng/mL for ruling out the diagnosis of mesothelioma were 100% and 77%, respectively. CONCLUSION: A CEA level above 3 ng/mL in pleural fluid eliminated the diagnosis of mesothelioma, whereas the other markers were not sufficiently discriminant. However, despite a negative predictive value of 100% at a cutoff of 3 ng/mL, CEA assay in pleural fluid only avoids a small number of diagnostic thoracoscopies.

Adenocarcinoma↗
PubMed2000

[Evaluation of occupational exposures in lung cancer].

Occupational lung cancers are underestimated by the number of cases compensated in the French National Insurance System. Rules of compensation of occupational diseases were recently modified in France. Therefore a study was conducted on incident cases of lung cancer in a general hospital in the Paris area. The aim was to evaluate the exposure to carcinogens using data of a detailed specific occupational questionnaire, and to determine the number of cases who could receive compensation. Two hundred and seven subjects (171 males, 36 females, mean age = 64.5 years) were eligible in 1996, and 122 had an occupational questionnaire. Definite exposure to one or more occupational carcinogens in at least one job was identified in 50 subjects, the most frequent agent was asbestos (42 subjects). Claim for compensation was done in 32 subjects, mainly for asbestos (30 subjects). This study emphasizes the frequency of occupational exposure to carcinogens, and the usefulness of systematic occupational questionnaire in subjects having lung cancer. Social and financial consequences are important for these subjects. Further studies are needed, with recruitement of control subjects to allow calculation of the attributable risk to occupational factors in lung cancer.

Aged↗
PubMed1997

[Diagnosis of pleurisy].

Diagnosis of pleural effusion, suggested by chest pain or dyspnea, is assessed by physical examination, chest X-ray sometimes completed by other imaging techniques, and mainly by thoracentesis. Thoracentesis is mandatory for the diagnostic of pleural effusion as three diagnosis are associated with an emergency treatment: pulmonary embolism; hemothorax; empyema. If the fluid is a transudate, no further invasive studies are necessary. If the cause of pleural exsudat cannot be established by a careful history, physical examination and fluid analysis, generally closed pleural biopsy should be done, followed, in absence of an established diagnosis, by thoracoscopy. At this time, less than 10% of the cases remain without explanation, leading to a careful follow-up of patients since a carcinomatous lesion may develop in 1/3 of them.

Biopsy, Needle↗
PubMed1994

Secondary alveolar proteinosis is a reversible cause of respiratory failure in leukemic patients.

We report here our experience of secondary pulmonary alveolar proteinosis (PAP) in patients with hematologic malignancies. The diagnosis of PAP was made by bronchoalveolar lavage (BAL) and based on the identification of periodic acid-Schiff-positive proteinaceous material with the characteristic ultrastructural pattern. Ten patients with leukemia and secondary PAP are described. Three patients had received bone marrow transplants. Data obtained from sequential BAL have shown that at least four of them--all of them achieving complete remission or recovery from neutropenia after bone marrow transplantation--had reversible PAP, and we emphasize this potential reversibility. Furthermore, in order to estimate the frequency of PAP in hematologic patients, we retrospectively studied 113 episodes of pneumonia occurring in our department over a 2-yr period. The incidence of secondary PAP in patients with pulmonary symptoms was so estimated at 5.3% among all the hematologic population, and to 10% in patients with myeloid disorders. This report (1) confirms that BAL is an accurate way to diagnose PAP in immunocompromised hosts, (2) emphasizes that PAP is not an unusual cause of respiratory failure in this population and that it is strongly associated with myeloid disorders, and (3) shows that secondary PAP is potentially reversible, especially if complete remission of the underlying disease is achieved.

Adolescent↗
PubMed1988

[Peripheral bronchopulmonary cancers. Diagnostic efficiency of fibroscopic samples. Prospective study on 561 patients].

The purpose of this french multicentric study was to evaluate the diagnostic accuracy of samples collected by fibroscopy in peripheral lung cancer with normal endoscopy. Five hundred and sixty-one patients entered the study; a tumour had been diagnosed in 350 of them (62 p. 100). Among these 350 patients, 147 were examined with the help of a light-amplifier screen, and a positive diagnosis was made in 97 (66 p. 100). Guided sample collection in the pathological area (biopsy, brushing, transcatheter aspiration) proved much more rewarding than unguided sample collection (biopsy of the bronchus, simple aspiration or cytology of 3-day sputum): 45 p. 100 positive results versus 18 p. 100 (P less than 0.001). However, sputum cytology still had good diagnostic value since it provided by itself the diagnosis in 14 p. 100 of the cases. Results were significantly inferior in tumours less than 3 cm in diameter.

Adult↗
PubMed1986

Bronchoalveolar lavage fluid and serum complement activity in pulmonary sarcoidosis.

In this work, using bronchoalveolar lavage fluids (BALF), we demonstrated the presence of complement within airways by assaying hemolytic activity of the whole classical pathway (CH50) and by measuring the complement component C2 (C2H50). Patients with sarcoidosis, patients with idiopathic pulmonary fibrosis (IPF), and healthy control subjects were compared. No CH50 activity was found in BALF from healthy control subjects (n = 9), but some activity (mean, 20 CH50) was associated with IPF (n = 7). Complement activities ranged from 40 to 554 CH50 in patients with sarcoidosis (n = 27). During the treatment, complement activity decreased in BALF from the few patients in our series who received corticotherapy. C2 hemolytic activity was detected in BALF from the normal control group (in the absence of CH50 activity). In the sarcoidosis and IPF groups when CH50 was present, the variations in the C2/CH50 ratio were studied. The high ratio observed in BALF from patients with sarcoidosis and a chronic derangement of alveolar structure suggests either an increased C2 production or an alternative complement pathway (C2-independent) activation within their lungs.

Adult↗
PubMed1985

Diagnostic yield of bronchoalveolar lavage in pneumonitis occurring after allogeneic bone marrow transplantation.

Fifty-two bronchoalveolar lavages (BAL) were performed in order to investigate 46 episodes of pneumonitis that occurred after allogeneic bone-marrow transplantation. No complications have been attributed to this procedure. A specific etiologic diagnosis was obtained in 24 of 46 episodes (52%) by 26 of 52 BAL (50%). Cytomegalovirus (CMV), diagnosed by the presence of typical inclusions, was the pathogen most frequently identified by BAL (13 of 46 episodes) and was associated with other causes of pneumonia in 4 patients. The other causes of pneumonitis diagnosed by BAL were: giant-cell pneumonia: 1, aspergillosis alone: 3, Pneumocystis carinii: 1, Hemophilus influenzae: 3, isolated pulmonary hemorrhage: 3. One false negative (aspergillosis, n = 1) was diagnosed at autopsy. The overall mortality rate of these episodes was 24%. Thus, BAL appears to be a rapid and reproducible diagnostic method for monitoring pneumonitis in grafted patients, particularly CMV pneumonitis, and may avoid the need for surgical biopsy.

Adolescent↗
PubMed1981

[Diagnostic value of fiberoptic bronchoscopy in pneumopathies in immunodeficient adults: a report on 59 examinations (author's transl)].

Fifty-nine fiberoptic examinations with endobronchial sampling, brushings, distal bronchial biopsy, and alveolar lavage were conducted during the course of recent pneumopathies in immunodeficient adults with malignant hemopathies (41 cases), solid tumors (7 cases), and other affections (11 cases). Diagnosis was established by fiberoptic bronchoscopy in 4 cases with specific locations of hemopathy or cancer, after bronchial biopsy, in 5 cases of mycoses, after bronchial biopsy, aspiration and/or alveolar lavage, in 4 patients with bacterial pneumonia after bronchial aspiration, and in 1 case of pneumocystosis, after distal biopsy. Diagnosis was not confirmed in the other cases. Mortality (50 p. cent) was similar in the diagnosed group and the group without confirmation of diagnosis. No significant complications due to the examination were observed, except for worsening of the respiratory condition in 7 patients with hypoxemia. The role of fiberoptic bronchoscopy in causing these alterations cannot be excluded. Fiberoptic bronchoscopy appears to be a safe examination except in patients with hypoxemia (PaO2 less than or equal to 50 mmHg). Distal biopsy appeared to be of less value than bronchial biopsy in these patients, as there was a positive correlation between the results of the latter examination and the macroscopic lesions observed in all cases.

Adult↗
PubMed1980

[Efficiency of bronchial and trans-bronchial lung biopsies in 45 cases of sarcoïdosis (author's transl)].

Forty five patients with suspected sarcoïdosis underwent bronchial and trans-bronchial lung biopsies in the course of fiberoptic bronchoscopy. Specific histologic lesions were found in 51% of the bronchial biopsies (23/45) and in 67% of trans-bronchial biopsies (30/45). The combination of these two different technics of biopsy has significantly increased the efficacity of fiberoptic bronchoscopy in the diagnosis of sarcoïdosis (87%: 39/45). [P. < 0,01]. The presence of specific histologic lesions in the trans-bronchial biopsy was independent of the presence or absence of pulmonary parenchyma in the biopsy. The results were classified according to the radiologic stages of the disease. The trans-bronchial lung biopsy, which is described, is well tolerated. Only one complication was observed (partial pneumothorax).

Adolescent↗
PubMedDate not supplied

Right atrial myxoma: an unusual cause of intracardiac right-to-left shunt.

A case of a right-to-left intracardiac shunt caused by a right atrial myxoma is reported. Sudden hypoxaemia was the unique symptom. Measurement of Pao2 while the patient breathed pure oxygen demonstrated the presence of a shunt. Right heart catheterization showed a patent foramen ovale and a pressure gradient between the right atrium and the right ventricle, and between the right and the left atria, explaining the shunt. Cineangiography demonstrated a right atrial myxoma, which was surgically removed. This case report illustrates how a step-by-step diagnostic procedure, based on pathophysiology, may lead to such unexpected findings.

Adult↗