[Isolated pulmonary Hodgkin's disease. Diagnosis and treatment].
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Adult↗
Biomedical subjects
M Perrin-Fayolle
Publications and source records attributed to M Perrin-Fayolle.
A comparison of flunisolide inhaler and beclomethasone dipropionate inhaler in bronchial asthma.
Ninety-nine patients, who had never previously taken inhaled steroids were enrolled in a randomized, single-blind, parallel study, the aim of which was to compare the efficacy and safety of flunisolide inhalation, 500 mcg twice daily, with beclomethasone dipropionate inhaler 100 mcg four times daily for the treatment of chronic asthma. The treatment period was for 6 weeks. The patients were examined clinically at entry, week 3 and week 6 and both treatment groups showed a marked improvement in almost all parameters during the course of the study. Flunisolide was statistically significantly superior to beclomethasone dipropionate for wheezing at week 6, coughing at week 6 and chest tightness at weeks 3 and 6. The number of asthma attacks per day decreased significantly more with flunisolide treatment than with beclomethasone dipropionate. The over-all evaluation of efficacy by both doctors and patients also showed flunisolide to be superior to beclomethasone dipropionate. In several other parameters there was a trend shown favouring flunisolide, and beclomethasone dipropionate did not show a superiority over flunisolide in any efficacy parameter. Both drugs were well-tolerated, with unpleasant taste being the most frequent complaint in the flunisolide group. No patient in either group withdrew from the study because of adverse events. In this study, flunisolide inhaler was more effective than beclomethasone dipropionate inhaler for the treatment of chronic asthma exhibited by patients who had never been treated with inhaled steroids.
Adolescent↗
[Beta-mimetics and tachyphylaxis].
This study covers current knowledge concerning the risks of tachyphylaxis induced by prolonged use of beta-mimetics in the asthmatic. The organization of the adrenergic membrane system is reviewed, as well as the various mechanisms which may lead to desensitization. Experimental evidence of the latter is described. The most extensive studies have involved circulating cells and, more precisely, lymphocytes and polynuclear neutrophils. Clinical trials are then dealt with. Studies concerned with bronchomotility and the possible loss of sensitivity of the bronchi after a therapeutic sequence using a sympatho-mimetic. No definite conclusion concerning this aspect can be made by review of the literature, because of contradictory results, and this regardless of the beta-mimetic used. However, it would seem that relative tachyphylaxis may develop in the bronchi. Nevertheless, the latter would not seem to be sufficiently marked in order to have clinical manifestations. Studies concerned with lymphocytes and polynuclears. Published studies are more in agreement here, demonstration of tachyphylaxis by measurement of cellular cyclic AMP or measurement of the density of receptors after impregnation by a beta-adrenergic being constant. The practical consequences of this risk is discussed, but cannot yet be accurately fixed. Therapeutic deductions from the findings described are then discussed. The protective role of corticosteroid therapy and of Ketotifen against the risk of tachyphylaxis is emphasized in particular.
Adrenergic beta-Agonists↗
[Different models for the study of a new anti-asthmatic substance].
The various physiopathological components of asthmatic disease are interwoven. Experimental models used to study the sites of impact of an anti-asthmatic substance seek to separate the different mechanisms. The in vitro bronchial tissue model is rarely available in man. Progress is being made towards the development of a multicellular and membrane experimental model. However, it is still difficult to establish links between clinical findings, the results of respiratory function tests and biological results at cell or membrane level. There would seem to be a number of essential basic factors in this area: determination of the categories of asthma studied, regular surveillance of respiratory function tests combining spirometric and plethysmographic studies with pharmacodynamic tests, precise therapeutic protocols and the simultaneous use of several cellular biological models.
Anaphylaxis↗
[Which therapeutic attitude should be adopted in the presence of non-small cell bronchopulmonary cancer?].
Complete surgical excision is the best method of obtaining cure. However, this is only possible in less than one quarter of the patients. In all of the other patients, the hopes for cure are based on combinations of chemotherapy-radiotherapy-surgery, in particular preoperative chemotherapy. Phase II trials of chemotherapy are underway. Real progress will only be achieved when joint multicentric studies can be conducted.
Adenocarcinoma↗
[Respiratory function and alveolar biological changes under the effect of CDP-choline in pulmonary interstitial pathology: pulmonary fibrosis and sarcoidosis].
Various anomalies of pulmonary surfactant have been described in relation to acute respiratory distress syndromes, hypersensitivity lung disease and pulmonary sarcoidosis. Phosphatidylcholine (PC) is the essential phospholipid component of pulmonary surfactant. Cytidine diphosphocholine (CDP-choline) is an essential intermediary in the biosynthesis of PC. The authors studied two groups of patients: one group consisted of diffuse interstitial pulmonary fibrosis and the other consisted of pulmonary sarcoidosis with parenchymal involvement. They observed quantitative and qualitative abnormalities of the phospholipid fractions of surfactant and more particularly of PC. The finding of a marked decrease in this phospholipid, especially in the cases of pulmonary fibrosis, justified the study of the therapeutic effects of CDP-choline. After one month of treatment with this substance, at a dose of 1 g I.M. per day, the PC fraction had returned to normal and, at the same time, there was an improvement in the PaO2 at rest and after exercise. Long term administration of CDP-choline appears to be valuable in the maintenance of the phospholipid equilibrium of pulmonary surfactant and in the improvement of the quality of alveolar gas exchange.
Adult↗
[Diagnostic value of passive anterior rhinomanometry in everyday allergological practice. 4 years' experience].
Passive anterior rhinomanometry used for nasal provocation tests in respiratory allergology is a very easy test to perform. On the basis of five years' experience, the authors analyse their opinion concerning this technique and review the value of nasal challenge tests in allergic rhinitis. The only real problem is that of the quality of the allergen used, this being the essential factor in terms of correlation with other diagnostic tests (for D.P.: 66.6% between challenge test and skin tests, and 78.5% between challenge test and RAST). Indications are very wide and the results of nasal challenge provide a substantial diagnostic argument when taking therapeutic decisions. However it cannot serve as a substitute for the bronchial challenge test in cases of combined rhinitis and asthma since there are differences in sensitivity and reactivity between the nasal and bronchial mucosae.
Aerosols↗
[Pulmonary sarcoidosis. Study of the distribution of active alveolitis assessed by comparison of data from radiological examination, gallium 67 scintigraphy and double bronchoalveolar lavage].
Abnormal uptake of gallium in alveolar structures, raised lymphocyte levels, ECA and, to a lesser degree, proteins in alveolar washings are the principal currently known criteria used to recognise cases of sarcoidosis with persistent immunological activity. The contribution of data concerning broncho-alveolar washings (BAW) in the context of this diagnostic assessment has never been the subject of a critical evaluation. It would nevertheless seem that the distribution of sarcoidosis lesions is not always diffuse and homogeneous, leading to the possibility of errors of assessment in this technique. The aim of the present study was to assess the true existence, degree and consequences of this risk. It was based upon the study of 41 cases of active pulmonary sarcoidosis. Search for homogeneity and heterogeneity between lesions and active alveolitis involved precise radiological study, gallium isotope scan with determination of the index of uptake as well as the quality of the latter, and double BAW carried out in the most radioactive and least radioactive regions respectively. Comparative study of the results obtained showed that zones of active alveolitis were distributed unevenly and heterogeneously in more than half of the patients (71% for gallium and 54% for BAW). This would explain the fact that in 14 cases (34%) criteria of alveolar activity were present in only one of the two specimens of washings. Identification of the zones which should be included in BAW cannot be determined accurately by radiological analysis, regardless of the degree and distribution of radiological abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)
Adult↗
[Value of realistic exposure tests in the diagnosis of occupational asthma due to exotic woods].
Respiratory pathology related to the increased use of exotic woods has become much more extensive in recent years. The recognition of occupational asthma due to these woods is easy when the history is sufficiently striking. By contrast, the diagnosis may be much more difficult because of frequent inadequacy in classical allergological and immunological tests. This leads to the need for more extensive special investigations. Realistic tests are the most valuable. In the present report, the authors describe the results of such tests in 10 cases of occupational asthma due to exotic woods. They compared history (past, clinical manifestations), results of pulmonary function tests, allergological studies (skin tests and laboratory) and realistic exposure tests. They describe the principles, value, results, limitations and disadvantages.
Adult↗
[Membrane phosphatidylethanolamine methylase in blood leukocytes and alveolar macrophages of asthmatic patients].
Phosphatidyl ethanolamine methylase (PEMT) is an enzyme involved in the methylation of membrane phospholipids which plays a very important role in the modulation of the activity of the beta-receptors and the production of phosphatidylcholine, substrate of phospholipase A2. This report describes a study of PEMT on the membranes of blood leucocytes and alveolar macrophages obtained by bronchoalveolar washings in different types of asthma: allergic, intrinsic and occupational. This was accompanied by parallel study of respiratory function tests and the level of bronchial reactivity to carbachol in asthma sufferers as well as other alveolar biological parameters: phospholipid fractions of surfactant, angiotensin conversion enzyme and protein/albumin ratio. The authors found a significant increase (in comparison with controls) in PEMT activity both in macrophages and leucocytes in cases of intrinsic asthma. However, there was no correlation between the level of activity of the enzyme and the degree of bronchial hyper-reactivity. There was no change in alveolar phospholipid environment. In the light of these findings, the role of membrane activation of the alveolar macrophage is discussed in the physiopathology of intrinsic asthma.
Adult↗
[Laser treatment in malignant tracheo-bronchial pathology].
The laser is of proved efficacy in tracheo-bronchial pathology, provided the indication is well selected. Their current role is minimal. Perspectives are opening up in terms of the photoradiation of dysplasia, carcinomas in situ and small tumors.
Bronchial Neoplasms↗
[Multiple pulmonary emboli and paradoxical embolism caused by right-to-left shunt. Value of contrast two-dimensional echocardiography].
The authors report a case of paradoxal embolism. They review the usual circumstances of such a diagnosis and emphasise the value of contrasted two-dimensional echocardiography.
Aged↗
[Late post-traumatic hemoptysis caused by hypervascularization in the area of pulmonary hematomas. Apropos of a case].
The authors report a case of hemoptysis occurring after closed chest trauma complicated by spontaneously regressive parenchymatous hematomas. Bronchial arteriography showed systemic hypervascularisation with shunt in the territory of a hematoma which had regressed spontaneously several months previously. The authors mention the rarity of this aetiology and emphasise the value of bronchial arteriography and of embolisation.
Adult↗
[Acute disseminated tuberculosis with pancytopenia and a favorable outcome].
The authors report a case of febrile pancytopenia of tuberculous origin with a normal chest X-ray at the outset. The diagnosis was virtually confirmed by bone marrow biopsy, even before the result of AAFB cultures. The course was rapidly favorable under the influence of triple anti-tuberculous therapy, with normalisation of the bone marrow biopsy. The degree of thrombocytopenia would seem to be of considerable prognostic interest.
Acute Disease↗
[Bronchoalveolar lavage data in localized pulmonary tuberculosis].
Twenty-two patients with radiologically localised pulmonary tuberculosis underwent one or more broncho-alveolar lavages: 10 patients had a single lavage in the disease area, 11 had two lavages (1 in a healthy zone and 1 in the affected zone) and 1 patient had a triple lavage. The laboratory analysis of the fluid revealed that the tuberculosis was accompanied by an elevation of the various proteins assayed and by an alteration in the cytology (lymphocytosis, neutrophilia or mixed) in the radiologically involved zone. In contrast,the healthy zone revealed normal values except in 2 cases which presented a lymphocytosis. The type of cytological abnormality does not appear to have any prognostic value, but is probably related to different pathophysiological mechanisms.
Adult↗
[Tracheobronchial clearance in the hypersecreting asthmatic patient].
Tracheo-bronchial clearance in the hyper-secreting asthmatic patient was studied by observing the elimination over a period of time of a tracer placed on the bronchial wall over time. The authors describe the method used. The analysis of the results enables two purification processes to be distinguished: muco-ciliary activity and cough. The reliability of the method enabled comparison of the results obtained in 7 healthy subjects and 11 hyper-secreting asthmatics. In the healthy subjects, clearance is carried out by the muco-ciliary activity. In the asthmatics, global clearance is normal, but the cough plays an essential role as the muco-ciliary activity is decreased. The question then arises as to whether the decreased muco-ciliary activity in asthmatic patients is due to failure of the bronchial cilia or to the mucus.
Adult↗
Activity of cyclic AMP phosphodiesterase and methyltransferases in leukocyte membranes from allergic patients.
Cyclic AMP metabolism and methylation of phospholipids are central events which occur at the membrane level. Since a dysfunction of cell membranes seems to characterize some allergic diseases, we investigated cyclic AMP phosphodiesterase and methyltransferase activities in leukocyte membrane fractions obtained from healthy volunteers and from allergic patients. The allergic group presented a significantly decreased methyltransferase activity compared with a control group, whereas cyclic AMP phosphodiesterase and noradrenaline (NA)-stimulated methyltransferase were found to be increased with respect to the control group. A significant correlation has been found between cyclic AMP phosphodiesterase and NA-stimulated methyltransferase with both control and allergic subjects, which suggests close relationships between these two enzymes within the cell membrane.
3',5'-Cyclic-AMP Phosphodiesterases↗
Modulation by S-adenosyl-methionine and S-adenosyl-homocysteine of the human leucocytes histamine release.
Methylation of membrane phospholipids is an important stage in the process of histamine release. This methylation reaction can be modulated by S-adenosyl-methionine (SAM) as well as by S-adenosyl-homocysteine (SAH). The influence of SAM and of SAH upon the histamine release of leucocytes from asthmatic and normal subjects were compared. In concentration of 10(-4) M, SAM enhanced spontaneous and the specifically induced histamine release. In concentration of 10(-5) M SAM enhanced the histamine release only in normals. This phenomenon could indicate a deficit in methyl-transferase activity in the asthamatics. In concentration of 10(-4) M, SAH reduced spontaneous and specifically induced histamine release, having an effect comparable to that of 10(-4) M Theophylline.
Allergens↗