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Biomedical subjects

M Reynaud-Gaubert

Publications and source records attributed to M Reynaud-Gaubert.

33 records · Page 2Linked to original sources
PubMed1998

Idiopathic chronic eosinophilic pneumonia. A clinical and follow-up study of 62 cases. The Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P).

Idiopathic chronic eosinophilic pneumonia (CEP) is a rare disorder of unknown cause with nonspecific respiratory and systemic symptoms but rather characteristic peripheral alveolar infiltrates on imaging, developing mainly in women and in atopic subjects. The disorder is highly responsive to oral corticosteroid therapy, but relapses are frequent on reducing or stopping treatment. The long-term course of the disease and data regarding outcome, particularly the need for prolonged oral corticosteroid therapy and the development of severe asthma, are somewhat contradictory. A multicentric retrospective study was conducted in an attempt to describe better the initial features and, above all, the later course of CEP in a large homogeneous series of 62 stringently selected patients of whom 46 were followed for more than 1 year. The prevalence of smokers was low (6.5%) and about half of our patients (51.6%) had a previous, and often prolonged, history of asthma. The clinical and roentgenographic features were in keeping with previous studies, but we found that computed tomography could disclose ground glass opacities not detected by X-ray, and that migratory infiltrates before treatment were more frequent (25.5%) than reported previously. The bronchoalveolar lavage cellular count always showed a striking eosinophilic pattern, thus allowing distinction between CEP and cryptogenic organizing pneumonia, both syndromes sharing many common clinical and imaging features. About two-thirds of the patients (68%) showed a ventilatory defect in pulmonary function tests, with about one-half of these presenting with an obstructive pattern, sometimes without previous asthma. Along with the submucosal eosinophilic infiltration noted in 2 patients without ventilatory defect, this is strong evidence to confirm that CEP is not only an alveolointerstitial but also an airway disease. The dramatic response to oral corticosteroid therapy was observed in all treated patients. Although only 1 patient initially treated for less than 6 months did not relapse, longer oral corticosteroid therapy in no way provided protection from further relapses. We thus propose to try to wean oral corticosteroid therapy after 6 months in patients without severe asthma, because recurrences remain responsive to oral steroids. However, prolonged oral corticosteroid therapy was necessary in the majority of patients, with 68.9% of those followed for more than 1 year still on oral corticosteroid therapy at the last follow-up, either because of relapse or because of severe asthma.

Adolescent↗
PubMed1993

Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients.

We studied 70 patients with biopsy-proven pulmonary non-Hodgkin's lymphomas without extrathoracic involvement or mediastinal adenopathy to determine the clinical, imaging, and endoscopic features of this condition in a homogeneous series. In low-grade (LG) lymphomas, symptoms were cough, dyspnea, chest pain, hemoptysis. Imaging features consisted of localized alveolar opacities, infiltrative diffuse opacities, atelectasis, and pleural effusions. Inflammatory changes of the mucosa were present in some patients, leading to bronchial stenosis in 7; biopsies showed lymphomatous infiltration in 12. Prognosis of LG lymphomas was excellent, with 93.6 percent survival at five years. High-grade lymphomas differed from LG lymphomas principally by a more aggressive course and a worse survival. Inflammatory changes occurred in seven of nine cases leading to stenosis in two, and biopsies showed lymphomatous involvement in five. The profile of primary pulmonary lymphomas in this study could help clinicians consider this condition and prompt them to evaluate new diagnostic tools.

Adult↗
PubMed1992

Relationship between inspired and expired gas temperatures in a hyperbaric environment.

When breathing room air at sea level the expired gas temperature (TE) increases in proportion to the inspired one (TI). Previous studies conducted under hyperbaric conditions have assumed that the TE vs TI relationship was the same when humans breathed room air at atmospheric pressure or helium-oxygen mixture under hyperbaric conditions. We hypothesized that the use of dilutant gases, as helium (He) or hydrogen (H2), having low density but high specific heat compared to nitrogen, could change the TE vs TI regression. The present study was conducted on 3 professional divers participating in the COMEX Hydra IX experiment. Three conditions were studied: A, (23.5 ATA, He-H2-O2 mixture); B, (21 ATA, H2-O2 mixture); and C, (21 ATA, He-O2 mixture). In each condition six different inspired temperatures were tested, while minute ventilation, TI and TE values were measured simultaneously. In all cases a linear relationship was found between TE and TI, but the slopes of the regression lines obtained in conditions A and B (gas mixture containing H2) were significantly lower than in condition C (He-O2 mixture). Computation of the convective respiratory heat loss (Cr) revealed that, when the subjects breathed the coldest gas mixtures (+10 degrees C), Cr value was 1.6 times higher in condition B than in C. These data are consistent with theoretical considerations and they demonstrate that a single equation cannot be used to predict the TE vs TI relationship in all environmental circumstances.

Body Temperature Regulation↗
PubMed1992

[A phase II trial of pirarubicin in untreated disseminated small cell lung cancer. A cooperative study of the French Pneumo-Cancerology Group].

The usual form of chemotherapy of metastatic small cell lung cancer gives a 50% objective response with a mean survival of 7-8 months. We have tested a new antimitotic drug using pirarubicin alone in 26 patients. After the second treatment we noticed a response level of 12% with moderate toxicity. Then, we undertook classical chemotherapy using cisplatin-V16. After 3 doses the response level was 50% with a median survival of 32 weeks. In our study the use of a single drug pirarubicin in metastatic small cell cancer did not appear to worsen the chance of survival in patients if polychemotherapy was carried out immediately in cases which failed on the single drug. Our monotherapy did not appear to induce resistance to affective polychemotherapy. This method applied carefully to patients with metastatic disease with a strict follow up may be utilised in the assessment of the efficacy of the newer antimitotic drugs.

Adult↗
PubMed1991

[Treatment of pulmonary artery hypertensions].

The pulmonary hypertension (PAH) in chronic obstructive lung disease include therapy of the respiratory disease i.e. bronchodilator, kinesitherapy. Long-term oxygen therapy (more than 15 h/day) reverse the course of PAH and increase survey. Long-term efficiency of vasodilators is not well demonstrated. Primary PAH could benefit from vasodilators, especially waiting lung or heart-lung transplantation. Patients with PAH secondary to respiratory insufficiency could also be successfully transplanted. In post embolic PAH, antithrombotic agents are useful. Thrombectomy or transplantation are sometimes proposed.

Humans↗
PubMed1991

Effects of nicardipine on pulmonary and systemic vascular reactivity to oxygen in patients with pulmonary hypertension secondary to chronic obstructive lung disease.

We compared the acute effects of nicardipine and a placebo on the response of pulmonary and systemic circulation to different inspiratory fractional concentrations of O2 (FiO2) in 10 patients with pulmonary hypertension secondary to chronic obstructive lung disease. After catheterization of the pulmonary and femoral arteries, gas mixtures containing 15, 21, and 30% O2 were randomly administered for 20 min each during infusion of saline and then nicardipine (0.06 mg/kg/min). Plasma nicardipine level was maintained at 30 ng/ml. During nicardipine infusion, cardiac index (CI) was significantly higher (+20%, p less than 0.05) than during placebo infusion, with no change in mean pulmonary artery pressure (MPAP). Pulmonary resistances also decreased significantly (-20%) during nicardipine. No change in arterial or mixed venous O2 contents was noted. Mean arterial pressure (MAP) and systemic resistances decreased significantly with nicardipine. Inhaling a hyperoxic mixture was followed by a significant decrease in arterial pressure during placebo infusion; this was not observed during nicardipine. In contrast with systemic circulation, the response of the pulmonary circulation to different FiO2 levels was unaffected by nicardipine.

Blood Gas Analysis↗
PubMed1990

Comparison of Berodual and salbutamol in asthma: a multicenter evaluation.

A 2-month study was carried out to compare the efficacy and safety of Berodual (B) (Boehringer Ingelheim) and salbutamol (S) in asthma. B is a combined agent with 20 micrograms of ipratropium bromide and 50 micrograms of fenoterol in each metered aerosol puff. Each puff of S contained 100 micrograms of drug. 196 patients were included in the study and received 4 x 2 puffs a day of either B or S. FEV1 and FVC were measured every month, and peak expiratory flow rate (PEFR) 4 times a day, i.e. morning and evening before and after administration of drug. Improvement of PEFR was the same in the two groups. No tachyphylaxis occurred. No difference was observed between the two drugs with regard to heart and respiratory rate, dyspnea and blood pressure. Tremor seemed less frequent with B but this difference was not statistically significant. B achieved the same effects as S though containing less beta-2-agonist agent.

Aerosols↗
PubMed1990

[The bronchodilator effect of aerosol beta-2-mimetic and anticholinergic agents in patients with chronic bronchitis].

The aim of this study was to compare the effects of beta-2 stimulant adrenergic bronchodilators, salbutamol (S) and atropinic bronchodilators, oxitropium bromide (O). The drugs were administered by aerosol, alone or in combination. 20 patients with stable chronic bronchitis were randomised into two groups G1 and G2 and respiratory function tests were done on each group in two sequences, S1 and S2 with 24 hours between. The sequence S1 consisted of three spirometric measurements; an initial control measurement (C) preceding the inhalation of two puffs of 100 mcg of S with a repeat spirometry 15 minutes later followed by the inhalation of two puffs of 100 mcg of O followed by a final spirometry 45 minutes later, one hour after beginning the test. The protocol S2 was similar but the order of drugs was reversed (O then S). The subjects were subjected successively to regimes S1 and S2 for group 1 and inversely for group 2 according to the standard procedure for a crossover trial. The forced expired volume (FEV1) was expected as a percentage of the predicted values and absolute values. Thus only the first dose of inhaled bronchodilator increased slightly but significantly the FEV1. In effect, the administration of the second product led to no supplementary bronchodilator effect. The patients were classified as responders or non-responders for different thresholds of improvement of FEV1 of 10, 15 and 20%. The number of non-responders to the 2 classes of drugs was much greater when the threshold of improvement was raised to 20%. Some patients responded to bronchodilators, others uniquely to one of the two products and finally some to neither. Without reversibility tests it is not possible to predict the response to atropine from the response to beta-2-mimetics.

Aerosols↗
PubMed1990

[Wegener's granulomatosis. Contribution of computed tomography and nuclear magnetic imaging].

Amongst the endothoracic forms of Wegener's granulomatosis, tracheal, bronchial and above all mediastinal localisations are unusual. Such a case having a bad outcome is reported here. Computed Tomography (TDM) was used to assess the extend of pulmonary parenchymal involvement. Magnetic Resonance Imaging (MRI) was superior to TDM for showing transmural infiltration of the tracheal and the origin of main bronchi.

Bronchial Diseases↗
PubMedDate not supplied

[Video-assisted thoracic surgery. Current techniques and indications].

Up til recently, thoracoscopy was essentially performed for diagnostic purposes, allowing biopsies of the pleura or peripheral lesions of the lung tissue. Indications with a therapeutic objective were less frequent, usually in cases of recurrent pneumothorax. The recent development of less aggressive, more surgical instruments has virtually "forced" the surgeon to use the thoracoscope. Video thoracoscopy surgery thus entered the therapeutic armenatum. Small access channels less than a centimeter in diameter are used for videothoracoscopy giving an indirect view on the screed of the thoracic contents. Under these conditions, thoracoscopic procedures are possible to treat pneumothorax and resect small pleural or parenchymatous tumours. Inversely, gross resections (lobectomy, pneumonectomy) are technically more complex and raise the nearly unsolvable problem of removing the surgical specimen. In fact, a mini-thoracotomy has been required in many cases, leading to the development of video-assisted thoracic surgery. This new surgical technique is performed via a small incision and is guided by optic probes connected to the video screen. The surgeon can thus follow the entire operation both directly via the mini-thoracotomy and indirectly on the screen. This new approach is an interesting compromise between conventional thoracic surgery and videothoracoscopy.

Humans↗