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Biomedical subjects

P Ramon

Publications and source records attributed to P Ramon.

At least 19 recordsLinked to original sources
PubMed1992

[Bronchial endoscopy. Technical aspects in adults].

The author analyses all the practical aspects of bronchial endoscopy: the choice of equipment amongst equipment available from the makers for flexible and rigid endoscopes; the place of the most recent developments such as video-endoscopy; the upkeep of the equipment and specific problems linked to disinfection. Then the examination techniques of endoscopy are described from the admission of the patient and the anaesthesia to the completion of the report. Finally side effects and possible complications are reviewed. A protocol is specified.

Adult↗
PubMed1991

[Auricular chondritis, malignant glomerulonephritis and pulmonary hemorrhage].

Relapsing polychondritis is a rare connective tissue disorder characterized by inflammation of cartilagenous structures such as ears, nose, joints, trachea and larynx. Renal disease is unusual. A 41 years old man presented with auricular chondritis, subacute renal failure and lung hemorrhage. A renal biopsy disclosed a diffuse proliferative glomerulonephritis with extensive crescents. Immunofluorescent studies suggested a GNRP type III so called "non immunologic disease". He was treated by prednisone and plasmapheresis with rapid disappearance of pulmonary hemorrhages and good renal functional improvement.

Adult↗
PubMed1990

Short-term decrease of skin-test sensitivity after rush desensitization in Hymenoptera venom hypersensitivity.

Thirty-seven patients with a history of systemic anaphylactic stings were desensitized by the rush method. Patients were evaluated by skin testing twice, before and 6 weeks after desensitization. An additional control group of 10 patients, not yet desensitized, were tested for skin test technique reproducibility at 6-week intervals. Results were compared with IgE and IgG antibody levels, and with platelet reactivity towards specific Hymenoptera venom. Before desensitization, the maximum skin-test sensitivity was observed at 10(-5) micrograms venom/ml in 56% of patients and decreased to 10(-1) micrograms venom/ml after desensitization (48.6% of patients). Decrease of cutaneous tests was observed in 28/37 patients (75%) (P less than 0.001) and was not associated with significant variations of specific IgE or IgG antibody levels, but was correlated with the decrease of platelet reactivity (P less than 0.05). Conversely, variations of skin-test sensitivity in the control group was not significant.

Adolescent↗
PubMed1990

Plasmapheresis in a patient with severe asthma associated with auto-antibodies to platelets.

Although the pathogenesis of aspirin-sensitive asthma remains to be specified, it is known that in the presence of acetylsalicylic acid or non-steroidal anti-inflammatory drugs, platelets from aspirin-sensitive asthmatics have been described as generating cytocidal mediators that killed parasite targets such as Schistosoma mansoni larvae. Here we report, in a patient with corticosteroid-dependent asthma associated with aspirin sensitivity, the presence of circulating IgE antibodies against 55 kD and 68 kD platelet antigens. In addition, the serum from this patient was shown to contain a factor able to trigger the release of cytocidal mediators from his platelets as well as from normal individual platelets. This platelet stimulatory activity was presumably supported by IgE antibodies or immune complexes. After informed consent the patient was submitted to plasma exchanges. Plasma removal induced clinical improvement, anti-platelet antibody decrease, and the reduction of the platelet stimulatory activity. All clinical symptoms disappeared within 2 weeks. The disease remained quiescent for 2 months, and daily requirements for prednisone (20-5 mg), and beta-agonist (10-16 to 0-1 inhalations) could be kept at a low level follow-up. The plasma exchanges were delayed by 3 mg kg-1 azathioprine with the maintenance of clinical improvement. A relapse occurred after the arrest of immunosuppressive therapy with the reappearance of both asthma attacks and anti-platelet antibodies, as well as the increase of the platelet stimulatory activity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1990

Subclinical alveolitis in immunological systemic disorders. Transition between health and disease?

A subclinical inflammatory alveolitis as assessed by BAL cell analysis may be present in a high proportion of symptomless patients with immunological systemic disorders and with normal chest roentgenogram. Subclinical alveolitis can be characterized by the relative proportions of the different cell populations comprising the alveolitis and by the activated state of the cells. Thus, subclinical alveolitis can be classified into two major groups: lymphocyte and neutrophil alveolitis. Lymphocyte alveolitis is frequently found in patients with extrathoracic granulomatosis (Crohn's disease, primary biliary cirrhosis, extrathoracic sarcoidosis) or with some collagen vascular diseases (Sjögren's syndrome, rheumatoid arthritis, systemic lupus erythematosus). Neutrophil alveolitis is a main finding in collagen vascular diseases, especially progressive systemic sclerosis, dermatopolymyositis and mixed connective tissue disease. In addition, alveolar macrophages may be spontaneously activated and release various mediators that could be relevant to the pathogenesis of interstitial lung disease. On the other hand, some other alveolar macrophage functions (antibacterial activity may be severely impaired in some diseases, for example systemic lupus erythematosus). Alveolar inflammation is associated with an increase in the permeability of the alveolar membrane responsible for an increased influx of blood proteins in the alveolar spaces. Although subclinical inflammation may also be detected by high resolution computed tomography (HRCT) scan and/or lung permeability scintigraphic studies, the significance and prognostic value remains unclear and clearly differs according to both the disease and the pattern of alveolitis.

Humans↗
PubMed1989

A circulating suppressive factor of platelet cytotoxic functions after rush immunotherapy in Hymenoptera venom hypersensitivity.

A receptor for the Fc fragment of IgE has been described on human blood platelets. This receptor mediated the IgE-dependent stimulation of platelets by the specific allergen in Hymenoptera venom (HV) hypersensitivity. This platelet reactivity was abolished after rush desensitization. To understand the mechanism of such a down-regulation, we studied the effects of sera recovered from patients treated by HV rush desensitization on platelets of untreated HV sensitive patients. The present data describe the presence of a circulating factor able to suppress, in a dose-dependent manner, platelet stimulation by the specific allergen. This circulating factor was not allergen specific, not depleted by IgE or IgG antibody immunoadsorption, and was found at higher concentrations in the sera of patients receiving monthly high dosages of HV (200 micrograms maintenance dose). The physicochemical characterization showed that this circulating factor had a m.w. of 20,000 to 25,000, an isoelectric point of 4.2, was heat and acid stable, and sensitive to trypsin, but not to neuraminidase. These characteristics were similar to a newly described lymphokine, platelet activity suppressive lymphokine, suggesting the intervention of such a lymphokine in HV rush desensitization.

Bee Venoms↗
PubMed1989

[Treatment of severe hemoptysis with terlipressin. Study of the efficacy and tolerance of this product].

Terlipressin (Glypressin) is a "pro-hormone"; after intravenous injection the glycyl radicals are slowly cleaved by enzymatic action, liberating vasopressin. We have assessed the efficacy of terlipressin in the treatment of severe hemoptysis. The study was performed on 20 patients: in 5 cases there was very copious hemoptysis and in 15 cases there was repeated hemoptysis of lesser volume. The cause was distributed as follows: 6 cases of neoplasms, 5 were sequelae of tuberculosis, bronchial dilatation 2 cases, pneumonia with abscess 2 cases, chronic airflow obstruction (COPD) 2 cases and 3 cases of silicosis. The treatment consisted of a slow intravenous injection of 2 mgm 4 times per day (9 patients), then in 11 patients an injection of 2 mgm at the time of acute episodes followed by 1 mgm every 6 hours. The patients received an average of between 15 and 20 mgm of the product for a treatment lasting over 5 days at the maximum. The results were as follows: total success 12 cases; partial success (a reduction to at least one-third of the initial hemoptysis): 5 cases; failure: 3 cases. The failures were linked in two cases to neoplastic disease and in one case there was an intolerance to the drug which did not allow the treatment to be pursued.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1988

Lympho-epithelial thymomas. A retrospective study of 88 resections.

Of 113 lympho-epithelial thymomas retrospectively studied, 56 were epithelial, 20 lymphocytic, 30 mixed and 7 were undefined forms. There were 88 resections (20 stage I, 47 stage II, 13 stage III and 8 stage IV). There were 69 primary resections (followed by radiotherapy in 54 cases) of which 57 were complete and 12 were incomplete. There were 19 secondary resections after radiotherapy: 10 were complete and 9 were incomplete and 25 patients were not operated upon and were treated by radio- and chemotherapy. After primary resection, the actuarial 5-year survival is 64.07% and the 10-year survival is 50.86%. After a secondary resection, the 5 year-survival is 43.74%. After non-surgical treatment, it is 18.67%. After surgery, the prognostic importance of staging is confirmed as more important than the cellular structure. Myasthenic patients are subject to late accidents. Postoperative radiotherapy seems to be justified, but its effect is not statistically significant when resection is complete. Post-radiotherapy surgery is beneficial only in cases of complete resection. The metastatic evolution of thymomas has been underrated and seems to depend upon the local control of the tumour. The use of chemotherapy remains to be defined.

Actuarial Analysis↗
PubMed1988

Bronchoscopic protected catheter brush for the diagnosis of pulmonary infections.

A new bronchoscopic-protected catheter brush (BPCB), designed to obtain uncontaminated bronchial secretions, was studied in vitro and in vivo. The device was composed of a standard biopsy brush, protected by a single catheter and occluded with an agar plug. Ejection of the plug was obtained neither by advancing the brush nor by advancing an inner cannula (as in a telescoping catheter brush), but instead, by an air flux, provided by a syringe which was connected to the proximal tip. In the first part of the study the ability of the BPCB to obtain uncontaminated specimens was tested in comparison with the reference telescoping catheter brush (BFW brush 10/70/90, Medi-Tech Corp Watertown, MA). Catheters of each type were successively passed through the inner channel of a bronchofiberscope which was contaminated with Klebsiella pneumonia. After ejection of the distal plug, sampling of bronchial secretions infected with a marker organism (Pseudomonas aeruginosa), was performed with the brush. Culture of brush specimens of each type of catheter grew the marker organism in pure culture and obtained the same amount of bronchial secretions (0.001 ml). The manual vortexing of the brush in the transport medium (Ringer's solution) proved to be as effective as the mechanical vortexing so that transecting of the brush was no longer mandatory. In the second part of this study, paired bronchial samplings from 27 patients were performed using both types of catheters and similar results for both were obtained. In these in vitro studies, completed by a clinical trial, our single-sheathed, plugged catheter brush proved to be as reliable as the double telescoping catheter brush. However, because of its relatively simple conception, making it easier to use and lower in cost than the double catheter brush, routine use of this sampling device should be considered.

Biopsy↗
PubMed1988

[Invasive thymoma with pulmonary metastasis. Complete remission 5 years after surgery and chemotherapy using the CHOP-BLEO protocol].

We report a case of invasive lympho-epithelial thymoma with pulmonary metastases, treated by complete macroscopic excision of primary tumour and then by chemotherapy using CHOP-BLEO. The epithelial nature of the tumour was confirmed by immunohistochemical studies. Chemotherapy enabled a complete and prolonged remission (greater than 63 months). Therapeutic trials of CHOP-BLEO merit further assessment and the results should be compared to the baseline treatment using platinum and prednisolone.

Adolescent↗
PubMed1988

[The role of bronchoalveolar lavage in the diagnosis of viral pneumopathies. Apropos of 76 cases].

Specimens obtained by broncho-alveolar lavage (LBA) allow for an examination for viral antigens by a direct technique using monoclonal antibodies and by culture, and the level of IgM and IgG antibodies by the ELISA technique. LBA is used in the screening of immuno-depressed subjects and in the search for an aetiology in overt cases of interstitial pneumonia. Ninety-six specimens of LBA from 76 patients were analysed [38 had immunological deficits of whom 14 had haematological disorders, 15 were transplant cases and there were 9 in the miscellaneous group (group A). There were 38 pneumonias occurring in pre-existing chronic disorders (group B)]. Twenty respiratory viral infections were identified (26.3%): 17 by direct examination or culture (22.4%), 3 by serology. CMV was identified in 14 cases, HSV1 in 4 cases, VZV and VRS in one case each. In the haematological cases there was a positivity of 28.6%, 66% in the transplants (100% for heart transplants), and from 11 to 13.2% in other groups. Ten patients in 56 (17.8%) possessed anti CMV IgG antibodies (the mean level was 745) and 5 had IgM (mean level 18) (9%). One case of pneumonia due to VZV with IgM and IgG in the LBA was reported. In summary, a direct examination by LBA is positive in a quarter of the cases and a culture in three quarters. The conventional methods failed here, showing the frequency of purely localised infections in the respiratory tract.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1988

[Invasive pulmonary aspergillosis].

Invasive pulmonary aspergillosis is an opportunistic pneumonia which is particularly common in immuno-depressed subjects. The most frequent risk factors are the intensity and duration of leucopaenia, cytotoxic drugs and steroid therapy. In the respiratory tract, the proliferation of Aspergillus fumigatus becomes possible when there is a failure of the reticulo-endothelial system and of the polymorphonuclear leucocytes. There is no typical clinical picture: one sees an acute febrile pneumonia resistant to antibiotics. However, the radiological signs are more suggestive with nodules and bilateral infiltrates with a tendency to cavity formation and sequestration. The prognosis is clinically linked to the rapidity of diagnosis. Broncho-alveolar lavage offers a new and non-invasive diagnostic method to search for Aspergillus mycelia or specific antigens. A direct examination and culture of sputum expectoration are both insensitive and non-specific but remain useful in some patients with leukaemia in a phase of agranulocytosis. Treatment rests on Amphotericin B taken orally.

Acute Disease↗
PubMed1988

[Lympho-epithelial thymoma. Anatomo-clinical and therapeutic study of 113 cases].

One hundred and thirteen cases of lympho-epithelial thymomas were studied retrospectively: 56 were of epithelial type, 20 of lymphocytic type, 30 were mixed and 7 were not defined. Eighty-eight were operated on (20 stages I, 47 stages II, 13 stages III and 8 stages IV). There were 69 primary resections (57 complete and 12 incomplete), followed by radiotherapy in 54 cases and 19 secondary resections after radiotherapy (10 complete and 19 incomplete). Twenty-five patients did not have an operation and were treated with radio- and chemotherapy. After primary resection the actuarial survival at 5 years was 64.07% and at 10 years 50.86%. After a secondary resection it was 43.74% at 5 years. After radiotherapy it was 18.67% at 5 years. In operated cases the prognostic importance of staging was confirmed. The cytological structure was not. In myasthenic cases the secondary respiratory complications worsened the prognosis. Post-operative radiotherapy seems to be justified in all cases, but its effect is not statistically significant when resection was complete. Those operated after radiotherapy only showed a benefit if the resection was complete. The outcome of metastatic disease in TLE has been under-estimated and seems to depend on local control of the tumour. The use of chemotherapy remains to be defined.

Adolescent↗
PubMed1988

Decrease of IgE-dependent platelet activation in Hymenoptera hypersensitivity after specific rush desensitization.

A receptor for the Fc fragment of IgE on human platelets has been recently described, which mediated an IgE-dependent activation in the presence of specific allergen. We investigated the allergen-induced activation of platelets from patients with Hymenoptera hypersensitivity before and after specific rush desensitization. Nineteen patients with a history of anaphylactic reactions were included (15 sensitive to yellow-jacket and four to honey-bee venom), fourteen/nineteen having experienced severe life-threatening systemic reactions and 5/19 large local reactions. All showed positive skin tests and high values of specific IgE. By comparison to the baseline results obtained before desensitization, a significant decrease of platelet activation (76.8% inhibition) after rush desensitization was observed. In the case of two polysensitized patients, after Hymenoptera venom desensitization alone, platelets not only lost their reactivity to venom but also towards the other allergen. This modulation of the IgE-dependent platelet reactivity during desensitization offers therefore a new approach for the study of allergen-induced desensitization.

Adolescent↗
PubMed1987

Lymphocyte subpopulations in bronchoalveolar lavage in Sjögren's syndrome. Evidence for an expansion of cytotoxic/suppressor subset in patients with alveolar neutrophilia.

We initiated this study to determine the cellular composition and T-lymphocyte subpopulations of fluid from bronchoalveolar lavage from 15 patients with primary Sjögren's syndrome (1SS), six patients with secondary Sjögren's syndrome associated with primary biliary cirrhosis (2SS-PBC), eight patients with secondary Sjögren's syndrome associated with collagen-vascular diseases (2SS-CVD), and 12 normal subjects. All were nonsmokers who were free of clinical pulmonary symptoms and had normal findings on chest roentgenograms. Lymphocyte subsets were identified by mouse monoclonal antibodies that were specific for T-cells, helper/inducer, and suppressor/cytotoxic (namely, OKT3, OKT4, and OKT8). Patients with 1SS, patients with 2SS-PBC, and patients with 2SS-CVD had a significantly increased percentage of lymphocytes in fluid from bronchoalveolar lavage (respectively, 21.6 +/- 3.7 percent, 24.3 +/- 6.1 percent, and 25.6 +/- 3.9 percent) compared with the normal value of control subjects (9.9 +/- 1.5 percent). In addition, two of the 15 patients with 1SS and five of the eight patients with 2SS-CVD demonstrated an increased percentage of alveolar neutrophils. The predominant T-cell subset in patients with 1SS was T4+, and the mean T4:T8 ratio was normal. The percentage of T4+ cells was increased in patients with 2 SS-PBC, resulting in an increased T4:T8 ratio. In contrast, patients with 2 SS-CVD demonstrated a markedly increased percentage of T8+ cells, reflected by a shift in the T4:T8 ratio which was inverted. Patients with Sjögren's syndrome and with neutrophilia on bronchoalveolar lavage had a marked expansion of the T8+ lymphocyte subpopulation, where as patients with Sjögren's syndrome and with pure lymphocytosis on bronchoalveolar lavage showed predominantly T4+ cells. In addition, we found a strong positive correlation between the number of neutrophils and the number of T8+ cells in bronchoalveolar lavage from patients with Sjögren's syndrome (r = 0.74; p less than 0.05). Until the functional activities of OKT4+ and OKT8+ cells are better defined, the role that these cells play in the pathogenesis of pulmonary disease in Sjögren's syndrome remains unclear.

Adult↗
PubMed1986

Activated alveolar macrophage and lymphocyte alveolitis in extrathoracic sarcoidosis without radiological mediastinopulmonary involvement.

Cellular characteristics of BAL were investigated in 18 patients with proved extrathoracic sarcoidosis (that is, sarcoidosis that affected the skin, eyes, parotid glands, stomach, nose, kidneys, or meninges) without clinical or radiological mediastinopulmonary involvement. Computed tomography of the thorax was performed on five patients: four patients were normal, and one had enlarged lymph nodes (these enlargements were not detectable on the patient's chest roentgenogram). The results of pulmonary function tests were normal in all patients. The total BAL cell count did not differ significantly between controls and patients. Abnormal percentages of alveolar lymphocytes (from 18 to 87%) were noted in 15 out of 18 patients. SACE levels were normal in 15 patients. No pulmonary gallium uptake was detected. The chemiluminescence of AM's, whether spontaneous or PMA induced, was increased in five out of seven patients. The percentages of T3+ lymphocytes in sarcoidosis patients did not significantly differ from those in controls. The T4+:T8+ ratio was normal in four patients and slightly increased in one. Follow-up of patients showed that alveolar lymphocytosis is as lasting as extrathoracic involvement. Our data demonstrate increased percentages of lymphocytes and activated AM's in the BAL of patients with extrathoracic sarcoidosis. This may be due to the initial involvement of the respiratory tract in extrathoracic sarcoidosis or to the diffusion of activated macrophages and lymphocytes from an extrathoracic site into the lung.

Adult↗