[ value of computed tomography in the diagnosis and staging of bronchiectasis]

Basing themselves on literature data, the authors specify the tomodensitometric semiology of bronchiectasis and locate the place of the computed tomography [C.T] in the diagnosis and staging of bronchiectasis in comparison with standard chest radiograph and bronchography They notice the advantages and limits of each method of examination The C.T, as non invasive examination which revolutionized the medical imaging in the last years, intervenes at all the stages of diagnosis of bronchiectasis. Recognition morphologic type, extension and associated damages. But technical Conditions are indispensable, as achievement of thin-section C.T, Judicious choice of windows with use of wide "bronchic" Window and apparatus with high Space resolution. At present, the choice between C.T and bronchograpy in the diagnosis of bronchiectasis seems to depend on quality of tomodensitometric images, localized or diffuse bronchiectasis and degree of Clinical suspicion The C.T of thorax must be done at any suspicion of bronchiectasis and only after the study of its results will be established the management. It seems that bronchography has no more to be indicated at first intention, but it restes indicated in case of discordance between a very suggestive symptomatology and a doubtful C.T. and in case of limited but complicated bronchiectasis which can undergo surgical operation

[Etiologic profile of hemoptysis in pneumology unit: [291 cases]]

To determine the profile of hemoptysis their main etiologies, we reviewed 291 cases hospitalized in 5 years [from 1980 to 1984] in a service of pneumology. Patients with hemoptysis represente 8,8% of all hospitalized patients. They have a mean age of 46 years and 47% of them have less than 50 years; 69,4% are men. The hemoptysis is a telltale sign of a thoracic pathology in 35,4%. It is trivial in 71,1% medium in 26,8%, important in 2,1%. In all the cases the chest radiograph is abnormal, the abnormalities evokating the etiologies in 70,8%. The prevailing etiologies are lung cancer [34,4%] and both active and sequelary tuberculosis [18,9%]. Among other causes bronchectasies hold an important place [15,1%] as well as broken hydatic cysts [9,3%]. The other causes are as follows: bacterial pneumopathies with or without abcess [7,2%], pulmonary aspergillosis [6,9%], chronic bronchitis with or without emphysema [3,5%]. Exceptional causes gather only 4 cases. In 3,1% no cause for the hemoptysis is demonstrated. This study emphasizes the leading role of lung cancer as an etiology of hemoptysis, even in country with a great tuberculosis prevalence. Nevertheless this outward reality is also due in part to the fact that most of patients with tuberculosis are hospitalized in specific yards

Haemorrhagic pleural effusion. A report of 123 cases

1.132 pleural effusion admitted to the hospital in 113 months, 123 haemorrhagic pleural effusions are confirmed by puncture. The most reliable means the pleural biopsy with the Abrams needle which is systematically used. It has often led to adjust the diagnosis suggested by the clinical context. The pleural metastasis is the dominating aetiology, 53 cases are confirmed on the biopsy or cytodiagnosis and 28 cases are suspected which makes a total of 81 cases [65.9%] then pleural tuberculosis are confirmed in 11 cases, suspected in 8 cases [15.4%]. The cardiovascular etiology represents 3 cases [2.4%], different other causes 2 cases [1.6%], no etiology 18 cases [14.6%]

Asthma: diagnosis, investigation and exploration strategy

The diagnosis of asthma is essentially based on clinical data: occurrence of paroxystic episodes of dyspnea with wheezing. The onset of symptoms is often difficult to recognise in non-typical forms. In these cases the ventilatory function test response to histamin or acetylcholin can be used to demonstrate bronchial hyperresponsiveness. Besides chronic bronchitis and emphysema the main differential diagnoses may be regrouped in adults, within 6 etiologies: cardio-vascular, tumoral, inflammatory and/or immunological, congenital and finally functionnal. In childhood other differential diagnoses may be added like bronchitis, tracheal or bronchial foreign body, cystic fibrosis and gastroesophageal reflux. Asthma is regarded as a syndrome with numerous etiologies: allergic and non - allergic [viral infections, pollution, neuro-endocrine diseases, drugs and psychologic factors]. The investigations are based on chest X-ray, hemogram, ventilatory function tests and allergologic testing [skin tests and measurement of serum IgE and specific IgE]. The history of symptoms and skin tests would give the main results of allergolic investigations. The diagnosis of allergic asthma [allowing hyposensitization] is based on clinical data, positive skin tests and if needed, elevation of total and specific IgE. In adults, it is however necessary to perform bronchial provocation tests to demonstrate the allergic cause of asthma

Clinical profile and follow-up study of 277 children consulting in pneumo-allergology from 1980 to 1982

The authors report the results of a retrospective follow-up study of 277 children under 15 years of age, confirming the close correlation already noted between skin tests on one hand [household dust+acariens], and both total and specific IgE on the other. Indeed, a positive correlation was found between skin tests household dust+acariens and total IgE essays in 77.3% of the children in the groups, as compared with 55% in adults [p 0.01]. Household dust and acariens constitute the antigenic mixture most often incriminated, with a positive correlation of skin tests to specific IgE results of 97%. Specific immunotherapy using essentially extracts from household dust and/or acariens concerned 234 children, of which 96 [41%] dropped out of the program months to 3 years after the beginning of treatment. Thus, among the 138 children who carried through their desentization treatment for at least 3 years, the authors note a global subjective improvement in 75% of the cases

Interest of dosage of theophyllinemia in bronchial asthma and adaptation of an efficient dosage

In 54 asthmatic patients, we assessed the interest of a simple protocol to adapt an efficient dosage of theophylline. Each patient has received a standard dose of 10 per Kg of ideal weight every 24 hours, distributed in 3 doses. The blood sample of theophylline is realized at the 48 th hours. 94.44% of patients accept the therapeutic regiment adopted after adjustement of their posologie for 20 cases

Pulmonary hypertension secondary to pulmonary asbestos. About 3 cases

After having during twenty years in a factory using asbestos cement, three morkmen have presented pulmonary fibrosis that manifested itself by a severe dyspnea, cough and expectoration, radiologically by diffuse pulmonary lesions with basal predominance and linear disposition, associated to a pleural calcification characteristic of the asbestosous origin. During the evolution, this pulmonary fibrosis has been complicated by chronic cor pulmonale: right ventricular hypertrophy and a pulmonary hypertension in those cases

[Idiopathic pulmonary hemosideros. report of a 3 cases]

Idiopathic pulmonary hemosiderosis, one of the "pneumo-anemic" syndroms is a very rare disease of unknown etiology and pathogeny. The study of three personal cases associating both an anemic and respiratory syndrom and the study of the literature have led to the description of the clinical manifestations of the disease. Particular attention should be paid to monosymptomatic cases. The presence of macrophages loaded with iron in bronchial secretions, and pulmonary sequestration of radioactive iron [iron 59], revealed by isotopic exploration should be enough to lead to the diagnosis; however a histo-pathological study of pulmonary biopsy, particularly after thoracotomy, seems to be necessary both for a better diagnosis and prognosis. The aetiopathogeny of this affection seems to depend from an immunological mechanism, which is not actually well known. Treatment by corticoids and/or immunosupressive drugs is controversed, and generally the disease evolves towards death within four years usually

[Non pyogenic pleural effusion: a report of 219 cases]

299 pleural effusion admitted to the hospital in 25 months 263 of these are confirmed by puncture which 219 pleuresies with clear and haemorrhagic fluid with no associated pneumothorax More than the two-thirds of the patients are male, the most reliable means of investigation remains the pleural biopsy with the Abrams needle which is systematically used. It has often led to adjust the diagnosis suggested by the clinical context. The tuberculosis is the dominating aetiology: 108 cases are confirmed on the biopsy and 58 cases are suspected which makes a total of 166 cases [75.80%], then pleural metastasis [confirmed in 9 cases, suspected in 11] [9,1]. The cardiovascular aetiology represents 14 cases [6.39%], different other causes 10 cases [4,56%], aetiologies 9 cases [4,10%]