[Pentamidine aerosol in the preventive treatment of pneumocystosis in AIDS patients. Comparison of two salts and two nebulizers]. / Aérosol de pentamidine dans la prévention des pneumocystoses des malades atteints de SIDA. Comparaision de deux sels et de deux systèmes de nébulisation.

In a randomized trial conducted in AIDS patients requiring prophylaxis against pneumocystosis we compared two pentamidine salts, isethionate (I) and mesylate (M), and two nebulizers (a modified ultrasonic Ultraneb 99 Devilbiss nebulizer, and a disposable jet nebulizer). Patients were randomized to one or the other nebulizer and received alternatively, once every other week, the two pentamidine salts in the IMIM or MIMI order. Characteristics and the side effects of the two courses of each pentamidine salt, as well as drug delivery by each nebulizer during the first course, were studied in 48 patients. The ultrasonic nebulizer was more effective (nebulization time: 19.8 +/- 7.3 mn versus 30.7 +/- 11 mn) and produced less side-effects (FEV1 decrease: 186 +/- 677 versus 571 +/- 708 ml) than the jet nebulizer. The mesylate salt tended to produce more side-effects than the isethionate, but the difference was not significant (FEV1 decreases: 439 +/- 688 ml and 295 +/- 756 ml respectively). We concluded that the best therapeutic procedure is to use pentamidine isethionate delivered by the ultrasonic nebulizer.

[Aspects of pneumocystosis seen in a French pneumonology department in 1987-1988]. / Aspects des pneumocystoses observées dans un service de pneumologie français en 1987-1988.

Over a 2 years' period, 49 AIDS patients and 3 non AIDS patients were treated for pneumocystosis in our chest department. Forty-six were male and 6 were female. Pneumocystosis was the first opportunistic infection in 77 p 100 of patients. Fever above 38.5 degrees C was the major symptom in 92 p 100. Cough was present in 90 p 100 and dyspnoea in 94 p 100. Clinical symptoms had begun 21.7 +/- 15.7 days before diagnosis. Mean PaO2 value was 50.9 +/- 15.7 mmHg. Forty-eight patients were initially treated by daily intravenous administration of trimethoprim 960 mg and sulfamethoxazole 4,800 mg. Three patients received a pentamidine aerosol and one received DFMO. Treatment was effective in 39 patients; 11 patients died between the 5th and the 29th days of treatment; 2 had an early relapse. Fever disappeared after 9.8 +/- 6.6 days, and blood gases returned to normal within 10.8 +/- 7.7 days. All patients whose PaO2 was above 56 mmHg were cured. Thus, the trimethoprim-sulfamethoxazole combination proved active in the treatment of pneumocystosis. Other treatments are useful in case of side-effects or failure of the initial therapy. Failures can be suspected on the fourth day of treatment and in such cases CMV co-infection must be looked for and treated.

[Chronic respiratory diseases and their decompensation during pregnancy (asthma excluded)]. / Maladies respiratoires chroniques et leurs décompensations pendant la grossesse (en dehors de l'asthme).

There are relatively few observations on the influence of pregnancy in chronic respiratory illness, excluding asthma and interstitial pneumonia. Chronic airflow obstruction only presents at a relatively advanced age, past the menopause. Chronic respiratory failure due to restrictive lung disorders appears well tolerated as long as the vital capacity is greater than one litre. Mucoviscidosis has been the object of more detailed studies since the management of this disorder now raises hopes of survival compatible with pregnancy.

[Use of intrapleural doxycycline via lavage-drainage in recurrent effusions of neoplastic origin]. / Utilisation de la doxycycline intrapleurale par lavage-drainage dans les épanchements récidivants d'origine néoplasique.

27 patients (17 F, 10 M) with a mean age of 65 +/- 11 years and suffering from recurrent pleural effusions were treated with locally administered Doxycycline by lavage-drainage to achieve pleural symphysis (17 adeno-carcinomas, 3 large cell carcinomas; 3 epidermoid cancers; 3 non-Hodgkin's lymphoma; 1 small cell carcinoma). The solution used was a dilution of 50 ml doxycycline in 250 cc of isotonic saline. 22 of the 27 patients could be evaluated long term, 5 were lost to follow up, of whom two had recurred straight away despite local treatment. An immediate response was obtained in 23 out of the 28 patients (85%). Later the absence of recurrence was seen in 90% of the patients evaluated. The incidence of antimitotic therapy did not seem to be the determining factor in the 7 patients who received this in parallel. The duration of drainage was 11 +/- 6 days, the local treatment was well tolerated in the majority of cases. The use of the technique of lavage-drainage of doxycycline could be an alternative in those patients with a malignant pleural effusion whose general condition contra-indicates a symphysis under pleuroscopy.