Bronchial hyperresponsiveness to inhaled methacholine in subjects with chronic left heart failure at a time of exacerbation and after increasing diuretic therapy.

Cough and wheezing are common findings in left heart failure. However, it is still questionable whether nonallergic bronchial hyperresponsiveness, the hallmark of asthma, is also associated with this condition. In 12 subjects with acute decompensation of chronic postischemic LV failure, we assessed the PC20 methacholine during an episode of acute LV failure and after five to 15 days of intensive diuretic therapy. Weight, arterial blood gases, plethysmographic lung volumes, and expiratory flows were also measured on both visits. Extravascular lung water was estimated indirectly with a radiologic score. During acute decompensation, six subjects had significant airway obstruction and eight had a PC20 less than or equal to 16 mg/ml (significant bronchial hyperresponsiveness). After diuretic therapy, subjects improved significantly, losing an average of 2.2 kg, but they still had chronic LV failure and evidence of an obstructive breathing defect. Although mean PC20 was unchanged, three subjects had significantly improved PC20 after treatment. We conclude that: (1) left ventricular failure is often associated with mild bronchial hyperresponsiveness, although it is not excluded that smoking and the resulting possibility of bronchial obstruction can also play some role; and (2) acute treatment does not generally alter bronchial responsiveness to methacholine, suggesting that chronic LV failure can cause chronic changes to the airways.

Malignant neoplasms of the trachea.

Tracheal tumors are rare. They tend to be diagnosed late because of delayed specific symptoms. Of the nine patients studied, eight had primary tumors (squamous cell carcinoma) and one had a metastasis from a primary colon cancer. Most of these tumors could be seen on good quality chest radiographs. Linear tomograms and esophagograms were useful. Computed tomography tends to underestimate the size of the lesion.

Pulmonary complications of multimodality therapy for esophageal carcinoma.

Thirty patients with cancer of the esophagus were treated with multimodality therapy. We studied the incidence of pulmonary complications in these patients. The value of chest radiographs and sequential measurements of carbon monoxide diffusing capacity (DLco) in predicting pulmonary toxicity was determined. Patients were divided into two groups, according to treatment. Patients in group I (n = 16) received two cycles of chemotherapy (bleomycin 15 units/m2, cisplatinum 120 mg/m2, vincristine 2 mg) and radiotherapy (50 Gy). Based on the presence of interstitial lesions on chest radiographs in five patients the incidence of pulmonary toxicity was 32%. In four of these five patients such an appearance was preceded by a drop in DLco: this was documented in 8 of the 16 patients. Nine patients of group I underwent esophagectomy and four (44%) developed adult respiratory distress syndrome (ARDS). In group II (n = 14) the tumor was resected without other treatment and four (29%) of these patients developed ARDS. The incidence of ARDS in both groups demonstrates that pulmonary complications are mainly related to surgical manipulation and to preexisting lung disease. Preoperative radiotherapy and chemotherapy may be associated factors. Sequential measurements of DLco are more sensitive for detecting pulmonary damage than chest radiographs and should be used to predict pulmonary toxicity.

[Yellow nail syndrome. Apropos of a case. A review of the main radiologic manifestations]. / Le syndrome des ongles jaunes. A propos d'un cas. Revue de ses principales manifestations radiologiques.

The authors report a case of "yellow nail syndrome" and emphasize the radiological features of this recently described entity which physiopathology has not yet been established. A new feature to be described: a non symptomatic pericardial effusion in association with long standing bilateral pleural effusions.

Pulmonary hyalinizing granuloma: a cause of pulmonary nodules.

The radiological and histological appearance of pulmonary hyalinizing granuloma (PHG) and its pathogenesis are described. The histological features bear a striking resemblance to fibrosing mediastinitis. Patients present clinically with nonspecific respiratory or general symptoms. Slowly growing solitary or, more often, multiple nodules are found on radiographs of the chest, suggesting neoplastic disease. Four patients with PHG are described. Four patients with PHG are described. One had lesions in the kidneys that were pathologically identical to those of PHG. There is no clear etiology for this disease, but from the cases reported here and those reported previously it is postulated that diverse etiologic factors might lead to a common immunological response. Inflammatory agents such as tubercle bacilli or fungal organisms (e.g., Histoplasma), or a collagen or autoimmune disease may act as trigger mechanisms for the induction of PHG.

Small nodular pattern in the lungs due to opportunistic toxoplasmosis.

We report a patient with widespread nodular densities in the lungs complicating massive infestation by Toxoplasma gondii in an immunologically compromised host.

Intra-arterial infusion chemotherapy in rectal cancer.

Chemotherapy by intra-arterial infusion, using mitomycin C and 5-fluorouracil, was administered to six patients with cancer of the rectum. In three patients who presented initially with an inoperable rectal tumour, medication was infused through the inferior mesenteric artery. Tumour regression was documented in all three, allowing subsequent resection in two. Of three other patients with locally recurrent rectal cancer, none showed tumour regression after infusion, but two experienced substantial relief of perineal pain, with improvement in the quality of life. Unexpected complications occurred in the form of a reversible ischemic colitis in two patients and an arterioenteric fistula in a third.

Narrowband teleradiology.

A narrowband communication system using the Canadian satellite ANIK-B was used to transmit radiographic images from northern Quebec to Montreal. This slow scan television (SSTV) system was used to study the accuracy of the radiologist's interpretation, both with samples of pre-selected films and current patients. Several hours of training in the technique of radiographic interpretation from a static image displayed on a TV monitor was an important factor affecting performance. In selected patients, based on a sample of 124 error-free direct viewing interpretations by four radiologists, SSTV reading by the same fully trained radiologists was correct in 84.5%. With actual patients, and assuming the interpretation from direct viewing to be the correct one, SSTV reading of the radiographs by the same radiologist gave a corresponding figure of 84.1% in a sample of 518 patients containing 73.4% of negative findings, and 89.4% in another sample of 305 patients, including 82% of negative findings. The present error rate on SSTV reading is twice as great as radiographic interpretation using a broadband television system.

[Pleural mesothelioma: 3 developmental forms]. / Mésothéliome pleural: trois formes évolutives.

In the medical literature, there have been fewer reports on benign pleural mesotheliomas than on their malignant counterparts. We have reviewed the clinical, radiological and pathological features of mesotheliomas seen at the Hôtel-Dieu in Montreal over the past ten years. This experience leads us to postulate that there are three types of mesothelioma. The malignant form is often typical. Pedunculated lesions most often prove to be asymptomatic and benign. However, we have identified an intermediate category where the definitive nature of the mesothelioma could only be established after long term follow-up of the biological behaviour of the tumor.

Thoracic fatty lesions - some usual and unusual appearances.

Since the advent of computed tomography (CT) special attention has been given to fatty lesions because of their specific coefficient of attenuation (-100 to -30 Housfield units) permitting a definitive non-interventional diagnosis. Many reports have appeared in connection with unusual conventional radiographic images related to lipid lesions as demonstrated by CT. We reviewed the different features of fatty accumulations in the thorax and report on 15 lesions, not including a number of large pleuropericardial fat pads, that we have encountered in our practice between January 1976 and December 1979. Two patients underwent surgery. The diagnosis was otherwise established by CT. All the lesions were benign. A classification is suggested.