[The place of bronchoalveolar lavage in the diagnosis of pneumonia in the immunocompromised patient]. / Place du lavage broncho-alvéolaire dans l'exploration d'une pneumopathie de l'immunodéprimé.

INTRODUCTION: Bronchoalveolar lavage (BAL) was previously considered as the standard diagnostic procedure to investigate pneumonia occurring in immunocompromised patients, and it is probably still widely used. However, the development of new microbiological diagnostic tools, applicable to samples obtained non-invasively, leads to questioning of the predominant place of BAL in this situation. BACKGROUND: The available studies agree on the acceptable tolerance of BAL performed in immunocompromised patients. Although imperfect, the diagnostic yield of BAL in immunocompromised patients is well established, but it may vary between studies depending on the underlying disease. However, it must also be compared to the yield of non-invasive microbiological tools, now widely available and effective. The position of BAL remains important both for the diagnosis of fungal infections (invasive aspergillosis, pneumocystis pneumonia) and non-infectious lung diseases both of which occur frequently in immunocompromised patients. CONCLUSION: The place of BAL in the diagnostic work-up of pneumonia occurring in immunocompromised patients must be considered in the framework of a structured consideration, taking into account the diagnostic performance of non invasive microbiological tests and the broad spectrum of lung diseases occurring in this context.

[Pulmonary hamartoma with lipomatous form]. / Hamartome pulmonaire à forme lipomateuse.

We report of the case of a 41-year-old patient, who had previously undergone thoracic surgery at the age of 16 for a single giant emphysematous bulla. The CT scan showed an abnormal middle mediastinal lesion containing an aerated cystic areas and areas of fat density. The patient underwent surgery and a well-defined mass was found between the mediastinum and the pulmonary hilum, which was able to be completely resected. Microscopic examination disclosed a composite tumour containing a bronchogenic cyst, a benign lipoma and two hamartochondromas. As no similar case had been reported previously, it was difficult to assert the nature of the lesion, which has been labelled as a "hamartoma". The main diagnoses which should be considered when an intra pulmonary fat density mass is disclosed, are discussed.

Nerve growth factor is released by IL-1beta and induces hyperresponsiveness of the human isolated bronchus.

Nerve growth factor (NGF) is a neurotrophic factor essential for the development and survival of neurons, and is also an important mediator of inflammation. It is released by airway cells stimulated by interleukin (IL)-1beta. As IL-1beta induces airway hyperresponsiveness (AHR) to the tachykinin NK-1 receptor agonist [Sar9,Met(O2)11]-substance P in human isolated bronchi, the aim of this study was to determine whether IL-1beta was able to induce NGF release from isolated bronchi, and whether NGF might participate into IL-1beta-induced AHR. IL-1beta (10 ng x mL(-1); 21 degrees C; 15 h) increased the release of NGF from human isolated bronchi in vitro, and, in organ bath studies, the response of human bronchi to [Sar9,Met(O2)11]-substance P (0.1 microm). A significant correlation was found between these responses. AHR induced by IL-1beta was abolished by a blocking anti-human NGF antibody. Finally, NGF (1 ng x mL(-1); 37 degrees C; 0.5 h) by itself induced a significant increase in [Sar9,Met(O2)11]-substance P responsiveness. By contrast, it did not change the maximal contraction to acetylcholine. In conclusion, the present study clearly demonstrated that nerve growth factor may participate in the airway hyperresponsiveness induced by interleukin-1beta, which supports the neuro-immune cross-talk that may be active in the development of hyperresponsiveness in the human airways, and suggests nerve growth factor is active in the airways in asthma.

Relaxation of proximal and distal isolated human bronchi by halothane, isoflurane and desflurane.

Volatile anaesthetics relax airway smooth muscle in vitro. The amount of relaxation might depend on the type and concentration of volatile anaesthetics, the calibre and precontraction level of the bronchi, and also on the species considered. These effects were investigated on isolated human bronchi. Isometric relaxations produced by halothane, isoflurane and desflurane bubbled on human bronchial rings precontracted with carbachol were recorded and compared with time controls. Volatile anaesthetics induced a concentration-dependent relaxation at 0.66, 1.33 and 2 minimum alveolar concentration (MAC). The relaxation was greater in mildly (carbachol 3x10(-7) M) than in highly (carbachol 2x10(-6) M) precontracted bronchi. Halothane was more potent in relaxing distal as compared to proximal bronchi; this differential effect was less pronounced with isoflurane and not observed with desflurane. While the three volatile anaesthetics induced similar relaxation on proximal bronchi, halothane was significantly more potent than desflurane on distal bronchi, with isoflurane being intermediate. The relaxation induced by 1.33 MAC of halothane, isoflurane and desflurane on moderately precontracted distal bronchi (carbachol 1x10(-6) M) was attenuated by pretreatment with glibenclamide 1x10(-5) M. In conclusion, halothane, isoflurane and desflurane exert direct but differential relaxant effects on human isolated bronchial smooth muscle. This may provide supplemental bronchodilation during anaesthesia. Although adenosine triphosphate-sensitive K+ channels are involved in these relaxant effects, they are unlikely to explain the observed differences between the three volatile anaesthetics.

Caries experience and oral cleanliness in cystic fibrosis homozygotes and heterozygotes.

OBJECTIVES AND STUDY DESIGN: In the present study, the caries experience (ie, the number of decayed, missing, and filled teeth) and oral cleanliness (ie, measures of plaque, calculus, and gingival bleeding) of patients homozygous for cystic fibrosis (CF; n = 42), patients heterozygous for CF (n = 48), and healthy control subjects (n = 62) were recorded and statistically analyzed. RESULTS: Those who were homozygous for CF had a significantly lower caries experience than both the control subjects (P <.001) and those who were heterozygous for CF (P =.011). They also had significantly less gingival bleeding sites than the controls (P =.014) and those heterozygous for CF (P =.019). Patients heterozygous for CF showed significantly more extensive restorations than those who were homozygous (P =.015) and significantly more missing teeth than the controls (P =.008), whereas the controls had significantly more missing teeth than those who were homozygous for CF (P <.001). CONCLUSIONS: Although those homozygous for CF are expected to have a high caries risk because of their essential sugar-rich diet, they did not have a significantly higher caries experience in this study. Their better gingival health and lower caries experience may be attributed to medication use (antibiotics) and as-yet unidentified intrinsic salivary mechanisms.

Interleukin-1beta-induced hyperresponsiveness to [Sar9,Met(O2)11]substance P in isolated human bronchi.

Interleukin-1beta has been reported to induce airway hyperresponsiveness in several animal models. In this study, we have investigated whether interleukin-1beta was able to potentiate the contractions of human isolated small bronchi (internal diameter < or = 1 mm) provoked by a specific tachykinin NK1 receptor agonist, [Sar9,Met(O2)11]substance P. Pre-incubation of human isolated small bronchi with interleukin-1beta (10 ng/ml, in Krebs-Henseleit solution, at 21 degrees C for 15 h) potentiated the contractile response to [Sar9,Met(O2)11]substance P. It also increased the [Sar9,Met(O2)11]substance P-induced release of thromboxane B2, the stable metabolite of thromboxane A2. Indomethacin (10(-6) M), a non-specific cyclooxygenase inhibitor, or GR 32191 ((1R-(1alpha(Z)),2beta,3beta,5alpha))-(+)-7-(5-(((1,1' -biphenyl)-4-yl)-methoxy)-3-hydroxy-2-(1-piperidinyl)cyclopentyl)-4-hept enoic acid, hydrochloride) (10(-6) M), a prostanoid TP-receptor antagonist, blocked the contractions induced by [Sar9,Met(O2)11]substance P both in control experiments and after interleukin-1beta pre-treatment, indicating that prostanoids and thromboxane receptors are directly implicated in the [Sar9,Met(O2)11]substance P-induced contractile response. The thromboxane mimetic U-46619 (10(-8)-10(-6) M) (9,11-dideoxy-11alpha,9alpha-epoxymethano-prostaglandin F2alpha)-induced contractions of human isolated small bronchi were not enhanced by interleukin-1beta pre-treatment, suggesting that no up-regulation of thromboxane receptors occurred. Furthermore, the cyclooxygenase-2 inhibitor CGP 28238 (6-(2,4-difluorophenoxy)-5-methyl-sulfonylamino-1-indanon e) (10(-6) M) had no direct effect on [Sar9,Met(O2)11]substance P-provoked contractions, but inhibited the interleukin-1beta-induced potentiation of [Sar9,Met(O2)11]substance P response. In conclusion, our results show that interleukin-1beta pre-treatment is able to potentiate the contractions of isolated human small bronchi provoked by [Sar9,Met(O2)11]substance P both by increasing prostanoid synthesis and by inducing a cyclooxygenase-2 pathway.

[Endocrine component of exocrine pancreatic tumors. Apropos of 2 cases]. / Composante endocrine des tumeurs excréto-pancréatiques. A propos de deux observations.

Two cases of pancreatic exocrine tumors with endocrine component are reported. The first case concerned a microcystic cystadenoma including an endocrine tumor identified by Grimelius staining and positive immunostaining for neurone specific enolase and the second a tubular adenocarcinoma including cells with positive immunostaining for glucagon and neurone specific enolase. The malignant nature of the endocrine component of both tumors which was certain for the first one and probable for the second whose endocrine component was distinct from the hyperplastic endocrine reaction observed at the periphery of the tumor, seems to support the hypothesis of exocrine and endocrine differentiation from a common precursor cell. The precise value of such a sub-group of pancreatic tumors with double component need to be clarified.

[Pancreatic epithelial tumors with double cellular components. Report of two cases with immunohistochemical study]. / Tumeurs épithéliales pancréatiques à double composante cellulaire. A propos de deux cas avec étude immunohistochimique.

Histopathological studies of pancreatic tumors can show two different cellular components: exocrine and endocrine. Histological and immunohistochemical staining is used to confirm the diagnosis and to appreciate the probable presence of an endocrine secretion. The hypothetical common embryological origin of the different pancreatic components is strengthened by the coexistence of these two cellular types; experimental studies in animals seem to confirm this view.

[Unusual thoracic localization of Castleman's tumor. Apropos of a case]. / Localisation thoracique inhabituelle d'une tumeur de Castleman. A propos d'une observation.

We report a case of angiolymphoid hyperplasia, or Castleman's pseudotumour, located in the chest and most unusually opposite an intercostal space. Pain led to the discovery of the tumour, the nature of which was discovered at surgery, and disappeared after surgical excision. No antigenic stimulus or local haemodynamic disturbance was found, which could have accounted for the very unusual intercostal site of the lesion.

[Distal lesions of the Fallopian tubes. Prognostic values of peroperative tubal biopsy]. / Lésions tubaires distales. Intérêt pronostique de la biopsie tubaire per-opératoire.

78 biopsies were carried out during 63 distal tubal microsurgical operations, followed up for two years at least. The clinical outcome was studied according to the pathological state of the better tube: Viable pregnancies become more frequent with subnormal tubes (40%) and with tubes with moderate chronic salpingitis (65%). The risk of extra-uterine pregnancy is at a maximum with chronic cicatricial salpingitis (29.4%). Progressive chronic salpingitis results in only 6.6% viable pregnancies and will definitely constitute an indication for in vitro fertilization rather than microsurgery.