[Is helium beneficial in a pulmonary rehabilitation program for severe COPD?] / Apport de l'hélium dans la réhabilitation respiratoire de patients BPCO sévères.

Helium is known to reduce airflow limitation. Our hypothesis was that severe COPD patients undertaking exercise would show greater improvement in endurance under a heliox mixture (80/20%) than under air alone. This hypothesis was tested in a double-blinded, randomized study. METHODS: Out of the 53 patients included, 45 were randomly assigned to two groups : Heliox (n= 23) and Air (n= 22). Patients were assessed with spirometry under air and heliox, incremental exercise test, constant workload (80% Wmax) exercise test and weekly 6-minute walk test. The two groups went through fifteen 30-minute retraining sessions in the overall framework of an identical pulmonary rehabilitation program. RESULTS: There was no significant difference in endurance improvement (Heliox : +52.5 sec, Air:+114sec, median value). FEV1 improvement under heliox exceeding 10% identified a group of 20 patients as "helium responders", who improved their endurance time by a median of 135sec compared to 50sec for the "non-responders" (non-significant difference). CONCLUSION: In patients with severe COPD, use of Heliox in exercise retraining did not produce significantly improved endurance. On the other hand, "helium responders" showed more FEV1 improvement than non-responders. Improved FEV1 under heliox should therefore be used in future studies as an inclusion criterion.

[Contribution of psychomotricity in respiratory rehabilitation programs]. / Apport de la psychomotricité au sein de la prise en charge des patients insuffisants respiratoires dans le cadre d'un programme de réhabilitation.

Pulmonary rehabilitation traditionally benefits COPD patients through physical training, optimization of medical treatment, education and nutritional advice. In this paper we introduce psychomotricity which provides these with a more global approach to pulmonary rehabilitation. This approach takles postural tone, mobility, anxiety and self-confidence in order to improuve control of breathing and perception of breathlessness. Consequently handicap is reduced and its adverse effects are curbed. Psychomotricity, through corporeal techniques and relaxation, complements the other components of pulmonary rehabilitation. We report on our experience with ninety patients. All the assessments were carried out before and after the program. This study showed significant improvement in many outcomes including psychomotricity assessments, quality-of-life questionnaire scores and visual analogue scales. Psychomotricity, when incorporated into a multi-disciplinary rehabilitation program, appears to help patients regain self-confidence and use their capacities in a better way. This technique gives patients better control over their handicap and allows them to face the future with more dignity.

Subepithelial fibrosis and degradation of the bronchial extracellular matrix in cystic fibrosis.

Cystic fibrosis is a genetic disease caused by mutations of the cystic fibrosis transmembrane conductance regulator gene. Chronic inflammation and proteolysis lead to progressive damage of the bronchial wall. Extracellular matrix determines the structural organization and the mechanical properties of lung airways. It was thus examined in nine patients with cystic fibrosis (six bronchial biopsies and three lobectomies) in order to assess its level of alteration. The submucosal changes in matrix protein distribution were analyzed by immunochemistry and electron microscopy: the subepithelial basal lamina was thinned; an acellular collagen fiber layer composed of interstitial collagens (types I and III) subtended by tenascin and devoid of elastin-associated microfibrils was deposited beneath the basal lamina; this dense fibrous deposit generally formed a thick layer and could extend into the bronchial wall; the bronchial elastic framework lost arborescent distribution and appeared slender, packed, or lacunar; ultrastructural observation gave evidence for elastic and collagenic fiber lysis. Proteolytic activity is probably the major cause of matrix degradation. Fibrosis appears as a repair process rather than as an active fibrogenesis. The reversibility of extracellular matrix alterations is an important challenge and various interventions such as anti-inflammatory treatments can be targeted to halt or reverse this degradation process.

Picosecond nonlinear refraction measurement in single-beam open Z scan by charge-coupled device image processing.

We propose a picosecond single-beam open Z-scan experiment in which the usual apertured detection scheme is replaced by a two-dimensional single-shot CCD camera. This enables us to extract the two-dimensional transverse modifications of the whole far-f ield pattern that are due to nonlinear refraction as well as to measure the induced nonlinear phase shift with increased sensitivity compared with that of the conventional Z scan.

Fibrosing vasculitis in Wegener's granulomatosis: ultrastructural and immunohistochemical analysis of the vascular lesions.

This study of two cases of pulmonary Wegener's granulomatosis (WG) focuses on the ultrastructural aspects of the vascular wall injury and on the immunohistochemical characterization of the perivascular connective matrix. The iterative waves of endothelial cell necrosis and regeneration are demonstrated by the multilamellar appearance of the basal lamina. Neutrophils infiltrate the vessel wall and myofibroblasts are recruited to injured vessels. The perivascular connective matrix associates basement-membrane like and fibrillar material with fibrin deposits. The initiation of the fibrosing process was assessed by the visualization of matrix molecules involved in targeting (p-fibronectin), organizing (cellular fibronectin and tenascin) and stabilizing (lysyl-oxidase) the fibrogenic activity. These elementary lesions affect different levels of the vascular tree, and capillaritis is involved in the extension of the pathological process. Lysyl-oxidase labelling reveals the fibrosing front which is located on the border of dense fibrosis. The markers of fibrosing activity disappear in the areas of fibrosis following vasculitis and/or ischaemic necrosis and/or granulomatosis. Vasculitis plays a major role in both the genesis and progression of the fibrosis observed in the late stage of WG.

Characterization of the smooth muscle cell infiltrate and associated connective matrix of lymphangiomyomatosis. Immunohistochemical and ultrastructural study of two cases.

Lymphangiomyomatosis (LAM) consists of smooth muscle (SM) cell proliferation of unknown origin involving the lymph nodes and the lung interstitium. From morphological studies showing both SM differentiation of the proliferating cells and lymphatic hyperplasia, hypotheses were suggested concerning the origin of the proliferation. Two cases of LAM were investigated by electron microscopy and immunohistochemistry; tissues were obtained by lymph node and open lung biopsies. Cytoplasmic and matrix protein markers were used in order to clarify the pattern of differentiation of the proliferating cells and to characterize their connective tissue environment. The proliferating cells present ultrastructural characteristics of SM cells; they contain vimentin, desmin, and alpha-SM actin and are devoid of Factor VIII, favouring a parieto-arterial origin. The connective tissue matrix inside the infiltrate is composed of interstitial collagens and basement membrane components. At the late stage of the disease, remodelling of the interstitial matrix accompanies the infiltrate and remains perilesional.

[Metachronous primary pulmonary cancers. Apropos of a new case report]. / Cancers pulmonaires primitifs métachrones. A propos d'une nouvelle observation.

The appearance of a second primary lung cancer more than four months after the initial cancer is called a metachronous cancer (as opposed to a synchronous cancer). We provide a case report of an epidermoid carcinoma coming more than three years after the initial diagnosis of an anaplastic small cell cancer of the lung. This second cancer developed in a different territory from the initial lesion. Amongst the hypotheses proposed chemotherapy may through an oncogenic action favour the appearance of a new type of cancer.

[Karyotype study of blood lymphocytes in sarcoidosis]. / Etude caryotypique des lymphocytes sanguins dans la sarcoïdose.

Among 31 patients presenting with pulmonary sarcoidosis, two had abnormalities of their blood lymphocyte karyotypes. The karyotype of the first patient showed an initially high percentage of non-specifically broken chromosomes. The second patient, who had been treated with azathioprine (AZ) one year previously, had an apparently balanced translocation 46 XX, t (11; 11) (p 12, p 14) in blood T lymphocytes but not in skin fibroblast culture. Various hypotheses can be discussed to explain this translocation: a direct toxic effect of AZ or a genomic abnormality depending upon sarcoidosis and possibly revealed by AZ. It is important to note that this translocation concerned a region of the short arm of chromosome 11, where Harvey ras I and parathormone genes have been located.

[Pulmonary sarcoidosis. Study of the distribution of active alveolitis assessed by comparison of data from radiological examination, gallium 67 scintigraphy and double bronchoalveolar lavage]. / Sarcoïdoses pulmonaires. Etude de la répartition de l'alvéolite active appréciée par comparaison des données de l'examen radiologique, de la scintigraphie au gallium 67 et de doubles lavages broncho-alvéolaires.

Abnormal uptake of gallium in alveolar structures, raised lymphocyte levels, ECA and, to a lesser degree, proteins in alveolar washings are the principal currently known criteria used to recognise cases of sarcoidosis with persistent immunological activity. The contribution of data concerning broncho-alveolar washings (BAW) in the context of this diagnostic assessment has never been the subject of a critical evaluation. It would nevertheless seem that the distribution of sarcoidosis lesions is not always diffuse and homogeneous, leading to the possibility of errors of assessment in this technique. The aim of the present study was to assess the true existence, degree and consequences of this risk. It was based upon the study of 41 cases of active pulmonary sarcoidosis. Search for homogeneity and heterogeneity between lesions and active alveolitis involved precise radiological study, gallium isotope scan with determination of the index of uptake as well as the quality of the latter, and double BAW carried out in the most radioactive and least radioactive regions respectively. Comparative study of the results obtained showed that zones of active alveolitis were distributed unevenly and heterogeneously in more than half of the patients (71% for gallium and 54% for BAW). This would explain the fact that in 14 cases (34%) criteria of alveolar activity were present in only one of the two specimens of washings. Identification of the zones which should be included in BAW cannot be determined accurately by radiological analysis, regardless of the degree and distribution of radiological abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

[Multiple pulmonary emboli and paradoxical embolism caused by right-to-left shunt. Value of contrast two-dimensional echocardiography]. / Embolies pulmonaires multiples et embolie paradoxale par shunt droit-gauche. Intérêt de l'échocardiographie bidimensionnelle contrastée.

The authors report a case of paradoxal embolism. They review the usual circumstances of such a diagnosis and emphasise the value of contrasted two-dimensional echocardiography.

[Late post-traumatic hemoptysis caused by hypervascularization in the area of pulmonary hematomas. Apropos of a case]. / Hémoptysies post-traumatiques tardives par hypervascularisation dans le territoire d'hématomes pulmonaires. A propos d'un cas.

The authors report a case of hemoptysis occurring after closed chest trauma complicated by spontaneously regressive parenchymatous hematomas. Bronchial arteriography showed systemic hypervascularisation with shunt in the territory of a hematoma which had regressed spontaneously several months previously. The authors mention the rarity of this aetiology and emphasise the value of bronchial arteriography and of embolisation.

[Acute disseminated tuberculosis with pancytopenia and a favorable outcome]. / Tuberculose aiguë disséminée avec pancytopénie d'évolution favorable.

The authors report a case of febrile pancytopenia of tuberculous origin with a normal chest X-ray at the outset. The diagnosis was virtually confirmed by bone marrow biopsy, even before the result of AAFB cultures. The course was rapidly favorable under the influence of triple anti-tuberculous therapy, with normalisation of the bone marrow biopsy. The degree of thrombocytopenia would seem to be of considerable prognostic interest.

[Localized pulmonary pseudo-tumoral form of Wegener's disease and fulminating evolution. Apropos of a case]. / Maladie de Wegener à forme pulmonaire pseudo-tumorale localisée et d'évolution fulminante. A propos d'une observation.

A case of Wegener's granulomatosis starting as a localized pseudo-tumoral lung lesion and following a fulminating course is reported. The histological diagnosis required thoracotomy. New pulmonary lesions developed post-operatively, together with severe renal failure which was responsible for the patient's death 5 weeks after the thoracotomy. The authors describe the lesions characteristic of the disease and their pathogenesis and discuss the relationship between Wegener's syndrome and other granulomatous angiitis.