ABSTRACT
In tuberculous meningitis there is a disturbance of control involving hyponatraemia and increased urinary elimination of antidiuretic hormone resulting in hypersecretion of vasopressin. This inappropriate secretion of antidiuretic hormone should not be confused with the Schwartz-Bartter syndrome, which is reserved for paraneoplastic syndromes. The pathophysiology remains poorly understood but its recognition in cases of lymphocytic meningitis is improved as the correct diagnosis has precise therapeutic implications.
Subject(s)
Inappropriate ADH Syndrome/urine , Tuberculosis, Meningeal/urine , Vasopressins/urine , Aged , Female , Humans , Hyponatremia/urine , Male , Middle AgedABSTRACT
Small-cell lung carcinoma can be distinguished from other histological types of lung cancer because of its high metastatic potential. Initial staging procedures divide the patients into two main prognostic groups: the so-called "limited" (to the thorax) and the extensive disease patients. Based on the results of a prospective pilot study involving 182 patients and on a review of the literature, the authors discuss the usefulness of initial staging in increasing the number of detectable metastases, assessing tumour burden, evaluating treatment results and identifying prognostic factors. Complete tumour staging at the time of diagnosis appears to be very helpful for a better knowledge of the disease and better therapeutic decisions.
Subject(s)
Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Carcinoma, Small Cell/pathology , Lung Neoplasms/pathology , Adrenal Gland Neoplasms/drug therapy , Adrenal Gland Neoplasms/secondary , Carcinoma, Small Cell/drug therapy , Clinical Trials as Topic , Combined Modality Therapy , Doxorubicin/administration & dosage , Etoposide/administration & dosage , Female , Humans , Ifosfamide/administration & dosage , Liver Neoplasms/drug therapy , Liver Neoplasms/secondary , Lung Neoplasms/drug therapy , Male , Middle Aged , Multicenter Studies as Topic , Neoplasm Staging , Prognosis , Prospective Studies , Spinal Cord Neoplasms/drug therapy , Spinal Cord Neoplasms/secondaryABSTRACT
The cardiotoxicity of 5 fluoro-uracil is currently recognised. We report here a new case in which an effort test and a Methergin test were carried out in the hours following the episode and at a later date. With normal coronary arteriography the evidence is in favour of coronary artery spasm which is the usual mechanism for this type of toxicity.
Subject(s)
Coronary Vasospasm/chemically induced , Fluorouracil/adverse effects , Coronary Vasospasm/physiopathology , Electrocardiography , Humans , Male , Middle AgedSubject(s)
Kidney Diseases/etiology , Nephritis, Interstitial/etiology , Sarcoidosis/pathology , Adult , Female , HumansABSTRACT
A 63-year-old woman treated 28 years ago for pulmonary sarcoidosis was operated upon for gastric cancer. Histology showed combined lesions of gastric sarcoidosis and adenocarcinoma. This is an exceptional association, and the relation between the two affections is discussed, the most likely hypothesis being a sarcoid reaction to the cancer.
Subject(s)
Adenocarcinoma/complications , Sarcoidosis/etiology , Stomach Diseases/etiology , Stomach Neoplasms/complications , Adenocarcinoma/secondary , Female , Humans , Lung Diseases , Lymphatic Metastasis , Middle Aged , Ovarian Neoplasms/secondary , Time FactorsABSTRACT
There has recently been renewed interest in thoracoscopy. Among its indications we consider talc therapy for a pneumothorax particularly worthy of interest. We report the three year results obtained on a series of 109 pneumothoraces. The indication for thoracoscopy were considered either for a chronic pneumothorax (failure of drainage after 8 days) or for a recurrent pneumothorax. We perform this technique under local anaesthetic with talc therapy given direct vision on the macroscopic lesions encountered. Patients were in hospital for a mean of five days. The results were as follows: Lung appearance. Normal 19%-Dystrophic bullae and giant bullae 41%. blebs: 13%-a visible breach 14%-Diverse anomalies 13%. The immediate failures with talc numbered 6 (5%) each time from the chronic pneumothorax group. They were treated surgically. There were 7 recurrences after talc therapy, 5 were partial recurrences requiring no further treatment and two total relapses were surgically treated. The radiological sequelae appeared minimal. On 5 occasions pleural discomfort hindered the diaphragmatic movement, in the other cases the radiological sequelae consisted of discrete pleural thickening. 42 patients had respiratory function testing and no abnormalities were noted. The failures or recurrences in the talc treated patients were all in the recurrent pneumothorax and were only 13 cases (12%). Thus thoracoscopy is a treatment of choice in the treatment of recurrent pneumothorax, and often replaces surgery. In certain cases (pneumothorax in respiratory failure) it is only possible treatment.
Subject(s)
Lung Diseases/therapy , Pneumothorax/therapy , Talc/therapeutic use , Adolescent , Adult , Aged , Chronic Disease , Female , Humans , Lung Diseases/complications , Male , Middle Aged , Pneumothorax/etiology , Recurrence , Talc/administration & dosage , ThoracoscopyABSTRACT
The objectives of this study, in which Almitrine bismesylate was administered for one year in chronic bronchitics with obstructive hypoxia, were to assess its clinical and gasometric efficacy and its clinical, laboratory, spirometric and electrocardiac acceptability. The blood gas results show a significant rise in PaO2 (p less than 0.001) rising by 5.5 mmHg after 6 months (T6) and by 6.0 mmHg after 12 months (T12) in comparison with the value at the study's onset. The PaCO2 fell by 3.3 mmHg at T6 and 2.7 mmHg at T12 (p less than 0.001). The dyspnoea of the patient, scored by the doctor on a scale of severity from 0 to 5 was situated on a mean of 3.3 points at the beginning of the study. It was significantly reduced by 0.8 points at T6 and by 0.9 points at T12 (p less than 0.001). The percentage of patients hospitalised during the course of the study fell significantly in comparison with the previous year, from 68% to 49% (p less than 0.001). The improvement in clinical status and in blood gases bore no relation to changes in respiratory function. The clinical acceptability of the product was good; few side effects were observed and the respiratory, digestive and neurological problems were often pre-existing. They only led to cessation of treatment in three cases. The electrocardiogram was unchanged. The laboratory investigations was unchanged, with the exception of a fall in red blood cells in relation to the correction of the hypoxaemia in polycythaemic patients.
Subject(s)
Bronchitis/drug therapy , Central Nervous System Stimulants/therapeutic use , Piperazines/therapeutic use , Almitrine , Bronchitis/physiopathology , Chronic Disease , Drug Tolerance , Dyspnea/drug therapy , Female , Follow-Up Studies , Humans , Male , Pulmonary Gas Exchange , Respiratory Function TestsABSTRACT
Thoracoscopy examinations in 5 cases of solid tumors of the pleura: 1 case of Pancoast's and Tobias' tumors of neoplastic origin, 1 case of asbestosis-induced fibrohyaline plaques, and 2 cases of benign pleural tumors, 1 neurinoma emphasized the diagnostic value of thoracoscopy for tumors of this type. Direct visualization of the lesion is possible, its precise site and extent can be determined, and biopsy samples obtained for pathology under direct visual guidance.
Subject(s)
Carcinoma, Squamous Cell/diagnosis , Lipoma/diagnosis , Neurilemmoma/diagnosis , Pleural Neoplasms/diagnosis , Thoracoscopy , Adult , Asbestosis/diagnosis , Female , Humans , Male , Mediastinal Neoplasms/diagnosis , Middle Aged , Pancoast Syndrome/diagnosis , Pleural Diseases/diagnosis , SyndromeABSTRACT
The diagnostic value of different respiratory function tests in the respiratory distress syndrome was compared in 5 groups of subjects: healthy non-smokers, asymptomatic smokers, patients with bronchitis affecting the large bronchi, asthmatic patients between attacks, and patients with emphysema. Indices measured were the forced expiratory volume per second (FEV1), mean expiratory flow between 25 and 75% of vital capacity (MEF 25-75%), maximum instantaneous flow at 25-50-75% of vital capacity, and peak flow (Vmax 25-50-75%, PF), residual volume, expiratory resistance volume, and the curve of the alveolar plateau of expired nitrogen. The Vmax 50% and the MEF 25-75% appear to be sufficiently sensitive indices of bronchial obstruction in current practice, the MEF 25-75% being simple to measure, and presenting the advantage of not requiring complicated equipment. The Vmax 25% and the respiratory resistance volume present wide inter-individual variations, and this, together with their lack of reproducibility, limit their value in exploratory tests in isolated cases.
Subject(s)
Lung Diseases, Obstructive/diagnosis , Lung Volume Measurements , Adult , Aged , Asthma/diagnosis , Bronchitis/diagnosis , Female , Humans , Male , Middle Aged , Pulmonary Emphysema/diagnosis , SmokingABSTRACT
The therapy to be used when an endobronchial foreign body is discovered on X-ray is still debated. Some recommend a bronchoscopy with a rigid tube, others favour a fibroscopy with flexible tube. We report four observations of endobronchial foreign bodies of different sizes extracted by fibroscopy with flexible tube and foreign body forceps. We underline from these observations the value of fibroscopy which enabled the extraction of far situated bodies which sometimes could not be removed by bronchoscopy with a rigid tube. Therefore, we strongly advise, when in presence of endo-bronchial foreign bodies, to use fibroscopy first.
Subject(s)
Bronchi , Foreign Bodies/diagnosis , Adult , Aged , Bronchoscopy , Female , Fiber Optic Technology , Foreign Bodies/therapy , Humans , Male , Middle AgedABSTRACT
On the basis of a case of asthma due to maleic anhydride, a description is given of occupational asthma due to anhydrides, the physiopathology of which is similar to that related to isocyanates. In contrast to the latter, this disorder is not listed amongst occupational diseases, which should not prevent action by the occupational health physician.
Subject(s)
Asthma/chemically induced , Furans/adverse effects , Maleic Anhydrides/adverse effects , Occupational Diseases/chemically induced , Adult , Asthma/diagnosis , Female , HumansABSTRACT
A patient, 37 years old in 1966, presented hemoptysis and an excavated lesion of left upper lobe; there were no acid-fast bacilli in the sputum, but he was considered as having tuberculosis. After one year of treatment, the lesion had progressed and was removed surgically; pathologic diagnosis was silicosis. During the following years, three excavated lesions developed in the controlateral lung. When seen in 1979, the patient had consolidation of the whole right upper lobe and an excavated mass of right lower lobe. Amyloidosis was suggested; the pathologic sections of 1967 were reviewed and confirmed amyloidosis.
