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1.
Rev Med Interne ; 23(3): 317-21, 2002 Mar.
Article in French | MEDLINE | ID: mdl-11928380

ABSTRACT

INTRODUCTION: Tracheo-bronchial amyloidosis is an uncommon localized form of amyloidosis. We report two new cases. EXEGESIS: Two patients had developed expiratory dyspnea for several months. CT-scan and flexible bronchoscopy confirmed tracheal narrowing and a diagnosis of tracheo-bronchial amyloidosis was made by tissue biopsies. The immunohistochemical type was AL in one case, undetermined in the other case. There was no argument for systemic involvement. The two patients benefited from bronchoscopic dilatation. This treatment improved clinical symptoms and pulmonary function tests with a follow up of 12 and 18 months respectively. CONCLUSION: Tracheo-bronchial amyloidosis is a localised form of amyloidosis with various respiratory symptoms. Diagnosis is made by CT-scan and flexible bronchoscopy that allows biopsies. Immunohistochemical type is more often AL. Recurrence, respiratory insufficiency and tracheo-bronchial metaplasia are the most important complications. Treatment consists of bronchoscopic dilatation or excision, and bronchoscopic laser-YAG. Pulmonary function testing allows precise follow-up.


Subject(s)
Amyloidosis , Bronchial Diseases , Tracheal Diseases , Aged , Amyloidosis/diagnosis , Amyloidosis/diagnostic imaging , Amyloidosis/pathology , Amyloidosis/therapy , Biopsy , Bronchi/pathology , Bronchial Diseases/diagnosis , Bronchial Diseases/diagnostic imaging , Bronchial Diseases/pathology , Bronchial Diseases/therapy , Bronchoscopy , Female , Humans , Middle Aged , Prognosis , Respiratory Function Tests , Tomography, X-Ray Computed , Trachea/pathology , Tracheal Diseases/diagnosis , Tracheal Diseases/diagnostic imaging , Tracheal Diseases/pathology , Tracheal Diseases/therapy
2.
Rev Mal Respir ; 16(5): 839-41, 1999 Nov.
Article in French | MEDLINE | ID: mdl-10612156

ABSTRACT

We report a case of bronchiectasis in a 26-year-old man associated with the following congenital abnormalities: deafness, purulent bronchorrhea, nasal polyps, dysmorphic physical pattern and chronic sinusitis. Situs inversus was absent. A sampling was performed on the posterior nasal mucous membrane and displayed structural ciliary abnormality: a deficiency of the intern dynein-arm. The patient's bother was affected and had similar features: congenital bronchiectasis, deafness, mental deficiency and sinusitis. Young's syndrome was relevant in this case. Hereditary ciliary dyskinesia should be considered in adults with bronchiectasis together with rhinologic and alimentary canal disorders. Nasal biopsies are safe and allow cilia examination.


Subject(s)
Bronchiectasis/complications , Ciliary Motility Disorders/complications , Adult , Biopsy , Bronchiectasis/diagnosis , Bronchiectasis/genetics , Ciliary Motility Disorders/genetics , Ciliary Motility Disorders/pathology , Dyneins/analysis , Humans , Male , Nasal Mucosa/pathology
3.
Endoscopy ; 31(3): 232-6, 1999 Mar.
Article in English | MEDLINE | ID: mdl-10344427

ABSTRACT

BACKGROUND AND STUDY AIMS: Locoregional progression of esophageal cancer can result in respiratory distress aving to tracheoesophageal (T-E) fistula or central airways stenosis. We report our experience of airway stenting in 51 patients with esophageal carcinoma involving the central airways. PATIENTS AND METHODS: All data were recorded retrospectively. Fifty-one patients (44 men and seven women), with a mean age of 58.6 years, were analyzed. All had an esophageal squamous cell carcinoma. Severe respiratory impairment due to tumor invasion or to a tracheobronchial fistula (n= 14) was present in all patients. Nine of the 14 patients with fistula had dysphagia. Among the 37 patients without fistula, 19 had dysphagia. RESULTS: Sixty-six tracheobronchial stents were inserted in 51 patients: 65 Dumon stents and one Wallstent. Forty stents were implanted in the trachea, 16 in the left main bronchus and 10 in the right main bronchus. In 47 patients there was a significant improvement of respiratory symptoms. Esophageal intubation, carried out in nine patients, allowed eating and drinking in all cases. Mean survival was 107.7 days, with the longest follow-up 587 days. There was no difference between mean survival in the patients with fistulae (103.3+/-days) and the others (109.3+/-days). In two cases stent placement was responsible for death (massive hemoptysis and pneumonia). The main complications were migration (n=6), granuloma (n=2), pneumonia (n=2) and pneumothorax (n = 2). In 13 patients tumor progression in the airways was noted from one to 11 months after stenting, inducing a relapse of dyspnea. CONCLUSIONS: Complications are easily detected by the appearance of respiratory symptoms and do not necessitate systematic flexible bronchoscopy, but only preventive measures such as regular aerosol therapy, adapted respiratory physiotherapy and regular clinical follow-up.


Subject(s)
Carcinoma, Squamous Cell/complications , Esophageal Neoplasms/complications , Respiratory Insufficiency/etiology , Stents , Tracheoesophageal Fistula/complications , Adult , Aged , Aged, 80 and over , Carcinoma, Squamous Cell/pathology , Esophageal Neoplasms/pathology , Female , Humans , Male , Middle Aged , Neoplasm Invasiveness , Treatment Outcome
4.
Rev Mal Respir ; 14(1): 37-43, 1997 Jan.
Article in French | MEDLINE | ID: mdl-9082504

ABSTRACT

Since Ellmann's description in 1948 numerous authors have studied the respiratory manifestations associated with rheumatoid arthritis. Amongst the numerous disorders described, dilatation of the bronchi, although one of the most frequent, remains largely under-estimated. The authors report a series of 21 patients presenting jointly with both rheumatoid arthritis and bronchiectasis which was documented using thoracic computed scanning. All the subjects were female. For 20 of these patients, the appearance of bronchial suppuration preceded that of the articular manifestations by several years. Bronchial dilatation in these cases can, only with difficulty, be considered as a complication of arthritis as has been previously suggested. Rather it appears as a possible pre-disposing factor in the occurrence of the rheumatoid disease. These hypotheses explain the pathophysiological mechanisms implicated in this association are discussed.


Subject(s)
Arthritis, Rheumatoid/complications , Bronchiectasis/complications , Adult , Arthritis, Rheumatoid/drug therapy , Arthritis, Rheumatoid/physiopathology , Bronchiectasis/diagnosis , Bronchiectasis/physiopathology , Causality , Female , Humans , Middle Aged , Respiratory Function Tests , Retrospective Studies , Tomography, X-Ray Computed
5.
Ann Pathol ; 16(6): 445-8, 1996 Dec.
Article in French | MEDLINE | ID: mdl-9090935

ABSTRACT

We present a case of a primary pericardic thymoma, revealed by a pericardic effusion. This ectopic localisation is very unusual; neoplastic pericarditis are usually due to metastasis of carcinomas or lymphomas. Sometimes, they are secondary to pericardic invasion by mediastinal malignant thymomas or a metastasis of thymomas. Our patient presented a single pericardic localisation of thymoma without any other site. We discuss ectopic localisations of thymic tissue and thymomas and the diagnostic usefulness of the MIC 2 antibody.


Subject(s)
Pericarditis/etiology , Pericardium , Thymoma/complications , Humans , Male , Middle Aged , Pericarditis/pathology , Thymoma/pathology
6.
Rev Mal Respir ; 12(6): 625-7, 1995.
Article in French | MEDLINE | ID: mdl-8677358

ABSTRACT

A cavernous haemangioma of the mediastinum is a rare benign vascular tumour. Generally it is totally asymptomatic and the diagnosis is most often made in a child or young adult. The treatment is surgical. We report a case in a 60 year old man who was a smoker.


Subject(s)
Hemangioma, Cavernous/diagnosis , Mediastinal Neoplasms/diagnosis , Hemangioma, Cavernous/pathology , Hemangioma, Cavernous/surgery , Humans , Male , Mediastinal Neoplasms/pathology , Mediastinal Neoplasms/surgery , Middle Aged , Smoking
7.
Rev Pneumol Clin ; 49(3): 153-5, 1993.
Article in French | MEDLINE | ID: mdl-8296145

ABSTRACT

The authors report about one case of respiratory distress occurring after pleural talcage for pneumothorax. Although few cases have been published, this complication is known, and it should lead to carefully consider the indication of this technique and to limit the total amount of talc used.


Subject(s)
Pneumothorax/therapy , Respiratory Insufficiency/etiology , Talc/adverse effects , Adult , Female , Granuloma, Foreign-Body/etiology , Humans , Inflammation/physiopathology , Pleura , Recurrence , Respiratory Insufficiency/physiopathology , Talc/therapeutic use
8.
Sarcoidosis ; 8(2): 129-33, 1991 Sep.
Article in English | MEDLINE | ID: mdl-1669978

ABSTRACT

In its pulmonary form, sarcoidosis generally resolves spontaneously, but it may lead to fibrosis of the lung. The clinical, radiological and functional tests, as well as activity markers such as the serum angiotensin converting enzyme, intrathoracic uptake of 67Gallium and the cytological data provided by bronchoalveolar lavage are only the expressions at any given time of a disease which is constantly progressing and only partly express its evolutive potential. The authors studied the distribution of T-lymphocyte subsets in the peripheral blood and from bronchoalveolar lavage. 32 patients were included in the study. They were suffering from acute or chronic sarcoidosis of the mediastinum and lungs and were divided into 2 groups according to clinical, radiological and pulmonary function criteria; Group A (n = 19) included regressive forms (minimum follow up 2 years) and group B (n = 13) the progressive untreated forms. Lymphopenia with a decrease in the percentage of CD3 cells was found in both groups. The percentage of CD4 cells is significantly lower in group B (28 +/- 11%) than in group A (45 +/- 8%) (p < 0.01) or in the control population (46 +/- 8%) (p < 0.01). The percentage of CD8 cells is higher in group B (30 +/- 8%) than in group A (18 +/- 6%). This results in a CD4/CD8 ratio which is significantly reduced in group B (1 +/- 0.5) when compared with group A (2.72 +/- 0.8) (p < 0.01) and the control group (2.17 +/- 0.8) (p < 0.01), the difference between group A and the controls being minimal.(ABSTRACT TRUNCATED AT 250 WORDS)


Subject(s)
Sarcoidosis/immunology , T-Lymphocyte Subsets , Adult , Bronchoalveolar Lavage Fluid/immunology , CD4-CD8 Ratio , Female , Humans , Male , Mediastinal Diseases/blood , Mediastinal Diseases/immunology , Prognosis , Sarcoidosis/blood , Sarcoidosis, Pulmonary/blood , Sarcoidosis, Pulmonary/immunology
9.
Rev Pneumol Clin ; 47(2): 95-7, 1991.
Article in French | MEDLINE | ID: mdl-1836895

ABSTRACT

Infections caused by Mycobacterium chelonei are rare. We report a case of pulmonary infection in a 57-year-old non-immunocompromised woman. Most of the abnormalities were observed at radiology which showed bilateral apical excavated opacities. The disease could only be diagnosed on surgical biopsies. Beside diagnostic problems, M. chelonei infections are a source of therapeutic problems.


Subject(s)
Mycobacterium Infections, Nontuberculous/diagnosis , Mycobacterium chelonae , Pneumonia/diagnosis , Clarithromycin , Erythromycin/analogs & derivatives , Erythromycin/therapeutic use , Female , Humans , Middle Aged , Mycobacterium Infections, Nontuberculous/drug therapy , Pneumonia/drug therapy , Tomography, X-Ray Computed
10.
Thorax ; 45(9): 707-8, 1990 Sep.
Article in English | MEDLINE | ID: mdl-2218977

ABSTRACT

A 27 year old white woman with a history of chronic eczema and episodes of serious infection of the chest, skin, and bone presented with acute respiratory failure. She was found to have a spontaneous right pneumothorax and a pneumatocele in the left upper lobe. Despite a left upper lobectomy she was left with chronic respiratory failure, bullous lung disease, and bilateral bronchiectasis. The hyperimmunoglobulinaemia E and recurrent infections syndrome was diagnosed only in adult life.


Subject(s)
Bacterial Infections/complications , Hypergammaglobulinemia/complications , Immunoglobulin E , Job Syndrome/complications , Adult , Bacterial Infections/diagnostic imaging , Female , Humans , Hypergammaglobulinemia/diagnostic imaging , Job Syndrome/diagnostic imaging , Lung/diagnostic imaging , Lung Diseases/diagnostic imaging , Radiography , Recurrence
11.
J Radiol ; 70(10): 569-71, 1989 Oct.
Article in French | MEDLINE | ID: mdl-2593111

ABSTRACT

CT and MRI features of a multicystic mediastinal teratoma, which was surgically and pathologically confirmed, are presented. CT found 4 cystic tumors of mediastinum with water density content and thick capsule. One kyste contained a fat density area and peripheric calcifications. MRI showed will defined high signal intensity on Spin-echo T1 weighted images. CT and MRI are not reliables in predicting or excluding adherence to adjacent structures. The particularity of this case was the presence of a communication between the anterior right cyst and the posterior left one. This communication passed by the transverse sinus of pericardium.


Subject(s)
Dermoid Cyst/diagnosis , Magnetic Resonance Imaging , Mediastinal Neoplasms/diagnosis , Tomography, X-Ray Computed , Adult , Dermoid Cyst/diagnostic imaging , Female , Humans , Mediastinal Neoplasms/diagnostic imaging
12.
J Radiol ; 70(8-9): 491-6, 1989.
Article in French | MEDLINE | ID: mdl-2685280

ABSTRACT

The authors report a case of pleural tumor discovered in case of thoracic pain in a 72 year old woman. This lesion, discovered on chest X-Ray, developed in the left costo-vertebral groove and was seen as a homogeneous opacity, multilobate, well-defined. CT confirmed the pleural origin, showed a thickening of posterior pleural, a polylobate tumor well-defined on its lung side, non-invasive and of tissue density. Histopathological examination of the operative specimen showed it to be a thymoma with an exceptional localization.


Subject(s)
Pleural Neoplasms/diagnosis , Thymoma/diagnosis , Aged , Diagnosis, Differential , Female , Humans , Pleural Neoplasms/diagnostic imaging , Pleural Neoplasms/pathology , Radiography , Thymoma/diagnostic imaging , Thymoma/pathology , Thymus Gland/embryology
14.
Presse Med ; 17(8): 369-72, 1988 Mar 05.
Article in French | MEDLINE | ID: mdl-2966366

ABSTRACT

The purpose of this french multicentric study was to evaluate the diagnostic accuracy of samples collected by fibroscopy in peripheral lung cancer with normal endoscopy. Five hundred and sixty-one patients entered the study; a tumour had been diagnosed in 350 of them (62 p. 100). Among these 350 patients, 147 were examined with the help of a light-amplifier screen, and a positive diagnosis was made in 97 (66 p. 100). Guided sample collection in the pathological area (biopsy, brushing, transcatheter aspiration) proved much more rewarding than unguided sample collection (biopsy of the bronchus, simple aspiration or cytology of 3-day sputum): 45 p. 100 positive results versus 18 p. 100 (P less than 0.001). However, sputum cytology still had good diagnostic value since it provided by itself the diagnosis in 14 p. 100 of the cases. Results were significantly inferior in tumours less than 3 cm in diameter.


Subject(s)
Lung Neoplasms/diagnosis , Adult , Aged , Aged, 80 and over , Biopsy , Bronchial Neoplasms/diagnosis , Bronchial Neoplasms/pathology , Bronchoscopy , Catheterization, Peripheral , Female , Fiber Optic Technology , Humans , Lung Neoplasms/pathology , Male , Middle Aged , Prospective Studies
15.
Rev Mal Respir ; 5(1): 67-70, 1988.
Article in French | MEDLINE | ID: mdl-3368637

ABSTRACT

Pneumatocele and haemato-pneumatocele are air or air/fluid cavitary lesions which develop in the lung parenchyma after thoracic trauma. The formation of this lesion requires a direct violent impact on the pliable lung wall which explains its frequency in young adults. They are preferentially localised in the lung bases. The importance of associated lesions often marks the pneumatocele. Though rarely described, its frequency is certainly underestimated. If haemoptysis is the most frequent clinical sign it is the chest x-ray which demonstrates the early abnormality in the form of a rounded translucent image with a fine contour and variable diameter. The existence of a fluid level suggests the presence of blood (haemato-pneumatocele). The differential diagnosis with a localised pneumothorax, a diaphragmatic hernia and a pre-existing cystic lesion is easy as a rule but an evacuated pulmonary haematoma may lead to the discussion, especially as the mechanism of their formation may be the same. In isolation their clinical implications are minimal, their evolution favourable and after several weeks with a restitution of the integrity of the pulmonary parenchyma the absence of therapeutic intervention is justified.


Subject(s)
Cysts/etiology , Lung Diseases/etiology , Thoracic Injuries/complications , Wounds, Nonpenetrating/complications , Adolescent , Air , Blood , Cysts/diagnostic imaging , Female , Humans , Male , Middle Aged , Radiography
16.
Rev Pneumol Clin ; 44(3): 136-9, 1988.
Article in French | MEDLINE | ID: mdl-3057563

ABSTRACT

A 38-year-old woman was known to have had a histologically proven "idiopathic" pulmonary hemosiderosis for 7 years; the authors report the onset in this patient of polyarthralgias with articular swelling and positivity of rheumatoid factor, all features consistent with the diagnosis of rheumatoid arthritis, whose beginning was certainly hidden by steroid therapy. This case, as some others previously published, outlines the possibility of the association of pulmonary hemosiderosis and rheumatoid arthritis: is this a casual association, or may pulmonary hemosiderosis be a rare manifestation of rheumatoid arthritis?


Subject(s)
Arthritis, Rheumatoid/complications , Hemosiderosis/complications , Lung Diseases/complications , Adult , Female , Humans , Male
17.
Pathol Biol (Paris) ; 35(10): 1301-8, 1987 Dec.
Article in French | MEDLINE | ID: mdl-2963992

ABSTRACT

Accumulation of inflammatory and immune cells within lung parenchyma would constitute the initial step in producing the alveolar structural abnormalities. It is usually assumed that alveolitis, as assessed by broncho-alveolar lavage (BAL), represents a biological assessment of lung disease activity. The aim of this study, using monoclonal antibodies, is to characterize the T lymphocytes alveolitis in the lung and in peripheral blood in 3 well-defined populations: 1 degree) control subjects (n = 7); 2 degrees) patients with biopsy proven mediastino-pulmonary sarcoidosis (sarc) (n = 73), classified according to their clinical activity as active, inactive, chronic, and treated; 3 degrees) patients with extrinsic alveolar alveolitis (EAA) (n = 19). For the same BAL volume, the % of CD4+ cells and the CD4/CD8 ratio are increased in chronic and active sarc, contrasting with an increase in the % of CD8+ cells and a decrease in the CD4/CD8 ratio in the EAA. In absolute values, there are 2 times as many CD4+ cells and 5 times as many CD8+ cells in EAA than in sarcoidosis. In sarcoidosis, corticotherapy tends to normalize the CD4/CD8 ratio although the intensity of the lymphocytic alveolitis is not affected. In the peripheral blood, lymphopenia is observed only in the active form of sarc. in the CD4+ population, without any significant change in the CD4/CD8 ratio compared to the other groups. The number and distributions of BAL. T lymphocytes subsets may constitute a biological indicator for diagnostic orientation, but they do not distinguish sufficiently between the different groups of sarcoidosis to be of any prognostic value.


Subject(s)
Alveolitis, Extrinsic Allergic/pathology , Bronchoalveolar Lavage Fluid/pathology , Sarcoidosis/pathology , T-Lymphocytes/pathology , Adult , Antibodies, Monoclonal , Female , Fluorescent Antibody Technique , Humans , Leukocyte Count , Male , T-Lymphocytes, Cytotoxic/pathology , T-Lymphocytes, Helper-Inducer/pathology , T-Lymphocytes, Regulatory/pathology
20.
J Chir (Paris) ; 122(10): 561-5, 1985 Oct.
Article in French | MEDLINE | ID: mdl-4066805

ABSTRACT

A patient presented with rupture of right bronchus associated with rupture of the homolateral subclavian artery (diagnosed secondarily at the false aneurysm stage) and bilateral fracture of the 1st rib. Two stage repair operation provided lasting recovery. This case is used as a basis for emphasizing the diagnostic problems raised by combined endothoracic lesions, the need for systematic investigation of possible presence of a lesion of subclavian artery in patients with fracture of 1st rib, and finally various operative tactics (in the framework of false aneurysms of proximal subclavian vessels).


Subject(s)
Bronchi/injuries , Rib Fractures/etiology , Subclavian Artery/injuries , Thoracic Injuries/complications , Wounds, Nonpenetrating/complications , Adolescent , Humans , Male , Rupture , Thoracic Injuries/diagnosis , Wounds, Nonpenetrating/diagnosis
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