Cardiac lymphoma presenting as atrial flutter in an AIDS patient.

An increasing number of patients with the acquired immunodeficiency syndrome (AIDS) and cardiac lymphoma have been documented. Antemortem diagnosis of cardiac non-Hodgkin lymphoma in AIDS is difficult because of the non-specificity of the clinical findings. Rapid progression of cardiac dysfunction is common after symptoms appear. We report the case of a patient with AIDS and cardiac lymphoma revealed by an atrial flutter.

Effects on the isolated human bronchus of SR 48968, a potent and selective nonpeptide antagonist of the neurokinin A (NK2) receptors.

Tachykinins produce concentration-dependent contraction of the human isolated bronchus by stimulation of receptors that belong to the NK2 type. The aim of this study was to investigate the inhibitory effects of a new, potent, and selective nonpeptide antagonist of the neurokinin A (NKA) (NK2) receptors, SR 48968 [(S)-N-methyl-N-[4-acetylamino-4-phenylpiperidino-2-(3,4-dichlorophenyl) butyl]benzamide] on human isolated airways. Our experiments were performed on human isolated bronchi obtained from patients with lung cancer. Phosphoramidon, 10(-5) M, was added to the bath to inhibit neurokinin metabolism. SR 48968 induced a parallel shift to the right of the concentration-response (C/R) curves to [Nle10]-NKA(4-10), a specific NK2 receptor agonist. The antagonism was of the competitive type, with a pA2 of 9.40 +/- 0.19 (slope = 0.95 +/- 0.08, n = 13). The (R)-enantiomer of SR 48968 was 100-fold less potent and a noncompetitive antagonist (slope = 0.56 +/- 0.11, n = 8); pA2 and slope of the racemate were 8.86 +/- 0.21 and 1.09 +/- 0.21 (n = 7), respectively. Under similar conditions, racemic CP-96,345, a nonpeptide NK1 antagonist, did not modify the C/R curves to [Nle10]-NKA(4-10) until 10(-7) M. SR 48968 did not modify C/R curves to acetylcholine, histamine, KCI, or PGF2 alpha on the human isolated bronchus. Finally, SR 48968 shifted to the right C/R curves to substance P on isolated human bronchi, whereas racemic CP-96,345 was without effect.(ABSTRACT TRUNCATED AT 250 WORDS)

Tracheal sleeve resection for iatrogenic stenoses (subglottic laryngeal and tracheal).

Since 1975 200 tracheal sleeve resections for iatrogenic tracheal and subglottic laryngeal stenoses have been performed in our institution. Preoperative Nd:YAG laser is of paramount help in opening the stenoses. Tracheography is usually performed to specify the length of the stenosis and the distance from the vocal cords. Operative procedures are described. One hundred seventy five (87.5%) patients are definitely cured, but in this group 16 patients required a Montgomery tube for 6 months to 1 year to recover a normal tracheal diameter. Two patients needed a second tracheal sleeve resection. Nine (4.5%) patients died, and 16 (8%) had recurrent stenoses. Stenoses in these patients were treated with use of a tracheostomy tube, a permanent Montgomery tube, or an endotracheal stent. Partial anterior cricoid resections performed in 21 patients have had the same results as those of the whole series. Twenty one laryngeal releases were performed and proved to be efficient and safe. In our experience complications can be avoided by good selection and preparation of the patients, accurate identification of the level and length of the stenosis, and meticulous technique.

[Mucoepidermoid bronchial carcinoma. Review of the literature apropos of a new case]. / Carcinomes bronchiques muco-épidermoïdes. Revue générale à l'occasion d'une nouvelle observation.

Muco-epidermoid bronchial tumours are rare and characterized by the coexistence of epidermoid, mucus-secreting and intermediate cells. The authors report the case of a 22-year old unmarried woman hospitalized for exploration of a febrile dyspnoea related to a right superior lobar atelectasis. Endoscopy showed a smooth, pediculate tumour arising from the right superior lobar bronchus where bronchial biopsy was negative. Right superior lobectomy was performed through thoracotomy and established the diagnosis of muco-epidermoid bronchial tumour. Surgery was followed by radiotherapy of the chest. Over a 5-year follow-up period there was no local or extrathoracic recurrence, and the patient is in good condition.

Penetration of minocycline into lung tissues.

The penetration of minocycline into different lung tissues and bronchial mucus was studied in 17 patients undergoing pulmonary surgery for cancer. The patients received oral minocycline 100 mg at night for 3 days preceding surgery. Minocycline concentrations were measured in plasma samples collected before the operation and in tissues and mucus taken from in and around the part of the lung that was surgically removed. Mean tissue or mucus concentration to plasma concentration ratios were 3.78 +/- 1.10 for lung parenchyma, 4.04 +/- 1.31 for bronchial walls, 3.37 +/- 1.00 for pulmonary arterial walls, 1.99 +/- 1.80 for intraluminal mucus collected from bronchi located in healthy tissue proximal to the tumour, 5.16 +/- 3.26 for intraluminal mucus collected in a bronchus distal to the tumour, and 3.06 +/- 1.99 for catheter-collected mucus from the trachea and principal bronchi. These results indicate that minocycline is found in high concentration in all types of lung tissue and mucus in man.

[Diffusion of minocycline in pulmonary tissue]. / Diffusion de la minocycline dans le tissu pulmonaire.

The penetration of minocycline into lung tissue was evaluated in 14 patients about to undergo excision of the lung for cancer. The patients received minocycline orally in doses of 100 mg twice a day for 3 days, the 100 mg in the morning of the operation day. Minocycline concentrations were measured in plasma samples taken before surgery and in the lung tissue resected. The mean tissue/plasma concentration ration was 3.17 +/- 0.41 (range: 1.5 to 7.48). The same ratios were obtained in peritumoral and tumoral tissues. These results indicate that minocycline penetrates well into tissues.

Characterization of neurokinin effects and receptor selectivity in human isolated bronchi.

Sensitive afferent nerves and the neurokinins they release upon activation are considered to be important in controlling bronchomotor tone. Human isolated bronchi respond to neurokinin A (NKA), substance P (SP), and neurokinin B (NKB) with dose-dependent contractions. The order of potency of the three natural neurokinins is NKA greater than SP greater than NKB, suggesting the presence of NK-2 receptors. To further characterize the neurokinin receptors in human bronchi, we used selective agonists for each receptor type (i.e., NK-1, NK-2, and NK-3). In fact, NK-1 selective compounds, [Pro9]SP(1-11) sulfone and [beta-ala4,Sar9]SP(4-11) sulfone, did not induce significant contractions up to 10(-5) M. Similarly, the selective agonist for the NK-3 receptor, [MePhe7]NKB(4-10), was almost inactive. However, the NK-2 selective fragment [Nle]NKA(4-10) was a potent stimulant. The negative log of the peptide concentration that caused 50% of maximal effect (pD2) was 6.99 for NKA and 6.12 for [Nle10]NKA(4-10). Removal of the epithelium significantly enhanced the contractile responses to the three neurokinins and also to the NK-2 selective agonist. Phosphoramidon, an enkephalinase inhibitor, was more potent than epithelium removal in enhancing the contractile responses to these agonists. However, epithelium removal and phosphoramidon did not increase the weak responses to the NK-1 and NK-3 selective compounds. In the presence of phosphoramidon, removal of the epithelium slightly enhanced the contractile responses to NKA and [Nle]NKA(4-10) but not to SP and NKB.(ABSTRACT TRUNCATED AT 250 WORDS)

[Pulmonary papillomatosis]. / La papillomatose pulmonaire.

The authors report a case of a 30 year old woman with juvenile laryngeal papillomatosis (JLP) who subsequently developed intra-alveolar papillomas. These papillomas demonstrated a marked pseudo-neoplastic loco-regional invasive activity, but did not possess the histological criteria of malignancy and were treated by pneumonectomy and lobectomy.

Interaction between fenoterol, ipratropium, and acetylcholine on human isolated bronchus.

Functional antagonism between fenoterol (F) and acetylcholine (ACh) and interaction between F and ipratropium (Ipr) on ACh-induced contraction were evaluated on isolated human bronchi. In the presence of increasing concentrations of ACh (2 X 10(-4) and 2 X 10(-3) mol/L), dose-response curves of the relaxant effect of F were shifted to the right (0.45 and 0.92 log units), and the maximal effect of F, expressed as a percentage of the effect of theophylline, 3 X 10(-3) mol/L, was reduced from control values of 92.1 +/- 4% to 70.8 +/- 7.0%, and to 67.2 +/- 7.1%, according to the functional antagonism. In the presence of Ipr, 10(-9) and 10(-8) mol/L, the functional antagonism between ACh and F was partially reversed. Concentration response-curves to F versus ACh, 2 X 10(-3) mol/L, were shifted to the left, and although the -log molar concentration producing 50% of maximal effect was not significantly modified, the maximal effect of F was significantly increased in the presence of Ipr, 10(-8) mol/L. It is concluded that the effect of combined F and Ipr on the isolated human bronchus contracted with ACh appears to be of the additive type.

Effects of noradrenaline on the isolated human bronchus. Comparison with the isolated guinea pig trachea.

The pharmacodynamic activity of noradrenaline was evaluated comparatively in vitro on isolated human bronchi and on guinea pig tracheal spirals. Noradrenaline exerted a contractile effect on both preparations under resting tone and in the presence of propranolol 10(-6) M; maximal noradrenaline-induced contraction was 15-20% of maximal acetylcholine (ACh)-induced contraction. Without propranolol, the contractile effect of noradrenaline was negligible when the preparations were under resting tone and absent when they were precontracted with ACh. In contrast, noradrenaline exerted a strongly relaxant effect on both human bronchi (-log ED50 5.24 +/- 0.17; N = 5) and guinea pig tracheae (-log ED50 6.15 +/- 0.29; N = 8). With maximal contraction induced by ACh 3.10(-3) M the -log ED50 of both preparations were shifted to the right by functional antagonism and became 4.72 +/- 0.17 and 5.31 +/- 0.11, respectively. The pKD values of noradrenaline, calculated according to Furchgott and Bursztyn (1967), were 4.79 +/- 0.04 in human bronchi (N = 5) and 4.77 +/- 0.16 in guinea-pig tracheae (N = 8). In the presence of cocaine plus phenoxybenzamine these values were not significantly modified in human bronchi and only slightly modified in guinea pig tracheae. It is concluded that noradrenaline induces a strong beta-adrenergic response and a negligible alpha-adrenergic response from both human bronchi and guinea pig tracheae in vitro.

[Development of anesthetic technics for resection-anastomosis of the trachea]. / Evolution des techniques d'anesthésie pour résection-anastomose de trachée.

A series is reported of 109 patients, 45 +/- 18 yr old, undergoing tracheal sleeve resection. 101 patients had iatrogenic tracheal stenosis, 5 tracheal cylindroma, 2 tracheal cancer and 1 tracheal trauma. 84 patients underwent preoperative laser coagulation to increase the airway internal diameter. Anaesthesia for the sleeve resection was induced by thiopentone, and maintained by an opiate, nitrous oxide and, if necessary, a volatile anesthetic. Patients were intubated, after having been given a muscle relaxant, with either a normal length and diameter tube with a low pressure cuff, or a narrow (internal diameter less than 6 mm) 50 cm long tube with or without a low pressure cuff. Patients with long tubes were ventilated with intermittent positive pressure, and the others with high frequency jet ventilation (HFJV) via a urethral catheter within the endotracheal tube. 20% of the long tubes had to be replaced during surgery because of perforation of the cuff by a tracheal stitch. In all, six patients died, one as a result of a pneumothorax and air embolus due to HFJV. Preoperative photocoagulation reduced the risk of induction and intubation; the choice of endotracheal tube no longer depended on the tracheal diameter, but on the method of ventilation chosen. However, HFJV has tended to be phased out, except for the surgery of lesions close to the carena; it has been replaced by intermittent positive pressure ventilation via long tubes. Because laser photocoagulation can completely cure small stenoses, these patients requiring surgery were those with long stenoses which were difficult to treat.(ABSTRACT TRUNCATED AT 250 WORDS)

Early detection of streptococcal group antigens in skin samples by latex particle agglutination.

The streptococcal group antigens (A to G) were researched in skin biopsy specimens by a latex agglutination technique using commercial (Slidex Streptokit bio-Mérieux and Streptex Wellcome) and experimental reagents. Twenty-seven patients with obvious cutaneous infections (12 cases of erysipelas, nine cases of cellulitis, and six cases of necrotizing fasciitis) and 27 age- and sex-matched controls were studied. Our preliminary data demonstrated the possibility of an early diagnosis of streptococcal cutaneous infections involving the deep dermis and/or hypodermis. We used a latex agglutination technique that is quite specific and gives a better sensitivity (0.63) than either conventional bacteriologic cultures on needle aspiration or skin biopsy specimens.

[Benign mediastinal hemangiomas]. / Hémangiomes bénins du médiastin.

Haemangiomas represent a very rare form of primary mediastinal tumour. Their benign character, though rare, should not allow one to forget that their excision is correct, though sometimes tricky on account of their special anatomic situation. Two new observations are reported here as evidence of this difficulty. The prognosis, save for a few exceptional cases of local recurrence as in one of the cases sighted here is always good.

Indications and technique for endoscopic laser resections in bronchology. A critical analysis based upon 2,284 resections.

Over a period of 6 years, we have treated 1,310 patients in 2,284 sessions using a neodymium-yttrium aluminum garnet laser. Indications are more often palliative than curative, with the primary goal to relieve an obstructed airway in a single treatment. The effectiveness of such resections is widely recognized, but indications for such a technique with its limitations deserve emphasis. The use of a rigid bronchoscope is important to provide satisfactory operating conditions and especially to manage hemorrhage rapidly while maintaining a satisfactory airway.

Superinfection by Aspergillus fumigatus of a pulmonary lesion caused by Mycobacterium xenopi.

A 36-year-old man had a pulmonary infection with a cavity in the right upper lobe caused by Mycobacterium xenopi. A superinfection by Aspergillus fumigatus occurred 1 year later. Both organisms were found in the resected lung specimen. The patient remained asymptomatic after surgery. The superinfection of healed tuberculous lesions by 'atypical' mycobacteria or Aspergillus species is well known but the co-existence of the 2 organisms is very rare.

[Variations in the distribution of bronchial arteries. Apropos of 72 arteriographies]. / Variations de la distribution des artères bronchiques. A propos de 72 artériographies.

Anatomic distribution of bronchial arteries was studied by arteriography, and evaluation conducted of 72 images considered as being complete. Seven frequent types of distribution were note and findings compared with those of previous studies. Frequency of collateral circulation and of anastomosis was comparable with that reported in the literature. One new distribution pattern was observed: common lower trunk, right upper intercostobronchial trunk, left upper trunk.