[Pulmonary textiloma revealed by hemoptysis 12 years after thoracotomy]. / Textilome pulmonaire révélé par une hémoptysie 12 ans après thoracotomie.

INTRODUCTION: Pulmonary textiloma or retained surgical sponge is rare but can have detrimental consequences. Its diagnosis is difficult, even when using computerized tomography (CT) scan and is always a medical and legal problem. EXEGESIS: We report the case of a 46-year-old man with a history of pulmonary tuberculosis diagnosed by thoracotomy in 1986, who was admitted to hospital for hemoptysis. CT scan showed the existence of a pulmonary lesion. Clinical, radiological and fiberoptic endoscopy features mimicked an abscess or bronchiectasis. The patient underwent left inferior lobectomy. Anatomical findings led to the diagnosis of textiloma. CONCLUSION: This case shows the difficult in diagnosing pulmonary textiloma, even when using CT scan. Textiloma should be considered when an atypical pulmonary mass is found in a patient with past history of thoracotomy.

[Monitoring of small cell bronchopulmonary cancer by bronchial biopsies]. / Surveillance des cancers broncho-pulmonaires à petites cellules par biopsies bronchiques.

This retrospective study of 149 patients with small cell lung cancer highlights the value of bronchial endoscopies combined with biopsies for the follow-up of these cases. A control endoscopy performed during the third month showed that macroscopic lesions had completely disappeared in 42 percent of the patients. Each subsequent endoscopy offered a probability rising from 20 to 50 percent of diagnosing a recurrence in the patients explored. Our study particularly demonstrates the usefulness of bronchial biopsy at the initial site of the lesion, even when the bronchial mucosa seems to have returned to normal, since this biopsy is positive in 4.5 percent of the cases.

Transbronchial biopsy without fluoroscopy: a five year experience in outpatients.

Transbronchial biopsy is the technique of choice for obtaining tissue for histological diagnosis in many pulmonary disorders. The procedure has usually been carried out as an inpatient procedure with the use of fluoroscopy, though this policy has recently been questioned. This report concerns a five year experience of 174 transbronchial biopsies performed without fluoroscopy as an outpatient procedure in patients with interstitial lung disease or a suspicion of sarcoidosis. Chest radiography was carried out only if the patient developed symptoms. No major complications were encountered and the overall complication rate was low. Pneumothorax occurred in six patients (3.4%), only one of whom required intercostal intubation, and bleeding of more than 30 ml occurred in two patients. Histological diagnosis was obtained in 154 patients (88%). In the experience of this group transbronchial biopsy has been safe when carried out as an outpatient procedure without fluoroscopic guidance.

[Pulmonary hemorrhage complicating transthoracic puncture]. / Hémorragie pulmonaire compliquant une ponction transthoracique.

Fine needle transthoracic aspiration (FNTA) of pulmonary opacities under guidance of computerized tomography (CT) is a simple procedure yielding conclusive results in many patients with malignant lung tumours. The small caliber of the needles utilized and the CT control make this increasingly popular procedure both accurate and safe. Yet a number of complications have occurred; most of them were benign (e.g. pneumothorax) but some were potentially dangerous (e.g. pulmonary haemorrhage), so that the pros and cons of the procedure must carefully be weighed. We report the case of a patient in whom FNTA was complicated by copious haemoptysis and a pulmonary haematoma clearly visible at CT. The literature concerning the potential complications of transthoracic puncture is reviewed.

[Asthma and pregnancy: peculiarities, therapeutic precautions]. / Asthme et grossesse: particularités, précautions thérapeutiques.

Asthma is a very common disease and may be encountered in pregnant women. The physiological changes which accompany pregnancy, as well as the risks of drug teratogenicity and drug interactions make it necessary to take certain therapeutic precautions. Following a review of the specific respiratory physiological changes observed in pregnant women, the authors describe the risks inherent in the various treatments of asthma and the precautions to be taken during delivery and breast-feeding.

[Inhalation pneumonia presenting as a pneumocystis infection]. / Pneumopathie d'inhalation révélée par une pneumocystose.

A case of Pneumocystis carinii pneumonia is presented. Following presentation a chronic alveolitis was uncovered, which was due to ultimately repeated and prolonged inhalation of sweets containing gum arabic. The diagnosis was confirmed by a trans-bronchial biopsy and by chemical analysis of centrifugation of the alveolar lavage deposit. After cessation of the inhalation the progress was satisfactory both in terms of clinical status and lung function measurement.

[Thoracic actinomycoses. General illustrated review of 4 surgical cases]. / Les actinomycoses thoraciques. Revue générale illustrée de 4 cas chirurgicaux.

Actinomycosis of the lung is rare and difficult to diagnose. Its good prognosis after medical treatment contrasts with the high frequency of surgical excision, due to the fact that pre-operative diagnosis is exceptional. Following a review of the recent bacteriological, radiological and therapeutic data available in the literature, 4 personal cases are presented. In all 4 cases actinomycosis was diagnosed post-operatively on the presence of yellow grains in the histological specimens. In 2 cases surgical excision proved impossible, but an almost complete radiological recovery could be obtained after prolonged treatment with co-trimoxazole. This shows how important it is to be aware of the disease, to improve its diagnostic approach and to remember its sensitivity to antibacterial agents, even in well organized forms.

[Value of alveolar lavage and transbronchial biopsy in the diagnosis of isolated sarcoid uveitis]. / Intérêt du lavage alvéolaire et des biopsies transbronchiques dans le diagnostic des uvéites sarcoïdosiques isolées.

The diagnosis of sarcoidosis is established by biopsy of sarcoid tissues demonstrating non-caseating granuloma, but difficulties arise when extra pulmonary organs are involved separately. Positive histologic signs can however be found in the lung even when there are no radiologic features. Bronchoalveolar lavage and biopsies were performed in 19 patients presenting severe, strictly isolated uveitis (5 cases of anterior uveitis, 3 cases of posterior uveitis and 11 cases of panuveitis). Criteria of positivity were non-caseating granuloma and lymphocytosis. Positive signs were obtained in 6 cases (31,5%); 1 case of posterior uveitis and 5 of panuveitis. There was no case of false positive results but one false negative result. There was a lack of correlation between results of these investigations and angiotensin converting enzyme blood levels. These investigations are non-invasive in experienced hands.

[Chemotherapy of bronchopulmonary and pleural adenocarcinoma. Apropos of 31 cases]. / Chimiothérapie des adénocarcinomes broncho-pulmonaires et pleuraux. A propos de 31 cas.

Between January 1978 and June 1983, 31 patients aged between 35 and 73 years, with an adenocarcinoma of the respiratory system (25 lung cancers and 6 pleural cancers) were treated by chemotherapy, either exclusively or following failure of surgery. In 21 patients, the treatment consisted of a combination of cyclo-phosphamide (600 mg/m2), adriamycin (40 mg/m2) and 5-fluoro-uracil (600 mg/m2) by intravenous injection, every four weeks. The other 10 patients received different treatments, but platinum salts were administered in only 2 cases. The treatment was fairly well tolerated (only 1 death due to toxicity), but the effectiveness remained disappointing: only 1 complete response (alive after 48 months), 2 partial responses and 4 stabilisations. The overall median survival was 9 months, with a mean survival of 11.6 months. The mean survival of the responder and stabilised patients was more than 21 months. These results lead us to recommend that, apart from randomised trials, chemotherapy should be stopped after the second course in the absence of at least a stabilisation of the disease, in which prolonged survivals are sometimes observed when treatment is limited to purely symptomatic measures.

[Contamination of bronchial fiberscopes by mycobacteria. Myth or reality?]. / Contamination des fibroscopes bronchiques par les mycobactéries. Mythe ou réalité?

The authors report the results of a study into mycobacterial contamination of bronchial fibroscopes over a 6 year period during which 8,750 fibroscopies were performed. On 19 occasions, there were two positive results on the same day which could have led to contamination (0.07 p. 100). In 12 cases, there was heavy bacterial contamination on the first examination and at least 5 colonies on the second. Crossed transmission was not observed. The authors emphasize the role of the accessory parts and connections which are often neglected and which may lead to false positive results in the following patients; a sterilisation procedure is proposed which seems to be effective as no mycobacterial contamination has been observed since it was introduced.

[Is bronchial fiberscopy always indicated in hemoptysis? Apropos of 427 tests]. / La fibroscopie bronchique doit-elle être systématique en cas d'hémoptysie? A propos de 427 examens.

The authors report the results of a retrospective study of 427 fiberoptic bronchoscopies in patients with haemoptysis. The patients were classified into 4 groups according to the results: Group I: a specific diagnosis was made (cancer, tuberculosis, infection); 151 cases (35 p. 100); Group II: inflammatory mucosa, 172 cases (40 p. 100); Group III: normal bronchoscopy, 84 cases (20 p. 100); Group IV, only blood, 20 cases (5 p. 100). Of the 151 patients in Group I, 12 had a normal chest X-ray (8 p. 100); seven of them had bronchopulmonary carcinoma (7 out of 65 cases of cancer: 10.7 p. 100). These results show that bronchoscopy is essential in cases of haemoptysis even when the chest X-ray is normal.

Primary pneumococcal pericarditis complicated by acute constriction.

We report a case of a 31-year-old male with primary pneumococcal pericarditis. Severe acute constrictive pericarditis developed within a month of the onset of the illness in spite of adequate antibiotic therapy and pericardial drainage.

[Treatment of status asthmaticus. Prospective evaluation of a protocol combining aminophylline and terbutaline (44 cases)]. / Traitement de l'état de mal asthmatique. Appréciation prospective d'un protocole associant aminophylline et terbutaline (44 cas).

The treatment of status asthmaticus remains poorly defined. Even the definition of the condition is controversial. We have therefore attempted to define a therapeutic protocol consisting of a combination of terbutaline, aminophylline and hydrocortisone administered parenterally. We have conducted a prospective evaluation of the effectiveness and tolerance of this protocol. 44 consecutive patients with status asthmaticus (defined as an abnormally severe episode of asthma with early or marked alveolar hypoventilation: PaCO2 greater than or equal to 5.20 kPa) were entered into the study over a period of 56 months. The effectiveness of this combination is reflected by the rapid improvement in the clinical and blood gas parameters, the relatively rare use of mechanical ventilation (of brief duration) and the low mortality. The tolerance proved to be excellent, as the terbutaline only had to be stopped in 1 case (permanently) and the aminophylline in one other case (temporarily). These initial results encourage us to a more aggressive approach in the early treatment of status asthmaticus with particular attention to the associated metabolic acidosis.