[Screening program for tuberculosis among international exchange students in the Department of Isère]. / Dépistage de la tuberculose chez les étudiants étrangers en échange international en Isère.

INTRODUCTION: France is a low-incidence country for tuberculosis (TB). Consequently screening is focused on high-risk populations, in particular migrants. The aim of this study was to evaluate the epidemiology of TB among international exchange students in the Department of Isère and the screening programs used. METHODS: We carried out an organizational audit based on interviews with physicians involved in the management of TB in Isère. We conducted a retrospective descriptive study based on a case series of foreign students treated for TB from 2003 to 2013 inclusively. RESULTS: Forty-six international exchange students were treated for active TB during this time, representing an average incidence of 284/100,000. Two thirds of our studied population were Africans, 72% were asymptomatic at the time of screening. A quarter of our cohort developed TB after the initial screening. Thirty-one cases were confirmed bacteriologically, mainly through bronchoscopy. Outcome (radiological and clinical) on quadruple therapy was satisfactory in all patients. Two patients relapsed, one of them with multi-drug resistant TB. CONCLUSION: Our work confirms that international exchange students are a population at high risk of TB and that screening of this population is essential. The significant number of active TB cases diagnosed after the initial screening stresses the importance of diagnosis and follow up of patients with latent TB infection.

[Tuberculosis control in France--evaluation of practice by a working group of the Société de Pneumologie de Langue Française]. / La lutte antituberculeuse en France: évaluation des pratiques par un groupe de travail de la SPLF auprès des services de lutte antituberculeuse.

INTRODUCTION: The management of tuberculosis has been the subject of renewed interest in France. Recently, the recommendations and the regulations concerning the disease have been updated. However, the resources that are actually available and the processes in place in different French departments are not clearly known. A national survey was thus carried out by a working group of the SPLF in charge of the recommendations concerning the medical, social and administrative management of the disease. METHODS: A questionnaire was sent to the 100 French departmental Antituberculous Services (SLAT). This explored the structures, activity, organisation involved, and difficulties encountered in Tuberculosis management. RESULTS: Ninety SLAT took part in the study. Their answers reveal: a discordance between a number of cases notified to the Department of Sanitation and Health (DDASS) and the number of cases known to the SLAT; a disparity between means involved in this study and the number of patients followed up as well as the choice of populations targeted for tracing); a willingness to deal with contact tracing although the investigations around individual cases and the definition of which subjects should be followed up were variable; a demand for protocols, networks and national recommendations. CONCLUSIONS: The SLAT are involved in the fight against tuberculosis with 20 years experience. The needs expressed in this survey point the way towards future prioritary actions to improve tuberculosis control nationally.

[Routine preoperative evaluation of hemostasis]. / Exploration pratique pré-opératoire de l'hémostase.

Preoperative evaluation of hemostasis is mainly based on the clinical investigation. Clinical symptoms and history taking help target the most at risk patients. Clinical assessment is also helpful in defining the acquired or constitutional nature of any hemostatic disorder and the type of anomaly involved, e.g. primary hemostatic disorder or coagulation defect. Proper evaluation also helps detect the potential risk of bleeding independently of biological defects detectable with routine tests. Applied in an informative population, clinical evaluation enables optimal utilization of laboratory results.

Surgery in severe factor XIII deficiency: report of a case of epilepsy neurosurgery and review.

Factor XIII (FXIII) deficiency is a rare autosomal recessive congenital disorder of haemostasis, associated with a high risk of intracranial haemorrhage. Intracranial haemorrhage can result in neurological sequelae including seizure disorders. In some cases, medically intractable epilepsy led to epilepsy surgery. Little has been reported on the management of FXIII deficiency during surgery, and there is only a few data on the management, safety and efficacy of epilepsy surgery in the patients with haemostatic disorder. We report here an epilepsy neurosurgery in a case of severe FXIII deficiency.

Endogenous megakaryocytic colony formation and thrombopoietin sensitivity of megakaryocytic progenitor cells are useful to distinguish between essential thrombocythemia and reactive thrombocytosis.

Diagnosis of essential thrombocythemia (ET) is controversial and remains mainly an exclusion diagnosis. Endogenous megakaryocyte colony (EMC) formation have been largely evaluated to identify specific criteria for ET, but results are impeded by the lack of medium standardization. We evaluated megakaryocyte (MK) colony formation in a serum-free collagen-based medium, without cytokine and in the presence of various concentrations of thrombopoietin (TPO). Thirty-six bone marrows from patients diagnosed with ET (n = 11), polycythemia vera (PV; n = 12), reactive thrombocytosis (RT; n = 6) and healthy donors (n = 7) were assessed. We demonstrate that 11 out 11 of the ET patients had spontaneous megakaryocyte colony-forming unit (CFU-MK) formation, in contrast to none of the RT patients and healthy donors. MK progenitors from ET patients remained responsive to TPO, because exogenous addition of TPO significantly increased cloning efficiency. Moreover, at low doses of TPO (0.5 ng/ml and 5 ng/ml), the number of positive cultures and mean number of TPO stimulated CFU-MK were significantly higher in cultures of cells from patients with ET than in patients with RT. In summary, we have described a standardized serum-free, collagen-based assay that allows differential diagnosis of ET and RT, according to endogenous CFU-MK formation and sensitivity to TPO.

[Diagnosis of broncholithiasis. Role of high resolution tomodensitometry]. / Diagnostic de la broncholithiase. Rôle de la tomodensitométrie haute résolution.

PURPOSE: to evaluate high resolution computed tomography (HRCT) in the diagnosis of broncholithiasis. PATIENTS AND METHODS: 10 patients with broncholithiasis underwent chest X ray, fiberoptic bronchoscopy (FOB), CT and HRCT. RESULTS: in 9 cases, chest X rays were abnormal but the diagnosis of broncholithiasis can't never be affirmed. In 9 cases, FOB was abnormal: broncholith were identified in only 2 cases; the other diagnosis were tumor like stenosis (n = 3), inflammatory stenosis (n = 3), extrinsic compression (n = 1). On conventional CT scan, broncholithiasis was suspected in 8 patients but because of volume averaging the relationship between calcified lymph nodes and bronchial tree was difficult to determine exactly. Only HRCT sections, sometimes tilted in the axis of the middle lobar bronchus, can affirm the endobronchial or peribronchial location of calcified lymph nodes in all patients. CONCLUSION: conventional CT scan can suggest the presence of broncholithiasis but HRCT sections are need to affirm the diagnosis.

[Chemotherapy of small-cell lung cancer by a combination of teniposide, ifosfamide and carboplatin]. / Chimiothérapie du cancer bronchique à petites cellules par une association de téniposide, ifosfamide et carboplatine.

Thirty six SLC patients have been treated with a combination therapy of ifosfamide 2 g/m2, D1 and D2, carboplatin 300 mg/m2 D1 and teniposide 100 mg/m2 D1 to D3. All patients were younger than 70 years, 31 males, five females, ten limited diseases, 26 extended diseases (without brain metastasis) Performance status 0, 1 or 2, mean weight loss 3.7 kg. Thirty six patients were evaluable for response. We have noted three complete response and 28 partial response (objective response rate 86%). The main toxicity of this combination therapy was myelo-suppression (86% of grade 3 and 4). Twenty seven patients have relapsed, the median relapse free survival time is 310 days. The median survival of the 36 patients is 340 days, one patient is alive more than 30 months after the diagnosis. The ifosfamide-carboplatin-teniposide combination is an effective treatment in small cell lung cancer, its toxicity remains tolerable.

Nonspecific increased serum levels of secretory component in lung tumors: relationship to the gene expression of the transmembrane receptor form.

Polymeric immunoglobulin receptor (pIg-R) is synthesized by epithelial cells lining the bronchial mucosa. It is released in secretions as free secretory component (SC) or bound to Ig as secretory Ig (S-IgA and S-IgM). To evaluate the usefulness of SC and pIg-R expression as tumour markers, we measured SC and secretory Ig, using enzyme-linked immunosorbent assay, in the serum of 45 patients with lung carcinomas, in the serum of 10 patients with non-neoplastic diseases, and in the serum of 45 control subjects. We also studied the immunohistochemical expression of pIg-R and its mRNA in tumors from 20 out of the 45 patients. Serum levels of SC and S-IgA were similarly and significantly elevated in patients with lung cancer (squamous cell carcinoma [25 cases], small cell carcinoma [7 cases], adenocarcinoma [13 cases]) and with non-neoplastic diseases, as compared with control subject levels (P < 0.001). The highest SC levels were found in patients with adenocarcinoma although the mean SC level was not different from other pathologic conditions. pIg-R was usually not detected in the cells of small cell carcinoma or of squamous cell carcinoma, whereas it was found in the cells of five adenocarcinomas and in the two in situ carcinomas under study. The specific mRNA analysis usually agreed with the immunolocalization of pIg-R. A single band at 3.8 kb was detected in the positive tumor tissues and in normal lung tissues. However, the signal was weak in one case of squamous carcinoma and stronger in two out of three adenocarcinomas, than in normal tissues.(ABSTRACT TRUNCATED AT 250 WORDS)

Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients.

We studied 70 patients with biopsy-proven pulmonary non-Hodgkin's lymphomas without extrathoracic involvement or mediastinal adenopathy to determine the clinical, imaging, and endoscopic features of this condition in a homogeneous series. In low-grade (LG) lymphomas, symptoms were cough, dyspnea, chest pain, hemoptysis. Imaging features consisted of localized alveolar opacities, infiltrative diffuse opacities, atelectasis, and pleural effusions. Inflammatory changes of the mucosa were present in some patients, leading to bronchial stenosis in 7; biopsies showed lymphomatous infiltration in 12. Prognosis of LG lymphomas was excellent, with 93.6 percent survival at five years. High-grade lymphomas differed from LG lymphomas principally by a more aggressive course and a worse survival. Inflammatory changes occurred in seven of nine cases leading to stenosis in two, and biopsies showed lymphomatous involvement in five. The profile of primary pulmonary lymphomas in this study could help clinicians consider this condition and prompt them to evaluate new diagnostic tools.

Double-lung transplantation using donor lungs with a right tracheal bronchus.

A 58-year-old man underwent sequential bilateral lung transplantation. On the donor heart-lung block, it was discovered that the right apical segment was supplied by a tracheal bronchus. After the separate implantation of both lungs, a right apical segmentectomy was performed and the postoperative course was uneventful. The management of this problem is discussed.

[Diffuse infiltrative lung diseases: histological support of elementary lesions observed on tomodensitometry]. / Pneumopathies infiltratives diffuses: support histologique des lésions élémentaires observées en tomodensitométrie.

High resolution computed tomography (TDM-HR) is now the technique of choice in the diagnosis and management of diffuse infiltrative lung disease (PID). After a brief review of the technique the authors describe the normal appearance; anatomical observations and the in vivo findings have shown that TDM-HR allow for the exploration of details of structure down to the second pulmonary lobule. Thus, through the alterations that are transmitted in the lobular area, and from its contents and its limits, PID has led to the elaboration of a new semeiology. The authors review the basic computed tomographic images and correlate these in each case with the histological evidence. The spatial distribution and the time sequence of the elementary images are the two other terms in the diagnostic equation of PID. The spatial distribution of several elementary images presents in TDM-HR a superior aetiological pointer to that which is furnished by thoracic radiographs; and the time sequence may furnish a useful indication as to the progress of the treated disease. Sarcoidosis, histiocytosis X, idiopathic interstitial fibrosis and lymphangitis carcinomatosis would serve as examples. Nevertheless, the authors point out that it would be dangerous during the period of evaluation to prematurely extend to all cases of PID conclusions which are only possible to make at present in a restricted number of disorders.

[Diffuse bronchomalacia after double lung transplantation. Thoughts apropos of a case]. / Bronchomalacie diffuse après greffe pulmonaire bilatérale. Réflexions à propos d'un cas.

A 40 year old woman suffered from respiratory insufficiency (arterial PaO2 = 47 mmHg) because of a chronic beryllium intoxication. On 6th June 1990, she underwent double lung transplantation with cardio-pulmonary bypass. Each lung was separately implanted via an extra-pericardial approach, and both bronchi were anastomosed at the hilum. On the seventh post operative day, a severe bilateral bronchial ischemia was noticed (black mucosa). Few weeks later, a diffuse bronchomalacia was noticed in the proximal and distal parts of both bronchial trees. To our knowledge, such a bronchial post-ischemic complication has never been reported. The explantation could be several added causes: imperfect preservation of the lung during harvesting, post operative pulmonary oedema, and operative use of an antifibrinolytic agent (aprotinin).

[Tracheo-bronchial granular cell tumors. Apropos of 4 cases]. / Les tumerus trachéo-bronchiques à cellules granuleuses. A propos de quatre observations.

We have seen four cases of granular cell tumor (Abrikossoff's tumour) and it is recalled that these tumours are most often discovered fortuitously by bronchoscopy in the tracheo-bronchial region because they have a non specific clinical presentation. The cytological and histological characteristics enable an accurate diagnosis but there are problems posed as to the histogenesis of these tumours. With a tumour with a slow progression regular surveillance with regular biopsies seems preferable as in certain cases the tumour regresses spontaneously or disappears after ablation with the forceps. A good alternative approach is destruction of the tumours with a laser in certain complicated forms which enables one to avoid surgical excision.

Sequential combination of 5-fluorouracil, cis-platinum and irradiation in unresectable non-small cell lung cancer.

Twenty patients with unresectable non-small cell lung carcinoma, 15 stage III and 5 stage IV (supraclavicular lymphadenopathy) were treated with a combination of three courses of chemotherapy and hypofractionated irradiation followed after 3 weeks by split-course radiotherapy. Each course was repeated every 3 weeks with the following sequence. Cis-platin (CDDP) (20 mg/m2) was given in a 20-min infusion, followed by a 2-h infusion of 5-fluorouracil (5-FU) (400 mg/m2) on days 1, 2, 5 and 6. Radiation with a dose of 3 Gy on the target volume was given on days 3 and 4, after a 2-h infusion of 5-FU (400 mg/m2). Split course of irradiation consisted of 16 Gy in 5 fractions repeated after 3 weeks interval. The objective response rate was 75%. Median follow-up was 24 months, the median survival was 14 months. The 1-year survival was 53% and the 2-year survival was 16%.