Gallium-67 in the evaluation of sarcoidosis: correlations with serum angiotensin-converting enzyme and bronchoalveolar lavage.

Gallium-67 (67Ga) scanning was assessed for its usefulness in the evaluation and follow-up of 54 patients with sarcoidosis, both treated and untreated. Scans were repeated in 23 subjects. Serum levels of angiotensin-converting enzyme (ACE) were determined concurrently in all 54 patients and bronchoalveolar lavage was performed in 29 patients. Gallium-67 scan was effective in the detection and assessment of lesions not revealed by traditional methods of investigation, particularly those affecting the mediastinum, spleen, and salivary glands. The scan also enabled fibrotic lesions, which do not show uptake, to be distinguished from granulomatous lesions, which do--an advantage of prognostic interest particularly in patients with pulmonary lesions. Another merit of 67Ga scanning was that it offered a means of following disease progression in each site. In patients showing spontaneous clearing of disease or receiving treatment the scintigraphic method was more sensitive than serum ACE determination. Scan findings showed a rough correlation with serum ACE but not with bronchoalveolar lavage findings. This suggests that the three markers probably reflect different stages of the granulomatous process. On the strength of this study the indications for gallium scanning in sarcoid patients can be defined more clearly than has previously been possible.

[Male sterility and bronchial dilatation (author's transl)]. / Stérilité masculine et dilatation des bronches.

Male infertility in patients with bronchial dilatation is related to the progressive obstruction of the epididymo-deferential loop. When bronchial dilatation is diagnosed early enough, a spermogram should be performed to conserve the quality of the semen before it starts to deteriorate. In cases of excretory azoospermia it is essential to consider the diagnosis of bronchial dilatation and possible mucoviscidosis among the various etiologies.

[Serum level of angiotensin-converting enzyme in sarcoidosis. Attempted correlation with the clinical activity of the disease (author's transl)]. / Taux sérique de l'enzyme de conversion de l'angiotensine dans la sarcoïdose. Essai de corrélation avec l'activité clinique de la maladie.

Serum levels of angiotensin-converting enzyme (ACE) were measured in 111 healthy subjects and in 117 adult patients with mediastinal and pulmonary sarcoidosis. The patients were followed up for 3 years. Detailed clinical investigations and ACE level measurements were performed every three months. The activity of the disease was assessed in 94 patients without treatment and in 23 patients under corticosteroid therapy. Mean ACE levels were significantly higher (p less than 0,0001) in all patients with sarcoidosis than in controls. They were also high (greater than 35 units/ml) in 32 patients with active forms of the disease. In 19 patients with inactive forms ACE levels were either moderately raised on normal, while considerable variations were observed in those with stable, persistent sarcoidosis. Complete spontaneous or therapeutically induced remission were accompanied by a return of ACE to normal values, but this was not the case for incomplete remission. There was no correlation between ACE levels and the radiological stages of the disease. Measuring ACE levels in patients with sarcoidosis may therefore contribute to diagnosis and surveillance and help to distinguish between complete and incomplete remissions.

[Extensive Wegener's granulomatosis: treatment with immunodepressants and complicated by pulmonary aspergillosis (author's transl)]. / Maladie de Wegener extensive sous immunodépresseurs et compliquée d' aspergillose pulmonaire.

The case reported is of Wegener's granulomatosis which responded only temporarily to immunodepressant treatment and complicated by pulmonary aspergillosis. This combination poses a diagnostic since the respiratory manifestation of the two conditions may be confused, and a therapeutic problem because of contradictions in the drugs indicated.

[Spectrophotometric assay of angiotensin I-converting enzyme (author's transl)]. / Le dosage de l'enzyme de conversion de l'angiotensine I par méthode spectrophotométrique.

The method of chemical assay of angiotensin I-converting enzyme described is a modification of the previously published spectrophotometric assay based on quantitation of hippuric acid released from hippuryl-L-histidyl-L-leucine. The new procedure involves extraction of hippuric acid with ethylacetate, evaporation to dryness of the extract, solubilization of the residue with 1 mol/l NaCl and purification with petroleum ether before measurements of the absorbance at 228 nm of the aqueous phase. Under these conditions, hippuric acid insoluble in petroleum ether remains in the aqueous phase, whereas other A228-absorbing materials, readily soluble in the ether and able to interfere with the assay, are eliminated.

[Activity and safety of fenspiride in bronchial hyperexudation (author's transl)]. / Efficacité-tolérance du fenspiride dans les hyper-exsudations bronchiques.

This clinical trial of fenspiride (injectable and sustained-release 80 mg tablet) was carried out on patients selected because their bronchopathy was of a hypersecretory type. Interesting results were observed in 20 out of 37 cases, but they were often delayed. This group of patients included a high proportion of patients with major hypersecretion; the efficacy of fenspiride is often evident, (in 8 out of 11 cases) but it is unpredictable individually. It can be concluded from this trial that a long term treatment with fenspiride, well tolerated, can usefully be tried in patients with predominant signs of bronchial hyperexudation.

[Alveolar proteinosis and acute leucosis. One observation (author's transl)]. / Protéinose alvéolaire et leucose aiguë. A propos d'une observation.

The authors observed a pulmonary alvelolar proteinosis in an 11 years old child with acute leucosis. They underlined the exceptional character of this association in a child, while it is known in the adult and almost always with a bad prognosis. A dysimmunity context linked to a hematological disease and/or its treatment, is favoured among the pathogenic hypotheses.

[One case of severe tracheobronchopathy with immune depression : herpetic disease?]. / Un cas de trachéobronchopathie grave avec immunodépression : maladie herpétique?

The authors report a case of severe obliterating laryngo-tracheo-bronchitis without any evident etiology in a young patient with depressed immunity. A herpetic virus was isolated by distal bronchial brushing and by larynx biopsy. The level of specific antibodies rose significantly. These facts together with the clinical history and unsuccessful microbiological searches, suggest the herpetic nature of this affection, albeit exceptional. At this opportunity, a review of the literature is presented showing the imprecision of diagnostic criteria in this field of pathology.

[Acute, lethal miliary tuberculosis due to Mycobacterium bovis]. / Miliaire aiguë mortelle due a Mycobacterium bovis.

The authors report a case of lethal acute miliary with bovine tuberculous bacilli. They stress the main characteristics of this exceptional observation :--difficulties in isolating and identifying,--favourable disposition linked to age and to a depressed cellular immunity,--pathogenic interest in the mechanisms of late endogenous reinfestation and of suffocating acute evolution.

[X-ray pictures in pneumonia caused by Pneumocystis carinii. Nine cases of immunodepressed patients (author's transl)]. / Aspects radiologiques de la pneumonie à Pneumocystis carinii. A propos de 9 observations de patients immunodéprimés.

The authors analyse the pulmonary symptoms found by X-Ray in nine immunodepressed patients who were hosts to Pneumocystis carinii. The radiological abnormalities do not generally appear early nor are they specific; the syndrome of diffuse alveolar consolidation only appears at a late stage, it is most serious in the base and the peri-hilar regions, but does not affect the apex. It would appear that no prognostic value can be ascribed to the radiological results. The authors therefore suggest bronchial scanning for tracking down the Pneumocystis whenever suspicious clinical symptoms appear.