[Severe uncontrolled asthma in patients over 75 years old: Treatment with omalizumab]. / Asthme sévère mal contrôlé de sujets de plus de 75 ans : traitement par omalizumab.

INTRODUCTION: With an aging population and an increase in the prevalence of asthma, this disease is becoming more common in the elderly. Nevertheless, the management of severe asthma can be complex, due to an increased risk of uncontrolled disease in patients over 65 years old and partly to the inherent characteristics of old age: comorbidities, underestimation of the role of allergies, poor adherence, difficulties with inhalation devices, etc. CASE REPORTS: We report two cases of women over 75 with severe persistent allergic asthma not controlled by high doses of inhaled corticosteroids and long-acting beta-2-agonists in whom treatment with omalizumab was initiated. Following treatment with omalizumab a decrease in the number and severity of exacerbations, improved asthma control and dose reduction or discontinuation of systemic corticosteroids were observed. The tolerance of omalizumab was good in both cases. CONCLUSIONS: Omalizumab is to be considered an effective and well-tolerated therapeutic option for elderly patients with inadequately controlled severe allergic asthma.

[COLIBRI: Improving clinical practice and producing relevant scientific data]. / COLIBRI : optimiser la pratique clinique et produire des données scientifiques pertinentes.

COLIBRI-COPD is a francophone consultation web portal accessible to pulmonologists in the hospital and in the community. We present this observation which describes the phenotype of COPD patients entered (anthropometry, exposures, addictions, functional impairments, questionnaires: MRC, DIRECT, CAT, HAD, Epworth, co-morbidities, incidence of exacerbations, drug treatment or other treatments). The results of the first 1079 patients show a high level of completeness for the main data items. A comparison of patients seen in outpatient consultations shows significant variability between patients with the same GOLD stage, regarding the incidence of exacerbations, signs of anxiety-depression, of diabetes mellitus, or the prescriptions of anticholinergics and inhaled corticosteroids. These initial results suggest that data collection in real life gives a reliable database to obtain longitudinal data on various aspects of COPD. The data quality (completeness, reliability) is partly related to the usability of the web tool and to the possibility of doing self-assessment of practitioners' own recorded data.

[Pituitary metastasis revealing a lung cancer]. / Métastase hypophysaire symptomatique révélant un cancer bronchique.

INTRODUCTION: Pituitary metastases are rare and difficult to diagnose. Their optimal approach and management remains to be defined. CASE REPORT: We report the case of a 56-year-old patient suffering from squamous cell lung carcinoma who developed pituitary metastasis with secondary hypopituitarism, the symptoms of which were initially attributed to depression. CONCLUSION: Pituitary metastases can be difficult to diagnose, which may lead to delays in care, which can be fatal.

Hunter's syndrome and associated sleep apnoea cured by CPAP and surgery.

A 42-yr-old male with Hunter's syndrome presented with severe obstructive sleep apnoea syndrome (OSAS) and daytime respiratory failure. Continuous positive airway pressure (CPAP) therapy was initially ineffective and produced acute respiratory distress. Extensive Hunter's disease infiltration of the upper airway with a myxoma was confirmed. Following surgery to remove the myxoma at the level of the vocal cords, CPAP therapy was highly effective and well tolerated. This report demonstrates the necessity of evaluating fully the upper airway in patients with unusual variants of OSAS, particularly where the disease is not adequately controlled by CPAP.

[Comparative trial of the clinical efficacy and tolerance of cefatrizine (Cefaperos) and cefpodoxime proxetil (Orelox) in superinfections of chronic obstructive bronchopneumopathies in adults in urban practice]. / Essai comparatif de l'efficacité et de la tolérance clinique entre la céfatrizine (Cefaperos) et le cefpodoxime proxétil (Orelox) dans les surinfections des bronchopneumopathies chroniques obstructives de l'adulte en médecine de ville.

In order to compare the clinical efficacy and safety of cefatrizine (Cefaperos) and cefpodoxime proxetil (Orelox) in the treatment of secondarily infected chronic obstructive pulmonary disease (COPD) in adults, a multicentre, randomized, open study was conducted by 60 general practitioners in two parallel groups of patient suffering from COPD complicated by an acute episode of superinfection (Anthoniesen stages 2 and 3). After verification of the eligibility criteria, written consent and randomization, the patients received, for 10 days, either cefatrizine at the dose of 1 g/day or cefpodoxime proxetil at the dose of 400 mg/day. A self-assessment form was given to the patient. A telephone visit was planned for D3. The final visit on D11 +/- 1 evaluated clinical efficacy (success or failure) and safety. The study population was composed of 250 patients with a mean age of 59.9 +/- 15.9 years (sex ratio M/F = 1.5). The principal etiology of COPD was chronic bronchitis in 67.5% of patients, longstanding asthma in 24.5% and emphysema in 6.8%. The mean history of the disease was 13.0 +/- 10.8 years. The Anthoniesen score was equal to 2 in 73.6% of patients, 3 in 8.8% of patients and 1 in 17.6% of patients. No significant difference concerning these criteria was observed between the two study groups. The clinical success rate was equivalent in the two groups. The time to regression of clinical signs tended to be shorter, up until the sixth day (mainly between D4 and D6) for patients treated with cefatrizine (p = 0.09; NS). The clinical safety was considered to be good and was comparable in the two study groups. This study concluded on the equivalent clinical efficacy of cefatrizine and cefpodoxime proxetil in the treatment of superinfections of COPD in general practice (97.5% and 99%, respectively), with a satisfactory and comparable safety, but with a much lower cost of treatment for cefatrizine. This conclusion is particularly important in the context of opposable medical references, as, although the treatment of superinfections of COPD by second and third generation cephalosporins is frequently proposed, the prescription of a less expensive cephalosporin appears to be more relevant.

[Somatoform disorders. Analysis of 43 patients in an unit of internal medicine. Diagnostic attitude and proposal of management]. / Les troubles somatoformes. Analyse de 43 patients d'un service de Médecine Interne. Attitude diagnostique et proposition de prise en charge.

The frequency of hospitalization for somatoform disorders in France has been difficult to evaluate owing to the lack of papers published on this subject. Retrospective analysis of the medical records of 43 patients hospitalized on an internal medicine ward for whom this diagnosis was retained enabled us to characterize this population according to the following criteria: socioeconomic-professional group, family environment, probable triggering factors, and patient's evolution before and after hospitalization. Based on this study, we propose a diagnostic approach to and some guidelines for management of these patients, and discuss their place in internal medicine.

[Value of high resolution tomodensitometry in pulmonary histiocytosis X. Radiological, clinical and functional correlations]. / Valeur de la tomodensitométrie haute résolution dans l'histiocytose X pulmonaire. Corrélations radiocliniques et fonctionnelles.

Histiocytosis is a rare cause of diffuse interstitial pneumonia. Its aetiology is not known and the outcome is often unsatisfactory. In 10 subjects in whom the diagnosis of histiocytosis X was established at CHU in Grenoble, 7 could be followed up. We report the clinical, functional, radiological and high resolution tomographic data on these 7 subjects suffering from histiocytosis X and followed up for a period between 3 and 13 years (8 +/- 3 years). All the subjects were symptomatic at the time of diagnosis. The clinical outcome amongst the 10 subjects included 2 patients who died, 2 who stabilised, 1 worsened and there were 4 clinical cures, 1 patient was lost to follow up. The respiratory function tests of the 7 subjects who were followed up was characterised by the appearance of airflow obstruction and a significant fall in the DLCO/VA (KCO) of 68 +/- 17% of the predicted value to 43 +/- 13%. An analysis comparing the initial pulmonary radiography to the current films showed that the reticular nodular lesions tended to progress to a diminution in size, while there was an increase in the reticulation. The high resolution computed tomography was confirmed as better technique than pulmonary radiography in detailing the cystic and nodular lesions. This was the only examination which correlated with DLCO/VA (R: 0.8; p: 0.018). A progressive model for computed tomographic lesions is proposed. Computed tomography appears to be the key examination, orientating the diagnosis based on the association of the nodules and cysts and enabling a better appreciation of the severity of the pulmonary disease taking account of its excellent correlation with diffusion.

[Diagnostic delay in Horton's disease. Analysis of the diagnostic delay based on a retrospective study of 130 cases]. / Le retard diagnostique dans la maladie de Horton. Analyse du délai diagnostique à partir d'une étude rétrospective de 130 cas.

Temporal arteritis (Horton's disease) is a multifocal granulomatous arteritis which affects elderly people. Its prognosis depends upon the risk of blindness. In a retrospective study of 130 patients we paid special attention to the delay in diagnosis and its relation to the occurrence of ophthalmic complications. In 73 patients (56.2%), this delay exceeded 3 months and reached more than one year in 22 of them. It was not influenced by age or sex. In requests for admission, the diagnosis of temporal arteritis was suggested in only 28 of the 130 cases; 17.7% of the patients were blind. There was a significant increase in the occurrence of ophthalmic lesions when the diagnosis was delayed by 2 to 6 months. In 6 cases, blindness had been preceded by transient amaurosis. These findings confirm that temporal arteritis is belatedly diagnosed by practitioners and that blindness could be avoided by an earlier diagnosis.

[Effect of nebulized salbutamol in 26 patients hospitalized for asthma attack]. / Effets du salbutamol nébulisé chez 26 sujets hospitalisés pour attaque d'asthme.

Twenty-six asthmatic patients who were hospitalised following an acute asthmatic attack and who had a peak expiratory flow of less than 50% predicted, without hypercapnia, received 5 mg. of salbutamol delivered by a micronebulizer LSA on admission (HO). At H1, 10 mg of additional salbutamol were nebulised in cases where there had been an increase of less than 20% of the PEF. At H2, all the subjects received steroid therapy. Group 1 in which success was defined by an increase of 20% of peak flow judged at H1 and H2, and group II where the increase in peak flow was less than 20%. Group II benefited at H2 by treatment with theophylline or salbutamol intravenously given in a randomised fashion. At H8 the 2 treatments were associated in group II in cases of failures. 15 men, and 11 women aged 40 +/- 17 suffering from severe asthma (65% of Charpin Stage IV) were included. The mean peak flow at HO was 32 +/- 9% of the predicted PEF. 21 subjects, or 81% improved their peak flow by more than 20% at H2. The toleration for salbutamol was very good from the cardiovascular point of view. At HO there was no clinical criteria nor peak flow assessment which would enable one to predict the failures from nebulized salbutamol for a given subject. Nevertheless a level of dyspnoea of greater than 5 on Borg's scale and a peak flow of less than 150 l/min made failure likely.(ABSTRACT TRUNCATED AT 250 WORDS)

[Bronchiolitis obliterans with idiopathic organized pneumonia. Anatomoclinical analysis and nosologic discussion apropos of 6 cases]. / La bronchiolite oblitérante avec pneumonie organisée idiopathique. Analyse anatomo-clinique et discussion nosologique a propos de 6 observations.

The clinical, radiological, physiological and pathological features were studied in 6 cases of idiopathic bronchiolitis obliterans organized pneumonia (BOOP). Patients characteristically had a history of exertional dyspnea, cough, fever, weight loss, bilateral radiographic shadowing, elevated ESR and hypoxemia. Corticosteroids were effective; however, one patient died of cytomegalovirus pneumonia. The pathological features, distinguished by the presence of granulation tissue plugs extending from bronchioles into alveolar ducts and alveoli, are described in detail. The place of BOOP within the broad spectrum of bronchiolitis obliterans between small airways disease and usual interstitial pneumonia is discussed.

[Prevention of acute infectious pneumopathies in adults]. / Prévention des pneumopathies infectieuses aiguës de l'adulte.

The frequency and potential severity of infective pneumonia in adults justifies all attempts at prevention which is conditioned by the patient's underlying condition and the micro-organism involved. The value of antipneumococcal and anti-influenza vaccination in populations at risk is unquestionable, but ancillary measures, such as giving up smoking and improving the patient's immune mechanisms, should not be neglected.

[Bronchial adenocarcinoma in tuberculosis scars]. / Adénocarcinome bronchique sur cicatrices tuberculeuses.

The relation between bronchial cancer and fibrous scars still remains controversial. We report, with regard to a typical case, the histological arguments for this hypothesis in the knowledge that only a clinical history and above all a radiographic progress will evoke the carcinomatous transformation. We report on the diagnostic peculiarities, the evolution, the therapeutic approach and histogenetics of bronchial cancers developing on a scar. This association and the interest of pursuing these investigations in the presence of evocative clinical or radiographic anomalies enable a better understanding of the natural history of bronchial cancer.