[Sarcoidosis simulating a pulmonary veno-occlusive disease]. / Sarcoïdose simulant une maladie veino-occlusive pulmonaire.

We report the case of a man of 43 years old presenting with sarcoidosis which produced pulmonary hypertension and respiratory failure without radiological evidence of interstitial fibrosis. In spite of treatment with steroids and corticosteroids (1 mg/kg) there was progression over 2 1/2 years to respiratory failure and irreversible right heart failure and the death of the patient. At autopsy the pulmonary veins were obliterated by non caseating granulomas and there were minimal fibrotic parenchymal lesions. To our knowledge this is only the second case of sarcoidosis resulting in a veno occlusive pulmonary disorder.

Motor abnormalities of digestive and urinary tracts in patients on ventilator for acute exacerbation of chronic obstructive pulmonary disease.

The frequency of digestive motor abnormalities was evaluated in 30 consecutive patients ventilated for acute exacerbation of chronic obstructive pulmonary disease. Total and segmental colonic transit times were investigated by radiopaque marker transit time in all patients. Eleven patients also had rectoanal and esophageal manometries, combined with urodynamic study in eight cases. The results show that total radiopaque marker transit time was increased, 201 +/- 14 hr (mean +/- SE), with two main regions of decreased transit rates: the right colon (42% of global transit time) and the rectosigmoid (36%). Delayed transit of radiopaque markers in nine of 11 cases was combined with esophageal motor dysfunction and absence of rectoanal inhibitory reflex. In three of eight cases there was disinhibition of urinary bladder contraction, and micturition was impossible in two of eight cases. We conclude that patients on ventilator for exacerbation of chronic obstructive pulmonary disease always have a delayed colonic transit time with diffuse digestive and bladder motor dysfunction.

Intrapulmonary haematoma complicating mechanical ventilation in patients with chronic obstructive pulmonary disease.

Intrapulmonary haematomas occurred during mechanical ventilation of two patients with advanced chronic obstructive pulmonary disease and bullous dystrophy. In both cases, the haematomas were revealed by blood-stained aspirates, a fall in haemoglobin level, and the appearance of radiological opacities. Haematoma occurrence in the area of a bulla which recently has rapidly increased in size, suggests that the haematoma is due to the rupture of stretched vessels embedded in the wall of the bulla.

[Acute paraffin oil pneumopathies. Apropos of a case in a fire-eater]. / Les pneumopathies pétroliques aiguës. A propos d'un cas chez un cracheur de feu.

A case of acute paraffin oil-induced pneumonia due to accidental inhalation by a fire-eater of kerdane, a petroleum derivative is reported. The symptoms and course of respiratory manifestations of acute paraffin oil poisoning are reviewed. The physical properties of the petroleum derivative inhaled account for the pathogenesis of the pneumonia. Pulmonary lesions, usually fully reversible, result from the joint effects of an inflammatory phase with exudate and a proliferative phase.

[Surgery of intracranial metastases of bronchial origin]. / La chirurgie des métastases intra-crâniennes d'origine bronchique.

Forty-six out of a series of 76 patients with intracranial metastases from lung cancer underwent a surgical operation for complete macroscopic resection. 44 cases presented with a single metastasis. In 2 cases, there were 2 cerebral metastases. Most of the lesions were situated in the frontal lobe (41%). In more than one half of cases, the primary lung cancer was squamous carcinoma. The mean survival was 9 months. It was shorter in the case of anaplastic cancers (6 months) and adenocarcinomas (8 months) than in the squamous carcinomas (12 months). The five patients still alive 2 years after surgery all belong to this histological group. The results suggest that surgical treatment of single cerebral metastases from lung cancer, in the absence of extracranial dissemination, allows a considerable improvement in the quality and duration of the survival.

Preoperative chemotherapy in epidermoid bronchogenic carcinoma.

Palliative chemotherapy in cases of epidermoid bronchogenic carcinoma, initially judged to be inoperable, made it possible to perform operative resection in 50 cases. An association of cis-platinum and bleomycin was used, this combination having previously been considered synergistic. In certain cases the tumour seemed to have disappeared on macroscopic examination of the resected specimen, and in some instances no tumoral cells could be found on histological examination. This series brought out several positive features: chemotherapy made it possible to operate on patients previously judged to be inoperable; it ensured maximum local efficiency of drugs because of the absence of abnormal vascularity; and it made it possible to anticipate the cure of occult metastases. However, three negative aspects were also present: modification of postoperative TNM classification making it difficult to establish a prognosis; difficulty in determining therapeutic strategy for pNo; and inadequate long-term follow-up. On the whole the positive points appeared to outweigh the negative aspects, but a randomized study is necessary to confirm this.