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1.
Pulmonology ; 2024 Feb 23.
Artigo em Inglês | MEDLINE | ID: mdl-38402125

RESUMO

BACKGROUND AND OBJECTIVE: Traditionally, the diagnosis of acute rejection (AR) relies on invasive transbronchial biopsies (TBBs) to obtain histopathological samples. We aimed to evaluate the diagnostic yield of probe-based confocal laser endomicroscopy (pCLE) as a complementary and non-invasive tool for ACR screening, comparing its results with those obtained from TBBs. METHODS: Between January 2015 and April 2022, we conducted a retrospective study of all lung transplant recipients aged over 18 years at Toulouse University Hospital (France). All patients who underwent bronchoscopies with both TBBs and pCLE imaging were included. Two experienced interpreters (TV and MS) reviewed the pCLE images independently, blinded to all clinical information and pathology results. RESULTS: From 120 procedures in 85 patients, 34 abnormal histological samples were identified. Probe-based confocal laser endomicroscopy revealed significant associations between both alveolar (ALC) and perivascular (PVC) cellularities and abnormal histological samples (p<0.0001 and 0.003 respectively). Alveolar cellularity demonstrated a sensitivity (Se) of 85.3 %, specificity (Spe) of 43 %, positive predictive value (PPV) of 37.2 % and negative predictive value (NPV) of 88.1 %. For PVC, Se was 70.6 %, Spe 80.2 %, PPV 58.5 % and NPV 87.3 %. Intra-interpreter correlation (TV) was 88.3 % for the number of vessels (+/-1), 98.3 % for ALC and 90 % for PVC. Inter-interpreter correlation (TV and MS) was 80 % for vessels (+/-1), 97.5 % for ALC and 83.3 % for PVC. CONCLUSION: Our study demonstrates the feasibility of incorporating pCLE into clinical practice, demonstrating good diagnostic yield and reproducible outcomes in the screening of AR in lung transplant recipients.

2.
Rev Mal Respir ; 38(5): 466-476, 2021 May.
Artigo em Francês | MEDLINE | ID: mdl-33926779

RESUMO

INTRODUCTION: Fungal aspergillosis colonization and allergic bronchopulmonary aspergillosis (ABPA) can have a strong impact on the prognosis in cystic fibrosis (CF). We conducted round table discussions involving French experts from pediatric and adult centers caring for patients with CF, microbiologists, radiologists and pharmacists. The aim was to explore the current state of knowledge on: the pathophysiological mechanisms of Aspergillus and other micromycetes infections in CF (such as Scedosporium sp.), and on the clinico-biological diagnosis of ABPA. In perspective, the experts explored the role of imaging in the diagnosis of APBA, specifically CT and MRI; as well as the role of bronchoscopy in the management. We also reviewed the therapeutic management, including different corticosteroid regimens, antifungals and anti-IgE antibodies. CONCLUSION: The diagnosis of ABPA in CF should be based on more standardized biological assays and imaging to optimize treatment and follow-up.


Assuntos
Aspergilose Broncopulmonar Alérgica , Fibrose Cística , Corticosteroides , Adulto , Antifúngicos/uso terapêutico , Aspergilose Broncopulmonar Alérgica/complicações , Aspergilose Broncopulmonar Alérgica/diagnóstico , Aspergilose Broncopulmonar Alérgica/tratamento farmacológico , Aspergillus fumigatus , Criança , Fibrose Cística/complicações , Fibrose Cística/diagnóstico , Fibrose Cística/epidemiologia , Humanos
5.
Rev Mal Respir ; 31(1): 78-81, 2014 Jan.
Artigo em Francês | MEDLINE | ID: mdl-24461447

RESUMO

BACKGROUND: Lung transplant patients are characterized by a high use of healthcare resources and an elevated rate of hospitalization. In lung transplant recipients, spirometry home monitoring has been advocated for the early detection of acute infection and rejection of the allograft. We will test a new system that allows regular monitoring of the patient's pulmonary status at home after discharge from hospital. METHODS: This study will be prospective and in addition to usual healthcare. The main aim of this feasibility study will be to evaluate the compliance of patients in performing three spirometric measurements per week. Patients will have received a lung transplant more than three months prior to entering the study. The home equipment will comprise a data transmitting box (Twitoo(®)) and a spirometer. A decrease of 10% from baseline in one or more parameters will generate an alarm, which will lead to the transplant physician calling the patient and possibly inviting him to the hospital. EXPECTED RESULTS: The feasibility will be considered as acceptable for an average compliance of 70%. The coefficient of variation and the number of spiro-measurements will be adjusted according to the results obtained.


Assuntos
Ensaios Clínicos como Assunto/métodos , Serviços de Assistência Domiciliar , Transplante de Pulmão , Monitorização Fisiológica/métodos , Telemedicina , Estudos de Viabilidade , França , Hospitalização/estatística & dados numéricos , Humanos , Transplante de Pulmão/reabilitação , Monitorização Fisiológica/instrumentação , Visita a Consultório Médico , Cooperação do Paciente , Projetos de Pesquisa , Espirometria/instrumentação , Espirometria/métodos , Telemedicina/métodos
6.
Rev Mal Respir ; 28(3): 328-35, 2011 Mar.
Artigo em Francês | MEDLINE | ID: mdl-21482336

RESUMO

INTRODUCTION: Bronchial colonisation is frequently reported in patients with lung cancer. These colonisations could influence patient therapeutic management and prognosis. The aim of our study is refine incidence and nature of bronchial colonisations in patients presenting with lung cancer. METHODS: Three hundred and eighty-eight patients with lung cancer underwent a flexible bronchoscopy at the time of diagnosis. Among them, 216 patients had a bacteriological, mycobacteriological and fungal investigation. Type and frequency of these colonisations were analyzed. RESULTS: Potential pathogens were found in 39.8% of samples, including mainly 39.8% of Gram-negative bacilli (Haemophilus influenzae, Enterobacter sp., Escherichia coli). In addition, we found 0.9% of mycobacteria and 13.9% of Candida albicans. Among these 216 patients where microbiological analysis was performed, patient features and tumor stage were not significantly correlated to microbial colonisation. CONCLUSIONS: Colonisation of airways is frequently reported when a lung cancer is diagnosed. Our data suggest that bronchial colonisation should be prospectively collected due to its potential interest in the management of lung cancer patients.


Assuntos
Adenocarcinoma/complicações , Brônquios/microbiologia , Bronquite/microbiologia , Líquido da Lavagem Broncoalveolar/microbiologia , Infecções por Bactérias Gram-Negativas/complicações , Infecções por Bactérias Gram-Positivas/complicações , Neoplasias Pulmonares/complicações , Broncoscopia , Candida albicans/isolamento & purificação , Candidíase/complicações , Feminino , França/epidemiologia , Bactérias Gram-Negativas/isolamento & purificação , Infecções por Bactérias Gram-Negativas/epidemiologia , Bactérias Gram-Positivas/isolamento & purificação , Infecções por Bactérias Gram-Positivas/epidemiologia , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Fatores de Risco , Fumar/efeitos adversos
8.
Medicine (Baltimore) ; 78(5): 321-37, 1999 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-10499073

RESUMO

Pulmonary lymphangioleiomyomatosis (LAM) is a rare disorder of unknown cause characterized by peribronchial, perivascular, and perilymphatic proliferation of abnormal smooth muscle cells leading to cystic lesions. The hypothesis of hormonal dependence and the effectiveness of hormonal therapy have not yet been demonstrated conclusively, and the prevalence of extrathoracic manifestations and the survival of patients with LAM are somewhat contradictory. A multicentric retrospective study was conducted in an attempt to describe better the initial features, the diagnostic procedures, the associated lesions, and, above all, the management and course of LAM in a large homogeneous series of 69 stringently selected patients, with a majority of cases diagnosed since 1990. The aim of the study, based on a review of the literature, also was to provide a comprehensive view of this uncommon disease. The clinical features were in keeping with previous studies, but we found that exertional dyspnea and pneumothorax were the most common features, and chylous involvement was less frequent. LAM was diagnosed after menopause in about 10% of cases. The onset of LAM occurred during pregnancy in 20% of cases, and a clear exacerbation of LAM was observed in 14% of cases during pregnancy. Pulmonary LAM was diagnosed on lung histopathology in 83% of cases, but renal angiomyolipoma, observed in 32% of our patients, may be a useful diagnostic criterion when associated with typical multiple cysts on chest CT scan or with chylous effusion. Chest CT scan was more informative than chest X-ray (normal in 9% of cases), and may be indicated in spontaneous pneumothorax or renal angiomyolipoma in women of childbearing age. About 40% of the patients had a normal initial spirometry, while an obstructive ventilatory defect (44%), a restrictive ventilatory defect (23%), was observed in other patients. Initial diffusing capacity for carbon monoxide was frequently decreased (82%). Hormonal therapy was administered in 57 patients, but a clear > or = 15% improvement of FEV1 was observed in only 4 evaluable patients, treated with tamoxifen and progestogens (n = 2), progestogen (n = 1), and oophorectomy (n = 1). Probably 1 of the most urgent needs for clinical research in LAM is to test the currently available hormonal treatments in the context of international multicenter prospective controlled studies. Pleurodesis was performed in 40 patients. Lung transplantation was performed in 13 patients, 7.8 +/- 5.2 years after onset of LAM, in whom the mean FEV1 was 0.57 +/- 0.15 L. After a follow-up of 2.3 +/- 2.2 years, 9 patients were alive. Mean follow-up from onset of disease to either death or closing date was 8.2 +/- 6.3 years. Overall survival was better than usually reported in LAM, and Kaplan-Meier plot showed survival probabilities of 91% after 5 years, 79% after 10 years, and 71% after 15 years of disease duration.


Assuntos
Neoplasias Pulmonares/fisiopatologia , Linfangioleiomiomatose/fisiopatologia , Adolescente , Adulto , Obstrução das Vias Respiratórias/fisiopatologia , Angiomiolipoma/patologia , Antineoplásicos Hormonais/uso terapêutico , Quilotórax/fisiopatologia , Dispneia/fisiopatologia , Feminino , Seguimentos , Volume Expiratório Forçado/fisiologia , Humanos , Neoplasias Renais/patologia , Neoplasias Pulmonares/diagnóstico , Neoplasias Pulmonares/patologia , Neoplasias Pulmonares/terapia , Linfangioleiomiomatose/diagnóstico , Linfangioleiomiomatose/patologia , Linfangioleiomiomatose/terapia , Menopausa , Pessoa de Meia-Idade , Músculo Liso/patologia , Neoplasias Primárias Múltiplas/patologia , Pneumotórax/fisiopatologia , Gravidez , Complicações Neoplásicas na Gravidez/diagnóstico , Capacidade de Difusão Pulmonar/fisiologia , Estudos Retrospectivos , Espirometria , Tomografia Computadorizada por Raios X
10.
Ann Med Interne (Paris) ; 148(1): 2-10, 1997.
Artigo em Francês | MEDLINE | ID: mdl-9137692

RESUMO

We describe five cases of polymyositis/dermatomyositis with interstitial lung disease, occurring in women, with a mean follow up of 28 months (15 to 51). One remained without respiratory symptoms, two had a chronic and relapsing course, and two an acute course, leading to death with respiratory failure in one. Anti-Jo1 antibody was found in two patients, without relation to the gravity of the respiratory illness. The two others with a severe course had anticardiolip antibodies, and one cutaneous necrosis of the fingers. Cancer-associated dermatopolymyositis was never seen at diagnosis, but a lymphoma of the brain was diagnosed after two years in one patient. Combination of corticosteroids with another immunomodulator treatment was necessary for all, because of frequent relapses. Methotrexate was effective in one case for the muscular and the respiratory signs, plasma exchanges with azathioprine in two cases, and intravenous immunoglobulin in one patient with acute lung injury.


Assuntos
Doenças Pulmonares Intersticiais/etiologia , Miosite/complicações , Adulto , Idoso , Feminino , Humanos , Doenças Pulmonares Intersticiais/fisiopatologia , Doenças Pulmonares Intersticiais/terapia , Pessoa de Meia-Idade , Miosite/fisiopatologia , Miosite/terapia , Prognóstico , Fatores de Tempo
12.
Biotechnol Bioeng ; 29(7): 884-91, 1987 May.
Artigo em Inglês | MEDLINE | ID: mdl-18576533

RESUMO

Immobilization of Mycobacterium PY1 and Xanthobacter PY2 in alginate and in or on hydroculture has a minor influence on the maximum rate of oxidation of propene and ethane. The apparent K(m) values of the immobilized cells are slightly higher than those of the free cells, indicating the presence of diffusion limitation in the immobilized systems. Both bacterial strains rapidly lose their alkene-oxidizing activity when the water activity is decreased. This decrease in activity is so rapid that most of the activity is lost already when the pores of the pertinent supports are still filled with water. Therefore, it is not possible with this system to study the transition of mass transfer of substrates entirely in the water phase to mass transfer to substrates entirely through the gas phase.

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