Provocation test coupled with bronchoalveolar lavage in diagnosis of propranolol-induced hypersensitivity pneumonitis.

A 59-yr-old man was given over a 30-month period a cumulative dose of 36 g of propranolol for treatment of angina pectoris. He then presented with respiratory disease, having all the clinical, radiologic, and functional characteristics of interstitial pneumonitis. No other cause of pneumonitis was found.

[Unusual thoracic localization of Castleman's tumor. Apropos of a case].

We report a case of angiolymphoid hyperplasia, or Castleman's pseudotumour, located in the chest and most unusually opposite an intercostal space. Pain led to the discovery of the tumour, the nature of which was discovered at surgery, and disappeared after surgical excision. No antigenic stimulus or local haemodynamic disturbance was found, which could have accounted for the very unusual intercostal site of the lesion.

[Drug-induced pneumopathies (excluding cytostatic drugs)].

Establishing the diagnosis of drug-induced pneumonitis is always difficult and requires that the following criteria be met: administration of the drug on a long-term basis; knowledge that the drug is able to induce pulmonary disorders; occurrence during therapy of interstitial pneumonitis with clinical, radiological and functional characteristics of this type of lung disease; exclusion of all other causes of interstitial pneumonitis (cardiac failure, infections, collagen vascular diseases, malignancies); bronchoalveolar lavage specimen, revealing lymphocytosis with an inverted CD4/CD8 lymphocyte ratio, isolated or associated with neutrophil and/or eosinophil alveolitis; finally, full recovery within several weeks or months after drug withdrawal unless irreversible pulmonary fibrosis has occurred. Certain specific characteristics correspond to the therapeutic class of the drug, i.e.

Late pleuropulmonary metastases of a cerebral ependymoma.

A patient with a 12-year history of occipital ependymoma was found to have late pleuropulmonary metastases without recurrence of the primary tumor. The pleural metastases were diagnosed by histologic, ultrastructural features and finally by glial fibrillary acidic protein (GFAP) labeling positive reaction. This case is unique because of the long interval between occurrence of the initial tumor and the metastases, and because of the apparent quiescence of the cerebral lesion when the pleuropulmonary metastases were discovered.

Leukocyte migration inhibition in amiodarone-associated pneumonitis.

Amiodarone-associated pneumonitis is now a well-known clinical entity, but the mechanism for the induction of the pulmonary disease is ill defined. In four patients with this disorder, evidence was obtained for elaboration of a lymphokine, leukocyte inhibitory factor (LIF), by peripheral blood lymphocytes after incubation with amiodarone in the direct leukocyte migration inhibition test. Control lymphocytes from normal subjects, as well as from patients receiving amiodarone but without pneumonitis, failed to elaborate LIF in the presence of the drug in this test.

Vitamin D metabolism in tuberculosis. Production of 1,25(OH)2D3 by cells recovered by bronchoalveolar lavage and the role of this metabolite in calcium homeostasis.

To investigate the extrarenal production of 1,25(OH)2D3 in tuberculosis, we extensively evaluated a patient with tuberculosis, hypercalcemia, and an elevated plasma concentration of 1,25(OH)2D3. Fresh total cells and cultured alveolar macrophages obtained by bronchoalveolar lavage were demonstrated to synthesize 1,25(OH)2D3 prior to and after nine months of successful antituberculous therapy. The continued capacity to produce 1,25(OH)2D3 was associated with a persistent lymphocytic alveolitis in this patient.

[Immunological studies in hypersensitivity pneumopathies].

In immunological investigations in hypersensitivity pneumonia some have a diagnostic value for the clinician but many others are essentially of interest in research and in analysing the pathophysiology. Unfortunately, skin tests with the responsible antigens are often positive in patients but also in exposed subjects without the lung disease. Studies on peripheral blood require a search for IgE immediate hypersensitivity which is rarely positive and above all a search for precipitating antibodies by the different standard tests available: there again, positive findings occur often enough in exposed but asymptomatic subjects; the sensibility and specificity of cell-mediated hypersensitivity tests seem much more reliable.

[Pulmonary aspergilloma appearing early].

A 62-year old smoker and alcoholic woman with chronic obstructive lung disease was admitted for suppurative pneumonia with cavitation and developed an intracavitary aspergilloma less than 2 months after the first signs of pneumonia. In view of the short time elapsed between the aspergilloma and the onset of suppurative pneumonia, 2 possibilities are discussed: either an aspergilloma developed unusually early in the cavity of a recent pulmonary abscess, or the patient had a chronic necrotizing pulmonary aspergillosis diagnosed at an early stage, which would account for all the manifestations observed.

[Thoracic metastases of ependymoma. Apropos of a case and review of the literature].

A 27-year old woman with occipital ependymoma treated by surgery and radiotherapy for multiple recurrences developed a right lymphocytic pleural effusion. After 3 inconclusive needle biopsies of the pleura, pleurectomy was performed. Pathological examination with a specific immunohistochemical marker provided a diagnosis of pleuro-pulmonary metastases from the ependymoma.

Use of bronchoalveolar lavage in the evaluation of methotrexate lung disease.

The results of bronchoalveolar lavage in three patients with a presumptive diagnosis of methotrexate induced lung disease are presented. Lavage fluid was characterised by the presence of large numbers of lymphocytes, which in two patients were predominantly lymphocytes of the T8 phenotype. These findings further support the hypothesis that immune mediated mechanisms may play a part in the pathogenesis of this disorder in some patients, and indicate that bronchoalveolar lavage may be helpful in the evaluation of patients suspected of having methotrexate induced lung disease.

Thyroid tuberculosis associated with mediastinal lymphadenitis.

A 25-year-old man developed thyroid tuberculosis associated with mediastinal lymph node enlargement. He was treated by antituberculosis chemotherapy and hemithyroidectomy.

[Endobronchial metastases of cancer. Apropos of 29 cases].

In a retrospective study covering a 3-year period, 29 cases were reviewed. All concerned patients with endoscopic abnormalities resembling those of a primary carcinoma and histologically of the same type as a previously known tumour affecting areas as diverse as the E.N.

[Role of thoracic x-ray computed tomography in the pretherapeutic evaluation of bronchial cancer. A prospective study of 60 patients].

The value of computerized tomography (CT) was compared with that of conventional exploratory methods (standard radiology, bronchial tomography and endoscopy) in 60 patients with non-anaplastic bronchial cancer evaluated preoperatively. After CT examination thoracotomy was avoided in 14 (23%) patients with local or distal extension. CT proved more sensitive than conventional methods in the assessment of pleural and/or parietal extension, and of direct or lymph-node mediastinal invasion (67% vs 33%, 50% vs 33%, 64% vs 45% respectively).