[Cross-sectional study of school integration of asthmatic children in a general population sample].

Aims: Asthma is one of the most frequently encountered chronic illnesses in children. The aim of the present study was to investigate the problem of integration of asthmatic subjects at school by assessing the reactions of parents and teachers, and also by considering the medical aspects.

Population And Methods: A cross-sectional random study was carried out during autumn 1994 including 4,251 primary school children aged between five and 14 years, and including teachers from 188 classes and 26 schools in Grenoble and its inner suburbs.

[Giant thymic lipoma: anatomical, radiologic and clinical aspects].

We report the case of a 51-year-old man who presents with worsening dyspnea at exercise caused by a large thymic lipoma (6 kg). We present the clinical, radiological, and spiral CT scan features of this rare and benign tumor and correlate them with the pathologic findings.

Accuracy of oximetry for detection of respiratory disturbances in sleep apnea syndrome.

Study Objective: The cost and inconvenience of polysomnography make simplified techniques of screening desirable in the strategy of diagnosis of sleep apnea syndrome (SAS). We have evaluated, in a prospective study of 301 consecutive patients referred for suspected sleep disorders, an index (delta index) that detects apneic events by quantifying arterial oxygen saturation (SaO2) variability.

Setting: Regional sleep laboratory taking referrals from general practitioners and specialists.

Mechanism of gluconeogenesis inhibition in rat hepatocytes isolated after in vivo hypoxia.

Gluconeogenesis was studied in hepatocytes isolated from fasted rats submitted to 24 h of hypoxic exposure (inspired O2 fraction 0.1) or to room air. Hepatocytes from hypoxic rats compared with controls exhibited a lower gluconeogenic rate with lactate (5.

[Right to left shunts in the adult].

Right to left shunts in the adult in their usual location are either intraarticular or intrapulmonary, and are often congenital. The acquired intrapulmonary shunt of the cirrhotic is now well defined by the hepatopulmonary syndrome. The major complication of right to left shunts are paradoxical pulmonary emboli which are often more severe than haemoptysis or chronic hypoxia.

[Acute eosinophilic pneumonia and the larva migrans syndrome: apropos of a case in an adult].

Toxocariasis is a frequent disease in children, but the severe clinical manifestations are rare in the literature (diffuse interstitial pneumonia with hypoxaemia and acute severe asthma). The diagnosis is made thanks to the reliability of serological techniques (the ELISA test and using antigen excretion-secretion tests of the larvae of Toxocara canis). The authors report a case of acute severe eosinophilic pneumonia whose outcome was rapidly favourable following steroid therapy; the existence of positive Toxocara canis serology with a contamination risk of the patient in the domestic environment leads us to integrate the clinical picture into the larva migrans syndrome.

Muscular metabolism during oxygen supplementation in patients with chronic hypoxemia.

The effects of supplemental oxygen (O2) versus air on working calf muscle metabolism were studied in seven patients with stable chronic obstructive pulmonary disease (COPD) and chronic hypoxemia (PaO2 = 57 +/- 3 SE mm Hg) and seven age-matched control subjects. Oxygen and air were randomly administrated at 24-h intervals, and O2 flow rate was adjusted to correct hypoxemia (PaO2 = 87 +/- 4 mm Hg) in the COPD group. The relative concentrations of ATP, phosphocreatine (PCr), inorganic phosphate (Pi), phosphomonoesters (PME), and the intracellular pH (pHi) were determined with 31P magnetic resonance spectroscopy at rest, during a graded standardized and localized exercise protocol (360 active plantar flexions), and during recovery.

[Long-term tolerability of formoterol in chronic obstructive bronchopathies].

Formoterol aerosol, a long-acting new beta 2-mimetic was administered over a year at a dose of 12 micrograms twice daily, to 62 chronic obstructive bronchitics of mean age 66 +/- 6 years and of whom the basal VEMS was at 12,801 +/- 0.59. Clinical tolerance of the product was good with undesirable effects in 13 patients, the most frequent being shaking.

Combination of 5-FU cisplatinum and hypofractionated irradiation followed by split-course radiotherapy in 47 patients with unresectable non small cell lung cancer.

Forty-seven patients with unresectable non small cell lung carcinoma, 15 stage IIIA, 31 stage IIIB, 1 stage IV (cervical lymphadenopathy) were treated with a combination of three courses of chemotherapy and hypofractionated irradiation followed after 3 weeks by split course radiotherapy. Each course was repeated every 3 weeks with the following sequence: Cisplatinum (CDDP) (20 mg/m2) was given in a 20-min infusion, followed by a 2-h infusion of 5-fluorouracil (5-FU) (400 mg/m2) on days 1, 2, 5 and 6. Radiation with a dose of 3 Gy on the target volume was given on days 3 and 4--in one fraction for the former 27 patients, in 2 fractions of 1.

Basal cell (basaloid) carcinoma of the lung: a new morphologic and phenotypic entity with separate prognostic significance.

On review of 115 poorly or undifferentiated lung cancers from 671 lung tumors resected over a 7-year period, we have found 38 cases of basaloid carcinoma. The cardinal histopathologic features distinguishing this tumor from other non-small cell lung cancers are a lobular growth pattern of small cells with moderately hyperchromatic nuclei, with no prominent nucleoli, and with scant cytoplasm, a high mitotic rate, and peripheral palisading. Basaloid carcinoma was present in a pure form in 19 cases and the other 19 tumors were of a mixed, but prominent, basaloid type associated with squamous cell carcinoma, large cell carcinoma, or adenocarcinoma.

[A rare cause of upper digestive tract hemorrhage: an esophageal fistula in mediastinal tuberculous adenopathy].

We report a case of esophageal fistula of a tubercular mediastinal adenopathy revealed by melena and which was diagnosed partly by means of endoscopy and partly by scanning after carrying out endoscopic fistulography. Endoscopic ultrasound, which was carried out as a complementary examination, confirmed this diagnosis.

Changes in left ventricular ejection fraction during REM sleep and exercise in chronic obstructive pulmonary disease and sleep apnoea syndrome.

Nine patients, 4 with chronic obstructive pulmonary disease (COPD) and 5 with obstructive sleep apnoea syndrome (OSAS) were monitored during sleep, rest and exercise. Left ventricular ejection fraction (LVEF) was investigated using gated equilibrium 99mtechnetium ventricular scintigraphy during rapid eye movement (REM) sleep, during exercise, and during wakeful rest. Control wakeful rest periods used for comparison with a study state (either REM sleep or exercise) were always selected during the same circadian segment as that state.

[The role of new medical imaging technics (TDM and MRI) in the diagnostic strategies of superior vena cava syndrome].

Superior vena caval syndrome (VCS), is easily recognised in the advanced case, however in the early case without clinical signs its detection is much less easy. New techniques of medical imagery such as IRM and above all computer tomography (TDM) have shown an increasing place in the daily clinical practice of the respiratory physician; these enable an early diagnosis to be made and a work up of the aetiology of the syndrome of VCS. With TDM the obstruction of the VCS appears the sign of direct obstruction (thrombosis or extrinsic compression) and of a collateral venous circulation deriving some anastomoses from the brachio-cephalic venous trunk (TVBC) and the azygos system, the VCS and the inferior vena cava (VCI), the two TVBC at the junction of the median line principally by the suprasternal network and finally these portal systemics, by the veins from the anterior wall of the trunk and the accessory portal veins of the round ligament.

[Tracheo-bronchial granular cell tumors. Apropos of 4 cases].

We have seen four cases of granular cell tumor (Abrikossoff's tumour) and it is recalled that these tumours are most often discovered fortuitously by bronchoscopy in the tracheo-bronchial region because they have a non specific clinical presentation. The cytological and histological characteristics enable an accurate diagnosis but there are problems posed as to the histogenesis of these tumours. With a tumour with a slow progression regular surveillance with regular biopsies seems preferable as in certain cases the tumour regresses spontaneously or disappears after ablation with the forceps.

Effects of captopril combined with oxygen therapy at rest and on exercise in patients with chronic bronchitis and pulmonary hypertension.

The aim of this study was to determine the effects of captopril combined with oxygen therapy on pulmonary hemodynamics and gas exchange in chronic obstructive pulmonary disease (COPD) patients with pulmonary hypertension. Eleven subjects, with severe airflow obstruction (FEV1/FVC: 42 +/- 11%) and chronic respiratory failure (PaO2: 54 +/- 6 mm Hg, PaCO2: 46 +/- 8 mm Hg) treated with long-term oxygen, underwent two successive hemodynamic and arterial gas studies, at rest and during exercise. All the studies were performed whilst the patients were breathing oxygen, at rest and during exercise and 1 h after intake of 12.

Pulmonary histiocytosis X with mediastinal lymph node involvement.

In this report, we describe a patient with the classic histology of pulmonary histiocytosis X, who had bilateral reticulonodular densities and mediastinal lymph node involvement. The diagnosis was confirmed by the use of electron microscopy and immunohistochemical markers (PS100, HLA-DR, and CD1), which allowed us to recognize the lymph node infiltration of X histiocytes. An association of mediastinal lymph node enlargement with pulmonary histiocytosis X has been reported but it has never been histologically documented.

[Can oximetry contribute to the detection of apnea? The use of a mathematical analysis of the oximetry signal].

The aim of this study was to test the efficacy of nocturnal oximetry as a means of continuous recording of SaO2 in the identification of apnoeic events in the recognition of non-apnoeic desaturation. The oscillations of SaO2 in relation to successive periods of apnoea during the course of the sleep apnoea syndrome (SAS) or with apnoeic episodes in patients with chronic airflow obstruction (BPCO) or restricted disease, were identified using a new delta index quantifying the variations of SaO2 during the night. 26 successive patients in whom there was an indication for nocturnal oximetry were included in a prospective study comparing nocturnal oximetry and polysomnography during 34 nights.

[Effect of nebulized salbutamol in 26 patients hospitalized for asthma attack].

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.

[Bronchiolitis obliterans with idiopathic organized pneumonia. Anatomoclinical analysis and nosologic discussion apropos of 6 cases].

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.

[Benign pleural fibroma. An anatomo-clinical study of 10 cases].

We present an anatomical-clinical analysis of ten cases of benign pleural fibroma. This tumour was discovered in a systematic fashion in 8 of the 10 cases and fortuitously in one. Recent radiological examinations enabled the diagnosis to be suspected.

Heterotransplantation of small cell lung carcinoma into nude mice. Stability of the phenotypic characters.

In order to validate xenografted small cell lung carcinomas (SCLC) for biological studies, the authors established 12 lung neuroendocrine (NE) tumors (eight typical SCLC and four atypical NE tumors [ANE]) by heterotransplantation onto nude mice. Their characterization was performed using serial ultrastructural, enzymatic, and immunohistochemical methods on primary tumors and after xenografts. These were subclassified into epithelial (one), neuroendocrine (three), and multidifferenciated (eight) types.

Sequential combination of 5-fluorouracil, cis-platinum and irradiation in unresectable non-small cell lung cancer.

Twenty patients with unresectable non-small cell lung carcinoma, 15 stage III and 5 stage IV (supraclavicular lymphadenopathy) were treated with a combination of three courses of chemotherapy and hypofractionated irradiation followed after 3 weeks by split-course radiotherapy. Each course was repeated every 3 weeks with the following sequence. Cis-platin (CDDP) (20 mg/m2) was given in a 20-min infusion, followed by a 2-h infusion of 5-fluorouracil (5-FU) (400 mg/m2) on days 1, 2, 5 and 6.

Clinical value of an amplified electrophoretic determination of enolase isoenzymes in small cell lung carcinoma patients.

Neurone specific enolase (NSE); alpha gamma and gamma gamma isoenzymes of the glycolytic enzyme enolase, is found in considerable quantity in serum of patients with small cell lung cancer (SCLC). The spectrophotometric measurement of serum enolase activity, plus the electrophoretic separation of isoenzymes (alpha alpha, alpha gamma and gamma gamma) using an amplification reaction constitute a simple method, the application of which has not yet been demonstrated. In patients, serum values of higher than 25 U/l of total enolase activity, with more than 10% NSE, were considered to be positive.