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ABSTRACT: Identifying the role of fungi present in the domestic environment in the development of interstitial pneumonia can be a difficult clinical problem. We report a case of interstitial lung disease case occurring in a 53-year-old patient. He presented with profound hypoxemia (PaO(2) 54mmHg). Chest CT showed diffuse ground glass opacities. Initial blood tests for allergy and autoimmune disease were negative. Faced with a worsening of his clinical status after returning home he was hospitalized several times. At fibreoptic bronchoscopy, multiple white deposits were observed. Bronchoalveolar lavage with differential cell count was performed, revealing a 23% lymphocytosis. Serology for specific household molds showed moderate reaction to various molds found in homes, especially Stachybotrys chartarum. Pulmonary function tests revealed a moderate restrictive pattern with impaired diffusion of carbon monoxide and a bronchiolocentric interstitial pneumonia was found at lung biopsy. After a permanent move to a new residence, clinical parameters, radiological, biological and functional normalized. The final diagnosis was interstitial lung disease related to mycotoxins of S. Chartarum. The diagnosis of hypersensitivity pneumonitis to domestic mold or interstitial lung disease secondary to mycotoxins should be considered in patients presenting with interstitial pneumonia and requires specific investigations to ensure that an environmental cause with an allergic or toxic role is not missed.
Revue des Maladies Respiratoires 09/2011; 28(7):913-8. · 0.59 Impact Factor
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ABSTRACT: Few chemotherapeutic agents have demonstrated their efficacy in malignant mesothelioma. The cisplatin plus doxorubicin combination has one of the highest response rates. Epirubicin is an anthracyclin, analogous to doxorubicin, with a different toxicologic pattern. As there are no data on the activity of the combination cisplatin plus epirubicin in malignant mesothelioma, the European Lung Cancer Working Party (ELCWP) designed a phase II study with response rate as primary objective. Sixty-nine eligible patients with malignant pleural mesothelioma were centrally registered. The majority of the patients were male (n=59), had a Karnofsky performance status of 80 or more (n=62) and presented with an epithelial histologic subtype (n=43). Median age was 62 years. In nine patients, metastases were documented at the initial work-up, mainly in bone, lung and skin. Three hundred and twenty-four cycles of chemotherapy were administered. The main toxicities were nausea and vomiting, neutropenia and alopecia. Among 63 assessable patients, response rate was 19.0% (95% confidence interval [CI] 9-29%). Median survival was 13.3 months. In multivariate analysis, poor prognostic factors for survival were neutrophil count and CALGB groups 4-6. In conclusion, cisplatin plus epirubicin appears as an effective regimen in malignant mesothelioma, with a favourable toxicity profile. However, it does not demonstrate superior activity to other active regimens in this disease.
Lung Cancer 11/2005; 50(1):75-82. · 3.43 Impact Factor
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ABSTRACT: Brain metastases occur in 17 to 40% of lung carcinoma and 30 to 60% of brain metastases originate from a lung carcinoma. Brain metastasis directly influences prognosis and treatment of lung cancer. The aim of this study was to prospectively compare the findings of the neurological examination performed by a neurologist and results of double dose delayed computed tomography (CT DDD). The neurologist and radiologist were blinded to each other's results. Patients included had non-small-cell lung cancer (NSCLC) and were neurologically asymptomatic with no other cancer. From November 1993 to May 1996, 135 patients were included (126 men and 9 women). Ninety neurological examinations were normal, 34 suggested brain metastasis and 11 were abnormal but did not suggest brain metastasis. One hundred thirteen CTs were normal, 1 showed a brain metastasis and 11 were abnormal but did not evidence brain metastasis. The sensitivity, specificity, positive predictive value and negative predictive value of the neurological examination were 73, 79, 23 and 97% respectively. The presence of brain metastasis was directly related to tumor stage but not to age or histology. We suggest that brain CT DDD should be performed in stage IIIA, IIIB, IV whereas in stage I or II, the neurological examination is sufficient. However, a larger number of patients would be required to confirm these findings.
Revue des Maladies Respiratoires 07/1999; 16(3):361-8. · 0.59 Impact Factor
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ABSTRACT: The adverse effect of long-term steroid treatment on respiratory muscle function remains controversial. We evaluated inspiratory muscle strength and endurance in steroid-dependent asthmatics in comparison with other asthmatics or with patients with chronic obstructive pulmonary disease exhibiting a comparable level of lung hyperinflation. Inspiratory muscle function was assessed by maximal inspiratory pressure (Pimax) and by an incremental inspiratory threshold loading test in 19 patients who had had steroid-dependent asthma (SDA) requiring a mean daily dose of 20.7 +/- 0.8 mg prednisone for 5 +/- 1.4 yr. They were compared with 16 healthy control subjects, 30 patients with COPD, and 16 patients with non-steroid-dependent asthma (NSDA). Pimax as percentage of predicted values (%Pimax) was not significantly different in patients with SDA (77 +/- 5%) or NSDA (83 +/- 6%) than in control subjects (93 +/- 4%). In contrast, %Pimax was lower in patients with COPD (59 +/- 4.4%) than in those with SDA or NSDA (p < 0.05) or the control subjects (p < 0.0001). A significant correlation was found between %Pimax and hyperinflation assessed by the FRC/TLC ratio (r = 0.42; p < 0.001). Inspiratory endurance, defined as the ratio of maximal peak inspiratory pressure sustained for 2 min to individual Pimax (Plim2/Pimax), was significantly lower in the SDA (43 +/- 3%; p < 0.0001), NSDA (65 +/- 4%; p = 0.01), and COPD (55 +/- 3%; p < 0.0001) groups than in the control group (76 +/- 2%). Plim2/Pimax was also lower in patients with SDA than in those with COPD (p = 0.0073) or NSDA (p < 0.0001). Hyperinflation plays a major role in inspiratory muscle dysfunction associated with obstructive lung disorders, but the finding of a significantly decreased endurance in patients with SDA when compared with patients with COPD, despite a lower level of hyperinflation in the former group, points to a deleterious effect of long-term corticosteroid treatment on inspiratory muscle function in asthmatics.
American Journal of Respiratory and Critical Care Medicine 02/1996; 153(2):610-5. · 11.08 Impact Factor
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ABSTRACT: The optimal amount of systemic corticosteroids to be used in acute severe asthma remains an unresolved issue. In this double-blind, randomized study we compared two doses of methylprednisolone (1 vs 6 mg.kg-1 q.d.) in asthmatics presenting with an acute severe asthma attack, unresponsive to an intensive beta 2-agonist regimen administered during a run-in period. Concurrent therapy, including oxygen, inhaled and intravenous salbutamol, and aminophylline was strictly standardized. The response was assessed by serial bedside spirometry. The primary outcome measurement was forced expiratory volume in one second (FEV1) (expressed as percentage of predicted values) at 24 and 44 h. The trial was designed in order to achieve a statistical power of 90%. Twenty three patients were included in the low-dose group and 24 in the high-dose group. Both groups were comparable in terms of demographic profiles, history of asthma, and severity of the current attack. Improvement in pulmonary function was similar in both groups. At 44 h, the mean (+/- SD) FEV1 values were 53 +/- 22 and 45 +/- 14% in the low and in the high-dose group respectively (NS). We conclude that high dose systemic corticosteroids offer no further benefit over low-doses in the treatment of severe acute asthma.
European Respiratory Journal 02/1995; 8(1):22-7. · 5.89 Impact Factor
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ABSTRACT: We report the case of a patient suffering from a glandular pleural lesion. The evolution of the disease was punctuated by periods of hypoglycaemia, which caused a coma. There was no clinically evident explanation for these hypoglycaemic episodes. Investigations revealed adrenal failure, but this adrenal failure was unrelated to the neoplastic process in the patient. This case is a reminder that the cause of hypoglycaemia associated with tumours can really have a paraneoplastic origin and justifies an in depth study to achieve an aetiological diagnosis.
Revue des Maladies Respiratoires 02/1992; 9(4):474-6. · 0.59 Impact Factor
