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The Grande Rose of Reims Cathedral (France), a UNESCO Cultural Heritage Monument from the 13 th century, underwent several restoration works during the 20 th century. Its colours result from centuries of colour management from which little information remain. We used non-destructive and portable optical absorption spectroscopy to quantify glass colour and determine the colouring species on a large-scale study of this monumental window. We found six distinct colour groups, each containing both medieval and modern glasses, with colouring processes specific to each colour. This illustrates medieval glassmakers' mastering of glass colouring and modern glassmakers' management to reproduce medieval glasses colours. Full UV-visible-NIR energy range is necessary for determining the contribution of colouring elements as Fe 2+ and Cu 2+ . Systematic thickness measurements reveal an average glass thickness of 3 mm and demonstrate the major control of chromophore concentration on glass colour. Yellow, red and purple colours arise from a single chromophore each, suggesting the use of well-defined glassmaking techniques leading to robust colour reproducibility. By contrast, blue and green glasses show different chromophore combinations depending on production time, which suggests more diversity in glassmaking techniques.

Objective: Increased postoperative mortality in low volume centers has contributed to merge and space thoracic surgical centers. Some studies have showed that the likelihood of receiving surgery was lower in lung cancer patients living far from a thoracic surgery center. Our objective was thus to determine whether surgery and survival rates in patients with non-small-cell lung cancer (NSCLC) were influenced by the distance between the respiratory and thoracic surgery departments., Methods: KBP-2010-CPHG is a prospective multicenter epidemiological study including 6083 patients followed in 104 nonacademic hospitals for primary NSCLC diagnosed in 2010. Distance between respiratory and thoracic surgery departments were obtained retrospectively. Predictive factors for surgery and mortality were identified by logistic regression and Cox hazard model., Results: Twenty-three percent of hospitals had a thoracic surgery department; otherwise, mean distance between the hospital and the surgery center was 65km. Nineteen percent of patients underwent surgery. Distance was neither an independent factor for surgery (odds-ratios [95% CI]: 0.971 [0.74-1.274], 0.883 [0.662-1.178], and 1.015 [0.783-1.317] for 1-34, 35-79, and ≥80km vs. 0km) nor for mortality (hazard-ratios [95% CI]: 1.020 [0.935-1.111], 1.003 [0.915-1.099], and 1.006 [0.927-1.091]) (P>0.05)., Discussion: This result supports the French national strategy which merges surgery departments and should reassure patients (and physicians) who could be afraid to be lately addressed to surgery or loose chance when being followed far from the thoracic surgical center., (Copyright © 2017 Société Française du Cancer. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: The aim of our study was to examine the practices and performance of a team working in a respiratory unit concerning the palliative care of patients with COPD, in a group of patients who died in hospital as a result of their disease., Methodology: The first step was focused on those patients who died in the respiratory care unit of the General Hospital of Saint-Nazaire during the year 2008 and who received end-of-life care, and the reasons for their death. In the second step, we selected and analysed retrospectively the records of patients who died from COPD. In the third step semi-directive interviews were held with a sample of nine care workers who were judged to be representative of the staff working in the respiratory ward of Saint-Nazaire Hospital. The interviews consisted of seven questions related to palliative practices and professional experiences acquired during the care of patients with COPD., Results: In a population of 51 patients who received end-of-life care during the year 2008, 34 were referred on account of lung cancer and only one was referred for COPD. Bronchial carcinoma was the main cause of death (36 cases) then COPD (16 cases) in a total of 92 deaths (2008). Retrospective analysis of the records of patients who died from COPD showed a limitation of care in 43% of cases, midazolam induced sedation in 43%, treatment with morphine in 37%, support for the family or relatives in 62% and some anticipated decisions in 6%. Analysis of the interviews showed that the subject of death is rarely or never discussed with these patients in contrast to patients dying from bronchial cancer., Conclusion: The practices of a respiratory team concerning palliative care in COPD patients appear to be limited to end-of-life care. This clearly reflects a need for palliative care education in workers of respiratory care units in order to deliver a global palliative approach at an earlier stage in the care of COPD patients and to improve communication concerning end-of-life treatments., (Copyright © 2012 SPLF. Published by Elsevier Masson SAS. All rights reserved.)

Introduction: Mucormycosis is a rare opportunistic fungal infection due to filamentous fungi of the order Mucorales in the class Zygomycetes. Rhino-cerebral and pulmonary manifestations predominate on account of the airborn spread of the spores. Gastro-intestinal, cutaneous and disseminated disease is less common. The principal risk factors are immuno-suppression and diabetic keto-acidosis., Case Reports: One case of fatal pulmonary mucormycosis and two cases of colonisation illustrate both the extreme severity of this disease and the diagnostic difficulties facing the physician. The ubiquitous nature of the organism leads to frequent colonisation and, moreover, the symptomatology readily mimics that of invasive pulmonary aspergillosis. The diagnosis of mucormycosis can only be confirmed by pathological and mycological examination of biopsy specimens. These requirements conflict with the need for urgent treatment with surgical debridement, amphotericin B and control of the underlying pathology. Sadly the mortality remains very high, between 50 and 80% in published series., Conclusion: Currently there is hope of new therapeutic approaches with posaconozole but the ineffectiveness of voriconozole and the echinocandines, used more and more against aspergillus, raises the possibility of an increase in mucormycosis by selection.

Sulfites are compounds which are mainly used in the agricultural, food and pharmaceutical industry as preservatives. The possibility of manifestations of acute hypersensitivity appearing after the ingestion or inhalation of sulfites has already been described several times, over the past twenty years. Amongst these manifestations and indeed the one that is most often present is bronchospasm, which can sometimes be severe. A few cases of occupational intolerance through contact eczema to sulfites have also been published. The idea of occupational asthma to metabisulphates is, on the other hand, extremely recent; its legal recognition only dates back to 1989. The authors present three new cases of occupational asthma to metabisulphites stressing the value of a specific provocation test and the different hypotheses for the pathogenesis of the disorder are reviewed. Preventative measures are always preferable to avoid the development of severe occupational asthma. In all cases, notification of occupational asthma is necessary.

Endothelial cells are involved in important pathological situations. They could be the target for infectious processes as for example in Cowdriosis, an important disease in cattle due to the rickettsia Cowdria ruminantium prevalent in the south of the Sahara. They are also connected to angiogenic processes related to tumor invasion.Our results indicate that AIDS related Kaposi sarcoma cells may be of endothelial origin. We conclude from our data the mobility of those cells, related to the expression of the metalloproteinases (especially the 92 kD form of the enzyme), is an important factor in Kaposi saroma dissemination and is the main factor limiting the scale up of Cowdriosis vaccine production in Bovine Umbilical Endothelial Cell line. We showed that PMA and TNF increased the 92 kD Metallaproteinase and that TGFβ, produced in an inactive form in cultures of Human Umbilical Vein Endothelial Cells, is a potential inhibitor of Kaposi sarcoma spreading, and could also be useful in improving our process for Cowdria ruminantium vaccine production, since it reduces the sensitivity of the cells to mechanical stress without affecting significantly the overall infectious process.

The echographic study of the sub-costal pleura of 20 patients with occupational exposure to asbestos fibers and exhibiting pleural calcifications and thickenings on the chest X-Ray, allowed us to define the main semeiologic aspects of this pleural disease: horizontal striation and echo-poor thickenings of the sub-pleural region and irregularities of the pulmonary surface generating Ring-Downs. Comparison of this group with 20 normal subjects quantified this pleural thickening (pleural plaques: 5.5 +/- 2.09 mm, limit values: 3 to 12 mm). Our results are similar to those of the recent literature on this subject. The interest of the echographic study of the pleura in patients submitted to asbestos fibers is enhanced by the easy use of the echographic procedure.

Serum angiotensin conversion enzyme (serum ACE) is a dipeptidylcarboxypeptidase which activates angiotensin I to angiotensin II and inactivates bradykinine. It is a glycoprotein with an MW of 126,000 to 480,000. It is produced by all endothelial cells, and is located on the cell membrane. It is inhibited by EDTA (chelator of Zn-- cofactor), teprotide (snake venom nonapeptide) and captopril. Estimation of ACE has greatly benefitted from the use of synthetic tripeptides. An example is the method of Cushman and Cheung using hippuryl histidyl leucine. A raised serum ACE level in sarcoidosis has been demonstrated by Liebermann in 1975. The diagnostic value is limited by the existence of high levels in other pulmonary diseases (asbestosis, silicosis). Serum ACE levels in sarcoidosis are all higher when the disease is diffuse from a pulmonary and extrapulmonary standpoint. They decrease when the disease regresses spontaneously and rise if it worsens. Radiological improvement in pulmonary sarcoid lesions under the influence of corticosteroid therapy is accompanied by a fall in serum ACE levels. Persistence of this normalization as the dose is decreased is a favourable sign, whilst the reappearance of a high serum level may either reflect simple and isolated biological "rebound" or may accompany a recurrence of signs of the disease. Serum ACE measurement is thus an important factor in the surveillance of cases of treated sarcoidosis when the dose of corticosteroids is to be reduced.

The authors analyze seric levels of Angiotensin converting enzyme (A.C.E.) with the method of Cushman and Cheung in 200 cases of sarcoidosis, and 130 cases of various bronchopulmonary diseases. All values equal or greater than 35.3 u/ml are considered high (M + 2 DS, control: 71 cases, 23.3 +/- 5.99 u/ml). 67% of sarcoid cases reveal high levels, mainly radiologic stages II and forms with evidence of clinic dissemination. A significant decrease of seric levels is observed in cases with spontaneous radiologic improvements, and in cases with radiologic amelioration under corticotherapy. A not-significant increase of seric levels appears in cases with radiologic aggravation. Radiologic stable forms have a variable evolution of their seric levels. Less than 10% of tuberculosis, asthma, chronic bronchitis and interstitial pneumopathies reveal elevated levels, but the prevalence reaches 61% in pneumoconiosis. However, the observed values never get over 60 u/ml, seric levels over this range being only noted in sarcoidosis. So, the determination of seric A.C.E. level has a positive interest in the diagnosis of sarcoidosis and in following sarcoidosis evolution. Its prognostic significance yet is difficult to evaluate.

Thirty-three cases of sarcoidosis (4.4% of 746 patients) showed an alveolar radiological pattern. A study of pulmonary function was carried out in 25 patients and compared with that of 46 patients with the interstitial radiological type of sarcoidosis. Twenty-two cases have been followed up from one to six years after the initial examination. The radiographic lesions were most often bilateral and included nodules greater than 15 mm with ill-defined margins or diffuse, infiltrative, non-retractile opacities with fluffy margins. Bilateral mediastinal lymph nodes were present in 27 patients. In 20 patients an associated reticulation was found on radiography. In four patients an open lung biopsy was done. The granulomatous nodules were identical to those found in other forms of sarcoidosis, although they were more confluent in the affected areas. Clinical and functional findings did not differ from those in the more common forms of sarcoidosis. Alveolar sarcoidosis has a sudden course. The alveolar radiological patterns always disappeared, with or without steroid treatment, while reticular patterns persisted in four patients. Rapid radiological changes were observed. Some functional abnormalities persisted in cases that were followed. It is concluded that alveolar sarcoidosis is a distinct acute form of sarcoidosis.

Bronchoalveolar lavage (BAL) was performed in 1,188 patients suffering from sarcoidosis. After technical considerations, the authors analyze the results of BAL from a practical point of view concerning its value for the diagnosis of sarcoidosis and its prognostic value and its value for the selection of therapy, particularly for the decision as to steroid treatment. BAL helps in the diagnosis of sarcoidosis, but is not specific enough to provide this diagnosis on its own. The persistence of high alveolar lymphocytosis within the first year of evolution is strongly correlated with nonrecovery from pulmonary sarcoidosis at 2 years and thus with the evolution towards a chronic phase of the disease. On the other hand, BAL can provide basic information for a better understanding of the disease and permits immunocompetent cells and soluble factors to be recovered from the lung, which is useful for immunological studies.

Two hundred ninety three patients with mediastinal and pulmonary sarcoidosis were assayed one or more than one time for seric angiotensin converting enzyme (SACE) using the method of Cushman and Cheung (substrate hippuryl-histidyl-leucin). Seventy one normal subjects and 163 patients with various broncho-pulmonary diseases excluding sarcoidosis were used as control. SACE is elevated in 67.2 p. 100 of the patients with sarcoidosis and reflects the intra and extrathoracic extend of the granuloma. Elevated levels of SACE in pneumoconiosis diminishes the diagnostic value of this test (as well as the presence of a normal SACE level in some sarcoid patients). There is no correlation between SACE and the percentage of lymphocytes in bronchoalveolar lavage fluid. SACE returns to normal in cases with spontaneous radiological improvement, and reaches more elevated levels in cases with worsening. An initial low level of SACE is usually a sign of a future good evolution. An initial high level is an argument for starting on steroid treatment. Repeated dosages of SACE are useful for monitoring the steroid posology at the end of the treatment and for deciding to stop it. Persistence of low levels allows to stop the treatment. Re-elevation of SACE may correspond to a radiological and clinical relapse or to an isolated and resolvent rebound.

The treatment of pulmonary TB due to bacilli sensitive to antituberculous treatment should lead to 100 p. 100 therapeutic success. However, this result implies a good bacteriological knowledge of the Koch bacillus, of antituberculous drugs, of therapeutic strategy, of the duration of treatment and, finally, of the reasons for failure. The association of isoniazide (5 mg/kg/day), rifampicin (10 mg/kg/day) and ethambutol (20 mg/kg/day for the first two months) sterilizes tuberculous lesions in 9 months. The introduction of a fourth antituberculous drug, pyrazinamide (35 mg/kg/day for the first two months) enables the duration of treatment to be reduced to 6 months without any loss of efficiency. Tuberculous relapses, sometimes due to polyresistant bacilli, pose difficult problems requiring detailed bacteriological studies of antibiotic sensitivity. Specific measures have to be taken (adaptation of dosage, contra-indications of certain drugs) with respect to the individual patient (elderly patients, pregnant or lactating women). Surgery has a role to play, especially in the treatment of sequellae. Admission to a sanatorium is reserved for infectious cases at the beginning of treatment and for patients living in poor conditions. The cover of social security is essential for successful treatment. Tuberculous is a compulsory notifiable disease.

Cells recovered by bronchoalveolar lavage from seven normals and seven sarcoid patients were centrifuged on discontinuous bovine albumin (BSA) gradients to study alveolar macrophage (AM) heterogeneity. The gradient was made with nine BSA concentrations from 8 to 30%. After centrifugation, the cells were recovered from the nine interfaces, named a to i. The majority of the AM was recovered from layers b to g. Regulatory activity of AM subpopulations was tested on mitogen-induced blood mononuclear cells (BMC) proliferation: autologous BMC were cocultured with AM from the different layers; 16-h culture supernatants of AM subfractions were added to allogeneic BMC cultures from normal donors. In the autologous assay, AM from the middle layers exhibited a stimulatory activity in normals and even more in sarcoid patients, while AM from the upper layers showed an inhibitory activity in normals but a stimulatory activity in sarcoid patients. In the allogeneic assay, a suppressive effect was found in culture supernatants from normal AM. On the other hand, in sarcoid patients, culture supernatants were less inhibiting, but the inhibitory activity was in both cases maximal in b. These results confirm functional heterogeneity of human AM, and demonstrate that the AM subpopulations differ between normals and sarcoid patients.

A study of the genealogy of a 53 year old lady (A.M...) suffering from diffuse interstitial pulmonary fibrosis (FID) has revealed several cases of FID in her forbears and relations. Two brothers of A.M... died of histologically proven FID; FID was also discovered in one of their daughters. A sister died young of some unclassified respiratory problem. Two cousins died likewise at a young age of acute FID proven histologically. The level of spontaneous pneumothorax was particularly elevated in this family which represented a clinical peculiarity when compared to sporadic FID. The most probable mode of transmission of familial FID is autosomal dominant with variable penetrance. The HLA group seen in A.M... showed the A2 and B12 alleles. The B12 allele was also present in the niece of A.M...

A tuberculous pseudo-aneurysm of the thoracic descending aorta was found in a 57 year-old female with haemoptysis three months after successful chemotherapy for a miliary tuberculosis. After aortic angiography, the aneurysm was resected and the aorta was repaired with a Dacron prosthetic graft. The patient is doing well one year after the operation.

A 35 year-old woman exhibited a stenotic lesion of the right pulmonary artery with a severe inflammatory syndrome. A diagnosis of Takayasu arteritis was made, although no aortographic abnormality was present. Involvement of pulmonary arteries during the course of Takayasu arteritis is frequent, but a localisation of the disease to the pulmonary arterial tree alone is a very rare condition.

To study the effects on cell counts of different ways of processing bronchoalveolar lavage (BAL) fluid, we performed 77 BAL in 19 healthy control subjects and in 58 patients with sarcoidosis. We investigated the role of readers, hemocytometers, mode of identification of macrophages, cell washing, and speed of cytocentrifugation. No significant effect of reader or hemocytometer was observed. The percentage of macrophages, determined as large cells stained with neutral red in a Malassez hemocytometer (63.9 +/- 24.6%, mean +/- SD) was lower than the percentage of macrophages determined by May Grunwald Giemsa staining (76.3 +/- 19.2%, p less than 10(-9)). Cell counts decreased 34% after 2 washings (p less than 0.001), and more lymphocytes were counted after cytocentrifugation at 90 g (33.2 +/- 25.3%) than at 23 g (27.7 +/- 22.1%). We conclude that bronchoalveolar cell counts vary with changes in processing lung lavage fluid and that this variability should be considered when using BAL cell counts.

Cells recovered by bronchoalveolar lavage (BAL) from ten subjects (five normals and five sarcoid patients) were centrifuged on discontinuous albumin gradients to study alveolar macrophage (AM) heterogeneity. The gradient was made with nine bovine albumin concentrations (from 8 to 30%). After centrifugation (4000 X g) cells were recovered from the interfaces. The majority of AM was recovered in upper and medium layers with AM purity reaching 90-100% in upper layers, while lymphocytes and granulocytes were found in lower layers. Alveolar macrophage morphology was different along the gradient. Large cytoplasmic vacuoles were found in AM from upper layers. Alveolar macrophage cytoplasmic diameters decreased from the top to the bottom of the gradient, but AM from sarcoid patients appeared larger than AM from normals. Alveolar macrophage nucleo-cytoplasmic ratios increased from top to bottom, but were lower in sarcoid patients than in normals. Alveolar macrophage peroxidase activity was rare (0.5-2% of AM) but reached a higher proportion in upper and lower layers.

Lungs have rarely been reported to be affected by any side effects of BCG therapy. Interstitial pneumonitis, though, is known to occur under such circumstances, but its pathogenesis is still debated between an infectious and a hypersensitivity mechanism. We report here 3 cases of pulmonary complications of BCG therapy evaluated by bronchoalveolar lavage (BAL). Cellular data obtained from all 3 patients were characterized by a markedly increased alveolar lymphocytosis. The T4/T8 ratio was elevated compared with that in normal subjects and with the T4/T8 ratio of circulating lymphocytes. Furthermore, alveolar lymphocytes were highly sensitized to PPD, as evaluated by their proliferation and their production of interleukin 2 in the presence of PPD. Mycobacteria were not found in the 3 patients. We conclude that interstitial pneumonitis occurring during BCG therapy could be explained by a hypersensitivity phenomenon, leading to an intense immune and lymphocyte-mediated response within involved organs.