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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.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. The first screening questionnaire was completed by the parents, and data on 3,799 children were obtained; from this, 191 currently asthmatic children were identified. One hundred and forty-six parents of the identified asthmatics subsequently answered a second questionnaire on the severity of the illness and its effects on school attendance and educational activities. The 186 teachers from the schools involved were interviewed about their knowledge of the disorder, and about what they knew of the treatment and management of asthmatic children in school.It was found that the cumulative prevalence of asthma amounted to 7.6%, and that the prevalence over the previous 12-month period was 4.3%. Sixteen percent of the asthmatic children reported an asthma-associated school absence of more than six days during the six preceding months. In 45.2% of cases, physical exercise was responsible for an asthmatic attack, but premedication was used in only 21% of cases. Nine percent of the children had obtained a medical certificate which exempted them from participating in sports activities and physical exercise. Seventy-three percent of the parents had informed the teachers of their child's illness, but the information communicated was incomplete. It was found that the teachers did not have a thorough knowledge of the disorder, but that many of them (92.7%) would appreciate further information on the subject and on its management. Eighty-three percent of the teaching staff were unaware that the ministerial circular No. 93-248 of 22 July 1993 had been issued on the proposed management of chronic disorders at school, advocating a combined effort on the part of the parents, the child's physician, the school doctors and the teachers in setting up a concerted plan of action.This study has demonstrated that the school integration of asthmatic children remains problematical both as regards treatment and the pursuit of indoor and outdoor school activities. Integration could be improved by using parent-doctor-teacher liaison forms, thereby maintaining closer communication regarding the child's needs. When this is not sufficient, an individualized asthma management plan could be introduced in collaboration with the parents, doctors and teachers, which might result in improved treatment and integration of asthmatic children in school.

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. The diagnosis of intracardiac shunts as well as intrapulmonary shunts is now easier, thanks to transoesophageal ultrasound associated with contrast. Pulmonary angiography enables the treatment of arteriovenous fistula to be carried out by embolisation, and also avoids any surgery.

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.

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. No untoward effect was seen on systolic or diastolic arterial pressure, or the heart rate over successive visits at 1, 3, 6, 9 months and one year. Electrocardiographic surveillance found in only four patients electrical abnormalities that may be due to Formoterol, these were patients without previous cardiac problems but of advanced mean age. Functionally, a significant improvement of basal VEMS was noticed from the 6th month. The VEMS improved significantly after administration of 12 micrograms on successive visits, without tachyphylactic signs. Well tolerated, with functional benefits, Formoterol is a promising product amongst the long-acting beta 2-mimetics. Its usefulness and limitations in the basic treatment of these chronic bronchopathies remains to be defined.

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.

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. IRM introduced more recently enables a direct vision of the causal lesion endo or extra luminally, enabling an early detection of the syndrome by showing signs of a slow down of the venous flow. But the detection of a collateral circulation seems more difficult to demonstrate by this method.

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. A good alternative approach is destruction of the tumours with a laser in certain complicated forms which enables one to avoid surgical excision.

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. The pathological features, distinguished by the presence of granulation tissue plugs extending from bronchioles into alveolar ducts and alveoli, are described in detail. The place of BOOP within the broad spectrum of bronchiolitis obliterans between small airways disease and usual interstitial pneumonia is discussed.

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. Computerised tomography most often precisely identified the pleural topography and imagery by nuclear magnetic resonance in one case visualised fibrous tissue (with a zone of low signals on the scale in T2). The final diagnosis was achieved at the same time as the treatment when an exploratory thoracotomy was performed. In all the cases there was a tumour composed of fusiform cells covered by normal epithelium coming from the viscera pleura 8 times out of 10. The ultrastructure examination and immunohistochemistry of the fusiform cells (Vimentin plus, EMA-, KL1-) allowed for a differentiation of these tumours of connective tissue origin from tumours of mesothelial origin. These analyses constitute an argument in favour of the fibroblastic origin of pleural fibromas.

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. At H2, all the subjects received steroid therapy. Group 1 in which success was defined by an increase of 20% of peak flow judged at H1 and H2, and group II where the increase in peak flow was less than 20%. Group II benefited at H2 by treatment with theophylline or salbutamol intravenously given in a randomised fashion. At H8 the 2 treatments were associated in group II in cases of failures. 15 men, and 11 women aged 40 +/- 17 suffering from severe asthma (65% of Charpin Stage IV) were included. The mean peak flow at HO was 32 +/- 9% of the predicted PEF. 21 subjects, or 81% improved their peak flow by more than 20% at H2. The toleration for salbutamol was very good from the cardiovascular point of view. At HO there was no clinical criteria nor peak flow assessment which would enable one to predict the failures from nebulized salbutamol for a given subject. Nevertheless a level of dyspnoea of greater than 5 on Borg's scale and a peak flow of less than 150 l/min made failure likely.(ABSTRACT TRUNCATED AT 250 WORDS)

Authors bring forth the results of the determination of CO2 ductances in 28 patients : 14 cases of pulmonary arterial thrombosis, 7 cases of diffuse interstitial fibrosis recognizing various etiologies, 4 cases of endothoracic sarcoidosis and 3 cases of pure restrictive syndrome due to functional amputation of some territories. The global CO2 ductance is lowered in 24 cases. In each one of these cases the PACO2 determination makes possible to decompose the global ductance into a ventilatory ductance and a circulatory ductance. The circulatory ductance is lowered in the case of pulmonary arterial thrombosis; the ventilatory component is lowered in the case of restrictive syndromes and in the case of diffuse interstitial fibrosis. For what concerns the pulmonary arterial thrombosis, authors discuss then the value of the information contained in the expression of the CO2 arterial-alveolar gradient on the one hand, and in the circulatory component of the ductance on the other hand. At last, the determination of the ductances appears interesting in the supervision of the course of various diseases.

The authors report the results obtained with one single daily dose of 10 mg/kg of a long-acting theophylline preparation administered in the evening to asthmatic patients previously treated with the same dose twice a day. Twenty-seven patients presenting with airway obstruction reversible by beta-stimulants entered the study; their mean FEV1 value was 57% of the expected value, and diffuse sibilances were present; paroxysmal attacks occasionally occurred, particularly at night. No significant difference was found between the two dosage regimens with regard to symptomatic improvement, adjuvant drug consumption, and plasma theophylline levels 12 hours after the evening dose. The classical side-effects of theophylline therapy were not increased by the once-a-day regimen. It is concluded that one dose of theophylline per day is effective in the treatment of nocturnal asthma.

Two new cases of rheumatic pelvispondylitis associated with bilateral fibrosis of the pulmonary apex are reported and published data are reviewed. The clinical, radiological, evolutive and diagnostic features of this probable pulmonary manifestation of rheumatic spondylitis are described, and the pathogenesis is discussed.

The authors report a case of Pancoast and Tobias syndrome due to a hydatic cyst on the apex of the left lung. This parasitosis is together with tuberculosis and least infrequent benign etiology of Pancoast and Tobias syndrome. In our observation it was a young cyst without complications as opposed to previously reported cases.

In patients with sleep apnoea syndrome abnormalities of the upper airways may play a major role in the genesis of apnoea. Three cases are presented which illustrate the part played by hypertrophy of the tonsils in a child and by stenosis of the pharynx in an adult and of the larynx in another adult. All three patients were cured by surgical correction of these abnormalities. The physiopathology of alveolar hypoventilation, present in one of the three patients, is discussed in relation to the effects of pure oxygen inhalation on the patient's ventilation.

22 patients with severe respiratory insufficiency were treated by definitive tracheostomy for intermittent ventilatory assistance. Early mortality is heavy (9/22 before three months). After three months, the respiratory condition of patients improved greatly and survival rate is good. Tracheostomy is too often delayed and realized at the bad time of a severe acute respiratory failure.

Pneumoconiosis was diagnosed in 10 patients working in a silicon factory. The exposure time varied between seven and thirty-five years. All patients had only slight or no symptoms, except one presenting an important dyspnea. The radiologic study showed an interstitial syndrome. The functional lung test revealed a restrictive syndrome. Seven patients underwent fibroscopy with alveolar washing and transbronchial biopsy. A surgical biopsy was performed in two patients. The histological lesions showed an accumulation of alveolar and interstitial macrophages and the existence of fibrous interstitial micronodules. The ultrastructural study revealed an interstitial fibrosis. The macrophages contained numerous dense, homogenous small spheres of amorphous structure, composed of silicon and oxygen. These spheres represent amorphous silica smoke particles. Less than 1% of the particles are crystalline silica. Thus, the amorphous silica particles seem to be responsible for the histological and radiological lesions observed.

If diagnosis of chronic thromboses of pulmonary arteries is usually easy at the stage of confirmed chronic pulmonary heart, it is not so when dysponea is the only symptom of the disease. The authors report 30 cases of chronic thrombosis and remark that if respiratory alkalosis is very frequent, hipoxemia is often missing. On the other hand they observe 27 times out of 28 an increase of CO2 alveoloarterial difference; measuring the CO2 difference appears a safe and reliable test for detecting chronic thrombosis. It should take place in every systematic complete examination of unexplained dyspnoea.

Hypoxic vasoconstriction is one of the main determinants of pulmonary arterial hypertension in C.O.P.D. The authors study in two groups of respiratory insufficiency patients (82 C.O.P.D. and 46 non-C.O.P.D.) correlations between mean pulmonary arterial pressure (PAP) and gasometric values. They show that: --no correlation exists in the patients who suffer from a restrictive syndrome; --in the obstructive patients, correlations are poorer between PAP and PaO2 or PvO2 than between PAP and a factor made up of these two parameters, according to the percentage of their theoretical values.

Twenty patients with severe and chronic respiratory insufficiency (SaO2 less than or equal to 80% - PaCO2 greater than or equal to 50 mmHg) were treated with intermittent ventilatory assistance. They used volumetric apparatus 2 to 8 hours a day, during at least 6 months (22 months +/- 13). Respiratory status never improved strikingly, on the contrary most of the time it worsened and patients needed other ventilatory technics and/or died (11 of 20). This technic of ventilatory assistance does not seem to really change the prognosis of these patients in a severe and chronic state.

In a prospective study 43 patients with chronic obstructive lung disease and severe respiratory insufficiency were systematically investigated for polyneuropathy, although they had no risk factor of that disease. Electrophysiological recordings showed slight or significant signs of polyneuropathy in 17 and 15 patients respectively, thus indicating that the condition is frequent. Clinically, it was often silent or manifested only by sensory disorders predominant in the lower limbs. Electrophysiology suggested axonal degeneration associated with some degree of demyelinization, and these lesions were found at histology to be present in sensory nerves. Histological examination of the muscles showed peripheral mixed neurogenic atrophy probably due to hypoxia. Major thickening of basal material was observed in capillaries of the endomysium and endoneurium. Statistical analysis of clinical parameters and respiratory function values in relation to the presence and importance of polyneuropathy showed that the only significant difference was the longer duration of hypoxia in patients with nerve involvement. Age, alcoholism and the other respiratory function values did not seem to be correlated with lesions of the peripheral nervous system.

A case of primary malignant fibrous histiocytoma of the lung is reported. The clinical course was divided into 2 periods: slow tumoral growth followed by rapid aggravation. The pathological aspects of the first localization and of the relapse are analyzed and discussed. Data from the literature are reviewed, with special attention to diagnostic and prognostic problems.

The authors report the case of a patient with severe alveolar hypoventilation, with a large emphysematous bulla in the upper part of the right pulmonary field. The drainage aspiration of the bulla as a life saving technique greatly improved the respiratory function. Blood gases reverted to normal and the bullae disappeared. Literature reviewing. Discussion of radiological and functional criteria of compressing the pulmonary parenchyma around the bulla.

Two anatomoclinical observations of lymphomatoid granulomatosis are reported. The first case concerns a patient presenting a cutaneous localisation and a severe pulmonary infection with acute febrile dyspnea and macronodular opacities seen in pulmonary radiographs. The treatment associating cortisone and chlorambucil led to a complete remission. Five years later a pulmonary recurrence was treated successfully with the same association. The second patient presents dyspnea upon progressive effort, a radiologic and functional syndrome of interstitial involvement. In the absence of precise diagnosis after pulmonary biopsy, the patient was treated with corticosteroids. Four months later, encephalitic damage led to death. In the 2 observations, the biopsies or autopsic samples from the lungs or brain showed necrotic nodular lesions. Bordering on the necrosis, the small arteries and veins are strictured or obstructured by an infiltrate of lymphocytes, plasmocytes, histiocytes, and large cells with atypical nucleus. The ultrastructural examination of the 2 pulmonary biopsies shows the reactional polymorphic nature of the lymphoid infiltrate, the generally imprecise nature of atypical large cells and the modifications of vascular elastic limitations. The blades of elastine are surrounded by microfibrillar material. These different data are compared with those in the literature.

We report the results of 82 needle biopsies of pulmonary nodules, using a fine screw needle. Owing to the very small diameter of the needle (0.8 mm), very few complications were observed (minor pneumothorax 13%, major pneumothorax 2.5%). The screw needle provided samples adequate for both cytological and histological examination. Forty-eight out of 53 cancers were diagnosed by this method (sensitivity 83%, specificity 100%).

In order to determine the frequency and the characteristics of neuropathies in chronic respiratory insufficiency, a systematic study of 43 patients affected by a chronic obstructive pulmonary disease was performed. In addition to neurological and electrophysiological examinations (including 6 nerve conduction studies on median, ulnar and peroneal nerves and EMG of 4 to 8 muscles), nerve and muscle biopsies (of the superficial peroneal nerve and lateral peroneus brevis muscle) were performed in 13 cases. Polyneuropathies were found in 74% patients: but mild in 39%, severe in 35%. Most were subclinical or poorly symptomatic. We determined the importance and distribution of abnormalities on the different nerves. From this we established that neuropathies are mixed but predominantly of the axonal type. Axonal degeneration and demyelination were confirmed by nerve biopsy; muscles presented neurogenic atrophy. Statistical analysis showed that the duration of hypoxemia was related to neuropathy. The pathogeny of these neuropathies is discussed.

Sixty cases of occult carcinoma of the lung are described. A distinction is made between "revealed cases" (23 cases) in which the carcinoma revealed itself within 5 months after the first cytological findings, and true occult carcinomas (37 cases) in which lesions developed within 5 months to 8 years after the first positive cytology. Mean survival in the "revealed cases" was 13 months. It was 51 months for true occult lung carcinomas and 68.5 months for occult carcinomas treated by chemotherapy starting at the time of discovery of malignant cells in the sputum. The method of choice is selective bronchial aspirates and brushings after repeated sputum cytology which allows for localization of the lesion and early surgery.

Results of nuclear magnetic resonance exploration in a patient with chronic thrombosis of main pulmonary arteries are used to outline an elementary semiology in agreement with current documented data. Signs observed relate to the thrombosis and showing of flow due to associated pulmonary artery hypertension. Cardiac synchronization is essential: obtaining 2 echos by the spin-echo technique allows differentiation of circulatory slowing phenomena, which provoke increased strength of 2nd echo, from the thrombus itself. Correlations established with V/Q scintigraphy, angiography and CT scan findings in this case provided preliminary evaluation of use of this imaging technique in this affection.

A new case of asymptomatic thymolipoma in a 4.5 years old girl is reported. It was discovered during systematic medical investigation. Its radiological characteristics and the lack of evolutivity made the authors suspect the diagnosis before operating. A total surgical extraction of the 300 g weighing tumor was performed through a right thoracotomy. No complication occurred in the post-operative time. Others authors already indicated the scarcity of this affection (less than 10 cases in children) as well as the special radiological characteristics of this tumor and the noticeable clinical tolerance often despite a large bulk. Histologically the tumor is made of an infiltrating of the normal thymic tissue by proliferating adipose adulte cells, the benignity of which is demonstrated by the evolution. In this study a differential diagnosis between thymolipoma and other mediastinal tumors is made and also some pathogenic assessments. Surgery always is required for treatment.

Oxygen therapy is justified both on theoretical grounds and by clinical studies. Chronic hypoxia bodes ill for the system and is a prognostic factor in pulmonary disease. Low flow oxygen therapy has not shown any risk of pulmonary toxicity from anatomical or physiological studies. Clinical studies have shown that the correction of hypoxaemia by long term oxygen therapy improves exercise tolerance, mental state, the general sense of well being, polycythaemia, pulmonary hypertension, the quality of sleep, and finally the prognosis. But long term oxygen therapy is costly and requires patient co-operation and close supervision. It should be reserved for hypoxic patients in a stable state: the exact degree of hypoxaemia at which oxygen therapy is permissible cannot be defined precisely and depends on other criteria (such as polycythaemia, pulmonary arterial hypertension, nocturnal desaturation). Account should be taken of the PaCO2 level and the cause of the disease in deciding the oxygen flow. Polycythaemia, pulmonary arterial hypertension, nocturnal desaturation despite a normal waking PaO2, may represent some indications for oxygen therapy but further studies are necessary.

In order to assess the value of nuclear magnetic imagery NMR in the diagnosis of the extent of bronchial cancers, 61 patients with operable bronchial carcinoma had both a CT scan and an NMR scan pre-operatively. Fifty one mediastinoscopies were performed. Twelve times there were mediastinal glandular enlargement. Ten times the thoracotomy was performed straight away. After pathological studies of the biopsy, 24 patients were N2, 25 N1, 12 N0; the sensibility of NMR to foresee lymph node invasions was 83% (specificity 70%), for CT scanning 75% (specificity 81%). Thirteen patients presented with a direct mediastinal or parietal invasion. The sensibility of detecting these invasions was only 38% for NMR (specificity 94.5%) and for CT scanning 54% (specificity 94.5%). There is little difference in the results and no statistical difference. This leads us to conclude that at present, NMR does not give more information than TDM in the diagnosis of operability in bronchial cancers.

The purpose of this controlled, double-blind therapeutic trial in chronic bronchitis patients with hypoxia and normocapnia was to evaluate the beneficial effects of a 6-month treatment with almitrine bismesylate on dyspnoea and blood gases, as well as the clinical, spirometric and pulmonary haemodynamic acceptability of the drug. Patients were allotted at random to either almitrine bismesylate 100 mg/day in two divided doses (n = 10) or a placebo similarly administered (n = 9). On entering the trial, both groups had comparable clinical symptoms, lung function, blood gas values and pulmonary haemodynamic values. A significant (p = 0.014) reduction of dyspnoea was observed in the treatment group but not in the placebo group. A significant (p less than 0.05) improvement in PaO2 was noted after 3 and 6 months of treatment while PaCO2, initially normal, was not significantly modified. There were no significant changes in respiratory rate and external ventilation in either group, and the mean pulmonary arterial pressure remained unchanged in all patients. No significant variations were observed in the patients' weight, systemic arterial pressure, heart rate or signs of right ventricular failure. In conclusion, this trial in chronic bronchitis patients with hypoxia and normocapnia demonstrated sustained improvement in hypoxaemia and clinical symptoms during a 6-month treatment with almitrine bismesylate, without changes in pulmonary haemodynamic values.

The authors report the cases of two men with coronary artery disease by amiodarone for 8 and 24 months respectively. They developed clinical and radiological changes of diffuse interstitial pneumonia, characterised by an inflammatory syndrome, restrictive changes on spirometry, reduced CO transfer and abnormal blood gases. Broncho-alveolar lavage showed a lymphocytosis with a large quantity of iodine in the macrophages and the presence of amiodarone and its metabolite in the supernatant fluid. The responsibility of this drug is imputed and the patients were cured within 3 months of its withdrawal with regression of clinical, radiological, spirometric and control alveolar lavage abnormalities. A favourable outcome without steroid therapy is practically unknown in the literature. These cases illustrate the possible risk of alveolitis or diffuse interstitial pneumonia during long term amiodarone therapy, the pathogenesis of which is discussed: iodine overload, direct drug toxicity or an immunological mechanism.

Ten patients with chronic respiratory failure (PaO2 = 56,19 +/- 10,54; PaCO2 = 49,17 +/- 7,31 torr) were given intramuscular injections of tiapride, Changes in alveolar ventilation were assessed clinically and by monitoring blood gases. No adverse effects were recorded. PaO2 was similar before and one hour after tiapride. There was no hypoventilation but, on the contrary, a slight decrease in PaCO2 (49,17 +/- 7,3 and 47,10 +/- 7,3 torr) and a significant increase in pH (7,358 +/- 0,023 and 7,378 +/- 0,028; p less than 0,05). Tiapride was also given to ten patients before fiberoptic bronchoscopy. Endoscopy was well tolerated in eight patients, in six there was no anxiety, and in all normal vigilance was retained.

Three cases of severe slow-release theophylline toxicity (plasma theophylline levels above 30 mg/l) in patients with severe chronic pulmonary disease are reported. Seizures were noted in all patients, and one had tachyarrhythmia. Two of the patients died. Several factors were present which may have impaired theophylline clearance, leading to toxic plasma levels. The mortality rate of theophylline intoxication being high, the initial doses should be sufficiently low to minimize the risk of adverse affects, and the best way to prevent theophylline toxicity is to monitor plasma concentrations. A management of patients with theophylline overdosage is suggested: oral administration of activated charcoal is the primary therapeutic measure; haemoperfusion or haemodialysis should be considered only in patients in whom conservative measures have failed.

Pleural effusions from 200 patients with benign or malignant pleural involvement have been cultured in vitro and observed from 48 hours to 9 months. The morphology and "social behavior" of the different types of cells are described. Mesothelial cells settle down quickly and come into contact with each other by long cytoplasmic processes. The tendency of epithelial malignant cells is to clump and grow in clusters. These "balls" of varying size are freed into the culture medium. Similar clusters may be found in benign effusions showing mesothelial hyperplasia. In case of malignant primary tumor of the pleura, the morphology of cultured cells is similar to that of mesothelial cells. In 3 cases, typical malignant epithelial cells have allowed us to discard the diagnosis of malignant mesothelioma. Discrepancies between conventional cytology and cell culture were found in 13 cases: in 6 cases, positive for malignant cells using conventional cytology, cell culture was negative. In 7 cases with negative routine techniques, cell culture disclosed malignant cells. Large multinucleated syncytia were observed in 15 cultures. They suggest a cytopathic effect similar to that seen in myxovirus infected cells. Correlation with the etiology of pleural effusions in these cases is described.

The influence of low flow oxygen on saturation (SaO2) and mean nocturnal pulmonary artery pressure (PAP), was studied in a group of chronic bronchitics suffering from severe airflow obstruction with moderate respiratory failure. 20 patients had oxymetry on ambient air, six underwent a continuous recording of SaO2 and of PAP for 2 nights; the first on ambient air, the second on Oxygen. The six patients showed transitory desaturation, accompanied by instantaneous rise in PAP. The oxygen greatly improved the mean values and maximal variation of SaO2 and PAP, supporting the hypothesis that this treatment is capable of preventing T.A.P., and chronic cor pulmonale in patients whose diurnal blood gas values do not justify continuous oxygen therapy, according to classical criteria.