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International audience; No abstract available

Resume La pentoxifylline (PTX) semble avoir des effets sur les cellules immunitaires en inhibant le tumor necrosis factor alpha (TNFα). Son role en tant qu’epargneur de corticoides dans le traitement de la sarcoidose reste a definir. Nous presentons le cas d’une patiente atteinte d’une sarcoidose corticodependante malgre l’utilisation d’azathioprine. Elle s’etait finalement amelioree cliniquement, fonctionnellement et scannographiquement avec l’adjonction du PTX. Lorsque la tolerance de la PTX est bonne et en absence de risque hemorragique, son rapport benefice/risque a long terme pourrait etre interessant chez certains patients atteints de sarcoidose corticodependante.

National audience; Objectifs : L'administration nasale de médicaments sous forme d'aérosol est largement utilisée par les otorhinolaryngologistes. Bien qu'elle manque d'évaluations cliniques, la nébulisation ORL se présente comme une option thérapeutique intéressante pour l'administration nasale de médicaments. Les aérosols permettraient de cibler les sites anatomiques d'intérêt situés derrière la valve nasale. Le nébuliseur sonique NL11SN utilise l'addition d'un son de 100 Hertz (Hz) à l'aérosol produit afin d'améliorer le dépôt dans les sinus. L'objectif de notre étude était : (1) d'évaluer in vivo chez le volontaire sain l'influence du son sur la ventilation sinusienne et le dépôt nasal et pulmonaire d'un aérosol sonique, et (2) de quantifier in vitro le dépôt d'aérosols soniques dans les sinus maxillaires d'un modèle plastiné. Patients et méthodes : In vivo, une scintigraphie de ventilation au gaz 81mKr et une scintigraphie de dépôt d'aérosol (99mTc-DTPA) sonique produit par le NL11SN étaient réalisées chez sept volontaires sains. En parallèle, des nébulisations de gentamicine étaient réalisées en présence ou en absence du son de 100 Hz sur un modèle de tête humaine plastinée avec le NL11SN. La quantité de gentamicine déposée dans les sinus était dosée par FPIA. Résultats : L'addition du son de 100 Hz au gaz 81mKr permettait la ventilation des cavités sinusiennes des volontaires sains. Le 99mTc-DTPA nébulisé avec le NL11SN chez les volontaires se déposait majoritairement dans les cavités nasales (2/3 vs 1/3 dans les poumons). In vitro, le NL11SN utilisé en mode sonique a permis d'augmenter d'un facteur 3 (p < 0,002) le dépôt de gentamicine dans les sinus du modèle plastiné. Les quantités d'antibiotiques déposées dans les sinus du modèle plastiné pouvaient être considérées comme suffisantes pour avoir un effet thérapeutique local. Conclusions : Le nébuliseur NL11SN assure un dépôt préférentiel de l'aérosol dans les cavités nasales et cible efficacement les sinus maxillaires.

The aim of our study was to evaluate the prognostic value of serum procalcitonine (PCT) assay in adult respiratory infections. Forty-nine patients admitted with pleurisy, community-acquired pneumonia, tuberculosis, infection were included in this prospective study. PCT was assayed on admission and discharge. Biological and clinical parameters of gravity were also evaluated. Twenty patients had elevated PCT of more than 0.50 ng/ml. In 29 patients, PCT was undetectable. The serum PCT level was normal in the patients with tuberculosis, infection, pneumocytosis. PCT did not correlate with the biological and clinical markers of the disease severity but the evolution of PCT correlated with the evolution of C-reactive-protein (r = 0.58, p0.05). PCT seems to be an early marker of the evolution of respiratory infections, but it does not help to establish prognosis. Further studies are necessary to assess the potential value of PCT in more severe respiratory infections requiring assisted ventilation.

Adult pleuropulmonary blastoma is an uncommon mesenchymal tumor of the peripheral lung parenchyma composed of undifferentiated cells. The differential diagnosis with Askin-Rosaï's tumor, an extrapulmonary pleuroparietal neuroectodermal tumor, may be a difficult task. We propose a similar therapeutic approach for these two malignant conditions: surgical excision associated with chemotherapy and autologous bone marrow transplant with adjuvant radiotherapy in case of recurrence. These two entities have many epidemiological, clinical, histological and immunohistochemical similarities.

Aerosol drug delivery is widely used by patients with asthma and chronic bronchial obstruction for beta-2 agonists and anticholinergic drugs. More recently, inhaled steroid sprays have also been introduced. The efficacy of easy to use aerosol sprays is well proven and has become an important administration route. Different models of metered dose inhalers with gas propellants or dry powder devices help improve patients compliance. Nebulizers can be used in particular situations. Aerosol administration is proposed for anti-infectious agents and for rhDNase in cystic fibrosis. Aerosol delivery of nucleotides and antiproteases are currently under evaluation. Gene therapy can also benefit from the aerosol route which may be proposed in the near future for many different types of systemic treatments. Possible drugs include cyclosporin for lung grafts, prostacyclin for primary pulmonary hypertension, insulin for diabetes or morphine in certain types of dyspnea.

Scintigraphic imagery is a functional image based on the difference of the in vivo concentration of injected radio-active traces as a function-of the metabolic characteristics of the tissues. A positive emission tomography (TEP) relies on an injection of substances which reflect the metabolic activity of the tissues and consist of protein renewal with 11C-methionine or glucose metabolism with F18-fluorodeoxyglucose (FTG). The imagery by TEP enables 85-90% of solitary pulmonary nodules to be detected. The degree of capture of the tracer enables some differentiation of a malignant lesion from a benign lesion which fixes less. In the assessment of the degree of extension in the mediastinal nodes of non-small cell Stage III cancers imagery by TEP has a sensitivity ads specificity which appears superior to those of computed tomography (TEM). The interpretation of the image is simplified by carrying out fusion images between TEM and TEP. The application of TEP in the research into thoracic recurrence has shown a cumulated specificity of 81% and a reliability of 91%. The imagery by TEP is only practised in a few centres. It should be developed in pulmonary pathology if the cost of the apparatus diminishes and if FTG is available. Radioscintigraphy is losing ground in the precise domain of non-small cell carcinoma although it shows up well as a technique in neuro-endocrine tumours. Few studies have shown a decisive value in the radioimmunoscintigraphic evaluation of the extension of mediastinal nodes. A gallium 67 scintigraphy has weak specificity and on account of this has been abandoned for the staging of tumours. Another approach has been isotopic imagery of macrophages but is major inconvenience is a lack of specificity. Scintigraphic studies coupled with ventilation/perfusion remains a useful pre-operative test above all in patients with chronic airflow obstruction with gross tumours at the borderline of operability.

With aerosolized administration of medicines, direct access to the lung is possible. Depending on the intrapulmonary behavior of each molecule, the aerosol mode of administration makes possible either a pulmonary topical action or a systemic action, thanks to the lung's wide vascular network. An inhaled molecule's pulmonary behavior is not predictable and must be studied on its own. Some medicines with a systemic aim have a topical effect after aerosol administration: furosemide, amiloride, morphine, interferons, cyclosporin and prostacyclin. Other medicines have systemic effects after aerosol administration: insulin, growth hormone, LHRH, calcitonin and nicotine. Heparin can be classified in either group depending on the dose and type of use.

The frequency and severity of pneumococci infections, the isolation of invasive serotypes and the fact that certain serotypes develop cross-resistance to antibiotics constitute justifications for anti-pneumococci vaccination. A 23-valence vaccine (Pneumo 23) has been marketed since 1983. A meta-analysis of 9 randomized studies concluded that anti-pneumococci vaccination reduces the overall incidence of pneumococci pneumonia with bacteremia. The efficacy of the vaccine was demonstrated on 4 parameters: proven pneumococci pneumonia, proven pneumococci pneumonia and serotypes contained in the anti-pneumococci vaccine, presumed pneumococci pneumonia, presumed pneumococci pneumonia and serotypes contained in the anti-pneumococci vaccine. The efficacy of the vaccine was significant only for low-risk subjects. The protective effect was not demonstrated against pneumonia whatever the cause and against bronchitis. Other case-control or retrospective studies have also been reported. The results have been somewhat contradictory but there is a demonstration of the usefulness of vaccination in patients over 65 years of age with a moderate risk (living in institution, obstructive bronchopneumonary disease, heart failure). Vaccination is advocated not only after splenectomy and in subjects with sickle cell anemia, but also in frequently hospitalized subjects, particularly those with respiratory failure and smokers. Vaccination is also recommended in case of nephrotic syndrome or an osteomeningeal breach. In at-risk children under 2 years of age, antibiotic prophylaxis is recommended in association with vaccination. The data of revaccination is not clearly determined.

Thyomas are benign or malignant lymphoepitelial tumors often associated with parathymic syndromes. A 74-year-old subject developed a recurrent thyoma over 15 year with bronchial dilatations and repeated bronchopulmonary and sinus infections. This clinical presentation suggests Good's syndrome which combines thyoma, bronchial dilatations and hypogammaglobulinemia.