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The incidence of chronic respiratory failure is underestimated in Martinique. The aim of our retrospective study was to determine local particularities. Between December 1991 and December 1995, 128 patients (55% men, mean age 60 years, range 18-89 years) were hospitalized in our pneumology unit to receive a respiratory device (oxygen concentrator, respirator, continuous positive pressure generator). The high percentage of continuous positive pressure generators contrasted with the low number of oxygen concentrators prescribed indicating that obstructive disease is relatively less common due to the absence of widespread smoking habits. Sleep apnea syndrome (SAS) was particularly frequent in women (44% of the SAS patients). 10% of the SAS patients had perturbed blood gases unexplained by an associated bronchopathy. SAS in obese, hypertensive, diabetic women in Martinique is a public health problem and should be assessed by a prospective study. We observed that home care was particularly difficult for the most severely diseased patients, especially those with a tracheotomy, due to the lack of a management structure.

Optimal dosage for chemotherapy administered to patients on chronic hemodialysis remains a difficult question. We report the case of a patient with chronic renal failure on hemodialysis for 9 years who was treated for small-cell lung cancer. The chemotherapy protocol combined carboplatin and etoposide at doses adapted to creatinine clearance. Tumor regression was observed after 6 cycles without major intolerance.

Hyperventilation syndrome is a frequent, but poorly understood clinical entity. The clinical expression is a rich combination of respiratory, cardiac and neurological signs which can simulate various organic diseases. Hypocapnia remains the primum movens for most authors although the relationship with psychiatric situations, in particular in anxious patients, is increasingly emphasized. The diagnosis is currently based on the elimination of diseases associated with hyperventilation, then on Nijmegen's questionnaire and is confirmed by the reproduction of the same clinical picture in a voluntary hyperventilation test. Respiratory function tests offer little information. Treatment is based on combining rehabilitation therapy focused on the diaphragm and on relaxation. Specialized care may be needed in psychiatric patients.

A rare small-cell carcinoma of the trachea was observed in a 27 year-old man. Treatment included chemotherapy and radiotherapy as for bronchogenic small cell carcinomas. This treatment regimen led to complete but temporary remission. The patient died 4 months after the end of the treatment due to multiple cerebral metastases.

Rhabdomyosarcoma is a malignant tumour generally observed in children or adolescents; thoracic localization is rare. The authors report a case of embryonary rhabdomyosarcoma of the thoracic wall in a 36-year-old subject. Pathology examination of surgical specimens confirmed the diagnosis. Treatment included surgical exeresis together with pre- and post-operative chemotherapy combining doxorubicine (40 mg/m2/cycle), ifosfamide (6 g/m2/cycle) and dacarbazine (900 mg/m2/cycle). Local recurrence, requiring radiotherapy, was observed a few months later and led to the patient's death after a 9-month clinical course.

We report the results of a combined of chemotherapy with CDDP and 5 FU repeated every 3 weeks in sixteen men (age range 31-73 years) with brain metastases. CT was performed after 2, 4 and 6 cycles to assess efficiency. Response was considered complete when no lesion was found on the CT scan and partial when the lesion shrunk to least half its the total volume. After two cycles, the response rate was 8/16 (50%). Treatment toxicity was mild with only one case of severe but reversible myelotoxicity (grade III). CDDP and 5 FU combined chemotherapy can be a useful treatment for brain metastasis of lung carcinoma.

Lymphocytes forming E rosettes, active E, autologous and EA antibodies were studied in 66 subjects (56 men, 10 women, mean age 59, range: 40-85 years) who presented with lung cancer classified on the TMN scale in stages I and II: 19; stage III: 20; stage IV: 27. In comparison to the controls, there was a significant reduction (p less than 0.01) in E, autologous and EA rosettes in the patients. A reduction in E active rosettes (compared to controls) was noted for stage IV cases (p less than 0.01) and rose with the stage. The formation of rosettes was reduced in 50 squamous carcinomas compared to 12 anaplastic carcinomas for E rosettes (p less than 0.01) and E active (p less than 0.02). If one compares the actuarial survival curves of 37 patients with E act rosettes greater than or equal to 23% and of 29 with a level of less than 23%, the mean survival for all stages combined was 14.1 months in the first group and 8.2 months in the second group. Associated with an extension of the tumour, the immunological system has a role in determining outcome and lymphocytes forming active E rosettes appear to be the subpopulation most closely correlated with survival.

Two cases of systemic lupus erythematosus (SLE) complicated by pneumonia which resulted in death are reported. The first patient, a 21-year old woman, died of acute diffuse lupus pneumonia; the initial and unusual radiological image of "multiple balloons" progressed within 2 months to terminal interstitial fibrosis. The second patient, a 60-year old woman, died of infection on an interstitial pneumonia which turned into severe fibrosis within 16 months. Acute or chronic lupus pneumonia is uncommon, but it may follow a very serious course. Clinically, true lupus pneumonia must be distinguished from all other types of lung involvement in SLE, such as infection, pulmonary haemorrhage or oedema, iatrogenic pathology, thromboembolic disease, etc. The pathogenetic mechanism of pulmonary lesions directly related to SLE is obscure, although some lung biopsy specimens have shown positive immunofluorescence. Concerning treatment, the initial response to corticosteroid therapy is usually very good, especially in the acute forms of the disease. However, in severe cases immunosuppressive drugs or even plasma exchanges must be added to steroids. For treatment to be rapidly initiated the diagnostic procedures must be completed in the early stages of the disease, involving, when necessary, surgical lung biopsy.

The case reported here concerns a 30-year old male patient who had both very severe, multivisceral tuberculosis and equally severe sarcoidosis, with repercussions on the respiratory function that required corticosteroid therapy. Prolonged anti-tuberculous therapy and corticosteroids gave favourable results. This case is remindful of an old debate which opposed the two diseases on account of their histological lesions. It offers a new example of the severity of tuberculosis in "immunocompromised" patients, and it raises anew the still unresolved problem of the individuality of sarcoidosis in pulmonary pathology.

We report a case of myasthenia gravis occurring in a 70-year old patient with old chronic bronchitis. Anticholinesterase therapy led to an increase in respiratory symptoms, but relief was obtained with inhaled ipratropium. The activity of this drug was confirmed by spirography. This clinical finding is compared with similar data found in the literature.

In the context of two recent cases, the authors briefly review the clinical, laboratory and anatomical features of Wegener's granulomatosis and, in particular, its clinical course in response to treatment. These 2 cases include fairly original features: one case presented with abundant haemoptysis with a radiological picture of extensive diffuse bilateral pneumonia; the other case presented with a very large pleural effusion with no E.N.T. involvement whatsoever. The authors then summarise the classical features of this severe form of granulomatous vasculitis, which essentially affects the lungs, the kidneys and the ear, nose and throat. The lesions have a typical histological appearance. The major interest of this disease lies in its treatment. The natural evolution of this disease is very serious with a mean survival of 5 months. However, with immunosuppressant and corticosteroid treatment, a complete remission is obtained and maintained in more than 90% of cases. The therapeutic protocol used, as in one of the present cases, prevents the development of the lesion responsible for the very serious prognosis, irreversible renal failure.

This case concerns a 48 year-old patient whose endobronchial malignant melanoma was discovered on the occasion of a haemoptysis. A search for primary localization remained negative, suggesting a primary endobronchial lesion. Only a few cases of endobronchial malignant melanoma have been published, and several assumptions can be raised to explain the possibility of their primary origin.