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A 34-yr-old male presented with a 1-week history of a productive cough associated with small volume haemoptysis. This was preceded by a 3-month history of a chronic nonproductive cough and 6 kg weight loss. He denied chest pain, fever or night sweats. He admitted to increasing fatigue, but denied arthalgia, myalgia or skin rash. His past medical history was noncontributory. The patient worked in the construction industry and smoked 20 cigarettes per day. He admitted to illicit drug usage, both cannabis and cocaine on a regular basis. On examination, he was afebrile and haemodynamically stable. There was evidence of recent weight loss. His respiratory rate was 18 breaths·min−1 and oxygen saturations were 99% in room air. Lung examination was unremarkable. Laboratory examination included the following: white blood cell count 8.28 g·L−1 with 43% neutrophils; haemoglobulin 16.3 g·L−1; haematocrit 47%; erythrocyte sedimentation rate 1 mm in the first h and C-reactive protein 1.55 mg·L−1. The results of renal function tests and biochemistry were within normal limits. Sputum specimens for culture and sensitivity and total blood count were negative. A plain chest radiograph and computer tomography (CT) of the thorax were performed (fig. 1a–c⇓). Further investigations including α1 antitrypsin, pulmonary function and bronchoprovocation tests were normal. Oral examination and gastroscopy were within normal limits and did not reveal any source of bleeding. A bronchoscopy was performed (fig. 1d⇓) and aspirates demonstrated a positive culture of Haemophilus influenzae , which was sensitive to amoxicillin. Fig. 1— a) A chest radiograph, b and c) computed tomography images at the level of the trachea and d) endoscopic view of the trachea at …

This study investigated the relation between positive thyroid transcription factor 1 (TTF1) staining and survival of patients affected by primary adenocarcinoma (ADC) of the lung. Pathological tissue from consecutive ADC patients was collected from 2002 to 2004. The anti-TTF1 antibody (8G7G3/1, dilution of 1/200) was used. Thyroid transcription factor 1 staining was assessed for each tumour as positive or negative. Probability of survival was estimated by Kaplan-Meier and difference tested by log-rank test. A Cox's regression multivariate analysis was carried out. In all, 106 patients were studied (66% male, 69% PS0-1, 83% with stage III or IV). Tumours expressed positive TTF1 staining in 66% of cases. Multivariate analysis demonstrated an independent lower risk of death for patients whose tumour expresses positive TTF1 staining (HR = 0.51, 95% CI 0.30-0.85; P = 0.01) and higher grade of differentiation (HR = 0.40, 95% CI 0.24-0.68; P = 0.001). In conclusion, positive TTF1 staining strongly and independently correlates with survival of patients with primary ADC of the lung.

International audience; In this article a French working party critically review the international literature to revise the definition, pathophysiology, treatment and cost of exacerbations of adult asthma. The various guidelines do not always provide a consistent definition of exacerbations of asthma. An exacerbation can be defined as deterioration of clinical and/or functional parameters lasting more than 24 hours, without return to baseline, requiring a change of treatment. No single clinical or functional criterion can be used as an early marker of an exacerbation. Innate and acquired immune mechanisms, modified by contact with infectious, irritant or allergenic agents, participate in the pathogenesis of exacerbations, which are accompanied by bronchial inflammation. In 2010, mortality is related to progression of exacerbations, often occurring before the patient seeks medical attention. The objective of treatment is to control asthma and prevent exacerbations. However, many factors can trigger exacerbations and often cannot be controlled. The efficacy of inhaled corticosteroids has been demonstrated on reduction of the number of exacerbations and the number of asthma-related deaths. This treatment is cost-effective, especially in terms of reduction of exacerbations.