Download the Free Unbound MEDLINE PubMed App to your smartphone or tablet.
Available for iPhone, iPad, iPod touch, and Android.
Rev Mal Respir [journal]
- [The acute pulmonary renal syndrome: An unusual presentation of granulomatosis with polyangiitis]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Sep; 31(7):636-40.
We report a case of acute pulmonary renal syndrome mimicking septic shock, which led to the diagnosis of granulomatosis with polyangiitis.A 70-year-old man was hospitalized because of acute kidney injury and acute respiratory distress syndrome with diffuse alveolar hemorrhage associated with a serum procalcitonin level of 18μg/L. Initially, septic shock was suspected and antibiotic therapy was started. The absence of microbiological isolates and the patient's rapid clinical deterioration prompted laboratory testing for autoimmune disease, which confirmed the diagnosis of granulomatosis with polyangiitis. Immunosuppressive therapy was promptly initiated with corticosteroids, cyclophosphamide and several plasma exchanges, which resulted in a rapid clinical improvement and ICU discharge.Granulomatosis with polyangiitis is a systemic necrotizing vasculitis with antineutrophil cytoplasmic antibodies, which can present with acute pulmonary renal syndrome, combining acute respiratory distress syndrome and acute kidney injury. This misleading presentation must prompt an autoimmune disease testing in order to yield an early diagnosis of a vasculitis, allowing for timely initiation of immunosuppressive treatment. Serum procalcitonin levels can be markedly elevated and this must not override the possibility of a vasculitis where the patient shows a compatible symptomatology.
- [A rare cause of pulmonary opacities: Lung localization of Waldenström's macroglobulinemia]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Sep; 31(7):632-5.
Pulmonary localized forms of Waldenström's macroglobulinemia are rare.We report the observation of a 71-year-old woman with chronic cough and persisting alveolar opacities after several courses of antibiotics. Physical examination was unremarkable. Protein electrophoresis identified a monoclonal IgM in the serum. The lymphocyte immunophenotyping from the bronchoalveolar lavage was consistent with a B-cell lymphoma and Waldenström's macroglobulinemia was confirmed by the bone marrow biopsy. Chemotherapy with a combination of rituximab, fludarabine and cyclophosphamide improved the patient's symptoms and caused the pulmonary opacities to resolve. We discuss the various clinical and radiological pulmonary manifestations of this slowly progressive hematological condition.Pulmonary manifestations of Waldenström's macroglobulinemia result in various clinical and radiological patterns. A serum protein electrophoresis should be performed in cases of pleuropulmonary opacities persisting despite antibiotics.
- [Safety of reintroduction of erlotinib at low doses following hand-foot syndrome induced by erlotinib treatment for a Pancoast-Tobias tumour]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Sep; 31(7):628-31.
Erlotinib, an epidermal growth factor receptor tyrosine kinase inhibitor (EGFR-TKI), is a targeted therapy used in first, second or third line treatment of non-small cell lung carcinoma. Several cutaneous toxicities after the use of EGFR-TKI are well-described.After 13 days of erlotinib treatment, an 82-year-old man, diagnosed with squamous cell lung carcinoma, developed an acneiform rash in parallel with hand-foot syndrome (HFS). This led to the interruption of his treatment because of the patient's distress. However, for the first time and after a total recovery of the toxidermia, we reintroduced the therapy at very low doses without any HFS recurrence being observed.The HFS is a dose-dependent toxidermia appearing within the first week following administration of the triggering cytotoxic agents (chemotherapies or target therapies). It appears that a specific pathogenic mechanism exists for each cytotoxic agent triggering the skin damage, resulting in different clinical presentations. A major aspect of HFS treatment involves the reduction or withdrawal of the treatment.We describe what is to our knowledge, the third case of erlotinib-induced HFS, a new secondary undesirable skin pathology for which, currently, exist few direct causal explanations or drug monitoring. This observation highlights the importance of broadening our knowledge of the exact mechanisms linking EGFR-TKI to the appearance of HFS in order to optimize treatment.
- [An unusual mediastinal mass]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Sep; 31(7):624-7.
Primary mediastinal tumors are rare diseases including a broad spectrum of pathologies ranging from the well-known, such as lymphoma, thymoma or germ-line tumors to some very unusual presentations.We describe a solitary mediastinal mass compressing the bronchial and vascular system in a patient suffering from chronic dyspnea. Diagnosis, obtained by means of a CT-guided biopsy, was a melanoma without any sign of a primary cutaneous lesion which harbored the BRAF V600E mutation.An exclusive mediastinal presentation of a malignant melanoma is exceptional and, in the context of BRAF mutation needs to be considered and diagnosed given the potential therapeutic impact.
- [Severe pulmonary involvement in the course of type 1 neurofibromatosis]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Sep; 31(7):621-3.
Type 1 neurofibromatosis (NF1) is a hereditary disease inherited as an autosomal dominant. Respiratory involvement is rare. We report the case of a woman suffering from NF1 with mutation of the corresponding gene and with respiratory involvement combining diffuse parenchymatous lesions, severe precapillary pulmonary hypertension and an enlarging, spiculated pulmonary nodule, very suspicious of malignancy, though histological examination was not possible on account of the patient's poor respiratory function. There was progressive deterioration of the patient's respiratory condition, leading to death, despite the introduction of oral therapy combining a phosphodiesterase 5 inhibitor and an endothelin receptor antagonist. Our case illustrates the development of multiple severe respiratory pathologies in the setting of NF1. The specific contribution of the NF1 gene mutation in the pathophysiology of these different pulmonary manifestations needs to be examined in detail.
- [Obesity and the severity of asthma crisis]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Sep; 31(7):616-20.
Obesity is associated with inflammatory processes, which could influence the airway inflammation that is found in patients with asthma. Obesity may thus have a role in the development of asthma. However, the role of obesity in the severity of acute asthma has not been well described.We performed a retrospective study, which included 77 patients hospitalized for acute asthma. Two groups of patients were formed according to their body mass index (BMI): group 1 consisting of 59 patients with a BMI inferior to 30kg/m(2) and group 2 consisting of 18 patients with a BMI superior or equal to 30kg/m(2). These two groups were compared according to demographic factors, clinical features and the spirometric severity of asthma.The mean age was 43±17.4years with a sex-ratio 0.57 (28 men/49 women). Thirty-one percent of these patients had a severe asthma attack requiring hospitalization in intensive care in four patients with the use of mechanical ventilation in two patients. The comparison between obese and non-obese patients did not show a significant difference in the severity of asthma.Although a contribution of obesity to the manifestation and severity of asthma is commonly recognized, the present data to not confirm the impact of obesity on the severity of acute attacks.
- [Is stairclimbing a maximal exercise test for COPD patients?]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Sep; 31(7):608-15.
Variable tests evaluate the cardio-respiratory working capacity of COPD patients. Stairclimbing testing has been less studied. Our hypothesis is that this functional exercise test represents a submaximal effort for these patients.We compared in 10 COPD patients the main metabolic and ventilatory parameters at the end of an effort between stairclimbing and cycle ergometer test.The following parameters studied (RER, V'CO2, lactates, V'E) are significantly lower for stair climbing. Nevertheless, in 8 patients, the V'O2 at the end of the stairclimbing testing is equal to the cycle ergometer test and in two patients superior. Concerning the evolution of some parameters during stairclimbing, 2 distinct profiles were observed: stabilization of the V'O2, HR, V'E and Vt (6/10 patients) or a constant increase of those parameters (4/10 patients).Stairclimbing represents a submaximal effort for the majority of COPD patients combined with a high metabolic cost. However, some COPD patients execute a maximal effort like in the cycle ergometer test when climbing stairs. These two groups could not be differentiated with the rest lung function data. The hypothesis of different mechanical constraints and/or motivation is suggested.
- [Paclitaxel-bevacizumab is a possible alternative as salvage chemotherapy in advanced non-small cell bronchial carcinoma]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Sep; 31(7):601-7.
Bevacizumab is recommended in first line chemotherapy for advanced non-squamous non-small cell lung cancer (NSCLC). Paclitaxel is a doublet drug also widely used in cisplatin-based regimens. Paclitaxel plus bevacizumab is a standard regimen as first line treatment of metastatic breast cancer. Since there is no guideline for third line treatment of NSCLC, some oncology units use paclitaxel-bevacizumab in some NSCLC patient after relapse of the second line. The aim of this study was to assess retrospectively the feasibility and efficacy of this treatment option in stage IV NSCLC.Patients who had received the combination of paclitaxel (80 to 90mg/m(2) in a weekly schedule) and bevacizumab (7.5 to 15mg/kg every 21 days) in the thoracic oncology departments of two university hospitals in the Rhone-Alpes Department were retrospectively reviewed.Twelve patients underwent this treatment. Their mean age was 56 years and their performance status was less or equal to 1 in 50 % of the cases. The chemotherapy was given as fifth line in 67 % of the patients and 67 % were antiangiogenic naïve. They received a mean of 6 courses. The overall response rate was 33 % and the disease control rate 66 %. Median progression-free survival was 5.1 months (95 %CI 1.0-9.1). Ten patients (82 %) experienced toxicity, the majority grade 1 to 2 events, and only one a grade 3 event (febrile neutropenia). There were no severe bleeding episodes.Combined paclitaxel-bevacizumab chemotherapy seems feasible in patients with NSCLC. The toxicity profile is acceptable. This regimen should be evaluated in further prospective studies.
- [Retrospective analysis of 50 thymic epithelial tumors in Rennes university hospital]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Sep; 31(7):591-600.
Thymic epithelial tumors (TET), including thymomas and thymic carcinomas, are rare and characterized by very different evolutionary patterns depending on histology and invasion stage. The therapeutic management is not well defined but is a subject of increasing interest. The descriptive and analytic objectives of this retrospective monocentric study were to analyze the clinical characteristics of patients with TET, and to assess the management of these tumors in our centre.Adult patients with TET managed in the Rennes university hospital in the period 2000-2011 were selected via the pathology department. Their clinical and pathological features and survival were analyzed retrospectively.Fifty TET were retrieved (46 thymomas and 4 thymic carcinomas). Their clinical and histological features and their invasion stages were concordant with published studies. Their diagnostic and therapeutic managements were also in accordance with current guidelines. In univariate analysis, myasthenia and surgery were associated with better survival rates.Management of TET in Rennes university hospital is in accordance with guidelines.