A number of studies in western countries have shown that respiratory and physical rehabilitation of patients with chronic obstructive pulmonary disease (COPD) only has a minimal effect on respiratory function but can significantly improve physical capacity. The aim of our study was to apply these methods to patients in Kinshasa, Democratic Republic of Congo. We treated 38 patients (20 women) who had bronchial asthma (n = 14) or COPD (n = 24). These ambulatory patients were treated in two different hospitals in Kinshasa, the university hospital and the general hospital, three times per week for twelve weeks. The patients were treated with kinestherapy and inhaled bronchodilator drugs (salbutamol, and/or ipratropium bromide with a boreal nebulizer) as well as bronchial hygiene and performed breathing exercises on a Bodyguard Ergometer 990 with walking, running and climbing steps until exhaustion. After the rehabilitation program FEV1 increased from 1.37 ± 0.62 (50% expected) to 1.54 ± 0.69 (56% expected) (p < 0.01). The same trend was observed for walking distance (from 644 ± 459 m to 1213 ± 569 m, p < 0.001) and for maximal power developed on the cycloergometer (from 45 ± 20 w to 73 ± 37 w, p < 0.001). In contrast, the maximal work load performed during climbing steps (from 106 ± 44 w to 115 ± 23 w) did not improve significantly. COPD patients improved their FEV1 significantly compared with asthma patients. Our study show that pulmonary rehabilitation increase the level of spontaneous physical activity. The pulmonary rehabilitation program changes the quality of life of COPD patients who are able to move about better for longer periods of time, have a longer walking distance, and improved physical activity level.
The authors report 4 cases of round atelectasis seen over a period of 3 years. They review the very limited literature on this subject. In the light of their experience and according to the work of Hanke, they believe this to be a fairly common disease. This condition was first described during collapsotherapy, but now, it is essentially seen following pleurisy. For Hanke, round atelectasis may occur in almost one quarter of cases of pleural effusion. The authors also believe that this condition is common and that it is usually confused with or grouped together with "pleural sequelae". However, their original mechanism of formation, the reversible parenchymal involvement, and not pleural, and their radiological appearance clearly distinguish them. Round atelectasis is an interesting topic of discussion in terms of diagnosis, in the broad framework of round intrathoracic opacities (especially when the initial pleural episode has not been recognized) and also in terms of treatment, which consists of decortication when they are large.
Mycosis fungoides is today classified amongst the cutaneous T lymphomas. The course of the disease is slow, first strictly dermatological, then with polyvisceral spread most often presenting as lymphadenopathy. Pulmonary involvement, with a poor prognosis, is often recognised only at autopsy. The differential diagnosis between pulmonary involvement by the disease and isolated or associated opportunistic infectious pathology is virtually impossible during the patient's lifetime except by surgical lung biopsy. The case reported here illustrates these data and has the particular feature of the onset of pulmonary involvement during cutaneous remission of the disease, contrasting with the visceral spread found at autopsy.
The hyper IgE syndrome develops in childhood and leads to repeated infectious episodes, usually of staphylococcus aureus origin and affecting mainly the skin and pulmonary parenchyma. It may be associated with a predominantly facial atypical dermatitis and more rarely with allergic manifestations. Biological tests show mainly an eosinophilia and a hypergammaglobulinemia E alone without modifications in other immunoglobulin types. Disorders of neutrophil and monocyte chemotaxis are inconstant findings. The initial mechanism of the affection appears related to a deficit in suppressive T function selectively acting on the IgE isotype.
After seeing 9 cases of digitalis intoxication in patients with acute respiratory decompensation of chronic respiratory failure in one year in an intensive care unit, the authors decided to review the literature on the subject. They set out to: --determine the clinical, laboratory and electrical features of digitalis intoxication in patients with chronic respiratory failure, accounting for the frequency of supraventricular arrhythmias; --evaluate the frequency of this intoxication (20% in this study), introducing a definite risk factor, given the poor haemodynamic effectiveness of digitaloids in this indication; --establish a therapeutic management based on the use of anti-arrhythmics and especially on the prevention of predisposing factors (hypoxaemia--functional renal failure and abuse of diuretics).
Pneumatocele, a special form of lung injury, is characterized by intrathoracic images of cavities detected on X-ray films. These cavities develop immediately after a trauma of the thorax, disappear rapidly and have a relatively favourable outcome.
The authors report a case of acquired tracheomalacia occurring in an adult with a definitive tracheostomy. They make a review of the clinical, radiological and bronchological features of tracheomalacia. They insist on the pathophysiology and report the first case successfully treated with spontaneous ventilation and end expiratory positive pressure.
Pathologic findings in two patients with no previous history of atopic affections were apical pulmonary infiltration, a marked general syndrome with altered general state and hyperthermia, a productive cough, and a circulating eosinophilia. Clinical manifestations and the particular radiographic images of homogeneous condensation of the two apices in the form of "helmet crests", together with the typical course during corticoid treatment and histopathologic findings in one case, established a diagnosis of chronic eosinophil pneumonia. The principal characteristics of this affection, as exemplified by these two cases, are analyzed.
Five cases of eosinophil lung are reported in which the fungus responsible for the affection was not Aspergillus. Documented data include reports on 19 similar cases with a clinical picture suggestive of allergic bronchopulmonary aspergillosis but with negative tests for Aspergillus. The various fungal species isolated included Candida albicans, Penicillium, Geotrichum candidum, Stemphylium lanuginosum, Culvularia lunata, and Drechsleria hawaïensis. Diagnostic criteria are discussed, with particular emphasis on the importance of the inhalation provocation test, as well as possible efficacy of antifungal treatment.
Larva migrans syndromes are rare affections that occur mainly in young children. The usual parasite involved is Toxocara canis, its presence in humans leading to encystment of the larvae and an eosinophilic granulomatous reaction. A case of an adult with this affection is reported, and clinical aspects and diagnostic and therapeutic problems discussed.
Two cases of nitrofurantoin induced acute pneumopathy are reported. The characteristics of the pulmonary reactions to this drug are described, and currently accepted pathogenic mechanisms, and diagnostic and therapeutic means discussed.
Whereas pulmonary fibrosis is a very frequent manifestation of scleroderma, pulmonary hypertension of the precapillary type is a much rarer occurrence in this affection. Two cases of scleroderma with subsequent development of a pulmonary hypertension are reported. Various hypotheses have been advanced to explain the origin of this disorder during the course of scleroderma. Rather than a direct consequence of the sclerodermic pulmonary fibrosis it probably arises secondary to the specific, diffuse, primary pulmonary vascular lesions.
Epithelial or mixed mesotheliomas were detected in 38 patients in the region of Marseilles over a period of 9 years. Though an occupational element was involved in 80% of cases, no history of contact with asbestos could be obtained in certain of the patients. Confirmation of diagnosis requires wide pleural biopsies, because of the high level of false negatives and false positives from cytology and pleural needle biopsy. Hyaluronic acid levels are significant only when they are markedly enhanced. Local and regional tumor spread provides an aid to prognosis, but authentic metastases, with further worsening of prognosis, were detected in more than 75% of patients while still alive. Nodules appeared along the course of punctures of drainage tubes or in thoracotomy scars in 56% of cases, and appear to be a very frequent and characteristic feature of mesothelioma. Their therapy involves preventive irradiation.
Re-expansion pulmonary edema (RPE) due to pneumothorax aspiration can lead to a fatal outcome, as in the case reported, the chronic nutritional deficiency and hypoproteinemia that it provokes probably playing a contributing role. Pathogenesis and factors affecting prognosis of RPE are discussed. These include the duration of the pulmonary collapse, though this is not an essential factor, the alterations in alveolar surfactant activity possibly related to the chronicity of the collapse, and the abruptness of aspiration which is, in contrast, a determining mechanical factor. Finally, the hypoproteinemia present in certain cases could facilitate fluid extravasation towards the alveolus. It is concluded that aspiration should be a gentle procedure in all cases, and should be conducted with extreme caution in the presence of hypoproteinemia.
