Revue des maladies respiratoires
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Pulmonary fibrosis is a frequent and serious complication of scleroderma whose pathophysiology remains poorly understood. The alveolar structures are infiltrated by activated chronic inflammatory cells, alveolar macrophages and polymorphonuclear neutrophils in particular and these could play a determining role. We have studied the state of activation of alveolar macrophages and monocytes circulating in these patients who presented with scleroderma and interstitial pulmonary involvement and also in healthy subjects. ⋯ The neutrophil alveolitis is accompanied by a breakdown in the equilibrium of elastase-antielastase which could participate in the development of alveolar lesions leading to fibrosis. In addition to the activation of macrophages, there is an activation of monocytes marked by the increase in secretion of interleukin-6 and interleukin-8 in vitro during the progression of the disease of scleroderma. Thus, alveolar inflammation is integrated with the overall systemic inflammation whose causes remain unknown.
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Primary pulmonary arterial hypertension (PPH) is a rare disorder with a predilection for young subjects (most commonly of 20-40 years) and of the female sex. The prognosis is very poor because the average life expectancy is of the order of two to three years from the time of diagnosis. ⋯ A very recent case-control study has shown that any use of anorexic drugs (mainly fenfluramine derivatives) was associated with an increased risk of PPH (odds ratio: 6/1), and particularly when the duration of treatment exceeds 3 months. Outside the group of appetite suppressants few medications are capable of favouring the development of PPH, the cases are sporadic and the relationship between cause and effect is hardly established.
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Respiratory mechanics abnormalities in patients with chronic obstructive pulmonary disease (COPD) in acute respiratory failure (ARF) consist of the followings : 1) expiratory flow limitation, 2) marked increase in airway resistance, 3) dynamic hyperinflation. As a results, both resistive and elastic loads to the respiratory muscles are increased. These abnormalities, which are already present in stable COPD patients, are considerably more marked in ARF. ⋯ Shortening the inspiratory time could result not only to reduce the hyperinflation but also to increase expiratory flow through the increased dynamic pulmonary elastance. The inspiratory work was twice higher in COPD than in normals because of the PEEPi and the resistive components. Due to their flow and volume dependence, the results of resistances and elastances should be standardized.
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The main primary pollutants released into the atmosphere are sulfur dioxide (SO2), nitrogen monoxide and dioxide (NOx), particulate dust and in a less important part carbon monoxide (CO), hydrocarbons and heavy metals (Pb, Cd). Sulfur and nitrogen oxides are released from combustion of coals and fuels. Sulfates, nitrates and ozone are secondary pollutants resulting from chemical reactions within the atmosphere. ⋯ Since most of these studies do not include bacteriologic and virologic confirmation, it is unclear whether this respiratory morbidity is due to respiratory irritation or infection. In conclusion, we think that high concentrations of air pollutants are very likely to increase sensibility to respiratory infections in humans. There are however no sufficient data to clearly establish whether air pollution constitutes a risk factor for respiratory infections at usual ambient concentrations.
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Review Randomized Controlled Trial Clinical Trial
[Non-invasive ventilation in acute respiratory insufficiency in chronic obstructive bronchopneumopathy].
At the time of acute exacerbations of chronic airflow obstruction (BPCO) non-invasive ventilation represents an alternative to endotracheal intubation. In patients with respiratory distress, the use of a face mask is often preferable to a nasal mask alone, by avoiding the escape of oxygen which occurs around the mouth in nasal ventilation. ⋯ The consequences were a significant reduction of the complications of acute respiratory failure which were linked to artificial ventilation (p < 0.05) with a reduction of the hospital stay (p < 0.05) and finally a significant reduction in mortality (29 per cent - 9 per cent, p < 0.005). From now on, this technique could be used in many centres as the first treatment in acute exacerbations of BPCO patients to avoid the use of endotracheal intubation.