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La chimio-radiothérapie néoadjuvante dans le cancer bronchique de stade III

February 2013
Publication year: 2013
Source:Revue des Maladies Respiratoires, Volume 30, Issue 2



La chirurgie est souvent indiquée pour les patients N2 pouvant être opérés par lobectomie depuis les deux essais EORTC 08941et RTOG 9309, ce dernier ayant montré une mortalité importante après pneumonectomie. Si l’utilité de la chimiothérapie adjuvante est démontrée et celle de la radiothérapie adjuvante moderne suspectée, une chimiothérapie néoadjuvante est souvent pratiquée en France. La chimio-radiothérapie néoadjuvante est plébiscitée aux États-Unis et en Europe du Nord. Quelques études randomisées la comparant à la chimiothérapie néoadjuvante n’ont pas montré d’avantage probant en raison d’une surmortalité postopératoire, mais les séries rétrospectives dans des centres spécialisés ont montré à l’inverse des risques opératoires très réduits, même après irradiation à 60 Gy ou après pneumonectomie. Dans les envahissements de l’apex, la chimio-radiothérapie suivie de chirurgie est souvent proposée. Enfin, une chirurgie d’exérèse doit être discutée à distance d’une chimio-radiothérapie exclusive en cas de rechute locale isolée. Surgery is often performed when N2 non-small-cell lung cancer can be resected by lobectomy since the publication of the “EORTC 08941” and “RTOG 9309” trials (the latter showed high mortality rate after pneumonectomy). The usefulness of adjuvant chemotherapy has been proved, and that of modern adjuvant radiotherapy is suspected, but neoadjuvant chemotherapy is also routinely performed in France. Neoadjuvant chemo-radiotherapy is more accepted in the USA and northern Europe. Four randomized trials have not shown any advantage in comparison with neoadjuvant chemotherapy, due to increased postoperative mortality, but retrospective studies in specialized centers have demonstrated low operative risks, even after high-dose radiation, or pneumonectomy. In the case of invasive apical tumors, neoadjuvant chemo-radiotherapy is recommended. In case of local recurrence without distant recurrence after exclusive chemo-radiotherapy, curative surgery may be envisaged.




Immunothérapie allergénique dans le traitement de l’allergie aux pollens

February 2013
Publication year: 2013
Source:Revue des Maladies Respiratoires, Volume 30, Issue 2



Depuis sa description en 1911 par Noon, la désensibilisation ou immunothérapie allergénique (ITA) a été très largement utilisée, par voie sous-cutanée, dans le traitement des maladies allergiques. Elle reste le seul traitement à visée étiologique en allergologie. Le développement de la voie sublinguale, alternative à la voie injectable et de nouvelles formes galéniques ont donné lieu à des études cliniques à grande échelle, en particulier dans le domaine de l’allergie pollinique. Celles-ci permettent de confirmer l’efficacité de l’ITA sur les symptômes de l’allergie respiratoire. Il existe également des données démontrant un impact de ce traitement à long terme avec un effet rémanent après l’arrêt de l’immunothérapie. Certaines données sont en faveur du rôle de l’ITA sur l’histoire naturelle de la maladie allergique, en particulier sur la diminution du risque d’asthme chez les sujets rhinitiques désensibilisés et sur l’acquisition de nouvelles sensibilisations. Les mécanismes d’action sont de mieux en mieux connus, permettant d’envisager d’améliorer encore cette technique dans le futur. La voie sublinguale améliore le rapport bénéfice/risque de la désensibilisation en diminuant le risque d’effets indésirables graves. Ces données permettent de penser que les indications de l’ITA pourraient être élargies à un plus grand nombre de patients atteints de pathologies respiratoires allergiques. Since its description by Noon in 1911, desensitization or allergen-specific immunotherapy (SIT) has been largely given by sub cutaneous injection in the treatment of allergic diseases. It remains the only treatment for allergic diseases aimed at the etiology. The development of sublingual route as an alternative to sub cutaneous injection, and of new forms of medication, has led to large-scale clinical trials, many of them performed with allergen tablets, particularly in the field of pollen allergy. These studies have confirmed that SIT is efficient in reducing allergic respiratory symptoms. Data on long term benefits and sustained efficacy after stopping treatment have also been published. These show an impact on the natural history of allergic disease and, in particular, a reduction in the risk of asthma in desensitized rhinitic subjects and in the acquisition of new sensitivities. The basic mechanisms of immunotherapy are becoming better understood and allow us to envisage improvements in this technique in the future. The sublingual route improves the risk/benefit ratio of desensitization and reduces the risk of serious side effects. These data suggest that the indications for SIT may be extended in a large number of patients with allergic respiratory diseases.




Immunopathology of exercise-induced bronchoconstriction in athletes - a new modified inflammatory hypothesis.

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Immunopathology of exercise-induced bronchoconstriction in athletes - a new modified inflammatory hypothesis.

Respir Physiol Neurobiol. 2013 Mar 5;

Authors: Kuchar E, Miskiewicz K, Nitsch-Osuch A, Kurpas D, Han S, Szenborn L

Abstract
Elite athletes have a higher prevalence of exercise-induced bronchoconstriction than the general population. The pathogenesis of exercise-induced bronchoconstriction is not fully elucidated. Increasing evidence suggests that airway inflammation plays a major role in the immunopathogenesis of exercise-induced bronchoconstriction. The aim of our review is to discuss existing evidence and to present a new, modified inflammatory hypothesis of exercise-induced bronchoconstriction. Exercise alters the number and function of circulating immune cells. Episodes of upper respiratory symptoms in elite athletes do not follow the usual seasonal patterns. Moreover, they have an unusual short-term duration, which suggests a non-infectious etiology. If the pro-inflammatory response to exercise has the potential to induce symptoms that mimic respiratory tract infection, it definitely up-regulates pro-inflammatory cytokine expression in the airways. We can conclude that exercise up-regulates airway cytokine expression in a way that favors inflammation and allergic reactions in bronchi and lowers the threshold for bronchoconstriction to different stimuli like cool, dry air, allergens, and pollutants.

PMID: 23473923 [PubMed - as supplied by publisher]

Diagnosis and Management of Pulmonary Arterial Hypertension using MR Imaging.

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Diagnosis and Management of Pulmonary Arterial Hypertension using MR Imaging.

Magn Reson Med Sci. 2013 Mar 11;

Authors: Iwasawa T

Abstract
Pulmonary arterial hypertension (PAH) is a syndrome that results from restricted blood flow through the pulmonary arterial circulation, which leads to a pathological increase in pulmonary vascular resistance (PVR) and ultimately to right heart failure. The prognosis of patients with PAH has improved with the recent development of new medications. The need for new noninvasive diagnostic tools is increasing. Magnetic resonance (MR) imaging is the gold standard for assessing the right ventricle (RV). Its high degree of reproducibility makes it ideal for monitoring changes in RV parameters in response to therapy. MR imaging can also provide both anatomical and functional information about pulmonary hemodynamics. This article reviews the current status of MR imaging of the right side of the heart and pulmonary circulation in patients with PAH and other associated pulmonary diseases.

PMID: 23474963 [PubMed - as supplied by publisher]

Smoking-related interstitial fibrosis (SRIF) and pulmonary hypertension.

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Smoking-related interstitial fibrosis (SRIF) and pulmonary hypertension.

BMJ Case Rep. 2013;2013

Authors: El-Kersh K, Perez RL, Smith JS, Fraig M

Abstract
Smoking-related interstitial fibrosis (SRIF) is a relatively new term used to describe chronic interstitial fibrosis that can develop in smokers. The association of SRIF with pulmonary hypertension has not been described. We present a 55-year-old man with an extensive smoking history who presented for evaluation of insidious onset of dyspnoea on exertion and hypoxaemic respiratory failure. Physical examination was unremarkable. Pulmonary function testing demonstrated a marked reduction of the diffusion capacity with no obstruction or restriction. Ventilation perfusion scan showed no evidence of thromboembolic disease. High-resolution chest CT revealed minimal biapical pleural parenchymal scarring and subtle dependent atelectasis. Serological markers for connective tissue diseases were negative. Open lung biopsy was consistent with SRIF. Vascular intimal proliferation consistent with pulmonary hypertension was also noted. Right heart catheterisation yielded mild pulmonary hypertension and treatment was initiated with tadalafil and bosentan.

PMID: 23483063 [PubMed - in process]

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