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Rev Mal Respir [journal]
- [Bronchiolo-alveolar carcinoma: An exceptional cause of diffuse lung disease in a patient with acute myeloid leukaemia]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Mar; 31(3):259-62.
Bronchiolo-alveolar carcinoma is a primary pulmonary adenocarcinoma developing in the terminal respiratory unit.An 84-year-old non-smoker woman with a history of untreated acute myeloid leukaemia was referred to the intensive care unit for pneumonia and acute respiratory failure. The patient reported dyspnoea and a productive cough for 3months, treated by antibiotics and steroids without improvement. Thoracic CT-scan showed alveolar condensations and multiple nodular lesions. All microbiological samples were negative and the evolution was fatal within 72hours despite empirical antibiotic therapy and noninvasive ventilation. Post-mortem lung biopsies gave a diagnosis of mucinous and non-mucinous bronchiolo-alveolar carcinoma with typical lepidic growth pattern of tumor cells and discrete septal thickening but no fibrosis, inflammation or local invasion.Bronchiolo-alveolar carcinoma is an alternative diagnosis in alveolar condensations associated with pulmonary nodules even in a patient with immunosupression. Early diagnosis allows effective treatment in some cases.
- [Severe hypercalcaemia revealing sarcoidosis precipitated by etanercept]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Mar; 31(3):255-8.
The principal secondary effects of anti-TNF alpha therapy are now well understood, particularly the risk of opportunistic infections. Other paradoxical effects have been described much more occasionally such as the developement of sarcoid-like granulomatous reactions.We report here the case of a woman of 39 years treated for severe rheumatoid arthritis for five years with etanercept. She was admitted to hospital as an emergency with vomiting and diffuse abdominal pain. Investigations revealed severe hypercalcaemia and acute renal failure. After correction of the metabolic disturbances with rehydration and biphosphonates, CT scanning of the abdomen, pelvis and thorax showed bilateral interstitial infiltration and splenomegaly. The diagnosis of sarcoidosis was confirmed by endoscopic bronchial biopsies. Progress was satisfactory following withdrawal of the etanercept and corticosteroid therapy in reducing dosage.The risk of induced sarcoidosis should be understood in patients receiving anti-TNF therapy and should be considered in cases of hypercalcaemia and/or splenomegaly.
- [Smoking behaviour among nursing students in Sousse, Tunisia: A preliminary study]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Mar; 31(3):248-54.
Smoking is an entirely preventable, man-made, epidemic. It is a major, worldwide, public health problem whose social costs are very high. Health care workers have an important role to play in tobacco control. We conducted a study among nursing students to examine their smoking behavior, their attitudes towards smoking, and their participation in prevention.This descriptive, transverse study was conducted in March 2011 during which an anonymous self-completion questionnaire was administered to nursing students.The study included 150 students aged between 18 and 25 years with a sex ratio of 1:3. The prevalence of smoking was 32.6%. Male students began smoking at an earlier age (16.5±2.3 years vs 18.9±1.1 years). The main initiating factors were stress (55%), pleasure (46.9%) and peer influence (36.5%). The Fagerstrom score showed a high level of dependency in 26.5% of smokers. More than 75% of student smokers have tried to quit. Most of the students surveyed (93%) think that health care workers should set a good example by not smoking and 91% of them think they should help others quit smoking.Health care workers should be well informed about the harmful effects of tobacco. They should be convinced of the need for their participation in smoking prevention and the fight against this medico-social scourge. It is essential that their training prepares them for this task and that their environment helps them fulfill their responsibility.
- [Perceptions of cystic fibrosis patients, patient relatives and physicians: Barriers or motivations to lung transplantation]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Mar; 31(3):237-47.
The aims of this study are to describe qualitatively the perceptions of three groups involved in the cystic fibrosis transplant decision, looking for similarities and differences between groups, and to identify those that act as motivations or barriers to transplantation.Thirty patients, 26 patient relatives and 27 physicians were interviewed, and concept maps were constructed from those interviews. Their degree of transplant acceptance at the time of the interview was measured.There were motivations and barriers in the pre-, peri- and post-transplant period. Analysis revealed similar perceptions regarding the risks and benefits of transplantation, but also different perceptions in the specific concerns of each group. Patients and patient relatives expressed many questions and fears in their concept maps, and physicians expressed difficulties.This study highlights the value of better understanding the perceptions of patients, relatives and physicians, in order to remove some of the barriers to transplantation. It also demonstrates the benefits of education and support activities for patients and patient relatives prior to transplantation, and continuing education and supervision for physicians.
- [Anxiety-depressive disorders and bronchiectasis]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Mar; 31(3):230-6.
Bronchiectasis is a chronic lung disease that may be associated with anxiety-depressive disorders affecting the quality of life of patients. Detecting these anxiety-depressive disorders may be necessary in the support and overall management of a patient with bronchiectasis.To evaluate the prevalence of anxiety and depression in patients with bronchiectasis and to investigate the possible correlation between the severity of the disease and the importance of these psychological disorders.This was a prospective study that included 53 patients with stable bronchiectasis and without other comorbidities. All the patients underwent a complete clinical examination, spirometry and chest computed tomography. All the 53 patients responded to the Hospital Anxiety and Depression Scale (HAD) questionnaire.Anxiety was present in 22.7% of patients and depression in 20.8%. Subjects who had an anxiety disorder had symptoms primarily of dyspnoea (P=0.001), a low FEV (P=0.04) and respiratory failure at a stage requiring home oxygen therapy (P=0.009). A similar comparison of patients with and without depressive disorder again found a high prevalence of dyspnea (P=0.003), a low FEV (P=0.04), and chronic respiratory failure in the depressive patients.Symptoms of depression and anxiety are common in patients with bronchiectasis and appear to be associated with dyspnoea. Early detection is necessary in the context of the overall management of these patients.
- [Contribution of identification of occupational exposure in thoracic oncology: A Belgian experience]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Mar; 31(3):221-9.
In Belgium in 2008, the body responsible for compensating and indemnifying victims of occupational diseases recognized 62 cases of lung cancer, although 702 cases were expected. There is an "underreporting" of occupational lung cancer. This study aimed to assess the number of cases of occupational lung cancer in a Belgian hospital specialized in oncology.From September 1st, 2009 to January 31st, 2011, each new patient with lung cancer has been directed to a consultation identifying occupational exposure to lung carcinogens.Among 81 occupational histories, 28 patients (35%) were found to have been definitely or probably exposed to one or more lung carcinogens (known or suspected). These patients were all male, mostly blue collar workers. Thirteen compensation claims for occupational disease have been introduced: nine recognized, one rejected and three pending.This study demonstrates the importance of a physician trained in occupational diseases within a thoracic oncology unit in reducing the "underreporting" of occupational lung cancer and thus providing the victims with the compensation to which they are legitimately due.
- [Treatment and prognosis of advanced stage non-small-cell lung cancer]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Mar; 31(3):214-20.
Lung cancer is the main cause of death from cancer in both men and women worldwide. In 70 to 80% of cases, the diagnosis is made at an advanced stage. Although the management of non-small-cell lung cancer (NSCLC) has continued to improve over the last 5years, the prognosis remains poor with a 5-year survival rate of about 16%. The aim of this study was to evaluate the management of locally advanced or metastatic NSCLC in our patients and to analyze overall survival (OS) and prognostic factors at these stages.A retrospective study, including cases of locally advanced and metastatic NSCLC diagnosed in our department between 2008 and 2011.We included 150 patients with a mean age of 60.2years. The cancer was at stage IIIA in 21% of cases, IIIB in 14% of cases and IV in 65% of cases. Thoracic surgery was performed in 5 patients; 61.4% of patients received chemotherapy and chemo-radiotherapy was given in 21% of patients. Overall survival was 6months. Better survival was observed in patients aged less than 60years, having better performance status (PS), having no metastatic mediastinal lymph nodes and patients who received specific anti-tumor treatment.The prognostic factors in locally advanced and metastatic NSCLC in our patients were: age, PS, status of mediastinal lymph nodes at diagnosis and treatment. These factors should be considered by physicians when treating patients with advanced stage NSCLC.
- [An analysis of delays in the management of thoracic cancers: A prospective study]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Mar; 31(3):208-13.
Lung cancer is the main cause of cancer death in France. The diagnosis is often late and the delay between the onset of symptoms and management is considered an aggravating factor.Our prospective study collected the dates of the start of management of 139 consecutive patients receiving first line treatment for thoracic cancer in our hospital between November 2008 and May 2009. The aim of this study was to evaluate the delays in medical or surgical treatments in patients with thoracic cancer and to determine the cause of these delays.The median delay between the first abnormal chest X-ray and treatment was 9.6 weeks. The delays were significantly shorter in the late stages and in small cell cancer (P=0.001). There was a tendency for shorter delays in women and for longer delays in older patients.Evaluation of the delays in treatment, particularly in the early stages, is part of the quality control of management of these diseases.
- [Tobacco in words: A semantic and historical journey within total in-dependence]. [Editorial]
- Rev Mal Respir 2014 Mar; 31(3):203-7.