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Rev Mal Respir [journal]
- [Individual lung cancer screening in practice. Perspectives on the propositions from the multidisciplinary group of the Intergroupe francophone de cancérologie thoracique, the Société d'imagerie thoracique and the Groupe d'oncologie de langue française]. [Journal Article]
- Rev Mal Respir 2014 Jan; 31(1):91-103.
- [Regarding a case of rifampicin-induced pruritus and thrombocytopenia]. [Letter]
- Rev Mal Respir 2014 Jan; 31(1):84.
- [Hydatic pulmonary embolism: A very rare complication of renal hydatid cyst]. [Letter]
- Rev Mal Respir 2014 Jan; 31(1):82-3.
- [Telemedicine and lung transplanted patients: A feasibility study]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Jan; 31(1):78-81.
Lung transplant patients are characterized by a high use of healthcare resources and an elevated rate of hospitalization. In lung transplant recipients, spirometry home monitoring has been advocated for the early detection of acute infection and rejection of the allograft. We will test a new system that allows regular monitoring of the patient's pulmonary status at home after discharge from hospital.This study will be prospective and in addition to usual healthcare. The main aim of this feasibility study will be to evaluate the compliance of patients in performing three spirometric measurements per week. Patients will have received a lung transplant more than three months prior to entering the study. The home equipment will comprise a data transmitting box (Twitoo(®)) and a spirometer. A decrease of 10% from baseline in one or more parameters will generate an alarm, which will lead to the transplant physician calling the patient and possibly inviting him to the hospital.The feasibility will be considered as acceptable for an average compliance of 70%. The coefficient of variation and the number of spiro-measurements will be adjusted according to the results obtained.
- [Organizing pneumonia during treatment with mesalazine]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Jan; 31(1):70-7.
The distinction between extra-intestinal manifestations of ulcerative colitis (UC) and drug-induced pneumonia can often be difficult.We describe the case of a 72-year-old male who presented fever and sub-acute respiratory insufficiency, after 4 months of treatment with mesalazine for ulcerative colitis (UC). Initial tests found serum C-reactive protein, eosinophil count and total IgE to be elevated. Routine bacteriological, fungal and mycobacterial cultures were negative. Bronchoalveolar lavage fluid cellularity was normal with elevated lymphocyte, neutrophil, and eosinophil counts (35 % mononuclear cells, 23 % lymphocytes, 28 % neutrophils, 14 % eosinophils). The diagnosis of organizing pneumonia (OP) with eosinophilic pneumonia component was confirmed after examination of a lung biopsy specimen. Clinical improvement occurred after cessation of mesalazine and initiation of prednisolone (1mg/kg/day). Nine months later, a recurrence of gastrointestinal symptoms required a 5months reintroduction of an amino salicylate by topical therapy (4- acide aminosalicylique [ASA enemas]). There was no resurgence of the pneumonia.Organizing pneumonia is a rare extra-intestinal manifestation of UC. There was no resurgence of OP after amino salicylate enemas rechallenge but mesalazine-induced pneumonia cannot be excluded.
- [Pulmonary nodules and arachnophobia]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Jan; 31(1):66-9.
Pulmonary nodules are a common reason for consultation and their investigation must always exclude a possible neoplastic cause. This means that, in addition to a thorough history, investigations may be necessary which are sometimes invasive and therefore potentially a cause of iatrogenic harm. The toxic aetiologies for pulmonary nodules are rare. We report a case of a patient with pulmonary nodules occurring predominantly in the right lung, about 1cm in diameter, non-cavitating without calcification, and sometimes surrounded by a peripheral halo. The nodules were a chance finding during preoperative evaluation. After a comprehensive review, a reaction to an inhaled irritant was the preferred hypothesis, specifically overuse of a compound insecticide containing, in addition to the propellant gas and solvent type hydrocarbon - a mixture of piperonyl butoxide, of esbiothrine and permethrin. Removal of this led to the complete disappearance of nodules. Pathological examination identified bronchiolitis obliterans with organising pneumonia accompanied by non-necrotizing granulomas and lipid vacuoles.
- [Pseudotumoral pulmonary AL amyloidosis]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Jan; 31(1):61-5.
Thoracic involvement in amyloidosis is rare. An isolated pseudotumor without extra-thoracic disease suggests a malignant process. We present the case of a patient with pseudonodular AL amyloidosis, confirmed by lobar lung resection.A 57-year-old woman, with a 25-pack-year smoking history, presented with a nodular opacity on chest x-ray. Physical examination was normal. Thoracic CT-scan revealed an isolated spiculated nodule in the right upper lobe. A whole body positron emission tomography (PET) scan revealed high FDG activity in this nodule, without evidence of metastatic disease. Bronchoscopy was negative. Lobectomy revealed lambda L-chain amyloidosis. Investigation for systemic extension was negative. Follow up has been unremarkable.A spiculated lung nodule on conventional imaging (radiography, scanner) is cancer until proven otherwise. The use of PET scan in this context is sensitive but not specific. Definitive diagnosis must be obtained by histological examination. Nodular lung amyloidosis must be included in the differential diagnosis of lung nodules and false-positive FDG PET.
- [Chamberlain biopsy is not necessary when mature teratoma is evident on imagery]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Jan; 31(1):57-60.
Mature teratoma represents 60 % of germinal cells tumours of the mediastinum. Most patients with these tumours are asymptomatic, so the neoplasms are usually discovered by accident during routine chest X-ray examination. They have specific and almost pathognomonic radiological features. However, patients can be symptomatic and may present with chest, back, or shoulder pain; dyspnoea; fever; pleural effusion; cough; and bulging of the chest wall.We report the case of a young woman presenting with a giant mediastinal mature teratoma compressing the left lung. The patient was admitted for dyspnoea and non productive cough. The chest X-ray showed a mediastinal mass and a chest computed tomography scan revealed a heterogeneous pluritissular mass lesion of the mediastinum. Complete surgical removal is the treatment of choice for mature cystic teratomas, with optimal results and an acceptable surgical risk. This approach allows confirmation of the diagnosis and is the only way to rule out the presence of malignancy. Surgical biopsy by the Chamberlain method is therefore not strictly necessary.When chest X-ray and a computed tomography scan show specific radiological features of teratoma, a complete resection should be undertaken if the patient is fit for surgery. This will confirm the anatomico-pathological diagnosis, exclude the presence of malignant cells and it represents the treatment of choice of mature teratomas.
- [Use of sedation in the palliative care situation by respiratory physicians]. [English Abstract, Journal Article]
- Rev Mal Respir 2014 Jan; 31(1):48-56.
The prognosis of advanced stage chronic lung disease, including lung cancer, is often poor and associated with uncomfortable symptoms for the patient, especially in the end of life phase. In the case of intolerable symptoms, refractory to maximal treatment, sedation may then be considered. This is sometimes a source of confusion and difficulty for clinicians who need to know the official guidelines. The purpose of this study was to investigate the use of sedation by respiratory physicians, in order to understand their difficulties in these complex situations.The study was conducted using semi-structured, anonymous interviews of volunteers. The topics discussed included their definition of sedation, its indications, their possible difficulties or reluctance in using it, the information given to the patient and the traceability of the sedation prescription.All respiratory physicians agreed to participate in the study, indicating a major interest in this topic. No sedation decision is taken without careful consideration. The majority of physicians understand the difference between anxiolysis and sedation, most defining the latter as using a drug to sedate a patient faced with uncontrollable symptoms. All doctors refused to link sedation to euthanasia, although half expressed a feeling of causality between sedation and the patient's death - knowing that few consider the possibility of transient sedation. The main reluctance among doctors is in chronic respiratory insufficiency. Any decision concerning sedation should be discussed beforehand with the care team and the resident in charge of the patient, but not necessarily with another colleague. There is rarely evidence of this discussion in the medical records or of the information given to the patient and his family, thus increasing the difficulties of decision-making, especially at nights or weekends. The decision to start sedation is seen as difficult because it presupposes that a life-threatening short-term prognosis has been already been given to the patient.In this medical population, already aware of palliative care issues, the majority of respiratory physicians know the definition, the indications for sedation and the principles of collective decision, but few are aware of the need of regular reappraisal of the sedation, to record it, and of its potential reversibility. There is, therefore, a clear need for regular and further training of clinicians to improve their professional practice.