[Mycobacterial pulmonary infection due to Mycobacterium simiae]

INTRODUCTION

Mycobacterium simiae pulmonary infections remain exceptional in France.

CASE REPORT

We report a case of M. simiae lung infection and a 10-year follow-up in a non-immunocompromised host.

CONCLUSION

This case emphasizes the difficulties of choosing the appropriate drugs and their side effects in the absence of any existing gold standard.

[Bifocal lung cancer: the same histology?]

Whereas synchronous lung cancer is rare, synchronous small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are exceptional. The authors report the case of a 61-year-old man with synchronous unilateral adenocarcinoma and small cell lung cancer, raising the question as to the need for the histology of all of the lesions in the same lobe or same lung as well as the treatment. The medical history, biology, CT and (18)F-FDG TEP-CT did not support a diagnosis of synchronous lung cancer. The prognosis was poor and only surgery could improve the prognosis. This is a rare case and illustrates the difficulty in the diagnosis of multiple lung cancer and the difficulty in treating synchronous lung cancer with different histologies (SCLC and NSCLC).

[Role of chest physician in the management of patient with thoracic trauma]

Thoracic traumas are frequent and potentially fatal, because of the associated neurological and abdominal lesions. They are observed in car crashes, combat environments and urban terrorist bombings. The mechanisms of the traumatic injury are complex and account for the diversity of the lesions. The management of a chest trauma patient is a model of multidisciplinary collaboration where the chest physician can make a significant contribution.

[What is the role of FDG-PET in thoracic oncology in 2010?]

18F-Fluorodeoxyglucose-Positron Emission Tomography (FGD-PET) has been considered to have a major impact on the management of lung malignancies since the beginning of this century. Its value has been demonstrated by many publications, meta-analysis and European/American/Japanese recommendations. PET combined with computed tomography has provided useful information regarding the diagnosis and staging of lung cancer and allows for the delivery of adaptive radiotherapy. In its more common uses, PET has been shown to be cost-effective. With the widespread use of new radiotracers, PET will play an increasing role in the evaluation of response to treatment.

[Dyspnea in lung cancer]

Dyspnea is a subjective symptom defined as an experience of uncomfortable and difficult breathing which strongly affects the quality of life. It is the most common symptom in lung cancer but its physiopathology remains unclear. Dyspnea is due to cancer itself, specific therapies or comorbidities. To evaluate intensity of dyspnea, analogue visual and verbal rating scales need to be preferred. Diagnosis of underlying cause, based on rational and non invasive strategy is needed to perform effective treatment if possible. Despite its frequency, few therapies are really effective, except nonpharmacologic measures: only morphine can be actually recommend, especially with naive patients. In palliative cases, if dyspnea is uncontrolled, benzodiazepine can be used and may represent ethic approach.

[A case of atypical pericarditis]

INTRODUCTION

An acute viral pericarditis may reveal a congenital pericardial abnormality.

CASE HISTORY

We report the case of a young man of 29 years in whom the development of rapidly progressive dyspnoea and fever led to the echocardiographic diagnosis of a pericardial tumour. The thoracic CT scan showed a mass arising in the superior mediastinum with no evidence of spread. Surgical exploration allowed the excision of a soft mutilobular mass adherent only to the aorta. Histological examination revealed an intrapericardial bronchogenic cyst.

CONCLUSION

After a review of bronchogenic cysts we point out the properties of this rare intra-pericardial localisation, one of which is the frequently observed secretion of CA 19-9.

[Positron emission tomography in the diagnosis and follow up of non-small cell lung cancer]

In the space of a few years 18F-FDG PET scanning has acquired a place in the management of all stages of the clinical care of patients with lung cancer. Its contributions are being more and more precisely understood during the assessment of mediastinal and metastatic extension and it carries the hope of better therapeutic management and surveillance.

La tomographie par émission de positons au 18fluorodésoxyglucose (18FDG-TEP) dans la prise en charge du cancer bronchique non à petites cellules en 2006

Technological progress and numerous published studies allow to estimate the best place of the 18F-fluorodeoxyglucose positron emission tomography, a real functional metabolic imagery, in the clinical and therapeutic strategy of non small cell lung cancers.

[The risk of thromboembolism in airline passengers]

Long carrier flights favor thromboembolism. The risk is well known to the general public but is probably really very low. The risk is however pertinent due to the volume of air travel in the world. Sitting in the same position for a long time induced venous stasis which is the principal factor favoring thrombosis in travelers, irrespective of the means of transportation. Long carrier flights also expose passengers to specific factors related to air travel: coagulation disorders and alterations of the endothelium related to hypobarism, hypoxia and low hygrometry in the cabin. Presence of pathogenic thrombophilia is not a constant factor. The prevention of venous thrombosis in air travelers calls upon simple measures: abundant hydration, avoiding use of alcohol and tobacco, walking and dorsal flexion of the feet. The only preventive option with proven efficacy is the use of elastic contention which reduces the risk of thromboembolic events. There is no consensus concerning the use of drugs proposed by certain authors; prudence should be the rule. All passengers should become aware of the risk of thromboembolism related to sitting in the same position for a long time.

[Parasitic eosinophilic lungs]

The eosinophilic lung is a term used to identify a heterogeneous group of parasitic diseases leading to common manifestations including alveolar or tissular pulmonary eosinophilia and, classically, radiological visible lesions of the lung. The different clinical presentations--Löffler's syndrome, larva migrans syndrome and tropical pulmonary eosinophilia are analyzed in this article and the particular features of the different causal parasites are discussed. Positive and differential diagnostic procedures in patients with pulmonary eosinophilia due to mycoses, drugs, vasculitis or an unknown cause are detailed.

[Travel and patients with allergies]

By changing their surroundings and lifestyle, travelers with allergic conditions exposed themselves to new risks. The main perennial allergens are house dust mites which thrive in tropical areas and can be especially sensitizing. The risk of seasonal reactions to grass-pollens varies from region to region. Reactions to some highly sensitizing respiratory allergens can occur in travelers who return to regions where they were previously exposed. Subjects with food allergies should beware of possible reactions to ingredients in exotic dishes. The bites of several insects can cause anaphylactic reactions. Some medications required for tropical travel (e.g. antimalarial drugs) can trigger severe hypersensitivity reactions. Avoidance of allergens is more difficult during travel. Travelers with allergic conditions should carry alert identification cards and medications for routine as well as emergency treatment including self-injectable adrenaline.

[Travel and chronic respiratory insufficiency]

Changes in climate, altitude and lifestyle during travel confronts patients presenting chronic respiratory insufficiency with special problems. A major challenge is related to high altitude during air travel. To limit risks, a preflight examination is necessary to ascertain respiratory status. Patients requiring oxygen therapy must ensure availability both during the flight and at the destination. Patients with asthma or chronic bronchitis must bring along a sufficient supply of usual inhalers. All patients should carry a doctor's letter describing their condition and listing medications. Using these elementary precautions, patients with chronic respiratory insufficiency can safely enjoy sightseeing and outdoor leisure activities.

[Clinical aspects and diagnosis of sulfite intolerance. Apropos of 9 patients]

We performed an oral tolerance test for potassium metabisulfite in 33 patients and discovered sulfite intolerance in 9. These 9 patients had rhinitis including 7 with asthma. Alcoholic beverages, especially champagne, were the triggering factors the most frequently found for respiratory manifestations. Alcoholic beverages triggered bronchial or nasal reactions in 7 patients out of 9 (rhinitis in 7, asthma in 2). As in a large number of published cases, sulfite intolerance was evidenced by respiratory manifestations in our patients. Exceptional anaphylactic reactions have also been reported. Respiratory intolerance to sulfites in uncommon. A nasal or bronchial reaction occurring within minutes following ingestion of alcoholic beverages is highly suggestive of sulfite intolerance as is the development of acute asthma after administration of sulfite-containing drugs. Diagnosis is confirmed by oral tolerance tests versus placebo. The only effective preventive measure is to eliminate food and drugs containing sulfites. Such measures are justified to prevent acute episodes of asthma.

[Therapeutic strategy in anaphylactoid shock during general anesthesia. Etiologic agents and diagnostic evaluation]

In 1983, the risk of developing severe shock during anaesthesia was estimated to be 1 case in 4600 procedures with an associated mortality rate of 6 per cent. The incidence of severe accidents has further increased since this time. This review focuses on the aspects of anaphylactoid shock (AS) in the context of iatrogenic responsibility involving drugs or substances used during anaesthesia or placed in contact with viscera. The elements predictive of anaphylactoid shock are described together with the arguments involved in a biochemical conception and a physiological conception. The authors emphasize the importance of the operative report and anaesthetic sheet to retrospectively establish the chronology of the events and to facilitate the allergologic work-up. The treatment of AS is an emergency. The therapeutic protocol is relatively well defined and, in addition to IV fluids, adrenalin is the drug of choice during the acute phase of AS. The therapeutic approach to certain particular cases is discussed and future therapeutic concepts are proposed. The aetiological agents of AS are discussed together with their respective frequencies in the specific case of the anaphylaxis reaction. Muscle relaxants are the leading cause of anaphylaxis (70 per cent of cases), especially suxamethonium, vecuronium and atracurium (43 per cent, 33 per cent and 6.8 per cent of cases, respectively). Latex present in various materials, especially surgical gloves, has become the most disturbing substance, responsible for 0.5 per cent of AS in 1989 vs 12.5 per cent of cases in 1991. Hypnotic drugs, although very widely used, are much more rarely incriminated.

[Respiratory involvement in ankylosing spondylarthritis: relations to alpha-1-antitrypsin phenotypes and tobacco consumption]

The distribution of alpha-1-antitrypsin phenotypes was similar in 555 controls and 98 patients with ankylosing spondylitis: the MM phenotype (including "main" MM subtypes, i.e., M2M2 and M3M3, and "secondary" MM subtypes) was found in 86% of subjects and "rare" phenotypes combining M, F, S, and Z in 14%. Six per cent of the controls and none of the ankylosing spondylitis patients had the M4M4 phenotype (p < 0.01). Respiratory function tests were performed in 49 patients with axial ankylosing spondylitis and 30 controls matched on sex, age, body mass index, smoking status, nonsteroidal antiinflammatory drug use and distribution of "main" and "secondary" phenotypes (no subjects in this study had "rare" phenotypes); the significant reduction in chest expansion seen in the ankylosing spondylitis group (5.6 +/- 2.7 cm versus 8.7 +/- 1.2; p < 0.001) was correlated with total capacity (p < 0.04) and vital capacity (p < 0.001). Restrictive ventilatory dysfunction was seen in four ankylosing spondylitis patients versus no controls (p < 0.02). Proximal airway obstruction, pulmonary distension and decreases in the diffusing capacity for carbon monoxide were seen in similar proportions of ankylosing spondylitis patients and controls. In the ankylosing spondylitis group, evidence of pulmonary distension included increases in mean residual functional capacity and mean residual volume (105.6 +/- 21.2% versus 94.8 +/- 17.4, p < 0.03, and 100.3 +/- 22.8% versus 88.6 +/- 17.9, p < 0.04, respectively) and bullous emphysema in the lung bases in two patients (versus no controls). In the small subgroup of ankylosing spondylitis patients with lung distension or a decreased diffusing capacity for carbon monoxide, smokers and nonsmokers were evenly balanced but subjects with "secondary" phenotypes outnumbered those with "main" phenotypes (p < 0.02); in contrast, our data suggested that smoking may play the central role in the proximal airway obstruction. Our findings suggest that in addition to previously established causes of pulmonary involvement in ankylosing spondylitis a "secondary" MM phenotype (i.e., neither M2M2 nor M3M3) may be a risk factor for lung distension and impaired diffusing capacity for carbon monoxide.

[Current epidemiology of tuberculosis]

A major health threat in developing countries, the incidence of tuberculosis has decreased steadily in Western countries over the last century. However, since 1986, first in the United States, then more recently in several European countries, the number of declared cases has increased. The current epidemiology of tuberculosis is presented with special emphasis on French data. The possible causes of this revival have been carefully analyzed: better registration, role of immunodepression and particularly the HIV epidemic, geographical origin, drug abuse, poor living conditions.... Based on the description of resistant forms and the observations of hospital epidemics, particularly in the United States and in patients with HIV infection, curative and preventive measures may and must be undertaken whenever a case of tuberculosis is observed.

[Severe forms of effort-induced asthma]

Severe reactions in exercise-induced asthma (EIA) seem to be underestimated in the published literature. We report two cases of near-miss death from EIA that occurred after a short run. We review 364 exercise tests that were performed between September 1987 and October 1988 by a standardised protocol on a treadmill, on patients with possible EIA. A positive test, defined by a fall of FEV1 of at least 20% was found in 173 patients. From 21 patients with a fall of greater than 50%, 4 presented severe signs of: Cyanosis. Intense dyspnea with impediment of speech. General malaise with hypertension. These 4 patients were not greatly different from patients of the 50% fall group when compared for FEV1 before the test and for heart-rate during the test. They differed in the duration of the asthma attack, which was more protracted, despite the use of beta-2 agonists. The onset of severe reactions is 2.3% of positive tests and seems to be unpredictable.