[Take-home messages from the 2nd COPD 2023 Biennial of the French Society of Respiratory Diseases. Placing the patient at the center of the care pathway]. / Principaux messages de la deuxième Biennale BPCO 2023 de la SPLF. Le patient au cœur du parcours de soins.

INTRODUCTION: The second COPD Biennial organized by the COPD working group of the French Society of Respiratory Diseases took place in Paris (Cochin) on 13th December 2023. STATE OF THE ART: Major trends in 2023 were discussed; they encompassed concepts, definitions, biologics, care pathways, pulmonary rehabilitation and complex situations entailed by respiratory infections, cardiovascular comorbidities and pulmonary hypertension, and modalities of oxygen therapy and ventilation. PERSPECTIVES: The different talks underlined major changes in COPD including the concepts of pre-COPD, etiotypes, health trajectories and new definitions of exacerbation. Recent results in biologics for COPD open the door to new pharmacological options. Assessment of current care pathways in France highlighted some causes for concern. For example, pulmonary rehabilitation is a key but insufficiently practiced element. Respiratory infections require careful assessment and treatments. Diagnosis and treatment of cardiovascular comorbidities and pulmonary hypertension are of paramount importance. As of late, oxygen therapy and ventilation modalities have evolved, and are beginning to afford more personalized options. CONCLUSIONS: As regards COPD, a personalized approach is crucial, placing the patient at the center of the care pathway and facilitating coordination between healthcare providers.

[Take-home messages from the COPD 2021 biennial of the French Society of Respiratory Diseases. Understanding to so as to better innovate]. / Principaux messages de la première Biennale BPCO 2021 de la SPLF. Mieux comprendre pour innover.

INTRODUCTION: The first COPD biennial organized by the French Society of Respiratory Diseases (SPLF) took place on 17 December 2021. STATE OF THE ART: The objective of the biennial was to discuss current knowledge regarding COPD pathophysiology, current treatments, research development, and future therapeutic approaches. PERSPECTIVES: The different lecturers laid emphasis on the complexity of pathophysiologic mechanisms including bronchial, bronchiolar and parenchymal alterations, and also dwelt on the role of microbiota composition in COPD pathenogenesis. They pointed out that addition to inhaled treatments, ventilatory support and endoscopic approaches have been increasingly optimized. The development of new therapeutic pathways such as biotherapy and cell therapy (stem cells…) call for further exploration. CONCLUSIONS: The dynamism of COPD research was repeatedly underlined, and needs to be further reinforced, the objective being to "understand so as to better innovate" so as to develop effective new strategies for treatment and management of COPD.

[Treatment of GERD in asthma]. / Traitement du reflux gastro-œsophagien dans l'asthme.

Gastro-oesophageal reflux disease (GORD) is one of the most frequent conditions associated with asthma. GORD has an impact on asthma control and quality of life of asthmatic patients. Its treatment relies on lifestyle modifications, anti-acidic treatment with proton pump inhibitors (PPI) and/or surgical management by fundoplication in some situations. The impact of lifestyle modifications has not been analysed on asthma outcomes alone. Several randomised controlled trials assessed the efficacy of PPI on asthma control, peak expiratory flow and/or quality of life. The impact of fundoplication in asthma has mainly been analysed in retrospective or prospective observational studies. This review highlights the limited impact of GORD treatment on asthma control. Current guidelines are to restrict GORD treatment in asthma to asthmatic patients with actual symptomatic GORD. Given the lack of controlled studies, the place of surgical management of GORD in asthma is currently not defined.

[A case of multifocal cavernous haemangiomas of the lung, spleen and bone]. / Hémangiomatose multifocale bronchique, ganglionnaire, splénique et osseuse.

INTRODUCTION: Haemangiomas are vascular malformations, frequently cutaneous, hepatic and splenic. Respiratory involvement and multiple localisations are uncommon. CASE REPORT: We present a rare case of multiple cavernous haemangiomas in a 35 year old woman presenting with repeated haemoptysis. Thoracic CT scanning showed a mass in the left lower lobe associated with lymph node enlargement above and below the diaphragm, heterogeneous splenomegaly and a single spinal lesion without hypermetabolism on PET scanning. Enbronchial ultrasound-guided trans-bronchial needle aspiration was not contributory. Histopathological diagnostic was made firstly by splenectomy with lumbar-aortic curettage and then by lobectomy for haemostasis. A final diagnosis of multiple cavernous haemangiomas involving lung, lymph nodes, spleen and bone was made. CONCLUSIONS: Bronchopulmonary cavernous haemangiomas associated with extra-thoracic lesions are exceptionally rare and their presentation, suggesting, a malignant cause, often leads to surgical resection for diagnostic and, eventually, therapeutic management. We report an original case of cavernous haemangiomas involving lung, lymph nodes, spleen and bone.

[Ultrasonographic score for predicting vaginal delivery within 24h of induction: a pilot study]. / Étude préliminaire pour la réalisation d'un score échographique de prédiction d'accouchement par voie naturelle dans les 24h après déclenchement du travail.

OBJECTIVE: Evaluate if a score based on ultrasound measurements (cervical length, perineal-fetal presentation distance, fetal occiput position) before the induction of labour is a good predictive test of vaginal delivery within 24h and compare it to Bishop score. METHODS: From January to April 2014, we included in a monocentric prospective study 45 patients who underwent a labour induction in the department of obstetrics and gynecology at Croix-Rousse Hospital. Ultrasound measurements of the distance between the perineum and the foetal presentation (with transperineal ultrasound), of the cervical length (with transvaginal ultrasound) and of the position of the occiput were collected before induction. Bishop score was also calculated for these patients, without receiving ultrasound data (and vice versa), in order to determine the mode of induction. Receiver Operating Characteristics (ROC) curves were used to evaluate performance of the ultrasonographic score and the Bishop score for predicting vaginal delivery within 24h. RESULTS: The area under the ROC curve for ultrasonographic score was 84.5% (IC95% 64,6-100%). The area under the ROC curve for Bishop score was 73.2% (IC95% 64,2-82,2%). The comparison of these areas under the curve has shown a difference of 11.3% with a P-value of 0.055 in a two-tailed test. CONCLUSION: Ultrasonographic score made with a combination of these ultrasound measurements appears to be an effective test to predict the chances of vaginal delivery within 24h of induction.

[In vivo confocal microscopy evaluation of corneal changes induced after LASIK using the IntraLase femtosecond laser technique]. / Evaluation en microscopie confocale des modifications morphologiques cornéennes induites après LASIK et découpe du volet stromal par laser femtoseconde IntraLase.

PURPOSE: To assess stromal modifications occurring after IntraLase femtosecond laser for laser in situ keratomileusis (LASIK) using the Heidelberg retina tomograph II/Rostock cornea module. MATERIAL AND METHODS: Twelve eyes from six patients were examined using the Heidelberg retina tomograph II cornea module after IntraLase femtosecond laser: ten eyes were examined at 1 week and 2 months after laser surgery, including four eyes examined at day 1, and two eyes examined at day 2. Morphological modifications of the corneal stroma, flap interface, and flap margin were evaluated at these different times and compared with the mechanical microkeratome interfaces of five patients (ten eyes), using the same technique at the same periods after the surgical intervention. RESULTS: Evaluations at days 1 and 7 showed simultaneous depletion and activation of keratocytes on both sides of the interface. We also observed some brightly reflecting particles together with scattered, less bright dots, from day 7 and increasing after 2 months. Some clinically visible deposits at the level of the interface were observed at the periphery of the flap at day 1 and could represent cell-degradation products. With confocal microscopy, they appeared as homogeneous reflective deposits with a larger size than that of particles; they had decreased at month 2. The flap margin appeared microscopically as a very clear-cut edge, including epithelial cells, while those performed with a mechanical microkeratome appeared more like a poorly limited fibrotic scar. We also observed a secondary fibrotic reaction at month 2, adjacent to the still well-defined IntraLase flap edge. CONCLUSION: This study showed substantial morphological similarity between the interfaces obtained with femtosecond laser and mechanical microkeratome. The discovery of brightly reflecting particles in the IntraLase interface goes against the hypothesis of the metallic origin of these deposits. The flap margin microscopically looked extremely well delimited, but seemed to provoke an adjacent secondary fibrotic reaction, both microscopically and macroscopically, greater at 2 months than after a mechanical microkeratome cut.

[Excimer laser photorefactive keratectomy retreatment following photokeratectomy under-correction]. / Retraitement à l'aide du laser excimer de surface des sous-corrections dans les suites de photokératectomies réfractives.

PURPOSE: Results of excimer laser photorefractive keratectomy are well accepted for the correction of low to moderate myopia. However, the occurrence of a regression is still a frequent complication. The purpose of the present study is to evaluate the interest and risk of excimer photorefractive keratectomy retreatment of eyes that underwent a regression of the refractive effect. PATIENTS AND METHODS: A retreatment was achieved in 27 eyes of 22 patients. This reshaping was required because of either an expected undercorrected initial treatment, either a regression of the refractive effect of the first photorefractive keratectomy that did not respond to the topical steroid therapy. As we used two different types of excimer laser to achieve the retreatments, we formed two subgroups. In the first sub-group, 13 eyes were retreated with an Excimed (Summit), and in the second one, that included 14 eyes, a laser EC5000 (Nidek) was used. The delay between the first procedure and the retreatment was 16.38 +/- 7.56 months in the first sub-group and 29.85 +/- 13.09 months in second one. The mean attempted correction for the reshaping was -3.01 +/- 1.25 diopters in the first sub-group and -1.63 +/- 0.80 diopters in the second one. RESULTS: No specifical problem was encountered during the retreatment. Specifically, we did not observe any decentring. By the third post-operative month, patients recovered a mean uncorrected visual acuity of nearly 7/10 in both sub-groups. This mean uncorrected visual acuity did not regressed during the follow-up. In addition, the mean post-operative refraction was 0.11 +/- 0.78 diopters in the first sub-group and -0.20 +/- 0.59 diopters in the second, three months after reshaping. The final refraction was -0.15 +/- 0.30 dioptres in the first sub-group and -0.70 +/- 0.62 dioptres in the second one. Nine eyes exerienced a regression during the follow-up period, from which three responded to the topical steroids. These regressions occurred in 4 eyes from the first sub-group and 5 of the second one. No other complication were observed. DISCUSSION: Although there is a aggreement about the efficacy of excimer laser in the treatment of low or moderate myopia, regressions of the refractive effect is not unfrequent. It can warrant a reshapping. Our results demonstrate the simplicity and the predictive value of excimer laser in the retreatment of these regressions after photorefractive keratectomy. This method seems more accurate than radial keratotomy. CONCLUSION: Excimer laser retreatment is highly effective in the correction of undercorrection after a previous procedure of photorefractive keratectomy, especially when the attempted correction of the initial treatment was under -6 diopters.

[Results of treatment of undercorrections of radial keratotomy by Excimer laser]. / Résultats du traitement des sous-corrections de kératotomie radiaire au laser Excimer.

Photorefractive keratectomy (PRK) was performed with Excimer Laser after undercorrected radial keratectomy in 21 eyes of 15 patients (maximum 8 incisions, 3 mm optical zone). There was at least a 6-month interval between the two procedures. At the time of PRK, the mean age of the patients was 31 years and the mean spherical equivalent -2.3 D. Mean follow-up after PRK was 7.5 months; 10 eyes were followed for more than one year. Quite satisfactory results were obtained since PRK was effective in 88% (eyes with uncorrected visual acuity of 20/40 or better); predictability at +/- 1 D was 89%. Stable refractiveness was achieved at 3 months. The procedure is safe: there was no loss of best corrected visual acuity nor haze at one year. Other means of treating for undercorrection after refractive keratectomy were discussed in comparison with this technique.

[Posterior chamber implantation in black Africa. Apropos of 150 cases with an 18 months follow-up]. / L'implantation de chambre postérieure en Afrique noire. A propos de 150 cas suivis pendant 18 mois.

The purpose of this article is to report our study of 150 cases of posterior chamber implantations carried out at the Hôpital Principal de Dakar between 1988 and 1991. We report the specific difficulties of such operations in black Africans and their complications and follow-up. At the end of this study, after observations over an eighteen month period, we noticed a visual acuity of more than 20/30 for 105 patients (70%) and a secondary cataract in 22 cases (14.6%). Despite less favourable material conditions, we think that such an operation can perfectly be made in Africa and that it gives quite acceptable results.

[Clinical results of photo-refractive keratectomy. Preliminary study with 57 eyes]. / Résultats cliniques de la photo-kératectomie réfractive. Etude préliminaire sur 57 yeux.

The authors report their personal experience of Photo-Refractive Keratectomy (PRK) with an Excimer Laser based on the study of 57 sighted eyes, 24 with more than six months and 11 with more than one year of follow-up. The initial myopia ranged from -1 to -13 D with a spherical average equivalent of -6.36 D. The photo-ablations, performed with the Excimer of the Summit Company, ranged from 3.7 to 5 mm of diameter and 16 to 76 mu in depth. Results are reported overall and for sub-groups of myopia (A < or = -3 D, -3 D < B < or = -7 D, -7 D, < C). They were satisfactory since at one year 45% of eyes obtained a visual acuity without correction > or = 5/10 and 64% of eyes were within one dioptre of emmetropia; stability of refraction from six months to one year is close to 80%; safety was good since no patient has lost a line of best spectacle corrected visual acuity at one year and we only found one case of haze at 1+ without visual loss. These encouraging results lead the authors to pursue their study and to include new patients to obtain larger groups in order to establish statistically significant differences for parameters such as age, sex, myopia, keratometry, depth and optical zone of photo-ablation.