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1.
Rev Mal Respir ; 41(2): 145-155, 2024 Feb.
Article in French | MEDLINE | ID: mdl-38030554

ABSTRACT

INTRODUCTION: Probe based confocal laser endomicroscopy (pCLE) is a new endoscopic imaging technology. It uses mini probes which can be introduced through the working channels of endoscopes. Whenever applied on the tissue of interest, they allow imaging of tissue at a cellular level. STATE OF ART: In the filed of pleuropulmonary malignancies, pCLE showed mostly its ability to guide biopsies samplings. Those results need to be validated in larger prospective studies. In interstitial lung diseases, pCLE provides information complementary to other clinical and paraclinical data. The valuability of these informations need to be investigated further, prospectively in randomized trials. In obstructive pulmonary diseases, pCLE is able to investigate the structural and functional relationships between pulmonary structures. pCLE showed good ability in the identification of acute cellular rejection after lung transplantation. PERSPECTIVES AND CONCLUSION: For the time being, pCLE is not part of routine clinical practice. The data available need to be validated in larger randomized prospective trials, before it can be recommended as a guiding tool for biopsies or as a diagnostic tool for pathologic process. New fluorophores are now available. They are specific of some molecular sequences, allowing the enhancement of specific targets within the sample studied.


Subject(s)
Endoscopy , Lung , Humans , Prospective Studies , Microscopy, Confocal/methods , Lung/diagnostic imaging , Lasers
2.
Rev Med Liege ; 77(5-6): 295-301, 2022 May.
Article in French | MEDLINE | ID: mdl-35657186

ABSTRACT

Chronic Obstructive Pulmonary Disease (COPD) is a disease caused by a chronic inflammatory response induced by the inhalation of cigarette smoke or toxic particles/gases in the airways. However, we actually know that COPD is a disease that does not only induce inflammation in lung parenchyma and bronchi, but also provokes systemic inflammation which plays a role in multiple comorbidities. Thereby, treatment of COPD should not only focus on the bronchi to relieve symptoms, improve respiratory function and reduce the rate of exacerbations, but must also be extended to the systemic effects of the disease.


: La Broncho-Pneumopathie Chronique Obstructive (BPCO) est une maladie provoquée par une réponse inflammatoire chronique suite à l'inhalation de la fumée de cigarette ou d'aérocontaminants toxiques pour les voies aériennes. Cependant, nous savons aujourd'hui que la BPCO est une maladie induisant non seulement une inflammation au niveau du parenchyme pulmonaire et des bronches, mais aussi une inflammation systémique qui peut jouer un rôle dans de multiples comorbidités. Ainsi, le traitement de la BPCO ne doit pas seulement se focaliser sur le versant bronchique dans le but de soulager les symptômes, d'améliorer la fonction respiratoire et de réduire le taux d'exacerbation, mais doit aussi s'étendre aux effets systémiques de la maladie.


Subject(s)
Pulmonary Disease, Chronic Obstructive , Bronchi , Comorbidity , Humans , Inflammation/complications , Lung , Pulmonary Disease, Chronic Obstructive/complications , Pulmonary Disease, Chronic Obstructive/therapy
3.
Rev Med Liege ; 77(4): 244-248, 2022 Apr.
Article in French | MEDLINE | ID: mdl-35389009

ABSTRACT

Here we present pharmacological and clinical properties of a new fixed triple inhaled combination including an inhaled corticoid, a long acting ?2 agonist and a long acting anticholinergic for the treatment of severe chronic obstructive pulmonary disease (COPD). Trixeo Aerosphere® is the name of this triple combination which contains 160 µg budesonide, 4,8 µg formoterol and 9 µg glycopyrronium delivered by a pMDI. As compared to a budesonide/formoterol combination, Trixeo Aerosphere® improves forced expiratory volume in the first second (FEV1). As compared to glycopyrronium/formoterol combination, Trixeo Aerosphere® reduces exacerbation rate, improved quality of life and most importantly reduces mortality with a benefit increasing with blood eosinophil count. Trixeo Aerosphere® 320/18/9.6 is delivered twice daily 2 inhalations and is indicated in moderate to severe COPD insufficiently controlled by LABA/LAMA (long-acting ?2-adrenergic receptor agonist/ long-acting ?2-muscarinic receptor agonist) or ICS/LABA (inhaled corticosteroid/long-acting ?2-adrenergic receptor agonist).


Nous présentons dans cet article les propriétés pharmacologiques et les effets cliniques d'une nouvelle triple combinaison fixe inhalée comprenant un corticoïde inhalé, un ?2 mimétique à longue durée d'action et un anticholinergique à longue durée d'action, destinée au traitement de la bronchopneumopathie chronique obstructive (BPCO) sévère. Cette combinaison qui porte le nom de Trixeo Aerosphere® regroupe, dans le même dispositif, 160 µg de budésonide, 4,8 µg de formotérol et 18 µg de glycopyrronium. Par rapport à une combinaison budésonide/formotérol, le Trixeo Aerosphere® améliore la valeur du volume expiratoire maximum par seconde (VEMS). Par rapport à une combinaison formotérol/glycopyrronium, le Trixeo Aerosphere® réduit la fréquence des exacerbations et réduit la mortalité avec un bénéfice qui augmente avec le taux des éosinophiles circulants. Le Trixeo Aerosphere®, à la dose de 2X2 bouffées/24h, est indiqué dans le traitement des patients BPCO modérés à sévères insuffisamment contrôlés par une bithérapie LABA/LAMA (long-acting ?2-adrenergic receptor agonist/ long-acting ?2-muscarinic receptor agonist) ou ICS/LABA (inhaled corticosteroid/long-acting ?2-adrenergic receptor agonist).


Subject(s)
Glycopyrrolate , Pulmonary Disease, Chronic Obstructive , Administration, Inhalation , Adrenal Cortex Hormones/therapeutic use , Adrenergic Agonists/therapeutic use , Bronchodilator Agents/pharmacology , Bronchodilator Agents/therapeutic use , Budesonide/therapeutic use , Drug Combinations , Formoterol Fumarate/pharmacology , Formoterol Fumarate/therapeutic use , Glycopyrrolate/therapeutic use , Humans , Metered Dose Inhalers , Pulmonary Disease, Chronic Obstructive/drug therapy , Quality of Life
4.
Rev Med Liege ; 77(2): 110-117, 2022 Feb.
Article in French | MEDLINE | ID: mdl-35143131

ABSTRACT

Chronic obstructive pulmonary disease (COPD) and its exacerbations cause a deterioration in quality of life and a significant consumption of medical resources. Patient empowerment supported by education and self-monitoring practices can improve quality of life and reduce the number of hospital admissions. With the development of telemedicine, a lot of digital applications have been studied. Many are considered too complicated to use. So, we partnered with an IT company in Liège named «COMUNICARE¼ to develop a simplified application that is managed autonomously, without the support of a health professional. In addition, we conducted a prospective pilot study including patients with severe COPD with exacerbations. We observed an excellent rate of use despite low comfort with a smartphone. The primary objective of reducing the number of hospitalizations was not achieved. Nevertheless, we observed interesting results concerning the symptomatology, overall satisfaction and help with therapeutic compliance.


La bronchopneumopathie chronique obstructive (BPCO) et ses exacerbations engendrent une dégradation de la qualité de vie ainsi qu'une consommation importante des ressources médicales. L'autonomisation du patient appuyée par des pratiques d'éducation et d'auto-surveillance permet d'améliorer la symptomatologie et de diminuer le nombre d'hospitalisations. Avec le développement de la télémédecine, de nombreuses applications digitales ont été étudiées. Beaucoup sont jugées trop compliquées d'utilisation. Par conséquent, nous nous sommes associés à la société informatique liégeoise «COMUNICARE¼ pour développer une application simplifiée gérée de façon autonome, sans l'appui d'un professionnel de santé. En complément, nous avons réalisé une étude pilote prospective incluant des patients atteints d'une BPCO sévère à caractère exacerbateur. On observe un excellent taux d'utilisation malgré une faible aisance avec un smartphone. L'objectif primaire d'une diminution du nombre d'hospitalisations n'est pas atteint. Néanmoins, nous observons des résultats intéressants concernant la symptomatologie, la satisfaction globale et l'aide à l'observance thérapeutique.


Subject(s)
Pulmonary Disease, Chronic Obstructive , Quality of Life , Feasibility Studies , Humans , Pilot Projects , Prospective Studies , Pulmonary Disease, Chronic Obstructive/therapy
5.
Lung ; 199(5): 549-557, 2021 10.
Article in English | MEDLINE | ID: mdl-34518898

ABSTRACT

PURPOSE: To investigate whether eosinophils and other white blood cell subtypes could be used as response and prognostic markers to anti-Programmed cell Death-1 or anti-PD-Ligand-1 treatments in non-small cell lung cancer patients. METHODS: We retrospectively analyzed data from the NSCLC patients consecutively treated at our hospital with a PD-1/PD-L1 inhibitor in monotherapy for advanced disease. A total of 191 patients were evaluated at three time-points to investigate any relation between tumor response and WBC counts. RESULTS: Baseline WBC and subtypes did not differ according to the type of response seen under treatment. A higher relative eosinophil count (REC) correlated with more objective responses (p = 0.019 at t1 and p = 0.014 at t2; OR for progression = 0.54 and 0.53, respectively) independently of the smoking status, PD-L1 status, and immune-related toxicity (IRT). Higher REC was also associated with a longer duration of treatment (p = 0.0096). Baseline absolute neutrophil count was prognostic (p = 0.049). At t1 relative lymphocytes, absolute and relative neutrophils, and neutrophil-to-lymphocyte ratio were prognostic (p = 0.044, p = 0.014, p = 0.0033, and p = 0.029, respectively). CONCLUSION: Our results show that in NSCLC patients anti-PD-1/PD-L1 therapy induces an early increase only in blood eosinophils, more prominent in responding patients and independent of the smoking status, PD-L1 status, and IRT. Eosinophils are also associated with a longer duration of treatment. Furthermore, our data support a prognostic role of neutrophils, lymphocytes, and their ratio for NSCLC patients with advanced disease treated with PD(L)-1 blockade.


Subject(s)
Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Apoptosis , Carcinoma, Non-Small-Cell Lung/drug therapy , Humans , Lung Neoplasms/drug therapy , Lymphocytes , Retrospective Studies
6.
Rev Med Liege ; 76(5-6): 432-439, 2021 May.
Article in French | MEDLINE | ID: mdl-34080376

ABSTRACT

The perception of ventilatory effort is common in oncology, especially but not exclusively in the advanced stages of neoplastic disease. Dyspnea is a symptom whose discomfort and anguish it generates in the patient and his/ her entourage require constant management throughout the illness. The first step is to identify and optimize the treatment of comorbidities associated with tumour disease. Relief of respiratory oppression as a symptom requires a multidisciplinary approach. Opiates and benzodiazepines are at the forefront of pharmacological management. The mechanical obstruction that limits ventilatory flow and/or chest ampliation may justify more invasive management, including endoscopic techniques. Oxygen therapy will be considered on a case-by-case basis. Finally, global management includes respiratory revalidation, psychological support and improvement of environmental quality.


La perception d'un effort ventilatoire est fréquente en oncologique en particulier, mais non exclusivement, aux stades avancés de la maladie néoplasique. La dyspnée constitue un symptôme dont l'inconfort et l'angoisse qu'elle génère chez le patient et son entourage nécessitent une prise en charge constante tout au long de la maladie. La première étape est d'identifier et d'optimaliser le traitement des pathologies dyspnéisantes conjointes à la maladie tumorale. Le soulagement de l'oppression respiratoire en tant que symptôme nécessite une approche pluridisciplinaire. Les opiacés et les benzodiazépines sont au premier plan de la prise en charge pharmacologique. La levée d'un obstacle mécanique limitant les débits ventilatoires et/ou l'ampliation thoracique peut justifier des techniques plus invasives, notamment endoscopiques. L'oxygénothérapie sera envisagée au cas par cas. Enfin, la prise en charge globale inclut la revalidation respiratoire, le support psychique et l'amélioration de la qualité de l'environnement.


Subject(s)
Dyspnea , Neoplasms , Analgesics, Opioid/therapeutic use , Anxiety , Benzodiazepines , Dyspnea/etiology , Dyspnea/therapy , Female , Humans , Neoplasms/complications , Neoplasms/therapy
7.
Rev Med Liege ; 76(5-6): 440-445, 2021 May.
Article in French | MEDLINE | ID: mdl-34080377

ABSTRACT

Lung cancer remains the deadliest cancer. It is the result of genetic aberrations in the cells of the respiratory tract exposed to carcinogenic agents, responsible for their anarchic multiplication. It is necessary to study these abnormalities in order to better understand the early stages and the mechanisms of evolution, thereby to establish new screening, monitoring and treatment strategies. The NELSON study confirms that systematic screening for lung cancer in target populations leads to a reduction in mortality from this disease. Despite this, there is currently no consensus in Belgium between medical experts and politicians for systematic lung cancer screening.


Le cancer pulmonaire reste le cancer le plus mortel. Il est le résultat d'aberrations génétiques au niveau de cellules des voies respiratoires exposées aux agents carcinogènes, responsables de leur multiplication anarchique. Il est nécessaire d'étudier ces anomalies pour mieux comprendre les stades précoces et les mécanismes d'évolution afin d'établir de nouvelles stratégies de dépistage, de suivi et de traitement. L'étude NELSON confirme qu'un dépistage systématique des cancers pulmonaires de populations cibles permet une diminution de la mortalité liée à cette pathologie. Malgré cela, il n'y a, actuellement, pas de consensus en Belgique entre les experts médicaux et le monde politique pour un dépistage systématique du cancer pulmonaire.


Subject(s)
Early Detection of Cancer , Lung Neoplasms , Belgium , Humans , Lung , Lung Neoplasms/diagnosis , Lung Neoplasms/epidemiology , Mass Screening , Tomography, X-Ray Computed
8.
Rev Med Liege ; 76(5-6): 452-457, 2021 May.
Article in French | MEDLINE | ID: mdl-34080379

ABSTRACT

Small cell lung cancer is a malignant tumour with a poor prognosis. Standard treatment of metastatic stages has been a platinum doublet since 1980, but the addition of immunotherapy has improved prognosis. For locally advanced stages, the combination of radio-chemotherapy remains the treatment of choice, with no evidence at present of the value of immunotherapy in consolidation, and for localized stages, surgery is the first-line therapy. Unfortunately, in the second line, we have no other molecule than the topotecan despite several studies. Prophylactic brain irradiation remains debated even if it has been validated in localized forms. Finally, there is hope with targeted therapy following the development of subtypes of small cell lung cancer but studies remain difficult to conduct.


Le cancer pulmonaire à petites cellules est une tumeur maligne de mauvais pronostic. Le traitement standard des stades métastatiques était un doublet à base de sels de platine depuis 1980, mais l'ajout de l'immunothérapie a, quand même, permis d'améliorer le pronostic. Pour les stades localement avancés, l'association d'une radiochimiothérapie reste le traitement de choix, sans évidence actuellement de l'intérêt d'une immunothérapie en consolidation, et pour les stades localisés, la chirurgie. Malheureusement, en deuxième ligne, nous n'avons pas d'autre molécule que le topotécan malgré plusieurs études. L'irradiation cérébrale prophylactique reste débattue, même si elle a été validée dans les formes localisées. Enfin, il existe un espoir avec une thérapie ciblée suite à la mise en évidence de sous-types de cancers pulmonaires à petites cellules, mais les études restent difficiles à mener.


Subject(s)
Lung Neoplasms , Small Cell Lung Carcinoma , Antineoplastic Combined Chemotherapy Protocols , Humans , Immunotherapy , Lung Neoplasms/therapy , Prognosis , Small Cell Lung Carcinoma/drug therapy
9.
Rev Med Liege ; 76(5-6): 458-463, 2021 May.
Article in French | MEDLINE | ID: mdl-34080380

ABSTRACT

The majority of non-small cell lung cancers are diagnosed as advanced disease. Subsets of adenocarcinomas and of squamous cell carcinomas in nonsmokers present a molecular aberration leading to tumour survival. Epidermal Growth Factor Receptor (EGFR), Anaplastic Lymphoma Kinase (ALK) and Repressor Of Silencing1 (ROS1) have been identified and targeted with good efficacy for fifteen years. Newer inhibitors brought even greater efficacy with a generally better tolerability. Other molecular aberrations (Kirsten Rat Sarcoma, Rearranged during Transfection, MET, NeuroTrophic Receptor yrosine kinase) are targets for newly developed, more selective drugs. As more and more patients will benefit from targeted therapies, the identification of molecular aberration is more than ever crucial for optimal lung cancer patient care.


La majorité des cancers pulmonaires non à petites cellules se présentent à un stade avancé. Une faible proportion des adénocarcinomes et des cancers épidermoïdes des non-fumeurs est porteur d'(une) anomalie(s) génétique (s) et moléculaire(s) dont dépend leur survie. Depuis une quinzaine d'années, les anomalies de l'«Epidermal Growth Factor Receptor¼ (EGFR), «Anaplastic Lymphoma Kinase¼ (ALK) et Repressor Of Silencing1 (ROS1) sont connues et ciblées par des inhibiteurs efficaces. De nouvelles générations permettent actuellement d'augmenter leur efficacité thérapeutique pour une toxicité globalement moindre. De nouvelles anomalies («Kirsten Rat Sarcoma¼, «Rearranged during Transfection¼, MET, «NeuroTrophic Receptor tyrosine kinase¼) sont, elles aussi, à présent ciblées de manière efficace. La recherche des anomalies moléculaires dans ces sous-types histologiques est devenue incontournable car elle modifie fondamentalement la prise en charge thérapeutique et le pronostic d'une proportion grandissante de patients.


Subject(s)
Antineoplastic Agents , Carcinoma, Non-Small-Cell Lung , Lung Neoplasms , Antineoplastic Agents/therapeutic use , Carcinoma, Non-Small-Cell Lung/drug therapy , Carcinoma, Non-Small-Cell Lung/genetics , Humans , Lung Neoplasms/drug therapy , Lung Neoplasms/genetics , Molecular Targeted Therapy , Mutation , Protein-Tyrosine Kinases/genetics , Protein-Tyrosine Kinases/therapeutic use , Proto-Oncogene Proteins/genetics
10.
Rev Med Liege ; 76(3): 166-172, 2021 Mar.
Article in French | MEDLINE | ID: mdl-33682385

ABSTRACT

Pulmonary fibrosis is a pathological entity still too little understood today, burdened with significant morbidity and mortality. Idiopathic pulmonary fibrosis is a complex diagnostic disease requiring a multidisciplinary approach and in some cases the performance of a lung biopsy. In addition, the early identification of the pathology remains the key in order to preserve lung function as much as possible. In this context and in view of the diagnostic difficulty, it seems essential to identify new biomarkers to help with the differential diagnosis, the evaluation of the prognosis and the response to treatment. In addition, the evolution of the pathology remaining inexorable despite anti-fibrotic treatments, it appears critical to be able to identify new potential therapeutic routes.


La fibrose pulmonaire est une entité pathologique de nos jours encore trop méconnue, grevée d'une morbi-mortalité importante. La fibrose pulmonaire idiopathique est une maladie de diagnostic complexe nécessitant une approche pluridisciplinaire et, dans certains cas, la réalisation d'une biopsie pulmonaire. De plus, l'identification précoce de la pathologie reste la clé afin de préserver au maximum la fonction pulmonaire. Dans ce contexte et devant la difficulté diagnostique, il semble primordial de pouvoir identifier de nouveaux biomarqueurs permettant d'apporter une aide au diagnostic différentiel, à l'évaluation du pronostic et à la réponse au traitement. De plus, l'évolution de la pathologie restant inexorable en dépit de traitements anti-fibrotiques, il apparaît comme critique de pouvoir identifier de nouvelles voies thérapeutiques potentielles.


Subject(s)
Idiopathic Pulmonary Fibrosis , Biomarkers , Biopsy , Diagnosis, Differential , Humans , Idiopathic Pulmonary Fibrosis/diagnosis , Idiopathic Pulmonary Fibrosis/therapy , Prognosis
11.
Cytokine ; 140: 155421, 2021 04.
Article in English | MEDLINE | ID: mdl-33486314

ABSTRACT

INTRODUCTION: Alarmins ((IL-25, IL-33 and thymic stromal lymphopoietin (TSLP)) are known to promote Th2 inflammation and could be associated with eosinophilic airway infiltration. They may also play a role in airway remodeling in chronic airway obstructive diseases such as asthma and chronic obstructive pulmonary disease (COPD). IL-23 and IL-36 were shown to mediate the neutrophilic airway inflammation as seen in chronic airway obstructive diseases. OBJECTIVES: The purpose of this project was to determine the expression and the production of these cytokines from induced sputum (IS) in patients with chronic airway obstructive diseases including asthmatics and COPD. The relationship of the mediators with sputum inflammatory cellular profile and the severity of airway obstruction was assessed. METHODS: The alarmins (IL-25, IL-33 and TSLP) as well as IL-23 and IL-36 concentrations were measured in IS from 24 asthmatics and 20 COPD patients compared to 25 healthy volunteers. The cytokines were assessed by ELISA in the IS supernatant and by RT-qPCR in the IS cells. RESULTS: At protein level, no difference was observed between controls and patients suffering from airway obstructive diseases regarding the different mediators. IL-36 protein level was negatively correlated with sputum eosinophil and appeared significantly decreased in patients with an eosinophilic airway inflammation compared to those with a neutrophilic profile and controls. At gene level, only IL-36, IL-23 and TSLP were measurable but none differed between controls and patients with airway obstructive diseases. IL-36 and IL-23 were significantly increased in patients with an neutrophilic inflammatory profile compared to those with an eosinophilic inflammation and were correlated with sputum neutrophil proportions. None of the mediators were linked to airway obstruction. CONCLUSIONS: The main finding of our study is that patients with eosinophilic airway inflammation exhibited a reduced IL-36 level which could make them more susceptible to airway infections as IL-36 is implicated in antimicrobial defense. This study showed also an implication of IL-36 and IL-23 in airway neutrophilic inflammation in chronic airway obstructive diseases.


Subject(s)
Cytokines/metabolism , Eosinophils/metabolism , Interleukin-17/metabolism , Interleukin-1/metabolism , Interleukin-23/metabolism , Interleukin-33/metabolism , Pulmonary Disease, Chronic Obstructive/metabolism , Asthma/metabolism , Female , Humans , Inflammation/metabolism , Male , Middle Aged , Neutrophils/metabolism , Phenotype , Sputum/metabolism
12.
Rev Med Liege ; 76(1): 13-17, 2021 Jan.
Article in French | MEDLINE | ID: mdl-33443323

ABSTRACT

Empyema and subacute invasive aspergillosis are rare pathologies that should not be overlooked because of the need for early treatment and a different management of bacterial infections which are more frequent. We report the case of a 75-year-old man with subacute invasive aspergillosis and an empyema following drowning and cardiopulmonary arrest.


L'empyème à Aspergillus fumigatus et l'aspergillose invasive subaiguë sont des pathologies rares à ne pas méconnaître au vu de la nécessité d'un traitement précoce et d'une prise en charge différente des infections pleuropulmonaires bactériennes qui sont plus fréquentes. Nous rapportons le cas d'un patient de 75 ans présentant une aspergillose invasive subaiguë, associée à un empyème, dans les suites d'une noyade avec arrêt cardiopulmonaire.


Subject(s)
Aspergillosis , Drowning , Empyema , Aged , Aspergillosis/diagnosis , Humans , Male
13.
Respir Investig ; 58(6): 437-439, 2020 Nov.
Article in English | MEDLINE | ID: mdl-32978099

ABSTRACT

INTRODUCTION: Patients with interstitial lung diseases (ILD) can be suspected to be at risk of experiencing a rapid flare-up due to COVID-19. However, no specific data are currently available for these patients. METHODS: We retrospectively analyzed a cohort of 401 patients with ILD and determined the proportion of patients hospitalized for proven severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and specific symptoms of COVID-19. RESULTS: We found that 1% of patients (n = 4) were hospitalized (1 in ICU) for COVID-19. In total, 310 of the 401 patients answered the phone call. Only 33 patients (0.08%) experienced specific symptoms of SARS-CoV-2 infection. CONCLUSION: Our study did not demonstrate any increased occurrence of severe COVID-19 in ILD patients compared to the global population. Based on our findings, we could not make any conclusion on the incidence rate of SARS-CoV-2 infection in patients with ILDs, or on the overall outcome of immunocompromised patients affected by COVID-19.


Subject(s)
COVID-19 , Lung Diseases, Interstitial , Humans , Lung Diseases, Interstitial/epidemiology , Pandemics , Retrospective Studies , SARS-CoV-2
15.
Rev Med Liege ; 74(12): 627-632, 2019 Dec.
Article in French | MEDLINE | ID: mdl-31833271

ABSTRACT

Malignant pleural mesothelioma is a rare disease originating from mesothelial cells of the pleura and is related to asbestos exposure. The tumor is generally extended at the time of diagnosis and the treatment consists of a systemic palliative therapy. Radical approach is limited to very selected patients and is performed in expert centers but without validated schema. Radiotherapy alone is mainly used in palliative intent. Platinum-based chemotherapy in association with pemetrexed is the frontline standard of care and provides a 12-month overall survival. The addition of bevacizumab, an antiangiogenic drug, shows an improvement in median survival. To date, there is no second-line treatment approved for this disease and therefore inclusion in trials is recommended. Currently, various studies are investigating target therapy, immunotherapy and intrapleural perioperative treatment.


Le mésothéliome pleural malin est une tumeur rare, issue des cellules mésothéliales de la plèvre et liée à un contact avec l'amiante. Au moment du diagnostic, la maladie est souvent de stade avancé et est prise en charge par un traitement systémique palliatif. Un traitement radical est réservé pour de rares cas très sélectionnés, au sein de centres experts et ce, sans qu'aucun schéma de prise en charge ne soit validé. La radiothérapie seule est essentiellement utilisée à titre palliatif antalgique. Le traitement systémique de référence consiste en une chimiothérapie à base de cisplatine et pemetrexed permettant une survie globale de 12 mois. L'ajout à la chimiothérapie d'une thérapie ciblée anti-angiogénique, le bévacizumab, a permis une amélioration significative de la survie. A ce jour, il n'y a pas de traitement de 2ème ligne validé et il est donc recommandé d'inclure les patients dans des études cliniques. Actuellement, de multiples études évaluent des thérapies ciblées, des immunothérapies et des traitements intrapleuraux peropératoires.


Subject(s)
Mesothelioma , Pleural Neoplasms , Antineoplastic Combined Chemotherapy Protocols , Bevacizumab , Combined Modality Therapy , Humans , Mesothelioma/drug therapy , Pemetrexed , Pleural Neoplasms/drug therapy
16.
Rev Med Liege ; 74(11): 566-571, 2019 Nov.
Article in French | MEDLINE | ID: mdl-31729844

ABSTRACT

Following a solicitation of INAMI in 2016, a team of the CHU Liège pneumology department has proposed a telemonitoring pilot project in severe chronic obstructive pulmonary disease (COPD) patients. The main objective of the study was to reduce the number of hospitalizations for COPD exacerbation. The patients included in the study had been at least hospitalized once in 12 months before the beginning of the telemonitoring. A close collaboration with the general practitioner was required. Patients were educated in the manipulation of the application and connected objects. The numerous technical difficulties encountered limited the number of patients studied within the short time allowed by INAMI. However, some interesting observations could be made and a first experience in the field acquired. A project on a large scale seems necessary.


Suite à un appel lancé par l'INAMI en 2016, une équipe de soins du Service de Pneumologie du CHU de Liège a proposé un projet pilote de télé-monitoring de patients souffrant de bronchopneumopathie chronique obstructive (BPCO) sévère dont l'objectif principal était de réduire le nombre de ré-hospitalisations pour exacerbation de BPCO. Les patients sélectionnés étaient des patients sévèrement atteints et ayant été au moins hospitalisés une fois dans les 12 mois précédant la mise en place de la surveillance à distance. Une collaboration étroite avec le médecin généraliste était requise. Les patients ont été éduqués à la manipulation de l'application et des objets connectés proposés. Les nombreuses difficultés techniques rencontrées ont limité le nombre de patients étudiés dans les délais courts autorisés par l'INAMI. Cependant, quelques observations intéressantes ont pu être faites et une première expérience dans le domaine a été acquise. Un projet à plus grande échelle paraît nécessaire.


Subject(s)
Pulmonary Disease, Chronic Obstructive , Telemedicine , Hospitalization , Humans , Pilot Projects , Pulmonary Disease, Chronic Obstructive/diagnosis
17.
Rev Med Liege ; 74(7-8): 394-400, 2019 Jul.
Article in French | MEDLINE | ID: mdl-31373453

ABSTRACT

We report the case of a 38-year old non-smoking female who initially presented to the hospital with frequent cough and sputum for several weeks. The investigations confirmed the diagnosis of tuberculosis and a triple therapy was introduced with clinical improvement. Two years later, the patient reported recurrence of respiratory symptoms. The new investigations concluded initially to a recurrence of tuberculosis and a quadriple therapy was introduced. The treatment was poorly tolerated and rapidly stopped. It was then decided to perform a biopsy through mediastinoscopy in the hilar ganglia, which confirmed the diagnosis of sarcoidosis. The etiology of sarcoidosis is not yet clearly established, one of the hypothesis would be the direct involvement of an infectious agent that would induce an excessive immune response. The clinical case below supports a possible role of Mycobacterium tuberculosis in the pathogenesis of sarcoidosis.


Nous rapportons le cas d'une patiente âgée de 38 ans, non fumeuse, qui s'est présentée à l'hôpital pour une symptomatologie de toux et d'expectorations depuis plusieurs semaines. Les différentes investigations ont permis d'établir un diagnostic de tuberculose et une trithérapie a été introduite avec une évolution favorable de la patiente. Deux ans plus tard, la patiente rapporte une récidive des plaintes respiratoires. Les nouveaux examens menés concluent, dans un premier temps, à une récidive de tuberculose et une quadrithérapie est instaurée. Le traitement fut mal toléré et stoppé rapidement. Il est alors décidé de réaliser une biopsie par médiastinoscopie au niveau des ganglions hilaires qui permettra de confirmer le diagnostic de sarcoïdose. L'étiologie de la sarcoïdose n'étant pas encore clairement établie, une des hypothèses est l'implication directe d'un agent infectieux qui induirait une réaction immunitaire excessive. Le cas clinique ci-dessous étaye la théorie selon laquelle le Mycobacterium tuberculosis pourrait être un des agents étiologiques de la sarcoïdose.


Subject(s)
Mycobacterium tuberculosis , Sarcoidosis , Tuberculosis , Adult , Biopsy , Female , Granuloma , Humans , Mycobacterium tuberculosis/pathogenicity , Sarcoidosis/complications , Tuberculosis/complications
18.
Rev Mal Respir ; 36(6): 688-696, 2019 Jun.
Article in French | MEDLINE | ID: mdl-31030998

ABSTRACT

INTRODUCTION: The incidence of pleural disease continues to increase worldwide. Medical thoracoscopy remains the standard method for exploration of the pleural cavity. METHOD: We report the retrospective evaluation, the efficacy and the observed complications in 1024 medical thoracoscopies undertaken in the University Hospital of Liège between 2000 and 2017. RESULTS: In total, 100 pneumothoraces and 400 benign and 501 malignant pleural diseases were identified. The main indication for thoracoscopy remains the diagnosis of an exudative, lymphocytic pleural effusion of unknown aetiology after thoracocentesis. The diagnostic sensibility of thoracoscopy was 99.2% in distinguishing benign from malignant pleural disease. Talc pleurodesis was performed in 69.5% of the total population and in 66.1% of pleural effusions or thickening. Failure of pleurodesis was observed in 11% of the patients with recurrent pneumothorax and in 7.8% of neoplastic pleural effusion. We report a mortality of 0.6% in the 30 days post procedure, long duration of drainage in 8.3% and serious complications in 4.7%. In 22/1024 (2.1%) thoracoscopic evaluation was not feasible because of dense pleural fibrosis. CONCLUSION: Medical thoracoscopy is a safe, well-tolerated procedure with high accuracy in the diagnostic and therapeutic management of pleural disease.


Subject(s)
Pleural Diseases/diagnosis , Thoracoscopy , Adolescent , Adult , Aged , Aged, 80 and over , Belgium , Female , Hospitals, University , Humans , Male , Middle Aged , Postoperative Complications/epidemiology , Retrospective Studies , Young Adult
19.
Respir Med ; 147: 72-75, 2019 02.
Article in English | MEDLINE | ID: mdl-30704703

ABSTRACT

Probe based confocal laser endomicroscopy (pCLE) is a new optical endoscopic technique, generating fluorescent light emission from the tissue of interest and allowing in vivo live imaging at a cellular level ("optical biopsies"). To the best of our knowledge, this article is the first to present pCLE images during medical thoracoscopy. We present here 3 different patients referred for various health problems. A precise description of pleural cavity pCLE images after intravenous fluorescein injection (a fluorophore) together with corresponding macroscopical and histological studies is performed. This led to the diagnosis of normal pleura in one case, carcinomatous pleuritis in another case and a malignant mesothelioma in the third case. We believe that optical biopsies could help clinicians to make an early diagnosis, thereby allowing rapid therapeutic intervention (talc pleurodesis for example). Furthermore, it could help to guide biopsies when affected zones are not obvious to macroscopic examination. In a near future, new fluorophores could be developed to stain some pathophysiological processes, therapeutic targets, or enzymes activities bringing new insights in endoscopic pleural disease work-up.


Subject(s)
Lung Neoplasms/diagnostic imaging , Mesothelioma/diagnostic imaging , Microscopy, Confocal/methods , Pleural Diseases/diagnostic imaging , Pneumothorax/diagnostic imaging , Thoracoscopy/instrumentation , Administration, Intravenous , Adult , Aged , Biopsy , Carcinoma/therapy , Carcinoma, Non-Small-Cell Lung/complications , Carcinoma, Non-Small-Cell Lung/pathology , Early Diagnosis , Female , Fluorescein/administration & dosage , Humans , Lung Neoplasms/pathology , Male , Mesothelioma/pathology , Mesothelioma, Malignant , Pleural Diseases/pathology , Pleural Effusion/etiology , Pleural Effusion/pathology , Pleurodesis/methods , Pneumothorax/pathology , Pneumothorax/therapy
20.
Rev Med Liege ; 74(1): 54-60, 2019 Jan.
Article in French | MEDLINE | ID: mdl-30680975

ABSTRACT

The role of the anti-inflammatory and bronchodilator triple therapy, including a long acting ß2-agonist (LABA), a long-acting muscarinic antagonist (LAMA) and an inhaled corticosteroid (ICS), in the prevention of the exacerbations of chronic obstructive pulmonary disease (COPD) is still not clearly established, and requires comparison with dual therapy (LABA-CSI or LABA-LAMA). IMPACT is a phase 3, double-blind randomized study comparing the tritherapy (LABA-LAMA-ICS) in a single inhaler (vilanterol 25 ?g/umeclidinium 62.5 ?g/fluticasone furoate 100 ?g) with the LABA-ICS association (vilanterol 25 ?g-fluticasone furoate 100 ?g) and the combination LABA-LAMA (vilanterol 25 ?g/umeclidinium 62.5 ?g) on the reduction of the rate of exacerbation as the primary outcome, but also on the pulmonary function, the quality of life, the dyspnea and the mortality.Triple therapy by comparison with dual therapy (LABA-ICS or LABA-LAMA) improves numerous parameters such as the rate of moderate to severe exacerbations, the symptoms, the respiratory function, the quality of life, while being well tolerated. Finally, the IMPACT study gives an "evidence base" for the GOLD guidelines proposing triple therapy in symptomatic COPD patients presenting exacerbations despite dual therapy.


La place de la trithérapie bronchodilatatrice et anti-inflammatoire, comprenant un bêta-2 mimétique à longue durée d'action (LABA), un anticholinergique à longue durée d'action (LAMA) et un corticostéroïde inhalé (CSI), dans la prévention des exacerbations de la bronchopneumopathie chronique obstructive (BPCO) n'est pas encore clairement établie, et nécessite une comparaison avec les associations de LABA-CSI ou les combinaisons LABA-LAMA. IMPACT est une étude randomisée en double aveugle de phase 3 comparant la trithérapie (LABA-LAMA-CSI) en un seul inhalateur (vilantérol 25 ?g/ uméclidinium 62,5 ?g/fluticasone furoate 100 ?g) avec une association LABA-CSI (vilantérol 25 ?g-fluticasone furoate 100 ?g) et une combinaison LABA-LAMA (vilantérol 25 ?g/uméclidinium 62,5 ?g) sur la réduction du taux d'exacerbations comme critère de jugement primaire, mais aussi sur la fonction respiratoire, la qualité de vie, la dyspnée et la mortalité. La trithérapie entraîne une diminution significative du taux d'exacerbations modérées ou sévères, améliore la dyspnée, la fonction respiratoire et la qualité de vie par rapport à l'association fluticasone-vilantérol et la bithérapie bronchodilatatrice uméclidinium-vilantérol chez des patients BPCO symptomatiques et présentant des exacerbations, tout en étant bien tolérée. Finalement, l'étude IMPACT apporte une évidence clinique aux directives du GOLD proposant la trithérapie chez des patients BPCO symptomatiques présentant toujours des exacerbations malgré une bithérapie.


Subject(s)
Pulmonary Disease, Chronic Obstructive/drug therapy , Androstadienes/therapeutic use , Benzyl Alcohols/therapeutic use , Chlorobenzenes/therapeutic use , Clinical Trials, Phase III as Topic , Drug Combinations , Glucocorticoids/therapeutic use , Humans , Muscarinic Antagonists/therapeutic use , Nebulizers and Vaporizers , Quinuclidines/therapeutic use , Randomized Controlled Trials as Topic
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