[Obesity hypoventilation syndrome and obstructive sleep apnea syndrome: is there an association?]. / Syndrome d'obésité hypoventilation et syndrome d'apnées de sommeil : quel type d'association?

BACKGROUND: Severe obesity sometimes leads to a chronic alveolar hypoventilation: obesity hypoventilation syndrome (OHS), (Pao2<70mmHG, Paco2>45mmHG and body mass index (BMI)>30Kg/m2). The association with an OSAS is frequent. AIM: To assess predicting factors that lead to hypoventilation in a population of obese patients with SAS and to deduct the type of association between OHS and SAS. METHODS: We have study during 4 years, at pneumology service of Charles Nicolle hospital, 62 obese patients (BMI>30Kg /m2), 41men and 21 women and presenting an OSAS. We excluded those carriers of a bronchial obstruction (VEMS/CV <60%) and we have compared anthropométriques, functional, gazométriques and polysomographiques details of the groupe1 (G1): OHS=9 and of the groupe2 (G2): obesity without hypoventilation (n=53). RESULTS: We didn't identified any significant difference between the two groups concerning (age, sex, the frequency of smokers, the frequency of the nasopharynx region abnormalities, apnea-hypopnea index (AHI), the SAS severity and the respiratory functional exploration). The obesity is significant more important in the G1, it is sever (BMI>40) in 77.8% of patients of the G1 with significant difference with the G2 (P=0.004). We noted that there is a positive interrelationship between BMI and Paco2. We identified severe gazométrique perturbation in G1 (Pao2 medium = 61± 9 mmHg,Paco2 medium=50 ± 7 mmHg), in the G2 we noted a moderate hypoxemia. Patients of the group1 make of the minimal desaturation of 63 ± 17% and a Sao2 average of 81 ± 20% what is meaningfully more important than in the G2. CONCLUSION: The alveolar hypoventilation in SAS seems to be in correlation with the degree of obesity. The hypercapnie in the OHS is in relation neither with the SAOS nor with its severity. The OHSSAS association is usual but not synonym; the OHS is an autonomous disease.

[Pulmonary sequestrations: from radiologic to preoperative diagnosis: 2 cases with review of the literature]. / Les sequestrations pulmonaires: du diagnostic radiologique au diagnostic per-opératoire. A propos de deux cas avec revue de la littérature.

Pulmonary sequestrations are defined by the presence of a non fonctional pulmonary parenchyma with an abnormal vascularisation. Their incidence ranges from 1.1% to 1.8% of all the malformations in the general population. Two types of sequestrations are described: Intralobar sequestrations: the most common, localised within a normal parenchyma. Extralobar sequestrations: totally separate from the lung with their own pleural covering. We report two cases of sequestrations. In the first case, the radioclinical presentation was strongly suggestive of this diagnosis in a 32-year old woman with recurrent hemoptysis, airspace opacity in the left retrocardiac region and a systemic vascularisation of this mass on tomodensitometry. Pathological studies after surgery confirmed the diagnosis of intralobar sequestration type I in the classification of PRYCE. In the second case a thoracoscopy performed on a 14-year-old boy who had a serohematic pleural effusion, revealed a left costodiaphragmatic mass. Surgical removal of this mass confirmed its extralobar pulmonary nature.