[Early detection of COPD in occupational medicine in the Alpes-Maritimes]. / Détection précoce de la BPCO en milieu professionnel dans les Alpes-Maritimes.

INTRODUCTION: This study evaluated a standardized procedure aiming at early detection of COPD in a consecutive population of employees visiting occupational medicine. METHODS: A total of 2818 employees were included by 22 occupational physicians in 5 centers. Respiratory symptoms, smoking status, occupational exposures and socioprofessional categories were collected. Subjects with at least one symptom and/or risk factor underwent spirometry. RESULTS: In this population aged 39±12 years, 2603 patients were free of known asthma or COPD. The presence of at least one symptom was observed in 23.6 % of employees and was significantly associated with smoking status, occupational exposure to organic dust, gas fumes and vapors, and agriculture (P<0.0001). Airflow obstruction (FEV1/FVC < 0.70) was detected in 1.7 % of 1605 employees who underwent spirometry. With the inclusion of known COPD subjects (n=22), the prevalence reached 2.38 %. COPD was significantly associated with smoking intensity. Information on subsequent diagnosis was obtained in only two cases. The quality of spirometry was inadequate in 30 % of cases. Thirty-three percent of detected COPD subjects did not report any respiratory symptoms. CONCLUSION: The strategy used in this study (specific questionnaire plus spirometry) allowed detection of a few cases of previously undiagnosed COPD. Occupational physicians need specific training in spirometry and a better follow-up of care pathways is required to obtain diagnostic confirmation.

[Disproportionate pulmonary arterial hypertension and lung respiratory diseases: distinctive clinical, hemodynamic and prognosis of patients versus primary pulmonary arterial hypertension]. / Hypertension artérielle pulmonaire disproportionnée : caractéristiques et pronostic d'une cohorte de patients niçois référés au laboratoire d'échocardiographie.

OBJECTIVES: To characterize and compare patients with disproportionate PH versus patients with primary pulmonary arterial hypertension (PAH). METHODS: All patients referred to our cardiology unit for echocardiography from November 2006 to May 2008 and who have been followed by our pneumologist were screened for severe PH (i.e mean arterial pulmonary pressure>35-40 mmHg at rest). Patients were excluded if a factor that could influence pulmonary hemodynamics was present. We investigated these patients by pulmonary function tests, echocardiography and right heart catheterisation. RESULTS: We reported 16 cases of severe PH in stable patients (n=8, chronic obstructive pulmonary disease-emphysema) and 13 patients with PAH. Our findings suggest that the patients with disproportionate PH had right heart dysfunction similar to that observed in PAH. But their outcomes were more severe. It seemed that specific vasodilatator therapy was not efficient.

[Interest of tricuspid annular displacement (TAD) in evaluation of right ventricular ejection fraction]. / Evaluation de la fraction d'éjection ventriculaire droite par la mesure du déplacement de l'anneau tricuspide via l'utilisation du tricuspid annular displacement (TAD).

INTRODUCTION: The ultrasound assessment of RV structure and function is often sub-optimal. The range of excursions of the mitral or tricuspid annulus measured in millimetre by 2D or TM-mode in centimetre per second by DTI-mode echocardiography has been shown to reflect the systolic function of both ventricles. METHODS: We studied a new technique based on a tissue tracking algorithm that is ultrasound beam angle independent for automated detection of tricuspid annular displacement (TAD) (QLAB, Philips Medical Imaging). Twenty-six patients (pts) referred for magnetic resonance imaging (MRI) and 44 control subjects underwent a complete transthoracic echocardiography. MRI of the right ventricular ejection fraction (RVEF) was correlated by linear regression with TAD. Sixteen pts (61.5%) exhibited right ventricular systolic dysfunction (MRI RVEF<40%). RESULTS: The MRI RVEF was positively correlated with TAD (R(2)=0,65; p<0,0001). A value of TAD <14mm predicted right ventricular dysfunction with a sensitivity of 87.5% and a specificity of 90%. Most of (90%) healthy subjects exhibited TAD values exceeding this cut-off point (mean: 16.9+/-1.64mm; range: 13.3 to 24.8mm). Negative correlation was found between TAD and age (R(2)=0,36; p<0,0001). CONCLUSION: Our study is the first to correlate TAD with MRI RVEF. TAD is a simple, rapid, and non-invasive tool for right ventricular systolic function assessment.

[Pulmonary artery compression by a mediastinal tumor]. / Compression extrinsèque de l'artère pulmonaire secondaire à une tumeur germinale non séminomateuse médiastinale.

Acquired arterial pulmonary stenosis is rarely found in adults. Reviews and case reports suggest that tumours of the mediastinum (teratomatas and Hodgkin's disease) are the most frequent culprits leading to compression of the main pulmonary artery. We present the case of a young patient with chest pain. Compression of the main and left pulmonary artery by an anterior mediastinal nonseminomatous germ cell tumors (GCTs) was diagnosed by transthoracic echocardiography and CT scan.

[Practical and technical aspects of noninvasive ventilation]. / Aspects pratiques et techniques de la ventilation non invasive.

INTRODUCTION: Noninvasive ventilation refers to the delivery of positive pressure ventilation via a mask or "interface" rather than via an invasive conduit. Until recently, equipment for noninvasive ventilation was frequently custom-made to meet the needs of an individual patient. During the past 15 years, there have been significant advances in the equipment available for noninvasive ventilation. STATE OF THE ART: Interfaces that have been designed specifically for noninvasive ventilation are now commercially available from several manufacturers. Commonly used interfaces include nasal and full face masks, and mouthpieces. The main characteristics, and potential advantages and disadvantages of each interface are described. Portable volume-limited or pressure-limited ventilators are available for home noninvasive ventilation. As with critical care ventilators, home mechanical ventilators are capable of delivering a variety of modes of ventilation. Furthermore, they are lightweight and economical. Technical aspects of ventilator circuits are also discussed here and some practical considerations about selection and maintenance of materials are proposed. CONCLUSIONS: Although major technical advances have been made, optimal delivery of noninvasive ventilation requires knowledge of, and experience with, the application of the equipment used.

[Alveolar hypoxemic interstitial pneumonia related to rituximab therapy]. / Une pneumopathie alvéolo-interstitielle hypoxémiante associée à la prise de rituximab.

INTRODUCTION: Rituximab is indicated for the treatment of low-grade lymphoma. Pulmonary toxicity related to rituximab is exceptional. CASE REPORT: Here we report a patient with non-Hodgkin lymphoma treated with "CHOP" chemotherapy (cyclophosphosphamide, adriamycin, vincristine and prednisolone) and rituximab who developed an interstitial pneumonia with acute respiratory failure. The differential diagnosis of this clinical and radiological diagnosis is discussed. CONCLUSION: Although cases of interstitial pneumonia associated with rituximab are rare, they may be severe and thus any patient experiencing respiratory symptoms on this therapy should be monitored closely.

[Comparison of volume preset and pressure preset ventilators during daytime nasal ventilation in chronic respiratory failure]. / Etude comparative de respirateurs à régulation de volume et à régulation de pression au cours de la ventilation nasale diurne en situation d'éveil dans l'insuffisance respiratoire chronique.

Both volume preset and pressure preset ventilators are available for domiciliary nasal ventilation. Owing to their technical characteristics, it has been suggested that impaired ventilatory mechanics might cause a drop in the tidal volume (Vt) delivered by pressure preset devices, thereby placing mechanical ventilation at risk of inefficacy. We have assessed two ventilator systems (one pressure preset and one volume preset) with regard to the tidal volume and end-tidal carbon dioxide tension (PetCO(2)) changes that may be achieved in a group of awake patients with stable chronic respiratory failure (CRF). Eleven patients with stable CRF were ventilated in the assist/control mode for two consecutive one-hour periods. One ventilator was tested each hour, in random order. The VIGIL'AIR(R) system was used to record Vt, Respiratory Rate (RR), and Inspiratory/Expiratory ratio (I/E). The deviation E (E=preset value - measured value) was calculated for each measurement. Changes in PetCO(2) and arterial oxygen saturation were determined respectively by a capnometer and a pulse oximeter. Comparison of the mean deviation of Vt calculated for the two ventilators revealed a difference in patients with chronic obstructive pulmonary disease (COPD). The deviation was greatest with the pressure preset ventilator (PPV), which gave mean measured values higher than the mean preset values. The same comparison failed to reveal any difference in restrictive CRF. Comparison of the volume preset and pressure preset ventilators for RR, I/E and PetCO(2) did not reveal any difference. Compared to the volume preset ventilator, the efficacy of PPV to ventilate is not affected by the restrictive or obstructive nature of CRF. Our results show that pressure-preset ventilator is an adequate alternative to the volume-preset device for daytime non invasive ventilation in chronic respiratory insufficiency.

[Impact of acute respiratory failure on survival of COPD patients managed with long-term non-invasive ventilation and oxygen therapy]. / Impact de la décompensation respiratoire aiguë sur la survie des BPCO prises en charge au long cours par ventilation non invasive et oxygénothérapie.

Our study aimed to assess the impact of acute respiratory failure (ARF) on survival of patients with chronic obstructive pulmonary disease (COPD) receiving long-term oxygen therapy (LTOT) plus nasal intermittent positive pressure ventilation (NIPPV). Survival was analysed retrospectively in 24 patients with severe COPD initiated to NIPPV in addition to LTOT. Fourteen patients were established on NIPPV following exacerbation of acute respiratory failure which has required mechanical ventilation (group 1). Ten patients (group 2) have never been hospitalized for ARF. Comparison of clinical details at baseline, 6 months, 1, 2, and 3 years for the two groups failed to reveal any difference with the exception of prior episodes of ARF. The probability of survival at 3 years was 65% (95% confidence interval [CI] 43-86) for the overall population, 46% (95% CI 15-77) in group 1, and 74% (95% CI 42-105) in group 2. The difference between the two groups was statistically significant. We show that ARF requiring mechanical ventilation appears to be a factor that is negatively correlated with survival for patients treated by LTOT plus NIPPV. This data suggests that NIPPV should be tried before ARF arising in COPD patients who present a deterioration in chronic respiratory failure with hypercapnia.

Domiciliary nasal intermittent positive pressure ventilation in severe COPD: effects on lung function and quality of life.

The aim of this study was to determine the effect of domiciliary nasal intermittent positive pressure ventilation (NIPPV) on lung function and quality of life in hypercapnic patients with chronic obstructive pulmonary disease (COPD). Fourteen hypercapnic COPD patients in a stable clinical condition were evaluated in a prospective study of domiciliary NIPPV plus long-term oxygen therapy. Baseline data obtained during a 4 week run-in period were compared with measurements at the end of the 6 month study period. Spirometric parameters, arterial blood gas tensions, and quality of life were assessed. Quality of life was measured using the St George's Respiratory Questionnaire (SGRQ) and the French version of the Nottingham Health Profile (FVNHP). All patients completed 6 months of domiciliary NIPPV. Gastro-intestinal inflation was reported by eight patients. Daytime arterial oxygen tension and arterial carbon dioxide tension, improved after therapy. During the NIPPV study period, the total SGRQ score and impacts score both improved significantly; significant improvements were also noted in the total FVNHP score and the physical mobility, emotional reactions, and energy component scores. Domiciliary nasal intermittent positive pressure ventilation combined with long-term oxygen therapy has been found to improve blood gases in spontaneous ventilation, as well as the quality of life of patients with chronic obstructive pulmonary disease.

[Pleural and subsequent peritoneal effusions of pancreatic origin. Pleural talc treatment as a cause?]. / Epanchements pleural et péritonéal successifs d'origine pancréatique. Le talcage pleural en cause?

A new case is described of a recurrent pleural effusion during the course of chronic pancreatitis. The diagnosis of the effusion was not established and a pleural talcage was performed. The pleurisy did not recur but a peritoneal effusion subsequently appeared. The potential responsibility of the pleural talcage was discussed.

[What is the value of tracheobronchial fibroscopy in the assessment of esophageal cancer?]. / Que faut-il attendre de la fibroscopie trachéo-bronchique dans le bilan d'un cancer de l'oesophage?

The aim of this study is to evaluate the role of bronchoscopy in the assessment of resectability of esophageal carcinomas. From 1981 to 1986, 125 patients were referred for a carcinoma of the esophagus. Bronchoscopy was performed in 105 cases. Patients were classified into 3 groups: group I: normal bronchoscopy (58 cases: 55.2%); group II: compression, localized inflammation (35 cases: 33.3%); Group III: invasion (12 cases: 11.5%). Tracheo-bronchial abnormalities were found whatever the site of the esophageal carcinoma: 60% of cases for the upper third, 40% for the middle third and 36% for the lower third. They were significantly more frequent when the esophageal tumor was larger than 5 centimeters. Correlation with CT scan was good in 75% of cases. Sensitivity and specificity of these two exams were similar and they appeared to be complementary. In group I, resection was impossible or palliative for bronchial reasons in 10% of cases, while resection was impossible or palliative in 35% of cases in group II. Lastly, resection was curative in 73.5% of cases in group I and in only 39% of cases in group II. Bronchoscopy must be systematically performed in carcinoma of esophagus. It may predict the palliative nature of resection if abnormalities are present, and may contraindicate the resection when invasion of the bronchial tree is discovered.

[Amoxicillin as a 1st choice: 275 acute focal pneumopathies treated on an outpatient basis]. / Amoxicilline en première intention: 275 pneumopathies aiguës en foyer traitées en ville.

From December 1986 to January 1988, 100 General Practitioners and Pneumologists working outside hospital included in open unmatched series 275 patients who were diagnosed as having pneumonia at home. The study consisted of 53.2% men with an average age of 49.3 plus or minus 19.3. Their temperature on the first day (J1) was in 72.7% of cases greater than 38.5 degrees Centigrade. The doctors felt that the general state was good in 66.5% of the cases. Cough was present in 83.5% of cases but was dry in one out of every two. The patients received Amoxycillin in a dose of 2 grams per day orally (66.9%), or by injection (33.1%). On the third day (J3) 90% of the patients had a temperature below 38.5 degrees Centigrade. Their general state was improved in 94.6% of cases. The diagnosis of pneumonia at home was confirmed radiologically on 219 of the films available, confirming the good specificity of the clinical diagnosis of pneumonia at home. Ten patients were hospitalised. The apparent treatment of Amoxycillin was given in 247 cases (89.8% of cases). In 28 cases (10.2%) the treatment was changed by the addition or substitution of a Macrolide (15), or another antibiotic (5), and in 80 cases a change of treatment was not specified. 25 of these 28 cases were reviewed on the 14th day (J14) and no failures were observed after the change of treatment. In 247 patients in whom the treatment with Amoxycillin was followed 336 were reviewed on the 15th day and there had been four failures. Three were intolerant to the drug and there was one relapse.(ABSTRACT TRUNCATED AT 250 WORDS)

[Long-term beta adrenergic antagonists in spastic bronchopathies]. / Les antagonistes bêta-adrénergiques au long cours dans les bronchopathies spastiques.

Beta-blockers are usually contra-indicated or reluctantly prescribed in cases of chronic obstructive bronchopathy. The aim of this study is firstly to show their tolerance in the long term in this pathology when the condition is stable and secondly to judge their efficacy in controlling side effects caused by bronchodilators (trembling, tachycardia) which are often administered at the same time. This study concerned 21 patients: 8 asthmatics and 13 spastic bronchitics, treated over a period of 4 months in a cross-over, double-blind test by 2 cardio-selective beta-blockers (2 months: betaxolol, 2 months atenolol). During the study, respiratory tolerance proved to be good and side effects of bronchodilators were controlled.

[Intravenous theophylline in the treatment of asthma attacks]. / La théophylline par voie intra-veineuse dans le traitement des attaques d'asthme.

Intravenous administration of theophylline for acute asthmatic attacks treatment requires statistical adjustment of the dosage. In the absence of a residual level the former one is of 6 mg/kg for the loading dose and 0.6 mg/kg/h for the maintenance dose. In case of non estimated residual rate, it's possible either not to use the loading dose, or to use a reduced dosage of 3 mg/kg. In both cases, the maintenance dose is 0.7 mg/kg/h. In future, rapid theophylline dosage technics should allow a more appropriate adaptation in emergency treatment.

Circadian rhythm in gamma glutamyltranspeptidase and leucine aminopeptidase urinary activity in rats.

Urinary gamma glutamyltranspeptidase (GGT) and leucine aminopeptidase (LAP), renal tubular brush border enzymes, have been shown to be sensitive indicators of renal tubular functions. This study documents circadian rhythms in the urinary activity of GGT and LAP, statistically validated and quantified by the cosinor method, in 15 male Wistar rats standardized to a LD 12:12 illumination schedule (light from 0800 hr to 2000 hr) and fed ad libitum. The acrophase of the circadian rhythms in urinary GGT and LAP activity occurred at the end of the rest span of the animals: between 1730 and 1915 for GGT (depending on the mode of expression of the activity) and between 1700 and 1910 for LAP. Of striking resemblance in their timing, both these rhythms were also of large amplitude (about 50% of the mesor for urinary GGT activity and about 45% for LAP one). The circadian acrophases of urinary GGT and LAP activity led in timing the circadian rhythms in urine volume and creatinine excretion by about 13 hr. Such findings consistent with the circadian variations found by other investigators in GGT in kidney homogenates or in LAP in human urine thus reflect a periodicity in renal tubular function. The reasons for these circadian variations, still unknown at this time, are discussed. The influence recently demonstrated of the hormonal context on protein and enzyme synthesis at the tubule, and its phase relations to urinary enzyme excretion emphasize how much the circadian rhythm in urinary GGT and LAP activity is well included in the murine time structure.(ABSTRACT TRUNCATED AT 250 WORDS)