[Home respiratory care]. / L'assistance respiratoire traitée à domicile.

In 1980, 11,000 French patients were given home respiratory care (HRC); today there are ten times more cases, i.e. about 120,000. There are two principal conditions in this population: chronic severe lung disease (CSLD), treated mainly with long-term oxygen therapy and assisted ventilation, and sleep apnoea syndrome (SAS), treated with continuous positive airway pressure (CPAP), a treatment that first became available in 1985. The mean age of patients with CSLD is currently 67 years and is increasing annually, while for SAS it is 58 years. The constraints of treatment, prescribed for the rest of the patient's life, are incompatible with long-term hospitalization, given the daily length of treatment (12-24 h for CSLD, and 5-8 h at night for SAS). The number of medical and social workers involved in providing these types of treatment requires complex coordination for the patient to be able to benefit from such highly cost-effective medical and technical services. In the case of home respiratory care, France has benefited for almost twenty years from the services of a not-for-profit network that comprises a national coordinating body, ANTADIR, and regional HRC services administered by physicians specializing in pneumology or resuscitation, often from university hospitals.

Primary pneumococcal pericarditis complicated by acute constriction.

We report a case of a 31-year-old male with primary pneumococcal pericarditis. Severe acute constrictive pericarditis developed within a month of the onset of the illness in spite of adequate antibiotic therapy and pericardial drainage.

[Respiratory insufficiency in kyphoscolioses (author's transl)]. / L'insuffisance respiratoire des cypho-scolioses.

After a brief recall of etiology and anatomo-pathology, the authors tried to sum up the knowledge concerning the physio-pathology of kyphoscolioses. First the respiratory repercussion of the disease was studied with its classical spirometric data, the abnormalities of gas exchanges (alveolar hypoventilation, decreased diffusion capacity, inhomogeneous distribution of the ratio ventilation/perfusion which plays a large part in these abnormalities), altered ventilatory mechanics and the response to CO2. Then they studied the anatomical and functional repercussion on the lesser circulation which is at the origin of the chronic pulmonary heart. When present, correlations with the clinic are underlined. In a second part, the clinical evolution of the respiratory insufficiency in kyphoscolioses is approached. The brutality of respiratory decompensations and the very poor prognosis linked to the beginning of a chronic pulmonary heart are underlined. Finally, the therapeutical side of the disease is approached. The classical medical and surgical means are recalled and the paper ends on the changing of the prognosis, which became possible because of the techniques of ventilation at home, currently in expansion.

[Vasodilators in the treatment of cardiac insufficiency (author's transl)]. / Les vasodilatateurs dans le traitement de l'insuffisance cardiaque.

The use of vasodilators represents a new approach to the treatment of cardiac insufficiency, either chronic or acute. Their field of action is venous, arterial or mixed. Decreasing the pre-load, the "venous" vasodilators lighten the congestive symptoms of cardiac insufficiency. By decreasing the post-load, the "arterial" vasodilation increases the cardiac output. Some vasodilators, venously administered, imply a continuous hemodynamic checking (Sodium Nitroprussiate, Phentolamine, injectable Trinitrine). Others are active orally (Trinitrine, Isosorbide Dinitrate, Hydralazine, etc.). Vasodilating treatment is recommended for acute cardiac insufficiency, particularly during myocardium infarct and some acute valvular insufficiencies. It is also successfully used in acute lung edema. Finally it takes an increasing importance in the treatment of chronic cardiac insufficiency.