[Tracheal lipoma: An exceptional cause of tracheal tumors]. / Lipome trachéal : une cause exceptionnelle de tumeur trachéale.

INTRODUCTION: Tracheal tumors are rare, they are most often malignant and can manifest themselves by a non-specific respiratory symptomatology with progressively increasing dyspnea orienting in the first place towards a COPD or even an asthma. Among them, tracheal lipoma is exceptional. Its management is based on removal by rigid bronchoscopy. OBSERVATION: We report the case of a 73-year-old male patient who presented with non-specific dyspnea that progressively worsened over several months. The EFR showed a flattening of the flow-volume curves, the CT scan showed an anterolateral oval tracheal tumor with fatty density, the bronchial endoscopy showed a tumor lesion with stenosis of about 90% of the airway. Management consisted of a rigid bronchoscopy to delete obtruction with biopsies. Anatomopathology concluded to a tracheal lipoma. CONCLUSION: Progressively worsening dyspnea, especially if there are signs of inspiratory dyspnea, required a systematic bronchial endoscopy to avoid the possibility of a tracheal tumor.

Predictive factors for the participation of general practitioners in lung cancer screening by low-dose CT scan in the Somme department in northern France.

INTRODUCTION: A study on lung cancer screening using low-dose computed tomography (DEP KP80) was conducted in the Somme department in northern France between May 2016 and December 2018. We conducted a cross-sectional survey of family physicians in that department to identify potential predictive factors for their participation in this pilot study. METHODS: A survey questionnaire was sent to the 545 general practitioners (GPs) of the Somme department. This survey rendered it possible to identify the investigators who were active in the DEP KP80 study. The questionnaire's content was focused on the socio-demographic conditions of GPs, their professional practices, and their medical practice situations. RESULTS: The response rate was 38% (206 completed questionnaires). Active investigators in DEP KP80 accounted for 55% (n=113) of the GPs surveyed, and non-investigators for 45% (n=93). Age, gender, or medical practice situation were not related to the active GPs' participation in DEP KP80. A multivariate analysis revealed that two factors were correlated with active participation in organized screening: (1) prescription of nicotine replacement therapy; (2) smoking history of the GP. CONCLUSIONS: Securing the active involvement of family physicians and of the French regional cancer screening coordination centers seems essential for the future organization of lung cancer screening on a regional or national level. Our results demonstrate that incorporating smoking cessation support structures into the program would maximize the mechanism's potential.

[Lung cancer screening with low-dose thoracic CT-scan in the Somme area]. / Dépistage des cancers bronchopulmonaires par tomodensitométrie thoracique à faible dose dans la Somme.

RATIONALE: This feasibility trial proposes to set up in the department of the Somme an annual screening for lung cancer with low-dose thoracic CT. It responds to the first objective of the third cancer plan and follows the publication of the results of the National Lung Screening Trial in 2011. METHODS: The method of this study is to use the existing networks among and between healthcare professionals and the departmental cancer screening structure. The inclusion criteria will be those of the National Lung Screening Trial. Screening will be proposed by treating physicians and chest physicians. The CT-scan will be performed in radiological centers that adhere to the good practice charter for low radiation scanning. A copy of CT results will be sent to the departmental structure of cancer screening (ADEMA80) which will ensure traceability and will perform statistical analysis. The study received funding from the Agence régionale de santé de la Picardie and la ligue contre le cancer. EXPECTED RESULTS: The primary endpoints of this screening will be the number of cancers diagnosed and the survival of the patients. The follow-up of positive examinations, delays in management and the level of participation will also be assessed.

[Thoracic endometriosis: A difficult diagnosis]. / Endométriose thoracique : un diagnostic difficile.

Thoracic endometriosis is a rare disease, which presents in women at a mean age of 35 years, later than for pelvic endometriosis. There are no known predisposing factors for the condition and its pathogenesis is not yet clearly established. The symptoms always appear in connection with the periods of the person affected by the condition, occurring within 24-48 h after the start of menstruation. Catamenial pneumothorax is the most common clinical entity. It is associated with pelvic endometriosis in 30-50% of cases. Thoracoscopy, preferably performed during menstruation, allows full inspection of the diaphragm and the pleural cavity for defects in the diaphragm, endometrial nodules and bullae. The level of CA 125 is often elevated but this is not a reliable or specific marker. Medical treatment is aimed at blocking the action of estrogen on the endometrium and ectopic endometrial implants. GnRH analogues or danazol are the preferred treatments. Surgery to repair and strengthen the diaphragm and/or resect nodules or bullae also has a role, supplemented by pleurodesis to prevent further pneumothorax or effusions. The main risk is recurrence, and thus the current usual practice is to combine surgery, immediately followed by hormone therapy focusing on GnRH analogues.

[Pulmonary epithelioid haemangioendothelioma: reports of three cases and a review of the literature]. / Hémangioendothéliome épithélioïde pulmonaire: à propos de trois cas et revue de la littérature.

INTRODUCTION: Pulmonary epithelioid haemangioendothelioma (PEH) is a rare vascular tumour of intermediate malignancy that predominantly affects women. CLINICAL CASE REPORTS: We report three cases of PEH. Though all three diagnoses were confirmed by surgical biopsy, it is notable that, in one case, a tracheal biopsy by flexible bronchoscopy was contributory. Two patients had undergone positron emission tomography, which showed the lesions to be well established. The three cases show that the evolution of this pathology can be very varied. In the first case, the disease was multifocal and needed to be treated with several pulmonary resections. In the second case no recurrence has been observed after surgery; in the third case the patient died following a haemothorax. CONCLUSION: The discovery of a PEH is usually fortuitous. The diagnosis is confirmed by immuno-chemical analysis of a lung biopsy. No standard treatment has been validated and no treatment is necessary if the disease is asymptomatic. If there is only one nodule, surgery is the treatment of choice. The prognosis is variable. Usually the evolution is slow except when the disease is complicated by haemoptysis, pleural effusion, haemothorax, mediastinal lymphadenopathy or hepatic spread.

Oxygen consumption and PEEPe in ventilated COPD patients.

The intrinsic positive-end-expiratory pressure (PEEPi) increases the inspiratory load, the cost of breathing and thus oxygen consumption (V(O2)). It has been shown that applying an extrinsic positive-end-expiratory pressure (PEEPe) reduces the inspiratory threshold load but the optimal PEEPe level is still in debate. We hypothesize that the best level of PEEPe could induce a decrease in V(O2) by reducing the V(O2) demands from PEEPi. Nine mechanically ventilated COPD patients were included. The level of PEEPe was determined in accordance with the static PEEPi. V(O2) was measured using an automatic gas analyser during synchronized intermittent mandatory ventilation (SIMV): without PEEPe, with a PEEPe equal to 50% of static PEEPi and with a PEEPe equal to 100% of static PEEPi. Static PEEPi appeared to be significantly correlated with the degree of airflow obstruction (FEV1) (P<0.05). Applying a PEEPe equal to static PEEPi resulted in a significant decrease in V(O2) (P<0.05) whereas the change in V(O2) proved to be unpredictable for a PEEPe level of 50% of static PEEPi. In conclusion, V(O2) decreases progressively when increasing PEEPe up to a level equal to 100% of static PEEPi. Thus, in mechanically ventilated COPD patients with a FEV1 < or = 1000 ml, applying a PEEPe of 5 cmH2O should be recommended.

[Results of an ambulatory respiratory rehabilitation program: observations in 100 COPD patients]. / Résultats d'un programme de réhabilitation respiratoire en mode ambulatoire chez 100 patients atteints de broncho-pneumopathie chronique obstructive.

INTRODUCTION: Respiratory rehabilitation is a multidisciplinary approach enabling personalized management adapted for each patient's handicap. METHOD: Our ambulatory program includes twenty sessions per week (four half-days/week) for respiratory training at the ventilatory threshold, respiratory physical therapy, and health education. One hundred COPD patients participated in this retrospective study: mean age 62.1 +/- 9.6 years; FEV1: 1.51 +/- 0.66 (53 +/- 22% of theoretical). RESULTS: At the ventilatory threshold, there was a significant 9% gain in oxygen uptake and a 31% gain in power. At maximal exercise, there was a 6% improvement in oxygen uptake, 21% gain in power, and 7% gain in tidal volume (p<0.05). Walking distance improved 15% (+ 61 m). Quality of life was also improved significantly, with loss of 8 points on the Saint-George's Hospital respiratory questionnaire. CONCLUSION: This study demonstrates the beneficial effect of respiratory rehabilitation in terms of improved tolerance to exercise and improved quality of life for COPD patients.

[Aortobronchial fistulas]. / Fistules aorto-bronchiques.

INTRODUCTION: Aortobronchial fistulas are uncommon but generally fatal if not treated surgically. Haemoptysis is the main symptom of this pathology. STATES OF ART AND PERSPECTIVES: Aortobronchial fistulas occur most commonly in patients with thoracic aneurysms (atherosclerosis, mycotic, aortic surgery's complication...). Main investigation is CT angiography with 2 D and 3 D reconstructions. CONCLUSION: Endovascular exclusion can be efficient treatment option.

[Amyloidosis and pleural calcification]. / Amylose et calcinose pleurale.

INTRODUCTION: Pulmonary diseases during the course of generalised amyloidosis are principally represented by tracheobronchial involvement and diffuse parenchymal localizations. CASE REPORT: The authors report the case of a 66-year-old woman presenting with pleural amyloidosis in the context of generalised amyloidosis. Thoracoscopy performed in the investigation of recurrent transudative pleural effusions found evidence of an inflamed parietal pleura with areas of calcification. Pleural biopsies confirmed amyloid infiltration pleural ossification. Talc pleurodesis was performed. CONCLUSIONS: The authors' conclusion is that, meeting an unexplained pleural effusion even transudative during the course of a generalised amyloidosis, the thoracoscopy is the diagnosis key test as it allows moreover a pleural pleurodesis to be performed.

[Bronchiolitis obliterans organizing pneumonia associated with dermatomyositis and antiphospholipid syndrome]. / Bronchiolite oblitérante avec pneumopathie organisée associée à une dermatomyosite et à un syndrome des antiphospholipides.

Dermatomyositis and antiphospholipid syndrome are rare diseases that can be associated pulmonary damage. We report a case of anti-phospholipid syndrome that presented with bilateral pulmonary embolism and subsequently developed pulmonary infiltrates in association with the characteristic muscular and cutaneous features of dermatomyositis. Histological examination of trans-bronchial biopsies revealed bronchiolitis obliterans organizing pneumonia.

[Effects of a pressure support ventilation of 6 cm H2O on oxygen consumption of the respiratory muscles during weaning of mechanical ventilation]. / Effets de l'adjonction d'une aide inspiratoire de 6 cm H2O sur la consommation en oxygène des muscles respiratoires au cours du sevrage de la ventilation mécanique.

OBJECTIVE: To determine the effects of a pressure support ventilation (PSV) of 6 cm H(2)O during spontaneous breathing on oxygen consumption of the respiratory muscles (VO(2) resp), gas exchange, respiratory rate, tidal volume and to determine if these low levels of PSV can reduce or cancel the increase in work of breathing induced by the resistances of the endotracheal tube and the circuit of the respirator. PATIENTS AND METHODS: Prospective study. Twenty intubated patients were studied. The VO(2) resp was assessed by measurements of inspired and expired concentrations of oxygen (O(2)) and carbon dioxide (CO(2)) in patients during controlled ventilation and spontaneous breathing. Gas exchange, respiratory rate, minute ventilation, tidal volume and VO(2) resp were collected during spontaneous breathing with a PSV level of 6 cm H(2)O and without PSV. SETTING: Respiratory Intensive Care Unit, Amiens, University Hospital 80054 Amiens. RESULTS: A PSV level of 6 cm H(2)O significantly increased the spontaneous tidal volume (+12%) without any modification in respiratory rate, minute ventilation, tidal volume and gas exchange. No significant improvement in VO(2) resp was found when a PSV level of 6 cm H(2)O was added. CONCLUSION: Despite a significant increase in spontaneous tidal volume, adding a PSV level of 6 cm H(2)O did not improve VO(2) resp. Thus, low level of PSV did not reduce the increased work of breathing induced by the resistances of the ventilator tubing and the endotracheal tube.

[Difficult catheterization]. / Un cathéter bien capricieux.

We report a case of a spontaneously ruptured implantable-chamber catheter which migrated to the right atrium. Removal by interventional radiology techniques is the treatment of choice for this type of complication.

[Tuberculosis of the breast]. / Tuberculose mammaire.

The authors report a case of tuberculosis of the breast in a patient aged 71. The case described is an example of a rare form of extra pulmonary tuberculosis whose diagnosis can pose problems. In view of the recent increase in the incidence of tuberculosis in certain developed countries and the growth in the proportion of cases of extra pulmonary tuberculosis especially in HIV sero-positive individuals an observation such as this is useful in that it recalls for clinicians the fact that tuberculosis may present in very unusual forms which are easily forgotten.

[Surgical emergency disclosing sarcoidosis. Apropos of a case]. / Urgence chirurgicale révélant une sarcoïdose. A propos d'un cas.

Sarcoidosis is a diffuse granulomatosis predominately with mediastino-pulmonary localizations. A wide range of extrathoracic localizations can also occur and when they are the initial manifestation, may lead to misdiagnosis. We observed a rare case of peritoneal sarcoidosis revealed by a surgical emergency.