[Chylous ascites complicating domiciliary ventilation by tracheostomy]. / Ascite chyleuse compliquant une ventilation à domicile par trachéotomie.

INTRODUCTION: Despite the development of non-invasive ventilation there remain indications for domiciliary ventilation by tracheostomy (TDV). The principal complications are mechanical and infective. We report a case of chylous ascites secondary to compression of the thoracic duct by the tracheostomy cuff. CASE REPORT: A man of 65 had had TDV for over one year. During hospitalisation for possible weening chylous ascites was discovered. The classical causes of this condition were excluded. CT scan of the neck and thorax showed evidence of significant dilatation (over 45 mm) of the upper part of the trachea in association with an over-inflated cuff, leading to compression of the thoracic duct. On reducing the inflation pressure of the cuff the chylous ascites has not recurred. CONCLUSION: The management of the tracheostomy tube cuff is an important matter for the personel involved in the management of TDV. Regular radiological surveillance is useful to ensure that there is no tracheal dilatation in association with the cuff.

[Pleural effusion following hepatic radiofrequency]. / Pleurésies post radiofréquence hépatique.

INTRODUCTION: Surgery is the treatment of choice for primary or secondary hepatic tumours. If surgery is contra-indicated radiofrequency offers an alternative treatment capable of destroying tumours small in size and/or number. It is undertaken percutaneously, during laparotomy or endoscopically. Respiratory physicians should be familiar with certain complications. CASE REPORTS: We report two cases of pleurisy following hepatic radiofrequency. The effusions were diagnosed 15 days and one month after radiofrequency treatment for liver metastases from colonic carcinoma. The effusions were exudative and predominantly lymphocytic. The first effusion required thoracoscopy to establish the diagnosis; the second dried up following 5 pleural aspirations. CONCLUSION: Post radiofrequency pleurisy may develop late and present problems in diagnosis and treatment.

[Pneumomediastinum complicating the anti-synthetase syndrome]. / Pneumomédiastin compliquant un syndrome des anti-synthétases.

INTRODUCTION: Pneumomediastinum is a rare but classical complication of dermatomyositis. Its development is a serious matter and necessitates prompt recourse to aggressive treatment with corticosteroids combined with immuno-suppressants or intravenous human immunoglobulin. CASE REPORT: We report the case of a 63 year old woman presenting with pulmonary infiltration, in the presence of dermatomyositis, as a clinical manifestation of the anti-synthetase syndrome. The progress was rapidly unfavourable with pneumomediastinum and acute respiratory distress despite initial treatment with corticosteroids followed by human immunoglobulin and immunosuppressants. CONCLUSION: The identification of cutaneous or muscular signs in the initial investigation of a pulmonary infiltrate should lead to a search for anti-synthetase antibodies in order to determine the optimal clinical management as quickly as possible.

[Spontaneous pneumothorax revealing malignant pleural mesothelioma. Three case reports]. / Trois cas de pneumothorax spontané révélant un mésothéliome pleural malin.

Spontaneous pneumothorax is an uncommon inaugural presentation of malignant pleural mesothelioma. We report three cases in men aged 65, 30 and 76 years. The diagnosis was suggested at medical imaging and was confirmed at histological analysis of biopsies obtained by thoracoscopy in two patients and thoracotomy in one. The first patient (age 65 years) died two months after the initial diagnosis. The second patient (age 30 years) was alive 40 months after 15 chemotherapy cycles using a platinim-gemcitabine combination. Complete tumor response was achieved in the third patient (age 76 years) after 9 chemotherapy cycles with the same combination. Since mid-term prognosis is fatal for this type of tumor, we propose thoracoscopy in all patients over 30 years who develop spontaneous pneumothorax with no morphological features increasing the risk of pneumothorax, and particularly in patients with asbestos exposure.

[Rapid identification of pneumococcal antigenes in urines by the Now Streptococcus pneumoniae Binax test]. / Détection rapide des antigènes pneumococciques urinaires par le test Now Streptococcus pneumoniae Binax.

Streptococcus pneumoniae is responsible for many infectious conditions but probably with an underestimated incidence especially because of the fragility of the bacteria. The present study has evaluated a new test which detects a pneumococcal antigen in urine (Now S.p Binax). Urine samples from 181 children and 40 adults have been tested. All the patients presented with typical clinical signs of pneumococcal infection. Sensitivity = 91.7 %; specificity = 54.2 %; positive predictive value = 50 %; and negative predictive value = 92.9 % have been observed. Although the sensitivity and specificity were lower than those announced by the manufacturer, the test is easy to handle and provides a rapid argument for the diagnosis of pneumococcal infection, especially in the case of invasive infections like meningitis and bacteraemia.

[Pulmonary aspergillosis complicating chronic septic granulomatosis. Treatment with itraconazole and gamma interferon]. / Aspergillose pulmonaire compliquant une granulomatose septique chronique. Traitement par itraconazole et interféron gamma.

A 20-year-old patient suffering from chronic granulomatous disease developed pulmonary aspergillosis with thoracic wall invasion. Treatment with itraconazole combined with 3-weekly injections of interferon gamma (INF gamma) improved the patient's general state of health within two months. Functional signs resolved totally and x-ray images continued to improve for 6 months. INF gamma was withdrawn after 11 months and was replaced with cotrimoxasole. Itraconazole was continued in a long-term regimen. Four years after onset of treatment, the clinical status of the patient remained satisfactory, and the radiological aspect was unchanged. Pulmonary aspergillosis affects up to 40% of patients suffering from chronic granulomatous disease. Mortality is high, to the order of 25%. The classical treatment is based on amphotericin B, but this case points out the significant contribution of itraconazole as first-line therapy. This antimycotic has been suggested for prophylaxis. The combined use of INF gamma can be discussed due to the uncertainties about its long-term effects and because of the requirement for 3-weekly injections. High cost is another important consideration.

[Semi-invasive pulmonary aspergillosis. Apropos of a case]. / L'aspergillose pulmonaire semi-invasive. A propos d'une observation.

A 43-year-old man was admitted to hospital for excavated pneumopathy of the upper part of the right lung, revealed by signs of respiratory infection evolving for a few weeks and involving a 10-kg weight loss. The radiological and clinical evolution and the demonstration of Aspergillus fumigatus allowed establishing a diagnosis of semi-invasive aspergillosis. The treatment, associating amphotericin B and 5-fluorocytosine, replaced by itraconazole 15 days later, soon produced clinical healing and radiological improvement. Since serology remained positive, surgery was performed to remove the residual lesions after a 7-month course of itraconazole. Within the scope of this case, the diagnostic criteria of this form of pulmonary aspergillosis are discussed, as well as the merits and limitations of itraconazole.

[Bilateral Torulopsis glabrata pneumonia]. / Pneumopathie bilatérale à Torulopsis glabrata.

In a 48-year old male patient hospitalized for evaluation of fatigue with non-productive cough and dyspnoea, standard radiography and computerized tomography of the chest showed nodular opacities in both lung apices. Examination of intrabronchial specimens revealed mycelial filaments, and Torulopsis glabrata grew in culture. Under antifungal treatment the clinical signs rapidly improved and the radiological abnormalities disappeared more slowly, which confirmed the diagnosis of T. glabrata pneumonia. The authors recall the pathogenic role of this yeast-like fungus, closely related to Candida albicans, which mainly causes severe opportunistic infections. The diagnostic criteria, the part played by immunodepression in the disease and the therapeutic problems encountered are also discussed.