[Pneumococcal spondylodiscitis. A case report]. / Spondylodiscite à pneumocoque. A propos d'un cas.

We report on a case of a 66 years-old patient suffering weight loss and lumbar pain, localized at L2-L3. A spondylodiscitis was revealed by CT and MRI; intervertebral disc puncture was positive for Pneumococcus Pneumoniae. The clinical evolution was good with the anti-bacterial treatment, while the patient developed a synostosis L2-L3. Incidence, bacteriology, imaging and therapy of spondylodicitis are discussed.

[Role of clinical thoracoscopy in the diagnosis and treatment of pleuropulmonary cancer]. / Place de la thoracoscopie médicale dans le diagnostic et le traitement du cancer pleuropulmonaire.

Pleuro-pulmonary cancer has a place of choice in medical thoracoscopy. From the diagnostic point of view, this technique, performed under local anesthesia leads to the diagnosis of neoplastic effusion in most cases in the shortest possible time. It improves therapeutic efficacy and especially demonstrates as resectable tumours which could have been declared inoperable. For pleurodesis, pleural talc insufflation under thoracoscopy seems to be the best available technique. Complications are rare with a well-trained operator, as long as he keeps in mind the contraindications of this technique which should be taught to future pneumologists.

[Sleep apnea syndrome and hypothyroidism: apropos of a new case and a review of the literature]. / Syndrome d'apnée du sommeil et hypothydroïdie: à propos d'un nouveau cas et revue de la littérature.

We present the case of a 63 years old man (177 cm height, 111 kg weight) with autoimmune thyroiditis. He had a long term history of hypersomnolence and heavy snoring. Two years ago, because of a bifascicular block and sinus pauses, a cardiac pace-maker was placed. Polysomnography recording showed a systematic periodic breathing characterized by profound desaturation waves (often 92% Sa O2 to 60% Sa O2) every 60 seconds, secondary to prolonged mixed apneas. Hormone replacement therapy and a 17 kg weight loss completely suppressed the sleep apnea syndrome within five months. We conclude that SAS is a major component of the respiratory depression in hypothyroidism and that normalisation of thyroid function can definitely cure the patient.

Technetium-99m MDP vs technetium-99m dicarboxypropane diphosphonate. A clinical comparison in various pathologic conditions.

The performance of Tc-99m MDP vs Tc-99m dicarboxypropane diphosphonate (DPD) was evaluated in 20 patients with various skeletal bone diseases. Each patient was investigated twice, with an interval of three days between studies and using the same protocol, hence each case served as its own control. The results were: In a subjective interpretation by five independent and experienced investigators, the difference between agents was small, yet in favor of MDP. Region of interest (ROI) analysis of the pooled results in 74.4% of all cases shows a higher bone lesion to normal bone ratio (BL/NB), and in 79.3% of all cases, a better bone lesion to soft tissue ratio (BL/ST) with Tc-99m MDP. When considering pathology types separately, the BL/NB ratio of Tc-99m MDP was 17.7% higher than the one of Tc-99m DPD in metastases, 9.5% higher in rheumatoid arthritis, 2.8% higher in metabolic diseases, and 24% higher in bone fractures. Student's paired t test on the pooled BL/NB ratios shows a difference of 15.5% for Tc-99m MDP, significant at P = 0.00155. The overall results of our study favor Tc-99m MDP.

Changes in regional and overall lung function after bronchography.

This investigation compares the effects of unilateral bronchography on classical pulmonary function parameters (spirometry, CO transfer, flow-volume curve, and arterial blood gases) and radioisotopic measurements by means of 99mTc-labeled microspheres and 81mKr. The regional changes of ventilation and perfusion were quantified by a radioisotopic index, which was established for each zone of interest: explored lung and unexplored lung. The quantitative study of regional perfusion and ventilation reveals significant reduction of ventilation for lung bases, but not for lung apices. The radioisotopic measurements show a reduction of perfusion parallel to the reduction of ventilation. There is no significant correlation between traditional pulmonary function parameters and isotopic indices. Radioisotopy proved a sensitive tool for investigation of unilateral alterations.

Left chylothorax complicating a translumbar aortography.

The authors report a case of left chylothorax after a translumbar aortography, successfully managed by conservative means. As far as they known 16 similar cases are described. They review the literature on this subject.