[Assessment of recent weight history before instituting continuous positive airways pressure in a cohort of patients with severe obstructive sleep apnoea/hypopnea syndrome]. / Histoire pondérale récente, avant l'institution de la pression positive continue, dans une cohorte de patients ayant un syndrome d'apnées-hypopnées obstructives du sommeil sévère.

OBJECTIVES: The aim of this study is to evaluate the recent weight history in patients with the obstructive sleep apnoea/hypopnoea syndrome (OSAHS) needing treatment with continuous positive airways pressure (CPAP). PATIENTS AND METHODS: Over a period of 18 months, a self-administered questionnaire concerning recent weight history was given to patients during the installation of CPAP. RESULTS: The study population consisted of 1337 patients. An increase in weight of at least 5% over the 5 years preceding the institution of CPAP was found in 44% of patients. This increase was moderate (5-10%), important (10-20%) and very important (>20%) in respectively 12.3%, 16.1% and 15.6% of patients. The patients with important or very important weight gain differed from those whose weight remained steady in a higher percentage of women, young people, and patients with a higher prevalence of obesity, persistent smoking, a history of venous thromboembolism and treatment with anti-depressants. CONCLUSION: A recent increase in weight is frequently seen in severe OSAHS and is associated with some clinical characteristics.

[Contamination of bronchial fiberscopes by mycobacteria. Myth or reality?]. / Contamination des fibroscopes bronchiques par les mycobactéries. Mythe ou réalité?

The authors report the results of a study into mycobacterial contamination of bronchial fibroscopes over a 6 year period during which 8,750 fibroscopies were performed. On 19 occasions, there were two positive results on the same day which could have led to contamination (0.07 p. 100). In 12 cases, there was heavy bacterial contamination on the first examination and at least 5 colonies on the second. Crossed transmission was not observed. The authors emphasize the role of the accessory parts and connections which are often neglected and which may lead to false positive results in the following patients; a sterilisation procedure is proposed which seems to be effective as no mycobacterial contamination has been observed since it was introduced.

[Treatment of status asthmaticus. Prospective evaluation of a protocol combining aminophylline and terbutaline (44 cases)]. / Traitement de l'état de mal asthmatique. Appréciation prospective d'un protocole associant aminophylline et terbutaline (44 cas).

The treatment of status asthmaticus remains poorly defined. Even the definition of the condition is controversial. We have therefore attempted to define a therapeutic protocol consisting of a combination of terbutaline, aminophylline and hydrocortisone administered parenterally. We have conducted a prospective evaluation of the effectiveness and tolerance of this protocol. 44 consecutive patients with status asthmaticus (defined as an abnormally severe episode of asthma with early or marked alveolar hypoventilation: PaCO2 greater than or equal to 5.20 kPa) were entered into the study over a period of 56 months. The effectiveness of this combination is reflected by the rapid improvement in the clinical and blood gas parameters, the relatively rare use of mechanical ventilation (of brief duration) and the low mortality. The tolerance proved to be excellent, as the terbutaline only had to be stopped in 1 case (permanently) and the aminophylline in one other case (temporarily). These initial results encourage us to a more aggressive approach in the early treatment of status asthmaticus with particular attention to the associated metabolic acidosis.

[Amyloidosis and its bronchopulmonary localizations. Apropos of 3 cases]. / L'amylose et ses localisations broncho-pulmonaires. A propos de trois observations.

Amyloidosis of the lower respiratory tract is a rare condition. We report three new cases and we review the literature. Tracheobronchial amyloidosis is the most frequent form. The diagnostic is made by fiberoscopy and biopsies with a risk of bleeding. Our patients were usually treated with intermittent bronchoscopic resections. In one of the three cases reported, desobstruction of the large airway was performed with laser. Nodular pulmonary amyloidosis is usually asymptomatic, and surgical resection results in cure in all cases. Diffuse pulmonary amyloidosis is very unusual and fatal.