[Functional exercise testing in idiopathic inflammatory myopathies with pulmonary involvement]. / Intérêt de l'épreuve fonctionnelle d'exercice au cours des myopathies inflammatoires avec atteinte pulmonaire.

INTRODUCTION: Dyspnoea occurring during inflammatory myopathy associated with interstitial lung disease (ILD) can be ascribed to several physiopathological pathways. The purpose of this study was to analyse cardiopulmonary exercise testing (CPET) abnormalities in these patients in order to precise mechanisms responsible for decreased aerobic capacity. METHODS: Ten patients (52 +/- 12 years) were diagnosed as having inflammatory myopathy with interstitial lung disease. Exercise dyspnoea was found in 9 patients. All of them had a restrictive pattern associated to and impairment of the transfer factor for carbon monoxide. CPET was performed with a bicycle ergometer using a standard protocol of incremental increasing work load. RESULTS: Two patients had a normal exercise capacity while eight patients had abnormal VO2 associated with hyperventilation, abnormal gas exchange, as well as and abnormal dead space. Five patients also exhibited decreased oxygen pulse (<80% expected value) at peak exercise; 4 out of 5 had persistence of ventilatory reserve. In addition DeltaFC/DeltaVO2 was increased (>50) in 7 cases. CONCLUSION: CPET provides useful information in the understanding of mechanisms of dyspnoea and might be an effective tool in treatment decision making: in patients with inflammatory myopathy and associated ILD abnormal oxygen pulse may reflect cardiac disorder or muscular abnormalities (inflammatory or steroid myopathy).

[Compliance to the antibiotic committee guidelines in Tourcoing Hospital]. / Evaluation du respect des choix de molécules recommandées par le guide d'antibiothérapie de l'adulte du centre hospitalier de Tourcoing.

AIMS OF THE STUDY: We evaluated the compliance to the antibiotic committee guidelines of Tourcoing Hospital. METHODS: A national nosocomial infections prevalence study was conducted in June 2006. We collected additional data on the name and indication of prescribed antibiotics compared to recommended drugs in our therapeutic guidelines. Endpoints were antibiotic indication, compliance to local guidelines, unjustified combination therapy and deescalation therapy if possible. Situations non included in the guidelines were evaluated on a case to case basis after discussion with the prescribing physician. Pediatric (N=5) or prophylaxis (N=4) prescriptions were not analysed. RESULTS: Antibiotics were used in 97/669 (14.5%) patients including 32% in acute care, 11% in rehab and 0,9% in long term care. Drugs recommended in the guidelines were used in 63 cases (60.5%) including 56.3% first line and 4.2% justified second line therapy. When including situations not included in the guidelines and judged as correct, compliance reached 64.9%. The 41 variations from guidelines observed in 34 patients concerned: molecule choice (N=12), lack of antibiotic indication (N=12), unjustified combination therapy (N=12), drug choice in combination therapy (N=5), lack of deescalation (N=1). Lower respiratory tract (N=12) and urinary tract (N=7) infections as well as fluoroquinolones (N=12) were the most frequent deviations from guidelines. CONCLUSION: Compliance rate is encouraging. This study pinpoints specific targets for future interventions.

[Endodermal pulmonary tumor resembling a fetal lung]. / Tumeur pulmonaire endodermique ressemblant au poumon foetal.

We report a case of a 56-year-old man who developed a flu-like syndrome associated with weight loss. Chest X-ray revealed a homogeneous round lesion of the lung with sharply defined margins in the central lobe. At pathology, the tumor was found to be an endodermal pulmonary tumor resembling a fetal lung. This uncommon tumor is generally a fortuitous chest X-ray finding seen as a rounded peripheral opacity. Diagnosis is based on pathology examination of the surgical specimen. Complementary investigations are not contributory. Unlike blastoma, a differential diagnosis, prognosis is generally good.