Revue des maladies respiratoires最新文献

Introduction: Tuberculous otomastoiditis is a rare and serious infection that most often occurs in association with pulmonary involvement. It is easy to diagnose when the two pathologies are associated and isolated. We herein report the case of a patient initially hospitalized for Pseudomonas aeruginosa necrotising otitis externa (NOE), which delayed the diagnosis of tuberculous otomastoiditis.

Observation: The 50-year-old patient was hospitalized for NOE and concurrently presented with pulmonary tuberculosis. NOE was associated with temporal bone lysis with carotid canal involvement. Despite appropriate treatment, NOE evolution was unfavourable. Two months later, the patient underwent a mastoidectomy to evacuate a mastoid abscess. In a deep tissue sample, tuberculosis complex was detected by PCR assay. For 12 months, the patient underwent for pulmonary and osseous tuberculosis. While the clinical course was favourable but deafness occurred subsequently.

Conclusion: An association of P. aeruginosa NOE and tuberculous otomastoiditis is a highly exceptional event.

Introduction: After a pulmonary rehabilitation (PR) program, 30 to 70% of patients fail to pursue maintenance of physical activity. This study aimed to identify psychosocial markers associated with MPA subsequent to an initial outpatient PR course (≥10 sessions).

Material and methods: Patients were enrolled in an exploratory quantitative monocentric retrospective study. Clinical data were extracted from the PR center database. Psychosocial data were collected by a postal questionnaire. A telephone interview assessed maintenance of physical activity at 12months, which was defined as self-reported physical activity≥30min,≥2 times per week.

Results: Among 134 patients (age 67years [31-88], 88% COPD, FEV1 55% [25-103]), 95 (71%) reported maintenance of physical activity at 12months. Multivariate logistic regression analysis showed that compared with subjects without maintenance of physical activity, those with the latter: (1) reported greater self-efficacy and internal locus of control, (2) considered their health status as less severe and (3) resided closer to the PR center.

Conclusion: Patient-declared self-efficacy and locus of control internalization were independently associated with maintenance of physical activity 12months after an initial PR program.

Otherwise known as mediastinal emphysema, pneumomediastinum (PNM) in connective tissue diseases is a rare clinical entity. Few cases have been described in the literature. In fact, it only exceptionally complicates the evolution of connective tissue diseases. In this paper report, two cases of spontaneous PNM secondary to scleroderma and Sjogren's syndrome. Based on the data in the literature, we discuss the etiology, frequency of occurrence, and the pathophysiological mechanisms of this unusual complication.

Introduction: Pulmonary airway dystrophy (PAD) is a rare disease that may be either innate or acquired. Very few publications have been dedicated to the repercussions of the air pressure variations that may be encountered during an airplane journey in a pressurized cabin, an aerial tramway ascent or a stay in a high-altitude setting. Variations may also occur during deep-sea diving with modification of absolute air pressure.

State of knowledge: The published observations show that all PAD cases have been associated with accidents during exposure or with variations in ambient air pressure. The different published reports should be considered with maximum caution and circumspection. It is of the utmost importance to painstakingly study each case in view of proposing a line of conduct in accordance with the etiology and severity of the disease. It also matters to take into full account the activity under consideration (climbing into altitude or deep-sea diving); the risks incurred are by no means identical.

Perspectives: It would be of interest to hold a register of barotrauma cases or other accidents resulting from air pressure variations affecting persons with cystic lung disease or with pulmonary bullae in cases of PAD.

Conclusion: While expert opinions and recommendations differ from one another, and notwithstanding the assistance provided by thoracic tomodensitometry, a premium should be placed on caution. In contentious cases, it makes sense to obtain the informed opinion of a pneumologist or certified hyperbaric physician familiar with PAD and its possible complications.

Introduction: BCG therapy is the standard treatment for bladder tumors that do not infiltrate smooth muscle. Fluoroquinolones for antibiotic prophylaxis are recommended to lessen the risk of BCG infection (BCGitis) with respiratory involvement.

Case report: This study describes five cases of BCGitis in males, with a median age of 71years [range: 66-77years] having undergone ofloxacin prophylaxis during their BCG therapy for a non-invasive bladder tumor (grade pT1a). Among these patients, four experienced fever within eight hours of the last instillation, as well as respiratory symptoms such as dyspnea and cough. Three of them exhibited substantial weight loss over the course of one month. Chest scans consistently revealed miliary patterns. While only in one patient was BCG identification confirmed, typical clinical and CT presentations prompted the initiation of treatment, predominantly employing a combination of isoniazid, rifampicin, and ethambutol in four patients, and isoniazid and rifampicin in the fifth. Treatment duration ranged from six to nine months. One-year follow-up indicated a favourable outcome for all patients.

Conclusions: This study shows that ofloxacin prophylaxis may in some cases fail to prevent iatrogenic BCGitis.

In a qualitative investigation carried out in different environments (hospital, school, home) among 12-to-21-year-old asthmatics, we describe their perceptions of a pathology that is at once chronic and intermittent. More specifically, we show how an asthma attack constitutes a traumatic experience occurring in a temporality characterized by bodily upheaval. We describe the emotional labor provided by young asthmatics in their interpretation of their bodily signs, which are often read differently than in the medical sphere. The intermittency of the disease and the occurrence of crises in specific situations lead adolescents to achieve improved knowledge of their bodies. In this study, we analyze the roles of supports (inhalers…) and adaptative techniques in the development of know-how enabling them to autonomously treat their symptoms and monitor the signs of an upcoming attack.

As the effects of electronic cigarettes (ECs) have rapidly become widely known, we propose to take stock of recent findings on the bronchopulmonary and cardiovascular adverse effects (AEs) and the risks of cancer occurrence entailed by EC use. METHOD: We carried out a search from 2018 to October 19, 2023 on PubMed, adopting the PRISMA guidelines (2020) with the following keywords in "Titles and abstracts": electronic cigarette, or e-cigarette, or ENDS, AND safety or toxicology or effect or health effect, using "Systematic Review" as a filter. The inclusion criteria were: systematic review of in vitro or in vivo studies in English or French dealing with the risks of ECs for the bronchopulmonary system, the cardiovascular system, or cancer occurrence. CONCLUSION: Twenty-eight systematic reviews on the adverse effects (AE) of electronic cigarettes (EC) in selected humans show that the toxic substances they generate can cause cancers and increase the risk of cardiac and pulmonary disorders. New studies on the potential dangerousness of EC use are essential and urgent.

Functional exercise testing (FET) assesses an individual's capacity to adapt to effort and identifies limiting factors, particularly dyspnea. It orients therapeutic choices, predicts the progression of chronic pathologies, and estimates preoperative risks, at times contraindicating surgery. The aim of this article is to provide a summary of the specific indications for functional exercise testing, test protocol selection, test equipment, appropriate personnel, and patient and test safety. This article is intended for healthcare professionals conducting or considering functional exercise testing.

Introduction: Pleural procedures are painful interventions. While there exist recommendations aimed at preventing pain induced by local anesthesia, they have never been evaluated with regard to the thoracic wall. The objective of this study was to evaluate the effectiveness of buffered lidocaine local anesthesia in pleural procedures.

Methods: Descriptive, monocentric, prospective study, including all initial pleural procedures performed in our unit. Pain was assessed 20minutes after the procedure using the VAS (Visual Analog Scale) or the NRS (Numerical Rating Scale).

Results: Two hundred and fifty-one patients were included. The procedures included thoracocentesis (58%), pleural or pulmonary biopsy (28%), or drainage (14%). Average pain intensity was 0.6 on a scale of 10. Over two thirds (68%) of patients had a VAS or NRS score of 0, and 91%≤2. Infectious pleuritis, pneumothorax, and drainage were associated with more pain. The pain levels were acceptable (average VAS/NRS scores of 1.3, 1.8, 1.7 respectively).

Conclusion: Buffered lidocaine local anesthesia provides excellent pain control for pleural procedures, regardless of their nature. Recommendations regarding local anesthesia apply to the thoracic wall, and their dissemination is essential to reduction of the pain induced by pleural procedures.