Telemonitoring in continuous positive airway pressure-treated patients improves delay to first intervention and early compliance: a randomized trial.

OBJECTIVE: Telemonitoring (TM) has been used in continuous positive airway pressure (CPAP)-treated patients to improve compliance, but results have been inconsistent. The purpose of this study was to assess the impact of TM on the delay to the first technical intervention after CPAP initiation. The impact of TM on mean compliance during the first 3 months of treatment was measured as a secondary outcome. METHODS: Patients diagnosed with moderate to severe obstructive sleep apnea syndrome were prospectively included and randomized to receive usual care (UC) or TM. In both arms, an educational session was scheduled 1 month after CPAP initiation, and medical visits were planned after 1.5 and 3 months. In the TM arm, we added a universal TM unit (T4P) to the CPAP device. RESULTS: Delay to first intervention was significantly shorter in the TM group (29 ± 25 vs 47 ± 30 days, p = 0.02). The first intervention in the TM group was motivated by detection of problems by the TM system in 39% of patients. Compliance at 3 months was significantly better in the TM group (5.7 ± 1.6 vs 4.2 ± 1.9 h/night, p = 0.018). CONCLUSION: This is the first randomized study showing that TM reduces delay to first technical intervention in CPAP-treated patients. This early activation of troubleshooting was associated with improved compliance at 3 months. Since CPAP side effects at 1 month have been shown to predict lower 12-month CPAP compliance, TM seems to be an excellent tool for improvement of long-term CPAP acceptance.

[Atypical respiratory tract infections in adult patients in the primary care]. / Les infections broncho-pulmonaires à germes atypiques chez l'adulte : Mythe ou réalité ?

Respiratory tract infections remain one of the most frequently encountered acute illnesses in the primary care. Atypical germs along with Streptococcus pneumoniae are an important cause of community-acquired pneumonia. Most infections caused by atypical germs are mild or moderate but some of them might cause a severe disease with important morbidity and mortality. Diagnosis of community-acquired pneumonia remains a challenge in the primary care. On the other hand some of them are reported to be associated with chronic cough which is a common problem in the general practice. The aim of this mini-review is to give a short overview of some data on local prevalence, presentation and scoring systems, with stress on feasibility of current diagnostic methods in the primary care practice and therapeutic considerations for the general practitioners.

Les infections respiratoires sont la première cause de consultation en médecine générale. Le Streptococcus pneumoniae suivi par les germes atypiques sont une cause importante de pneumonies bactériennes en médecine extrahospitalière. La cause d'une pneumonie communautaire chez les patients hospitalisés est par ordre de fréquence décroissante, un organisme encore inconnu ou non détecté, des virus et enf in des bactéries1. Les germes atypiques sont généralement la cause d'infections peu sévères, mais peuvent malgré tout générer occasionnellement des infections plus sévères, parfois mortelles. Elles peuvent parfois simplement se manifester par de la toux chronique, un problème courant en première ligne. Diagnostiquer une pneumonie communautaire peut s'avérer difficile en médecine générale. Le but de cette mini-revue de littérature est de revoir la prévalence, la présentation clinique et les méthodes diagnostiques accessibles en première ligne, ainsi que les traitements à appliquer.

[Does sleep apnea disappear once acromegaly is adequately treated?]. / Les apnées du sommeil disparaissent-elles une fois l'acromégalie traitée ?

Acromegaly is a rare hormonal disease related to excessive growth hormone secretion. It can result in a range of complications, including cardiovascular, respiratory, metabolic, articular and neoplastic disorders. Among patients with the condition, obstructive sleep apnea syndrome occurs frequently and the effect of treatment is inconstant: improvement, statu quo or deterioration can be observed. We here report three clinical cases, which illustrate the unpredictable evolution of this condition.

[Determining factors of walking distance during 6-minutes walk test in COPD patients]. / Déterminants de la distance parcourue et de la dyspnée lors du test de marche de six minutes chez les patients atteints de BPCO.

INTRODUCTION: In stable COPD, we studied the factors determining six-minute walking distance and dyspnea at the end of the test. METHODS: Patients were evaluated by tests of lung function, St Georges' respiratory questionnaire (SGRQ) and 6MWT with inspiratory capacity measurements (IC) and continuous oxymetry. RESULTS: Eighty-two patients (mean FEV(1): 56+19% predicted) were studied. Mean 6-minute walking distance was 477+89m, (72+14% PV). Walking distance during 6MWT (m) was correlated with FEV(1), IC/TLC ratio, TLC, pre-test IC and DLco/VA. When expressed as a percent of predicted values, walking distance was correlated with FRC, pre-test IC and SGRQ activity score. End-test dyspnea was correlated with FRC, pre-test dyspnea and SGRQ activity and total scores. CONCLUSION: The factors determining 6-minute walking distance and end-test dyspnea are complex and include both functional and non-functional factors. In COPD, 6MWT is thus an investigation that has additional integrative value.

Extrapulmonary small cell carcinoma following augmentation enterocystoplasty.

Tumours developing after urinary tract or bladder reconstruction with intestinal tissue have well been described. Adenocarcinomas and transitional cell carcinomas are the most frequent histological features. We report here a case of small cell carcinoma developing after augmentation enterocystoplasty. This rare observation is an opportunity to review the literature about extrapulmonary small cell carcinoma and tumours developing after uro-intestinal reconstruction surgery.

[Hemoglobinopathy C and splenomegaly in an Ivory Coast patient. Value of splenectomy]. / Hémoglobinopathie C et splénomégalie chez un patient ivoirien. Intérêt de la splénectomie.

We report the case of a young patient native of the Ivory Coast who suffered from homozygous hemoglobin C disease. He presented with the usual findings of this hemoglobinopathy: a moderate hemolytic anemia and a massive, painful and even disabling splenomegaly. Pain completely disappeared following splenectomy. However, postoperative course was complicated by portal venous thrombosis, which was medically treated. No deficiency of natural coagulation inhibitors could be demonstrated, so splenectomy was the only factor predisposing to thrombosis. We consider that in only very few cases of hemoglobin C disease, splenectomy (preceded by prophylactic antipneumococcic vaccine) may be indicated from pain and risk of spontaneous splenic rupture.

[Detection of early stage bronchopulmonary cancer: contribution of bronchoscopy]. / Détection du cancer bronchopulmonaire au stade précoce: apport de la bronchoscopie.

Efficient methods for lung cancer screening is today an important challenge in research. Into this article, we review the available techniques for the detection of hilar located lung cancers, mainly squamous cell carcinoma. Fluorescence bronchoscopy is the latest major advance for lung cancer diagnosis.

[Use of kohl and severe lead poisoning in Brussels]. / Usage de khôl et intoxication saturnine grave à Bruxelles.

The authors report the observation of lead poisoning in a young Moroccan woman, which was caused by prolonged use of a khol made of lead sulphide. Khol is a black eye make-up used since Ancient Egypt. Clinically, this poisoning presented with abdominal crampoid pain, encephalopathy (manifested as anxiety and irritability), a Burtonian gingival border and microcytic sideropenic anaemia. Emergency chelate treatment permitted to improve clinical state and to decrease blood levels (initial blood concentration: 490 micrograms/dl; concentration six weeks after treatment: 49 micrograms/dl). The interest of such a case is recognizing, in French speaking regions, of a public health problem, largely ignored, although real, considering the high lead concentrations found in a majority of kohls available in Brussels and this very old cultural practice among Muslim populations.