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1.
J Fr Ophtalmol ; 47(5): 104133, 2024 Mar 06.
Article in English | MEDLINE | ID: mdl-38696863

ABSTRACT

PURPOSE: To study the structural and dynamic alterations in the lacrimal sac vasculature of patients with congenital, primary, and secondary acquired nasolacrimal duct obstructions (CNLDO, PANDO, SANDO) and patients with acute dacryocystitis (AD) and failed dacryocystorhinostomy (DCR). METHODS: A prospective study was performed on 65 consecutive lacrimal sacs following their complete exposure during endoscopic dacryocystorhinostomy. High magnification chromo endoscopy and changes in effective spectral response was achieved using the Storz professional image enhancement system (SPIES®). Structural characteristics studied include vascular arrangement, superficial and deep vessels, vessel calibers on cut section, abnormal branching, localized and generalized dilatations and pathologies like varices. Flow characteristics in different caliber vessels and their alterations were assessed in Spectra A mode of SPIES®. RESULTS: Distinct vascular alterations were noted in several lacrimal disorders. Vascular dilatations differed between the fundus and the body segments of the lacrimal sac, except in cases of traumatic SANDO and prior failed DCRs. 23% (7/30) of PANDO sacs showed peri sac varices and severe tortuosity. The flow in the dilated vessels was either very slow or showed intermittent backflow. Moderate dilatation of peri sac venous plexus with distinct surface linear vessels was noted in CNLDO. The cut surface of the sac wall and luminal surface differentially demonstrated several vascular patterns like speckled, scattered, branched loops, and skip areas in various diseased states. CONCLUSION: The present study found distinct alterations of lacrimal sac vasculature in several lacrimal drainage disorders and provides impetus to the vascular theory for pathogenesis of PANDO.

3.
Rev Mal Respir ; 41(3): 257-261, 2024 Mar.
Article in French | MEDLINE | ID: mdl-38388288

ABSTRACT

Tracheostomy cannula care is of paramount importance in the daily management of tracheotomized patients. While some complications are commonplace, specific events can occur, often according to type of cannula. We herein report the case of a 71-year-old patient; following a lengthy stay in the intensive care unit, she had received a Safe T-Tube cannula designed to provide support in a stenotic trachea. At home, while suctioning her tracheal secretions, she suddenly experienced respiratory distress requiring a rapid intervention. On arrival, no seeable cannula was found, either in the tracheostomy or in the patient's immediate surroundings. Following her transfer to intensive care, a new cannula was inserted into the tracheostomy opening, enabling mechanical ventilation to begin and achieving rapid relief of dyspnea and improvement of the patient's overall condition. Bronchial fibroscopy was then performed, during which the Safe T-Tube cannula was found folded on itself in a supra-carinal intra-tracheal position. It was extracted and replaced by a cannula of the same model, which was sewn to the skin. Although rare and usually limited to flexible cannulas, this complication is potentially fatal. Generally speaking, when cannula obstruction is suspected, bronchial endoscopy in an intensive care setting is a vital necessity. It is not only the cornerstone of the diagnosis, but also of paramount importance in treatment taking into full account the mechanism of obstruction.


Subject(s)
Respiratory Distress Syndrome , Tracheal Stenosis , Female , Humans , Aged , Tracheostomy/adverse effects , Trachea , Bronchoscopy , Dyspnea/etiology , Respiratory Distress Syndrome/diagnosis , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy
4.
Rev Mal Respir ; 41(1): 59-68, 2024 Jan.
Article in French | MEDLINE | ID: mdl-37827927

ABSTRACT

The role of surveillance bronchoscopy after lung transplantation. Lung transplantation is currently accepted as a potential treatment for end-stage respiratory diseases. That said, airway complications and the onset of chronic lung allograft dysfunction remain major causes of morbidity and mortality subsequent to lung transplantation and a significant obstacle to long-term survival. In this article, we discuss the advantages and limitations of bronchial endoscopy in post-lung transplant monitoring.


Subject(s)
Bronchoscopy , Lung Transplantation , Humans , Bronchoscopy/adverse effects , Lung Transplantation/adverse effects , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiology
5.
West Afr J Med ; 40(12 Suppl 1): S16, 2023 Dec 04.
Article in French | MEDLINE | ID: mdl-38063475

ABSTRACT

Introduction: L'objectif de ce travail était d'établir le profil épidémiologique, diagnostique, thérapeutique et pronostique des hémorragies digestives basses (HDB) à Cotonou. Méthode: Il s'agissait d'une étude rétrospective, descriptive sur une période de janvier 2017 à décembre 2022 dans deux unités d'endoscopies digestives à Cotonou. Elle avait porté sur les dossiers médicaux des patients admis pour HDB. Résultats: Au total 674 patients avaient été inclus, d'âge moyen 49,2 ± 2,5 ans, de sex-ratio à 2,0. L'hématochézie était le mode d'HDB le plus fréquent (94,4% ; n=636). La durée d'évolution des symptômes était inférieure à un mois chez la majorité des patients (50,6% ; n=365). L'HTA étaient l'antécédent le plus retrouvé (38,0% ; n=203). La majorité des patients avait réalisé l'endoscopie 48 h après leur première consultation (51,1% ; n=405). L'étiologie la plus fréquente était la maladie hémorroïdaire (35,9% ; n=621), suivie des polypes coliques (23,0% ; n=621). La ligature élastique était le moyen thérapeutique le plus utilisé dans les maladies hémorroïdaires (74,4% ; n=223) et la polypectomie endoscopique dans les cas de polypes (100% ; n=143). L'évolution était favorable dans la majorité des cas (90,0%; n=559) avec une récidive hémorragique dans 10,0% (n=56). La mortalité était de 2,7% (n=18). Conclusion: Les HDB sont fréquentes à Cotonou. Les moyens diagnostiques disponibles sont performants et la prise en charge est de bonne qualité dans les principaux centres de Cotonou. Mots clés: Hémorragies digestives basses, endoscopie, étiologies, Cotonou.

6.
Prog Urol ; 33(14): 871-874, 2023 Nov.
Article in English | MEDLINE | ID: mdl-37918986

ABSTRACT

The primary objective of the combined approach is to limit the number of percutaneous access tracts for the treatment of staghorn, or complex kidney stones by simultaneous percutaneous antegrade and retrograde ureteroscopy. The other indication is the simultaneous presence of several kidney and ureteral stones or of an impacted pelvic stone. The combination of the two techniques may increase the stone-free rate and decrease the retreatment rate of complex stones compared with percutaneous nephrolithotomy alone. The patient is usually in the modified supine position. METHODOLOGY: These recommendations were developed using two methods: the Clinical Practice Recommendation (CPR) method and the ADAPTE method, depending on whether the question was considered in the European Association of Urology (EAU) recommendations (https://uroweb.org/guidelines/urolithiasis) [EAU Guidelines on urolithiasis. 2022] and their adaptability to the French context.


Subject(s)
Kidney Calculi , Lithiasis , Nephrostomy, Percutaneous , Ureteral Calculi , Humans , Nephrostomy, Percutaneous/methods , Ureteroscopy/methods , Ureteral Calculi/surgery , Kidney Calculi/surgery , Kidney , Treatment Outcome
7.
Ann Chir Plast Esthet ; 68(4): 308-314, 2023 Aug.
Article in English | MEDLINE | ID: mdl-36328867

ABSTRACT

BACKGROUND: The purpose of this study is to investigate the usefulness of endoscopy-assisted latissimus dorsi muscle flap (LDMF) harvesting in immediate breast reconstruction following partial mastectomy. MATERIALS AND METHODS: From November 2016 to December 2019, sixteen female breast cancer patients who underwent immediate breast reconstruction following partial mastectomy underwent LDMF harvesting with endoscopic assistance. This surgical technique was carried out with only one subaxillary skin incision without leaving a scar on the back. Patients' demographic characteristics, histopathologic factors, operative data, postoperative complications, and oncologic safety were collected through electronic chart review. RESULTS: In sixteen patients, LDMFs were harvested successfully using an endoscopy-assisted technique without conversion to an open technique. The mean age of the patients was 48.0±8.0 years, and the mean body mass index was 24.4±3.9kg/m2. The most common histologic subtype was invasive ductal carcinoma, with a mean tumor size of 3.2±2.3cm. In terms of LDMF harvesting time, it took 168.4±44.0minutes. The most common postoperative complication, donor site seroma (75%), was managed non-surgically during the outpatient visit. In terms of cosmetic aspects, we've seen a high level of patient satisfaction, especially with scarring. CONCLUSIONS: Endoscopy-assisted LDMF harvesting technique is safe and useful for breast reconstruction after partial mastectomy. Compared to the conventional open technique, this method does not leave a long scar on the donor site. As a result, it leads to better cosmetic outcomes and improves patient satisfaction.


Subject(s)
Breast Neoplasms , Mammaplasty , Superficial Back Muscles , Humans , Female , Adult , Middle Aged , Breast Neoplasms/surgery , Breast Neoplasms/pathology , Mastectomy/methods , Superficial Back Muscles/surgery , Cicatrix/surgery , Mammaplasty/methods , Endoscopy/methods , Postoperative Complications/surgery , Retrospective Studies
8.
Rev Mal Respir ; 40(1): 94-100, 2023 Jan.
Article in French | MEDLINE | ID: mdl-36577607

ABSTRACT

Up to 30% of lung cancer patients suffer from central airway obstruction, resulting in major deterioration in prognosis and quality of life. Interventional bronchoscopy combines a number of invasive techniques used during rigid bronchoscopy. It is designed to rapidly improve symptoms, primarily dyspnea. Applied according to very precise indications, this technique requires careful patient selection and needs to be incorporated into the multimodal oncological management in combination with systemic treatments, radiation therapy and surgery.


Subject(s)
Airway Obstruction , Lung Neoplasms , Humans , Quality of Life , Airway Obstruction/diagnosis , Airway Obstruction/etiology , Airway Obstruction/surgery , Lung Neoplasms/complications , Bronchoscopy/methods , Prognosis , Stents
9.
Ann Cardiol Angeiol (Paris) ; 72(2): 101577, 2023 Apr.
Article in French | MEDLINE | ID: mdl-36543711

ABSTRACT

The techniques of derivation of the high urinary tract are indispensable in common practice for the management of ureteral obstructions. Like any surgical gesture, its techniques are not without complications; Among those common are hematuria, urinary incontinence, migration in the bladder and rupture of the probe. However, intracardiac probe migration has rarely been described. We report the case of a 68-year-old patient treated for cervical cancer who benefited from the rise of a bilateral single-J probe, admitted for accidental migration of the left probe into the heart. The diagnosis was made by plain abdominal X-ray and confirmed by thoraco-abdominal CT angiography. The patient benefited, in the catheterization room, from a withdrawal of the probe by endoscopic way and under radioscopic control successfully and without any incident.


Subject(s)
Fluoroscopy , Foreign-Body Migration , Uterine Cervical Neoplasms , Aged , Humans
10.
Rev Mal Respir ; 40(1): 47-60, 2023 Jan.
Article in French | MEDLINE | ID: mdl-36470780

ABSTRACT

Over recent years, High Flow Nasal Cannula (HFNC) oxygen therapy has been more and more extensively applied in numerous medical settings, and it is now carried out in invasive procedures such as pre-oxygenation before orotracheal intubation, often leading to complications. More generally, pre-oxygenation is aimed at maintaining the highest possible oxygen saturation for extended periods of time. With this in mind, HFNC seems as effective as standard oxygen delivery with regard to hematosis in patients with mild or moderate hypoxemia, and it presents the advantage of reducing the adverse events associated with intubation. That said, during pre-oxygenation of patients with severe hypoxemia, non-invasive ventilation (NIV) is probably more effective than HFNC, especially in the prevention of respiratory events. However, in patients with little or no hypoxemia undergoing risky procedures such as bronchial endoscopy, HFNC allows better oxygen saturation than standard methods. To summarize, even though NIV remains useful in unstable patients, especially in decreasing desaturation episodes, HFNC could represent a reasonable alternative in case of poor tolerance, allowing continuous oxygenation of patients requiring digestive endoscopy or trans-esophageal ultrasound.


Subject(s)
Noninvasive Ventilation , Respiratory Insufficiency , Humans , Oxygen , Cannula/adverse effects , Lung , Oxygen Inhalation Therapy/methods , Intubation, Intratracheal/adverse effects , Hypoxia/etiology , Hypoxia/prevention & control , Noninvasive Ventilation/methods , Respiratory Insufficiency/therapy
11.
Rev Mal Respir ; 39(9): 801-803, 2022 Nov.
Article in French | MEDLINE | ID: mdl-36272857

ABSTRACT

INTRODUCTION: Inflammatory myofibroblastic tumors are a rare cause of primary lung tumors, most often solitary and in more than 50% of cases detected in individuals under 40 years of age. OBSERVATION: A 17-year-old patient consulted in pneumology for development of hemoptysis over a period of two weeks. Thoracic computed tomography revealed a left lower lobe cavity 24mm in diameter with bronchial fistulation and hydro-aeric level. Bronchial fibroscopy by mini-endoscope highlighted an endobronchial lesion in a subdivision of the sub-segmental posterior aspect of the left lower lobe. Paraclinical assessment highlighted a probable inflammatory myofibroblastic tumour. A surgical intervention was indicated and a lower left lobectomy performed. Histological analysis confirmed the presence of the tumour, which was resected in healthy margins by left lower lobectomy.


Subject(s)
Granuloma, Plasma Cell , Lung Neoplasms , Humans , Adolescent , Lung Neoplasms/diagnosis , Lung Neoplasms/surgery , Tomography, X-Ray Computed , Lung , Bronchi
12.
Rev Med Interne ; 43(8): 506-508, 2022 Aug.
Article in French | MEDLINE | ID: mdl-35184868

ABSTRACT

INTRODUCTION: Acute esophageal necrosis (AEN) is a rare medical disorder, which is characterized by a diffuse black esophageal mucosal during upper gastrointestinal endoscopy which is a highly recommended diagnostic tool. Its high mortality rate requires to be quickly evocated and an early management. CASE REPORT: We report a case of a 93-year-old patient with upper gastrointestinal bleeding. The upper endoscopy shows a grade D AEN according to the Los Angeles classification. Treatment consists of a parenteral nutritional support and an intravenous proton pump inhibitors treatment, which increase chances of a favorable outcome on endoscopic controls at 2 and 6 weeks. CONCLUSION: AEN has to be quickly evocated in a polyvascular and old patient with upper gastrointestinal bleeding. Our experience confirms that optimal and early management allow a esophageal complete healing at 6weeks.


Subject(s)
Esophageal Diseases , Acute Disease , Aged, 80 and over , Esophageal Diseases/diagnosis , Esophageal Diseases/etiology , Esophageal Diseases/therapy , Gastrointestinal Hemorrhage/diagnosis , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/therapy , Humans , Necrosis/complications , Necrosis/diagnosis
13.
Rev Mal Respir ; 39(1): 58-61, 2022 Jan.
Article in French | MEDLINE | ID: mdl-34974925

ABSTRACT

INTRODUCTION: Tracheal tumors are rare, they are most often malignant and can manifest themselves by a non-specific respiratory symptomatology with progressively increasing dyspnea orienting in the first place towards a COPD or even an asthma. Among them, tracheal lipoma is exceptional. Its management is based on removal by rigid bronchoscopy. OBSERVATION: We report the case of a 73-year-old male patient who presented with non-specific dyspnea that progressively worsened over several months. The EFR showed a flattening of the flow-volume curves, the CT scan showed an anterolateral oval tracheal tumor with fatty density, the bronchial endoscopy showed a tumor lesion with stenosis of about 90% of the airway. Management consisted of a rigid bronchoscopy to delete obtruction with biopsies. Anatomopathology concluded to a tracheal lipoma. CONCLUSION: Progressively worsening dyspnea, especially if there are signs of inspiratory dyspnea, required a systematic bronchial endoscopy to avoid the possibility of a tracheal tumor.


Subject(s)
Asthma , Lipoma , Tracheal Neoplasms , Aged , Bronchoscopy , Humans , Lipoma/complications , Lipoma/diagnosis , Lipoma/surgery , Male , Trachea , Tracheal Neoplasms/complications , Tracheal Neoplasms/diagnosis
14.
Mali Med ; 38(1): 21-25, 2022.
Article in French | MEDLINE | ID: mdl-38506203

ABSTRACT

OBJECTIVE: to determine the indications and results of upper digestive endoscopy (EDH) at the Zinder National Hospital. MATERIALS AND METHODS: this is a retrospective analysis of EDH reports, from digestive endoscopy registers from January 1, 2020 to February 28, 2021, covering 667 examinations, or a monthly frequency of 48 EDH. RESULTS: the average age of patients was 38.98±14.84 (13-80 years) with a sex ratio of 1.02. Epigastralgia represents 42.8% (n = 363) of indication of EDH, dyspepsia 15.2% (n = 129), diffuse abdominal pain 11.9% (n = 101), vomiting 8.1% (n = 69), search for endoscopic signs of portal hypertension 5.1% (n = 43), dysphagia 4.9% (n = 42) and digestive hemorrhages 3.2% (n = 27Depending on the anatomical segment concerned, the stomach accounted for 55.51% (n=419), the esophagus 19.6% (n=148) and the duodenum 6.68% (n=50). Inflammatory lesions account for 63.04% (n=475), ulcers 6.65% (n=50), tumours 3.03% (n=23) and miscellaneous lesions 27.28% (n=205). The biopsy was performed in 22 patients (3.46%) and 10 histological reports were obtained, divided into 06 gastric adenocarcinomas, 02 chronic gastric with intestinal metaplasia, 01 epidermoidal carcinoma of the esophagus and 01 hyperplastic gastric polyp. CONCLUSION: Epigastralgia dominates the indications of HRE. Upper digestive pathology is certainly dominated by inflammatory lesons, but ulcers and tumors are increasingly diagnosed. These lesions would be better evaluated if systematic biopsies were performed in our patients.


OBJECTIF: déterminer les indications et résultats de l'endoscopie digestive haute (EDH) à l'Hôpital National de Zinder. MATÉRIELS ET MÉTHODES: il s'agit d'une analyse rétrospective des comptes rendus d'EDH, à partir des registres d'endoscopie digestive du 1er Janvier 2020 au 28 Février 2021, portant sur 667 examens, soit une fréquence mensuelle de 48 EDH. . RÉSULTATS: l'âge moyen des patients était de 38,98±14,84 (13-80 ans) avec un sex ratio de 1,02. Les épigastralgies représentent 42,8% (n=363) d'indication d'EDH, la dyspepsie 15,2% (n=129), les douleurs abdominales diffuses 11,9% (n=101), les vomissements 8,1% (n= 69), la recherche des signes endoscopiques d'hypertension portale 5,1% (n= 43), la dysphagie 4,9% (n=42) et les hémorragies digestives 3,2% (n=27). Selon le segment anatomique concerné, l'estomac comptait pour 55,51% (n=419), l'œsophage 19,6% (n=148) et le duodénum 6,68% (n=50). Les lésions inflammatoires représentent 63,04% (n=475), les ulcères 6,65% (n=50), les tumeurs 3,03% (n=23) et les lésions diverses 27,28% (n=205). La biopsie était réalisée chez 22 patients (3,46%) et 10 comptes rendus histologiques étaient parvenus, repartis en 06 adénocarcinomes gastriques, 02 gastriques chroniques avec métaplasie intestinale, 01 carcinome épidermoïde de l'œsophage et 01 polype gastrique hyperplasique. CONCLUSION: Les épigastralgies dominent les indications de l'EDH. La pathologie digestive haute est certes dominée par les lésons inflammatoires, mais les ulcères et les tumeurs sont de plus en plus diagnostiqués. Ces lésions allaient être mieux évaluées si des biopsies systématiques étaient réalisées chez nos patients.

15.
Ann Pathol ; 41(5): 476-480, 2021 Sep.
Article in French | MEDLINE | ID: mdl-34376296

ABSTRACT

Glomus tumors are rare mesenchymal tumors, mostly benign, although a few malignant cases have been described in the literature. These tumors are usually localized subcutaneously or subcutaneously, however they may exceptionally be gastric localized. We report two new observations diagnosed on biopsies performed by echo endoscopy. The first was a 66-year-old man and the second a 78-year-old man. In both cases, the lesions were on astral, nodular, and very limited location. The biopsies revealed a tumor proliferation of trabecular architecture, composed by monomorphic cells, with eosinophilic cytoplasm, medium size, with a rounded, regular nucleus, without mitosis or necrosis, with distended and branched capillaries on the periphery. In immunohistochemical studies, tumor cells expressed smooth muscle actin and caldesmone. The proliferation index KI 67 was very low. In practice, however, preoperative diagnosis remains difficult because there is no typical appearance in imaging or echo-endoscopy to distinguish them from other gastric parietal tumors. To date, there is no consensus on the therapeutic management of gastric glomus tumors. However, endoscopic resection by dissection under the mucosa associated with endoscopic monitoring seems to be a method of choice as well as a way to postpone open or laparoscopic surgery, especially when these tumors are small (<30mm).


Subject(s)
Glomus Tumor , Stomach Neoplasms , Aged , Biopsy , Endosonography , Glomus Tumor/diagnostic imaging , Glomus Tumor/surgery , Humans , Male , Stomach Neoplasms/diagnostic imaging
16.
Prog Urol ; 31(14): 937-942, 2021 Nov.
Article in French | MEDLINE | ID: mdl-34456138

ABSTRACT

INTRODUCTION: Sate of the art on the indications, methods of implementation and medico-economic considerations of reusable flexible ureteroscopes (URSr) vs single use (URSuu)? METHOD: Review of the literature (Pubmed) on reusable and single-use ureteroscopes, as well as on the expertise of our center. A PubMed search and narrative review of the data was performed in July 2021. Only articles in French or English were selected. RESULTS: The URSr and URSuu have similar technical characteristics and are suitable for the exploration of the upper urinary excretory tract: treatment of stones of the kidney <2cm or of the ureter. The URSr is the most common type of ureteroscope. URSuu are newer and associated with many advantages: no sterilization procedure, immediate availability of equipment in the operating room, reduced waste production at the institutional level. A hybrid use of URSr and URSuu currently seems to be the best compromise from a medico-economic point of view for high volume centers. In the case of a smaller activity or a secondary site, URSuu are more advantageous and the reduction in purchasing costs should accentuate this benefit. CONCLUSION: URSr and URSuu are technically similar and allow identical treatment of upper urinary tract pathologies. Their complementary use optimizes the care of urology patients. The barrier to the exclusive use of URSuu remains their cost.


Subject(s)
Ureteroscopy , Urology , Equipment Design , Humans , Operating Rooms , Ureteroscopes
17.
Ann Pathol ; 41(3): 300-309, 2021 Jun.
Article in French | MEDLINE | ID: mdl-33926759

ABSTRACT

INTRODUCTION: Graft-versus-host disease (GVHD) is a complication of hematopoietic stem cell transplantation. It frequently affects the digestive tract. Oesophageal damage is not part of its typical clinical picture. The objective of this study was to determine whether oesophageal lesions could be found in this condition. MATERIAL AND METHODS: Cases coded as GVH at the CHU of Amiens in anatomopathology were identified from 2004 to 2019. Each patient who had an oesophageal biopsy was included. The slides were re-read by 2 pathologists to assess the lesions. RESULTS: A total of 24 patients were included. A total of 79.1 % of the biopsies showed inflammatory lesions: 25 % erosions, 37.5 % a cleavage between the lamina propria and squamous epithelium, 41.7 % a lichenoid inflammatory infiltrate, 54.1 % apoptotic cells and 54.1 % epithelial vacuolations. 25 % of the biopsies were classified as Lerner's grade 4 (used in dermatopathology to assess cutaneous GVH lesions), 12.5 % as grade 3, 25 % as grade 2, 16.7 % as grade 1, and 20.8 % of the biopsies did not show oesophageal GVH lesions. None of the histological lesions observed were correlated with the prognosis, however erosions and epithelial cleavage were more frequently associated with death. CONCLUSION: Lesions evocative and probably specific for acute GVH can be found in the esophagus. They could help and be part of the diagnosis. A protocol for oesophageal biopsy sampling, and the exclusion of other causes of esophagitis, should be performed in the future during suspicion of acute GVH.


Subject(s)
Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Biopsy , Esophagus , Hematopoietic Stem Cell Transplantation/adverse effects , Humans , Prognosis
18.
Rev Mal Respir ; 37(8): 652-661, 2020 Oct.
Article in French | MEDLINE | ID: mdl-32888730

ABSTRACT

INTRODUCTION: Bronchoalveolar lavage (BAL) was previously considered as the standard diagnostic procedure to investigate pneumonia occurring in immunocompromised patients, and it is probably still widely used. However, the development of new microbiological diagnostic tools, applicable to samples obtained non-invasively, leads to questioning of the predominant place of BAL in this situation. BACKGROUND: The available studies agree on the acceptable tolerance of BAL performed in immunocompromised patients. Although imperfect, the diagnostic yield of BAL in immunocompromised patients is well established, but it may vary between studies depending on the underlying disease. However, it must also be compared to the yield of non-invasive microbiological tools, now widely available and effective. The position of BAL remains important both for the diagnosis of fungal infections (invasive aspergillosis, pneumocystis pneumonia) and non-infectious lung diseases both of which occur frequently in immunocompromised patients. CONCLUSION: The place of BAL in the diagnostic work-up of pneumonia occurring in immunocompromised patients must be considered in the framework of a structured consideration, taking into account the diagnostic performance of non invasive microbiological tests and the broad spectrum of lung diseases occurring in this context.


Subject(s)
Bronchoalveolar Lavage , Immunocompromised Host , Pneumonia/diagnosis , Bronchoalveolar Lavage/methods , Bronchoalveolar Lavage Fluid/chemistry , Bronchoalveolar Lavage Fluid/microbiology , Bronchoscopy/methods , Humans , Microbial Sensitivity Tests , Pneumonia/etiology , Pneumonia/immunology , Pneumonia/microbiology , Pneumonia, Pneumocystis/diagnosis , Pneumonia, Pneumocystis/microbiology , Predictive Value of Tests
20.
Ann Chir Plast Esthet ; 65(1): 91-99, 2020 Feb.
Article in English | MEDLINE | ID: mdl-31101396

ABSTRACT

INTRODUCTION: Forehead osteoma is an uncommon benign bone tumor that causes cosmetic disfigurement and occasional pain. Traditional excision directly over the lesion creates a visible scar on the forehead. PROCEDURE: We describe a method of endoscopic resection of the forehead osteoma, via incisions within the hairline. The access incision was hidden behind the frontal hairline and the dissection plane went in the subperiosteal layer. The injury of the nerve branch and vessel can be easily avoided and endorsed by manipulating the endoscope. CONCLUSION: Aesthetic considerations are important features in the craniomaxillofacial region. Especially for patients who are not willing to accept the risk of a prominent forehead scar. Endoscopic resection of forehead osteomas might be a useful tool in forehead osteoma resections. It might be an alternative tool in an Oral and Maxillofacial Surgeon's and in a Plastic Surgeon's repertoire.


Subject(s)
Cicatrix/prevention & control , Endoscopy/methods , Facial Neoplasms/surgery , Forehead/surgery , Osteoma/surgery , Postoperative Complications/prevention & control , Skull Neoplasms/surgery , Dissection/methods , Humans , Periosteum/surgery
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