Integrated care pathways for airway diseases (AIRWAYS-ICPs).

The objective of Integrated Care Pathways for Airway Diseases (AIRWAYS-ICPs) is to launch a collaboration to develop multi-sectoral care pathways for chronic respiratory diseases in European countries and regions. AIRWAYS-ICPs has strategic relevance to the European Union Health Strategy and will add value to existing public health knowledge by: 1) proposing a common framework of care pathways for chronic respiratory diseases, which will facilitate comparability and trans-national initiatives; 2) informing cost-effective policy development, strengthening in particular those on smoking and environmental exposure; 3) aiding risk stratification in chronic disease patients, using a common strategy; 4) having a significant impact on the health of citizens in the short term (reduction of morbidity, improvement of education in children and of work in adults) and in the long-term (healthy ageing); 5) proposing a common simulation tool to assist physicians; and 6) ultimately reducing the healthcare burden (emergency visits, avoidable hospitalisations, disability and costs) while improving quality of life. In the longer term, the incidence of disease may be reduced by innovative prevention strategies. AIRWAYSICPs was initiated by Area 5 of the Action Plan B3 of the European Innovation Partnership on Active and Healthy Ageing. All stakeholders are involved (health and social care, patients, and policy makers).

[Evaluation and symptomatic treatment of surinfectious exacerbations of COPD: preliminary study of antibiotic treatment combined with fenspiride (Pneumorel 80mg) versus placebo]. / Evaluation du traitement symptomatique des poussées de surinfection de BPCO: étude préliminaire Pneumorel 80 mg versus placebo en association avec une antibiothérapie.

UNLABELLED: Exacerbations of chronic obstructive pulmonary disease (COPD) have an inflammatory component in addition to the possible infectious component. The antiinflammatory properties of fenspiride (Pneumorel(R) 80 mg) should be evaluated in this frequent clinical situation. OBJECTIVES: Assess the supplementary therapeutic benefit provided by fenspiride administered in combination with antibiotics in COPD patients presenting an episode of bronchial infection. PATIENTS AND METHODS: A preliminary randomized placebo-controlled double-blind study was conduced in 7 centers. Patients under 80 years of age of both sexes were included. All patients had COPD and presented a bronchial infection defined as the presence of at least 2 of the 3 criteria defined by Anthonisen. Patients were randomly assigned to group F or group P. Group F received an antibiotic therapy from day 1 to day 11 plus fenspiride (3 x 80mg/d from day 0 to day 30). Group P received the same antibiotic therapy plus placebo. Amoxicillin 500mg plus clavulanic acid 125, 3 tablets/day, was administered in both groups. RESULTS: Thirty-nine patients were included (group F 19 patients, group P 20 patients; 6 women and 33 men; mean age 61.1 +/- 9.8 years). The 3 Anthonisen criteria were present in 79% and 75% of the patients in group F and P respectively (NS). On day 11, expectoration resolved in 39% and 32% (NS) and cough in 44% and 16% (NS) of the patients in groups F and P respectively. Lung auscultation returned to normal in 83% of the patients in group F compared with 47% in group P (p=0.05). A composite clinical score including expectoration cough and auscultation findings showed that 28% of the patients in group F were symptom-free on day 11 compared with 0% in group P (p=0.04). On day 30, the two groups were comparable. CONCLUSION: In this preliminary study of patients with COPD presenting a bronchial superinfection, there was a significant improvement in lung auscultation and in the composite clinical score in patients given fenspiride. Fenspiride was thus found to provide an early clinical benefit.

[Diagnostic percutaneous thoracic punctures. Assessment through a critical study of a compliation of 2406 cases]. / Ponctions thoraciques percutanées à visée diagnostique. Mise au point à partir de l'étude critique d'une expérience de 2406 cas.

The aim of this retrospective study of 2,406 diagnostic percutaneous thoracic needle aspirations under computer tomographic control was to assess the diagnostic value of this method, the technical problems and the complications and finally, to refine the indications. Percutaneous needle aspiration had been carried out after negative fibreoptic bronchoscopy. The authors review their technique and show the value of biopsy material which is only slightly traumatised. Computerised tomography and fine needle aspiration reduce the risk of pneumothorax and haemorrhage in a significant fashion. Personalized collaboration between the radiologist, physician and cytologist is a vital pre-requisite. The indications are discussed notably in cases of solitary pulmonary nodules and of mediastinal masses.

[Pulmonary embolism: contribution of spiral x-ray computed tomography]. / Embolie pulmonaire: apport de la tomodensitométrie hélicoïdale.

PURPOSE: Spiral computed tomography was compared retrospectively with digital subtraction pulmonary angiography (PA) in 45 patients suspected of having acute or chronic pulmonary embolism. MATERIALS AND METHODS: 45 patients in whom the presence of acute or chronic pulmonary embolism was suspected underwent examination by spiral CT and PA. Diagnosis of pulmonary embolism was based on the direct visualization of intraluminal clots. The study of the agreement between the two methods was based on the Kappa test. In 35 cases, pulmonary emboli were proved. Acute pulmonary emboli were present in 28 cases and chronic in 7 cases. RESULTS: Spiral computed tomography represents an excellent way to detect acute pulmonary embolism. In the chronic form, spiral CT is better than PA to detect intraluminal clots. However, Spiral CT can fail to detect small embole in the peripheral arterial bed. In the 10 patients without pulmonary embolism, the spiral CT proved diagnosis pulmonary oedema (n = 3), lymphangitic carcinoma (n = 4), pleural effusion (n = 3). CONCLUSION: This study suggest that the spiral CT examination is accurate for diagnosis of pulmonary embolism specifically in case of suspected important embolism. The advantages of spiral CT are multiple (non invasive, wide diagnosis spectrum). However, may be a limitation to is use is insufficient distal thrombi detection. This eventuality (5 to 10% in the Pioped study) justify the practice of pulmonary angiography. Spiral CT improvements should reduce this insufficiency in the next future.

[Magnetic resonance imaging of pulmonary coin lesion and bronchopulmonary cancer]. / Nodule pulmonaire et cancer broncho-pulmonaire en imagerie par résonance magnétique (IRM).

Magnetic resonance imagery (MRI) is less sensitive than computed tomography (CT) for the detection of pulmonary masses and cannot detect calcifications within such masses. MRI performed during the work-up for bronchial cancers has often been compared with CT scans: neither T nor N can be evaluated with more precision. Nevertheless, there are certain specific indications such as the exploration of proximal tumours with suspected extension into the mediastinum including cardiac and vascular invasion, tumours of the aorto-pulmonary window, the Pancoast-tobias syndromes, and tumours situated near the thoracic wall or the spine.

[Contribution of magnetic resonance imaging to the exploration of the mediastinum]. / Apport de l'imagerie par résonance magnétique (IRM) à l'exploration du médiastin.

Magnetic resonance imaging (MRI) already has a number of indications in exploration of the mediastinum, the most frequent of which being exploration of vascular pathologies facilitated by visualization of vascular lumina without need for a contrast medium, MRI can provide detailed information concerning the size, relations and wall thickness of these vessels ans sometimes of aneurysmal thrombosis. It also makes it possible to study aortic dissections and venous diseases of the mediastinum. As regards mediastinal masses, MRI complements computerized tomography (CT): it is better than the latter to distinguish vascular relations and it provides aetiological arguments based on the intensity of T1 and T2-weighted signals.

[Magnetic resonance imaging of the respiratory airways and the pulmonary parenchyma]. / L'imagerie par résonance magnétique des voies aériennes et du parenchyme pulmonaire.

In the study of the proximal airways, MRI is mainly appropriate for the trachea and the mainstem bronchi, in case of tracheal stenosis or tumors. CT remains the reference examination for the distal airways. In alveolar condensation, MRI may help differentiating some of the involved materials (blood, lipids). Lastly, the role of MRI is limited in interstitial pathology, even though some indications may be appearing: fibrosis following radiation therapy, determination of the inflammatory component.

[Treatment of obstructive bronchial cancers with high dose, endobronchial curietherapy. Technical aspects and clinical results]. / Traitement des cancers bronchiques obstructifs par curiethérapie endobronchique à haut débit. Aspects techniques et résultats cliniques.

Between September 1990 and September 1991, 35 patients with mainly recurrent or residual endobronchial carcinoma were treated with 91 high-dose-rate endobronchial brachytherapy applications. Treatment technique was fairly simple and could easily be performed on an outpatient basis. Endoscopic placement of one or two applicators is followed by computerized dosimetry and irradiation during a median time of 10 minutes. Treatment included 3 sessions of 10 grays measured at 10 mm from the center of the radioactive source at 2-week intervals. Response rate was 81.8% including 51.5% complete clinical response. There were 12 microscopically complete response out of 14 patients biopsied. Immediate tolerance was excellent in 90% of cases. However, late complications were severe in 25% of cases. Ongoing radiobiological research should determine an optimal therapeutic approach in term of efficacy and long term toxicity before using endobronchial brachytherapy as a part of the initial management of unresectable lung cancers.

[Pleural involvements in thymoma. Apropos of 5 cases and review of the literature]. / Les atteintes pleurales des thymomes. A propos de cinq cas et revue de la littérature.

The authors report five cases of pleural involvement in patients with thymoma. In 3 cases these sites were not directly related to the primary and in 1 case they constituted the first event in the disease. CT and MRI allow effective assessment of these pleural lesions ... provided this phenomenon, reported in the literature, is well known by the radiologist.

[Contribution of high resolution x-ray computed tomography to the diagnosis of pulmonary histiocytosis X. Apropos of 12 cases]. / Apport de la tomodensitométrie haute résolution au diagnostic de l'histiocytose X pulmonaire. A propos de douze cas.

The authors studied the value of high resolution computed tomography in twelve patients with pulmonary histiocytosis X. The aim of this study was to define the CT signs. More or less thin-walled air-filled cysts were observed in all but one case, although the subsequent follow-up of this case revealed the development of such cysts 6 months later. Nodules were also present in all but two cases. They sometimes consisted of excavated nodules. Reticulations, "frosted glass" appearance and irregularities of interface--all signs of a classical interstitial syndrome--were observed less frequently. The lesions were always diffuse, cortical and medullary. The predominance for the upper lobes was only observed in 50% of cases. The case examined on 2 occasions during the course of the disease at an interval of 6 months suggested the progression of small solid nodules towards larger, excavated nodules, finally resulting in thin-walled cysts which may eventually coalesce to force a "lacework" appearance. The pathophysiology of this progression of the lesions and therefore of the pulmonary eosinophilic granuloma is discussed by the authors.

[Re-expansion pulmonary edema after iatrogenic pneumothorax. A propos of 1 case]. / OEdème pulmonaire de réexpansion (ORP) après pneumothorax iatrogène. A propos d'un cas.

Re-expansion pulmonary edema (RPE) due to pneumothorax aspiration can lead to a fatal outcome, as in the case reported, the chronic nutritional deficiency and hypoproteinemia that it provokes probably playing a contributing role. Pathogenesis and factors affecting prognosis of RPE are discussed. These include the duration of the pulmonary collapse, though this is not an essential factor, the alterations in alveolar surfactant activity possibly related to the chronicity of the collapse, and the abruptness of aspiration which is, in contrast, a determining mechanical factor. Finally, the hypoproteinemia present in certain cases could facilitate fluid extravasation towards the alveolus. It is concluded that aspiration should be a gentle procedure in all cases, and should be conducted with extreme caution in the presence of hypoproteinemia.