[Pulmonary embolism as a presentation of nephrotic syndrome]. / Embolie pulmonaire révélant un syndrome néphrotique.

BACKGROUND: Nephrotic syndrome (NS) in adults is defined by proteinuria>3g/24h or 50mg/kg/d, hypoproteinemia<60g/24h and hypoalbuminemia<30g/L. The final diagnosis is guided by the histopathology evidence when a renal biopsy is possible. The consequences of NS are multiple: high blood pressure, undernutrition, infections and a hypercoagulable state. OBSERVATION: We report the case of a patient presenting with thromboembolic disease, occurring in the absence of other thromboembolic risk factors, which revealed NS with spontaneously favorable evolution. CONCLUSION: Thromboembolic disease in NS is frequent but underestimated and may remain underdiagnosed. Thorough investigation - including serum protein levels and testing for proteinuria - are essential in thromboembolism, as is excluding cancer or another cause. The treatment of thromboembolic disease in NS is based on anticoagulation for as long as the NS persists. There is no consensus about primary prophylaxis but an albumin level below 20g/L should be considered as a risk factor of thrombosis and prophylactic anticoagulation should be started.

[Tumor-bronchial actinomycosis simulating a recurrence of lung cancer 14 years after initial treatment: A case report]. / Actinomycose bronchique pseudo-tumorale simulant une ré-évolution d'un cancer bronchique 14ans après la prise en charge thérapeutique initiale : à propos d'un cas.

A patient with a history of squamous cell carcinoma of the right upper lung lobe treated 14 years before by concomitant chemo-radiotherapy was referred on account of dyspnea. Bronchial endoscopy revealed complete obstruction of the right main bronchus highly suggestive of a tumor recurrence. However, biopsy samples only showed inflammatory and necrotic tissue with no evidence of malignancy. Despite complete tissue resection by rigid bronchoscopy, a rapid and complete recurrence occurred requiring the placement of a Y-shaped bronchial prosthesis. Repeat histological, bacteriological and mycological analyses were negative. The patient was soon readmitted to hospital for a lung infection due to recurrence of obstruction inside and around the prosthesis. Bacterial examination of biopsy samples identified Actinomyces meyeri. Appropriate antibiotic therapy led to a complete regression of the bronchial obstruction. Unfortunately, the patient died a few months later due to massive hemoptysis after the removal of the prosthesis. Autopsy examination showed a fistula between the right main bronchus and pulmonary artery, with no evidence of neoplastic recurrence nor the persistence of lesions associated with actinomycosis.

[Idiopathic constrictive péricarditis revealed by a massive left pleural effusion]. / Epanchement pleural gauche massif révélateur d'une péricardite constrictive idiopathique.

INTRODUCTION: We report a case of constrictive péricarditis initially revealed by a massive left sided pleural effusion. CASE REPORT: The patient was dyspnoeic without any associated clinical signs. Only cardiac catheterization gave the diagnosis with a characteristic dip-plateau of the right ventricle. After full assessment, no aetiology was found. CONCLUSION: After a treatment with corticosteroids, the progress has been favourable to date.

[Changes in inspiratory capacity during acute respiratory failure in COPD patients]. / Evolution de la capacité inspiratoire au cours de la BPCO décompensée.

INTRODUCTION: Inspiratory Capacity (IC), which reflects dynamic pulmonary hyperinflation, correlates with outcome in moderate exacerbation of COPD. Whether this is also true in COPD with acute respiratory failure (ARF) has not been studied. METHODS: A prospective multicenter assessment of IC measurement feasibility, reliability, time-course and relationship to outcome in COPD with ARF was conducted. Dyspnea (visual analogue scale) and IC were repeatedly measured. Outcome was classified as not favourable (death or intubation or non invasive ventilation increased or patient referred to ICU from respiratory ward) or favourable (none of the above criteria). RESULTS: Fifty patients were included and 48 analysed. IC measurement was possible in all but one patient and its coefficient of variation was 9+/-8%. Between inclusion into the study and discharge, IC increased from 39.9+/-15.5 to 50.2+/-14.5% pred (p<0.001) and dyspnea declined from 48+/-23 to 33+/-22 mm (p<0.001). Inclusion IC was not different on average between patients with or without favourable outcome. CONCLUSION: In COPD patients with ARF, IC measurement at bedside was feasible and reproducible. IC was low at entry and increased over time from inclusion to discharge tending to correlate with patient outcome.

[Outcome in COPD patients treated with at-home, long-term, non-invasive ventilation]. / Devenir des patients BPCO traités par ventilation non invasive prolongée à domicile.

BACKGROUND: The use of domiciliary non-invasive positive pressure ventilation (NIPPV) is still controversial in stable hypercapnic COPD. METHODS: Records of COPD patients who received home NIPPV from 1990 to 2002 either following an acute exacerbation or because of stable hypercapnia were retrospectively reviewed. RESULTS: Thirty-seven patients receiving long term oxygen therapy for 50 +/- 47 months were included. At inclusion, their mean +/- SD: FEV1 was 27 +/- 9% predicted, inspiratory capacity was 45 +/- 14% predicted, PaO2 breathing room air was 50 +/- 10 mm Hg, PaCO2 breathing room air = 53 +/- 8 mm Hg, PaCO2 with oxygen was 60 +/- 9 mm Hg. Median survival with NIPPV was 41 months. The 1-year, 3-year and 5-year survival rates with NIPPV were 92%, 62% and 24% respectively. Twelve months after onset of home NIPPV, PaCO2 breathing room air and with oxygen were significantly lower (47 +/- 8 mm Hg, p = 0.028 and 53 +/- 8 mm Hg, p = 0.005, respectively), inspiratory capacity was significantly improved (54 +/- 18% predicted, p = 0.033). CONCLUSION: This study suggests that home NIPPV allows a lasting physiological stabilization in selected COPD patients, particularly those with an advanced disease, by reducing hypercapnia and improving inspiratory capacity.

[Disseminated actinomycosis]. / Actinomycose disséminée.

INTRODUCTION: We report the case of a patient suffering from disseminated actinomycosis. CASE REPORT: A fifty-two year old man, who was both a heavy smoker and an alcoholic, was admitted to hospital with confusion associated with a pseudo-tumoral right upper lobe pneumonia. Brain computed tomography was normal on the day of admission but when repeated fifteen days later four lesions were seen with appearances suspicious of metastatic malignant disease. The isolation of Actinomyces odontolyticus in the bronchoalveolar lavage culture and the absence of evidence for neoplastic disease despite extensive investigation led to a diagnosis of disseminated actinomycosis with pulmonary and cerebral involvement. The patient's clinical condition improved with antibiotic therapy. The disseminated form of this infection as well as presentation with multifocal brain abscesses is rare. CONCLUSION: The diagnosis of actinomycosis is problematic because it is an uncommon infection and microbiological identification is often difficult and delayed. It should be considered when clinical presentation suggests malignant disease but there is no histological confirmation.

[Herpes simplex and Geotrichum candidum pneumonia in a patient with moderate renal failure]. / Pneumopathie à Herpes simplex et Geotrichum candidum chez un patient présentant une insuffisance rénale modérée.

Viral or fungal pneumonia generally occurs in immunocompromised patients. We report a case of hypoxic pneumonia unresponsive to broad-spectrum antibiotic therapy in a patient whose only risk factor for immunodeficiency was mild silent renal failure. The causal association between Herpes simplex and Geotrichum candidum was retained on the basis of endobronchial samples and the favorable course after institution of specific treatment. It is thus useful to consider these pathogens in patients with lung infection in order to institute specific treatment.

[Mediastinal adenopathies and presence of anti-cytoplasmic antibodies of diffuse type polynuclear neutrophils]. / Adénopathies médiastinales et présence d'anticorps anti-cytoplasme des polynucléaires neutrophiles de type diffus.

We report a case of sarcoidosis with mediastinal and pulmonary localizations associated with diffuse antineutrophil cytoplasmic antibodies (c-ANCA). This led to discuss the differential diagnosis with vascularitis and the specificity of c-ANCA in Wegener's granulocytosis.

[Rare pulmonary complication in intravesical BCG treatment]. / Complication pulmonaire rare d'un traitement par BCG intravésical.

We report a case of epithelioid granulomatous allergic lung disease in a patient given intra-bladder BCG therapy for treatment of a tumor. This uncommon complication is sometimes related to bacterial dissemination or to an immunoallegic reaction occurring from the third to eigth week after onset of the instillation. Clinically, the patient presents a flu-like syndrome. The standard chest X-ray followed by computed tomography, demonstrates the extension of the pulmonary lesions. Miliary dissemination is rarely reported (10 cases in the literature). Histological proof can be obtained from an endoscopic bronchial biopsy or a surgical specimen of the pulmonary parenchyma. Treatment is based on corticosteroid therapy in combination with antituberculosis antibiotics. Prognosis is generally good with treatment.

[Post-cardiac injury syndrome: an rare cause of pleurisy, value of pleural fluid analysis]. / Syndrome de post-agression cardiaque: une étiologie rare de pleurésie, intérêt de l'analyse du liquide pleural.

The post-cardiac injury syndrome is an inflammatory process concerning the pericardium, the pleura and/or the pulmonary parenchyma, that develops after different kinds of cardiac aggression. The diagnosis can be evoked when some clinical and biological results are present but remains one of exclusion. We report a case of post-cardiac injury syndrome for which we demonstrate an immunologic involvement of the pleura. The antimyocardial antibodies and the low complement index found in the pleura strongly support an immunologic process, and this suggests that the analysis of the pleural fluid could be useful for the diagnosis of the post-cardiac injury syndrome.

[Fortuitous discovery of infiltration of the lung bases]. / Découverte fortuite d'un aspect infiltratif des bases pulmonaires.

We report a case of interstitial pneumonia found by a woman who suffered from a gastroesophageal reflux unamenable to usual treatments. The HR-tomographic discovery of a tone esophagus lead to a manometric study. The association of high autoantibodies levels and radiographic and manometric data were characteristic of esophageal and pulmonary scleroderma.

[Larva migrans syndrome: a rare differential asthma diagnosis]. / Syndrome de larva-migrans: un diagnostic différentiel rare de l'asthme.

We report a case of sudden-onset bronchospasm which developed in a 68-year-old patient. Peripheral eosinophila suggested several possible diagnoses. Positive serology for Toxocara canis and clinical and radiological regression without treatment were particularly noteworthy.

[Restrictive myocardiopathy and pulmonary Raynaud's syndrome]. / Myocardiopathie restrictive et phénomène de Raynaud pulmonaire.

Idiopathic restrictive myocardiopathy is an uncommon condition. The differential diagnosis with constrictive pericarditis may require endomyocardial biopsy or surgical exploration. The prognosis of idiopathic restrictive myocardiopathy reported in the literature is to the order of several years. In this case the association with pulmonary Raynaud syndrome appears to be fortuitous and has not been previously reported.

[Spontaneous resolution of multiorgan sarcoidosis associated with malignant lymphoma]. / Sarcoïdose multiviscérale spontanément résolutive associée à un lymphome malin.

We report a case of multisystemic sarcoidosis with adenopathy, skin and respiratory involvements, which have a prolonged evolution. After 3 years with corticosteroid and synthetic antimalarial drugs treatment, the patient have a new skin and pseudo-tumoral pulmonary development, which have a spontaneous regression. Few month later, he developed a malignant lymphoma.

[Acute diffuse interstitial pneumopathy following docetaxel (Taxotère). Apropos of 2 cases]. / Pneumopathie interstitielle diffuse aiguë sous docétaxel (Taxotère). A propos de 2 observations.

Docetaxel, a new chemotherapeutic agent, has demonstrated activity in non-small cell lung cancer and breast cancer. Toxicities associated with treatment using docetaxel include hypersensitivity reactions and fluid retention, which can be prevented by pretreatment with corticosteroids. We describe herein two cases of acute interstitial pneumonitis after administration of docetaxel to patients suffering from metastatic non-small cell lung cancer. A pulmonary toxicity of docetaxel from an hypersensitivity reaction is likely because of symptoms course, radiological demonstration of an interstitial pneumonitis, lack of an infectious etiology and of clinical response to antibiotic treatment, and rapid recovery with corticosteroids. This unusual pulmonary toxicity has been rarely described with docetaxel, as transient pulmonary infiltrates have been observed during treatment with paclitaxel. The possibility of an hypersensitivity pneumonitis must be taken into account when a patient with docetaxel treatment presents pulmonary infiltrates.

[Percutaneous closure of an right-left interatrial shunt acquired after pneumonectomy]. / La fermeture percutanée du shunt droit-gauche interauriculaire acquis après pneumonectomie.

Right to left shunt through a patent foramen ovale after pneumonectomy is a rare complication. Its clinical presentation is a severe dyspnea with posture dependency. The diagnosis is easily confirmed by contrast echocardiography. The purpose of this article is to expose the interest of interventional catheterization and transcatheter closure. This method appears to be a viable alternative to surgery for those patients with precarious respiratory function.

[Association of idiopathic eosinophilic pleurisy and a severe pericardial effusion]. / Association d'une pleurésie à éosinophiles idiopathique et d'un épanchement péricardique mal toléré.

A 52-year-old man presented with a two month history of left sided chest pains related to a pleurisy which showed an 18 per cent eosinophilia on pleural aspiration. He was hospitalised one month later and at that stage was very dyspnoeic and there was a bilateral pleural effusion associated with a significant pericardial effusion causing compression. A pleuro-pericardial drainage eased the patient's symptoms. The pleural fluid showed an 87 per cent lymphocytosis and a complete diagnostic work up was negative thus a diagnosis of idiopathic eosinophilic pleurisy with an associated pericarditis was made. Steroid therapy was instituted using half a milligram per kilo and this led to a rapid functional improvement and no recurrence of the effusions were noted. The treatment was progressively stepped down over the next five months and the patient's condition was satisfactory without any recurrence at nine months.