A solitary bronchial papilloma with unusual endoscopic presentation: case study and literature review.

BACKGROUND: Solitary endobronchial papillomas (SEP) are rare tumors and most of them are described by case report. A misdiagnosis is common with viral related papillomas. A histopathological classification has recently permitted a major advancement in the understanding of the disease. CASE PRESENTATION: We report a case of a mixed bronchial papilloma with an unusual endoscopic presentation. The literature was extensively reviewed to ascertain the unusual characteristics of the current case. A 39-year of age male was referred to our institution for the investigation of a slight hemoptysis. Routine examination was normal. A fibroscopy revealed an unusual feature of the right main bronchus. The lesion was a plane, non-bleeding, non-glistering sub-mucosal proliferation. No enhanced coloration was noticed. Biopsies revealed a mixed solitary bronchial papilloma. In situ HPV hybridization was negative. Endoscopic treatment (electrocautery) was effective with no relapse. CONCLUSION: This lesion contrasts with the data of the literature where papilloma were described as wart-like lesions or cauliflower tumors, with symptoms generally related to bronchial obstruction. We advise chest physicians to be cautious with unusually small swollen lesions of the bronchi that may reveal a solitary bronchial papilloma. Endoscopic imaging can significantly contribute to the difficult diagnosis of SEP by pulmonary physicians and endoscopists.

Persistent arthralgia associated with chikungunya virus: a study of 88 adult patients on reunion island.

BACKGROUND: An outbreak of chikungunya virus infection occurred on Reunion Island during the period 2005-2006. Persistent arthralgia after chikungunya virus infection has been reported, but few studies have treated this aspect of the disease. METHODS: Adult patients with laboratory-confirmed acute chikungunya virus infection who were referred to Groupe Hospitalier Sud Reunion during the period 2005-2006 were asked to participate in the study. Patients were assessed a mean of 18 months after acute disease occurred. Assessment consisted of answering questions on a standard form, undergoing a medical examination, and being tested for the presence of IgM antibodies to chikungunya virus. RESULTS: Eighty-eight patients (mean age, 58.3 years; male-to-female ratio, 1.1:1.0) were included in this study. Fifty-eight patients (65.9%) had been hospitalized for acute chikungunya virus infection, and a history of arthralgia before chikungunya virus infection was reported by 39 patients (44%). Fifty-six patients (63.6%) reported persistent arthralgia related to chikungunya virus infection, and in almost one-half of the patients, the joint pain had a negative impact on everyday activities. Arthralgia was polyarticular in all cases, and pain was continuous in 31 patients (55.4%). Overall, 35 patients (39.7%) had test results positive for IgM antibodies to chikungunya virus. CONCLUSIONS: Persistent and disabling arthralgia was a frequent concern in this cohort of patients who had experienced severe chikungunya virus infection approximately 18 months earlier. Further studies are needed to evaluate the prevalence of persistent arthralgia in the general population to determine the real burden of the disease.

Leptospirosis in Reunion Island (Indian Ocean): analysis of factors associated with severity in 147 confirmed cases.

OBJECTIVE: Analysis of risk factors associated with severity in patients with confirmed leptospirosis. DESIGN AND SETTING: Retrospective study in 147 leptospirosis-confirmed patients at two tertiary nonteaching hospital in Reunion Island. PATIENTS: 138 men and 9 women, aged 36+/-14 years, 80 in the ICU and 67 in medical wards. MEASUREMENTS AND RESULTS: We collected demographic, clinical, biological, and radiographic data and performed univariate and multivariate analysis to examine risk factors associated with admission in ICU and mortality. Pulmonary forms were more frequent (85%) than in previous reports, with 85 cases (65.3%) on abnormal chest radiography. Among the 38 patients who underwent bronchoalveolar lavage at admission 31 (81.5%) had alveolar hemorrhage. Independent factors related to ICU admission were: age over 46[Symbol: see text]years (OR 3.02), creatinine higher than 200[Symbol: see text]mumol/l (6.69), shock (13.87), and acute respiratory failure (20.69). Mortality was 12.9%. The only factor independently related to mortality was need for mechanical ventilation (OR 20.94). Icterohemorrhagiae serogroup was found in 62 cases (42.8%) but was not related to death. CONCLUSIONS: Pulmonary involvement is a major feature in leptospirosis disease but is not associated with poor outcome. Identification of clinical and laboratory findings on admission may help to better characterize severe cases.

[Chikungunya on Reunion Island: chronicle of an epidemic foretold]. / Chikungunya à l'île de la Réunion: chronique d'une épidémie annoncée.

Chikungunya is a viral disease transmitted by a mosquito of the genus Aedes. It is currently epidemic on Reunion Island, in the Indian Ocean. It is essentially characterized by an influenza syndrome but associated with polyarthralgia and an eruption. The disabling and chronic nature of the arthralgia is the most remarkable clinical aspect of chikungunya infection. Severe and unusual forms have appeared, not previously described in the literature. These forms must be studied to determine whether there is a direct relation between the chikungunya virus and the severity factors. Treatment is solely symptomatic, combining analgesic and/or antiinflammatory agents. There is no vaccine. The epidemic is not limited to Reunion: cases of chikungunya have also been reported in neighboring islands (Maurice, Seychelles, and Madagascar). Travelers planning to visit the region should be counseled.

[The effectiveness of leukotriene antagonists in the treatment of aspirin-intolerant asthmatic patients]. / Intérêt des anti-leucotriènes dans la prise en charge des asthmatiques intolérants à l'aspirine.

INTRODUCTION: The aim of this study was to assess the efficacy of leucotrien- antagonists in aspirin-intolerant asthma (AIA). The severity of asthma was evaluated according to GINA guidelines. On each consultation, the patients filled-in a simplified self-assessment questionnaire on rhinitis and quality of life (QOL). METHODS: Montelukast was administered during the inclusion visit. Patients' general state of health was assessed, FEV1 and MMEF25-75 were measured and the QOL and rhinitis scores and therapeutic impact were analysed at 3 and 6 months. RESULTS: Sixteen patients were included. FEV1 was initially recorded at 62% +/- 23 of theoretical values and then improved to 73% +/- 26.8 (p<0.002), and 77.2% +/- 17. Initial rhinitis score was 13 +/- 3.7 then 9 +/-5 (p<0.006) and 5.7 +/- 3.5 (p<0.03). Oral corticosteroids were required in 12 patients (8.5 +/- 5.6 mg). This dose was tapered to 3.4 +/- 6.4 mg (p<0.04) and 2.1 +/- 4.4 mg and stopped in 8 patients. The initial QOL score was of 4.36 +/- 1.4 and improved to 5.87 +/- 1.06 (p<0.002), and to 5.90 +/- 1.12. DISCUSSION: Aspirin-induced asthma is a challenging issue. Rhinitis is a major feature of discomfort. Following montelukast administration, we noted an improvement in the QOL and rhinitis subjective parameters, and an objective improvement in spirometrical measurements and in the doses of oral corticosteroids. CONCLUSION: Early recognition of these asthmatic patients is required in order to optimise their management. Administration of montelukast could be envisaged as unofficial first-line therapy in these patients combined with the recommended treatments.

Airway and esophageal stenting in patients with advanced esophageal cancer and pulmonary involvement.

BACKGROUND: Most inoperable patients with esophageal-advanced cancer (EGC) have a poor prognosis. Esophageal stenting, as part of a palliative therapy management has dramatically improved the quality of live of EGC patients. Airway stenting is generally proposed in case of esophageal stent complication, with a high failure rate. The study was conducted to assess the efficacy and safety of scheduled and non-scheduled airway stenting in case of indicated esophageal stenting for EGC. METHODS AND FINDINGS: The study is an observational study conducted in pulmonary and gastroenterology endoscopy units. Consecutive patients with EGC were referred to endoscopy units. We analyzed the outcome of airway stenting in patients with esophageal stent indication admitted in emergency or with a scheduled intervention. Forty-four patients (58+/-\-8 years of age) with esophageal stenting indication were investigated. Seven patients (group 1) were admitted in emergency due to esophageal stent complication in the airway (4 fistulas, 3 cases with malignant infiltration and compression). Airway stenting failed for 5 patients. Thirty-seven remaining patients had a scheduled stenting procedure (group 2): stent was inserted for 13 patients with tracheal or bronchial malignant infiltration, 12 patients with fistulas, and 12 patients with airway extrinsic compression (preventive indication). Stenting the airway was well tolerated. Life-threatening complications were related to group 1. Overall mean survival was 26+/-10 weeks and was significantly shorter in group 1 (6+/-7.6 weeks) than in group 2 (28+/-11 weeks), p<0.001). Scheduled double stenting significantly improved symptoms (95% at day 7) with a low complication rate (13%), and achieved a specific cancer treatment (84%) in most cases. CONCLUSION: Stenting the airway should always be considered in case of esophageal stent indication. A multidisciplinary approach with initial airway evaluation improved prognosis and decreased airways complications related to esophageal stent. Emergency procedures were rarely efficient in our experience.