Outbreak of Stenotrophomonas maltophilia bacteremia among patients undergoing bone marrow transplantation: association with faulty replacement of handwashing soap.

Using molecular typing methods, we confirmed an outbreak of Stenotrophomonas maltophilia among bone marrow transplant patients. The likely source was a healthcare worker who may have washed with moisturizer instead of soap between patients. Hospital epidemiologists need to go beyond antibiograms when evaluating outbreaks and be vigilant about all aspects of hand washing.

[Purulent pleurisy and lung cancer. Non-iatrogenic forms and therapeutic management]. / Pleurésies purulentes et cancer du poumon. Formes non iatrogènes et prise en charge thérapeutique.

Thoracic empyemas may occur during the course of lung cancer as a post-thoracotomy complication, or after pleural drainage and/or chemotherapy in cases when surgery was unfeasible, or may complicate the natural history of the disease and appear as the clinical event that led to its discovery. This latter situation is a challenge requiring to cure the infection in order to further treat the underlying lung cancer. We reviewed the cases of 18 men aged between 46 and 79 years that were referred to our surgical department from 1984 to 1996 for management of a thoracic empyema with an underlying lung cancer. Initial presentation of empyemas, lung tumor characteristics, treatments performed and their results were analyzed so as to formulate guidelines if possible. Mean duration of 17 empyemas before arrival was 26 days (8 to 60 days) and in one case empyema occurred during diagnostic work-up of an excavated lesion. Frank pus was observed in all cases and micro-organisms were identified in 13 cases. Empyema and diagnosis of lung cancer were concomitant in 15 cases: in 3 cases lung neoplasia was already diagnosed but patients had refused surgery. Empyema was treated by under water-seal chest tube drainage with adjunct fibrinolytic therapy in all cases; 2 elderly and cachectic patients suffering metastatic diffusion died rapidly. The other 16 recovered within one month. In 7 cases management was limited to medical treatment (palliative n = 2, chemotherapy n = 1, chemo combined radiotherapy n = 2 and radiotherapy alone n = 2) but only short survivals were observed (inferior to 10 months). Surgery was possible in 9 (pneumonectomy n = 8, lobectomy n = 1); there was no death; postsurgical empyemas complicated the cause twice but were easily cured by drainage; long term survivals were observed in 3 cases that were p NO. Pleural empyema complicating lung cancer is a rare but challenging situation. Once the pleural empyema has been controlled, surgical resection must be performed when indicated: postoperative complications are rare and long-term survival is possible.

[Cardiac rhythm disorders after pneumonectomy]. / Troubles du rythme cardiaque après pneumonectomie.

The authors studied 13 cases of arrhythmia following pneumonectomy in a series of 94 pneumonectomies performed in the Thoracic Surgery Unit. The arrhythmias essentially consisted of atrial fibrillation which was well tolerated haemodynamically. It generally occurred in ambulant patients on about the 5th postoperative day. These arrhythmias responded well to treatment with continuous infusion of amiodarone. By comparing the files of the standard series of 94 pneumonectomies to the series of 13 cases of arrhythmia, the authors tried to determine the predisposing causes. The most obvious cause was the opening of the pericardium, but a number of other predisposing factors were detected: not so much hypoxia or hypovolaemia, but, more importantly, an increase in the effusion in the pneumonectomy cavity with displacement of the mediastinum.

[Reversible pulmonary hypoperfusion following proximal bronchial obstruction caused by a benign process]. / Hypoperfusion pulmonaire réversible secondaire à l'obstruction d'une bronche proximale par un processus bénin.

Obstruction of a major bronchus by a benign lesion can be accompanied by a functional reduction of the perfusion of the distal lung. This disorder is reversible after removal of the obstruction. We present 5 cases of obstruction of a main bronchus with functional exclusion of the affected lung on scintigraphy. The obstructing lesion was carcinoid tumour in 4 cases and a plasmocytic granuloma in another case. The perfusion was found to be restored following the operation (one bronchotomy, three isolated resection-anastomoses and one resection-anastomosis with lobectomy). These disorders are due to reflex phenomena and anatomical modifications related to the trapping effect. These phenomena are revealed by plain chest x-rays and by perfusion and ventilation pulmonary scintigraphy.

[Lung volume reduction surgery for emphysema and bullous pulmonary emphysema]. / Chirurgie de réduction volumique et des bulles géantes dans l'emphysème pulmonaire.

The improvement of respiratory symptoms for emphysematous patients by surgery is a concept that has evolved over time. Initially used for giant bullae, this surgery was then applied to patients with diffuse microbullous emphysema. The physiological and pathological concepts underlying these surgical procedures are the same in both cases: improve respiratory performance by reducing the high intrapleural pressure. The functional benefit of lung volume reduction surgery (LVRS) in the severe diffuse emphysema has been validated by the National Emphysema Treatment Trial (NETT) and the later studies which allowed to identify prognostic factors. The quality of the clinical, morphological and functional data made it possible to develop recommendations now widely used in current practice. Surgery for giant bullae occurring on little or moderately emphysematous lung is often a simpler approach but also requires specialised support to optimize its results.