[First intention management of obstructive sleep apnea syndrome (OSAS) by custom-made mandibular advancement device: the medium-term results. Prospective study by the General Hospital Pneumologists College (CPHG)]. / Traitement du syndrome d'apnées obstructives du sommeil (SAOS) par orthèse d'avancée mandibulaire sur mesure, en première intention: quels résultats à moyen terme? Etude prospective du Collège des pneumologues des hôpitaux généraux (CPHG).

OBJECTIVES: To demonstrate the efficacy and tolerance of present generation mandibular advancement devices in the first intention treatment for obstructive sleep apnea syndrome (OSAS), even when severe, after one year. METHODS: Between June 2006 and December 2007, 152 patients (male: 77%; age: 50.9±10.9 years; BMI: 26.3±3.6 kg/m(2); AHI: 25.5±13.9), without previous treatment, requesting management other than continuous positive pressure and dentally apt for a mandibular advancement device, were pre-included in a prospective one-year multicenter study (13 general hospitals). RESULTS: One hundred and twenty-nine patients were assessed at least once after fitting. The efficacy was noted as of day 90: the overall AHI fell from 24.8 to 10.8 (from 40.6 to 17.7 in the 40 patients with AHI>30) and the Epworth index decreased from 11.2 to 6.9 (12.8 to 8.1 for AHI>30). The AHI reduction was independent of gender, age, BMI and baseline AHI. The efficacy was maintained throughout the study period. Only eight patients withdrew for adverse events and seven for reasons of therapeutic failure. CONCLUSION: Mandibular advancement devices proved effective in first intention, including severe OSAS. No predictive individual efficacy factors emerged.

[Obstructive sleep syndrome, a prospective multicentric study (SASOM)]. / Le syndrome d'apnées du sommeil en pratique clinique: l'étude SASOM du CPHG.

UNLABELLED: A prospective multicentric study ("SASOM" for "Syndrome d'Apnées du Sommeil") was carried out from 1996 to 1998 among pulmonary departments of 57 French general Hospitals, about diagnostic, treatment and outcome of Obstructive Sleep Apnea Syndrome (OSAS). All successive adult patients diagnosed by polygraphic recording as having OSAS were included. Mean characteristics of the 1720 patients (1455 M, 245 W) were as follows: age 58 years, BMI 34, FEVI 86%, VC 88%, PO2 77 mmHg, PCO(2) 42 mmHg, AHI 46. Other determined values were: clinical signs, systemic hypertension, treatment, follow-up during 18 months. Main results were: - there was a strong correlation between clinical signs and AHI, - 70% of the patients (n=1227) were treated with CPAP; among them, withdrawals were 7% at 6 months, 15% at 1 year, 20% at 18 months, 24% at 2 years, - among patients whose AHI was<30, and who were treated, withdrawals were 33% at 18 months, - there was non difference of diagnostic, treatment and follow-up according to the modalities of the diagnostic (ventilation polygraphy of full polysomnography). CONCLUSION: Among a large population of 1720 OSAS without any selection in this multicentric study: - clinical signs are correlated with AHI, - a full polysomnography is not required of the initial diagnosis, - among the less severe patients who are treated by CPAP, the compliance is quite good at 18 months.

[Is spontaneous regression of pulmonary metastasis of renal cancer possible? Apropos of a case with review of the literature]. / La régression spontanée de métastases pulmonaires de cancer rénal est-elle possible? A propos d'un cas, avec revue de la littérature.

A 64-year-old man was hospitalized with a cancer of the right kidney associated with pulmonary images suggestive of parenchymatous metastases. After nephrectomy and no further treatment, we observed an involution of the images which disappeared completely within a few months and did not recur. Twenty months after the nephrectomy, the chest X-ray remained normal. This case raised the problem of possible spontaneous regression of renal cancer pulmonary metastases. Seventy-two observations were found in the literature: those sufficiently described were analyzed, but certain observations were questionable; a formal pathology diagnosis was only confirmed in two cases in 1959 and in 1977. Because of the rarity of these documented cases and due to the large number of possible causes of round, sometimes transitory, opacities on the chest X-ray, it would appear that one must be very sceptical about the existence of true spontaneous regression of renal cancer pulmonary metastases.

[Demons-Meigs syndrome caused by ovarian goiter]. / Syndrome de Demons-Meigs dû à un goitre ovarien.

In a 66-year old woman, progressive worsening of an exertional dyspnoea revealed the presence of an abundant right pleural effusion. The patient had a right ovarian mass, highly suspect at ultrasonography. Thoracoscopy showed a macroscopically normal pleura with normal cytology and histology. The ovarian tumour was very irregular, but it was found to be benign at histology. This gonadic goitre of the right ovary was entirely removed, and the pleural effusion did not recur.

Two cycles of cisplatin-vindesine and radiotherapy for localized nonsmall cell carcinoma of the lung (stage III). Results of a prospective trial with 149 patients.

One hundred forty-nine patients with localized nonsmall cell carcinoma of the lung (Stage III A and B) were treated with two monthly cycles of initial chemotherapy that included vindesine-cisplatin followed by 6000 cGy of thoracic irradiation. Patients with complete, partial, and minor response after initial chemotherapy were randomized into groups to receive either maintenance chemotherapy (four cycles) after radiotherapy or radiotherapy alone. The objective response rate was 24% after chemotherapy and 41% after combined chemoradiotherapy (complete response, 7.5%). The overall median survival was 9 months and the 2-year survival was 14%. Survival was identical with or without maintenance chemotherapy. The 2-year survival of patients with complete response was 75% compared with 9% for patients with partial or minor response. These results suggest that only the few patients (ten) who achieve complete response have a strong probability of survival. It is therefore essential to search for other therapeutic modalities that result in an increase of the complete response rate.

[Spontaneous regression of bronchial epidermoid cancer]. / Régression spontanée d'un cancer épidermoïde bronchique.

We report the case of an elderly man in whom a small squamous cell carcinoma was discovered by chance during fibroscopy performed for another reason. A control endoscopy performed 4 years later gave perfectly normal results, although this patient had not received any treatment. Up to now, only 3 other cases of proven spontaneous regression of squamous cell bronchial carcinoma have been published.

[Rheumatic pelvispondylitis and non-tuberculous sclerotic lesions of the pulmonary apex]. / Pelvispondylite rhumatismale et lésions scléreuses non tuberculeuses des sommets.

Two new cases of rheumatic pelvispondylitis associated with bilateral fibrosis of the pulmonary apex are reported and published data are reviewed. The clinical, radiological, evolutive and diagnostic features of this probable pulmonary manifestation of rheumatic spondylitis are described, and the pathogenesis is discussed.

[Pulmonary arterial pressure in chronic bronchitis with respiratory insufficiency on long-term oxygen therapy. Outcome of 16 patients with review of the literature]. / La pression artérielle pulmonaire des bronchiteux chroniques insuffisants respiratoires sous oxygénothérapie au long cours. Evolution chez 16 malades avec revue de la littérature.

A study was made of pulmonary artery pressure in 16 chronic bronchitics with severe respiratory failure, who were treated with continuous oxygen therapy at home. At the beginning of the study these patients presented with a pure and severe obstructive syndrome with marked hypoxaemia at rest (mean PaO2 = 6.8 kPa), had a suitable interval from a recent exacerbation, in a stable clinical and functional respiratory state. The duration of longterm oxygen therapy was controlled, as the efficacy of the blood gases (PaO2 of O2 greater than or equal to 8 kPa). The pulmonary artery pressure was measured using a microcatheter, at the beginning, and for most of the 18 months breathing ambient air in a stable state. At the end of this time a significant diminution of the FEV1 (VEMS) (a mean of 100 ml, p less than 0.01). This was evidence of the deterioration in the ventilatory state which contrasted with the improvement in the diminution of pulmonary artery hypertension (HTAP) from 3.43 to 2.97 kPa (p less than 0.05) without the deterioration in the other values. The good result above in chronic bronchitics contrasts with a stable or deteriorating pulmonary arterial pressure in a group of emphysematous (n = 6) and bronchiectatic subjects (n = 4) with somewhat similar functional characteristics but in whom the effect was too small to allow for any statistical comparison. Our results are compared with those in the literature much of which applies to only a few patients and for the great part revealed only haemodynamic stability of oxygen therapy. Possible reasons for these discordant findings are discussed.

[Desaturation and nocturnal pulmonary arterial hypertension in C.O.P.D.: effects of oxygen therapy]. / Désaturations et hypertension artérielle pulmonaire nocturnes dans les B.P.C.O.: effet de l'oxygénothérapie.

The influence of low flow oxygen on saturation (SaO2) and mean nocturnal pulmonary artery pressure (PAP), was studied in a group of chronic bronchitics suffering from severe airflow obstruction with moderate respiratory failure. 20 patients had oxymetry on ambient air, six underwent a continuous recording of SaO2 and of PAP for 2 nights; the first on ambient air, the second on Oxygen. The six patients showed transitory desaturation, accompanied by instantaneous rise in PAP. The oxygen greatly improved the mean values and maximal variation of SaO2 and PAP, supporting the hypothesis that this treatment is capable of preventing T.A.P., and chronic cor pulmonale in patients whose diurnal blood gas values do not justify continuous oxygen therapy, according to classical criteria.

[Influence of mixed venous blood PO2 on the pulmonary arterial pressure in chronic obstructive pulmonary disease (COPD): correlations in 128 patients]. / Influence de la PO2 du sang veineux mêlé sur la pression artérielle pulmonaire dans les bronchopathies chroniques obstructives (B.P.C.O.): corrélations chez 128 malades.

Hypoxic vasoconstriction is one of the main determinants of pulmonary arterial hypertension in C.O.P.D. The authors study in two groups of respiratory insufficiency patients (82 C.O.P.D. and 46 non-C.O.P.D.) correlations between mean pulmonary arterial pressure (PAP) and gasometric values. They show that: --no correlation exists in the patients who suffer from a restrictive syndrome; --in the obstructive patients, correlations are poorer between PAP and PaO2 or PvO2 than between PAP and a factor made up of these two parameters, according to the percentage of their theoretical values.

[Rheumatoid arthritis, obliterating bronchiolitis and D-penicillamine. Apropos of a new case with ultrastructural examination and review of the literature]. / Polyarthrite rhumatoïde, bronchiolite oblitérante et D-penicillamine. A propos d'un nouveau cas avec examen ultrastructural et revue de la littérature.

Over recent years, several cases have been reported of bronchiolitis obliterans, of very rapid onset and serious clinical course in patients with rheumatoid arthritis being treated with D-Penicillamine. After reporting a new case, the authors stress the unusual features of this bronchiolar condition which is probably of iatrogenic origin and irreversible, with death occurring within a few years. The pathogenesis is poorly understood and many questions still remain concerning the relationships between rheumatoid arthritis, the bronchiolar lesions and D-Penicillamine in this disease of pulmonary collagen. The ultrastructural examination and the morphometric examination of this new case suggest the presence of predominantly type III collagen, which is normally present in the lungs in only small quantities.

[Indications and decision criteria for supplemental oxygen therapy in chronic hypoxemia]. / Indications et critères de décision de l'oxygénothérapie de suppléance pour hypoxémie chronique.

Oxygen therapy is justified both on theoretical grounds and by clinical studies. Chronic hypoxia bodes ill for the system and is a prognostic factor in pulmonary disease. Low flow oxygen therapy has not shown any risk of pulmonary toxicity from anatomical or physiological studies. Clinical studies have shown that the correction of hypoxaemia by long term oxygen therapy improves exercise tolerance, mental state, the general sense of well being, polycythaemia, pulmonary hypertension, the quality of sleep, and finally the prognosis. But long term oxygen therapy is costly and requires patient co-operation and close supervision. It should be reserved for hypoxic patients in a stable state: the exact degree of hypoxaemia at which oxygen therapy is permissible cannot be defined precisely and depends on other criteria (such as polycythaemia, pulmonary arterial hypertension, nocturnal desaturation). Account should be taken of the PaCO2 level and the cause of the disease in deciding the oxygen flow. Polycythaemia, pulmonary arterial hypertension, nocturnal desaturation despite a normal waking PaO2, may represent some indications for oxygen therapy but further studies are necessary.