[An unusual complication of thoracostomy]. / Une complication inhabituelle d'une thoracostomie.

INTRODUCTION: Post pneumonectomy infection is a well-described surgical complication. Treatment usually involves thoracostomy and requires local treatments. We report here an unusual complication of this situation. CASE REPORT: A 62 year old man had a pneumonectomy for non-small cell lung cancer. Following this he required a thoracostomy to treat a thoracic empyema and this was treated with local anti-septic agents. Subsequently he developed asthenia and a diagnosis of hyperthyroidism was made secondary to local disinfectant treatment with iodine agents. CONCLUSIONS: We describe an original case of thyroxicosis occurring in a patient following treatment for post-pneumonectomy empyema. We would recommend monitoring thyroid function in this context.

[Developping real time lymph node aspiration under endobronchial ultrasound control. One year's French experience in two different pulmonary departments]. / Mise en place de l'échoendoscopie bronchique avec ponction ganglionnaire en pneumologie: expérience française de deux centres.

INTRODUCTION: The histology and staging of bronchial carcinoma determines the treatment options for the condition. Endobronchial ultrasound allows the needle aspiration of mediastinal lymph nodes or pulmonary neoplasia where there is tracheo-bronchial contact under visual control. This procedure is aid for diagnosis and for mediastinal staging. French pulmonary departments have been slow to introduce this technique compared to other countries. METHODS: All Endobronchial ultrasound procedures performed during 2007 were retrospectively analysed in two pulmonary centres. The indications, practice management, complications, and diagnostic yield were reported. RESULTS: 103 Endobronchial ultrasound procedures were performed, in the majority under local anaesthesia in out-patients. Real time needle aspiration was performed only in 92 patients. Only 11 procedures were performed for mediastinal staging prior to thoracic surgery. 12.6% of patients had minor complications. 136 lymph node stations were sampled in 92 patients, but only 97 (70.3%) in 63 patients were judged to be 'satisfactory"(malignant cells and/or lymphocytes on cytology results). CONCLUSIONS: It is difficult to rapidly reach the diagnostic yield reported in literature. We think that appropriate training in the technique is of great importance.

[Pneumothorax following recreational inhalation of nitrous oxide]. / Pneumothorax et inhalation volontaire de protoxyde d'azote.

CASE REPORT: A 21 year old man was admitted to hospital as an emergency complaining of left sided chest pain. Chest radiograph revealed a complete non compressive left-sided pneumothorax which resolved following thoracic drainage. A more detailed history revealed repeated and regular use of nitrous oxide by inhalation, for its consciousness-altering effect during rave parties. DISCUSSION: The principal side effects occurring as a consequence of repeated exposures to nitrous oxide are haematological, neuropsychiatric and teratogenic. Rare cases of pneumothorax have been described associated with the use of nitrous oxide occurring as complications of anaesthesia or during laparoscopy where gas diffuses from the abdominal to the pleural cavity. Illicit use of nitrous oxide is rare and usually occurs in medical workers. Its spreading to the public may lead to accidents and unanticipated side effects. CONCLUSION: Inhaled nitrous oxide can reveal asymptomatic pneumothorax by worsening it. The consequences can be dramatic in case of illicit use because of ignorance of side effects.

[Evaluation of combined chemotherapy with vinorelbine, ifosfamide and cisplatin in the treatment of metastatic non-small cell bronchial carcinoma]. / Evaluation de la chimiothérapie associant vinorelbine-ifosfamide-cisplatine dans le traitement des cancers bronchiques non à petites cellules métastatiques.

INTRODUCTION: In France, cancer of the bronchus is responsible for 25,000 deaths per year. Non small cell lung cancer (NSCLC) represents 80% of bronchial carcinoma of which 40-50% are mefastatic at the time of diagnosis. At present, although the therapeutic benefits are modest, it is now recognised that combination chemotherapy including platinum salts improves the survival of these patients. METHODS: We analysed retrospectively a cohort of 57 patients suffering from stage IV NSCLC treated with chemotherapy combining cisplatin (80 mg/rn2 on day 1), vinorelbine (25 mg/rn2 on days 1 and 8) and ifosfamide (3000 mg/in 2 on day 1), (NIP), repeated every 21 days. RESULTS: The population studied comprised 6 women and 51 men, of average age 59.8 +/- 9.1 years. A history tobacco use (smokers and ex-smokers) was identified in 93%. The WHO performance index was equal to or greater than 2 in 22.8%. All patients were studied in terms of toxicity and overall survival but only 40 (70%) were able to be evaluated in terms of response to treatment (on account of having received more than three cycles of NIP chemotherapy). For the group considered as a whole, the median survival was 6.7 months with a one year survival of 24.5%. Median survival without progression was 4.4 months. The most frequent toxicities were haematological and digestive. They were most common among patients over the age of 70 but had no effect on median survival. For the 40 patients for whom chemotherapy was evaluable, the objective response rate was 20%. This objective response was the only factor that was signiticantly correlated with one year survival: 62.5% in responders, 28.1% in non-responders (p < 0.05). CONCLUSION: Treatment of stage IV NSCLC with NIP chemotherapy is effective and improves the survival of these patients independently of other prognostic factors such as age, the presence of cerebral metastases, performance status, histological type, the number of metastatic sites or the serum LOH level.

[Transudative pleural effusions and the ovarian hyperstimulation syndrome]. / Epanchements pleuraux transsudatifs et syndrome d'hyperstimulation ovarienne.

INTRODUCTION: Pleural effusions occurring in the ovarian hyperstimulation syndrome (OHS) are frequently associated with haemoconcentration. OBSERVATIONS: We report three cases of symptomatic pleurisy with ascites, requiring therapeutic pleural aspiration. Biochemical analysis of these effusions may give rise to confusion as consideration of the pleural fluid protein levels in isolation may lead to the incorrect diagnosis of an exudate. On account of the electrolyte disorders and haemoconcentration seen in OHS a pleural fluid protein level of over 30 g per litre (the traditional definition of an exudative pleurisy) should be interpreted in relation of a serum concentration. CONCLUSIONS: Measurement of the pleural and serum protein and LDH levels, complemented by a serum-effusion albumin gradient, should permit confirmation of the transudative nature of the pleural effusions. It seemed important to us to confirm this concept in three personal cases, as the data reported in the literature are more often reported as evidence for an exudates. Furthermore, a favourable response to symptomatic treatment tends to confirm the transudative nature of the effusions in OHS.

[Anaesthesia for bronchial echoendoscopy: experience with the laryngeal mask]. / Anesthésie en échoendoscopie bronchique : expérience du masque laryngé

INTRODUCTION: Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has recently been shown to be an accurate modality in the diagnosis and staging of mediastinal lymph node metastases. This procedure takes significantly longer than a conventional bronchoscopy and may therefore cause more discomfort. Since its introduction into respiratory practice in France, several airway management strategies have been used. PATIENTS AND METHODS: Both anaesthesia care and procedural sedation services share the goals of providing the patient with comfort during a potentially distressing procedure while also ensuring that the operating physician has an acceptable working environment. Historically, anaesthesiologists have applied the expertise gained in managing anaesthesia for major surgery to sedation care for minor procedures. While the supply of anaesthesiologists and anaesthetists has shown only a modest increase, the growth in minimally invasive procedures has been exponential in recent years. To investigate this further, we performed a retrospective study of the use of general anaesthetic with ventilation by a laryngeal mask during EBUS, which we have adopted in our unit. RESULTS: Sixty-three patients were included in the study. In 41 a laryngeal mask was used and in 22 the examination was performed under local anaesthetic alone. Eighty-seven percent of procedures were informative with cells from lymph nodes obtained (89% from examinations using laryngeal mask with a mean of 3.8 passes and 86% with sedation alone with a mean of 2.9 passes). In 45 cases (78%) it was possible to avoid mediastinoscopy. CONCLUSION: It was possible to establish a secure airway and maintain oxygenation with the laryngeal mask during bronchoscopy without any reduction in the success of the procedure.

[Tuberculosis of the submandibular gland: a case report]. / Tuberculose de la glande sous-mandibulaire: un piège diagnostique.

INTRODUCTION: Tuberculosis remains an important public health problem in France. After a certain decline, its incidence has remained unchanged since 1990. 30% of tuberculosis cases are extra-pulmonary form, most of them concern nodes especially in cervical areas. CASE REPORT: This case of submandibular tuberculosis illustrates diagnostic and therapeutic difficulties. DISCUSSION: There are few clinical signs or laboratory clues suggestive of tuberculosis, however a surgery cannot be avoided and must be performed in combination with antituberculosis chemotherapy.