[Malignant pleural effusion as the presenting site of cancer: comparison with metastatic pleural effusions from known cancers]. / Pleurésies malignes révélatrices d'un cancer: comparaison des étiologies avec les pleurésies métastatiques d'un cancer connu.

INTRODUCTION: Few studies have focused on malignant pleural effusions as the presenting site of cancer. The aim of our study is to evaluate their proportion in the total number of malignant pleural effusions, to identify their causes and determine their prognosis. PATIENTS AND METHODS: Patients were selected retrospectively from the database of the Pathology Department of the University Hospital of Nantes (France), which contained only the patients in whom a diagnosis of malignant effusion was made as the result of cytology of pleural fluid or pleural biopsy, between January 1999 and December 2001. Pleural effusions as the presenting site of cancer (R group) and those metastatic from known cancer (C group) were identified by study of the clinical data. RESULTS: Of 209 cases, the malignant effusion was presenting site of cancer in 85 patients. In this group (R), a male predominance was identified (sex-ratio 1.36 vs. 0.42 in group C, p<0.01). In order of frequency the causes were: lung cancer (31 cases), mesothelioma (18 cases), primary cancer unknown (15 cases), ovarian carcinoma (10 cases), lymphoma (5 cases) and other carcinoma (2 cases). In men lung cancer was the leading cause (42.8%); and in women its frequency was the same as ovarian carcinoma (27.7%). The median survival of these patients was 6.5 months. CONCLUSION: Pleural effusions as the presenting site of cancer account for 41% of all malignant pleural effusions. Their causes are mainly lung cancer in men and lung and ovarian cancers in women.

[Necrotizing pneumonia due to Staphylococcus aureus producing Panton-Valentine toxin]. / Pneumonie nécrosante à Staphylococcus aureus secréteur de la toxine de panton valentine.

BACKGROUND: Necrotizing pneumonia caused by Staphylococcus aureus producing Panton Valentine Leukocidine (PVL) has been described recently and is associated with a high mortality (75%). OBSERVATION: We report a case of pneumonia due to PV secreting Staphylococcus aureus in a healthy young adult, complicated by multiple necrotizing lung lesions and major cystic changes, with a favourable final outcome. Acute respiratory failure with haemodynamic failure and ARDS developed a few days after an influenza-like illness. The appearances at fibreoptic bronchoscopy were atypical, consisting of a purulent, necrotic tracheo- bronchitis with desquamation. The initial unfavourable progress despite broad spectrum antibiotic therapy and, finally, the identification of PV leukotoxin in blood cultures and tracheal aspirate, led to the diagnosis. During the clinical course there were repeated pneumothoraces (8 drains) due to multiple bilateral cystic lesions. Ultimately progress was favourable following treatment with antibiotics (flucloxacillin and clindamycin) and steroids. CONCLUSION: It is important to consider pulmonary complications of the Panton-Valentine leukotoxin in a healthy young adult who presents with necrotizing pneumonia and an unfavourable outcome in spite of broad spectrum antibiotics. Treatment is difficult on account of the extent of the necrotizing lesions and the need to use antibiotics effective against both the bacterium and its toxin.

[Survey on the use of electronic cigarettes and tobacco among children in middle and high school]. / Enquête sur l'usage de la cigarette électronique et du tabac en milieu scolaire.

PURPOSE OF STUDY: To estimate the prevalence of electronic cigarette use among teenagers and its connection with the consumption of tobacco. METHODS: In 2014 we conducted a survey of 3319 middle and high school students. RESULTS: Among the students, 56% had tried an electronic cigarette at least once (boys: 59.9%, girls: 49.3%; ranging from 31.3% for the 8th grade students to 66.1% for the 12th grades). However, only 3.4% reported that they used electronic cigarettes every day. Initiation of e-cigarette use in these teenagers was principally due to use by friends or triggered by curiosity and they usually choose fruit or sweet flavours initially. The majority could not give the concentration of nicotine in e-cigarettes that they used. Moreover, 61.5% of the students had ever tried tobacco and 22.3% were daily smokers. Our study found a strong link between vaping and smoking. 80% of the students who had ever tried conventional cigarettes (94% for the daily smokers) had also tried an electronic cigarette, versus 16% of the student who have never smoked. Few students (6.2%) used electronic cigarettes without smoking tobacco too. Usually, they have tried tobacco before trying an electronic cigarette. Only tobacco smokers seem to smoke electronic cigarettes with nicotine. CONCLUSION: Although our study shows that teenagers frequently try electronic cigarettes, it does not prove, for the moment, that vaping itself usually leads to nicotine addiction. However, as most of the teenagers are unable to tell if the electronic cigarette they are testing contains nicotine, it raises the possibility that they could be vulnerable to manipulation by the tobacco industry.

Predictors of survival in patients receiving domiciliary oxygen therapy or mechanical ventilation. A 10-year analysis of ANTADIR Observatory.

STUDY OBJECTIVE: To analyze predictors of survival for patients receiving home long-term oxygen therapy (LTOT) or prolonged mechanical ventilation (PMV) according to the cause of chronic respiratory insufficiency (CRI) and the patients physiologic data. DESIGN: Analysis of a nationwide database (ANTADIR Observatory). SETTING: The national nonprofit network for home treatment of patients with CRI Association Nationale pour le Traitement a Domicile de lInsuffisance Respiratoire Chronique (ANTADIR); founded in France in the 1980s. PATIENTS: There were 26,140 patients receiving LTOT or PMV (noninvasive or via tracheostomy) between January 1, 1984 and January 1, 1993 (chronic bronchitis, 12,043; asthma, 1,755; bronchiectasis, 1,556; emphysema, 551; tuberculosis sequelae, 4,147; kyphoscoliosis, 1,574; neuromuscular diseases, 1,097; pneumoconiosis, 919; and fibrosis, 2,498. MEASUREMENTS AND RESULTS: Survival analysis was performed using the actuarial and the Cox's semiparametric model. The mean survival for patients with chronic bronchitis is 3 years. Survival is slightly better for patients with bronchiectasis and asthma and worse for those with emphysema. Patients with kyphoscoliosis and a neuromuscular disease have the longest survival (8 and 6.5 years, respectively). Patients with CRI due to tuberculosis sequelae experience the same survival as COPD patients (3 years). Prognosis is the worst in patients with pneumoconiosis or fibrosis: 50% of these patients die during the year following the beginning of home treatment. The association of an obstructive lung disease worsens the prognosis of patients with kyphoscoliosis or neuromuscular disease and tends to bring the survival rate of the patients with pneumoconiosis or fibrosis closer to that of COPD patients. In COPD, male sex, older age, lower body mass index (BMI),FEV1 percent predicted,PaO2,and PaCO2 are independent negative prognostic factors. For tuberculous sequelae and kyphoscoliosis, female sex, younger age, a high BMI, PaO2 and PaCO2 (and for kyphoscoliosis a higher FEV1/vital capacity [VC] ratio) are all independent favorable prognostic factors. In pulmonary fibrosis, a lower PaO2 and PaCO2 values, a lower VC percent predicted, and a higher FEV1/VC ratio are negative prognostic factors. CONCLUSIONS: The ANTADIR Observatory allows a unique opportunity to analyze long-term survival of a large population with CRI treated at home.

Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients.

We studied 70 patients with biopsy-proven pulmonary non-Hodgkin's lymphomas without extrathoracic involvement or mediastinal adenopathy to determine the clinical, imaging, and endoscopic features of this condition in a homogeneous series. In low-grade (LG) lymphomas, symptoms were cough, dyspnea, chest pain, hemoptysis. Imaging features consisted of localized alveolar opacities, infiltrative diffuse opacities, atelectasis, and pleural effusions. Inflammatory changes of the mucosa were present in some patients, leading to bronchial stenosis in 7; biopsies showed lymphomatous infiltration in 12. Prognosis of LG lymphomas was excellent, with 93.6 percent survival at five years. High-grade lymphomas differed from LG lymphomas principally by a more aggressive course and a worse survival. Inflammatory changes occurred in seven of nine cases leading to stenosis in two, and biopsies showed lymphomatous involvement in five. The profile of primary pulmonary lymphomas in this study could help clinicians consider this condition and prompt them to evaluate new diagnostic tools.

Prognostic factors in diffuse malignant pleural mesothelioma. A study of 167 patients.

The existence of large shipyards accounts for the particular frequency of pleural mesothelioma in the Nantes-St. Nazaire region of France. From 1955 to 1985, 167 cases were diagnosed. Occupational exposure to asbestos was involved in 131 cases (88 percent). There was a great predominance of epithelial types (135) over mixed (25) and fibrosarcomatous (7) types. Survival, estimated by the actuarial method, was 54 percent at one year from first symptoms and 39 percent from histologic diagnosis. No subject was alive four years after diagnosis. Histologic type and asbestos exposure had no predictive value in our series. Survival was longer in patients under 60 years of age and when mesothelioma originated on the left side. Overall, treated patients had significantly longer survival than untreated patients. However, there was no significant difference in survival with respect to the type of treatment given: surgery, chemotherapy, talc poudrage or their combination.

[Medical impact of screening of benign pleural lesions associated with the inhalation of asbestos dust]. / Impact médical du dépistage des lésions pleurales bénignes liées à l'inhalation de poussières d'amiante.

Asbestos-related benign pleural lesions can involve the parietal pleura (pleural plaques), and/or visceral pleura as focal or diffuse (diffuse pleural thickening) fibrosis. Benign asbestos pleurisy and rounded atelectasis are linked with visceral pachypleuritis, the former as a cause, the latter as a consequence. The prevalence of these lesions, particularly pleural plaques, is very high, reaching 25% in populations of workers exposed intermittently to asbestos. Conventional radiology has a sensitivity less than 50% for detection of plaques, and a specificity less than 85%. Tomodensitometry is today the reference diagnostic tool: availability, cost and irradiation have to be considered before its use in mass screening. Pleural plaques are most often asymptomatic and a functional impairment cannot be proven usually on an individual basis. Visceral pleural thickening is more often accompanied by symptoms (dyspnea, pain) and functional impairment. There is no treatment susceptible to produce a regression of pleural lesions. Asbestos exposure increases the risk of pulmonary and pleural cancers. However there is no evidence of an increased risk in subjects with plaques compared with subjects without plaques but an equivalent asbestos exposure. The cost and the risk of diagnostic procedures induced by the screening, as well as the anxiety provoked by the detection of radiologic abnormalities are to be considered. Finally it is difficult today to justify the screening of benign pleural lesions by arguing an improvement of the life expectancy or of the quality of life of former asbestos exposed workers. It is probable that benefit of a screening will be of a social type, at an individual or a collective level.

[Prognostic factors in survival of patients with obstructive respiratory insufficiency treated by long-term oxygen therapy. Data from the ANTADIR registry]. / Facteurs pronostiques de la survie des insuffisants respiratoires obstructifs traités par oxygénothérapie à long terme. Données de l'observatoire de l'ANTADIR.

Prognostic survival factors in COPD patients obtaining long-term oxygen therapy (LTO) through 25 french associations were studied using data from the ANTADIR register. Selection criteria included age (50 to 79 yr), FEV1/VC < 60%, PaO2 < 60 mmHg and start of therapy between beginning 1984 and end 1988. A total of 1,775 patients were selected (1,462 men, 313 women, mean age 66.1 yr). PaO2 was 50.9 +/- 5.8 mmHg, PaCO2 47.1 +/- 5.8 mmHg, FEV1 8.81 +/- 0.31 l (30.4 +/- 11.1% of predicted values) and FEV1/VC 37.7 +/- 10.1%. Overall survival was 81.6% at 1 yr, 68.6% at 2 yrs, 55.7% at 3 yr, 44.9% at 4 yr and 37.3% at 5 yr (survival median 3.5 yr). Age was the most predictive survival factor (5 yr survival 48.8% for 50-59 yr-old patients vs 27.3% for 70-79). Survival was longer in women (49% at 5 yr vs 34.9% for men). After stratification by age, FEV1, FEV1/VC, PaO2, PaCO2 and Body Mass Index (BMI) were all significant predictive factors for men. FEV1/VC was the only prognostic factor for women. For all the population multivariate analysis showed that age, sex and BMI were the most significant variables. A prognostic score determined from the final Cox model and based on sex, age, BMI, FEV1, PaO2 will be validated in an independent patient series. Our data confirm the influence of age, airways obstruction and hypoxemia on survival of COPD patients under LTO. Furthermore they demonstrate a poorer survival in men, in underweight patients and in non hypercapnic patients.

[Apical pleural fibrosis related to inhalation of asbestos fibers]. / La pachypleurite apicale liée à l'inhalation de fibres d'amiante.

The involvement of the apical pleura is infrequent in diffuse pleural thickening secondary to asbestos exposure. Most often diffuse pleural thickening is accompanied by an obliteration of the costophrenic angle and the posterior and paraspinous pleural surfaces of the pleura are involved to the greatest extent. Unlike this typical form, we observed in five patients exposed to asbestos an apical pleural fibrosis, uni or bilateral, accompanied with lung retraction, hilar ascension and tracheal attraction. Apical pleural thickening with upper lobe changes in asbestos-exposed persons should be regarded as due to the asbestos exposure, after exclusion of other causes like tuberculosis and the apex tumors. Usually the evolution of the lesions is slowly progressive over several years or even decade, and results in mild restrictive defect.

[Sleep apnea syndrome in intensive care]. / Le syndrome d'apnée du sommeil en réanimation.

The aim of this work was to study the existence of special characteristics in the sleep apnoea syndrome (SAS) discovered following a stay on the Intensive Care Unit. This retrospective study of 25 casenotes of SAS patients who were resuscitated has enabled a comparison with 182 SAS patients who have never had acute respiratory failure. The intensive care consisted of controlled ventilation, following intubation, in a clinical context of acute respiratory failure with major problems of conscious level. The diagnosis of SAS was made using conventional or computerised polysomnography, or a computerised study of transcutaneous SaO2 (SaO2TC) which had been validated before. The results show that patients with SAS in an Intensive Care Unit, differs significantly from other patients with SAS by the permanent presence of alveolar hypoventilation in a stable state, associated with a significant decrease in the FEV1 (VEMS) in relation to the group that had not been in intensive care. However, the FEV1/VC ratio did not differ between the two groups which were expressed in absolute values or as a percentage of the theoretical value defined on the basis of their age. There was no difference on the data from the sleep studies and notably the hypoapnoeic indices, nor on age, the index of body mass or the sex ratio. We conclude that there is a need to look for SAS in the presence of acute respiratory failure in the obese without a recognised cause.

[Constrictive pericarditis due to asbestos exposure]. / Péricardite constrictive liée à l'exposition à l'amiante.

INTRODUCTION: Constrictive pericarditis is a rare complication of asbestos exposure and few cases have been reported in the literature. CASE REPORT: We report two cases of constrictive pericarditis in subjects previously exposed to asbestos. The first case, a 62 years old man, had occupational asbestos exposure whilst working for seven years in an electric plant 23 years before the diagnosis. The second case, a 76 years old man, had worked 21 years as a lagger up until 20 years before. The initial presentation in both cases was of sub-acute right heart failure. Both underwent pericardectomy which revealed pericardial thickening due to collagen fibrosis. Both patients died, one and five years respectively after surgery. Eight other cases of pericardial effusion and/or thickening, some with calcification, have been reported in association with previous asbestos exposure. Most of these cases had coexisting pleural lesions. CONCLUSIONS: As the prognosis is guarded (three of the eight reported cases died), making an early diagnosis is desirable.

[Secondary neuromuscular deficiencies in critical care patients]. / Déficits neuromusculaires secondaires en réanimation.

The authors report three cases of neuromuscular deficits occurring after a variable time of mechanical ventilation in ICU patients suffering from acute respiratory failure requiring sedation and neuromuscular blockade by pancuronium bromide. The clinical features of these deficits were similar : flaccid quadriparesia slowly reversible without sensory loss and difficult weaning from ventilation for two patients. The paraclinical investigations (measurements of creatine kinase, electrophysiological examination) permitted to distinguish two diseases: critical illness polyneuropathy (in patient with ARDS) and acute myopathy (in other patients with severe asthma) caused by corticosteroids and potentiated by neuromuscular blocking agents. This myopathy differs from the chronic myopathy caused by long term corticotherapy. After a status asthmaticus treated with corticosteroids and mechanical ventilation under muscle relaxants, creatine kinases should be measured in plasma and a neurological examination be performed. The value of neuromuscular blockade monitoring for the prevention of this myopathy should be assessed.

[Prognostic factors in the survival of patients with neuromuscular diseases after an episode of acute respiratory insufficiency]. / Facteurs pronostiques de la survie de patients atteints de maladies neuromusculaires après une insuffisance respiratoire aiguë.

We have studied the survival of 49 patients suffering from neuromuscular disease, who were hospitalised in the Respiratory Intensive Care Unit between 1981 and 1990 (29 males and 20 females with a mean age of 49.3 +/- 17 years with a range of 15 to 79). The neuromuscular diseases consisted of 8 with multiple sclerosis, 9 with amyotrophic lateral sclerosis, 8 with Steinert's disease, 11 myopathies, and 10 suffering from miscellaneous neurological diseases. Initially 27 of the 49 patients had been intubated and ventilated. During the hospital stay long-term ventilation was undertaken in 27 patients (21 by tracheotomy and 6 by nasal mask). The principal prognostic factor was the aetiology. Three groups of varying degrees of severity could be individualized: progressive neuromuscular disease (amyotrophic lateral sclerosis and multiple sclerosis), primary muscle disorders (myopathies and Steinert's disease), and neuromuscular disease with little or no evolution (survival at two years was 15%, 45% and 71% respectively for three groups. p = 0.001 by log-rank testing). The other factors which influence survival are age (p < 0.01), the presence of false route (p < 0.01), and the reason for hospitalisation (acute as opposed to chronic progressive deterioration, p < 0.05). In a multivariate analysis the most significant factors associated with the diagnosis were age, the reason for hospitalisation, and the existence of false routes. The initial treatment (intubation) and the prescription of long-term ventilation did not bring with it any significant further information as to prognosis, compared to the model which included these four factors.

[Complex respiratory aspergillosis: diagnostic and therapeuthic difficulties]. / Aspergilloses respiratoires complexes: difficultés diagnostiques et thérapeutiques.

INTRODUCTION: Respiratory aspergillosis with different physiopathologic mechanisms can be associated in one patient in rare occasions. CASE REPORT: We review three cases associating an allergic bronchopulmonary aspergillosis (ABPA) and an other form of aspergillosis: aspergilloma, chronic necrotizing pulmonary aspergillosis and we present a review of literature. CONCLUSION: Such associations result in diagnostic and therapeutic difficulties. Corticosteroid treatment used for ABPA can increase the risk of severe infections. Such cases are a good indication of systemic antifungal therapy.

[Malignant pleural mesothelioma: radiotherapy for the prevention of seeding nodules]. / Mésothéliome malin pleural: radiothérapie préventive des nodules de perméation.

INTRODUCTION: Radiotherapy for the prevention of skin nodules appearing at the sites of aspiration, needle biopsies, chest drains or surgical incisions is the only treatment currently recommended for malignant mesothelioma. METHODS: 59 patients suffering from this condition were identified from the database of the Nantes Regional Cancer Centre. 33 received prophylactic irradiation, 25 did not and 1 was excluded. RESULTS: The treated group showed typical demographic and histological features. The delay in initiating radiotherapy ranged from 10 to 123 days and several different treatment regimes were used. In the treated group 7 out of 32 patients developed nodules following radiotherapy with 4 recurrences in the treated and 3 in the untreated areas. The mean interval before recurrence was 9 months (range 3 to 17 months). The recurrence rate was lower in the treated (21%) than in the untreated group (48%;12 out of 25). CONCLUSIONS: The poor results compared with the reference series may be explained by a longer follow-up (mean 12 months), less thorough treatment of all puncture sites and a very long delay before treatment (mean 37 days).

[Asthma and air pollution. A study of admissions to the Hospital of Saint-Nazaire]. / Asthme et pollution atmosphérique. Une étude des admissions à l'Hôpital de Saint-Nazaire.

To test the possible influence of atmospheric pollution on the frequency of asthmatic exacerbations we have looked to see whether there is a link between the number of daily admissions for asthma in hospitals in Saint-Nazaire and data from pollution sensors in the network of the Association for the Measurement of Atmospheric Pollution in the Loire estuary. The pollutions studied were sulphur dioxide, oxide of nitrogen (NOx) and non sedimenting dust (black smoke). The meteorological data (speed and direction of the wind and temperature) were also recorded. The study was carried out for 18 months in a retrospective fashion. During this period 372 hospital admissions were recorded in 229 subjects. The number of daily admissions correlated in a significant fashion with the level of black smoke (r = 0.149, p less than 0.001) and this result was particularly due to subjects who were less than 15 years old. In this group the frequency of hospital admission was doubled on those days when the level of smoke was at its most elevated. There was a weak link between the peaks of SO2 (r = 0.116, p less than 0.05). An analysis of the place of residence in those hospitals and the dominant direction of the wind did not enable us to confirm the role of the principal sources of industrial pollution, which were all situated to the east of Saint-Nazaire.

[Reliability of transcutaneous PO2 measurements and ear oximetry at different levels of exercise]. / Fiabilité de la PO2 transcutanée et de l'oxymétrie par pince d'oreille à différents niveaux d'exercice.

Measurement of transcutaneous PO2 (PtcO2) and of the saturation of hemoglobin by ear oximetry (StcO2) are two non-invasive methods which can be used when performing exercise tests in patients with respiratory failure. To evaluate their reliability, we have compared 18 patients recording the PtcO2 (Radiometer electrode TCM1) and of StcO2 (Biox II A) with arterial samples using a radial artery catheter at rest and at a level corresponding to 50% of the maximal predicted effort and at maximal power (Wmax) obtained at the time of a triangular exercise (increasing the charge at 15 watts/min). The PtcO2 was significantly lower than the PaO2 at rest and on exercise: the variation between PaO2 and PtcO2 was 1.85 kPa at rest (confidence interval -0.25 to 3.96 kPa) but decreased with exercise reaching 1.22 kPa at the last level of exercise (confidence interval -1.2 to 3.65 kPa). The relative raising of PtcO2 in relation to the PaO2 masks a fall in the observed PaO2 on average for the entire group (the PaO2 falls from 9.49 kPa to 8.62 kPa whereas the PtcO2 only falls from 7.64 kPa to 7.39 kPa). The mean StcO2 does not differ from th SaO2 at rest as on exercise. However, the confidence interval of the scatters between SaO2 and StcO2 increase considerably at maximal power: whereas it ranges between -5.5 and 3.5% at rest and in the middle range effort, and is between -13.4 and 11.1% at the last stage.(ABSTRACT TRUNCATED AT 250 WORDS)

[Predictive factors in maintaining nocturnal continuous positive pressure in patients with sleep apnea syndrome]. / Facteurs prédictifs de l'observance de la pression positive continue nocturne chez les patients porteurs d'un syndrome d'apnées du sommeil.

A retrospective study was carried out on 347 case notes involving 303 men and 44 women who were suffering from a sleep apnea syndrome (SAS). The mean age was 57 plus or minus 10 years, and the diagnosis was made between 1982 and 1992. We have carried out the research to examine if there were clinical factors or factors related to respiratory function which would predict the acceptance in the short or long term and the correct observation in a daily time-table of nocturnal continuous positive pressure (PPC). The diagnosis of SAS was made using conventional polygraphy (35%), computerised cardiorespiratory recording 38%, or limited to transcutaneous saturation 27%. The mean number of respiratory nocturnal events in the three groups were respectively 48 plus or minus 25 per hour during sleep, and 45 plus or minus 23 and 51 plus or minus 20 per hour by the recording techniques. We have suggested a treatment by PPC in 235 patients: 86 patients refused at the outset (37%), 26 stopped secondarily (11%), and 108 (46%) continued until the end point 1992 with a mean duration of treatment of 24 (plus or minus 17), months and a mean duration of nocturnal usage of 6.2 (plus or minus 2.5) hours a mean level of positive pressure of 11 (plus or minus) 2) centimetres. The primary acceptance of PPC is significantly linked to the understanding of the patient of the functional signs (p less than 0.001) and of the severity of diurnal hypersomnolence (p less than 0.001). The acceptance in the long-term is linked in a weakly significant manner to the recognition by the patient of functional signs (p less than 0.04). None of the other 68 criteria used for assessing the severity of the patient and the SAS had any influence on the acceptance of PPC in short or long term. The compliance with a daily time-table is a weakly significant factor to the severity of the SAS judged by the number of nocturnal respiratory events (p less than 0.03).

[A rare and curable cause of acute respiratory insufficiency after a pneumonectomy. The platypnea-orthodeoxia syndrome by the reopening of the foramen ovale]. / Une cause rare et curable d'insuffisance respiratoire aiguë après pneumonectomie. Le syndrome de platypnée-orthodéoxie par réouverture du foramen ovale.

We describe a case of a 54 year old patient who had developed a right to left shunt due to a patent foramen ovale as a late consequence of a pneumonectomy; this was responsible for acute respiratory insufficiency and respiratory failure. This is a rare complication, but its clinical presentation as platypnea-orthodeoxia should lead to the correct diagnosis. The diagnosis can be rapidly confirmed by a non-invasive examination, namely contrast echocardiography, coupled with color doppler. The treatment is surgical with excellent results. The pathophysiological mechanism is also discussed.

[Disseminated invasive aspergillosis associated with Mycoplasma pneumoniae infection]. / Aspergillose invasive disséminée associée à une infection à Mycoplasma pneumoniae.

Disseminated aspergillosis is rare in patients not suffering from haematological disorders and myelo-suppression. We report a case of pulmonary cardiac and renal aspergillosis diagnosed at autopsy in a patient with chronic respiratory failure dying in the intensive care unit during an acute exacerbation. The role of risk factors associated with invasive aspergillosis in patients not suffering from myelosuppression is discussed (steroid therapy, chronic respiratory disease, concomitant viral or bacterial infection). The discovery in this patient of a pulmonary infection associated with mycoplasma pneumonia (the micro-organisms were found in necropsy specimens of pulmonary tissue) does not seem to have been reported before in the literature.