[Significance of systematic endoscopic decannulation. Retrospective study on intensive care patients]. / Intérêt de la fibroscopie systématique de décanulation. Etude rétrospective portant sur des malades de réanimation.

We performed a retrospective study in 42 consecutive tracheotomy patients hospitalized in an intensive care unit. Endoscopy was used systematically to assess all patients at decanulation and whenever symptoms suggested possible tracheal granuloma. Nine tracheal granulomas were evidenced. There was no significant association between presence of a granuloma and patient status: age, underlying chronic respiratory failure, or tracheobronchial infection. In initial stages, tracheal granulomas usually have little clinical expression. Difficulty in weaning from ventilatory assistance is generally the main sign. The long-term course after decanulation can progress to major respiratory disorders due to tracheal stenosis. We emphasize the importance of systematic endoscopy at decanulation to recognize existing granulomas early when local treatment remains simple (usually laser vaporization).

[Fat embolism after intrapenile injection of sweet almond oil]. / Embolie graisseuse après injection intrapénienne d'huile d'amande douce.

We report a case of fat embolism following self injection of vegetable oil in the penis, to treat an impotence. The patient developed respiratory failure and neurological disorders as confusion. A chest roentgenogram revealed diffuse alveolar infiltrate. Initially, he presented an hemoconcentration, and fat globules in his urine. The outcome was favourable in 72 hours, with oxygen and hydration. The diagnosis of fat embolism was made after neurological improvement: the patient admitted to injection his penis with vegetable oil, in his corpus cavernosum.

Left-sided superior vena cava: diagnosis by magnetic resonance imaging.

We describe a case of left-sided superior vena cava. The diagnosis was suggested by chest radiograph after central venous catheter placement. This was subsequently confirmed by magnetic resonance imaging.

[Chronic atrophic polychondritis. Clinical polymorphism and severity of respiratory lesions]. / Polychondrite chronique atrophiante. Polymorphisme clinique et gravité des localisations respiratoires.

The authors report the case of chronic destructive polychondritis (PCA) with extensive and predominant laryngo-tracheal involvement. The respiratory localisation of PCA is apparent in around 50% of cases. In a quarter of patients presenting with this type of localisation, the outcome is fatal. Tracheal disorders as the presenting feature is a rarity, as in the majority of cases it occurs either concomitantly or after the appearance of classic cartilagenous disease in the nose or ear. The diagnosis of the airways disease rests on the interpretation of the flow volume curve and the CT scan of the inspiration and expiration. Taking account of the absence of any correlation between the disturbed respiratory function and the laryngotracheal bronchial lesions, the authors stress the value of an endoscopic assessment with a fibroscope of reduced calibre. The narrowing of the laryngo-tracheal region is due to a thickening of the walls with oedema and inflammatory granulomas, and to collapse of the lumen caused by the destruction of cartilage and by fibrous scarring of the tracheal walls. Either general or local treatment is virtually non-existent and the prognosis of these extensive respiratory forms of the disease is very poor.