Six-minute stepper test to assess effort intolerance in interstitial lung diseases.

The six-minute stepper test (6MST) is a new test for evaluating exercise tolerance. Unlike the six-minute walk test (6MWT) it can be carried out in a limited space. The aim of this study was to compare the 6MST and the 6MWT in patients with various diffuse interstitial lung disease (ILD). 6MWT and 6MST were performed the same day in 84 patients with various ILD. The covered distance during 6MWT was compared to the number of steps during the 6MST. We also compared heart rate, oxygen saturation, dyspnoea and leg tiredness on a Borg scale. All the patients successfully completed the tests, and tolerance was considered good. The number of steps completed in the 6MST was strongly correlated with the distance walked in the 6MWT (r2 = 0.5; p < 0.0001). Oxygen desaturation was less frequent and less severe (p < 0.0001), heart rate was higher (p < 0.0001) and dyspnoea and leg tiredness were more marked (p < 0.0001) in the 6MST than in the 6MWT. The 6MST is feasible for patients with ILD. It is a simple, safe, mobile test that is cheap and easy to carry out in all structures.

Long-term effects of pulmonary rehabilitation on daily life physical activity of patients with stage IV sarcoidosis: A randomized controlled trial.

INTRODUCTION: Pulmonary rehabilitation (PR) is known to improve exercise tolerance, mood, and quality of life in patients with chronic respiratory diseases. The aim of this work was to determine whether PR provides long-term benefits in increasing daily life physical activity in patients with chronic sarcoidosis. METHODS: This randomized prospective study (registered ClinicalTrials.gov NCT02044939) of 38 patients with stage IV chronic sarcoidosis was performed between 2012 and 2016. Patients were assigned to participate in a 2-month PR program (n=20) or receive counseling (n=18). Assessments were performed at baseline, 2 months (end of the PR program), 6months, and 12months, and included daily life physical activity parameters (measured for 5 consecutive days), exercise tolerance, dyspnea, anxiety, depression, fatigue, and quality of life. The primary outcome was the 12-month change in time spent in activities above an estimated energy expenditure of 2.5metabolic equivalents (METs). Secondary daily life physical activity outcomes included number of steps per day, total daily energy expenditure, and total energy expenditure above 2.5METs. RESULTS: The primary outcome did not differ between the two groups; mean between-group differences were -13.2min (95% confidence interval [CI]: -76.3 to 49.8) at 6 months and -18.1min (95% CI: -55.7 to 19.4) at 12months. Although PR had no effect on secondary daily life physical activity outcomes, it did significantly increase exercise tolerance at 6 and 12 months and decrease the dyspnea score at 6 months and the fatigue score at 12months. CONCLUSION: This trial failed to demonstrate a beneficial effect of PR on daily life physical activity in sarcoidosis patients, suggesting that long-term behavioral programs may be necessary to complement PR.

[What can be expected from suspension of the bladder neck in effort incontinence of urine? 85 operated cases (author's transl)]. / Que peut-on attendre de la suspension du col vésical dans l'incontinence urinaire d'effort? A propos de 85 opérées.

Among the large number of technics proposed to cure effort urinary incontinence in women, two types of operation are usually considered: --indirect cervico-cystopexy or colopexy (Marshall-Marchietti-Krantz operation or its derivatives); --operations of catapult type or suspension of the bladder neck, e.g. Goebell-Stoeckel's operation. The latter was chosen exclusively by us over the last ten years. We have thus grouped together 85 cases of effort urinary incontinence operated and followed up for a period of 1 to 11 years. At five years, this operation gave 82.85% good results and a delay of two years seemed to us the minimum necessary to assess these results. We noted 6 failures (7.05%) and 4 relapses (4.7%). Suspension of the bladder neck is often disputed and even denigrated. Some authors consider it is the best operation available especially in cases of relapse of effort incontinence [21]. Its technical difficulty has been reproached. Our objective thus double: --describe our technic of musculo-aponeurotic suspension of the bladder neck; --give our results emphasising the long term results. We thus hope to prove that this operation maintains its place in the treatment of effort incontinence.

[Effects of thromboendarterectomy for post-embolic pulmonary hypertension on physiological dead space on exercise]. / Effets de la thromboendartériectomie pour hypertension pulmonaire post-embolique sur l'espace mort physiologique à l'exercice.

The effect of therapy on the modification of a functional parameter is an elegant method for assessing the causal relationship between functional abnormalities and symptoms. We report an analysis of the effects of thromboendarterectomy for post-embolic pulmonary arterial hypertension on exercise functional parameters. A patient (62 years) had post-embolic pulmonary hypertension documented by pulmonary angiography and right heart catheterization (PAP mean: 48 mmHg). Cardiopulmonary exercise testing demonstrated a decreased aerobic capacity (59% predicted), significant hyperventilation (VE/VO(2) at peak 82) and a dead space to tidal volume ratio (VD/Vt) increased at rest (0.55) and remaining high at peak exercise (0.48). Thromboendarterectomy was performed and led to a dramatic improvement in dyspnoea (NYHA class II to I), a gradual improvement in aerobic capacity, and a significant decrease of VD/Vt (0.26) and hyperventilation (VE/VO(2) at peak: 38) on exercise. This observation illustrates the fact that an increase in the physiological dead space on exercise is associated with significant hyperventilation and consequently dyspnoea of effort.

[Hepatopulmonary syndrome and diffuse interstitial lung disease]. / Syndrome hépatopulmonaire et pneumopathie interstitielle diffuse idiopathique.

INTRODUCTION: The association between interstitial pneumonia and hepatopulmonary syndrome (HPS) has rarely been described. OBSERVATION: We report the cases of two patients, 62 and 64 years old, who presented with idiopathic interstitial pneumonia (IIP) and severe, disproportionate hypoxemia, PaO(2) 42 and 47 mmHg, respectively. This hypoxemia lead to search for associated disease. The diagnosis of right-to-left shunt was established by the 99mTc-MAA perfusion lung imaging. A contrast cardiac echography confirmed the intrapulmonary shunt. Both patients were found to have hepatic cirrhosis, classed as Child Grade A6 and C10. In this context of chronic hepatopathy, the diagnosis of SHP associated with IIP was established. Liver transplantation, the only way to cure the lung consequences of the HPS, was planned. CONCLUSION: These two cases highlight the importance of searching for right-to-left shunt in patients who have lung disease with severe disproportionate hypoxemia. Liver transplantation is the only way to cure the lung consequences of the hepathopathy. The rare association between ILD and HPS raises problems when deciding to go forward to transplantation in the absence of a histological diagnosis of the lung disease and where the prognosis of the lung disease is unclear.

[Secondary tumors of the kidney]. / Les tumeurs secondaires du rein

Secondary tumours of the kidney are relatively common. Found at autopsy in approximately 4 per cent of patients dying of malignant disease, they are clinically latent in most instances. Thus in a total series of 295 malignant tumours of the kidney, only 8 were metastases. The primary tumour is most often a bronchial carcinoma, this being confirmed in our series (5 cases). This is followed, in order of decreasing frequency, the breast, stomach, pancreas and stomach. Two of the 8 cases were rarities: a renal metastasis from a meningoblastoma and a metastasis from one tumour to another, a carcinoma of the ovary metastasising to a hypernephroma. The pathogenesis of these secondary tumours leads to the consideration of 2 modes of spread: haematogenous and lymphatic. They present no special clinical features. Intravenous pyelogram reveals the appearances of a malignant tumour mass. Angiography is more informative, the results reflecting the histological nature of the primary tumour. The latter being most frequently a carcinoma, the arteriographic image is one of hypovascularisation, thus differing from a hypernephroma with its rich vascularisation and resembling an infiltrating pelvi-calyceal carcinoma. Histopathological examination is not always conclusive itself. Nephrectomy is effectively only justified if the primary tumour has been or can be successfully treated in the absence of other metastases.

Renal angiomyolipoma. A report of 11 cases.

Renal angiomyolipomas are benign mesenchymal tumours. Whether isolated or associated with phacomatosis, they are histologically identical, but it is often difficult to distinguish an isolated angiomyolipoma from renal cancer. When it is combined with phacomatosis, it is frequently bilateral and can provoke retroperitoneal haemorrhages. These peculiarities qualify the therapeutical management which would a priori be conservative in the case of a benign tumour.

Bladder neck suspension for stress incontinence: long-term evaluation.

Remembering that the diagnosis of stress urinary incontinence is essentially clinical, the authors describe the fundamental stages of their technique, i.e. the musculo-aponeurotic suspension of the bladder neck (Goebell-Stoeckel technique). This operation has enabled them to have good results in 88% of their cases. The long-term study of these results shows slight deterioration of the success rate which becomes stable after 2 years.

Urinary lithiasis in children. A review of 155 cases.

155 children presenting with lithiasis have been studied. The study confirms other recent analyses: (1) Urinary lithiasis in the child is far more frequent than was previously thought. It is not always easy to diagnose because of the limited opacity of the calculi. (2) Its secondary nature is shown in 25% of the cases. (3) Its cause is still debated in spite of the evident part played by Proteus infection. (4) The prognosis is generally favourable.

[Renal angiomyolipomas. 9 cases (author's transl)]. / Les angiomyolipomes rénaux. Apropos de 9 observations.

Renal angiomyolipoma is a benign mesenchymatous tumour. Whether isolated or associated with phacomatoses, they are histologically identical and the hypothesis which suggests that isolated angiomyolipomas represent a forme fruste or tuberose sclerosis is attractive. The tumour is benign and resembles a carcinoma clincally and radiologically, to such an extent as to lead to confusion. Improved knowledge and more detailed study of radiological documents should avoid their always being, in the words of R. Couvelaire" a constant operative or histological surprise". However whilst there remains no doubt as to its benign nature, the association of true malignant tumours is possible and even seems frequent, which takes us back to the starting point and, given the difficulty of the pre-operative differential diagnosis with a carcinoma; we prefer to opt for extended nephrectomy when operation is indicated.