ABSTRACT
Chronic obstructive pulmonary disease (COPD) is the chronic respiratory disease with the most important burden on public health in terms of morbidity, mortality and health costs. For patients, COPD is a major source of disability because of dyspnea, restriction in daily activities, exacerbation, risk of chronic respiratory failure and extra-respiratory systemic organ disorders. The previous French Language Respiratory Society (SPLF) guidelines on COPD exacerbations were published in 2003. Using the GRADE methodology, the present document reviews the current knowledge on COPD exacerbation through 4 specific outlines: (1) epidemiology, (2) clinical evaluation, (3) therapeutic management and (4) prevention. Specific aspects of outpatients and inpatients care are discussed, especially regarding assessment of exacerbation severity and pharmacological approach.
Subject(s)
Pulmonary Disease, Chronic Obstructive/therapy , Acute-Phase Reaction , Disease Progression , France , Humans , Language , Pulmonary Disease, Chronic Obstructive/epidemiology , Pulmonary Disease, Chronic Obstructive/pathology , Quality of Life , Severity of Illness Index , Societies, Medical/standards , Survival AnalysisABSTRACT
INTRODUCTION: The majority of pleural and peritoneal mesotheliomas are linked to asbestos exposure but, in around 20% of cases, no history of such exposure is found. Periodic disease is associated with recurrent serositis, which could favor the development of mesothelioma. CASE REPORT: We report a case of pleural mesothelioma in a 50-year-old Lebanese woman, with no detectable exposure to asbestos but suffering from periodic disease (familial Mediterranean fever) with recurrent episodes of serositis. DISCUSSION: Many cases of peritoneal mesothelioma in patients with FMF are reported in the literature. This is the second reported case of pleural mesothelioma associated with periodic disease. Because of the low incidence of both diseases, further publications are required to support the hypothesis of a causal link. It is important, therefore, that all cases of an association of periodic disease and mesothelioma are reported.
Subject(s)
Familial Mediterranean Fever/complications , Mesothelioma/etiology , Pleural Neoplasms/etiology , Antineoplastic Combined Chemotherapy Protocols/therapeutic use , Causality , Colchicine/therapeutic use , Familial Mediterranean Fever/drug therapy , Familial Mediterranean Fever/pathology , Female , Humans , Inflammation , Lebanon/ethnology , Mesothelioma/diagnosis , Mesothelioma/drug therapy , Middle Aged , Organoplatinum Compounds/administration & dosage , Pemetrexed/administration & dosage , Peritoneum/pathology , Pleural Neoplasms/diagnosis , Pleural Neoplasms/drug therapy , Serous Membrane/pathologySubject(s)
Pulmonary Disease, Chronic Obstructive/physiopathology , Respiratory Rate/physiology , Telemetry/instrumentation , Confidence Intervals , Disease Progression , Forced Expiratory Volume , Humans , Oxygen Inhalation Therapy , Pulmonary Disease, Chronic Obstructive/therapy , Regression AnalysisABSTRACT
INTRODUCTION: Bronchiolo-alveolar carcinoma is a primary pulmonary adenocarcinoma developing in the terminal respiratory unit. CASE REPORT: An 84-year-old non-smoker woman with a history of untreated acute myeloid leukaemia was referred to the intensive care unit for pneumonia and acute respiratory failure. The patient reported dyspnoea and a productive cough for 3 months, treated by antibiotics and steroids without improvement. Thoracic CT-scan showed alveolar condensations and multiple nodular lesions. All microbiological samples were negative and the evolution was fatal within 72 hours despite empirical antibiotic therapy and noninvasive ventilation. Post-mortem lung biopsies gave a diagnosis of mucinous and non-mucinous bronchiolo-alveolar carcinoma with typical lepidic growth pattern of tumor cells and discrete septal thickening but no fibrosis, inflammation or local invasion. CONCLUSION: Bronchiolo-alveolar carcinoma is an alternative diagnosis in alveolar condensations associated with pulmonary nodules even in a patient with immunosupression. Early diagnosis allows effective treatment in some cases.
Subject(s)
Adenocarcinoma, Bronchiolo-Alveolar/diagnosis , Leukemia, Myeloid, Acute/complications , Lung Neoplasms/diagnosis , Neoplasms, Multiple Primary/diagnosis , Aged, 80 and over , Fatal Outcome , Female , Humans , Immunocompromised HostSubject(s)
Adenocarcinoma, Mucinous/surgery , Adenocarcinoma/surgery , Celiac Disease/etiology , Common Bile Duct Neoplasms/surgery , Pancreaticoduodenectomy/adverse effects , Adenocarcinoma/complications , Adenocarcinoma/diagnosis , Adenocarcinoma, Mucinous/complications , Adenocarcinoma, Mucinous/diagnosis , Biopsy , Celiac Disease/diagnosis , Common Bile Duct Neoplasms/complications , Common Bile Duct Neoplasms/diagnosis , Diarrhea/etiology , Female , Humans , Jaundice/etiology , Middle AgedSubject(s)
Cholesterol , Colitis, Ischemic/etiology , Embolism/complications , Humans , Male , Middle AgedABSTRACT
A case of acquired jejuno-ileal malabsorption complicated by vitamin B12 malabsorption with macrocytic anemia and posterior column dysfunction is reported. Few such observations have been published in the medical literature. In the light of published studies and case-reports the authors review the pathogenic hypotheses concerning the formation of diverticula, the part played by bacterial infection in the mechanisms of malabsorption and the value of antibiotic therapy in the initial treatment of this condition.