Management of acute exacerbations of chronic obstructive pulmonary disease (COPD). Guidelines from the Société de pneumologie de langue française (summary).

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.

Management of acute exacerbations of chronic obstructive pulmonary disease (COPD). Guidelines from the Société de pneumologie de langue française / Prise en charge des exacerbations de la bronchopneumopathie chronique obstructive (BPCO). Recommandations de la Société de pneumologie de langue française

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.(AU)

La bronchopneumopathie chronique obstructive (BPCO) est la maladie respiratoire chronique dont le poids sur la santé publique est le plus grand par sa morbidité, sa mortalité et les dépenses de santé qu'elle induit. Pour les individus atteints, la BPCO est une source majeure de handicap du fait de la dyspnée, de la limitation d'activité, des exacerbations, du risque d'insuffisance respiratoire chronique et des manifestations extra-respiratoires qu'elle entraîne. Les précédentes recommandations de la Société de pneumologie de langue française (SPLF) sur la prise en charge des exacerbations BPCO date de 2003. Se fondant sur une méthodologie adaptée de GRADE, le présent document propose une actualisation de la question des exacerbations de BPCO en développant un argumentaire couvrant quatre champs d'investigation : (1) épidémiologie, (2) évaluation clinique, (3) prise en charge thérapeutique et (4) prévention. Les modalités spécifiques de la prise en charge hospitalière et ambulatoire y sont discutées, particulièrement les aspects relevant de l'évaluation de la sévérité de l'exacerbation et de la prise en charge pharmacologique.(AU)

[Mesothelioma and familial Mediterranean fever: A relationship?]. / Mésothéliome et fièvre méditerranéenne familiale : quelle relation ?

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.

[Bronchioloalveolar carcinoma: an exceptional cause of diffuse lung disease in a patient with acute myeloid leukemia]. / Le carcinome bronchiolo-alvéolaire, une cause exceptionnelle de pneumopathie infiltrante diffuse au cours d'une leucémie aiguë myéloïde.

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.

[Diffuse diverticulosis of the small intestine and malabsorption syndrome. Apropos of a case]. / Diverticulose diffuse du grêle et syndrome de malabsorption. A propos d'une observation.

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.