[Postoperative pulmonary torsion after upper lobectomy by thoracotomy]. / L'image du mois. Torsion pulmonaire en post-opératoire après lobectomie supérieure par thoracotomie.

The aim of this case report is to describe a lobar torsion after elective pulmonary resection. This is a rare but potentially fatal condition in which the lung rotates on its own axis. Although this condition may occur spontaneously, it most often follows lobectomy. Early diagnosis and prompt surgical intervention are essential to prevent complications. Treatment is surgical, and involves repositioning the lung in a physiological position. However, the presence of ischaemic lesions may lead to the resection of the lung portion concerned.

Le but de cet article est de décrire le cas d'une torsion pulmonaire survenue après une résection pulmonaire élective. C'est une affection rare, mais potentiellement mortelle, qui se traduit par une rotation du poumon sur son propre axe. Bien que cette affection puisse survenir de manière spontanée, elle apparaît le plus souvent dans les suites d'une lobectomie. Un diagnostic précoce et une intervention chirurgicale rapides sont essentiels afin de prévenir les complications. Le traitement est chirurgical et consiste à repositionner le poumon en position physiologique. Toutefois, la présence de lésions ischémiques peut conduire à une résection plus large de la portion pulmonaire concernée.

On-table Extubation After Minimally Invasive Cardiac Surgery: A Retrospective Observational Pilot Study.

OBJECTIVE: To assess the safety of "on-table" extubation after minimally-invasive heart valve surgery. DESIGN: A single-center retrospective observational study. SETTING: At a tertiary referral academic hospital. PARTICIPANTS: Patients who underwent nonemergent isolated heart valve surgery through a minithoracotomy approach between January 2016 and August 2021. INTERVENTION: All patients were treated by 1 of the 6 cardiac anesthesiologists of the hospital. Only some of them practiced "on-table" extubation, and the outcome of patients extubated "on-table" was compared to those extubated in the intensive care unit (ICU). MEASUREMENT AND MAIN RESULTS: The primary outcome was the occurrence of any postoperative respiratory complication during the entire hospital stay. Secondary outcomes included the use of inotropes and vasopressors, de novo atrial fibrillation, and lengths of stay in the ICU and the hospital. A total of 294 patients met inclusion criteria, of whom 186 (63%) were extubated "on-table." Cardiopulmonary bypass duration was significantly longer, and moderate intraoperative hypothermia was significantly more frequent in patients extubated in the ICU. After adjustment for these confounders and for the European System for Cardiac Operative Risk Evaluation (EuroSCORE) II using a multivariate logistic model, no association was found between the extubation strategy and postoperative pulmonary complications (adjusted odds ratio = 0.84; 95% CI = 0.40-1.77; p = 0.64). "On-table" extubation was associated with a lower risk of postoperative pneumonia and fewer vasopressors requirements. CONCLUSION: "On-table" extubation was not associated with an increased incidence of respiratory complications. A randomized controlled trial is warranted to confirm these results and determine whether "on-table" extubation offers additional benefits.

[Fibromyalgia, where are we in 2023 ?] / Fibromyalgie, où en est-on en 2023 ?

Fibromyalgia remains a nebulous clinical entity for many practitioners. Actually, this pathology associates diffuse chronic pain with a host of somatic complaints, which may be variable from one patient to another. The difficulty resides also in establishing the diagnosis, which remains essentially clinical, in the absence of anatomical lesions, as well as biological or anatomopathological anomalies. Patients are usually confronted to a therapeutic wandering phase, of variable duration, before being recognized in their pathology. Management of fibromyalgia has to be multimodal, including physiotherapy, a cognitive-behavioural approach, and an individually tailored medical support.

La fibromyalgie reste une entité clinique nébuleuse dans l'esprit de nombreux praticiens. En effet, cette pathologie associe douleurs chroniques diffuses à une multitude de symptômes tels que des troubles du sommeil, des troubles cognitifs, ainsi que de nombreuses plaintes somatiques variables d'un patient à l'autre. La difficulté réside également dans l'établissement du diagnostic. Celui-ci reste avant tout clinique, en l'absence de lésions anatomiques, d'anomalies biologiques ou anatomo-pathologiques. Les patients passent, généralement, par une phase plus ou moins longue d'errance thérapeutique avant d'avoir une reconnaissance de leur pathologie. La prise en charge doit être multimodale, incluant une revalidation en kinésithérapie, une thérapie cognitivo-comportementale, et un accompagnement médical adapté au cas par cas.