[Lung transplantation in Reunion Island, current situation from January 2005 till May 2015]. / État des lieux de la transplantation pulmonaire à la Réunion de janvier 2005 à mai 2015.

Lung transplantation (LT) is a therapeutic option for patients with terminal respiratory failure and high risk of mortality in two years. Until now, this activity is not performed in Reunion Island. The candidate potential are thus directed to the metropolitan reference centres causing logistics and financials constraints. This work presents a current situation of the pulmonary transplantation in Reunion Island. This retrospective study includes patients from Reunion Island with respiratory insufficiency who have been transferred to metropolitan centres to apply to LT. The selection was made from January, 2005 till May, 2015. Twenty-nine patients included, aged from 14 to 64 years, were transferred to metropolitan France: 13 patients with cystic fibrosis, 13 patients with pulmonary fibrosis, 1 patients with bronchiectasis, 1 patient with chronic obstructive pulmonary disease (COPD) and 1 patient with pulmonary arterial hypertension. Fifteen patients underwent LT (4 live in Reunion Island, 5 live in metropolitan France and 6 are dead), 1 patient is alive on waiting list, 3 died on the waiting list, 7 patients were refused for transplantation and 3 patients are lost to follow-up. The number of patients transferred for LT increases over 10 years with a maximal incidence in 2013 of 7 repatriated patients including 3 transplanted patients. LT could be performed in half of our patients with possible come back and follow-up on Reunion Island. Indications follow the current trends except an under representation of COPD.

[Massive haemoptysis revealing bilateral sequestration in an adult: 3-year follow-up after embolization and surgery]. / Hémoptysie massive révélatrice de séquestration pulmonaire bilatérale chez un adulte : évolution à 3ans après embolisation et chirurgie.

Pulmonary sequestration is a rare vascular malformation which is most of the time unilateral. We report here the case of a 35-year-old male admitted for severe haemoptysis revealing bilateral pulmonary sequestration: one type 1 of Pryce in the right lower lobe and one type 2 of Pryce in the left lower lobe. Bilateral embolization was performed followed by a segmental resection of the left lower lobe sequestration by thoracotomy. After 3-year follow-up, the patient was asymptomatic and had no recurrence of haemoptysis. Enhanced computed tomography scan showed proximal occlusion of the right lower lobe sequestration systemic artery.

[American histoplasmosis: clinicopathological features in immunocompetent and immunocompromised patients. A report of two cases of infection by Histoplasma capsulatum on Reunion Island]. / Histoplasmose : aspects clinicopathologiques chez l'immunocompétent et l'immunodéprimé. À propos de deux cas d'infection à Histoplasma capsulatum sur l'Île de la Réunion.

INTRODUCTION: Histoplasmosis is a fungal infection caused by Histoplasma capsulatum var. capsulatum. It shows pulmonary or multivisceral involvement. Infective spores are inhaled from soils that contain bat or bird guano. The clinical picture depends on the intensity of the exposure and the immune status of the host. CASE REPORTS: We report two cases of histoplasmosis that reflect its variability in clinical and histopathological expression: a pseudo-tumoral nodular form or histoplasmoma in a pauci-symptomatic immunocompetent patient and a disseminated form with severe respiratory and mucocutaneous involvement in an immunocompromised patient. The histoplasmoma presented as a spiculated, hypermetabolic, solitary pulmonary nodule. Histopathological examination showed well-formed epithelioid granulomas with caseous central necrosis containing numerous histoplasma yeasts. In the patient with disseminated infection, the diagnosis was confirmed by seeing yeast forms in bronchoalveolar lavage fluid and skin biopsy. CONCLUSIONS: These patients are the second and third cases of histoplasmosis reported on Reunion Island. Both had traveled in endemic areas several years previously. The most likely pathophysiological mechanism is the reactivation of an old latent infection. There is, therefore, no argument at present in favor of the presence of contaminated soils on Reunion Island.

[Disseminated histoplasmosis caused by Histoplasma capsulatum in a renal transplant patient: first case report in the Reunion Island]. / Premier cas d'histoplasmose disséminée a Histoplasma capsulatum a la Réunion, chez une transplantée rénale.

The purpose of this report is to describe the first case of indigenous disseminated histoplasmosis caused by Histoplasma capsulatum in a patient on immunosuppression 22 months after renal transplantation in the Reunion Island. Involvement was predominantly pulmonary and outcome was rapidly fatal. Diagnosis based on isolation of characteristic intramacrophagic Histoplasma capsulatum yeast cells from bronchoalveolar fluid was delayed since indigenous cases of this opportunistic infection were unprecedented. In addition to demonstrating the difficulty of achieving diagnosis in places located outside endemic areas without modern facilities, this case underlines the potentially the poor prognosis of disseminated histoplasmosis. This disease should be included in differential diagnosis in the Reunion Island where many patients undergo immunosuppresion and receive organs shipped in from outside locations.

[Acute leptospirosis in children in Reunion Island: a retrospective review of 16 cases]. / Leptospiroses de l'enfant à l'île-de-la-Réunion: à propos de 16 cas.

INTRODUCTION: Leptospirosis is a worldwide zoonosis caused by pathogenic species of the genus Leptospira. This infectious disease known with a high incidence in Reunion island (French overseas territories in Indian Ocean) is in state of endemia especially during rains season. OBJECTIVES: The aim of our work was to identify the mains epidemiologic, clinical, biological, and therapeutic features of leptospirosis in children. POPULATION AND METHODS: We conducted a retrospective analysis of children hospitalized in pediatric unit with the diagnosis of leptospirosis from January 2001 to June 2004 in general hospital of Saint-Denis. We found out 16 cases (mean age 14 years, range 9-17), mainly boys (ratio 7:1). RESULTS: The patient sera reacted most strongly with Leptospira interrogans serovars canicola (66%), icterohaemorrhagiae (17%), and sejroe (17%). Epidemiologic data indicated contact with contaminated water in most cases (68%). Jaundice was present in 43% of the patients, increased transaminase levels in 56%, renal failure in 50%, meningitis in 25%, ECG abnormalities in 6%, respiratory manifestations in 6%, systemic manifestations in 12% and thrombocytopenia in 56%. Death rate was zero, but renal failure is likely to induce life prognosis. DISCUSSION: The diagnosis' traps are numerous, leading to an underestimation and underdiagnosis of the leptospirosis, more over there is a lack in specific, reliable, and quick biological test to make the diagnosis. A negative polymerase chain reaction analysis (PCR) do not exclude the diagnosis, and the microagglutination test (MAT) remains the reference of the undoubtly diagnosis of leptospirosis. It appears that it is more often the conjunction of epidemiologic data (young boy, swimming or fishing in river, rains season), with clinical and biological data that lead to the diagnosis. Diagnosis was not evoked at the emergency room in 37% of the patients. CONCLUSION: Leptospirosis should be considered face to an influenza like illness especially during rains season.

The medical engineering program of Forschungszentrum Karlsruhe.

The research activities of the Forschungszentrum Karlsruhe on minimally-invasive surgery (MIS) have for several years improved techniques and instrumentation for different types of MIS. Many types of instruments and robotic devices have been developed and new techniques implemented. In this paper we present the most recent results from our different projects, such as endoscopic heart surgery, tracking systems, a camera guidance device, telemanipulator systems, minimally-invasive breast biopsy in closed-bore MRI, endoscopic training simulators and developments using smart materials (e.g. Nitinol).