Anesthesia for adult rigid bronchoscopy.

Rigid bronchoscopy under general anesthesia enables performing diagnostic and/or therapeutic procedures in the tracheobronchial tree. This technique is characterized by specific technical problems, insofar as the anesthesiologist and the operators share the same space, namely the airway. Several potential complications (hemorrhage inside the airway, threat to ventilation ...) may arise. These challenges render the ability to use the variable available techniques essential, as well as knowledge of the complications they could entail, and the ability to rapidly solve them. General anesthesia is usually total intravenous anesthesia, using short acting agents. Ventilation can be spontaneous, but more often insured using high-frequency jet ventilation. The hospital infrastructure and staff must have the expertise to perform this particular procedure, in order to limit the complication rate.

Pulmonary arterial hypertension in a patient with stage II sarcoidosis and Hashitoxicosis.

Although pulmonary arterial hypertension is usually associated with advanced stages of sarcoidosis, its occurrence in early stage disease is rare. Herein, a case of associated pulmonary arterial hypertension in the setting of Hashitoxicosis and stage II pulmonary sarcoidosis is reported. The case of associated pulmonary arterial hypertension occurred in a young female without clinically significant medical history and who completely recovered after receiving oral corticotherapy only. Furthermore, this case report suggests the presence of an interaction between pulmonary arterial hypertension, sarcoidosis and Hashitoxicosis.

About an unusual systemic disorder: report of a cryptic miliary tuberculosis.

We report here the case of a young Chinese woman with cryptic miliary tuberculosis associated with acute hepatitis, pancytopenia, biological disseminated intravascular coagulation (DIC), and hyponatremia. Following the introduction of a classic tuberculostatic treatment, her general status quickly improved. After an extensive review of the literature, this is, to the best of our knowledge, the first case of cryptogenic miliary tuberculosis with all its cumulative complications.

[Anatomic and clinical features of a case of synoviosarcoma]. / Particularités anatomo-cliniques d'un cas de synoviosarcome.

An asymptomatic patient presented a pulmonary metastatis of a synovial sarcoma 15 years after resection of the primary tumor localized in the right groin area. The pathology findings demonstrated the non-specific variable nature of the biphasic epithelial and mesenchymatous feature of such tumors. No treatment was initiated and the patient has remained asymptomatic after five years follow-up. Lack of change in the radiological images led us to re-examine the prognosis and treatment in light of data in the literature.

Epithelioid hemangioendothelioma with solitary bone location associated to multiple lung and liver lesions. A case report.

Progressive development of a lobulated osteolytic lesion of the left calcaneus was observed in a 28-year-old woman. The bone tumor was associated with multiple lung nodules and later with a few small nodular liver lesions. A histological and immunochemical diagnosis of epithelioid hemangioendothelioma was obtained by bone tumor resection and thoracoscopic lung biopsy. Imaging aspects are reported with emphasis on its multifocality.

Basithoracic pain as first manifestation of pustulotic arthro-osteitis.

We report the case of a woman with atypical anterior basithoracic pain as only initial symptom of pustulotic arthro-osteitis. Early diagnosis was made only after development inferior lumbar pain, some months later. At that time, the radiological investigations revealed the osteoarticular counterpart of pustulotic arthro-osteitis.

Bronchial stenosis and sclerosing mediastinitis: an uncommon complication of external thoracic radiotherapy.

The side-effects of radiation therapy on the bronchial tree or on the mediastinum are seldom reported. In this setting, we report a case of sclerosing mediastinitis with bronchial stenosis discovered 1 yr after external radiotherapy for lung cancer. The patient was treated with a Dumont stent and has so far had an uneventful further course for up to 42 months. Bronchial stenosis related to mediastinal fibrosis after radiotherapy has not been reported previously.

[Chronic eosinophilic pneumopathy in a black African patient]. / Pneumopathie chronique à éosinophiles chez un patient Africain de race noire.

The authors report a case of a black African patient who suffers from a chronic eosinophilic pneumonia. In view of the lack of precise reporting in the literature of such a case in black Africans, the initial difficulty of strictly excluding a parasitologic etiology is discussed. From the comparison of paraclinical and clinical data with those of the literature, the authors emphasize the close relationship between asthma and chronic eosinophilic pneumonia and the role of alveolar eosinophils in the physiopathology of that illness.

[Wegener's granulomatosis: clinical, radiological and diagnostic characteristics. Apropos of a case]. / La granulomatose de Wegener: particularités cliniques, radiologiques et diagnostiques. A propos d'un cas.

The authors report an observation of Wegener's granulomatosis with pulmonary, bronchial, renal, cutaneous and sinusal involvement. Five years ago, the patient was referred to us because of bilateral diffuse pulmonary infiltrates of unknown origin. A corticotherapy was introduced at that time and a complete clearance of the pulmonary infiltrates was noted. Nineteen months after the treatment's withdrawal, the disease recurs with the reappearance of pulmonary infiltrates. Beyond these unusual clinical aspects, histological examination of the bronchial biopsies were of diagnostic value.

Upper airway anesthesia induces airflow limitation in awake humans.

Upper airway receptors are thought to contribute to upper airway stability by reducing collapsing forces. Their activity can be abolished by topical anesthesia. We have measured in 16 healthy volunteers (mean +/- SD age, 23.7 +/- 1.6 yr) specific airway conductance (SGaw), maximal inspiratory (MIFR) and expiratory (MEFR) flow rates before and 15, 35, and 45 min after extensive upper airway anesthesia (UAA) with 10% lidocaine. Average values of MIFR decreased (p less than 0.01) 15 min after UAA, but they returned to or near to control values at 45 min: MIF25 (4.8 versus 6.0 L/s); MIF50 (5.1 versus 6.2 L/s); MIF75 (4.4 versus 5.3 L/s). Transient decreases in flow (V) rates, reaching zero flow in some subjects, were observed in 13 subjects during forced inspiratory vital capacity (FIVC) maneuvers and in seven subjects during forced expiratory vital capacity (FEVC) maneuvers. MEFR at 25, 50, and 75% FVC, SGaw, and FVC did not change after anesthesia. Simultaneous measurements of supraglottic pressure, V, and lung volume in 12 of the 16 subjects showed that the site of flow limitation was localized at the level of the glottis in all except one subject in whom there was both a glottic and a supraglottic obstruction. We conclude that extensive upper airway anesthesia induced a profound but transitory upper airway obstruction during FIVC and FEVC maneuvers. These findings are compatible with the concept of reflex regulation of upper airway caliber.

Diurnal and nocturnal diuresis and natriuresis in obstructive sleep apnea. Effects of nasal continuous positive airway pressure therapy.

Excessive nocturnal diuresis and natriuresis have been reported in patients with sleep apnea. The mechanisms responsible for these alternations in nocturnal renal function have not been clearly identified. To gain further insight into this matter, we studied 12 patients (one woman) with a mean +/- SD age of 50 +/- 9 yr and body mass index of 36.9 +/- 8.6 kg/m2. Polysomnography showed in all a sleep apnea syndrome with an apnea-hyponea index (AHI) of 81.3 +/- 41.7. Treatment with nasal continuous positive airway pressure (nCPAP) resulted in an AHI of 19.4 +/- 13.7 and in normalization of sleep characteristics. Diurnal renal function was normal in all subjects. Although untreated, patients showed an abolition of the well-known decrease in diuresis and natriuresis during the night (diurnal and nocturnal diuresis 56.3 +/- 26.8 and 77.2 +/- 33.4 ml/h, respectively, p = NS; diurnal and nocturnal fractional urinary Na+ excretion 0.42 +/- 0.09 and 0.70 +/- 0.55 ml/100 ml glomerular filtration [GF], respectively, p = NS). Results of nocturnal studies under nCPAP therapy showed a significant decrease in diuresis and natriuresis (nocturnal diuresis before and under nCPAP, respectively: 90.4 +/- 27.3 and 70.6 +/- 25.1 ml/h, p less than 0.02; nocturnal fractional urinary sodium excretion before and under nCPAP, respectively: 0.76 +/- 0.53 and 0.44 +/- 0.37 ml/100 ml GF, p less than 0.03). Morning blood levels of renin, aldosterone, antidiuretic hormone, epinephrine, and atrial natriuretic factor showed no significant difference before and under nCPAP, whereas norepinephrine significantly decreased from 309.5 +/- 104.2 before to 230.4 +/- 88.4 pg/ml under nCPAP (p less than 0.02).(ABSTRACT TRUNCATED AT 250 WORDS)

Spontaneous favorable outcome of tracheal laceration.

We present the case of a 57-year-old woman with a huge tracheal laceration after intubation. With simple supportive therapy, the laceration healed in ten days, and the patient made an uneventful recovery. At the three-month follow-up, no sequelae were observed.

[Treatment of severe hemoptysis with terlipressin. Study of the efficacy and tolerance of this product]. / Traitement des hémoptysies graves par la terlipressine. Etude de l'efficacité et de la tolérance du produit.

Terlipressin (Glypressin) is a "pro-hormone"; after intravenous injection the glycyl radicals are slowly cleaved by enzymatic action, liberating vasopressin. We have assessed the efficacy of terlipressin in the treatment of severe hemoptysis. The study was performed on 20 patients: in 5 cases there was very copious hemoptysis and in 15 cases there was repeated hemoptysis of lesser volume. The cause was distributed as follows: 6 cases of neoplasms, 5 were sequelae of tuberculosis, bronchial dilatation 2 cases, pneumonia with abscess 2 cases, chronic airflow obstruction (COPD) 2 cases and 3 cases of silicosis. The treatment consisted of a slow intravenous injection of 2 mgm 4 times per day (9 patients), then in 11 patients an injection of 2 mgm at the time of acute episodes followed by 1 mgm every 6 hours. The patients received an average of between 15 and 20 mgm of the product for a treatment lasting over 5 days at the maximum. The results were as follows: total success 12 cases; partial success (a reduction to at least one-third of the initial hemoptysis): 5 cases; failure: 3 cases. The failures were linked in two cases to neoplastic disease and in one case there was an intolerance to the drug which did not allow the treatment to be pursued.(ABSTRACT TRUNCATED AT 250 WORDS)