Chronic inflammatory demyelinating polyneuropathy and ventilatory failure: report of seven new cases and review of the literature.

BACKGROUND: Ventilatory involvement is rarely reported in chronic inflammatory demyelinating polyneuropathy (CIDP), but small prospective studies showed frequent involvement of phrenic nerves, which is usually overshadowed by severe limb weakness. OBJECTIVES: To report the clinical features of CIDP associated with ventilatory failure. RESULTS: There were seven patients (43% women), with a mean age of 58.6 (range 38-82). The clinical courses were relapsing in five and progressive in two. Four patients had an initial event simulating Guillain-Barre syndrome (GBS). Ventilatory failure was recurrent in three patients. Five patients had full or nearly complete recoveries; one still requires nocturnal ventilation; and one died (14%) of myocardial infarction while still requiring mechanical ventilation. CONCLUSIONS: Clinical ventilatory dysfunction in CIDP is usually not an indicator of poor prognosis, and many patients recover without significant permanent disability. The mortality rate is similar to intubated patients with GBS. Patients with cardiopulmonary comorbidities and acute GBS-like onset of CIDP may be at higher risk of ventilatory failure which typically responds to 'standard' treatments of CIDP. Larger prospective studies are needed to define the prevalence, clinical spectrum and significance of ventilatory involvement in CIDP and to establish guidelines for evaluation and treatment.

[Functional secondary megaduodenum]. / Megaduoden secundar functional.

This paper aim is to present the case of a 72 year old male, diagnosed with functional secondary megaduodenum. We intend to discuss the pathogenic and positive diagnostic difficulties (the presence or absence of a mechanical obstructive factor or the participated of the megaduodenum in an intestinal pseudo-obstruction syndrome). Also we outline the rare frequency of this disease and especially the therapeutic difficulties: inefficiency of conservatory treatment, delicate problems of surgical tactics and technique.