[Recommendations for the management of bone demineralization in cystic fibrosis]. / Recommandations pour la prise en charge de la déminéralisation osseuse dans la mucoviscidose.

A high prevalence of low bone mineralization is documented in adult patients with cystic fibrosis (CF). Osteopenia is present in as much as 85% of adult patients and osteoporosis in 13 to 57% of them. In children, studies are discordant probably because of different control database. Denutrition, inflammation, vitamin D and vitamin K deficiency, altered sex hormone production, glucocorticoid therapy, and physical inactivity are well known risk factors for poor bone health. Puberty is a critical period and requires a careful follow-up for an optimal bone peak mass. This review is a consensus statement established by the national working group of the French Federation of CF Centers to develop practice guidelines for optimizing bone health in patients with CF. Recommendations for screening and for calcium, vitamin D and K supplementation are given. Further work is needed to define indications for treatment with biphosphonates and anabolic agents.

[Dantrolene-induced pleurisy: a case report]. / Pleurésie médicamenteuse au dantrolène. A propos d'un cas.

We report the case of a patient who developed dantrolene-induced pleurisy. Dantrolene (Dantrium) is a muscle relaxing agent used for the treatment of spastic neurological manifestations which has known liver toxicity. Lung toxicity is rarely reported. Six cases of dantrolene-induced pleurisy occurring after chronic administration (> 60 days) have been described in the literature. The pleurisy is associated with pleural and peripheral eosinophilia. Spontaneous regression a few days after withdrawal and radiological cure a few months later is the rule. The precise mechanism of this drug-induced pleural reaction remains unknown.

Efficacy of intravenous spiramycin in the treatment of severe Legionnaires' disease.

Spiramycin is a 16-membered macrolide that has been shown in cell and animal models to be active against Legionella spp. The activity of the injectable form of spiramycin was evaluated in the treatment of severe Legionnaires' disease in seven immunocompromised and three previously healthy patients. Seven of the ten patients were cured. Three patients died primarily from the underlying disease or from intercurrent complications. This result and the better tolerance of spiramycin compared with 14-membered macrolides suggest that spiramycin may be a suitable alternative to erythromycin for the treatment of Legionnaires' disease.

[Significance of the presence of Candida sp. in bronchopulmonary secretions. Contribution of pulmonary biopsy]. / Signification de la présence de Candida sp dans les sécrétions bronchopulmonaires. Apport de la biopsie pulmonaire.

Candida SP is often found in broncho-pulmonary secretions (expectorations, bronchial aspirations, bronchiolo-alveolar lavage...); however, its presence even in massive amounts, is difficult to interpret. Is it a sign of broncho-pulmonary candidosis or mouth-pharynx contamination? The different clinical and biological elements, in particular immunology in immunodepressed patients, bring little information. In this article, we present the retrospective study of 18 patients hospitalized in Pneumology Department of Tenon Hospital for severe extensive pneumopathy of unexplained origin. In these patients, for the most part immunodepressed, Candida sp was found in large amounts in at least a sample (expectorations [5] and/or bronchial aspirations [4] and/or bronchiolo-alveolar lavage [12]. No lesion suggestive of candidiasis was found during bronchial endoscopy carried out for these different samples. In pulmonary biopsy with diagnostic in view, these yeasts were found only in one patient. In this patient, as C. tropicalis was associated with Pneumocystis carinii and Cryptococcus neoformans, it was difficult to know the respective part of each of these agents in pulmonary symptomatology. In the other 17 cases, the direct examination and cultures were negative. The presence of Candida sp in the different broncho pulmonary secretions is not synonymous of bronchopulmonary candidiasis; likely it is, in most cases, a sign of contamination of mouth-pharynx origin.