Removal of airway foreign body using flexible bronchoscopy in children.

BACKGROUND: Flexible bronchoscopy is mainly used to diagnose airway foreign bodies (AFBs). Due to advances in pediatric anesthesia, many teams have considered the extraction of AFBs by flexible bronchoscopy. We aimed to assess the success of flexible bronchoscopy in AFB removal in children. PATIENTS AND METHODS: We analyzed retrospectively the data of children admitted for AFB aspiration in the Pediatric Respiratory Diseases Department B of Abderrahmane Mami Hospital in Tunisia between January 2012 and December 2022. AFB removal was performed by flexible bronchoscopy through the use of a laryngeal mask airway (LMA) or intubation. RESULTS: Of the 105 children included, AFB was removed by flexible bronchoscopy in 99 children (94.3 %). The mean age of the children was 32 months (9-150 months) with a sex ratio of 2:3. The foreign body was organic in 67 % of cases. Overall, 37 children underwent rigid bronchoscopy first (35.2 %). Flexible bronchoscopy was performed through the LMA in 77 cases (73 %) and after intubation in the other cases. Thoracic surgery was needed in two cases (1.9 %). Four infants expectorated the AFB after the procedure (3.8 %). Only two children developed laryngeal edema with transient oxygen desaturation. CONCLUSION: AFB removal using a flexible bronchoscope is an efficient and safe procedure when performed by an experienced team. The recent use of LMA has facilitated the use of a larger bronchofiberscope and the insertion of multiple tools that can reach distal airways.

Management peculiarities of costovertebral hydatidosis.

Background: Costovertebral hydatidosis is a rarely reported clinical and radiological entity, estimated at less than 1% of thoracic hydatid locations. Its management is still not codified. Objective: The aim of our study was to specify the management peculiarities of costovertebral hydatidosis. Methods: Between January 2000 and December 2018, 14 patients were managed for costovertebral hydatidosis in a thoracic surgery department. Results: The mean age of our patients was 48 years. The history of a prior hydatid disease was found in 7 patients. Imaging features were suggestive in 13 cases. They showed: involvement of the spinal canal (6 cases), of the soft tissues (5 cases) and spinal cord compression (3 cases). Costovertebral resection of the hydatid lesions was complete in 12 cases. Four patients presented postoperative complications. Conclusion: Costovertebral hydatid involvement, may threaten the functional and vital prognosis. Therefore, early diagnosis and management are mandatory, before the occurrence of irreversible neurological impairment. Surgical resection remains the treatment of choice and must be complete whenever possible. Relapse is frequent, hence the importance of a regular follow-up.

Beneficial of adding Tocilizumab to standard care in critical forms of Covid-19 pneumonia: Study on paired series.

INTRODUCTION: Tocilizumab (TCZ), a humanized monoclonal antibody directed against interleukin-6 (IL-6) receptors, has been tried in various studies as a Covid-19 therapy with controversial results. AIM: To evaluate the effectiveness of adding TCZ to standard care (SC) in critical Covid-19 patients. METHODS: it was designed retrospectively as a comparative study on two paired series of critical patients affected with Covid-19: the 1st group received TCZ plus SC versus a 2nd group which received only SC. The matching criteria were age, sex and severity score and the matching was based on the propensity score matching (PSM) by the nearest neighbor. Outcomes were: survival, mechanical ventilation (MV) and nosocomial infections. RESULTS: Ninety patients were included by pairing estimated successful (PSM > 0.5 in more than 50% in each group for all matching criteria). 55.5% of SC group progressed to stage 3-acute respiratory distress syndrome (ARDS) versus 31% of TCZ+SC patients (p=0.03). No effect of TCZ was found on mortality (49% in each group, p=1) nor on MV use (p=0.67). ICU stay was more prolonged in TCZ+SC group (16 versus 8 days, p<10-3). The administration of TCZ induced a significant decrease in CRP but not changed the IL-6 dosage. Nosocomial infections occurred in 18 (40%) of TCZ+SC group comparatively to 15 (33,5%) of SC group, p=0.66. CONCLUSION: Tocilizumab reduced the risk of progression to severe ARDS probably due to its immune-modulating properties. But no beneficial effect was found on survival or on the use of ventilation.

Conservative management of postoperative bronchopleural fistulas.

OBJECTIVE: A bronchopleural fistula (BPF) is a serious complication after pulmonary resection and carries a high mortality rate. It remains a therapeutic challenge. The lack of a consensus suggests that no optimal therapy is available; however, endoscopic closure of a fistula may avoid extensive and potentially risky surgery. METHODS: Seventeen patients (15 men and 2 women) with a BPF after a pneumonectomy (n = 2) or a lobectomy (n = 15), seen between 1995 and 2010, were reviewed. Their median age was 50 years (range, 14-75 years). Underlying diseases were malignant (n = 4) and nonmalignant (n = 13). RESULTS: The mean interval between surgery and fistula development was 20 days (range, 5-270 days). Clinical symptoms leading to a diagnosis of BPF were a persistent air leak (n = 2), a persistent air leak associated with pleural empyema (n = 3), pleural empyema alone (n = 11), and dyspnea (n = 1). Mean fistula size was 3.3 mm (range, 2-9 mm). Treatment consisted of oriented pleural drainage, adequate antibiotic therapy, and endoscopic closure of the fistula with local application of silver nitrate through a flexible bronchoscope (3-15 sessions, 3 times per week). Fistula closure was successful in 16 patients, but failed in 1 patient, who died from acute respiratory distress. CONCLUSIONS: BPF is a severe complication in thoracic surgery. The combination of pleural drainage, adequate antibiotic treatment, and mucosal application of silver nitrate, through a flexible bronchoscope, is an efficient alternative and avoids extensive surgical intervention.

[Beating heart coronary artery bypass: 100 cases]. / Pontage coronaire à coeur battant : A propos de 100 cas.

BACKGROUND: Coronary artery revascularization with cardiopulmonary bypass has been reported to carry several risks. AIM: Off-pump coronary artery bypass grafting has been proposed to result in a better outcome. The aim of this study is to assess the effect of off-pump cardiopulmonary bypass. METHODS: In a 7-year period, a total of 100 patients undergoing isolated first-time off-pump coronary artery bypass graft were studied. The mean ejection fractions was 48% and the EUROSCORE mean was 4.9. RESULTS: The average number of grafts was 1.55 per patient. The postoperative outcomes were simple for most patients with little use of inotropes after 24 hours (42%), few cases of atrial fibrillation (9.4%), and transfusion (27.3%). Time to extubation was less than 48 hours in most cases (94.7%) and hospital mortality rate was 10.5%. CONCLUSION: The beating heart bypass surgery allows good immediate results including multi-vessel disease and in patients at high risk.

What outcome after the prescription of neoadjuvant chemotherapy in lung cancer?

BACKGROUND: The treatment of patients with locally advanced non-small-cell lung cancer is controversial. Surgery remains the gold standard, even in this group. Neoadjuvant chemotherapy could allow surgical resection in patients initially judged inoperable. METHODS: From January 2009 to May 2010, neoadjuvant chemotherapy was indicated in 27 patients with NSCLC (25 men, 2 women). Their mean age was 65 years. The stages were: IIB in 5, IIIA in 17 (6 in stage IIIAN2), IIIB in 2, and IV in 3. RESULTS: 23 patients received neoadjuvant chemotherapy, 2 refused induction treatment, and 2 had impaired status. The neoadjuvant chemotherapy regimen was gemcitabine-cisplatin in 17 patients and vinorelbine-cisplatin in 6. Only 5 patients underwent complete surgical treatment after induction: 1 in stage IIB, 1 in stage IIIAN0, 1 in IIIB, and 2 in stage IV (1 operated brain metastasis, and 1 operated adrenal metastasis). Surgical treatment was not achieved after neoadjuvant chemotherapy in 18 patients because of progressive disease. CONCLUSION: Neoadjuvant chemotherapy offers several potential benefits, but it may delay surgery or eliminate eligibility as a surgical candidate. Rigorous patient selection for this type of multimodal treatment is essential.

[N-acetylcysteine in septic shock]. / La N-acétylcysteine dans le choc septique.

AIM: To focus on the various studies evaluating the effects of Nacetylcysteine in septic shock METHODS: Main references obtained from the medical database Medline using the keywords: N-acetylcysteine; septic shock, free radicals. RESULTS: Septic shock remains the leading cause of mortality in intensive care units. The progressive knowledge of the pathophysiology of septic shock, underline the production of free radicals and their cellular and microcirculatory effects. The Nacetylcysteine used mainly in paracetamol poisoning, has properties to control free radicals. The explosion of free radicals in septic shock has led to multiple studies assessing the role of N-acetylcysteine as an anti radical, and for its anti inflammatory action. CONCLUSION: NAC seems to play an important role in septic shock to control free radicals and the inflammatory response. But these results remain contradictory. Some larger and more standardized studies should allow to evaluate the actual effects of NAC in septic shock.

[Iatrogenic gas embolism after use of hydrogen peroxide in the treatment of lung hydatid cyst: a report of 2 cases]. / Embolie gazeuse iatrogène après utilisation de peroxyde d'hydrogène dans le traitement du kyste hydatique du poumon: a propos de deux cas.

BACKGROUND: Echinococcus disease is endemic in our country. Surgical resection of the hydatid cyst with the use of a protoscolicidal solution in the operative field remains the standard treatment. The degradation of hydrogen peroxide results in considerable amounts of gaseous oxygen witch has proven protoscolicidal properties. This gas can enter the circulation and determine severe embolism. AIM: We report two cases of severe oxygen embolism with neurological signs during surgical treatment of thoracic hydatid cysts. CASES REPORT: We report 2 cases of embolic events with neurological signs. The first, during a pleural cleaning with hydrogen peroxide after cystectomy of a pulmonary hydatic cyst at the right upper lobe. The second case, after a pleural washing during the treatment of hepatitic hydatidosis complicated by a ruptured cyst in the thorax. CONCLUSION: The most important diagnostic criterion is the patient's history, because the clinical suspicion of embolism is based on the initial neurologic or cardio-respiratory symptoms and the direct relation between these symptoms and the use of hydrogen peroxide and imposes appropriate treatment before further examination including brain imaging. The treatment with hyperbaric oxygen is the first line treatment, thus, transfer to a hyperbaric oxygen facility should be accomplished without delay. The possibility of such serious complication leads us to use hydrogen peroxide with great care or to use other protoscolicidal solutions.

Combined use of crystalloid preload and low dose spinal anesthesia for preventing hypotension in spinal anesthesia for cesarean delivery: a randomized controlled trial.

BACKGROUND AND OBJECTIVE: Spinal anaesthesia for caesarean section is commonly associated with hypotension and crystalloid preload is widely recommended. Low-dose spinal appears to cause less hypotension. The aim of this study was to investigate whether the combined use of crystalloid preload and low dose spinal anaesthesia might further reduce the rates of hypotension. METHODS: Sixty-two patients were randomly assigned to two groups: crystalloid preload anaesthesia (P): received a rapid infusion of 20 mL/kg lactated Ringer's solution (LR), and no preload anaesthesia (N). The incidence of hypotension and the amount of ephedrine used to treat it were compared. Spinal anaesthesia was performed with 0.5% isobaric bupivacaine 7.5 mg and fentanyl 10 microg and morphine 100 microg. RESULTS: The incidence of hypotension was similar in the P and N groups. Same doses of ephedrine were required to treat hypotension in the two groups. CONCLUSION: Crystalloid preload combined with low-dose spinal anaesthesia do not reduce the incidence of hypotension nor its severity.

[Endoscopic thoracic sympatecomy for hyperhidrosis]. / Sympathectomie par vidéo-thoracoscopie pour hyperhidrose palmo-plantaire.

BACKGROUND: Hyperhidrosis is a benin affection representing a social and professional problems and occupational handicaps in young patient. Endoscopic thoracic sympathectomy thus provides a radical treatment for severe palmar and axillary hyperhidrosis. AIM: We describe the technique used in our institut and present results METHODS: From 1995 to 2002, 32 patients were operated on for hyperhidrosis. There were 17 mens and 15 women raging in age from 15 to 32 years The intervention consisting on destruction by electrocoagulation to the sympathetic trunk RESULTS: There was no major complication and the mean postoperative hospital stay was 2 days. The disappearance of the palmar sweating was immediately after operation. 7 patients complained of compensatory sweating CONCLUSION: Endoscopic thoracic sympathectomy for hyperhidrosis is a safe effect technique for treating palmar and axillary hyperhidrosis. Compensatry sweeting represent the major that necessite a preable information

[Pulmonary alveolar proteinosis in two siblings. A case report]. / La protéinose alvéolaire pulmonaire de l'enfant. A propos d'une observation familiale.

Pulmonary alveolar proteinosis (PAP) is a rare disorder in children. This report describes two siblings in whom PAP developed during infancy (three years for the boy and four years two months for the girl). The girl was admitted for chronic respiratory distress. Chest x-ray showed a reticulonodular pattern. Her brother was asymptomatic. The diagnosis of PAP was confirmed by open lung biopsy for the boy and broncho-alveolar lavage for the girl. Therapeutic broncho-alveolar lavages were performed (six for the girl and two for the boy), the girl lost dependence on oxygen therapy. 6 years later, the brother is still asymptomatic. The sister had two episodes of respiratory distress, after two and four years, that required therapeutic lavages. The last therapeutic bronch-oalveolar lavage was performed for the first time by a Tunisian team.

[Endobronchial hamartoma revealed by hemoptysis]. / Hamartochondrome endobronchique révélé par hémoptysie.

UNLABELLED: Hamartoma is the most frequent benign tumor of the lung. Its endo bronchial location is rare. We report two cases of endo bronchial hamartoma occurring in 2 men aged 68 and 60 years respectively. The two cases were revealed by hemoptysis. Bronchial fibroscopy showed a bud respectively in the left stump and in the lower left bronchus. Treatment consisted in a pneumonectomy and a lower lobectomy. A histological examination confirmed the diagnosis of endo bronchial hamartoma. CONCLUSION: Diagnosis of endobronchial hamartoma before surgery is difficult. Pulmonary resections are often necessary because of parenchyma lelions caused bronchial obstruction.

[Factors associated to maternal mortality among preeclamptic parturients. About 55 cases]. / Facteurs associees a la mortalite maternelle chez les preeclamptiques: a propos de 55 cas.

Retrospective study about 55 preeclamptic parturients. Data was collected from the medical files of the patients hospitalized during two consecutive years. Admittance of preeclamptic women in the intensive care unit was 6,37 % (55/689). Mortality rate was 11% (6 deaths). Complications associated with the maternal death were renal failure, disseminated intravascular coagulopathy and Hemorrhagic shock after subcupsular liver hematoma. Advanced maternal age is a factor associated to maternal mortality. All these risk factors of death may be avoided if adequate management was performed.