The natural course of lung function decline in asbestos exposed subjects with pleural plaques and asbestosis.

While there is a good knowledge of the natural course of lung function in interstitial lung diseases (ILD) like idiopathic lung fibrosis (IPF), many ambiguities remain in patients with asbestosis. Therefore, we evaluated the change in lung function in asbestos exposed subjects with pleural plaques and asbestosis and analysed corresponding morphology of computer tomography of the thorax. METHODS: 93 asbestos exposed subjects with pleural plaques and asbestosis were analysed retrospectively at the Klinikum Bergmannsheil of the Ruhr-University of Bochum. Parameters of lung function were obtained at least twice and annual changes of FVC, TLC and DLCOsb were calculated. In addition, we assessed the predominant pattern in high-resolution computer tomography of the thorax (HRCT) and differentiated three phenotypes: p (pleural) -type, f (fibrosis) -type and m (mixed) -type. RESULTS: FU data are available in 56/93 (60.2%) patients. The annual deterioration (Mean ±â€¯SEM) of FVC is -31.46 ±â€¯17.34 ml, of TLC -55.55 ±â€¯25.67 ml, of DLCOsb -0.38 ±â€¯0.07 mmol/min/kPa and of DLCOva -0.05 ±â€¯0.01 mmol/min/kPa/L. A categorical change of FVC > -100 ml was found in 12/56 (21.4%) and 18/56 (32.1%) patients showed an annual loss of TLC > -100 ml. The greatest annual decline of FVC was observed in patients with the fibrotic phenotype on HRCT (-76.76 ±â€¯66.43 ml) and the mixed phenotype (-81.52 ±â€¯24.79 ml), while the pleural phenotype was less affected (-10.52 ±â€¯25.07 ml). CONCLUSION: More than 20% of our cohort have a progressive disease with an annual loss of FVC > -100 ml. Patients with the fibrotic-phenotype or mixed-phenotype on HRCT are particularly at risk.

[Osteointegrated cranio-facial implants: 49 patients report]. / Implants ostéointégrés cranio-faciaux. A propos de 49 patients.

OBJECTIVES: To analyze the results obtained in the total implanted population in Strasbourg, in order to assess the reliability of this technique over the long-term, especially in children and in irradiated patients. METHODS: This is a retrospective study including all the cases of cranio-facial epitheses implanted in the department of Otorhinolaryngology, head and neck surgery at the University Hospital of Strasbourg since 1992, date of the first epithesis implantation. The results (rate of osseo-integration, cutaneous complications, degree of satisfaction) are presented according to the site of implantation and the antecedent of irradiation. The results obtained in children (16 years of age and less) are specified. RESULTS: The study involved 50 patients (including 11 children), that is 51 epitheses, auricular, orbito-palpebral or naso-maxillary. 142 implants were fixed, including 49 in irradiated patients. The average rate of osseo-integration was 95.7% in the absence of irradiation, and 81.6% following irradiation, with significant differences according to the site of the implant (worse in the nasal site). Radiotherapy being a factor which reduces the rate of osseo-integration. The success rate in children was comparable to the one obtained in adults. CONCLUSION: The extraoral osseous implantology has made it possible for the facial epitheses to be considered as a forerunner in the strategies of rehabilitation in facial loss of substance, with the surgical rehabilitation techniques. It is particularly interesting in oncology, as it allows easy clinical monitoring of the operation site.

[Neutrophilic leukocytosis of systemic or bacterial origin: discriminative C-reactive protein?]. / Polynucléoses neutrophiles d'origine systémique ou bactérienne: valeur discriminante de la C réactive protéine?

Neutrophilic leucocytosis is frequent in systemic diseases and often leads to confusion with infective diseases. A C-reactive protein (CRP) level of 100 mg/l or more has been claimed to indicate a bacterial infection in over 80% of the cases. The purpose of this study was to test the discriminative value of CRP in patients with neutrophilic leucocytosis of bacterial or systemic origin. Sixty patients presenting with an inflammatory syndrome with neutrophilia entered the study and were divided into 2 groups. Group I comprised 30 patients with Horton's disease (n = 9), systemic vasculitis (n = 6), deep cancer (n = 5), connective tissue disease (n = 4) or Still's disease (n = 4). Group II consisted on 30 patients with infective diseases: septicaemia (n = 13), bacterial pneumonia (n = 12), pyelonephritis (n = 4) or cholecystitis (n = 1). In both groups the number of neutrophils was higher than 12,000/cubic mm. Mean CRP values were lower in group I (75.3 +/- 70 mg/l) than in group II (153 +/- 61 mg/l) (P less than 0.01). With values above 100 mg/l the specificity and sensitivity of CRP for infection were 45% and 55% respectively; the positive predictive value of CRP was 66% and its negative predictive value 76%. Specificity rose to 65% with a CRP level higher than 150 mg/l, and 74% for a CRP level higher than 200 mg/l, but such values were also observed in 4 patients of group I.(ABSTRACT TRUNCATED AT 250 WORDS)

Contribution of virtual endoscopy to the investigation of laryngotracheal pathological conditions.

Three-dimensional CT scan imaging obtained by using helicoidal CT scan provides the basis for an endoscopic exam said to be virtual since no invasive procedure is actually performed. Compared to optical endoscopy this easily accessible exam offers additional information especially for the analysis of the infraglottic and tracheal areas, which are two anatomically rigid segments. This property facilitates their three-dimensional reconstruction. Our study encompassed 6 patients presenting with a stenosis of the laryngotracheal tract. In 5 of them it was possible to correlate optical and virtual endoscopic imaging. Coupling both exams significantly improved the diagnostic investigation and facilitated the management of the disease. However, the real contribution of virtual endoscopy to the exploration of tumoral conditions still remains to be determined given the low degree of tissue resolution. As a consequence parietal and extraparietal lesional spreading is more accurately assessed by axial scan imaging.