Fixed-pressure CPAP versus auto-adjusting CPAP: comparison of efficacy on blood pressure in obstructive sleep apnoea, a randomised clinical trial.

BACKGROUND: Millions of individuals with obstructive sleep apnoea (OSA) are treated by CPAP aimed at reducing blood pressure (BP) and thus cardiovascular risk. However, evidence is scarce concerning the impact of different CPAP modalities on BP evolution. METHODS: This double-blind, randomised clinical trial of parallel groups of patients with OSA indicated for CPAP treatment compared the efficacy of fixed-pressure CPAP (FP-CPAP) with auto-adjusting CPAP (AutoCPAP) in reducing BP. The primary endpoint was the change in office systolic BP after 4 months. Secondary endpoints included 24 h BP measurements. RESULTS: Patients (322) were randomised to FP-CPAP (n=161) or AutoCPAP (n=161). The mean apnoea+hypopnoea index (AHI) was 43/h (SD, 21); mean age was 57 (SD, 11), with 70% of males; mean body mass index was 31.3 kg/m(2) (SD, 6.6) and median device use was 5.1 h/night. In the intention-to-treat analysis, office systolic blood pressure decreased by 2.2 mm Hg (95% CI -5.8 to 1.4) and 0.4 mm Hg (-4.3 to 3.4) in the FP-CPAP and AutoCPAP group, respectively (group difference: -1.3 mm Hg (95% CI -4.1 to 1.5); p=0.37, adjusted for baseline BP values). 24 h diastolic BP (DBP) decreased by 1.7 mm Hg (95% CI -3.9 to 0.5) and 0.5 mm Hg (95% CI -2.3 to 1.3) in the FP-CPAP and AutoCPAP group, respectively (group difference: -1.4 mm Hg (95% CI -2.7 to -0.01); p=0.048, adjusted for baseline BP values). CONCLUSIONS: The result was negative regarding the primary outcome of office BP, while FP-CPAP was more effective in reducing 24 h DBP (a secondary outcome). TRIAL REGISTRATION NUMBER: NCT01090297.

Imaging of tumors of the trachea and central bronchi.

Tumors of the trachea and central bronchi can be benign or malignant. Clinical presentation may be confusing, particularly in benign tumors that can be misdiagnosed as asthma or chronic bronchitis. Chest radiography has many limitations and is often considered unremarkable in patients with tumors of the central airways; therefore, multidetector CT (MDCT) has become the most useful noninvasive method for diagnosing and assessing the central airways. The purpose of this article is to provide a review of imaging of the tumors of the trachea and central bronchi. We emphasize the crucial role of MDCT and postprocessing techniques in assessing neoplasms of the central airways.

Imaging of tumors of the trachea and central bronchi.

Tumors of the trachea and central bronchi can be benign or malignant. Clinical presentation may be confusing, particularly in benign tumors that can be misdiagnosed as asthma or chronic bronchitis. Chest radiography has many limitations and is often considered unremarkable in patients with tumors of the central airways; therefore, multidetector CT (MDCT) has become the most useful noninvasive method for diagnosing and assessing the central airways. The purpose of this article is to provide a review of imaging of the tumors of the trachea and central bronchi. We emphasize the crucial role of MDCT and postprocessing techniques in assessing neoplasms of the central airways.

[Mediastinal haematoma: A little known complication of ultrasound-guided trans-bronchial lymph node aspiration (EBUS-TBNA)]. / Un hématome médiastinal : complication méconnue d'une ponction transbronchique échoguidée.

INTRODUCTION: Endobronchial ultrasound-guided trans-bronchial needle aspiration (EBUS-TBNA) has emerged as a minimally invasive, highly accurate technique for sampling intrathoracic lymph nodes. The complication rate after EBUS-TBNA is estimated at between 0.22% to 1.44%. Analysis of the different series of EBUS-TBNA reveals that mediastinal haematoma has not been described as a complication. CASE REPORT: We describe the case of a 65-year-old-man who underwent an EBUS-TBNA of a subcarinal lymph node. Few days later the patient presented with haemoptysis of average amount associated with a haematoma in the subcarinal area seen on CT-scan. It was suggested that puncture of a bronchial artery occurred during passage of the needle. This complication occurred during the change from treatment by low molecular weight heparin to antivitamine K. The patient was monitored in the intensive care unit and received medical treatment only. CONCLUSIONS: This patient developed a complication after an EBUS-TBNA that is rarely described and probably under diagnosed. This complication occurred during the change between two anticoagulant treatments, which requires special attention in this particular context.

[Prediction of the efficiency of endoscopic lung volume reduction by valves in severe emphysema]. / Prédiction de l'efficacité de la réduction endoscopique d'emphysème pulmonaire par valve.

INTRODUCTION: In severe emphysema, endoscopic lung volume reduction with valves is an alternative to surgery with less morbidity and mortality. In 2015, selection of patients who will respond to this technique is based on emphysema heterogeneity, a complete fissure visible on the CT-scan and absence of collateral ventilation between lobes. Our case report highlights that individualized prediction is possible. CASE REPORT: A 58-year-old woman had severe, disabling pulmonary emphysema. A high resolution thoracic computed tomography scan showed that the emphysema was heterogeneous, predominantly in the upper lobes, integrity of the left greater fissure and no collateral ventilation with the left lower lobe. A valve was inserted in the left upper lobe bronchus. At one year, clinical and functional benefits were significant with complete atelectasis of the treated lobe. CONCLUSION: The success of endoscopic lung volume reduction with a valve can be predicted, an example of personalized medicine.

Lung adenocarcinomas: correlation of computed tomography and pathology findings.

Adenocarcinoma is the most common histologic type of lung cancer. Recent lung adenocarcinoma classifications from the International Association for the Study of Lung cancer, the American Thoracic Society and the European Respiratory Society (IASLC/ETS/ERS, 2011) and World Health Organization (WHO, 2015) define a wide range of adenocarcinoma types and subtypes featuring different prognosis and management. This spectrum of lesions translates into various CT presentations and features, which generally show good correlation with histopathology, stressing the key role of the radiologist in the diagnosis and management of those patients. This review aims at helping radiologists to understand the basics of the up-to-date adenocarcinoma pathological classifications, radio-pathological correlations and how to use them in the clinical setting, as well as other imaging-related correlations (radiogenomics, quantitative analysis, PET-CT).

[Acute eosinophilic pneumonia and the larva migrans syndrome: apropos of a case in an adult]. / Pneumopathie éosinophilique aiguë et syndrome de Larva migrans. A propos d'un cas chez un adulte.

Toxocariasis is a frequent disease in children, but the severe clinical manifestations are rare in the literature (diffuse interstitial pneumonia with hypoxaemia and acute severe asthma). The diagnosis is made thanks to the reliability of serological techniques (the ELISA test and using antigen excretion-secretion tests of the larvae of Toxocara canis). The authors report a case of acute severe eosinophilic pneumonia whose outcome was rapidly favourable following steroid therapy; the existence of positive Toxocara canis serology with a contamination risk of the patient in the domestic environment leads us to integrate the clinical picture into the larva migrans syndrome.

[Subacute idiopathic eosinophilic pneumopathy with favorable outcome without corticotherapy]. / Pneumopathie éosinophilique subaiguë idiopathique d'évolution favorable sans corticothérapie.

The authors report a case of acute idiopathic eosinophilic pneumonia, a recently described entity of unknown etiology. The patients develop a rapidly progressive respiratory failure which is reversible following steroid therapy. The key to the diagnosis is an eosinophilia in the broncho-alveolar lavage or in the lung biopsy. Our observation of a favourable outcome in this case without steroid therapy is evidence perhaps of a less aggressive form of the disease.

[Thymoma and primary Gougerot-Sjögren syndrome progressing to severe bronchiolitis]. / Thymome et syndrome de Gougerot-Sjögren primitif évoluant vers une bronchiolite sévère.

The authors report a case of a thymoma associated with Gougerot-Sjögren's syndrome in a patient aged 40 years. The excision of the thymic tumour and complementary radiotherapy lead to a remission in the patient. There was an unfavourable progression of this syndrome from a respiratory stand-point with the development of a predominantly bronchiolitic picture over four years.

[Endobronchial stenoses in Wegener's granulomatosis]. / Sténoses endobronchiques au cours d'une granulomatose de Wegener.

The authors describe a case of a patient suffering from Wegener's disease with endobronchial manifestations which progressively developed tracheal stenosis which was not accessible to the usual immunodepressive therapy. Repeated endobronchial dilatation using a balloon introduced via supple fibroscope was carried out with success. The balloon dilatation seems a useful alternative approach to other therapies such as surgery. It is a non-aggressive technique which is easily performed and has no complications.

[Thoracic meningocele and neurinoma complicating von Recklinghausen disease. Value of imaging in therapeutic management. Apropos of 2 cases]. / Méningocèle et neurinome thoraciques compliquant une maladie de von Recklinghausen. Intérêt des moyens d'imagerie dans la prise en charge thérapeutique, à propos de deux observations.

We report two cases neurogen tumors (neurinoma and méningocèle) in neurofibromatosis. The progress of imaging techniques, with the use of CT and MRI, is helpful for evaluating these patients, distinguish malignant from benign neoplasm and screening the therapeutic indication.

[Multiple congenital stenoses of the segmental pulmonary arteries in an elderly patient]. / Révélation tardive de sténoses congénitales multiples des artères pulmonaires segmentaires.

Congenital stenoses of the pulmonary artery are a rare cause of pulmonary arterial hypertension, usually diagnosed in childhood. We report the first description of multiple arterial pulmonary malformations in an elderly patient, revealed by an acute severe pulmonary embolism. Despite an immediate excellent response to fibrinolysis, persistent and elevated arterial pulmonary pressures were consistent with the presence of an underlying arterial pulmonary disease. Pulmonary angiography led to the diagnosis of type III multiple segmental arterial pulmonary stenoses. Eight years later, the patient remained well. This original report underlines the potential good outcome of pulmonary artery stenoses, and suggests the presence of such silent or misdiagnosed lesions in adulthood.

[Primary tumor of the thoracic wall unusual in aged patients: costal osteosarcoma]. / Une tumeur primitive de la paroi thoracique inhabituelle chez le sujet âgé: l'ostéosarcome costal.

Osteosarcoma is a tumour that is encountered in children and young adults but is exceptional in elderly people. Moreover, it is very rarely located in the chest. A case of costal osteosarcoma revealed by a pleural blood effusion is reported in a 66-year old male patient. Full surgical excision completed by parietal reconstruction was performed. The diagnosis of osteosarcoma was definitely confirmed at pathological examination. A few months later, a local recurrence associated with ipsilateral lung metastasis, was discovered and the patient was put on chemotherapy. The clinical, radiological and therapeutic aspects of this case are discussed.

Endobronchial tumours in a campaign for early detection of bronchial cancer: Computed tomography versus endoscopy.

OBJECTIVE: To study endobronchial cancers occurring in a population at high risk of bronchial cancer (history of surgically treated bronchial or ENT cancer in complete remission, and symptoms due to smoking) detected by annual volume CT scans and biannual fibroscopy. MATERIAL AND METHODS: Two hundred and sixty-six patients were included in this single centre prospective study; 27 bronchopulmonary cancers were detected. Ten endobronchial cancers (37%) were identified by fibroscopy (nine invasive cancers and one carcinoma in situ) in 10 patients (nine men) (51-78 years old) nine of whom were smokers (dark tobacco: seven). The screening CTs were reappraised by two radiologists. RESULTS: Three cancers out of 10 were detected by CT during the initial reading. The sensitivity of the reappraised CT was 80% with seven false positives. In five cases, the mean period between the first CT scan where the lesion was visible retrospectively, but not described, and the diagnostic fibroscopy was 463 days (213-808 days); two cancers were not visible in the CT scan. Seven curative treatments were undertaken. CONCLUSION: In this population, the sensitivity of the initial reading of the CT scan for detecting endobronchial tumours was 30%, while 80% of the tumours were visible retrospectively, underlining the importance of careful analysis of the proximal bronchial tree.