Revue des maladies respiratoires
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Review Case Reports
[Episodic laryngeal dyskinesia: a functional cause of stridor].
We present five cases of episodic laryngeal dyskinesia. This term describes an entity associating acute dyspnea with inspiratory and/or expiratory stridor, sometimes ending in acute respiratory distress. ⋯ The definitive diagnosis is made by excluding organic pathology, by visualising laryngeal spasm and by the inspection of flow volume curve. A comparison of all the published papers since 1974 reveals the benign nature of this "noisy" disorder and to bring out the diagnostic criteria thus avoiding too aggressive an approach in these patients.
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Bronchiolitis obliterans organizing pneumonia (BOOP) is defined by endoluminal obstruction of distal airspaces by a fibrous granulation tissue consisting of inflammatory cells, fibroblasts, and connective tissue. The morphogenesis of the process is the following: diffuse alveolar injury leading to basement membrane denudation and intra-alveolar exudate of fibrinogen, immunoglobulins, coagulation factors, fibronectin; intra-alveolar migration of interstitial fibroblasts through gaps of the epithelial basement membrane; intra-alveolar secretion of loose connective tissue (codistribution of collagens I, III, V, and fibronectin) by the fibroblasts-myofibroblasts. The main characteristic of this peculiar fibrosis is its possible reversibility. ⋯ But in some cases BOOP remains idiopathic and has to be individualized. Three clinical and imaging profiles are distinguished: the most characteristic consists of an inflammatory context with imaging patchy alveolar opacities, migrating and relapsing, and most steroid sensitive; the other two presentations are less remarkable: pseudo-neoplastic localized chronic pneumonia, and diffuse infiltrative lung disease. BOOP is a clinico-pathologic entity that the clinician must know because of the efficacy of corticosteroid treatment in most cases, and it further represents an unique model to understand the pathogenesis of fibrosing pulmonary diseases.
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We have studied post-operative pain in 116 patients who underwent a thoracotomy. The pains were assessed using a visual analogue scale and were significant and identical whatever type of operation was used and irrespective of sex or diagnostic disease category. On the operative day only the surgeon seemed to have any influence. ⋯ The insertion of drains had no influence on the pain. Massage and physiotherapy decreased the pain in a significant fashion. The importance of taking account of post-operative pain is underlined.