Revue des maladies respiratoires
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Numerous acute and chronic neuromuscular disorders may induce an acute ventilatory failure. The latter is sometimes triggered by a complication like a bronchial aspiration, a pneumonia, or an atelectasis. ⋯ Four different clinical presentations are depicted in this review: slowly progressive (Duchenne muscular dystrophy), rapidly progressive (Guillain-Barré syndrome), chronic with exacerbations (myasthenia gravis), and a form consecutive to critical care (critical care polyneuropathy and myopathy). For each type of ventilatory failure, the review discusses the preventive surveillance, the treatment of acute respiratory failure, and the long-term management.
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The involvement of the apical pleura is infrequent in diffuse pleural thickening secondary to asbestos exposure. Most often diffuse pleural thickening is accompanied by an obliteration of the costophrenic angle and the posterior and paraspinous pleural surfaces of the pleura are involved to the greatest extent. ⋯ Apical pleural thickening with upper lobe changes in asbestos-exposed persons should be regarded as due to the asbestos exposure, after exclusion of other causes like tuberculosis and the apex tumors. Usually the evolution of the lesions is slowly progressive over several years or even decade, and results in mild restrictive defect.
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Mechanical ventilation is one of the fundamentals of intensive care assuring the correction of blood gas anomalies in patients with respiratory distress. However, positive pressure ventilation is extremely deleterious for the lung due to barotrauma. Among avenues of research over the last twenty years is a technique which has been successfully developed in neonatal intensive care: ventilation by high frequency oscillation (VOHF). ⋯ The usual model for alveolar ventilation is unable to explain how gas exchange is possible with this mode of ventilation. The explanations are still incomplete but this new type of artificial ventilation is in line with current studies by physiologists whose research may explain this totally new type of pulmonary physiology. However, it should be used cautiously and reserved to those practitioners experienced in the technique.
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Computed tomography, and particularly high-resolution computed tomography, allows a detailed exploration of the pulmonary parenchyma. We discuss here work on the use of this technique in the diagnosis and quantification of pulmonary emphysema. ⋯ We summarize our work which has demonstrated. 1) that the relative surface with density below -950 Hounsfield units and measured on millimetric tomographic slices obtained at the end of maximal inspiration is a valuable measurement of the extent of the macroscopic emphysema and reflects the microscopic emphysema; 2) that subjective quantification overestimates minimally extensive emphysema and shows important intra- and inter-operator variability; 3) that indexes derived from computed tomographic images acquired at the end of expiration reflect more the obstructive syndrome than emphysematous destruction; 4) that age and the size of the lungs influence computed tomographic measurements while hyperinflation appears to have no effect. Finally, we present an example of recent work applying the computed tomographic technique.