Revue des maladies respiratoires
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Decision analysis has greatly benefited to the field of pulmonary embolism diagnosis, by allowing the theoretical assessment of potential novel strategies, which could in turn be validated in clinical trials. The adjunction of clinical probability assessment, plasma D-dimer measurement, and lower limb venous compression ultrasonography, to pulmonary scintigraphy and angiography in the diagnostic workup, results in a considerable reduction in the requirement for angiography. ⋯ Finally, spiral CTscan combined with D-dimer and ultrasonography could also prove highly cost-effective, and replace either pulmonary angiography, or even both lung scan and angiography, if ongoing studies confirm the promising preliminary results obtained with CTscan. However, such a conclusion awaits the validation of algorithms including CTscan by clinical outcome trials, in which the therapeutic decision would rest on the result of the spiral CTscan.
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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.