Revue des maladies respiratoires
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Review Case Reports
[A rare and curable cause of acute respiratory insufficiency after a pneumonectomy. The platypnea-orthodeoxia syndrome by the reopening of the foramen ovale].
We describe a case of a 54 year old patient who had developed a right to left shunt due to a patent foramen ovale as a late consequence of a pneumonectomy; this was responsible for acute respiratory insufficiency and respiratory failure. This is a rare complication, but its clinical presentation as platypnea-orthodeoxia should lead to the correct diagnosis. ⋯ The treatment is surgical with excellent results. The pathophysiological mechanism is also discussed.
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Pleural diseases frequently pose problems to the pulmonary physician. The clinical and radiological approaches are often insufficient and it is necessary to resort to techniques which enable a precise morphological diagnosis of the pleural lesion. ⋯ Using this technique the diagnostic yield and the harmless nature of the technique are of the first importance. After recording traditional techniques of investigation of lung disease (puncture, needle biopsy) the equipment, the technique, the indications and the risks and the diagnostic results from thoracoscopy are discussed.
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Multicenter Study Clinical Trial
[The quality of oxygen therapy delivery systems using oxygen-saving valves. A multicenter study. The ANTADIR Medico-Technical Commission].
The saturation of oxygen (SaO2) using oxygen therapy with an oxygen saving system, Optimox (CFPO) or COS 5 (Puritan, Bennett) has been compared to the SaO2 using continuous oxygen therapy. The oxygen output using the oxygen saving system was regulated in such a way as to be equivalent to the oxygen flow without the economiser. Three situations were studied: the day, the night and during effort. ⋯ T greater than 90 AVECO was below T greater than 90 SSECO in 52% of patients and was greater in 23% of subjects. The nasal, auditory and respiratory comfort was good whatever the period of examination for more than half of the subjects. In conclusion for an equivalent oxygen flow the addition of an oxygen saving device significantly alters the quality of diurnal and nocturnal oxygen therapy in one patient out of two.
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The occurrence in a young patient of a chronic cough with dyspnoea and restrictive ventilatory failure as shown by respiratory function tests suggested the possibility of a Mac Leod syndrome. However, other aetiologies could be considered such as vascular malformations, bronchial malformations and also tumours. If the chest X-ray sometimes enables an aetiological slant, bronchoscopy remains a first line investigation.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
[Sequential administration of a reduced dose of almitrine to patients with chronic obstructive bronchopneumopathies. A controlled multicenter study].
Recent multi-centre studies have shown that high doses of Almitrine (100-200 mg per day), lead to a significant improvement in the hypoxaemia of patients presenting with chronic airflow obstruction, but that a high blood level (greater than 500 ng/ml) is often seen after 1 year, sometimes associated with signs of peripheral neuropathy. In order to maintain Almitrine blood levels in the range 200-300 ng/ml we have used an intermittent regime (with a "window" of 1 month every 3 months) and a dose limited to 100 mg per day. 102 hypoxic patients with chronic airflow obstruction, who were in a stable state were included. 65 patients were in the Almitrine group (A) and 37 patients in the placebo group (P). The treatment lasted for 1 year. ⋯ The PaCO2 did not change in either group. On the other hand there was a significant fall in the subgroup of patients with hypercapnia in group A (p less than 0.001). The outcome of the neurological and electrophysiological assessments did not show any significant difference between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)