Revue des maladies respiratoires
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The authors report a case of pulmonary tuberculosis appearing after an endobronchial fistula from a Pott's abscess. Such a clinical presentation is rare even in a developing country (PVD), where there is experience of more than 200 cases of tuberculous spondylodiscitis seen over a period of six years. The frequency of paravertebral abscess during the course of Pott's disease is around 52%, in the thoracic lesion their exteriorization by endobronchial fistula is around 4% (5 out of 114). The outcome is generally more simple and here a cure was achieved after six months of chemotherapy.
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Ultrasound of 28 radiologically confirmed cases of pneumothorax were compared to 100 controls. Specific ultrasonographic signs were shown in all cases and could be categorised into four groups: isolated pneumothorax (n = 16), hydro-pneumothorax (n = 9), subcutaneous emphysema (n = 1) and post aspiration pneumothorax (n = 2). The isolated pneumothorax was characterised by the disappearance of the lung deflection signal. ⋯ Pneumothoraces appearing during an echo guided thoracic puncture are confirmed by the disappearance of the pathological image. Thus echography appears to be a new method in the diagnosis of pneumothoraces and is complimentary to standard radiology. It should be confirmed as particularly useful during the process of thoracic puncture or juxta-diaphragmatic puncture when following the process of a pneumothorax, for emergency situations and/or those in which no radiological equipment is available.
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The presence of air in the interstitial pulmonary tissues is shown as interstitial emphysema and is often the first sign of barotrauma. It results from hyper-pressure in the airways occurring for the greater part of the time on some underlying pulmonary pathology. ⋯ The lesions seem to us to represent a radiological entity and evidence of barotrauma due to mechanical ventilation and possessing its own potential outcome, namely rupture leading to pneumothorax, infection, persistence, or disappearance. The early occurrence in its history of a particular disease should be noted, enabling one to minimise the factors contributing to the barotrauma.
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Recent studies have shown that normal bronchial secretion composed of proteoglycans, atypical glycoproteins and neutral lipids neither includes mucins nor glycolipids, nor phospholipids. The rheological characteristics of bronchial mucus thus depend on mucociliary clearance and clearance of bronchial secretions by cough, which in turn depend on the properties of the glycoprotein acids secreted and on the degree of their entanglement which is linked to their water content and on the chemical bonds with other protein or lipid components which are present in the secretions. ⋯ In certain conditions mucus plugs can form. An understanding of the pathology of bronchial mucus in the adult enables one to choose the best therapeutic prescriptions but the efficacy of measurements available remains imperfect.