Bruno Blaive

Seasonal variations in hospital admission for deep vein thrombosis and pulmonary embolism: analysis of discharge data

Seasonal variation in fatal pulmonary embolism has been well documented by at least 23 reports comprising nearly 11 000 cases.1 Evidence is lacking, however, for seasonal variation in deep vein thrombosis—the only large hospital series available did not establish significant variation.2 We analysed hospital admissions for deep vein thrombosis and pulmonary embolism in France over four years. We reviewed all cases with a discharge diagnosis of deep vein thrombosis or pulmonary embolism entered on the national hospital discharge register between 1995 and 1998. We used the international classification of diseases, ninth and 10th revisions (deep vein thrombosis: ICD-9 codes 451.1 and 451.2 and ICD-10 codes I80.1 and I80.2; pulmonary embolism: ICD-9 code 415.1 and ICD-10 codes I26.0 and I26.9). This dataset is a collection of all discharges from public and non-profit making, short stay, or acute hospitals in France (71% of hospital capacity). We included discharge data if the usual confirmatory tests—or specific fibrinolytic or surgical therapy—were mentioned. Usual confirmatory …

Efficacy and safety of videothoracoscopic lung biopsy in the diagnosis of interstitial lung disease

OBJECTIVE The aim of this study was to determine the efficacy and safety of videothoracoscopic lung biopsy (VTLB) in the diagnosis of infiltrative lung disease (ILD) and compare the results of VTLB with the results previously obtained in patients with open lung biopsy at the same institution. METHODS Forty-one patients undergoing VTLB between May 1991 and December 1994 were retrospectively studied and compared with 25 patients who have undergone OLB during the period from January 1987 to April 1991. The two groups were comparable with respect to age, sex, and severity of lung disease. RESULTS Three of 41 patients (7%) who underwent VTLB with minithoracotomy. There was no significant difference between the group of VTLB (38 patients) and the group OLB (25 patients) with regard to, the number of biopsies (VTLB 1.8 +/- 0.4 versus OLB 2 +/- 0.6), or diagnostic yield (VTLB 37/38 versus OLB 25/25). In contrast, patients who underwent VTLB demonstrated a significant reduction of the operative time (VTLB 45.3 +/- 12.2 min), length of chest tube drainage (3.55 +/- 1.2 days), hospital stay (5.5 +/- 1.3 days), and analgesia (buprenorphine 0.85 +/- 0.44 mg; paracetamol 5.9 +/- 2.5 g) compared to patients who underwent OLB (55.6 +/- 11.2 min, 5.2 +/- 1.5 days; 7.1 +/- 2.3 days; buprenorphine 1.17 +/- 0.5 mg, paracetamol 8.9 +/- 2.3 g). Morbidity and mortality were similar in the two groups (morbidity VTLB 10.5%, OLB 12%; mortality VTLB 5.2%, OLB 8%). Regardless of the biopsy technique, the most serious complications and deaths occurred with the same frequency in those patients with a severe underlying disease. CONCLUSIONS VTLB is a valid alternative to OLB in most cases. Along with a comparable efficacy, VTLB has several advantages that should make it the method of choice for patients with only minimally impaired respiratory function. In contrast, the role and advantages of VTLB compared to OLB in patients with severe lung disease, require further investigation.

Pulmonary toxicity of a combination of low-dose doxorubicin and irradiation for inoperable lung cancer

In 1980, 27 patients with inoperable lung cancer (26 non-oat cell, one oat cell) were treated by split-course irradiation (40 Gy/10 fractions) plus concomitant low-dose chemotherapy (doxorubicin 10 mg/m2). Twenty-four of the 27 patients received the entire treatment course. Fifteen of the 27 patients were administered various chemotherapy protocols after a period of one month. Median survival was 16 weeks despite a 60% response rate. The lungs were the main site of complications (13 cases of radiation pneumonitis for the 24 patients), which occurred primarily when an objective response was obtained. These complications partially explain the poor results. Injection of doxorubicin during irradiation appears to have been a determining factor.

Une pneumopathie alvéolo-interstitielle hypoxémiante associée à la prise de rituximab

Resume Introduction Rituximab a ete recemment propose dans le traitement des lymphomes non hodgkiniens de type B de bas grade de malignite. Les cas de toxicite pulmonaire lies a la prise de rituximab restent exceptionnels. Cas clinique Nous rapportons le cas d’une pneumopathie alveolo-interstitielle compliquee d’insuffisance respiratoire aigue chez une patiente traitee par polychimiotherapie de type CHOP (cyclophosphamide, adriamycine, oncovin, prednisolone) et rituximab pour lymphome non hodgkinien de la parotide. Les diagnostics differentiels poses par cette presentation clinique et radiologique sont discutes. Conclusion Bien que les pneumopathies alveolo-interstitielles liees a la prise de rituximab soient rares, elles peuvent etre severes et ainsi, necessitent une prise en charge precoce.

Un cas d’œdème pulmonaire neurogénique unilatéral

Resume Cette observation rapporte le cas d’un patient âge de 65 ans qui, hospitalise pour accident vasculaire de la fosse cerebrale posterieure, a brutalement presente un œdeme pulmonaire unilateral. Alors que la forme radiologique habituelle des œdemes pulmonaires neurogeniques (OPN) est associee a des opacites alveolaires bilaterales, la presentation unilaterale au cours de cette affection est extremement rare. Le diagnostic differentiel entre un OPN et un exces de remplissage vasculaire, une pneumopathie infectieuse, un œdeme pulmonaire secondaire a l’inhalation de liquide gastrique ou un œdeme pulmonaire cardiogenique, de meme que le mecanisme pouvant etre responsable de cette presentation, sont discutes.

Actuarial survival after surgery for 350 patients with bronchial carcinoma

Abstract In a retrospective study, the authors analyzed 350 patients with bronchial carcinoma who were treated surgically by the same team for seven years. This paper discusses modalities of treatment and emphasizes that surgery must be practiced as often as possible and should be followed by radiotherapy in the case of lymph node involvement. Following a discussion of the various parameters studied for this group of patients, both immediate and secondary causes of death are analyzed. The survival of patients who had involvement of the bronchial margin is also discussed. Results at 5 years are identical to those of other investigators. The authors conclude that surgery does not improve results whether it is extensive as a precautionary measure, or whether it is associated with radiotherapy and/or chemotherapy.

La fibrose interstitielle pourrait être prédictive de rechute dans la pneumopathie organisée cryptogénique

Resume Introduction Bien que l’efficacite des glucocorticosteroides par voie generale soit admise au cours de la pneumopathie organisee cryptogenique (POC), les rechutes sont frequentes et rendent les modalites de traitement imprecises. Nous avons tente d’identifier des marqueurs histopathologiques predictifs de recidive au cours de la POC. Cas clinique Six cas de POC confirmes par biopsie pulmonaire chirurgicale ont ete evalues. Parmi ces sujets, 3 ont presente au moins 2 rechutes. La comparaison des donnees histopathologiques au premier episode de POC de ces patients avec celles des sujets indemnes de rechute a mis en evidence un epaississement de nature collagene de l’interstitium inter-alveolaire et inter-lobulaire avec hyalinisation des bourgeons fibromyxoides intra-alveolaires. Conclusion Ce depot collagene dans l’interstitium inter-alveolaire et inter-lobulaire pourrait representer un marqueur histopathologique predictif de recidive au cours de la POC.