François Arbib

Haemoptysis associated with pulmonary varices: demonstration using computed tomographic angiography

A 67 yr old female with mitral stenosis presented with an acute haemoptysis caused by the rupture of pulmonary varices. Chest radiography and bronchoscopy showed nonspecific abnormalities. The diagnosis of this rare but potentially lethal complication was made using computed tomographic angiography with three-dimensional volume rendering.

Reduced six-minute walking distance, high fat-free-mass index and hypercapnia are associated with endothelial dysfunction in COPD.

This study investigated the determinants of endothelial function in patients with chronic obstructive pulmonary disease (COPD). Digital pulse amplitude augmentation was measured by post-ischemic reactive hyperemia (RH-PAT) in 44 COPD patients and analyzed with covariates: condition vs. exacerbation, fat-free mass index (FFMI), pulmonary function, blood pressure, inflammation, six-minute walking distance, muscle function, medications, diabetes and prevalent cardiovascular diseases. RH-PAT was 0.43 (-0.14 to 1.30) with 50% of patients exhibiting abnormal RH-PAT ≤ 0.40. After adjustment for age and sex, RH-PAT was linked to condition, FFMI, myocardial infarction history, FEV(1), PaCO(2), heart rate, bicarbonates, inflammation and walking distance (p<0.10). In multivariate analysis, walking distance, FFMI and PaCO(2) were independent contributors of RH-PAT explaining 49% of the variance (p<0.0001). Higher FFMI was associated with higher inflammation, oxidative stress and endothelial dysfunction. Six-minute walking distance which is a widely available marker of severity and functional capacity in COPD patients is a main predictor of endothelial dysfunction.

Arterial stiffness by pulse wave velocity in COPD: reliability and reproducibility.

To the Editor: Cardiovascular diseases are the most common cause of mortality in chronic obstructive pulmonary disease (COPD) [1]. Arterial stiffness certainly plays a role in the increased cardiovascular risk of these patients [2, 3]. Arterial pulse wave velocity (PWV) constitutes a useful and safe non-invasive method [4] for assessing central arterial stiffness. The carotid-femoral PWV is considered as the gold standard method by the European Society of Hypertension/European Society of Cardiology [5] and is a strong predictor of future cardiovascular events and all-cause mortality, supporting its implementation into clinical research and daily practice [6]. In patients with COPD, feasibility and validity of this marker of arterial stiffness have been confirmed [2] and PWV is now used in studies evaluating cardiovascular risk and/or the efficacy of new bronchodilators and rehabilitation programmes [3, 7, 8]. However, little is known about its variability and reproducibility studies are lacking in the COPD population. Here we report on the variability of PWV measurements between baseline, day 15 and day 42 in stable COPD patients. The carotid-femoral PWV was assessed using the Complior device (Alam Medical, Vincennes, France) and pulmonary function, blood pressure, metabolic and inflammatory markers were systematically measured at each evaluation. Pearson or Spearman correlation coefficients and intraclass correlation coefficient (ICC) allowed comparison of PWV at day 0 versus day …

Wegener Granulomatosis Revealed by Pleural Effusion

Pulmonary signs are common in Wegeners granulomatosis (WG). However, an initial presentation including pleural effusion has not been described. We describe a case of WG in which pleural effusion was the first clinical manifestation. A 45-year-old man with dorsal pain presented with pleural thickening and effusion, and a visible nodule on a thoracic scan. A dense chronic inflammatory infiltrate was obtained by pleural biopsy and an open lung biopsy revealed necrotizing granulomatous vasculitis. Serologies were positive for antineutrophil cytoplasmic antibodies and antiproteinase 3 antibodies. A diagnosis of WG was conducted and the patient was started on cyclophosphamide and methylprednisolone as an initial treatment, with a favorable evolution. Although pleural effusion is rarely described in WG, this pathology must be considered in the presence of this clinical manifestation.

De novo malignancies screening after liver transplantation for alcoholic liver disease: a comparative opportunistic study

Patients having received a liver transplantation (LT) for alcoholic liver disease (ALD) have a high risk of de novo malignancies, especially in the upper aerodigestive tract and lungs due to their smoking and alcohol history. The aim of this retrospective study was to compare a group of patients transplanted for ALD who continue to smoke and who were included in an intensive screening program for tobacco‐related cancers implemented at the Grenoble University Hospital and a group of similar patients followed according to usual practice (chest computed tomography [CT] scan every 5 years) at the Edouard Herriot Hospital in Lyon. The intensive screening program consisted of an annual checkup, including a clinical examination by an otorhinolaryngologist, a chest CT scan, and an upper digestive endoscopy. A total of 147 patients were included: 71 patients in Grenoble and 76 patients in Lyon. The cumulative incidence of a first tobacco‐related cancer was 12.3% at 3 years, 20.6% at 5 years, 42.6% at 10 years, and 64.0% at 15 years. A curative treatment was possible in 80.0% of the patients in Grenoble versus 57.9% in Lyon (P = 0.068). The rates of curative treatment were 63.6% versus 26.3% (P = 0.062) for lung cancers, 100.0% versus 87.5% (P = 0.498) for lip‐mouth‐pharynx and larynx cancers, and 66.7% versus 100.0% (P = 1) for esophageal cancers, respectively. In addition, for lung cancers, regardless of study group, 68.7% received a curative treatment when the diagnosis was made by CT scan screening versus 14.3% when it was made because of symptoms (P = 0.008). In conclusion, our study strongly confirms the high rate of tobacco‐related de novo malignancies in LT patients for ALD and suggests that the screening of lung cancer by annual chest CT scan could significantly increase the rate of curative treatment.

Quadriceps muscle fat infiltration is associated with cardiometabolic risk in COPD

Losses of peripheral muscle mass and ectopic fat accumulation have been associated with cardiometabolic morbidity in COPD. We aimed at identifying the relationship between quadriceps muscle fat infiltration and cardiovascular risk.

Severe central sleep apnoea associated with nalmefene: a case report

Nalmefene, an opioid antagonist, has recently been approved for the treatment of alcohol dependence. We describe here the first case of a 52‐year‐old woman who developed a severe central sleep apnoea (CSA) 5 months after initiation of nalmefene. Scoring of ventilation during sleep recording revealed an apnoea‐hypopnoea index of 67/h with 98.7% of central events and an apnoea index of 65/h. Nalmefene was withdrawn and a new polysomnography was performed which concluded that CSA has disappeared. Pathophysiology is still unclear but could involve the κ‐opioid receptors. Physicians should be aware that CSA might affect patients treated with nalmefene. Further investigations are required to determine the pathophysiology, frequency, and treatment of CSA associated with nalmefene and other therapy for alcohol disorders.