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Surgical resection of bubbles or bullectomy is the gold standard in the treatment of bubbles arising from pulmonary emphysema. It is usually indicated for patients with complicated bubbles or when they are the underlying cause of disabling dyspnea. This study aims to determine the indications for bullectomy and to evaluate surgical outcomes in our Department. We conducted a retrospective, descriptive study of 24 patients (23 men and 1 woman) whose average age was 49 years and who had undergone bullectomy between 2004 and 2013. Collected data were: factors favoring the occurrence of bullous emphysema, the circumstances in which bubble was detected, data from the radiological examinations, data from pulmonary and cardiovascular function testing, data from bullectomy, data from postoperative clinical and functional examination. Morbidity rate was 37.5 %. The main complication was persistent air leak (7 cases). One patient died two days after surgery due to acute respiratory failure. The average followup period was 26 months during which we observed improvement of dyspnea in all patients and no complications. Bullectomy is an effective, reliable and safe surgical technique that may improve patients' quality of life for a few years. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To describe the use of lung ultrasound in clinical practice and the new opportunities offered by this technology in intensive care unit (ICU) patients. Method: Review of signs identified by lung ultrasound and systematic analysis of data published within the last 5 years on its use in ICU. The literature has been extracted from the database Pubmed™. Specific keywords were used to select relevant publications. Clinical studies published in French and English languages were assessed. Results: Lung ultrasound serves to diagnose, quantify, drain and monitor pleural effusions. In patients with acute respiratory failure, lung ultrasound participates to the diagnosis, the implementation of treatments and their follow-up. It helps to manage patients with pneumonia and acute lung injury. Finally, the investigation of the interstitial edema brings information about hemodynamics that can serve to manage our patients. Conclusion: Lung ultrasound is an easy, non-invasive, and non-irradiant technology. It brings lot of useful information at the patient''s bedside. [Copyright &y& Elsevier]

Abstract: We report a paediatric case of survival following severe hydrogen sulfide (H2S) gas intoxication. A 13-year-old boy was found submerged to the neck in a manure tank. He was hypothermic, unresponsive with bilateral mydriasis, and had poor oxygen saturation. After intubation, he was transferred to the paediatric intensive care unit of a tertiary care children''s hospital. He developed acute respiratory distress syndrome (ARDS) requiring high frequency percussive ventilation. Cardiac evaluation was significant for myocardial infarction and left ventricular function impairment. He completely recovered from the respiratory and cardiac failure. Neurological examinations showed abnormal signals on MRI in the semi-oval center and in the frontal cortex. Follow-up detected partial impairment of axonal fibers of the right external popliteal sciatic nerve. Paediatric cases of survival after H2S intoxication have been rarely reported. Such exposures can evolve to severe ARDS and benefit from high frequency percussive ventilation. Hypothermia and other metabolic abnormalities are now better explained thanks to actual knowledge about endogenous H2S function. Lessons learned from paediatric accidents should result in better information about this threat for farmers and families living in houses with septic tanks, reducing the risk to their own and their children''s safety. [Copyright &y& Elsevier]

The article presents information on a study regarding the elevation of mortality rate in relation to the acute respiratory distress syndrome (ARDS). As per the study, the ventilator-associated pneumonia (VAP) is a complication of the ARDS which may increase mortality. The study found that in severe ARDS patients, VAP does not increase the intensive care unit (ICU) mortality.

Copyright of Reanimation is the property of Lavoisier and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Abstract: Objectives: To describe the characteristics, treatment and outcome of critically ill patients with influenza A(H1N1) infection at St Pierre Hospital in Reunion Island during the 2009 outbreak, as well as the measures of care reorganization implemented to face them. Patients and methods: Prospective observational study of probable and confirmed cases of influenza A (H1N1)/2009 infection concerning hospitalized patients in a polyvalent intensive care unit (ICU). Results: Thirteen patients have been included between August and September 2009. Three (23 %) didn’t have any medical history. The median age was 42 [22–69]. Eleven have required pulmonary ventilation for 10.3 days (± 8). Three (23 %) have developed an ARDS. Three patients (23 %) died. To cope with the influx of cases and considering our situation of geographic isolation, it has been needed to totally rework the organization of care: set-up of a specific welcoming channel, division into sectors of the department, opening of additional beds, new on-duty assignment, inter and intra hospital cooperation. Conclusion: Reunion Island has been an experimental lab of crisis management during the H1N1/2009 epidemic, several months ahead of the mother country. To anticipate the reorganization of care in intensive care units during an outbreak period, particularly in small units or units isolated like ours, looks to us a must so to quietly face a sharp influx of patients. [Copyright &y& Elsevier]

Abstract: Introduction: The French Express study compared two alveolar recruitment managements (maximal versus standard) in Acute Respiratory Distress Syndrome (ARDS) patients ventilated with 6ml/kg of ideal body weight (IBW). The objective of the present study was to assess in a single intensive care unit, the impact of Express study on the mechanical ventilation settings in non-included ARDS patients. Patients and methods: From 16 October 2002 to 14 January 2005 all consecutive eligible but non-included patients in Express study were studied. The maximal and minimal tidal volumes, and the minimal and maximal respiratory rates were retrospectively recorded. These parameters were compared according to the date of patient''s admission and then the patients were separated in four quartiles (14, 15, 15, 15 patients). Results: From the first to the last study period separated by 26 months, the mean maximal tidal volume decreased from 9.0±1.3 to 7.4±1.0ml/kg of IBW (p =0.03), the proportion of patients ventilated with a maximal tidal volume greater than 8ml/kg decreased from 93% to 20% (p <0.01), the median minimal respiratory rate increased from 14 to 18 b/min (p =0.03) and the proportion of patients with a respiratory rate less than 20 b/min decreased from 100% to 73% (p <0.01). There were correlations between the time of patient''s admission and the maximal tidal volume (r =−0.43, p <0.01), the minimal tidal volume (r =−0.28, p <0.04) and the minimal respiratory rate (r =0.33, p <0.02). Conclusion: The participation in Express study led physicians to modify their mechanical ventilation settings. The maximal tidal volume decreased and the minimal respiratory rate increased in the ARDS eligible but non-included patients. [Copyright &y& Elsevier]

Abstract: The first influenza pandemic of the xxist century is due to a novel A (H1N1) strain. The infection, which affects younger patients than seasonal influenza, presents most often under a benign form. But it can rarely and rapidly evolve to pulmonary parenchymal involvement, independently of any bacterial superinfection or co-infection. It becomes a true viral pneumonia, which can evolve to acute respiratory distress syndrome (ARDS). This phenomenon was well described for the three xxth century pandemics, especially for the 1968–1969 one. These cases of “malignant flu” benefitted from the great breakthroughs in medical intensive care made in the previous 15 years. The specificity of these pandemic strains to infect lower respiratory tract is of immunological origin: only patients with little or no immunity to the virus can develop viral pneumonia and ARDS. This is why trivalent vaccination against seasonal flu appears to be somewhat protective against severe presentations of the disease. During winter 2009–2010, an inflow of flu-related ARDS cases is expected in French ICUs. Aggressive oxygenation techniques, high dose and prolonged antiviral treatment, and steroid adjunctive therapy, could be used, adding to the experience acquired during previous pandemics. [Copyright &y& Elsevier]

Abstract: Between August and September 2009, on Reunion Island, our Intensive Care Unit (ICU) treated several severe Influenza A (H1N1) S-OIV cases. We report the following case: a 23-year-old female patient with no prior medical history presented a severe respiratory distress that required high frequency oscillation ventilation and finally Extracorporeal Membrane Oxygenation (ECMO). She was hospitalized in the ICU for 41 days. Recovery was complete. It is important to note the stead of each technique in those types of respiratory distresses and describe the practical details of the ECMO''s set up by a non-trained medical crew. We want to underline, within the current context of severe respiratory distresses due to Influenza A pandemic, the necessity to develop a multidisciplinary care network, or to reinforce the existing channels between well-trained medical crews familiar with ECMO''s technics and the ICU that are not. [Copyright &y& Elsevier]

Abstract: Pregnant women are particularly vulnerable to the pandemic influenza A(H1N1) 2009. Indeed, they are at high risk of developing a severe or fatal form of the disease. The physiological changes and the “immune deviation” from cellular to humoral immunity occurring during pregnancy are hypotheses to explain this vulnerability. Severe forms, mainly viral pneumonias, require an urgent prescription of an effective antiviral therapy. Preventive measures, mainly vaccination, are essential to avoid the appearance of these severe forms. [Copyright &y& Elsevier]

Abstract: Novel influenza A (H1N1) at the origin of the 2009 pandemic flu developed mainly in subjects of less than 65 years contrary to the seasonal influenza, which usually developed in elderly patients of more than 65 years. Elderly subjects are partly protected by old meetings with close stocks. Influenza A(H1N1) can arise in serious forms within 60 to 80% of cases a fulminant acute respiratory distress syndrome (ARDS) “malignant and fulminant influenza” in subjects without any comorbidity, which makes the gravity and the fear of this influenza. The fact that this influenza A (H1N1) can develop in healthy young patients and evolve in few hours to a severe ARDS with a refractory hypoxemia gave to the foreground the possible interest of the recourse to extracorporeal oxygenation (ECMO) in some selected severe ARDS (5–10%). The first publications of patients admitted in intensive care unit (ICU) for severe influenza A (H1N1) often associated to an ARDS reported a mortality rate from 15 to 40%. This mortality variability may be explained in part by different studied populations, ARDS characteristics and human and material resources in the ICUs between the countries. Indeed, the highest mortality rates (30–40%) have been reported by in Mexico which were affected the first by pandemic flu and which were not prepared. A bacterial pneumonia was associated to H1N1 influenza in approximately 30% of the cases as at admission in ICU or following the days of the admission justifying an early antibiotherapy associated to the antiviral treatment by oseltamivir (Tamiflu®). Obesity, pregnancy and respiratory diseases (asthma, COPD) seem to be associated to the development of a severe viral pneumonia due to influenza A (H1N1) often with ARDS. Older age, high APACHE II and SOFA scores and a delay of initiation of the antiviral treatment by oseltamivir are associated to higher morbidity and mortality. Other analyses of the results obtained from the first published papers included more patients and future studies would permitted to better define the role of therapeutics such as steroids and ECMO. [Copyright &y& Elsevier]

Summary: Background: In the last years Non-Invasive Ventilation (NIV) has been playing an important role in the treatment of Acute Respiratory Failure (ARF). A lot of trials have shown improvements in clinical features (respiratory rate, neurological score), pH and arterial blood gases. Methods: In particular clinical conditions, such as Acute Cardiogenic Pulmonary Edema (ACPE) and acute exacerbation of Chronic Obstructive Pulmonary Disease (COPD), systematic reviews and meta-analysis show a reduction in the need for intubation and in-hospital mortality compared to standard medical treatment. In other clinical conditions, such as acute asthma, Acute Lung Injury (ALI)/Acute Respiratory Distress Syndrome (ARDS) and severe pneumonia, NIV does not show significant improvements in term of avoided intubations or mortality rate. Although the first important data on NIV comes from studies performed in Intensive Care Units (ICUs), subsequently these methodologies of ventilation have been used with increasing frequency in Emergency Departments (ED) and medical wards. Results: Studies developed in ICU sometimes report slightly worse outcomes compared to studies performed in general wards due to the need to treat more severe patients in ICU. Aetiology remains one of the most important factor determining prognosis: different pathological mechanisms substain different clinical conditions and not in all cases the application of positive pressures to the airways is useful. NIV for ARF due to COPD and ACPE is feasible, safe and effective also in a general medical ward if selection of patients, staff training and monitoring are appropriate: its early application improves clinical parameters, arterial blood gases, prevents endotracheal intubation, decreases mortality and hospitalisation. This should encourage the diffusion of NIV in this specific setting. Conclusions: According to strong evidences in literature, NIV should be considered a first line and standard treatment in these ... [Copyright &y& Elsevier]

Abstract: Objectives: Non-invasive ventilation (NIV) in patients with acute respiratory failure (ARF) is subject to a large number of failures due to discomfort of the art, the feeling of difficulty breathing and pain. The purpose of this study was to evaluate the efficiency of sophrology to improve conditions for the realization of NIV in patients with ARF. Patients and methods: In this prospective randomized and controlled study, consecutive patients with ARF were included. From the very first NIV session, they received either sophrology during the first 30min of NIV (S group), or standard care by the same nurse during 30min (T group). The hemodynamic and ventilatory data were recorded continuously; pain, respiratory difficulty and discomfort were measured with a numeric scale at the end of the session. Results: Thirty patients were included in the study, 27 have been analysed. Each patient received an average of four sessions NIV during the protocol. There was no significant difference between the two groups in terms of improvement in gas exchange. In contrast, there was a significant difference in terms of reduction of difficulty in breathing (−76%), discomfort (−60%) and decrease the pain (−40%) in the sophrology group (p <0.001). Respiratory rate, heart rate and systolic arterial blood pressure were decrease during NIV. Conclusion: Sophrology constitutes aid for the achievement of the meetings of NIV in patients IRA. [Copyright &y& Elsevier]

Abstract: The nutritional guidelines in patients suffering from acute respiratory insufficiency are close to these recommended in the critically ill patients. But in acute respiratory failure, the constancy of an oxygen debt and the frequent high carbon dioxide levels, are particular elements to consider at the time of the choice of the nutrition support. Lipid emulsions used in parenteral nutrition have been associated with different pulmonary function changes. In general, caloric intakes should not exceed the total energy expenditure because of the risk of hypercapnia, mainly in patients with reduced ventilatory capacities, carbohydrates ensuring 65 to 70% of the energy. Parenteral fat emulsions, in particular those containing soybean oil, may induce pulmonary gas exchange disturbances in patients with underlying abnormalities of the ventilation-perfusion ratio, but only with fast infusion rates or if the amounts of linoleic acid are too high. Some pharmaconutrients, in particular glutamine, n-3 serie long chains polyunsaturated fatty acids (DHA and EPA), gamma-linoleic acid and trace elements, represent important ways of progress in the population of ARDS patients. By modulating pulmonary inflammation, immunity, bronchial reactivity and by improving the nutritional status, they open new and promising prospects in the prevention and the treatment of ARDS, whose prognosis remains poor. [Copyright &y& Elsevier]

Abstract: Objective: The aim of this study was to evaluate the accuracy of the BNP as a marker of acute cor pulmonale in patients with ARDS. Study design: Prospective clinical trial. Patients and methods: At day 2 or 3 after the onset of the ARDS, an echocardiography was performed. Patients with left ventricular dysfunction were excluded. Right ventricular area (RVA) and RVA/LVA ratio were measured. ACP was defined as RVA/LVA>0.6 associated with septal dyskinesia. Simultaneously, 5 ml of blood was collected for BNP measurement. Results: 26 patients were studied. BNP levels were higher in 10 patients with ACP: 585.5 [189–4830] vs 145.5 [36.5–346] pg/ml (P =0.01) but in those with creatinine clearance<90 ml/min: 602 [331–3530] vs 125 [39–189] pg/ml (P =0.007). BNP was correlated with RVA (r=0.5; p =0.01), RVA/LVA ratio (r=0.61; p =0.001), sPAP (r=0.58; p =0.002) and with age, cardiac index and creatinine clearance (r=0.61; p =0.001). In multivariate analysis, BNP was only correlated with creatinine clearance (p =0.03), and RVA (p =0.06). Conclusion: In ARDS patients without left ventricular dysfunction, BNP level is more elevated in patients with acute cor pulmonale than patients without cor pulmonale. [Copyright &y& Elsevier]

Abstract: In winter, French Medicalised Ambulance Service rescued a 50-year-old patient after suicide attempts by jump from a bridge in the Seine. The body was discovered after more than 10 minutes of immersion. She was unconscious and in deep hypothermia with circulatory arrest. Basic CPR was started immediately and oral intubation and 100% oxygen ventilation was performed. Ventricular fibrillation appeared but repeated defibrillation failed due to profound hypothermia (rectal temperature: 28 °C). The patient was immediately transported to hospital. CPR and mechanical ventilation was continued during transport. The patient was taken in emergency room. The oesophageal temperature was 22 °C. Rewarming using extracorporeal circulation was immediately initiated after insertion of femoral access. At 27 °C, ventricular fibrillation started and was converted by external defibrillation to a pulse-generating cardiac rhythm. At 360 minutes, the patient''s rectal temperature had reached 36 °C and she was disconnected from cardiopulmonary bypass with inotropic support. She was transferred to the intensive care unit after 9 hours of resuscitation, rewarming and stabilisation. Mechanical ventilation was needed for 15 days because of adult respiratory distress syndrome. Renal failure, pneumonia also occurred. She was successfully extubated on day 15 and was discharged from intensive care unit on day 21, suffering no neurological side effects. [Copyright &y& Elsevier]

Abstract: Transfusion-Related Acute Lung Injury (TRALI) is a post-transfusion acute respiratory distress syndrome (ARDS). TRALI is a non-cardiogenic lung œdema occurring within 6 hours following the infusion of a blood component. Its frequency has been estimated from 1 in 5.000 to 1 in 500.000 injected blood products. Its aetiology is still controversial. Antibodies against HLA class I molecules or granulocyte surface molecules recognizing recipient leukocyte antigens were implicated at first. More recently anti HLA class II were involved in some cases. Finally granulocyte activating lipids released from cells during blood storage were claimed to account for cases in which no antibody were detected. Nevertheless, in most cases, none of these triggering factors alone seems sufficient to induce a TRALI. A predisposing condition, associated with leucostasis in pulmonary vessels, is required. Whatever the mechanism, the pulmonary lesion is eventually due to release of neutrophil granule content in contact with endothelial cells of lung micro-capillary vessels. The basement membrane damages leads to fluid and cell extravasations in interstitial and alveolar spaces. Among blood donors multiparous women are the most frequently involved. Up to now there are neither definite guidelines regarding detection of harmful antibodies nor regulation for deferral of potentially dangerous blood donors. [Copyright &y& Elsevier]

Copyright of EMC-Medecine is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The development of an acute respiratory distress syndrome following hip surgery in elderly patients is suggestive of thromboembolism in most instances. However, we must keep in mind the possibility of rarer complications, which can remain undiagnosed because they are hidden by prominent abnormal behaviours, which can develop following any type of anaesthesia. We report the case of a patient who developed a confusion following an orthopaedic surgery under spinal anaesthesia; this confusion concealed a penetration syndrome resulting from accidental inhalation of a dental crown. Because this patient was old and had previously developed chronic lung disorders, we selected a spinal anaesthesia for performing the surgery; these underlying respiratory disorders worsened the clinical consequences of the inhalation. The dental crown was removed under general anaesthesia with spontaneous ventilation using a bronchoscope after an unsuccessful attempt with a fibrescope due to the size of the foreign body. [Copyright &y& Elsevier]

Purpose. – Progresses in intensive care medicine have concerned major syndromes associated with life threatening organ dysfunction, like the acute respiratory distress syndrome (ARDS) or septic shock.Current knowledge and key points. – A better understanding of interactions between mechanical ventilation and the underlying lung lesions, has lead to define a so-called «lung protective ventilation», which resulted in an improved prognosis of ARDS. In numerous situations of acute respiratory failure, including acute exacerbation of chronic obstructive pulmonary disorder or immunosuppressed patients, endotracheal intubation can be avoided by the use of face mask ventilation, also called noninvasive ventilation. This approach results in a reduction of complications associated with mechanical ventilation or with the entire intensive care unit stay, including nosocomial infections. As a result, survival is increased when this kind of ventilation is feasible. In septic shock, pharmacological improvements have concerned effects of sepsis on coagulation, and the unexpectedly high frequency of relative adrenal insufficiency. Lastly, improvements have been made regarding the prevention and management of ventilator-associated pneumonia. [Copyright &y& Elsevier]

We report the case of a 46-year-old patient with liver transplantation who developed an acute respiratory distress syndrome (ARDS). The commonly associated clinical disorders, those associated with direct injury to the lung and those that cause indirect lung injury in the setting of a systemic process, were not responsible for the clinical picture. Finally, because of progressive clinical deterioration, an open-lung biopsy was performed and revealed a bronchiolitis obliterans with organizing pneumonia (BOOP). Physicians should be aware of this rare aetiology of ARDS. [Copyright &y& Elsevier]

Objectives: To assess the feasibility and safety of a new technique of fiberoptic bronchoscopy (FOB) tracheal intubation (TI) with noninvasive ventilation (NIV) via an endoscopic full facial mask with two openings, in case of acute respiratory failure (ARF) temporally improved by NIV, but requiring a mechanical ventilation.Study design: Clinical, prospective, open, non-comparative trial of feasibility with direct individual profit.Patients: Sixteen patients with ARF (age : 60 ± 17 years, PaO2 = 59 ± 16 mmHg, PaCO2 = 64 ± 26 mmHg, PaO2/FIO2= 142 ± 70 before NIV) (m ± SD), requiring TI. Including were : TI necessity (SpO2 < 90 % or hypercapnic despite NIV, dependence of NIV, exhaustion, septic syndrome), clinical and SpO2 improvement with NIV.Methods: After IV injection of 5 mg midazolam and topical anesthesia (TA) of the nose, the endoscopic mask (modified Fibroxy™, Pe´ters) was applied to the face, fixed with elastic straps, then connected to the ventilatory support system with IPAP=20 cmH2O, EPAP = 5 to 12 cmH2O, FIO2 = 1. A tube was slid on the FOB. As soon as SpO2⟦⟦⟦nbsp〉 94 %, the extremity of the FOB, was inserted through the lower opening of the mask, slid in the nostril, positioned in front of the glottis for AL, then pushed in the trachea authorizing AL and IV injection of 0.15 mg.kg–1 of etomidate (Ramsay⟦⟦⟦nbsp〉3). The tube was then slid in the trachea, then, FOB was removed from trachea.Results: The FOB intubation was easy at the patientˈs, without any failure or any complication. The procedure was 6.7 ± 2 min. SpO2 significantly improved during TI, from 84 ± 5 % (FIO2 = 0,6 ± 3) to 97 ± 1 ( FIO2 = 1 ± 0), without decrease in oxygen saturation off 90 %. Arterial pressure decreased only after the 5th min. The quantities of midazolam and of etomidate used were 4.6 ± 2 mg and 12 ± 4 mg. Three patients benefited from EPAP > 10 cmH2O.Conclusion: Fiberoptic tracheal intubation with NIV via an adapted endoscopic facial mask is a safe technique in patient with ARF temporally improved by NIV. This procedure requires TA and conscious sedation. [Copyright &y& Elsevier]

Abstract: We report the case of a 63-year-old patient admitted to the ICU for an acute respiratory failure one week after an outpatient cataract surgery that revealed a nemaline rod myopathy. We present this rare myopathy whose particularities are its aetiology, which can be inherited, mostly with a congenital onset, or sporadic, and the variability of the age at presentation. We discuss the exceptional onset of severe unknown underlying diseases in the context of outpatient surgery. [Copyright &y& Elsevier]

Abstract: The majority of chest penetrating trauma patients are successfully managed with tube thoracostomy and general supportive measures. Pulmonary resection for hemorrhagic shock is rarely required after trauma to control bleeding. Both pulmonary injury and massive blood transfusion can lead to acute respiratory distress syndrome (ARDS). The mortality rate in these patients reaches up to 40% despite advanced ventilatory treatment. The use of extracorporeal membrane oxygenation (ECMO) can be started as rescue therapy. We report a case of 24-year-old man with major hemorrhagic shock with cardiac arrest and ARDS after traumatic penetrating lung injury that was successfully treated with pulmonary resection and ECMO. [Copyright &y& Elsevier]

Abstract: Paradoxical gas embolism is rare but life threatening complication of central venous access. In this observation, we report a paradoxical gas embolism accompanied by an acute respiratory failure and a coma following a jugular central venous access withdrawal in a liver transplanted patient. Following this observation, we discuss the prevention of gas embolism accidents and the hyperbaric oxygen therapy for its management. [Copyright &y& Elsevier]

Abstract: The antisynthetase syndrome is a subgroup of idiopathic inflammatory muscle diseases. Its characteristics are interstitial lung disease, myositis, polyarthritis, mechanic’s hand like cutaneous involvement, and the presence of antisynthetase antibodies (anti-Jo1). The lung disease is the presenting feature in 50% of cases. We report a patient with an antisynthetase syndrome, revealed by an acute respiratory distress syndrome. This patient was already followed-up for a scleroderma and presented a probable overlap syndrome. The disease course was favourable with anti-CD20 therapy. [Copyright &y& Elsevier]

Abstract: We report a case of disseminated strongyloidiasis with parasitemia in a 53-year-old man under corticosteroid therapy. It occurred more than 16years after contamination and led to severe sepsis and acute respiratory failure with P. aeruginosa pneumonia. The patient recovered after specific treatment (thiabendazole followed by albendazole) and antibacterial drugs. [Copyright &y& Elsevier]

Abstract: Idiopathic chronic eosinophilic pneumonia (ICEP) is one of the idiopathic hypereosinophilic lung diseases. ICEP differs from idiopathic acute eosinophilic pneumonia (IAEP) by its progressive onset, and the absence of severe hypoxemia. We report a case of acute respiratory distress syndrome revealing an ICEP, which needed a 48h of mechanical ventilation. ICEP is an exceptionnal cause of acute respiratory failure. Symptoms always improve with corticosteroids. But relapses are frequent after stopping corticosteroid treatment, as well as the occurrence of severe asthma. Distinction between ICEP and IAEP is essential because of its impact on treatment duration and on prognosis. [Copyright &y& Elsevier]

Abstract: Background: Severe community acquired pneumonia is a common cause of acute respiratory failure. The influenza virus itself can cause a severe pneumonia and non-respiratory illness. Case report: A physician developed an acute respiratory failure associated with hemolytic anemia, acute renal failure, and myocarditis. Influenza A infection was diagnosed by screening for antibodies (complement fixation, ELISA Ig A). Discussion: Fulminant influenza pneumonia is a rare clinical presentation of influenza infection and usually has a severe clinical course. Influenza infection is also associated with myositis, myocarditis, acute renal failure, encephalopathy, and hemolytic anemia. Rapid laboratary diagnosis can be made by PCR or immunofluorescence applied directly to respiratory specimens. Antiviral treatment did not prove its efficacy in fulminant Influenza. This case report is an opportunity to stress the importance of seroprophylaxis by parenteral vaccination in exposed occupations. [Copyright &y& Elsevier]

Abstract: A 37-year-old woman presented an acute respiratory distress syndrome six days after a post-traumatic vertebral osteosynthesis. First, a pulmonary embolism was suspected, and a thrombolysis realised. This diagnosis was secondary excluded, and the diagnosis of probable fatty embolism was established by the bronchoalveolar lavage. So, this case shows a delayed presentation of fatty embolism and permits a discussion about clinical presentation, and diagnosis methods of such pathology. [Copyright &y& Elsevier]

Abstract: A 34-year-old woman with toxic coma developed inhalation pneumonia complicated by the acute respiratory distress syndrome. Marked parenchymal destruction and recurrent pneumothorax occurred despite protective ventilation. Altered consciousness persisted after sedative withdrawal, and the patient subsequently died. Computed tomography revealed multiple cerebral, renal and splenic infarcts. The only identified cause of systemic embolism was multiple gas embolisms. We discuss the physiopathological mechanisms, and the diagnostic and therapeutic management of such patients. [Copyright &y& Elsevier]

Objectif: analyser les aspects cliniques d’un ecthyma gangrénosum (EG) et guider le diagnostic étiologique en particulier la recherche d’un déficit immunitaire. Observation: nourrisson âgé de 1 an, issu de parents consanguins de 2éme degré, et ayant des antécédents de pneumopathies récidivantes, a été hospitalisé pour une détresse respiratoire aigue avec fièvre. À la biologie, il avait une leucopénie (GB : 4 600), une anémie hypochrome microcytaire (Hb : 7,9 g/l), une CRP à 150 mg/l. Le test de la sueur est négatif. L’évolution sous oxygénothérapie et céfotaxime a été marqué par l’aggravation de l’état respiratoire nécessitant le recours à la ventilation artificielle. L’apparition secondaire, 24 heures après, d’un EG au niveau du tronc et des membres inférieurs a motivé la mise sous Fortum et amiklin. dans la crainte d’un pseudomonas aéroginosae. Ce dernier a été isolé au niveau du prélèvement cutané et du prélèvement trachéal distal. Devant l’association de pneumopathies récidivantes avec ecthyma gangrénosum, le bilan immunitaire a été fait diagnostiquant une maladie de Bruton. L’issue était fatale suite à un état de choc septique réfractaire. Conclusion: Il est indispensable de penser à un déficit immunitaire devant toute atteinte cutanée de type d’EG. [ABSTRACT FROM AUTHOR]

Observation: Y., 9 mois, est porteuse d’une maladie de Byler (cholestase intra-hépatique héréditaire). Elle est hospitalisée pour un 3e épisode de virose respiratoire compliquée d’un SDRA, un mois après une fracture du fémur en bois vert suite à un traumatisme mineur. La vitaminothérapie recommandée n’a pas été administrée au domicile. Les radiographies retrouvent des appositions périostées, une hypertransparence et surtout des lésions physaires (élargissement, irrégularité), le thorax montre des opacités floconneuses diffuses et une déformation latérale de la cage thoracique en coup de hache avec un chapelet costal. Le dosage de la vitamine D est effondré, la PTH élevée et la calcémie normale. La TDM thoracique retrouve des troubles ventilatoires disséminés. L’amélioration est lente sous vitaminothérapie D, avec disparition progressive des déformations et des troubles ventilatoires (suivi à 1 an). Conclusion: Le poumon rachitique est une pathologie respiratoire chronique associant une insuffisance respiratoire restrictive secondaire à l’ostéomalacie déformante, une bronchopathie et une sensibilité accrue aux infections respiratoires. La réversibilité sous vitaminothérapie semble être complète mais peu de cas pédiatriques ont été rapportés. [ABSTRACT FROM AUTHOR]

Introduction et objectifs: En janvier 2009, dans la même unité de soins, 4 patients âgés de 49 à 83 ans, ont déclaré simultanément une grippe à virus A, confirmée par PCR temps réel, dont une compliquée d’une détresse respiratoire aiguë. Deux des 4 cas avaient été vaccinés 3 et 4 semaines auparavant. Le cas index n’a pas été identifié. À cette même période, 6 cas de syndromes grippaux ont été rapportés chez les soignants (avec arrêt de travail), mais aucun virus grippal n’a pu être mis en évidence avec une technique identique. Matériels et méthodes: À cette occasion et dans le contexte de l’épidémie communautaire de grippe (3e semaine de janvier : 705 cas pour 100 000 habitants, 5e semaine en France), nous avons évalué la couverture vaccinale antigrippale de l’ensemble du personnel du service. Résultats: Dix-neuf des 62 (30 %) professionnels du service avaient été vaccinés contre la grippe, soit 25 % des infirmiers, 17 % des aides-soignants, 33 % des cadres, 100 % des kinésithérapeutes, 66 % des internes et 90 % des médecins seniors. L’assistante sociale n’était pas vaccinée Conclusion: Malgré les nombreuses incitations institutionnelles, relayées par la médecine du travail et les infectiologues, et la gratuité du vaccin, le taux de vaccination antigrippale des professionnels de santé est très insuffisant. Ce travail doit nous inciter à réfléchir aux modalités de la vaccination antigrippale (vaccination obligatoire sauf CI ?), ainsi qu’à une meilleure information et implication des personnels soignants sur ce point. [Copyright &y& Elsevier]