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INTRODUCTION To assess the impact of nocturnal continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) on lower urinary tract (LUTS) symptoms. MATERIALS AND METHODS A prospective, monocentric study was conducted between June 2018 and August 2019. Patients with moderate to severe OSA with an indication for treatment with nocturnal CPAP in combination with SBAU were included. SBAUs and their impact were evaluated by completing two self-administered questionnaires (Urinary Symptom Profile (USP) and International Prostate Score Symptom (IPSS)) filled out during the night-time ventilatory polygraph or diagnostic polysomnography for OSA and after 4 months of CPAP treatment. RESULTS In 79 patients, after four months of CPAP treatment, USP scores for stress urinary incontinence and overactive bladder were significantly improved, respectively 0.65±1.38 vs 1.13±2.10 ; p

Summary Background The use of cyclophosphamide in patients with acute exacerbation of idiopathic pulmonary fibrosis (IPF) is unknown. Our study was designed to evaluate the efficacy and safety of four cyclophosphamide pulses in addition to high-dose methylprednisolone in this population. Methods In this double-blind, placebo-controlled trial done in 35 departments across 31 hospitals in France, adult patients (≥18 years) with acute exacerbation of IPF and those with suspected acute exacerbation of IPF were randomly assigned in a 1:1 ratio using a web-based system to receive either intravenous pulses of cyclophosphamide (600 mg/m2) plus uromitexan as haemorrhagic cystitis prophylaxis (200 mg/m2) at the time of cyclophosphamide administration and then again, 4 h later, or placebo at days 0, 15, 30, and 60. Random assignment was stratified according to the severity of IPF and was block-balanced with variable block sizes of four or six patients. Patients receiving mechanical ventilation, with active infection, with active cancer, or who were registered on the lung transplant waiting list were excluded. All patients received standardised high-dose glucocorticoids. The investigators, patients, and the sponsor were masked to the treatment assignments. The primary endpoint was 3-month all-cause mortality, analysed by a χ2 test adhering to an intention-to-treat principle. The trial is now complete and registered with ClinicalTrials.gov , NCT02460588 . Findings Between Jan 22, 2016, and July 19, 2018, 183 patients were assessed for eligibility, of whom 120 patients were randomly assigned and 119 patients (62 [52%] with severe IPF) received at least one dose of cyclophosphamide (n=60) or placebo (n=59), all of whom were included in the intention-to-treat analysis. The 3-month all-cause mortality was 45% (27/60) in patients given cyclophosphamide compared with 31% (18/59) in the placebo group (difference 14·5% [95% CI −3·1 to 31·6]; p=0·10). Similar results were found after adjustment by IPF severity (odds ratio [OR] 1·89 [95% CI 0·89–4·04]). The risk of death at 3 months, independent of the treatment received, was higher with severe than non-severe IPF (OR 2·62 [1·12–6·12]) and was lower with the use of antifibrotic therapy (OR 0·33 [0·13–0·82]). Adverse events were similar between groups by 6 months (25 [42%] in the cyclophosphamide group vs 30 [51%] in the placebo group) and their proportion, including infections, did not differ. Overall infection was the main adverse event and occurred in 20 (33%) of 60 patients in the cyclophosphamide group versus 21 (36%) of 59 patients in the placebo group. Interpretation In patients with acute exacerbation of IPF, adding intravenous cyclophosphamide pulses to glucocorticoids increased 3-month mortality. These findings provide evidence against the use of intravenous cyclophosphamide in such patients. Funding Programme Hospitalier de Recherche Clinique of the French Ministry of Health (PHRC 2014–502), Roche Pharmaceuticals.

Background While sleep disruption is a common complaint among children with cystic fibrosis (CF), only a few studies have investigated insomnia in adults. The aim of this study was to identify factors associated with insomnia in clinically stable adult CF patients. Methods Twenty-eight CF patients (18M/10F), with a median age of 27 (22–34) (median (interquartile range) years and a median of forced expiratory volume in one second of 72 (39–93) % predicted completed questionnaires on insomnia (Insomnia Severity Index, ISI), sleep quality (PSQI), daytime sleepiness (Epworth), restless legs syndrome (IRLS), pain (NRS), anxiety/depression (HAD) and quality of life (CFQ-R 14+). Respiratory assessment data, including symptoms, sputum analysis, arterial blood gases, 6-min walking test, pulmonary function tests and polysomnographic variables, were also analyzed. Results Forty-three percent of patients were insomniac (ISI > 7). Compared with non-insomniac patients (ISI ≤ 7), insomniac patients had more severely impaired quality of life and a higher HAD score: median anxiety score of 9 (8–11) vs 4 (3–6) (p p p 2 during sleep. Conclusions The strong association between insomnia, impaired quality of life and increased HAD score should prompt physicians to be particularly attentive to the management of anxiety and depression in adult CF patients with insomnia. Trial registration: On clinicaltrials.gov (NCT02924818, date of registration: October 5, 2016).

Background Obesity is a risk factor for dyspnea. However, investigations of daily living obesity-related dyspnea are limited and its mechanisms remain unclear. We aimed to analyze the relationships between dyspnea in daily living, lung function, and body composition in patients with obesity.Methods One-hundred and thirty patients (103 women/27 men), candidate for bariatric surgery, with a mean ± SD Body Mass Index (BMI) of 44.8 ± 6.8 kg/m² were included. Dyspnea was assessed by the modified Medical Research Council (mMRC) scale. Comorbidities, laboratory parameters, pulmonary function tests, arterial blood gases, six-minute walk test (6MWT), handgrip strength, and DXA body composition were analyzed.Results Thirty-one percent of patients exhibited disabling dyspnea in daily living (mMRC ≥ 2). Compared with patients without disabling dyspnea (mMRC < 2), significant dyspnea (mMRC ≥ 2) was associated with a lower 6MWT distance (395 ± 103 m vs 457 ± 73 m, pvs 54 ± 27%, p=0.024), Vital Capacity (95 ± 14 vs 106 ± 15%, pvs 105 ± 15%, p=0.002), a higher BMI (48.2 ± 7.7 vs 43.2 ± 5.7 kg/m², p=0.001) and a higher percentage of fat mass in the trunk (46 ± 5 vs 44 ± 5 p=0.012) and android region (52 ± 4 vs 51 ± 4%, p=0.024). There was no difference regarding comorbidities (except hypertension), laboratory parameters, and sarcopenia markers between patients with (mMRC ≥ 2) and without (mMRC < 2) disabling dyspnea. Conclusion Dyspnea in patients with obesity is associated with a reduction in lung volumes and a higher percentage of fat mass in central body regions. How dyspnea and body composition may change with interventions like physical activity or bariatric surgery remains to be investigated. Trial Registration Reims University Hospital Institutional Review Board (IRB-17-10-2012).

International audience; Le reflux gastro‐oesophagien (RGO) est une des pathologies les plus fréquemment associées à l’asthme, avec un impact sur le contrôle et la qualité de vie des patients. Le traitement du RGO repose sur des mesures hygiéno‐diététiques, un traitement médicamenteux anti‐acide et, dans certains cas, une prise en charge chirurgicale par fundoplicature. Si l’impact de mesures hygiéno‐diététiques seules sur l’asthme n’a pas été étudié, l’efficacité d’un traitement par inhibiteurs de la pompe à protons sur le contrôle de l’asthme, le débit expiratoire de pointe ou la qualité de vie a été analysée dans plusieurs essais randomisés contrôlés, détaillés dans cette revue. Les données d’efficacité de la prise en charge chirurgicale reposent principalement sur des études observationnelles rétrospectives ou prospectives, également détaillées. Devant l’impact limité du traitement du RGO dans l’asthme, les recommandations actuelles sont de limiter un traitement médical du RGO aux asthmes associés à un RGO symptomatique. Il n’existe pas actuellement de données suffisantes pour recommander un traitement chirurgical du RGO pour l’indication spécifique de l’asthme.

Gastro-oesophageal reflux disease (GORD) is one of the most frequent conditions associated with asthma. GORD has an impact on asthma control and quality of life of asthmatic patients. Its treatment relies on lifestyle modifications, anti-acidic treatment with proton pump inhibitors (PPI) and/or surgical management by fundoplication in some situations. The impact of lifestyle modifications has not been analysed on asthma outcomes alone. Several randomised controlled trials assessed the efficacy of PPI on asthma control, peak expiratory flow and/or quality of life. The impact of fundoplication in asthma has mainly been analysed in retrospective or prospective observational studies. This review highlights the limited impact of GORD treatment on asthma control. Current guidelines are to restrict GORD treatment in asthma to asthmatic patients with actual symptomatic GORD. Given the lack of controlled studies, the place of surgical management of GORD in asthma is currently not defined.

In recent years, many bronchoscopic techniques have been developed in chronic obstructive airway inflammatory diseases, including asthma, COPD and emphysema. The main techniques with available data from randomised controlled trials are: 1) bronchial thermoplasty in asthma; 2) valves, coils and thermal vapor ablation in emphysema; and 3) targeted lung denervation in COPD. The objectives of this article are to describe the levels of evidence for efficacy and safety, long-term follow-up results beyond 1 year, and current recommendations for clinical practice from international guidelines for each technique.

To assess the impact of nocturnal continuous positive airway pressure (CPAP) treatment of obstructive sleep apnea (OSA) on lower urinary tract (LUTS) symptoms.A prospective, monocentric study was conducted between June 2018 and August 2019. Patients with moderate to severe OSA with an indication for treatment with nocturnal CPAP in combination with SBAU were included. SBAUs and their impact were evaluated by completing two self-administered questionnaires (Urinary Symptom Profile (USP) and International Prostate Score Symptom (IPSS)) filled out during the night-time ventilatory polygraph or diagnostic polysomnography for OSA and after 4 months of CPAP treatment.In 79 patients, after four months of CPAP treatment, USP scores for stress urinary incontinence and overactive bladder were significantly improved, respectively 0.65±1.38 vs 1.13±2.10 ; p0.0001 and 3.24±2.58 vs 5.43±3.66 ; p0.0001, IPSS and IPSS-Qdv were significantly improved, respectively 5.20±3.78 vs. 7.44±5.05 ; p0.0001 and 1.93±1.26 vs. 2.27±1.56 ; p=0.002 as well as IPSS score items on pollakiuria, urgency and nocturia.Treatment with CPAP significantly improved SBAU in four months. Testing urology patients for symptoms of OSA in urology patients seeking SBAU would allow referral of patients suspected of OSA to a specialist for diagnosis and management if necessary.

International audience; Rationale: Lymphoid interstitial pneumonia is a rare benign pulmonary lymphoproliferative disorder usually presenting with a subacute or chronic condition and frequently associated with autoimmune disorders, dysgammaglobulinemia, or infections. Patient concerns: A 74-year-old woman with no past medical history presented with acute dyspnea, nonproductive cough, hypoxemia (room air PaO 2 : 48 mmHg) and bilateral alveolar infiltrates with pleural effusion. Antibiotics and diuretics treatments did not induce any improvement. No underlying condition including cardiac insufficiency, autoimmune diseases, immunodeficiency, or infections was found after an extensive evaluation. Bronchoalveolar lavage revealed a lymphocytosis (60%) with negative microbiological findings. High-dose intravenous corticosteroids induced a mild clinical improvement only, which led to perform a surgical lung biopsy revealing a lymphoid interstitial pneumonia with no sign of lymphoma or malignancies. Diagnoses: Acute severe idiopathic lymphoid interstitial pneumonia. Interventions: Ten days after the surgical lung biopsy, the patient experienced a dramatic worsening leading to invasive mechanical ventilation. Antibiotics and a new course of high-dose intravenous corticosteroids did not induce any improvement, leading to the use of rituximab which was associated with a dramatic clinical and radiological improvement allowing weaning from mechanical ventilation after 10 days. Outcomes: Despite the initial response to rituximab, the patient exhibited poor general state and subsequent progressive worsening of respiratory symptoms leading to consider symptomatic palliative treatments. The patient died 4 months after the diagnosis of lymphoid interstitial pneumonia. Lessons: Idiopathic lymphoid interstitial pneumonia may present as an acute severe respiratory insufficiency with a potential transient response to rituximab. Abbreviations: EBV = Epstein-Barr virus, HIV = human immunodeficiency virus, HTLV-1 = human T-cell lymphotropic virus-1, LIP = lymphoid interstitial pneumonia.

Resume Introduction Les hemangiomes sont des malformations vasculaires de localisation frequentes cutanees, hepatiques et spleniques. L’atteinte respiratoire reste rare et peu decrite. Observation Une femme de 35 ans se presente pour hemoptysie recidivante. L’iconographie met en evidence une masse lobaire inferieure gauche associee a des adenomegalies sus et sous-diaphragmatiques, ainsi qu’une splenomegalie heterogene et une lesion rachidienne isolee sans hyper metabolisme au TEP-scanner. La fibroscopie bronchique simple ainsi que l’echo-endoscopie bronchique seront non contributives. Une preuve histologique sera obtenue par une splenectomie avec curage lombo-aortique, puis une lobectomie d’hemostase. Sera retenu le diagnostic d’hemangiomatose multi-viscerale bronchique, ganglionnaire, splenique et osseuse. Conclusions Les hemangiomes caverneux broncho-pulmonaires associes a des hemangiomes extra-thoraciques sont exceptionnels. La presentation faisant suspecter une pathologie maligne doit conduire a une analyse histologique. Nous rapportons ici une premiere observation combinant des atteintes pulmonaires, spleniques, ganglionnaires et osseuses.

Jeanne-Marie Perotin,1,2 Claire Launois,1 Maxime Dewolf,1 Antoine Dumazet,1 Sandra Dury,1 François Lebargy,1 Valérian Dormoy,2 Gaëtan Deslee1,2 1Department of Respiratory Diseases, University Hospital of Reims, Reims, France; 2INSERM UMRS 1250, University Hospital of Reims, Reims, France Abstract: Chronic cough is a common complaint and a frequent cause of medical consultation. Its management can be difficult. We present here an overview of the current guidelines for the management of chronic cough. Different steps are detailed, including the initial research of an obvious etiology and alert signs that should lead to further investigation of underlying condition. The diagnosis of the most frequent causes: asthma, non-asthmatic eosinophilic bronchitis, gastroesophageal reflux disease and upper airway cough syndrome should be considered, assessed and treated accordingly. Recent advances have been made in the comprehension of refractory chronic cough pathophysiology as well as its pharmacologic and non-pharmacologic treatment, especially speech pathology therapy. Keywords: asthma, gastroesophageal reflux, upper airway cough syndrome, chronic hypersensitivity syndrome, refractory chronic cough, speech pathology therapy

Rationale Thoracic endometriosis is a rare disorder that can involve airways, pleura and lung parenchyma. It is the most frequent form of extra-abdominopelvic endometriosis. Multiple lung cavitations are a rare feature of thoracic endometriosis. Patient concerns A 46-year-old woman was referred to our hospital after incidental finding of multiple pulmonary cavitations with surrounding areas of ground glass opacity on a thoraco-abdominal computed tomography-scan performed for abdominal pain. Retrospectively, the patient also reported mild hemoptysis occurring 4 months ago. Diagnoses Positron emission tomography-computed tomography scan revealed moderate and homogeneous [18F] fluoro-2-deoxy-D-glucose (18F-FDG) uptake in pulmonary cavitations (maximum standardized uptake value 5.7). The diagnosis of thoracic endometriosis was confirmed by histological examination of surgical resection of a left lower lobe cavitation. Interventions and outcome Gonadotropin-releasing hormone analogues associated with add-back therapy was started. Four months after initiating pharmacological treatment, the chest computed tomography-scan showed a dramatic decrease in lung cavitations size. Lessons Thoracic endometriosis is a rare disorder requiring a multidisciplinary management including gynaecologist, pulmonologist, radiologist, nuclear physician, pathologist and thoracic surgeon for early diagnosis and treatment. Our case report highlights that an increased 18F-FDG uptake can be found in thoracic endometriosis syndrome presenting as multiple lung cavitations.

Introduction L’obesite est un facteur de risque connu de dyspnee. La dyspnee dans les activites de la vie quotidienne liee a l’obesite a ete peu etudiee et ses mecanismes restent encore peu elucides. Notre objectif etait d’identifier les facteurs associes a une dyspnee invalidante au quotidien chez les patients obeses. Methodes Cent trente patients (103 femmes et 27 hommes), candidats a une chirurgie bariatrique avec un indice de masse corporelle (IMC) moyen de 44,8 ± 6,8 kg/m2 ont ete etudies. La dyspnee etait evaluee par l’echelle mMRC. Les comorbidites, les parametres biologiques, les explorations fonctionnelles respiratoires, les gaz du sang arteriels, le test de marche de 6 min, la force de prehension mesuree avec un dynanometre a mains ainsi que la composition corporelle par absorptiometre biphotonique a rayons X (DXA) ont ete analyses. Resultats Trente et pour cent des patients presentaient une dyspnee invalidante dans la vie quotidienne (mMRC ≥ 2) ( Fig. 1 ). Le pourcentage de patients presentant une dyspnee mMRC ≥ 2 augmentait significativement en fonction de l’IMC groupe selon la classification de l’obesite definie par l’Organisation mondiale de la sante (0% pour l’obesite de classe I, 21% pour l’obesite de classe II, 27 % pour l’obesite de classe III et 57% pour la super obesite, p = 0,006). En comparaison avec les patients sans dyspnee invalidante (mMRC Conclusion Une partie de la dyspnee des patients obeses pourrait etre expliquee par une diminution des volumes pulmonaires, possiblement en lien avec une augmentation du pourcentage de masse grasse au niveau des regions centrales du corps. Il reste a determiner si la chirurgie bariatrique, en modifiant la composition corporelle, pourrait avoir un impact sur la dyspnee des patients obeses.

Objectif Determiner les facteurs associes a l’insomnie chez les patients adultes atteints de mucoviscidose. Methodes Evaluation prospective, chez des patients adultes atteints de mucoviscidose, a l’etat clinique stable, de l’insomnie (ISI), qualite du sommeil (PSQI), somnolence diurne (Epworth), syndrome des jambes sans repos (IRLS), douleur (EVA), anxiete/depression (HAD), qualite de vie (CFQR 14 + ) associee a une evaluation respiratoire clinique, fonctionnelle, microbiologique et par polysomnographie avec mesure de la PCO2 transcutanee. Resultats Vingt-huit patients (18 H/10 F), âge median 27 (22–33) ans, volume expiratoire maximal en une seconde 72 (39–93) % ont ete analyses. Quarante-trois pour cent des patients presentaient une insomnie (ISI > 7). En comparaison aux patients non insomniaques (ISI ≤ 7), les patients insomniaques (ISI > 7) avaient une qualite de vie plus alteree et un score HAD plus eleve : score anxiete median a 9 (8–10) vs 4 (3–5), p Conclusion L’association forte entre insomnie, alteration de la qualite de vie et augmentation du score HAD doit inciter a detecter et proposer une prise en charge specifique du syndrome anxio-depressif chez les patients adultes insomniaques atteints de mucoviscidose.

International audience; No abstract available

Asthma and obesity are both common conditions, which lead to a substantial public health burden. The obese-asthma phenotype is characterized by poor asthma control, impaired lung function and decreased efficacy of inhaled treatment. However, this phenotype is highly heterogeneous and involves numerous mechanisms, including systemic inflammation and adipokines. A role for microbiota modifications and genetics has been suggested. Obese-asthma patient management currently consists in weight loss and usual anti-asthmatic treatment. New therapeutic options are being evaluated.

Relapsing polychondritis (RP) is a rare immune-mediated disease affecting cartilaginous structures. Respiratory tract manifestations are frequent and constitute a major cause of morbidity and mortality. The present review of the literature was designed to assess the efficacy of tumor necrosis factor alpha (TNF-α) inhibitors in respiratory tract involvement of RP. A MEDLINE literature search was performed from January 2000 to December 2016 to identify all studies and case reports of anti-TNF-α therapy in RP. Articles published in English or French concerning patients with respiratory tract involvement were eligible. Two authors (JB, FL) independently reviewed and extracted data concerning each patient and 2 personal cases were added. Treatment efficacy was assessed according to systemic and/or respiratory criteria. A total of 28 patients (mean age: 41.6 years; 16 females/12 males) were included in the final analysis. Anti-TNF-α therapy was associated with improved health status and respiratory symptoms in 67.8% and 60.1% of cases, respectively. These results suggest that TNF-α inhibitors could be considered for the treatment of respiratory tract involvement of RP.

Asthma and obesity are both common conditions, which lead to a substantial public health burden. The obese-asthma phenotype is characterized by poor asthma control, impaired lung function and decreased efficacy of inhaled treatment. However, this phenotype is highly heterogeneous and involves numerous mechanisms, including systemic inflammation and adipokines. A role for microbiota modifications and genetics has been suggested. Obese-asthma patient management currently consists in weight loss and usual anti-asthmatic treatment. New therapeutic options are being evaluated.

Introduction : There are currently only little data available on the factors predicting the respective efficacy of fixed CPAP (FP-CPAP) or automated CPAP (APAP) for OSAS treatment. Aims and objectives : We evaluated the efficacy of a 3month-period treatment with FP-CPAP versus APAP on a composit criteria involving apnoea/ hyponoea index (AHI) and the Epworth score (ESS), according to the level of effective pressure (Peff) as well as pressure variability (Pvar). Methods : A multicenter prospective controlled study was conducted in 22 academic and non academic french centers. Initial clinical and polygraphic data were obtained before initiating a 7-day period using APAP delivering a variable pressure between 4 and 20 cm Hg. Then, patients were randomised to either FP-CPAP or APAP used during 3 months, and the data obtained at the end of the study period were analysed according to the inital level of Peff and Pvar. Results : 616 patients (mean age : 56.8 yrs ± 11.2, mean AHI : 51.7/h ± 20.8) were included. CPAP compliance was the same in both groups (FP-CPAP : 5.78h ± 1.9 vs APAP : 5.85h± 1.9) with an identical efficacy on AHI and the ESS (FP-CPAP : 6.11/h ± 7.94 and 6.02 ± 4.37, and APAP 5.71/h ± 6.75 and 6.05 ± 4.5). Despite the lack of influence of Pvar on FP-CPAP vs APAP efficiency, a greater initial pressure variability was associated with a significant higher residual AHI whatever the mode of CPAP applied. Conclusion : The efficiency of FP-CPAP and APAP was identical on OSAS improvement after 3 months of treatment, independently of initial level of effective pressure and variability.

Haemangiomas are vascular malformations, frequently cutaneous, hepatic and splenic. Respiratory involvement and multiple localisations are uncommon.We present a rare case of multiple cavernous haemangiomas in a 35 year old woman presenting with repeated haemoptysis. Thoracic CT scanning showed a mass in the left lower lobe associated with lymph node enlargement above and below the diaphragm, heterogeneous splenomegaly and a single spinal lesion without hypermetabolism on PET scanning. Enbronchial ultrasound-guided trans-bronchial needle aspiration was not contributory. Histopathological diagnostic was made firstly by splenectomy with lumbar-aortic curettage and then by lobectomy for haemostasis. A final diagnosis of multiple cavernous haemangiomas involving lung, lymph nodes, spleen and bone was made.Bronchopulmonary cavernous haemangiomas associated with extra-thoracic lesions are exceptionally rare and their presentation, suggesting, a malignant cause, often leads to surgical resection for diagnostic and, eventually, therapeutic management. We report an original case of cavernous haemangiomas involving lung, lymph nodes, spleen and bone.

Resume Introduction Les pleuresies a eosinophiles, definies par un taux d’eosinophiles ≥ 10 %, representent environ 10 % des pleuresies exsudatives. Observation Nous rapportons le premier cas de pleuresie a eosinophiles survenu apres traitement par lisinopril. Une disparition de la pleuresie a l’arret du traitement et la recidive lors de sa reintroduction ont apporte la preuve de l’imputabilite du lisinopril dans la survenue de la pleuresie. Conclusion Frequemment d’origine infectieuse ou tumorale, les pleuresies a eosinophiles necessitent une demarche diagnostique rigoureuse. Les etiologies medicamenteuses, principalement en lien avec des traitements a visee cardiovasculaire et neuro-psychiatrique, sont beaucoup plus rares. Leur diagnostic repose sur des criteres d’imputabilite intrinseques et extrinseques.

International audience; AbstractBackgroundNuclear protein in testis carcinoma is a rare and very aggressive undifferentiated cancer which characteristically arises in the midline of the head, neck, and mediastinum.Case presentationWe describe the case of a 46-year-old white woman admitted for superior vena cava syndrome revealing a mediastinal tumor. Pathological examination of specimens obtained by mediastinoscopy revealed an undifferentiated tumor with solid growth and positive immunoreactivity for p40 and negative immunoreactivity for cytokeratin markers. Immunohistochemical staining was positive for nuclear protein in testis, allowing the diagnosis of nuclear protein in testis midline carcinoma of the mediastinum.ConclusionsWe present a rare case of mediastinal nuclear protein in testis carcinoma with diagnosis based on nuclear protein in testis protein positivity and atypical immunohistochemical features including p40 positivity and anti-cytokeratin negativity. Physicians must remain aware of the possibility of nuclear protein in testis carcinoma especially in young patients with thoracic symptoms and suspicion of neoplasm.

Objectives To assess the effects of bariatric surgery in patients with obesity on dyspnea and to analyze the relationships between improvement of dyspnea after bariatric surgery and changes in pulmonary function, especially Expiratory Reserve Volume (ERV) which is the lung volume abnormality most frequently associated with obesity. Methods Forty-five patients (5 males/40 females, mean Body Mass Index = 46.2 ± 6.8 kg/m2) were evaluated before and 6 to 12 months after bariatric surgery. Dyspnea was assessed by the modified Medical Research Council (mMRC) scale. Pulmonary function tests, arterial blood gases and six-minute walk test were performed. Laboratory parameters including C-Reactive Protein (CRP) were analyzed. Results Ninety percent of patients were dyspneic before surgery (mMRC scale ≥ 1) versus 59% after surgery (p

Introduction Many studies have shown a high prevalence of sleep apnea syndrome (SAS), whether obstructive sleep apnea (OSA) or central sleep apnea (CSA) in heart failure patients (HF). Very few data exit about HF patients with cardiac resynchronization therapy (CRT). Purpose In this study, we will determine the prevalence of SAS in this population and study the influence of CRT about SAS. Methods A prospective open-label, single-center, non-interventional, cohort-type study was conducted at Reims University Hospital between 1st January and 31st August 2016. All patients implanted with CRT device without known SAS were included. Screening polysomnography was performed before and 6 months after implantation. Primary endpoint was the incidence of SAS and secondary endpoint was the evaluation of the impact of CRT on SAS. Results During the study period, 31 patients were implanted with a CRT device: 10 were already known having SAS and 5 did not give their consent. At M0, 100% of the 16 included patients were diagnosed having SAS, with 69% severe OSAS. All were treated by CPAP according to guidelines. At 6 months, after 48 h CPAP washout, no independent significant influence of CRT on the Apnea-Hypopnea Index (AHI) was demonstrated (37 ± 19 vs 60 ± 12, P = 0.0625). An improvement in HF parameters was observed (NYHA class (−1, P = 0.0195), QRS width (−26 ms, P = 0.0002) and LVEF (+9.5%, P = 0.0039)). At 6 months, the CRT response rate was high with significant NYHA class and LVEF improvement in 79 and 57% patients respectively. Conclusion SAS (especially OSA) is frequent in HF patients eligible for CRT and mostly under-diagnosed. The lack of improvement of the AHI by the CRT alone and the existence of a specific treatment of the OSAS improving morbi-mortality, maintaining a very good response rate to the CRT invite to screen this population.

Objectif Nous avons precedemment montre, chez des patients en position assise ayant un syndrome d’apnees obstructives du sommeil, la presence de potentiels pre-moteurs inspiratoires (PPI) sur l’electroencephalogramme d’eveil, traduisant l’existence d’une compensation corticale de la charge mecanique situee au niveau de leurs voies aeriennes superieures (VAS). Il a ete montre que le deplacement des fluides des membres inferieurs vers la region cervicale (DF) augmente la charge mecanique au niveau des VAS et favorise la survenue d’apnees obstructives. Notre objectif est d’evaluer si le DF entraine l’apparition d’une compensation corticale. Methodes Nous avons induit un DF par le passage de la position assise a allongee puis par l’application d’un pantalon anti-gravite (PAG) chez des sujets sains, a l’eveil, et recherche l’apparition d’un PPI. Resultats Nous avons inclus 12 hommes sains (âge median 27 ± 6 ans ; IMC 21,7 ± 4,6 kg/m2). Le passage de la position assise a la position allongee a provoque un DF de 410 ± 140 mL et le PAG de 95 ± 143 mL Un PPI etait retrouve chez 1 sujet en position assise, chez 5 sujets en position allongee et chez 0 sujet apres application du PAG. Les sujets ayant un PPI en position allongee avait un DF plus important lors du passage de la position assise a allongee que les sujets sans PPI en position allongee (440 ± 90 vs 320 ± 45 mL, p = 0,02), sans difference d’âge et d’IMC. Conclusion Le passage de la position assise a allongee entraine un DF et est associe a l’apparition d’une compensation corticale transitoire chez le sujet sain a l’eveil.

Resume Introduction Le syndrome de Protee est une maladie genetique exceptionnelle due a une mutation somatique en mosaique activatrice de l’oncogene AKT1 qui est responsable d’une croissance excessive, asymetrique et deformante de multiples tissus notamment osseux, conjonctif et adipeux. Observation Nous rapportons l’observation d’un patient de 25 ans, atteint d’un syndrome de Protee diagnostique a l’âge de six mois devant une hyperdystrophie asymetrique des mains et des jambes ayant necessite une amputation bilaterale des membres inferieurs a l’âge de dix ans. Ce patient etait hospitalise pour une detresse respiratoire aigue sur une infection broncho-pulmonaire revelant un emphyseme bulleux majeur predominant a gauche avec deviation mediastinale. L’evolution clinique etait favorable sous antibiotherapie. Le bilan fonctionnel realise a deux mois montrait une hypoxemie moderee (PaO2 = 75 mmHg) et un trouble ventilatoire obstructif tres severe (VEMS = 1260 mL, 28 %, VEMS/CV = 69 %) associe a une distension thoracique (CPT = 7840 mL soit 107 % des valeurs theoriques, VR = 6010 mL, soit 253 % des valeurs theoriques). Conclusion Le syndrome de Protee est une cause exceptionnelle d’emphyseme pulmonaire. La physiopathologie de la formation de kystes pulmonaires evoluant vers cet emphyseme est actuellement meconnue mais pourrait presenter des similitudes avec celle de la lymphangioleiomyomatose pulmonaire par l’activation de la voie AKT1.

International audience; Obstructive fibrinous tracheal pseudomembrane (OFTP) is a rare and potentially severe complication of endotracheal intubation characterized by a tubular pseudomembrane that obstructs the trachea and induces clinical symptoms of airway obstruction after extubation. In this report, we reviewed and summarized all published cases of OFTP (n = 58) between 1981 and 2015. Twenty-three of 52 patients were men, and the mean age was 36 ± 22 years. Intubation was emergent in 41 of 53 cases. OFTP was revealed by acute symptoms in 19 of 39 cases and led to acute respiratory failure in 13 of 39 cases. Symptoms occurred 3 ± 3 days after extubation. A tracheal obstruction ≥70% was observed in 14 of 18 cases. Bronchoscopic removal was performed in 49 of 58 cases with no recurrence. In conclusion, OFTP is characterized by a typical clinical and endoscopic presentation, with no recurrence after bronchoscopic removal. Early recognition and bronchoscopy are key elements for efficient diagnosis and treatment.

Rationale: Hereditary multiple exostoses (HME) is a genetic musculoskeletal condition causing multiple exostoses. Rib location of exostosis can be complicated by thoracic injuries. Patient concerns and diagnoses: We report a case of pneumothorax in a 32-year-old man with a partial left-sided pneumothorax caused by an exostosis of the fourth and fifth ribs. Interventions and outcomes: Clinical and radiological presentations allowed a conservative management. A video-assisted thoracoscopic surgery was performed a few weeks later to avoid any recurrence. Lessons: Rib exostosis represents an unusual cause of pneumothorax. Any local modification of symptoms or size of the exostosis should lead to investigations in regard to chondrosarcoma transformation.

Background F-Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) is increasingly used for the initial staging and restaging of lung cancer. Incidental gastrointestinal findings are often observed on 18F-FDG PET/CT. The objective of this study was to assess incidental 18F-FDG uptake by the gastrointestinal tract (GIT) in patients with lung cancer. Methods Two hundred thirty consecutive 18F-FDG PET/CT examinations performed for lung cancer over a 3-year period were retrospectively reviewed for the presence of incidental FDG uptake in the GIT. The charts of patients with positive FDG uptake were then reviewed and analysed to determine the GIT uptake sites, the standardized uptake value (SUV) max and the final clinical diagnosis. Results Fifty-two patients (52/230, 23 %) demonstrated incidental FDG uptake in the GIT. Thirty-three patients (63.5 %) had diffuse uptake (oesophagus, n = 2, colon, n = 31) and 19 patients (36.5 %) had focal uptake (oesophagus, n = 1, small bowel, n = 1, ascending colon, n = 5, descending colon, n = 4, sigmoid, n = 4, rectum, n = 3, and anal margin, n = 1). Twelve of the 52 patients with GIT uptake were further investigated, revealing, a diagnosis of malignancy in 4 patients with focal FDG uptake. No significant differences in mean SUVmax were observed between patients with malignant and benign GIT diseases. Conclusion This study demonstrates a high incidence of FDG uptake in the GIT associated with lung cancer. Focal GIT uptake was frequently associated with malignant disease. These results suggest that further GIT investigations should be performed in patients with focal GIT uptake.

Background Bronchiectasis is characterized by abnormal, permanent and irreversible dilatation of the bronchi, usually responsible for daily symptoms and frequent respiratory complications. Many causes have been identified, but only limited data are available concerning the association between bronchiectasis and renal transplantation. Methods We conducted a retrospective multicenter study of cases of bronchiectasis diagnosed after renal transplantation in 14 renal transplantation departments (French SPIESSER group). Demographic, clinical, laboratory and CT scan data were collected. Results Forty-six patients were included (mean age 58.2 years, 52.2 % men). Autosomal dominant polycystic kidney disease (32.6 %) was the main underlying renal disease. Chronic cough and sputum (50.0 %) were the major symptoms leading to chest CT scan. Mean duration of symptoms before diagnosis was 1.5 years [0–12.1 years]. Microorganisms were identified in 22 patients, predominantly Haemophilus influenzae. Hypogammaglobulinemia was observed in 46.9 % patients. Bronchiectasis was usually extensive (84.8 %). The total bronchiectasis score was 7.4 ± 5.5 with a significant gradient from apex to bases. Many patients remained symptomatic (43.5 %) and/or presented recurrent respiratory tract infections (37.0 %) during follow-up. Six deaths (13 %) occurred during follow-up, but none were attributable to bronchiectasis. Conclusions These results highlight that the diagnosis of bronchiectasis should be considered in patients with de novo respiratory symptoms after renal transplantation. Further studies are needed to more clearly understand the mechanisms underlying bronchiectasis in this setting.

The shrinking lung syndrome (SLS) is a rare complication of systemic lupus erythematosus.A 69-year-old man presented with exertional dyspnoea, muscle weakness, and weight loss of 15kg in 6months. Pulmonary function tests revealed a restrictive lung disorder, with a dramatic decrease in maximal inspiratory pressure (17% of theoretical value), and alveolar hypoventilation (pH 7.43; PaCOThe interesting features of this case report consist of: 1) the presentation of the SLS as an alveolar hypoventilation with a fatal outcome, 2) the presentation of systemic lupus as SLS.

Eosinophilic pleural effusions are defined by an eosinophil count ≥10% in pleural fluid and represent approximately 10% of exudative pleural effusions.We report the first case of eosinophilic pleural effusion occurring due to lisinopril treatment. Improvement after drug discontinuation and recurrence after reintroduction indicated that lisinopril was responsible for the effusion.The main causes of eosinophilic pleural effusions are infections including tuberculosis, and malignancies. Drug-induced eosinophilic pleural effusions have only rarely been described, mainly caused by cardiovascular or neuropsychiatric medicines.

15 sujets sains ont realise des contractions maximales volontaires du quadriceps. Pendant chaque contraction, l’activation cerebrale etait etudiee au moyen de la spectroscopie proche infrarouge (variation de [O2Hb]) sur les aires corticales motrices (M1), sensorielles (S1) primaires, premotrices (PMC) et prefrontales (PFC). Resultats et discussion.– Compares aux sujets sains, la force maximale etait diminuee de 24,8 % chez les patients (131,9 64,3 Nm vs 175,4 49,3, p < 0,05). Parallelement, un deficit d’activation cerebrale significatif (p < 0,05) a ete observe sur M1, PMC et PFC chez les patients, indiquant que la commande nerveuse en provenance des aires motrices etait alteree. Conclusion.– Les muscles extenseurs du genou ne sont pas actives de maniere optimale par le cerveau chez les patients BPCO. Ces resultats permettent de comprendre pourquoi une perte de force musculaire est retrouvee chez certains patients en l’absence evidente d’atrophie musculaire [2]. Un nouveau champ physiopathologique demande donc a etre explore, de facon a comprendre les origines et les repercussions precises de ces alterations de la commande centrale dans la tolerance a l’effort.

The Proteus syndrome is a rare genetic disease which is characterized by the overgrowth of tissues, especially bone, connective and adipose tissue. This condition is related to a somatic mosaic activating mutation in the AKT1 oncogene.We report the case of a 25-year-old man, diagnosed with the Proteus syndrome at the age of 6 months. He exhibited an asymmetric overgrowth of the extremities leading to bilateral amputation of the legs at the age of 10 years. He was hospitalized for acute respiratory failure due to a bronchopulmonary infection. Severe bullous pulmonary emphysema, predominantly on the left, with mediastinal deviation, was diagnosed. The patient recovered with antibiotics. An assessment 2 months later revealed mild hypoxaemia (PaO2=75 mmHg) and severe airflow limitation (FEV1=1260 mL [28% th.], FEV1/V C=69%) with hyperinflation (TLC=7840 mL [107% th.], RV=6010 mL [253% th.]).The Proteus syndrome is a very rare cause of pulmonary emphysema. The pathophysiology of emphysema in this syndrome is unknown. It can be hypothesized that the development of pulmonary cysts leading to emphysema may share the same AKT1 activation pathway with lymphangioleiomyomatosis.

International audience; ABSTRACT: BACKGROUND: Mechanical ventilation (MV) is imperative in many forms of acute respiratory failure (ARF) in COPD patients. Previous studies have shown the difficulty to identify parameters predicting the outcome of COPD patients treated by invasive MV. Our hypothesis was that a non specialized score as the activities daily living (ADL) score may help to predict the outcome of these patients. METHODS: We studied the outcome of 25 COPD patients admitted to the intensive care unit for ARF requiring invasive MV. The patients were divided into those weaning success (group A n = 17, 68%) or failure (group B n = 8, 32%). We investigated the correlation between the ADL score and the outcome and mortality. RESULTS: The ADL score was higher in group A (5.1 +/-1.1 vs 3.7 +/- 0.7 in group B, p < 0.01). Weaning was achieved in 76.5of the cases with an ADL score [greater than or equal to] 4 and in 23.5of the cases with an ADL score < 4 (p < 0.05). Pulmonary function test, arterial blood gases collected during period of clinical stability and at admission and nutritional status were similar in both groups. The mortality, at six months, was 36%. The ADL score was a significant predictor of 6-month mortality (80with an ADL score

Introduction Les pseudomembranes fibrineuses obstructives de trachee (OFTP) sont une complication rare mais potentiellement severe des intubations endotracheales. Elles constituent un manchon tubulaire fibrineux obstruant la trachee, survenant apres l’extubation. Ses caracteristiques principales ne sont toutefois pas clairement connues. Methodes L’ensemble des cas d’OFTP publies entre 1981 et 2015 ont ete systematiquement revus. Nous avons analyse les caracteristiques demographiques, cliniques et endoscopiques des OFTP, leur prise en charge therapeutique et leur evolutivite. Resultats Cinquante-neuf patients etaient inclus, 44 % etaient des hommes, avec un âge moyen de 36 ± 22 ans. Dans 77 % des cas, l’intubation endotracheale etait realisee dans des conditions d’urgence, des difficultes mecaniques etaient decrites dans 23 % des cas. Les OFTP etaient revelees par des symptomes respiratoires aigus dans 54 % des cas, avec une detresse respiratoire aigue dans 17 % des cas. Les premiers symptomes survenaient 3,1 ± 3 jours apres l’extubation. Le degre moyen d’obstruction tracheale etait de 79 ± 11 %. Une extraction mecanique de l’OFTP par bronchoscopie etait realisee dans 85 % des cas, efficace dans tous les cas, sans recidive apres 6 ± 11 mois de suivi. Deux patients etaient decedes avant la realisation d’investigations. Trois patients avaient spontanement expectore l’OFTP lors d’un effort de toux. Conclusion Les OFTP sont caracterisees par une presentation clinique et endoscopique typiques et une absence de recidive apres une ablation mecanique par endoscopie interventionnelle. La realisation precoce d’une bronchoscopie est un element clef de la prise en charge diagnostique et therapeutique des OFTP.

Introduction La TEP-TDM est de plus en plus utilisee pour le bilan initial et la reevaluation dans cancers bronchopulmonaires. Son utilisation croissante amene a etre souvent confronte a des lesions hypermetaboliques de decouvertes fortuites extra thoraciques et notamment au niveau du tube digestif. L’objectif de notre etude est d’evaluer l’incidence et l’etiologie de ces lesions. Patients et methodes Deux cent trente patients atteints de cancer bronchopulmonaires ont beneficie d’une TEP-TDM en 3 ans. Les comptes rendus ont ete analyses retrospectivement afin d’identifier ceux avec une fixation au niveau du tube digestif. Les dossiers des patients identifies ont ete ensuite analyses pour obtenir les informations sur la localisation gastro-intestinale, la SUVmax et le diagnostic final. Resultats Une fixation digestive a ete mise en evidence pour 52/230 (23 %). Trente-trois patients (63,5 %) avaient une fixation diffuse et 19 (36,5 %) avaient une fixation focale. Dans les deux groupes, le colon a ete le siege privilegie des fixations. Douze sur cinquante-deux patients ont poursuivi les investigations. Parmi ces 12 patients, 4 patients avec des lesions focales ont eu un diagnostic de malignite. Il n’a pas ete identifie de difference significative dans les moyennes de SUVmax entre les 4 groupes de diagnostic (malignite certaine, haute probabilite de malignite, benignite certaine, haute probabilite de benignite). Conclusion Cette etude montre une incidence elevee de lesion gastro-intestinale hyperfixante de decouverte fortuite associee au cancer du poumon. Ces resultats suggerent que des explorations doivent etre realisees en cas de lesion focale gastro-intestinale de decouverte fortuite en TEP-TDM.

Organisation Travail realise sous la direction de V. Attali et T. Similowski. Introduction Le syndrome d’apnees obstructives du sommeil (SAOS) est caracterise par des episodes repetitifs de collapsus des voies aeriennes superieures durant le sommeil, dus a une alteration de leurs proprietes mecaniques, que l’on peut assimiler a une « charge inspiratoire ». La charge inspiratoire chez le sujet sain induit l’activation des circuits corticaux pre-moteurs, visualisables sous forme de potentiels pre-moteurs inspiratoires (PPI) a l’electroencephalogramme (EEG). Nous avons fait l’hypothese que les patients atteints de SAOS pouvaient se comporter comme des sujets sains soumis a une charge inspiratoire en activant les circuits corticaux pre-moteurs et que la pression positive continue (PPC) en annulant cette charge inspiratoire mettait « au repos » ces circuits de compensation (disparition du PPI). Materiels et methodes Des PPI a l’eveil ont ete recherches chez 23 patients « SAOS » et 10 sujets « controle » (8 somnambules et 2 sujets sains), en position assise ( n = 33), en decubitus dorsal ( n = 32) et sous PPC. Resultats En position assise et en decubitus dorsal, la prevalence du PPI etait respectivement de 56 % et 63 % dans le groupe « SAOS severe » (IAH ≥ 30/h), de 29 et 43 % dans le groupe « SAOS leger/modere » (5 ≤ IAH p = 0,02). Sous PPC, 5 patients « SAOS » sur 7 traites, presentaient un PPI en ventilation spontanee, et chez 4 d’entre eux, le PPI disparaissait sous PPC. Conclusion Cette etude met en evidence l’implication de circuits corticaux pre-moteurs dans la compensation de la charge inspiratoire dans le SAOS a l’eveil. Elle suggere egalement une relation entre severite du SAOS et compensation corticale.

Background Dyspnea is very frequent in obese subjects. However, its assessment is complex in clinical practice. The modified Medical Research Council scale (mMRC scale) is largely used in the assessment of dyspnea in chronic respiratory diseases, but has not been validated in obesity. The objectives of this study were to evaluate the use of the mMRC scale in the assessment of dyspnea in obese subjects and to analyze its relationships with the 6-minute walk test (6MWT), lung function and biological parameters. Methods Forty-five obese subjects (17 M/28 F, BMI: 43 ± 9 kg/m2) were included in this pilot study. Dyspnea in daily living was evaluated by the mMRC scale and exertional dyspnea was evaluated by the Borg scale after 6MWT. Pulmonary function tests included spirometry, plethysmography, diffusing capacity of carbon monoxide and arterial blood gases. Fasting blood glucose, total cholesterol, triglyceride, N-terminal pro brain natriuretic peptide, C-reactive protein and hemoglobin levels were analyzed. Results Eighty-four percent of patients had a mMRC ≥ 1 and 40% a mMRC ≥ 2. Compared to subjects with no dyspnea (mMRC = 0), a mMRC ≥ 1 was associated with a higher BMI (44 ± 9 vs 36 ± 5 kg/m2, p = 0.01), and a lower expiratory reserve volume (ERV) (50 ± 31 vs 91 ± 32%, p = 0.004), forced expiratory volume in one second (FEV1) (86 ± 17 vs 101 ± 16%, p = 0.04) and distance covered in 6MWT (401 ± 107 vs 524 ± 72 m, p = 0.007). A mMRC ≥ 2 was associated with a higher Borg score after the 6MWT (4.7 ± 2.5 vs 6.5 ± 1.5, p Conclusion This study confirms that dyspnea is very frequent in obese subjects. The differences between the “dyspneic” and the “non dyspneic” groups assessed by the mMRC scale for BMI, ERV, FEV1 and distance covered in 6MWT suggests that the mMRC scale might be an useful and easy-to-use tool to assess dyspnea in daily living in obese subjects.