[Pleural sarcoidosis: contribution of thoracoscopy].
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Biomedical subjects
Publications and source records attributed to C Aron.
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We report the case of a 69-year-old woman investigated for suspected pleuropneumopathy. Thoracoscopy led to the diagnosis of sarcoidosis with pleural involvement. This case illustrates an uncommon localization of sarcoidosis and its clinical course after corticosteroid treatment.
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BACKGROUND: Although experience acquired with non-invasive ventilation is recent, it is often proposed in selected patients with acute respiratory failure occurring in a background of chronic airflow obstruction. Barometric or volumetric techniques can be used. PATIENTS AND METHODS: We compared tolerance and efficacy of inspiration assist (IA) using a preset pressure and volume-controlled ventilation (VC). Twelve patients with chronic airflow obstruction were randomized to IA (n = 7) or VC (n = 9) mode and ventilated with the appropriate mask. RESULTS: Tolerance was equivalent for the two groups although hypercapnia fell more in the IA group, particularly after 24 h ventilation (p < 0.03), after three days (p < 0.05), and at complete weaning (p < 0.03). Correction of pH was significantly more rapid in the IA group than in the VC group (p < 0.05 at 24 h). There was no difference in the number of days of ventilation, total ventilation time, or length of hospital stay. Success of non-invasive ventilation, defined as the control of acute respiratory failure without recourse to endotracheal ventilation, was similar in the two groups (86% in group IA and 60% in group VC). Two of the 5 patients in the VC group and one of the 7 in the IA group required intubation.
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Extra-intestinal manifestations of inflammatory bowel disease (Crohn's disease) are frequent although pulmonary signs are uncommon. We report the case of a patient with sarcoidosis and inflammatory bowel disease and discuss the common features of these two diseases.
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Sarcoidosis is a diffuse granulomatosis predominately with mediastino-pulmonary localizations. A wide range of extrathoracic localizations can also occur and when they are the initial manifestation, may lead to misdiagnosis. We observed a rare case of peritoneal sarcoidosis revealed by a surgical emergency.
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Lung cancer is a common pathology with high mortality due to late diagnosis. The 1987 TNM classification clearly defines the different steps and their prognosis. Although the prognostic value of some biological parameters (mainly serum LDH, sodium and/or albumin) has been established, these are not much used. We have prospectively studied the serum levels of seven proteins (RBP, prealbumin, albumin, transferrin, haptoglobin, orosomucoid, CRP) and we demonstrate the predominant value of prealbumin for the establishment of the prognosis of lung cancer; determination of orosomucoid increases the prognostic value of prealbumin. We confirm, for lung cancer, the prognostic value of the orosomucoid-prealbumin ratio, already known for other cancers.
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Various respiratory signs (other than infectious pathology), either very frequent and mild or very rare but with a poor prognosis, can be observed in cirrhotic subjects. Hypoxemia raises the greatest diagnostic problems in these subjects. The poor homogeneity of ventilation-perfusion ratios is the most commonly proposed cause of hypoxemia in cirrhosis. In such cases, hypoxemia is typically moderate (60-80 mmHg). Conversely, anatomical shunts, especially intrapulmonary ones, account for severe hypoxemia (< 60 mmHg). We are reporting about the case of a severe form of hypoxemia without anatomical shunt, caused by an anomalous ventilation-perfusion ratio in a female patient with ethylic cirrhosis.
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A case of extrapleural haematoma consecutive to a chest injury is reported. This is a rare site of blood effusion since such injuries usually result in haemothorax. These two diagnosis can be distinguished not only by exploratory thoracotomy but also by computerized tomography which shows a characteristic subpleural fat-like ribbon.