Oximetry alone versus portable polygraphy for sleep apnea screening before bariatric surgery.

Background: Screening for obstructive sleep apnea (OSA) is recommended as part of the preoperative assessment of obese patients scheduled for bariatric surgery. The objective of this study was to compare the sensitivity of oximetry alone versus portable polygraphy in the preoperative screening for OSA.

Methods: Polygraphy (type III portable monitor) and oximetry data recorded as part of the preoperative assessment before bariatric surgery from 68 consecutive patients were reviewed.

Right-to-left shunt with hypoxemia in pulmonary hypertension.

Background: Hypoxemia is common in pulmonary hypertension (PH) and may be partly related to ventilation/perfusion mismatch, low diffusion capacity, low cardiac output, and/or right-to-left (RL) shunting.

Methods: To determine whether true RL shunting causing hypoxemia is caused by intracardiac shunting, as classically considered, a retrospective single center study was conducted in consecutive patients with precapillary PH, with hypoxemia at rest (PaO2 < 10 kPa), shunt fraction (Qs/Qt) greater than 5%, elevated alveolar-arterial difference of PO2 (AaPO2), and with transthoracic contrast echocardiography performed within 3 months.

Results: Among 263 patients with precapillary PH, 34 patients were included: pulmonary arterial hypertension, 21%; PH associated with lung disease, 47% (chronic obstructive pulmonary disease, 23%; interstitial lung disease, 9%; other, 15%); chronic thromboembolic PH, 26%; miscellaneous causes, 6%.

[Torsade de pointes: a severe and unknown adverse effect in a patient taking methadone].

We present here the case of a young drug-addicted patient, who showed a cardio-respiratory arrest attributed to a torsade de pointe-type ventricular arrhythmia. After excluding the usual causes of such arrhythmia, we concluded that it was consecutive to high-dose methadone intake. Methadone can induce torsade de pointe through two mechanisms: a QT interval prolongation secondary to a bradycardia or a prolongation of the myocardial action potential.

[Salami and extrinsic allergic alveolitis: a new occupational disease in Switzerland].

The authors report a case of extrinsic allergic alveolitis in a patient working in an industrial butchery where she is involved in the preparation of dry sausages. The molds proliferating at the surface of these sausages, molds from the Penicillium family, are responsible for the disease. The respective value of laboratory tests such as the presence of precipitating antibodies and the analysis of the cellularity of the bronchoalveolar lavage are discussed.