Late-onset post-lesional paroxysmal hypothermia: a case series and literature review.

Background: Paroxysmal hypothermia (PH) is a rare condition characterized by recurrent episodes of spontaneous hypothermia, bradycardia, disorders of consciousness and, in some cases, hyperhidrosis. When associated with a detectable hypothalamic lesion, PH episodes usually occur shortly after the brain insult.

Methods: We performed a retrospective study to identify patients who had demonstrated at least one episode of symptomatic spontaneous PH as defined by (i) tympanic temperature < 35 °C; (ii) drowsiness and/or confusion state and/or coma; (iii) duration of the episode ≥ 24 h; (iv) absence of other condition resulting in hypothermia RESULTS: Among 8824 patients, we identified four patients with recurrent late-onset PH episodes of 1-26-day duration that occurred 6-46 years after the brain insult.

Reliability of Tidal Volume in Average Volume Assured Pressure Support Mode.

Background: Remote monitoring is increasingly used in patients who receive home mechanical ventilation. The average volume assured pressure support mode is a target volume pressure preset mode that delivers a given tidal volume (V) within a range of controlled inspiratory pressures. In a mode such as this, it is important to verify that the V value retrieved from the ventilator SD card is accurate.

[Pulmonary embolism as a presentation of nephrotic syndrome].

Background: Nephrotic syndrome (NS) in adults is defined by proteinuria>3g/24h or 50mg/kg/d, hypoproteinemia<60g/24h and hypoalbuminemia<30g/L. The final diagnosis is guided by the histopathology evidence when a renal biopsy is possible. The consequences of NS are multiple: high blood pressure, undernutrition, infections and a hypercoagulable state.

Mechanisms of Orthopnea in Stable Obese Subjects.

Background: The present study explored the role of closing volume as a determinant of orthopnea in stable obese subjects. We hypothesized that: (1) increase in closing volume in supine position would be greater in orthopneic than in non-orthopneic subjects, and (2) the relationship of change in closing volume to change in dyspnea with position would be dependent on expiratory flow limitation in the sitting position.

Methods: In stable obese subjects, in sitting and supine positions, we measured the Borg dyspnea score, static lung volumes, expiratory flow limitation during tidal breathing, and single-breath nitrogen expiration test.

[Tumor-bronchial actinomycosis simulating a recurrence of lung cancer 14 years after initial treatment: A case report].

A patient with a history of squamous cell carcinoma of the right upper lung lobe treated 14 years before by concomitant chemo-radiotherapy was referred on account of dyspnea. Bronchial endoscopy revealed complete obstruction of the right main bronchus highly suggestive of a tumor recurrence. However, biopsy samples only showed inflammatory and necrotic tissue with no evidence of malignancy.

Quantitative analysis of acid-base disorders in patients with chronic respiratory failure in stable or unstable respiratory condition.

Background: The Stewart approach theorizes that plasma pH depends on P(aCO₂), the strong ion difference, and the plasma total concentration of non-volatile weak acids (A(tot)). The conventional approach measures standardized base excess, bicarbonate (HCO₃⁻), and the anion gap.

Objective: To describe acid-base disorders with the Stewart approach and the conventional approach in patients with chronic respiratory failure.

Sleep apnea in patients with heart failure: could cardiac resynchronization therapy be the first line treatment?

Adaptive servo-ventilation as well as continuous and bi-level positive airway pressure seems to effectively treat sleep apnea syndrome (SAS) in patients with chronic heart failure (CHF), and to improve left ventricular function. However, no randomized data show a significant impact of ventilation on survival in patients with CHF. By contrast, there is overwhelming evidence that cardiac resynchronization therapy (CRT) improves outcomes in patients with CHF.

[Idiopathic constrictive péricarditis revealed by a massive left pleural effusion].

Introduction: We report a case of constrictive péricarditis initially revealed by a massive left sided pleural effusion.

Case Report: The patient was dyspnoeic without any associated clinical signs. Only cardiac catheterization gave the diagnosis with a characteristic dip-plateau of the right ventricle.

Effect of a noninvasive ventilatory support during exercise of a program in pulmonary rehabilitation in patients with COPD.

Background: Breathlessness is the most common symptom limiting exercise in patients with chronic obstructive pulmonary disease (COPD). Exercise training can improve both exercise tolerance and health status in these patients, intensity of exercise being of key importance. Nevertheless, in these patients extreme breathlessness and/or peripheral muscle fatigue may prevent patients from reaching higher levels of intensity.

[Changes in inspiratory capacity during acute respiratory failure in COPD patients].

Introduction: Inspiratory Capacity (IC), which reflects dynamic pulmonary hyperinflation, correlates with outcome in moderate exacerbation of COPD. Whether this is also true in COPD with acute respiratory failure (ARF) has not been studied.

Methods: A prospective multicenter assessment of IC measurement feasibility, reliability, time-course and relationship to outcome in COPD with ARF was conducted.

[Outcome in COPD patients treated with at-home, long-term, non-invasive ventilation].

Background: The use of domiciliary non-invasive positive pressure ventilation (NIPPV) is still controversial in stable hypercapnic COPD.

Methods: Records of COPD patients who received home NIPPV from 1990 to 2002 either following an acute exacerbation or because of stable hypercapnia were retrospectively reviewed.

Results: Thirty-seven patients receiving long term oxygen therapy for 50 +/- 47 months were included.

[Disseminated actinomycosis].

Introduction: We report the case of a patient suffering from disseminated actinomycosis.

Case Report: A fifty-two year old man, who was both a heavy smoker and an alcoholic, was admitted to hospital with confusion associated with a pseudo-tumoral right upper lobe pneumonia. Brain computed tomography was normal on the day of admission but when repeated fifteen days later four lesions were seen with appearances suspicious of metastatic malignant disease.

[Herpes simplex and Geotrichum candidum pneumonia in a patient with moderate renal failure].

Viral or fungal pneumonia generally occurs in immunocompromised patients. We report a case of hypoxic pneumonia unresponsive to broad-spectrum antibiotic therapy in a patient whose only risk factor for immunodeficiency was mild silent renal failure. The causal association between Herpes simplex and Geotrichum candidum was retained on the basis of endobronchial samples and the favorable course after institution of specific treatment.

Acute effects of hyperoxia on dyspnea in hypoxemia patients with chronic airway obstruction at rest.

Study Objectives: Supplemental oxygen is used in hypoxemic patients with chronic airways obstruction (CAO) because it reduces pulmonary artery pressure and prolongs life. The purpose of this study was to assess at rest the effects of 30% oxygen inhalation on dyspnea, breathing pattern, neuromuscular inspiratory drive based on measurement of mouth occlusion pressure (P(0.1)), and dynamic hyperinflation (DH), as reflected by changes in inspiratory capacity (IC).

[Mediastinal adenopathies and presence of anti-cytoplasmic antibodies of diffuse type polynuclear neutrophils].

We report a case of sarcoidosis with mediastinal and pulmonary localizations associated with diffuse antineutrophil cytoplasmic antibodies (c-ANCA). This led to discuss the differential diagnosis with vascularitis and the specificity of c-ANCA in Wegener's granulocytosis.

[Post-cardiac injury syndrome: an rare cause of pleurisy, value of pleural fluid analysis].

The post-cardiac injury syndrome is an inflammatory process concerning the pericardium, the pleura and/or the pulmonary parenchyma, that develops after different kinds of cardiac aggression. The diagnosis can be evoked when some clinical and biological results are present but remains one of exclusion. We report a case of post-cardiac injury syndrome for which we demonstrate an immunologic involvement of the pleura.