Positive Effect of Teriparatide on Areal Bone Mineral Density in Young Women with Anorexia Nervosa: A Pilot Study.

The present pilot study investigated the effect of Teriparatide 1-34 rh-PTH (TPT) in young women diagnosed with anorexia nervosa (AN), and markedly compromised Bone Mineral Density (BMD). Patients were included who had (i) very low BMD (defined as Z-Score <  - 2.5 or T-Score <  - 2.

Assessment of Muscle Function and Physical Performance in Daily Clinical Practice : A position paper endorsed by the European Society for Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO).

It is well recognized that poor muscle function and poor physical performance are strong predictors of clinically relevant adverse events in older people. Given the large number of approaches to measure muscle function and physical performance, clinicians often struggle to choose a tool that is appropriate and validated for the population of older people they deal with. In this paper, an overview of different methods available and applicable in clinical settings is proposed.

New insights and improved strategies for the management of primary spontaneous pneumothorax.

The pathophysiology and management of primary spontaneous pneumothorax (PSP) are a subject of debate. Despite advances in the understanding of its etiopathogenesis and improvements in its management, implementation in clinical practice is suboptimal. In this manuscript, we review the recent literature with a focus on PSP pathophysiology and management.

Feasibility, acceptability and effectiveness of integrated care for COPD patients: a mixed methods evaluation of a pilot community-based programme.

Question Under Study: The aim of this study was to assess the feasibility, acceptability and effectiveness of a pilot COPD integrated care programme implemented in Valais, Switzerland.

Methods: The programme was adapted from the self-management programme Living Well with COPD, and included the following elements: self-management patient-education group sessions, telephone and medical follow-ups, multidisciplinary teams, training of healthcare professionals, and evidence-based COPD care. A process and outcome evaluation of the pilot phase of the programme was conducted by means of qualitative and quantitative methods.

Spontaneous pneumothorax: time to rethink management?

There are substantial differences in international guidelines for the management of pneumothorax and much geographical variation in clinical practice. These discrepancies have, in part, been driven by a paucity of high-quality evidence. Advances in diagnostic techniques have increasingly allowed the identification of lung abnormalities in patients previously labelled as having primary spontaneous pneumothorax, a group in whom recommended management differs from those with clinically apparent lung disease.

ERS task force statement: diagnosis and treatment of primary spontaneous pneumothorax.

Primary spontaneous pneumothorax (PSP) affects young healthy people with a significant recurrence rate. Recent advances in treatment have been variably implemented in clinical practice. This statement reviews the latest developments and concepts to improve clinical management and stimulate further research.

Sleep fragmentation and sleep-disordered breathing in individuals living close to main roads: results from a population-based study.

Background: Nighttime traffic noise is associated with sleep disturbances, but sleep fragmentation and sleep-disordered breathing (SDB) have not been demonstrated in individuals living near busy roads.

Methods: We asked 1383 participants to answer a health questionnaire and to undergo 24-h electrocardiogram (ECG). Nocturnal ECG records were used to calculate the very low frequency index (VLFI) interval, a surrogate marker of sleep fragmentation.

Primary malignant achromic melanoma of the lung.

Currently, less than thirty cases of primary malignant melanoma of the lung have been reported in the literature. Thus, strict criteria for diagnosis have been published and include: malignant melanoma associated with bronchial epithelial changes; a solitary lung tumor; no prior history of skin, mucous membrane, intestinal or ocular melanoma; and absence of any other detectable tumor at the time of diagnosis. In this article we present a case of melanoma of the lung without evidence of extra-pulmonary disease.

[Health promotion from the 20th to the 21th century. The Valais Ligue for fighting tuberculosis--a visionary model started in 1951].

At the beginning of the twentieth century, tuberculosis was really a plague. Many people had been mobilised to successfully fight against this infectious disease. Valais, a Swiss alpine canton developped then an original concept of health promotion by involving all the health partners including a specialised hospital under the auspices of the local Health Departement.

[Pulmonary fibrosis and emphysema].

We report a case of combined pulmonary fibrosis and emphysema. This syndrome, including upper-lobe emphysema and pulmonary fibrosis of the lower lung was recently described in smokers or ex-smokers (mean age: 65 years). Exertional dyspnea is always present.

[Cystic fibrosis, a paradigm for modern medicine].

Cystic fibrosis is the most frequent and severe genetic disorder in caucasian children. It is a multisystemic disease progressively involving many organs. Patients' survival was poor most of them dying as children.

[Foreign bodies and hemoptysis: about danger of ingesting blister-wrapped tablets].

A case of hemoptysis may be challenging for clinicians because of the many etiologies involved in this differential diagnosis. Sometimes the cause of this symptom may be very surprising. We present a case of hemoptysis due to ingestion of a blister.

[Medical thoracoscopy].

Medical thoracoscopy (MT) remains a mini-invasive and very efficient technique to diagnose pleural diseases. In case of pleural effusion of unknown etiology its diagnostic yield is higher than 90%. MT also allows to perform cheap and successful pleurodesis by simple talc insufflation in case of recurring pneumothorax and invalidating malignant pleural effusion with very poor quality of life despite repeated thoracocentes.

[Endobronchic palliative brachytherapy].

Brachytherapy, the placement of an encapsuled radioactive source (Iridium) in or near a tumor, is a palliative therapeutic modality available for patients suffering of a bronchogenic cancer, especially if they present invalidating symptoms such an incoercible cough, haemoptysis, dyspnea. The treatment modality is indicated if chemotherapy or external irradiation are not possible. It is typically a team work.

[Referring to an unusual case: pulmonary affection and rheumatoid arthritis].

We report the case of a 60 year female patient suffering from rheumatoid arthritis for the last 25 years, under TNF-blocker and leflunomide, affected by a recurrent pneumothorax with several subpleural nodules, basal bronchiectasis and apical bullous emphysema. The patient was administered several treatments: aspiration, talc pleurodesis, surgical pleurodesis, pleurodesis induced by tetracycline and autologous blood. To allow the pleural inflammatory reaction necessary to the success of the pleurodesis, we had to interrupt the treatment by TNF-blocker and leflunomide.

[Progress in bronchoscopy: ultrasound guided fine-needle aspiration (EBUS-TBNA)].

In case of lung cancer, evaluation of the extension disease is mandatory. Mediastinal nodes must also be evaluated: if a controlateral to the tumor node is metastatic (N3), surgery is no more indicated. As specificity of PET-CT scan is not satisfaying (78%), cytology or histology of a suspect node is necessary.

[Continuous positive airway pressure : a therapy for life].

The treatment by continuous positive airway pressure (CPAP) corresponds to the application of a pneumatic splint to remove the collapses of the air routes higher at the origin of the apnea during the sleep. The CPAP is transmitted to the patient by means of an interface. The effectiveness of the device is recognized in the treatment of symptomatic sleep apnea syndrome (SAS) with the disappearance of diurnal sleepiness.

[Bochdalek hernia: a rare cause of dyspnea and abdominal pain in adults].

We present here a case of a sixty year old man with a symptomatic hernia of Bochdalek. Its diagnostic was long to be established because this type of congenital diaphragmatic hernia is rare and mainly occurs in neonates. However when looking at a patient with dyspnea and lasting atypical abdominal pain, such a diagnosis has to be looked for, even if such a clinical entity is extremely rare in adults.

[Bronchopleural fistula: a serious complication after thoracic surgery].

Postsurgical bronchopleural fistula (BPF) is a serious complication accompanied with a high mortality, requiring early and correct diagnosis. The acute form of BPF is usually a technical failure of the surgical stump requiring an immediate surgical reoperation. The subacute or chronic BPF is more difficult to diagnose because of non specific symptoms.

[Pulmonary rehabilitation: a multidisciplinary and comprehensive intervention].

Pulmonary rehabilitation is an evidence-based, multidisciplinary and comprehensive intervention for chronic pulmonary diseases, adressed to symptomatic patients and to patients with impairment of activities of daily life. The major outcomes of this intervention are an increased exercise capacity, a decrease in dyspnea and thereby a better quality of life. Underweight patients may benefit from a caloric and protein supplementation.

Titrated sedation with propofol or midazolam for flexible bronchoscopy: a randomised trial.

In this study, we questioned whether propofol provided clinical benefits compared with midazolam in terms of neuropsychometric recovery, safety profile and patient tolerance. Patients, aged >18 yrs, were randomised to receive midazolam or propofol, given by non-anaesthetist physicians to achieve moderate levels of sedation as assessed by the electroencephalographic bispectral index (BIS; between 70 and 85). The primary end-point was the time delay until recovery of the BIS above 90.

Sleep apnea syndrome: improved detection of respiratory events and cortical arousals using oxymetry pulse wave amplitude during polysomnography.

Respiratory events (RE) during sleep induce cortical arousals (A) and marked changes in autonomic markers in sleep apnea syndrome (SAS). The aims of the study were double. First, we assessed whether pulse wave amplitude (PWA) added to polysomnography (PSG) could improve RE and A detection; second, we wanted to know whether the quality of detection of these two parameters could be improved using PWA.