Mycobactériose pulmonaire à Mycobacterium xenopi: sensibilité "in vitro" aux antituberculeux classiques et évolution clinique

Out of 11 patients suffering from Mycobacterium xenopi lung disease, 9 were treated with an empiric antituberculous triple chemotherapy until specific identification and antibiogram were available. Despite the important "in vitro" resistance to drugs, most of the patients improved; in the other patients, the impairment was always due to the underlying pathology. We conclude that the "in vivo" response of M. xenopi infections to antituberculous drugs is little influenced by the "in vitro" sensitivity

[Pulmonary infection due to Mycobacterium xenopi - In vitro sensitivity to classical antituberculotic drugs and clinical development]

Out of 11 patients suffering from Mycobacterium xenopi lung disease, 9 were treated with an empiric antituberculous triple chemotherapy until specific identification and antibiogram were available. Despite the important ''in vitro'' resistance to drugs, most of the patients improved; in the other patients, the impairment was always due to the underlying pathology. We conclude that the ''in vivo'' response of M. xenopi infections to antituberculous drugs is little influenced by the ''in vitro'' sensitivity

[Endoscopic treatment of post-intubation tracheal stenosis. A review of 58 cases.]

Over a period of 6 years, 58 patients aged between 55+/-16 years have been treated for post-intubation tracheal stenosis (STPI). These patients were characterised by their frequency of an underlying respiratory or cardiac failure, a duration of intubation which was sometimes short and a delay between the extubation and the detection of stenosis Which was less than one month in about one half of the cases. Thirty of the 58 patients presented with respiratory distress on admission. All the stenoses were treated initially by mechanical dilatation using a rigid bronchoscope. Radial incisions using an Nd-Yag laser were performed when necessary to facilitate the dilatation. The great majority of stenoses which were not fitted up with a tracheal endoprosthesis (EPT) at the first attempt recurred leading to repeated therapeutic bronchoscopies (221 sessions in all). Fitting an EPT (Dumon prosthesis) was necessary in 35 cases on 12 occasions at the first attempt with the first bronchoscopy, and 23 times following a recurrence. Amongst the recurring stenoses a stabilisation was obtained at the price of repeated dilatations (4.3 sessions on average in only nine patients). Seven patients finally had a surgical resection and anastamosis of the trachea, of whom four had a transitory instillation of an EPT for the stenosis. The removal of the EPT was later attempted in 11 patients. Four did not present with any symptomatic recurrence. The secondary migration of the EPT is in practice one of the main inconveniences of the silicon prosthesis (8 cases now experienced). Our approach, which used to favour the mechanical dilatation has lead to a relatively high number of failures and thus to repeated bronchoscopies. This has lend us to re-define our therapeutic approach. The current schema which we propose is in the course of being validated in which we use EPT and surgical repair of the trachea more often. Only short stenoses (less than 1 cm) with a diaphragm are treated by dilatation and laser. The others are fitted initially with an EPT. The final management is guided by the progress in the stenosis, the tolerance of the endoprosthesis and the operability of the patients

Acute Cardiogenic Pulmonary-edema and Pregnancy - a 10-year Experience

We reviewed the cardiac emergencies that occurred during or soon after pregnancy and required admission in an intensive care unit. The study sample consisted of 22248 pregnant women representing the whole obstetrical population collected from 3 hospitals over a ten-year period. Among the 88 patients admitted to our ICU during this decade, only 5 suffered from a specific cardiac disorder. Acute pulmonary edema was the common clinical presentation in the 4 cases reported. Despite the severity of cardiac involvement on admission none had previous evidence of heart disease that could have heralded acute left ventricular failure. From these observations it can be concluded that preexisting cardiovascular disease and circulatory changes related to pregnancy should no longer be regarded as the unique contributors to the development of severe heart failure during pregnancy