A solitary bronchial papilloma with unusual endoscopic presentation: case study and literature review

<p>Abstract</p> <p>Background</p> <p>Solitary endobronchial papillomas (SEP) are rare tumors and most of them are described by case report. A misdiagnosis is common with viral related papillomas. A histopathological classification has recently permitted a major advancement in the understanding of the disease.</p> <p>Case Presentation</p> <p>We report a case of a mixed bronchial papilloma with an unusual endoscopic presentation. The literature was extensively reviewed to ascertain the unusual characteristics of the current case. A 39-year of age male was referred to our institution for the investigation of a slight hemoptysis. Routine examination was normal. A fibroscopy revealed an unusual feature of the right main bronchus. The lesion was a plane, non-bleeding, non-glistering sub-mucosal proliferation. No enhanced coloration was noticed. Biopsies revealed a mixed solitary bronchial papilloma. In situ HPV hybridization was negative. Endoscopic treatment (electrocautery) was effective with no relapse.</p> <p>Conclusion</p> <p>This lesion contrasts with the data of the literature where papilloma were described as wart-like lesions or cauliflower tumors, with symptoms generally related to bronchial obstruction. We advise chest physicians to be cautious with unusually small swollen lesions of the bronchi that may reveal a solitary bronchial papilloma. Endoscopic imaging can significantly contribute to the difficult diagnosis of SEP by pulmonary physicians and endoscopists.</p

Airway and Esophageal Stenting in Patients with Advanced Esophageal Cancer and Pulmonary Involvement

BACKGROUND: Most inoperable patients with esophageal-advanced cancer (EGC) have a poor prognosis. Esophageal stenting, as part of a palliative therapy management has dramatically improved the quality of live of EGC patients. Airway stenting is generally proposed in case of esophageal stent complication, with a high failure rate. The study was conducted to assess the efficacy and safety of scheduled and non-scheduled airway stenting in case of indicated esophageal stenting for EGC. METHODS AND FINDINGS: The study is an observational study conducted in pulmonary and gastroenterology endoscopy units. Consecutive patients with EGC were referred to endoscopy units. We analyzed the outcome of airway stenting in patients with esophageal stent indication admitted in emergency or with a scheduled intervention. Forty-four patients (58+/-\-8 years of age) with esophageal stenting indication were investigated. Seven patients (group 1) were admitted in emergency due to esophageal stent complication in the airway (4 fistulas, 3 cases with malignant infiltration and compression). Airway stenting failed for 5 patients. Thirty-seven remaining patients had a scheduled stenting procedure (group 2): stent was inserted for 13 patients with tracheal or bronchial malignant infiltration, 12 patients with fistulas, and 12 patients with airway extrinsic compression (preventive indication). Stenting the airway was well tolerated. Life-threatening complications were related to group 1. Overall mean survival was 26+/-10 weeks and was significantly shorter in group 1 (6+/-7.6 weeks) than in group 2 (28+/-11 weeks), p<0.001). Scheduled double stenting significantly improved symptoms (95% at day 7) with a low complication rate (13%), and achieved a specific cancer treatment (84%) in most cases. CONCLUSION: Stenting the airway should always be considered in case of esophageal stent indication. A multidisciplinary approach with initial airway evaluation improved prognosis and decreased airways complications related to esophageal stent. Emergency procedures were rarely efficient in our experience

La tuberculose à La Réunion (analyse des données 2008-2009)

POITIERS-BU Médecine pharmacie (861942103) / SudocSudocFranceF

Analyse des broncho-pneumopathies chroniques obstructives chez les patients exposés à la distillation du géranium à l'île de la Réunion (comparaison de populations de patients exposés aux fumées de distillation et ou au tabac)

RENNES1-BU Santé (352382103) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Etude de la sévérité des asthmatiques à l'ile de la Réunion" (aspect clinique et épidémiologique)

Une étude, sur la sévérité des asthmatiques à l'île de la Réunion, a été réalisée à partir d'un échantillon de 253 patients suivis à la consultation d'asthmologie du centre hospitalier départemental de Bellepierre de 1997 à 1999. Le degré de sévérité de l'échantillon étudié a été obtenu en se basant sur les recommandations internationales du Global Initiative for Asthma. Les données recueillies ont été comparées aux résultats de l'étude du CREDES (Centre de Recherche, d'Etude et de Documentation en Economie de la Santé), qui porte sur l'asthme en France selon les stades de sévérité. Il en ressort que l'asthme à la Réunion serait non seulement 2 fois plus fréquente qu'en France métropolitaine, mais également plus grave . Ainsi, la fréquence de l'asthme persistant modéré et sévère à la Réunion serait 2 fois supérieure à celle de l'hexagone, soit 43,9% contre 21%. Cette différence s'expliquerait par une prise en charge globalement médiocre des asthmatiques réunionnais, en terme d'évaluation du degré de sévérité de l'asthme et en terme de pertinence de prescription du traitement de fond. Différents facteurs environnementaux, notamment les facteurs allergologiques comme les acariens et les pollens, sont également proposés comme pouvant favoriser les crises d'asthme en milieu tropical humide. Le profil de l'asthme traité à la Réunion et l'insuffisance de son contrôle, implique une sensibilisation des professionnels de la santé à ce sujet, par la connaissance et surtout l'application rigoureuse des recommandations internationales de prise en charge de l'asthme.GRENOBLE1-BU Médecine pharm. (385162101) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

Radiotherapy for a Phalanx Bone Metastasis of a Lung Adenocarcinoma

Phalanx bone metastasis as the initial presenting sign of lung cancer is a rare presentation. Lung cancer is known to metastasize to the bone, but rarely to the fingers. A 61-year-old male smoker presented with pain in the left ring finger. Severe pain discouraged the patient from using his left hand. An X-ray of the left hand showed a lytic bone lesion. The patient was treated with finger radiotherapy. Analgesics were no longer needed and the patient was able to reuse his left hand in his everyday life. Palliative radiotherapy relieved our patient and improved his quality of life

Clinical Study Distal Airway Impairment in Obese Normoreactive Women

Background. Asthma-like symptoms are frequent in overweight and obesity, but the mechanism is unclear when airway hyperresponsiveness (AHR) is lacking. In this study, we focused on obese women with a clinical suspicion of asthma but negative methacholine challenge and tested distal airway hyperreactivity, explored by Forced Vital Capacity dose-response slope (FVC DRS). Objective. To question AHR at the distal airway level in obese women. Methods. A total of 293 symptomatic obese and nonobese women free of treatment were investigated. Methacholine challenge tests were undertaken, and patients were divided according to their results to the test. In hyperreactive and nonhyperreactive patients and in our total population, correlations, regression analyses, and analyses of covariance were performed to compare distal airway hyperreactivity in three groups of body mass index (BMI). Results. After adjusting for age and baseline respiratory values, the relationship between FVC and FEV1 (forced expiratory volume in one second) DRS was influenced by BMI, with a lower slope in obese than overweight and normal patients in our total population ( = 0.008) and in our nonhyperreactive one ( = 0.028). Conclusion. Distal airway hyperresponsiveness was observed in symptomatic wheezing obese women negative to methacholine challenge

Persistent Arthralgia Associated with Chikungunya Virus: A Study of 88 Adult Patients on Reunion Island

International audienceBackground: An outbreak of chikungunya virus infection occurred on Reunion Island during the period 2005-2006. Persistent arthralgia after chikungunya virus infection has been reported, but few studies have treated this aspect of the disease.Methods: Adult patients with laboratory-confirmed acute chikungunya virus infection who were referred to Groupe Hospitalier Sud Reunion during the period 2005-2006 were asked to participate in the study. Patients were assessed a mean of 18 months after acute disease occurred. Assessment consisted of answering questions on a standard form, undergoing a medical examination, and being tested for the presence of IgM antibodies to chikungunya virus.Results: Eighty-eight patients (mean age, 58.3 years; male-to-female ratio, 1.1:1.0) were included in this study. Fifty-eight patients (65.9%) had been hospitalized for acute chikungunya virus infection, and a history of arthralgia before chikungunya virus infection was reported by 39 patients (44%). Fifty-six patients (63.6%) reported persistent arthralgia related to chikungunya virus infection, and in almost one-half of the patients, the joint pain had a negative impact on everyday activities. Arthralgia was polyarticular in all cases, and pain was continuous in 31 patients (55.4%). Overall, 35 patients (39.7%) had test results positive for IgM antibodies to chikungunya virus.Conclusions: Persistent and disabling arthralgia was a frequent concern in this cohort of patients who had experienced severe chikungunya virus infection approximately 18 months earlier. Further studies are needed to evaluate the prevalence of persistent arthralgia in the general population to determine the real burden of the disease