Place du dépistage du syndrome des apnées du sommeil avant une chirurgie bariatrique (incidence sur la prise en charge péri-opératoire)

L'obésité, définie par un indice de masse corporelle supérieur (IMC) à 30 kg/m2, est devenue un problème de santé publique. En France 15 % de la population est obèse et 1,1 % est porteuse d'une obésité massive. Le retentissement médico-économique est important en termes d'arrêts maladies, de comorbidités et de mortalité induites. La chirurgie bariatrique est le traitement qui s'est révélé être le plus efficace sur la perte de poids notable et durable. Elle est indiquée par la Haute Autorité de Santé pour un IMC supérieur à 40 kg/m2 ou à 35 kg/m2 en cas de comorbidités associées. La pratique de la chirurgie bariatrique pose la question du bénéfice-risque intégrant la prise en charge des comorbidités. Le syndrome des apnées hypopnées obstructives du sommeil (SAROS), dont le premier facteur de risque est l'obésité, doit être recherché et pris en charge avant la chirurgie au risque d'augmenter les complications péri-opératoires. En revanche il n'existe pas de consensus national ou international quand aux moyens de dépistage et de diagnostic du SAHOS, qu'il s'agisse des scores cliniques ou du type d'exploration polygraphique. Objectifs de l'étude : Nous avons étudié la prévalence du SAHOS dans la population bariatrique du CHU de Rouen. Puis nous avons recherché des facteurs prédictifs cliniques, gazométriques et fonctionnels respiratoires du SAHOS sévère. Enfin nous avons étudié les répercussions de la perte de poids consécutive de la chirurgie bariatrique sur le SAHOS. Méthodes : Dans cette étude monocentrique rétrospective de cohorte, nous avons réalisé un score d'Epworth, des mesures morphométriques, une impédancemétrie et une polygraphie ventilatoire chez les patients qui ont consulté de mai 2009 à mai 2010 en pneumologie pour le bilan préopératoire d'une chirurgie bariatrique. Nous avons ensuite suivi les patients pendant 18 mois. Résultats : 198 patients ont été inclus dans l'étude. Les patients avaient en moyenne 37 ans, un IMC de 45 kg/m2, une obésité de type androïde et 92 % étaient des femmes. Les explorations fonctionnelles respiratoires et les gaz du sang étaient majoritairement normaux. Le score d'Epworth moyen était de 6/24 et 55 % des polygraphies ventilatoires étaient anormales. Dans 14,6 % des cas un SAHOS sévère a été retrouvé dont 89 % nouvellement diagnostiqué. Nous avons développé un score clinique, le score EPAIS, prédictif du SAHOS sévère basé sur le sexe masculin, le périmètre ombilical > 133 cm, l'âge > 37 ans, le score d'Epworth > 10/24, l'iMC > 47 kg/m2. Un score > 2/5 était prédictif d'un SAHOS sévère (sensibilité - 84%; spécificité = 71%). A 7 mois de la chirurgie, 81 % des patients porteurs d'un SAHOS ventilé ont pu être désappareillé. La perte d'excès de poids était alors de 49 % et l'index apnées hypopnées (IAH) médian de 4/h. Discussion et conclusion: La recherche d'un SAHOS est indispensable avant une chirurgie bariatrique. Un score clinique EPAIS > 2/5 pourrait permettre de détecter les patients à haut risque de SAHOS sévère et de sursoir à l'oxymétrie nocturne. La polygraphie ventilatoire reste nécessaire en cas de score [PAIS > 2/5 ou d'oxymétrie nocturne pathologique. La perte de poids induite par la chirurgie bariatrique est associée à une réduction significative de l'IAH et permet de guérir dans la majorité des cas un SAHOS sévère 6 mois après la chirurgie.ROUEN-BU Médecine-Pharmacie (765402102) / SudocSudocFranceF

Therapeutic Drug Monitoring of Sputum Voriconazole in Pulmonary Aspergillosis

Voriconazole is one of the most used antifungal azoles against pulmonary aspergillosis. Therapeutic drug monitoring (TDM) of the voriconazole concentration in plasma is recommended in clinical practice guidelines to prevent treatment failure and toxicity. The aim of this study was to evaluate the feasibility and utility of TDM of the voriconazole concentration in the sputum of patients treated for pulmonary aspergillosis. Fifty sputum and 31 plasma samples were analysed with high-performance tandem mass spectrometry (HPLC-MS/MS) in 24 patients included in the study. The voriconazole concentration was simultaneously assessed in the plasma and sputum in 22 samples. The correlation between the sputum and plasma levels was estimated with a univariate linear regression model, and the observed R2 was 0.86. We determined the following equation, Csputum = 0.45 (Cplasma) + 0.21, which could predict the voriconazole concentration in plasma from sputum. TDM of the voriconazole concentration in sputum is an easy, non-invasive and accurate method with which to evaluate voriconazole exposure in patients with pulmonary aspergillosis

Hypnosis associated with 3D immersive virtual reality technology during bronchoscopy under local anesthesia

Patients undergoing flexible bronchoscopy under local anesthesia usually experience anxiety before and during the procedure. Different non-pharmacological techniques, including music and hypnosis, are used to distract patients' attention, and to reduce anxiety. The new technique "virtual reality hypnosis (VRH)", defined as a hypnotic induction suggestion delivered by personalized virtual reality software, can generate a simulation of a lifelike environment. No study has described the use of VRH during bronchoscopy. The objective is to investigate the anxiety reducing effect and the satisfaction of patients, physicians, and nurses using VRH during bronchoscopy

Crizotinib-induced osteitis mimicking bone metastasis in a stage IV ALK-rearranged NSCLC patient: a case report

International audienceBACKGROUND:Targeted therapies are a standard of care for first-line treatment of Anaplastic lymphoma kinase (ALK)-rearranged non small cell lung cancer (NSCLC). Giving the rapid pace of drug discovery and development in this area, reporting of adverse effects of ALK inhibitors is crucial. Here, we report a case of osteitis induced by an ALK inhibitor mimicking bone metastasis, a previously undescribed side effect of crizotinib.CASE PRESENTATION:A 31-year-old woman with stage IV ALK-rearranged NSCLC presented with back pain after 3 months of crizotinib treatment. Diagnostic work-up showed osteitis on the 4th and 5th thoracic vertebrae, anterior soft tissue infiltration and epiduritis, without any sign of infection. Spinal cord decompression, histological removal and osteosynthesis were performed. Histologic examination showed necrosis with abundant peripheral neutrophils, no microorganism nor malignant cell. Symptoms and Computarized Tomography-abnormalities rapidly diseappeared after crizotinib withdrawal and did not recur after ceritinib onset.CONCLUSIONS:This is the first report of crizotinib-induced osteitis. Crizotinib differs from other ALK inhibitors as it targets other kinases as well, which may have been responsible for the osteitis. Crizotinib can induce rapidly extensive osteitis, which can mimic tumor progression

Amikacin Liposomal Inhalation Suspension in the Treatment of Mycobacterium abscessus Lung Infection: A French Observational Experience

International audienceBackground Mycobacterium abscessus infections remain difficult to manage in both cystic fibrosis (CF) and non-CF patients and reported clinical outcomes are largely unsatisfactory. Clinical trial data are limited and no approved therapies are currently available for the management of M abscessus lung diseases. As an alternative, cohort studies may provide insightful information into the management of M abscessus pulmonary disease.Methods Based on a retrospective observational cohort study, we investigated the safety and efficacy of amikacin liposome inhaled suspension (ALIS) as an adjunct to a standard antibiotic regimen for M abscessus lung infection in both CF and non-CF patients. We also assessed the association of patient drug compliance with culture conversion and clinical outcomes.Results Twenty-six patients had long-term follow-up data available. Culture conversion was achieved in 54% (14/26) of the patients with no difference between CF and non-CF patients after an average treatment duration of 10 months. Patient treatment compliance was significantly better in the converter group compared to nonconverters with an odds ratio of 44.78 associated with good compared to poor patient compliance. Overall, 9 patients (35%) experienced an adverse event that led to treatment discontinuation.Conclusions ALIS appears beneficial in both CF and non-CF populations with M abscessus lung disease

Similarities and differences of interstitial lung disease associated with pathogenic variants in SFTPC and ABCA3 in adults

International audienceAbstract Background and Objective Variants in surfactant genes SFTPC or ABCA3 are responsible for interstitial lung disease (ILD) in children and adults, with few studies in adults. Methods We conducted a multicentre retrospective study of all consecutive adult patients diagnosed with ILD associated with variants in SFTPC or ABCA3 in the French rare pulmonary diseases network, OrphaLung. Variants and chest computed tomography (CT) features were centrally reviewed. Results We included 36 patients (median age: 34 years, 20 males), 22 in the SFTPC group and 14 in the ABCA3 group. Clinical characteristics were similar between groups. Baseline median FVC was 59% ([52–72]) and DLco was 44% ([35–50]). An unclassifiable pattern of fibrosing ILD was the most frequent on chest CT, found in 85% of patients, however with a distinct phenotype with ground‐glass opacities and/or cysts. Nonspecific interstitial pneumonia and usual interstitial pneumonia were the most common histological patterns in the ABCA3 group and in the SFTPC group, respectively. Annually, FVC and DL CO declined by 1.87% and 2.43% in the SFTPC group, respectively, and by 0.72% and 0.95% in the ABCA3 group, respectively (FVC, p = 0.014 and DL CO , p = 0.004 for comparison between groups). Median time to death or lung transplantation was 10 years in the SFTPC group and was not reached at the end of follow‐up in the ABCA3 group. Conclusion SFTPC and ABCA3 ‐associated ILD present with a distinct phenotype and prognosis. A radiologic pattern of fibrosing ILD with ground‐glass opacities and/or cysts is frequently found in these rare conditions

Phenotypic characterization of interstitial lung disease associated with mutations inSFTPC and ABCA3 in adults

International audienceIntroduction: Mutations in surfactant genes SFTPC or ABCA3 are responsible for interstitial lung disease (ILD) in children and adults. Despite numerous paediatric data, few studies described these entities in adults.Methods: We conducted a multicenter retrospective study of adult patients with ILD associated with mutations in SFTPC or ABCA3 in the French rare pulmonary diseases network OrphaLung.Results: We included 36 patients, 22 in the SFTPC group and 14 in the ABCA3 group. Clinical characteristics were similar between the two groups. Baseline pulmonary function tests reported a median FVC of 59% ([52 – 72]%), a median FEV1 of 63% ([48,3 – 73,3] %), a median TLC of 65 % ([59 – 76] %) and a median DLco of 44 % ([35,4 – 50] %). A pattern of unclassifiable fibrosing ILD was the most frequent on chest computed tomography, found in 85% of patients. Nonspecific interstitial pneumonia and usual interstitial pneumonia were the most common histological patterns in the ABCA3 group and in the SFTPC group, respectively. Median survival before death or lung transplantation was 10 years in the SFTPC group (4 deaths and 8 patients with lung transplantation) and was not reached at the end of follow-up in the ABCA3 group (1 death and 2 patients with lung transplantation).Conclusion: Patients with ILD and mutations in SFTPC or ABCA3 present a distinct phenotype of unclassifiable fibrosing ILD with cysts and ground glass opacities, and their prognosis is often severe. While our results highlight the phenotypical heterogeneity of these patients, they also expand our knowledge of these rare causes of ILD in adult

Phenotypic characterization of interstitial lung disease associated with mutations inSFTPC and ABCA3 in adults

International audienceIntroduction: Mutations in surfactant genes SFTPC or ABCA3 are responsible for interstitial lung disease (ILD) in children and adults. Despite numerous paediatric data, few studies described these entities in adults.Methods: We conducted a multicenter retrospective study of adult patients with ILD associated with mutations in SFTPC or ABCA3 in the French rare pulmonary diseases network OrphaLung.Results: We included 36 patients, 22 in the SFTPC group and 14 in the ABCA3 group. Clinical characteristics were similar between the two groups. Baseline pulmonary function tests reported a median FVC of 59% ([52 – 72]%), a median FEV1 of 63% ([48,3 – 73,3] %), a median TLC of 65 % ([59 – 76] %) and a median DLco of 44 % ([35,4 – 50] %). A pattern of unclassifiable fibrosing ILD was the most frequent on chest computed tomography, found in 85% of patients. Nonspecific interstitial pneumonia and usual interstitial pneumonia were the most common histological patterns in the ABCA3 group and in the SFTPC group, respectively. Median survival before death or lung transplantation was 10 years in the SFTPC group (4 deaths and 8 patients with lung transplantation) and was not reached at the end of follow-up in the ABCA3 group (1 death and 2 patients with lung transplantation).Conclusion: Patients with ILD and mutations in SFTPC or ABCA3 present a distinct phenotype of unclassifiable fibrosing ILD with cysts and ground glass opacities, and their prognosis is often severe. While our results highlight the phenotypical heterogeneity of these patients, they also expand our knowledge of these rare causes of ILD in adult

Phenotypic characterization of interstitial lung disease associated with mutations inSFTPC and ABCA3 in adults

International audienceIntroduction: Mutations in surfactant genes SFTPC or ABCA3 are responsible for interstitial lung disease (ILD) in children and adults. Despite numerous paediatric data, few studies described these entities in adults.Methods: We conducted a multicenter retrospective study of adult patients with ILD associated with mutations in SFTPC or ABCA3 in the French rare pulmonary diseases network OrphaLung.Results: We included 36 patients, 22 in the SFTPC group and 14 in the ABCA3 group. Clinical characteristics were similar between the two groups. Baseline pulmonary function tests reported a median FVC of 59% ([52 – 72]%), a median FEV1 of 63% ([48,3 – 73,3] %), a median TLC of 65 % ([59 – 76] %) and a median DLco of 44 % ([35,4 – 50] %). A pattern of unclassifiable fibrosing ILD was the most frequent on chest computed tomography, found in 85% of patients. Nonspecific interstitial pneumonia and usual interstitial pneumonia were the most common histological patterns in the ABCA3 group and in the SFTPC group, respectively. Median survival before death or lung transplantation was 10 years in the SFTPC group (4 deaths and 8 patients with lung transplantation) and was not reached at the end of follow-up in the ABCA3 group (1 death and 2 patients with lung transplantation).Conclusion: Patients with ILD and mutations in SFTPC or ABCA3 present a distinct phenotype of unclassifiable fibrosing ILD with cysts and ground glass opacities, and their prognosis is often severe. While our results highlight the phenotypical heterogeneity of these patients, they also expand our knowledge of these rare causes of ILD in adult

Phenotypic characterization of interstitial lung disease associated with mutations inSFTPC and ABCA3 in adults

International audienceIntroduction: Mutations in surfactant genes SFTPC or ABCA3 are responsible for interstitial lung disease (ILD) in children and adults. Despite numerous paediatric data, few studies described these entities in adults.Methods: We conducted a multicenter retrospective study of adult patients with ILD associated with mutations in SFTPC or ABCA3 in the French rare pulmonary diseases network OrphaLung.Results: We included 36 patients, 22 in the SFTPC group and 14 in the ABCA3 group. Clinical characteristics were similar between the two groups. Baseline pulmonary function tests reported a median FVC of 59% ([52 – 72]%), a median FEV1 of 63% ([48,3 – 73,3] %), a median TLC of 65 % ([59 – 76] %) and a median DLco of 44 % ([35,4 – 50] %). A pattern of unclassifiable fibrosing ILD was the most frequent on chest computed tomography, found in 85% of patients. Nonspecific interstitial pneumonia and usual interstitial pneumonia were the most common histological patterns in the ABCA3 group and in the SFTPC group, respectively. Median survival before death or lung transplantation was 10 years in the SFTPC group (4 deaths and 8 patients with lung transplantation) and was not reached at the end of follow-up in the ABCA3 group (1 death and 2 patients with lung transplantation).Conclusion: Patients with ILD and mutations in SFTPC or ABCA3 present a distinct phenotype of unclassifiable fibrosing ILD with cysts and ground glass opacities, and their prognosis is often severe. While our results highlight the phenotypical heterogeneity of these patients, they also expand our knowledge of these rare causes of ILD in adult