Tumeur d’Abrikossoff à localisation œsophagienne. À propos de deux cas

Granullar cell tumors or Abrikossoff tumors are benign submucosal tumors of neural origin. They represent less than 1% of all soft tissues. Esophageal localization is the most frequent: only 270 cases of granular cell tumors have been reported. Diagnosis is confirmed by histology, which eliminates a possible epidermoid carcinoma. There is no consensus about treatment. However, endoscopic resection is often indicated. We report two cases of Abrikossoff tumors, and discuss their clinical, endoscopic, histologic, and therapeutic characteristics through a review of literature.     

Sevrage difficile d’origine cardiaque

Acute pulmonary oedema is a frequent cause of failure of weaning from mechanical ventilation, especially in patients with underlying left-sided heart disease and associated chronic obstructive pulmonary disease. There are three main factors that can lead to the development of cardiogenic pulmonary oedema during weaning: (1) negative intrathoracic pressure, which leads to an increase in systemic venous return pressure, central blood volume and left ventricular preload, as well as increasing the left ventricular afterload; (2) increase in respiratory rate, leading to an increase in myocardial oxygen demand, which increases the risk of myocardial ischaemia in predisposed patients and (3) intense stimulation of the sympathetic nervous system caused by emotional stress, hypoxaemia, and in some cases, hypercapnia when patients are disconnected from a ventilator. An increase in pulmonary artery occlusion pressure measured during a spontaneous breathing trial using a pulmonary artery catheter can be used to help diagnose weaning-induced pulmonary oedema. Less invasive diagnostic methods have also recently been developed. Thus, during a spontaneous breathing trial, changes in echocardiographic indices of left ventricular function or in B-type natriuretic peptide (BNP) biomarker levels and in plasma protein concentration have been reported to have diagnostic value in weaning-induced pulmonary oedema. It is important to diagnose patients presenting with weaning-induced pulmonary oedema, as appropriate treatment with diuretics and/or vasodilators (e.g. nitrate derivatives), based on the predominant mechanism, can enable successful weaning.     

pH-métrie œsophagienne par capsule Bravo®: faut-il réaliser la pose au cours d’une gastroscopie sous sédation ?

The Bravo® oesophageal pH monitoring system uses a telemetric capsule and allows a recording to be made for a longer period under conditions which are physiologically closer to normal. The objective of this study was to use a retrospective series to assess whether the results were different according to the method employed to place the capsule. Oesophageal pH monitoring with the Bravo® system was carried out in 145 patients. In 85 of these, the nasal or oral route was used without anaesthesia or endoscopy, while the remaining 60 patients had the capsule placed during gastroscopy performed under general anaesthetic. The oral route is better than the nasal, with a failure rate of 35% for the latter. The overall failure rate (failure of the procedure or a recording of less than 48 hours duration) or that associated with placement of the device was the same in both groups. A 48-hour trace was obtained in 123 patients (85%). The diagnostic benefit of the second 24 hours of this recording was 18%, with no significant difference between the two groups. The placement of the device can, therefore, be effected with or without gastroscopy. Results are similar and the choice of technique depends on local expertise and the indication for pH measurement.     

Prise en charge des hépatites fulminantes d’origine toxique en réanimation

Toxin-related liver diseases are a common cause of acute and fulminant liver failure. Numerous substances may be involved. The diagnosis is important because in some cases specific treatment with an antidote is required. Other therapeutic interventions such as supportive measures, liver assist devices and transplantation are discussed.     

Douleurs et césariennes : l’inattendu

This text deals with the experiences of women undergoing cesarean section before anesthesia is effective or with insufficient anesthesia. Though these are isolated cases, they nonetheless require a specific listening to women going through such an experience. Their experience of pain is traumatic and can seriously hinder the connection with the baby born in this context.     

Bilan des masses et ganglions médiastinaux (hors cancer de l’œsophage) : indications respectives de l’échoendoscopie transbronchique et transœsophagienne

Mediastinum is rich in masses and lymph nodes. The histologic diagnostic is often needed: transesophageal and transbronchial have similar results; the use of one of them depends on the localization of the target, the need of a complete evaluation and the ability to perform one technique or the other.     

Prise en charge initiale d’un œdème pulmonaire cardiogénique du sujet agé

Heart failure of the elderly patients is a frequent pathology. It is responsible for recurrent hospitalisations and an important mortality rate. The diagnosis of cardiogenic pulmonary edema may be difficult in elderly patients. Brain Natriuretic Peptide measurement may be useful in this situation. In more than 50% cases, echocardiography will evidence a diastolic heart failure. Medical treatment mainly relies on high doses nitrates. Non-invasive ventilation decreases cardiogenic pulmonary edema-induced morbidity and early mortality. Beside patients’ age, invasive mechanical ventilation may be used when conventional treatment and non-invasive ventilation failed.