The Chicago classification for achalasia in a French multicentric cohort

Background

Achalasia is divided into 3 subtypes using the Chicago classification for high-resolution manometry. Aim of this study was to apply this classification to a multicentric French cohort of achalasia and to compare clinical and manometric characteristics between the 3 subtypes.

Methods

Oesophageal symptoms were collected in a retrospective study of patients diagnosed with achalasia on high-resolution manometry. Manometry data were analyzed with oesophago–gastric junction resting and relaxation pressures, and upper oesophageal sphincter resting pressure. Achalasia was classified according to the Chicago classification.

Results

From 2007 to August 2011, achalasia was diagnosed in 169 patients, 14% classified as type I, 70% as type II and 16% as type III. Type III patients were older than types I and II (62 years vs. 52, p = 0.03). Ninety five percent of patients complained of dysphagia, 16% of chest pain (no difference between the 3 subtypes); 50% of type I patients presented regurgitations compared to 33% of type II and 22% of type III (p = 0.10). Oesophago–gastric junction and upper oesophageal sphincter pressures did not differ between the 3 groups.

Conclusion

Type II was the more prevalent subtype of achalasia in this French multicentre cohort. The older age of patients with type III achalasia suggests a different pathophysiology.     

Fibrose rétropéritonéale idiopathique : évolution à long terme du pronostic rénal dans une série rétrospective multicentrique de 30 cas

Purpose

Idiopathic retroperitoneal fibrosis (IRF) is an inflammatory disorder, affecting the aorta and the surrounding vessels and tissues. The prognosis is mainly driven by the risks of chronic kidney disease and relapse. Our aim was to assess the prevalence of chronic kidney disease at follow-up.

Methods

We retrospectively reviewed the medical records of patients diagnosed for IRF in Seine-Saint-Denis (France) between 1987 and 2011. We collected informations about presentation, radiologic findings and follow-up. Diagnosis of IRF was confirmed when all the following criteria were met: infiltration of the infrarenal aorta or iliac vessels, absence of aneurysmal dilation, lack of clinical suspicion of malignancy.

Results

Thirty patients were identified, with a male/female ratio of 4.9. Mean age was 55 ± 13 years old. The mean creatinine clearance was 66 mL/min/1.73 m² and the mean CRP was 45 ± 36 mg/L. In 24 (80%) patients, the location of IRF was periaortic and periiliac. Eleven patients (37%) underwent a diagnostic biopsy, and 14 (47%) required an ureteral procedure. A mean follow-up of 63 months was available for 29 patients: 69% relapsed, 7 developed chronic renal disease (24%), and one died of urinary sepsis. Older age (P = 0.023), diabetes (P = 0.007), and initial renal insufficiency (P = 0.05) were associated with a risk of chronic renal insufficiency.

Conclusion

The high frequency of relapses and chronic renal disease emphasizes the need of close follow-up in patients diagnosed with IRF.     

The glider balloon: A useful device for the treatment of bifurcation lesions

Background

Final kissing balloon dilatation (FKBD) is a recommended final step in case of treatment of bifurcation lesions by two stents approaches. Furthermore, dilatation of the side branch (SB) may be necessary following main vessel (MV) stenting. Occasionally, recrossing the stent struts with a balloon is hampered because the tip hits a stent strut.

Methods

The Glider (TriReme Medical, Pleasanton, CA) is a dedicated balloon designed for crossing through struts of deployed stents toward a SB. From October 2010 to January 2012, FKBD was attempted in 236 consecutive bifurcation lesions treated in our Institution. FKBD was successfully performed by conventional balloon catheters in 221 (93.5%) lesions (Conventional group). In the remaining 15 (6.5%) lesions, where a conventional balloon failed to cross the stent strut, the Glider balloon was attempted (Glider group).

Results

The angle beta (between the axis of the MV after the branch point and the SB axis at the point of divergence) was wider in the Glider group (83 ± 17° versus 65 ± 27°; p = 0.032). A trend toward an higher rate of the true bifurcation lesions was observed in the Glider group (93% versus 70.5%; p = 0.07). The Glider balloon successfully crossed through MV stent struts toward a SB in 12 patients (80%), whereas failed in the remaining 3 patients.

Conclusions

The Glider balloon represents an unique bail-out device which offers an effective rescue strategy for recrossing stent struts during complex bifurcation stenting.     

Capacidad diagnóstica del antígeno carcinoembrionario

Introduction

There is little information on the oncologic diagnostic accuracy of carcinoembryonic antigen (CEA) levels more than 3-fold above normal.

Objetives

To determine the prevalence of underlying cancer in patients with mild CEA elevation and the mean cost per patient of CEA determination.

Methods

A retrospective study was carried out in all patients with CEA elevation (3-10 ng/ml) and suspicion of cancer referred to the gastroenterology or internal medicine outpatient units from 2001 to 2007.

Results

We studied 100 patients (60 men and 40 women), with a mean age of 67.4 ± 14.2 years and baseline CEA of 5.8 ± 1.7 ng/ml. The most important symptoms and signs were laboratory abnormalities (19 patients [19%]). Cancer was diagnosed in 4 patients (one gastric, 2 lung and one colon). Among patients without malignancies, 49 patients (49%) had no related processes, and 47 (47%) had benign diseases. During follow-up, one laryngeal cancer, one acute myeloid leukemia, and one colon cancer were detected (54.3 ± 24.6 months). We found no differences between baseline CEA levels in patients with and without cancer (6.6 ± 2.4 vs. 5.8 ± 1.7 ng/ml, p = 0.2). The mean cost per patient was 503.6 ± 257.6 €.

Conclusions

Cancer was detected in a small proportion (7%) of patients with mild CEA elevation. The study of these patients is directly and indirectly associated with a not inconsiderable cost.     

Factores predictores de recanalización arterial en pacientes con hemoptisis amenazante que requieren embolización arterial

Introduction

Artery embolization (AE) is a safe and useful procedure in the management of massive hemoptysis. The objective of our study was to describe the experience of AE in a tertiary referral center, to characterize angiographic findings at the time of recurrence, and to analyze factors associated with these findings.

Material and methods

Observational retrospective study of patients presenting with life-threatening hemoptysis. All consecutive patients with at least one episode of hemoptysis that required AE during a 13-year period were included. The effects of i) time to recurrence; ii) use of coils, and iii) number of arteries embolized on the likelihood that the recurrence was secondary to recanalization were assessed.

Results

One hundred seventy-six patients were included in the study. Twenty-two patients (12.5%) died due to hemoptysis. Probability of recurrence-free survival at one month was 0.91 (95% CI: 0.87 to 0.95), at 12 months was 0.85 (95% CI: 0.79 to 0.91), and after 3 years was 0.75 (95% CI: 0.66 to 0.83). A longer time to recurrence was associated with a higher probability that the hemorrhage affected the same artery (estimate = 0.0157, z-value = 2.41, p-value = 0.016).

Conclusion

AE is a safe and useful technique in the management of massive and recurrent hemoptysis. Nevertheless, recurrence after embolization is not uncommon. Recurring hemoptysis due to recanalization is related to time to recurrence, but not to the use of coils or number of arteries embolized.     

Características clínicas y pronóstico de la neumonía adquirida en la comunidad causada por Staphylococcus aureus resistente a la meticilina

Introduction

The aim of this study is to describe the epidemiological and clinical features, treatment and prognosis of community-acquired pneumonia (CAP) caused by methicillin-resistant Staphylococcus aureus (MRSA) in two different geographic regions where community-acquired MRSA (CA-MRSA) infections have different frequencies.

Methods

Observational study of patients admitted to two hospitals (one in Argentina, the other in Spain) between March 2008 and June 2012.

Results

We documented 16 cases of CAP caused by MRSA. MRSA accounted for 15 of 547 (2.7%) cases of CAP in Hospital Rodolfo Rossi and 1 of 1258 (0,08%) cases at the Hospital Universitari de Bellvitge (P ≤ .001). Most patients were young and previously healthy. Multilobar infiltrates, cavitation and skin and soft tissue involvement were frequent. All patients had positive blood cultures. Five patients required admission to the intensive care unit. Early mortality (≤ 48 hours) was 19%, and overall mortality (≤ 30 days) was 25%.

Conclusion

CAP caused by MRSA causes high morbidity and mortality rates. It should be suspected in areas with a high prevalence of CA-MRSA infections, and especially in young and healthy patients who present with multilobar pneumonia with cavitation. Mortality is mainly related to septic shock and respiratory failure and occurs early in most cases.     

Sclérites,aspects cliniques, étiologiques et thérapeutiques : à propos d’une série de 32 observations

Purpose

To report on the various clinical presentations, etiological diagnosis, prognosis and treatment of patients with scleritis evaluated at a tertiary care eye center.

Methods

Retrospective, monocentric study on a series of 32 patients in a tertiary center.

Results

The mean age of included patients with scleritis was 46.8 years (range, 22 to 77 years). Nineteen patients were women and 13 were men. Twenty-six patients (81%) had anterior scleritis (15 nodular, 8 diffuse and 3 necrotizing), six (19%) had posterior scleritis. Unilateral inflammation was present in 24 patients (75%). Twelve out of the 32 patients (37.5%) had an underlying systemic disease: granulomatosis with polyangiitis (n = 3), Behçet's disease (n = 2), unspecified inflammatory arthritis (n = 2), psoriatic arthritis (n = 1), ankylosing spondylitis (n = 1), sarcoidosis (n = 1), Cogan's syndrome (n = 1) and ulcerative colitis (n = 1). Six patients (18.8%) were suspected of having infectious disease with herpes virus: clinical context and positive treatment response with oral valacyclovir. Systemic agents and topical agents were required in 28 patients (87.5%). The first line therapy was mainly oral non-steroidal anti-inflammatory drugs in 15 patients (47%) and oral corticosteroids in 8 (25%). Immunosuppressive drugs were required in 6 patients. The mean follow-up was 16.3 months. Six patients (19%) had a decrease in visual acuity.

Conclusion

The number of systemic disease in our series is similar to the main series in the literature. Treatment with valaciclovir might be effective in patients with suspected herpes simplex scleritis.     

Résultats diagnostiques à court terme et pronostiques à long terme chez des patients avec syncopes inexpliquées : résultats d’un série menée en centre hospitalier

Objective

Evaluate the diagnostic and prognostic input of head-up tilt test in the exploration of unexplained syncope.

Method

Between January 2009 and December 2012, all patients undergoing a head-up tilt test for recurrent syncope were studied. Follow-up data were obtained using telephone interviews and medical record reviews.

Results

A head-up tilt test was realized in 77 patients (47.8 ± 20 years, 53% female) for an exploration of syncope. The tilt test elicited syncope or pre-syncope in 57 patients (74%). The positive response included vaso-vagal syncope in 53 patients and psychogenic syncope in 4 patients. After a mean follow-up of 32 ± 11 months (range 6–54 months), 90% of patients had not a recurrence of syncope. Of note, the incidence of recurrence was the same regardless of whether the patients had a positive (n = 5/48; 10%) or a negative head-up tilt test response (n = 2/19; 10%).

Conclusion

The tilt test has a certain diagnostic value in the exploration of unexplained syncope. Recurrence rate of syncope after a tilt test is low. However, our study suggests no correlation between head-up tilt test results and the likelihood of recurring syncope.     

Dilation of peripheral vessels in Marfan syndrome: Importance of thoracoabdominal MR angiography

Objectives

Aim of this study was to assess vascular morphology and dimension of the entire aorta and branch vessels in MFS using thoracoabdominal MR angiography (MRA).

Background

Evaluation of vascular involvement in Marfan Syndrome (MFS) is focused to the ascending aorta, which has the major risk of dissection/rupture.

Methods

From March 2006 to January 2011, 64 patients (35 ± 13 years old) with MFS underwent echocardiography and MRA of thoracic and abdominal aorta. Measurements of ascending aorta, aortic arch, descending thoracic and abdominal aorta, and aortic branch vessels were assessed. In patients with aortic dissection only non dissected vessels were considered for measurements.

Results

64 Marfan patients were divided into 2 groups: patients in natural history (group A, 55%) and patients previously submitted to aortic root and/or ascending aorta replacement because of severe aortic dilation or dissection (group B, 45%).Dilation of the descending aorta, mostly of the aortic isthmus, occurred in 18/53 patients (8/35 group A, 10/18 group B). Abdominal aorta resulted in the normal range in group A and in 16/18 patients of group B, while iliac vessels were dilated in 7/35 patients of group A and in 10/23 patients of group B. Four patients of group B presented isolated dilation of subclavian, celiac, mesenteric, or renal arteries.

Conclusions

Vascular dilation beyond the aortic root is not uncommon in MFS. The systematic use of MRA provides a comprehensive evaluation of the entire arterial system.     

Insuffisances cardiaques du sujet jeune : aspects épidémiologiques,cliniques et étiologiques au CHU Sylvanus Olympio de Lomé

Aims

The aim of the study was to analyze the epidemiologic, clinical and etiologic aspects of heart failures of the young age to 18 to 45 years.

Patients and method

It consisted of a cross-sectional study realized in hospitalization in the service of cardiologic of Teaching Hospital Sylvanus Olympio of Lomé on 35 months (January 2009 to November 2012). The completion of a Doppler echocardiography was necessary to include the patients in the study.

Results

The prevalence heart failure in the 45 years old young people to more was of 28.6%. The median age of the patients was of 36.5 ± 3 years with a sex ratio of 10.7. Heart failure was total among 268 patients (71.3%). The electrocardiogram found 88 patients (23.4%) in complete arrhythmia by auricular fibrillation. Cardiac echography found a dilation of the left ventricle among 271 patients (72.1%), a systolic dysfunction of left ventricle among 213 patients (56.6%) and an intracavitary thrombus among 37 patients (9.8%). The etiologies were: hypertension 161 cases (42.8%), heart valve diseases 68 cases (18.1%), the peripartum cardiomyopathy 58 cases (15.4%), dilated cardiomyopathy 22 cases (5.8%), the alcoholism 12 cases (3.1%), ischaemic heart diseases 10 cases (2.7%), congenital heart diseases 10 cases (2.7%), the chronic pulmonary heart 8 cases (2.1%), the cardiothyreosis 7 cases (1.8%), the pericardial tamponnade 4 cases (1.1%) and myocarditis with VIH 4 cases (1.1%). Hospital lethality was of 16.4% (62 patients).

Conclusion

Heart failure is a serious and frequent pathology in Africa. It affects young and active subjects. The causes are dominated by hypertension.     

Validation de la reproductibilité de la mesure de la surface de l’orifice régurgitant par planimétrie dans l’insuffisance aortique : une étude préliminaire d’échocardiographie trans-œsophagienne tridimensionnelle

Background

Aortic regurgitation is mainly evaluated by trans-thoracic echocardiography using multi-parametric qualitative and semi quantitative tools. All those parameters can fail to meet expectations, resulting in an imperfect diagnostic reliability and assessment of aortic regurgitation severity can be challenging.

Objectives

We sought to evaluate feasibility and intra- and inter-observer reproducibility of aortic regurgitant orifice area measured by planimetry with tridimensional trans-esophageal echocardiography on patients with at least grade 2/4 aortic regurgitation.

Patients and methods

Consecutive patients with at least grade 2/4 aortic regurgitation measured by trans-thoracic echocardiography and referred for trans-esophageal echocardiography for any reason were included. Planimetric reconstructions of regurgitant orifice area were studied and reproducibility indexes between senior and junior observers were calculated.

Results

Twenty-three patients were included in this study. Intra- and inter-observer reproducibility were excellent with an ICC of 0.95 [0.88–0.98], P < 0.0001 and 0.91 [0.79–0.96], P < 0.0001, respectively. Mean length of the measurement was 6.6 ± 0.9 min [CI95% 6.23–7.01].

Conclusion

Planimetric measurement of the aortic regurgitant orifice using tridimensional trans-esophageal echocardiography seems to be feasible and has great intra- and inter-observer reproducibility. Reconstruction durations were compatible with a daily use. There is a need now to investigate the reliability of this measurement as compared with the reference technique.     

Efficacy of trimetazidine on functional capacity in symptomatic patients with stable exertional angina — The VASCO-angina study

Background/objectives

Trimetazidine (TMZ) is a metabolic agent of proven efficacy in improving myocardial ischemia and angina. VASCO, a randomised double-blinded, placebo-controlled trial, assessed anti-anginal efficacy and safety of standard and high dose of modified-release TMZ (70 mg/d and 140 mg/d) in symptomatic and asymptomatic patients with chronic ischemic heart disease receiving background atenolol 50 mg/d on exercise test parameters.The VASCO-angina study assessed the efficacy of the two doses of TMZ on total exercise duration (TED) and time to 1-mm ST segment depression (T1), in symptomatic patients with chronic stable angina receiving background atenolol treatment.

Methods and results

In the all cohort of chronic stable angina patients TMZ significantly improved TED compared to baseline and to placebo. Both doses of TMZ significantly increased TED (p = 0.0044 and p = 0.0338 for TMZ 140 mg/d and TMZ 70 mg/d, respectively). A greater TED improvement was observed in TMZ 140 mg/d than in TMZ 70 mg/d, although the difference was not significant. Amongst patients with limiting angina during exercise test, both doses of TMZ significantly improved both T1 and TED. No difference in serious adverse events was noted between TMZ and placebo.

Conclusions

The VASCO-angina gives evidence for the efficacy and tolerability of standard and high dose of TMZ in improving effort-induced myocardial ischemia and functional capacity in patients with chronic stable angina receiving background beta-blockers.     

Características de pacientes asmáticos ingresados en una unidad de cuidados respiratorios intermedios

Introduction

Intermediate respiratory care units (IRCU) provide continuous monitoring and non-invasive mechanical ventilation (NIMV) in patients with severe respiratory failure who are usually admitted to intensive care units (ICU). The usefulness of IRCU in managing severe asthma exacerbations has never been evaluated.

Methods

Clinical data were prospectively and systematically compiled from patients admitted to the IRCU with a principal diagnosis of bronchial asthma exacerbation. We assessed therapeutic failure (intubation or exitus) and patient evolution up until 6 months after discharge compared with a group of patients admitted to a conventional hospital ward, paired for age and sex, and with the same principal diagnosis.

Results

A total of 74 asthma patients were included (37 admitted to IRCU and 37 to the hospital ward) with a mean age (± SD) of 58 ± 20 years, who were predominantly women (67%), with previous diagnosis of asthma and persistent asthma treatment. The main cause of admittance to the IRCU was severe respiratory failure. The patients who were admitted to the IRCU presented more radiological affectation (alveolar infiltrates) and had significantly higher pCO₂. Ten patients admitted to the IRCU required NIMV. There were no differences between the two groups regarding either therapeutic failure or the 6-month follow-up after discharge.

Conclusions

Patients with severe asthma exacerbations can be managed in an IRCU while avoiding hospitalization in an ICU and demonstrating a prognosis similar to milder exacerbations treated in conventional hospital wards.     

Pulmonary vein isolation using a single size cryoballoon chosen according to transesophageal echocardiography information

Background

Pulmonary vein isolation (PVI) using cryoballoon (CB) catheter is a new technique for atrial fibrillation (AF) ablation. Previous studies used computer tomography (CT) or magnetic resonance imaging (MRI) scan to determine the pulmonary vein (PV) diameter and anatomy for choosing the CB size. We evaluated pre-ablation transoesophageal-echocardiography (TEE) as an alternative to CT/MRI scan in patients undergoing AF ablation for determining the appropriate size of the CB.

Methods

Fifty-five consecutive patients (men = 43, women = 12) with a mean age of 63 ± 12.5 years, and with drug-refractory paroxysmal AF (34 patients) or persistent AF (21 patients) were included in this prospective study. All patients underwent pre-ablation TEE.

Results

Hypertension was present in 19 patients (34%). Mean anterior–posterior left atrium diameter was 45.1 ± 8.9 mm. In total, 217 PV were targeted using a single 23-mm (n = 14) or 28-mm (n = 40) CB catheter chosen according to TEE-obtained measurements. PVI was achieved in 195 PV (90%). Mean number of CB applications per patient was 9.8 ± 2.1 (range 8–14). Mean procedure duration and fluoroscopy times were 131 ± 27 min (90–190 min) and 36 ± 12 min (22–66 min) respectively. Phrenic nerve palsy occurred in 3 patients (5.4%) and was transient (< 1 month) in all of them.

Conclusion

This study suggests that TEE is an easily available and effective tool to select the size of the CB for PVI according to evaluated PV diameters and anatomy.     

Evaluation by MRA of aortic dilation late after repair of tetralogy of Fallot

Objectives

This study evaluated predictors for aortic dilation (AD) in patients with repaired tetralogy of Fallot (rTOF) using magnetic resonance angiography (MRA).

Background

AD is common in patients with rTOF and may result in increased morbidity and mortality. There are no guidelines for evaluation of AD for rTOF patients.

Methods

All adults with rTOF who previously underwent MRA had retrospective aortic measurements at the sinuses of Valsalva (SoV) and ascending aorta (AsAo). Rate of change in diameter was determined in patients with multiple MRAs. Chart review identified risk factors for AD. Univariate and multivariate analyses tested predictors of AD.

Results

Of the 87 patients who met the inclusion criteria, 12 (14%) had AD. At baseline, mean diameter was 3.6 ± 0.6 cm and 3.1 ± 0.6 cm at the SoV and AsAo, respectively. The AsAo was larger than the SoV in 17%. Predictors of AD included male gender, age, right aortic arch, pregnancy, older age at complete repair, smoking, and systemic hypertension. Serial studies were available in 55 patients; the rate of growth was slow: 0.4 ± 0.9 mm/year (SoV) and 0.1 ± 0.8 mm/year (AsAo).

Conclusions

AD is common in rTOF at the SoV and AsAo. Transthoracic echocardiography, which does not always image the AsAo as well as MRA, may not image AD in rTOF in cases in which the AsAo is dilated. Although several risk factors correlate with AD in rTOF, the rate of aortic growth is slow, suggesting that rTOF patients may not require frequent aortic imaging.     

Experiencia de un programa de fast-track surgery en resección pulmonar

Introduction

This paper intends to assess the influence of a fast-track surgery program on hospital stay and morbidity/mortality in lung resection surgery.

Patients and methods

A prospective study including 100 patients who underwent open lung resection due to neoplastic pathologies. The variables analyzed were demographic, clinical, resection type, length of hospital stay and postoperative complications, adjusting these to the classification established according to the treatment required.

Results

Seventy-three patients were men, and mean age was 60.8. 82% of the subjects were asymptomatic, 97% had a history of smoking and the majority presented associated comorbidities. The resection types included 7 pneumonectomies, 79 lobectomies, 6 bilobectomies and 8 segmentectomies. Mean hospital stay was 5.4 ± 4.2 days (range: 3-23), varying between 3.4 ± 0.8 days (range: 3-6) and 9.8 ± 5.3 days (range: 4-23) according to the absence or presence of complications. Associated mortality was 2% and morbidity 31%; the most frequent complications were persistent air leak (10%) and atrial fibrillation (6%). 51.5% of the complications were classified within the lower grade complication group, depending on treatment required. Four patients required readmittance after hospital discharge.

Conclusions

Fast-track surgery programs are able to reduce hospitalization times by planning a multidisciplinary strategy of the surgical procedure, in which the patient him/herself participates. It is equally necessary to establish systems to classify postoperative complications that can evaluate the quality of the surgery.     

Utilidad de la ultrasonografía endobronquial radial en el diagnóstico de lesiones pulmonares periféricas. Estudio controlado con fluoroscopia

Introduction

Fluoroscopy-guided bronchoscopy is usually performed for the diagnosis of peripheral pulmonary lesions (PPL), but the diagnostic yield varies widely among studies. Endobronchial ultrasound (EBUS) can increase the diagnostic yield of bronchoscopic diagnosis of PPL.

Objective

To compare the diagnostic yield of fluoroscopy-guided bronchoscopy and EBUS with fluoroscopy-guided bronchoscopy in the study of PPL.

Methods

All patients who underwent bronchoscopy to study PPL from January 2009 to December 2012 were prospectively included. 145 consecutive patients were randomly distributed in two groups: EBUS and fluoroscopy (50 patients, 71.3 ± 8.2 years) or fluoroscopy alone (95 patients, 68 ± 10.5 years). The mean diameter of the lesions was 41.97 ± 19.22 mm. Cytological brushing and transbronchial biopsies were obtained. All procedures were performed under fluoroscopic guidance with intravenous conscious sedation. EBUS was performed using an endoscopic ultrasound system equipped with a 20-MHz radial miniprobe introduced via a guide-sheath. Bronchoscopist, cytologist, study protocol, techniques and tools were the same throughout the whole study.

Results

129 (89%) patients had malignant disease. A diagnosis with bronchoscopy was established in 105 (72.4%) patients. EBUS plus fluoroscopy obtained a diagnostic yield in 78% of patients and fluoroscopy alone in 69.5% (non-significant). In contrast, for lesions smaller than 30 mm, EBUS plus fluoroscopy guidance provided significantly greater diagnostic performance than fluoroscopy alone (90 vs. 52%; P = .05).

Conclusions

Bronchoscopy under EBUS plus fluoroscopy guidance is a technique that has become useful for the diagnostic of LPPs, especially those smaller than 30 mm in diameter.     

Corrélation entre les dosages des dérivés methoxylés urinaires et l’index d’apnée-hypopnée dans une population d’hypertendus : étude pilote

Aims

Sleep disorders like obstructive sleep apnea in adults are associated with increased sympathetic activity, which induced high blood pressure and could be associated with resistant hypertension. Some studies have demonstrated that high urinary catecholamine levels in obstructive sleep apnea patients may be decreased with continuous positive airway pressure therapy. However, very few studies have demonstrated a correlation between apnea-hypopnea index and urinary catecholamine levels in hypertension patients.

Methods

In this pilot study, 20 hypertensive patients referred for hypertension work-up including night-time polygraphy and 24 h urinary catecholamine dosage were included.

Results

Mean age was 51 ± 11 years (30–76), 68% were males. Diagnosis of obstructive sleep apnea was confirmed in 13 patients at the end of the work-up. Mean apnea-hypopnea index was 14 ± 9 (2–32). The only urinary catecholamine parameter significantly increased in patients with obstructive sleep apnea was 24 h urinary normetanephrine (1931 ± 1285 vs 869 ± 293 nmol/24 h; P < 0.05). However, this difference was not significant when this parameter was adjusted to 24 h urinary creatinine. We observed a significant positive correlation between AHI and 24 h urinary normetanephine (r = 0.486; P = 0.035).

Conclusion

This pilot study confirms an isolated elevation of 24 h urinary normetanephrine in hypertensive patients with obstructive sleep apnea and shows a significant correlation between sleep disorders expressed by apnea-hypopnea index and urinary catecholamines excretion.