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L'essentiel de la littérature réçente en Pneumologie

Dans cette rubrique on vous propose une revue de la littérature à travers une sélection d'abstracts d'articles originaux.
On essaiera de vous tenir informé des dernières nouveautés de recherche en matière de Pneumologie. On ne vous fournit que le résumé de l'article et le lien correspondant, pour accéder à l'article en full text vous devez être inscrits à la revue correspondante.
Cliquez ici pour consulter la liste des revues de Pneumologie disponibles en libre accès.

Fungal infections of the lung in children. Imprimer Envoyer
Lundi, 26 Septembre 2016 06:12
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Fungal infections of the lungs are relatively common and potentially life-threatening conditions in immunocompromised children. The role of imaging in children with lung mycosis is to delineate the extension of pulmonary involvement, to assess response to therapy, and to monitor for adverse sequelae such as bronchiectasis and cavitation.

The aim of this paper is to show imaging findings in a series of patients with fungal pneumonia from two tertiary children's hospitals, to discuss differential diagnoses and to show how imaging findings can vary depending on the host immune response.

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Transbronchial Cryobiopsy in Diffuse Parenchymal Lung Disease: Retrospective Analysis of 74 Cases. Imprimer Envoyer
Lundi, 26 Septembre 2016 06:12
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BACKGROUND: Diagnostic evaluation of patients with diffuse parenchymal lung disease (DPLD) is best achieved by a multidisciplinary team correlating clinical, radiologic, and pathologic features. Surgical lung biopsies remain the gold standard for histopathologic diagnosis of idiopathic interstitial pneumonias. Emerging data suggest an increasing role for transbronchial cryobiopsy (TBC) in DPLD evaluation. We describe our experience with TBC in patients with DPLD.

METHODS: We retrospectively reviewed medical records of patients with radiographic features of DPLD who underwent TBC at Mayo Clinic, Rochester, Minnesota in June 2013-September 2015.
RESULTS: Seventy-four patients (33 female, 45%) with a mean age of 63 years (SD 13.8) were included. Mean maximal diameter of samples was 9.2 mm (range 2-20, SD 3.9). The median number of samples per procedure was 3 (range 1-7). Diagnostic yield was 51% (38/74). The most frequent histopathologic patterns were granulomatous inflammation (12) and organizing pneumonia (OP) (11), resulting in the final diagnoses of hypersensitivity pneumonitis (6), cryptogenic OP (6), connective tissue disease-associated OP (3), drug toxicity (3), infection-related OP (2), sarcoidosis (2), and aspiration (1). Other histopathologic patterns included respiratory bronchiolitis (3), acute fibrinous and organizing pneumonia (2), desquamative interstitial pneumonia (1), diffuse alveolar damage (1), pulmonary alveolar proteinosis (1), amyloidosis (1), eosinophilic pneumonia (1), necrotizing vasculitis (1), bronchiolitis with food particle (1), and malignancy (3). Pneumothorax developed in one patient (1.4%), bleeding occurred in 16 (22%).

CONCLUSIONS: Our single center cohort demonstrated 51% diagnostic yield from TBC; the rates of pneumothorax and bleeding were 1.4% and 22%, respectively. Optimal use of TBC needs to be determined.

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Azithromycin for Acute Exacerbations of Asthma : The AZALEA Randomized Clinical Trial. Imprimer Envoyer
Lundi, 26 Septembre 2016 06:12
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Importance: Guidelines recommend against antibiotic use to treat asthma attacks. A study with telithromycin reported benefit, but adverse reactions limit its use.
Objective: To determine whether azithromycin added to standard care for asthma attacks in adults results in clinical benefit.
Design, Setting, and Participants: The Azithromycin Against Placebo in Exacerbations of Asthma (AZALEA) randomized, double-blind, placebo-controlled clinical trial, a United Kingdom-based multicenter study in adults requesting emergency care for acute asthma exacerbations, ran from September 2011 to April 2014. Adults with a history of asthma for more than 6 months were recruited within 48 hours of presentation to medical care with an acute deterioration in asthma control requiring a course of oral and/or systemic corticosteroids.
Interventions: Azithromycin 500 mg daily or matched placebo for 3 days.

Main Outcomes and Measures: The primary outcome was diary card symptom score 10 days after randomization, with a hypothesized treatment effect size of -0.3. Secondary outcomes were diary card symptom score, quality-of-life questionnaires, and lung function changes, all between exacerbation and day 10, and time to a 50% reduction in symptom score.

Results: Of 4582 patients screened at 31 centers, 199 of a planned 380 were randomized within 48 hours of presentation. The major reason for nonrecruitment was receipt of antibiotics (2044 [44.6%] screened patients). Median time from presentation to drug administration was 22 hours (interquartile range, 14-28 hours). Exacerbation characteristics were well balanced across treatment arms and centers. The primary outcome asthma symptom scores were mean (SD), 4.14 (1.38) at exacerbation and 2.09 (1.71) at 10 days for the azithromycin group and 4.18 (1.48) and 2.20 (1.51) for the placebo group, respectively. Using multilevel modeling, there was no significant difference in symptom scores between azithromycin and placebo at day 10 (difference, -0.166; 95% CI, -0.670 to 0.337), nor on any day between exacerbation and day 10. No significant between-group differences were observed in quality-of-life questionnaires or lung function between exacerbation and day 10, or in time to 50% reduction in symptom score.

Conclusions and Relevance: In this randomized population, azithromycin treatment resulted in no statistically or clinically significant benefit. For each patient randomized, more than 10 were excluded because they had already received antibiotics.
Trial Registration: Identifier: NCT01444469.

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