[Spontaneous pneumothorax: moving towards simplification].
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Ambulatory Care↗
Biomedical subjects
Sylvie Leroy
Publications and source records attributed to Sylvie Leroy.
MDCT of right ventricular function: comparison of right ventricular ejection fraction estimation and equilibrium radionuclide ventriculography, part 1.
OBJECTIVE: The aim of this study was to calculate right ventricular ejection fraction by use of ECG-gated MDCT and to compare the results with those of equilibrium radionuclide ventriculography. SUBJECTS AND METHODS: Forty-nine consecutively examined patients (30 men, 19 women; mean age, 59 years) with known or suspected right ventricular dysfunction secondary to bronchopulmonary (n = 30) or pulmonary vascular (n = 19) disease underwent ECG-gated 16-MDCT angiography of the heart (rotation time, 0.42 second; 120 kV; 300 mAs; collimation, 12 x 0.75 mm; pitch, 0.2) after CT angiographic examination of the entire thorax according to a standard protocol. Biphasic administration of a 30% contrast agent was systematically performed (phase 1, 90 mL at 3 mL/s; phase 2, 30 mL at 1.5 mL/s); no patient received additional medication. Right ventricular ejection fraction was calculated after two reviewers in consensus determined the reconstruction windows and segmentation of the right ventricular cavity on a series of diastolic and systolic short-axis images. The results were compared with those of equilibrium radionuclide ventriculography. RESULTS: At data acquisition, the mean (+/- SD) heart rate of the study group was 82 +/- 13.87 beats per minute (BPM) (range, 51-115 BPM). ECG showed a sinus rhythm in 30 (61%) of the patients and irregular cardiac rhythm in 19 (39%) of the patients. Agreement between the two techniques was estimated by intraclass correlation coefficient (0.77), the method of Bland and Altman (limits of concordance, -14.9 and 13.7), and percentage of variability between two measurements expressed by mean absolute percentage error (12.1%). The estimated effective dose for heart examination was 7.48 mSv with CT and 5 mSv with scintigraphy. The mean effective dose for the chest and heart CT examinations was 11.64 mSv. CONCLUSION: Right ventricular ejection fraction can be reliably estimated with 16-MDCT in unselected patients.
Adult↗
Endobronchial phototoxicity of WST 09 (Tookad), a new fast-acting photosensitizer for photodynamic therapy: preclinical study in the pig.
Photodynamic therapy (PDT) has been used for many years for both palliative and curative treatment of bronchial carcinomas. However, prolonged skin phototoxicity and reduced depth of penetration has limited the widespread use of PDT. We studied the endobronchial phototoxicity of a novel photosensitizer, WST 09 (Tookad). Fourteen pairs of Large White-Landrace male piglets were given intravenous WST 09 followed by laser light illumination of the left mainstem bronchus. Different settings for light dose (fluence), fluence rate (FR), drug dose (D) and drug-light interval (DLI) were applied to each pair. Bronchial toxicity was assessed with repeat bronchoscopic photographic evaluation as well as by pathologic examination following autopsy. Animals developed no toxicity, moderate toxicity or severe toxicity. Increased toxicity was seen with increasing D and fluence and decreasing DLI, whereas no increased toxicity was seen with higher FR. PDT-related histological changes in the normal bronchus confirm the vascular effect of WST 09. Depending on the parameter settings for fluence, D and DLI, the lesions ranged from focal intramucosal ischemia to transmural infarction with subsequent acute inflammation and fibrosis. Clinically feasible parameters for drug and light dosimetry were documented. These data will be important in determining safe starting doses for human phase I/II studies.
Animals↗
Tracheo-bronchial foreign bodies.
Suspicion of foreign bodies inhalation is a frequent problem in clinical practice. Despite the fact that the parents or the patients themselves easily notice symptoms, the delay in initiating diagnostic procedures is important. Delaying diagnosis and extraction results in potential severe complications. Diagnosis and treatment rely on invasive bronchoscopic procedures and therefore a careful designed standardized evaluation should be employed in order to decrease unnecessary bronchoscopies. Classical clinical signs of foreign body inhalation have low positive predictive values and every attempt to confirm or exclude the diagnosis should be done. Patients should be addressed to experienced centers for evaluation and treatment. Confirmation of the diagnosis should be done by flexible bronchoscopy. Extraction generally relies on rigid bronchoscopy, which seems to be more secured. Flexible bronchoscopy can also be used for extraction but rigid bronchoscopy should be always immediately available. Extraction failure rate and complications are rare in hands of experienced individuals and surgical removal is seldom necessary.
Bronchi↗