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V Jounieaux

Publications and source records attributed to V Jounieaux.

At least 19 recordsLinked to original sources
PubMed2006

[Tuberculosis of the submandibular gland: a case report].

INTRODUCTION: Tuberculosis remains an important public health problem in France. After a certain decline, its incidence has remained unchanged since 1990. 30% of tuberculosis cases are extra-pulmonary form, most of them concern nodes especially in cervical areas. CASE REPORT: This case of submandibular tuberculosis illustrates diagnostic and therapeutic difficulties. DISCUSSION: There are few clinical signs or laboratory clues suggestive of tuberculosis, however a surgery cannot be avoided and must be performed in combination with antituberculosis chemotherapy.

Antitubercular Agents↗
PubMed2005

Oxygen consumption and PEEPe in ventilated COPD patients.

The intrinsic positive-end-expiratory pressure (PEEPi) increases the inspiratory load, the cost of breathing and thus oxygen consumption (V(O2)). It has been shown that applying an extrinsic positive-end-expiratory pressure (PEEPe) reduces the inspiratory threshold load but the optimal PEEPe level is still in debate. We hypothesize that the best level of PEEPe could induce a decrease in V(O2) by reducing the V(O2) demands from PEEPi. Nine mechanically ventilated COPD patients were included. The level of PEEPe was determined in accordance with the static PEEPi. V(O2) was measured using an automatic gas analyser during synchronized intermittent mandatory ventilation (SIMV): without PEEPe, with a PEEPe equal to 50% of static PEEPi and with a PEEPe equal to 100% of static PEEPi. Static PEEPi appeared to be significantly correlated with the degree of airflow obstruction (FEV1) (P<0.05). Applying a PEEPe equal to static PEEPi resulted in a significant decrease in V(O2) (P<0.05) whereas the change in V(O2) proved to be unpredictable for a PEEPe level of 50% of static PEEPi. In conclusion, V(O2) decreases progressively when increasing PEEPe up to a level equal to 100% of static PEEPi. Thus, in mechanically ventilated COPD patients with a FEV1 < or = 1000 ml, applying a PEEPe of 5 cmH2O should be recommended.

Aged↗
PubMed2005

Community-acquired bacteraemic pneumococcal pneumonia in adults: effect of diminished penicillin susceptibility on clinical outcome.

Pneumococcal pneumonia remains a common disease with a high mortality rate. Between 1995 and 2000, we prospectively analyzed 95 consecutive adult cases of community-acquired bacteraemic pneumococcal pneumonia treated in a single centre. The incidence of pneumococcal resistance to penicillin increased from 19 to 50% during the study period. Multivariate analysis showed that only age and recent hospitalization were independently associated with fatal outcome. The proportion of penicillin-resistant strains was slightly but not significantly higher among patients who died before the fourth hospital day than among those who died later. Patients who died before D4 were more likely to have a recent history of hospitalization, cancer and/or chemotherapy. It thus appears that infection by a resistant pneumococcal strain is not in itself a gravity factor in this setting, but that their acquisition is associated with pejorative clinical features.

Adult↗
PubMed2005

[Evaluation of combined chemotherapy with vinorelbine, ifosfamide and cisplatin in the treatment of metastatic non-small cell bronchial carcinoma].

INTRODUCTION: In France, cancer of the bronchus is responsible for 25,000 deaths per year. Non small cell lung cancer (NSCLC) represents 80% of bronchial carcinoma of which 40-50% are mefastatic at the time of diagnosis. At present, although the therapeutic benefits are modest, it is now recognised that combination chemotherapy including platinum salts improves the survival of these patients. METHODS: We analysed retrospectively a cohort of 57 patients suffering from stage IV NSCLC treated with chemotherapy combining cisplatin (80 mg/rn2 on day 1), vinorelbine (25 mg/rn2 on days 1 and 8) and ifosfamide (3000 mg/in 2 on day 1), (NIP), repeated every 21 days. RESULTS: The population studied comprised 6 women and 51 men, of average age 59.8 +/- 9.1 years. A history tobacco use (smokers and ex-smokers) was identified in 93%. The WHO performance index was equal to or greater than 2 in 22.8%. All patients were studied in terms of toxicity and overall survival but only 40 (70%) were able to be evaluated in terms of response to treatment (on account of having received more than three cycles of NIP chemotherapy). For the group considered as a whole, the median survival was 6.7 months with a one year survival of 24.5%. Median survival without progression was 4.4 months. The most frequent toxicities were haematological and digestive. They were most common among patients over the age of 70 but had no effect on median survival. For the 40 patients for whom chemotherapy was evaluable, the objective response rate was 20%. This objective response was the only factor that was signiticantly correlated with one year survival: 62.5% in responders, 28.1% in non-responders (p < 0.05). CONCLUSION: Treatment of stage IV NSCLC with NIP chemotherapy is effective and improves the survival of these patients independently of other prognostic factors such as age, the presence of cerebral metastases, performance status, histological type, the number of metastatic sites or the serum LOH level.

Adenocarcinoma↗
PubMed2004

[Home mechanical ventilation: indications and pathophysiological limitations].

INTRODUCTION: Domiciliary assisted ventilation (DAV) may be undertaken invasively or non-invasively. Non-invasive DAV is used for patients suffering from alveolar hypoventilation due to restrictive pathology. Invasive DAV is reserved for "indications of necessity" that is when non-invasive ventilation is contraindicated due to the absence of adequate cough and for alveolar hypoventilation leading to hypercapnoea during spontaneous ventilation. STATE OF THE ART: The main pathophysiological limitation to non-invasive ventilation is the interference of the glottis. In this mode the glottis imposes a variable resistance to the ventilation delivered. Its behaviour is more predictable during Volume controlled than during pressure controlled ventilation. The control parameters of a Volume controlled ventilator are very different from those used in invasive ventilation during which the respiratory system may be regarded as a single compartment (provided a cuffed tube bypasses the upper airway). In non-invasive DAV: mode VCM, tidal volume 13 mls kg(-1), rate 20 cycles min(-1), insp/exp ratio 1/1.2. In invasive DAV: mode VCM, tidal volume 8-10 mls kg(-1), rate 12 cycles min(-1), insp/exp ratio depending on the pathology 1/2. PERSPECTIVES: As non-invasive DAV is essentially delivered during sleep the parameters for each patient can be optimised during polysomnography because waking, leading to a partial glottic occlusion, interferes with the ventilation delivered. CONCLUSIONS: Recent understanding of the way the glottis interferes with mechanical ventilation when delivered non-invasively should lead to a revision of earlier practices based on invasive ventilation.

Contraindications↗
PubMed2004

[The COPD-PE study: prevalence and prediction of pulmonary embolism in acute exacerbations of chronic obstructive pulmonary disease].

INTRODUCTION: Patients suffering from chronic obstructive pulmonary disease (COPD) are often admitted to hospital with an exacerbation of their disease that manifests itself with an increase in cough and/or sputum, increased dyspnoea and sometimes chest pain. These episodes are most often attributed to an acute exacerbation of bronchial infection but the real cause is often unknown. COPD is considered a risk factor for pulmonary embolism (PE) and PE is part of the differential diagnosis of an acute exacerbation of COPD. However, the symptoms of these two conditions overlap to a considerable extent and the investigation of PE is often ignored in these patients. Therefore the true prevalence of PE in this situation is unknown. Nevertheless several small series suggest that up to 30% of patients seen as emergencies with exacerbations of COPD may have a deep vein thrombosis or PE. The aims of this study are therefore: 1. To evaluate the prevalence of PE in patients admitted as emergencies with exacerbations of COPD; and 2. To attempt to develop a prediction guide for PE in this population in order to identify the patients in whom PE should be investigated. MATERIALS AND METHODS: 600 consecutive patients admitted as emergencies with exacerbations of COPD will be included in a cross sectional study in three university hospitals (Geneva and Lausanne in Switzerland, and Amiens in France). Patients fulfilling the inclusion criteria will be investigated by a diagnostic algorithm appropriate for the study of PE, including D-dimer levels and, in those with abnormal results, ultrasonic scan of the deep veins of the legs and spiral CT scan. The patient characteristics on admission will be incorporated in a multivariate regression analysis in an attempt to identify the predictive factors for PE in these patients. The expected duration of the study is 24 months. EXPECTED RESULTS: This study should determine the prevalence of PE in patients admitted as emergencies with exacerbations of COPD and therefore help decide when, and in which patients, a systematic search for PE should be undertaken.

Algorithms↗
PubMed2004

[Aortobronchial fistulas].

INTRODUCTION: Aortobronchial fistulas are uncommon but generally fatal if not treated surgically. Haemoptysis is the main symptom of this pathology. STATES OF ART AND PERSPECTIVES: Aortobronchial fistulas occur most commonly in patients with thoracic aneurysms (atherosclerosis, mycotic, aortic surgery's complication...). Main investigation is CT angiography with 2 D and 3 D reconstructions. CONCLUSION: Endovascular exclusion can be efficient treatment option.

Aortic Diseases↗
PubMed2003

[Transudative pleural effusions and the ovarian hyperstimulation syndrome].

INTRODUCTION: Pleural effusions occurring in the ovarian hyperstimulation syndrome (OHS) are frequently associated with haemoconcentration. OBSERVATIONS: We report three cases of symptomatic pleurisy with ascites, requiring therapeutic pleural aspiration. Biochemical analysis of these effusions may give rise to confusion as consideration of the pleural fluid protein levels in isolation may lead to the incorrect diagnosis of an exudate. On account of the electrolyte disorders and haemoconcentration seen in OHS a pleural fluid protein level of over 30 g per litre (the traditional definition of an exudative pleurisy) should be interpreted in relation of a serum concentration. CONCLUSIONS: Measurement of the pleural and serum protein and LDH levels, complemented by a serum-effusion albumin gradient, should permit confirmation of the transudative nature of the pleural effusions. It seemed important to us to confirm this concept in three personal cases, as the data reported in the literature are more often reported as evidence for an exudates. Furthermore, a favourable response to symptomatic treatment tends to confirm the transudative nature of the effusions in OHS.

Adult↗
PubMed2003

[Medico-economic evaluation of a care management program for asthmatic patients].

This study aimed at measuring the medico-economic interest of a care management programme established for asthmatic patients in the Amiens region ("Action Asthma Amieris") by using and comparing different evaluation tools. Three tools were used in parallel: 1) a questionnaire for collecting information on healthcare received was completed monthly by 305 patients recruited by 73 physicians between November 1998 and January 1999; 2) data issued by the national insurance fund for the years 1998 and 1999, for those patients included after January 1999; and 3) data on all hospitalisations for 1998 and 1999 in the University Hospital Centre obtained from the French hospital information database (PMSI). Data from the national insurance fund and from the PMSI are essential to evaluate costs, since the patients' statements proved to under-estimate the amount of healthcare administered and received. Following the implementation of this asthma care management programme, an increase of pharmaceutical expenses and a decrease in the number of hospitalisations for asthmatic patients were observed.

Adolescent↗
PubMed2002

[Bronchiolitis obliterans organizing pneumonia associated with dermatomyositis and antiphospholipid syndrome].

Dermatomyositis and antiphospholipid syndrome are rare diseases that can be associated pulmonary damage. We report a case of anti-phospholipid syndrome that presented with bilateral pulmonary embolism and subsequently developed pulmonary infiltrates in association with the characteristic muscular and cutaneous features of dermatomyositis. Histological examination of trans-bronchial biopsies revealed bronchiolitis obliterans organizing pneumonia.

Antiphospholipid Syndrome↗
PubMed2002

[Pulmonary embolism and sibilant types of chronic obstructive pulmonary disease decompensations].

Pulmonary Embolism (PE) poses an important diagnostic problem in patients with chronic obstructive pulmonary disease (COPD). Indeed PE may aggravate the already precarious respiratory state of these fragile patients. Moreover, these two conditions share common symptoms: dyspnoea, wheezing, pleural pain, haemoptysis, palpitations and signs of right cardiac insufficiency. In two studies, one retrospective and the other prospective, we investigated the incidence of PE in patients with non-infective exacerbations of their COPD. The retrospective study was carried out over two years and involved 50 COPD patients with non-infective respiratory exacerbations. In this population, 10 patients out of 50 (20%) had a documented PE. No predictive factor was identified. The prospective study was conducted over one year and COPD patients admitted to hospital with exacerbations were included in the study if they had a positive D-dimer blood test and no evidence of acute respiratory infection. 31 patients were studied with Doppler ultra-sound examination of the legs and a lung perfusion scan. The presence or absence of PE was determined and the two groups were compared. 9 patients out of 31 (29%) had a documented PE. Six of these nine patients had a deep venous thrombosis (DVT). Two predictive factors of PE were identified: existence of a DVT and a significant fall in PaO(2) from baseline state (DeltaPaO(2) > 22 mmHg). We conclude that PE is a frequent (20 to 30%) of non-infective respiratory decompensation in COPD patients. Faced with an unexplained respiratory exacerbation in these patients, a lung perfusion scan should be routinely undertaken to rule out a PE when the D-dimers are positive.

Aged↗
PubMed2001

[Effects of a pressure support ventilation of 6 cm H2O on oxygen consumption of the respiratory muscles during weaning of mechanical ventilation].

OBJECTIVE: To determine the effects of a pressure support ventilation (PSV) of 6 cm H(2)O during spontaneous breathing on oxygen consumption of the respiratory muscles (VO(2) resp), gas exchange, respiratory rate, tidal volume and to determine if these low levels of PSV can reduce or cancel the increase in work of breathing induced by the resistances of the endotracheal tube and the circuit of the respirator. PATIENTS AND METHODS: Prospective study. Twenty intubated patients were studied. The VO(2) resp was assessed by measurements of inspired and expired concentrations of oxygen (O(2)) and carbon dioxide (CO(2)) in patients during controlled ventilation and spontaneous breathing. Gas exchange, respiratory rate, minute ventilation, tidal volume and VO(2) resp were collected during spontaneous breathing with a PSV level of 6 cm H(2)O and without PSV. SETTING: Respiratory Intensive Care Unit, Amiens, University Hospital 80054 Amiens. RESULTS: A PSV level of 6 cm H(2)O significantly increased the spontaneous tidal volume (+12%) without any modification in respiratory rate, minute ventilation, tidal volume and gas exchange. No significant improvement in VO(2) resp was found when a PSV level of 6 cm H(2)O was added. CONCLUSION: Despite a significant increase in spontaneous tidal volume, adding a PSV level of 6 cm H(2)O did not improve VO(2) resp. Thus, low level of PSV did not reduce the increased work of breathing induced by the resistances of the ventilator tubing and the endotracheal tube.

Adult↗
PubMed2001

[Spontaneous rupture of the esophagus or Boerhaave syndrome. Report of 3 cases and review of the literature].

A triad of signs constitutes Boerhaave syndrome: forceful vomiting, chest pain and subcutaneous emphysema. The syndrome results from spontaneous rupture of the oesophageal wall leading to an oeso-pleural or oeso-mediastinal fistula. Positive diagnosis is established with a water-soluble swallow, sometimes coupled with computed tomography of the thorax. Boerhaave syndrome is a surgical emergency. We report three cases of spontaneous rupture of the oesophagus and analyze the importance of emergency surgery as well as emergency treatment of the sepsis, an important prognosis factor.

Esophageal Diseases↗