Publications by authors named "Jérôme Plojoux"

27 Publications

  • Page 1 of 1

Impact of Confinement in Patients under Long-Term Noninvasive Ventilation during the First Wave of the SARS-CoV-2 Pandemic: A Remarkable Resilience.

Respiration 2021 Jun 15:1-9. Epub 2021 Jun 15.

Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland.

Background: During the first wave of the SARS-CoV-2 pandemic in Switzerland, confinement was imposed to limit transmission and protect vulnerable persons. These measures may have had a negative impact on perceived quality of care and symptoms in patients with chronic disorders.

Objectives: To determine whether patients under long-term home noninvasive ventilation (LTHNIV) for chronic respiratory failure (CRF) were negatively affected by the 56-day confinement (March-April 2020).

Methods: A questionnaire-based survey exploring mood disturbances (HAD), symptom scores related to NIV (S3-NIV), and perception of health-care providers during confinement was sent to all patients under LTHNIV followed up by our center. Symptom scores and data obtained by ventilator software were compared between confinement and the 56 days prior to confinement.

Results: Of a total of 100 eligible patients, 66 were included (median age: 66 years [IQR: 53-74]): 35 (53%) with restrictive lung disorders, 20 (30%) with OHS or SRBD, and 11 (17%) with COPD or overlap syndrome. Prevalence of anxiety (n = 7; 11%) and depressive (n = 2; 3%) disorders was remarkably low. Symptom scores were slightly higher during confinement although this difference was not clinically relevant. Technical data regarding ventilation, including compliance, did not change. Patients complained of isolation and lack of social contact. They felt supported by their relatives and caregivers but complained of the lack of regular contact and information by health-care professionals.

Conclusions: Patients under LTHNIV for CRF showed a remarkable resilience during the SARS-CoV-2 confinement period. Comments provided may be helpful for managing similar future health-care crises.
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http://dx.doi.org/10.1159/000516327DOI Listing
June 2021

Self-proning in COVID-19 patients on low-flow oxygen therapy: a cluster randomised controlled trial.

ERJ Open Res 2021 Jan 8;7(1). Epub 2021 Mar 8.

Division of Lung Diseases, Geneva University Hospitals, Geneva, Switzerland.

Rationale And Objectives: Prone positioning as a complement to oxygen therapy to treat hypoxaemia in coronavirus disease 2019 (COVID-19) pneumonia in spontaneously breathing patients has been widely adopted, despite a lack of evidence for its benefit. We tested the hypothesis that a simple incentive to self-prone for a maximum of 12 h per day would decrease oxygen needs in patients admitted to the ward for COVID-19 pneumonia on low-flow oxygen therapy.

Methods: 27 patients with confirmed COVID-19 pneumonia admitted to Geneva University Hospitals were included in the study. 10 patients were randomised to self-prone positioning and 17 to usual care.

Measurements And Main Results: Oxygen needs assessed by oxygen flow on nasal cannula at inclusion were similar between groups. 24 h after starting the intervention, the median (interquartile range (IQR)) oxygen flow was 1.0 (0.1-2.9) L·min in the prone position group and 2.0 (0.5-3.0) L·min in the control group (p=0.507). Median (IQR) oxygen saturation/fraction of inspired oxygen ratio was 390 (300-432) in the prone position group and 336 (294-422) in the control group (p=0.633). One patient from the intervention group who did not self-prone was transferred to the high-dependency unit. Self-prone positioning was easy to implement. The intervention was well tolerated and only mild side-effects were reported.

Conclusions: Self-prone positioning in patients with COVID-19 pneumonia requiring low-flow oxygen therapy resulted in a clinically meaningful reduction of oxygen flow, but without reaching statistical significance.
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http://dx.doi.org/10.1183/23120541.00692-2020DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7869594PMC
January 2021

[Novel therapies in respiratory management].

Rev Med Suisse 2021 Jan;17(723):209-213

Service de pneumologie, Département des spécialités de médecine, HUG, 1211 Genève 14.

In this review of the recent medical literature, we have identified 4 topics of interest for the readers of Revue Médicale Suisse. Use of antifibrotic drugs in interstitial lung diseases will soon be extended to a phenotype labeled « progressive fibrosing interstitial lung disease » (PF-ILD). While awaiting for evidence-based treatment, consensual recommendations for a treatment algorithm in pulmonary sarcoidosis has been published. New guidance for non-invasive ventilation in COPD and obesity-hypoventilation syndrome are available in Switzerland and are in line with international recommendations. New treatments targeting CFTR protein activity have become available and could become a therapeutic option for up to 85% of cystic fibrosis patients in Switzerland.
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January 2021

Acute lupus pneumonitis as the initial presentation of systemic lupus erythematosus.

BMJ Case Rep 2020 Jul 7;13(7). Epub 2020 Jul 7.

Division of Pulmonary Diseases, Geneva University Hospitals, Geneva, Switzerland.

Systemic lupus erythematosus is a multisystem autoimmune disease with wide-ranging pleuropulmonary manifestations. Acute lupus pneumonitis is one of its uncommon complications. We report a 36-year-old woman with acute lupus pneumonitis as the initial presentation of systemic lupus erythematosus. Clinical, biological, radiological and functional improvements were noticed with the administration of steroids, hydroxychloroquine and immunoglobulin.
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http://dx.doi.org/10.1136/bcr-2020-234638DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7342476PMC
July 2020

[Revolution in the treatment of cystic fibrosis].

Rev Med Suisse 2020 Jun;16(698):1229-1235

Service de pneumologie, CHUV, 1011 Lausanne.

Cystic Fibrosis is a genetic disorder resulting in the absence or dysfunction of the CFTR protein, a chloride channel present on the surface of epithelia, particularly respiratory. Until recently, treatments only concerned the consequences of the disease. But a new type of molecules called « modulators », is already available to some patients and targets the origin of the disease. « Modulators » are divided into « potentiators », which improve the transport of chloride by the CFTR protein, and « correctors », increasing the amount of CFTR proteins. An oral triple therapy combining a potentiator and two correctors has just been approved in the USA and will treat 85 % of patients. The clinical benefit of « modulators » is remarkable, and these drugs are revolutionizing the treatment of Cystic Fibrosis.
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June 2020

Clinical experience with lung-specific electromagnetic transponders for real-time tumor tracking in lung stereotactic body radiotherapy.

Phys Imaging Radiat Oncol 2019 Oct 28;12:30-37. Epub 2019 Nov 28.

Department of Radiation Oncology, Geneva University Hospital, 53 Av. de la Roseraie, 1205 Geneva, Switzerland.

Background And Purposes: Motion management is crucial for optimal stereotactic body radiotherapy (SBRT) of moving targets. We aimed to describe our clinical experience with real-time tracking of lung-specific electromagnetic transponders (EMTs) for SBRT of early stage non-small cell lung cancer in free-breathing (FB) or deep inspiration breath-hold (DIBH).

Material And Methods: Seven patients were implanted with EMTs. Simulation for SBRT was performed in FB and in DIBH. We prescribed 60 Gy in 3, 5 or 8 fractions to the tumor and delivered SBRT with volumetric modulated arcs and a 6 MV flattening filter free photon beam. Patients' setup at the linac was performed using EMT positions and cone-beam CT (CBCT) verification. Four patients were treated in DIBH because of a dosimetric benefit. We analysed patient alignment and treatment delivery parameters using DIBH or FB and EMT real-time tracking.

Results: There were no complications from the EMT implantation. Visual inspection of CBCT before and/or after SBRT revealed good alignment of structures and EMTs. The median setup time was 9.8 min (range: 4.6-34.1 min) and the median session time was 14.7 min (range: 7.3-36.5 min). EMT positions in lungs remained stable during overall treatment and allowed real-time tracking both in FB and in DIBH SBRT. The treatment beam was gated when EMT centroid position exceeded tolerance thresholds ensuring correct delivery of radiation to the tumor.

Conclusion: Using EMTs for real-time tracking of tumor motion during lung SBRT proved to be safe, accurate and easy to integrate clinically for treatments in FB or DIBH.
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http://dx.doi.org/10.1016/j.phro.2019.11.002DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7807938PMC
October 2019

Comparison of intrapleural use of urokinase and tissue plasminogen activator/DNAse in pleural infection.

ERJ Open Res 2019 Jul 10;5(3). Epub 2019 Sep 10.

Thoracic and Endocrine Surgery, University Hospitals of Geneva and Faculty of Medicine, Geneva, Switzerland.

Fibrinolysis can be used to improve fluid drainage in pleural infection. Treatment with either urokinase or tissue plasminogen activator (t-PA) in association with DNAse a chest tube has been effective at reducing the need for surgery. This study is the first to compare the efficacy of these two treatments. We performed a single-centre, controlled, prospective cohort study. All individuals with pleural infection admitted to our hospital between January 2014 and December 2017 who were treated with antibiotics, a chest tube and fibrinolysis were included in this study. The rate of additional procedure requirements (additional chest tube or surgery) after initial fibrinolysis, complications, costs, and radiological and biological outcomes were analysed. Among the 93 patients included in this study, 34% required additional procedures after an initial fibrinolysis, including 21% who received an additional chest tube and 13% who underwent thoracoscopy. The need for additional procedures arose due to presence of multiple pleural collections (p=0.01) and was associated with the use of large-bore drain (p=0.01). The success rate of fibrinolysis was not significantly different between urokinase and t-PA/DNAse (p=0.35). The differences in drainage duration and in length of hospital stay were not significant either (p=0.05 and p=0.12, respectively). Treatment with t-PA/DNAse was cheaper (p=0.04) but was associated with a higher rate of haemothorax (p=0.002). In conclusion, treatment with urokinase is safer and equally effective when compared with treatment with t-PA/DNAse.
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http://dx.doi.org/10.1183/23120541.00084-2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734009PMC
July 2019

Identification of Non-Tuberculous Mycobacteria in COPD Patients Undergoing Lung Volume Reduction: More Frequent than Expected?

Respiration 2019 22;98(3):279-280. Epub 2019 Jul 22.

Division of Pulmonology, Geneva University Hospitals, Geneva, Switzerland.

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http://dx.doi.org/10.1159/000501697DOI Listing
September 2020

Endoscopic control of gastric emptying after administration of intravenous erythromycin in an awake patient scheduled for urgent rigid bronchoscopy.

BMJ Case Rep 2019 Feb 26;12(2). Epub 2019 Feb 26.

Division of Anaesthesiology, Geneva University Hospitals, Geneva, Switzerland.

Certain interventional pulmonology procedures such as the placement of a tracheal stent or resection of stenosing tracheal tumours require rigid bronchoscopy under general anaesthesia. Unlike an endotracheal tube with a cuff, the rigid bronchoscope only partially protects the airway from bronchoaspiration. For this reason, this procedure is performed on an elective basis in fasted patients. We describe the case of a 60-year-old man with acute respiratory distress requiring emergent rigid bronchoscopy following distal migration of a tracheal stent. One hour before the procedure, the patient had eaten a full meal. Gastric emptying was accelerated by perfusion of intravenous erythromycin and verified by endoscopy with a small diameter gastric endoscope under local anaesthesia. This 1 min procedure was very well tolerated by the patient and allowed to verify with certainty that the stomach was empty. The urgent rigid bronchoscopy for stent retrieval could then be performed safely without any risk of bronchoaspiration.
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http://dx.doi.org/10.1136/bcr-2018-228049DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6398749PMC
February 2019

[New treatments in respiratory medicine in 2018 : asthma, cystic fibrosis and nocturnal positive pressure (CPAP or NIV)].

Rev Med Suisse 2019 Jan;15(N° 632-633):96-100

Service de pneumologie, Département des spécialités de médecine, HUG, 1211 Genève 14.

In this review of novel therapies in pulmonary disorders in 2018, we cover 3 different entities. In GINA stage 1 and 2 asthma, new strategies allow a more individualized treatment. In more severe asthma, there is an increasing interest in biotherapies, with dupilumab, an anti-IL-4 receptor, completing the already available panel which includes anti-IgE, anti-IL-5 and anti-IL-5 receptor antibodies. In cystic fibrosis, a better understanding of the pathogenesis and the genetics of the disease is leading to new treatments acting directly on the function of the CFTR (Cystic fibrosis transmembrane conductance regulator), which, when used in combination, show very promising results. Finally, nocturnal positive pressure treatment (either CPAP or non invasive ventilation : NIV) is used more and more frequently. Recent studies have clarified therapeutic algorithms for the most frequent indications for NIV : COPD and obesity-hypoventilation.
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January 2019

New insights and improved strategies for the management of primary spontaneous pneumothorax.

Clin Respir J 2019 Apr 18;13(4):195-201. Epub 2019 Mar 18.

Centre Valaisan de Pneumologie, Department of Internal Medicine, Montana, Switzerland.

The pathophysiology and management of primary spontaneous pneumothorax (PSP) are a subject of debate. Despite advances in the understanding of its etiopathogenesis and improvements in its management, implementation in clinical practice is suboptimal. In this manuscript, we review the recent literature with a focus on PSP pathophysiology and management. Blebs and emphysema-like changes (ELC) are thought to contribute to the pathophysiology of PSP but cannot explain all cases. Recent studies emphasize the role of a diffuse porosity of the visceral pleura. Others found a relationship between smoking, occurrence of a PSP and bronchiolitis, which could be the initial pathological process leading to ELC development. Recent or ongoing studies challenge the need to systematically remove air from the pleural cavity of stable patients, introducing conservative management as a valuable therapeutic option. Evidence is growing in favour of needle aspiration instead of chest tube insertion, when air evacuation is needed. In addition, ambulatory management is considered as a successful approach in meta-analyses and is under exploration in a large randomized study. Because of a high recurrence rate of PSP, the benefit of performing a pleurodesis at first occurrence is under evaluation with interesting but not generalizable results. Better identification of 'at risk patients' is needed to improve the investigation strategy. Finally, recent publications confirm the efficacy, security and cost-effectiveness of graded talc poudrage pleurodesis to prevent PSP recurrence. In conclusion, PSP pathophysiology and management are still under investigation. The results of recently published and ongoing studies should be more widely implemented in clinical practice.
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http://dx.doi.org/10.1111/crj.12990DOI Listing
April 2019

[Transbronchial cryobiopsies : a minimally invasive tool for the diagnosis of interstitial lung disease].

Rev Med Suisse 2018 Nov;14(627):2079-2083

Service de pneumologie, Département des spécialités de médecine, HUG, 1211 Genève 14.

The diagnosis of interstitial lung disease (ILD) is challenging and relies on a multidisciplinary discussion involving clinical, radiological and sometimes histological features. Bronchoscopic lung cryobiopsies have emerged as a new minimally invasive method of lung sampling and an alternative to surgical lung biopsies. A good diagnostic performance and excellent safety profile make it an interesting and worthful procedure which could decrease the number of patients without proper diagnosis and treatment. There is a need for further studies to standardize the technique in expert centers and to establish its role in the diagnostic work-up of ILD.
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November 2018

Utility of Rapid On-Site Cytologic Evaluation during Endobronchial Ultrasound-Guided Transbronchial Needle Aspiration in Malignant and Nonmalignant Disease.

Acta Cytol 2018 21;62(5-6):380-385. Epub 2018 Sep 21.

Department of Pulmonology, Geneva University Hospitals, Geneva, Switzerland.

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an accurate procedure to sample mediastinal tissue. Rapid on-site cytologic evaluation (ROSE) has been advocated to improve the performance of this procedure, but its benefit remains controversial. Our objective is to assess the utility of ROSE for EBUS-TBNA diagnostic accuracy among unselected patients.

Methods: We prospectively collected data from all consecutive EBUS-TBNA procedures performed between 2008 and 2014. ROSE was introduced since 2011 in our daily practice. The accuracy of EBUS-TBNA with and without ROSE was compared in a univariate and multivariate model accounting for confounding factors. The impact of ROSE was then analyzed according to the etiology and size of the lesions.

Results: Among 348 EBUS-TBNA procedures analyzed, 213 were performed with ROSE. The overall accuracy tended to be better with ROSE than without (90.6 vs. 84.4%; p = 0.082). After adjustment in a multivariate model, the benefit of ROSE still did not reach statistical significance (adjusted odds ratio 1.86; 95% confidence interval 0.79-4.41). Similar results were obtained in subgroups of patients with malignant disease or sarcoidosis. The size of the lesion did not influence the impact of ROSE on accuracy.

Conclusions: ROSE was associated with a moderate increase in the accuracy of EBUS-TBNA, but the difference was not statistically significant. The same effect of ROSE was observed in malignant and nonmalignant lesions and this effect was not influenced by the lesion's size.
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http://dx.doi.org/10.1159/000493334DOI Listing
January 2019

Endobronchial coil therapy in severe emphysema: 6-month outcomes from a Swiss National Registry.

J Thorac Dis 2018 Aug;10(Suppl 23):S2711-S2718

Division of Pulmonary Medicine, Geneva University Hospitals, Geneva, Switzerland.

Background: Endobronchial coils have been demonstrated in three randomized, controlled trials to improve quality of life, exercise tolerance, and lung function in patients with severe emphysema. This therapy is CE-marked and commercially available in Switzerland. Coil treated patients are followed in a post-market Swiss registry to collect safety and effectiveness data in routine clinical practice.

Methods: The Swiss coil registry was initiated in October 2013. At the end of November 2016, an interim analysis of all 64 patients treated in five centers was performed to evaluate safety and effectiveness at six months post treatment.

Results: patients had completed bilateral treatment with 6-month follow up at the time of data analysis. Patients had very severe, symptomatic emphysema and hyperinflation [38% male, mean age 66 years, BMI 24, FEV1 30% pred., residual volume (RV) 247% pred., 6-minute walking distance (6-MWD) 272 m, St. George Respiratory Questionnaire (SGRQ) 57 points]. Up to 6 months following treatment, seven serious adverse events (SAE) were reported in 6/29 patients. No device removals were necessary. At 6 months, responder rates [% achieving the minimal clinically important difference (MCID)] were as follows: RV (-0.35 L) 76%; FEV1 (+10%) 57%; SGRQ (-4 points) 87%; 6MWD (+26 m) 60%.

Conclusions: Endobronchial coil therapy performed in expert centers in Switzerland yields high 6-month responder rates across all relevant outcome.
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http://dx.doi.org/10.21037/jtd.2018.04.53DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6129812PMC
August 2018

Azole Resistance of Environmental and Clinical Aspergillus fumigatus Isolates from Switzerland.

Antimicrob Agents Chemother 2018 04 27;62(4). Epub 2018 Mar 27.

Institute of Microbiology, University of Lausanne and University Hospital Center, Lausanne, Switzerland

is a ubiquitous opportunistic pathogen. This fungus can acquire resistance to azole antifungals due to mutations in the azole target (). Recently, mutations typical for environmental azole resistance acquisition (for example, TR/L98H) have been reported. These mutations can also be found in isolates recovered from patients. Environmental azole resistance acquisition has been reported on several continents. Here we describe, for the first time, the occurrence of azole-resistant isolates of environmental origin in Switzerland with mutations, and we show that these isolates can also be recovered from a few patients. While the TR/L98H mutation was dominant, a single azole-resistant isolate exhibited a mutation (G54R) that was reported only for clinical isolates. In conclusion, our study demonstrates that azole resistance with an environmental signature is present in environments and patients of Swiss origin and that mutations believed to be unique to clinical settings are now also observed in the environment.
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http://dx.doi.org/10.1128/AAC.02088-17DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5913999PMC
April 2018

Prise en charge d’un nodule pulmonaire (pour généraliste).

Authors:
Jérôme Plojoux

Rev Med Suisse 2018 Jan;14(591):227-228

Service de pneumologie, HUG, 1211 Genève 14.

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January 2018

[Inhaled antibiotics for the management of non cystic fibrosis bronchiectasis].

Rev Med Suisse 2017 Nov;13(583):2001-2004

Service de pneumologie, Département des spécialités de médecine, HUG, 1211 Genève 14.

Bronchiectasis is irreversible bronchial dilatation associated with chronic respiratory symptoms. Management is aimed at reducing symptoms and slowing the progression of the disease by interrupting the vicious circle: bronchial infection, inflammation, altered mucociliary clearance, lung destruction. Unlike the literature on inhaled antibiotics in cystic fibrosis, literature data are limited and of low quality for bronchiectasis of other causes. However, new recommendations from the European Respiratory Society propose the conditional use of inhaled antibiotics to prevent repeated infectious exacerbations and to eradicate colonization.
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November 2017

Positive pleural cytology is an indicator for visceral pleural invasion in metastatic pleural effusions.

Clin Respir J 2018 Mar 15;12(3):1011-1016. Epub 2017 Mar 15.

Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, Aix-Marseille University, Marseille, France.

Introduction: In case of undiagnosed pleural effusions, it is necessary to conduct thoracentesis with pleural fluid (PF) cytology. Yet, sensitivity of PF cytology is widely variable as a result of sample size, experience, and preparation method.

Objectives: The aim of this study was to assess whether pleural fluid (PF) cytology is correlated to visceral or parietal pleural invasion as assessed by thoracoscopy in metastatic pleural effusions.

Methods: All records of patients with pleural effusion were reviewed. The inclusion criteria were as follows: PF cytology, reported appearance of macroscopic pleural invasion during thoracoscopy and malignant diagnosis. Patients with mesothelioma were excluded. Finally, 287 patients who met all criteria were selected. According to the thoracoscopy findings, the extent of the disease on the pleura was analyzed in relation to the PF cytology.

Results: In this study, 160 patients (55.7%) had a positive PF cytology (Group A) while 127 (44.3%) recorded negative PF cytology (Group B). From Group A, patients with visceral pleural invasion were 120 (75%) while only 49 patients (38.5%) were found from Group B and the difference was statistically significant (P < .00001). In univariate analysis, visceral pleural invasion was strongly associated with positive PF cytology (P < .001). Other significant associations with positive PF cytology included PF bloody aspect (P = .012), and endoscopic mixed pattern of pleural invasion (P = .0039). Only visceral pleural invasion was statistically significant in multivariate analysis (P < .001).

Conclusions: In patients with pleural metastatic disease, visceral pleural invasion is the only significant factor associated with positive pleural fluid cytology.
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http://dx.doi.org/10.1111/crj.12619DOI Listing
March 2018

Pulmonary Perfusion Changes as Assessed by Contrast-Enhanced Dual-Energy Computed Tomography after Endoscopic Lung Volume Reduction by Coils.

Respiration 2016 8;92(6):404-413. Epub 2016 Nov 8.

Service of Pulmonary Medicine, Geneva University Hospitals, Geneva, Switzerland.

Background: Endoscopic lung volume reduction by coils (LVRC) is a recent treatment approach for severe emphysema. Furthermore, dual-energy computed tomography (DECT) now offers a combined assessment of lung morphology and pulmonary perfusion.

Objectives: The aim of our study was to assess the impact of LVRC on pulmonary perfusion with DECT.

Methods: Seventeen patients (64.8 ± 6.7 years) underwent LVRC. DECT was performed prior to and after LVRC. For each patient, lung volumes and emphysema quantification were automatically calculated. Then, 6 regions of interest (ROIs) on the iodine perfusion map were drawn in the anterior, mid, and posterior right and left lungs at 4 defined levels. The ROI values were averaged to obtain lung perfusion as assessed by the lung's iodine concentration (CLung, μg·cm-3). The CLung values were normalized using the left atrial iodine concentration (CLA) to take into account differences between successive DECT scans.

Results: The 6-min walk distance (6MWD) improved significantly after the procedure (p = 0.0002). No lung volume changes were observed between successive DECT scans for any of the patients (p = 0.32), attesting the same suspended inspiration. After LVRC, the emphysema index was significantly reduced in the treated lung (p = 0.0014). Lung perfusion increased significantly adjacent to the treated areas (CLung/CLA from 3.4 ± 1.7 to 5.6 ± 2.2, p < 0.001) and in the ipsilateral untreated areas (from 4.1 ± 1.4 to 6.6 ± 1.7, p < 0.001), corresponding to a mean 65 and 61% increase in perfusion, respectively. No significant difference was observed in the contralateral upper and lower areas (from 4.4 ± 1.9 to 4.8 ± 2.1, p = 0.273, and from 4.9 ± 2.0 to 5.2 ± 1.7, p = 0.412, respectively). A significant correlation between increased 6MWD and increased perfusion was found (p = 0.0027, R2 = 0.3850).

Conclusions: Quantitative analysis based on DECT acquisition revealed that LVRC results in a significant increase in perfusion in the coil-free areas adjacent to the treated ones, as well as in the ipsilateral untreated areas. This suggests a possible role for LVRC in the improvement of the ventilation/perfusion relationship.
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http://dx.doi.org/10.1159/000452477DOI Listing
September 2017

[New therapeutic approaches in 2015 in pulmonary medicine].

Rev Med Suisse 2016 Jan;12(500):80-2, 84-5

During the past year, among the many novelties in the field of pulmonary medicine, the authors chose to focus on 4 items: the positive contribution of systemic steroids on clinical improvement and length of stay in patients hospitalized for community-acquired pneumonia; the interesting results obtained with high flow oxygen, heated and humidified, in acute care and in normocapnic respiratory failure, a device which warrants further clinical testing in other indications; the now documented benefits of lung volume reduction procedures by bronchoscopy using coils in severe emphysema with hyperinflation; and the publication of new recommendations regarding pulmonary hypertension, with an emphasis on new molecules and their efficacy, on an early use of combination treatments, and on the importance of expert centres in managing these patients.
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January 2016

Minimally Invasive but Maximally Obstructive: Carcinoma In Situ Obstructing a Mainstem Bronchus.

J Bronchology Interv Pulmonol 2017 Jan;24(1):67-69

Departments of *Thoracic Oncology, Pleural Diseases and Interventional Pulmonology †Pathology §Thoracic Surgery, Hôpital Nord, Assistance Publique-Hôpitaux de Marseille (AP-HM) ‡URMITE CNRS IRD UMR 6236, Aix-Marseille University, Marseille, France.

Here we report a case of mainstem bronchus obstruction due to a carcinoma in situ. Preinvasive lesions, such as carcinoma in situ, are usually small and limited to the bronchial wall. This exceptional presentation shows a tumor growth large enough to completely occlude the right mainstem bronchus. The endoluminal lesion was removed using rigid bronchoscopy. The patient, not eligible for a local treatment, has been treated with surgery.
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http://dx.doi.org/10.1097/LBR.0000000000000219DOI Listing
January 2017

Management of benign dynamic "A-shape" tracheal stenosis: a retrospective study of 60 patients.

Ann Thorac Surg 2015 Feb 12;99(2):447-53. Epub 2014 Dec 12.

Thoracic Oncology, Pleural Diseases and Interventional Pulmonology Department, North University Hospital, Marseille, France. Electronic address:

Background: Benign tracheal stenosis complicates tracheal intubation or tracheostomy in 0.6% to 65% of cases. Surgical resection is the standard treatment. Endoscopic management is used for inoperable patients with 17% to 69% success. Dynamic "A-shape" tracheal stenosis (DATS) results in a dynamic stenosis with anterior fracture of tracheal cartilage and frequently associated posterior malacia. We report the results of our multidisciplinary management.

Methods: Sixty patients with DATS were included. Management decision was made during initial bronchoscopy. When suitable, patients were referred to thoracic surgery for tracheal resection. Posterior localized tracheomalacia was treated with laser photocoagulation of the posterior tracheal wall. Tracheal stents were placed if the stenosis persisted after laser treatment. The choice of stent (straight silicone, hour-glass shaped silicone, T-tube, or fully-covered self-expandable metallic stent) was based on operator's judgment. After 12 to 18 months, stents were removed. If the stenosis persisted after stent removal, surgery was reconsidered. If surgery was not possible, a stent was replaced. In case of satisfactory result, a stent was replaced only after recurrence. Stable patients after treatment were considered as success, requirement of long-term tracheostomy or T tube as failure, and long-term stent as partial success.

Results: All patients developed DATS after tracheostomy. Thirty-three patients had posterior tracheomalacia. In 13 patients, mild stenosis required only endoscopic surveillance. Two patients were referred to thoracic surgery for tracheal resection surgery. Endoscopic management was the initial therapy in 45 patients (75%) and was considered successful in 23 patients (51%), partially successful in 10 (22%), and failed in 12 (27%). Five patients with successful outcomes required only laser therapy. Overall 70 stents were placed in 35 patients, with a migration rate of 31%.

Conclusions: The DATS management was successful in 63%. Stent migration was frequent. Posterior tracheomalacia was successfully treated in selected cases, avoiding stent placement.
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http://dx.doi.org/10.1016/j.athoracsur.2014.08.037DOI Listing
February 2015

Endobronchial sealing with glue for malignant hemoptysis.

J Bronchology Interv Pulmonol 2014 Oct;21(4):373-5

*Department of Thoracic Oncology Pleural Diseases and Interventional Pulmonology, Hôpital Nord †Aix-Marseille University Marseille Cedex, France.

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http://dx.doi.org/10.1097/LBR.0000000000000117DOI Listing
October 2014

Endobronchial occlusion for massive hemoptysis with a guidewire-assisted custom-made silicone spigot: a new technique.

J Bronchology Interv Pulmonol 2014 Oct;21(4):366-8

Department of Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Hôpital Nord, University of the Mediterranean, Marseille, France.

Endobronchial Watanabe spigot is a device used to occlude bronchus for a variety of indications. It has been recently used for endobronchial occlusion for hemoptysis. However, its application is not always easy, particularly if the bleeding is originating from the upper lobes. To facilitate its placement, we developed a new technique using a guidewire and a custom-made spigot. We report a case of massive hemoptysis from a left lung cancer describing this new approach.
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http://dx.doi.org/10.1097/LBR.0000000000000106DOI Listing
October 2014

Guillain-Barre syndrome after lung lobectomy: is there any relationship?

Ann Thorac Surg 2014 May;97(5):e133-4

Department of Thoracic Oncology, Pleural Diseases, and Interventional Pulmonology, Hôpital Nord, Marseille, France; School of Medicine, Aix-Marseille University, Marseille, France. Electronic address:

Guillain-Barré syndrome (GBS) is an acute inflammatory polyradiculopathy frequently triggered by infection. It has also been reported in some cases after surgical procedures. We describe the first case of GBS occurring 9 days after lung lobectomy for localized lung cancer and efficiently treated with intravenous immunoglobulins. The exact physiopathology of GBS after surgical procedures is unknown. An immune-mediated process and perioperative infection are the most accepted etiologic hypotheses.
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http://dx.doi.org/10.1016/j.athoracsur.2013.12.067DOI Listing
May 2014

The use of self-expandable metallic stents in the airways in the adult population.

Expert Rev Respir Med 2014 Apr 22;8(2):179-90. Epub 2014 Jan 22.

North University Hospital, Thoracic Oncology, Pleural Diseases and Interventional Pulmonology, Marseille, 13015 France.

The airway stents restore patency in the face of luminal compromise from intrinsic and/or extrinsic pathologies. Luminal compromise beyond 50% often leads to debilitating symptoms such as dyspnea. Silicone stents remain the most commonly placed stents worldwide and have been the "gold standard" for the treatment of benign and malignant airway stenoses over the past 20 years. Nevertheless, silicone stents are not the ideal stents in all situations. Metallic stents can serve better in some selected conditions. Unlike silicone stents, there are large and increasing varieties of metallic stents available on the market. The lack of prospective or comparative studies between various types of metallic stents makes the choice difficult and expert-opinion based. International guidelines are sorely lacking in this area.
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http://dx.doi.org/10.1586/17476348.2014.880055DOI Listing
April 2014

Prehospital emergency physician activation of interventional cardiology team reduces door-to-balloon time in ST-elevation myocardial infarction.

Swiss Med Wkly 2010 Apr;140(15-16):228-32

Emergency Department, Geneva University Hospitals, Geneva, Switzerland.

Question Under Study: To explore whether early activation of an interventional cardiology team, by prehospital emergency physicians, reduces door-to-balloon time (DTBT) in patients with ST-elevation myocardial infarction (STEMI) diagnosed with prehospital ECG.

Methods:

Design: before-after comparison.

Setting: emergency department (ED) of an urban teaching hospital with a catheterisation laboratory open continuously.

Study Subjects: patients with STEMI diagnosed in the prehospital setting or in the ED within 12 hours of symptoms.

Intervention: a paging system or "STEMI alarm", activated by prehospital physicians, which simultaneously notified both the catherisation laboratory and cardiology teams before the patient's arrival to the ED.

Outcome Measures: DTBT and the proportion of patients with DTBT <90 minutes.

Results: A total of 196 patients were included; 77 before and 119 after implementation of the "STEMI alarm". Between the two periods, median DTBT decreased from 109 to 76 minutes (p <0.001) and the proportion of patients treated within 90 minutes increased from 36% to 66% (p <0.001). During intervention, the STEMI alarm was activated in 67 patients (56%). In these cases the median DTBT was 50 minutes, with 96% within 90 minutes. The alarm was inappropriately activated in 9 cases (11%).

Conclusions: Catheterisation laboratory activation by a prehospital emergency physician markedly reduces DTBT in STEMI patients.
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http://dx.doi.org/smw-12927DOI Listing
April 2010
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