Introduction. - Pulmonary siderosis or welder's lung is an occupational lung disease that is usually observed after chronic exposure to iron dust. Observation. - A 55-years-old welder visited hospital with dyspnea linked to occupational exposure. Pulmonary function studies revealed lung function abnormalities with decerase of FEV1 and TPC. Based on the chest Tomography CT results, he was diagnosed with obliterans bron-chiolitis. A chest biopsy was performed and the specimen is for a pulmonary siderosis aspect. Discussion. - This case of pulmonary siderosis is an unusual one by symptoms, CT images and short latency of exposure. An intense inhalation of iron particles could explain this case and inflammatory process and it highlights need of histological analysis of chest biopsy. (C) 2022 SPLF. Published by Elsevier Masson SAS. All rights reserved.

Pulmonary siderosis or welder's lung is an occupational lung disease that is usually observed after chronic exposure to iron dust.A 55-years-old welder visited hospital with dyspnea linked to occupational exposure. Pulmonary function studies revealed lung function abnormalities with decerase of FEV1 and TPC. Based on the chest Tomography CT results, he was diagnosed with obliterans bronchiolitis. A chest biopsy was performed and the specimen is for a pulmonary siderosis aspect.This case of pulmonary siderosis is an unusual one by symptoms, CT images and short latency of exposure. An intense inhalation of iron particles could explain this case and inflammatory process and it highlights need of histological analysis of chest biopsy.

Urinothorax refers to the presence of urine in the pleural space. Urinothorax is an infrequent and underdiagnosed pathology, with few cases reported, and these often suspected only with hindsight. It is usually a transudative pleural effusion. We report a case of urinothorax presenting as a purulent pleural effusion. Management of the urinothorax required antibiotics and surgical unblocking of the urinary tract. Currently, no test is available to confirm the diagnosis. The ratio of serum creatinine/pleural creatinine could suggest the presence of urinothorax but this parameter needs to be validated by complementary studies. Urinothorax should be suspected in the context of pleural effusion occurring after a recent urologic surgery.

L’urinothorax correspond à la présence d’urine dans la cavité pleurale. Il s’agit d’une pathologie peu fréquente, sous diagnostiquée et souvent suspectée a posteriori. Habituellement, il s’agit d’un transsudat. Nous rapportons le cas d’une patiente dont l’urinothorax est révélé par une pleurésie purulente. La désobstruction des voies urinaires et l’instauration d’une antibiothérapie adaptée ont permis une régression quasi-complète de l’épanchement pleural. Actuellement, aucun test paraclinique ne semble être spécifique de l’urinothorax. En revanche, il semble que le ratio créatinine pleurale sur créatinine sérique puisse orienter vers ce diagnostic mais des études complémentaires semblent nécessaires pour valider ce paramètre biologique. De manière générale, tout geste urologique récent associé à l’apparition d’une pleurésie doit faire suspecter un urinothorax.

Introduction. Infection with Mycobacterium abscessus sensu lato is uncommon in patients without cystic fibrosis. We are interested in these patients and have collected cases in Finistere between 2007 and 2011.Case reports. Four patients met the infection criteria recommended by the American Thoracic Society in 2007. Among them, all had Aspergillus spp. in sputum, 3 had gastroesophageal reflux and two had the criteria for allergic bronchopulmonary aspergillosis. We identified Mycobacterium massiliense in the single patient in our series whose therapeutic outcome was successful.Conclusion. By comparing these data with those in the literature, we believe that the search for allergic bronchopulmonary aspergillosis and gastroesophageal reflux is necessary in these patients and that species identification is essential for prognosis. (C) 2015 SPLF. Published by Elsevier Masson SAS. All rights reserved.

La bronchopneumopathie chronique obstructive (BPCO) est une maladie inflammatoire chronique associée à un état procoagulant. L’objectif principal était d’évaluer le risque de récidive de maladie veineuse thromboembolique (MVTE) associé à la présence d’une BPCO après arrêt du traitement anticoagulant initial. Il s’agit d’une cohorte prospective de patients ayant un premier épisode de MVTE recrutés entre 2001 et 2014. La présence d’une BPCO a été confirmée sur les données spirométriques. Le critère de jugement principal était la survenue d’une récidive thromboembolique documentée et adjudiquée, définie par une récidive de thrombose veineuse profonde (TVP) symptomatique ou d’embolie pulmonaire (EP) symptomatique ou de MVTE fatale. Les critères de jugements secondaires étaient le phénotype de la récidive (sous la forme d’une EP ou TVP) et la mortalité globale. Les facteurs prédictifs de récidive ont été étudiés selon une analyse univariée (test de Log Rank) puis multivariée (modèle de Cox). Sur les 1948 patients, 139 patients présentaient une BPCO et 423 ont présenté une MVTE récidivante (45 patients avec BPCO et 378 patients sans BPCO), sur une médiane de suivi de 2,4 ans. L’incidence annuelle de récidive était de 9,2 % [IC95 % : 6,9–12,3] chez les patients BPCO et 5,1 % [IC95 % : 4,6–5,6] chez les patients sans BPCO. En analyse multivariée, la BPCO n’était pas associée à une augmentation du risque de MVTE récidivante (hazard ratio : 1,2 ; IC95 % : 0,9–1,6 ; p = 0,29). Les patients ont récidivé d’avantage sous la forme d’une EP que d’une TVP. Le risque de décès, ajusté sur les caractéristiques démographiques et cliniques, n’était pas différent entre les patients avec et sans BPCO. Chez les patients ayant une MVTE, la présence d’une BPCO n’a pas été retrouvée associée à un risque accru de récidive thromboembolique ni de décès. Toutefois, la forme clinique de la récidive est essentiellement une EP.

Autologous blood transfusions (ABTs) has been used by athletes for approximately 4 decades to enhance their performance. Although the method was prohibited by the International Olympic Committee in the mid 1980s, no direct detection method has yet been developed and implemented by the World Anti-Doping Agency (WADA). Several indirect methods have been proposed with the majority relying on changes in erythropoiesis-sensitive blood markers. Compared with the first methods developed in 1987, the sensitivity of subsequent tests has not improved the detection of blood doping. Nevertheless, the use of sophisticated statistical algorithms has assured a higher level of specificity in subsequent detection models, which is a crucial aspect of antidoping testing particularly to avoid "false positives." Today, the testing markers with the best sensitivity/specificity ratio are the Hbmr model (an algorithm based on the total amount of circulating hemoglobin level [hemoglobin level mass] and percentage of reticulocytes, 4.51⋅ln(Hbmass)−%ret) and the OFF-hr model (algorithm based on hemoglobin level concentration and percentage of reticulocytes, Hb(g/L)−60⋅%ret). Only the OFF-hr model is currently approved by WADA. Recently, alternative indirect strategies for detecting blood doping have been proposed. One method is based upon a transfusion-induced immune-response resulting in specific changes in gene expression related to leukocytes such as T lymphocytes. Another method relies on detecting increased plasticizer metabolite levels in the urine caused by the leakage of plasticizers from the blood bags used during the blood storage. These methods need further development and validation across different types of transfusion regimes before they can be implemented. In addition, several research projects have been funded by WADA in recent years and are now under development including "Detection of Autologous Blood Transfusions Using Activated Red Blood Cells (the red blood cells eNOS system)" and "Detection of Autologous Blood Transfusion by Proteomic: Screening to find Unique Biomarkers, Detecting Blood Manipulation from Total Hemoglobin Mass using 15-nitric Oxide as a Tracer Gas, Storage Contamination as a Potential Diagnostic Test for Autologous Blood Transfusion and Test for Blood Transfusion (Autologous/Homologous) based on Changes of Erythrocyte Membrane Protome" (WADA, WADA Funded Research Projects. http://www.wada-ama.org/en/Science-Medicine/Research/Funded-Research-Projects/. 2010). Although strategies to detect autologous blood transfusion have improved, a highly sensitive test to detect small volumes of transfused autologous blood has not yet been implemented.

This paper presents a ship inventory routing and scheduling problem with undedicated compartments (sIRPSP-UC). The objective of the problem is to find a minimum cost solution while satisfying a number of technical and physical constraints within a given planning horizon. In this problem, we identify four sub-problems that need to be decided simultaneously: route selections, ship selection, loading, and unloading activity procedures. To solve this problem, first, we developed a mixed integer linear programming model. We then developed a one-step greedy heuristic, and then based on this heuristic, we propose a set of heuristics. Each heuristic has a combination of rules for each sub-problem. A number of problem instances are used to compare the solutions of the two approaches. We applied selected good combinations of rules to solve each problem using the heuristic approach. The results show that 8 out 12 of the considered problem instances have no gap with MILP solution solved using LINGO. We also find that the average gap is 1.96%. In contrast when we consistently use the same combination for all iterations, there are no dominant combinations of heuristics that can find good solutions for all the problem instances.

Le traitement des infections à mycobactéries atypiques est entrepris après identification précise de la mycobactérie et enquête sur son rôle pathogène. L'apparition de l'épidémie de SIDA a totalement modifié l'aspect de ces infections qui sont beaucoup plus fréquentes au cours du SIDA que dans la population générale. L'infection à M. kansasii doit être traitée durant 12 mois après négativation bactériologique par l'association isoniazide, rifampicine et éthambutol. L'infection à M. xenopi est résistante à la plupart des traitements antituberculeux. Des essais sont en cours, utilisant de nouvelles quinolones, de nouvelles ansamycines et de nouveaux macrolides. Le traitement des infections à M. avium intracellulare, responsables chez les patients atteints de SIDA de mycobactérioses disséminées, est particulièrement difficile. La clofazimine, de nouveaux macrolides comme la clarithromycine, des nouvelles quinolones, l'amikacine et des dérivés de la rifampicine sont actuellement testés. Les autres infections à mycobactéries sont rares et les traitements, peu codifiés, ne sont qu'inconstamment efficaces contre la plupart de ces mycobactéries.The treatment of non tuberculous mycobacteria was initiated after complete identification of the responsible agent. The responsability of mycobacteria in disease had to be established in each case for mycobacteria other than M. tuberculosis. M. kansasii infections are treated during 12 months after bacteriological clearance by an combination of rifampicin, isoniazid and ethambutol. M. xenopi infections are resistant to major antituberculous drugs. Studies using new quinolones, new ansamycines and new macrolides are ongoing. M. avium intracellulare is the responsible agent of subcutaneous, nodes and lung infections in immunocompetent subject. In HIV infected patients M. avium is the responsible agent of disseminated disease. The association of rifabutin isoniazid, clofazimine and ethambutol recommanded has no established efficacy. New drugs as clarithromycin, a new macrolid, fluoroquinolones, ansamycines, amikacine and others are tested to efficacy with promising results for several of them. Other mycobacterial diseases were unfrequent, and most of the potential pathogenic mycobacteria are not susceptible to antimycobacterial agents.

Objective. - To describe the features of pulmonary arterial hypertension (PAH) in elderly patients.Methods. - A single centre, descriptive study of PAH patients consecutively referred to a regional centre, from September 2002 to February, 1st, 2009. The group of patients aged 65 and above at the time of the diagnosis was compared to the younger patients.Results. - Sixty-six patients suffering from PAH (group 1) have been investigated by means of right heart catheterisation. There were 24 patients aged 65 and above. Mean pulmonary arterial pressure was tower in the patients aged over 65. The older patient group had more respiratory and/or cardiac co-morbidities, a lower median distance in the 6 minute walk test and a higher median Pro-BNP level. Specific PAH treatments were prescribed in both groups. Fifteen patients aged 65 and above were on long-term oxygen therapy (vs four younger patients, p < 0.0001). The elderly patients had a median survival of 32 months.Conclusion. - The diagnosis of PAH in elderly patients is associated with a poor prognosis. The management of these patients needs further studies. (C) 2009 Published by Elsevier Masson SAS.

Background: Currently, two sputum colour charts (SCC) are used in bronchiectatic disease. The SCC developed by Stockley1, consists of 9 colour fields. The SCC developed by Murray2, encompasses 8 sputum photographs. Both SCC have arbitrary gradations and are rather difficult to reproduce. Aimes: Development of a continuous, standardized and easy to reproduce SCC, based on the Natural Colour System (NCS). Methods: Every colour has an NCS code, composed of a darkness, a saturation and a hue. By comparing the photographs of the Murray chart with the NCS, we selected corresponding NCS hues. We have modified the saturation and darkness for each hue in order to achieve 17 successive colours per hue. The achieved colours were inserted in a 17x4 table. Printing with Docucolor 242 Xerox laser printer; brightness 85%. Results: A new, reproducible 17-part SCC, built up with NCS colours (figure 1). The spectrum is ranging from bright yellowish/greenish colours (low saturation-low darkness) to dark brown/green colours (high saturation-high darkness). In the vertical direction each section is composed of equivalent boxes that have a different hue but otherwise the same properties (same saturation and darkness). Conclusions: We developed a fluent, reproducible 17-part SCC encoded in the NCS. Further research is needed to assess its reliability and to evaluate the number of categories. 1Stockley RA et al. Thorax 2001 2Murray MP et al. Eur Respir J 2009.

La performance de la ponction ganglionnaire à l’aiguille par voie transbronchique sous repérage échographique (EBUS-PTBA) pour le diagnostic d’adénopathies médiastinales survenant chez des patients aux antécédents de néoplasie extrapulmonaire est peu décrite.Sur la période de janvier 2007 à juillet 2011, 68 patients aux antécédents de néoplasie extrapulmonaire, actuels ou passés, ont bénéficié d’une exploration par EBUS-PTBA dans le cadre d’adénopathies médiastinales suspectes.Sur les 68 patients, 31 présentaient un diagnostic de cancer. Dix-neuf avaient un résultat anatomopathologique similaire à l’histologie initiale (essentiellement pour les néoplasies coliques, œsophagiennes et lymphomateuses), 12 étaient « inattendus » dont dix cancers pulmonaires. Parmi les 37 patients sans diagnostic, 27 avaient du matériel lymphoïde, deux une inflammation non spécifique et huit un examen non contributif. On constatait que les conditions de réalisation étaient plus souvent rapportées difficiles chez ces patients.Le rendement de l’EBUS-PTBA dans un contexte de néoplasie extrapulmonaire est très variable selon l’origine néoplasique. Néanmoins, un diagnostic est retenu dans près de 50 % des cas. Ces résultats sont encourageants et mettent l’accent sur l’intérêt de mieux cibler les indications et les conditions de réalisation.There is limited data about the diagnostic performance of EBUS-TBNA in patients with mediastinal lymphadenopathy and extrathoracic malignancy.From January 2007 to July 2011, EBUS-TBNA was performed in 68 patients with a history of extrathoracic malignancy (current or past) and suspected mediastinal lymph node metastases.Thirty-one patients had a final diagnosis of cancer. In nineteen patients, the same histology was identified in the mediastinal nodes as in their prior extrathoracic cancer (colorectal cancer, esophageal cancer and lymphoma). In 12, the diagnosis was not “as expected” (ten lung cancers, one colorectal cancer, one unidentified cancer). Among 37 patients without diagnosis, biopsies in 27 showed normal lymphoid material, two had non-specific inflammation and eight had no contributory results. It was noted that procedures were reported to have been more difficult in these patients.Diagnostic performance of EBUS-TBNA in the context of extrathoracic malignancy is very variable depending on the origin of the cancer. Nevertheless, a diagnosis is concluded in almost 50% of the cases. These results underline the necessity to select carefully the indications of EBUS-TBNA in extrathoracic cancer.