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Background SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection is associated with various complications. PMA (primary meningococcal arthritis) is a rare meningococcus-associated disease causing arthritis of the knee usually, without any signs of invasive meningococcal disease. No case of PMA in a COVID-19 (coronavirus disease, 2019) patient has yet been described. PMA mainly strikes young adults. PMA is not associated with any immunocompromising condition. It has a better outcome than usual septic arthritis Case presentation Herein, we report an 18-year-old man diagnosed with COVID-19, later admitted with persistent fever, right knee arthralgia and maculopapular rash. Due to family history, psoriasis and Henoch-Schönlein purpura were hypothesized and ruled out. Finally, synovial fluid culture confirmed Neisseria meningitidis serogroup B arthritis without any other symptoms of invasive meningococcal disease. Healing was achieved quickly with surgery and antibiotics. We concluded in a PMA. Conclusion We describe here the first primary meningococcal arthritis in a COVID-19 patient and we hope to shine a light on this rare but serious complication.

Coastal marine ecosystems, which play a crucial role in the biogeochemical and ecological functioning of the Earth, are highly sensitive to the combined effects of climate and human activities. Because of their location, coastal ecosystems are directly influenced by human activities, but it remains challenging to assess the spatial and temporal scales at which climate influences coastal ecosystems. We monitored 12 sampling stations, distributed in 8 ecosystems in France, over 2 decades for physico-biogeochemical parameters (temperature, salinity, concentrations of dissolved oxygen, nutrients and particulate material). The study encompasses a large diversity of temperate coastal ecosystems with respect to e.g. geomorphology, trophic status, tidal regime, river influence and turbidity. Time-series analysis coupled with standardised 3-mode principal component analyses, partial triadic analyses and correlations were used to assess bi-decadal variability and ecosystem trajectories, and to identify large-scale, regional and local drivers. Our results highlighted 2 abrupt changes in 2001 and 2005. The bi-decadal changes were related to changes in large-scale and regional climate, detected through proxies of temperature and atmospheric circulation, as well as through river discharge. Ecosystem trajectories tended to move towards an increase in temperature and salinity, and/or a decrease in chlorophyll a, nutrients and particulate matter. However, the magnitude of change, the year-to-year variability and the sensitivity to the 2001 and 2005 changes varied among the ecosystems. This study highlights the need for establishing long-term time series and combining data sets as well as undertaking multi-ecosystem and local studies to better understand the long-term variability of coastal ecosystems and its associated drivers.

Resume Introduction La recherche de mutations de l’ epidermal growth factor receptor (EGFR) a modifie l’approche therapeutique et le pronostic des carcinomes bronchiques non a petites cellules (CBNPC). L’efficacite des inhibiteurs des tyrosines kinases (TKI) par voie orale a ete demontree chez les patients mutes. Nous rapportons le cas d’une patiente pour laquelle le traitement par TKI a ete initie avec efficacite en reanimation. Observation Une patiente de 59 ans est suivie pour un adenocarcinome pulmonaire stade IV au niveau hepatique, cerebral, surrenalien, pulmonaire et pleural. Apres une 1 re cure de chimiotherapie (cisplatine/gemcitabine), la patiente presente au decours une detresse respiratoire aigue d’origine multifactorielle. Une mutation de l’EGFR etant presente, le transfert en reanimation est decide puis une intubation orotracheale avec ventilation mecanique. Il est alors decide d’instaurer un traitement par erlotinib via la sonde nasogastrique. L’evolution sera marquee par une reponse tumorale permettant une evolution favorable. Conclusions Ce cas clinique met en evidence l’interet d’initier les TKI malgre une hospitalisation en reanimation et pose la question du passage en reanimation des patients porteurs d’une mutation EGFR.

Revue des Maladies Respiratoires - In Press.Proof corrected by the author Available online since vendredi 5 septembre 2014

Resume Introduction Le carcinome a petites cellules (CPC) est un cancer rapidement evolutif de tres mauvais pronostic. Sa chimio-sensibilite implique un traitement rapide. L’hyponatremie du CPC rapportee au syndrome de secretion inappropriee d’hormone antidiuretique est classique. Nous rapportons un cas d’hyponatremie severe induite par la chimiotherapie ayant entraine une prise en charge de soins intensifs. Observation Un patient âge de 68 ans est pris en charge pour un cancer bronchique a petites cellules envahissant le poumon droit. A la premiere cure, le patient presente un coma necessitant une prise en charge en soins intensifs le deuxieme jour (j2) de chimiotherapie (cisplatine-vepeside) qui est rapporte a une hyponatremie severe (107 mmol/L) et d’evolution favorable sous therapeutiques specifiques. Le patient presentera ces memes episodes aux j2 des cures suivantes mais avec des manifestations cliniques de moins en moins intenses. Conclusions La notion d’hyponatremie induite par la chimiotherapie du CPC est peu connue. Ce cas clinique met en evidence le risque d’hyponatremie severe sous chimiotherapie du carcinome a petites cellules. Celle-ci pourrait etre correlee a la fonte tumorale. Une surveillance biologique lors du j2 de chimiotherapie est preconisee.

Recent studies have demonstrated that elevated BMI is associated with improved survival in patients with lung cancer. According to the authors, this "obesity paradox" could be a true benefit or a spurious relationship. In this context, data from the French KBP-2010-CPHG cohort (7,051 patients followed up for primary lung cancer diagnosed in 2010 in the respiratory medicine departments of 104 nonacademic hospitals) were analyzed.Patients were stratified according to BMI at diagnosis using the definition of the French-Speaking Society of Clinical Nutrition and Metabolism (Société Francophone de Nutrition Clinique et Métabolisme). Survival was analyzed using log-rank and a univariate Cox model. Prognostic factors were identified using a multivariate Cox model with backward elimination procedure, and with or without inclusion of prediagnosis weight loss in the model.Patients were followed for a median 20.2 months. At diagnosis, respectively 12%, 28%, 45%, and 15% of the 6,595 patients with BMI data were obese, overweight, normal-weight, and underweight; 35%, 43%, 57%, and 75% reported prediagnosis weight loss (i.e., weight loss within the 3 months prior to diagnosis). One-year survival (% [95% CI]) was 53% [50%-57%], 50%, [48%-52%], 43%, [42%-45%], and 32% [29%-35%] in obese, overweight, normal-weight, and underweight patients, respectively (p 0.001). It was particularly low in underweight patients with prediagnosis weight loss: 27% [24-30%]. BMI did not remain an independent prognostic factor associated with survival when prediagnosis weight loss was introduced in the Cox model. Risk of death was increased by 17%, 23%, and 46% in patients with5 kg, 5-10 kg, or ≥10 kg prediagnosis weight loss, respectively (p 0.001).BMI is an easy but crude assessment tool. Other variables should be used to improve management of patients, and understanding of how prediagnosis body size and nutritional status are associated with cancer survival.

Introduction: Parapneumonic pleuritis are frequently associated with high morbidity and severe sequelae. Management of this complication include early pleural evacuation. Guidelines do not currently recommend the use of lung ultrasound (LUS) as an alternative to chest X-ray (CXR) or chest computerized tomography (CT) scan for the diagnosis of pleural effusion. Chest x-ray (CXR) is the simplest diagnostic tool of Community Acquired Pneumonia (CAP), but it has some limitation. Therefore, the aim of this study is evaluate pleural sequelae with early use of LUS in detection Methods: In this multicentric prospective study, a consecutive sample of suspected patients with CAP was underwent daily LUS. Each patient received a chest x-ray and ultrasound on admission every day. The analysis of the pleural fluid was left to the discretion of the physician . The patients were monitored only 4 days if they had no para pneumonic pleurisy and benefited from an appropriate management if not. Complete respiratory explorations were carried out at 3 and 6 months. Results: In this preliminary reports , 65 patients with CAP were enroled : 48,3% females , mean age 64,4 years Sensitivity of LUS and CXR in detection of parapneumonic effusion were 91% and 40% respectively. Specificity of CXR was 40% while the LUS specificity was 92%. The evolution of pleurisy was unpredictable over the observation period with a significant diagnostic delay of the CXR. No pleurisy occurred after the 4-day period, the failure was 4.6% Compared with nearly 20% of the literature. Conclusion: Findings of the present study demonstrated high incidence of parapneumonic effusion and the higher diagnostic accuracy of LUS versus CXR. A daily echography is necessary and sufficient to detect the effusion and take care of it.

Rationale: EBUS-TBNA is now an usual technique in the diagnosis of mediastinal adenopathy. Some authors describe the use of a pathologist on site. To improve the diagnosis and reduce the number of procedures, we try to optimize the efficiency of EBUS-TBNA by a non-pathologist. Objectives: To determine efficiency of a non-pathologist to evaluate sample quality Methods: On each procedure of puncture, we have asked our nurses to evaluate the sample quality (presence of lymph nodes or not) based on the aspect of the aspiration. The responses (ROS) of the nurses were compared prospectively with responses of cytologist (ROC). Results: Between 2010 and 2016, 415 men and 188 women (mean age 63,1 ± 12) underwent a EBUS-TBNA. 1325 procedures were performed. The mean size of lymph nodes was 15,6 mm in CT and 17,4 mm in EBUS. With a mean punctures number of 3,2 the mean duration procedure was 30 min 40 sec. 72 % of our patients underwent this procedure for a diagnosis or a staging of cancer. With EBUS-TBNA, we obtained a final diagnosis for 73,2 % of them. The area 7 was the most often punctured (64,8 %) followed by the 11R area (23,2%). There were 88,2 % of correlation between ROS and the final diagnosis by the cytologist. There were more correlations ROS-ROC (p = 0,01) when the final diagnosis was obtained (vs only lymph nodes), if the number of punctures increased (p = 0,008) and if experience of the nurse increased (first 3 months of the study vs. last 3 months: p = 0,01). The correlation ROS-ROC was not associated with the size of lymph nodes or length of the exam. Conclusion: Evaluation by a non pathologist may optimize efficiency of EBUS-TBNA

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is an increasingly used mediastinal sampling technique. The purpose of the study is the evaluation of the tolerance during EBUS-TBNA according to the choice of anesthesia. Methods: this is a prospective two-center observational study extended form january 2012 to April 2014. We conducted a systematic review of patients undergoing EBUS-TBNA in the hospitals of Amiens and Saint Quentin where we practiced respectively under conscious sedation or under general anesthesia with propofol and laryngeal mask. The main objectives were the hemodynamic tolerance and the subjective tolerance collected by a questionnaire. Results: Eighty eight patients were included in our study, forty one in the general anesthesia group and forty seven in the conscious sedation group. Arterial blood pressure and heart rate increased in midazolam group, and decreased in propofol group. No incident occured in the general anesthesia group.The subjective tolerance seemed better in the general anesthesia group with an visual analogue scale estimated at 3/100 versus 32,6/100 in the conscious sedation group (p Conclusion: the tolerance is better under general anesthesia but the choice of anesthesia does not affect the profitability of the examination,.

The search for mutations epidermal growth factor receptor (EGFR) has changed the therapeutic approach and prognosis of non-small cell lung cancer (NSCLC). The effectiveness of tyrosine kinase inhibitors (TKI) has been demonstrated orally in patients with EGFR mutation. We report the case of a patient for whom treatment with TKI was started effectively in a Critical Care Unit.A patient of 59 years is followed for a stage IV lung adenocarcinoma with metastases in liver, brain, adrenal, lung and pleura. After a first course of chemotherapy (cisplatin-gemcitabine), the patient presents a multi-factorial acute respiratory distress. Due to an EGFR mutation, transfer to intensive care is decided then orotracheal intubation with mechanical ventilation. It is decided to initiate treatment with erlotinib via nasogastric tube. The evolution will be marked by a tumor response leading to a favorable issue.This case shows the value of initiate TKI despite hospitalization in Intensive Care Unit and highlights the question of the transfer in ICU patients with EGFR mutation.

Summary Reasons for performing study: As critical locomotion events (e.g. high-speed and impacts during racing, jump landing) may contribute to tendinopathies, in vivo recording of gaits kinematic and dynamic parameters is essential for 3D reconstruction and analysis. Objective: To propose a 3D model of the forelimb and a ground reaction force recording shoe (GRF-S) for noninvasively quantifying tendon and ligament loads and strains. Methods: Bony segments trajectories of forelimbs placed under a power press were recorded using triads of ultrasonic kinematic markers linked to the bones. Compression cycles (from 500–6000 N) were applied for different hoof orientations. Locations of tendon and ligament insertions were recorded with regard to the triads. The GRF-S recorded GRF over the hoof wall and used four 3-axis force sensors sandwiched between a support shoe and the shoe to be tested. Results: Validation of the model by comparing calculated and measured superficial digital flexor tendon strains, and evaluation of the role of proximal interphalangeal joint in straight sesamoidean ligament and oblique sesamoidean ligament strains, were successfully achieved. Objective comparisons of the 3 components of GRF over the hoof for soft and hard grounds could be recorded, where the s.d. of GRF norm was more important on hard ground at walk and trot. Conclusions: Soft grounds (sand and rubber) dissipate energy by lowering GRF amplitude and diminish bounces and vibrations at impact. At comparable speed, stance phase was longer on soft sand ground. Potential relevance: The conjugate use of the GRF-S and the numerical model would help to quantify and analyse ground/shoe combination on comfort, propulsion efficiency or lameness recovery.

Resume Introduction L’echoendoscopie est une technique en cours de developpement en France dans le staging et le diagnostic des cancers bronchopulmonaires. Cet examen, par la taille de l’endoscope et par la duree de cet examen, pose le probleme du type d’anesthesie propose aux patients. Nous avons developpe au sein de notre centre hospitalier une technique interessante pour la realisation de cet examen. Celle-ci utilise le masque larynge. Patients et methodes Nous avons realise une etude retrospective monocentrique afin de comparer les resultats de l’echoendoscopie bronchique realisee sous masque larynge par rapport a l’anesthesie locale pure. Resultats Soixante-trois patients ont ete inclus. Quarante et un (65 %) examens ont ete effectues sous masque larynge et 22 (35 %) examens sous anesthesie locale. Cinquante examens sur cinquante-sept (87 %) ont ete informatifs, c’est-a-dire avec cellules ganglionnaires (34/38 [89 %] pour les examens sous masque larynge avec 3,8 ponctions en moyenne et 17/19 [86 %] pour les examens sous anesthesie locale avec en moyenne 2,9 ponctions en moyenne). Quarante-cinq (78 %) resultats ont permis d’eviter la mediastinoscopie. Conclusion La realisation des echoendoscopies bronchiques sous anesthesie generale avec ventilation par masque larynge semble ne pas perturber les resultats de l’examen avec une bonne tolerance et peu de complications.

International audience; INTRODUCTION:The small cell lung cancer (SCLC) is a rapidly progressive malignancy with a poor prognosis. Its chemosensitivity mandates prompt treatment. Hyponatremia occurs frequently in patients with small cell lung cancer due to the syndrome of inappropriate antidiuretic hormone (SIADH). We report a case of severe hyponatremia induced by chemotherapy that required management in intensive care.OBSERVATION:A 68-year-old patient was undergoing treatment for small cell cancer, invading the right lung. On the second day of the first cycle of treatment (cisplatine-vepeside), the patient became comatose and required transfer to an intensive care unit. The coma was due to severe hyponatremia (107 mmol/L) and improved with specific treatment. The patient had similar episodes on the second day of each chemotherapy treatment but with less and less severe clinical manifestations. Hyponatremia due to chemotherapy in SCLC is not commonly known; a relation between hyponatremia intensity and the tumor size is suspected.CONCLUSION:This clinical case highlights the possibility of severe hyponatremia during small cell lung cancer chemotherapy. Hyponatremia may be related to the reduction in tumor size. Monitoring of electrolytes on day 2 of chemotherapy is advised.

Introduction : Le cancer bronchique a petites cellules (CBPC) represente environ 20% des cancers broncho-pulmonaire. Il se caracterise par son agressivite et sa rapidite d’evolution. Au vu de son pronostic, la question de la realisation de la 2eme ligne se pose chez beaucoup de praticiens. Le traitement de premiere ligne est bien codifie mais il n’existe pas de recommandation claire pour la 2eme ligne. Il existait des differences de prise en charge en fonction des centres. Materiel et methode : Il s’agissait d’une etude observationnelle, retrospective, incluant tous les patients ayant beneficie d’au moins 2 cures de chimiotherapie suivies d’un bilan de reevaluation en 2eme ligne de traitement chez les patients atteints d’un CBPC entre 2004 et 2014 dans les centres hospitaliers d’Amiens et de Saint-Quentin. Les 3 protocoles etudies etaient : le topotecan seul, le paclitaxel-topotecan et le CEV (cyclophosphamide, epirubicine, vincristine) ou CAV (cyclophosphamide, adriamycine, vincristine). Notre critere de jugement principal etait la survie sans progression en 2eme ligne de chimiotherapie. Resultats : Sur la periode de 10 ans, 62 patients ont ete inclus dans notre etude. Parmi notre population, 38,7% des patients ont eu une chimiotherapie par topotecan seul, 35,5% ont eu une chimiotherapie par paclitaxel-topotecan et 25,8% ont eu une chimiotherapie par CAV ou CEV. Il n’a pas ete retrouve de difference significative en terme de survie sans progression et de survie globale entre les differents protocoles avec des medianes de survie sans progression respectivement a 3,34 mois (OR = 0,42 ; IC 95% [2,51-4,17]), 3,57 mois (OR = 0,53 ; IC 95% [2,51-4,62]) et 3,11 mois (OR = 0,49 ; IC 95% [2,15-4,07]). On retrouve une difference significative (p = 0 ,032) entre les differents protocoles en terme d’effets indesirables (grade > ou = 2 de la classification OMS). En ce qui concerne le performance statut (PS) en 1ere et 2eme ligne, il n’a pas ete retrouve d’influence en terme de survie sans progression en 2eme ligne. La presence de metastases cerebrales au diagnostic, la progression cerebrale en 1ere et 2eme ligne n’a pas ete retrouve comme un facteur modifiant la survie sans progression. Conclusion : Nous avons mis en evidence que la 2eme ligne de chimiotherapie dans le CBPC est bien toleree chez des patients jeunes et en bon etat general. Elle a un reel interet en terme de survie. Le CEV est le protocole qui a presente le moins d’effets indesirables dans notre etude. La radiotherapie stereotaxique propose probablement les meilleures perspectives pour la 2eme ligne.

Introduction L’infection des loges de pneumonectomie est une complication classique. Son traitement consiste le plus souvent en une thoracostomie. Celle-ci necessite une prise en charge par des soins locaux. Nous rapportons ici une complication inhabituelle de cette situation. Observations Un homme de 62 ans subit une pneumonectomie pour carcinome bronchique non a petites cellules. Il beneficie par la suite d’une thoracoplastie a la suite d’une surinfection de sa loge de pneumonectomie. Il beneficie alors de soins locaux. Lors d’un bilan d’alteration de l’etat general, il est diagnostique une hyperthyroidie due aux mechages effectues avec des produits desinfectants iodes. Conclusion Il s’agit d’un cas original de thyreotoxicose chez un patient porteur d’une thoracoplastie. Nous preconisons la surveillance reguliere du bilan thyroidien dans de tels cas.

Introduction L’interet d’une endoscopie bronchique dans la reevaluation des carcinomes bronchiques non a petites cellules (CBNPC) n’est pas clairement etabli. A l’heure des mutations et du concept d’heterogeneite tumorale, il nous a semble utile de realiser une etude sur ce sujet. Objectifs Comparer l’aspect endoscopique, les biopsies et la recherche des mutations avant et apres une premiere ligne de chimiotherapie et leur impact sur la survie sans progression. Methodes Il s’agit d’une etude prospective multicentrique sur des patients porteurs d’un CBNPC stade IV chez lesquels nous avons effectue une endoscopie, des biopsies et une recherche des mutations avant et apres une premiere ligne de chimiotherapie. Nous avons inclus 50 patients sur deux CHG et un CHU. Resultats Nous avons inclus 50 patients (39 hommes et 11 femmes) porteurs d’un CBNPC (28 adenocarcinomes, 12 epidermoides et 10 d’une autre histologie). Cent pour cent avaient une histoire tabagique. Une mutation a ete retrouvee dans 33 % des cas mais seulement 21 % lors de la deuxieme. Soixante-deux pour cent des patients reevalues avaient des prelevements biopsiques exploitables en terme d’histologie. Soixante-sept pour cent ont presente une reponse objective sous chimiotherapie. Il n’a ete retrouve que 53 % de correlation entre les donnees histologiques a la reevaluation et celles de l’imagerie. Conclusion Les donnees de cette etude vont permettre de discuter de l’interet des reevaluations par voie endoscopique avec prelevements histologiques et de biologie moleculaire des patients porteurs d’un CBNPC et de leur impact sur le pronostique de la maladie.

Infectious complications are common in patient with multiple myeloma. However, Paecilomyces variotii, a common saprophytic fungus, rarely causes human infection. We report the first case of P. variotii fungemia in this illness with good response with adapted anti-mycotic treatment.

Background The chemotherapy used to treat lung cancer causes febrile neutropenia in 10 to 40% of patients. Although most episodes are of undetermined origin, an infectious etiology can be suspected in 30% of cases. In view of the scarcity of data on lung cancer patients with febrile neutropenia, we performed a retrospective study of the microbiological characteristics of cases recorded in three medical centers in the Picardy region of northern France. Methods We analyzed the medical records of lung cancer patients with neutropenia (neutrophil count < 500/mm3) and fever (temperature > 38.3°C). Results The study included 87 lung cancer patients with febrile neutropenia (mean age: 64.2). Two thirds of the patients had metastases and half had poor performance status. Thirty-three of the 87 cases were microbiologically documented. Gram-negative bacteria (mainly enterobacteriaceae from the urinary and digestive tracts) were identified in 59% of these cases. Staphylococcus species (mainly S. aureus) accounted for a high proportion of the identified Gram-positive bacteria. Bacteremia accounted for 60% of the microbiologically documented cases of fever. 23% of the blood cultures were positive. 14% of the infections were probably hospital-acquired and 14% were caused by multidrug-resistant strains. The overall mortality rate at day 30 was 33% and the infection-related mortality rate was 16.1%. Treatment with antibiotics was successful in 82.8% of cases. In a multivariate analysis, predictive factors for treatment failure were age >60 and thrombocytopenia < 20000/mm3. Conclusion Gram-negative species were the most frequently identified bacteria in lung cancer patients with febrile neutropenia. Despite the success of antibiotic treatment and a low-risk neutropenic patient group, mortality is high in this particular population.

Objective: To report a case of bronchial fistula associated with sunitinib in a patient previously treated with radiation therapy. Case Summary: A 40-year-old man with renal cell cancer diagnosed in 2005 and initially treated by radical nephrectomy presented in March 2007 with a recurrence with cerebral, mediastinal, and lung metastases. A thoracic computed tomography (CT) scan showed a subcarinal tumor obstructing the bronchus intermedius. The patient was initially treated with cerebral and thoracic radiotherapy and then with sunitinib 50 mg/day (4 weeks on, 2 weeks off). Two months after the beginning of treatment, a CT scan revealed a dramatic reduction in the size of the tumor, associated with a bronchial fistula. This was confirmed by flexible bronchoscopy, which showed complete necrosis of the tumor and a large perforation of the bronchus intermedius. Sunitinib was immediately withdrawn and antibiotic prophylaxis was instituted. It was not possible to place an endobronchial stent. Two weeks later, flexible bronchoscopy revealed the reappearance of a yellowish mass protruding into the bronchus intermedius (40% obstruction). A few months later, the obstruction of the bronchus intermedius progressed to 90% and was associated with a contralateral obstruction of the left mainstem bronchus (20%). A rigid bronchoscopy was then performed to clear the obstruction and an endobronchial stent was placed, with satisfactory initial results. In February 2008, the patient presented with new bronchial obstruction under the endobronchial stent but refused a rigid bronchoscopy and died in March 2008. Discussion: Sunitinib, a multitarget tyrosine kinase inhibitor with antiangiogenic and antitumoral activities, has been approved for the treatment of advanced renal cell carcinoma. This treatment is generally well tolerated. Serious complications may occur, however. According to the Naranjo probability scale, the bronchial fistula was possibly related to sunitinib treatment. Conclusions: This is a rare case of a bronchial perforation leading to a fistula associated with sunitinib treatment after mediastinal radiation therapy. Clinicians may consider strict follow-up of patients with proximal lung metastases treated with sunitinib (CT scan and, if appropriate, placement of an endobronchial stent).

Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TBNA) has recently been shown to be an accurate modality in the diagnosis and staging of mediastinal lymph node metastases. This procedure takes significantly longer than a conventional bronchoscopy and may therefore cause more discomfort. Since its introduction into respiratory practice in France, several airway management strategies have been used.Both anaesthesia care and procedural sedation services share the goals of providing the patient with comfort during a potentially distressing procedure while also ensuring that the operating physician has an acceptable working environment. Historically, anaesthesiologists have applied the expertise gained in managing anaesthesia for major surgery to sedation care for minor procedures. While the supply of anaesthesiologists and anaesthetists has shown only a modest increase, the growth in minimally invasive procedures has been exponential in recent years. To investigate this further, we performed a retrospective study of the use of general anaesthetic with ventilation by a laryngeal mask during EBUS, which we have adopted in our unit.Sixty-three patients were included in the study. In 41 a laryngeal mask was used and in 22 the examination was performed under local anaesthetic alone. Eighty-seven percent of procedures were informative with cells from lymph nodes obtained (89% from examinations using laryngeal mask with a mean of 3.8 passes and 86% with sedation alone with a mean of 2.9 passes). In 45 cases (78%) it was possible to avoid mediastinoscopy.It was possible to establish a secure airway and maintain oxygenation with the laryngeal mask during bronchoscopy without any reduction in the success of the procedure.

Post pneumonectomy infection is a well-described surgical complication. Treatment usually involves thoracostomy and requires local treatments. We report here an unusual complication of this situation.A 62 year old man had a pneumonectomy for non-small cell lung cancer. Following this he required a thoracostomy to treat a thoracic empyema and this was treated with local anti-septic agents. Subsequently he developed asthenia and a diagnosis of hyperthyroidism was made secondary to local disinfectant treatment with iodine agents.We describe an original case of thyroxicosis occurring in a patient following treatment for post-pneumonectomy empyema. We would recommend monitoring thyroid function in this context.

Co-infection with Schistosoma mansonii and Mycobacterium tuberculosis have been rarely reported in spite of the high African incidence of these two infections. We report the case of a 32 years old Mauritanian male living in France since 2001 who consulted with isolated abdominal pain. Rectal biopsies showed granuloma around Schistosoma mansonii eggs. He had persistent abdominal pain despite a treatment with Praziquantel , the biology stayed abnormal: elevated aspartate-(AST) and alanine transaminase (ALT), inflammatory syndrome and hypereosinophilia. Patient was explored for another diagnosis, 4 epigastric nodules were found and a punction is performed. Anatomopathology observed granulomatous lymphadenitis with necrosis, and positive acid-fast bacilli on excisional lymph node biopsy was found (culture showed Mycobacterium tuberculosis ). Tuberculous lymphadenitis diagnosis is then performed and standard anti-tuberculosis drugs are prescribed. Reviewing the literature on Schistosoma mansonii and Mycobacterium tuberculosis co-infections, one interrogate on the potential link between those two infections, specially on an immunophysiopathological basis. Described as an ulcerating mycobacteria, Schistosoma induce a specific cellular Th2-predominant immune response, on the opposite Mycobacteria's immunity which is rather Th1 cell-mediated related. The lymphocyte population imbalanced with Th2 could enhance susceptibility to mycobacterial diseases. This communication rounds up Schistosoma and Mycobacterium co-infection and studies the different physiopathological hypothesis for co-development.

e19078 Background: In recent years, many major advances have been made in non-small-cell lung cancer (NSCLC), and in particular in adenocarcinoma, but not in SCLC. In 2010, the French College of General Hospital Respiratory Physicians (CPHG) performed a prospective multicentre epidemiological study (KBP-2010-CPHG) to describe the baseline characteristics and management of all new cases of primary lung cancer and to evaluate survival. The present abstract reports results in SCLC patients. Methods: 7,051 patients ≥18 years presenting with a new case of primary lung cancer, histologically or cytologically diagnosed between 1 January and 31 December 2010 and managed in the respiratory department of one of the 104 general hospitals participating in the study, were included. A standardised form was completed for each patient. A steering committee checked data collection exhaustiveness. SCLC data were analysed separately. Results: There were 968 SCLC patients: mean age, 65.6 years (+/-10.6); 23.2% female; 4.4% non-smokers (11 % in women), 35.8% ex-smokers, 59.8% current smokers; 63.4% with performance status 0 or 1; 59.9% having lost weight within the previous 3 months (19.8% of whom had lost >10 kg). Main tumour characteristics at diagnosis were: 71.2% stage IV, 24.7% stage IIIA or IIIB, 4.1% of stage 70 (59.1%) than

International audience; Synechococcus spp. constitute a major and ubiquitous component of marine ecosystems. The genome of one strain of this genus, WH8102, has recently been completely sequenced. Since it can also be genetically manipulated, this clone has the potential to become a new model organism; however, to date, it remains poorly characterised in terms of pigment composition, optical properties and photophysiology. It has a very high phycourobilin to phycoerythrobilin (PUB:PEB) ratio (ca. 1.95 at low light), and is therefore representative of Synechococcus populations found in oligotrophic areas of the ocean. We show here that this strain has a very wide growth irradiance range from 650 μmol photons m-2 s-1 continuous white light, with a maximum growth rate (μmax = 1.13 ± 0.02 d-1) at 207 μmol quanta m-2 s-1 (Imax). As cells acclimated to high light, drastic variations in the chlorophyll a (chl a), b-carotene and phycoerythrin (PE) contents were observed, reaching a quasi steady state around Imax. In contrast, the zeaxanthin content remained approximately constant whatever the light level. Similarly, the carbon and nitrogen contents did not significantly vary with irradiance. Red and orange fluorescences, as measured by flow cytometry, were found to correlate well with chl a and PE contents, respectively. Spectrometric analyses of phycobilisome (PBS)-containing fractions from cells grown under different photon fluxes suggest a specific reduction of the PEII content relative to other phycobiliproteins (PBPs) during acclimation of the PBSs to high light.