Éditeur(s) : HAL CCSD Public Library of Science
Résumé : International audience
RATIONALE: Optimal management of complicated parapneumonic effusions (CPPE) remains controversial. OBJECTIVES: to assess safety and efficacy of iterative therapeutic thoracentesis (ITTC), the first-line treatment of CPPE in Rennes University Hospital. METHODS: Patients with CPPE were identified through our computerized database. We retrospectively studied all cases of CPPE initially managed with ITTC in our institution between 2001 and 2010. ITTC failure was defined by the need for additional treatment (i.e. surgery or percutaneous drainage), or death. RESULTS: Seventy-nine consecutive patients were included. The success rate was 81% (n = 64). Only 3 patients (4%) were referred to thoracic surgery. The one-year survival rate was 88%. On multivariate analysis, microorganisms observed in pleural fluid after Gram staining and first thoracentesis volume ≥450 mL were associated with ITTC failure with adjusted odds-ratios of 7.65 [95% CI, 1.44-40.67] and 6.97 [95% CI, 1.86-26.07], respectively. The main complications of ITTC were iatrogenic pneumothorax (n = 5, 6%) and vasovagal reactions (n = 3, 4%). None of the pneumothoraces required chest tube drainage, and no hemothorax or re-expansion pulmonary edema was observed. CONCLUSIONS: Although not indicated in international recommendations, ITTC is safe and effective as first-line treatment of CPPE, with limited invasiveness.
ISSN: 1932-6203

hal-00945622
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00945622
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00945622/document
https://hal-univ-rennes1.archives-ouvertes.fr/hal-00945622/file/fetchObject.pdf
PUBMED : 24400113

Éditeur(s) : HAL CCSD Elsevier
Résumé : International audience
Recent research has demonstrated the importance of dermal exposure for some semivolatile organic compounds (SVOCs) present in the gas phase of indoor air. Though models for estimating dermal intake from gaseous SVOCs exist, their predictions can be subject to variations in input parameters, which can lead to large variation in exposure estimations. In this sensitivity analysis for a steady state model, we aimed to assess these variations and their determinants using probabilistic Monte Carlo sampling for 8 SVOCs from different chemical families: phthalates, bisphenols, polycyclic aromatic hydrocarbons (PAHs), organophosphorus (OPs), organochlorines (OCs), synthetic musks, polychlorinated biphenyls (PCBs) and polybromodiphenylethers (PBDEs). Indoor SVOC concentrations were found to be the most influential parameters. Both Henry's law constant (H) and octanol/water partition coefficient (Kow) uncertainty also had significant influence. While exposure media properties such as volume fraction of organic matter in the particle phase (fom-part), particle density (ρpart), concentration ([TSP]) and transport coefficient (ɣd) had a slight influence for some compounds, human parameters such as body weight (W), body surface area (A) and daily exposure (t) make a marginal or null contribution to the variance of dermal intake for a given age group. Inclusion of a parameter sensitivity analysis appears essential to reporting uncertainties in dermal exposure assessment.
ISSN: 0160-4120

hal-01526430
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01526430
https://hal-univ-rennes1.archives-ouvertes.fr/hal-01526430/file/Dermal%20absorption%20of%20semivolatile%20organic%20compounds_accepted.pdf
DOI : 10.1016/j.envint.2017.02.005
PUBMED : 28249739