[A rare cause of stridor in a 59 year old woman in intensive care]

INTRODUCTION

Stridor in the post extubation period occurs frequently and is most commonly caused by laryngeal oedema. During this period, the trachea can also be obstructed by pseudomembranes.

CASE REPORT

We report the case of a 59 year old woman who required re-intubation, 15 days after extubation because of the acute onset of severe respiratory distress secondary to pseudomembranes in her trachea.

CONCLUSION

It is essential that physicians who care for patients during the post extubation period are aware of this severe and life threatening cause of stridor. Definitive treatment with the rigid bronchoscope allows for rapid recanalisation of the airway.

Hypersensibilité au carboplatine : Un rôle pour les génériques ?

INTRODUCTION

Carboplatin is a chemotherapeutic agent used frequently in thoracic medicine on account of its relatively good tolerance. Nevertheless hypersensitivity reactions have been described.

CASE REPORTS

We report the cases of 2 patients, treated for undifferentiated bronchial carcinoma and carcinoma of the breast, presenting with hypersensitivity reactions to carboplatin developing after 6 and 8 courses respectively. The first patient presented with an irritant maculo-papular rash and the second with severe hypotension and bronchospasm. Neither of these reactions was fatal. Both of these reactions occurred when generic carboplatin was substituted for the propriety preparation.

CONCLUSION

Hypersensitivity reactions to carboplatin should be recognised by respiratory physicians on account of their potential seriousness and their occurrence after several courses of treatment. This takes on particular importance at a time when plans for domiciliary treatment of patients are being considered. In addition a national survey of hypersensitivity to carboplatin should be considered by the regional drug safety centres.

[Acute respiratory distress syndrome following inhalation of barium sulfate]

INTRODUCTION

Barium sulfate (BS) is chosen to explore swallowing disorders because of its reduced osmolality allowing no adverse reaction if aspirated in the bronchial tree.

CASE REPORT

A 66-years old man treated for an advanced stage mesothelioma experienced a BS aspiration during an esophagography. He developed 3 days after an acute respiratory distress syndrome (ARDS) and deceased. The post-mortem examination revealed a diffuse alveolar damage (DAD).

CONCLUSION

Whereas BS aspiration is generally well tolerated, serious adverse event as a DAD would exceptionally occurs. Thus, a close watch over respiratory symptoms has to be kept after BS administration, especially in debilitated and elderly patients.