We prospectively assessed the safety and cost saving of a small-bore drain based procedure for outpatient management of first episodes of primary spontaneous pneumothorax.Patients were managed by observation alone or insertion of an 8.5-F ''pig-tail'' drain connected to a oneway valve, according to size and clinical tolerance of the pneumothorax. All patients were reassessed after 4 h, on the first working day after discharge and on day 7. Patients still exhibiting air leak on day 4 underwent thoracoscopy. The primary end-point was complete lung re-expansion at day 7.60 consecutive patients entered the study. 48 (80%) met the definition of large pneumothorax. The success rate was 83%. The 1-year recurrence rate was 17%. 36 (60%) patients were discharged after 4 h and 50% had full outpatient management. No severe complication was observed. The mean¡SD length of hospitalisation was 2.3¡3.1 days. This policy resulted in about a 40% reduction in hospital stay-related costs.The present study supports the use of a single system combined with a well-defined management algorithm including safe discharge criteria, as an alternative to manual aspiration or chest tube drainage. This approach participates in healthcare cost-savings. @ERSpublications Primary spontaneous pneumothorax can be managed outside the hospital, subject to strict predischarge safety criteria

Obstructive sleep apnea and hypopnea syndrome (OSAHS) is poorly documented in Sub-Saharan Africa, especially in the hospital setting. The aim of this study was to determine its prevalence and to investigate the associated factors in patients admitted in a tertiary referral hospital in Cameroon. Methods In this cross-sectional study conducted in the Cardiology, Endocrinology and Neurology departments of the Yaounde Central Hospital; all patients aged 21 and older were included consecutively. A sample of randomly selected patients was recorded using a portable sleep monitoring device (PMD). OSAHS was defined as apnea-hypopnea index (AHI) � 5/hour (with > 50% of events being obstructive) and moderate to severe OSAHS as an AHI > 15/ hour. Logistic regression was used to identify factors associated to OSAHS. Results Of the 359 patients included, 202 (56.3%) patients were women. The mean age (standard deviation) was 58 (16) years. The prevalence of OSAHS assessed by PMD (95% CI) was 57.7% (48.5-66.9%), 53.8% in men and 62.7% in women (p = 0.44). The median (25 th-75 th percentiles) AHI, body mass index and Epworth Sleepiness Scale score of OSAHS patients were 17 (10.6-26.9)/hour, 27.4 (24.7-31.6) kg/m 2 and 7 (5-9) respectively. The only factor

BackgroundThere exists considerable debate concerning management of prosthetic vascular graft infection (PVGI), especially in terms of antimicrobial treatment. This report studies factors associated with treatment failure in a cohort of patients with staphylococcal PVGI, along with the impact of rifampin (RIF).MethodsAll data on patients with PVGI between 2006 and 2010 were reviewed. Cure was defined as the absence of evidence of infection during the entire post-treatment follow-up for a minimum of one year. Failure was defined as any other outcome.Results84 patients (72 M/12 F, median age 64.5 ± 11 y) with diabetes mellitus (n = 25), obesity (n = 48), coronary artery disease (n = 48), renal failure (n = 24) or COPD (n = 22) were treated for PVGI (median follow-up was 470 ± 469 d). PVGI was primarily intracavitary (n = 47). Staphylococcus aureus (n = 65; including 17 methicillin-resistant S. aureus) and coagulase-negative Staphylocococcus (n = 22) were identified. Surgical treatment was performed in 71 patients. In univariate analysis, significant risk factors associated with failure were renal failure (p = 0.04), aortic aneurysm (p = 0.03), fever (p = 0.009), aneurysm disruption (p = 0.02), septic shock in the peri-operative period (p = 0.005) and antibiotic treatment containing RIF (p = 0.03). In multivariate analysis, 2 variables were independently associated with failure:septic shock [OR 4.98: CI 95% 1.45-16.99; p=0.01] and antibiotic containing rifampin [OR: 0.32: CI95% 0.10-0.96; p=0.04].ConclusionResults of the present study suggest that fever, septic shock and non-use of antibiotic treatment containing RIF are associated with poor outcome.

Osteomyelitis of the wrist caused by Mycobacterium arupense in an immunocompetent patient: a unique case Mycobacterium arupense, a slow-growing Mycobacterium, was first isolated from clinical samples in 2006 by Cloud et al. 1 and in water by another team. 2 Two cases of tenosynovitis have recently been reported. 3,4 We report here the first case of osteomyelitis of the wrist caused by M. arupense following a penetrating injury to the hand.In December 2008, a 35-year-old patient without any significant medical history presented with progressive swelling and pain of the left wrist. Eight months earlier, he had cut the flexor tendons of his left hand with a glass filled with mud. An X-ray of the wrist showed a narrow joint space and two cortical erosions. Echography revealed an abscess extending to the dorsal face of the wrist. A synovectomy was performed. Both site cultures for common bacteria and Mycobacterium were negative. Pathological examination revealed granulomatous inflammation with Langhans giant cells. Because of the progressive pain in the wrist, a corticosteroid injection was performed, but did not alleviate the pain.In May 2010, an X-ray of the wrist showed multiple erosions. An arthrodesis was performed. M. arupense was identified by sequencing of hsp65 and 16S rRNA genes and on culture. The patient then received clarithromycin (1000 mg daily), rifabutin (300 mg daily), and ethambutol (1000 mg daily). Rifabutin was discontinued after 2 weeks because of liver disorders. The patient was treated with clarithromycin-ciprofloxacin (1500 mg/day) for 12 months.