Revue des maladies respiratoires
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A 49-year-old man with disseminated histoplasmosis (pulmonary and central nervous system involvement) successfully treated with ketoconazole and fluconazole combination is reported. Histoplasma capsulatum infection of the central nervous system is extremely rare in France partly because the organism is not endemic. Oral treatment with newer triazoles may be useful for central nervous system histoplasmosis, but additional information is needed to establish their effectiveness.
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Decision analysis has greatly benefited to the field of pulmonary embolism diagnosis, by allowing the theoretical assessment of potential novel strategies, which could in turn be validated in clinical trials. The adjunction of clinical probability assessment, plasma D-dimer measurement, and lower limb venous compression ultrasonography, to pulmonary scintigraphy and angiography in the diagnostic workup, results in a considerable reduction in the requirement for angiography. ⋯ Finally, spiral CTscan combined with D-dimer and ultrasonography could also prove highly cost-effective, and replace either pulmonary angiography, or even both lung scan and angiography, if ongoing studies confirm the promising preliminary results obtained with CTscan. However, such a conclusion awaits the validation of algorithms including CTscan by clinical outcome trials, in which the therapeutic decision would rest on the result of the spiral CTscan.