<p>Cher Confr&egrave;re</p>
<p>J'ai vu ce jour M. FONTAINE Gerard n&eacute; le 30/06/1967.</p>
<p>Il est mari&eacute; et a 2 enfants.Il a fum&eacute; pendant 15 ans et est sevr&eacute; depuis 23 ans . Il totalise environ 25 PA (4 Pqts/j en dernier.</p>
<p>Il est diab&eacute;tique depuis 15 ans DNID et suivi peu regulier.Il est suivi pour HTA.</p>
<p>Il pr&eacute;sente une dyspn&eacute;e grade II/IIIUde l'&eacute;chelle du Modified Medical Research Council.</p>
<p>Il dit pr&eacute;senter une nyctiurie tous les deux heures.Son score d'Epworeth est de 6/21 avec un&nbsp;&nbsp;score de Mallampati est de 3/4.Le perim&egrave;tre cervical est de 38cm avec un perim&egrave;tre abdominal de 94cm.</p>
<p>Ce patient a &eacute;t&eacute; hospitalis&eacute; du 9 au 14/12/2018 au CHU F.Guyon en Chiururgie thoracique pour un &eacute;panchement pleural gauche suite &agrave; une pneumopathie.Il a eu une videothoracoscopie gauche avec d&eacute;cortication pleurale et &eacute;vacuation d'une collection liquidienne.</p>
<p>Il est actuellement sous kin&eacute;sieth&eacute;rapie respiratoire intensive centr&eacute;e sur l'hemicoupole diaphragmatique gauche.La radiographie thoracique en date du 26/12/2018 retrouve une poche a&eacute;rique gauche avec emoussement du cul de sac costo diaphragmatique gauche sans anomalie liquidienne retrouv&eacute; &agrave; l'echographie pleurale gauche.</p>
<p>En revanche son diab&egrave;te est totalement d&eacute;sequilibr&eacute; avec glyc&eacute;mie &agrave; jeun &agrave; 16.56 mmol/L et HbAC1 &agrave; 11.6%.Je pense qu'une consultation specialis&eacute; en diabetologie s'impose.&nbsp;</p>
<p>L'auscultation pulmonaire est ce jour peu perturb&eacute;.</p>
<p>Ses EFR retrouvent un trouble ventilatoire restrictif relativement mod&eacute;r&eacute; avec CPT &agrave; 67% et VR &agrave; 71%. Le rapport de Tiffeneau est &agrave; 99%.</p>
<p>Il convient de poursuivre la kin&eacute;sieth&eacute;rapie respiratoire avec de l'ULTRALEVURE avec sa diarrh&eacute;e.</p>
<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l'assurance de mes sentiments distingu&eacute;s,</p>
<p>Dr. B. TANGUY.</p>
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