INSERT INTO `courrier_client` VALUES (19525,729,1,'2020-02-18','Dr Goulam Abasse\nISIS Réunion','<p>Cher Confr&egrave;re</p>\n<p><strong>J\'ai vu ce jour M. MHARCHI Ahmed n&eacute; le 20/06/1964.Il achang&eacute; de prestataire et est appareill&eacute; par ISIS R&eacute;union.</strong></p>\n<p><strong>Il a une bonne utilisation de sa PPC de 4:22 avec un IAH r&eacute;siduel de 1.17 sur l\'ann&eacute;e.</strong></p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19526,698,1,'2020-02-18','Dr B.TANGUY\nISIS R2union','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme TANGUY Dominique n&eacute;e le 17/11/1952.</p>\n<p>Poids ce jour:73.500K idem au 31/07/2019.et 72.300 le 18/02/2020 soit une diminution de 1K200.</p>\n<p>Elle ressennt depuis quelques jours une douleur lat&eacute;rale ant&eacute;rieure sous le genou droit avec perte de tonus musculaire.</p>\n<p>je lui prescrit une kin&eacute;sieth&eacute;rapie.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19527,3274,1,'2020-02-18','Dr Rambolomanana\nISIS Réunion','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme HOUSSOUMA MOHAMED NADJI n&eacute;e le 05/06/1974.</p>\n<p>Elle est plus &eacute;veill&eacute;e.Mais il existe d\'importantes fuites.</p>\n<p>Il a &eacute;t&eacute; decid&eacute; de r&eacute;duire en auto pilot&eacute; la pression &agrave; 10 et 4 cm sur une semaine.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19528,1510,1,'2020-02-19','Dr Andriatavy\nSEPRODOM','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme RONSARD Yolande n&eacute;e le 08/08/1933.</p>\n<p><strong>la patiente a &eacute;t&eacute; plac&eacute;e en pression fixe &agrave; 10 cm d\'eau .</strong></p>\n<p><strong>Son rapport du 13/02/2020a retrouv&eacute; une utilisation m&eacute;diane quotidienne de 4:09&nbsp; et un IAH r&eacute;siduel de 0.3.</strong></p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19529,464,1,'2020-02-19','Dr Van Grevelynghe\nSEPRODOM','<p>Cher Confr&egrave;re,</p>\n<p>J\'ai vu ce jour M. MAILLOT Mario n&eacute; le 18/09/1961.</p>\n<p>Ilm se plaint depuis 3 semaines d\'une douleur de l\'&eacute;paule gauche pour laquelle je demande un IRM des deux &eacute;paules.</p>\n<p>Il p&egrave;se ce jour 64.800K. Sa TA est &agrave; 12.3/8.4 avec un pouls &agrave; 91 et une SaO2 &agrave; AA &agrave; 97%.</p>\n<p>Il a une bonne observance de 4:30 avec un IAH r&eacute;siduel de 3.3&nbsp; en date du 12/02/2020.</p>\n<p>L\'Auscultation pulmonaire est revenue dans les limites de la norm&ugrave;ale.</p>\n<p>Il pr&eacute;sente un DNID depuis une dizaine d\'ann&eacute;es.il est sous Insuline le soir.</p>\n<p>Je lui prescrit du RELVAR pendant 2 mois.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19530,5458,1,'2020-02-19','Dr Colomb\nISIS Réunion','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour M. SADOWSKI Jan n&eacute; le 15/09/1949.</p>\n<p>Sa TA est &agrave; 13.6/9.1 avec un pouls &agrave; 68 et une SaO2 &agrave; AA &agrave; 94%.</p>\n<p>Il a une bonne observance de 4:12 avec un IAH r&eacute;siduel de 2.76. sur les 3 derniers mois.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19531,539,1,'2020-02-19','Dr Akbaraly\nSOS Oxygène','<p>Cher Confr&egrave;re,</p>\n<p>J\'ai vu ce jour M. MAMODALY Aziz Aly n&eacute; le 10/02/1943.</p>\n<p>Sa TA est &agrave; 12.3/5.1 avec un pouls &agrave; 55 et une SaO2 &agrave; AA &agrave; 98%.</p>\n<p>Il a une observance de 5:40 avec un IAH r&eacute;siduel de 3.7 en date du 9/05/2019.</p>\n<p>Nous lui octroyons un masque facial et nous le mettons en pression fixe &agrave; 8.3cm d\'eau.</p>\n<p>L\'auscultation pulmonaire est dans les limites de la normale.l</p>\n<p>Je demande &agrave; SOS Oxyg&egrave;ne de r&eacute;aliser un relev&eacute; plus r&eacute;cent.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19532,5799,1,'2020-02-19','Dr Pauvert\nTampon','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme NATIVEL Marie Adele n&eacute;e le 24/09/1931.</p>\n<p>Cette dame est mari&eacute; et a 6 enfants.Elle est sans profession.</p>\n<p>Elle n\'a jamais fum&eacute;e.</p>\n<p>Dans ses ant&eacute;c&egrave;dents elle est trait&eacute; pour HTA et DNID.</p>\n<p>Elle a eu une bronchite sans fi&egrave;vre avec toux et expectoration . Elle est sous AMOXILLINE depuis 5 jours.</p>\n<p>Sa TA est &agrave; 11.9/5.7 avec un pouls &agrave; 57 et une SaO2 &agrave; AA &agrave; 95%.</p>\n<p>L\'auscultation pulmonaire retrouve cdes ronchi dissemin&eacute;s.</p>\n<p>Nous la pla&ccedil;ons sous a&eacute;rosolth&eacute;rapie ATROVENT m et s avec BUDESONIDE m et s avec rin&ccedil;age.</p>\n<p>Nous la reverrons au mois de juin avec une radiographie thoracique.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>\n<p>&nbsp;</p>'),(19533,5792,1,'2020-02-19','Dr Pauvert','<p>Cher Confr&egrave;re,</p>\n<p>J\'ai vu ce jour Mme HOARAU Marie Annick n&eacute;e le 17/07/1964.Depuis janvier 2020 elle pr&eacute;sente une toux grasse &agrave; son retour de Maurice ou elle a fait de la plong&eacute;e.</p>\n<p>Cette est mari&eacute; et a 2 enfants.Elle est aide soignante.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note une ligature des trompes.</p>\n<p>Elle a eu une radiographie thoracique en date du 18/02/2020 qui est normale.</p>\n<p>Elle pr&eacute;sente des ronflements dans le sommeil.</p>\n<p>L\'auscultation pulmonaire retrouve des ronchi et des sibilances dissemin&eacute;s avec un l&eacute;ger freinage expiratoire.</p>\n<p>Nous la pla&ccedil;ons sous a&eacute;rosolth&eacute;rapie ATROVENT-BUDESONIDE et RELVAR.</p>\n<p>Je la reverrai en juin pour des EFR.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19534,1288,1,'2020-02-19','Dr Aouate','<p>Chere Consoeur</p>\n<p>J\'ai vu ce jour M. LECOT Jean n&eacute; le 08/06/1946.</p>\n<p>Il n\'arrive pas &agrave; mettre sa PPC et SOS Oxyg&egrave;ne a repris sa PPC. et la VNI.</p>\n<p>Le XOLAIR a &eacute;t&eacute; arret&eacute; par le CHU F.Guyon.</p>\n<p>Il pr&eacute;sente une symptomatologie de RGO. Je demande un test respiratoire &agrave; l\'ur&eacute;e.</p>\n<p>L\'auscultation pulmonaire retrouve des ronchi et des sibilances avec un freinage expiratoire.</p>\n<p>Sa polysomnographie en date du 240/04/2019 a retrouv&eacute; un IAH &agrave; 42/H. Cet index passe &agrave; 47/H en position dorsale. On retrouve un index de micro&eacute;veils de 10/H. Il existe 2 ronflements/H avec une energie moyenne de 79db. Le patient pr&eacute;sente 9 d&eacute;saturations/*H avec un NADIR de 70%. Il passe 44% de son temps de sommeil en dessous de 90% de saturation. On retrouve 1 mvt periodique des jambes /H.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, chere consoeur, l\'assurance de mes sentiments distingu&eacute;s</p>'),(19535,5394,1,'2020-02-19','Dr T. Abdallah Charif\nISIS Réunion','<p>Cher Toiliha,</p>\n<p>J\'ai vu ce jour M. M\'DAHOMA Chioni n&eacute; le 23/12/1945.</p>\n<p>il a une bonne observance de 2:33 avec un OIAH r&eacute;siduel de 0.44 sur les 3 derniers mois.</p>\n<p>Ses EFR retrouvent un trouble ventilatoire restrictif avec VGT &agrave; 73%,CPT &agrave; 63% et VR &agrave; 84%.Led rapport de Tiffeneau est &agrave; 87%. C\'est en grande partie li&eacute;e &agrave; son poids 85 kilos pour 1m65.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Toiliha , l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Bernard.</p>'),(19536,5780,1,'2020-02-19','Dr Crutchet','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour M. DECAESTEKER Stephane n&eacute; le 25/10/1964.</p>\n<p>Ce monsieur est mari&eacute; et a 3 enfants.Il est ancien fumeur et totalise environ 12PA. Il est sevr&eacute; depuis 11/1987.</p>\n<p>Il travaille &agrave; pole emploi&nbsp; comme correspondant informatique.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on retrouve un phymosis,une appendicectomie, une hernie discale op&eacute;r&eacute;e &agrave; Ste Clotilde et pr&eacute;sente des probl&egrave;mes de dos, il a &eacute;t&eacute; op&eacute;r&eacute; du menisque gauche en 2000.Thermocoagulation lombaire et des infiltrations.</p>\n<p>Il est trait&eacute; pour une hypothyroidie trat&eacute; par LEVOTHYROX avec des crampes dans les jambes au r&eacute;veil depuis 3 &agrave; 41 mois.Son FEVG &eacute;tait &agrave; 60% le 10/01/2019.Le 22/03/2019 son epreuve d\'effort cardiologique &eacute;tait normal.</p>\n<p>Il ,a eu par le Dr Chopra une PSG qui a retrouv&eacute; un IAH &agrave; 23.9 positionnel.</p>\n<p>Son probl&egrave;me majeur est la hernie discale L5-S1 et L4-L5.Sciatiques &agrave; bascule droit et gauche.Il est trait&eacute; par SKENAN LP 10mg.</p>\n<p>Il pr&eacute;sente des ronflements nocturnes avec 1 &agrave; 2 nyctiuries.On retrouve parfois des cephal&eacute;es matinales.Et surtout on <strong>retrouve</strong> une somnolence avec fatigue diurne.Son score d\'Epworth est &agrave; 14/24.Le score de Mallampati est de 3/4.Le perim&egrave;tre cervical est de 45cm avec un perim&egrave;tre abdominal de 112cm.</p>\n<p>Nous lui donnons un RV pour une polysomnographie.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>\n<p>&nbsp;</p>'),(19537,2674,1,'2020-02-19','Dr Goburdhun\nISIS Réunion','<p>Cher Siddick</p>\n<p>J\'ai vu ce jour M. SILEMAN Seraly n&eacute; le 29/09/1936.</p>\n<p>Il pr&eacute;sente un Overlap syndrome avec association d\'une BPCO et dun syndrome d\'apn&eacute;es du sommeil.</p>\n<p>Son CAT COPD assesment Test est de 26 et il n\'a pas &eacute;t&eacute; hospitalis&eacute; cette ann&eacute;e . il est donc Classe B Gold II avec un VEMS &agrave; 1.19 soit 55% non r&eacute;versible sous b2agoniste. Il pr&eacute;sente &agrave; l\'EFR une participation restrictive avec CPT &agrave; 63% en date du 10/10/2019.</p>\n<p>Ce monsieur est g&eacute;n&eacute; pour respirer au moindre effort et pr&eacute;sente donc une dyspn&eacute;e grade IV de l\'&eacute;chelle du Modified Medical Research Council</p>\n<p>Ses EFR retrouvent un trouble ventilatoire restrictif avec VGT &agrave; 87%,CPT &agrave; 68% et VR &agrave; 89%. Le rapport de Tiffeneau est &agrave; 87%.</p>\n<p><strong>Il est sous SYMBICORT RAPIHALER 2 B M et s avec une chambre d\'inhalation,a&eacute;rosolth&eacute;rapie BRICANYL X2:/j associ&eacute; &agrave; BUDESONIDE et ZITHROMAX 250 mg X3/semaine avec kin&eacute;sieth&eacute;rapie respiratoire.</strong></p>\n<p><strong>Il est sous OLD avec&nbsp; oxyg&eacute;noth&eacute;rapie de d&eacute;ambulation.Je lui demande de mettre son oxyg&eacute;noth&eacute;rapie toute la journ&eacute;e surtout quand il se d&eacute;place.</strong></p>\n<p>Avec mes remerciements, veuilles agr&eacute;er, cher Siddick , l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Bernard.</p>'),(19538,5731,1,'2020-02-19','Dr Bonne','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour M. MERA Christian n&eacute; le 26/03/1972.</p>\n<p>Ce monsieur est mari&eacute; et a 2 enfants.Il est m&eacute;canicien.</p>\n<p>Il n\'a jamais fum&eacute;.Dans ses ant&eacute;c&egrave;dents on note une m&egrave;re asthmatique.</p>\n<p>Il pr&eacute;szente une opression thoracique avec sibilances depuis 4 &ugrave;mois.</p>\n<p>Il pr&eacute;sente dce plus une rhinite avec &eacute;ternuments et toux.il pr&eacute;sente des expectorations blanchatres abondantes .Il pr&eacute;sente de plus des ronflements nocturnes avec 2 nyctiuries.</p>\n<p>Son scorte d\'Epworth est de 12/18 avec un score de Mallampati est de 2 /4</p>\n<p>Le perim&egrave;rtre cervical est de 37cm avec un perim&egrave;tre abdominal de 87cm;</p>\n<p>L\'auscultation pulmonaire retrouve des ronchi dissemin&eacute;s.</p>\n<p>Le TDM des sinus en date du 18/01/2020 retrouvent une ethmoidite .</p>\n<p>La NFS ne retrouve pas d\'hypereosinophilie et les IgE Totales sont &agrave; 84.9 UI/ml.</p>\n<p>Nous programmons&nbsp; une polygraphie ventilatoire.</p>\n<p>Ses EFR sont dans les limites de la normale.</p>\n<p>Sa polygraphie ventilatoire en date du 13/02/2020 a retrouv&eacute; un IAH &agrave; 2/H passant &agrave; 4/h en position dorsale. Le patient ne pr&eacute;sente donc pas de SAHOS.</p>\n<p>Il convient qu\'il puisse etre dot&eacute; pendant son travail d\'un masque ad&eacute;quat.</p>\n<p>Il arretera l\'a&eacute;rosolth&eacute;rapie et poursuivra :RELVAR et ULTIBRO.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19539,5781,1,'2020-02-19','Dr Grondin','<p>Chere Consoeur</p>\n<p>J\'ai vu ce jour Mme MERA L&eacute;a n&eacute;e le 11/12/2000.</p>\n<p>Cette jeune fille pr&eacute;sente des grandsparents asthmatiques.</p>\n<p>Elle est non fumeuse.elle a &eacute;t&eacute; op&eacute;r&eacute;e des v&eacute;g&eacute;tations.</p>\n<p>Elle pr&eacute;sente une toux alternante avec rhinite.Il s\'agit d\'une toux diurne et nocturne.</p>\n<p>L\'auscultation pulmonaire est ce joutr dans les limites de la normale.</p>\n<p>Nous demandons une radiographie thoracique avec un TDM des sinus.</p>\n<p>Nous programmons une EFR&nbsp; et nous demandons une NFS avec IgE totales.</p>\n<p>Nous demarrons un traitement par RELVAR.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, chere Consoeur, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19540,5782,1,'2020-02-19','Dr Grondin','<p>Chere Consoeur</p>\n<p>J\'ai vu ce jour M. MERA Marie n&eacute; le 17/12/1965.</p>\n<p>Cette dame est mari&eacute; et a 2 enfants.Elle est adjoint administratif.</p>\n<p>Elle n\'a jamais fum&eacute;e.Dans ses ant&eacute;c&egrave;dents on note une appendicectomie.</p>\n<p>Elle pr&eacute;sente des ant&eacute;c&egrave;dents familiaux d\'asthme.</p>\n<p>Elle pr&eacute;sente parfois des crises de toux s&eacute;ches dans la nuit,plus rarement la journ&eacute;e.</p>\n<p>L\'auscultation pulmonaire retrouve des ronchi dissemin&eacute;s.</p>\n<p>Nous demandons un test respiratoire &agrave; l\'ur&eacute;e devant une symptomatologie de RGO.</p>\n<p>Nous demandons une radiographie thoracique .</p>\n<p>Nous programmons une EFR et nous demandons une NFS avec IgE Totales. nous demarrons un traitement par RELVAR.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, chere Consoeur, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19541,176,1,'2020-02-20','DR Leveque\nDr Genin\nSEPRODOM','<p>Cher Confr&egrave;re,</p>\n<p>J\'ai vu ce jour Mme ALIDINA Rosemine n&eacute;e le 04/05/1960.</p>\n<p>Elle va mieux mais continue de tousser.</p>\n<p>L\'auscultation pulmonaire retrouve quelques ronchi dans les deux champs pulmonaires.</p>\n<p>Je la place sous PAROEX ,AVAMYS,RELVAR,a&eacute;rosolth&eacute;rapie BRICANYL-ATROVENT et BUDESONIDE pendant 10 jrs.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19542,4430,1,'2020-02-20','Dr Issac Ismael\nSOS Oxygène','<p>Cher Confr&egrave;re,</p>\n<p>J\'ai vu ce jour M. BOURRAN Abas n&eacute; le 21/07/1949.</p>\n<p>Son observance est de 4:42 avec un IAH r&eacute;siduel de 0.6 en date du 24/02/2020.</p>\n<p>Son TDM thoracique en date du 30/09/2019 retrouve une nette am&eacute;lioration parenchymateuse pulmonaire.</p>\n<p>Ses EFR en date du 11/06/2019 retrouvent un trouble ventilatoire restrictif mod&eacute;r&eacute; avec CPT &agrave; 77 % et VR &agrave; 80%. Le rapport de Tiffeneau est &agrave; 100%.</p>\n<p>Ses probl&egrave;mes d\'insomnie se sont amelior&eacute;s.Il devra se faire vacciner contre la grippe.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>'),(19543,5084,1,'2020-02-20','Dr Vinguetama','<p>Cher Joselito</p>\n<p>J\'ai vu ce jour Mme PAYET Monique n&eacute;e le 26/02/1969.</p>\n<p>Elle va bien et ne pr&eacute;sente plus de probl&egrave;mes respiratoires.</p>\n<p>Cette dame est mari&eacute; et a 1 enfant.Elle est sans profession.Elle a &eacute;t&eacute; peintre en batiment pendant 5 ans.</p>\n<p>Elle est non fumeuse.Dans ses ant&eacute;c&egrave;dents on&nbsp; retrouve&nbsp; une rhinite allergique.</p>\n<p>Depuis 1 mois elle pr&eacute;sente une toux le soir ou dans la voiture du &agrave; la penetration de vent froid.Elle pr&eacute;sente des ronflements nocturnes avec 3 nyctiuries.Elle pr&eacute;sente une fatigue diurne surtout depuis 1 ann&eacute;e.</p>\n<p>Elle a eu en date du 18/12/2018 un TDM thoracique qui a retrouv&eacute; un discret &eacute;paississement des parois bronchiques sans foyer bronchiolaire.</p>\n<p>.<strong>Les pricks tests ont &eacute;t&eacute; pratiqu&eacute;s &agrave; D.Farina: n&eacute;gatif&nbsp; ; &nbsp; D.Pteronyssinus: n&eacute;gatif&nbsp; ; &nbsp;Blomia n&eacute;gatif ; &nbsp;poil de chat:N&eacute;gatif &nbsp; &nbsp;; &nbsp; B.Germanicus: N&eacute;gatif&nbsp; ; 3Graminee:8 mm.</strong></p>\n<p><strong>Nous demarrons ce jour une d&eacute;sensibilisation aux 3 gramin&eacute;es.</strong></p>\n<p>L\'examen clinique retrouve une symptomatologie de RGO mod&eacute;r&eacute;e.L\'auscultation note des ronchi dissemin&eacute;s.</p>\n<p>Elle a pris 4 kilos en quelques mois. Elle presente des ronflements nocturnes avec 4 nyctiuries.Son score d\'Epworth est de 6/24 avec un&nbsp;&nbsp;score de Mallampati est de 3 /4.</p>\n<p>Le perim&egrave;tre cervical est de 34 cm avec un perim&egrave;tre abdominal de 91 cm.</p>\n<p>La NFS ne retrtouive pas d\'hyper&eacute;osinophilie.Les IgE totales sont &agrave; 165.5 UI/*ml.</p>\n<p>Ses EFR en date du 8/02/2019 retrouvent un trouble ventilatoire mixte avec VEMS &agrave; 1.21 soit 50 % passant &agrave; 1.46 soit 60% sous b2agoniste.</p>\n<p>Sa polygraphie ventilatoire en date du 12/02/2019 a retrouv&eacute; un IAH &agrave; 6/H. Il existe 142 ronflemen,ts/h avec une energie moyenne de 86db. Il existe une SaO2 de 88% &agrave; l\'&eacute;veil avec un NADIR de 81%.&nbsp;</p>\n<p>Sa polygraphie ventilatoire en date du 26/03/2019 a retrouv&eacute; un IAH &agrave; 3/H. Il existe 4 d&eacute;saturations/h avec un NADIR de 88%.</p>\n<p>Elle a un&nbsp; traitement par ULTIBRO&nbsp; et&nbsp; MIFLONIL.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>'),(19544,4051,1,'2020-02-20','Dr Deboisvilliers','<p>Cher Confr&egrave;re,</p>\n<p>J\'ai vu ce jour M. CLAIN R&eacute;gis n&eacute; le 16/02/1947.</p>\n<p>L\'auscultation pulmonaire est ce jour dans les limites de la normale.</p>\n<p>Son TDM thoracique en date du 4/05/2019 a retrouv&eacute; le micronodule de 6 mm du LSD inchang&eacute;.Il existe des DDB lobaires inf&eacute;rieurs droites et du lobe moyen.</p>\n<p>Nous le pla&ccedil;ons sous ZITHROMAX 250 mg 1 cp X 3/semaine pendant 3 mois.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19545,4297,1,'2020-02-20','','<p>Je soussign&eacute; Dr B.TANGUY certifie que l\'&eacute;tat de sant&eacute; de</p>\n<p>Mme BARBE Fabiola n&eacute;e le 09/12/1964&nbsp;</p>\n<p>n&eacute;cessite un am&eacute;nagement d\'horaire lui permettant de prendre son travail &agrave; 8:30 du matin.</p>\n<p>Fait &agrave; Saint Denis le 20/02/2020 et remis en main propre &agrave; l\'interess&eacute;e pour servir et valoir ce que de droit.</p>\n<p>&nbsp;</p>\n<p>Dr B.TANGUY.</p>'),(19546,4297,1,'2020-02-20','Médecin du travail\nMairie de Saint Denis','<p>Cher Confr&egrave;re</p>\n<p>Mme BARBE Fabiola n&eacute;e le 09/12/1964 est suivi par moi pour un syndrome d\'apn&eacute;es hypopn&eacute;es du sommeil s&eacute;v&egrave;re.</p>\n<p>Elle pr&eacute;sente un IAH &agrave; 29/H passant &agrave; 32/H en position dorsale.</p>\n<p>On retrouve 7 micro-&eacute;veils/H.</p>\n<p>Mme BARBE pr&eacute;sente 16 d&eacute;saturations/H avec un NADIR de 83%.Elle passe 1% de son temps de sommeil endessous de 90% de saturation.</p>\n<p>De ce fait en raison de sa perturbation de sommeil je vous serai gr&eacute; de bien vouloir autoriser un am&eacute;nagement de son temps de travail et lui permettre de commencer &agrave; 8:30 du matin au&nbsp; lieu de 7:00 du matin.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19547,5796,1,'2020-02-20','Dr I.Patel','<p>Cher Ibrahim</p>\n<p>J\'ai vu ce jour Mme LIN-SI Simone n&eacute;e le 23/07/1940.</p>\n<p>Cette dame est veuve et a 4 enfants.Elle est commercante &agrave; la retraite.</p>\n<p>Elle n\'a jamais fum&eacute;e.Dans ses ant&eacute;c&egrave;cents elle a &eacute;t&eacute; op&eacute;r&eacute;e de la cloison nasale.</p>\n<p>Elle a une soeur et des neveux asthmatiques.Elle a pr&eacute;sent&eacute; de l\'ecz&egrave;ma. Elle est trait&eacute; pour HTA .</p>\n<p>Depuis 3 ans elle pr&eacute;sente des&nbsp; narines bouch&eacute;s.</p>\n<p>L\'auscultation pulmonaire est ce jour quasiment dans les limites de la normale.</p>\n<p>Je demande ce jour une radiographie thoracique et je demarre un traitement anti reflux.</p>\n<p>Avec mes remerciements, veuilles agr&eacute;er, cher Ibrahim, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19548,5765,1,'2020-02-20','Dr Francois Lo Line Mei','<p>Cher Francois</p>\n<p>Je te remercie de m\'avoir adress&eacute; pour avis M. MAHABO Marcely, n&eacute; le 21/03/1944.</p>\n<p>Ce monsieur est mari&eacute; et a 3 enfants.il est mecanicien &agrave; la retraite.</p>\n<p>Il fumait 1pqt /j et est sevr&eacute; depuis 230 ans Il totalise environ 30PA.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note un pontage femoral bilat&eacute;ral et une op&eacute;ration de cataracte bilat&eacute;ral.</p>\n<p>Il est suivi pour diab&egrave;te et HTA,gonarthrose et arthrose femoro patellairte droite.</p>\n<p>Il a &eacute;t&eacute; appareill&eacute; par ISIS pour SAHOS mais a rendu la PPC depuis 3 ans.</p>\n<p>Il pr&eacute;sente ce jour des ronflements nocturnbes avec plusieurs nyctiuries.On retrouve une somnolence diurne avec fatigue diurne.Le score d\'Epworth est &agrave; 12/21 avec un score de Mallampati est de 3 /4.Le perim&egrave;tre cervical est de 40cm avec un perim&egrave;tre abdominal &agrave; 105cm.</p>\n<p>L\'auscultation pulmonaire est dans les limites de la normale.</p>\n<p>Sa radiographie thoracique est dans les limites de la normale.</p>\n<p>Nous programmons une EFR avec une polygraphie ventilatoire.</p>\n<p>Nous pla&ccedil;ons ce patient sous PPC en mode autopilot&eacute; entre 4 et 14 cm d\'eau.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19549,5777,1,'2020-02-21','Dr Cassamaly','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour M. PAYET Kendjy n&eacute; le 26/10/2013.</p>\n<p>Il pr&eacute;sente une tante et une m&egrave;re asthmatique .</p>\n<p>Il a pr&eacute;sent&eacute; une otite bilat&eacute;rale qui a &eacute;t&eacute; drain&eacute;e.Il pr&eacute;sente une surdit&eacute; de transmission &agrave; pr&eacute;dominance droite.</p>\n<p>Il pr&eacute;sente de l\'asthme avec hospitalisation en 2019 au CHU F.Guyon en p&eacute;diatrie.il est trait&eacute; par VENTOLINE et FLIXOTIDE.</p>\n<p>Il&nbsp; a une rupture de traitement depuis samedi avec toux,expectoration .</p>\n<p>L\'examen clinique retrouve des adenomegalies sous angulo maxillaires bilat&eacute;rales.</p>\n<p>L\'auscultation pulmonaire retrouve des ronchi et des sibilances bilat&eacute;rales dissemin&eacute;s.</p>\n<p><strong>Les pricks tests ont &eacute;t&eacute; pratiqu&eacute;s &agrave; D.Farinae: 5 mm &nbsp;; &nbsp; D.Pteronyssinus: 4mm &nbsp;; &nbsp;Blomia 5 mm&nbsp; &nbsp; ; &nbsp; B.Germanicus: N&eacute;gatif &nbsp; ; 5 graminee: N&eacute;gatif. </strong></p>\n<p>Je demande une radiographie thoracique avec une EFR, des prick tests,une NFS .</p>\n<p>Je demarre un traitement de fond par SERETIDE et singulair 5 mg le s.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19550,25,1,'2020-02-21','Dr Fun Yan Yuen\nISIS Réunion','<p>Cher Confr&egrave;re</p>\n<p>J\'ai revu ce jour Mme. RASOANANTENAINA Edwige n&eacute; le 19/02/1953.</p>\n<p>Sa TA est &agrave; 11.1/5.9 &nbsp; &nbsp;avec un pouls &agrave; 69&nbsp; et une SaO2 &agrave; 96%.</p>\n<p>L\'auscultation pulmonaire est ce jour dans les limites de la normale ainsi que ses EFR.</p>\n<p>Elle a une bonne utilisation de sa PPC avec une observance de 5:04 en p&eacute;riode enti&egrave;re et un IAH r&eacute;siduel de 0.50 sur un an.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19551,5642,1,'2020-02-21','Dr Kapler\nDr Gruzon \nISIS Réunion\nMédecin du Travail','<p>Cher Confr&egrave;re</p>\n<p>Je vous remercie de m\'avoir adress&eacute; pour avis M. DUPUY Benoit, n&eacute; le 19/12/1964.</p>\n<p>Il a diminu&eacute; sa consommation tabagique et fume 13 cigarettes/j.</p>\n<p>Il exerce la profession de chauffeur de bus et est actuellement en arret maladie jusqu\'au 28/02/2020.</p>\n<p>Son TDM thoracique retrouve des calcifications vasculaires.Il existe une hypodensit&eacute; arrondie de 11 mm du dome hepatique pour laquelle nous demandons un IRM h&eacute;patique avec injection de gadolinum.Son IRM c&eacute;r&eacute;bral en date du 25/11/2019 &eacute;tait normal.</p>\n<p>Ce patient a 5 enfants.Il est chauffeur de bus.Il fumait 1 paquet /j depuis l\'age de 16 ans et totalise environ 35PA.Sa TA est &agrave; 13.20/8.4 avec un pouls &agrave; 57 et une SaO2 &agrave; AA &agrave; 97%.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on ne retrouve rien de particulier.</p>\n<p>Il a pr&eacute;sent&eacute; 2 malaises chez lui au repos.Le premier il y a un mois un matin avec chute et perte de connaissance pendant quelques secondes. 15 jours apr&egrave;s il a pr&eacute;sent&eacute; un arret respiratoire dans son lit pendant quelques secondes.Il pr&eacute;sente des vertiges &agrave; la marche depuis 1 mois.</p>\n<p>Il pr&eacute;sente une toux matinale avec expectorations blanchatres et visqueuses.</p>\n<p>Il pr&eacute;sente une dyspn&eacute;e grade III de l\'&eacute;chelle du Modified Medical Research Council.</p>\n<p>Il pr&eacute;sente dces ronflements nocturnes avec 2 &agrave; 3 nyctiuries.On retrouve des cephal&eacute;es matinales avec somnolence et fatigue diurne.Le score d\'Epworth est &agrave; 19/21.</p>\n<p>Le score de Mallampati est de3 /4 avec un perim&egrave;tre cervical &agrave;37 cm&nbsp; et un perim&egrave;tre abdominal &agrave; 84 cm.L\'auscultation pulmonaire est dans les limites de la normale.</p>\n<p>Ses EFR en date du 3/12/2019 retrouvent un trouble ventilatoire obstructif Gold II avec VEMS &agrave; 2.10 soit 58% peu r&eacute;versible sous b2agonistes.Le rapport de Tiffeneau est &agrave; 74%.</p>\n<p>Sa polygraphie ventilatoire en date du 19/12/2020 retrouve un IAH &agrave; 30/H. Cet index passe &agrave; 35/H en&nbsp; position dorsale.Il existe 293 ronflements/H avec une energie moyenne de 86db.On retrouve 8 d&eacute;saturations/h avec un NADIR de 90%.</p>\n<p><strong>Ce patient pr&eacute;sente un SAHOS n&eacute;cessitant une mise sous PPC.Son observance est assez irreguli&egrave;re. Il ne mets pas tous les jours sa PPC condition n&eacute;cessaire pour la reprise du travail.</strong></p>\n<p><strong>Je le reverrai d&eacute;but juin pour son observance.</strong></p>\n<p>Je programme&nbsp; une polygraphie ventilatoire.Je le place sous RELVAR ELLIPTA et SPIOLTO.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19552,5759,1,'2020-02-21','Médecin traitant','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour M. AUBER Matthieu n&eacute; le 13/10/1984.</p>\n<p>Ce monsieur est c&eacute;libataire.il est professeur de francais.</p>\n<p>Il n\'a jamais fum&eacute;.Dans ses ant&eacute;c&egrave;dents on ne retrouve pas d\'astme familial.</p>\n<p>Il est allergique &agrave; la poussi&egrave;re et pr&eacute;sente des crises d\'asthme dans l\'enfance sans hospitalisation.</p>\n<p>Au Mexique il pr&eacute;sentait 1 crise tous les 2 mois soulag&eacute; par BRICANYL. Il ne prenait de fond.A Paris chez son frere qui possedait un chien dans l\'appartement et devait prendre du BRICANYL tous les soirs.Il a &eacute;t&eacute; mis par SOS M&eacute;decins &agrave; la R&eacute;union d&eacute;but janvier sous BRICANYL et FLIXOTIDE.</p>\n<p>L\'auscultation pulmonaire retrouve quelques ronchi dissemin&eacute;s.</p>\n<p>La radiographie thoracique en date du 15/01/2020 est dans les limites de la normale.</p>\n<p>Sa NFS en date du 18/02/2020 n\'a pas retrouv&eacute; d\'hyper&eacute;osinophilie.Les IgE Totales sont &agrave; 107UI/ml.</p>\n<p>L\'EFR retrouve une distension pulmonaire avec VGT &agrave; 126%.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19553,1107,1,'2020-02-21','Dr Al Assaf\nORL \nFAX:0262.37.36.09.\nMail:contact@orl-alassaf.fr','<p>Cher Ami</p>\n<p>Je te serai tr&egrave;s oblig&eacute; de bien vouloir examiner</p>\n<p>&nbsp;Mme VITRY Marie Reine n&eacute;e le 07/11/1948</p>\n<p>qui pr&eacute;sente une presbyacousie bilat&eacute;rale.</p>\n<p>Avec mes remerciements, veuilles agr&eacute;er, cher Ami, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19554,5487,1,'2020-02-21','Dr Roseline PAYET\nGEP Santé','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour M. HOOSSAIN Michael n&eacute; le 01/04/1958.</p>\n<p>Depuis 5 jours il pr&eacute;sente une g&egrave;ne respiratoire &agrave; l\'effort au bout de 50 m de marche avec une douleur thoracique droite.</p>\n<p>Sa TA est &agrave; 13.4/9.9 avec un pouls &agrave; 95 et une SaO2 &agrave; AA &agrave; 94%.</p>\n<p>Il a &eacute;t&eacute; hospitalis&eacute; au CHU F. Guyon du 6 au 8/10/2019 pour une embolie pulmonaire et a &eacute;t&eacute; mis sous PLAVIX et ELIQUIS.</p>\n<p>Le test respiratoire &agrave; l\'ur&eacute;e retrouve de l\'H.Pylori;</p>\n<p>Je pr&eacute;f&egrave;re l\'adresser aux Urgences du CHU pour pratiquer un angiscanner thoracique pour eliminer une r&eacute;cidive d\'embolie pulmonaire.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19555,1589,1,'2020-02-21','Dr Corouge','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour M. CADET Angelo n&eacute; le 18/06/1944.</p>\n<p>Il va mieux sous a&eacute;rosolth&eacute;rapie.</p>\n<p>Il dit pr&eacute;senter une toux et dit avoir eu du mal &agrave; respirer hier soir.</p>\n<p>Son poids est de 47.700K.</p>\n<p>Sa TA est &agrave; 14/8.3 avec un pouls &agrave; 66 et une SaO2 &agrave; AA &agrave; 96%.</p>\n<p>Ses EFR retrouvent un trouble ventilmatoire restrictif mod&eacute;r&eacute; avec une distension pulmonaire avec VGT &agrave; 127%.</p>\n<p>L\'auscultation pulmonaire retrouve des ronchi dissemin&eacute;s.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19556,4518,1,'2020-02-21','Dr Bachun \nSOS Oxygène','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme BEGUE V&eacute;ronique n&eacute;e le 01/01/1969.</p>\n<p>Elle pr&eacute;sente une assez bonne observance de 3:09 avec un IAH r&eacute;siduel de 0.8. en date du 03/09/2019.</p>\n<p>Elle pr&eacute;sente des signes de RGO. Le test respiratoire &agrave; l\'ur&eacute;e est n&eacute;gatif.</p>\n<p>L\'auscultation pulmonaire est redevenu normal.</p>\n<p>Ses EFR sont quasiment dans les limites de la normale.</p>\n<p>Nous demarrons un traitement de fond par SERETIDE 250 2 B m et s avec rin&ccedil;age et nous demarrons un traitement antireflux de 3 mois.</p>\n<p>Nous demandons &agrave; SOS Oxyg&egrave;ne de lui octroyer un masque anti allergique en raison des frottements du masque.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19557,599,1,'2020-02-21','',''),(19558,2669,1,'2020-02-21','',''),(19559,5411,1,'2020-02-21','Dr Rahabarisoa\nISIS Réunion','<p>Cher Confr&egrave;re,</p>\n<p>J\'ai vu ce jour M. SOUANTO Jean Rosaire n&eacute; le 20/05/1969.</p>\n<p>Ses EFR retrouvent un trouble ventilatoire restrictif avec VGT &agrave; 67%,CPT &agrave; 66% et VR &agrave; 75%. Le rapport de Tiffeneau est &agrave; 89%.</p>\n<p>L\'auscultation pulmonaire est dans les limites de la normale.</p>\n<p>Il a une bonne observance de 6:05 avec un IAH &agrave; 0.19.</p>\n<p>Je le place sous CHAMPIX pour son sevrage tabagique.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19560,2455,1,'2020-02-24','Dr Olivier Dupuis','<p>Cher Olivier</p>\n<p>J\'ai vu ce jour Mme CAMATCHY Marie Gisele n&eacute;e le 15/04/1949.</p>\n<p>L\'auscultation pulmonaire est ce jour dans les limites de la normale.</p>\n<p>Je lui conseille &agrave; elle comme &agrave; son mari de se faire vecciner d&egrave;s &agrave; pr&eacute;sent par le PREVENAR et dans 3 mois par le PNEUMOVAX . Bien entendu vaccinoth&eacute;rapie d&egrave;s avril 2020 par le vaccin antigrippal.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Olivier, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19561,220,1,'2020-02-24','Dr Sery\nSEPRODOM','<p>Cher Confr&egrave;re,</p>\n<p>J\'ai vu ce jour M. GRONDIN Henri Claude n&eacute; le 14/04/1958. Taille 1m68 poids:64 kilos.</p>\n<p>Son masquie a &eacute;t&eacute; renouvel&eacute; par SEPRODOM.</p>\n<p>Il pr&eacute;sente une BPCO Gold III avec un VEMS &agrave; 1.02 soit 33% non r&eacute;versible sous b2agonistes. Son rapport de Tiffeneau est &agrave; 64% post bronchodilatateur.</p>\n<p>Il existe une distension pulmonaire avec VGT &agrave; 124% et VR &agrave; 143%.On retrouve une augmentation des resistances des voies a&eacute;riennes avec RVA &agrave; 0.58.</p>\n<p>Il est grade B car il n\'a pas eu d\'exacerbation en date du 10/10/2019.</p>\n<p>L\'auscultation pulmonaire retrouve ce jour des ronchi dissemin&eacute;s.</p>\n<p><strong>il ne supportait plus la PPC . Nous avons fait un essai de VNI qu\'il n\'a pas non plus support&eacute;.</strong></p>\n<p>Sa capnie nocturne retrouve une pCO2 moyenne de 45.2 mm de Hg.Il ne pr&eacute;sente pas d\'hypoxie nocturne.</p>\n<p>Son TDM thoracqique en date du 23/01/2020 retrouve un emphys&egrave;me centro lobulaire et paraseptal pr&eacute;dominant aux apex.</p>\n<p>Il poursuivra le meme traitement par AITHROMYCINE,A&eacute;rosolth&eacute;rapie BRICANYL-ATROVENT et BUDESONIDE.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19562,2658,1,'2020-02-24','Dr Martinez\nSOS Oxygène','<p>Cher ami</p>\n<p>J\'ai vu ce jour Mme PICARD Marie-Line Patricia n&eacute;e le 15/09/1963.</p>\n<p>Son traitement de d&eacute;sensibilisation allergique lui a fait du bien ainsi que l\'a&eacute;rosolth&eacute;rapie qu\'elle voudrait renouveler de fa&ccedil;on intermittente.</p>\n<p>L\'auscultation pulmonaire&nbsp; est redevenue normale.</p>\n<p>Ses EFR sont ce jour dans les limites de la normale.</p>\n<p>Elle a &eacute;t&eacute; op&eacute;r&eacute;e le 15/06/2017 par le Dr Boyet &agrave; Ste Clotilde pour un carcinome colique sans traitement adjuvant.</p>\n<p>Sa polygraphie vetilatoire en date du 14/03/2018 a retrouv&eacute; un IAH &agrave; 36/H. Cet index passe &agrave; 58/H avec les diminutions(&eacute;v&egrave;nements).il est de 51/H en position dorsale.On retrouve 201 ronflements/H avec une energie moyenne de 83db. On retrouve 20 d&eacute;saturations/H avec un NADIR de 77%. La patiente passe 1% de son temps de sommeil endessous de 90% de saturation.</p>\n<p><strong>Les pricks tests ont &eacute;t&eacute; pratiqu&eacute;s &agrave; D.Farinae: &nbsp;12 mm &nbsp;; &nbsp; D.Pteronyssinus: 12 mm &nbsp;; &nbsp;Blomia 10 &nbsp;mm &nbsp; &nbsp;; &nbsp; B.Germanicus: N&eacute;gatif &nbsp; ; 5 graminee: N&eacute;gatif &nbsp;; 3Graminees N&eacute;gatif.&nbsp; Elle a demarr&eacute; son traitement anti allergique en mars 2018.</strong></p>\n<p><strong>Je la place ce jour sous PNEUMOVAX.Faire au mois d\'avril le vaccin antigrippal.</strong></p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY.</p>'),(19563,29,1,'2020-02-24','Dr Meyer','<p>Cher Consoeur,</p>\n<p>J\'ai vu ce jour Mme SERY Rosemay n&eacute;e le 23/10/1961.</p>\n<p>Son auscultation pulmonaire retrouve un freinage expiratoire avec des ronchi.</p>\n<p>Elle n\'a pas eu d\'exacerbation asthmatique.On redemande une NFS pour recherche d\'une hyper&eacute;osinophilie.</p>\n<p>Elle est sous ;Hydrocortisone 20mg le m + 10mg si stress ou infection intercurrente:a&eacute;rosolth&eacute;rapie(Bricanyl-Atrovent)X4;PulmicortX2 avec rincage;Seretide 500 Diskus 2BX2;Atarax 25 mgX2;Singulair 10 mg le s;Aerius 5 mg le s;Kin&eacute;sieth&eacute;rapie respiratoire et Om&eacute;prazole 20 mg 1 cp le soir.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, chere consoeur,Cher confr&egrave;re &nbsp;l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY.</p>'),(19564,5770,1,'2020-02-24','Dr Pierre Bernard','<p>Cher Confrere</p>\n<p>Je te remercie de m\'avoir adress&eacute; pour avis Mme JAMBERT Francoise, n&eacute;e le 20/10/1959.</p>\n<p>Cette dame est divorc&eacute;e et a 3 enfants.Elle est assistante maternelle.</p>\n<p>Elle est non fumeuse.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on&nbsp; note une appendicectomie et une hysterectomie en 1998 pour un cancer de l\'ut&eacute;rus.Elle pr&eacute;sente une allergie m&eacute;dicamenteuse .</p>\n<p>Cette patiente pr&eacute;sente des ronflements nocturnes avec parfois des cephal&eacute;es matinales.On retrouve une fatigue avec somnolence diurne.Le score d\'Epworth est de 17/24 avec un</p>\n<p>score de Mallampati est de 3 /4.Le perim&egrave;tre cervical est de 34 cm avec un perim&egrave;tre abdominal de 85 cm.</p>\n<p>L\'auscultation pulmonaire est dans les limites de la normale.</p>\n<p>Nous lui donnons un rendez vous pour une polygraphie ventilatoire.</p>\n<p>Avec mes remerciements, veuilles agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>\n<p>&nbsp;</p>'),(19565,171,1,'2020-02-24','Dr Fouassin','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme MOREAU LUCETTE MARIE n&eacute;e le 16/10/1948.</p>\n<p>Elle n\'a pas eu d\'exacerbation asthmatique.</p>\n<p>l\'auscultation pulmonaire est ce jour dans les limites de la normale.</p>\n<p>L\'EFR retrouve un trouble ventilatoire obstructif Gold II avec un VEMS &agrave; 1.00 soit 56 % non r&eacute;versible sous b2agonistes.Le rapport de Tiffeneau est &agrave; 66%.Il existe une distension pulmonaire avec VGT &agrave; 106%&nbsp; et VR &agrave; 103%.Il existe une augmentation des resistances des voies a&eacute;riennes avec RVA &agrave; 1.27.</p>\n<p>Elle poursuivra SPIRIVA RESPIMAT 2B/j avec FORADIL et FLIXOTIDE</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>'),(19566,5655,1,'2020-02-24','Dr Eric Fontaine','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme PANDOR Falida n&eacute;e le 27/11/1960.</p>\n<p>Elle a diminu&eacute; sa consommation tabagique.</p>\n<p>Je la place sous SPIOLTO et RELVAR.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19567,2947,1,'2020-02-24','Dr Didier RAZAKASOA','<p>Cher Didier,</p>\n<p>J\'ai vu ce jour Mme JAOSOA Jannie n&eacute;e le 25/12/1973.</p>\n<p>Ses palpitatiopns ont regrss&eacute;es.</p>\n<p>Ellme a eu le 17/02/2020 une polysomnographie qui a retrouv&eacute;e un IAH &agrave; 30/H. Il existe 9 micro-&eacute;veils/H. La patiente pr&eacute;sente 57 ronflements/H avec une energie moyenne de 88db.On retrouve 2 d&eacute;saturations/H avec un NADIR de 92%.&nbsp;</p>\n<p>La patiente qui avait d&eacute;ja &eacute;t&eacute; appareill&eacute; par le Dr Omarjee avec le prestataire ISIS ne tient pas &agrave; remettre sa PPC.</p>\n<p>Nous lui accordons un temps de reflexion.</p>\n<p>En revenche elle a &eacute;t&eacute; am&eacute;lior&eacute;e par l\'association RELVAR et SPIOLTO.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Didier , l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>\n<p>&nbsp;</p>'),(19568,5797,1,'2020-02-24','Dr Goburdhun\nMédecin Cardiologue ','<p>Cher Siddick,</p>\n<p>J\'ai vu ce jour M. BREZE Olivier n&eacute; le 10/06/1984.</p>\n<p>Ce monsieur est c&eacute;libataire.Il est ancien fumeur de cannabis 1 fois /semaine sevr&eacute; depuis 1 an.Il travaille comme ASH.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note une op&eacute;ration pour canal carpien gauche,3 coloscopies pour MICI.</p>\n<p>Il fait de la musculation en salle.Le 13/02/2020 il a ressenti une difficult&eacute; &agrave; reprendre la respiration.L\'auscultatio,n retrouve quelques ronchi dissemin&eacute;s.</p>\n<p>Ses EFR en date du 24/02/2020 retrouvent une distension pulmonaire avec VGT &agrave; 136%.</p>\n<p><strong>Il pr&eacute;sente une tachycardie &agrave; 124 au repos et qui passe lors du TM6 &agrave; 154 au bout de 3 minutes.Je lui conseille de consulter un cardiologue pour pratiquer une echocardiographie afin de tirer au clair l\'origine de cette tachycardie.</strong></p>\n<p>Avec mes remerciements, veuilles agr&eacute;er, cher Siddick, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19569,5672,1,'2020-02-24','Dr Didier RAZAKASOA\nSOS Oxygène','<p>Cher Didier,</p>\n<p>J\'ai vu ce jour M. KONRAD Jean Pierre n&eacute; le 05/03/1965.</p>\n<p>Il a une bonne observance de 4:21 avec un IAH r&eacute;siduel de 1.</p>\n<p>Avec mes remerciements, veuilles agr&eacute;er, cher Didier, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19570,5727,1,'2020-02-24','Dr Philippe CRUTCHET','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour M. CARPAYE Joe Steven n&eacute; le 07/01/1970.</p>\n<p>Ce monsieur a un enfant.Il est gerant de soci&eacute;t&eacute; de travaux publiques.</p>\n<p>Il fume 1pqt/j et totalise environ&nbsp; 32 PA. Je le place sous CHAMPIX.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on retrouve une rhinite allergique dans l\'enfance avec d&eacute;sensibilisation efficace.</p>\n<p>Depuis environ 3 mois il pr&eacute;sente une toux matinale avec des secretions grasses.</p>\n<p>Il prsente des ronflements nocturnes avec une nyctiurie et perturbation du sommeil.</p>\n<p>On retrouve des ronflements nocturnes avec des vertiges.Le score d\'Epworth est de 7/21.</p>\n<p>Le score de Mallampati est de 3 /4.Le perim&egrave;tre cervical est de 40 cm avec un perim&egrave;tre abdominal de 101cm.</p>\n<p>L\'auscultation pulmonaire retrouve des ronchi dissemin&eacute;s.</p>\n<p>Nous demandons&nbsp; une EFR et une polygraphie ventilatoire.</p>\n<p>Son TDM thoracique en date du 20/02/2020 n\'a pas retrouv&eacute; de l&eacute;sion suspecte.</p>\n<p>Nous le placons sous SPIOLTO et RELVAR.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19571,5619,1,'2020-02-24','Dr Pascal KLEIN\nDr Philippe BLANC\nISIS Réunion','<p>Cher Pascal, Cher Philippe&nbsp;</p>\n<p>J\'adresse&nbsp; M. MAILLOT Lucien, n&eacute; le 02/12/1950 en vue d\'une r&eacute;habilitation respiratoire.</p>\n<p>Son numero de telephone est le :06.92.87.36.65 et le 0262.21.56.04.</p>\n<p>Ce monsieur est divorc&eacute; et a 2 enfants.Il est p&eacute;cheur &agrave; la retraite.</p>\n<p>Il est ancien fumeur sevr&eacute; depuis 25 ans,2 paquets/j et totalise environ 50 PA.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note une AOMI avec amputation du gros orteil droit.</p>\n<p>En 2010 revascularisation du MI Droit avec angioplastie iliaque et thromboarteriectomie femoro-poplit&eacute; .</p>\n<p>Il est suivi pour HTA,dyslipid&eacute;mie .Il a b&eacute;n&eacute;fici&eacute; d\'une angioplastie coronarienne avec stent en 2017.</p>\n<p>Depuis 3 mois il pr&eacute;sente une dyspn&eacute;e &agrave; l\'effort.Il a un RV en d&eacute;cembre 2019 avec le Dr Chopra ,cardiologue.Il est pass&eacute; aux Urgences du CHU F.Guyon le 22/10/2019. Bilan biologique:Tropo et BNP n&eacute;gatifs.</p>\n<p>Il pr&eacute;sente 7 nyctiuries et son score d\'Epworth est &agrave; 9/24.</p>\n<p>Le score de Mallampati est de 3/4 avec un perim&egrave;tre cervical &agrave; 30.4cm et un perim&egrave;tre abdominal &agrave; 91 cm.L\'auscultation pulmonaire est ce jour dans les limites de la normale.</p>\n<p>Son TDM thoracique en date du 31/10/2019 a retrouv&eacute; un emphys&eacute;me bulleux pr&eacute;dominant dans les r&eacute;gions apicales avec des micronodulmes pulmonaires &agrave; surveiller dans 6 mois.</p>\n<p>Ses EFR retrouvent un trouble ventilatoire mixte avec CPT &agrave; 60%. Le VEMS est &agrave; 1.59 soit 53% non r&eacute;versible sous b2agonistes.Le rapport de Tiffeneau est &agrave; 85%.</p>\n<p>Sa polysomnographie en date du 13/02/2020 a retrouv&eacute; un iAH &agrave; 30/H. Cet index passe &agrave; 31/H en position dorsale.On retrouve 10 micro-&eacute;veils/H . Il existe 33 ronflements/H avec une energie moyenne de 85db.Le patient pr&eacute;sente 10 d&eacute;saturations/H avec un NADIR de 85%. Il passe 1% de son te&ugrave;mps de sommeil endessous de 90% de saturation.</p>\n<p>Il pr&eacute;sente un SAHOS n&eacute;cessitant une mise sous PPC.</p>\n<p>Je le place de plus sous RELVAR et SPIOLTO.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, Cher Pascal, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Bernard</p>'),(19572,464,1,'2020-02-24','Dr Yves LE GOC\nRhumatologue','<p>Cher Confr&egrave;re,</p>\n<p>Je vous adresse pour avis&nbsp; M. MAILLOT Mario n&eacute; le 18/09/1961.</p>\n<p>Ilm se plaint depuis 3 semaines d\'une douleur de l\'&eacute;paule gauche pour laquelle je demande un IRM des deux &eacute;paules.</p>\n<p>Il p&egrave;se ce jour 64.800K. Sa TA est &agrave; 12.3/8.4 avec un pouls &agrave; 91 et une SaO2 &agrave; AA &agrave; 97%.</p>\n<p>Son IRM de l\'&eacute;paule gauche a retrouv&eacute; une tendinopathie d\'insertion du sus-&eacute;pineux avec micro-ulc&eacute;ration de sa face profonde.Il existe une artyhropathie acromio-claviculaire avec &eacute;paississement de la bourse sous acromio deltoidienne .</p>\n<p>A DROITE ON NOTE UNE ARTHROPATHIE DEGENERATIVE ACROMIOCLAVICULAIRE AVEC UN ASPECT DE TENDINOPATHIE INFLAMMATOIRE DU SUPRAEPINNEUX.</p>\n<p>Il pr&eacute;sente un DNID depuis une dizaine d\'ann&eacute;es.il est sous Insuline le soir..</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19573,5806,1,'2020-02-24','Dr Pierron','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme SERY loane n&eacute;e le 28/04/2011.</p>\n<p>Cette enfant a une grand m&egrave;re asthmatique.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on retrouve un asthme qui a d&eacute;marr&eacute; &agrave; l\'age de 5 ans.</p>\n<p>Elle a consult&eacute; SOS M&eacute;decins il y a 1an et demi.</p>\n<p>Elle ne prend pas de traitement de fond.</p>\n<p>Elle ne pr&eacute;sente pas d\'allergie alimentaire.</p>\n<p>L\'auscultation pulmonaire est ce jour dans les limites de la normale.</p>\n<p>Nous demandons une radiographie pulmonaire avec un TDM des sinus.</p>\n<p>Ceci associ&eacute; &agrave; une NFS et un dosage des IgE Totales.</p>\n<p><strong>Les pricks tests ont &eacute;t&eacute; pratiqu&eacute;s &agrave; D.Farinae: 4mm &nbsp;; &nbsp; D.Pteronyssinus: 10mm &nbsp;; &nbsp;Blomia 5 mm ; &nbsp;poil de chat:N&eacute;gatif &nbsp; &nbsp;; &nbsp; B.Germanicus: N&eacute;gatif &nbsp; ; 5 graminee: N&eacute;gatif &nbsp;; 3Graminee:N&eacute;gatif. &nbsp;</strong></p>\n<p>Nous demarrons un traitement de fond par SERETIDE et SINGULAIR.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19574,3166,1,'2020-02-24','Dr Pierron','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme SERY loane n&eacute;e le 28/04/2011.</p>\n<p>Cette enfant a une grand m&egrave;re asthmatique.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on retrouve un asthme qui a d&eacute;marr&eacute; &agrave; l\'age de 5 ans.</p>\n<p>Elle a consult&eacute; SOS M&eacute;decins il y a 1an et demi.</p>\n<p>Elle ne prend pas de traitement de fond.</p>\n<p>Elle ne pr&eacute;sente pas d\'allergie alimentaire.</p>\n<p>L\'auscultation pulmonaire est ce jour dans les limites de la normale.</p>\n<p>Ses EFR retrouvent une distension pulmonaire avec VGT &agrave; 138% et VR &agrave; 106%.</p>\n<p>Nous demandons une radiographie pulmonaire avec un TDM des sinus.</p>\n<p>Ceci associ&eacute; &agrave; une NFS et un dosage des IgE Totales.</p>\n<p><strong>Les pricks tests ont &eacute;t&eacute; pratiqu&eacute;s &agrave; D.Farinae: 4 mm &nbsp;; &nbsp; D.Pteronyssinus: 10mm &nbsp;; &nbsp;Blomia n&eacute;gatif ; &nbsp;poil de chat:N&eacute;gatif &nbsp; &nbsp;; &nbsp; B.Germanicus: N&eacute;gatif &nbsp; ; 5 graminee: N&eacute;gatif poil de chien :8 mm.</strong></p>\n<p>Nous demarrons un traitement de fond par SERETIDE et SINGULAIR.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19575,2168,1,'2020-02-25','Dr Nadia Ramassamy\nSOS Oxygène','<p>Ch&egrave;re &nbsp;Consoeur,</p>\n<p>J\'ai vu ce jour M. TIAN-VAN-KAI Andr&eacute; n&eacute; le 01/08/1938.</p>\n<p>L\'auscultation pulmonaire est revenu dans les limites de la normale.</p>\n<p>Il pr&eacute;sente une symptomatologie de RGO et je lui prescrit un test respiratoire &agrave; l\'ur&eacute;e.</p>\n<p>Il pr&eacute;sente de plus une toux incoercible en particulier nocturne.</p>\n<p>Il a une observance de 2:50 avec un IAH r&eacute;siduel de 0.6 en date du 9/12/2019.</p>\n<p>Il convient de poursuivre SPIOLTO 2B cons&eacute;cutves en reprenant&nbsp; reprend l\'a&eacute;rosolth&eacute;rapie.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19576,5690,1,'2020-02-25','Dr Andre\nCHU F. Guyon','<p>Cher Ami et Coll&egrave;gue</p>\n<p>Je vous adresse pour prise en charge Mme CHANTO HING Marie France n&eacute;e le 12/01/1943.</p>\n<p>Cette dame est mari&eacute;e et a 3 enfants. Elle pr&eacute;sente un tabagisme passif ,son mari fume 3 paquets/j.</p>\n<p>Elle est commer&ccedil;ante &agrave; la retraite.</p>\n<p>Dans ses ant&eacute;c&eacute;dents on retrouve une coloscopie avec pr&eacute;sence de polpes(polyadenome tubuleux) n&eacute;cessitant une coelioscopie pour ablation; une &eacute;ventration abdominale, une valvulopathie mitrale op&eacute;r&eacute;e au CHU F. Guyon. un an&eacute;vrisme de l\'aorte abdominal suivie; une arteriopathie iliaque; une hypercholesterol&eacute;mie; une HTA; des nodules thyroidiens. une cataracte; des cystites r&eacute;cidivantes.</p>\n<p>Son mari a d&eacute;velopp&eacute; un cancer pulmonaire et elle a b&eacute;n&eacute;fici&eacute; un TDM thoracique en, date du 7/12/2019. Cet examen a retrouv&eacute; une masse spicul&eacute;e de la lingula de 4 cm.<br />Sa fibroscopie bronchique a &eacute;t&eacute; non contributive.</p>\n<p>Son PET Scan en date du 23/01/2020 a permis de retrouver un TDM thoracique en date de 2016.il existait d&eacute;j&agrave; des l&eacute;sions pulmonaires gauches moins volumineuses.</p>\n<p>Je t\'adresse le compte rendu du PET scan. La l&eacute;sion pulmonaire gauche est mod&eacute;r&eacute;ment hyperm&eacute;taolisme et le Dr Bourquard pense qu\'il s\'agit &agrave; priori de l&eacute;sions inflammatoires d\'origine post chirurgicales.</p>\n<p><strong>La ponction sous scanner pratiqu&eacute; par le Dr Kuhl a permis de retrouver un adenocarcinome pulmonaire de type acinaire.</strong></p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Ami et Coll&egrave;gue, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19577,4950,1,'2020-02-25','Dr Andriatavy\nDr Ratoanina\nDr Gasnier\nDr Kuhl','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme MAHAVANDE Marie C&eacute;line n&eacute;e le 15/04/1968.</p>\n<p>Ellle aura un TDM thoracique le 28/02/2020 . Il serait bon qu\'elle soit vu par la suite par le Dr Kuhl le 4/03/2020 &agrave; 8:30 pour r&eacute;aliser des novelles biopsies sous scanner.</p>\n<p>Je lui prescrit ce jour une NFS -plaquettes avec TP et TCA.</p>\n<p>Ce jour ses EFR retrouvent un trouble ventilatoire restrictif mod&eacute;r&eacute; avec CPT &agrave; 73%. Le rapport de Tiffeneau est &agrave; 100%.</p>\n<p>Elle est actuellement trait&eacute; par chimioth&eacute;rapie Alimta - Avastin 11 e cycle.</p>\n<p>Elle pr&eacute;sente un adenocarcinome lobaire moyenne TTF1 positif d\'embl&eacute;e metastatique .</p>\n<p>Ses marqueurs sont ALK n&eacute;gatif,PDL1 n&eacute;gatif.Les autres marqueurs n\'ont pas &eacute;t&eacute; explor&eacute;s.</p>\n<p>Or cette dame pr&eacute;sente un cancer bronchique primitif chez une non fumeuse .</p>\n<p><strong>Il est &agrave; mon avis indispensable que les autres marqueurs mol&eacute;culaires:soient explor&eacute;s &agrave; la recherche d\'une mutation vis &agrave; vis de l\'EGFR,KRAS,BRAF,ERBB,PIK 3CA,ROS1 ...</strong></p>\n<p><strong>Ces marqueurs tumoraux peuvent etre recherch&eacute;s sur les biopsies anciennes . Il suffirait que ces biopsies soient adress&eacute;es par le laboratoire anatpath du CHU de Saint Denis au laboratoire de biologie mol&eacute;culaire de Bordeaux.</strong></p>\n<p>Avec mes remerciements pour ce que vous ferez pour cette patiente , veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19578,154,1,'2020-02-25','Dr Pauvert\nSOS Oxygène','<p>Cher Confr&egrave;re</p>\n<p><strong>J\'ai vu ce jour M. BOYER Th&eacute;r&egrave;sien n&eacute; le 17/12/1933.</strong></p>\n<p><strong>Sa TA est &agrave; 17.1/12.1 avec un pouls &agrave; 91 et une SaO2 &agrave; 88% &agrave; AA.</strong></p>\n<p><strong>Jed le place sous LOXEN LP 50 mg m et s avant les repas.</strong></p>\n<p><strong>Je lui demande de vous consulter d\'urgence &agrave; ce sujet.</strong></p>\n<p><strong>Il a recommenc&eacute; &agrave; mettre sa BIPAP et est sous OLD de d&eacute;ambulation par SOS Oxyg&egrave;ne.</strong></p>\n<p>L\'auscultation pulmonaire s\'est plus ou moins normalis&eacute;e.</p>\n<p>Sur le plan th&eacute;rapeutique il &nbsp;est trait&eacute; par a&eacute;rosolttt(Bricanyl-Atrovent)X3 avec SPIOLTO 2 B cons&eacute;cutives et SYMBICORT RAPIHALER 2B m et s avec une chambre d\'inhalation et&nbsp; rin&ccedil;age de la bouche et kin&eacute;siettt respiratoire.Il est sous oxyg&eacute;noth&eacute;rapie de d&eacute;ambulation et en permanence.</p>\n<p>.Je vous laisse prescrire la kin&eacute;sieth&eacute;rapie respiratoire.</p>\n<p>&nbsp;Avec mes remerciements, veuillez agr&eacute;er, cher confr&egrave;re, l\'assurance des mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19579,926,1,'2020-02-25','Dr Boudaille\nISIS Réunion','<p>Cher Consoeur</p>\n<p>J\'ai vu ce jour Mme GAUDENS&nbsp; Graziella n&eacute;e le 31/01/1964.<br />Elle demande &agrave; ISIS de changer le masque de sa PPC.</p>\n<p>Le Dr Roelens lui a diagnostiqu&eacute; une fibromyalgie depuis 3 &agrave; 4ans et elle pr&eacute;sente une fonte depuis.</p>\n<p>L\'auscultation pulmonaire est dans les limites de la normale.</p>\n<p>&nbsp;Elle a une bonne observance &agrave; 4.45 avec un IAH r&eacute;siduel de 1.0.</p>\n<p>Ses EFR sont ce jour dans les limites de la normale.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Consoeur, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY.</p>'),(19580,5781,1,'2020-02-25','Dr Grondin','<p>Chere Consoeur</p>\n<p>&nbsp;UI/ml traduisant un terJ\'ai vu ce jour Mme MERA L&eacute;a n&eacute;e le 11/12/2000.</p>\n<p>Cette jeune fille pr&eacute;sente des grandsparents asthmatiques.</p>\n<p>Elle est non fumeuse.Elle a &eacute;t&eacute; op&eacute;r&eacute;e des v&eacute;g&eacute;tations.</p>\n<p>Elle pr&eacute;sente une toux alternante avec rhinite.Il s\'agit d\'une toux diurne et nocturne.</p>\n<p>L\'auscultation pulmonaire est ce joutr dans les limites de la normale.</p>\n<p>Son TDM des sinus retrouve une rhinosinusite maxillaire probablement allergique.</p>\n<p>Sa radiographie thoracique est normale.</p>\n<p>Sa NFS retrouve une hypereosinophilie &agrave; 1.28 Giga/L avec des IgE totales tr&egrave;s elev&eacute;es &agrave; 1927 UI/mL traduiosant un terrain allergique tr&egrave;s probable.</p>\n<p><strong>Ses</strong> EFR retrouvent une diminution du VEMS &agrave; 1.83 soit 66% non r&eacute;versible sous b2agonistes.Le VGT est &agrave; 104% traduisant une distension pulmonaire.</p>\n<p>Nous demarrons un traitement par RELVAR et nous demandons des RAST aux trophallerg&egrave;nes.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, chere Consoeur, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19581,5804,1,'2020-02-25','Dr Jean Yves MARI','<p>Cher Confr&egrave;re</p>\n<p>Je vous remercie de m\'avoir adress&eacute; pour avis Mme DOMO Angelica, n&eacute;e le 09/10/1982.</p>\n<p>Cette dame est mari&eacute; et a un enfant.Elle est professeur de piano.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note un asthme depuis l\'age de 10 ans trait&eacute; par SERETIDE avec VENTOLINE surtout en cas de changement de saison.</p>\n<p>Ce jour on retrouve une respiration nocturne de&nbsp; forte intensit&eacute;,avec des cephal&eacute;es matinales.Elle pr&eacute;sente une somnolence diurne avec fatigue diurne.Son score d\'Epworth est de 6/24 avec un score de Mallampati est de 3/4.Le pertim&egrave;tre cervical est de 34cm avec un perim&egrave;tre abdominal de 87cm.L\'auscultation pulmonaire est dans les limites de la normale.</p>\n<p>Nous lui donnons un RV pour une EFR et une polygraphie ventilatoire.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19583,2817,1,'2020-02-25','Dr Legal','<p>Chere Consoeur</p>\n<p>J\'ai vu ce jour Mme ICHANE Charlotte n&eacute;e le 28/07/1987.</p>\n<p>Cette dame est mari&eacute; sans enfants.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note un nodule du sein gauche op&eacute;r&eacute; par Dr Cuilleier.</p>\n<p>Elle pr&eacute;sente une acn&eacute; trait&eacute; par ROACCUTANE et suivi de naus&eacute;es.</p>\n<p>Elle a eu un AVP en mai 2019.Elle a ressenti quelques jours plus tard une douleur cervicale .</p>\n<p>Elle a present&eacute; une arythmie Elle a &eacute;t&eacute; mise sous aspegic pendant 1 mois.</p>\n<p>Depuis elle ressent des picotements dans la poiitrine et coliques avec des gaz.</p>'),(19584,4207,1,'2020-02-25','Dr Didier RAZAKASOA\nISIS Réunion','<p>Cher Didier</p>\n<p>J\'ai vu ce jour M. RANAIVOSON Adam n&eacute; le 05/02/1958.</p>\n<p>L\'auscultation pulmonaire est ce jour dans les limites de la normale.</p>\n<p>Il a une bonne observance de sa&nbsp; PPC&nbsp; sup&eacute;riur &agrave; 4:00.</p>\n<p>Il a compl&egrave;tement cess&eacute; de fumer. Ses EFR se sont normalis&eacute;s.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Didier, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Bernard</p>'),(19585,5803,1,'2020-02-25','Dr Der Kasberian','<p>Chere Consoeur</p>\n<p>J\'ai vu ce jour M. ZANEGUY Isidore n&eacute; le 12/08/1955.</p>\n<p>Ced monsieur est mari&eacute; et a 3 enfants. Il est m&eacute;canicien.</p>\n<p>Il est ancien fumeur 1 paquet/j depuis l\'age de 18 ans .Il totalise environ 28PA.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on retrouve une HTA,un glaucome.Il a &eacute;t&eacute; appareill&eacute; par le Dr Chopra pour SAHOS mais ne mets pas sa PPC.</p>\n<p>Il pr&eacute;sente une toux depuis 6 mois. Il aurait eu un TDM thoracique qui &eacute;tait normal.</p>\n<p>Je lui demande de pratiquer un test respiratoire &agrave; l\'ur&eacute;e et un TDM de s sinus.</p>\n<p>Nous programmons une EFR.</p>\n<p>Je le ppmlace sous a&eacute;rosolth&eacute;rapie BUDESONIDE .</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, chere Consoeur, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>\n<p>&nbsp;</p>'),(19586,5795,1,'2020-02-25','Dr Gruzon','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme MOUTIALGADOU Blandine n&eacute;e le 01/12/1973.</p>\n<p>Cette dame est mari&eacute; et a 2 enfants. Elle est agent administratif au CHU F.Guyon.</p>\n<p>Elle n\'a jamais fum&eacute;e.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note un terrain allergique avec une rhinite et toux&nbsp; depuis 2 ans.</p>\n<p>Ces crises surviennent 2 fois l\'an.</p>\n<p>L\'examen clinique retrouve un freinage expiratoire.</p>\n<p><strong>Les pricks tests ont &eacute;t&eacute; pratiqu&eacute;s &agrave; D.Farinae: 4mm &nbsp;; &nbsp; D.Pteronyssinus: 10mm &nbsp;; &nbsp;Blomia 5 mm ; &nbsp;poil de chat:N&eacute;gatif &nbsp; &nbsp;; &nbsp; B.Germanicus: N&eacute;gatif &nbsp; ; 5 graminee: N&eacute;gatif &nbsp;; 3Graminee:N&eacute;gatif. &nbsp;</strong></p>\n<p>Nous demandons une NFS et dosage d\'IgE Totales . Nous programmons une EFR avec Prick tests et radiographie thoracique et TDM des sinus.</p>\n<p>Nous demarrons un traitement par RELVAR.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19587,5703,1,'2020-02-25','',''),(19588,5357,1,'2020-02-25','Dr Goburdhun\nISIS Réunion','<p>Cher Siddick,</p>\n<p>J\'ai vu ce jour M. VIDOT Gianti n&eacute; le 07/03/1954.</p>\n<p>Son observance s\'est nettement am&eacute;lior&eacute;e passant &agrave; 3:18 avec un IAH r&eacute;siduel de 0.1 sur le dernier mois.</p>\n<p>Ses EFR retrouvent un trouble ventilatoire obstructif Gold III avec un rapport de Tiffeneau &agrave; 64% et un VEMS &agrave; 0.92 soit 47% non r&eacute;versible sous b2agonistes.Il existe une augmentation de la resistance des voies a&eacute;riennes avec RVA &agrave; 1.16.Ces chiffres sont en am&eacute;lioration par rapport au mois de juin 2019 avec &agrave; l\'&eacute;poque un VEMS &agrave; 0.77 soit 40% et un VGT &agrave; 168% avec VR &agrave; 175% traduisant &agrave; l\'&eacute;poque une distension pulmonaire qui a regress&eacute;e.</p>\n<p>Elle poursuivra AZITHROMYCINE 250 mg X3/semaine.</p>\n<p>Avec mes remerciements, veuilles agr&eacute;er, cher Siddick, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19589,5581,1,'2020-02-25','Dr Kabagema\nISIS Réunion','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme JAGANARDINPOULLE Sooryah n&eacute;e le 30/10/1938.</p>\n<p>Depuis quelques jours elle recommence &agrave; presenter des troubles respiratoires.</p>\n<p>Cette dame est veuve et a 5 enfants.Elle est sans profession .Elle a aid&eacute; son mari agriculteur dans les champs.</p>\n<p>Elle n\'a jamais fum&eacute;.Dans ses ant&eacute;c&egrave;dents on note une hysterectomie pour fibrome.Elle a eu une intervention avec mise en place d\'une proth&egrave;se cervicale.Une drepanocytose.</p>\n<p>Elle est trait&eacute; pour DNID et a pr&eacute;sent&eacute; un I.du myocarde en 03/2018 .Elle a eu 3 stents coronariens.Son FEVG est &agrave; 45%.Sa scintigraphie myocardique est normale.</p>\n<p>Elle pr&eacute;sente des ronflements avec plus de 4 nyctiuries.Il existe une somnolence avec fatigue diurne.Le score d\'Epworth est de 18/21 avec un score de Mallampati &agrave; 3.Nous programmons une PSG.</p>\n<p>L\'auscultation pulmonaire retrouve des ronchi dissemin&eacute;s.</p>\n<p>Son TDM thoracique n\'a pas retrouv&eacute; d\'image pathologique pulmonaire.</p>\n<p>Ses EFR en date du 13/11/2019 retrouvent un trouble ventilatoire restrictif avec CPT &agrave; 72%. Le rapport de Tiffeneau est &agrave; 87%.</p>\n<p>Le TDM thoracique en date du 18/02/2020 retrouve une PINS fibrosante .</p>\n<p>Sa polysomnographie en date du 6/02/2020 retrouve un IAH de 30/H . En position dorsale l\'IAH passe &agrave; 80/H. Il existe 7 micro-&eacute;veils/H. On note 16 ronflements/H avec une energie moyenne de 84db.Il existe 16 d&eacute;saturations/H avec un NADIR de 88%.&nbsp;</p>\n<p>Elle pr&eacute;sente un SAHOS n&eacute;cessitant un appareillage qu\'elle avait ant&eacute;rieurement refus&eacute;e et dont nous ferons un essai avec ISIS.</p>\n<p>Nous prescrivons un vaccinoth&eacute;rapie par PNEUMOVAX&nbsp; avec a&eacute;rosolth&eacute;rapie BUDESONIDE et ATROVENT pendant 1 semaine.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19590,5390,1,'2020-02-25','Dr Uva PARATIAN\nMédecin Cardiologue ','<p>Cher Uva</p>\n<p>J\'ai vu ce jour Melle&nbsp; MANON Coralie n&eacute;e le 02/10/1993.</p>\n<p>Cette dame est c&eacute;libataire.Elle est vendeuse en recherche d\'emploi.Elle n\'a jamais fum&eacute;.</p>\n<p>Dans ses ant&eacute;c&egrave;dents familiaux on note un neveu asthmatique.Elle meme presente une rhinite allergique et une allergie &agrave; l\'amoxicilline.</p>\n<p>Elle pr&eacute;sente un asthme ayant d&eacute;but&eacute; &agrave; l\'age de 10 ans.Elle ne prend pas de traitement de fond.</p>\n<p>Elle dit etre g&eacute;n&eacute;e pour respirer en permanence.Elle a fait en randonn&eacute;e le Grand Bassin et a eu du mal &agrave; remonter.</p>\n<p>L\'auscultation pulmonaire est ce jour dans les limites de la normale.</p>\n<p>Ses EFR traduisent une distension pulmonaire avec VGT &agrave; 104%,VR &agrave; 134%.Il existe une diminution du VEMS &agrave; 2.61 soit 79%, en partie r&eacute;versible sous b2agonistes.&nbsp;</p>\n<p>La NFS ne retrouve pas d\'hyper&eacute;osinophilie et les IgE Totales sont &agrave; 40UI/ml.</p>\n<p>Ler TDM des sinus retreouve une hyperplasie muqueuse des cornets inf&eacute;rieurs ,des v&eacute;g&eacute;tations adenoidiennes et des amygdales palatines.La radiographie thoracique en date du 10/07/2019 est dans les limites de la normale.</p>\n<p>..<strong>Les pricks tests ont &eacute;t&eacute; pratiqu&eacute;s &agrave; D.Farinae: 5 mm &nbsp;; &nbsp; D.Pteronyssinus:&nbsp; 5 mm &nbsp;; &nbsp;Blomia 5 mm ; &nbsp;poil de chat:N&eacute;gatif &nbsp; &nbsp;; &nbsp; B.Germanicus: N&eacute;gatif&nbsp; ; 3Graminee:N&eacute;gatif.&nbsp;</strong></p>\n<p><strong>Le TM6 en date du 25/02/2020&nbsp; retrouve une tachycardie &agrave; 100 au repos qui s\'accentue &agrave; l\'effort passant &agrave; 129 au bout de 2 minuites sans un effort demesur&eacute; vitesse moyenne de 1.79 m/s.</strong></p>\n<p><strong>Nous conseillons vivement une consultation cardiologique avec pratique d\'une echocardiographie.</strong></p>\n<p>Nous la pla&ccedil;ons sous SERETIDE et singulair.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19591,5456,1,'2020-02-25','Dr Fuchsbauer','<p>Cher Confr&egrave;re</p>\n<p><strong>J\'ai vu ce jour Mme ROBERT Jeanine n&eacute;e le 24/12/1935.</strong></p>\n<p><strong>Elle a refus&eacute;e une hospitalisation en HDJ au CHU F.Guyon pour faire le point sur sa PID.</strong></p>\n<p><strong>Son TDM thoracique en date du 13/01/2020 compar&eacute;e avec le TDM du 22/07/2019 retrouve une relative stabilit&eacute; de la pneumopathie infiltrante diffuse.</strong></p>\n<p><strong>Ses EFR en date du 17/02/2020 sont quasiment dans les limites de la normale.</strong></p>\n<p><strong>Son&nbsp; TM 6 en date du 25/02/2020 retrouve une d&eacute;saturation &agrave; 89% au bout de 4 minutes .La SaO2 passant de 97%&agrave; 89% . Le pouls passant dans le meme teps de 93 &agrave; 120 avec une vitesse de marche de 1.01 m/s.</strong></p>\n<p><strong>Dans ces conditions nous d&eacute;conseillons un voyage par avion sans oxyg&egrave;ne.</strong></p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19592,5814,1,'2020-02-25','Dr Al Assaf','<p>Cher Wared&nbsp;</p>\n<p>Je te remercie de m\'avoir adress&eacute; pour avis M. MEYER Alexandre, n&eacute; le 17/04/2013.</p>\n<p>Il a un oncle maternel asthmatique.Dans ses ant&eacute;c&egrave;dents on note 2 bronchiolite &agrave; l\'age dfe 1 et 2 ans.Il a pr&eacute;sent&eacute; une otite.</p>\n<p>Il a consult&eacute; SOS M&eacute;decins en 09/2018 avec g&egrave;ne respiratoire et sibilances.</p>\n<p>Cet enfant pr&eacute;sente un fond de toux avec g&egrave;ne respiratoire et a consult&eacute; SOS M&eacute;decins la semaine derni&egrave;re.</p>\n<p>L\'auscultation pulmonaire retrouve quelques&nbsp; ronchi dissemin&eacute;s.</p>\n<p>Nous demandons une radiographie thoracique avec une NFS et un dosage d\'IgE totales.</p>\n<p>Les EFR retrouvent ce jour une distension pulmonaire avec VGT &agrave; 140%.</p>\n<p>Nous conseillons un traitement de fond par SERETIDE et SINGULAIR et je le reverrai pour des prick tests.</p>\n<p>Avec mes remerciements, veuilles agr&eacute;er, cher Wared , l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Bernard</p>\n<p>&nbsp;</p>\n<p>&nbsp;</p>'),(19593,4173,1,'2020-02-26','Dr Gigleux-Gandon\nDr Al Assaf\nORL','<p>Cher Consoeur,</p>\n<p>J\'ai vu ce jour M. AVICE Bertrand n&eacute; le 25/02/1972.</p>\n<p>Ce monsieur est divorc&eacute; et a 3 enfants.Il est charg&eacute; de mission.</p>\n<p>il pr&eacute;sente une douleur recurrente thoracique &agrave; type de brulure avec une an&eacute;mie &agrave; 10.7g/dl le 16/04/2018;</p>\n<p>Jze lui conseille de consulter un gastro enterologue pour un FOGD et un hematologiqste pour la surveillance de sa maladie d\'Hodgkin.</p>\n<p>il est ancien fumeur et totalise environ 3PA. il est sevr&eacute; depuis mai 2017.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note une maladie de Hodgkin trait&eacute; par le Dr Gaud en 1992 et en partie &agrave; l\'hopital Saint Louis &agrave; Paris.Il n\'est pour ainsi dire plus suivi pour cette maladie.Il a consult&eacute; aux Urgences du GHER le 13/07/2017 pour une contracture des masseters.il a eu un IRM c&eacute;r&eacute;bral le 13/07/2017:N.</p>\n<p>Depuis avril 2017 il a pr&eacute;sent&eacute; 3 bronchites en 8 mois.</p>\n<p>Il a eu un test respiratoire &agrave; l\'ur&eacute;e qui est n&eacute;gatif.</p>\n<p>jke demande un TDM des sinus et un Panorex dentaire et je lui donne un traitement pour la sinusite.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19594,2465,1,'2020-02-26','Dr Patel\nISIS Réunion','<p>Cher Ibrahim,</p>\n<p>J\'ai vu ce jour M. ROSELLY Ren&eacute; Albert n&eacute; le 07/02/1953.</p>\n<p>Son nouveau numero de telephone est le:06.92.204.300.</p>\n<p>Sa TA est &agrave;&nbsp; 14.8/9.0 avec un pouls &agrave; 85 et une SaO2 &agrave; AA &agrave; 99%.</p>\n<p>Son auscultation pulmonaire est dans les limites de la normale.</p>\n<p>Il a une assez bonne obsevance de 4:01 et un IAH de 0.13 sur les 3 derniers mois.<br />je lui donne de l\'AVAMYS et du PAROEX pour son &eacute;coulement nasal.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Ibrahim, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19595,5815,1,'2020-02-26','Dr Galea','<p>Chere Consoeur</p>\n<p>Je vous remercie de m\'avoir adress&eacute; pour avis M. GRONDIN Michel, n&eacute; le 16/12/1951.</p>\n<p>Ce monsieur est mari&eacute; et a 4 enfants.Il a eu plusieurs professions et ne travaille plus .</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note une hernie inguinale droite .</p>\n<p>Il fumait 2Pqts/j et est sevr&eacute; depuis 1an et 3 mois et totalise environ 60PA.</p>\n<p>Depuis novembre 2018 il pr&eacute;sente une dyspn&eacute;e gradeIII de l\'&eacute;chelle du Modified Medical Research Council, &agrave; la mont&eacute;e d\'un &eacute;tage d\'escalier.Il pr&eacute;sente une toux matinale.</p>\n<p>L\'auscultation pulmonaire retrouve des ronchi dans les deux champs pulmonaires.</p>\n<p>Son TDM thoracique en date du 14/02/2020 retrouve un emphys&egrave;me s&eacute;v&egrave;re centrolobulaire des deux champs pulmonaires avec pr&eacute;sence de bulles apicales et de DDB bilat&eacute;rales des bases.</p>\n<p>Nous programmons une EFR avec un TM6 au mois de juin.</p>\n<p>Le traitement que vous avez prescrit est correct.Il convient &agrave; mon avis d\'ajouter le Vaccin PREVENAR avec le SPIOLTO 2 B cons&eacute;cutives et du ZITHROMAX 250 mg X3/semaine.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, chere Consoeur, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>\n<p>&nbsp;</p>'),(19596,5538,1,'2020-02-26','Dr Etienne SERY\nDr El Assaf','<p>&nbsp;</p>\n<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme DUCHEMANN Anne Marie n&eacute;e le 14/05/1941.</p>\n<p>Elle pr&eacute;sente une extinction de voix par atteinte des cordes vocales apr&egrave;s kin&eacute;sieth&eacute;rapie. Je l\'adresse pour avis au Dr Al Assaf.Je demande un ECBC.</p>\n<p>Fin avril 2019 elle ressent une g&egrave;ne respiratoire qui a conduit &agrave; pratiquer un TDM thoracique le 14/06/2019 et qui a retrouv&eacute; des DDB avec des condensations du Lobe moyen et de la lingula ainsi que du segment post&eacute;rieur des lobes inf&eacute;rieurs.</p>\n<p>Elle pr&eacute;sente une toux matinale avec expectoration abondante.</p>\n<p>L\'auscultation pulmmonaire retrouve des ronchi dissemin&eacute;s.</p>\n<p>Elle prend&nbsp; un traitement par ZITHROMAX 250 mg X3/semaine pendant&nbsp; 3 mois avec SPIOLTO&nbsp; B cons&eacute;cutives /j et lin&eacute;sieth&eacute;rapie respiratoire.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>'),(19597,5633,1,'2020-02-26','Dr Mogalia\nSOS Oxygène','<p>Chere Consoeur</p>\n<p>J\'ai vu ce jour Mme BERTIN Anne Marie n&eacute;e le 11/11/1951.</p>\n<p>Elle a une observance de 2:22 avec un IAH de 0.5.</p>\n<p>Je demande &agrave; SOS Oxyg&egrave;ne de repasser voir la patiente pour lui expliquer comme,nt remettre le masque la nuit.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, chere Consoeur, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19598,2332,1,'2020-02-26','Dr Bobate\nMedecin \nService de Cardiologie\nCHU F.Guyon','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme HADJI Moinaecha n&eacute;e le 01/01/1949.</p>\n<p>Elle a rendez vous avec vous au CHU la semaine prochaine.</p>\n<p>Elle se plaint&nbsp; d\'une symptomatologie de RGO et- je demande un test respiratoire &agrave; l\'ur&eacute;e qu\'elle n\'a pas pu faire.</p>\n<p>Son poids est de 102.100K.Elle pr&eacute;sente des oed&egrave;mes des M.I.</p>\n<p>Elle pr&eacute;sente une asthme depuis l\'enfance et r&eacute;side &agrave; la R&eacute;union depuis 1983.Elle a &eacute;t&eacute; hospitalis&eacute; pour asthme.Cliniquement on note une ob&eacute;sit&eacute; avec symptomatologie de RGO.On retrouve un oed&egrave;me des M.I avec des ronchi et des sibilances dans les 2 champs pulmonaires.</p>\n<p>Sa NFS ne retrouve pas d\'hyper&eacute;osinophilie.Les IgE totales sont &agrave; 49 UI/mL.</p>\n<p>La radiographie thoracique retrouve une l&eacute;g&egrave;re cardiom&eacute;galie sans atteinte parenchymateuse pulmonaire.</p>\n<p><strong>Ses EFR en date du 25/11/2019 retrouvent un trouble ventilatoire mixte obstructif avec rapport de Tiffeneau &agrave; 83%. Le VEMS est &agrave; 1.11 soit 51% peu r&eacute;versible sous b2agonistes.Il existe une augmentation des resistances des voies a&eacute;riennes avec RVA &agrave; 0.45.La CPT est &agrave; 66%.</strong></p>\n<p><strong>La patiente ne supporte pas l\'appareil de PPC qui a &eacute;t&eacute; &nbsp;reprise par l\'ARAR.Elle refuse le traitement par PPC.</strong></p>\n<p><strong>Je demande un bilan biologique avec glyc&eacute;mie&nbsp; &agrave; jeun,HbA1C,Ur&eacute;e/creatinine,ASAT/ALAT.</strong></p>\n<p>Elle est trait&eacute; par&nbsp; a&eacute;rosolth&eacute;rapie BRICANYL -ATROVENT X3/j avec PULMICORT m et s avec rin&ccedil;age. ainsi que SYMBICORT TURBUHALER 2B m et s avec rin&ccedil;age auquel je rajoute du ZITHROMAX.</p>\n<p>En vous remerciant de m\'adresser vos conclusions &agrave; propos de cette patiente&nbsp;&nbsp;veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19599,5323,1,'2020-02-26','Dr Abdullah','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour M. MARIAYE Jean Baptiste n&eacute; le 24/06/1958.</p>\n<p>Il a eu un TDM thoracique en date du 19/02/2020 qui retrouve une atelectasie sous segmentaire antero basale du LID probablement cicatricielle avec des ectasies moniliformes des bronches des lobes inf&eacute;rieurs.</p>\n<p>Nous ferons un TDM de comparaison dans 6 mois.</p>\n<p>Il avait&nbsp; &eacute;t&eacute; hospitalis&eacute; en cardiologie &agrave; la clinique Ste Clotilde du 15 au 16/07/2019 .</p>\n<p>Son FEVG est normale &agrave; 70%.La coronarographie n\'a pas retrouv&eacute; de st&eacute;nose significative.&nbsp;</p>\n<p>Le TDM abdominal en date du 14/06/2019 suspecte une pancreatite chronique calcifiante avec dilatation distale du Wirsung.Amylas&eacute;mie et lipas&eacute;mie en cours.D\'autant plus que le patient est un ancien tabacco-ethylique.</p>\n<p>Le test respiratoire &agrave; l\'ur&eacute;e a retrouv&eacute; la presence d\'H.Pylori.</p>\n<p>Nous mettons en route une trith&eacute;rapie pendant 10 jrs comportant Esomeprazole 40 mg m et s avec amoxicilline 1gX3/j et Clarithromycine 500mg X2/j.</p>\n<p>Le FOGD a retrouv&eacute; une anthro-bulbo-duodenite.</p>\n<p>Ce monsieur est mari&eacute; et a 5 enfants. Il est ma&ccedil;on. Il fumait un paquet /j et totalise environ 42PA.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note un DNID depuis 2014 avec&nbsp; dyslipid&eacute;mie.Il presente une surcharge atheromateuse des troncs jambiers distaux.</p>\n<p>Depuis 3 ans il est davantage g&eacute;n&eacute; pour respirer.Depuis vendredi 17/05/2019 il a reduit sa consommation de cigarettes et ne fume plus du tout..Le score de Mallampati est de 3/4.Le perim&egrave;tre cervical est de 38cm avec un perim&egrave;tre abdominal de 90cm.</p>\n<p>Il a eu le 20 mai 2019 un TDM thoracique qui a retrouv&eacute; un emphys&eacute;me bulleux des apex.</p>\n<p>Son HbAC1 est &agrave; 6.8% avec triglycerides &agrave; 2.11.</p>\n<p>Il a consult&eacute; un cardiologue qui a retrouv&eacute; un FEVG &agrave; 68%.Une scintigraphie myocardique est p&eacute;vue et les troponine sont normaux.</p>\n<p>Ses EFR en date du 28/05/2019 retrouvent un trouble ventilatoire mixte &agrave; pr&eacute;dominance restrictif avec VGT &agrave; 67%,CPT &agrave; 58% et VR &agrave; 64%. Le rapport de Tiffeneau est &agrave; 100%. Le VEMS est &agrave; 2.14 soit 69% non r&eacute;versible sous b2agonistes.Soit Gold II.&nbsp;</p>\n<p>Sa polygraphie ventilatoire en date du 6/06/2019 retrouve un IAH &agrave; 6/H. Cet index passe &agrave; 8/H en position dorsale.Il existe 160 ronflements/ H&nbsp; avec une energie moyenne de 84db.On note 4 d&eacute;saturations/H&nbsp; avec un NADIR de 88%.</p>\n<p>Je le place pour l\'instant sous SYMBICORT RAPIHALER 2 B m et s avec rin&ccedil;age,BUDESONIDE a&eacute;rosol pendant 15 jrs et SPIOLTO&nbsp; 2 B cons&eacute;cutives.Nous pr&eacute;voyons une r&eacute;habilitation respiratoire.Nous pouvez poursuivre le meme traitement.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19600,5793,1,'2020-02-26','Dr VERMEL','<p>Chere Consoeur</p>\n<p>Je vous remercie de m\'avoir adress&eacute; pour avis M. MANDON Priscilla, n&eacute; le 09/01/1987.</p>\n<p>Cette dame a 1 enfant. Elle s\'occupe d\'enfants handicap&eacute;s.</p>\n<p>Elle n\'a jamais fum&eacute;e . Dans ses ant&eacute;c&egrave;dents familiaux on retrouve un p&egrave;re asthmatique.</p>\n<p>Dans ses ant&eacute;c&egrave;dents personnels on retrouve une allergie alimentaire au pizza avec oed&egrave;me de Quincke.</p>\n<p>Elle pr&eacute;sente une rhinite allergique . On a retrouv&eacute; dans l\'enfance une allergie aux pollens.Elle a &eacute;t&eacute; hospitalis&eacute; en metropole pour asthme &agrave; l\'age de 2 ans.</p>\n<p>Elle a eu des difficult&eacute;s &agrave; respirer en 2019 et ne prend pas de traitement de fond.</p>\n<p>L\'auscultation retrouve des ronchi dissemin&eacute;s.</p>\n<p>Je vous conseille de pratiquer une radiographie thoracique avec un TDM des sinus.Il serait bon de rechercher une hyper&eacute;osinophilie et de faire des prick tests avec un RAST pour recherche de sensibilisation aux trophallerg&egrave;nes.</p>\n<p>Ses EFR sont ce jour dans les limites de la normale.</p>\n<p>Un traitement de fond par exemple par RELVAR ELLIPTA 184/22 1 B /j avec rin&ccedil;age et SINGULAIR 10 mg 1 cp le s me semble&nbsp; utile.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, chere Consoeur, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19601,2034,1,'2020-02-26','Dr Kuhl\nDr Meyer','<p>&nbsp;</p>\n<p>Cher Consoeur</p>\n<p>J\'ai vu ce jour Mme AKHOUN Rachida n&eacute;e le 28/05/1954.</p>\n<p>Elle a pr&eacute;sent&eacute; il y a 3 semaines une hemoptysie qui s\'est tarie.</p>\n<p>Je la place sous EXACYL 1 amp buv X4/j pendant 15 jrs.</p>\n<p>Si l\'hemoptysie recidivait je lui conseille de consulter le Dr Kuhl ,radiologue interventionnel au CHOR Centre Hospitalier Ouest Reunion pour pratiquer un TDM thoracique avec injection et &eacute;ventuellement pratiquer une embolisation arterielle.</p>\n<p>Je lui demande de faire d&egrave;s demain matin un bilan biologique avec Ur&eacute;e,creatinine,MDRD.</p>\n<p>Le TDM thoracique du 14/03/2019 retrouve des DDB du lobe moyen et de la lingula.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Consoeur, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19602,1499,1,'2020-02-26','Dr Gilli','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme TURPIN Renata n&eacute;e le 17/01/1966.</p>\n<p>Le test respiratoire &agrave; l\'ur&eacute;e apr&egrave;s traitement d\'H.Pylori est n&eacute;gatif.</p>\n<p>Sa voix s\'est am&eacute;lior&eacute;.</p>\n<p>nous modifions le traitement par RELVAR 1 B/j et SPIOLOTO 2 B cons&eacute;cutives.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19603,3110,1,'2020-02-26','Dr Patel\nSOS Oxygène','<p>Cher Ibrahim</p>\n<p>J\'ai vu ce jour M. POTHIN Jean n&eacute; le 28/03/1946.</p>\n<p>Sa TA est &agrave; 13.5/6.9 avec un pouls &agrave; 72&nbsp; et une SaO2 &agrave; AA &agrave; 95%.</p>\n<p>il &nbsp;a une tr&egrave;s bonne observance de sa PPC avec une utilisation quotidienne de 7:14 et un IAH r&eacute;siduel de 3.6 en date du 11 /2019.</p>\n<p>L\'auscultation pulmonaire est dans les limites de la normale.</p>\n<p>Il pr&eacute;sente des signes de RGO et je lui ai prescrit un test respiratoire &agrave; l\'ur&eacute;e pour recherche d\'H.Pylori.Tu as du recevoir les r&eacute;sultats.</p>\n<p>Avec mes remerciements, veuilles agr&eacute;er, cher Ibrahim, l\'assurance de mes sentiments distingu&eacute;s,</p>'),(19604,5639,1,'2020-02-26','Dr Viel \nGEP Santé','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour M. SINATA Giovanni n&eacute; le 28/01/1976.</p>\n<p>Il p&egrave;se ce jour 110.600K pour 176 cm.</p>\n<p>Il a une assez bonne observance de 3:14 avec un iAH r&eacute;siduel de 1.6 en date du 18/02/2020.</p>\n<p>Ce monsieur est c&eacute;libataire .Il travaille &agrave; temps partiel &agrave; la poste de Saint Denis.</p>\n<p>Il fumait 1pqt/j depuis l\'age de 18 ans et fume actuellement la cigarette electronique . Il totalise environ 26 PA.</p>\n<p>&nbsp;</p>'),(19605,396,1,'2020-02-26','Dr Eric FONTAINE','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme CADET Marie France n&eacute;e le 09/09/1954.</p>\n<p>L\'auscultation pulmonaire est ce jour dans les limites de la normale..</p>\n<p>&nbsp;Mme Cadet poursuivra &nbsp;Seretide 500 BX2;Aerius 5mg et Singulair 10mg 1cp le soir associ&eacute; &agrave;&nbsp; Paroex avec&nbsp; LAROSCORBINE.</p>\n<p>Avec mes remerciements, veillez agr&eacute;er, cher Confr&egrave;re, l\'assurance des mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19606,1945,1,'2020-02-26','Dr Corouge\nISIS Réunion','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme PEDIL Solange n&eacute;e le 08/03/1936.</p>\n<p>Le test respiratoire &agrave; l\'ur&eacute;e est n&eacute;gatif.</p>\n<p>Ses EFR se sont normalis&eacute;s.</p>\n<p>Je lui prescrit un traitement par RELVAR et ULTIBRO.</p>\n<p>Sa polygraphie ventilatoire en date du 18/02/2020 retrouve un IAH de 35/H. Cet index passe &agrave; 51/H en positrion dorsale.Il existe 609 ronflrements/H avec une energie moyenne de 86db.On note 19 d&eacute;saturations/H avec un NADIR de 82%. La patiente passe 3% de son te&ugrave;mps de sommeil en dessous de 90% de saturation.</p>\n<p>Elle pr&eacute;sente un SAHOS n&eacute;cessitant une mise sous PPC.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>\n<p>&nbsp;</p>'),(19607,3018,1,'2020-02-26','Dr Eric Bourdais\nISIS Réunion','<p>Cher Confr&egrave;re,</p>\n<p>J\'ai vu ce jour Mme GODRON Iris n&eacute;e le 02/07/1942.</p>\n<p>Sa TA est est &agrave; 17.4/9 avec un pouls &agrave; 80 avec un pouls de 97%.</p>\n<p>Elle a oubli&eacute; de prendre ce matin son traitement antihypertenseur.</p>\n<p>Elle a une bonne observance de 2:53 avec un IAH r&eacute;siduel de 1.86 sur 1 an qui est pass&eacute; &agrave; 1:24 d\'observance et de 2.72 sur le dernier mois.</p>\n<p>Je lui demande de remettre sa PPC et de prendre son traitement antihypertenseur.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>'),(19608,5720,1,'2020-02-26','Dr Carole VIGNAL','<p>Chere Consoeur</p>\n<p>Je vous remercie de m\'avoir adress&eacute; pour avis Mme MALLY Rasomanajara (pr&eacute;nom), n&eacute;e le 24/06/1955</p>\n<p>Cette dame est mari&eacute; et a 1 enfant.Elle est sans profession.Elle n\'a jamais fum&eacute;e.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note une coloscopie avec FOGD qui aurait retrouv&eacute; en 2017 un UGD.</p>\n<p>Elle est suivi pour HTA , arthrose diffuse et a fait un AVC&nbsp; isch&eacute;mique en aout 2018.</p>\n<p>Elle a &eacute;t&eacute; hospitalis&eacute;e en r&eacute;education &agrave; Ste Clotilde pour hemipar&eacute;sie droite et dysarthrie secondaire &agrave; un AVC isch&eacute;mique lacunaire le 25/08/2018.</p>\n<p>Elle pr&eacute;sente une dyspn&eacute;e grade IV de l\'&eacute;chelle du Modified Medical Research Council.</p>\n<p>Cela depuis plusieurs ann&eacute;es avec aggravation.Elle pr&eacute;sente parfois des sibilances.</p>\n<p>L\'auscultation pulmonaire retrouve quelques ronchi.</p>\n<p>Cette patiente pr&eacute;sente des ronflements avec 4 nyctiuries.On retrouve des cephal&eacute;es matinales avec une somnolence diurne et une fatigue diurne.Son score d\'Epworth est &agrave; 11/21.</p>\n<p>Le score de Mallampati est de 3 /4.Le perim&egrave;tre cervical est de 34 cm avec un perim&egrave;tre abdominal &agrave; 88cm.on retrouve une macroglossie.</p>\n<p>La radiographie thoracique en date du 18/12/2019 est dans les limites de la normale ainsi que le TDM thoracique.</p>\n<p>Ses EFR sont dans les limites de la normale.</p>\n<p>Son TM6 en date du 11/02/2020 retrouve l\'absence de d&eacute;saturation et d\'augmentation pathologique du pouls.La distance parcourue est de 606 m soit 130% de la distance th&eacute;orique.</p>\n<p>Sa polygraphie ventilatoire en date du 19/02/2020 retrouve un IAH &agrave; 11/H. il existe 34 ronflements/H avec une energie moyenne de 84db.On retrouve 15 d&eacute;saturations/H avec un NADIR de 84%.&nbsp;</p>\n<p>Nous demandons une polysomnographie.</p>\n<p>Je la place sous ULTIBRO et RELVAR.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, chere Consoeur, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19609,5817,1,'2020-02-26','Dr Pascal KLEIN','<p>Cher Pascal</p>\n<p>Je vous remercie de m\'avoir adress&eacute; pour avis M. STROHM Heinrich, n&eacute; le 06/07/1952.</p>\n<p>Ce monsieur est sportif . Il n\'a presque jamais fum&eacute;.</p>\n<p>Il est coach sportif.Dans ses ant&eacute;c&egrave;dents on note des hemorroides internes ligatur&eacute;s par Dr Kwong Cheong, une .insuffisance veineuse superficielle du M I droit.</p>\n<p>Il est suivi par le Dr Feno pour des extrasystoles ventriculaires de Rosembaum.FEVG &agrave; 60% datant de 2014.Il pr&eacute;sente des bronchites &agrave; repetition.Je lui propose une vaccinoth&eacute;rapie par PREVENAR&nbsp; et dans 3 mois le PNEUMOVAX.</p>\n<p>Il a eu un holter cardiologique par le Dr Benaich qui a montr&eacute; une salve supra ventriculaire non soutenue en date du 23/09/2019.</p>\n<p>Ce patient pr&eacute;sente 4 &agrave; 5 nyctiuries avec parfois une somnolence diurne avec fatigue diurne.Son score d\'Epworth est de 9/21 avec un&nbsp;score de Mallampati est de 2 /4.<br />le perim&egrave;tre cervical est de 35cm avec un perim&egrave;tre abdominal &agrave; 81cm.</p>\n<p>L\'auscultation pulmonaire est ce jour dans les limites de la normale.</p>\n<p>Je lui donne un RV pour une EFR et une polysomnographie.</p>\n<p>Avec mes remerciements, veuilles agr&eacute;er, cher Pascal , l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Bernard.</p>\n<p>&nbsp;</p>\n<p>&nbsp;</p>'),(19610,4762,1,'2020-02-27','Dr Ah Sing\nISIS Réunion','<p>Cher Jean Pierre,</p>\n<p>Je te remercie de m\'avoir adress&eacute; pour avis M. CHEUNG AH SEUNG Jean Louis, n&eacute; le 03/12/1952.</p>\n<p>Sa TA est &agrave; 13.0/ 8.5 avec un pouls &agrave; 71 et une SaO2 &agrave; AA &agrave; 96%.</p>\n<p>Il a une bonne observance de 2:37 avec un IAH r&eacute;siduel de1:14 en date du 27/02/2020.</p>\n<p>Ses EFR sont dans les limites de la normale.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19611,5802,1,'2020-02-27','Dr Satsou\nCardiologue\nDr Legris','<p>Cher Confr&egrave;re</p>\n<p>Je vous remercie de m\'avoir adress&eacute; pour avis Mme CHAVRIACOUTY Bernadette, n&eacute;e le 05/01/1945. Cette dame est mari&eacute; et a 3 enfants.</p>\n<p>Elle est facturi&egrave;re &agrave; la retraite. Elle n\'a jamais fum&eacute;e.</p>\n<p>Dans ses ant&eacute;c&egrave;dents elle a &eacute;t&eacute; op&eacute;r&eacute;e d\'une tumeur du tympan gauche.</p>\n<p>Elle est trait&eacute; pour HTA&nbsp; et hypercholesterol&eacute;mie.</p>\n<p>Elle a pr&eacute;sent&eacute;e une infection s&eacute;v&egrave;re au mois de d&eacute;cembre 2019 avec TA difficile &agrave; &eacute;quilibrer.</p>\n<p>Elle a eu une polygraphie ventilatoire qui a retrouv&eacute; un IAH &agrave; 25/H passant &agrave; 36/H en position dorsale.Elle a &eacute;t&eacute; mise sous PPC en pression fixe &agrave; 5cm d\'eau.</p>\n<p>Elle &eacute;tait suivi au pr&eacute;alble par le Dr Paganin qui a arret&eacute; la PPC.</p>\n<p>Cette dame pr&eacute;sente une fatigue avec somnolence diurne.</p>\n<p>Son score d\'Epworth est &agrave; 15/18 avec un &nbsp;score de Mallampati est de 3/4.Le perim&egrave;tre cervical est &agrave; 37cm avec un perim&egrave;tre abdominal de 96cm.L\'ausculltation pulmonaire est ce jour dans les limites de la normale.</p>\n<p>Je propose de pratiquer une polysomnographie &agrave; cette patiente.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19612,403,1,'2020-02-27','DR Morel','<p>Chere Consoeur</p>\n<p>J\'ai vu ce jour Mme AUBRAS Marie Lise n&eacute;e le 02/03/1958.</p>\n<p>Elle a eu un TDM thoracique le 21/08/2018 qui n\'avait pas retrouv&eacute; de l&eacute;sion &eacute;volutive.</p>\n<p>L\'auscultation pulmonaire est ce jour dans les limites de la normale.</p>\n<p>Ses EFR en date du 27/02/2020 sont dans les limites de la normale.</p>\n<p>Nous demandons un nouvel TDM thoracique.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19613,5725,1,'2020-02-27','Dr Issac Ismael\nGEP Réunion','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour M. SADAR Ibrahim n&eacute; le 24/04/1946.</p>\n<p>Ce monsieur a une fille.Il est gerant de soci&eacute;t&eacute;.</p>\n<p>il est ancien tabagique sevr&eacute; depuis 10 ans . Il fumait 10 cigarettes/j et totalise environ 20PA.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note une HTA . Il est suivi par le Dr Blais pour unr an&eacute;mie et a eu une FOGD et une coloscopie/normales.L\'examezn urinaire retrouve une prot&eacute;inurie &agrave; 0.60 g/L.</p>\n<p>Par ailleurs il est trait&eacute; par METFORMINE ,CLOPIDOGREL et LIPUR et est suivi par Dr Chopra.</p>\n<p>il pr&eacute;sente des ronflements nocturnes avec 2 &agrave; 3 nyctiuries.On retrouve une somnolence diurne avec une fatigue diurne. le score d\'Epworth est &agrave; 12/24 avec un score de Mallampati est de 3 /4.Le perim&egrave;tre cervical est de 42 cm avec un parim&egrave;tre abdominal de 121 cm.</p>\n<p>L\'auscultation pulmonaire retrouve des ronchi dissemin&eacute;s.</p>\n<p>le TDM thoracique en date du 19/12/2019 retrouve des DDB LI pr&eacute;dominant &agrave; droite avec un emphys&egrave;me pulmonaire bilat&eacute;ral.Le TDM du 14/01/2020 a retrouv&eacute; un emphys&egrave;me centro lobulaire avec un syndrome bronchique mod&eacute;r&eacute;.</p>\n<p>L\'EFR retrouve un trouble ventilatoire restrictif avec VGT &agrave; 75%,CPT &agrave; 63% et VR &agrave; 87%. Le rapport de Tiffeneau est &agrave; 99%.Le VEMS est &agrave; 62% peu r&eacute;versible sous b2agoniste.</p>\n<p>Sa CRP est &agrave; 46.6 avec une VS &agrave; 80 mm &agrave; la 1ere heure. Une electrophor&egrave;se des proteines pourrait s\'av&egrave;rer utile.</p>\n<p>Sa polygraphie ventilatoire en date du 20/02/2020 retrouve un IAH &agrave; 30/H . Cet index passe &agrave; 32/H en position dorsale.On retrouve 99 ronflements/H avec une energie moyenne de 83db.Il existe 31 d&eacute;saturations/H avec un NADIR de 58% Le patient passe 29% de son temps de sommeil endessous de 90% dfe saturation et 3% de son temps de sommeil e,n dessous de 80% de saturation.</p>\n<p>il pr&eacute;sente un SAHOS n&eacute;cessitant une mise sous PPC.</p>\n<p>Pour sa DDB nous le pla&ccedil;ons en cure de 3 mois de ZITHROMAX 250 mgX3/semaine .</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19614,5819,1,'2020-02-27','Dr martin Champetier\nDr Robin \nneuropédiatre \nCHU F.Guyon','<p>Cher Confr&egrave;re</p>\n<p>Je vous remercie de m\'avoir adress&eacute; pour avis Mme HOARAU Delphine, n&eacute;e le 10/06/2005.</p>\n<p>Elle pr&eacute;sente des crises d\'epilepsie depuis l\'age de 18 mois.</p>\n<p>Elle &eacute;t&eacute; hospitalis&eacute;e pendant 1 mois en septembre 2019 avec fi&egrave;vre ,infection pulmonaire et &eacute;tat comateux.</p>\n<p>Elle a pr&eacute;sent&eacute;e une SDRA compliquant une grippe avec hospitalisation en r&eacute;animation du 28/09 au 21/10/2020 puis en p&eacute;diatrie du 21 au 28/10/2020.</p>\n<p>Depuis mardi elle pr&eacute;sente une toux avec un foyer gauche &agrave; la radiologie thoracique et des CRP &agrave; 107 mg/L.</p>\n<p>Je pr&eacute;ferv&egrave;re mettre en route un traitement par AUGMENTIN 1gX3/j avec Ultyralevure pendant 7 jours et dans les suites le Vaccin PREVENAR associ&eacute; au PNEUMOVAX dans 3 mois.*</p>\n<p>Le vaccin antigrippal &agrave; r&eacute;aliser d&egrave;s le mois d\'Avril / Mai 2020.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>\n<p>&nbsp;</p>'),(19615,5819,1,'2020-02-27','','<p>Je soussign&eacute; Dr B.TANGUY certifie que</p>\n<p>&nbsp;Melle HOARAU Delphine n&eacute;e le 10/06/2005.</p>\n<p>doit etre dispens&eacute; de IME pendat 1 mois.</p>\n<p>Fait &agrave; Saint Denis</p>'),(19616,5742,1,'2020-02-27','Dr Merle \nSOS Oxygène','<p>Cher Confr&egrave;re</p>\n<p>Je vous remercie de m\'avoir adress&eacute; pour avis Mme PERROT Maximilienne, n&eacute;e le 19/09/1958.</p>\n<p>Elle est plus &eacute;veill&eacute;e sous PPC.</p>\n<p>Elle a une bonne observance de 6:40 avec un IAH r&eacute;siduel de 7.1.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>\n<p>&nbsp;</p>'),(19617,5663,1,'2020-02-27','Dr Akbaraly\nISIS Réunion','<p>Cher Confr&egrave;re,</p>\n<p>J\'ai vu ce jour Mme ABASSE Fijabay n&eacute;e le 17/02/1947.</p>\n<p>Elle a une mauvaise observance de 2:00 car elle dit tousser sous la PPC.</p>\n<p>nous renforcons son traitement m&eacute;dicamenteux avec SPIOLTO et RELVAR associ&eacute; &agrave; AVAMYS et PAROEX.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19618,595,1,'2020-02-27','Dr Ciceron\nSOS Oxygène','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour M. VIDOT David n&eacute; le 18/04/1977.</p>\n<p>Il dit mettre davantage sa PPC.</p>\n<p>Sa TA est &agrave; 12.7/8.4 avec un pouls &agrave; 86+ et une SaO2 &agrave; AA &agrave; 96%.</p>'),(19619,4212,1,'2020-02-27','Dr Sanselme','<p>Cher Consoeur,</p>\n<p>J\'ai vu ce jour M. DEL BOVE Olivia n&eacute; le 18/08/1999.</p>\n<p>Elle tousse depuis 2 semaines avec de la fi&egrave;vre.</p>\n<p>L\'auscultation pulmonaire retrouve dces sibilances et des ronchi dissemin&eacute;s.</p>\n<p><strong>Les pricks tests ont &eacute;t&eacute; pratiqu&eacute;s &agrave; D.Farinae:&nbsp; 12 mm &nbsp;; &nbsp; D.Pteronyssinus: 10mm &nbsp;; &nbsp;Blomia 8 mm&nbsp; &nbsp; &nbsp;; &nbsp; B.Germanicus: N&eacute;gatif &nbsp; ; 5 graminee: 12 mm .&nbsp;</strong></p>\n<p><strong>Nous remettons un dossier en vue d\'une d&eacute;sensibilistion allergique &agrave; la famille et nous reverons cet enfant dans 2&agrave; 3 semaines pour envisager une d&eacute;sensibilisation aux acariens.</strong></p>\n<p>Nous la pla&ccedil;ons sous SERETIDE 250&nbsp; 2 B m et s avec rin&ccedil;age associ&eacute; &agrave; AMOXICILLINE pendant 5 jrs.</p>'),(19620,3755,1,'2020-02-27','Dr Le Goc\nRhumatologue\nDr Blais\nGastro Enterologue','<p>Cher Confr&egrave;re,</p>\n<p>J\'ai vu ce jour M. DIMAURO Jean Fran&ccedil;ois n&eacute; le 11/02/1954.</p>\n<p>Ce monsieur est mari&eacute; et a 2 enfants.Il a fum&eacute; pendant 10 ans .</p>\n<p>Il pr&eacute;sente des douleurs lombaires.</p>\n<p>Il est retrait&eacute; .Dans ses ant&eacute;c&egrave;dents on note un paludisme &agrave; Madagascar .</p>\n<p>Il est trait&eacute; pour HTA depuis 3 ans.Sa TA est &agrave; 14.4/9 avec un pouls &agrave; 78 et une SaO2 &agrave; 97%.</p>\n<p>Il existe 2 nyctiuries avec des cephal&eacute;es.Son score d\'Epworth est &agrave; 8/24 avec un&nbsp;score de Mallampati est de 3 /4.</p>\n<p>le perim&egrave;tre cervical est de 37 cm avec un perim&egrave;tre abdominal de 95 cm.</p>\n<p>Sa polygraphie ventilatoire en date du 01/08/2017 a retrouv&eacute; un iAH &agrave; 46/H. Cet index passe &agrave; 52/H en position dorsale.</p>\n<p>Il existe 133 ronflements/H avec une energie moyenne de 82db.On retrouve 38 d&eacute;saturations/H .</p>\n<p>L\'energie moyenne est de 82db.Il existe 38 d&eacute;saturations/H avec un NADIR de 83%.le patient passe 5% de son temps de sommeil en dessous de 90% de saturation.</p>\n<p>le patient n&eacute;cessite une mise sous PPC .</p>\n<p>Son TDM du rachis lombo-sacr&eacute; a retrouv&eacute; une hernie discale L4-L5 avec une hernie discale L5-S1 avec empreinte sur le fourreau dural.Je l\'adresse pour kin&eacute;sieth&eacute;rapie.</p>\n<p>Il ira consulter le Dr Blais pour des probl&egrave;mes coliques.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19621,5816,1,'2020-02-27','Dr Goburdhun\nDr Chopra','<p>Cher Siddick</p>\n<p>Je vous remercie de m\'avoir adress&eacute; pour avis M. CATANCAVERY Christophe, n&eacute; le&nbsp; 02/11/1950.</p>\n<p>Ce monsieur est mari&eacute; et a 2 enfants.Il est retrait&eacute; du batiment.</p>\n<p>Il n\'a jamais fum&eacute;.Il aurait present&eacute; de l\'asthme &eacute;tant jeune.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note la&nbsp; pose de&nbsp; stent coronarien apr&egrave;s&nbsp; un infarctus du myocarde en 2014 ,2016 et 2019.</p>\n<p>On note plusieurs hospitalisations en cardiologie au CHU F. Guyon en 2019.</p>\n<p>Il est diab&eacute;tique trait&eacute; par INSULINOTHERAPIE.Il a pr&eacute;sent&eacute; 2 AVC.</p>\n<p>Il est pr&eacute;vu un pontage aorto coronarien chez ce patient entre mai et juin 2020.</p>\n<p>Il pr&eacute;sente des ronflements nocturnes avec 2 nyctiuries.On note des migraines matinales avec une fatigue et une somnolence diurne.Le score d\'Epworth est de 7/24 avec un score de Mallampati est de 3 /4.Le perim&egrave;tre cervical est de 39 cm avec un parimm&egrave;tre abdominal de 92 cm.l\'auscultation pulmo,naire retrouve qulques ronchi dissemin&eacute;s.</p>\n<p>Ses EFR retrouvent une augmentation des resistances des voies a&eacute;riennes &agrave; 0.66.Le reste de l\'examen est correct au repos.Nous conseillons de pratiquer une polysomnographie.</p>\n<p>Je le place sous RELVAR,SPIOLTO et ZITHROMAX.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19622,2093,1,'2020-02-28','Dr Vinguetama\nSOS Oxygène','<p>Cher Joselito</p>\n<p>J\'ai vu ce jour M. PAYET Jean Olivier n&eacute; le 01/02/1971.</p>\n<p>Il va bien . En 2016 il avait &eacute;t&eacute; not&eacute; au TDM thoracique des nodules pulmonaires et des ad&eacute;nom&eacute;galies m&eacute;diastinales qui ont regress&eacute;s.Nous demandons un TDM thoracique de controle sans injection.</p>\n<p>Seule persiste l\'ad&eacute;nom&eacute;galie axillaire gauche profonde&nbsp;</p>\n<p>Il a b&eacute;n&eacute;fici&eacute; le 11/01/2016 d\'un IRM de la paroi thoracique qui avait retrouv&eacute; en dessous du muscle pectoral gauche d\'une formation ovalaire &nbsp;de 26 mm de diam&egrave;tre prenant le contraste apr&egrave;s injection de Gadolinum.</p>\n<p>&nbsp;</p>\n<p>Avec mes remerciements, veuilles agr&eacute;er, cher Joselito, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Bernard</p>'),(19623,2485,1,'2020-02-28','Dr Vinguetama\nSEPRODOM','<p>Cher Joselito,</p>\n<p>J\'ai vu ce jour Mme PAYET Marie Annick n&eacute;e le 17/10/1970.</p>\n<p>L\'auscultation pulmonaire est ce jour dans les limites de la normale.</p>\n<p>Elle a une dur&eacute;e d\'utilisation de 5:32&nbsp; avec un IAH r&eacute;siduel de 0.3 en date du 08/11/2019..</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Joselito, l\'assurance de mes sentiments distingu&eacute;s,</p>'),(19624,5813,1,'2020-02-28','Médecins \nService de Cardiologie\nCHU F.Guyon\n','<p>Cher Coll&egrave;gues&nbsp;</p>\n<p>Je vous adresse en consultation pour une hospitaisation de coute dur&eacute;e&nbsp; M. MADELY Guy, n&eacute; le 09/09/1949.</p>\n<p>Ce monsieur est mari&eacute; et a 4 enfants.Il est couturier &agrave; la retraite.Il n\'a jamais fum&eacute;.</p>\n<p>Dans ses ant&eacute;c&egrave;dents il a pr&eacute;sent&eacute; en 2006 un infarctus du mycorde avec une hospitalisation au CHU F.Guyon.Il a eu la pose de 2 stents coronariens.Il est trait&eacute; pour hypercholesterol&eacute;mie.&nbsp;</p>\n<p>Il pr&eacute;sente une dyspn&eacute;e grade III de l\'&eacute;chelle du Modified Medical Research Council.</p>\n<p>Son FE au repos est &agrave; 24%.Il pr&eacute;sente une opression thoracique avec somnolence et fatigue diurne.Son score d\'Epworth est &agrave; 10/21 avec un &nbsp;score de Mallampati est de 2 /4.</p>\n<p>La TA est &agrave; 11/7.1 avec un pouls &agrave; 87 et une SaO2 &agrave; AA &agrave; 97%.</p>\n<p>Ses EFR retrouvent un trouble ventilatoire mixte avec CPT &agrave; 69%. Le VEMS est &agrave; 1.71 soit 66% non r&eacute;versible sous b2agonistes. nous le pla&ccedil;on pes sous RELVAR,SPIOLTO et BUDESONIDE en a&eacute;rosolth&eacute;rapie.</p>\n<p>Il a du mal &agrave; dormir.Je lui propose&nbsp; une polysomnographie.</p>\n<p>Je pense que son probl&egrave;me respiratoire est avant tout li&eacute; &agrave; son insuffisance cardiaque et je lui demande de consulter en cardiologie au CHU F.GUyon pour programmer une courte hospitalisation pour faire le point sur son probl&egrave;me cardiaque.</p>\n<p>Il a RV en cardiologie le 30/03/2020.au CHU F.Guyon.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Coll&egrave;gues, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY.</p>'),(19625,48,1,'2020-02-28','Dr Bobate\nSEPRODOM','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour M. LERY Issop n&eacute; le 22/11/1934.</p>\n<p>Il a une bonne utilisatiopn de sa BIPAP.</p>\n<p>Ses oed&egrave;mes ont fondus.L\'auscultation pulmonaire est revenu dans les limites de la normale.</p>\n<p>Il est sous a&eacute;rosolth&eacute;rapie BRICANYL-ATROVeNT et BUDESONIDE.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>'),(19626,5808,1,'2020-02-28','Dr Francois Lo Line Mei\nDr KUHL\n','<p>Cher Francois,Cher Emmanuel,</p>\n<p>Je te remercie de m\'avoir adress&eacute; pour avis Mme BERILE Marie Lucie, n&eacute;e le 21/07/1957.</p>\n<p>Cette dame est mari&eacute; et a 3 enfants.Elle n\'a jamais fum&eacute;.</p>\n<p>Elle est sans profession.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note 3 c&eacute;sariennes.Elle pr&eacute;sente une hypothyroidie et des allergioes aux acariens;</p>\n<p>Elle a eu une nephrectomie partielle au mois d\'octobre 2019 pour un carcinome r&eacute;nal &agrave; cellules claires de grade II.</p>\n<p>Son TDM thoracique pr&eacute; op&eacute;ratoire avait retrouv&eacute; une petite l&eacute;sion non suspecte du LIG &agrave; recontroler en post op&eacute;ratoire.</p>\n<p>Le TDM thoracique de controle du 14/02/2020 a retrouv&eacute; un nodule de 12 mm de diam&egrave;tre du lobe inf&eacute;rieure gauche.</p>\n<p>Je demande &agrave; Mme Berile de consulter le Dr Kuhl &agrave; St Paul pour comparaison des deux scanners et &eacute;ventuellement r&eacute;aliser une ponction de ce nodule.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Fran&ccedil;ois,Cher Emmanuel l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>\n<p>&nbsp;</p>'),(19627,4941,1,'2020-02-28','Dr Didier Razakasoa','<p>Cher Didier</p>\n<p>J\'ai vu ce jour M. SOULE Serge n&eacute; le 20/05/1956.</p>\n<p>Il a compl&egrave;tement cess&eacute; de fumer.Il sera suivi par le Dr Kong pour son hyperthyroidie.</p>\n<p>L\'auscultation pulmonaire une diminution des bruits pulmonaires sthetacoustiques.</p>\n<p>Son TDM thoracique en date du 23/11/2018 retrouvent un aspect de BPCO.</p>\n<p>Le patient peut etre class&eacute; GOLD B grade 3 de la nouvelle classification GOLD.</p>\n<p>Ses EFR en date du 19/12/2019 retrouvent un VEMS qui est pass&eacute; de 0.89 &agrave; 1.01 sur 1 an.Soit de 29 &agrave; 33%.Le rapport de tiffeneau est &agrave; 45%.il existe une distension pulmonaire avec VGT &agrave; 120%.Le VR est &agrave; 109%.Il y a une am&eacute;lioration des resist(ances des voies a&eacute;riennes avec RVA &agrave; 0.77 alors qu\'il &eacute;taient &agrave; 1.05 en novembre 2018.</p>\n<p>Je lui conseille le traitement suivant: ULTIBRO 1&nbsp; B cons&eacute;cutives avec du ZITHROMAX 250 X3/semaine et RELVAR&nbsp; associ&eacute; &agrave; kin&eacute;sieth&eacute;rapie respiratoire.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19628,5809,1,'2020-02-28','Dr Razakasoa\nM. le Médecin Radiologue\nDR Low Hong','<p>Cher Didier</p>\n<p>Je te remercie de m\'avoir adress&eacute; pour avis M. RAKOTOARINEFITRA Rodolphe, n&eacute; le 11/04/1951.</p>\n<p>Ce monsieur est veuf et a 4 enfants.Il est ancien fumeur sevr&eacute; et totalise environ 60PA.</p>\n<p>IUl est retrait&eacute; de la police et de la m&eacute;canique.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on retrouve une hemorroidectomie,un UGD,un cervicarthrose avec lombarthrose.Et surtout une BPCO.</p>\n<p>Il pr&eacute;sente une dyspn&eacute;e grade II de l\'&eacute;chelle du Modified Medical Research Council.</p>\n<p>Il a eu un &eacute;tat grippal il y a 20 jours.</p>\n<p>L\'auscultation pulmonaire retrouve dces rtonchi dans les deux champs pulmonaires.</p>\n<p>Je demande une EFR avec un TM6.</p>\n<p>Son TDM thoracique en date du 21/02/2020 retrouve des l&eacute;sions sclero emphysemateux avec des bulles aux apex.Il existe des petites zones infiltratives de la region moyenne et ^post&eacute;rieurs gauches n&eacute;cessitant un controle dans 4 mois.</p>\n<p>je conseille de le placer sous ZITHROMAX,SPIOLTO et RELVAR ELLIPTA.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>\n<p>&nbsp;</p>'),(19629,5778,1,'2020-02-28','Dr Didier RAZAKASOA\nSOS Oxygène','<p>Cher Didier</p>\n<p>Je te remercie de m\'avoir adress&eacute; pour avis M. ROSSANALLY Issa, n&eacute; le 23/11/1946.</p>\n<p>Ce monsieur est mari&eacute; et a 7 enfants.Il &eacute;tait commercant &agrave; Madagascar.</p>\n<p>Il fumait 1 pqt/j et actuellement 5 cigarttes /J. Il totalise environ 50PA.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note qu\'il est trait&eacute; pour HTA,Il pr&eacute;sente une fatigue diurne avec 2 &agrave; 3 nyctiuries .Le score d\'Epworth est &agrave; 13/21 avec un score de Mallampathi de 3. Le perim&egrave;tre cervical est de 35 cm avec un perim&egrave;tre abdominal de 95cm.&nbsp;</p>\n<p>L\'auscultation pulmonaire retrouve des ronchi dissemin&eacute;s.</p>\n<p>Le TDM thoracique retrouve une dystrophie emphys&eacute;mateuse de type mixte centro lobulaire et paraseptale.</p>\n<p>Ses EFR en date du 24/02/2020 retrouvent un trouble ventilatoire restrictif mod&eacute;r&eacute; avec CPT 0 74% et VR &agrave; 76%.&nbsp;</p>\n<p>Je le pl:ace sous CHAMPIX pour son sevbrage tabagique d&eacute;finitif.</p>\n<p>Sa polygraphie ventilatoire en date du 25/02/2020 retrouve un IAH &agrave; 42/H. Cet index passe &agrave; 79/H en position dorsale.Il existe 53 ronflements/H avec une energie moyenne de 83db. On retrouve 14 d&eacute;saturations/H avec un NADIR de 87%.</p>\n<p>Ce patient pr&eacute;sente outre sa BPCO un SAHOS (Overlap Syndrome) n&eacute;cessitant une mise sous PPC.</p>\n<p>Nous placons ce patient sous SPIOLTO et RELVAR.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19630,5117,1,'2020-02-28','Dr Lu Yen Tung Murielle\nDr Chopra','<p>Chere Consoeur</p>\n<p>J\'ai vu ce jour M. ASSIGARALY SP n&eacute; le 19/12/1940.</p>\n<p>la&nbsp; famille et le patient est contre la chimioth&eacute;rapie propos&eacute;e par le Dr Saint Paul au CHU de Saint Denis. Il revient d\'un s&eacute;jour de deux mois &agrave; Madagascar.</p>\n<p>Il verra le Dr Chopra apr&egrave;s mon rendez vous ce jour.</p>\n<p>Je demande ce jour un TDM thoraco abdominal sans injection d\'&eacute;valuation.</p>\n<p>Je lui prescrit de l\'EXACYL 4 amp buvable /j en cas de nouvelle hemoptysie.Je lui prescrit un traitement de fond par RELVAR ELLIPTA 184/22 1 B/j avec rin&ccedil;age ,SPIOLTO 2 B cons&eacute;cutives,ZITHROMAX 250 1 cp X3/semaine ?</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, chere Consoeur, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19631,3810,1,'2020-02-28','Dr Corouge\nSOS Oxygène','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme MURAT Marie Claudine n&eacute;e le 10/08/1948.</p>\n<p>Elle met bien sa PPC avec une observance de 6:00 et un IAH r&eacute;siduel de 2.7 en date du 26/02/2020.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19632,5686,1,'2020-02-28','','<p>Tout va bien .</p>\n<p>Il n\'y avait qu\'une prostatite chronique.</p>'),(19633,1865,1,'2020-02-28','ISIS Réunion \nDr Thia\nDr \n','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour M. TECHER Jean Marie n&eacute; le 25/12/1964.</p>\n<p>Ce monsieur c&eacute;libataire a 7 enfants.Il s\'occupait d\'entretien d\'immeuble et est actuellement en invalidit&eacute;.Il a retrouv&eacute; sa libert&eacute; depuis le mois d\'aout 2019.</p>\n<p>Il fumait 30 cigarettes /j et est sevr&eacute; depuis et totalise plus de 40PA.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note une intervention de chirurgie thoracique pour un pr&eacute;l&egrave;vement ganglionnaire m&eacute;diastinal qui s\'est r&eacute;v&egrave;l&eacute; n&eacute;gatif en 2009.Il a &eacute;t&eacute; op&eacute;r&eacute; des 2 m&eacute;nisques.</p>\n<p>Il est trait&eacute; pour HTA depuis 5 ans et a un d&eacute;fibrillateur implante.Il a eu une r&eacute;education cardiaque pour cardiopathie cong&eacute;nitale et isch&eacute;mique.La FEVG est de 30%.</p>\n<p>Il pr&eacute;sente 4 &agrave; 5 nyctiuries.Il pr&eacute;sente une hypersomnie diurne.Son score d\'Epworth est &agrave; 18 avec un&nbsp;score de Mallampati est de 1 /4.Le perim&egrave;tre cervical est de 36 cm avec un perim&egrave;tre abdominal de 101 cm.</p>\n<p>La TA est de 12/6.8 avec un pouls &agrave; 69 et une SaO2 &agrave; AA &agrave; 97%.L\'auscultation pulmonaire est dans les limites de la normale.</p>\n<p>Son agenda de sommeil retrouve en moyenne 2 &agrave; 3 nyctiuries avec pratique de la sieste pratiquement la moiti&eacute; du temps.Le sommeil est qualifi&eacute; de moyen par le patient.Son score de Beck (BDI) est de 6,ce qui traduit une d&eacute;pression l&eacute;g&egrave;re.Ses EFR retrouvent un trouble ventilatoire restrictif avec CPT &agrave; 64%.Le VEMS &agrave; 2.14 soit 62% non r&eacute;versible sous b2-agonistes.Le rapport de Tiffeneau est &agrave; 86%.Il existe un trouble du transfert avevc TLCO &agrave; 41%.</p>\n<p>Son TDM thoracique sans injection retrouve des l&eacute;sions d\'emphys&egrave;me pulmonaire plus marqu&eacute;s aux sommets.Il existe une cardiom&eacute;galie .Je le place &nbsp;sous kin&eacute;sieth&eacute;rapie respiratoire:TVD.</p>\n<p>Sa polysomnographie en date du 03/08/2015 a retrouv&eacute; un IAH (index d\'apn&eacute;es hypopn&eacute;es) de 27/H. Ct index passe &agrave; 32/H quand on y associe les &eacute;v&egrave;nements(diminutions).</p>\n<p>il existe 17 micro-&eacute;veil/H avec une nombre de &nbsp;sec soit une dur&eacute;e totale de &nbsp;100 minutes.</p>\n<p>On note 71 ronflements/H avec une energie moyenne de 84db.Il existe 17 d&eacute;saturations/H avec une SaO2 minimale de 87%.On retrouve 11 mouvements p&eacute;riodiques des jambes.</p>\n<p>Nous allons appareiller en mode autopilot&eacute; par PPC (pression positive continue) ce patient.</p>\n<p>Ses EFR retrouvent un trouble ventilatoire mixte avec CPT &agrave; 62%. Le VEMS est &agrave; 2.10 soit 63% non r&eacute;versible sous b2agonistes.Le rapport de Tiffeneau est &agrave; 91%.</p>\n<p>Nous le pla&ccedil;ons sous SPIOLTO et RELVAR.</p>\n<p><strong>Je demande &agrave; ISIS de repasser voir ce patient pour le motiver.</strong></p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19634,1775,1,'2020-02-28','Dr Ilponse\nISIS Réunion','<p>Ch&egrave;re Consoeur,</p>\n<p>J\'ai vu ce jour Mme BALMER Odile Marie Celine n&eacute;e le 12/05/1953.</p>\n<p>Elle fait actuellement de la r&eacute;education pour les yeux.</p>\n<p>Elle a une bonne observance de 5:15 avec un IAH r&eacute;siduel de 1.16 sur une ann&eacute;e.</p>\n<p>ses EFR sont dans les limites de la normale.</p>\n<p>L\'auscultation pulmonaire est ce jour dans les limites de la normale.</p>\n<p>Je pense qu\'il faut qu\'elle de la kin&eacute;sieth&eacute;rapie avec &eacute;tirement.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19635,5714,1,'2020-02-28','Dr Jankowski','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour Mme SELEMON Graziella n&eacute;e le 09/02/1988.</p>\n<p>Elle pr&eacute;sente un p&egrave;re asthmatique.Elle a fum&eacute; pendant 5 ans 4 &agrave; 5 cigarettes/j. Elle est sans profession . Elle est mari&eacute; et a 3 enfants.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note un drainage des sinus.Elle a &eacute;t&eacute; trait&eacute; pour un karetocone.</p>\n<p>Elle pr&eacute;sente une malformation ureterorenale droite .</p>\n<p>Elle pr&eacute;sente des crises d\'asthme des manifestations allergiques avec un urticaire au mois d\'aout 2019 et decembre 2019.</p>\n<p>Elle a prsente une crise d\'asthme en 06/2019 avec mise sous a&eacute;rosolth&eacute;rapie.</p>\n<p>Depuis octobrte 2019 elle prend un traitement de fond par SYMBICORT arret&eacute; depuis 1 mois avec reprise de la g&egrave;ne respiratoire.</p>\n<p>Elle pr&eacute;sente des ronflements nocturnes avec parfois des cephal&eacute;es matinales.Son score d\'Epworth est de 22/24 avec un score de Mallampati est de 3/4.Le perim&egrave;tre cervical est de 36 cm avec un perim&egrave;tre abdominal de 118cm. cette dame a pris 45 kilos en 1 ann&eacute;e.</p>\n<p>Sa polygraphie ventilatoire en date du 14/01/2020 retrouve un IAH &agrave; 10/H. Cet index passe &agrave; 12/H en position dorsale.On retrouve 87 ronflements/H avec une energie moyenne de 84db.Il existe 8 d&eacute;saturations/h avec un NADIR de 88%. Nous proposons une polysomnographie &agrave; la patiente.</p>\n<p>le TDM des sinus en date du 8/01/2020 retrouve un tr&egrave;s minime sinusite maxillaire gauche chronique.La radiographie thoracique est dans les limites de la normale.</p>\n<p><strong>Les pricks tests ont &eacute;t&eacute; pratiqu&eacute;s &agrave; D.Farinae: 4mm &nbsp;; &nbsp; D.Pteronyssinus: 10mm &nbsp;; &nbsp;Blomia 5 mm ; &nbsp;poil de chat:N&eacute;gatif &nbsp; &nbsp;; &nbsp; B.Germanicus: N&eacute;gatif &nbsp; ; 5 graminee: N&eacute;gatif &nbsp;; 3Graminee:N&eacute;gatif. &nbsp;</strong></p>\n<p><strong>Ses EFR en date du 6/02/2020 retrouvent un trouble ventilatoire obstructif avec rapport de Tieffeneau &agrave; 72%.Le VEMS est &agrave; 1.88 soit 61% non r&eacute;versible sous b2agoniste.Il existe une augmentation&nbsp; de la resistance des voies a&eacute;riennes avec RVA &agrave; 1.62.</strong></p>\n<p><strong>Sa polysomnographie en date du 24/02/2020 a retrouv&eacute; un index de micro-&eacute;veils de 6/H. Il existe un IAH &agrave; 13/H. On retrouve 111 ronflements /H avec une energie moyenne de 83db.On retrouve 6 d&eacute;saturations /heure avec un NADIR de 88%.</strong></p>\n<p><strong>Pour l\'instant il n\'existe pas d\'indication de PPC.</strong></p>\n<p><strong>En revanche il est imperieux que Mme Selemon perde du poids.</strong></p>\n<p><strong>Elle demarre d&egrave;s demain sa d&eacute;sensibilisation anti allergique.</strong></p>\n<p>Les IgE totales sont &agrave; 194UI/ml.Les RAST avec IgE sp&eacute;cifiques aux trophallerg&egrave;nes sont n&eacute;gatifs.</p>\n<p>Elle continuera le RELVAR 1 B/j avec rin&ccedil;age</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19636,5715,1,'2020-02-28','Dr Jankowski','<p>Cher Confr&egrave;re</p>\n<p>J\'ai vu ce jour M. HOARAU Julianna n&eacute; le 16/02/2006.</p>\n<p>Cette jeune fille est scolaris&eacute; et a une m&egrave;re asthmatique.</p>\n<p>Elle n\'a jamais fum&eacute;e.Elle pr&eacute;sente des allergies avec de l\'asthme derni&egrave;re crise d&eacute;but decembre 2019 avec Cs de SOS M&eacute;decins .Elle pr&eacute;sente une crise d\'asthme / mois et va mieux depuis qu\'elle est sous a&eacute;rius.</p>\n<p>L\'auscultation pulmonaire est revenue dans les limites de la normale.</p>\n<p>.<strong>Les pricks tests ont &eacute;t&eacute; pratiqu&eacute;s &agrave; D.Farinae: 10 mm &nbsp;; &nbsp; D.Pteronyssinus: 8 mm &nbsp;; &nbsp;Blomia Tropicalis:8 mm&nbsp; &nbsp; ; &nbsp; B.Germanicus: N&eacute;gatif &nbsp; ; 5 graminee: N&eacute;gatif &nbsp;; 3Graminee:N&eacute;gatif. &nbsp;</strong></p>\n<p><strong>Ses EFR en date du 12/02/2020 sont quasiment dans les limites de la normale.</strong></p>\n<p><strong>La NFS retrouve endate du 2/01/2020 une hypereosinophilie &agrave; 0.95G/L avec des IgE totales &agrave; 291 UI/ml.</strong></p>\n<p><strong>Nous demarrons ce jour une d&eacute;sensibilisation anti allergique.</strong></p>\n<p><strong>Le TDM des sinus retrouve une sinusite maxillaire chronique mod&eacute;r&eacute;e.</strong></p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19637,5753,1,'2020-02-28','Dr Andriatavy','<p>Cher Consoeur</p>\n<p>Je vous remercie de m\'avoir adress&eacute; pour avis Mme RAKOTONIAINA Nicolle, n&eacute;e le 06/12/1949 . Cette dame est veuve et a 3 enfants.Elle &eacute;tait institutrice &agrave; Madagascar.</p>\n<p>Elle est &agrave; la R&eacute;union depuis 2000.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note une hysterectomie totale en 1977 &agrave; Madagascar.un cancer du sein en mars 2016 avec ablation et radioth&eacute;rapie avec hormonoth&eacute;rapie.</p>\n<p>Elle est suivie pour nodule thyroidien ,un prediab&egrave;te ,HTA,phl&eacute;bite du MI Gauche ,SAHOS suivi par le Dr Omarjee.</p>\n<p>Elle a un fils qui a &eacute;t&eacute; trait&eacute; pour asthme &agrave; Madagascar dans son enfance.</p>\n<p>Elle pr&eacute;sente une toux avec crachats abondants.</p>\n<p>L\'auscultation pulmonaire retrouve quelques ronchi dxissemin&eacute;s.</p>\n<p>Sa radiographie pulmonaire est normale.</p>\n<p>Son TDM thoracique en date du 20/08/2019 retrouve une impaction mucoide bronchiolaire dans le lobe sup&eacute;rieur droit.</p>\n<p>Le&nbsp; TDM des sinus est normal.</p>\n<p>Le test respiratoire &agrave; l\'ur&eacute;e est normal.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Consoeur, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19638,5724,1,'2020-02-28','Dr Aouiate','<p>Cher Consoeur</p>\n<p>Je vous remercie de m\'avoir adress&eacute; pour avis M. VISAGE Pierre, n&eacute; le 31/01/1963.</p>\n<p>Ce monsieur a un enfant.Il est commercial.</p>\n<p>Il acess&eacute; de fumer depuis 4 jours.</p>\n<p>Ses EFR sont dans les limites de la normale.Il a toujours le nez bouch&eacute; et la gorge qui gratte. Je le place sous PAROEX et AVAMYS.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note un PNO droite en 2001.Il a &eacute;t&eacute; op&eacute;r&eacute; d\'une hernie inguinale droite&nbsp; et op&eacute;r&eacute; de la main droite il y a 10 ans.</p>\n<p>Il pr&eacute;sente une symptomatologie de RGO.Il va essayer d\'arreter de fumer avec le CHAMPIX.</p>\n<p>Il pr&eacute;sente une dyspn&eacute;e grade III de l\'&eacute;chelle du Modified Medical Research Council.</p>\n<p>Par ailleurs on note des ronflements nocturnes avec 2 &agrave; 3 nyctiuries.Il existe une fatigue avec somnolence diurne.Le score d\'Epworth est &agrave; 6/21 .</p>\n<p>Le score de Mallampati est de 3 /4.Le perim&egrave;tre cervical est de 37 cm avec un perim&egrave;tre abdominal de 95cm;</p>\n<p>L\'auscultation pulmonaire retrouve des ronchi bilat&eacute;raux.</p>\n<p>Il a eu un TDM thoracique le 16/12/2019 qui a retrouv&eacute; un emphys&egrave;me centrolobulaire et une volumineuse hernie hiatale.</p>\n<p>Nous programmons une EFR avec un TM6 et une polygraphie ventilatoire.</p>\n<p>Son TM6 en date du 14/01/2020 retrouve une distance parcourue de 600 m pour une distance th&eacute;orique de 688 m,soit 87%.la SaO2 est pass&eacute;e de 97% &agrave; 96% . Le pouls est pass&eacute; de 110 &agrave; 126 au bout de 5 minutes.</p>\n<p>Sa polygraphie ventilatoire du 18/02/2020 a retrouv&eacute; un IAH &agrave; 12/ H. Cet index passe &agrave; 44/H en positon dorsale. Il pr&eacute;sente donc essentiellement un syndrome d\'apn&eacute;es positionnel mais ne passe que 89 minuts sur le dos sur une dur&eacute;e de 8H53.Il pr&eacute;sente 92 ronflements/H avec une energie moyenne de 85db.Il ne pr&eacute;sente que 2 d&eacute;saturations/H avec un NADIR de 90%.</p>\n<p>Je le place sous ULTIBRO et RELVAR. Je lui propose &eacute;galement une r&eacute;habilitation respiratoire &agrave; Ste Clotilde.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19639,5685,1,'2020-02-28','Dr Andry RANDRIAJOHANY\nMedecine Interne \nGHER St Benoit ','<p>Cher Confr&egrave;re,</p>\n<p>Je vous adresse pour avis&nbsp; &nbsp;Mme RANGASSAMY Magalie n&eacute;e le 10/07/1968.</p>\n<p>Cette dame a 2 enfants. Elle est assistante de direction.</p>\n<p>Elle n\'a jamais fum&eacute;e.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on ne note une d&eacute;viation de la cloison nasale., une gastrite trait&eacute; par Dr Blais en 2017.Elle a consult&eacute; un cardiologue, le Dr Thia, qui a retrouv&eacute; une minime lame pericardique &agrave; recontroler dans 1 an.</p>\n<p>Depuis 1 an elle pr&eacute;sente une g&egrave;ne respiratoire qui s\'est aggrav&eacute;e avec assechement des larmes.</p>\n<p>Elle a eu une biopsie des glandes salivaires qui a retrouv&eacute; une maladie de Gougerot-sjogren&nbsp; avec une classification&nbsp; grade II de la classification de Chisholm et Mason. (Voir ci joint le compte rendu anatomopathologique)&nbsp;</p>\n<p>Son TDM thoracique en date du 12/12/2019 n\'a pas retrouv&eacute; d\'anomalie.</p>\n<p>Ses EFR sont normales au repos.Le TM6 en date du 18/12/2019 a montr&eacute; une distance parcourue de 653 m soit 112% de la th&eacute;orique sans d&eacute;saturation ni augmentation pathologique du pouls.</p>\n<p>La scintigraphie pulmonaire Ventilation/Perfusion en date du 28/02/2020 est normale.</p>\n<p>Le Pr Hilario Nunes avait demand&eacute; cet examen car compte tenu de l\'absence de l&eacute;sion de pneumopathie infitrante diffuse au TDM thoracique il voulait &eacute;liminer une embolie pulmonaire.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>\n<p>&nbsp;</p>'),(19640,5775,1,'2020-02-28','Dr Bourgi','<p>Chere Consoeur</p>\n<p>Je vous remercie de m\'avoir adress&eacute; pour avis Melle&nbsp; PAYET Eloise, n&eacute;e le 20/02/2004.</p>\n<p>Cette jeune fille est scolaris&eacute;e et est non fumeuse.</p>\n<p>Elle ne pr&eacute;sente pas d\'ant&eacute;c&egrave;dent d\'asthme.</p>\n<p>Jeudi 6/02/2020 &agrave; 20:00 dans sa baignoire elle a eu du mal &agrave; respirer avec perte de conaissance pendant quelques secondes.Elle aurait eu le meme malaise en 2018 avec un bilan cardiologique normal.</p>\n<p>L\'auscultation pulmonaire est dans les limites de la normale.</p>\n<p>Sa TA est &agrave; 10.6/7.1 avec un pouls &agrave; 92 avec une SaO2 &agrave; A2A &agrave; 100%.</p>\n<p>Elle a eu le 4/10/2019 un TDM thoracique qui &eacute;tait normal.</p>\n<p>Son echocardiographie en date du 22/07/2019 &eacute;tait normal.</p>\n<p>Elle a un signe de Chvostek et il peut s\'agir de manifestation de la spasmophilie.</p>\n<p>Ses EFR sont dans les limites de la normale.&nbsp;Nous conseillons des exercises de d&eacute;contraction avec du magnesium marin.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, chere Consoeur, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY</p>'),(19641,4890,1,'2020-02-28','Dr Georges RICHER','<p>Cher Georges</p>\n<p>J\'ai vu ce jour Mme PATEL Yasmina n&eacute;e le 24/12/1960.</p>\n<p>Cette dame est divorc&eacute; et a 2 enfants. Elle exerce la profession de formatrice.Elle n\'a presque pas fum&eacute;e.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on retrouve une an&eacute;mie qui a donn&eacute; lieu &agrave; une coloscopie et une fibroscopie gastrique par le Dr Lemba.Elle a une fuite mitrale mod&eacute;r&eacute;e.</p>\n<p>Elle a &eacute;t&eacute; suivi par le Dr Zaidou pour de l\'asthme sans r&eacute;el traitement de fond . Elle prenait du SERETIDE en cas de g&egrave;ne repiratoire.</p>\n<p>Elle a cess&eacute; de tousser mais a des crachats par p&eacute;riodes.</p>\n<p>L\'auscultation pulmonaire est ce jour dans les limites de la normale.</p>\n<p>Ses EFR en date du 19/10/2018 retrouvent une distension pulmonaire avec VGT &agrave; 154%,CPT &agrave; 116% et VR &agrave; 194% de la norme. Le VEMS est &agrave; 1.57 soit 68% peu r&eacute;versible sous b2agonistes.Le rapport de Tiffeneau est &agrave; 87%.</p>\n<p>Sa radiographie thoracique en date du 30/10/2018 n\'a pas retrouv&eacute; d\'anomalie parenchymateuse pulmonaire hormis un arc moyen convexe pour lequel je demande une echocardiographie.Elle a eu une angiocoronarographie en date du 7/12/2018 qui s\'est r&eacute;v&eacute;l&eacute;e normale.</p>\n<p>Sa polygraphie ventilatoire en date du 5/12/2018 retrouve un IAH &agrave; 15/H. Cet index passe &agrave; 29/H en position dorsale.Il existe 54 ronflements/H avec une energie moyenne de 83db.On retrouve 7 d&eacute;saturations/H avec un NADIR de 88%.</p>\n<p>Le TDM des sinus en date du 30/10/2018 retrouve un granulome apical en 22-26 -27,probablement responsable d\'un petit &eacute;paississement du bas fond du sinus.</p>\n<p>Son TM6 en date du 13/11/2018 retrouve une distance parcourue de 630 m pour une th&eacute;orique de 542 m ,soit&nbsp; 116 % de la th&eacute;orique.La saturation n\'a pas beaucoup vari&eacute; passant de 94% &agrave; 92% et le pouls est pass&eacute; de&nbsp; 91 &agrave;120&nbsp; au bout de 4 minutes.&nbsp;</p>\n<p>Elle pr&eacute;sente parfois une nyctiurie.Son score d\'Epworth est &agrave; 6/24 avec un&nbsp;&nbsp;score de Mallampati est de 2 /4.Son perim&egrave;tre cervical est de 33cm avec un perim&egrave;tre abdominal de 81cm.&nbsp;</p>\n<p>Nous lui proposons une polysomnographie.Je lui conseille de remplacer le SERETIDE part du RELVAR.</p>\n<p>Nous proposons de r&eacute;aliser un TDM thoracique sans injection.</p>\n<p>Avec mes remerciements, veuillez agr&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>'),(19642,5746,1,'2020-02-28','Dr Leveque','<p>Cher Consoeur</p>\n<p>Je vous remercie de m\'avoir adress&eacute; pour avis M. MAILLOT Patrice, n&eacute; le 02/05/1981;</p>\n<p>Ce monsieur a un enfant.Il est sans profession.il fume occasionellement.</p>\n<p>Dans ses ant&eacute;c&egrave;dents on note une appendicectomie,une fracture de la machoire,une brulure de 3 &egrave;me degr&eacute; en 1997 avec hospitalisation aux Grands Brul&eacute;s.Il est trait&eacute; pour HTA.</p>\n<p>Il pr&eacute;sente une toux chronique depuis octobre 2019 . Cette toux s\'accompagne de secretions visqueses jaunatres.Son perim&egrave;tre cervical est de 41 cm avec un perim&egrave;tre abdominbal de 94 cm.Le score de Mallampati est de 2.</p>\n<p>L\'auscultation pulmonaire retrouve des ronchi dissemin&eacute;s.</p>\n<p>Il existe une douleur epigastrique &agrave; la palpation.</p>\n<p>Le TDM thoracique en date du 11/01/2020 reptrouve un &eacute;paissement r&eacute;gulier des parois bronchiques sans DDB.&nbsp;</p>\n<p>Le TDM des sinus en date du 10/01/2020 a retrouv&eacute; une polysinusite chronique et la patient a consult&eacute; le Dr Gojon ,ORL.&nbsp;</p>\n<p>Ses EFR retrouvent un l&eacute;ger trouble ventilatoire restrictif avec CPT &agrave; 76% et VR &agrave; 73%.&nbsp;</p>\n<p>Sa polygraphie ventilmatoire en date du 20/02/2020 a retrouv&eacute; un IAH &agrave; 14/H. Cte index passe &agrave; 19/H en position dorsale.Il existe 136 ronflements/H avec une energie moyenne de 89db. Le patient pr&eacute;sente 7 d&eacute;saturations/h avec un NADIR de 89%.</p>\n<p>Il demande un test respiratoire &agrave; l\'Ur&eacute;e.</p>\n<p>Avec mes remerciements, veuillez ag/r&eacute;er, cher Confr&egrave;re, l\'assurance de mes sentiments distingu&eacute;s,</p>\n<p>Dr. B. TANGUY&nbsp;</p>'),(19643,5707,1,'2020-09-24','AG2R La Mondiale',''),(19644,5707,1,'2020-09-30','',''),(19645,5827,1,'2020-10-15','',''),(19646,698,1,'2021-02-12','',''),(19647,697,1,'2021-07-20','',''),(19648,697,1,'2021-08-12','','');

--
-- Table structure for table `docteurs`
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CREATE TABLE `docteurs` (
  `id_docteur` int(11) NOT NULL AUTO_INCREMENT,
  `nom_docteur` varchar(255) NOT NULL,
  `AM` int(11) NOT NULL,
  `commentaire` text NOT NULL,
  `delai_mois_entre_2_efr` int(11) NOT NULL,
  `entete` text NOT NULL,
  `lettre_debut` text NOT NULL,
  `lettre_fin` text NOT NULL,
  `lieu` text NOT NULL,
  `pantone_enveloppe` int(11) NOT NULL,
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  `qualite_ligne_2` text NOT NULL,
  `qualite_ligne_3` text NOT NULL,
  `RPPS` bigint(20) NOT NULL,
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  `telephone_2` varchar(255) NOT NULL,
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INSERT INTO `docteurs` VALUES (1,'Bernard TANGUY',971404397,'Vous êtes prié d’apporter vos attestations de prise en charge\r\n(Carte vitale, mutuelle, CMU, attestation ALD).\r\nEn cas d’empêchement, veuillez nous contacter 48h avant le rendez-vous',4,'Ancien chef de service au CHU de Bellepierre\r\nAncien Médecin des Hôpitaux\r\n49 Allée des Topazes 97400 SAINT DENIS\r\nTéléphone : 02 62 41 77 53 - Fax : 0 970 630 637','Cher confrère','Confraternellement,','49, allée des Topazes 97400 Saint-Denis (en face du CHU)',363,'Médaille d\'Argent de l\'Académie Nationale de Médecine','Ancien chef de Service au CHU de BellePierre','Médecin Honoraire des Hôpitaux',10002317096,'Pneumologue','02 62 41 77 53',''),(2,'Maurice TANGUY',0,'',0,'','','','',0,'','','',0,'','','');

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  `id_personnel_update` int(11) NOT NULL,
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INSERT INTO `documentation` VALUES (1,'1','Authentification','','portrait','2018-05-13 16:48:01',4),(2,'1.1','Login','','portrait','2018-05-06 15:04:11',4),(3,'1.2','Récupération de mot de passe','','portrait','2018-05-13 20:31:16',4),(4,'1.2.1','Email','','portrait','2018-05-13 20:31:48',4),(5,'1.2.2','Code authentification','','portrait','2018-05-25 15:02:33',4),(6,'1.2.3','Réinitialise le mot de passe','','portrait','2018-05-06 19:12:30',4),(7,'2','Bibliothèque de fonctions','','portrait','2018-06-03 13:01:06',4),(8,'2.1','Fonctions sur les fichiers','<p><span style=\"color: #ff0000;\"><strong>Fichier : lib.files.inc.php</strong></span></p>\r\n<p>Cette biblioth&egrave;que contient 4 fonctions</p>\r\n<ol>\r\n<li><span style=\"color: #008000;\">function <strong>formatBytes</strong>($size, $precision = 2)</span>\r\n<p>Exemple :&nbsp;formatBytes(1140338,2) renvoi&nbsp;1.09 Mo</p>\r\n<table style=\"border-collapse: collapse; width: 62.4198%; height: 108px;\" border=\"1\">\r\n<tbody>\r\n<tr style=\"height: 18px;\">\r\n<td style=\"width: 38.2941%; height: 18px;\"><strong>Taille des fichiers</strong></td>\r\n<td style=\"width: 17.3662%; height: 18px;\"><strong>Formatage</strong></td>\r\n</tr>\r\n<tr style=\"height: 18px;\">\r\n<td style=\"width: 38.2941%; height: 18px;\">1</td>\r\n<td style=\"width: 17.3662%; height: 18px;\">1 o</td>\r\n</tr>\r\n<tr style=\"height: 18px;\">\r\n<td style=\"width: 38.2941%; height: 18px;\">1.024</td>\r\n<td style=\"width: 17.3662%; height: 18px;\">1 Ko</td>\r\n</tr>\r\n<tr style=\"height: 18px;\">\r\n<td style=\"width: 38.2941%; height: 18px;\">1.084.576</td>\r\n<td style=\"width: 17.3662%; height: 18px;\">1 Mo</td>\r\n</tr>\r\n<tr style=\"height: 18px;\">\r\n<td style=\"width: 38.2941%; height: 18px;\">1.073.741.824</td>\r\n<td style=\"width: 17.3662%; height: 18px;\">1 Go</td>\r\n</tr>\r\n<tr style=\"height: 18px;\">\r\n<td style=\"width: 38.2941%; height: 18px;\">1.099.511.627.776</td>\r\n<td style=\"width: 17.3662%; height: 18px;\">1 To</td>\r\n</tr>\r\n</tbody>\r\n</table>\r\n</li>\r\n<li><span style=\"color: #008000;\">function <strong>extension</strong>($file)</span><span style=\"color: #000000;\"><br />Exemple : <strong>extension</strong>(\'image.png\') renvoi&nbsp;png<br /></span></li>\r\n<li><span style=\"color: #008000;\">function <strong>file_without_extension</strong>($file)</span><br /><span style=\"color: #000000;\">Exemple : <strong>file_without_extension</strong>(\'image.png\') renvoi&nbsp;image<br /></span></li>\r\n<li><span style=\"color: #008000;\">function <strong>imagesize</strong>($file)</span><br /><br />Exemple : <strong>imagesize</strong>(<span style=\"color: #000000;\">\'image.png\'</span>)&nbsp; renvoi un tableau $array.<br />$array[\'width\'] et&nbsp;$array[\'height\']</li>\r\n</ol>','portrait','2018-06-03 13:42:49',4),(9,'2.2','Bibliothèque montant en littéral','<p><span style=\"color: #ff0000;\"><strong>Fichier lib.nuts.inc.php</strong></span></p>\r\n<pre>$obj = new nuts(\"12345.67\", \"EUR\");<br />$text = $obj-&gt;convert(\"fr-FR\");<br />$nb = $obj-&gt;getFormated(\" \", \",\")</pre>\r\n<p>&nbsp;</p>\r\n<p>$text renvoi&nbsp;douze mille trois cent quarante-cinq euros, soixante-sept centimes<br />$nb renvoi 12 345,67 EUR</p>\r\n<p>&nbsp;</p>','portrait','2018-06-03 14:13:23',4),(10,'3','Clients et CCAM','','landscape','2018-05-10 21:21:46',4),(11,'5','Technologies utilisées','','portrait','2018-05-20 09:32:51',4),(12,'5.1','TinyMCE','<p style=\"text-align: center;\"><img title=\"images.png\" src=\"data:image/png;base64,[encoded data, 5220 characters]\" alt=\"\" width=\"351\" height=\"92\" /></p>\r\n<p>TinyMCE (Tiny Moxiecode Content Editor) est un &eacute;diteur de HTML de type WYSIWYG, &eacute;crit en JavaScript. Il permet notemment :</p>\r\n<ul>\r\n<li>de stocker le contenu au format HTML</li>\r\n<li>d\'integrer des images (format PNG par exemple) dans le code (format base64)</li>\r\n</ul>\r\n<p>&nbsp;</p>','portrait','2018-05-13 20:56:18',4),(13,'5.2','TCPDF','<p style=\"text-align: center;\"><img title=\"tcpdf_logo.png\" src=\"data:image/png;base64,[encoded data, 86720 characters]\" alt=\"\" width=\"80\" height=\"80\" /></p>\r\n<p>TCPDF est une classe PHP permettant de cr&eacute;er des documents PDF.</p>\r\n<p>&nbsp;</p>','portrait','2018-05-13 20:28:14',4),(14,'6','Schémas','','portrait','2019-07-23 11:17:08',4),(15,'6.1','Schéma général','','landscape','2019-07-23 11:48:22',4),(16,'6.2','Schéma Documentation','<p>Fonctionnement de la documentation</p>','portrait','2019-07-23 11:16:54',4);

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INSERT INTO `documents_scan` VALUES (1,1790,'Document 1','COTCHE_Louis_Michel_Dossier_Cotche_1.pdf'),(2,1790,'Document 2','COTCHE_Louis_Michel_Dossier_Cotche_2.pdf'),(3,1624,'Demande de prescription','BALDINOT_Gervais_demande_de_prescription.pdf'),(4,249,'Compte rendu operatoire - Chirurgie Thoracique.pdf','GOASGUEN_Marie_Pierre_M_Goasguen_-_compte_rendu_operatoire_-_Chirurgie_Thoracique.pdf'),(5,249,'Lettre Dr. Charpentier','GOASGUEN_Marie_Pierre_M_Goasguen_-_Lettre_Dr._Charpentier.pdf'),(6,249,'Lettre consultation Pr. Alifano','GOASGUEN_Marie_Pierre_M_Goasguen_-_Lettre_consultation_Pr._Alifano.pdf');

--
-- Table structure for table `etablissements`
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CREATE TABLE `etablissements` (
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  `service` varchar(50) NOT NULL,
  `adresse` mediumtext NOT NULL,
  `code_postal` varchar(50) NOT NULL,
  `ville` varchar(50) NOT NULL,
  PRIMARY KEY (`id_etablissement`)
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-- Dumping data for table `etablissements`
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INSERT INTO `etablissements` VALUES (1,'EPSMR','Services Economiques','11 rue Hopital','97460','Saint Paul');

--
-- Table structure for table `file`
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CREATE TABLE `file` (
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-- Dumping data for table `file`
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INSERT INTO `file` VALUES ('csv','text/csv','Fichier CSV','green','bi bi-file-earmark-excel'),('doc','application/vnd.msword','Document Word','blue','bi bi-file-earmark-word'),('docx','application/vnd.openxmlformats-officedocument.wordprocessingml.document','Document Word','blue','bi bi-file-earmark-word'),('odp','application/vnd.oasis.opendocument.presentation','Presentation OpenDocument','orange','bi bi-file-earmark-ppt'),('ods','application/vnd.oasis.opendocument.spreadsheet','Feuille de calcul OpenDocument','green','bi bi-file-earmark-excel'),('odt','application/vnd.oasis.opendocument.text','Texte OpenDocument','blue','bi bi-file-earmark-word'),('pdf','application/pdf','Fichier PDF','red','bi bi-file-earmark-pdf'),('ppt','application/vnd.ms-powerpoint','Fichier PowerPoint','orange','bi bi-file-earmark-ppt'),('pptx','application/vnd.openxmlformats-officedocument.presentationml.presentation','Fichier PowerPoint','orange','bi bi-file-earmark-ppt'),('rar','application/x-rar-compressed','Archive compressé','orange','bi bi-file-earmark-zip'),('sql','','Fichier SQL','#0078D7','bi bi-file-earmark'),('txt','text/plain','Fichier Texte','black','bi bi-file-earmark-text'),('xls','application/vnd.ms-excel','Feuille de calcul Excel','green','bi bi-file-earmark-excel'),('xlsx','application/vnd.openxmlformats-officedocument.spreadsheetml.sheet','Feuille de calcul Excel','green','bi bi-file-earmark-excel'),('zip','application/zip','Archive compressé','orange','bi bi-file-earmark-zip');

--
-- Table structure for table `files`
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CREATE TABLE `files` (
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