Lymphome non hodgkinien revele par une tumeur endobronchique [a propos d'une observation]

The endobronchial localization of non - hodgkinian lymphoma [N.H.L.] is exceptionnally inaugural but appears nearly always in the course of a disseminated disease. We report one case in a 70 years woman who had prestend with a little productive cough, thoracic pain, dyspnea, and a left pulmonary opacity evolving 3 years and 9 months before a bronchoscopy was performed. The bronchoscopy discovred an endobronchial tumor on the left superior lobe. Histology revealed a N.H.L. with small cells and a feable degree of malignancy. The patient presented also with a splenomegaly and a bone marrow infiltration by a lymohomatous process giving evidence of the exceptional cases where the endobronchial tumor is a tell tale sign of a N.H.L

[ value of computed tomography in the diagnosis and staging of bronchiectasis]

Basing themselves on literature data, the authors specify the tomodensitometric semiology of bronchiectasis and locate the place of the computed tomography [C.T] in the diagnosis and staging of bronchiectasis in comparison with standard chest radiograph and bronchography They notice the advantages and limits of each method of examination The C.T, as non invasive examination which revolutionized the medical imaging in the last years, intervenes at all the stages of diagnosis of bronchiectasis. Recognition morphologic type, extension and associated damages. But technical Conditions are indispensable, as achievement of thin-section C.T, Judicious choice of windows with use of wide "bronchic" Window and apparatus with high Space resolution. At present, the choice between C.T and bronchograpy in the diagnosis of bronchiectasis seems to depend on quality of tomodensitometric images, localized or diffuse bronchiectasis and degree of Clinical suspicion The C.T of thorax must be done at any suspicion of bronchiectasis and only after the study of its results will be established the management. It seems that bronchography has no more to be indicated at first intention, but it restes indicated in case of discordance between a very suggestive symptomatology and a doubtful C.T. and in case of limited but complicated bronchiectasis which can undergo surgical operation

[Etiologic profile of hemoptysis in pneumology unit: [291 cases]]

To determine the profile of hemoptysis their main etiologies, we reviewed 291 cases hospitalized in 5 years [from 1980 to 1984] in a service of pneumology. Patients with hemoptysis represente 8,8% of all hospitalized patients. They have a mean age of 46 years and 47% of them have less than 50 years; 69,4% are men. The hemoptysis is a telltale sign of a thoracic pathology in 35,4%. It is trivial in 71,1% medium in 26,8%, important in 2,1%. In all the cases the chest radiograph is abnormal, the abnormalities evokating the etiologies in 70,8%. The prevailing etiologies are lung cancer [34,4%] and both active and sequelary tuberculosis [18,9%]. Among other causes bronchectasies hold an important place [15,1%] as well as broken hydatic cysts [9,3%]. The other causes are as follows: bacterial pneumopathies with or without abcess [7,2%], pulmonary aspergillosis [6,9%], chronic bronchitis with or without emphysema [3,5%]. Exceptional causes gather only 4 cases. In 3,1% no cause for the hemoptysis is demonstrated. This study emphasizes the leading role of lung cancer as an etiology of hemoptysis, even in country with a great tuberculosis prevalence. Nevertheless this outward reality is also due in part to the fact that most of patients with tuberculosis are hospitalized in specific yards

Asthma: diagnosis, investigation and exploration strategy

The diagnosis of asthma is essentially based on clinical data: occurrence of paroxystic episodes of dyspnea with wheezing. The onset of symptoms is often difficult to recognise in non-typical forms. In these cases the ventilatory function test response to histamin or acetylcholin can be used to demonstrate bronchial hyperresponsiveness. Besides chronic bronchitis and emphysema the main differential diagnoses may be regrouped in adults, within 6 etiologies: cardio-vascular, tumoral, inflammatory and/or immunological, congenital and finally functionnal. In childhood other differential diagnoses may be added like bronchitis, tracheal or bronchial foreign body, cystic fibrosis and gastroesophageal reflux. Asthma is regarded as a syndrome with numerous etiologies: allergic and non - allergic [viral infections, pollution, neuro-endocrine diseases, drugs and psychologic factors]. The investigations are based on chest X-ray, hemogram, ventilatory function tests and allergologic testing [skin tests and measurement of serum IgE and specific IgE]. The history of symptoms and skin tests would give the main results of allergolic investigations. The diagnosis of allergic asthma [allowing hyposensitization] is based on clinical data, positive skin tests and if needed, elevation of total and specific IgE. In adults, it is however necessary to perform bronchial provocation tests to demonstrate the allergic cause of asthma