Primary sarcomatoid lung cancer: clinical and evolutive features: a propos of five case reports

Primary sarcomatoid carcinoma of the lung are rare non small cell lung cancers [NSCLC] recently individualized by the World Health Organization. Their clinical, radiological and evolutive features are not well known but they seem to have bad prognosis with rapid progression and early metastases. Although they are felt to be chemo-refractory they must be treated as the other subtypes of NSCLC. To evaluate clinical, radiological and evolutive features of primary sarcomatoid carcinoma of the lung. We report the cases of five patients presenting sarcomatoid carcinomas and assess their clinical and evolutive data. One patient had stage IIB cancer underwent surgical resection and adjuvant chemotherapy, he is alive 18 months later; another had stage IIIB was treated by radio and chemotherapy and is alive 6 months later; and three other patients had stage IV in whom one had chemotherapy, the two others did not because of they had performance status. They died 1 to 3 months after the diagnosis. Lung sarcomatoid carcinomas are of bad prognosis. Their treatment is nowadays not well established. Much more good studies are therefore needed

Metabolic and cardiorespiratory response in swimmers during head-out immersion: a prospective study

Sport represents a stress for the body. Many metabolic and cardiorespiratory changes are known during physical activity. However, little is known in swimmers particularly during head-out immersion. To determine the metabolic and cardiorespiratory response in swimmers during head-out immersion. The energetic, cardiovascular function and ventilatory requirements of a 10 min steady state arm exercise performed by 13 healthy subjects in air and during immersion up to the hip in 26[degree sign]C water were compared. The same ergometric work load was achieved with an average maximum oxygen uptake of 3.9 +/- 2.63 l/min in air versus 3.55 +/- 2.48 l/min in water [p=0.953]. During exercise, the average values of minute ventilation, ventilation equivalent for oxygen, ventilation equivalent for CO2, peak expiratory flow, respiratory exchange ratio and heart rate were not different in water and in air. However, first ventilatory threshold was significantly higher in water than in air. The mean value of the first ventilatory threshold was 0.89 +/- 0.23 l/min in air, and 1.08 +/- 0.23 l/min in water immersion; [p=0.016]. These results suggest that training swimmers favoring immersion [weight belts] may improve their aerobic capacity

Systemic al amyloidosis of the tracheobronchial tract and lungs: a rare finding

A 67- year old man presented with cough, weight loss and night sweats. Fiberoptic bronchoscopy did not show any abnormality. Chest computed tomography scan revealed peribronchovascular thickening, sheathing and narrowing of some bronchi. There were also mediastinal and interbronchial Lymphadenopathies. The patient became lost to follow-up. He presented 5 years later with pneumonia. Flexible bronchoscopy showed diffuse infiltration of the bronchi suggesting lung cancer. Histopathological study with histochemical staining revealed tracheobronchial tract AL amyloidosis. Chest CT-scan revealed extension of the broncho-vascular thickening and superimposed pulmonary calcified nodules and lymphadenopathies. Labial biopsy revealed AL amyloidosis. No specific treatment of amyloidosis was thought to be necessary for the patient. At 6 years follow-up the disease had not progressed. This case report highlights the fact that even very rarely, systemic AL amyloidosis can involve the tracheobronchial tract. Moreover, the lungs and the tracheobronchial tract can, although rarely, be affected in the same patient

Assessment of quality of life in asthmatics in Tunisia: a prospective study of 85 cases

Asthma is a frequent pathology all over the world. The patient well-being becomes an aim to achieve in the management of a patient with asthma. Thus, the factors affecting quality of life [QOL] in these patients should be determined. Moreover, as QOL is affected by the socio-cultural and psychological context of each patient, QOL should be assessed in the country where the patient lives. To determine the factors influencing QOL in our country: Tunisia: a Mediterranean, Arabic and developing country. Eighty five adult patients with asthma were included prospectively. The questionnaire of the alteration of QOL in asthmatics in Tunisia [AQLAT] was used. QOL was moderately altered. The score didn't differ between men and women and was not correlated with age. In students, the QOL was less altered than in non students. Patients with severe asthma had a significantly more altered QOL than those with mild to moderate asthma. Nevertheless, there was no correlation between the oldness of asthma and the AQLAT. Besides, the QOL didn't differ in patients with controlled asthma and those with uncontrolled one. A good analysis of the factors determining QOL is patients with asthma would allow a more efficient care of them

syndrome of combined pulmonary fibrosis and emphysema

A syndrome associating an upper-lobe emphysema and pulmonary fibrosis of the lower lung was recently characterized. Few cases were identified in the literature. We report a case of a 68 year- old smoker man presented for exacerbation of a severe dyspnea. Physical examination revealed basal crackles and finger clubbing. Blood gas analysis showed hypoxemia. Chest radiography showed features compatible with emphysema of the upper lobes and fibrosis of the basis. Chest computed tomography confirmed chest radiography's findings and revealed fibrosis. The diagnosis of idiopathic pulmonary fibrosis was made. Pulmonary function tests showed obstructive pattern. Systolic pulmonary arterial pressure was elevated up to 87 mm Hg on heart ultrasonography. The authors emphasize the importance of the diagnosis of this entity made through chest computed tomography and the fact that it is characterized by severe impairment of gas exchange, the high prevalence of pulmonary hypertension and poor survival

[Current etiologies of hemoptysis in eldery: comparative study about 360 cases]

Hemoptysis is an alarming symptom. The etiology of hemoptysis varies among different series according to time of publications, geographic location and diagnosis tests employed but also according to the age of patients. To describe the etiologies of hemoptysis in eldery. We retrospectively reviewed of hemoptysis in eldery. We retrospectively reviewed the records of all patients admitted to three respiratory departments [B, I and C] in Abderrahmen Mami hospital between January 2003 and December 2007. Of the 360 patients hospitalized for hemoptysis, 248 were aged 18-64 years and 112 were aged more than 65 years. At the term of our study, bronchiectasis [21% versus 11,6%, p<0,03] and hydatid cyst [6% versus 0%, p>0,007] were the most common causes of hemoptysis in people less than 65, while tuberculosis sequel [20,5% versus 5,4%, p>0,01] and pulmonary oedema [16,9% versus 0,4%, p<0,001] were significantly more frequent in the eldery. There was no difference between the two groups concerning lung cancer [25% in patients less than 65 years versus 16,9% in eldery, p=NS], infections [10,5% in patients less than 65 years versus 12,5% in eldery, p=NS] and pulmonary tuberculosis [14,1% in patients less than 65 years versus 4,5% in eldery, p=NS]. Elderly patients are more likely than younger patients to have tuberculosis sequel and pulmonary oedema as an etiology of their hemoptysis, while bronchiectasis and hydatid cyst were more common in patients less than 65 years. The results of our study will allow us to better prioritize the investigations necessary to etiological diagnosis

[Asthma control status in Tunisia]

Transversal study during hospital allergology visit which aim is to evaluate asthma control levels in Tunisia. Questionnaire issue of global initiative for asthma [GINA] guidelines. 400 asthmatics were included [70%of women and 30%men], aged 32 +/- 11 years old. Asthma was intermittent in 43%of patients, mild persistant [27%], moderate [14%] and severe in 16%of patients. Daytime symptoms were observed in 56%of cases, nocturnal symptoms in 40%, exacerbations in 39%of cases, activities limitation in 44%of cases and need of rescue treatment in 56%. Controller medications were used in 63%of patients. Inhaled Gluocorticosteroids were used in 90%of patients with persistent asthma. Subjective self evaluation of asthma showed that 83%of patients felled better with treatment, whereas, asthma objective control was obtained only in 10%of them. For the rest, asthma was partly controlled in 35%of patients and uncontrolled in 55%. College and professional absenteeism was observed in 60%of cases, with a mean of 1 to 5 days per month. Control factors seem to be young age, non smoker status and mild persistent asthma. Although GINA 2006 guidelines and treatment progress, an important rate of asthmatics [90%] continue to present symtoms, underuse their treatment and Overestimate control level of their disease

Prevalence of exercise induced bronchoconstriction in teenage football players in Tunisia

Studies on exercise-induced bronchoconstriction [EIB] in team sports are lacking. The aim of this study was to screen for EIB among amateur teenage football players in Tunisia and to compare EIB prevalence between regions. One hundred ninety-six male football players [mean age [SD], 13.5 [0.5] yrs], practicing in three different cities of Tunisia [Tunis, Sousse and Sfax], underwent an outdoor free run of 7 minutes. Forced expiratory volume in one second [FEV [1]] was recorded prior to and at 0, 3, 5, 10, 15, 20 and 30 minutes after the run. Players were screened for EIB positivity defined as a greater than 10% decline in FEV [1] from the resting value at any time point. FEV [1] decreased more than 10% in 30% of the players. EIB positivity was more common in Sfax [15.8%] than in Tunis [7.7%] [P =.03]. Air humidity during the study was higher in Tunis. EIB is prevalent among amateur teenage football players in Tunisia. The prevalence differs between regions and seems to be dependent on air humidity levels