[Allergic bronchopulmonary aspergillosis: a review of 3 cases]

Allergic bronchopulmonary aspergillosis [ABPA] is a rare affection, initially described in 1952. Its pathophysiology incriminate several mechanisms in relation with the organism of the patient and the bronchial colonisation by the fongic agent. To report three cases of ABPA. Three patients had been treated for ABPA in Ibn Nafiss department in Abderrahmen Mami hospital in Ariana. ABPA had been discovered in the three cases by a corticodependant asthma, refractory for different therapeutics. Positif diagnosis reposed in the 3 patients at 6 major and one minor criterion. Traitment was essentially based in corticotherapy. Positif diagnosis of ABPA is actually well established, however, its traitement, although based on corticotherapy, remind not clearly codified. Association of antifongic treatment may improve the prognosis

[Palliative chemotherapy of non small lung cancer in Tunisia. prospective study of the cost and impact on the quality of life]

Bronchopulmonary cancer is actually the first cancer in the world. In Tunisia, recent statistics are alarmous. The most bronchopulmonary cancer in tunisian series are diagnosis at metastatic states. To evaluate the cost of the global treatment by chemotherapy in patients with metastatic non small lung cancer and its impact over the quality of life in Tunisia. It's a prospective study lead between January 2006 and Juin 2007 to evaluate the quality of life for patients hading metastatic non small lung cancer treated by palliative chemotherapy in Ibn Nafiss department in Abderrahmen Mami hospital.The evaluation of the qualitt of life is inspired by the questionnary of EORTC: QLQC30 version 3 translated in en arab langage, filled before chemotherapy, after the le 3rdcycle, and at the end of the first ligne. The study of the cost is effectued for the 2 protocols whose the most used in first ligne: Cisplatin-Vinorelbine [P-V] and Cisplatin- Gemcitabine [P-G]. 30 patients had benefit from palliative chemotherapy based on P-V [18 cases] or P-G [12 cases]. All patients had responded for the questionnary in the opportunt moments. After 3 cycles of chemotherapy, we note an improve of the symtomatic, physical, activity, emotional and global health scales. In opposition, we note a deterioration of cognitive and social scales without any supplementary improvement[no significant difference] if we add other cycles in the twice protocols. At the same level of the benefit in term of quality of life and survival without supplementary toxicity, the choice is made by the less cost's protocol in other words P-V. Our results confirm the benefit from chemotherapy in term of survival and quality of life in our context, howewer, the important cost of the chemotherapy necessitate to rationnalize the indications and the le choice of the treatments in this palliative indication

[Thoracic manifestations of systemic lupus erythematosus]

Systemic lupus erythematosus [SLE] is an autoimmune disease. The respiratory system is more commonly involved in SLE than in any other collagen vascular disease. To study the pleuropulmonary manifestations of SLE. Retrospective study including 10 patients hospitalized between January 2000 and December 2008 for pleuro-pulmonary manifestation revealing or complicating the SLE. Nine women and only one man aged between 21 and 67 years-old were included in this study. Two patients had already SLE and for the other patients the pleuro-pulmonary manifestations were revealing the SLE. Pleural effusion was the most common manifestation witch represents 50% of the patients. For the other patients we find one case of interstitial pneumonia, one case of pulmonary embolism, on case of pneumonia, on case of pulmonary haemorrhage and on case of pulmonary hypertension. All these patients were treated by corticoids and only one patient takes high doses of corticoids for managing a massive pulmonary haemorrhage. The evolution was favourable for 9 patients, one patient dead because of massive pulmonary haemorrhage complicated with acute respiratory failure. Pleuro-pulmonary involvement in SLE is common and may be life threatening, in which case prompt and aggressive treatment is mandatory

[Pulmonary atinomycosis: a great clinical polymorphism]

Pulmonary actinomycosis is a rare bacteriological disease, caracterized by local suppuration and an extensive fibroinflammatory process, with a possible pseudotumoral outcome. To report a new observation of a pulmonary actinomycosis. A 52-year-old patient, smoker, admitted in our department for infectious pneumopathy complicated by purulent pleurisy. Clinical and radiological findings were not contributive.Fiberoptic had evocate the diagnosis of bronchopulmonary cancer. Evolution had been marqued by abondant hemoptysia indicating right low lobectomie. The diagnosis of actinomycosis was obtained by the pathology of the surgical resection. Diagnosis of pulmonary actinomycosis can be difficult because it can mimic the presentation of lung carcinoma.If the diagnosis is no late established, and if the patient is correctely treated medically, the prognosis still excellent

[Neoplasic vena cava syndrome]

Vena cava superior syndrome results of an obstruction of superior vein cava [SVC] and/or brachiocaphalic venous troncs by extrinsic compression and/or by tumoral or cruoric thrombosis. The bronchopulmonary cancer represents the most frequent aetiology. The aim of this study is to establish clinical, radiological, evolutive profiles and modalities of treatment of neoplastic vena cava superior syndrome independently of its histological type. It is a retrospective study about 20 patients presenting vena cava superior syndrome compliquating primary bronchopulmonary cancer, hospitalized between January 2000 and December 2007 in Ibn Nafiss department in Abderrahmen Mami hospital. All patients were males with an average of 57, 8 years. Vena cava superior syndrome had revealed cancer in 60% of cases. It was metachrone in 40% of the patients. The most frequent histological type was small cell lung cancer. Treatment was proceeded in 2 steps, symptomatic and etiologic for the bronchopulmonary cancer. The bronchopulmonary cancer is the most frequent aetiology of vena cava superior syndrome. Its treatment is actually well codified

[Adjuvant chemothgerapy in resected non small cell lung cancer: preliminary results about 8 cases]

Report the preliminary results of adjuvant chemotherapy in patients surgically treated for non small lung cancer. Its a prospective study about 12 patients surgically treated between January 2005 and December 2007.8 patients had benefit of adjuvant chemotherapy. The protocol had been based at 4 cycles of Cisplatine Our 8 men patients, aged for the mean of 59 years with a Performans Status at 1, had benefit of adjuvant chemotherapy after curative surgery. Six patients considered us II B stage, had benefit immediately for surgically treatment. Adjuvant chemotherapy protocol had been based of Cisplatin and Vinorelbine [5 patients] and Cisplatin and Gemcitabine [1 patient]. The 4 cycles can be administered without any limiting toxicity only for one patient who's received 2 cycles of Cisplatin and Gemcitabine in front of the severity of digestive side effects. Two patients considered us IIIB stage, had been surgically treated after neo adjuvant chemotherapy based at Cisplatin and Vinorelbine. Histological response was complete for twice of them. The same chemotherapy was stopped after 2 cycles us adjuvant, in front of haematological side effects. Two patients did at 4 and 15 months of neoplasic progression. The six other patients had been still on life with a move back of 33 months. Post operative adjuvant chemotherapy is the standard treatment for the II A and II B stages and probably for lB stage. For none immediately operative patients [IIIA and some III B], articulation of chemotherapy with surgery must be clarified

[Pulmonary metastases revealing choriocarcinoma]

Uterine choriocarcinoma is a trophoblastic tumour characterised by high metastasis potential. Pleuropulmonary metastasis can reveal rarely the neoplasm. Report a new case. We report the case of a 31 years- old woman, with no pathological antecedent, admitted in our department for thoracic pain and haemoptysis occurring two months after delivery of a dead child-birth. Chest X ray and thoracic CT scan showed several bilateral opacities. A diagnosis of metastatic choriocarcinoma was confirmed by plasmatic level of beta human chorionic gonadotrophin [beta HCG] superior to 4000 Ul/ml. Gynaecological exam revealed latero-uterine mass. Abdomino-pelvicn ultra sound and CT scan showed tissular latero uterine and hepatic masses. Brain CT scan had been normal. Patient did after 3 cures of chemotherapy because of acute respiratory failure caused by massive pulmonary embolism. Diagnosis of choriocarcinoma must be evocated in front of several pulmonary opacities occurring in genital activity women and necessities the dosage of level of betaHCG

[Rare localisation of sarcoma of the child: thoracic Ewing sarcoma]

Ewing Sarcoma is considered as primitive neuron ectodermic tumor. It's the most frequent osseous tumor in children and adolescent. It was localised frequently at long osseous and pelvis, however, it can be arising from the rib. this article aimed to show that Ewing sarcome could arise twely from thorax. We report the case of 15-year-old girl, admitted in our hospital because of left scapular pain with important weight loss. Chest X ray showed dense left latero tracheal opacity with mediastinal limits. Bronchofiberoscopy was performed and it showed no abnormalities. Thoracic CT scan and MRI noted left posteroir expansif mediastinal process infiltrating D2, D3 and homolateral conjugation's canal. This process was associated at vertebral metastasis in Dl, D4 and D8.Rapid clinical aggravation, with installation for medullar compression was noted. The patient had benefit for three cures of decompress radiotherapy and treated by laminectomy of dorsal vertebras in neurosurgery department. Morphologic aspects and immunohistochimical study for the operator piece concluded at Ewing sarcoma of the children considered as primitive neuron ectodermic tumor. Six cures of chemotherapy had been prescribed with well recuperation of the motor failure. She still on life since 7 months. Even rare, thoracic localisation of Ewing sarcoma in not exceptional, it is necessary to evocate it in front of mediastinal mass

Association deep veinous thrombosis with pulmonary tuberculosis

Pulmonary tuberculosis has been reported as a risk factor for deep venous thrombosis. In the present study we reported, physiopathological, epidemiological, clinical and therapeutic features of the association of deep venous thrombosis and pulmonary tuberculosis. This is a retrospective study done in our department between January 2000 and December 2007 It is about 14 cases of confirmed pulmonary tuberculosis associated with deep venous thrombosis. It is about 14 men. The mean age was 40 years old. Pulmonary tuberculosis was confirmed by the presence of acido-alcoolo-resistant bacillus on the sputum at direct exam in 12 cases [81, 8%] and in the bronchial aspiration in 2 cases [18%]. Phlebitis occurred within a mean of 20 days after the diagnosis of tuberculosis. It was confirmed by doppler deep venous ultrasound of inferior members. All patients received anti-tuberculosis drugs in association with anticoagulant treatment. Etiologic investigations showed positive anti-phospholipids antibodies in one case, and decrease in C and S proteins for 2 patients in which phlebitis was complicated by arterial pulmonary embolism. We had difficulties for controlling prothrombin level in 4 cases and we must prescribe low molecular weight heparin for 6 months in one case. A lot of attention should be done, in the follow up of pulmonary tuberculosis especially in severe presentation; because of the deep venous thrombosis's risk occurrence. Prophylactic anticoagulant treatment should be done in some cases, when the risk is higher

[Pseudo tumoralbronchial tuberculosis about 4 cases]

Bronchial lesion is a rare site for tuberculosis, It can mimic lung cancer especially when sputum- smear is negative, and this be a cause of a delay in diagnosis, that can be made later on by a culture of Koch bacillus or after a bronchial biopsy. Through these 4 cases reports, the authors recall the ethiopathogenic hypotheses of this lesion and review the radiologic, clinical and prognostic features of these unusual forms of T.B.

Application d'un algorithme decisionnel au diagnostic de l'embolie pulmonaire non grave en milieu pneumologique: Resultats d'une etude prospective de 40 cas

We have study prospectively cases of non severe pulmonary embolism in a pulmonary department by an analysis based strategy associating radio-clivical probability, venous ultra sonography, D-Dimers value followed, if no performed diagnosis, by pulmonary scintigraphy or angio-CT scan. 64 cases of pulmonary embolism suspicion have been hospitalised in our department between October 1998 and July 2001; 40 patients was included in our study and have been classified in 3 groups regarding pre test clinical probability. Anticoagulant treatment has been initialised only in the third group [probability > 80%]Clinical probability associated with venous ultra sonography and D- Dimeres value allow or exclude pulmonary embolism diagnosis in 27 patients. In the others, scintigraphy and angio CT scan were necessary for establishing diagnosis. Application of this algorithm allow diagnosis of pulmonary embolism in 29 patients and exclude this pathology in the other 11. None of this patient complained from recurrent thrombo embolic accident during 17 to 42 months observance period