[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

[Impact of tobacco on bronchopulmonary affections: magnitude of the problem]

Tobacco smoking is frequent in the world affecting 20 a 50% of the population but with a decrease in occidental countries due to a huge effort based on sensiblisation and anti-tobacco decisions. To review the impact of tobacco on bronchopulmonary affections. A narrative review of literature. In the next future, yearly tobacco-related deaths could increase from 4.2 millions in 2000 to 10 millions in 2025-2030 making smoking as the main evitable cause of deaths by respiratory diseases. Lung cancer is the leading killer cancer. Tobacco is the most frequent cause of respiratory diseases. It is responsible of 80 to 90% of deaths by chronic obstructive pneumobronchopathiy [COPD] and 80 to 85% deaths by bronchopulmonary cancer. Tobacco is a " chronic disease " necessitating management with advices and medical treatment

[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.