[ Pollen-food olive-olive syndrome]

Background: The pollen-foods syndrome is rare and of difficult diagnosis. The aim is to report a rare case, it's the four case reported in the literature

Case report: A 48-year-old woman presenting with palatal itching and generalized urticaria following ingestion of olive fruit, 5 years after being diagnosed with olive pollinosis. She did not have a history of other food allergy or urticaria. The prick-test was positive in olive pollen.The olive pollen specific IgE was positive. The oral provocation test was positive for olives and negative for olive oil. The diagnosis of "pollen-food olive-olive syndrome" was accepted. Interestingly, in this rare case the patient developed olive fruit allergy in the presence of olive pollinosis, but did not experience allergic symptoms to fruits other than olive

Conclusion: In spite its rarity this syndrome should be evoke particularly in our country

[Pulmonary tuberculosis in immunocompetent: causes and consequenses]

Background: Despite scientific advances, extended forms of pulmonary tuberculosis are still relevant. The aim of our study was to determine clinical features and outcome of extended pulmonary tuberculosis in immunocompetent patients

Methods: Retrospective comparative study including 100 patients HIV negative, presenting pulmonary tuberculosis divided into 2 groups of 50 patients [group1: extended tuberculosis and group2: localized tuberculosis]. Tuberculosis was considered extended when reaching above one lobe

Results:The average age was comparable in the 2 groups [p = 0.138]. In group1, we noted a higher incidence of diabetes [p = 0.037] and malnutrition [p = 0.045]. Clinically, patients in group1 had more general signs [p=0.033] and dyspnoea [p=0.037]. Biologically, anemia [p<0.001], leukocytosis [p=0.05], elevated CRP [p=0.031], thrombocytosis [p=0.023], hyponatremia [p = 0.001] and liver disturbances [p = 0.001] were significantly more frequent in group1. Concerning the evolution, time to smear negativity was significantly longer [p=0.012]. Similarly, radiological sequelae were more frequent [p = 0.02] and more extensive [p = 0.012]. Positive predictive value of radiological extent in disease evolution was 62% with a confidence interval between 47.2% and 75%

Conclusions: The extent of pulmonary tuberculosis is an important factor in clinical and biological presentation and disease evolution. Indeed, patients with extended tuberculosis develop more severe presentation and are more likely to develop parenchymal sequelae

[Lung cancer with venous thrombo-embolism: clinical characteristics]

Lung cancer is the most common malignancy diagnosed in patients with venous thrombo-embolism [VTE]. To investigate clinical, biological, radiological features and survival of lung cancer patients with VTE. Retrospective case-control study investigating biologic, clinical course and survival of 25 patients lung cancers with VTE [Group M] and 50 lung cancers without VTE [group T]. The frequency of the VTE was 5.88% with 2.58% pulmonary embolism [PE]. The mean age was 58 years +/- 9.8 in group M and 57.9 years +/- 9.6 in group T. No significant difference concerning medical or surgical history for both groups was found. The dyspnea and chest pain were at equal frequency [63.6%]. Regarding the clinical probability of the PE, it was no significant differences between the two groups. A rate of D-dimer > 0.7micro g/l was more frequent among group M [75% vs 20%; p = 0.054]. The most common histological type was nonsmall cell lung cancer [88%]. A stage IV was significantly more frequent in group M [86.4% vs. 52.3%; p = 0.007]. The mean period of survival in Group M was 10.6 +/- 1.2 month and 20.2 + 1.8 month in group T; p = 0.38. The VTE associated to lung cancer is under diagnosed. Prospective studies are needed to establish more adapted scores

[Isolated bilateral pulmonary occlusion]

Takayasu's arteritis [TA] is an unusual cause of bilateral and isolated pulmonary artery occlusion that may be difficult to distinguish from other aetiologies. Report a new case of isolated bilateral pulmonary occlusion. A 19 year-old girl presented to the hospital with a 2-year history of dyspnoea and recurrent hemoptysis. She was in respiratory distress on physical examination Clinical investigations revealed a total occlusion of the right pulmonary artery on perfusion lung scan. Pulmonary angiogrphy confirmed these data and revealed further more a partially occluded left lower lobe artery. Diagnosis of Takayasu's arteritis was suspected and a complete aortogram was made but proved to be normal. Corticosteroid therapy was prescribed but interrupted within 2 months for absence of clinical improvement. Patient's assessment revealed worsening of the clinical condition and she became oxygendependant. Early diagnosis of isolated involvement of pulmonary arteries in TA while systemic arteries are normal may prove to be difficult. In spite of insufficient data to confirm TA, the latter seems to be the most probable diagnosis in our patient regarding clinical [young age] and angio graphic arguments

[Idopathic Chylothorax: usefulness of aeti ologic survey and the follow-up]

Chylothorax is an uncommon condition. It's characterized by the presence of chyle in the pleura. The most common causes are malignancy and trauma. When an underlying cause is excluded, the chylothorax is called idiopathic. We report a case of a 68 aged woman, admitted for abundant chylothorax. Thoraco-abdominal computed tomography. magnetic reso-nance imaging of the chest and thoracotomy showed no lesion of the lymphatic duct. Fibrothorax has developed after pleurodesis. Stable clinical and radiological condition was noticed during 3 years. We discuss the difficulty in the exclu-sion of a malignancy and the necessity of the follow up for these patients