[Melanoma bronchopulmonary metastasis concerning 2 cases]

Melanoma is a malignant melanocytary tumor that has a great metastatic potential. Bronchopulmonary metastases are the most frequent ; estimated up to 33% according to the review of literature. The authors report two observations of melanoma bronchopulmonary metastases. The first observation concerns a 61 year-old patient, with as antecedent a melanoma of the thigh confirmed by exersis biopsy and who shows two years later a bronchic syndrome with thoracic pain in a context of general condition alteration. Chest x-ray revealed a retractile opacity of all the right hemithorax associated to a left mediothoracic macronodular opacity. Bronchoscopy detected a tumor obstructing the right bronchus strain whose anatomopathologic exam concluded to a bronchic melanoma. The diagnosis of the melanoma bronchopulmonary metastases of the thigh was thus maintained and the proposed treatment was palliative symptomatic. The second observation concerns a 42 years patient who showed 1 month before had admittance to hospital a bronchic syndrome and thoracic pain in a context of general condition alteration with a naevus of the right cheek of 3 cm in an ulcerous detected a stage melanoma. The chest x-ray found multiple macronodular opacities in baloon-letting out form of tissular density at CT-scan evoking pulmonary metastases. Bronchoscopy revealed a burgeoning tumor witely necrosed at the left basal pyramid. The diagnosis of melanoma bronchopulmonary melanoma of the cheek was maintained and the treatment was symptomatic

[Recurrent pleural fibromatosis revealed by a spontaneous pneumothorax: about one case]

Pleural fibroma, also called benign pleural mesothelio-ma, is a rare tumor not linked to the exposure to "l'amiante", developed through the underpleural conjunctive tissue and whose pathology remains unclear. The authors report the case of a patient, 51 year-old, operated for left solitary pleural fibroma and who shows two years later left thoracic pain with exercise dyspnea with alteration of the general conditions. Chest X-ray and chest CT-scan revealed left hydropneu-mothorax with tissular mass in contact with lung stump and tissular left axillary mass. Punction exsuflation in left basithoracic draws serohematic exsudative lympho-cytary liquid with non malignant cells. Bronchoscopy detected a diffuse 2[nd] degree bronchic inflammation. Lateral left thoracotomy is then carried out and showed pleural tumor of 8 cm in diameter linked to the lung stump and a second necrosed pleural tumor whose ana-tomopathologic study concluded to pleural fibromatosis, with normal follow-up. Through this observation, the authors recall the recidivating character after the surgical resection of pleural fibromas that in certain cases can supervene on a malignant pattern [fibrosarcoma], and also underline that spontaneous pneumothorax can reveal this recidivation and that hypoglycemia, classically a sign associated to these tumors, can be inexistent despite the multiplicity and the important size of the fibromas

Education for tuberculous patients: a quest about the knowledges and impact upon the therapeutic results

At the begining of 1990, and on the occasion of the adoption of the new programme of fight against tuberculosis, the Moroccan Association of Prevention and Health Education decided to arrange sessions of health education. These sessions concerned persons with tuberculosis in the Great Wilaya of Casablanca. In order to evaluate this act, we compared the therapeutic results of two groups of 100 patients, the first group received a health education, the other, reference sample, was treated under usual conditions. We noticed that the educated patients "knowledge about tuberculosis notably improved; these patients had better adhesion to treatment against 18% in the reference group. [p=0.03]. Whereas, relapse and death. The relative success of our intervention may be explained by the persistance of supervisory problems, thereby diminishing the effectiveness of the health education and causing bad patient/health agent relationship

[Diaphragm pathology seen by specialist in lungs disease]

38 cases of diaphragmatic pathology has been observed in the CHU Pneumology unit -Ibn Rochd hospital- between 1976 and 1989, and from 1987 to 1989 [in 20 Aout hospital]. The serie is dominated by diaphragmatic hernia and eventration divided into 22 cases of diaphragmatic eventration 11 cases of post traumatic diaphragmatic hernia and 3 cases of retro rib xyphoid hernia. The circumstances of discovery are variable: respiratory symptoms [chest aches and dyspnea] associated with abdominal pain and dyspepsia. After the analysis of the cases the authors stress the importance of following elements: Variability of radiologic anomaly is very suggestive of the hernia or eventration, so as pneumoperitoneum and gastroduodenal transit with chest photos delayed. It's useful to precise the nature of the organs intrachest. Concerning therapy repercussions only the eventration with functional re are to be proposed to a surgical, intervention. For the post traumatic hernia or retro-ribxyphoidhernia, the indication of surgical operation is formal because of the risk of a stranglement which is very important

[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

Haemorrhagic pleural effusion. A report of 123 cases

1.132 pleural effusion admitted to the hospital in 113 months, 123 haemorrhagic pleural effusions are confirmed by puncture. The most reliable means the pleural biopsy with the Abrams needle which is systematically used. It has often led to adjust the diagnosis suggested by the clinical context. The pleural metastasis is the dominating aetiology, 53 cases are confirmed on the biopsy or cytodiagnosis and 28 cases are suspected which makes a total of 81 cases [65.9%] then pleural tuberculosis are confirmed in 11 cases, suspected in 8 cases [15.4%]. The cardiovascular etiology represents 3 cases [2.4%], different other causes 2 cases [1.6%], no etiology 18 cases [14.6%]

Clinical profile and follow-up study of 277 children consulting in pneumo-allergology from 1980 to 1982

The authors report the results of a retrospective follow-up study of 277 children under 15 years of age, confirming the close correlation already noted between skin tests on one hand [household dust+acariens], and both total and specific IgE on the other. Indeed, a positive correlation was found between skin tests household dust+acariens and total IgE essays in 77.3% of the children in the groups, as compared with 55% in adults [p 0.01]. Household dust and acariens constitute the antigenic mixture most often incriminated, with a positive correlation of skin tests to specific IgE results of 97%. Specific immunotherapy using essentially extracts from household dust and/or acariens concerned 234 children, of which 96 [41%] dropped out of the program months to 3 years after the beginning of treatment. Thus, among the 138 children who carried through their desentization treatment for at least 3 years, the authors note a global subjective improvement in 75% of the cases

Interest of dosage of theophyllinemia in bronchial asthma and adaptation of an efficient dosage

In 54 asthmatic patients, we assessed the interest of a simple protocol to adapt an efficient dosage of theophylline. Each patient has received a standard dose of 10 per Kg of ideal weight every 24 hours, distributed in 3 doses. The blood sample of theophylline is realized at the 48 th hours. 94.44% of patients accept the therapeutic regiment adopted after adjustement of their posologie for 20 cases

Value of immunodiagnosis of pulmonary aspergillosis: about 327 serodiagnosis

Value of immunodiagnosis of pulmonaly aspergillosis [327 sera]. 327 sera from 214 patients the most of whom were tuberculous have been tested for antibodies to Aspergillus fumigatus, flavus, nigel; nidulans and terreus, by counterimmunoelectrophoresis in an agar gel coated support. Positive sera have been controled by immunoelectrophoresis. 10% of sera investigated were positive and 12% of patients had antibodies. Antibodies to Aspergillus fumigatus have been detected in 78,8% of pulmonary aspergillosis and in 58% of aspergilloma. Neither radiology, nor culture have been helpful for the diagnosis. The immunodiagnosis was negative one to 18 months after medical treatment

[Isoniazid acetylor phenotype in Morocco]

A preliminary study of determination of the acetylor phenotype of the izoniazid is achieved for the first time in Morocco in 100 patients. The results have shown a correlation between the methods of determination on blood samples [Delacoux] and urinary ones [Hodgkin] with 59% of quick acetylors and 41% of slow acetylors; these rates are equivalents to those met in Black Africa. The prevalence of the quick acetylors certainly explains the good tolerance of the important doses of the INH [10 mg/kg] used in Morocco. If the determination of the acetylor phenotype cannot be achieved in a systematic way in our country, aiming to an individual adaptation of the posology owing to the calculation of the index of inactivation made on a single swab -, this dosage may on the other hand be achieved in a punctual way against poisoning signs, appeared with a dose of 10mg/kg of INH

[Non pyogenic pleural effusion: a report of 219 cases]

299 pleural effusion admitted to the hospital in 25 months 263 of these are confirmed by puncture which 219 pleuresies with clear and haemorrhagic fluid with no associated pneumothorax More than the two-thirds of the patients are male, the most reliable means of investigation remains the pleural biopsy with the Abrams needle which is systematically used. It has often led to adjust the diagnosis suggested by the clinical context. The tuberculosis is the dominating aetiology: 108 cases are confirmed on the biopsy and 58 cases are suspected which makes a total of 166 cases [75.80%], then pleural metastasis [confirmed in 9 cases, suspected in 11] [9,1]. The cardiovascular aetiology represents 14 cases [6.39%], different other causes 10 cases [4,56%], aetiologies 9 cases [4,10%]