Pulmonary tuberculosis in its pseudotumoral form; one new case

Pulmonary tuberculosis in its pseudo tumoral form is a rare entity. This pseudo tumor is suggested by a radiological parenchymal lesion or neoplastic-like presence in bronchoscopy of a bud or lung infiltration. The diagnosis is confirmed by bacteriological and/or different histological samples. We report a patient aged 26 with no history conditions, no notion of contagious tuberculosis and without toxic habits, who reports with three months isolated type left chest pain operating in a context of significant weight loss but not encrypted, evening fever and altered general condition. The clinical syndrome is a condensation of apical left and the rest of the examination is unremarkable. The chest radiograph shows an opaque round, dense and homogeneous apical left chest scan objective mass density tissue. Bronchoscopy was performed of a small bud at the apex of the segmental left upper lobe whose biopsy was inconclusive. Transparietal puncture with histological study confirmed the diagnosis of pulmonary tuberculosis. The patient was then put under treatment with antibacillaire. The diagnosis of tuberculosis should be considered in any tumor-like lung, as well as to step up bronchoscopic radiation, especially in an epidemiological context and is suggestive. This will allow early treatment of tuberculosis. The aim of our study is to report the rare and special appearance of pulmonary tuberculosis pseudo-tumoral form in imaging

[Obstructive sleep apnea-hypopnea syndrome: risk factors and comorbidities]

A common condition in the middle-aged adults, the obstructive sleep apnea-hypopnea syndrome is a disease which has been considered both rare and benign illness. Now it is "taken seriously" and considered as a real public health problem because, it untreated, it leads to increased morbidity or even mortality concerning the cardiovascular system [hypertension particularly resistant to medical treatment, coronary artery disease.], the endocrine system [metabolic syndrome], the neurological system [stroke, thromboembolic disease.] and also psychologically [depression, impairment of cognitive performance.]. As concern the pathophysiology, the disease is characterized by a complete or partial obstruction of the upper airways on inspiration due to a collapse of the pharyngeal structures occurring repeatedly during sleep. This collapse is secondary to a number of risk factors crucial to recognize because they allow to suspect the disease [male gender, advanced age, obesity, drug taking, certain disorders as endocrinal diseases, malformation diseases, digestive diseases.]. Due to its pathophysiology, the diversity of its risk factors, comorbidities and complications, the pathology is considered as "transversal" that support should be multidisciplinary

[ tracheal adenoid cystic carcinoma]

Adenoid cystic carcinoma [CACC], also called cylindroma, are rare epithelial malignant tumors, their favorite seat is at the salivary glands [95% of cases], they represent 20 to 40% of tracheal carcinoma and 0,1% of respiratory tract cancers. Bronchial localization is rare, estimated only between 0.3 and 2%. This is a retrospective study ranging from 1997 to 2006 concerning five patients treated in the thoracic surgery department, for tracheal tumor and whose final histological diagnosis was in favor of adenoid cystic carcinoma [ACC]. All the patients had inspiratory dyspnea. Bronchoscopy showed a smooth tracheal tumor, the biopsy revealed a ACC. Four of our patients underwent resection of the tumor-by-end anastomosis and one patient was deceased prior to surgery. Adjuvant radiotherapy was indicated in one case. The short term, outcome was good, but local recurrence with lung and cervical lymph node metastases appeared after 6 years in one patient. The adenoid cystic carcinoma of the trachea is a rare tumor. Its diagnosis and surveillanse based on bronchial Bibroscopy combined with biopsy. CT better evaluates the scope and extent of the peri tracheal tumor. The therapeutic management is based mainly on surgery combined with radiotherapy. adenoid cystic carcinoma of the trachea are rare malignant tumors issues to think about before a lesion at this level

[ bagassose: extrinxic allergic alveolite]

The extrinsic allergic alveolites are interstitial and alveolar pneumopathies of complex immunological mechanisms, related to the inhalation organic chronicles of substances. We report the observation of a 61 years old, old patient nicotinic chronicle, without particular pathological antecedents, having a concept of professional exposure to the cane with sugar during 40 years. It presents 4 months before its hospitalization a dyspnea of effort of progressive aggravation currently stage IV of the EEC associated with a productive cough mucopurulente, the whole evolving/ moving in a context of apyrexie and slimming quantified to 15 kg. The clinical examination finds a patient polypneic with 26c/mn and rails crepitants bilateral with the sounding pleuropulmonaire. Thoracic radiography shows an interstitial syndrome diffuse reticulo-micronodulaire. The thoracic TDM highlights an aspect in honeycomb evoking a pulmonary fibrosis. Washing bronchioloalveolaire objectifies a rate of polynuclear neutrophiles with 6%. Respiratory functional exploration finds a moderate restrictive syndrome with a reduction in the DLCO. In front of these clinical, radiological and functional criteria, the diagnosis of the bagassose was retained. In the light of this observation, we underline the diagnostic difficulties of the alveolite allergic extrinsic and we propose a review of the literature

[Allergic to sunflower]

The allergic to sunflower [Helianthus annuus] of the composite family is a rare, however, 13 cases of IgE-mediated anaphylactic reactions have been reported. It is most often generalized immediate reaction, with a total tolerance to the sunflower oil. This allergy manifests itself polymorphic and responds to all possible routes of exposure: ingestion, inhalation or contact. This is a boy of 18 years, followed for assessment of acute urticaria [4 episodes in 1 year]. The questioning is the notion of eating sunflower seeds before the symptoms. Skin tests were negative for aeroallergens and positive currents to extract seeds and sunflower oil. Specific IgE were increased. Allergy to sunflower seeds was used. The patient progressed well with conservative treatment [corticosteroids and oral antihistamine] with the eviction action. Through this observation, we emphasize the rarity of this form of allergy, the difficulty of the diagnostic investigation with an explanation of the pathophysiological mechanism

[Inhalation of scarf pin: specificities of this foreign body]

The inhalation of scarf pin is a phenomenon increasingly common in countries where women wear the veil and whose consequences can be grave. The aim of this study is to emphasize the danger of holding this object in the mouth and to describe through a retrospective study the diagnostic, the clinical features and the management of 24 cases of inhalation of this foreign body. All cases were young veiled women aged between 13 and 23 years, all victims of accidental inhalation of a metal pin. The most frequently reported symptom was cough in 58% of cases. Chest radiography helped confirm diagnosis and guide the location of the foreign body which was in equal frequency at the right and left bronchial tree [46%] and 8% in the trachea. Flexible bronchoscopy, performed by first intention in all our patients, helped to locate the pin in 19 cases and its extraction in extraction. The spontaneous expulsion was noted in five cases. The inhalation of pin is a pulmonary emergency where endoscopy occupies a primordial place. Prevention remains the best treatment

[Allergy to the latex]

The immediate allergy to the natural latex did not stop increasing during this last decade in exposed persons particularly in health professionals. Its frequency is very variable. The aim of this work is to evaluate the frequency of allergy to the natural latex proteins in the paramedical staff of Ibn Sina academic hospital center of Rabat. It is a prospective survey lasts for a period of three months, aided by a questionnaire. 22 departments were participated in this survey, the number of distributed questionnaire depends on the work force of each department, it was 619. Among only 268 have been filled i-e 43,2%. And only 119 participants reported allergic manifestations i-e 44.4% Alter making an allergiology consultation only 45 persons had a real allergic manifestations related to manipulation with natural late proteins i-e 16-7%. Clinical pictures were: prauritus [51%] allergic rhinitis [48.8%], conjunctivitis [46.6%], contact eczyma [26.6%], contact rash [8.8%], asthma [8.8%] and only one case of Quink edema [2%]. Prick tests to the current pneumoallergenes and to some exotic fruits have been done to all the participants, 45 positivity was found in 5 persons i.e [11.1%] Sentization was isolated in two cases one was sensitized to avocet only, associate to a sensitization to avocet DP type, DF in one case and to avocet, banana and kiwi for the other case. The frequency of allergy to latex in this selected sample was of 11.1% which remains comparable to the data of literatures

[Exploration of sleep-disordered breathing]

Sleep-disordered breathing become more frequent mostly affecting adult male subjects and overweight. We distinguish in this context apneic and non apneic sleep-disordered breathing whose leaders are respectively sleep apnea syndrome and obesity-hypoventilation syndrome. The diagnosis of these disorders is obligatory based on explorations achievable only in sheep laboratory. In these explorations, it is important to distinguish two types of investigations. The ventilatory polygraphy: simple investigation, but limited to the registration of different ventilation parameters of severe sleep apnea syndrome with an apnea-hyponea index >30/ h. Polysomnography, besides the respiratory signals recorded previously, it collects other signals that can recognize the succession of different stages of sleep [hypnogram]. It remains the gold standard of sleep-related breathing disorders. Through this update we will discuss the technical side of these two investigations and also their relevance