[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

[ value of computed tomography in the diagnosis and staging of bronchiectasis]

Basing themselves on literature data, the authors specify the tomodensitometric semiology of bronchiectasis and locate the place of the computed tomography [C.T] in the diagnosis and staging of bronchiectasis in comparison with standard chest radiograph and bronchography They notice the advantages and limits of each method of examination The C.T, as non invasive examination which revolutionized the medical imaging in the last years, intervenes at all the stages of diagnosis of bronchiectasis. Recognition morphologic type, extension and associated damages. But technical Conditions are indispensable, as achievement of thin-section C.T, Judicious choice of windows with use of wide "bronchic" Window and apparatus with high Space resolution. At present, the choice between C.T and bronchograpy in the diagnosis of bronchiectasis seems to depend on quality of tomodensitometric images, localized or diffuse bronchiectasis and degree of Clinical suspicion The C.T of thorax must be done at any suspicion of bronchiectasis and only after the study of its results will be established the management. It seems that bronchography has no more to be indicated at first intention, but it restes indicated in case of discordance between a very suggestive symptomatology and a doubtful C.T. and in case of limited but complicated bronchiectasis which can undergo surgical operation

[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%]

Asthma: diagnosis, investigation and exploration strategy

The diagnosis of asthma is essentially based on clinical data: occurrence of paroxystic episodes of dyspnea with wheezing. The onset of symptoms is often difficult to recognise in non-typical forms. In these cases the ventilatory function test response to histamin or acetylcholin can be used to demonstrate bronchial hyperresponsiveness. Besides chronic bronchitis and emphysema the main differential diagnoses may be regrouped in adults, within 6 etiologies: cardio-vascular, tumoral, inflammatory and/or immunological, congenital and finally functionnal. In childhood other differential diagnoses may be added like bronchitis, tracheal or bronchial foreign body, cystic fibrosis and gastroesophageal reflux. Asthma is regarded as a syndrome with numerous etiologies: allergic and non - allergic [viral infections, pollution, neuro-endocrine diseases, drugs and psychologic factors]. The investigations are based on chest X-ray, hemogram, ventilatory function tests and allergologic testing [skin tests and measurement of serum IgE and specific IgE]. The history of symptoms and skin tests would give the main results of allergolic investigations. The diagnosis of allergic asthma [allowing hyposensitization] is based on clinical data, positive skin tests and if needed, elevation of total and specific IgE. In adults, it is however necessary to perform bronchial provocation tests to demonstrate the allergic cause of asthma

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

[Idiopathic pulmonary hemosideros. report of a 3 cases]

Idiopathic pulmonary hemosiderosis, one of the "pneumo-anemic" syndroms is a very rare disease of unknown etiology and pathogeny. The study of three personal cases associating both an anemic and respiratory syndrom and the study of the literature have led to the description of the clinical manifestations of the disease. Particular attention should be paid to monosymptomatic cases. The presence of macrophages loaded with iron in bronchial secretions, and pulmonary sequestration of radioactive iron [iron 59], revealed by isotopic exploration should be enough to lead to the diagnosis; however a histo-pathological study of pulmonary biopsy, particularly after thoracotomy, seems to be necessary both for a better diagnosis and prognosis. The aetiopathogeny of this affection seems to depend from an immunological mechanism, which is not actually well known. Treatment by corticoids and/or immunosupressive drugs is controversed, and generally the disease evolves towards death within four years usually

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

Mortality in a thoracic surgery department of a University Hospital of Rabat

This study was mainly done from the wards' registers, the hospital's registers, the death certificates and the medical charts. We noted 343 deaths among the 10.140 patients admitted during the ten years [3.4%]. Deaths were more frequent in males [3.7%] than in females [2.6%]. Deaths were more frequent in patients admitted from the emergency unit of the hospital [8%]. They occured a little more during autumn and winter [55.4%]. Forty two percent occured during the first ten days of hospitalisation and 15% during the first day. Cancer was the most frequent cause of death [36.7% with 20.4% were primitive lung cancer]. The principal other causes were: tuberculosis and its sequelae [15.6%], bronchial, pulmonary and pleural non specific infections [12.5%], hydatic cyst [9%], chronic broncho-pulmonary diseases [6.1%]. No cause was determined in 10% of cases. Among the 3.248 surgical patients we noted 63 deaths [1.9%]: 10.6% for primitive lung cancer, 5% for aspergilloma, 2.1% for tuberculosis and its sequelae and 0.9% for hydatic cysts. The importance of hospital mortality studies is stressed

[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

[Nuclear scanning in liver hydatidosis]

The authors present the results of liver scanning in 447 patients with pulmonary hydatic cysts. Abnormal scan was noted in 126 cases [28,2%]. The percentage of abnormal scan is only 4,4% in patients without clinical or radiological indication of hepatic disease. This percentage is 23% in presence of pain in the right hypochondrium, 32% in presence of raising of the right diaphragm in chest Ray, 51,6% in presence of hepatomegaly and 75%, in cases with association of two or three of previous elements. Liver scan is more often abnormal in right unic pulmonary hydatic cyst [32,1%] than in left one [23,7]. In multiple pulmonary hydatic cyst the percentage is 28,7%. At last results vary also according to immunologic reactions. Liver scan is more often abnormal in cases with positive Casoni [28,2%] than,in cases with negative Casoni [5%]. It is more often abnormal in cases with positive serologic reactions [34%] than in cases with negative ones [20%]

[Spontaneous pneumothorax in the adult]

Two hundred and seventy six cases of spontaneous pneumothorax seen in 11 years [1967-1977] were studied. The frequency of the disease has rised sharply but seems to have stabilised for the last 3 years. Males are more frequently involved [84.8%]. 53.2% of the patients were less than 30 years old. Clinically typical symptoms were found in 70% of cases. On the X-Rays, fluid reactions were frequently seen [34%]. Radiology is very important for determining the etiology. 51,8% of cases were primitive [idiopathic], 24% were tuberculous, 8,7% were of hydatic etiology and 4,7% were infectious. 263 patients were cured [95%]. 25 presented with recurrence. Therapeutic result and recurrences were analysed depending on the etiology and the therapeutics used

Abcesses in previously unaffected adult's lungs. 100 cases

The authors recall the main clinical radiological, bacteriological and therapeutic characteristics of a 100 cases of abcesses in previously unaffected adults lungs observed over a period of 10 years [1968-1977]. They note the young age of a great number of patients, the long evolution preceeding the first consultation illustrated by the frequency of the vomica and the dyspnea. The radiological aspect is typical in 89% of the cases. The bacteriological study, not quite conclusive is in fact not necessary to conduct the treatment. Recovery is achieved in 94% of the cases