[Lymphangioleiomyomatosis and tuberous sclerosis association]

The Lymphangioleiomyomatosis is a rare lung disease encountered almost exclusively in women of childbearing age. The combination with tuberous sclerosis is even more rare. Lung affection is characterized by thin walled multiple pulmonary cysts, recurrent pneumothorax, an obstructive ventilatory trouble, and an evolation to chronic respiratory failure within an average of 10 years. A patient aged 51 years old with a history of generalized seizures, hospitalized in the department for exertional dyspnea of NYHA stage III of gradual onset since 5 years, combined with a dry cough and some episodes of minimal hemoptysis leading to weakness of the general condition. Clinical examination found diffuse bilateral crepitational rale. The chest radiograph showed diffuse bilateral interstitial syndrome. The cardiovascular examination with ECG and echocardiography showed a mild PAH of 42 mmHg. The chest CT revealed multiple diffuse thin-walled cystic formations highly suggestive of lymphangioléimyomatose. Abdominal and kidney ultrasound showed no appearance of renal angiomyolipoma or uterine fibroids. Furthermore, cerebral CT showed encephalic calcifications objectified for a Tuberous sclerosis of Bourneville. Plethysmography showed a mixed ventilatory disorder predominantly obstructive. The diagnosis of pulmonary Lymphangioleiomyomatosis associated with Tuberous sclerosis of Bourneville has been retained. The patient was put on a long term oxygen therapy with good evolution. The combination Lymphangioleiomyomatosis and tuberous sclerosis of Bourneville is rare, interesting almost exclusively young women. International diagnostic criteria have been proposed for the diagnosis of these disorders. The prognosis remains reserved

[Obesity and asthma]

Asthma is a chronic disease whose prevalence continues to increase. Obesity is a comorbidity makes it difficult to support and control of asthma. A retrospective study on 39 cases of obese asthmatics, whose body mass index [BMI] exceeds 30 kg/m2, followed by allergy consultation service between January 2007 and August 2009. 31 women and 8 men aged between 23 and 79 years [average age: 48.5 years]. Diabetes is associated in 2 cases, hypertension in 5 cases and a sicca syndrome in one case. The asthma was intermittent in 17 cases [43.5%], mild persistent in 7 cases [18%], moderate persistent in 11 cases [28.25%] and severe persistent in 4 cases [10.25%]. The gastro-esophageal reflux was found in 25%, an allergic rhinitis in 41% cases, conjunctivitis in 28% of cases, eczema in 7.6% cases, food allergy in 10% of cases especially Fish and drug in 0.7% cases intolerance to aspirin. A family atopy was noted in 10% of cases. The recommended treatment based on inhaled corticosteroids and beta 2 mimetiques long duration of action in 22 cases associated with xanthine in 4 cases, antihistamines and nasal corticosteroids in 16 cases and inhibitors of proton pump in 10 cases. Asthma is well controlled in 60% of cases, partially controlled in 30% of cases and uncontrolled in 10% of cases. The flow volume curve done in all our patients had obstructive ventilatory disorder objectified in 89.7% and mixed in 10.3%. The obstructive ventilatory disorder was mild in 60% of cases, moderate in 28.6% cases and severe in 11.4%. Obesity is a bad factor in controlling asthma and a multidisciplinary care must be taken to assure the best therapeutical approach

[ 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

[Amiodarone pneumopathy]

The frequency of which has occurred of pulmonary toxicity related to the amiodarone is variable between 1, 4 and 20% of the cases

Observation: We report the case of a 74 year old patient who has been put under amiodarone for 3 months. The patient has presented a cough and a dyspnea of effort for one month. The thoracic radiography and TDM showed an interstitial attack associated alveolar hearths. After stop of the amiodarone, the patient is put under prednisolone during 10 days. The evolution was good

Discussion: The amiodarone is responsible for various tables of pulmonary toxicity: an interstitial pneumopathy, a pneumonia with eosinophilic, an organized pneumonia,…. The positive diagnosis is based on a whole of clinical, radiological and biological criteria

Conclusion: The medicamentous knowledge of pneumopathy in general and especially to the amiodarone is important because it enables us to evoke this diagnosis and to stop the suspected drug

surgical treatment of the dilatations of the bronchi [about 48 cases]

In spite of the progress of the medical treatment of the bronchiectasies or dilations of the bronchi, a certain number of patients can benefit from a surgical treatment. The aim of our work is to value the results of the surgical treatment and to specify the moment of the surgical intervention. Our work is about 48 cases of bronchectasies operated in the service of the emergencies visceral Ibn Rochd of Casablanca between January 1994 and February 2001. It was about 30 women for 18 men, the middle age of our patients was 27 years. It was a sequelae of respiratory infections of the childhood in 22.9%, of tuberculosis in 35.42% of the cases, and 10.41% of the patients had presented a pulmonary abscess. The dilations of the bronchi were apparently primitive in 31.45% of the cases. The sits of the bronchiectasies has been specified the most often by a thoracic computed tomography in 80%, in 20% of the cases the lesion was bilateral. The type of intervention practiced was 33 cases of lobectomies, 6 cases of bilobectomies and 9 case of trisegmentectomies. The operative continuations were simple in the majority of the cases, except in 9 cases: 4 cases of pyopneumothorax, 2 case of emphysema under cutaneous and 3 case of parietal suppuration. The long-term follow-up interested 34 patients, 30 became asymptomatic, 1 patient presented a parietal pain, an obstinate cough has been noted in one patient and two patients presented occasional respiratory infections