Patient taking chemotherapy for a small cell lung cancer: not every cerebral nodule is a metastasis: the tree that hides the forest

We report the case of a 53- year-old man in whom the diagnosis of small cell lung cancer [SCLC] was made by the biopsy of a mass of the right trapezius muscle. A tumor was revealed on flexible bronchoscopy which pathological study showed tuberculosis [TB]. Chest computed tomography [CT] scan revealed findings related to the SCLC associated to micronodules and nodules compatible with pulmonary TB. Cerebral CT scan revealed a nodule of 4.5 mm in diameter presenting enhancement after contrast material injection thought to be a metastasis. The patient was administered antitubercular treatment. Fiveteen days later, the patient started chemoptherapy with etoposid and carboplatin. A control cerebral CT scan realized after the end of the chemotherapy [2 months and a half of antitubercular treatment] revealed numerous cortical and subcortical infracentimetric nodules with contrast enhancement with a tentorial and subtentorial location considered to be in relation with cerebral miliary TB. The nodule discovered on the first cerebral scan was therefore a posteriori considered to have been of tubercular origin. The PS of the patient rapidly worsened. He presented mental confusion and died in some days

Primary sarcomatoid lung cancer: clinical and evolutive features: a propos of five case reports

Primary sarcomatoid carcinoma of the lung are rare non small cell lung cancers [NSCLC] recently individualized by the World Health Organization. Their clinical, radiological and evolutive features are not well known but they seem to have bad prognosis with rapid progression and early metastases. Although they are felt to be chemo-refractory they must be treated as the other subtypes of NSCLC. To evaluate clinical, radiological and evolutive features of primary sarcomatoid carcinoma of the lung. We report the cases of five patients presenting sarcomatoid carcinomas and assess their clinical and evolutive data. One patient had stage IIB cancer underwent surgical resection and adjuvant chemotherapy, he is alive 18 months later; another had stage IIIB was treated by radio and chemotherapy and is alive 6 months later; and three other patients had stage IV in whom one had chemotherapy, the two others did not because of they had performance status. They died 1 to 3 months after the diagnosis. Lung sarcomatoid carcinomas are of bad prognosis. Their treatment is nowadays not well established. Much more good studies are therefore needed

Metabolic and cardiorespiratory response in swimmers during head-out immersion: a prospective study

Sport represents a stress for the body. Many metabolic and cardiorespiratory changes are known during physical activity. However, little is known in swimmers particularly during head-out immersion. To determine the metabolic and cardiorespiratory response in swimmers during head-out immersion. The energetic, cardiovascular function and ventilatory requirements of a 10 min steady state arm exercise performed by 13 healthy subjects in air and during immersion up to the hip in 26[degree sign]C water were compared. The same ergometric work load was achieved with an average maximum oxygen uptake of 3.9 +/- 2.63 l/min in air versus 3.55 +/- 2.48 l/min in water [p=0.953]. During exercise, the average values of minute ventilation, ventilation equivalent for oxygen, ventilation equivalent for CO2, peak expiratory flow, respiratory exchange ratio and heart rate were not different in water and in air. However, first ventilatory threshold was significantly higher in water than in air. The mean value of the first ventilatory threshold was 0.89 +/- 0.23 l/min in air, and 1.08 +/- 0.23 l/min in water immersion; [p=0.016]. These results suggest that training swimmers favoring immersion [weight belts] may improve their aerobic capacity

Systemic al amyloidosis of the tracheobronchial tract and lungs: a rare finding

A 67- year old man presented with cough, weight loss and night sweats. Fiberoptic bronchoscopy did not show any abnormality. Chest computed tomography scan revealed peribronchovascular thickening, sheathing and narrowing of some bronchi. There were also mediastinal and interbronchial Lymphadenopathies. The patient became lost to follow-up. He presented 5 years later with pneumonia. Flexible bronchoscopy showed diffuse infiltration of the bronchi suggesting lung cancer. Histopathological study with histochemical staining revealed tracheobronchial tract AL amyloidosis. Chest CT-scan revealed extension of the broncho-vascular thickening and superimposed pulmonary calcified nodules and lymphadenopathies. Labial biopsy revealed AL amyloidosis. No specific treatment of amyloidosis was thought to be necessary for the patient. At 6 years follow-up the disease had not progressed. This case report highlights the fact that even very rarely, systemic AL amyloidosis can involve the tracheobronchial tract. Moreover, the lungs and the tracheobronchial tract can, although rarely, be affected in the same patient

Assessment of quality of life in asthmatics in Tunisia: a prospective study of 85 cases

Asthma is a frequent pathology all over the world. The patient well-being becomes an aim to achieve in the management of a patient with asthma. Thus, the factors affecting quality of life [QOL] in these patients should be determined. Moreover, as QOL is affected by the socio-cultural and psychological context of each patient, QOL should be assessed in the country where the patient lives. To determine the factors influencing QOL in our country: Tunisia: a Mediterranean, Arabic and developing country. Eighty five adult patients with asthma were included prospectively. The questionnaire of the alteration of QOL in asthmatics in Tunisia [AQLAT] was used. QOL was moderately altered. The score didn't differ between men and women and was not correlated with age. In students, the QOL was less altered than in non students. Patients with severe asthma had a significantly more altered QOL than those with mild to moderate asthma. Nevertheless, there was no correlation between the oldness of asthma and the AQLAT. Besides, the QOL didn't differ in patients with controlled asthma and those with uncontrolled one. A good analysis of the factors determining QOL is patients with asthma would allow a more efficient care of them

syndrome of combined pulmonary fibrosis and emphysema

A syndrome associating an upper-lobe emphysema and pulmonary fibrosis of the lower lung was recently characterized. Few cases were identified in the literature. We report a case of a 68 year- old smoker man presented for exacerbation of a severe dyspnea. Physical examination revealed basal crackles and finger clubbing. Blood gas analysis showed hypoxemia. Chest radiography showed features compatible with emphysema of the upper lobes and fibrosis of the basis. Chest computed tomography confirmed chest radiography's findings and revealed fibrosis. The diagnosis of idiopathic pulmonary fibrosis was made. Pulmonary function tests showed obstructive pattern. Systolic pulmonary arterial pressure was elevated up to 87 mm Hg on heart ultrasonography. The authors emphasize the importance of the diagnosis of this entity made through chest computed tomography and the fact that it is characterized by severe impairment of gas exchange, the high prevalence of pulmonary hypertension and poor survival