Last discovery of a congenital broncho-oesophageal fistula

Broncho-oesophageal fistula is rare and occurs mostly in acquired condition. Report of a new case. We report a case of a 58-years-old woman which has, since 38 years ago, a chronic cough, recurrent bronchopulmonary suppurations and hemoptysis. Clinical examination let to the diagnosis of a broncho-oesophageal fistula. Surgical treatment resulted in complete recovery. There was no evidence of any aetiology. Congenital origin of the fistula was deduced

Late onset systemic lupus erythematosus

Late onset systemic lupus erythematosus [SLE] after 50-year-old is rare. We report a case of 84-year-old woman presenting with systemic lupus revealed by pleural effusion associated with renal involvement. The pleural effusion, renal abnormalities and the immunological abnormality improved within 4 weeks after prednisone therapy [1 mg/kg/day]. The late onset lupus differs from those with early onset, in terms of mild clinical presentation and favourable prognosis. Our observation is exceptional due to the very late onset of the lupus and involvement of a major organ, the kidney, which is usually exceptional in this age

[Asthma in the elderly]

Asthma in elderly is actually well individualized. Two entities are considered: - "Ageing asthmatics" who have had asthma since childhood, adolescence or adulthood and persisting after 65 years old. This situation is the most frequent.- Late-onset asthmatics in persons 65 years old and more. Clinically, asthma in elderly is frequently represented by a dyspnoea at rest during the day. Diagnosis remains difficult because of the non-specifity of clinical symptoms and the frequency of comorbidity. Many differential diagnosis must be considered, dominated by congestive heart failure and COPD. Concerning treatment of asthma in the elderly, a few particularities should be known: prudence in the prescription of beta-2-adrenergic drugs. Anticholinergic drugs have a place in the treatment. contrary to younger asthmatics. A great importance to inhalation devices should be allowed because of their use difficulties in the elderly. The main goal of asthma management in the elderly is to improve the quality of life

Corps etrangers tracheo-bronchiques de l'enfant. Aspects diagnostiques et therapeutiques.

In this retrospective study, the authors reviewed 31 cases of tracheobronchial foreign body in children ranging in age from one to 15 years, recruited in Ariana hospital since 1987. 74% of the patients were male, and only 26% were less than 3 years old. The foreign body is mostly revealed by a radio-clinical presentation of a feverish bronchopneumonia [32%]; children were referred to the hospital within 15,4 months. Although penetration syndrome was reported in 61% of patients, it represented the reason of consultation in only 19% of cases, and children were referred within 4,5 days. The main radiographic findings were atelectasis [32%] and non specific foci of pneumonia [19%]. Air trapping was noted in just 10% of cases. 55% of foreign bodies were vegetable in nature, with sunflower seeds at the head of the list [16%]. They have been lodged preferentially in the right bronchial tree [58%] and 51% of them were found in the mainstem bronchus. 71% were removed by endoscopic procedures; a surgical operation was performed in 6 cases [1 9%]: one case of pneumotomy to extract a metallic foreign body from distal respiratory tract, and five cases of parenchymal excision, including four for bronchiectasis. 77% of patients had symptoms that lasted at least 2 weeks before diagnosis; the long delay in diagnosis [average of 7,6 months] explains the high-level of bronchiectasis in our study [22%]. The authors emphasize the necessity to promote preventive measures by information parents and physicians on risks of foreign body aspiration, which early diagnosis can save much trouble in children