[Melanoma bronchopulmonary metastasis concerning 2 cases]

Melanoma is a malignant melanocytary tumor that has a great metastatic potential. Bronchopulmonary metastases are the most frequent ; estimated up to 33% according to the review of literature. The authors report two observations of melanoma bronchopulmonary metastases. The first observation concerns a 61 year-old patient, with as antecedent a melanoma of the thigh confirmed by exersis biopsy and who shows two years later a bronchic syndrome with thoracic pain in a context of general condition alteration. Chest x-ray revealed a retractile opacity of all the right hemithorax associated to a left mediothoracic macronodular opacity. Bronchoscopy detected a tumor obstructing the right bronchus strain whose anatomopathologic exam concluded to a bronchic melanoma. The diagnosis of the melanoma bronchopulmonary metastases of the thigh was thus maintained and the proposed treatment was palliative symptomatic. The second observation concerns a 42 years patient who showed 1 month before had admittance to hospital a bronchic syndrome and thoracic pain in a context of general condition alteration with a naevus of the right cheek of 3 cm in an ulcerous detected a stage melanoma. The chest x-ray found multiple macronodular opacities in baloon-letting out form of tissular density at CT-scan evoking pulmonary metastases. Bronchoscopy revealed a burgeoning tumor witely necrosed at the left basal pyramid. The diagnosis of melanoma bronchopulmonary melanoma of the cheek was maintained and the treatment was symptomatic

[Recurrent pleural fibromatosis revealed by a spontaneous pneumothorax: about one case]

Pleural fibroma, also called benign pleural mesothelio-ma, is a rare tumor not linked to the exposure to "l'amiante", developed through the underpleural conjunctive tissue and whose pathology remains unclear. The authors report the case of a patient, 51 year-old, operated for left solitary pleural fibroma and who shows two years later left thoracic pain with exercise dyspnea with alteration of the general conditions. Chest X-ray and chest CT-scan revealed left hydropneu-mothorax with tissular mass in contact with lung stump and tissular left axillary mass. Punction exsuflation in left basithoracic draws serohematic exsudative lympho-cytary liquid with non malignant cells. Bronchoscopy detected a diffuse 2[nd] degree bronchic inflammation. Lateral left thoracotomy is then carried out and showed pleural tumor of 8 cm in diameter linked to the lung stump and a second necrosed pleural tumor whose ana-tomopathologic study concluded to pleural fibromatosis, with normal follow-up. Through this observation, the authors recall the recidivating character after the surgical resection of pleural fibromas that in certain cases can supervene on a malignant pattern [fibrosarcoma], and also underline that spontaneous pneumothorax can reveal this recidivation and that hypoglycemia, classically a sign associated to these tumors, can be inexistent despite the multiplicity and the important size of the fibromas

Education for tuberculous patients: a quest about the knowledges and impact upon the therapeutic results

At the begining of 1990, and on the occasion of the adoption of the new programme of fight against tuberculosis, the Moroccan Association of Prevention and Health Education decided to arrange sessions of health education. These sessions concerned persons with tuberculosis in the Great Wilaya of Casablanca. In order to evaluate this act, we compared the therapeutic results of two groups of 100 patients, the first group received a health education, the other, reference sample, was treated under usual conditions. We noticed that the educated patients "knowledge about tuberculosis notably improved; these patients had better adhesion to treatment against 18% in the reference group. [p=0.03]. Whereas, relapse and death. The relative success of our intervention may be explained by the persistance of supervisory problems, thereby diminishing the effectiveness of the health education and causing bad patient/health agent relationship

[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