[Loosening of osteosynthesis screw as a rare cause of haemorrhagic pleurisy]. / Cause rare de pleurésie hémorragique: descellement d'une vis d'ostéosynthèse.

The occurrence of haemorrhagic pleurisy in patients with myeloma is most often related to a non-specific cause. Pleural myeloma is rare but this diagnosis should be excluded. We here report a rare case of haemorrhagic pleurisy due to the loosening of an osteosynthesis screw. The study involved a 55-year-old female patient who had been followed up for multiple myeloma since 2012. Diagnosis was confirmed by the presence of haemorrhagic pleural effusion, by chest computerized tomography scan which showed the loosening of left-sided osteosynthesis screw with tip located in the prevertebral region at the level of the pleural effusion and by negative etiological assesment.

Factors associated with discrepancies between poor dyspnea perception and abnormal lung function in 65 asthmatic patients.

BACKGROUND: Dyspnea is a subjective symptom of asthma whose perception is characterized by an interindividual variability. Poor dyspnea perception is usually associated with increased risk of exacerbation and may lead to inappropriate asthma management and under-treatment. We sought to identify factors associated with discrepancies between poor dyspnea perception and abnormal lung function in patients with moderate persistent asthma. METHODOLOGY: 65 patients, who attended their scheduled follow-up pulmonology consultation at Ibn Sina Hospital (Rabat - Morocco), underwent interrogation including modified Medical Research Council (mMRC) scale for dyspnea, physical examination and spirometry. Two groups, those with mMRC < 2 (poor dyspnea perceivers) and those with mMRC scale ≥ 2 were compared. RESULTS: Poor dyspnea perception was found in 21 patients (32.3%). Associated factors were male sex (p : 0.03), low socio-economic income (p : 0.01), an onset of symptoms greater than 10 years (p : 0.01), BMI ≥ 25 Kg/m2 (p : 0.04) and depression (p : 0.04). CONCLUSION: The results revealed factors significantly associated with poor dyspnea perception despite an obstructive ventilatory disorder. These factors could usefully be considered to successfully manage asthma as well as the regular prescription of an objective test like spirometry.

[Pseudotumoral bronchopulmonary tuberculosis mimicking cancer in an immunocompetent patient]. / Forme pseudo-tumorale d'une tuberculose broncho-pulmonaire chez un immunocompétent mimant un cancer.

Tuberculosis is a disease caused by tubercle bacillus infection. It can affect all of the body's organs. Pulmonary tuberculosis accounts for a little more than 50% of its occurrences. It is a public health problem worldwide, and developing countries in particular. Pseudotumoral bronchopulmonary tuberculosis is a particular form of tuberculosis in immunocompetent subject. It can manifests as a bronchial or pulmonary lesion, suggesting a neoplasia visible on chest CT scan or bronchoscopy. This similarity can confuse clinicians, making diagnosis challenging and requiring the use of invasive diagnostic techniques, since traditional means are often lacking. This increases burden of care and causes delayed treatment. This study aims to educate clinicians about this particular and uncommon form of tuberculosis, which should be suspected in patient with radiological findings compatible with the disease, especially since they live in a highly endemic country. Therapy and treatment duration are the same as for common forms of tuberculosis.

[Pseudo-Meigs syndrome secondary to ovarian serous cystadenoma]. / Pseudo-syndrome de Demons Meigs secondaire à un cystadénome séreux de l'ovaire: cas clinique.

Pseudo-Meigs syndrome combines a benign (all histological types are included) or malignant (primitive ovarian tumor or ovarian metastasis from another primitive tumor) ovarian tumor or a pelvic tumor (not necessarily ovarian or uterine, for example) with ascites and pleurisy (non-metastatic in the case of malignant tumor). These effusions disappear after tumor resection. A 37-year old female patient was admitted to our Department with dyspnoea and left intercostal pain. Radiological examinations showed left pleurisy of average abundance, ascites of low abundance and a pelvic mass. Surgical exploration showed ovarian tumor. After ablation, pleurisy solved spontaneously. Of particular interest, with regard to pneumology, is that this syndrome has occurred in a woman with pleurisy whose etiological assessment was negative and that abdominopelvic ultrasound allows diagnostic orientation.

Factors associated with asthma control: MOSAR study (Multicenter Observational Study of Asthma in Rabat-Morocco).

BACKGROUND: The purpose of the study is to describe the profile of patients with asthma and to identify the signifiant risks and the protective factors associated with asthma control. METHODS: A prospective epidemiological study was conducted in three hospitals of Rabat-Morocco and included 396 patients with asthma. Differences in characteristics across the levels of asthma control were compared by the one-way analysis of variance for continuous variables, and chi-square test was used for categorical variables. The risk and protective factors associated with the asthma control levels were determined by Proportional Odds Model (POM) for bivariate and multivariate ordinal logistic regression, also expressed as Odds Ratios (OR) and 95% Confidence Intervals (95% CI). RESULTS: From 7440 patients screened by 28 physicians, 396 were included in study. 53% of the particiants sufferd controlled, 18% had partly controlled and 29% had uncontrolled asthma symptoms. A multivariate ordinal logistic regression analysis showed that having respiratory infections (AOR = 5.71), suffering from concomitant diseases (AOR = 3.36) and being allergic to animals (AOR = 2.76) were positively associated with poor control of asthma. However, adherence to treatement (AOR = 0.07), possession of health insurance (AOR = 0.41) and having more than 2 children (AOR = 0.47) were associated with good asthma control. CONCLUSION: The study established a clinical-epidemiological profile of asthmatic patients in Rabat region in Morocco. By ordinal logistic regression we found that 6 factors - respiratory infections, concomitant diseases, animals allergy, adherence to treatment, health insurance and having more than two children - were associated with asthma control.

A Rare Case of Idiopathic Plastic Bronchitis.

Plastic bronchitis is a rare disorder characterized by formation of large, branching bronchial casts, which are often expectorated. We present an interesting case of a 35-year-old woman who presented for evaluation of a chronic cough productive of voluminous secretions. Clinical and radiological examination confirmed a total left lung atelectasis without any pathological mediastinal node. Flexible bronchoscopy demonstrated tenacious, thick, and sticky whitish secretions blocking the left stem bronchus. This material was extracted, and inspection demonstrated a bronchial cast, whose pathological analysis revealed necrotic epithelial cells, some eosinophils, and Charcot-Leyden crystals. Two days after bronchoscopy, the patient rejected more bronchial casts, and dyspnea improved. Control of chest x-ray revealed complete left lung aeration and the diagnosis of idiopathic plastic bronchitis was obtained. This article shows the interest in clinical practice to evoke the diagnosis of plastic bronchitis in front of a productive chronic cough. Our case illustrates a rare clinical presentation represented by an atelectasis of an entire lung.

[When the denture becomes dangerous!] / Quand le dentier devient danger!

Although rare in adults, foreign body aspiration (FBA) is a serious accident which can be potentially life threatening or lead to significant sequelae. We report the case of a 50 year old patient without previous pathological history, presenting to the emergency department with chest pain, intermittent cough and exertional dyspnea occurring six days after the accidental aspiration of his plastic dental prosthesis during a meal. Clinical examination was unremarkable. Chest X-ray as well as abdominal x-ray requiring no prior preparation showed no abnormalities. Flexible bronchoscopy under general anesthesia showed FBA at the level of the intermediate trunk. Successful extraction was performed avoiding a much more invasive procedure. Standard X-ray can be useful to visualize radio-opaque FBA or indirect signs suggesting the presence of FBA, but diagnostic and therapeutic bronchoscopyis is essential.

[Management of spontaneous pneumothorax: about 138 cases]. / La prise en charge du pneumothorax spontané: à propos de 138 cas.

Pneumothorax is a collection of air in the pleural cavity. We conducted a retrospective study of patients with spontaneous pneumothorax in the Department of Pneumology at the Ibn Sina Hospital in Rabat (2009-2011) with the aim to determine the epidemiological, clinical, radiological, therapeutic and evolutionary manifestation of spontaneous pneumothorax. The study involved 138 patients: 128 men and 10 women (17-83 years), with an average age of 44.5 +/- 17.4 years and sex ratio of 12/8. 81.2% of patients were smokers. Clinical symptomatology was chest pain (92%), dyspnea (60%). Chest radiograph showed total unilateral (110 cases); partial (10 cases); localized (6 cases); bilateral (4 cases); right (51.4%) or left (45.7%) PNO (pneumothorax). During our study period we found that 70% of patients had spontaneous primitive pneumothorax and 30% had PNO secondary to Chronic obstructive pulmonary disease (COPD) (44%) and pulmonary tuberculosis (TB) (39%). Initial management included patients hospitalization, chest drainage (95%), needle exsufflation (1%), rest and O2 (4%). It enables the lung to stick to the chest wall within 10 days in 63% of patients. Evolution was favorable in 89% of patients. Immediate complications included: subcutaneous emphysema (5 cases); infection (6 cases) and 3 deaths (cardiorespiratory arrest). Late complications included: recurrences in 11.6%; the first recurrence occurred in 13 cases (chest drainage in 11 cases and oxygen therapy in 2 cases) while the second recurrence occurred in 3 cases (surgery). This study shows the role of chest drainage and monitoring in the management of pneumothorax to avoid complications and especially to prevent recurrences, with a possible need to resort to surgery.

[Primary mediastinal large B-cell lymphoma in women: about five cases]. / Lymphome B à grandes cellules primitif du médiastin chez la femme: à propos de cinq cas.

Primary mediastinal large B-cell lymphoma (PMBL) is a lymphoma occurring in the anterior mediastinum starting from the cells B of the thymique medullary zone. This is a rare entity characterized by epidemiological, clinical and evolutionary peculiarities as well as by pathological and immunohistochemical peculiarities. We report a case series of 5 patients with diagnosed PMBL hospitalized in Pulmonology Department of Ibn Sina Hospital between January 2012 and May 2016. The average age was 34 years, the median of consultation time was 2 months. Reported symptoms were dyspnea, chest pain, dry cough; two patients suffered from superior vena cava syndrome. LDH level was high in 4 patients. Thoracic imaging showed an anterior mediastinal tissue processing in 5 patients. Histological diagnosis was based on ultrasound-guided transparietal puncture biopsy in 5 patients. The contribution of immunohistochemistry was decisive in all cases. Patients were sent to the National Institute of Oncology for therapeutic management. PMBL prognosis is reserved, it most commonly occurs in young women, which increases the need of aggressive therapy to improve survival rate.

Mediastinal Mature Teratoma Revealed by Empyema.

Teratomas are germ cell tumors, manifested with a great variety of clinical features; the most common extragonadal site is the anterior mediastinum. In this case, we report the patient with a large mature mediastinal teratoma with several components of ectodermal and endothermal epithelium. A 24-year-old female patient presented with history of persistent chest pain and progressively aggravating dyspnea for the previous 3 months. A chest X-ray showed a large opacity of the entire left hemithorax. Transcutaneous needle aspiration revealed a purulent fluid. The tube thoracostomy was introduced and the effusion was evacuated. Some weeks later, patient was seen in emergency for persistent cough and lateral chest pain. CT scan revealed a mass of the left hemithorax. The mass showed heterogeneous density, without compressing mediastinum great vessels and left hilar structures. Lipase value was elevated in needle aspiration. The patient underwent a total resection of the mediastinum mass via a left posterolateral thoracotomy. Microscopy revealed a mature teratoma with cystic structures. The patient subsequently made a full recovery. This case provide benign mediastinal teratoma with total atelectasis of left lung and elevated lipase value in needle transcutaneous aspiration; this event is explained by pancreatic component in the cystic tumor. Total removal of the tumor is adequate treatment for this type of teratoma and the prognosis is excellent.