[Extrapulmonary tuberculosis]. / Les tuberculoses extrapulmonaires.

Each year, there are more than eight million new cases of tuberculosis and 1.3 million deaths. There is a renewed interest in extrapulmonary forms of tuberculosis as its relative frequency increases. Among extrapulmonary organs, pleura and lymph nodes are the most common. Their diagnosis is often difficult and is based on clinical, radiological, bacteriological and histological findings. Extrapulmonary lesions are paucibacillary and samplings, in most cases, difficult to obtain, so diagnosis is often simply presumptive. Nucleic acid amplification tests, which are fast and specific, have greatly facilitated the diagnosis of some forms of extrapulmonary tuberculosis. However, their sensitivity is poor and a negative test does not eliminate the diagnosis. Treatment is the same as for pulmonary forms, but its duration is nine to 12 months for central nervous system and for bone tuberculosis. Corticosteroids are indicated in meningeal and pericardial localizations. Complementary surgery is used for certain complicated forms.

[Determinants of quality of life in chronic obstructive pulmonary disease]. / Déterminants de la qualité de vie dans la bronchopneumopathie chronique obstructive.

INTRODUCTION: Chronic obstructive pulmonary disease (COPD) is considered as a systemic disease with pulmonary starting point. The use of spirometry alone is certainly not the best way to reflect the impact of disease on quality of life for patients. PATIENTS AND METHODS: Prospective study concerning 70 patients treated for COPD. Quality of life was assessed using the French version of the Saint-George questionnaire. RESULTS: Our population was predominantly male (97%) with a mean age of 63 years. All patients were smokers with an average of 46 pack-years. The total score of the Saint-Georges respiratory questionnaire was 50.7%. The mean scores of different fields were 68% for the field activities, 49% for impact and 26% for the item of symptoms. The multidimensional BODE index was correlated with the quality of life and its various fields were more powerfully than the forced expiratory volume per second, the number of exacerbations, the six-minute walking test and dyspnea score. CONCLUSION: It is important to integrate the multidimensional classification indices in assessing the severity of the disease because only these indices can reflect the systemic aspect of the disease.

[Aging of the respiratory system: anatomical changes and physiological consequences]. / Vieillissement de l'appareil respiratoire: modifications anatomiques et conséquences physiologiques.

The respiratory system undergoes progressive involution with age, resulting in anatomical and functional changes that are exerted on all levels. The rib cage stiffens and respiratory muscles weaken. Distal bronchioles have reduced diameter and tend to be collapsed. Mobilized lung volumes decrease with age while residual volume increases. Gas exchanges are modified with a linear decrease of PaO(2) up to the age of 70 years and a decreased diffusing capacity of carbon monoxide. Ventilatory responses to hypercapnia, hypoxia and exercise decrease in the elderly. Knowledge of changes in the respiratory system related to advancing age is a medical issue of great importance in order to distinguish the effects of aging from those of diseases.

[Excavated pulmonary opacity in diabetes]. / Une opacité pulmonaire excavée chez un diabétique.

Mucormycosis or zygomycosis is a group of infections caused by filamentous fungi of the mucorales order belonging to the zygomycetes family. They generally appear in patients with uncontrolled diabetes or immunodepression, especially neutropenic immunodepression. Incidence has increased with progress in immunosuppressive therapy and chemotherapy and the absence of the use of antifungal prophylactic agents effective against mucors. We report the case of a diabetic patient presenting with an excavated opacity in the right lung which failed to improve after receiving non-specific antibiotic treatment. Direct examination of the bronchial washing specimen led to the diagnosis of pulmonary mucormycosis. Prognosis depends mainly on early diagnosis, enabling appropriate treatment with amphotericin B. Mortality remains high, around 80%; diagnosis is commonly established post-mortem.

[Localized tracheobronchial amyloidosis: a rare cause of pseudo-asthma]. / L'amylose trachéobronchique localisée: une cause rare de pseudo-asthme.

Localized tracheobronchial amyloidosis is an uncommon disease of unknown cause. Bronchial amyloid deposits can occur as focal nodules or multifocal infiltration of the submucosa. Clinical signs are not specific and the chest x-ray is usually normal. Diagnosis is rarely evoked before bronchial biopsies are done. We report a case of tracheobronchial amyloidosis disclosed by asthmatiform dyspnea. The diagnosis was obtained at bronchial fibroscopy performed as part of the work-up for secondary pneumonia.

[The aging lung: structural and functional modifications related to aging]. / Le poumon sénile: les modifications structurales et fonctionnelles en rapport avec le vieillissement.

Ageing is accompanied by numerous structural and functionnel pulmonary modifications. Structural modifications concern the thoracic well- and the broncho-pulmonary system. Functionnel modifications are numerous and concern specially respiratory changes, pulmonary circulation, adaptation to exercise, biochemical system and pulmonary defences. The knowledge of these modification allows better care of the aged affected by respiratory diseases.

[Bilateral excavated nodular pneumopathy: amebiasis? Report of a case]. / Pneumopathie nodulaire excavée bilatérale: l'amibe responsable? A propos d'un cas.

Pleuropulmonary amibiasis is generally secondary to hepatic amibiasis with migration into the thorax. Direct pulmonary involvement is exceptional. We report a case of pulmonary ambiasis without associated liver involvement causing multiple bilateral pulmonary lesions.

[Initial management of community-acquired pneumonia]. / La prise en charge initiale des pneumonies communautaires.

There continue to be major controversies in the management of community-acquires pneumonia, concerning either investigations, decision to hospitalize and antibiotic therapy. All authors agree that a chest radiography must be obtained in all cases, and two sets of blood cultures for hopitalized patients but there is there controversies about other microbiological tests. Decision to hospitalize must be based on clinical judgement but can be helped by Fine's predictive rule. Initial therapy is almost always empiric, antibiotic selection being primarily based on disease severity.