[Pleural effusion following hepatic radiofrequency]. / Pleurésies post radiofréquence hépatique.

INTRODUCTION: Surgery is the treatment of choice for primary or secondary hepatic tumours. If surgery is contra-indicated radiofrequency offers an alternative treatment capable of destroying tumours small in size and/or number. It is undertaken percutaneously, during laparotomy or endoscopically. Respiratory physicians should be familiar with certain complications. CASE REPORTS: We report two cases of pleurisy following hepatic radiofrequency. The effusions were diagnosed 15 days and one month after radiofrequency treatment for liver metastases from colonic carcinoma. The effusions were exudative and predominantly lymphocytic. The first effusion required thoracoscopy to establish the diagnosis; the second dried up following 5 pleural aspirations. CONCLUSION: Post radiofrequency pleurisy may develop late and present problems in diagnosis and treatment.

[Pneumomediastinum complicating the anti-synthetase syndrome]. / Pneumomédiastin compliquant un syndrome des anti-synthétases.

INTRODUCTION: Pneumomediastinum is a rare but classical complication of dermatomyositis. Its development is a serious matter and necessitates prompt recourse to aggressive treatment with corticosteroids combined with immuno-suppressants or intravenous human immunoglobulin. CASE REPORT: We report the case of a 63 year old woman presenting with pulmonary infiltration, in the presence of dermatomyositis, as a clinical manifestation of the anti-synthetase syndrome. The progress was rapidly unfavourable with pneumomediastinum and acute respiratory distress despite initial treatment with corticosteroids followed by human immunoglobulin and immunosuppressants. CONCLUSION: The identification of cutaneous or muscular signs in the initial investigation of a pulmonary infiltrate should lead to a search for anti-synthetase antibodies in order to determine the optimal clinical management as quickly as possible.

[Spontaneous pneumothorax revealing malignant pleural mesothelioma. Three case reports]. / Trois cas de pneumothorax spontané révélant un mésothéliome pleural malin.

Spontaneous pneumothorax is an uncommon inaugural presentation of malignant pleural mesothelioma. We report three cases in men aged 65, 30 and 76 years. The diagnosis was suggested at medical imaging and was confirmed at histological analysis of biopsies obtained by thoracoscopy in two patients and thoracotomy in one. The first patient (age 65 years) died two months after the initial diagnosis. The second patient (age 30 years) was alive 40 months after 15 chemotherapy cycles using a platinim-gemcitabine combination. Complete tumor response was achieved in the third patient (age 76 years) after 9 chemotherapy cycles with the same combination. Since mid-term prognosis is fatal for this type of tumor, we propose thoracoscopy in all patients over 30 years who develop spontaneous pneumothorax with no morphological features increasing the risk of pneumothorax, and particularly in patients with asbestos exposure.

[Rapid identification of pneumococcal antigenes in urines by the Now Streptococcus pneumoniae Binax test]. / Détection rapide des antigènes pneumococciques urinaires par le test Now Streptococcus pneumoniae Binax.

Streptococcus pneumoniae is responsible for many infectious conditions but probably with an underestimated incidence especially because of the fragility of the bacteria. The present study has evaluated a new test which detects a pneumococcal antigen in urine (Now S.p Binax). Urine samples from 181 children and 40 adults have been tested. All the patients presented with typical clinical signs of pneumococcal infection. Sensitivity = 91.7 %; specificity = 54.2 %; positive predictive value = 50 %; and negative predictive value = 92.9 % have been observed. Although the sensitivity and specificity were lower than those announced by the manufacturer, the test is easy to handle and provides a rapid argument for the diagnosis of pneumococcal infection, especially in the case of invasive infections like meningitis and bacteraemia.

[Pulmonary carcinosarcoma with jejunal metastasis: complete response to chemotherapy]. / Carcinosarcome pulmonaire avec métastase jéjunale et réponse complète à la chimiothérapie.

We report a case of pulmonary carcinosarcoma with jejunal metastasis. The lung is an exceptional localization for carcinosarcoma, a tumor with carcinomatous and sarcomatous components. These two components are closely related but well-defined morphologically and immunohistochemically. Risk of metastasis and local recurrence is high. Surgery is the treatment of choice for localized forms. Prognosis depends on the sarcomatous component which is usually sensitive to chemotherapy, with at least doxorubicin and ifosfamide. This rare case illustrates the potential for jejunal metastasis and complete response to chemotherapy, proven histologically at 33 months.

[An unusual thoracic opacity]. / Opacité radiologique thoracique insolite.

We report a case of a paraspinal meningocele in a 37-year-old man with no other clinical manifestation. The diagnosis was established on the basis of the computed tomography and magnetic resonance imaging features.

[Thymoma and dilatation of the bronchi]. / Thymome et dilatation des bronches.

Thyomas are benign or malignant lymphoepitelial tumors often associated with parathymic syndromes. A 74-year-old subject developed a recurrent thyoma over 15 year with bronchial dilatations and repeated bronchopulmonary and sinus infections. This clinical presentation suggests Good's syndrome which combines thyoma, bronchial dilatations and hypogammaglobulinemia.