Ganoderma lucidum: Unutilized natural medicine and promising future solution to emerging diseases in Africa.

Ganoderma lucidum is a well-known medicinal mushroom that has been used for the prevention and treatment of different ailments to enhance longevity and health specifically in China, Japan, and Korea. It was known as "God's herb" in ancient China as it was believed to prolong life, enhance the youthful spirit and sustain/preserve vitality. G. lucidum is seldom collected from nature and is substantially cultivated on wood logs and sawdust in plastic bags or bottles to meet the international market demand. Both in vitro and in vivo studies on the copious metabolic activities of G. lucidum have been carried out. Varied groups of chemical compounds including triterpenoids, polysaccharides, proteins, amino acids, nucleosides, alkaloids, steroids, lactones, lectins, fatty acids, and enzymes with potent pharmacological activities have been isolated from the mycelia and fruiting bodies of G. lucidum. Several researchers have reported the abundance and diversification of its biological actions triggered by these chemical compounds. Triterpenoids and polysaccharides of G. lucidum have been reported to possess cytotoxic, hepatoprotective, antihypertensive, hypocholesterolemic, antihistaminic effects, antioxidant, antimicrobial, anti-inflammatory, hypoglycemic antiallergic, neuroprotective, antitumor, immunomodulatory and antiangiogenic activities. Various formulations have been developed, patented, and utilized as nutraceuticals, cosmeceuticals, and pharmaceuticals from G. lucidum extracts and active compounds. Thus, this review presents current updates on emerging infectious diseases and highlights the scope, dynamics, and advances in infectious disease management with a particular focus on Ganoderma lucidum, an unutilized natural medicine as a promising future solution to emerging diseases in Africa. However, details such as the chemical compound and mode of action of each bioactive against different emerging diseases were not discussed in this study.

The major prognostic factors of thymomas: about a Tunisian study of 100 cases.

AIM: Thymomas are characterised by their rarity, histologic variability and peculiar patterns of recurrence. Herein, we present the experience of a single institution and aim to highlight the major prognostic factors of these tumours. MATERIALS AND METHODS: We present a retrospective study on 100 thymomas diagnosed between 1994 and 2011. Statistical analyses were performed using version 18.0 SPSS. The Kaplan Meier method was used to estimate survival, and survival curves were compared using the Log-Rank test. A p < 0.05 was considered statistically significant. RESULTS: 50 men and 50 women underwent surgical resection for thymoma. Radiologic findings highlighted a diagnosis of thymoma in 51% of cases. The thymomas were classified as stage I in 25 cases, stage II in 47 cases, stage III in 25 cases and stage IV in 3 cases. According to the WHO classification, tumours were classified as type A in 14 cases, type AB in 24 cases, type B1 in 17 cases, type B2 in 20 cases, type B3 in 8 cases, B1/B2 in 8 cases and B2/B3 in 9 cases. The mean survival of patients was 136 months. Age, sex, tumour size, WHO classification and Masaoka stage were evaluated as prognostic factors. Univariate analysis showed that the major prognostic factors were WHO classification (p = 0.019) and Masaoka Stage (p = 0.0001). CONCLUSION: Our results place emphasis on the prognostic value of WHO classification and Masaoka stage in thymomas; in addition, the necessity of improving reproducibility of microscopic classification to avoid discrepancies among prognostic groups is highlighted.

[Bronchopulmonary carcinoid tumors: Tunisian experience with 115 surgically treated cases]. / Tumeurs carcinoïdes bronchopulmonaires : une série tunisienne de 115 cas opérés.

INTRODUCTION: Bronchial carcinoid tumors are rare well-differentiated, neuro-endocrine tumors, with low-grade malignancy. They are distinguished in two different groups: typical and atypical carcinoid. The purpose of this study was to review clinical, surgical and pathological characteristics in patients with primary bronchopulmonary carcinoid tumors. METHODS: This retrospective study included 115 bronchial carcinoid tumors surgically treated at a single institution during a twenty-one-year period, between 1992 and 2012. RESULTS: There were 56 men and 59 women, with a mean age of 43.73 years. Hundred patients had typical carcinoids and 15 atypical carcinoids. The majority of patients were symptomatic (96.52%). CT revealed a proximal mass in 51% which was obstructive leading to ventilator disorders in 80%. Bronchoscopy showed an endo-bronchial tumor in 83.48% of the cases. Anatomical resection had been achieved among 99 patients, and a conservative resection among 16 patients with typical carcinoid tumor. Lymph node metastases were present in 12.17% of the cases. Follow-up revealed recurrence in one patient and distant metastasis in 4 others. The 5-year survival rate was worse for atypical carcinoid with 45% than typical carcinoid with 95%. CONCLUSIONS: Carcinoids are rare malignant tumors, and their outcome is usually favorable after surgery. However, local recurrence and/or metastases can occur with both typical and atypical carcinoid tumors, justifying the need of prompt diagnosis and long-term follow-up. The factors influencing the survival included the pathological type, distant metastasis and mediastinal lymph node involvement.

[Surgery for thoracic tuberculosis]. / La chirurgie dans la tuberculose thoracique.

Tuberculosis is mainly a medical disease. Surgery has been the unique therapeutic tool for a long time before the advent of specific antituberculous drugs, and the role of surgery was then confined to the treatment of the sequelae of tuberculosis and their complications. The resurgence of tuberculosis and the emergence of multidrug-resistant TB combined to immunosuppressed patients represent a new challenge for tuberculosis surgery. Surgery may be indicated for a diagnostic purpose in patients with pulmonary, pleural, mediastinal or thoracic wall involvement, or with a therapeutic purpose (drainage, resection, residual cavity obliteration). Modern imaging techniques and the advent of video-assisted thoracic surgery allowed a new approach of this pathology; the majority of diagnostic interventions and selected cases requiring lung resection can be performed through a mini-invasive approach. Patients proposed for aggressive surgery may be treated with the best results thanks to a good evaluation of the thoracic lesions, of the patients' nutritional, infectious and general status combined with a good coordination between the specialized medical team for an optimal preparation to surgery.

[Pulmonary zygomycosis in a diabetic child complicated with thrombus of the left atrial auricle]. / Mucormycose pulmonaire chez une enfant diabétique, compliquée d'un thrombus intra-auriculaire gauche.

Mucormycosis is a rare but fatal, opportunistic fungal infection caused by fungi of the order of mucorales in the class of Zygomycetes. Isolated pulmonary mucormycosis is rare and occurs principally in particular conditions, especially in patients with uncontrolled diabetes. The fungi invades the blood vessels and causes distal ischemic necrosis. We report a case in a 13-year-old girl with diabetes mellitus who developed pulmonary zygomycosis complicated with thrombus of the left atrial auricle. The diagnosis of mucormycosis was confirmed by histologic examination of endobronchial biopsies. Combined treatment with systemic amphotericin B and surgery resulted in a favorable outcome. This difficult diagnosis must be raised in diabetic patients with unresponsive lung infections in order to apply early aggressive therapy. Successful management continues to be early diagnosis, followed by systemic antifungal therapy and surgical resection combined with control of the underlying disease.

Epicardial cavernous hemangioma: a two-case report.

AIMS: We report two-cases of cavernous hemangiomas arising from the epicardium in two women aged respectively 24 and 79 years old. The first patient was symptomatic and presented with palpitations. The second patient was referred after a random discovery at echocardiography. Chest CT and MRI were performed in the two cases and showed a mass located in the pericardial cavity. Coronary CT was necessary in the first case to ascertain the degree of coronary artery involvement. Both of our patients underwent surgical resection under cardiopulmonary bypass with an uneventful postoperative course for the first case. The second one, died postoperatively from pneumonia. CONCLUSION: Cardiac cavernous hemangiomas, although rare and well tolerated require prompt management and surgery at discovery to avoid further complications which may put at risk the patient's life prognosis.

About a challenging tumour, elastofibroma dorsi: an eight-case study.

Elastofibroma dorsi is an uncommon benign soft tissue pseudotumour usually located at the lower pole of the scapula, deep to the serratus anterior and often attached to the periosteum of the ribs. This lesion is usually seen in patients over the age of 50 years and is commonly misdiagnosed as a malignant tumour because of its size and deep location. We describe 8 cases of elastofibroma dorsi diagnosed over a 10-year-period. Our study contained 5 females and 3 males with a mean age at diagnosis of 62.5 years (range 47-75 years). We aim to highlight the clinical and radiologic presentation of elastofibroma dorsi in order to increase awareness of its existence and management.

Diagnosis and clinical course of cardiac myxoma.

Cardiac myxomas are the most common benign tumours of the heart. In spite of their benign nature, these tumours may induce metastasis or recurrences. Their diagnosis is challenging because of the lack of specific signs, and positive diagnosis is based on microscopic findings. We report a case series of 6 patients documented by radiologic and microscopic findings. In addition, one case was unique due to its location in the right atrium. Tumours were detected by trans-oesophageal ultra-sound examination in all cases. They were located in the left atrium in five cases and in the right side in one case. All patients underwent a successful surgical excision with en-bloc removal of the tumour. The outcome was fatal in one patient because of atrial arrhythmia.

About the necessity of improving the current nodal classification of non-small cell lung carcinoma.

BACKGROUND: The current classification of lymph node status in non-small cell lung carcinoma has not been revised since 1997. This fact has prompted many authors to point out the limits of this classification. METHODS: We tried to explore the prognostic relevance of the current TNM classification in comparison with the nodal classification based on the ratio of metastatic lymph nodes (LNR) and the nodal classification based on the number of metastatic LNs (nLN). Additionally, we tried to explore the recommended number of resected LNs. This was done through a retrospective study of 39 cases. We compared the survival curves of patients using the current, RLN and nLN classifications. In the nLN classification, we grouped patients into three categories: nNO (no metastatic LNs), nN1 (1 to 2 metastatic LNs) and nN2 (> 2 metastatic LN). In the LNR classification, we grouped patients into three categories: rNO (0%), rN1 (< or = 12) and rN2 (> 12). Concerning the total number of the resected LNs, patients were categorized into two groups according to the number of LNs: < 10 versus > or = 10 and < 15 versus > or = 15. RESULTS: Our results showed that the LNR classification highlighted a difference in prognosis between the rN1 and rN2 groups. Moreover, survival of patients seemed to be better when the number of the resected LNs was higher. CONCLUSION: The ratio of metastatic LNs seems to be an important prognostic factor, but further studies are necessary to standardize this classification.

[Conservative surgery in pulmonary aspergilloma]. / Place de la chirurgie conservatrice dans l'aspergillome pulmonaire.

INTRODUCTION: Pulmonary aspergilloma is a mycotic infection due to the deposit of mycelial fibres, usually in a pre-existing cavity within the lung. Surgical resection is the treatment of choice, with anatomical resection the most practiced technique. Simple aspergillomas are becoming more and more frequent urging this review of the place of conservative surgery. AIM: The aim of this study was to establish the characteristics of aspergillomas which may benefit from a conservative surgery. METHODS: We undertook a retrospective study of 64 cases that were operated on in the thoracic surgery unit in Abderrahmen-Mami Ariana's hospital between 1984 and 2008. RESULTS: Fourteen patients had conservative surgical treatment, with an atypical resection to remove the aspergilloma. The other 50 patients had undergone anatomical resection; segmental resection, lobectomy or pneumonectomy. The perioperative mortality rate was 5%. One case of aspergilloma recurrence had been recorded in a patient who had had conservative surgery for a complex aspergilloma. CONCLUSION: Surgery is the only effective treatment of aspergilloma. Conservative surgery may be an alternative in simple-peripheral forms, which have a diameter less than 4cm.

The efficacy of bronchial washings in diagnosis of lung carcinoma.

BACKGROUND: The accurate diagnosis of lung carcinoma has become compulsory, especially after the introduction of new targeted therapies. The majority of these patients are non-operable, highlighting the importance of the cytology specimen. Our aim was to assess the diagnostic efficacy of bronchial washings in low income countries where this low cost technique is widely performed. MATERIAL AND METHODS: We conducted a study of 118 bronchial washings collected in the Department of Pathology. Bronchial washings were smeared on 5-6 clean slides. These were fixed in 95% ethyl alcohol for haematoxylin and eosin staining. Cases were retrospectively reviewed by two pathologists (FM and MM) together with the corresponding biopsies. False negative cases were reviewed twice, and the diagnosis was reassessed in one case. We calculated the sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and Yoden index. CONCLUSIONS: Our study showed a sensitivity of 56%, specificity of 90%, PPV of 55%, NPV of 76% and a Yoden index of 0.45. These results emphasise the diagnostic efficacy of bronchial washings and the possibility of performing molecular tests on cytology specimens.

[A case of costal haemangioma]. / Un cas d'hémangiome costal.

UNLABELLED: Costal primary tumors are rare and dominated by malignant tumors. Haemangioma of the bone represents only 1% of bone tumors. Costal localization accounts only for 1% of the cases and only about fifty cases have been reported in the literature. AIM: The authors aim to describe a rare costal tumor, its histological features and the main differential diagnoses. OBSERVATION: The authors describe the case of a 46-year-old woman who presented with chest pain. Radiological findings did not permit a malignant tumor to be ruled out and the treatment consisted of a resection of the posterior arch of the rib. Microscopic examination concluded that the patient had a costal haemangioma and the patient didn't present any recurrence after a six-year follow-up. CONCLUSION: The costal haemangioma is a very rare tumor with a debated etiology. Some radiological features are specific such as the "soap bubble" or "honeycomb" aspect. However, the basis for diagnosis remains microscopic examination. These tumors have a good prognosis and no cases of recurrence have been reported following complete resection.

[Clinical characteristics of resected bronchial hamartoma. Study of seven cases]. / Particularités anatomocliniques des hamartochondromes endobronchiques opérés. Étude de sept cas.

INTRODUCTION: Endobronchial hamartoma is a benign tumour derived from peribronchial mesenchymal tissue. It is a form of intrapulmonary hamartoma and can cause irreversible pulmonary destruction due to bronchial obstruction. Early diagnosis and treatment is very important and endoscopic treatment is usually the first choice. In cases in which prolonged bronchial obstruction has produced irreversible lung destruction surgical, resection of the tumour is necessary. The aim of this study is to describe the clinicopathological characteristics of resected endobronchial hamartoma. PATIENTS AND METHODS: Seven cases of endobronchial hamartoma, diagnosed in our institution between January 1995 and December 2009, were reviewed retrospectively. RESULTS: The patient population consisted of four males and three females with mean age of 53.7 years (41-68 years). The most frequent clinical presentation was obstructive pneumonia. Endoscopy and imaging showed an endobronchial mass in most cases. Surgical treatment consisted of atypical resection in one case, lobectomy in five cases and pneumonectomy in one case. Tumour size ranged between 0.5 and 3.5 cm. The diagnosis was confirmed in all cases by histological examination. The outcome was favorable in all cases. CONCLUSION: Endoscopic techniques are effective for the diagnosis and treatment of endobronchial hamartochondroma. Treatment should be prompt to prevent irreversible lung damage due to chronic obstruction and suppuration, in which case, pulmonary resection may be necessary.

[Primary heterotopic pleural hydatid cyst presenting as a pneumothorax]. / Un pneumothorax révélateur d'une hydatidose pleurale primitive hétérotopique.

INTRODUCTION: Hydatid cyst is a parasitic disease that is endemic in many countries. Pneumothorax may be a presentation of this disease that presents urgent problems of diagnosis and treatment. CASE REPORT: We report the case of a 23-year-old woman, amenorrheic for 22 weeks, who presented with chest pain and dyspnoea. Chest x-ray revealed a right-sided tension pneumothorax. A check x-ray after drainage showed a homogeneous opacity of water density occupying the lower 2/3 of the right hemithorax. Thoracic ultrasound suggested an uncomplicated hydatid cyst at the right base. Surgical exploration revealed a hydatid cyst 14cm in diameter in the pleural space, and a cavity in the right lower lobe with two bronchial fistulae. Treatment consisted of removal of the cyst intact, closure of the bronchial fistulae and capitonnage of the residual cavity. The postoperative course was uncomplicated. CONCLUSION: Primary heterotopic pleural hydatid cyst is an exceptional cause of pneumothorax that should considered in countries where hydatid disease is endemic. Treatment is surgical following drainage of the pneumothorax.

[Hypertrophic osteoarthropathy associated with pulmonary tuberculosis]. / Ostéoarthropathie hypertrophique pneumique associée à la tuberculose pulmonaire.

Hypertrophic osteoarthropathy is a syndrome frequently described in intrathoracic diseases, especially malignant ones. The association with lung tuberculosis is rarely reported. The authors describe the case of a 35-year-old patient, a smoker, hospitalised for lung cavitation associated with hypertrophic osteoarthropathy. The assessment of the aetiology was negative and the patient underwent lung surgery. The histopathological examination concluded as to chronic pulmonary tuberculosis. This report aims at alerting physicians about the possibility of hypertrophic osteoarthropathy in non malignant diseases, especially pulmonary tuberculosis which is still endemic in our country.

[Primary mediastinal sarcomas]. / Les sarcomes primitifs du médiastin.

INTRODUCTION: Primary sarcomas of the mediastinum are rare and account for 2 to 8% of malignant mediastinal tumours. The aim of this study is to describe their clinical and pathological characteristics. PATIENTS AND METHODS: Fifteen cases of primary mediastinal sarcoma, diagnosed between 1993 and 2009, were reviewed retrospectively, noting the clinical, radiological and pathological findings, and the treatment given. RESULTS: The patient population consisted of eight females and seven males with mean age of 40 years (14 to 73 years). The symptomatology was predominately respiratory. Imaging showed a mediastinal mass invading adjacent organs in nine cases. The diagnosis was made in all cases by histological examination. These 15 mediastinal sarcoma comprised 12 malignant peripheral nerve tumours, two liposarcomas and one angiosarcoma. Three were grade III, six grade II and six grade I. Ten were treated surgically, of which seven had radical resections. Associated treatments were neoadjuvant (one case) or adjuvant (one case) chemotherapy and postoperative radiotherapy (five cases). Radiotherapy was undertaken alone in three inoperable tumours. Eight patients (53%) had died. CONCLUSION: Management of primary mediastinal sarcoma needs a multidisciplinary approach, and is based mainly on radical resection. The prognosis is poor and depends mainly on surgical excision and histological grade.

Desmoid-type chest wall fibromatosis. A six cases series.

PURPOSE OF THE STUDY: Desmoid-type fibromatosis is a fibroblastic proliferation that develops in the deep soft tissues and is characterized by infiltrative growth and a tendency towards local recurrence but does not metastasize. Fibromatosis of the chest wall is rare, representing only 10 to 20% of all deep fibromatoses. CASE REPORT: We report a six cases series of fibromatosis of the chest wall treated at our institution between 1996 and 2009. There were five men and one woman with a mean age of 42.2. Swelling of the chest wall was the most frequent symptom. Imaging showed an expansive homogeneous mass, invading the rib (four cases) or the sternum (two cases). Surgical resection was performed in all cases. The outcome was favorable (five cases) or marked by local recurrence (one case). DISCUSSION: Although it is considered to be a benign lesion, this tumor can be locally very aggressive, and has a high local recurrence rate depending upon the efficacy of surgical resection.

Cardiac cavernous haemangioma.

BACKGROUND: Cardiac haemangioma was first described in 1893. It is an infrequent and benign neoplasm which accounts for about 2.8% of all benign primary cardiac tumours, arising from the cardiac ventricles, valves, atria and rarely the epicardium. METHODS AND RESULTS: We report the case of a 24-year-old woman with a cardiac haemangioma detected by transthoracic echocardiography, computed tomography, and magnetic resonance imaging. The coronary CT showed a mass located in the pericardial cavity with close relationship to the myocardium. The mass surrounded completely the segments 2 and 3 of the left anterior descending coronary artery. At operation, the tumour was incompletely resected, leaving a remnant in the left anterior descending coronary artery contact, one diagonal branch has been sacrificed. Pathologic study diagnosed a cavernous haemangioma. Transthoracic echocardiography eight months later showed a remnant of haemangioma with a left ventricular ejection fraction estimated to 69%. The coronary CT 10 months after surgery showed the remnant of the tumour with normal cardiac cavities and absence of visualisation of the diagonal artery. The patient is currently asymptomatic and doing well 14 months after surgery. CONCLUSIONS: Cardiac haemangioma is a rare cardiac tumour with an unknown aetiology. The diagnosis is aided by imaging techniques. The coronary CT may be useful when more precise evaluation of the tumour extent is required. It allows specifying the relationship of the mass with the coronary vessels. Successful treatment usually requires timely surgery. However, periodic examinations and echocardiography are recommended.

The effect of adding intrathecal magnesium sulphate to morphine-fentanyl spinal analgesia after thoracic surgery. A prospective, double-blind, placebo-controlled research study.

BACKGROUND: We investigated whether intrathecally magnesium sulphate added to morphine and fentanyl reduces patients' postoperative analgesia requirements and prolongs spinal opioid analgesia after thoracotomy. METHODS: In a single-center, prospective, placebo-controlled, double-blind trial, we enrolled 58 adult patients undergoing elective posterolateral thoracotomy. Patients were randomized to receive either 25 µg of fentanyl citrate (0.5 mL)+300 µg of morphine+1.0 mL of preservative-free 0.9% sodium chloride (Group S) or 25 µg of fentanyl citrate (0.5 mL)+300 µg of morphine+50mg of magnesium sulphate 5% (1.0 mL) (Group MgSO(4)) for intrathecal analgesia. Opioid consumption and postoperative pain were assessed for 36 hours. RESULTS: VAS pain scores at rest and on coughing were similar in all groups. The total 36-h intravenous morphine requirements were significantly lower in group MgSO(4) (14 [9.50-26.50] mg vs. 33 [30-41] mg, p<0.001); i.e. 57% less for the group MgSO(4). The total dose of intravenous morphine administered during titration was significantly lower in this group (4 [2-8] mg vs. 8 [6-10] mg, p=0.001). Morphine consumption was significantly lower in the group MgSO(4) at intervals 0-12, 12-24 and 24-36 h. The number of patients requiring titration was significantly lower in group MgSO(4) (68% vs. 96%, p=0.001). There is no difference in opioid side effects. No patient experienced side effects resulting from lumbar puncture, or neurological deficit or signs of systemic magnesium toxicity. CONCLUSION: We found that in patients undergoing pulmonary resection with elective posterolateral thoracotomy, magnesium sulphate (50mg), when added to spinal morphine analgesia reduces postoperative morphine requirements, the number of patients requiring morphine titration without increasing opioid side effects.