Atypical emphysema formation in a never-smoker with scleroderma-related interstitial pneumonia: a case report.

Scleroderma is an autoimmune connective tissue disorder which is characterized by fibrosis of visceral organs, blood vessels and skin. The most common manifestations of lung disease in systemic sclerosis are interstitial lung disease and pulmonary hypertension and, together, are the leading cause of mortality in systemic sclerosis. Recently, we notice a new pattern called Combined-pulmonary emphysema and lung fibrosis. Most patients with this entity are male smokers or ex-smokers. This entity is characterized by the coexistence of both centro-lobular and para-septal emphysema in the upper lobes and interstitial lung disease in the lower lobes. Here, we present a case of a nonsmoker adult woman with systemic sclerosis, in which High Resolution Computed Tomography of lung showed combined fibrosis and emphysema with atypical radiological presentation and unusual distribution. This case outlines the importance of recognizing the presence of combined fibrosis and emphysema in patient with systemic sclerosis even without smoking history.

Unusual case of spontaneous hemopneumothorax in a Tunisian pulmonology department: a case report.

Spontaneous hemopneumothorax is a rare encountered entity in clinical practice. It can be life threatening, so a prompt diagnosis and therapeutic intervention are required. We report a case of a right spontaneous hemopneumothorax in a 31-year-old man, complicated with hemorrhagic shock. Conservative therapy with only thoracic drainage with close monitoring of outflow and hemodynamic parameters was performed. In front of hemodynamic instability, an emergency video-assisted thoracoscopic surgery was performed. An apical bulla adhering to the parietal pleura has been identified as the source of the bleeding. The resection of the bullae and electrocauterization of the bleeding adhesion were effectuated. The hemostasis was easily achieved. The actual experience suggests that video-assisted thoracoscopic surgery should be performed as soon as possible after the diagnosis of spontaneous hemopneumothorax. Indeed, conservative therapy with chest drainage should only be performed as bridge to recovery for the stabilization before the video-assisted thoracoscopic surgery.

[Chemotherapy in advanced non small cell lung cancer]. / Apport de la chimiotherapie dans le cancer bronchique non a petites cellules aux stades avances.

Lung cancer is the world's first cause of death by cancer. Locally advanced and metastatic non small cell cancers represent 2/3rd of cases at diagnosis and are of worst prognosis. We conducted a retrospective study of 202 patients to investigate the effect of chemotherapy on survival and quality of life. 95 patients received chemotherapy with VP16-CDDP (88%) or Gemcitabin-CDDP. Improvement survival was observed in the chemotherapy group: 8 month IC 95% [6.6-9.3] 4 month IC 95% [3.1-4.9] in the control group. Chemotherapy also had a good perfect on the quality of life with improvement of performance status, symptoms and need of analgesic. However although significant, the role of chemotherapy in NSCLC remains modest and new therapeutic approaches are needed including prevention and early detection which are probably more effective and cheaper.

[Clinical course of the ventilatory function in COPD: analytical study of 160 cases]. / Evolution de la fonction ventilatoire chez les BPCO. Etude analytique de 160 cas.

The incidence of chronic obstructive pulmonary disease (COPD) is increasing particularly in developing countries. Their prognosis depend on several factors in particular the one second forced expiratory volume (FEV1) decline. To study FEV1 decline speed and factors affecting it, we carried out a retrospective study of 160 cases of COPD in stable state and heaving at least two FEV1 measures at 6 months of interval in the minimum and. The middle age was 63 +/- 12 yr, 52% was former smokers and 46% current smokers, with middle of 50 +/- 27 pack-yr. The FEV1 decline was calculated by linear regression models. The decline average in FEV1 with time was 72 +/- 55 ml/yr. Absolute value was higher than 30 ml/yr therefore more accelerated than general population in 79% of cases. We confirmed by multivariate analysis that age and smoking habit and increased the FEV1 decline. However this last correlated with FEV1% predicted. We concluded that the decline of FEV1 is higher in COPD that in the general population and slowing it needs smoking stop.

[Thyroid assessment in suspected sleep apnea syndrome]. / Le bilan thyroidien au cours des suspicions de syndrome d'apnées du sommeil.

The sleep apnea syndrome (SAS) and hypothyroidism have several common signs. This similarity creates a significant risk of undiagnosed hypothyroidism during the SAS. We studied the interest of thyroid function testing at patients suspected of having SAS. 201 consecutive patients, having a suspicion of SAS without history of hypothyroidism, underwent polysomnography (PSG) and biochemical thyroid testing. 91 patients (47%) had a SAS. Three patients among them (1.5% of patients undergoing PSG or 3.3% of those having a SAS) had previously undiagnosed hypothyroidism. These three patients have been treated by thyroxine. After euthyroidism was obtained by the treatment, SAS disappeared in 2 patients. The prevalence of the hypothyroidism in patients suspected of having SAS is not different from the one in the general population. However it is greater in patients with SAS. So we can conclude that biochemical screening for hypothyroidism is indicated only in case of proven SAS, in order to distinguish between a primary and a secondary origin.

[Obstructive sleep apnea syndrome. Analytical study of 63 cases]. / Syndrome d'apnees obstructives du sommeil (SAOS). Etude analytique de 63 cas.

Obstructive sleep apnoea (OSA) is a relatively common disorder, in developed country with prevalence estimated to lie between 2 and 4% in adult population. The diagnosis of this syndrome is made on the basis of characteristic clinical features and the results of nocturnal polysomnography. There is no data concerning the OSA in developing country. It is therefore of interest to determine the clinic and polysomnographic profile of this disease and to landmark factors correlated with severity in our country. This was achieved by studying a set of 63 OSA. The mean of age was 53 + 13 years with sex ratio 1. The means of Epworth sleepiness scale score, BMI and Apnoea/Hypopnoea index (AHI) were respectively 16 + 4, 38.8 + 7 kg/m2 and 51.7 + 28.6. 44% of patients have OSA severe with IAH > 50/h. Arousal index and desaturation index were respectively 36.4 + 21.7 and 49 + 26. Trial of continuous positive airway pressure (CPAP) therapy was proposed first to 40 patients, 17 were able to use CPAP.

[Survival and prognostic factors of non small cell lung cancer: analytic review of 211 cases]. / Survie et facteurs pronostiques du carcinome bronchique non a petities cellules: revue analytique de 211 cas.

Prognostic factors have a pivotal role in clinical oncology. They are helpful in the selection of treatment, provide insights into the disease process and the therapeutic response. The number of possibly useful prognostic factors in the lung cancer is large. This study attempts to observe the survival of non small cell lung cancer (NSCLC) and to find prognostic factors and other variables potentially associated with outcome of lung cancer. It's a retrospective study based on 211 patients with NSCLC. Median survival was 6 months with 95% confidence interval: [4.2 - 7.8]. Overall 3 and 5 year survival were respectively 8.3% and 5.2%. Various Prognostic factors have been identified through univariate (Kaplan-Meier) then multivariate (Cox) analyses. In addition to the clinical factors such as age, disease extent and performance status, other variables were found of significant prognostic value, like pretherapeutic leukocyte level. Survival was significantly improved with surgery, radiation and also with chemotherapy, mainly in advanced stage (IIIB and IV).

[Embolic pseudotumor diagnosed by surgery]. / Nodule pulmonaire pseudotumoral d'origine embolique de decouverte chirurgicale.

We report a case of pulmonary infarction in a 72-year-old woman who was hospitalised for hemoptysis, chest pain and weight and coin a lesion in the loss periphery of the left lower lobe. Camputed tomography of the chest demonstrated a sub pleural solitary nodule with spicular radiation. Video-assisted thoracoscopic surgery was performed to obtain a histological diagnosis. Thoracoscopic examination showed a lesion that evoked chronic abscess. Histological examination confirmed an ischemic infarction. This is the second case of pseudotumor due to pulmonary infarction that was diagnosed by video-assisted thoracoscopic resection.