A. Abdelghani

Évaluation de l’observance et de l’acceptation du traitement du syndrome d’apnées obstructives du sommeil par pression positive continue. Étude prospective de 72 patients appareillés entre 2004 et 2007

Patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) treated by continuous positive airway pressure (CPAP) need to use long-term CPAP to prevent cardiovascular disease. The method of survival analysis was used to allow for long-term CPAP use in 72 patients who were prescribed a CPAP. During a mean follow-up of 22+/-15 months, one patient died and 17 patients stopped their treatment, 29% of them in the first 6 months. In compliant patients, the median value of daily CPAP use was 4.5hours. Kaplan Meier analysis showed that 92% of patients were still using CPAP at 6 months, 83% at 12 months and 59.9% at 3 years. Chronic obstructive pulmonary disease was identified as a predictor factor of long-term CPAP use (OR=4.53, p=0.01). CPAP is a well-accepted long-term therapy for OSAHS with 60% of patients continuing to be compliant with treatment at 3 years.

Le pneumothorax tuberculeux: Etude rétrospective de 23 cas à l’Hôpital Farhat-Hached de Sousse, Tunisie

The tubercular pneumothorax is a rare and severe form of tuberculosis which persists in Tunisia. We reviewed retrospectively our experience at the Pneumology-Allergology Department of the Sousse Hospital with 23 cases of tubercular pneumothorax observed between 1985 and 2003. The suggestive symptom, pneumothorax, always occurred within a context poor general health and fever. The chest roentgengraph showed pneumothorax (n=8) or hydropneumothorax (n=15), and pulmonary lesions associated in 82.5% of patients. Bacteriological proof was obtained in 21 cases; in the two other patients, histological examination of the surgical specimen was highly suggestive of tuberculosis. Treatment associated antitubercular chemotherapy in compliance with the National Plan of against Tuberculosis (n=23), chest drainage (n=21) and respiratory physiotherapy (n=18). Five patients underwent surgery: pleural decortications (n=3), pulmonary resections (n=2). Two were lost to follow-up. The course was favourable in 78% of patients; there were two cases of partitioned pyopneumothorax and one post-operative death. In our experience, tubercular pneumothorax was always associated with active cavitated tuberculosis. The course was almost favorable with antitubercular chemotherapy and chest drainage.Resume Le pneumothorax tuberculeux est une forme rare mais grave de la tuberculose, qui persiste en Tunisie. Pour analyser notre experience dans le service de Pneumologie-Allergologie de l’Hopital de Sousse (Tunisie), nous avons realise une etude retrospective a partir des observations de pneumothorax tuberculeux, pris en charge entre 1985 et 2003. Les donnees cliniques, radiologiques, diagnostiques et evolutives ont ete renseignees. En 18 ans, nous avons collige 23 cas de pneumothorax tuberculeux (dont 16 hommes ; âge moyen : 36 ans). La symptomatologie evocatrice de pneumothorax est toujours survenue dans un contexte d’alteration febrile de l’etat general. La radiographie thoracique a montre soit un pneumothorax (n = 8), soit un hydropneumothorax (n = 15) et des lesions parenchymateuses associees dans 82,5 % des cas. Le diagnostic bacteriologique a ete obtenu dans 21 cas ; chez les deux patients restants, l’origine tuberculeuse a ete suggeree par l’examen histologique d’une piece operatoire. Le traitement a associe une chimiotherapie antituberculeuse conforme aux recommandations du plan National de Lutte contre la Tuberculose (n = 23), un drainage thoracique (n = 21) et une kinesitherapie respiratoire (n = 18). Cinq patients ont ete operes : decortication pleurale (n = 3), exerese pulmonaire (n = 2). Deux patients ont ete perdus de vue. L’evolution a ete favorable dans 78 % des cas et defavorable chez 3 patients : pyopneumothorax cloisonne (n = 2) et deces post-operatoire (n = 1). Dans notre experience, le pneumothorax tuberculeux est, dans la majorite, des cas en rapport avec une tuberculose pulmonaire cavitaire. L’evolution est le plus souvent favorable, sous traitement antituberculeux et drainage thoracique.

Volumineuses opacités pulmonaires bilatérales: Large bilateral lung opacities

We report the case of a 42-year-old woman operated for neurofibroma of the scalp on two occasions who consulted for bilateral chest pain which reveated two voluminous bilateral pulmonary masses. Biopsy of one of these masses was in favor of secondary or primary leiomyosarcoma. The association of Von Recklinghausens disease and soft tissue sarcoma is rare: most often neurofibroma which degenerates is observed. Other types of sarcoma, like leiomyosarcoma, have been described.