Habib Ghedira

L’embolie pulmonaire hydatique: À propos de 7 observations

Resume L’embolie pulmonaire hydatique est une pathologie rare, de diagnostic particulierement difficile, dont le traitement est mal codifie et dont le pronostic est generalement pejoratif. Nous avons effectue une etude retrospective concernant les dossiers de patients hospitalises entre 1994 et 2002, chez qui le diagnostic d’embolie pulmonaire hydatique a ete retenu. Sept observations ont ete colligees. Chez tous nos patients, la rupture du kyste dans la circulation s’est produite spontanement. Tous nos patients etaient symptomatiques. La radiographie thoracique a revele des images d’echinococcose metastatique pulmonaire dans tous les cas. Le scanner et/ou l’angioscanner thoracique ont permis de poser le diagnostic dans 5 cas. Dans un cas, le diagnostic a ete fait par l’angiographie pulmonaire, et dans un autre par les donnees de la chirurgie et de l’examen anatomo-pathologique. La recherche de la localisation hydatique primitive a permis de retrouver la notion de kystes hepatiques chez tous les patients associes dans un cas a un kyste de l’oreillette droite. Le kyste cardiaque n’a pas ete opere et tous les kystes hepatiques ont ete reseques. Une embolectomie a ete effectuee chez un seul patient. Un traitement medical a base d’albendazole a ete entrepris chez 5 patients. L’evolution a ete marquee par le deces de 2 patients dans un tableau d’hemoptysie abondante. Les 5 autres patients sont regulierement suivis, avec un recul allant de 6 mois a 5 ans. Le diagnostic de l’embolie pulmonaire hydatique repose essentiellement sur l’imagerie. Le traitement repose sur l’extirpation chirurgicale du foyer emboligene, puis en second lieu une embolectomie peut etre proposee. La place du traitement medical n’est pas encore clairement etablie. Le pronostic est generalement redoutable a plus ou moins breve echeance.

Skeletal muscle metastases from lung cancer.

Lung cancers are diagnosed at a metastatic stage in 40% to 50% of cases. Skeletal muscle metastases are rare and usually discovered at autopsy. We report 3 cases of skeletal muscle metastasis. Muscular metastasis revealed the cancer in one patient. The metastases were asymptomatic in all patients. The diagnosis was confirmed histologically in one case and by radiography in the other 2. The evolution was characterized by tumor progression and death after 1–7 months.

Prevalence of exercise-induced bronchoconstriction in teenage football players in Tunisia.

Background and Objectives :Studies on exercise-induced bronchoconstriction (EIB) in team sports are lacking. The aim of this study was to screen for EIB among amateur teenage football players in Tunisia and to compare EIB prevalence between regions. Methods: One hundred ninety-six male football players (mean age [SD], 13.5 [0.5] yrs), practicing in three different cities of Tunisia (Tunis, Sousse and Sfax), underwent an outdoor free run of 7 minutes. Forced expiratory volume in one second (FEV 1 ) was recorded prior to and at 0, 3, 5, 10, 15, 20 and 30 minutes after the run. Players were screened for EIB positivity defined as a greater than 10% decline in FEV 1 from the resting value at any timepoint. Results: FEV 1 decreased more than 10% in 30% of the players. EIB positivity was more common in Sfax (15.8%) than in Tunis (7.7%) ( P =.03). Air humidity during the study was higher in Tunis. Conclusion: EIB is prevalent among amateur teenage football players in Tunisia. The prevalence differs between regions and seems to be dependent on air humidity levels.

When the bronchoalveolar lavage makes the diagnosis of interstitial pneumonia.

A 30-year-old non-smoker woman without a particular past medical history consulted for dyspnoea and non-productive cough. Chest CT scan revealed mediastinal and hilar adenopathies associated with bilateral ground glass opacities with thickened interlobular septa. Bronchoalveolar lavage was performed (Fig. 1). The fluid was opaque with a milky turbid gross appearance. On microscopic examination, finely granular amorphous material was apparent in the background along with numerous lymphocytes and fragmented macrophages. Zhiel stain was performed but was negative. The diagnosis of pulmonary alveolar proteinosis (PAP) was suspected but the association of mediastinal adenomegalies was not concordant with the diagnosis. Surgical biopsy of the lung and the mediastinal lymph nodes was performed. Histological examination revealed granulomatous inflammation with caseous necrosis in the lymph nodes and an amorphous PAS positif lipoprotein material filling the alveolar spaces in the lung (Fig. 2). The final diagnosis of associated PAP with tuberculosis infection was established. The patient was put on anti-tuberculosis drugs and presented an improvement of her general state.

Pulmonary embolism and tuberculosis

Tuberculosis has a high prevalence in Tunisia, but pulmonary embolism is rarely reported in Mycobacterium tuberculosis infection. We describe 3 cases of pulmonary embolism associated with severe pulmonary tuberculosis. Pulmonary embolism occurred within 2 to 13 days of pulmonary tuberculosis diagnosis. Clinical, bacteriological, and radiological evolutions were noted within 6 months for pulmonary tuberculosis, but controlling the international normalized ratio was difficult in 2 cases, and low-molecular-weight heparin was prescribed for 6 months in one case. The association between tuberculosis and pulmonary embolism is rare, but it should be systematically investigated, particularly in those with severe pulmonary or disseminated 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.

Exercise-induced bronchoconstriction in Tunisian elite athletes is underdiagnosed

Many studies have shown an increased risk of developing exercise-induced bronchoconstriction among the athletic population, particularly at the elite level. Subjective methods for assessing exercise-induced bronchoconstriction such as surveys and questionnaires have been used but have resulted in an underestimation of the prevalence of airway dysfunction when compared with objective measurements. The aim of the present study was to compare the prevalence of exercise-induced bronchoconstriction among Tunisian elite athletes obtained using an objective method with that using a subjective method, and to discuss the possible causes and implications of the observed discrepancy. As the objective method we used spirometry before and after exercise and for the subjective approach we used a medical history questionnaire. All of the recruited 107 elite athletes responded to the questionnaire about respiratory symptoms and medical history and underwent a resting spirometry testing before and after exercise. Post-exercise spirometry revealed the presence of exercise-induced bronchoconstriction in 14 (13%) of the elite athletes, while only 1.8% reported having previously been diagnosed with asthma. In conclusion, our findings indicate that medical history-based diagnoses of exercise-induced bronchoconstriction lead to underestimations of true sufferers.

Seasonal Differences in the Occurrence of Exercise-Induced Bronchoconstriction in Healthy School Children: Dependence on Climatic Factors

Background: Most studies on the effects of environmental factors on exercise-induced bronchoconstriction (EIB) in children have been carried out under indoor conditions. The purpose of this study w...

About molecular profile of lung cancer in Tunisian patients

ABSTRACT Background: Molecular profile of lung cancer is well known in developed countries. These countries reached the era of liquid biopsies, immunotherapy, and urine circulating tumor DNA. The discrepancies between developed countries and developing ones are becoming deeper. Because of a lack of data in Tunisia, we tried to analyze the molecular profile of non-small-cell carcinomas and to assess the morphologic subtype of adenocarcinomas according to their mutational profile. Methods: We performed molecular analyses in Tunisia and in France of 84 patients who were able to afford the cost of the diagnostic techniques carcinomas diagnosed between 2012 and 2015. The diagnosis was established in our Department of Pathology and the percentage of the tumor cells was estimated by the pathologists. The paraffin-embedded blocks were sent to France, in 41 cases and were analyzed in Tunisia in 43 cases. A next-generation sequencing was performed in France and a real-time polymerase chain reaction (PCR) was performed in our country. Results: During the period of study, 1122 lung cancers were diagnosed and 87 patients were able to afford the molecular analyses cost. The mean age of these patients was 53 years. The sex ratio reached 1.9. The molecular analyses were not performed in three cases because of a low tumor cell rate. EGFR mutations were present in 16 cases: 3 men and 13 women. The adenocarcinomas were classified as acinar in 11 cases and solid in 5 cases. ALK-EML4 translocation was present in six cases. Mutations of BRAF, KRAS, P53, and ERBB4 genes were, respectively, detected in two cases, five cases (3 codon 12), three cases, and one case. Conclusion: This study made us wonder about the possibility of implementing molecular techniques in low-income countries and about the necessity of optimizing the financial resources.

Facteurs pronostiques du cancer bronchique non à petites cellules au stade avancé

INTRODUCTION Primary lung cancer is the leading cause of cancer death in men in the world. Although the introduction of new drugs, new therapeutic strategies and despite therapeutic advances, the prognosis is relatively improved during the last years. AIM To evaluate the prognosis of patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) and to identify prognostic factors at these stages. METHODS A retrospective study, including 140 cases of locally advanced or metastatic NSCLC diagnosed in our department between 2003 and 2013. RESULTS The average age was 61±10 years (35 to 90 years). Sex ratio was 18. The delays management were 80±25 days for presentation, 45±20 days for the diagnostic, while the treatment delay was 8±2.33 days. The cancer was at stage IIIA in 14%, IIIB in 27% and IV in 59%. Six months and one-year survival was between 50 and 74% and between 9 and 25%, respectively. Better survival was observed in patients with NSCLC on stage III, having better performance status, having comorbid conditions, with prolonged delays management, a short therapeutic delay and patients who received specific antitumor treatment. CONCLUSION The prognostic factors in locally advanced and metastatic NSCLC in our patients were: stage of cancer, performance status, comorbid conditions, delay of management and specific antitumoral treatment. These factors should be considered in the management of patients with advanced NSCLC.