I. Mejri

Management of pulmonary tuberculosis sequelae

Introduction: Pulmonary tuberculosis still raises many problems. The delay in care can affect respiratory functional prognosis. We were interested to difficulties in management of tuberculosis sequelae. Patients and Methods: A retrospective study including patients treated for pulmonary tuberculosis between January 2012 and January 2014. We selected patients with pulmonary sequelae. Results: Sixty-five cases have been collected. 81.5 % were male and 18.5% female. The mean age was 55.6 years ± 13. Seventy seven percent of these patients were smokers. The mean time to the onset of respiratory symptoms related to pulmonary sequelae was 15.6 ± 8 years. The clinical symptoms were dominated by a chronic sputum (74%), dyspnea (68%) and hemoptysis (34%). The thoracic imaging showed: a destroyed lung (46%), bronchiectasis (31%), aspergilloma (14%), emphysema (12.3%), pulmonary fibrosis (7.7%), residual cavity (6.2%) and lung cancer (1.5%). Functional respiratory explorations found a restrictive ventilatory defect in 78% of cases, chronic respiratory failure in 24% of cases. Treatment was essentially medical consisting in ininhaled corticosteroids, theophyllin and long acting beta agonist. Long term oxygen therapy was indicated for 8 patients. Surgery was indicated for only 5 patients whose, 3 of them had symptomatic aspergilloma. During the period of study the average number of hospitalization per year for all patients was 1.68 ± 2. Conclusion: The prevention of tuberculosis sequelae requires both early diagnosis and available treatment of the disease. These lesions increase morbidity and a preventable mortality.

What outcome after pleurodesis in malignant pleural effusion in lung cancer

Introduction: Malignant pleural effusions (MPE) are a commonly encountered clinical problem in patients with lung cancer, contributing to a poor quality of life in this group of patients. Chemical pleurodesis using various sclerosing agents is an accepted palliative therapy for patients with recurrent, symptomatic MPE. Methods: 100 patients (75 men, 25 women), from 40 to 78 years of age, following-up for lung cancer with biopsy proven malignant pleural effusions were evaluated in a retrospective study. Video-assisted thoracoscopy (VATS) talc pleurodesis was done in all patients. Results: The VATS talc pleurodesis was successful in all patients. It resulted in clinically significant improvement of dyspnea and chest pain in respectively 90% and 80% of patients. Karnofsky performance status (KPS) was consideredbefore an attempt at pleurodesis, variable from 50 to 90%. The mean duration of postoperative survival was 8 months. Recurrent pleural effusion occurred in 5% of patients after a mean interval of 6 months. The mean duration of survival was 4.2 months. Conclusions: The VATS talc pleurodesis is appropriate for palliation of patients with recurrent, symptomatic malignant pleural effusions and should be performed once the diagnosis has been confirmed. It is a simple and acceptable procedure with high efficacy for controlling MPE, especially when used in appropriate patients.

Prognostic factors in non-small cell lung cancer

Introduction : Lung cancer is one of the most frequently occurring neoplasms and usually has a poor prognosis because most of the patients present with advanced or metastatic disease at the time of diagnosis. Numerous prognostic factors (PF) have been studied. Aim: Study the prognostic factors in non small-cell lung cancer. Methods : A retrospective study had enrolled 269 cases of non small-lung cancer between January 2008 and December 2012. Results : The average age of ourpatients was61 years [44-80 years]. Lungcancer wasmore frequently observedin men (94,5%). Smoking wasnoted in 96% of patients. Histological types were adenocarcinoma (61%), squamous cell cancer (28%), non-smallcell carcinomacellsuntyped (11%) and large cell carcinoma (1%). TNM classification revealed stage IA (1,5%), IB (2%), IIA(3%), IIB (5%), IIIA (12%), IIIB (16%) and IV (60,5%). Median survival wasestimated at 575±70 days.Women , patients aged under 45 years and non-smoking patients have a better survival (p=0,005 ; 0,05 and 0,017 respectively). The other prognostic factors were the average intoxication tobacco, the stage of cancer, performance status, the number of metastases, the introduction of aspecific treatment, consultation delay and therapeutic delay (p=0,024; 0,031; 0,006; 0,001; 0,006; 0,46 and 0,001 respectively). Conclusion : Prognostic factors (PF) 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, and are fundamental in the design of clinical trials or in the interpretation of data from the literature.

Pulmonary embolism: Diagnosis and mortality in patients with COPD

Background: Previous studies have suggested that most patients with pulmonary embolism dies of their underlying diseases and PE is itself responsible for a minority of deaths. It has not been determined whether pulmonary embolism is associated with increased mortality among patients with specific diseases as COPD. Methods: we assessed the clinical and paraclinical characteristics, evolving therapeutic and prognosis in 300 patients who had had CT scans to confirm the diagnosis of pulmonary embolism. An outcome classification reviewed deaths occurring up to 1 month. We have defined 2 groups: GI (92 COPD patients) and GII (208 patients without history of COPD). Results: Patients with COPD were significantly older and had more risk factors for PE. Main symptoms in group I were dyspnea and cough. The Geneva score was low in 10 % of COPD patients. At admission, 10% of patients in GI were shocked vs 22% in GII. Acute respiratory failure was more frequent in GI (82% vs 65%). 31% of patients in GI had acute corpulmonale at echocardiography vs 24% in GII. Mechanical ventilation was more used in COPD patients (54% vs 32%). Prognostic PESI score was higher (4-5) in GI (64% vs 40%). Mortality rate was 29% in GI vs 25% in GII. Multivariate analysis showed that Predictive factors of mortality in COPD group were shock and mechanical ventilation use at admission. Conclusion: Patients with COPD and pulmonary embolism have increased 1-month mortality. Shock and use of mechanical ventilation at admission are poor prognostic factors. Further studies were needed to clarify the reason(s) for this increase in mortality.