S. Msaad

Métastase ovarienne d’un carcinome bronchique

INTRODUCTION The ovary, being a richly vascular organ, may receive metastases from numerous tissues, particularly of gynecologic origin. Extragenital cancers are dominated by gastro-intestinal and breast tumors. The lung is exceptionally described as a primary site of ovarian metastasis. CASE REPORT We report a 28-year-old woman who was found to have a right perihilar opacity. The diagnosis of small cell bronchial carcinoma was made by bronchial biopsy. A right-sided uterine mass was also identified. This was resected and histopathology identified it as an ovarian metastasis from the pulmonary tumor. CONCLUSION We report, through this case, and present a review of the literature on ovarian metastasis originating from bronchopulmonary neoplasms.

Carcinome à petites cellules du poumon et syndrome néphrotique d’évolution rapidement fatale

Nephrotic syndrome due to membranous glomerulonephritis is observed in 1 to 3% of patients with lung cancer. The nephrotic syndrome usually precedes the discovery of the causal tumor, but diagnosis can be concomitant or during the disease course. We describe a case of small-cell carcinoma of the lung without metastases revealed by a paraneoplastic nephrotic syndrome. Complete remission of the tumor was achieved with chemotherapy and radiotherapy with resolution of the nephrotic syndrome, but tumor progression occurred together with rapidly fatal renal failure. In this case, and the review of the literature, illustrate the association between paraneoplastic nephrotic syndrome and lung cancer, as well as the disease course and prognosis of the lung cancer and the accompanying glomerulopathy.Nephrotic syndrome due to membranous glomerulonephritis is observed in 1 to 3% of patients with lung cancer. The nephrotic syndrome usually precedes the discovery of the causal tumor, but diagnosis can be concomitant or during the disease course. We describe a case of small-cell carcinoma of the lung without metastases revealed by a paraneoplastic nephrotic syndrome. Complete remission of the tumor was achieved with chemotherapy and radiotherapy with resolution of the nephrotic syndrome, but tumor progression occurred together with rapidly fatal renal failure. In this case, and the review of the literature, illustrate the association between paraneoplastic nephrotic syndrome and lung cancer, as well as the disease course and prognosis of the lung cancer and the accompanying glomerulopathy.

Influence of Ramadan Observance on Sleep Pattern and Wakefulness at Workamong Medical Trainer in Tunisia

Introduction: Muslims practice intermittent Islamic fasting all over the globe each year during Ramadan. This practice induces several changes that may affect work performance. The aim of this study is to evaluate the impact of fast during Ramadan on eating behaviors, sleep habits, daytime sleepiness, and professional life. Methods: Target population was medical trainees who were working since at least 4 months at the beginning of the study. They were invited to complete an anonymous self-administered questionnaire during and apart from Ramadan. Results: Two hundred forty-three subjects (243) had correctly completed the questionnaire (mean age = 26.81 ± 2.17 years and sex-ratio = 0.69). During Ramadan, all Alcohol drinkers had stopped drinking (p<0.001), and daily tobacco consumption had significantly dropped from 14.82 ± 8.26 to 11.67 ± 8.64 cigarettes during Ramadan (0.002). Consumption of both coffee and tea was significantly reduced from 2.44 ± 1.3 to 1.03 ± 0.71 and from 1.06 ± 0.59 to 0.77 ± 0.66 cups a day, respectively (p<0.0001). The average number of meals per day dropped from 2.92 ± 0.49 before Ramadan to 1.79 ± 0.58 during Ramadan (p = 0.032). The average bedtime was significantly delayed until to 3.80 ± 5.37 am, while it was at 9.7 ± 10.93 pm during the previous month (p<0.0001). The percentage of subjects who went to bed after midnight also had significantly increased from 57.1% to 93.1% (p<0.001). The degree of dissatisfaction about sleep quality had substantially increased from 18.9% at baseline to 54.7% during Ramadan (p<0.0001). Fasted Trainees found more difficult getting up in the mornings (74.1% versus 79% respectively, p<0.0001). The percentage of trainees who often arrived late for work or missed it increased significantly, from 3.7% at baseline to 11.9% during Ramadan (p<0.0001). The majority (81.1%) reported feeling extra sleepy during the daytime of Ramadan month as compared to 60.1% during the previous month (p<0.0001). It was also noted a higher frequency of digestive disorders (46.9% versus 29.6%, <0.001), morning headaches (15.2% versus 6.6%), excessive nervousness (65% versus 57.6%, p<0.001) and concentration and memory disturbances (88.9% versus 77%, p<0.001). Both daily and weekly working hours had significantly decreased during the month of Ramadan (p<0.001). Trainees started their daily work 15 minutes later and left 20 minutes earlier, which results in 35 less minutes worked per day, and around 3 and half hours less per week. Most of participants (88.1%) thought that Ramadan had a negative effect on their sleeping pattern and affected their daytime functioning. Although, the percentage of those who took sedative-hypnotics for sleep disorders had significantly dropped from 7% at baseline to 3.3% during this month (p = 0.0001). Conclusion: The present study showed that Ramadan is associated with several changes in eating behaviors and sleep habits. These changes resulted in sleep pattern impairment, increased daytime sleepiness and reduced work performance. Healthy sleep and eating habits with a suitable work rhythm should be recommended to Fasted medical trainees to minimize the impact of Ramadan on their wellbeing and professional life.

Do inhaled corticosteroids increase the risk of Pneumocystis pneumonia in people with lung cancer

Pneumocystis pneumonia (PCP) is a life-threatening infection in immunocompromised patients. It is relatively uncommon in patients with lung cancer. We report a case of PCP in a 59-year-old man with a past medical history of chronic obstructive pulmonary disease treated with formoterol and a moderate daily dose of inhaled budesonide. He had also advanced stage non-small lung cancer treated with concurrent chemo-radiation with a cisplatin-etoposide containing regimen. The diagnosis of PCP was suspected based on the context of rapidly increasing dyspnea, lymphopenia and the imaging findings. Polymerase chain reaction testing on an induced sputum specimen was positive for Pneumocystis jirovecii. The patient was treated with oral trimethoprim-sulfamethoxazole and systemic corticotherapy and had showed clinical and radiological improvement. Six months after the PCP diagnosis, he developed a malignant pleural effusion and expired on hospice care. Through this case, we remind the importance of screening for PCP in lung cancer patients under chemotherapeutic regimens and with increasing dyspnea. In addition, we alert to the fact that long-term inhaled corticosteroids may be a risk factor for PCP in patients with lung cancer. Despite intensive treatment, the mortality of PCP remains high, hence the importance of chemoprophylaxis should be considered.

Giant cystic schwannoma of the middle mediastinum with cervical extension

Schwannomas (neurilemmomas) are benign tumors arising from the Schwann cells of the neural sheath. They are typically, well-encapsulated lesions which rarely adhere to the adjacent structures. In the chest, schwannomas are often seen within the posterior mediastinum and commonly originating along intercostal nerves. Several operative approaches have previously been described for the resection of these tumors, including thoracoscopic techniques and posterolateral thoracotomy. We report in this case a giant cystic mediastinal schwannoma of the left recurrent laryngeal nerve with cervical extension, unresectable by the usual described approaches, which was completely removed through a cervical approach.

Une fibrose pulmonaire révélant une granulomatose de Wegener

Resume Introduction La presence d’une fibrose pulmonaire satellite aux vascularites associees aux anticorps anticytoplasme des polynucleaires neutrophiles est rarement observee. La plupart des cas decrits sont survenus avec la polyangeite microscopique. Observation Nous rapportons l’observation d’un patient âge de 82 ans se presentant pour fibrose pulmonaire avec a la tomodensitometrie thoracique des images en rayon de miel et des bronchectasies de traction a predominance peripherique et basale. Le diagnostic de granulomatose de Wegener a ete etabli devant la positivite des anticorps anticytoplasme des polynucleaires neutrophiles, les anomalies du sediment urinaire et les donnees de la biopsie renale. Conclusion Nous insistons, a travers cette observation, sur la rarete de la fibrose interstitielle comme manifestation pulmonaire de vascularite et nous discutons la pathogenie de cette association.

Une localisation rare de plasmocytome solitaire

INTRODUCTION Solitary bone plasmocytoma is rare, characterized by malignant plasmocyte proliferation, derived from a sole B lymphocyte clone located on a bony segment without medullar invasion. It, above all, affects the thoracolumbar spine. Costal involvement is rarely described. CASE REPORT The authors report the case of a 60-year-old man who complained of dyspnea, dry cough, and thoracic pain four months before admission. Thoracic imaging revealed a left apical tissue mass with osteolysis of the first rib. A transparietal biopsy of the mass was not helpful. Surgical biopsy concluded as to the diagnosis of costal plasmocytoma. All of the examinations carried out to search for other localizations were negative confirming the solitary nature of the tumor. The treatment consisted of complementary radiotherapy at a dose of 45Gy. The patient was in remission after eight months. CONCLUSION Solitary costal plasmocytoma should be called to mind when confronted with a lytic tumor of the rib. The treatment is based on surgery and radiotherapy. The prognosis is dominated by the risk of progression to multiple myeloma.

Une tumeur primitive rare du médiastin : le liposarcome pléomorphe

Resume Le liposarcome mediastinal constitue une tumeur rare, comportant plusieurs types histologiques. Il est souvent source de difficultes diagnostiques et therapeutiques. Nous rapportons un cas de liposarcome pleomorphe du mediastin, revele par des douleurs thoraciques et une alteration de l’etat general, chez un homme de 37 ans. La tomodensitometrie thoracique, qui a revele un processus expansif mediastinal anterieur, n’a pas permis d’evoquer le diagnostic en l’absence de densite graisseuse. Le diagnostic histologique a ete etabli par biopsie transthoracique sous controle scanographique. Une premiere cure de chimiotherapie a base de cisplatine et gemcitabine n’a pu empecher la progression tumorale rapide, qui a abouti au deces du patient 3 mois plus tard. Le liposarcome mediastinal pleomorphe constitue une tumeur exceptionnelle, touchant habituellement l’adulte d’âge moyen. Cette tumeur, souvent volumineuse, est habituellement symptomatique par compression des structures mediastinales. La chirurgie en constitue le traitement de choix, alors que la place des traitements associes reste controversee. Le pronostic depend essentiellement du grade de malignite et de la qualite de l’exerese.

Left lung agenesis discovered by a spontaneous pneumothorax in a 20-year-old girl

Lung agenesis is a rare condition which prognosis widely depends on associated malformations. Clinical presentation is so variable and diagnosis is often made in childhood. Here, we present a case of a 20-year-old girl who was admitted because of a spontaneous pneumothorax. Explorations concluded at a left lung agenesis, a hyperinflated right lung crossing the midline with a corresponding pneumothorax. There was no malformation else. This congenital condition and treatment for this rare presentation are discussed in detail.

Secondary pleural hydatidosis: Complication of intrapulmonary echinococcosis

Hydatid disease has a wide geographic distribution around the world. In human, the liver is the most commonly affected organ, followed by the lungs. Intrathoracic extrapulmonary locations are generally the mediastinum, pleura, pericardium and chest wall. Pleural involvement usually follows the rupture of a pulmonary or hepatic cyst inside the pleural space causing secondary pleural hydatidosis. We report four cases of patients who were referred to our hospital for management of pleural hydatid disease as a complication of intrapulmonary echinococcosis.