Antinuclear antibodies in interstitial lung disease: Prevalence and clinical significance.

INTRODUCTION: The diagnosis of interstitial lung disease (ILD) requires elimination of underlying connective tissue disease. Consequently, antinuclear antibodies (ANA) are routinely screened in patients with idiopathic interstitial pneumonia. However the clinical usefulness of this practice is not well clear. AIM: In this study, we evaluated the frequency of ANA in ILD's patients and investigated the clinical significance of the ANA's presence in these patients. METHODS: We conducted a retrospective study of hospitalized patients diagnosed ILD at pulmonary department and for which ANA was performed in the immunology laboratory of our institution. Demographic features, clinical symptoms, biological and radiologic findings and CTD-ILD diagnoses were compared between patients with positive ANA versus negative ANA. RESULTS: We enrolled 73 patients. The ANA's prevalence was 32%. There were no significant differences in demographics, pulmonary function test values and radiologic findings between patients with and without ANA. Patients with positive ANA had more cutaneous manifestations (p꞊0.011) and Raynaud's phenomenon (p꞊0.029). The diagnosis of connective tissue disease was made in 42% of patients with positive ANA versus 8% with negative ANA (p꞊ 0.001). ANA's titer higher than 1/320 was predictive of CTD diagnosis (OR꞊14.4) (p<0.001). CONCLUSIONS: The research of ANA in PID's patients is an important tool of CTD diagnosis specially in those with suggestive symptoms of autoimmune disease.

Hypertension and Atrial Fibrillation: What is the prevalence of obstructive sleep apnea syndrome?

INTRODUCTION: Obstructive sleep apnea-hypopnea syndrome (OSAS) and cardiovascular disease are public health problems. The objective of our study was to evaluate the frequency of OSAS in patients with hypertension and atrial fibrillation (AF) and to investigate the factors associated with OSAS in this population. METHODS: It's a cross-sectional study including 73patients with hypertension and AF. All patients underwent a respiratory polygraphy. RESULTS: Seventy-Threepatients were included (57 women). The mean age was 66.6±10.7 years. Obesity was found in 75% of patients. The mean duration of hypertension and AF evolution was respectively 8.7±7.3 years and 4.5±5.6 years.A resistant hypertension was found in 16% of patients. AF was paroxysmal in 34% of patients, persistent in 33% and permanent in 33% of patients.The mean Epworth score was 6.7±6.1 with excessive diurnal somnolence found in 30% of patients. According to the Berlin questionnaire, OSAS was "very likely" in 84% of patients. The prevalence of OSAS in patients with hypertension and AF was 77% with an average HAI of 23.26±19.57 per hour of sleep. OSAS was severe in 44% of patients, moderate in 15% of patients, and mild in 18% of patients. Factors associated with OSAS in our population were cognitive disorders (21% vs 0%, p=0.03), diurnal excessive sleepiness (21% vs. 0%, p=0.05), antiarrythmic therapy (63% vs 29%, p=0.016, OR=4.13, 95% CI 1.25-13.64) and nocturnal desaturation (25.86±17.68 vs 9.15±14.3 / H, p<0.0001). Our study did not find any significant difference between the groups regarding demographic characteristics, anthropometric, ultrasound data of patients and characteristics of hypertension and AF. CONCLUSION: OSAS is common among patients followed for hypertension and atrial fibrillation. Its screening is necessary to improve the management and prognosis of these two diseases. However, in the absence of predictive factors for OSA, a polygraph could be recommended for this population.

[Acquired hypogammaglobulinemia associated with thymoma: Good syndrome]. / Hypogammaglobulinémie acquise associée au thymome: le syndrome de Good.

Good syndrome (GS) is defined as the association between thymoma and immune deficiency. It is often complicated by broncho-pulmonary bacterial infections and rhinosinusitis. This disease accounts for only 5% of all parathymic syndromes. These recurrent respiratory infections can cause bronchiectasis associated with Good syndrome. We report the case of a 52-year old woman hospitalized for non resolutive infectious pneumonitis. Chest CT scan showed bronchiectasis associated with thymoma confirmed by biopsy. The discovery of hypogammaglobulinemia allowed the diagnosis of Good syndrome.

Spontaneous Right Hemothorax in the Elderly.

Rupture of thoracic aortic aneurysm is a life threatening condition. Rupture in the right pleural cavity is extremely rare. We report the case of an 80-year-old man with a spontaneous right hemothorax. Diagnosis was made by computed tomography (CT) scan. He was managed with chest tube and stabilization. The patient died before any surgical intervention. We report this case to emphasize that rupture of aortic aneurysm should be considered in the evaluation of spontaneous hemothorax even if it is right-sided particularly in the elderly. Emergent therapy is necessary to prevent mortality.

Pulmonary carcinosarcoma with heterologous component: report of two cases with literature review.

Carcinosarcoma is an uncommon malignant biphasic tumor that accounts for less than 1% of all lung cancers. It is defined by coexisting histologic elements of carcinomatous and sarcomatous components. We report two cases of carcinosarcoma in a 68-year-old patient and a 78-year-old patient explored for lung masses. Macroscopically, the resected tumors were 7 and 10 cm in diameter. Histologically, they consisted in adenosquamous carcinoma with osteosarcoma in one case and adenocarcinoma with chondrosarcoma in the other case.

Synovial sarcoma of the chest wall: a case report and literature review.

Synovial sarcoma is a malignant soft-tissue tumor that most commonly occurs in the extremities of young adults. Synovial sarcoma arising from the chest wall is rare and only some cases had been reported in the literature. We present a 57-year-old woman who presented with chest pain. Radiologic evaluation revealed a right parietal tumor destructing the mid-portion of the 8(th) rib, with heterogeneous enhancement and invasion of the pectoral muscle and extra pleural fat. A surgical resection consisting in parietectomy was achieved. The histological and immunohistochemical findings were consistent with synovial sarcoma. An adjuvant chemotherapy was prescribed but the patient was lost of view. She presented 6 months later with a recurrent huge parietal mass.

[Predictive factors of obstructive sleep apnea syndrome in obesity]. / Facteurs prédictifs du syndrome d'apnées obstructives du sommeil chez les obèses.

BACKGROUND: Obstructive sleep apnea (OSA) syndrome is frequent, and misdiagnosed. THE AIM: Of this study is to assess the prevalence of OSA syndrome in a Tunisian population of obese (body mass index > or = 30 Kg/m2) and to determine its predictive factors. METHODS: It's a transversal study. One hundred patients (63 females, 37 males) were inculded. All patients underwent nocturnal polysomnography or respiratory polygraphy. RESULTS: Sixty-five patients had an OSA syndrome: mild (24.6%), moderate (30.7%) and severe (44.6%). We compared, by a statistical analysis, the group with OSA syndrome and the group without OSA syndrome. There was a predominance of men (81% of men vs 55.5 of women had OSA). Age was higher in the group with OSA syndrome (56.8 years +/- 10 vs 48.1 +/- 12, P = 0.04). Clinical symptoms such as snoring, daytime sleepiness, nocturnal awakening and respiratory pauses were more frequent in the group with OSA syndrome. Morphological abnormalities such as retrognathy and/or short neck were significantly more frequent in the group with OSA syndrome (p = 0.05 and 0.02 respectively). Cardiopathies and diabetes were more frequent in obese with OSA syndrome. CONCLUSION: In obese persons, male gender, comorbidities and /or clinical symptoms such as snoring, daytime sleepiness, nocturnal awakening and respiratory pauses, retrognathy and/or short neck are predictive of OSA syndrome. So, we propose a nocturnal recording in obese presenting at least one of these predictive factors.