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.

Association of obesity with asthma severity, control and quality of life.

BACKGROUND: The association between asthma and obesity is becoming increasingly established but the mechanism that might explain the observed differences in asthma severity, control and quality of life between obese and non-obese adult asthmatics is not clear. THE PURPOSE OF THIS STUDY WAS: 1) to determine asthma severity, control and quality of life in obese asthmatics and 2) to explore, according to the body mass index (BMI), the systemic inflammatory state of asthmatic people. MATERIALS AND METHODS: A cross-sectional study was conducted between 2009 and 2010. Two hundred adult asthmatic patients were included. Data analysis consisted of univariate analysis with chi-square comparison test followed by a multivariate logistic regression. RESULTS: Obesity worsens the severity of asthma. This finding was more strongly observed among women than men. Obesity and overweight are associated with a poorer control of asthma. According to BMI, obese asthmatics had 6 times more frequent emergency visits, 5 times more frequent hospitalizations for asthma related complaints, increased missed work days and greater dose of inhaled corticosteroids (1025µg/day vs. 759µg/day of beclometasone equivalent). Mean serum level of C-reactive protein (CRP) and leptin was significantly correlated with asthma severity based on GINA classification (5.75 vs. 2.81 mg/l; 20.5 vs. 5.38 ng/ml; respectively). CONCLUSION: In summary, it appears that obesity is significantly associated with a greater asthma severity and a poorer asthma control and quality of life. Chronic systemic inflammation state may explain the relationship between obesity and asthma.

Multispecific anti neutrophil cytoplasm antibodies: a case report.

AIM: To report the presence af ANCA with an unusual polyreactivity. CASE REPORT: 50 year-old woman with pulmonary fibrosis whose immunological investigations showed the presence of ANCA with an unusual polyreactivity against several neutrophil proteins (PR3,MPO, BPI, lysozyme, elastase and cathepsine G) which could be related to a polyclonal hypergammaglobulinemia occurring in this patient. CONCLUSION: The international consensus on the testing of ANCA recommends seeking major specificities like MPO and PR3 which are good markers of ANCA-associated vasculitides. The use of multiantigenic ELISA can be helpful to detect various target antigens at the same time and may thus explain some atypical fluorescent patterns observed when searching for ANCA by Indirect immunofluorescence, these results, however, must be interpreted with caution.

[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.

[Pulmonary tuberculosis and diabetes. A retrospective study of 60 patients in Tunisia]. / La tuberculose pulmonaire provoque un déséquilibre du diabète Etude rétrospective de 60 malades en Tunisie.

BACKGROUND: Tuberculosis is a frequent infectious disease in Tunisia. The estimated case rate is 22.3 per 100,000 inhabitants. The risk of tuberculosis is 2 to 6 times greater in patients with diabetes. The purpose of this study was to analyze the particularities in the etiology, diagnosis and bacteriologic course of pulmonary tuberculosis in patients with diabetes and to evaluate the impact of tuberculosis on diabetes control. METHOD: This retrospective case-control study of 142 patients with confirmed pulmonary tuberculosis seen from 2000-2006 compared the 60 patients with diabetes with the 82 without diabetes. RESULTS: Diabetes was more frequent in older patients with tuberculosis and in women. 91.5% had type 2 diabetes. A history of contact with people with tuberculosis was significantly less frequent in the group with diabetes (13.3% vs 30.5%; p=0.01). Tuberculosis symptoms and their duration did not differ between the 2 groups. Basal lesions and cavitation occurred more frequently in the patients with diabetes, but this difference was not significant. The time for conversion to negative of sputum culture was longer in case patients (43+/-27 days) than in controls (28.2+/-20.5) (p=0.03). The proportion of patients with uncontrolled diabetes was elevated, and 50% required frequent insulin treatment. CONCLUSION: Tuberculosis is frequently associated with diabetes, usually due to reactivation of Mycobacterium tuberculosis. It is characterized by a longer time to culture conversion to negative and a risk of uncontrolled diabetes that requires frequent treatment adjustment and insulin use.

[Last discovery of a congenital broncho-oeso-phageal fistula]. / Fistule broncho-oesophagienne congenitale de revelation tardive.

BACKGROUND: Broncho-oesophageal fistula is rare and occurs mostly in acquired condition. AIM: Report of a new case. CASE: We report a case of a 58-years-old woman which has, since 38 years ago, a chronic cough, recurrent bronchopulmonary suppurations and hemoptysis. Clinical examination let to the diagnosis of a broncho-oesophageal fistula. Surgical treatment resulted in complete recovery. There was no evidence of any aetiology. Congenital origin of the fistula was deduced.

[Fortuitous discovery of hydatid cyst of the breast]. / Kyste hydatique du sein de découverte fortuite.

INTRODUCTION: Hydatid cyst of the breast is rare even in areas of endemic echinococcosis. It accounts for 0.3% of all localizations and 2% of the uncommon sites. It can be isolated or associated with other localizations. CASE: We report the case of a hydatid breast cyst, associated with a pulmonary hydatid cyst, fortunately diagnosed by mammography and ultrasonography. Both cysts were removed. DISCUSSION: Hydatid breast cysts must be considered in any cystic breast mass, particularly in endemic countries.

[Asthma in the elderly]. / Asthme du sujet agé.

Asthma in elderly is actually well individualized. Two entities are considered: Ageing asthmatics" who have had asthma since childhood, adolescence or adulthood and persisting after 65 years old. This situation is the most frequent. Late-onset asthmatics in persons 65 years old and more. Clinically, asthma in elderly is frequently represented by a dyspnoea at rest during the day. Diagnosis remains difficult because of the non-specifity of clinical symptoms and the frequency of comorbidity. Many differential diagnosis must be considered, dominated by congestive heart failure and COPD. Concerning treatment of asthma in the elderly, a few particularities should be known: prudence in the prescription of beta-2-adrenergic drugs. Anticholinergic drugs have a place in the treatment, contrary to younger asthmatics. A great importance to inhalation devices should be allowed because of their use difficulties in the elderly. The main goal of asthma management in the elderly is to improve the quality of life.

[Association of IGg multiple myeloma with pulmonary amyloidosis: about one case]. / Association myelome multiple à IG G--amylose pulmonaire: a propos d'un cas.

Pulmonary amyloidosis is a rather rare complication of multiple myeloma particularily the rare Ig D myeloma. It is often generalized and is seen in a late stage of the disease. We report a case of an Ig G myeloma complicated of a pulmonary amyloidosis in a 66-year-old man hospitalised for infectious pulmonary disease with a radiologic interstitial syndrome. Discovery of the multiple myeloma and of the amyloidosis was fortuitous.

[Isoniazid-induced visual hallucinosis]. / Hallucinose visuelle induite par l'isoniazide.

INTRODUCTION: Isoniazid is the antituberculosis drug that causes psychiatric manifestations most often. Their incidence is nonetheless rare: a review of the literature found only 16 cases. Only one author has reported hallucinosis, defined by isolated sensorial symptoms, and perceptions not believed to be the reality of the object. CASE: We report a case of a 42-year-old woman, a nonsmoker with no particular history and with lymph node tuberculosis. Three weeks after beginning antituberculosis treatment (isoniazid, rifampicin, pyrazinamide and streptomycin), visual hallucinosis and a headache appeared. The symptoms disappeared when Isoniazid was stopped and an anxiolytic drug prescribed. These findings suggest that these effects were due to isoniazid. DISCUSSION: Two mechanisms may explain these psychiatric manifestations: vitamin B6 deficiency or interference between isoniazid and bioamine metabolism.

Vertebral tuberculosis revealed by thoracic manifestations. A study of five cases.

BACKGROUND: Spine is the most frequent location of bone tuberculosis, which can seldom be revealed by thoracic manifestations. METHODS: In a seven-years retrospective study, we reported radioclinical manifestations revealing Pott's disease, methods of diagnosis and the treatment outcome. RESULTS: Five non immunocompromised female patients were hospitalized between 1997 and 2003 in Clinical Department of Pulmonary Diseases in Abderrahmane Mami Hospital Ariana Tunisia, for thoracic manifestations that led to the diagnosis of Pott's disease, which represents 4.2% of extrapulmonary tuberculosis and 1.3% of all cases of tuberculosis cared for in the same period. The median age was 48.6 years. The disease was revealed by a paramediastinal radiographic shadow infiltrating the contiguous left lung in one case, abscesses of chest wall in two cases. Another patient was hospitalized for a tuberculous empyema. The last case had a diffuse miliary shadow in both lungs. All patients complained from thoracic or respiratory problems and constitutional symptoms, that evolved for an average of 5.6 months. Computed tomography (CT) and magnetic resonance imaging (MRI) of the spine identified monolevel spondylitis in two cases and multilevel disease in three cases. Diagnosis of tuberculous infection was confirmed in only one case by CT-guided biopsy of a perivertebral abscess, it was retained in three cases by bacteriological and or histopathological exams obtained from extra-vertebral lesions, and presumed in the fifth on a favorable treatment outcome. All patients had at least one extra-vertebral location of tuberculosis. Four patients were treated successfully with antituberculosis chemotherapy, prescribed for 18 to 22 months. Relapse occurred only in one patient, who received 12 months of treatment. CONCLUSION: Pott's disease can be observed in non immunocompromised patients. In the Lung Diseases Department, it is often revealed by thoracic manifestations and associated to pulmonary lesions, which makes the formal diagnosis easy. Here, vertebral tuberculosis does not have anatomical specificities; nevertheless, the multilevel forms are relatively frequent. It constitutes an index of bacillus dissemination, requiring the search for other extra-vertebral locations.

[Lung cancer and chondromatous hamartoma: a case report]. / Association hamartochondrome pulmonaire et cancer bronchique, à propos d'un cas.

The association lung cancer with chondromatous hamartoma is frequent. We present a case of synchronous primary lung adenocarcinoma and chondromatous hamartoma. Although hamartoma is generally considered to be a benign tumor, there have been several reports of increased risk of lung cancer in patients with a chondromatous hamartoma. Therefore we recommend that patients with hamartoma should be submitted to a complete evaluation and to regular follow up, considering the risk of associated synchronous malignancy.

[Tracheobronchial foreign bodies. Diagnostic and therapeutic aspects in children]. / Corps étrangers trachéo-bronchiques de l'enfant. Aspects diagnostiques et thérapeutiques.

In this retrospective study, the authors reviewed 31 cases of tracheobronchial foreign body in children ranging in age from one to 15 years, recruited in Ariana hospital since 1987. 74% of the patients were male, and only 26% were less than 3 years old. The foreign body is mostly revealed by a radio-clinical presentation of a feverish bronchopneumonia (32%); children were referred to the hospital within 15.4 months. Although penetration syndrome was reported in 61% of patients, it represented the reason of consultation in only 19% of cases, and children were referred within 4.5 days. The main radiographic findings were atelectasis (32%) and non specific foci of pneumonia (19%). Air trapping was noted in just 10% of cases. 55% of foreign bodies were vegetable in nature, with sunflower seeds at the head of the list (16%). They have been lodged preferentially in the right bronchial tree (58%) and 51% of them were found in the mainstem bronchus. 71% were removed by endoscopic procedures; a surgical operation was performed in 6 cases (19%): one case of pneumotomy to extract a metallic foreign body from distal respiratory tract, and five cases of parenchymal excision, including four for bronchiectasis. 77% of patients had symptoms that lasted at least 2 weeks before diagnosis; the long delay in diagnosis (average of 7.6 months) explains the high-level of bronchiectasis in our study (22%). The authors emphasize the necessity to promote preventive measures by information parents and physicians on risks of foreign body aspiration, which early diagnosis can save much trouble in children.