[Treatment and prognosis of advanced stage non-small-cell lung cancer]. / Traitement et pronostic du cancer bronchique non à petites cellules au stade avancé.

INTRODUCTION: Lung cancer is the main cause of death from cancer in both men and women worldwide. In 70 to 80% of cases, the diagnosis is made at an advanced stage. Although the management of non-small-cell lung cancer (NSCLC) has continued to improve over the last 5 years, the prognosis remains poor with a 5-year survival rate of about 16%. The aim of this study was to evaluate the management of locally advanced or metastatic NSCLC in our patients and to analyze overall survival (OS) and prognostic factors at these stages. MATERIALS AND METHODS: A retrospective study, including cases of locally advanced and metastatic NSCLC diagnosed in our department between 2008 and 2011. RESULTS: We included 150 patients with a mean age of 60.2 years. The cancer was at stage IIIA in 21% of cases, IIIB in 14% of cases and IV in 65% of cases. Thoracic surgery was performed in 5 patients; 61.4% of patients received chemotherapy and chemo-radiotherapy was given in 21% of patients. Overall survival was 6 months. Better survival was observed in patients aged less than 60 years, having better performance status (PS), having no metastatic mediastinal lymph nodes and patients who received specific anti-tumor treatment. CONCLUSIONS: The prognostic factors in locally advanced and metastatic NSCLC in our patients were: age, PS, status of mediastinal lymph nodes at diagnosis and treatment. These factors should be considered by physicians when treating patients with advanced stage NSCLC.

[Sternal tuberculosis causing spontaneous fracture of the sternum]. / Tuberculose sternale avec fracture spontanée du sternum.

Sternal tuberculosis is an uncommon condition. Few cases have been reported. We report the case of a 74-year-old man, presented with a swelling and pain of the anterior chest wall associated to worsening of general state. All routine investigations were normal. Chest radiograph in lateral view showed sternal and chest wall hypertrophy with spontaneous fracture of the sternum. Computed tomography (CT) scan demonstrated ring-enhancing hypodense soft tissue mass surrounding the sternum with sternal fracture. Tuberculosis diagnosis was confirmed by histological study of the mass biopsy. We noted clinical and radiological recovery with medical tuberculosis treatment.

Burden of Chronic Respiratory Diseases (CRD) in Middle East and North Africa (MENA).

Chronic respiratory diseases involve a heterogenous group of diseases, including, chronic obstructive pulmonary disease (COPD), asthma, sleep apnea syndrome, pulmonary hypertension, and many occupational diseases. They affect more than one billion people worldwide. Their medical, social, and economic impacts are heavy, especially in developing countries such as Middle East and North Africa countries, where they represent a public health problem. They are essentially represented by COPD, asthma, and allergic diseases. Chronic respiratory diseases are increasing in frequency, morbidity, and mortality. In addition, their economic and social impact is increasing rapidly in this region. Main risk factors are represented by tobacco smoking and exposure to biomass fuel. Smoking prevention and standardized management programs for asthma and COPD are now available but prompt actions are needed to make them more effective in this region and thus avoid an adverse impact on national economic development.

Spontaneous pneumothorax in adulthood varicella.

Varicella is a generalized viral infection that is generally benign if it occurs in childhood, but it has a severe outcome in adulthood. Pneumonia is the main complication of adulthood varicella and may lead to respiratory failure. Spontaneous pneumothorax is a rarely reported complication during varicella in adult patients. Only one case of spontaneous pneumothorax associated with varicella pneumonia (VP) was published in 1990. We report a new case of pneumothorax in VP.

[Acute chest syndrome as the inaugural sign of sickle cell anemia. A case report and review of the literature]. / Syndrome thoracique aigu révélateur d'une drépanocytose. A propos d'un cas avec revue de la littérature.

Acute chest syndrome is a frequent complication of sickle cell disease. This syndrome is characterized by recent infiltrate on chest X-ray with chest pain or fever or dyspnea. We report the case of a 26-year-old man in whom an acute chest syndrome with fat embolism was the inaugural sign of sickle cell disease. This report illustrates the frequency of potentially serious fat embolism in the acute chest syndrome and the importance of bronchoscopy and bronchoalveolar lavage (fatty macrophages) for determining the etiology of acute chest syndrome.

[Asthma and atmospheric pollution]. / Asthme et pollution atmosphérique.

Alteration of the air we breathe, due mainly to the transformation of the environment by mankind, is a increasing cause of concern for physicians, public health deciders and government agencies responsible for environmental protection. Modifications of air composition have a proven harmful effect on health and provoke predominantly respiratory symptoms. Asthma is considered as a disease resulting from complex interactions between genetic and environmental factors. Since asthma-related morbidity and mortality have risen constantly over the past decades, many studies were conducted to identify and evaluate the factors responsible for the onset and/or aggravation of the underlying inflammation. Various atmospheric toxic compounds appear to be responsible, and some experts think that asthmatics are excellent indicators for atmospheric pollution and its intensity. Doses and conditions of experimental exposure are however often quite different from real population exposure, implicating very critical evaluation of demonstrated effects and extreme prudence when extrapolating results.

A five-year study of the incidence of insulin-dependent diabetes mellitus in young Tunisians (preliminary results).

Three Tunisian districts were selected to estimate the incidence of insulin-dependent diabetes mellitus (IDDM): Beja, Monastir and Gafsa. A population-based registry for new cases of IDDM was established in 1990 in these three areas according to WHO DIAMOND project methodology. A local extension of the protocol consisted in the inclusion of children up to 19 years of age. Children with a diagnosis of IDDM discharged from general hospitals and private clinics in these areas were recorded in the corresponding registry. A secondary source of case ascertainment was provided by regional school health centers. The findings of the five-year study showed that 156 cases of IDDM were recorded among children aged 0 to 19 years in the three regions. The degree of ascertainment was estimated at 96%. The global age-adjusted incidence rates were 6.76.100,000(-1) year-1 and 6.95.100,000(-1).year-1 in the 0 to 14- and 0 to 19-year age-groups respectively. Age-adjusted incidence rates were lower in Monastir than in Beja and Gafsa, respectively 4.69, 8.13 and 8.33.100,000(-1).year-1 for subjects aged 0 to 19 years. Incidence rates showed no significant difference by gender but were lower in the 0 to 4- and higher in the 10 to 14-year age groups. No time trend was detected. Sixty-two percent of all cases were diagnosed in the cold season. The incidence rate of IDDM in Tunisia is thus close to that observed in most Mediterranean countries.