The diagnostic value of the bronchoalveolar lavage in interstitial lung diseases.

OBJECTIVE: Bronchoalveolar lavage (BAL) is a diagnostic tool often used during the management of interstitial lung diseases (ILD). However, its diagnostic value in discrimination between entities comprising the very heterogenous group of ILD, is still a controversial issue. The objective of our study is to assess the diagnostic value of BAL in the management of ILD, by comparing the cytological findings in BAL fluid among the different diseases of this group. METHODS: It was a retrospective, observational study of 151 patients between January 2012 and December 2015. BAL fluid cytology was performed to analyse the distribution of leucocytes population subsets in patients with ILD. RESULTS: The mean age was 52.78 years; 74.83% were women. The analysis of the following main groups of diseases was performed : sarcoïdosis (n = 30), idiopathic pulmonary fibrosis (IPF; n = 22), other idiopathic interstitial pneumonia (non specific interstitial pneumonia, cryptogenic organising pneumonia and respiratory bronchiolitis interstitial lung disease; n = 20) and connective tissue disease (n = 14). Overall, out of 141 patients, 22% had sarcoïdosis, 15.6% had idiopathic pulmonary fibrosis (IPF), 14.18% had other idiopathic interstitial pneumonia (IIP) and 9.9% had connective tissue disease (CTD). Mixed alveolitis was common in the 4 groups, sarcoïdosis had higher proportion of lymphocytes and IPF had higher neutrophils count. However, there was no significant statistical difference of BAL cellular count among these diseases (p > 0.05). Also, the prevalence of studied diseases did not change with variation of BAL cellular count (p > 0.05). CONCLUSION: Alone, the BAL cytological analysis has a limited value to provide substantial information that could lead to discriminate between diseases that form ILD. Thus, it must be always associated with other diagnostic methods.

A Simplified Technique for Drainage of Chronic Calcified Pleural Empyema.

Chronic pleural pocket has well-known diagnosis and treatment principles since first described by Hippocrates 2,400 years ago. However, its treatment remains constant even though its causes, severity during management, and terrain vary considerably. In well-structured health care systems, posttuberculous empyema has become rare; its well-codified medical treatment relies on early diagnosis and adapted antibiotherapy, punctures/drainage, and appropriate intrapleural antifibrinolytics. In developing countries, a poor health organizational system increases the incidence of pleural pocket, which can progress until surgery is indicated. In such a context, the general principles of treatment include pleural decortication along with pulmonary resection. This technique remains difficult, risky, and, sometimes, impossible due to the chronicity of the lesion. In patients debilitated by several months of septic evolution, a simplified thoracostomy technique permits complete resection of the pocket.

How can I treat calcified chronic pleural empyema in African context: A case report.

INTRODUCTION AND IMPORTANCE: Despite the chance of a complete cure that surgery offers for patients seen early, the management of some complicated forms of chronic pyothorax with calcified pleural pockets of tuberculosis origin is risky, if not impossible. In these conditions, thoracomyoplasty with complete effacement of the pleural pocket is an effective alternative in the surgical management of these pockets. CASE PRESENTATION: We report the case of a 37-year-old male African Arab who was treated for a chronic, calcified pleural pocket of tuberculous origin and in whom low thoracomyoplasty was performed because of the impossibility of performing a left pleuropneumonectomy. The operating courses were uneventful with full pocket closures. REVIEW: 1 year later, the patient reported having resumed his active professional life. CLINICAL DISCUSSION: Pleural decortication associated or not with a pulmonary resection is the main surgical procedure used to manage chronic pyothorax. However, this procedure remains difficult with the risk of death, if not impossible, in cases of long-term chronicity with calcification of the pleural poche wall. In these cases, thoracomyoplasty constitutes a viable alternative in the surgical management of these pleural pockets. CONCLUSION: In the context of tuberculosis and chronic pleural empyema, thoracomyoplasty can be an alternative with satisfactory results when performed by an experienced team using this technique.

Outcomes after Thymectomy in Patients with Thymomatous Myasthenia Gravis.

Objectives This article describes the clinical outcomes after thymectomy in patients with thymomatous myasthenia gravis (T-MG) managed in the department of thoracic surgery of Hassan II University Hospital of Fez, Fez, Morocco. Materials and Methods We performed a retrospective analysis of medical records of 16 patients with T-MG between January 2009 and January 2017. Results There were 11 women and 5 men with a median age of 40 years at the thymectomy time and a median time of onset of symptoms to thymectomy of 12 months. At the preoperative evaluation (Myasthenia Gravis Foundation of America [MGFA] clinical classification), 7 patients were class II, 7 class III, and 2 class IV. Nine patients were in Masaoka stage I, and the remaining 7 patients stage II. We recorded one case of postoperative myasthenic crisis. At 3 years of follow-up after thymectomy, 6 patients had complete stable remission and the other 10 patients improved. Of these patients with clinical improvement, 6 patients were in MGFA class I and the remaining 4 patients class II. Conclusion The present study shows the beneficial effect of thymectomy in patients with T-MG. Postoperative clinical outcomes seem to be better when the preoperative severity of myasthenic symptoms is mild (MGFA class II).

The value of intraoperative parathyroid hormone assay in the surgery of mediastinal ectopic parathyroid adenoma (A case series).

BACKGROUND AND AIMS: Ectopic parathyroid adenoma is a rare entity. Its clinical management is challenging due to varying locations in the mediastinum. The aim of our study is to report our experience about the preoperative localization of the ectopic parathyroid adenoma and to emphasize the major role of the intraoperative parathyroid hormone assay in such circumstances. METHODS: It is a monocentric, retrospective study about patients diagnosed with EPA (ectopic parathyroid adenoma) from January 2015 to December 2016. Clinical aspects, preoperative management as well as the surgical procedures have been analyzed. RESULTS: There were 7 women, with an average age of 59.14 years. Six patients presented with biological disorders of the phosphocalcic metabolism such as spontaneous bone fracture and recurrent renal lithiasis. In one case, EPA was discovered in the setting of malignant hypercalcemia. The topographic preoperative assessment with a cervicothoracic CT (computed tomography) showed spontaneously hyperdense tissular masses of variable localizations in the mediastinum. A Tc-99 m (99mTc - MIBI) scintigraphy was performed in 5 patients and showed uptake in all cases. We performed cervicotomy in 1 case, manubriotomy in 2 patients, neck manubriotomy in 2 cases, total vertical sternotomy in 1 case, and posterolateral thoracotomy in 1 patient. The lesion was localized in the mediastinum in 1 patient in the perithymic fat in 1 case; EPA was laterotracheal in 1 case, retro tracheal in 1 case, intra-thymic in 2 cases, inter-jugulo-carotidian with contact with the left subclavial artery in 1 case, and anterior mediastinal in 1 patient. The 1-h after-parathormonemia following removal of the surgical specimens showed a decrease value of 45 and 80% of the baseline value. No surgical morbidity was noted after an average follow-up of 7.9 months (range of 5-18 months). CONCLUSION: The preoperative topographic diagnosis of ectopic parathyroid adenoma is challenging for the surgeon despite progress in the morphological assessment. The intraoperative parathyroid hormone assay is a valuable tool for an appropriate surgical management.

How thoracic surgeon manage tracheal tumors in African country? (Case series).

INTRODUCTION: Tracheal tumors are a rare pathological entity whose diagnosis is usually delayed by clinical latency. Surgery, which consists of a tracheal resection-anastomosis with or without reconstructive reconstruction, remains the treatment that ensures the best long-term survival. METHODS: This is a retrospective study about 8 patients admitted in the department of thoracic surgery of Hassan II's university hospital of Fes for tracheal tumors management during 7 years time (December 2010 to December 2017). RESULTS: There were 6 men and 2 women with an average age of 44.4 years ranged from 17 to 65 years, 4 were smokers. Dyspnea was the main trigger sign. Seven (7) have undergone bronchial fibroscopy diagnostic with a finding of budding process in 5 patients, the middle of the trachea is often concerned in 3 patients, obstructing the lumen of the trachea in almost all patients. The treatment in all patients was surgical with an intubation via the operative field, 4 trachea resection-anastomosis, 4 plasty (Lateral resection with V plasty, Kergin's plasty, Mattey's tracheobronchial anastomosis and widened V-resection to the carina). The most common histological type in our series was Adenoid Cystic Carcinoma in 2 of our patients. For the other patients we have found squamous cell carcinoma (1 case), adenocarcinoma (1 case), atypical carcinoid tumor (1 case), low grade mucoepidermoid carcinoma (1 case), an adenoma pleomorph (1 case) and endotracheal goiter (1 case). The operative follow-up was simple in 7 of our patients, all of whom underwent post-operative fibroscopy within an average of 9 days. Two cases of post-operative recurrent palsy had been observed, all of which had progressed well under treatment. We have noted 2 deaths, including one at day 4 post-operative, and the other died from complications of post-radiation tracheal stenosis. Back to 32 months' average follow-up, we have enregistered a case of a distant relapse by cervical lymph node metastasis in one patient, 5 years after surgery. CONCLUSION: Primary tumors of the trachea remain of reserved prognosis with 5-year survival of 57% of all histological types combined. Computed tomodensitometry and tracheobronchial fibroscopy remain the means of reference exploration in the diagnosis and assessment of surgical resectability.

An Unusual Mass of Posterior Mediastinum: A Case of Retrotracheal Parathyroid Adenoma Presenting With Primary Hyperparathyroidism.

Although parathyroid ectopy in the mediastinum has been the subject of several publications, its location in the posterior mediastinum is very rarely reported. We report a case of a 69-year-old patient who presented with clinical symptoms of malignant hypercalcemia due to a retrotracheal mediastinal parathyroid adenoma. The surgical excision leads to a quick normalisation of the phosphocalcic balance with improvement of the clinical symptoms. Ectopic hypersecreting parathyroid adenoma with life-threatening hypercalcemia should prompt radiological assessment and appropriate surgical management to prevent further clinical complications.

Surgical management of hydatid Bilio-bronchial fistula by exclusive thoracotomy.

In the industrialized countries, most of Bilio-bronchial fistula are secondary to hepatobiliary trauma, hepatic resection surgery or in the case of congenital malformation of the biliary tract, Bilio-bronchial fistula is recognized as the complication of a number of infectious pathologies such as hydatidosis and hepatic amoebiasis. Among the causes, the Bilio-bronchial fistula of hydatic origin is by far the most frequent especially in the zones of hydatid endemic as Morocco. It is a serious complication of liver hydatid cysts. The surgical management has long been believed to be difficult, and often associated with a very pejorative prognosis due to the simultaneous attack of the thoracic and abdominal stage through the diaphragm. This tripartite involvement reflects the difficulty of choosing the first approach between the thoracic, abdominal or a combination of both approaches. However, progress, especially in the possibility of carrying out adequate preoperative preparation with the increasing introduction of retrograde endoscopic cholangiography with sphincterotomy, has made possible this exclusive thoracotomy surgery with acceptable outcomes.

Thymic large cell neuroendocrine carcinoma - a rare and aggressive tumor: a case report.

BACKGROUND: Neuroendocrine tumors are a large group of tumors with a wide spectrum of behavior, affecting mainly the digestive system and the lung. The thymus is very rarely affected. CASE PRESENTATION: A 28-year-old Arab woman presented with chronic chest pain and dyspnea. A computed tomography scan showed a huge anterior mediastinal mass invading neighboring structures. A mediastinotomy was performed with biopsies of the mass. Pathological findings were consistent with a thymic large cell neuroendocrine carcinoma. CONCLUSIONS: The occurrence of a large cell neuroendocrine carcinoma in the thymus, especially in young people, is extremely rare. In this current report, we discuss the clinicopathological issues of this rare tumor according to recent literature data.