[Acute pericarditis associated with Plasmodium ovale malaria]. / Péricardite aiguë associée a un accès palustre de reviviscence a Plasmodium ovale.

The purpose of this report is to describe a rare case of benign acute pericarditis associated with recurrent Plasmodium ovale malaria. It was observed in a 33-year-old soldier who was stationed in Djibouti after serving several previous stints in West Africa. A favorable clinical outcome was achieved using chloroquin (30 mg/kg on 6 days) in association with NSAID followed by salicylates for one month. Re-examination at one year showed no recurrence. This case shows that Plasmodium ovale malaria must be considered as a potential etiology for acute benign pericarditis in patients with a history of travel to endemic countries.

[Morbidity and mortality after intensive care management of hemorrhagic stroke in Djibouti]. / Morbi-mortalité des accidents vasculaires cérébraux hémorragiques après prise en charge en réanimation a Djibouti.

Prospective data on management and outcome of stroke in Africa is scarce. The purpose of this prospective descriptive study is to present epidemiologic, clinical and outcome data for a series of patients with hemorrhagic stroke in Djibouti. All patients admitted to the intensive care unit of the Bouffard Medical-Surgical Center in Djibouti for cerebral hemorrhage documented by CT-scan of the brain were recruited in this study. A total of 18 patients including 16 men were enrolled. The median patient age in this series was 51.5 years [range, 20-72]. The median duration of intensive care was 3 days [range, 1-38]. Mean Glasgow score at time of admission was 9 [range, 3-14]. Five patients were brought in by emergency medical airlift. The main risk factors for stroke were arterial hypertension, smoking, and regular khat use. Mechanical ventilation was performed in 10 patients with a survival rate of 40%. Six patients (33%) died in the intensive care unit. Hospital mortality within one month was 39% and mortality at 6 months was 44.4%. One-year survival for patients with a Glasgow score < or = 7 at the time of admission was 33%. Arterial hypertension, khat use, and smoking appeared to be major risk factors for male Djiboutians. Neurologic intensive care techniques provided hospital mortality rates similar to those reported in hospitals located in Western countries. Functional outcome in local survivors appeared to be good despite the absence of functional intensive care. These data argue against the passive, fatalistic approach to management of hemorrhagic stroke and for primary prevention of cardiovascular risk factors.

[Pleuro-pulmonary manifestations disclosing hepatic amoebiasis]. / Manifestations pleuropulmonaires révélatrices de l'amibiase hépatique.

During a mission in ex-Yugoslavia between 2001 and 2004, three French soldiers were sent home because of right pneumopathy, right pleurisy after appendicectomy, haemoptysis and liver haematoma, respectively. They previously were stationed in Africa and/or South America. The initial diagnosis was quickly modified: pleuropulmonary manifestations of amoebic hepatic abscess in two cases, and pleuropulmonary amoebiasis in the last case. The outcome was favourable with standard anti-amoebic treatment. The reports illustrate the possibility of hepatic amoebiasis with local pleuropulmonary manifestations and an exceptional case of pleuropulmonary amoebiasis with hepatobronchial fistula. The authors report this experience because it demonstrates that amoebiasis in European countries remains an often forgotten diagnosis. Although known for a long time in developing countries, amoebiasis in the military or in tourists should be systematically considered.

[Celiac disease: special features in Africa. Description of 8 cases in Djibouti (horn of Africa)]. / Maladie coeliaque: particularités africaines. A propos de 8 cas à Djibouti.

Celiac disease is poorly documented in intertropical Africa. The purpose of this retrospective report was to describe 8 cases observed at the Groupement Medico-Chirurgical of Bouffard Hospital in Djibouti (Horn of Africa) between January 2003 and January 2006. There were 5 females and 3 males ranging in age from 9 months to 17 years old (mean age: 48 months). Six patients were of Somali ethnic origin and two of Yemenite ethnic origin. Six were classified as middle class and 2 as lower class. All forms were symptomatic associating constant loss of weight with digestive manifestations (diarrhoea and vomiting). Diagnosis of celiac disease was based on the presence of anti-gliadin antibodies IgA and IgG associated with anti-endomysium or anti-transglutaminase antibodies that were measured in six and two cases respectively. Gastroduodenal endoscopy performed in three cases including two with duodenal biopsy demonstrated villous atrophy associated with gross of intra-epithelial lymphocytosis. A gluten-free diet initiated in five patients led to clinical improvement in four cases with a follow-up of 8.25 months. The findings of this study in Djibouti show that celiac disease exists in intertropical Africa. Its presentation is quite similar to elsewhere but diagnosis is more difficult due to poor knowledge about the disease and limited diagnostic facilities. Favourable response to presumptive treatment by a gluten-free diet is an alternative for diagnosis especially in Djibouti where eating habits differ from those in industrialized countries and this type of diet is easier to follow.

[Asbestos in the National Navy: Employment-exposure matrix]. / L'Amiante dans la Marine nationale : matrice emploi-exposition.

INTRODUCTION: The odd risk ratio for an asbestos-related disease is 6.9 for National Defense personnel and 94% of the victims who are compensated belong to the French Navy. While employment-exposure matrices exist for the civilian environment, none are available to the military. Our work consists of the creation of the first employment-exposure matrix in the French Navy, in order to optimize post-occupational medical surveillance. METHOD: We conducted a bibliographic search for asbestos in naval repair, naval embarking and foreign navies. From databases such as Medline, Pubmed, we used the following keywords "Navy", "Asbestos", "Shypyard" and "Military" and we have extended ourselves to the registers of existing theses on the subject. RESULTS: Epidemiological and bibliographic data confirm the increased risk in the French Navy. Three variables are important in the proposal of this employment-exposure matrix: employment, year of arming the ship and duration of embarkation. There is a major risk for personnel whose work is in direct contact with asbestos, in particular machine personnel, irrespective of their duration of exposure. For embarked personnel who do not have direct contact with asbestos in their jobs, the increase in risk depends essentially on the ship's year of arming and the presence of asbestos, whether or not on board, as well as the duration of exposure of seafarers. CONCLUSION: These results allow us to recommend a classification of the risk in accordance with the recommendations of the French Health Authority and to propose an adequate post-professional follow-up for the personnel of the Navy.

[Cannabis "bong": A frequent, original and dangerous way of consumption]. / Le « bang ¼ de cannabis, un mode de consommation original, fréquent et dangereux.

The bong is a water pipe craft, used to smoke tobacco or cannabis. The benefit of consuming cannabis as a "bang" is based on the intensity and speed of the effect. The cannabis intoxication can then be associated with disorders of sensory functions, the type of distortion of perceptions or hallucinations, often accompanied by intense anxiety. Bong cannabis consumption appears to be responsible for specific side effects (especially hemoptysis), possibly related to the importance of inhalation of products of combustion of cannabis and combustion of plastic parts used in its manufacture.

[Spinal cord compression from a malignant pleural mesothelioma]. / Compression médullaire par extension intra-canalaire d'un mésothéliome pleural malin.

Thoracoscopy-talc led to the diagnosis of epithelial pleural mesothelioma in a 58-year-old man who presented with pleurisy. The course was rapidly unfavorable despite systemic chemotherapy. Dorsal pain revealed invasion of the spine and spinal canal leading to cord compression three months after the diagnosis of mesothelioma.

[Pseudotumoral presentation of American pulmonary histioplasmosis]. / Présentation pseudo-tumorale de l'histoplasmose pulmonaire américaine.

In France, American pulmonary histoplasmosis is an imported deep mycosis, caused by inhalation of Histoplasma capsulatum. Clinical and radiological features of this exotic disease are multiple, simulating tuberculosis or cancer. We report two cases of American histoplasmosis with pseudo-tumoral form, in immunocompetent subjects working in Venezuela, with a multinodular pulmonary presentation.

[Practical conduct for patients with a lonely hypoxemia at rest or during exercise]. / Démarche diagnostique d'une hypoxémie « nue ¼ de l'adulte.

INTRODUCTION: Hypoxemia is a decrease in blood oxygen partial pressure. This work aims at presenting a practical conduct for patients with a lonely hypoxemia at rest or during exercise, defined by the absence of dyspnea at rest, obvious clinical or radiographic abnormality. STATE OF THE ART: Diagnostic tools available to the clinician are clinical examination, CT scan, echocardiography, hyperoxia test, trans cranial ultrasound and lung scintigraphy. This work proposes a practical diagnostic approach, with a main role of chest CT. PERSPECTIVES: Work is underway to determine more precisely the place of echocardiography for the diagnosis of intra or extra cardiac shunts. CONCLUSIONS: The finding of a lonely hypoxemia requires careful diagnostic approach to quickly rule out potentially serious causes and not to disregard the rare causes.

[Positron emission tomography in thoracic radiography]. / Apport de la tomographie par émission de positons à la radiothérapie thoracique.

The optimisation of the field of irradiation is the aim of the radiotherapist. Pet-Scan provides information revealing a better cartography of node involvement and allowing a better delineation of the tumour zone. In the follow-up of irradiated patients, PET-Scan provides information on the nature of residual lesions and a possible recurrence.

[Interest in 18-FDG positron emission tomography in radiotherapy planning: example of lung cancer radiotherapy]. / Intérêt de la tomographie à émission de positons au 18fluoro-déoxy-glucose dans la définition des champs de radiothérapie: exemple de la radiothérapie thoracique.

18 FDG positon emission tomography provides metabolic images and allows better local and metastatic staging than radiologic methods. A best cartography of node involvement and a best delineation of the tumor zone should allow an optimal radiotherapy. Lung cancer is a good example of the interest of this new method.

[Loeffer's syndrome: is Taenia responsible?]. / Syndrome de Loeffler: responsabilité du Taenia?

Taenia saginata is a parasite of the gastrointestinal tract which is often encountered in France. Its responsibility in the occurrence of pulmonary eosinophilic infiltrates is only exceptionally suspected. We report a case of Loeffler's syndrome most probably caused by Taenia saginata. This case illustrates the diagnostic problems encountered to determine the responsibility of this cestode.

[Laryngeal disorder revealing unrecognized pulmonary tuberculosis]. / Atteinte laryngée révélatrice d'une tuberculose pulmonaire méconnue.

Laryngeal tuberculosis is exceptional and identification in this localization can reveal clinically unrecognized pulmonary tuberculosis. We report two cases illustrating this situation. The pseudo-tumor aspect observed at endoscopy may be wrongly suggestive of neoplasia. Bacteriological examination provides the diagnosis. New methods of genomic diagnosis (Gen-Probe) and culture now allow particularly rapid diagnosis. Outcome is always favorable with standard anti-tuberculosis treatment.

[Parasitic eosinophilic lungs]. / Les poumons éosinophiles parasitaires.

The eosinophilic lung is a term used to identify a heterogeneous group of parasitic diseases leading to common manifestations including alveolar or tissular pulmonary eosinophilia and, classically, radiological visible lesions of the lung. The different clinical presentations--Löffler's syndrome, larva migrans syndrome and tropical pulmonary eosinophilia are analyzed in this article and the particular features of the different causal parasites are discussed. Positive and differential diagnostic procedures in patients with pulmonary eosinophilia due to mycoses, drugs, vasculitis or an unknown cause are detailed.

[Evaluation of preoperative non-invasive ventilation in thoracic surgery for lung cancer: the preOVNI study GFPC 12-01]. / Évaluation de la ventilation non invasive préopératoire avant chirurgie de résection pulmonaire. Étude préOVNI GFPC 12-01.

BACKGROUND: Surgical resection is the best treatment for stage I and II non-small cell lung cancer. Despite an improvement in the perioperative management of cancer patients and specialization of surgical teams, morbidity and mortality remains significant. Non-invasive ventilation (NIV) is an effective therapeutic option in hypercapnic respiratory failure. It also improves functional and gasometric parameters when undertaken before surgery. The objective of the preOVNI study is to demonstrate that preoperative non-invasive ventilation for 7 days, at home, reduces the postoperative respiratory and cardiovascular complications of lung resection surgery, in a high-risk population. METHODS: A prospective, randomized, controlled open-labelled multicentric French study, under the supervision of the Groupe Français de Pneumocancérologie (GFPC), comparing 7 days of preoperative non-invasive ventilation with standard treatment. Inclusion criteria are: patients suitable for lobectomy or segmentectomy for primary bronchial carcinoma and presenting with obstructive or restrictive lung disease, obesity or chronic cardiac insufficiency. The primary criterion is a composite one, including all respiratory and cardiac complications. The number of patients is 150 in each treatment arm, 300 in total. EXPECTED RESULTS: We think that preoperative NIV will be able to reduce the rate of postoperative complications. If this objective is achieved, the management of these patients could be changed.

[Pulmonary sarcomatoid carcinoma: Clinical and prognostic characteristics, a case report]. / Particularités cliniques et évolutives des carcinomes sarcomatoïdes du poumon: à propos d'un cas.

Sarcomatoid carcinoma is a rare malignancy in the family of non-small-cell lung cancer. They belong to a mixed group of poorly differenciated neoplasia, including sarcomatous cells or sarcomatoid-like cells with giant or spindle cells. We report the case of a 69-year-old man with sarcomatoid carcinoma. We describe the main characteristics of these tumors. Diagnosis is frequently delayed and lesions are locally advanced. The prognostic is poorer than other non-small-cell lung cancer. Chemotherapy is often not efficient.

[Acute cardiac failure due to itraconazole]. / Insuffisance cardiaque aiguë sous itraconazole: une complication prévisible ?

INTRODUCTION: Itraconazole is an azole derivative used for the treatment of aspergillosis. Cardiac failure is a rare complication of treatment. Most cases occur in patients with cardiovascular risk factors, or taking multiple medications, and a causal relationship is not well-established. CASE REPORT: We report the case of a patient, without cardiovascular risk factors, presenting with cardiac failure during treatment with itraconazole. Pre-treatment stress testing and echocardiography were normal. Resolution was complete without sequelae. CONCLUSION: Cardiac failure can occur in association with itraconazole despite normal cardiological investigations before treatment.

[Fatal alveolar haemorrhage following a "bang" of cannabis]. / Hémorragie alvéolaire fatale après bang de cannabis.

The new methods of cannabis consumption (home made water pipe or "bang") may be responsible for fatal respiratory complications. We present a case, with fatal outcome, of a man of 19 years with no previous history other than an addiction to cannabis using "bang". He was admitted to intensive care with acute dyspnoea. A CT scan showed bilateral, diffuse alveolar shadowing. He was anaemic with an Hb of 9.3g/l. Bronchoalveolar lavage revealed massive alveolar haemorrhage. Investigations for infection and immunological disorder were negative and toxicology was negative except for cannabis. Antibiotic treatment was given and favourable progress allowed early discharge. Death occurred 15 days later due to alveolar haemorrhage following a further "bang" of cannabis. Autopsy showed toxic alveolar haemorrhage. The probable mechanism is pulmonary damage due to acid anhydrides released by the incomplete combustion of cannabis in contact with plastic. These acids have a double effect on the lungs: a direct toxicity with severe inflammation of the mucosa leading to alveolar haemorrhage and subsequently the acid anhydrides may lead to the syndrome of intra-alveolar haemorrhage and anaemia described in occupational lung diseases by Herbert in Oxford in 1979. It manifests itself by haemoptysis and intravascular haemolysis. We draw attention to the extremely serious potential consequences of new methods of using cannabis, particularly the use of "bang" in homemade plastic materials.

[Cannabis and myocardial infarction without angiographic stenosis in young patient: guilty or not guilty? A case report]. / Cannabis et infarctus du myocarde du sujet jeune : association fortuite ? À propos d'une observation.

Cannabis is the most consumed drug in France, particularly in young adults. Few reports have suggested a causal role of cannabis in the development of cardiovascular events. We describe one case of 26-year-old man, cannabis and tobacco smoker, admitted with recurrent ischemic stroke cause by post-myocardial infarction left ventricular thrombus. Coronary arteries were angiographicaly normal and etiological tests were negative. We suggest the possible relationship between marijuana use with coronary heart disease.