[Nutritional status and dietary intake in patients with chonic obstructive pulmonary disease]. / Apports nutritionnels et état nutritionnel au cours de la broncho-pneumopathie chronique obstructive.

INTRODUCTION: Undernutrition is a predictor of mortality in chronic obstructive pulmonary disease (COPD). The objectives of our study were to assess nutritional intake in COPD and to study its relationship with disease severity. METHODS: A cross-sectional study that included 66 patients followed for COPD. Patients included had a body composition study and a respiratory and nutritional assessment. RESULTS: The mean age of the population was 66±9 years. The lean body mass index (LMI) was reduced in 26.1% of patients. It was significantly associated with the GOLD group (P=0.04) and significantly correlated with the forced expiratory volume in the first second (FEV1) (P=0.02) and the distance covered during the six-minute walk test (TM6) (P=0.01). A significant difference was found between the caloric intakes and the different GOLD groups (P=0.04). Mean intakes of calories (P=0.002; r=0.07), protein (P=0.01; r=0.16), carbohydrates (P=0.02; r=0.2) and iron (P=0.01; r=0.13) were significantly correlated with the TM6 results. Caloric intake was significantly correlated with LMI (P=0.01; r=0.16), body mass index (P=0.04; r=0.12), FEV1 (P=0.04; r=-0.12) and GOLD stage (0.002). Similarly, protein intake was significantly correlated with LMI (P=0.001; r=0.11), body mass index (P=0.02; r=0.16), FEV1(%) (P=0.001; r=-0.16) and GOLD stage (P=0.002). CONCLUSION: Undernutrition in COPD is caused by decreased food intake and increased resting energy expenditure. Adequate intakes of glucose, protein, fibers, vitamins and zinc are associated with improved ventilatory function.

Fast Stent Retrieval during Mechanical Thrombectomy Improves Recanalization in Patients with the Negative Susceptibility Vessel Sign.

BACKGROUND AND PURPOSE: In acute ischemic stroke, the negative susceptibility vessel sign on T2*-weighted images traditionally highlights fibrin-rich clots, which are particularly challenging to remove. In vitro, fast stent retrieval improves fibrin-rich clot extraction. We aimed to evaluate whether the speed of stent retrieval influences the recanalization and clinical outcome of patients presenting with the negative susceptibility vessel sign. MATERIALS AND METHODS: Patients were identified from a registry of patients with ischemic stroke receiving mechanical thrombectomy between January 2016 and January 2020. Inclusion criteria were the following: 1) acute ischemic stroke caused by an isolated occlusion of the anterior circulation involving the MCA (Internal Carotid Artery-L, M1, M2) within 8 hours of symptom onset; 2) a negative susceptibility vessel sign on prethrombectomy T2*-weighted images; and 3) treatment with a combined technique (stent retriever + contact aspiration). Patients were dichotomized according to retrieval speed (fast versus slow). The primary outcome was the first-pass recanalization rate. RESULTS: Of 68 patients who met inclusion criteria, 31 (45.6%) were treated with fast retrieval. Patients receiving a fast retrieval had greater odds of first-pass complete (relative risk and 95% confidence interval [RR 95% CI], 4.30 [1.80-10.24]), near-complete (RR 95% CI, 3.24 [1.57-6.68]), and successful (RR 95% CI, 2.60 [1.53-4.43]) recanalization as well as greater odds of final complete (RR 95% CI, 4.18 [1.93-9.04]), near-complete (RR 95% CI, 2.75 [1.55-4.85]), and successful (RR 95% CI, 1.52 [1.14-2.03]) recanalization. No significant statistical differences in procedure-related serious adverse events, distal embolization, or symptomatic intracranial hemorrhage were reported. No differences were noted in terms of functional independence (RR 95% CI, 1.01 [0.53-1.93]) and all-cause mortality (RR 95% CI, 0.90 [0.35-2.30]) at 90 days. CONCLUSIONS: A fast stent retrieval during mechanical thrombectomy is safe and improves the retrieval of clots with the negative susceptibility vessel sign.

[Testosterone and chronic obstructive pulmonary disease]. / Testostéronémie et bronchopneumopathie chronique obstructive.

INTRODUCTION: Testosterone level has been shown to be associated with respiratory function and loss of lean body mass in patients with chronic obstructive pulmonary disease (COPD). The aim of this study was to assess the relationship between testosterone level and functional respiratory parameters during COPD. METHODS: We conducted a cross-sectional study that included 95 male patients with stable COPD. Functional tests (body plethysmography, six-minute walk test (6MWT), arterial blood gas) were performed in all patients and serum levels of testosterone, prolactin, FSH, LH and C-reactive protein were determined. Lean body mass was measured using bioelectric impedance. RESULTS: The average age was 63.78±8.90years. COPD was classified as stage 3 in 38% of cases and stage 4 in 11% of cases, group C in 10% of cases and group D in 18% of cases. The average testosterone was 20.87±8.60nmol/L. A significant positive correlation was found between FEV1 (P=0.005), FVC (P=0.005), FEV1/FVC ratio (P=0.001), lean mass index (P=0.021), and testosterone. However, testosterone was not correlated with 6MWT or blood gas parameters. Similarly, it was not correlated with FSH, LH, prolactin and C-reactive protein. CONCLUSION: This study found that serum testosterone level was associated with lung function and lean mass during COPD. Further investigations are required to better evaluate the relationship between COPD and serum testosterone levels and the effect of androgen substitution in lung function.

[Assessment of insomnia among Tunisian patients with lung cancer]. / Évaluation de l'insomnie chez les patients tunisiens atteints de cancers bronchopulmonaires primitifs.

INTRODUCTION: Sleep disorders are relatively common in oncology. However, they have not been well studied and are often treated insufficiently. AIM: To assess the prevalence and severity of insomnia in lung cancer patients and evaluate the relationship between insomnia and certain clinical parameters. METHODS: A cross-sectional study was undertaken of patients in Tunis with primary lung cancer. Socio-demographic and clinical data were obtained from the medical records Patients were then asked to answer questionnaires related to insomnia (ISI), depression-anxiety (HAD) and quality of life (QLQ-C30). RESULTS: Fifty patients with lung cancer were included (46 men, 4 women). The average age was 59±9 years. Insomnia was found in 24 patients (48%) and 60% of patients had depression. HAD was significantly higher in the insomniac patients (21.54±8.96 vs. 9.81±5.28, P<0.0001). Similarly, the QLQ-C30 was significantly lower in these patients (41.24±12.55 vs. 56±16.88, P<0.01). ISI was significantly correlated with HAD and QLQ-C30. CONCLUSION: Insomnia is common in patients with lung cancer. It is responsible for impaired quality of life and psychological distress. Diagnosis and management of insomnia in patients with lung cancer is therefore mandatory.

[Home non-invasive ventilation for chronic obstructive pulmonary disease]. / Ventilation non invasive à domicile au cours de la broncho-pneumopathie chronique obstructive.

INTRODUCTION: The benefits of long-term non-invasive ventilation (NIV) in the management of chronic obstructive pulmonary disease (COPD) patients remain controversial. AIM: To analyze the characteristics of COPD patients under home NIV and to evaluate its impact among this population. METHODS: We carried out a retrospective study between January 2002 and April 2016 of COPD patients under long-term NIV at "la Rabta" and the Military Hospital. RESULTS: There were 27 patients with an average age of 64 and a sex ratio (M/F) of 0.92. Active smoking was reported in 96.3%. A persistent hypercapnia following an acute exacerbation of COPD with failure to wean the NIV was the main indication of long-term NIV. We noted a reduction in hospital admissions in the first year of 60% and in intensive care of 83.3% (P<10-3). There was no non-significant decrease of PaCO2 (4.5mmHg). There was no modification in FEV 1 and in FVC (P>0.05). The survival rate was 96.3% at 1 year, 83.3% at 2 years and a median survival of 24 months. CONCLUSIONS: Our study suggests that home NIV contributes to the stabilization of some COPD patients by reducing the hospitalizations rates for exacerbation. More prospective studies are needed to better assess the impact of NIV on survival and quality of life and to better define the COPD patients who require NIV.

[Acute respiratory failure as the sol inaugural sign of Arnold-Chiari malformation. Two cases]. / Insuffisance respiratoire aiguë isolée révélant une malformation d'Arnold-Chiari.

Arnold-Chiari malformation is an occipitocervical malformation where the cerebellar amygdales descend below the occipital foramen. Acute respiratory failure is an exceptional inaugural sign. We report two cases disclosed by alveolar hypoventilation associated with type I Arnold-Chiari malformation. The two patients age 51 and 52 years had an uneventful past history and presented with hypercapnic encephalopathy with acute respiratory failure requiring ventilatory assistance. Respiratory function tests, helicoidal thoracic computed tomographic angiography, electromyogram, cardiac echography, and thyroid and immunological tests were normal. Blood gases and polysomnography were in favor of central hypoventilation without sleep apnea. Magnetic resonance imaging demonstrated type I Arnold-Chiari malformation. The course was complicated by recurrent respiratory failure in both patients. Surgical decompression performed for the first patient provided no improvement. This patient died two months after surgery subsequent to aspiration pneumonia. The second patient was treated with continuous positive pressure noninvasive ventilatory assistance and had a good outcome at 25 months. These two cases illustrate the absence of any neurological sign, acute respiratory failure being the only sign of Arnold-Chiari malformation.

[Treatment of recurrent pulmonary tuberculosis]. / Traitement des récidives de tuberculose pulmonaire.

INTRODUCTION: Tuberculosis (TB) is a greatest public health problem of the world. This work aims to study the antituberculous treatment and the evolution of the patients with recurrent tuberculosis. PATIENTS AND METHOD: The study is a retrospective study on 64 patients with recidivant pulmonary TB: A1 group: at the first TB attack; A2 group: at the time of recidivant TB, and 105 controls patients with confirmed TB without recidive. RESULTS: Multidrug-resistant TB is more frequent with recidivant TB (21.1% vs 3%, P<0.05) and also extensively drug-resistant. Antituberculous treatment duration in group A1, A2 and T was respectively 8.63 months, 9.79 months, and 7.08 months. Antituberculous drug complications were more frequent in group A2 compared to group T (76.1% vs 41.2%; P<0.001). CONCLUSION: All tuberculous patients, specially recidivant TB, should benefit of particular care and drug protocol adaptation.

[Silicoproteinosis: a specific clinical and radiological entity]. / La silicoprotéinose : une entité radioclinique à part.

INTRODUCTION: Silicoproteinosis is a rare disease, which can cause the rapid onset of respiratory failure following massive exposure to silica dust. CASE REPORT: A 25-year-old patient presented with altered state and dyspnea. The diagnosis of military pulmonary tuberculosis was first considered and antituberculous treatment was started. The diagnosis was reconsidered due to a lack of improvement and the discovery of an 18-month history of exposure to silica. The patient had stopped work 6 months prior to hospitalization. High-resolution CT showed air space condensation associated to centrilobular nodules throughout the lungs and multiple mediastinal lymph nodes, suggesting sarcoidosis. Bronchoalveolar lavage (BAL) suggested the diagnosis of lipoproteinosis. Because of discordance between the bacteriological, radiological and the BAL results, a surgical lung biopsy was performed which led to the diagnoses of a secondary lipoproteinosis. The diagnosis of silicoproteinosis was then considered. Over a one-year follow up, the patient's respiratory failure has progressed markedly despite treatment with corticosteroids. CONCLUSION: Silicoproteinosis is a distinct pathological entity, the diagnosis of which depends on clinical and radiological features as well as BAL findings, which may avoid the need for more invasive investigations.

[Anaphylaxis due to chicken meat]. / Choc anaphylactique à la viande de poulet.

Acute anaphylaxis due to chicken meat is very rare; only a few cases have been reported in the literature. We report the case of a 13-year-old girl, with a past history of allergic urticaria due to eggs, who presented immediately after ingestion of lightly grilled chicken meat with facial edema, dysphonia, acute dyspnoea and a feeling of suffocation. A few months later, the patient developed asthma in the vicinity of poultry and after contact with chicken feathers.

[Pain and primary lung cancer in the elderly]. / Douleur et cancer bronchopulmonaire primitif du sujet âgé

The study of pain in elderly patients with a primary lung cancer (PLC) deserves special attention particularly because this symptom is frequently associated with the condition and influences the management and prognosis. To study the characteristics of pain due to PLC in the elderly, we prospectively evaluated pain in all patients aged over 65 years admitted for PLC. Thirty-nine elderly patients were enrolled in 15 months (62% of all PLC). The average age was 72 years. The cancer was advanced NSCLC in most cases. Pain was present in 74.3%. It was significantly less common among those over 75 years (50% versus 85.1%; P<0.05). The pain, mild in most cases, worsened during follow-up in 55.5%. The last mean visual analogue scale score was significantly lower than the first (1.3 versus 3.6; P=0.001). The pain treatment required was based on level I in 20.6%, level II in 48.2% and level III in 31% of cases. Pain management in the elderly should be early, adequate and continued in order to preserve to a maximum the quality of life of these patients with PLC.

[Diagnostic difficulty in bronchopulmonary tuberculous pseudotumor]. / Difficulté diagnostique de la tuberculose bronchopulmonaire pseudotumorale.

Pseudotumour is a rare presentation of bronchopulmonary tuberculosis, occurring in immunocompetent patients, which simulates lung cancer and may thus cause diagnostic difficulty. To assess the frequency and clinical features of tuberculous pseudotumour in immunocompetent patients, we analyzed all cases of pulmonary tuberculosis hospitalized in our department. Tuberculous pseudotumour was defined by the presence of a bronchial or pulmonary lesion suggestive of lung cancer. Over a period of 11 years, 12 cases of tuberculous pseudotumour were collected among 341 cases of pulmonary tuberculosis (3.5%). Mean age was 45 years. All patients were smokers. Symptoms were not specific and were dominated by cough and chest pain. Radiological investigations showed consolidation in five cases and a mass lesion in five cases. Fibreoptic bronchoscopy visualized a tumour in four cases and stenosing bronchial wall infiltration in one case. Mean delay to diagnosis was 47 days. The confirmation of tuberculosis was bacteriologic in only three cases but histological in the others (four bronchial biopsies, two transbronchial biopsies, one pleural biopsy, four surgical specimen). The positive diagnosis of tuberculous pseudotumour is difficult because the clinical and radiological presentation may closely mimic lung cancer, especially as the cases are usually smear negative, leading to a very late diagnosis.

[Invasive inflammatory pseudotumor of the lung]. / Pseudotumeur inflammatoire pulmonaire invasive.

Inflammatory pseudotumor of the lung is an uncommon nonneoplastic tumor of unknown origin. It can mimic lung carcinoma. We report a 65-year-old man who presented with productive cough, weight loss, and a heterogeneous right apical lung condensation. This clinical and radiographic presentation suggested a malignant lung tumor. Surgery was performed and the histological examination of the surgical specimen concluded to an inflammatory pseudotumor. A pneumonectomy was performed because of the tumor extension towards the lower lobe and the mediastinum. No recurrence was observed after a 2-year follow-up. Surgery is essential to confirm the diagnosis of inflammatory pseudotumor. Complete resection is the only guarantee to prevent recurrence.