[Multi-resistant tuberculosis at the hôpital d'instruction des armées de Libreville (Gabon) about 16 cases]. / Tuberculose multirésistante à l'hôpital d'instruction des armées de Libreville (Gabon) à propos de 16 cas.

According to WHO estimates, between 1 and 20% of tuberculosis cases in the world are multiresistant. In Gabon, this prevalence is estimated at 1.9%. In this forward-looking study from March 2006 to August 2010, we report 16 cases of multi-resistant tuberculosis out of 24 suspected resistant samples (persistence of the clinical and radiological signs after three months of well conducted treatment with first-line anti-tuberculous drugs). This study is realized in association with the laboratory of mycobacterium of the Percy military teaching hospital, Clamart, France.

[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.

[Lung cancer in Senegal]. / Le cancer bronchique au Sénégal.

In Africa the incidence of lung cancer is rising rapidly. The purpose of this prospective study was to analyze clinical, therapeutic, and prognostic features of lung cancer patients treated at the Principal Hospital in Dakar between 2002 and 2007. A total of 72 cases were compiled over the 5-year study period. In 88% of cases the patient was a male smoker with a mean age of 59.2 years. Histological samples were obtained in 79.1% of cases by bronchial fibroscopy (n=33), CT-guided transthoracic needle biopsy (n=17), or from a metastatic site (n=7). The histological diagnosis was squamous cell carcinoma in 23 cases, adenocarcinoma in 14, large-cell carcinoma in 17, small-cell lung cancer in 2, and bronchiolo-alveolar cancer in 1. Tumor staging demonstrated grades I-II in 6 cases, grade II in 17, and grade IV in 49. Symptomatic management was performed in 68% of patients. In the remaining cases management consisted of chemotherapy in 22 cases, radiotherapy for pain relief in 5, and surgery in 1. Ten patients were lost from follow-up. Median survival was 7 or 3 months depending on whether or not chemotherapy was performed. The much higher rate of histological diagnosis than in the sub-region is due mainly to the availability of trained personnel with access to bronchial endoscopy and CT-scan needle biopsy since September 2003. Administration of cytotoxins is feasible but the cost is excessive due to the lack of universal health care coverage: two-thirds of cases were abandoned whereas chemotherapy significantly improved median survival by 4 months (p < 0.0001). Prognosis of the disease is poor because management is undertaken at an advanced stage. Lung cancer is a health issue in Dakar, Senegal. It is urgent to develop therapeutic standards adapted to the African socio-economic setting as well as an anti-tobacco prevention policy.

[Spontaneous regression of hepatic and splenic involvements during sarcoidosis]. / Nodules hépato-spléniques d'évolution spontanément favorable au cours d'une sarcoïdose.

Splenic and hepatic involvements are frequent and usually clinically silent during systemic sarcoidosis. Imaging findings are extremely rare. We report hepatic and splenic nodules diagnosed on abdominal computed tomography with spontaneous regression.

[The problem of oxygen in developing countries]. / Le problème de l'ovoxygène dans les pays en voie de développement.

Availability of a reliable oxygen (O2) supply is critical for hospitals in developing countries. The AIDS pandemic that is associated with severe pulmonary infections has further enhanced this problem. Today in 2006, even though a number of financially viable solutions adapted to conditions in developing countries are available, lack of oxygen is still a cause of death in Africa including in some capital cities. Hospitals in industrial countries have wall outlets supplied from liquid O2 storage tanks (-183 degrees C). However this solution requires advanced cryogenic technology with storage as well as transportation of liquid O2. In developing countries, O2 is supplied from pressurized O2 cylinders (200 bars) sometimes stored in racks to supply wall outlets but more often moved from bed to bed as needed. This solution is expensive because of the cost of transportation on poor roads in all areas outside capital cities. Frequent supply shortages lead to major disruptions in care quality. Properly maintained O2 concentrators can provide a highly effective low-cost easy-to-use solution for health facilities in developing countries. The pressure swing adsorption (PSA) process based on reversible nitrogen adsorption is a reliable economical autonomous oxygen production process ideally suited to hospitals in developing countries. It can be used to supply wall outlets or fill cylinders. Return on investment is achieved within one to two years.

[Respiratory dysfunction in burned patients]. / Lésions respiratoires et brûlures.

INTRODUCTION: Smoke inhalation and respiratory complications are still the major causes of mortality in severely burned patients. STATE OF THE ART: The diagnosis is suspected clinically on the basis of history and physical examination and can be confirmed bronchoscopically. Respiratory failure in burned patients occurs through a number of associated mechanisms. Pneumonitis and adult respiratory distress syndrome (ARDS) are common early complications. New pulmonary treatments and advances in ventilation have reduced the incidence of both barotrauma and infectious complications. Tracheal stenosis can occur as a late complication of prolonged mechanical ventilation. PERSPECTIVES: Clinical and experimental studies have shown that damage to the mucosal barrier and the release of inflammatory mediators are the most important pathophysiological events following smoke inhalation. Manipulation of the inflammatory response following inhalation may be a treatment option in the distant future. CONCLUSION: Inhalation injury occurring in burned patients can produce severe respiratory and systemic complications.

[18-FDG positon emission tomography and distal metastasis from lung cancer]. / Tomographie à émission de positons au [18F]-FDG et métastases distales dans les cancers broncho-pulmonaires.

"Whole body" FDG-PET usually covers the body from the base of the skull to the upper third of the thighs, arms in abduction. Thus, the upper part of the head and the lower limbs are not included in the acquisition field. We report the cases of three patients with non-small-cell lung cancer who developed secondary distal localizations beyond the acquisition field of "whole body" FDG-PET. Lung cancer is known to favor hematogenic dissemination, raising the possibility of early distal metastasis. A pretherapeutic PET scan which includes the extremities can be useful to search for distal extension. These true whole body scans are time consuming and can thus limit machine availability. Furthermore, the diagnostic yield of this type of examination may be low since it can be estimated that about 1% of patients will develop isolated distal metastases (3 out of 293 patients in our series initially treated for non-metastatic non-small-cell lung cancer). In the current context of technical availability, systematic inclusion of the lower limbs in the PET scan acquisition field would not appear warranted for the initial work-up of patients with non-small-cell lung cancer. However, clinicians must be aware that distal metastases (brain, lower limbs) may not be detected.

[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.

[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.

[Osteochondroplastic tracheobronchopathy: 5 cases]. / Trachéobronchopathie ostéochondroplastique: cinq observations.

Five new cases of tracheobronchopathia osteochondroplastica (TBOCP) are reported and clinical, radiological and pathological features are reviewed. TBOCP is a rare disease characterized by cartilaginous and bony nodules lining the mucosa of the trachea and major bronchi. The endoscopic features realize pathological evolution by stadiums. The prognosis is usually favourable. The etiology of TBOCP remains unknown, even though some cases were reported in association with amyloidosis.

[Evaluation of the epidemic caused by the human immunodeficiency virus in Cambodia]. / Bilan de l'épidémie due au virus de l'immunodéficience humaine au Cambodge.

The infection by the human immunodeficiency virus is in the process of expanding to a dramatical level in South East Asia. At the moment, the few available datas on Cambodia are increasingly worrying, with a rate of seropositivity of prostitutes higher than 9% in 1992 and a clear progression of the rate of seropositivity of blood donors: 1.3% by the second quarter of 1993.

[Sarcoidosis and sarcoid reaction associated with Hodgkin's disease]. / Sarcoïdose et réaction sarcoïdosique associées à la maladie de Hodgkin.

The authors report a case of Hodgkin's disease associated with pulmonary and mediastinal sarcoidosis, and they recall the frequency of sarcoid reactions in lymphoma, notably in Hodgkin's disease. The Hodgkin's disease-sarcoidosis association is much less common and sometimes raises difficult diagnostic problems. The physiopathological mechanisms that are possibly involved are analyzed.

[Value of video-assisted thoracic surgery in internal medicine. Apropos of 7 cases]. / Intérêt de la chirurgie thoracique vidéoassistée en médecine interne. A propos de sept observations.

Since a few years, the medical thoracoscopy has already been used specially for the diagnostic and therapeutic taking up of the pleural pathology. Behind it, the video-assisted thoracic surgery has been improved since 1990. As a surgical technology, it proved its interest refering to the classical thoracotomy by lessening operative morbidity and mortality. The authors discuss its main indications about seven cases, recruted in the internal medicine service and operated in the thoracic surgery service of the Val-de-Grâce hospital. Some of these indications are now admited by most of the authors: 1) diagnostic aims: pulmonary biopsy in case of interstitial pathology, of pulmonary peripheral under-pleural nodule and sometimes of solid tumors of the mediastinum, specially of some lymph-nodes. 2) Therapeutic aims: the spontaneous pneumothorax treatment of the adult remains the most classical indication; the thoracic sympathectomy, the creation of pleuropericardial windows and the resection of benign tumors of the mediastinum are now well acknowledged indications.

[Spontaneous hematoma of the mediastinum]. / Hématome spontané du médiastin.

We report a case of spontaneous mediastinal haematoma. This unusual clinical entity, though uncommon, must be considered in any patient presenting with the typical triad of symptoms of acute superior mediastinal compression, widening of the superior mediastinum on chest radiographs, bruises on the neck appearing within 48 hours of exertion, sneezing, coughing or vomiting. The signs observed with computed tomography in mediastinal haemorrhage are described. The exact source of the haemorrhage remains unknown despite careful radiological investigation and thoracotomy.

[Thoracic nocardiasis associated with macrophage activation syndrome]. / Nocardiose thoracique associée à un syndrome d'activation macrophagique.

Nocardiasis is an uncommon bacterial disease often observed in immunodepressed patients. Its interactions with the immune system remain poorly known. We report a case of Nocardia asteroides thoracic nocaridiasis in an African subject who also had macrophage activation syndrome. We recall the classic data on nocardiasis in Africa and emphasize the importance of emergence in HIV-infected subjects. The association between nocardiasis and macrophage activation syndrome suggest a possible pathogenic mechanism involving the immune system (lymphocytes and macrophages) and Nocardia asteroides.

[Cancer of the testis, sarcoidosis and neurinoma]. / Cancer du testicule, sarcoïdose et neurinome.

The association of testicular cancer, sarcoidosis and neuroma is reported. Review of the literature revealed the rarity of the association of testicular cancer and sarcoidosis which is probably a chance association, but which is important in the context of staging, as overstaging may lead to useless or even dangerous treatment.

[Travel and chronic respiratory insufficiency]. / Le voyage de l'insuffisant respiratoire chronique.

Changes in climate, altitude and lifestyle during travel confronts patients presenting chronic respiratory insufficiency with special problems. A major challenge is related to high altitude during air travel. To limit risks, a preflight examination is necessary to ascertain respiratory status. Patients requiring oxygen therapy must ensure availability both during the flight and at the destination. Patients with asthma or chronic bronchitis must bring along a sufficient supply of usual inhalers. All patients should carry a doctor's letter describing their condition and listing medications. Using these elementary precautions, patients with chronic respiratory insufficiency can safely enjoy sightseeing and outdoor leisure activities.

[Clinical and therapeutic aspects of hepatic amebiasis in Cambodia]. / Aspects cliniques et thérapeutiques de l'amibiase hépatique au Cambodge.

Amoebic liver abscess is a common disease in developing countries. Although therapy is now perfectly standardized, errors and inaccuracies are frequent in daily practice. A study was performed at the Calmette Hospital in Phnom Penh (Cambodia) to evaluate and improve this situation. Diagnostic criteria and the outcome of treatment with oral or parenteral metronidazole were analyzed in 38 patients presenting amoebic liver abscess. Hepatalgia was observed in 100% of cases. Hyperleukocytosis and enhancement of the sedimentation rate occurred in 95% of cases. Diagnosis was confirmed by ultrasonography. Serodiagnosis, given its high cost, was not indispensable. Metronidazole was of comparable effectiveness and tolerance (90%) whether administered by the oral or parenteral route. The parenteral route should be used only for patents presenting digestive intolerance. Drainage of the abscess is necessary in cases characterized by immediate complications, abscesses with diameters greater than 120 mm and absence of improvement after 5 days of treatment.

[Severe pulmonary and meningeal cryptococcosis in an immunocompetent Cambodian]. / Cryptococcose grave, pulmonaire et méningée, chez un cambodgien non-immunodéprimé.

A chest x-ray showing a large tumor-like opacity in the left lower lobe and endoscopy visualizing a budding mass suggested a diagnosis of bronchial carcinoma in a 55-year old, tobacco-smoking Cambodian who consulted for hemoptysis and altered general status. Histological study of bronchial biopsies allowed differential diagnosis of cryptococcosis. Serologic tests for human immunodeficiency virus were negative and there was no other cause of immunodepression. Left lower lobectomy was performed at the German hospital of the APRONUC in Phnom Penh. Examination of the surgical specimen confirmed massive bronchopulmonary cryptococcosis. Two months after the procedure the patient was readmitted for neuromeningial cryptococcosis that responded well to fluconazole. Another relapse occurred 5 months later and was treated using the same drug. The patient is currently in remission. An increasingly common deep mycosis that is serious but curable with proper treatment, cryptococcosis deserves the full attention of physicians working in Cambodia where, as in other tropical zones, it is likely that this infection will progress with the incidence of AIDS. Symptoms can be misleading, suggesting neuromeningial or pulmonary tuberculosis. The value of India ink smear which should be performed in all patients presenting lymphocytic meningitis with hypoglycorrhachia must be emphasized. In the present case bronchoscopy was useful to distinguish from bronchopulmonary cancer.