[Soft tissue metastasis revealing an asymptomatic bronchial adenocarcinoma]. / Métastase musculaire squelettique révélatrice d'un adénocarcinome bronchique.

Skeletal muscle metastases from non-small-cell lung cancer are uncommon. We report a case of lung adenocarcinoma disclosed by metastatic dissemination to a forearm muscle. A 46-year-old man consulted for a painful mass of the right forearm. Ultrasonography and computed tomography revealed a heterogeneous collection in the forearm invading the cortex of the humerus. An excisional biopsy of the right forearm showed an infiltration of the muscle with metastatic adenocarcinoma. Immunohistochemical patterns suggested the pulmonary origin. Chest x-ray was normal. Bronchoscopy revealed an endobronchial mass that was confirmed by biopsy to be an adenocarcinoma. The lung tumor was staged T2N0M1. The patient has received local radiation therapy and chemotherapy. After eighteen months, the disease progressed but without local muscular recurrence. Skeletal muscle metastases from lung cancer are rare and although their prognosis is poor, local treatment may be worthwhile.

[Primary pulmonary angiosarcoma]. / Angiosarcome pulmonaire primitif.

Pulmonary angiosarcoma is an uncommon vascular and usually secondary tumor. Only a few primary cases of pulmonary angiosarcoma have been described. We report a case of primary pulmonary angiosarcoma in an adult man who presented with hemoptysis. Chest x-ray film and chest CT showed a right para-cardiac opacity associated with diffuse alveolar consolidation of the right basal lobe. Right inferior lobectomy has been performed. Pulmonary angiosarcoma was diagnosed on histological and immuno-histochemical studies of the operative specimen. The primitive character was retained after ruling out all other tumor localizations. The clinical outcome was rapidly fatal. This observation is added to the other rare cases published of primitive pulmonary angiosarcoma. It confirms the poor prognosis and the extremely hemorrhagic nature of this tumor. Isolated necrotic parenchymatous mass was an original radiological pattern observed in this patient.

[Tuberculosis prevention]. / Prévention de la tuberculose.

UNLABELLED: Tuberculosis prevention is classically based on early detection of potential contagious cases and their effective treatment. But due to new parameters such as migration flows around the world, the emergence of Mycobacterium tuberculosis resistant strains and the increase of the population at risk, screening should be more active and target those who are more vulnerable to developing the disease. Traditional screening methods such as chest X-ray and tuberculin skin test, due to their high sensitivity and low cost, remain valid especially in populations with a high prevalence of the disease. The interferon-gamma release assays (IGRAs) seem to be very useful in immunodeficient patients with prior BCG vaccination. The treatment of subjects at high risk of developing active tuberculosis with a daily isoniazid self-administrated dosage for a period of 9 months is a prevention measure not only at the individual level but also at the collective one. All prevention interventions should be part of a national program concordant with the guidelines of the WHO Stop TB program that recommend a universal access to quality diagnosis and treatment focused on the patient. OUTLOOK: New methods of detection based on gene amplification would better suit to detect tuberculosis in immunodeficient patients and identify treatment-resistant strains. The development of the third part of the Stop TB project would reduce the morbidity and mortality of this disease by 2025. CONCLUSION: The prevention of tuberculosis has been a major epidemiological challenge around the world and is continuously improving to adapt to the evolving disease.

[Disseminated tuberculosis in non-immunocompromised host: three case reports]. / Tuberculose disséminée sur terrain non immunodéprimé: à propos de trois cas.

INTRODUCTION: Disseminated tuberculosis, i.e., tuberculosis involving lung, liver, spleen, bone marrow and lymph nodes is rare (2.8%), particularly when immunocompromised diathesis is lacking. EXEGESIS: We report three cases of disseminated tuberculosis confirmed by bacteriology or histology, which occurred in non-immunocompromised patients. Disease evolution under antituberculous treatment was favorable in two cases and fatal in the third one. CONCLUSION: Disseminated tuberculosis must be suspected when miliary pulmonary lesions are associated with hematologic abnormalities, even in non-immunocompromised host. Early treatment is mandatory to avoid fatal outcome.

[Bronchiectasis in a patient with ulcerative colitis]. / Bronchectasies chez un patient porteur d'une rectocolite ulcéro-hémorragique.

Bronchopulmonary involvement is uncommon in ulcerative colitis. Bronchiectasis is a rare manifestation of the disease. We report a case of a 65-year-old patient with ulcerative colitis in whom we diagnosed bronchiectasis. The evidence of a relationship between bronchiectasis and ulcerative colitis was established on the basis of 3 criteria: the late occurrence of bronchiectasis in a patient without pulmonary history, their appearance after the ulcerative colitis developed and their improvement after inhaled corticosteroid treatment. This observation points out that ulcerative colitis investigations should be extended to the respiratory structures. The respiratory involvement is not always concomitant with the bowel disease. This observation suggests the efficiency of the inhaled corticosteroids in this disease.

[Giant lobar emphysema. The cause of a compressive hemithoracic opacity in a newborn infant]. / Emphysème lobaire géant. Cause d'une opacité hémithoracique compressive chez le nouveau-né.

The authors describe a case of congenital lobar emphysema of the upper right pulmonary lobe discovered at birth with an opaque hemithorax and a shift of mediastinum. The diagnosis was confirmed by a CT-scan. A lobectomy was performed at 6 weeks of age. The different diagnosis and physiopathological mechanisms are discussed.

[Maximal ventilatory pressure through the mouth in adults: normal values and explanatory variables]. / Les pressions ventilatoires maximales à la bouche chez l'adulte: valeurs normales et variables explicatives.

Mouth pressure measured during maximal inspiratory or expiratory efforts depends on the force exerted by ventilatory muscles. Normal values and anthropometric factors accounting for maximal inspiratory and expiratory pressures (MIP, MEP) are not fully agreed upon to date. We measured MIP and MEP in 253 normal subjects (135 females and 118 males, age 15-59 years) using a digital transducer (163 Sibelmed). All subjects had normal forced vital capacity (FVC) and one second forced expiratory volume (FEV1). Sex, age, height and weight were recorded for all subjects and were entered as independent variables in computation of linear multiple regressions with MEP or MIP the dependent variables. MEP and MIP were greater in males than in females (p less than 0.01) with MIP lower than MEP in both sexes (p less than 0.01). In both males and females, FVC and FEV1 depend on age and height (p less than 0.01). In the entire group, we found a correlation of MIP in females and MEP in males with age (p less than 0.01) and of both MIP and MEP in females with weight (p less than 0.01). However, in subjects aged 20-59 years, there was no significant dependence of MIP and MEP on age, and when the weight of subjects was normal (n = 170), MIP and MEP were independent of weight. We conclude that in adults aged 20-59 years and with normal weight, maximal ventilatory pressures depend solely on sex. In this subgroup mean (+/- SD) values of MEP and MIP were 111 +/- 25 cmH2O and 79 +/- 19 cmH2O respectively in females and 192 +/- 42 cmH2O and 117 +/- 25 cmH2O in males.

[Ion transports across the respiratory epithelium]. / Les transports ioniques à travers l'épithélium respiratoire.

The electrolytes and water transport across the respiratory epithelium have aroused particular interest for 20 years ago, with regard to the essential role they play in the regulation of the bronchial mucus composition and volume. The development of new in vitro and in vivo, techniques, allow better knowledge of these transport systems and their regulation. Transport involves two main ionic movements: chloride secretion and sodium absorption by the epithelial cells, associated with parallel water movements. In cystic fibrosis, the modification of bronchial mucus results from a defective protein-kinase dependent regulation of chloride secretion. This defect blocks water and chloride secretion by the respiratory epithelium causing dehydration of the mucus.

[Measurement of nasal transepithelial potential difference: a diagnostic test for cystic fibrosis]. / Mesure de la différence de potentiel transépithélial nasal: un test diagnostique de la mucoviscidose.

Measurement of nasal transepithelial potential difference allows the exploration of transepithelial ionic transports in vivo. Cystic fibrosis is an interesting indication of this test. Indeed, this disease is characterized by a chloride and water secretion deficit across respiratory epithelium. We have measured nasal potential in 8 healthy volunteers. Measurements were repeated 3 times a day, during 3 days for each subject. The reproducibility of the data was analysed with factorial variance model. The mean nasal potential in the healthy volunteers group and in 10 patients with cystic fibrosis was compared. In the cystic fibrosis group, the nasal potential was measured 3 times with a 2 mn-interval between the measurements. No significant variation of the nasal potential values was found from day to day or in the same day from one measurement to another. Mean value was -19 +/- 3.5 mv in normal subjects and -42.6 +/- 5.1 mv in cystic fibrosis patients. We conclude that nasal potential measurement is an easy and reproducible test that might be a complementary tool routinely used along with the classical tests in the diagnosis of cystic fibrosis.

[Sub-pleural lipoma: apropos of a case]. / Le lipome sous-pleural: à propos d'un cas.

Lipomas are rarely observed in a subpleural localization. Clinical signs are uncommon and most are an incidental discovery at x-ray. We report a case of an incidentally discovered lipoma in the subpleural area observed in a 56-year-old patient. Physical examination showed normal respiratory function. An extrapulmonary intrathoracic opacity situated in the right axillary area was observed on standard chest x-ray. Computed tomography established the diagnosis of a subpleural fatty mass. This case draws attention to this uncommon localization of lipomas and illustrates the contribution of computed tomography for diagnosis. The CT pattern allowed us to avoid transmural or surgical biopsy.

[Axonal neuropathy revealing pleural lymphoma as a long-term outcome of therapeutic pneumothorax]. / Neuropathie axonale révélant un lymphome pleural primitif sur séquelles de collapsothérapie.

Peripheral neuropathy is a rare presenting feature of malignant lymphoma, and commonly associated with diagnostic delay. We report a patient with axonal neuropathy revealing primary pleural lymphoma as a late outcome of pulmonary tuberculosis. A 72-year-old-man with a past medical history of pulmonary tuberculosis presented with a 5-month history of axonal neuropathy. The patient complained of chest pain, altered general status. Chest computed tomography (CT) showed pleural tumour invading the chest wall and CT-guided pleural biopsy revealed a B-cell lymphoma. Chemotherapy was not started in consideration of the poor performance status of the patient. Despite corticosteroids, the peripheral neuropathy worsened and the patient died 2 months after the diagnosis of lymphoma. To our knowledge, no previous case of peripheral neuropathy revealing pleural lymphoma has been reported. The diagnosis of lymphoma must be entertained in the presence of peripheral neuropathy of unknown aetiology. Neuropathy associated to lymphoma results from various mechanisms and is characterised by clinical polymorphism. Their prognosis depends on the mechanism of the neuropathy and the severity of the lymphoma.