[Recurrent pneumothorax revealing a tuberous sclerosis complex]. / Sclérose tubéreuse de Bourneville révélée par des pneumothorax à répétition.

Tuberous sclerosis complex (TSC) is an autosomal dominant phacomatosis. We report a 29-year-old woman who presented with recurrent pneumothorax in whom the diagnosis of TSC relied on the existence of family history (child with cardiac rhabdomyome), skin lesions, pulmonary lymphangiomyomatosis, hepatic lipomas, renal angiomyolipomas, uterine myomas and cerebral lesions on MRI. The diagnostic of TSC might be difficult as it could mimic pulmonary lymphangiomyomatosis.

[Audit of management of chronic obstructive pulmonary disease by general practitioner in Morrocco]. / Evaluation de la prise en charge des broncho-pneumopathies chroniques obstructives auprès des médecins généralistes marocains du secteur libéral.

OBJECTIVE: The purpose of this study initiated in January 2003 was to evaluate the awareness of general practitioners in Morrocco concerning the diagnosis and initial management of chronic obstructive pulmonary disease (COPD). METHOD AND RESULTS: Ten percent of the COPD patients, selected at random, participated in the study, i.e; 223 patients/2186. The proportion of COPD patients among patients attending consultations was 5 to 10% for 40% of general practitioners. Only 48.9% of the general practitioners were aware of international guidelines for the management of COPD. For 97.8%, chronic bronchial symptoms were the predominant reasons for suspecting the diagnosis of COPD; other symptoms included exercise induced dyspnea (95.1%). Only 10.8% of the general practitioners ordered a spirometry examination. Only 30.5% managed patients themselves. CONCLUSION: Our findings show that general practitioners should be implicated in the diagnosis and early management of COPD but that management practices could be improved.

Prevalence and trend of self-reported asthma and other allergic disease symptoms in Morocco: ISAAC phase I and III.

BACKGROUND: The prevalence of asthma and other allergic diseases is increasing in many parts of the world. OBJECTIVE: To determine the prevalence of asthma, rhinoconjunctivitis and skin allergy symptoms in Morocco as part of the International Study of Asthma and Allergic Diseases in Children (ISAAC). METHODS: The survey was conducted using the standardised method of ISAAC Phase III in four centres in Morocco-Casablanca, Marrakech, Ben Slimane and Boulmane-with respectively 1777, 1689, 1008 and 1254 13-14-year-old schoolchildren participating. A comparison of the results with ISAAC Phase I was carried out in two centres. RESULTS: The prevalence of self-reported symptoms of wheeze in the last 12 months (6.4-16.2%), nasal symptoms (27.9-52.8%), rhinoconjonctivitis (8.8-28%) and eczema (13.3-20.2%) varied between centres, and were highest in Casablanca, the largest city in Morocco. Significant increases in almost all symptoms were found in the two centres of Casablanca and Marrakech between ISAAC Phase I and Phase III. CONCLUSION: Morocco could be classified as a country with an intermediate burden of asthma (between 10% and 15%) and other allergic disorders. The prevalence of these symptoms has increased in the past 5 years.

[Disseminated erythematous lupus with bilateral diaphragmatic involvement]. / Lupus érythémateux disséminé avec atteinte diaphragmatique bilatérale.

The diaphragm is an unusual localization for disseminated erythematous lupus and is generally not recognized. We present the case of a 34-year-old woman who developed bilateral pain in the base of the thorax 15 days before hospitalization without any bronchial signs and NYHA stage II dyspnea. The patient's general health status remained satisfactory and the physical examination was normal except for diffuse inflammatory joint pain and cutaneous photosensitivization. The chest x-ray disclosed ascension of both hemidiaphragms with retracted lungs associated with bilateral basal atalectasia. The diagnosis of lupus with diaphragmatic involvement was retained due to the clinical presentation with diffuse joint pain, photosensitization with facial erythema, pericardial effusion and elevated antinuclear antibody and lymphopenia (1 100/mm3). Lung function tests revealed a restrictive syndrome. Oral corticosteroids 1 mg/kg/d enabled clinical and functional improvement. In light of this observation we discuss the pathogenic mechanisms of this uncommon localization of lupus and the difficulty of establishing a sure diagnosis.

Survey of primary drug resistance of Mycobacterium tuberculosis in Casablanca, Morocco.

SETTING: In 1990, a 6-month short-course regimen (2 SHRZ/4 RH) was introduced for the treatment of tuberculosis in Morocco. OBJECTIVE: To assess the efficacy of the national tuberculosis control programme, a prospective study of primary drug resistance was conducted from April 1992 to July 1994 in Casablanca. DESIGN: A total of 402 strains isolated from 402 patients living in Casablanca with no previous history of tuberculosis was included in the study. RESULTS: The overall rate of primary drug resistance to at least one drug was 23.9%; it was 19.7% to streptomycin, 11.4% to isoniazid, and 8.2% to both streptomycin and isoniazid. The rates of resistance to rifampicin and ethambutol were both less than 1%. The survey was divided into two periods of 14 months each. The rates of primary drug resistance increased from 21.1% to 27.6% during these two periods (Odds Ratio [OR] 1.43; 95% Confidence Interval [CI] 0.88 to 2.32); this increase occurred only for streptomycin (15.9% to 24.7%, OR 1.73; 95% CI 1.02 to 2.93). CONCLUSION: The rate of primary drug resistance of Mycobacterium tuberculosis in Casablanca has risen in recent years to an ominous level. Urgent measures are needed in order to interrupt this trend.

[Latex allergy in a hospital setting. Results of a study in Casablanca]. / Allergie au latex en milieu hospitalier. Résultats d'une étude à Casablanca.

On account of the increased use of rubber gloves, latex allergy is a current problem. The problem can present as anaphylaxis revealing its serious nature. The aim of this study was to evaluate the prevalence of sensitivity to latex in health personnel. We carried out an enquiry on the hospital staff in Casablanca (Hospital of the 20th of August, Childrens Hospital, the Dental Centre, the Bouafi Hospital and Sidi Otmane Hospital). This study involved 600 subjects; 408 women and 192 men. The population was composed of 273 nurses of either sex, 169 doctors and 104 care workers and 54 administrators. The study was carried out using an anonymous questionnaire and cutaneous prick tests looking for latex allergy and atopy. Thirty two subjects (5.3%) showed a positive prick test to latex. There were 19 nurses, nine doctors, two health workers and two administrators. A study of specific immunoglobulins to latex carried out in 15 cases was positive in four. In the population with a positive prick test an alimentary allergy was identified in nine cases. The prevalence of atopy in the subjects allergic to latex (81%) was greater than in the latex negative population (16%). After seeing the frequency of latex allergy in hospital personnel we believe that a replacement of other types of gloves (e.g. vinyl) would probably be preferable for all tasks where latex is not indispensable.

[Multiple pulmonary hydatidosis with floating balloon appearance and cardiac localization]. / Hydatidose pulmonaire multiple en lâcher de ballons avec localisation cardiaque.

Multiple hydatidosis in a thoracic localization is unusual and a cardiac localization very exceptional. We report a case of multiple hydatidosis greatly improved by medical treatment with albendazole which was associated with a cardiac cyst successfully treated by surgical resection. No recurrence has been observed at 4 year follow-p. We point out therapeutic management options in these unusual forms of the disease.

[Parietal thoracic tuberculosis in the absence of immunosuppression by HIV infection]. / La tuberculose pariétale thoracique en dehors de l'immunodépression par le virus de l'immunodéficience humaine.

Parietal thoracic abscess formation of a tuberculous nature is a rare form of extrapulmonary tuberculosis, usually described in cases of severe tuberculosis encountered in HIV-infected patients. We report 13 cases of parietal tuberculosis in patients without HIV infection who were investigated between October 1988 and December 1999. During this period, we cared for 2 663 patients with tuberculosis. The series included 9 women and 4 men age 17 to 60 years, mean age 39 years. The clinical aspect of the parietal abscess was variable. Cold fluctuating abscess was dominant in 10 cases. In 3 cases, the parietal abscess had a hard consistence simulating a malignant tumor. The parietal abscess was in a posteriosuperior or posteriobasal location in 4 cases, and in an anterosuperior, anterobasal or axillary location in 6. Multiple thoracic abscesses were observed in only 3 cases. The size of the abscess varied from 2 to 2.5 cm. Radiologically, rib damage was present in 4 cases, scapular damage in 1, with bone lysis in 3 cases. Other localizations of tuberculosis were observed in 4 cases. one patient had multiple peripheral node enlargement, another had parenchymal lung damage and a third had a vertebral localization. Culture of abscess pus provided the diagnosis in 10 cases. the diagnosis was confirmed by pathology in 8 cases on a biopsy of the abscess border. Anti-tuberculosis drugs allowed successful recovery in all patients. We analyzed the clinical aspects of cold thoracic abscesses and discuss differential diagnosis. Early diagnosis and treatment is essential.

[Clinical characteristics and etiology in hemoptysis in a pneumology service. 291 cases]. / Caractéristiques cliniques et étiologiques des hémoptysies dans un service de pneumologie. A propos de 291 cas.

The aim of this work is to determine the clinical characteristics of haemoptysis and their principal aetiologies in a retrospective study of 291 cases collected over 5 years and occurring in adults who were hospitalised in a pneumology service. The annual incidence of haemoptysis was 8.8% of the in-patient population. The mean age of the patients was 46 and 47% were less than 50. The males were most frequent (69.4%) and haemoptysis was the presenting feature in 35.4%; it was minimal in 71.1% of average quantity in 26.8% and severe in 2.1%. The thoracic radiograph was judged abnormal in all cases and the abnormalities noted were suggestive of a particular aetiology in 70.8% of cases. The aetiological cause was dominated by bronchial cancer and of active pulmonary tuberculosis or its sequalae with levels of 34.4% and 18.9% respectively. For the other causes bronchial dilatation was important with 15.1% and hydatic cysts another 9.3%. Other aetiologies were represented by bacterial pneumonias with or without abscesses 7.2%, pulmonary aspergilloma 6.9%, chronic bronchitis with or without emphysema 3.5% and by rare causes in 4 cases. The cause for the haemoptysis was not found in 3.1%. This study brings out the preponderant place of bronchial cancer as a cause of haemoptysis in a country which still has a high prevalence of tuberculosis. Nevertheless the existence of tuberculosis services where the greater part of tuberculosis patients are hospitalised explains in part the predominance of bronchial cancer increasing very rapidly in our service.

[Pleural fibrous mesothelioma. Apropos of a case]. / Le mésothéliome pleural fibreux. A propos d'une observation.

A 27-year-old man with an uneventful history was hospitalized after fortuitous discovery of an opacity in the right lung field. The clinical examination revealed a multi-nodular euthyroidian goiter. Laboratory tests, including blood glucose, were normal. Computed tomography of the chest showed a pleural formation and associated pleural effusion. Complete surgical exeresis led to the diagnosis of benign fibrous pleural mesothelioma. Fibromas of the pleura are rare and usually discovered due to extra thoracic signs. The clinical course is long and often silent. Surgical removal is indicated and usually is complete.

[Pleural fibroma revealed by hypoglycemia]. / Fibrome pleural révélé par une hypoglycémie.

Pleural fibroma or solitary fibrous tumor of the pleura (SFTP) is a rare tumor generally discovered fortuitously or in patients with non-specific respiratory symptoms, more rarely with hypoglycemia. We report the case of a 51-year-old man with a history of smoking (30 pack-years) and no other disease history whose chest x-ray revealed an enormous opacity occupying the lower two-thirds of the left hemithorax. This radiological anomaly had led to episodes of lipothymia three months earlier together with mental confusion in the morning as well as an episode of hypoglycemia (0.48 g/l) which rapidly resolved after administration of hypertonic dextrose. Ultrasonography and chest scan were performed later and confirmed the tissular nature of the opacity which was well limited with a left base. Minimally abundant homolateral pleural effusion was also noted. The diagnosis of SFTP revealed by hypoglycyemia was the most probably diagnosis. Emergency thoracotomy enabled removal of a hard tumor weighing 2115 g. Histology confirmed the diagnosis of benign SFTP. Hypoglycemia in the context of SFTP would be related to tumor secretion of insulin-like proteins. Complete emergency resection is required to avoid the risk of life-threatening hypoglycemia.

[Unusual diagnosis of cavitating pulmonary opacity]. / Diagnostic inhabituel d'une opacité pulmonaire excavée.

The authors reported a case of Hodgkin disease with excavated lung localisation discovered during a systematic detection in the occupational medicine framework. This observation raised the differential diagnosis problems mainly with tuberculosis in endemic countries.

[A rare and benign etiology of Pancoast-Tobias syndrome]. / Une étiologie rare et bénigne du syndrome de Pancoast-Tobias.

Although lung cancer is the leading cause of Pancoast-Tobias syndrome, benign etiologies have been rarely described in the literature. We report two cases of Pancoast-Tobias syndrome caused by hydatidosis of the apex. Outcome was favorable after surgical treatment.

[Serous fibrinous pleurisy disclosing hydatid cyst of the liver fistulizing into the pleura]. / Pleurésie séro-fibrineuse révélatrice d'un kyste hydatique du foie fistulisé dans la plèvre.

Hydatic cyst of the liver remains a serious public health problem in Morocco and several other Mediterranean countries. This benign affection can cause serious sometimes fatal complications such as cyst rupture into the biliary ducts or the thorax. We present the case of a patient with serofibrous pleurisy and recall the often late diagnosis of hydatic cyst. Biliary pleural fistulization is a rare but serious complication.

[The "DRESS" syndrome in antituberculosis drugs]. / Le « DRESS ¼ syndrome aux antituberculeux.

The DRESS syndrome is a serious drug reaction that may involve life-threatening. We have to think before any skin reaction after taking drugs. We report a clinical case of a 27-year-old patient treated for pleural tuberculosis with the DRESS syndrome induced by antituberculosis. Through this work, we underline the rarity of this syndrome to antituberculosis treatment, but it should not be underestimated.

[Diffuse infiltrative lung disease in scleroderma. Analysis of radio-clinical and functional semiology]. / Pneumopathie infiltrante diffuse (PID) de la sclérodermie. Analyse de la sémiologie radioclinique et fonctionnelle.

Scleroderma (SD) is a systemic disease that predominantly affects the skin. Diffuse infiltrative lung disease (DILD) is rare and occurs most often in the course of the disease. We analyzed seven cases of DILO of SD recorded between 2003 and 2010 among 196 PID (3.6%). Functional signs were limited to respiratory dyspnea, it was associated to dysphagia in six cases, dry syndrome in five cases and Raynaud's phenomenon in four cases. Clinical examination found crackles in the bases of the thorax in all cases and specific cutaneous signs in six cases. The chest radiograph showed that interstitial disease predominates at the lung bases in all cases with a large aspect of the pulmonary arteries in two cases. The chest CT scan confirmed the predominance of basal and peripheral damage with signs of fibrosis in six cases. The pulmonary function objectified a severe restrictive ventilatory defect in all cases. Bronchoscopy showed a normal macroscopic appearance in all cases, the broncho-alveolar lavage was predominated by neutrophilic formula in four cases. SCL 70 antibodies were positive in four cases. All patients were treated by steroids with improvement of dyspnea and stabilization of radiographs. A patient had died in an array of acute respiratory failure and one patient was lost to follow-up. DILD in scleroderma is rare and seldom reveals the disease, it affects the patient's prognosis especially when associated with arterial pulmonary hypertension.

[Imaging of hydatid cyst of the lung]. / Analyse de la sémiologie radioclinique du kyste hydatique pulmonaire.

The pulmonary hydatid cyst is frequent in Mediterranean countries such as Morocco. Our analytic study concerned 70 cases of lung hydatid cysts collected from 2007 to 2010. Mean age was 35years and we noted a male predominance (53%). Forty-seven percent of patients belong to rural environment where 64% of them were in contact with dogs. The respiratory symptomatology was made mostly by cough (86%) and chest pain (70%). Diagnosis was based on radioclinical arguments with positive hydatic serology in some cases. The cyst was single in 84% of the cases, safe in 55% of the cases. The location in the right lung was dominant with a major affection of the right lower lobe. Conventional surgery was indicated in 67 cases. The liver hydatid cyst was discovered in 20% of cases and treated at the same time phases in 71% of cases. The evolution was good in 73% of the cases and marked by a recurrence in three of the operated cases.

[Multicystic lung revealing a Sjogren's syndrome]. / Poumon multikystique révélant un syndrome de Gougerot-Sjögren.

The Sjogren's syndrome is a chronic inflammatory autoimmune disease that affects primarily the exocrine glands, but can affect other organs particularly the lungs. Cystic lung disease is very significant but exceptionally recounted in the literature. We report the case of a patient, 54 years old, whose disease was discovered incidentally after a routine chest radiograph. The diagnosis of cystic lung revealing a primary Sjogren's syndrome was held before a group of radio-clinical, immunological and histological arguments. Through our observation, the diagnosis of Sjogren's syndrome should be included in the list of diagnoses to raise in a multicystic lung.

[Pott's disease (about 16 cases)]. / Mal de Pott (à propos de 16 cas).

INTRODUCTION: Pott's disease or spinal tuberculosis is rare, but represents the most common form of osteo-articular tuberculosis in endemic countries. MATERIAL AND METHODS: [corrected] From January 2000 to December 2010, we collected 16 cases of Pott's disease. We analyzed clinical and radiological profile, means of confirmation and treatment. RESULTS: Spinal and chest pain were the most frequent signs. Four patients had neurological signs. The diagnosis was made by the detection of bacillus in the pus of paravertebral abscess in six cases, by histological study of vertebral biopsy in five cases, biopsy of another associated lesion in one case and in front of radio-clinical arguments with good clinical evolution under antibacillary treatment in four cases. The antibacillary treatment associating four drugs was indicated and correctly followed by all patients. Surgical drainage was associated in five cases. The evolution was good in all cases. DISCUSSION: Diagnosis of Pott's disease is late when there is no neurological sign. Imaging allows to make early diagnosis with MRI. Prognosis is good when treatment is started early.