[Necrotizing pneumonia due to Gemella morbillorum in an immunocompetent patient]. / Pneumopathie nécrosante à Gemella morbillorum chez un patient immunocompétent.

BACKGROUND: Gemella morbillorum is an anaerobic to aerotolerant Gram positive coccus. It is considered a member of the normal upper respiratory tract flora including the oropharynx and also the gastro-intestinal and female genital tract. However severe infections are reported like endocarditis, septic shock and septic arthritis, more often in immunocompromised hosts. It is an infrequently isolated organism and a rare cause of pulmonary or pleural infections. CASE REPORT: We report a case of necrotizing pneumonia due to Gemella morbillorum in a 45-years-old Melanesian, smoker patient. The presentation was subacute with a four month history of loss of appetite, progressive weight loss and cough without fever. Initial presentation seems to be a malignant disease. The positive diagnosis has been established on the results of BAL fluid and the protected specimen brush samples. It was an immunocompetent patient presenting dental inflammation but not oral infection. Further management included intravenous administration of amoxicillin during two weeks. We recommended oral antibiotic treatment for another six weeks. After two months the patient was reevaluated. The CT scan showed no evidence of persistent infection. The HR CT scan will reveal multiple kystic bronchiectasies not seen on the first CT scan. CONCLUSION: Gm can be found endoscopic samples. Gemella morbillorum can be responsible of community-acquired pneumonia in immunocompetent host.

[Acute dyspnoea in elderly patients]. / La dyspnée aiguë du sujet âgé.

There is a natural physiological decline in pulmonary function and the cardiovascular system with age. In emergency medicine, acute dyspnoea is a common problem among elderly patients. Some causes, such as pulmonary embolism and diastolic heart failure, are probably under-diagnosed. A good clinical history and examination are as important as arterial blood gas analysis, chest radiography and electrocardiography. Few studies have examined acute dyspnoea in elderly patients, except in the setting of pneumonia. Establishing the underlying diagnosis is often difficult because of atypical presentation and the interaction between cardiac and pulmonary underlying functions. This topic describes several respiratory and cardiac diseases presenting as acute dyspnoea, especially "cardiac asthma" and pulmonary embolism. The clinical usefulness of new investigations such as cardiac and lung echography, pulmonary function tests, serum Brain Natriuretic Peptide and thoracic CT scan are discussed. Further studies looking at acute dyspnoea in elderly patients are needed.

[Acute dyspnoea in elderly patients]. / La dyspnée aiguë du sujet âgé

There is a natural physiological decline in pulmonary function and the cardiovascular system with age. In emergency medicine, acute dyspnoea is a common problem among elderly patients. Some causes, such as pulmonary embolism and diastolic heart failure, are probably under-diagnosed. A good clinical history and examination are as important as arterial blood gas analysis, chest radiography and electrocardiography. Few studies have examined acute dyspnoea in elderly patients, except in the setting of pneumonia. Establishing the underlying diagnosis is often difficult because of atypical presentation and the interaction between cardiac and pulmonary underlying functions. This topic describes several respiratory and cardiac diseases presenting as acute dyspnoea, especially "cardiac asthma" and pulmonary embolism. The clinical usefulness of new investigations such as cardiac and lung echography, pulmonary function tests, serum Brain Natriuretic Peptide and thoracic CT scan are discussed. Further studies looking at acute dyspnoea in elderly patients are needed.

Immunohistochemical expression of the intracellular component of galectin-8 in squamous cell metaplasia of the bronchial epithelium in neoplastic and benign processes.

Specified galectins are known to play a role in regulating cell proliferation, differentiation, adhesion and migration. Po66, a mouse IgG1 monoclonal antibody produced by immunization against squamous cell cancer, reacts against a carbohydrate-binding protein (Po66-CBP), recently shown to be a member of the galectin family with a strong homology with galectin-8 (PCTA-1), identified as a human tumor-associated antigen. We studied Po66 in squamous metaplasia of the bronchi in order to determine whether it could be specifically involved in neoplastic conditions and if so, if it would be helpful in distinguishing metaplasia at risk of cancer. Twenty-eight formalin-fixed, paraffin-embedded archival tissues of 17 metaplasias with SCC, 3 metaplasia with distant neoplastic disease and 8 metaplasias with an inflammatory process, were immunostained using a streptavidin biotin peroxydase method. The squamous metaplasias were positively stained in non-neoplastic disease as well as in neoplastic processes. Expression was also observed in stromal and normal cells. Po66-CBP was not associated with a pre-neoplastic character. We discussed the expression of this intra-cellular component of galectin-8 according to the functions of galectins in cellular differentiation, host reaction against tumor, and inflammation.

[Fire-eater's lung: report of six cases]. / Le poumon du cracheur de feu: à propos de six cas.

Lung damage due to inhalation of inflammable products, especially Kerdane, is mainly observed in young subjects. Lung damage is rarely severe and the diagnosis is facilitated by the notion of inhalation. These conditions regress favorably in a few days. We report six cases.

[Chronicity and diagnostic doubts of Melkersson-Rosenthal syndrome. Analysis of developing ways in 5 cases]. / Chronicité et incertitudes diagnostiques du syndrome de Melkersson-Rosenthal. Analyse des modalités évolutives de cinq cas.

In order to demonstrate the variability of the muco-cutaneous and neurovegetative signs and symptoms of Melkersson-Rosenthal syndrome (MRS), we report the cases of five out of 80 patients suffering from this complex oro-facial syndrome. In the majority of our patients the major symptoms, and in particular recurrent labial or intraoral swellings and/or facial palsy, did not occur simultaneously, which delayed the definite diagnosis of either complete or incomplete type of MRS. However, more than 80 p. 100 of our patients complained of various relapsing cranio-facial neurovegetative troubles that constitute the so-called minor symptoms of MRS, whereas a history or sequelae of facial palsy were found in only 35 p. 100 of our patients followed up for years or decades. In patients with solitary facial palsy or oro-facial oedemas as the initial symptom of putative MRS, the uncovering of concomitant minor symptoms proves to be helpful for substantiating the recognition of incomplete MRS. Thus, in questionable cases of MRS attention should be paid to seemingly incidental disturbances of the cranio-facial neurovegetative system (e. g., relapsing disorders of lacrimation, sweating, migraine-like headache) forming minor but characteristic hints to incomplete or unusual cases of MRS.