Critical appraisal of the clinical utility of sublingual immunotherapy in allergy.

Since it was introduced by Noon in 1911, allergen-specific immunotherapy or desensitization has been widely prescribed in the management of allergic diseases. Aimed at the etiology, it represents the only effective treatment for allergy. The basic mechanisms of immunotherapy are becoming better understood and allow us to improve this technique in the future. The sublingual immunotherapy as an alternative to subcutaneous route has been widely studied. Several clinical trials confirmed that sublingual immunotherapy is efficient in reducing allergic respiratory symptoms. The sublingual immunotherapy reduces the risk of developing serious side effects due to desensitization. We performed a literature review in order to remind the mechanisms of action and to demonstrate efficacy and tolerability of the sublingual immunotherapy in the treatment of allergic rhinoconjunctivitis and asthma and its impact on the quality of life.

[Prevalence of metabolic syndrome in a population of apneic patients: a prospective study with cardiovascular risk estimation]. / Prévalence du syndrome métabolique dans une population de patients apnéiques: étude prospective avec calcul du risque cardiovasculaire.

BACKGROUND: Obstructive sleep apnea syndrome (OSAS) is a highly prevalent clinical condition and frequently associated with obesity. Recent literature has suggested the independent contribution of OSAS in the pathogenesis of metabolic disturbances. Metabolic syndrome (MS), a cardiovascular risk factor, was frequently associated with OSAS. METHODS: This is a prospective study without intervention. Will be included, all consecutive patients referred to the Department of Pulmonology for suspected OSAS confirmed by respiratory polygraphy. Anthropometric, clinical and biological parameters needed to define the MS will be collected. MS was defined according to the IDF 2005. Assessment of cardiovascular risk related to MS will be performed by appropriate scores. EXPECTED RESULTS: To determine the prevalence of MS in a sample of OSAS patients recruited in the Department of Pulmonology of Farhat Hached Hospital (Sousse, Tunisia). To identify risk factors independently associated with the presence of MS in patients with OSAS among the following parameters (age, gender, degree of obesity and the various parameters of OSAS severity). To assess compared cardiovascular risks according to the presence of MS by validated scales to demonstrate the impact of MS in patients with OSAS.

[Knowledge, attitudes and behaviors of hospital staff members towards smoking and anti-smoking regulations: results of a survey in F.-Hached University Teaching Hospital of Sousse (Tunisia)]. / Connaissances, attitudes et comportements du personnel hospitalier vis-à-vis du tabagisme et de la réglementation anti-tabac : résultats d'une enquête réalisée au CHU F.-Hached de Sousse (Tunisie).

BACKGROUND: Promoting a smoke-free hospital is a priority component for tobacco control strategies. The aim of our investigation was to study the attitudes and behaviors of the hospital staff of the F.-Hached UH of Sousse towards smoking, and to assess their knowledge about the harms of passive smoking and about tobacco regulations in the hospital. METHODS: We conducted a descriptive cross-sectional study using an anonymous self-administered questionnaire. In January-February 2008, the questionnaire was submitted to hospital staff members selected at random from the care units at F.-Hached UH of Sousse, Tunisia. RESULTS: The response rate was 92.8% (452 participants). The average age of the population was 39.7±19 years; all professional categories were represented. The prevalence of active smoking among the staff interviewed was 19% (89.5% males). About 75% of the smokers stated they smoked on the work site and 8% in the presence of patients. The majority of the smokers wished to stop smoking. Discomfort from exposure to tobacco smoke was reported by 83.4% of respondents. The large majority of staff respondents (95%) knew that tobacco smoke is dangerous and 80% were aware of the existence of a law that prohibits smoking in the hospital. CONCLUSION: The prevalence of smoking remains high among male hospital workers. In our hospital, the majority of the care staff favored promotion of a tobacco-free hospital. The success of this project will depend on education, implicating the entire hospital staff in the anti-smoking battle. Smoking staff members should be supported in their attempts to stop smoking.

[Acceptance and long-term compliance to continuous positive airway pressure in obstructive sleep apnea. A prospective study on 72 patients treated between 2004 and 2007]. / Evaluation de l'observance et de l'acceptation du traitement du syndrome d'apnées obstructives du sommeil par pression positive continue. Etude prospective de 72 patients appareillés entre 2004 et 2007.

Patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) treated by continuous positive airway pressure (CPAP) need to use long-term CPAP to prevent cardiovascular disease. The method of survival analysis was used to allow for long-term CPAP use in 72 patients who were prescribed a CPAP. During a mean follow-up of 22+/-15 months, one patient died and 17 patients stopped their treatment, 29% of them in the first 6 months. In compliant patients, the median value of daily CPAP use was 4.5hours. Kaplan Meier analysis showed that 92% of patients were still using CPAP at 6 months, 83% at 12 months and 59.9% at 3 years. Chronic obstructive pulmonary disease was identified as a predictor factor of long-term CPAP use (OR=4.53, p=0.01). CPAP is a well-accepted long-term therapy for OSAHS with 60% of patients continuing to be compliant with treatment at 3 years.

[Varicella pneumonia: a serious complication of varicella in adults]. / La pneumonie varicelleuse: une complication grave de la varicelle chez l'adulte.

Pneumonia caused by varicella infection is a serious and severe complication of the disease when it occurs in adults. The authors report two cases of a varicella pneumonia in a 36 and a 41 year-old non-immunocompromised man. They were admitted to hospital for acute respiratory failure, not requiring intensive care, associated with exanthema. High resolution CT revealed well-defined diffuse nodules throughout both lungs, nodules with a surrounding halo of ground-glass opacity. Thrombocytopenia, hepatic cytolysis and an increase in lacticodeshydrogenase were noted. The patients made a full recovery with anti-viral therapy and oxygen therapy. Varicella pneumonia is the most common complication of varicella in adults. Anti-viral treatment is usually successful.

[Tuberculous pneumothorax. Retrospective study of 23 cases in Tunisia]. / Le pneumothorax tuberculeux. Etude rétrospective de 23 cas à l'Hôpital Farhat-Hached de Sousse, Tunisie.

The tubercular pneumothorax is a rare and severe form of tuberculosis which persists in Tunisia. We reviewed retrospectively our experience at the Pneumology-Allergology Department of the Sousse Hospital with 23 cases of tubercular pneumothorax observed between 1985 and 2003. The suggestive symptom, pneumothorax, always occurred within a context poor general health and fever. The chest roentgengraph showed pneumothorax (n=8) or hydropneumothorax (n=15), and pulmonary lesions associated in 82.5% of patients. Bacteriological proof was obtained in 21 cases; in the two other patients, histological examination of the surgical specimen was highly suggestive of tuberculosis. Treatment associated antitubercular chemotherapy in compliance with the National Plan of against Tuberculosis (n=23), chest drainage (n=21) and respiratory physiotherapy (n=18). Five patients underwent surgery: pleural decortications (n=3), pulmonary resections (n=2). Two were lost to follow-up. The course was favourable in 78% of patients; there were two cases of partitioned pyopneumothorax and one post-operative death. In our experience, tubercular pneumothorax was always associated with active cavitated tuberculosis. The course was almost favorable with antitubercular chemotherapy and chest drainage.

[Recurrent spontaneous pneumothorax complicating osteosarcoma pulmonary metastasis]. / Un pneumothorax spontané récidivant compliquant les métastases pulmonaires d'un ostéosarcome.

We report the case of a 15-year-old girl with osteosarcoma in the left distal femur who developed a recurrent spontaneous pneumothorax. The patient was treated by neoadjuvant chemotherapy followed by surgery (limb-sparing surgical procedure with insertion of a knee prosthesis) and then adjuvant chemotherapy. The initial extension assessment was normal. No pulmonary metastasis was found. The chest tomography performed at the end of treatment (8 months after surgery) revealed two peripheral pulmonary nodules not seen on the chest X-ray. Palliative chemotherapy was given, the thoracic tomography after four chemotherapy courses showed a progress of the pulmonary metastasis and on the right more abundant bilateral pneumothorax which had recurred two months after thoracic draining. Thoracoscopy showed no pleural lesions.

[Large bilateral lung opacities]. / Volumineuses opacités pulmonaires bilatérales.

We report the case of a 42-year-old woman operated for neurofibroma of the scalp on two occasions who consulted for bilateral chest pain which reveated two voluminous bilateral pulmonary masses. Biopsy of one of these masses was in favor of secondary or primary leiomyosarcoma. The association of Von Recklinghausen's disease and soft tissue sarcoma is rare: most often neurofibroma which degenerates is observed. Other types of sarcoma, like leiomyosarcoma, have been described.

[Primary calcified mediastinal hydatid cyst producing compression]. / Kyste hydatique médiastinal primitif compressif calcifié.

A mediastinal hydatid cyst is rare (< 0.1% of hydatidosis). It most frequently progresses to calcification rather than a pulmonary hydatid cyst because there is no relationship to ventilation. We report a case of calcified mediastinal hydatid cyst which was confirmed on histological examinations from the operative specimen, in an agricultural worker of 58 who presented with a homolateral paralysed diaphragm.

[Unilateral hyperlucent lung]. / Un poumon clair unilatéral.

We report a case of 33 year old man who consulted us in 1994 for recurrent bronchitis sometimes with haemoptysis. The physical examination was unremarkable. At consultation abnormal fascicular sounds were noted at the left base. A chest x-ray showed hyperlucency of the left lung associated with a very small left hilar shadow. We considered the diagnosis of Mac Leod's syndrome after eliminating a proximal obstructive pathology and pulmonary embolus. Mac Leod's syndrome or Swyer James' syndrome was described in 1954 and is suggested on the standard radiograph above all if the expiratory films have confirmed the presence of air trapping. Angiography shows a slender and fine pulmonary network. Computer tomographic examination of the chest rules out a bronchial tumour, excludes bullous emphysema and reveals hyperlucent zones. Scintigraphy with ventilation perfusion supplies the essentials to understanding the mechanism (a syndrome of aerated lung which is neither directly ventilated nor perfused). The expiratory function tests most often show a restrictive syndrome but sometimes an obstructive syndrome is found with associated air trapping. The disorder does not progress and the prognosis is good.

[Brain abscess in the course of miliary tuberculosis: a case report and review of the literature]. / Abcès cérébraux au cours d'une miliaire tuberculeuse: à propos d'un cas et revue de la littérature.

The frequency of tuberculous cerebral involvement associated with miliary tuberculosis is not well known; some authors have evaluated it at around 22%. We report the case of a 43-year-old man hospitalised in the pulmonology department with bacillary positive miliary tuberculosis. On the 26th day of antituberculosis treatment he complained of frontal headaches, with impairment in visual acuity. Examination of the optic fundus showed bilateral papillary oedema. Cerebral computed tomography showed diffuse rounded lesions with significant oedema. Antituberculosis chemotherapy was supplemented with steroid treatment. Clinical and radiological progress was good.

Hydatid disease of the lungs. Study of 386 cases.

During a 10-yr period, 386 patients with hydatid disease of the lung were treated at our hospital. There were 165 male and 221 female patients with a mean age of 30.15 + 16.9 yr. There were 286 solitary, 20 multiple, and 21 bilateral cysts. In 59 patients, the cysts included the lung and other organs; in 54, the lung and the liver; in four, the lung and the kidney; in one, the lung and the peritoneum. Diagnosis was made using clinical criteria, serologic findings, and imaging techniques; 373 patients were treated surgically. Surgical procedures consisted of cystectomy in 93 patients, pericystectomy in 166 patients, and lung resection in 114 patients. Mebendazole and flubendazole were used in three patients. Postoperative complications occurred in 44 patients (15.8%). There were two operative deaths (mortality rate, 0.53%). Patients have been followed yearly, with a median follow-up of 6 yr. Active hydatid disease has been found in two patients.

Blastomycosis in Africa: a new case from Tunisia.

Although blastomycosis is prevalent in the North American continent, it occurs only sporadically in Africa. We describe a 42 yr old patient who complained of intermittent cough and haemoptysis. Clinical findings were strongly suggestive of lung cancer. The diagnosis of pulmonary blastomycosis was made at thoracotomy. This rather unusual disease in our areas caused a considerable delay in securing the diagnosis and we suggest that this infection may be found elsewhere in Africa and the distribution may be wider than has previously been suspected.