RESUMEN
Lepidic adenocarcinoma is a cancer with atypical radiological presentation making its diagnosis difficult and late. Here,we report the case of a 64-year-old man, who presented with respiratory distress his thoracic CT showed ground glass areas and diffuse condensations with blood hypereosinophilia. He was diagnosed to have eosinophilic lung and was placed on corticosteroid therapy but he did not show any improvement. A CT-guided biopsy showed lepidic adenocarcinoma.
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Mounier Kuhn Syndrome or tracheobronchomegaly is a rare disease, characterized by dilatation of the trachea and the main bronchi. Our study concerns a case of 67-years old male patient, smoker, with a chronic cough. Chest scan was requested; it shows an enlargement of the tracheal clarity and the two main bronchi. Meanwhile, the Functional respiratory exploration was normal. The treatment includes mucolytics and pulmonary physiotherapy. Mounier-Kuhn syndrome is rare and the clinical signs are not specific, the positive diagnosis is purely radiological. The treatment is about to free the airways to prevent infection.
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BACKGROUND: Chronic obstructive lung disease (COPD) is the third most common cause of death in the world. Factors other than smoking, such as socio-economic status, could be involved in the development of COPD.OBJECTIVE: To investigate the association between chronic airflow obstruction and socio-economic status in Morocco.DESIGN: Questionnaires were administered and spirometry tests performed as part of the BOLD (Burden of Obstructive Lung Disease) Study carried out in Fez, Morocco. Socio-economic status was evaluated using a wealth score (0-10) based on household assets. The ratio of forced expiratory volume in 1 s (FEV1) to forced vital capacity (FVC) was used to measure airflow obstruction.RESULTS: A total of 760 subjects were included in the analysis. The mean age was 55.3 years (standard deviation [SD] 10.2); the average wealth score was 7.54 (SD 1.63). After controlling for other factors and potential confounders, FEV1/FVC increased by 0.4% (95%CI 0.01-0.78; P < 0.04) per unit increase in wealth score. Ageing, tobacco smoking, underweight, history of tuberculosis and asthma were also independently associated with a higher risk of airflow obstruction.CONCLUSION: Our findings suggest that airflow obstruction is associated with poverty in Morocco. Further investigations are needed to better understand the mechanisms of this association.
Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica , Volumen Espiratorio Forzado , Humanos , Persona de Mediana Edad , Marruecos/epidemiología , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Factores de Riesgo , Espirometría , Capacidad VitalRESUMEN
OBJECTIVE: To present population-estimated prevalence of spirometrically confirmed chronic obstructive pulmonary disease (COPD) in adults (age ⩾40 years), living in the city of Fez, Morocco. DESIGN: Following the Burden of Lung Disease (BOLD) methodology, population-based sampling plans were used for the recruitment of eligible adults. The study collected questionnaire data on respiratory symptoms, medical history, health status, exposure to risk factors for COPD and quality of life. Post-bronchodilator spirometry was performed and COPD and its stages were defined according to Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. RESULTS: Among 768 individuals with valid data and acceptable quality post-bronchodilator spirometry results, the overall prevalence of stage 1 or higher COPD was 12.6%. The prevalence of GOLD stage 2 or higher COPD was 7.9%. The population-estimated prevalence of lower limit of normal (LLN) modified stage 1 or higher COPD was 8% among non-smokers, and it increased with number of pack-years (17.8% for >20 pack-years vs. 3.8% for <10 pack-years). The prevalence of physician-diagnosed COPD was 3.2%; this was associated with an increase in smoking pack-years. CONCLUSION: These results emphasise the urgent need to take necessary measures to reduce the prevalence of tobacco smoking.
Asunto(s)
Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad , Marruecos/epidemiología , Prevalencia , Enfermedad Pulmonar Obstructiva Crónica/prevención & control , Pruebas de Función Respiratoria , Fumar/epidemiología , Encuestas y CuestionariosRESUMEN
Subcutaneous emphysema develops from the spread of air essentially from the mediastinum into the subcutaneous tissue causing progressive distension and infiltration. Diagnostic and therapeutic delay expose the patient to massive air effusion and risk of compression of cervical and mediastinal structures. The initial mechanism is a breach in the tracheobronchial tree with air diffusion into the interstitial space and along the perivascular spaces toward the mediastinum, and then spread and dissection in the subcutaneous tissue. A tracheobronchial foreign body is a very rare cause of emphysema and is often localized. An association with a combination of epidural emphysema, pneumopericardium, or pneumoretroperitoneum is exceptional. Here, we present a unique case associating massive subcutaneous emphysema, pneumomediastinum, pneumopericardium, pneumorrhachis, and pneumoretroperitoneum in a 3.5-year-old child complicating an unrecognized aspirated foreign body. The extraction of the foreign body resulted in gradual regression of the symptoms and the disappearance of these emphysematous locations.
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Bronquios , Cuerpos Extraños/complicaciones , Enfisema Mediastínico/etiología , Neumopericardio/etiología , Neumorraquis/etiología , Enfisema Subcutáneo/etiología , Broncoscopía/métodos , Preescolar , Cuerpos Extraños/diagnóstico por imagen , Cuerpos Extraños/cirugía , Humanos , Enfisema Mediastínico/diagnóstico por imagen , Neumopericardio/diagnóstico por imagen , Neumorraquis/diagnóstico por imagen , Radiografía , Enfisema Subcutáneo/diagnóstico por imagen , Resultado del TratamientoAsunto(s)
Equinococosis Pulmonar/diagnóstico por imagen , Pulmón/diagnóstico por imagen , Mediastino/diagnóstico por imagen , Albendazol/uso terapéutico , Antihelmínticos/uso terapéutico , Procedimientos Quirúrgicos Cardíacos , Cardiomiopatías/complicaciones , Cardiomiopatías/diagnóstico , Cardiomiopatías/diagnóstico por imagen , Cardiomiopatías/tratamiento farmacológico , Cardiomiopatías/cirugía , Terapia Combinada , Tos/etiología , Diagnóstico Diferencial , Disnea/etiología , Equinococosis/complicaciones , Equinococosis/diagnóstico , Equinococosis/diagnóstico por imagen , Equinococosis/tratamiento farmacológico , Equinococosis/cirugía , Equinococosis Pulmonar/complicaciones , Equinococosis Pulmonar/diagnóstico , Equinococosis Pulmonar/tratamiento farmacológico , Atrios Cardíacos/parasitología , Atrios Cardíacos/cirugía , Humanos , Pulmón/parasitología , Masculino , Neoplasias del Mediastino/diagnóstico , Mediastino/parasitología , Neoplasias de Células Germinales y Embrionarias/diagnóstico , Neoplasias de Células Germinales y Embrionarias/secundario , Radiografía , Ultrasonografía , Adulto JovenRESUMEN
Hepato-pulmonary hydatidosis is a parasitic disease common in Mediterranean countries. Hydatid pulmonary embolism is extremely rare and is due to rupture of a cardiac hydatid cyst or, more rarely, rupture of a hepatic hydatid cyst. We report three cases of hydatid pulmonary embolism secondary to rupture of a hydatid cyst into the inferior vena cava. Thoracic imaging, mainly CT angiography and MRI, was important for both the diagnosis and decisions on treatment. The prognosis of intra-arterial pulmonary hydatid cyst is poor because of the risk of acute fatal complications such as anaphylactic shock and vascular rupture and also of chronic progression to cor pulmonale and respiratory failure. The therapeutic management is difficult and often only partially effective hence the importance of focusing on preventative treatment.
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Equinococosis Hepática/complicaciones , Embolia Pulmonar/etiología , Adulto , Albendazol/uso terapéutico , Antihelmínticos/uso terapéutico , Terapia Combinada , Equinococosis Hepática/tratamiento farmacológico , Equinococosis Hepática/cirugía , Equinococosis Pulmonar/complicaciones , Equinococosis Pulmonar/diagnóstico por imagen , Equinococosis Pulmonar/tratamiento farmacológico , Urgencias Médicas , Femenino , Hemoptisis/etiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Arteria Pulmonar/parasitología , Embolia Pulmonar/diagnóstico por imagen , Embolia Pulmonar/parasitología , Recurrencia , Rotura Espontánea , Tomografía Computarizada por Rayos X , Vena Cava InferiorAsunto(s)
Pulmón/diagnóstico por imagen , Pulmón/patología , Atelectasia Pulmonar/diagnóstico por imagen , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/diagnóstico por imagen , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Atelectasia Pulmonar/complicaciones , Atelectasia Pulmonar/etiología , Radiografía TorácicaRESUMEN
Sclerosing mediastinitis is a rare and benign disease, which can cause obstruction of mediastinal structures, this determines the clinical presentation and prognosis. The obstruction of pulmonary venous structures secondary to mediastinal fibrosis has been rarely reported, clinically it mimics mitral stenosis. We describe the clinical case of a young patient with idiopathic sclerosing mediastinitis. The radiologic exams found stenosis of the right pulmonary artery, the right bronchus and pulmonary veins. Through this observation, we discuss this rare entity that although benign, can also be deadly. We study the different etiologies, clinical and therapeutic possibilities.
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Mediastinitis/complicaciones , Edema Pulmonar/etiología , Esclerosis/complicaciones , Enfermedad Aguda , Femenino , Humanos , Mediastinitis/diagnóstico , Mediastinitis/diagnóstico por imagen , Edema Pulmonar/diagnóstico , Edema Pulmonar/diagnóstico por imagen , Radiografía Torácica , Esclerosis/diagnóstico , Esclerosis/diagnóstico por imagen , Adulto JovenRESUMEN
Renal failure is a rare complication of tetanus in children. It occurs following poorly controlled muscle spasms and rigidity. We describe a severe case of tetanus complicated with rhabdomyolysis and acute renal failure in a child.
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Lesión Renal Aguda/etiología , Rabdomiólisis/etiología , Tétanos/complicaciones , Niño , Humanos , Masculino , Índice de Severidad de la EnfermedadRESUMEN
OBJECTIVES: The aim of this study was to compare two approaches used for internal jugular venous cannulation: the anterior way, described by English et al. and the posterior way, described by Jernigan et al. The primary endpoint was the rate of success. The secondary endpoints were the related adverse events and the difficulty factors. STUDY DESIGN: Prospective, randomized open clinical trial. PATIENTS AND METHODS: The study took place in the vital emergency room, the operating room and the emergency intensive care unit of Ibn Sina University hospital (Rabat, Morocco), between June and September 2010. Hundred and one patients needing a central venous catheter were randomized to undergo one of the two techniques. We compared: demographics, success rates, number of attempts, difficulty factors and adverse events. RESULTS: The success rate was significantly higher in the posterior group (96% versus 68%, P < 0.001), with fewer attempts (1.3 ± 0.7 versus 2.1 ± 1.3; P < 0.001). There were less pneumothorax, (0 versus 6%) and more accidental arterial punctures (34 versus 25.5%) in the posterior group, but the difference wasn't significant. Finally, none of the difficulty factors were correlated to the failure rate. CONCLUSION: This study shows that the posterior approach in internal jugular venous cannulation is more efficient than and as safe as the anterior approach.
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Cateterismo Venoso Central/métodos , Venas Yugulares , Adulto , Anciano , Cateterismo Venoso Central/efectos adversos , Determinación de Punto Final , Femenino , Humanos , Unidades de Cuidados Intensivos , Venas Yugulares/anatomía & histología , Masculino , Errores Médicos , Persona de Mediana Edad , Neumotórax/epidemiología , Neumotórax/etiología , Estudios Prospectivos , Insuficiencia del TratamientoRESUMEN
Desmoid tumors are rare forms of low grade malignancies. They are characterized by a strong potential of local invasion. Although they are considered histologically benign they behave aggressive locally. They typically occur in the abdominal wall or within the abdomen. Mediastinal localisation is very rare. The only curative treatment is wide surgical excision but the surgery is difficult and the risk of local recurrence is high.
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Fibromatosis Abdominal/patología , Neoplasias del Mediastino/patología , Mediastino/patología , Síndrome de la Vena Cava Superior/etiología , Adulto , Taponamiento Cardíaco/etiología , Femenino , Fibromatosis Abdominal/complicaciones , Humanos , Neoplasias del Mediastino/cirugíaRESUMEN
BACKGROUND: Tripe palms is a rare cutaneous paraneoplastic syndrome, primarily evocative of lung and gastric neoplasia. Association of many paraneoplastic diseases has also been reported. PATIENTS AND METHODS: A 49-year-old man with a history of alcoholism and smoking addiction reported haemoptysis and thoracic pains present for one year. The physical examination showed left lung condensation. The skin examination revealed a thickened yellowish keratoderma with exaggerated skin ridges and digital clubbing. A diagnosis of paraneoplastic tripe palms was made, prompting repetition of the biopsy which ultimately revealed a neuroendocrine carcinoma. Skeletal scintigraphy showed periosteal proliferation with hypertrophic osteoarthropathy. COMMENTS: "Tripe palms" or "osteoarthritic acanthosis" is a paraneoplastic syndrome. It involves an acquired keratoderma taking on a yellow velvety appearance with accentuation of dermatoglyphic lines. Malignancy is discovered in over 90% of individuals with tripe palms. If malignancy is isolated, it mostly involves the lung (53%). Gastric cancer is associated in 77% of cases if the condition is associated with acanthosis nigricans. In approximately one third of cases, the keratoderma may resolve, generally after treatment of the tumour. The association of many paraneoplastic syndromes has also been reported, in particular digital clubbing and hypertrophic osteoarthropathy. At least 90% of cases of hypertrophic osteoarthropathy in adults occur in patients who have or will eventually develop a malignancy. It is characterized by periostosis of long bones, joint pain, and clubbing, and it is often seen on bone scintigraphy during staging of lung carcinoma.
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Carcinoma de Células Grandes/diagnóstico , Carcinoma Neuroendocrino/diagnóstico , Queratosis/etiología , Neoplasias Pulmonares/diagnóstico , Osteoartropatía Hipertrófica Secundaria/etiología , Síndromes Paraneoplásicos/etiología , Biomarcadores de Tumor/análisis , Carcinoma de Células Grandes/complicaciones , Carcinoma Neuroendocrino/complicaciones , Cromogranina A/análisis , Dermatoglifia , Humanos , Queratosis/patología , Neoplasias Pulmonares/complicaciones , Neoplasias Pulmonares/diagnóstico por imagen , Neoplasias Pulmonares/metabolismo , Metástasis Linfática , Masculino , Fumar Marihuana/efectos adversos , Persona de Mediana Edad , Proteínas de Neoplasias/análisis , Proteínas de Neoplasias/metabolismo , Cuidados Paliativos , Síndromes Paraneoplásicos/patología , Cintigrafía , Fumar/efectos adversos , Sinaptofisina , Tibia/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Proteínas de Transporte Vesicular/análisisAsunto(s)
Angioedema/inducido químicamente , Inhibidores de la Enzima Convertidora de Angiotensina/efectos adversos , Antihipertensivos/efectos adversos , Enalapril/efectos adversos , Angioedema/patología , Preescolar , Diuréticos/farmacología , Quimioterapia Combinada , Furosemida/farmacología , Humanos , Nicardipino/farmacología , Lengua/efectos de los fármacos , Lengua/patología , Resultado del Tratamiento , Privación de TratamientoAsunto(s)
Calcinosis/diagnóstico por imagen , Litiasis/diagnóstico por imagen , Enfermedades Pulmonares/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto , Enfermedades Asintomáticas , Bronquitis/complicaciones , Bronquitis/diagnóstico por imagen , Diagnóstico Diferencial , Humanos , Hallazgos Incidentales , Masculino , Marruecos , Proteínas Cotransportadoras de Sodio-Fosfato de Tipo IIb/genética , Tuberculosis Miliar/diagnósticoRESUMEN
Tuberculosis is still endemic in Morocco. Cutaneous tuberculosis is the fifth most common form after pleuropulmonary, glandular, digestive and urogenital tract tuberculosis. The purpose of this single-center prospective study is to describe all cases of cutaneous tuberculosis treated between May 2006 and June 2009. Diagnosis was suspected based on clinical, immunological and histological features. The main clinical presentations, i.e., scrofuloderma and gumma, were consistent with endemicity of tuberculosis in Morocco. Since definitive diagnosis by detection of the tubercle bacillus was rarely possible, therapy was usually undertaken presumptively based on clinical and laboratory findings and therapeutic response.
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Tuberculosis Cutánea , Adolescente , Adulto , Anciano , Niño , Humanos , Persona de Mediana Edad , Marruecos , Estudios Prospectivos , Tuberculosis Cutánea/diagnóstico , Tuberculosis Cutánea/tratamiento farmacológico , Adulto JovenRESUMEN
BACKGROUND: The association between smoking and tuberculosis (TB) treatment failure has not yet been assessed in Morocco. OBJECTIVE: To evaluate the impact of smoking on the failure rate of patients with TB. METHODS: A cohort of 727 new TB cases was followed between 2004 and 2009. Socio-demographic measurements and smoking status were collected by questionnaire. Treatment failure was defined according to international guidelines. Univariate analyses were used to assess associations of treatment failure with smoking status and demographic characteristics. Multivariate logistic regression was used to adjust for potential confounding. RESULTS: The patients' mean age was 35.0 ± 13.2 years. The monthly household income was <180 for 71.4% of the patients. The rate of treatment failure was 6.9%. Failure was significantly higher among smokers (9.1% vs. 4.5%; P < 0.01), alcohol drinkers (18.5% vs. 4.9%; P < 0.01), and those with a monthly income of <180 (8.4% vs. 3.3%; P < 0.01). After adjusting for confounding variables, smoking and low income remained significantly associated with treatment failure (adjusted OR 2.25, 95%CI 1.06-4.76, and 3.23, 95%CI 1.12-9.32). CONCLUSION: Smoking is associated with TB treatment failure in Morocco. Anti-smoking interventions should be incorporated into current TB case management.
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Antituberculosos/uso terapéutico , Fumar/efectos adversos , Tuberculosis/tratamiento farmacológico , Adolescente , Adulto , Anciano , Estudios de Cohortes , Humanos , Masculino , Persona de Mediana Edad , Marruecos/epidemiología , Factores de Riesgo , Fumar/epidemiología , Encuestas y Cuestionarios , Insuficiencia del Tratamiento , Tuberculosis/epidemiología , Adulto JovenRESUMEN
Despite tobacco control legislation enacted in Morocco in 1996, the Moroccan population appears to have little interest in or awareness of tobacco control measures. This household survey aimed to assess sectional study was conducted on a random sample of 9195 Moroccans. Only 33.3% knew about the antismoking legislation: 38.7% of smokers versus 32.3% of non-smokers. Among the 3050 people who knew about the law, 60.1% knew about the ban on smoking in public areas and 22.4% knew there was an obligatory health warning on tobacco packaging. The attitude questions showed that 27.2% agreed that the price of tobacco products should increase sharply and 45.0% that antismoking legislation should prohibit tobacco sales to children. These data demonstrate low levels of information among Moroccans concerning current tobacco control legislation.
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Actitud Frente a la Salud , Concienciación , Fumar/epidemiología , Fumar/legislación & jurisprudencia , Adolescente , Adulto , Distribución de Chi-Cuadrado , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Marruecos/epidemiología , Encuestas y CuestionariosRESUMEN
Despite tobacco control legislation enacted in Morocco in 1996, the Moroccan population appears to have little interest in or awareness of tobacco control measures. This household survey aimed to assess knowledge and attitudes about tobacco legislation among Moroccans, according to their smoking status. A cross-sectional study was conducted on a random sample of 9195 Moroccans. Only 33.3% knew about the antismoking legislation: 38.7% of smokers versus 323% of non-smokers. Among the 3050 people who knew about the law, 60.1% knew about the ban on smoking in public areas and 22.4% knew there was an obligatory health warning on tobacco packaging. The attitude questions showed that 27.2% agreed that the price of tobacco products should increase sharply and 45.0% that antismoking legislation should prohibit tobacco sales to children. These data demonstrate low levels of information among Moroccans concerning current tobacco control legislation