Unicentric Castleman's disease: an uncommon cause of chronic cough.

Castleman disease (CD) or angiofollicular lymph node hyperplasia is a rare lymphoproliferative disorder characterized by lymph node hyperplasia of uncertain etiology. CD is divided clinically into unicentric (localized to one region of the body) considered as a benign disease and multicentric with less favourable prognosis. We describe a case of intrathoracic unicentric CD revealed by a chronic non-productive cough in a 50-year-old non-smoker female. Chest computed tomography revealed a bulky right hilar mass with intense homogenous contrast enhancement. The patient underwent a right upper lobectomy and mediastinal lymphadenectomy. Histopathology was consistent with hyaline-vascular (HV) type CD. The patient remained asymptomatic throughout the subsequent 6-months of follow-up.

Chronic arthritis revealing sarcoidosis in a patient exposed to silica.

Sarcoidosis is a systematic, granulomatous disease of unknown cause which can affect any organ in the body. Pulmonary involvement is the most common. Musculoskeletal manifestations of sarcoidosis are less common affecting 10-25% of patients and chronic arthritis occurs rarely. We report the case of sarcoidosis revealed by left knee chronic and destructive monoarthritis with only asymptomatic pulmonary involvement in a Caucasian male miner exposed to silica. The patient was treated with corticosteroids during 2 years after diagnosis. In addition, arthroplasty with total left knee prosthesis was performed. The patient is well without any recurrence of symptoms of the musculoskeletal system for a 2 years follow-up period after surgery.

Impact of malnutrition in advanced non-small cell lung cancer.

BACKGROUND: Malnutrition is so commonly associated with cancer disease. Our work aims to highlight the impact of malnutrition on the survival and toxicity of chemotherapy in patients with advanced stages of non-small cell lung cancer (NSCLC). METHODS: A retrospective study including 60 patients followed for NSCLC stage IIIB and IV, between January 2007 and December 2013. An evaluation of the impact of malnutrition was carried out according to different markers (weight loss, body mass index (BMI), albumin and NRI score). RESULTS: The mean age was 59. Taking Weight loss> 10 % as a criterion of malnutrition, 22% of patients were malnourished. Based on a BMI lower than 18.5 Kg/m², 14% of patients were malnourished. Ganglionic extension, anemia and hypoalbuminaemia were associated with malnutrition (p=0.016; p=0.02 and p=0.03 respectively). The Overall survival (OS) was 2.65 months and 6.95 months (p <0.0003) in malnourished and non-malnourished groups. The definition of malnutrition can also be based on an albumin level <35 g/l. According to this criterion, 55% of the patients were undernourished. Anemia and lymphopenia were associated with malnutrition respectively (p=0.002; p=0.001). The OS was 4.45 months and 8.42 months respectively in malnourished and non-malnourished groups (p <0.0002). NRI score<100 and <97.5 (moderate to severe malnutrition) was found in respectively 100% and 74 % of patients. The OS was 4.67 months and 9.12 months respectively in moderate to severe malnutrition (NRI<97.5) and mild malnutrition groups (NRI≥97.5) (p<0.001). CONCLUSION: Malnutrition was common in patients with advanced stage of NSCLC and was associated with poor prognosis.

Brain metastases of non-small cell lung cancer: prognostic factors and management.

BACKGROUND: The prognosis of patients with non-small cell lung cancer (NSCLC) with brain metastasis (BM) is dark. The aim of our study was to analyze the prognostic factors after the onset of BM and to evaluate the current management of BM. METHODS: We conducted a retrospective study that included 100 patients diagnosed with primary NSCLC with BM. Survival was analysed using Kaplan Meier curve.Univariate survival analysis was performed to assess the prognostic value of sex, age, gender, performance status, histologic type, tumor size, BM features and treatment modality of primary lung tumor and BM. RESULTS: The median age was 57 years; 94% of the patients were male. Most patients (85%) had a PS of (0-1). BM were unique in 54% of cases, symptomatic in 40% of cases and synchronous in 72% of cases. Chemotherapy was administered to 78% of patients; pulmonary tumor surgery was performed in 5% of patients. BM surgery and panencephalic irradiation were performed in 13% and 86% of patients, respectively. The median overall survival after NSCLC diagnosis was 13.33 months. The median overall survival after BM was 10.6 months. The Control of the primary tumor was the only factor associated with better overall survival (64.95 months Vs 10.6 months (p=0.02)). CONCLUSION: Pulmonary tumor control with complete surgical excision is predictive of better overall survival in patients with NSCLC and BM.

Prognostic factors for second-line chemotherapy of metastatic non-small-cell lung cancer.

BACKGROUND: Few studies have been conduct¬ed to determine prognostic factors of second-line chemotherapy. The aim of this study was to determine the prognostic factors for survival in patients receiving second-line treatment for advanced NSCLC. METHODS: We retrospectively reviewed the records of 71 patients with metastatic NSCLC who received second-line chemotherapy from January 2006 to January 2013. RESULTS: The mean age was 57 years. All patients were male. The performance status was 0 or 1 in 90.1% of cases. Sixty-four patients received a first line platinum-based chemotherapy. The second line chemotherapy regimen was docetaxel in 31 cases and pemetrexed in 18 cases. Fourteen patients (19.71%) had received third-line chemotherapy. The median overall survival was 13.5 months. Age older than 65 years (p=0.025), advanced T stage (T4 versus T3 and T2; p=0.01), advanced N stage (N3 versus N2 and N1; p=0.001), lower level hemoglobin (p=0.05) and non-responders who showed progression with first-line chemotherapy (p=0.04) were significant negative predictors in univariate analysis for overall survival (OS). The multivariate analysis showed that age≥ 65 years (HR=2.15; 95% CI[1.26-2.44]), advanced N stage (HR=2.273; 95% CI [1.26-2.44]) were independent prognostic factors for OS. CONCLUSION: Age and advanced N stage were important factors in predicting the outcome of advanced NSCLC patients who were undergoing second-line chemotherapy.

Advanced Lung Cancer Inflammation index: a prognostic score in patients with metastatic non-small cell lung cancer.

INTRODUCTION: Recent studies have identified that inflammation had a significant association with cancer development and progression. AIM: To explore the relationship between ALI score and prognosis of metastatic non-small cell lung cancer (NSCLC). METHODS: we conducted a retrospective study of 41 patients with metastatic NSCLC diagnosed between January2010 and January2012. ALI was calculated as body mass index x serum albumin/neutrophil to lymphocyte ratio. Patients were divided as low inflammation (ALI≥23.2) and high inflammation (ALI<23.2) groups. RESULTS: Mean age was 56.3 years, 100% were male, and 49% had adenocarcinoma. The overall survival was 8.9months. Median ALI was 23.2. The median overall survival was 6.7 months and 11.3 months respectively in patients with ALI score<23.2 and ≥23.2 (p=0.043). On multivariate analysis, ALI score < 23.2 remained significantly associated with worse outcome. CONCLUSION: Lower ALI (<23.2) was significantly associated with worse overall survival in metastatic NSCLC. The assessment of the ALI is inexpensive and widely available; it could help in identifying patients with poor prognosis in clinical routine practice.

Combined C-reactive protein and Neutrophil to Lymphocyte ratio use predict survival innon-small-cell lung cancer.

BACKGROUND: Inflammation markers have been shown to predict prognosis during cancer including non-small cell lung cancer (NSCLC). In particular, C-reactive protein (CRP) and Neutrophil to Lymphocyte Ratio (NLR) have been investigated. The aim of our work is to study the combination of these two markers in optimizing prognostication in advanced NSCLC. METHODS:   We conducted a retrospective study that included all patients diagnosed with primary NSCLC stage IIIB or IV in our respiratory department from January 2005 to January 2013. RESULTS: A total of 142 male patients were included. Most of them (80.3%) had a Performance Status (PS) 0-1. Median progression-free survival (PFS) was 4.6 months (95% confidence interval (CI) 3.9-5.3) and median overall survival (OS) was 8.9 months (95%CI7.7-10.1). Survival analysis showed that CRP<10 mg/l and NLR<3.87 were predictive of better prognostic (respectively p= 0.015 and 0.049), along with chemotherapy use (p<0.0001), PS <2 (p=0.009) and age<65 (p=0.013). In addition, combined use of NLR and CRP was significantly associated with OS (p=0.0009). Median OS for patients having both high NLR (≥3.87) and CRP (≥10 mg/l) was 6.7 months. It was significantly shorter than patients having only one elevated inflammatory marker (8.8 months; p=0.025). CONCLUSIONS: High CRP and NLR (≥10 mg/l and ≥ 3.87 respectively) were associated with poorer survival in advanced NSCLC. Their combined use maximizes their prognostic value.

Assessment of eating behavior after smoking cessation.

Background Weight gain is very frequent after smoking cessation and constitutes an obstacle to the decision to quit smoking. Aim To assess the impact of smoking cessation on the weight and eating behaviour. Methods This was a prospective study that included thirty four smokers. A questionnaire allowing the assessment of the eating behaviour was given to all smokers at the first consultation and at one month of smoking cessation. Results The mean age was 40.32 years. Thirty two smokers were males. The mean weight had increased by 1.7 kg at 1 month of smoking cessation (p=0.00). The increase of weight was significativelly associated with the female gender, the age of smoking initiation and the consumption of cigarettes per day. The waist and hip circumferences had also increased (p=0.00). The calories intake had increased from 3875.70 Calories to 4168.85 Calories (p=0.03). Snacking had increased from de 73.5% to 82.4% (p= 0.263). The intake of lipids and carbohydrates had not changed. The intake of protein had decreased from 14.57% to 13.5% (p= 0.041). An increase of the intake of fiber (p= 0.033), zinc (p= 0.033), and vitB9 (p= 0.044) had been noted. Conclusion The weight gain is an unwanted effect of smoking cessation which justifies a global care.

The Pollen-Food Olive-Olive Syndrome.

BACKGROUND: The pollen-foods syndrome is rare and of difficult diagnosis. The aim is to report a rare case, it's the four case reported in the literature. CASE REPORT: A 48-year-old woman presenting with palatal itching and generalized urticaria following ingestion of olive fruit, 5 years after being diagnosed with olive pollinosis. She did not have a history of other food allergy or urticaria. The prick-test was positive in olive pollen.The olive pollen specific IgE was positive. The oral provocation test was positive for olives and negative for olive oil. The diagnosis of "pollen-food olive-olive syndrome" was accepted. Interestingly, in this rare case the patient developed olive fruit allergy in the presence of olive pollinosis, but did not experience allergic symptoms to fruits other than olive. CONCLUSION: In spite its rarity this syndrome should be evoke particularly in our country.

[Extended pulmonary tuberculosis and immunocompetence: causes and consequences]. / La tuberculose étendue de l'mmunocompétent: causes et consequences.

BACKGROUND: Despite scientific advances, extended forms of pulmonary tuberculosis are still relevant. The aim of our study was to determine clinical features and outcome of extended pulmonary tuberculosis in immunocompetent patients. METHODS: Retrospective comparative study including 100 patients HIV negative, presenting pulmonary tuberculosis divided into 2 groups of 50 patients (group1: extended tuberculosis and group2: localized tuberculosis). Tuberculosis was considered extended when reaching above one lobe. RESULTS: The average age was comparable in the 2 groups (p = 0.138). In group1, we noted a higher incidence of diabetes (p = 0.037) and malnutrition (p = 0.045). Clinically, patients in group1 had more general signs (p=0.033) and dyspnoea (p=0.037). Biologically, anemia (p<0.001), leukocytosis (p=0.05), elevated CRP (p=0.031), thrombocytosis (p=0.023), hyponatremia (p = 0.001) and liver disturbances (p = 0.001) were significantly more frequent in group1. Concerning the evolution, time to smear negativity was significantly longer (p=0.012). Similarly, radiological sequelae were more frequent (p = 0.02) and more extensive (p = 0.012). Positive predictive value of radiological extent in disease evolution was 62% with a confidence interval between 47.2% and 75%. CONCLUSIONS: The extent of pulmonary tuberculosis is an important factor in clinical and biological presentation and disease evolution. Indeed, patients with extended tuberculosis develop more severe presentation and are more likely to develop parenchymal sequelae.

[Lung cancer with venous thrombo-embolism: clinical characteristics]. / Maladie veineuse thromboembolique en cas de cancer bronchopulmonaire : approche clinique.

BACKGROUND: Lung cancer is the most common malignancy diagnosed in patients with venous thrombo-embolism (VTE). AIM: To investigate clinical, biological, radiological features and survival of lung cancer patients with VTE. METHODS: Retrospective case-control study investigating biologic, clinical course and survival of 25 patients lung cancers with VTE (Group M) and 50 lung cancers without VTE (group T). RESULTS: The frequency of the VTE was 5.88% with 2.58% pulmonary embolism (PE). The mean age was 58 years ± 9.8 in group M and 57.9 years ± 9.6 in group T. No significant difference concerning medical or surgical history for both groups was found. The dyspnea and chest pain were at equal frequency (63.6%). Regarding the clinical probability of the PE, it was no significant differences between the two groups. A rate of D-dimer > 0.7µg/l was more frequent among group M (75% vs 20%; p = 0.054). The most common histological type was nonsmall cell lung cancer (88%). A stage IV was significantly more frequent in group M (86.4% vs. 52.3%; p = 0.007). The mean period of survival in Group M was 10.6 ± 1.2 month and 20.2 + 1.8 month in group T; p = 0.38. CONCLUSION: The VTE associated to lung cancer is under diagnosed. Prospective studies are needed to establish more adapted scores.

[Palliative chemotherapy of non small lung cancer in Tunisia. Prospective study of the cost and impact on the quality of life]. / Chimiothérapie palliative des cancers bronchiques non à petites cellules (CBNPC) métastatiques en Tunisie: etude prospective du coût et impact sur la qualité de vie.

BACKGROUND: Bronchopulmonary cancer is actually the first cancer in the world. In Tunisia, recent statistics are alarmous. The most bronchopulmonary cancer in tunisian series are diagnosis at metastatic states. AIM: To evaluate the cost of the global treatment by chemotherapy in patients with metastatic non small lung cancer and its impact over the quality of life in Tunisia. METHODS: It's a prospective study lead between January 2006 and Juin 2007 to evaluate the quality of life for patients hading metastatic non small lung cancer treated by palliative chemotherapy in Ibn Nafiss department in Abderrahmen Mami hospital.The evaluation of the quality of life is inspired by the questionnaire of EORTC: QLQC30 version 3 translated in en Arab language, filled before chemotherapy, after the le 3rd cycle, and at the end of the first ligne. The study of the cost is effected for the 2 protocols whose the most used in first ligne : Cisplatin-Vinorelbine (P-V) and Cisplatin- Gemcitabine (P-G) RESULTS: 30 patients had benefit from palliative chemotherapy based on P-V (18 cases) or P-G (12 cases). All patients had responded for the questionnaire in the opportunity moments. After 3 cycles of chemotherapy, we note an improve of the symptomatic, physical, activity, emotional and global health scales. In opposition, we note a deterioration of cognitive and social scales without any supplementary improvement(no significant difference) if we add other cycles in the twice protocols. At the same level of the benefit in term of quality of life and survival without supplementary toxicity, the choice is made by the less cost's protocol in other words P-V. CONCLUSION: Our results confirm the benefit from chemotherapy in term of survival and quality of life in our context, however, the important cost of the chemotherapy necessitate to rationalize the indications and the le choice of the treatments in this palliative indication.

[A rare costal tumor]. / A propos d'une tumeur costale rare.

BACKGROUND: Costal primary tumors are rare and dominated by malignant tumors. Hemangioma of the bone represents only 1% of the bone tumors. Costal localization accounts only for 1% of the cases and only about fifty cases have been reported in the literature. AIM: To describe a rare costal tumor, its histological features and the main differential diagnoses. OBSERVATION: The authors describe the case of a 46 - year-old woman who present with chest pain. Radiological findings didn't allow to rule out a malignant tumor and the treatment consisted in the resection of the posterior arch of the rib. Microscopic examination concluded to a costal hemangioma and the patient didn't present recurrences after 6 years of follow up. CONCLUSION: Costal hemangioma is an exceptional tumor with a debated etiology. Some radiological features may be specific but the diagnosis is based on histological findings. These tumours have a good prognosis and no case of recurrence have been reported in the literature.

[Pulmonary tuberculosis in smokers]. / Particularités de la tuberculose pulmonaire chez le tabagique.

INTRODUCTION: Tobacco smoking and tuberculosis (TB) are two major public health problems, and the former may affect the morbidity and mortality rates for the latter. This study sought to compare the clinical and radiologic aspects of pulmonary TB, as well as outcome, in smokers and nonsmokers. METHODS: This retrospective case control study examined the files of 90 patients in our pulmonary department with active pulmonary TB, 45 of them smokers and 45, nonsmokers. To analyze the seriousness of the radiologic lesions, we used a score based on the International Labour Organization classification for simple pneumoconiosis, rating lesions in 4 grades according to severity and extent. RESULTS: The mean age of the patients, all men, was 29 years (range: 16-50 years). Symptoms were similar in both groups, with no significant clinical or bacteriological differences between the two groups. However, the highest severity score was found in 81% of the smoking group compared with 15% of the nonsmokers (p<0.001). Moreover, after patients were cured, only smokers had severe radiological sequelae (13.8% versus 0%, p<0.05). CONCLUSION: Our study is one of the few to compare the radiological appearance of TB in smoking and nonsmoking patients. Smoking is associated with much more extensive and severe radiological TB lesions and sequelae and increases the risk of morbidity and mortality in TB patients. Therefore smoking prevention and cessation should be a priority in TB prevention programs.