[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.

[Allergic bronchopulmonary aspergillosis. A review of 3 cases]. / L'aspergillose broncho-pulmonaire allergique. A propos de 3 cas.

BACKGROUND: Allergic bronchopulmonary aspergillosis (ABPA) is a rare affection, initially described in 1952. Its pathophysiology incriminate several mechanisms in relation with the organism of the patient and the bronchial colonisation by the fongic agent. AIM: To report three cases of ABPA. CASES REPORT: Three patients had been treated for ABPA in Ibn Nafiss department in Abderrahmen Mami hospital in Ariana. ABPA had been discovered in the three cases by a cortico dependant asthma, refractory for different therapeutics. Positive diagnosis reposed in the 3 patients at 6 major and one minor criterion. Treatment was essentially based in corticotherapy. CONCLUSION: Positive diagnosis of ABPA is actually well established, however, its treatment, although based on corticotherapy, remind not clearly codified. Association of antifongic treatment may improve the prognosis.

[Pulmonary atinomycosis: a great clinical polymorphism]. / Actinomycose pulmonaire: un grand polymorphisme clinique.

BACKGROUND: Pulmonary actinomycosis is a rare bacteriological disease, caracterized by local suppuration and an extensive fibroinflammatory process, with a possible pseudotumoral outcome. AIM: To report a new observation of a pulmonary actinomycosis. CASE REPORT: A 52-year-old patient, smoker, admitted in our department for infectious pneumopathy complicated by purulent pleurisy. Clinical and radiological findings were not contributive.Fiberoptic had evocate the diagnosis of bronchopulmonary cancer. Evolution had been marqued by abondant hemoptysia indicating right low lobectomie. The diagnosis of actinomycosis was obtained by the pathology of the surgical resection. CONCLUSION: Diagnosis of pulmonary actinomycosis can be difficult because it can mimic the presentation of lung carcinoma.If the diagnosis is no late established, and if the patient is correctely treated medically, the prognosis still excellent.

[Thoracic manifestations of systemic lupus erythematosus]. / Manifestations thoraciques du lupus érythémateux systémique.

BACKGROUND: Systemic lupus erythematosus (SLE) is an autoimmune disease. The respiratory system is more commonly involved in SLE than in any other collagen vascular disease. AIM: To study the pleuropulmonary manifestations of SLE. METHODS: Retrospective study including 10 patients hospitalized between January 2000 and December 2008 for pleuro-pulmonary manifestation revealing or complicating the SLE. RESULTS: Nine women and only one man aged between 21 and 67 years-old were included in this study. Two patients had already SLE and for the other patients the pleuro-pulmonary manifestations were revealing the SLE. Pleural effusion was the most common manifestation witch represents 50% of the patients. For the other patients we find one case of interstitial pneumonia, one case of pulmonary embolism, on case of pneumonia, on case of pulmonary haemorrhage and on case of pulmonary hypertension. All these patients were treated by corticoids and only one patient takes high doses of corticoids for managing a massive pulmonary haemorrhage. The evolution was favourable for 9 patients, one patient dead because of massive pulmonary haemorrhage complicated with acute respiratory failure. CONCLUSION: Pleuro-pulmonary involvement in SLE is common and may be life threatening, in which case prompt and aggressive treatment is mandatory.

[Neoplasic vena cava syndrome]. / Le syndrome cave supérieur néoplasique.

BACKGROUND: Vena cava superior syndrome results of an obstruction of superior vein cava(SVC)and/or brachiocaphalic venous troncs by extrinsic compression and/or by tumoral or cruoric thrombosis. The bronchopulmonary cancer represents the most frequent aetiology. AIM: The aim of this study is to establish clinical, radiological, evolutive profiles and modalities of treatment of neoplasic vena cava superior syndrome independently of its histological type. METHODS: It is a retrospective study about 20 patients presenting vena cava superior syndrome complicating primary bronchopulmonary cancer, hospitalised between January 2000 and December 2007 in Ibn Nafiss department in Abderrahmen Mami hospital. RESULTS: All patients were males with an average of 57,8 years. Vena cava superior syndrome had revealed cancer in 60% of cases. It was metachrone in 40% of the patients. The most frequent histological type was small cell lung cancer. Treatment was proceeded in 2 steps, symptomatic and etiologic for the bronchopulmonary cancer. CONCLUSION: The bronchopulmonary cancer is the most frequent aetiology of vena cava superior syndrome. Its treatment is actually well codified.

[Adjuvant chemotherapy in resected non small cell lung cancer: preliminary results about 8 cases]. / Chimiothérapie Adjuvante Des Cancers Bronchopulmonaires Non A Petites Cellules Opérés: Résultats Préliminaires A Propos De 8 Cas.

AIM: Report the preliminary results of adjuvant chemotherapy in patients surgically treated for non small lung cancer. METHODS: It's a prospective study about 12 patients surgically treated between January 2005 and December 2007.8 patients had benefit of adjuvant chemotherapy. The protocol had been based at 4 cycles of Cisplatine. RESULTS: Our 8 men patients, aged for the mean of 59 years with a Performans Status at 1, had benefit of adjuvant chemotherapy after curative surgery. Six patients considered us II B stage, had benefit immediately for surgically treatment. Adjuvant chemotherapy protocol had been based of Cisplatin and Vinorelbine (5 patients) and Cisplatin and Gemcitabine (1 patient). The 4 cycles can be administered without any limiting toxicity only for one patient who's received 2 cycles of Cisplatin and Gemcitabine in front of the severity of digestive side effects. Two patients considered us IIIB stage, had been surgically treated after neo adjuvant chemotherapy based at Cisplatin and Vinorelbine. Histological response was complete for twice of them. The same chemotherapy was stopped after 2 cycles us adjuvant, in front of haematological side effects. Two patients did at 4 and 15 months of neoplasic progression. The six other patients had been still on life with a move back of 33 months. CONCLUSION: Post operative adjuvant chemotherapy is the standard treatment for the II A and II B stages and probably for IB stage. For none immediately operative patients (IIIA and some III B), articulation of chemotherapy with surgery must be clarified.

[Rare localization of sarcoma in an adolescent: thoracic Ewing sarcoma]. / Localisation rare du sarcome de l'enfant: sarcome d'Ewing thoracique.

BACKGROUND: Ewing Sarcoma is considered as primitive neuro ectodermic tumor. It's the most frequent osseous tumor in children and adolescent. It was localised frequently at long osseous and pelvis, however, it can be arising from the rib. AIM: this article aimed to show that Ewing sarcome could arise twely from thorax. CASE REPORT: We report the case of 15-year-old girl, admitted in our hospital because of left scapular pain with important weight loss. Chest X ray showed dense left latero tracheal opacity with mediastinal limits. Bronchofiberoscopy was performed and it showed no abnormalities. Thoracic CT scan and MRI noted left posteroir expansif mediastinal process infiltrating D2, D3 and homolateral conjugation's canal. This process was associated at vertebral metastasis in D1, D4 and D8.Rapid clinical aggravation, with installation for medullar compression was noted. The patient had benefit for three cures of decompress radiotherapy and treated by laminectomy of dorsal vertebras in neurosurgery department. Morphologic aspects and immunohistochimical study for the operator piece concluded at Ewing sarcoma of the children considered as primitive neuro ectodermic tumor. Six cures of chemotherapy had been prescribed with well recuperation of the motor failure. She still on life since 7 months. CONCLUSION: Even rare, thoracic localisation of Ewing sarcoma in not exceptional, it is necessary to evocate it in front of mediastinal mass.

Pulmonary metastases revealing choriocarcinoma.

BACKGROUND: Uterin choriocarcinoma is a trophoblastic tumour characterised by high metastasis potential. Pleuropulmonary metastasis can reveal rarely the neoplasm. AIM: Repport a new case. CASE REPORT: We report the case of a 31-years-old woman, with no pathological antecedent, admitted in our department for thoracic pain and haemoptysis occurring two months after delivery of a did in child-birth. Chest X ray and thoracic CT scan showed several bilateral opacities. A diagnosis of metastatic choriocarcinoma was confirmed by plasmatic level of beta human chorionic gonadotrophin (beta HCG) superior to 4000 UI/ml. Gynaecological exam revealed latero-uterine mass. Abdomino-pelvien ultra sound and CT scan showed tissular latero uterine and hepatic masses. Brain CT scan had been normal. Patient died after 3 cures of chemotherapy because of acute respiratory failure caused by massive pulmonary embolism. CONCLUSION: Diagnosis of choriocarcinoma must be evocated in front of several pulmonary opacities occurring in genital activity women and necessities the dosage of level of BHCG.