Évolution catastrophique d'une électrisation des deux membres supérieurs: désarticulation bilaté-rale des épaules.

The importance of tissue damage secondary to high voltage electrical injury to the limbs often makes the management of this kind of burn very difficult. Repair interventions are sometimes ineffective and amputations are then unavoidable. We report the case of a young patient suffering electrical injury to both upper limbs caused by a high voltage current, whose evolution was dramatically marked by bilateral disarticulation of both shoulders.

[Unusual complication of noninvasive ventilation: The œsogastric pneumatosis associated with a subcutaneous emphysema]. / Complication inhabituelle de la ventilation non invasive : la pneumatose œsogastrique associée à un emphysème sous-cutané

The non-invasive ventilation (NIV) is a technique of ventilator support to avoid endotracheal intubation and its potential complications. However, it has some complications that are usually harmless to type of erythema and/or cutaneous ulcerations, mouth or nose dryness, conjunctival irritation and rarely lesions of barotrauma, volotrauma or gastric insufflation with nausea and vomiting. We report the case of a patient who had an unusual complication of NIV: sub mucosa gastro-esophageal pneumatosis associated with subcutaneous emphysema occurring on the second day after one hepatectomy which was settled but complicated with a postoperative pulmonary aspiration syndrome.

[Incidence of venous thromboembolism in men admitted to a pneumology unit for acute respiratory disease]. / Incidence de la maladie thromboembolique veineuse chez des hommes admis dans un service de pneumologie pour affection respiratoire aiguë

BACKGROUND: Venous thromboembolism (VTE) is a major source of morbidity and mortality all over the world. It is one of the complications arising in a hospital environment. The main aim of this study is to estimate the incidence of VTE in respiratory inpatients. METHOD: The authors carried out a prospective study on acute respiratory disease inpatients. A medical analytical index card was used. An echo-venous Doppler of lower limbs was practiced on D1 and D10 of hospitalization. The Wells scored was used to estimate the clinical probability of the occurrence of VTE. RESULTS: Seven of 100 patients studied developed VTE (95% CI : 2-12%), four of which presented a pulmonary embolism. The patients with VTE are 60-years-old±11.67. The incidence of VTE includes 20% (95% CI : 12.2-27.8%) of the patients hospitalized for bronchial cancer, 7.14% (95% CI : 2.1-12.18) of the patients presenting pulmonary tuberculosis and 4.54% (95% CI : 0.46-8.62%) of the patients hospitalized for exacerbation of chronic obstructive pulmonary disease (COPD). The duration of hospitalization was prolonged for the treatment of VTE (21±4.41 days for these patients compared with 12±5 days in the absence of VTE (P<0.001)). The analysis of the various risk factors shows that a Performance Status>2 (P=0.005) and lung cancer (P=0.028) are the factors most incriminated in the occurrence of VTE. It is associated with a mortality of 2%. CONCLUSION: VTE is a reality which is necessary to prevent in respiratory inpatients in situations at risk, especially in patients with lung cancer and with a PS>2.

[Hypertrophic osteoarthropathy associated with pulmonary tuberculosis]. / Ostéoarthropathie hypertrophique pneumique associée à la tuberculose pulmonaire.

Hypertrophic osteoarthropathy is a syndrome frequently described in intrathoracic diseases, especially malignant ones. The association with lung tuberculosis is rarely reported. The authors describe the case of a 35-year-old patient, a smoker, hospitalised for lung cavitation associated with hypertrophic osteoarthropathy. The assessment of the aetiology was negative and the patient underwent lung surgery. The histopathological examination concluded as to chronic pulmonary tuberculosis. This report aims at alerting physicians about the possibility of hypertrophic osteoarthropathy in non malignant diseases, especially pulmonary tuberculosis which is still endemic in our country.

[Epithelioid hemangioendothelioma mimicking hypersensitivity pneumonitis]. / Hémangioendothéliome épithélioïde pulmonaire mimant une pneumopathie d'hypersensibilité

Epithelioid haemangioendothelioma is a rare vascular tumour of slow growth and unfavourable outcome. The diagnosis of the pulmonary localisation is difficult and can mimic by clinical and radiological features other diagnosis as hypersensitivity pneumonitis. We report the case of a 28-year-old man, farmer handling with palm tree pollens, admitted to the hospital for dry cough. Clinical and thoracic computed tomography findings revealed diffuse infiltrating pneumopathy; bronchoalveolar lavage results and professional exposure were suggestive for hypersensivity pneumonitis. Surgical lung biopsy with immunochemistry study concluded to pulmonary epithelioid haemangioendothelioma. Extra pulmonary localisation research was negative. No treatment was indicated. At three years, the patient is steel asymptomatic. Epithelioid haemangioendothelioma is a tumour of intermediate malignancy, of which pulmonary localisation has a nonspecific clinical presentation mimicking diffuse infiltrating pneumonitis. Diagnosis is essentially made by surgical lung biopsy with pathological and immunohistochemical study.

Desmoid tumour of the chest wall in a patient with a previous aortocoronary bypass: a complication or a coincidence?

Desmoid tumour is an uncommon, locally invasive non-metastasizing neoplastic lesion. The pathogenesis of this tumour is unclear and its treatment is controversial. In this paper, the authors report a new case of chest wall desmoid tumour in a 67-year-old man previously operated by sternotomy for a triple aortocoronary bypass. To the best of our knowledge only two cases of thoracic desmoid tumours following aortocoronary bypass have been reported in literature. The correlation between the site of the surgical approach and the tumour, and the time interval between surgery and presentation, supports the hypothesis of a causal role of surgical trauma in the occurrence of this tumour. The Authors discuss the pathogenesis of this tumour with review of the current literature.

[Acute rhabdomyolysis during pneumococcal pneumonia: two cases]. / Rhabdomyolyse aiguë au cours des pneumonies à pneumocoque. A propos de deux observations.

Acute rhabdomyolysis is a clinical and biological syndrome generally with a toxic or traumatic cause. Only 5% of cases are infectious, and rarely in relation to a pneumococcal infection. We report two cases of acute rhabdomyolysis which developed in patients with severe Streptococcus pneumoniae pneumonia. No other cause could be identified in these two patients aged 32 and 37 years. Rhabdomyolysis was discovered in the first patient because of acute kidney failure and elevated serum transaminase levels. The second patient presented an inflammatory edema affecting the soft tissues. Blood cultures isolated a pneumococcus in both patients. The rhabdomyolysis regressed favorably in both patients despite the transient renal failure in the first patient. Prognosis is generally poor for rhabdomyolysis during the course of pneumococcal pneumonia, with increased morbidity and mortality for these infections. Early detection of bacteriemia enables rapid and adequate treatment and prevention of renal failure.

[Smoking cessation program in Tunisia: experience of a respiratory service]. / Aide au sevrage tabagique en Tunisie: expérience d'un service de pneumologie.

A tobacco cessation programme was recently introduced into medical practice in Tunisia. The medical staff in the pulmonary disease ward at Charles Nicolle Hospital, Tunis, has been the first to implement such a programme for people motivated to quit smoking. This programme has been run for 3 years in the respiratory disease out-patient department. It acts essentially against psychological and pharmacological dependence on tobacco. The results obtained were very encouraging: 298 smokers have participated in this programme. The global success rate at 12 months of tobacco withdrawal was about 25% for people who were followed up, and 17% for the whole sample. Medical help for smoking cessation should be more widely promoted in Tunisia to increase the number of smokers who consult and improve the quality of medical intervention.