[Choosing the best panel of aeroallergen prick-tests for patients in Lebanon with rhinitis and asthma: A retrospective study of 2350 patients]. / Choix du meilleur panel de prick-tests pour explorer une rhinite ou un asthme au Liban : une étude rétrospective sur 2350 patients.

INTRODUCTION: The aim of this study was to evaluate the profile of skin prick-test reactivity to different aeroallergens in patients with rhinitis and asthma in Lebanon and its geographic variation within the country. It was also to suggest a minimal panel of allergens that should be used to detect sensitized patients. METHODS: All patients who underwent skin prick-testing, because of rhinitis and/or symptoms suggesting asthma, between 2004 to 2011 in the hôtel-Dieu de France university hospital of Beirut, were studied. The total number of patients was 2350 and all were tested with the same panel of 24 aeroallergens. A further series of 208 patients were added because Cupressaceae antigens were not included in the initial series. RESULTS: The overall rate of sensitization to any allergen was 75.6%. A battery of eleven allergens (Dermatophagoides pteronyssinus, Dermatophagoides farinae, Blomia, Parietaria, grass, Salicaceae, oak, Oleaceae, dog, cat, and cockroaches) was found to identify sensitized patients with a sensitivity of 96% and a negative predictive value of 90%. Cupressaceae should be added to this battery in view of the results of the additional series. The Bekaa region had a unique profile of sensitization. CONCLUSION: Twelve allergens are able to detect almost all sensitized patients suffering from respiratory symptoms in Lebanon.

[Validation of the Arabic Version of the Epworth Sleepiness Scale: Multicentre study]. / Validation de la version arabe de l'échelle de somnolence d'Epworth: étude multicentrique.

OBJECTIVES: The Epworth Sleepiness Scale (ESS) is a self-completion questionnaire developed in the English language and used for the evaluation of sleepiness. The objective of this study was to develop an Arabic version of ESS (AESS) and to investigate its reliability and the validity. METHODS: The AESS was created according to the recommendations of the ISPOR Task Force for Translation and Cultural Adaptation with bilingual individuals. It was applied to 91 patients referred to three sleep Lebanese centers for suspicion of sleep-related breathing diseases, and to 166 controls in good health. AESS scores of 60 patients were compared to 60 matched controls according to their age, sex and body mass index. Reproducibility was tested in 30 controls. The treatment response was tested among 15 patients after one month of CPAP treatment. RESULTS: Principal component analysis showed convergence towards only one latent factor. The AESS had a good internal consistency (Cronbach's alpha 0.76, intraclass correlation coefficient of 0.85 (IC95%: 0.76-0.92), Spearman 0.97, P<0.001). An increase in the severity of sleep apnea was accompanied by an increase in the score on the AESS (P<0.001). AESS scores improved significantly after CPAP. CONCLUSION: The AESS, a reliable and valid instrument for the evaluation of daytime sleepiness, is a valuable tool for clinical practice and multicenter research.

[Massive iatrogenic haemothorax treated by lidocaïne-adrenaline intercostal injection]. / Hémothorax iatrogène massif jugulé par injection intercostale de lidocaïne-adrénaline.

INTRODUCTION: Massive haemothorax is a relatively rare complication of thoracocentesis or the placement of tube thoracostomy. It is principally caused by intercostal vessel injury. The therapeutic approach consists in pleural drainage and sometimes thoracotomy for haemostasis. CASE REPORT: We describe a frail 72 year old patient, who developed a massive haemothorax occurring after a tube thoracostomy placing, persisting despite second pleural drainage, and complicated by deep haemodynamic shock. He was considered to have a very high risk of mortality if surgery was undertaken. Haemorrhage was totally stopped after intercostal instillation of lidocaïne-adrenaline. CONCLUSION: This case report suggests a role for pleural vasoconstrictor injection as initial treatment in case of persistent pleural haemorrhage caused by intercostal vessel injury.

[Acute respiratory distress syndrome complicating Ebstein-Barr virus pneumonia]. / SDRA par pneumonie à EBV.

INTRODUCTION: In the immuno-competent adult Ebstein-Barr virus (EBV) infection is a self-limiting disease that resolves spontaneously. CASE REPORT: We report a case of acute respiratory distress syndrome (ARDS) complicating severe EBV pneumonia and requiring prolonged artificial ventilation. The diagnosis was confirmed by specific serology and estimation of the viral load by PCR. Apart from supportive treatment with artificial ventilation the medical treatment included the use of Acyclovir and polyclonal immunoglobulins in the early phase and corticosteroids in the late phase. Recovery was progressive and complete. CONCLUSION: ARDS can complicate EBV pneumonia in an immuno-competent subject. Its management represents a diagnostic and therapeutic challenge.

[Cutaneous nodules recurring in the legs ten years before the diagnosis of Wegener's granulomatosis]. / Nodules cutanés récidivants des membres inférieurs précédant de dix ans le diagnostic de granulomatose de Wegener.

INTRODUCTION: Although cutaneous disorders preceding Wegener's granulomatosis are common, they usually are not isolated clinical features. We describe the case of a patient who presented Wegener's granulomatosis-related cutaneous disorders ten years before diagnosis, suggesting a protracted form of the disease. EXEGESIS: At first visit in 1987 a 44-year-old woman presented leg skin nodules since six months. Following biopsy clinical findings showed non-specific inflammation. Due to lung nodular lesions tuberculosis was diagnosed in 1993. Though bacteriology did not confirm diagnosis, treatment was successful. After relapse in 1996, thoracotomy was performed and anatomic pathology findings uncovered Wegener's granulomatosis. The patient's history showed many flares of skin nodules since 1986. This is only in 1997 that cutaneous pathologic findings showed the existence of Wegener's granulomatosis. CONCLUSION: The time to diagnosis after the occurrence of the first clinical signs is usually shorter than that observed. Superficial, protracted forms of the disease have been described. As in the present case, they raise diagnostic issues regarding the lack of specificity of anatomic pathology findings. This also suggests that Wegener's granulomatosis and infections might be related.

Retinoic acid receptor and retinoid X receptor alterations in lung cancer precursor lesions.

Smoking prevention will decrease lung cancer incidence in time. However, early detection would improve lung cancer prognosis in subjects at risk provided that specific markers could be identified. We previously reported that retinoic acid receptor (RAR) and retinoid X receptor (RXR) expression was altered in lung tumors. RAR-beta gene status could be derived from corresponding allelotyping and immunohistochemistry data. We now report the continued study on lung cancer precursor lesions. Fluorescence PCR-based assays were used for allelotyping at the RAR/RXR loci of: (a) 66 lung precursor lesions found at the free resection margins of 41 patients undergoing surgery for lung cancer (+ 31 paired tumors); and (b) bronchial cells also found at the free resection margins from 16 current and 8 never smokers operated on for noncancerous diseases. Three microsatellites located at 3p14-21 and 9p21 were also used for interwork comparison. Immunohistochemistry was additionally performed to evaluate P53 and RAR-beta expression in precursor lesions. Chi2 tests showed significant differences (P < 0.05) when comparing the results obtained from never smokers, smokers, squamous metaplasia, dysplasia + in situ carcinoma, and tumors. Microsatellite changes occurred frequently in all samples, but without specificity for any group (P < 0.08-0.52). They were globally correlated with tobacco exposure (P < 0.04), for which the RAR-gamma marker appeared as a preferential target (P < 0.004). Few reparation error phenotypes were observed, mostly at the RXR-alpha and RXR-gamma markers for which combined changes were also linearly increasing from never smokers to dysplasia + in situ carcinoma (P < 0.05 and P < 0.03). RAR-beta marker losses also increased from the first to the last group studied (P < 0.01), with a concomitant decrease in RAR-beta protein expression and correlated p53 increased immunoreactivity (P < 0.02). Losses at 3p14, 3p21, and P16 were frequent, but no significant differences between groups could be found. Unexpectedly, high constitutive homozygosity was observed near the RAR-alpha locus in squamous cell lung cancer cases. RARs/RXRs form homodimers or heterodimers involved in ligand binding. Their added alterations could result in a state of functional vitamin A deficiency in the affected bronchial cells. Further deletion events drawn from a limited repertoire of specific regions such as 3p14-21 and 9p21 could subsequently drive the deficient cells to invasive carcinoma.

Complex allele [-102T>A+S549R(T>G)] is associated with milder forms of cystic fibrosis than allele S549R(T>G) alone.

We recently reported a novel complex allele in the cystic fibrosis transmembrane regulator (CFTR) gene, combining a sequence change in the minimal CFTR promoter (-102T>A) and a missense mutation in exon 11 [S549R(T>G)]. Here we compare the main clinical features of six patients with cystic fibrosis (CF) carrying the complex allele [-102T>A+S549R(T>G)] with those of 16 CF patients homozygous for mutation S549R(T>G) alone. Age at diagnosis was higher, and current age was significantly higher (P=0.0032) in the group with the complex allele, compared with the S549R/S549R group. Although the proportion of patients with lung colonization was similar in both groups, the age at onset was significantly higher in the group with the complex allele (P=0.0022). Patients with the complex allele also had significantly lower sweat test chloride values (P=0.0028) and better overall clinical scores (P=0.004). None of the 22 patients reported in this study had meconium ileus. All 16 patients homozygous for S549R(T>G), however, were pancreatic insufficient, as compared with 50% of patients carrying the complex allele (P=0.013). Moreover, the unique patient homozygous for [-102T>A+S549R(T>G)] presented with a mild disease at 34 years of age. These observations strongly suggest that the sequence change (-102T>A) in the CFTR minimal promoter could attenuate the severe clinical phenotype associated with mutation S549R(T>G).