Rasmussen aneurysm: A forgotten complication of tuberculosis in the COVID-19 era.

COVID-19 pandemic has led to an overwhelming healthcare system causing a delay in management of other infectious diseases such as tuberculosis. Rasmussen aneurysm (RA) appears in chronic cavitary tuberculosis. We report here, three cases of pulmonary tuberculosis complicated by RA admitted to Department 1 of Abderrahmane Mami hospital in Tunisia. Data were collected from June 2020 to September 2021. All patients presented with hemoptysis. Sputum was positive for the acid-fast bacilli. Computed tomographic pulmonary angiography showed RA. Only one patient underwent emergent glue embolization. These cases give an insight into the importance of timely therapeutic care for tuberculosis.

[Prognostic factors of advanced stage non-small-cell lung cancer]. / Facteurs pronostiques du cancer bronchique non à petites cellules au stade avancé.

INTRODUCTION: Primary lung cancer is the leading cause of cancer death in men in the world. Although the introduction of new drugs, new therapeutic strategies and despite therapeutic advances, the prognosis is relatively improved during the last years. AIM: To evaluate the prognosis of patients with locally advanced or metastatic non-small-cell lung cancer (NSCLC) and to identify prognostic factors at these stages. METHODS: A retrospective study, including 140 cases of locally advanced or metastatic NSCLC diagnosed in our department between 2003 and 2013. RESULTS: The average age was 61±10 years (35 to 90 years). Sex ratio was 18. The delays management were 80±25 days for presentation, 45±20 days for the diagnostic, while the treatment delay was 8±2.33 days. The cancer was at stage IIIA in 14%, IIIB in 27% and IV in 59%. Six months and one-year survival was between 50 and 74% and between 9 and 25%, respectively. Better survival was observed in patients with NSCLC on stage III, having better performance status, having comorbid conditions, with prolonged delays management, a short therapeutic delay and patients who received specific antitumor treatment. CONCLUSION: The prognostic factors in locally advanced and metastatic NSCLC in our patients were: stage of cancer, performance status, comorbid conditions, delay of management and specific antitumoral treatment. These factors should be considered in the management of patients with advanced NSCLC.

[Respiratory symptoms and obstructive ventilatory disorder in Tunisian woman exposed to biomass]. / Symptômes respiratoires et trouble ventilatoire obstructif chez la femme tunisienne exposée à la biomasse.

INTRODUCTION: In some Tunisian cities, especially semi-urbanized, the exposure to the smoke produced during combustion of the biomass, main source of pollution of indoor air, remains prevalent among non-smoking women. AIM: To assess the relationship between exposure to biomass smoke and the presence of obstructive ventilatory disorder in the non-smoking women in semi-urban areas of Tunisia. METHODS: Cross etiological study, using a questionnaire, including 140 non-smoking women responsible for cooking and/or exposed during heating by traditional means with objective measurement of their respiratory functions. RESULTS: We found 81 women exposed to biomass for a period > or equal to 20 hours-years and 59 unexposed women. Exposed women reported more respiratory symptoms namely exertional dyspnea and/or chronic cough than unexposed. Of the 140 women, 14 women have an FEV/FEV6 <70 % of which 13 are exposed to biomass. We found a correlation between respiratory symptoms and obstructive ventilatory disorder in exposed women. CONCLUSION: The air pollution inside the home during the traditional activities of cooking and/or heating is a respiratory risk factor for non-smoking women over the age of 30 years. Exposure to biomass smoke can cause chronic respiratory symptoms and persistent obstructive ventilatory disorder that can be consistent with COPD.

[Respiratory symptoms and obstructive ventilatory disorder in Tunisian woman exposed to biomass]. / Symptômes respiratoires et trouble ventilatoire obstructif chez la femme tunisienne exposée à la biomasse.

INTRODUCTION: In some Tunisian cities, especially semi-urbanized, the exposure to the smoke produced during combustion of the biomass, main source of pollution of indoor air, remains prevalent among non-smoking women. AIM: To assess the relationship between exposure to biomass smoke and the presence of obstructive ventilatory disorder in the non-smoking women in semi-urban areas of Tunisia. METHODS: Cross etiological study, using a questionnaire, including 140 non-smoking women responsible for cooking and/or exposed during heating by traditional means with objective measurement of their respiratory functions. RESULTS: We found 81 women exposed to biomass for a period of≥20 hours-years and 59 unexposed women. Exposed women reported more respiratory symptoms namely exertional dyspnea and/or chronic cough than unexposed. Of the 140 women, 14 women have an FEV/FEV6<70% of which 13 are exposed to biomass. We found a correlation between respiratory symptoms and obstructive ventilatory disorder in exposed women. CONCLUSION: The air pollution inside the home during the traditional activities of cooking and/or heating is a respiratory risk factor for non-smoking women over the age of 30 years. Exposure to biomass smoke can cause chronic respiratory symptoms and persistent obstructive ventilatory disorder that can consistent with COPD.

[Pleural complications of pulmonary hydatid disease]. / Kyste hydatique du poumon ouvert dans la plèvre.

BACKGROUND: Pulmonary hydatid disease encountered in Tunisia frequentely. Rupture of pulmonary cyst into the pleural cavity is rare, but represents the most serious complication of the hydatid disease. AIM: We analyse clinical, radiologic and outcome of intrapleural rupture of lung hydatic cyst and evaluate our experience in the surgical treatment. METHODS: We report 5 cases of rupture of rupture of pulmonary hydatid cyst into the pleural cavity hospitilazed during 1995 to 2010. RESULTS: Mean age of patients was 22,4 years. Three patients presented with hydropneumothorax, one with spontaneous pneumothorax and one with haemoptysis. The diagnosis was determined peropreratively in the first case and based on radiographic and serology findings in the other cases. Surgical treatment consist on decortication and cystotomy with capitonnage in three cases, pleurectomy one and lobectomy in the other case. Post operative course was unventful in four cases, one patient had bronchopleural fistula, pneumothorax and wound infection (parietal abssess) resolved with local treatment. After surgery, all patients were treated in post operative by 3 months course with Albendazole chemotherapy with a favourable outcome. CONCLUSION: Rupture of a pulmonary cyst into the pleural cavity is rare, but represents the most serious complication of the hydatid disease. The therapeutic progress has improved the prognosis of intrapleural ruptured hydatid cysts.

[Treatment of sarcoidosis]. / Traitement de la sarcoïdose.

Sarcoidosis is a common disorder with heterogeneous severity. Corticosteroids are the cornerstone of its treatment and allow a disease remission but only with a suspensive effect. Immunosuppressive drugs, hydroxychloroquine and infliximab may be useful in some patients. Half of the patients recover spontaneously without any treatment. In the remaining patients, a treatment is necessary either at presentation or during the follow-up in the presence of a disease flare. Treatment duration should be of at least 12 months. The main indications of a systemic treatment include ophthalmologic, neurologic, cardiovascular, renal, laryngeal involvements, severe pulmonary manifestations, lupus pernio and marked hypercalcaemia. Initially, patients should receive prednisone or prednisolone at 0.5 to 1 mg/kg daily for 6 to 12 weeks to obtain a complete remission, and then followed by a gradual dose reduction every 6 to 12 weeks. After treatment completion, a 36-month duration monitoring is warranted to confirm recovery. Low-dose methotrexate and azathioprine are the most useful immunosuppressive drugs and are indicated in patients with of failure or contra-indication of corticosteroids or in those patients who needs a long term prednisone dose higher than 10 mg daily to control the sarcoidosis. Cyclophosphamide used is severe neurologic or heart involvement that is resistant to corticosteroids and other immunosuppressive drugs. Hydroxychloroquine and chloroquine are indicated in extensive skin lesions or as corticosteroids sparing agents. Infliximab can be useful in some severe sarcoidosis patients refractory to classical treatment, except for cardiac involvement. Topical corticosteroids can be used for limited skin involvement, anterior uveitis or cough. In the future, a more individualized treatment could be drawn from pharmacogenetic studies. The key point remains the availability of etiologic or innovative drugs for sarcoidosis refractory to currently available therapy.

Cutaneous metastasis of lung carcinoma: a retrospective study of 12 cases.

BACKGROUND: The skin is a rare site of metastasis of the internal malignancies. On the contrary, lung cancer is a common primary malignancy of skin metastasis. The latter is either synchronous with the primary lung tumour or can reveal it. OBJECTIVE: To analyse the clinical findings and the outcome of cutaneous metastasis in patients with primary lung cancer. METHODS: Retrospective study including 12 cases of cutaneous metastasis of lung cancer diagnosed in our institution during 6years. RESULTS: Our patients included three women and nine men with a median age of 59.83years. The cutaneous metastases were unique in seven cases. They revealed the primary tumour in two cases, were discovered synchronously with the primary tumour in six cases and after the primary tumour in four cases. They appeared in patients presenting multiple metastases in 10 cases. Clinical appearance consisted on a firm nodule, sometimes ulcerated with a diameter ranging from 0.5 to 5.5cm. The tumour was sited in the thorax, the back, the abdomen; or the upper or lower limbs. Pathological examination of bronchial biopsy revealed an adenocarcinoma in eight cases, a squamous cell carcinoma in two cases and a small cell carcinoma in two cases. In spite of lung cancer therapies, the patients with metastasis to other organs with a median follow-up time of 4months died. CONCLUSION: Cutaneous metastases of lung cancer are of poor prognosis. They are most of the time associated with an advanced neoplastic process with metastasis to other organs. Median survival after skin involvement does not exceed months.

[Management of spontaneous pneumomediastinum in the adult: 14 cases and a review of the literature]. / Prise en charge du pneumomédiastin spontané chez l'adulte: à propos de 14 cas avec revue de la littérature.

The authors report a series of 14 patients hospitalized for spontaneous pneumomediastinium between 1992 and 2006. They included 10 men and four women with an average age of 27.84 years. Dyspnoea dominated the symptoms. The pneumomediastinum was idiopathic in five patients and secondary in the other nine patients, involving an attack of severe asthma in half of the patients, polymyositis in one patient and idiopathic pulmonary fibrosis in one patient, respectively. The patients presenting polymyositis and pulmonary fibrosis died due to respiratory distress. The other patients benefited from asthma treatment or thoracic drainage, and were kept at rest. Their outcome was good. No cases of relapse were observed after an average follow up of 2.11 years.

[Hydatid cyst of the chest wall mimicking metastatic colon cancer]. / Kyste hydatique de la paroi thoracique mimant une métastase de cancer colique.

Chest wall hydatidosis, rare even in the endemic countries, represents 0.09 to 0.3 % of all cases of thoracic echinococcosis. The authors report the case of a 76 year-old man presenting a chest wall mass 4 years after surgery for colic carcinoma. The mass presented both hypoechoic and hyperechoic structures in the ultrasound chest echography. Therefore, metastastic colon cancer was suspected. The pathological study of the mass revealed hydatid membranes. Thoracic tomodensitometry supported the diagnosis of costovertebral and soft tissue hydatid cysts. The patient underwent the surgical resection of two rib arches, a transverse apophysis and the neighbouring soft tissue associated with pre- and post-surgical albendazole. No clinical manifestations were noted in the follow-up after 1 year.

[Left hemothorax caused by aortic dissection]. / Hémothorax gauche, mode de révélation d'une dissection aortique.

Hemothorax is generally secondary to trauma, invasive thoracic surgery or specific lung of pleural disease. Hemothorax secondary to aortic dissection is rare. We report a case in a 69-year-old man with a history of smoking and hypertension. The patient was referred for exploration of a left pleural opacity with mediastinal widening. Pleural puncture produced a hemorrhagic fluid. The thoracic scan led to the diagnosis of Stanford type B aortic dissection. The patient was given antihypertensive treatment and now has a sixteen month follow-up. Aortic dissection can give rise to hemothorax, especially in a hypertensive subject with an anomalous aortic arch or mediastinal widening on the chest X-ray. Computed tomography generally gives the diagnosis. Treatment may be medical or surgical, depending on the site of the lesion and the severity of the clinical presentation. Aortic dissection is a cause of hemothorax, particularly in patients with favorable conditions or a suggestive radiological anomaly.

[Solitary plasmocytoma of the rib: a rare tumor not to miss]. / Plasmocytome solitaire à localisation costale: une tumeur rare à ne pas méconnaître.

Solitary plasmocytoma is a rare tumor accounting for 5% of all plasma cell neoplasias. The diagnosis is based on identification of the localized tumor composed of monoclonal plasma cells identical to those observed in multiple myeloma, and absence of the signs in favor of a disseminated form. We report the case of a52-year-old man who presented a growth of the chest wall in the left axillary region. Imaging disclosed a mass of tissue with a large zone of osteolysis of the 6th rib and infiltration of the chest wall. Surgical biopsy for pathology study and immunohistochemistry enabled the diagnosis of costal plasmocytoma. Blood protein immunoelectrophoresis revealed a monoclonal kappa type IgG. Bence-Jones proteinuria was positive. Search for other localizations was negative and the diagnosis of solitary plasmocytoma was retained. Radiotherapy was delivered and the patient has remained in remission at one year. Costal localization is rare for solitary plasmocytoma. The diagnosis is based on imaging findings and pathology. Radiotherapy is the treatment of choice but with the risk of progression with other bone lesions, the development of medullary plasmocytosis and multiple myeloma. Factors predictive of systemic recurrence have not been identified. Regular surveillance is required.

[Abundant hemothorax revealing extralobular pulmonary sequestration]. / Un hémothorax abondant révélateur d'une séquestration pulmonaire extra-lobaire.

Hemothorax is an exceptional, serious and misleading manifestation of extralobular sequestration. We report the case of a 15-year-old patient who consulted for chest pain and sudden onset dyspnea. The chest x-ray revealed fluid pleural effusion. Pleural puncture produced a bloody fluid and the angioscan showed a hyperdense formation without a systemic artery. Thoracotomy was performed. A left intrapleural pyramidal formation vascularized with a pedicle from the thoracic aorta was identified and sequestrectomy performed. At two years, the patient has remained symptom free. Extralobular sequestration is an exceptional cause of hemothorax. The absence of an aberrant systemic vessel on the angioscan should not rule out the diagnosis of sequestration. Precautions must be taken at surgery to avoid vessel damage.

[Complete extraction of a hydatid membrane by bronchial fibroscopy]. / Extraction complète d'une membrane hydatique par fibroscopie bronchique.

Pulmonary hydatid cyst is exceptional in our country. The diagnosis is generally established on the basis of imaging. Surgical treatment is indicated in most patients. We report a case of pulmonary hydatid cyst in a 74-year-old smoker (11 package-years) who presented cough with mucopurulent expectoration and occasional hemoptysis. The chest x-ray demonstrated a poorly delimited heterogeneous opacity in the upper third of the left lung which persisted after antibiotic therapy. Bronchial fibroscopy revealed a hydatid membrane in the left superior bronchus which was totally removed by aspiration. A control radiography after the fibroscopy demonstrated a clear regression of the opacity. A thoracic CT-scan was performed and revealed a residual cavity in the left upper lobe with bronchial dilatation. The indication for surgery was not retained. Treatment of pulmonary hydatid cyst by endoscopy is an exceptional event. Our exceptional case illustrates an atypical radiological presentation and the use of "therapeutic" fibroscopy.