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Various characterization techniques were used to study the composition of the glass series xAl2O3-(40 - x)CaO-10Na2O-50P2O5 (with 0 ≤ x ≤ 10) in terms of chemical durability, X-ray diffraction, IR spectroscopy and scanning electron microscopy (SEM). The improved chemical durability was attributed to the replacement of easily hydrated P-O-P bonds by covalent and resistant Ca-O-P and Al-O-P bonds. However, the change in the dissolution rate (DR) versus time showed a marked decrease in chemical durability with increasing the Al2O3 content to the detriment of the CaO content. The X-ray diffraction analysis of glasses annealed at 550°C and 660°C for 48 hours indicated the presence of pyrophosphate phases and predominant metaphosphates or cyclic metaphosphate phases when the Al2O3 content was ≤7.5 mol%. Nevertheless, both, X-ray diffraction and IR spectroscopy confirmed the structural tendency change from metaphosphate (Q2) and pyrophosphate structural units (Q1). Toward short isolated orthophosphate units (Q0) when the Al2O3 content above 7.5 mol%. SEM micrographs illustrated that the number of crystallites increased in the glass network when the Al2O3 content increased at the expense of the CaO content. An increase in the Al2O3 content to 10 mol% led to the formation of a larger number of crystallites of different sizes, dominated by small crystallite sizes assigned to short isolated orthophosphate groups. This phenomenon led to a decrease in chemical durability and seems to be a favorable factor for the formation of the apatite layers which enclose the glass, in a SBF solution test, able of regenerating bone tissue in biomedical application.

Resume Introduction Les kystes cœlomiques intrathoraciques sont des tumeurs benignes tres rares d’origine embryonnaire tapissees par un mesothelium. Ils sont le plus souvent asymptomatiques, decouverts de facon fortuite sur une radiographie thoracique et sont principalement localises dans l’angle cardiophrenique realisant les kystes pleuropericardiques. Observation Un homme âge de 50 ans a ete adresse pour des douleurs thoraciques gauches atypiques depuis deux ans. L’examen physique et la radiographie thoracique etaient sans particularite. La tomodensitometrie thoracique a montre la presence d’un kyste du mediastin superieur et posterieur au niveau de la gouttiere costovertebrale gauche. Compte tenu de sa localisation atypique et de son caractere symptomatique, une kystectomie par thoracotomie posterolaterale a ete realisee permettant de poser le diagnostic de kyste cœlomique ectopique. Le patient rapporte une disparition des douleurs thoraciques apres la resection chirurgicale, avec un recul de 3 ans. Par ailleurs, le scanner thoracique a visualise une artere sous-claviere retro-œsophagienne qui est une anomalie des arcs aortiques d’origine congenitale de decouverte fortuite. A notre connaissance, l’association de ces deux anomalies congenitales n’a jamais ete rapportee auparavant dans la litterature. Conclusion La localisation ectopique du kyste cœlomique dans le mediastin posterieur et superieur au niveau de la gouttiere costovertebrale gauche est tres rare, imposant sa resection chirurgicale a la fois a visee diagnostique et therapeutique d’autant plus qu’il est symptomatique.

Various characterisation techniques were used to study the composition of the glass series 55-P2O5-2Cr2O3-(43-x) Na2O-xPbO (with 8 ≤ x ≤ 38; mole %) in terms of chemical durability, IR spectroscopy and scanning electron microscopy (SEM). The change in the dissolution rate as a function of time when the studied glasses were kept submerged in distilled water at 90°C for 20 days showed an improvement in the chemical durability when Na2O content was substituted to PbO content. IR spectroscopy revealed a structural change from ultraphosphate groups to pyrophosphate, orthophosphate and probably ring metaphosphate groups. SEM revealed the existence of two phases: a vitreous phase and a crystalline phase. The presence of Cr2O3, even in small amounts, seems to play an important role in the formation of crystallites in the glass network. The improved chemical durability is attributed to the replacement of the easily hydrated Na-O-P and P-O-P bonds by covalent and resistant Pb-O-P bands. Both the increase in PbO content and in the Pb + Cr/P ratio causes an increase in the number of covalent Pb-O-P and Cr-O-P bonds, making the glass structure more rigid. The increase of the covalent Pb-O-P bands leads to a clear evolution of the structure and chemical resistance, caused by grain-boundary resistance as a result of glass crystallisation. The IR spectra indicate that the increase in PbO content favours the formation of isolated PO3-4 orthophosphate groups at the expense of pyrophosphate groups. The radical change in the structure from ultraphosphate groups to pyrophosphate and orthophosphate groups seems to be the cause of the formation of crystallites. The existence of crystallites in these glasses results in a marked improvement in their chemical durability. However, when the crystallites exceed a certain limit, the equilibrium between the glass bath and these crystallites is no longer maintained; we notice, once, a decrease in the chemical durability.

Introduction Bien qu’elle soit indispensable, la bronchoscopie rigide a ete longtemps delaissee au profit de l’endoscopie souple. Cette technique n’est redevenue disponible dans le secteur public tunisien que depuis quelques annees. Le but de notre travail etait d’evaluer cette nouvelle activite d’endoscopie interventionnelle. Methodes Il s’agit d’une etude retrospective descriptive incluant tous les patients qui ont subi une bronchoscopie rigide, pris en charge dans le service de pneumologie et d’endoscopie interventionnelle (pavillon 2) de l’hopital A.-Mami de l’Ariana. Resultats L’activite a demarre en janvier 2016. A ce jour, nous avons effectue 64 bronchoscopies rigides pour 41 patients adultes. La bronchoscopie rigide etait indiquee pour une extraction de corps etranger chez 3 patients et pour une desobstruction de stenose tracheale acquise dans tous les autres cas. Tous les patients presentant une stenose tracheale ont eu une desobstruction mecanique dont 7 etaient laser assistee et 7 avec mise en place d’une prothese endotracheale. Nous ne rapportons aucune complication au decours de l’intervention. Un echec a ete note dans 2 cas (3 %) a cause d’une difficulte d’intubation dans 1 cas et un corps etranger inaccessible dans un autre cas. L’evolution immediate etait favorable dans tous les cas. Toutefois, 11 patients ont recidive leur stenose (29 %), necessitant un complement de traitement par laser dans 2 cas, la mise en place d’une prothese dans 3 cas et une resection-anastomose dans 6 cas. Conclusion L’endoscopie interventionnelle est un moyen therapeutique indispensable dans la prise en charge de nos patients. Elle permet, dans plusieurs cas, d’eviter une tracheotomie inutile ou une chirurgie lourde et surtout constitue dans certains cas le seul moyen therapeutique qui permet de preserver le pronostic vital du patient.

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.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.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)).Pulmonary tumor control with complete surgical excision is predictive of better overall survival in patients with NSCLC and BM.

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.

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).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).The mean age was 59. Taking Weight loss10 % 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 (p0.0003) in malnourished and non-malnourished groups. The definition of malnutrition can also be based on an albumin level35 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 (p0.0002). NRI score100 and97.5 (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 (NRI97.5) and mild malnutrition groups (NRI≥97.5) (p0.001).Malnutrition was common in patients with advanced stage of NSCLC and was associated with poor prognosis.

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.

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. 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.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 CRP10 mg/l and NLR3.87 were predictive of better prognostic (respectively p= 0.015 and 0.049), along with chemotherapy use (p0.0001), PS2 (p=0.009) and age65 (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).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.

Recent studies have identified that inflammation had a significant association with cancer development and progression.To explore the relationship between ALI score and prognosis of metastatic non-small cell lung cancer (NSCLC).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 (ALI23.2) groups.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 score23.2 and ≥23.2 (p=0.043). On multivariate analysis, ALI score23.2 remained significantly associated with worse outcome.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.

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.We retrospectively reviewed the records of 71 patients with metastatic NSCLC who received second-line chemotherapy from January 2006 to January 2013.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.Age and advanced N stage were important factors in predicting the outcome of advanced NSCLC patients who were undergoing second-line chemotherapy.

Malignant peripheral nerve sheath tumors (MPNST) are rare nervous tumors usually located in the posterior mediastinum in the paravertebral gutters. We report the case of a non-smoking 62-year-old man who was admitted with a 4 months history of cough, hoarseness and shortness of breath. Physical examination noted a superior vena cava syndrome. CT scan of the chest revealed a right anterior and middle mediastinal mass compressing the superior vena cava, the ascending aorta, the right pulmonary artery, invading the superior root of the pulmonary vein and the right auricle. Flexible bronchoscopy showed extrinsic compression of the right main bronchus, the right upper lobe bronchus and intermedius bronchus. The patient underwent surgical biopsy of the mass by mediastinoscopy. Histological examination revealed a malignant peripheral nerve sheath tumor. The patient received a single cycle of chemotherapy (ifosfamid-adriamycin). Clinical course was marked by the fast worsening of the dyspnea and the general state. Patient died three weeks after the cure of the chemotherapy. This case is original by the exceptional clinical presentation of MPSNT with a superior vena cava syndrome and the very rare location of this tumor in the anterior and middle mediastinum.

La Presse Medicale - In Press.Proof corrected by the author Available online since mardi 24 novembre 2015

Introduction: C-reactive protein (CRP) is an inflammatory mediator that could be elevated in malignant conditions. The aim of our study is to assess the relationship between CRP and response to chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). Methods: This is a retrospective study including 142 patients with advanced NSCLC (stage IIIB and IV) diagnosed between January 2005 and January 2013. Prior to chemotherapy, a CRP level higher than 10mg/l is related to cancer if a decrease of 50% is noted after two cycles of chemotherapy. An initial CRP level that decreases by 50% after antibiotics is related to an infection. Results: The average age was 60 years. The median level of CRP was 47.9 mg/l. Only 16.9% of patients had a CRP level lower than 10mg/l. Correlations between CRP level and BMI (r=-0.34, p=0.0001), tumor size (r=0.25, p=0.039), smoking (r=0.17, p=0.04) and serum albumin level (r=-0.66; p Conclusion: CRP could be taken into account with RECIST criteria to evaluate the response to chemotherapy in advanced NSCLC.

Introduction: Brain metastases (BM) are a common complication for patients with non-small-cell lung cancer (NSCLC) and a significant cause of morbidity and mortality. The aim of this study was to evaluate the management of BM for patients with NSCLC. Methods: This was a retrospective study including 100 patients with BM of NSCLC hospitalized in our service between January 2009 and December 2015. Results: Median age was 57 years, 94 patients were male. Ninety patients (90%) were smokers. The performans status was Conclusion: Survival remains poor for patients with NSCLC and BM. However, aggressive therapy of both the lung primary tumour and the BM may provide a survival advantage.

The influence of CaO on the glass forming characteristics and properties of Na2O-CaO-ZnO-P2O5 glasses has been investigated. According to the studies that we performed on phosphate based glass within system xCaO-(40-x)ZnO-15Na2O-45P2O5 (10 ≤ x ≤ 30; mol%), it was found that the increase of CaO and substitution of ZnO can give a good chemical durability. Both Cristallographies X-ray and IR spectroscopy have confirmed the structure change when the CaO content increases in the glass. This change results in the formation of metaphosphate and/or rings of metaphosphate groups at the expense of pyrophosphate. So it indicates the formation of Ca-O-P bonds in the network glass that replaces hydrated P-O-Na and P-O-P bands. The phosphate chains units can be bonded together in rings forming meta-phosphate groups. These rings likely lead to the formation of agglomerates of crystalline phases, which is the main cause of the increase in the chemical durability of the glasses when the CaO content increases. The latter may lead to wider use of these materials, especially in the biomedical field.

Introduction Malgre les strategies mises en œuvre pour la lutte nationale contre la tuberculose, cette maladie represente encore aujourd’hui un probleme de sante majeur dans notre pays. Il est donc important d’identifier les facteurs qui ont un impact sur l’adherence au traitement. Parmi ces facteurs, les troubles anxio-depressifs ont ete rarement etudies. Methodes Nous avons mene une etude prospective de fevrier 2017 a juin 2017, recrutant 50 patients traites (a la periode d’attaque ou d’entretien) et suivis aux pavillons I, II, IV et C de l’hopital Abderrahmane-Mami de l’Ariana, pour une tuberculose pulmonaire bacillifere. L’evaluation de l’anxiete et de la depression a ete faite par le score Hospital Anxiety and Depression scale (HAD). Resultats L’âge moyen de nos patients etait de 42 ans. Quatre-vingt-douze pour cent des malades etaient de sexe masculin. L’evaluation du score HAD a ete faite entre la premiere semaine et 2 mois de traitement chez 32 % des patients, entre 2 et 4 mois chez 32 % des cas, entre 4 et 6 mois dans 20 % des cas et a plus de 6 mois de traitement chez 16 % des malades. Le score moyen d’HAD etait de 14,2. Quarante-huit pour cent des patients n’avaient pas de syndrome anxio-depressif (score HAD entre 0 et 8) ; 2 % avaient un score entre 8 et 11 et 50 % des malades avaient un syndrome anxio-depressif certain (score HAD entre 11 et 35). Le score HAD etait correle au delai de negativation des bacilloscopies (p = 0,03), au delai de nettoyage radiologique (p = 0,03) et a la survenue de rechute (p = 0,0003). Conclusion Le depistage et la prise en charge des troubles anxio-depressifs chez les tuberculeux s’imposent afin d’ameliorer l’observance therapeutique et le pronostic de la tuberculose.

Introduction L’anemie chimio-induite (ACI) est definie par un taux d’hemoglobine (Hb) Methodes Une etude retrospective incluant 97 patients atteints de CBPNPC aux stades avances ayant recu au moins une premiere ligne de chimiotherapie sur une periode de 6 ans (allant de janvier 2010 a janvier 2016). Resultats La moyenne d’âge etait de 59,5 ans. Tous les patients etaient de sexe masculin. Le performance status etait 0–1 dans 84 % des cas. Un tabagisme etait note dans 96 % des cas. Le type histologique le plus frequent etait l’adenocarcinome dans 54 % des cas suivi par le carcinome epidermoide dans 24 % des cas. Au bilan pre-therapeutique, le taux moyen d’hemoglobine (Hb) est de 12,53 g/dL (extremes : 6–16,8). Trente-sept patients (38 %) avaient une anemie pretherapeutique (Hb 12 g/dL), 39 (65 %) avaient developpe une anemie chimio-induite ACI : 21 apres le premier cycle et 11 apres le deuxieme cycle de chimiotherapie. Il s’agissait d’une anemie legere a -modere grade 1/2 dans 97 % des cas. Le taux d’Hb moyen etait de 11,49 g/dL ; 10,83 g/dL et 10,72 g/dL respectivement apres le premier, le deuxieme et le troisieme cycle de chimiotherapie. L’administration d’une cure de chimiotherapie etait responsable de la baisse de l’Hb de 1,83 g/dL en moyenne. Une transfusion sanguine etait pratiquee chez 19 patients. L’erythropoietine n’etait prescrite vu sa non-disponbilite. La presence d’ACI etait associee a une survie moindre (la survie globale chez les patients ayant developpe une ACI etait de 5,85 mois vs 7,47 mois pour les patients non anemique ; p = 0,18). Conclusion L’ACI est une complication frequente au cours des cancers bronchiques et elle est dotee d’une mortalite elevee. Des traitements d’appoint a la chimiotherapie comme l’erythropoietine (EPO) pour l’anemie se sont developpes. Des recommandations nationales devraient etre elaborees afin de favoriser leur prescription pour les ACI aux cours des CBNPC.

Introduction La tuberculose est une maladie contagieuse causee par le Mycobacterium tuberculosis. Elle pose un probleme de sante public en Tunisie. Le profil Bacteriologique apres deux mois du traitement antituberculeux pourrait influencer la prise en charge et le pronostic. Methodes Une etude retrospective portant sur des patients suivis dans notre service pour tuberculose pulmonaire du janvier 2015 au juin 2017. Deux groupes ont ete compares : G1 : Patients ayant un frottis positif a 2 mois du traitement antituberculeux (29 patients) G2 : patients ayants un frottis negatif a 2 mois du traitement antituberculeux (89 patients). Resultats Cent dix-huit patients ont ete inclus. Tous les patients etaient de sexe masculin. Les bacilloscopies etaient positives a l’examen direct et a la culture chez tous les patients. L’âge moyen etait 43,5 ans (19 au 88 ans). Le diabete etait note chez dix-huit patients (16,6 %). Quatre-vingt pour cent des patients etaient des tabagiques actifs. L’ethylisme etait note dans 21 % des cas. Neuf pour cent des patients avaient des antecedents d’incarceration. Un frottis positif a l’examen direct et a la culture a 2 mois du traitement antituberculeux etait note chez 29 patients (26,8 %). Les facteurs associes etaient le diabete (G1 = 4 %, G2 = 6 % ; p = 0,001), l’incarceration (G1 = 16,7 % vs G2 = 13 % ; p = 0,001), les images radiologiques etendues (G1 = 51,5 % vs G2 = 36,1 % ; p = 0,001) et l’observance therapeutique. Une correlation statistiquement significative entre le traitement antituberculeux dissocie, comparativement a l’association de drogues fixes et le retard de negativation des bacilloscopies n’a pas ete retrouvee. Conclusion La presence du diabete, incarceration et l’etendue des images radiologiques sont des facteurs predictifs de retard de negativation des bascilloscopies a deux mois. Ces patients meritent une prise en charge particuliere.

Resume Objectifs Evaluer les resultats de l’embolisation arterielle bronchique (EAB), a court, a moyen et a long terme et identifier les facteurs favorisant la recidive de l’hemoptysie. Patients et methodes Il s’agit d’une etude retrospective, de janvier 2001 a juin 2010, comportant 53 patients consecutifs ayant eu une EAB. L’âge moyen etait de 53,8 ans, Il s’agissait de 15 femmes (28,30 %) et de 38 hommes (71,69 %). Resultats Les etiologies de l’hemoptysie etaient dominees par les sequelles de tuberculose pulmonaire : 18 cas (33,96 %), les dilatations de bronches : 12 cas (22,64 %) et l’aspergillome : cinq cas (9,43 %). L’arteriographie bronchique a montre des signes d’hypervascularisation bronchiques dans 92,45 % des cas. Quarante-six patients ont eu une premiere embolisation (86,79 %) avec une efficacite immediate dans 84,90 % des cas (n = 45), et a plus de trois ans dans 60,08 % des cas. Une recidive de l’hemoptysie a ete notee a court ( 30 jours et trois ans) etait correle a l’âge. La survie sans recidive etait statistiquement meilleure quand l’âge etait inferieur a 60 ans (p = 0,0041). Conclusion L’EAB est un moyen therapeutique efficace. L’aspergillome represente le facteur de risque majeur a l’origine des recidives hemoptoiques. Une embolisation repetee peut etre proposee pour ces patients.

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.

There is increasing evidence to suggest that neutrophil-to-lymphocyte ratio (NLR) is an independent predictor of poor outcome in patients with cancer. The aim of our study was to determine the association between baseline NLR and prognosis in patients with advanced inoperable non-small cell lung cancer (NSCLC). Methods: All patients with a new diagnosis of advanced inoperable NSCLC (stages III and IV) presenting at our thoracic oncology department between January 2005 and January 2013 (n = 142) were included. To evaluate the independent prognostic relevance of the NLR, univariate and multivariate Cox regression models were used. Progression-free survival (PFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Results: Median age was 60 years, all patients were male, and 50.2% had adenocarcinoma. The median NLR value was 3.42 (ranged between 0.11 and 25.06). High NLR was significantly associated with tumor metastasis (P = 0.028), high C-reactive protein (P = 0.0001), and low albumin (P = 0.0001).Patients with an NLR ≥3.42 showed a significantly lower PFS (P =0 .008) and OS (P = 0.04) than patients with an NLR Conclusion: Elevated NLR indicates a poor prognosis for patients with advanced NSCLC. It potentially represents a simple, easily-obtained, low cost and reliable biomarker with prognostic potential for advanced NSCLC.

Introduction: The association of pulmonary tuberculosis and diabetes presents clinical, radiological and therapeutic particularities. Objectives: To determine the clinical and radiological characteristic and outcomes of pulmonary tuberculosis (PT) in patients with diabetes mellitus. Materials and Methods: we conducted a retrospective case-control study between 2007 and 2012 on 120 patients hospitalized in a pulmonology department for a first episode of confirmed PT. patients were divided into two groups: group 1 (G1) represents 30 diabetics and Group 2 (G2) included 90 non diabetic patients. Results: The mean age was 45.5 years in G1 and was comparable to the G2. All patients were male. Diabetes was type 2 in 76% of cases. General symptoms were more frequent in the G2 (p=0.04). Dyspnea was more noted in the G1 (p=0.03). The classical various types of radiological lesions of PT were found in similar proportion in the two groups with parenchymal shadowing the most frequent appearance in both diabetics (86%) and control (84%). However cavitations occurred less frequently in diabetics than controls (p=0,04). Radiological abnormalities were bilateral and diffuse in 65% of cases of G1 against 45% in G2 (p=0.01). There was a trend for basal lesions to occur more frequently in diabetics than controls (p=0.005). The delay of sputum smear conversion was longer in G1(p=0.03). An extension of the duration of treatment was necessary in 22% of patients in the G2. Two patients died in the G1 within the first 24 hours of hospitalization. Conclusion: Diabetics have severe forms of tuberculosis, atypical and often extensive radiographic abnormalities, requiring special care to prevent complications.

Background: Systemic inflammation has been shown to be responsible of tumor growth and shortened survival. Advanced lung cancer inflammation index (ALI) was developed to assess inflammation and prognostic in lung cancer at the time of diagnosis. Therefore, the aim of this study was to explore the relationship between ALI and the prognosis of NSCLC. Methods: Patients diagnosed with stage IV NSCLC at our institution between janv 2010 and janv 2013 were screened. ALI score was calculated as BMIxALB/NLR with BMI=body mass index, Alb=serum albumin and NLR=neutrophil lymphocyte ratio. Patients were divided into low inflammation (ALI>18) and high inflammation (ALI Results Fifty eight patients were included. Median age was 61 years, all patients were male and 48.7 % had adenocarcinoma. Compared to patients with ALI score>18, Patients with ALI score 18 (p=0.043). On multivariate analysis, Performans status (p=0.006), CRP (p=0.007), receiving chemotherapy (p=0.003) and ALI score (HR=2.38; IC95% [1.00-5.67]; p=0.049) were independent prognostic factors for OS. Conclusion: ALI is an easy to calculate tool to assess systemic inflammation in advanced NSCLC. Lower ALI could authenticate the patients with poor prognosis and be a useful marker in clinical practice.

Background: Non-small cell lung cancer (NSCLC) remains the leading cause of cancer deaths in the world. Despite the efforts made for addressing the issues of heterogeneity within the TNM system, an overlap in survival rates between stages remains. Aim: To identify factors affecting outcomes in NSCLC and develop a prognostic score predicting survival in NSCLC patients. Methods: The case records of 338 consecutive patients with lung cancer admitted to our department from 2008 to 2012 were analyzed. After applying exclusion criteria, 262 cases were included. Data needed for calculating survival was prospectively collected. Multivariate analysis using Cox regression was used. Prognostic indexes (PI) using additive and multiplicative patterns were developed from the models obtained. The PI with the best predictive accuracy was picked and validated by Cox regression analysis. Results: The median overall survival was 13.8±1.3 months (95% CI: 11.2–16.4). Univariate analysis followed by multivariate analysis yielded 2 models with the 9 following variables as independent prognostic factors: age, performance status, hemoglobin level, leucocyte count, calcium level, lactate dehydrogenase, alkaline phosphatases, histologic type and TNM stage. Four PI were developed. The one with the best discriminative ability was picked and validated on a subpopulation of 251 patients who were divided into 5 risks groups (RG). On multivariate analysis, OR from RG II to RG V increased significantly from 2.61 to 74.66 (p -6 ). Conclusion: This tool can be used as a first building block for a decision support system as it predicts survival in NSCLC. Its validation by large prospective studies is needed.

Introduction: Alteration in blood lymphocyte count has been well-established in pulmonary TB. The study aims to determine the predictive value of lymphocytopenia in the severity of clinical and radiological manifestations in TB patients. Material and methods: We performed a retrospective case-control study involving, while excluding HIV patients, a group of 32 lymphocytopenic patients (LP) and a group of 99 non lymphocytopenic patients (NLP). Clinical and biological data were analysed: Radiological analysis was based on chest-x-ray findings based on a pre-established score deduced from the pneumoconiosis international labour office score. Results: Mean age of patients was 40,96 years . All of them were males. A history of incarceration was found in 21.8% in LP vs 10.1% in NLP. Diabetes was note in 6,24% in LP vs 17,7% in NLP. 34.3 % of LP presented acute respiratory failure vs 10% in NLP. Radiological lesions at grade 3 in LP were more frequent than in NLP (56,25 vs.19,2%; p=0.06). Anaemia was significantly more noted in LP than in NLP (65,6% vs. 37,3%; p=0, 03). A paradoxical reaction occurred in three patients of LP (9,37%). A delay of smear negativity was noted in 43.7% of LP vs 35.3%. The recurrence rate was higher in the LP (15.6% vs 0.5%; p=0,03) with a mean duration of 16.6 months. Conclusion: Lymphocytopenia in pulmonary tuberculosis patients is associated with severe radiological lesions, increased paradoxical reaction.

Introduction: Cytotoxic chemotherapy is widely used to palliate advanced non-small-cell lung cancer (NSCLC) but can induce severe toxic events. The aim of this study was to evaluate the chemotherapy toxicity in adavanced non-small cell lung cancer (NSCLC) and its impact on overall survival (OS). Methods: We retrospectively reviewed 99 advanced stage NSCLC patients treated with chemotherapy over a period of 3 years. Pre-therapeutic clinical and biological data were assessed. OS was calculated using the Kaplan Meier method and compared between two groups (having or not toxicity) by log rank test. Results: Median age was 65 years, 84% of patients had Performans status (PS) Conclusion: Our study suggested that Chemotherapy-induced toxicity in advanced NSCLC patients was associated with poor survival.

Introduction: Elderly patients is a group with a higher risk of infection, particularly tuberculosis (TB). Objectives: To determine the clinical and radiological features and outcomes of pulmonary tuberculosis (PTB) in the elderly. Materials and Methods: we conducted a retrospective case-control study between 2004 and 2012 on 150 patients hospitalized in a pulmonology department for a first episode of confirmed PTB . This population was divided into two groups: group 1 (G1) represents 40 elderly TB patients (over 65 years) and Group 2 (G2) represents 110 patients (under 65 years). A radiological score was used to evaluate the extension of pulmonary lesions. Results: The mean age was 68 years (G1) and 25 years (G2). All patients were male. Comorbidities were more noted in G1 (p=0.02). Smoking and alcoholism were similar in both groups but tobacco consumption was higher in G1 (p> 0.05). The mean time of consultation was longer for G1 (p> 0.05). Clinical signs were similar in both groups, however, hemoptysis was more marked among young people (33%) and dyspnea predominated in the elderly (20%). The tuberculin skin test was positive in 58% of cases in the G1 and 73% of cases in the G2 (p> 0.05). The radiological lesions were more extensive (p=0,04) in G1. However, a predominance of cavitary lesions was more frequent in G2 (p=0,02).The delay of sputum smear conversion was longer in G1(p=0,04). Complications of tuberculosis treatment were more noted in G1 (p = 0.02). Three deaths occurred in G1 while One patient died in the G2. Conclusion: Pulmonary tuberculosis in the elderly is particular by the severity of pulmonary lesions and the frequency of treatment side effects which require more vigilance for this group.

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.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.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 (p0.001), 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%.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.

Resume Introduction La silicoproteinose (SP) est une forme rare et aigue de silicose. Elle survient apres une exposition breve et massive a la silice et evolue rapidement vers l’insuffisance respiratoire chronique et le deces. Observation Il s’agit d’un patient de 25 ans qui a presente une alteration de l’etat general et une dyspnee. Le diagnostic de miliaire tuberculeuse a ete retenu et un traitement antituberculeux a ete demarre mais sans amelioration, faisant ainsi rediscuter le diagnostic d’autant plus qu’une exposition a la silice a ete notee durant 18 mois. Le patient etait deja en arret de travail six mois avant l’hospitalisation. Le scanner thoracique a montre des micronodules diffus avec des condensations parenchymateuses sous-pleurales et des adenomegalies mediastinales evoquant une sarcoidose. Le lavage bronchoalveolaire (LBA) etait en faveur d’une lipoproteinose. Devant la discordance entre les donnees bacteriologiques, radiologiques et celle du LBA et vu l’aggravation clinique, une biopsie pulmonaire chirurgicale a ete realisee. Celle-ci a conclu a un aspect de lipoproteinose. Le diagnostic de SP a ete alors retenu. L’evolution a ete marquee par l’installation d’une insuffisance respiratoire chronique malgre la corticotherapie. Le recul actuel est d’une annee. Conclusion La SP est une entite radioclinique particuliere. Son diagnostic repose sur la clinique, les donnees du LBA et de l’imagerie qui permettraient d’eviter au patient les examens invasifs.

Resume Introduction La tuberculose (TB) sevit a l’etat endemique dans le monde. Elle est preoccupante, etant donne les difficultes de sa prise en charge et sa mortalite elevee. Cela nous a amene a analyser la prise en charge therapeutique et l’evolution des patients ayant eu au moins une recidive tuberculeuse. Patients et methode Etude retrospective a partir des dossiers de 64 patients, analyses lors de la premiere atteinte tuberculeuse (groupe A1) et au moment de la recidive (groupe A2). Le groupe temoin (T) est constitue de patients ayant eu une TB confirmee, sans notion de recidives. Resultats L’etude des donnees de l’antibiogramme a montre que le taux de multiresistance etait plus important en cas de recidive (21,1 % vs 3 %, p Conclusion Tout patient tuberculeux, notamment en cas de recidive tuberculeuse, doit beneficier d’une prise en charge particuliere avec un schema therapeutique adapte.

Resume Introduction La tumeur fibreuse solitaire pleurale (TFSP) est une tumeur mesenchymateuse rare, le plus souvent benigne, d’evolution imprevisible. Patients et methodes Entre le 1er janvier 1999 et le 31 decembre 2010, cinq cas de TFSP ont ete diagnostiques dans notre service. Pathologie. A travers une analyse de ces cinq cas et une revue de la litterature, une mise au point sur les caracteristiques cliniques, radiologiques, anatomopathologiques, therapeutiques et evolutives de cette pathologie a ete faite. Resultats Il s’agit de quatre hommes et une femme avec un âge moyen de 55 ans. Tous les patients etaient symptomatiques. La toux et la douleur thoracique etaient les symptomes les plus frequents. L’imagerie a identifie la lesion pleurale mesurant en moyenne 11 cm de diametre avec des extremes allant de 3 a 17 cm. Le diagnostic final a ete fait sur la piece de resection de la tumeur developpee a partir de la plevre parietale dans trois cas et de la plevre viscerale dans deux cas. La resection a ete complete sous thoracotomie pour tous les patients. L’aspect histologique a conclu en la malignite dans deux cas et la benignite dans trois cas. A l’immunohistochimie, les cellules tumorales exprimaient la vimentine, le CD34, le CD99 et le Bcl2. L’evolution pour les deux patients presentant une forme maligne a ete marquee par la recidive tumorale a six mois et a 21 mois apres la chirurgie et entrainant le deces de deux patients, les trois patients presentant une forme benigne sont en survie sans recidive a trois ans, 11 ans et deux ans et demi apres la chirurgie. Conclusion La TFSP est une tumeur rare, evoquee par l’imagerie et confirmee a l’histologie obtenue grâce a la resection chirurgicale des lesions. Une surveillance au long cours pour tous les patients apres la resection est recommandee devant le risque de recidive ou de transformation maligne.

Resume L’etude de la douleur chez le sujet âge presentant un cancer bronchopulmonaire (CBP) merite une attention particuliere surtout que ce symptome est frequemment associe a ces deux conditions et peut influencer la prise en charge et le pronostic de ces patients. Afin d’etudier les caracteristiques de la douleur due au CBP primitif chez le sujet âge, nous avons evalue prospectivement la douleur chez tous les patients âges de plus de 65 ans hospitalises pour CBP primitif de novo. Trente-neuf patients ont ete inclus en 15 mois (62 %). L’âge moyen etait de 72 ans. Le cancer etait a type de CNMC et a un stade avance dans la majorite des cas. La douleur etait presente chez 74,3 % des patients. Elle etait significativement moins frequente chez les plus de 75 ans (50 % versus 85,1 % ; p p = 0,001). Le traitement antalgique permettant de soulager la douleur etait de palier I dans 20,6 % des cas, de palier II dans 48,2 % des cas et de palier III dans 31 % des cas. La prise en charge de la douleur du sujet âge doit etre precoce, adaptee et repetee afin de preserver au maximum la qualite de vie des patients âges presentant un CBP.

Resume Introduction La tuberculose reste endemique en Tunisie. Bien que rares, les recidives tuberculeuses (RT) exposent classiquement au risque de resistance. Le but de cette etude etait de rechercher des facteurs predictifs de RT. Patients et methodes Soixante-quatre patients ayant presente une tuberculose pulmonaire confirmee, puis au moins une RT, ont ete compares a 105 patients constituant le groupe temoin. Resultats Un taux de 9,48 % de RT a ete note de septembre 1995 a decembre 2007 chez des patients, tous de sexe masculin. Il n’y avait pas de difference entre les deux groupes en ce qui concerne l’âge. Un tabagisme superieur a 20 PA etait plus frequent en cas de recidive (44,89 % versus 21,4 % ; p = 0,055). La douleur thoracique et la dyspnee etaient plus frequentes dans le groupe recidive, de meme qu’une hemoglobine basse (11,33 ± 1,57 g/dL versus 12,41 ± 1,66 g/dL ; p = 0,008). L’intradermoreaction (IDR) etait negative chez 73,7 % des recidives contre 31,1 % des temoins ( p = 0,001). La cytolyse hepatique etait plus frequente dans le groupe recidive (27,3 % versus 8,6 % ; p p p Conclusion Tout patient tuberculeux, notamment devant la presence de facteurs predictifs de RT, devrait beneficier d’une prise en charge et d’un schema therapeutique adapte.

Introduction Le cancer broncho-pulmonaire primitif (KBP) est actuellement la premiere cause de mortalite par cancer dans le monde. Son pronostic sombre est en partie explique par son diagnostic tardif. Methodes Etude retrospective portant sur 344 hommes hospitalises dans notre service pour KBP entre 2010 et 2015. Resultats Le delai moyen entre le debut de la symptomatologie et la premiere consultation etait de 65,6 jours et mediane a 30 jours. Le delai moyen de realisation de la fibroscopie bronchique etait a 10,99 jours et une mediane a 6 jours. Le delai moyen de realisation du scanner thoracique etait a 12,78 jours et une mediane de 7 jours. Le delai moyen entre la date de la 1re consultation et la date de la confirmation du diagnostic etait de 34,67 jours quel que soit le moyen utilise avec une mediane de 22,5 jours. Le delai moyen de confirmation histologique etait de 25,15 jours pour la biopsie bronchique, de 24,19 jours pour la biopsie pleurale, de 49,68 jours pour la biopsie trans-parietale et de 65,53 jours pour la biopsie chirurgicale. L’etude des facteurs influencant ce delai montre qu’une difference significative existe entre les stades (32,28 jours pour les stades III et IV et 70,46 jours pour les stades I et II ; p = 0,013). Quand on compare le delai diagnostique entre les stades localises I et II (70,46 jours), localement avances III (31,2 jours) et les stades IV avances (31,98 jours), on note une difference significative avec un p = 0,003. Cependant, au moment du diagnostic, 78,48 % des patients ont ete classes stades IIIB et IV. Cinquante-trois patients (15,4 %) etaient au stade IIIA, 13 (3,78 %) au stade II et 8 (2,32 %) au stade I. Conclusion Le diagnostic du KBP reste tardif avec un retard de consultation et un retard de confirmation diagnostique. Il est important de multiplier les efforts d’une part au pres des medecins de premiere ligne et d’autre part de revoir notre facon de faire afin de permettre une prise en charge precoce.

Introduction Le cancer bronchopulmonaire primitif est de mauvais pronostic. La chimiotherapie a permis certainement d’ameliorer la survie et la qualite de vie. Les facteurs pronostiques de la chimiotherapie de premiere ligne ont ete largement etudies. Cependant, peu d’etudes ont ete menees sur les determinants pronostiques de la chimiotherapie de deuxieme ligne du cancer bronchopulmonaire non a petites cellules (CBPNPC). Le but de cette etude etait de determiner les facteurs pronostiques de survie chez les patients recevant un traitement de deuxieme ligne pour CBPNPC aux stades avances. Methodes Etude retrospective incluant 71 patients ayant un CBPNPC aux stades avances III b-IV qui ont recu une chimiotherapie de deuxieme ligne et suivis dans deux services de pneumologie (Pavillon 2 et Ibn Nafis) entre janvier 2006 et janvier 2013. Resultats La moyenne d’âge etait de 57 ans. Tous les patients etaient de sexe masculin. Le performans status etait 0 ou 1 dans 90,1 % des cas. L’intoxication tabagique etait notee dans 68 cas (95,8 %). Le type histologique le plus frequent etait l’adenocarcinome dans 48 cas (67,6 %) suivi par le carcinome epidermoide dans 14 cas (19,7 %). Soixante-quatre patients avaient recu une bitherapie a base de sels de platine en premiere ligne. La chimiotherapie de deuxieme ligne etait a base de docetaxel dans 31 cas, pemetrexed dans 18 cas et gemcitabine dans 4 cas. Quatorze patients avaient recu une troisieme ligne de chimiotherapie. La mediane de survie globale etait de 13,5 mois. L’analyse univariee avait montre que l’âge ≥ 65 ans ( p = 0,025), un stade T avance (T4 par rapport T3 et T2 ; p = 0,01), un stade N avance (N3 par rapport N2 et N1 ; p = 0,001), une anemie ( p = 0,05) et la progression tumorale apres une chimiotherapie de premiere ligne ( p = 0,04) etaient associes a une mauvaise survie globale (OS). L’analyse multivariee avait montre que seuls l’âge ≥ 65 ans (HR = 2,15 ; intervalle de confiance IC a 95 %, [1,26 a 2,44]) et un stade N avance (HR = 2,273 ; IC a 95 % [1,26 a 2,44]) etaient des facteurs pronostiques independants de mauvaise survie globale. Conclusion Dans notre etude, l’âge ≥ 65 ans et le stade N avance sont des facteurs de mauvais pronostic chez les patients atteints de CBPNPC aux stades avances recevant une chimiotherapie de deuxieme ligne. Ces facteurs peuvent etre consideres dans la selection des patients candidats a une deuxieme ligne de chimiotherapie.

Resume Les tumeurs primitives costales sont des tumeurs rares dominees par les tumeurs malignes. L’hemangiome osseux ne represente que 1 % des tumeurs osseuses. La localisation costale ne represente que 1 % des cas avec uniquement une cinquantaine de cas decrits dans la litterature. But Les auteurs ont pour objectif de rapporter une tumeur costale rare, de decrire ses aspects histologiques et de rapporter les principaux diagnostics differentiels. Observation Les auteurs decrivent le cas d’une patiente âgee de 46 ans qui consultait pour des douleurs thoraciques. Les donnees radiologiques n’ont pas permis d’eliminer une tumeur maligne et le traitement a consiste en une resection de l’arc posterieur de la sixieme cote emportant toute la tumeur. L’examen microscopique a conclu a un hemangiome costal et la patiente n’a pas presente de recidive apres un recul de six ans. Conclusion L’hemangiome costal est une tumeur tres rare d’etiologie controversee. Certains aspects radiologiques sont specifiques comme l’aspect de bulles de savon ou de nids d’abeilles. Cependant, le diagnostic de certitude demeure microscopique. Ces tumeurs sont de bon pronostic et aucun cas de recidive n’a ete decrit apres resection complete.

Drug-induced muscle disorders are now well known and vary from a simple isolated increase in muscle enzymes to severe drug-induced myopathy. The list of drugs inducing myopathy is very long and continues to grow. The onset of muscle disorders under isoniazid often falls within a drug-induced neuropathy or a drug-induced lupus. However, the occurrence of isolated isoniazid-induced drug myopathy without neuropathy is an extremely rare condition especially with non-toxic doses. The authors report the case of a 28-year-old man, without a previous medical history, hospitalized for pulmonary tuberculosis. After initiating tuberculosis treatment for five days, he presented muscle pain, fasciculation and weakness initially involving the lower left limb that quickly propagated to all four limbs. The physical examination noted a left ankle flush, a swollen left calf and fasciculation of both calves while the neurological examination was normal. The CPK was normal. Electromyography confirmed the myopathy without neuropathic findings. Isoniazid withdrawal was marked by the rapid disappearance of the symptoms. The reintroduction of a half-dose of isoniazid only induced a few transitional muscular fasciculations. The onset of the symptoms under tuberculosis treatment, the absence of later muscle disorders, the absence of any other cause of myopathy and the total disappearance of the symptoms after isoniazid withdrawal confirmed the diagnosis of isoniazid-induced myopathy.

Resume Introduction Le syndrome d’Erasmus est defini par l’association d’une sclerodermie systemique (SS) a une exposition a la silice. Une silicose peut preceder la SS mais celle-ci peut etre inaugurale, dans ce cas la notion d’exposition a la silice doit etre recherchee comme un element du diagnostic. Observation Patient âge de 46 ans aux antecedents de tuberculose pulmonaire, qui consultait pour une dyspnee d’effort et une dysphagie. A l’examen, il presentait un visage fige avec un erytheme et des telangiectasies, un nez effile, une secheresse cutanee, un syndrome de Raynaud ainsi qu’une sclerodactylie. L’imagerie thoracique montrait des pseudo-masses de fibrose bilaterales. Les anticorps antinucleaires, anti-topo-isomerase 1 et antihistones etaient positifs. Conclusion Cette presentation clinique du syndrome d’Erasmus associant une sclerodermie systemique et des masses pseudo-tumorales peut poser le probleme de diagnostic differentiel avec le cancer bronchopulmonaire, et necessite une surveillance clinique et radiologique stricte puisque aussi bien la silicose que la sclerodermie sont a haut risque de neoplasie.

Inflammatory pseudotumor of the lung is an uncommon nonneoplastic tumor of unknown origin. It can mimic lung carcinoma. We report a 65-year-old man who presented with productive cough, weight loss, and a heterogeneous right apical lung condensation. This clinical and radiographic presentation suggested a malignant lung tumor. Surgery was performed and the histological examination of the surgical specimen concluded to an inflammatory pseudotumor. A pneumonectomy was performed because of the tumor extension towards the lower lobe and the mediastinum. No recurrence was observed after a 2-year follow-up. Surgery is essential to confirm the diagnosis of inflammatory pseudotumor. Complete resection is the only guarantee to prevent recurrence.