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Introduction: Hydatid disease remains a real public health problem in many traditional pastoral farming countries. Its prevention is the most effective solution. Aim: Our study aimed to assess the knowledge of patients managed for a lung hydatid cyst concerning their pathology. Methods: Between November 2018 and July 2019, we carried out a descriptive cross-sectional study, in a thoracic surgery department, about the knowledge and information that patients with hydatid cyst had about the disease. Results: Thirty-four patients responded to our survey. The mean age was 37.18 ± 18.43 years old. Most of our patients came from rural areas. Among the 30 patients under the age of 60, 12 (40%) were housewives. Three patients (8.8%) had already been operated on for a cyst. Thirty patients (88.3%) reported having contact with dogs and sheep. If a cyst was suspected in the sheep’s offal, 20.6% (7 cases) threw them in the trash and 14.8% gave them to the dog (5 women). Among the respondents, 50% (17 cases) did not know the modes of human contamination. Knowledge of clinical signs suggestive of the disease and modes of contamination were correlated with the level of education. Fourteen patients (41.2%) raised the possibility of disease recurrence. Among the means of prevention, thorough washing of fruits and vegetables was cited in 3 cases (21.4%) and incineration of soiled offal in 1 case (7.2%). Conclusion: Assessment of patients9 knowledge about hydatid disease must be systematic in countries with high endemicity of hydatidosis, in order to identify false practices and correct them, to break the parasitic cycle. Educational messages should target the rural population and be adapted to their level of education.

Synovial sarcoma is a soft tissue sarcoma. Its occurrence as a primary mediastinal neoplasm is very rare. We report a case of mediastinal synovial sarcoma in a 14‐year‐old girl with exertive dyspnoea at presentation. On physical examination, there was a superior vena cava syndrome and café‐au‐lait spots. Chest X‐ray revealed a white left hemithorax with mediastinal deviation to the opposite side. Thoraco‐abdomino‐pelvic scanner showed a voluminous posterior cervico‐mediastinal tissue mass. Computed tomography (CT)‐guided biopsy of the mediastino‐pleural mass was performed. Histological examination reported fusocellular malignant mesenchymal proliferation. A complementary immunohistological study with a broad range of antibodies was performed with a high‐grade single‐phase spindle cell synovial sarcoma of the mediastinum. She presented a respiratory distress, did not respond to resuscitation, and died. Mediastinal synovial sarcoma is a rare tumour that is difficult to diagnose. Its slow progression and delay in diagnosis may lead to a fatal evolution., Synovial sarcoma is a soft tissue sarcoma. Its occurrence as a primary mediastinal neoplasm is very rare. We report a fatal case of mediastinal synovial sarcoma in a 14‐year‐old girl with exertive dyspnoea at presentation. We highlight the role of imaging, the means of diagnosis, and the importance of the speed of therapeutic management. Mediastinal synovial sarcoma is a rare tumour that is difficult to diagnose. Its slow progression and delay in diagnosis may lead to a fatal evolution.

Introduction: Primary tracheal tumors are rare. They represent less than 1% of primary tumors of the chest. However, they are diagnostic and therapeutic challenges. Our aim was to study the characteristics and management of primary tracheal tumors Methods: We retrospectively reviewed the clinical data from patients who were operated for primary tracheal tumors within 17 years at the thoracic surgery department of Abderrahmen Mami Hospital Ariana – Tunisia Results: There were 5 women and 4 men.The main symptom was dyspnea, accompanied with dysphonia in 1 case and dysphagia in another case. Bronchoscopy showed the lesion within the lumen in all cases. The median size of the tumor was 32.5 mm.The tumor was located in the upper third of the trachea (2 cases), the middle third (4 cases) and the lower third (3 cases). A tissue diagnosis was obtained in all patients by direct biopsy at bronchoscopy. Pathological study revealed : adenoid cystic carcinoma (4 cases), mucoepidermoid carcinoma (1 case), carcinoma with lymphoid stroma (1 case), schwannoma (1 case), glomus tumor (1 case) and cylindroma (1 case). All patients were managed by resection with reconstruction by primary anastomosis. Neck-collar incision was used in 4 cases, median sternotomy in 3 cases and posterolateral thoracotomy in 2 cases. Negative margin resection was achieved in 6 cases. The postoperative course was complicated in 3 cases. Two weeks postoperatively, bronchoscopy showed satisfactory lumen (6 cases), a lesion in the carina (1 case) and a reduced lumen (2 cases) Conclusion: Primary tracheal tumors are the least common neoplasic lesions of the airways. Non specific symptoms delay diagnosis. Resection with primary reconstruction should be preferred in initial treatment

Introduction: Cystic echinococcosis, which is commonly contracted during childhood or adolescence, is still a serious health problem in many countries. Pulmonary hydatid location is more frequent than hepatic, in children. Material and Methods: The records of 75 children managed for LHC between 2010 and 2019 in a thoracic surgery department were retrospectively reviewed. Results: There were 47 boys and 28 girls, with a mean age of 11.31 years (2–15 years). Parasitic exposure was found in 80% of the cases. The most common signs were: cough (62%), chest pain (49%), hemoptysis (42%) and fever (36%). Imaging tools showed a single LHC in 74 cases and bilateral in one case. It was right seated in 33 cases (45.3%) and left in 42 (56%). Mean size of LHC was 7 cm. Associated hydatic lesions were seen in the liver in 11 cases and in the spleen in one case. All the patients were operated. The most used approach was a video-assisted mini-thoracotomy. LHC was complicated in 34 cases and non-complicated in 41 cases. For the treatment of the residual cavity, parenchyma-saving procedures were performed most of the time: cystectomy in 64 cases (85.3%) and pericystectomy in 6 cases (8%). Anatomical resection was performed in 5 cases (6.6%): 4 complicated cysts and one simple cyst. The postoperative course was uneventful in 97% of the cases. Complications were seen in 2 patients: fever (1 case) and hemothorax (1 case). Secondary pleural hydatidosis was reported in one case during follow-up. conclusion: LHC are often asymptomatic and diagnosed at a later stage in children. Intact cysts should be operated rapidly to avoid rupture and parasitic dissemination. Parenchyma-saving procedures should be performed whenever possible, even in infected cysts.

Cyriax syndrome is a rare entity of the chest wall, which mainly affects young people. It can manifest as abdominal pain in the right or left hypochondriac region, which may be very intense, and often causes problems in the differential diagnosis. We report the case of a 36-year-old man who presented with intense left hypochondrial pain, worsening on exercise. After multiple specialized consultations and several unnecessary and expensive investigations, a diagnosis of Cyriax syndrome was obtained. A thorough physical examination might have been sufficient to evoke the diagnosis.

Background: Bronchogenic cysts (BC) result from a congenital abnormality in the development of the tracheobronchial tree. BC remain asymptomatic for a long time and the occurrence of clinical signs points towards complication. The aim of our study was to assess the clinical and therapeutic characteristics of BC discovered in adulthood. Methods: We retrospectively reviewed the records of 106 patients managed between 1985 and 2018 in the thoracic and cardiovascular surgery department of Abderrahmen Mami Hospital Ariana - Tunisia. Results: There were 47 women and 59 men, with a mean age of 42 years [18-83 years]. The most common signs were chest pain (51 cases), cough (44 cases) and dyspnea (31 cases). Dysphagia was reported in 3 cases, dysphonia in 1 case and 11 patients were asymptomatic. Chest X-ray showed a homogeneous opacity (37 cases), an air-fluid level (23 cases), a suspicious opacity (14 cases) and was normal in 16 cases. Fiberoptic bronchoscopy showed: inflammation (26 cases), signs of extrinsic bronchial compression (8 cases) and an endobronchial bud (3 cases). CT-scan revealed 67 intra-parenchymal BC and 37 mediastinal BC, mainly at the subcarinal level (28 cases). All patients were operated. The most common surgical approach was thoracotomy (82 cases). Cystectomy was total in 68 cases and subtotal in 13 cases. Lobectomy was required in 23 cases and segmentectomy in 2 cases. The postoperative course was uneventful in 102 cases (96.2%). Reported complications were pulmonary infection and pneumothorax. Conclusion: Because of the risk of complications, which make surgical management more difficult, surgical resection of BC is recommended, whatever the age of discovery.

Background: Liver Hydatid cyst with intrathoracic rupture is a rare complication, which may be life-threatening. Currently there is a lack of consensus about the best way of management. The aim of our study was to assess the characteristics and outcomes of patients presenting with liver hydatid cyst ruptured into the thorax and managed through a thoracic approach. Methods: The records of 113 patients managed between 1994 and 2018, in the thoracic and cardiovascular surgery department of Abderrahmen Mami Hospital Ariana - Tunisia, were retrospectively analyzed. Results: There were 64 women and 49 men. The mean age was 48 years [13-86 years]. Reported signs were: chest pain in 68 cases (60.1%), fever in 49 cases (43.3%), dyspnea in 41 cases (36.2%), cough in 30 cases (26.5%), or pain in the right upper quadrant of the abdomen in 5 cases (4.4%), and 21 patients (18.5%) were admitted in emergency. The cysts were assessed with abdominal ultrasonography, CT-scan or both. Surgery was performed in 106 cases. The main procedure was cystectomy through thoraco-phrenotomy and ‘Lagrot’ on the liver in 57 cases (53.7%). Lung resections were performed in 17 cases: segmentectomy (2 cases), bilobectomy (2 cases), lobectomy (12 cases) and right pneumonectomy (1 case). Twenty three patients had a decortication. Mortality rate was 2.6% and morbidity rate was 23.5%. Conclusion: Intrathoracic rupture of liver hydatid cyst may be managed through an abdominal or a thoracic approach. The thoracic approach should be preferred whenever the lung or the pleura are involved. In some cases, a combined thoracic and abdominal approach should be considered in order to prevent recurrences.

In this paper, we describe a simulation system of myopathicsurface electromyography (sEMG) signals. The architecture of the proposed system consists of two cascading modules. SEMG signals of three pathological skeletal muscles (Biceps Brachii, InterosseursDorsalis, TibalisAnterior) were generated. Root Mean Square (RMS Envelope) and Power Spectral Density (PSD) were used to validate our system.

Iatrogenic tracheal stenosis is a severe late complication of tracheal intubation and tracheotomy. Its features have a strong impact on the therapeutic strategy. The records of 73 patients managed for iatrogenic tracheal stenosis in the department of thoracic surgery ofAbderrahmenMami hospital, between January 1995 and December 2015, were reviewed in order to study the clinical, radiological and therapeutic features of this disease. The mean age of the patients was 31years (10 to 64 years). All the patients reported a past history of intubation, associated with tracheotomy in 34%of the cases. Mean intubation time was 12days. The mean interval between extubation and the diagnosis was 106days. Fiberoptic bronchoscopywas performed in 67cases(92%). It showed a circumferentialstenosis in87.6% of the cases and a complex stenosis in12%. Chest CT scan or MRI was performed in95.5% of the cases. The mean distance between the stenosis and vocal cords was 3.17 cm[1-7.5cm]. The mean length of the stenosis was 2.2 cm. Thirteen patients(17.8%) underwent endoscopic treatment before surgery(dilatation 8cases, laser treatment 5 cases)with good immediate results in 53%of the cases. In our study, all the patients underwent tracheal resection and reconstruction. Postoperative complications were observed in 10.9%of cases. One patient died in the immediate postoperative period secondary to hemorrhage. The follow-up periods ranged from 2 to 69 months and showed a recurrence in one patient. Tracheal stenosis is a serious cause of morbidity and mortality in patients who underwent intubation, tracheotomy, or both. Its management is challenging and requires a multidisciplinary team. Its features have to be well analyzed in order to adopt the suitable therapeutic choice.

In Tunisia substantial economic and financial vulnerability are mainly caused by the civil unrest and the subsequent regime change after the Tunisian revolution in 2011. In order to quantify this fragility, in this paper, we use reverse stress testing (RST) based on combination of relevant risk factors that lead to the worst case in which the bank becomes unviable and insolvent. Given the financial stress testing scenarios shortcomings (i.e. plausibility, subjectivity), the use of RST methodology is explained by the fact that it identify the probability of realization of such scenarios. We apply this new methodology on Tunisian banks which are the core for financial stability; more specifically, we focus on credit risk RST. We choose the upper bound for value at risk (VaR) in order to identify worst VaR at probability of realization a. Our proposed framework relies on the logistic regression to identify stress probability and the linear regression of financial stress index output gap versus macroeconomic risk factors in order to search for scenarios at 1%, 3% and 5% levels of plausibility. Empirical results show that Tunisian banks have likely to reach the WVaR in 2012 at 5% level. Besides the more extreme the scenarios which are considered the less plausible they become. Our reverse FST is a complement, and never a substitute for risk manager and what matters most is the mindset of those employing it.

Financial stress index (FSI) is considered to be an important risk management tool to quantify financial vulnerabilities. This paper proposes a new framework based on a hybrid classifier model that integrates rough set theory (RST), FSI, support vector regression (SVR) and a control chart to identify stressed periods. First, the RST method is applied to select variables. The outputs are used as input data for FSI–SVR computation. Empirical analysis is conducted based on monthly FSI of the Federal Reserve Bank of Saint Louis from January 1992 to June 2011. A comparison study is performed between FSI based on the principal component analysis and FSI–SVR. A control chart based on FSI–SVR and extreme value theory is proposed to identify the extremely stressed periods. Our approach identified different stressed periods including internet bubble, subprime crisis and actual financial stress episodes, along with the calmest periods, agreeing with those given by Federal Reserve System reports.