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Vascular lesions in Von Recklinghausen’s disease also known as Neurofibromatosis type 1 (NF1), are rare but have a fatal and potentially life threatening complications such as spontaneous hemothorax. An emergent thoracotomy is indicated when there is an active bleeding associated unstable hemodynamic status. Despites surgery is laborious and unpredictable but it have a merit to stop hemorrhage. A conservative management with endovascular embolization or non-operative approach have also been reported in case of hemodynamic stability. We report two case report of spontaneous hemothorax in patient with Recklinghausen disease. A chest tube was immediately inserted for two patients. Due to continuous bleeding and hemodynamic instability (Patient 1), and the increase of pleural effusion volume (Patients 1 & 2), emergent surgery of thorax was done with favourable post-operative follow up.

IntroductionEctopic breast tissue is present in 2–6% of women. Ectopic breast cancer represents an uncommon disease accounting for about 0.3% of all breast neoplasms, limiting the available evidence. Thus, we aim to report long-term outcomes in five cases treated at our institution.Case seriesOur Tunisian patients’ median age was 48 years (33–60 years), and the median follow-up was 8 years (4–10 years). The ectopic breast tissue was located four times in the right axilla. The median tumor size was 25 mm (15–55 mm). Four of the patients underwent a wide local excision and axillary lymph node dissection. Three of those women had positive lymph nodes; thus, they received adjuvant chemotherapy, radiation therapy, and hormone therapy. The patient with a negative lymph node (case 5) had adjuvant radiation therapy and hormonal therapy. One of the patients (case 1) had a positive supraclavicular lymph node and received radiation therapy, chemotherapy, and hormonal therapy. The latter developed a locoregional relapse after 4 years and was treated with mastectomy and chemotherapy. One patient (case 4) had a distant metastasis after 2 years of follow-up and received chemotherapy. The three other patients were free of relapse during their follow-up period.ConclusionPrimary axillary breast carcinoma is a rare entity. Despite the paucity of literature, our findings and authors’ recommendations suggest that local excision can be performed safely with promising outcomes in this subset of patients.

Background Neurogenic tumors of the mediastinum are rare tumors located mainly in the posterior mediastinum. The aim of this study was to report a single-institution experience of these tumors. Methods This study was conducted between 2005 and 2017. Bivariate analysis was performed to assess correlations between the cellularity, mitotic index, presence of a capsule, and potential for malignancy of peripheral nerve sheath tumors. Results There were 86 patients enrolled in the study. The mean age was 42.51 years. Nineteen patients were asymptomatic and their tumors were discovered incidentally. Microscopic diagnosis confirmed a schwannoma in 45 cases, neurofibroma in 12, malignant peripheral nerve sheath tumor in 9, ganglioneuroma in 14, ganglioneuroblastoma in 4, and neuroblastoma in 2. Bivariate analysis showed a significant correlation between the absence of a capsule, the degree of atypia, a high mitotic index, and high cellularity with the potential for malignancy ( p Conclusion Even if radiologic means are helpful in suggesting the diagnosis, a positive diagnosis of neurogenic tumors is based on microscopic features. High mitotic activity and cellularity, and severe cytonuclear atypia are the features most suggestive of malignancy.

Mediastinal paraganglioma presented as a large dumbbell tumor is a rare entity. We report a case of a 47 year old woman who suffered from spinal pain and sporadic lower limb paresis. The imaging studies showed a voluminous mass occupying the posterior mediastinum with right foraminal extension. For excellent results, a combined effort was necessary including thoracic and neurosurgeons teams. Complete resection was successfully performed without laminectomy. The operative course was uneventful.

Lung carcinoid tumours are rare neoplasms with a favourable prognosis. Bronchoplasty can be a conservative treatment for typical carcinoid tumours and can be applied for patients with limited respiratory function. We report the case of a 34‐year‐old woman, with a polypoid tumour located at the distal right main bronchus. Bronchial biopsy showed a typical carcinoid tumour. After resection of the tumour in the right main bronchus, bronchoplasty was performed by end‐to‐end anastomosis of the remaining right main bronchus, right upper lobar bronchus, and the upper bronchus intermedius. Bronchoscopy showed a good quality anastomosis with slightly reduced endoluminal calibre only. The post‐operative period was uneventful and the patient was discharged at the seventh day. One year later, no complications occurred and the patient is still being followed up regularly., In this article, we try to demonstrate the possibility of creating a "neo‐spur" without lobectomy to treat an intra‐bronchial typical carcinoid tumor.

Background: Hydatid cyst is an endemic disease that is common in the Mediterranean countries .Extra pulmonary intrathoracic localization of the cysts such as thoracic wall involving ribs, muscles, and vertebrae is very rare Methods: We retrospectively reviewed the records of 26 patients managed between 2000 and 2020 in the thoracic and cardiovascular surgery department of Abderrahmen Mami Hospital Ariana – Tunisia. Results: There were 9 woman and 17 men, with a mean age of 41 years (18-76).The most common signs were chest pain (12 cases), neurological deficit (5 cases) ,cough and dyspnea (3 cases). Parietal swelling was reported in 10 cases and 1 patient was asymptomatic. Chest X-ray showed an homogeneous opacity (6 cases), bone destruction (4 cases) and was normal in 5 cases. The cysts mostly were located at ribs (16 cases) and ribs with vertebrae (13 cases). Other parts of chest wall were involved like muscles and sub-cutaneous tissue in 1 case in the sternum in 2 cases. CT scan and MRI often revealed the diagnosis .The cyst was mimicking tumor in 1 case.15 patients underwent costal resection; 7 underwent a costovertebral resection. Other surgical procedures were partial resection of the sternum (two cases) and cystectomy with resection of parietal soft tissue (2 cases).the postoperative course was uneventful in 22 cases .reported complications were paraplegia in 1 case , ARDS and death in 1 case and severe sepsis in 2 cases. Albendazole was given for most cases. Conclusion: Current imaging investigations make diagnosis of chest wall hydatidosis easier. Radical surgery combined with antihelminthic therapy is the best treatment. Prevention is necessary.

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.

Partial Anomalous Pulmonary Venous Connection (PAPVC) is a rare congenital abnormality characterized by drainage of one or more pulmonary veins to the right atrium or to one of the systemic veins. This pathology has low prevalence, although it is probably underestimated and is rarely diagnosed in adults. We reported a rare case of hemoptysis in adult associated to isolated partial anomalous pulmonary venous return. He is a patient of 49 years-old man who had a partial anomalous pulmonary venous connection (PAPVC) from the right upper lobe to the superior vena cava without other congenital heart disease. A right bilobectomy (superior and middle lobe) was performed for the treatment for hemoptysis and PAPVC. The patient has an uneventful postoperative recovery and remained well at follow-up 8 months after surgery.

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.

Tumors of the thymus are rare. Neuroendocrine tumors are extremely rare. We report a case of a 39-year-old man, referred to our hospital for a paraneoplastic Cushing syndrome with a thymic tumor. Despite bilateral adrenalectomy, the patient still had signs of hypercorticism. A CT scan revealed a 25-mm nodule in the thymic compartment. A resection was indicated and surgery was successful. No adjuvant therapy was administrated. After 10 months, the patient was in good health and his clinical symptoms resolved, with no signs of recurrence. Lung and thymic neuroendocrine carcinomas with Cushing syndrome are aggressive with a high risk of recurrence even after a complete resection. A close follow-up is recommended.

Introduction/Background Ocular toxicity of tamoxifen can be corneal, neurological or retinal. The risk is low but can occurs in small doses. Indeed, a careful examination is recommended to look for it, specially since continued therapy may decrease reversibility chances. Methodology We report a case of a 46 years old woman with retinal central vein occlusion due to tamoxifen therapy. we did a systematic review of the litterature. Results We report a case of 46 years old woman with thyroiditis history, treated for invasive ductal carcinoma of the right breast. She underwent radical right mastectomy with axillary lymph node dissection. It was a luminal A SBR I Tumour. She underwent hormonotherapy by Tamoxifen and ovarian suppression by radiotherapy. After a follow-up of 13 months, she presented an ocular redness pain, blurring of vision and loss of eyesight. Funduscopic examination and fluorescein angiography showed a right retinal vein occlusion and an early stage of occlusion of the left one. She received a curative low-molecular-weight heparin. Thrombophilia research was negative, so tamoxifen was incriminated and stopped. Control funduscopic examination was performed and showed a repermeability of both retinal veins. Hormonotherapy was switched to aromatase inhibitor. However, the patient developed, despite cessation of the treatment, an irreversible right blindness. Conclusion Ocular side effects of tamoxifen are known since 1978 such as optical neuropathy, vein occlusion and most of all retinal effects. It can occur even for usual doses and can be potentiated by chorio-retinal and thromboembolic diseases. Treatment and outcome surveillance are non-codified, we must be careful because reversibility of the side effect depends on the earliness of treatment. Disclosure Nothing to disclose.

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.

Background Thymic carcinomas are rare tumors with a challenging diagnosis. Our aim was to report our 17-year experience of these tumors and to highlight the challenges encountered and the main differential diagnoses ruled out. Methods We studied 12 (92%) men and 1 (7.7%) woman with a mean age of 37 years (range 15–60 years). All patients were symptomatic, with chest pain representing the most frequent symptom. Radiology revealed anterior mediastinal masses in all cases, with either infiltration of the adjacent organs or pulmonary parenchymal metastases. Results The diagnosis was made on surgical biopsies in 12 cases and a lymph node biopsy in one. Microscopic examination revealed squamous carcinoma in 3 cases, synovial sarcoma in 1, mucinous adenocarcinoma in 1, undifferentiated carcinoma in 2, clear cell carcinoma in 1, lymphoepithelioma-like carcinoma in 2, atypical carcinoid tumor in 2, and sarcomatoid carcinoma in 1. Total surgical resection was possible in one patient after neoadjuvant chemotherapy and radiotherapy. Follow-up was possible in only 6 patients, and the mean survival reached 13 months. Conclusion In spite of the lack of follow-up information, this study demonstrates the poor outcome associated with these tumors and the need for standardized treatment.

Background: The objective study was to evaluate the use and the effectiveness of hyperbaric oxygen therapy as an adjuvant therapy in 6 cases of descending necrotizing mediastinitis.Methods: This is a retrospective descriptive study, performed between 2010 and 2019. Hyperbaric oxygen therapy was indicated in difficult clinical management cases despite surgery and antibiotic therapy.Results: Six patients had oxygen therapy sessions in addition to antibiotic treatment and surgery. There was marked clinical and radiological improvement in 5 cases. Only one patient died in a septic shock.Conclusions: Hyperbaric oxygen therapy, as adjuvant therapy to surgery and antibiotic treatment, can increase survival and provide good clinical results.

Background: Uncontrollable bleeding during thoracic surgery has been a challenging problem faced by surgeons. The aim of this study was to clarify the usefulness of pleural packing as a good alternative to control hemorrhage and to deduce the common point between those patients.Methods: This was a retrospective case series study of eight patients who underwent thoracic surgery with uncontrollable intrathoracic haemorrhage and shock which required intrathoracic packing from January 2014 to December 2019.Results: During the study period, eight patients underwent thoracic surgery with uncontrollable intrathoracic haemorrhage and needed packing. Successful hemostasis was achieved in all cases after pleural packing. The mean age was 58.5 years and six patients were males. The common point was the history of pulmonary tuberculosis which was with invasive pulmonary aspergillosis for two patients. Incision was a posterolateral thoracotomy in all cases and six patients required pulmonary resection (five lobectomy and one bilobectomy), one patient required decortication, and one had tumorectomy of a paragonglioma located in the Barety’s space. The unpacking took place right after 48 hours. An arrest of the bleeding was noticed in all the remaining patients. The mean time of the mechanical ventilation was 11 days. Complications included atelectasis and infectious pneumonitis. We noted one case of death.Conclusions: Intrathoracic packing may be an effective and feasible technique in managing uncontrollable post-operative hemorrhage when the life of patients is in danger. This technique should always be considered for patients with tuberculosis history.

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.

We report a new case of a mediastinal mass in a 19-year-old patient corresponding microscopically to an association of unilocular thymic cyst and true thymic hyperplasia. Our aim is to highlight the absence of specificity of clinical and radiological findings and the necessity of a thorough sampling of the tumor in order to establish the diagnosis.

Tuberculosis is mainly a medical disease. Surgery has been the unique therapeutic tool for a long time before the advent of specific antituberculous drugs, and the role of surgery was then confined to the treatment of the sequelae of tuberculosis and their complications. The resurgence of tuberculosis and the emergence of multidrug-resistant TB combined to immunosuppressed patients represent a new challenge for tuberculosis surgery. Surgery may be indicated for a diagnostic purpose in patients with pulmonary, pleural, mediastinal or thoracic wall involvement, or with a therapeutic purpose (drainage, resection, residual cavity obliteration). Modern imaging techniques and the advent of video-assisted thoracic surgery allowed a new approach of this pathology; the majority of diagnostic interventions and selected cases requiring lung resection can be performed through a mini-invasive approach. Patients proposed for aggressive surgery may be treated with the best results thanks to a good evaluation of the thoracic lesions, of the patients' nutritional, infectious and general status combined with a good coordination between the specialized medical team for an optimal preparation to surgery.

Background: Hydatid disease remains a serious health problem in Mediterranean countries. Complicated forms are frequent and require a complex management with significant morbidity and mortality rates. Thoracic rupture of hydatid liver cyst is rare and may cause lifethreatening complications. Methods: It is a retrospective study extending over a period of 24 years from 1992 to December 31, 2016 and investigating cases with hydatid cysts of the liver with thoracic rupture, treatment modalities, and factors of morbidity and mortality analyzed by a multivariate analytical study. Results: There were 47 women and 39 men, the mean age was 48 years with the age ranging from 13 to 85 years. Nineteen patients (22. 1%) were admitted in emergency. The most common symptom was the chest pain which occurred in 58 cases (67.4%); the other findings were cough [n:25 (29.06%)], dyspnea [n:37 (43.02%)] and fever [n:47 (54.65%)]. The main procedure was cystectomy and capitonnage with thoracophrenotomy and ‘Lagrot’ on the liver in 50 cases. Two patients underwent segmentectomy, two bilobectomy and 12 underwent lobectomy. Twenty three patients had a decortication. The overall mortality rate was 3.48% while the overall morbidity rate was 23.5%. Predictors of morbidity included advanced age (p=0.03), cysts larger than 7 cm (p=0.04), cysts with bilious contents (p=0.03), type II, III and IV on ultrasound classification (p=0.02)and patients operated lately(p=0.04), patients who underwent decortication or lobectomy(p=0.01). Conclusion: The hepatic hydatid cyst with rupture into thorax is a major complication of the hydatid cyst with a high morbidity and mortality.

Background: Paragangliomas are rare tumors with a slow progress representing difficulties in diagnosis and treatment. Thoracic location is exceptional. Methods: Our aim is to study this rare entity from a series of 9 thoracic paragangliomas (PG) and demonstrate the benefits of surgery. Results: Nine patients (5 men / 4 women) with a mean age of 42 year-old (range:5-17 years) were operated for thoracic PG. The majority of patients were symptomatic. The main symptoms were chest pain and hemoptysis. The predominant radiological aspect was that of a posterior hypervascularized mediastinal mass in 5 cases, a balloon release in 2 cases and a left lower lobe mass in 2 cases. Fibroscopy was normal in the majority of cases. Two patients had associated extrathoracic PGs (upper limb). Tumor markers were negative in all 9 cases. Patients were operated by Video-assissted thoracic surgery (2) or left posterolateral thoracotomy (6). Five patients had complete tumor resection. For one patient the resection was deemed impossible, he had a diagnostic biopsy by mediastinoscopy. Two patients had a lower left lobectomy associated in one case with a lingulectomy and with tumor resection in the other case. The surgical follow-up was simple for all patients. The two patients who had a complete resection had a survival of 6 and 8 months respectively. Non-metastatic patients who had R0 resection had prolonged survival. Conclusion: mediastinal PGs are suspected on the highly vascular aspect of the tumor on CTKey words: chest, mediastinal, tumor. The treatment of choice of thoracic PG is a surgical resection R0.

Background: Hydatidosis is an infectious disease resulting from the development of the larval form of the parasite Echinococcus granulosus in humans. The invasion of the chest wall by echinococcosis is rarely described. Methods: The current study reported all cases of chest wall hydatidosis treated in the department of cardiothoracic surgery from January 1990 to December 2011. Results: The mean age of the patients was 41.316.8 years. Males and females were equally affected. The cysts mostly were located at ribs (13 cases) and ribs with vertebrae (10 cases). The chest wall muscles, the sub-cutaneous tissue and the sternum were involved in four, three and two cases, respectively. A costal resection was performed in 13 cases (one to three ribs; mean, 1.5 ribs) and a costovertebral resection was performed in 10 cases (transverse process three, vertebral body four and both three). The other surgical procedures were partial resection of the sternum (two cases) and cystectomy with resection of parietal soft tissue (nine cases). The outcome was favorable for 29 patients. A recurrence was observed in two patientswhopresented costovertebral and sternal involvements. Conclusions: The chest wall localization of the hydatid cyst is rare. In the costovertebral involvements, this parasitic disease behaves locally as a bone malignancy. The treatment is surgical and the resection should be large and radical to avoid recurrences

Summary Purpose of the study Desmoid-type fibromatosis is a fibroblastic proliferation that develops in the deep soft tissues and is characterized by infiltrative growth and a tendency towards local recurrence but does not metastasize. Fibromatosis of the chest wall is rare, representing only 10 to 20% of all deep fibromatoses. Case report We report a six cases series of fibromatosis of the chest wall treated at our institution between 1996 and 2009. There were five men and one woman with a mean age of 42.2. Swelling of the chest wall was the most frequent symptom. Imaging showed an expansive homogeneous mass, invading the rib (four cases) or the sternum (two cases). Surgical resection was performed in all cases. The outcome was favorable (five cases) or marked by local recurrence (one case). Discussion Although it is considered to be a benign lesion, this tumor can be locally very aggressive, and has a high local recurrence rate depending upon the efficacy of surgical resection.

Resume Les fibromatoses de type desmoide sont des tumeurs fibroblastiques des tissus mous profonds, caracterisees par une capacite infiltrante invasive, un taux de recidive locale tres eleve mais sans potentiel metastatique. Les fibromatoses de la paroi thoracique sont rares ne representant que 10 a 20 % de l’ensemble des fibromatoses profondes. Nous rapportons une serie de six cas de fibromatose de la paroi thoracique operes et colliges dans notre institution entre 1996 et 2009. Il s’agissait de cinq hommes et une femme avec un âge moyen de 42,2 ans. Une tumefaction parietale etait le principal motif de consultation. L’imagerie montrait une masse tissulaire homogene expansive, de siege costal (quatre cas) ou presternal (deux cas). Une exerese chirurgicale etait realisee dans tous les cas. L’evolution etait favorable (cinq cas) ou marquee par des recidives locales (un cas). Bien qu’elles soient considerees comme des lesions benignes, les fibromatoses peuvent etre tres agressives localement avec un haut risque de recidive locale qui reste lie a la qualite de l’exerese chirurgicale.

BACKGROUND. Although the use of antibiotics in the treatment of acute exacerbation of chronic obstructive pulmonary disease (COPD) is largely accepted, controversy remains regarding whether the choice of antibiotic has any impact on outcome. Our aim was to compare the effects of the combination of trimethoprim and sulfamethoxazole and ciprofloxacin in patients treated for severe COPD exacerbation requiring mechanical ventilation. METHODS. In a randomized, double-blind trial, we included 170 patients with an acute exacerbation of COPD requiring mechanical ventilation. Enrolled patients received trimethoprim-sulfamethoxazole (n = 85) or ciprofloxacin (n = 85) for 10 days. Main outcomes were hospital death and need for an additional course of antibiotics. Secondary outcomes were duration of mechanical ventilation, length of hospital stay, and exacerbation-free interval. RESULTS. Combined hospital death and additional antibiotic prescription rates were similar in the 2 groups (16.4% vs 15.3% for trimethoprim-sulfamethoxazole group vs ciprofloxacin group; difference, 1.1%; 95% confidence interval [CI] -9.8% to 12.0%; P = .832). Hospital death occurred in 7 patients (8.2%) receiving trimethoprim-sulfamethoxazole and 8 patients (9.4%) receiving ciprofloxacin (difference, -1.2%; 95% CI, -9.7 to 7.3; P = .90). The need for an additional antibiotic course was observed in 8 patients in the trimethoprim-sulfamethoxazole group and 5 patients in the ciprofloxacin group (difference, 2.3%; 95% CI, -5.4 to 10.0; P = .549). The mean exacerbation-free interval (+/- standard deviation) was similar in both treatment groups (83 +/- 25 vs 79 +/- 22 for the trimethoprim-sulfamethoxazole group vs ciprofloxacin group; difference, 4 days; 95% CI, -15 to 19 days; P = .41). Duration of mechanical ventilation and hospital stay was not significantly different between the 2 groups. CONCLUSIONS. In patients with acute exacerbation of COPD requiring mechanical ventilation, efficacy of trimethoprim-sulfamethoxazole was not inferior to ciprofloxacin. Trial registration. ClinicalTrials.gov identifier: NCT00791505.

Objective To evaluate the effects of catecholamine therapy on the accuracy of capillary glucose measurements in hyperglycemic patients. Participants 43 hyperglycemic patients older than 18 years admitted to the intensive care unit of a tertiary medical center were included from December 2005 to March 2006. Measurements This prospective study compares fingerstick and earlobe measurements simultaneously to sampled laboratory venous glucose in patients treated without (group 1) or with (group 2) catecholamine. Three venous samples for serum glucose analysis at three fixed hours and simultaneously two capillary glucose determinations were performed during the two first successive days after inclusion. A difference between the methods of glucose measurements greater than 2.3 mmol/l was considered significant. Results The mean difference between the two methods was −0.05 mmol/l in group 1 and +0.29 mmol/l in group 2, while the limits of agreement were +4.03 and −4.13 mmol/l and +5.63 and −5.05 mmol/l in groups 1 and 2, respectively. A difference between paired measurements greater than 2.3 mmol/l was observed in 29% in group 1 and in 40% in group 2 (p = 0.038). The alternative site did not improve the accuracy. Conclusions In critically ill patients treated with catecholamine capillary fingerstick blood glucose measurement seems inaccurate. Earlobe sampling does not improve accuracy.

Resume Nous rapportons cinq cas de chondrosarcomes (CS) costaux survenus chez quatre femmes et un homme, âges entre 28 et 49 ans. Dans quatre cas, la tumeur etait etendue et infiltrait les structures adjacentes (tissus mous, vertebres thoraciques, mediastin…). Le diagnostic de CS a ete pose sur les pieces d’exereses chirurgicales larges chez trois malades et sur des biopsies de la tumeur dans deux cas. Le CS etait de grade II dans trois cas. Chez les deux autres malades, le CS etait respectivement de grade I et III. Une resection chirurgicale large a ete pratiquee chez trois malades, associee dans un cas a une radiotherapie et chimiotherapie adjuvantes. Dans les trois cas, l’evolution etait favorable apres un recul de un mois a quatre ans. Deux malades sont decedees, dont un apres radio- et chimiotherapie seules, pratiquees d’emblee devant l’importance de l’envahissement tumoral. Le CS costal se caracterise par un haut potentiel d’invasion locoregionale et a distance. Son diagnostic est anatomopathologique. L’exerese chirurgicale large est le seul traitement curatif meme dans les CS de haut grade.