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Resume But de l’etude L’objectif de cette etude debutee en janvier 2003 aupres des medecins generalistes du secteur liberal national (MGL) est d’evaluer les connaissances de ces MGL en ce qui concerne le diagnostic, le bilan initial et la prise en charge de la BPCO. Methode et resultats L’enquete est realisee au moyen d’un questionnaire pre-etabli et anonyme. Dix pour cent des MGL ont participe a l’etude par tirage au sort, soit un total de 223 (sur les 2 186 MGL marocains). La proportion des BPCO par rapport aux autres consultants etait estimee entre 5 a 10 % pour 40 % des MGL. Seuls 48,9 % des MGL ont pris connaissance des recommandations internationales sur la prise en charge de la BPCO. Pour 97,8 % des MGL, ce sont surtout des symptomes bronchiques chroniques qui orientent vers le diagnostic de BPCO, suivis par la dyspnee d’effort (95,1 %). Seuls 10,8 % des MGL proposent une spirometrie. Quant a la prise en charge des BPCO, seuls 30,5 % prennent en charge le patient. Conclusion Ces resultats montrent les insuffisances de prise en charge d’une telle pathologie par le MG qui doit etre implique dans le diagnostic precoce et la prise en charge.

Resume L’atteinte diaphragmatique au cours du lupus erythemateux dissemine (LED) est une entite rare et le plus souvent meconnue. Nous presentons l’observation d’une patiente âgee de 34 ans qui a presente, 15 jours avant son hospitalisation, des douleurs basithoraciques bilaterales, sans syndrome bronchique, avec une dyspnee stade II de NYHA evoluant dans un contexte de conservation de l’etat general. L’examen clinique etait sensiblement normal, en dehors de polyarthralgies diffuses de type inflammatoire avec une photosensibilite cutanee. La radiographie thoracique a objective un aspect d’ascension des deux coupoles diaphragmatiques realisant des petits poumons retractes, associe a des atelectasies planes basales bilaterales. Le diagnostic de LED avec atteinte diaphragmatique a ete retenu sur les polyarthralgies, la photosensibilite cutanee a type d’erytheme du visage, la presence d’un epanchement pericardique, un titre eleve d’anticorps antinucleaires et une lymphopenie a 1 100 elements/mm3 controlee. Les epreuves fonctionnelles respiratoires ont montre un syndrome restrictif. Sous corticotherapie orale a la dose de 1 mg/kg/j, l’evolution etait marquee par une nette amelioration clinique et fonctionnelle. A la lumiere de cette observation, les auteurs soulignent la rarete de l’atteinte diaphragmatique au cours du LED, la difficulte du diagnostic positif et rappellent les mecanismes physiopathologiques de cette atteinte.

Resume Le fibrome pleural ou tumeur solitaire fibreuse de la plevre (TSFP) est une tumeur rare. Sa decouverte est le plus souvent fortuite ou se fait a l’occasion de signes respiratoires non specifiques, plus rarement au decours d’une hypoglycemie. Les auteurs rapportent l’observation d’un patient âge de 51 ans, tabagique a 30 paquets-annees, sans antecedent pathologique particulier, qui presente a la radiographie thoracique une enorme opacite occupant les deux tiers inferieurs de l’hemithorax gauche. Cette anomalie radiologique avait ete precedee, 3 mois auparavant, par des episodes de lipothymies et de confusion mentale survenant le matin a jeun, et avait ete decouverte a l’occasion d’une hospitalisation pour coma hypoglycemique rapidement jugule par l’administration de serum glucose hypertonique. L’echographie et le scanner thoracique realises ulterieurement confirment la nature tissulaire de l’opacite qui est bien limitee, de siege basal gauche, et associee a un epanchement pleural homolateral de faible abondance. Le diagnostic de TSFP revelee par une hypoglycemie est le diagnostic le plus probable. La thoracotomie en urgence permet l’ablation d’une tumeur dure, de 2 115 g, dont l’etude histologique conclut a une tumeur fibreuse solitaire de la plevre (TSFP) de nature benigne. L’hypoglycemie dans le cadre d’une TSFP serait due a la secretion de proteines insulin-like par la tumeur, ce qui impose en urgence la resection complete de celle-ci etant donne le risque d’hypoglycemie grave.

Many studies report the considerable frequency of respiratory infections due to Chlamydiae pneumoniae (CP), especially in patients with asthma and chronic obstructive broncho-pneumonia COBP. Objective. – The aim of this prospective study was to define the seroprevalence of CP infection in acute episodes in the adult. Methods. – 265 patients were involved in this study, presenting with a non-severe community acquired acute lower respiratory tract infections (acute bronchitis, exacerbation of the COBP) over a 13 month period, from November 1997 to December 1998. These patients were divided in 3 groups: Group 1–103 healthy patients, Group 2–59 patients with COBP, Group III–103 patients with asthma. The CP serology was made on admission, on D30 after admission, and on D45, using an immuno-enzymatic technique. A recent infection or CP was proved by a rate of IgG > 1/512 or for a seroconversion (4 times the initial rate of IgG antibodies). A rate of IgG ranging between 1/16 and 1/512 revealed positive serology but without diagnosis criteria of a recent infection. Results. – The latter was noted in 34% of the patients that were studied, all groups included. The CP seroprevalence was 33.3% in healthy patients, 27.8% in asthmatic patients and 54.5% in patients with COBP. A positive serology without diagnosis criteria of a recent infection was noted in 25.8% of the healthy patients, 25% of the asthmatic patients and 9.1% of the patients with COBP.

Resume La presence de debris de blattes dans la poussiere des maisons est connue depuis longtemps et l'existence d'une allergie aux blattes a ete demontree dans divers pays. Afin de preciser la place de la sensibilisation aux blattes sous nos climats, une etude prospective a ete menee sur une periode de 9 mois, s'etendant de mai 1993 a janvier 1994. Elle concerne 205 patients, âges de 29 ans en moyenne, sans predominance de sexe. Tous ces patients ont beneficie d'un interrogatoire minutieux, d'un examen clinique complet et d'un telethorax. Des tests cutanes pour les principaux pneumallergenes ont ete pratiques, avec un temoin positif (histamine) et un temoin negatif (glycerosalin). L'extrait de blattes provient de corps entiers de blattes germaniques dilues en poids/volume au 1/10. La sensibilisation cutanee aux blattes est retrouvee chez 43 patients (21 %). Chez 6 patients, seul le test cutane a la blatte est positif (14 %). Chez les 37 autres patients, les sensibilisations cutanees les plus souvent associees sont : Dermatophagoides pteronyssinus (83,6 %), Dermatophagoides Farinae (83,8 %), les 3 graminees (48,6 %), et les moisissures (24,3 %). La sensibilisation cutanee aux blattes vient en seconde position apres les acariens (46,3 %). Chez les patients allergiques a la blatte, l'asthme souvent severe, est presque constant ; il est associe a une rhinite + conjonctivite dans 22 cas (51,2 %) ; a une conjonctivite + eczema dans un cas (2,3 %), a une rhinite dans 5 cas (11,6 %) et a une conjonctivite dans 3 cas (7 %). Les IgE specifiques aux blattes n'ont ete realisees que chez 10 malades et ont ete positives dans 2 cas. Ces resultats confirment la haute prevalence de la sensibilisation a la blatte et soulignent la frequence de l'association a une sensibilisation aux acariens.

The purpose of this study initiated in January 2003 was to evaluate the awareness of general practitioners in Morrocco concerning the diagnosis and initial management of chronic obstructive pulmonary disease (COPD).Ten percent of the COPD patients, selected at random, participated in the study, i.e; 223 patients/2186. The proportion of COPD patients among patients attending consultations was 5 to 10% for 40% of general practitioners. Only 48.9% of the general practitioners were aware of international guidelines for the management of COPD. For 97.8%, chronic bronchial symptoms were the predominant reasons for suspecting the diagnosis of COPD; other symptoms included exercise induced dyspnea (95.1%). Only 10.8% of the general practitioners ordered a spirometry examination. Only 30.5% managed patients themselves.Our findings show that general practitioners should be implicated in the diagnosis and early management of COPD but that management practices could be improved.

The prevalence of asthma and other allergic diseases is increasing in many parts of the world.To determine the prevalence of asthma, rhinoconjunctivitis and skin allergy symptoms in Morocco as part of the International Study of Asthma and Allergic Diseases in Children (ISAAC).The survey was conducted using the standardised method of ISAAC Phase III in four centres in Morocco-Casablanca, Marrakech, Ben Slimane and Boulmane-with respectively 1777, 1689, 1008 and 1254 13-14-year-old schoolchildren participating. A comparison of the results with ISAAC Phase I was carried out in two centres.The prevalence of self-reported symptoms of wheeze in the last 12 months (6.4-16.2%), nasal symptoms (27.9-52.8%), rhinoconjonctivitis (8.8-28%) and eczema (13.3-20.2%) varied between centres, and were highest in Casablanca, the largest city in Morocco. Significant increases in almost all symptoms were found in the two centres of Casablanca and Marrakech between ISAAC Phase I and Phase III.Morocco could be classified as a country with an intermediate burden of asthma (between 10% and 15%) and other allergic disorders. The prevalence of these symptoms has increased in the past 5 years.

Pleural fibroma or solitary fibrous tumor of the pleura (SFTP) is a rare tumor generally discovered fortuitously or in patients with non-specific respiratory symptoms, more rarely with hypoglycemia. We report the case of a 51-year-old man with a history of smoking (30 pack-years) and no other disease history whose chest x-ray revealed an enormous opacity occupying the lower two-thirds of the left hemithorax. This radiological anomaly had led to episodes of lipothymia three months earlier together with mental confusion in the morning as well as an episode of hypoglycemia (0.48 g/l) which rapidly resolved after administration of hypertonic dextrose. Ultrasonography and chest scan were performed later and confirmed the tissular nature of the opacity which was well limited with a left base. Minimally abundant homolateral pleural effusion was also noted. The diagnosis of SFTP revealed by hypoglycyemia was the most probably diagnosis. Emergency thoracotomy enabled removal of a hard tumor weighing 2115 g. Histology confirmed the diagnosis of benign SFTP. Hypoglycemia in the context of SFTP would be related to tumor secretion of insulin-like proteins. Complete emergency resection is required to avoid the risk of life-threatening hypoglycemia.

The aim of this prospective study was to evaluate the results of a four-month regimen (2HRZ/2HR) in the treatment of isolated tuberculous pleurisy with effusion. It included 68 patients presenting with histologically confirmed tuberculous pleurisy treated with 2HRZ/2HR, physiotherapy and aspiration of the pleura. Patients were seen every 2 months during treatment, and then 1, 3, 4, 6, 12, and 24 months after the end of treatment. Preliminary results show a favourable response in 58 patients (85%) and minimal pleural thickening in 10 patients. There were no failures, no relapses nor any extrapleural dissemination after a follow-up period of on average 20 months. These encouraging results need to be evaluated in a long-term study.

Although lung cancer is the leading cause of Pancoast-Tobias syndrome, benign etiologies have been rarely described in the literature. We report two cases of Pancoast-Tobias syndrome caused by hydatidosis of the apex. Outcome was favorable after surgical treatment.

Hydatic cyst of the liver remains a serious public health problem in Morocco and several other Mediterranean countries. This benign affection can cause serious sometimes fatal complications such as cyst rupture into the biliary ducts or the thorax. We present the case of a patient with serofibrous pleurisy and recall the often late diagnosis of hydatic cyst. Biliary pleural fistulization is a rare but serious complication.

Parietal thoracic abscess formation of a tuberculous nature is a rare form of extrapulmonary tuberculosis, usually described in cases of severe tuberculosis encountered in HIV-infected patients. We report 13 cases of parietal tuberculosis in patients without HIV infection who were investigated between October 1988 and December 1999. During this period, we cared for 2 663 patients with tuberculosis. The series included 9 women and 4 men age 17 to 60 years, mean age 39 years. The clinical aspect of the parietal abscess was variable. Cold fluctuating abscess was dominant in 10 cases. In 3 cases, the parietal abscess had a hard consistence simulating a malignant tumor. The parietal abscess was in a posteriosuperior or posteriobasal location in 4 cases, and in an anterosuperior, anterobasal or axillary location in 6. Multiple thoracic abscesses were observed in only 3 cases. The size of the abscess varied from 2 to 2.5 cm. Radiologically, rib damage was present in 4 cases, scapular damage in 1, with bone lysis in 3 cases. Other localizations of tuberculosis were observed in 4 cases. one patient had multiple peripheral node enlargement, another had parenchymal lung damage and a third had a vertebral localization. Culture of abscess pus provided the diagnosis in 10 cases. the diagnosis was confirmed by pathology in 8 cases on a biopsy of the abscess border. Anti-tuberculosis drugs allowed successful recovery in all patients. We analyzed the clinical aspects of cold thoracic abscesses and discuss differential diagnosis. Early diagnosis and treatment is essential.

Multiple hydatidosis in a thoracic localization is unusual and a cardiac localization very exceptional. We report a case of multiple hydatidosis greatly improved by medical treatment with albendazole which was associated with a cardiac cyst successfully treated by surgical resection. No recurrence has been observed at 4 year follow-p. We point out therapeutic management options in these unusual forms of the disease.

The authors reported a case of Hodgkin disease with excavated lung localisation discovered during a systematic detection in the occupational medicine framework. This observation raised the differential diagnosis problems mainly with tuberculosis in endemic countries.

On account of the increased use of rubber gloves, latex allergy is a current problem. The problem can present as anaphylaxis revealing its serious nature. The aim of this study was to evaluate the prevalence of sensitivity to latex in health personnel. We carried out an enquiry on the hospital staff in Casablanca (Hospital of the 20th of August, Childrens Hospital, the Dental Centre, the Bouafi Hospital and Sidi Otmane Hospital). This study involved 600 subjects; 408 women and 192 men. The population was composed of 273 nurses of either sex, 169 doctors and 104 care workers and 54 administrators. The study was carried out using an anonymous questionnaire and cutaneous prick tests looking for latex allergy and atopy. Thirty two subjects (5.3%) showed a positive prick test to latex. There were 19 nurses, nine doctors, two health workers and two administrators. A study of specific immunoglobulins to latex carried out in 15 cases was positive in four. In the population with a positive prick test an alimentary allergy was identified in nine cases. The prevalence of atopy in the subjects allergic to latex (81%) was greater than in the latex negative population (16%). After seeing the frequency of latex allergy in hospital personnel we believe that a replacement of other types of gloves (e.g. vinyl) would probably be preferable for all tasks where latex is not indispensable.

A 27-year-old man with an uneventful history was hospitalized after fortuitous discovery of an opacity in the right lung field. The clinical examination revealed a multi-nodular euthyroidian goiter. Laboratory tests, including blood glucose, were normal. Computed tomography of the chest showed a pleural formation and associated pleural effusion. Complete surgical exeresis led to the diagnosis of benign fibrous pleural mesothelioma. Fibromas of the pleura are rare and usually discovered due to extra thoracic signs. The clinical course is long and often silent. Surgical removal is indicated and usually is complete.

Introduction Les tumeurs thymiques sont rares et representent 20 % des tumeurs mediastinales. Elles regroupent un ensemble heterogene de tumeurs situees dans le mediastin anterosuperieur au sein de la loge thymique. Methodes Nous avons realise une etude retrospective s’etalant de janvierb1989 a juillet 2016, nous avons collige 21 cas de tumeurs thymiques, concernant 15 hommes et 6 femmes, la moyenne d’âge est de 50 ans. Resultats Le syndrome parathymique est retrouve dans 4 cas, Le tableau clinique est domine par la toux seche, la douleur thoracique et la dyspnee d’effort. Les examens radiologiques ont objective a une masse mediastinale anterieure dans tous les cas, les marqueurs tumoraux (alpha-F.P. et beta-H.C.G.) sont negatifs dans tous les cas. Le diagnostic est confirme par la ponction biopsie transparietale dans 14 cas, mediastinoscopie dans 4 cas, et par thoracotomie dans 3 cas. L’etude anatomopathologique apres immunomarquage a conclu dans 16 cas a un thymome et dans 2 cas a un carcinome thymique neuroendocrinien et dans 3 cas a un lymphome. Le traitement a ete chirurgical seulement dans 6 cas avec bonne evolution, associe a la chimiotherapie et la radiotherapie premieres dans 4 cas, et base sur la chimiotherapie seule dans 11 cas. Conclusion Les auteurs rappellent a travers ce travail les differents types histologiques des tumeurs thymiques, et les demarches diagnostiques et therapeutiques relatives a chaque type histologique.