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Mid-term subclinical myocardial injury detection in patients who recovered from COVID-19 according to pulmonary lesion severity. Front Cardiovasc Med 2022; 9:950334. [DOI: 10.3389/fcvm.2022.950334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV 2) may cause damage to the cardiovascular system during the acute phase of the infection. However, recent studies reported mid- to long-term subtle cardiac injuries after recovering from acute coronavirus disease 2019 (COVID-19). This study aimed to determine the relationship between the severity of chest computed tomography (CT) lesions and the persistence of subtle myocardial injuries at mid-term follow-up of patients who recovered from COVID-19 infection.MethodsAll patients with COVID-19 were enrolled prospectively in this study. Sensitive troponin T (hsTnT) and chest CT scans were performed on all patients during the acute phase of COVID-19 infection. At the mid-term follow-up, conventional transthoracic echocardiograph and global longitudinal strain (GLS) of the left and right ventricles (LV and RV) were determined and compared between patients with chest CT scan lesions of < 50% (Group 1) and those with severe chest CT scan lesions of greater or equal to 50% (Group 2).ResultsThe mean age was 55 ± 14 years. Both LV GLS and RV GLS values were significantly decreased in group 2 (p = 0.013 and p = 0.011, respectively). LV GLS value of more than −18 was noted in 43% of all the patients, and an RV GLS value of more than −20 was observed in 48% of them. The group with severe chest CT scan lesions included more patients with reduced LV GLS and reduced RV GLS than the group with mild chest CT scan lesions [(G1:29 vs. G2:57%, p = 0.002) and (G1:36 vs. G2:60 %, p = 0.009), respectively].ConclusionPatients with severe chest CT scan lesions are more likely to develop subclinical myocardial damage. Transthoracic echocardiography (TTE) could be recommended in patients recovering from COVID-19 to detect subtle LV and RV lesions.
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[Factors predicting the need for invasive mechanical ventilation in patients with chronic obstructive pulmonary disease (COPD)]. Pan Afr Med J 2021; 39:119. [PMID: 34512855 PMCID: PMC8396382 DOI: 10.11604/pamj.2021.39.119.27514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/15/2021] [Indexed: 11/11/2022] Open
Abstract
Introduction the use of invasive mechanical ventilation (IMV) in acute exacerbations of chronic obstructive pulmonary disease (AECOPD) constitutes a negative turning point in the progression of the disease. The purpose of this study is to determine factors predicting the need for IMV in AECOPD. Methods we conducted a retrospective study by reviewing the medical records of patients with AECOPD hospitalized in our Department over a 18-year period (2000-2017). We compared 2 groups: G1: patients with AECOPD undergoing at least one IMV and G2: patients who had never undergone IMV following AECOPD. Results the study included 1152 patients with COPD: 133 in the G1 group (11.5%), and 1019 in the G2 group (88.5%). G1 patients were more symptomatic (p < 0.001), with more severe bronchial obstruction (p < 0.001). G1 patients had more exacerbations (p < 0.001), more hospitalizations and a higher need for non-invasive ventilation (NIV) (p < 0.001). Similarly, G1 patients more often developed chronic respiratory failure (p < 0.001) and had significantly lower survival rates. Independent risk factors associated with IMV were hypercapnia and decreased pH (in patients with severe AECOPD), a history of NIV, and chronic respiratory failure (CRF). Conclusion respiratory function impairment, the severity of exacerbation and the need for NIV in a previous episode are factors predicting the need for IMV and poor outcomes.
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Bilateral pleural metastases of a primary central nervous system neuroblastoma in an adult: First case in the world. Respirol Case Rep 2021; 9:e0829. [PMID: 34430031 PMCID: PMC8365541 DOI: 10.1002/rcr2.829] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/19/2021] [Accepted: 07/30/2021] [Indexed: 11/16/2022] Open
Abstract
Primary central nervous system neuroblastoma (PCNS-NBL) is a rare and aggressive malignant tumour. Pleural metastases of PCNS-NBL have not been documented before. We report a case of a 30-year-old male patient, with a history of PCNS-NBL treated with surgery, radiation and chemotherapy. Three years later, he presented an aggravated dyspnoea with impaired general condition. The different investigations confirmed that his PCNS-NBL has relapsed with bone, lymph nodes and bilateral pleural metastases. Because of the disseminated disease and the poor general condition of the patient, only symptomatic treatment measures were preconized. The patient died 3 months later following cardiorespiratory arrest. To the best of our knowledge, this is the first case reporting bilateral pleural metastases of a PCNS-NBL in a young adult.
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[Prognostic factors in idiopathic pulmonary fibrosis in a tunisian cohort]. Rev Mal Respir 2021; 38:681-688. [PMID: 33992493 DOI: 10.1016/j.rmr.2021.04.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Accepted: 03/31/2021] [Indexed: 10/21/2022]
Abstract
We present data on prognostic factors in a Tunisian cohort of people with Idiopathic pulmonary fibrosis. INTRODUCTION Idiopathic pulmonary fibrosis (IPF) has a poor prognosis, with a median survival in patients with the condition of only 3 to 5 years. Previous studies have identified a number of prognostic factors in this chronic pulmonary disease. METHODS We conducted a retrospective study, including patients with idiopathic pulmonary fibrosis (IPF) who were diagnosed at the Pneumology Department of the University Hospital Fattouma-Bourguiba, Monastir, between 1991 and 2014. The aim of this study was to compare clinical, radiological, pulmonary functional predictors of survival in IPF in a Tunisian cohort with those of previous studies. RESULTS This study included 126 patients. Their mean age was 66 years, with a male predominance (68.3%). Respiratory function tests revealed a restrictive ventilatory deficit in 72.6% of cases. The median survival of our study population was 22.5 months [6.7-49.5]. In univariate analysis, factors associated with a poor prognosis were: lower baseline values of TLC, FCV and DLco, level of dyspnea assessed by mMRC scale, hypoxemia at diagnosis, the degree of desaturation during exercise, a higher annual decline of FVC and DLco, acute respiratory distress and also the GAP score. In multivariate analysis, independent prognostic factors were: baseline DLco, level of dyspnea, desaturation at exertion and the annual decline of the DLco. CONCLUSION Lower baseline DLco, the level of dyspnea, desaturation on exercise, and annual decline in DLco are all associated with a poor prognosis in IPF.
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[Effect of intensity of smoking intoxication on severity parameters of acute exacerbations of chronic obstructive pulmonary disease treated in a hospital milieu]. Pan Afr Med J 2021; 38:91. [PMID: 33889257 PMCID: PMC8035682 DOI: 10.11604/pamj.2021.38.91.21512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/09/2020] [Indexed: 11/20/2022] Open
Abstract
Introduction le tabagisme constitue le principal facteur de risque de la broncho-pneumopathie chronique obstructive (BPCO). Le cours évolutif de cette maladie est caractérisé par la survenue des exacerbations aiguës (EA). L'objectif de notre travail est d'évaluer l´impact de l´intensité de l´intoxication tabagique (en paquets-années (PA)) sur les différents paramètres de sévérité des EA des patients BPCO non sevrés hospitalisés. Méthodes c´est une étude rétrospective, monocentrique, portant sur 685 patients porteurs de BPCO, tabagiques non sevrés ayant été hospitalisés au moins une fois pour une EA entre 1990 et 2017. Nous avons défini 2 groupes de patients (G1: < 30PA, et G2: ≥ 30PA). Nous avons comparé les différents paramètres de sévérité des EA BPCO entre les deux groupes. Résultats l´âge moyen de nos patients était de 66 ans. Il n'y avait pas de différence significative entre les deux groupes concernant l´importance du syndrome inflammatoire biologique, la durée de l´hospitalisation et celle de l´antibiothérapie. Le G2 était caractérisé par une PaO2 plus basse au cours des EA (G1: 63,5, G2: 59,3, p: 0,007), avec plus d'hospitalisation en réanimation (p < 0,001), plus de recours à la ventilation non invasive (p: < 0.001) et à la ventilation invasive (p: 0,008). Le G2 avait plus d'EA/an (G1: 2,06, G2: 2,72/patient/an, p: 0,001) avec un délai moyen de survenue d'EA sévère plus court (p: 0,038). Conclusion l´intensité de l´intoxication tabagique a un impact négatif sur plusieurs paramètres de sévérité des EA sévères de BPCO. D´où l´intérêt de sevrage tabagique pour prévenir la maladie et ses complications.
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Miliary tuberculosis following intravesical Bacillus Calmette and Guérin therapy: A rare complication of a frequent procedure. Urol Case Rep 2021; 38:101655. [PMID: 33868941 PMCID: PMC8040259 DOI: 10.1016/j.eucr.2021.101655] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 03/18/2021] [Accepted: 03/20/2021] [Indexed: 12/02/2022] Open
Abstract
The standard treatment for superficial vesical tumors is transurethral resection (TUR) followed by intravesical instillation of Bacillus Calmette and Guérin (BCG). Pulmonary complications of BCG-therapy are rare but could be life threatening. We report the case of a 54-year-old patient who received BCG-therapy after TUR. After the sixth session of BCG instillations, the patient was diagnosed with a miliary tuberculosis secondary to BCG-therapy. We observed a progressive clinical and radiological improvement under specific tuberculosis treatment. Early diagnosis of pulmonary side effects of BCG-therapy and prompt treatment are the keys to complete recovery and survival.
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A Rare Case of Haemoptysis Revealing Aortic Coarctation in an Adult. Eur J Case Rep Intern Med 2020; 7:001804. [PMID: 33194853 DOI: 10.12890/2020_001804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/30/2020] [Indexed: 11/05/2022] Open
Abstract
Haemoptysis is a frequently occurring but sometimes life-threatening condition. Congenital cardiovascular abnormalities are rare causes of haemoptysis. We report a case of a 33-year-old man without any past medical history complaining of haemoptysis with no other associated clinical manifestations. A contrast-enhanced chest computed tomography scan revealed aortic coarctation with dilation of the internal mammary, intercostal and bronchial arteries. He underwent stent placement after balloon angioplasty with favourable outcomes. LEARNING POINTS Adult patients with congenital cardiovascular abnormalities such as aortic coarctation may rarely, due to the high pressure and dilation in the bronchial arteries, present with recurrent haemoptysis as the sole clinical sign.A multidetector computed tomography scan contributes significantly to the aetiological diagnosis of haemoptysis in cases of congenital cardiovascular abnormalities.Interventional procedures such as stenting are currently the preferred approach for the treatment of aortic coarctation in adults, with good outcomes.
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Inflammatory myofibroblastic tumor of the lung: A rare entity. Respir Med Case Rep 2020; 31:101287. [PMID: 33251105 PMCID: PMC7683262 DOI: 10.1016/j.rmcr.2020.101287] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/02/2020] [Accepted: 11/07/2020] [Indexed: 11/26/2022] Open
Abstract
Inflammatory myofibroblastic tumor (IMT) is a rare mesenchymal tumor usually seen within the first and second decade. They are extremely rare in adults, constituting less than 1% of adult lung tumors. It's usually benign, but it had a tendency for local recurrence. We report a case of asymptomatic inflammatory myofibroblastic tumor of lung in a 46-year-old non-smoker woman.
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[Bronchial dilatations in patients with chronic obstructive pulmonary disease in a Tunisian center: effect on disease progression and prognosis]. Pan Afr Med J 2020; 37:200. [PMID: 33505569 PMCID: PMC7813652 DOI: 10.11604/pamj.2020.37.200.24448] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2020] [Accepted: 09/12/2020] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION bronchial dilations (BDs) seem to have a major role in the natural history of chronic obstructive pulmonary disease (COPD). The purpose of our study was to evaluate the impact of BDs on the severity and progression of COPD as well as on patients' prognosis. METHODS we conducted a retrospective, single-center, analytical study over the period 1995- 2017. The study was based on data from the medical records of patients with COPD who had undergone chest CT scan during the follow-up period. We compared two groups (G) of patients: G1: COPD with BDs; G2: COPD without BDs. RESULTS our study included 466 patients with COPD. Among them 101 (21.6%) had BDs associated with COPD. G1 patients had lower maximum expiratory volume in the first second (FEV1) (G1: 1.21 L, G2: 1.37 L, p = 0.015), lower forced vital capacity (FVC) (p = 0.014), a lower PaO2 at steady state (p = 0.049), a higher rate of acute exacerbations (AE) per year (G1: 3.31, G2: 2.44, p = 0.001) and a higher rate of hospitalizations in the Intensive Care Unit per year (p = 0.02). G1 patients with AE receiving treatment in hospital had lower PaO2 3) on admission (G1: 60 mmHg, G2: 63.7 mmHg, p = 0.02 G2: 63.7 mmHg, p = 0.023), more elevated carbon dioxide (CO2) levels (p = 0.001) and were characterized by a higher use of non-invasive ventilation (NIV) (p = 0.044) and invasive mechanical ventilation (p = 0.011). G2 patients had better overall survival (p = 0.002). CONCLUSION bronchial dilatations are an indicator of poor prognosis in patients with chronic obstructive pulmonary disease, expecially because of the higher rate and severity of exacerbations, airway obstructions and mortality.
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Mounier-Kuhn syndrome: A variable course disease. Respir Med Case Rep 2020; 31:101238. [PMID: 33088707 PMCID: PMC7567047 DOI: 10.1016/j.rmcr.2020.101238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 09/19/2020] [Accepted: 09/19/2020] [Indexed: 12/02/2022] Open
Abstract
Mounier-Kuhn syndrome or tracheobronchomegaly is a rare disease characterized by marked dilation of the trachea and proximal bronchi with recurrent lower tract respiratory infections. Computed tomography and bronchoscopy are the key tools to accomplish the diagnosis. This is a condition with a clinical polymorphism, symptoms vary from minor with preserved respiratory function, to very severe with life threatening exacerbations leading to respiratory failure and premature death. The treatment is mainly symptomatic, stenting or surgery are reserved to extreme cases.Herein, we report two cases of the same condition with different clinical signs and diverse outcome.
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Simultaneous bilateral spontaneous pneumothorax as the first manifestation of primary pulmonary MALT lymphoma. Pan Afr Med J 2020; 37:11. [PMID: 33062114 PMCID: PMC7532852 DOI: 10.11604/pamj.2020.37.11.24494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/20/2020] [Indexed: 12/02/2022] Open
Abstract
Primary pulmonary lymphoma is a rare entity. Furthermore, simultaneous bilateral spontaneous pneumothorax (SBSP) is a very rare condition which is often related to therapeutic complications. We present, to the best of our knowledge, the first case of primary pulmonary mucosa associated lymphoid tissue (MALT) lymphoma revealed by SBSP. A 50-year-old female was diagnosed with organizing pneumonia. One month later, she presented with sudden chest pain and shortness of breath due to SBSP. Bilateral chest tubes were inserted. A scan- guided right lung biopsy led to the diagnosis of primary pulmonary MALT lymphoma. The patient was treated with R-CHOP chemotherapy. The association between lymphoma and pneumothorax is extremely rare, often related to therapeutic toxicity. We report the case of SBSP as the first manifestation of primary pulmonary MALT lymphoma.
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[Influence of co-morbidities on the progression and prognosis of patients with chronic obstructive pulmonary disease in a Tunisian Hospital]. Pan Afr Med J 2020; 36:76. [PMID: 32774635 PMCID: PMC7386274 DOI: 10.11604/pamj.2020.36.76.21511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 03/15/2020] [Indexed: 11/18/2022] Open
Abstract
Introduction la broncho-pneumopathie chronique obstructive (BPCO) s’associe fréquemment avec des comorbidités. L’objectif de notre travail est d'étudier l'impact des comorbidités sur l’évolution et le pronostic de la BPCO. Méthodes il s’agit d’une étude rétrospective incluant des patients porteurs de BPCO hospitalisés et/ou suivis à la consultation de Pneumologie au Centre Hospitalo-Universitaire Fattouma Bourguiba de Monastir entre Janvier 2000 jusqu’à Décembre 2017. Les patients ont été répartis initialement en deux groupes, le groupe G0: BPCO isolée et le groupe G1: au moins une comorbidité. Nous avons divisé les patients du groupe G1 en deux sous-groupes: Groupe A: patients ayant 1-2 comorbidités et Groupe B: ≥ 3 comorbidités associées. Nous avons comparé les différents paramètres de sévérité de la BPCO entre les différents groupes. Résultats en tout 1152 patients BPCO ont été inclus. Soixante-dix-neuf pourcent des patients avaient au moins une pathologie chronique associée à leur BPCO. La présence d’au moins une comorbidité était associée à l'augmentation du nombre des exacerbations sévères (p = 0,004), avec plus de recours à l’oxygène longue durée (p = 0,006) et à une survie réduite (p = 0,001). De même, un nombre de comorbidités plus important (≥ 3 comorbidités) était associé à une inflammation systémique plus importante, à un recours plus fréquent à la ventilation mécanique ou la ventilation non invasive (p = 0,04) et à une survie réduite (p = 0,05). Conclusion la présence de comorbidités au cours de la BPCO s’associe à une sévérité plus importante et un pronostic plus sombre de la maladie. Abstract
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Transudative chylothorax in liver cirrhosis; an underappreciated entity. Respir Med Case Rep 2020; 31:101151. [PMID: 32714824 PMCID: PMC7369586 DOI: 10.1016/j.rmcr.2020.101151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 07/03/2020] [Indexed: 02/07/2023] Open
Abstract
Chylothorax is a rare pathology with potentially severe consequences. Transudative chylothorax remain an extremely rare entity. Cirrhosis is often an underappreciated cause. We report a case of transudative chylothorax in 62-year-old woman with cirrhosis due to hepatitis C.
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[Recurrence score to predict the risk of recurrence after first episode of primary spontaneous pneumothorax]. Pan Afr Med J 2020; 36:107. [PMID: 32821318 PMCID: PMC7406466 DOI: 10.11604/pamj.2020.36.107.23432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 05/26/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction the relationship between computed tomography (CT) scan findings and the risk of recurrence of primary spontaneous pneumothorax (PSP) is controversial. The purpose of this study is to determine the relationship between the Dystrophy Severity Score (DSS) and PSP recurrence after an initial episode. Methods we conducted a retrospective study including patients admitted to the hospital with PSP (first episode) between 2005-2017. The study population was divided into 2 groups, G1: PSP recurrence, G2: No recurrence. We undertook univariate analysis including various variables such as the DSS score followed by multivariate analysis. Results eighty-six patients were included in this study. Forty-eight percent of cases had PSP recurrence. Although the DSS score was significantly associated with PSP recurrence (p=0.008), multivariate analysis showed that the presence of bubbles on chest CT scan was the independent risk factor associated with PSP recurrence after a first episode (risk report: 3.26, p < 0.008). Conclusion the risk of PSP recurrence is significantly associated with the presence of bubbles on chest CT scan. Further studies are needed for better assessment of the DSS score.
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[Asthma and obesity: relationship and therapeutic implications in patients with asthma at the Department of Pneumology in Monastir, Tunisia]. Pan Afr Med J 2020; 36:49. [PMID: 32774625 PMCID: PMC7388602 DOI: 10.11604/pamj.2020.36.49.21098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 03/15/2020] [Indexed: 11/11/2022] Open
Abstract
Introduction L’obésité et l’asthme sont deux maladies chroniques touchant des millions d’individus à travers le monde. La présence d’un lien de causalité est suggérée. L'objectif de notre travail est d'étudier le profil de l’asthmatique obèse et de déterminer la relation entre les différents paramètres de sévérité de l’asthme avec les grades de l’obésité. Méthodes Il s'agit d'une étude rétrospective, monocentrique, analytique menée au Service de Pneumologie et d’Allergologie au CHU Fattouma Bourguiba de Monastir portant sur 450 asthmatiques, ayant un indice de masse corporelle (IMC) ≥ 30 kg/m2 avec un recul d’au moins 6 mois. Résultats L’âge moyen au moment du diagnostic était de 45±12.8 ans. L’IMC moyen était de 34,8±4,2 kg/m2. L’asthme était bien contrôlé chez 55,3% des patients. Des critères de sévérité étaient notés dans 37.4% des cas. Selon GINA 2016, 24,2% sont traités par le palier 4. Deux phénotypes de l’asthme associé à l’obésité étaient notés. Le premier phénotype (52,4%) était caractérisé par un asthme à début précoce, associé à une fréquence plus élevée d’allergie, et des manifestations d'atopie. Le deuxième (47,6 %) était caractérisé par un asthme à début tardif, fréquemment associé au sexe féminin et un taux plus élevé de comorbidités et d’hospitalisations. Les obèses de grade II et III avaient un déficit ventilatoire important (CVF: p = 0,002 et VEMS: p = 0,007). Conclusion L’obésité est l’un des facteurs clefs impliqués dans le mauvais contrôle de l’asthme. Sa prise en charge, qui n'est pas encore codifiée, doit être multidisciplinaire.
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Thyroid metastasis revealing a lung adenocarcinoma. Respir Med Case Rep 2020; 30:101065. [PMID: 32489846 PMCID: PMC7256324 DOI: 10.1016/j.rmcr.2020.101065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Revised: 03/23/2020] [Accepted: 04/21/2020] [Indexed: 11/19/2022] Open
Abstract
Thyroid metastasis revealing a primary lung cancer is an extremely rare condition. Only few cases have been reported in the literature. A multidisciplinary approach is essential for the diagnosis. The prognosis is generally poor. We report a case of a 50-year-old man presented with cervical nodules corresponding to a thyroid nodule and lymph nodes. The ultrasonography-guided fine-needle aspiration cytology of the thyroid nodule and a cervical lymphadenopathy concluded to a poorly differentiated adenocarcinoma. Cervical lymphadenopathy biopsy with immunohistochemistry and additional imaging explorations contributed to the diagnosis of a lung adenocarcinoma stage IVB. He died few days after the diagnosis.
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[Survival and prognostic factors of non-small-cell lung cancer among young people in central Tunisia]. Pan Afr Med J 2020; 35:19. [PMID: 32341740 PMCID: PMC7170746 DOI: 10.11604/pamj.2020.35.19.21100] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Accepted: 12/10/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction Non-small cell lung cancer (NSCLC) is a public health problem that usually affects the elderly. Currently and for some years now, this disease is increasingly affecting the young population. The purpose of this study was to analyze the features of NSCLC in young subjects and to assess survival as well as the various prognostic factors. Methods We conducted a retrospective study of all patients under the age of 50 years treated in the Department of Pneumology at the Fattouma Bourguiba University Hospital, Monastir for NSCLC. Survival and prognostic factors have been analyzed according to Kaplan Meier method. Results The average age of patients was 43.8 ± 5.29 years. The most common histological type was lung adenocarcinoma (66.1%). NSCLC was discovered at an advanced or metastatic stage in 79.7% of cases. The median overall survival was 8 ± 0.72 months. Univariate analysis showed that survival was significantly influenced by patients' general status, assessed according to the "Performance Status (PS)" index of the World Health Organization on admission, tumor stage and CRP concentrations. Multivariate analysis was performed, which enabled us to use PS index ≥ 2 and high CRP concentrations as factors of poor prognosis. Conclusion Despite the therapeutic progress, prognosis in young subjects with NSCLC is poor. Early diagnosis and management can improve survival in these patients.
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Rare case of vascular ring with Kommerell diverticulum mimicking uncontrolled asthma. Respirol Case Rep 2020; 8:e00535. [PMID: 32076553 PMCID: PMC7029337 DOI: 10.1002/rcr2.535] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 01/19/2020] [Accepted: 01/27/2020] [Indexed: 11/12/2022] Open
Abstract
Anomalies of the aortic arch associated with Kommerell diverticulum (KD) are rare congenital malformations. Symptomatic thoracic vascular rings presenting in adults are rare. We report a case of a 39-year-old woman who was diagnosed with uncontrolled asthma. She was complaining of worsening respiratory symptoms with dysphagia. Imaging studies and preoperative findings concluded to type II congenital anomaly of the aortic arch or Neuhauser's anomaly: a right-sided aortic arch with aberrant left subclavian artery, tracheoesophageal compression by KD and ligamentum arteriosum (LA). This compression was relieved by the resection of the LA and KD.
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Choroidal metastasis as the initial presentation of lung adenocarcinoma: A case report. Respir Med Case Rep 2020; 29:100992. [PMID: 31956477 PMCID: PMC6957837 DOI: 10.1016/j.rmcr.2019.100992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Revised: 12/26/2019] [Accepted: 12/26/2019] [Indexed: 11/19/2022] Open
Abstract
Clinical reports of symptomatic choroidal metastasis as the initial presentation of lung cancer are rare. Here, we report such a presentation in a female patient of non small cell lung cancer. She presented with loss of vision in her left eye. On further analyses, the patient was diagnosed with a lung adenocarcinoma.
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Rare case of cavernous hemangioma of the thymus. Respir Med Case Rep 2019; 29:100986. [PMID: 31890561 PMCID: PMC6928372 DOI: 10.1016/j.rmcr.2019.100986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 12/13/2019] [Indexed: 11/29/2022] Open
Abstract
Cavernous hemangioma (CH) of the thymus is an extremely rare congenital venous malformation. Related symptoms are non-specific and patients are often asymptomatic. The diagnosis is difficult to make either by non-invasive or mini-invasive procedures. Surgical resection is usually required for diagnosis and treatment. We report a case of a 46-year-old men with an incidental finding of an anterior mediastinal tissue mass on chest computed tomography scan. A complete surgical resection of the mass was performed. Histopathological examination concluded to a thymic CH.
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[Study of the role of blood eosinophil count in patients with severe acute exacerbation of chronic obstructive pulmonary disease hospitalized in a Tunisian Center]. Pan Afr Med J 2019; 34:138. [PMID: 33708307 PMCID: PMC7906554 DOI: 10.11604/pamj.2019.34.138.17392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 10/25/2019] [Indexed: 11/11/2022] Open
Abstract
Introduction There is a controversy over the relationship between blood eosinophil count (BEC) and the severity of chronic obstructive pulmonary disease (COPD) exacerbations. The purpose of our study was to determine the relationship between blood eosinophil count and multiple parameters in assessing the severity of serious acute exacerbation (AE) of obstructive pulmonary disease. Methods We conducted a retrospective monocentric study of hospitalized patients with obstructive pulmonary disease treated between 2005 and 2015. We compared 2 groups of patients: G1(BEC+): BEC ≥ 200 cell/μl (103 cases, 20.4%), G2(BEC-): BEC < 200 cell/μl (403 patients: 79.6%). Results A total of 506 subjects with obstructive pulmonary disease were included in the study. No significant difference between the two groups in age, gender, forced expiratory volume in one second (FEV1), and the number of AE/year (BEC+: 2.6, BEC-:2.5 AE/year; p = 0.48) was found. The analysis of the parameters of severity of serious AE showed no difference between the two groups in partial pressure of oxygen PaO2 measured on admission (60.5, 59.2 mmHg; p = 0.26), capnia (p=0.57), pH (p=0.74), C-reactive protein rate (mg/L) (82.7, 81; p = 0.89), leukocytosis (p = 0.36), non-invasive mechanical ventilation (5.8%, 6.5%; p = 0.81), invasive mechanical ventilation (p = 0.5),length of stay in hospital (9.7, 9 days; p = 0.21), mean time to next AECOPD (p = 0.32). Survival at 1 year was comparable between the two groups (94% vs 96%; Log Rank: 0.708). Conclusion Increased BEC in patients with COPD does not appear to have a negative effect on patients with severe AE. Despite the recent guidelines recommend to consider blood eosinophil count while making treatment decisions, the role and the prognostic interest of blood eosinophil count in patients with COPD could be population-dependent.
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Primary adenoid cystic carcinoma of the tracheobronchial tree: report of two cases. Pan Afr Med J 2019; 34:137. [PMID: 33708306 PMCID: PMC7906545 DOI: 10.11604/pamj.2019.34.137.14902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 10/25/2019] [Indexed: 11/19/2022] Open
Abstract
Adenoid cystic carcinoma (ACC) is a rare malignant epithelial tumor that predominantly originates in the salivary glands. Primary ACC of the tracheobronchial tree is extremely rare. We report two new cases of central airways primary ACC: a 58 year-old male with an ACC of the left main bronchus who underwent a pneumonectomy with node dissection, and a 52 year-old female with proximal tracheal ACC presenting as asthma treated by surgical resection and a postoperative radiotherapy. Primary ACC of the tracheobronchial tree is often misdiagnosed given the non-specific clinical presentation. An early diagnosis is essential to ensure good outcomes. An interdisciplinary treatment is required based especially on surgery and radiotherapy.
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Predictive factors of severe asthma in women. LA TUNISIE MEDICALE 2019; 97:950-955. [PMID: 32173841] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
INTRODUCTION Severe asthma is an uncontrolled asthma despite an optimal treatment. The aim of this study was to determine predictive factors of severe asthma in Tunisian asthmatic women. METHODS A retrospective study including 910 women followed for asthma at pneumology department during a period of 10 years. We compared 2 groups: Patients with severe asthma and asthmatic patients without severe asthma. This comparison was based on demographic, clinic and functional criteria. A multivariate logistic regression study enabled to identify predictive factors of severe asthma in women. RESULTS In univariate analysis, significant predictive factors of severe asthma were: Late age of asthma diagnosis, advanced age of asthma onset, obesity, aspirin intolerance, gastro esophageal reflux (GERD) symptoms and ventilator disorder at spirometry. The main predictive factors of severe asthma in a logistic regression analysis were GERD symptoms (p=0, 02) and ventilatory deficit: Lower forced expiratory volume in 1 second (FEV) (p=0,002) and reduced FEV/CVF (forced vital capacity) (p<10-3). CONCLUSION Knowledge of the predictors of severe asthma in women enables optimization of patients care and help to prevent this form of asthma.
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Rare case of primary extranodal marginal zone lymphoma of the thorax. Respir Med Case Rep 2019; 26:251-254. [PMID: 30788210 PMCID: PMC6369120 DOI: 10.1016/j.rmcr.2019.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2019] [Revised: 02/05/2019] [Accepted: 02/06/2019] [Indexed: 11/26/2022] Open
Abstract
Primary lymphoma presenting a solitary lesion of the chest wall is extremely rare, as the majority of chest-wall tumors arise from metastasis. We report a case of a 64-year-old man with no history of HIV infection or pyothorax who presented with dry cough, right pleuritic pain and dyspnea. A computed tomography scan revealed an irregular pleural mass invading his right chest wall with pleural effusion. CT-guided needle biopsy revealed extranodal marginal zone B-cell lymphoma. The patient was treated with chemotherapy and radiotherapy. The patient has 9 years of follow up with 2 relapse's episodes.
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Influence du délai de chimiothérapie adjuvante sur l’évolution des cancers broncho-pulmonaires opérés. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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26
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Pneumopathies infiltrantes diffuses associées aux connectivites. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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27
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Survie et facteurs pronostiques du cancer bronchique non à petites cellules chez le sujet jeune. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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28
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La rentabilité de la biopsie pleurale à l’aveugle dans le diagnostic de la pleurésie tuberculeuse. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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29
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Asthme allergique et obésité. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.188] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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30
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L’asthme allergique tardif : quelles particularités ? Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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31
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Homogénéité du groupe BPCO obèses. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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32
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Les patients BPCO emphysémateux : à propos de 310 cas. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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33
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Profil clinique, thérapeutique et évolutifs des pleurésies tuberculeuses. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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34
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Le pneumothorax récidivant. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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35
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Évolution de l’asthme allergique au cours de la grossesse. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.403] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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36
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La pneumopathie interstitielle non spécifique (PINS) : aspects cliniques, radiologiques et évolutifs. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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37
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Profil allergénique de l’asthme chez l’enfant tunisien. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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38
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Impact des comorbidités sur l’évolution et la sévérité des DDB. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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39
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Délai d’accès à la chimiothérapie adjuvante après une chirurgie curative dans le cancer du poumon. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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40
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Facteurs prédictifs du pneumothorax chronique. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.539] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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41
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Test d’acétylation dans le suivi thérapeutique des antituberculeux chez l’adulte. Rev Mal Respir 2019. [DOI: 10.1016/j.rmr.2018.10.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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42
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Facteurs prédictifs de réhospitalisation après une première admission pour exacerbation aiguë de DDB. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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43
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Facteurs pronostiques du syndrome cave supérieur. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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44
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Profil clinique, histologique et thérapeutique du cancer bronchopulmonaire opéré. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.505] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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45
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Particularités de l’association asthme et obésité. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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46
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Taille tumorale et résultats de la chirurgie dans le carcinome bronchique non à petites cellules. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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47
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Facteurs influençant la réponse thérapeutique au cours du syndrome cave supérieur. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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48
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Particularités évolutives de la BPCO chez les anciens tuberculeux. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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49
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Syndrome cave supérieur d’origine maligne : circonstances de découverte et manifestations atypiques. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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50
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Les facteurs prédictifs d’une hospitalisation prolongée pour pneumopathie aiguë bactérienne communautaire. Rev Mal Respir 2018. [DOI: 10.1016/j.rmr.2017.10.580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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