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Resume La constipation est l’effet indesirable le plus frequemment decrit par les patients beneficiant d’un traitement opioide au long cours. C’est la raison pour laquelle la constipation induite par les opioides doit avant tout faire l’objet d’une approche preventive. Les objectifs de notre travail sont d’evaluer la prevalence de la constipation et d’etudier ses caracteristiques chez les patients suivis pour cancer du poumon et traites par opioides. A travers ce travail nous decrivons les moyens de prise en charge preventive et curative de la constipation induite par les opioides.

Resume Les soins palliatifs sont une approche multidisciplinaire pour ameliorer la qualite de vie des patients et leurs familles a tous les stades d’une maladie grave. Cette approche est accomplie en gerant les symptomes penibles tels que la douleur et la dyspnee. La dyspnee refractaire se caracterise par une difficulte respiratoire persistante au repos ou avec un effort minimal malgre un traitement optimal de la maladie sous-jacente. L’utilisation d’opioides a ete bien documentee dans ce contexte ; cependant, l’hesitation persiste lors de la prescription d’opioides jusqu’aux etapes terminales de la maladie. Ce travail decrit les preuves actuelles de l’utilisation des opioides pour le traitement de la dyspnee en soins palliatifs, les protocoles et les voies de leur administration.

Background. Acute hypercapnic respiratory failure (AHRF) is a common life-threatening event in patients with obesity hypoventilation syndrome (OHS). Objectives. To study the clinical pattern, noninvasive ventilatory support, as well as the short- and long-term outcomes of patients with OHS admitted in a ward because of AHRF. Methods. We conducted a retrospective cohort study including all adults with OHS aged ≥ 18 − year − old , admitted in a 90-bed-ward for AHRF. Results. A total of 44 patients were included. Fifteen (34.1%) and 29 (65.9%) patients were diagnosed with malignant OHS (mOHS) and nonmalignant OHS (non-mOHS), respectively, while 36 (81.8%) had coexisting obstructive sleep apnea hypopnea syndrome (OSAHS). Patients with mOHS had a significantly higher rate of heart failure (100% vs. 31%; p < 0.001 ), chronic renal insufficiency (CRI) (73.3% vs. 41.4%; p = 0.04 ), and dyslipidemia (66.7% vs. 34.5%; p = 0.04 ) than those with non-mOHS. The mean forced vital capacity (FVC) in our patients was of 59.5 % ± 18.5 of the predicted value, lower than what is usually reported in stable patients with OHS. At hospital admission, more than two-thirds ( n = 34 , 77.3%) were misdiagnosed as having asthma exacerbation ( n = 4 , 4.9.1%), chronic obstructive pulmonary disease (COPD) exacerbation ( n = 12 , 27.3%) and/or heart failure ( n = 29 , 65.9%). Acute pulmonary oedema (ACPE) ( n = 16 , 36.4%) and acute viral bronchitis ( n = 12 , 27.3%) were the main identified causal factors, while no cause could be determined in 5 (11.4%) patients. Noninvasive positive pressure ventilation (NIPPV) using bilevel positive airway pressure (BIPAP) was very highly effective to treat AHRF, with only 2.27% of patients failing the modality. Median overall duration of ventilation was 9 hours per day (1.3–20) and was significantly longer in patients with mOHS than in those with non-mOHS (10 [6–18] vs. 8 [1.3–20], respectively; p = 0.01 ). Forty two of the forty-three patients discharged alive were treated with BIPAP or continuous positive airway pressure (CPAP) in 26 and 16 patients, respectively. The probability of survival was 90% at 12 months, while the probability of readmission for a new episode of AHRF was 56% at 6 months and 22% at 12 months, respectively. Conclusion. AHRF in OHS patients is a life-threatening event which can be successfully and safely treated with BIPAP, with a low long-term mortality even in patients with mOHS.

The onset of a spontaneous hemothorax may represent a life threatening emergency. Several etiologies may be involved, mainly vascular abnormalities. Pulmonary Arterio Venous Malformation (PAVM) is a rare etiology, and it is often associated with Hereditary Hemorrhagic Telangiectasia HHT. We report the case of a young women who was presented to the emergency department with left basal chest pain and mild dyspnea. Hemodynamic and respiratory states were maintained. Vesicular murmuring was abolished on the left side. The chest roentgenogram showed a left pleural effusion with mild deviation of the mediastinum to the opposite side. Thoracocentesis found a serohematic liquid. While the patient was undergoing exploration by computed chest tomography, she represented a cardio respiratory arrest. Resuscitation was successful after few minutes. The chest CT showed a PAVM located on the upper lobe that was very enhanced after injection of the contrast product, with a feeding artery coming from the pulmonary artery. The patient underwent an emergent left upper lobectomy thorough a posterolateral thoracotomy. The PAVM was peripheral, large with a diameter of 5 cm, and ruptured on the pleural cavity. Elective controlling the hemorrhage was very difficult, so a total hilar clamping was done with a Satinsky clamp. The postoperative course was complicated with pulmonary embolism managed by anticoagulation treatment. The definitive histological management concluded to a PAVM. Retrospectively, there was no personal or familial sign of HHT, neither any anomaly of blood hemostasis. Isolated PAVM is a rare cause of spontaneous hemothorax. Rapid worsening of an initially maintained state makes the situation more critical. Rapid control of a massive bleeding is mandatory to better explore and plan surgical resection. For stable patient, endovascular treatment may represent an effective option.

Tuberculous cold abscesses are a rare and unusual form, accounting for 1% of extrapulmonary tuberculosis (TB).To describe clinical, diagnostic, therapeutic and prognostic aspects of cold tuberculous abscesses.Retrospective multicentre study of 26 patients followed for cold abscesses tuberculous in respiratory departments of AbderrahmenMami hospital between 2009 and 2017.We included 24 patients. Mean age was 36.9 years. Six patients had a personal history of pulmonary TB. Circumstances of the discovery were chronic pain (n = 15), parietal swelling (n = 7) and parietal fistulization (n = 2). The mean duration of the symptoms was 2.8 months. Fever was absent in 15 patients. The cold abscess was multifocal in 3 patients, associated with pleuropulmonary TB in 16 patients and extrapulmonary TB in 9 patients. Thoracic wall was the most frequent localization (n=13), followed by subcutaneous and intramuscular localization (n = 6). The surgical flattening of the abscess with biopsy of the edges was performed in 15 patients. The positive diagnosis was pathological in 15 patients and bacteriological in 12 patients. GeneXpert was positive in 2 patients. All patients received anti-tuberculosis treatment. The mean duration of TB was 10.7 months. Evolution was marked by the cure of 20 patients and tuberculous relapse in 1 patient after 6 months.Tuberculous cold abscess should be evoked in front of any chronique collection occurring especially in a context of risk factors of TB. Early diagnosis is the best guarantee of a cure without complications.

Background: Obstructive sleep apnea hypopnea syndrome (OSAHS) has been shown to be associated with many serious health conditions. The impact on occupational health is still unclear as it was scarcely studied. Purpose: The aim of this study was to assess the association of work performance with OSAHS and daytime sleepiness. Methods: A cross-transversal study was conducted including Tunisian active adult subjects referred for suspected sleep disordered breathing. All subjects completed the Epworth Sleepiness Scale (ESS), the Work Productivity and Activity Impairment Questionnaire (WPAI), and the Patient Health Questionnaire 9 (PHQ9). They all underwent polygraph testing level 3. Result: One hundred thirty-nine subjects completed the survey, including 107 (77%) blue-collar workers, and 32 (23%) white-collar workers. Participants were classified as following: 50 patients with apnea hypopnea index (AHI) ≥ 30 and 89 with AHI

Objectif Le tabagisme est un fleau mondial. Il est etabli que le tabac est un facteur de risque du syndrome d’apnees hypopnees obstructives du sommeil (SAHOS). L’influence du tabac sur la severite du SAHOS reste peu documentee. Le but de notre travail est d’evaluer l’influence du tabagisme sur la severite du SAHOS. Methodes Une etude prospective comparative a ete menee a l’unite des troubles respiratoires du sommeil du service de pneumologie du CHU Hedi-Chaker de Sfax entre janvier 2015 et septembre 2015. Ont ete inclus les patients suivis pour SAHOS, âges entre 20 et 70 ans. Ont ete exclus les patients ayant une insuffisance respiratoire chronique, une BPCO, un asthme ou une insuffisance cardiaque. Nous avons releve les donnees cliniques, demographiques, le statut tabagique et les donnees de l’enregistrement polygraphique. Les patients ont ete divises en deux groupes selon qu’ils soient tabagiques ou non. Resultats Nous avons collige 70 patients (25 hommes et 45 femmes) d’âge moyen 54,9 ans. Le groupe 1 comporte les patients non tabagiques (71,4 % etaient des cas), le groupe 2 comporte les sujets tabagiques (28,6 % des cas). L’intoxication tabagique moyenne etait de 18,55 PA. Le SAHOS etait leger chez 21,4 % des patients, modere (27,1 %) et severe (51,4 %) avec un IAH moyen de 35,5/h. L’index apnees hypopnees (IAH) etait plus eleve chez les fumeurs par rapport aux non-fumeurs (avec p = 0,004). Conclusion Le tabagisme est un facteur de risque de survenue et de severite du SAHOS. Le sevrage tabagique occupe donc une place importante dans la prise en charge therapeutique du SAHOS.