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Resume Nous rapportons l’observation d’un homme de 79 ans pour lequel les investigations d’un syndrome cave superieur ont abouti a la mise en evidence d’un plasmocytome extramedullaire. Parmi les modes d’expression des neoplasies plasmocytaires, le plasmocytome extramedullaire (PEM) est celui le moins frequemment rencontre. La localisation mediastinale des PEM est rare et le caractere compressif de celle-ci exceptionnel. Autre particularite de notre observation, le PEM etait associe a un authentique myelome multiple a chaines legeres kappa.

Whereas synchronous lung cancer is rare, synchronous small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are exceptional. The authors report the case of a 61-year-old man with synchronous unilateral adenocarcinoma and small cell lung cancer, raising the question as to the need for the histology of all of the lesions in the same lobe or same lung as well as the treatment. The medical history, biology, CT and (18)F-FDG TEP-CT did not support a diagnosis of synchronous lung cancer. The prognosis was poor and only surgery could improve the prognosis. This is a rare case and illustrates the difficulty in the diagnosis of multiple lung cancer and the difficulty in treating synchronous lung cancer with different histologies (SCLC and NSCLC).

Primary pulmonary malignant melanoma is rare (0.01% of pulmonary cancers); only 25 cases are published in the literature. The diagnosis of primary pulmonary malignant melanoma is controversial, the pathogenesis is unknown and a pulmonary metastasis from a mucocutaneous melanoma is the main differential diagnosis. The diagnosis is based on the strict application of the Jensen criteria published in 1967. We report the case of an asymptomatic 82-year-old man presenting with a fortuitously discovered primary pulmonary malignant melanoma according to the Jensen criteria and treated by lobectomy (cT1N0M0). Surgery seems to be the gold standard treatment on account of the poor sensitivity of melanoma to chemotherapy and radiotherapy. Surgical resection and the absence of nodal involvement suggest a good prognosis even though the small number of cases does not produce useful statistical data. This observation raises the question of (18)FDG CT-PET in this situation, particularly of the whole body, by extrapolation from the recommendations in mucocutaneous melanoma. The lack of increased uptake on (18)FDG CT-PET could be a new paraclinical diagnostic criterion to add to the clinical criteria of Jensen. This report is the first, which shows the results of (18)FDG CT-PET (standard and whole-body) under this situation.

Emmonsia crescens is a saprophytic fungus that is distributed worldwide, causing diseases mostly in rodents. It has also been described, though rarely, as an etiologic agent of pulmonary pathology in humans, potentially leading to death. A case of pulmonary adiaspiromycosis is reported in a 30-year-old immunocompetent man. The patient presented with a history of several weeks of weakness, cough, fever, and weight loss of 10 kg. Clinical and radiographic findings showed pulmonary lesions consistent with tuberculosis or histoplasmosis, but no pathogen was found with classical microbiological procedures. The diagnosis of adiaspiromycosis due to Emmonsia crescens was initially made using molecular biology techniques. Histological observations subsequently confirmed the presence of adiaspores in granulomas. To our knowledge, this is the first case of adiaspiromycosis diagnosed by PCR and sequencing. The patient was treated with itraconazole and was seen at 1 month with symptomatic improvement. Here we will discuss this rare fungal infection and its difficult treatment and diagnosis. As represented in this case, molecular biology is a powerful method to optimize diagnostic tests and therefore improve the care of the infected patient.

Technological progress and numerous published studies allow to estimate the best place of the 18F-fluorodeoxyglucose positron emission tomography, a real functional metabolic imagery, in the clinical and therapeutic strategy of non small cell lung cancers.

Background: The surgery of the posterior fossa is quite complex, the development of neuromodulation allowed many possibilities of treatments for neurological diseases. Auditory brain implant can restore auditory function for people with diseases in cochlear nerves and are not candidates for cochlear implantation such as patients with Neurofibromatosis type 2. Objectives: To report a case and describe the far lateral surgical approach for brainstem implantation. Methods: The technique was described and the steps required for the surgery were detailed. Results: We described in details the surgical technique, how cochlear nucleus can be found, how brain implant must be placed, how to configure auditory brain implant, the intraoperative challenges and possible complications of this surgical approach. Conclusion: The far lateral surgical approach is a feasible techinique for auditory brainstem implant for patients with neurofibromatosis type 2.

Resume La tomographie par emission de positons au 18 Fluoro-deoxyglucose realise une imagerie metabolique permettant de mieux evaluer le bilan d’extension tumorale loco-regional et metastatique des cancers. Cette meilleure caracterisation tissulaire a entraine un boule versement de la prise en charge des cancers broncho-pulmonaire. Des recommandations nationales et internationales aident a son utilisation.

Resume La TEP-FDG dite « corps entier » correspond le plus souvent a une acquisition allant de la base du crâne au tiers superieur des cuisses, bras en abduction. Ainsi, ni la partie superieure de la tete, ni les membres ne sont compris dans le champ d’exploration. Nous rapportons les observations de trois patients atteints d’une neoplasie broncho-pulmonaire non a petites cellules (CBNPC) chez lesquels une localisation secondaire peripherique a ete decouverte. Dans ces trois cas, la metastase etait situee en dehors du champ d’acquisition de l’examen TEP. Les cancers pulmonaires, connus pour leur dissemination hematogene, ont la particularite de pouvoir entrainer des metastases distales precoces. La realisation d’une TEP incluant les extremites dans le bilan pre-therapeutique des neoplasies pulmonaires permettrait de detecter ce type de lesion. Cependant, ces acquisitions « corps entier » entraineraient un allongement du temps d’examen avec, pour consequence, une reduction de la disponibilite, deja reduite, des appareils TEP-TDM. De plus, la rentabilite d’un tel examen serait faible puisque l’on peut estimer a environ 1 % la survenue de metastases distales isolees (3 patients sur 293 traites pour un CBNPC initialement non metastatique). Ainsi, du fait des contraintes techniques actuelles, il ne nous semble pas justifie d’inclure systematiquement les membres dans le champ d’acquisition TEP lors du bilan des CBNPC. Toutefois, la non-detectabilite des metastases distales par la TEP-TDM doit etre connue du clinicien, comme cela est le cas pour les metastases cerebrales.

We report a 27-year-old man who presented with a Lemierre's syndrome associated with two uncommon complications: a septic sternoclavicular joint arthritis and a cavitating pneumonia.

Mycobacterium kansasii is one of the main mycobacterial species. Among the numerous subtypes, I and II subtypes are the only pathogens ones. A 56 years old woman has been under observation during her hospitalization for a cervical adenitis check-up; these one having been evolving for 2 months, without inflammatory syndrome. The failures of various antibiotics treatments lead one to withdraw some cervical ganglions whose histopathologic aspect reminds tuberculosis. These adenitis being isolated. An INH, rifampin, and ethambutol associated treatment is set up. After 2 weeks, the different cultures enable to isolated numerous photochromogenic colonies; a positive result is obtained with M. kansasii probe (Accuprobe). The identification is confirmed in 24 hours time with another molecular hybridation test (INNO-LiPA V2); the various specific probes of the different M. kansasii subtypes show it's not a I or II subtype (subtype IV by sequence analysis). This observation underlines the advantage and rapidity of the new diagnosis methods for nontuberculous mycobacterial diseases.

Introduction La place de la videothoracoscopie (VT) dans la pleuresie infectieuse para-pneumonique (PIPP) est controversee. Nous avons souhaite etudier la faisabilite de la vt dans ce contexte. Methodologie Nous avons realise une etude retrospective descriptive monocentrique colligeant toutes les VT pour PIPP realisees entre le 1er juin 2002 et le 31 decembre 2013, dans l’hopital d’instruction des armees Percy (Clamart). Les patients ont ete identifies a partir de la base locale EPITHOR et les donnees ont ete recueillies a partir des dossiers medicaux. Resultats Soixante-quinze patients ont beneficie d’une VT convertie en thoracotomie dans 9 cas. En moyenne, le delai de la VT etait de 4,02 jours [1–14], la duree de drainage postoperatoire de 4,8 jours, le temps d’hospitalisation de 8,25 jours. La bacteriologie etait positive dans 21,5 % des liquides pleuraux initiaux et dans 22,67 % des prelevements peroperatoires. Le taux de succes primaire (ou resolution de la PIPP dans les 30 jours apres VT sans autre intervention medicale ou chirurgicale) etait de 91,3 %. Le taux de complications postoperatoires etait egal a 17,33 % (majeures dans 4 cas, mineures dans 9 cas) ; La mortalite a un mois etait egale a 3,07 %, et a 6 mois egale a 7,89 %. Conclusion Dans la PIPP, la realisation d’une VT precoce de debridement est efficace et faisable au prix d’une morbi-mortalite acceptable. La VT precoce ne doit etre proposee qu’a des patients aptes a l’anesthesie generale et au sein d’equipes medico-chirurgicale entrainee.

We report the case of a 79-year-old man for whom investigations of superior vena cava syndrome have revealed extramedullary plasmocytoma. Extramedullary plasmocytoma (EMP) is the less frequent form of plasma cell neoplasms. The mediastinal location of EMP is rare, and its compressive nature is exceptional. Another particular feature we observed is that the EMP was associated with an authentic kappa light chain multiple myeloma.

Whereas synchronous lung cancer is rare, synchronous small cell lung cancer (SCLC) and non-small cell lung cancer (NSCLC) are exceptional. The authors report the case of a 61-year-old man with synchronous unilateral adenocarcinoma and small cell lung cancer, raising the question as to the need for the histology of all of the lesions in the same lobe or same lung as well as the treatment. The medical history, biology, CT and (18)F-FDG TEP-CT did not support a diagnosis of synchronous lung cancer. The prognosis was poor and only surgery could improve the prognosis. This is a rare case and illustrates the difficulty in the diagnosis of multiple lung cancer and the difficulty in treating synchronous lung cancer with different histologies (SCLC and NSCLC).

Primary pulmonary malignant melanoma is rare (0.01% of pulmonary cancers); only 25 cases are published in the literature. The diagnosis of primary pulmonary malignant melanoma is controversial, the pathogenesis is unknown and a pulmonary metastasis from a mucocutaneous melanoma is the main differential diagnosis. The diagnosis is based on the strict application of the Jensen criteria published in 1967. We report the case of an asymptomatic 82-year-old man presenting with a fortuitously discovered primary pulmonary malignant melanoma according to the Jensen criteria and treated by lobectomy (cT1N0M0). Surgery seems to be the gold standard treatment on account of the poor sensitivity of melanoma to chemotherapy and radiotherapy. Surgical resection and the absence of nodal involvement suggest a good prognosis even though the small number of cases does not produce useful statistical data. This observation raises the question of (18)FDG CT-PET in this situation, particularly of the whole body, by extrapolation from the recommendations in mucocutaneous melanoma. The lack of increased uptake on (18)FDG CT-PET could be a new paraclinical diagnostic criterion to add to the clinical criteria of Jensen. This report is the first, which shows the results of (18)FDG CT-PET (standard and whole-body) under this situation.

We report a 27-year-old man who presented with a Lemierre's syndrome associated with two uncommon complications: a septic sternoclavicular joint arthritis and a cavitating pneumonia.

Technological progress and numerous published studies allow to estimate the best place of the 18F-fluorodeoxyglucose positron emission tomography, a real functional metabolic imagery, in the clinical and therapeutic strategy of non small cell lung cancers.

18FDG-PET scanning enables the imaging of metabolic activity giving an assessment of the local extent of thoracic malignancies as well as an indication of the presence of nodal or metastatic spread. This enables more accurate staging and has revolutionised the management of lung cancer. National and international guidelines describe the role of this technique.

"Whole body" FDG-PET usually covers the body from the base of the skull to the upper third of the thighs, arms in abduction. Thus, the upper part of the head and the lower limbs are not included in the acquisition field. We report the cases of three patients with non-small-cell lung cancer who developed secondary distal localizations beyond the acquisition field of "whole body" FDG-PET. Lung cancer is known to favor hematogenic dissemination, raising the possibility of early distal metastasis. A pretherapeutic PET scan which includes the extremities can be useful to search for distal extension. These true whole body scans are time consuming and can thus limit machine availability. Furthermore, the diagnostic yield of this type of examination may be low since it can be estimated that about 1% of patients will develop isolated distal metastases (3 out of 293 patients in our series initially treated for non-metastatic non-small-cell lung cancer). In the current context of technical availability, systematic inclusion of the lower limbs in the PET scan acquisition field would not appear warranted for the initial work-up of patients with non-small-cell lung cancer. However, clinicians must be aware that distal metastases (brain, lower limbs) may not be detected.

Introduction Parce qu’elle est souvent asymptomatique, d’abord histologique peu sensible et potentiellement mortelle, la sarcoidose cardiaque (SC) est un diagnostic difficile et souvent presomptif. Il existe depuis 2006 des recommandations japonaises (SJS) dont nous avons voulu evaluer la diffusion au sein des hopitaux d’instruction des armees (HIA). Methodologie A partir des bases PMSI, nous avons identifie tous les cas cumules de SC dans les HIA entre 1996 et 2011. Ont ete extraites a partir des dossiers medicaux les donnees : patient (âge, sexe, ethnie), sarcoidose (stade, activite, extension), SC (date, diagnostic Dg1, traitement, evolution). Nous avons etabli un diagnostic selon les recommandations de la SJS (Dg2) puis analyse la concordance entre Dg1 et Dg2. Resultats 16 SC ont ete incluses avec : une histologie extra-cardiaque toujours validee, des symptomes evocateurs dans 11/16 cas et inauguraux dans 7/16 cas, un ECG et une echocardiographie anormaux dans 8/16 cas, un holter ECG anormal dans 8/11 cas, une IRM anormale dans 11/11 cas, une scintigraphie cardiaque anormale dans 2/2 cas, une TEP-FDG anormale dans 2/5 cas. Dg2 differait de Dg1 chez 9 patients, avec une discordance variant entre 50 % et 75 % selon les centres. Conclusion L’heterogeneite observee entre nos differentes equipes illustre la difficulte du diagnostic de la SC et une faible diffusion des recommandations de la SJS. Nous proposons un algorithme diagnostique valide collegialement et desormais mis en œuvre prospectivement dans les HIA.

Acute or chronic prolonged ischaemia of the limbs may cause lasting neurological damage. This has been shown in clinical, electrophysiological and anatomopathological studies. The aim of this study was to search for signs of neurological suffering during ischaemia of effort. Twenty patients with occlusive lower limb arterial disease with ischaemia of effort were studied. None of the patients had other causes of neuropathy: none of the patients had potentially neurotoxic therapy. All underwent haemodynamic assessment (Doppler ultrasonography treadmill test, transcutaneous oxygen diffusion) and electrophysiological study (nerve conduction studies and an electromyogramme). Ten patients had abnormalities during stimulation-detection and on electromyography. These abnormalities were always observed in the limbs with the poorest blood flow. The pressure index and transcutaneous oxygen diffusion in lying position were significantly lower (pressure index: 0.43 vs 0.72, p0.03; TcPO2: 20.3 vs 27.2, p0.04). The authors consider that effort ischaemia is associated with neurological damage. Repeated transient episodes of ischaemia could cause neuropathy.

Introduction et objectifs Nous rapportons un cas rarissime d’adiaspiromycose, pathologie pulmonaire liee a Emmonsia crescens. Materiels et methodes Homme, 25 ans, sans ATCD, aux activites troglodytes (elargissement de galeries souterraines), hospitalise pour une dyspnee aigue dans un contexte d’AEG evoluant depuis 2 mois. L’examen clinique retrouvait une fievre a 38,7 °C, des crepitants fins des deux champs pulmonaires, des ADP sousmaxillaires bilaterales, une discrete hepatomegalie. Biologiquement, presence d’un SIB, serologie VIH negative. La RP puis le scanner retrouvaient un syndrome reticulo-micronodulaire diffus des 2 champs pulmonaires avec de multiples ganglions mediastinaux. Un 1er bilan infectieux complet etait negatif au niveau sanguin, urinaire, fecal. 2 endosopies bronchiques etaient non contributives. La biopsie pulmonaire retrouvait un granulome necrotique avec identification par sequencage genetique d’un champignon : Emmonsia crescens. Un traitement par itraconazole 400 mg/j per os etait instaure, sans amelioration apres deux mois de traitement justifiant l’utilisation d’amphotericine B liposomale a la dose de 3 mg/kg/j, avec une evolution precoce favorable. Resultats Emmonsia crescens et Emmonsia parva sont les agents pathogenes d’une pathologie pulmonaire appelee l’adiaspiromycose. Bien que present de maniere ubiquitaire chez les rongeurs et les petits animaux sauvages, cette pathologie est rarement diagnostiquee chez l’homme et moins de 60 cas sont publies dans la litterature mondiale, principalement chez des patients immunodeprimes. Emmonsia sp. sont des champignons saprophytes du sol et il est probable que la contamination se fasse par inhalation de spores fungiques. Notre patient s’est probablement infecte lors de ses activites souterraines dans des galeries colonisees par les terriers de petits rongeurs. Les elements histopathologiques typiques de la maladie pulmonaire incluent des granulomes necrotiques et la mise en evidence d’adiaspores, eponyme de la maladie. L’adiaspore se presente sous la forme d’une spherule de 50 a 500 μm. Sa mise en culture est difficile et sa mise en evidence de maniere accidentelle est souvent faite sur les pieces autopsiques. Ceci expliquerait probablement une prevalence sous estimee. Des auteurs allemands rapportent l’utilisation de la technique de sequencage par ARN 18S pour l’identification de l’adiospore. Si divers antifungiques ont ete utilises dans le traitement de l’adiaspiromycose, c’est l’amphotericine B qui est la plus frequemment utilisee. Conclusion Emmonsia sp. est l’agent pathogene inhabituel d’une pathologie pulmonaire rare appelee l’adiaspiromycose. Bien que l’epidemiologie de la pathologie ne soit pas connue, cet agent fungique pathogene devrait etre evoque dans le diagnostic differentiel des granulomatoses infectieuses pulmonaires chez des patients ayant des activites speleologiques.

High energy ruby laser pulses were used to dissolve the precipitates formed during the thermal diffusion of phosphorus into silicon in order to improve the characteristics of diffused solar cells. A maximum Voc of 600 mV and a fill factor of 0.75 were obtained for a laser energy density of 1.1 J cm−2.