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Since Ellmann's description in 1948 numerous authors have studied the respiratory manifestations associated with rheumatoid arthritis. Amongst the numerous disorders described, dilatation of the bronchi, although one of the most frequent, remains largely under-estimated. The authors report a series of 21 patients presenting jointly with both rheumatoid arthritis and bronchiectasis which was documented using thoracic computed scanning. All the subjects were female. For 20 of these patients, the appearance of bronchial suppuration preceded that of the articular manifestations by several years. Bronchial dilatation in these cases can, only with difficulty, be considered as a complication of arthritis as has been previously suggested. Rather it appears as a possible pre-disposing factor in the occurrence of the rheumatoid disease. These hypotheses explain the pathophysiological mechanisms implicated in this association are discussed.

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The main respiratory manifestations of amylosis are tracheobronchial involvement and modular or diffuse parenchymal disease. Amyloid deposits in the pleura are exceptional. We observed transsudative pleural effusion and heart failure in a patient with multiple myeloma, leading to the discovery of pleural amylosis. Amyloid deposits in the pleura may be fortuitous discoveries since pleural effusion is not necessarily observed. It is however important to be aware of this possibility since the localization is easily accessible for diagnosis. Specific stains are effective diagnostic tools even for transsudative effusions, particularly in suggestive clinical conditions such as multiple myeloma.

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The authors report two cases of myelomatosis localised to the pleura, one of which was associated with an adenocarcinoma. Pleural effusions are relatively rare during the course of multiple myeloma and most often occur with non-specific disorders of the disease. The myelomatous origin of a pleural effusion can only be made by analysis of the pleural fluid and should be recognised early enough to enable aggressive treatment to be instituted even if the prognosis associated with such a localisation is very poor.

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The authors report a case of pleural fibroma discovered during an examination for thoracic pains in a 65 year old woman. Histochemical studies were positive with vimentin and negative with KL1 antibodies and compatible with the most recent hypotheses concerning the purely fibroblastic origin of these tumours.

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We report a fatal case of acute interstitial pneumonitis in a patient treated with carmustine (BCNU) for a brain tumor. Bronchoalveolar lavage (BAL) revealed lymphocyte alveolitis with a low CD4/CD8 ratio (0.36), consistent with an immunoallergic phenomenon, rather than the most often evoked toxic hypothesis.

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The authors report a case of pulmonary blastoma, a rare type of pulmonary malignant tumour. The patient was treated by pneumonectomy combined with chemotherapy and radiotherapy. The outcome was favourable, and during an 11-year follow-up there was no sign of recurrence.

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The authors report two cases of thoracic actinomycosis with contrasting presentations, just as the diagnosis was obtained by different tests underlying the varied aspects of this disease. Indeed this infectious pathology does infrequently mimic tuberculosis or lung cancer with similar clinical and radiological appearances. The particular characteristic of the bacteriological culture and the quasi specific character of the pale, yellow grains on histology are recalled, as well as the different treatments necessary to ensure a cure in 90% of cases.

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The authors report about one case of respiratory distress occurring after pleural talcage for pneumothorax. Although few cases have been published, this complication is known, and it should lead to carefully consider the indication of this technique and to limit the total amount of talc used.

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Infections caused by Mycobacterium chelonei are rare. We report a case of pulmonary infection in a 57-year-old non-immunocompromised woman. Most of the abnormalities were observed at radiology which showed bilateral apical excavated opacities. The disease could only be diagnosed on surgical biopsies. Beside diagnostic problems, M. chelonei infections are a source of therapeutic problems.

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In this article the authors start by going over the anatomical and neuro-physiological pathways of transmission of painful nerve impulses from the periphery to the centres. Pain is a "sensation" which is integrated in both a psychological and an emotional context. Psycho-physiological studies show that the cortex of the brain therefore plays a basic role in this integration and this allows us to consider the psycho-prophylaxis of delivery. Certain failures of psychoprophylaxis demonstrate the role of cultural factors and of factors that are specific to the subject of the pain of labour. The latter are dominated by anxiety, wich is at the same time due to the circumstances of the labour and of the individual patient. The latter stem from several sources: fear of death, separation, guilt and castration. There is one more psychological element that seems to be equally important and that is, morbid narcissism. The obstetrician should fight against the patient's anxieties which will thwart his work and disturb the onward progress of the labour. He will usually succeed but not always by the pathways that he thinks he is taking.

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