Revue francaise des maladies respiratoires最新文献

A present report on insulin dependant diabetics described changes in ventilatory mechanics and a decrease of pulmonary volumes; other studies ended up with different results, i.e. an absence of any spirographic change: the current study agrees with the latter findings. Yet, we noticed an alteration in the CO transfer of the lungs at the alveolar-capillary membrane level which appeared to be due to a reduced pulmonary capillary volume. The duration of the disease and the possible appearance of characteristic complications of diabetes did not seem to have any influence on the functional parameters measured. On the other hand, a broncho-pulmonary disorder independant of diabetes but associated with certain ailments (chronic bronchitis, sequelae of tuberculosis, ... tobacco smoking, etc.) led, as one might have foreseen, to functional ventilatory disturbances. A histological and haematological study would be a logical sequel to our study to clarify the mechanism of the diminished pulmonary transfer capacity.

One of the interests of experimental animal work is the power to analyse a given pathophysiological mechanism and also the privilege of witnessing its appearance. Immuno-allergic asthma, mediated by specific IgE of an allergen only represents one aetiological form, among many others, that make up the clinical spectrum of asthma in the human species. It is, however, the type of asthma whose experimental reproduction, a priori, is the most easily reproduced and has been the most tested. The different protocols used an analysis of the results and the lines of current or projected research form the object of this review.

All the Tahitian school children from 3rd to final grade were questioned by an auto-questionnaire in May 1979. 93% replied to the questions asked (3,870). The prevalence of upper respiratory infections was increased as well as broncho-pulmonary symptoms (cough or other lung disease) during the year under study when compared to a control group in Metropolitan France. This prevalence was significantly increased both in boys and girls who smoked. The incidence of frequent or chronic cough was most increased in the older pupils, boarders, those followed a technical curriculum and belonging to the lower socio-professional categories. Asthma was very frequent at 11.5%, had an equal sex incidence and was not linked to any identifiable factor--the same enquiry was done in the Bas-Rhin department in France 3 years before; Tahitian school children, in general, have double the incidence of respiratory disease that is found in the Bas-Rhin.

A deficiency of alpha 1 antiproteases is associated with severe and early emphysema. This emphysema can be experimentally produced in animals by endotracheal instillation of elastolytic proteases. Thus it would seem that emphysema is linked to an imbalance between proteases and antiproteases at the pulmonary level. This work studies the proteases, whose role in the genesis of emphysema is highly probable in view of the data in the literature (leukocyte elastase), disputed (macrophage elastase) or transitory (microbial elastases). We contrast the main agents capable of inhibiting these proteases (alpha 1 antiprotease and bronchial inhibitors) or of changing their activity (alpha 2 macroglobulins). The relative importance of these antiproteases is discussed in the light of studies made on bronchial secretions and bronchoalveolar lavage. These irritants may influence the protease - antiprotease equilibrium and favour the development of emphysema by increasing the proteases or decreasing the antiproteases. It appears that tobacco, as well as infection and anything which sets in motion the pulmonary phagocytes favour the liberation of leucocyte elastase. These attacks inactive the alpha 1 antiproteases in addition to the bronchial inhibitor. They may be recognized by a change in elastolytic and anti-elastolytic activity observed in bronchial secretions and in bronchoalveolar lavage (which is more disputed in the latter).

The great variability in the metabolism and degradation of theophylline in different people demands an individual dosage to be effective; this is to maintain the theophylline levels between the threshold of therapeutic activity (10 mg/L) to the upper limit of tolerance (15 to 20 mg/L according to different studies). The effective individual doses may be determined before commencing treatment by a Theophylline Test. This allows the dose over 24 hours to be specified as well as the number of tablets necessary to maintain the theophylline levels in the chosen range. The principle of the Theophylline Test is to administer intravenously a test dose of theophylline, then with 5 successive samples for blood theophylline to assess the individual elimination of the drug. For each subject two pharmacokinetic parameters are determined: clearance and plasma half life. The plasma clearance allows the total dose over 24 hours to be calculated, the half life the number of doses and the type of preparation used: microkrystalline theophylline (Techniphylline), slow release theophylline (Theophylline Bruneau) and prolonged action theophylline (Armophylline).

Lymphocytes forming E rosettes, active E, autologous and EA antibodies were studied in 66 subjects (56 men, 10 women, mean age 59, range: 40-85 years) who presented with lung cancer classified on the TMN scale in stages I and II: 19; stage III: 20; stage IV: 27. In comparison to the controls, there was a significant reduction (p less than 0.01) in E, autologous and EA rosettes in the patients. A reduction in E active rosettes (compared to controls) was noted for stage IV cases (p less than 0.01) and rose with the stage. The formation of rosettes was reduced in 50 squamous carcinomas compared to 12 anaplastic carcinomas for E rosettes (p less than 0.01) and E active (p less than 0.02). If one compares the actuarial survival curves of 37 patients with E act rosettes greater than or equal to 23% and of 29 with a level of less than 23%, the mean survival for all stages combined was 14.1 months in the first group and 8.2 months in the second group. Associated with an extension of the tumour, the immunological system has a role in determining outcome and lymphocytes forming active E rosettes appear to be the subpopulation most closely correlated with survival.

The diagnosis of chylous effusions of the pleura hardly poses any problems if one carefully differentiates the true chylothorax rich in triglycerides from chylous effusions rich in cholesterol and poor in triglycerides. The pathology of chylothorax requires a double breach of both thoracic duct and pleura. The causes are dominated by complications of thoracic surgery direct trauma, closed chest injuries and malignant mediastinal tumours. Other rarer causes raise the difficult problem of the spontaneous chylothorax. Even the idea of an idiopathic chylothorax is controversial and makes one suspect the rupture of a previously fragile thoracic duct, following apparently minimal trauma. Treatment is not yet standardised but requires strict rest, and a medium chain triglyceride diet, correction of fluid and electrolyte balance and careful nutrition. Surgery, generally delayed for a few weeks, may lead to the repair of a lymphatic leak, localised by a biological tracer or a contrast material; sometimes only a ligature at the base of the thoracic duct will dry up the effusion. The prognosis still remains mediocre and is dominated by the cause, notably when this is a tumour and also by the localised or diffuse character of the lymphatic disturbance.

Collagen is a macro-molecule of polypeptide chains arranged in a triple helix. The biosynthesis and degradation of collagen require complex enzymes systems; considerable progress has been made in their understanding in recent years. Collagen is the most important connective tissue of the body and five types are present in the lower respiratory tract. Genetic disorders of collagen (e.g. the Ehlers-Danlos or Marfan's syndrome) may affect the lung. Furthermore certain pulmonary diseases such as fibrosis are associated with changes in the ratio of the different types of collagen. Collagen can no longer be dissociated from the study of tissue changes in pulmonary pathology; the aim of our study is to provide elementary data concerning this aspect of modern pneumology.