Revue francaise des maladies respiratoires最新文献

The present study relates to 39 children, 24 boys and 15 girls, aged 1 to 17 (mean age, 6 1/2 years) suffering from chronic airflow obstruction without muco-viscidosis. The search for a ciliary anomaly was motivated either by the coexistence of situs inversus (group I: 12 cases) or by the negative or scanty aetiological history (group II: 27 cases). The investigation of the cilia consists of a study of ciliary motility and an ultrastructural study of biopsy specimens using the electron microscope. Groups I and II were similar as regards severity of disease, assessed by the incidence of bronchiectasis and chronic hypoxia at rest; a higher incidence of neonatal respiratory distress was noted in group I (7 cases against 4 in group II). Ciliary immotility was particularly noted in group I (7 cases) and one case of weak motility in group II. The major ultrastructural anomalies of the axonemal complex were seen as well in both groups I and II; it was noted that all the structures may be totally or partially missing with the exception of the peripheral microtubules. The discussion centred on three points: 1. In the first analysis, the discordance between the existance of major ultrastructural anomalies of the axonemal complex, a priori incompatible with the conservation of ciliary motility on light microscopy; the link seems to lie in the percentage of cilia affected, the existence of ciliary dyskinesia and finally the disorientation of the basal corpuscles. 2. The immunologic abnormalities sometimes associated with a syndrome of ciliary immotility: that is the anomalies of leucokyte migration under the control of microtubular structures in the peri-centriolar region. 3. The practical consequences. Current treatment rests on daily respiratory physiotherapy and antibiotics adapted for cases of superinfection; also there are drugs stimulating ciliary activity perhaps by the effect on their residual motility; some substances carrying ATP and ATP-ase may re-establish ciliary motility anulled by the absence of dynein arms; also the observations of major ultrastructural abnormalities ought to lead to better genetic counselling than at present, where the mode or modes of transmission are uncertain.

The theoretical cost of the medical treatment of a case of tuberculosis in France in 1982 was calculated after considering the price of diagnosis, drugs, in-patient care and follow up. For exclusively out-patient (ambulatory) care, 9 months treatment was 10 times less expensive than a therapeutic regime which included a hospital/sanatorium stay of four months followed by a return home. The major differences of theoretical costs involved were more closely related to location of treatment rather than either the drugs chosen (as Rifampicin was always used), or the type of follow up over 9 months.

The results of recent experiences with experimental tuberculous chemotherapy in the mouse give information on the activity of rifampicin (RMP) administered intermittently and on the activity of Cyclopentyl-Rifampicin (or DL473). The activity of RMP decreases as one spaces the treatment without increasing the dose. These observations are compatible with the known facts concerning the mechanism of action of RMP on RNA polymerase, and are unfavourable as regards the intermittent administration of RMP. Cyclopentyl-Rifampicin, a new derivative of Rifamycine SV, administered once per week, is as active as RMP administered six days per week, both in the initial as well as the continuation phase of treatment.

The authors discussed the malign form of lymphomatoid granulomatosis on the basis of two cases and consider the possible role of an aerocontaminant which is usually responsible for the extrinsic allergic type of alveolitis. A detailed biochemical and cytological study of the alveolar fluid from one of these patients is presented in parallel with immunofluorescent histology and electron microscopy of the lung. The observed biochemical abnormalities in the alveolar fluid could be superimposed on those formed in certain types of hypertensive lung disease. On the other hand the cytology was different, the cytofluorimetric technique revealed a mononuclear cell population rich in RNA whose role in the genesis of the disease of malign nature are discussed. The hypothesis of a hypersecretion of IgA by this malign process is raised by immunofluorescent studies of the lung. The role of IgA in lymphomatoid granulomatosis and bird fanciers lung is discussed in the light of recent work on pigeon IgA.

We studied the diagnostic value of the detection of soluble pneumococcal antigens by counter-immunoelectrophoresis (ES) in patients with pneumonia. Pneumococcal antigens were detected in blood, urine and pleural fluid. 59 patients were distributed into 3 groups: (Group 1) - 19 patients with a non-pneumococcal, but bacteriologically-proven pneumonia, (Group 2)-32 patients with a bacteriologically confirmed pneumococcal pneumonia, (Group 3)-8 patients with a non-bacteriologically proven pneumonia, but with pneumococcal antigens. No Group 1 patients had pneumococcal antigens. In Group 2 pneumococcal antigens were present in 15 cases. The sensitivity of ES in the detection of soluble pneumococcal antigens (APS) in the blood, urine and pleural fluid during pneumococcal pneumonias was 57.5%. There was a diagnostic benefit when compared to bacteriological analysis alone of 20%. We believe that ES is a useful complementary examination to classical bacteriology.

The problem of occupational asthma is in state of change as evidenced by the official reports: The official Journal of the 23 January 1982 contains important alterations in the lists of occupational asthma, changing some and creating others, as with table 66 in which numerous occupational allergies are listed. The authors discuss current diagnostic methods in which realistic provocation tests play an important part; current causes are considered and are duly allocated between natural animal or vegetable products or chemicals produced by industry. The authors strive to define which aetiologies are declining and which remain every day problems. Occupational asthma should be treated at source though the offending agent is not always apparent. The mechanism may be allergic, or often non allergic histamine-liberation or other pharmacodynamic mechanisms. Finally, the understanding of occupational asthmas throws light on the mechanism of asthma itself.

The acute decompensation of chronic obstructive respiratory failure is characterised by a deterioration of the respiratory mechanics which leads to a reduction of maximum ventilatory output, the respiratory muscles are placed at a mechanical disadvantage and in attempting to compensate are vulnerable to muscle fatigue. A large part of ventilation is wasted in ventilatory dead space. Total ventilation is normal but tidal volume is shallow and respiratory rate rapid. This type of breathing is partially responsible for the large dead space effect. Respiratory centre activity is greatly increased. The prescription of bronchodilators is debatable because there is a risk of increasing the dead space effect. The hypoxic and hypercapnic stimuli have a weak and roughly similar effect on ventilatory control, but the effect of pure oxygen on PaCO2 is due to factors other than those relating to respiratory centre activity.

A lymphocytic alveolitis is a common stage in a number of types of interstitial pneumonia where the lymphocytes accumulate in the alveoli and play a major pathogenic role by the regulation or activation of the inflammatory reaction, controlling the outcome either to healing, chronicity or fibrosis. A study of lymphocytes obtained by broncho-alveolar lavage enables the study of different parameters whose functional value is discussed from information derived form in vitro models. These models show the need for activating signals acting in a sequential manner on cells whose function and mode of response are remarkably varied. Three successive phases may be defined during activation: first a "membrane" stage with changes in the lipid (in the metabolism of arachidonic acid) and kinetic framework, a second phase corresponds to the beginning of "blastic transformation" with the production of lymphocytes, an increase in the protein content and RNA (phase G1), then a third stage of DNA synthesis (phase S-G2) preceding cell division; it is necessary to have new markers of differentiation. The joint study of the phases of cell cycles and the antigenic expression of differentiation, identified by monoclonal antibodies within a heterogeneous population nowadays benefit from techniques of cytofluorimetry. The methods combined with a measure of mediators produced (interleukins) or the non-specific markers of activation by macrophages ought to lead to a definition of initial stages of the clinical immunology of alveolitis. Finally these methods permit the development of cellular immunopharmacology which to open the possibilities of new forms of treatment.

The acetylator phenotype of 204 tuberculous patients was assessed (152 men and 52 women aged between 15 and 90). The INH dose was adjusted according to Vivien's protocol, measuring the index of inactivation of Isoniazid I3, three hours after the oral dose. In fixing the transition zone of I3 at 0.50 the distribution between slow and rapid acetylators was 53% and 47% respectively. There was no difference for sex, age or ethnic group. The dosage used according to this protocol varied greatly, going from 1.64 mg/kg/day to 13.3 mg/kg/day with a mean value of 2.74 mg/kg/day for slow acetylators and 6.13 mg/kg/day for rapid acetylators. The usual dose advised is 5 mg/kg/day, which may lead equally to over or under treatment though the former is more likely in our experience. Adjusting the dosage is an important feature in good tolerance of the treatment: indeed only 4 of 86 subjects whose dosage has been adjusted showed elevated transaminases, whereas 34 of 118 patients had raised transaminases in the control group on a standard dose before the adjusted treatment was introduced. The difference was significant between the two groups.

Epidemiological methods may be used to study the causes of respiratory troubles at work, to test the hypothesis that there is a statistically significant relationship between professional risk factors and respiratory disease. The prognostic value of certain indices and the impact of preventative measures may also be assessed. The choice of method, type of enquiry and selection of the population to be studied and the resources to be used depend on the aims of the study. The definitions both of occupational exposure and the disease should be clearly established in the protocol. The questionnaire, which is indispensable in all investigation into respiratory disorder, should be adapted to the specific research project (for contents, lay-out, relevance and order of questions, allowing for distorting factors). The final objective in the application of an epidemiological method to study occupational risk factors is to develop a preventative strategy at each stage, but most importantly at the very first stage to prevent the appearance of respiratory troubles.