Revue francaise des maladies respiratoires最新文献

We have measured flow-volume curves (FV) in 167 normal individuals of both sexes aged 20 to 89. All were non-smokers and none had cardio-respiratory disease. The flows at 25, 50 and 75 per cent of vital capacity (VC) as well as flows normalized by VC or total lung capacity (TLC) gave, in general, good correlation coefficients with age. The parameters V25/TLC and especially V50/TLC gave for the best correlations with age and we suggest these parameters in future when flow volume curves are used to assess respiratory pathophysiology. Normal values as well as regression equations of these parameters with age are proposed for various age groups in the 20-89 years age range.

An atypical disturbance of ventilation supervening a pleural effusion may occur due to atelectasis by lung folding which is seen radiologically as a round image close to the chest wall with the appearance of a pseudo-tumour. The authors review the mechanisms and the clinical and radiological presentation of this disorder based on 7 cases and a review of the literature. The posterior basal type with adhesions to the chest wall are the most frequent. An intra-parenchymatous and a double-form are described. The diagnosis of this benign disorder is radiological. It is based on a characteristic displacement of the vessels and bronchi and associated pleural signs. Recognition of these signs avoids all invasive procedures.

There are two essential steps in the analysis of carcinogenic risks in the work place: first, a descriptive approach which might raise the suspicion of an agent related to the frequency of a disease or mortality rate and then the analytical approach, based on retrospective and prospective cross-sectional studies. Such studies allow proof of the existence of a relation between a carcinogenic product and the frequency of lung cancer. The richer the contribution of such studies, the more difficult their accomplishment. All these studies assume that certain constraints are accepted: a precise protocol, collection of correct data, choice of a relevant population to be studied and controlled when necessary; rigorous supervision of each cohort under observation in the prospective studies, provision made for distorting factors. Such studies ought to result in averting occupational cancers rather than detecting them when clinically or radiologically apparent.

Three 6 month antituberculous regimes were compared during a controlled trial in Algiers. Isoniazid and Rifampicin were used every day for six months in all three regimes; a third drug was used as a supplement in two of the three regimes during the first three months (Ethambutol or Pyrazinamide). The aim of the study was to assess the role of the third drug and also the suitability of a self-administered regime in routine practice. The results were analysed at eighteen months, twelve months after the end of therapy. The third drug had no influence on outcome in patients with sensitive organisms. There was a 2.5% relapse rate with no significant difference between the groups. On the other hand the third drug was crucial for those patients initially resistant to Isoniazid, because a relapse or failure due to primary resistance was avoided. The 6 month regimes were well tolerated: the treatment was only changed in 0.8% of cases for major toxicity. Finally, short self-administered oral regimens were well tolerated by the patients.

Liz... Josiane, a 9 year old girl, was admitted with a 24 hours history of severe headache and vomiting. On admission she was conscious, irritable and complained of a severe headache. Clinical examination revealed a right hemiparesis with cyanosis of the lips and extremities and clubbing of the fingers, all consistent with chronic hypoxia. Cardiovascular examination was normal apart from a systolic murmur which could be heard posteriorly under the left scapula. There were no angiomatous or telangiectatic lesions of the skin. A blood examination revealed a raised ESR, a marked polycythaemia with a decreased arterial oxygen tension. Chest x-rays showed the presence of an irregular well delineated opacity in the posterior basal segment of the left lower lobe. This opacity was confluent with the ipsilateral hilum and was suggestive of a pulmonary arteriovenous fistula. An intracranial space occupying lesion in the left temporal region of the brain was revealed by electroencephalographic and CT scan investigations; this proved to be an abscess which was surgically removed with no subsequent complications. Further radiological investigations of the chest revealed the pulmonary lesion was an arteriovenous aneurysm occupying the whole left inferior lobe. This was removed at thoracotomy three months after the acute neurological event. The results of respiratory function and regional isotopic investigations before and after surgery will be discussed.

The statistics of occupational diseases in industrial medicine, as well as the markedly elevated incidence of chronic bronchitis amongst workers, show that there is an additional respiratory risk linked to industrial environment and the conditions of work. Epidemiological studies in industry and in particular certain occupations, such as mining and the construction industry have led to a better understanding of this industrial risk as a generator of the additional obstructive respiratory disease occurring in exposed workers. Among the unrecognised risks is the prolonged exposure to the oxides of nitrogen which are capable of affecting gas exchange, as has been shown in one of our investigations in the production of nitrogenous fertilizers, which explains the mechanism. In industrial medicine, a preventative strategy should be planned, on the one hand considering individual risks and taking account of personal and genetic factors, on the other hand monitoring of respiratory risks by the identification of new irritants and finally the organisation of respiratory function screening for the early detection of lung dysfunction, by more sensitive tests than the FEV1 (VEMS), whose validity should be studied. The priority is primary prevention by the suppression of toxic irritants and by the improvement of working conditions.

Computer assisted teaching in thoracic medicine (E.A.O.) is described for the recognition and diagnosis of pulmonary opacities. Two programmes were used, both designed specially for medical study:--the first programme was for the recognition of shapes for the beginner to read abnormal radiographs (chest opacities), and--a programme to teach the beginner the diagnosis and to formulate a diagnostic strategy (diagnosis of pulmonary opacities). Working areas consisting of an alpha-numeric keyboard with a display screen and a slide projector are at present installed in two CHU hospitals in Paris and are connected by a special telephone line to the central computer C1T12 (in the Faculty of Medicine). Four practicals, lasting about 6 hours and 22 simulated cases lasting 8 hours are provided each with illustrated commentaries for the different stages, covering the overall educational objectives of the medical practitioner. After two years of experimentation the method was given a good reception by the medical students. Full confirmation of the technique as well as an evaluation to compare the method to other forms of teaching are at present under study.

The observations of the National Association for the Domiciliary treatment of respiratory failure (A.N.T.A.D.I.R.) affords the opportunity for some hard information on the complex problem of chronic respiratory failure in France. The objectives were to perceive the demographic fluctuations of the population, to follow the development of the distribution of health care, to assess the cost effectiveness of the activities and to place the different participants in the overall schema of the system. The initial results on 3,120 patients show one female for every 2.5 males with a mean age of 62.87. Disorders with chronic airflow obstruction account for 60% and restrictive disorders for 20%. Assisted tracheal ventilation (20% overall) was applied, particularly to this latter type, long term oxygen (O.L.D.) 28% or assisted ventilation with a mouthpiece (VAB) to 45% with chronic airflow obstruction. VAB is still widely practised in France but there is a trend towards O.L.D. VAT and VAB use oxygen bottles as a supply while O.L.D. uses nitrogen extraction in 2 cases out of 3. These are preliminary results and it will be interesting to follow the outcome of these techniques of assisted ventilation in the home, so that there efficacy by gathering functional data (particularly blood gases) may be assessed and either the survival curves analysed or the time spent in hospital.

Certain physiotherapy techniques can actively contribute to alter the functional consequences of chronic airflow obstruction (hyperinflation, respiratory rhythm and limitation of expiratory flow). Postural drainage does not seem useful until the secretions exceed 30 ml/24 hours. A search for a comfortable body position will no doubt offer mechanical and/or muscular advantages to the patient's breathing. Expiration with pursed lips slows the respiratory rate and limits airway collapse on expiration. Breathing at low frequency improves gas exchange but increases muscular work particularly if the physiological end tidal volume is exceeded. The rules of respiratory physiotherapists should in practice be modified to suit each individual patient.