Revue francaise des maladies respiratoires最新文献

Broncho-alveolar cells (BAC) act as defence means in the lower respiratory tract and acinus; equally they determine the evolution of inflammatory phenomena, whatsoever its cause. Alveolar macrophages (AM) play an important role in the regulation of the immune response and presentation of antigen to lymphocytes. In the alveolar microclimate AM exert a suppressor effect. AM can be equally considered as true inflammatory cells, either through their own mediators or through the skewed pattern of cellular recruitment. Among these cells polymorphonuclear cells and eosinophils, present in small numbers in broncho-alveolar lavage (BAL) may be encountered in a number of pathological conditions. Finally, free mast cells probably play an important role in the induction of the inflammatory reaction in the distal air spaces.

A cooperative french trial in the treatment of pulmonary tuberculosis has compared the efficacy and the tolerance of daily antituberculous regimes, one of short duration of 18 weeks (HRSZ/HRZ), the other of standard duration of 9 months (HRE). Of 204 patients included in the trial 180 were analysed. No significant difference was found between the two regimes regarding either biological tolerance or clinical outcome. Four relapses were seen within 24 months of the onset of treatment, two in each regime, which shows that 18 weeks treatment is ethically acceptable. Such short course therapy is useful in those patients who would sometimes find prolonged therapy difficult or would be likely to abandon treatment prematurely.

Isocyanates are chemical compounds used in making polyurethane (for flexible or rigid foam, paint, varnish, glue and textiles). In strong concentrations isocyanates are powerful irritants producing chemical bronchopulmonary lesions. In weak doses they are responsible for occupational asthma and more rarely allergic alveolitis. Long term exposure to isocyanates may produce a deterioration in pulmonary function in asymptomatic patients. The pathophysiology of isocyanate asthma remains uncertain: immunological data remains contradictory while isocyanates have been shown to have a Betablocking effect. The maximum allowable concentration in the working environment, at present proposed in the U.S.A. is 0.005 ppm.

In a brief historical review the author shows that the delayed recognition of coal miners pneumoconiosis as an independent nosological entity was mainly due to an insufficiently experimentally orientated approach before 1940. The principal characteristics of the french endemic are described: a slow decline in incidence yet a continued elevated prevalence, due to the increased life span of the sufferers; the late appearance of the first radiological manifestations, most often after the working life of a Miner; a disparity of the endemic levels between mining regions without the reasons being fully elucidated. Finally the principal lines of current research are recalled which take account of new data on epidemiology and modern dust analysis processes as well as information collected in man using recent biological techniques.

The aim of this work was to study drug resistance of M. tuberculosis to Streptomycin (SM), Isoniazid (INH), Ethambutol (EMB) and Rifampicin (RMP) in the department of the Bas-Rhin from 1971 to 1978. On 2,995 original culture plates which were positive, 1,561 antibiograms were performed at the C.E.R.P. The proportion of those tested has increased over the years from 27.8% in 1971 to 80.6% in 1978 because of the increasing number of laboratories participating in the study. The research is based on 1,511 cultures of M. tuberculosis and the population was split into two groups: 1,386 untreated subjects or treated for less than 15 days (primary resistance) and 125 subjects who had already been treated (acquired resistance). Over all the years, primary resistance to at least one drug was 6.9%. Primary resistance to SM was 3.0%, to INH 2.2% and to both 1.4% (the levels of primary resistance to EMB and RMP were practically nil). Acquired resistance to at least one of these antibiotics was 16.0% with the same order as for primary resistance: resistance to SM alone = 7.2%, to INH alone 4.0% and both together 2.4%. The proportions were greater than for primary resistance but concerned fewer subjects as only 8% of the population had been previously treated. There were no cases of primary or acquired resistance to Rifampicin alone.

Twenty children aged between 5 and 16 suffering from severe asthma were treated with long acting oral theophylline. The minimum duration of treatment was three months and the maximum 12 months. Clinical, pharmacokinetic and pulmonary function studies were made. With a mean dose of 8.75 mg/kg, morning and evening, the theophylline blood levels on the 4th day of treatment (4 hours after the morning dose) were 12.3 +/- 4.36 mg/l. Those taken 4 hours after the evening dose 9.41 +/- 3.75 mg/l, suggesting a circadian rhythm for theophylline blood levels. The importance if fever is stressed in relationship to blood levels, which were increased by 67-100% with fevers of 38.5-39 degrees C. Treatment was very beneficial in 53% of cases. Respiratory function studies were performed in 13 children. After 4 days of treatment there was a significant decrease in airflow obstruction and hypoxemia However, despite carefully adjusted treatment, functional disturbances persisted, in particular hyperinflation.

The cytological characteristics of broncho-alveolar fluid were studied in 94 coal workers and six subjects exposed to varied risks of silicosis. In coal worker's pneumoconiosis with the usual micronodular or nodular type, there was a significant increase in the cellularity of the peripheral airways compared to non-exposed controls, making allowances for smoking habits. There were no striking changes in the white cell count nor any correlation with the possible elevation in the serum angiotensin I-enzyme conversion level. On the other hand a striking elevation of the alveolar lymphocyte count was noted in three cases with rapidly developing silicosis. Where there was the co-existence of another disorder (connective tissue disorders, sarcoid, extrinsic allergic alveolitis, radiation lung or diffuse interstitial fibrosis) the anomalies noted were those occurring during the progress of the associated disease. At the time of collection the alveolar macrophages in the dust exposed subjects showed a similar vitality to these observed in control subjects. After 24 hours of observation " in vitro ", the vitality of the cells and their phagocytic and bactericidal activity was markedly diminished.

One hundred years after the discovery of the tubercle bacillus the struggle against tuberculosis still poses numerous problems on a world scale. Each year, 10 million new cases appear: nearly five million are highly contagious; 95% of these cases come from developing countries. The official notification system currently in force is imperfect but a reckoning of the annual infection risk, from a methodical enquiry into tuberculous disease gives exact information on the size of the problem and its evolutionary time scale in each country. This is the best epidemiological index currently available. The technical problems of the struggle against tubercle are resolved in theory: the selective detection of groups at risk, centered on a network of bacteriology laboratories enables identification of all the sources of infection; chemotherapy, becoming safer and safer, with a duration reduced to 6 or 9 months at the maximum and curing practically 100% of the patients; properly performed BCG vaccination reduces the risk of infantile tuberculosis. Operational problems remain the most serious. The greatest difficulties are seen in countries with the highest prevalence: they are linked to a global shortage of resources but also at times a poor utilisation of the resources available. A concerted international action could render antituberculous drugs and the appropriate sanitary technology to all countries. With a judicious use of available information and means each country could today achieve an effective national antituberculous programme.