Role of tropomyosin as a cross-reacting allergen in sensitization to cockroach in patients from Martinique (French Caribbean island) with a respiratory allergy to mite and a food allergy to crab and shrimp.

BACKGROUND: Tropomyosin has been described as cross-reacting allergen between mite, cockroach and shrimp. METHODS: In 13 patients with asthma and/or rhinitis sensitized to mite and/or German cockroach and presenting urticaria, oral allergy syndrome or angio-edema upon eating shrimp and/or crab, we measured specific IgE to mite, cockroach, crab and shrimp tropomyosin. RESULTS: Ten patients had specific IgE to tropomyosin from mite, 8 from shrimp, 6 from crab and 5 from cockroach. AST inhibition tests indicated that mite allergen is a primary sensitizer and is cross-reacting with shrimp, crab and cockroach allergens. CONCLUSION: Tropomyosin could be the cross-reacting allergen relevant for clinical symptoms to mite, cockroach, shrimp and crab.

[Characteristics of patients with domiciliary equipment for chronic respiratory diseases in Martinique]. / Particularités des patients appareillés au domicile pour pathologie respiratoire chronique en Martinique.

The incidence of chronic respiratory failure is underestimated in Martinique. The aim of our retrospective study was to determine local particularities. Between December 1991 and December 1995, 128 patients (55% men, mean age 60 years, range 18-89 years) were hospitalized in our pneumology unit to receive a respiratory device (oxygen concentrator, respirator, continuous positive pressure generator). The high percentage of continuous positive pressure generators contrasted with the low number of oxygen concentrators prescribed indicating that obstructive disease is relatively less common due to the absence of widespread smoking habits. Sleep apnea syndrome (SAS) was particularly frequent in women (44% of the SAS patients). 10% of the SAS patients had perturbed blood gases unexplained by an associated bronchopathy. SAS in obese, hypertensive, diabetic women in Martinique is a public health problem and should be assessed by a prospective study. We observed that home care was particularly difficult for the most severely diseased patients, especially those with a tracheotomy, due to the lack of a management structure.

Coal worker's pneumoconiosis: CT assessment in exposed workers and correlation with radiographic findings.

To study the signs of coal worker's pneumoconiosis (CWP) at computed tomography (CT), the authors obtained thoracic CT scans in 170 coal-dust-exposed workers who were concomitantly evaluated with conventional posteroanterior and lateral radiography. The profusion and extent of disease was assessed by means of CT in two groups of miners: group 1 (n = 86), miners with worker's compensation and radiographic evidence of CWP, and group 2(n = 84), miners who had applied for compensation without radiographic evidence of CWP. The CT signs of CWP consisted of micronodules, nodules, and progressive massive fibrosis. The comparative analysis demonstrates the superiority of an optimal CT technique over chest radiography in the evaluation of simple silicosis, with improved sensitivity in the detection of small parenchymal opacities. CT provides additional information on the stage of the disease but also clarifies some ambiguities of the ILO classification of small opacities. CT was equivalent to radiography for complicated silicosis, except in the identification of necrosis. CT evaluations are complementary to plain radiography in the assessment of CWP, and the addition of high-resolution CT is useful in achieving a more accurate evaluation of the small parenchymal opacities.

Abnormal secretion of interleukin-1 and tumor necrosis factor alpha by alveolar macrophages in coal worker's pneumoconiosis: comparison between simple pneumoconiosis and progressive massive fibrosis.

The aim of this study was to compare the secretion of tumor necrosis factor alpha (TNF alpha) and interleukin-1 (IL-1) by alveolar macrophages (AMs) harvested from patients with coal worker's pneumoconiosis (CWP) and control subjects. We observed higher levels of spontaneous TNF alpha and IL-1 secretion by AMs from patients with CWP than in those from healthy controls. We did not find any significant difference between the two groups in the incidence of simple pneumoconiosis and progressive massive fibrosis. In the group of coal miners without radiologic signs of pneumoconiosis, we found high levels of both cytokines in a subgroup of subjects still exposed to the mineral dust but not in the subgroup of subjects removed from exposure. These results indicate that AMs are involved in chronic lung inflammatory reactions to mineral dusts, partly by way of cytokine secretion. Moreover, cytokine secretion by AMs appears to be an early event that is detectable at the moment of mineral dust exposure. The results open new perspectives in the study of the mechanisms leading to CWP.

[Should a cancer of the bronchi be surgically treated after excision of a cerebral metastasis?]. / Faut-il opérer un cancer bronchique après exérèse d'une métastase cérébrale révélatrice?

Between 1964 and 1987 35 patients were operated on for cerebral metastases due to an underlying bronchial carcinoma. In 26 cases (group 1) there was excision of the primary tumour also and in 9 cases combined medical treatment was given with radiotherapy and chemotherapy. The neurological state was improved by the neurosurgical operation in 88% of patients in group 1 and in 66% of patients in group 2. This improvement was maintained in 30% of the patients as long as they survived. 2 patients died following thoracic surgery (7.69%). The median survival was 11 months in group 1 and 9 months in group 2. Three patients in group 1 were living two years after craniotomy whilst. 1 patient in group 2 is still alive four years after the neurosurgical procedure. The heterogeneity of the two groups does not permit a comparative statistical analysis but overall there does not seem to be any difference in duration or quality of life between the two groups. Complementary cerebral radiotherapy did not affect the prognosis.

[Pure bronchial adenoma. Anatomico-clinical and ultrastructural study of a case]. / Adénome bronchique pur. Etude anatomoclinique et ultrastructurale d'un cas.

We report a case of monomorphic bronchial cystadenoma (or mucous gland adenoma). This exceptional tumor (only 34 cases reported up to now) is benign, but a lobectomy is often necessary because of severe inflammatory lesions of the surrounding lung. Ultrastructurally it was different from the other tumors of bronchial glands, since it contained mucous cells, myoepithelial cells, and oncocytic cells, and the basement membrane was thickened.

[An unusual cause of right-left shunt: anastomosis of the left superior vena cava with the left atrium]. / Une cause exceptionnelle de shunt droit-gauche: l'abouchement de la veine cave supérieure gauche dans l'oreillette gauche.

We report the case of a 73 year old man presenting with severe hypoxaemia due to an anatomical right to left shunt from a persistent left superior vena cava (VCSG) anastomosing with the left auricle. This was fortuitously discovered while placing a left sub clavicular catheter; the diagnosis of the VCSG draining into the left auricle was confirmed by superior phlebography and CT scanning. The discovery of this shunt after a pulmonary embolus suggested to us that the rise in venous pressure secondary to the embolus led to both clinical symptoms and hypoxaemia from the shunt, which had until then been clinically silent. No surgical treatment was performed.