[Young man with intermittent dysphagia]. / Rezidivierende Schluckbeschwerden bei einem jungen Mann.

Endoscopic findings of an 18-year old man with intermittent dysphagia showed widespread white exudations of the oesophagus. First misinterpreted as oesophageal candidiasis the mucosal biopsies revealed the histological features of a severe eosinophilic oesophagitis. Under treatment with topical steroids the symptoms dissolved. The control endoscopy showed a histological remission with absence of eosinophilic granulocytes, too. The eosinophilic oesophagitis is a rare allergy-like inflammation of the oesophagus especially seen in young men with increasing incidence. Without treatment the long-term risk of eosinophilic oesophagitis is the induction of severe oesophageal strictures.

[Chemoprevention of cancers, the point of view of health insurance]. / Chimioprévention des cancers, le point de vue de l'Assurance maladie.

Faced with scientific progress, social security must be concerned by ethics, especially by protection of personal integrity. Financial necessities lead to take into account the efficiency of public health interventions. But in front of potentially toxic drug, are we allowed to compare possible advantages with potentially serious risks for healthy women? For these reasons, social security takes a stand in favour of carefully controlled trials, focused on restricted target populations which are estimated at high risk of cancer. Research of side effects should be included in the follow of the patients and special caution should be taken to avoid premature spreading of this behaviour. About a financial contribution of social security, the National fund for health prevention, education and information (FNPEIS) could perhaps not support such a project, regarding to his experimental nature. CNAMTS-INSERM research contracts could be an alternative.

Reliability of respiratory symptoms to diagnose atopy.

As reliance of responses to epidemiological questionnaires on atopic symptoms is doubtful, we studied the predictive value of these questions relative to atopy, defined by the presence of serum specific IgE, taking into account some extraneous variables such as age and sex. The study population included 2067 adults, 20-60 years old. The protocol consisted of a standardized questionnaire and an evaluation of serum specific IgE using the Phadiatop (Pharmacia Diagnostics, Uppsala, Sweden) test. The predictive value of each symptom suggestive of atopy was quite low, but was much dependent on age and sex. Women more often than men reported atopic symptoms in the absence of atopy. Similarly, the predictive value of each symptom decreased with age. Thus atopic symptoms do not have the same value as predictors of atopy. These findings have both clinical and epidemiological important implications.

Is intrinsic asthma a hereditary disease?

Although studies of families, inbred populations and twins have established that asthma has a hereditary basis, little evidence has shown that intrinsic asthma has an increased familial occurrence. To document this issue, we compared the prevalence of asthma in families of intrinsic asthmatics, extrinsic asthmatics and non-asthmatics. The intrinsic asthma group included those with negative skin tests to common aero-allergens (n = 117). The extrinsic asthma group included those with one or more positive skin tests (n = 164). The non-asthmatic group (n = 224) was recruited at a check-up center. The siblings of each subject completed a standardized questionnaire on history of asthma. The results showed that asthma was more prevalent (P less than 0.001) in siblings of intrinsic asthmatics (8.9%) than in siblings of the non-asthmatic group (2.4%). The prevalence of asthma in siblings of intrinsic and extrinsic asthmatics was similar. In conclusion, both intrinsic and extrinsic asthma have an increased family occurrence.

Atopy and systemic reactions to drugs.

To elucidate whether systemic reactions (SR) to drugs should be included in the atopic status in epidemiological studies, we compared the distribution of atopy in subjects with or without a history of SR to drugs. The studied population comprised 2067 adults, 20 to 60 years old, visiting a health care center for a check-up examination. The protocol included a questionnaire related to history of SR to drugs and a Phadiatop test which evaluates on a blood sample the presence of specific IgE against common aeroallergens. Overall, 14.7% of the study group, including 66% women, reported reliable histories of SR to drugs. The cumulative prevalence of asthma, hay fever and childhood dermatitis was higher in the SR group. By contrast, the percentage of positive Phadiatop tests was similar in subjects with or without a history of SR. Thus atopy, defined by an objective criterion, i.e. the presence of specific IgE against common aero-allergens, is not associated with the occurrence of SR to drugs. Such a history should not be included as part of the atopic status.

[Respiratory allergy and domestic animals. Survey in a sample of the general population]. / Allergie respiratoire et animaux domestiques. Enquêtes réalisées en population générale.

To evaluate the role of exposure to furred pets on respiratory allergic disorders, we interviewed 10,338 adults, selected at random from communities of South-East France. All subjects answered a standardized questionnaire related to asthma and perennial rhinitis and to present or past exposure to furred pets and respiratory symptoms related to this exposure. Besides, a sample of the population had a blood analysis for detection of specific IgE directed against common aero-allergens (Phadiatop). Overall, more than half of the households had a pet, more often in rural than urban communities. Among asthmatics 9.3% acknowledged respiratory symptoms when exposed to pets and 5.9% had parted from their pets because of respiratory symptoms; among patients with chronic rhinitis, those figures were 5.1% and 2.6%, respectively. However, these subjects with respiratory symptoms had pets as often as the whole population. In atopic subjects (positive Phadiatop test), exposed to cats, the prevalence of perennial rhinitis was higher than in atopic subjects not exposed to cats and in non-atopic subjects. Thus furred pets have a deleterious influence on patients with asthma or rhinitis, especially in the atopic subgroup. Pet avoidance is an important factor in the management of these diseases.

[Allergy to Hymenoptera. Incidence and degree of public knowledge]. / Allergie aux hyménoptères. Fréquence et degré d'information du public.

The prevalence of systemic reactions to hymenoptera stings in adults is unknown. To elucidate this point we interviewed 2.067 persons aged from 20 to 60 years who attended a medical screening centre. We asked them whether they had ever experienced a reaction this kind, what they knew about it and what they did, and we performed skin tests to hymenoptera venoms in those who gave a positive answer. The proportion of subjects who had had at least one type of systemic reaction after being stung was 1.2 per cent; 0.9 per cent of the subjects had both a history of reaction and a positive skin test. This figure is in keeping with those obtained in surveys carried out among children, but is does not tally with the mortality figures which probably are grossly under-estimated. The general population is not adequately informed of possible systemic reactions to hymenoptera stings, so that people often fail to consult, and the practitioners themselves do not advise their patients to see an allergologist for evaluation. Thus, adequate information of the general population and the physicians is badly needed.

Interstitial 9q- deletions in hematologic malignancies.

Sixteen patients with interstitial deletions of the long arm of chromosome #9 (9q-). were studied. From our observations and the findings of ten other cases in the literature, it can be deduced that the anomaly is almost exclusively found in myeloproliferative disorders and that it rarely occurs as the sole anomaly; however, in more than one-third of the cases, it was associated with a t(8;21) and occurred as a secondary event. The deletion appears to be interstitial, the breakpoints are somewhat variable, and the region carrying the abl oncogene was never involved.

Translocation t(3;17)(q26;q22): a marker of acute disease in myeloproliferative disorders?

A new reciprocal translocation, t(3;17)(q26;q22), has been observed in three patients with myeloproliferative disease. The t(3;17) seems to be associated with acceleration of the disorder, thus adding further evidence to a relationship between 17q22 rearrangements and acute myeloproliferation .

[Granulocytic progenitors in bone marrow autografts]. / Apport de l'étude des progéniteurs granulocytaires (CFC) dans les auto-greffes de moelle osseuse.

Granulocytic progenitor cells (CFC) are a better reflection of stem cell pools than precursors. Their total number can be estimated during hematologic steady-state (N = 70 +/- 29 x 10(5) CFC/kg); the amount of marrow necessary to perform a bone marrow transplantation is only 1% of the total pool. CFC are useful but have a mainly qualitative value in evaluating the viability of marrow stored for 24 h at room temperature (92%) or marrow thawed after DMSO cryopreservation (62%). Sequential study of CFC in patients receiving autologous marrow transplantation enables differentiation of engraftment from autologous recovery. In 11 recipients of autologous marrow transplantation, no statistical relation was observed between number of infused CFC and severity of granulocytopenia. Further studies will be necessary to evaluate a better marker of real hematopoietic stem cells.