[Long-term radiology and respiratory function study following exposure to asbestos]. / Etude radiologique et fonctionnelle respiratoire au long cours après exposition à l'amiante.

During the supervision of 93 workers in an asbestos factory pulmonary function tests and radiographs were performed using the same equipment and by the same team, at 5 yearly intervals. The assessment of radiographic changes was judged by following both the reader of the films and the technique used (either un-named films or simultaneous films at 5 yearly intervals). On reading un-named films the appraisal of parenchymal abnormalities was variable from one reader to another; on the other hand they were less marked for simultaneous readings made by the same observer. Progressive pulmonary function tests showed that the fall in vital capacity and of VEMS in 5 year intervals was more rapid when there was a parenchymal abnormality, when the duration of exposure was long or the subject was older when first exposed. The results showed that in spite of ceasing to be exposed the parenchymal abnormalities progressed.

[Lessons from a long-term survey on the effects of massive occupational exposure to asbestos. The AMISOL affair 10 years later]. / Enseignements d'une enquête au long cours sur les effets d'une exposition professionnelle massive à l'amiante. L'affaire AMISOL 10 ans plus tard.

For the past 10 years the authors have followed up a cohort of workers who had been massively exposed to dust in an asbestos textile factory which closed down in 1974. They report on the difficulties of all kinds they encountered during this epidemiological survey. The most original result is that they were able to establish that the radiological and functional manifestations of asbestosis pursue their course after the subjects have ceased to be exposed. Another important point is the early development of lesions in peripheral bronchioles, detected by volume-flow loops. The authors insist on the psycho-social problems at the site of work or in daily life which arise from the use of asbestos or of fibres with similar properties. Social protection, at present well organized, should suppress the risk of asbestosis in Western countries. However, a number of problems remain to be solved, notably those concerning the long-term risk of pleural mesothelioma, the mode of action of the fibers and the immune reactions they induce, and the economic and social consequences of a hypothetical ban on asbestos--a material very difficult to replace. This study embodies, in miniature, all the problems of society associated with asbestos during this second half of the XX th century.

[Long-term results of a trial of short-term chemotherapy. French study 6.9.12]. / Résultats lointains d'un essai de chimiothérapie de courte durée. L'enquête française 6.9.12.

The relapse rate after short course chemotherapy is usually assessed by cases that are available for analysis, with a delay which rarely exceeds 3 years from the time of instituting therapy. This level may be disputed if too many are lost to follow up or non-compliers appearing late. To understand the true failure rate we strove to trace every patient in a trial carried out between 1969 and 1973, consisting of three groups of patients treated with the same chemotherapy: Isoniazid (450 mg/day), Rifampicin (600 mg/day) given every day but for differing durations: 6 months (Group A), 9 months (Group B), 12 months (Group C), with either daily Ethambutol or Streptomycin in addition for the first three months. Amongst the 356 patients in the trial 86 were eliminated for failure to comply with the protocol, either due to a mishap or change of treatment. Amongst the 270 remaining patients, 248 were traced with a mean delay of post-therapy follow up of 101 months for patients still living and of 72 months for patients who had died in the intervening period, but of non-tuberculous disease. In the 242 old patients whose disease could be evaluated, the number of bacteriological relapses was 4/81 (6.2 %) in group A, and 2/85 (2.3 %) in group B and 2/76 (2.6 %) in group C. There was no significant differences between the groups. From these results it is seen that the Isoniazid/Rifampicin combination given daily for 6 months is a powerful combination with few failures. Maintaining such chemotherapy for 12 months does not seem to yield substantial gains. In conclusion nine months of chemotherapy with this regime offers a sufficiently ample guarantee of cure.

[Value of determining plasma INH during antitubercular treatment. Retrospective analysis of 204 cases]. / Intérêt de la détermination de l'INH plasmatique au cours du traitement antituberculeux. Analyse rétrospective de 204 observations.

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.

[Pulmonary hemangiopericytoma. Apropos of a case]. / L'hémangiopéricytome pulmonaire. A propos d'un cas.

A primary pulmonary location of a hemangiopericytoma, a tumor of vascular origin developing from pericytes, is very rarely observed, no more than 40 cases having been reported in the published literature. Diagnosis cannot be based on clinical symptomatology, often inexistent, or on radiological findings which are not very characteristic, but depends on results of pathological examination. Malignant potentiality, assessed by the pathologist mainly by the presence of necrotic zones in the tumor, is evidenced by local recurrence and by metastases. The course is unpredictable and the tendency is for local recurrences to occur. The only current effective treatment is by excision.

[Double blind study of the mucoregulating action of sodium thiophene carboxylate (author's transl)]. / Etude en double aveugle de l'activité mucorégulatrice du tiophène carboxylate de sodium.

A double blind study of thiophene carboxylate in 32 chronic bronchitis patients, show an improvement of clinical and respiratory condition in the treated group. However, there is no increase in volume of expectoration and no fluidizing. The product acts as mucoregulator, the reorganization of fibrillary mucus allowing a better efficiency of mucociliary apparatus.

[Correlations between chest X-rays, clinical data, and lung function tests (flow-volume curve) in asbestos workers (author's transl)]. / Corrélations entre les données radiocliniques et fonctionnelles respiratoires (courbe débit-volume) chez les ouvriers d'une usine textile d'amiante.

This study concern 61 asbestos workers, exposed to very dusty conditions, but exposure is stopped for 4 years. Flow-volume curve shows a decrease in flow, at low-volume, particularly in old subjects, with a great dust index. In 13 subjects (21%), with normal chest radiographs, we observe a decrease in flow. This is interpreted as an airway obstruction, and it is an early effect of asbestos exposure. This obstruction concerns the small airways because the Vmax is density independent in the last portion of the VC. Flow-volume curve breathing helium oxygen mixture is not more sensitive, than breathing air. So, this test seems sufficient, to monitor the exposed workers, in epidemiological studies, and prevent repeated chest X-ray examinations which may be dangerous.

[Immunological approach to asthmatic disease (author's transl)]. / Critères immunologiques de la maladie asthmatique.

Research into the environmental factors in the aetiological diagnosis of asthma is a fundamental measure which must direct complementary test and therapy. Extrinsic asthma is mostly found in young people, with atopic antecedents. Immunological study is based on the clinical history and skin tests (IgE dosage, in vitro tests and provocation tests are difficult to apply in epidemiology due to their high cost). In children 3/4 of asthma cases are extrinsic. Differential diagnosis is especially a problem with rhinitis. There is only a small percentage of cases of non atopic extrinsic asthma which can bring other immunological mechanisms into play. So-called intrinsic asthma (late onset asthma, with continuous dyspnea, corticodependent) is mostly observed in adults. The age has an influence on the severity of the attacks, the curve of asthma with permanent dyspnea being a function increasing with age, whereas that of less severe asthma is a function decreasing with age. The role of extrinsic factors does not seem important in this category of asthmatics (10 to 25% according to the statistics). Immunofluorescence studies of the bronchial mucosa show up the possibility of local immunological reactions, whether specific or not (frequent presence of the C3 complement). This means that the immunologist can, in many cases of asthma, help the epidemiologist to define and to understand the physiological mechanisms of the disease.

[Epidemiology of adult asthma (Socio-economic effects) (author's transl)]. / Asthme de l'adulte: enquête de prévalence et retentissement socio-économique.

A study of the prevalence of adult asthma (subjects over 18 years of age) has been carried out in the Puy-de-Dôme area over the past two years by means of a questionnaire sent out to all the doctors in the area. 1,130 asthmatics have been inventoried to this day (547 males and 583 females). A study of the geographical distribution carried out in terms of demographic data on thhe present time, but is certainly underestimated. Correspondence analysis shows up the influence of age on the severity of the attacks. Frequency calculation and the cumulated frequency of the answers to the question concerning the date of the onset of asthma, leads to the conclusion that there will probably be an important increase of cases of late asthma in the next few years. The socio-economic and professional (sick leave, change of job) effects of this type of asthma in adults are analysed.