[Prevention of asthma caused by dust mites]. / Prévention de l'asthme aux acariens.

The house-dust mites are responsible for the majority of allergic asthma. It is currently possible to measure the exposure to their allergens, and this allows for a better guide as to the indications for eviction measures; there is also a more objective appreciation of the efficacy of these measures. A decrease in the relative humidity of the interior of the house effectively hinders the proliferation of the mites. Vacuuming the room, notably the mattress, is not sufficient in the majority of cases to reduce the level of allergenicity of the mites to a tolerable level for the asthmatic patient. Thus, it is necessary to renew the bedding, or to hermetically seal the mattress in a plastic cover. Washing the bedding at a temperature above 55 degrees C will kill the mites. Amongst the chemicals available in the struggle to reduce the mite population, the acaricides lead to an elimination of 65-100% of the mites in a mite culture. Tannic acid, which is a protein de-naturing agent, can reduce the allergenicity of the house-dust. Certain control studies related to the effect of the acaricides demonstrate an improvement in objective and subjective parameters of both asthma and rhinitis due to mites. However, the efficacy of these acaricides, as well as measures to clean up the environment within the house, merit more precise evaluation on the symptomatology, the changes of expiratory flow rates, and finally of broncho-reactivity in patients. It is probable that several preventative measures need to be associated if one wishes to improve the efficacy of the struggle to control the house-dust mites.

Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients.

We studied 70 patients with biopsy-proven pulmonary non-Hodgkin's lymphomas without extrathoracic involvement or mediastinal adenopathy to determine the clinical, imaging, and endoscopic features of this condition in a homogeneous series. In low-grade (LG) lymphomas, symptoms were cough, dyspnea, chest pain, hemoptysis. Imaging features consisted of localized alveolar opacities, infiltrative diffuse opacities, atelectasis, and pleural effusions. Inflammatory changes of the mucosa were present in some patients, leading to bronchial stenosis in 7; biopsies showed lymphomatous infiltration in 12. Prognosis of LG lymphomas was excellent, with 93.6 percent survival at five years. High-grade lymphomas differed from LG lymphomas principally by a more aggressive course and a worse survival. Inflammatory changes occurred in seven of nine cases leading to stenosis in two, and biopsies showed lymphomatous involvement in five. The profile of primary pulmonary lymphomas in this study could help clinicians consider this condition and prompt them to evaluate new diagnostic tools.

The antielastase screen of the lower respiratory tract of alpha 1-proteinase inhibitor-sufficient patients with emphysema or pneumothorax.

The present study was aimed at testing whether alpha 1-proteinase inhibitor-sufficient patients with lung emphysema or idiopathic spontaneous pneumothorax have an impaired antielastase protection at the lung alveolar level. We have collected bronchoalveolar lavage fluids (BALF) from 20 PIMM emphysematous patients (44 +/- 12 yr), 24 patients with pneumothorax but no radiologic evidence of emphysema (30 +/- 11 yr), 32 healthy subjects (27 +/- 6 yr), and 56 patients with sarcoidosis (30 +/- 11 yr). The BALF were assayed for immunoreactive albumin, alpha 1-proteinase inhibitor (alpha 1PI), leukocyte elastase-alpha 1PI complex (LE-alpha 1PI), and mucus proteinase inhibitor (MPI) as well as for porcine pancreatic elastase inhibitory capacity, a measure of active alpha 1PI. The healthy subjects and the patients with emphysema or pneumothorax had comparable levels of total and active alpha 1PI and total MPI. In contrast, the levels of LE-alpha 1PI complex were elevenfold higher in patients with emphysema than in normal subjects (p = 0.021) and tended to increase with the severity of the disease because they were negatively correlated with FEV1/FVC% (r = -0.55; 0.05 less than p less than 0.1). They did not vary with age in a population of patients with sarcoidosis (r = 0.03), suggesting that their eleven-fold increase in emphysematous patients is not related to the age of these subjects. Patients with pneumothorax had levels of LE-alpha 1PI complex that did not significantly differ from those of normal subjects (p = 0.24).(ABSTRACT TRUNCATED AT 250 WORDS)

[Evaluation of the prognosis in sarcoidosis: remission as an issue of biological criteria and current cellular activities (ACE and alveolar lymphocytosis)]. / Evaluation du pronostic de la sarcoïdose: remise en question des critères biologiques et cellulaires usuels d'activité. (ECA et lymphocytose alvéolaire).

The spontaneous evolution of 60 patients suffering from recently diagnosed sarcoidosis was compared with their initial biological profile of "activity". 47% of this unselected group of patients belonged to an inactive group (ACE less than 35 nmol/ml/mn and the percentage of alveolar lymphocytes less than 30%). After a mean period of two years of follow up it turned out that the initial bioprofile of activity had no predicted value, even in the absence of any initial elevation of the markers (3 cases out of 28 grew worse). The repeated controls of criteria of activity did not objectively show any concordant change with the outcome in such cases. It is necessary to point out the unfavourable character of very raised ACE activity greater than 50 nmol/ml/mn (7 deteriorations out of 8 cases). It would appear that a systematic search for these criteria should be deferred principally in type 1 lymph node involvement or pulmonary and mediastinal type IIA, all the more so as in practice they have little influence on therapeutic decisions.

[Multiple elemental organic components of the broncho-alveolar lavage fluid in normal subjects and in various lung pathologies (excluding silica and asbestos fibers)]. / Etude multi-élémentaire des composants inorganiques du liquide de lavage broncho-alvéolaire chez le sujet normal et dans diverses pathologies pulmonaires (silice et fibres d'amiante exclues).

Owing to a technical analysis enabling the detection of mineral elements present in trace amounts in small volumes, an analysis of the liquid obtained in 148 broncho-alveolar lavages could be studied. The elements consistently recovered were as follows: iron, copper, zinc, nickel, lead and titanium. Normal values were established. In the absence of exposure, there was no significant difference distinguishing the different pulmonary diseases studied. In occupational disease, the presence of iron in large quantities, tungsten, nickel and rare earths could be shown objectively, as well as the persistence of gold or iodine after medical absorption. However, this preliminary work does not allow one to establish a formal correlation between the alveolar concentrations obtained and the pulmonary disease observed.

Celery allergy: clinical and biological study of 20 cases.

In 20 patients, the ingestion of celery was responsible for mucocutaneous symptoms (generalized urticaria and angioedema) (18/20) and respiratory disorders (7/20). Four cases of systemic anaphylaxis were observed. The main associated allergic disorder was pollinosis (16/20). Food allergy to other vegetable products, mainly other Umbelliferae and apples, coexisted with celery allergy in 12 cases. It was found that celery allergy is mediated by IgE antibodies: it is easily diagnosed by skin tests (fresh extracts of celery may be used) and by adequate RAST (17 positive results). Cosensitization with mugwort pollen (14 cases) and birch pollen (9 cases) was found. Celery allergens responsible for clinical sensitization originate chiefly in the tuber and are at least partly thermally labile. The frequent association with pollen sensitization suggests the existence of common antigenic epitopes in celery extracts and mugwort and birch pollens. The immunologic investigations carried out so far (RAST inhibition and immunoprint) seem to support this hypothesis.

[Long-term efficacy of high-dose aerosol corticotherapy in the treatment of severe asthma]. / Efficacité au long cours d'une corticothérapie en aérosol fortement dosé dans le traitement de l'asthme sévère.

Forty-five patients with severe, poorly controlled asthma, including 23 corticosteroid-dependent patients, were treated with a preparation of beclomethasone dipropionate aerosol delivering 250 mcg per puff. The daily dose ranged from 1000 to 2000 mcg. The mean follow-up period was 14 +/- 7 months, and 11 patients have now been followed up for more than 2 years. Forty-two patients were improved, and total withdrawal of continuous steroid therapy could be achieved in 13 cases. Treatment remained effective in long term use, provided a minimum of 1000 mcg/day was given. However, despite clinical improvement the obstructive syndrome persisted in 65% of the patients.

[Mechanism of action and mode of administration of high-dose inhaled corticotherapy in the treatment of asthma]. / Mécanisme d'action et mode d'administration d'une corticothérapie inhalée à forte dose dans le traitement de l'asthme.

The commercial availability of high-dose inhaled corticosteroid preparations for the treatment of asthma offers an occasion for reviewing the different mechanisms of action of glucocorticoids notably glucocorticoids, notably their interference with lipocortin protein synthesis and arachidonic acid metabolism. A favourable effect on bronchial hyper-reactivity and on delayed hypersensitivity reactions has also been observed. The problems raised by the various preparations responsible for varying degrees of systemic activity, the difficulties inherent in the use of inhalers and the side-effects of these products are discussed. The effectiveness and safety of the current high-dose inhaled preparations are emphasized.

Simultaneous determination of trace elements in lavage fluids from human bronchial alveoli by energy-dispersive x-ray fluorescence. 3. Routine analysis.

We applied the energy-dispersive x-ray fluorescence technique to determination of trace elements in human bronchoalveolar lavage fluids. Our analysis of more than 200 samples allowed us to determine normal reference values, to be used in characterizing occupational exposure. These values are expressed both in nanograms per 1000 cells (of all kinds) and nanograms per 1000 macrophages to correlate lavage efficiency and dust content of the alveoli. The result expressed in milligrams per liter is not sufficient, because some healthy volunteers showed high concentrations of iron but normal values when expressed vs the number of cells. Some examples of abnormal compositions of broncho-alveolar lavages are reported and the fully automated spectrometer developed for clinical and biological investigations is described.

[Pleural and mediastinal metastases from a malignant mesothelioma of testicular vaginalis membrane]. / Métastases pleurales et médiastinales d'un mésothéliome malin de la membrane vaginale testiculaire.

The authors describe an original observation of secondary intrathoracic metastases due to a malignant adenomatoid tumour or mesothelioma of the testicular tunica vaginalis. The hypothesis of a primary pleural mesothelioma could be excluded here as could secondary pleural deposits from another neoplasm. The exceptionally malign potentialities of this common tumour of the testicular adnexae were reviewed as well as the extremely poor prognosis.

[Profile of a respiratory allergy department from computerized data collected between 1968 and 1984 (3962 cases)]. / Profil d'une consultation d'allergie respiratoire d'après des données informatisées de 1968 à 1984 (3,962 dossiers).

A prospective study of clinical, cutaneous and biological sensitivity to the common air-borne allergens was conducted over a 16-year period in a total of 3,962 patients who reported to a hospital consultation for respiratory allergy. The study confirmed certain widely recognized semiological features, but it did it on the basis of a real population with a large number of subjects and therefore was a true textbook of allergology with a live material. In addition, the study benefited from the major advantage of computer data processing: an accurate and rapid analysis. Yet some uncertainties and omissions remained concerning answers to certain questions, but such gaps are inherent in the natural subjectivity of allergic patients and their doctors.

Simultaneous determination of trace elements in lavage fluids from human bronchial alveoli by energy-dispersive x-ray fluorescence. 2: Determination of abnormal lavage contents and verification of the results.

We applied energy-dispersive x-ray fluorescence to the determination of abnormally present elements or abnormal concentrations of elements in human broncho-alveolar lavage fluids. The low detection limits and the ability to perform multi-elemental analysis permit one to establish or confirm occupational exposure of workers. We also describe different methods used to check our method and our results. We report examples of abnormal compositions of broncho-alveolar lavages containing W, Ce, La, Nd, I, Fe, or Ni. We discuss the limits of the method for characterizing silicosis or asbestosis.

Celery sensitivity: clinical and immunological correlations with pollen allergy.

The authors studied twenty patients with celery allergy and concomitant hypersensitivity to certain pollens (mugwort, birch). The specific symptoms induced by eating celery were attacks of urticaria and angio oedema (seventeen out of twenty) respiratory complaints (eight out of twenty), systemic anaphylaxis with vascular collapse (three out of twenty). A strong association between clinical reactions to celery and mugwort sensitization, and to a lesser degree between celery allergy and birch pollen sensitization was established. Celery allergy is mediated by IgE antibodies and can be easily diagnosed by cutaneous tests using fresh material and/or by adequate RAST test. RAST inhibitions performed on individual sera suggest the existence of common antigens in celery and mugwort, and in celery and birch pollen. However, the exact nature of these common antigens has not yet been determined.

[Invasive aspergillar pneumopathy during the treatment of microcellular bronchial cancer. Efficacy of early antifungal treatment]. / Pneumopathie aspergillaire invasive au cours du traitement d'un cancer bronchique microcellulaire. Efficacité du traitement antifungique précoce.

The invasive aspergillus pneumonias have been described particularly in chemotherapy for patients with haematological disorders. In respiratory disorders such cases are exceptional. The authors report a case of invasive aspergillus pneumonia, occurring during treatment of a small cell cancer; the rapid commencement of anti-fungal treatment by Amphotericin "B" and Flucytosine enabled an apparent cure of the tumour by radiotherapy and chemotherapy. The authors stress the difficulty of definitive diagnostic criteria at the beginning of the disorder and also the need to start anti-fungal treatment as soon as possible.

[Preliminary results concerning the value of chemotherapy in the treatment of inoperable bronchial carcinoma (excluding small-cell anaplastic carcinoma)]. / Résultats préliminaires concernant l'intérêt d'une chimiothérapie dans le traitement des carcinomes bronchiques inopérables (à l'exclusion des carcinomes anaplasiques à petites cellules).

Inoperable non- microcellular primary bronchial carcinomas have been reputed up to now to be chemo-resistant. The introduction of Cis-platinum into a polychemotherapy protocol leads to revision of this concept. The authors report the preliminary results of a polychemotherapy protocol (including Cis-platinum, Vindesine, CCNU, Cyclophosphamide) associated, in cases of non- metastasized carcinomas, with radiotherapy to the tumour itself, the mediastinum and the supraclavicular fossae. These results confirmed the value of such chemotherapy in forms with metastases. In localised inoperable forms, conclusions could be reached only on the basis of a randomised comparative trial of chemotherapy + radiotherapy versus radiotherapy alone.

[Recurrent sarcoidosis in skin scars disclosing repeated thoracic sarcoidosis]. / Sarcoïdes récidivantes sur cicatrices cutanées révélatrices de sarcoïdose thoracique itérative.

Recurrence of thoracic sarcoidosis after spontaneous regression is extremely rare. Its existence is proven by two new cases associating sarcoidosis with L ofgren 's syndrome and sarcoid in skin scars, the latter facilitating the recognition of the presence of thoracic disease. Surveillance of the behaviour of scars forms part of routine examinations in the sarcoid patient. Even when there has been total spontaneous regression, subsequent clinical and radiological follow-up every two years must be continued.