[Descriptive and prognostic value of health status perception by a group of patients with chronic respiratory insufficiency using respirators]. / Valeur descriptive et pronostique de la santé perçue dans une population d'insuffisants respiratoires chroniques appareillés.

Using a self questionnaire we have done a domiciliary study of the perception of health and respiratory function in a population of 537 patients suffering from chronic respiratory disease. We arranged elsewhere the objective biological data of the severity of the disease represented in the computerised dossier on each patient and were able to compare this objective data to the subjective data gathered by the questionnaire. The objective data, in particular the blood gas analysis, appeared to be very weakly linked to the perception that the subjects had of their health and of their physical mobility. A study of the survival at one year showed that functional capacity and psychological approach of subjects were better predictive factors of mortality than the severity of the disease defined according to medical criteria. This study recalls the limits of standard methods of follow up for chronic respiratory failure, and stresses the importance of physical independence in these subjects: this functional indicator seems to have a value which is both descriptive as it is connected, as a whole, to the indicators of the quality of life and also prognostic as it is a better predictive factor for mortality at one year.

[Medico-social consequences of asthma in adults (author's transl)]. / Conséquences médico-sociales de la maladie asthmatique chez l'adulte.

The evaluation of the medico-social consequences of asthma in adults encounters difficulties that are inherent to a chronic disease with varying clinical pictures. Overall statistical analyses, particularly concerning mortality, provide little information in a socio-economical perspective, especially in France. However, based on the results of fragmentary but varied analyses, the study of this disease in relation to the working careers of asthmatic subjects underlines the importance of the repercussions at the very start of professional life (choice of profession, recruitement in a company). The study of absenteeism and inaptitude reveals to what degree these consequences are related to the seriousness of the disease and to the asthmatic person's social sphere. The same is true for family and social life which is more difficult to evaluate. Systematic analyses alone will be useful in determining whether asthma is considered a "social disease" with its eventual implications on a public health program.

[Pulmonary allescheriosis (author's transl)]. / Alleschériose pulmonaire.

In a patient properly treated for a previous cavitary tuberculosis, we had the surprise, after hemoptyses, to find a sleigh-bell shaped picture suggesting an intra-cavitary aspergilloma with a very special mycosis with Allescheria Boydii. Proof was provided by the presence of the fungus in direct examination and in culture in bronchial secretions. Surgical exeresis did not cure the patient and a secondary recurrence appeared on which antifungal drugs were ineffective. Antigens were made from the strain. They are used for immunoprecipitations tests. Only the patient's serum is positive; 82 serum test (18 concerned patients with visceral mycosis of farmer's lung disease) remained negative. Twenty two observations or pulmonary allescheriosis were recorded in the world. These figures are certainly below the truth. Three practical consequences can be drawn: --for an intra-cavitary mycetoma, with negative anti-aspergillus precipitins, such a disease must be kept in mind and the fungus looked for in bronchial secretions and specific immuno-precipitation test done; --any mycotic growth must be systematically cultured to determine the type of fungus; --for therapy, if diagnosis was made before the intervention, an antifungal treatment either local or general must be associated to the surgical treatment (contrary to aspergilloma treatment).

[Broncho-pulmonary amylosis (about two cases) (author's transl)]. / Amylose broncho-pulmonaire. A propos de deux observations.

The authors reported two recent cases of broncho-pulmonary amylosis with monoclonal gammapathy. The first observation concerned a diffuse amylosis characterized by a bilateral pulmonary infiltration with pleural effusions and secretion of IgGlambda with a Bence Jones proteinuria. Pleural and pulmonary biopsies will provide the proof of amylosis. Evolution will rapidly be fatal in case of renal insufficiency. Post-mortem sampling will confirm the amyloid involvement (muscle, liver, kidney). The second observation described a localized amylosis developed in contact with a mediastino-pulmonary lymphoplasmocytic lymphoma with tumoral secretion of IgMlambda. Although pneumonectomy brought out the disappearance of the abnormal paraportein, death occurred within a few months, linked either to the spreading of the lymphomatous process or to the onset of a bacillary surinfection. The authors then recalled the main clinical and diagnostic data of the broncho-pulmonary amylosis. They underlined the importance of GLENNER'S work who, by proving the immunoglobulinic nature of amyloid, explained that in both cases, amylosis appeared as the consequences of an abnormal immunoglobulins synthesis.