[Reliability of the transcutaneous PO2 measurement in the adult by the TCM 1 radiometer electrode]. / Fiabilité de la mesure de la PO2 transcutanée chez l'adulte par l'électrode radiometer TCM 1.

The accuracy of transcutaneous PO2 measurements (PtcO2; Radiometer TCM 1) was evaluated by comparison with arterial PO2 (PaO2) on 115 recordings in 35 patients: 20 during exercise testing (group I) and 14 during assisted ventilation at different FIO2 values (group II). The correlation coefficient between PaO2 and PtcO2 was satisfactory (r = 0.977; n = 115). However PaO2 and PtcO2 mean values were significantly different in group I, and in group II at 45% FIO2. The analysis of variance showed that the difference between PaO2 and PtcO2 was significant among the patients but did not vary with exercise and FIO2 changes (group I: F19 = 6.28, p less than 0.001; group II: F19(19) = 2.54, p less than 0.025). In the adult, transcutaneous PO2 measurement by TCM 1 radiometer electrode seems to be interesting in the context of monitoring blood gases with exercise and assisted ventilation. The significant variation with arterial PO2 sometimes registered should make one cautious in the interpretation of accurate measurements.

[Contribution of nocturnal polygraphy to the diagnosis of Pickwickian syndrome. 10 cases]. / Apport de la polygraphie nocturne au diagnostic du syndrome de Pickwick. A propos de 10 observations.

The authors studied a series of 10 obese patients with respiratory failure referred for treatment because of sleep disorders and diurnal, sometimes uncontrollable, episodes of somnolence. 8 parameters were recorded in the polygraphic study performed during a night of hospitalization: electroencephalogram, electrocardiogram, electro-oculogram, chin electromyogram, thoracic movements, and nasal and buccal air flows. SaO2 and transcutaneous PO2 were recorded simultaneously. A sleep apnea syndrome was diagnosed in 6 of the 10 patients, whose apnea index was markedly above the limit of 5 apneas per hour. The apnea index was below 5 in the other 4 patients. Most patients with sleep apnea syndrome suffer from obstructive apneas of varying duration taking up as much as 48% of total sleep time. The cardiorespiratory effects of these events are apparent, with a drop in PO2 and SaO2 and a decrease in heart rate at the end of apnea. Polygraphic studies seem useful in the diagnosis of the pickwickian syndrome. They allow the type of apnea and its effects to be specified and thus guide treatment.

[Respiratory pathology of isocyanates]. / Pathologie respiratoire des isocyanates.

Isocyanates are chemical compounds used in making polyurethane (for flexible or rigid foam, paint, varnish, glue and textiles). In strong concentrations isocyanates are powerful irritants producing chemical bronchopulmonary lesions. In weak doses they are responsible for occupational asthma and more rarely allergic alveolitis. Long term exposure to isocyanates may produce a deterioration in pulmonary function in asymptomatic patients. The pathophysiology of isocyanate asthma remains uncertain: immunological data remains contradictory while isocyanates have been shown to have a Betablocking effect. The maximum allowable concentration in the working environment, at present proposed in the U.S.A. is 0.005 ppm.

[Clinical aspects of 27 cases of severe primary infectious lung diseases]. / Aspects cliniques de 27 cas de pneumopathies infectieuses graves primitives.

The authors report 27 cases of severe primary pulmonary infections which resulted in acute respiratory failure and which were treated in a Respiratory Medicine Intensive Care Unit. A bacteriological specimen (blood culture, transtracheal aspiration, fibroscopy, pleural tap) and/or a serological examination permitted the responsible agent to be identified in 20 of the 27 cases (74%). Apart from antibiotics and symptomatic treatments, 13 patients also received oxygen therapy and 14 other patients were intubated and ventilated. In the first group, 3 patients died (24%) and in the second group, the mortality was much higher, with 9 deaths out of 14 patients (64%). The authors present the clinical features, the frequency of the various micro-organisms isolated, the therapeutic modalities and various prognostic factors. Although repeated early specimens usually provide bacteriological diagnosis and therefore appropriate antibiotic therapy, the prognosis of these conditions, at the stage of acute respiratory failure remains serious and is probably related to risk factors linked with predisposition. The exact nature and the relative importance of these risk factors still needs to be determined.

[Asbestos exposure and pleural calcification : functional effects in 34 patients]. / Exposition asbestosique et calcifications pleurales : appréciation du retentissement fonctionnel chez 34 sujets.

Respiratory function disturbances were evaluated in 34 patients, mostly retired naval shipyard workers, with asbestos-related pleural calcifications. All patients had spirography tests, while 20 of them were studied by CO transfer in steady-state and measurements of arterial gases. Results were correlated with previous clinical history (chronic bronchopathy and/or pleural effusions), smoking habits, and the duration of exposure to asbestos dust. Patients with no previous history had mean spirographic values close to the normal (VC: 96% of lower limits; TC: 113%, mean VEMS/CV: 72.5%). Previous clinical history had a very much more marked effect on spirographic results than on gas exchanges: whereas CO transfer and blood gases were usually fairly normal (97% of normal for TCO and DuCO, mean PaO2 at 78 mmHg, mean PaCO2 at 34,5 mmHg), many patients had markedly altered altered values. A clear correlation was found for TCO, DuCO, Du a and PaCO2 with the duration of exposure. This suggests that in some cases there is a certain degree of pulmonary fibrosis associated with the pleural thickening.

[Oxygen enrichers and different ways of using them]. / Enrichisseurs d'oxygène et différents modes d'utilisation.

Different ways of using oxygen enrichers have been studied. First, the performances of two different devices were tested: the results were very similar to the constructors' previsions. Second, oxygen concentrations in venturi masks connected to enrichers were measured with a mass spectrometer. The authors suggest to adjust the flow delivered by enrichers at 3 liters/min for any type of venturi mask. Pharyngeal oxygen concentration curves show the reliability of masks connected to enrichers compared to other modes of administration (nasal cannulae, nasal catheter).

[Primary lymphosarcoma of the lung secreting immunoglobulin (author's transl)]. / Lymphomes pulmonaires primitifs immuno-sécrétants.

A case of primary lymphosarcoma of the lung with monoclonal seric dysglobulinemia of IgM type is reported in a 48-year-old man. This bilateral tumour consisted of lymphocytes with some plasmacytoïd and plasma-cells. There was no bone, liver or lymph node involvement. A 3-year follow-up shows clinical remission with continuous chlorambucil therapy. The interest of the observation lies in the rarity of secretory lymphosarcoma of the lung: only five cases have been reported. Nosologic and diagnostic problems of lymphocyte and plasma cell proliferations in the lung are discussed. The difficulty to differentiate diffuse hemopathy from localized lymphoma and tumour from pseudo-tumour is emphasized.

Tuberculosis therapy and enzyme induction in man.

The enzymatic inducing effect of an antituberculous treatment (Rifampicin, Isoniazid and Ethambutol) is tested by recording variations in the urinary D-glucaric acid elimination and in the antipyrine half-life test, measured before starting treatment and after two weeks of treatment. This study concerns 21 patients: 14 are slow acetylators and 7 are rapid acetylators of isoniazid. After two weeks of treatment an increase of the urinary glucaric acid elimination is observed but variations in the antipyrine half-life test are not univocal and allow us to separate two categories of patients: 10 have a significant decrease of antipyrine half-life, 11 have not. A link seems to exist between the rapid acetylator phenotype and this enzyme induction which is revealed by the antipyrine test. An interpretation of these two enzyme induction tests, the nature of the rifampicin inducing action and its relation to the acetylator phenotype are discussed.

[Two-year assisted ventilation at home experiment study of 15 patients (author's transl)]. / Expérience de deux années de ventilation assistée à domicile. Surveillance de 15 malades.

Assisted ventilation at home requiring volume relaxators affected 15 patients suffering from a restrictive syndrome (cyphoscoliosis or after effects of tuberculosis). The blood gases of 8 patients who had been looked after for more than one year, at home by the physio-therapist and in hospital by repeated controls, improved (especially the PaO2). The most important fact is the noteworthy decline in the annual time of hospitalisation.

[Value of isotope study with ytterbium-169 citrate in the diagnosis of pulmonary opacities of cancerous nature]. / Intérêt de l'étude isotopique au citrate d'ytterbium169 dans le diagnostic des opacités pulmonaires de nature cancéreuse.

Out of 60 observations, the authors deduct the value of the isotopic study with Ytterbium169 citrate in the diagnosis of cancerous pulmonary opacities. Ytterbium169 is a radiolanthanide with a period of 32 days. Patients receive intravenously 500 muCi of Ytterbium169 citrate. Recordings are made on the 2nd, 7th and 14th day. Valuable information on the data of the fixation rate on the 2nd and 14th day can be obtained from drawing a curve of fixation. As shown by the dosimetric study the radioactive pollution is minimal; nevertheless the dose of irradiation should not be underestimated and not recommended for young patients. Reliability of the examination is great: the percentage of true positive results is satisfactory (87%) and above all the percentage of false positive results (7.7%) much below that of other isotopes (30-40%). Results are excellent for peripheral opacities which escape the usual diagnostic mean. The main failure of the examination is the relatively frequent lack of fixation, not prejudicial in itself as it has no diagnostic value. Indications and limits of this examination are drawn from this study.

[Asbestosic pleural calcifications and the associated pathology (study of 32 cases)]. / Calcifications pleurales asbestosiques et pathologie associée (étude de 32 observations).

The presence of calcified pleural plaques together with asbestos professional exposition is the sign of patent dust inhaling and can be related to asbestos pathology. The observations on a homogeneous group of 32 cases of asbestosic pleural calcifications are analyzed. The frequency of malignant pleural and bronchial tumours (2 pleural mesothelioma, 3 bronchial epithelioma) is classical. That there was no serious pulmonary fibrosis can be attributed to the conditions of dust inhaling. There was a relatively high frequency of pleural effusions, the benignity of which could not always be ascertained. Therefore, besides the convincing facts, the precise study of cases with calcified pleural plaques (pleural antecedents, circumstances of the discovery, evolution) could be a rough way of appreciating the frequency of benign asbestos pleurisies.

[Effects of asbestos on respiratory pathology. 27 cases observed in 6 years in a pneumo-phthisiology department in Nantes]. / Incidence de l'amiante sur la pathologie respiratoire. 27 observations recueillies en 6 ans dans un Service de pneumono-phtisiologie de Nantes

A search for respiratory disease due to asbestos permitted the authors, during a review of 6 years' activity on a Chest Unit in Nantes, to collect 27 cases which represents 2.4% of all cases examined. They were male subjects usually aged about 60 years exposed to dust mildly but continuously during a long career as metal workers, mainly in the shipyards. Pleural involvement was constant, usually limited to characteristic pleural calcifications which were well tolerated. Two cases of asbestos pleurisy were diagnosed, but above all we noted 7 cases of mesothelioma with a very poor prognosis. It is difficult to say whether asbestos is responsible for bronchial carcinoma but we noted two cases in patients with calcifications. The authors emphasise the necessity for revision of the table of occupational diseases which does not yet include pleural disease due to asbestos.

[Diagnostic value of ytterbium 169 citrate in cancerology]. / Intérêt diagnostique du citrate d'ytterbium 169 en cancérologie

Several radio-nuclides are used in Cancerology for their tumoral tropism and, in fact, 67 gallium citrate and 57Co bleomycin almost exclusively. But, these nuclides have some disadvantages, such as we tried to evaluate the interest to 169 ytterbium citrate; this radiolanthanide has already been studied in animals for its affinity for tumoral and normal tissues by HISADA and al. [5]. Our preliminary study has been made on 44 patients bearing different neoplastic diseases. In 8 cases, we have measured the percent radioactivity excreted by urines and stools in 5 days following injection. Scintigraphy of most of the patients has been made at 48 hours, but for several cases of non malignant or malignant pulmonary diseases, a cinetic study allowed us to follow the evolution of the intensity the pathological fixation. The results show: -- a weak urinary and fecal excretion; -- a good scintigraphic contrast from 48 hours; -- an important radioactive fixation in bone metastasis of various origins, in primary and secondary brain and liver tumors; -- an important radioactive fixation in lung cancers and inflammatory diseases however our preliminary cinetic study seems to be a good mean of differential diagnosis. At the cost of a non negligeable irradiation dose of bone, the tumoral fixation can be considered as good and the cinetic studies we intend to develop will perhaps improve the specificity of the diagnosis.