Chronic bronchiolitis in ankylosing spondylitis.

The pleuro-pulmonary signs of ankylosing spondylitis are generally asymptomatic, typically represented by biapical lung fibrosis. To our knowledge, the severe bronchiolitis which is sometimes observed in other spondyloarthropathies has not been described in ankylosing spondylitis. We report two cases of severe chronic bronchiolitis in ankylosing spondylitis patients. Their clinical and radiological presentation were similar, characterized by progressive deterioration of stage III-IV dyspnea, non-reversible obstructive ventilatory defect, and CT scan showing air trapping with mosaic attenuation and ground-glass opacity in expiration. Lung biopsies confirmed the diagnosis of severe follicular bronchiolitis in one patient and constrictive bronchiolitis is suspected in the other. Only the patient with follicular bronchiolitis responded positively to treatment with low doses of macrolides.

[Particular aspects of rhinitis and rhino-conjunctivitis]. / Aspects particuliers des rhinites et rhino-conjonctivites.

The authors report their experience of 28 years of practice in the opthalmology service of the CHRU at Rennes. The describe certain particular aspects of rhinitis and rhino-conjuctivitis where the danger resides in an extensive risk to the uvula or the bronchi. They insist on the importance of understanding polyvalents in internal medicine (rôle of the seat of gingivodentary "ideas", value of research into indicative markers of protection A2 and B40 in the HLA system. In the region of nutrition, they emphasize the importance of the rôle of zinc, of vitamin C and of magnesium. They base their hopes on study of the local markers of sensitivity, in order to assess the elements of preventative action for an eventual ocular and bronchial extension.

[Asthma caused by isocyanate exposure]. / L'asthme par exposition à l'inhalation d'isocyanates.

Asthma from exposure to inhalation of isocyanates is an affection recognised under the title of work place diseases within table no 62 in the General Regulations and no 43 in the Agricultural Regulations. If workplace induced asthma is the most frequent of the workplace respiratory illnesses with a frequency of 2 to 15% of the asthmatic population, 1 patient in 2 will only be the object of a declaration and 1 in 3 the objective of a survey by the administrative authorities. The frequency of isocyanate asthma is on average 16.4% amongst workplace asthmas (19.6% in the industrial environment and 1.5% in an agricultural environment); if this prevalence is dose-dependent according to Baür, 30% of patients exposed to weak doses of isocyanate (0.3% ppb according to White) develop asthmatic disease whilst Bernstein estimates as 5 to 10% the frequency of asthmatic disease per 100,000 persons who are exposed to isocyanates.

[Food allergy in the chronic alcoholic and alcohol in food allergy: apropos of 38 cases]. / L'allergie alimentaire chez l'alcoolique chronique et l'alcool dans l'allergie alimentaire: à propos de 38 cas.

Exacerbation or appearance of hypersensitivity of food origin in chronic alcoholics appears to be linked to a basis of catabolism of histamine, a facilitation of penetration of allergens under the impetus of the mucosa-irritating power of alcohol and its potential as a histamine-liberator; it results frequently in an elevated total IgE that predisposes to conflictual sub-cutaneous mechanisms, so explaining the easy appearance or exacerbation of food allergies. We have used skin tests of the principal food allergens to evaluate the influence of alcohol in the development of allergies, by determining the allergy profile of each patient and consequently, the titres of total IgE. Our results show the potentiating role in the physiopathology of allergy and food intolerance without which it helps as much by an evident inducing role in the appearance of true food allergy.

[The physician-pharmacist team in the education of patients concerning inhalant therapy]. / Duo medecin-pharmacien dans l'education du malade face aux therapeutiques inhalees.

The value of educational measures in consideration of the asthmatic patient appeared at first twenty years ago to the eyes of clinical physicians, generalists or specialists. Round about the year 76 the first associations for asthmatic patients were born, under pressure from pneumologists, with the aim of clarifying their illness to asthmatics, to counsel them and especially to enable them to associate their symptoms with their treatment, to assure them of a ready availability of materials more or less onerous to test, aerosolizers, nebulizers, ionizers of the environment, peak flow meters, inhalation chambers, acaricides.... Twenty years after these pioneers of this education of the patient to these responsibilities, the associations devoted to asthma as well as schools of asthma have recently been instigated in order to complete the venture on the ground, often with only feeble means. It is hardly necessary to make an illusion: asthmatic patients, children or adults within these associations are always the same: it is those who are prepared to stir themselves to take part in meetings. There remains the great majority of asthmatics who necessarily need a particular treatment that is adapted to their personal case: it is the duo of physician-pharmacist which is and which constitutes always the best point of impact to devote the time necessary at the best appropriate moment. Such is the aim of this presentation which should not be considered as a return to the past, but an advance towards the individualized formulation of patients by benefitting from the former experiences of corporative formations.

[Importance of blood tests for the diagnosis of drug allergies]. / Intérêt des tests sériques pour le diagnostic des allergies médicamenteuses.

This work is devoted to the study of 22 dossiers of persons who have presented with clinical signs following taking a drug. The study was confined to patients in whom the symptoms had as origin a hypersensitivity (true or non-specific by histamine release). This study has allowed analysis of the value of several serological tests (measurement of leukotrienes, activation of basophils and T specific lymphocytes) in diagnosis and so to define the path to take that is best adapted to each case. The conclusion presents an agreement between the suspected diagnosis, after allergy enquiry and prick-tests, and the results of serological tests.

[Value of esophageal scintigraphy in exploration of a gastro-esophageal reflux in a respiratory patient]. / Intérêt de la scintigraphie oesophagienne dans l'exploration d'un reflux gastro-oesophagien chez le patient respiratoire.

Patients with respiratory pathologies in the forms of tracheitis, rhino-sinusitis, and asthma sometimes have symptoms of gastro-oesophageal reflux, that should be taken into consideration in order to treat the co-factors associated with the etiopathology. However, these patients, because of their respiratory handicaps, are frequently unwilling to submit themselves to traumatic investigations. Oesophageal scintigraphy, because of its perfect tolerance and reliability, seems to be an examination that is adapted to the situation to resolve this dilemma.

[Value of specific IgE and IgG4 measurements in the follow-up of a hymenoptera venom immunotherapy treatment: apropos of 82 cases]. / Intérêt du dosage des IgE et IgG4 spécifiques dans le suivi d'un traitement d'immunothérapie aux venins d'hyménoptères: à propos de 82 cas.

The work is devoted to the study of 82 dossiers of patients who were treated by immunotherapy (IT) to hymenoptera venoms, following various manifestations. The study has permitted analysis of the value of measurement of specific immunoglobulins, both IgE and IgG4 (1), in following IT in patients who were treated for at least three years. It especially emphasized the usefulness of adopting management that is appropriate to the clinical and biological characteristics of each patient.

[The role of the pharmacist in the educational charge of the asthmatic patient]. / Rôle du pharmacien dans la prise en charge éducative du patient asthmatique.

The problem of educative charge of the asthmatic patient has mobilised general physicians, specialists and kinesitherapists for many years. The first mutual aid associations for asthmatic patients, created at the initiative of pneumologists and allergists or their patients date back for a score or so of years and their principal objectives are the adaption of educational measures, in transmission of clear information and in the loan of surveillance equipment, to ensure that inhalation equipment is adapted appropriately to the case. Since, the mediatisation has reinforced this action in all directions, in the interests of and for the great benefit of asthmatic patients; and so the role of the pharmacist has also become essential not only in the field of information but also in that of control of the self-evaluation of the patient; three inseparable aspects are thus emphasized: information aspect, technical aspect, initiation of surveillance of the illness.

[History-taking of the allergic patient]. / L'interrogatoire du malade allergique.

Etiological diagnosis of an allergic condition is assured mostly clinically and in particular by the data from a specific and minute interrogation. Complementary investigations only confirm the diagnostic suspicion produced by this interrogation, which includes several essential steps: The history of the patient from the first symptom to the day of consultation. The common criteria of unity of time, place or action on the different manifestations of hypersensitivity. The provocation factors and improvement of critical episodes. The mode of life of the subject and the factors of environmental imbalance.

[Advice for allergic travellers]. / Conseils aux voyageurs allergiques.

Business and tourist journeys by air contribute to exposure of the body to multiple environments. The allergic patient, considered rightly to be a sentry of the environment, has many reasons to care about his journeys and to take precautions that are adapted to his case under the impetus of advice and information from his physician and his specialist. Some advice falls within a simple logic that is enough to remember when planning the journey while the others measures must follow a correct preventative strategy for allergy risks as much as those that concern the modalities before leaving as a drive taken on the ground. It is important therefore to know how to give advice and information on the different risks linked to the allergic condition and to the field of allergy and help the patient to orientate his choice of place of the journey, the methods of lodging, of transport and the programme of the journey. The advice should also include the preventative measures as a function of the known pathology under the form of medical equipment before, during the stay and on return. Finally some advice relative to medical equipment for prevention and cure would appear to be judicious.

Current synthetic notions on aspirin induced asthma.

Aspirin was discovered by Gerhardt in 1853. The first examples of its negative side-effects in the form of asthma like dyspnea were described as early as 1911 by Gilbert, and then by Reeds and by Cookes. Widal depicted the typical symptomatic triad of aspirin-associated illness in 1922, with the symptoms 'nasal polyposis, severe asthma, and intolerance to aspirin'. The role of inhibition of the cyclooxygenase was highlighted in the physiopathologic interpretation of the diseases in 1975. Since then, great progress has been made not only in the analysis of the disease, but also in the way to treat it that has been performed thanks to a new approach in the relative positions of 'nose bronchi' that enables the development of a new strategy in the relation between 'nasal and chest specialists'. If the mean of immuno-allergologic investigations, and particularly the scanographic and endoscopic imaging, have enabled a better cure for 'illness due to aspirin', it is nevertheless the case that this illness remains cortico-dependent too often. Important progress has been expected since the discovery of anti-leukotriens and several teams apparently emphasize how useful anti-leukotriens are in the control of aspirin-associated illness. Thus, this enables one to hope for a decrease in the first effective dose of corticosteroids and ever for the total elimination thereof.

[Asthma and aspirin]. / Asthme à l'aspirine.

Aspirin was discovered by Gerhardt in 1853. The first signs of problems in the form of asthmatiform dyspnoea were described in 1911 by Gilbert, then Reed and Cookes. Fernand Widal described the symptomatic triad characteristic of "aspirin illness" in 1922 with the association of "nasal polyposis, severe asthma and aspirin intolerance". It was in 1975 that the role of inhibition of cyclo-oxygenase was emphasized in physiological interpretation of the illness. Since then, very important progress has been made not only in the analysis of the affection, but also in its control not only by a new approach to "nose-bronchus" relationship which have enabled development of a new strategy in the "ORL and pneumologists". If the methods of immuno-allergological investigations, and especially scanning imagery and endoscopy, have made possible a better control of "aspirin illness" it still remains that this last often remains corticosteroid dependent. Important progress is expected with the discovery of anti-leucotrienes and several groups have shown the value of anti-leucotrienes in the management of "aspirin illness" so leading to the hope that one day there will be a reduction in the efficient limiting dose of corticosteroids.

[Brief update on bisulfite allergy]. / Notions d'actualité brèves sur l'allergie au bisulfite.

The consumption of bisulphites is considerable in the general population as it is a preservative that is used both in foods and medications. Nevertheless, incidents or accidents of hypersensitivity are rare, but special attention must be given to subjects at risk: asthmatics and those who are allergic and intolerant to aspirin. The course to follow is to consider these three principal points: To watch for clinical signs that may precede more severe accidents. To recognize the responsibility of sulphites and detect the mechanism. Inform the patient of the need to avoid it as far as possible: any label that is coded with preservatives E 220 to E 227.

[Pleural lipoma]. / Lipome pleural.

Reviewing the clinic cases of two patients bearing with asymptomatic pleural lipoma, whose general course and treatment of their disease were very different, it seemed useful to us to focus on such a benign uncommon tumor. We therefore analysed this tumour's features, especially its scanographic characteristics, its spontaneous evolution, and its potential complications, in order to avoid diagnostic thoracotomy as far as possible.

[Pleural fibroma: a case of a patient exposed to tungsten carbide and asbestos]. / Le fibrome pleural: un cas chez un patient exposé au carbure de tungstène et à l'amiante.

We report here a case of localized fibrous pleural mesothelioma diagnosed in a sixty-year old patient, who had been exposed to tungsten carbide and asbestos dust for almost twenty years. He first consulted because of enduring lateral chest pains combined with progressive and increasing dyspnea on exertion. The initial diagnosis, after both pulmonary radiograph and computerised tomography, was confirmed by a histology which revealed fusiform cells of fibroblastic origin. After simple and total excision of the tumor, symptoms improved.

[Preliminary study of the importance of trace elements in immunostimulation]. / Etude préliminaire de l'intérêt des oligo-éléments en immuno-stimulation.

Stimunal is an original immuno-stimulant of which the action is between adapted therapy and probability. It has a composition of trace elements which are usually recognised to be useful for the function of immune defences and this requires a clinical research of two populations: Those subjects who are predisposed to infections of the upper and lower respiratory tract. Those allergic subjects who do not respond overall to the protocols for specific desensitisation. The study of 27 cases shows a modality of modest but not negligible response in particular in 8 patients who showed objective clinical and complementary improvement. This study should be extended to a larger sample.

[Specific immunotherapy using Alpha-Fraction-Retard-D. pteronyssinus. Double-blind study in asthma]. / Immunothérapie spécifique par l'alpha-fraction-retard-D. ptéronyssinus. Etude en double aveugle dans l'asthme.

A multicenter, double blind clinical study on two homogeneous, treated and untreated groups, has allowed an objective appreciation of the results of specific immunotherapy using the alpha-fraction of D. pteronyssinus in asthma. A statistically significant difference was seen of the consumption of drugs in the treated group and in infants of less than 5 years (p = 0.047). Tolerance, evaluated as a function of local and secondary effects was excellent and comparable in the two groups.

[Antigenicity and allergenicity of acarians. Study of 7 varieties in a population of 33 allergic patients]. / Antigénicité et allergénicité des acariens. Etude de 7 variétés sur une population de 33 patients allergiques.

A population of 33 patients who were known to be sensitive to mites were studied by the authors to establish whether 7 types of mites were responsible. A complementary and comparative study by the same Immunology laboratory compared the RAST and TDBH values as an addition to the skin test responses. The role of storage mites seemed to be sufficiently clear to advise increase in systematic research. The discovery of possibly frequent presence of Pyroglyphus africanus was a discovery that justifies other epidemiological and ethnic investigations.