[Transmission of tuberculosis in Gironde: epidemiologic investigation by genomic analysis of Mycobacterium tuberculosis]. / Transmission de la tuberculose en Gironde : approche épidémiologique par l'analyse génomique du Mycobacterium tuberculosis.

BACKGROUND: Over the past few years, epidemiologic surveys of tuberculosis have been strengthened by new biologic technology, in particularly using RFLP (Restriction Fragment Length Polymorphism). This technique, which identifies Mycobacterium tuberculosis patterns, has allowed to study thoroughly tuberculosis bacilli transmission and pathogenesis. First applied on tuberculosis epidemics in at risk groups, RFLP has now an interest in the epidemiologic molecular survey of urbans populations. The aim of this study is to identify, in a French department, the proportion of clustering cases of tuberculosis, suspected of recent contamination. METHODS: An active surveillance of tuberculosis allows to record systematically the cases of tuberculosis-disease in Gironde. All M. tuberculosis isolates from the patients reported in this surveillance system were processed through IS6110 based RFLP analysis. Patients were interviewed face to face before this analysis, using a standardised data collection instrument. RESULTS: 102 patients were included in 1997; the RFLP analysis of all available strains identifies a high degree of polymorphism with 71 unique patterns; twelve groups with clustering patterns were found, grouping two (nine clusters), three (two clusters) and seven patients (one cluster) each. Those cases suspected of recent transmission were younger (age<60 years) and lived in poorer conditions. Epidemiologic links were confirmed in only 35% of the 31 patients clustered. CONCLUSION: This community survey analysis has allowed to identify at risk groups for tuberculosis transmission and to strengthen tuberculosis control in Gironde.

[Survey on cases of primary tuberculosis in the department of Gironde]. / Enquête sur les cas de primo-infection tuberculeuse dans le département de la Gironde.

French official statistics do not mention primary tuberculosis and data on its prevalence are rare, despite the fact that the annual number of cases of primary tuberculosis is a clear indicator of the progression or regression of what remains an endemic disease in Europe. In order to collate information on the subject, a questionnaire was sent to 132 doctors practising in Gironde. These included pulmonologists, pediatricians and child health doctors. One hundred and one questionnaires were returned, listing a total of 18 cases of primary tuberculosis for the first half of 1997. Children were more often affected by the disease and presented a latent form. In 61% of cases, patients infected had not previously received BCG vaccination and in 56% of cases the infectious patient was identified. Furthermore, 4 of the non-vaccinated patients had been in close contact with an infectious patient and 3 patients among these should have been vaccinated since they were living in community structures. The 2 symptomatic cases reported occurred in non-vaccinated adults. This study was of limited-scope and duration but provides interesting information on the population affected by primary tuberculosis. These results underline the necessity of maintaining a high level of BCG vaccination amongst children and adults in community structures if we wish to lower the prevalence of the disease in France.

[Comparison of cases of isolated pulmonary tuberculosis with cases of other localizations of tuberculosis in the course of an active surveillance (Gironde, 1995-1996)]. / Comparaison des cas de tuberculose pulmonaire isolée aux cas de tuberculose d'autre localisation dans un système de surveillance active (Gironde, 1995-1996).

PURPOSE: Data collected during the years 1995 and 1996 in the course of an epidemiological survey of tuberculosis in Gironde allowed comparison of pulmonary tuberculosis with extrapulmonary localizations, evaluation of the importance of each localization and highlighting of potential risk factors. METHODS: Patients living in Gironde who had evidence of either clinical, radiological or bacteriological expression of tuberculosis were included in the survey. Statistical comparisons were done using either Pearson's Chi 2 or Fisher's exact test. RESULTS: The survey included 292 cases subdivided into 183 cases of pulmonary tuberculosis (63%) and 109 cases in which another localization had been diagnosed (37%). Extrapulmonary localizations that were the most often encountered either alone or in association with pulmonary localization were the following: lymphadenopathy (32%), pleural (28%), genito-urinary (12%) and osteo-articular localizations (7%). The survey showed that patients in whom tuberculosis localization was extra-pulmonary were more frequently under 20 years of age or over 60 years of age (P < 0.04). These patients also presented more often with HIV-infection (P < 0.02). CONCLUSION: Extrapulmonary localizations of tuberculosis should be systematically investigated in young and elderly patients as well as in HIV-infected patients.

[Sequential administration of a reduced dose of almitrine to patients with chronic obstructive bronchopneumopathies. A controlled multicenter study]. / Administration séquentielle d'une posologie réduite d'almitrine à des malades BPCO. Etude multicentrique contrôlée.

Recent multi-centre studies have shown that high doses of Almitrine (100-200 mg per day), lead to a significant improvement in the hypoxaemia of patients presenting with chronic airflow obstruction, but that a high blood level (greater than 500 ng/ml) is often seen after 1 year, sometimes associated with signs of peripheral neuropathy. In order to maintain Almitrine blood levels in the range 200-300 ng/ml we have used an intermittent regime (with a "window" of 1 month every 3 months) and a dose limited to 100 mg per day. 102 hypoxic patients with chronic airflow obstruction, who were in a stable state were included. 65 patients were in the Almitrine group (A) and 37 patients in the placebo group (P). The treatment lasted for 1 year. In addition there was a 3 monthly follow up with arterial blood gases and spirometry, a clinical neurological examination and also electrophysiology, initially and after 6 and 12 months. 43% of patients in group A and 32% of patients in group P, left the study, most often due to poor cooperation, but sometimes as a result of side effects. After 12 months the PaO2 rose significantly in group A from 59.1 +/- 0.7 to 65.8 +/- 1.6 mmHg (p less than 0.001) whilst it was not changed in group P. The PaCO2 did not change in either group. On the other hand there was a significant fall in the subgroup of patients with hypercapnia in group A (p less than 0.001). The outcome of the neurological and electrophysiological assessments did not show any significant difference between the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Dietary vitamin A, beta carotene and risk of epidermoid lung cancer in south-western France.

This hospital-based case-control study was designed to investigate the association of low dietary vitamin A and beta carotene consumption with epidermoid lung cancer. Cases were patients with histologically confirmed epidermoid lung cancer diagnosed in six selected hospitals of southwestern France in 1983-84. Controls were selected from patients admitted to the same hospitals during the same period with diagnoses other than cancer. Cases and controls were matched for sex, age, place of residence, occupation, professional exposure to carcinogens, tobacco and alcohol consumption. A total of 106 cases of epidermoid lung cancer and 212 controls were interviewed on their typical weekly intake of 80 food items rich in preformed vitamin A and beta carotene. Index measures of the vitamin A and beta carotene daily intakes were computed for each individual patient and expressed in retinol equivalent (RE). A statistically significant odds ratio (OR) was found for preformed vitamin A (OR = 4.3; 95% CI: 2.5-7.3) with the threshold of 1,000 RE. A similar result was found for beta carotene with the same threshold (OR = 4.1; 95% CI: 2.3-7.4). Using the conditional logistic regression, consumption of preformed vitamin A and consumption of beta carotene were significantly and independently associated with epidermoid lung cancer. While confirming the protective role of beta carotene against epidermoid lung cancer, this study also shows that preformed vitamin A might have a distinct and important protective effect.

[Epidermoid bronchial cancer induced by radiotherapy]. / Cancer bronchique épidermoïde induit par la radiothérapie.

The occurrence is reported of a bronchial epidermoid cancer appearing 13 years after irradiation for an intra-thoracic paraganglioma. Four criteria are required when considering the carcinogenic effects of radiation: a documented history or irradiation, a latent period of 8 to 20 years, histological evidence of the development of a malign tumor within the irradiated zone and a different histological type from that of the primary tumor. All these criteria are satisfied in this case. The occurrence of post radiation fibrosis and the knowledge of a cancer developing in primary or secondary pulmonary fibrosis are considered in discussing carcinogenesis. Radiation induces fibrous and an oncogenic mutation which by the secretion of certain proteins, notably a growth factor, favours the development of a cancer.

[Mycobacterium szulgai pulmonary mycobacteriosis, Apropos of a new case]. / Mycobactériose pulmonaire à Mycobacterium szulgai. A propos d'un nouveau cas.

A case of pulmonary mycobacteriosis due to Mycobacterium szulgai is reported in a 58-year-old man. Clinical and radiological features suggested tuberculosis. The etiologic agent was M. szulgai which was recovered from six sputum samples. The condition has remained unchanged without therapy for four years.

[Results of a sequential polychemotherapy (adriamycin, vincristine, cyclophosphamide, methotrexate) in small-cell and undifferentiated bronchial cancer]. / Résultats d'une polychimiothérapie séquentielle (adriamycine, vincristine, cyclophosphamide, méthotrexate) à petites cellules et indifférenciés.

40 patients suffering from inoperable bronchial cancer (25 anaplastic cancers, 15 undifferentiated cancers) were treated by a sequential association (Adriamycinee, Vincristine, Cyclophosphamide, Méthotrexate), repeated every 5 weeks. 28 patients already had metastatic cancer. A partial objective response (regression greater than 50%) was observed in 7 undifferentiated cancers and 14 anaplastic cancers. The treatment was interrupted 3 times for digestive and/or hematological toxicity; however, no deaths due to toxicity were reported. The mean survival is 8 months and 5 patients live for more than 18 months. The immediate effectiveness and mean survival place this protocol among polychemotherapies presently considered for this type of cancer. The number of evolutive recoveries observed during the maintenance stage settles the problem of the use of an efficient, slightly toxic and durable chemotherapy.

[Left ventricular function in chronic obstructive lung disease (author's transl)]. / La fonction ventriculaire gauche au cours des bronchopneumopathies chroniques obstructives.

Left ventricular function was studied at rest and during post-extrasystolic potentiation in 18 patients with chronic obstructive lung disease. The contractility indices used were obtained from pressures recorded in the isovolumetric period (left ventricular end-diastolic pressure, Vmax., VECmax., dP/dtmax.) and from volume variations during ejection (end-diastolic volume, ejection fraction, VCF). Left ventricular diastolic compliance was also evaluated. All patients were hypoxic (PaO2 = 58 +/- 7 torr); six of them had cor pulmonale (group B); the remaining 12 patients constituted group A. Left ventricular function of groups A and B was similar; we conclude that right cardiac failure, in cor pulmonale, is not secondary to left ventricular failure. However, left ventricular dysfunction exists; the left ventricle is hypertrophied (probably resulting from chronic hypoxia). Pump function is altered (abnormal ventricular function points are found), but left ventricular kinetics is normal or exaggerated (ejection fraction and VCF are increased). Isovolumetric phase contractility indices are diminished; however, they may increase normally during post-extrasystolic potentiation. Left ventricular compliance is abnormal due to left and right ventricular hypertrophy and to paradoxical movement of the interventricular septum which impedes diastolic expansion of the left ventricle. These changes are responsible for decreased left ventricular output. There seems to exist an impairment of left ventricular function related to both intrinsic (secondary to hypoxia, hypercapnia, left ventricular hypertrophy) and extrinsic factors (right ventricula hypertrophy deviating interventricular septum, lowering of left ventricular preload).