Prevalence of chronic bronchitis and respiratory function in a group of dairy farmers in the French Doubs province.

We used a questionnaire combined with medical history and spirometric studies to compare symptoms and respiratory function in two groups of subjects living in the French province of Doubs. A group of 250 dairy farmers was compared with 250 control subjects, matched with regard to sex, age, height, and smoking habits. The prevalence of acute bronchial infections and dyspnea was identical in the two groups. Among dairy farmers, 30 (12 percent) had chronic bronchitis vs 15 (6 percent) in the control group (p less than 0.05). Chronic bronchitis was more common in patients aged over 40 years (p less than 0.001) and in nonsmokers (p less than 0.001). All respiratory function parameters measured (expressed as a mean percentage of values measured in comparison with theoretic values) were lower in the dairy farmer group than in the control group. With regard to degree of bronchial obstruction, the difference between the two groups was more marked in patients aged 40 years and over and in nonsmokers. Dairy farmers' occupation is a risk factor of chronic bronchitis and bronchial obstruction, in particular in patients aged 40 years and over and in nonsmokers.

Etiologic factors of chronic bronchitis in dairy farmers. Case control study in the Doubs region of France.

Relationships were investigated between chronic bronchitis and plant dust exposure assessed by quantification of barn threshing and cattle foddering and chronic bronchitis and acute respiratory syndromes after plant mold dust exposure. Two groups of male dairy farmers were studied in the Doubs region, France: 197 with chronic bronchitis and 163 control subjects without chronic bronchitis. There was no relationship between chronic bronchitis and exposure. Thirty-three chronic bronchitis patients had semidelayed respiratory syndromes (SDRS) vs two control subjects. Twenty-seven times out of 33 (16 of 17 in the nonsmokers), the SDRS preceded chronic bronchitis. Past history of acute respiratory syndromes during barn threshing (RSBT) was more frequent in chronic bronchitis; RSBT always preceded chronic bronchitis. It is concluded that host factors are important in chronic bronchitis and that acute effects after exposure may be predisposing factors to chronic bronchitis.

Concurrent cisplatin/etoposide chemotherapy plus twice daily thoracic radiotherapy in limited stage small cell lung cancer: a phase II study.

Thirty-one previously untreated patients with limited stage small-cell lung cancer (LSCLC) were included in a prospective study, to investigate the feasability and the efficacy of a combined modality treatment using concurrent hyperfractionated chest irradiation and cisplatin (P) plus etoposide (E) chemotherapy. All patients received intravenously P=75 mg/m(2) at day 1, plus E=120 mg/m(2) days 1-3, at 3-week intervals for six cycles. Irradiated patients received 45 Gy in two daily fractions, 5 days a week, from week 4 to week 6. During week 5, prophylactic cranial irradiation was initiated, in one daily fraction of 2.5 Gy for a total dose of 25 Gy. Twenty-nine patients were evaluable for response. Twenty-two (76%) achieved a complete response, five (17%) had a partial response. Five patients are currently alive. The overall response rate was 93% (CI 95% (83.7-100)). The median survival time was 14 months and the 2-year survival rate was 25%. Main toxicities were grade 3-4 esophagitis in half of the patients and myelosuppression. The results are not as optimistic as other studies using a similar regimen.

Multivariate analysis of factors predictive of brain metastases in localised non-small cell lung carcinoma.

Brain metastases are a frequent feature of the course of non-small cell lung carcinoma (NSCLC). The potential usefulness of prophylactic cranial irradiation (PCI) has led to the search for target groups likely to derive benefit. This multivariate analysis looked for factors predictive of brain metastases in a group of stages I-III NSCLC patients under care of the thoracic oncology unit of Besançon University Hospital from 1977 to 2001. All the patients had the same follow-up. They were divided into two groups: BM+ when they had a brain metastasis as the first site of progression, whether solitary or not, and BM(-) otherwise. Variables analysed were age, gender, performance status (0-1 versus 2-3), weight-loss stage T-status, N-status, pathological type, type of treatment, administration of chemotherapy, use of cisplatin and response to treatment. Three hundred and five patients were eligible and there were 77 patients (25.25%) in the BM+ group. Median time to onset of brain metastases was 12 months (1-163 months) and median survival from the diagnosis of brain metastases was 6 months (1-65 months). Factors predictive of brain progression were age < or =62 years (RR: 2.5, 95% CI: 1.33-4.76 and P = 0.004), T4 tumour status (RR: 3.75, 95% CI: 1.72-8.21 and P = 0.0009), N2-3 (RR: 2.61, 95% CI: 1.32-5.15 and P = 0.0057), and adenocarcinoma (RR: 3.39, 95% CI: 1.78-6.46 and P = 0.0002). No aspect of treatment plays a role in the frequency of this type of metastasis. These factors predictive of brain progression could serve as a basis for the selection of patients with the aim of sitting of studies on prophylactic cranial irradiation in NSCLC.

Predictive factors of death in primary lung cancer patients on admission to the intensive care unit.

OBJECTIVE: To assess the lung cancer patient's prognosis in the intensive care unit with early predictive factors of death. DESIGN: Retrospective study from July 1986 to February 1996. SETTING: Medical intensive care unit at a university hospital. PATIENTS: Fifty-seven patients with primary lung cancer admitted to our medical intensive care unit (MICU). MEASUREMENTS AND RESULTS: Data collection included demographic data (age, sex, underlying diseases, MICU admitting diagnosis) and evaluation of tumor (pathologic subtypes, metastases, lung cancer staging, treatment options). Three indexes were calculated for each patient: Karnofsky performance status, Simplified Acute Physiology Score (SAPS) II, and multisystem organ failure score (ODIN score). Mortality was high in the MICU: 66% of patients died during their MICU stay, and hospital mortality reached 75%. In multivariate analysis, acute pulmonary disease and Karnofsky performance status < 70 were associated with a poor MICU and post-MICU prognosis. For the survivors, long-term survival after MICU discharge depended exclusively on the severity of the lung cancer. CONCLUSIONS: We confirmed the high mortality rate of lung cancer patients admitted to the MICU. Two predictive factors of death in MICU were identified: performance status < 70 and acute pulmonary disease.

Relevance of an intensive postoperative follow-up after surgery for non-small cell lung cancer.

BACKGROUND: Although a minimal follow-up with periodic clinic visits and chest radiographs is usually recommended after complete operation for non-small cell lung cancer, the ideal follow-up has not been defined yet. Objectives of this prospective study were to determine the feasibility of an intensive surveillance program and to analyze its influence on patient survival. METHODS: Follow-up consisted of physical examination and chest roentgenogram every 3 months and fiberoptic bronchoscopy and thoracic computed tomographic scan with sections of the liver and adrenal glands every 6 months. Influence of patient and recurrence characteristics on survival from recurrence was successively analyzed using the log-rank test and a Cox model adjusted for treatment. RESULTS: Among the 192 eligible patients, recurrence developed in 136 patients (71%) and was asymptomatic in 36 patients (26%). In 35 patients, recurrence was asymptomatic and detected by a scheduled procedure: thoracic computed tomographic scan in 10 (28%) patients and fiberoptic bronchoscopy in 10. Fifteen patients (43%) had a thoracic recurrence treated with curative intent. From the date of recurrence, 3-year survival was 13% in all patients and 31% in asymptomatic patients whose recurrence was detected by a scheduled procedure. Asymptomatic recurrences (p < 0.001), female sex (p < 0.001), performance status 2 or less (p = 0.01), and age 61 years or younger (p = 0.01) were shown to be significantly favorable prognostic factors. CONCLUSIONS: This intensive follow-up is feasible and may improve survival by detecting recurrences after surgery for non-small cell lung cancer at an asymptomatic stage.

Respiratory status in dairy farmers in France; cross sectional and longitudinal analyses.

AIMS: To compare respiratory status in dairy farmers with that of non-farming controls. METHODS: Longitudinal study in the Doubs (France). From a cohort constituted in 1994 (T1), 215 (81.1%) dairy farmers and 110 (73.8%) controls were reevaluated in 1999 (T2). The protocol comprised a medical and occupational questionnaire, spirometric tests at both evaluations, allergological tests at T1, and a non-invasive measure of blood oxygen saturation (SpO2) at T2. RESULTS: In 1999 analyses, the prevalence of chronic bronchitis was higher (p = 0.013), and FEV1/VC (p < 0.025) and SpO2 (-0.7%, p < 0.01) lower in dairy farmers than in controls. In a multiple linear regression model, farming, age, and smoking were significantly and inversely correlated with SpO2. In the whole population, the mean annual decline in FEV1 and FEV1/VC was -13.4 ml and -0.30%, respectively. Farming was associated with an accelerated decline in FEV1/VC (p < 0.025) after adjustment for covariates. No relation between allergy and respiratory function changes was observed, except for FEF25-75. CONCLUSIONS: This prospective study shows that dairy farming is associated with an excess of chronic bronchitis, with a moderate degree of bronchial obstruction and a mild decrease in SpO2.

[Prognostic factors of small cell bronchial carcinomas]. / Facteurs pronostiques des carcinomes bronchiques a petites cellules.

Prognostic factors in small cell lung carcinoma have a great importance with regard to the interpretation of treatment results. The main prognostic factors are the extent of the disease, performance status, age and sex. Other factors are discussed.

[Prevalence of immediate allergy to respiratory allergens in fodder farmers in Doubs]. / Prévalence de l'allergie immédiate aux pneumallergènes chez les agriculteurs fourragers du Doubs.

The Doubs is a damp, semi-mountainous fodder farming department in which occupational respiratory diseases (including asthma) are common in farmers. We studied the prevalence of IgE-mediated allergy (total IgE, Phadiatop and skin prick tests) in a group of 265 exclusive dairy farmers of both sexes of the department and in a control group of non exposed, administrative workers living in the same area. Skin prick tests were: Dermatophagoides pteronyssinus, Acarus siro, cat hair, cow danders, grass pollens, betullacea pollens (trees from the East of France), and hay extracts from the Doubs. Total IgE were higher than 180 KUI/l in 26 (9.9%) farmers and in 15 (10.5%) controls (NS). Phadiatop was positive in 41 (15.7%) farmers and in 27 (19%) controls (NS). Prevalence of positive skin prick tests (at least one) in farmers and controls was respectively 36% and 40% (NS). Farmers were more frequently sensitized to hay extracts (OR = 1.7), cow danders (OR = 1.3) and less frequently to cat hair (OR = 0.63) than controls but the differences were not statistically significant. In conclusion, this study fails to give evidence of a risk of IgE-mediated allergy to work-related and other common inhalation allergens in dairy farmers the Doubs.

[Bronchial involvement disclosing Wegener's granulomatosis]. / Atteinte bronchique révélatrice d'une granulomatose de Wegener.

The authors report a case of Wegener's granulomatosis, whose initial manifestation was an isolated endobronchial stenosis. In connection with this observation, it calls to mind, within the scope of the pulmonary granulomas (in view of such a rare clinical presentation) the difficulties of differential diagnosis, in particular with bronchocentric granulomatosis, and stresses the need for pulmonary histological examination to open lung biopsy.

[Symptoms and respiratory function in a group of Gruyère cheese processors in Comté]. / Symptômes et fonction respiratoires dans un groupe d'affineurs de gruyère de Comté.

We have analysed the symptoms and respiratory function of a group of cheese processors making gruyère Comté in relation to a group of controls: 96 male cheese workers (mean age 36 +/- 11.1) and 97 controls who were of the male sex and of comparable age, height, weight and smoking habits. The cheese workers had a lower educational and professional level (p less than 0.01) and had a higher level of alcohol consumption than the controls (p less than 0.05). The prevalence of chronic bronchitis and of dyspnoea in the cheese workers (respectively 13.5 and 23.9%) was not significantly different from that in the controls (10.3 and 35%). 5 cheese workers (5.2%) were suspected of having occupational asthma; 5 (5.2%) were suspected of having hypersensitivity pneumonia (cheese workers' disease): 41 (42.7%) had signs of conjunctivitis during work, of whom 30 occurred only in the hot cellars. The respiratory function parameters measured were identical in the two groups (vital capacity, FEV1, mean expiratory flow at 25% and 75% of vital capacity). In conclusion, evidence of allergic problems (asthma, hypersensitivity pneumonia and conjunctivitis) seems to be frequent in refiners of Comté but the cases identified need to be confirmed; cheese refiners of Comté do not seem to have any particular risks of chronic bronchitis and of alteration of respiratory function.

[Evaluation of the reliability of the diagnostic methods in farmer's lung]. / Evaluation de la fiabilité des moyens de détection de la maladie du poumon de fermier.

Following a study of the diagnosis of farmer's lung (PDF) carried out in 1763 active farm workers in Doubs, 294 (16.7%) were suspected of PDF and they were invited to a secondary consultation in hospital for a further work up which consisted of a clinical examination for crepitations (RC) on pulmonary auscultation (AP) and for evidence of an interstitial lung disorder (SI) on pulmonary radiograph (RP) and for evidence of a restrictive syndrome (SR) on pulmonary function tests (EFR). 238 patients (80%) accepted the additional assessment and were divided into two groups on the basis of the history and serology (precipitin tests), group 1: probable PDF (n = 65): symptoms suggestive of PDF in the presence of serum precipitins; group 2: possible PDF (n = 173): non specific symptoms with or without serum precipitins. RC were present in 21.9% of patients in group 1 and 6.4% of patients in group 2 (p less than 0.001). There was an SI in 9.2% of patients in group 1 and 4% of patients in group 2 (non significant). For the elevated radiology scores for SI there was a significant difference: 7.7% for SI in group 1 and 1.73% in group 2 (p less than 0.05). There was 38.1% of abnormal EFR in group 1 and 14.7% in group 2 (p less than 0.001) but the difference of the frequency of SR in the 2 groups was not statistically significant (9.5% in group 1 and 4.7% in group 2). In this study, an additional assessment (AP, RP, EFR) carried out at a difficult moment during winter does not appear to confirm great benefit.(ABSTRACT TRUNCATED AT 250 WORDS)

[A misleading form of hypersensitivity pneumonitis]. / Une forme trompeuse de pneumopathie d'hypersensibilité.

A 47-year-old woman, without significant past medical history, presented an acute dyspnea with hypoxia, marked pulmonary arterial hypertension (PAH) and signs of right heart failure. Chest x-ray showed a moderate dilatation of the right heart cavities. Pulmonary embolism was suggested. After detailed questioning and complete explorations, a bird hypersensitivity pneumonitis (HP) was demonstrated. This case illustrates a misleading presentation of an acute form of HP consisting of apparently isolated PAH.

[Second line chemotherapy in patients with refractory and resistant non small cell lung cancer]. / Chimiothérapie de deuxième ligne chez les patients réfractaires et résistants atteints de cancers du poumon non à petites cellules.

Effectiveness of chemotherapy has been demonstrated in stage IV non small cell lung cancer as well as in stage IIIb disease when combined with radiotherapy. A significant improvement of both survival and quality of life was shown and is thought to be associated with higher efficiency. Therefore, treatment of relapses is now a question of practical interest. Ninety-seven non small cell lung cancer patients who were delivered a second line chemotherapy following primary chemotherapy alone were reviewed. Sixty-five patients were administered a 2 drug cisplatin-based regimen (with etoposide, bleomycin or vinorelbine). Twenty eight patients received no cisplatin but the cyclophosphamide, epirubicin combination or any 2-drug regimen assembled from the following agents: etoposide, mitomycin, ifosfamide. The last 4 patients were given single-agent vinorelbine. Fifteen objective responses (15.2%) (95% CI: 9-24%) were observed. The median response duration was 27 weeks. Response rates were 18.4% (95% CI 9-28%) and 9.3% (95% CI: 0-19%) in cisplatin-based combinations and in other regimens, respectively. No difference in response rates was observed between primary responsive and non responsive patients but response rates were influenced by the choice of the first line combination chemotherapy.

[Respective influence of occupational and personal factors on respiratory function in dairy farmers]. / Influence respective des facteurs professionnels et personnels sur la fonction respiratoire en milieu agricole de production laitière.

Occupational and individual factors influencing respiratory function were analysed in a sample of dairy farmers. The study protocol included a medical questionnaire, an occupational questionnaire, spirometry and allergological tests (skin prick tests for a panel of inhalant allergens, serum total IgE level and Phadiatop (CAP System). Two hundred and forty-five farmers were studied (140 men, 105 women with an average age of 45.9 (11.3) years, 35 were smokers, 27 ex-smokers and 183 non-smokers). A multiple linear regression model was used to analyse the correlations between respiratory function and the different independent variables. There was a statistically significant negative correlations between smoking (expressed in pack-years) and all the respiratory function parameters (p < 0.01). Respiratory function was significantly impaired in farmers working on traditional farms (p < 0.05 for VC and for FEV1), and the respiratory function values increased proportionally with the modernisation of the farms (notably using an artificial barn drying system for hay and a ventilation system for the cow byres). No significant relationship between respiratory function and quantitative indicators of exposure (size of farm, amount of livestock, quantity of hay handled during professional lifetime) or indicators of IgE-mediated allergy was observed. In conclusion, this study suggests that traditional work conditions in farms which have little mechanisation are, along with tobacco, the determining factors for the respiratory function impairment in dairy farmers.

[Non-small-cell bronchial cancers: long-term survival after single drug chemotherapy with vinorelbine]. / Cancers bronchiques non à petites cellules: étude des longues survies après monochimiothérapie par Vinorelbine.

We studied a cohort of 120 patients with inoperable non-small-cell lung cancer treated with vinorelbin at the dose of 25-30 mg/m2/week in a single drug chemotherapy regimen. Surgery was contraindicated due to staging or to concomitant morbidity. Twenty patients survived 18 months or more. One survivor responded exceptionally, surviving 120 months. The mean dose intensity of Vinorelbine in long-term survivors was 21 mg/m2/week. Objective response was found at multivariate analysis to be a prognostic factor for survival beyond 18 months. Weight loss (< 5 kg) was an unfavorable prognostic factor in patients with metastases.

[Initial radiological images of primary bronchogenic cancer. A study of standard film in 250 consecutive cases]. / Les images radiologiques initiales du cancer bronchique primitif. Etude du cliché standard de 250 cas consécutifs.

The advent of fibroscopy, between 1865 and 1970, has made it possible to extend endoscopic exploration to high risk subjects, irrespective of their radiological image. We studied the initial radiological images observed on the standard film of 250 consecutive patients and compared these images with those observed and published by Emerson, Bariety and the Mayo Clinic 1970. The frequency of hilar mass (38%), peripheral tumours more than 4 cm in diameter (16%) and such pulmonary alterations as atelectasis or non-specific pneumonia (23.6%) has remained unchanged during the last decades. Similarly, the frequency of lung carcinomas discovered before they produced a radiological image is still low (2.8%).

[Bilateral purulent pleurisy and spontaneous rupture of the esophagus (Boerhaave's syndrome). Apropos of a case]. / Pleurésie purulente bilatérale et rupture spontanée de l'oesophage (syndrome de Boerhaave). A propos d'un cas.

The authors report a case of bilateral purulent pleurisy consecutive to spontaneous rupture of the oesophagus (Boerhaave's syndrome). In such cases Mackler's triad, when complete, confirms the diagnosis. Standard radiography of the chest remains essential as it shows, at an early stage, the presence of mediastinal emphysema.