[Pleural involvement and functional effect of asbestosis in 380 exposed patients]. / Atteintes pleurales et retentissement fonctionnel de l'asbestose chez 380 sujets exposés.

A large number of pleural abnormalities was detected by radiological and functional monitoring of 380 persons (mean age: 47 years) working in an asbestos processing factory. There were 127 cases of parietal pleura thickening (after 22 1/2 years' exposure), 11 cases of pleural calcifications (after 26 years' exposure) and 29 cases of obliteration of the costophrenic angle. Fourteen images of pulmonary asbestosis were encountered, 7 of which were associated with pleural effusion; they occurred at a mean age of 50 years, after 22 years' exposure. Pleural lesions had a restrictive influence on respiratory function in 24% of the cases and were sometimes painful. Small airway obstruction was detected by flow-volume loops in 9% non-smokers with pleural thickening, which suggests that intra-radiological lung lesions exist in asbestosis.

[Respiratory manifestations of ankylosing spondylitis (50 cases)]. / Manifestations respiratoires de la spondylarthrite ankylosante (50 observations).

Fifty patients with ankylosing spondylitis underwent radiography of the chest. In addition, 2 of them had bronchography, 3 had computerized tomography (CT) of the chest, 9 had respiratory function tests and 8 head ventilation/perfusion study by the Xenon method. Seven thoracic images were questionably specific of spondylitis, showing plural symphysis, strips of atelectasis, pleural thickening, apical pulmonary sclerosis and opacities of the diaphragmatic hilum. CT proved valuable in 1 case to confirm pulmonary fibrosis and in 2 cases to reveal that pleural thickening was continuous with an opacity ensheathing the vertebral body. In 7 out of 9 cases the functional restrictive deficit was accompanied by normal or supranormal functional residual capacity and increased residual volume. In all patients explored by the Xenon method, there was apical-caudal inversion of the ventilation/perfusion ratio. These findings suggest 3 pathogenic hypotheses: mere sequelae of hypoventilation, specific lung tissue fibrosis, extension by continuity of the vertebra-ensheathing process to the subpleural spaces.

[Prognostic value, at the onset of an asthma attack, of respiratory, hemodynamic, and acid-base equilibrium parameters]. / Valeur pronostique, au début d'une crise d'asthme, des paramètres respiratoires, hémodynamiques, et de l'équilibre acido-basique.

Sudden death is still a common complication of acute asthma. The authors analysed statistically the prognostic value of the respiratory rate (RR), the heart rate (HR), blood gases, systolic blood pressure (BP syst), and diastolic pressure (BP diast) and the amplitude of the P wave in lead II on the ECG, recorded at the beginning of the asthma attack. This retrospective study concerns two groups of patients distinguished on the basis of the severity of the attack (group I: simple retrospective study concerns two groups of patients distinguished on the basis of the severity of the attack (group I: simple attack; group II; status asthmaticus). A HR greater than 24 per minute, a P wave greater than or equal to 2.5 mm or a PaCO2 greater than or equal to 6.3 kPa (47.25 mmHg) are three highly sensitive and specific criteria of the evolution of the asthma attack towards a more severe form (status asthmaticus). Patients who present one or more of these parameters should be monitored in a respiratory intensive care unit in order to prevent avoidable sudden death.

[Haemophilus influenzae in respiratory pathology in adults]. / Haemophilus influenzae en pathologie respiratoire chez l'adulte.

Fifty patients were diagnosed bronchopulmonary Haemophilus infections, because of the production of a purulent sputum, containing at least 10(8) Haemophilus influenzae per ml. Among them were 36 males (average 52 years old) and 14 females (average 58 years old). There was a high percentage (64%) of smokers (over 30 packs/year) within this population, which also included heavy drinkers. The top incidence occurred in winter and spring. Most cases were related to an acute infection in a chronic bronchitis (26 cases). The other cases included 6 cancers, 6 sequelae of tuberculosis, 4 bronchiectasis, 4 asthma, and only 3 pulmonary consolidations. There usually was a low grade fever (only 8 cases reached or went beyond 38 degrees, while in 29 cases the body temperature kept below 38 degrees). The return to a normal temperature was obtained after 4 to 10 days of ampicillin therapy, with no fatal case within this series. The 50 strains were studied by the microbiology laboratory. The minimum inhibitory concentrations showed a peculiar response to ampicillin and erythromycin, and a less dramatic response to chloramphenicol and tetracyclin. Some strains were proved resistant (MIC over 4 micrograms per ml) to cefoxitine and cefamandole.

[Haemophilus influenzae in respiratory pathology in adults]. / Haemophilus influenzae en pathologie respiratoire chez l'adulte.

Fifty patients were diagnosed bronchopulmonary Haemophilus infections, because of the production of a purulent sputum, containing at least 10(8) Haemophilus influenzae per ml. Among them were 36 males (average 52 years old) and 14 females (average 58 years old). There was a high percentage (64%) of smokers (over 30 packs/year) within this population, which also included heavy drinkers. The top incidence occurred in winter and spring. Most cases were related to an acute infection in a chronic bronchitis (26 cases). The other cases included 6 cancers, 6 sequelae of tuberculosis, 4 bronchiectasis, 4 asthma, and only 3 pulmonary consolidations. There usually was a low grade fever (only 8 cases reached or went beyond 38 degrees, while in 29 cases the body temperature kept below 38 degrees). The return to a normal temperature was obtained after 4 to 10 days of ampicillin therapy, with no fatal case within this series. The 50 strains were studied by the microbiology laboratory. The minimum inhibitory concentrations showed an elective response to ampicillin and erythromycin, and a less dramatic response to chloramphenicol and tetracyclin. Some strains were proved resistant (MIC over 4 micrograms per ml) to cefoxitin and cefamandole.

[Relation between the HLA system and the development of asbestosis fibrosis in a group of workers exposed to asbestos]. / Etude des relations entre le système HLA et l'apparition d'une fibrose asbestosique dans un groupe de travailleurs exposés à l'aminate.

The various studies which have dealt up to the present with a possible relationship between asbestosis and HLA groups have led to differing conclusions. The present study evaluated this relationship by comparison of 57 workers with asbestosis confirmed radiologically (minimum S1 type opacities) and functionally (VC and/or DuaCO less than 88%) with 58 controls from the same population. In a second phase, statistical analysis involved the combination of these cases with those reported in the literature, estimating the mean relative risk and, for each gene, the heterogeneity of the results thus collected. No relation was found between class I (A and B) HLA antigens and asbestosis. The authors suggest extension of this study to class II (DR) and III (components of complement) antigens and to seek possible links between combinations of antigens and the development of asbestosis.

[Mode of action and results of home assisted ventilation. Study by the Association of Aid to Respiratory Insufficient Patients of Basse-Normandie from 1976 to 1978 (author's transl)]. / Modalités d'action et résultats de la ventilation assistée à domicile. Expérience de l'Association d'Aide aux Insuffisants Respiratoires de Basse-Normandie de 1976 à 1978.

Since 1970, 168 patients, mostly of the obstructive type, received an apparatus of assisted ventilation at home, according to the degree of their hypoxia-hypercapnia, following one or several acute failures. Oral ventilation, at a daily minimum of 90 min, distributed in 4 to 8 sessions, was continued for variable duration, from 1 to 5 years. The results, analysed statistically for 40 subjects, show a blood-gas improvement greater in patients whose PaO2, PaCO2 and RV/TC ratio were initially lower. For 17 patients controlled before and after assisted ventilation at home, a reduction in the number of days of hospitalization and acute failures was observed. The cost involved was particulary economical because of the simplicity of the equipment and the possibilities of control of patients and apparatus at the C.H.U. (20 F monthly in 1977 for 145 selected patients).

[The relevance of chest X-rays and respiratory function tests to the assessment of occupational hazards in asbestos factory workers (author's transl)]. / Expertise de dossiers d'ouvriers d'une filature d'amiante. Place de la radiographie et de l'exploration fonctionnelle (70 cas).

The authors have analyzed the medico-legal records of 70 workers from an asbestos factory, who developed pneumoconiosis, sometimes after prolonged exposure. X-ray films were interpreted (though not without some difficulty) according to the I.L.O. classification criteria. Respiratory function tests included spirometry, gas exchange determination and blood gas measurements. There was a correlation between the duration of occupational exposure and the onset of chest lesions visible on X-ray films (pleural thickening, pulmonary fibrosis and later, pleural calcifications) and a closer correlation between these and the results of the two main respiratory function tests: vital capacity and fractional global and arterio-alveolar CO uptake coefficient (DuaCO). It appeared, however, that lung function impairment sometimes preceded radiological abnormalities, and this should be taken into consideration when assessing the financial compensation due to workers exposed to asbestos.

[Pulmonary alveolar proteinosis: eleven-year follow-up in one case (author's transl)]. / La protéinose alvéolaire. A propos d'un cas suivi depuis onze ans.

A case of pulmonary alveolar proteinosis followed-up for eleven years is presented and this poorly recognised affection discussed. It is a rare disease arising from filling of the alveoli by a non-surface-acting surfactant, either as a response to a non-specific aggression, experimentally reproducible, or spontaneously. The mechanism by which this accumulation occurs is still a controversial subject: increased production by the granular pneumocytes, deficiency of alveolar clearance, or loss of phagocytic activity of alveolar macrophages. The diagnosis, suggested by the only slightly specific clinical picture after elimination of more common aetiologies, is confirmed by electron microscopy of alveolar lavage fluid without, as in the past, the need for lung biopsy. The various treatments proposed have lacked efficacy and are not really necessary, except for symptomatic extensive pulmonary lavage, which should be reserved for severe cases and may need to be repeated.

[Comparison of data of respiratory function tests and pulmonary radiology images. Apropos of 106 subjects exposed to asbestos]. / Comparaison entre les données de l'exploration fonctionnelle respiratoire et les images radiologiques pulmonaires. A propos de 106 sujets exposés a l'amiante.

We have compared X-ray and lung function data in 106 asbestos workers with diverse, yet most often prolonged and important, exposure times. Based on the international B.I.T. classification, we have found a significant link between VC and type, density, opacity extent and presence of pleural thickening. The same relationship is found with alveolo-arterial ductance. On the whole, however, it is difficult to determine lung function condition with X-ray. Thus, certain criteria concerning function should be considered as well as radiography.