[The candidacy and reception of Nancy]. / La candidature et l'accueil de Nancy.

As soon as the peace treaty terms were known (1871), Nancy purposed to shelter the Strasbourg Faculte de Medecine. Nevertheless, many people thought that Lyon would be more suitable for the transfer. Then, the final wars settled by Thiers (President de la Republique) was a political one showing his will to found, close to the new border line, a scientific centre which would include the Strasbourg Faculte de Medecine transferred into Nancy.

Expiratory capnography in asthma: evaluation of various shape indices.

The shape of the capnogram is modified by airway obstruction, and the evaluation of this deformation, using measurable indices, could allow an indirect measurement of bronchial patency. A previous study undertaken in asthmatic subjects showed a good correlation between a capnographic index (end-tidal slope) and a spirometric parameter (forced expiratory volume in one second as a percentage of predicted (FEV1 %pred)) and suggested the study of other indices. The correlations between capnographic and spirometric indices were measured in 10 healthy subjects and 30 asthmatic patients. The usefulness of eight descriptive indices, analysing the successive phases of the capnogram, was assessed by measuring their reproducibility and their sensitivity to airway obstruction. The intraindividual and interindividual variabilities (Vi and VI) and the noise/signal ratio (Vi/VI) were measured by comparing the results of two successive capnographic measurements in 14 asthmatic subjects. The results show an increasing noise/signal ratio along the expiration (between 23 and 62%). Significant correlations between spirometry and capnography were found with all indices, but the strongest were observed with indices analysing the intermediate phase of the capnogram, that is the angle between the ascending phase (E2) and the alveolar plateau (E3). The correlations show that the analysis of the capnogram's shape is a quantitative method for evaluating the severity of bronchospasm. This ability, added to specific advantages (noninvasiveness, effort-independency, measurements during tidal breathing) opens new fields of application to capnography, such as measurement of bronchospasm in children and computerized monitoring of asthma.

[Expiratory capnography in asthma. Perspectives in the use and monitoring in children]. / La capnographie expiratoire dans l'asthme. Perspectives d'utilisation chez l'enfant et comme méthode de monitorage.

The shape of the capnogram, which is related to uneven ventilation, is modified in obstructive diseases and especially during crisis of asthma. The most significant change is a rise in the slope of the "alveolar plateau". In this study, we measured the end-tidal slope (ETS) of the capnogram, calculated on 0.36 s before the end of expiration, and we compared this indice to usual spirometric measurements (FEV 1) in 21 control subjects and in 24 asthmatic subjects. The mean ETS in control subject was 0.08 +/- 0.06%/s, it was 0.3 +/- 0.23% in asthmatic subjects (p < 0.001). In the latter, we found a very significant correlation between ETS and FEV 1 (r = 0.83, p < 0.001). Thirteen asthmatic subjects were tested for a second time, immediately after inhalation of a beta 2-mimetic drug. They exhibit a very strong correlation between the rise of FEV 1 and the loss of ETS (r = 0.96, p < 0.001). These results show that the analysis of the capnogram's shape is a quantitative method for evaluating the severity of the bronchospasm. This ability, added to specific advantages (non-invasiveness, effort-independence) opens new fields of application to capnography: measurement of the bronchospasm in children, computerized monitoring of asthma.

Anaphylactic shock induced by paracetamol.

A 46 year old woman had adverse reactions to paracetamol. Oral challenge tests with the drug showed that the reactions were dose-dependent and they reproduced similar symptoms consisting of vomiting, diarrhoea, pruritus, skin rashes, facial oedema, dyspnoea and hypotension. There was a marked increase in blood histamine but the complement components C3 and C4 remained at normal levels. Treatment with epinephrine and moderate doses of betamethasone brought fast recovery without any further complication.

Comparative evaluation of RAST and FAST for 11 allergens in 288 patients.

The specific IgE levels for 11 allergens were compared in 288 patients by means of the Phadebas RAST and the IgE-FAST. Agreement (less than 1 class difference) was observed in 78.7% of the cases. The best agreement was observed with Phleum pratense, egg white, corn, Betula verrucosa and cat epithelium. In 91 cases the results were retrospectively compared with clinical data and skin tests. When RAST and FAST differed (n = 31) 93.5% and 51.6% of the respective results were in agreement with the skin test. When RAST and FAST were similar (n = 60) 81.7% and 80.0% of the respective results were in agreement with the skin test. It was concluded that the RAST and the FAST gave similar results in most cases but that the RAST was more sensitive than the FAST, especially when the results obtained with both methods differed.

French multicentre double-blind study to evaluate the efficacy and safety of acrivastine as compared with terfenadine in seasonal allergic rhinitis.

In this double-blind, multicentre study the antihistamine acrivastine was compared with terfenadine for the treatment of seasonal allergic rhinitis. The study was divided into three periods which together lasted 56 days. Patients (n = 83) were randomly assigned treatment with either 8 mg acrivastine three times daily or 60 mg terfenadine twice daily. Both agents were equally efficacious in reducing the severity of sneezing, itchy nose, blocked nose, running nose, itchy eyes, watery eyes and itchy throat as recorded daily by patients, and as rated by both the patients and their physicians at the end of each treatment period. Acrivastine and terfenadine were equally well tolerated with no serious side-effects. Both effectively controlled the symptoms of seasonal allergic rhinitis in otherwise healthy individuals.

[Catamenial hemoptysis caused by bronchopulmonary endometriosis]. / Hémoptysie cataméniale par endométriose broncho-pulmonaire.

The thoracic localization of endometriosis may involve the pulmonary pleura and the diaphragm, or the bronchopulmonary parenchyma, according to mechanisms which appear to be quite different. The principal clinical manifestations express themselves depending on their localization, a pneumothorax in the first case and hemoptysis in the second. One clinical characteristic, however, applies to them all, a rhythm strictly related to periods. The current methods of visualization of the pleura enable a macroscopic diagnosis to occur in the former cases in 64% and the body scanner now localizes the second in all cases. Treatment by Danatrol is often strikingly effective in a few months, notably in the cases with parenchymal localization.

[Acute use of adrenergic drugs in asthma and anaphylactic shock in clinical practice]. / Usage aigu des médicaments adrénergiques dans l'asthme et le choc anaphylactique en pratique médicale.

There are two situations where these products may be used and their justifications are quite different. For anaphylactic shock, the treatment should be aimed at limiting the effects of the acute reduction of volume due to vasoplegia and peripheral diapesis provoked by the liberated histamine. The medullary-suprarenal hormones are the first recourse, efficacious on the alpha and beta receptors. The alpha action is of the excitative type and provokes peripheral vasoconstriction. The beta-action suppresses the contraction of the smooth muscle, but in isolation can facilitate vasodilation. This is why adrenalin is suitable for strict control of arterial pressure: Immediate administration in IM (0.25 to 1 mg), by slow I.V. (dilution 1/10) It is appropriate, where possible to restore the blood volume with a volume expander. Cortico-therapy, both general and by aerosol is used in relays. For asthma: The question is, whether to use beta-2-agonists that have an action on muscle relaxation, on mucosal oedema, also on the secretion of mucus and indirectly on liberation of intermediate substances. Acute use of beta-2-agonists is: Perhaps for a specific purpose, for example to prevent effort-induced asthma: use of a spray is simple and efficacious. Perhaps for a greater and more prolonged use to treat an attack of asthma or a bad state of asthma before hospitalisation.(ABSTRACT TRUNCATED AT 250 WORDS)

[Occurrence of IgE-dependent food allergy in asthmatic disease]. / Incidence de l'allergie alimentaire IgE-dépendante dans la maladie asthmatique.

The incidence of food allergy has been evaluated in 67 asthmatic patients (allergic asthma: 52, intrinsic asthma: 15). History was positive for post-meals attacks (7), symptoms involving other target organs (61%). Prick tests were found positive in 17/60; intradermal 77/682. Out of 110 human basophil degranulation tests or RAST, performed in 44 patients, 21/15 patients were found positive. Out of 18 inhalation challenges, 7 were positive. Out of 17 food oral challenges, 6 were positive (8 patients). A definite diagnosis of food allergy was accepted for 9 patients. Elimination diet, with 600 mg/day of cromolyn, induced a major improvement in 7 patients within 3 months, with 2 further failures after 1 year. A successful elimination diet was correlated with a positive food challenge. The relative incidence of food allergy in asthmatic adults is discussed (5.8%), as well as a non-immunologic mediated intolerance to food additives in intrinsic asthmatics, the incidence of vegetable allergies in pollen-sensitive patients, the procedures and meaning of inhalation and oral challenges, the relative importance of trophallergens. Food allergy appears to be a variable co-factor in bronchial hyperreactivity.

[Epidemiologic study of atopic environment in Lorraine]. / Etude épidémiologique du terrain atopique en Lorraine.

An epidemiology study on atopy was performed in a Center of Preventive Medicine, in 505 children aged from 4 to 14 years old, in good health, in consultation with their parents. The clinical atopy was evaluated by a questionnaire inquiring about atopic dermatitis, hay fever, infantile asthma, previous recurrent infections, breast or bottle feeding. Total serum IgE were dosed (Phadezym) and pricks performed to mites and pollens. The clinical atopy is diagnosed in 14.46% of cases (atopic dermatitis: 10.28%--asthma: 3.76%--hay fever: 2/98%). Pricks are positive in 14.85% of cases (mites: 11.48%--pollen: 99.11%--both: 5.74%). The cutaneous sensibility is observed in 32.8% of cases with clinical atopy, 12.5% of other children. The total IgE are very variable and does not correlate with a normal distribution. This allows definition of the quartile below which 90% of the sample is to be found: 474 kUI/l. There is a highly significant relation (p 0.001) between clinical atopy and positive pricks to airborne allergens, clinical atopy and raised alone 474 kUI/l, positive pricks and IgE of more than 474 kUI/l. There is a close relation between atopy and recurrent infections, raised IgE in children and paternal atopy, specific IgE in children and maternal atopy. It appears also that breast feeding is a risk factor for raised IgE in children when the mothers are not atopic, which is somewhat unexpected. Investigation of an atopic terrain may be performed through skin tests or an assay of seric IgE, which seem to be closely comparable.

Autonomic dysfunction in perennial vasomotor rhinitis and the effect of mequitazine.

Thirty patients with perennial vasomotor rhinitis were submitted to pharmacological tests to assess the autonomic responsiveness of extra-nasal and intra-nasal receptors to isoprenaline and phenylephrine by infusion, and to evaluate the effect of 14-days' treatment with mequitazine (5 mg twice daily) and placebo on clinical symptoms and on autonomic sensitivity. Isoprenaline induced a similar tachycardia in all patients, more pronounced than that observed in normal subjects, at the different times of testing, and also an increase in nasal resistance. With phenylephrine, marked bradycardia was observed, reflecting high vagal baroreflex sensitivity, and a transient decrease in nasal resistance was obtained. Mequitazine improved significantly the clinical symptoms but did not modify the autonomic receptivity. It is suggested that in patients with vasomotor rhinitis an autonomic dysfunction may play a role in a predisposing factor in nasal hyperreactivity with non-specific histamine release.

Vagal sensitivity in intrinsic and allergic asthma.

In 20 intrinsic and 25 allergic asthmatic patients with active disease, vagal baroreflex sensitivity was assessed by use of the phenylephrine test, and vagal blockade effects on airways were measured by the response to intravenous atropine. For a given phenylephrine-induced increase in blood pressure, bradycardia was more marked in patients with intrinsic asthma than in those with allergic asthma. Intravenous atropine caused a similar spirometric improvement in both groups. It is suggested that: 1) an inverse relationship exists between vagal sensitivity and the allergic state in asthma; 2) antigenic related stimulation modulated by a low vagal tone and non-antigenic related stimuli with high tone modulation result in similar cholinergic discharges.