Itraconazole in the treatment of aspergillosis: a study of 16 cases.

Itraconazole, a new triazole antifungal agent, has marked in vitro activity against filamentous fungi, particularly Aspergillus. We studied three groups of patients suffering from aspergillosis (16 cases): six affected with aspergilloma, three with allergic bronchopulmonary aspergillosis and seven with invasive aspergillosis. The survey consisted in clinical, radiological, mycological and serological evaluations with respect to drug plasma levels. Itraconazole was given at a dosage of 200-400 mg day-1 for periods ranging from 14 to 488 days. Out of the 16 patients, nine responded to therapy (recovery or improvement) and one failed to respond. Three patients improved but experienced relapses and three others could not be evaluated because of liver function disorders, so that treatment had to be stopped prematurely.

[Passive smoking respiratory risk. A quantitative synthesis of the literature]. / Tabagisme passif et risque respiratoire. Une synthèse quantitative de la littérature.

Fifty nine scientific papers had been published in english or french literature, by 1988, on the matter of respiratory health effects of environmental tobacco smoke exposure (ETS). Fifteen dealt with lung cancer. An original meta-analytical approach was used in order to assess the consistency of these results, where the quality of the papers contributes to the weighing scheme, along with the traditional precision parameters. Lung cancer studies converge towards a point estimate of the relative risk (RR) near 1.5, contrasting non smokers exposed during a long time to ETS (mostly at home) and non exposed non smokers (95% confidence interval = 1.3-1.6). Important methodological difficulties did not allow, to date, to show consistent dose-effect relationship with duration or intensity of exposure. Chronic infections of lower respiratory tract related to ETS have been frequently observed (RR = 1.3; 1.2-1.4) as well among adults as among children. Wheezing and asthma are likewise more frequent among children exposed to ETS at home (RR = 1.2; 1.1-1.4). A modest, although statistically significant decrease of Forced Expiratory Volume at One Second is associated with passive smoking among children (mean effect = -0.5%). Health risk related to passive smoking are much lower than those caused by active smoking. However, this hazard should not be underlooked, since ETS is universally present in everyday life and since anyone may be exposed, including children, the elderly and those who suffer from chronic respiratory diseases. Many research needs are underscored by this meta-analysis. It remains that the current state of knowledge on health risks associated with passive smoking warrants that strong preventive action, educative or statutory, be promoted.

[Clinical trial of an antipneumococcal vaccine in elderly subjects living in institutions]. / Essai clinique du vaccin antipneumococcique chez des personnes âgées vivant en institution.

Pneumococcal vaccine effectiveness was assessed in a randomized trial among 1,686 old people (mean age: 74, standard deviation: 4 years) living in 24 geriatric hospitals and 26 homes for the aged in our district; 937 were vaccinated with Merck-Sharp and Dohme pneumococcal vaccine (14 serotypes). The 749 others composed the reference group. This study was performed during 2 years, since December 1980. Both groups were randomized after a two-criteria stratification: by clinical risk assessed before the study, and by type of homes for the aged. Forty pneumonias were diagnosed, with 13 proved pneumococcal etiology. The incidence of pneumonia was significantly reduced in the vaccinated group (p less than 10(-4) but the mortality rate was not modified. We concluded in favor of the effectiveness of pneumococcal vaccine: etiological fraction 77.1% (51.2%-89.3% confidence limits, 95% risk) in the population we studied. The incidence of pneumococcal-proved pneumonia was not significantly reduced.

[Diagnostic radiology in mediastinal disorders : technical progress and current strategy (author's transl)]. / Le diagnostic radiologique des affections du médiastin evolution technique et stratégie actuelle.

After a brief reminder of recent progress in radiological methods in the diagnosis of mediastinal disorders, the authors study the contribution of Computerised Axial Tomography (T.D.M.). The advantages of T.D.M. in mediastinal disease rest on two characteristics : the morphological study of the mediastinum is made easier by the display of transverse axial cuts with nothing superimposed; the density measurements can distinguish between opacities which would appear similar on conventional radiology. Three facts have been established by the authors : T.D.M. raises the diagnostic sensitivity of radiology; in distinguishing between fatty, watery, vascular and solid tumours, it increases aetiological specificity; it simplifies the diagnostic approach while increasing the efficiency of radiology and the importance of its role in therapeutic decisions. In a typical case where one has just discovered an abnormal mediastinal opacity (and in whom a gastro-intestinal primary has been excluded), T.D.M. should be the first examination after standard radiography, because its results determine the remaining investigation. T.D.M. is specially indicated in evaluating a myasthenic or when investigating an anomaly in the infero-posterior mediastinum. A few cases do not entirely fit in to this schema, because of a particular clinical or radiological situation such as : mediastinal adenopathy; the assessement of the extent of a bronchogenic carcinoma; anterior cardio-phrenic opacities. The examination of the hila again has its limits when the abnormal opacity is small as there are errors in the technique due to the effects of incomplete volume. Finally, there remains the improved cost-effectiveness of the radiological examination of the mediastinum with the rational use of T.D.M.

[Mediastino-pulmonary sarcoidosis in Ivory Coast. Epidemiological and clinical significance of sixteen new cases observed in Abidjan (author's transl)]. / La sarcoidose mediastino-pulmonaire en Côte-d'Ivoire. Intérêt épidémiologique et clinique de seize nouveaux cas observés à Abidjan.

Sixteen cases of mediastion-pulmonary sarcoïdosis are reported, half of them presenting extra-thoracic associated lesions. The clinical and epidemiological study of these cases, compared to the previously published ones, demonstrates that the clinical features are similar in Africans and Black Americans and that the disease in coming out in Africa South of the Sahara.

[Tuberculosis in tropical Africa. Tuberculosis primary infection: some clinical aspects in tropical Africa]. / La tuberculose en Afrique tropicale. La primo-infection tuberculeuse. Quelques aspe,ts cliniques en milieu tropical africain.

A review of 140 cases of tuberculous patent primary infections from the hospital of Abidjan University and from an antituberculous unit. The disease begins slowly, general condition is rapidly altered, ventilation troubles are very frequent and so are complications as meningitis and miliary dissemination. In 11,4 p. cent of the cases, measles occurred before the primo-infection. In 38 p. cent of the cases the source of contamination could be identified and in one out of two cases, the mother proved to be responsible for it.

[Effect of atypical mycobacteria infections on BCG immunization in man (author's transl)]. / Effet des infections occultes par des mycobactéries atypiques sur l'hypersensibilité retardée à la tuberculine.

The influence of atypical mycobacteria infections on BCG responses was studied in 1,038 schoolchildren. A comparaison of the sizes of the scars and a study of control tuberculin tests 10 weeks later confirm the experimental results and suggest that there is a protective effect against tuberculosis induced by atypical mycobacteria.

[Value of the measurement of ventilatory and circulatory components in CO2 ductance]. / Intérêt de la mesure des composantes ventilatoire et circulatoire de la ductance au CO2

Authors bring forth the results of the determination of CO2 ductances in 28 patients : 14 cases of pulmonary arterial thrombosis, 7 cases of diffuse interstitial fibrosis recognizing various etiologies, 4 cases of endothoracic sarcoidosis and 3 cases of pure restrictive syndrome due to functional amputation of some territories. The global CO2 ductance is lowered in 24 cases. In each one of these cases the PACO2 determination makes possible to decompose the global ductance into a ventilatory ductance and a circulatory ductance. The circulatory ductance is lowered in the case of pulmonary arterial thrombosis; the ventilatory component is lowered in the case of restrictive syndromes and in the case of diffuse interstitial fibrosis. For what concerns the pulmonary arterial thrombosis, authors discuss then the value of the information contained in the expression of the CO2 arterial-alveolar gradient on the one hand, and in the circulatory component of the ductance on the other hand. At last, the determination of the ductances appears interesting in the supervision of the course of various diseases.