Symptoms and serum precipitins in workers exposed to dry sausage mould: consequences of exposure to sausage mould.

OBJECTIVE: Hypersensitivity pneumonitis due to dry sausage mould has been reported in workers who brush off the excess mould which coats dry sausage. Prevalence of symptoms and sensitization to mould among these pork-butchery workers is unknown. The aim of the study was to assess the clinical, radiographic, functional, and immunological features in exposed and non-exposed workers in semi-industrial pork butcheries. PATIENTS AND METHODS: Symptoms, and serum precipitins against mould extracts, were studied in workers in semi-industrial pork butcheries. Of 600 workers asked to participate, 123 (20.5%) were included. Fifty-nine workers, exposed to dry (raw) sausage mould and Penicillium nalgiovense were compared with 64 non-exposed subjects, for symptoms, chest X-rays, spirometry and CO-transfer measurements. Precipitating antibodies were detected by immunoelectrophoresis and electrosyneresis. RESULTS: Sneezing, cough, dyspnoea, nasal obstruction, headache, and discomfort were significantly more frequent in the exposed group at work and after work than in the control group (P < 0.05). The prevalence of precipitating antibodies for sausage mould was higher in the exposed group (37%) than in the non-exposed group (9%) (P < 0.01). The mean number of precipitating lines measured by electrosyneresis was higher in exposed workers than in non-exposed workers for mould extract (1.09 vs 0.28, P < 0.05) and for Penicillium nalgiovense (1.77 vs 0.33, P < 0.05). No specific X-ray opacity or lung function impairment was found in either group. CONCLUSIONS: Clinical symptoms and sensitization to Penicillium nalgiovense are frequent among workers exposed to mould during brushing in dry sausage plants.

Rupture of the airways after blunt chest trauma in two children.

Rupture of the airways after blunt chest trauma is exceptional in children. Two recent cases are reported, in a 3-year-old boy and in a 12-year-old girl. Both had longitudinal tears, of the trachea for Patient 1, and of the main left bronchus for Patient 2 with many associated lesions for this patient. Diagnosis of rupture of the airways must always be referred to the mechanisms of the accident. Bronchoscopy is mandatory, in order to define the lesions, and to guide the treatment. Immediate surgery is not always necessary if the chest roentgenogram demonstrates a good reexpansion, with a well tolerated and decreasing air leakage. Even in case of a delayed surgery, it is possible to perform a local reconstruction.

[Treatment of community-acquired pneumonia by pristinamycin (Pyostacine 500). Results of a non comparative open study]. / Traitement des pneumopathies communautaires par la pristinamycine (Pyostacine 500). Résultat d'une étude ouverte non comparative.

UNLABELLED: Activity of natural streptogramin (NSG) appears well adapted to pathogens responsible for CAP. The goal of this multicenter pilot study was to bring first data about efficacy of NSG in treatment of CAP. PATIENTS METHOD: Ten days of a NSG (1 gr b.i.d. or t.i.d.) regimen was administered to 46 hospitalized adult patients for CAP defined with fever > 38 degrees C, respiratory symptoms and X-ray opacity. Severely ill patients were excluded. A broncho-pulmonar sample (expectoration or trantracheal aspiration or protected distal sample) was performed in all patients. RESULTS: two patients were excluded because of pulmonary embolism (n = 1) or tuberculosis (n = 1) and 44 patients were analyzed. 50% of them had associated disease, 20% had failure of prior antibiotherapy. At inclusion, mean fever was 39.2 +/- 0.7 degrees C, respiratory rate was 22 +/- 5/mn, PaO2 was 74 +/- 10 mmHg, chest X-ray showed bilateral opacity in 16%, unilateral in 84% and pleural fluid level in 6 cases. Etiological diagnosis was determined in 70% of cases. Streptococcus pneumoniae (n = 14), Haemophilus influenzae (n = 5), Legionella pneumophila (n = 2), Mycoplasma pneumoniae (n = 2) and Chlamydia psittaci (n = 1) were the most frequent isolated pathogens. 40 patients (91%) were cured with NSG and delay to obtain apyrexia was 4.4 +/- 3.9 days. NSG was stopped in 4 patients: 1 clinical and bacteriological failure (Klebsiella pneumoniae), 2 clinical failures (1 pneumococcus with purulent pleurisy, 1 pneumococcus with worsening of respiratory status), 1 patient with resistant H. influenzae strain in spite of favourable clinical evolution. NSG was well tolerated in 86% of patients. CONCLUSION: these data invite to carry on evaluation of first line therapy of CAP with NSG.

[Bronchogenic cyst disclosed by pericarditis. Value of transesophageal echocardiography apropos of a case]. / Kyste bronchogénique révélé par une péricardite. Intérêt de l'échocardiographie transoesophagienne à propos d'un cas.

Pericarditis is one of the possible complications of mediastinal teratoma. Bronchogenic cysts are the commonest mediastinal cysts and may be observed at any age. We report our diagnosis of a bronchogenic cyst by transoesophageal echocardiography. It was successfully excised surgically. This is the eleventh case published in the world literature.

[Mediastinal adenopathy and cancer of the prostate]. / Adénopathies médiastinales et cancer de la prostate.

The authors report a case of metastases from a carcinoma of prostate producing mediastinal adenopathy with compression. The clinical presentation was unusual as this is an unusual area for lymphadenopathy and an abnormal lymphatic pattern was invoked as a possible cause or that the lymphatic channels communicating with these nodes had an abnormal thoracic duct. The aetiological diagnosis was facilitated by the presence of a specific prostatic antigen on the lymph node biopsy which allowed one to use an effective androgen suppression therapy.

Walk headache: an unusual manifestation of ischemic heart disease.

A 71 year old man sought neurological advice because for two years he had suffered from headache every time he made an effort. A treadmill stress test showed a relation between effort, headache and depression of ST segments on E.C.G. With isosorbide dinitrate and diltiazem, the manifestations improved. This suggests a referred head pain due to myocardial ischemia.