[Survey on the use of electronic cigarettes and tobacco among children in middle and high school]. / Enquête sur l'usage de la cigarette électronique et du tabac en milieu scolaire.

PURPOSE OF STUDY: To estimate the prevalence of electronic cigarette use among teenagers and its connection with the consumption of tobacco. METHODS: In 2014 we conducted a survey of 3319 middle and high school students. RESULTS: Among the students, 56% had tried an electronic cigarette at least once (boys: 59.9%, girls: 49.3%; ranging from 31.3% for the 8th grade students to 66.1% for the 12th grades). However, only 3.4% reported that they used electronic cigarettes every day. Initiation of e-cigarette use in these teenagers was principally due to use by friends or triggered by curiosity and they usually choose fruit or sweet flavours initially. The majority could not give the concentration of nicotine in e-cigarettes that they used. Moreover, 61.5% of the students had ever tried tobacco and 22.3% were daily smokers. Our study found a strong link between vaping and smoking. 80% of the students who had ever tried conventional cigarettes (94% for the daily smokers) had also tried an electronic cigarette, versus 16% of the student who have never smoked. Few students (6.2%) used electronic cigarettes without smoking tobacco too. Usually, they have tried tobacco before trying an electronic cigarette. Only tobacco smokers seem to smoke electronic cigarettes with nicotine. CONCLUSION: Although our study shows that teenagers frequently try electronic cigarettes, it does not prove, for the moment, that vaping itself usually leads to nicotine addiction. However, as most of the teenagers are unable to tell if the electronic cigarette they are testing contains nicotine, it raises the possibility that they could be vulnerable to manipulation by the tobacco industry.

[Malignant pleural effusion as the presenting site of cancer: comparison with metastatic pleural effusions from known cancers]. / Pleurésies malignes révélatrices d'un cancer: comparaison des étiologies avec les pleurésies métastatiques d'un cancer connu.

INTRODUCTION: Few studies have focused on malignant pleural effusions as the presenting site of cancer. The aim of our study is to evaluate their proportion in the total number of malignant pleural effusions, to identify their causes and determine their prognosis. PATIENTS AND METHODS: Patients were selected retrospectively from the database of the Pathology Department of the University Hospital of Nantes (France), which contained only the patients in whom a diagnosis of malignant effusion was made as the result of cytology of pleural fluid or pleural biopsy, between January 1999 and December 2001. Pleural effusions as the presenting site of cancer (R group) and those metastatic from known cancer (C group) were identified by study of the clinical data. RESULTS: Of 209 cases, the malignant effusion was presenting site of cancer in 85 patients. In this group (R), a male predominance was identified (sex-ratio 1.36 vs. 0.42 in group C, p<0.01). In order of frequency the causes were: lung cancer (31 cases), mesothelioma (18 cases), primary cancer unknown (15 cases), ovarian carcinoma (10 cases), lymphoma (5 cases) and other carcinoma (2 cases). In men lung cancer was the leading cause (42.8%); and in women its frequency was the same as ovarian carcinoma (27.7%). The median survival of these patients was 6.5 months. CONCLUSION: Pleural effusions as the presenting site of cancer account for 41% of all malignant pleural effusions. Their causes are mainly lung cancer in men and lung and ovarian cancers in women.

[Necrotizing pneumonia due to Staphylococcus aureus producing Panton-Valentine toxin]. / Pneumonie nécrosante à Staphylococcus aureus secréteur de la toxine de panton valentine.

BACKGROUND: Necrotizing pneumonia caused by Staphylococcus aureus producing Panton Valentine Leukocidine (PVL) has been described recently and is associated with a high mortality (75%). OBSERVATION: We report a case of pneumonia due to PV secreting Staphylococcus aureus in a healthy young adult, complicated by multiple necrotizing lung lesions and major cystic changes, with a favourable final outcome. Acute respiratory failure with haemodynamic failure and ARDS developed a few days after an influenza-like illness. The appearances at fibreoptic bronchoscopy were atypical, consisting of a purulent, necrotic tracheo- bronchitis with desquamation. The initial unfavourable progress despite broad spectrum antibiotic therapy and, finally, the identification of PV leukotoxin in blood cultures and tracheal aspirate, led to the diagnosis. During the clinical course there were repeated pneumothoraces (8 drains) due to multiple bilateral cystic lesions. Ultimately progress was favourable following treatment with antibiotics (flucloxacillin and clindamycin) and steroids. CONCLUSION: It is important to consider pulmonary complications of the Panton-Valentine leukotoxin in a healthy young adult who presents with necrotizing pneumonia and an unfavourable outcome in spite of broad spectrum antibiotics. Treatment is difficult on account of the extent of the necrotizing lesions and the need to use antibiotics effective against both the bacterium and its toxin.

[Malignant pleural mesothelioma: radiotherapy for the prevention of seeding nodules]. / Mésothéliome malin pleural: radiothérapie préventive des nodules de perméation.

INTRODUCTION: Radiotherapy for the prevention of skin nodules appearing at the sites of aspiration, needle biopsies, chest drains or surgical incisions is the only treatment currently recommended for malignant mesothelioma. METHODS: 59 patients suffering from this condition were identified from the database of the Nantes Regional Cancer Centre. 33 received prophylactic irradiation, 25 did not and 1 was excluded. RESULTS: The treated group showed typical demographic and histological features. The delay in initiating radiotherapy ranged from 10 to 123 days and several different treatment regimes were used. In the treated group 7 out of 32 patients developed nodules following radiotherapy with 4 recurrences in the treated and 3 in the untreated areas. The mean interval before recurrence was 9 months (range 3 to 17 months). The recurrence rate was lower in the treated (21%) than in the untreated group (48%;12 out of 25). CONCLUSIONS: The poor results compared with the reference series may be explained by a longer follow-up (mean 12 months), less thorough treatment of all puncture sites and a very long delay before treatment (mean 37 days).

[Complex respiratory aspergillosis: diagnostic and therapeuthic difficulties]. / Aspergilloses respiratoires complexes: difficultés diagnostiques et thérapeutiques.

INTRODUCTION: Respiratory aspergillosis with different physiopathologic mechanisms can be associated in one patient in rare occasions. CASE REPORT: We review three cases associating an allergic bronchopulmonary aspergillosis (ABPA) and an other form of aspergillosis: aspergilloma, chronic necrotizing pulmonary aspergillosis and we present a review of literature. CONCLUSION: Such associations result in diagnostic and therapeutic difficulties. Corticosteroid treatment used for ABPA can increase the risk of severe infections. Such cases are a good indication of systemic antifungal therapy.

[Constrictive pericarditis due to asbestos exposure]. / Péricardite constrictive liée à l'exposition à l'amiante.

INTRODUCTION: Constrictive pericarditis is a rare complication of asbestos exposure and few cases have been reported in the literature. CASE REPORT: We report two cases of constrictive pericarditis in subjects previously exposed to asbestos. The first case, a 62 years old man, had occupational asbestos exposure whilst working for seven years in an electric plant 23 years before the diagnosis. The second case, a 76 years old man, had worked 21 years as a lagger up until 20 years before. The initial presentation in both cases was of sub-acute right heart failure. Both underwent pericardectomy which revealed pericardial thickening due to collagen fibrosis. Both patients died, one and five years respectively after surgery. Eight other cases of pericardial effusion and/or thickening, some with calcification, have been reported in association with previous asbestos exposure. Most of these cases had coexisting pleural lesions. CONCLUSIONS: As the prognosis is guarded (three of the eight reported cases died), making an early diagnosis is desirable.

[Chronic respiratory insufficiency in France]. / L'insuffisance respiratoire chronique en France.

The data concerning the prevalence of chronic respiratory insufficiency (CRI) in France are scarce: in 1994 official numbers were 14,000 deaths due to chronic bronchitis, 2,000 due to asthma for a total number of 40,000 deaths with respiratory cause; the same year 27,000 new patients were compensated for chronic respiratory insufficiency by social security services. On January 1st 2000 the non-profit organizations was in charge of 21,500 patients with long term oxygen therapy and 10,500 with home ventilation, and the commercial companies respectively 30,000 and 6,000. Accordingly the total of patients treated at home for CRI is about 68,000. The repartition by cause of CRI, the characteristics of patients and the prognosis can be evaluated thanks to the ANTADIR observatory which collects medical data since 1981. Chronic obstructive pulmonary diseases (chronic bronchitis, emphysema, asthma, bronchiectasis) count for more than half of the total of cases. Other causes comprise pleuro-parietal diseases (tuberculosis sequelae, kyphoscoliosis), neuro-muscular diseases and interstitial lung diseases. CRI is a severe disease with a survival median of three years for chronic obstructive pulmonary diseases, and a prognosis slightly better for kyphoscoliosis and neuro-muscular diseases, and worse for pulmonary fibrosis.

Mortality of sleep apnoea patients treated by nasal continuous positive airway pressure registered in the ANTADIR observatory. Association Nationale pour le Traitement A Domicile de l'Insuffisance Respiratoire chronique.

The aim of this study was to examine risk factors for and causes of mortality in patients with obstructive sleep apnoea syndrome (OSAS) treated by nasal continuous positive airway pressure (CPAP). Univariate and multivariate analyses of the data on patients registered in the Association Nationale pour le Traitement A Domicile de l'Insuffisance Respiratoire chronique (ANTADIR) Observatory between January 1, 1985 and December 31, 1993 and followed to January 1, 1996. Survival ratios were compared to those of the French population. A case control study compared patients who died with patients of the same age and sex, in the same Regional Association, who were equipped with CPAP at the same time. Five-thousand-six-hundred-and-sixty-nine patients had CPAP treatment. Two-hundred-and-seventy-six had died. One-hundred-and-twenty-four deaths were examined and compared to 123 control subjects. Overall mortality was the same as the general French population. Independent risk factors for death were age, oxygen tension in arterial blood (Pa,O2) and forced expiratory volume in one second (FEV1) (per cent predicted). In the case-control study independent risk factors for death in the past history were cardiac arrhythmia with an odds ratio (OR) of 2.8 (95% confidence interval (CI) 1.1-7.2), respiratory disorders (OR 2.8; CI 1.6-4.9) ischaemic events (OR 2.2; CI 1.2-4.2), neurological and psychiatric disorders (OR 2.4; CI 1.1-5.4). A significant excess of cardiovascular deaths and an excess of deaths from accidents and poisonings was found. In conclusion, patients die on therapy predominantly from cardiovascular causes but many have a past history of cardiovascular conditions. Compliance with treatment may be important for survival. Continuous positive airway pressure is an effective therapy for obstructive sleep apnoea syndrome but older patients with reduced spirometry and hypoxaemia may need more attention paid to these aspects of their condition.

[Apical pleural fibrosis related to inhalation of asbestos fibers]. / La pachypleurite apicale liée à l'inhalation de fibres d'amiante.

The involvement of the apical pleura is infrequent in diffuse pleural thickening secondary to asbestos exposure. Most often diffuse pleural thickening is accompanied by an obliteration of the costophrenic angle and the posterior and paraspinous pleural surfaces of the pleura are involved to the greatest extent. Unlike this typical form, we observed in five patients exposed to asbestos an apical pleural fibrosis, uni or bilateral, accompanied with lung retraction, hilar ascension and tracheal attraction. Apical pleural thickening with upper lobe changes in asbestos-exposed persons should be regarded as due to the asbestos exposure, after exclusion of other causes like tuberculosis and the apex tumors. Usually the evolution of the lesions is slowly progressive over several years or even decade, and results in mild restrictive defect.

Respiratory epithelial ion transport in patients with disseminated bronchiectasis.

The nosological limits between disseminated bronchiectasis and cystic fibrosis (CF) remain unclear. In patients with isolated congenital bilateral absence of the vas deferens, a forme fruste of the CF disease, a normal baseline nasal transepithelial potential difference (PD) but an impaired response to pharmacological interventions have been reported. The purpose of the present study was to explore ion transport in respiratory epithelium from patients with disseminated bronchiectasis. The PD under both baseline and pharmacological interventions was investigated in 13 healthy subjects, six patients with genetically proven CF and 15 patients with disseminated bronchiectasis as confirmed by computed tomography scan. Baseline PD was similar in the control and bronchiectasis groups but, as expected, was significantly more negative in the CF group. Patients with bronchiectasis responded to pharmacological tests (sequential perfusion with amiloride, chloride-free solution, isoprenaline and uridine triphosphate (UTP) similarly to healthy subjects. In contrast, CF patients exhibited an increased response to amiloride and an impaired response to chloride-free solution and isoprenaline. The data show that patients with disseminated bronchiectasis exhibit normal electrophysiological properties in their nasal epithelium. Nasal transepithelial potential difference including pharmacological tests may appear a valuable diagnostic procedure for cystic fibrosis with disseminated bronchiectasis.

[Medical impact of screening of benign pleural lesions associated with the inhalation of asbestos dust]. / Impact médical du dépistage des lésions pleurales bénignes liées à l'inhalation de poussières d'amiante.

Asbestos-related benign pleural lesions can involve the parietal pleura (pleural plaques), and/or visceral pleura as focal or diffuse (diffuse pleural thickening) fibrosis. Benign asbestos pleurisy and rounded atelectasis are linked with visceral pachypleuritis, the former as a cause, the latter as a consequence. The prevalence of these lesions, particularly pleural plaques, is very high, reaching 25% in populations of workers exposed intermittently to asbestos. Conventional radiology has a sensitivity less than 50% for detection of plaques, and a specificity less than 85%. Tomodensitometry is today the reference diagnostic tool: availability, cost and irradiation have to be considered before its use in mass screening. Pleural plaques are most often asymptomatic and a functional impairment cannot be proven usually on an individual basis. Visceral pleural thickening is more often accompanied by symptoms (dyspnea, pain) and functional impairment. There is no treatment susceptible to produce a regression of pleural lesions. Asbestos exposure increases the risk of pulmonary and pleural cancers. However there is no evidence of an increased risk in subjects with plaques compared with subjects without plaques but an equivalent asbestos exposure. The cost and the risk of diagnostic procedures induced by the screening, as well as the anxiety provoked by the detection of radiologic abnormalities are to be considered. Finally it is difficult today to justify the screening of benign pleural lesions by arguing an improvement of the life expectancy or of the quality of life of former asbestos exposed workers. It is probable that benefit of a screening will be of a social type, at an individual or a collective level.

Characteristics and survival of patients prescribed long-term oxygen therapy outside prescription guidelines.

Criteria for the prescription of long-term oxygen therapy (LTOT) have been published by academic societies and regulatory bodies, but many prescriptions for LTOT do not fulfil these criteria. Demographic, functional data and survival were compared in chronic obstructive pulmonary disease (COPD) patients with different levels of oxygenation, i.e. arterial oxygen tension (Pa,O2) < 8 kPa or > or = 8 kPa (60 mmHg), at the time of initial registration in the ANTADIR Observatory. Data were collected between 1984-1995. Selection criteria were a diagnosis of COPD or emphysema with forced expiratory volume in one second (FEV1) < 80% pred, FEV1/vital capacity (VC) < 70% and age between 18-75 yrs. Of 7,700 patients prescribed LTOT 18.5% had stable Pa,O2 > or = 8 kPa. While the FEV1 was the same they differed from the patients with more severe hypoxaemia in having a higher rate of diagnosis of primary emphysema and a lower arterial carbon dioxide tension (Pa,CO2). In this group of patients LTOT was more frequently administered as liquid oxygen than in other patients on LTOT. The survival of these patients was reduced compared to the general population of the same age and sex but comparable to that of patients with a Pa,O2 between 6.7-8 kPa (50-60 mmHg). Patients prescribed long-term oxygen therapy with an arterial oxygen tension > or = 8 kPa (60 mmHg) in the ANTADIR network were shown to have severe chronic obstructive pulmonary disease on the basis of spirometry and their survival was similar to that of more hypoxaemic patients. Randomized controlled trials of the effect of long-term oxygen therapy in patients with arterial oxygen tension > or = 8 kPa are needed.

[Unusual bronchial tumor...]. / Une tumeur bronchique inhabituelle....

We report a case of atelectasis of the upper right lobe which did not respond to antibiotics. A third bronchial endoscopy with bronchoalveolar lavage was required to make the diagnosis of endobronchial nocardiasis. Search for extension revealed a brain localization. Search for immune deficiency only revealed calcification of the bronchial mucosa in the area of the nocardiasis.

Leukaemia inhibitory factor (LIF) production in pleural effusions: comparison with production of IL-4, IL-8, IL-10 and macrophage-colony stimulating factor (M-CSF).

Leukaemia inhibitory factor (LIF), a pleiotropic cytokine detected in various inflammatory body fluids, plays a poorly defined role in the pathogenesis of human disease. This study was conducted to correlate the LIF concentrations in pleural effusions with the type of pathology and to compare its levels with those of IL-4, IL-8, IL-10 and M-CSF for a given pathology. Pleural fluids from 97 patients were assayed for cytokines by specific ELISAs. The concentrations of all cytokines tested were higher in infectious pleural effusions than in other pathologies (malignant or transudative). The lowest levels were observed for transudates. Significant differences were noted between pathology groups for each cytokine. A good correlation was observed between LIF and IL-8 for malignant effusions [regression correlation coefficient (RC) = 0.480, P < 0.01], between LIF and IL-4 for infectious disorders (RC = 0.543, P < 0.05) between LIF and IL-10 for transudates (RC = 0.798, P < 0.001) and between M-CSF and IL-8 in all pathologies tested except for primitive neoplasia (P < 0.05). The LIF concentration in pleural space seems to be strongly associated with the intensity of inflammatory reaction. The LIF production appears to have different regulatory patterns between aetiologic groups.

Predictors of survival in patients receiving domiciliary oxygen therapy or mechanical ventilation. A 10-year analysis of ANTADIR Observatory.

STUDY OBJECTIVE: To analyze predictors of survival for patients receiving home long-term oxygen therapy (LTOT) or prolonged mechanical ventilation (PMV) according to the cause of chronic respiratory insufficiency (CRI) and the patients physiologic data. DESIGN: Analysis of a nationwide database (ANTADIR Observatory). SETTING: The national nonprofit network for home treatment of patients with CRI Association Nationale pour le Traitement a Domicile de lInsuffisance Respiratoire Chronique (ANTADIR); founded in France in the 1980s. PATIENTS: There were 26,140 patients receiving LTOT or PMV (noninvasive or via tracheostomy) between January 1, 1984 and January 1, 1993 (chronic bronchitis, 12,043; asthma, 1,755; bronchiectasis, 1,556; emphysema, 551; tuberculosis sequelae, 4,147; kyphoscoliosis, 1,574; neuromuscular diseases, 1,097; pneumoconiosis, 919; and fibrosis, 2,498. MEASUREMENTS AND RESULTS: Survival analysis was performed using the actuarial and the Cox's semiparametric model. The mean survival for patients with chronic bronchitis is 3 years. Survival is slightly better for patients with bronchiectasis and asthma and worse for those with emphysema. Patients with kyphoscoliosis and a neuromuscular disease have the longest survival (8 and 6.5 years, respectively). Patients with CRI due to tuberculosis sequelae experience the same survival as COPD patients (3 years). Prognosis is the worst in patients with pneumoconiosis or fibrosis: 50% of these patients die during the year following the beginning of home treatment. The association of an obstructive lung disease worsens the prognosis of patients with kyphoscoliosis or neuromuscular disease and tends to bring the survival rate of the patients with pneumoconiosis or fibrosis closer to that of COPD patients. In COPD, male sex, older age, lower body mass index (BMI),FEV1 percent predicted,PaO2,and PaCO2 are independent negative prognostic factors. For tuberculous sequelae and kyphoscoliosis, female sex, younger age, a high BMI, PaO2 and PaCO2 (and for kyphoscoliosis a higher FEV1/vital capacity [VC] ratio) are all independent favorable prognostic factors. In pulmonary fibrosis, a lower PaO2 and PaCO2 values, a lower VC percent predicted, and a higher FEV1/VC ratio are negative prognostic factors. CONCLUSIONS: The ANTADIR Observatory allows a unique opportunity to analyze long-term survival of a large population with CRI treated at home.