Spirometry and maximal expiratory flow-volume curve reference standards for Polynesian, European, and Chinese teenagers.

Lung function was compared and reference standards were determined in 1,007 Polynesian, European, and Chinese teenagers attending school in Tahiti (517 boys, 490 girls; mean age, 14.4 years). Spirometric study results and maximal expiratory flow-volume curves were measured using techniques recommended by the American Thoracic Society. Age, standing height, and weight were chosen as the independent variables for males, and age and standing height for females. Regression equations constructed with logarithmically transformed dependent variables provided accurate predictions. We observed significant racial differences: in the Europeans, forced vital capacity (FVC) and forced expiratory volume in one second (FEV1) were higher than the mean values predicted for the whole study population, while forced expiratory flow during the middle half of the FVC (FEF25-75%) and maximal expiratory flows after 25, 50, and 75 percent of FVC had been exhaled (V max 25, 50, and 75, respectively) were about equal to the mean values; in the Polynesians, volumes and flows were mostly lower than the mean; in the Chinese, FVC in boys and girls, and FEV1 in girls only, were lower, while the other flows were higher. The FEV1/FVC, FEF25-75%/FVC, Vmax25/FVC, Vmax50/FVC, and Vmax75/FVC were significantly higher than the mean in the Chinese boys and girls and often lower in the Europeans.

Respiratory history during infancy and childhood, and respiratory conditions in adulthood.

The aim of this paper was to study respiratory disorders in infancy and childhood as a risk factor for respiratory conditions in adulthood. During the first part of the survey 15,247 adolescents in the Bordeaux area (average age: 16.5 years, boys = 46.6%) filled in a self-administered questionnaire concerning their respiratory history during infancy and childhood, their present symptoms and their smoking habits. Each subject with chronic cough (n = 538) was then matched with two controls (n = 1094) and the parents of these subjects and of their controls were sent a complementary questionnaire. During the second part, 1807 adults (average age: 39.3 years; men = 49.7%) working at Bordeaux University filled in a self-administered questionnaire about their present respiratory symptoms, smoking habits and respiratory symptoms during adolescence. Spirometry was performed in 172 adolescents and 1665 adults. The results of the first part showed a very significant relationship in adolescents between respiratory history during infancy and childhood and current chronic cough even in non-smokers, non-wheezers and non-asthmatics. The second part showed a very significant relationship in adults between respiratory symptoms during adolescence and present respiratory symptoms on the one hand, and a lower pulmonary function on the other, taking wheezing, smoking and asthma into account. In common with many similar studies, we conclude that respiratory disorders in young children may predispose to later disease, and that consequently it might be important to determine appropriate measures to prevent respiratory illness in childhood.

Prevalence of asthma among teenagers attending school in Tahiti.

The prevalence of asthma was studied in 6731 adolescents (average age 13.5 years, 48.6% boys) attending school in three towns of the isle of Tahiti, according to the ethnic origin of both parents. The pupils completed a self-administered questionnaire in class; 14.3% gave an affirmative answer to the question "Have you ever had attacks of asthma?" (cumulative prevalence). That prevalence was 11.4% in the Europeans, 13.7% in the Chinese, 13.8% in the Polynesians, 15.3% in those whose parents were "halves" (half-bred from Polynesians and Europeans), and 16.0% in the miscellaneous group (= other origins) (P less than 0.02). Asthma was significantly more frequent in boys only among the Europeans and those with one European parent. The results of this study confirm the high prevalence of asthma in French Polynesia found in a previous study. They give no evidence of a racial difference in prevalence but suggest an influence of environment.

[Current role of chemotherapy in the treatment of invasive cancers of the bladder]. / Place actuelle de la chimiothérapie dans le traitement des cancers infiltrants de vessie.

Treatment of bladder carcinoma with cystectomy and or radiotherapy provide 5-year survival rates of 28-50%. Phase II chemotherapy trials have proven its efficacy with a partial and complete response rate of 20% and 10% respectively for drugs such as cisplatin or methotrexate. Recent phase III studies have demonstrated the superiority of associations such as CMV, CISCA or M-VAC with complete response rates of 28-39%. Neoadjuvant chemotherapy may increase local control and offer the possibility of conservative treatment after complete tumor regression (one third of cases). The positive effect of neoadjuvant chemotherapy on survival has not yet been demonstrated and randomized trials are now in progress. The concomitant association of cisplatin or fluorouracil with radiation therapy provides high complete response rates (65-88%) in all published studies. A longer follow-up period is necessary to confirm these results in terms of local control gain and survival benefit, but this strategy seems to constitute a major advancement for patients unable to undergo radical cystectomy. Further studies are needed before extending this conservative approach to less advanced invasive bladder carcinoma. Adjuvant chemotherapy may decrease metastasis rate, but survival benefit has not yet been definitively established by randomized studies.

[Congenital arteriovenous fistula of the kidney. Report on a further case (author's transl)]. / Fistule artério-veineuse congénitale du rein. Un nouveau cas.

A congenital arteriovenous fistula of the kidney was discovered in a 75-year-old man presenting with hematuria and a silent kidney on I.V.U. The diagnosis had been suggested from the results of pre-operative arteriography examination. Treatment consisted of a total nephrectomy, because of the age of the patient and the hilar site of the "angioma". Reports in the published literature confirm the rare nature of this type of lesion and the difficulties encountered when trying to classify them in precise nosological groups.

[Smoking in adolescents in Guadeloupe]. / Tabagisme chez les adolescents en Guadeloupe.

A study was made of the smoking habits of 10,349 teenagers attending secondary school in Grande-Terre, Lamentin and Marie-Galante in Guadeloupe (41.4% were male; mean age 16.4 +/- 1.8). The study was made using a self administered questionnaire which also included questions on respiratory symptoms in teenagers and the smoking habits of their parents. The proportion of regular smokers (greater than one cigarette per day) was 9.2% in boys and 5.6% in girls: the boys were smoking on average 7.3 cigarettes a day, the girls 5.9. The proportion of smokers increased with age, being the highest in the children of managerial and commercial classes or skilled artisans, and was strongly linked to the smoking habits of the parents. Respiratory symptoms were more common in teenagers who smoked.

[Chronic cough in adolescents and respiratory symptoms in adults]. / Toux chronique de l'adolescent et symptômes respiratoires de l'adulte.

The object of this work was to study the relationship between chronic cough in adolescence, and chronic symptoms and airflow obstruction in adults. The data were collected between 1982 and 1984 from 1807 men and women living in Bordeaux (France) and its surrounds. A self administered questionnaire was used which focused on current respiratory symptoms and respiratory symptoms during adolescence. Spirometric curves (FVC, FEV1 and FEF 25-75) were measured. The population was evenly split between men (mean age 40.1) and women (mean age 38.6). Most subjects were French; more than half were non smokers; all socioprofessional categories were represented except farmers, craftsmen and merchants. The proportion of subjects with current respiratory symptoms was 2 to 10 times higher amongst subjects with respiratory symptoms during their adolescence than in those who had none. The relationships were highly significant and remained so after adjustments for the confounding factors following: sex, age, nationality, socio-economic status, smoking habits, occupational exposure and previous occupational disease. Mean spirometric values were higher amongst subjects without chronic cough during their adolescence than those who had cough. Differences were significant for FVC, FEV1, FEF 25-75 in women and were on the borderline for FEF 25-75 in men. This study showed that respiratory conditions in adolescence represent an important risk factor for chronic symptoms and airflow obstruction in adult life.

[Smoking among nursing students]. / Le tabagisme chez les élèves infirmières.

The aim of this work is to study smoking habits in young adults in a particularly sensitive environment. The data were collected in 28 nursing schools of the Public Hospital System in Paris by means of anonymous self-administered questionnaire. The questions focused on smoking habits, knowledge of risks and student attitudes. The 5,598 respondents (mean age of 22.6 years) were 89 per cent female. The results showed a high prevalence of current smoking (44%) especially amongst the younger students. Students preferred brands with a medium range tar level. Most of the students knew the smoking risk, agreed with the policy of prohibiting smoking in the hospital and thought that it is the role of nurses to counsel patients to stop smoking, but only one third hold a positive view of this role.

[Radiotherapy of localized prostatic cancer: follow-up of 48 patients. G.C.C.P. (Cooperative Group for the Study of Prostatic Cancer)]. / Radiothérapie des cancers de prostate localisés: 48 malades suivis plus de dix ans. G.C.C.P. (Groupe Coopératif d'Etude du Cancer de la Prostate).

OBJECTIVE: To evaluate the safety and long-term efficacy of curative-intent radiation therapy in patients with apparently localized prostate cancer. METHOD: 48 patients with T < 3 M0 prostate cancer recruited between 1981 and 1985 received regular clinical follow-up for at least ten years or until their death. Radiation therapy was given according to the protocols established by Ray and Bagshaw. RESULTS: Radiation therapy was safe and effective in most patients. The rate of escape phenomenon was less than 10% after two years. Tumor control rates were greater than 80% after five years and 50% after ten years. Unfortunately, local remission, even when prolonged, did not necessarily indicate a complete cure: 20% of local recurrences developed five to 11 years after radiation therapy. CONCLUSION: Radiation therapy may be the best first-line treatment in men older than 75 years of age and in those whose life expectancy seems shorter than ten years, but should probably not be considered curative.

[Complications of transurethral resection in the treatment of benign prostatic hypertrophy. Apropos of a series of 1180 adenomas--1976-1986]. / Complications de la résection transurétrale dans la cure de l'hypertrophie prostatique bénigne. A propos d'une série de 1 180 adénomes--1976-1986.

This was a homogeneous series treated by the same surgeon between January 1977 and December 1986. During this period, out of 1,806 certico-prostatic obstacles, 1,180 were treated by resection of a prostatic adenoma with a mean age of 68,3 years and a range of 37 to 94 years. The surgical indications fell into four groups: dominant dysuria, dominant pollakiuria, complicated adenomas and patients with a single past episode of acute urinary retention. Resection was performed with a direct current (Iglésias) essentially with sterile demineralized water. General anesthesia was used in 2/3 of the cases and loco-regional anesthesia in 1/3 of the cases. A traditional resection technique was used, and postoperative bladder drainage used a Mercier 24 catheter. Continuous lavage was not performed. Duration of resection was 10 to 120 minutes with a mean of 39 minutes. The resected weight ranged between 8 and 130 grams with a mean of 24.2 grams. Duration of the indwelling catheter decreased from 5 days in 1976 to 24 or 48 hours in 1982. Duration of hospitalization decreased from 12 to 7 days, and down to 5 days today. Complications were uncommon: 2 deaths (0.17%) due to acute pancreatitis and mesenteric infarction; 1 perforated bladder; 4 septicemia with shock; 2 acute renal failures requiring dialysis; 5 pulmonary emboli; 3 hemiplegia; 1 acute nonfatal pancreatitis. Only 50 patients (4.2%) required transfusions. There was no permanent urinary incontinence but there were 12 (0.1%) cervical stenoses, and 37 (3.13%) urethral stenoses. Five-hundred-and-fifty-two patients were followed for one year and more: the results were overall very good.(ABSTRACT TRUNCATED AT 250 WORDS)

[Respiratory history of children and chronic cough in adolescents]. / Antécédents respiratoires de l'enfant et toux chronique de l'adolescent.

The purpose of this work was to study the relation between respiratory history during childhood and teenagers' chronic cough and possible abnormalities of pulmonary function. This etiological survey was carried out among 538 pupils with a chronic cough and 1,094 controls (boys and girls), teenagers attending school in Bordeaux and its surroundings (average age, 16.7 years). The data were collected by means of self-administered questionnaires among the teenagers and their parents. Spirometry was performed in a randomised sample of 172 pupils. A significant relation was found between chronic cough and both respiratory history and a decrease of F.E.V.1 (in boys and girls) and F.E.F. 25-75 (in girls only). Moreover this relation was present also among the subjects with incomplete answers and in the group of non-asthmatics.

[Severe postpartum hemorrhage]. / Les hémorragies graves de la délivrance.

The authors report 95 cases of post-partum haemorrhage estimated at one litre or more seen in the Department of Obstetrics between 1979 and 1982 for 11 662 deliveries. Classical treatment combining artificial delivery or uterine manual evacuation-oxytocics led to the arrest of bleeding in 73 cases. Severe haemorrhage persisted in 22 cases, including 13 patients who were found to be suffering from a coagulopathy. Treatment of these severe forms is based upon: local haemostasis (in the presence of inertia, prostaglandins must be used before surgery) and correction of the coagulation disorder by substitution therapy providing the missing factors.