Prevalence of asthma and asthma-like symptoms in three French cities.

Background: This study is part of the European Community Respiratory Health Survey (ECRHS), which uses a common methodology in different areas throughout the world. This paper describes the prevalences of reported asthma, asthma-like symptoms and nasal allergies, their relationships to age group and sex, and the relationships of asthma-like symptoms to current asthma, in the general population aged 20-44 years of three French urban areas.

Methods: The study population of 2804 subjects in Grenoble, 3774 in Montpellier and 3152 in Paris (18th district), randomly selected from electoral rolls, answered a postal questionnaire (stage I of ECRHS).

[Mechanisms of bronchial hyperreactivity: role of airway inflammation and atopy].

The mechanisms of airway hyperresponsiveness are numerous and complex. The inflammatory process is one of the most important. It is characterized by epithelial damage and sloughing, by cellular infiltration of the bronchial mucosa and submucosa and by anatomical modifications of the bronchial wall.

Airway inflammation in symptomatic and asymptomatic children with methacholine hyperresponsiveness.

A definition of asthma includes symptoms due to reversible airflow limitation and airway hyperresponsiveness. Characteristically, there is also airway inflammation. In children with methacholine airway hyperresponsiveness but no asthma symptoms, we examined whether there were features of asthmatic airway inflammation.

Double-lung transplantation using donor lungs with a right tracheal bronchus.

A 58-year-old man underwent sequential bilateral lung transplantation. On the donor heart-lung block, it was discovered that the right apical segment was supplied by a tracheal bronchus. After the separate implantation of both lungs, a right apical segmentectomy was performed and the postoperative course was uneventful.

Changes in the cellular profile of induced sputum after allergen-induced asthmatic responses.

Allergen inhalation causes airway inflammation and an increase in histamine airway responsiveness. We have used cell counts in sputum induced by hypertonic saline aerosol to assess airway inflammation before and 32 h after asthmatic responses to allergen. Twelve asthmatic subjects (mean age, 27.

[Atypical pleural effusion secondary to transdiaphragmatic communication. Apropos of two cases: a chylothorax and a hydrothorax].

We report two cases of pleural effusion in which a subdiaphragmatic cause was noted. In both cases it was necessary to obliterate a defect in the diaphragm via a thoracic incision. In one case, a left chylothorax occurred in a patient with hepatic cirrhosis.

[Long-term tolerance of inhaled corticosteroids].

The effect of inhaled steroids on adrenal glands of asthmatic subjects are often difficult to assess because subjects may have received oral steroids before. Moreover, even if the Synacthen test is abnormal, it does not necessarily mean that the adrenals are clinically inefficient. Adrenal insufficiency can certainly occur at high doses of inhaled steroids.

Use of induced sputum cell counts to investigate airway inflammation in asthma.

Background: Airway inflammation is considered to be important in asthma but is relatively inaccessible to study. Less invasive methods of obtaining sputum from patients unable to produce it spontaneously should provide a useful investigational tool in asthma.

Methods: A method to induce sputum with inhaled hypertonic saline was modified for use in 17 asthmatic patients and 17 normal subjects who could not produce sputum spontaneously.

[Atypical pleural effusion by transdiaphragmatic communication. Apropos of two cases: chylothorax and hydrothorax].

We report two cases of pleural effusion in which a subdiaphragmatic cause was noted. In both cases it was necessary to obliterate a defect in the diaphragm via a thoracic incision. In one case, a left chylothorax occurred in a patient with hepatic cirrhosis.

[A fatal respiratory form of type C Niemann-Pick disease].

An unusual case of Niemann-Pick disease type C is reported. The disease was first manifested in utero with hepatomegaly and ascitis. At the age of 3 months, respiratory signs were noted due to diffuse alveolar and interstitial pneumonia.

[Meningo-encephalomyelitis in Lyme disease].

A case of isolated central nervous system involvement in Lyme disease is described. A 13 year-old boy developed progressive spastic quadraparesis, chronic lymphocytic meningitis with a low CSF glucose concentration and demyelinating lesions of the white matter on MRI. The diagnosis was proved serologically by high antibody titers against Borrelia burgdorferi (BB) in the serum (1:5, 120) and CSF (1:1,280).

[Effect of nebulized salbutamol in 26 patients hospitalized for asthma attack].

Twenty-six asthmatic patients who were hospitalised following an acute asthmatic attack and who had a peak expiratory flow of less than 50% predicted, without hypercapnia, received 5 mg. of salbutamol delivered by a micronebulizer LSA on admission (HO). At H1, 10 mg of additional salbutamol were nebulised in cases where there had been an increase of less than 20% of the PEF.

The role of measurements of airway responsiveness.

In smokers with chronic airflow limitation (CAL), airway hyperresponsiveness (AHR) to stimuli like methacholine, which act directly on airway smooth muscle, are not specific for the pathogenesis which is responsible for AHR to methacholine in subjects with normal spirometry, nor predictive for a beneficial effect of glucocorticosteroid (GCS) treatment. In contrast, AHR to stimuli like hyperventilation, which act indirectly through mediator release, may be specific for the pathogenesis of asthma and predictive for a beneficial effect of GCS. The validation of this possibility requires the demonstration that patients with CAL and AHR to hyper-ventilation demonstrate improvement after treatment with GCS (and have an increase in eosinophils and metachromatic cells in the sputum or bronchoalveolar lavage (BAL), like that seen in asthmatics uncomplicated by CAL).

[Chronologic relationship between gastroesophageal reflux and asthma. Simultaneous study of the measured pH and respiratory function].

Unlabelled: The aim of the study was: 1) to define the frequency of gastroesophageal reflux (GER) in asthmatics; 2) to study a possible relationship between episodes of GER and changes in airflow obstruction while maintaining as far as possible physiological conditions. Nineteen consecutive patients (aged 40.3 +/- 19 years) presenting with severe asthma requiring continuous treatment, were studied in a stable period.

[Treatment of asthma crises in children with nebulized salbutamol].

Thirty-two children were treated with nebulized salbutamol for acute asthma. Seventy-five per cent of the treatments were efficient, either after a first nebulization at 0.15 mg/kg (47% = group I), or after a second nebulization 45 min later, at 0.

[A case of pleuropneumopathy due to Eikenella corrodens].

We report the observation of a pleuropneumonia due to Eikenella corrodens in a man of 39 years old suffering from diffuse dilatation of the bronchi. This small micro-aerophilic Gram negative bacillus has rarely been implicated as a cause of pneumonia. It appears that it may often be associated with streptococcal infections and that it becomes a pathogen when the immunity is lowered.

[Primary alveolar hypoventilation. Clinical aspects and diagnostic problems. Apropos of a case].

Primary alveolar hypoventilation is a rare syndrome of unknown origin, characterized by a dysfunction of the automatic respiratory pattern in spite of normal lungs and in the absence of mechanical ventilatory defects. A reduction of the ventilatory response to CO2 is regularly found, and cardiac failure is common. The differential diagnosis mainly concerns the sleep apnoea syndrome.

[Sleep apnea syndrome combined with an anatomical obstruction of the upper airways].

In patients with sleep apnoea syndrome abnormalities of the upper airways may play a major role in the genesis of apnoea. Three cases are presented which illustrate the part played by hypertrophy of the tonsils in a child and by stenosis of the pharynx in an adult and of the larynx in another adult. All three patients were cured by surgical correction of these abnormalities.

[Immediate hypersensitivity to quinine].

Systemic anaphylactic reaction with shock was observed after ingestion of an antipyretic combination product containing quinine. That quinine was responsible for the reaction was proven by immediate skin tests and by oral challenge tests. The demonstration of specific IgE's by a radioallergosorbent test (RAST) provided evidence for an immediate hypersensitivity mechanism.

[Diffuse familial interstitial pulmonary fibrosis. Study of a family].

A study of the genealogy of a 53 year old lady (A.M..