Epidemiological study of farmer's lung in five districts of the French Doubs province

The prevalence of farmer's lung was studied in five districts of the French Doubs province (Rougemont, Clerval, Levier, Montbenoît, Mouthe) on the basis of a medical and occupational questionnaire and serological studies for precipitins. Of the 1763 active farmers (response rate 69%) who participated in the study, 270 were suspected of having farmer's lung and divided, on the basis of clinical and serological criteria, into probable and possible farmer's lung groups. This subgroup of 270 patients was examined in more detail with physical examination, chest radiographs, and pulmonary function tests. Probable farmer's lung was diagnosed in 77 cases (53 men and 24 women, mean age 51.7 years), a prevalence of 43.7/1000. Possible farmer's lung was present in a further 193 subjects. Fever was the most specific symptom. In the group with probable farmer's lung the frequency of crepitations, restrictive ventilatory defect, and radiological interstitial abnormalities was 21.5%, 9.5%, and 9.2% at the time of the study. Farmer's lung was more common in the middle tablelands than in the plain or mountain areas (p less than 0.01). The difference in prevalence of farmer's lung between the Mouthe mountain and Levier middle tableland districts (25.2/1000 and 60.8/1000) raises the possibility that cold may protect against the disease. Farmer's lung was more frequent in men and in the age group 51-55 years. Among possible occupational factors, only regular work connected with feeding animals was associated with a significant risk (odds ratio 2.55 with a 95% confidence interval of 1.09-5.93). The frequency of chronic bronchitis in the population studied was 14.8%. There was a close link between farmer's lung and chronic bronchitis, 50.6% of patients with probable farmer's lung having it but only 8.6% of patients without farmer's lung (p less than 0.001). In patients with probable farmer's lung chronic bronchitis was independent of smoking and age. There were fewer smokers in the probable farmer's lung than in the non-farmer's lung group (p less than 0.05).

[X-ray computed tomography in purulent pleurisy]

Complementary CT scan imaging during investigation of 18 cases of empyema showed it to be an essential examination, since it established the diagnosis in all cases, determined possible extension of the infectious process and possible causal lesion, defined the most effective approach for percutaneous drainage and evaluated efficacy of the later.

[Lonely pulmonary varices. Report of two new cases]

Authors report two new cases of lonely pulmonary varices, raising the number of lonely pulmonary varices to 34 and to 61 the number of pulmonary varices related in literature. In both cases the dilated veins were discovered by chance on a chest roentgenogram. The pulmonary angiogram has brought the diagnosis out. A recall of the clinical symptoms and radiological aspects shown off the importance of the pulmonary angiography and of a regular supervision of those patients. If some complications appear or if some shadows extend on chest roentgenogram, the surgical treatment might become necessary.

[Preliminary results of postoperative trial therapy of epidermoid cancer of the lung (European Organization for Research on the Treatment of Cancer, Bronchus Group. Protocol 08741)]

650 patients entered the study between 5/74 and 4/79 and are currently evaluable. Prior to entry, all underwent complete resection of squamous cell bronchial carcinoma. Patients were initially randomized to receive radiotherapy versus no radiotherapy. Following that a second stage randomization ascribed patients to chemotherapy, immunotherapy, immunochemotherapy and observation. Current analysis of results shows that : 1. Patients with negative nodes did not benefit from post-operative radiotherapy; on such patients, survival was significantly shorter following radiotherapy. 2. In patients with positive nodes, post-operative radiotherapy prevented local recurrence, but did not prolong survival. The data from the second stage randomization are currently being analyzed.

Phase i Trial with Peptichemio

Thirty-two patients with tumor progression, even after conventional cytostatic drug treatment, were treated with peptichemio, with increasing doses for groups of 4 patients. The maximum tolerated dose (with minimum hematological toxicity and without any other evident toxicity) with repeated administrations, was 1.2 mg/kg twice weekly. The recommended doses for phase II trials are, as shown by the detailed analysis of the results, 0.9 mg/kg, twice weekly and administered alone, and 1.3 mg/kg, once weekly combined with other cytostatic drugs, in 500 ml of infusion fluid, with 25 mg of heparin and 25 mg of hydrocortisone to minimize the frequent risk of local phlebosclerosis.

[Long survival periods after therapy for metastatic or reccurrent cancer (author's transl)]

Out of 671 cases of various cancers, first seen for growing metastases and or recurrences (resectable cases being excluded) the 3 years survival rate has been 18 per cent (121 cases). This result was obtained by various combinations of chemotherapy and radiotherapy. It follows that advanced cases should not be abandoned without any attempt at control, and that earlier treatments in cases being at high risk for metastases would probably further increase such results.

[Comparative study of carcino-embryonic antigen and beta2-microglobulin. Methodological study and clinical interpretation (author's transl)]

beta2m was determined by radioimmunoassay in 43 serums from healthy blood donors. Serum concentrations varied from 0.67 to 1.9 mg/l with a mean of 1.29 mg/l. Reproductibility and sensitivity of the method were evaluated. 66 patients with advanced neoplasia were studied. Serum beta2m was greater than 2 mg/l in 70% of the cases and carcinoembryonic antigen (CEA) in 54%. In 26 documented cases with tumor progression and 14 with regression, associated variations of CEA were formed more frequent and of greater magnitude than those of beta2m.

Immunochemotherapy in 34 cases of oat cell carcinoma of the lung with 19 complete responses

Thirty-four previously untreated patients with oat cell carcinoma of the lung were treated with a myelotoxic combination of cyclophosphamide, adriamycin, methotrexate, CCNU, and Corynebacterium parvum (regimen A) every 4 weeks, interspersed with a non-myelotoxic combination including bleomycin, vincristine, dehydroemetine, and Corynebacterium parvum (regimen B) weekly the other 3 weeks or when hematologic toxicity prohibited administration of regimen A. Hematologic toxicity was frequent but was never a serious problem except in two cases of profound leukopenia in which fatal supervening infection occurred. Nineteen patients in this series (56%) showed a complete response lasting from 4+ to 65+ months. Eight of these patients are still alive with a followup of 6+ to 65+ months. Nine patients (26%) showed a partial response (greater than 50%) lasting 1-10+ months. Only one patient in this group is surviving (10+ months). The overall response rate was thus 82%. It is concluded from this study that only a complete response has any significant effect on survival, the benefit of a partial response over no response being only slight. The results achieved are compared to those of available series in the literature and from this comparison strategic deductions for the treatment of oat cell carcinoma of the lung are made.

Daily intravenous infusions of Corynebacterium parvum in twenty patients with disseminated cancer: a preliminary report of clinical and biologic findings

Twenty terminally ill patients with various disseminated tumors were treated with daily iv infusions of Corynebacterium parvum given alone at doses of 4 mg/day, 5 days/week, for 4-16 weeks. In 8 patients (40%), the lesions partially regressed to less than 50% of their original size. Another patient who did not improve with C. parvum therapy had a complete remission after the first course of chemotherapy. Skin tests, total leukocyte counts, and T- and B-cell counts revealed variable and unpredictable changes. Phytohemagglutinin- and concanavalin A-induced blastogenesis tended to increase. Of 10 patients, 8 had a significant decrease in serum C3 levels after completion of C. parvum therapy, possibly due to an increased C3 consumption by macrophages activated by the immunostimulant. That nonspecific immune stimulation after repeated iv infusions of an immunostimulant can by itself induce regression in disseminated disease does not agree with the current concept that immunotherapy can be effective only against minimal residual disease. The therapeutic procedure proposed here, though frequently associated with moderate short-lasting side effects, is devoid of serious toxicity.

Response of 65 measurable epidermoid bronchogenic tumors of known spontaneous doubling time to four different chemotherapeutic regimens--strategic deductions

Variations in the dimensions of 65 bronchogenic epidermoid tumors of known spontaneous doubling time were studied under the influence of four chemotherapeutic regimens: cyclophosphamide, 19 cases; Mitomycin C, 20 cases; CCNU, 9 cases; and a five-drug combination, 17 cases. Several parameters were measured, and escape was defined as the moment in time when the growth curve during treatment became parallel to the spontaneous growth curve. The parameters measured were nature and distribution of responses (unchanged progression, slowing-down, plateau, regression), duration of response, time required to achieve maximum response, and time lapse between maximum response and escape. Regarding application to lung cancer, we have concluded from out results that Mitomycin C should replace cyclophosphamide in combination chemotherapeutic regimens. With regard to general strategy, our results suggest that the drug regimen should be changed as soon as maximum response is reached or immediately following the first course if progression continues unchanged. Moreover, in all of the 27 patients whose tumors regressed, escape occurred within less than three months from the onset of the treatment. In view of this fact and insofar as chemotherapy is considered for adjuvant therapy aiming at complete eradication, sequential combinations would be preferable to prolonged administration of a single agent or combination.