1
|
Guion Dusserre M, Soumagne T, Reboux G, Maitre J, Dalphin JC. Second Hypersensitivity Pneumonitis in the Same Patient Caused by Chinchillas. J Investig Allergol Clin Immunol 2019; 28:441-442. [PMID: 30530399 DOI: 10.18176/jiaci.0319] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- M Guion Dusserre
- Department of Respiratory Diseases, University Hospital of Besançon, Besançon, France
| | - T Soumagne
- Department of Respiratory Diseases, University Hospital of Besançon, Besançon, France
| | - G Reboux
- Department of Parasitology and Mycology, University Hospital of Besancon, Besançon, France.,UMR/CNRS 6249 Chrono-Environment, University of Franche-Comté Besançon, France
| | - J Maitre
- Department of Respiratory Diseases, Hospital of Haute-Saône, Vesoul, France
| | - J C Dalphin
- Department of Respiratory Diseases, University Hospital of Besançon, Besançon, France.,UMR/CNRS 6249 Chrono-Environment, University of Franche-Comté Besançon, France
| |
Collapse
|
2
|
Abstract
Hypersensitivity pneumonitis (HP) is an interstitial lung disease caused by an immune response to a variety of antigens to which patients have been previously sensitised. It can occur at any age. In children, it is a rare disease, probably under-diagnosed, with an estimated prevalence of 4 per million. The paediatric forms are not really different from those of adults but present some particularities. Avian exposure is by far the most frequent cause of HP, accounting for nearly two-thirds of cases. Although there is no current recommendation for the diagnosis of HP, it is commonly considered that the diagnosis can be made with confidence on the combination of (1) compatible respiratory symptoms, (2) exposure to a known offending antigen, (3) lymphocytic alveolitis, (4) decreased transfer factor for carbon monoxide or hypoxia on exertion and (5) compatible radiologic features. The treatment is based on antigen avoidance that must be complete and definitive. Corticosteroids can be necessary in severe forms. The prognosis of HP in children is better than in adults, with a full clinical and functional recovery in the majority of cases after complete antigenic withdrawal.
Collapse
Affiliation(s)
- T Soumagne
- Service de pneumologie, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France.
| | - M L Dalphin
- Service de pédiatrie, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France
| | - J C Dalphin
- Service de pneumologie, hôpital Jean-Minjoz, CHU de Besançon, 25030 Besançon cedex, France; UMR CNRS 6249, Chrono-environnement, université de Franche-Comté, 25000 Besançon, France.
| |
Collapse
|
3
|
Tiotiu A, Oster JP, Roux PR, Nguyen Thi PL, Peiffer G, Bonniaud P, Dalphin JC, de Blay F. Effectiveness of Omalizumab in Severe Allergic Asthma and Nasal Polyposis: A Real-Life Study. J Investig Allergol Clin Immunol 2019; 30:49-57. [PMID: 30931917 DOI: 10.18176/jiaci.0391] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Omalizumab is a human anti-IgE antibody approved for the treatment of severe allergic asthma (SAA). However, its effectiveness in SAA associated with chronic rhinosinusitis with nasal polyposis (CRSNP+) is less well documented. Objective: The aim of this study was to evaluate the real-life effectiveness of omalizumab in patients with SAA and CRSNP+ who tolerated and did not tolerate aspirin. METHODS We performed a retrospective, observational, multicenter, real-life study of patients with SAA and CRSNP+ treated with omalizumab for 6 months. Asthma outcome parameters (symptoms, number of salbutamol rescues/wk, number of moderate/severe exacerbations, Asthma Control Test score, and lung function), sinonasal outcome parameters (symptoms, number of episodes of acute rhinosinusitis, sinus computed tomography images, nasal polyps endoscopy score), and serum eosinophil levels were analyzed 6 months before and after treatment with omalizumab. RESULTS Twenty-four adult patients were included (9 with documented aspirin intolerance). All respiratory parameters were significantly improved by the treatment. In parallel, a significant improvement was observed in sinonasal clinical outcomes and sinus computed tomography images, with no major effect on the nasal polyps endoscopy score. The serum eosinophil count decreased significantly after 6 months of treatment with omalizumab. CONCLUSION Treatment of SAA with omalizumab improves the outcome of associated CRSNP+, thus supporting the concept of a "one airway disease".
Collapse
Affiliation(s)
- A Tiotiu
- Department of Pulmonology, University Hospital of Nancy, Nancy, France.,EA 3450 DevAH - Development, Adaptation and Disadvantage, Cardiorespiratory Regulations and Motor Control, University of Lorraine, Nancy, France
| | - J P Oster
- Department of Pulmonology, Hospital of Colmar, Colmar, France
| | - P R Roux
- Department of Pulmonology, University Hospital of Besançon, Besançon, France
| | - P L Nguyen Thi
- Centre hospitalier universitaire de Nancy, Plateforme d'aide à la recherche clinique, Nancy, France
| | - G Peiffer
- Department of Pulmonology, Hospital of Metz-Thionville, Thionville, France
| | - P Bonniaud
- Department of Pulmonary Medicine and Intensive Care Unit, University Hospital, Dijon, France.,Inserm, LNC UMR866, LipSTIC LabEx team, Dijon, France.,Bourgogne Franche-Comté University, Dijon, France
| | - J C Dalphin
- Department of Pulmonology, University Hospital of Besançon, Besançon, France.,Franche-Comté University, Besançon, France
| | - F de Blay
- Department of Pulmonology-Allergology, University Hospital of Strasbourg, Strasbourg, France.,University of Strasbourg, Strasbourg, France
| |
Collapse
|
4
|
Blanc FX, Dalphin JC, Chabot F. [Erratum to the abstracts of the scientific communications presented at the 21st Congrès de pneumologie de langue française. January 27-29, 2017, Marseille (France)]. Rev Mal Respir 2017; 34:1040-1042. [PMID: 29126748 DOI: 10.1016/j.rmr.2017.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- F X Blanc
- L'institut du thorax, service de pneumologie, hôpital G.-et R.-Laennec, boulevard Jacques-Monod, 44093 Nantes cedex, France.
| | - J C Dalphin
- Service de pneumologie, hôpital Jean-Minjoz, CHRU de Besançon et UMR, CNRS Chrono-E, université de Franche-Comté, 25000 Besançon, France
| | - F Chabot
- Service des maladies respiratoires et réanimation respiratoire, hôpital de Brabois, CHU de Nancy, rue du Morvan, 54511 Vandoeuvre-Lès-Nancy, France
| |
Collapse
|
5
|
Poble PB, Dalphin JC, Degano B. Severe dyspnea in a patient with neurofibromatosis type 1. Respir Med Case Rep 2017; 22:74-76. [PMID: 28702341 PMCID: PMC5491756 DOI: 10.1016/j.rmcr.2017.06.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Revised: 06/13/2017] [Accepted: 06/14/2017] [Indexed: 11/30/2022] Open
Abstract
Neurofibromatosis type 1 (NF1) is a genetic disease in which pulmonary complications are rare, but severe, especially pulmonary hypertension (PH). The mechanisms underlying the onset of PH in patients with NF1 are unclear and might be multifactorial. In particular, the frequent presence of pulmonary parenchymal lesions makes etiological diagnosis of PH difficult. We describe here the case of a patient with NF1 admitted to our clinic with dyspnea and right heart failure revealing severe pre-capillary PH. Parenchymal lesions were mild and PH was attributed to pulmonary vascular involvement. Clinical and hemodynamic conditions of the patient improved under pulmonary arterial hypertension-specific combination therapy. This case suggests that treatment of PH due to pulmonary vascular involvement in NF1 may be aligned with recommendations for PAH treatment.
Collapse
Affiliation(s)
- P B Poble
- Department of Respiratory Diseases, University Hospital of Besançon, Besançon, France
| | - J C Dalphin
- Department of Respiratory Diseases, University Hospital of Besançon, Besançon, France
| | - B Degano
- Department of Physiology and Respiratory Investigation, University Hospital of Besançon, Besançon, France
| |
Collapse
|
6
|
Tual S, Lemarchand C, Boulanger M, Dalphin JC, Rachet B, Marcotullio E, Velten M, Guizard AV, Clin B, Baldi I, Lebailly P. P054 Lower lung cancer risks among farmers raising cattle and horses in the agrican cohort. Cancer 2016. [DOI: 10.1136/oemed-2016-103951.377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
7
|
Lavaud F, Bonniaud P, Dalphin JC, Leroyer C, Muller D, Tannous R, Mangiapan G, De Blay F. Usefulness of omalizumab in ten patients with severe occupational asthma. Allergy 2013; 68:813-5. [PMID: 23647648 DOI: 10.1111/all.12149] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND The management of severe occupational asthma (OA) remains problematic and new alternative treatments providing better disease control are required, ideally enabling affected individuals to remain in their job. METHODS Ten patients with severe uncontrolled OA were treated with the monoclonal anti-IgE antibody omalizumab. In six cases the causative agent was a high molecular weight (HMW) compound and in four cases it was a low molecular weight (LMW) chemical. All of the patients had well documented OA despite workplace adjustments. RESULTS During treatment, nine patients exhibited a lower rate of asthma exacerbations and used less oral or inhaled corticosteroids. Seven patients were able to continue working at the same workplace as before treatment. CONCLUSION We have demonstrated that omalizumab is a potential treatment for severe uncontrolled OA and enabled seven of the ten patients in the study to remain in their job.
Collapse
Affiliation(s)
- F. Lavaud
- Maladies Respiratoires et Allergiques; CHU; Reims; France
| | - P. Bonniaud
- Department of Respiratory Diseases; CHU; Dijon; France
| | - J. C. Dalphin
- Department of Respiratory Diseases; CHU; Besancon; France
| | - C. Leroyer
- Internal Medicine and Chest Diseases; CHRU De La Cavale Blanche; Brest; France
| | - D. Muller
- Respiratory Diseases; Montigny Les Metz; France
| | - R. Tannous
- Department of Respiratory Diseases; CHG; Forbach; France
| | | | - F. De Blay
- University Hospital; Department of Chest Diseases; Strasbourg; France
| |
Collapse
|
8
|
Roussel S, Sudre B, Reboux G, Waser M, Buchele G, Vacheyrou M, Dalphin JC, Millon L, Braun-Fahrländer C, von Mutius E, Piarroux R. Exposure to moulds and actinomycetes in Alpine farms: a nested environmental study of the PASTURE cohort. Environ Res 2011; 111:744-750. [PMID: 21600574 DOI: 10.1016/j.envres.2011.05.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2010] [Revised: 04/18/2011] [Accepted: 05/04/2011] [Indexed: 05/30/2023]
Abstract
Several studies have suggested that children exposed to a farm environment are protected against allergies and asthma. The present work is an environmental study nested within the PASTURE cohort and includes 97 farmers and 74 non-farmers in three regions of the Alpine Arc (Switzerland, France and Germany). The objectives were to determine and compare the fungi and actinomycetes present in farming and non-farming environments (children's bedrooms and cowsheds), and to identify the agricultural practices associated with an increase in airborne fungi and actinomycetes in cowsheds. Air samples were collected by air pump and were analysed by culture and by direct counting of spores on membranes. During their stay in bedrooms, children living on farms were exposed to significantly greater amounts of Absidia spp., Eurotium spp., Cladosporium spp., Penicillium spp. and mesophilic actinomycetes than children who did not live on farms. Depending on the season, the levels of moulds, yeasts and actinomycetes were from 14 to 82 times higher in cowsheds before feeding the cattle than in children's bedrooms, and from 12 to 464 times higher in cowsheds after feeding than in children's bedrooms. Feeding cattle in cowsheds was associated with a significant peak in airborne moulds and actinomycetes, and this peak was higher in winter than in summer. Silage distribution was associated with low amounts of moulds and actinomycetes. Other significant agricultural factors were the type of cowshed, cowshed volume, method of food distribution to cattle and use of fresh grass. An assessment of the microbiological diversity on farms and in children's rooms may help to determine the factors protecting children from asthma and atopic diseases.
Collapse
Affiliation(s)
- S Roussel
- UMR/CNRS Chrono-Environnement 6249, University of Franche-Comté, 25000 Besancon, France.
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
9
|
Thaon I, Thiebaut A, Jochault L, Lefebvre A, Laplante JJ, Dalphin JC. Influence of hay and animal feed exposure on respiratory status: a longitudinal study. Eur Respir J 2010; 37:767-74. [PMID: 21030452 DOI: 10.1183/09031936.00122209] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Our aim was to study respiratory symptoms and lung function decline in farmers, with particular attention to the influence of handling hay, straw and animal feed. From a cohort recruited in 1993-1994, 219 (82.6%) dairy farmers, 130 (62.5%) nondairy agricultural workers and 99 (66.4%) controls were re-evaluated in 2006. They answered medical and occupational questionnaires, underwent spirometric tests at both evaluations and pulse oximetry in 2006. Dairy and nondairy agricultural workers showed an increased risk for usual morning phlegm (adjusted OR 4.27 (95% CI 1.41-12.95) and 3.59 (95% CI 1.16-11.10), respectively). Animal feed handling was associated with increased risks of wheezing (p = 0.01) and usual morning phlegm (p = 0.04); hay or straw handling was associated with increased risk of wheezing (p = 0.008). Adjusting for smoking, age, height, sex and altitude, dairy farmers had greater declines in forced expiratory volume in 1 s (FEV(1))/forced vital capacity ratio (p = 0.01) than controls. An increased decline in FEV(1) for all agricultural workers was associated with animal feed handling, both measured as a categorical (currently versus never handling; p = 0.05) or quantitative value (years of exposure during the survey period; p = 0.03). Hay, straw or animal feed handling represents a risk factor of bronchial symptoms and, for animal feed only, of accelerated decline in expiratory flows.
Collapse
Affiliation(s)
- I Thaon
- Occupational Diseases Dept, UMR 6249 CNRS/Université de Franche-Comté, Laboratoire Chrono-environnement, France
| | | | | | | | | | | |
Collapse
|
10
|
Abstract
UNLABELLED Our prospective case-control study of 118 dwellings in Eastern France examined fungal contamination in unhealthy dwellings (n = 32) (homes with visible mold contamination and adverse health outcomes reported by the occupants), dwellings occupied by allergic patients (with medical diagnostic and positive prick-tests for molds) (n = 27) and matched control dwellings (n = 59). Unhealthy dwellings present higher airborne concentrations of Aspergillus, Penicillium, and Cladosporium than control dwellings, irrespective of the room sampled. Bedroom walls were more highly contaminated by molds than others. Dwellings occupied by allergic patients differed significantly for airborne concentrations of Penicillium only, but not for wall surface contamination, whereas bathroom walls were more highly contaminated than other rooms. Molecular identification of 12 Penicillium species showed Penicillium chrysogenum and Penicillium olsonii to be the two main species. From the total average of molds, by impaction method, useful thresholds can be given: below 170 CFU/m(3), between 170 and 560 CFU/m(3), 560 and 1000 CFU/m(3) and above 1000 CFU/m(3), respectively for dwellings with low, moderate, high, and very high concentrations. The latter would be considered a potential health hazard. PRACTICAL IMPLICATIONS A single measure of airborne concentrations of molds by impaction allows to establish useful thresholds by social services to estimate in a objective way the housing moldiness. Excluding the summer period, reproducibility of this kind of measure on 3 months, in the fixed limits, is 94.3%. The differences in terms of biodiversity of the unhealthy housing and those accommodating allergic patients imply a specific approach to decrease fungi airborne concentrations. The biodiversity of Penicillium raises the problem of the use of the single extract of Penicillium chrysogenum for skin-tests. The extent of the contaminated surfaces must be measured to assess the potential risk linked to spore contamination. Indeed, surface sampling mostly allows qualitative assessment of the environment.
Collapse
Affiliation(s)
- G Reboux
- Department of Mycology, University Hospital, Besançon, France.
| | | | | | | | | | | | | | | |
Collapse
|
11
|
Dalphin JC. [In the agricultural environment there is asthma and asthma... or the paradox of agricultural asthma]. Rev Mal Respir 2008; 24:1083-6. [PMID: 18176383 DOI: 10.1016/s0761-8425(07)74256-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
12
|
Abstract
INTRODUCTION Hypersensitivity pneumonitis (HP) is a granulomatous disease of the lungs due to immune reactions following chronic inhalation of organic dusts or chemicals especially encountered in the occupational environment. The main purpose of this review is to report current concepts regarding aetiologies, epidemiology, diagnosis, treatment as well as legal aspects of HP. STATE OF THE ART The following aspects will be focused: (1) increase in new etiological circumstances, especially occupational and news antigens, (2) for diagnosis, the major contribution of chest high resolution CT scan which often shows characteristic images but also recent developments in simple diagnostic criteria that may be used for an epidemiological approach, (3) importance of bronchial obstruction and even emphysema as a long term sequelae, finally (4) the possibility of continuing occupational activities in certain circumstances where preventive measures can be used. PERSPECTIVES The increasing knowledge of etiological agents and circumstances as well as the development of secondary and especially primary preventive measures should lead to reduce the frequency of this disease and of its medico-social consequences.
Collapse
Affiliation(s)
- I Thaon
- Service des Maladies Professionnelles, CHU de Besançon, France
| | | | | | | |
Collapse
|
13
|
Ameille J, Dalphin JC, Descatha A, Pairon JC. [Occupational chronic obstructive pulmonary disease: a poorly understood disease]. Rev Mal Respir 2006; 23:13S119-30. [PMID: 17057637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
INTRODUCTION According to several recent population-based studies 15-20% of chronic obstructive pulmonary disease (COPD) is work related. BACKGROUND The occupational fields in which a causal relationship is established are the mining industry, construction and public works, iron and steel, textiles, grain (silo workers), dairy and pig farming. The main causative substances are silica, coal dust, cotton dust, grain dust and endotoxins. VIEWPOINT Knowledge of the occupational causes of COPD is important for both prevention and compensation. CONCLUSIONS The undertaking of a complete and rigorous occupational questionnaire is essential for all patients with COPD.
Collapse
Affiliation(s)
- J Ameille
- Unité de pathologie professionnelle, de santé au travail et d'insertion, Hôpital Raymond Poincaré, AP-HP Garches, France.
| | | | | | | |
Collapse
|
14
|
Dalphin JC, Pairon JC. [Respiratory industrial diseases: common pathologies often unrecognised and under reported]. Rev Mal Respir 2006; 23:13S11-2. [PMID: 17057627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
|
15
|
Venier AG, Chaudemanche H, Monnet E, Thaon I, Fury R, Laplante JJ, Dalphin JC. Influence of occupational factors on lung function in French dairy farmers. A 5-year longitudinal study. Am J Ind Med 2006; 49:231-7. [PMID: 16550561 DOI: 10.1002/ajim.20278] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Dairy farming is associated with a high prevalence of respiratory disorders but the respective influence of occupational exposures, environmental, and individual factors on lung function remain unclear. METHODS In 1994 and 1999, dairy farmers were examined in the Doubs province, France. Spirometric measures and allergological tests were performed. Medical and professional data were obtained by questionnaires. A multiple linear regression analysis was performed. RESULTS An accelerated decline in lung function parameters was associated with age, male sex, traditional farm (as opposed to modern farms), and a high rate of total IgE (P < 10(-2)). Blood oxygen saturation (SpO2) was significantly positively linked with the modernization of the farm and negatively with age, smoking status, and log IgE (P < 10(-2)). Geographical factors (altitude and climatic conditions) had no significant effect. CONCLUSIONS The modernization of the farm has an important and beneficial impact on lung functiony.
Collapse
Affiliation(s)
- A G Venier
- Department of Public Health, Clinical Epidemiology Unit, University Hospital, Besançon, France
| | | | | | | | | | | | | |
Collapse
|
16
|
Dalphin JC, Caillaud D. [Immuno-allergic testing in agricultural professions]. Rev Mal Respir 2006; 23 Suppl 2:4S85-4S86. [PMID: 16823955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Affiliation(s)
- J C Dalphin
- Service de pneumologie, CHU Jean Minjos, Besançon Cedex, France
| | | |
Collapse
|
17
|
Bajard A, Westeel V, Dubiez A, Jacoulet P, Pernet D, Dalphin JC, Depierre A. Multivariate analysis of factors predictive of brain metastases in localised non-small cell lung carcinoma. Lung Cancer 2004; 45:317-23. [PMID: 15301872 DOI: 10.1016/j.lungcan.2004.01.025] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2003] [Revised: 01/25/2004] [Accepted: 01/29/2004] [Indexed: 12/30/2022]
Abstract
Brain metastases are a frequent feature of the course of non-small cell lung carcinoma (NSCLC). The potential usefulness of prophylactic cranial irradiation (PCI) has led to the search for target groups likely to derive benefit. This multivariate analysis looked for factors predictive of brain metastases in a group of stages I-III NSCLC patients under care of the thoracic oncology unit of Besançon University Hospital from 1977 to 2001. All the patients had the same follow-up. They were divided into two groups: BM+ when they had a brain metastasis as the first site of progression, whether solitary or not, and BM(-) otherwise. Variables analysed were age, gender, performance status (0-1 versus 2-3), weight-loss stage T-status, N-status, pathological type, type of treatment, administration of chemotherapy, use of cisplatin and response to treatment. Three hundred and five patients were eligible and there were 77 patients (25.25%) in the BM+ group. Median time to onset of brain metastases was 12 months (1-163 months) and median survival from the diagnosis of brain metastases was 6 months (1-65 months). Factors predictive of brain progression were age < or =62 years (RR: 2.5, 95% CI: 1.33-4.76 and P = 0.004), T4 tumour status (RR: 3.75, 95% CI: 1.72-8.21 and P = 0.0009), N2-3 (RR: 2.61, 95% CI: 1.32-5.15 and P = 0.0057), and adenocarcinoma (RR: 3.39, 95% CI: 1.78-6.46 and P = 0.0002). No aspect of treatment plays a role in the frequency of this type of metastasis. These factors predictive of brain progression could serve as a basis for the selection of patients with the aim of sitting of studies on prophylactic cranial irradiation in NSCLC.
Collapse
Affiliation(s)
- A Bajard
- Department of Respiratory Medicine, University Hospital, Boulevard Fleming, 25030 Besançon Cedex, France
| | | | | | | | | | | | | |
Collapse
|
18
|
Abstract
AIMS To compare wage earner dental technicians with non-exposed salaried subjects for the prevalence of respiratory symptoms and function, and chest x ray abnormalities. METHODS A total of 134 dental technicians and 131 non-exposed subjects participated. A medical and an occupational questionnaire were filled in to evaluate the prevalence of respiratory symptoms and occupational exposures. Subjects underwent respiratory tests and chest x ray examination. RESULTS Mean age of the dental technicians was 36.6 years with a mean duration of dental work of 16.5 years. There was a significant risk of cough (day and night) and usual phlegm in dental technicians. Respiratory function parameters were lower in dental technicians with a significant difference between exposed and non-exposed groups for % FVC (forced vital capacity), % FEF(25) (forced mid expiratory flow), and % FEF(50). The prevalence of small opacities increased with age. Small opacities were significantly related to an exposure to asbestos in the past. CONCLUSIONS Our young population of dental technicians is at risk of respiratory morbidity. They should benefit from adequate technical prevention measures.
Collapse
Affiliation(s)
- S Radi
- Association Comtoise Interprofessionnelle de Médecine du Travail, 5 A rue Victor Sellier, 25041 Besançon Cedex, France.
| | | | | | | | | | | |
Collapse
|
19
|
Dalphin JC. [Toward an improvement in the notification of professional lung cancer: a common action of SPLF-SFMT]. Rev Mal Respir 2002; 19:149-51. [PMID: 12040313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/25/2023]
|
20
|
Gautier-Brun V, Beurton-Chataigner I, Manzoni P, Emonot A, Miguet JP, Dalphin JC, Bresson-Hadni S. [The hepatopulmonary syndrome]. Presse Med 2002; 31:271-80. [PMID: 11883372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/24/2023] Open
Abstract
DEFINITION The hepatopulmonary syndrome (HPS) associates a chronic hepatic affection, hypoxemia < 70 mm Hg and pulmonary vasodilatation. PHYSIOPATHOLOGY The mechanisms leading to pulmonary vasodilatation are complex and unclear. There appears to be an imbalance between the vasodilatating and vasoconstricting mediators. Nitrogen monoxide and endotheline-1 are well known. Hypoxia can be explained by the association of heterogenic ventilation-perfusion, shunts (rare), and a default in "diffusion-perfusion". CLINICAL ASPECTS In a hypoxic patient, platypnoea and orthodeoxia are characteristic of HPS. Stellar angioma associated with digital hippocratism and signs of portal hypertension are usually present. TO PERMIT DIAGNOSIS The air of blood gases, followed by 100% O2, standing and reclining, must be measured in all cirrhotic patients to detect hypoxemia. Contract sonography is the key diagnostic examination. Pulmonary perfusion scintigraphy establishes prognosis. Pulmonary angiography differentiates two groups of patients and, for type II patients, embolization therapy can be proposed. Preliminary data indicate that densitometry, conducted in rigorous conditions, can show pulmonary vasodilatation. Its interest must be confirmed by further studies on larger cohorts of patients. THERAPEUTIC POSSIBILITIES The only efficient treatment of HPS is hepatic transplant (HT). The placing of an intra-hepatic portal systemic shunt can be proposed while waiting for HT, or in certain patients not requiring HT. No medical treatment has demonstrated its efficacy, but better knowledge of the physio-pathologic mechanisms should improve this situation in the future.
Collapse
Affiliation(s)
- V Gautier-Brun
- Service d'Hépatologie et de Soins Intensifs Digestifs, CHRU Jean Minjoz, F25030 Besançon.
| | | | | | | | | | | | | |
Collapse
|
21
|
Dalphin JC. [Occupational chronic obstructive pulmonary disease (COPD)]. Rev Mal Respir 2001; 18:581-3. [PMID: 11924176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
|
22
|
Bourke SJ, Dalphin JC, Boyd G, McSharry C, Baldwin CI, Calvert JE. Hypersensitivity pneumonitis: current concepts. Eur Respir J Suppl 2001; 32:81s-92s. [PMID: 11816827] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Hypersensitivity pneumonitis (HP), or extrinsic allergic alveolitis, is due to a hypersensitivity reaction after repeated inhalation of finely dispersed antigens, mainly organic particles or low molecular weight chemicals. The essence of this disease is an interaction between the host's immune system and external antigen, influenced by both genetic and environmental factors. In susceptible subjects, it leads to a combined type III allergic reaction of Gell and Coombs (with formation of precipitines) and a type IV lymphocytic reaction (with a granulomatous inflammation in the distal bronchioles and alveoli). This review gives an update on epidemiology, antigens, pathogenesis, host susceptibility, environmental factors, clinical features, diagnosis and treatment in HP. The list of aetiological agents is long and new sources of antigens are constantly being identified. Host risk factors are poorly characterized, with the exception of those linked to exposure factors. Environmental factors and cofactors may be critical for the pathogenesis of the disease. HP is not a uniform disease entity, but a complex dynamic clinical syndrome such that different patterns of disease emerge over time. The diagnosis is made from a combination of clinical features, radiographic abnormalities, lung function tests and immunological tests. The use of inhalation challenge tests for the diagnosis has been hampered by the lack of standardization. Antigen avoidance is the key element in the treatment. There is often an apparent beneficial response to corticosteroids, but it may be difficult to distinguish between the effects of treatment, the natural course of the disease and the effect of antigen avoidance.
Collapse
Affiliation(s)
- S J Bourke
- Dept of Respiratory Medicine, Royal Victoria Infirmary, Newcastle-uponTyne, UK
| | | | | | | | | | | |
Collapse
|
23
|
Demedts M, Wells AU, Antó JM, Costabel U, Hubbard R, Cullinan P, Slabbynck H, Rizzato G, Poletti V, Verbeken EK, Thomeer MJ, Kokkarinen J, Dalphin JC, Taylor AN. Interstitial lung diseases: an epidemiological overview. Eur Respir J Suppl 2001; 32:2s-16s. [PMID: 11816822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
Abstract
Epidemiological studies on interstitial lung diseases (ILDs) may be schematically subdivided into the following major types: 1) quantifications of disease, broken down into incidence, prevalence and mortality data; 2) identification of aetiological factors; and 3) clinical epidemiological studies. Epidemiological data may be obtained from different sources or population groups, using different study designs such as systematic national statistics, population-based data and registries, and large case series of specific diseases. Differences in results between epidemiological studies may be due to real differences in incidence, but may also be due to changes in disease definitions and classifications, differences in the epidemiological design of the studies, or even registration bias. Comparative epidemiological data of different ILDs are almost limited to the general population study in Bernalillo County and to national mortality statistics, which should be interpreted with great caution. Also, some, mostly national registries of the different ILDs have been carried out by specific medical profession groups (especially pulmonologists), which clearly underestimate the real incidence of ILDs, but in which the comparison of the relative frequencies is probably accurate. Based on all these comparative studies, sarcoidosis and idiopathic pulmonary fibrosis appear to be the most frequent ILDs, followed by hypersensitivity pneumonitis and ILD in collagen vascular disease, when classical pneumoconioses are not included. There is also a relatively large group of nonspecific fibrosis. Much more data have been published on the epidemiology of specific forms of interstitial lung disease. Most information is available on the epidemiology of sarcoidosis, and those data are probably the most accurate. Data on idiopathic pulmonary fibrosis have the disadvantage of the recent changes in definition and classification of this disease. Hypersensitivity pneumonitis has been studied epidemiologically, especially in some exposure groups such as farmers and pigeon breeders, and in some regions in North America, UK, France and Scandinavia. Estimates of frequencies of interstitial lung disease in collagen vascular disease or of drug-induced interstitial lung disease are less accurate and more variable, depending on diagnostic criteria. Notwithstanding the aforementioned problems, this report tries to provide a balanced overview of the epidemiology of different interstitial lung diseases.
Collapse
Affiliation(s)
- M Demedts
- Pulmonary Division, University Hospital Gasthuisberg, Katholieke Universiteit Leuven, Belgium
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
24
|
Reboux G, Piarroux R, Mauny F, Madroszyk A, Millon L, Bardonnet K, Dalphin JC. Role of molds in farmer's lung disease in Eastern France. Am J Respir Crit Care Med 2001; 163:1534-9. [PMID: 11401869 DOI: 10.1164/ajrccm.163.7.2006077] [Citation(s) in RCA: 102] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Farmer's lung disease (FLD) is common in the east of France. In the absence of the primary recognized FLD agent, Saccharopolyspora rectivirgula, its etiology remains unknown. A prospective case-control study was performed to find the etiology of FLD in this area. Eleven patients were matched with 11 healthy control farmers. Twenty-two urban subjects constituted the nonexposed control group. Microorganisms from cowshed air and fodder were identified and counted. The antigens of the microorganisms most frequently isolated at the 22 farms were used for serological tests. Farms of patients with FLD contained more Absidia corymbifera than those of healthy farmers (p < 0.05 in air, p < 0.01 in fodder). Electrosyneresis, performed with A. corymbifera somatic antigen, differentiated 9 of 11 patients with FLD from control subjects (p < 0.01). Other significant results were obtained with Eurotium amstelodami (p < 0.01) and Wallemia sebi (p < 0.05). In contrast, no significant results were obtained with the other seven antigens tested, including S. rectivirgula. Absidia corymbifera and, to a lesser degree, W. sebi or E. amstelodami are likely to be the main causes of FLD in this area. Modifications in working conditions over time could explain the emergence of these new contributing etiologies.
Collapse
Affiliation(s)
- G Reboux
- Department of Mycology, University Hospital, Besançon, France
| | | | | | | | | | | | | |
Collapse
|
25
|
Dalphin JC. [Diffuse infiltrative lung diseases due to allergy and iatrogenic causes]. Rev Prat 2000; 50:1894-900. [PMID: 11151330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
Iatrogenic and hypersensitivity infiltrative pneumonias comprise 3 distinct entities: extrinsic allergic alveolitis, drug-induced pneumonia and radiation-induced pneumonia. The diagnosis of the latter is usually easy, except for the recently identified postradiation bronchiolitis obliterans organizing pneumonia. Diagnosis of extrinsic allergic alveolitis is based on the association of clinical, radiological, functional, immunological criteria and bronchoalveolar lavage fluid analysis. The polymorphous presentation of drug-induced pneumonia makes its diagnosis critical except for a few causes such as amiodarone pneumonia or lipoid pneumonia.
Collapse
Affiliation(s)
- J C Dalphin
- Service de pneumologie Centre hospitalier universitaire Hôpital Jean-Minjoz 25030 Besançon.
| |
Collapse
|
26
|
Westeel V, Julien S, De Champs C, Polio JC, Mauny F, Gibey R, Laplante JJ, Aiache JM, Depierre A, Dalphin JC. Relationships of immunoglobulins E and G sensitization to respiratory function in dairy farmers. Eur Respir J 2000; 16:886-92. [PMID: 11153588 DOI: 10.1183/09031936.00.16588600] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
An impairment of respiratory function has been demonstrated in dairy farmers. The objective of this study was to evaluate the relationship of allergy to respiratory function in dairy farmers in a longitudinal study conducted in the Doubs (France). A cohort of male dairy farmers constituted in 1990 was re-evalued in 1995. Subjects completed a medical and occupational questionnaire, and a spirometry test in both 1990 and 1995, in 1995 they were also subjected to immunological tests. Relationships between immunological variables and respiratory function were studied by a multiple linear regression model adjusted for age, smoking status, respiratory symptoms, altitude and occupational exposure. Amongst the 394 subjects of the initial cohort, 330 were included in the longitudinal study and 320 had immunological tests. Log immunoglobulin (Ig) E was negatively correlated with the 1995 respiratory function parameters (p<0.05 for forced expiratory volume in one second (FEV1) and FEV1/vital capacity (VC). Immunoglobulin (Ig) G response to Aspergillus fumigatus detected by enzyme-linked immunosorbent assay (ELISA) was negatively correlated to 1995 respiratory function parameters (VC: p<0.01; FEV1: p<0.001; FEV1/VC: p<0.01). There was a positive relationship between IgG antibodies against Aspergillus fumigatus and the mean annual decline in FEV1 (p<0.01) and FEV1/VC (p<0.01). To conclude, allergy may play a role in the impairment of respiratory function in dairy farmers of the Doubs and sensitization to Aspergillus fumigatus seems to constitute an independent risk factor for the development of airflow obstruction in this occupational setting.
Collapse
Affiliation(s)
- V Westeel
- Dept of Chest Diseases, Besançon, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
27
|
Ameille J, Dalphin JC, Pairon JC. [Occupational chronic obstructive pulmonary diseases. Medical-legal aspects, practice management]. Rev Mal Respir 2000; 17:915-22. [PMID: 11131869] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
The existence of occupational chronic obstructive pulmonary diseases (COPD) is now well established. Since 1989, several regulations have been progressively settled, allowing compensation for some cases of COPD.
Collapse
Affiliation(s)
- J Ameille
- Unité de pathologie professionnelle et de santé au travail, Hôpital Raymond-Poincaré, 104, bd Raymond-Poincaré, 92380 Garches.
| | | | | |
Collapse
|
28
|
Gainet M, Chaudemanche H, Westeel V, Lounici A, Dubiez A, Depierre A, Dalphin JC. [A misleading form of hypersensitivity pneumonitis]. Rev Mal Respir 2000; 17:987-9. [PMID: 11131880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023]
Abstract
A 47-year-old woman, without significant past medical history, presented an acute dyspnea with hypoxia, marked pulmonary arterial hypertension (PAH) and signs of right heart failure. Chest x-ray showed a moderate dilatation of the right heart cavities. Pulmonary embolism was suggested. After detailed questioning and complete explorations, a bird hypersensitivity pneumonitis (HP) was demonstrated. This case illustrates a misleading presentation of an acute form of HP consisting of apparently isolated PAH.
Collapse
Affiliation(s)
- M Gainet
- Service de Pneumologie, CHU, bd Fleming, 25000 Besançon
| | | | | | | | | | | | | |
Collapse
|
29
|
Dalphin JC, Pernet D, Hubert C, Pairon JC. [Chronic obstructive lung disease in the agricultural milieu and in textile employees]. Rev Mal Respir 1999; 16 Suppl 3:S33-4. [PMID: 10088233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
30
|
Pairon JC, Pernet D, Hubert C, Dalphin JC. [Chronic obstructive lung disease in the industrial milieu]. Rev Mal Respir 1999; 16 Suppl 3:S34-5. [PMID: 10088234] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
31
|
Ameille J, Dalphin JC, Pairon JC. [Medical-legal management in a suspected occupational chronic obstructive lung disease]. Rev Mal Respir 1999; 16 Suppl 3:S35-7. [PMID: 10088235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2023]
|
32
|
Choma D, Westeel V, Dubiez A, Gora D, Meyer V, Pernet D, Polio JC, Madroszyk A, Gibey R, Laplante JJ, Depierre A, Dalphin JC. [Respective influence of occupational and personal factors on respiratory function in dairy farmers]. Rev Mal Respir 1998; 15:765-72. [PMID: 9923031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/10/2023]
Abstract
Occupational and individual factors influencing respiratory function were analysed in a sample of dairy farmers. The study protocol included a medical questionnaire, an occupational questionnaire, spirometry and allergological tests (skin prick tests for a panel of inhalant allergens, serum total IgE level and Phadiatop (CAP System). Two hundred and forty-five farmers were studied (140 men, 105 women with an average age of 45.9 (11.3) years, 35 were smokers, 27 ex-smokers and 183 non-smokers). A multiple linear regression model was used to analyse the correlations between respiratory function and the different independent variables. There was a statistically significant negative correlations between smoking (expressed in pack-years) and all the respiratory function parameters (p < 0.01). Respiratory function was significantly impaired in farmers working on traditional farms (p < 0.05 for VC and for FEV1), and the respiratory function values increased proportionally with the modernisation of the farms (notably using an artificial barn drying system for hay and a ventilation system for the cow byres). No significant relationship between respiratory function and quantitative indicators of exposure (size of farm, amount of livestock, quantity of hay handled during professional lifetime) or indicators of IgE-mediated allergy was observed. In conclusion, this study suggests that traditional work conditions in farms which have little mechanisation are, along with tobacco, the determining factors for the respiratory function impairment in dairy farmers.
Collapse
Affiliation(s)
- D Choma
- Service de Pneumologie, CHR de Besançon
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Crestani B, Valeyre D, Roden S, Wallaert B, Dalphin JC, Cordier JF. Bronchiolitis obliterans organizing pneumonia syndrome primed by radiation therapy to the breast. The Groupe d'Etudes et de Recherche sur les Maladies Orphelines Pulmonaires (GERM"O"P). Am J Respir Crit Care Med 1998; 158:1929-35. [PMID: 9847288 DOI: 10.1164/ajrccm.158.6.9711036] [Citation(s) in RCA: 95] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Reports of bronchiolitis obliterans organizing pneumonia (BOOP) occurring in women after radiation therapy for breast cancer have suggested that radiation to the lung could participate in the development of BOOP. We now describe the clinical, radiographic, functional, and bronchoalveolar lavage characteristics of this syndrome in a series of 15 patients reported to the Groupe d'Etudes et de Recherche sur les Maladies "Orphelines" Pulmonaires (GERM"O"P) in France. All 15 women (60 +/- 6 yr of age) fulfilled the following inclusion criteria: (1) radiation therapy to the breast within 12 mo, (2) general and/or respiratory symptoms lasting for at least 2 wk, (3) lung infiltrates outside the radiation port, and (4) no specific cause. The patients presented with fever, nonproductive cough, mild dyspnea, and peripheral alveolar opacities on chest radiograph with a characteristic migratory pattern. In five patients, BOOP was found at lung pathologic analysis. In all the patients dramatic improvement was obtained with corticosteroids, but relapses occurred in 12 patients while tapering or after stopping corticosteroids. This report demonstrates that a characteristic BOOP syndrome may occur after radiation therapy to the breast, including tangential radiation to the lung, thus suggesting that radiation therapy may prime the development of BOOP.
Collapse
Affiliation(s)
- B Crestani
- Unité de Pneumologie, Hôpital Bichat, Paris, France
| | | | | | | | | | | |
Collapse
|
34
|
Dalphin JC, Dubiez A, Monnet E, Gora D, Westeel V, Pernet D, Polio JC, Gibey R, Laplante JJ, Depierre A. Prevalence of asthma and respiratory symptoms in dairy farmers in the French province of the Doubs. Am J Respir Crit Care Med 1998; 158:1493-8. [PMID: 9817698 DOI: 10.1164/ajrccm.158.5.9709108] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
With the aim of determining whether dairy farming is associated with an excess of asthma and respiratory symptoms, we compared the respiratory status in a sample of dairy farmers (n = 265) and a control group of nonexposed subjects (n = 149). The study protocol comprised a questionnaire, spirometry, and a bronchodilatation test (400 micrograms salbutamol powder), and an allergological evaluation: serum total IgE level, Phadiatop test, and skin prick tests (SPT) for seven inhalant allergens. Cumulative prevalences of self-reported asthma and of current asthma were respectively 5.3% and 1.5% in farmers, and respectively 3.4% and 1.3% in control subjects (both NS). Prevalences of all the respiratory symptoms studied were higher in farmers, with statistically significant differences after adjusting for age, sex, and smoking, for wheezing ever (OR: 2.7, p < 0.05), wheezing within the last year (OR: 5.2, p < 0.025), usual morning cough (OR: 5, p < 10(-)3), usual morning phlegm (OR: 11.3, p < 10(-)4), and chronic bronchitis (OR: 11.8, p < 0.01). The effect of exposure on these symptoms was more pronounced than, or of the same magnitude as that of smoking. Smoking and exposure had an additive effect except for chronic cough for which a positive interaction was observed (p = 0.05). Mean FEV1/VC (percentage of predicted) was statistically negatively correlated to dairy farming (p < 0.025) after adjusting for confounders. Bronchial obstruction was reversible in about 10% of subjects in both groups. In conclusion, this study mainly demonstrated an excess of respiratory symptoms in dairy farmers which is weak and nonsignificant for asthma, and high for cough, phlegm, and chronic bronchitis. It also suggested that the combined effect of farming and smoking was synergistic on chronic cough.
Collapse
Affiliation(s)
- J C Dalphin
- Departments of Respiratory Disease, Public Health, and Biochemistry, University Hospital of Besançon, Medical Department of the Mutualité Sociale Agricole of the Doubs, Besançon, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
35
|
Dalphin JC. [Respiratory pathology in the agricultural environment]. Rev Prat 1998; 48:1313-8. [PMID: 9781190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
Farmers are usually exposed to a wide variety of noxious organic or chemical substances. This explains why agriculture is probably one of the occupations where prevalences of respiratory diseases are the highest. Some diseases such as extrinsic allergic alveolitis, allergic asthma, silo filler's disease or pesticides-related fibrosis are classic and well described. Others, more recently identified although probably more frequent, remain often unrecognized. This is notably the case of agricultural chronic bronchitis and of organic dust toxic syndrome. Sometimes, these respiratory pathologies are intricate and lead to a complex presentation where signs of irritation or inflammation of the respiratory tract, bronchial hyperreactivity and chronic bronchial obstruction are mixed.
Collapse
Affiliation(s)
- J C Dalphin
- Service de pneumologie Centre hospitalier universitaire, Besançon
| |
Collapse
|
36
|
Dalphin JC, Maheu MF, Dussaucy A, Pernet D, Polio JC, Dubiez A, Laplante JJ, Depierre A. Six year longitudinal study of respiratory function in dairy farmers in the Doubs province. Eur Respir J 1998; 11:1287-93. [PMID: 9657568 DOI: 10.1183/09031936.98.11061287] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A previous study, carried out in 1986 in France, showed the prevalence of respiratory symptoms and of respiratory function impairment to be higher in dairy farmers than in a control group of nonexposed subjects living in a rural zone. In order to confirm the harmful effect of dairy farming, the two groups were re-studied 6 yrs later at the same period of the year. One hundred and ninety-four (77.6%) farmers and 155 (62%) control subjects were available for re-examination. Non-re-evaluated subjects were comparable to re-evaluated subjects for age, sex, smoking and respiratory symptoms and function at initial evaluation. Dairy farmers consistently had more respiratory symptoms and lower levels of respiratory function than did control subjects. In the study populations as a whole, the mean annual decline in vital capacity (VC) and forced expiratory volume in one second (FEV1) was slightly, but nonsignificantly, higher in farmers than in control subjects: in mL x yr(-1) (SD), -43.1 (68.2) versus -37.9 (60.2) for VC and -32.8 (56.7) versus -30 (47.2) for FEV1. There was a positive interaction between farming and age (i.e. duration of exposure in this cohort) on respiratory function decline, and in male subjects aged > or = 45 yrs, dairy farming was associated with an accelerated loss in VC (p<0.05) and FEV1 (p<0.05) after controlling for age, smoking, height and geographic location in a multiple linear regression model. Initial values of respiratory function, age and pack-years smoked (only for VC) were the other variables found to be significant determinants of decline in lung function. In conclusion, this study mainly suggests that dairy farming is associated to a very moderate accelerated loss in respiratory function that increases with duration of exposure and is significant in older male subjects.
Collapse
Affiliation(s)
- J C Dalphin
- Dept of Chest Disease, University of Besançon, France
| | | | | | | | | | | | | | | |
Collapse
|
37
|
Dalphin JC, Dubiez A. [Acute dyspnea: diagnostic trends]. Rev Prat 1998; 48:781-5. [PMID: 11767375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/23/2023]
|
38
|
Mauny F, Polio JC, Monnet E, Pernet D, Laplante JJ, Depierre A, Dalphin JC. Longitudinal study of respiratory health in dairy farmers: influence of artificial barn fodder drying. Eur Respir J 1997; 10:2522-8. [PMID: 9426089 DOI: 10.1183/09031936.97.10112522] [Citation(s) in RCA: 24] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Factors influencing respiratory consequences of dairy farming have not been extensively investigated to date. To evaluate the effects of barn fodder drying on respiratory symptoms and lung function, a 5 yr follow-up study was performed in the Doubs (France). A cohort of male dairy farmers was analysed in 1990. The initial cross-sectional results suggested that barn-drying fodder may protect dairy farmers from lung function impairment. In 1995, 113 barn-drying farmers (92%) and 231 traditional-drying farmers (84%) were re-analysed. Barn and traditional fodder-drying farmers were compared for prevalence of symptoms and spirometric measures of lung function. After controlling for age, smoking status, altitude and cumulative exposure, barn-drying farmers compared to traditional-drying farmers had a lower prevalence of chronic bronchitis (4 versus 10%; p<0.05) and slightly higher values of forced expiratory volume in one second (FEV1) (p=0.06) and FEV1/vital capacity (VC) (p<0.01). Nevertheless, decline of the respiratory function parameters was not significantly different between the two groups. Variables positively and significantly associated to longitudinal decline of lung function parameters were: age (FEV1, FEV1/VC); altitude (VC, FEV1) and chronic bronchitis and dyspnoea at the initial survey (FEV1/VC). Persistence and emergence of chronic bronchitis, dyspnoea and symptoms at exposure were also significantly associated to an acceleration in the annual decline of the respiratory function. In conclusion, the mode of fodder drying does not seem to significantly influence the decline in lung function. Nevertheless, this study confirms the results of the initial cross-sectional analysis and supports the hypothesis that barn drying fodder may have a protective effect on respiratory health in dairy farming.
Collapse
Affiliation(s)
- F Mauny
- Dept of Chest Diseases, University of Besançon, France
| | | | | | | | | | | | | |
Collapse
|
39
|
Dalphin JC. [Chronic obstructive bronchitis in a fodder farming setting]. Rev Mal Respir 1996; 13:575-81. [PMID: 9036502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Respiratory disease in agricultural workers are dominated both in terms of frequency and severity by chronic obstructive long disease. In the Doubs, in dairy cereal farmers, the prevalence of chronic bronchitis in active farm workers is around 10 per cent, and 6 per cent are non-smokers. It is twice the level of the control population of non-exposed subjects. The frequency is most elevated in the men and increases both with age and with altitude. A longitudinal study of male farm workers aged more than 45 has shown that there is an abnormally rapid loss of forced expired volume in one second (FEV1). Two different studies carried out in the Doubs have revealed epidemiological, respiratory function and immunological arguments in favour of immuno-allergic mechanisms. Notably, obstructive chronic bronchitis (OCB) occurs more frequently in agricultural workers with a previous history of farmer's lung or previous sub-acute delayed symptoms in relation to exposure. On the other hand, there are no close links between OCB and the intensity of antigenic exposure (the total quantity of fodder handled). By contrast, there is a relationship between exposure to thermophillic actinomycetes (antigen of farmer's lung) and OCB. The frequency of serum precipitins is most elevated in farm workers with OCB than in asymptomatic agricultural workers. Finally, non-smokers who are suffering from OCB without evidence of farmer's lung, have a respiratory function profile and also alveolar lavage cell pattern characteristic of extrinsic allergic alveolitis after provocation tests to mouldy hay. These arguments are in favour of immuno-allergic mechanisms in the pathogenesis of chronic bronchitis in farm workers which seems to be well differentiated from chronic bronchitis due to smoking.
Collapse
Affiliation(s)
- J C Dalphin
- Service de Pneumologie, Hôpital Saint-Jacques, CHR de Besançon
| |
Collapse
|
40
|
Despaux J, Polio JC, Toussirot E, Dalphin JC, Wendling D. Rheumatoid arthritis and bronchiectasis. A retrospective study of fourteen cases. Rev Rhum Engl Ed 1996; 63:801-8. [PMID: 9010967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Since 1928, 288 cases of rheumatoid arthritis and bronchiectasis have been reported in the medical literature. The interactions between these two conditions and the etiopathogenic mechanisms they involve remain unclear. During a retrospective study of 100 rheumatoid arthritis patients and 80 bronchiectasis patients, we identified 14 additional patients with both conditions. There were 10 females and four males (ratio 2.5/1). Bronchiectasis was confirmed either by computed tomography of the chest or by bronchography. The respiratory manifestations antedated the joint disease in 12 patients, by a mean interval of 28.5 years. An infectious cause was identified in six cases. Neither the age at onset nor the duration of rheumatoid arthritis were influenced by the presence of bronchiectasis. Seven patients had 15 extraarticular manifestations suggesting potentially severe joint disease. The flares of joint and respiratory symptoms were concomitant in six patients. In six patients, the respiratory manifestations worsened after onset of the joint disease. Tests for rheumatoid factors were positive in 73% of cases. Panhypogammaglobulinemia was found in one case. Ten patients underwent lung function tests, which showed evidence of nonspecific obstructive disease. Overall, our findings are consistent with previous reports in the literature. In patients with predisposing immunogenetic factors, bronchiectasis may be involved in the genesis of rheumatoid arthritis.
Collapse
Affiliation(s)
- J Despaux
- Rheumatology Department, Jean Minjoz Hospital, Besançon, France
| | | | | | | | | |
Collapse
|
41
|
Gondouin A, Manzoni P, Ranfaing E, Brun J, Cadranel J, Sadoun D, Cordier JF, Depierre A, Dalphin JC. Exogenous lipid pneumonia: a retrospective multicentre study of 44 cases in France. Eur Respir J 1996; 9:1463-9. [PMID: 8836660 DOI: 10.1183/09031936.96.09071463] [Citation(s) in RCA: 155] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
A nationwide retrospective study of exogenous lipid pneumonia (ELP) was carried out to update the data on this disease, with emphasis on thoracic computed tomography (CT) scan and bronchoalveolar lavage (BAL) findings. The inclusion criteria were: 1) presence of abnormal imaging features compatible with the diagnosis of ELP; 2) presence of intrapulmonary lipids; and 3) exogenous origin of the lipid pneumonia. Forty four cases were included (20 males and 24 females; mean age 62 +/- 11 yrs), of which four were occupational (chronic inhalation of cutting mist or oily vapour in an industrial environment). Thirty of the 40 nonoccupational cases were related to aspiration of liquid paraffin used for the treatment of constipation. A condition possibly favouring oil aspiration or inhalation was present in 34 patients (77%), most commonly gastro-oesophageal reflux (n = 20) and neurological or psychiatric illness (n = 14). Fever (39%), weight loss (34%), cough (64%), dyspnoea (50%) and crepitations (45%) were the most frequent symptoms. BAL was performed in 39 cases: 23% had a lymphocytic alveolitis; 14% neutrophilic alveolitis; and 31% a mixed alveolitis (lymphocytic and neutrophilic). Alveolar consolidations (57%), ground glass opacities (39%), and alveolar nodules (23%) were the most common radiological abnormalities. The changes were bilateral (79%), predominant in the posterior and lower zones of the lobes concerned (74%), hypodense (71%), and spared the subpleural zones (52%). In 13 cases, hypodensity was retrospectively established on CT scan by the presence of a "positive angiogram". This sign may be of diagnostic value when the density measurement is either not possible or not reliable. In conclusion, this study provides an update of the clinical, biological and radiological profile of exogenous lipid pneumonia and, in particular, confirms the diagnostic benefit of computed tomography scan, which revealed bilateral and hypodense changes in a large majority of cases.
Collapse
Affiliation(s)
- A Gondouin
- Dept. of Respiratory Disease, University Hospital of Besançon, France
| | | | | | | | | | | | | | | | | |
Collapse
|
42
|
Dalphin JC, Toson B, Monnet E, Pernet D, Dubiez A, Laplante JJ, Aiache JM, Depierre A. Farmer's lung precipitins in Doubs (a department of France): prevalence and diagnostic value. Allergy 1994; 49:744-50. [PMID: 7695064 DOI: 10.1111/j.1398-9995.1994.tb02097.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
In a French region where farmer's lung (FL) is common, we determined the prevalence of FL precipitins in dairy farmers and analyzed the relation between the presence of FL precipitins and the clinical probability of the disease. All the exposed dairy farmers of both sexes (n = 2555) from five districts of the Doubs department were asked to respond to a medical and professional questionnaire. A total of 1763 (69%) farmers agreed to participate. Precipitins tests were conducted in 551 (31%) farmers who showed any respiratory symptom and in a random sample of 100 asymptomatic farmers. Serum for each farmer was analyzed by both double diffusion and immunoelectrophoresis against Micropolyspora faeni (MF) and extracts of moldy hay (HE) from Doubs. The 651 farmers were then divided into four groups (G 1-4) with a decreasing probability of FL (G1: typical FL symptoms; G4: asymptomatic farmers). The estimated prevalence of precipitins in the whole population was as follows: 1) by double diffusion, against HE: 83%, against MF: 27%; 2) by immunoelectrophoresis, against HE: 26%, against MF: 19%. There was a close "linear" relation between the prevalence of precipitins detected by immunoelectrophoresis against HE and the symptoms: 51% in G1, 36% in G2, 29% in G3, and 13% in G4. Precipitins detected by immunoelectrophoresis were also related to exposure and geography (more immunization in tableland area than in plain or mountain area). Presence of precipitins detected by double diffusion was not related to symptoms, exposure, or geography.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- J C Dalphin
- Department of Respiratory Disease, CHRU of Besançon, France
| | | | | | | | | | | | | | | |
Collapse
|
43
|
de Wazières B, Fest T, Dalphin JC, Ranfaing E, Capellier G, Dupond JL. [Osteochonroplastic tracheopathy associated with dermatomyositis: apropos of a case]. Rev Med Interne 1994; 15:121-3. [PMID: 8059118 DOI: 10.1016/s0248-8663(05)81185-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
We report a case of a 35 year-old-man with dermatomyositis associated with tracheopathia osteoplastica. The swallowing perturbation secondary to myositis and airway involvement by tracheopathia induced fatal outcome. Tracheopathia osteoplastica is a rare disease and occurs exclusively in men over the age of 50. The association of two rarest disease is not a fortuitous event. The common pathogenic factor may be, in this case, the occupational exposure to silicon.
Collapse
Affiliation(s)
- B de Wazières
- Service de médecine interne, immunologie clinique et gériatrie, CHU Jean-Minjoz, Besançon, France
| | | | | | | | | | | |
Collapse
|
44
|
Dalphin JC, Polio JC, Pernet D, Maheu MF, Toson B, Dubiez A, Monnet E, Laplante JJ, Depierre A. Influence of barn drying of fodder on respiratory symptoms and function in dairy farmers of the Doubs region of France. Thorax 1994; 49:50-3. [PMID: 8153940 PMCID: PMC474086 DOI: 10.1136/thx.49.1.50] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
BACKGROUND A previous study showed there to be fewer microorganisms (especially thermophilic actinomycetes) on farms with artificial barn drying of fodder than on those using traditional storage methods. A cross sectional study was performed to see whether barn drying provides protection against respiratory problems in dairy farmers. METHODS The respiratory symptoms and function of a group of 123 farmers with daily exposure to cattle foddering from farms which had had a barn drying system for at least three years were compared with those of a representative sample of 274 farmers working in farms with traditional storage in five districts in the Doubs region of France. RESULTS Both groups were comparable for mean age, weight, height, smoking habits, alcohol consumption, past history of respiratory disease, history of allergy, geographical location of the farm, and length of exposure. Retrospectively estimated exposure to fodder was greater in the group using a barn drying system than in the group working with traditional storage. Acute symptoms at exposure (rhinitis, eye irritation, dry cough, asthma symptoms) and chronic symptoms all tended to be less frequent in the barn drying group, although not individually significantly so. Mean (SD) respiratory function parameters were higher in the barn drying group than in the traditional group: % vital capacity (VC) 104 (14) v 102 (15); % forced expiratory volume in one second (FEV1) 99 (14) v 94 (18); % FEV1/VC 96 (11) v 92 (16); % forced mid expiratory flow (FEF25-75) 87 (24) v 79 (25). CONCLUSION The results of this cross sectional study suggest that barn drying of fodder may protect respiratory function in dairy farmers.
Collapse
Affiliation(s)
- J C Dalphin
- Department of Respiratory Disease, Centre Hospitalier Universitaire, Besançon, France
| | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Dalphin JC, Debieuvre D, Pernet D, Maheu MF, Polio JC, Toson B, Dubiez A, Monnet E, Laplante JJ, Depierre A. Prevalence and risk factors for chronic bronchitis and farmer's lung in French dairy farmers. Br J Ind Med 1993; 50:941-4. [PMID: 8217855 PMCID: PMC1035525 DOI: 10.1136/oem.50.10.941] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
The prevalence of chronic bronchitis and of clinical farmer's lung was studied in 30 districts of the French Doubs province in relation to individual (age, sex, smoking) and geographical (altitude) factors. 5703 exclusively dairy farmers (response rate 83%) participated in the study by answering a medical questionnaire. Prevalences of chronic bronchitis and clinical farmer's lung were 9.3% and 1.4% respectively. A logistic regression model was used to evaluate risk factors for chronic bronchitis and clinical farmer's lung. A risk of chronic bronchitis was associated with male sex (p < 10(-4)), age (p < 10(-4)), smoker category (p < 10(-4)), and altitude (p < 10(-4)). A risk of clinical farmer's lung was associated with non-smokers (p < 0.05), and linearly with altitude (p < 10(-4)). Also there was a strong positive relation between chronic bronchitis and clinical farmer's lung (odds ratio 19.5 (95% confidence interval 12.1-31.4) after adjustment for confounding variables. The main finding of this study is the highly significant increase of prevalence of the diseases in relation to altitude.
Collapse
Affiliation(s)
- J C Dalphin
- Department of Respiratory Disease, CHR of Besançon, France
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
Dalphin JC, Pernet D, Dubiez A, Debieuvre D, Allemand H, Depierre A. Etiologic factors of chronic bronchitis in dairy farmers. Case control study in the Doubs region of France. Chest 1993; 103:417-21. [PMID: 8432130 DOI: 10.1378/chest.103.2.417] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Relationships were investigated between chronic bronchitis and plant dust exposure assessed by quantification of barn threshing and cattle foddering and chronic bronchitis and acute respiratory syndromes after plant mold dust exposure. Two groups of male dairy farmers were studied in the Doubs region, France: 197 with chronic bronchitis and 163 control subjects without chronic bronchitis. There was no relationship between chronic bronchitis and exposure. Thirty-three chronic bronchitis patients had semidelayed respiratory syndromes (SDRS) vs two control subjects. Twenty-seven times out of 33 (16 of 17 in the nonsmokers), the SDRS preceded chronic bronchitis. Past history of acute respiratory syndromes during barn threshing (RSBT) was more frequent in chronic bronchitis; RSBT always preceded chronic bronchitis. It is concluded that host factors are important in chronic bronchitis and that acute effects after exposure may be predisposing factors to chronic bronchitis.
Collapse
Affiliation(s)
- J C Dalphin
- Department of Chest Diseases, Centre Hospitalier Régional de Besançon, France
| | | | | | | | | | | |
Collapse
|
47
|
Cordier JF, Chailleux E, Lauque D, Reynaud-Gaubert M, Dietemann-Molard A, Dalphin JC, Blanc-Jouvan F, Loire R. Primary pulmonary lymphomas. A clinical study of 70 cases in nonimmunocompromised patients. Chest 1993; 103:201-8. [PMID: 8417879 DOI: 10.1378/chest.103.1.201] [Citation(s) in RCA: 235] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
We studied 70 patients with biopsy-proven pulmonary non-Hodgkin's lymphomas without extrathoracic involvement or mediastinal adenopathy to determine the clinical, imaging, and endoscopic features of this condition in a homogeneous series. In low-grade (LG) lymphomas, symptoms were cough, dyspnea, chest pain, hemoptysis. Imaging features consisted of localized alveolar opacities, infiltrative diffuse opacities, atelectasis, and pleural effusions. Inflammatory changes of the mucosa were present in some patients, leading to bronchial stenosis in 7; biopsies showed lymphomatous infiltration in 12. Prognosis of LG lymphomas was excellent, with 93.6 percent survival at five years. High-grade lymphomas differed from LG lymphomas principally by a more aggressive course and a worse survival. Inflammatory changes occurred in seven of nine cases leading to stenosis in two, and biopsies showed lymphomatous involvement in five. The profile of primary pulmonary lymphomas in this study could help clinicians consider this condition and prompt them to evaluate new diagnostic tools.
Collapse
MESH Headings
- Adult
- Aged
- Bronchoalveolar Lavage Fluid/pathology
- Bronchoscopy
- Combined Modality Therapy
- Female
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/pathology
- Lung Neoplasms/therapy
- Lung Volume Measurements
- Lymphoma, B-Cell/pathology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Non-Hodgkin/diagnostic imaging
- Lymphoma, Non-Hodgkin/pathology
- Lymphoma, Non-Hodgkin/therapy
- Male
- Middle Aged
- Retrospective Studies
- Survival Rate
- Tomography, X-Ray Computed
Collapse
Affiliation(s)
- J F Cordier
- Hôpital Cardiovasculaire et Pneumologique, Claude Bernard University, Lyon, France
| | | | | | | | | | | | | | | |
Collapse
|
48
|
Dalphin JC. [Extrinsic allergic alveolitis in agricultural environment]. Rev Prat 1992; 42:1790-6. [PMID: 1480939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The term extrinsic allergic alveolitis involves a group of interstitial and alveolar lung diseases with an immunoallergic mechanism. These diseases are associated with chronic inhalation of usually organic particles and therefore encountered almost exclusively in an agricultural environment. The most frequent and best known of them is the farmer's lung disease and therefore is largely described by the authors. Specific points concerning pigeon breeder's disease and cheese worker's disease, are also reviewed since they are quite frequently observed in France. The diagnosis is difficult because the radiological and functional abnormalities are transient and the signs of immunization in serum and alveoles are unspecific. This problem is developed here, and a practical diagnostic approach is suggested. Treatment is essentially preventive and includes modifications of the working tools and work conditions in order to reduce exposure to airborne pathogenic antigens.
Collapse
Affiliation(s)
- J C Dalphin
- Service de pneumologie, centre hospitalier régional, Besançon
| |
Collapse
|
49
|
Dalphin JC, Pernet D, Reboux G, Martinez J, Dubiez A, Barale T, Depierre A. Influence of mode of storage and drying of fodder on thermophilic actinomycete aerocontamination in dairy farms of the Doubs region of France. Thorax 1991; 46:619-23. [PMID: 1948788 PMCID: PMC463340 DOI: 10.1136/thx.46.9.619] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Airborne contamination by thermophilic actinomycetes, micromycetes and Gram negative bacteria was determined on 34 dairy farms and related to fodder drying and storage methods. Eighteen farms had a barn drying system, eight with additional heating; the remaining 16 had traditional fodder storage methods. Three air samples were obtained for each farm with a six stage Andersen sampler. The thermophilic actinomycetes were identified as Streptomyces and the dominant micromycetes as Aspergillus spp; there was no relation between the levels of these organisms. There were fewer thermophilic actinomycete colonies per Petri dish (stage 5 on the Anderson sampler) on farms with barn drying than on those with traditional storage (median (range) 7 (0-2628) and 56 (4-2628) respectively). The three farms where no thermophilic actinomycetes were found had barn drying with heating and the four most modern farms had lower thermophilic actinomycete colony counts than the others (median (range) 3 (0-10) and 48 (0-2628)). The level of thermophilic actinomycetes and, to a lesser degree, of micromycetes was higher where the farmer had farmer's lung. Thermophilic actinomycetes of the genus Streptomyces are probably the antigens associated with farmer's lung in the Doubs, and modern farms with barn drying and heating furnish some protection against this disease.
Collapse
Affiliation(s)
- J C Dalphin
- Department of Chest Diseases, Centre Hospitalier de Besançon, France
| | | | | | | | | | | | | |
Collapse
|
50
|
Duche JC, Joanne C, Barre J, de Cremoux H, Dalphin JC, Depierre A, Brochard P, Tillement JP, Bechtel P. Lack of a relationship between the polymorphism of debrisoquine oxidation and lung cancer. Br J Clin Pharmacol 1991; 31:533-6. [PMID: 1888620 PMCID: PMC1368471 DOI: 10.1111/j.1365-2125.1991.tb05575.x] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
1. Determination of debrisoquine oxidation phenotype was carried out in 119 healthy subjects, 135 patients with chronic bronchitis and 153 patients with lung cancer, all of Caucasian origin. 2. A non-Gaussian distribution of the log D/HD ratio was observed in the three groups. 3. Assuming an antimode of 1.12, the proportion of PMs was found to be 6.7% in healthy subjects, 8.9% in chronic bronchitics and 6.5% in patients with lung cancer. These differences were not significant. 4. The presence of a lung tumour itself had no influence on phenotype in a group of 14 patients who were phenotyped before and after surgery. 5. We conclude that a link between debrisoquine phenotype and lung cancer is unlikely.
Collapse
Affiliation(s)
- J C Duche
- Laboratoire hospitalo-universitaire de Pharmacologie, Creteil, France
| | | | | | | | | | | | | | | | | |
Collapse
|