[Pollinosis: drug treatments]

The medical treatment of allergic rhino-conjunctivitis involves different classes of drugs administered locally or by general route. They belong to three main classes, antihistamines, steroids and mast cell stabilizers. Since it is a relatively benign and also highly common disease, treatment options are limited by possible, even mild, side effects and by cost efficacy restriction. In the more severe forms of the condition, treatment efficacy remains unsatisfactory.

Un cas d’aspergillome associé à une bronchite aspergillaire traités par voriconazole

INTRODUCTION

Aspergillus fumigatus is a ubiquitous soil-dwelling organism, which can cause both aspergillomas which develop in a preformed lung cavity, and aspergillus bronchitis. The two pathologies can occasionally co-exist, notably in patients with of cystic fibrosis.

CASE REPORT

We describe a 57 year old patient, with diffuse bronchiectasis, who developed aspergillus bronchitis as well as an aspergilloma complicating a cavity caused by an atypical mycobacterial infection. After one month of therapy with voriconazole the aspergilloma had decreased in size and the endobronchial changes had resolved.

CONCLUSION

This case report illustrates that in addition to its established role for the treatment of invasive aspergillosis, voriconazole is a promising new therapy for the treatment of aspergilloma and aspergillus bronchitis.

Association between major histocompatibility complex class II DRB alleles and parasite load in the hairy-footed gerbil, Gerbillurus paeba, in the southern Kalahari

We investigated the importance of the MHC-constitution (major histocompatibility complex-constitution) on the endoparasite load in free-range hairy-footed gerbils (Gerbillurus paeba) in the southern Kalahari Desert. While the number of alleles of the duplicated DRB exon 2 gene had no significant effects on the individual status of being 'not infected' or 'infected' and on the number of helminth morphotype infections per individual, it significantly affected the faecal egg count values. One allele (Gepa-DRB*15) was only found in uninfected mice. Our results support the hypotheses that MHC polymorphism in G. paeba is maintained by pathogen-driven selection. The present study is the first investigation on associations between duplicated DRB gene loci and the parasite load in mammals.

[Consumption of allergy medicines in 2000 and 2001: data from 12 Primary Medical Insurance Offices (CPAM) in the Rhône-Alpes region]

OBJECTIVES

Comparison of the annual consumption of different classes of antiallergy medicines in the Rhône-Alpes region and as a function of the pollen calendar.

MATERIAL AND METHODS

Exhaustive review, over all the beneficiaries of the general system of social security aged from 6 to 65 years, of the number of weekly supplies: non-cholinergic oral antihistamines (antiH1), anti-allergy nasal sprays, anti-allergy eye lotions, delayed release injectable orticosteroids. In the twelve Primary Offices of Medical Assurance of the Rhône-Alpes region for the years 2000 and 2001. The results are expressed as the number of units (boxes)/100 beneficiaries.

RESULTS

The principal reports are: Consumptions vary in a parallel way between the different regions with a south > north and plain > mountain gradient between the different therapeutic classes (per os > local administration); a fluctuation closely linked to the presence of allergizing pollens: ragweed is responsible for high consumption in all the departments except the two Savoie. The observed peak of pollinization of birch in 2001 was associated with a peak of deliveries. These data confirm the value of data of medicines consumption both economically and medically.

[Pollinosis and use of anti-allergic drugs: ragweed in the Rhone-Alpine region]

Ragweed pollinosis was first described in the middle Rhône valley in the early sixties. Prevalence has increased steadily since that time. The aim of the present study was to determine whether this phenomenon is perceptible in terms of anti-allergic drug sales (eye drops, nasal spray, oral antihistamines) and if so, to compare sales with those related to hay fever. For this purpose, monthly sales in July, August and September were compared between an area of high infestation, a control area and national data for France. The comparisons showed a steep rise in sales for all kinds of anti-allergic drugs related to ragweed pollens, the level being comparable with that observed for gaminaceae. Surprisingly we were unable to find this type of data in the literature despite the evident usefulness of an epidemiological and economical analysis of the progression of pollen allergy.

[Neoadjuvant chemoradiotherapy and peroperative radiotherapy for non-small-cell lung cancer of the apex. A study of 5 cases]

The management of superior sulcus tumors with Pancoast 's syndrome is not well defined, especially in view of their low frequency. Even if surgery performed by "en bloc" resection of the tumor and the chest wall is recommended, neoadjuvant treatment could have a potential benefit on the resecability and pain control. We report five cases of Pancoast tumors (NSCLC), treated by radiotherapy and chemotherapy before surgery. Four tumors was on stage IIIb. A regimen with radiotherapy (50 Gy) and chemotherapy (cisplatinum + etoposide) was initially performed. Four tumors were resected, with 2 complete pathologic responses and good control on pain. Three patients received radiotherapy during surgery. No toxic reaction was observed. This regimen may be discussed with locally advanced tumors and poor prognosis.

Identification of profilin as an IgE-binding component in latex from Hevea brasiliensis: clinical implications

Considering the high occurrence of profilin as an allergen in many plant species, the assumption was made that profilin might be an allergen in Hevea brasiliensis, a member of the latex producing Euphorbiaceae family. Using IgE-binding inhibition by purified profilins we demonstrated that profilin is an IgE-binding component in the cytosolic fraction of natural latex and, to a lower extent, in the rubber fraction. Thirty-five out of 36 sera containing IgE to ragweed-profilin reacted with profilin from latex, indicating structural homologies between profilins from latex and ragweed. A large percentage (59%) of these sera were found to be positive in CAP latex assay. The preincubation of these sera with purified ragweed profilin greatly inhibited the CAP latex. Because profilin is also present in banana extract, it is likely to be involved in cross-sensitivity to banana and latex. In a group of 19 individuals allergic to latex only two had anti-profilin IgE antibodies. Profilin was barely detectable on glove extract immunoblots, whereas some sera from patients allergic to latex reacted with a 15 kDa allergen which was not profilin. Consequently, IgE antibodies to latex-profilin is a questionable factor for sensitization of occupationally-exposed patients; however, sensitization to profilin should be taken into account when interpreting the results of latex IgE antibody assays.

HIV infection and tuberculosis: an epidemiological study from a French register

SETTING

The possible impact of the human immunodeficiency virus (HIV) infection on the epidemiology of tuberculosis has never been studied in a general French population.

OBJECTIVE

To describe the evolution of tuberculosis incidence from 1983 to 1991 in a French district (Rhône) and to assess its relationships to HIV-related factors, and to determine the prevalence of HIV infection among adult tuberculosis patients registered from 1989 to 1991.

DESIGN

Information on sex, age, country of birth and the history and site of tuberculosis was derived from notification forms, and information on HIV testing was collected especially for this study.

RESULTS

During these nine years, 2916 tuberculosis cases were registered. The incidence increased in 1991 after a slow decline in previous years. An analysis of the evolution in the distribution of cases did not suggest any effect of HIV infection on the epidemiology of tuberculosis, with the exception of an increase in the proportion of patients originating from the Antilles and sub-Saharan Africa. The conservative estimate of prevalence of HIV infection was 9.8% in young adult patients.

CONCLUSION

The overlap between the population with HIV infection and that with tuberculosis seems to be small and restricted to particularly vulnerable sub-groups of the population of this region.

Accumulation of pefloxacin in the lower respiratory tract demonstrated by bronchoalveolar lavage

The in-vivo pulmonary disposition of pefloxacin in alveolar macrophages alveolar macrophages and in the alveolar epithelial lining fluid recovered by bronchoalveolar lavage was studied in 10 healthy volunteers. Bronchoalveolar lavage was performed either 2 or 4 h after oral intake of 800 mg of the drug. The recovered fluid was immediately centrifuged and processed for the assays. Pefloxacin was assayed by High Pressure Liquid Chromatography (HPLC) and by a microbiological method. The mean concentrations of pefloxacin assayed by HPLC were 106 +/- 11.1 mg/L in alveolar macrophages and 88.2 +/- 10 mg/L in the epithelial lining fluid, whereas the mean serum concentration was 6.67 +/- 0.47 mg/L. Therefore, pefloxacin accumulated rapidly in human alveolar macrophages. The high epithelial lining fluid concentrations may be attributed to lipophilicity of the drug and to rapid diffusion from blood, pulmonary cells and interstitium during the bronchoalveolar lavage procedure. The substantial accumulation of pefloxacin in alveolar components (alveolar macrophages and epithelial lining fluid) endorses its use in the treatment of intracellular bacterial infections such as legionellosis; for these diseases, pefloxacin represents an alternative to the macrolide antibiotics.

In-vitro concentration of azithromycin in human phagocytic cells

The in-vitro intraphagocytic uptake and retention of azithromycin in both human polymorphonuclear leucocytes (PMN) and alveolar macrophages was measured by an improved high-performance liquid chromatography (HPLC) method that was approximately three-fold more sensitive than previous methods. Azithromycin was accumulated in PMN and alveolar macrophages (about 300-fold), with maximum uptake being obtained after incubation for 60 min. Azithromycin was eliminated only partially from the cells during the washing process, and was released slowly during re-incubation of phagocytic cells in antibiotic-free medium. This intracellular retention distinguishes azithromycin from most of the macrolides and quinolones which, in spite of high I/E ratios, are released rapidly from cells.

[Biological and clinical prevalence of pollinosis caused by ragweeds of the upper valley of the Rhône corridor]

An epidemiological study of ragweed allergy was conducted on 646 employees belonging to 6 factories located in the Rhone valley south of the city of Lyon. Information on seasonal evocative clinical symptoms was obtained through a self-administered questionnaire. Biological prevalence was assessed by measuring anti-ragweed IgE specific antibodies. Measurements were performed by immunoenzymatic assay (W1 Phadezym RAST from Pharmacia). 34 (5,4%) subjects had evocative symptoms whereas 37 (5,9%) had increased specific IgE. Persons with the highest IgE levels were symptomatic. Concordance between symptoms and biology was 35% (12/34). Results indicate that sensitization level varies according to the location of the factory and people's residence, the risk to become allergic being of 10% in the most exposed population. This data emphasize the need to promote anti-ragweed eradication policy.

[Penetration of antibiotics in alveolar macrophages compared by in vitro and in vivo data in man]

Optimal therapy of infections caused by intracellular organisms requires an active antibiotic prone to intracellular penetration. This phenomenon has been studied on alveolar macrophages as well in vitro as in vivo for most groups of antibiotics. The comparison of data shows that the values obtained by incubation are not predictive of what happens in situ. These results must be taken in account for the choice of an antibiotic in pulmonary infections as well as its spectrum, pharmacokinetic, and possible side effects.

Stabilization of atlantoaxial instability

Eight patients with atlantoaxial instability were treated by arthrodesis of the first and second cervical spine. Internal fixation was achieved by passing two 18 gauge stainless steel wires beneath the posterior arch of the atlas and around a threaded Steinmann pin which was drilled through the base of the spinous process of the axis. The wires were tightened over a preshaped iliac bone graft. A solid fusion was achieved in all patients. The risk of compression of the cord is decreased with this technique because the wires are not passed under the lamina of the axis. The lateral placement of the wires provides an excellent internal fixation and control of the forward flexion and rotation.

Josamycin pulmonary penetration determined by broncho-alveolar lavage in man

Macrolide antibiotics are concentrated by phagocytic cells in vitro. We studied the in-vivo uptake of josamycin by alveolar macrophages recovered by broncho alveolar lavage performed in patients 3 h after ingestion of 1 g of the drug. Simultaneous determination of the antibiotic levels was performed on the BAL supernatant and the serum and the results compared to those obtained by incubating alveolar macrophages and blood polymorphonuclears at 2 and 8 mg/l. Josamycin concentration was measured using a high pressure liquid chromatography method. Results show that intracellular josamycin levels in vivo are similar to those observed in vitro. Accumulation of the drug also occurs in BAL fluid (reaching about a 100-fold the serum concentration). Pulmonary and serum levels are significantly correlated.

Spiramycin uptake by alveolar macrophages

The in-vitro and in-vivo uptake of spiramycin by human and animal alveolar macrophages was studied. In-vitro penetration was studied in guinea pig and human alveolar macrophages incubated in medium 199 at 37 degrees C containing spiramycin at various concentrations. Results were expressed as the cellular/extracellular concentration ratio (C/E). The in-vivo study was performed in patients receiving 500 or 1000 mg spiramycin every 8 h as a 1-h infusion on day 1. A single infusion was given on day 2, 2 h before serum and bronchoalveolar lavage (BAL) sampling. Spiramycin was assayed by HPLC, and by a microbiological assay. In guinea pig alveolar macrophages, the C/E ratio of spiramycin after 60 min at 37 degrees C was 20.3 +/- 6.5 when the concentration was 10 mg/l. In human alveolar macrophages, the C/E ratio was 21.3 +/- 8.7 at 5 mg/l spiramycin and 23.8 +/- 8.7 at 50 mg/l. The accumulated spiramycin was slowly released when the cells (guinea pig alveolar macrophages) were washed and re-incubated in antibiotic free medium. Spiramycin was able to penetrate the alveolar space. In BAL supernatant, spiramycin levels were about 24-fold the serum level (n = 6 patients), when the BAL/serum glucose ratios were used as the dilution estimate. Alveolar macrophage levels ranged from 17 to 210 mg/l (n = 6 patients receiving 500 mg spiramycin infusion). These results are consistent with the in-vitro data.

Determination of rifampicin, desacetylrifampicin, isoniazid and acetylisoniazid by high-performance liquid chromatography: application to human serum extracts, polymorphonucleocytes and alveolar macrophages

A method for the determination of rifampicin, desacetylrifampicin, isoniazid, and acetylisoniazid by high-performance liquid chromatography and using the same extract of the same sample is reported. After protein precipitation and extraction of these antituberculous drugs, two reversed-phase chromatographies were necessary. The technique was applied to serum extracts, polymorphonucleocytes and alveolar macrophages from patients treated for tuberculosis.

Angiotensin converting enzyme in bronchoalveolar lavage fluid in pulmonary sarcoidosis

Alveolar angiotensin converting enzyme (ACE) and serum ACE were measured simultaneously in 16 patients with histologically confirmed sarcoidosis and in 16 control subjects. Although alveolar ACE was abnormally elevated in all 15 cases of active sarcoidosis, serum ACE was not. No correlations were found between radiographic staging of pulmonary sarcoidosis and the levels of these enzymes. There was a clear correlation, however, between the levels of alveolar ACE and counts made on bronchoalveolar lavage fluid. This correlation was closer than that existing between serum ACE and bronchoalveolar lavaged lymphocytes. It is suggested that alveolar ACE is an additional biological marker of pulmonary sarcoidosis which is possibly more sensitive than serum ACE.