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A patient with positive smear tuberculosis infects approximately 50% of his domestic contacts; post-primary morbidity may reach 10% of the cases infected under the age of 24 years. Infection rate among professional and social contacts is low and the morbidity much lower. Smear-positive tuberculous patients develop the disease in a few months, therefore indiscriminate case finding is not effective in disclosing patients before they are infectious. Smear-negative, culture-positive patients do not play a role as far as epidemiology is concerned. Prognostic significance of tuberculin conversion depends upon the duration and closeness of the contact with the infectious patient, and chemoprophylaxis of infected contacts reduces post-primary morbidity. Chemotherapy of smear-positive patients suppresses infectiousness in a few weeks, where it lasted for several months previously. Therefore hospitalization of treated patients does not afford additional protection to contacts, and disinfection is superfluous. In a country where tuberculosis prevalence is low, the influence of BCG vaccination in decreasing morbidity can hardly be demonstrated. The three main antituberculous measures remain case-finding of smear-positive patients, identification of infected domestic contacts, and their treatment.

Three observations are adduced to illustrate the relative importance of clinical and immunologic data and the patient's history in the diagnosis of allergic lung disorders. A case of sensitization to vineyard pollen has been identified by intradermal test and the effect of specific hyposensitization.

In 21 patients with asymptomatic respiratory sarcoidosis, 11 with hilar lymph node enlargement (stage I) and 10 with both hilar and lung involvement (stage II), pulmonary function tests revealed that the closing volume was increased as compared with control values obtained from healthy individuals of the same age and smoking habits. The difference was statistically significant but more pronounced in stage II patients than in stage I patients. Other function tests were normal (VC, FEV1, MMF, RV, TLC, DLCOSB).

The clinical signs produced by the respiratory movements reveal the main patho-physiological types in patients with chronic obstructive lung disease. Roentgenological signs do not correlate with the severity of ventilatory disorders and pre-capillary hypertension. Conversely the roentgenological signs of the post-capillalry hypertension are precocious and reliable.

Oxygen arterial partial pressure (PaO2) has been measured in 38 patients with idiopathic spontaneous pneumothorax (ISP) and in 20 of them 8-9 days after full expansion of the lung within 1-3 days by aspiration through chest tube drain. The PaO2 was initially 69.0 +/- 9.6 Torr (predicted value 99.6 +/- 6.6 Torr, p < 0.01) and the alveolo-arterial O2 pressure (AaDO2) difference was 28.2 +/- 8.9 Torr (pred. val. 8.6 +/- 2.5 Torr, p < 0.05). PaO2 in complete ISP (25 cases) was 65.6 +/- 6.9 Torr and in incomplete ISP 74.3 +/- 11.1 Torr (p < 0.01). PaO2 difference between initial values (64.6 +/- 7.4 Torr) and after full expansion of the lung (77.6 +/- 10.0 Torr), as measured in 20 cases and AaDO2 difference (27.5 +/- 9.8 Torr and 15.33 +/- 10.5 Torr), were statistically significant with p < 0.01). The hypoxemia still observed after full expansion of the lung may be explained by the persistent small airway closure possibly due to increased surface tension and the subsequent transsudation still present in some peripheral air spaces.

44 out of 50 patients with idiopathic fibrosing alveolitis were followed up from 1 month to 11 years (mean 2 years 9 months). One patient out of 13 (8%) with 4 symptoms or fewer (mean follow-up 55 months) died. 23 out of 31 (74%) with 5 symptoms or more (mean follow-up 24.3 months) died, and 68% of fatalities occurred within 2 years. Lung function tests were performed in 47 cases and histological diagnosis in 38. Correlations between symptoms, lung function, and roentgenological and histological patterns are discussed. Two circumstances dramatically increased lethality: occurrence of 5 symptoms or more in a period of less than 2 years.

The sarcoid granulomas and the preceding mononuclear infiltration are composed of immunologically activated cells. Hyperactivity of circulating B cells and the frequent impairment of cell-mediated hypersensitivity could be due to an imbalance between T cell sub-populations. Kveim-Siltzbach test positivity and demonstration of circulating antibodies specifically directed against a sarcoid spleen extract suggest that this extract could have antigenic properties. Cell populations yielded by broncho-alveolar lavage in patients with hypersensitivity pneumonitis or with respiratory sarcoidosis are closely related. It is conceivable that sarcoidosis could result from some inhaled agent(s) which induce a self-perpetuating immunologic response of indeterminate duration. The relevance of immunological studies on sarcoidosis for medical practice is summarized.

Case report on a 57-year-old man who died in progressive respiratory distress with bilateral infiltrates. Sarcoidosis was suspected because of the presence of non-caseating epitheloid granulomas in transbronchial lung biopsies and the elevation of circulating antibodies directed against Kveim antigen. Temperature rose progressively one month after starting steroid treatment. Broad spectrum antibiotics were given without success. Autopsy showed invasive isolated pulmonary cryptococcosis.

Longitudinal studies on the effects of atmospheric pollutants on the respiratory system have yielded conflicting conclusions. Socio-economic situation, cigarette smoking and chronic diseases must be taken in account in this multifactorial problem. Nevertheless, evidence has been accumulating that exposure brings a consistent rise in the frequency of chest conditions. Although current levels of pollution are apparently tolerable, unusual weather variations may result in a disquieting situation with ultimately increasing morbidity and mortality rates. Limit levels of pollutant concentration have to be respected since air quality standards adequately protect against adverse health effects, at least in high risk populations.

Incidence of and mortality from bronchial carcinoma are reviewed. The advantages of early recognition of the disease and the favourable role of early recognition as a factor in the therapeutic outcome are stressed. Etiologic factors and diagnostic procedures are summarized. The need for a public education program is emphasized.

A hemagglutination test using coated sheep erythrocytes was devised for quantifying circulating antibodies directed against an extract of sarcoid spleen (K veim suspension). Out of 361 patients with respiratory sarcoidosis, the titres for 336 were less than 1:1,280. In 335 patients with various disorders the titres were less than 1:1,280 in 29. In 151 healthy controls the titres were never found to be less than 1:160. The circulating antibodies seemed to react specifically with antigenic determinant(s) contained in the K veim suspension and belonged primarily to the IgM class.

268 patients with suspected lung cancer were examined over the period 1 January 1972 to 31 May 1974. On the basis of the 735 investigations performed, a 6-8 h workup program has been established including physical and functional examination, standard X-rays and hilar tomography, endoscopy and biopsy for cytologic or histologic study. Several biopsy technics are described and their indications tabulated according to their efficiency in relation to the radiologic aspect of the lesion. The number of cases and the yield for each technic are summarized in Table 2.

Five patients with acute pneumonia and transitory atelectasis without bronchial obstruction are presented. The reduced lung volume in these cases, in a case of shock lung, together with a similar phenomenon in pulmonary embolism, is tentatively related to a possible disorder of the surfactant system.

The frequency of bronchial and parenchymal involvement was studied in 44 patients with intrathoracic sarcoidosis by means of histologic and cytologic analysis of bronchial and pulmonary biopsies taken through bronchofiberscope. Endoscopy showed mucosal hyperemia with or without superficial granules in 59% of cases. Bronchial granulomatosis was found in 50% of cases at stages 0 and I, in 38% at stage II and in 42% at stage III. Epithélioid granulomas were seen in lung parenchym in 63% of cases at stages 0 and I, in 90% at stage II and 73% at stage III. Cytologic examination of bronchial brushings and biopsy imprints showed epithelioid and/or giant cells in 47% of cases at stages 0 and I, in 70% at stage II and in 68% at stage III. Cytology is therefore very useful in patients presenting with a clinical and radiological picture compatible with sarcoidosis. Bronchial and transbronchial lung biopsies represent the method of choice for obtaining histologic confirmation of intrathoracic sarcoidosis at all stages.

A report is presented on 20 patients with cryptogenetic hemoptysis. The following investigations are necessary and sufficient for diagnosis: history, physical examination, chest roentgenogram in posteroanterior and lateral projection, fiberoptic bronchoscopy with bacterial and cytologic analysis of bronchial brushing material, and determination of coagulation factors. Further explorations can be regarded as unnecessary since the above program discloses the cause of hemoptysis in more than 90% of cases. The prognosis of cryptogenetic hemoptysis was good in the 20 cases studied, which were followed up for 1 to 12 (mean 5.5) years.