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It has been suggested that solvent exposure may have a role in the progression of glomerulonephritis (GN) to ESRD, but this has never been tested with an appropriate cohort study design. A total of 338 non-ESRD patients with a first biopsy for primary GN between 1994 and 2001 were included: 194 IgA nephropathies (IgAN), 75 membranous nephropathies (MN), and 69 FSGS. ESRD, defined as an estimated GFR <15 ml/min per 1.73 m2 or dialysis, was registered during a mean follow-up period of 5 yr. Patients' lifelong solvent exposures before and after diagnosis were recorded by interview and assessed by industrial hygienist experts. Cox models were used to estimate adjusted hazard ratios (HR) of ESRD related to exposures. Overall, 15 and 14% of the patients had been exposed at a low and a high level before diagnosis, respectively. Forty-two with IgAN, 12 with MN, and 22 with FSGS reached ESRD. A graded relationship was observed for MN (age- and gender-adjusted HR [95% confidence interval] for low exposure versus none was 3.1 [0.5 to 18.2] and for high exposure versus none was 8.2 [1.9 to 34.7]) and for IgAN (1.6 [0.7 to 3.9] and 2.2 [1.0 to 4.8]) but not for FSGS. Solvent risk was mediated only partly by baseline proteinuria: Adjusted HR for high exposure versus none was 5.5 (1.3 to 23.9) for MN and 1.8 (0.8 to 3.9) for IgAN. In patients with IgAN, there was a trend in increasing HR with exposure duration before and its persistence after diagnosis. These findings support the hypothesized association of solvent exposure with the progression of GN to ESRD. They should prompt clinicians to give greater attention to patients' occupational exposures and possibly to consider professional reclassification.

The association between membranous nephropathy (MN) and cancer is often mentioned in textbooks but poorly substantiated, and the characteristics of cancer-associated MN are unknown. To address these questions, we studied a cohort of 240 patients with MN, among them 24 had malignancy at the time of renal biopsy or within a year thereafter. The incidence of cancer was significantly higher in these patients than in the general population (standardized incidence ratio 9.8 [5.5-16.2] for men and 12.3 [4.5-26.9] for women). The frequency of malignancy increased with age. At the time of diagnosis, clinical presentation did not differ between the patients with cancer-associated MN and those with idiopathic MN, but smoking was more frequent among patients with cancer. Analysis of renal biopsies revealed that the number of inflammatory cells infiltrating the glomeruli was significantly higher in patients with cancer-associated MN (P = 0.001). The best cutoff value for distinguishing malignancy-related cases from controls was eight cells per glomerulus. Using this threshold led to a diagnosis of cancer-associated MN with a specificity of 75% and a sensitivity of 92%. In patients with cancer-associated MN, there was a strong relationship between reduction of proteinuria and clinical remission of cancer (P < 0.001). In conclusion, our study provides epidemiologic evidence of an excess of cancer risk in patients with MN. It also shows that age, smoking, and the presence of glomerular leukocytic infiltrates strongly increase the likelihood of malignancy in MN patients.

Obesity and insulin resistance are directly associated with the presence of microalbuminuria. However, the prospective relationship between abdominal adiposity and the occurrence of micro-albuminuria has been little studied in a non-diabetic population. From the DESIR cohort, we examined whether waist circumference was associated with the incidence of micro-albuminuria at 6 years (D6). The study evaluated 2738 non-diabetic subjects without micro-albuminuria at inclusion who were then followed prospectively. At 6 years, 254 individuals (9.3%) had developed pathological micro-albuminuria (> or =20 mg/l) measured at micturation. In both sexes, the incidence of micro-albuminuria was associated with increased waist circumference and blood pressure, but not with blood glucose levels, lipid parameters or body mass index. Subjects with a higher waist circumference at inclusion were at a higher risk of having micro-albuminuria at 6 years compared to those with a normal waist circumference. Logical regression analysis showed that waist circumference as a continuous value, or greater than 94 cm for males and 88 cm for females, were predictive factors for the incidence of micro-albuminuria, after adjustment for age, hypertension, ACE inhibitor usage, fibrinogen, and blood glucose level. Abdominal adiposity is thus linked in both sexes to the development of microalbuminuria, which underlines the importance of measuring waist circumference when assessing risk factors for renal lesions in non-diabetic hypertensives.

Objective: Metabolic determinants of microalbuminuria remain poorly understood in non-diabetic individuals and particularly in women. We investigated in both sexes whether an elevated waist circumference (WC) or the presence of the metabolic syndrome (MetS) predict the development of elevated albuminuria at 6 years., Design and Patients: We studied 2738 subjects from the DESIR cohort without microalbuminuria or diabetes at baseline and who were followed up for 6 years., Results: At 6 years, 254 individuals [9.3%; 95% confidence interval (CI) 8.2-10.4%] had developed elevated albuminuria (> or = 20 mg/l), which was significantly and positively associated with WC and blood pressure, but not with fasting glucose, lipids or body mass index in either sex. In both sexes, subjects with a high WC or with MetS at baseline were more likely to develop elevated albuminuria at 6 years compared with those with a normal WC or absence of MetS. In multivariate logistic analysis, WC as a continuous variable or a WC of 94 cm or greater for men and a WC greater than 88 cm for women were predictive of the development of elevated albuminuria, after adjusting for age, hypertension, the use of angiotensin-converting enzyme inhibitors, fibrinogen and glycaemia. MetS was a risk factor for elevated albuminuria in men (odds ratio 1.87; 95% CI 1.25-2.81), with differences according to the MetS definition., Conclusion: Abdominal adiposity is related to the development of elevated albuminuria in both sexes, suggesting that the measurement of WC may improve the identification of non-diabetic individuals at risk of developing microalbuminuria and emphasizing the interest of screening for albuminuria among those with MetS.

The French Renal Epidemiology and Information Network (REIN) registry began in 2002 to provide a tool for public health decision support, evaluation and research related to renal replacement therapies (RRT) for end-stage renal disease (ESRD). It relies on a network of nephrologists, epidemiologists, patients and public health representatives, coordinated regionally and nationally. Continuous registration covers all dialysis and transplanted patients. In 2003, 2070 patients started RRT, 7854 were on dialysis and 7294 lived with a functioning graft in seven regions (with a population of 16.5 million people). The overall crude annual incidence rate of RRT for ESRD was 123 per million population (p.m.p.) with significant differences in age-adjusted rates across regions, from 84 [95% confidence interval (CI): 74-94] to 155 [138-172] p.m.p. The principal causes of ESRD were hypertension (21%) and diabetic (20%) nephropathies. Initial treatment for ESRD was peritoneal dialysis for 15% of patients and a pre-emptive graft for 3%. The one-year survival rate was 81% [79-83] in the cohort of 2002-2003 incident patients. As of December 31, 2003, the overall crude prevalence was 898 [884-913] p.m.p, with 5% of patients receiving peritoneal dialysis, 47% on haemodialysis and 48% with a functioning graft. The experience in these seven regions over these two years clearly shows the feasibility of the REIN registry, which is progressively expanding to cover the entire country.

Background: There is concern about the rising prevalence of type 2 diabetes mellitus and of the resultant nephropathy. This study uses data from the European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry to provide information on the epidemiology and outcome of renal replacement therapy (RRT) for end-stage renal disease (ESRD) due to diabetic nephropathy (DN)., Methods: Data from the following 10 registries: Austria, French-speaking Belgium, Denmark, Finland, Greece, Norway, Scotland (UK), Catalonia (Spain), Sweden, and The Netherlands were combined. Average annual changes (%) were estimated by Poisson regression. Analyses of mortality were performed by Cox regression., Results: An increase in patients with type 2 DN entering RRT has been observed (+11.9% annually, P < 0.05), while large differences in RRT incidence in this disease continue to exist between countries in Europe. There was a reduction in mortality during the first 2 years on dialysis therapy among patients with type 2 DN (AHR 0.96, 95%CI 0.94-0.97 annually). The mortality among transplant recipients decreased for both type 1 DN and nondiabetic ESRD (non DN) within the 1995-1998 cohort (type 1 DN: AHR 0.49, 95% CI 0.35-0.68; non DN: AHR 0.79, 95% CI 0.69-0.90) compared to the 1991-1994 cohort., Conclusion: This report has shown that during the last decade there has been a marked increase in the incidence of RRT for type 2 DN. Survival analysis showed that over the period 1991-1999 the mortality rates of all dialysis patients and of type 1 diabetic and nondiabetic renal transplant recipients have fallen.

Chronic glomerular diseases are the cause of 35 to 55% of end-stage renal failure, according to countries or regions. In France, the estimated annual incidence of nondiabetic glomerular nephropathies is 82 per million population. IgA deposits, membranous and minimal change glomerulopathies, and focal and segmental glomerulosclerosis are the most common; crescent proliferative glomerulonephritis has the worse prognosis. Combined patient and kidney survival varies from 24 to 62% according to histologic types. Their incidence remains relatively stable in contrast with the constant rise of type 2 diabetic nephropathy. Over the 90s, the annual incidence rate of renal replacement therapy for end-stage renal failure due to diabetes doubled in Europe, reaching 10 to 50 per million population according to the country in Europe, and 144 per million population in the United States.

Background: In the past 2 decades, a rapid growth has occurred in the number of patients over 65 years of age accepted for renal replacement therapy (RRT) with an increasing need for dialysis resources as a consequence. The aim of this study is to describe the trends in incidence, treatment and outcome of RRT of these elderly patients included in the new ERA-EDTA Registry database., Methods: Data from 6 national renal registries have been included for the period 1985 - 1999, comprising data of 18,920 elderly patients starting RRT. We used Cox-proportional hazards regression to predict patient and technique survival., Results: The incidence and prevalence of RRT showed a 4- to 5-fold increase over the period, resulting in 48% of the new patients being older than 65 years in 1999. However, the rates varied considerably between countries. The 2-year patient survival was 51% in dialysis patients. Mortality due to social causes increased with age. Multivariate analysis showed no change with time in patient survival on dialysis, but the risk of death following a first renal allograft between 1995 and 1999 was reduced by 31%, compared with the 1985 - 1989 time period (RR 0.69; 95% CI: 0.54 - 0.90). The relative risk of peritoneal dialysis technique failure was more than doubled in the 1995 - 1999 cohort compared to the 1985 - 1989 cohort (RR 2.38; 95% CI: 1.89 - 3.01), with the highest technique failure rate in the first 2 years of the 1995 - 1999 cohort., Conclusions: The number of elderly patients receiving RRT is rising rapidly. Patient survival on dialysis has been stable over the last 15 years, whereas transplant outcome has improved. The increased peritoneal dialysis technique failure and the high mortality due to social causes in the elderly age groups require further investigation. The challenge of the years ahead is to provide this life-prolonging therapy to all patients who need it in such a way that it improves quality of life and at a cost that a society can afford.

Background: The epidemiology of renal replacement therapy (RRT) for end-stage renal disease (ESRD) varies considerably worldwide, but we have lacked reliable quantitative estimates of trends in the incidence by age, sex and cause in Europe over the last decade., Methods: We analysed data from nine countries participating in the ERA-EDTA registry: Austria, Belgium, Denmark, Finland, Greece, The Netherlands, Norway, Spain and UK (Scotland). Adjusted incidence rates for age and sex were studied for 2 year periods between 1990 and 1999. Average annual changes (%) were estimated by Poisson regression., Results: The adjusted incidence rate of RRT increased from 79.4 per million population (pmp) (range: 58.4-101.0) in 1990-1991 to 117.1 pmp (91.6-144.8) in 1998-1999, i.e. 4.8% (3.1-6.4%) each year. This increase did not flatten out at the end of the decade, except in The Netherlands, and was greater in men than women, 5.2 vs 4.0%/year. In most countries, the incidence rate remained stable for those younger than 45 years; it rose by 2.2%/year on average in the 45-64 year age group and by 7.0% among those 65-74 years; it tripled over the decade in those 75 years or older, and by 1998-1999 it ranged from 140.9 to 540.4 pmp between countries. The incidence of ESRD due to diabetes, hypertension and renal vascular disease nearly doubled over 10 years; in 1998-1999, it varied between countries from 10.2 to 39.3 pmp for diabetes, from 5.8 to 21.0 for hypertension, and from 1.0 to 15.5 for renal vascular disease., Conclusion: RRT incidence continues to rise but at various rates in the European countries studied, tending to widen the gap between them. This mainly results from enlarging differences in incidence in the elderly and, to a lesser extent, in that due to diabetes, hypertension and renal vascular disease.

Background: Long-term lithium administration in humans may lead to chronic tubulointerstitial nephritis, which develops very slowly. Its progression to end-stage renal disease (ESRD) has been rarely reported. The aim of this study is to document the rate of progression of lithium-induced nephropathy and its prognostic factors, and to provide an estimation of the percentage of lithium-induced ESRD in France., Methods: Two groups have been studied: 54 patients with lithium-induced renal failure, nine of whom underwent renal biopsy; and 20 patients who were referred for systematic renal biopsy, 14 of whom were subsequently followed up. In addition, a survey of lithium-induced ESRD was conducted in French dialysis centers., Results: The mean annual loss of creatinine clearance in patients with lithium-induced nephropathy was 2.29 mL/min. Among 74 patients, 12 reached ESRD at a mean age of 65 years. Creatinine clearance at referral and at last follow-up was inversely related to the duration of lithium therapy in both univariate and multivariate analyses adjusting for age, gender, hypertension, and proteinuria. The degree of interstitial fibrosis on renal biopsy was also related to the lithium duration and cumulative dose. It was predictive of the final creatinine clearance. About 35% of the patients tested had moderate hypercalcemia, due to hyperparathyroidism. The prevalence of lithium-related ESRD in France was estimated as two per 1000 dialysis patients. The average latency between onset of lithium therapy and ESRD was 20 years., Conclusion: Lithium-induced chronic renal disease is slowly progressive. Its rate of progression is related to the duration of lithium administration. Lithium-related ESRD represents 0.22% of all causes of ESRD in France. Regular monitoring of estimated creatinine clearance is mandatory in long-term lithium-treated patients.

Background: Some lifestyle behaviors and obesity are risk factors for vascular disease, but their relation to kidney disease is uncertain., Methods: To determine whether physical inactivity, smoking, alcohol drinking and obesity are associated with the risk of chronic kidney disease, we examined data from a nonconcurrent cohort study of 9,082 U.S. adults, aged 30-74 years, who participated in the second National Health and Nutrition Examination Survey (NHANES II) from 1976 through 1980. By linking the NHANES II Mortality Study with the Medicare end-stage kidney disease registry, we identified 189 incident cases of either treated end-stage kidney disease or chronic kidney disease-related death through 1992., Results: The risk of chronic kidney disease was related to physical inactivity both with and without adjustment for age, sex, race and body-mass index. The adjusted relative risk (RR) of moderately active versus very active persons was 1.2 (95% confidence interval = 0.7-1.8), and of inactive versus very active was 2.2 (1.3-3.8). Risk was also related to smoking; the RR in smokers of 1-20 cigarettes a day versus never smokers was 1.2 (0.7-2.3), and in smokers of more than 20 cigarettes a day, the RR was 2.3 (1.3-4.2). The RR in morbidly obese (body-mass index >/= 35 kg/m2) compared with normal weight persons was 2.3 (1.1-4.9), but risk was not increased for those classified as overweight or obese. Obesity risk appeared largely mediated by diabetes and hypertension, whereas physical inactivity risk was only partly explained by these factors, and smoking risk was independent of them. Alcohol consumption was not related to chronic kidney disease., Conclusions: These data suggest that physical inactivity, smoking and morbid obesity contribute to the risk of chronic kidney disease.

Objectives: Study the renal consequences of lithium therapy and find out whether lithium-induced chronic renal toxicity can provoke a progressive nephropathy, leading to advanced renal failure, requiring periodical dialysis., Methods: Fifty-three patients treated with long-term lithium salts were included in the study. They had developed chronic renal failure (creatinine clearance inferior to 80 ml/min) not due to any other cause., Results: These patients had received lithium salts for a mean period of 17.7 years. The mean reduction in creatinine clearance was of 2.23 ml/min/year. Final clearance correlated negatively with the duration of lithium administration. In 7 patients treated a mean of 22 years, progression towards terminal kidney failure required periodical dialysis. Around 30% of patients exhibited mild hypercalcemia., Conclusion: Lithium nephropathy inducing progressive renal failure is a reality. Its prevalence in patients treated long-term with lithium should be assessed.

We examined the relationship between acquired color vision loss and exposure to toluene and total hydrocarbons among 125 male workers. Seventy-two toluene-exposed printers were compared with 34 workers from the same photogravure plant with ambient background exposure, and with 19 workers from a bookbinding plant located in the same town (nonexposed). Environmental mean toluene exposure level at workstation was estimated from individual 8-h sampling. Historic exposure data from the last 30 years were used to construct two cumulative exposure indices, one for toluene and one for total hydrocarbons. Airborne toluene levels were overall lower than the current Threshold Limit Value (TLV) of 50 ppm. Color vision was assessed by the Lanthony D-15 desaturated panel. Color vision loss was quantitatively established by the Color Confusion Index (CCI) and classified by type of acquired dyschromatopsia according to Verriest's classification. CCI was positively related to current airborne toluene levels, and cumulative exposure indices for toluene and total hydrocarbons (.18< or =r< or =.35). Odds ratios of acquired dyschromatopsia were significant for current airborne toluene, toluene, and total hydrocarbon past exposure (1.27 [1.02-1.58], 1.21 [1.04-1.39], 1.15 [1.02-1.31], respectively). In conclusion, this study suggests that the Lanthony D-15 desaturated panel detects early neurotoxic effects among workers exposed to toluene.

Few published studies have explored the impact of smoking prevention programs among elementary-school children. This study describes a qualitative, cross-sectional evaluation of the Tar Wars tobacco prevention program among 5th-grade students (n = 888), along with impressions from classroom teachers and program presenters. Results from this evaluation reveal that all constituencies involved with the Tar Wars program--5th-grade students, classroom teachers, and program presenters--indicated high satisfaction with this youth tobacco education program. Students enjoyed the program and indicated understanding of key themes, classroom teachers stated that the program was worthwhile in presenting unique information, and presenters were enthusiastic about the ease of presentation and opportunities for future presentations.

Background: Smoking is a known risk factor for renal damage in diabetic patients, but its relationship to other renal diseases is less clear. To assess its effect in primary glomerular nephropathy (GN), we used data from a case control study designed to assess several environmental risk factors., Methods: This study included 295 biopsy-proven GN cases, 80 membranous nephropathy, 116 IgA nephropathy, and 99 nephrotic syndrome with either minimal change nephropathy or focal segmental hyalinosis, and 242 matched hospital controls, with diseases unrelated to smoking. Subjects were interviewed about their smoking history. Chronic renal failure (CRF), defined by serum creatinine> 150 micromol/L, was present in 74 cases (57 men and 17 women). Logistic regression was used to estimate odds ratios (ORs) adjusted for age and social class., Results: In men, the percentage of ever-smokers did not differ between GN cases (60%) and controls [65%, OR = 0.9 (95% Confidence Interval 0.6-1.4)], but was significantly higher among cases with CRF (75%) than those without [55%, OR = 2.4 (1.2-4.5)]. Dose-effect relationships were observed with both the daily and cumulative dose; this relationship was stronger in the comparison of cases with CRF and those without CRF than in the comparison of cases with CRF with controls: OR = 1.9 versus 1.3 (20 cigarettes/day); OR = 1.9 versus 1.4 (15 pack years). Interactions between age, hypertension, and smoking were observed in the risk of CRF: smoking was significantly related to CRF among cases who were older than 40 years and/or hypertensive, but not among those cases younger than 40 or normotensive. The results did not significantly differ among the three histologic types. No relationship was shown between smoking and CRF in women., Conclusion: This study provides additional support for the hypothesis that smoking is related to GN severity, particularly in the at-risk groups of men older than 40 and/or hypertensive patients. These findings should be corroborated by further observations in other populations.

The aim of this study was to answer the question: is it possible to save motor nerves when dissecting tissue with the hydro-jet dissector? In order to study the influence of the hydro-jet on motor nerves the function of the sciatic nerves of 10 Wistar rats was evaluated. The sciatic nerves were dissected bilaterally and only the left one was exposed to the hydro-jet. The water-jet emerged from a nozzle with a diameter of 0.1 mm and was applied to the nerve for 2, 5 or 10 s and with jet pressures of 80, 85 and 90 bar, respectively. After the operation the animals were observed for 5 months in order to monitor the degree of limping using a scale with 10 clinical grades of function. Five months postoperatively the animals were sacrificed and the sciatic nerves were studied by light and electron microscopy. It was found that hydro-jet pressures of 80 bar and exposure times of 2 s had already lead to irreversible damage to the sciatic nerve. Therefore further studies with lower pressures or shorter exposure times are required before considering hydro-jet cutting for parotid gland surgery. It must be confirmed as harmless to motor nerves before applying this method in humans.

Objectives: To quantify and identify sources of within- and between-subject variability of microalbumin, N-acetyl-beta-D-glucosaminidase (NAG) and alanine aminopeptidase (AAP), three biomarkers used for early detection of renal injury, and to assess the consequences of this variability for the design and power of epidemiological studies., Methods: Urinary excretion of microalbumin, NAG, AAP and creatinine as well as blood pressure (BP) were measured three times over a 2-year period among 142 healthy male workers. To minimise physiopathological and analytical sources of variation, standardised methods were used for urine collection and assays, and severe exclusion criteria were applied. At the first and third examinations, subjects completed the same questionnaire, providing information about their personal characteristics, tobacco and alcohol consumption, and health. A linear mixed model was used to estimate the within- and between-subject variance components and to analyse the relation between subjects' characteristics and the biomarkers., Results: No change in the mean value of any of the biomarkers was observed over the 2-year period. Intra-class correlation coefficients between repeated measurements were 0.53, 0.57 and 0.56 for microalbumin, NAG and AAP, respectively; the between-subject variance was slightly higher than the within-subject variance. Subjects' age, BP, body mass index and smoking and drinking habits explained 7.2%, 12.5% and 4.2% of the total variance of microalbumin, NAG and AAP, respectively., Conclusions: In this healthy population of male workers, day-to-day differences in biomarker values appeared to be nearly as great as differences between subjects. The within-subject variance of these biomarkers is not high enough to justify systematic repeated measurements in epidemiological surveys. But, in some situations where the number of subjects is limited, measuring the subjects twice may improve study power by reducing the total variance by about 25% for each biomarker. Taking the above covariates into account would slightly improve study power and the accuracy of parameter estimates for NAG, but would add little to the analysis of microalbumin and AAP.

End-stage renal failure (ESRD) is an important public health issue, because of both the increasing number of patients requiring renal replacement therapy and the cost of treatment. The need for a reliable data system, capable of describing the patient care network as a whole, including dialysis or transplantation, has often been reiterated. The Direction Générale de la Santé (the French Department of Health) commissioned INSERM (the National Institute of Health and Medical Research) to "study the feasibility of different scenarios of data collection about ESRD patient care in order to meet the priority needs of health care administration, physicians, and researchers". Analysis of these needs allowed the goals to be defined: to provide an accurate picture of ESRD patient care in order to guide and evaluate health care policy, to inform clinicians, and to provide a tool for more focused special studies in renal research issues. Three scenarios were studied: the first would use data systems of both the government and the National Health Insurance system for planning health care services, upon EfG (The French Transplant Agency) network to evaluate transplantation, and upon a few regional registries for epidemiology and research; the second is based on repeated cross-sectional surveys; the third would rely upon the organization of an information system, the Renal Epidemiology and Information Network (REIN). Regional centers and a national coordinating office would register and follow-up ESRD patients, principally to evaluate health care supply and quality. The REIN database would also be a resource for research. The advantage of the first scenario is its low cost; its principal drawback is that evaluations will not be possible in the regions without registries. The second suggestion is inadequate. The last project would fulfil the goals that were defined. The REIN data system would be a true public health project of interest to all the participants and institutions in this field.

Objectives: This study assessed immunologic and early renal effects of chronic toluene exposure., Methods: In a longitudinal study of 92 printers and 74 referents, 145 subjects had pre- and poststudy samples of blood and urine taken for the following measurements: immunoglobulin E (IgE), antiglomerular basement membrane (anti-GBM) and antilaminin (anti-LAM) antibodies in blood; creatinine and beta2-microglobulin in blood and urine; and microalbumin, N-acetyl-b-D-glucosaminidase (NAG) and alanine-aminopeptidase in urine. Creatinine clearance was calculated according to the Cockroft-Gault formula. Eight-hour personal air samples were collected twice to assess present exposure to toluene. A job-exposure matrix was developed to estimate past cumulative exposure. Information about potential confounders was recorded by questionnaire. Multiple regression analysis was performed to study dose-effect relations adjusted for age and smoking., Results: No subject was positive for anti-GBM antibodies, and only 12 were positive for anti-LAM. No relation was observed between the markers studied and present exposure to toluene except that creatinine clearance was higher among the exposed subjects than among the referents. A dose-response relation was observed between cumulative toluene exposure and both IgE and NAG excretion. No interaction was observed between hypertension and exposure, but the relationship with NAG did not persist when subjects with hypertension were excluded. Past or present exposure did not alter the 2-year trend of any marker studied., Conclusions: According to the results of this study, toluene at 50 ppm is not related to detectable renal dysfunction. The increased IgE levels associated with present and past exposure require further investigation.

An unusual case of nonhealing necrotizing gingivostomatitis in a 66-year-old man is described. Microscopic examination of biopsy material showed an infiltrate of Langerhans cells. Merely oral lesions of Langerhans cell granulomatosis--especially in an old person--occur very seldom.

In May 1994 in Toulouse, there were two cases of end-stage renal failure (ESRF) related to Chinese herbs similar to those incriminated in the case series reported in Belgium in 1992-93, they led to an epidemiologic investigation aimed at evaluating the risk linked to these plants in France. Studies carried out by the Pharmacy Inspection showed that powders labelled Stephania Tetrandra, but consisting instead of Aristolochia Fangji and containing aristolochic acid, were sold in France between 1989 and May 1994. A systematic attempt to ascertain cases of ESRF associated with ingesting Chinese herbs was carried out by analysing data from the ERA-EDTA Registry of ESRF as well as from the French adverse drug reaction monitoring system. Registry data showed no significant increase over previous years in the number of new ESRF cases caused by tubulo-interstitial nephritis (TIN) between 1990 and 1993. In eight regions of France, the files of 85 ESRF cases were examined, and all patients whose nephropathy began after 1989 were interviewed using a very detailed questionnaire. No association with Chinese herb use was found in any of these cases. In 1996, two new ESRF cases were reported in Nice; the regional adverse drug reaction monitoring center considered the relationship with Aristolochia Fangji to be as possible (I2) for one case and dubious (I1) for the other. Despite a lack of sensitivity of the methods used to detect cases, it seems clear that no phenomenon as extensive as that observed in Belgium occurred in France, although the same drugs prescribed at the same doses have been widely distributed in our country. A possible explantation for the difference in the number of cases in Belgium and France is that of an unrecognised factor, promoting the toxicity of aristolochic acid or peculiar to the Belgian clinic and causative. The precautionary principle led the authorities to ban Stephania Tetrandra and Aristolochia Fangji from the market permanently.

We report a locally recurrent retiform haemangioendothelioma (RHE) on the right great toe in a 40-year-old woman. There was a secondary soft tissue lesion on her right lower leg. Histologically, primary lesion, local recurrence and the secondary soft tissue lesion (soft tissue metastasis?) showed identical features. Long, arborizing, neoplastic blood vessels were lined by CD31 and factor VIII-positive, monomorphic endothelial tumour cells; focally solid tumour areas, papillae and a prominent inflammatory infiltrate consisting of mature B and T lymphocytes were noted. The concept and the group of low-grade malignant vascular neoplasms is discussed, with special emphasis on inclusion of RHE in this category.

Several studies have suggested that exposure to organic solvents is associated with glomerular nephropathies (GN), but this relationship remains controversial. A case-control study of 298 biopsy-proven cases and 298 hospital controls, matched for year of birth, sex, origin, and place of residence, was conducted between 1989 and 1991 in five hospitals in the Paris area : 82 cases of membranous glomerulopathy were included ; 100, nephrotic syndrome with either minimal change nephropathy or focal and segmental hyalinosis (MCN/FSH); and 116, IgA nephropathy (IgA N). Subjects were interviewed about their lifelong occupational and non-occupational activities. Type, level, and duration of solvent exposure were assessed blind with respect to case-control status by two industrial hygienists. HLA phenotypes were determined. Among males, a clear association, which was not explained by social class, was observed between chronic renal failure and high exposure to solvents for both MCN/FSH (OR = 7.7, 95% CI 1.4-41.6) and IgA N (OR = 3.5, 95% CI 1.0-11.8). The odds ratios increased with duration of exposure. No relationship was observed between such exposure and GN cases with normal renal function. No evidence was found that the HLA phenotype plays a role in the solvent exposure-disease association. These results support the hypothesis of a causal relationship between high solvent exposure, which concerned 15% of the males in this study, and the development of GN with chronic renal failure.

Oculocerebrocutaneous syndrome consists essentially of orbital cysts and microphthalmia/anophthalmia, focal dermal defects, skin appendages and malformations of the central nervous system. Up to now, about 20 sporadic cases have been reported. Limited information is available on the clinical spectrum and on the natural history. We present the long-term follow-up of a 19 year-old patient who was one of the first two patients described by Delleman and Oorthuys in 1981. Furthermore, we report on a new case presenting with bilateral anophthalmia and orbital cysts, typical skin lesions, a complex brain malformation and cleft lip palate. This infant died due to the severe cerebral malformations at the age of 10 months. Encephalocraniocutaneous lipomatosis, focal dermal hypoplasia and microphthalmia with linear skin defects (MLS) syndrome are discussed as the most important differential diagnostic entities.

Background: Several studies have suggested that exposure to organic solvents is associated with glomerular nephropathies (GN), but this relationship remains controversial., Methods: A case-control study of 298 biopsy-proven cases and 298 hospital controls, matched for year of birth, sex, origin, and place of residence, was conducted between 1989 and 1991 in five hospitals in the Paris area: 82 cases of membranous glomerulopathy were included; 100, nephrotic syndrome with either minimal change nephropathy or focal and segmental hyalinosis (MCN/FSH); and 116, IgA nephropathy (IgA N). Subjects were interviewed about their lifelong occupational and non-occupational activities. A 'blind' assessment of type, level, and duration of solvent exposure was carried out by two industrial hygienists. Human leucocyte antigen (HLA) phenotypes were determined., Results: Among males, a clear association, which was not explained by social class, was observed between chronic renal failure and high exposure to solvents for both MCN/FSH (OR = 7.7, 95% CI: 1.4-41.6) and IgA N (OR = 3.5, 95% CI: 1.0-11.8). The odds ratios increased with duration of exposure. No relationship was observed between such exposure and GN cases with normal renal function. No evidence was found that the HLA phenotype plays a role in the association between solvent exposure and the disease., Conclusions: These results support the hypothesis of a causal relationship between high solvent exposure, which concerned 15% of the males in this study, and the development of GN with chronic renal failure.

Epidemiological validity of early markers of nephrotoxicity currently used in occupational epidemiology has been poorly investigated. The aim of this study was to identify variation factors of these markers, to quantify their intra- and inter-individual variability and to evaluate the consequences of these results on study size and power. A cross-sectional survey was carried out in 1991 in a rotogravure plant including 168 male subjects (92 exposed to toluene and 76 controls). Blood and urine samples were taken twice: at study onset and one to five months later for 40% of the subjects. Creatinine and beta-2-microglobulin (beta 2M) were measured in both blood and urine; microalbumin (microALB), N-acetyl-beta-D-glucosaminidase (NAG), and alanine-aminopeptidase (AAP), in urine. Sources of physiological variation were reduced by standardization of collection and assay methods. Subjects completed a questionnaire to record information about their personal characteristics, alcohol, tobacco and drug consumption and their health. Statistical analysis of all subjects was adjusted for exposure status. Several factors were significantly related to the markers: age with beta 2M, NAG and AAP; smoking, alcohol drinking, and blood pressure with both microALB and NAG; urinary pH with beta 2M. These factors explained from 13 to 21% of the total variance of these markers. Short-term reproducibility, i.e. the correlation between the two measurements, was high for microALB (r = 0.75), moderate for NAG (r = 0.51), and low for beta 2M (r = 0.33) and AAP (r = 0.17). These results showed that confusion bias in the evaluation of exposure-marker association can be reduced by adjusting for several factors and that accuracy and study power can be improved by repeating measurements, especially for beta 2M and AAP.

Correct retrospective assignment of subjects to an exposure category is affected by a variety of problems: 1) lack of an objective lifetime measurement; 2) dependence upon the accuracy and thoroughness of the job description; 3) heavy reliance upon the knowledge of experts. The aim of the study was the quantification of the performance of a job exposure matrix (JEM) in evaluating solvent exposure, using expert judgements as the reference method. The sources of discrepancies between the two methods were analysed within the framework of two community-based case-control surveys. One included 765 cases of bladder cancer (BC) and 765 controls, the other 298 cases of glomerulonephritis (GN) and 298 controls. The JEM had been set up previously for a case-control study on laryngeal cancer and is based on 4000 discrete job titles. Comparison between the JEM and expert exposure evaluation was carried out for 2736 job periods in the BC study and 929 in the GN study. Categories of exposure for both experts and JEM were dichotomized, using different cutoff points for exposure and non-exposure. Prevalence of exposure as assessed by the experts was twice as high in the GN study (19%) as in the BC study (10%), showing the importance of the questionnaire design and of the inclusiveness of the definition of exposure. Sensitivity of the JEM vis-a-vis the experts was low (23-63%), whereas specificity was rather high (87-98%). The best concordance between the two methods was obtained with a specific dichotomy from the JEM and a narrow definition of exposure by the experts. Bias and loss of power resulting from JEM misclassifications were calculated with a theoretical population odds ratio of 3 and an exposure prevalence of 10%. If the experts' classification of the subjects according to exposure is assumed to be 100% correct, using the JEM led to a bias in estimating the odds ratio, ranging from 1.5 to 2.1, and to a loss of power equivalent to a reduction in the number of subjects by a factor of 5 to 10. Analysis of systematic discrepancies between exposure assessments of the experts and the JEM showed that they were clustered with some job categories and arose from different sources: 1) inadequate job descriptions, related to the codification system adopted and necessitating the gathering of information at the individual level; 2) true disagreements between JEM and experts regarding the definition of solvent exposure.(ABSTRACT TRUNCATED AT 400 WORDS)

A cross-sectional survey of hematological parameters was carried out among 221 workers exposed to styrene in the reinforced plastics industry and 104 controls. Styrene exposure was assessed in both groups by monitoring urinary excretion of styrene metabolites (i.e. mandelic and phenylglyoxylic acids) in post-shift urinary samples collected over five consecutive days. Blood tests were performed with the same counter for all subjects. Information on factors liable to affect hematological parameters was collected from personal questionnaires completed by the workers. Urinary excretion of styrene metabolites varied from 15 to 3740 mg/g creatinine. Exposed subjects exhibited significantly lower mean values of neutrophils and mean corpuscular hemoglobin concentration (MCHC) than controls, and significantly higher mean values for monocytes and mean corpuscular volume. A dose-effect relationship was found for MCHC which decreased with urinary metabolite concentrations. These results remained statistically significant for all parameters after adjustment for age, sex, tobacco and alcohol consumption, place of residence (rural or urban) and time of blood sampling (morning or afternoon) with the exception of neutrophils whose relationship with exposure was essentially explained by smoking. These results are suggestive of a direct effect of styrene-exposure--in the range considered--on the statistical distribution of some hematological parameters.

Preserved allogeneic bone is possibly to repair the permanent shortness in autogeneic bone tissue in clinical practice. Complications as to the incorporation were observed after using lyophilised allogeneic implants. These were attributes to immunologic defense reaction. Demineralised bone caused a more intensive bone regeneration histologically than lyophilised bone. The clinical test of a superficial demineralised lyophilised preserved bone with osteoinductive potency and structural stability is recommended.

From national surveys on representative samples of births, in France, in 1972 and in 1981, prenatal care and outcome of pregnancy among immigrant women--having been born outside continental France--have been studied. In spite of an increase in the number of prenatal visits, between 1972 and 1981, foreign women born in North Africa or in other non-European countries in 1981 had still less prenatal visits than women born in continental France. Few differences in outcome of pregnancy according to the women's birthplace in 1981 are shown, preterm deliveries' and birthweight less than 2,500 g rates had decreased between 1972 and 1981 among most groups of women. Nevertheless, in 1981 stillbirth was more frequent among foreign women, especially women born in North Africa.

Data from a national sample of births in France in 1981 were used to analyse the relationship between occupational activity, antenatal care and pregnancy outcome among immigrant women. On the whole, occupational activity was less common among immigrant than among French women, although the occupational activity rate varied according to country of origin. Among French women, work during pregnancy was related to better antenatal care and more favourable outcome. The same tendency was observed among immigrant women whatever their origin, though they had less qualified occupations and harder working conditions than those of French women. Occupational activity of immigrant women was more frequent among women with a higher educational level, better knowledge of the French language, and residence in France for a longer time. These characteristics were also associated with better antenatal care, but the relationship between work and antenatal care remained significant after taking them into account.

An extraadrenal myelolipoma inside a lymph node in a 70-year-old man is reported as the first description of this tumour in the given localization.

Data from a survey conducted in 1981 on a national sample of 5508 births in France were used to analyse the role of a history of previous adverse pregnancy outcome (spontaneous abortion, perinatal death or adverse fetal condition) in the selection mechanisms of women with regard to occupational activity, and the impact on the relation between work and preterm delivery. The study, carried out separately in each parity group, showed that occupational activity was associated with a more favourable outcome for women of parity one: the preterm delivery rate was significantly higher among women who had never worked than among those who continued working during pregnancy. However, the hypothesis of a "healthy worker effect" linked to a history of adverse obstetric outcome was not confirmed in this study. A selection effect of women from a history of spontaneous abortions was observed, but these were not linked to preterm delivery. Among multiparous women, a history of perinatal death or adverse fetal condition did not seem to modify women's behaviour towards their work. Selection mechanisms of women towards occupational activity according to sociodemographic factors were also analysed and showed that the higher percentage of younger women among those who had never worked explained the higher rate of preterm delivery in that group.