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Resume Etat des connaissances Les visites ou les hospitalisations imprevues sont frequentes chez les patients transplantes pulmonaires. Elles pourraient etre en partie reduites par un suivi regulier a domicile de certains parametres respiratoires dont la degradation est predictive d’une complication. L’utilisation de la tele-transmission couplee aux mesures spirometriques devrait permettre d’optimiser le suivi a domicile. Dans cette etude de faisabilite, l’objectif principal sera le respect des trois mesures spirometriques hebdomadaires, a domicile, demandees au patient. Methodes L’etude sera monocentrique, prospective. Elle s’adressera a des patients majeurs transplantes pulmonaires depuis plus de trois mois. Le patient sera equipe a domicile avec un spirometre et un outil de teletransmission des mesures effectuees. Des seuils d’alertes seront predefinis et entraineront une action allant du simple appel telephonique au patient a une intervention par le pneumologue hospitalier ou a une hospitalisation. Cette procedure vient en complement d’une prise en charge classique. Resultats attendus La faisabilite sera consideree comme satisfaisante pour une compliance moyenne de plus de 70 %. Cette etude de faisabilite permettra d’ajuster si besoin le nombre d’utilisations demandees au patient et l’amplitude de la variation des parametres etudies.

Resume Introduction L’application nocturne d’une pression positive continue (PPC) reste le traitement de reference du syndrome d’apnee du sommeil (SAS), malgre un taux d’acceptation d’environ 70 %. Methodes Cette etude cas–temoin concerne une population de patients ( n = 133) atteints de SAS et appareilles par PPC par un prestataire (SADIR). Une education therapeutique (ET) dispensee par un intervenant competent en ET et consistant en cinq appels a j3/10/30/60/90 a ete proposee a 66 patients. La faisabilite de cette methode a ete evaluee ainsi que le benefice eventuel sur l’acceptation et l’observance de l’appareillage. Resultats Quatre-vingt-dix-huit pour cent des patients (65/66) ont accepte ce suivi personnalise. Cinquante-sept patients (86 %) ont suivi la totalite du programme et 44 patients (66 %) ont repondu precisement aux dates d’appels definis par le protocole. Cet accompagnement telephonique a permis d’augmenter l’acceptation (94 % versus 81 %, p = 0,027) et l’observance (4 h 39 ± 2 h 17 versus 3 h 45 ± 2 h 45, p = NS) pour ces patients par rapport aux patients beneficiant d’un suivi classique. Conclusions La mise en place d’une ET par telephone et par un personnel competent est faisable et semble ameliorer l’observance et l’adhesion des patients au traitement par PPC. Ces dernieres donnees devront etre confirmees sur une population de patients plus importante et randomisee.

Resume Etat des connaissances L’application nocturne d’une pression positive continue (PPC) par masque de ventilation reste le traitement de reference du syndrome d’apnees du sommeil (SAOS). L’observance est un element essentiel de l’efficacite de la PPC. Celle-ci est dependante de la qualite de la prise en charge et de l’information des patients. C’est pourquoi, en lien avec l’emergence de la telemedecine, la tele-observance de la PPC fait son apparition. Methodes Cette etude est observationnelle et multicentrique. Elle s’adresse a des patients atteints de SAOS et necessitant un traitement par PPC, qui auront comme consigne de connecter la carte Secure Digital de leur PPC a un boitier de transmission des donnees, toutes les semaines pendant deux mois. La transmission des donnees s’effectuera vers le coordonateur de l’etude, la SADIR, prestataire de sante a domicile, en passant par une plateforme de telemedecine. Notre etude a pour objectif principal d’evaluer la faisabilite de la mise en place de la tele-observance de la PPC a domicile. Resultats attendus Cette etude permettra de quantifier l’acceptation et la compliance des patients a domicile face a ce nouvel outil de transmission des donnees de leur appareillage PPC.

Resume La BPCO sera durant la prochaine decennie la troisieme cause de mortalite dans le monde. Due principalement au tabagisme a la cigarette, elle revet une gravite distincte selon les individus, impliquant des facteurs environnementaux et genetiques incompletement apprehendes. Des travaux recents mettent en cause la colonisation microbienne des bronches et les exacerbations infectieuses comme facteur d'aggravation via l'effet pro-inflammatoire et le stress oxydatif. Cela implique de recenser les moyens d'une prevention anti-infectieuse au nombre desquels la place de l'antibiotherapie prophylactique et des antioxydants doit etre discutee.

Oxidative stress is a frequent mechanism involved in the pathogenesis of bronchopulmonary disease. The cause can be exogenous, in particular related to to atmospheric pollution and tobacco smoke, or endogenous, related to mobilization of inflammatory cells (macrophages and polymorphonuclear neutrophils). In this general review, we present work demonstrating this oxidative stress and activation of inflammatory cells. We discuss the effect of oxidative stress on the bronchial tree and the need to maintain an adequate balance between oxidants and anti-oxidants. This reviews focuses on experimental studies proving the anti-oxidant effect of NAC on glutathione synthesis and on different pharmacological models. We then discuss human trials, initially experimental then in different bronchopulmonary pathologies related to oxidative stress. Acetaminophen intoxication and pulmonary fibrosis are models for use of NAC. Recent work on COPD appears to show a decrease in exacerbations, improvement in symptoms and quality-of-life, and perhaps a reduction in the alteration of ventilatory function.

Resume L'objectif de cette etude multicentrique, prospective, randomisee, en double aveugle, etait de comparer l'efficacite et la tolerance du cefotiam hexetil (CTM) a la dose de 400 mg matin et soir avec celles de l'amoxicilline/acide clavulanique (AAC) a la dose de 1 g matin et soir sur une periode de dix jours de traitement au cours d'une exacerbation de bronchite chronique. Cent cinquante sept patients adultes souffrant d'une exacerbation de bronchite chronique ont ete inclus par des pneumologues. Les deux populations etaient comparables a l'inclusion en ce qui concerne les donnees demographiques et la clinique. En fin de traitement, 92 % des patients du groupe cefotiam hexetil et 88 % du groupe amoxicilline/acide clavulanique etaient gueris apres analyse en intention de traiter, respectivement 96 % versus 94 % apres analyse en per protocol. Le nombre d'effets secondaires a ete moins frequent dans le groupe cefotiam hexetil (9 % versus 21 %). Cette difference etait statistiquement significative (p = 0,03). En conclusion, le cefotiam hexetil 400 mg matin et soir peut etre considere comme une bonne alternative therapeutique dans le traitement des exacerbations de bronchite chronique de l'adulte avec une efficacite equivalente et une tolerance meilleure que l'amoxicilline/acide clavulanique 1 g matin et soir.

Resume Le pourcentage de souches de pneumocoque de sensibilite diminuee a la penicilline G est actuellement en France de plus de 20 % au cours des pneumonies a pneumocoque bacteriemiques de l'adulte. Les facteurs de risque principaux d'isolement de telles souches sont : la prescription anterieure de betalactamines et/ou une hospitalisation recente, un antecedent de pneumonie, le caractere nosocomial de la pneumonie, et la presence d'une maladie chronique ou immunosuppressive sous-jacente. La progression des souches resistantes par rapport aux souches intermediaires pose la question des limites d'activite de l'amoxicilline dans cette situation. Toutes les etudes cliniques montrent que la resistance aux betalactamines n'est pas isolement un facteur de risque de deces et qu'il n'y a pas de correlation entre le niveau de resistance bacteriologique et les resultats cliniques obtenus a la posologie “standard” de 1 g d'amoxicilline 3 fois par jour pour des concentrations minimales inhibitrices (CMI) a l'amoxicilline comprises entre 0,01 mg/l et 2 mg/l. Vis-a-vis de souches ayant des CMI superieures a 2 mg/l, l'experience clinique limitee ne permet pas de conclure, meme si les caracteristiques pharmacocinetiques seriques et tissulaires de l'amoxicilline peuvent laisser penser que des posologies superieures d'amoxicilline devraient etre efficaces.

Resume Le niveau de resistance, variable selon les pays, des principales bacteries responsables de pneumonies communautaires rend compte des differences entre les Consensus concernant l'antibiotique de premiere intention et sa posologie. En France, dans le contexte epidemiologique actuel de resistance du pneumocoque, toute antibiotherapie prenant en charge une pneumonie communautaire alveolaire presumee pneumococcique doit etre active sur des souches de pneumocoque pour lesquelles la CMI de la penicilline G est egale a 2 mg/l. Cinq ans apres la publication du Consensus Francais (1991), les donnees de la litterature permettent de valider la posologie de 1 g × 3/24 h per os ou IV d'amoxicilline au cours d'une pneumonie alveolaire pneumococcique, sans signe de gravite (ou de 1 g × 3/24 h d'amoxicilline-acide clavulanique IV lorsque l'on souhaite elargir le spectre probabiliste du traitement antibiotique de 1ere intention : en 1996, 27 % des H. influenzae sont producteurs de β-lactamases). Dans le cas exceptionnel de souches dont la CMI de la penicilline G est > a 2 mg/l, les caracteristiques pharmacodynamiques de l'amoxicilline laissent penser qu'une posologie de 6 g/24 h IV d'amoxicilline serait efficace. En cas de gravite symptomatique, il est d'usage de recommander de fortes posologies d'amoxicilline, jusqu'a 150 mg/kg/24 h IV.

A questionnaire survey was performed on the use of investigations and their impact on treatment of adult lower respiratory tract infection in the community. Data on the management of 2,056 such infections were obtained simultaneously from general practitioners in France, Germany, Italy, Spain and the UK. Diagnostic tests were only performed in 29% of cases. Chest radiographs were performed most frequently (22%), followed by peripheral blood white cell count (15%) and microbiological examination of sputum (7%), with major differences being found in the frequency of these tests both by clinical diagnosis and country. A change in initial antibiotic therapy was made in 12% of cases, with use of investigation being significantly linked to such changes. Second- and third-line antibiotics were significantly different to first-line therapy, with macrolides the most frequently prescribed second-line and quinolones the most frequently prescribed third-line antibiotics.

A survey of first-line antibiotic prescription in community-acquired lower respiratory tract infection (LRTI) by general practitioners (GP) was carried out simultaneously, using the same methodology in France, Germany, Italy, Spain and the UK. Data were obtained from 2,056 patients and 605 GPs. There was no antibiotic prescription in 17% of all LRTIs and 13% of community-acquired pneumonia (CAP) in the five countries taken together; and in 32% of all LRTIs and in 23% of CAP in Germany. Of patients with acute bronchitis, exacerbation of chronic bronchitis and viral lower respiratory tract infection, 87, 92 and 71% received antibiotics, respectively. The most frequent prescriptions were penicillins in France and the UK, third-generation cephalosporin in Italy, tetracycline in Germany and macrolide in Spain. The daily dosage of aminopenicillin prescribed was: 41% or = 1.5 g and or = 3 g. In Italy, 53% of all antibiotics were injected in all LRTIs, and 71% in CAP; in contrast, antibiotic injection was lower than 2% both in the UK and Germany, with an average of 14% in the five countries combined. We conclude that there are variations in antibiotic prescription by GPs in Western Europe; differences are likely to be multifactorial, but could, in part, be explained by differences in health systems and sources of information available to GPs.

Lung transplant patients are characterized by a high use of healthcare resources and an elevated rate of hospitalization. In lung transplant recipients, spirometry home monitoring has been advocated for the early detection of acute infection and rejection of the allograft. We will test a new system that allows regular monitoring of the patient's pulmonary status at home after discharge from hospital.This study will be prospective and in addition to usual healthcare. The main aim of this feasibility study will be to evaluate the compliance of patients in performing three spirometric measurements per week. Patients will have received a lung transplant more than three months prior to entering the study. The home equipment will comprise a data transmitting box (Twitoo(®)) and a spirometer. A decrease of 10% from baseline in one or more parameters will generate an alarm, which will lead to the transplant physician calling the patient and possibly inviting him to the hospital.The feasibility will be considered as acceptable for an average compliance of 70%. The coefficient of variation and the number of spiro-measurements will be adjusted according to the results obtained.

The tachykinin substance P (SP) is present in lung sensory nerve endings and may be released after neurogenic stimulation. Its role in the pathogenesis of asthma is still unclear. Nevertheless, it may play a major role in airway neurogenic inflammation. Alveolar macrophages are the predominant cells of the airway space and are involved in various types of airway inflammation. We studied guinea pig alveolar macrophage response to SP and other related peptide (C- and N-terminal sequences, NK1-receptor agonist) stimulation. Alveolar guinea pig macrophages were recovered by bronchoalveolar lavage (BAL). Macrophage reactive oxygen intermediate (ROI) production was studied by luminol-dependent chemiluminescence with several concentrations of SP and related peptides. Eicosanoid synthesis after stimulation was evaluated by thin-layer chromatography (TLC) and enzyme-linked immunosorbent assay (ELISA). SP, C-terminal sequence, and NK1-receptor agonist significantly increased ROI production by alveolar macrophages (P < 0.01). NK1-agonist and C-terminal sequence modified arachidonic acid metabolism and induced a significant increase in prostaglandin (PG)D2 synthesis (211% and 66%, respectively). We concluded that SP and related peptides directly affect guinea pig alveolar macrophages by inducing the production of inflammatory metabolites.

Resume Si l'epidemiologie bacterienne des surinfections bronchiques est actuellement bien connue sur le plan national, il n'en n'est pas de meme sur le plan regional. Afin de tenter d'apporter une reponse a cette question, un recueil des expectorations a ete effectue dans 10 centres urbains differents sur le territoire national, regroupes sur le plan statistique en 5 regions, au cours de l'hiver 1992–1993. Trois cent soixante sept prelevements ont ete ainsi recueillis de septembre 1992 a avril 1993 ; 264 presentaient les criteres macroscopiques et cytologiques requis pour pouvoir etre inclus dans l'etude. Le prelevement a permis d'isoler 1 ou 2 germes presumes pathogenes dans 57 % des cas. Ce germe etait H. influenzae dans 48 % des cas, S. pneumoniae dans 19 % et M. catarrhalis dans 9 % des cas. La sensibilite de ces germes aux differents antibiotiques etait variable, mais aucun des pneumocoques isoles n'avait une sensibilite diminuee a la penicilline. Sur le plan regional, on retrouve des variations notables dans la repartition des especes bacteriennes, avec en particulier un taux d' Haemophilus de 59 % dans la region Nord-Est et de 31 % dans la region Sud-Ouest, un taux de S. pneumoniae de 31 % dans la region Sud-Ouest et de 7 % dans la region Sud-Est, un taux de M. catarrhalis de 21 % dans la region Centre et de 5 % dans la region Sud-Est.

The most commonly used treatment for the sleep apnoea syndrome (SAS) is the application of constant positive airway pressure (CPAP) during sleep. Compliance is an essential element in the efficiency of CPAP. This is dependent on the quality of the management of care and on the education of the patients. With the emergence of telemedicine, telemonitoring of CPAP has been developed in France.This study will be observational and multicentered. The main aim is to evaluate the feasibility of CPAP telemonitoring in SAS patients (n=90). During the installation of the equipment, the patients will be instructed how to connect the CPAP Secure Digital card to a data transmitting box every week for two months. The actual number and frequency of remote-monitoring box connections will be recorded. The data transmission will be made to the study coordinator, the home care provider SADIR, by the way of a telemedicine platform, located in France.This study will allow measurement of the adherence of the patients to their CPAP treatment by telemonitoring using this new tool of data transmission and the impact of this on CPAP compliance.

The most commonly used treatment for obstructive sleep apnea syndrome (OSA) is the application of continuous positive airway pressure (CPAP) during sleep. However compliance with this treatment is frequently below 70%.The main aim of this study was to evaluate the feasibility of an educational intervention (EI) delivered in phone calls made to OSA patients (n=66) treated with CPAP by a home care provider (SADIR). The educational intervention consisted of five sessions of telephone based counseling intervention by appropriately trained staff delivered on day 3, 10, 30, 60 and 90 after initiation of treatment. Secondary objectives were to compare, using a case-control design, CPAP compliance of OSA patients (n=133) with or without EI.Ninety-eight percent of patients accepted the intervention to participate in the study. Fifty-seven patients (86%) received the full intervention program and 44 patients (66%) strictly respected the pre-defined timings per protocol. A higher adherence to CPAP at six months was observed in the EI group compared to patient without EI (94% versus 81%) (P0.05). CPAP compliance at three months was 54minutes higher in the EI group compared to the control group (4h39±2h17 and 3h45±2h45 respectively) but this difference was not statistically significant.An educational intervention dispensed by phone is applicable and would have an impact on CPAP compliance. Its efficacy on long-term compliance has to be confirmed in a larger group using a randomized procedure.

Resume Les auteurs rapportent un nouveau cas de syndrome œufoiseau particulier par son intrication avec une alveolite allergique extrinseque de type poumon d'eleveurs d'oiseaux. L'association de ces deux formes d'hypersensibilite est exceptionnelle, elle est caracterisee par un polymorphisme des manifestations cliniques et serait en rapport avec un mecanisme de sensibilisation inhabituel lie a une exposition aerienne intense et double aux allergenes aviaires et aux proteines d'œuf. Notre observation souligne la coexistence possible de plusieurs mecanismes d'hypersensibilite chez les patients presentant un syndrome œuf-oiseau.

Oxidative stress is a frequent mechanism involved in the pathogenesis of bronchopulmonary disease. The cause can be exogenous, in particular related to to atmospheric pollution and tobacco smoke, or endogenous, related to mobilization of inflammatory cells (macrophages and polymorphonuclear neutrophils). In this general review, we present work demonstrating this oxidative stress and activation of inflammatory cells. We discuss the effect of oxidative stress on the bronchial tree and the need to maintain an adequate balance between oxidants and anti-oxidants. This reviews focuses on experimental studies proving the anti-oxidant effect of NAC on glutathione synthesis and on different pharmacological models. We then discuss human trials, initially experimental then in different bronchopulmonary pathologies related to oxidative stress. Acetaminophen intoxication and pulmonary fibrosis are models for use of NAC. Recent work on COPD appears to show a decrease in exacerbations, improvement in symptoms and quality-of-life, and perhaps a reduction in the alteration of ventilatory function.

Levofloxacine is a fluoroquinolone presenting good anti-pneumococcal activity, including against strains with reduced sensitivity to penicillin. Four randomized controlled studies have compared the efficacy of levofloxacine versus other antibiotics (amoxacillin-clavulanic acid, amoxicillin, ceftriaxone, ceftriaxone plus cefuroxime +/- erythromycin) for the treatment of acute community-acquired pneumonia in adults. Grouping the 1,738 analyzable patients in these four studies, a meta-analysis was performed on the sub-group of 275 patients with documented pneumococcal infection (86 with bacteriemia) in order to compare the efficacy of levofloxacine with that of the comparer antibiotics. The trials were homogeneous, allowing the meta-analysis. The overall rate of clinical success was 88.6% in the levofloxacine group and 86.7% in the comparer group. The interval of confidence for the difference in the rate of estimated clinical success was between -5.65% and +9.39%. Bacteriologically, the rate of eradication was 90.2% and 90.4% respectively with an interval of confidence for the difference between -7.83% and +7.36%. The results of this meta-analysis confirmed that the efficacy of levofloxacine for the treatment of acute community-acquired pneumococcal pneumonia is not inferior to that of the comparers; the interval of confidence for the difference in the estimated rate of success did not include the breaking point of non-inferiority (-10% set for the clinical studies) and included zero.

Strongyloides is an helminthic infection that may induce bronchospasm during systemic migration of larvae. We report a case of a 60 years old man originating from Caribbean who had corti-codependent asthma since 30 years. He was hospitalized for severe exacerbation that worsen when steroid dosage was increase. Sputum examination revealed the presence in great number of Larvae of Strongyloides stercoralis. A good clinical evolution was achieved after specific anti-helminthic treatment. Later on, it was even possible to stop completely steroid treatment. This clinical case demonstrates the interest to look for Strongyloides superinfection in asthmatic patients that worsen when receiving increasing dose of steroids. This is particularly important for patients who have resided, even many years earlier, in areas where intestinal helminthic infection are endemic.

The relationship between infections of the respiratory tract and exacerbations of pulmonary symptoms in individuals with asthma is well established on clinical grounds. Patients having an acute attack of asthma often give a history of a "cold" before the onset of the exacerbation. The identification rate of viruses during exacerbations of asthma (10-30%) is much higher than the viral identification rate generally found during asymptomatic periods in asthmatics (3%). The mechanisms whereby upper respiratory viruses might induce or contribute to attacks of asthma are currently unknown: epithelial damage, increased cytokines releasability, mouth breathing.... Influenza vaccination is recommended in patients with chronic pulmonary diseases. However, bronchial hyperreactivity has been reported after influenza vaccination in asthmatics. Reactions to these vaccines may be due to non-immunogenic impurities, which are not present in the more recently developed subunit vaccines. In spite of the lack of double-blind studies between subunit and killed influenza virus vaccines, and because of the potential bad prognosis of influenza infection on airway obstruction, influenza vaccination should be recommended in asthmatics with stable respiratory function but influenza vaccination rate remains low.

The efficacy and safety of the methylprednisolone prodrugs methylprednisolone suleptanate and methylprednisolone sodium succinate were evaluated in a multicentre, randomised, double-blind, double-dummy parallel study of 88 patients hospitalised with acute asthma. Each study drug was administered as a bolus intravenous injection of 40mg methylprednisolone equivalents every 6 hours for 48 hours. Methylprednisolone 32mg was administered orally 6 hours after the last dose. Pulmonary function, medical events, and clinical laboratory values were assessed at predefined intervals before and during the 72-hour study. The primary response measure of pulmonary function was per cent predicted forced expiratory volume in one second (FEV1) at 48 hours. Secondary response measures were peak expiratory flow rate (PEFR) and FEV1/forced vital capacity (FVC) ratio. Although both drugs demonstrated within-group mean changes from baseline (starting at 6 hours) that were statistically significant for each response, there were no statistically significant differences between the two groups. The mean percent predicted FEV1 at 48 hours and mean per cent change from baseline were 64% and 13% (p0.0001) for the methylprednisolone suleptanate group and 67% and 17% (p0.0001) for the methylprednisolone sodium succinate group, respectively. The mean PEFR and FEV1/FVC ratio at 48 hours were 5.77 l/s and 73% for the methylprednisolone suleptanate group and 5.78 l/s and 76% for the methylprednisolone sodium succinate group, respectively. There were no clinically or statistically significant between-group differences in any of the safety parameters. In this study, methylprednisolone suleptanate and methylprednisolone sodium succinate have been shown to be therapeutically equivalent in the treatment of patients hospitalized with acute asthma.

BACKGROUND: The purpose of this study was to identify factors on which European general practitioners (GPs) base their decisions to admit to hospital patients with lower respiratory tract infections (LRTI). METHODS: A survey was carried out from December 1993 to January 1994 to identify factors that affect GPs' decisions to admit to hospital patients with LRTI by collecting data on 2056 patients from 605 GPs in France, Germany, Italy, Spain, and the UK. RESULTS: Only 93 (4.5%) of the patients included in the study were admitted to hospital. Univariate analysis showed that age > 60 years, institutionalisation of the patient, concomitant diseases, cardiac insufficiency, asthma, a diagnosis of pneumonia, and clinical signs such as chest pain, cyanosis, tachypnoea and hypotension significantly (odds ratio (OR) > 2.0, p < 0.002) influenced the decision to admit to hospital. No influence could be shown for sex, smoking habits, history of bronchiectasis or chronic bronchitis, the presence of fever, chills, myalgia, cough or purulent sputum, and the diagnoses of acute bronchitis, influenza or exacerbation of chronic bronchitis. In the multivariate analysis only the presence of chest pain (OR 2.3, 95% confidence interval (CI) 1.5 to 3.5), cyanosis (OR 4.1, 95% CI 2.4 to 7.1), dyspnoea (OR 4.9, 95% CI 3.1 to 7.9), and hypotension (OR 2.9, 95% CI 1.6 to 5.2), as well as a diagnosis of pneumonia (OR 6.6, 95% CI 4.3 to 10) (all p < 0.00001) remained as factors that significantly affected the decision to admit to hospital. CONCLUSIONS: Clinical signs of severe infection and a diagnosis of pneumonia are the main factors that induce GPs to admit patients with LRTI to hospital in Europe.

Pulmonary nocardiosis is a respiratory infection which is usually described in the immunocompromised. We report three cases in patients suffering from chronic airflow obstruction. In two cases there was a parenchymal disorder and in one case bronchial suppuration without involvement of the alveolar region. The diagnosis was made in all cases by bacteriological examination from specimens obtained at fiberoptic bronchoscopy. The outcome was favourable in all three cases after appropriate treatment. These observations underline the diversity of the clinical forms of respiratory nocardiosis. Furthermore, it demonstrates their possible occurrence in non-immunocompromised patients and the need to look for this germ specifically in long drawn infections. A bacteriological diagnosis is vital to start early and appropriate antibiotic therapy which should be prolonged because of the risk of recurrence and disseminated infection.

Treatment of healthy volunteers by Ribomunyl, whether or not in association with in vitro antibiotics (amoxicillin or josamycin), has been earlier demonstrated to be an efficient stimulant of PMN functions (adhesion and migration). This second double-blind study versus placebo was performed on 17 patients with acute respiratory infections (placebo group: eight subjects; Ribomunyl group: nine subjects). Ribomunyl treatment (four days) associated with antibiotherapy (amoxicillin) induced a significant increase of PMN adhesion (p = 0.014) with no significant effect of the placebo (p = 0.30) and no significant difference between the initial level of PMN adhesion of the two groups (placebo-Ribomunyl).

Reports of allergy to latex have been increasingly frequent during the last few years. The culprit is the natural Hevea Brasiliensis latex which is present in numerous latex-containing materials for daily use. Clinical manifestations are usually benign. Systemic manifestations have been reported mainly in general anaesthesia. We report a case of severe anaphylactic manifestations that occurred during a condom-protected sexual intercourse. The responsibility of latex for this accident was demonstrated by skin and biological tests.Numerous cases of immediate hypersensitivity to latex have been reported since 1979 involving household and surgical gloves, condoms, and sounds, usually with minor cutaneous symptoms; however, severe symptoms have also been reported during general anesthesia. A 34-year-old woman was hospitalized in October 1989 for Quincke's edema an generalized urticaria, accompanied by acute dyspnea, a few minutes after protected sexual intercourse. Clinical examination was normal with respect to respiration; however, an edema of the eyelids and generalized urticaria was found, which was treated with antihistamines and corticotherapy. The notion of a previous anaphylactic shock during an arteriography in August 1989 and contact urticaria of the hands when using surgical gloves was suggested, as she was an assistant pediatric nurse. Allergic tests indicated seasonal rhinitis. Cutaneous tests for pneumallergens according to the technique of Prick indicated polysensitivity to pollens, as papules of 4-4.5 mm size formed. Cutaneous test with a commercial latex extract was positive, producing a papule of 6 mm. Also tests with different latex-based products (surgical gloves, Durex and Trepharm brand condoms) were strongly positive, producing papules of 6.5 mm and 8.5 mm, respectively. The specific IgE (gamma-E globulin) to latex was of class 3 (8.3 PRU/ml). In the majority or cases reported, besides the positivity of skin tests, the specific IgEs were identified in the serum by the technique of RAST. The incriminated product was the latex derivative of Hevea brasiliensis. Therefore, the existence of allergy to latex was responsible for these symptoms of anaphylactic nature.

The frequent association of sleep apnea syndrome and essential hypertension led to think of sleep apnea as an etiology of hypertension, especially as a good correlation has been found between the severity of both diseases. Moreover, treating the apnea syndrome results in a decrease of blood pressure. The aim of our study is to depict the outlines of a severe hypertensive individual with sleep apnea by comparing 9 men primarily referred to the hypertension clinic with refractory hypertension and finally found to have sleep apnea (study group) to 23 men whose diagnosis of sleep apnea was made in the pulmonary unit (controls). Fifteen of these were hypertensives. Mean age of the study group was 47 +/- 7 years vs 60 +/- 11. Controls were less overweighted: BMI = 33 +/- 6 kg/m3 vs 39 +/- 5. Mean blood pressure was 171 +/- 16/107 +/- 4 mmHg in the study group vs 157 +/- 19/92 +/- 12 mmHg in controls. Prevalence of glucose metabolism disorders was significantly greater in the study group: 6 patients with maturity onset diabetes and 3 with proven glucose intolerance, vs respectively 4 and 6 controls. Triglycerides were elevated in both groups whereas mean cholesterol was slightly above normal values. Six patients of the study group could have an echocardiogram which showed left ventricular hypertrophy (mean left ventricular mass index = 206 +/- 31 g/m2 after the Penn convention).(ABSTRACT TRUNCATED AT 250 WORDS)