All patients seen in 1975 to 1984 with benign asbestos pleural effusion (BAPE) were studied. In all, 73 exudates occurred in 60 patients, 40 on the left side and 33 on the right. Relapses occurred on the same side in two patients; 11 had bilateral exudates, three of them concomitantly, in the other patients with a free interval of 1-15 years. The mean latency time from the first exposure to asbestos was 30 years, with a range of 1 to 58 years. The effusions lasted from 1 to 10 months, with a median of 3 months. The most common symptoms were pain, fever, cough, and/or dyspnoea; however, 46% of the episodes were symptomless. The total number of thoracocenteses was 66, with removal of 50 to 2000 ml (mean 460) each time. Fifty-three per cent of the pleural fluids were macroscopically haemorrhagic and 26% eosinophilic. Two findings contribute to a better understanding of the entity: first, even a comparatively slight occupational exposure can be sufficient; secondly, BAPE can occur many years after exposure to asbestos, and not only in the first one or two decades.
Thoracic physicians are rightly concerned that mortality from asthma fails to decline despite more widespread enthusiasm for modern management. The recorded mortality rate in England and Wales has remained roughly constant since the epidemic of the mid-1960s subsided.' There is no definite trend occurring generally or for any particular age group when corrections made necessary by the eighth and ninth revisions of the International Classification of Diseases coding in 1968 and 1979 are applied to mortality statistics obtained from the Office of Population Censuses and Surveys up to the end of 1982. About 1500 patients die annually in England and Wales despite improvements in modern pharmaceutical products and a wider understanding of the practicalities of their application in the management of a disorder now regarded as amenable to treatment. These facts are particularly regrettable since avoidable factors were identified in the events leading up to 77 of 90 (82%) deaths reported in the most detailed prospectively planned study of deaths from asthma yet reported, which was carried out by the research committee of the British Thoracic Association (BTA) in 1979.2 This emphasised the very serious deficiencies which occurred in the management of these asthmatic patients, selected for inclusion in the survey by their death. Of course, a description of shortcomings does not amount to an account of the reasons for the deaths and the discovery that there were avoidable factors cannot necessarily be taken to mean that the deaths were preventable. The nature of deficiencies in the treatment of patients both at home, where most deaths occur, and in hospital has been described repeatedly.26 None of the studies concerned was controlled, however, and it remains uncertain whether management is more deficient in those who die than it is in asthmatic patients in general. There is a need to test the relationship between deficient treatment and death scientifically, though this would require a large, carefully controlled epidemiological study and the
The aim of this series of studies was to investigate the quality and quantity of farmers' exposure to airborne spores during the handling of hay or grain. In the beginning, the Petri dish method and later a six-stage Andersen sampler were used to collect the samples. The number of spores of mesophilic fungi, thermotolerant fungi, thermophilic actinomycetes and fungi of the Aspergillus glaucus group were determined in order to find possible causative agents of farmer's lung disease. The level of exposure varied from 10(4) cfu/m3 to 10(7) cfu/m3 (cfu = colony forming unit). In hay, fungi of the A. glaucus group usually dominated. In grain the most common moulds were Cladosporium spp. and Penicillium spp. In both hay and grain the most common thermophilic actinomycete was Thermoactinomyces vulgaris; Micropolyspora faeni was found less frequently. Silaging was found to be the best method to prevent moulding of hay. Chemicals added during baling did not satisfactorily prevent moulding of hay. For stored grain, however, the best results were obtained with propionic acid treatment. The quality and quantity of airborne spores found suggests that farm work exposes farmers to a high risk of becoming sensitized, which leads to the development of asthma or farmer's lung. Few of the methods presently available for making or storing hay and grain can satisfactorily prevent moulding. So far, use of personal dust respirators with a type P2 (previously II b) filter seems to be the only way to effectively diminish exposure to spores.
The pathogenesis of "shrinking pleuritis with atelectasis" or "rounded atelectasis" is discussed on the basis of 37 operated patients and on experiments on cadaver lungs. Peroperative dissections with microscopic examinations and the results of experiments with the cadaver lungs support the concept that the lesion is caused by an inflammatory reaction in the visceral layer of the pleura, caused by asbestos fibers. The inflammation occurs in stages, with deposition of connective tissue that shrinks and causes considerable atelectasis of the underlying pulmonary parenchyma. Compression of the lung due to fluid collecting in the pleural cavity involved was not noted.
A well-recognized complication of ethambutol use is optic neuropathy, but the potential ocular toxicity of isoniazid is often overlooked. A patient developed optic neuropathy while being treated with isoniazid and ethambutol. The optic neuropathy subsided only when both drugs were discontinued, suggesting an additive toxic effect.
In order to compare the prevalences of common allergic symptoms identical postal questionnaires were sent to all farmers of a rural municipality in eastern Finland and to a sample of similar size in the adjacent industrialized urban municipality. To investigate the validity of the survey random subsamples of each study group participated in health examinations. In both the rural and urban populations subjects most frequently suffered from allergic rhinitis, 26.7% and 28.8%, respectively of the two populations. The proportions of individuals with any one of the five allergic symptoms recorded did not differ significantly in the two populations. Asthma was somewhat more frequent among the urban than among the rural population. The difference was not statistically significant, however, and could be due to the difference in smoking habits. The factors reported to provoke allergic symptoms were significantly different in the two groups. In the rural population the provoking factors were mostly work-related, whereas in the urban population these factors were related to living conditions.
Seventeen victims of farmer's lung were monitored during two indoor feeding seasons for cattle. The victims, who had all recovered from the acute phase of the disease before entering the experiment, used powered helmets for respiratory protection (Air-Stream) equipped with Type P2 filters. Filters were changed once a week. The lung function of each subject was investigated at the beginning and towards the end of the indoor feeding season. Each subject kept a diary about the use of dust respirators, changing of filters, inconvenience related to the use of respirators, and symptoms experienced during the follow-up. None of the subjects reported symptoms they related to farmer's lung, and mean values for the lung function parameters (PEF, FEV1, FVC, DLCO, and KCO) did not decrease during the two follow-up periods. In contrast, mean DLCO and KCO increased slightly. At the very end of the both indoor feeding seasons, after the actual follow-up periods, one subject developed mild recurrences of the disease without deterioration detectable by radiology. The patient asserted that he had used the protective helmet properly. The results indicate that powered respirator helmets have protective value in farmer's lung and are appropriate for long-term use. A possibility remains, however, that the disease may recur in highly sensitized individuals, despite the use of efficient protective devices. Other measures for preventing or decreasing mould exposure are equally important.
The sera from 26 patients with serological evidence of infection with Mycoplasma pneumoniae and 23 patients with influenza virus A infection were examined for autoantibodies to smooth muscle, cell nuclei and 'reticulin'. There is an increased incidence of autoantibodies to smooth muscle (46%) in the serum of patients infected with M. pneumoniae. There is no increase in autoantibodies to cell nuclei or 'reticulin' in these patients. There is no increased incidence of autoantibodies in patients infected with influenza virus A. The possible aetiology of the raised incidence of smooth muscle autoantibodies in the patients with M. pneumoniae is discussed.
In dairy farmers exposed to the microbes present in hay, precipitating antibodies against these microbes are frequently found regardless of the state of health of the farmer. The prognostic value of these antibodies for the future health and working ability of farmers was studied in a six-year follow-up survey of 292 farmers. During these six years, of the farmers aged 45-59 years in the primary survey, 14 men (22%) and 15 women (22%) had retired or changed occupation because of illness. Among the men, the presence of precipitins was negatively correlated with their working ability reported in the follow-up study. The risk of occupationally disabling respiratory disease was three times higher in men with precipitins against microbes present in mouldy hay than in precipitin-negative farmers of the same age. No similar correlation was found for women.
The relationship between smoking habits, respiratory symptoms and lung function at the start of the study and mortality during a follow-up period of 11 years was studied in 607 men, aged 50 and 60 years at entry and sampled from the general population. The overall mortality rate in the sample was 18%. In a logistic multiple regression model, mortality rate was significantly related to age, smoking habits, dyspnea and one of the lung function variables FEV1, VC or the slope of phase III. Smokers had a double mortality rate compared to non-smokers (22 versus 10%) after allowing for age, dyspnea and lung function. Similarly, in subjects with abnormal FEV1, VC or slope of phase III, the mortality rate was almost doubled compared to subjects with normal lung function, other factors being equal. Thus, impaired lung function is an important factor to be considered in the assessment of mortality risk, besides smoking and dyspnea.
Deux cas: anamnese d'infection sinopulmonaire chronique, d'azoospermie persistante, d'anomalies epididymiques obstructives caracteristiques, de spermatozoides normaux. Diagnostic differentiel: fibrose kystique, syndrome de Kartagener (cils immobiles)
