Poultry and pig farmers' respiratory symptoms.
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Animals↗
Biomedical subjects
J D Dewitte
Publications and source records attributed to J D Dewitte.
[Return to work after cardiac valvular surgery. Retrospective study of a series of 105 patients].
This was a retrospective study realised by a mailed questionnaire of the medical and socio-professional conditions of return to work in patients with valvular heart disease aged 20 to 59 and operated in the cardiac surgery department of Rennes University Hospital in 1998. The results concern 105 patients of whom 78 were working before surgery and 27 were unemployed, and 53 were professionally active after surgery. The average age was 48 +/- 9 years and the male/female ratio was 2.38. After surgery, 78.4% of patients were NYHA Stages I or II, compared with 38.1% before surgery. Three main surgical procedures were carried out, sometimes in association: aortic valve replacement (71.4%), mitral valve replacement (21%) and mitral valvuloplasty (11.4%). Valve replacement was with a mechanical prosthesis in 83% of cases, a bioprosthesis in 11% of cases and a homograft in 6% of cases. Return to work (67.9%) after an average of 5.3 +/- 3.9 months was correlated with the following factors: age: 50 years old patients or more, were less likely to return to work (p < 0.02); postoperative NYHA stage: patients in stages III and IV were less likely to return to work (p < 0.03); the time off work before surgery: the longer the time (threshold > 6 months) the less likely the patients are to return to work (p < 0.03). Return to work was preferred to non-return (p < 0.03). This study shows the difficulties of professional rehabilitation of patients despite a satisfactory general condition. This is partially explained by the difficult economic context which favorises invalidity but also by the lack of information concerning the role of works doctors in the return to work. The realisation of a liaison file with permission of the person concerned between the general practitioner, the cardiologist and a medico-social security doctor and works doctor should remedy the difficulties in communication and sustain a policy of return to work.
Adult↗
Education and self-management: a one-year randomized trial in stable adult asthmatic patients.
OBJECTIVE: to assess the effects of an educational program in asthmatic patients, following treatment readjustment. METHODS: moderate to severe asthmatic adults underwent a run-in period (up to 45 days) in order to optimize their treatment. Patients were then randomized to an educational or control group over a one-year period. Education consisted of five individual sessions covering: pathophysiology of asthma, role of medication and side-effects, asthma triggers and their avoidance, detection of an asthma flare-up, and self-management plan based on symptoms and peak-flow monitoring. MAIN OUTCOME CRITERION: symptom-free days over the study period (SFD). RESULTS: a total of 72 patients were enrolled (36 in the "education group" and 36 in the "control group"), 54 of whom completed the study. Mean SFD was comparable in the two groups (88% in the education group and 89% in the control group, respectively). When the analysis was restricted to the education group, those patients who complied perfectly with the action plan (n = 5) exhibited a higher SFD, compared to the others (97% vs. 87%, p = 0.009). CONCLUSION: both education and control groups showed high and comparable percentages of SFD. Compliance with self-management plans appears to be an important determining factor in educational programs.
Adolescent↗
Comet assay and early apoptosis.
The comet assay is a single cell gel electrophoresis test currently used as a qualitative and quantitative genotoxicity test. However, some of the results from this comet assay and current knowledge on apoptosis lead us to suspect the presence of some false positive results. The aim of this study was to ascertain if apoptotic cells can yield comet images that might distort the interpretation of the results. Using Jurkat cells, that hardly express Fas antigen, and apoptosis induction with anti-Fas antibody, it was possible to show that apoptosis can generate typical comet pictures as soon as the cells enter the apoptosis process. Therefore, comet images cannot be interpreted as a genotoxicity indicator when an apoptosis risk is present. Yopro-1 staining, that is also nearly immediate after apoptosis induction, can be used to balance comet assay results.
Apoptosis↗
[Asbestosis and sarcoid-like thoracic lesions: a case report].
Mediastinal nodes evidenced in a patient referred for an expert opinion concerning an occupational disease were found to have a sarcoid-like character. The patient was a former smoker who had been exposed to asbestos for 27 years. The patient also had an ENT neoplasia. The nodal enlargements evidenced at mediastinoscopy were the only manifestations compatible with sarcoidosis, a rare association recognized in asbestosis.
Aged↗
Knowledge, self-management, compliance and quality of life in asthma: a cross-sectional study of the French version of the Asthma Quality of Life Questionnaire.
The Asthma Quality of Life Questionnaire (AQLQ) is a well-validated instrument. Our objectives were to explore the cross-sectional validity of the French version, using usual outcomes of asthma, as well as assessment of knowledge of asthma, self-management and compliance. A self-administered version of the AQLQ was given to 124 consecutive patients recruited from two out-patient clinics and an emergency room in order to reflect a wide range of asthma severity. The other outcomes of asthma measured were the FEV1, patient-perceived asthma severity using a visual analogue scale, compliance, knowledge of asthma condition and self-management autonomy. Correlations were predicted before analysis ( r > 0.5, strong correlation, ++ r = 0.35-0.5, moderate correlation and + r = 0.20-0.35, fair correlation). The AQLQ scores correlated moderately to strongly with asthma severity and fairly with the pulmonary function results. Of the behavioural outcomes assessed, only knowledge of asthma correlated fairly with the AQLQ scores, as expected. This study of the French version of the AQLQ, while showing similar cross-sectional correlations with functional assessment and asthma severity to those observed with the original English version, suggested in addition a positive association between quality of life and knowledge of asthma.
Adult↗
Occupational asthma due to chromium.
We describe a 28-year-old subject employed as a roofer in a construction company since the age of 19, who developed work-related symptoms of a cough, shortness of breath, wheezing, rhinitis and headaches. A description of a usual day at work suggested that the symptoms worsened while he was sawing corrugated fiber cement. Baseline spirometry was normal, and there was a mild bronchial hyperresponsiveness to carbachol. A skin patch test to chromium was negative. A specific inhalation challenge showed a boderline fall in forced expiratory volume in 1 s (FEV1) after exposure to fiber cement dust. Exposure to nebulization of potassium dichromate (K2Cr2O7), at 0.1 mg.ml-1 for 30 min, was followed by an immediate fall by 20% FEV1. Simultaneously, a significant increase in bronchial hyperresponsiveness was demonstrated.
Adult↗
[Chronic hyperventilation syndrome].
Hyperventilation syndrome is a frequent, but poorly understood clinical entity. The clinical expression is a rich combination of respiratory, cardiac and neurological signs which can simulate various organic diseases. Hypocapnia remains the primum movens for most authors although the relationship with psychiatric situations, in particular in anxious patients, is increasingly emphasized. The diagnosis is currently based on the elimination of diseases associated with hyperventilation, then on Nijmegen's questionnaire and is confirmed by the reproduction of the same clinical picture in a voluntary hyperventilation test. Respiratory function tests offer little information. Treatment is based on combining rehabilitation therapy focused on the diaphragm and on relaxation. Specialized care may be needed in psychiatric patients.
Chronic Disease↗
Respiratory symptoms and bronchial reactivity among pig and dairy farmers.
OBJECTIVES: This study assessed the prevalence of respiratory manifestations among French pig and dairy farmers and determined the relationship between bronchial reactivity and respiratory manifestations. METHODS: The pig farmers included 102 men working more than half-time inside swine confinement buildings. There were 51 male dairy farmers and 81 male referents. The demographic characteristics of the three groups were similar except for more smokers among the referents. Each subject completed a standardized questionnaire. Pulmonary function tests were performed before and after a methacholine challenge (cumulative doses 80, 240, and 560 micrograms). Airborne dust, ammonia, and carbon dioxide were measured inside 28 swine confinement buildings. RESULTS: The pig farmers were exposed to a total dust level of 2.41 mg.m-3. The respirable particle concentration was low. The pig and dairy farmers had a significantly higher prevalence of cough and morning phlegm than the referents. Before the methacholine challenge, the dairy farmers had nonsignificantly lower mean lung function values than the other groups. Among the subjects with no history of asthma, nonspecific bronchial hyperreactivity was significantly higher among the pig and dairy farmers than among the referents. There was a fall in the forced expiratory volume in 1 s (FEV 1.0) that was greater than 10% in 6.7% of the referents, 17.9% of the swine workers, and 35.6% of the dairy farmers. This result was unchanged after adjustment for the initial FEV1.0. CONCLUSIONS: The prevalence of respiratory symptoms was significantly higher among the pig farmers without base-line lung function impairment. However, both the pig and the dairy farmers had increased bronchial reactivity.
Adult↗
Medicolegal and compensation aspects of occupational asthma.
The medicolegal aspects (primary prevention, secondary prevention or surveillance) and the system of compensation (tertiary prevention) for occupational asthma are reviewed in this article. Due to the significant medical, medicolegal, social and financial consequences, it is of the utmost importance that the diagnosis of occupational asthma be proved by objective means, whenever feasible. Compensation for temporary and permanent disability/impairment should be offered to workers. Attempts to retain subjects rapidly and efficiently are preferable, as occupational asthma generally affects young workers. The evaluation of permanent asthma and the awarding of relative permanent disability compensation should be effected 2 yrs after exposure to the causative agent has ended, as asthma generally persists even after exposure to the causative agent ceases. A tabulated review of prevailing medicolegal compensation systems in various countries is presented. Data on an evaluative assessment of the Quebec system of compensation are included.
Asthma↗
Quality of life of subjects with occupational asthma.
BACKGROUND: The aim of the study was to assess the quality of life in subjects with occupational asthma after removal from exposure to the offending agent by comparison with a group of subjects paired for clinical and functional indices in order to show the separation between the two groups of subjects with a hypothesized different quality of life and relate the impairment in quality of life to anthropometric, clinical, and functional variables. METHODS: A previously described asthma quality of life questionnaire (Juniper EF, et al. Thorax 1992;47:76-83) was administered to two groups of subjects in a prospective manner. Information on the clinical and functional severity of asthma was obtained from each subject. Two groups of subjects were assessed: group 1, 134 subjects with occupational asthma who were seen more than 2 years after the diagnosis was confirmed, and group 2, 91 subjects who were seen in specialized asthma clinics of tertiary care hospitals for treatment of nonoccupational asthma and matched with 91 of the 134 subjects with occupational asthma from group 1 according to need for medication and (when available), baseline forced expiratory volume in 1 second (FEV1), and level of bronchial responsiveness. RESULTS: A statistically significant difference was seen in the four domains (asthma symptoms, limitation of activities, emotional dysfunction, environmental stimuli) and in the total score of the quality of life questionnaire between the two groups of matched subjects; the mean difference in the total score was 0.6 on a scale of 1 (no limitation or none of the time) to 7 (severe limitation or all the time). A weak but statistically significant correlation between the total score and several indices (FEV1, bronchial responsiveness and asthma severity) was generally obtained. CONCLUSION: The quality of life of subjects with occupational asthma is slightly less satisfactory than that of subjects paired for clinical and functional indices, although the magnitude of the difference is small; and quality of life is weakly correlated with clinical and functional indices.
Adult↗
Mesenchymal cystic hamartoma of the lung.
We report the case of an asymptomatic 51-year-old man, presenting with chest X-ray abnormalities consisting in multiple pulmonary nodules; the diagnosis of mesenchymal cystic hamartoma of the lung was made by an open lung biopsy, revealing both nodules of mesenchymal cells and cysts with a lining of normal or metaplastic epithelium. Clinical and pathological characteristics of this rare entity are reviewed.
Cysts↗
[The Quebec system of indemnification for occupational asthma. Description, efficacy, and costs].
This study describes the Quebec system of compensation for occupational asthma, assessing the functional and social outcome of claimants and estimating the efficiency and cost. Information was obtained on the clinical, functional and social outcome as well as the estimated costs for 134/211 subjects (participation rate of 64%), who received compensation between 1986 and 1988. At the time of assessment (2 years and more after the diagnosis), 93% of participants still demonstrated significant bronchial hyperresponsiveness and 84% required anti-asthma medication. None of the participants remained exposed to the offending agent: 67% were working for the same or another employer, 16% were retired, 8% were retraining for a new job and 8% were still unemployed. Quality of life was mildly affected, more so than for a control group of subjects. The mean interval between the time claims were addressed and the first medicolegal decision was 8.1 months. The mean total cost (including temporary and permanent disability indemnities, medical and technical costs) was $CAN 49,200 (minimum and maximum values of $2,100 and $330,900). We conclude that for subjects with occupational asthma in Quebec: 1) the mean interval for a medicolegal decision to be made is eight months: 2) a minority is still unemployed two to four years after being assessed; 3) the quality of life is more affected than in a control group; 4) the mean cost is close to $CAN 50,000.
Activities of Daily Living↗
[Respiration through nasal masks and cutaneous lesions of the nose].
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Aged↗
[Septic risk after fiberoptic bronchoscopy brush in lower respiratory tract infection].
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Aged↗
[Value of ipratropium (Atrovent) in the treatment of chronic obstructive lung diseases in myasthenic patients treated with anticholinesterase agents. Apropos of a case].
We report a case of myasthenia gravis occurring in a 70-year old patient with old chronic bronchitis. Anticholinesterase therapy led to an increase in respiratory symptoms, but relief was obtained with inhaled ipratropium. The activity of this drug was confirmed by spirography. This clinical finding is compared with similar data found in the literature.
Aged↗
[Mucoviscidosis: current diagnostic possibilities. Applications in perinatology].
The gene of cystic fibrosis is localised on the long arm of chromosome 7. DNA probes placed close to the gene enable a study of restriction polymorphism to follow the transmission of the gene in index families. It is now possible to counsel those families, who already have an affected child, with an early antenatal diagnosis at ten weeks after the last period. In our personal experience, based on a study of the genotype of 48 families, 70% were informative when they were studied by two probes corresponding to the local pJ3.11 and met. When the latter probes Km19-XV2c were studied concurrently useful information was achieved in 96%. DNA analysis non enables the detection of the chromosome carrying the deleterious gene in practically every family where there is a child suffering from the disease.
Chromosomes, Human, Pair 7↗
[Inflammatory pseudo-tumor of the lung in adults. 1 case].
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Aged↗