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Biomedical subjects

Y Cormier

Publications and source records attributed to Y Cormier.

At least 127 records · Page 7Linked to original sources
PubMed1988

Chemotherapy can prolong survival in patients with advanced non-small-cell lung cancer--report of a Canadian multicenter randomized trial.

The survival benefit of combination chemotherapy to patients with advanced non-small-cell carcinoma of the lung (NSCLC) is controversial. To study this question, the National Cancer Institute of Canada (NCIC) Clinical Trials Group conducted a prospective randomized trial comparing best supportive care (BSC) to two chemotherapy regimens, vindesine and cisplatin (VP), and cyclophosphamide, doxorubicin, and cisplatin (CAP). Between February 1983 and January 1986, 23 centers across Canada entered 251 patients on study. Eighteen centers participated in the three-arm schema (150 patients); centers choosing not to participate in a study with a no-chemotherapy arm followed a two-arm schema comparing VP with CAP (101 additional patients). Altogether, 233 patients were eligible. Patients had measurable or evaluable disease, with either distant metastases (82.5%) or bulky limited disease considered inoperable or unsuitable for radical radiotherapy. The treatment groups were comparable in terms of age, sex, performance status, histology, disease extent, and weight loss. The overall response rates (complete response [CR] plus partial response [PR]) on the chemotherapy arms were CAP, 15.3%, and VP, 25.3% (P = .06). Patients on the three-arm portion of the trial had a median survival of 32.6 weeks when treated with VP, 24.7 weeks with CAP, and 17 weeks with BSC. The significance of the differences in survival, adjusted for prognostic factors, is as follows: chemotherapy v BSC, P = .02; VP v BSC, P = .01; and CAP v BSC, P = .05. Toxicity on the chemotherapy arms was significant, with leukopenia of severe or greater degree occurring in 37.8% (CAP) and 40.0% (VP), severe vomiting in 12.2% (CAP) and 23.3% (VP), and severe neurotoxicity in 15.6% (VP).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1988

Increasing the functional residual capacity may reverse obstructive sleep apnea.

We describe the reversal of obstructive sleep apnea with a 0.5 L increase in the functional residual capacity (FRC) in a patient with sleep apnea syndrome. The patient had been treated with medroxyprogesterone acetate for 8 months. The increase in FRC was obtained by applying a constant negative extrathoracic pressure (NEP) with a poncho-type respirator. With pulmonary inflation, there was a dramatic decrease in the apnea index and the percent apnea time, and an improvement in sleep architecture. At all sleep stages, the desaturation duration was shorter with NEP. The exact mechanisms by which pulmonary expansion improved sleep apnea in this patient remain unclear; lung volume dependence of upper airway patency and the improvements in apnea-induced desaturation may be contributing factors. Our observation illustrates that lung volumes may be an important factor in the pathophysiology of obstructive sleep apnea, especially in the apnea onset and in the apneic-induced desaturation.

Airway Obstruction↗
PubMed1987

Prognostic significance of bronchoalveolar lymphocytosis in farmer's lung.

In 1983, we studied and reported the clinical and bronchoalveolar lavage (BAL) data of 26 patients with a history of previous farmer's lung. Most of these subjects (24 of 26) had a BAL lymphocytosis. In 1985, we restudied 14 of these subjects. Each subject had a clinical evaluation, chest roentgenogram, pulmonary function tests, and bronchoalveolar lavage. Results show that only 1 subject had evidence of an episode of acute recurrent disease, and only 1 had clinically progressive disease; however, 6 complained of chronic cough and sputum production. There were some fluctuations in individual pulmonary functions, with a significant decrease in FVC during the 2-yr period. The total number of cells on repeated lavage was 55.20 X 10(6) +/- 41.10 X 10(6) (mean +/- SD). This was not statistically different from the results obtained 2 yr earlier (69.5 X 10(6) +/- 43.01 X 10(6)). The percentage of BAL lymphocytes was also similar between the 2 studies, with abnormal values (greater than 20%) in 13 of 14 subjects (47.2 +/- 19.2). The BAL lymphocyte subsets, measured by monoclonal antibody in 8 subjects, showed a wide range of values, with individual OKT4/OKT8 ratios remaining similar at both studies. There were no correlations between changes seen in individual pulmonary function and BAL lymphocytosis. We conclude that a high intensity lymphocytic alveolitis, which persists after an acute episode of farmer's lung, does not predict the outcome of the disease.

Adult↗
PubMed1986

Bronchoalveolar lavage in farmers' lung disease: diagnostic and physiological significance.

A group of 92 farmers had clinical evaluation, pulmonary function tests, and bronchoalveolar lavage (BAL). There were 12 patients with acute farmers' lung disease (FLD) (group 1) and 37 farmers who had had acute FLD, of whom 22 were still on their farm (group 2) and 15 had ceased contact (group 3); others were normal dairy farmers, 23 serology positive to Micropolyspora faeni (group 4), 20 serology negative (group 5), and 42 normal controls (group 6). Of the 134 subjects, 59 had an increase in alveolar lymphocytes (greater than 22% lymphocytes in BAL) (12 in group 1, 19 in group 2, six in group 3, 14 in group 4, five in group 5, and three in group 6). Within each group there was no correlation between BAL lymphocytes (% and absolute number) and most pulmonary function tests. It is concluded that although an increase in BAL lymphocytes is always seen in acute FLD it may also be seen in the absence of clinically evident disease and that BAL lymphocytosis does not correlate with physiological changes in FLD.

Acute Disease↗
PubMed1986

Relationships between radiographic change, pulmonary function, and bronchoalveolar lavage fluid lymphocytes in farmer's lung disease.

Ninety four dairy farmers were investigated by chest radiography, pulmonary function tests, and bronchoalveolar lavage. They were divided into five groups--1: 11 subjects with acute farmer's lung; 2: 25 subjects with previously diagnosed farmer's lung who had stayed on their farm; 3: 15 farmers with previously diagnosed farmer's lung who had left the farm; 4: 23 precipitin positive symptomless farmers; 5: 20 precipitin negative symptomless farmers. The study evaluated the relationships between radiographic changes measured with a scoring system derived from the International Labour Office (ILO) classification, the results of pulmonary function tests, and bronchoalveolar lavage fluid. Thirty eight subjects had radiographic evidence of interstitial pulmonary infiltrates. Group 1 had the highest percentage of lymphocytes recovered by bronchoalveolar lavage (mean 66.3 (SD 19.2]. For all subjects carbon monoxide transfer factor (TLCO) and total lung capacity were negatively correlated with radiographic changes (r = -0.45 and -0.30; p less than 0.001 and less than 0.01 respectively). TLCO was also negatively correlated with radiographic change in group 2 (r = -0.59, p less than 0.005). The percentage of lavage lymphocytes was correlated with radiographic changes for all subjects (r = 0.36, p less than 0.001), but this correlation was not seen within groups. This study shows good correlation between radiographic abnormalities, pulmonary function changes and the cellular composition of bronchoalveolar lavage fluid.

Adolescent↗
PubMed1986

Bronchoalveolar lavage in pulmonary mycotoxicosis (organic dust toxic syndrome).

Two cases of pulmonary mycotoxicosis (organic dust toxic syndrome) are described in which bronchoalveolar lavage was undertaken during the acute phase and after recovery. Both cases occurred after exposure to mould dust in a silo in the course of removing the top mouldy layer of silage or oats at the start of unloading. The workers suffered an acute febrile illness accompanied by cough and dyspnoea. One patient had impaired ventilatory function and both had arterial desaturation in the acute phase. There was mild impairment of diffusing capacity (transfer factor). Bronchoscopy showed inflammation of the bronchial mucosa in one patient. Fungal spores were cultured from the lavage fluid in both patients. In both patients there was an increase in the percentage of neutrophils in the lavage fluid without increase in lymphocytes. The immunoglobulin concentration in the lavage fluid was normal. At the follow up lavage the neutrophils had returned to normal while a mild lymphocytosis of the lavage fluid was seen in both patients.

Acute Disease↗
PubMed1986

Acute effects of marihuana smoking on maximal exercise performance.

To evaluate the effects of marihuana smoking on exercise performance, 12 healthy young subjects did progressive exercise testing on an ergocycle to exhaustion under two conditions: non-smoking (control) and 10 min after smoking a marihuana cigarette (containing 1.7% of delta-9-tetra-hydro-cannabinol) of 7 mg X kg-1 body weight. Heart rate, arterial blood pressure, minute ventilation (VE), breathing rate (fb), oxygen uptake (VO2), and carbon dioxide output (VCO2) were measured before, during, and for 4 min after the exercise. Tidal volume was calculated from VE X fb-1. The exercise duration was also measured. Forced expiratory volume (FEV1) was measured: before smoking (rest); before exercise (10 min after smoking); and after exercise. Carboxyhemoglobin levels were measured before and 10 min after smoking in four subjects. Marihuana smoking reduced exercise duration (16.1 +/- 4.0 to 15.1 +/- 3.3 min, P less than 0.05). At peak exercise performance, there were no differences in VO2, VCO2, heart rate, and VE between the two experimental conditions. Marihuana induced tachycardia at preexercise (94.3 +/- 13.3 beats X min-1 to 119.0 +/- 18.0, P less than 0.01) that was sustained up to 80% of maximum effort and during the recovery period. After marihuana, VE, VO2 and VCO2 were increased above control from 50% of maximum effort to the end of the test. Marihuana induced a bronchodilation (FEV1 from 4.28 +/- 1.00 to 4.43 +/- 1.031, P less than 0.0) that was still present after exercise. Exercise induced a bronchodilation in the control condition but not in the marihuana smoking condition.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1986

Persistent bronchoalveolar lymphocytosis in asymptomatic farmers.

We previously demonstrated that 14 of 23 asymptomatic dairy farmers with positive precipitins and 5 of 20 without precipitins had an alveolar lymphocytosis (greater than 22%). To verify the outcome of this lymphocytosis, we restudied, 2 or 3 yr later, 27 of these subjects. No subject had had symptoms suggestive of farmer's lung disease either prior to the initial study or between the 2 studies. All were still on their farm. Physical examination and chest roentgenograms were normal for all subjects at both studies. Pulmonary function tests showed a small but significant change in RV (101.8 +/- 20.4% to 118.7 +/- 27.6% of predicted, p less than 0.05) and FVC (98.0 +/- 12.6% to 94.3 +/-9.5%, p less than 0.05), whereas TLC, FEV1, and DLCO showed no changes. Lymphocytes from BAL were still increased in 9 of 12 subjects, whereas 3 had returned to normal; of the 15 subjects with previous normal values, 3 now had an abnormal lavage lymphocytosis. There was no correlation between lung function variations and the percentage of lymphocytes in the previous or the present BAL. We conclude that a bronchoalveolar lymphocytosis is a persistent phenomenon in a large number of asymptomatic dairy farmers, and that this finding is not related to significant disease, at least in the time span studied.

Adult↗
PubMed1986

Long-term clinical and functional results of sleeve lobectomy for primary lung cancer.

Sleeve lobectomy is a lung-saving operation in which a portion of main bronchus is removed in continuity with the involved lobe to preserve distal parenchyma. Current controversies relate to indication and safety of the procedure, adequacy as a cancer operation, and contribution of the reimplanted lobe to overall remaining lung function. Between 1975 and 1985, sleeve lobectomy was done electively in 72 patients with lung cancer. There were no operative deaths, but major complications occurred in 10% of patients. Most resected carcinomas were squamous (65/72). Complete resection was performed in all but five patients. A minimum of 1 year's follow-up information was available for all patients. For patients with N0 disease (n = 34) the cumulative 5 year survival rate was 67%, and for patients with N1 status (n = 34) it was 60%. Although postoperative pulmonary function studies at 5 years (n = 19) show subnormal values, they were not severely altered with regard to percent of predicted (forced vital capacity, 85.9% +/- 17.5%; forced expiratory volume in 1 second, 74.9% +/- 19.4%). Regional function was determined by ventilation/perfusion isotope scanning methods. For 15 patients with right lung bronchoplasties, perfusion ratios were 41.1% right lung/58.9% left lung. For four patients with left sleeve operations, these ratios were 29.3% left lung/51.7% right lung. Washout curves show comparable ventilation between the reimplanted lobe and the contralateral lung. The data show that sleeve lobectomy is a safe and adequate operation for patients with resectable lung cancer. The reimplanted lobe or lobes contribute significantly to the overall remaining lung function.

Actuarial Analysis↗
PubMed1986

Relationship among antigen contact, alveolitis, and clinical status in farmer's lung disease.

We studied 41 subjects with a history of farmer's lung disease who had been free of acute episodes for at least one year. Twenty-six were still in daily contact with hay (group 1), and 15 had ceased all antigenic exposure (group 2). While the incidence of dyspnea was similar in both groups, coughing and sputum were more frequent in group 1. Inspiratory crackles were frequent in group 1 subjects (15 of 26) and absent in all group 2 subjects. In both groups, a high percentage of lymphocytes was demonstrated by bronchoalveolar lavage: 52.5% +/- 21.1% (mean +/- SD) and 26.3% +/- 18.7%, respectively. Lymphocytic alveolitis (greater than 22% lymphocytes) was more common in group 1 (23 of 26) than in group 2 (6 of 15). There was no relationship between functional abnormalities and the intensity of the alveolitis. We conclude that lymphocytic alveolitis may persist after an acute episode of farmer's lung disease, but the intensity of the alveolitis is not associated with functional alterations.

Acute Disease↗
PubMed1985

Factors influencing the development of serum precipitins to farmer's lung antigen in Quebec dairy farmers.

A total of 888 randomly selected dairy farmers participated in an epidemiological study to evaluate the prevalence of precipitins to farmer's lung antigens, and the socioeconomic factors associated with their presence. Precipitins were present in 75 farmers (8.4%) (65 to Micropolyspora faeni, seven to Aspergillus spp, two to both Aspergillus and Micropolyspora faeni, and one to Aspergillus and Thermoactinomyces vulgaris). The titres ranged from a dilution of 1/32 to a concentration of X 2 (Ouchterlony's double diffusion method). In the study population there were 544 who had never smoked, 146 ex-smokers, and 198 smokers. Sixty nine precipitin positive subjects were either never smokers or ex-smokers; only six were smokers. The negative relationship between cigarette smoking and precipitins was highly significant (p = 0.004). Factors positively associated with positive precipitin reactions were: size of farm, time spent in the barn, and the presence of a family member previously diagnosed as having farmer's lung disease. Interestingly, positive precipitin reactions were not associated with any of the following: use of silos, hay conditioners, or hay dryers; the presence or quantity of mouldy hay; or the presence of respiratory symptoms. It is concluded that precipitin analysis is not useful as a screening method for farmer's lung, though it can be of diagnostic value in acute farmer's lung disease.

Adult↗
PubMed1985

Long-term physiologic outcome after acute farmer's lung.

We performed a follow-up study of 61 patients who had an acute episode of farmer's lung (54 men and seven women). Twenty-four subjects had ceased all contact with the barn, while 37 had continued farming. Pulmonary function tests for all subjects showed an initial improvement after the acute episode: 92.4 +/- 36.9 percent of predicted for carbon monoxide diffusing capacity (Dco) after one year, compared to 61.5 +/- 28.5 percent at diagnosis (p less than 0.01); and 6.01 +/- 1.50 L for total lung capacity (TLC) after three years, compared to 5.35 +/- 1.42 L (p less than 0.05). Subsequently, pulmonary function decreased over time. Five years or more after the acute episode, pulmonary function tests in subjects who had continued farm work were not worse than those of subjects who had ceased contact for Dco (68.1 +/- 21.4 percent of predicted vs 80.6 +/- 27.7 percent, respectively [p greater than 0.1]) and for TLC (5.55 +/- 1.31 L vs 5.90 +/- 0.84 L [p greater than 0.2]). This study shows that during a long-term follow-up, subjects with farmer's lung who stayed on the farm have subnormal values for pulmonary function but comparable values to those who left their farm.

Acute Disease↗
PubMed1985

Absence of correlation between the degree of alveolitis and antibody levels to Micropolysporum faeni.

Specific IgG antibody (Ab) levels to Micropolysporum faeni (MF) antigen were measured in three study groups: 29 farmers of whom one had acute, two chronic and 26 with a past history of Farmer's lung disease (FLD), 91 clinically asymptomatic but exposed farmers and 23 unexposed donors. This study confirms the greater sensitivity of enzyme linked immunosorbent assay (ELISA) over double immunodiffusion (DID): 34 (37%) sera negative by DID were positive by ELISA and only two (4%) were positive by DID and negative by ELISA. Antibody levels to MF were higher in the serum of farmers whether symptomatic (113.2 +/- 196.1 u) or not (25.2 +/- 64.7 u) than in that of unexposed donors (1.05 +/- 1.46 u), (P less than 0.001). In a subgroup of farmers, antibody levels were compared in the serum and bronchoalveolar lavage (BAL) fluid; the levels were higher in the serum than in BAL fluids in all farmers except the only patient with acute FLD. A significant correlation was seen between Ab levels of the serum and BAL fluids. Finally, no correlation was seen between the serum antibody levels and the total number of cells or the percentage of lymphocytes found in BAL fluids, either in the subjects with a history of FLD or the asymptomatic group.

Antibodies, Bacterial↗
PubMed1984

Abnormal bronchoalveolar lavage in asymptomatic dairy farmers. Study of lymphocytes.

Bronchoalveolar lavage (BAL) was performed on 24 asymptomatic dairy farmers. Thirteen had serum precipitins to Micropolyspora faeni (MF) antigens (Group 1), and 11 were seronegative control subjects (Group 2). All were nonsmokers and had no history of previous lung disease. Thirteen of 24 subjects (9 in Group 1 and 4 in Group 2) had a high percentage of lymphocytes (greater than or equal to 20%) in their BAL. The T-lymphocyte subpopulations as estimated by OKT3, OKT4, and OKT8 monoclonal antibody reactivity were measured in peripheral blood lymphocytes; OKT3 = 58.5 +/- 15.6% for Group 1, and 58.5 +/- 8.7% for Group 2; OKT4 = 40.6 +/- 10.7% and 39.9 +/- 10.0%; OKT8 = 21.5 +/- 10.6% and 22.4 +/- 8.0%, respectively (p = NS). These lymphocyte characteristics were also similar when subjects with a high percentage of lymphocytes in BAL were compared to those with a normal percentage. Specific (MF-coated) chicken erythrocyte lymphocytotoxicity (Group 1, 45.2 +/- 29.5%, Group 2, 49.2 +/- 23.4%), and nonspecific lymphocytotoxicity (Group 1, 43.9 +/- 28.6%, Group 2, 37.9 +/- 18.0%) were also similar. We conclude that a large number of asymptomatic dairy farmers have an increased percentage of lymphocytes in their BAL ("alveolitis") and that peripheral blood lymphocytes in these subjects have normal subpopulations, as assessed by monoclonal antibodies, and normal lymphocytotoxicity.

Adult↗