Early brain amyloidosis in APP/PS1 mice with serum insulin-like growth factor-I deficiency

The influence of insulin-like growth factor I (IGF-I) on the progression of Alzheimer's disease (AD) is discussed controversially. To help clarify the role of this circulating neurotrophic factor in brain amyloidosis, the major pathological trait in AD, we analyzed plaque formation in a mouse model of AD transgenic for human APP and PS1 mutations with reduced serum IGF-I levels (LIDAD mice). We found that brain amyloidosis in LIDAD mice appeared earlier than in AD mice, at 2 months of age, while attained comparable levels at 6 months. In parallel, early microgliosis was observed in LIDAD mice also at 2 months and remained exacerbated at 6 months. Collectively, these observations suggest a role of serum IGF-I in delaying early brain amyloidosis.

Deletion of the Coffin-Lowry syndrome gene Rsk2 in mice is associated with impaired spatial learning and reduced control of exploratory behavior

Coffin-Lowry Syndrome (CLS) is an X-linked syndromic form of mental retardation associated with skeletal abnormalities. It is caused by mutations of the Rsk2 gene, which encodes a growth factor regulated kinase. Gene deletion studies in mice have shown an essential role for the Rsk2 gene in osteoblast differentiation and function, establishing a causal link between Rsk2 deficiency and skeletal abnormalities of CLS. Although analyses in mice have revealed prominent expression of Rsk2 in brain structures that are essential for learning and memory, evidence at the behavioral level for an involvement of Rsk2 in cognitive function is still lacking. Here, we have examined Rsk2-deficient mice in two extensive batteries of behavioral tests, which were conducted independently in two laboratories in Zurich (Switzerland) and Orsay (France). Despite the known reduction of bone mass, all parameters of motor function were normal, confirming the suitability of Rsk2-deficient mice for behavioral testing. Rsk2-deficient mice showed a mild impairment of spatial working memory, delayed acquisition of a spatial reference memory task and long-term spatial memory deficits. In contrast, associative and recognition memory, as well as the habituation of exploratory activity were normal. Our studies also revealed mild signs of disinhibition in exploratory activity, as well as a difficulty to adapt to new test environments, which likely contributed to the learning impairments displayed by Rsk2-deficient mice. The observed behavioral changes are in line with observations made in other mouse models of human mental retardation and support a role of Rsk2 in cognitive functions.

Effects of rearing conditions on sand digging efficiency in juvenile cuttlefish

The effect of environment on the maturation of sand digging behaviour in cuttlefish was studied. Sand digging behaviour of cuttlefish individually reared on sand was daily observed in their rearing tanks (first study). Other cuttlefish were individually reared from hatching to 2 weeks of life in different conditions (Group A, on a sandy substrate and group B, without sand). At days 0, 3, 6, 9, 12 and 15, cuttlefish from Groups A and B were placed in a novel tank, the bottom of which was covered by sand (second study). The first study shows that more and more cuttlefish sand dig in their rearing tank during the first 6 days of life. The second study shows that, confronted with a novel sand bottom, cuttlefish from Group A show shorter latencies of sand digging and they cover more completely than do cuttlefish from Group B. This indicates that the developmental changes in sand digging appear not totally pre-programmed, but at least partially experience-dependent. Presence of sand in rearing tanks may allow cuttlefish to acquire experience of digging to make this behaviour more efficient.

Lower respiratory tract infections in adults: non-antibiotic prescriptions by GPs

BACKGROUND

The AIR II study is a prospective multicentre assessing management of lower respiratory tract infections (LRTIs) in adults by general practitioners (GPs). Epidemiological studies generally address the prescriptions of antibiotics. To our knowledge, little is known about the real impact of non-antibiotic therapeutic prescriptions (defined here as co-prescriptions) in LRTI. Therefore, the aim of the study was to evaluate non-antibiotic prescriptions in LRTIs.

METHODS

Two thousand general practitioners (GPs) were randomly selected and asked to participate in each of 30 predefined areas covering mainland France. The patient's sociomedical record was completed by the GP during the consultation and sent to the data processing centre at the same time as an anonymous copy of his prescription. The GP also had to report the inclusion by telephone and agree to a telephone appointment with an interviewer.

RESULTS

GPs (n = 3144) reported 5469 evaluable cases. Pneumonia accounted for 9.6% of diagnoses, acute exacerbations of chronic bronchitis 14.9% and acute bronchitis 72.5%. Antibiotics were prescribed to 96.5% of patients. In addition to the 5270 prescriptions of antibiotics, co-prescriptions proved to be twice as numerous as prescriptions of antibiotics (10,027 prescriptions for 5115 patients). Mucomodifiers, steroidal anti-inflammatory drugs and bronchodilators were significantly more prescribed in AECB than others. Non-steroidal anti-inflammatory drugs and antitussives were significantly more prescribed in acute bronchitis than AECB or CAP.

CONCLUSIONS

Our results suggest that recommendations of management in LRTIs need to take into account co-prescriptions.

Management of lower respiratory tract infections by French general practitioners: the AIR II study. Analyse Infections Respiratoires

The Analyse Infections Respiratoires (AIR) II study is a prospective, multicentre survey of the management of lower respiratory tract infections in patients aged 15-65 yrs by general practitioners (GPs) in France. To obtain real-time data recording, practitioners were required to submit an anonymous copy of their drug prescriptions. They were then interviewed over the telephone about the patients' sociodemographic data, signs and symptoms, as well as their presumptive diagnosis and the investigations they had decided upon. GPs (n=3,144) reported 5,469 evaluable cases. Pneumonia accounted for 9.6% of diagnoses, acute exacerbations of chronic bronchitis 14.9% and acute bronchitis 72.5%. The symptomatology covered an extremely wide range of clinical features, which, although statistically different in terms of incidence, overlapped to a large extent across diagnoses. By contrast, hospitalization, investigations or referral to a specialist were much more prevalent in pneumonia, although still very infrequent in general terms (0.5, 1.2 and 10.8%, respectively). Antibiotics were prescribed in 96.5% of patients, with minor differences between diagnoses. However, other medications such as nonsteroid, anti-inflammatory drugs, steroids, nonspecific antitussives and bronchial liquefiers accounted for two-thirds of the prescriptions. This study demonstrates the lower respiratory tract infections encountered by general practitioners are usually mild. However, antibiotic prescription was more systematic than in previous studies and the prescription of nonspecific symptomatic treatments was twice as frequent. General practitioners did not perform additional examinations or refer on a regular basis. There was a high prescription rate for symptomatic treatment.

[Management of lower respiratory tract infections by general practitioners in France]

OBJECTIVE

The purpose of this study was to describe the diagnostic and therapeutic strategies used by general practitioners (GPs) in patients with lower respiratory tract infections (LRTI).

METHODS

Four hundred fifty GPs practicing in France participated in the study; they included 804 patients. The GP recorded social and demographic data and their prescription on a data sheet and responded to a phone questionnaire about their strategy.

RESULTS

Most of the LRTI were acute bronchitis (72%); pneumonia and acute exacerbations of chronic bronchitis were observed respectively in 11% of the patients recruited. Diagnostic criteria used by the GPs were generally auscultation signs in patients with fever, cough and expectoration. Specialized advice (always a chest physician) and hospitalization were exceptional. Prescription of complementary exams was strongly related to the diagnosis of pneumonia (OR = 33.3; CI0.95: 15.48-70.4). Sick leaves were related to general symptoms (fever, asthenia). Antibiotics were prescribed in 95.7% of the patients, mainly aminopenicillin (40.4%) and macrolides (33.2%). Nonsteroidal or steroidal antiinflammatory drugs were prescribed in 72.5% of the patients irrespective of the LRTI diagnosis.

DISCUSSION

The fact that GPs do not often refer patients to specialists or order hospitalization confirms their important role in setting up recommendations. It would also be necessary to develop an education program on better use of antibiotics targeted to GPs and patients.

Phase II trial of paclitaxel and carboplatin in metastatic small-cell lung cancer: a Groupe Français de Pneumo-Cancérologie study

PURPOSE

To evaluate the efficacy and safety of paclitaxel and carboplatin in the treatment of previously untreated patients with metastatic small-cell lung cancer (SCLC).

PATIENTS AND METHODS

Eligible patients were aged 18 to 75 years with an Eastern Cooperative Oncology Group (ECOG) score < or = 2 and life expectancy > or = 12 weeks. Paclitaxel (200 mg/m(2)) was infused over 3 hours, before carboplatin (area under the curve [AUC] 6; Calvert formula) infused over 1 hour, once every 3 weeks for six cycles maximum. Prednisolone, dexchlorpheniramine, and ranitidine were standard premedication. Response to treatment was assessed every two cycles, and nonresponding patients were withdrawn from the trial to receive standard chemotherapy.

RESULTS

Of the 50 patients entering the study, 48 and 46 patients were assessable for toxicity and response, respectively. The overall response rate was 65%, with complete responses in three patients. Five patients had stable disease (11%) and 11 patients experienced progressive disease (24%). Median survival was 38 weeks, and median duration of response was 20 weeks. One-year survival was 22.5%. For a total of 232 cycles, grade 3 and 4 toxicity was 33% for neutropenia, 3.5% for thrombocytopenia, and 4% for anemia. Four patients had neutropenic fever (one toxic death). Nonhematologic toxicity was mainly grade 1 and 2 paresthesia (21% of patients); grade 3 myalgia/arthralgia was observed in 6.5% of patients.

CONCLUSION

First-line chemotherapy with paclitaxel and carboplatin in metastatic SCLC achieved a response rate and survival similar to standard regimens. With 1-day administration and a tolerable toxicity profile, this combination merits further investigation.

[Draft of the Aix-en Provence pollen calendar]

Because of some divergences between the pathologics of Aix and the pollinic accounts found by the spore-trap of Marseilles, a spore-trap has been installed since the beginning of 1997 in Aix hospital to prove that these two sites are specific for pollen identification and dates of pollinisation as well. After three years of measures, the correlation between the vegetation of Aix and the pathological symptoms is established. They are coherent with those published in other sound European countries and confirm the "mediterreean" feature of Aix.

[Pristinamycin in the treatment of acute communicable pneumopathies in adults]

ALTERNATIVE TO BETA-LACTAMS: Due to the rapid and increasing development of resistance in the two main bacteria, S. pneumoniae and H. influenzae, it is important to determine whether pristinamycin, with known efficacy against these germs, could be a useful alternative to beta-lactams for the treatment of adult acute community-acquired pneumonia.

PRISTINAMYCIN VS AMOXICILLIN/CLAVULANIC ACID

A double-blind placebo-controlled randomized multicentric study with two treatment arms enrolling hospitalized patients was conducted. Pristinamycin, 1 g b.i.d., demonstrated an efficacy equivalent to that of the amoxicillin/clavulanic acid combination, 500 mg x 4/d.

IN CLINICAL PRACTICE

Pristinamycin is effective for the treatment of community-acquired pneumonia. Comparative studies including a large number of penicillin-resistant pneumococci remain to be performed, but the first intention use of pristinamycin is already fully warranted in patients at risk treated in an outpatient setting.

Carboplatin as radiosensitizer in non-small cell lung cancer after cisplatin containing chemotherapy. A phase I study of a groupe francais de pneumo-cancerologie (G.F.P.C.)

A Phase I trial of carboplatin therapy was performed on patients with locally advanced non-small cell lung cancer who had been previously treated with cisplatin, mitomycin and a vinca aklaloïd. This was administered as a daily bolus infusion or as a continuous infusion for 6 weeks with concurrent daily thoracic radiation. All patients had to be objective responders or to show no change after chemotherapy. The carboplatin was started at 10 mg/m2 per day, and increased to 15 mg/m2 per day and 20 mg/m2 per day, if treatment was feasible in successive cohorts of at least six patients. The radiation therapy consisted of 62-66 Gray on the tumor and the ipsilateral mediastinal nodes, 50 Gray on the mediastinum and 40-45 Gray on the supraclavicular lymph nodes. Twenty-nine patients took part in this study. Thrombocytopenia was the principal dose-limiting toxicity, with 15 mg/m2 per day of bolus or continuous infusion. Other toxicities included a fall in haemoglobin level, a fall in white-blood cell count, nausea and vomiting. The median survival time was 12 months, but the response rate cannot be determined among patients selected on the basis of response to chemotherapy. The recommended Phase II dose for patients previously treated with cisplatin containing chemotherapy, is 10 mg/m2 per day of either a bolus or continuous infusion.

[Efficacy and tolerability of pristinamycin vs amoxicillin-clavulanic acid combination in the treatment of acute community-acquired pneumonia in hospitalized adults]

The aim of this double-blind, 2 parallel group, randomized, multicenter study was to compare the efficacy and the safety of pristinamycin (P), 1 g bid, versus amoxicillin-clavulanic acid (AAC), 500 mg q.i.d., for 10-14 days in the treatment of non severe community-acquired pneumonia in hospitalized adults. From December 1992 to July 1994, 180 patients were included: 92 in the group P and 88 in the group AAC. The both groups were similar on demographic, clinical and bacteriological criteria. 96 pathogens of which more than half were pneumococci, were isolated in 79/180 (44%) patients. The primary assessment was the global success rate defined as long-term (D40 +/- 7), clinical, radiological and bacteriological efficacy in the "per protocol" population (75 patients in the group P and 83 in the group AAC). The global success was obtained in 63/75 (84%) patients in the group P and 70/83 (84.3%) patients in the group AAC. At the end of treatment (D14 +/- 3), theses rates were respectively 85.4% and 84.3%. The both treatments were equivalents. Adverse events (mainly gastro-intestinal disorders) were reported by 55/92 (59.8%) patients in the group P and 49/87 (56.2%) patients in the group AAC.

Multicenter randomized trial comparing cisplatin-mitomycin-vinorelbine versus cisplatin-mitomycin-vindesine in advanced non-small cell lung cancer. 'Groupe Français de Pneumo-Cancérologie'

The study was designed to evaluate the value of vinorelbine in a cisplatin-mitomycin-vinca alkaloid regimen for treatment of locally advanced or metastatic non-small cell lung cancer (NSCLC). A group of 227 patients with inoperable NSCLC in stage III (58%) or stage IV (42%) were included in this randomized multicenter trial comparing a reference regimen (VDS group, n = 113) cisplatin (120 mg/m2 on day 1, day 29 and day 71), mitomycin (8 mg/m2 on day 1, day 29 and day 71) and vindesine (3 mg/m2/week for 5 weeks and then every 2 weeks up to the 15th week) to a cisplatin-mitomycin-vinorelbine combination (VNB group, n = 114), with cisplatin and mitomycin at the same doses, and vinorelbine 25 mg/m2/week for 16 weeks. The objective response rate (evaluated at 17th week) was 17% in the VDS group and 25% in the VNB group (P = 0.15). Median survival was 33.4 weeks and 34.5 weeks in the VDS and VNB arms, respectively. Overall survival duration was not significantly different between the two arms (logrank test, P = 0.20) despite a trend to an increased survival in the VNB group. This essentially benefited the patients with stage III disease with a clear-cut lengthening of median (45.9 vs. 33.4 weeks) and 1 year survival (44.6% vs. 26.2%, P < 0.05) in favor of the VNB group. Nevertheless, there was no significant difference in overall survival (logrank, P = 0.13). Survival duration of the patients with stage IV disease was comparable in the two arms (logrank test, P = 0.90). Grade 3 or 4 neutropenia was found in 61% and 87% of the VDS and VNB groups, respectively (P < 0.01). Grade 2-4 peripheral neuropathy was observed in 23% of the patients in the VDS group and in 6% of the patients in the VNB group (P < 0.01). Replacement of vindesine by vinorelbine in a cisplatin-mitomycin-vinca alkaloid chemotherapeutic regimen did not lead to a significant improvement in objective response rate or in duration of survival. There was a reduction in neurotoxicity at the expense of an increased hematologic toxicity. However, for patients with stage III disease there was an increase in 1 year survival with the vinorelbine combination.

[Treatment of community-acquired pneumonia by pristinamycin (Pyostacine 500). Results of a non comparative open study]

Activity of natural streptogramin (NSG) appears well adapted to pathogens responsible for CAP. The goal of this multicenter pilot study was to bring first data about efficacy of NSG in treatment of CAP. PATIENTS METHOD: Ten days of a NSG (1 gr b.i.d. or t.i.d.) regimen was administered to 46 hospitalized adult patients for CAP defined with fever > 38 degrees C, respiratory symptoms and X-ray opacity. Severely ill patients were excluded. A broncho-pulmonar sample (expectoration or trantracheal aspiration or protected distal sample) was performed in all patients.

RESULTS

two patients were excluded because of pulmonary embolism (n = 1) or tuberculosis (n = 1) and 44 patients were analyzed. 50% of them had associated disease, 20% had failure of prior antibiotherapy. At inclusion, mean fever was 39.2 +/- 0.7 degrees C, respiratory rate was 22 +/- 5/mn, PaO2 was 74 +/- 10 mmHg, chest X-ray showed bilateral opacity in 16%, unilateral in 84% and pleural fluid level in 6 cases. Etiological diagnosis was determined in 70% of cases. Streptococcus pneumoniae (n = 14), Haemophilus influenzae (n = 5), Legionella pneumophila (n = 2), Mycoplasma pneumoniae (n = 2) and Chlamydia psittaci (n = 1) were the most frequent isolated pathogens. 40 patients (91%) were cured with NSG and delay to obtain apyrexia was 4.4 +/- 3.9 days. NSG was stopped in 4 patients: 1 clinical and bacteriological failure (Klebsiella pneumoniae), 2 clinical failures (1 pneumococcus with purulent pleurisy, 1 pneumococcus with worsening of respiratory status), 1 patient with resistant H. influenzae strain in spite of favourable clinical evolution. NSG was well tolerated in 86% of patients.

CONCLUSION

these data invite to carry on evaluation of first line therapy of CAP with NSG.

Epidemiologic features and clinical presentation of acute Q fever in hospitalized patients: 323 French cases

PURPOSE

To contribute to the knowledge of epidemiologic and clinical features of patients hospitalized with Q fever in France.

METHODS

We conducted a retrospective analysis of 22,496 sera submitted between 1982 and 1990 to the French National Reference Center for Rickettsial Diseases (NRC). The diagnosis of acute Q fever was based on an IgG titer greater than or equal to 1:200 and an IgM titer greater than or equal to 1:25 against phase II Coxiella burnetii antigen on an indirect immunofluorescence test (IFA). Fifteen cases prior to 1985 were diagnosed on the basis of a complement fixation titer greater than or equal to 1:8. A serosurvey of blood donors from Marseille was also conducted in 1988 on 924 sera, using IFA with a cutoff titer of 1:25.

RESULTS

The serosurvey conducted in 1988 showed a seroprevalence of 4.03%, without age or sex prediction. The incidence rate of acute Q fever detection at the NRC was 0.58 per 100,000 inhabitants over the 9-year period. Three hundred twenty-three clinical cases were diagnosed, rising from 1 in 1982 to 107 in 1990. In patients hospitalized for acute Q fever, there was a significantly higher sex ratio of males to females (2.3), which, coupled with the age distribution, indicated that elder males, who are overrepresented due to our recruitment bias, are more susceptible to C. burnetii infections. The mean age of the patients was 45.5 years, while the risk was increased in the 30 to 39 age group as well as in the 60 to 69 age group. Usual epidemiologic risk factors were found in 20.1% of the cases. Hepatitis (61.9%) was a more common clinical presentation in our patients with Q fever than pneumonia (45.8%). This might reflect differences in strains of C. burnetii or the biology of the host. However, French farmers and stock breeders commonly drink unpasteurized raw milk from their cattle, which might indicate a relationship between hepatitis and infection via the digestive tract.

CONCLUSION

Our results indicate that many cases of acute Q fever are undiagnosed. A greater awareness of the disease and more extensive serologic testing of patients with symptoms compatible with Q fever may improve the situation.

Comparative study of azithromycin and amoxicillin/clavulanic acid in the treatment of lower respiratory tract infections

Forty-eight patients with acute bronchitis and four with pneumonia were randomly assigned to receive five doses (500 mg on day 1, plus 250 mg/day on days 2-5) of azithromycin; 54 patients with acute bronchitis and four with pneumonia were assigned 30 doses (625 mg every eight hours for ten days) of amoxicillin/clavulanic acid (CA). The two regimens were equally effective, with clinical improvement or cure in 92% and 87% of patients respectively, bacteriological cure in 89% and 86%, with 91% and 89% of pathogens eliminated. Minor side effects occurred in 6% and 12% of patients in the two groups, respectively. No major abnormalities in laboratory safety parameters were seen in either group.

Comparative study of clarithromycin and roxithromycin in the treatment of community-acquired pneumonia

The efficacy and tolerance of clarithromycin (250 mg twice daily) were compared with those of roxithromycin (150 mg twice daily) in an open, multicentre trial of 77 inpatients with community-acquired pneumonia. Sixty-five patients were clinically evaluable (34, clarithromycin; 31 roxithromycin). Efficacy was comparable between treatment groups: 26 of 34 patients (76%) treated with clarithromycin were clinically cured, including four with atypical pneumonia. In the roxithromycin group 25 of 31 patients (81%) were clinically cured and one was improved. Cough, appearance of sputum, and fever improved in most patients in both treatment groups. Chest X-rays after treatment showed resolution or improvement in 76% of patients who received clarithromycin and 87% of those who received roxithromycin. The clinical evaluation of the response generally agreed with the bacteriological response. Among patients who were bacteriologically evaluable for four target organisms (Streptococcus pneumoniae, Haemophilus influenzae, H. parainfluenzae, and Branhamella catarrhalis) the pathogen was eradicated in four of seven (57%) in the clarithromycin-treated group and in five of six (83%) in the roxithromycin-treated group. Adverse events were reported in more patients who received roxithromycin (21.6%) than in those who received clarithromycin (12.5%) although the incidences were not statistically significantly different. The majority of adverse events were transient increases in serum alanine aminotransferase, serum aspartate aminotransferase, and alkaline phosphatase. Clarithromycin was shown to be effective and well-tolerated; the clinical efficacy and safety of clarithromycin and roxithromycin were comparable.

Pirarubicin phase II study in untreated metastatic small-cell lung carcinoma. A cooperative study of the Groupe Français de Pneumo-Cancérologie (GFPC)

Pirarubicin (THP) (Roger Bellon Laboratory, France) is a new anthracycline under clinical development. In order to assess the efficacy and toxicity of the drug in small-cell lung carcinoma (SCLC), we have undertaken this trial in front-line therapy in patients with metastatic disease, PS less than 3 and at least one evaluable lesion. Responses were assessed after two cycles of THP (60 mg/m2 i.v. bolus every 3-4 weeks) and a further cross over to VP16 + CDDP (three cycles) was systematic whatever the response to THP. This crossover was performed after only one cycle in case of obvious progression. From June 1988 to April 1990, 32 patients were enrolled: 6 were ineligible (4 non-SCLC, 2 M0), 26 patients were fully evaluable for THP and 18 patients for VP16-CDDP. The characteristics of the patients were as follows: mean age 57.4 years (38-71); T4: 54%; T3: 27%; T2: 19%; N3: 62%; N2: 35%; No: 4%. The efficacy was as follows 1 complete response and 2 partial responses (confirmed by endoscopy); 12 patients received only one cycle because of obvious progression; the overall response rate is 12% (95% confidence interval 0-24%). The patient who had complete response after pirarubicin remained in CR after VP16-CDDP, whereas the 2 patients who had partial response achieved CR for one and PR for the other; among the 15 who did not respond 1 CR and 7 PR were observed. The only significant toxicity of THP was granulopenia without infection. THP seems to be an effective anthracycline in SCLC, and the study is continuing. A response could be reached in 50% of the nonresponders with standard therapy and 10 of 24 patients (42%) finally responded. Therefore, this schedule for testing new drugs in metastatic SCLC appears ethically acceptable.

Treatment of brain metastases of lung cancer with high doses of etoposide (VP16-213). Cooperative study from the Groupe Franais Pneumo-Cancérologie

To study the efficacy of etoposide in brain metastases of lung carcinoma, etoposide was given during 3 consecutive days. The total dose of 1500 mg/m2 was divided into six 1 h perfusions delivered over 3 days to 19 patients having squamous (7), large cell (3), small cell (5) or adenocarcinoma (4). Response to chemotherapy was assessed by means of computerized tomography (CT) before and 15-30 days after the last course of chemotherapy (course interval = 28 days, maximum of four courses). Severe myelotoxicity was observed in nine patients with seven patient deaths resulting from infection. Efficacy could be evaluated in 13 patients. Failure was observed in seven cases. An objective response was observed in six patients (4/14 NSCLC and 2/5 SCLC), two patients having a complete regression. Average survival time was 10 weeks.

Prospective study of insulin-dependent diabetes mellitus

Laboratory study fo 109 insulin-dependent diabetics younger than 17 yr of age and resident in greater Montreal at the time on onset of symptoms is reported. The cases were diagnosed during a 2-yr period (1976-1978). Sibling controls were obtained for 72 of the cases studied. Viral titers to coxsackie B, rubella, and mumps virus for the 72 patient-sibling pairs showed no difference in geometric mean titers or in change of titer between samples taken at the time of diagnosis and those taken 28 days later. The incidence of positive islet cell antibody in teh IDdM cases was 68.0% at the time of diagnosis compared with 56.(% 4 wk later. The comparative figures of sibling controls were 4.2% and 1.4%, respectively. The frequency of HLA B8, B15, B18, and B7 antigens were compared both with the sibling controls and a normal control population. Pairing of high risk HLA antigens were found more frequently in cases than controls. There was no difference in geometric mean viral titers in cases with risk risk haplotypes compared with those cases in which such haplotypes were absent.

Insulin dependent diabetes: a comparison of families with single and multiple affected siblings

Families (n = 14) with more than 1 sibling with insulin dependent diabetes were matched with families of similar size and age distribution containing only 1 affected child. The distribution of HLA haplotypes, age of onset of disease, and seasonal onset of disease were compared in the two groups. The data are not consistent with the hypothesis of a single autosomal recessive gene linked to the HLA region. The data do not permit a choice between other current hypotheses although they are compatible with the theory of 2 genes linked to the HLA region, acting additively, and requiring interaction either with environmental factors or other disease susceptibility genes. Diabetic children in the multiplex and simplex families did not differ in the month of onset of symptoms nor in the age at diagnosis although three multiplex pedigrees in which diabetes developed in all affected children before the age of 6 years were identified.

[Methodologic problems concerning pharmacology effect on bronchomotricity in asthma (Raw, V/V) (author's transl)]

Study of spirometric, flow-rate and Raw modifications in three groups of 5 to 8 asthmatic patients (stage I or II) before and after acetylcholine and pneumallergen (dust) action is made. The same modifications were studied on the action of dust before and after a chemical protector effect. In two control groups the following parameters were verified: 1) the stability of Raw and V/V (normal subjects: 8); 2) the reproductibility of the acetylcholine bronchospasm, before and after the action of chemical protector (asthmatic patients: 11). Some considerations about the methodology in the practice of bronchomotricity data are submitted.

[Contribution to the study of the phagocytosing ability of broncho-alveolar macrophages in smokers and non-smokers (author's transl)]

Broncho-alveolar macrophages were obtained by bronchial washing from 20 pairs of matched smokers and non-smokers. The following parameters were studied: phagocytosing ability of macrophages on silica in cell culture in the presence or absence of cotinin, a biocompound of nicotin; migration inhibitory factor (MIF), and power and level of alpha 1-antitrypsin in sera of patients. The results are reported as a function of absolute number of macrophages obtained, their viability, the amount of cigarettes smoked, and the action of cotinin. MIF was stronger in the smokers. There was no difference between the groups as far as power and level of alpha 1-antitrypsin are concerned. Cotinin provokes important lesions in the macrophages. The phagocytic power was not significantly different in smokers and non smokers, but the results were better in non-smokers.

[Study of the regional distribution of inspired gas with radioactive tracers (author's transl)]

Two different techniques are utilized: aerosol with 198Au particles (size 0.5-15 micron) and different gaz mixtures (air; O2 20% + He 80+; O2 60% + N2 40%; O2 60% + He 40%) with 133Xe and registration of the regional distribution along a wash-in (upper, middle and basal) of every lung (gamma camer, computer, Polaroid photographs, scans), performed in three groups of subjects (normal: 5, bronchogenic carcinoma: 11 and chronic bronchitis: 5). Modifications of the airway distribution and blood gas data according to the technical approach (particularly, variations of densities and viscosities) are compared with results in normal subjects.

Corneal ulceration due to Shigella flexneri

Shigella keratitis with ulceration is a rare occurrence with only four previous reports in the literature. Corneal ulceration appears to be characteristically superficial with a predilection for the inferior cornea. In the case reported here, resolution of ulceration occurred with the use of gentamicin and chloramphenicol, following a poor response to sulfacetamide. Experimental evidence strongly suggests that the course of infection is usually self-limited but that corneal scarring is a common sequelae. In the majority of the clinical cases reported to date, corneal ulceration has responded to appropriate antimicrobials with resolution, but has left residual opacification. To the extent that all of the cases were in young children, assessment of the degree of visual loss has been difficult to ascertain.

[Radiotherapy of localized inoperable bronchial squamous cell carcinoma (author's transl)]

Authors have shown that in some favorable cases radiotherapy of localized bronchial carcinoma could give very good results. The study on the cases from 1960 to 1969 shows that authors have 8% of three years survival upon 105 patients who have been treated by 50 Grays or more in 5 weeks. The survival was better for the small cancers T2 than for the large ones. The study on the cases from 1970 to 1977 shows that to obtain 101 cases of squamous cell carcinoma (T2,4 -N0,2 -M0) authors were obliged to study 564 cases. The three years survival was 3,1% for carcinoma receiving more than 40 Grays/4 weeks. The survival is better for small cancer and for the cases without radiological mediastinal nodes. In conclusion, radiotherapy is the best treatment after surgery, limited disease can be cure, and iterative radiotherapy increases our results.

Epidemiologic survey of juvenile-onset diabetes in Montreal

Active search of hospital records was used to survey insulin-dependent juvenile-onset diabetics younger than 17 years resident in General Montreal at the time of onset of symptoms during a seven-year period (1971-1977). A mean annual incidence of 8.8/100,000 was found with variation from year to year (5.8 to 10.3). Eighty percent were five years of age or more at time of diagnosis, and the increase with advancing age was similar to that seen in other studies including the somewhat earlier increase in incidence among females. Seasonal peaks were noted in some but not all years and were more marked in years of high incidence and among males. More cases occurred in areas of high socioeconomic level as measured by average family income. The estimated incidence among siblings of diabetics is 15 times the incidence in the general population. Ten percent of diabetics have a first degree relative who is insulin dependent.