[Legionnaires' disease. Epidemiologic considerations].
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Biomedical subjects
Publications and source records attributed to A Roussel.
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Autopsy findings for 111 cases of esophageal cancer are presented. Residual tumor in the esophagus was present in 75% of the cases. Lymph node metastases were found in 74.5% and visceral metastases in 50% of the cases. Autopsy revealed a second primary tumor in 21% of the cases; 12% of these were oropharyngeal-laryngeal (OPL) carcinomas, and 9% were visceral carcinomas or malignant lymphomas. Nonmalignant disease found in association with esophageal cancer was dominated by conditions related to chronic alcoholism. Autopsy findings thus revealed that the patients bore not only esophageal lesions, but also patterns of other associated malignant and nonmalignant diseases which would seem to correspond to a complex pathologic state occurring in association with chronic alcoholism. The time between onset of symptoms and autopsy averaged 10.6 months and between first consultation and autopsy, 6.3 months. The brevity of survival from onset of symptoms would seem to confirm that by the time esophageal cancer manifests clinically, it is already at a stage of development beyond the scope of treatment.
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Circadian rhythms of cortisol were studied in 10 patients. This study was made shortly after the burn and for a short period of one or two days maximum in 9 patients. Blood level measurements of cortisone were made in 4 patients. 7 patients died. The analysis of circadian rhythm was made with a computer (méthode de régression harmonique combinée à une analyse de variance). The results are deceiving: there are qualitative and quantitative disturbances but we could not give a significance to them, each patient reacting differently. In one case, a drop of cortisol to 0 was observed and the patient died, this observation shows the development of corticosurrenal failure. So, one or several measurements do not allow the study of corticosurrenal function which differs in each case. Theoretical appreciations in handbooks on the subject must be tempered.
The suppressive effect on PTH secretion of propranolol, a beta 1 and beta 2 blocker, and that of atenolol a specific beta 1 betablocker was compared in 24 uraemic patients not yet on dialysis in a cross over study. Although plasma PTH concentrations were comparable, plasma bicarbonate was higher with propranolol suggesting that the initial suppression of PTH secretion by propranolol was greater as a higher bicarbonate should lead to lower ionised calcium. The suppressive effect of cimetidine on PTH secretion was assessed in 12 patients on chronic haemodialysis. In the seven compliant patients there was no change in N and C terminal plasma PTH values but plasma calcitonin concentrations significantly decreased with cimetidine and returned to initial values after cimetidine was discontinued.
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Salmonella ordonez (BM 2000) codes for kanamycin (Km, aphA), ampicillin (Ap), streptomycin (SmSp:aadA and Sm:aphC), chloramphenicol (Cm), tetracycline (Tc) and sulfonamide (Su) resistances and for production of colicin Ib (Cib). Genetical analysis by incompatibility testing, conjugation, transformation and physical studies using electron microscopy, agarose gel electrophoresis, led us to associate the Km and Cib characters to a 98.7 kilobase (kb) IncI1 plasmid (pIP565), and the Sm (aphC) and Su determinants to a 8.3 kb plasmid (pIP605). The ApCmSmSp(aadA)SuTc determinants were not associated in BM2000 S. ordonez with a plasmid structure. Following conjugation of S. ordonez to E. coli, the ApCmSmSpSuTc determinants were found stably associated with a single plasmid structure (pIP173, 127.5 kb) belonging to IncI1 group. Agarose gel electrophoresis of plasmid DNA restriction endonuclease digests and electron microscopy heteroduplex analysis showed that the acquisition of the ApCmSmSpSuTc determinants resulted from the insertion into pIP565 of a 28.8 kb DNA sequence. This sequence coding for ApCmSmSpSuTu resistances in S. ordonez could be translocated either to pIP565 plasmid or to several IncI1 plasmids but never to plasmids belonging to IncW, IncP or IncFII, suggesting the existence of specific sequences on the IncI1 receptor plasmids. Moreover, R-determinants were translocated back "en bloc" from pIP173 to the chromosome of a susceptible S. ordanez. The results were consistent with the presence in BM2000 S. ordonez chromosomal DNA of an integrated translocatable sequence encoding ApCmSmSpSuTc resistances. Such a structural association could account for the stability of these resistances in the Salmonella ordonez serotype.
Resistance plasmids isolated from Streptococcus agalactiae (group B) and S. faecalis (group D) have been compared in regard to resistance markers, molecular weight, and DNA-DNA homology. Three of them (pIP501, pIP612, and pIP613) have been found to confer identical (or very similar) resistance patterns (erythromycin, lincomycin, and streptogramin B, respectively) and to have similar molecular weights (19.8 x 10(6), 22.7 x 10(6), and 17.6 x 10(6), respectively) and a high level of DNA-DNA homology in hybridization experiments (90 to 100%). These results are compatible with the view that these plasmids may derive from one common ancestor, and/or that they can be transferred between unrelated Streptococcus strains belonging to the same or different groups.
As nitrate consumption may have considerable importance for the in vivo formation of nitrites and potentially carcinogenic N-Nitroso compounds, we have studied salivary nitrite levels in patients with oesophageal cancer and adult volunteers before and after administering 100 ml beet juice containing 160 mg nitrate. Initial salivary nitrite levels were slightly lower in the cancer patients, perhaps because of previous malnutrition. In both groups there was a marked increase in salivary nitrite levels 90 minutes after ingesting beet juice and the attained levels in the two groups were similar. The results imply that formation of salivary nitrite is highly dependent on exogenous dietary nitrate and that there is no difference in the capacity to form nitrites between oesophageal cancer patients and healthy adult subjects.
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A retrospective review was made of 1 400 cases of cancer of the esophagus treated at the Centre "Francois Baclesse" between 1964 and 1975. The disease appeared at an earlier age and more frequently in men (95%) than in women. The lesions were located predominantly in the middle third of the esophagus. There was a high frequency of local, regional and general extension of the disease due to late diagnosis. Less than one-third of the patients were eligible for surgery--which was excluded in the other cases because of age or the presence of associated pathology or secondary neoplasm--and only 10 per 100 of this group were potentially curable.
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