[Aspects of tuberculosis in France].
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Biomedical subjects
Publications and source records attributed to S Pretet.
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A cooperative french trial in the treatment of pulmonary tuberculosis has compared the efficacy and the tolerance of daily antituberculous regimes, one of short duration of 18 weeks (HRSZ/HRZ), the other of standard duration of 9 months (HRE). Of 204 patients included in the trial 180 were analysed. No significant difference was found between the two regimes regarding either biological tolerance or clinical outcome. Four relapses were seen within 24 months of the onset of treatment, two in each regime, which shows that 18 weeks treatment is ethically acceptable. Such short course therapy is useful in those patients who would sometimes find prolonged therapy difficult or would be likely to abandon treatment prematurely.
The theoretical cost of the medical treatment of a case of tuberculosis in France in 1982 was calculated after considering the price of diagnosis, drugs, in-patient care and follow up. For exclusively out-patient (ambulatory) care, 9 months treatment was 10 times less expensive than a therapeutic regime which included a hospital/sanatorium stay of four months followed by a return home. The major differences of theoretical costs involved were more closely related to location of treatment rather than either the drugs chosen (as Rifampicin was always used), or the type of follow up over 9 months.
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Vitamin A and its derivatives, so-called retinoids, can prevent squamous metaplasia induced not only by vitamin A deficiency but also by carcinogenic hydrocarbons. An aromatic retinoid, such as ET1, has been shown to prevent chemically induced papillomas in mice and to amplify certain immunologic reactions. Heavy smokers, 106 volunteers, were submitted to fibrobronchoscopy with bronchial biopsies. An index of metaplasia (IM) was calculated on the basis of microscopical examination of a total of 9,633 sections of 1,010 biopsies. Despite the subjectivity of the estimates of cigarette consumption, this was significantly (P less than 0.02) and positively correlated to the IM. Eighty-five percent of the women had a low IM as compared to only 42% of the men (P less than 0.01), although there was no significant difference in the reported cigarette consumption. Fifty-two subjects had an IM greater than 15% and were given 25 mg ET1 orally daily for 6 months. The bronchoscopy was repeated in 30 patients following completion of the 6-month treatment. The IM was significantly (P less than 0.01) reduced after treatment.
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Pyrazinamide, an antituberculous drug discovered in 1952, was first considered as a toxic drug. As it appeared as a bactericidal drug for the organisms inside macrophages, its usefulness has been re-appraised. In combination with other bactericidal drugs, it contributes to speed up the sterilization of tuberculous lesions. A review of the more recent clinical trials allows to assess the real toxicity of Pyrazinamide. Prescribed at a daily dosage of 30 to 35 mg/kg (1,5 to 2 g daily), it gives no major side effects.
Actinomycosis due to Nocardia asteroides is a mainly pulmonary disease; the metastases are due to migration of the germ in the blood from the primary lung focus. The case reported here concerned a patient whose initial symptoms were mainly hepatic, suggesting an amoebic abscess of the liver. The pulmonary lesions appeared only secondarily with presence in the sputum of the nocardia which was responsible. Prolonged treatment with trimethoprime sulfamethazole led to complete and lasting cure of the lesions, confirmed radiographically and by a liver scan.
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