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In a prospective study of 100 adults, we determined the frequency of hypersensitivity to allergens most often diagnosed in patients suffering from rhinitis and bronchial asthma. Skin-prick tests and RAST for 15 allergens were performed in all patients. The most frequent allergen detected by skin-prick test was the extract "total house dust" (50%) but the corresponding RAST was rarely positive (16%); then came grass pollens (46%), house dust mites (D. pteronyssinus, 38%) and animal danders (cat 33%). On the other hand, a positive skin test with the two moulds chosen was rare (Alternaria tenuis 5%, Cladosporium herbarum 4%). For all the allergens investigated, the correlation between positive skin test and positive RAST was proportional to the intensity of the skin reaction (94% for the skin tests +, 40% for the skin tests ++). 35% of the patients with at least a positive skin test and a RAST for one of the allergens tested had in fact a total IgE concentration not suggestive of atopy (less than 100 kU/1). The results indicate that, with the exception of the 2 moulds chosen, the frequency of allergens diagnosed in Switzerland is very similar to what has been found in other countries with different climates.
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A study was applied in traditionally raised small ruminants in the Senegal Sahelian zone, in order to define the breeding factors linked to respiratory disorders, and to suggest an efficient prevention scheme. A first analysis, which took into account the season, age, and sex effects, led to a definition of the importance of the disease in sheep using different parameters to characterize the pathology. The between-group variability will allow the identification of the factors linked to the disorder, among which breeding techniques may be of great importance.
Respiratory failure is rarely a presenting symptom of motor neuron disease. Seven patients with motor neuron disease who presented with acute respiratory failure of unknown cause and required mechanical ventilation were studied. They all had symptoms and signs suggestive of diaphragmatic weakness. Respiratory involvement seemed disproportionately severe, as six were ambulatory and only three noted limb weakness. Only one had tongue weakness and none had swallowing difficulty. Electrophysiological studies showed widespread denervation and, in particular, diaphragmatic involvement to explain the severe respiratory failure. Weaning from the ventilator was unsuccessful in all cases. The four patients examined at necropsy showed severe loss of anterior horns cells in the cervical cord, with only minimal upper motor neuron involvement. Motor neuron disease should be recognised as a cause of acute respiratory failure, secondary to diaphragmatic paralysis from involvement of phrenic motor neurons.
OBJECTIVE: To describe 2 cases of coexisting rheumatoid arthritis (RA) and Wegener's granulomatosis (WG), and to summarize the clinical and serological data for all 6 patients reported in the English literature since 1966. METHODS: Medline review over a 35-year period (1966-2002) revealed 4 reported cases of RA associated with WG. Patients were diagnosed based on symptoms, radiographic changes, bronchoalveolar lavage fluid analysis, hematuria, serology, and biopsy. We describe 2 additional cases of WG developing in Caucasian women with RA. These are the first reported patients to possess positive antineutrophil cytoplasmic antibodies (ANCA) and autoantibodies to proteinase 3 (PR3). RESULTS: All 6 cases of coexisting RA and WG were female. The diagnosis of RA preceded WG diagnosis in all cases; mean age at RA onset was 43.7 +/- 15.0 years, duration of RA prior to WG diagnosis 7.9 +/- 9.1 years. Clinical findings included erosive articular disease on radiographs (n = 4; 67%), positive rheumatoid factor (n = 6; 100%), upper respiratory involvement (n = 5; 83%), lower respiratory signs (n = 4; 67%), renal involvement (n = 2; 33%), and positive ANCA (n = 2/3; 67%). Five patients were treated with corticosteroids and cyclophosphamide, with clinical improvement. CONCLUSION: Although rare, WG may develop in patients with preexisting RA and may present with end-organ involvement.