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Compensation for occupational pulmonary diseases requires the establishment of guidelines based on standardized and objective criteria, in order to provide compensation that is as fair as possible to patients who suffer from them. A review of the elements necessary for the examination of an individual file was carried out by a working group. It is accepted that respiratory functional exploration is the key element in assessing the level of permanent disability in all of these conditions, with the exception of thoracic malignancies. Guiding scales have been developed for the respiratory impairment of three types of conditions: occupational asthma, thoracic malignancy, and other respiratory diseases. Additional criteria for increasing the permanent disability level are also proposed in order to take into account professional prejudice, in particular the possibility or not of continuing the occupational activity, in the same job or after changing to another. For certain respiratory diseases, a periodic reassessment of the initially attributed permanent disability level is recommended as well as the initial one at the time of definitive cessation of occupational activity.

Resume Les etiologies des syndromes cavitaires pulmonaires sont multiples, notamment neoplasiques, infectieuses ou inflammatoires. Une etiologie particuliere est celle d’infarctus pulmonaires multiples secondaires a des embolies pulmonaires. Ce diagnostic peut etre suspecte devant la localisation sous-pleurale des lesions et l’association avec un thrombus arteriel pulmonaire. Nous rapportons le cas d’une patiente atteinte d’une hypertension pulmonaire post-embolique (HTP PE) chronique associee a une thrombophilie familiale revelee par des infarctus pulmonaires excaves. L’HTP PE chronique est parfois diagnostiquee lors d’une recidive embolique sur des lesions anciennes passees inapercues. Parmi les conditions medicales associees au developpement d’une HTP PE, figurent certaines thrombophilies telles que l’elevation isolee du facteur VIII.

In this article a French working party critically review the international literature to revise the definition, pathophysiology, treatment and cost of exacerbations of adult asthma. The various guidelines do not always provide a consistent definition of exacerbations of asthma. An exacerbation can be defined as deterioration of clinical and/or functional parameters lasting more than 24 hours, without return to baseline, requiring a change of treatment. No single clinical or functional criterion can be used as an early marker of an exacerbation. Innate and acquired immune mechanisms, modified by contact with infectious, irritant or allergenic agents, participate in the pathogenesis of exacerbations, which are accompanied by bronchial inflammation. In 2010, mortality is related to progression of exacerbations, often occurring before the patient seeks medical attention. The objective of treatment is to control asthma and prevent exacerbations. However, many factors can trigger exacerbations and often cannot be controlled. The efficacy of inhaled corticosteroids has been demonstrated on reduction of the number of exacerbations and the number of asthma-related deaths. This treatment is cost-effective, especially in terms of reduction of exacerbations.

Resume Objectif Caracteriser la periode de sevrage de la population des femmes fumeuses au cours de la grossesse. Patientes et methodes Il s'agit d'une enquete descriptive par questionnaire sur un echantillon de femmes accouchant dans quatre regions francaises incluant 979 sujets. Les variables analysees concernent les caracteristiques maternelles de l'accouchement et du nouveau-ne, les habitudes tabagiques avant et pendant la grossesse de la patiente, la notion de risque lie au tabagisme, ainsi que les motivations au sevrage tabagique. Resultats Dans notre population, le taux de femmes fumeuses en debut de grossesse est de 30,9 %, et de 18,1 % au jour de l'accouchement. De plus, environ une fumeuse sur 50 realise son sevrage en vue de la grossesse. Ainsi, 45 % des femmes sont sevrees, essentiellement au premier trimestre : parmi les femmes fumeuses a la date de debut de grossesse et sevrees au jour de l'accouchement, 84 % le sont au premier trimestre, 8,8 % au deuxieme et 7,1 % et troisieme. Discussion et conclusion La plupart des arrets a lieu avant toute intervention specifique de tabacologie. En effet, la premiere consultation de grossesse se produit alors meme que, le plus souvent, la patiente est deja sevree.

Journal de Gynecologie Obstetrique et Biologie de la Reproduction - Vol. 34 - N° 7-C1 - p. 674-678

Many studies have been carried out on reactive hyperaemia parameters in laser Doppler flowmetry (LDF) analysis. For the diagnosis of peripheral arterial occlusive diseases, the most important parameters are the time to peak flow (tpLDF) and the peak flow value (pLDF). However, the determination of these parameters is very often subjective due to the presence of marked oscillations on LDF signals. The present work shows that the de-noising of the concentration of m oving b lood c ell signals (CMBC) can be of great interest in determining new reliable reactive hyperaemia parameters (tpCMBC and pCMBC). 40 CMBC signals recorded on 10 healthy subjects and on 10 patients with peripheral arterial occlusive diseases are thus smoothed using wavelets. For a 1 min occlusion, the parameters computed are tpCMBC healthy = 20.9 s, pCMBC healthy = 40.3 arbitrary units (a.u.), tpCMBC patient = 31.2 S, pCMBC patients = 31.5 a.u. After 2 min of occlusion, tpCMBC healthy = 28.7 s, pCMBC healthy = 61.0 a.u., tpCMBC patient = 38.8 s, pCMBC patient = 41.7 a.u. The 2 new parameters, tpCMBC and pCMBC, are computed on de-noised signals. Therefore, they can improve the diagnosis of peripheral arterial occlusive diseases.

Laser Doppler flowmetry (LDF) is a noninvasive method to monitor skin perfusion and is very useful in studying reactive hyperemia signals. For this latter case, the determination of peak flow (pLDF) and time to peak flow (tpLDF) is of great interest in discriminating between subjects with peripheral arterial obliterative diseases and those who are healthy. However, the myogenic mechanism provokes marked oscillations on all LDF signals. Therefore, an accurate detection of the parameters is very difficult. The present study shows that wavelets are a powerful tool to overcome this drawback. Six different processes using several wavelets are tested on 44 signals recorded on 11 healthy volunteers. The results prove that thresholding coefficients of a multilevel wavelet decomposition does not allow a valuable computation of the parameters but that the reconstruction of the approximation branch is an efficient method to accurately determine pLDF and tpLDF. Using this latter method, mean results for a 3-min occlusion give pLDF = 46.80 a.u. and tpLDF = 17. 08 s. For a 2-min occlusion, pLDF and tpLDF are 39.19 a.u. and 11.63 s, respectively. For a 1-min occlusion, the results give pLDF = 36. 01 a.u., tpLDF = 8.48 s. Eventually, for a 30-s occlusion they give pLDF = 33.86 a.u. and tpLDF = 5.60 s. These results can now be compared with those obtained on pathological subjects.

Les procedures administratives pour la reparation des maladies professionnelles doivent etre connues par les pneumologues afin de conseiller leurs patients. Ces procedures de declaration, de reconnaissance et d’indemnisation dependent de la couverture sociale du patient. Cependant les principes generaux sont analogues et reposent sur un systeme mixte : 1) la presomption d’origine si l’affection est mentionnee dans un « tableau » publie au Journal Officiel et si tous les criteres administratifs et d’exposition indiques dans le tableau sont remplis, 2) un avis au cas par cas, avec certaines limites, si la presomption d’origine ne s’applique pas. Mais ces procedures ne concernent pas les travailleurs independants qui n’ont pas de couverture du risque maladie professionnelle. De plus, les patients atteints d’affections en rapport avec l’amiante beneficient d’avantages complementaires dont les conditions d’acces sont rappelees : fonds d’indemnisation des victimes de l’amiante et cessation anticipee d’activite.