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We report the long-term results of surgical repair of gastroesophageal reflux in 44 asthmatic patients who underwent surgery more than five years earlier (mean = 7.9 +/- 1.5 years). The severe asthma was associated with clinically evident reflux, and repair was attempted by surgical technique Nissen transabdominal gastropexy, with the following results: total cure, 11 cases (25 percent); marked improvement, 7 (16 percent); moderate improvement, 11 (25 percent); no improvement, 15 (34 percent). Cure was attained in intrinsic asthma with a predominance of nocturnal crises, associated with nocturnal tracheitis and with significant reflux, objective signs of which had appeared before the beginning of the asthma. Other results concerned asthmas complicated secondarily by GER in which it was impossible to determine whether the reflux was only a complication, without effect on the respiratory illness, or exacerbating the asthma. The question of surgery in these patients should be considered with care, being reserved for cases of severe asthma, poorly controlled by antiasthmatic drugs, and complicated by a severe reflux that encompasses ulcerative esophagitis.

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Bi-apical pulmonary fibrosis particular to ankylosing spondylitis is found in 1 to 10% of cases. The non-specific fibrosis or fibrosis of a more specific character such as iritis or the aortic disease are discussed. The fibrosis may be provoked by repeated infections which would favour an eventual hypoventilation at the apices secondary to the rigidity of the thoracic cage. To test this hypothesis we have studied muco-ciliary clearance in 10 subjects presenting with ankylosing spondylitis without any pulmonary radiological lesion and have compared these to 7 control subjects. No statistical difference was found in the clearance rate between the control subjects and the patients on the one hand (whether or not they had extra articular manifestations) and between the different areas of the lung (notably superior and inferior) in patients on the other hand. Thus this bi-apical fibrosis does not seem to explain the phenomena repeated infections at the apices which might have been favoured by any secondary deficiency in muco-ciliary clearance and hypoventilation of the apices. It seems most likely that the fibrosis has a specific origin related to the nature of the disease.

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Tracheo-bronchial clearance in the hyper-secreting asthmatic patient was studied by observing the elimination over a period of time of a tracer placed on the bronchial wall over time. The authors describe the method used. The analysis of the results enables two purification processes to be distinguished: muco-ciliary activity and cough. The reliability of the method enabled comparison of the results obtained in 7 healthy subjects and 11 hyper-secreting asthmatics. In the healthy subjects, clearance is carried out by the muco-ciliary activity. In the asthmatics, global clearance is normal, but the cough plays an essential role as the muco-ciliary activity is decreased. The question then arises as to whether the decreased muco-ciliary activity in asthmatic patients is due to failure of the bronchial cilia or to the mucus.

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Abnormal uptake of gallium in alveolar structures, raised lymphocyte levels, ECA and, to a lesser degree, proteins in alveolar washings are the principal currently known criteria used to recognise cases of sarcoidosis with persistent immunological activity. The contribution of data concerning broncho-alveolar washings (BAW) in the context of this diagnostic assessment has never been the subject of a critical evaluation. It would nevertheless seem that the distribution of sarcoidosis lesions is not always diffuse and homogeneous, leading to the possibility of errors of assessment in this technique. The aim of the present study was to assess the true existence, degree and consequences of this risk. It was based upon the study of 41 cases of active pulmonary sarcoidosis. Search for homogeneity and heterogeneity between lesions and active alveolitis involved precise radiological study, gallium isotope scan with determination of the index of uptake as well as the quality of the latter, and double BAW carried out in the most radioactive and least radioactive regions respectively. Comparative study of the results obtained showed that zones of active alveolitis were distributed unevenly and heterogeneously in more than half of the patients (71% for gallium and 54% for BAW). This would explain the fact that in 14 cases (34%) criteria of alveolar activity were present in only one of the two specimens of washings. Identification of the zones which should be included in BAW cannot be determined accurately by radiological analysis, regardless of the degree and distribution of radiological abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

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