Alain Grimfeld

Expandable prosthesis in right postpneumonectomy syndrome in childhood and adolescence

Right pneumonectomy can lead to severe respiratory impairment due to stenosis of the left main bronchus. This syndrome is usually treated by inserting a fixed-volume prosthesis but, in children, expandable prostheses have the advantage of being adaptable to growth and permit progressive recentering of the mediastinum. We report 3 such cases, with the results of pulmonary function tests. The patients were aged 11, 17, and 22 years at the time of implantation and had undergone pneumonectomy during childhood for either bronchiectasis or complete pulmonary sequestration. All 3 patients are doing well, with a follow-up of 1 to 3 1/2 years. Pulmonary function tests have shown a substantial improvement in the obstructive syndrome in 2 patients whereas, in the third patient, in whom the contralateral lung was not perfectly healthy, the functional improvement was only moderate.

Proteinase 3 mRNA expression is induced in monocytes but not in neutrophils of patients with cystic fibrosis

Proteinase 3 (PR3), a serine proteinase which can degrade lung tissue, is present in the cystic fibrosis (CF) sputum. In the present study, PR3 protein and mRNA expression was determined in circulating neutrophils and monocytes. CF neutrophils contained similar PR3 concentrations as healthy controls and poorly expressed PR3 mRNA. In contrast, CF monocytes showed significantly higher PR3 concentrations than controls, together with an upregulation of PR3 mRNA expression especially during pulmonary exacerbation. Interestingly, antibiotic treatment fully abrogated PR3 mRNA expression and decreased PR3 protein in monocytes. Our findings highlight a potential role of monocyte‐derived PR3 in CF‐associated airway inflammation.

Opinion of the committee for prevention and precaution about the precautionary principle

The precautionary principle has been the subject of a heated debate in recent months in France, not least because it was mentioned in the Environmental Charter discussed by the French Parliament in 2005, and included in the French constitution. In this context, the French Committee for Prevention and Precaution has issued a position paper—presented hereafter—in order to remind legislators and the public of the essential rationale of the precautionary principle, as the committee conceives it. The Committee for Prevention and Precaution (CPP) is an advisory body to the French Ministry of the Environment (now Ministry of Ecology and Sustainable Development), which was created by a Ministerial Decree on 30 July 1996 with the aim of contributing to giving sound foundations to the Ministrys policies in matters related to risk prevention and precaution; detecting, and providing warning and expertise on health issues related to disruptions in the environment; and creating a linkage between scientific research and knowledge on one hand, and regulatory action on the other. Its operational resources are provided by the Ministrys Department of Economic Studies and Environmental Assessment. The CPP is comprised of 19 scientific experts from the field of health and environment, and chaired by Professor Alain Grimfeld.1 List of members of the CPP: Claude Alzieu, Denis Bard, Frédéric‐Yves Bois, Patrick Brochard, Sylvaine Cordier, François Daniellou, Jacques Fontan, Alain Grimfeld, Jean‐Marie Haguenoer, Philippe Hartemann, Philippe Hubert, Armand Lattes, Reza Lahidji, Christine Noiville, Martine Remond‐Gouilloud, Jacques Varet, Pierre Verger, Philippe Verger, Sylvie Charron (Scientific Sectretariat).