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Biomedical subjects

A Grimfeld

Publications and source records attributed to A Grimfeld.

At least 55 records · Page 3Linked to original sources
PubMed1992

[Reliability and reproducibility of 3 peak flowmeters determined in a population of primary school children].

Peak-flow measurement increasingly seems to be very useful for routine monitoring of asthma in children. The purpose of this study was to evaluate the reliability and reproductibility of three different peak-flow meters: Miniwright, Vitalograph and Assess. This prospective study was conducted in 100 primary school children aged from 6 to 11 years. In each child, 9 measurements of expiratory peak-flow rate (EPF) were performed with these 3 peak flow meters in a random order. Reproductibility was assessed for each instrument by the greatest divergence observed between the 3 EPF values measured in the same session. Reliability was assessed by comparison between the values obtained with each instrument and theoretical EPF values calculated from a formula which included age, sex and size. Our study validated the reliability and reproductibility of the 3 peak flow meters studied. EPF values were more scattered and less reproductible with Assess, but the difference was not significant.

Asthma↗
PubMed1992

[Role of inhalation therapy in the management of childhood asthma].

Inhaled drugs became of great interest in the treatment of childhood asthma. They must be adapted now to age and each form of the disease. The primarily interest of an organ therapy is to lead to a maximal efficacy by bringing locally an optimal quantity of drug without or with very few side effects. The choice of the device depends upon age which determines drug tolerance and quality of the inhalation technique. In infants and young children the use of nebulizers appears to be the most suitable technique; preschool children are capable to use metered-dose inhalers (MDI) with spacers; in older children the use of MDI, without spacers, or dry powder inhalers is allowed. During attacks of asthma, inhaled therapy appears to be effective in most cases using either B2 agonists alone in moderate forms, or B2 agonists associated with oral or parenteral corticoids in more severe forms. For the preventive treatment of asthma, in order to prevent attacks, some inhaled drugs also belong to a first line therapy against either allergy or on specific bronchial hyperreactivity: cromolyn or nedocromil are often used in mild to moderate forms (in association with oral anti-histamine drugs in some cases); in more severe forms we can start with a bronchodilator B2 agonist long-term treatment (associated with sustain-released theophylline in some cases), except in infants before twelve or eighteen months of age; in the most severe forms of chronic asthma an anti-inflammatory long-term treatment with inhaled corticosteroids may be prescribed even in young children.

Administration, Inhalation↗
PubMed1992

[Treatment understanding and compliance in asthma of children. Results of a prospective survey].

Compliance with treatment is a crucial factor in the management of asthmatic children which depends on the understanding of the disease and its treatment. The understanding of, and compliance with treatment were evaluated by means of a questionnaire in 50 parents of asthmatic children. 50% of these parents used anti-histamines as maintenance treatment and 30% also used these drugs during attacks. Half the parents knew about the bronchodilator effects of theophylline and B2-agonists. 42% and 30% respectively of the parents thought that the side-effects of theophylline or corticosteroids were few or inexistent; 86% claimed regular attendance to out-patient clinics, but 30% confessed that they had forgotten such drugs as theophylline and antihistamines. 50% took the appropriate therapeutic measures when confronted with a moderate or severe attack of asthma. Each child received 2.3 drugs on average for his or her asthma. This study shows that parents have an insufficient knowledge of asthma treatments, and this may partially explain the poor compliance with therapy as well as the morbidity and mortality associated with childhood asthma.

Adolescent↗
PubMed1992

[Reevaluation of environmental factors in allergy to mites: bedding not a factor?].

Prospective multicentric study was conducted among parents of children referred in three allergy units. Unlike current opinions: carpets are less frequent in bedrooms of mite's allergic children. foam bedding don't play any role, local humidity non significantly increases the mite's allergy risk. the sunlight absence is significantly correlated with this hypersensitivity. These data, mainly inconsistent with general conviction, could be explained by socio economic diversity of patients.

Allergens↗
PubMed1992

Evaluation of clinical trials of immunomodulators for prevention of recurrent respiratory infections in children.

Despite numerous clinical studies showing "significant differences" in favour of immunomodulators versus placebo in the treatment and/or prevention of recurrent respiratory tract infections, the efficiency of such treatments is still not readily acknowledged by a large part of the medical profession nor by governmental authorities in several countries. In an effort to analyze the causes of this scepticism we performed a retrospective study of 15 clinical trials, using a series of quality assessment criteria. From the results of our analysis we propose a series of recommendations for improving the quality of clinical trials with immunomodulators. Furthermore, in order to avoid suspicion of a publication bias, we recommend setting up a registry of all ongoing clinical studies with immunomodulators.

Adjuvants, Immunologic↗
PubMed1992

[Asthma in infants. Clinical and functional aspects].

BACKGROUND: The incidence of asthma in infancy is rising but its clinical and physiological components remain unclear. METHODS: A total of 24 infants, aged less than 48 months, in whom the first wheezing episode (WE) appeared before the age of 30 months (mean age: 9 months) underwent clinical examination and pulmonary function tests at least 2 weeks after the last WE. RESULTS: The mean WE frequency was 1.1 per month and the mean number of admissions for WE was 1.8. 63% of patients showed symptoms between WE and 50% had an allergic profile. There was no evidence of thoracic distension. Bronchial obstruction (BO) occurred in 71% of patients; among these, BO was distal or generalized in 59% and medium or severe in 47%. 12.5% of patients were hypoxemic at testing. BO was less severe in patients treated with theophylline; it was more frequent (87%) in those with symptoms between WE and/or several admissions, and/or admission to the intensive care unit. CONCLUSION: This study provides additional evidence that infants presenting with asthma at an early age have severe clinical and physiological profiles.

Age Factors↗
PubMed1992

[Allergy: the pressing need for public education].

Data collected using a self-questionnaire filled out by the families of 294 children under 12 years of age seen in a pneumoallergology clinic showed widespread lack of information on the role of environmental factors in allergic diseases. Parents ascribed their child's disease to the environment at home only when they were dissatisfied by their housing conditions. Parents who were satisfied with their home failed to perceive that indoor factors with detrimental effects may nevertheless be present. This lack of information was seen across the spectrum of enrolled patients, including in those with hypersensitivity to house mites. The need for health education of the public at large aimed at promoting preventive strategies is underlined.

Allergens↗
PubMed1992

[Value of accelerated hyposensitization with mixed allergens in severe childhood asthma].

The value (in terms of decreased numbers of attacks and of hospitalizations for attacks, decreased need for asthma medications, and improved tolerance to allergens) of rush immunotherapy to a mixture of allergens was studied in children with multiple sensitizations and severe asthma (as evaluated on the number of attacks, number of hospitalizations, and dependence on corticosteroids) already receiving optimal medical therapy. Because syndromic reactions are common, rush immunotherapy should be performed in the hospital and premedication with corticosteroids may be warranted in the most severe cases.

Adolescent↗
PubMed1991

[Mediastino-pulmonary sarcoidosis in children. Clinical study, analysis of data of bronchoalveolar fluid lavage and respiratory function tests, therapeutic trends].

A series of 27 children (mean age: 12 yrs, 5 mos.) presenting with thoracic sarcoidosis is reported. This series, collected from 1961 to 1988 shows the rarity of the disease at that age. However the low rate of asymptomatic forms (22%) suggests that the frequency of the disease is underestimated, as it is not diagnosed. The histological proof is necessary for the diagnosis. When peripheral lesions available for biopsy are lacking, a liver needle biopsy is helpful (93% of positivity). This study shows the frequency of multivisceral types, the intensity of the macrophagic and lymphocytic alveolitis. The therapeutic indications depend on the comparison of the radiological stage, the results of pulmonary function tests (PFT), those of the bronchoalveolar lavages (BAL) and of the serum granulomatous activity markers, especially concerning angiotensin converting enzyme (ACE). When present at the beginning of evolution, several risk factors lead to use a corticosteroid treatment: age of onset before 4 years, multivisceral involvement, presence of functional pulmonary signs, delayed diagnosis and onset of treatment, impaired respiratory function (especially concerning the alveolo-capillary diffusion), PMN cells greater than or equal to 2% in the initial BAL, and IgG proteins greater than 4 SD. Thus sarcoidosis in children differs from that seen in adults as it has a more marked evolutive tendency and leaves severe sequelae in one third of patients.

Adolescent↗
PubMed1990

Indications of the carbon dioxide laser in tracheobronchial pathology of the infant and young child: 14 cases.

Fourteen children aged between 6 months and 7 years (mean age = 3.5 years) were treated by CO2 broncholaser in the ENT Department of Trousseau Hospital. Three groups of diagnostic indication were identified: 1. Granulomas treated after mucosal trauma (tracheotomy, foreign body). 2. Granulomas due to pulmonary and/or lymph node tuberculosis. 3. Adhesions and stenosis secondary to neonatal ventilation. The operative and anesthetic technique is described in detail, together with any possible adverse events. The CO2 broncholaser appears to be a technique of choice in this age group, in which the narrowness of the airways makes any endoscopic procedure difficult. The broncholaser allows the early treatment of obstructive tracheobronchial pathology with its risks of severe ventilatory sequelae.

Bronchi↗
PubMed1990

Cutaneous acquired immunodeficiency syndrome-associated Kaposi's sarcoma in pediatric patients.

Kaposi's sarcoma has only rarely been reported in children with acquired immunodeficiency syndrome. In contrast to adult patients, in whom the disease is predominantly cutaneous, among pediatric patients with acquired immunodeficiency syndrome, Kaposi's sarcoma is primarily limited to the lymphadenopathic form. We describe two children with the acquired immunodeficiency syndrome who developed diffuse nodular skin lesions of Kaposi's sarcoma.

Acquired Immunodeficiency Syndrome↗
PubMed1989

[Etiologic diagnosis of severe acute pneumopathies in infants and children].

In infants and children suffering from severe acute lung disease the problem of aetiological diagnosis arises in two sets of circumstances. In cases of diffuse primary pneumonitis, which occurs mainly in immunocompromised subjects, broncho-alveolar lavage is the ideal technique to discover opportunistic infections; besides, the technique is little invasive and well tolerated. It is only when its results are negative that lung biopsy still has a few indications. In hospital-acquired lung diseases occurring in children under mechanical ventilation the results of broncho-alveolar lavage are more difficult to evaluate owing to possible contamination by tracheal organisms. The various ways of solving this problem (bacterial counts, sampling by means of a protected brush operated by remote control) are discussed.

Acute Disease↗
PubMed1989

[The carbon dioxide laser in tracheobronchial diseases in children. A prospective study of 11 cases].

Carbon dioxide laser has been used in bronchology for over 15 years, primarily in adults and older children. With the recent development of appropriate bronchoscopes, one has now been able to extend its application to infants and small children. 11 patients, aged 10 months through 7 years, were treated by this technic at the ENT Service of the Hôpital Trousseau (Paris). Indications for broncholaser management at this age and the particularities thereof are specified, as well as the results obtained and the complications linked with its use. This new therapeutic tool appears to be reliable and effective in a certain number of cases, representative of which are circumscribed bronchostenoses, granulomas resulting from trauma or associated with tuberculosis, and benign tumors.

Bronchial Diseases↗