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Biomedical subjects

A Sardet

Publications and source records attributed to A Sardet.

At least 55 records · Page 3Linked to original sources
PubMed1990

[Cystic fibrosis: home treatment].

The authors describe the rules of monitoring and treatment of cystic fibrosis at home. These rules apply to the respiratory component of the disease, which is often insidious and yet clinically predominant and has repercussions on the patient's nutritional status. They also apply to the hepatic and diabetic components, both of which must be recognized and treated. Most of the treatment can be carried out at home with obvious social, epidemiological, psychological and financial benefits.

Cystic Fibrosis↗
PubMed1990

[Cystic fibrosis in infants revealed by severe respiratory distress. Mid-term course].

We report the follow-up of 13 infants aged 2.5 to 24 months in whom cystic fibrosis disease presented as respiratory distress. All infants received an intensive treatment. Mean clinical, radiological and microbiological follow-up was 3.1 years. Ten children aged 1.5 to 8.5 years are still alive. One of them presents with serious respiratory failure, with a Shwachman score of 50. The Shwachman score is between 85 and 70 for 8 of 13 and 65 for one. The prognosis of this group did not differ from the one usually observed in the disease. It depends partially on early intensive care management and is not altered by mechanical ventilation.

Child, Preschool↗
PubMed1990

[Otorhinolaryngologic involvement in cystic fibrosis].

ENT involvement is very frequent in mucoviscidosis, particularly rhinitis and sinusitis. This prospective study, which spanned from September 1st, 1988 to August 31st, 1989 anc included 27 children with cystic fibrosis of pancreas was carried out with the intent of determining the incidence of the various associated diseases, their bacteriologic profile, and the optimal therapeutic procedure. Less than a child in 5 is symptomless when the nose and sinuses are affected. Polyposis is found to occur in 6/27 cases, and all children have sinus radio-opacities. Ear disease is rare (1/4 of cases) and is manifested by asymptomatic tubal dysfunction with minimal audiometric repercussions. Bacteriologic specimens of sputum and sinus purulent discharge show simultaneous germ positivity (10 times out of 11). Our therapeutic recommendations are based on our own experience as well as literature data, and are, in our opinion, only relevant for children with clinical signs of disease, as opposed to advocating systematic treatment of sinus foci found on X-ray.

Adolescent↗
PubMed1989

[Chronic respiratory insufficiency in the child].

Chronic respiratory failure in childhood is a common occurrence, defined as permanent hypoxemia below two standard deviations under the mean for the child's age. In infants, this definition is less clear than in adolescents and adults. Etiologies are numerous, with the most prevalent being chronic obstructive lung disease. Chronic respiratory failure requires etiologic investigations, assessment of lesions and respiratory function, and treatment that can usually be carried out at home. Long-term oxygen therapy is indicated in severe respiratory failure. Oxygen is supplied by an extractor for at least 15 hours per day, and flows are adjusted and monitored using non-invasive measurements of oxygen saturation throughout the 24-hour cycle. The outcome of chronic respiratory failure depends on the cause, the quality of care, and the initial lesions. Chronic respiratory failure should not be considered as necessarily a permanent condition, particularly in infants.

Child↗
PubMed1988

Activation of alveolar macrophages from children with the acquired immunodeficiency syndrome-related complex.

The ability of alveolar macrophages (AM) to release hydrogen peroxide (H2O2), an indicator of AM function, was studied in five children with the acquired immunodeficiency syndrome (AIDS) related complex and, for comparison, in 11 children without disorders of the lung parenchyma. In the AIDS-related complex group, pulmonary manifestations were mild, and lung involvement was suspected by moderate clinical and/or radiological features. None had a past history of opportunistic infections; neither did any have lymphopenia. Cytologic study of the bronchoalveolar lavage (BAL) fluid revealed increased cellularity with increased percentage of lymphocytes. The study of H2O2 release was performed on unstimulated AM and on AM stimulated by phorbol myristate acetate (PMA). Under both experimental conditions, the amount of H2O2 accumulated in the medium was significantly increased in the group with AIDS-related complex (P less than 0.001). As no enhanced oxidative activity has been reported in AM from patients with full-blown AIDS, an increased ability of AM to release oxygen metabolites from children with AIDS-related complex may reflect an initial and temporary step in the course of the LAV/HTLV-III pulmonary disease. Determining AM activation might be a reliable method of assessing the evolution of lung disorder in AIDS.

AIDS-Related Complex↗
PubMed1988

Alveolar macrophage status in bronchopulmonary dysplasia.

The predominant inflammatory cell type within the alveolar structure in bronchopulmonary dysplasia (BPD) is the alveolar macrophage (AM). AM ability to release hydrogen peroxide, a way to evaluate the cell status, was studied in nine infants who developed clinical and radiological evidence of BPD, and was compared to those from infants without lung parenchymal disorders (n = 6). AM were collected by bronchoalveolar lavage which was done after the mechanical ventilation stage in the BPD group. The experiments were performed on unstimulated AM and on AM stimulated by phorbol myristate acetate. Results revealed that the amount of hydrogen peroxide accumulated in the culture medium was significantly enhanced in the BPD group, in both experimental conditions (p less than 0.01 and less than 0.001, respectively). Furthermore, improvement of patients treated with glucocorticoids was closely related to a reduction of the alveolitis with a decrease of AM ability to generate hydrogen peroxide. These data indicate that AM activation is a central component of alveolitis in BPD and that extracellular production of oxidants by stimulated AM may play a critical role in the pathogenesis of the disease.

Bronchopulmonary Dysplasia↗
PubMed1987

A controlled study of oxygen metabolite release by alveolar macrophages from children with interstitial lung disease.

The ability of alveolar macrophages (AM) to release O2 metabolites was studied in 8 children with interstitial lung disease (ILD), and in 11 children without lung parenchyma disorder. AM were collected by bronchoalveolar lavage. The experiments were performed on unstimulated AM and on AM stimulated by phorbol myristate acetate (PMA) or zymosan. Our results indicated that, with or without triggering agent, the amount of O2 metabolites release was a linear function pattern with time. The accumulation of superoxide anion (O2-) and hydrogen peroxide (H2O2) into the extracellular medium differed depending on the triggering agent used: with PMA, the amount of O2- released was threefold the amount of H2O2 detected in the medium, whereas with zymosan the O2- accumulation was tenfold higher than the amount of H2O2 measured. In patients with ILD, a significant increase in the amount of H2O2 release was observed for both unstimulated and stimulated AM (p less than 0.001). In this group, the measurement was repeated after a 2-month steroid treatment: prednisone had markedly improved the clinical, radiologic, and functional status of the patients, and this improvement was in good correlation with the decrease of O2 metabolite production. The amount of H2O2 release in each case was within the range of control values. Evaluation of O2 metabolite release by AM could be a useful parameter in the assessment of the activity of ILD.

Adolescent↗
PubMed1985

[Ceftazidime absorption into bronchial secretions in mucoviscidosis patients].

Penetration of ceftazidime into bronchial secretions was studied in 23 patients, of which 18 had cystic fibrosis. Ceftazidime was used as the single drug for treating exacerbations caused by Pseudomonas aeruginosa. Dosage was 6 g/1.73 m2/day divided into three intravenous injections for 14 to 21 days. Bronchial secretion samples were obtained by fiber-optic bronchoscopy or physical therapy. Serum and bronchial secretion ceftazidime concentrations were assayed using a microbiological method. Ceftazidime concentrations in both media were lower in children than in adults : elimination half-life is shorter (1.7 h against 2.45 h in adults), extravascular distribution is faster, with earlier (1 h against 2 h in adults) achievement of the peak bronchial secretion concentration (2 micrograms/ml). The ratio of bronchial secretion concentration to concomitant serum concentration did not exceed 5% at the time of peak bronchial concentration. These results suggest that in cystic fibrosis patients, the faster and lower bronchial penetration of ceftazidime may be due to faster elimination as compared to adults. Although transient elimination of Pseudomonas aeruginosa was achieved in 12 study patients, our findings support the use of higher dosages or alternative administration modalities designed to increase in situ ceftazidime concentrations.

Adolescent↗
PubMed1982

[Treatment of ventricular tachycardia in infancy and childhood with amiodarone].

Ventricular tachycardia, especially in its apparently primary form, is rare in children and difficult to treat, often requiring aggressive methods of reduction or antiarrhythmic drugs unsuited for paediatric practice. Therefore, we investigated the use of amiodarone whose efficacity in the treatment of resistant ventricular tachycardia and good tolerance in children have been established. Three infants, aged from 9 to 15 months, and two children aged 6 and 7 years with apparently primary VT were selected. Etiological investigations were negative in four cases but in one of the older children a left ventricular fibroma was diagnosed and removed surgically. Amiodarone was administered orally at a dose of 500 mg/m2/24 hrs for 5 to 15 days, and then 250 mg/m2/24 hrs for one month in the surgical patient and for 9 to 39 months in the four "idiopathic" cases. Reduction of VT was obtained in all cases 8 to 48 hours after the first dose. There was only one recurrence, attributed to an over-rapid reducing in dosage; it quickly regressed after returning to the initial dosage. Stable sinus rhythm was maintained at long-term: 18 months, 2 years and 5 years after tailing off a course of 20, 40 and 1 month's treatment in 3 children. These cases are considered to be cured, but in one of these children two courses of amiodarone were required, the second for a relapse 3 months after stopping a 9 month's course of therapy. The other two children are still under treatment after 9 and 15 months with no recurrences. There were no hemodynamic, ocular or thyroid side effects. On the other hand, three cases of photosensitivity, two minor and one major requiring termination of therapy after a 20 months course, were observed. In conclusion, amiodarone would appear to be the treatment of choice for ventricular tachycardia in children, reduction of the arrhythmia being obtained in all cases even by oral administration within reasonable limits: its prophylactic value is excellent and clinical tolerance very satisfactory: a definitive cure can be hoped for an idiopathic VT providing that maintenance therapy has been sufficiently prolonged (2 years).

Amiodarone↗
PubMed1982

[Medium- and long-term results of palliative surgery in complex cyanotic cardiopathies. A propos of 228 cases and 292 operations].

The results of palliative surgery are assessed in a retrospective study of 228 children operated between 1968 and 1977 for complex cyanotic congenital cardiac malformations, the longest follow-up period being 10 years. The surgery consisted in revascularising the lung by systemo-pulmonary anastomoses: Blalock-Taussing, Potts, Waterston, cavo-pulmonary shunts or, on the contrary, of avoiding pulmonary hypertension by limiting pulmonary flow with banding. In addition to these two techniques, in some cases atrial septal defects were created to improve mixing of the two circulations; equalise the pressures between the two atria and relieve the left ventricle (Blalock-Hanlon procedure) or during catheterisation (Rashkind manoeuvre). The results of pulmonary revascularisation by systemo-pulmonary anastomoses were generally satisfactory with respect to the complexity of the malformations. There were 56% good results, 82 out of 146 cases. It often provided the time for curative surgery to be performed under better conditions for the children. The results were worse in children with pulmonary hypertension, with only 33% of good results, 25 out of 82 children, and there were many complications of banding which additional problems at the time of definitive repair. Despite the tendency to widen the indications of so-called curative surgery even in very small infants, palliative surgery retains a role in complex cardiac malformations either by allowing the children to reach an optimal age for repair or by being the only possible therapeutic attitude.

Adolescent↗
PubMed1982

[Radiologic manifestations of bronchogenic cysts of the carina in children. A propos of 5 cases].

The authors report 5 cases of bronchial cysts of the carina tracheae in girls. Symptomatic cysts were located on the left. Diagnostic delay was often very long: about 2 years between the first signs and surgery. When the cyst was on the left side, it was not directly visible on standard x-ray films or tomographies of the chest. Barium swallow shows a typical compression on the anterior part of the esophagus. In children with relapsing atelectasis or over distension, localized on the left, CT scan might allow for earlier diagnosis, as the density of bronchial cysts in high: about 50 Hounsfield units.

Adult↗