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Biomedical subjects

C Gaultier

Publications and source records attributed to C Gaultier.

212 records · Page 12Linked to original sources
PubMedDate not supplied

[Tracheal dyskinesia (tracheomalacia) in infants and children. Study of 127 cases diagnosed through endoscopic examination (author's transl)].

127 cases of tracheal dyskinesia were seen in infants and children out of which 87 were 1 to 12 months of age. The diagnosis was based on the existence of a collapse reducing the tracheal diameter of more than 50% on endoscopy. Endoscopic examination was performed without general anesthesia. This material represents 5,8% of the patients submitted to this procedure. 85 patients had "primitive" dyskinesia and 42 had major associated abnormalities. Uni or bilateral bronchial dyskinesia was associated in 43% of the cases. The four commonest presenting symptoms were a stridulous or wheezing respiration, recurrent bronchitis, chronic cough, cyanosis. The frequency of associated digestive troubles: gastroesophageal reflux aspiration was noteworthy. Several functional consequences were encountered: hypoxemia, hypercapnia, abnormalities of FRC, increased RL, lowering of dynamic compliance, alterations of perfusion and ventilation on scintiscans. The prognosis was good in primitive cases. Two deaths occurred, in the group with associated abnormalities. The pattern of the patient with primitive dyskinesia and that of the patient with dyskinesia and associated abnormalities are outlined. Some features remarkable in this series of patients are pointed out in a discussion of the pathophysiology of the syndrome. Increased transmural pressure is not a common cause of tracheal dyskinesia and infection as well. The possibility of a temporary intrinsic anomaly of the tracheal wall is suggested. Even if its exact mechanism remains unknown, tracheal dyskinesia is a distinct entity observed in infants and children. It appears as a common cause of recurrent bronchopulmonary disease in the young.

Adolescent↗
PubMedDate not supplied

[Hypersensitivity pneumonitis in children. A study of 5 cases (author's transl)].

Five cases of hypersensitivity pneumonitis in children are reported. Four had the pattern of bird breeder's disease and one of aspergillus lung hypersensitivity. All were clearly defined by clinical, radiological, functional and immunologic features. The possible difficulties in diagnosis are emphasized. The disease might be frequently overlooked and its frequency underestimated in children. The diagnostic value of precipitating antibodies is discussed. Although some immunologic studies suggest immune complex mechanisms, recent experimental and clinical data are in favor of a role for cell-mediated immunity. In addition whether or not immunological damage is to occur and result into disease depends not merely upon the characteristics of the antigen exposure. Genetic and/or acquired individual differences in immune reactivity can play a definite role as well. The risk of secondary pulmonary fibrosis and chronic respiratory failure in untreated patients is emphasized. Immunologic and functional tests for identification of the provoking antigen and ceasing of contamination exposure are urgent : they are also useful for monitoring steroid therapy.

Adolescent↗
PubMedDate not supplied

Hypoxemia in attack free asthmatic children: relationship with lung volumes and lung mechanics.

In 113 asthmatic children (mean age +/- SD = 11.0 +/- 2.8 years), the presence of hypoxemia was evaluated during an attack free period. Blood gases were measured in arterialized blood samples. 71% of the patients were hypoxemic. Hypoxemia was defined as partial pressure of O2 (PaO2) below 90% of the mean value for normal children. In a first step, the relationship between hypoxemia and frequency of asthma attacks was examined: frequency of attacks appeared to be a poor predictor of hypoxemia in an attack free period. In a second step, the relationship between hypoxemia and 9 pulmonary function test variables was examined. The static lung volumes considered were: functional residual capacity (FRC: helium dilution technique); thoracic gas volume (TGV: body plethysmography technique) and trapped gases (TG: difference between TGV and FRC). TG was expressed as a percentage of 1) measured FRC (TG/FRCmeas), 2) measured TGV (TG/TGVmeas), 3) predicted FRC (TG/FRCpred). Lung mechanics variables were determined by the oesophageal catheter technique: lung resistance (RL) and dynamic lung compliance (CLdyn). RL and CLdyn were expressed 1) in absolute terms, 2) as a percentage of the index of distension (ID: TGV/FRCpred). All variables are expressed as a percentage of predicted values except for TG/FRCmeas and TG/TGVmeas. Considering lung volumes, hypoxemia was found when TG was present. When lung mechanics were altered, hypoxemia was also present. The relationship between PaO2 and PFT variables was best expressed by the following equation: PaO2 (%) = 85.393 + 0.121 CLdyn/ID--0.151 TG/FRCpred--0.026 RL.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMedDate not supplied

Effects of naloxone on the control of breathing in children with chronic obstructive pulmonary disease.

The effect of naloxone on occlusion pressure (P0.1), the pattern of breathing and the expiratory flows during spontaneous ventilation was studied in 16 children with chronic obstructive pulmonary disease under control conditions, after isotonic saline injection and 5 (N5) and 25 (N25) min after i.v. injection of naloxone (2 micrograms X kg-1). At N5, no change was observed in tidal volume normalized for body weight (VTBW), inspiratory time (TI), respiratory frequency (f), mean inspiratory flow (VTBW/TI) and the ratio of TI and total duration of the respiratory cycle (TI/TT). P0.1 decreased significantly (p less than 0.001) at N5 and returned to control values at N25. The decrease in P0.1 without any change in the breathing pattern suggests that naloxone has an effect on respiratory mechanics. Indeed, at N5, the expiratory flows generated at 25% of VT, measured on the flow-volume curves during spontaneous ventilation, increased significantly when compared to control values. Moreover, the decrease of P0.1 after naloxone was found to be correlated to the reduction of dynamic lung compliance (CLdyn) (p less than 0.02). It is speculated that peripheral airway obstruction, as reflected by the decrease in CLdyn, might be a triggering factor for the release of endorphins. The bronchodilation observed after naloxone could then be due to naloxone's antagonistic effect on endorphin-induced bronchoconstriction.

Bronchi↗
PubMedDate not supplied

Lung function of children treated for malignant extrapulmonary tumors.

Lung function was studied in 29 children suffering from extrapulmonary tumors of varying etiology (Wilm's tumor, n = 7; bone malignancy, n = 17; nasopharyngeal epithelioma, n = 5). Lung volume: vital capacity (VC) and functional residual capacity (FRC), lung mechanics: lung resistance (RL), dynamic lung compliance (CLdyn) and static lung compliance (CLstat) and lung transfer factor for CO (TLCO), and blood gases were determined at different stages of therapy: at t0, before any aggressive treatment for respiratory function; at t1, after the initiation of polychemotherapy with or without local tumoral treatment (surgery or local irradiation); at t2, less than 6 months after onset of thoracopulmonary irradiation (whole lung irradiation at 20 grays) (group I), or local thoracopulmonary irradiation at high exposure greater than 40 grays (group II); at t3 after more than 6 months following irradiation with chemotherapy maintained; at t4, after cessation of all treatment (mean: 25 months +/- 14 after cessation of treatment). At t0, lung function data in children without pulmonary metastases did not deviate from predicted values. At t1, group I showed a significant decrease in CLdyn, which could be due to chemotherapy and for 5 children to consequences of abdominal surgery. In group II, only two children had a low CLdyn and also a significant decrease in VC (possibly due to the site of the tumor). After irradiation (at t2), FRC, TLCO and CLdyn were significantly lower than the predicted values and lower than at t1 in both groups (p greater than 0.01). At t3, functional parameters did not show any change compared to t2. At t4, FRC and TLCO were within normal limits in both groups but CLdyn, CLstat and the CLdyn/FRC ratio remained significantly decreased. It is suggested that these functional abnormalities are due to inadequate alveolar growth.

Adolescent↗
PubMedDate not supplied

Occlusion pressure and breathing pattern in children with chronic obstructive pulmonary disease.

The control of breathing at rest was studied in 30 children (3 to 17 years old) with chronic obstructive pulmonary disease (COPD). Five of them were tested several times during the follow-up of the COPD. Breathing pattern was evaluated and mouth occlusion pressure (PO.1) was measured. Results in COPD children were compared to previously reported values in healthy controls. PO.1 was significantly increased. In 11 children breathing O2, PO.1 decreased but remained at higher levels than predicted. However, the decrease in PO.1 in COPD was not significantly greater than in healthy children. These results may be explained by the relative mild hypoxemia in those children. The increase in PO.1 was significantly correlated with the increase in lung resistance (p less than 0.02) and with the decrease in dynamic lung compliance (p less than 0.01). Most of the COPD children were normocapnic. However, modifications in the breathing pattern were observed. The inspiratory time (TI) was significantly shortened, the expiratory time was prolonged and the TI over the total duration of the respiratory cycle was lowered. The respiratory frequency was unchanged. The tidal volume, normalized for body weight (VTBW), was increased. The mean inspiratory flow (VTBW/TI) was significantly augmented, but not as much as PO.1: in consequence, the effective inspiratory impedance was higher than predicted. Thus, as adults, COPD children had a greater inspiratory neural drive. In contrast to normocapnic COPD adults, they had a modified respiratory timing.

Adolescent↗