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Biomedical subjects

J de Blic

Publications and source records attributed to J de Blic.

At least 73 records · Page 4Linked to original sources
PubMed1997

Use of the paediatric bronchoscope, flexible and rigid, in 51 European centres.

We have undertaken a survey to establish current practices and differences in the use of bronchoscopes in children in European centres. A questionnaire was sent to all 220 members of the Paediatric Assembly of the European Respiratory Society (ERS). The questions concerned the following points: indications for bronchoscopy; site of bronchoscopy; type of sedation; any oxygen supplementation during the procedure; number of procedures performed in the previous 12 months; number of procedures performed in the neonatal intensive care unit; number of bronchoalveolar lavages (BALs); side-effects during and after the procedures; and diagnostic yield. Fifty one European centres (40.8% of the European centres contacted) took part in the study. A total of 7,446 bronchoscopies had been performed in the last 12 months: 4,587 using the flexible bronchoscope and 2,859 using the rigid bronchoscope. At centres using only the fibreoptic bronchoscope, the most frequent indication was "recurrent/persistent pneumonia" (17%); at centres using only the rigid bronchoscope, it was "foreign body inhalation" (36.7%); at centres using both methods, the most frequent indication was "other indications" (23.9%). In 12 months, 2,231 BALs were performed: 1,419 in immunocompetent children and 812 in immunocompromised patients. In centres using only the fibreoptic bronchoscope, the highest yield was for "stridor" (81%); in centres using only the rigid bronchoscope, the highest yield was for "persistent atelectasis" (68%); and in centres using both instruments, it was for "foreign body inhalation" (93%). The results of the study suggest that bronchoscopy in children is now a well-established procedure at several European centres, while others are just beginning to use this technique.

Bronchoalveolar Lavage Fluid↗
PubMed1997

Increased spontaneous release of tumour necrosis factor-alpha by alveolar macrophages from wheezy infants.

We determined if alveolar macrophages (AMs) from infants with severe recurrent wheezing episodes release increased amounts of tumour necrosis factor-alpha (TNF-alpha), as described in adults with asthma. We compared TNF-alpha release by unstimulated and lipopolysaccharide-stimulated AMs obtained by bronchoalveolar lavage in 13 wheezy and seven nonwheezy infants (aged 6-36 months) and analysed its regulation by dexamethasone. Metabolites in cell supernatants were quantified by enzyme-linked immunosorbent assay (ELISA) (TNF-alpha) or radioimmunoassay (thromboxane B2 and prostaglandin E2). Comparison of results was performed by the Mann-Whitney U-test and values were expressed as median (interquartile range) in ng x 10(6) cells(-1). Resting AMs from wheezy infants released larger amounts of TNF-alpha and thromboxane B2 as compared to controls: 2.67 (0.89-8.33) vs 0.48 (0.25-1.08) and 75.63 (38.07-158.91) vs 10.03 (7.36-76.08), respectively (p<0.05). When stimulated overnight with bacterial lipopolysaccharide, AMs from both groups released similar amounts of metabolites. Dexamethasone induced a consistent inhibition of the lipopolysaccharide-stimulated release of all the mediators. Our results show that alveolar macrophages from wheezy infants are activated to release increased amounts of tumour necrosis factor-alpha, as in asthma, and suggest that infants with recurrent wheezing may eventually benefit from treatment with glucocorticoids.

Bronchoalveolar Lavage Fluid↗
PubMed1996

[Acute viral respiratory infections and asthma].

Respiratory viral infections are very important triggers of asthma exacerbation. Recent epidemiologic studies support the hypothesis that they are associated with 80 to 85% of acute attacks of asthma in children. The respiratory syncytial and parainfluenza viruses are predominantly detected in infants, while rhinovirus and mycoplasma are the commonest in children. In practice for an asthmatic child, it is necessary: 1. to vaccinate against influenza; 2. resume or increase the inhaled antiinflammatory therapeutics in moderate to severe asthma, before the viral epidemic season; 3. teach the child and his family on the attitude to have during an upper respiratory infection and when to visit a physician.

Acute Disease↗
PubMed1996

[Allergic children].

Epidemiologic data have shown an increased prevalence (and severity) of atopy related diseases (asthma, eczema and allergic rhinitis) during the post 15-20 years. Atopic respiratory diseases such as allergic rhinitis and asthma represent the effects of an immunological response to allergens, mediated through immunoglobulins E. Development of a clinically significant atopic reaction depends on environmental exposure. The majority of allergic children display positive skin tests to house dust mites, animal danders or pollens. Immediate hypersensitivity to food allergens starts early in life and is most often associated with atopic dermatitis. Allergic reactions to peanuts are generally acute and severe, with an increasing frequency. Parents must be aware of their child's problem and preventive measures must be undertaken very early in life, first at home and later also at school. Family history remains the best predictor of atopy in newborn babies.

Age Factors↗
PubMed1996

Cd1a-positive cells in bronchoalveolar lavage samples from children with Langerhans cell histiocytosis.

We evaluated CD1a-positive cells in bronchoalveolar lavage samples from children with Langerhans cell histiocytosis (LCH). All children with multifocal LCH and pulmonary symptoms scored higher than 5% (30.6% +/- 7.2%), whereas those with other lung disorders scored much less than 5%. In children with multifocal LCH, bronchoalveolar lavage fluid abnormalities can precede pulmonary symptoms. During chemotherapy the CD1a-positive cell count lends to decrease.

Adolescent↗
PubMed1996

Efficacy of nebulized budesonide in treatment of severe infantile asthma: a double-blind study.

BACKGROUND AND OBJECTIVE: Treatments with inhaled corticosteroids yielded conflicting results in infants with severe asthma. The purpose of this study was to assess the efficacy of nebulized budesonide on the control of asthma in this age group. METHODS: In a double-blind, placebo-controlled study, 40 infants with severe asthma received either nebulized budesonide (1 mg) or placebo twice daily for 12 weeks, followed by a follow-up period of up to 12 weeks. A jet nebulizer driven by an air compressor was used to administer budesonide and placebo. RESULTS: Fewer patients in the budesonide group had an exacerbation during the treatment period (40%) compared with the placebo group (83%, p < 0.01). The duration of oral steroid therapy was shorter in the budesonide group than in the placebo group (median number of days of exacerbation as a proportion of the total treatment time, 0% vs 14.5%; p < 0.05). The incidence of daytime (p < 0.05) and nighttime wheezing (p < 0.01) was lower in the budesonide group than in the placebo group during the treatment period. The proportion of patients without an exacerbation of asthma during the entire 24 weeks was 28% for those patients who had received budesonide and 0% for those patients who had received placebo. Asthma improved in more patients in the budesonide group (17 and 19, 89%) than in the placebo group (7 of 16, 44%; p < 0.005). These results should improve and modify the treatment of infants with severe asthma. CONCLUSION: Nebulized budesonide (1 mg twice daily) is a well-tolerated and efficient treatment for severe infantile asthma.

Aerosols↗
PubMed1996

Nasal cytology in rhinitis children: comparison between brushing and blowing the nose.

Allergic rhinitis is a common disease in childhood, but nasal cytology is rarely used by pediatricians. We compared two techniques of cell sampling, brushing and blowing the nose, among 77 children suffering from chronic rhinitis, of whom 59 were allergic. Staining by the May-Grunwald-Giemsa method enabled the evaluation of the density of cells and especially differential counting of the inflammatory cells. Staining by the Luna method was used as a control for the eosinophils. For the eosinophil count, we found a strong correlation between the two methods of collecting the nasal secretions (r = 0.96). Because blowing the nose is painless and easy to perform, it is more appropriate than brushing in routine use for the diagnosis of allergic rhinitis in children and in nasal challenge with allergens.

Adolescent↗
PubMed1996

Unapparent systemic dissemination of Mycobacterium tuberculosis.

A healthy 6-week-old girl exposed to tuberculosis presented a positive DNA amplification for Mycobacterium tuberculosis complex in gastric aspirates and cerebrospinal fluid whereas she had no other clinical or biological symptoms. Cultures were negative. This report underlines the interest of polymerase chain reaction for early diagnosis of tuberculosis and suggests the importance of treating exposed neonates and young infants just as active tuberculosis.

Cerebrospinal Fluid↗
PubMed1996

Pulmonary alveolar proteinosis: experience with eight pediatric cases and a review.

We report eight pediatric cases of pulmonary alveolar proteinosis (PAP) that illustrate the polymorphic nature of this disease: two cases with severe neonatal onset, three cases with progressive respiratory distress in patients under 1 year old, and three cases in older children with mild symptoms. Consanguineous parents or affected siblings were identified or suspected in four families. Three patients suffered from associated immune or blood disorders (severe combined immune deficiency, myelodysplasia). The respective roles of a macrophagic dysfunction and of an anomaly of the surfactant are discussed according to the various clinical presentations of pediatric PAP. We performed eight unilateral pulmonary lavages under endoscopy and selective ventilation for two patients under 7 kg in weight. These interventions led to progressive discontinuation of oxygen therapy in one case, and temporarily stabilized the disease for the second. Subsequent recurrence in this second patient was treated by massive lavage under extracorporeal oxygenation. A third infant was successfully transplanted with no recurrence within 3 years. Ambroxol was administered in one case. The three oldest children of our series remained asymptomatic, whereas three of the younger patients died. In the light of this experience, we propose that the treatment administered should be determined according to the age of the patient, the degree of respiratory deficiency, and the nature of any associated pathology.

Ambroxol↗
PubMed1996

Short-term clinical measurement: acute severe episodes.

Clinical measurements are widely used to evaluate both the severity and outcome of acute and severe episodes of wheeze. A large number of clinical scores have been produced, rating the severity from 0 to 3 or 4. The heterogenicity of these clinical scores, their subjective nature, shown by the poor interobserver agreement and the poor correlation with oximetry, make comparison between trials very difficult. Other clinical indicators, such as duration of hospitalization, maximum inspired oxygen fraction (FI,O2) and need for additional treatment, may be confounded by factors other than the wheezing episode. In contrast, provided standardized methods are used, respiratory rate, oxygen saturation and arterial blood gases are objective measurements and valuable tools. In order to evaluate the effect of interventions it is necessary to undertake a systematic evaluation of clinical variables: Which variables have the least interobserver error? Which variables are the most discriminant? New techniques, such as acoustic measurement, cough recording, respiratory inductive plethysmography (quantifying thoracoabdominal asynchrony and derived timing indices) should be developed and validated.

Acute Disease↗
PubMed1995

[Inhalation therapy for asthma in children. Questions about effectiveness].

A better understanding of childhood asthma, a disease affecting 6 to 10% of the paediatric population, has led to the development inhalation systems which can provide undeniably effective therapy but also raise a certain number of questions as to the quantity of drug actually reaching the pulmonary airways. When aerosols, the reference system, are used with a good inhalation technique, as much as 80% of the active product goes no further than the oral cavity, only 10% reaching the intrapulmonary airways. In addition, the system requires a co-ordination between hand movements and inspiration which is beyond the capacity of children under 7 or 8 years of age. Doses and granulometric flow also vary greatly depending on the propulsion gas. Inhalation chambers mounted on face masks avoid the problem of co-ordinated movements, increasing pulmonary deposition, but real drug delivery in infants who breathe through the nose remains to be determined. Systems which deliver the drug in the form of a powder have also been developed. With these devices, the product is held in a chamber together with carrier particles and is inhaled as inspiration creates air turbulence in the chamber. Minimal inhalation peak is the limiting factor. Nebulizers offer another possibility since no voluntary control of respiration is required, the child breathes at his own rhythm. The drug is nebulized either by a forced air or ultrasound system. Such systems may be very useful for infants but are usually not adapted for toddlers or older children. Despite the lack of precision as to the quantity of drug actually delivered to the pulmonary airways, the use of inhalations has completely changed the quality of life of children with chronic asthma. Further progress will be made through a better understanding of the two most important factors: the child and corticosteroids. Indeed, the child's co-operation (or non-co-operation) is one of the major sources of (un)successful treatment: even the best inhalation system can have little impact on the disease if it is not accepted and used correctly by the child.

Asthma↗
PubMed1995

Azathioprine-induced pulmonary haemorrhage in a child after renal transplantation.

We report a case of azathioprine-induced haemorrhagic alveolitis, in a 14-year-old boy, after renal transplantation. On day 25 the patient developed haemoptysis, fever and hypoxaemia. Chest X-ray showed diffuse reticulo-nodular shadows in both lung fields. Bronchoalveolar lavage samples were haemorrhagic and demonstrated a relative neutrophilia and a mild lymphocytosis, with a normal CD4/CD8 ratio. Azathioprine was discontinued on day 26. The patient required mechanical ventilation for 4 days. A positive leucocyte migration inhibition test and the recurrence of the symptoms after a second short course of azathioprine therapy suggested a cell-mediated mechanism. This patient is, to our knowledge, the first child to suffer from azathioprine-induced pulmonary haemorrhage.

Acute Disease↗
PubMed1995

Correlation between activity of beta-lactam agents in vitro and bacteriological outcome in acute pulmonary exacerbations of cystic fibrosis.

A study was conducted to determine whether a direct relationship exists between beta-lactam and/or aminoglycoside activity measured in vitro and bacteriological outcome in acute pulmonary exacerbations of cystic fibrosis. Twenty-seven patients, aged between 6 months and 24 years (mean age 10 1/2 years), were included in the study and received 41 i.v. courses of a beta-lactam agent combined with an aminoglycoside. A total of 63 Pseudomonas aeruginosa strains were found in sputum taken on admission at densities exceeding 10(6) cfu/g of sputum. For each episode, the serum inhibitory quotient (SIQ) and the serum bactericidal quotient (SBQ) of the beta-lactam agent and of the aminoglycoside administered were determined for the Pseudomonas aeruginosa isolate(s). The SIQs and SBQs were calculated by dividing the average peak serum levels achievable in the patients by the minimal inhibitory concentrations and minimal bactericidal concentrations, respectively. The SIQs and SBQs were compared to bacteriological outcome. Bacteriological success was defined as a decrease of 2 log10 counts or more in the Pseudomonas aeruginosa density in sputum between days 0 and 7 of therapy. The SIQ and SBQ of beta-lactam agents were good predictors of bacteriological outcome: SIQs of < 1:16 were 100% predictive of failure (chi 2 28; p < 0.001) and of > or = 1:64 were 92.9% predictive of success (chi 2 35.68; p < 0.001); SBQs of < 1:8 were 100% predictive of failure (chi 2 42.78; p < 0.001) and of > or = 1:32 were 95.8% predictive of success (chi 2 31.5; p < 0.001). Aminoglycoside SIQs and SBQs were not predictive of outcome.

Adolescent↗
PubMed1995

[Chronic septic granulomatosis revealed by neonatal pulmonary aspergillosis].

BACKGROUND: Pulmonary aspergillosis is now the main cause of death in chronic granulomatous disease (CGD); it may occur before the age of one year and then often reveals CGD. CASE REPORT: A male newborn was referred to hospital at 27 days of age for fever (39 degrees C), hemodynamic failure and biological inflammation syndrome caused by pulmonary infection. Chest CT scan revealed multiple and bilateral intraparenchymatous nodules. An open lung biopsy showed histiocystic granuloma with multinucleated giant cells. Culture of tracheal, bronchoalveolar lavage samples and lung biopsy grew positive for Aspergillus fumigatus. Impaired chemiluminescence production by neutrophils was detected, enabling the diagnosis of CGD. It was later confirmed by the study of neutrophils functions. The child recovered after 12 months of parenteral amphotericin B therapy. CONCLUSION: A febrile multifocal pneumopathy occurring in infancy should lead to consider the possibility of CGD which may be confirmed by the chemiluminescence test.

Aspergillosis↗