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Biomedical subjects

P Scheinmann

Publications and source records attributed to P Scheinmann.

At least 73 records · Page 4Linked to original sources
PubMed1998

Repeatability of lung function tests during methacholine challenge in wheezy infants.

BACKGROUND: The repeatability of lung function tests and methacholine inhalation tests was evaluated in recurrently wheezy infants over a one month period using the rapid thoracic compression technique. METHODS: Eighty-one wheezy, symptom free infants had pairs of methacholine challenge tests performed one month apart. Maximal flow at functional residual capacity (VmaxFRC) and transcutaneous oxygen tension (Ptco2) were measured at baseline and after methacholine inhalation. Provocative doses of methacholine causing a 15% fall in Ptco2 (PD15 Ptco2) or a 30% fall in VmaxFRC (PD30 VmaxFRC) were determined. RESULTS: Large changes in VmaxFRC were measured from T1 to T2 with a mean difference between measurements (T2-T1) of 7 (113) ml/s and a 95% range for a single determination for VmaxFRC of 160 ml/s. The mean (SD) difference between pairs of PD30 VmaxFRC measurements was 0.33 (1.89) doubling doses with a 95% range for a single determination of 2.7 doubling doses. Repeatability of PD15Ptco2 was similar. A change of 3.7 doubling doses of methacholine measured on successive occasions represents a significant change. CONCLUSIONS: Baseline VmaxFRC values are highly variable in wheezy, symptom free infants. Using either VmaxFRC or Ptco2 as the outcome measure for methacholine challenges provided similar repeatability. A change of more than 3.7 doubling doses of methacholine is required for clinical significance.

Asthma↗
PubMed1997

Successful bronchotracheal reconstruction in esophageal bronchus: two case reports.

Esophageal bronchus is the most common congenital bronchopulmonary foregut malformation. Current surgical treatment is resection of anomalous pulmonary tissue, which is often hypoplastic and destroyed by infection. The authors report two cases of bronchotracheal reconstruction. The diagnosis was early, before 15 days of age. The anomalous pulmonary tissue had a pulmonary arterial supply and venous drainage as assessed by angiography and a good functional capacity on selective ventilation. Bronchotracheal anastomosis was successful in both cases: a right main bronchus at 25 days of age and a left main bronchus at 13 days of age. One child underwent reoperation 1 year later for bronchomalacia of the reimplanted bronchus. Both children are well with normal growth 3 and 7 years after surgery. Chest roentgenograms showed normal and symmetrical lung aeration. Tracheal reimplantation may be preferred to pulmonary resection when the anomalous pulmonary tissue is not destroyed. The pulmonary functional capacity is increased and the complications of pneumonectomy avoided.

Anastomosis, Surgical↗
PubMed1997

In vitro susceptibilities to amphotericin B, itraconazole, and miconazole of filamentous fungi isolated from patients with cystic fibrosis.

The antimicrobial activities of amphotericin B, itraconazole, and miconazole against 101 filamentous fungi from patients with cystic fibrosis were tested by a reproducible microdilution method. Itraconazole was very active against Aspergillus species and Scedosporium species (MIC at which 90% of the isolates were inhibited [MIC90], 0.06 to 0.5 mg/liter), whereas amphotericin B was less effective (MIC90, 0.5 to 8 mg/liter).

Amphotericin B↗
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↗