Anne Sardet

Alveolar Macrophage Status in Bronchopulmonary Dysplasia

ABSTRACT: 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 < 0.01 and < 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.

Idiopathic pulmonary fibrosis in infants

Idiopathic pulmonary fibrosis is a poorly characterized disease in infants. In the present report, we reviewed our experience with 10 infants during a 10‐year period. In 9 patients, onset of symptoms occurred before the age of 2 months and included tachypnea, cough, and inadequate weight gain. However, despite the presence of these symptoms, diagnosis was delayed for 3 months at which time the infants were referred to the pediatric pulmonary department, when the diagnosis was confirmed by open lung biopsy. At the time of admission, bronchoscopy with alveolar lavage was performed in 9 children and showed severe alveolitis with an increase in the neutrophil count. Nine infants were treated with prednisone alone or in combination with chloroquine, colchicine, or cyclophosphamide; all these patients died despite treatment. One infant was treated with pulses of methylprednisolone because of a failure in response to oral prednisone. This girl who displayed similar clinical, radiological, and histological abnormalities as the other children at the time of diagnosis is the only child still alive after 3 years of follow‐up. She is now free of respiratory symptoms and has a normal growth curve. The present report raised two important points: (1) a thorough evaluation of characteristic symptoms should lead to an early diagnosis of pulmonary fibrosis in infants; and (2) administration of pulse therapy using corticosteroids has been helpful and needs to be evaluated further. Pediatr Pulmonol. 1997; 23:49–54.

La fibroscopie bronchique chez l’enfant: Expertise des centres français de pneumologie pédiatrique

INTRODUCTION Fibreoptic bronchoscopy (FB) is an important diagnostic examination in paediatric pulmonology. In 2002 the Paediatric Pulmonology and Allergy Club undertook a retrospective study to establish the current status of fibreoptic bronchoscopy among its members. METHODS In 2001 sixty five paediatric pulmonologists carried out an average of 116 examinations (+/- 111) in 35 paediatric centres. FB was performed either in an operating theatre (15 centres), a dedicated bronchoscopy suite (6 centres) or an endoscopy suite shared with gastro-enterologists (7 centres). Other examinations were performed in areas dedicated to, or associated with intensive care. General anaesthesia was routinely used in 18 centres. The others used sedation including an equimolar mixture of oxygen and nitrous oxide in 14 centres. Ten centres performed less than 50 examinations, 12 between 51 and 100, 4 between 101 and 200 and 8 centres more than 200 in the year. Seventy two per cent of the children were less than 6 years old. The washing and disinfection procedures were manual in 20 centres and automatic in 15. RESULTS Three principal indications were reported: persistent wheezing, suspicion of a foreign body and ventilatory difficulties. Cough, desaturation and fever were the most frequently reported side effects. CONCLUSIONS This is the first survey in paediatric pulmonology in France. It shows a wide variation in the practice of fibreoptic bronchoscopy in children.Resume Introduction La fibroscopie bronchique est un examen complementaire cle dans la demarche diagnostique en pneumologie pediatrique. Le Club Pediatrique de Pneumologie et d’Allergologie a realise en 2002 une enquete retrospective permettant d’etablir un etat des lieux de la pratique par les pneumopediatres de la fibroscopie bronchique. Methodes Soixante cinq pneumopediatres ont effectues en moyenne 116 examens (± 111) dans 35 centres pediatriques en 2001. Les fibroscopies ont ete realisees soit dans un bloc operatoire (15 centres), soit un bloc dedie a la fibroscopie (6 centres), soit un site partage avec les gastroenterologues (7 centres). Les autres examens ont ete pratiques dans des locaux pediatriques (salle dediee et/ou unite de soins intensifs). L’anesthesie generale a ete systematique dans 18 centres. Les autres centres ont pratique une sedation consciente, avec utilisation de melange gazeux equimolaire oxygene protoxyde d’azote dans 14 centres. Dix centres ont realise moins de 50 examens, 12 entre 51 et 100, 4 entre 101 et 200 et 8 centres plus de 200 fibroscopies dans l’annee. Soixante douze pour cent des enfants avaient moins de 6 ans. Les procedures de lavage desinfection ont ete « manuelles » dans 20 centres et automatisees dans 15 centres. Resultats Trois indications principales ont ete rapportees : respiration sifflante persistante, suspicion de corps etranger et troubles de ventilation. Parmi les effets indesirables, la toux, la desaturation en oxygene et la fievre ont ete le plus souvent rapportees. Conclusion Cette enquete est une premiere en pneumologie pediatrique en France. Elle montre l’heterogeneite des pratiques en matiere de fibroscopie bronchique chez l’enfant.

Impact of intravenous antibiotic therapy on total daily energy expenditure and physical activity in cystic fibrosis children with Pseudomonas aeruginosa pulmonary exacerbation

Resting energy expenditure (REE) increases during pulmonary exacerbation by Pseudomonas aeruginosa in cystic fibrosis (CF) patients, and decreases after i.v. anti-Pseudomonas aeruginosa antibiotic therapy (IVAT). However, the impact of IVAT on total energy expenditure (TEE) is unknown. The aim of this study was to assess the changes in TEE and its main components after IVAT administered at home. Body composition measured by skinfold thickness and bio-impedance analysis, energy intake (EI) assessed by a weekly diary, REE measured by indirect calorimetry (IC), TEE assessed by a technique using 24-h heart-rate monitoring method and physical activity (PA) monitored using an activity diary (AD) were assessed in 16 patients (9 boys and 7 girls) aged 12.1 ± 2.3 y (range, 7.1–14.6 y), before and after 28 ± 4 d including a 14-d IVAT course. After IVAT, weight increased significantly by 1.9% (32.1 ± 7.5 versus 32.7 ± 7.6 kg; p < 0.05), while fat mass and fat free mass increased non significantly. EI increased by 4.6% (10,797 ± 3,039 versus 11,320 ± 3,074 kJ/d; p < 0.05). TEE was not affected by IVAT (7,014 ± 1,929 versus 7,081 ± 1,478 kJ/d) whereas REE decreased by 4.1% (5,295 ± 909 versus 5,093 ± 837 kJ/d; p < 0.05), resulting in 9.3% increase in PA assessed by AD converted to metabolic equivalent tasks (MET) (37.0 ± 3.1 versus 40.7 ± 4.5 MET; p < 0.05). The improvement in nutritional status after IVAT is not related to a decrease in TEE, but probably to an increase in EI and a decrease of REE after IVAT. After IVAT, the reduction in REE is probably compensated by an increase in PA in CF patients.

Carcinomes mucoépidermoïdes bronchiques: à propos de trois observations

BACKGROUND: Mucoepidermoid carcinomas (MEC) are very rare (less than 20 cases reported in the literature) and potentially malignant bronchial gland carcinomas. PATIENTS: Three children, two boys (11 and 7 years old) and one girl (5 years old) suffered from respiratory symptoms such as cough, recurrent pneumonia and/or hemoptysis for 2 to 12 months. Bronchial endoscopy showed a mass into the left (two cases), or the right main bronchus (one case). Chest CT scan identified local extension, and lung-associated lesions. Histopathological study concluded to MEC in the three cases. The patients were treated by segmental bronchial resection, completed with left upper lobectomy (two cases), bronchotomy (one case). All the tumor could be removed; there was no metastasis. The outcome was uneventful with a 8 to 24 months follow-up. CONCLUSION: Bronchial tumors of children must be considered in patients with chronic cough, recurrent pneumonia and/or hemoptysis and require bronchial endoscopy for their diagnosis.

Central venous thrombosis and thrombophilia in cystic fibrosis: A prospective study

BACKGROUND AND AIMS Catheter venous thrombosis may result in life-threatening embolic complications. Recently, a thrombophilic tendency was described in cystic fibrosis (CF), the significance of which remains unclear. The aims of this study were to (1) document the frequency of catheter venous thrombosis detected by colour-Doppler-ultrasound (Doppler-US), (2) assess genetic and acquired thrombophilia risk factors for catheter venous thrombosis and hypercoagulability status and (3) provide recommendations on laboratory screening when considering insertion of a totally implantable vascular access device (TIVAD) in CF patients. METHODS We designed a multicentre prospective study in patients selected at the time of catheter insertion. Doppler-US was scheduled at 1 and 6months after insertion and before insertion in case of a previous central line. Blood samplings were drawn at insertion and at 1 and 6months later. RESULTS One-hundred patients received a TIVAD and 90 completed the 6-month study. Prevalence of thrombophilia abnormalities and hypercoagulability was found in 50% of the cohorts. Conversely, catheter venous thrombosis frequency was low (6.6%). CONCLUSION Our data do not support biological screening at the time of a TIVAD insertion. We emphasise the contribution of a medical history of venous thromboembolism and prospective Doppler-US for identifying asymptomatic catheter venous thrombosis to select patients who may benefit from biological screening and possible anticoagulant therapy.

Changes in lung function in young cystic fibrosis patients between two courses of intravenous antibiotics against Pseudomonas aeruginosa.

Repeated intravenous antibiotic therapy (IVAT) against chronic pulmonary infection with Pseudomonas aeruginosa is often necessary in cystic fibrosis patients (CF). The aim of this study was to monitor kinetics of degradation of pulmonary and nutritional status after IVAT in CF patients.

La fibroscopie bronchique chez l’enfant

INTRODUCTION Fibreoptic bronchoscopy (FB) is an important diagnostic examination in paediatric pulmonology. In 2002 the Paediatric Pulmonology and Allergy Club undertook a retrospective study to establish the current status of fibreoptic bronchoscopy among its members. METHODS In 2001 sixty five paediatric pulmonologists carried out an average of 116 examinations (+/- 111) in 35 paediatric centres. FB was performed either in an operating theatre (15 centres), a dedicated bronchoscopy suite (6 centres) or an endoscopy suite shared with gastro-enterologists (7 centres). Other examinations were performed in areas dedicated to, or associated with intensive care. General anaesthesia was routinely used in 18 centres. The others used sedation including an equimolar mixture of oxygen and nitrous oxide in 14 centres. Ten centres performed less than 50 examinations, 12 between 51 and 100, 4 between 101 and 200 and 8 centres more than 200 in the year. Seventy two per cent of the children were less than 6 years old. The washing and disinfection procedures were manual in 20 centres and automatic in 15. RESULTS Three principal indications were reported: persistent wheezing, suspicion of a foreign body and ventilatory difficulties. Cough, desaturation and fever were the most frequently reported side effects. CONCLUSIONS This is the first survey in paediatric pulmonology in France. It shows a wide variation in the practice of fibreoptic bronchoscopy in children.Resume Introduction La fibroscopie bronchique est un examen complementaire cle dans la demarche diagnostique en pneumologie pediatrique. Le Club Pediatrique de Pneumologie et d’Allergologie a realise en 2002 une enquete retrospective permettant d’etablir un etat des lieux de la pratique par les pneumopediatres de la fibroscopie bronchique. Methodes Soixante cinq pneumopediatres ont effectues en moyenne 116 examens (± 111) dans 35 centres pediatriques en 2001. Les fibroscopies ont ete realisees soit dans un bloc operatoire (15 centres), soit un bloc dedie a la fibroscopie (6 centres), soit un site partage avec les gastroenterologues (7 centres). Les autres examens ont ete pratiques dans des locaux pediatriques (salle dediee et/ou unite de soins intensifs). L’anesthesie generale a ete systematique dans 18 centres. Les autres centres ont pratique une sedation consciente, avec utilisation de melange gazeux equimolaire oxygene protoxyde d’azote dans 14 centres. Dix centres ont realise moins de 50 examens, 12 entre 51 et 100, 4 entre 101 et 200 et 8 centres plus de 200 fibroscopies dans l’annee. Soixante douze pour cent des enfants avaient moins de 6 ans. Les procedures de lavage desinfection ont ete « manuelles » dans 20 centres et automatisees dans 15 centres. Resultats Trois indications principales ont ete rapportees : respiration sifflante persistante, suspicion de corps etranger et troubles de ventilation. Parmi les effets indesirables, la toux, la desaturation en oxygene et la fievre ont ete le plus souvent rapportees. Conclusion Cette enquete est une premiere en pneumologie pediatrique en France. Elle montre l’heterogeneite des pratiques en matiere de fibroscopie bronchique chez l’enfant.

BRONCHO-ALVEOLAR LAVAGE IN PULMONARY VIRAL INFECTIONS IN CHILDREN

Fifteen infants with acute pneumonia, mean age 11 months (Group I) and 24 immuno-depressed (ID) children with severe interstitial pneumonitis, mean age 8 1/2 years (Group II) were studied using broncho-alveolar lavage (BAL). Each BAL fluid (F) examination comprised : 1) cytological examination (CE) 2) virological study 3) total proteins (TP) and Ig classes (G, A, M) concentrations quantification. Specific activity (Act) of anti-cytomegalovirus (CMV) Ig anti bodies (Ab) was titrated simultaneously in BALF and sera by ELISA method, only in ID. Group I : 7 viruses were isolated : para influenza type 1 (1), 3 (1), adenoV type 1 (1), 2 (1), 6 (1), RSV (2) ; CE was normal (4) or showed an increase in polymorphonuclears (PN) (2) or lymphocytes (L) count (C). Group II : 2 viruses were isolated : measles (1) RSV (1) with increase in PNC and in IgG/TP ratio ; in 2 other cases (with bone marrow transplantation) o local pulmonary production of anti CMV IgG/Ab was observed (increase in BALF Act/sera Act ratio) with LC increase.In conclusion BAL in children is a safe productive mean in diagnosis of virus infection responsible for severe pneumonitis and reveals a local correlative increase in PNC or LC and IgG production.