J. Paupe

Congenital Ciliary Aplasia in Two Siblings: A Primitive Disregulation of Ciliogenesis?

Congenital ciliary aplasia was demonstrated in two siblings with clinical history of primary ciliary dyskinesia. Ultrastructural histochemistry of successive bronchial biopsies revealed the predominance of immature mucous cells and the total absence of ciliated or preciliated cells in the respiratory epithelium. This original disorder may represent a unique variant of primary ciliary dyskinesia with primitive disregulation of ciliogenesis.

Un corps étranger hors du commun. À propos d'un cas d'emphysème sous-cutané lors d'une crise d'asthme

Summary Pneumomediastinum is an uncommon complication after an asthma attack. The essential clinical sign is the presence of subcutaneous emphysema. In the great majority of cases, the treatment of pneumomediastinum corresponds to that of asthma, with resorption over several days. The situation is very different when the development of pneumomediastinum and subcutaneous emphysema is secondary to an aspiration syndrome. Pneumomediastinum is an uncommon complication after an asthma attack. The essential clinical sign is the presence of subcutaneous emphysema. In the great majority of cases, the treatment of pneumomediastinum corresponds to that of asthma, with resorption over several days. The situation is very different when the development of pneumomediastinum and subcutaneous emphysema is secondary to an aspiration syndrome.

Esophageal motility and gastroesophageal reflux in children with chronic respiratory diseases

Children with chronic respiratory diseases may be a high-risk population for gastroesophageal reflux (GER). In order to describe GER in this population, we systematically studied 7-h pH-metry and prolonged esophageal manometry (over 45 min) in 124 children admitted for respiratory disorders without digestive symptoms. The results showed that: (1) GER varied in significance before and after meals; (2) postprandial reflux was correlated with esophageal motor activity, but preprandial reflux was not; (3) moderate refluxers had reduced lower esophageal sphincter (LES) pressure, but severe refluxers had no significative decrease in LES pressure. The use of multivariate analysis permitted us to conclude that long-term esophageal manometry and pH-metry were complementary in defining severe GER.

Blood histamine levels (BHL) in infants and children with respiratory and non-respiratory diseases

BACKGROUND: Blood histamine levels are decreased after severe allergic reactions and in various chronic diseases. AIMS: To study blood histamine levels in infants and children with acute infectious and non-infectious, non-allergic, disease. METHODS: Blood histamine levels were investigated by a fluorometric method in infants and children admitted to hospital with bronchiolitis, non-wheezing bronchitis, acute infections of the urinary tract, skin and ear-nose-throat, gastroenteritis, or hyperthermia of unknown aetiology. Results of blood histamine levels and white blood cell counts were compared with those obtained for children recovering from benign non-infectious, non-allergic illnesses. RESULTS: As compared with control children, white blood cell numbers were significantly increased in children with acute infections of the urinary tract, skin and ear-nose-throat, and were significantly decreased in children with gastroenteritis. Blood histamine levels were significantly lower in children with gastroenteritis and hyperthermia than in children with other diseases and control children. It was not possible to correlate blood histamine levels and the number of blood basophils. CONCLUSIONS: BHL are significantly decreased in infants and children with acute gastroenteritis and hyperthermia of unknown aetiology. The mechanisms responsible for the decrease in blood histamine levels in children with gastroenteritis and hyperthermia are discussed.

Nebulized salbutamol in the treatment of severe asthmatic attacks in children

Summary Fifteen children who were admitted to hospital with a severe asthmatic attack, refractory to oral bronchodilators, were treated initially with an oxygen-propelled nebulized 0,5 % solution of salbutamol. Significant clinical improvement occurred rapidly in fourteen of these children. There was a significant decrease in their specific airway resistance (SRaw) 1 min after the end of the nebulization and this decrease was still present 1 hour later. Significant improvement of forced expiratory volume (FEV1), forced vital capacity (FVC) and peak expiratory flow rate (PEFR) paralleled the decrease in SRaw. Increased heart rate occured but was not perceived by the children. Transcutaneous arterial O2 tension (TcPaO2) was increased in thirteen children and unchanged in two of them 10 min after the nebulization. These results demonstrate that nebulized salbutamol is safe and highly effective in the treatment of severe asthmatic attacks in children.

Management of atopic dermatitis in infants and prevention of asthma

Summary Allergic disease in childhood is to a large degree determined before birth or during infancy. In that last case, atopic dermatitis is often the first alarm signal of atopy. Research of recent years brought new evidence that similar mechanisms are involved in the pathogenis of atopic dermatitis and allergic bronchial asthma. Atopic dermatitis in infants requires heavy treatment. It does alert pediatrician that the child is atopic and is at risk of developing asthma. It is also extremely important to recognize and to treat it as soon as possible.

Relationship between gastro esophageal reflux and airway response to acid infusion test in asthmatic children

Summary Gastro esophageal reflux (GER) was investigated in 15 children with asthma by esophageal pH monitoring and manometry. Bronchial response to Acid Infusion Test (AIT) was also evaluated by comparing specific baseline airway resistance (sRAW) and carbachol bronchial responsiveness before and after AIT. The response of the children in this study to AIT was considerably less than that reported in adults. AIT did not change baseline sRAW or bronchial sensitivity to carbachol (p = NS), but did significantly increase the bronchial reactivity (p

NECNATAL ATELECTASIS AND|[sol]|OR EMPHYSEMA: VALUE OF FLEXIBLE BRONCHOSCOPY

Occurence of atelectasis and/or emphysema is common in neonatal intensive care units and sets both diagnostic and therapeutic problems. During the last three years we performed flexible bronchoscopy (FB) in 50 neonates and premature infants (mean weight 2050 gr, range 950-4050 gr). Fourty four were intubated before examination. FB was performed under EKG and TcPO2 monitoring. We used a three way stopcock connected to both mechanical ventilation and aspiration source. This procedure allowed alternative adequate ventilation or suctioning. Ten newborns had acute postextubation or post-surgical atelectasis, affecting particularly right upper lobe. No important anatomic lesion was discovered, yet suctioning was effective in 7 cases (70 %). Fourty had persistent atelectasis and/or emphysema and were long term intubated. Endoscopic abnomalities were frequent : 2 mucopurulent plugs, 4 important tracheobronchial dyskinesia, 13 severe local inflammatory injuries narrowing one or more lobar opening, 5 lower tracheal stenosis (1 congenital and 4 acquired) and 6 bronchial stenosis (4 troncus intermedius and 2 left main stem bronchus). Only 10 FB were normal. Suctioning was effective in only 11 cases (22 %). These results confirm interest of FB in neonates and premature infants to remove an acute atelectasis and to explore a persistent atelectasis and/or emphysema. FB allows thus to emphasize the role of inflammatory injuries due to iterative suctioning and the risk of tracheal or bronchial stenosis (27 %).