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1.
Arch Pediatr ; 22(12): 1240-6, 2015 Dec.
Article in English | MEDLINE | ID: mdl-26596857

ABSTRACT

BACKGROUND: Pseudomonas aeruginosa and Staphylococcus aureus toothbrush contamination in cystic fibrosis (CF) is unknown. This pilot study aimed to determine their prevalence and the potential involvement of toothbrushes in pulmonary infection. METHODS: Toothbrush bacteriological analysis for children aged 8-18 years was conducted on 27 CF patients, 15 healthy siblings, and 15 healthy children from the general population. RESULTS: S. aureus was detected on 22% of the patients' toothbrushes, and 13% of healthy children's toothbrushes and P. aeruginosa on 15% of patients' toothbrushes and 0-13% of healthy children's toothbrushes. There was no statistical correlation between pulmonary colonization and toothbrush contamination. P. aeruginosa genotyping showed two identical clones on the patients' toothbrushes and in their sputum, and between one patient's sputum and his sibling's toothbrush. CONCLUSION: S. aureus and P. aeruginosa can colonize CF patients' toothbrushes. The impact on pulmonary colonization remains unknown. Toothbrush decontamination methods need to consider these bacteria in CF patients.


Subject(s)
Cystic Fibrosis , Dental Devices, Home Care/microbiology , Equipment Contamination , Pseudomonas aeruginosa/isolation & purification , Staphylococcus aureus/isolation & purification , Adolescent , Child , Female , Humans , Lung/microbiology , Male , Pilot Projects , Sputum/microbiology
2.
Arch Pediatr ; 19(1): 27-30, 2012 Jan.
Article in French | MEDLINE | ID: mdl-22169572

ABSTRACT

We report the case of an 18-month-old boy operated on for a right lower lobe bronchopulmonary sequestration. At the immediate postoperative check-up, a septic right thoracic effusion appeared, connected to a cystic mediastinal retrocrural formation on CT. After a drainage attempt and medical therapy, the abdominal lesion was resected. Histological examination showed that the cyst cavity was lined with pseudostratified non-ciliated epithelium, without cartilage, consistent with an enteric cyst. Regardless of the embryological theory, a literature review confirmed that in presence of one of these two lesions, one should systematically look for the other.


Subject(s)
Bronchopulmonary Sequestration/diagnostic imaging , Bronchopulmonary Sequestration/surgery , Mediastinal Cyst/diagnostic imaging , Mediastinum/abnormalities , Bronchopulmonary Sequestration/complications , Follow-Up Studies , Humans , Infant , Intestines/embryology , Male , Mediastinal Cyst/complications , Mediastinal Cyst/surgery , Pneumonectomy , Radiography , Thoracic Surgical Procedures , Treatment Outcome
5.
Arch Pediatr ; 11 Suppl 2: 86s-92s, 2004 Jun.
Article in French | MEDLINE | ID: mdl-15301803

ABSTRACT

Mortality by asthma has decreased, but the number of children being hospitalized is stable: 10% of the asthmatic children are hospitalized within the year, or will be at least once before their tenth year. Some factors are associated with occurrence of a severe asthma attack: poor lung function, bronchial hyperreactivity or poor asthma control, a food allergy, a decreased perception of airway obstruction prior hospitalisation, denial of illness, psychological and social difficulties. The prevention of most asthma exacerbations is possible. The treatment must be adapted to severity of asthma: inhaled steroids, even low doses, have been proven efficient. The follow-up must be regular: planned consultations, repeated lung function testing. Educational programs show an increased quality of life, therapeutic adherence or reduction of hospitalization. The patient and care giver must be able to recognize the signs of severity of asthma exacerbation; an exacerbation is considered severe if it begins suddenly, if its progression or symptoms are unusual, and therefore requires a prompt adapted treatment. An action plan and accessible emergency care are essential.


Subject(s)
Asthma/mortality , Asthma/therapy , Administration, Inhalation , Asthma/drug therapy , Asthma/epidemiology , Asthma/etiology , Asthma/prevention & control , Child , Follow-Up Studies , France/epidemiology , Health Education , Hospitalization , Humans , Prevalence , Quality of Life , Risk Factors , Severity of Illness Index , Steroids/therapeutic use
7.
Eur Respir J ; 23(3): 430-4, 2004 Mar.
Article in English | MEDLINE | ID: mdl-15065834

ABSTRACT

The use and complications of totally implantable vascular access devices (TIVADs) were examined during multiple courses of antibiotics in cystic fibrosis (CF) patients. This retrospective study involved 36 CF centres. Risk factors for removal and septicaemia were sought by survival analysis of censored data. Multivariate Cox models were constructed with removal or septicaemia as the event and the characteristics of TIVADs as explanatory variables. TIVADs (n = 452) were implanted in 315 patients. The mean functional time per device was 32 +/- 25 months. Long-term complications occurred with 188 devices (42%); they consisted mainly of occlusion (21%, requiring removal in 77%), infection (9.3%, requiring removal in 851%; septicaemia in 7.3%; rate 0.3 per 1,000 days, Candida in 66%), and vascular thrombosis (4.7%, removal in 58%). Multivariate survival analysis showed that removal, whatever the reason, was associated with polyurethane (versus silicone) and routine use of the device for blood sampling (versus never). No risk factors, including heparin lock, were identified for septicaemia or for removal for obstruction. Totally implantable venous access devices appear to be safe and reliable for long-term intermittent venous access. Although retrospective, this study suggests that the characteristics of the material and blood sampling are risk factors for removal.


Subject(s)
Catheters, Indwelling , Cystic Fibrosis/therapy , Anti-Bacterial Agents/administration & dosage , Blood Specimen Collection , Catheters, Indwelling/adverse effects , Child , Focal Infection/epidemiology , Follow-Up Studies , Humans , Infusions, Intravenous , Parenteral Nutrition , Proportional Hazards Models , Retrospective Studies , Risk Factors , Sepsis/epidemiology , Thrombosis/epidemiology , Time Factors
8.
J Epidemiol Community Health ; 58(1): 18-23, 2004 Jan.
Article in English | MEDLINE | ID: mdl-14684722

ABSTRACT

STUDY OBJECTIVE: The Vesta project aims to assess the role of traffic related air pollution in the occurrence of childhood asthma. DESIGN AND SETTING: Case-control study conducted in five French metropolitan areas between 1998 and 2000. A set of 217 pairs of matched 4 to 14 years old cases and controls were investigated. An index of lifelong exposure to traffic exhausts was constructed, using retrospective information on traffic density close to all home and school addresses since birth; this index was also calculated for the 0-3 years age period to investigate the effect of early exposures. MAIN RESULTS: Adjusted on environmental tobacco smoke, personal and parental allergy, and several confounders, lifelong exposure was not associated with asthma. In contrast, associations before age of 3 were significant: odds ratios for tertiles 2 and 3 of the exposure index, relative to tertile 1, exhibited a positive trend (1.48 (95%CI = 0.7 to 3.0) and 2.28 (1.1 to 4.6)), with greater odds ratios among subjects with positive skin prick tests. CONCLUSIONS: These results suggest that traffic related pollutants might have contributed to the asthma epidemic that has taken place during the past decades among children.


Subject(s)
Air Pollution/adverse effects , Asthma/chemically induced , Vehicle Emissions/toxicity , Age Factors , Air Pollutants/toxicity , Air Pollution/statistics & numerical data , Asthma/epidemiology , Case-Control Studies , Child , Child, Preschool , Female , France/epidemiology , Humans , Incidence , Infant , Infant, Newborn , Male , Odds Ratio , Risk Factors , Urban Health
9.
Rev Mal Respir ; 21(6 Pt 1): 1098-106, 2004 Dec.
Article in French | MEDLINE | ID: mdl-15767954

ABSTRACT

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.


Subject(s)
Bronchoscopes , Bronchoscopy , Bronchoscopes/statistics & numerical data , Bronchoscopy/statistics & numerical data , Child , Equipment Design , France , Humans , Practice Patterns, Physicians' , Retrospective Studies , Surveys and Questionnaires
12.
Environ Int ; 28(3): 197-202, 2002 Jul.
Article in English | MEDLINE | ID: mdl-12222616

ABSTRACT

Exhaled ammonia (NH3ex) was measured by chemiluminescence in a group of healthy children (n = 20) and in two groups of asthmatic children, one (Group 1) residing in a National Park in the mountains (n = 68) and other (Group 2) in an urban area (n = 52). We also determined urinary ammonia, nitrates, urea, sodium and potassium normalized to osmolarity. Unlike exhaled nitric oxide (NOex), NH3ex was not specific to asthma as the children in Group 2 and the controls exhaled more ammonia that did the children in Group 1 (14.3 +/- 10.2 and 14.8 +/- 10.3 vs. 5.6 +/- 4.7 ppb; P < .001, respectively). In the urban environment, all children, including the healthy controls, excreted more ammonia (P < .001) and potassium (P < .001) but less urea (P < .02) than did the children residing in the National Park. These manifestations of moderate metabolic acidosis would favor excretion of ammonia at the expense of urea. In the children residing in the National Park, positive correlations were observed between NH3ex and urinary ammonia, and nitrates, age and morphological parameters. The relationship with the morphological parameters is a reflection of the normal physiological formation of NH3ex. In the children residing in the urban area, the other endogenous source of NH3ex was attributed to a slight disturbance in acid-base balance. In conclusion, the measurement of NH3ex appeared of limited interest, although the higher urinary urea/NH4+ ratio in Group 1 (P < .0001), especially in the treated children, appeared to be linked to the lack of atmospheric pollutants in the National Park. Further experimentation is in progress to confirm these findings.


Subject(s)
Air Pollutants/metabolism , Ammonia/metabolism , Asthma/metabolism , Quaternary Ammonium Compounds/urine , Breath Tests , Case-Control Studies , Child , Environmental Monitoring/methods , Female , France , Humans , Luminescent Measurements , Male , Nitric Oxide/metabolism , Osmolar Concentration , Potassium/urine , Rural Health , Sodium/urine , Spirometry , Urban Health , Urea/urine
13.
Arch Pediatr ; 9(6): 606-9, 2002 Jun.
Article in French | MEDLINE | ID: mdl-12108316

ABSTRACT

UNLABELLED: Pulmonary abscess is an uncommon complication of pneumonia in children. Pyogenes, in particular Staphylococcus aureus or Streptococcus pneumoniae are the principal responsible bacteria. Mycoplasma pneumoniae is rarely the cause. CASE REPORT: A 14-year-old child was hospitalized with right thoracic pain. The patient was non-febrile and had a recent history of moderate infection. He was receiving antibiotic (macrolide) and non-steroidal anti-inflammatory therapy. CT scan confirmed a mid-lobe abscess in the right lung. Interruption of therapy resulted in fever and increase in C-reactive level with hyperleucocytosis, suggesting that the abscess was caused by a bacterial infection. The child's general condition and the radiographic picture improved with combined antibiotic therapy with amoxycillin and clavulanic acid, aminoglycosides and macrolides. The suspected diagnostic of M. pneumoniae was confirmed by increased IgM antibodies for M. pneumoniae. Recovery was complete two months later without sequelae. COMMENT: Pulmonary abscess is a rare complication of M. pneumoniae infection in children. This complication should be considered when the general condition does not improve despite appropriate early treatment of a pneumonia, as in the case of our patient.


Subject(s)
Lung Abscess/microbiology , Mycoplasma pneumoniae/pathogenicity , Pneumonia, Mycoplasma/complications , Adolescent , Anti-Bacterial Agents/therapeutic use , Humans , Immunoglobulin M/analysis , Lung Abscess/drug therapy , Lung Abscess/etiology , Male , Mycoplasma pneumoniae/isolation & purification , Pneumonia, Mycoplasma/diagnosis , Pneumonia, Mycoplasma/drug therapy , Treatment Outcome
14.
J Expo Anal Environ Epidemiol ; 12(3): 186-96, 2002 May.
Article in English | MEDLINE | ID: mdl-12032815

ABSTRACT

A case-control study was conducted in five French metropolitan areas in order to assess the role of traffic-related air pollution in the occurrence of childhood asthma. This paper presents the study design and describes the distribution of key exposure variables. A set of 217 pairs of matched 4- to 14-year-old cases and controls were investigated (matching criteria: city, age, and gender). Current and past environmental smoke exposures, indoor allergens or air pollution sources, and personal and family atopy were assessed by standard questionnaires. When possible, direct measurements were done to check the validity of this information, on current data: skin prick tests, urine cotinine, house dust mites densities, personal exposures to, and home indoor concentrations of NO(x) and PM(2.5). Cumulative exposure to traffic-related pollutants was estimated through two indices: "traffic density" refers to a time-weighted average of the traffic density-to-road distance ratio for all home and school addresses of each child's life; "air pollution" index combines lifelong time-activity patterns and ambient air concentration estimates of NO(x), using an air dispersion model of traffic exhausts. Average current PM(2.5) personal exposure is 23.8 microg/m3 (SD=17.4), and average indoor concentrations=22.5 microg/m3 (18.2); corresponding values for NO(2) are 31.4 (13.9) and 36.1 (21.4) microg/m3. Average lifelong calculated exposures to traffic-related NO(x) emissions are 62.6 microg/m3 (43.1). The five cities show important contrasts of exposure to traffic pollutants. These data will allow comparison of lifelong exposures to indicators of traffic exhausts between cases and controls, including during early ages, while controlling for a host of known enhancers or precipitators of airway chronic inflammation and for possible confounders.


Subject(s)
Air Pollution/adverse effects , Air Pollution/statistics & numerical data , Asthma/chemically induced , Asthma/epidemiology , Inhalation Exposure/analysis , Vehicle Emissions/adverse effects , Adolescent , Air Pollution/analysis , Case-Control Studies , Child , Child, Preschool , Environmental Monitoring , Epidemiologic Studies , Epidemiological Monitoring , Female , France/epidemiology , Humans , Male , Nitrogen Dioxide/analysis , Particle Size , Surveys and Questionnaires , Urban Population , Vehicle Emissions/analysis
15.
Environ Int ; 27(4): 335-40, 2001 Oct.
Article in English | MEDLINE | ID: mdl-11686645

ABSTRACT

BACKGROUND: NO production (NOex) in the airway epithelium is increased in asthmatic patients and is potently inhibited by anti-inflammatory treatments. The study was designed to compare the: (i) levels of NOex in two groups of asthmatic children residing in different environments (one in a national park in the mountains and the other in a large city) and (ii) the influence of glucocorticoids on levels of NOex between the children and those without treatment. METHODS: The measurements were performed during the same period in the two locations, 100 km apart. NOex was measured using a chemiluminescence analyzer in controls and two comparable groups of asthmatic children. The first group included 63 children (10+/-3 years) recruited from a specialized institution for asthmatic children, and the second group consisted of 46 asthmatic children (9+/-3 years) living in an urban area. A reference group of 17 healthy children residing in the same city was also studied. MEASUREMENTS AND RESULTS: The concentrations of NOex in children in the specialized institution were significantly lower (P<.001) than those in asthmatic children living in the city (5.1+/-2.4 vs. 13.8+/-9.3 ppb) and comparable to those in healthy controls (5.3+/-4.0 ppb). In the urban area, NOex levels increased when atmospheric pollution recorded on the previous day had increased. In contrast to that observed in the urban children, glucocorticoids had little influence on the levels of NOex in the children living in the specialized institution. CONCLUSIONS: Although these relationships need to be confirmed, our findings show that for the determination of NOex, specifying the quality of the environment, in particular, the purity of the air respired by asthmatic children, not only at the time of measurement but also over the previous days, is important.


Subject(s)
Air Pollutants/adverse effects , Air Pollution , Asthma/physiopathology , Nitric Oxide/biosynthesis , Air Pollutants/analysis , Asthma/drug therapy , Breath Tests , Child , Female , France , Glucocorticoids/therapeutic use , Histamine Antagonists/therapeutic use , Humans , Male , Spirometry , Time Factors , Urban Population
16.
Arch Pediatr ; 8 Suppl 3: 597-599, 2001 Aug.
Article in French | MEDLINE | ID: mdl-11683081

ABSTRACT

Cough is a physiological reflex occurring when sensitive receptors located in upper airways and the larynx are activated. By definition a 'chronic cough' lasts at least 3 weeks. An analysis of clinical characteristics is essential for setting up the diagnosis and giving correct treatment. We can individualize three mainly clinical aspects: the young child of less than 3 years of age, the nocturnal cough and the productive cough. The 'variant of asthma' cough is a common problem among all ages that frequently goes unrecognized. Any patient with dry nocturnal coughing that lasts more than three weeks should have an empiric bronchodilator treatment. The prognosis is on the whole favourable.


Subject(s)
Asthma/diagnosis , Cough/drug therapy , Adolescent , Age Factors , Asthma/complications , Bronchodilator Agents/therapeutic use , Child , Child, Preschool , Chronic Disease , Cough/pathology , Humans , Infant , Infant, Newborn , Prognosis
17.
Arch Pediatr ; 8 Suppl 3: 610-622, 2001 Aug.
Article in French | MEDLINE | ID: mdl-11683084

ABSTRACT

Recurrent or chronic cough can be the symptom of a worrying condition which must be diagnosed without delay (cystic fibrosis, asthma, bronchial foreign body, bronchiectasis). Investigation of recurrent or chronic cough is based on simple principles: careful history-taking concerning the characteristics of the cough, full clinical examination to look for any associated symptoms, and auxological assessment to detect any interruption in weight increase. Only when this initial evaluation has been carried out can complementary investigations be sought. Ordinary respiratory infections that are part of the building up of immunity are predominant in coughs of children aged under 6 years and are aggravated by deleterious factors such as passive exposure to tobacco, early introduction to communal life, and urban pollution. We describe the most frequent causes of cough and their frequency according to the age of the child.


Subject(s)
Cough/etiology , Respiratory Tract Infections/complications , Age Factors , Asthma/complications , Asthma/diagnosis , Bronchiectasis/complications , Child , Child, Preschool , Chronic Disease , Cough/physiopathology , Cough/therapy , Cystic Fibrosis/complications , Cystic Fibrosis/diagnosis , Decision Trees , Diagnosis, Differential , Foreign-Body Reaction , Humans , Infant , Infant, Newborn , Medical History Taking , Patient Care Planning
18.
Arch Pediatr ; 8 Suppl 3: 629-634, 2001 Aug.
Article in French | MEDLINE | ID: mdl-11683086

ABSTRACT

Gastroesophageal reflux (GER) is one of the three most common causes of chronic cough in children, along with postnasal drip syndrome and asthma. There may be no gastrointestinal symptoms up to 50-75% of the time. GER plays a causative role in chronic cough, asthma without allergy and posterior laryngitis. GER most commonly provokes coughing by stimulating an esophageal-bronchial reflex and by irritating the lower respiratory tract by microaspiration. Twenty-four-hour pH monitoring of the distal esophagus is the most accurate diagnostic method for children with suspected GER and it helps to establish a temporal correlation between cough and GER. The first step of the treatment is the association of postural and dietetic measures and medications (prokinetics and antacids). The length of the treatment is a minimum of 3 months up to the age of walking. Surgical treatment must be reserved for the failure of medical treatment. The benefits of minimally invasive surgery are evident in children with chronic cough, who have a faster recovery with fewer complication than after open surgery.


Subject(s)
Cough/etiology , Gastroesophageal Reflux/complications , Adolescent , Age Factors , Antacids/therapeutic use , Asthma/physiopathology , Child , Child, Preschool , Chronic Disease , Cough/physiopathology , Diagnosis, Differential , Gastric Acidity Determination , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/therapy , Humans , Infant , Infant, Newborn , Minimally Invasive Surgical Procedures
19.
Arch Pediatr ; 8 Suppl 3: 645-649, 2001 Aug.
Article in French | MEDLINE | ID: mdl-11683089

ABSTRACT

In order to understand the epidemiological aspects of chronic cough, we analysed 100 patients' files referred for chronic cough in five pediatric-pulmonology consultations. The patients had a chronic cough for more than 3 weeks. The distribution of causes was: asthma, 56%; upper airway disorders, 16%; psychogenic, 4%; whooping cough, 4%; Mycoplasma pneumoniae pulmonary infection, 3%; Chlamydia pneumoniae pulmonary infection, 1%; bronchiectasis, 1%. In 15% of cases two or more causes were associated; In most cases, the clinical characteristics of the cough are evident enough to establish a diagnosis with few secondary explorations. The prognosis is on the whole favourable.


Subject(s)
Asthma/complications , Cough/etiology , Respiratory Tract Infections/complications , Adolescent , Child , Child, Preschool , Chronic Disease , Cough/physiopathology , Diagnosis, Differential , Epidemiologic Studies , Female , Humans , Infant , Male , Prognosis , Retrospective Studies , Whooping Cough/complications
20.
Arch Environ Health ; 56(4): 336-41, 2001.
Article in English | MEDLINE | ID: mdl-11572277

ABSTRACT

In epidemiological studies, investigators have routinely used ambient air concentrations, measured by air-quality monitoring networks, to assess exposure of subjects. When there is great spatial variability of ambient air concentrations or when there are specific indoor exposures, this approach may yield substantial exposure misclassification and distort the associations between exposure and the health endpoints of interest. In 3 French metropolitan areas, the cross-sectional relationships between 48 hr of nitrogen dioxide personal exposure of 73 children and the corresponding 48-hr background ambient air concentrations were analyzed. The crude correlation between ambient air concentrations and personal exposures was poor in all cities (r2 = .009 for Grenoble, r2 = .04 for Toulouse, and r2 = .02 for Paris). These correlations were improved when the authors took into account other ambient air or indoor air sources of nitrogen dioxide emissions (the corresponding multiple linear regression, r2, increased to .43 in Grenoble, .50 in Toulouse, and .37 in Paris). The main variables that explained personal exposures were an index of traffic intensity and proximity and use of a gas cooker at home. The results of this study confirm that ambient air-monitoring site measurements are poor predictors of personal exposure. Investigators should carefully characterize the proximity of roads occupied by dense traffic to the home/school as well as indoor sources of nitric oxide emissions; both of these careful characterizations will assist researchers in the prediction of personal exposure in epidemiological studies.


Subject(s)
Air Pollution, Indoor/analysis , Air Pollution/analysis , Child Welfare/statistics & numerical data , Environmental Exposure/analysis , Environmental Monitoring/methods , Environmental Monitoring/standards , Nitrogen Dioxide/analysis , Oxidants, Photochemical/analysis , Urban Health/statistics & numerical data , Vehicle Emissions/analysis , Adolescent , Air Pollution/statistics & numerical data , Air Pollution, Indoor/statistics & numerical data , Automobile Driving/statistics & numerical data , Bias , Child , Child, Preschool , Cooking/statistics & numerical data , Cross-Sectional Studies , Epidemiologic Studies , Epidemiological Monitoring , Female , France/epidemiology , Humans , Linear Models , Male , Predictive Value of Tests
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