Baseline and post-bronchodilator interrupter resistance and spirometry in asthmatic children.

In children unable to perform reliable spirometry, the interrupter resistance (R(int) ) technique for assessing respiratory resistance is easy to perform. However, few data are available on the possibility to use R(int) as a surrogate for spirometry. We aimed at comparing R(int) and spirometry at baseline and after bronchodilator administration in a large population of asthmatic children. We collected retrospectively R(int) and spirometry results measured in 695 children [median age 7.8 (range 4.8-13.9) years] referred to our lab for routine assessment of asthma disease. Correlations between R(int) and spirometry were studied using data expressed as z-scores. Receiver operator characteristic curves for the baseline R(int) value (z-score) and the bronchodilator effect (percentage predicted value and z-score) were generated to assess diagnostic performance. At baseline, the relationship between raw values of R(int) and FEV(1) was not linear. Despite a highly significant inverse correlation between R(int) and all of the spirometry indices (FEV(1) , FVC, FEV(1) /FVC, FEF(25-75%) ; P < 0.0001), R(int) could detect baseline obstruction (FEV(1) z-score ≤ -2) with only 42% sensitivity and 95% specificity. Post-bronchodilator changes in R(int) and FEV(1) were inversely correlated (rhô = -0.50, P < 0.0001), and R(int) (≥35% predicted value decrease) detected FEV(1) reversibility (>12% baseline increase) with 70% sensitivity and 69% specificity (AUC = 0.79). R(int) measurements fitted a one-compartment model that explained the relationship between flows and airway resistance. We found that R(int) had poor sensitivity to detect baseline obstruction, but fairly good sensitivity and specificity to detect reversibility. However, in order to implement asthma guidelines for children unable to produce reliable spirometry, bronchodilator response measured by R(int) should be systematically studied and further assessed in conjunction with clinical outcomes.

[Isocapnic hyperventilation test adjusted to child's resting ventilation rate]. / Un test d'hyperventilation isocapnique adapté à la ventilation de repos de l'enfant.

In order to validate an Isocapnic Voluntary Hyperventilation (IVH) test applicable to daily practice and to adapt the stimulus to height, 9 healthy and 15 asthmatic children performed a Resting Ventilation Rate (RVR)-corrected IVH. They performed a three-minute IVH with room temperature dry air achieving twice (IVH2) and three times (IVH3) their RVR. Mean Maximal Expiratory Flow (MEF) in the middle half of Forced Vital Capacity (FVC) (MEF25-75%) and mean MEF at 25% of FVC (MEF25%) are decreased in the asthmatic group 10 minutes IVH3 (p = 0.02 and < 0.002) compared to healthy group. Mean FEV1 of both group are not different. Comparing Forced Expiratory Flows variation after IVH to baseline intrasubject coefficient of variation, sensitivity of the test is 80% and specificity 100% when variations of MEF25-75% and MEF25% together with FEV1 variations are considered. This suggests an easy way to adapt an hyperventilation stimulus to size and emphasizes the utility of taking account of MEF25-75% and MEF25% in detecting non specific bronchial hyperreactivity in asthmatic children.

[Rapid diagnosis of tuberculous meningitis by polymerase chain reaction. A case in an infant]. / Diagnostic rapide de la méningite tuberculeuse par polymerase chain reaction. Une observation chez un nourrisson.

A fifteen-month-old child was admitted with a week history of isolated fever. On CSF (Cerebral Spinal Fluid) examination, hyperproteinorachy, hyperglycorachy and hypochlorurachy were found. The diagnosis of tuberculosis meningitis was suspected but usual tests were unable to find Mycobacterium tuberculosis in CSF, urine and sputum. Only the Polymerase Chain Reaction detected the Mycobacterium tuberculosis genome in the CSF. A specific treatment was started immediately. Apyrexia was obtained within 2 days; the outcome was favorable, without sequelae.

[Fatal acute encephalitis in primary Epstein-Barr virus infection]. / Encéphalite aiguë fatale au cours d'une primo-infection à virus d'Epstein-Barr.

A 6 year-old girl presented an acute onset of mononucleosis-like syndrome which progressed at day 19 to encephalitis, coma and death at day 27. Epstein-Barr virus (EBV) serology suggested that she suffered from a primary EBV infection. Therapeutic attempt with acyclovir did not improve the fatal course of the disease.

[Hygiene problems associated with characteristics of the sludge from purification plants in Liguria]. / Problemi igienici associati alle caratteristiche dei fanghi provenienti dagli impianti di depurazione in Liguria.

Sludge samples from five municipal sewage treatment plants in Liguria (Italy) were examined periodically during a whole year. Four of them are located in Genova and receive the sewage corresponding respectively to 20,000-53,000-125,000 and 285,000 equivalent inhabitants. The last one is in Chiavari and receives the sewage corresponding to 40,000 equivalent inhabitants. All plants included a preliminary screening treatment, primary sedimentation and a secondary activated sludge process. Sludge was thickened by centrifuge. The bacteriological and chemical characteristics of the sludge after centrifuging (detection and estimation of total and fecal coliforms, fecal streptococci and enumeration and isolation of Salmonella, pH, moisture, total and volatile residue, nitrogen, phosphorus, heavy metals) were measured in order to establish the possibility of land disposal. Dry solids contained on average 34 g/kg total nitrogen and 1,4 g/kg phosphorus. Among heavy metals copper and zinc reached high levels: 544 and 1587 mg/kg of dry solids. Other metals were present at lower concentrations (As 6, Cd 2, Cr 70, Hg 2, Ni 53, pb 416 mg/kg). Comparing these results with those of a research carried out contemporarily in another region (Emilia Romagna) it was observed that in Ligury there is a higher content of copper and bacteria (with an average of 69 Salmonella in 1 g of dry solids). The results showed that sludge produced in the five treatment plants in Ligury (Italy) was apt to be used as fertilizer in soil, but that care has to be taken for what concerns microbial contamination. For what regards the differences among the five sewage treatment plants under observation some heavy metals (arsenic and chromium) reached very high average levels (10-14 mg/kg of arsenic and 70-118 mg/kg of chromium) in the sludge of two of them, which treat the sewage from highly industrialized areas. On the contrary lead and cadmium were present at the same levels in all plants (416 mg/kg of lead and 2 mg/kg of cadmium) with the exception of one (Ge-Quinto) where cadmium was practically absent (0,2 mg/kg). The overall average concentrations of heavy metals resulted definitively lower than maximum concentration proposed by CEE (1986) and by some italian region as Lombardia. Some differences among plants for what regards microbiological parameters were noted only for total coliforms.

[Neonatal mortality at the Ille-et-Vilaine department. Results in 1987]. / Etude de la mortalité néo-natale dans le département d'Ille-et-Vilaine. Résultats en 1987.

All 56 neonatal deaths that occurred during 1987 in Ille-et-Vilaine department (France) were systematically analysed, and the history of pregnancy, delivery, neonatal resuscitation, circumstances under which death occurred in neonatal care unit as well as autopsy findings were studied. Each case was then discussed by a multidisciplinary staff and consensus was obtained regarding diagnosis and cause of death. There were 2 separate categories: 26 deaths (46%) were due to related to malformation, or to metabolic dysfunction; 30 deaths were a result of other causes (54%): 9 low birth weight, 5 respiratory disorders, 5 neurologic disorders, 6 infectious diseases, 2 hemorrhagic shock and 3 were of unknown etiology. Information on causes of neonatal death in a specific region may aid in determining public health priorities for that region; if similar studies were carried out in each department, and results compared, this could aid in setting the guidelines for more efficient health treatments and lead to national choices about neonatal public health.

[Researches on cholesterolemia "normal values" (author's transl]. / Ricerche sui "valori normali" della colesterolemia

The AA. have carried out a statistical analysis regarding the frequency of distribution of two series of laboratory data relative to blood cholesterol. The data were obtained by the "direct" method from two populations; healthy blood donors and out-patients of an INAM laboratory. The two distributions resulted to be heterogeneous and it was possible to identify three elementary Gaussian components, one of which indicates normal subjects (values between 140 and 240 mg%). The other two components may be tentatively defined (taking into account the position of the three components) by separating three distinct value levels: less than 210 mg% (normal values); 210-270 mg% (pre-disease); larger than 270 mg% (pathological values).