[Changes in the isoniazid inactivation index during antituberculosis treatment in children]. / Variations de l'indice d'inactivation de l'isoniazide au cours des traitements antituberculeux chez l'enfant.

Fluorimetric assays of serum isoniazid levels were performed in children treated either with isoniazid alone, or with isoniazid associated with other antituberculous drugs, in order to adjust the dosage. Study of the inactivation index at the 3rd hour, showed a faster metabolism in the younger children. Assays repeated twice or more in 160 patients, showed important variability in the results. The variation coefficient was 18,6% for the whole group and above 25% in 25% of cases. The younger age and the association of several other drugs (corticosteroids and possibly erythromycine) may be responsible, at least partly, for this variability. However, association with antituberculous drugs (ethambutol, rifampin) does not seem to change significantly isoniazid metabolism. The magnitude of these variations should lead to a greater caution in the interpretation of isolated isoniazid dosages.

[Hypersensitivity pneumonitis in children. A study of 5 cases (author's transl)]. / Pneumopathies par hypersensibilité chez l'enfant. A propos de cinq cas.

Five cases of hypersensitivity pneumonitis in children are reported. Four had the pattern of bird breeder's disease and one of aspergillus lung hypersensitivity. All were clearly defined by clinical, radiological, functional and immunologic features. The possible difficulties in diagnosis are emphasized. The disease might be frequently overlooked and its frequency underestimated in children. The diagnostic value of precipitating antibodies is discussed. Although some immunologic studies suggest immune complex mechanisms, recent experimental and clinical data are in favor of a role for cell-mediated immunity. In addition whether or not immunological damage is to occur and result into disease depends not merely upon the characteristics of the antigen exposure. Genetic and/or acquired individual differences in immune reactivity can play a definite role as well. The risk of secondary pulmonary fibrosis and chronic respiratory failure in untreated patients is emphasized. Immunologic and functional tests for identification of the provoking antigen and ceasing of contamination exposure are urgent : they are also useful for monitoring steroid therapy.

[Recurrent respiratory disease and IgA deficiency in infants and children (author's transl)]. / Broncho-pneumopathies récidivantes et déficit en IgA chez l'enfant.

Among nearly 1 300 infants and children studied for chronic or recurrent respiratory diseases 36 of them had plasma and/or salivary IgA deficiency. They were 1 to 13 years of age with 20 between 3 to 6 years; 11 had total, lack or traces of salivary IgA, 9 had very low or nul plasma IgA titer and 6 had both. The deficiency was transitory in 10. Associated abnormalities with potential liability for the disease: allergy, gastroesophageal reflux, alpha-1-antitrypsin deficiency and other immunologic deficiency were encountered in 26. The often multifactorial pattern of respiratory diseases in pediatrics is emphasized. The pathogenic role of IgA deficiency is discussed. Even though its responsibility is demonstrated, its real magnitude and extent requires further studies.

[Tracheal dyskinesia (tracheomalacia) in infants and children. Study of 127 cases diagnosed through endoscopic examination (author's transl)]. / La dyskinésie trachéale (trachéomalacie) chez l'enfant. Réflexions à propos de 127 cas reconnus par endoscopie.

127 cases of tracheal dyskinesia were seen in infants and children out of which 87 were 1 to 12 months of age. The diagnosis was based on the existence of a collapse reducing the tracheal diameter of more than 50% on endoscopy. Endoscopic examination was performed without general anesthesia. This material represents 5,8% of the patients submitted to this procedure. 85 patients had "primitive" dyskinesia and 42 had major associated abnormalities. Uni or bilateral bronchial dyskinesia was associated in 43% of the cases. The four commonest presenting symptoms were a stridulous or wheezing respiration, recurrent bronchitis, chronic cough, cyanosis. The frequency of associated digestive troubles: gastroesophageal reflux aspiration was noteworthy. Several functional consequences were encountered: hypoxemia, hypercapnia, abnormalities of FRC, increased RL, lowering of dynamic compliance, alterations of perfusion and ventilation on scintiscans. The prognosis was good in primitive cases. Two deaths occurred, in the group with associated abnormalities. The pattern of the patient with primitive dyskinesia and that of the patient with dyskinesia and associated abnormalities are outlined. Some features remarkable in this series of patients are pointed out in a discussion of the pathophysiology of the syndrome. Increased transmural pressure is not a common cause of tracheal dyskinesia and infection as well. The possibility of a temporary intrinsic anomaly of the tracheal wall is suggested. Even if its exact mechanism remains unknown, tracheal dyskinesia is a distinct entity observed in infants and children. It appears as a common cause of recurrent bronchopulmonary disease in the young.

[Diagnosis of interstitial pneumopathies in infants (author's transl)]. / Pneumopathies interstitielles de l'enfant.

The authors discuss the etiological features of interstitial pneumopathies, with particular emphasis on their characteristics in the newborn and in immunodeficient children, and review the diagnostic findings : clinical and radiological signs, functional disturbances, and results of pulmonary biopsy. The results of 154 needle biopsies in 124 children aged 1 month to 16 years are described. In 103 cases a diffuse pneumopathy was present and 80 % of the biopsies were successful. Precise diagnosis could be made from the histology specimen in 22 cases out of the 82 examined, while in 60 of these cases the specimen could be identified.

[Inappropriate secretion of ADH during acute respiratory infections due to adenovirus in children (author's transl)]. / Sécrétion inappropriée d'hormone antidiurétique au cours des infections respiratoires aiguës à adénovirus chez l'enfant.

Four children aged between 7 and 19 months with severe bronchopneumonia due to adenovirus type 7, proved by virology and/or serology developed severe hyponatraemia. One of them is reported in detail: it was possible to estimate plasma ADH levels and thereby prove the existence of reversible hypersecretion of the hormone. Whilst the syndrome of hyponatraemia with inappropriate secretion of ADH has not yet been reported in association with severe pneumonia in the child, it is known in adults. The limits of the syndrome and its physiopathology are discussed. It may be due either to vagal stimulation as a result of a fall in left aressure, or to central involvement. Therapeutic implications of the problem are emphasized.

[Tuberculous mediastinal adenopathy in a child]. / Adenopathies mediastinales tuberculeuses pseudo-tumorales chez l'enfant.

One case of mediastinal tuberculous lymph node with fistulae into the esophagus is reported in a 9 years old girl. The first symptom was the appearance of epigastric abdominal pain, with secondary dysphagia. The diagnosis was confirmed by histology after thoracotomy and surgical excision. Esophageal tuberculosis is rare and seems to be secondary to contamination from mediastinal lymph nodes. Treatment is always medical and often requires surgery.