[Chronic respiratory pathology in the child: overview of 10 years of multidisciplinary management in a pediatric medical center]. / Pathologie respiratoire chronique de l'enfant: bilan de dix ans de prise en charge pluridisciplinaire en centre médical pédiatrique.

Certain children presenting chronic pulmonary diseases, severe or relapsing, aggravated by unfavourable psychosocial factors are hospitalised in a repetitive manner. To try to help these children, we created a project for a family, school and social reintegration. We developed a program which by its multidisciplinary integrated approach tries to get the family to accept the illness and its constraints, to decrease the factors which lead to chronicisation or aggravation of the symptomatology. Right after the admission, a complete evaluation of the situation is performed according to three main axes: medical evaluation, family evaluation and individual evaluation. Two hundred and twenty five children aged between 2 months and 14 years have been admitted between October 92 and December 02. The treatment lasted between 2 and 24 months. The results evaluated at mid term after discharge show a globally favourable evolution for the majority of children. There is an improvement in the pulmonary status, the frequency of rehospitalizations or the length of institutional placement and a diminution of school absences. The improvement appears however quite precarious as the family's defaults need a major outpatient support system. The positive factors for a good prognosis are: approach integrating the medical, psychological and environmental aspects; multidisciplinary diagnosis which allows to identify the problematic and to provide the most adequate help without multiplying too much the interventions; health education in order to lead to autonomy for medical treatment; social work started at the entrance which sets the bases for the creation of a support network; family therapy often necessary for these very dysfunctional families.

Alveolar data in healthy, awake neonates during spontaneous ventilation: a preliminary investigation.

A computerized method for the measurement of alveolar ventilation (VA) and the mean alveolar partial pressures of CO2 and O2 is described and tested in healthy, awake fullterm (FT) newborns and preterm (PT) infants (postnatal age 40 days). This study emphasizes the technical pitfalls generally encountered when dealing with very small infants. A sensitive pneumotachograph with a small dead space volume and a low-flow sampling system for the gas analyzer are minimum requirements. Under these technical conditions, the major problem is the scanning time of the mass spectrometer (50 Hz), which fixes the time constant, as well as the digitization sampling rate of the gas signals. This rate was not sufficient when the respiratory rate was above 90 min-1. As critical visual evaluation of each breath is required, fully automatic access to mean alveolar data is not possible. The mean dead-space volume in both FT and PT infants was 2 ml.kg-1, with a VD/VT ratio of 0.3. The mean alveolar point was 2/3 VT, as found in adults. When expressed as ml.min-1.kg-1, VA appeared to be higher than in other studies, but related to the metabolic requirements. (VCO2 = 7.8 +/- 0.2 ml.min-1.kg-1 and VO2 = 8.0 +/- 0.2 ml.min-1.kg-1), in accordance with the state of vigilance of the neonates. Indeed, the PACO2 values, which depend on the ratio VCO2/VA, are in agreement with the values of PaCO2 generally considered normal in healthy newborns over 1 week of age.(ABSTRACT TRUNCATED AT 250 WORDS)

Mediators in the asthmatic child.

Prostaglandins (PGF) are known to occur in premature babies with hyaline membrane disease and so the levels of PGE during growth have been investigated. The levels are lower in children than in adults; but this fact cannot explain the high resistance to air flow in infants. The release of mediators has been shown in children and in adults. Release of histamine from circulating basophils occurs when the suspected allergenic extract is mixed with the blood of the asthmatic child. Other mediators have not been found in young children. Cutaneous tests and respiratory challenges demonstrate indirectly the action of mediators in children, but not in infants. Between 5 and 15 years of age, the frequency and type of response to these tests are not significantly different. One may assume that, at least within these age limits, release of mediators is similar qualitatively.

[Cerebral abscess and pulmonary arteriovenous fistula. A clinical and respiratory function study]. / Abcès cérébral et fistule artérioveineuse pulmonaire. Etude clinique et fonctionnelle respiratoire.

Liz... Josiane, a 9 year old girl, was admitted with a 24 hours history of severe headache and vomiting. On admission she was conscious, irritable and complained of a severe headache. Clinical examination revealed a right hemiparesis with cyanosis of the lips and extremities and clubbing of the fingers, all consistent with chronic hypoxia. Cardiovascular examination was normal apart from a systolic murmur which could be heard posteriorly under the left scapula. There were no angiomatous or telangiectatic lesions of the skin. A blood examination revealed a raised ESR, a marked polycythaemia with a decreased arterial oxygen tension. Chest x-rays showed the presence of an irregular well delineated opacity in the posterior basal segment of the left lower lobe. This opacity was confluent with the ipsilateral hilum and was suggestive of a pulmonary arteriovenous fistula. An intracranial space occupying lesion in the left temporal region of the brain was revealed by electroencephalographic and CT scan investigations; this proved to be an abscess which was surgically removed with no subsequent complications. Further radiological investigations of the chest revealed the pulmonary lesion was an arteriovenous aneurysm occupying the whole left inferior lobe. This was removed at thoracotomy three months after the acute neurological event. The results of respiratory function and regional isotopic investigations before and after surgery will be discussed.

[Short term efficacy of inhaler beta2 agonists in childhood asthma (author's transl)]. / Efficacité à court terme de bêta-mimétiques inhalés chez l'enfant asthmatique.

An attempt was made to assess the relationship between the bronchodilator response of three beta2-agonists (fenoterol salbutamol and terbutaline) administered by a metered aerosol inhaler during 43 lung function measurements on 25 asthmatic children. At constant one minute intervals the changes in total pulmonary flow resistance (R1) and dynamic lung compliance (C1 dyn) were measured. The effect of the three bronchodilators on the mean decrease of R1 was similar and not significantly different. Since R1 may fail to detect peripheral airway obstruction, the efficiency of the three drugs was evaluated on the basis of changes on C1 dyn in two subpopulations, one without signs of overinflation and one with evident overinflation, as judged from the initial values of the functional residual capacities and the C1 dyn's. On the basis of this distinction it is suggested that fenoterol has its predominant effect on patients with overinflation of the lungs and increased C1 dyn probably due to a loss of elastic recoil. Salbutamol is more efficient in patients suffering from a "primary bronchial disease", Terbutaline is equally effective in both.

Mode of action of bronchodilating drugs on histamine-induced bronchoconstriction in asthmatic children.

The bronchodilatory response of three beta 2-agonists (fenoterol, salbutamol, and terbutaline), administered by a metered aerosol inhaler, was assessed in 19 asthmatic children after histamine-induced bronchoconstriction. At 1-min intervals, the changes in total pulmonary flow resistance (R1) and dynamic lung compliance (C dyn) were measured. After rank-ordering according to the base line value of C dyn (62 to 200% predicted), the patients were divided into two groups according to lung compliance: (1) patients with greater compliance (C dyn, 129 to 200% predicted) and (2) patients with lesser compliance (C dyn, 69 to 116% predicted). The effect of the three bronchodilators on the mean decrease of R1 and on the increase of C dyn was studied and analyzed for each drug separately. In all patients, salbutamol was the most efficient bronchodilator of small airways (P less than 0.02). The most striking feature of this beta 2-mimetic was observed in patients whose lungs were initially overinflated (functional residual capacity over 120% predicted) but not obstructed before the histamine challenge (P less than 0.005). In these subjects C dyn and R1 are normalized after inhalation of salbutamol. After fenoterol and terbutaline inhalation, obstruction of the large airways was not fully alleviated. In addition, these two drugs seemed not to affect the ventilatory asynchronism (C dyn alterations) in patients whose lungs had been overinflated before drug inhalation (C dyn again around 150% predicted).