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Biomedical subjects

G Tournier

Publications and source records attributed to G Tournier.

At least 19 recordsLinked to original sources
PubMed1992

[Heart or heart-lung transplantation and toxoplasmosis].

Among all organ transplantations, those of heart or heart-lung carry the greatest risk of toxoplasmosis. The disease is observed mainly when the donor is seropositive and the recipient seronegative. In these mismatched couples the risk may be as high as 57 percent. Cardiac tissue transplants are responsible for most contaminations. A subclinical serological reactivation can be observed in seropositive recipients. Patent forms are associated with seroconversion in seronegative subjects. Toxoplasmosis is often severe with multivisceral foci; interstitial pneumonia is possible. The serological diagnosis is easy in cases with significant antibody movements, but it may be difficult if the titre is low or stable. The parasitological diagnosis rests on the isolation of toxoplasma in blood, cerebrospinal fluid, bronchoalveolar lavage fluid and cardiac or cerebral biopsy. Immune defence against toxoplasmosis is primarily cellular, with lymphocytosis and inversion of the CD4/CD8 ratio. Macrophages play a crucial role. Interferon-gamma is the major mediator of cellular resistance. In spite of its immunosuppressive action, cyclosporin clearly has an antiparasitic action in vitro and in vivo. A cytomegalovirus infection might facilitate toxoplasma reactivation. Prevention of toxoplasmosis in transplant recipients includes systematic serology of the recipient and, if possible, the donor, detection of mismatched couples and systematic treatment with pyrimethamine of recipients at risk (in seronegative recipients, this drug has reduced the risk from 57 to 14 percent). Cyclosporin should be used as immunosuppressant in preference to other drugs of this kind. Corticosteroids administered in rejections increase the risk of toxoplasmosis.

Cyclosporine↗
PubMed1992

Miliary tuberculosis with acute respiratory failure and histiocytic hemophagocytosis. Successful treatment with extracorporeal lung support and epipodophyllotoxin VP 16-213.

A 14-year-old girl with high fever, dyspnea and bilateral miliary nodules on chest X-ray, developed a rapidly progressive respiratory failure associated with histiocytic hemophagocytosis. Histologic examination of bone marrow biopsy revealed tuberculous granulomas with caseating necrosis. We report a pediatric case in which treatment with extracorporeal lung support and epipodophyllotoxin VP 16-213 was successful.

Adolescent↗
PubMed1992

[Reliability and reproducibility of 3 peak flowmeters determined in a population of primary school children].

Peak-flow measurement increasingly seems to be very useful for routine monitoring of asthma in children. The purpose of this study was to evaluate the reliability and reproductibility of three different peak-flow meters: Miniwright, Vitalograph and Assess. This prospective study was conducted in 100 primary school children aged from 6 to 11 years. In each child, 9 measurements of expiratory peak-flow rate (EPF) were performed with these 3 peak flow meters in a random order. Reproductibility was assessed for each instrument by the greatest divergence observed between the 3 EPF values measured in the same session. Reliability was assessed by comparison between the values obtained with each instrument and theoretical EPF values calculated from a formula which included age, sex and size. Our study validated the reliability and reproductibility of the 3 peak flow meters studied. EPF values were more scattered and less reproductible with Assess, but the difference was not significant.

Asthma↗
PubMed1992

[Treatment understanding and compliance in asthma of children. Results of a prospective survey].

Compliance with treatment is a crucial factor in the management of asthmatic children which depends on the understanding of the disease and its treatment. The understanding of, and compliance with treatment were evaluated by means of a questionnaire in 50 parents of asthmatic children. 50% of these parents used anti-histamines as maintenance treatment and 30% also used these drugs during attacks. Half the parents knew about the bronchodilator effects of theophylline and B2-agonists. 42% and 30% respectively of the parents thought that the side-effects of theophylline or corticosteroids were few or inexistent; 86% claimed regular attendance to out-patient clinics, but 30% confessed that they had forgotten such drugs as theophylline and antihistamines. 50% took the appropriate therapeutic measures when confronted with a moderate or severe attack of asthma. Each child received 2.3 drugs on average for his or her asthma. This study shows that parents have an insufficient knowledge of asthma treatments, and this may partially explain the poor compliance with therapy as well as the morbidity and mortality associated with childhood asthma.

Adolescent↗
PubMed1992

[Bronchogenic cysts in the carina].

Between 1977 and 1990, 11 children with carinal bronchogenic cysts were operated in our institution: 8 girls and 3 boys, ranging in age from 1 month to 5 years. All were symptomatic (acute respiratory distress and recurrent bronchiolitis). Chest X-ray showed an unilateral over distension in 10/11 cases. Barium oesophagogram showed a compression in 6/10 cases. Bronchoscopy noticed an extrinsic compression in 10/11 cases and a tracheal and/or bronchial diskinesia in 5/11 cases. The computed tomography showed a low density mass in 4/4 cases. 9 cysts were left-sided and 2 right-sided. Both children underwent a second surgery for a second cyst. 2 pneumonectomies for complete parenchyma destruction were realised. 1 left pulmonary hypoplasia was noticed. A tracheal and/or bronchial diskinesia in post-operative was noticed in 5/6 cases. The clinical and functional respiratory following was good in 10/11 cases. An early surgery treatment is necessary before definitive sequelae.

Barium Sulfate↗
PubMed1992

[Recurrent bronchopneumopathies in the infant due to swallowing dyspraxia. Two cases].

In two infants with recurrent lower respiratory tract infections starting within a few weeks of birth, dynamic electromyographic studies of sucking and swallowing evidenced a disorder of lingual and pharyngeal activities responsible for the episodes of aspiration. The central location of the anomaly was demonstrated by the absence of peripheral neuromuscular anomalies and by the presence of impaired blinking reflexes and brain stem potential anomalies. These neurofunctional anomalies improved over time and magnetic resonance imaging failed to disclose and structural anomalies of the central nervous system. The occurrence of the swallowing disorder as an isolated manifestation and its long duration, with follow-ups of 23 months and 4 years, are two unique features in these cases. Neurophysiologic investigations are essential for documenting the neurologic etiology of the swallowing disorders, demonstrating their location above or within the medulla oblongata, and differentiating functional and organic anomalies.

Deglutition Disorders↗
PubMed1992

[Asthma in infants. Clinical and functional aspects].

BACKGROUND: The incidence of asthma in infancy is rising but its clinical and physiological components remain unclear. METHODS: A total of 24 infants, aged less than 48 months, in whom the first wheezing episode (WE) appeared before the age of 30 months (mean age: 9 months) underwent clinical examination and pulmonary function tests at least 2 weeks after the last WE. RESULTS: The mean WE frequency was 1.1 per month and the mean number of admissions for WE was 1.8. 63% of patients showed symptoms between WE and 50% had an allergic profile. There was no evidence of thoracic distension. Bronchial obstruction (BO) occurred in 71% of patients; among these, BO was distal or generalized in 59% and medium or severe in 47%. 12.5% of patients were hypoxemic at testing. BO was less severe in patients treated with theophylline; it was more frequent (87%) in those with symptoms between WE and/or several admissions, and/or admission to the intensive care unit. CONCLUSION: This study provides additional evidence that infants presenting with asthma at an early age have severe clinical and physiological profiles.

Age Factors↗
PubMed1992

[Value of accelerated hyposensitization with mixed allergens in severe childhood asthma].

The value (in terms of decreased numbers of attacks and of hospitalizations for attacks, decreased need for asthma medications, and improved tolerance to allergens) of rush immunotherapy to a mixture of allergens was studied in children with multiple sensitizations and severe asthma (as evaluated on the number of attacks, number of hospitalizations, and dependence on corticosteroids) already receiving optimal medical therapy. Because syndromic reactions are common, rush immunotherapy should be performed in the hospital and premedication with corticosteroids may be warranted in the most severe cases.

Adolescent↗
PubMed1991

[Mediastino-pulmonary sarcoidosis in children. Clinical study, analysis of data of bronchoalveolar fluid lavage and respiratory function tests, therapeutic trends].

A series of 27 children (mean age: 12 yrs, 5 mos.) presenting with thoracic sarcoidosis is reported. This series, collected from 1961 to 1988 shows the rarity of the disease at that age. However the low rate of asymptomatic forms (22%) suggests that the frequency of the disease is underestimated, as it is not diagnosed. The histological proof is necessary for the diagnosis. When peripheral lesions available for biopsy are lacking, a liver needle biopsy is helpful (93% of positivity). This study shows the frequency of multivisceral types, the intensity of the macrophagic and lymphocytic alveolitis. The therapeutic indications depend on the comparison of the radiological stage, the results of pulmonary function tests (PFT), those of the bronchoalveolar lavages (BAL) and of the serum granulomatous activity markers, especially concerning angiotensin converting enzyme (ACE). When present at the beginning of evolution, several risk factors lead to use a corticosteroid treatment: age of onset before 4 years, multivisceral involvement, presence of functional pulmonary signs, delayed diagnosis and onset of treatment, impaired respiratory function (especially concerning the alveolo-capillary diffusion), PMN cells greater than or equal to 2% in the initial BAL, and IgG proteins greater than 4 SD. Thus sarcoidosis in children differs from that seen in adults as it has a more marked evolutive tendency and leaves severe sequelae in one third of patients.

Adolescent↗
PubMed1991

[Intralobar pulmonary sequestration manifested by neonatal cardiac insufficiency].

The authors report the case of an intralobar pulmonary sequestration in a newborn presenting congestive heart failure. The clinical symptoms mimicked a persistent ductus arteriosus. Clinical, radiographic and echographic data suggested the diagnosis which was confirmed by the angiography. A surgical treatment was realised at seven weeks consisting in the ligation of the abnormal artery and a right lower lobectomy. This is the 9th case found in the literature. A congestive heart failure in a neonate with normal intracardiac anatomy may suggest a pulmonary sequestration.

Bronchopulmonary Sequestration↗
PubMed1991

[6 cases of toxoplasmosis in twins].

Studies of congenital toxoplasmosis in twins confirm the definite role of the placenta in the modalities and mechanism of fetal contamination. In single-chorion twin pregnancies, clinical manifestations are generally identical in both infants. Conversely, twins from double-chorion pregnancies usually have different clinical patterns; occasionally, only one of the twins is affected (1 case). The diagnosis can be ascertained antenatally by sampling blood from each of the fetuses (2 cases). The cases reported herein illustrate some of the diagnostic pitfalls that may lead to inappropriate discontinuation of monitoring and treatment: negative placental studies, absence of specific IgM antibodies, transient fall in IgG antibody titers, delayed fetal contamination after a negative fetal blood study, and need for routine tests for increased CSF albumin levels.

Adult↗
PubMed1990

[Cutaneous reactions to tuberculin and BCG vaccine].

The only available method for quantitative exploration of skin allergy to tuberculin is intradermal injection, since there is no other satisfactory method to evaluate the induration observed. Below 5 mm the induration has no significance. Between 5 and 10 mm it corresponds to an allergic reaction induced by BCG vaccine or by usually inapparent infections due to atypical mycobacteria. A diameter of 10 mm or more suggests either M. tuberculosis infection or allergy to BCG. The intensity of allergic reaction varies under the influence of numerous factors which may be genetic or nutritional, or associated with viral infections, antiviral vaccines and medicinal treatments. Exploring this allergy is of interest on the scores: (1) for epidemiological purposes, to obtain information on the annual risk tuberculosis infection or on the quality of the protection conferred by the vaccine in a given population; (2) for diagnostic purposes, to detect tuberculosis, and especially primary tuberculosis in children; (3) for vaccinal purposes, to determine the limitation of BCG. In subjects who have been vaccinated tuberculosis is rare but remains possible, and in such cases reactions to tuberculin may be difficult or even impossible to interpret.

Adult↗
PubMed1990

[Cystic fibrosis in infants revealed by severe respiratory distress. Mid-term course].

We report the follow-up of 13 infants aged 2.5 to 24 months in whom cystic fibrosis disease presented as respiratory distress. All infants received an intensive treatment. Mean clinical, radiological and microbiological follow-up was 3.1 years. Ten children aged 1.5 to 8.5 years are still alive. One of them presents with serious respiratory failure, with a Shwachman score of 50. The Shwachman score is between 85 and 70 for 8 of 13 and 65 for one. The prognosis of this group did not differ from the one usually observed in the disease. It depends partially on early intensive care management and is not altered by mechanical ventilation.

Child, Preschool↗
PubMed1990

[Otorhinolaryngologic involvement in cystic fibrosis].

ENT involvement is very frequent in mucoviscidosis, particularly rhinitis and sinusitis. This prospective study, which spanned from September 1st, 1988 to August 31st, 1989 anc included 27 children with cystic fibrosis of pancreas was carried out with the intent of determining the incidence of the various associated diseases, their bacteriologic profile, and the optimal therapeutic procedure. Less than a child in 5 is symptomless when the nose and sinuses are affected. Polyposis is found to occur in 6/27 cases, and all children have sinus radio-opacities. Ear disease is rare (1/4 of cases) and is manifested by asymptomatic tubal dysfunction with minimal audiometric repercussions. Bacteriologic specimens of sputum and sinus purulent discharge show simultaneous germ positivity (10 times out of 11). Our therapeutic recommendations are based on our own experience as well as literature data, and are, in our opinion, only relevant for children with clinical signs of disease, as opposed to advocating systematic treatment of sinus foci found on X-ray.

Adolescent↗