Biomedical subjects
Publications and source records attributed to J Derelle.
Inflammation aggravates respiratory impairment in patients with cystic fibrosis. It plays an essential role in the genesis of bronchial hyperreactivity. Corticosteroids are the predominant therapeutic agents used. The importance of bronchial hyperreactivity in cystic fibrosis is correlated with disease severity. Treatment is essential to slow down the progression of bronchiopulmonary involvement.
Home care, sometimes in the technical form of home hospitalization, is essential in caring for patients with cystic fibrosis, both to avoid separating the children from their environment and rupturing their life rhythms, but also to reduce the risk of hospital contamination. Home care requires an evaluation of the disease status, good patient and family information and good coordination between the different partners. Thus the reduction in hospitalization greatly improves the quality of life in patients with cystic fibrosis.
We previously found that a significant underestimation of respiratory mechanical impedance (Zrs) at high frequency may result from the upper airway artefact in children, when pressure is directly varied at the mouth. To determine the importance of this artefact in estimating lung response to bronchomotor agents with the forced oscillation technique, input respiratory mechanical impedance was measured using 6-32 Hz pseudorandom pressure oscillations applied directly to the mouth (standard generator (SG)) and around the subject's head (head generator (HG)) in 35 children aged 2.5-13 yrs. Changes in resistance were generally larger with HG than SG. The mean +/- SEM changes in resistance of the respiratory system (Rrs) at 20 Hz induced by acetylcholine or allergen challenge were 15 +/- 4% for SG and 67 +/- 12% for HG, and changes induced by bronchodilators were -25 +/- 2% for SG, and -46 +/- 4% for HG (p < 0.01). Challenge induced negative frequency dependence of Rrs with SG and positive frequency dependence with HG. There was significant increase in inertance after salbutamol with SG, but no significant change occurred with HG. With both methods, respiratory compliance decreased significantly after challenge. Computer simulations showed that the difference in change in Rrs induced by airway challenge with HG and SG could be explained by the effect of the upper airway wall impedance (Zuaw). Zuaw could also account for the change in inertance and compliance observed with SG, but not for the change in compliance with HG. The latter could be reproduced by simulating unequal distribution of mechanical time constants within the lung, increased peripheral lung resistance with compliant central airways.(ABSTRACT TRUNCATED AT 250 WORDS)
We used DNA fingerprinting by the arbitrarily primed polymerase chain reaction (AP-PCR) technique for an epidemiological investigation of 23 Pseudomonas cepacia isolates obtained from 11 cystic fibrosis (CF) patients attending our CF center. This approach was compared with ribotyping, pulsed-field gel electrophoresis (PFGE), and conventional phenotypic typing. AP-PCR and ribotyping were identical in resolving power, since the two methods generated four different profiles and identified the same group of strains. Six patients on the one hand and four on the other harbored strains of the same genotype, thus raising the possibility of either patient-to-patient transmission or acquisition from a common hospital environmental source. PFGE results were in good agreement with those of the other two methods, but PFGE seems more discriminative since it generated a fifth profile for a single strain in a group of four. Our results show in vivo stability for the three methods during a period extending from 3 to 41 months. These genotypic techniques are particularly promising for clinical laboratories to help to clarify the epidemiology of P. cepacia in CF patients. The AP-PCR method constitutes an easier alternative to the well-established ribotyping method. AP-PCR provides the quickest results with minimal technical complexity. However, our results suggest that it is less discriminative than the labor-intensive PFGE method.
Chemoprophylaxis of tuberculosis may be primary or secondary. Primary chemoprophylaxis is intended for infants and children with negative tuberculin tests and exposed to contagion, in order to avoid primary tuberculosis. It lasts for three months and consists of oral isoniazide in one single daily dose of 5 to 10 mg/kg. Secondary chemoprophylaxis applies to all subjects, but principally to children, with a tuberculin test that has recently become positive in the absence of BCG vaccination. Its purpose is to protect against clinical tuberculosis. It lasts for six months and consists of isoniazid combined with rifampicin.
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We report an unusual case of a pelvic cystic lymphangioma. The first symptom was an inguinal mass which evoked a lymph node. Diagnosis was suspected thanks to CT. Surgery confirmed the diagnosis. It is an unusual aspect of a malformation which is itself not frequent.
Calcifications of cartilage in the larynx, trachea and bronchi are rare in children. Two cases reported and listed with 5 similar cases of the literature. Such calcifications are generally discovered in young children and congenital stridor is commonly associated with. Calcifications of bronchi are not present in every case. The blood calcium is normal. Laryngoscopic examination shows in two cases a laryngeal stiffness. The prognosis is good. In two cases, one of the parents of under 40 years old, also had calcifications of the trachea and of the bronchi.
The authors report three cases of tears in the tracheal or bronchial membrane in children resulting from an accidental external trauma of the trachea. Those children ranged from 3, to 5 and 10 years old. Those lesions showed a clinical gaseous syndrome associated with mediastinal and subcutaneous emphysema, in one of these cases complicated by unilateral pneumothorax and pneumomediastinum. After a symptomatic resuscitation, tracheobronchial endoscopy gives evidence each time of a crack of the posterior face of the trachea = cervix trachea in one case, end of the thorax trachea in the two other cases. Among them one was injured at the stem bronchi. These tracheobronchial lesions were treated nonoperatively and had a post-operative course uncomplicated. The author's attitude--except in case of extreme urgency--in front of a severe, isolated cervix thorax contusion in children, is to give systematically the indication for tracheobronchial endoscopy, in the view of knowing whether there is a tracheobronchial lesion or not and, if so, to five precisions about its location, its anatomic size, and its type (tear, fracture, disruption). An endoscopy performed immediately after cardiorespiratory rebalancing imposes the therapeutic conduct to be adopted, which is not always operative. Such is the case for the authors, especially in the case of children for whom the diagnosis of tracheobronchial lesion is sure, and in whom the stability of the vital signs are doubtless. In such cases, one is imposed not to operate.(ABSTRACT TRUNCATED AT 250 WORDS)
A case of juvenile papillomatosis involving the supra glottic area of the larynx and the esophagus in a 10 months old infant is reported. The patient was treated by multiple Laser CO2 resections of papillomas and received autogenous vaccine. He is now 5 years; he is well and apparently free of disease for the last two years. Radiography of the larynx and esophagogram were crucial for the initial diagnosis and the followup of this child.
Pulmonary sequestrations involving communication with the digestive tractus are known as bronchopulmonary foregut malformations. The authors add a peculiar case report: there was an hypoplastic right lung with a total sequestration from the bronchial tree and communicating with esophagus. This was fed from the pulmonary vasculature without collateral artery formation. The pulmonary vein was normal. Association with a facial dysmorphia and an occipital meningocele is also of interest. The radiological diagnosis is based on the pulmonary X-Ray and the oesophagogram.