Reye's syndrome in children with acute respiratory diseases

The authors report a clinico-morphological traits in Ray's syndrome which occurred in 10 children with acute respiratory disorders. The prevalent symptoms were encephalopathy with fatty dystrophy of the internal organs and mainly of the liver. Literature data concerning the clinical picture, diagnosis and treatment of this disorder are discussed.     

The biological properties of Haemophilus influenza isolated from healthy children and from patients with acute and chronic respiratory diseases

The comparative study of the biological properties of H. influenzae strains isolated from healthy children and from patients with acute and chronic respiratory diseases has been made, taking into account the biochemical features (biotypes) and adhesive activity of these strains. Differences in various biotypes of H. influenzae strains isolated from patients with bronchopulmonary diseases and from healthy carriers have been established. H. influenzae strains isolated from various sources differ by their adhesive properties: strains isolated from patients with acute bronchopulmonary diseases have the highest adhesive activity, while strains isolated from healthy controls have the lowest adhesive activity. The data thus obtained indicate the possible dependence of the degree and duration of the colonization of the respiratory tract by H. influenzae on the biological properties of these microorganisms. The monitoring of the sensitivity of H. influenzae strains to antibiotics has demonstrated that these strains retain high sensitivity to ampicillin, chloramphenicol, gentamicin and exhibit a tendency towards an increase in resistance to penicillin and erythromycin.     

Myrtol standardized in the treatment of acute and chronic respiratory infections in children. A multicenter post-marketing surveillance study

A total of 106 children suffering from perennial rhinitis and/or asthma, and all allergic to Dermatophagoides pteronyssinus (DP), underwent nasal provocation challenge (NPC) with DP to determine the best method of diagnosis. Posterior rhinomanometry was uninterpretable in 17 patients and gave negative results in 31. Clinical scores for sneezing and rhinorrhea were more effective but did not diagnose the disorder in 11 children. However, nine of the 11 had significant increases in eosinophil count in the late phase. Clinical scores and cytology were also useful for assessing whether NPC with allergens was positive in children. The feasibility and safety of NPC with DP are high for rhinitic and stable asthmatic patients, but mild reactions may occur during the late phase.     

Clinical significance of fungal and microbial associations and antibacterial therapy for treatment of chronic inflammatory respiratory tract diseases in children

Microbiological examination applied to 270 children with chronic inflammatory and relapsing respiratory tract diseases revealed that by the frequency of the etiologically significant organisms the main pathogens isolated from the bronchial secretion belonged to Haemophilus influenzae, then followed Streptococcus pneumoniae and the less frequent isolates belonged to Branhamella catarrhalis characterized by high susceptibility to the 2nd and 3rd generation cephalosporins, erythromycin and azithromycin. Mycological investigation of the oral mucus and sputum from the patients revealed high frequency of Candida, mainly C.albicans. The fungi were most frequent and abundant in the children with chronic pulmonary diseases and congenital immune deficiency and in the children with bronchial asthma and asthmatic bronchitis, as well as in the children with exacerbation of the chronic disease, especially with bronchial obstruction. The antibacterial therapy with semisynthetic penicillins, cephalosporins and macrolides led to an increase in the number of the Candida carriers and in the biological material contamination level. The fungal contamination of the host was mainly observed after the use of the penicillins and cephalosporins. Chronic Candida carriers were detected among the patients with chronic inflammatory diseases of the lungs. The diseases in such patients were particularly severe. There were also detected children with colonization resistance to Candida. In the latter cases the chronic process was more favourable. The data made it possible to recommend a more differential use of the antibacterial and antimycotic drugs in the treatment of children with chronic inflammatory diseases of the bronchopulmonary system.     

Therapy and prevention of chronic respiratory tract diseases

196 patients suffering from chronic infections of the respiratory tract (bronchial asthma, spastic bronchitis, sinobronchitis, increased liability to infections during childhood) were treated with non-specific hyposensitization by Paspat as no improvements had been obtained with other methods. The patients were observed for at least one year after the termination of the therapy: Recovery in 62,2%, clear improvements in 23% of the cases; only 14,8% did not respond. The author can now rely on a total of 466 cases, who have been treated by this method for 21 years. The results obtained after the childhood were significantly improved by modifying the treatment and the remedies and by increasing the numbers of injections. Consequently, repeated applications of Paspat for treating and preventing chronic infections of the respiratory tract are considered a real progress.     

Home treatment for chronic respiratory failure in children: a prospective study

Home treatment for children with chronic respiratory failure (CRF) is increasing. However, the causes of CRF in children and the details of their home treatment are not well-known. The aim of this study was to describe the causes of CRF in the paediatric population and the treatments that the patients received at home. We surveyed all children (aged < or = 18 yrs) entering the Association Nationale pour le Traitement à Domicile de l'Insuffisance Respiratoire chronique (ANTADIR) for home treatment of CRF between March 1992 and March 1993. Two hundred and eighty seven children (178 boys, 62%) started home treatment for CRF during the year. One hundred and eleven patients had obstructive respiratory disease: cystic fibrosis (CF) (n = 24); bronchopulmonary dysplasia (BPD) (n = 79); other obstructive respiratory disease (n = 8). One hundred and seventy six patients had restrictive lung disease: neuromuscular disease (n = 87); kyphoscoliosis (n = 21); pulmonary fibrosis (n = 6); cardiac disease (n = 14); stomatological disease (n = 10); other restrictive respiratory disease (n = 9); and 29 miscellaneous causes. One hundred and thirteen patients received oxygen therapy, with a mean daily use of 17.7 h (20 h.day-1 for BPD patients and 12.3 h.day-1 for CF patients). Oxygen was delivered by a concentrator in 88% of cases. One hundred and fifty eight children received mechanical ventilation (MV). Five children received nasal continuous positive airway pressure ventilation for sleep apnoea, four had pneumatic belt ventilation, and 12 had a tracheostomy without MV. Treatment was stopped in 21 children, because of death in nine and improvement in the other 12. Home treatment for children with CRF is well developed in France via the ANTADIR network. Causes of CRF in children are heterogeneous, with a relatively good prognosis.