Sinonasal Angiomatous Polyp: A Case Report and Review of Literature

Sinonasal angiomatous polyp (SAP) is a benign pseudoneoplastic lesion rarely reported in the literature. It may be misdiagnosed as a malignant neoplasm due to its aggressive features of bone erosion clinically or on imaging. We report the case of a 43-year-old woman with a 3 month history of unilateral nasal obstruction with recurrent epistaxis. Nasal endoscopy showed polypoid nasal mass occupying the left nasal cavity. Imaging was suggestive of malignant vascular tumor. The patient underwent surgical excision after embolization. Histopathology concluded to the diagnosis of SAP.

Isolated laryngeal tuberculosis: A diagnostic dilemma

INTRODUCTION AND IMPORTANCE

Primary laryngeal tuberculosis (PLTB) is a rare condition. The symptoms and findings are not specific in most of the cases. Patients are diagnosed essentially based on histopathological examination and mycobacterial culture.

CASE REPORT

We report the case of a 42-year-old woman who presented to our hospital with dysphonia and dysphagia. Direct laryngoscopy revealed a lesion of the supraglottis. CT scan found a diffuse thickening of the entire surface of the larynx. A biopsy confirmed the diagnosis of tuberculosis.

CLINICAL DISCUSSION

Primary laryngeal tuberculosis is a rare clinical entity despite its close anatomical and physiological proximity to the lungs.

CONCLUSION

Clinician should keep in mind the existence of primary laryngeal tuberculosis to avoid delayed diagnosis and treatment, which can lead to high morbidity and mortality.

Intérêt, spécificités et bénéfices d’un programme de remédiation cognitive pour les patients bipolaires

Introduction

La présence d’une symptomatologie cognitive marqueur trait dans les troubles bipolaires est actuellement reconnue dans la littérature scientifique [1]. Ces déficits cognitifs spécifiques, présents dès le premier épisode et persistant tout au long de la vie, ont un impact fonctionnel important sur la vie les patients [2]. La remédiation cognitive est une thérapie prometteuse pour cette population en demande. Une diminution des troubles cognitifs et fonctionnels des patients bipolaires suite à une thérapie de remédiation cognitive a été observée [3,4]. Cependant, les programmes proposés actuellement présentent un intérêt limité en raison d’un manque d’adaptation à la spécificité des troubles cognitifs prévalents dans les troubles bipolaires [4].

Objectif

Notre objectif est d’observer sur le plan cognitif et fonctionnel, l’effet d’un programme de remédiation cognitive spécifiquement développé pour les patients souffrant d’un Trouble Bipolaire.

Méthodologie

Nous présentons une première étude de cas d’un patient ayant bénéficié du programme ECo, actuellement en cours de validation dans le cadre d’étude contrôlée, randomisée en double aveugle. Une évaluation neuropsychologique ainsi que des échelles de fonctionnement psycho-social ont été administrées avant et après la thérapie. Le programme ECo se compose de 24 séances individuelles comprenant deux séances de psychoéducation sur les troubles cognitifs et des séances de généralisation des stratégies acquises à des situations de la vie quotidienne. Ce programme cible majoritairement les déficits cognitifs des patients souffrant d’un trouble bipolaire : mémoire et apprentissage verbal, flexibilité, planification, inhibition, raisonnement, vitesse psychomotrice et attention [2].

Discussion

Les améliorations observées sur le plan cognitif et fonctionnel permettent d’émettre l’hypothèse du bénéfice d’un programme spécifiquement adapté aux difficultés des patients souffrant d’un trouble bipolaire. Notre étude de validation en cours permettra de préciser l’intérêt, la spécificité et les bénéfices de cette prise en charge.

Impact de la rTMS sur les fonctions mnésiques : présentation de cas cliniques

Introduction

La rTMS est une technique non invasive modulant l’excitabilité corticale. Elle peut améliorer les performances mnésiques des patients âgés souffrant de troubles cognitifs. L’objectif est de présenter l’évolution des fonctions mnésiques de patients traités par rTMS. Sujet 1 : 73 ans, patient inclus dans une étude ayant pour but d’évaluer l’impact de la rTMS sur les troubles cognitifs. Le critère principal est l’évolution de la MoCA.

Méthode

Stimulation du cortex préfrontal dorso-latéral droit à 1 Hz. Le patient reçoit 20 séances sur 4 semaines, 8 séances le 2e mois, 4 séances le 3e mois puis 6 séances les 3 derniers mois.

Résultats

MoCA pré-inclusion : 25/30. Augmentation progressive jusqu’à M6 pour atteindre 30/30 puis diminution entre M6 et M12 jusqu’à 27/30. Sujet 2 : 81 ans, patient atteint de la maladie d’Alzheimer depuis 5 ans, traité par Donepezil. Méthode : protocole iTBS, 600 pulses, sur cortex dorso-latéral préfrontal gauche, à 80 % du seuil moteur gauche. Quarante séances sur 4 semaines. Le MMSE initial est de 16/30. Le MMSE post-rTMS immédiat s’élève à 20/30 et le MMSE à 3 mois à 24/30. Sujet 3 : 73 ans, patiente présentant des plaintes mnésiques à type d’atteinte isolée de la mémoire épisodique verbale. Elle est traitée par Duloxétine 30 mg/j et Rivastigmine patch 4,6 mg/. Méthode : 30 séances d’iTBS, 600 pulses, à 80 % du seuil moteur appliqué sur le cortex dorso-latéral préfrontal gauche, sur 3 semaines, répétée à M3. La MoCA pré-stimulation est à 15/30 et augmente à 19/30 après la seconde série.

Conclusion

La rTMS a montré des résultats positifs et encourageants pouvant être une piste pour la future prise en charge des troubles mnésiques chez le sujet âgé.

Étude des différences d’activité cérébrale dans le traitement des émotions entre les hommes et les femmes

Introduction

Les troubles dépressifs concernent près de deux fois plus de femmes que d’hommes [1]. Cette prévalence pourrait être due à une sensibilité accrue des femmes aux émotions négatives [2]. Peu d’études d’imagerie cérébrale ont comparé l’activité cérébrale des hommes et des femmes lors de la présentation de stimuli émotionnels.

Objectif et hypothèse

Notre objectif était d’étudier les activations cérébrales des hommes et des femmes lors d’une tâche émotionnelle. Nous avons émis l’hypothèse que le pattern d’activations cérébrales diffère selon le sexe des individus et la valence des stimuli.

Méthodologie

Nous avons mené une étude en imagerie par résonance magnétique fonctionnelle (IRMf) chez 30 participants sains (15 hommes et 15 femmes). Des stimuli à valence positive, négative et neutre étaient présentés aux sujets. Les participants ont évalué subjectivement la valence et l’intensité des stimuli.

Résultats

Nous observons une activité plus importante chez les femmes que chez les hommes dans plusieurs régions clés du traitement des émotions lors de la présentation de stimuli négatifs. Aucune différence significative entre les hommes et les femmes n’a été relevée concernant l’évaluation subjective des stimuli en termes de valence et d’intensité.

Discussion

Les résultats suggèrent qu’il existe bien une différence de patterns d’activation entre les hommes et les femmes lors de la perception des émotions négatives, qui irait dans le sens d’une sensibilité accrue chez les femmes. Celle-ci pourrait expliquer leur plus grande vulnérabilité aux troubles dépressifs. Il pourrait être intéressant de répliquer cette étude chez des patients qui souffrent de troubles de l’humeur.

Évolution favorable d’un cas de syndrome de Wernicke et Korsakoff en secteur de psychiatrie

Le syndrome de Wernicke est caractérisé par un syndrome confusionnel, une paralysie oculomotrice, une ataxie cérébelleuse. Il serait secondaire à une carence en vitamine B1 souvent liée à une carence d’origine alcoolique. Le syndrome de Korsakoff est une complication du syndrome de Wernicke auquel s’ajoutent des troubles de la mémoire antérograde, des fabulations, des fausses reconnaissances et une polyneuropathie. Classiquement, le syndrome de Korsakoff est considéré de mauvais pronostic. Qu’apporte une prise en charge bio-psychosociale de ces troubles en secteur de psychiatrie ? Nous rapportons le cas d’un patient hospitalisé pour une tentative de suicide sans alcoolo-dépendance connue. Quelques jours après son admission, il présente un syndrome confusionnel, une paralysie oculomotrice, une ataxie cérébelleuse, une amnésie antérograde, des fabulations, des fausses reconnaissances et une polyneuropathie des membres inférieurs. Un diagnostic de syndrome de Wernicke compliqué de syndrome de Korsakoff a été posé. Par ailleurs, apparaissent une humeur dépressive, une alcoolo-dépendance niée, un délire confuso-onirique, une décompensation d’hypertension artérielle, diabétique et une hyperexcitabilité auriculaire. Des dosages montrent des carences en 25-OH vitamine D et en vitamine B9. Le dosage de la vitamine B1 est normal. Il reçoit des benzodiazépines à l’admission. En phase aiguë, il reçoit des vitamines B1, B6, D et B9. Après amélioration, il est traité par de la fluoxétine et de l’acamprosate. L’imagerie cérébrale après rémission ne montre pas d’atteinte des corps mamillaires. Un suivi psychométrique par mini mental state examination, un test de l’horloge et un test des 5 mots de Dubois a montré une normalisation. Après rémission, nous avons utilisé une approche psychothérapeutique motivationnelle. Une lourde prise en charge sociale axée sur la réinsertion a été nécessaire. Le syndrome de Korsakoff pris à un stade précoce ne serait pas toujours de mauvais pronostic. Une vision bio-psycho-sociale semble pertinente dans ces pathologies.

Impact d’une récompense sur la sensibilité à une douleur expérimentale chez des sujets sains et des patients schizophrènes

Introduction

Bien qu’il soit classiquement admis que les patients schizophrènes seraient moins sensibles à la douleur cela reste controversé. L’objectif de cette étude était d’évaluer l’effet d’une récompense sur la sensibilité et la tolérance à une douleur expérimentale au froid chez des patients schizophrènes et des sujets sains [1].

Méthodologie

La douleur expérimentale était réalisée en utilisant le Cold Pressor Task (CPT). Les sujets volontaires était divisés en 4 groupes : un groupe de 25 sujets sains récompensés (SSR), un groupe de 25 sujets sains non récompensés (SSNR), un groupe de 25 patients schizophrènes récompensés (PSR) et un groupe de 25 patients schizophrènes non récompensés (PSNR). La récompense était 70 euros.

Résultats

Pour la détection de la douleur : Pas de différence entre les PSNR et les SSNR : 9,7 sec (9,4) versus 8,14 sec (6,15), p > 0,05. Pas de différence entre les PSR et les SSR 30,84 sec (30,45) versus 22, 17 (18,30), p > 0,05 tout en ayant de meilleurs scores que les PSNR et les SSNR. PSNR = SSNR < PSR = SSR. Pour la tolérance à la douleur : SSNR avaient une meilleure tolérance que les PSNR : 36,43 sec (49,35) versus 18,22 (21,40), p = 0,05. Pas de différence entre les PSR et les SSR 74,9 sec (61,17) versus 66,16 sec (56,14), p > 0,05) tout en ayant de meilleurs scores que les SSNR.

Conclusion

En l’absence de récompense les patients schizophrènes stabilisés avaient le même seuil de détection de la douleur que les sujets sains mais une moindre tolérance. En présence d’une récompense les patients schizophrènes et les sujets avaient le même profil de sensibilité à la douleur (détection et tolérance). Cette étude suggère que la sensibilité à la douleur serait influencée par le circuit de la récompense.

Polyunsaturated fatty acids deficits are associated with psychotic state and negative symptoms in patients with schizophrenia

The study was aimed to examine membrane polyunsaturated fatty acids (PUFAs) profile in patients with schizophrenia (SZ) before and after antipsychotic medication and test their association with psychopathology. Erythrocyte membrane fatty acids were analysed by gas chromatography in 36 drug-free patients with SZ and 36 controls. Psychometric evaluation and blood sampling were achieved at baseline and after 3 months of antipsychotic treatment. At enrolment, levels of total PUFAs and arachidonic (AA) and docosahexaenoic (DHA) acids were significantly lower, but ω6/ω3 PUFAs ratio was higher in patients. AA and DHA were negatively related to the Andreason's scale for assessment of negative symptoms (SANS) score. DHA was inversely related to "alogia", "anhedonia", "avolition", and "blunted affect" subitems of SANS. After 3 months under typical antipsychotic drugs, fatty acid profile turned into comparable to controls in parallel with psychopathology improvement. Data indicate that PUFAs deficits are associated with psychotic state and negative symptoms of SZ.

[Isolated synovial chondromatosis of the subacromial bursa: report of a new case and review of the literature]

Synovial chondromatosis is a rare metaplasia of the synovium of unknown etiology that may involve occasionally the subacromial bursa. We report a new case diagnosed by ultrasound in a 30-year-old man and we present pathogenetic, diagnostic and therapeutic features of this disease with a literature review.

[Primary pulmonary angiosarcoma]

Pulmonary angiosarcoma is an uncommon vascular and usually secondary tumor. Only a few primary cases of pulmonary angiosarcoma have been described. We report a case of primary pulmonary angiosarcoma in an adult man who presented with hemoptysis. Chest x-ray film and chest CT showed a right para-cardiac opacity associated with diffuse alveolar consolidation of the right basal lobe. Right inferior lobectomy has been performed. Pulmonary angiosarcoma was diagnosed on histological and immuno-histochemical studies of the operative specimen. The primitive character was retained after ruling out all other tumor localizations. The clinical outcome was rapidly fatal. This observation is added to the other rare cases published of primitive pulmonary angiosarcoma. It confirms the poor prognosis and the extremely hemorrhagic nature of this tumor. Isolated necrotic parenchymatous mass was an original radiological pattern observed in this patient.

[Determination of anti-transglutaminase antibodies in the diagnosis of coeliac disease in children: results of a five year prospective study]

AIM

To evaluate the interest of IgA antibodies to tissue transglutaminase in the diagnosis of children coeliac disease compared with anti-endomysium and anti-gliadin antibodies.

SUBJECTS AND METHODS

Seventy children with coeliac disease (mean age: 5 years and 8 months) and 99 disease controls (mean age: 4 years and 5 months). IgA anti-transglutaminase were tested by ELISA using a human recombinant tissue transglutaminase. IgA anti-endomysium were detected by indirect immunofluorescence on monkey oesophagus.

RESULTS

The middle rate of IgA anti-transglutaminase was 101.06 units in patients and only 0.47 unit in controls. IgA anti-transglutaminase and IgA anti-endomysium were in agreement in 98.8% of cases; only two cases were discordant (+/- and -/+). Globally, the two markers had the same sensitivity (90%), specificity (98%), negative (93.2%) and positive (96.9%) predictive values. For anti-gliadin antibodies, the IgG were more sensitive (88.6%) and the IgA more specific (93.9%).

CONCLUSION

IgA anti-tissue transglutaminase can be used instead of IgA anti-endomysium as a serological marker of screening and diagnosis of coeliac disease in children after 3 years.

[Pseudotumoral eyelid inflammation. Apropos of an anatomo-clinical case]

A clinicopathological case of a 76-year-old male patient with a chronic inflammatory change of the inferior left eyelid is reported. The inflammation appeared as a reddish area of the inner part of the eyelid, without sharp limits, but with loss of lashes. Numerous local treatments did not to cure this condition. As some true eyelid tumors may mimic an inflammation during growth and, for example, sebaceous carcinoma may clinically present as chronic unilateral blepharitis, a surgical excisional biopsy was performed on this left eyelid. Its histopathological study showed a granulomatous inflammation, which was typical of a simple chalazion. This case clearly illustrates that the chalazion may not always appear as a limited nodular inflammation of the eyelid, but may have a more diffuse clinical presentation.

Endothelium and Venotropic Drugs in Chronic Venous Insufficiency: A Review

Objective:

To review the literature concerning chronic venous disease of the leg and the mechanisms of action of venotropic drugs.

Methods:

The authors identified relevant papers from their own collection and from medical literature databases.

Synthesis:

Endothelial cell activation caused by ex-posure to the hypoxic conditions that develop during blood stasis in chronic venous insufficiency patients is proposed to be one factor initiating a pro-inflammatory process in the leg veins. Recruited and activated neutrophils would then be responsible for alterations of the venous wall, typical of what is observed in varicose veins. Venotropic drugs used in the treatment of chronic venous insufficiency patients have long been known to decrease vascular permeability and increase venous tone. Recently, it has been shown that they are also able to prevent endothelial cell activation by hypoxia and a precise biochemical target common to all of them has been identified: the mitochondrial respiratory chain.

Conclusion:

The influence of venotropic drugs on the mitochondrial respiratory chain provides a rational explanation for the therapeutic benefit to patients of this class of drugs.

Role of the endothelium and blood stasis in the development of varicose veins

Today, chronic venous insufficiency affects millions of people but the investigation of veins and of venous diseases is still very poor. Additionally, the mechanism of the occurrence of varicose veins is not understood. Blood stasis is often associated with these pathological situations and we propose that resulting ischemic conditions can trigger the endothelium to release inflammatory mediators and growth factors. On one hand, the inflammatory mediators will recruit and activate neutrophils, which then infiltrate the venous wall and damage components of the extracellular matrix. On the other hand, growth factors induce smooth muscle cell migration, proliferation and de-differentiation into the synthetic phenotype, all together leading to the formation of neointima. These processes, being repeated over time, would eventually lead to alterations of the venous wall as observed in varicose veins. Venotropic drugs are used to treat chronic venous insufficiency. They are able to increase venous tone and to decrease vein and capillary permeability but they are also able to protect the endothelial cells against ischemia. Indeed, they target complexes of the mitochondrial respiratory chain and maintain ATP production during hypoxia. Hence, the cells are resistant to ischemia and do not release inflammatory mediators and growth factors. These drugs should thus be able to prevent the alterations of the venous wall induced by blood stasis.

Role of the endothelium and blood stasis in the appearance of varicose veins

Today, chronic venous insufficiency affects millions of people but the investigation of veins and of venous diseases is still very poor. Additionally, the mechanism of the occurrence of varicose veins is not understood. Blood stasis is often associated with these pathological situations and we propose that resulting ischemic conditions can trigger the endothelium to release inflammatory mediators and growth factors. On one hand, the inflammatory mediators will recruit and activate neutrophils, which then infiltrate the venous wall and damage components of the extracellular matrix. On the other hand, growth factors induce smooth muscle cell migration, proliferation and de-differentiation into the synthetic phenotype, all together leading to the formation of neointima. These processes, being repeated over time, would eventually lead to alterations of the venous wall as observed in varicose veins. Venotropic drugs are used to treat chronic venous insufficiency. They are able to increase venous tone and to decrease vein and capillary permeability but they are also able to protect the endothelial cells against ischemia. Indeed, they target complexes of the mitochondrial respiratory chain and maintain ATP production during hypoxia. Hence, the cells are resistant to ischemia and do not release inflammatory mediators and growth factors. These drugs should thus be able to prevent the alterations of the venous wall induced by blood stasis.

PGF(2alpha), a prostanoid released by endothelial cells activated by hypoxia, is a chemoattractant candidate for neutrophil recruitment

Despite increasing evidence supporting the involvement of neutrophils in ischemic and postischemic damages, the mechanisms underlying the early recruitment of these cells are not completely understood. In this report, the effects of conditioned media from hypoxic endothelial cells on neutrophil chemotaxis were investigated by biochemical and morphological studies. We showed that conditioned media collected from several endothelial cell origins submitted to hypoxia as well as ischemic rat liver perfusion liquids have a chemotactic activity for neutrophils. The role of various chemoattractant molecules like HETEs, platelet-activating factor, and cytokines such as interleukin-8 and interleukin-1 was examined in the same model. Chemotactic peptide contribution was ruled out as boiled conditioned media still trigger chemotaxis. However, cell treatment with cyclooxygenase inhibitors, neutralization of PGF(2alpha) biological activity with polyclonal antibodies, and the neutrophil preincubation with a specific PGF(2alpha) antagonist, all dramatically inhibited neutrophil chemotaxis. A strong chemoattractant effect of pure exogenous PGF(2alpha) or of a synthetic analog was also observed. The major effect of PGF(2alpha) on neutrophil chemotaxis was confirmed ex vivo in a rat liver perfusion ischemic model. These results suggest that PGF(2alpha), a prostanoid abundantly released by the endothelium of hypoxic or ischemic tissues, is a chemoattractant molecule that might be involved in the early recruitment of neutrophils in ischemic organs.

[Carotid body tumors: contribution of the various imaging techniques. A report of six cases]

INTRODUCTION

Carotid body tumors are rare hypervascular lesions arising from neural crest paraganglion cells.

MATERIALS AND METHODS

We retrospectively analyzed the imaging features of six patients with carotid body tumors to precise their imaging characteristics in order to find specific signs and elaborate a strategy for diagnosis.

RESULTS

Imaging features detect the vascular nature of these tumors of the carotid space causing characteristic widening of the carotid bifurcation. Two patients had multiple (two or more) localizations and one had a family history of glomus tumor.

CONCLUSION

MRI with MRA is considered as the gold standard imaging technique for the evaluation of glomus tumors as it allows a multiplanar approach which is important in the preoperative study.

[Evaluation of a questionnaire on the home environment of asthmatic patients]

Indoor environment outpatient asthmatics plays a major role in modulating asthma severity. Therefore many surveys devoted to studying risk factors for asthma include a questionnaire about housing characteristics. However no such questionnaire has been to date validated. In this study, we tried to validate such a questionnaire by comparing answers of a group of asthmatics outpatient to a questionnaire to de visu finding performed by a field worker during a home visit. Thirty asthmatic patients were included in the study. Housing characteristics were generally correctly acknowledged. Questions on the heating system should be clearly and simply formulated. Energetic supply of stoves and ventilation system is not always known. In the field of house equipment, especially bedding, photographs or drawings can be useful.

Effect of Ruscus extract and hesperidin methylchalcone on hypoxia-induced activation of endothelial cells

BACKGROUND

Ruscus aculeatus extract and the flavonoid hesperidin methylchalcone (HMC) are drugs used in the treatment of chronic venous insufficiency.

METHODS

In the present study, we investigated their effects on the activation of endothelial cells by hypoxia, a condition which mimics venous blood stasis.

RESULTS

We observed that Ruscus extract was able to inhibit the activation of endothelial cells by hypoxia: the decrease in ATP content, the activation of phospholipase A2 as well as the subsequent increase in neutrophil adherence with a maximal protection obtained at 50 microg/ml. HMC was also able to inhibit the hypoxia-induced decrease in ATP content. Furthermore, the effects of Ruscus extract and of HMC on this decrease seem to be additive.

CONCLUSIONS

The biochemical mechanism evidenced in this work might explain some of the beneficial therapeutic effects of these products in the treatment of chronic venous insufficiency patients.

Perfused human saphenous veins for the study of the origin of varicose veins: role of the endothelium and of hypoxia

If venous stasis due to blood stagnation has been recognized to be involved in the development of varicose veins, the mechanism linking this situation to the modifications of the venous wall observed in varicoses is still unclear. In order to study this mechanism, human saphenous veins were incubated in normoxic or hypoxic conditions and the interactions between the endothelium and neutrophils were investigated. We observed that many neutrophils adhered to the endothelium of veins incubated in hypoxic conditions rather than in normoxia and that these adherent neutrophils were activated: they released high amounts of superoxide anion and of leukotriene B4. Studies in scanning electron microscopy confirmed the increased neutrophil adherence to the endothelium as well as their activation. These results were then related to the histological observation of varicose veins. These veins show a thickening of the media with extracellular matrix deposit as well as an alteration of the elastic lamina with the presence of smooth muscle cells in the intima. These results are in agreement with in vitro studies on isolated endothelial cells. They all show that hypoxia is able to activate endothelial cells: they release inflammatory mediators and become adhesive for neutrophils which are then activated. These activated leukocytes release free radicals and proteases which are able to degrade the extracellular matrix. In addition, hypoxia-activated endothelial cells secrete growth factors which will trigger smooth muscle cell proliferation and the synthesis of extracellular matrix components. Altogether and because they are frequently repeated, these processes could eventually lead to alterations of the venous wall similar to those observed in varicose veins.

[Epidemiology of severe asthma]

Prevalence of severe acute asthma can be evaluated through mortality statistics, hospitalization rates and epidemiological studies. Risk factors include personnal characteristics (age, socio-economic status, disease denial, depression, medical features associated with increased severity), environment factors as life events and exposure to specific (allergens) and as non-specific factors (viral or microbial infections, passive smoking, air polluants) and the health care system (care delivery, quality of medical management). Such factors are inter-related. Their knowledge should allow a better management leading to a lower incidence of severe acute asthma attacks.

Respiratory system reactance as an indicator of the intrathoracic airway response to methacholine in children

The upper airways may contribute to increases in airway resistance in response to a bronchial challenge, and thus decrease the specificity of such challenge tests to diagnose airway hyperresponsiveness when forced oscillation techniques are used to evaluate changes in respiratory system resistance (Rrs). A concomitent decrease in respiratory system reactance (Xrs) may indicate a change in the intrathoracic airways and/or lung parenchyma, provided that extrathoracic airway wall motion is prevented. To test the value of Xrs in the evaluation of bronchial hyperresponsiveness, we studied the respiratory impedance response to methacholine in 38 children with a history of asthma (aged 6-14.5 years), and compared the results to changes in the forced expiratory volume in one second (FEV1). Rrs and Xrs were measured by the forced oscillation technique with pseudorandom (11 subjects) or sinusoidal (27 subjects) pressure variations applied around the child's head to minimize upper airway wall motion. Changes in Rrs and in Xrs at 12 Hz (Rrs12, Xrs 12) correlated significantly with changes in FEV1 (P < 0.005). A decrease in FEV1 > or = 20% was observed in 23 subjects. When these 23 subjects were compared with the 15 children who did not show significant changes in FEV1, the responding group had larger mean +/- SEM changes in Rrs (116.0 +/- 13.2% vs 60.4 +/- 11.4%, P < 0.006) and in Xrs (-2.1 +/- 0.4 hPa.s/L vs -0.9 +/- 0.3 hPa.s/L, P < 0.03) than the nonresponders. The receiver operating characteristics (ROC) curve analysis was used to assess the diagnostic value, i.e., specificity and sensitivity, of different levels of change in Rrs and Xrs, with reference to FEV1. The overall incidence of false results was similar for Rrs and Xrs. The optimum diagnostic value for Rrs was a 70% increase, which corresponded to a sensitivity of 87% and a specificity of 67%. For Xrs the optimum decision level was -1 hPa.s/L, corresponding to a sensitivity of 70% and a specificity of 80%. It is concluded that Xrs may improve the specificity of the forced oscillation technique in interpreting the airway response to methacholine. This may be of particular interest in young children unable to perform forced expirations.

Separation of airway and tissue properties by transfer respiratory impedance and thoracic gas volume in reversible airway obstruction

The aim of this study was to establish the ability to estimate separate airway and tissue properties from transfer respiratory impedance (Zrs,tr) data in the presence of airway obstruction. Zrs,tr, thoracic gas volume (TGV) and airway resistance (Raw,pleth) were measured in the presence of obstruction and after use of a bronchodilator (BD) in 13 normal or asymptomatic asthmatic adults and 28 children with symptomatic asthma. An analytical approach was used to solve the equations of a simplified variant of DuBois' model, including airway resistance (Raw*) and inertance (Iaw), tissue compliance (Ct) and resistance (Rt) and pulmonary gas compliance (Cg). The equations of the model could not be reliably solved in four children before BD. Mean Raw,pleth was not different from mean Raw* in adults before (mean +/- SEM) (3.4 +/- 0.5 vs 3.1 +/- 0.3 hPa.s.L-1) or after BD (1.4 +/- 0.2 vs 1.8 +/- 0.2 hPa.s.L-1), or in children after BD (2.9 +/- 0.3 vs 3.2 +/- 0.2 hPa.s.L-1, respectively). In children before BD, Raw* was significantly underestimated compared with Raw,pleth (3.8 +/- 0.4 vs 5.4 +/- 0.6 hPa.s.L-1). Overall, a significant positive correlation was found between the difference [Raw,pleth - Raw*] and Raw,pleth (r = 0.82). In adults, BD induced a decrease in Raw* and Rt, an increase in Ct, and no change in Iaw. In children after BD, there was no significant change in Raw* or Ct, whilst Rt decreased and Iaw increased. Taking Raw,pleth as the gold standard, it is concluded that coherent estimation of parameters of DuBois' model may be obtained from combined Zrs,tr and TGV measurements in normal subjects and moderately obstructed adults, but not in children with significant airway obstruction. This seems to be due to the systematic under-estimation of Raw*.

[The prevalence of dental caries in Provence in 6-15-year-old children]

An epidemiological study of the oral conditions of 771 schoolchildren aged 6 to 15 years was conducted in 5 departments of South of France (Alpes de Haute Provence, Hautes Alpes, Bouches du Rhône, Corse and Vaucluse). The DMFT and DMFS indices were slightly higher than the national means. The children had a mean DMFT of 0.66 at 6 years and 7 at 15 years. The periodontal conditions were relatively good.