Cytologic evaluation of pulmonary effluent in neonates with respiratory distress syndrome and bronchopulmonary dysplasia.

Tracheobronchial effluent from 108 infants with respiratory distress syndrome (RDS) was classified cytologically in relationship to the duration of endotracheal intubation and mechanical ventilation with supplemental oxygen. Three cytologic classes emerged: class I (1 to 4 days), associated with exfoliation of cohesive and organized sheets of tracheobronchial cells, class II (4 to 10 days), during which regeneration of tracheobronchial cells was prominent and reactive cells were present, and class III (after 10 days), during which squamous metaplasia, chronic inflammation and regeneration were characteristic. An influx of polymorphonuclear neutrophilic leukocytes and macrophages was typical of classes II and III. In 70% of the cases, the identification of class III changes enabled the diagnosis of bronchopulmonary dysplasia (BPD) to be made earlier than by radiography alone. This classification of tracheobronchial cytology should be of benefit in the identification and treatment of infants with bronchopulmonary dysplasia. It may also offer a more direct means for evaluating new therapy to prevent or modify this disorder.

[Top-Forum: an interactive multimedia knowledge database to improve quality of care in pediatric oncology]. / Top-Forum: une base de connaissances multimédia interactive pour améliorer la qualité des soins en oncologie pédiatrique.

The treatment of pediatric cancer patients is characterised by complex and aggressive chemotherapy, difficult decision making, the numerous protocols available and the necessity of highly skilled caregivers. Quality of care is a major issue in all pediatric oncology units. We created an interactive multi-media database available to each caregiver to permit him/her to have easy access to information and thus increase his/her knowledge and participate in increasing their group's know-how. The computer database is available to all on a free-access basis in each ward. This is a novel approach to quality care, as it accords great importance to personal formation, allowing each caregiver to broaden his/her knowledge via easily obtained data which he/she can help enrich by permanent feedback. This database may become the backbone of department know-how.

Impact of the TOP-FORUM hypermedia system in a pediatric oncology care unit.

This paper describes our approach in analyzing the impact of the TOP-FORUM hypermedia in a pediatric oncology care unit. The impact of this technology is realized through the study of accommodation and assimilation adoption. Accommodation refers to the technological adoption and Assimilation refers to the professional adoption. Results show that accommodation depends on information and formation of the users. Assimilation is more difficult to evaluate because it depends on human, social and organizational problems.

Newborn tracheal aspirate cytology: classification during respiratory distress syndrome and bronchopulmonary dysplasia.

Cytopathologic examinations of tracheobronchial aspirates from 108 infants sampled during mechanical ventilation demonstrated a well-defined progression of cytologic changes in bronchial cells that could be divided into three classes. Seventy percent of infants with respiratory distress syndrome who developed bronchopulmonary dysplasia had pulmonary effluent cytology designated Class III; no infants with RDS but without BPD had these cytologic findings. Additionally, a temporal progression of events involving polymorphonuclear leukocyte and macrophage populations occurred in the absence of infection; these events were associated with duration of assisted ventilation and oxygen exposure. The technique described provides a useful way to monitor the progression of lung injury and repair and offers a cytologic method to predict and diagnose the development of bronchopulmonary dysplasia.