Continuous subcutaneous infusion of beta 2-agonists in infantile asthma.

Eleven infants presenting with an asthmatic syndrome were treated with subcutaneous infusions of a beta 2-agonist (beta 2A) during an acute episode. This treatment was used after difficulties with or failure of beta 2A infusions and IV nebulizations. No local or general adverse reactions were observed. The serum concentrations of salbutamol obtained at a dose of 0.1 micrograms/kg/min were measured in six infants and found to be within the generally accepted therapeutic range. This mode of administration proved extremely useful, both by itself and as part of a therapeutic protocol, combined with an antibiotic, a corticosteroid, and theophylline. It avoids the difficulties of administering beta 2A intravenously or by nebulization, while preserving some degree of freedom and better general care for the child. The preferred indication is in treatment of severe acute asthmatic episodes after failure of nebulizations. The exact place in the therapeutic arsenal of infantile asthma remains to be defined.

Altered placental glutathione peroxidase mRNA expression in preeclampsia according to the presence or absence of labor.

Increased placental oxidative stress in preeclampsia (PE) has been associated in part to a decrease in glutathione peroxidase (GPX) antioxidant activity. However, it is not clear if GPX mRNA expression is affected in PE, and how the presence of labor may impair this expression. In this study, we characterized by quantitative PCR, in situ hybridization and immunohistochemistry, the expression of four GPX (GPX1 to 4) in the placenta of normotensive (NP; n = 23) and PE pregnancies (n = 25) according to mode of delivery: vaginal delivery (with labor) or cesarean (without labor); the tissue layer: amnion-chorion (AC) and villi; and the sampling site: peri-insertion or peripheral. Concomitantly, oxidative stress markers mRNA expression, HSP70 and HO-1 were measured. All GPX mRNA and protein were detected in all layers of the placenta and sampling sites. In absence of labor, GPX1 is more expressed near the umbilical cord than at the periphery of the villi (p = 0.037). At the periphery of AC membranes, GPX2 was more expressed in PE than in controls in presence of labor (p = 0.037). Interestingly, GPX4 mRNA level was clearly deficient in the PE villi in presence or absence of labor (p < 0.0473). Also, the GPX4 expression in PE was lower than controls in AC membranes in presence of labor (p = 0.0007). Oxidative stress markers, HSP70 and HO-1, were higher in PE placental membranes than in controls in absence of labor (p < 0.011). HSP70 was also upregulated in PE placental membranes in presence of labor (p = 0.034). Correlations between stress markers and GPX mRNA expression were mostly present in AC membranes in presence of labor in NP. Most of the latter correlations were lost in PE. In conclusion, our results suggest that the reported decrease in GPx activity and increased oxidative stress in PE placental villi may be attributed in part to GPX4 independently of the presence or absence of labor.

Expression of prostaglandin E synthases in the bovine oviduct.

The oviduct is a specialized organ responsible for the storage and the transport of male and female gametes. It also provides an optimal environment for final gamete maturation, fertilization, and early embryo development. Prostaglandin (PG) E(2) is involved in many female reproductive functions, including ovulation, fertilization, implantation, and parturition. However, the control of its synthesis in the oviduct is not fully understood. Cyclooxygenases (COXs) are involved in the first step of the transformation of arachidonic acid to PGH(2.) The prostaglandin E synthases (PGESs) constitute a family of enzymes that catalyze the conversion of PGH(2) to PGE(2), the terminal step in the formation of this bioactive prostaglandin. Quantitative real-time PCR was used to determine the expression of COX-1, COX-2, microsomal prostaglandin E synthase-1 (mPGES-1), microsomal prostaglandin E synthase-2 (mPGES-2), and cytosolic prostaglandin E synthase (cPGES) mRNA in various sections of the oviduct, both ipsilateral and contralateral (to the ovary on which ovulation occurred) at various stages of the estrous cycle. Furthermore, protein expression and localization of cPGES, mPGES-1, and mPGES-2 were determined by Western blot and immunohistochemistry. All three PGESs were detected at both mRNA and protein levels in the oviduct. These PGESs were mostly concentrated in the oviductal epithelial layer and primarily expressed in the ampulla section of the oviduct and to a lesser extent in the isthmus and the isthmic-ampullary junction. The mPGES-1 protein was highly expressed in the contralateral oviduct, which contrasted with mPGES-2 mostly expressed in the ipsilateral oviduct. This is apparently the first report documenting that the three PGESs involved in PGE(2) production were present in the Bos taurus oviduct.

[Continuous subcutaneous infusion of beta 2-agonists in infantile asthma]. / Infusion sous-cutanée continue de beta 2-stimulants dans l'asthme du nourrisson.

Five infants aged 7 to 17 months were treated for asthma with a continuous subcutaneous infusion of a beta 2-agonist for 6 to 11 days in a dosage of 0.1 microgram/kg/mn. The patients had a severe attack of asthma with problems with infusions and/or problems with nebulizations of beta 2-agonists and/or bronchial stasis. No local or systemic adverse effects were recorded. This mode of administration of beta 2-agonists proved extremely useful, either as single therapy or as part of a therapeutic protocol including antibiotics, steroids and theophylline. It avoids the problems met with administration of beta 2-agonists by the other routes and allows the child freedom of movement. The main indication is the severe attack of asthma that fails to respond to nebulizations. We suggest this new therapeutic method should be included in the therapeutic armamentarium for infantile asthma, although its exact place and indications need to be further defined by studies in a larger number of patients.

Investigation of growth hormone secretion in patients with intrauterine growth retardation.

Growth hormone (GH) deficiencies have rarely been reported in intrauterine growth retardation (IUGR). This study has investigated GH secretion using GH provocation tests, 24-hour GH secretory profiles, and insulin-like growth factor I (IGF-I) measurements in 24 children with intrauterine growth retardation. The criteria for diagnosis were a birth length and weight below the 10th percentile for gestational age. The average age at investigation was 5.5 years, and the average growth retardation was -3.3 SD. Twenty children had shown catch-up growth between the ages of 6 months and 3 years, followed by varying decreases in growth velocity. Studies of GH secretion demonstrated GH deficiency in 16 patients, with neurosecretory dysfunction in six. Treatment with pituitary GH in nine children increased mean growth velocity from 3.5 cm/year to 7 cm/year. GH therapy should thus be effective in improving the height prognosis of children with intrauterine growth retardation.

[Detection of respiratory allergies using the Phadiatop test in children 1 to 6 years of age]. / Le dépistage de l'allergie respiratoire par le Phadiatop chez l'enfant de un à six ans.

Phadiatop, a new test for detecting hypersensitivity to airborne allergens, was used in 83 children aged 9 months to 6 years with recurrent respiratory manifestations, i.e. recurrent expiratory obstruction and/or recurrent respiratory infections. A good correlation was found between this test and both the prick tests (95%) and the specific IgE assays (91% for RASTS of classes greater than or equal to 1, and 95% for RASTS of classes greater than or equal to 2). However, the correlation was less strong with the total IgE level (68%). The overall correlation with the specialist's prediction based on history and physical evaluation was excellent (94%). In this study, Phadiatop was found to have a 90% sensitivity and a 98% specificity. Furthermore, this test costs 40% less than the often used strategy combining skin tests and determinations of total and specific IgE levels. In the age group studied, Phadiatop is most useful above the age of two, since in younger patients true respiratory allergies are fairly infrequent in recurrent ENT and lower respiratory tract infections, whereas infections are far more common.