Alveolar LCI vs. standard LCI in detecting early CF lung disease.

Multiple breath washout (MBW) is a sensitive technique that detects early airways disease. However in very young children, large equipment and physiological dead space relative to lung volumes may result in a higher Lung Clearance Index (LCI). We investigated whether alveolar LCI (aLCI) is a more sensitive index than standard LCI in children. MBW data-sets from children aged 0.1-10.7 years [97 healthy controls and 93 with cystic fibrosis (CF)] were analysed. LCI is traditionally calculated by dividing the cumulative expired volume (CEV) by functional residual capacity (FRC) after correcting for equipment dead space. aLCI was calculated similarly, but after correcting the CEV and FRC for Langley's physiological dead space. There was a significant correlation between LCI and aLCI in health (r(2): 0.993; p<0.0001) and disease (r(2): 0.984; p<0.0001). Sensitivity of both LCI and aLCI in detecting abnormal lung function in CF was 39% during infancy, which increased to 77% and 83% respectively in older children. However, the difference in sensitivity (aLCI vs. LCI) was not significant (p=0.36). We conclude that LCI is minimally affected by airway deadspace, or relative equipment deadspace, and is an appropriate measure of lung function in infancy.

[Public sector psychiatry in Martinique in 1996: handicaps and hopes]. / La psychiatrie de secteur à la Martinique en 1996: handicaps et espoirs.

In the light of political, economic and cultural factors the authors give a historical overview of psychiatric practice in the public sector in Martinique (French West Indies) which was for a long time concentrated at the Colson Specialized Medical Center. The evolution of mental health problems is described in parallel with socio-economic changes. Broad opportunities for daily application of psychiatric practice in problematic social situations call forth the notion of "extended psychiatry". A number of changes are now shaping with the creation of diversified decentralized facilities, e.g. in penitentiaries and in some local hospitals. Other projects now being discussed are less certain and there is a risk of a two-speed system between the Specialized Hospital Center and the Regional University Hospital Center. Their authors place hopes in a project covering the whole island in which public sector psychiatry would represent a metacultural model going beyond ideologic handicaps and opening the way to new solidarity.

Auditory brainstem responses and ultrasound changes in a high-risk infants population.

50 neonates were selected in a high perinatal risk population and examined by means of cerebral ultrasound (US) and auditory brainstem responses (ABR). They were allocated in 5 groups according to their US diagnosis (normal scans, isolated peri-intraventricular haemorrhage, large haemorrhage with associated lesions, hypoxic-ischaemic lesions in term neonates, miscellaneous disorders). ABR abnormalities were found in 40% of the infants. They were more frequent in neonates with cerebral lesions. Furthermore, the more extensive the cerebral lesions, the more severe the ABR abnormalities. Most of the ABR changes were of audiological type (severe: threshold greater than 80 dB [14%]; moderate: threshold less than or equal to 80 dB [20%]), whereas neurological abnormalities were rare (6%). The prognostic value of ABR appears in this study to depend on the possible recovery in the neonatal period. Severe hearing loss was associated either with an early death or with major handicaps. ABR represent the method of first choice for the detection of hearing loss in the Neonatal Unit, while they seemed to be of limited value in assessing brainstem function.