Diagnostic des pathologies d'inhalation - SociÃ©tÃ© pÃ©diatrique de ...

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v Prémas Age< 28 j VA N = 256 Asp trach Chez 59 NN Positivité = 91.4 %
Pepsin PedLung We have extensive experience with various assays for pepsin. There are activity assays and immunoassays… The immunoassays are not specific enough, and pretty much EVERYONE has a positive test… The activity assays are variable and can be non-specific as well, picking up cathepsin for example. But they CAN be very sensitive and specific, in fact we have one that we believe is exactly that. We use it for research purposes though. Pepsin can retain its activity in BAL for a week at room temperature. ture. Perhaps it can likewise retain its activity in the airway itself for a long time too? So, here is the other issue… If you have a high pepsin level in airway fluid, it means aspiration… with reasonable confi<strong>de</strong>nce. But pretty much everybody probably aspirates from time to time. Does a high level mean LOTS of aspiration, or just a recent aspiration? Does a low level mean tiny aspiration, or a MAJOR aspiration four r days ago? This is not known. Aspiration remains a mystery to a great extent… This is what I do: I test lipid la<strong>de</strong>ns and pepsin, use technetium scans and gut feelings, empirically treat, , struggle, guess, hope and pray… Stick all that together in a pile and practice the art of medicine. ine. No computer can pull this off. No government edict can pull this off. This is not something that can get measured by ACGME or JCAHO… It cannot be quantified by Quality Initiatives, nor assisted by so-poorly named “best practices”. That being said, a NEGATIVE pepsin test is a good sign of infrequency of aspiration. And POSITIVE technetium scan is a good sign of a well-timed aspiration event..Not sensitive, but darn specific.. John Hunt, MD UVA
Page 1 and 2: Diagnostic des syndromes d’inhala
Page 3 and 4: Examen clinique Moyens diagnostique
Page 5 and 6: Présentation clinique Suffocation
Page 7 and 8: SC prédictifs d’une d Radiociné
Page 9: Lobes Inférieurs Segments basals e
Page 12 and 13: Les 4 phases de la déglutitiond Ha
Page 14 and 15: Inhalation importante (adulte)
Page 16 and 17: Inhalation discrète - Toux à l’
Page 18 and 19: Renseignements obtenus Vidange pré
Page 20 and 21: Recherche de RGO Performance en pé
Page 22 and 23: Inhalation chronique (rat) SP Liqui
Page 24 and 25: Endoscopie Nasofibroscopie de dégl
Page 26 and 27: Fibroscopie de déglutitiond Modali
Page 28 and 29: Inhalation +++ Adulte
Page 30 and 31: Validité interne Technique Techniq
Page 32 and 33: L Donato La Timone, Marseille
Page 34 and 35: 100 cellules = score max 400 P Ahre
Page 36 and 37: Age 1 mois - 16 ans Patho pulmonair
Page 38 and 39: Lipophages Faux POSITIFS : MCV Li
Page 40 and 41: Inhalation salivaire Proximale Dist
Page 42 and 43: Inhalation Pulmonaire Chronique ? E
Page 44 and 45: L’avenir ?
Page 46 and 47: Références : Boesch RP et al. ERJ
Page 50 and 51: N = 51 enfants normaux a/n neuro (m

Diagnostic des pathologies d'inhalation - SociÃ©tÃ© pÃ©diatrique de ...

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