PubMed Health⌕ Search

Biomedical subjects

A Van Gossum

Publications and source records attributed to A Van Gossum.

At least 19 recordsLinked to original sources
PubMed1992

Hyperammoniemic coma in a patient with ureterosigmoidostomy and normal liver function.

Hyperammoniemic encephalopathy has been reported after ureterosigmoidostomy. Its development is related to a problem of bacterial overgrowth and, most often, is favored by the presence of an underlying liver dysfunction. We report the case of a 43-year-old woman with a ureterosigmoidostomy done 28 years earlier who developed hyperammoniemic coma induced by an acute rectocolitis and in the absence of any detectable liver dysfunction. Neither administration of Lactilol and neomycin nor rectal tube drainage were effective; systemic antimicrobial therapy effective against the urease-producing gram-negative bacilli was required and led to a decrease in serum ammonia levels and a dramatic clinical improvement.

Acute Disease↗
PubMed1992

Factors related to early mortality in cirrhotic patients bleeding from varices and treated by urgent sclerotherapy.

Variceal haemorrhage in cirrhotic patients carries a high early mortality even when balloon tamponade or emergency sclerotherapy are applied. The aim of this study to identify patients dying within six weeks of their first variceal haemorrhage. One hundred and twenty one patients with parenchymal cirrhosis presenting with the first variceal bleeding episode between June 1983 and December 1988 were studied. Nineteen patients were excluded for various reasons. Emergency sclerotherapy was carried out in cases of active bleeding or where there were endoscopic signs of recent bleeding, and then regularly repeated afterwards. Of the 24 variables studied and included in a multivariate analysis using a logistic regression model, three had an independent prognostic value: encephalopathy, prothrombin time, and the number of blood units transfused within the 72 hours of time zero. The subsequent regression equation was able to predict 89% of the patients who will die and 97% of the patients who will still be alive six weeks after their first variceal haemorrhage treated by sclerotherapy. Pugh score was less discriminatory than these last three variables in terms of accuracy of adjustment, goodness of fit to the model, receiver operating characteristic curves, and percentage correct prediction. To measure the accuracy of the prediction rule, our model was applied to another series of 28 cirrhotic patients admitted with their first variceal bleeding during the next period (January 1989 to May 1990). Death and survival were correctly predicted in respectively 82% and 94% of the cases. The use of this score is recommended for the selection of patients with high early mortality after variceal bleeding despite sclerotherapy, and for the design of new therapeutic trials.

Acute Disease↗
PubMed1990

Macroscopic and microscopic gut lesions in seronegative spondyloarthropathies.

A retrospective study by ileocolonoscopy and multiple biopsies was performed on 96 patients with seronegative spondylarthropathy, 17 patients with osteoarthritis (OA) and 19 patients with chronic abdominal discomfort. Under these conditions, inflammatory gut lesions were detected in 66.7% of the patients with spondyloarthropathy, 12.5% with OA and 15.8% with chronic abdominal discomfort. In 10 patients treated by sulfasalazine (Salazopyrine), pathologic lesions disappeared simultaneously with an improvement of the rheumatic conditions. comparison between patients treated and untreated with nonsteroidal inflammatory drugs (NSAID) demonstrated that NSAID did not enter into the etiopathology of the intestinal lesions. Our study therefore confirms the high incidence of inflammatory gut lesions among patients with spondylarthropathy which seems not to be related to NSAID therapy.

Abdominal Pain↗
PubMed1990

[Lack of predictive factors for symptomatic recurrence of Crohn disease at the site of surgical anastomosis].

Recurrence of Crohn's disease at the ileocolonic anastomosis after curative surgery is frequent. Prognostic value of several parameters at the time of surgery was studied in 37 patients to detect early symptomatic recurrence of Crohn's disease after surgery. These included patient age at the time of surgery, sex, disease duration before surgery, clinical activity index, length of resected bowel, presence of granulomas in resected bowel segment, indication for surgery, type of medical treatment before surgery, and biochemical parameters at the time of surgery (ESR, C reactive protein and serum albumin level). Symptomatic recurrence associated with endoscopic lesions at the anastomotic site was observed in 10 of 37 patients (27 percent), within one year after surgery. None of the studied parameters were able to differentiate the patients with recurrence or not.

Adolescent↗
PubMed1989

Penetration of cefoperazone into ascites.

The pharmacokinetics of cefoperazone was studied in eleven cirrhotic patients with ascites after i.v. administration of a single dose of 15 mg.kg-1 (n = 7) or after three doses of 15 mg.kg-1 given at 12 h intervals (n = 4). The concentrations of cefoperazone in serum and ascitic fluid were determined by HPLC. The peak serum cefoperazone concentration after a single i.v. injection of 15 mg.kg-1 was 96.0 mg.l-1. The serum elimination half-life was longer (5.0 h) than in normal subjects. The penetration of cefoperazone into ascites was satisfactory (32.3% and 58.3% after single and repeated injections, respectively). Ascitic fluid concentrations of cefoperazone exceeded 5.4 mg.ml-1 from 0.5 to 6 h after the single i.v. injection, levels which are well above the MIC of most pathogens found in spontaneous bacterial peritonitis. Adjustment of the dose of cefoperazone in cases of severe hepatic insufficiency does not appear to be necessary provided that renal function is normal.

Adult↗
PubMed1989

Methods of disinfecting endoscopic material: results of an international survey.

A questionnaire on the methods of cleaning and disinfecting endoscopic equipment was mailed to 120 centers in Western Europe. Seventy-four questionnaires (61%) were returned. The centers were classified into three groups according to the number of endoscopic procedures performed per year. This survey has shown that precautions are more rigid in specialized centers than in units doing fewer than 1,500 endoscopic investigations a year. Complete disinfection is done by almost all the centers after ERCP in infected patients or in the case of HBsAg and HIV-positive patients, but only by 70% of centers after completion of endoscopies performed in patients with gastrointestinal hemorrhage and unknown immunological status. After endoscopic examination performed in presumably non-infected subjects, complete disinfection is not done in any center after gastroscopy, in 13% after colonoscopy and in 30% after ERCP. Continued education of endoscopic personnel and greater availability of adequate endoscopic equipment is mandatory for minimizing the risk of endoscopy-related infections.

Disinfection↗
PubMed1989

[Parenteral nutrition at home: 2 years' experience].

Home parenteral nutrition (HPN) must be reserved for patients with an dysfunctional bowel requiring a long-term nutritional support. We report a 2 year experience of HPN at Erasmus Hospital which includes seven patients. Indications and implications of HPN are also discussed.

Crohn Disease↗
PubMed1989

Breath alkanes as an index of lipid peroxidation.

Formation of free radicals and lipid peroxidation are mechanisms that are involved in many conditions including cellular damage. In a human body, there are many antioxidant systems likely to limit the production of free radicals and to reduce their deleterious effect. The peroxidation of polyunsaturated fatty acids, such as linoleic acid and linolenic acid which are cell membrane components, induces the formation of volatile alkanes that are excreted in the breath. The determination of breath alkanes (pentane and ethane) is considered to be a valuable and elegant method to assess lipid peroxidation. The method for collecting a breath sample and the chromatographic analysis of the collected gas require a strict methodology. Moreover, we must take into consideration some factors, such as the hepatic function, which may influence the pentane metabolism itself. We critically describe the results of breath alkane determination obtained in humans in different clinical conditions.

Breath Tests↗
PubMed1988

Immune status in healthy relatives of patients with familial Crohn's disease.

Immune-mediated mechanisms and genetic factors are believed to be involved in the pathogenesis of Crohn's disease. We studied T- and B-cell subpopulation proportions and various functional assays, including proliferative responses to PHA and Con A, Con A-induced suppressive activity, and natural killer cell assay toward the K562 cell line, in the peripheral blood of 22 patients with inactive familial Crohn's disease and their 35 healthy relatives including nine families. HLA-A, -B, and -DR antigens were determined in all the subjects. With the exception of minor abnormalities of suppressor cell activity present in some relatives of two families, neither significant impairments of immunological parameters in patients or their relatives nor concordant segregation of HLA haplotypes and disease were observed. These data indicate that peripheral immune abnormalities previously described in patients with Crohn's disease do not constitute primary factors involved in the disease itself and that familial incidence in Crohn's disease cannot be linked to immunological markers presently studied.

Adolescent↗
PubMed1988

Plasma vitamin E and selenium and breath pentane in home parenteral nutrition patients.

Because both vitamin E and selenium protect against lipid peroxidation, we evaluated the relationship between breath pentane, evolved from the peroxidation of linoleic acid, and plasma levels of alpha-tocopherol (vitamin E), Se, and Se-dependent glutathione peroxidase (Se-GSHPx). Nine home parenteral-nutrition (HPN) patients received added Se in intravenous solutions and were compared with 10 normal control subjects. The excretion of pentane (pmol.kg-1.min-1, means +/- SEM) in control subjects (6.34 +/- 0.96) was significantly lower than in HPN patients (15.02 +/- 1.12, p less than 0.001). alpha-Tocopherol (mumol/L), Se (mumol/L), and Se-GSHPx (U) values were, respectively, 18.13 +/- 1.70, 1.70 +/- 0.05, and 5.34 +/- 0.27 in control subjects and 10.21 +/- 1.66, 1.35 +/- 0.14, and 7.01 +/- 0.31 in HPN patients. All differences were statistically significant. Significant negative correlations were observed between plasma alpha-tocopherol levels and HPN duration and between pentane output and plasma alpha-tocopherol levels (r = -0.58, p less than 0.01). In HPN patients with reduced plasma alpha-tocopherol levels associated with increased pentane output, there is, inferentially, increased lipid peroxidation despite normal plasma Se and Se-GSHPx levels.

Adult↗
PubMed1988

Increased lipid peroxidation after lipid infusion as measured by breath pentane output.

We studied the effect of intravenous lipid infusion on lipid peroxidation as measured by breath pentane. Pentane, plasma alpha-tocopherol (alpha-tox) and plasma gamma-tocopherol (gamma-toc), selenium, and Se-dependent glutathione peroxidase (Se-GSHPx) were measured in 10 normal control subjects and in 10 home parenteral nutrition (HPN) patients before and after infusion of 100 mL Nutralipid 10% over 30 min. Before infusion, breath pentane was significantly higher and alpha-toc was significantly lower in the HPN group than in the control subjects. These two measurements were significantly negatively correlated (r = -0.54, p less than 0.05). Pentane, alpha-toc, and Se-GSHPx were significantly increased in both groups after lipid was infused but were still significantly higher in HPN patients than in control subjects. Thus, infusion of a small amount of lipid rich in linoleic acid induced a significant increase in breath pentane, reflective of increased lipid peroxidation.

Adult↗
PubMed1987

Breath pentane analysis as an index of lipid peroxidation: a functional test of vitamin E status.

Pentane, which evolves from the reaction involving omega-6 fatty acids, is a good index of lipid peroxidation. We describe a method for measuring breath pentane excretion in adult humans. After a 4-minute washout period, expired air was analyzed by gas chromatography. Breath was passed through a cooled loop of alumina to adsorb, concentrate, and release, on heating, pentane. Pentane was analyzed by a Porasil-D column with a derived calibration curve. The mean excretion of pentane in 10 normal adults was 6.34 +/- 0.96 pmol X kg-1 X min-1 (mean +/- SEM) and was significantly higher in five patients with plasma vitamin E deficiency (15.39 +/- 1.84 pmol X kg-1 X min-1). There was a significant negative correlation between pentane output and plasma vitamin E levels (r = -0.66, p less than 0.01). Moreover, breath pentane excretion was significantly decreased after a 10-d supplementation with vitamin E in five normal subjects. We conclude that breath pentane output is a sensitive, noninvasive, functional test for assessing vitamin E status.

Adult↗