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Biomedical subjects

B Person

Publications and source records attributed to B Person.

At least 19 recordsLinked to original sources
PubMed1995

Sclerotherapy with or without octreotide for acute variceal bleeding.

BACKGROUND: Sclerotherapy is considered the most effective way to stop bleeding from esophageal varices, but acute variceal bleeding is still associated with a high risk of rebleeding and death. We compared sclerotherapy alone with sclerotherapy and octreotide to control acute variceal bleeding and prevent early rebleeding in patients with cirrhosis. METHODS: In a double-blind, prospective trial, 199 patients with cirrhosis and acute variceal bleeding who underwent emergency sclerotherapy were randomly assigned to receive a continuous infusion of octreotide (25 micrograms per hour) or placebo for five days. The primary outcome measure was survival without rebleeding five days after sclerotherapy. RESULTS: After five days, the proportion of patients who had survived without rebleeding was higher in the octreotide group (85 of 98 patients, or 87 percent) than in the placebo group (72 of 101, or 71 percent; 95 percent confidence interval for the difference, 4 to 27 percent; P = 0.009). The mean number of units of blood transfused within the first 24 hours after sclerotherapy was lower in the octreotide group (1.2 units; range, 0 to 7) than in the placebo group (2.0 units; range, 0 to 10; P = 0.006). A logistic-regression analysis showed that the treatment assignment (P = 0.003) and the number of blood units transfused before any other treatment was undertaken (P = 0.002) were the only two variables independently associated with survival without rebleeding. After adjustment for base-line differences between the two groups, the odds ratio for treatment failure in the placebo group, as compared with the octreotide group, was 3.3 (95 percent confidence interval, 1.5 to 7.3). The mean (+/- SD) 15-day cumulative survival rate (estimated by the Kaplan-Meier method) was 88 +/- 12 percent in both groups. Side effects were minor, and their incidence was similar in the two groups. CONCLUSIONS: In patients with cirrhosis, the combination of sclerotherapy and octreotide is more effective than sclerotherapy alone in controlling acute variceal bleeding, but there is no difference between the overall mortality rates associated with the two approaches to treatment.

Acute Disease↗
PubMed1995

[A rare cause of severe diarrhea in children: pseudomembranous colitis].

BACKGROUND: Pseudomembranous colitis is a rare and serious complication of treatment by antibiotics. The case of a patient with a protracted pseudomembranous colitis followed by two relapses is reported. CASE REPORT: A 4 year-old boy was admitted after 18 days of profuse and feverish diarrhea. He had been given amoxycillin for 10 days, one and a half months previously. His temperature was 40 degrees C; he had abdominal pain and leucocytosis was 30,000/mm3. The situation rapidly improved with digestive rest and i.v. antibiotic therapy. Relapse of diarrhea together with bilious vomiting and acute abdominal pains required readmission three days after his discharge. Search for Clostridium difficile in stools remained negative. The diagnosis of pseudomembranous colitis was confirmed by sigmoidoscopy and intestinal biopsy. The patient was given parenteral nutrition for 3 weeks and vancomycin. The disease was complicated by anasarca related to severe protein-loosing enteropathy but evolution was finally favourable after a two month period. CONCLUSION: Pseudomembranous colitis remains a serious affection in childhood; its prognosis largely depends on the precocity of diagnosis and treatment.

Anti-Bacterial Agents↗
PubMed1994

[Lansoprazole versus ranitidine in the prevention of early recurrences of digestive hemorrhages from gastroduodenal ulcers. Randomized double-blind multicenter study].

Strong inhibition of acid secretion could be able to decrease gastric and duodenal ulcer early rebleeding. OBJECTIVE--The aim of this double blind randomized trial was to compare early rebleeding rates of 2 groups of patients treated with ranitidine (600 mg/day) or lansoprazole (60 mg/day) per os for 6 consecutive days. METHODS--Seventy five patients with a high risk of rebleeding (clinical and endoscopical criteria) were included in this trial. These ulcers were Ia (n = 10), Ib (n = 20), IIa (n = 13), IIb (n = 32) in Forrest classification. RESULTS--Nineteen out of 75 patients rebled (25.3%): 11 out of 37 (30%) and 8 out of 38 (21%) in the ranitidine and lansoprazole groups respectively. Rates of rebleeding were 10%, 12.5%, 36% and 29% respectively in the ulcers grade Ia (previously treated with endoscopic sclerosis), Ib, IIa and IIb in the Forest classification. CONCLUSION--The rates of rebleeding were not statistically different in the 2 groups of treatment. The high rebleeding rates observed with Forrest IIa and IIb and duodenal ulcers support the need of haemostatic endoscopic therapy associated to antisecretory treatment in such patients.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1992

[Predictive factors of response to chemotherapy in epidermoid cancer of the esophagus. Study apropos of 60 patients and evaluation of a response score].

The aim of this study was to select predictive factors for response to chemotherapy in esophageal squamous cell carcinoma. Sixty patients, aged between 39 and 77 years (mean 61.5) received two initial chemotherapy sessions of 5 FU (1 mg/m2/24 h) and cisplatinum (20 mg/m2/24 h) during four days. Sixteen clinical, endoscopic, biological, and histological factors were collected. The response to chemotherapy was evaluated one month after completion of the second session by means of endoscopic and computed tomographic data. Thirty-two percent (CI: 20-44 percent) of patients had an objective response to chemotherapy (according to WHO criteria). Univariate analysis showed two predictive factors: obstructing pattern of tumor (P less than 0.01) and albuminemia less than 35 g/l (P less than 0.01). A response score was calculated with a stepwise regression model. The score correctly predicted a satisfactory response to chemotherapy with a sensitivity and specificity of 84.2 and 73 percent, respectively. Overall survival of these patients was statistically higher (P less than 0.001) compared with patients without any response. A satisfactory response to chemotherapy in patients with esophageal squamous cell carcinoma can be expected according to certain pretreatment factors.

Aged↗
PubMed1991

Prevention of recurrent variceal bleeding in alcoholic cirrhotic patients: prospective controlled trial of propranolol and sclerotherapy.

We conducted a prospective randomized controlled study to evaluate the effectiveness of propranolol and sclerotherapy, compared to a control group, in the prevention of variceal rebleeding in alcoholic cirrhotic patients. Among the 79 patients included, the distribution of patients according to Child-Pugh classification was: A, 22%; B, 40%; and C, 38%. Propranolol was given twice daily with a mean final dose of 54 +/- 16 mg/day, this resulted in a mean reduction in resting heart rate of 26 +/- 7%. Sclerotherapy was performed weekly using 1% polidocanol. End points were rebleeding or death. During the mean follow up of 19 +/- 16 months, 43 patients bled and 22 patients died. The cumulative percentages of patients free of rebleeding at 1 year were: propranolol, 81% (95% confidence interval (CI): 63-92); sclerotherapy, 64% (95% CI: 45-82); control, 54% (95% CI: 36-71); these differences did not reach statistical significance. The cumulative percentages of patients alive at 1 year were: propranolol, 92% (95% CI: 76-98); sclerotherapy, 79% (95% CI: 58-91); control, 81% (95% CI: 60-93); these differences were not statistically significant. Alcohol withdrawal, which occurred in 66% of patients, was an independent predictive factor associated with a decreased risk of rebleeding or death. In conclusion, a life table analysis of patients free of rebleeding, as well as of patients surviving, revealed a tendency in favour of propranolol. The lack of a statistical support for these two favorable effects could be due to poor statistical power.(ABSTRACT TRUNCATED AT 250 WORDS)

Combined Modality Therapy↗
PubMed1991

Pancreas divisum and pancreatitis: a coincidental association?

The aim of the present study is to assess the frequency of pancreas divisum and the features of patients with pancreas divisum in order to assess the role of this anomaly in the occurrence of pancreatitis. A total of 1049 endoscopic retrograde pancreatographies were studied between 1978 and 1988. Patients with pancreas divisum were studied in terms of their clinical findings and their disease (pancreatitis or not). Pancreas divisum was diagnosed in 62 patients (5.9%). No statistical differences with regard to age and sex were found between patients with and without pancreas divisum. The frequency of pancreas divisum was similar in the different groups of disease, especially chronic pancreatitis, acute pancreatitis, recurrent pancreatitis and idiopathic pancreatitis. The study of pancreatograms showed that dorsal ductal abnormalities alone were found as frequently as ventral alterations alone. Our results show that pancreas divisum cannot be directly implicated in the occurrence of pancreatitis, and should not prompt a systematic sphincterotomy of the accessory papilla. This treatment should only be considered in the rare cases of acute recurrent idiopathic pancreatitis with dorsal ductal dilatation and stenosis of the accessory papilla.

Acute Disease↗
PubMed1990

[Rectal micropolyps after total colectomy in familial polyposis. Efficacy of sulindac].

The aim of this study was to assess the effectiveness of sulindac therapy for eradication of micropolyps in 8 patients with familial polyposis coli. All patients had undergone colectomy and ileoproctostomy 4.5 years (range 3 months-20 years) before and had tubulous adenomas micropolyps in the rectum. Initial sulindac therapy 200 mg or 300 mg daily was started in all patients and was continued in 7 patients. In these 7 patients macroscopic and microscopic eradication of micropolyps was obtained within 3.4 months (1-8). After discontinuation of sulindac therapy, recurrence of micropolyps occurred in 4 patients within 3 to 4 months. Three patients had no recurrence with a follow-up of 1 to 19 months. A new eradication of micropolyps was obtained in these 4 patients with a second sulindac cure within 3 to 6 months. These observations confirm the effectiveness of sulindac therapy for eradication of tubulous adenomas micropolyps in familial polyposis, but after discontinuation of therapy, recurrence is frequent. Continuous or intermittent therapy might reduce recurrence.

Adenomatous Polyposis Coli↗
PubMed1987

Lipoproteins status in professional football players after period of vacation and one month after a new intensive training program.

Plasmatic lipoproteins were evaluated in a group of 11 professional football-players after a 3-week rest, and one month later, after an intensive training (characterized by a succession of aerobic and anaerobic efforts), for engaging a new competition. At day 0, total cholesterol (TC = 4.4 +/- .04 mmol/l), triglycerides (TG = .6 +/- .04 mmol/l), and LDL-TC (2.54 +/- .18 mmol/l) were significantly decreased versus sex and age matched sedentary subjects (TC = 5.13 +/- .2 mmol/l, P less than .02; TG = .99 +/- . mmol/l, P less than .01; LDL-CT = 3.26 +/- .2 mmol/l, P less than .02). HDL-TC was increased (1.50 +/- .06 vs 1.30 +/- .05 mmol/l, P less than .05). The apoprotein A1 (apoA1) was higher in football-players (1.5 +/- .06 vs 1.16 g/l, P less than .001), while the apoprotein B (apoB) was lower (.6 +/- .03 vs .88 +/- .04 g/l, P less than .001). Even after 3 weeks of rest, the football-players lipoproteins were still identical to aerobic elite-athletes. At day +30, after a daily training involving 2 anaerobic sequences, the maximal aerobic capacity was increased by 21%, without any change in nutritional, plasmatic and hepatic status. Weight was diminished (-0.8 kg, P less than 0.05). TC (4.14 +/- .2 mmol/l), TG less than .64 +/- .08 mmol/l), LDL-TC (3.37 +/- .17 mmol/l), apo B (.64 +/- .05 g/l) were unchanged. HDL-CT fell to controls values while apoA1 increased (1.66 +/- .06 mmol/l, P less than .001). Thus, HDL-CT/apoA1 ratio (indicating the TC content of HDL) was decreased, whereas apoB/apoA1 ratio was unchanged. The decrease of TC content of HDL was not related to dietary change nor to weight decrease. As TG were stable, the lipoprotein lipase activity could not be modified.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Mixed carcinoid tumor-adenocarcinoma of the stomach. Review of the literature, apropos of a case].

We report a case of mixed tumor of the stomach with a double histological population: carcinoid and adenocarcinoma. The carcinoid component presented an usual morphological pattern with "atypical" elements, and without argyrophilic cells; the carcinoid cells were exclusively marked by an anti-serotonin serum. The other component was a poorly differentiated carcinoma, with muco secretion, which was not marked by and anti-carcino-embryonic antigen serum. The limit between the two components was sharp. The association of mucin in the carcinoma and serotonin in the carcinoid component was an argument in favour of the diagnosis of mixed tumor carcinoid-adenocarcinoma (composite tumor) of the stomach. The evolution after operation leaded to a local recurrence and to the death 10 months later, in spite of chemotherapy. The existence of composite tumors raises nosological, histogenetical and diagnostic problems, which are discussed in this work. The prognosis of these tumors is unknown and therapeutic possibilities seem to be scanty.

Adenocarcinoma↗