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Biomedical subjects

E H Metman

Publications and source records attributed to E H Metman.

At least 19 recordsLinked to original sources
PubMed2001

Evolution of clinical and radiological features at diagnosis of achalasia during a 19-year period in central France.

OBJECTIVES: Symptoms of achalasia are often misinterpreted, resulting in delayed diagnosis. The aims of our study were (1) to estimate the evolution of clinical and radiological features of a large population of achalasic patients between two successive periods; and (2) to determine the influence of symptoms on diagnostic delay. METHODS: Between 1980 and 1998, all achalasia patients treated in our unit were assessed at the time of manometric diagnosis for clinical and radiological features. These data were compared between two successive periods (1980-1994 and 1994-1998). Then, a correlation between the diagnostic delay, clinical and radiological data and symptoms was investigated. RESULTS: Three hundred and forty-five consecutive achalasia patients were assessed (mean age at diagnosis, 56 years; mean diagnostic delay, 5.7 years). The duration of the disease was correlated with the oesophageal diameter (P = 0.0001). Dysphagia, chest pain and heartburn were more frequent in young patients (respectively, P = 0.003, 0.0001 and 0.001). Women had 1.7 times the risk of men for suffering of chest pain (95% CI, 1.1 -2.6) and 2.2 times the risk for heartburn (95% CI, 1.2-4.0). Pulmonary involvement was more frequent when the oesophagus was dilated (P = 0.0002), and 3.4 times more frequent when associated with regurgitations (95% CI, 1.3-8.9). The oesophageal diameter was significantly smaller (38 vs 48 mm) in the last period, but we have not observed any significant shortening of the diagnostic delay. No symptoms influenced the diagnostic delay. CONCLUSIONS: Despite a smaller oesophageal diameter at the time of diagnosis, during the period 1994-1998, diagnostic delay was not reduced. No clinical features associated with late diagnoses could be identified.

Adolescent↗
PubMed1999

Esophageal swallowing phase assessed by audiosignal recording: relationship with manometry in gastroesophageal reflux disease patients.

The acoustic technique has been used for pharyngeal exploration but to date no such technique has been devised to assess esophageal motility. The aim of this study was to demonstrate that displacement through the esophagus can be quantified using this method in healthy subjects and in patients with gastroesophageal reflux. Concurrent manometric and acoustic recordings were also performed in the patients. Fifteen controls (38.5 +/- 13 years old) and 10 patients (34.9 +/- 6 years old) were included. All were recorded during wet and dry swallow sequences with microphones placed below the cricoid cartilage and on the xiphoid appendix. Standard manometry was performed for lower esophageal sphincter (LES) exploration. For the acoustic technique, the frequency of xiphoid signals (FX), esophageal transit time (ETT), duration of xiphoid sound (SD), and for the manometric study, the duration of LES relaxation (RD) were recorded and mean values were calculated (FXm), (ETTm), (SDm), (RDm). FXm for wet (94 vs 81.6%) and dry swallows (86 vs 66.6%) decreased in patients. ETTm was significantly higher (P < 0.01) for wet than for dry swallows (5.6 +/- 0.9 vs 5.2 +/- 1.2 sec) for controls but not for patients. ETTm was significantly higher for patients for wet (7.2 +/- 2.1 sec) and for dry swallows (6.5 +/- 2.3 sec) than for controls and SDm was lower. Xiphoid sound appeared in the second half of LES relaxation. Our noninvasive acoustic technique is simple and reproducible. It is well correlated with manometry, and it allows characterization of the displacement of the bolus through the esophagus and the LES. The technique could be used alone to determine appropriate pharmacological and surgical treatments for esophageal motility disorders.

Acoustics↗
PubMed1999

Risk factors for immediate complications after progressive pneumatic dilation for achalasia.

OBJECTIVE: The aim of this retrospective study was to determine the risk factors of early complications after progressive pneumatic dilation for achalasia. METHODS: Five hundred four dilations were performed in 237 consecutive achalasic patients between 1980 and 1994 with the same technique: low-pressure pneumatic dilation every other day with balloons of increasing diameter until success criteria were obtained (depending on manometric examination and esophageal x-ray transit performed 24 h after each dilation). Clinical, radiographical, endoscopical, and manometrical data as technical procedure characteristics for patients with perforations or other early complications were compared with those without complications. RESULTS: We observed 15 complications (6% of patients): 7 perforations (3%), 3 asymptomatic esophageal mucosal tears, 4 esophageal hematomas, and 1 fever. Perforations occurred in 6 of 7 patients during the first dilation. The mean age was 68.5 yr in the group with complications versus 56.4 yr for the remainder (p < 0.05). Two deaths occurred in patients older than 90 yr. Instability of the balloon during dilations was noted in 8 of 15 cases of complications versus 57 of 222 patients (p < 0.05). No other data differed significantly. CONCLUSIONS: This study showed a low prevalence of early complications using this progressive technique. Patients with hiatal hernia, esophageal diverticulum, or vigorous achalasia may safely undergo progressive pneumatic dilation. Only patients older than 90 yr should be referred for progressive pneumatic dilation with caution. Most of perforations arose during the first dilation, but there was no predictive pretherapeutic factor of perforation.

Adolescent↗
PubMed1998

[Complete remission of a mesenteric fibromatosis after taking sulindac].

We report the case of a 22-year-old-man having a familial adenomatous polyposis coli treated by total colectomy with ileo-rectal anastomosis. Two years after the operation, an asymptomatic mesenteric fibromatosis appeared which was nonresectable due to mesenteric vessels infiltration. Nine years later, sulindac therapy was started for residual polyps in the rectal stump. This treatment was taken intermittently, during periods of 1 to 8 months, for 6 years. After 4 years of treatment, the tumor was no longer palpable. Four years after sulindac discontinuation, the patient was operated on for suspicion of intestinal adhesion. The mesenteric fibromatosis had completely disappeared and mesenteric vessels were free. This complete macroscopic regression of a desmoid tumor after sulindac therapy emphasizes again the interest of this treatment for mesenteric fibromatosis.

Adenomatous Polyposis Coli↗
PubMed1998

[Myotomy for esophageal muscular hypertrophy with eosinophil infiltration of the esophagus associated with toxocariasis revealed by esophageal motor disorder].

We report the case of a 61-year-old-man with an eosinophilic esophagitis with esophageal motor disorder associated with toxocariasis. He complained of non cardiac chest pain and had eosinophilia leading to the detection of Toxocara canis infection. Pain persisted despite treatment of toxocariasis. Basal manometry was normal but ambulatory 24-hour manometry-pHmetry showed diffuse esophageal spasm. Ultrasonography showed a thickening of the esophageal musculature in the two inferior thirds of the esophagus. After failure of treatment with sodium cromoglycate steroids and esophageal dilatation, calcium antagonists were partially effective. A long esophageal myotomy was performed permiting the disappearance of symptoms. The histological examination of a side myotomy biopsy showed an eosinophilic infiltration of the esophageal muscle layer. This observation leads to discuss the possible relation between toxocariasis, the esophageal motor disorder and the eosinophilic infiltration of the esophageal muscle layer.

Eosinophilia↗
PubMed1997

Exploration of pharyngeal swallowing by audiosignal recording.

The aims of this study were to analyze the following by audiorecording of swallows: (1) the influence on the volume and consistency of ingested substances on the audiosignal recorded during separate swallows; and (2) the characteristics of successive swallows during ingestion of 100 ml of the same substances to define deglutitive behaviors. Volunteers followed two protocols. Protocol (P) 1 comprised ingestion of 100 ml of water or yoghurt in successive swallows and Protocol 2 comprised separate swallows of different volumes of the same substances. Audiosignal recordings were made with a dynamic microphone. The following parameters were measured in P1: total time of ingestion (TT), number of swallows necessary for ingestion (N), and spontaneous swallowing intervals (SI). In P2 the duration (d) of each signal was measured according to consistency and volume. Mean (m) values were then calculated (TTm, Nm, SIm, and dm). During P1, TTm for yoghurt was significantly longer than for water (23.1 vs. 6.5 sec (men) and 21.8 vs. 7.8 sec (women). Nm was also greater for yoghurt (10.1 vs. 4.3 (men) and 10.0 vs. 4.8 (women). Three types of swallowing behavior were defined according to SI: swallowing at regular intervals (Reg) with increasing intervals during ingestion (Prog) and swallowing at variable intervals (Irreg). These patterns did not differ significantly according to sex. In P2 the increase in volume swallowed increased the duration (dm) of the signal for water (600 msec for 5 ml and 960 msec for 15 ml). The dm for yoghurt was significantly less than for water (580 msec for 5 ml and 920 msec for 15 ml). Our technique of recording sounds of pharyngeal swallowing is simple, reproducible, and not expensive. It permitted the analysis of each swallow according to volume and consistency and the determination of three swallowing patterns (Reg, Prog, and Irreg), taking into account the spontaneous swallowing interval. Ingestion by successive swallows could be used to characterize certain pharyngoesophageal motor dysfunctioning in relation to this reference population and to integrate this into a deglutition rehabilitation program.

Acoustics↗
PubMed1997

Erythromycin elicits opposite effects on antro-bulbar and duodenal motility: analysis in diabetics by cineradiography.

We have previously demonstrated by cineradiography analysis that erythromycin (Ery) increases antral contractility and antropyloric coordination in diabetics. The aim of this study was to further characterize antro-bulbar and duodenal motility after Ery i.v. administration. Fourteen diabetic patients (mean age 61.2 years) were randomly allocated to receive either 100 or 500 mg of Ery intravenously 4 hours after a standard solid liquid meal. After ingestion of a barium sulfate suspension, a series of 15 fluorographic plates (one every two seconds) was performed. the same procedure was repeated twice for each subject with a delay of 3 days once before and once after Ery. Antral, bulbar and duodenal areas and evolution diagrams were calculated in baseline conditions and after Ery administration using a graphic table connected to a microcomputer. No differences were found between the two doses of the drug. Ery significantly decreased antral (1284 +/- 268 mm2 vs 704 +/- 181 mm2; P < 0.01) and bulbar areas (127 +/- 26 mm2 vs 73 +/- 21 mm2; P < 0.01). In contrast, duodenal areas were significantly increased after Ery (875 +/- 112 mm2 vs 575 +/- 112 mm2; P < 0.01). This study suggests that the known prokinetic effect of Ery on gastric emptying seen in diabetic patients could be related to an increase of motility in the antrum and in the bulb simultaneously with a relaxation in the duodenum.

Adult↗
PubMed1997

Achalasia: outcome of patients treated with intrasphincteric injection of botulinum toxin.

BACKGROUND: To evaluate the safety and clinical efficacy of botulinum toxin (BT) in patients with achalasia followed up for six months. METHODS: Fifty five symptomatic patients with manometrically proven achalasia were included in a multicentre prospective trial. Before and two weeks and two months after intrasphincteric injection of BT, symptoms of dysphagia, regurgitation, and chest pain were scored on a 0-3 scale, and lower oesophageal sphincter pressure (LOSP) was assessed. The symptom score was determined again at six months, clinical improvement being defined by < or = 3, relapse by > 3, and failure as a relapse after two injections or loss to follow up. RESULTS: Except for transient chest or epigastric pain (22%), no side effects were observed. There was a significant decrease in LOSP after treatment. Symptom scores were significantly improved at two weeks (2.0 (SD 1.6)), two months (1.7 (1.8)), and six months (1.9 (2.0)) compared with pretreatment values (5.1 (1.8), p < 0.001). At six months, 33 patients had clinical improvement (27 after one injection), 17 were considered failures, and five had just relapsed. Although there was a trend for age (older patients being more responsive), age, sex, prior duration of symptoms, initial symptom score, weight loss, LOSP, magnitude of oesophageal contractions, vigorous or non-vigorous achalasia, previous dilatations, and radiological features were not predictive of results. CONCLUSIONS: This multicentre series confirms that intrasphincteric injection of BT is a safe procedure, resulting in clinical improvement in 60% of patients with achalasia at six months. The therapeutic role of BT in achalasia needs further evaluation with regard to other alternatives.

Adult↗
PubMed1997

[Acute reversible pan-dysautonomia: effect of erythromycin on gastrointestinal involvement].

We describe a case of acute autonomic neuropathy in an 18-year-old woman. Gut dysfunction was sufficiently severe for the patient to undergo laparotomy for suspected mechanical-intestinal obstruction before the diagnosis was made. Apart from the gut, other organs affected included the pupils, sweat and lachrymal glands. Cardiovascular autonomic function tests showed the involvement of sympathetic adrenergic nerves. Small bowel barium X-ray showed resolution of gastric stasis and emergence of jejunum dilatation during intravenous administration of erythromycin but this treatment did not eliminate intestinal obstructive symptoms. The patient had an incomplete recovery in 3 months. Erythromycin might have therapeutic value in patients with intestinal motility dysfunction in acute dysautonomia.

Acute Disease↗
PubMed1996

[Monitoring of the permeability of the inferior esophageal sphincter using sound signals].

An original method is described for graphic display of sounds arising from the cardia during the swallowing of saliva or water. Two dynamic microphones were placed on the skin of epigastric xyphoid area and simultaneously on the latero-cervical position. The following conditions must be filled: position of the subject (upright or lying), correct application of microphone with pressure (2 kPa), specially for the xyphoid situation. For graphic restitutions from magnetic signal, a time-recording paper was used, on line or off line, with an analogical device including Butterworth band active filter (optimal frequency range 0.8-1.2 kHz), amplifier and integrator (tau = 2 s). Occurrence of typical cardia sounds were 86-97 % for saliva and 95-100 % for water in two normal subjects for the evaluation of reproducibility (one man and one woman 35 and 47 years old respectively, n = 234 sequences, interval 20 s). Using the distance between the upper and lower microphones, the esophageal time transit can be measured. The signal was more unconstantly recorded for saliva 40 +/- 44 % in adults (n = 10) and 76 +/- 17 % in children (n = 7), than for 80 et 87 % for water respectively. The optimal interval between two swallows appeared to be 15-25 s. In patients with presumption of achalasia (n = 8), the two phonic signals were recorded during esophageal pressure measurement. The presence of esophageal sounds seems to be the sign of absence of achalasia.

Adolescent↗