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Biomedical subjects

E H Metman

Publications and source records attributed to E H Metman.

At least 55 records · Page 3Linked to original sources
PubMed1991

[Merycism or gastroesophageal reflux: value of antroduodenal manometry].

Decrease in lower esophageal sphincter (LES) pressure and frequent acid reflux were observed in 3 of 5 adult patients with rumination syndrome confirmed by antroduodenal manometry. The role of the LES in the rumination syndrome is unclear but decreased LES pressure could be a determining factor. Antroduodenal manometric studies should therefore be performed during ordinary gastroesophageal reflux in order to determine the diagnostic value of antroduodenal manometry in the rumination syndrome.

Adolescent↗
PubMed1990

Ursodeoxycholic acid for primary sclerosing cholangitis.

The effects of ursodeoxycholic acid (UDCA, 750-1250 mg/day) were evaluated prospectively in 15 patients with primary sclerosing cholangitis (PSC). Five patients had associated inflammatory bowel disease. After 6 months of treatment, the proportion of patients suffering from fatigue or pruritus decreased from 60% to 20% and from 33% to 20%, respectively. No exacerbation of associated disorders was observed. Serum alkaline phosphatase levels (normal less than 100 IU/l) decreased from 401 +/- 53 to 222 +/- 42 (mean +/- S.E.; p less than 0.001), those of gamma-glutamyl transpeptidase, (normal less than 40 IU/l) from 520 +/- 89 to 185 +/- 32 (p less than 0.001) and those of alanine aminotransferases, (normal less than 30 IU/l) from 79 +/- 12 to 42 +/- 6 (p less than 0.02). In three patients, the discontinuation of UDCA was associated with an aggravation of the liver test results. In conclusion, this study shows that 6 months of treatment with UDCA leads to clinical and biochemical improvements in patients with PSC. These results suggest that UDCA could be an effective treatment for PSC, and may justify a controlled therapeutic trial.

Adult↗
PubMed1990

[Primary non-Hodgkin's high grade malignant lymphoma of the digestive system. A prospective study of the combination of surgery-chemotherapy-radiotherapy].

We report a prospective study concerning the association of surgery-chemotherapy and radiotherapy in the treatment of primary high grade digestive non-Hodgkin's lymphomas in 19 patients. The analysis of 11 stages IE, 5 stages II1E and 3 stages II2E allowed us to evaluate the efficacy and the tolerance of this triple therapeutic association. Fifteen patients are alive and well with a median follow-up of 54 months. One of these patients relapsed, but after autologous bone marrow transplantation is in second unmaintained complete remission. Four patients died of intercurrent aetiology although one death was related to treatment morbidity. Our results and the analysis of literature data lead us to recommend the triple association in the treatment of stage II2E high grade primary digestive lymphomas (PDL) and for PDL without complete resection. However, surgery and chemotherapy appear to be sufficient in the treatment of stages IE and II1E with complete resection.

Adult↗
PubMed1989

Randomized controlled trial of adenine arabinoside 5'-monophosphate in chronic active hepatitis B: comparison of the efficacy in heterosexual and homosexual patients.

Twenty-two heterosexuals and 21 homosexuals with chronic active hepatitis B and who had HBsAg, HBeAg and hepatitis B virus DNA in serum were randomized separately to receive adenine arabinoside monophosphate or placebo. In the 10 heterosexuals and nine homosexuals who received placebo, no change in hepatitis B virus DNA level and HBeAg was observed. Among the patients who received adenine arabinoside monophosphate, seven of the 12 heterosexuals and five of the 12 homosexuals lost hepatitis B virus DNA; five heterosexuals and three homosexuals also lost HBeAg; one homosexual lost HBsAg. There was no significant differences in response between heterosexual and homosexual patients. When results were pooled, there was a significant effect of adenine arabinoside monophosphate on hepatitis B virus replication. None of the 19 patients who received placebo but 50% of the 24 patients who received adenine arabinoside monophosphate were negative for serum hepatitis B virus DNA at 10 months after treatment (p less than 0.001) and none of the 19 patients who received placebo and 33% of the 24 patients who received adenine arabinoside monophosphate were negative for HBeAg in serum (p less than 0.005). Retrospective analysis showed that disappearance of hepatitis B virus DNA after administration of adenine arabinoside monophosphate was more common (i) in patients with a low pretreatment hepatitis B virus DNA level than in patients with a high pretreatment hepatitis B virus DNA level (8/11 vs. 4/13, p less than 0.05); (ii) in patients with a high pretreatment ALT level than in patients with a low pretreatment ALT level (10/14 vs. 2/10, p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

[Hepatitis due to nonsteroidal anti-inflammatory agents].

The extended prescription of non-steroidal anti-inflammatory drugs in medical practice involve numerous adverse effects. Among them, hepatic injuries, rather uncommon, are very diverse with regard to clinical type and evolution scheme, according to the derivatives used. Salicylates, when taken at high doses, increase serum transaminases, mostly without overt clinical symptoms. Phenylbutazone is obviously hepatotoxic: it induces cytolytic hepatitis, in some cases with fatal issue. Among the indole derivatives, indometacine was involved, especially in children; mixed hepatitis have been noted during sulindac therapy, mostly with favourable outcome. In the group of propionic acid derivatives, ibuprofen, pirprofen and naproxen have been implicated in hepatitis of various types; ibufenac and benoxaprofen were quickly retired after occasioning several deaths. Concerning others non-steroidal anti-inflammatory drugs, some cases have been reported with piroxicam and diclofenac. Hepatotoxicity mechanisms are often unknown; they appear different according to each drug. Besides, the rheumatic disease under treatment and pharmacokinetic particularities (sulindac, diclofenac) might be important in this view. Monitoring of serum hepatic-enzyme concentrations seems recommended for patients receiving non-steroidal anti-inflammatory for long time therapy.

Adult↗
PubMed1987

[Fine needle cytopuncture of the pancreas. Apropos of 45 cases].

In this report, we examined the sensitivity and specificity of pancreatic fine needle aspiration cytology in the diagnosis of pancreatic cancer. Aspiration cytodiagnosis was performed in 45 patients (36 cancers and 9 benign pancreatic lesions) using a 22 Gauge fine needle either percutaneously in 25 patients with real-time ultrasonic guidance or during surgery in 20 patients. Cytologic examination included a precise description and the classification in one of the 4 Papanicolaou classes, the fourth only being considered as positive in terms of cancer. No complication occurred with either technic. Overall sensitivity was 75 p. 100, 74 p. 100 percutaneously and 77 p. 100 intraoperatively, but specificity was 78 p. 100 due to two false-positive results recorded among the 9 benign lesions. Retrospective analysis of cytologic examinations of the 29 class IV lesions led us to differentiate cases with "sure malignancy" (20 cases) from those with "strong suspicion of malignancy" (9 cases including the 2 false-positives). Only class IV lesions with "sure malignancy" call for aggressive treatment, whereas a "strong suspicion of malignancy", which may result from carcinoma or severe cellular abnormalities occasionally found in inflammatory pancreatic lesions, should lead to a second pancreatic aspiration.

Adult↗
PubMed1987

[Propagation of the gastric peristalsis in normal subjects and duodenal ulcer patients].

The velocities of gastric peristaltic waves were measured on fluorographic series made in normal subjects and patients with duodenal ulcer. After an overnight fast, the subjects drank 250 ml of barium suspension. Sequential radiograms were taken every 2 s during 30 s after two pyloric ejections. Peristaltic waves were located and their displacements measured with an Apple Graphic Tablet. Wave progression diagrams and velocity histograms were drawn for each subject. The velocities were calculated every 2 s. A "spread index" Ip was determined for each subject, characterizing the irregularity of propagation. Mean frequency and mean velocity were greater in duodenal ulcer patients (3.6 c/min; 3.7 mm/s) than in normal subjects (2.9 c/min; 2.4 mm/s; p less than 0.001). Nevertheless, no significant difference was found between proximal or midcorpus and antral velocities, in ulcer patients as well as in normal subjects, contrarily to classical data. However, the velocities were not uniform along the stomach. The contractions spread unevenly and displayed transient slopes. The irregularities of propagation were more pronounced in normal subjects, ranging from 0 to 14 mm/s with 28 p. 100 of velocities less than 1 mm/s, then in ulcer patients (0 to 13 mm/s with 12 p. 100 of low velocities). The spread index Ip was greater in normal (ranged from 0.54 to 2.62) than in ulcer patients (ranged from 0.16 to 0.48; p less than 0.001). This study showed that the propagation velocity of the peristaltic waves and its regularity were different in normal subjects and in duodenal ulcer patients.

Adult↗
PubMed1986

[Severe constipation indicative of pseudohypoparathyroidism and resolved after normalization of the blood calcium].

Hypocalcemia does not appear among the endocrine and metabolic causes of constipation. The work-up of a severe constipation has disclosed a pseudo-hypoparathyroidism according to the clinical picture described by Albright, associating signs of hypo-parathyroidism, a characteristic dysmorphic syndrome, mental deficiency and normal PTH dosages. The resolve of the constipation along with the return to a normal calcemia suggests that hypocalcemia should be added to the long list of endocrine and metabolic causes of constipation.

Adult↗