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Biomedical subjects

F Carbonnel

Publications and source records attributed to F Carbonnel.

At least 55 records · Page 3Linked to original sources
PubMed1995

Intestinal histoplasmosis in AIDS patients: report of three cases observed in France and review of the literature.

We report three cases of colonic histoplasmosis observed in a non-endemic area in patients with AIDS. The patients presented with fever, abdominal pain and an abdominal mass in the right lower quadrant. Diagnosis was obtained using Gomori-Crocott staining of endoscopic or surgical biopsies. One patient died without specific treatment and two patients had a complete remission when treated with intravenous amphotericin B but suffered a relapse when given oral itraconazole. Thus, physicians in areas where intestinal histoplasmosis is not endemic should be aware of the condition. Diagnosis can easily be obtained using Gomori-Crocott staining of colonoscopic biopsies; this should avoid unnecessary laparotomies and allow specific treatment to be instituted rapidly.

AIDS-Related Opportunistic Infections↗
PubMed1995

[Sclerosing peritonitis. A series of 10 cases and review of the literature].

OBJECTIVE AND METHODS: The aim of this study was to describe the main features of sclerosing peritonitis, using a retrospective study in 10 patients. RESULTS: The main causes of sclerosing peritonitis were continual ambulatory peritoneal dialysis (n = 3), peritoneal chemotherapy (n = 2) and liver cirrhosis (n = 2). Sclerosing peritonitis was revealed by acute or chronic bowel obstruction (n = 8). Small bowel X-rays and abdominal tomodensitometry showed a small bowel dilatation with a normal mucosa (n = 7), ascites (n = 5) as well as agglutination and fixation of small bowel loops within a cocoon (n = 3). Surgical viscerolysis was performed in 9 patients and allowed prolonged clinical remission in 4; 3 patients died postoperatively (1 had a cirrhosis and 2 were treated with continuous ambulatory peritoneal dialysis), 1 patient had a complicated postoperative course with recurrent enterocutaneous fistulae. CONCLUSION: Sclerosing peritonitis may be suspected in a patient who presents a combination of bowel obstruction, small bowel dilatation without mucosal disease and ascites. Surgical viscerolysis is a dangerous operation associated with high mortality in patients with renal failure or cirrhosis.

Adult↗
PubMed1994

Extensive small intestinal T-cell lymphoma of low-grade malignancy associated with a new chromosomal translocation.

BACKGROUND: Primary T-cell lymphoma of the small intestine is rare, and most cases have proved rapidly fatal. METHODS: We describe a case of lymphoma involving the small intestine uniformly and extensively in a 28-year-old man on initial examination seen with long-standing diarrhea, malabsorption, and recurrent episodes of intestinal obstruction. Clinical remission was obtained with pentostatin (2'-deoxycoformycin, supplied by Professor Catovsky, London UK) after the patient had failed to improve under conventional chemotherapy. Tumor specimens as well as mesenteric lymph node, liver, and bone marrow specimens were studied with conventional pathology and immunochemistry. Additionally, mesenteric lymph nodes and peripheral blood cells were studied for T-cell receptor (TCR) gene rearrangement and karyotype. RESULTS: Lymphoma cells were small T-lymphocytes with irregular pleomorphic nuclei, bearing the CD3, CD4 and TCR alpha-beta phenotype. Peripheral-blood cytology and bone marrow biopsy were normal. Southern blot analysis of the TCR beta-chain gene revealed the same monoclonal rearrangement in the mesenteric lymph nodes and peripheral blood lymphocytes. An as yet undescribed t(4;16)(q26;p13) translocation, involving the region where the interleukin-2 (IL-2) gene has been mapped, was present in the mesenteric lymph nodes and peripheral blood lymphocytes. CONCLUSION: We believe this is the first description of an extensive, small intestinal lymphoma of low-grade malignancy made up of monoclonal T-cells with a TCR alpha-beta and helper/inducer phenotype, associated with a novel chromosomal translocation.

Adult↗
PubMed1994

Classification of the sequelae of bowel resection for Crohn's disease.

A postoperative handicap index designed to predict diarrhoea and malnutrition following bowel resection in patients with Crohn's disease is proposed. The index takes into account the location and extent of resection, and its value can be calculated from operative records. Retrospective (n = 218) and prospective (n = 68) series of patients were studied. Diarrhoea and malnutrition developed in 102 patients (47 per cent) and 13 patients (6 per cent) respectively in the retrospective series, and in 40 (59 per cent) and one (1 per cent) of those in the prospective series. The handicap index correlated with faecal weight and faecal fat in 112 patients tested. Positive and negative predictive values of an index score greater than 20 for the development of diarrhoea, and over 50 for the development of malnutrition, were 0.64 and 0.90, and 0.60 and 0.99 respectively in the retrospective series; values were 0.80 and 0.71, and 0.25 and 1.00 in the prospective series. The postoperative handicap index is a useful tool for predicting the functional consequences of bowel resection for Crohn's disease.

Adult↗
PubMed1994

Colonoscopy of acute colitis. A safe and reliable tool for assessment of severity.

Complications that might lead to surgery in severe attacks of ulcerative colitis have been found to be correlated with the depth of colonic ulcerations as measured by pathological examination of colectomy specimens. In order to evaluate the value of colonoscopy for the assessment of colonic ulcerations, we have reviewed the clinical, biological, colonoscopic, and anatomical findings in 85 consecutive patients with attacks of ulcerative colitis involving at least the rectosigmoid and part of the descending colon, seen in our center between 1981 and 1989. All had colonoscopy performed by a senior endoscopist at entry. Extensive deep colonic ulcerations were diagnosed in 46 of them, and moderate endoscopic colitis in 39. No complication related to colonoscopy occurred except for one colonic dilatation. Forty-three of the 46 patients with severe endoscopic colitis were operated upon; 38 of them failed to improve with high-dose corticosteroids and five had a toxic megacolon. Extensive ulcerations reaching at least the circular muscle layer were found at pathological examination of colectomy specimen in 42 of the 43 patients. Conversely, 30 of 39 patients with moderate endoscopic colitis went into clinical remission with medical treatment, and only nine patients needed further surgery because of medical treatment failure. Six of these nine patients underwent another colonoscopy prior to colectomy, and all six showed features of severe endoscopic colitis. Deep ulcerations reaching the circular muscle layer were found at pathological examination in five of these six patients and in one additional patient whose colonoscopy had been performed 21 days before colectomy.(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMed1994

Etiology and management of toxic megacolon in patients with human immunodeficiency virus infection.

We report six cases of toxic megacolon in patients with human immunodeficiency virus (HIV). One case, at an early stage of HIV infection, mimicked a severe attack of Crohn's disease, with a negative search for infectious agents. Subtotal colectomy was successfully performed with an uneventful postoperative course. The five other cases concerned patients with acquired immunodeficiency syndrome at a late stage of immunodeficiency. They were related to Clostridium difficile or cytomegalovirus (CMV) intestinal infection in two and three patients, respectively. One case of CMV colitis presented macroscopically and histologically as pseudomembranous colitis. Emergency subtotal colectomy, performed in the first four patients with acquired immunodeficiency syndrome was followed by a fatal postoperative outcome. The last patient treated conservatively by colonoscopic decompression, in association with anti-CMV therapy, had a favorable short-term outcome. From the experience of our series and data from the literature, we discuss the best diagnostic and therapeutic approach to toxic megacolon in patients with HIV.

Adult↗
PubMed1994

Effect of the energy density of a solid-liquid meal on gastric emptying and satiety.

The effect of the energy density of a meal on gastric emptying and satiety was assessed in nine volunteers. They ingested, in randomized order, a diluted (2671 kJ/L, 950 mL) and a concentrated (7452 kJ/L, 350 mL) test meal of 2500 kJ each (80% as solids). Half-emptying times of solids and liquids were not significantly different for the diluted and concentrated meal (solids: 145 +/- 18 and 156 +/- 16 min, respectively; liquids: 76 +/- 10 and 84 +/- 10 min, respectively), and consequently, pyloric outputs of energy were identical. Neither the intensity and duration of satiety, nor the amount of energy ingested, ad libitum, 6 h after the test meal, were significantly affected by energy density of the food ingested. Both the intensity and duration of satiety correlated significantly with the gastric emptying time for solids (r = 0.60 and 0.67, respectively, P < 0.01). These results show that satiety depends on gastric emptying of energy and is not affected by the energy density of food intake.

Adolescent↗
PubMed1992

A new gene, BCM, on chromosome 16 is fused to the interleukin 2 gene by a t(4;16)(q26;p13) translocation in a malignant T cell lymphoma.

A t(4;16)(q26;p13.1) chromosome translocation found in tumour cells from a patient with a T cell lymphoma was shown to rearrange the interleukin 2 gene, normally located on chromosome band 4q26, with sequences from chromosome band 16p13.1. A cDNA library of tumour cells was screened with an interleukin 2 gene-specific probe. Three clones were isolated, which consisted, from 5' to 3', of the three first exons of the interleukin 2 gene followed by a 16p13 in-frame sequence encoding 181 amino acids. A probe derived from this sequence detected a 1.2 kb transcript in various cell lines exhibiting mature B lymphoid cell features, but this was not detected in other cell lines representative of other haematopoietic lineages, or in other organs. For this reason, the novel gene was termed BCM for B cell maturation. The open reading frame of BCM normal cDNA predicted a 184 amino acid protein with a single transmembrane domain which had no homology with any protein sequence stored in data banks. Our data indicate that BCM is a new gene whose expression coincides with B cell terminal maturation.

Amino Acid Sequence↗
PubMedDate not supplied

The role of anatomic factors in nutritional autonomy after extensive small bowel resection.

BACKGROUND: It is difficult to predict which patients with a postsurgical short bowel will require long-term parenteral nutrition. METHODS: We performed a retrospective prognostic study for the time to home parenteral nutrition or death from malnutrition (nonautonomy), on the basis of 103 patients with a residual short bowel of 17 to 150 cm. The influence of anatomic variables was summarized through the use of Cox regression model. RESULTS: Of the 103 patients included, 24 lost nutritional autonomy. Three anatomic variables were identified as having independent predictive information; remaining small bowel length (measured on small bowel x-rays; p = .0001), and jejunoileal anastomosis (p = .01) promoted autonomy, whereas end jejunostomy (p = .002) increased the risk of losing nutritional autonomy. CONCLUSIONS: On the basis of these results and on the relative weight of these variables, high-risk patients for loss of nutritional autonomy were defined as those with jejunoileal anastomosis and a remaining small bowel length < 35 cm, patients with jejunocolic anastomosis and remaining small bowel length < 60 cm, and patients with an end jejunostomy and remaining small bowel length < 115 cm. This classification was thereafter validated on a prospective series of 32 patients.

Adolescent↗
PubMedDate not supplied

[The clinical activity of Crohn's disease in the Paris area is maximal in the spring].

The aim of this study was to look for seasonal fluctuations in the clinical course of Crohn's disease. Eighty-three patients residing in the Paris area were included in the study and they had all undergone continuous clinical monitoring throughout the first three years of the disease. During this period, the clinical activity of the disease was ranked monthly on a semi-qualitative scale ranging from 0 to 4. The dates of corticosteroid treatment and of resection surgery carried out during the first three years of the disease were also recorded. The mean clinical score varied significantly (P < 0.0001) for different months of the year, the three highest scores being recorded during the three months of Spring-time (April, May and June). The number of months of corticosteroid treatment differed significantly (P < 0.05) for the various seasons, the six highest values being reported during Spring and Summer months. The number of intestinal resections differed significantly (p < 0.05) during different seasons, the highest incidence again being reported during Spring. This study demonstrates seasonal variations in the clinical course of Crohn' disease in the Paris area, with a peak occurring in the Spring.

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Lamprene in ano-perineal lesions of Crohn's disease. A retrospective study].

UNLABELLED: The efficacy of clofazimine (Lamprene) was analysed retrospectively in twenty one patients with anoperineal lesions (APL) of Crohn's disease. Clofazimine is known for its antimycobacterial, antiinflammatory and immunomodifier properties. It is used with success in leprosy and certain dermatological disorders. A number of clinical and laboratory arguments suggest the probability of a role of mycobacteria in the etiology of Crohn's disease. METHODS: twenty one patients with ileo-colono-anal or bucco-colono-anal Crohn's disease formed the basis of this study. They had been treated in various ways for APL, without success. They had APL of varying degrees of advancement (primary lesions: seven cases; secondary lesions: ten cases; major advanced lesions: four cases). Treatment with Lamprene was given for three to 38 months (mean: 12 months), the mean cumulative dose being 40 grams (4 to 146). Other therapeutic measures were started simultaneously in twelve patients: medical in six cases, medico-surgical in four cases and surgical only in two cases. The aim of treatment in fourteen cases was to obtain the healing of ulcerated lesions and/or fistulas, in three patients to delay dilatation sessions and in four patients to avoid proctectomy in the short-term. RESULTS: ten patients showed no improvement while eleven were improved (with regression of primary lesions in ten cases). Taking combined treatment into consideration, the link between the result obtained and Lamprene was considered probable in five cases, possible in four cases and uncertain in one case. Lamprene was well tolerated in general. It was not possible to evaluate the efficacy of treatment regarding intestinal disease. CONCLUSION: the efficacy of Lamprene in ano-perineal lesions of Crohn's disease is possible and is worthy of evaluation in a controlled trial.

Adolescent↗