Biomedical subjects

F Pessione

Publications and source records attributed to F Pessione.

18 recordsLinked to original sources

PubMed2000

Aquaretic effects of niravoline, a kappa-opioid agonist, in patients with cirrhosis.

BACKGROUND/AIMS: In patients with cirrhosis, decreased renal water excretion is a common complication. Niravoline (RU51599), a kappa-opioid receptor agonist, has been shown to induce an aquaretic response. The aim of this study was to evaluate the aquaretic effect and tolerance of niravoline in patients with cirrhosis. METHODS: Biochemical tests and hemodynamic values were determined before and 1, 2, 3 and 24 h after niravoline administration at doses ranging from 0.5 to 2 mg iv in 18 patients with cirrhosis. RESULTS: Diuresis significantly increased in the first hour from 64+/-9 to 146+/-31 ml/h, and returned to basal values after 3 h. Free water clearance also significantly increased, reaching the positive range at 1 h. Plasma osmolality significantly decreased at 2 h (from 290+/-4 to 286+/-4 mOsm/kg). Plasma sodium concentrations increased significantly at 3 h (from 133+/-1 to 134+/-1 mEq/l). Heart rate and arterial pressure did not change. The highest doses (1.5 mg or 2 mg) induced personality disorders and mild confusion within 2 h. These effects reversed completely within 8 h. CONCLUSION: This study shows that niravoline administration induces an aquaretic response and is well tolerated, at moderate doses, in patients with cirrhosis. Thus, moderate doses of niravoline may be useful for treating patients with cirrhosis and water retention.

Benzeneacetamides↗

PubMed2000

Recent portal or mesenteric venous thrombosis: increased recognition and frequent recanalization on anticoagulant therapy.

Characteristics and outcomes of recent portal or mesenteric venous thrombosis are ill-known. We intended to compare these features with those of patients with portal cavernoma, and also to assess the incidence of recanalization of recent thrombosis on anticoagulation therapy. All patients seen between 1983 and 1999 were enrolled into this retrospective study if recent portal or mesenteric venous thrombosis or portal cavernoma had been documented, and if cancer of the liver, pancreas, or bile duct, intrahepatic block including cirrhosis, and obstruction of the hepatic veins had been ruled out. The proportion of recent thrombosis was 7% in patients seen before 1990 and 56% after 1994 (P <.05). Patients with recent thrombosis (n = 33) or cavernoma (n = 108) did not differ with regard to age, sex ratio, or prevalence of prothrombotic states and of previous thrombotic events. In patients with recent thrombosis, septic pylephlebitis was more common and the incidence of gastrointestinal bleeding was lower (2.4 vs. 12.7/100 patient-years). Recanalization occurred in 25 of 27 patients given anticoagulation and 0 of 2 patients not given anticoagulation. The probability of recanalization was related to the extent of thrombosis (P =.003). In conclusion, mesenteric or portal venous thrombosis is increasingly recognized at an early stage. The features differentiating recent thrombosis and cavernoma are related to silent onset precluding early recognition and therapy in the latter. Frequent association with prothrombotic states and frequent recanalization on anticoagulation support the recommendation of early anticoagulation therapy in all patients with recent portal vein thrombosis.

Adult↗

PubMed2000

Evidence for an endothelium-derived hyperpolarizing factor in the superior mesenteric artery from rats with cirrhosis.

In cirrhosis, in splanchnic arteries, endothelium-dependent relaxation may persist even if overactive nitric oxide synthase (NOS) and cyclooxygenase (COX) are inhibited. In normal arteries, a significant endothelium-dependent relaxation to acetylcholine persists after NOS/COX inhibition. This relaxation is caused by smooth muscle cell (SMC) membrane hyperpolarization, which is sensitive to a combination of the potassium channel blockers apamin and charybdotoxin, and is mediated by an endothelium-derived hyperpolarizing factor (EDHF). The aim of this study was to detect EDHF and evaluate its pathophysiologic role in isolated superior mesenteric arteries from cirrhotic rats. Arterial rings were obtained and exposed to N(w)-nitro-L-arginine (L-NNA, a NOS inhibitor) and indomethacin (a COX inhibitor). Acetylcholine-induced membrane potential responses and concentration-response curves to the relaxant of acetylcholine were obtained with and without apamin plus charybdotoxin. Acetylcholine-induced responses were measured in certain rings from endothelium-denuded arteries. Contractions caused by the alpha(1)-adrenoceptor agonist phenylephrine were obtained in cirrhotic and normal rings with and without apamin and charybdotoxin. Significant acetylcholine-induced, endothelium-dependent, apamin- and charybdotoxin-sensitive, SMC membrane hyperpolarization and relaxation were found. An apamin- and charybdotoxin-sensitive hyporesponsiveness to the contractile action of phenylephrine was found in cirrhotic rings. In conclusion, in cirrhotic rats, in the superior mesenteric artery exposed to NOS/COX-inhibitors, an EDHF exists that may replace NOS/COX products to induce endothelium-dependent arterial relaxation.

Acetylcholine↗

PubMed1999

[Problem drinking].

The seriousness and the difficult care of the alcohol-dependent persons often occult an other category of persons drinking too much: the problem drinkers. Nevertheless, these persons are as many in the practice of all the physicians and their various pathologies concern all the medical specialties. Their identifying is based on the self declared consumption. Their lack of dependence and their attendance with their general practitioner make their care easier. A brief intervention aiming to reduce their consumption is a primary or secondary prevention which is more often enough to resolve all or part of their complaints.

Alcohol Drinking↗

PubMed1999

Cardiac metaiodobenzylguanidine uptake in patients with moderate chronic heart failure: relationship with peak oxygen uptake and prognosis.

OBJECTIVES: This prospective study was undertaken to correlate early and late metaiodobenzylguanidine (MIBG) cardiac uptake with cardiac hemodynamics and exercise capacity in patients with heart failure and to compare their prognostic values with that of peak oxygen uptake (VO2). BACKGROUND: The cardiac fixation of MIBG reflects presynaptic uptake and is reduced in heart failure. Whether it is related to exercise capacity and has better prognostic value than peak VO2 is unknown. METHODS: Ninety-three patients with heart failure (ejection fraction <45%) were studied with planar MIBG imaging, cardiopulmonary exercise tests and hemodynamics (n = 44). Early (20 min) and late (4 h) MIBG acquisition, as well as their ratio (washout, WO) were determined. Prognostic value was assessed by survival curves (Kaplan-Meier method) and uni- and multivariate Cox analyses. RESULTS: Late cardiac MIBG uptake was reduced (131+/-20%, normal values 192+/-42%) and correlated with ejection fraction (r = 0.49), cardiac index (r = 0.40) and pulmonary wedge pressure (r = -0.35). There was a significant correlation between peak VO2 and MIBG uptake (r = 0.41, p < 0.0001). With a mean follow-up of 10+/-8 months, both late MIBG uptake (p = 0.04) and peak VO2 (p < 0.0001) were predictive of death or heart transplantation, but only peak VO2 emerged by multivariate analysis. Neither early MIBG uptake nor WO yielded significant insights beyond those provided by late MIBG uptake. CONCLUSIONS: Metaiodobenzylguanidine uptake has prognostic value in patients with wide ranges of heart failure, but peak VO2 remains the most powerful prognostic index.

3-Iodobenzylguanidine↗

PubMed1998

Effect of alcohol consumption on serum hepatitis C virus RNA and histological lesions in chronic hepatitis C.

The role of alcohol intake in the occurrence of severe liver disease in chronic hepatitis C virus (HCV) carriers is still debated. A cross-sectional study has been conducted in 233 chronic hepatitis C virus carriers. Weekly self-reported alcohol consumption (SRAC) was evaluated, serum HCV RNA levels were measured by a branched DNA technique (Quantiplex 2.0) and HCV genotypes were determined. A liver biopsy was performed simultaneously and liver lesions were graded with the Knodell histological activity index. Data were examined by uni- and multivariate analyses. Alcohol consumption was relatively low (< 140 g/per week in 193/233 patients [80%]). We found a highly significant correlation between SRAC and serum HCV RNA levels (r = .26, P = .001). Fibrosis was significantly correlated with age and alcohol consumption. These results suggest that in HCV carriers, alcohol consumption, even with low alcohol intake, increases viremia and hepatic fibrosis. Chronic HCV carriers should be advised to avoid regular alcohol intake.

Adult↗

PubMed1998

Diagnostic accuracy and prognostic value of combined dipyridamole-exercise thallium imaging in hemodialysis patients.

BACKGROUND: Non-invasive detection of coronary artery disease in dialysis patients, a major cause of mortality, often remains difficult. The aim of the study was to test the diagnostic and prognostic accuracies of combined dipyridamole-exercise thallium imaging in dialysis patients. METHODS: Dipyridamole-exercise thallium imaging and coronary angiography were both performed prospectively in 60 asymptomatic hemodialysis patients who were followed up, long term, by recording any major coronary event. RESULTS: Coronary angiography was abnormal in 13 patients (21%), and there was abnormal thallium uptake in 17 patients. Sensitivity, specificity, positive and negative predictive values, and overall accuracy of thallium to detect a coronary artery disease were 92, 89, 71, 98 and 90%, respectively. After a median follow-up of 2.8 years, 12 patients experienced at least one major coronary event (4 cardiac deaths, 5 myocardial infarctions and 3 revascularizations). Eight of the 17 patients with abnormal thallium uptake (47%) suffered a coronary event, compared to only 4 of the 43 patients (9%) with a normal thallium uptake (P < 0.001). The positive prognostic predictive value of thallium imaging was 47% and its negative predictive value was 91%. The probability of survival free of coronary events was significantly higher in patients with normal thallium uptake than in those with abnormal thallium uptake (crude risk ratio 7.6; P < 0.001) even after adjustment for several risk factors for cardiovascular disease (adjusted risk ratio 9.2; P < 0.005). CONCLUSION: In dialysis patients, combined dipyridamole-exercise thallium imaging is an accurate method for detecting coronary stenosis and for predicting future coronary events.

Adult↗

PubMed1997

Comparison of the long-term prognostic value of peak exercise oxygen pulse and peak oxygen uptake in patients with chronic heart failure.

OBJECTIVE: To evaluate the ratio of peak oxygen consumption to peak heart rate (peak oxygen pulse) as a predictor of long term prognosis in chronic heart failure. PATIENTS AND SETTING: 178 consecutive heart failure patients recruited to the cardiology department of a tertiary referral centre between 1986 and 1993. DESIGN: Bicycle ergometry with measurement of respiratory exchange. Mean (SD) follow up was 32 (25) months. RESULTS: Patients who died had a lower peak oxygen consumption (16.0 (5.5) v 18.0 (5.5) ml/min/kg, p = 0.05), lower indexed peak oxygen consumption (52 (14) v 60 (16)%, p = 0.006) but similar peak oxygen pulse (8.4 (2.6) v 8.4 (3.0) ml/beat, NS). The following variables were associated with a good long term prognosis: New York Heart Association class II, non-ischaemic heart failure, peak oxygen consumption > or = 17 ml/min/kg, indexed peak oxygen consumption > 63%. Peak oxygen pulse did not have predictive value. Only indexed peak oxygen consumption remained an independent predictor of survival in multivariate analysis. CONCLUSIONS: Peak oxygen pulse has lower prognostic value than peak oxygen consumption, especially when the latter is indexed to predicted values.

Exercise↗

PubMed1995

Prompting alcoholics to be referred to an alcohol clinic: the effectiveness of a simple letter.

Many patients received in emergency units (EU) of hospitals present alcohol-related problems. Most are alcohol dependent or abusers and enter for drunkenness, stay a few hours and return home. To assess the effectiveness of a letter referring these patients to an outpatient alcoholism treatment clinic, we performed a randomized study. For 6 months, all the patients who had been diagnosed as alcoholic, who had an address and who had not consulted a physician for alcoholism in the 6 previous months were selected from the records of the EU of a French university hospital. At least 2 days after their stay in the EU, we sent a letter to 181 patients of an experimental group (group E) suggesting they make an appointment with a physician specializing in alcoholism. No letter was sent to 181 patients in a control group (group C). Six months later, 21 patients (11.2%) of group E had called the outpatient alcoholism treatment clinic to make an appointment and came to a consultation. Two of the 181 patients of group C came to the consultation. The effectiveness of this method for referring alcoholics to a clinic had been controlled by another prospective study. We concluded that sending a letter 2 days after the passage of an alcoholic to an EU for drunkenness is a useful method of referral to an outpatient alcoholism treatment clinic.

Adult↗

PubMed1995

Relationship between alcohol and tobacco dependencies among alcoholics who smoke.

Outpatients followed in an alcoholic clinic and who fulfilled DSM-III-R criteria for alcohol dependence and had used both tobacco (at least one cigarette every day) and alcohol in the preceding week were studied. For each patient, two experimenters assessed: (1) the amount of tobacco and alcohol used; (2) the severity of dependence for each product. Results showed that: (a) The prevalence of smoking in this population of current alcohol dependents was 88%; (b) 91.6% of this sample of smoker alcoholics were dependent on nicotine; (c) the amount of tobacco smoked was correlated to the amount of alcohol consumed and the severity of alcohol dependence; and (d) there was a correlation between the severity of alcohol and nicotine dependencies. The results of this study may help to clarify the difficulty of treating tobacco dependence in alcoholics.

Adult↗

PubMed1995

Parental history of alcoholism: a risk factor for alcohol-related peripheral neuropathies.

The aim of this study was to identify the risk factors of alcohol-related peripheral neuropathies. A case-control study was performed to compare two groups of alcoholic patients, one with peripheral neuropathy and the other without, but with alcohol-related cirrhosis, pancreatitis or cardiomyopathy. Ninety patients were recruited in four in-patient units of a French hospital: 32 patients had a peripheral neuropathy and 58 patients did not. Univariate analysis showed no differences between the two groups for sex, age, body mass index and duration of the alcoholic disease. Peripheral neuropathies were associated with a higher frequency of parental history of alcoholism, severity of alcohol dependence, heavier alcohol consumption and more alcohol-related somatic diseases. Multivariate analysis showed a strong relationship between a parental history of alcoholism and the presence of a neuropathy, when the severity of the alcoholic disease was taken into account (adjusted OR = 6.8, IC95% [2.2-21.6], P < 0.001). The hypothesis that neuropathy may be a marker of an inherited susceptibility to alcoholism is discussed.

Adult↗

PubMed1993

[Chlamydia trachomatis: risk factors in women in the Parisian region. Importance of smoking and cervical ectropion].

A study of chlamydial infection and its clinical correlates was undertaken collaboratively among french women attending sexually transmitted disease (STD, prenatal, and teen clinics (n = 148). A complete sexual and gynecologic history and pelvic exam was performed on all women. Endocervical and urethral cultures were obtained for C. trachomatis and N. gonorrhoeae. Reason for visit included suspected STD in 97% of STD, 5% of prenatal and 17% of teen women. N. gonorrhoeae was isolated from STD clinic patients only (17%). C. trachomatis was found in 22% of teen, 17% of STD and 2% of prenatal clinic women. C. trachomatis was significantly associated with smoking, a history of urethral discharge in the male partner, and endocervical ectopy > 50% of total cervical surface.

Adolescent↗

PubMed1991

Lead-exposed workmen and fertility: a cohort study on 354 subjects.

A cohort study was conducted in a French battery factory in 1977-1982 to explore the relationship between occupational lead exposure and fertility. A total of 354 battery workers, divided into 229 lead-exposed subjects (corresponding with 886 person-years) and 125 non-lead-exposed subjects (corresponding with 598 person-years) were compared, in a person-year analysis, for the risk of infertility. Lead exposure, at any level of absorption, did not appear significantly associated with a reduction in fertility after controlling for potential confounders: age, French origin, educational level, number of children at start of the period, cigarette smoking and exposure to heat. The apparent inconsistency between our results and those of several studies involving biological data and semen analysis is partially explained by recent knowledge relating to predictive value on the pregnancy of semen abnormalities.

Adult↗

PubMed1991

The problem of a covariate-time qualitative interaction in a survival study.

We introduce a test for the equality of two survival distributions against the specific alternative of crossing hazards. Although this kind of alternative is somewhat rare, designing a test specifically aimed at detecting such departures from the null hypothesis in this direction leads to powerful procedures, upon which we can call in those few cases where such departures are suspected. Furthermore, the proposed test and an approximate version of the test are seen to suffer only moderate losses in power, when compared with their optimal counterparts, should the alternative be one of proportional hazards. Our interest in the problem is motivated by clinical studies on the role of acute graft versus host disease as a risk factor in leukemic children and we discuss the analysis of this study in detail. The model we use in this work is a special case of the one introduced by Anderson and Senthilselvan (1982. Applied Statistics 31, 44-51). We propose overcoming an inferential problem stemming from their model by using the methods of Davies (1977, Biometrika 64, 247-254; 1987, Biometrika 74, 33-43) backed up by resampling techniques. We also look at an approach relying directly on resampling techniques. The distributional aspects of this approach under the null hypothesis are interesting but, practically, its behaviour is such that its use cannot be generally recommended. Outlines of the necessary asymptotic theory are presented and for this we use the tools of martingale theory.

Biometry↗

PubMed1990

Homogeneity of relative risk against two-step alternatives.

In this paper the computational aspects of testing the null hypothesis of homogeneity of relative risk against two-step alternatives are examined. This representation is the same as that introduced by Anderson and Senthilselvan (Appl. Stat. 31 (1982) 44-51), i.e. a two-step model. Such alternatives may be used to represent decay in effect or, perhaps, inversion of the regression effect or crossing hazards. For such models inferential aspects are slightly more involved than for instance with proportional hazards models having fixed effects, even when time dependent as in O'Quigley and Pessione (Biometrics 45 (1989) 135-144). The necessary techniques for carrying out tests based on the two-stage model have recently been developed (O'Quigley and Pessione (Biometrics (1990) (in press] and in this paper we outline the necessary steps to be taken in the construction of algorithms to implement the proposed procedures. Programs enabling analyses based on the assumption of homogeneity of risk are very widely available. These include software packages such as BMDP, SAS, SPSS and GLIM. In the output of these packages, as well as that from most other standard routines, is contained all the necessary information to carry out the tests proposed by O'Quigley and Pessione. Here we detail the explicit formulae needed for carrying out the calculations in practice. The special cases of crossing hazards are considered in detail.

Mathematical Computing↗

PubMed1989

Score tests for homogeneity of regression effect in the proportional hazards model.

A simple model, containing the proportional hazards regression model as a special case, is presented. The purpose of the model is to provide a framework in which specific alternatives to the proportional hazards assumption may be tested. Rank-invariant score tests for linear, quadratic, or exponential trends can, for instance, all be undertaken within this framework. In the case of the two-sample problem the required calculations are shown to take a particularly simple form. Special consideration is given to the two-sample case in which there is an inversion of the regression effect, i.e., where the hazard functions cross at some given point. Both of the motivating examples are concerned with this problem. Computational aspects are relatively straightforward and some discussion on this is provided.

Actuarial Analysis↗

PubMed1989

[Prognosis of spontaneous ascitic infection in cirrhotic patients].

The aim of this retrospective study was to define prognostic factors for cure and survival after spontaneous bacterial peritonitis. In a 4-year period from 1982 to 1986, spontaneous bacterial peritonitis was diagnosed in 38 consecutive hospitalized cirrhotic patients (positive ascites culture and polymorphonuclear cell concentration greater than 250 cells per mm3). Twenty-five patients recovered from their infection (69 p. 100) in a mean time of 9 +/- 7 days. The cumulative survival was 68 p. 100 at one week, 50 p. 100 at one month, and 25 p. 100 at one year. The best independent prognostic factors for lack of cure from peritonitis were a low ascitic pH value (p less than 0.001), an elevated serum creatinine level (p = 0.01) and the presence of hepatocellular carcinoma (p less than 0.05). The best prognostic factors for death were low ascitic pH value (p = 0.001) and gastrointestinal hemorrhage (p = 0.005). A low ascitic pH value was correlated with other signs of severe infection (signs of generalized infection, ongoing infection during the first week after diagnosis), with signs of severe liver disease (encephalopathy, hepatocellular carcinoma) or severe renal dysfunction (high serum creatinine level, low arterial pH value). Because of the late high-death rate associated with spontaneous bacterial peritonitis, liver transplantation should be considered in these patients.

Bacterial Infections↗

PubMedDate not supplied

Sexual behavior and smoking: risk factor for urethritis in men.

Two hundred men who had symptoms of urethritis and 207 controls were interviewed. Because 60% of the men were of foreign nationality, the analysis of risk factors for urethritis was undertaken separately for the French and foreign subpopulations. The risk factors for urethritis were different for the French and foreign men. For the French men who had smoked, the risk of infection was 2.9 times greater than that for men who had never smoked (95% confidence interval, 1.2-7.6), after taking type of sexual behavior into account. There is a significant increase in the risk of urethritis when the amount of tobacco consumed daily increases (P less than 0.02). This finding suggests that smoking is an independent risk factor.

Chlamydia trachomatis↗