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Biomedical subjects

J C Chaput

Publications and source records attributed to J C Chaput.

At least 91 records · Page 5Linked to original sources
PubMed1988

[Hepatic involvement in HIV 1 virus infection].

One hundred consecutive patients with serum antibodies against HIV 1 were evaluated for the prevalence and the type of liver injury. According to the CDC classification, 16 patients belonged to group II (asymptomatic patients), 47 to group III (persistent generalized lymphadenopathy) and 37 to group IV (11 constitutional disease, 19 secondary infectious diseases, 5 secondary cancers, one chronic lymphoid interstitial pneumonitis and one visceral leishmaniasis). Liver histology was studied in 32 patients. Clinical, biological and histologic abnormalities were assessed according to the clinical group and to the number of T4 lymphocytes. The prevalence of HBV infection was determined by HBV DNA and monoclonal antibodies. Clinical hepatic abnormalities were rare (13 p. 100) and no difference was found between groups. Transaminases or GGT activities were elevated in 60 p. 100 of all cases. Serum GGT activity was higher and serum albumin lower in patients in group IV. HBV infection markers were less frequently found in patients with opportunistic infection (74 p. 100) than in asymptomatic patients (100 p. 100; p less than 0.05). Prevalence of serum HBsAg detected by poly- or monoclonal antibodies was very high (29 p. 100) in all clinical groups. Prevalence of serum HBsAg detected only by monoclonal antibodies (10 p. 100) suggest infection of these patients by an HBV variant. Of the 32 patients undergoing liver histology, only 5 (16 p. 100) had signs of activity. There was no association between clinical or histologic signs and the number of T4 lymphocytes per ml. Alkaline phosphatase, ASAT and GGT activities were higher and serum albumin lower in patients with less than 200 T4 lymphocytes per ml.

Adolescent↗
PubMed1988

[Sclerotherapy of esophageal varices using ethanol in combination with propranolol: clinical study of 30 patients].

A prospective study was conducted in 30 patients to assess the efficacy and safety of endoscopic sclerotherapy with absolute alcohol associated with propranolol for prevention of recurrent variceal bleeding. Patients were included if propranolol alone had failed or if they had at least three factors which increased the risk of rebleeding although the patients were receiving propranolol; two patients were treated by sclerotherapy only because of contraindications to propranolol. Etiology of portal hypertension was cirrhosis in 29 patients and portal vein thrombosis in one patient. Seventeen patients were grade A and 13 were grade B according to Child-Pugh's classification. The cumulative percentage of patients free of rebleeding 12 months after inclusion was 43 +/- 10 p. 100 (m +/- SD). The cause of recurrent bleeding was esophageal varices in nine patients and esophageal ulcers in five patients. The cumulative percentage of variceal rebleeding 12 months after inclusion was 61 +/- 10 p. 100. The cumulative percentages of patients free of rebleeding from varices were not significantly different between the Pugh A (64 +/- 14 p. 100) and Pugh B (56 +/- 15 p. 100) patients. The cumulative percentage of patients surviving 12 months after inclusion was 55 +/- 9 p. 100. The cause of death was not related to sclerotherapy in 11 patients. Two patients died of esophageal wall necrosis associated with mediastinitis. These two patients had received large volumes of sclerosing agent because of important bleeding during the last injection. Our results suggest that in patients without severe cirrhosis who cannot be treated by propranolol alone, the risk of rebleeding and the risk of death are high despite sclerotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

[Development of an expert system as a teaching aid in the serological diagnosis of acute viral hepatitis].

The serological diagnosis of acute viral hepatitis is complex for both practitioners and students. We have developed an expert system to teach the serological diagnosis of acute viral hepatitis in order to help non-specialists in deciding on the diagnosis. Three levels of increasing difficulty have been devised. The procedure consists of the following steps: choice of first-line examinations; discontinuation of the examinations in cases where the diagnosis is ascertained; choice of the most discriminant examination in cases where the diagnosis is doubtful. The value of this computer-assisted teaching must be confirmed by randomized studies involving a group of students trained by "classical" methods and a group of students trained by a computer-assisted method.

Diagnosis, Computer-Assisted↗
PubMed1987

[Palliative treatment of cancers of the esophagus and cardia with neodymium YAG laser: short-term results and multidimensional analysis of factors related to functional improvement and tumor destruction].

The aim of this study was to report initial results of endoscopic Nd YAG laser therapy in palliative treatment of esophageal and cardial carcinoma and to define parameters that could predict initial outcome. Of 116 patients, 95 men and 21 women (mean age 68 years, range 33-94 years), 6 patients presented with inaccessible, completely obstructing squamous cell carcinoma. Of these 6 tumors, 5 were located in the cervical esophagus. Seventy-two patients with squamous cell carcinoma and 38 patients with adenocarcinoma were treated. Improvement of dysphagia was achieved in 90 of 110 patients (82 p. 100) after 2.8 sessions (range 2-7 sessions). Total destruction of the intraluminal tumor was achieved in 66 patients (60 p. 100) after 3.3 sessions, partial destruction in 36 patients (33 p. 100) after 4.3 sessions and treatment had no effect in 8 patients (7 p. 100) after 3.8 sessions. Forty-four of the 52 impassable stenoses with the Olympus GIFP3 endoscope were passed through with the Olympus GIFQ endoscope after 3.7 sessions. Six complications occurred: 1 esophageal perforation and 5 esobronchotracheal fistulas. Improvement of dysphagia and tumoral destruction were analyzed in two manners. Of 13 selected variables, 3 were significantly related with improvement of dysphagia after stepwise logistic regression: destruction of intraluminal tumor (p = 0.003), endoscopic fungating appearance (p = 0.03) and the age related type of surgical contraindication (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1987

[Treatment of gastroesophageal reflux: analysis of randomized double-blind trials].

The aim of this study was to analyze the results and the quality of methodology of 51 controlled double blind trials in the medical treatment of gastroesophageal reflux. The results of H2 receptor antagonist treatment were evaluated by the pooling method. Evaluation of methodology was carried out by using a special form filled in by two independent observers. The major criticisms in methodology were: small sample size, unblind evaluation of end-points, inappropriate statistical tests for small samples, and inaccurate handling of the withdrawals. There were only two trials concerning antacids versus placebo: one showed that Novaluzid improved symptoms and another that Maalox did not differ from placebo. The effectiveness of alginic acid and domperidone on either symptoms or endoscopic lesions was not demonstrated. Metoclopramide and bethanechol produced significant relief of reflux symptoms. Sucralfate and bethanechol were better than placebo in improvement of esophagitis endoscopic lesions. The H2-inhibitors efficiently relieved symptoms and esophagitis. Pooling analysis showed that H2-inhibitors were superior to placebo in the healing of esophagitis; the odds ratios were 2.5 for cimetidine and 3.3 for ranitidine, without significant difference. Omeprazole was better than ranitidine in relief of symptoms and esophagitis. The comparison of cimetidine alone with cimetidine plus metoclopramide showed that combined therapy was better in one trial out of two. New controlled trials are necessary to compare these different drugs and their association.

Clinical Trials as Topic↗
PubMed1987

Reduction of the observed prevalence of so-called non-A non-B hepatitis using sensitive markers of HBV and herpes viruses infections.

In the absence of a specific marker, the observed prevalence of so called non-A non-B hepatitis depends on the sensitivity of the markers of the other viral infections known to induce hepatitis. We have reevaluated this prevalence after using sensitive markers of HBV (HBs monoclonal radioimmunoassay M-RIA and IgM anti-HBc), EBV (IgM anti-VCA), CMV (IgM anti-CMV) and HSV (IgM anti-HSV) in a group of 53 subjects usually considered as having acute or chronic hepatitis. Detection of IgM against HBc, CMV and HSV used immunocapture tests. Among the 37 patients with acute hepatitis, 11 (30 p. 100) were positive for at least one sensitive marker, including 10 markers of HBV (7 M-RIA and 3 IgM anti-HBc) and one IgM anti-CMV. Among the 16 patients with chronic hepatitis, one was positive for HBV by M-RIA; five patients had a false positive reaction to EBV (IgM anti-VCA) disappearing when rheumatoid factor was eliminated. This study shows that many cases of the so-called non-A non-B hepatitis are in fact due to HBV or to a variant of HBV. Definition of non-A non-B hepatitis must include subjects negative for HBV by M-RIA and IgM anti-HBc and negative for CMV by IgM anti-CMV.

Acute Disease↗
PubMed1987

[Prognosis of acute viral hepatitis in patients with alcoholic cirrhosis].

We report 20 cases of alcoholic cirrhosis with superimposed episodes of acute viral hepatitis. Four had acute type B hepatitis and 16, presumed non A non B hepatitis. Before hepatitis, 17 patients had stopped drinking and only four had a complicated cirrhosis. Eighteen patients had received a blood transfusion within the 6 months before the occurrence of hepatitis (mean: 52 days). All patients developed jaundice, 7 encephalopathy, and 5 ascites. The ASAT/ALAT ratio was greater than 1 in 18 patients. Two patients died of hepatic failure. Follow-up was known in 17 of the 18 surviving patients: in all patients jaundice disappeared and transaminases returned to values less than 3 times the upper limits of normal. In our experience, the prognosis is good when viral hepatitis occurs in patients with non complicated alcoholic cirrhosis.

Acute Disease↗
PubMed1986

[Palliative treatment of adenocarcinoma of the rectum by Nd-YAG laser. Immediate and long-term results. Study of factors related to the initial destruction of the tumor].

Fourty-five patients, 28 men, 17 women (mean age 73 +/- 18 yrs) with rectal carcinoma underwent palliative endoscopic neodymium YAG laser therapy. Rectal hemorrhage ceased in 89 p. 100 of affected patients after 3 +/- 2 sessions and a normal rectal transit was restored in 80 p. 100 of affected patients after 3 +/- 1 sessions. Total destruction of intraluminal tumor was achieved in 40 p. 100 of patients after 4 +/- 1 sessions. Symptomatic improvement was more frequent in patients in whom total destruction of intraluminal tumor was achieved (p less than 0.01). Stepwise logistic regression selected 2 independent variables capable of predicting tumoral destruction: the kind of surgical contraindication, more often related to cancer extension (p less than 0.001) and a greater tumor length (p less than 0.03) in patients in whom destruction of intraluminal tumor was incomplete. Twenty-eight patients were subsequently treated after palliation was achieved. Cumulative probability of remaining improved at 6 months when treatment was not stopped was 40 p. 100 (confidence limits to 95 p. 100: 23 p. 100-59 p. 100). Five complications occurred, 3 rectovaginal fistulas and 2 stenosis.

Adenocarcinoma↗
PubMed1986

[Ulcerative colitis caused by Histoplasma capsulatum in a patient with the acquired immunodeficiency syndrome].

The authors report a case of ulcerative colitis due to Histoplasma capsulatum in a previously healthy 35 year-old french geologist with acquired immune deficiency syndrome (AIDS). Gomori-Grocott and PAS stains and indirect immunofluorescence revealed Histoplasma capsulatum in colonic biopsies. The search for LAV antibody was positive. T-lymphocyte analysis revealed 10/mm3 OKT4 with OKT4/OKT8 ratio of 0.16. Histoplasmosis should be considered in subjects with ulcerative colitis according to the epidemiological context. In patients with AIDS relapses after discontinuation of treatment are to be expected and suppressive therapy with an imidazole derivative should probably be continued indefinitely.

Acquired Immunodeficiency Syndrome↗
PubMed1985

[Simultaneous detection of IgM antibodies against the hepatitis A virus and the viral capsid antigen of Epstein-Barr virus in acute hepatitis].

The simultaneous detection of IgM antibodies to hepatitis A virus (anti-HAV IgM) and IgM antibodies to viral capsid antigen (anti-VCA IgM) of Epstein-Barr virus (EBV) in patients with acute viral hepatitis has led us to systematically study serological markers of EBV in patients with anti-HAV IgM positive acute hepatitis and to test for anti-HAV IgM in sera of patients with acute hepatitis associated with serological evidence of current primary EBV infection. All patients studied were HBsAg negative and were not drug-addicts, nor homosexuals. In 15 consecutive patients with anti-HAV IgM positive acute hepatitis, anti-HAV IgM and anti-VCA EBV IgM antibodies were simultaneously detected in 9 cases. Of these 9 patients, antibodies to nuclear antigen were positive in 8 cases, antibodies to early antigen were positive in 7 cases and rheumatoid factor was positive in 4 cases. In 5 consecutive patients with acute hepatitis associated with serological evidence of current primary EBV infection, anti-HAV IgM was not detected. Simultaneous presence of anti-VCA EBV IgM, early antigen IgG antibodies and nuclear antigen antibodies in 7 patients with acute hepatitis associated with anti-HAV IgM suggests reactivation of EBV or reactivation of clones secreting antibodies anti-EBV in HAV infections. Furthermore, these results show that anti-VCA IgM only cannot be considered to be a specific marker of early EBV infection in patients with acute hepatitis.

Acute Disease↗
PubMed1984

[Peri-anal ulceration. Tuberculosis should not be overlooked].

Two cases of peri-anal ulceration of tuberculous origin are reported: one revealed an active pulmonary and ileo-caecal tuberculosis, the other complicated a chronic pulmonary tuberculosis of several years' duration. Cutaneous manifestations of tuberculosis are exceptional. In patients with protracted peri-anal ulceration, a biopsy should be performed that will show a typical tuberculoid granuloma. The most frequently encountered anorectal tuberculous lesions are suppurations and fistulae. The main differential diagnosis is Crohn's disease with anorectal manifestations.

Adult↗