PubMed Health⌕ Search

Biomedical subjects

J C Grimaud

Publications and source records attributed to J C Grimaud.

At least 19 recordsLinked to original sources
PubMed2005

Long-term healing of Crohn's anal fistulas with fibrin glue injection.

BACKGROUND: Injecting fibrin glue has proved to be an effective means of treating anal fistulas (AF). There has been some debate, however, as to whether this technique should be used on the AF often involved in Crohn's disease (CD). AIM: To assess the effectiveness of injecting heterologous fibrin glue as a means of treating AF refractory to immunosuppressive treatment in patients with CD. METHODS: Fourteen CD patients (five men and nine women, average age 42 years) presenting with refractory AFs were included in this study. Heterologous fibrin glue was injected into the fistula tract under general anaesthesia under continuous endosonographic monitoring using a 7.5-MHz blind linear probe. The patients were followed up clinically and ultrasonographically for 3 months after the procedure, and then at regular intervals. RESULTS: Three months after the fibrin glue injection, the fistulas had completely dried up in 10 patients (71%), the leakage had decreased in one patient (7%), and no improvement was observed in the other three patients (21%). Endosonographic findings showed that the fistula tract had completely disappeared in two cases (14%). The fistula tract was found to be non-permeable in eight cases (57%), and no change in the fistula was observed in four patients (29%). At the end of the follow-up period [average 23.4 months (12-26 months)], the leakage had completely dried up in eight of the 14 patients (57%). No side effects were observed. CONCLUSION: Nearly 2 years after the use of a heterologous fibrin glue to treat an AF, over half of the patients with CD showed clinical signs of remission. Because it is easy to use and harmless as well as being effective, this method provides a good alternative to classical methods of surgical treatment.

Adult↗
PubMed2004

[Necrotizing enterocolitis during pregnancy in a woman operated on at six months of Hirschsprung's disease].

Necrotizing enterocolitis is a rare and severe complication of Hischsprung's disease. Aggravation of unknown or undertreated Hischsprung's disease may be seen during pregnancy. To our knowledge, the following case is the first combining those two elements: necrotizing enterocolitis in a 20 years old women operated on of Hischsprung's disease when she was six months. The final diagnosis was made 24 hours later. Definitive treatment was a three-stage ileal pouch-anal anastomosis.

Adult↗
PubMed2003

Retreatment with interferon and ribavirin vs interferon alone according to viraemia in interferon responder-relapser hepatitis C patients: a prospective multicentre randomized controlled study.

Low pretreatment viral load has consistently been shown to be an independent predictor of sustained response (SR) in patients with chronic hepatitis C infection. We assessed the efficacy of interferon (IFN) plus ribavirin vs IFN alone in low viraemic patients (<2 millions copies/mL) who had relapsed to a previous course of IFN and the efficacy of 24 vs 48 week combination therapy in high viraemic patients. Two hundred and ninety-seven patients were randomly assigned to one of the four regimens after stratification on pretreatment viral load. All patients received IFN-alpha2b (6 million units thrice weekly for 24 weeks and 3 million units thrice weekly for 24 weeks). Patients with low viraemia received either IFN-alpha2b alone for 48 weeks (R1: 42 patients) or IFN-alpha2b plus ribavirin (600 mg/day) for 24 weeks and IFN-alpha2b alone for the next 24 weeks (R2: 48 patients). Patients with high viral load received either IFN-alpha2b plus ribavirin for 24 weeks and then IFN-alpha2b alone for the next 24 weeks (R3: 104 patients) or IFN-alpha2b plus ribavirin for 48 weeks (R4: 103 patients). In low viraemic patients the rate of SR was 37.7% in group R1 and 59.6% in group R2 (P < 0.05). In high viraemic patients, the rate of SR was 44.7% in group R3 and 51.4% in group R4 (P: NS). Thirty-one patients discontinued treatment (10.4%) without difference regarding treatment regimen. In the regimen using ribavirin we found no difference in terms of SR between patients receiving a dose of ribavirin below 10.6 mg/kg/day (55%) or over 10.6 mg/kg/day (58%). Histological improvement occurred in 70.2% of patients regardless of the regimen. Logistic regression showed that genotype 2 and 3, Knodell score <6 and alanine aminotransferase pretreatment level >3 x upper limit of normal were significantly and independently correlated with SR. In low viraemic patients who relapsed to a previous IFN treatment, combination therapy using high-dose IFN and low-dose ribavirin is better than high-dose IFN alone. In high viraemic patients there was no benefit in increasing the duration of combination therapy from 24 to 48 weeks. In this study, it was found that low dose of ribavirin can be used safely and there is no effect of ribavirin dose on SR.

Adult↗
PubMed2002

Anal endosonography for assessment of anal incontinence with a linear probe: relationships with clinical and manometric features.

BACKGROUND AND AIMS: This study determined correlations of clinical and manometric features with those of anal endosonography (AES). PATIENTS AND METHODS: Between 1996 and 1999 we examined 58 patients suffering from anal incontinence (AI) by AES using a linear probe and anorectal manometry following a standardized protocol. RESULTS: Twelve of the 58 patients (21%) had a history of anal surgery. Of the 40 women who had under-gone at least one vaginal delivery 22 (55%) sustained an obstetric tear and 12 (30%) required forceps for delivery. A perineal descent was observed in 24 of 32 women with AI (75%) and urinary incontinence in 24 of 44 (54%). An anal sphincter defect was diagnosed in 45 of the 58 patients (77%). The internal anal sphincter defects occurring in 42 patients (72%) were significantly associated with a decrease in the resting anal pressure. The external anal sphincter defects occurring in 33 patients (57%) were significantly associated with a decrease in the voluntary anal contraction. CONCLUSION: Considering AES and manometric findings, a good correlation was observed between internal sphincter defect and the resting anal pressure and between external sphincter defects and the voluntary anal contraction. AI is usually associated with a global perineal insufficiency requiring special attention in terms of both training and medical management.

Adult↗
PubMed2002

Bifidobacterium animalis strain DN-173 010 shortens the colonic transit time in healthy women: a double-blind, randomized, controlled study.

BACKGROUND: A previous study has suggested that Bifidobacterium animalis DN-173 010 shortens the colonic transit time in women. AIM: To confirm this effect and to determine whether modifications of the faecal bacterial mass and/or faecal secondary bile salts may be the explanation. METHODS: A double-blind, cross-over study was performed. Thirty-six healthy women were studied in four consecutive 10-day periods. During periods 2 and 4, they ingested three 125 g cups per day of a fermented milk which was either a product containing B. animalis DN-173 010 or a control without bifidobacteria. Periods 1 and 3 were run-in and washout periods, respectively. The total and segmental colonic transit times were assessed using a pellet method. In 12 subjects, all stools were collected and analysed for pH, faecal weight, bacterial mass and bile acids. RESULTS: The total and sigmoid transit times were significantly shorter during dosing with B. animalis compared to the control period. The other transit times, faecal weight, pH, bacterial mass and bile acids were not significantly affected. CONCLUSIONS: B. animalis DN-173 010 shortens the colonic transit time in healthy women. This effect is not explained by modifications of the faecal bacterial mass or secondary bile acids.

Adult↗
PubMed2002

Early refeeding after endoscopic biliary or pancreatic sphincterotomy: a randomized prospective study.

BACKGROUND AND STUDY AIMS: Patients who have undergone endoscopic sphincterotomy (ES) are usually left to fast for arbitrary reasons until they are examined on the following day. The aim of this study was to check whether this systematic fasting after ES is actually justified. PATIENTS AND METHODS: A blinded randomized prospective study, involving 146 patients, was carried out from January 1999 to September 2001. All patients undergoing biliary and/or pancreatic endoscopic sphincterotomy during this period were randomly allocated to one of two groups: group 1 patients were re-fed 4 hours after ES, and the group 2 patients were only re-fed 24 hours after the procedure. These two groups were comparable for clinical and procedural data except for stenting. RESULTS: Eight patients in group 1 (11 %) and 26 patients in group 2 (37 %) suffered from abdominal pain which resolved with analgesic drug treatment (P = 0.01). Eight patients in the first group(11 %) and five patients in the second group (7 %) had to be given major opiate analgesics (P = 0.56). Refeeding resulted in abdominal pain in five patients in group 1 and 13 in group 2 (P = 0.04). The serum amylase and lipase levels increased significantly after refeeding in group 1, but lipasemia did not increase significantly in group 2. No significant differences in post-ES complications were observed between the two groups. The mean hospital stay was significantly shorter in group 1 : 2.6 days on average, vs. 3.8 days in group 2 (P = 0.03). CONCLUSIONS: In the absence of any perforation of the digestive tract or immediate severe acute pancreatitis, early refeeding could be helpful to decrease pain and shorten the hospital stay in patients who have undergone endoscopic sphincterotomy.

Amylases↗
PubMed2002

Complications of endoscopic sphincterotomy: results from a single tertiary referral center.

BACKGROUND AND STUDY AIMS: Complications of endoscopic sphincterotomy (ES) have been assessed in recent multicenter studies. The aim of this series was to report and identify risk factors for complications of ES at a single tertiary referral center. PATIENTS AND METHODS: Between 1996 and 2000, 1159 consecutive endoscopic retrograde cholangiopancreatographies (ERCP) procedures were performed and their related complications were assessed. A total of 658 patients (57 %) underwent ES. All the clinical, radiological and biological data were carefully recorded within the 30 days following the procedure. Multivariate analysis was performed using a stepwise logistic model. RESULTS: The morbidity rate for ES was 7.7 %, being moderate to severe in 5 %. Morbidity included acute pancreatitis (3.5 %), perforations (1.8 %), sepsis (1.2 %) and bleeding (1.2 %). The 30-day mortality was 0.9 %. In the 1159 ERCP procedures, 231 patients underwent precut papillotomy (20 %) followed by sphincterotomy in 174 cases. Using logistic regression analysis, the risk factors for ES were precut papillotomy (relative risk, RR 2.76), confidence interval, (CI 1.39 - 5.49) and the presence of sphincter of Oddi dysfunction (RR, 7.72, CI 3.2 - 18.4). CONCLUSIONS: In this single-center series, we found a complication rate of ES in about 7 %, comparable to that in multicenter series. Precut papillotomy and sphincter of Oddi dysfunction were the main independent risk factors for ES.

Female↗
PubMed2001

[Laparoscopic posterior fundoplication in gastroesophageal reflux: mid-term results].

STUDY AIM: The aim of this study was to report the mid-term results of the surgical management of gastroesophageal reflux disease (GERD) by laparoscopic posterior partial fundoplication (Toupet technique) in 100 patients, and to evaluate their post-operative quality of life. PATIENTS AND METHOD: Between November 1993 and January 2000, 100 patients were surgically treated for a medically refractory GERD. Laparoscopic posterior partial fundoplication was performed by the Toupet technique. In the postoperative period, the patients were asked to answer a questionnaire by telephone. The aim of this survey was three-fold: to identify clinical symptoms indicative of recurrence; to evaluate postoperative functional impairment; to assess the postoperative quality of life. pH monitoring was also proposed in asymptomatic patients at a minimum follow-up of two years, and in all patients with clinical symptoms of GERD recurrence. RESULTS: Six laparotomy conversions were necessary. The mean duration of follow-up was 18 months (range: 6 to 57 months). The rate of clinically diagnosed recurrence was 7.6%. Intermittent dysphagia was observed in 2.3% of cases. Postoperative digestive functional disorders were noted in 53% of patients without clinical recurrence, and 95.3% of them were satisfied or very satisfied with the results of surgery. CONCLUSION: Laparoscopic posterior partial fundoplication by the Toupet technique can satisfactorily treat GERD without mid-term recurrence in about 94% of cases. Patient satisfaction seems mainly to depend on the disappearance of clinical symptoms of GERD. It was found that postoperative functional disorders frequently occurred, but were well tolerated. Their etiology has not yet been determined, and it is considered that factors other than the surgical procedure may also play a role.

Adult↗
PubMed2001

[Risk factors for Crohn's disease relapse after treatment of intestinal stenosis].

BACKGROUND: Postoperative recurrences of Crohn's disease (CD) has been widely investigated in previous studies. Nevertheless, the risk factors for CD recurrence in patients presenting with intestinal stenosis are not clearly identified. PATIENTS AND METHOD: Thirty consecutive patients out of a cohort of 134 patients with CD presented with an intestinal stenosis diagnosed between 1995 and 1999. Epidemiological, clinical, and therapeutic data were carefully recorded. A univariate analysis followed by stepwise descending discriminant analysis was performed. RESULTS: Sixteen patients (53%) underwent surgery, six received steroid therapy, eight were given antibiotics, and seven took immunosuppressive drugs. The mean follow-up after medical or surgical management was 2.8 years. Thirteen patients (43%) had CD relapse during the follow-up. Considering the univariate analysis, the existence of a previous appendectomy and the persistence of tobacco consumption were significantly associated with the risk of CD relapse during the follow-up. The stepwise descending discriminant analysis identified three independant factors: tobacco consumption (p = 0.007), previous appendicectomy (p = 0.04) and duration of the follow-up (p = 0.02). CONCLUSION: The CD relapse after the management of small bowel stenosis occurred in 43% of the patients within a mean follow-up of 2.8 years. The significant factors associated with the risk of CD relapse were tobacco consumption, previous appendectomy and duration of the follow-up.

Adult↗
PubMed2001

Pseudotumorous chronic pancreatitis associated with inflammatory bowel disease.

Chronic pancreatitis associated with inflammatory bowel disease is now considered as extraintestinal manifestation of that disease. The clinical and radiological features of the new entity are markedly different from those of chronic calcifying pancreatitis. We report the case of a 68-year-old man presenting with a pseudotumorous chronic pancreatitis associated with ulcerative colitis. Diagnosis was made after endoscopic retrograde cholangiopancreatography (ERCP) and cytological analysis of stenosis brushings and was confirmed by the clinical evolution. Existence of IBD-associated pancreatitis with pseudotumorous features has to be taken into account in order to avoid inappropriate pancreatic resection.

Aged↗
PubMed2001

Biliopancreatic fistulas complicating pancreatic pseudocysts: a report of three cases demonstrated by endoscopic retrograde cholangiopancreatography.

Three patients were found to have fistulation of the pancreatic and common bile ducts, complicating chronic pancreatitis in one patient and acute pancreatitis in two patients. Closure of the fistula was achieved with biliary and pancreatic stenting in one patient; the other two patients were treated surgically because endoscopic treatment had failed. The clinical and radiological features of this exceptional complication are presented, with a brief review of the topic.

Aged↗
PubMed2001

Follow-up of selective endoscopic ultrasonography and/or endoscopic retrograde cholangiography prior to laparoscopic cholecystectomy: a prospective study of 300 patients.

BACKGROUND AND STUDY AIMS: This prospective study evaluated the selective use of endoscopic retrograde cholangiography (ERC) and endoscopic ultrasonography (EUS) in the context of laparoscopic cholecystectomy (LC). PATIENTS AND METHODS: Between 1993 and 1998, LC for symptomatic gallstones was indicated in 300 consecutive patients. In order to diagnose and treat choledocholithiasis preoperatively, we performed, on the basis of preoperative criteria, ERC in "high-risk" patients and EUS in "intermediate-risk" patients. Choledocholithiasis was treated by preoperative biliary endoscopic sphincterotomy (BES). LC was performed either after the endoscopic procedure or directly in "low-risk" patients. RESULTS: A total of 104 patients (35%) had 118 preoperative procedures: a) EUS (n = 68; feasibility 100%): choledocholithiasis was observed in 14/68 patients (21%); b) ERC (n = 50; feasibility 94%): 36 ERC were indicated on on preoperative criteria, and 14 on the basis of EUS results. Choledocholithiasis was found in 41/ 50 patients (82%) (13/14 patients with positive EUS), 19% of "intermediate-risk" patients, and 78% of "high-risk" patients; ERC failed in three patients who had no choledocholithiasis on subsequent intraoperative cholangiography (IOC). Clearance of the common bile duct (CBD) was achieved after BES in 41/41 patients. There was no mortality; complications occurred in 4/ 300 patients (1%). No retained stones were found in patients of any of the three groups, after a mean follow-up of 32 months. CONCLUSIONS: Combined endoscopic and laparoscopie management of cholecystolithiasis and choledocholithiasis is a viable option and is optimized by the use of EUS.

Adolescent↗
PubMed2000

Dynamic anal endosonography may challenge defecography for assessing dynamic anorectal disorders: results of a prospective pilot study.

BACKGROUND AND STUDY AIMS: The diagnosis of anorectal dynamic disorders and perineal insufficiency has been mainly based up to now on the use of defecography. Here, we performed a prospective blinded study to evaluate the accuracy of a new procedure, dynamic anorectal endosonography (DAE), by comparing it with defecography. PATIENTS AND METHODS: A total of 43 women (mean age 53), presenting with outlet obstruction, were prospectively enrolled in our study. The DAE was performed with a 7.5-Mhz linear probe (Toshiba, Tokyo, Japan) with basal and straining recordings. None of the DAE or defecography operators was informed about the results of the respective other investigation. RESULTS: Defecography showed a descending perineum in 29 patients (68%), a rectocele in 25 patients (58%), and a rectal intussusception in eight patients (18%). The rate of concordance between the diagnosis of descending urinary bladder at DAE and descending perineum at defecography was 35/43 (80%), and that between the descending puborectal muscle at DAE and descending perineum at defecography was 40/43 (93 %). The rates of concordance between DAE and defecography for the diagnosis of rectocele and rectal intussusception were 27/43 patients (57%) and 34/43 patients (80%), respectively. In the last 15 patients, the DAE technique was adapted in order to improve the accuracy for diagnosing rectocele by filling the rectum with water. This improved sensitivity from 36 to 86% and accuracy from 57 to 87%. CONCLUSIONS: DAE is a new imaging approach to anorectal dynamic disorders, providing a highly reliable means of diagnosing perineal insufficiency as well as rectocele. DAE should be substituted for previous methods since it makes it possible at the same time to assess the anal sphincters and to avoid pelvic irradiation.

Adult↗
PubMed1999

Prospective comparison of endosonography, magnetic resonance imaging and surgical findings in anorectal fistula and abscess complicating Crohn's disease.

BACKGROUND: Endosonography and magnetic resonance imaging (MRI) are promising methods for evaluating perineal and anorectal fistulas or abscesses. The aim of this study was to compare the results of anal endosonography (AES), MRI and surgical exploration in the assessment of anorectal fistula or abscess complicating Crohn's disease. METHODS: Twenty-two patients with Crohn's disease, seven men and 15 women of mean age 38 (range 17-67) years, were included in this prospective study. All patients underwent AES (linear probe 7 MHz), MRI and operative assessment. RESULTS: AES and MRI demonstrated 14 and nine abscesses respectively, whereas 11 abscesses were confirmed by surgical exploration in ten patients. The sensitivity of AES and MRI as means of evaluating anorectal abscesses was 100 and 55 per cent respectively. The agreement per patient was 86 per cent (19 of 22) for AES and 59 per cent (14 of 22) for MRI. AES and MRI demonstrated 26 and 14 fistulas respectively, whereas 27 fistulas were confirmed during surgical exploration in 16 patients. The sensitivity of AES and MRI was 89 and 48 per cent respectively. The level of agreement per patient was 82 per cent (18 of 22) for AES and 50 per cent (11 of 22) for MRI. CONCLUSION: AES with a linear probe is more accurate than MRI in detecting anorectal abscesses complicating Crohn's disease, and much more accurate in the evaluation of complex fistulas.

Abscess↗
PubMed1999

Chronic pancreatitis and inflammatory bowel disease: true or coincidental association?

OBJECTIVE: Several cases of pancreatitis have been described during the course of Crohn's disease (CD) or ulcerative colitis (UC), but many of them were related to either biliary lithiasis or drug intake. We tried to evaluate the clinical and morphological features of so-called idiopathic pancreatitis associated with inflammatory bowel disease and to define their pathological characteristics. METHODS: Chronic idiopathic pancreatitis was diagnosed on the basis of abnormal pancreatograms suggestive of chronic pancreatitis associated with or without impaired exocrine pancreatic function, or pathological examination in patients undergoing pancreatic resection. We found 6 patients presenting with features of chronic idiopathic pancreatitis and UC and 2 patients with CD seen between 1981 and 1996 in three hospital centers of the south of France. A review of the literature has identified 6 cases of pancreatitis associated with UC and 14 cases of pancreatitis associated with CD based on the above criteria. RESULTS: Hyperamylasemia was not a sensitive test since it was present in 44% and 64% of patients with UC or CD. In UC, pancreatitis was a prior manifestation in 58% of patients. In contrast, the pancreatitis appeared after the onset of CD in 56% of the cases. In patients with UC, pancreatitis were associated with severe disease revealed by pancolitis (42%) and subsequent surgery. Bile duct involvement was more frequent in patients with UC than with CD (58% vs 12%) mostly in the absence of sclerosing cholangitis (16% vs 6%). Weight loss and pancreatic duct stenosis were also more frequent in UC than in CD (41% vs 12% and 50% vs 23%, respectively). Pathological specimens were analyzed in 5 patients and demonstrated the presence of inter- and intralobular fibrosis with marked acinar regression in 3 and the presence of granulomas in 2 patients, both with CD. CONCLUSIONS: Pancreatitis is a rare extraintestinal manifestation of inflammatory bowel disease. Chronic pancreatitis associated with UC differs from that observed in CD by the presence of more frequent bile duct involvement, weight loss, and pancreatic duct stenosis, possibly giving a pseudotumor pattern.

Adolescent↗
PubMed1999

[Epidemiology of gastro-esophageal-reflux in general practice. . Predictive factors for health care utilization in the course of a year].

AIM: To assess the epidemiology and course of GORD, treatment demand, and factors predictive of GORD course in a 1-year study in patients with heartburn consulting general practitioners. METHODS: A total of 984 patients with pyrosis were included by general practitioners. After the initial visit, they had follow up at 3, 6 and 12 months by phone contact. RESULTS: Most patients (87%) had been suffering from heartburn for 4+/-1.5 years; upper GI endoscopy had been performed in 63% of patients. Patients evaluated the symptoms of the current episode as mild (6%), moderate (60%), or severe/incapacitating (34%). During the year of follow up, 12% of the patients were free of heartburn; the mean number of consultations with general practitioners and gastroenterologists was 5.1 and 0.5 respectively. At day 90, discomfort due to heartburn was absent in 4% of patients, slight in 51%, moderate in 32%, and severe in 6%. At day 360, predictive factors for discomfort were: discomfort related to heartburn on D90, the length of time the patients had been suffering from GORD, and the main reason for consultation on D1; patients for whom heartburn was not the main reason for consultation on D1 experienced a higher level of discomfort. The predictive factors for the extent of treatment demand over 12 months were: age, discomfort related to heartburn on D90, severity on D1, the frequency of episodes prior to the episode on D1 and the levels of stress and anxiety measured on D1. CONCLUSIONS: Epidemiologic characteristics of patients with heartburn consulting a general practitioner were different from these of the general population. Treatment demand depends both on severity of heartburn and level of stress and anxiety.

Adult↗
PubMed1998

Effects of trimebutine on sphincter of Oddi motility in patients with post-cholecystectomy pain.

BACKGROUND: Trimebutine is an opiate modulator of the gastrointestinal motility that interacts with enkephalinergic receptors. AIM: To evaluate the effects of trimebutine (50 mg intravenous injection) on the motility of the sphincter of Oddi (SO) as assessed by endoscopic manometry. METHODS: Endoscopic manometry was performed on 15 cholecystectomized patients who presented with symptoms suggestive of SO dysfunction. Prior to the endoscopic manometry, endoscopic ultrasonography was performed in order to rule out the possible presence of a bile duct stone. RESULTS: Injecting trimebutine resulted in a significant increase in the SO antegrade phasic contraction rate (P = 0.02). Trimebutine decreased the basal pressure of the SO (32.5 vs. 27.5 mmHg), but the difference is not statistically significant (P = 0.11). The effects of trimebutine differed depending on the basal SO motility anomalies involved, but the period of latency was similar (mean 89 s: range 30-240 s). The basal anomalies were an increased basal SO pressure of > 40 mmHg in three patients, a tachyoddia (frequency of phasic contractions (PC) > 10/min) in six patients, prolonged PC (> 10 s) in two patients and an absence of phasic contraction in one patient. The basal pressure of the SO decreased in the three patients presenting with SO hyperpressure, but returned to a normal value in one case. The frequency of the PC decreased to normal in three out of the six patients with tachyoddia. The duration of the PC returned to normal in the two patients with prolonged PC whereas their frequencies increased. Prolonged PC developed in the patient without any detectable phasic contraction. CONCLUSIONS: Trimebutine modulates SO motility in various ways depending on the basal SO motility anomaly observed after cholecystectomy. This regulatory effect suggests the existence of encephalinergic control of SO motility.

Adult↗