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Biomedical subjects

J Fournet

Publications and source records attributed to J Fournet.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Severe and recurrent digestive hemorrhage: an uncommon form of colonic schistosomiasis].

Schistosoma mansoni infection is frequent in certain areas of the world in which it is endemic. It is characterised by colonic and hepatic lesions. Gastrointestinal hemorrhages due to rupture of esophageal varices in case of hepatic involvement or moderate rectal bleeding due to colonic involvement may also be observed. We report a case of colonic Schistosoma mansoni infection presenting exclusively with recurrent episodes of serious gastrointestinal hemorrhage without hepatic lesions. All diagnostic investigations were negative. The diagnosis was only established on histological examination of the operative left hemicolectomy carried out with the utmost emergency for the serious recurrent hemorrhage. Histological examination revealed the presence of mucosal micro-ulcers, capillary neovascularization in the submucosa and serosa, and the presence of fibrous nodules and giant cell granulomas surrounding the eggs of Schistosoma mansoni in the serosa. This case is original by its clinical presentation and the difficulty to diagnose the Schistosomiasis.

Adult↗
PubMed1994

[Is the intestinal lavage with a solution of mannitol effective in the prevention of post-hemorrhagic hepatic encephalopathy in patients with liver cirrhosis? Results of a randomized prospective study].

OBJECTIVES: The aim of this study was to evaluate the usefulness of whole gut irrigation with a mannitol solution in the prevention of hepatic encephalopathy in patients with cirrhosis and bleeding oesophageal or gastric varices. METHODS: The randomized prospective study included 40 patients with a mean age of 59.6 +/- 9.6 years. Bleeding was controlled by a Blakemore or Linton haemostatic tube, in all cases. The patients were divided into a "mannitol" group (n = 20) treated by whole gut irrigation with a 5 L solution containing 40 g/L of mannitol, and a "control" group (n = 20). The two groups did not differ for age, sex, aetiology of cirrhosis or gastrointestinal bleeding, Child-Pugh classification, delay of minimum fare or the number of transfused blood units. The onset of hepatic encephalopathy was investigated within the first 48 hours after the beginning of gastrointestinal bleeding. The grade of hepatic encephalopathy was established using an index with 4 criteria (mental status, asterixis, number connection test, arterial ammonia concentrations), each with 5 grades of severity. RESULTS: There were no adverse side-effects in the mannitol group. The incidence of hepatic encephalopathy (5 vs 30%) and the length of hospitalization (8.2 +/- 2.3 vs 13.6 +/- 3.1 days) were significantly decreased in the mannitol group (P < 0.05). Mortality was not different between the 2 groups (P = 0.4). CONCLUSION: Whole gut mannitol irrigation appears to be an effective, simple, inexpensive, well tolerated technique in the prevention of hepatic encephalopathy after variceal bleeding in patients with cirrhosis.

Aged↗
PubMed1993

[Predictive factors for healing of esophagitis. Prospective study during ranitidine therapy].

This study was conducted to identify factors predicting favourable outcome after ranitidine 300 mg o.d. treatment for oesophagitis. Patients with grade 2 or 3 erosive oesophagitis were included in the study. Each investigator recruited 2 patients with the same grade of lesion in order to minimize bias in assessing symptoms. All patients received the same 6-week treatment: 300 mg ranitidine daily in the form of an effervescent tablet after the dinner. Symptomatology was assessed after 2 and 6 weeks of treatment and endoscopy was performed at the end of the treatment period. A successful outcome was defined as the absence of erosive lesions (grade 0 or 1). A total of 515 patients were recruited and 500 retained for analysis (15 patients did not follow the treatment protocol correctly): 267 grade 2 and 233 grade 3 (mean age: 52.5 years; sex ratio M/F: 1.7). Patients with grade 3 oesophagitis had more severe symptoms; hiatal hernia was also more frequent in this group. Alcohol intake and smoking habits were similar in both groups. After 6 weeks of treatment, successful healing was observed in 87 percent of the grade 2 patients and in 72 percent of the grade 3 patients. Three factors predicting successful outcome were found: grade 2 (odds ratio (OR): 1.50; p = 0.001), symptom duration less than 30 days after treatment onset (OR: 1.50; p = 0.001) and complete relief of symptoms after two weeks of treatment (OR: 1.31; p = 0.03). Disease history and the course of symptoms during treatment with ranitidine could help predict endoscopic outcome of oesophagitis.

Endoscopy, Digestive System↗
PubMed1993

Role of upper esophageal reflex and belch reflex dysfunctions in noncardiac chest pain.

Fifty-four patients examined for noncardiac chest pain (NCCP), showing no esophageal motor disorder or gastroesophageal reflux disease compatible with NCCP, were subjected to an intraesophageal balloon distension test and a study of the belching reflex provoked by intraesophageal air injection. Thirty-three control subjects were also studied, allowing us to define high-threshold belchers (group I) as those who belched during two of three 40-ml distensions and low-threshold belchers (group II) as those who did not. The balloon distension test induced NCCP in 64% of the patients in group I, and in 14% of the patients in group II (P < 0.01). High-threshold belching was a factor favoring the positivity of the balloon distension test. This result supports the hypothesis that esophageal distension by air due to a belching disorder may be the mechanism responsible for NCCP in some patients with an abnormal sensitivity to balloon distension.

Air↗
PubMed1993

[Churg-Strauss syndrome with rectal localization and exudative enteropathy].

The authors report the case of a 61-year old patient with a Churg-Strauss syndrome revealed by abdominal pain. Investigations showed a diffuse inflammatory digestive tract involvement, documented by endoscopy associated with protein-losing enteropathy. Deep rectal biopsy revealed vasculitis in an otherwise macroscopically normal rectum. Faced with acute and life-threatening course of disease, emergency medical treatment with steroids and cyclophosphamide led to rapid regression of clinical, biological and radiological abnormalities.

Barium Sulfate↗
PubMed1992

Chronic intestinal pseudoobstruction with myopathy and ophthalmoplegia. A muscular biochemical study of a mitochondrial disorder.

The association of chronic intestinal pseudoobstruction with ophthalmoplegia has been reported previously in visceral myopathies. We report a case of this association in which muscle mitochondria had a crystalline appearance, a dense core, and decreased cytochrome c oxidase and succinate cytochrome c reductase activities. The absence of evident mitochondrial DNA deletion in the skeletal muscle of this patient does not exclude the possibility of localized deletion or mutation of mitochondrial DNA in digestive muscle.

Chronic Disease↗
PubMed1992

[Barrett's esophagus, gastroesophageal acid reflux and duodenogastric reflux during the digestive and postprandial period].

Pathologic gastroesophageal acid reflux appears to be involved in the pathogenicity of Barrett's esophagus. The possible pathogenic role of duodenogastric reflux, however, has been suggested by several studies. The aim of this prospective study was to assess the prevalence of acid or duodenogastric reflux in patients with Barrett's esophagus. Nine patients with histologically proven Barrett's esophagus (mean length: 7.7cm; range: 2-13 cm) were studied by esophageal manometry and 24 hour pHmetry. Duodenogastric reflux was measured in the interdigestive period by aspiration and during the postprandial period using an isotopic method. The results of these different investigations were compared with healthy volunteers (n = 20 to 27). Three patients had complicated Barrett's esophagus (Barrett's ulcer: n = 2, high-grade dysplasia: n = 1). The results of the different investigations showed that a) all patients had abnormal acid exposure and an esophageal motor dysfunction (decrease in lower esophageal sphincter pressure, amplitude and duration of contractions and increase in percentage of peristaltic dysfunction); b) none of the patients had any pathologic duodenogastric reflux neither in the interdigestive nor in the postprandial period. These results a) confirm the high prevalence of acid reflux in patients with Barrett's esophagus, b) show that bile or pancreatic secretions are not involved in the pathogenicity of Barrett's esophagus.

Adult↗
PubMed1990

Scintigraphic study of gallbladder emptying and duodenogastric reflux during non-ulcerous dyspepsia.

Cholescintigraphy with technetium 99m hydroxy imino diacetic acid (99mTc-HIDA) was used to study gallbladder emptying (GE) and duodenogastric reflux (DGR) simultaneously during the postprandial period in humans. Two groups of subjects were examined prospectively; one was a group of healthy volunteers (n = 14) and the other a group of patients with non-ulcerous dyspepsia (NUD) (n = 22). Symptoms were quantified using a clinical score (CS). GE kinetics was quantified according to two indices. DGR episodes were detected by an image-subtraction method and quantified. The group of patients with NUD showed significant early acceleration of GE (P less than 0.01). One DGR episode equivalent to 1% of the injected dose was observed in 1 of the 14 control subjects, and greater than 1% in 3 of the 22 NUD patients. However, there was no correlation between the CS, GE kinetics and DGR episodes. The physiopathological mechanism and clinical significance of these digestive motility anomalies remain to be demonstrated.

Adult↗
PubMed1990

Is there an abnormal fasting duodenogastric reflux in nonulcer dyspepsia?

A quantitatively and/or qualitatively abnormal duodenogastric reflux (DGR) could be involved in the pathogenesis of nonulcer dyspepsia (NUD). The aims of this prospective study were to look for (1) a pathological DGR profile during fasting and (2) an eventual correlation between DGR profile and clinical symptoms. Twenty-six NUD patients were investigated. Seven other operated patients with a surgical procedure facilitating DGR episodes and 27 healthy volunteers served as control groups. A clinical score was determined for each patient from a standardized questionnaire. Gastric aspiration was performed for 6 hr in fasting subjects. The aspirates were pooled into 17 samples. In each sample the concentration and the output of total bile acids was determined. If the concentration was larger than 30 mumol/liter in pooled samples, the concentrations of free bile acids and the distribution of the conjugated bile acids was determined. The percentage of aliquots with a total bile acid concentration larger than 50 mumol/liter (without upper limit), and the percentage with a concentration larger than 2500 mumol/liter was also obtained. No significant difference was demonstrated between the healthy volunteers and NUD patients, whatever the parameter considered. However, there was a significant increase in each of the quantitative parameters for the group of operated patients in comparison with the NUD patient group. No significant correlation was found between the clinical score and the DGR profile in NUD patients. Apparently, DGR episodes do not play a primary role in the pathogenesis of NUD.

Adult↗
PubMed1990

Double-blind comparison of cisapride and cimetidine in treatment of reflux esophagitis.

In a double-blind, randomized, comparative trial of the prokinetic drug cisapride and the H2-blocker cimetidine, mucosal healing and changes in symptoms of gastroesophageal reflux were evaluated in patients with erosive reflux esophagitis. The patients were treated with either cisapride, 10 mg four times a day (N = 36) or cimetidine, 400 mg four times a day (N = 37) for six weeks, or for 12 weeks if mucosal healing was not obtained by week 6. Upon entry, two thirds of the patients in each group had grade I (Savary-Miller) esophagitis, and the remainder grade II or III. At the end of treatment, endoscopy showed mucosal healing in 56% (38-72%; 95% confidence interval) of cisapride and 57% (39-73%; 95% confidence interval) of cimetidine patients. After six weeks, both drugs significantly (P less than 0.01) decreased the intensity and frequency of heartburn, regurgitation, and the postural syndrome. No significant intergroup differences were found regarding endoscopic parameters or the improvement of heartburn and regurgitation. Concomitant antacid use was also comparable. Adverse effects were reported by four cisapride and nine cimetidine patients. These results indicate that the effects of cisapride compare well with those of cimetidine in terms of both esophageal mucosal healing and symptom relief.

Adult↗
PubMed1990

Randomized double-blind clinical trial of aluminum phosphate versus ranitidine in the acute treatment of duodenal ulcer.

A randomized double-blind clinical trial of aluminum phosphate versus ranitidine in the treatment of noncomplicated acute duodenal ulcer has been conducted in 91 patients. After randomization the 42 patients of the aluminum phosphate group were comparable to the 49 patients of the ranitidine group. At 4 weeks, 6 patients were not endoscoped and according to the intention-to-treat method they were considered as treatment failure. The endoscopy showed a 60% healing rate in the aluminum phosphate group (25/42) versus 55% in the ranitidine group (27/49); this difference was not significant. Among the factors assessed, only one, the round shape of the ulcer, was significantly and independently associated with ulcer healing in a multidimensional analysis. In conclusion, this double-blind trial showed that aluminum phosphate is an effective, save and cheap treatment of acute duodenal ulcer.

Aluminum↗