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Biomedical subjects

J P Pascal

Publications and source records attributed to J P Pascal.

At least 37 records · Page 2Linked to original sources
PubMed1990

[Obstructive intramural hematoma of the esophagus. A rare complication of endoscopic sclerotherapy of esophageal varices].

Obstructive intramural hematoma of the esophagus is an unusual complication of endoscopic sclerotherapy. We report three patients with liver cirrhosis who experienced such a complication. In our series, the frequency was 1.6 percent. A few hours after sclerotherapy, all three patients complained of low retrosternal pain, dysphagia and hypersialorrhea. Endoscopy was performed in two patients and showed a typical bluish submucosal mass occupying the esophageal lumen. Outcome was favorable in all patients within one week of conservative treatment. We hypothesized that hematoma could be ascribed to variceal puncture. The extension of the hematoma with dissection of the esophageal wall which had been fragilized by previous sclerotherapy sessions could have been facilitated by impaired coagulation.

Adult↗
PubMed1989

[Computerized tomographic diagnosis of hepatocarcinoma after injection of lipiodol into the hepatic artery].

Iodized oil (lipiodol) injected into the hepatic artery is selectively retained by hepatocarcinomas, as demonstrated by computerized tomography (CT) performed one week after the injection. The value of this technique for the diagnosis of hepatocarcinoma was assessed in a retrospective study of 45 patients. In 39 per cent of the cases intrahepatic tumoral extension was determined by the iodized oil which showed tumoral nodules that had not been detected by conventional methods, such as ultrasonography and CT alone. The lesions revealed by the iodized oil were small nodules around the main tumour. The combined iodized oil-CT technique plays an important role in the choice of treatment, especially when surgical excision is contemplated. It might also contribute to an early diagnosis of hepatocarcinoma in patients at risk, as illustrated by four of our cases where conventional morphological examinations had been negative.

Adult↗
PubMed1989

Propranolol does not alter cerebral blood flow and functions in cirrhotic patients without previous hepatic encephalopathy.

Since it has been suggested that propranolol could lead to hepatic encephalopathy, we undertook a study to assess the effects of propranolol on cerebral blood flow and cerebral functions. Sixteen patients with alcoholic cirrhosis and large esophageal varices and without major hepatic dysfunction (Child-Pugh score less than 14) or previous hepatic encephalopathy were randomized to receive either propranolol or placebo. The following measurements were performed before and 15 min after single intravenous administration of 15 mg propranolol or placebo and again 1 week after chronic oral administration of propranolol 160 mg per day or placebo: cerebral blood flow by the xenon-133 inhalation technique, quantitative electroencephalogram, psychometric test (number connection test), arterial ammonia, pH and pCO2, resting and exercise heart rates (after single administration, electroencephalogram, number connection test and biochemical measurements were not performed). Cerebral blood flow was not significantly modified by treatment (propranolol group: 80 +/- 23 vs. 76 +/- 11 and 83 +/- 9; placebo group: 73 +/- 10 vs. 75 +/- 11 and 81 +/- 18 ml per 100 gm per min, respectively, before and after single and repeated administration). Likewise, neither of the two treatments significantly altered number connection test, quantitative electroencephalogram index, arterial ammonia, pH and pCO2. We conclude that, in this population of cirrhotic patients, propranolol did not alter cerebral blood flow or neuropsychological functions. As a consequence, hemodynamic alterations cannot be considered as causes of possible cerebral side effects of propranolol in cirrhotic patients without severe hepatic dysfunction and previous hepatic encephalopathy.

Ammonia↗
PubMed1989

Verapamil has no effect on porto-hepatic pressure gradient, hepatic blood flow and elimination function of the liver in patients with liver cirrhosis.

This study aimed to assess the effects of verapamil, a calcium-channel blocker, on porto-hepatic pressure gradient and on hepatic function as measured by the intrinsic hepatic clearance of indocyanine green (ICG) in patients with biopsy proven alcoholic cirrhosis. Hepatic venous pressures and hepatic extraction of ICG were measured before and 60 min after intravenous injection of 10 mg of verapamil in 19 consecutive patients. Hepatic blood flow and intrinsic hepatic clearance of ICG were calculated in the 10 patients whose hepatic extraction fraction was higher than 10%. No significant difference was observed when comparing porto-hepatic pressure gradient (17.72 +/- 4.79 vs. 17.77 +/- 4.43 mmHg), hepatic blood flow (13.47 +/- 4.75 vs. 16.13 +/- 7.88 ml.min-1.kg-1) and intrinsic hepatic clearance of ICG (1.99 +/- 0.54 vs. 1.97 +/- 0.45 ml.min-1.kg-1) before and after verapamil injection. We conclude that verapamil has no beneficial effect in patients with alcoholic cirrhosis.

Adult↗
PubMed1989

Pharmacodynamic and pharmacokinetic study of propranolol in patients with cirrhosis and portal hypertension.

1. The aim of this study was to investigate the pharmacokinetics and the beta-adrenoceptor blocking activity according to time of conventional (C) and long acting (LA) propranolol in cirrhotic patients. Twenty-four patients with alcoholic cirrhosis and oesophageal varices were randomly assigned to receive either 160 mg C propranolol, 160 mg LA propranolol or placebo acutely and then following repeated administration (acute and chronic phases). Thereafter propranolol concentrations and beta-adrenoceptor blockade (resting and exercise heart rates) were measured at different intervals. 2. The Cmax was significantly higher with C propranolol in both phases. The time of Cmax was significantly later with LA propranolol in both phases. The AUCs were significantly higher after chronic administration with both formulations of propranolol. 3. The exercise peaks of beta-adrenoceptor blockade were similar between the two formulations and between the two phases of administration of propranolol. The duration of effective beta-adrenoceptor blockade was significantly longer in the chronic phase and seemed to be longer with LA than with C propranolol although this was not significant (72 +/- 31 vs 48 +/- 18 h, respectively). 4. There was a significant correlation between the log propranolol concentration and exercise heart rate but not with resting heart rate. No correlation could be demonstrated between pharmacological data and the Child Pugh score. 5. We conclude that in cirrhotic patients exercise testing was a reliable method in the assessment of beta-adrenoceptor blockade. Pharmacology of propranolol was found to be different according to the formulation or to the phase of administration.

Adrenergic beta-Antagonists↗
PubMed1989

Propranolol in the primary prevention of upper gastrointestinal tract haemorrhage in patients with cirrhosis of the liver and oesophageal varices.

A prospective, randomised, multicentre, single-blind comparison of propranolol with placebo in the primary prevention of upper gastrointestinal haemorrhage was conducted in 230 cirrhotic patients with large oesophageal varices. The dose of propranolol was progressively increased until resting heart rate was reduced by 20 to 25%. The final doses were 40 mg of conventional propranolol and 160 and 320 mg of long-acting propranolol daily in 22, 60 and 18% of patients, respectively. Patients who survived without bleeding were followed up for 436 +/- 172 days (mean +/- SD). After 2 years, the cumulative percentages of patients free from bleeding were 74% in the propranolol group and 39% in the placebo group (p less than 0.05). Similarly, cumulative 2-year survival was 72% in the propranolol group and 51% in the placebo group (p less than 0.05). Propranolol was well tolerated and only 13 patients were withdrawn from treatment. We concluded that propranolol treatment decreased the incidence of first bleeding and death during a period of 2 years in patients with cirrhosis and large esophageal varices.

Aged↗
PubMed1989

[Functional study, in man, of congestive gastropathy in cirrhosis by measurement of potential difference].

The morphologic features of the gastric mucosa in patients with cirrhosis have been well investigated. The aim of this study was to evaluate its functional disruption by measuring the gastric potential difference. Forty patients were investigated, 12 control subjects and 28 consecutive cirrhotic patients with endoscopically proved congestive gastropathy. Potential difference was measured the morning, on an empty stomach, at least 3 days after endoscopy; the method used a double channel gastric perfused probe placed under fluoroscopy 10 cm above the cardia, and a subcutaneous reference, both connected to a millivoltimeter via gelose agar-KCl bridges. Potential difference was recorded in each case 20 min before (baseline) and after local instillation of lysine acetylsalicylate (500 mg) as a provocative test. Cirrhotic patients had significantly lower basal potential difference than controls (-28.3 +/- 1.5 mV vs -33.8 +/- 1.3mV, p = 0.007). Potential difference was significantly lower in patients with severe gastropathy than in patients with mild gastropathy (-20.5 +/- 2.1 and -28.9 +/- 1.6 mV, respectively, p less than 0.01). After stimulation with acetylsalicylate, the area under curve and the irritability index were greater in patients with gastropathy (81.4 +/- 12.8 vs 41.2 +/- 8.6 mV.min, p = 0.032 and 0.935 +/- 0.19 vs 0.290 +/- 0.07 mV.mV.min, p = 0.022, respectively). These differences were explained by a higher drop in potential difference (delta DPmax/baseline; 28.1 +/- 3 vs 16.1 +/- 3 p. 100, p = 0.006) whereas basal return time remained unchanged (16.2 +/- 2.1 vs 13.7 +/- 2.2 min).(ABSTRACT TRUNCATED AT 250 WORDS)

Aspirin↗
PubMed1988

[Significance of antimitochondrial antibodies. In a population of 111 patients from the Midi-Pyrenees region].

The aetiological significance of antimitochondrial antibodies (anti-M) being debated, we conducted an aetiological study of 111 sera with anti-M2 antibodies from patients living in the Midi-Pyrénées region (South-West France); these anti-M2 antibodies had been detected in the years 1984-85. Fifty-nine percent of the patients had primary biliary cirrhosis (41 p. 100 were asymptomatic, and 6 p. 100 had normal liver function tests). Anti-M2 antibodies at a titer of 1/500 or more were significantly more frequent among these patients as compared with the others (P less than 0.001, probability = 0.73). Six percent of the patients had chronic active hepatitis. The incidence of primary biliary cirrhosis could be estimated at 8.5 per 10(6) people per annum. In this patient population, primary biliary cirrhosis was more common than all other causes of anti-M2 antibodies, and an anti-M2 titer of 1/500 or more had a 73 p. 100 predictive value for that disease. In the region concerned the incidence of primary biliary disease was higher than previously reported in Western Europe.

Autoantibodies↗
PubMed1988

Effect of propranolol on metabolic activity of the liver in patients with alcoholic cirrhosis.

Many studies have been performed to investigate the haemodynamic effects of propranolol. However, little is known of its actions on the metabolic activity of the liver. This study aimed to investigate the influence of propranolol on hepatic function as assessed by the galactose elimination capacity (GEC) and the intrinsic clearance of indocyanine green (ICG). 15 patients with biopsy-proven alcoholic cirrhosis and portal hypertension were studied. 10 had GEC and ICG clearance measured before and after the i.v. injection of 15 mg of propranolol (group P) and 5 had ICG clearance measurement before and after normal saline injection (group C). Propranolol significantly reduced heart rate (P less than 0.005) and the porto-hepatic pressure gradient (P less than 0.01). Hepatic blood flow was not changed. GEC was not altered by propranolol. Propranolol decreased the intrinsic hepatic clearance of ICG as determined by the 'sinusoidal' model by 12% (P less than 0.01). This suggests that propranolol may have an inhibitory action on the hepatic elimination of ICG that is independent of any effect on total liver blood flow or drug metabolism, since intrinsic clearance is not influenced by changes in blood flow and ICG is thought not to be metabolized.

Female↗
PubMed1987

Propranolol in the prevention of first upper gastrointestinal tract hemorrhage in patients with cirrhosis of the liver and esophageal varices.

We conducted a prospective, randomized, multicenter, single-blind trial of propranolol as compared with placebo in the prevention of first upper gastrointestinal tract bleeding in patients with cirrhosis of the liver. A total of 230 patients (90 percent with alcoholism and 46 percent with a Child-Pugh grade C classification) with large esophageal varices without previous bleeding were randomly assigned to receive either propranolol (n = 118) or placebo (n = 112), after they had been divided into two groups according to the severity of their liver disease. The end points of the study were bleeding and death. The dose of propranolol was progressively increased to decrease the heart rate by 20 to 25 percent. The final doses were 40 mg of conventional propranolol and 160 and 320 mg of long-acting propranolol daily in 22 percent, 60 percent, and 18 percent of patients, respectively. The mean (+/- SD) follow-up time among survivors without bleeding was 436 +/- 172 days. The cumulative percentages of patients free of bleeding two years after inclusion in the study were 74 percent (95 percent confidence limits, 61 and 83) in the propranolol group and 39 percent (95 percent confidence limits, 15 and 69) in the placebo group (P less than 0.05). Cumulative two-year survival was 72 percent (95 percent confidence limits, 60 and 81) in the propranolol group and 51 percent (95 percent confidence limits, 37 and 64) in the placebo group (P less than 0.05). The advantage of propranolol over placebo was maintained when potentially confounding variables were adjusted with use of the Cox model. Side effects occurred in 17 percent of the patients who received propranolol and led to the stopping of treatment in 11 percent. We conclude that propranolol can decrease the incidence of first bleeding and death during a period of two years in patients with cirrhosis and large varices.

Clinical Trials as Topic↗