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Biomedical subjects

J P Pascal

Publications and source records attributed to J P Pascal.

At least 73 records · Page 4Linked to original sources
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↗
PubMed1986

The treatment of refractory ascites by the LeVeen shunt. A multi-centre controlled trial (57 patients).

A multi-centre random trial of 57 cases of alcoholic cirrhosis with refractory ascites was carried out; 29 patients received a LeVeen shunt and 28 were treated by conventional medical therapy. The effectiveness of the LeVeen shunt in reducing ascites was good in the first month, but was not different from conventional medical therapy by the end of one year. Complications were significantly more frequent in the surgical group. Of the 29 patients fitted with a LeVeen shunt, 25 developed one or more complications. Of the 28 patients in the medical control group, only 8 developed complications. The mortality rate of the two groups also differed significantly. Twelve patients in the surgical group (41%) died in the course of the first month against only 5 (18%) in the medical control group. By the end of one year, the mortality rate of the two groups was almost identical: 23 (79%) and 21 (75%) respectively. These observations confirm the poor prognosis for refractory ascites in cases of alcoholic cirrhosis and the inadvisability of attempting to treat it by implanting a LeVeen shunt.

Ascites↗
PubMed1985

[Embolization of esophageal varices by the transjugular route in severe digestive hemorrhage in cirrhotic patients. Prospective study of 83 patients].

A prospective study was undertaken to assess the results of embolization of esophageal varices by the transjugular approach, in 83 patients with advanced cirrhosis (65 p. 100 Child's class C) admitted with severe bleeding (mean of 10 units of blood per patient). Embolization was successfully completed in 65 patients (78 p. 100) and complete obliteration was achieved in 50 (60 p. 100). Twenty-nine procedures were performed on actively bleeding patients. Cessation of bleeding was observed in 22 (76 p. 100). Excluding the 5 patients in whom embolization could not be achieved, the success rate was 92 p. 100. Embolization was attempted as an elective procedure in 54 patients who were not actively bleeding. Recurrent hemorrhage occurred in 18 patients (33 p. 100) during the first month of follow-up. Finally, 38 patients rebled and 57 died. No accident could be ascribed to the procedure. It is concluded that: (a) the transjugular approach proved to be safe in actively bleeding patients with severe cirrhosis; (b) variceal obliteration effectively controlled active bleeding. The efficacy of this procedure was limited in time. The use of embolization is further hindered by a consistent failure rate and by the development of new therapeutic modalities, such as sclerotherapy.

Adult↗
PubMed1984

[Emergency colonoscopy in lower intestinal occlusion].

From March 1980 to June 1983, 23 patients presenting with clinical and or radiological manifestations of colonic obstruction and with uncertainty as to medical/surgical possibilities of management, underwent emergency colonoscopy in the intensive care unit of our Digestive Disease Department. The investigations were conducted without preparation (enema) or premedication, using an ordinary colonoscope. The endoscopic examination led to correct diagnosis in 21 patients out of 23 (91.3 p. 100). The main causes of occlusion were: colonic or rectal cancer (11 cases), Ogilvie's syndrome (6 cases), volvulus of the sigmoid colon (3 cases). Endoscopy contributed to treatment in eight patients with good results in six. It was unsatisfactory in two cases of volvulus of the sigmoid colon which recurred. In two instances complications occurred which were attributable to the method: one pneumoperitoneum without frank perforation and a transtumoral perforation in a case of sigmoid cancer, discovered at laparotomy. No septic complication or mortality resulted from endoscopy. Colonoscopy under normal conditions should not be advocated systematically, but can be used as a method of investigation and possibly of therapy in selected cases of colonic obstruction admitted into intensive care units.

Adult↗
PubMed1983

[Esophageal pHmetry: comparison with clinical, endoscopic and histological data. Prospective study in 43 patients with suspected gastroesophageal reflux].

In order to evaluate the relationship between gastro-oesophageal acid reflux, as defined by pH recording, and clinical, endoscopic and histological findings, 43 patients with suspected gastro-oesophageal reflux (21 with typical and 16 with atypical symptoms) underwent endoscopy with biopsy and post-prandial oesophageal pH recording with a calculated acid reflux score. The history of each patient was carefully recorded. An acid reflux score higher than the mean +/- S.D. normal values was taken as diagnostic of gastro-oesophageal reflux. This level was reached in 30 out of the 43 patients. History taking gave 13 false-positive results (3 in the typical symptoms group, and 10 in the atypical symptoms group). The sensitivity and specificity of fiberoptic endoscopy as a means of diagnosing gastro-oesophageal reflux were 47% and 77% respectively. Histological data were available from only 77% of the patients; their diagnostic sensitivity and specificity values were 73% and 82% respectively. The absence of correlation between the intensity of the gastro-oesophageal reflux, as measured by pH recordings, and the severity of symptoms and endoscopic findings deserves to be noted.

Adult↗
PubMed1983

Somatostatin in peptic ulcer bleeding--results of a double-blind controlled trial.

The aim of this work was to assess the usefulness of somatostatin in acute peptic ulcer bleeding. Sixty-four patients with endoscopic evidence of duodenal ulcer bleeding completed a double-blind trial to compare the effectiveness of somatostain (6 mg i.v. per day) with that of placebo; incidence of treatment failure (i.e., rebleeding or persistent haemorrhage) was not different in the somatostatin and in the placebo groups (respectively 24% and 23%). Because the efficacy of cimetidine had previously been demonstrated in gastric ulcer bleeding, somatostatin was tested against cimetidine (1.6 g per day) in 50 patients with gastric ulcer haemorrhage. The treatment failed to control bleeding in 15% of somatostatin and in 17% of cimetidine treated subjects (n.s.). Both treatments were well tolerated and blood requirements were not different in the trial groups. These results show that the efficacy of somatostain in peptic ulcer bleeding is not different from placebo in duodenal ulcers and not different from cimetidine in gastric ulcers.

Age Factors↗
PubMed1983

[Familial autoimmune pathology comprising 2 cases of primary biliary cirrhosis].

Two cases of primary biliary cirrhosis (PBC) were observed in two brothers. Clinical, biochemical, immunological and genetic investigations (in particular by HLA typing) were systematically undertaken in nine subjects of this family (including the two above mentioned cases) in two generations. One case of granulomatous hepatitis associated with auto-immune thyroiditis was discovered in a sister. Immunological abnormalities were observed in six out of nine members of the family: anti-nuclear (four cases), anti-mitochondrial (two cases), anti-thyroid (two cases), auto-antibodies and rheumatoid factors (two cases). Six subjects (including the three with hepatic disease) had the same HLA haplotype (with in particular HLA DR4, which has been previously associated with sporadic PBC). However, the role of this haplotype in the transmission of PBC in a family could not be demonstrated. Biochemical and immunological survey might be of importance in the kindred of patients with PBC, thereby contributing to the screening of asymptomatic hepatic disease.

Autoimmune Diseases↗