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Biomedical subjects

M A Bigard

Publications and source records attributed to M A Bigard.

At least 19 recordsLinked to original sources
PubMed1997

Conservative treatment by irradiation of epidermoid cancers of the anal canal: prognostic factors of tumoral control and complications.

UNLABELLED: We analyzed in a retrospective series of patients treated by conservative irradiation for an epidermoid cancer of the anal canal (ECAC) the prognostic factors of locoregional control (LRC), survival, late severe complications (LSC), and sphincter conservation (SC). METHODS AND MATERIALS: From 1976 until 1994, 118 patients presenting with an ECAC were conservatively treated (mean age, 65 years). According to the 1987 International Union Against Cancer (TNM) classification, they were: 19 T1, 70 T2, 22 T3, 7 T4, 94 N0, and 24 N1-3. The treatment started with external beam irradiation (EBI) (36 Gy in 3 weeks or 45 Gy in 5 weeks). Concomitant chemotherapy (5-fluorouracil and mitomycin C) was delivered to 31 patients. Two months later, a boost of 20 Gy was delivered by interstitial 192Ir brachytherapy to 101 patients and EBI in 5. Twelve other patients had an abdominoperineal resection (APR). The mean follow-up was 6 years. RESULTS: At 5 years the overall survival was 60%, and specific survival (SS) was 75%; it was 94% for T1, 79% for T2, 53% for T3, and 19% for T4. In multivariate analysis, tumor size (> or = 4 cm), node involvement, and no response to the EBI were factors of poor prognosis for SS. Thirty-two locoregional recurrences occurred of which 21 were local recurrences in the 106 patients treated by a conservative schedule. Only tumor size and response to the EBI were prognostic factors on multivariate analysis for local and LRC. A total of 17 patients presented with LSC (Grade 3, 16 patients; and Grade 4, 1 patient), which was treated by APR in 4 patients and colostomy in 11 (of which 7 were definitive). The only significant prognostic factor for LSC in the multivariate analysis was the total extrapolated response dose of irradiation. The definitive rate of SC after conservative treatment in cured patients was 100% for T1, 82% for T2, 58% for T3, and 100% for T4. Since 1989, improvements of the technique have allowed reduction of the LSC in maintaining the same local control. CONCLUSION: The results of this series are similar to those of the literature. The confirmation of pretherapeutic prognostic factors related to response to the treatment should allow us to adapt the therapeutic intensity for each case to obtain better tumor control, with as few sequelae as possible, to yield a better rate of SC.

Adult↗
PubMed1996

Comparison of resection, liver transplantation and transcatheter oily chemoembolization in the treatment of hepatocellular carcinoma.

BACKGROUND/AIMS: Resection and liver transplantation are currently considered as the most useful treatments for hepatocellular carcinoma. However, transcatheter oily chemoembolization may be favourably compared with these two surgical treatments in patients with anatomically operable tumors. METHODS: Between 1985 and 1991, 122 patients with an Okuda stage I tumor were hospitalized in two French hospitals. Among these patients, 33 remained untreated, 42 were treated by transcatheter oily chemoembolization, 30 by resection and 17 by liver transplantation. The four groups were closely comparable except for age, the patients in the two surgical groups being significantly younger. Moreover, the frequency of pTNM II tumor was significantly higher in the resection group. RESULTS: The 5-year probability of survival was close to 45% in each of the three treated groups and was significantly higher than in the untreated group (0% at 4 years, p < 0.0001). The probability of cancer recurrence and/or metastatic dissemination was lower after transcatheter oily chemoembolization than after surgery. CONCLUSION: Thus, transcatheter oily chemoembolization seems comparable at 5 years with resection or transplantation for the treatment of resectable hepatocellular carcinoma.

Aged↗
PubMed1996

Cobalamin deficiency with megaloblastic anaemia in one patient under long-term omeprazole therapy.

The first case of cobalamin deficiency with megaloblastic anaemia in a patient under long-term omeprazole therapy is presented. This patient received omeprazole at a daily dose of 40-60 mg for 4 years as treatment for a gastro-oesophagal reflux complicated by peptic oesophagitis. Seric vitamin B12 was dramatically decreased at 80 pmol L-1. The Schilling test was normal (13%) with crystalline [57Co] cobalamin and it was at 0% with [57Co] cobalamin-labelled trout meat. All other assimilation tests were normal except an expiratory hydrogen breath test performed with lactulose. The haematological status was restored after intramuscular treatment with cobalamin. In conclusion, prolonged omeprazole therapy can be responsible for a cobalamin deficiency due to protein-bound cobalamin malabsorption.

Anemia, Megaloblastic↗
PubMed1996

[Low-dose polyethylene glycol 4000: digestive effects. Randomized double-blind study in healthy subjects].

OBJECTIVES: It was recently demonstrated that low-dose polyethylene glycol 4000 (PEG) electrolyte lavage solution, a colonic lavage solution used for cleaning the gut before colonic procedures, is effective in the treatment of chronic constipation. The aim of our study was to determine the digestive effects of low-dose PEG 4000 without electrolyte addition in healthy subjects. METHODS: Sixteen healthy male subjects with normal transit were included in a randomized controlled cross-over study. Study design included 4 successive periods: pre-inclusion (12 days), treatment (7 days), wash out (7 days), treatment (7 days). Colorectal transit time measurement and stool collection for physical and chemical investigations were performed during each period. During treatment period, either 20 g/d of PEG without electrolyte addition or placebo was given to each subject. RESULTS: With PEG, stool frequency increased significantly (1.26 +/- 0.09 with PEG versus 1.07 +/- 0.09 with placebo; P < 0.05) but no significant change in consistency was observed (P = 0.07). Total and segmental colonic transit time were comparable with PEG and placebo. Mean stool weight increased from 74 g/d, by increase of stool water output (54 g/d) and dry stool weight (20 g/d). Increase of stool water output was not associated with improvement in stool hydration: stool water content was comparable with PEG (75.4%) and with placebo (75.6%). No change was observed for the following parameters: stool electrolytes output, pH, organic acids, fecal output of fat, alpha-1-antitrypsin clearance, presence of red and white blood cells. Fecal output of protein increased significantly from 3.2 +/- 0.4 g/d to 6.0 +/- 0.7 g/d (P < 0.05). CONCLUSION: No effect on colonic transit and on stool hydration was observed with low dose of PEG 4000. With 20 g/d of PEG 4000, electrolytes addition is not necessary.

Adult↗
PubMed1995

Decreased activity of intestinal and urinary intrinsic factor receptor in Gräsbeck-Imerslund disease [corrected].

BACKGROUND/AIMS: The pathogenesis of inherited intestinal cobalamin malabsorption (Gräsbeck-Imerslund disease) remains unknown. The authors studied whether the disease corresponds to a defective expression and/or function of the intrinsic factor-cobalamin receptor in the ileum. METHODS: Intrinsic factor-cobalamin receptor activity was measured using radioisotope assay and gel-filtration exclusion chromatography in ileal biopsy specimens and urine concentrates from 4 patients with Gräsbeck-Imerslund disease and 5 controls. RESULTS: Receptor activity was 164 +/- 13 fmol/mg of protein in control biopsy specimens and < 2.6 fmol/mg protein in specimens from patients. The association constant was estimated to be 3.8 +/- 0.4 (nmol/L)-1 in controls. A dramatic decrease in receptor activity was also observed in urine concentrate from patients with an association constant of 1.9 and 3.3 (nmol/L)-1. Isoelectrofocusing of the cross-linked intrinsic factor-cobalamin receptor complex showed an isoelectric point at 4.8 in a patient as well as in control samples. CONCLUSIONS: It is concluded that Gräsbeck-Imerslund disease is related to decreased intrinsic factor-receptor activity in intestinal mucosa; the receptor assay in urine can be helpful for diagnosis.

Adult↗
PubMed1995

Double-blind comparison of pantoprazole and omeprazole for the treatment of acute duodenal ulcer.

OBJECTIVES: To compare the healing rates of acute duodenal ulcer in patients receiving pantoprazole 40 mg or omeprazole 20 mg once daily and to assess drug tolerance. DESIGN: Randomized, double-blind study evaluating patients with healed duodenal ulcer on endoscopy after 2 weeks of treatment and patients unhealed at 2 and after 4 weeks of treatment. SETTING: Hospital or private gastroenterology practice outpatients. PATIENTS: Men or women, aged at least 18 years, with one or two duodenal ulcers. Patients with ulcer complications or with other significant acid-related disease were excluded. A total of 270 patients entered the study, of whom 255 were included in the per-protocol analysis. RESULTS: The primary measure of efficacy was the healing rates of duodenal ulcers. Complete healing of ulcers was observed in 88 (71%) of the 124 patients in the pantoprazole group and in 85 (65%) of the 131 patients in the omeprazole group after 2 weeks of treatment. The cumulative healing rates after 4 weeks were 118 (95%) out of 124 and 117 (89%) out of 131 patients, respectively. There was no significant difference between treatment groups with respect to either healing rates or freedom from ulcer pain at 2 weeks. Both treatments were well tolerated: only 10 and 11 patients in the pantoprazole and omeprazole groups, respectively, reported adverse events. Diarrhoea was reported by two patients in each group. CONCLUSIONS: Pantoprazole 40 mg daily and omeprazole 20 mg daily are equally effective in inducing ulcer healing.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed1995

[Agenesis of the right lobe of the liver and portal hypertension].

A case of agenesis of the right lobe of the liver associated with portal hypertension is reported. This uncommon feature was diagnosed by computed tomography which excluded secondary liver atrophy due to cirrhosis or tumour. The main pathophysiological hypothesis for agenesis and portal hypertension, exceptionally associated, is arrest of hepatic development during foetal life.

Humans↗
PubMed1994

Transcatheter oily chemoembolization for hepatocellular carcinoma. A 4-year study of 127 French patients.

BACKGROUND: In Western countries, only a small proportion of patients with hepatocellular carcinoma (HCC) can be treated with surgical resection. For other patients, locoregional management by transcatheter oily chemoembolization seems to be useful and warrants evaluation. METHODS: One hundred and twenty-seven French patients with an inoperable HCC were treated by transcatheter oily chemoembolization. The efficiency of the treatment was assessed by a comparison of this group with a group of 127 untreated patients. Each patient of the treated group was matched closely with an untreated patient for all the main clinical, anatomic, and biologic features that characterize the spontaneous evolution of HCC. RESULTS: The overall probabilities of survival in the treated group were 64%, 38%, 27%, and 27% at 1, 2, 3, and 4 years, respectively; those for the untreated group were 18%, 6%, and 5% at 1, 2 and 3 years, respectively (P < 0.0001). The survival was significantly increased in patients with Okuda Stage I and II disease (P < 0.0001), but not in those with Stage III. Karnofsky and Child-Pugh scores remained stable during the follow-up period and dropped only shortly before patients died. CONCLUSION: Transcatheter oily chemoembolization is an efficient treatment for unresectable HCC for the palliation of symptoms as well as for the prolongation of survival with a good quality of life.

Aged↗
PubMed1994

Studies on peroxisomes of colonic mucosa in Crohn's disease.

The etiology and pathogenesis of Crohn's disease, a chronic inflammatory bowel pathology, have not been elucidated yet. In particular, the behavior of peroxisomes in inflamed colonic mucosa has not been investigated despite their important role in cellular oxidative metabolism. Using cytochemistry at the ultrastructural level, we have observed these catalase-positive organelles. In addition, biochemical analyses have revealed the specific activities of catalase and cyanide-insensitive acyl-CoA oxidase. Mucosal biopsy specimens from inflamed and noninflamed areas of Crohn's patients were compared to control biopsies. We found that Crohn's disease was marked by an important diminution in the peroxisomal frequency per cell unit area. If catalase activity was not affected by this pathology, cyanide-insensitive acyl-CoA oxidase, an enzyme of the peroxisomal beta-oxidation system, was found diminished in inflamed and in noninflamed areas. In conclusion, our results showed that Crohn's disease is accompanied by peroxisomal modifications but the number and the enzyme activities of colonic peroxisomes are less deeply altered in Crohn's disease than during neoplasia. This fact suggests that a relation may exist between the degree of peroxisomal deficiency and the clinical severity of colonic disease.

Acyl-CoA Oxidase↗
PubMed1994

Short report: treatment of gastric ulcer with lansoprazole or ranitidine: a multicentre clinical trial.

We studied the effectiveness of lansoprazole and ranitidine in promoting gastric ulcer healing in a multicentre double-blind trial, by comparing the proportion of healed ulcers after 4 and 8 weeks of treatment. One hundred and fifty-eight patients were randomly given either ranitidine (150 mg each morning and at bedtime) or lansoprazole (30 mg each morning and placebo at bedtime). One hundred and twenty-eight patients completed the trial (62 taking lansoprazole, 66 taking ranitidine). Fifty-one (80%) of those treated with lansoprazole and forty-two (62%) of those treated with ranitidine had healed ulcers at 4 weeks (P < 0.05). Sixty-one (98%) patients who received lansoprazole and 57 (86%) who received ranitidine had healed ulcers at 8 weeks (P < 0.05). The observed differences were not significant in the intention-to-treat analysis. No serious adverse event was reported with lansoprazole.

2-Pyridinylmethylsulfinylbenzimidazoles↗