Biomedical subjects
Publications and source records attributed to M Bouvry.
We report the case of a 72-year-old woman hospitalized for dysphagia and odynophagia due to an ulcer of the esophagus. Thoracic CT-scan and esophageal endosonography revealed a tumour of the mediastinum which invaded the esophagus. Per-operative biopsies concluded to a probable malignant fibrous histiocytoma.
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The relationships between clinical activity, endoscopic severity, and biological parameters in Crohn's disease have not been thoroughly investigated and a link was therefore sought between these three elements. The following parameters were determined simultaneously in 121 consecutive patients with colonic or ileocolonic Crohn's disease: Crohn's disease activity index, Crohn's disease endoscopic index of severity, and serum albumin, alpha 2-globulin, alpha 1-antitrypsin, orosomucoid, C reactive protein, erythrocyte sedimentation rate, platelets, lymphocyte and polymorphonuclear cell counts, haematocrit, and faecal alpha 1-antitrypsin concentration. The distribution of these parameters was studied and transformation was used so that data matched the normal distribution closely. A weak but significant correlation (r = 0.32; p < 0.001) was found between clinical and endoscopic indices in the whole group of patients and this correlation seemed to be homogenous in various patient subgroups (clinically quiescent or active disease, pure colonic disease, untreated patients). Endoscopic or clinical indices were also found to be weakly linked with biological parameters (r < 0.50). Stepwise linear regression identified C reactive protein as predictive of the clinical index, and, successively, alpha 2-globulin, erythrocyte sedimentation rate, faecal alpha 1-antitrypsin, serum orosomucoid, and alpha 1-antitrypsin as predictive of the endoscopic index. Both predictions were poor--the biological variables accounting for only 22 and 44% respectively of the clinical and endoscopic index variations. In conclusion, Crohn's disease clinical activity seems to be virtually independent of the severity of the mucosal lesions and biological activity.
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74 cirrhotic patients with a history of variceal or gastric bleeding were randomly assigned to treatment with propranolol (40 to 360 mg/day) or placebo. The patients were all in good condition and doses of propranolol were titrated until a 25% reduction in heart rate was achieved. After 2 years, the cumulative percentage of patients free from rebleeding was significantly greater among the patients receiving propranolol (79%) than in the placebo group (32%; p less than 0.0001). Similarly, the percentage of surviving patients was significantly greater with propranolol (90%) than with placebo (57%; p less than 0.02) after 2 years. It was concluded that in cirrhotic patients in good condition, propranolol reduced both the risk of recurrent gastrointestinal haemorrhage and the mortality rate during a 2-year period of continuous administration of the drug.
Seasonal changes in Fasciola hepatica egg passage were documented in 17 dairy herds in Portneuf County, Quebec (Canada). Egg passage was low or absent in spring and summer but rose in autumn to reach a peak in winter, then subsequently returned to low levels. This study suggests that there are two periods of transmission to the bovine host during the grazing season: a minor period in the spring, due to overwintered snails, and a major period in August and September due to snails that acquired the infection in May or June.
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We present the case of a 25-year-old man with Crigler-Najjar disease who had since birth a marked unconjugated hyperbilirubinemia without bilirubin overproduction, without any neurological involvement and in whom phenobarbital administration failed to produce any effect. Analysis of his biliary bile pigments on two occasions showed (i) a decrease excretion of bilirubin, as indirectly suggested by a high ratio of biliary bile acids over total bilirubin; (ii) an increase in unconjugated bilirubin IX alpha quantitated by thin-layer chromatography (TLC) following alkaline methanolysis and by direct extraction and TLC of the tetrapyrroles; (iii) a high proportion of bilirubin monoconjugates whereas the excretion of diconjugates was very low. Classification of the present patient into Crigler-Najjar disease type I or II was not possible. The most striking and practical difference among the various cases of Crigler-Najjar disease remains the response to phenobarbital. Among cases of Crigler-Najjar disease which respond to enzyme induction and Gilbert's syndrome, the continuous spectrum suggests a common defect.
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The purpose of this investigation was to compare techniques to diagnose herds infected by Fasciola hepatica. Based on a previous survey in the slaughter houses of Côtes-du-Nord, 37 herds were selected on the frequency of condemned livers per herd. Fecal examinations and immunodiagnosis by ELISA technique were performed. Antibodies were searched for in the pooled milk of each herd and in sera of 30 to 80% of the cattle. On 9 herds without any previous condemnation, seven had a negative immunodiagnosis on pooled milk and 0 to 16% serologically positive animals. The two other herds had a suspect immunodiagnosis on pooled milk and 28 to 65% serologically positive animals. In nine herds presenting a previous liver seizure, immunodiagnosis on pooled milk were positive on eight of them. 42 to 100% of the cattle were serologically positive and 25 to 75% of the fecal examinations were positive. In 19 herds having previously two or more liver confiscations, 68 to 100% of the cattle were serologically positive, all the pooled milk were immunologically positive and just one herd, treated previously, had a 100% negative fecal examination. The results of fecal examination and immunodiagnosis are globally comparable to the slaughter house survey. Nevertheless the sensitivity of the fecal examination and more specially the immunodiagnosis is higher. The herd diagnosis based on the examination of pooled milk has a practical application in further investigation of parasitic diseases distribution in dairy herd.
Twenty-one patients with advanced epidermoid carcinoma of the esophagus were treated with a combination of 5-fluorouracil (F) 600 mg/m2 day 1 and day 8; Adriamycin (A) 30 mg/m2 day 1; and cisplatin (P) 75 mg/m2 day 1 (FAP) with hydration and mannitol-induced diuresis. Each course was repeated every 4 weeks. All 21 patients are evaluable for response: 7 patients had an objective response (33%). Two of these responses were complete remissions according to negative endoscopic and pathologic results; five patients had a partial response; all 7 responding patients had metastasis prior to treatment. Median survival of the 21 patients was 8 months. Median survival of 9 months for responders is superior to 4.5 months for nonresponders. No severe myelosuppression or nephrotoxicity was observed. This FAP regimen is useful in the treatment of advanced esophageal tumors.
Three cases are reported in which unexpected generalized amyloïdosis was disclosed by biopsies. The authors emphasize the value of precise analysis of the deposits and particularly of Wright's method for studying their staining properties. This method can guide investigations towards one of the two main etiologies of amyloïdosis (immunoglobulinic or AA).
Twenty-one patients with advanced, inoperable epidermoid carcinoma of the oesophagus were treated with combined 5-fluorouracil (F, 600 mg/m2, days 1 and 8), adriamycin (A, 30 mg/m2, day 1) and cis-platinum (C, 75 mg/m2, day 1), together with hydratation and mannitol-induced diuresis. Each course was repeated after 4 weeks. Response could be assessed in all 21 patients and was objective in seven (33%), who had metastasis prior to treatment. Two of these 7 patients went into complete remission confirmed by negative endoscopy and pathology; 5 showed partial response. Median survival of the 21 patients was 8 months; it fell to 4.5 months in non-responders and rose over 9 months in responders. Three patients survived for more than 16 months. No severe bone marrow depression or nephrotoxicity was observed. The 3-drug combination appeared to be more effective than the additive effects of each drug given separately. It is concluded that the FAP regimen is useful in the treatment of advanced oesophageal tumours.
A double-blind clinical trial comparing ursodesoxycholic acid and chenodesoxycholic acid in patients with cholesterol stones in the gall-bladder showed that ursodesoxycholic acid was superior to the older drug not so much in percentage of biliary calculi dissolved but in dosage reduction (50%) and improved clinical and biological tolerance.
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