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Biomedical subjects

O Nouel

Publications and source records attributed to O Nouel.

At least 19 recordsLinked to original sources
PubMed2005

Long-term treatment of gastro-oesophageal reflux disease patients with frequent symptomatic relapses using rabeprazole: on-demand treatment compared with continuous treatment.

BACKGROUND: On-demand treatment may be an alternative in the long-term treatment of non-severe gastro-oesophageal reflux disease in patients with frequent symptomatic relapses. AIM: To compare the efficacy of on-demand treatment with rabeprazole 10 mg versus continuous treatment in the long-term treatment of patients with frequent symptomatic relapses of mild to moderate gastro-oesophageal reflux disease. METHODS: This randomized, open-label study enrolled patients diagnosed with non-erosive reflux disease or oesophagitis grade 1 or 2 (Savary-Miller classification) reporting frequent symptomatic relapses (requiring > or =2 courses of antisecretory therapy during the previous year), whose intensity is rated at least moderate (>2 on a 5-point Likert scale). After a 4-week selection phase with rabeprazole 10 mg once daily, patients reporting symptom relief (Likert score < or =2) were randomized to receive either rabeprazole 10 mg continuous treatment or on-demand treatment for 6 months. The main evaluation criterion was the rate of symptom relief (scored on the Likert scale) after 6 months. RESULTS: One hundred and seventy-six patients were enrolled in the 4-week selection phase (men, 53%; mean age, 49 years; non-erosive reflux disease, 36.4%; gastro-oesophageal reflux disease 1, 53.4%; gastro-oesophageal reflux disease 2, 10.2%). Rabeprazole relieved symptoms in 88.6% of patients. Of this group, 152 were randomized to the comparative phase to receive rabeprazole 10 mg continuous treatment (once daily) or on-demand treatment (continuous treatment, n = 81; on-demand treatment, n = 71). At month 6 (end point), the symptom relief rate was slightly higher for patients in the continuous treatment group compared with those in the on-demand treatment group: 86.4% versus 74.6%, respectively. This difference was not statistically significant (P = 0.065). For the overall quality of life score, there was no difference between the continuous treatment and on-demand treatment groups (86.25 and 84.94). Mean daily consumption of rabeprazole was significantly lower in the on-demand treatment group versus the continuous treatment group (0.31 tablets versus 0.96 tablets; P < 0.0001). CONCLUSION: On-demand therapy with rabeprazole 10 mg provides an alternative to continuous therapy in patients with mild to moderate gastro-oesophageal reflux disease suffering from frequent symptomatic relapses.

2-Pyridinylmethylsulfinylbenzimidazoles↗
PubMed2000

[Multicenter prospective study of prognostic factors of gastroduodenal ulcer hemorrhages. Reevaluation of clinical and endoscopic factors in the era of endoscopic hemostasis].

AIM: To evaluate in a prospective study the prognostic factors of recurrent bleeding and mortality in patients presenting with high risk peptic ulcer bleeding routinely treated by endoscopic hemostasis. PATIENTS AND METHODS: A multicenter study was carried out in 8 Western French hospitals in 144 patients with gastrointestinal bleeding peptic from ulcer type I or IIa, b as defined by Forrest classification. Thirty four and 38 parameters were studied respectively in order to predict recurrent bleeding and death. Significant predictive factors (P < 0.1) in univariate analysis were entered in a multivariate logistic regression analysis. RESULTS: Endoscopic hemostasis was performed in 108 of 144 cases (75%). Recurrent bleeding and death occurred in 39 (28%) and 22 cases (15%), respectively. By multivariate analysis, the only predictor of rebleeding was hypovolemia at admission. Predictors of death were ASA score, cardiovascular Goldman score and recurrent bleeding. In this study, prevalence of Helicobacter pylori infection was low (41%) but was not a predictive factor. CONCLUSIONS: In a selected population of peptic ulcer bleeding patients with high risk of rebleeding, prevalence of recurrent bleeding and death remains rather high, despite routine endoscopic hemostasis. In the era of endoscopic hemostasis, clinical parameters remain the best prognostic factors of peptic ulcer bleeding outcome.

Aged↗
PubMed1997

[Hepatic puncture biopsy in ambulatory care. Advantages and disadvantages].

There is a clear trend towards favoring outpatient care in an attempt to control health care costs. Despite widespread acceptance in some countries, many teams in France still prefer to hospitalize patients requiring percutaneous liver biopsy because the outpatient setting has not been encouraged in French text books on hepatology, many gastroenterologists do not have access to outpatient facilities, and the lack of French references which has raised questions as to the legal responsibilities involved. The series of 231 outpatient percutaneous liver biopsies reported by Bourgaux in this issue of La Presse Médicale will remove the doubt in many minds. There are many advantages for the generally young population with early stage liver disease, frequently hepatitis C, requiring percutaneous liver biopsy. Lower cost is probably the primary advantage, but improved patient comfort, especially if repeated procedures are needed, is also greatly appreciated. The outpatient procedure is safe when all the selection criteria are met including: normal coagulation, ultrasonographically homogeneous liver, patient compliance and availability of a structured outpatient clinic, and absence of a severe concomitent disease. These apparently restrictive criteria actually include the majority of the indications for liver biopsy. There is another debate on whether echo-guided biopsy would be even safer but as emphasized by Bourgaux et al. this would require a reorganization of most of the hepatogastroenterology departments. One other point cannot be overlooked. Some operators (and patients) may also feel that the impressive nature of the procedure merits a more impressive setting, i.e. full hospitalization. Consequently, while it is quite reasonable to propose outpatient liver biopsy as a classical procedure, there are situations when personal preference may still dictate hospitalization.

Ambulatory Care↗
PubMed1995

[Sclerotherapy versus ligation in hemorrhage caused by rupture of esophageal varices. Direct meta-analysis of randomized trials].

OBJECTIVES: To compare the advantages of endoscopic ligation and endoscopic sclerotherapy for bleeding esophageal varices, published randomized clinical trials were critically reviewed by meta-analysis. Only ten clinical trials concerning a history of recent or active bleeding esophageal varices were included. METHODS: The methodology, population, treatment and outcomes of each relevant trial were evaluated by duplicate independent review. RESULTS: Endoscopic sclerotherapy compared to banding ligation significantly increased the rate of rebleeding (OR: 1.6; 95% IC: 1.1-2.3) without increasing early mortality compared to endoscopic banding ligation (OR: 1.3; 95% IC: 0.8-1.9). The rate of varice eradication associated with these two types of treatment was not different (OR: 0.9; 95% IC: 0.6-1.3) but was obtained more quickly with endoscopic banding ligation (3.8 +/- 1.6 versus 5.8 +/- 2.2; P < 0.05). The rate of complications was higher after sclerotherapy (OR: 2.5; 95% IC: 1.7-3.7), in those cases with a positive heterogeneity test. CONCLUSIONS: This meta-analysis shows a lower morbidity with endoscopic banding ligation in patients with variceal hemorrhage. The most important advantage of endoscopic banding ligation was the reduction of the rate of rebleeding.

Endoscopy↗
PubMed1993

[Black esophagus. Three new cases].

We report three cases of "black esophagus" defined as a diffuse or patchy black color of the esophagus on endoscopy, associated with mucosa necrosis at histologic examination. Ischemia was invocated in two cases and alcaline reflux seemed to be likely in the third case. These observations are compared with the seven others cases previously reported in the literature.

Aged↗
PubMed1991

[Yersinia enterocolitica septicemia associated with idiopathic hemochromatosis and deferoxamine therapy. A case].

Yersinia enterocolitica septicaemia is an infrequent condition. We report a case in which septicaemia developed after an infusion of desferrioxamine in a man with idiopathic haemochromatosis. According to the literature, the association of idiopathic haemochromatosis, liver disease and desferrioxamine therapy is extremely favourable to the development of Yersinia septicaemia because iron intake is known to enhance the virulence of this organism, and desferrioxamine, acting like a chelator, enables Yersinia to incorporate iron, which it does not normally do.

Deferoxamine↗
PubMed1990

[New aspects of drug hepatotoxicity].

This article sets out to report the new hepatotoxic drugs identified during the course of 1989 and to describe the state of the art about drugs suspected of hepatotoxicity, such as amoxicillin-a clavulinic or, to a lesser extent, octreotide. In contrast, Exifone, a recently introduced drug, was withdrawn from the market within a year. One is surprised to find drugs such as Buprenorphine and Trimebutine listed, which have never induced clinical cases of hepatitis despite widespread use. The article also reviews the drugs with recognized hepatotoxicity and tries to present the most up-to-date information about them.

Chemical and Drug Induced Liver Injury↗
PubMed1989

A randomised controlled study of propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis.

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.

Adult↗
PubMed1983

[Acute rhabdomyolysis in alcoholic patients].

Six episodes of acute rhabdomyolysis were observed within a two-year period in 5 male adult alcoholic patients hospitalised in a hepatology intensive care unit. Painful muscle swelling was discrete of absent in 4 of the 5 patients. Acute rhabdomyolysis was preceded by grand mal seizures in 4 patients, delirium tremens in 1 and high fever with shivers in 3. All cases were rapidly diagnosed on the finding of very high serum creatinine phosphokinase levels. One patient developed acute respiratory failure and recovered after prolonged mechanical ventilation. Three patients had acute renal failure with severe hyperkalemia in one but none required dialysis. Three patients died within 2 to 6 days of the diagnosis, but the deaths were not directly related to rhabdomyolysis. It would appear that in alcoholic patients: the prevalence of rhabdomyolysis is probably underestimated; any muscular hyperactivity as seen in seizures, delirium tremens and prolonged shivers may be a precipitating factor; the condition is easily diagnosed by measuring serum creatinine kinase activity; some cases of acute renal failure in patients with alcoholic cirrhosis might be explained by acute rhabdomyolysis with minimal symptoms.

Acute Disease↗
PubMed1983

Efficiency of respiratory assistance in cirrhotic patients with liver failure.

In a 25-month period, 100 cirrhotic patients, in our intensive care unit (ICU) needed endotracheal intubation and mechanical ventilation. The overall mortality rate was 89%; the mortality rate was 100% among patients with septic shock and/or superimposed acute hepatitis and/or severe cirrhosis defined with clinical signs: jaundice and/or ascites and/or spontaneous hepatic encephalopathy and/or severe malnutrition. With these prognostic indices, using Bayes theorem, the probability of fatal evolution ranges from 95%-100% (alpha = 5%). These results allow a group of patients with high cost and poor prognosis to be defined.

Female↗