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Biomedical subjects

P Bernades

Publications and source records attributed to P Bernades.

At least 19 recordsLinked to original sources
PubMed1992

Splenic and portal venous obstruction in chronic pancreatitis. A prospective longitudinal study of a medical-surgical series of 266 patients.

The aim of this study was a prospective search for splenoportal venous obstruction (SPVO) in a medical-surgical series of 266 patients with chronic pancreatitis who were followed up a mean time of 8.2 years. SPVO was systematically searched for using ultrasonography and then confirmed by angiography or computed tomography. SPVO was found in 35 patients (13.2%) but was symptomatic in only two. Initial obstruction involved the splenic vein in 22 patients, the portal vein in 10, and the superior mesenteric vein in three. Since venous obstruction extended from the splenic to the portal vein in five patients, the prevalence of portal obstruction was 5.6% (15/266). Acute pancreatitis and pseudocysts were the probable cause of SPVO in 91.4% of our cases. Half the cases of splenic venous obstruction were related to pseudocysts of the caudal pancreas. Esophageal varices were found in two patients and gastric varices in four at the time of diagnosis and during follow-up. At the end of follow-up, 12 patients had undergone splenopancreatectomy (N = 11) or splenectomy (N = 1). Only one patient was operated on for massive esophageal variceal bleeding, and another patient died due to intractable colic variceal bleeding. In four of six patients operated on with portal vein obstruction, surgery was difficult due to venous collaterals. Ten patients were not operated on and 13 patients operated on were not treated for SPVO. The mean follow-up after diagnosis of SPVO for these final 23 patients was 28.9 months. None of these patients bled.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1992

[Cost of fibroscopy in gastroduodenal ulcer].

The assessment of mean cost of upper GI endoscopy is of critical importance if one wants to perform pharmacoeconomic studies, especially in peptic ulcer disease (PUD). The aim of this work was to calculate such costs, based on an inquiry conducted in December 1991 in a representative sampling of 94 French gastroenterologists (GEs) (i.e. 4.3% of the whole population). Thirty-nine percent of GEs work in their office; 25% work in private and 26% in public hospitals. GEs performed 70 +/- 5 (mean +/- SEM) upper GI endoscopies per month. Fifty-nine % are performed to investigate epigastric pain; PUD was found in nearly one patient out of four. Fifteen % of the endoscopies were performed for follow-up of PUD. Upper GI endoscopy modalities varied greatly according to whether performed in GEs' office, private or public hospital. The proportion of investigations performed with biopsies was 66, 71 and 50%, respectively. Neuroleptanalgesia (or general anesthesia), was performed in 8, 49 and 4% of cases, respectively, and a 24-hour hospitalization was required in 0, 7 and 2% of cases, respectively. Sources of expenditure were evaluated according to the current fares of the French Health Care System (for GEs' office and private hospitals) and to real costs (for public hospitals). Taking into account the differences in place and modalities of realization, mean cost of upper GI endoscopy was evaluated at 1,084 FF. This cost could be used in future cost or cost/effectiveness studies of diagnostic or therapeutic strategies.

Duodenal Ulcer↗
PubMed1991

[Does chronic pancreatitis promote duodenal ulcer in men?].

The aims of this study were to assess the prevalence of duodenal ulcer during chronic pancreatitis and the relationship between the occurrence of duodenal ulcer and the course of chronic pancreatitis. The population consisted of 264 men with chronic pancreatitis, 94 percent of which were of alcoholic origin. Duodenal ulcer occurred in 37 patients (14 percent). Fifteen patients with gastric or anastomotic ulcer were excluded. The 37 patients with duodenal ulcer were compared with 212 patients without ulcer. There was no significant difference between the two groups as regards the course of chronic pancreatitis except for insulin-dependent diabetes mellitus which was significantly more frequent in patients without duodenal ulcer (P less than 0.05). Eight patients with duodenal ulcer died but the cause of death was not related to their ulcer. All patients with duodenal ulcer and 92 percent of those without were smokers (not significant). Duodenal ulcer occurred in 25/37 patients (68 percent) before the clinical onset of chronic pancreatitis. The risk of duodenal ulcer occurrence was constant in 17-65 year old patients and independent of the time of chronic pancreatitis onset. We concluded that in men with chronic pancreatitis: a) prevalence of duodenal ulcer is 14 percent; b) duodenal ulcer occurred most often before clinical onset of chronic pancreatitis; c) duodenal ulcer occurs independently of the course of pancreatitis which cannot account for its high prevalence. Smoking may be a promoting factor.

Actuarial Analysis↗
PubMed1991

[Evolution of indications and results of the treatment of alcoholic chronic pancreatitis in men. Study of 222 cases].

The aim of this study was to analyze the evolution of surgical indications in alcoholic chronic pancreatitis (ACP) and to compare long term results after medical (n = 72) and surgical (n = 150) treatment with or without pancreatic resection. Since 1968, a retrospective study was carried out on 222 consecutive male patient. 68% of them, were operated on for unrelieved pain or complications at a mean of 5 years after the onset of the symptom. The mean follow-up was 10 years. The study of evolution of the indications and results of surgical treatment was made on two consecutive ten-year periods and showed that 68% of pancreaticoduodenectomies and 55% of distal pancreatectomies (DP) were performed during the first period. Indications for primary pancreaticoduodenectomy did not decrease since 1980, while those of distal pancreatectomy (DP) changed (no DP for acute pancreatic effusion with fistula before 1980, no DP for unrelieved pain after 1980). Ten patients underwent operative drainage of pseudocysts before 1980 versus 21 after 1980 (13% vs 29%) with no operative death. Twenty patients underwent biliary and/or intestinal and/or ductal drainage during the first period versus 22 during the second (25% vs 30%). The overall 12-year actuarial survival between operated and non operated patients was no significantly different (respectively 72% +/- 10% and 64% +/- 12%). The actuarial 10-year survival rate was significantly better after DP (73% versus 53% after drainage and 28% after pancreaticoduodenectomy). No patients underwent specific pancreatic reoperation after pancreaticoduodenectomy versus 25% after DP.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1991

[Value of computed tomography and celiomesenteric angiography in assessing vascular involvement in cancer of the exocrine pancreas. Apropos of 31 cases].

The prediction of vascular involvement by computed tomography (CT) with intravenous bolus contrast medium enhancement was compared to that of angiography in 31 patients with pancreatic carcinoma. CT was performed in 29 patients, angiography in 18 patients, while 16 had both investigations. Results of both radiological investigations were reviewed and compared with surgical findings. Sensitivity and specificity of CT was 88 and 100 percent respectively. Sensitivity and specificity of angiography was 57 and 100 percent respectively. The four false-negative results of CT concerned the superior mesenteric and portal veins. The ten false-negative results of angiography concerned the superior mesenteric and portal veins in four cases, and the celiac and superior mesenteric arteries in six cases. Comparison of results of CT and angiography revealed that the two methods concurred in 12 patients, five without and seven with vascular involvement. In three other cases, CT detected more abnormal vessels than angiography. In another case, only CT demonstrated nonresectability. In conclusion, CT with enhancement seems to be more accurate than angiography in the prediction of vascular involvement of pancreatic carcinoma.

Adenocarcinoma↗
PubMed1990

[Conclusions concerning the symptomatic treatment of cancer of the pancreas].

Symptomatic treatment is the only possibility in the large majority of patients with pancreatic cancer since a curative surgical excision of the tumor is only possible in less than 5% of cases. In most cases, symptomatic treatment must take short survival rate into consideration. Symptoms managed, in the aim to improve the quality of remaining life include weight loss and anorexia, abdominal pain, jaundice secondary to biliary compression, and sometimes digestive consequences of pancreatic surgery. Weight loss can be treated with nutritional support (particularly enteral nutrition) but the indications of such a treatment are rare. Abdominal pain should be treated by potent analgesics (opiates) and sometimes by percutaneous block of the coeliac ganglion rather than abdominal radiotherapy. Jaundice can be treated by surgical biliary drainage or better still by palliative biliary endoprothesis. Finally, digestive consequences of pancreatic surgery require symptomatic treatment.

Enteral Nutrition↗
PubMed1989

[Diarrhea caused by exocrine pancreatic insufficiency in adults].

Diarrhea induced by exocrine pancreatic insufficiency in relation to chronic pancreatitis, pancreatic cancer, or partial pancreatic excision is generally moderate without modification of the nutritional status of the patient. However, when the malabsorption of lipids is severe diarrhoea with steatorrhea can lead to an important weight loss. Exocrine pancreatic insufficiency is managed with diet and pancreatic enzyme replacement. In patients with alcoholic chronic pancreatitis, abstinence from alcohol is the most important measure. The new enteric coating pancreatic extracts have a good efficacy and a better acceptability.

Adult↗
PubMed1989

[Influence of bouts of acute pancreatitis on the course of chronic alcoholic pancreatitis in man].

The purpose of this study was to ascertain the influence of acute pancreatitis upon the course of chronic pancreatitis, its complications, the need for surgical treatment, and mortality, in alcoholic men. The studied population was composed of 222 men; 110 had never had acute pancreatitis and 112 had presented at least once with acute pancreatitis. The cumulative probability to have a first bout of acute pancreatitis was 41.5 percent, 2 years after the onset of chronic pancreatitis. There was no difference in follow-up but clinical onset of chronic pancreatitis was earlier in the "acute pancreatitis" group. There was no difference in the prevalence of biliary strictures, non-alcoholic hepatic disease or need for surgery. On the contrary, diabetes mellitus, alcoholic hepatic disease were less frequent and pseudocysts were more frequent in the "acute pancreatitis" group. We observed 56 deaths. The comparison of mortality and cumulative survival rates showed a lower mortality in the "acute pancreatitis" group (p less than 0.02 and 0.05, respectively). The main causes of death were alcohol-related hepatic disease, postoperative mortality, and carcinoma Alcoholic cirrhosis was more frequent in patients who died in the "no acute pancreatitis" group. We conclude that: a) acute pancreatitis is an early complication of chronic pancreatitis in one case out of two; b) clinical onset of chronic pancreatitis occurs earlier in patients who presented with acute pancreatitis; c) need for surgery is not different; d) alcoholic hepatic disease is more frequent in the "no acute pancreatitis" group; e) mortality is lower in the "acute pancreatitis" group.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
PubMed1989

Alipase versus nonenteric-coated enzymes in pancreatic insufficiency. A french multicenter crossover comparative study.

Pancreatic enzymes (PE) are prepared as pH-sensitive enteric coated microspheres [Pancrease, Alipase in France (P)], to prevent gastric inactivation of orally administered enzymes. The efficacy and tolerability of P were compared to those of Eurobiol (E) (PE lacking enteric coating) in patients with exocrine pancreatic insufficiency (PI) via an open crossover study conducted at 16 centers in France. Pancreatic insufficiency was diagnosed in patients with signs of chronic pancreatitis who showed steatorrhea (fecal fat excretion greater than 8.0 g/24 h). The dosage of P was 9 capsules/d and that of E, 3 vials/d. Stools were collected for 3 consecutive days at each of the following periods: after 10 d without any PE, and after 21 d of P and E administration. Results were analyzed statistically by the method of Hills and Armitage. Chronic pancreatitis was alcohol-induced in 33 of 35 patients (94%) who entered the study. The group that received P before E (n = 20) was comparable to the group that received E before P (n = 15) in patient and disease characteristics. Eight of 35 patients failed to complete the study for the following reasons: adverse reactions 2 cases, lost to followup 4 cases, dropped out of study 2 cases. The degree of steatorrhea was similar after P and E. However, symptomatic improvement was noted far more frequently with P than with E. Moreover, patients preferred P to E because of drug taste (p less than 10(-4] and ease of drug administration (p less than 10(-3). Drug safety was comparable in the two groups of patients.

Adolescent↗
PubMed1989

Mortality factors associated with chronic pancreatitis. Unidimensional and multidimensional analysis of a medical-surgical series of 240 patients.

The purpose of the study was to determine (a) the frequency and cause of mortality in patients with chronic pancreatitis; (b) the cumulative survival rates corrected by comparison of patients with a matched French population; and (c) the factors associated with mortality by a unidimensional and multidimensional analysis. The study population consisted of 240 patients (men = 208, women = 32; alcoholic = 210, nonalcoholic = 30) followed for a mean time of 8.7 yr. The status of the patients (dead or alive) was recorded in February 1987. Mean age at onset of chronic pancreatitis was 41.5 yr. Fifty-seven patients died. Mean age at time of death was 52.3 yr. "Overmortality" after 20 yr of course was 35.8% in comparison with a matched French population (p less than 0.0001). Chronic pancreatitis was the direct cause of death for only 19.3% of patients. The main causes of death have been alcoholic hepatopathy (n = 10), cancer (n = 9), postoperative mortality (n = 8). Unidimensional analysis of mortality rates showed that male sex (p less than 0.03), surgery (p less than 0.007), hepatopathy (p less than 0.01), diabetes mellitus (p less than 0.02), and absence of attack of acute pancreatitis (p less than 0.02) were associated with mortality. Multidimensional analysis showed that the following variables were linked with mortality: in a first model including the totality of the study population: surgery (p less than 0.006), hepatopathy (p less than 0.008), no attack of acute pancreatitis (p less than 0.03), male sex (p less than 0.03); in a second model excluding cirrhosis: surgery (p less than 0.001), male sex (p less than 0.06), diabetes mellitus (p less than 0.09). Nevertheless, surgery did not seem to interfere with long-term mortality. The lower mortality of patients with attacks of acute pancreatitis suggests a favorable influence for alcohol abstinence.

Actuarial Analysis↗