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Biomedical subjects

P Bories

Publications and source records attributed to P Bories.

At least 19 recordsLinked to original sources
PubMed1992

Methyl tert-butyl ether in the endoscopic treatment of common bile duct radiolucent stones in elderly patients with nasobiliary tube.

Methyl tert-butyl ether is an effective dissolution agent for cholesterol stones. The aim of this work was to evaluate the effect of methyl tert-butyl ether on radiolucent common bile duct stones in patients in whom endoscopic extraction has failed. From September 1985 to September 1987, 1374 patients underwent endoscopic retrograde cholangiopancreatography in our Liver Unit. An endoscopic sphincterotomy was indicated in 195 patients with common bile duct (CBD) stones because of an age over 65 years and/or surgical contraindications. Endoscopic sphincterotomy was efficient in 187 patients, allowing complete stone removal in association with conventional endoscopic methods and mechanical lithotripsy in 170 patients. Twelve of the 17 patients with failure of conventional endoscopic treatments were either older than 75 years (11 patients; mean age, 86 +/- 4.5 years) or exhibited a surgical contraindication. Stones completely obstructed CBD in six patients and had a diameter exceeding 25 mm in the six other patients. These subjects were selected for stone dissolution by methyl tert-butyl either (MTBE) according to the following protocol. MTBE was directly infused into CBD through a nasobiliary catheter, twice daily for 4-13 days (mean, seven days). Bile duct opacification, repeated after MTBE treatment, revealed the complete disappearance of CBD stones in one patient, a decrease in stone size in five patients and no change in the six other patients. MTBE treatment was well tolerated except in three patients who complained from transient abdominal pains and nausea. At the second attempt of endoscopic treatment, CBD stones were found to be softened and easily broken up, allowing a complete clearance in six patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1992

Endoscopic monitoring of Crohn's disease treatment: a prospective, randomized clinical trial. The Groupe d'Etudes Therapeutiques des Affections Inflammatoires Digestives.

A randomized clinical trial was conducted to determine whether colonoscopy is useful in deciding how long to maintain steroid treatment in attacks of Crohn's disease involving the colon. One hundred forty-seven patients with acute attacks of colonic or ileocolonic Crohn's disease were treated by oral prednisolone, 1 mg.kg-1.day-1; 136 achieved clinical remission, but 96 of them still had active endoscopic lesions and were randomized either to immediate start of steroid tapering (group A; n = 46) or to continued prednisolone treatment at the same dosage for 5 more weeks before steroid tapering was begun (group B; n = 50). In the remaining 40 patients (already in endoscopic remission, group C), steroid tapering was begun immediately. After prednisolone discontinuation, patients were followed up for 18 months or until clinical relapse. Prolongation of prednisolone therapy significantly improved the endoscopic scores in group B (30% of endoscopic remission). The frequency of successful steroid weaning was almost identical in groups A and B (82% and 80%, respectively), as was the actuarially calculated relapse clinical rate after steroid withdrawal (P = 0.22). No factor predictive of clinical relapse could be found. The clinical course of patients in group C was similar to that of those in groups A and B. Overall, only 22% of the 147 patients were still in clinical remission and off steroids 18 months after prednisolone discontinuation, outlining the need for maintenance therapy. In conclusion, for patients who have achieved clinical remission, adjustment of steroid treatment duration on the basis of endoscopy results is of no benefit, and the endoscopic aspect has no prognostic value; thus, it appears unnecessary to repeat colonoscopy in such patients before steroid tapering is begun.

Adult↗
PubMed1991

Jejunal permeability to water and electrolytes in patients with chronic intrahepatic hypertension: evidence for a role of aldosterone.

Acute prehepatic portal hypertension induces intestinal secretion in animal models. In the course of chronic liver disease, however, these changes are not observed, despite higher portal pressures than those found in experimental studies. Eight patients without diarrhoea and with chronic alcoholic liver disease were examined for evidence of increased jejunal secretion; their suprahepatic wedge pressure was raised from 21 to 45 mmHg (mean 34.6 mmHg). Jejunal perfusion with a triple lumen catheter and a proximal occluding balloon was used to study net flows of water and chloride as well as net and unidirectional flows of sodium and potassium. No statistical difference in intestinal flows of water and electrolytes was noted between cirrhotic patients and control subjects after infusion with a 30 mmol/l glucose solution. Infusion with a 30 mmol/l mannitol solution resulted in a lower absorption of water, Na, K, and Cl than with the glucose solution. A higher rate of Na secretion was observed in cirrhotic patients than control subjects after infusion with 30 mmol/l mannitol (p less than 0.01). In addition, the rate of Na secretion was higher in cirrhotic patients than in control subjects (p less than 0.05). There was no correlation between the net flow of Na and the suprahepatic wedge pressure. A second perfusion with a 30 mmol/l glucose solution was given 75 minutes after a bolus injection of spironolactone (400 mg). Net flows of Na and Cl were lower in cirrhotic patients than in control subjects (p less than 0.05) because of a lower absorption of Na. Patients with gradually developing portal hypertension have moderate jejunal secretions of H2O and electrolytes which we assume are partly masked by increased absorption resulting from hyperaldosteronism. In contrast to animal models, this mechanism may be part of the jejunal adaptation to permeability in acute portal hypertension.

Adult↗
PubMed1991

[Corticoid therapy in the treatment of acute alcoholic hepatitis. Results of a meta-analysis].

A meta-analysis of 10 randomized trials comparing steroid therapy with placebo or abstention was performed. Trials were pooled for severity of acute alcoholic hepatitis and time of analysis. Papers with survival analyses at one and three months were included. The robustness of this meta-analysis was analysed after exclusion of trials analysing survival at three months only, trials including mild forms, or atypical trials. Comparisons were made use the Der Simonian-Laird and Mantel-Haenszel-Peto methods. All results were statistically significant. However, if only one medium size trial were to be added, the results would no longer be significant. Taking into account the complications of steroid therapy, we conclude that further clinical trials are necessary to confirm the effectiveness of steroid therapy, especially for the group of patients with severe alcoholic hepatitis.

Acute Disease↗
PubMed1990

Omeprazole is an aryl hydrocarbon-like inducer of human hepatic cytochrome P450.

Omeprazole is a new drug used for its high efficiency as an inhibitor of gastric acid secretion. This substituted benzimidazole molecule had been shown to decrease several liver cytochrome P450-mediated monooxygenase activities both in vitro and in vivo. The present work was undertaken to determine whether this drug was an inducer of cytochrome P450 in humans. Primary cultures of human hepatocytes were maintained in a serum-free, chemically defined medium for 0-96 hours in the absence or in the presence of omeprazole (1-100 mumol/L) or of other cytochrome P450 inducers such as 3-methylcholanthrene, beta-naphthoflavone, or rifampicin for comparison. Omeprazole produced a time- and concentration-dependent increase in (a) cytochrome P450IA2 accumulation determined by western blot in microsomes from omeprazole-treated cells, while the level of other cytochrome P450 forms including P450IID6, IIE1, and IIIA was not increased in the same culture; (b) several monoxygenase activities, including phenacetin deethylase and acetanilide hydroxylase (cytochrome P450IA2) and ethoxyresorufin deethylase and benzpyrene hydroxylase (cytochrome P450IA1); (c) cytochrome P450IA2 de novo synthesis, determined by immunoprecipitation of cell lysate from [3H]Leu-labeled cells; (d) cytochromes P450IA1 and IA2 mRNAs, determined by northern blot analysis. An in vivo study was carried out on liver microsomes from five patients for whom hepatic biopsy specimens were available before and after repeated administration of omeprazole (20 mg/day for 4 days). In all cases, several-fold increases in cytochrome P450IA2 and specific cytochrome P450IA subfamily-dependent monooxygenase activities were observed in agreement with the results from cell culture. It was concluded that omeprazole is an aryl hydrocarbon-like inducer of cytochrome P450 secretion in human liver both in vitro and in vivo. This drug is therefore likely to increase the metabolism of any xenobiotic specifically oxidized by a cytochrome P450IA subfamily. This could potentiate the hepatotoxicity of phenacetin or paracetamol and activation of procarcinogens.

Aged↗
PubMed1990

[Ileal pouch in the treatment of ulcerative rectocolitis and familial polyposis. Analysis of morbidity in a series of 30 cases].

Between 1984 and 1989, 30 patients underwent total coloproctectomy with J ileal pouch and ileo-anal anastomosis. They corresponded to 29 cases of ulcerative colitis and one case of familial polyposis. The authors report their own experience and the related morbidity and functional results. There were 23% fistulae, 6.6% pouchitis, 10% stenoses, 8.7% pelvic abscesses, 10% bowel obstructions, 6.6% fistulae after ileostomy closure. Only one pouch had to be removed for severe pouchitis. Functional results were partly related to post-operative complications: 50% of patients had normal continence, 57% at least 6 stools per day, 81% had one stool per night, 15% had soiling. Morbidity is discussed for the various types of complications.

Adenomatous Polyposis Coli↗
PubMed1990

[Thermic and metabolic effects of meals in liver cirrhosis assessment of oxidation and storage rates of nutrients].

The thermic effect of food was evaluated in 10 cirrhotic patients and 7 normal controls by indirect calorimetry during 6 hours following intake of a mixed meal supplying 15 kcal/kg of body weight and containing 30, 15 and 55 percent as lipid, protein and carbohydrate calories respectively. The rates of storage and oxidation of nutriments, as well as variations of blood glucose, insulin, plasma lactates, free fatty acids, glycerol, and ketonic corps were also evaluated. The thermogenic response to food was lower (p less than 0.025) and delayed in cirrhotic patients. In cirrhotic patients the rate of glucose oxidation was significantly increased (70.2 +/- 3.9 vs 50.4 +/- 3.9 percent of the glucose load; p less than 0.01) suggesting a defect in glycogen storage. These results can be related to insulin resistance as attested by a larger increase of glucose and insulin levels in cirrhotics than in controls (p less than 0.001 and p less than 0.001, respectively). Compared with controls, lipolysis in cirrhotic patients was more suppressed as shown by a sharper decrease of free fatty acids and glycerol levels (p less than 0.001 and p less than 0.02, respectively). Furthermore, the rate of lipid oxidation decreased more in cirrhotic as compared with controls (p less than 0.001) before becoming completely suppressed. De novo lipogenesis appeared between the 2nd and 4th hours. Consequently, the rate of lipid oxidation was significantly reduced in cirrhotic vs controls (14.3 +/- 5.0 vs 30.5 +/- 3.7 percent of the lipid load; p less than 0.02) showing an increased rate of lipid storage.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Prevention of recurrent hemorrhage caused by the rupture of esophageal varices in cirrhotic patients. A controlled study of propranolol and clip ligation of the esophagus].

Among the various treatments of ruptured oesophageal varices two seem to be effective: oral propranolol therapy and ligation of the oesophagus on clip. In this controlled study these two methods were compared in a series of 55 patients hospitalized for ruptured oesophageal varices. After haemodynamic stability was obtained, the patients were allocated at random to either propranolol therapy (n = 28) or surgery (n = 27). Twenty-one per cent of these patients belonged to group C of Child's classification and 54 per cent to group A. The parameters studied were similar in both groups. Five patients were excluded from the study: 2 in the medical group when it appeared that propranolol was contra-indicated and 3 in the surgical group who died before the operation; however, these 5 patients were taken into account in a second statistical evaluation. Nineteen out the 26 patients under propranolol (73 per cent) had rebleeding (within the first 10 days in 3 cases). In the surgical group recurrent bleeding was observed in 4 out of the 24 patients (17 per cent), and 4 other patients died post-operatively. The difference in favour of the surgical group was highly significant (P less than 0.001), and it remained significant (P less than 0.05) when the 5 patients who could not be treated were included into the calculations. Cox's multivariate analysis showed that patients in Child's C group had a poorer prognosis.

Adult↗
PubMed1989

The increase in urinary excretion of 6 beta-hydroxycortisol as a marker of human hepatic cytochrome P450IIIA induction.

1. Urinary excretion of 6 beta-hydroxycortisol, hepatic microsomal cortisol 6 beta-hydroxylase and the specific content of several forms of cytochrome P450 were measured in 8 to 14 patients before and after treatment with rifampicin (600 mg orally per day for 4 days). 2. Rifampicin treatment produced an average five fold increase in daily excretion of urinary 6 beta-hydroxycortisol. 3. Cortisol 6 beta-hydroxylase activity increased from 15 +/- 6 pmol min-1 mg-1 in organ donors (considered as 'control subjects') to 87 +/- 31 pmol min-1 mg-1 in rifampicin treated patients. 4. Among three forms of human P450 (P450IA, IIC and IIIA), (1), (2), measured by Western blots, only P450IIIA was significantly induced by the antibiotic. 5. Only antibodies against P450IIIA selectively inhibited cortisol 6 beta-hydroxylase in human liver microsomes. 6. Cortisol 6 beta-hydroxylase was correlated with P450IIIA specific content. 7. The urinary level of 6 beta-hydroxycortisol correlated with liver microsomal cortisol 6 beta-hydroxylase and P450IIIA specific content. 8. We conclude that P450IIIA is predominantly responsible for cortisol 6 beta-hydroxylase activity in human liver microsomes and that urinary 6 beta-hydroxycortisol is a marker of the induction of this cytochrome P450.

Adult↗
PubMed1989

[Collagen colitis. Reflections apropos of 40 patients].

The aim of this study was to evaluate the frequency of a thickened subepithelial collagen band in the colon, its relationship to diarrhea, and the clinical relevance of its detection. During a 3.5 year period (May 1985-January 1989), a total of 3,323 biopsy specimens were obtained during 6,254 colonoscopies. A subepithelial collagen thickening greater than 10 microns was found in 40 patients (1.5 percent of the patients). Further assessment of these 40 patients showed that this histological lesion was characterized by a frequent association with chronic diarrhea (in 36 patients, i.e. 90 percent) whatever the cause, with diseases such as diabetes mellitus (8 cases) or inflammatory arthropathies (6 cases) and with a microscopic colitis in all cases. Course of collagen thickening was variable and independent of clinical course. Diarrhea was a constant finding when the collagen thickening was greater than 15 microns and frequently improved (12 patients/14) during treatment with Collagenan. This study suggests that a subepithelial thickened collagen band is an uncommon change in the colon and is frequently associated with chronic diarrhea. The significance of this morphological change is unknown, and its contribution to the pathogenesis of the diarrhea remains questionable.

Chronic Disease↗
PubMed1989

[Chronic hepatic encephalopathy in cirrhotic patients and spontaneous portacaval anastomosis. Portal angiographic and manometric study].

Portal angiographic and manometric studies were prospectively carried out in 9 cirrhotic patients with spontaneous chronic portal-systemic encephalopathy. Hepatic encephalopathy presented as coma in 8 patients, and was the first manifestation of chronic liver disease in 6 cases. Hemodynamic studies showed a) a large single spontaneous portacaval anastomosis (gastrorenal, splenorenal, gradient (mean +/- SD = 16.3 +/- 5.4 mm Hg); c) a wedge hepatic venous pressure higher than portal pressure in 8 cases (difference: 1-11 mm Hg).

Blood Pressure Determination↗
PubMed1989

[Measurement of the sus-hepatic pressure gradient in differential diagnosis of chronic persistent or active hepatitis].

The value of the hepatic venous pressure gradient, measured during a transjugular liver biopsy procedure, was evaluated in the differential diagnosis of chronic persistent versus active hepatitis. The diagnosis of chronic persistent or active hepatitis was carried out according to classical clinical, biological, and above all pathological criteria. Patients with chronic active hepatitis were divided in to subgroups according to the degree of aggressivity and the presence of cirrhosis. Of the 70 patients studied, 13 had a gradient lower than 0.79 kPa, and all had chronic persistent hepatitis; 48 patients had a gradient higher than 0.93 kPa, they all had a chronic active hepatitis. For the 9 remaining patients, the gradient was between 0.79 and 0.93 kPa, 3 had persistent hepatitis, and 6 had active hepatitis. There was no significant variation of the gradient according to aggressivity in the subgroups of chronic active hepatitis. The gradient separated clearly chronic active hepatitis with or without cirrhosis. The measurement of the hepatic venous pressure gradient allows to differentiate between chronic persistent versus active hepatitis in 87 p. 100 of cases. This simple procedure offers a quick clue to diagnosis before obtaining histologic results.

Blood Pressure Determination↗