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Biomedical subjects

P Denis

Publications and source records attributed to P Denis.

At least 73 records · Page 4Linked to original sources
PubMed2000

Roux-en-Y limb motility after total or distal gastrectomy in symptomatic and asymptomatic patients.

BACKGROUND: The aims of this study were to compare Roux-en-Y limb motor patterns after total or distal gastrectomy, and to identify possible motor differences between symptomatic and asymptomatic patients. The usefulness of preoperative recording was also investigated. STUDY DESIGN: Sixteen patients were enrolled in the study, 10 patients after total gastrectomy (TG group) and 6 patients after distal gastrectomy (DG group). In 6 of 10 patients in the TG group, recordings were obtained before and after operation. Manometric recordings in the limb lasted 6 hours in all patients, 3 hours during fasting, and 3 hours after a 750-kcal meal. An intravenous injection of trimebutine (100-mg i.v.) was systematically administered at the end of each recording session. Motor results of the patients were compared with those obtained in the intact jejunum of 20 healthy controls. RESULTS: After operation, when patients were compared with controls, phase III (ie, regular activity of the migrating motor complex) was more frequent and more often incompletely propagated (5 of 16 patients versus 1 of 20 controls, unadjusted p < 0.05) and was significantly slower (p < 0.01 versus controls). Intravenous trimebutine induced phase III in 12 of 16 patients within a mean of 8.8 +/- 1 (SEM) minutes, longer than in controls (delay < 2 minutes). The fed pattern was shorter than in controls in both TG and DG groups, and the postprandial area under the curve during successive 30-minute periods was reduced in the DG group compared with controls (p < 0.01). In patients investigated before gastrectomy, motor parameters were not different from those of controls. Surgery resulted in an increased number of phase IIIs and a decreased migration velocity (p < 0.01) of phase III, a longer delay in response after trimebutine (p < 0.0001), and a reduced postprandial motor response (p < 0.01). After the operation, 4 of 10 patients in the TG group and 5 of 6 patients in the DG group were symptomatic. Symptomatic patients had slower and more often incompletely propagated (p < 0.01) phase III compared with asymptomatic patients. CONCLUSIONS: Roux-en-Y limb reconstruction mainly disturbs phase III propagation and the motor response to a meal. Motor changes are more marked after DG than after TG. Disturbed phase III propagation is the main difference between symptomatic and asymptomatic patients. Successful induction of phase III with trimebutine after gastrectomy and Roux-en-Y reconstruction indicates maintenance of encephalinergic mechanisms.

Anastomosis, Roux-en-Y↗
PubMed2000

Manometric assessment of an artificial bowel sphincter.

BACKGROUND: This study investigated the relationship between functional clinical results after artificial bowel sphincter implantation and manometric assessment in 12 consecutive patients. METHODS: A postoperative manometric study was performed in 12 patients, including measurement of resting and squeeze pressures, opening characteristics and pressure during straining. The relationship between postoperative findings, clinical outcome and preoperative manometric data was investigated. Anal pressure after rectal distension with a closed cuff was studied in seven patients. Results were expressed as mean(s.d.). RESULTS: Continence for solid stool was achieved in all 12 patients. Five patients remained incontinent for gas. Anal resting pressure was 108(22) cmH2O; there was no difference between continent and incontinent patients. Rectal distension induced anal relaxation in six of seven patients. Total duration of cuff opening was 113(8) s with an amplitude of 60(22) per cent; residual pressure was correlated with the preoperative resting pressure. The total duration of the opening phase in patients with defaecation difficulties (47(24) (range 0-65) s) was shorter than that in patients without defaecation difficulties (178(78) (range 100-320) s) (P = 0.0022). CONCLUSION: Postoperative defaecation difficulties after implantation of an artificial bowel sphincter are related to a short duration of opening of the cuff. The anal sphincter played a role in postoperative resting anal pressures and allowed relaxation even if the cuff was closed.

Adult↗
PubMed2000

Postprandial duodenojejunal motility in health and idiopathic severe gastroparesis: from conventional analysis to nonlinear dynamics analysis.

Our aim was to compare the results of the analysis of postprandial duodenojejunal motor patterns provided by a conventional computer-aided analysis with those provided by the new nonlinear mathematical method borrowed from 'chaos theory for determining how nonlinear analysis can improve fed motor pattern analysis and detect organization of postprandial contractions. Ten patients who had been explored for an idiopathic gastroparesis, and 20 healthy volunteers underwent duodenojejunal manometric recording for 3 h after a 750 kcal meal. Computer-aided analysis on each half-hour of the postprandial recording period calculated the number of waves (NW) and the area under the curve (AUC). Pressure signals were concurrently described by phase portraits obtained by plotting each pressure value at time t with the pressure value at time t + 1 s. The shape and amplitude of phase portraits were visually analysed and the relative area covered (RAC) by the phase portraits was calculated. With conventional analysis, NW and AUC were maximal during the first post-meal hour then decreased with time both in healthy volunteers and gastroparetic patients. With this analysis, the only difference between patients and controls was a lower NW (P < 0.02) in patients, observed only in the duodenum. Phase portraits analysis demonstrated lower RAC, a different distribution of RAC and more regular phase portraits in patients than in controls. Phase portraits outlined the heterogeneity of the patient group contrasting with the homogeneity of the control group when no subgroup was demonstrated by conventional analysis. We therefore conclude that the study of post prandial duodenojejunal motor behaviour could be improved by nonlinear dynamic analysis.

Adult↗
PubMed2000

Prolonged stationary colonic motility recording in seven patients with severe constipation secondary to antidepressants.

The aim of this study was to determine whether the colonic motor profile of seven patients with constipation secondary to antidepressants differed from the motility of seven patients with idiopathic constipation and seven healthy volunteers. All constipated patients had very severe constipation. Colonic manometric recordings were performed for 24 h. The number of high amplitude propagating contractions (HAPC) was lower in the two groups of constipated patients than in controls. No HAPC were observed in 5/7 patients with constipation secondary to antidepressants and in 1/7 patients with idiopathic constipation. The overall area under the curve (AUC) in the left colon was lower in the two constipated patient groups than in controls. AUC increased after a 1000-kcal standard meal given at noon in controls but not in the two groups of constipated patients. In conclusion, in patients with constipation secondary to antidepressants, the overall AUC was as poor as in patients with idiopathic constipation, and no colonic response to eating was observed. Moreover, the number of HAPC was more markedly decreased in patients with constipation secondary to antidepressants than in patients with idiopathic constipation.

Adult↗
PubMed2000

Severe dysphagia after laparoscopic fundoplication: usefulness of barium meal examination to identify causes other than tight fundoplication--a prospective study.

Background. The aim of this study was to determine the results of a barium meal examination after laparoscopic wrap in symptomatic patients (SPs) with no upper endoscopic anomalies and no increase in inferior esophageal sphincter pressure (SPs). Radiologic results were compared with results from patients with no symptoms (ASPs) and were compared with the surgical findings in patients who underwent reoperation. Methods. Twenty SPs were included 27 +/- 6 months after a total wrap (n = 13 Nissen procedures) or a posterior wrap (n = 7 Toupet procedures) performed in several hospitals in Haute Normandie. All patients had severe symptomatic dysphagia with epigastric pain (n = 18 patients) and/or marked weight loss (n = 16 patients). Control subjects were 31 consecutive ASPs within our center who were prospectively included 4 +/- 1 months after a Nissen (n = 6 patients) or a Toupet (n = 25 patients) procedure. A barium meal examination was performed in all patients and interpreted by 3 independent observers who knew that the patients had undergone a wrap but who did not know whether the patients had symptoms. Fifteen of the 20 SPs underwent a second operation. Results. Barium meal examination was more often abnormal in SPs than in ASPs (17/20 vs 4/31 patients; P <.001), whichever the type of wrap. Two abnormal radiologic results were observed in both groups: an esophageal barium level and an esogastric plication. Only a high barium level in the esophagus was more frequently observed in SPs than in ASPs (P <.05). Three radiologic results were specifically observed in SPs: a long cardial narrowing beginning above the wrap, a mediogastric plication, and a gastric volvulus. A comparison of radiologic anomalies and surgical findings showed that (1) a radiologic long cardial narrowing was explained by fibrotic stenosis of the muscular esophageal hiatus (n = 6 patients), (2) a mediogastric plication (n = 4 patients) was due to gastric volvulus (n = 3 patient) or to gastric wrap (n = 1 patient), and (3) results of volvulus (n = 5 patients) indicated a gastric volvulus. Additional surgical procedures resulted in the disappearance of symptoms in 13 of 15 patients. Conclusions. After laparoscopic fundoplication when upper endoscopy and esophageal manometry are normal, results of a barium meal examination can explain the cause of dysphagia in almost all patients. Three radiologic results were specific for SPs and indicated major morphologic disturbances that could not be treated by endoscopic dilation but that could be treated by additional surgical procedures.

Administration, Oral↗
PubMed2000

Does treatment of constipation improve faecal incontinence in institutionalized elderly patients?

OBJECTIVE: to evaluate whether faecal incontinence can be improved by treatment of constipation in elderly patients with faecal incontinence associated with impairment of rectal emptying. DESIGN: a prospective randomized study with a 2-month follow-up. SETTING: five long-term care units. SUBJECTS: 206 patients with daily faecal incontinence associated with chronic rectal emptying impairments such as faecal impaction received either a single osmotic laxative (group I) or an osmotic agent along with a rectal stimulant and weekly enemas (group II). MEASUREMENTS: episodes of faecal incontinence and associated details of soiled laundry (used as indicators of the workload for caregivers). We performed periodic digital rectal examinations on group II patients to evaluate whether treatment resulted in complete and long-lasting rectal emptying. We compared data between groups and in group II between persistently constipated patients and patients with complete rectal emptying. RESULTS: the frequency of faecal incontinence did not significantly differ between the two groups. The 23 patients in group II who had complete rectal emptying had 35% fewer episodes of faecal incontinence and 42% fewer incidents of soiled laundry than the rest of the group. CONCLUSIONS: when long-lasting and complete rectal emptying is achieved by laxatives, the number of episodes of faecal incontinence as well as the workload for caregivers is reduced.

Aged↗
PubMed2000

How do fiber-supplemented formulas affect antroduodenal motility during enteral nutrition? A comparative study between mixed and insoluble fibers.

BACKGROUND: Fiber supplementation during enteral nutrition has been recommended, but the effect of soluble compared with insoluble fiber supplements on antroduodenal motility is unknown. OBJECTIVE: The objective of this study was to compare antroduodenal motor patterns in 8 healthy volunteers during and after gastric infusion of 3 different diets: a fiber-free diet, an insoluble-fiber diet, and a mixed-fiber diet (50% soluble fiber and 50% insoluble fiber). DESIGN: Manometric studies with the 3 different diets (2100 kJ) were performed in random order. Antroduodenal motility was monitored continuously for 6 h by using a pneumohydraulic system to calculate the number, amplitude, and duration of the pressure waves; the area under the curve (AUC); and the percentage of time occupied by motor activity before, during, and after each type of infusion. Variations in antral areas were measured by ultrasonography. RESULTS: The gastric motor response was significantly higher, whatever the diet, in the distal antral recording site than in the 2 more proximal sites. In the proximal but not the distal antrum, the number of waves, the AUC, and the percentage of time occupied by motor activity were higher (P: < 0.04) with the mixed-fiber than with the insoluble-fiber diet. No significant differences in variations of antral area were observed among the 3 diets. In the duodenum, motor variables were not significantly different among the 3 diets. CONCLUSIONS: A gastric infusion induced a greater motor response in the distal than in the proximal antrum. A mixed-fiber diet was associated with significantly greater proximal antral motility than was an insoluble-fiber diet. There was no significant difference among the 3 formulas in duodenal motor variables or in variations in antral area as measured by ultrasound.

Adult↗
PubMed2000

Methionine transsulfuration is increased during sepsis in rats.

Methionine transsulfuration in plasma and liver, and plasma methionine and cysteine kinetics were investigated in vivo during the acute phase of sepsis in rats. Rats were infected with an intravenous injection of live Escherichia coli, and control pair-fed rats were injected with saline. Two days after injection, the rats were infused for 6 h with [(35)S]methionine and [(15)N]cysteine. Transsulfuration was measured from the transfer rate of (35)S from methionine to cysteine. Liver cystathionase activity was also measured. Infection significantly increased (P < 0.05) the contribution of transsulfuration to cysteine flux in both plasma and liver (by 80%) and the contribution of transsulfuration to plasma methionine flux (by 133%). Transsulfuration measured in plasma was significantly (P < 0.05) higher in infected rats than in pair-fed rats (0.68 and 0.25 micromol. h(-1). 100 g(-1), respectively). However, liver cystathionase specific activity was decreased by 17% by infection (P < 0.05). Infection increased methionine flux (16%, P < 0.05) less than cysteine flux (38%, P < 0.05). Therefore, the plasma cysteine flux was higher than that predicted from estimates of protein turnover based on methionine data, probably because of enhanced glutathione turnover. Taken together, these results suggest an increased cysteine requirement in infection.

Animals↗
PubMed2000

[Good practices in traumatic glaucoma].

We review different aspects of trauma induced glaucoma and hypertonia, discussing pathophysiology, patient management, and the main clinical presentations. One can distinguish schematically first acute hypertonia related to changes in the position of the crystalline lens or to a hyphema which requires emergency medical or surgical care and second, chronic situations generally related to definitive angle lesions. We also discuss particular presentations such as phantom cell glaucoma and glaucoma by chemical burn or siderosis.

Burns, Chemical↗
PubMed2000

[Neovascular glaucoma diagnosed following carotid endarterectomy].

We report a case of bilateral asymptomatic rebeosis iridis related to a bilateral obstruction of the carotid arteries. The iridocorneal angles were closed by a neovascular membrane and intraocular pressures were normal within both eyes (normotensive neovascular glaucoma). After left carotid endarterectomy, the increased perfusion of the ciliary body and the increased secretion of aqueous humor resulted in a sudden bilateral ocular hypertension. Management of ocular neovascularization related to carotid artery obstruction may involve the destruction of areas of retinal ishchemia (laser panretinal photocoagulation or cryotherapy) before carotid surgery.

Carotid Artery Thrombosis↗
PubMed2000

[Persistent hyperplastic primary vitreous syndrome in a girl with Aicardi syndrome].

Aicardi syndrome is characterized by infantile spasms, agenesis of the corpus callosum and chorioretinal lacunae. This disorder affects mostly females with early embryonic lethality in males. We present a case of persistent hyperplastic primary vitreous (PHPV) in association with Aicardi syndrome in a 2-year-old girl.

Abnormalities, Multiple↗
PubMed2000

[Relevance of quality of life and treatment compliance measurement in patients with chronic open-angle glaucoma].

Chronic glaucoma is a severe disease that can induce blindness.Early diagnosis and symptomatic treatment reduce the risk of blindness. Treatment that will be started before the onset of clinical signs and will remain lifelong thereafter is troublesome, and therapeutic compliance is usually poor. Thus, quality of life (QOL) measurement in patients with chronic glaucoma has a particular purpose: to measure patients' perception of the disease and treatment in order to maintain good treatment compliance to ensure therapeutic management efficacy and to preserve visual function. No glaucoma-specific instrument is available in the medical and QOL literature. Various generic(SF-36, SF-20 and SIP) and specific(VAQ, VF-14, NEI-VFQ) QOL questionnaires,one glaucoma-specific symptomatic scale (GSS),and one treatment preference scale (COMTol) have been used to measure QOL in glaucoma patients. These instruments do not sufficiently measure the psychosocial dimension of the disease and the QOL impact of treatment. An instrument able to measure all dimensions needs to be developed in order to help ophthalmologists in the therapeutic management of their patients and to measure QOLin patients in the successive stages of the disease.

Attitude to Health↗
PubMed1999

Beta-secretase cleavage of Alzheimer's amyloid precursor protein by the transmembrane aspartic protease BACE.

Cerebral deposition of amyloid beta peptide (Abeta) is an early and critical feature of Alzheimer's disease. Abeta generation depends on proteolytic cleavage of the amyloid precursor protein (APP) by two unknown proteases: beta-secretase and gamma-secretase. These proteases are prime therapeutic targets. A transmembrane aspartic protease with all the known characteristics of beta-secretase was cloned and characterized. Overexpression of this protease, termed BACE (for beta-site APP-cleaving enzyme) increased the amount of beta-secretase cleavage products, and these were cleaved exactly and only at known beta-secretase positions. Antisense inhibition of endogenous BACE messenger RNA decreased the amount of beta-secretase cleavage products, and purified BACE protein cleaved APP-derived substrates with the same sequence specificity as beta-secretase. Finally, the expression pattern and subcellular localization of BACE were consistent with that expected for beta-secretase. Future development of BACE inhibitors may prove beneficial for the treatment of Alzheimer's disease.

Alzheimer Disease↗
PubMed1999

Both familial Parkinson's disease mutations accelerate alpha-synuclein aggregation.

Parkinson's disease (PD) is a neurodegenerative disorder that is pathologically characterized by the presence of intracytoplasmic Lewy bodies, the major component of which are filaments consisting of alpha-synuclein. Two recently identified point mutations in alpha-synuclein are the only known genetic causes of PD, but their pathogenic mechanism is not understood. Here we show that both wild type and mutant alpha-synuclein form insoluble fibrillar aggregates with antiparallel beta-sheet structure upon incubation at physiological temperature in vitro. Importantly, aggregate formation is accelerated by both PD-linked mutations. Under the experimental conditions, the lag time for the formation of precipitable aggregates is about 280 h for the wild type protein, 180 h for the A30P mutant, and only 100 h for the A53T mutant protein. These data suggest that the formation of alpha-synuclein aggregates could be a critical step in PD pathogenesis, which is accelerated by the PD-linked mutations.

Cell Line↗
PubMed1999

Prevalence of anal incontinence in 409 patients investigated for stress urinary incontinence.

A clinical questionnaire concerning anorectal symptoms and urodynamic tests was used to investigate 409 women consulting for stress urinary incontinence. To compare urodynamic data, patients were divided into three groups of women who had either stress urinary incontinence associated with incontinence for formed and/or liquid stools or with gas incontinence, or isolated stress urinary incontinence. To take in account the patients'age for data interpretation, a Mantel-Haenszel test or covariate analysis was performed. Anal incontinence was reported in 114 (28%) of the 409 women investigated. The prevalence of incontinence for gas only, for liquid, or for solid stools was 18.3, 9.3, and 1%, respectively. The duration of gas incontinence was longer than that of fecal incontinence or stress urinary incontinence. Difficult defecation was more frequently observed in patients with double incontinence than in patients with only stress urinary incontinence, and the difference was significant between patients with gas incontinence and patients with stress urinary incontinence (53% versus 37%, P = 0. 03). There was no difference in the number of bowel movements per week among the three groups of patients. The number of vaginal deliveries was surprisingly lower in patients with fecal incontinence associated with urinary incontinence than in others. There was no urodynamic feature that could distinguish patients with urinary incontinence and patients with double incontinence. This study confirmed the close relationship between anal and stress urinary incontinence. Neurourol. Urodynam. 18:579-590, 1999.

Adolescent↗
PubMed1999

Pudendal neuropathy and severity of incontinence but not presence of an anal sphincter defect may determine the response to biofeedback therapy in fecal incontinence.

PURPOSE: It has been suggested that the severity of fecal incontinence, the presence of pudendal neuropathy, or an external anal sphincter defect does not preclude clinical improvement with biofeedback therapy. A discrepancy, however, is frequently found between subjective improvement and objective results after biofeedback therapy. Our aim was to assess whether severity of fecal incontinence, presence of pudendal neuropathy, or an external anal sphincter defect could influence the results of manometric parameters after biofeedback therapy in patients with fecal incontinence. METHODS: Biofeedback therapy was used to treat 27 patients with fecal incontinence (25 women; mean age, 53; range, 29-74 years), according to a strict protocol. Manometry, pudendal nerve terminal motor latency, and anal ultrasound were performed in all patients before biofeedback therapy. Manometric evaluation of external anal sphincter function was performed after the biofeedback sessions. RESULTS: Eight of 27 patients had a good clinical response to biofeedback, but with no significant difference in their mean amplitude and duration of squeeze pressure before and after biofeedback. There was no relationship between the clinical results of biofeedback therapy and the initial severity of fecal incontinence, pudendal neuropathy, or external sphincter defect. Patients with severe incontinence (incontinence to solids) and pudendal neuropathy failed to improve the amplitude and duration of their maximum voluntary contraction after biofeedback therapy. Patients with mild fecal incontinence (incontinence to flatus, liquids, or both) (P<0.04), without pudendal neuropathy (P<0.02), or with (P<0.05) and without (P<0.05) external sphincter defect improved their external anal sphincter function after biofeedback therapy. CONCLUSION: In patients with fecal incontinence, the severity of symptoms and pudendal neuropathy should be considered as two factors of poor prognosis of favorable manometric results after biofeedback therapy. Improvement, on the other hand, may be expected after biofeedback therapy despite an external anal sphincter defect.

Anal Canal↗
PubMed1999

Results of pudendal nerve neurolysis-transposition in twelve patients suffering from pudendal neuralgia.

PURPOSE: Pudendal neuralgia caused by nerve compression may be improved by surgical decompression of the pudendal nerve. This study was undertaken to determine if clinical symptoms, electrophysiological investigations, and the efficacy of preoperative pudendal nerve blocks could be used to predict the efficacy of surgery. METHODS: Twelve consecutive patients complaining of anal pain, genital pain, or both, exacerbated in the sitting position and unsuccessfully treated by analgesic drugs before referral were studied. In these 12 patients decompression of the pudendal nerve was performed after unsuccessful CT-guided injection of corticosteroids in the pudendal nerve at the ischial spine or after pain relapse following successful injections. Nineteen nerves were decompressed by surgery, and the compressed area was located between the sacrospinal and sacrotuberal ligaments for 18 nerves. RESULTS: Three months after surgery, four patients were totally relieved, and three were only partially improved. After 21 months of follow-up, three patients were cured, one was slightly improved, and eight remained in pain. In the three patients cured by surgery, pain completely disappeared for at least two weeks after a nerve block repeated twice before surgery, whereas pain relief was observed in only one of the nine other patients (P = 0.018). None of the three patients cured by surgery were being treated for depression, whereas six of the nine remaining patients were receiving antidepressants or were followed by a psychiatrist (P = 0.09). Results of surgery did not depend on other preoperative clinical or electrophysiological data. CONCLUSIONS: This preliminary study suggests that complete disappearance of pain for at least two weeks after a nerve block repeated twice before surgery may be the best criterion to predict success. Based on this criterion, surgery would have been performed in four patients in this study, of whom three would have been cured.

Aged↗