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Biomedical subjects

P Gaucher

Publications and source records attributed to P Gaucher.

At least 19 recordsLinked to original sources
PubMed1995

[Agenesis of the right lobe of the liver and portal hypertension].

A case of agenesis of the right lobe of the liver associated with portal hypertension is reported. This uncommon feature was diagnosed by computed tomography which excluded secondary liver atrophy due to cirrhosis or tumour. The main pathophysiological hypothesis for agenesis and portal hypertension, exceptionally associated, is arrest of hepatic development during foetal life.

Humans↗
PubMed1994

[Hepatitis induced by alpidem (Ananxyl). Four cases, one of them fatal].

Acute hepatitis related to psychotropic drugs has been rarely reported with anxiolytic treatments. Alpidem (Ananxyl) is a new imidazopyridine derivative with anxiolytic properties which was launched in October 1991. Several cases of acute hepatitis, some severe, were described with this drug and its liver toxicity was questioned. Results of a study monitoring drug side-effects caused this drug to be withdrawn from the market for one year. We report four cases of acute hepatitis and discuss the role of alpidem. All but one case were presented as severe acute hepatitis with hepatic failure. One patient ran a fulminant course and died despite liver transplantation. The mechanism of liver toxicity remains unclear.

Adult↗
PubMed1992

Relationship of insulin resistance to protein-energy malnutrition in patients with alcoholic liver cirrhosis: effect of short-term nutritional support.

Protein-energy malnutrition (PEM) and insulin resistance (IR) are common features of alcoholic liver cirrhosis (ALC). In order to determine a relationship between them, nutritional status and glucose homeostasis were studied in 26 patients with ALC. Nutritional status was assessed through dietary, anthropometric, and biological parameters. An IR index (M/I) was obtained from the euglycemic insulin clamp technique. M/I was significantly correlated with accurate markers of PEM (albumin, transthyretin, and retinol-binding protein) but not with other markers of liver dysfunction. Nine patients were studied before and after nutritional support: M/I was significantly improved as were serum markers of PEM. Other markers of liver dysfunction were also significantly improved. These findings suggest that PEM could be responsible, in part, for IR in patients with ALC who are frequently malnourished. Moreover, nutritional support improved insulin sensitivity in these patients.

Anthropometry↗
PubMed1992

Flow cytometric analysis of the cell cycle in chronic gastritis.

Flow cytometric cell cycle analysis was recorded in gastric biopsy specimens from patients with normal gastric mucosa (GM), superficial gastritis (SG) and chronic atrophic gastritis (CAG). Cell-cycle analysis showed significantly higher percentages of cells in S- and S+G2/M-phase in CAG than in SG and normal GM (P < 0.0001). Moreover, CAG with severe or moderate atrophy showed significantly higher percentages of cells in S-phase (P < 0.05) and S+G2/M-phase (P < 0.02) than CAG with mild atrophy in antrum. In fundus, even if this increase was observed, it did not reach statistical significance. Consideration of concomitant pathologic findings such as oesophagite, gastric or duodenal ulcer, duodenite or benign polyp allowed a better differentiation of CAG both in antrum and in fundus. Significantly higher S-phase was observed in CAG with severe or moderate atrophy than in CAG with mild atrophy (P < 0.05). No statistically significant results were observed in patients with normal gastric mucosa or chronic gastritis and a concomitant pathologic finding.

Cell Cycle↗
PubMed1990

Malabsorption of vitamin B12 in pancreatic insufficiency of the adult and of the child.

Vitamin B12 can bind two carrier proteins in the digestive tract, haptocorrin (R binder) and intrinsic factor, but only its binding to intrinsic factor allows its absorption. A malabsorption of vitamin B12 is observed in about 30% of adult patients with exocrine pancreatic insufficiency, using the Schilling test. None of the hypotheses that have tried to explain this malabsorption are entirely satisfactory. A failure to degrade haptocorrin can prevent the binding of vitamin B12 to intrinsic factor. It has also been suggested that pancreatic secretion could modify the structure of intrinsic factor, enabling the uptake of the vitamin B12-intrinsic factor complex by the ileum. Other factors can also affect the binding of vitamin B12 to intrinsic factor, such as the gastric pH and bile. The Schilling test is abnormal in nearly all cases of cystic fibrosis. One explanation could be the gastric hyperacidity observed in this disease. Despite the frequency of abnormal Schilling tests, vitamin B12 deficiency is very rare in cases of exocrine pancreatic dysfunction, in adults as well as in children with cystic fibrosis. The assimilation of this vitamin with a tracer included in food instead of the crystalline labeled cobalamin used in the Schilling test remains to be investigated.

Adult↗
PubMed1990

Randomized double-blind clinical trial of aluminum phosphate versus ranitidine in the acute treatment of duodenal ulcer.

A randomized double-blind clinical trial of aluminum phosphate versus ranitidine in the treatment of noncomplicated acute duodenal ulcer has been conducted in 91 patients. After randomization the 42 patients of the aluminum phosphate group were comparable to the 49 patients of the ranitidine group. At 4 weeks, 6 patients were not endoscoped and according to the intention-to-treat method they were considered as treatment failure. The endoscopy showed a 60% healing rate in the aluminum phosphate group (25/42) versus 55% in the ranitidine group (27/49); this difference was not significant. Among the factors assessed, only one, the round shape of the ulcer, was significantly and independently associated with ulcer healing in a multidimensional analysis. In conclusion, this double-blind trial showed that aluminum phosphate is an effective, save and cheap treatment of acute duodenal ulcer.

Aluminum↗
PubMed1989

Evaluation of fibrosis in the disse space in noncirrhotic alcoholic liver disease.

In 40 alcoholic noncirrhotic patients, we performed a liver biopsy and determined the wedged hepatic vein pressure, the free hepatic vein pressure, and the intrahepatic vein pressure. In 27 of them, the serum concentration of the N-terminal peptide of type III procollagen (PIIIP) and of the laminin P1 fragment was measured. All the liver biopsies were studied by light and transmission electronic microscopy. A score of collagenization of the Disse space (six classes) was performed using transmission electronic microscopy. 37 of the 40 patients had pathological collagenization of the Disse space which was correlated with intrahepatic pressure (p less than 0.01). The lamin P1 blood level in patients (1.38 +/- 0.51 U/ml) was increased, compared to the values of our controls (0.99 +/- 0.10 U/ml, p less than 0.01) and was correlated with the wedge hepatic vein pressure (p less than 0.01). The PIIIP blood level was not significantly increased except when Mallory bodies were found in hepatocytes (p less than 0.05). The laminin P1 blood level seemed to be a good biological marker for detection of liver fibrosis in long-term alcoholic intake.

Adult↗
PubMed1989

[Prospective study of the function of the anal sphincter before and after hemorrhoidectomy].

A prospective study was carried out on the anorectal function in patients with hemorrhoids (group H, n = 25) versus normal controls (group T, n = 22) and on the effect at three months of hemorrhoidectomy on sphincter function and anal continence. Hemorrhoidectomy was performed by the same surgeon using the standard Milligan Morgan procedure in all cases. All patients and controls underwent an anal manometry, a measure of the length of the anal sphincter and a saline continence test. Anal resting pressure was higher in group H as compared to group T before hemorrhoidectomy (136 +/- 32 cm H2O vs 98 +/- 19 p less than 0.001). After hemorrhoidectomy, and resting pressure was significantly lower (141 +/- 21 cm H2O vs 106 +/- 25 p less than 0.01). Anal length was similar in group H and in group T (50.2 +/- 6.6 mm vs 45 +/- 5.5 NS) but decreased significantly after hemorrhoidectomy (41.9 +/- 7.6 vs 50.3 +/- 7.3 p less than 0.01). Ultraslow waves were more often observed in patients with piles (60 p. 100 vs 9 p. 100 of normal controls). After hemorrhoidectomy ultraslow waves were less commonly encountered (25 p. 100 p less than 0.05). Anal leakage during the saline continence test was observed in 12 and 82 p. 100 of patients before and after hemorrhoidectomy, respectively (p less than 0.001). No anal leakage was observed in the control groups. After hemorrhoidectomy the mean volume of anal leakage was of 190 ml. In 35 p. 100 of the patients, anal leakage occurred before the anal infusion of 500 ml.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[Evaluation of exocrine pancreatic function by the haptocorrin degradation test of the duodenal fluid collected by endoscopy].

Two groups of biological methods are commonly used to evaluate the exocrine pancreatic function: tests which require tubes for the collection of duodenal juice and the tubeless tests which are indirect tests of pancreatic function. In this study we have attempted to improve a new test: the test of haptocorrin degradation (THD). This test measures the transfer of labelled cobalamin from haptocorrin to the intrinsic factor which is provoked by the degradation of the haptocorrin by proteases in the duodenal juice. We present the results of this test in 90 patients with chronic pancreatitis. THD was first assayed with basal duodenal juice collected by naso duodenal tubing during secretin cerulein stimulation. In this study the sensitivity and specificity of THD was 0.86 and 0.93, respectively. In the second part of this study we demonstrated that the means of collecting duodenal juice had no effect on the results of THD. Duodenal juice was collected during a secretin cerulein test or during a routine upper gastrointestinal endoscopy after pancreatic stimulation with secretin. The sensitivity and specificity of THD was 0.90 and 0.94, respectively, when duodenal juice was collected during endoscopy. THD was significantly correlated with the NBT-PABA test, steatorrhea, and with the activity of trypsin and chymotrypsin in the duodenal juice. In this study, NBT-PABA was less sensitive than THD for the diagnosis of chronic pancreatitis (sensitivity was 0.70 and 0.89, respectively). The specificity of THD was estimated at 0.94. THD seemed to be a valuable adjunct to test pancreatic function. As upper gastrointestinal endoscopy is usually performed in patients with proved or suspected chronic pancreatitis, THD seems to have a place of choice among the other tests of pancreatic exocrine function. Further evaluation of this test by a multicentric prospective trial is now needed.

Adult↗
PubMed1988

[Endoscopic sclerotherapy versus propranolol after hemorrhage caused by rupture of esophageal varices in patients with cirrhosis. Results of a 4-year randomized study].

Between December 1982 and April 1987, we conducted a prospective randomized trial comparing the efficiency of endoscopic sclerotherapy with oral propranolol after variceal hemorrhage in cirrhosis. We present our results after a median follow-up of 3 years (range = 57-231 weeks). The sclerotherapy group (S) consisted of 28 patients and the propranolol group (P), 27 patients. The two groups were similar for age, sex, etiology and severity of liver disease, and severity of hemorrhage; the only difference concerned previous hemorrhages which were significantly more numerous in the S group. Sclerotherapy was performed with polidocanol 1 p. 100. A slow-release preparation of propranolol was used; the average daily dose was 160 mg. Eighteen patients in the S group had at least one hemorrhagic recurrence as opposed to 12 in the P group. This difference was not significant nor was the difference between actuarial curves of no-rebleeding (p = 0.30). No difference was noted concerning total deaths (15 in S versus 12 in P). Cumulative survival curves showed a non-significative difference (p = 0.99) percentages of survival in S and P groups were 75.0 p. 100 and 73.6 p. 100 at 1 year, 67.9 p. 100 and 64.6 p. 100 at 2 years, and 51.1 p. 100 and 52.7 p. 100 at 3 years respectively. Stratification according to Child's group, variceal size and history of variceal hemorrhage did not modify these results. However, male patients had less hemorrhagic recurrences with propranolol than after sclerotherapy. Length of hospitalization was not different in the two groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Esophageal and Gastric Varices↗
PubMed1986

In-vitro test of haptocorrin degradation for biological diagnosis of exocrine pancreatic dysfunction using duodenal juice collected during endoscopy.

An in-vitro test of degradation of haptocorrin, a cobalamin-binding glycoprotein, was used to diagnose exocrine pancreatic dysfunction. This radioisotopic test (TDH) required only 50 microliters duodenal juice collected during endoscopy after stimulation with 1 U/kg secretin intravenously. The initial reaction mixture, composed of salivary haptocorrin saturated with cobalt-57-labelled cyanocobalamin and unsaturated intrinsic factor, was incubated with 25 microliters duodenal juice. The percentage of degraded haptocorrin was estimated from the proportion of labelled cyanocobalamin that was transferred from haptocorrin to intrinsic factor. The TDH result was 41.6 +/- 31.7% (SD) in a group of chronic pancreatitis patients (n = 22) and 91.5 +/- 4.8% in the control group (n = 47). The sensitivity and specificity for exocrine pancreatic dysfunction were estimated as 0.91 and 0.96, respectively, for a lower limit of normal values of 81.7%. A hyperbolic relation was found between the TDH and the trypsin or chymotrypsin activity in duodenal juice (p less than 0.001). In this study, the N-benzoyl-tyrosyl-p-aminobenzoic acid test was less sensitive than the TDH, since its result was abnormal in only 64% of the patients. The TDH was easier to carry out and less time-consuming than the determination of pancreatic enzyme output in duodenal juice collected after hormonal stimulation.

Adult↗
PubMed1986

[Percutaneous endoscopic gastrostomy].

Gastrostomy by endoscopy is a simple and fast procedure which does not require general anaesthesia. Its morbidity and mortality rates are low. With the initial technique, the gastrostomy tube was pulled in by a thread introduced percutaneously into the stomach. In cases with oesophageal stenosis, using a Foley balloon catheter is useful. Gastrostomy can be transformed into jejunostomy by a similar method. The main indications of percutaneous endoscopic gastrostomy are cancer of the upper respiratory or digestive tract, notably those complicated by fistulae, and disorders of deglutition due to abnormal buccal and pharyngeal stages.

Gastroscopy↗