Biomedical subjects

P Ingrand

Publications and source records attributed to P Ingrand.

At least 19 recordsLinked to original sources

PubMed2002

[Depression and Parkinson's Disease: study of a series of 135 Parkinson's patients].

OBJECTIVE: The prevalence of depression in Parkinson's disease (PD) raises the issues of the difficulties of diagnosing the condition and of the relationships between depression and the natural history of the disease. METHODS: A cohort of 135 consecutive patients with idiopathic PD underwent psychiatric (DSM-III-R, Goldberg depression scale), neurological (distinguishing "axial" signs from other signs of parkinsonism), and neuropsychological (particularly frontal tests) evaluations. RESULTS: Depression is present in more than half of the patients and it seems to be more frequent in patients with the akinetic and fluctuating forms of the disease. The subjects who are depressed do not have a greater degree of cognitive impairment, but their scores on frontal tests are higher. Moreover, the axial signs of the disease (postural instability, axial rigidity) are more severe in depressed parkinsonians suggesting a link between depression and the non-dopaminergic lesions of the disease. Even though slowness, appetite and sleep disturbances, and fatigue may be encountered in non-depressed parkinsonian patients, separation of the parkinsonian population into subgroups shows that certain symptoms are never seen in parkinsonians who are not depressed: it is thus evident that "the impression that life is not worth living", "the hopelessness", "the impression of being worthless and incompetent", "the low level of energy", "the morning sadness" are characteristic of parkinsonian depression. Parkinsonian depression has two major clinical forms. The first one is associated with a greater number of somatic manifestations: sleep disturbances, morning fatigue. corresponding to more severe depression with hopelessness and loss of self confidence. The second exhibits few somatic manifestations with apathy and slowness as frequent complaints. CONCLUSIONS: This study defines the symptoms of parkinsonian depression which should be better recognised in order to be treated. The link between depression and axial signs of the disease may explain why L-dopa and dopaminergic agonists improve the motor signs of depression without influencing depressive manifestations in most cases.

Aged↗

PubMed2002

[Chronic renal failure in Poitou-Charentes: prevalence, structure adequacy, and patient satisfaction].

The characteristics of the existing cases in the region, the adequacy of the structures with respect to the needs, and the satisfaction of patients undergoing dialysis have been analysed as part of an ongoing project for the development of a Regional Outline for Health Organisation in the Poitou-Charentes region of France. A cross-sectional survey was conducted in the haemodialysis units, dialysis facilities and patient associations in the region and bordering areas where patients were being treated. As of March 31, 2000, the prevalence of chronic renal failure was estimated to be 373 people per one million of the population. According to the nephrologist, the adequacy of the care structures was found to be satisfactory for 82% of the patients. The main reasons for non-adequacy were first, the lack of intermediate structures between centres and outpatient units; second, the patient's refusal to be referred to another structure; and finally, other medical, physical and intellectual factors. For 90% of patients, their treatment method corresponded to their choice of therapy. The lack of a nearby structure was equally recognised as a primary reason for dissatisfaction. It should be noted that 42% of the patients under 60 years old felt that they were either poorly or very poorly informed of their rights, the coverage and the treatment of this illness.

Adolescent↗

PubMed2001

Withholding and withdrawal of life support in intensive-care units in France: a prospective survey. French LATAREA Group.

BACKGROUND: In France, there are no guidelines available on withholding and withdrawal of life-sustaining treatments, and information on the frequency of such decisions is scarce. METHODS: We undertook a prospective 2-month survey in 113, of a total of 220, intensive-care units (ICUs) in France to study the frequency of, and processes leading to, decisions to withhold and withdraw life-sustaining treatments. FINDINGS: Life-supporting therapies were withheld or withdrawn in 807 (11.0%) of 7309 patients (withholding in 336 [4.6%] and withdrawal in 471 [6.4%], preceded in 358 by withholding). Of 1175 deaths in ICU, 628 (53%) were preceded by a decision to limit life-supporting therapies. Futility and poor expected quality of life were the most frequently cited reasons. Decisions were strongly correlated with the simplified acute physiological score, but an independent centre effect persisted after adjustment for this score. Decisions were mostly taken by all the ICU medical staff, with (54%) or without (34%) the nursing staff; however, a single physician made decisions in 12% of cases. The patient's family was involved in the decision-making process in 44% of cases. The patient's willingness to limit his or her own care was known in only 8% of the cases; only 0.5% of the patients were involved in decisions. INTERPRETATION: Withholding and withdrawal of life-support therapies are widely practised in French ICUs, despite their prohibition by the French legislation. The lack of an official statement from French scientific bodies may explain several limitations on the various steps of the decision-making process.

Adult↗

PubMed2001

[Regional program to improve the quality of blood transfusions in hospitals: experience of the Poitou-Charentes region].

In the Poitou-Charentes area, a regional pilot program was implemented over a two year-period to improve transfusion safety in public and private hospitals. This program consisted in: (i) an evaluation of the transfusion chain in hospitals; (ii) a regional program to guide hospitals in improving the quality process. Five workgroups were set up. Three persons in each hospital should participate in the workgroup: one representing the administration, one the medical staff and one the nursing staff. After a six months follow-up several hospitals were prompted to implement corrective and preventive measures to improve transfusion safety; (iii) a letter was regularly published to contribute to set-up a regional haemovigilance network. Such a quality improvement program revealed to be a relevant method to steer the changing blood transfusion process in hospitals.

Blood Specimen Collection↗

PubMed2001

Self-consciousness and Alzheimer's disease.

OBJECTIVES: To propose a neuropsychological study of the various aspects of self-consciousness (SC) in Alzheimer's disease. METHODS: Forty-five patients with probable mild or moderate AD were included in the study. Severity of their dementia was assessed by the Mini Mental State (MMS). Fourteen questions were prepared to evaluate SC. RESULTS: No significant correlations were found between SC score and educational level, age, and duration of disease. A significant correlation was found between SC score and the severity of dementia, whereas frontal disturbances were just short of the significance threshold. The various aspects of SC were not impaired to the same degree. The most disturbed ones were awareness of cognitive deficiencies, moral judgements and prospective memory. The least disturbed aspects were awareness of identity and of mental representation of the body. Items relating to anosognosia and moral judgements were significantly correlated with the MMS score, whereas affective state, body representation disorders, prospective memory, and capacities for introspection were not related to the severity of the dementia. Consciousness of identity was sound, regardless of MMS score. CONCLUSIONS: AD clearly induces an heterogeneous impairment of SC. SC requires a convergence of many neural networks. In AD, neuronal alterations involve many cortical areas and information sent to the associative frontal cortex from memory, language and visuospatial areas is lacking or disturbed. Thus, the sequential order of successive stimuli cannot be maintained by the heteromodal associative cortex (dorsal convexity of the prefrontal cortex), and the supramodal associative cortex (located rostrally in the frontal lobes) is unable to provide reliable monitoring and assessment of simultaneous neural cognitive networks carrying insufficient and inadequate input. The core deficiency in AD patients might be impaired SC equated with the disability to maintain sequential and simultaneous "attention to life". The Self-Consciousness Questionnaire, a clinical scale providing multidimensional measurement, indicates that different aspects of consciousness are not correlated with overall cognitive deficiency as determined by the MMSE.

Aged↗

PubMed2001

Intracranial hemorrhage and oral anticoagulant treatment.

OBJECTIVE: To detect risk factors for intracranial hemorrhage (ICH) in patients with long-term oral anticoagulant and to identify clinical or radiological data specific of anticoagulant-related ICH. METHODS AND PATIENTS: Three groups of patients were included. Group 1 represents patients who were admitted because of anticoagulant-related ICH between January 1984 and February 1996. All patients underwent CT scan. Clinical data, anticoagulation parameters, location and volume of the ICH, treatment and the 30-days in-hospital mortality were analyzed. Group 2 consisted of patients selected at random among all patients with spontaneous ICH admitted to our department during the same period of time. Patients without ICH, but regularly taking oral anticoagulants constituted group 3. RESULTS: Seventy-nine patients with anticoagulant-related ICH were compared to 127 patients with spontaneous ICH. The volume of supratentorial ICH was greater in group 1 of patients and was correlated with a worse prognosis. Comparison of group 1 with group 3 (212 controls) demonstrated that length of anticoagulation, prothrombin time or excessive anticoagulation, prior cerebral infarct and use of acénocoumarol, but not age or indication of anticoagulant, were significant risk factors for ICH in multivariate analysis. CONCLUSIONS: The results emphasize that anticoagulant-related ICH are not clinically different from spontaneous ICH except for volume of bleeding, and that frequent and careful coagulation monitoring is needed, especially during the first year in order to decrease the risk of ICH.

Administration, Oral↗

PubMed2001

Survival prognostic value of serum interleukin-6 level in very old people.

OBJECTIVE: To determine the survival prognostic value of serum interleukin-6 level in very old people. DESIGN: Prospective 12-month clinical survey in a long term ward and in a day care hospital. SETTING: A long-term ward and a day care hospital for very old and dependent people, located in Poitiers (France). PARTICIPANTS: A cohort of 115 old people [Range 64-101], either in a long-term ward (n=71) or in day care hospital (n=44). MEASUREMENTS: Patients were checked for different nutritional parameters and the Interleukin-6 level in the serum at baseline and patients were followed up for one year. RESULTS: A high level of interleukin-6 (Il-6) is associated with increased Prognostic Inflammatory and Nutritional Index (PINI) value, serum CRP thereby demonstrating the inflammatory role of this molecule. It is also associated with an increased risk of death. Using a survival regression model, a high Il-6 serum level observed at the beginning of the study is a bad prognostic indicator, with other biological or nutritional parameters having no significant influence. CONCLUSION: A high level of Interleukin-6 may be a better marker of prognosis than an increased PINI score.

Aged↗

PubMed2001

Prognostic impact of cathepsin D and c-erbB-2 oncoprotein in a subgroup of node-negative breast cancer patients with low histological grade tumors.

Some node-negative breast cancer patients, with initially good prognosis, relapse from their cancer and are poorly identified. In the present study, based on prospective data of 197 tumors, we measured cathepsin D (cath D, n=197), pS2 protein (n=125), c-erbB-2 oncoprotein (n=100) and epidermal growth factor receptor (EGF-R, n=99) to better define the risk of relapse of node-negative patients in comparison with that defined by the clinical and histological factors. The median follow-up in surviving patients was 75 months. Univariate analysis indicated that patients with histological grade III tumors (the Scarff, Bloom and Richardson classification) had a much poorer prognosis than those with histological grade I or II tumors (P=0.0027 for relapse-free survival and P=0.0156 for overall survival). When the population of node-negative patients was divided by tertiles, high cath D levels showed a significant association with an early relapse (P=0.0316). Using cut-off values, patients with high cath D (> or =25 pmol/mg protein) or c-erbB-2 oncoprotein (> or =4 Human Neu Unit/microg protein) levels, had a significant worse relapse-free survival (P=0.0147 and 0.0417, respectively). No prognostic information was supported by pS2 protein or EGF-R measurements. In multivariate analysis, histological grade, cath D and c-erbB-2 oncoprotein remained independent predictors of recurrence (P=0.005, 0.0361 and 0.0321, respectively). By combining low levels of cath D and c-erbB-2 oncoprotein in histological grade I or II tumors, we identified a subgroup of patients with a 100% relapse-free survival probability at 6 years of follow-up. Moreover, the subgroup of patients with histological grade I or II tumors and high values of both cath D and c-erbB-2 oncoprotein showed a prognosis as poor as the subgroup defined by histological grade III alone, respectively 66% and 70% relapse-free survival at 6 years of follow-up. In conclusion, the combination of conventional prognostic factor (histological grade) and biochemical factors (cath D and c-erbB-2 oncoprotein) enabled us to identify, in this preliminary study, a subgroup of patients having an increased risk of relapse in a group (node-negative patients with low histological grade tumors) considered as good prognosis.

Aged↗

PubMed2001

[Taste impairment in Alzheimer's disease].

We conducted a study of Alzheimer's disease focusing on taste impairment to determine at which step of gustatory information processing (discriminative or perceptive, gnosic or associative, gustatory-verbal) possible perturbations might be located. We used various foods found in a normal diet. Twenty patients and a matched control group participated in this study. The patients were divided into two subgroups according to disease severity (mild, moderate or severe). The study showed that patients with Alzheimer's disease exhibited an impairment at all three levels of gustatory information processing. Impairment of discriminative and gustatory-verbal stages was more obvious in the group of patients with severe Alzheimer's disease. Our study also showed that the gustatory deficiency can be described as an associative agnosia in the mild stage of Alzheimer's disease. This concept is in line with the notion of a dissociation between preservation of olfactory and gustatory thresholds and an alteration in odor identification in patients with mild stage Alzheimer's disease, suggesting that the alteration is central rather than peripheral. Our findings suggest that an alteration of the associative level of gustatory information processing can be found in Alzheimer's disease early stage.

Aged↗

PubMed2001

[Malnutrition is an independent risk factor of early complications following percutaneous endoscopic gastrostomy].

BACKGROUND: The relationship between malnutrition and complications occuring in hospitalized patients is debated. AIM: To assess prospectively the relationship between nutritional status and percutaneous endoscopic gastrostomy (PEG)-related complications and to determine the respective role of malnutrition and confounding variables on clinical outcome. METHODS: Ninety seven patients were followed up for 30 days after PEG insertion and complications were prospectively recorded. Patients were classified as malnourished when they met one of the following criteria: body mass index<20 kg/m(2) and/or weight loss > 5%. Multivariate logistic regression analysis was used to adjust for age, sex, diagnoses, functional status, antibiotic treatment and duration of hospital stay before PEG insertion. RESULTS: Sixty eight (70.1%) patients were malnourished. A significantly higher number of complications was seen in malnourished than in non malnourished patients (54.4% vs 31%; odds-ratio (OR): 2.65 [CI 95%: 1.06-6.66]; P=0.04). One-month mortality did not significantly differ between malnourished and non malnourished patients. Multivariate analysis showed that malnutrition (OR: 3.15 [1.21-8.24]; P=0.02) and > 10-day hospital stay (OR: 2.77 [1.13-6.82]; P=0.03) were significantly associated with early complications. CONCLUSION: These data suggest that malnutrition increases the risk of early complications after PEG insertion, independently of the underlying diseases and functional status of the patients.

Endoscopy↗

PubMed2000

Prevention of biliary stent occlusion by ursodeoxycholic acid plus norfloxacin: a multicenter randomized trial.

We report a prospective randomized multicenter trial that tested the efficacy of combining ursodeoxycholic acid and norfloxacin in the prevention of polyethylene stent clogging in patients with obstructive jaundice due to an unresectable malignancy at the level of the common bile duct. After insertion of a 10-Fr straight polyethylene stent, patients were allocated to receive oral treatment with ursodeoxycholic acid and norfloxacin, or conservative treatment. The primary outcome measure was stent blockage within six months. Thirty-three patients (group I) received ursodeoxycholic acid and norfloxacin, and 29 received conservative treatment (group II). At six months, cumulative stent patency rate did not differ significantly between group I (47+/-11%, mean +/- SE, median 149 days) and group II patients (24+/-10%, mean +/- SE, median 100 days, P = 0.23, log-rank test). Four stents were clogged by ursodeoxycholic acid. Survival did not differ between the two groups. Combined therapy with ursodeoxycholic acid and norfloxacin failed to improve stent patency. Moreover, ursodeoxycholic acid can cause stent obstruction.

Aged↗

PubMed2000

Neuropsychological disturbances in cerebellar infarcts.

BACKGROUND: Recent clinical and research reports suggest that the cerebellum may contribute to the modulation of higher cognitive functions. MATERIAL AND METHODS: We included 15 consecutive patients with isolated cerebellar infarcts (4 superior cerebellar artery territory infarcts, 1 anterior inferior cerebellar artery territory infarct and 10 posterior inferior cerebellar artery territory infarcts), all confirmed by magnetic resonance imaging. These subjects plus 15 controls matched for age, sex, and educational level underwent a neuropsychological test battery including vocabulary, similarities and block design subtests of the Wechsler Adult Intelligence Scale Revised (WAIS-R); verbal fluency tests (categorial, phonemic, and alternate categorial fluency tests); Rey's 15 auditory word learning list; the paced auditory serial addition task; the Stroop test and the Zerssen Rating Scale. One year after the cerebellar infarct, each subject with cerebellar infarct was asked to undergo a second neuropsychological examination with the same test battery. RESULTS: Patients with cerebellar infarcts exhibited significantly lower neuropsychological performances compared to those of the control group without any obvious difference between the different vascular cerebellar territories. After 1 year of follow-up, this neuropsychological impairment tended to improve. CONCLUSIONS: The pattern of deficits observed in isolated cerebellar infarcts highlights the nonmotor functions of the cerebellum and functional relationship between the cerebral cortex and the cerebellum.

Adult↗

PubMed2000

Errors in interpreting the pretransfusion bedside compatibility test: an experimental study.

BACKGROUND AND OBJECTIVE: Analysis of reports of incidents, involving ABO incompatibility suggests that the main problem is poor interpretation of the pretransfusion bedside compatibility test (PBCT). We studied sources of error as experienced by nurses as to the blood groups of donor blood and of the recipient. MATERIALS AND METHODS: According to their seniority in the profession and on the ward, 48 nurses were randomly selected from four transfusion sectors of the University Hospital of Grenoble, France. Each nurse interpreted 24 photos of PBCTs, including some with procedural irregularities, and was asked to assess the compatibility of the blood types of the donor and the recipient. At random, half the nurses were provided with a diagram to facilitate interpretation. RESULTS: The overall frequency of errors was 39.8%. Errors were fewer when the tests were interpreted as compatible (7.3%) or incompatible (6.3%), and when the nurse had been in the profession between 3 and 5 years and in the ward less than 3 years (25.5%), or worked in hematology (34.7%) or anesthesia (36.5%). Use of the diagram limited the number of errors, provided the test was interpretable (22.2%). CONCLUSION: PBCTs cannot be considered a valid safety procedure. We need other, more effective methods to reduce the risk of incompatibility accidents.

ABO Blood-Group System↗

PubMed2000

Intranasal midazolam in piglets: pharmacodynamics (0.2 vs 0.4 mg/kg) and pharmacokinetics (0.4 mg/kg) with bioavailability determination.

Intranasal midazolam was studied in two series of piglets: series 1, n = 20 (18 +/- 3 kg), a randomized double blind pharmacodynamic study to compare doses of 0.2 mg/kg and 0.4 mg/kg; series 2, n = 9 (42 +/- 8 kg), a pharmacokinetic study with a 0.4 mg/kg dose administered either intravenously (i.v.) or intranasally (i.n.) in a cross-over protocol with a one-week wash-out period between each. In series 1, midazolam caused significant anxiolysis and sedation within 3 to 4 min, without a significant difference between 0.2 and 0.4 mg/kg doses for any of the studied parameters. In series 2, after intranasal midazolam administration of 0.4 mg/kg, plasma concentrations attained a maximum (Cmax) of 0.13 +/- 0.04 mg/l at 5 min (median Tmax) and remained higher than 0.04 mg/l until 60 min. The bioavailability factor (F) in this study was F = 0.64 +/- 0.17 by the intranasal route. The terminal half-life (T1/2 lambda z) = 145 +/- 138 min was comparable with the i.v. administration half-life (158 +/- 127 min). In conclusion, optimal intranasal midazolam dose in piglets was 0.2 mg/kg, which procures rapid and reliable sedation, adapted to laboratory piglets.

Administration, Intranasal↗

PubMed2000

Primary intracerebral malignant lymphoma: report of 248 cases.

OBJECT: The authors present a retrospective analysis of 248 immunocompetent patients with primary intracerebral lymphoma treated at 19 French and Belgian medical centers between January 1980 and December 1995. METHODS: This study involved 127 female and 121 male patients with a median age of 61 years (range 2-88 years). All tumors available for review were classic diffuse non-Hodgkin's lymphoma, for which the phenotype was determined in 220 patients: 212 (96.4%) were B-cell and eight (3.6%) were T-cell type tumors. According to the Revised European-American classification of lymphoid neoplasms, most lesions were diffuse large cell tumors (62%). A total of 196 tumors were reviewed in 127 patients for whom preoperative computerized tomography and magnetic resonance studies were available. There was a single lesion in 66% of the cases, with a supratentorial location in 87%. Tumor location in the basal ganglia, corpus callosum, or fornix, infiltration of the periventricular ependyma, or a mirror pattern, were strongly suggestive of a lesion of lymphomatous origin. The histological diagnosis was obtained after surgical resection in 116 patients, with the remainder undergoing biopsy sampling only. Of the 248 patients studied, 129 (52%) received chemotherapy plus radiation therapy, 60 (24%) received radiation therapy alone, 35 (14%) received chemotherapy alone, and 24 (10%) received no postsurgical treatment. CONCLUSIONS: Using univariate analysis, the authors determined prognostic factors that were significantly associated with a favorable impact on survival including age younger than 60 years, radiation therapy (without evidence of a dose-response relationship), radiation therapy combined with chemotherapy, and chemotherapy consisting of anthracycline. Partial surgical resection was an unfavorable prognostic factor. Multivariate analysis was used to confirm the independent prognostic value of radiation therapy, age, chemotherapy consisting of anthracyclines or methotrexate, and partial surgical resection. This European survey provides a reasonable basis for the treatment of primary intracerebral lymphoma with the following sequence: stereotactic biopsy sampling, chemotherapy with a methotrexate- and anthracycline-based regimen, followed by cranial irradiation.

Adolescent↗

PubMed2000

[Which health information systems for the evaluation of health actions?].

The evaluation of health actions requires large amounts of information allowing an assessment of relevance, coherence, efficacy, efficiency and impact of these interventions. Information systems should support evaluation processes by helping to obtain pertinent indicators, tracers and standard operating procedures. To reach this objective, specific functions need to be implemented, including traceability, documentation, investigation and scientific awareness. But this supposes that health information systems respect quality criteria that this article defines. The following criteria are considered: simplicity, validity, acceptability, informative value, representativeness, continuity, reactivity, fluidity, flexibility of the system, and also confidentiality of information. The historical developments of medical informatics have induced the creation of independent information systems, answering to specific objectives. This lack of integration is an obstacle to the evaluation of health actions because of the difficulty to view transversally and longitudinally the sequence of actions for a same patient. Thus integrated health information systems, organised around patient care episodes, are necessary to support evaluation and to contribute effectively to decision making in public health, because the evaluation of health actions implies the availability of information about the individuals who are the targets of these actions.

Decision Making↗

PubMed1999

Autonomic nervous system activity in dipper and non-dipper essential hypertensive patients. What about sex differences?

OBJECTIVES: To compare the autonomic nervous system activity indexes obtained from photoplethysmography in dipper and non-dipper hypertensive patients and to seek a potential influence of sex on the relation between autonomic nervous system and the nocturnal decrease in blood pressure. METHODS: We studied 245 hypertensive patients, who underwent 24 h ambulatory blood pressure monitoring (ABPM), photoplethysmographic blood pressure recording, and echocardiography. Non-dipping patients were defined as those whose nocturnal decrease in systolic blood pressure (SBP), diastolic blood pressure (DBP), or both was less than 10% of the daytime blood pressure. Spectral powers of SBP, DBP and heart rate were obtained from photoplethysmographic recordings over three main frequency bands: very low frequency (0.005-0.05 Hz), low frequency (0.05-0.14 Hz) and high frequency (0.14-0.40 Hz). RESULTS: Because their ABPM were normal (less than 135/85 mmHg; n = 33), of poor quality (n = 22) or performed at a period too far from the photoplethysmographic recording (n = 17), 66 patients were excluded from the analysis. The remaining 179 patients comprised 117 dippers and 62 non-dippers. The groups did not differ regarding clinical and echocardiographic characteristics, irrespective of sex. Low-frequency spectral powers were significantly lower in non-dippers than in dippers, whatever the signal, whereas high-frequency spectral powers did not differ significantly between the groups. The nocturnal decrease in blood pressure increased with increasing low-frequency spectral powers, but was negatively correlated with high-frequency spectral powers. Multivariate linear regression analysis identified low-frequency spectral power of SBP and clinic DBP as independent factors determining the decrease in blood pressure. After adjustment for all significant covariates, the odds of being a non-dipper did not differ between men and women. CONCLUSION: A non-dipper profile seemed to be associated, in both men and women, with lower low-frequency spectral powers compared with those in dippers, suggesting impaired sympathetic arterial modulation.

Adult↗

PubMed1999

Anti-inflammatory drugs and variceal bleeding: a case-control study.

BACKGROUND: Non-steroidal anti-inflammatory drugs (NSAIDs) can have severe gastrointestinal effects and cause peptic ulcers to bleed. Acute bleeding from oesophageal varices is a major complication of cirrhosis of the liver. AIMS: To investigate the role, using a case-control study, of NSAIDs in first bleeding episodes associated with oesophageal or cardial varices in cirrhotic patients. PATIENTS/METHODS: A structured interview was conducted of 125 cirrhotic patients with bleeding mainly related to oesophageal varices and 75 cirrhotic controls with oesophageal varices who had never bled. RESULTS: Cirrhotic patients who were admitted for bleeding related to portal hypertension were more likely to have used NSAIDs during the week before the index day (31 of 125 (25%)) than the cirrhotic controls (eight of 75 (11%); odds ratio = 2.8, p = 0.016). Use of aspirin alone or combined with other NSAIDs was also more prevalent in the cases (21 of 125 (17%)) than in the controls (three of 75 (4%); odds ratio = 4.9, p = 0.007). Logistic regression analysis showed that NSAID use (p = 0.022, odds ratio = 2. 9, 95% confidence interval = 1.8 to 4.7) and variceal size (p<0.001, odds ratio = 4.0, 95% confidence interval = 1.4 to 11.5) were the only variables independently associated with the risk of bleeding. CONCLUSIONS: Aspirin, used alone or combined with other NSAIDs, was associated with a first variceal bleeding episode in patients with cirrhosis. Given the life threatening nature of this complication, the possible benefit of this treatment should be weighed against the risk shown here. No firm conclusions could be drawn on non-aspirin NSAIDs used alone.

Adult↗