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Biomedical subjects

R Fiasse

Publications and source records attributed to R Fiasse.

At least 73 records · Page 4Linked to original sources
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Treatment of acute diarrhoea: update of guidelines based on a critical interuniversity assessment of medications and current practices.

Further to a thorough analysis of the problem of acute diarrhoea and the therapeutic options, recommendations were defined following a multidisciplinary approach. These guidelines take into account the reality of frequent self-medication. They further differ as a function of age (children, primarily treated by ORS and for whom self-medication is not advised versus adults who can self-medicate), symptoms (uncomplicated diarrhoea versus dysentery) and location where the diarrhoea is contracted (at home or when travelling).

Acute Disease↗
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Feasibility and effectiveness of en bloc resection of the esophagus for esophageal cancer. Results of a prospective study.

En bloc resection of the esophagus was attempted by right thoracotomy, laparotomy, and left cervicotomy in 82 patients suffering from an esophageal cancer. Tumors were classified by the depth of wall penetration and node involvement: 21 tumors penetrated at the most into but not through the muscle (W1), and 61 invaded the full thickness of the wall (W2). Twenty-five were associated with normal lymph nodes (N0), 26 with metastatic thoracic nodes only (N1), and 31 with metastatic extrathoracic nodes (N2). Digestive continuity was restored by gastric pull-up in all cases except one in which the transverse colon was used. Thirty day and hospital mortality were 0 and 2.4% (2/82) respectively. Posterior mediastinectomy was feasible in 65 patients but in seven of them an unsuspected metastatic spread was detected during the second step of the operation. It was not feasible in 17 patients owing to the involvement of adjacent mediastinal organs. It was feasible in all W1 tumors and in 72% of W2. Feasibility did not significantly depend on the tumor location or length. Of the 24 palliative operations, 17 were carried out for N2 tumors. After potentially curative mediastinectomy (N = 58), three year survival was 38% and after palliative operation (N = 24), 18 months survival was 11% only. After mediastinectomy, survival dropped as the node involvement and the depth of wall penetration increased (W1: 66%, W2: 28%, N0: 58%, N1: 32% at three years and N2: 17% at 2 years). Overall survival in group N2 was not significantly different from that achieved in palliative cases and no patient classified W2 N2 was alive at 18 months.(ABSTRACT TRUNCATED AT 250 WORDS)

Actuarial Analysis↗
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[Current advances in the physiopathology of primary motility disorders of the esophagus].

The authors review the recent literature about the classification of primary motor disorders of the oesophagus: achalasia, diffuse oesophageal spasm, nutcracker oesophagus, hypertensive lower oesophageal sphincter and non-specific intermediary disorders. In fact these motility disorders belong to a spectrum of diseases closely related, with chronological transformation of a specific disorder to another one or to intermediary disorders. Most of the recent pathophysiological research concerned primary achalasia, secondary achalasia syndromes being a kind of experimental model. These studies point to a morphological or functional deficiency of postganglionic nerves inhibiting the lower oesophageal sphincter (LOS) through noncholinergic nonadrenergic neurotransmitters. Recent advances in the treatment of achalasia and other motility disorders are not yet based on these findings. Although calcium channel blockers, like nifedipine, lower LOS basal pressure, they are not very useful on long term relief of symptoms of achalasia. Pneumatic dilatations or cardiomyotomy still remain the best methods of treatment of this disease.

Esophageal Achalasia↗
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[Exudative enteropathy caused by an acute graft-vs-host reaction. Apropos of a case report].

The authors report the case of a 41-year-old woman who developed an acute graft-versus-host disease following bone marrow transplantation for post-polycythemic myeloid metaplasia; liver, cutaneous and intestinal lesions were present, associated, with a severe protein-losing enteropathy. Symptoms, diagnostic procedures and therapy of intestinal graft-versus-host disease are reviewed. The intestinal clearance of alpha-1 antitrypsin was particularly useful to assess the response to medial treatment, which induced a complete remission.

Adult↗
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[Ambulatory esophageal pH monitoring: critical review of methodology: (equipment, reproducibility, standards), clinical importance and personal experience].

The authors review the recent literature about the methodology of oesophageal pH monitoring, which has a high sensitivity and a high specificity for assessing gastro-oesophageal reflux. Combined electrodes offer most advantages. Ambulatory recording should be done in hospital under standard conditions (meals), particularly for clinical studies. The best clinical indication is to detect pathological reflux in case of atypical symptoms with negative oesophagoscopy. The authors give their normal values in a series of measurements with two systems as well as their results in a series of cases of oesophagitis of various grades.

Esophagitis↗
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Omeprazole in the treatment of patients with severe reflux oesophagitis not responding to H2-receptor antagonists and ineligible for surgery.

In 42 patients (25 men, 17 women, mean age 62 years) with severe erosive or ulcerative oesophagitis not responding to H2-receptor antagonist treatment over at least 3 months and ineligible for surgery, omeprazole was administered at an initial dose of 40 mg/day, subsequently reduced to 20 mg after healing of the lesions. Patients had monthly clinical, endoscopic, histological and laboratory assessment over the healing period, then were reevaluated 3-monthly over one year, then 6-monthly, during the maintenance treatment. Stages of oesophagitis were based on the Savary-Miller classification, modified for stage I (erosions must be present). With 40 mg omeprazole, healing was observed in 71%, 83% and 90% of the patients after 1, 2 and 3 months of treatment, respectively. After one month of treatment, a complete healing was less frequently observed in patients with stage IV oesophagitis pre-trial (55%) than in the patients with stages I, II and III pre-trial (90%) (p less than 0.05). Ninety per cent of the patients healed at one month were asymptomatic whereas 50% of the patients with incomplete healing still had symptoms, most often dysphagia, rarely heartburn. Maintenance treatment with 20 mg was sufficient in most patients, with a probability of remaining healed of 69% from 9 to 24 months after starting this dosage. In 9 patients with Barrett's oesophagus, the lengths of the circumferential metaplasia were found to be reduced after one year of treatment compared to pre-trial lengths (p less than 0.005). There was no further significant reduction of length after 2 years of treatment. Fasting gastrin was increased in most of the patients, although great inter-patient variability was observed; 50% of the patients had levels not exceeding 5 times the upper limit of normal. There was no consistent increase of enterochromaffin-like cell density in 29 patients investigated up to nearly 2 years of omeprazole administration. The treatment was well tolerated. By inducing a profound and sustained inhibition of acid secretion, as confirmed by pH monitoring, omeprazole promotes healing of the lesions of severe oesophagitis and prevents recurrence of lesions and symptoms. Omeprazole is therefore a valuable treatment for patients ineligible for surgery, particularly in the elderly.

Adolescent↗
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[Vipoma in an adolescent: treatment with a delayed-action somatostatin analog, octreotide or SMS 201-995, and surgical removal].

We report the case of a VIPoma diagnosed in a 15-year-old teenager who experienced profuse secretory diarrhea associated with hypokalemia, metabolic acidosis and high plasma levels of vasoactive intestinal peptide (VIP) and pancreatic polypeptide (PP). Angiography showed an abnormal mass in the head of the pancreas. Before surgery, subcutaneous injections (100 micrograms every 8 hours) of the long-acting somatostatin analogue octreotide or SMS 201-995, were administered in order to stabilize the clinical status of the patient and to reduce the intravenous administration of fluid and electrolytes. This treatment resulted in prompt relief of the symptoms and in a partial decrease of the plasma levels of VIP and PP. At subsequent laparotomy, there was a tumour localized in the head of the pancreas, which was completely removed by Whipple resection. The immunohistochemical staining revealed the presence of VIP and PP inside the tumour cells. Two years after surgical resection, the patient is healthy without clinical or laboratory evidence of recurrence.

Adolescent↗
PubMedDate not supplied

[Digestive system manifestations in Steinert's disease. Analysis of 19 cases of which 10 with digestive symptoms].

We studied digestive manifestations occurring during follow-up of 19 cases of myotonic dystrophy. GI symptoms occurred in 10 patients (53%), mainly dysphagia (n = 7). In patients undergoing investigations (n = 7), their digestive troubles were probably or definitively related to the neurological disease in 6 cases. Upper GI endoscopy was normal in 5 dysphagic patients. The oesophageal manometry was abnormal in 3 of 4 patients. Complications developed in 3 cases (16%). One patient presented two episodes of spontaneous pneumoperitoneum. A second one developed a chronic colonic pseudo-obstruction with megacolon treated by subtotal colectomy. Manometric studies revealed oesophageal aperistalsis, low amplitude of gastro-jejunal contractions but persistence of migrating motor complexes and a normal recto-anal reflex. A third patient developed an acute pseudo-obstruction with ischemic colitis. In conclusion, myotonic dystrophy frequently disturbs digestive tract motility and may cause complications such as intestinal pseudo-obstruction.

Adult↗
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[Physiopathology and diagnostic methods in esophagitis due to reflux].

Several sensitive and specific methods are now available for the investigation of gastro-oesophageal reflux and oesophagitis. Nevertheless, judicious medical or surgical management requires a good understanding of the pathophysiological aspects of these conditions and of the significance of the investigation results.

Esophagitis, Peptic↗
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Single dose ranitidine: influence of the time of administration on gastric acidity in normal subjects and in patients with duodenal ulcer.

Using ambulatory 24 hour pH monitoring, intragastric acidity was measured in 6 healthy volunteers and 8 patients with duodenal ulcer. According to a latin square design each patient was randomly assigned to receive placebo, 300 mg ranitidine at 19.00 h or 300 mg ranitidine at 22.00 h, on three separate occasions. Validation of the method was achieved by comparing the values indicated by the intragastric electrode and the pH of simultaneously aspirated gastric juice (y = 0.87x + 0.66, r = 0.93). Comparing the area under the curve of intragastric hydrogen ion activity, as well as the percent of time less than pH 5, we found a better inhibition of nocturnal acidity (20.00 h-08.00 h) with 19.00 h ranitidine than with ranitidine administered at 22.00 h (p less than 0.01). By contrast, there was no significant difference in diurnal acidity between both ranitidine regimens and placebo.

Adult↗