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R Thibault

Publications and source records attributed to R Thibault.

11 recordsLinked to original sources
PubMed2006

Antireflux surgery for non-erosive and erosive reflux disease in community practice.

BACKGROUND: Antireflux surgery has been mainly evaluated in tertiary referral centres. Data regarding post-operative outcome in non-erosive reflux disease are lacking. AIM: To assess long-term outcome after antireflux surgery performed in a community practice setting. METHODS: We selected consecutively 60 non-erosive reflux disease patients and 61 erosive oesophagitis patients with symptomatic gastro-oesophageal reflux disease. After surgery, each subject answered a validated disease-specific health-related quality of life questionnaire and another questionnaire focusing on symptoms, late morbidity and drug use. RESULTS: After a 43-month median follow-up, an excellent outcome was reported by less than two-thirds of patients. Quality of life scores were lower in the non-erosive reflux disease group, especially in female patients. Non-erosive reflux disease patients reported more daily symptoms and more reflux-related symptoms (P = 0.04). Proton-pump inhibitor use was higher in non-erosive reflux disease patients (P < 0.005). Multivariate analysis identified four independent predictive factors associated with better outcome, namely male gender, abnormal preoperative acid exposure, a long duration of symptoms and surgical expertise. CONCLUSIONS: In community practice, the results of antireflux surgery are inferior to those reported by tertiary centres. Outcome seems poorer in non-erosive reflux disease especially in female patients. Nearly one-third of the non-erosive reflux disease patients continue to take proton-pump inhibitors. These results highlight the need for careful selection of patients before antireflux surgery.

Antacids↗
PubMed2005

Simultaneous recordings of oesophageal acid exposure with conventional pH monitoring and a wireless system (Bravo).

OBJECTIVES: Oesophageal pH monitoring is a useful test for the diagnosis of gastro-oesophageal reflux disease (GORD) but has some limitations related to the nasopharyngeal electrode. Recently, a telemetric catheter free system (CFS) (Bravo; Medtronic) was developed. The aim of this study was to determine the concordance of data between the conventional pH measurement system (CPHMS) and the CFS Bravo. METHODS: Forty patients with symptoms suggestive of GORD underwent 24 hour oesophageal pH monitoring using the CPHMS with a nasopharyngeal electrode and the Bravo CFS simultaneously. The sensitive tips of both electrodes were positioned at the same level under fluoroscopy. In addition to automatic analysis, each reflux episode was checked visually and characterised. RESULTS: There was a significant correlation (r = 0.87, p < 0.0001) between the 24 hour oesophageal acid exposures recorded by the CPHMS and the CFS. Twenty four hour oesophageal acid exposure was significantly lower with the CFS than with the CPHMS (2.4 (0.4-8.7) v 3.6 (0.7-8.6); p < 0.0001). Consequently, with the CFS, the cut off level for the diagnosis of GORD, as calculated from the regression equation, was 2.9% (for the 4.2% cut off determined in controls with the CPHMS). After this adjustment, concordance of the diagnosis of GORD was 88% (kappa 0.760). Diagnosis of GORD was established in more patients with the CFS 48 hour results than with the 24 hour results. CONCLUSIONS: Despite strong correlations between oesophageal acid exposure recorded with the two devices, the Bravo CFS significantly under recorded acid exposure compared with the CPHMS. Provided some correcting factors are used, the Bravo CFS can improve the sensitivity of pHmetry for the diagnosis of GORD by allowing more prolonged recordings.

Adult↗
PubMed1991

Efficacy and pharmacokinetics of intravenous immune globulin administration to high-risk neonates.

UNLABELLED: OBJECTIVE--To determine whether intravenous immune globulin (IVIG) administration modifies the incidence of infections in high-risk neonates. DESIGN--Randomized, double-blind study. SETTING--Neonatal intensive care unit at a tertiary care center. PARTICIPANTS: A total of 170 infants were enrolled, 82 of whom received IVIG and 88 of whom received the placebo preparation. Infants were stratified by birth weight into one of three groups (category 1, those weighing less than 1000 g; category 2, those weighing between 1000 and 1500 g; and category 3, those weighing more than 1500 g). INTERVENTIONS--Intravenous immune globulin (750 mg/kg of body weight), or albumin placebo was administered within 72 hours of admission to the tertiary care center and every 14 days thereafter until discharge from the neonatal intensive care unit or age 3 months. Serum IgG levels were measured and data collected relating to the incidence of systemic and localized infections and to the course of hospitalization. MEASUREMENTS AND MAIN RESULTS--The administration of IVIG had no major side effects and resulted in higher serum IgG levels in infants in all birth weight categories compared with infants receiving the placebo. Systemic infections developed in five IVIG-treated infants and five placebo-treated infants. Administration of immunoglobulin had no significant effect on the rate of localized infections or necrotizing enterocolitis. It also did not affect hospital course of the infants as measured by length of hospitalization or the number of days on assisted ventilation, supplemental oxygen, or antibiotics was required. CONCLUSIONS--The general administration of IVIG using this dosage regimen has limited effects on the clinical course of infants in a neonatal intensive care unit.

Bacteremia↗
PubMed1991

Local toxicity with subcutaneous methadone. Experience of two centers.

We report on 8 patients treated with subcutaneous methadone for cancer-related pain at 2 institutions. The success of other subcutaneous agents for pain control has been well demonstrated. It was felt that methadone would be useful due to its low cost. Unfortunately, 7 of the 8 patients experienced adverse reactions at the subcutaneous sites requiring cessation of subcutaneous methadone.

Adult↗
PubMed1976

The genesis of bowel sounds: influence of viscus and gastrointestinal content.

This study was undertaken to try to solve the controversy about the influence of gastrointestinal contents on the genesis of bowel sounds, and to probe the respective importance of the various abdominal viscera. Eleven healthy volunteers were intubated by mouth with a multiple-lumen tube. Bowel sounds were recorded for 10 min when the tube was in the stomach, the upper jejunum, and the cecum, while it was left intact in situ, or perfused with isotonic saline (15 ml per min), or with an equal (7.5 ml per min of each) mixture of isotonic saline and air. Using a previously developed method, a computer analysis was made of the recording without any human intervention during the treatment of data. An analysis of variance demonstrated that the effect of perfusion varied according to site, with 46% of counted sounds while the tube was in the stomach, 32% in the jejunum, and 22% in the colon (P less than 0.05). There were two types of sounds: some exceeded in amplitude a preset threshold, and thus were picked up by the computer, but their average absolute value for 20 msec remained inferior to another preset threshold. Their number was kept in memory (NS--sounds having an amplitude exceeding a threshold S1, expressed in number per 10 min). A second type of sounds also exceeded the present threshold but their average absolute value for 20 msec also exceeded another preset threshold. Their number (NE--sounds having an amplitude exceeding the thershold S1 but having also a 20-msec average amplitude above another threshold S2, expressed in number per 10 min) was also memorized. The latter group was composed of two types of sounds: some had a limited spectrum of low frequency (100 Hz) and were of high amplitude and short (congruent to 5 msec) duration (NE1); some others had a higher and more dispersed frequency centered around 300 Hz (NE2). Fifty per cent of high energy (NE) sounds appeared while the tube was in the stomach, 30% in the colon, and 20% in the jejunum (P less than 0.005). Short and high amplitude sounds (NE1) were counted more often (43%) when it was in the colon than in the stomach (38%) and the jejunum (19%) (P less than 0.025), and this was confirmed (P less than 0.005) by a study of the ratio of NE1/NE. On the contrary, higher frequency sounds (NE2) were present more often when the tube was in the stomach (59%) than in the jejunum (24%) and in the colon (17%) (P less than 0.005). There was no influence of the presence of the unperfused tube on the genesis of bowel sounds in different sites (P greater than 0.05). In the stomach and the colon perfusion of the air/saline mixture increased the number of sounds (P less than 0.025) and all types of sounds in the stomach (P less than 0.025), whereas in the jejunum it was the perfusion of saline which increased them (P less than 0.025). It is concluded that the stomach is the most active site of production of bowel sounds, followed by the colon and then the small bowel, that sounds differ in different sites, and that all this is influenced by viscus content.

Cecum↗