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Biomedical subjects

S Roman

Publications and source records attributed to S Roman.

At least 19 recordsLinked to original sources
PubMed2007

Characterization of reflux events after fundoplication using combined impedance-pH recording.

BACKGROUND: Laparoscopic fundoplication effectively controls symptoms of gastro-oesophageal reflux disease (GORD) and decreases acid reflux, but its impact on non-acid reflux is not known. The aim of the study was to characterize reflux events after fundoplication using oesophageal combined multichannel intraluminal impedance (MII)-pH monitoring, to demonstrate its efficacy on acid as well as non-acid reflux events. METHODS: Thirty-six patients in whom ambulatory MII-pH recording was performed after laparoscopic fundoplication were reviewed retrospectively. There were 23 symptomatic and 13 asymptomatic patients, whose results were compared with those of 72 healthy volunteers. RESULTS: Oesophageal acid exposure was low in all but one operated patient, and there was no difference between those with and without symptoms. The median number of reflux events over 24 h was lower after fundoplication (11 in operated patients compared with 44 in healthy volunteers; P < 0.001). Almost all reflux events were non-acid after surgery whereas acid reflux episodes were predominant in healthy volunteers. Proximal reflux events were less common in operated patients. Non-acid reflux events were significantly associated with symptoms after surgery in some patients. CONCLUSION: Fundoplication restores a competent barrier for all types of reflux. Reflux events are mostly non-acid after surgery, and such events may be positively correlated with symptoms.

Adult↗
PubMed2006

Esophageal capsule endoscopy versus esophagogastroduodenoscopy for evaluating portal hypertension: a prospective comparative study of performance and tolerance.

BACKGROUND AND STUDY AIMS: Esophagogastroduodenoscopy (EGD) is the most effective method for examining the upper gastrointestinal tract, and particularly for evaluating portal hypertension in cirrhotic patients, especially for screening purposes. The aim of this study was to assess the feasibility, safety, accuracy, and tolerance of PillCam ESO capsule endoscopy for this indication. PATIENTS AND METHODS: In this prospective study, unsedated EGD and capsule endoscopy examinations were conducted on the same day in cirrhotic patients at the time of diagnosis. The patients quantified the tolerability (relative to pain, nausea, choking sensations, etc.) of the two procedures using a 100-mm visual analogue scale. The time required for the recording and for diagnosis with the capsule examination were documented, as were the patients' preferences in comparison with EGD. Two independent endoscopists blinded to the EGD diagnoses assessed the diagnostic accuracy of the images obtained. RESULTS: Twenty-one patients were included in the study (mean age 62, mean Model for End-Stage Liver Disease score 10.5, mean Child-Pugh score 7.3). The procedure was safe. One patient was unable to swallow the capsule. The mean recording time was 213 s (range 6 - 1200 s); the procedure accurately assessed the presence or absence of esophageal varices in 16 of 19 patients (84.2 %); and it correctly indicated a need for primary prophylaxis (esophageal varices of grade 2 or more and/or red signs) in 100 % of cases. The tolerability of the capsule endoscopy examination was significantly better, and all of the patients preferred capsule endoscopy to EGD (which was transnasal in 11 patients). CONCLUSIONS: Capsule endoscopy was feasible, safe, accurate, highly acceptable, and preferred by cirrhotic patients undergoing screening for portal hypertension. This new technique requires further and more extensive evaluation, as well as assessment of its cost-effectiveness.

Aged↗
PubMed2006

Ambulatory 24-h oesophageal impedance-pH recordings: reliability of automatic analysis for gastro-oesophageal reflux assessment.

Oesophageal pH-impedance monitoring allows detection of acid and non-acid gastro-oesophageal reflux (GOR) events. Visual analysis of impedance recording requires expertise. Our aim was to evaluate the efficacy of an automated analysis for GOR assessment. Seventy-three patients with suspected GORD underwent 24-h oesophageal pH-impedance monitoring. Recordings analysis was performed visually (V) and automatically using Autoscan function (AS) of Bioview software. A symptom index (SI) > or =50% was considered for a significant association between symptoms and reflux events. AS analysis detected more reflux events, especially non-acid, liquid, pure gas and proximal events. Detection of oesophageal acid exposure and acid reflux events was similar with both analyses. Agreement between V and AS analysis was good (Kendall's coefficient W > 0.750, P < 0.01) for all parameters. During pH-impedance studies, 65 patients reported symptoms. As compared to visual analysis, the sensitivity and specificity of a positive SI determined by AS were respectively 85.7% and 80% for all reflux events, 100% and 98% for acid reflux and 33% and 87.5% for non-acid reflux. Despite good agreement with visual analysis, automatic analysis overestimates the number of non-acid reflux events. Visual analysis remains the gold standard to detect an association between symptoms and non-acid reflux events.

Adolescent↗
PubMed2005

Pediatric paranasal sinus mucoceles: etiologic factors, management and outcome.

OBJECTIVES: To study the local and general etiological factors of paranasal sinus mucoceles in the pediatric population and to evaluate and discuss the clinical management and the results of endonasal marsupialization. DESIGN: Retrospective study. PATIENTS AND METHODS: A series of 10 cases of paranasal sinus mucocele in children were managed. For imaging, CT-scan and, sometimes MRI were performed. An ophthalmologic evaluation was performed preoperatively in all cases, and post-operatively in case of preoperative trouble. All patients were treated with endoscopic surgical procedure. Authors also looked for etiological factors. RESULTS: Cystic fibrosis was found in 6 cases out of 10. Others etiological factors were trauma and inflammatory process; one case was strictly idiopathic. Three patients out of 10 had ophthalmologic trouble related with the mucocele. With a mean follow-up of 17 months, neither recurrence nor complication were noted. All patients with ophthalmologic complain were free of trouble after surgery. CONCLUSION: Paranasal sinus mucoceles in children are still rare. In our experience, 9 out of 10 patients had predisposing factors, especially cystic fibrosis. Imaging with CT-scan and MRI allow the physician to rule out other tumors such as meningoceles or rhabdomyosarcoma. Endoscopic endonasal surgery is nowadays the gold standard for the treatment of paranasal sinus mucoceles.

Adolescent↗
PubMed2005

Normal values and day-to-day variability of 24-h ambulatory oesophageal impedance-pH monitoring in a Belgian-French cohort of healthy subjects.

BACKGROUND: Impedance-pH monitoring is the most sensitive method for detection and characterization of gastro-oesophageal reflux episodes. Normal values from European subjects are lacking. AIM: To build a database of gastro-oesophageal reflux patterns from French and Belgian healthy subjects. METHODS: Seventy-two healthy subjects (35 men, mean age 35 years, 18-72) underwent 24-h ambulatory impedance-pH studies. Gastro-oesophageal reflux episodes were detected using impedance and characterized by pH as acid, weakly acidic, or weakly alkaline. Analysis was performed visually and effects of age, gender and intra-individual reproducibility were evaluated. RESULTS: The total number of gastro-oesophageal reflux episodes was 44 (25,58,75) of which 59% were acid, 28% were weakly acidic and 10% weakly alkaline. Half of gastro-oesophageal reflux episodes were mixed (liquid/gas) and 22% reached 15 cm above the lower oesophageal sphincter. The bolus clearance time was 11 s while acid was chemically cleared in 34 s. Male gender was associated with increased number and proximal extent of total and acid gastro-oesophageal reflux. Repeated studies in 27 subjects showed good reproducibility for number, acidity and air-liquid composition of reflux (Kendall's W-values = 0.72-0.85). CONCLUSIONS: This study demonstrates good reproducibility of 24-h ambulatory impedance-pH studies and provides values of reflux patterns in healthy subjects for comparisons with European gastro-oesophageal reflux disease patients.

Adolescent↗
PubMed2005

Nicotinic-receptor potentiator drugs, huprine X and galantamine, increase ACh release by blocking AChE activity but not acting on nicotinic receptors.

The main goal of the present study was to analyse the effects of (+/-)-huprine X ((+/-)-HX) and galantamine (GAL), with potentiating action on nicotinic receptors, and huperzine A (HPA), devoid of nicotinic activity, on [3H]-acetylcholine ([3H]-ACh) release in striatal slices of rat brain. All compounds are non-covalent and reversible inhibitors of AChE. Addition of (+/-)-HX (0.01 microM), GAL (10 microM) and HPA (0.1 microM) to the superfusion medium decreased the release of the ACh neurotransmitter to a similar extent: 36%, 30% and 34%, respectively (P<0.01). This effect was reverted in the presence of atropine (ATR; 0.1 microM), which blocks the pre-synaptic muscarinic M2 receptor. After that, a wide range of concentrations of drugs, concomitantly with ATR (0.1 microM), was studied in the presence of haloperidol (HAL; 0.01 microM), a dopamine D2 antagonist. In these conditions, a dose-dependent increase of [3H]-ACh release was observed in the presence of (+/-)-HX, GAL and HPA. To test the role of nicotinic receptors in the drugs' effects on [3H]-ACh release, mecamylamine (MEC) 100 microM was used to block such receptors. MEC alone significantly decreased neurotransmitter release by 18% (P<0.05), but no change was obtained in the presence of both ATR and MEC. Under these conditions, (+/-)-HX, GAL and HPA increased the release of [3H]-ACh by 37%, 25% and 38%, respectively (P<0.01). Taking into account all of these data, the present results suggest that the effects induced by (+/-)-HX and GAL nicotinic-receptor potentiators seem to be mainly due to their ability in inhibiting acetylcholinesterase activity, but not by interaction on the nicotinic receptors.

Acetylcholine↗
PubMed2005

Progressive spontaneous unilateral enlargement of the breast twenty-two years after prosthetic breast augmentation.

Late spontaneous enlargement of the breast is a rare complication after prosthetic breast augmentation. It has been intermittently described in the literature over the last 24 years but its exact aetiology remains unknown. Several possible aetiologies have been proposed. We present a case of a 46-year-old female who developed spontaneous asymmetrical breast enlargement 22 years post-bilateral breast augmentation without any known precipitating factors. Radiographic imaging revealed a periprosthetic collection occupying 70% of the volume inside the capsule. Initial recommendations for capsulectomy and removal of the breast implant were delayed for a year by the patient who subsequently represented with ongoing enlargement of the affected breast. Pathological findings revealed an intact silicone implant surrounded by laminated blood clot, similar in appearance to a chronic subdural haematoma. The literature is reviewed and the possible pathophysiological mechanisms of this unusual condition discussed.

Breast↗
PubMed2005

Gene therapy in plastic and reconstructive surgery.

Gene therapy has been investigated in many aspects of plastic and reconstructive surgery. These areas ultimately involve various forms of tissue healing and the manipulation of bony and soft tissues to reconstruct defects secondary to neoplastic and congenital disorders and trauma. Most research has been limited to animal studies with the exception of clinical trials on the use of gene therapy in lower leg ulcer healing and as an adjunct to advanced recurrent squamous cell carcinoma of the head and neck. Overall, these preliminary studies have produced optimistic results. With the development of more efficient and safer delivery systems, the application of gene therapy in plastic surgery could become more widespread, especially in combination with tissue engineering technology.

Clinical Trials as Topic↗
PubMed2004

Comparison of morphological and functional characteristics of primary-cultured human conjunctival epithelium and of Wong-Kilbourne derivative of Chang conjunctival cell line.

PURPOSE: To analyze the relevance of a human conjunctival cell line in a study of conjunctival epithelium. We investigated and compared the effects of IFNgamma and TNFalpha in a primary culture of human conjunctiva and in a human conjunctival cell line. METHODS: A primary-cultured human conjunctival epithelium and a human conjunctival cell line (Chang cells) were treated for 72 hr with 20, 200, 400 and 600 U ml(-1) IFNgamma or with 1100 and 11,000 U ml(-1) TNFalpha. Then, the expression of HLA DR, CD40, CD44, CD63, CD80, CD86, Fas receptor, E-cadherin, ICAM-1, MUC1, cytokeratins and vimentin were investigated by flow cytometry. Cell morphology was studied with phalloidin staining. Apoptosis was detected by flow cytometry with Annexin V and via cell cycle analysis. RESULTS: The primary culture of human conjunctival epithelium expressed cytokeratin K4, non-keratinized squamous epithelial marker. Chang cells presented a more dedifferentiated phenotype and were cytokeratin K4 negative. In primary-cultured cells, IFNgamma (600 U ml(-1)) induced only a low level of apoptosis and a significant upregulation of most tested proteins such as HLA DR, Fas, ICAM-1, CD40 and CD63. In the Chang cell line, IFNgamma induced a significant level of apoptosis at concentrations of 200, 400 and 600 U ml(-1). HLA DR and CD63 were induced at lower levels than in primary-cultured cells. Other proteins were modified in a similar manner after IFNgamma treatment in both systems. In the primary-cultured cells, TNFalpha induced an important upregulation of ICAM-1, Fas and CD40 whereas CD44 and CD63 were significantly decreased. Conversely, only a very weak alteration of CD63 and ICAM-1 was observed in the Chang cell line after TNFalpha treatment. CONCLUSIONS: A primary culture of a human conjunctival epithelium demonstrated well-defined epithelial features. TNFalpha and IFNgamma, two inflammatory cytokines, induced different effects in both cellular systems, in a primary-cultured conjunctival epithelium and a human conjunctival cell line. Inflammation-related molecules were highly upregulated in the primary culture and, to a lesser extent, in the Chang cell line. Thus, the Chang cell line differs in certain features from a primary culture of human conjunctival epithelium, a fact which emphasizes the complexity of interpretation of in vitro data and this should be taken into consideration in in vitro studies of human conjunctival epithelium.

Antigens, Surface↗
PubMed2004

Congenital midline cervical cleft of the neck: a series of five cases.

Congenital midline cervical cleft is a very uncommon malformation. Through a series of five cases treated in the pediatric otolaryngology head and neck surgery department of an academic care center, authors discuss embryopathogeny and therapeutic management. It appears that complete surgical removal leads to cure in classic cases. No recurrence was noted and cosmetic damages were minor.

Child, Preschool↗
PubMed2004

Potentiation effects of (+/-)huprine X, a new acetylcholinesterase inhibitor, on nicotinic receptors in rat cortical synaptosomes.

The present experiments were developed to analyze the direct and/or potentiation effect of (+/-)-12-amino-3-chloro-9-ethyl-6,7,10,11-tetrahydro-7,11-methanocycloocta[b]quinoline hydrochloride ((+/-)huprine X) on nicotinic receptors using a synaptosomal superfusion method. (+/-)Huprine X (1 microM, 10 microM) increased [(3)H]-ACh release only at 10 microM (46%; P < 0.001) in basal, but not in stimulated, conditions. This effect was completely reverted by mecamylamine (100 microM; MEC). Potentiation of evoked-[3H]-ACh release induced by ACh (1 microM) and by galantamine (GAL) 0.4 microM and physostigmine (PHY) 10 microM (55% and 50%, respectively; P < 0.001), two well-known allosteric compounds, corroborate that the present experimental approach is a suitable method to study potentiation effects on nicotinic receptors in the central nervous system nerve terminals. (+/-)Huprine X potentiated the evoked-[3H]-ACh release induced by ACh (1 microM) by 166% and 90% (P < 0.001) at 10 microM and 30 microM, respectively, and this effect was completely blocked by MEC (100 microM). In the presence of different ACh concentrations, (+/-)huprine X 10 microM potentiated evoked-[3H]-ACh release at low ACh concentrations, while a decrease in neurotransmitter release was observed at high ACh concentrations. The highest potentiation effect was obtained at the ACh/(+/-)huprine X concentration ratio of 1:10, and this potentiation was observed at as low a (+/-)huprine X concentration as 0.1 microM (P < 0.05). While the results suggest that huprine may enhance the potency or effectiveness of ACh by an effect involving nicotinic receptors we cannot completely discard that the results could be explained by acetylcholine esterase inhibition.

Acetylcholine↗
PubMed2004

[Acute retinal necrosis: clinical presentation, treatment, and prognosis in a series of 22 patients].

PURPOSE: To evaluate the clinical outcome and medical management in a series of patients diagnosed with acute retinal necrosis. MATERIAL AND METHODS: Between 1993 and 2000, 22 patients suffering from acute retinal necrosis were referred to our department. We retrospectively reviewed the clinical course, delay between diagnosis and first clinical manifestation, biological profiles, treatment and complications. RESULTS: All patients had vitreous inflammation; retinitis was seen upon examination in 82% of the cases. Nevertheless, for six patients (27% of the cases), failure to recognize the diagnosis led to delay (mean, 5.5 days) between the first ophthalmological examination and antiviral therapy. Nineteen patients underwent laboratory evaluation, and virological diagnosis was made in 16 of them: varicella zoster virus was found in 11 cases, herpes simplex type 1 in three cases, and herpes simplex type 2 and cytomegalovirus in one case each. Nine patients were treated with a combination of aciclovir and foscarnet and 13 with aciclovir alone. Among the 16 patients who received aciclovir, one did not respond to therapy after 2 days and was cured only after foscarnet was added. Recurrence occurred at the end of treatment in only one patient. Retinal detachment complicated the course for 11 patients and was always associated with proliferative vitreoretinopathy. Among those, seven of the ten patients who accepted surgery were successfully treated. Eleven out of 22 patients had a final visual acuity up to 20/200 and two up to 20/40. CONCLUSION: In our series, acyclovir alone was sufficient to cure the majority of cases. Even with antiviral therapy, the prognosis of acute retinal necrosis remains poor. Retinal detachment is the main complication.

Acyclovir↗
PubMed2004

[Improvement in postural orientation and stability after stereotactic gamma irradiation of acoustic neurinomas].

Non-surgical stereotactic gamma ionizing irradiation was developed in order to produce a lethal effect on unilateral acoustic neurinomas (vestibular schvannomas). We present a study of postural vestibular dependent performances in 218 patients before and after curative irradiation. Subjects were asked to stand at ease on a static dynamometric foot-plate, gazing at a fixed point in front of them (EO condition) or to stand eyes closed (EC condition). Statokinesigrams were registered during two consecutive sessions of 51.2 sec, under EO and EC conditions. These sessions were first managed the days before (d-1), and after (d+1) irradiation; others were performed later (d+1 to 5 Years; n=37). Center of pressure (CofP) mediolateral (X) and sagittal (Y) positions were quantified every 100 msec. Mean Xm session value (with SD) was taken as a personal parameter for left or right body inclination. Area S for 90% of the XY successive placements of the CofP observed during a session was taken as an index for 2D postural way. Before irradiation the overall average of the 218 personal Xm mean values demonstrated a statistically significant body inclination toward the affected side, however under EC condition only. The day after irradiation, a significant reduction of the overall mean value of body inclination was observed. Paired Xm statistics of confirmed this trend toward usual symmetry. The day after stereo-irradiation, averaging areas S of ellipses indicated a shift of instability toward normality. For the two parameters, the pseudo-Romberg ratios (performance EC/performance EO) indicated that a special visual contribution to balance control is present in patients with a neurinoma tumor (here I and II grades). The relative importance of this visual support declined shortly after ionizing treatment. Because the radiation is neither noxious nor excitatory we think such a rapid recovery is due to some recovery of vestibular nerve afferent conduction, and a rapid neural reprogramming of the balance control. These attractive results call for deeper investigations of both vestibular and auditory functions.

Cohort Studies↗
PubMed2003

Tolerance and efficacy of argon plasma coagulation for controlling bleeding in patients with typical and atypical manifestations of watermelon stomach.

BACKGROUND AND STUDY AIMS: Watermelon stomach is a well-known cause of gastrointestinal bleeding and anemia. This study investigated the efficacy of and patient tolerance for argon plasma coagulation (APC) in this condition. PATIENTS AND METHODS: The reports of 21 patients with watermelon stomach who were treated using APC from February 1998 to August 2001 were reviewed. The efficacy of APC was evaluated on the basis of the patients' symptoms, transfusion requirements, and hemoglobin levels. RESULTS: Fifty-nine APC sessions were carried out (mean 2.81 sessions per patient, range one to five). Depending on the bleeding outcome and lesion intensity, repeat treatments were carried out with a mean delay of 1.8 months (range 2 days - 6 months). The mean follow-up period after the last session was 14.9 months (1 - 60.6 months). All of the patients required repeated blood transfusions before APC, compared with only two patients after treatment. One of these two patients died of uncontrolled bleeding despite APC. The mean hemoglobin level was 80.9 g/l before treatment, compared with 103.2 g/l after treatment. Three patients had recurrent bleeding 4.4 - 31.7 months (mean 13.8 months) after the last session and required a further session of APC, which controlled bleeding in all cases. Complications encountered consisted of two cases of hematemesis and one of sepsis. CONCLUSIONS: APC was effective in controlling bleeding due to watermelon stomach in the great majority of patients, with a low complication rate.

Aged↗
PubMed2003

[Pediatric cochlear implants].

Indications for cochlear implants have been widened since 1995. Most implant candidates are children with severe congenital deafness. The cochlear implant must be inserted as early as possible for these children in order to optimize development of perception and language. A cochlear implant can also be discussed in certain particular cases for children with associated diseases, malformation of the inner ear, or severe deafness. The educational project must be realistic and take into account the future difficulties as well as an established set of criteria for successful language acquisition.

Acoustic Impedance Tests↗
PubMed2003

[Choanal atresia: therapeutic management and results].

OBJECTIVES: To assess and compare long term results after surgical correction (transnasal or transplatine approaches) of unilateral or bilateral choanal atresia, in children with or without associated anomalies. PATIENTS: During a 13-year period, 58 children were included in this retrospective study. Seventy-five choanas were operated on (41 unilateral and 17 bilateral). The transpalatine approach was performed in 41 children (56 choanas) while the transnasal approach was performed in 17 patients (19 choanas). Associated anomalies were reported in 28 children and corresponded to CHARGE association in 13 cases. RESULTS: With a mean follow-up of 7 years, perfect choanal permeability was reported in 90% of children operated on through a transpalatine approach and in 76% of children with a transnasal approach. A complementary therapeutic procedure was required in 54% of transpalatine approaches and 46% of transnasal approaches to yield these results. Postoperative choanal permeability was obtained in 93% of children without an associated anomaly and in 77% of those with associated anomalies, such as in 88% of unilateral atresias and 80% of bilateral ones. CONCLUSION: Initial success rate after surgery is similar for all surgical procedure insofar as nearly half choanas required a complementary therapeutic procedure. The endonasal procedure using the microdebrider appears hopeful and the KTP laser is interesting in fibrous residual stenosis. Associated anomalies are factors which lower general prognosis while inducing a higher surgical failure rate.

Abnormalities, Multiple↗