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Biomedical subjects

T Poynard

Publications and source records attributed to T Poynard.

At least 217 records · Page 12Linked to original sources
PubMed1989

Perisinusoidal cells (Ito-cells) enlargement in a family with myotonic dystrophy.

Two cases are reported, a daughter and her mother who both have myotonic dystrophy with abnormalities of liver function tests and an important perisinusoidal cell enlargement without other pathologic features. In both cases, the myotonic dystrophy was clinically obvious and confirmed by electromyography. No other causes of perisinusoidal cell enlargement were found including vitamin A intake, psoriasis, viral disease or alcoholism. These observations suggest a genetic linkage and that serum test abnormalities could be associated with a perisinusoidal cell change.

Adolescent↗
PubMed1989

A randomised controlled study of propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis.

74 cirrhotic patients with a history of variceal or gastric bleeding were randomly assigned to treatment with propranolol (40 to 360 mg/day) or placebo. The patients were all in good condition and doses of propranolol were titrated until a 25% reduction in heart rate was achieved. After 2 years, the cumulative percentage of patients free from rebleeding was significantly greater among the patients receiving propranolol (79%) than in the placebo group (32%; p less than 0.0001). Similarly, the percentage of surviving patients was significantly greater with propranolol (90%) than with placebo (57%; p less than 0.02) after 2 years. It was concluded that in cirrhotic patients in good condition, propranolol reduced both the risk of recurrent gastrointestinal haemorrhage and the mortality rate during a 2-year period of continuous administration of the drug.

Adult↗
PubMed1989

Localization of apolipoprotein A-I and apolipoprotein A-II in human atherosclerotic arteries.

Apolipoprotein A-I and apolipoprotein A-II, the two major protein components of the high-density lipoproteins, were visualized in human arteries using an immunofluorescence technique. Apolipoprotein A-I and apolipoprotein A-II were codeposited into the intima and upper media of normal arteries of atherosclerotic patients. The amount of deposits increased in fatty streaks. In atherosclerotic plaques, apolipoproteins accumulated around the necrotic material. These two apoproteins were present in the extracellular matrix as well as in the foam cells surrounding the atherosclerotic lesions. The concomitant intracellular localization of apolipoprotein A-I and of apolipoprotein A-II in the cytoplasm of foam cells supports the hypothesis that extracellular high-density lipoprotein particles are internalized in the macrophages during the atheromatous process.

Aged↗
PubMed1988

[Evaluation of the methodological quality of randomized therapeutic trials].

A grid devised to evaluate the methodological quality of randomized therapeutic trials is presented. Fourteen items are analysed: description of the principal criterion of assessment, criteria of inclusion, number of subjects seen and excluded, number of subjects randomized to each group, number of subjects excluded who are alive or lost to follow-up and reasons for the fall-outs, blind character of the doctors, patients and persons responsible for the assessment criteria, calculation of the number of subjects required before starting the trial, method of randomization and its blind character, analysis and discussion of covariables, statistical tests used, taking into account of the fall-outs and power of the trials with non-significant results. This grid, used for the analysis of 527 randomized trials, showed that about one-half of them were of mediocre quality, the most frequent defects encountered being the multiplicity of assessment criteria, the lack of description of the subjects excluded, the absence of calculation of the number of subjects required before starting the trial and the small number of subjects in trials with non-significant results.

Clinical Trials as Topic↗
PubMed1988

Nadolol for prophylaxis of gastrointestinal bleeding in patients with cirrhosis. A randomized trial.

This controlled trial was designed to evaluate the prophylactic effect of nadolol on gastrointestinal bleeding in cirrhotic patients with large oesophageal varices who had never bled. Nadolol or placebo was given randomly to two groups of 53 patients. The percentage of patients free of gastrointestinal bleeding 1 year after inclusion in the study was 83 +/- 6% (mean +/- S.D.) in the nadolol group and 80 +/- 6% in the placebo group. In the nadolol and placebo groups, 40 and 47 patients, respectively, were compliant, i.e., took nadolol or placebo continuously. The percentage of patients who were free of bleeding 1 year after inclusion was 97 +/- 3% in the subgroup of compliant nadolol patients. This percentage was significantly higher than that of patients who were free of bleeding in the placebo group (P less than 0.03) as well as in the subgroup of compliant placebo patients (77 +/- 6%; P less than 0.02). We concluded that, although there was no overall significant effect of nadolol on the risk of bleeding in cirrhotic patients in good condition with large oesophageal varices, this study suggests that nadolol reduced the risk of bleeding in compliant patients.

Clinical Trials as Topic↗
PubMed1988

Observer variation in assessment of liver biopsies of alcoholic patients.

The aim was to construct a questionnaire analyzing pathological features possibly present in alcoholic liver disease, to assess its interobserver variation and to determine the influence of technical data on this variation. A total of 764 inpatients drinking 90 g (median) of pure alcohol per day for 25 years was observed; 402 patients were excluded because of associated nonalcoholic disease, refusal or contraindication to biopsy, leaving 362 patients included. Two pathologists independently analyzed each biopsy and completed a questionnaire including 41 items. Coefficient of concordance between observers was evaluated with the kappa statistic (k). The prevalence of 14 lesions was low, equal to or under 10%, leading to a nonsignificant concordance. For the 27 remaining features, two had an almost perfect degree of concordance (k greater than 0.81): presence of hepatocellular carcinoma and cirrhosis. Three had a substantial coefficient of concordance (k greater than 0.61): fibrous septa, size of cirrhotic nodules, and liver cell regeneration. Nine had a moderate (k greater than 0.41), 11 a fair (k greater than 0.21), and two a slight (k less than 0.21) coefficient of concordance. In terms of final diagnosis of alcoholic liver disease the concordance was substantial for cirrhosis with acute alcoholic hepatitis (k = 0.77), cirrhosis without alcoholic hepatitis (k = 0.75), acute alcoholic hepatitis without cirrhosis (k = 0.65) and normal liver (k = 0.64). Concordance was moderate for steatosis (k = 0.47) and slight for fibrosis alone (k = 0.16).(ABSTRACT TRUNCATED AT 250 WORDS)

Alcoholism↗
PubMed1988

[Hepatic involvement in HIV 1 virus infection].

One hundred consecutive patients with serum antibodies against HIV 1 were evaluated for the prevalence and the type of liver injury. According to the CDC classification, 16 patients belonged to group II (asymptomatic patients), 47 to group III (persistent generalized lymphadenopathy) and 37 to group IV (11 constitutional disease, 19 secondary infectious diseases, 5 secondary cancers, one chronic lymphoid interstitial pneumonitis and one visceral leishmaniasis). Liver histology was studied in 32 patients. Clinical, biological and histologic abnormalities were assessed according to the clinical group and to the number of T4 lymphocytes. The prevalence of HBV infection was determined by HBV DNA and monoclonal antibodies. Clinical hepatic abnormalities were rare (13 p. 100) and no difference was found between groups. Transaminases or GGT activities were elevated in 60 p. 100 of all cases. Serum GGT activity was higher and serum albumin lower in patients in group IV. HBV infection markers were less frequently found in patients with opportunistic infection (74 p. 100) than in asymptomatic patients (100 p. 100; p less than 0.05). Prevalence of serum HBsAg detected by poly- or monoclonal antibodies was very high (29 p. 100) in all clinical groups. Prevalence of serum HBsAg detected only by monoclonal antibodies (10 p. 100) suggest infection of these patients by an HBV variant. Of the 32 patients undergoing liver histology, only 5 (16 p. 100) had signs of activity. There was no association between clinical or histologic signs and the number of T4 lymphocytes per ml. Alkaline phosphatase, ASAT and GGT activities were higher and serum albumin lower in patients with less than 200 T4 lymphocytes per ml.

Adolescent↗
PubMed1988

[Sclerotherapy of esophageal varices using ethanol in combination with propranolol: clinical study of 30 patients].

A prospective study was conducted in 30 patients to assess the efficacy and safety of endoscopic sclerotherapy with absolute alcohol associated with propranolol for prevention of recurrent variceal bleeding. Patients were included if propranolol alone had failed or if they had at least three factors which increased the risk of rebleeding although the patients were receiving propranolol; two patients were treated by sclerotherapy only because of contraindications to propranolol. Etiology of portal hypertension was cirrhosis in 29 patients and portal vein thrombosis in one patient. Seventeen patients were grade A and 13 were grade B according to Child-Pugh's classification. The cumulative percentage of patients free of rebleeding 12 months after inclusion was 43 +/- 10 p. 100 (m +/- SD). The cause of recurrent bleeding was esophageal varices in nine patients and esophageal ulcers in five patients. The cumulative percentage of variceal rebleeding 12 months after inclusion was 61 +/- 10 p. 100. The cumulative percentages of patients free of rebleeding from varices were not significantly different between the Pugh A (64 +/- 14 p. 100) and Pugh B (56 +/- 15 p. 100) patients. The cumulative percentage of patients surviving 12 months after inclusion was 55 +/- 9 p. 100. The cause of death was not related to sclerotherapy in 11 patients. Two patients died of esophageal wall necrosis associated with mediastinitis. These two patients had received large volumes of sclerosing agent because of important bleeding during the last injection. Our results suggest that in patients without severe cirrhosis who cannot be treated by propranolol alone, the risk of rebleeding and the risk of death are high despite sclerotherapy.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1987

[Development of an expert system as a teaching aid in the serological diagnosis of acute viral hepatitis].

The serological diagnosis of acute viral hepatitis is complex for both practitioners and students. We have developed an expert system to teach the serological diagnosis of acute viral hepatitis in order to help non-specialists in deciding on the diagnosis. Three levels of increasing difficulty have been devised. The procedure consists of the following steps: choice of first-line examinations; discontinuation of the examinations in cases where the diagnosis is ascertained; choice of the most discriminant examination in cases where the diagnosis is doubtful. The value of this computer-assisted teaching must be confirmed by randomized studies involving a group of students trained by "classical" methods and a group of students trained by a computer-assisted method.

Diagnosis, Computer-Assisted↗
PubMed1987

Relationship between degree of portal hypertension and liver histologic lesions in patients with alcoholic cirrhosis. Effect of acute alcoholic hepatitis on portal hypertension.

The relationship between the degree of portal hypertension and histologic liver lesions was studied in a group of 84 patients with histologically proven alcoholic cirrhosis. The degree of portal hypertension was evaluated by the gradient between wedged and free hepatic venous pressures. Five histologic lesions were quantified: liver cell necrosis, Mallory bodies, neutrophilic infiltrate, fibrosis, and fatty infiltration. The gradient between wedged and free hepatic venous pressures was significantly correlated with the degree of liver cell necrosis and the degree of neutrophilic infiltrate. The stepwise regression analysis showed that only liver cell necrosis has a significant and independent correlation for the degree of portal hypertension. The value for the gradient between wedged and free hepatic venous pressures was significantly higher in patients with (N = 48) than in those without (N = 36) acute alcoholic hepatitis (19.4 +/- 0.8 and 16.5 +/- 0.7 mmHg, respectively). Thus, histologic liver lesions observed in acute alcoholic hepatitis may play a role in the risk of complications of portal hypertension in patients with alcoholic cirrhosis.

Acute Disease↗
PubMed1987

Failure of haemodynamic measurements to predict recurrent gastrointestinal bleeding in cirrhotic patients receiving propranolol.

In an attempt to identify the haemodynamic factors predicting the recurrence of gastrointestinal bleeding in cirrhotic patients receiving propranolol, haemodynamic measurements were prospectively collected. Systemic and splanchnic haemodynamics were assessed before propranolol administration. Among 77 patients receiving propranolol, 24 re-bled and 53 did not re-bleed in a follow-up period of 30-730 days (median 540). There was no difference between patients with and without recurrent bleeding with regard to the initial value of heart rate, mean arterial pressure, cardiac index, and hepatic venous pressure gradient. A subgroup of 43 patients was further investigated for the haemodynamic response to one single dose of 40 mg of propranolol. No difference was observed in the propranolol-induced changes of heart rate, mean arterial pressure, cardiac index or hepatic venous pressure gradient, between patients with (n = 14) and those without (n = 29) recurrent bleeding while taking propranolol. In conclusion, systemic haemodynamics and hepatic venous pressure gradient have no predictive value in evaluating the risk of recurrent bleeding in cirrhotic patients receiving propranolol. Furthermore, therapeutic efficacy of propranolol cannot be predicted from the haemodynamic response to a single first dose of this substance.

Adult↗
PubMed1987

[Palliative treatment of cancers of the esophagus and cardia with neodymium YAG laser: short-term results and multidimensional analysis of factors related to functional improvement and tumor destruction].

The aim of this study was to report initial results of endoscopic Nd YAG laser therapy in palliative treatment of esophageal and cardial carcinoma and to define parameters that could predict initial outcome. Of 116 patients, 95 men and 21 women (mean age 68 years, range 33-94 years), 6 patients presented with inaccessible, completely obstructing squamous cell carcinoma. Of these 6 tumors, 5 were located in the cervical esophagus. Seventy-two patients with squamous cell carcinoma and 38 patients with adenocarcinoma were treated. Improvement of dysphagia was achieved in 90 of 110 patients (82 p. 100) after 2.8 sessions (range 2-7 sessions). Total destruction of the intraluminal tumor was achieved in 66 patients (60 p. 100) after 3.3 sessions, partial destruction in 36 patients (33 p. 100) after 4.3 sessions and treatment had no effect in 8 patients (7 p. 100) after 3.8 sessions. Forty-four of the 52 impassable stenoses with the Olympus GIFP3 endoscope were passed through with the Olympus GIFQ endoscope after 3.7 sessions. Six complications occurred: 1 esophageal perforation and 5 esobronchotracheal fistulas. Improvement of dysphagia and tumoral destruction were analyzed in two manners. Of 13 selected variables, 3 were significantly related with improvement of dysphagia after stepwise logistic regression: destruction of intraluminal tumor (p = 0.003), endoscopic fungating appearance (p = 0.03) and the age related type of surgical contraindication (p less than 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1987

[Treatment of gastroesophageal reflux: analysis of randomized double-blind trials].

The aim of this study was to analyze the results and the quality of methodology of 51 controlled double blind trials in the medical treatment of gastroesophageal reflux. The results of H2 receptor antagonist treatment were evaluated by the pooling method. Evaluation of methodology was carried out by using a special form filled in by two independent observers. The major criticisms in methodology were: small sample size, unblind evaluation of end-points, inappropriate statistical tests for small samples, and inaccurate handling of the withdrawals. There were only two trials concerning antacids versus placebo: one showed that Novaluzid improved symptoms and another that Maalox did not differ from placebo. The effectiveness of alginic acid and domperidone on either symptoms or endoscopic lesions was not demonstrated. Metoclopramide and bethanechol produced significant relief of reflux symptoms. Sucralfate and bethanechol were better than placebo in improvement of esophagitis endoscopic lesions. The H2-inhibitors efficiently relieved symptoms and esophagitis. Pooling analysis showed that H2-inhibitors were superior to placebo in the healing of esophagitis; the odds ratios were 2.5 for cimetidine and 3.3 for ranitidine, without significant difference. Omeprazole was better than ranitidine in relief of symptoms and esophagitis. The comparison of cimetidine alone with cimetidine plus metoclopramide showed that combined therapy was better in one trial out of two. New controlled trials are necessary to compare these different drugs and their association.

Clinical Trials as Topic↗