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Biomedical subjects

T Poynard

Publications and source records attributed to T Poynard.

At least 253 records · Page 14Linked to original sources
PubMed1983

Efficiency of respiratory assistance in cirrhotic patients with liver failure.

In a 25-month period, 100 cirrhotic patients, in our intensive care unit (ICU) needed endotracheal intubation and mechanical ventilation. The overall mortality rate was 89%; the mortality rate was 100% among patients with septic shock and/or superimposed acute hepatitis and/or severe cirrhosis defined with clinical signs: jaundice and/or ascites and/or spontaneous hepatic encephalopathy and/or severe malnutrition. With these prognostic indices, using Bayes theorem, the probability of fatal evolution ranges from 95%-100% (alpha = 5%). These results allow a group of patients with high cost and poor prognosis to be defined.

Female↗
PubMed1983

[Analysis of factors related to length of stay in the hospital in a hepato-gastroenterology unit].

Because hospital length of stay is the most important determinant of cost of hospitalization, this study was performed to analyse factors contributing to hospital length of stay in an hepato-gastroenterology unit. Prospectively collected computerized files of the first 750 patients admitted in 1982 were analyzed according to primary diagnosis, age and sex. Ten primary diagnosis categories were established. By multivariate analysis, alcoholic liver disease and the non-digestive diseases correlated best with the hospital length of stay. Variables most predictive of an hospital length of stay greater than 14 days were diagnosis of alcoholic liver disease, patient age and diagnosis of non-alcoholic cirrhosis. Analyses of this kind are essential in making policy decisions regarding hospital cost reduction.

Adult↗
PubMed1982

Metformin reduces post-prandial insulin needs in type I (insulin-dependent) diabetic patients: assessment by the artificial pancreas.

It has been suggested that biguanides should be used in Type 1 (insulin-dependent) diabetic patients in order to diminish insulin requirements and reduce the chances of insulin reactions. The efficacy of these compounds in such patients has been controversial. We have studied the effect of metformin (850 mg) given at 08.00 h in diminishing insulin needs after a 60 g carbohydrate mixed meal taken at 12.00 h, using an artificial pancreas and a sequential analysis of the results. The morning test dose of metformin or placebo was preceded by 48 h treatment with metformin (850 mg twice daily) or placebo. After the eighth patient a 26% saving of insulin need was demonstrated in the metformin-treated group (p less than 0.01). Metformin is thus effective in reducing post-prandial insulin needs in Type 1 diabetic patients, although its use in such circumstances requires consideration of several other issues.

Adult↗
PubMed1982

The inconvenience of investigations used in hepatology: patients' and hepatologists' opinions.

The purpose of this study was to estimate and compare the inconvenience of six investigations used in hepatology, as experienced by 113 inpatients and imagined by 80 hepatologists. For patients, the investigations, in order of increased inconvenience rate were: (1) venous puncture, (2) BSP clearance, (3) transvenous liver biopsy, (4) percutaneous liver biopsy, (5) laparoscopy and (6) oesogastroscopy. Hepatologists gave a higher inconvenience rate for all investigations than patients and the ranking of the crude inconvenience rate of each investigation was different for hepatologists and patients. For 84% of patients, oesogastroscopy was over 10 times more inconvenient than a venous puncture, whereas only 15% of hepatologists considered oesogastroscopy over 10 times more inconvenient (p less than 0.001). Multidimensional analysis indicated that hepatologists underestimated the role of pain in the rejection of re-investigation for transvenous liver biopsy, percutaneous liver biopsy and oesogastroscopy. These results suggest that hepatologists must improve the psychological and pharmacological premedication of these investigations according to the reaction of their patients, especially before oesogastroscopy.

Biopsy, Needle↗
PubMed1982

Relations between effectiveness of a diagnostic test, prevalence of the disease, and percentages of uninterpretable results. An example in the diagnosis of jaundice.

The relations between effectiveness, the percentages of uninterpretable results of a test, and the prevalence of the disease are studied in the example of the diagnosis of jaundice. Ten hepatologists and ten hepatobiliary surgeons were interviewed, and nineteen articles were reviewed. Accuracies of ultrasonography, endoscopic retrograde cholangiography, and transhepatic cholangiography, as well as of three strategies combining these tests, were ranked by hepatologists in an order that differed from chance, and by surgeons in an order that did not differ from chance. Analyses of published data, taking into account the percentages of uninterpretable results, showed that for a high prevalence of extrahepatic cholestasis, as in jaundiced patients seen by surgeons, there is no significant difference between the respective effectiveness of each test or strategy. We concluded that effectiveness must take into account the percentages of uninterpretable results and must be expressed as a function of prevalence.

Cholangiography↗
PubMed1982

Reduction of post-prandial insulin needs by pectin as assessed by the artificial pancreas in insulin-dependent diabetics.

The efficacy of a moderate amount (7 grams) of apple pectin in diminishing post-prandial insulin needs in insulin dependent diabetics (IDD) has been tested using an artificial pancreas in a sequential analysis. With this method, only four patients who served as their own control, showed significant reductions in insulin requirement of 3 Iu with pectin after a 60 g carbohydrate mixed meal. The use of pectin cut by 35 per cent the post prandial insulin demand. The patients judged the treatment as acceptable. More prolonged use in IDD is advisable.

Adult↗
PubMed1981

Propranolol for prevention of recurrent gastrointestinal bleeding in patients with cirrhosis: a controlled study.

It has been suggested that because propranolol decreases portal venous pressure, it may prevent gastrointestinal bleeding associated with portal hypertension. We randomly assigned 74 patients with cirrhosis, who were admitted because of gastrointestinal bleeding, to either oral propranolol given in doses that reduced the heart rate by 25 per cent (38 patients) or to a placebo (36 patients). The proportion of patients free of recurrent gastrointestinal bleeding one year after inclusion in this study was 96 per cent in the propranolol group and 50 per cent in the placebo group (P less than 0.0001). We conclude that continuous administration of propranolol by mouth is effective in preventing recurrent gastrointestinal bleeding in patients with cirrhosis.

Administration, Oral↗
PubMed1981

[Search of a cytomegalovirus infection during pseudo-membranous colitis. 6 cases (author's transl)].

Six patients with pseudomembranous colitis unrelated to lincomycin or clindamycin treatment were investigated for signs of localised or diffuse cytomegalovirus (CMV) infection. Before the onset of colitis 3 patients had receive prednisone, associated in 2 of them with immunosuppressive drugs. Testing for CMV included rectal mucosa biopsies, culture of blood leucocytes with human embryo diploid fibroblasts in continuous layer and titration of complement-deviating anti-CMV antibodies. Cytomegalic cells with nuclear inclusion bodies were found in the rectal mucosa of 5 patients, 4 of whom also had foci of CMV-infected cells in leucocyte-fibroblast cultures, indicative of viraemia. The fifth patient was not tested for viraemia but developed very high anti-CMV antibodies titers at a later stage. These results show that pseudomembranous colitis that are not due to antibiotics are frequently associated with localised or diffuse CMV infection. Viral invasion of the colon might be encouraged by a state of immunodeficiency.

Adult↗
PubMed1981

Upper digestive tract hemorrhage in cirrhotic patients. Contribution of multidimensional analysis to the study of variables related to the cause of the hemorrhage.

Sixteen clinical and biological variables were recorded in 116 episodes of upper digestive tract hemorrhage of known cause in cirrhotic patients. One-dimensional analysis reveals a significant correlation between six variables and the rupture of esophagogastric varices, whereas multiple linear regression and partial correlation analysis reduces the significant variables to two: a history of digestive hemorrhage and the nonalcoholic etiology of the cirrhosis. A value of the discriminant function exists for which the specificity and, consequently, the positive predictive value are equal to 100%, but with a sensitivity of 39%. These results mean that, in an explanatory approach, partial correlation analysis seems to constitute an indispensable complement to analysis of clinical and biological variables, since it reduces the chances of unwarranted explanatory interpretation. However, in a pragmatic approach, the recording of 16 variables does not permit a clear discrimination between ruptured varices and nonruptured varices; this suggests that either other factor(s) remain to be discovered or else that those related to ruptured varices and to acute ulcerations are the same.

Alcoholism↗