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Biomedical subjects

Y Le Quintrec

Publications and source records attributed to Y Le Quintrec.

At least 19 recordsLinked to original sources
PubMed1992

[Psoas abscess complicating Crohn's disease].

Psoas abscess were found in 6 cases among 166 patients with Crohn's disease between 1985 and 1989; in one case, it was the first sign of Crohn's disease. Diagnosis was usually difficult and should be suspected on the following signs: lower abdominal quadrant pain, psoitis, abdominal mass, sciatica or pain along the course of the femoral nerve. Diagnosis was confirmed in nearly all cases by computerized axial tomography. Effective therapy combines drainage and bowel resection.

Adolescent↗
PubMed1991

Isotonic high-sodium oral rehydration solution for increasing sodium absorption in patients with short-bowel syndrome.

We compared the effect of a standard oral rehydration solution and a high-sodium polymeric-glucose solution on sodium absorption in short-bowel syndrome. Six patients with high jejunostomy were tested in a random order with the standard solution or a solution containing maltodextrins (18 g Glucidex 12/L) enriched with 2.5 g NaCl/L. Solutions were administered via a nasogastric tube at a rate of 2 mL/min. Jejunal effluent was collected during an 8-h period. The net 8-h fluid absorption was not significantly different in the two periods. Glucose absorption was greater than 90% of the administered amount for both solutions. Net sodium absorption was greater for the maltodextrin solution than for the standard solution (56 +/- 12 vs 24 +/- 20 mmol, P less than 0.05). We conclude that replacement of glucose with maltodextrins and addition of sodium in the standard oral rehydration solution results in improved sodium absorption in short-bowel syndrome.

Absorption↗
PubMed1991

Controlled trial comparing two types of enteral nutrition in treatment of active Crohn's disease: elemental versus polymeric diet.

To determine whether an elemental diet or a polymeric defined formula diet would be more effective for treating active Crohn's disease, we conducted a prospective randomised clinical trial in 30 patients with active Crohn's disease unresponsive to steroids and/or complicated by malnutrition. They received a four to six week enteral nutrition course with either an elemental diet or a polymeric diet. Clinical remission occurred in 10 of the 15 patients on elemental diet compared with 11 of the 15 patients assigned to polymeric diet. Both groups showed similar improvements in nutritional status, biological inflammation, alpha 1 antitrypsin clearance, and colonoscopic lesions (diminished in 17 out of 24 patients). Most patients relapsed during the year after discharge. We conclude that enteral nutrition, whatever the diet, is an efficient primary therapy for active Crohn's disease but does not influence the long term outcome.

Adult↗
PubMed1991

Modulation of orocaecal transit time by hypnosis.

The ability of hypnosis to modulate the orocaecal transit time of 10 g lactulose was tested in six healthy volunteers. Orocaecal transit time was measured by the hydrogen breath test during three periods in random order. During the control period the subjects remained throughout the test in a semirecumbent position without moving. During the hypnotic relaxation period subjects were hypnotised before lactulose ingestion and were instructed to experience relaxation till the orocaecal transit time had elapsed. During the acceleration suggestion period subjects were hypnotised before lactulose ingestion and were repeatedly instructed to imagine the acceleration of lactulose through the intestine until transit time had elapsed. The mean orocaecal transit time was significantly longer during the hypnotic relaxation period (mean (SEM) 133 (8) min) than during the control period (93 (13) min). The mean orocaecal transit time during the acceleration suggestion period was 105 (26) minutes and was not significantly different from the mean transit time during the control period. The individual values during the acceleration suggestion period were scattered. We conclude that lactulose orocaecal transit time is delayed during hypnotic relaxation.

Adult↗
PubMed1990

Adaptive hyperphagia in patients with postsurgical malabsorption.

The specific nutritional consequences of malabsorption after small-bowel surgery were studied in a consecutive series of 48 ambulatory patients who had had small-bowel resection (n = 43) or bypass (n = 5) and in 10 patients who had an ileal pouch (n = 10). The patients received a 3-day standardized oral regimen providing daily 30 kcal/kg of ideal body weight (IBW). Throughout the study, 41 patients had malabsorption (fecal fat greater than 5%); 17 had fecal fat less than 5% and served as controls. The malabsorption patients absorbed 70% of protein and 71% of fat. Twenty-one were normonourished and 20 had features of mild energy malnutrition, vs. 15 and 2 controls, respectively. Compared with controls, malabsorption patients had decreased body weight and triceps skin-fold but no features of protein malnutrition. their mean daily food intake at home was significantly enhanced (39.6 +/- 13.1 kcal/IBW kg) vs. controls (28.8 +/- 5.8 kcal/IBW kg, P less than 0.001). In the malabsorption group, caloric intake was higher in the normonourished patients than in those with mild malnutrition. This study shows that a chronic malabsorption has limited nutritional consequences. The patients compensate for their absorptive handicap by increasing their oral intake.

Absorption↗
PubMed1990

[Elemental feeding into the distal segment of a temporary small bowel].

Patients who have an interruption of the small bowel with a high enterostomy usually need parenteral supply or reinfusion of chyme to maintain nutritional and electrolytic balances before restoring intestinal continuity. Ten patients (aged 28-76 years) with a terminal jejunostomy located within the first meter of jejunum were treated by infusion of an elemental diet into the distal small bowel (IEDDSB). In addition, five of these patients had an extensive small bowel resection. IEDDSB was started 32 days after operation and lasted 4 to 8 weeks. Mean daily caloric infusion was 1,732 +/- 666 kcal diluted in 2,860 +/- 808 ml; mean associated oral intake was 1,187 +/- 480 kcal/24 hr, and jejunal fecal losses averaged 3 kg per day. IEDDSB was well tolerated in 4 patients; 5 experienced transient abdominal pain or diarrhea; 1 developed severe and protracted diarrhea. Biological cholestasis was seen before IEDDSB and persisted in most patients; 1 patient developed biliary sludge. Through IEDDSB, nutritional status improved or remained satisfactory in 9 patients, and worsened in 1 patient with sepsis and a short lower intestine. Mean body weight, triceps skin fold, muscle circumference, serum albumin, serum transferrin did not change significantly. Digestive nitrogen balance performed in 6 patients showed a net absorption between 5 and 15 g/24 hr. Fluid and electrolyte balance was maintained in 9 patients and 1 received iterative intravenous saline. Digestive sodium balance showed a net absorption rate greater than 60 mmol/24 hr. in all patients, except the one who required intravenous supply. Postoperative recovery was uneventful in all patients.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1989

[A prospective study of liver test anomalies during continuous enteral nutrition].

In 119 gastrointestinal patients, serum transaminases (ASAT) and alkalines phosphatases (AP) were prospectively measured on the first and the twenty first days of a continuous enteral nutrition (CEN) regimen. The exclusion criteria were: recent surgical procedure, transfusion or total parenteral nutrition (TPN), or a cancer during the previous five years. Of the 119 patients, 71 patients were included in the study. The patients received: (a) an exclusive elemental CEN (n = 25, all with Crohn's disease) or non elemental CEN (n = 9), providing 40 kCal/kg of ideal body weight (IBW)/day; (b) a non exclusive non elemental CEN providing a minimum of 30 kCal/kg IBW/day. Of the 56 patients having normal hepatic function tests (HFT) on the first day, only 2 developed mild abnormalities (incidence of 3.6%). Of the 15 remaining patients having abnormal HFT on the first day, HFT improved or returned to normal in 8 cases. During CEN: the appearance of abnormal HFT seems rare, pre-existing abnormalities can improve and there is no associated morbidity. These results suggest that there is no hepatic side effects of CEN, in contrast to TPN, and that CEN must be preferred over TPN whenever the choice is possible.

Adolescent↗
PubMed1989

Testing for course patterns in Crohn's disease using clustering analysis.

Using clustering analysis, we sought to identify groups of patients on the basis of the disease course among a population of 177 patients with Crohn's disease and followed for 3 years or more, starting from the first frank exacerbation of the disease. The first 36 values of a monthly clinical score represented the active variables of the clustering analysis. This method yielded 2 course groups, A and B, of 95 and 82 patients respectively. The unfavorable course in group A was characterized by the persistence of the clinically active disease at 3 years, whereas group B individuals achieved complete clinical remission within 2 years of onset on the average. Among the initially known clinical data which could explain the course, only the incidence of an occlusive syndrome was higher in group B, which showed a more favorable course. Although we applied clustering analysis to a patient sample over a period of only 3 years, our results do suggest the existence or 2 primary course groups within the population of patients with Crohn's disease. It would appear that the disease course cannot be predicted from the clinical parameters present at the time of onset, but rather becomes apparent during the course of the first 2 years.

Adult↗
PubMed1989

[Ischemic and inflammatory colitis in elderly subjects over 70].

Twenty-five cases of non-infectious, macroscopic colitis, observed consecutively in patients over 70, were studied. The final diagnosis was, in 12 instances, ischemic colitis, in 10 instances cryptogenetic colitis (6 ulcerative colitis and 4 Crohn's diseases), and in 3 instances, non-classified colitis. The clinical manifestations consisted of rectal bleeding (92%), abdominal pain (76%) and diarrhea (56%). In 3 cases, the ano-perineal lesions observed in Crohn's diseases were noted and, in one case, a pyoderma gangrenosum was present. Endoscopy and/or barium enema showed a lesion of the left colon in 92% of the cases and of the sigmoid colon in 80% of the cases. The prognosis was severe, requiring surgery in 32% of the cases (5 ischemic colitis, 3 cryptogenetic colitis), and a 24% mortality (3 ischemic colitis, 3 ulcerative colitis), secondary to the condition and the extent of the colic involvement. The best factors of the etiological diagnosis of colitis were: the type of onset of the symptoms, the presence of anal or cutaneous lesions, the information provided by endoscopy and histology, which were specific in 11 out of 20 cases. In 5 cases, the diagnosis was only made by examination of the surgical specimen; in 3 cases, the diagnosis remained uncertain. These results suggest that the clinical data combined with an early, minimally traumatizing left endoscopy in elderly patients, should allow a quick, positive and etiological diagnosis of colitis, in order to initiate a suitable treatment in most cases.

Aged↗
PubMed1988

Lymphoid follicular proctitis. A condition different from ulcerative proctitis?

A heterogeneous group is formed by patients presenting with clinical features suggestive of inflammatory bowel disease limited to the rectum and whose rectal biopsies show lymphoid follicular hyperplasia of the mucosa. All these cases are traditionally considered as one variant of chronic ulcerative colitis, so-called ulcerative proctitis. Twenty such cases were critically assessed on clinical, endoscopic, and histologic grounds, as well as on response to treatment and follow-up data. While 11 patients showed clinicopathologic features consistent with typical chronic ulcerative colitis, the other nine patients appeared to form a different group, for which the term "lymphoid follicular proctitis" seemed justified. Lymphoid follicular proctitis was, overall, characterized by rectal bleeding, a congested and granular mucosa without ulceration, abnormal and coalescing hyperplastic lymphoid follicles without acute inflammation, and failure to respond to local steroid therapy. The nature of lymphoid follicular proctitis is uncertain at present but seems unrelated to chronic ulcerative colitis.

Adolescent↗
PubMed1988

[The overwhelmed intestine syndrome].

We studied 54 patients who, after small intestinal resection, developed a massive protracted diarrhea with a daily fecal loss greater than 2 kg, status we defined as the "overwhelmed intestine syndrome" (OIS). Median length of residual small bowel was 120 cm, 19 patients had a definitive stoma (jejunostomy, n = 9; colostomy, n = 10), 26 patients had a provisional jejunostomy. Fecal weight greater than 2 kg was related to enteral hyperalimentation (greater than 3,500 Kcal) in 19 patients (induced OIS) and was clearly independent in 16 others who had fecal weight over 3 kg while receiving approximately 2,000 Kcal (obligatory OIS); the last 19 patients had fecal weight between 2 and 3 kg during normoalimentation. Hypocalcemia and hypomagnesemia were common in the three groups. The other complications were seen mostly in patients with obligatory OIS: in those patients, parenteral nutrition was maintained in 9 cases out of 16 (vs. 0 in other groups), nutritional gain was scanty, sodium equilibrium was difficult to obtain in spite of a large sodium intake (380 mmol/day), hospitalization lasted several months and autonomy via the enteral route could not be achieved in 7 out of the 9 patients with definitive short bowel (vs. 0 in other groups). This study shows that the OIS is an unique functional entity. Complications and prognosis are dependent on the obligatory or induced pattern of the syndrome. Only patients with obligatory OIS require definitive home parenteral nutrition.

Adult↗