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Biomedical subjects

B Moulinier

Publications and source records attributed to B Moulinier.

At least 19 recordsLinked to original sources
PubMed1999

Prospective evaluation of transnasal esophagogastroduodenoscopy: feasibility and study on performance and tolerance.

BACKGROUND: With a pediatric endoscope, esophagogastroduodenoscopy (EGD) can be performed via a nasal route in adults. To evaluate this new procedure, we conducted a randomized comparative study of the feasibility of diagnostic transnasal EGD and assessed the factors influencing its quality and tolerance (endoscope diameter or route). METHODS: Transnasal EGD was attempted in 100 patients to assess its feasibility. For the analysis of quality and tolerance, 150 patients were randomized as follows into 3 groups according to the route of examinations: (1) oral route with 9.8 mm diameter standard videoendoscope; (2) oral route with 6.0 mm diameter pediatric videoendoscope; (3) transnasal route with 6.0 mm diameter pediatric videoendoscope. The operator assessed the quality of examination by standard scores. Patients quantified pain intensity, nausea, and choking sensation. RESULTS: Transnasal EGD was feasible in 82% of patients. The quality of the examination was significantly lower with pediatric endoscope. No difference was noted concerning pain intensity, but nausea and choking sensation were significantly reduced when the nasal route was used. CONCLUSIONS: Transnasal EGD is feasible in the routine practice of diagnostic EGD. The nasal route, and not endoscope diameter (6.0 mm vs 9.8 mm diameter), is the determining factor that explains increased patient tolerance during transnasal EGD. Technical improvements in pediatric videoendoscopes are required.

Adolescent↗
PubMed1993

Five-year survival after transhiatal resection of esophageal carcinoid tumor with a lymph node metastasis.

BACKGROUND: Carcinoid tumors of the esophagus are rare. Most reported cases have had a poor prognosis. The authors report the case of a 64-year-old man with a 4-cm carcinoid tumor of the lower esophagus. METHODS: Following endoscopic resection of an argyrophilic, nonargentaffin, carcinoid tumor of the lower esophagus, endosonography showed residual tumor, suggestive of a metastatic lymph node. The findings were confirmed at transhiatal esophagectomy. RESULTS: No recurrence has been observed along the current 5-year follow-up. CONCLUSIONS: Lymph node metastasis does not rule out the possibility of prolonged survival in esophageal carcinoids. Endosonography is strongly advisable for preoperative evaluation.

Carcinoid Tumor↗
PubMed1993

Mutagens, N-nitroso compounds and their precursors in gastric juice from patients with and without precancerous lesions of the stomach.

This study examined whether elevated risk of gastric cancer is associated with high levels of total N-nitroso compounds (NOC), their precursors and nitrosation-dependent genotoxins in gastric juice (GJ). An improved method for quantifying total NOC was used and genotoxicity was assayed in E. coli. Results from patients (n = 210) with or without precancerous lesions of the stomach and living in three areas with up to 8-fold variations in gastric cancer risk (U.K., France, Colombia) were compared. The level of nitrite (range < 1-472 mumol/l) was found to increase with the pH of GJ from the three countries and was dependent on country of collection. The levels of NOC (range: < or = 0.01-8.0 mumol/l) in GJ were not affected by stomach histology and country of collection. NOC levels increased linearly with nitrite concentrations, but the slope of the regression line was greater for acidic GJ (pH < or = 4). These data together suggest that chemical nitrosation contributes at least as much as other nitrosation pathways to the intragastric formation of NOC. Acid-catalysed nitrosation of GJ in vitro increased the NOC concentration (range: 7-1332 mumol/l) up to several 1000-fold but this increase was not predictive of gastric cancer risk either by country or by stomach histology. After acid-catalysed nitrosation, direct genotoxicity (SOS-inducing potency) was significantly higher in GJ with original pH > 4 and highest in samples from Colombia. The results (a) provide no support that intragastric total NOC levels are elevated in subjects with precancerous stomach lesions or living in a high risk area for stomach cancer; (b) confirm that a high nitrite level and elevated pH in GJ are strongly associated, the level of nitrite being associated with precancerous stomach conditions only in Colombia; (c) reveal the presence of precursor compounds in GJ, that after nitrosation yield direct mutagens that probably contain NOC and other substances. As their concentrations were significantly higher in achlorhydric subjects and highest in Colombian patients, these data together provide support for a role of intragastrically formed nitrite-derived direct mutagens in gastric cancer aetiology.

Adult↗
PubMed1992

[Esophagectomy without thoracotomy for adenocarcinoma in Barrett's esophagus].

From April 1985 to November 1990, 12 patients with adenocarcinoma in a Barrett's esophagus, all of them men, with a median age of 62 years (range, 46 to 79 years), were operated by transhiatal esophagectomy and were submitted to a periodic follow-up. Dysphagia was the main symptom. Preoperative investigations included esogastroscopy and CT-scan of the abdomen and thorax in all patients. Esophageal endosonography was performed in the last 4 cases and MRI in one case. All patients recovered postoperatively and were discharged from hospital. The resected specimens were staged according to Rosenberg et al.'s classification: stage 1, 3 patients, stage 2, 2 patients, stage 3, 6 patients, stage 4, 1 patient. An anastomotic stricture occurred in 4 patients and was treated successfully by endoscopic dilatation. Five patients died during the follow-up period. Seven patients are alive without evidence of recurrence. Transhiatal esophagectomy appears to be the procedure of choice for adenocarcinoma arising from Barrett's esophagus.

Adenocarcinoma↗
PubMed1991

N-nitroso compounds, genotoxins and their precursors in gastric juice from humans with and without precancerous lesions of the stomach.

We are investigating the interrelationships between levels of total N-nitroso compounds (NOC), genotoxic activity (both before and after nitrosation), degree of bacterial colonization in gastric juice and degree of severity or absence of precancerous lesions of the stomach. The mean level of constitutive total NOC in gastric juice was similar in the different groups of patients, but it was higher in acidic gastric juice (n = 30) than in gastric juice at pH greater than 4.5 (n = 12). Acid-catalysed nitrosation of gastric juice in vitro increased the concentration of total NOC by up to several thousand fold, to a maximum of 1330 mumol/l. Genotoxicity, expressed as SOS-inducing potency per 100 microliters of gastric juice was measurable in only 20% of gastric juice samples tested. After acid-catalysed nitrosation, however, all samples showed genotoxic activity, the mean SOS-inducing potency being four to seven times greater than the corresponding constitutive value. There was no association between the mean SOS-inducing potency of gastric juice and the severity of precancerous lesions. The mean SOS-inducing potency of neutral or basic gastric juice was slightly greater than that of acidic samples. In a kinetic study on N-nitrosation of gastric juice in vitro, a mixture of amino and amido substrates was nitrosated; both qualitative and quantitative individual differences in nitrosatable substrates in gastric juice were seen. Fractionation of acidic, neutral and basic nitrosated gastric juice samples revealed a preponderance of nonvolatile, unknown NOC with varying polarities. The results of our study suggest that only pH determines the nature and level of precursors of NOC and of nitrosation-dependent genotoxins in gastric juice.

Adult↗
PubMed1989

Lymphocytic gastritis versus varioliform gastritis. A historical series revisited.

A historical series of varioliform gastritis published in 1978 by Lambert et al. (Digestion 1978; 17: 159-167) was revisited by two pathologists. The histological preparations from 35 patients were reread and interpreted in the light of endoscopic data found in the files. The results demonstrate a strict correlation between clinical diffuse varioliform gastritis and a recently recognized histopathological entity--lymphocytic gastritis, which is characterized by intense lymphocytic infiltration of the surface and foveolar epithelium. The rare discrepancies occur in Crohn's disease and in varioliform gastritis limited to part of the stomach, mostly the antrum.

Crohn Disease↗
PubMed1985

Adenocarcinoma in columnar-lined Barrett's esophagus. Analysis of 13 esophagectomies.

From 1977 to 1982, 13 patients with adenocarcinoma arising in the distal esophagus lined by columnar epithelium underwent esophagectomy with detailed analysis of the pathologic specimen. In three patients, microinvasive carcinoma was detected before dysplasia occurred. In five patients, the ectopic mucosa was discontinuous, prolonged cranially by islands of columnar epithelium scattered in the squamous mucosa. Variable degrees of dysplasia were found in the columnar epithelium in seven specimens in areas of intestinal metaplasia. In four patients with high-grade dysplasia, several foci of intramucosal carcinoma were identified. They were scattered over the whole length of the ectopic mucosa. These data strongly suggest that adenocarcinoma develops from dysplasia, the real premalignant lesion. Careful periodic screening must be carried out in patients identified as having Barrett's esophagus. Dysplasia may be detected and located by endoscopy with dye spraying with directed biopsies. Patients with high-grade dysplasia should undergo esophagectomy with resection of the whole ectopic mucosa because they are at high risk for development of carcinoma.

Adenocarcinoma↗
PubMed1983

Evidence for anaphylactic reactions in peptic ulcer and varioliform gastritis.

The theory of an allergic participation in the pathogenesis of gastric erosions occurring in varioliform gastritis and in peptic ulcer was tested in humans. Biopsies were obtained from the edges of gastric and duodenal ulcers and from the erosion edges of varioliform gastritis as well as from surrounding duodenal, antral and fundic mucosae. Intracellular immunofluorescence staining was used to identify mucosal plasma cells. The lesion edges were characterized by a marked increase of IgE cells. These features justify new therapeutic orientations.

Anaphylaxis↗
PubMed1982

Randomised placebo-controlled double-blind trial of two dosages of sodium cromoglycate in treatment of varioliform gastritis: comparison with cimetidine.

Eighteen patients with diffuse varioliform gastritis were enrolled in a double-blind, placebo-controlled trial of sodium cromoglycate, 200 mg a day, and sodium cromoglycate, 400 mg a day, for 28 days. An additional six patients were treated with cimetidine 1 g daily for 28 days. The improvement in terms of patient's subjective assessment, endoscopic assessment, and immunohistochemical measurements of IgE cells in the mucosa was significantly greater in patients given sodium cromoglycate than that in those given cimetidine or placebo. The results provide evidence that type 1 hypersensitivity plays some part in the pathogenesis of varioliform gastritis. It is, therefore, important to differentiate this condition from other types of gastritis, as treatment with sodium cromoglycate appears to be affective.

Cimetidine↗
PubMed1982

[Superficial gastric cancer. Results of surgery in 30 cases (author's transl)].

Gastrectomy was performed in 30 patients with superficial gastric cancer, equivalent to 12 p. cent of cases operated upon for gastric neoplasms since 1970. Presenting signs were epigastralgia in 19 cases (in 12 cases of the ulcer type), external bleeding from the digestive tract in 4 cases, dyspeptic disorders in 2 cases, and anaemia in one patient. The lesion was asymptomatic in 4 cases, while in 3 patients it was detected by endoscopy after polypectomy or for achlorhydria. In one case the lesion was discovered completely fortuitously. Cancer was suspected by the endoscopist from gross pathological findings in 7 of the 30 cases. An adenocarcinoma was diagnosed after biopsy in 26 cases, and suspected in the remaining 4 patients. Sub-total gastrectomy was employed in 27 cases, total gastrectomy in 2 cases, and extension to a total gastrectomy in one patient. Gross pathology showed cancer of type I : 8 cases, type II (IIa : 1, IIb : 0, IIc : 10) : 11 cases, type III : 6 cases, and mixed types IIc + III : 5 cases. The submucosa was invaded 17 times, the other 13 lesions involving the mucosa only. There were no immediate postoperative deaths. Three patients were not seen again, while 7 died from secondary causes : 5 for reasons unrelated to their cancer and 2 from unknown causes. By applying strict attention to surgical procedures and precise examination of histological data it should be possible to obtain postoperative survivals comparable to those of Japanese series (80 to 90 p. cent at 5 years, 70 p. cent at 10 years).

Adenocarcinoma↗
PubMed1979

Aspirin and gastrointestional bleeding. Interest of plasma salicylate determination.

From history-taking and from analysis of plasma salicylate levels it is shown that a link exists between aspirin and gastrointestinal bleeding in 68% of cases. Salicylate levels alone indicate that aspirin has been taken in 22% of cases. Plasma salicylate measurement and endoscopy allow a better understanding of haemorrhagic lesions due to aspirin. Aspirin is responsible especially for haemorrhage from ulcers and acute gastritis or duodenitis. Aspirin is seen to be dangerous in a moderate number of susceptible individuals: those with peptic ulcer constitution or cirrhosis.

Aspirin↗
PubMed1979

[G2 technic : a simplified procedure of reconstitution of the angle of His, applied to the treatment of hiatus hernia and malposition of the greater tuberosity (242 cases) (author's transl)].

A simple procedure of reconstitution of the angle of His applied to the treatment of hiatus hernia and malposition of the greater tuberosity is reported. Applied to 242 cases, it presents compared with the classical procedure several advantages : easy to carry out, including no complex manoevre, it does not endanger the vagus nerve and maintains firmly the anastomosis. Radiological control and, above all, the clinical results were excellent or good in 96% of cases, suggesting that this new procedure is perfectly valid.

Aged↗