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Biomedical subjects

C Buffet

Publications and source records attributed to C Buffet.

At least 271 records · Page 15Linked to original sources
PubMedDate not supplied

A randomized clinical trial of supplementary parenteral nutrition in jaundiced alcoholic cirrhotic patients.

Between March 1982 and September 1983, 40 inpatients (25 men and 15 women, mean age 53 years) with alcoholic cirrhosis and total serum bilirubin greater than or equal to 5 mg per dl were studied. Those with hepatocellular carcinoma, renal failure, hyponatremia, septicemia, spontaneous bacterial peritonitis, gastrointestinal bleeding, and hepatic coma were excluded. Patients were studied for 28 days. The two groups were offered an oral diet containing 40 kcal per kg per day. Patients in the supplementary parenteral nutrition group received 40 kcal per kg per day and 200 mg nitrogen per kg per day using a central catheter. The major endpoint was total serum bilirubin on Day 28. On admission, serum bilirubin was not significantly different in the two groups: oral group, 12.5 +/- 6.6 mg per dl; supplementary parenteral nutrition group, 12.3 +/- 8.5 mg per dl. On Day 28, serum bilirubin was lower in the supplementary parenteral nutrition group (2.5 +/- 1.4 mg per dl) than in the oral group (4.1 +/- 2.2 mg per dl) (p less than 0.02). Serum bilirubin was also lower in the supplementary parenteral nutrition group than in the oral group on Days 7, 14 and 21 (p less than 0.05). Analysis of covariance, considering serum bilirubin on admission and at randomization and time between admission and randomization, confirmed these results. On Day 28, anthropometric parameters, serum transferrin, prealbumin and retinol-binding protein were higher in the supplementary parenteral nutrition group, but the differences were not significant. Serum albumin was significantly lower in the supplementary parenteral nutrition group. The incidence of encephalopathy and sepsis was not significantly different between the two groups.

Adult↗
PubMedDate not supplied

[Intra-hepatic biliary cystadenocarcinoma].

Biliary cystadenocarcinoma is a rare tumor of the intrahepatic biliary tract, which frequently develops in a preexisting benign biliary cystadenoma. In the present case, diagnosis was difficult because of the lack of specificity of clinical, biological and radiological findings. The correct diagnosis was only achieved by histological examination of the resected lesion. Macroscopically, the right lobe of the liver showed evidence of a whitish, multilolobed, malignant mass of about 6 cm in diameter. Upon light microscopic analysis, cysts were found to be lined with papillary forms. In some areas, epithelial cells were clearly malignant contrasting with persistent non dysplasic areas, suggesting the presence of underlying cystadenomas. Eleven months after complete surgical resection, the patient is in good condition with no evidence of recurrence.

Bile Duct Neoplasms↗
PubMedDate not supplied

[Evaluation of nursing care during treatment of viral hepatitis C by interferon].

OBJECTIVE: Interferon alpha treatment requires parenteral administration and some patients receive injections from nurses. The aim of this study was to evaluate the role of nursing care during ambulatory treatment of hepatitis C by interferon alpha. METHODS: A questionnaire was sent by mail to all nurses who practice ambulatory care in the Val de Marne region (n =545). RESULTS: One hundred fourteen questionnaires were returned (return rate: 20%). Among these nurses, only 42 (37%) were caring for at least 1 patient for the treatment of hepatitis C by interferon. In the 16 months before the survey, these 42 nurses had cared for 135 patients. The nurses cared for the patients throughout the entire treatment in 81% and only to teach them in 19% of cases. The time spent for each injection was 12 min 48 sec, 2 min 42 sec for the injection itself, 3 min 54 sec to answer to patient's questions, 3 min 30 sec for psychological support, and 2 min 48 sec for unspecific time. In relation to hepatitis C and interferon treatment, 74% and 64% of the nurses felt that patients asked questions they did not ask their physician. Seventy seven of the nurses felt they were did not have enough training to answer the questions. Psychological support for the patient was noted as important or very important by 38 % of nurses. CONCLUSIONS: The role of nurses during interferon treatment is not limited to injecting the drug. Advice and psychological support takes up most of the time spent with patients. Specific training and better collaboration with the physician who prescribes the treatment are needed.

Ambulatory Care↗
PubMedDate not supplied

[Gastrointestinal complications of renal transplantation].

Out of a series of 614 renal transplantation performed over a 4-year period, using cyclosporin and cimetidine, 100 patients developed a gastrointestinal complication: 9.6% of gastroduodenal ulcers, 4.4% of intestinal complications, 1.3% of pancreatic complications. 7 patients died: 5 from stress haemorrhages, 2 from peritonitis secondary to intestinal perforation. 32% of patients who developed an ulcer had a history of ulcer, but none of them developed a serious complication of their ulcer under cimetidine treatment. 18% of patients with colonic diverticula developed a diverticular complication after transplantation. The patients who died died from stress haemorrhage generally in a context of sepsis or from peritonitis secondary to intestinal perforation diagnosed after a delay of 24 hours.

Adult↗
PubMedDate not supplied

[Homogeneity of the erythrocyte volume distribution during chronic alcoholism macrocytosis (author's transl)].

The increase in volume of human erythrocytes during chronic alcoholic intoxication and its decrease after alcoholic deprivation was studied with a multichannel analyzer. When fractions of the population of red cells were separated by differential centrifugation the macrocytosis was found to be uniformly distributed. The presence of macrocytes was not related to changes of plasma osmolality or hyperhydration of red cells. A central origin was evoked, however, the role of the folic acid deficiency could not explain the macrocytosis, the mechanism of which remains to be elucidated.

Adult↗
PubMedDate not supplied

[Metabolism and kinetics of ampicillin elimination in cirrhosis. Therapeutical consequences (author's transl)].

In cirrhotic patients, the authors studied the modification of the pharmacokinetics of ampicillin in the plasma and in the ascitic fluid, as well as its concentration in the urine. The influence of the jaundice, the ascites and diuretics were studied. In cirrhosis, dilution and elimination of the antibiotic are modified, as is shown by the increase in T 1/2 alpha and T 1/2 beta. These anomalies seem to be due essentially to modifications in the distribution volume; the degree of hepatocellular insufficiency does not appear to be of importance. The ascites acts as an independent compartment, into which the antibiotic's passage is slight. The practical consequences are the following: less frequent injections, increasing of the fractionated doses, in situ injections of ampicillin in cases of infection of the ascitic liquid.

Ampicillin↗
PubMedDate not supplied

[Bilio-digestive fistulae of lithiasic origin. A report of seventeen cases (author's transl)].

17 spontaneous bilio-digestive fistulae of lithiasic origin have been regrouped for study. 15 cases underwent operation and represent 1.3% of concomitant biliary diseases treated by surgery. The different symptomatic aspects are considered; biliary disorders have been found in 50% of the cases; concurrently, the frequent occurrence of biological cholestasis along with lithiasis of the common bile duct is emphasized. Preoperative diagnosis is usually established on discovery of aerobilia sometimes revealed only by X rays centred on the upper-right quadrant of the abdomen. These fistulae are in most cases cholecystoduodenal. The serious consequences of surgical treatment of biliary lesions and suture of the digestive tract seem to be related to age, usually advanced. Particular study is devoted to endoscopy both towards diagnosis and, in certain cases, therapeutic.

Aged↗
PubMedDate not supplied

[Anti-HBc IgM antibodies: prevalence during HB virus infection and value of studying titers].

IgM antibody to hepatitis B core antigen (IgM anti-HBc) was determined in acute and chronic hepatitis B by the immunocapture method. To avoid interference with the rheumatoid factor, F (ab')2 antibodies were used; non-specific reaction of IgG anti-HBc with anti-mu usually observed with 1/100 dilution of the serum was avoided by 1/1,000 dilution. IgM anti-HBc was positive in 100 p. 100 of the patients with acute hepatitis B (n = 32), in respectively 100 p. 100 and 70 p. 100 of the patients with complete recovery 6 and 12 months after acute illness (n = 10 and n = 10), 20.8 p. 100 of the healthy chronic HBs Ag carriers (n = 48), 80 and 85.7 p. 100 of the patients with chronic persistent and chronic active hepatitis (n = 40 and n = 14). S/N ratios (S = sample, N = negative controls) were above 5 in all patients with acute hepatitis. In patients with complete recovery, 6 to 12 months after acute illness, and in healthy chronic HBs Ag carriers, S/N ratios were above 5 in only 5 and 2 p. 100 of cases respectively whereas in patients with chronic hepatitis, the S/N values were dispersed. The main interest of the IgM anti-HBc test is to allow for the diagnosis between acute hepatitis B and acute hepatitis non B in healthy chronic HBs Ag carriers. In our patients, a S/N ratio above 5 discriminated between an acute hepatitis B and a healthy chronic HBs Ag carrier with a specificity of 98 p. 100.

Carrier State↗
PubMedDate not supplied

[Ascitic pH and infection in alcoholic cirrhosis].

The pH values of 108 samples of ascitic fluid in 94 alcoholic cirrhotic patients were analyzed in order to assess their diagnostic and prognostic value. The mean pH value of ascitic fluid was significantly lower (p less than 0.001) in patients with spontaneous bacterial peritonitis (7.23 +/- 0.22) or with suspected diagnosis of spontaneous bacterial peritonitis (7.29 +/- 0.15) than in patients with sterile ascites (7.45 +/- 0.06). However, there was an important overlap between these groups. In patients with and without spontaneous bacterial peritonitis, measurement of the difference between blood and ascitic pH was more discriminative than the ascitic pH alone: a difference of 0.10 or more was detected in all patients with spontaneous bacterial peritonitis, in 2 of 5 patients with suspected diagnosis of spontaneous bacterial peritonitis and in 3 of 97 patients with sterile ascites. When the ascitic pH value was lower than 7.15, death occurred rapidly. Ascitic pH rapidly increased when treatment of spontaneous bacterial peritonitis was clinically effective. These results suggest that measurement of pH in ascitic fluid is contributive to the diagnosis and prognosis of spontaneous bacterial peritonitis in alcoholic cirrhosis.

Adult↗
PubMedDate not supplied

Celiac artery aneurysm.

Aneurysms of the celiac axis are rare, since only 50 cases were reported in 1976, 14 of which were operated on successfully. We report here the 15th case. This celiac aneurysm involved the origin of the splenic left gastric and common hepatic arteries. After controlling the aorta by a thoraco-phrenolaparotomy, the celiac artery was ligated at its origin, the anterior wall of the aneurysm was incised and the splenic and the left gastric arteries ligated by an obliterative endoaneurysmorrhaphy. The hepatic vascularization was restored from the gastroduodenal artery with a restorative endoaneurysmorrhaphy. The control arteriogram showed a good arterial revascularization.

Aneurysm↗
PubMedDate not supplied

[Treatment of hepatocellular carcinoma in the presence of liver cirrhosis].

Hepatocellular carcinoma accounts for 90% of the primary malignant liver tumours. Most cases occur in cirrhotic livers. Management decisions should not be based on the stage of the tumour extension but rather on the functional situation of the liver. The first therapeutic option which should be considered is surgical resection if the case presents with a single tumour (or less than 4 tumours for some teams) without detectable metastasis nor intraportal thrombosis and if the liver remaining after surgery will be sufficient for normal hepatic functions. The disadvantage of resection is the high risk of recurrence in the long term. Liver transplantation cannot be proposed if the hepatocellular carcinoma has produced clinical signs but it can be a possibility in case of a resectable tumour in the framework of a prospective protocol comparing transplantation and resection. Intra-arterial injection of 131-iodine linked lipiodol is the only effective treatment in case of portal thrombosis. Chemoembolization of nonresectable hepatocellular carcinoma has led to spectacular tumour response but its effect on survival has not been demonstrated by randomized studies. For tumours less than 3 cm in diameter, even multifocal alcoholization has proved encouraging results. Although a randomized study of questionable quality suggested tamoxifen could be effective, there is no current indication for this drug. External radiotherapy may be a possibility in the future, especially with proton irradiation. Thus the current management of hepatocellular carcinoma is in a difficult, even paradoxical, situation since there is a wide therapeutic choice (resection, alcoholization, transplantation) for the rare cases with small tumours but almost no possibilities for the more severe cases most frequently encountered.

Adult↗