[Vascular purpura and cryoglobulinémia: the difficulties of pharmacovigilance].
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Biomedical subjects
Publications and source records attributed to C Caulin.
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PURPOSE: We propose a noninvasive method for the measurement of orocecal transit time assessed by the sulfapyridine appearance time in saliva after ingestion of sulfasalazine. METHOD: In 12 healthy volunteers, we studied the correlation between plasma and saliva sulfapyridine appearance times and then the sulfapyridine appearance times in saliva under various experimental conditions to assess the reproducibility, the effects of meals, and the role of the formulation, and the effects of gastrointestinal kinetic drugs. RESULTS: The correlation between saliva and plasma sulfapyridine appearance times was strong (r = 0.84; p = 0.0004). The sulfapyridine saliva appearance time was significantly delayed by the meal. Compared with placebo, the saliva sulfapyridine appearance time was reduced by cisapride (312 +/- 128 versus 551 +/- 97 minutes; p = 0.0001) and increased by loperamide (674 +/- 267 versus 501 +/- 131 minutes; p = 0.044). CONCLUSION: We propose the salivary sample method as a validated simplification of the plasma sulfasalazine-sulfapyridine test for the measurement of orocecal transit time.
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The prevalence of HIV infection was assessed among 15,611 consecutive patients attending a Parisian anonymous testing center from April 1988 to June 1993. Sera (17,910) were tested for the presence of anti-HIV antibodies using two different enzyme-linked immunosorbent assays. Seropositivity was verified by Western blotting. The sera were also assayed for HIV antigenemia detection in 2,493 cases. Six hundred and seventy-seven patients were found to be anti-HIV antibody positive: among them 666 were infected by HIV-1 and only 11 by HIV-2. Antigenemia was detected in 108 samples (4.3%). In all cases but 5, antigenemia was associated with the presence of specific antibodies. Risk factors for HIV infection could be determined for 5,735 patients. The HIV prevalence rates were 5.2% in 1988-89, 4.9% in 1990, 3.4% in 1991, 2.8% in 1992 and 1.8% for the 6 first months of 1993 (p < 0.01). Only one patient was coinfected with HTLV-1. This study shows a trend of decreasing seropositivity rates among the patients attending the anonymous testing center since 1990. By contrast, the percentage of seropositive patients with antigenemia was stable between 1988 and 1993.
The results of 30 months of activity of anonymous and free-of-charge HIV detection centres in Paris hospitals are presented. During this period (April 1988 to December 1990), 15805 subjects were seen. This population accounts for about 11 percent of all French anonymous and free detection centres in 1990, and for 26 percent of the number of subjects consulting in detection centres of the same type. Risk factors could be listed in 8132 consulting subjects: 73 percent were heterosexuals and not drug-addicts; 19.5 percent were homo- or bisexuals; 6 percent were drug-addicts; 0.6 percent were both homosexuals and drug-addicts; 29 percent of the 7806 persons questioned about their use of condoms stated that they used them often or always. A total of 15271 blood samples were taken. The percentage of seropositivity was 4.73 percent with a significant fall from 5.87 percent in 1988 to 4.38 percent in 1990; 23.4 percent of homosexual drug-addicts, 17.6 percent of heterosexual drug-addicts, 9.3 percent of homo- or bisexuals and 1.3 percent of heterosexuals were seropositive. In the seropositive population, 46.4 percent were homo- or bisexuals, 29.8 percent were drug-addicts, 19.7 percent were heterosexuals and 3.7 percent were homosexual drug-addicts. Three subjects had been contaminated by blood transfusion. The percentage of seropositive subjects in our study was superior to the mean found in other anonymous and free detection centres (4.73 percent versus 3 percent in 1990), this probably reflecting the high prevalence of the infection in the Paris region. The seropositive subjects usually belonged to the categories primarily affected by the HIV. The percentage of seropositivity in our drug-addicts (17.6 percent) was much lower than that usually reported in French drug-addicts (30 to 40 percent).
Non-steroidal anti-inflammatory drugs (NSAIDs) are estimated to be excessively prescribed. We have prospectively collected all drug prescriptions written by 50 doctors in an Outpatient Service, during a 5-day period. The purpose of this study was to draw the outline of NSAID prescriptors. Junior doctors (66%) wrote more controversial NSAID prescriptions (66%) than other doctors.
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In order to obtain information on prescribing habits concerning the prevention of gastroduodenal lesions induced by non-steroidal anti-inflammatory agents (NSAI), 356 physicians practicing in 2 French departments were asked to fill a posted questionnaire. Fifty-one percent of these doctors gave an assessable answer. Among these, 84 percent occasionally prescribe "gastric protectors" associated with NSAI's in 32 percent of the prescriptions. They use antacids (48 percent), anti-H2 products (27 percent), sucralfate (11 percent) or prostaglandins (13 percent). This represents a daily cost of additional treatment ranging from 0.87 to 2.49 francs. If fibroscopies and further consultations necessitated by the prescription of NSAI's are taken into account, then 86 to 140 percent must be added to the cost of NSAI's. The profitability of these preventive measures in terms of public health will be really estimated only when the number of severe gastroduodenal lesions effectively prevented by taking topical gastric protectors or anti-secretory agents will be known.
Endoscopic lesions of the gastric mucosa were evaluated in 12 healthy volunteers after administration of single doses of ketoprofen (25 mg), ibuprofen (200 mg) and aspirin (500 mg) in a randomized, double-blind, cross-over study. The grades of the lesions (according to Lanza's scale) were lower after the administration of ketoprofen than aspirin and were comparable to ibuprofen. An endoscopic score greater than 1 was observed in 3 cases after ibuprofen or ketoprofen, and in 8 cases after aspirin. At a time when low, single doses of NSAIDs are widely used as analgesics, gastroscopy makes it possible directly to assess the local aggressivity of these molecules. In this way it was possible to demonstrate that the local toxicity of NSAIDs was lower than that of aspirin.
The effect of omeprazole treatment on theophylline pharmacokinetics was studied in eight, non-smoking healthy male volunteers during repeated administration of a slow release formulation of theophylline. In a randomized double-blind cross-over study, the subjects received theophylline 5 mg.kg-1 per day with omeprazole 20 mg per day or identical placebo during two periods, each of 7 days, separated by a washout period of 7 days. The oral clearance of theophylline remained unchanged whether it was administered alone or with omeprazole (54.2 ml.min-1). The average urinary excretion of theophylline and its metabolites, 1,3 dimethyluric acid (1,3-DMU), 3-methylxanthine (3-MX), 1-methyluric acid (1-MU) amounted to 9%, 32%, 12% and 22% of the administered dose, respectively, and no significant change occurred during concomitant treatment with omeprazole. Thus, the formation and clearance of the metabolites was not altered by omeprazole. Consequently, omeprazole in the recommended dose of 20 mg daily can safely be administered to patients on theophylline therapy.
The aim of the study was to use a novel combination of two methods for the simultaneous evaluation of two effects of oral cisapride in 10 diabetic patients with autonomic neuropathy; gastric empyting time was measured by following radio-opaque markers and orocaecal transit time by the sulphasalazine-sulphapridine method. The study was of double-blind, randomized, placebo-controlled, cross-over design. It was possible to evaluate the effect of a prokinetic drug on gastric emptying and orocaecal transit times using these two noninvasive techniques at the same time. Cisapride significantly reduced both the gastric empyting (1.2 h versus 2.1 h) and orocaecal tansit (5.9 h versus 7.7 h) times.
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The protective effect of lansoprazole, a new proton pump inhibitor, against aspirin-induced gastric lesions was studied in a double-blind crossover trial with a simultaneous measure of the functional capacities of the mucosal barrier (by a recording of the gastric potential difference) and of the morphologic changes in the mucosa (by gastric endoscopy). After 1 week of treatment with lansoprazole (30 mg per day) or placebo, each healthy volunteer received 1 gm aspirin by mouth. Recording of the gastric potential difference lasted for 3 hours and was followed by gastric endoscopy. Morphologic lesions induced by aspirin were effectively prevented by lansoprazole: Lanza score was 0.67 +/- 0.98 (mean +/- SD) versus 2.25 +/- 1.1 with placebo (p < 0.005, ANOVA). Conversely, the decrease in the gastric potential difference was similar. The inhibition of acid secretion induced by lansoprazole was therefore sufficient to prevent aspirin-induced mucosal lesions without reinforcing the defense capacities of the mucosa. This simple pharmacologic model makes it possible to simultaneously evaluate the functional and morphologic effects of aspirin intake on the gastric mucosa.
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The correlation between ultrasonographic gastric emptying and appetite was studied. Echographic evaluation of gastric emptying by measurement of the antral vertical diameter and assessment of sensations of hunger and satiety using analogue visual scales were performed simultaneously in 12 healthy volunteers. Measurements were carried out after the intake of 10.8 g psyllium or placebo in a randomised, crossover, double blind trial. The correlation between echographic gastric emptying and sensations of hunger and satiety was excellent (p < 0.001) after the intake of either psyllium or placebo. Psyllium significantly delayed gastric emptying from the third hour after a meal. It increased the sensation of satiety and decreased hunger at the sixth hour after the meal. The association between echographic measurement and visual scales is a simple method of evaluating the relationship between the stomach and appetite. The pharmacodynamic effect of psyllium should be confirmed by longterm therapeutic trials.