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Biomedical subjects

C Molinié

Publications and source records attributed to C Molinié.

At least 19 recordsLinked to original sources

[Diabetic autonomic gastric neuropathy: contribution of the electrogastrogram].

OBJECTIVE: The aim of this study was to characterize the features of vegetative gastric neuropathy observed in diabetic patients based on surface electrogastrographic recordings. PATIENTS AND METHODS: An electrogastrogram was recorded over an 8 hour 30 minute period in 63 patients with asymptomatic insulin-dependent diabetes and in 15 non-diabetic controls. Normal the electrical frequency of the stomach is 2 to 4 cycles per minute (cpm). Bradygastria is defined as a frequency below 2 cpm and tachygastria by a frequency above 4 cpm. RESULTS: The diabetic patients showed a below normal gastric frequency and enhanced tachygastria over the entire recording period and during the pre, per and post-prandial periods. These vagal alterations were not correlated with the principle features of diabetes. CONCLUSION: Electrogastrography confirms that vegetative gastric neuropathy occurs early in patients with asymptomatic insulin-dependent diabetes. The tachygastria could lead to the increased rate of gastroparesis reported in these patients.

Adult

[Value of magnetic resonance cholangiography in the diagnosis of common bile duct cystic dilation].

BACKGROUND: Magnetic resonance cholangiography is a noninvasive method for exploring the biliary and pancreatic ducts. Allergic risk is reduced as no contrast agent is required and there is no risk of infectious contamination due to catheterism. Unlike endoscopic retrograde cholangiography which requires anesthesia, there is no risk of morbidity. We report one observation of Todani type Ia cystic dilation of the main bile duct explored preoperatively with MR-cholangiography. CASE REPORT: A 39-year-old woman complained of acute abdominal pain. Physical examination revealed jaundice and fever. MR-cholangiography gave the diagnosis of angiocholitis with cystic dilatation of the main bile duct (type Ia). Surgery was indicated. The procedure included a Y-loop hepato-jejunal anastomosis and cholecystectomy. The postoperative period was uneventful. Pathology reported a cystic formation with no signs of malignancy. DISCUSSION: Common manifestations of congenital cystic dilatation of the main bile duct are biliary pain, fever and jaundice. The MR-cholangiogram provides a map of the bile duct system directly with a noninvasive procedure. The map may be obtained in several planes to guide surgery. Indeed, since cholangiocarcinoma is found in numerous cases, surgery is a formal indication in patients with angiocholitis.

Abdominal Pain

[Viral hepatitis A with prolonged course in adults].

OBJECTIVE: The aim of this study was to determine the clinical and virological characteristics of patients with type A viral hepatitis and a protracted course. METHODS: Twenty-seven patients with hepatitis A virus and elevated serum ALT levels for more than 6 months were studied. Patients were tested for hepatitis C and E virus using conserved serums. RESULTS: A biological relapse was defined by a decrease of the serum ALT levels > or = 50% followed by a > or = 50% increase in the minimal value. Biological relapses occurred in all patients. The median time between the onset of the disease and the first relapse was 87 days. During relapse, jaundice and ascites were present in five and one patients, respectively. All patients recovered. Serum aminotransferase activities returned to the normal range in a median of 230 days. None of the 17 tested patients had hepatitis C virus antibodies. Sixteen patients were tested for hepatitis E virus antibodies; 8 were positive for IgG and one for IgM. Sixteen control patients with acute hepatitis A of short duration, matched for date and country of contamination, were also tested for antibodies to hepatitis E virus; 11 were positive for IgG and none for IgM. CONCLUSION: A protracted course of type A viral hepatitis is characterised by relapses with or without symptoms. The high frequency of a positive test for hepatitis E IgG associated with a negative test for IgM in patients with and without a protracted course does not suggest that hepatitis E virus plays a role in patients with a protracted course. These positive results might be due to either false positive results or to past contamination.

Adult

[Viral hepatitis E].

Thanks to progress in serologic techniques evidence was obtained in 1980 showing that acute hepatitis epidemics observed in India were due to neither virus A nor virus B. The presence of another virus was confirmed and its genome was cloned and sequenced in 1991. Hepatitis virus E is a small RNA virus that differs from other known human viruses. Man and probably a few animal species maintain dissemination by the fecal route. Subjects not previously contaminated are susceptible and produce protective antibodies. Contamination occurs by the fecal-oral route general from water or tainted food. Direct contamination is rare. Vertical transmission from mother to fetus can also be observed. Outbreaks of the disease are characterized by epidemic proportions, preferential involvement of adolescent and young adults, and high incidence of fulminant cases especially in pregnant women. Outbreaks have been observed in endemic settings in southern Asia, Africa, and Mexico where sporadic cases are observed. Endemic areas are found in all developing countries. Hepatitis E is not clinically different from other acute viral hepatitis. Asymptomatic forms are common especially in children. The course of the disease is usually benign with little risk of development of chronic symptoms and cirrhosis. However hepatitis E is associated with a high incidence of severe cases with a mortality of 1 to 2% from icteric forms which occur in 15 to 20% of cases involving women contaminated during the last three months of pregnancy. Diagnosis can be made using either synthetic proteins or recombinant peptides. for the epitopes of the virus. Prevention depends on protection of the water supply and proper sewage disposal. Successful active immunization of monkeys holds promise for development of a vaccine. Due to its magnitude and high mortality rate hepatitis E is a major health problem for numerous regions around the world including Southeast Asia.

Adolescent

Mapping of linear B cell epitopes on open reading frames 2- and 3-encoded proteins of hepatitis E virus using synthetic peptides.

Hepatitis E virus (HEV) is the causative agent of non-A, non-B hepatitis which is transmitted by the fecal-oral route and occurs principally in the form of large epidemics and outbreaks in developing countries. Two overlapping synthetic peptides corresponding to overlapping DNA sequences of the ORF 3 of HEV genome were found to be immunoreactive with sera from patients involved in two epidemics of enterically transmitted non-A, non-B hepatitis. The results suggested the existence of two distinct epitopes. The four synthetic peptides representing these two epitopes from Burma and Mexico strains of hepatitis E virus, were used to investigate anti-HEV reactivities. HEV antibodies were detected in 84-88% of HEV-infected individuals according to the peptide used. The results suggest that a peptide-based ELISA can provide an accurate tool for the diagnosis of acute hepatitis type E.

Amino Acid Sequence

Hepatitis E and hepatitis C virus infections among French soldiers with non-A, non-B hepatitis.

Serologic markers of HCV and HEV were investigated in 74 French soldiers with non-A, non-B hepatitis and in 18 patients involved in an outbreak of non-A,non-B hepatitis in Algeria. Moreover, anti-HCV antibodies were detected in 13 patients with non-A,non-B hepatitis of parenteral origin. HEV antibodies were investigated in 61-65% of patients involved in the 2 enterically transmitted outbreaks of non-A,non-B hepatitis observed in Algeria and Chad. The third cluster of non-A,non-B hepatitis observed in French soldiers serving in French Guyana is more likely to be attributed to malaria prophylactic treatment with Amodiaquine than to a viral origin. HCV infection was observed in 93% of acute or chronic cases associated with blood transfusion or parenteral drug abuse. Among acute cases, none of the soldiers who contracted the disease in Africa or in French Guyana was found to be anti-HCV positive compared to 78% of those who contracted the disease in France. HCV infections resulted in chronic hepatitis in 61% of cases.

Adult

Hepatitis B surface antigen reactivity in man due to a new variant of hepatitis B virus.

A new type of hepatitis B virus (HBV) infection has been encountered in Senegalese infants and French adults characterized by serum hepatitis B surface antigen (HBsAg) without antibodies to the core antigen (anti-HBc). As the infection is not associated with the presence of the e antigen, it differs from HBV in its core antigen. After the loss of HBsAg, neither anti-HBc nor antibodies to HBsAg (anti-HBs) become detectable. This new infection (called HBV2 as opposed to the classical HBV1 infection) was found in infants with anti-HBs, either naturally acquired or produced by immunization against HBV. The use of monoclonal anti-HBs antibodies showed that two epitopes of HBV1 surface antigen could be detected in HBV2-positive sera. HBV DNA sequences could only be found in one of 15 HBV2-infected children using a DNA-DNA hybridization procedure; low levels of HBV DNA were also detected in 58% of the HBsAg-positive adult sera tested. If this new infection, apparently related to HBV1, is shown to cause chronic liver disease, hepatitis B vaccine should also contain surface antigen from HBV2.

Adult

[Markers of viral hepatitis B and D and levels of alanine aminotransferase in military blood donors: a profile of 30,000 blood donations in 1989].

Serologic data for B and D viral hepatitis are studied on 30,000 military blood donors. Because of legal norms of blood products for transfusion 761 donations (2.53% have been destroyed). Exclusion criteria for viral B hepatitis and ALT are independent. In this study the prevalency of HBV infections is significantly lower than for other blood centers: probably in account of the young age of military blood donors.

Adult

[Acute icteric viral hepatitis type A, B, D and non-A non-B. Etiologic, clinical and developmental aspects in the young man. Apropos of 423 cases].

In the light of the present serological tests, the etiology, clinical features and course of acute viral hepatitis were reviewed in 423 consecutive male patients. Follow-up started less than 15 days after the onset of jaundice and continued until recovery or for at least six months if recovery did not occur before them. The incidence of type A viral hepatitis decreased in France but remained high in North Africa and tropical areas. During the acute phase it differed from hepatitis type B by a lower aminotransferase level. Relapse, however, was more common, as was protraction of longer than six months. Recovery ultimately occurred. The specific IgM antibody persisted throughout the condition. Type B hepatitis differed from type A hepatitis by a mean quicker normalization of the biochemical disturbances. In the absence of superinfection by delta hepatitis virus or by a non-A, non-B virus, the progression to chronic liver disease was rare. The course of non-A, non-B hepatitis was very dissimilar according to the circumstances of occurrence. In epidemic cases rapid recovery occurred and no progression to chronicity was noted. In the other cases, relapse and chronicity were more frequent than for type A or B hepatitis. Type D hepatitis was characterized by more pronounced biochemical disturbances during the acute phase and by more frequent progression to chronicity in case of superinfection.

Acute Disease

[Colonic cancer. Indications and results apropos of a continuous series of 223 patients].

The authors report a retrospective study of 223 surgical colonic carcinoma (1978-1987), the rectal carcinoma left out of them because of disparity in technical aspects. The total post-operative mortality rate was 9.4 per cent, made of great mortality in emergency (31 per cent) and in palliative surgery (17 per cent). Out of emergency, the mortality of curative surgery is 3.7 per cent. Surgical procedure was mechanical in 96 per cent with incidence of leakage in 3.9 per cent. The total survival rate is 53 per cent after 5 year follow-up, 70 per cent after curative surgery and 89 per cent for the first level (A) in DUKE'S classification. There is only a problem for the choice in size of resection for the sigmoid side (50 per cent of the cases). Contrary to recent studies, in our experience the post-operative mortality rate and survival rate are different with sigmoidectomy or left colectomy. Then the authors think that every model of resection has to be choice according age of patient and classification of carcinoma.

Adenocarcinoma

[Hepatic amebiasis: study of 152 cases].

The purpose of this study was to describe and analyse retrospectively the clinical, serological, anatomical and evolutive features of 152 cases of hepatic amebiasis in young adults, treated and followed up in France from 1969 to 1983. The disease was revealed 3 times out of 4 by tender hepatomegaly with fever, but only in 6 cases by complications. Serological tests (immunofluorescence or hemagglutination) were always positive for amebiasis, whereas Entamoeba histolytica was absent from stools in 96.7 p. 100 of the cases. Hepatic amebiasis always caused a hepatic abscess: in these cases, the superiority of ultrasonography over all other diagnostic methods was confirmed, especially concerning the detection of multiple abscesses (47 p. 100). Complete recovery was obtained by medical treatment in 117 cases, either alone (98 cases), or combined with needle aspiration (19 cases). Nitro-imidazoles are the simplest treatment, but nevertheless in 5 cases they were not effective. These patients were then treated with dehydroemetine, associated in 2 cases with surgery. Four patients relapsed at mid or long-term after apparent recovery, in the absence of any obvious reinfection. A significant correlation between the course of the treated disease and the size and number of abscesses was demonstrated: it was possible to define a group characterized by a slow and/or complicated course (with single abscess of the right lobe whose diameter is equal to or greater than 10 cm, or multiple abscesses). The pathogenesis of hepatic amebiasis is not yet fully understood.

Adult