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Biomedical subjects

D Urbain

Publications and source records attributed to D Urbain.

At least 37 records · Page 2Linked to original sources
PubMed2000

Intragastric balloons for preoperative weight reduction.

BACKGROUND: If medical treatment of obesity fails and if surgical gastroplasty is not indicated, insertion of an intragastric balloon may represent an intermediate modality. METHODS: Two patients are reported in whom a balloon was placed for weight reduction before elective surgery: 1) A 53-year-old woman with a BMI of 41.3 kg/m2 lost 18 kg in 6 months and then underwent surgical repair of a huge incisional hernia; 2) A 58-year-old woman with a BMI of 35.8 kg/m2 had total hip arthroplasty after losing 15.5 kg in 5 months. RESULTS: The uneventful postoperative recovery in both patients was thought to be positively influenced by their preoperative weight loss. CONCLUSION: In morbidly obese patients, intragastric balloon placement may contribute to preoperative weight reduction before elective surgery.

Female↗
PubMed1999

Chronic pancreatic alterations in AIDS patients.

Patients with acquired immunodeficiency syndrome (AIDS) can develop biliary and pancreatic disorders, like sclerosing cholangitis and acute pancreatitis. Chronic pancreatic changes are rare and only poorly described. In this study, we report our endoscopic retrograde cholangiopancreatography (ERCP) findings in 20 patients with AIDS, focusing on pancreatographic changes. ERCP findings from 20 patients with advanced disease were analyzed. Patients with history of chronic alcoholism were ruled out. ERCP findings were correlated to the coexistence of an opportunistic infection and the taking of antiviral therapies. Bile duct and pancreatic duct abnormalities were observed in 11 (55%) of 20 and seven (37%) of 19 patients, respectively. Bile duct lesions were mainly sclerosing cholangitis, and chronic pancreatic alterations consisted of side-branch involvement (n = 4), multiple and diffuse strictures of the main duct (n = 1), and diffuse dilatation of the main pancreatic duct (n = 2). The presence of an opportunistic infection was correlated with sclerosing cholangitis but not with chronic pancreatic changes. Similarly, there was no association between the finding of an abnormal cholangiogram and the presence of pancreatic alterations. This population of patients with AIDS had a significant proportion (37%) of chronic pancreatic ductal changes, which do not seem to be related to morphologic alterations and/or opportunistic infections of the biliary tract.

AIDS-Related Opportunistic Infections↗
PubMed1998

Persistent T cell and B cell activities in the duodenal mucosa of AIDS patients.

OBJECTIVE: As HIV infection most commonly occurs via a mucosal surface, and as gastrointestinal symptoms are very frequent among HIV-infected patients, we investigated the functional properties of residual lymphocytes in the duodenal mucosa from HIV-infected individuals. DESIGN: Duodenal biopsies and blood samples were obtained from 19 HIV-infected patients [Centers for Disease Control and Prevention (CDC) stage III] and from 19 controls. METHODS: Phenotypic analysis of lymphocytes was performed by flow cytometry and/or immunocytochemistry. Interferon gamma (IFN-gamma), interleukin (IL) 4 and immunoglobulin secretions were analysed by enzyme-linked immunospot techniques. The phenotype of cytokine-producing cells was analysed by flow cytometry. RESULTS: The proportions of duodenal T lymphocytes from HIV-infected patients spontaneously secreting IFN-gamma or IL-4 were not lower than those from healthy controls. In patients with a high intestinal mucosal viral load, they were higher than in controls (P < 0.05). The proportions of immunoglobulin-secreting cells were significantly raised in HIV-infected patients for the three main isotypes. CONCLUSIONS: T- and B-cell populations of the intestinal mucosa remain functional or are even activated in patients with AIDS, even when the numbers of both mucosal and circulating CD4+ lymphocytes are strongly decreased.

Adult↗
PubMed1995

Aminopyrine breath test improves long-term prognostic evaluation in patients with alcoholic cirrhosis in Child classes A and B.

In a 4-year survival study, we evaluated the prognostic value of the aminopyrine breath test and the Child-Turcotte-Pugh score in 190 alcoholic patients. Using aminopyrine breath test results, the patients were stratified into group 1 (aminopyrine breath test > 2%), group 2 (1% < or = aminopyrine breath test < 2%) and group 3 (aminopyrine breath test < 1%). Survival rates at 4 years were 68% in group 1, 35% in group 2 and 17% in group 3. Using the Child-Turcotte-Pugh score, survival rates at 4 years were 67% in Child-Turcotte-Pugh class A, 40% in class B and 7% in class C. To assess the value of aminopyrine breath test as an adjunct to Child-Turcotte-Pugh score in prognostic evaluation of patients with cirrhosis, two approaches have been used: a regression analysis using Cox's proportional hazard model by including the Child-Turcotte-Pugh score and aminopyrine breath test value, and the log-rank test to assess the prognostic value of aminopyrine breath test in each Child-Turcotte-Pugh class separately. The regression analysis showed that both parameters, the Child-Turcotte-Pugh score and the aminopyrine breath test results, were accepted in the model, suggesting that the aminopyrine breath test was still significantly related to survival once the Child-Turcotte-Pugh score had been entered into the model. Analysis of the prognostic value of the aminopyrine breath test in each Child-Turcotte-Pugh class separately indicated, however, that the contribution was negligible in the Child-Turcotte-Pugh class C.(ABSTRACT TRUNCATED AT 250 WORDS)

Aminopyrine↗
PubMed1995

A radionuclide study of regional gastric motility.

The aims of this research were to study some methodological aspects of radionuclide methods for assessing regional gastric motility and to determine the parameters that can be extracted along with their normal values or patterns. During the lag phase, the antral contraction curve showed three different patterns. At the beginning, the antral activity was too low to be analysed. Irregular variation of the count rate was then observed, followed by a more regular contraction. The application of Fourier transformation to the well-defined cyclical count rate variations revealed two areas with high amplitude values but with phase opposition. No peristaltic wave could be identified. After the lag phase, the antral curve showed cyclical variations of count rates with a frequency of about three cycles per minute. Slightly displaced curves but with a much lower amplitude were observed at different parts of the stomach. Several factors were found to influence the antral contraction curve, including the choice of region of interest and time since the last meal. Irregularities in the antral curve, both in terms of frequency and of amplitude, were not unusual in healthy subjects. These should be taken into account when interpreting antral contraction curves. The phase image showed a well-defined peristaltic contraction pattern. Three 360 degrees cycles were usually observed throughout the stomach, suggesting that the time necessary for a peristaltic wave to sweep through from the upper part of the stomach to the antrum is about 1 min. Similar phase images were obtained in all subjects regardless of the amount of time since the meal containing the radioactive tracer, suggesting that gastric peristalsis can easily be assessed and interpreted. The amplitude image showed high amplitude in the antral area and in the greater curvature of the stomach. In the lesser curvature, the amplitude was much lower. Unlike the phase image, however, there was marked variability in the regional amplitude distribution. The value of the regional amplitude distribution for evaluating regional gastric motility is therefore limited.

Adult↗
PubMed1995

Thallium-201 per rectal scintigraphy improves prognostic evaluation in alcoholic liver cirrhosis of low and mid severity.

OBJECTIVES: The aim of this work was to assess the contribution of thallium-201 chloride (Tl-201) per rectal scintigraphy in long term prognostic evaluation of alcoholic, cirrhotic patients. METHODS: The data obtained from 170 biopsy-proven cirrhotic patients have been used in this 4-yr survival study. The severity of the liver disease was assessed by using the classic Child-Turcotte score as modified by Pugh (CTP score). RESULTS: In patients belonging to CTP class A and CTP class B, the Tl-201 test allowed the identification of subgroups with different survival rates. In these two classes of patients, the Tl-201 per rectal scintigraphy could be used for improving prognostic evaluation. In patients of class C on the other hand, 4-yr survival rates were very low, and the Tl-201 test did not bring significant additional prognostic information. CONCLUSIONS: Therefore, we suggest performing the Tl-201 test in cirrhotic patients of classes A and B as defined by the CTP score.

Case-Control Studies↗
PubMed1994

Esophageal transit of liquid in chronic alcoholism in patients with cirrhosis. Influence of esophageal varices.

Disturbances of esophageal motility are often encountered in chronic alcoholism, and numerous physiopathologic mechanisms responsible for this alteration have been documented. The exact role of esophageal varices, however, in inducing esophageal transit abnormalities remains unclear. In this study using scintigraphy, the authors studied esophageal transit in a large number of patients with cirrhosis to assess the direct effect of esophageal varices. Esophageal transit was found altered in 58 out of 141 patients with cirrhosis (41.1%). It was prolonged in 47.3% of patients with esophageal varices and in 29.2% of patients without varices (P < 0.05). The frequency of esophageal transit alteration was also related to the Child-Turcotte-Pugh (CTP) score, an index of the severity of liver disease (P < 0.01). The relationship between CTP class and transit alteration remained statistically significant in the group of patients with esophageal varices (P < 0.05). Conversely, when patients in each CTP class were analyzed separately, the frequency of esophageal transit abnormalities was not different in patients with and without esophageal varices. These results suggest that the severity of cirrhosis, rather than the presence of esophageal varices, constitutes the major factor in inducing esophageal transit alteration in patients with cirrhosis.

Adult↗
PubMed1994

Prognostic value of thallium-201 per rectum scintigraphy in alcoholic cirrhosis.

METHODS: In a 4-yr survival study, the prognostic value of the inferior mesenteric shunt, as evaluated by 201Tl per rectum scintigraphy, was assessed in 170 alcoholic cirrhotic patients. The global severity of the hepatic disease was assessed by the Child score, and specific hepatocellular function was evaluated by the aminopyrine breath test. Using 201Tl scintigraphy, three groups were considered: group I, heart-liver activities ratio (H/L ratio) < or = 0.5, n = 55; group II, H/L between 0.5 and 0.85, n = 50; and group III, H/L > 0.85, n = 65. RESULTS: The 4-yr survival rates in the three groups were 76%, 36% and 18%, respectively. The log-rank test showed that the differences between the groups were statistically significant. Regression analysis using Cox's proportional-hazards model showed that the three parameters, Child score, aminopyrine breath test results and H/L ratio were significantly related to survival. CONCLUSION: The inferior mesenteric shunt per se has a prognostic value in alcoholic cirrhosis. Moreover, the H/L ratio provides additional information on survival after the Child score and the aminopyrine breath test results have been taken into account.

Administration, Rectal↗
PubMed1993

Physiopathological significance of thallium-201 per rectum scintigraphy in liver cirrhosis.

To define the physiopathological significance of 201Tl per rectum scintigraphy, we compared results obtained using this method with direct measurement of inferior mesenteric shunting, portal pressure, liver cellular function as evaluated by the Aminopyrine Breath Test and the size of esophagogastric varices and spleen, constituting, respectively, indirect representation of azygos and splenic shunts. Results indicated that a high correlation exists between the measures of portal systemic shunt estimated by the per rectal method and those obtained by direct administration of the tracer in the inferior mesenteric artery. No correlation was observed between 201Tl per rectal results and portal pressure or with azygos and splenic shunting. Fair correlation was observed with the Aminopyrine Breath Test. This could be explained by the fact that both methods are altered in advanced liver disease. These results suggest that the 201Tl per rectal scintigraphy explores the portal systemic shunt, which depends almost exclusively on the inferior mesenteric territory. While the limited territory explored by the method constitutes, undoubtedly, a limiting factor in detection and quantitation of total portal-systemic shunt, the specific information provided by the test could be useful in defining clinical and biological profiles of cirrhotic patients with inferior mesenteric shunting.

Adult↗
PubMed1993

Prognostic significance of hepatic venous pressure gradient in medically treated alcoholic cirrhosis: comparison to aminopyrine breath test.

In a long-term survival study, we compared the prognostic significance of the hepatic venous pressure gradient and of the aminopyrine breath test (ABT) in 99 alcoholic cirrhotic patients. Thirty patients survived and had a complete follow-up for at least 4 yr. Mean hepatic venous pressure gradient was 19.1 +/- 5.8 mm Hg (range 8-35 mm Hg). Variceal rupture occurred only when the gradient was > or = 12 mm Hg. Variceal bleeding was observed exclusively in patients with large varices. Survival was not influenced by the level of gradient. We used the ABT to classify patients into three groups (group I, ABT > or = 2%; group II, 1% < or = ABT < 2%; and group III, ABT < 1%). Survival was significantly higher in group I than in group II (p < 0.05) or III (p < 0.01), indicating a better prognosis at a residual functional hepatic cellular mass of about 50% of the lower limit of normal value.

Aminopyrine↗