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Biomedical subjects

E Lerebours

Publications and source records attributed to E Lerebours.

At least 109 records · Page 6Linked to original sources
PubMed1986

Colonic transit time of radiopaque markers and rectoanal manometry in patients complaining of constipation.

Transit time, rectoanal manometry, and symptoms were studied in 61 patients complaining of constipation. A slow transit, in the colonic area of most of the patients, was found in 49. Rectoanal manometry was abnormal in 40. Both examinations were abnormal in 32 patients, colonic transit only in 17, and manometry only in eight. Finally, both examinations were normal in only four subjects. A transit delay was always associated with less than three stools per week, and straining at stool was constant when rectoanal manometric disturbances were shown. Objective abnormalities appear common in patients complaining of constipation and, correlated with symptoms, suggest that clinical study in constipation could be of more value than usually is believed.

Adolescent↗
PubMed1986

Decreased brush border hydrolase activities without gross morphologic changes in human intestinal mucosa after prolonged total parenteral nutrition of adults.

Animal experimentation with total parenteral nutrition (TPN) has revealed the occurrence of atrophy of the intestinal mucosa and decreased enzyme activities of the brush border, notably the disaccharidases. These findings have heretofore not been confirmed in human investigation. We performed endoscopic biopsies in the third part of the duodenum in 7 adults before TPN, after 21 days of TPN, and after a progressive oral refeeding. We noted a clear-cut decrease of major enzyme activities during TPN (sucrase, maltase, lactase, glucoamylase, acid aminopeptidase, dipeptidyl peptidase) without any morphologic modifications as observed with standard histology. Electron microscopy showed a slight but significant decrease in the height of microvilli. The decreased enzyme activities were rapidly restored after oral refeeding. Thus, the functional consequences of the modifications observed during medium-term TPN in adults are probably limited.

Adult↗
PubMed1986

Controlled trial of bowel rest in the treatment of severe acute colitis.

In a prospective, randomised clinical trial, 47 patients with severe, acute, non-infective colitis treated with 60 mg intravenous prednisolone daily, received either bowel rest with parenteral nutrition or oral diet. Although those who received 'bowel rest' experienced a reduction in daily stool weight, there were no differences in the operation or mortality rates between the groups. Fourteen of the 27 patients with ulcerative colitis, but none of the 16 patients with Crohn's disease required urgent surgery. Bowel rest did not affect the outcome in severe ulcerative colitis treated with intravenous prednisolone. Ulcerative colitis and Crohn's colitis behaved differently in the acute attack.

Acute Disease↗
PubMed1986

[Hereditary visceral myopathy: an entity in idiopathic intestinal pseudo-obstruction].

A 17 year-old girl with chronic idiopathic intestinal pseudo-obstruction is reported. Abnormalities of smooth intestinal muscle were shown on light and electron microscopic studies of the excised small intestine and led to the diagnosis of visceral myopathy based on the following features: vacuolar degeneration of intestinal smooth muscle cells with replacement by fibrous preferential involvement of the external longitudinal muscle layer normal myenteric plexus. For the first time similar ultrastructural changes were found on histological study of the colon. Manometric studies revealed a diffuse disease involving the esophagus, small bowel, and bladder. Anorectal abnormalities, never described before, were reported. Family involvement was shown by abnormal esophageal and anorectal manometries in the patient's brother and by paternal history of fatal small intestine occlusion without mechanical obstruction. The prognosis of severe forms of visceral myopathy is generally poor because of the inefficiency of drugs. In this case, after a long period of parenteral nutrition with maintenance of a good nutritional status, a terminal ileostomy (with a special procedure to avoid evagination) associated with a second stage total colectomy allowed to stop parenteral nutrition.

Adolescent↗
PubMed1986

[Behavior and opinions of health care personnel with regard to breast feeding].

Breast feeding (BF) practice is related to cultural, social and economic patterns of the future mothers; nevertheless hospital personnel seems to have some influence on infant feeding habits. This study describes the professional practices among personnel in the maternity hospitals of the Departement de la Seine Maritime (France) and reports their opinions about BF. Most of the respondents consider that they have a small role in influencing the decision to breast feed, the choice being made before pregnancy. Delivery training sessions seem to be the most suitable time for information about BF. Psychological arguments are considered as the most effective approach. BF is not estimated as leading to an increased work goal by hospital personnel. BF appears to be generally well controlled by mothers before discharge. Technical factors were given as the primary influencing reason for cessation of BF. This survey indicates several ways for establishing future health education programs for the promotion of BF.

Breast Feeding↗
PubMed1985

Catheter obstruction during prolonged parenteral alimentation. Are lipids responsible?

Catheter obstruction is a serious incident during prolonged parenteral nutrition (PN). This retrospective study was carried out in order to compare the frequencies of catheter obstruction with nutritive mixtures in bags according to whether or not lipids were mixed with the entire 24 h nutritional supply (Group I, n=33) or infused separately (Group II, n=30). Our results show that obstructions are significantly more frequent in Group I (11 13 ) than in group 2 (3 10 ), appearing within a mean interval of 29 days after inserting the catheter. The global percentages of patients undergoing cyclic PN were the same in both patient groups. In group I, however, the percentage of patients on cyclic PN was significantly higher for the obstructed catheters (100%) than for the unobstructed catheters (59%). In conclusion, the mixture of lipids with the remainder of the nutrients in the conditions of this study is the prime cause of catheter obstruction, although the exact mechanism is not elucidated. The role of cyclic PN appears to be accessory.

Journal Article↗
PubMed1985

Hepatic antipyrine metabolism in malnourished patients: influence of the type of malnutrition and course after nutritional rehabilitation.

The present study of hepatic mixed function oxidase activity was carried out by determining antipyrine clearance in 49 patients presenting with energy malnutrition (group E, n = 26) or global protein-calorie malnutrition (group P, n = 23). A control group (group C, n = 25) was composed of subjects with good nutritional status. The metabolic clearance rate and weight-corrected clearance in group P were significantly lower than those in groups E and C. The weight clearances in the latter two groups were not significantly different, suggesting that mixed function oxidase activity decreases only in protein-calorie malnutrition. Antipyrine clearance was studied again in 27 patients after nutritional rehabilitation with artificial nutrition for 31 +/- 4 days (means +/- SEM). Concomitant with an improvement in nutritional state, clearances tended towards normal values in group P (n = 17) and were not significantly modified in group E (n = 10). It is thus important to take the type of malnutrition into account in pharmacological studies of malnourished humans in order to correctly adapt therapeutic doses.

Adult↗
PubMed1985

[Analysis of different factors affecting results of the surgical treatment of gastroesophageal reflux].

Gastric emptying, gastric secretion and esophageal pH were studied prospectively in 32 patients who had either a Lortat-Jacob type operation (n = 7) or a fundoplication with a 360 degrees (n = 4), 270 degrees (n = 5) or 180 degrees (n = 16) gastric fundic wrap. The goal was to determine the effects of various antireflux mechanisms on these functions as well as to try to explain abnormal postoperative esophageal pH scoring indexes. Esophageal pH was recorded during the 3 h period following a standard meal. Acid reflux was expressed using a scoring index taking into account the duration and magnitude of pH fall. Preoperatively, all patients had an abnormal pH scoring index. Postoperatively, the pH scoring index remained increased in 7 patients (group A) and returned to normal values in 25 (group B). Clinical data, esophageal pH parameters and gastric acid secretion measured preoperatively were not significantly different in the two groups of patients. Preoperative gastric emptying for liquids was shorter in group A than in group B patients (p less than 0.05). Postoperative gastric emptying of radiopaque markers was not different in the two groups of patients. Postoperative resting pressure of the lower esophageal sphincter was always less than 10 cm H2O in group A and more than 10 cm H2O in group B patients. Changes in lower esophageal pressure after surgery were higher in group B than in group A patients (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1985

[Temporo-spatial epidemiology of cancer of the pancreas. Study of international and French mortality].

The aim of this study was to describe the main geographical and chronological epidemiologic characteristics of the mortality rates for pancreatic cancer (PC) in France and in other countries. The international geographical study shows PC standardized rates ranging from 3.1 to 9.9/100,000 for men and from 2.1 to 7.2/100,000 for women. Higher rates are observed in Northern and Eastern Europe, as well as in North America. In France, mortality rates decrease from the North-East to the South-West of the country. During the period 1950-1980, the median annual increase in PC mortality rates was 3 p. 100 for men, and 2.5 p. 100 for women in the countries studied. The increase was greater where initial PC mortality rates were low. This trend has slowed down during the last ten years (1971-1980). In France, annual PC mortality rates have increased more for men (+ 3.46 p. 100) than for women (+ 1.94 p. 100). There is evidence of an increased PC mortality rate from one generation to another. Cohort analysis points to a significant stabilization of PC mortality rates for women in France.

Female↗
PubMed1984

[Treatment by arterial embolization of a case of Wirsung's duct hemorrhage].

A 49 years old patient was hospitalized following a eight days episode of gastro intestinal bleeding. Medical history revealed a chronic pancreatitis for more than three years. Physical examination upon admission was unremarkable. Acute oesophago-gastro-duodenoscopy showed red blood issue from the papilla. Echotomographic examination revealed no pancreatic pseudo cyst. A coeliac angiogram showed an extravasation of contrast material. Subselective pancreatico duodenal angiogram revealed the extravasation and the instantaneous opacification of the pancreatic duct with flow into the duodenum. Arterial embolization was chosen for treatment and stopped the bleeding. The patient has now been followed for three years and has had no recurrence of gastro intestinal bleeding.

Celiac Artery↗
PubMed1984

[Digestive hemorrhage under anticoagulant treatment. Retrospective analysis of a series of 178 consecutive cases].

The aim of this study was to describe the clinical characteristics, prognosis and epidemiological pattern of gastrointestinal bleeding occurring in patients receiving anticoagulant therapy. From 1971 to 1981, among 3,194 consecutive patients admitted to a gastrointestinal unit because of acute gastrointestinal bleeding, 178 were under anticoagulant therapy (i.e. antivitamin K and heparin or heparin derivative in respectively 85 and 13 p. 100 of the cases). Fourteen percent of these 178 patients had also taken gastrotoxic drugs before the bleeding occurred. Indications for anticoagulant therapy were as follows: ischemic heart disease (21 p. 100), arrhythmias (20.3 p. 100), venous thrombosis and pulmonary embolism (15.8 p. 100), arteritis (10.8 p. 100), aortic, coronary or peripheral arterial grafts (8.4 p. 100), prophylaxis of venous thrombosis (8.4 p. 100), valve prosthesis (7.3 p. 100). The lesion responsible for bleeding was found in 80 p. 100 of the cases. Surgical hemostasis was required in only 4 patients. Ten patients died (2 postoperatively). During the study period, the incidence of bleeding associated with anticoagulant therapy in the group of patients admitted to the unit with gastrointestinal hemorrhage increased from 1.5 p. 100 to 8.0 p. 100. This fact appeared to be closely related to new indications (valve prosthesis, arterial grafts, prophylaxis of venous thrombosis) and to an increased incidence of gastrointestinal bleeding especially in association with acenocoumarol treatment. These results show that, although occurring in a high risk population, gastrointestinal bleeding related to anticoagulant therapy generally has a favorable outcome. They also suggest that a prospective epidemiological study may be of interest to determine the reasons for the increasing incidence and to propose preventive measures.

Adult↗
PubMed1983

[Effects of the administration of somatostatin 14 in the carcinoid syndrome. Clinical and biological study of 2 cases].

The effects of synthetic cyclic somatostatin 14 were studied in two patients with the carcinoid syndrome. The 3-hour intravenous administration of somatostatin (250 micrograms X h-1), a) resulted in the disappearance of flushing in the first patient but was without any clinical effect in the second subject who remained chronically colored; b) lowered plasma levels of motilin, prostaglandins (E1, E2 and F2 alpha) and to a lesser extent of catecholamines in both patients whereas the serotonin level was not altered; c) was followed by a rebound effect with recurrence of severe flushing in the first patient and was associated with a dramatic increase of prostaglandin, substance P and catecholamine levels in both patients. The inhibitory effect of somatostatin and the occurrence of a rebound effect at the end of infusion were confirmed by infusing somatostatin (6 mg per day) during 48 h in the first patients. These results: a) show that somatostatin is an effective drug in carcinoid syndrome with severe flushing; b) confirm that several mediators are affected in carcinoid syndrome. However it could not be excluded that increased circulating levels of prostaglandins, substance P and catecholamines may represent unrelated secondary events; c) suggest that somatostatin primarily inhibits the release rather than the synthesis of tumor products. Owing to the severity of the rebound effect, treatment of the carcinoid syndrome with somatostatin must be undertaken with precaution until specific long-acting analogs are available.

Aged↗
PubMed1982

Hepatic alterations during total parenteral nutrition in patients with inflammatory bowel disease: a possible consequence of lithocholate toxicity.

In order to understand the mechanism of hepatic abnormalities appearing during total parenteral nutrition, biliary bile acid composition and liver function tests were examined serially in 15 patients undergoing total parenteral nutrition for inflammatory bowel disease. In all 12 patients who underwent duodenal intubation before initiation of total parenteral nutrition, lithocholic acid accounted for less than 1% of total biliary bile acids. After 11-22 days of total parenteral nutrition, lithocholic acid accounted for 7%-15% of biliary bile acids in 5 patients and less than 1% of biliary bile acids in 10 patients. In the 5 patients with elevated levels of biliary lithocholic acid, serum alkaline phosphatase and aminotransferase activities rose progressively at serial determinations, the increase being significant after 2 wk of total parenteral nutrition. These results suggest that lithocholic acid may be involved in the hepatic lesions observed in patients undergoing total parenteral nutrition.

Adult↗