[Esophageal mycosis during treatment with omeprazole].
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Biomedical subjects
Publications and source records attributed to G Lesur.
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In order to assess the responsibility of medicinal drugs for the disorders in electrolytes observed in elderly people, the prevalence of abnormal natraemia and kalaemia was prospectively established in 631 subjects aged 70 or more on the first day of hospitalization. Among 337 subjects not taking drugs likely to create problems (diuretics, angiotensin-converting enzyme inhibitors, anti-inflammatory agents) 3.6 percent had hyponatraemia (below 130 mmol/l) and 12.2 percent had hypokalaemia (below 3.5 mmol/l). Subjects with normal renal function who were taking angiotensin-converting enzyme inhibitors or non-steroidal anti-inflammatory agents showed no more electrolytic abnormalities than those who did not take them. Conversely, subjects on thiazides were more frequently hyponatraemic (11.8 percent) or hypokalaemic (16.2 percent; 20 percent in the absence of associated distal diuretics). These abnormalities were more frequent in women than in men (21.7 and 13 percent). This, together with the fact that 68 percent of subjects taking thiazides were women accounts for the marked female predominance of electrolytic abnormalities reported in the literature.
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Liver metastases are frequent, often large and sometimes very late in skin or choroid metastatic melanoma. Hepatic failure is a rarely described complication in metastatic liver melanoma. We report a case of liver failure in a metastatic liver melanoma in a woman 76 years old, treated 16 years before for a choroid melanoma. About this case, we discuss the frequency, the location of primitive tumors and mechanism of liver failure in metastatic liver.
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Asymptomatic bacterascites is defined as the presence of bacteria in ascitic fluid without clinical features of peritonitis or increased ascitic fluid polymorphonuclear cells. Asymptomatic bacterascites is a controversial entity, and little information is available regarding its spontaneous evolution. Clinical features, bacteriological data and outcome in 22 cirrhotic patients with asymptomatic bacterascites are reported and are compared with those of a group of 36 cirrhotic patients with spontaneous bacterial peritonitis. Eleven patients had gram-negative bacteria and 11 had one gram-positive bacteria. Only in three patients (13.6%) did peritonitis develop. Twelve patients received no antibiotic therapy, and in none did peritonitis develop. At 1 month, 27% of patients with asymptomatic bacterascites had died. Patients with asymptomatic bacterascites had less-severe liver disease; they more frequently had gram-positive bacteria in ascitic fluid and had a lower 1-mo mortality rate than did patients with spontaneous bacterial peritonitis. We conclude that asymptomatic bacterascites is usually the transient residence of bacteria in ascitic fluid. Peritonitis rarely develops in patients with asymptomatic bacterascites and, in most of them, antibiotic therapy is not required.
The aims of this study were to assess the prevalence of duodenal ulcer during chronic pancreatitis and the relationship between the occurrence of duodenal ulcer and the course of chronic pancreatitis. The population consisted of 264 men with chronic pancreatitis, 94 percent of which were of alcoholic origin. Duodenal ulcer occurred in 37 patients (14 percent). Fifteen patients with gastric or anastomotic ulcer were excluded. The 37 patients with duodenal ulcer were compared with 212 patients without ulcer. There was no significant difference between the two groups as regards the course of chronic pancreatitis except for insulin-dependent diabetes mellitus which was significantly more frequent in patients without duodenal ulcer (P less than 0.05). Eight patients with duodenal ulcer died but the cause of death was not related to their ulcer. All patients with duodenal ulcer and 92 percent of those without were smokers (not significant). Duodenal ulcer occurred in 25/37 patients (68 percent) before the clinical onset of chronic pancreatitis. The risk of duodenal ulcer occurrence was constant in 17-65 year old patients and independent of the time of chronic pancreatitis onset. We concluded that in men with chronic pancreatitis: a) prevalence of duodenal ulcer is 14 percent; b) duodenal ulcer occurred most often before clinical onset of chronic pancreatitis; c) duodenal ulcer occurs independently of the course of pancreatitis which cannot account for its high prevalence. Smoking may be a promoting factor.
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The anti-hypertensive treatment of 631 patients 70 years old and over was evaluated at the time of their hospitalization in 12 Internal Medicine departments in the western Paris suburbs, in May and June 1990. 49.6 +/- 3.9% received no such therapy; 30.3 +/- 3.6% were being treated for hypertension (group 1); 8.7 +/- 2.2% were taking anti-hypertensive drugs for poorly specified reasons (group 2); 11.4 +/- 2.5% were under such treatment for another reason. In groups 1 or 1 + 2, the most frequently prescribed medications were, in decreasing order: diuretics, calcium channel blockers, converting enzyme inhibitors, beta-blockers or central inhibitors. In the oldest patients, the beta-blockers were prescribed less and converting enzyme inhibitors more. More than half of the patients in groups 1 + 2 were taking a single drug. The most frequently prescribed combined therapy was diuretic + converting enzyme inhibitor. Our results seem to indicate that the prescription modalities depended, for the most part, upon an associated or suspected pathology, notably cardiac insufficiency.