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Biomedical subjects

J C Chaput

Publications and source records attributed to J C Chaput.

At least 55 records · Page 3Linked to original sources
PubMed1993

Diaphragm function is not impaired by pneumoperitoneum after laparoscopy.

Open cholecystectomy is known to induce a major restrictive respiratory syndrome. These respiratory disturbances, although of reduced magnitude, still persist after laparoscopic cholecystectomy. To determine the role of pneumoperitoneum per se in the respiratory dysfunction observed after this procedure, seven patients were studied before and 2 hours after laparoscopy. This diagnostic procedure avoids the upper midline incision and the surgical injury of cholecystectomy. Ventilatory performance and diaphragm function were assessed as follows: (1) during quiet tidal breathing by obtaining measurements of esophageal, gastric, and transdiaphragmatic pressures; determining the ratio of gastric pressures to esophageal pressures; and abdomen-rib cage partitioning of tidal volume obtained from two differential linear transformers and (2) during maximal respiratory efforts by obtaining measurements of vital capacity and maximal transdiaphragmatic pressure during Müller's maneuver and a sniff test. Although a large residual pneumoperitoneum (assessed as the maximal height of the suprahepatic space: Hmax = 30.3 +/- 7.8 mm) was observed after laparoscopy, we did not find any change suggestive of diaphragm dysfunction. We thus conclude that postoperative residual pneumoperitoneum per se is unable to explain the diaphragm dysfunction observed after open or laparoscopic cholecystectomy.

Cholecystectomy, Laparoscopic↗
PubMed1993

Transforming growth factor beta 1: in situ expression in the liver of patients with chronic hepatitis C treated with alpha interferon.

In a semiquantitative assessment of the expression of transforming growth factor (TGF) beta 1 in liver biopsy specimens from patients with chronic hepatitis C, treatment with interferon alfa-2b (3 million units (MU) three times weekly) decreased the expression of TGF beta 1 in six of seven patients. The reduction in TGF beta 1 correlated significantly with the scores for inflammation (p < 0.05) and necrosis (p < 0.05), but not with the alanine aminotransferase activities (p = 0.36) or the score for fibrosis (p = 0.86).

Adult↗
PubMed1992

A randomized trial of prednisolone in patients with severe alcoholic hepatitis.

BACKGROUND: Controlled trials have yielded inconsistent results with regard to the efficacy of corticosteroids in the treatment of alcoholic hepatitis. Three meta-analyses suggest that they may be effective in patients with encephalopathy who have severe liver disease. METHODS: We conducted a randomized, double-blind trial comparing 28 days of prednisolone treatment (40 mg per day) with placebo in 61 patients with biopsy-proved alcoholic hepatitis and either spontaneous hepatic encephalopathy (n = 19) or a discriminant-function value higher than 32. The discriminant function used was as follows: 4.6 (prothrombin time-control time [in seconds]) + serum bilirubin (in micromoles per liter)/17. Fifty-seven of the patients had evidence of cirrhosis on biopsy. The primary end point was death within two months. RESULTS: One patient was lost to follow-up after 56 days. Treatment was discontinued in two patients because of drug toxicity. By the 66th day after randomization, 16 of 29 placebo recipients had died (mean [+/- SE] survival, 45 +/- 8 percent), as compared with 4 of 32 prednisolone recipients (survival, 88 +/- 5 percent) (log-rank test, 10.9; P = 0.001). The survival advantage for prednisolone persisted after stratification according to center and the presence of encephalopathy, and after adjustment for prognostic factors in a proportional-hazards model. CONCLUSIONS: Treatment with prednisolone improves the short-term survival of patients with severe biopsy-proved alcoholic hepatitis.

Double-Blind Method↗
PubMed1992

Cirrhosis as an independent risk factor for colonic adenomas.

This study aimed to determine the relation between cirrhosis and colorectal adenomatous polyps after adjustment for alcoholism and other confounding variables. Four groups of patients aged 40 years or above were studied. Group I included 100 consecutive outpatients with irritable bowel syndrome, group II 100 consecutive alcoholic inpatients without cirrhosis, group III 100 consecutive inpatients with alcoholic cirrhosis, and group IV included 36 consecutive inpatients with non-alcoholic cirrhosis. All patients underwent colonoscopy. The prevalence of adenomatous polyps was 13% in group I, 26% in group II, 58% in group III, and 22% in group IV (p less than 0.001). The prevalence of adenomatous polyps was greater in patients with cirrhosis than in those patients without (48.5% v 19.5%). This difference remained significant after successive adjustment for alcoholism, sex, age, smoking, and serum cholesterol. The prevalence of adenomatous polyps was greater in alcoholic patients than in non-alcoholic patients (42% v 15.4%) (p less than 0.001). This difference remained significant after successive adjustment for cirrhosis, sex, age, smoking, and serum cholesterol. These results suggest that cirrhosis is an independent risk factor for colorectal adenomatous polyps and confirm that alcoholism increases this risk.

Adult↗
PubMed1992

[Analgesic effect of transcutaneous cranial electrostimulation in patients treated by Nd:YAG laser for cancer of the rectum. A double-blind randomized trial].

The aim of this double blind cross-over randomized trial was to assess if transcutaneous cranial electrical stimulation by Limoge current could decrease the dose of fentanyl required in patients with rectal cancer treated by Nd:YAG laser. Fifty patients, 29 women, 21 men, 78 +/- 10 years old (range: 53-96 years), were treated by 2 laser sessions with an interval of 48 hours between each session. Active and sham electrostimulation were given in random order for the 2 laser sessions. The major end point was the quantity of fentanyl injected when the score of pain was greater than or equal to 5 according to a visual analgesic scale. Age, sex, body weight, tumor location and length, tumor circumferential extent and luminal patency, duration of laser session, amount of energy delivered per session (watt-seconds), and number of patients with deep sedation did not differ between the 2 groups. There was no interaction between the order of treatments and the treatments. The mean quantity of fentanyl was 29 micrograms and 42 micrograms when sham electrostimulation was given. There was a decrease of 31 percent in the quantity of fentanyl with active electrostimulation (P less than 0.05). Results were not affected either by the treatment order nor by tumor location. There were no side effects in either group.

Aged↗
PubMed1991

[Laser in gastroenterologic endoscopic therapy].

Endoscopic gastrointestinal laser therapy was originally inspired by the haemostatic properties of the laser beam and was subsequently used to destroy tumours. In endoscopic gastroenterology, the most commonly used type of laser is the neodyme+-doped yttrium aluminium garnet (Nd:YAG) laser. Endoscopic Nd:YAG laser therapy of obstructive cancers of the oesophagus and cardia rapidly reduces dysphagia in 70 to 100% of the patients. In the treatment of colorectal cancers, the intestinal transit returns to normal in 57 to 83% of the cases, and rectal haemorrhages are controlled in 38 to 92% of the cases. However, sustained results can only be obtained by a maintenance treatment with at least one application every 4 weeks. The Nd:YAG laser makes it possible to destroy villose tumours in patients who cannot, or will not, be operated upon; the number of applications depends on the size of the tumour. Finally, the Nd:YAG laser seems to be able to control bleeding due to gastrointestinal angiodysplasia and to stabilize the course of Rendu-Osler-Weber disease.

Colonic Polyps↗
PubMed1991

Portal hypertensive colopathy. A new entity.

The aim of this paper was, first, to show in a case control study that in alcoholic cirrhotic patients colonic vascular ectasias (VE) are a complication of portal hypertension and, second, to establish in a histomorphometric study that colonic vascular ectasias and rectal varices (RV) are only endoscopic features of a new entity: portal hypertensive colopathy, the pathologic basis of which is colonic mucosal capillary ectasia. In the case control study, for each case, three age- and sex-matched controls selected from consecutive patients were used. Sixteen alcoholic cirrhotic patients, 12 men, 4 women (mean age +/- SD: 62 +/- 10 years) had colonic vascular ectasias. The prevalence of esophageal varices (88% vs 44%, P less than 0.005), esophageal varices (greater than or equal to 5 mm) (44% vs 12.5%, P less than 0.01), previous history of bleeding from esophageal varices (44% vs 8%, P less than 0.005), and rectal varices (63% vs 6%, P less than 0.001) was significantly greater in cases with colonic vascular ectasias than in controls without colonic vascular ectasias. The relative risk of colonic vascular ectasias in alcoholic cirrhotic patients with esophageal varices versus cirrhotic patients without esophageal varices was 14.4 (95% confidence interval 2.8-75.3). In the histomorphometric study, cirrhotic patients with vascular ectasias and/or rectal varices had a significantly higher mean diameter of vessels (20.3 +/- 1.5 microns vs 18.7 +/- 1.6 microns, P less than 0.05) and a higher mean cross-sectional vascular area (2143 +/- 396 microns 2 vs 1676 +/- 345 microns 2, P less than 0.05) than cirrhotic patients without vascular ectasias and/or rectal varices.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

A simple biological index for detection of alcoholic liver disease in drinkers.

To make liver biopsy unnecessary in certain cases, PGA (P, prothrombin time; G, gamma-glutamyl transpeptidase; A, apoliprotein AI), a simple biological index combining a specific test for severe liver disease (prothrombin time), a sensitive test of alcoholic liver disease (serum gamma-glutamyl transpeptidase), and a test for liver fibrosis (serum apolipoprotein AI), was evaluated in a training sample of 333 drinkers and validated in 291 other drinkers. All patients underwent an intercostal liver biopsy, and the specimen was independently read by two pathologists. The PGA index varied from 0 to 12. When PGA was less than or equal to 2, the probability of cirrhosis was 0% and the probability of normal liver or minimal changes 83%. Conversely, when PGA was greater than or equal to 9, the probability of normal liver or minimal changes was 0% and the probability of cirrhosis 86%. These values did not vary between training and validation periods, between asymptomatic vs. symptomatic subjects or between PGA at admission vs. PGA 1 week later. This index could be useful for general practitioners in identifying subjects at high risk for severe alcoholic liver disease.

Adult↗
PubMed1991

Efficacy of long term recombinant interferon-alfa in patients with chronic hepatitis C. A clinical, biological, histological and immunohistological study.

A prospective, non randomized trial was conducted in 22 patients with chronic hepatitis C treated for 6 months with interferon-alfa at the dose of 3 million units three times a week followed by decreasing doses for the following 6 months. Transaminase activity measurements were taken at 2, 6, 12, 18, and 24 months and a liver biopsy was performed at zero and 6 months to assess efficacy. Immunohistochemical study of HLA class I and lymphocyte subsets was performed on the biopsy specimen before and after 6 months of treatment. A complete biological response was observed in 82, 82, 60, 64 and 70 percent of patients at 2, 6, 12, 24 and 36 months, respectively. Four patients relapsed including 2 patients who suddenly stopped taking interferon-alfa. An improvement of histological features was observed in 90 percent of patients for necrosis and in 80 percent of patients for inflammation, with an overall improvement in Knodell's score reaching 85 percent. Immunohistochemical studies showed CD8+ cell infiltration already present in the area of necrosis before treatment. These tests also showed that HLA class I expression by the hepatocyte membranes was increased at 6 months and was identical in patients with or without histological improvement.

Adult↗
PubMed1991

[Endoscopic hemostasis for hemorrhagic gastroduodenal ulcer. Meta-analysis of randomized clinical trials].

To demonstrate the advantages of various endoscopic hemostatic methods (laser photocoagulation, electrocautery, injection therapy) for bleeding gastroduodenal ulcer in patients at high risk for continued or recurrent bleeding, a critical review of published randomized clinical trials was made with meta-analytic methods. Only the 15 clinical trials dealing either with patients with visible non bleeding vessels or spurting arterial bleeding were included. Regarding visible non bleeding vessels, the meta-analysis of five trials on electrocautery and two trials on sclerotherapy showed a significant reduction in rebleeding rates in the treatment group compared with untreated controls. The odds ratios were 4 (95 percent confidence levels (CL): 2.4-6.9) (P less than 0.001) and 6.8 (95 percent CL: 2.7-17.2) (P less than 0.001), respectively. As well, the meta-analysis of four trials on electrocautery and the two trials on sclerotherapy showed a significant reduction in the number of emergency surgical operations in the treated groups a compared with the untreated groups. The odds ratios were 5.5 (95 percent confidence levels (CL): 2.7-11.3) (P less than 0.001) and 6.1 (95 percent CL: 2.1-17.8) (P less than 0.001), respectively. Meta-analysis did not show any advantage for laser, electrocautery, or sclerotherapy in terms of mortality. Indirect meta-analysis did not reveal any difference between electrocautery and sclerotherapy. Regarding spurting arterial bleeding, meta-analysis of the two YAG laser trials, the two Argon laser trials, and the two electrocautery trials showed a significant reduction of rebleeding or continued bleeding in the treatment groups as compared with the control groups.(ABSTRACT TRUNCATED AT 250 WORDS)

Duodenal Ulcer↗
PubMed1991

Independent risk factors for hepatocellular carcinoma in French drinkers.

The aim of this study was to assess whether markers of hepatitis B virus or hepatitis C virus infection are independent risk factors for hepatocellular carcinoma in drinkers after adjustment for three known risk factors: cirrhosis, age and male sex. Among 2,015 consecutive drinkers admitted, hepatitis C virus antibodies were found by sensitive radioimmunoassay in 1,259. The following five factors have been identified and ranked as risk factors for hepatocellular carcinoma in unidimensional and regression analysis: cirrhosis (p less than 0.001), age (p less than 0.001), male sex (p less than 0.001), presence of HBsAg (p less than 0.001) and presence of hepatitis C virus antibodies (p less than 0.03). Among drinkers with cirrhosis, the patients with hepatocellular carcinoma were older (64 +/- 11 yr vs. 56 +/- 9 yr; p less than 0.001), were more often male (93% vs. 65%; p less than 0.0001) and had higher prevalence of HBsAg (9% vs. 2%; p = 0.02) and hepatitis C virus antibodies (41% vs. 26%; p = 0.02). A simple algorithm permitted us to identify a high-risk population of drinkers: the male cirrhotic patient older than 50 yr. The relative risk of hepatocellular carcinoma in this selected population was 17.7 (95% confidence interval = 9.0 to 37.5; p less than 0.0001). From a pragmatic point of view, the detection of HBsAg or hepatitis C virus antibodies, although independently associated with hepatocellular carcinoma, is not useful in increasing the diagnostic value of this algorithm because of the poor sensitivity of these tests. The weak relationships observed between hepatitis C virus antibodies and hepatocellular carcinoma needs confirmation by more accurate tests.

Age Factors↗
PubMed1990

Long-term results of treatment of vascular malformations of the gastrointestinal tract by neodymium YAG laser photocoagulation.

This study reports long-term results of treatment of vascular malformations of the gastrointestinal tract by neodymium YAG (Nd-YAG) laser photocoagulation in 60 patients (13 patients with hereditary hemorrhagic telangiectasia and 47 patients with angiodysplasias) and examines prognostic parameters of bleeding recurrence in 47 patients with angiodysplasias. In patients with hereditary hemorrhagic telangiectasia, the transfusion requirements were lower only in the second and third year following therapy than in the year before therapy; however, these differences were not significant. In patients with angiodysplasias, a median number of one laser session (range 1-8) was necessary to destroy angiodysplasias. A blood loss recurred in 15 patients. The cumulative probability of remaining free of blood loss recurrence at 24 months and at 54 months was 61 +/- 9%. Three parameters had an independent prognostic value, the initial number of angiodysplasias (P less than 0.02), the presence of coagulation disorders (P less than 0.05), and age (P less than 0.05).

Aged↗
PubMed1990

Endoscopic Nd-YAG laser therapy as palliative treatment for esophageal and cardial cancer. Parameters affecting long-term outcome.

The aim of this study was to report long-term results of endoscopic Nd-YAG laser therapy in the palliative treatment of 144 esophageal and cardial carcinomas and to define parameters that could predict the long-term outcome in order to better define the indications and limitations of Nd-YAG laser therapy for esophagocardial cancer. One hundred nineteen men and 25 women were treated. The mean age was 67 +/- 12 years. Histology showed 94 patients with squamous cell carcinoma and 50 with cardial or esophageal adenocarcinoma. Improvement of dysphagia was achieved in 119 of the 144 patients (83%) after a median of 2.9 sessions. For the 105 patients initially symptomatically improved by the first laser course, the cumulative probability of remaining symptomatically improved at three and six months was respectively 38.5 +/- 5% and 22 +/- 4%. Four perforations and nine esophagotracheal fistulas occurred. In the stepwise regression analysis (Cox model), among 11 variables, three variables had an independent prognostic value at six months. The importance of improvement after the initial laser treatment (P less than 0.005) and the presence of an adenocarcinoma (P less than 0.05) were positively correlated with the symptom improvement duration. The initial tumor length (P less than 0.01) was negatively correlated with the symptomatic improvement duration. Therefore, in inoperable patients, we think that laser therapy should be proposed first for adenocarcinoma and for squamous cell carcinoma less than 6 cm in length.(ABSTRACT TRUNCATED AT 250 WORDS)

Adenocarcinoma↗
PubMed1990

Expression of histocompatibility antigens and characterization of the lymphocyte infiltrate in hyperplastic polyps of the large bowel.

HLA-DR expression, lymphocyte subsets, and the distribution of proliferating cells were studied in hyperplastic polyps from the colorectum. The density of T-cells (CD5+) (mean of cells/mm2 of tissue +/- SEM) was higher in the lamina propria of hyperplastic polyps (64.2 +/- 4.2) than in normal colonic mucosa (36.7 +/- 2.6, P less than .001). The CD4/CD8 ratio was higher in hyperplastic polyps (6.3 +/- 0.9, P less than .0001) and in colonic adenomas (5.9 +/- 0.9, P less than .001) compared with normal mucosa (2.3 +/- 0.2). Lymphocytes of the lamina propria were never Ki-67 positive either in normal mucosa or in hyperplastic polyps or adenomas. The epithelial layer of hyperplastic polyps and of normal mucosa did not express the HLA-DR antigen, whereas pericryptal fibroblasts and most of the leukocytes of the lamina propria were strongly positive for this antigen. In the epithelial layer proliferating cells were localized exclusively in the lower part of epithelial crypts, as was the case in normal mucosa, whereas in adenomas Ki-67-positive cells were present throughout the entire height of the mucosa. Thus, in hyperplastic polyps lymphocytes are increased in the lamina propria, with a predominance of the CD4 subset in close contact with HLA-DR positive pericryptal fibroblasts.

Adenoma↗