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Biomedical subjects

J Guerre

Publications and source records attributed to J Guerre.

At least 37 records · Page 2Linked to original sources
PubMed1989

Proctocolectomy and ileoanal pouch anastomosis without conservation of a rectal muscular cuff.

The technique of proctocolectomy and formation of an ileal reservoir with ileoanal anastomosis is well described. It is believed that the conservation of a rectal muscular cuff is necessary for continence but no data are available to support this contention. The aims of this study were to describe the clinical and physiological aspects of continence after proctocolectomy and ileal J pouch anastomosis without conservation of a rectal muscular cuff. Eighteen consecutive patients (mean age 37.3 years, 16 ulcerative colitis, two familial polyposis) who underwent proctocolectomy and ileoanal anastomosis on the dentate line were studied 6 months after closure of the loop ileostomy. The 18 patients and eight controls underwent: (a) anal manometry; (b) determination of maximum tolerable volume (MTV); (c) liquid continence test (infusion of NaCl at 60 ml/min for 25 min) with simultaneous measurement of ileal reservoir pressure. The volume evacuated during 5 min after the continence test was also measured. The frequency of bowel actions was (mean +/- s.e.m.) 5.3 +/- 0.4 per 24 h (nocturnal 1.14 +/- 0.26). Seventeen of 18 patients (94 per cent) had normal continence and defaecation; one patient was incontinent. A decrease in resting anal canal pressure (102.5 +/- 4 versus 47.5 +/- 6 cmH2O) was observed after ileoanal anastomosis. A rectoanal inhibitory reflex was elicited in one of the 18 patients (6 per cent). Patients were able to retain 1023 +/- 68 ml saline during the liquid continence test. The percentage evacuation of the ileal reservoir was 61 +/- 4.5 per cent. Correlations were found (P = 0.05) between daily stool frequency and the volume of saline retained during the liquid continence test. It is concluded that conservation of a rectal muscular cuff is not necessary for the achievement of good clinical results.

Adult↗
PubMed1989

Determination of total and segmental colonic transit time in constipated patients. Results in 91 patients with a new simplified method.

Ninety-one patients with idiopathic constipation had segmental colonic transit studied with radiopaque markers using a new simplified technique to determine frequency and type of colonic transit time (CTT) abnormalities and to determine the utility of this test in planning therapy. Colonic transit studies defined four groups: normal CTT (N = 49), right colonic stasis (N = 16), outlet obstruction (N = 12), and isolated left colonic stasis (N = 14). Right colonic stasis and outlet obstruction were associated with frequent use of digital pressure to assist defecation. Right colonic stasis was characterized by a low stool frequency (less than 3 per week) in 93% of cases and failure to respond to bran therapy. Outlet obstruction also showed a poor response to bran therapy but weekly stool frequency was higher than 3 in 46% of cases. Normal colonic transit time and isolated left colonic stasis were characterized by a normal stool frequency (5.8 +/- 0.05 and 4.2 +/- 0.1, respectively) and clinical help with the use of bran treatment (72 and 64%, respectively). Our study suggested that patients who complain of idiopathic constipation represent a heterogenous group of disorders. Segmental CTT determination is a simple, useful, and noninvasive test of patients with constipation.

Adolescent↗
PubMed1989

[Efficacy and tolerability of enprostil in the treatment of duodenal ulcer. Comparison with cimetidine].

Enprostil, a synthetic PGE2, has been shown to have an inhibitory effect on gastric acid secretion, a mucoprotective effect and a postprandial lowering effect on gastrin. A double blind randomized study was performed in 80 patients, in order to evaluate the efficacy and safety enprostil (35 mu b.i.d) as compared to cimetidine (400 mg b.i.d) in duodenal ulcer. Healing rates after two, four and six weeks of treatment, as based on endoscopic evaluation, were 35, 72 and 83 p. 100 for enprostil and 45, 73 and 83 p. 100 for cimetidine, respectively. There were no significant differences between treatment groups. The time to relief of nighttime and daytime ulcer pain and antacid consumption were similar in the two groups. The patient's overall subjective assessment was better in the cimetidine group, but this was not confirmed by physicians' opinions. Diarrhea was observed in 7 p. 100 of patients treated by enprostil compared with 5 p. 100 for patients treated by cimetidine. One enprostil treated patient withdrew from the trial prematurely because of abdominal pain. This study demonstrates the efficacy and safety of enprostil in the treatment of active duodenal ulcer at the dosage of 35 micrograms twice daily.

Adult↗
PubMed1989

[Protein-losing enteropathy syndrome caused by a localization of Kaposi's sarcoma in AIDS].

A 35-year-old HIV positive patient with skin and gastrointestinal localization of a Kaposi's sarcoma was admitted for severe diffuse edema. Increased alpha-I-antitrypsin clearance (150 ml/24 h) allowed us to confirm the diagnosis of protein loosing enteropathy resulting from sarcoma infiltration in the stomach, the duodenum and the entire small bowel. At autopsy, ileal ulcerations were found. Gastrointestinal involvement occurring during Kaposi's sarcoma is common and usually symptomless. The discovery of a protein loosing enteropathy in our patient suggests that this gastrointestinal involvement could play a role in the hypoalbuminemia often found in these patients.

Acquired Immunodeficiency Syndrome↗
PubMed1988

Effect of theophylline on gastroesophageal reflux in patients with asthma.

A possible role of methylxanthines in the high incidence of gastroesophageal reflux (GER) in patients with asthma has been suggested. Therefore, we used a randomized, double-blind, crossover design to compare the effects of a 1-week conventional theophylline treatment and a 1-week placebo treatment in 16 adult patients with asthma. No oral or parenteral glucocorticoids were administered, but seven patients were taking inhaled corticoids. All patients needed inhaled adrenergic drugs. At the end of each period of theophylline or placebo treatment, the patients were carefully questioned with respect to respiratory and digestive symptoms, forced expiratory flows were measured, and GER was assessed by prolonged nocturnal intraesophageal pH monitoring. Peak expiratory flow was measured three times a day throughout the study. No significant increase in GER was found with theophylline compared to placebo, and forced expiratory flows improved with theophylline (p less than 0.05 for FEV1 and p less than 0.01 for peak expiratory flow rate). There was no correlation between GER, the duration of asthma, and forced expiratory flows. Thus, our study failed to demonstrate any adverse effect of a slow-release theophylline preparation on GER in patients with asthma. These results further suggest that the presence of GER is not a contraindication to the use of a slow-release theophylline in subjects with asthma.

Adrenergic beta-Agonists↗
PubMed1988

Effects of an enkephalinase inhibitor on esophageal motility in man.

Enkephalins are short lived peptides which are rapidly cleaved by 2 membrane peptidases: an enkephalinase and a carboxypeptidase. Enkephalin-like immuno-reactivity has been demonstrated in the smooth muscle and in the myenteric plexus of the human lower esophageal sphincter (LES). Opioid receptors have been found in the gastrointestinal tract and recently an enkephalin analog has been shown to inhibit LES relaxation and modify the peristaltic progression of the esophageal contractions. Acetorphan is an enkephalinase inhibitor which prevents, at least to some extent, the hydrolysis of endogenous enkephalins. Thus, the present work was designed to study the effect of acetorphan on esophageal motility. Ten healthy volunteers (mean age: 23 years) were studied. On 2 separate days, each subject received in random order acetorphan (2.5 mg/kg intravenously at a constant rate in 20 min) or placebo. Esophageal manometry was performed with a Dentsleeve. Wet swallows (5 ml) were performed at 1 min intervals during 80 min and results were pooled in 10 min periods. Acetorphan inhibited significantly (p less than 0.02) LES relaxation 20 min after the beginning of the infusion and throughout the study. The maximal effect occurred 50 min after the beginning of acetorphan infusion and LES relaxation (m +/- SEM) was reduced from 92 +/- 2.6 to 79.5 +/- 2.9 p. 100 (p less than 0.01). Duration, amplitude, and velocity of esophageal contractions were not modified. Acetorphan an enkephalinase inhibitor, is able to reproduce the effect of IV exogenous enkephalins on LES relaxation in man. This result suggest that endogenous enkephalins might play a role in the normal control of the LES relaxation.

Enkephalins↗
PubMed1987

[Intrahepatic collections of fluid of pancreatic origin. A case].

A case of intrahepatic liquid collections of pancreatic origin is reported. A search in the literature yielded 8 cases of pancreatic pseudocysts which developed in the liver left lobe. The present case was original owing to its localization in the right hepatic lobe, to the large volume of the intrahepatic effusions and to the scarcity of underlying pancreatic symptoms. Ultrasonography and computerized axial tomography were useful aids to the diagnosis as well as to the therapeutic procedures. Surgery, which usually is a matter of discussion in chronic pancreatitis, was necessary to obtain the favourable outcome expected in such diseases.

Humans↗
PubMed1987

[Campylobacter pyloridis and gastroduodenal pathology].

After the first report by Marshall and Warren of the presence of gastritis associated Campylobacter pyloridis in antral mucosa, many groups have found the same association in many countries of Europe, USA, Japan. In France, too C.P. is found in antral mucosa. We have studied 119 dyspeptic patients; during endoscopy 3 biopsy specimens were taken, one for microaerophilic culture and 2 for pathologic examination. We found the germ in 27 p. 100 of 22 normal subjects but no culture was positive. In chronic interstitial gastritis it is found in 90 p. 100 of cases and in 98 p. 100 if a duodenal ulcer is associated. Ten patients with healed duodenal ulcer have been treated by V Penicillin: 3 millions unit/day during 2 weeks. In five cases C.P. disappeared but 2 of them relapse 2 months later.

Adult↗
PubMed1986

[Bacterial flora in gastric juice taken at endoscopy in 93 normal subjects].

Bacteriologic examination of gastric juice samples taken during endoscopy in ninety-three subjects free of endoscopically-detectable disease was performed. Mucosal pH was determined using bromocresol green dye. Among the 17 subjects with a mucosal pH exceeding 4, 11 (64%) had more than 10(5) organisms/ml. In contrast, similar counts were found in only 10 of the 76 subjects with a normal mucosal pH. The pathogens recovered were normal hosts of the upper digestive tract and a few nitrate reductase + Enterobacteriaceae. Questions still to be resolved are whether these pathogens can induce disease and whether bacterial colonization correlates with the increased gastric nitrosamine levels and microscopic mucosal lesions previously described in patients with a gastric pH above 4.

Adult↗
PubMed1986

[Measurement of colonic transit time: description and validation of a new method].

The method described by Arhan et al. for measuring colon mean transit time requires plain films of the abdomen during 7 consecutive days (0.007 Gy). A new method is described for measuring the mean segmental transit time of radio opaque markers through the human colon which aims at decreasing ray exposure. While on a diet containing 20 g of bran, a dose of 20 markers was given to the subject for three consecutive days (D1, D2, D3) at the same hours. Each dose of markers was of different shape. A plain film of the abdomen was taken at D4, D7, D10 at the same time as the ingestion of the markers. The first X ray demonstrated the number of markers at 24, 48, 72 h simultaneously and so on from 96 to 216 h for the X ray taken at D7 and D10. Mean transit time in the right, left, rectosigmoid and the whole colon was measured in 22 volunteers and was respectively 6.9 h, 9.1 h, 18.4 h, 34.4 h. The upper limit of the mean transit time (m + 2 SD) was respectively 24 h, 30 h, 44 h, 67 h in the right, left, rectosigmoid and the whole colon. This method has been validated in 20 subjects (10 volunteers and 10 constipated patients) by comparing the mean segmental transit time with the mean segmental transit time measured by the method of Arhan et al. This new method could allow to explore patients with idiopathic constipation more frequently and to better assess the treatment of constipation.

Adult↗
PubMed1986

Buflomedil kinetics in patients with liver disease.

The pharmacokinetics of single intravenous (100 mg) and oral (450 mg) doses of buflomedil was studied in 3 and 6 patients respectively, suffering from chronic liver disease. Comparisons of buflomedil kinetic parameters between the patients and healthy subjects indicate a significant increase in AUC0 infinity, T beta, u' and a significant decrease in Cle', Clnr when the patients received the oral dose, but no significant differences when the patients received the intravenous dose probably due to the small number of patients explored. The elimination of buflomedil is impaired in chronic hepatic disease. It seems advisable to reduce the usual dose to half its value when the prothrombin index is around 50% associated with a low albumin concentration and a low factor V.

Administration, Oral↗