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Biomedical subjects

J M Raymond

Publications and source records attributed to J M Raymond.

At least 37 records · Page 2Linked to original sources
PubMed1996

[Patient's opinion following an upper digestive endoscopy in ambulatory care. Results of a national survey (II)].

OBJECTIVES: The aim of the study was to evaluate patient satisfaction after esophagogastroscopy performed in ambulatory care and to correlate it with conditions of usual practice. METHODS: Study was proposed to the French gastroenterologists. During a week, 2 questionnaires were filled out for each esophagogastroscopy performed in ambulatory care: one recorded conditions of examination and one was independently filled out by the patient one day after endoscopy. RESULTS: Seven hundred and thirty nine gastroenterologists and 4,585 patients participated in the study. Among the patients, 3,758 (82%) filled out the questionnaire. Sedation was performed in 36.6% of cases. Subsequent endoscopy would be accepted by 79.3% of patients in the same conditions. Acceptance was significantly better with use of sedation and use of propofol. Without sedation, independent factors associated with a better acceptance were: male gender, absence of habitual benzodiazepine medication, endoscopy performed in private practice or private hospitals, smaller size of endoscope. CONCLUSION: This study underlines factors associated with a good acceptance of esophagogastroscopy without sedation and could help to improve decision-making regarding use of sedation.

Adult↗
PubMed1996

[Appearance of hepatitis C virus replication and increase of aminotransferase activity after corticoid treatment of presumed autoimmune hepatitis. 2 cases].

Autoimmune-related and hepatitis C virus-related chronic hepatitis are sometimes difficult to differentiate. We report two cases of chronic hepatitis with high levels of serum anti-smooth muscle antibodies, positive hepatitis C virus serology, and negative serum RNA, which were first treated with corticotherapy. Both patients responded with marked increases in aminotransferase levels, and positive RNA. The first case may have been type 1 autoimmune hepatitis with hepatitis C virus infection, and the second chronic hepatitis C with positive serum auto-antibodies. The increase in viral antigen expression on the surface of the hepatocytes following corticosteroid treatment may have favoured a direct cytopathogenic effect of hepatitis C virus.

Aged↗
PubMed1995

Gallstone recurrence after successful lithotripsy.

We report the recurrence rate of gallstone within 5 years after successful lithotripsy. One hundred and fifty consecutive patients (solitary stones, 102 patients; multiple stones, 48 patients) were followed up for a median of 42 months (range 6-72) after stone clearance and cessation of bile acid therapy. No patient received any therapy to prevent recurrence. Thirty-seven patients developed recurrent gallstones. Probabilities of recurrence were (mean +/- SD) 6.6% +/- 2%, 15.7% +/- 3%, 22.8% +/- 3.6%, 29.7% +/- 4.5%, 32.2% +/- 5% at 1, 2, 3, 4 and 5 years, respectively. The recurrence rate was lower in patients who had solitary stones than in patients with multiple stones (26.1% versus 47% at 5 years, respectively; p<0.009 - log rank test). Only five patients developed recurrent symptoms or stone complication (14%). We conclude that the recurrence rate after successful lithotripsy is lower than expected from dissolution studies, due to a low recurrence rate in patients who had solitary stones.

Adolescent↗
PubMed1995

[Quality of psychomotor recovery after colonoscopy under general anesthesia using propofol. Value of tests of awakening].

Achieving colonoscopy under general anaesthesia entails the problem of ambulatory-care anaesthesia, in particular because perception of patient's recovery determines to some extent the length of monitoring following colonoscopy. The aims of the study was to assess the quality of patient's recovery after a colonoscopy under general anaesthesia while using propofol, by means of psychomotor-tests. METHODS--Colonoscopy was performed in 40 patients according to the following anaesthetic protocol: induction: propofol 2 mg/kg, continuous support: propofol 10 mg/kg/h i.v. with a 50 mg bolus in case of insufficient sedation; series of 3 psychomotor-tests were performed the day before and 1 hour, 3 hours and 6 hours after colonoscopy. The 3 psychomotor-tests studied: coordination (Newman test), time-space orientation and short-term memory. RESULTS--Forty patients, 25 females and 15 males, underwent colonoscopy with general anaesthesia for an average time-period of 22 +/- 11 min. The mean dose of propofol used was 286 +/- 102 mg. Awakening was complete in all patients, according to physical criteria such as consciousness and cardiovascular status, 20 min after receiving colonoscopy. The average psychomotor-tests results over time were (as percentages of original values) (*P < 10(-3); **P < 0.05): [table: see text] At 6 hours, 35 patients (87.5%) had recovered to their original performance and at 3 hours, 30 patients (75%) retained 90% their former state as measured with 3 psychomotor-tests. Neither by age or sex nor by propofol doses used or length or anaesthesia, the study population differed significantly. CONCLUSION--Three hours after colonoscopy under general anaesthesia using propofol, 30 patients (75%) had recovered at least 90% to their initial performances. Newman test was the most disturbed but there was no predictive factor for the quality of recovery. Psychomotor-tests may be useful before authorizing early discharge after colonoscopy under general anaesthesia but other recommendations about conditions of discharge after sedation must be also implemented.

Anesthesia Recovery Period↗
PubMed1994

[Necrotizing amebic colitis].

We report a case of necrotizing amebic colitis in a 43 year-old patient, 10 years after a stay in Senegal, successfully treated by right hemicolectomy. Entamoeba histolytica were found in colon necrosis and amoebiasis serology was positive, leading to the diagnosis. The epidemiologic, physiopathologic, clinical and therapeutic features of this exceptional affection are described. A few cases have been previously reported in non endemic areas where pre-operative diagnosis is rarely made. In endemic areas, a conservative treatment by ileostomy and colonic lavage seems to reduce the death rate.

Adult↗
PubMed1994

[Quality assessment of colonscopies in current practice in the Aquitaine area].

UNLABELLED: Sensitivity of colonoscopy depends on the technical quality of the procedure. The aims of this study were to evaluate the usual of colonoscopy in the French area of Aquitaine and to determinate the factors associated with a procedure of good quality. Thirty four gastroenterologists prospectively recorded indications, conditions of practice and results of the colonoscopies that were performed during 4 consecutive weeks. Six hundred and eighty six colonoscopies were analysed, performed in 387 women and 299 men, mean age: 59.9 years. INDICATIONS: irritable bowel syndrome: 34%, patients belonging to high risk groups: 30%, recent transit disturbance: 27%, rectal bleeding: 23%, positive fecal occult blood test: 4.3%. Preparations: polyethylene glycol (PEG) 78%, in 2 doses: 20%; PEG alone: 43%, associated with enemas and laxatives: 19%, with enemas: 14%, with laxatives: 2%; minimum-residue diet before colonoscopy: 58%. The caecum was reached in 86% of colonoscopies. Ninety-nine colonoscopies were incomplete. Fifty one per cent of colonoscopies reached the caecum with visualization of total colic mucosa, 35% reached the caecum with one at least imperfectly seen colic area.(ABSTRACT TRUNCATED AT 250 WORDS)

Colonoscopy↗
PubMed1992

Low early gallstone recurrence rate after successful extracorporeal lithotripsy in patients with solitary stones.

Piezoelectric lithotripsy with the EDAP LT-01 machine combined with adjuvant bile acid therapy results in complete clearance of radiolucent gallstones in selected patients. We assessed stone recurrence rate in 84 patients with complete clearance of stone fragments and followed up at least 12 months after cessation of bile acid therapy (mean 17 months, range 12-33). Fifty-four patients had a solitary stone and 30 multiple stones. Bile acid therapy was continued for 3 months after complete fragment stones clearance which was ascertained by two consecutive ultrasound examinations. Stone recurrence was assessed by ultrasonography at 6 and 12 months, and then at least once a year. Gallstone recurrence occurred in 5 patients (6%) between 9 and 12 months with no further recurrence up to 33 months. The rate of recurrence at one year was 3.7% in patients with a solitary stone and 10% in patients with multiple stones. Only one patient with stone recurrence had recurrent biliary pain. We concluded that early gallstone recurrence rate after successful lithotripsy seems to be low in patients with solitary stones.

Adolescent↗
PubMed1991

[Possible sexual transmission of hepatitis C virus].

The development of hepatitis C virus (HCV) serology has made it possible to identify high-risk populations. The predominant mode of contamination is parenteral, but the relative frequency of the so-called sporadic hepatitis C cannot be explained in this way, and this raises the question of possible sexual contamination. The risk of HCV being transmitted by sexual intercourse has been studied in 30 couples, each with one infected partner. Among the 30 HCV seropositive subjects, 18 were followed up for chronic hepatitis and 2 for haemophilia; 10 were recruited in sessions of blood donation. The other 30 partners were tested for HCV seropositivity and investigated for other possible risk factors by means of a questionnaire. Three of them had antibodies to HCV, but only one, whose partner had chronic hepatitis, showed no other source of contamination. The prevalence of HCV positivity was 3.3 percent overall and 5.5 percent in the chronic hepatitis group. Thus, the risk of HCV heterosexual contamination is low when compared with that of the other sexually transmitted diseases. However, the prevalence of HCV in this population seems to be 5 to 10 times higher on average than in the general population.

Adult↗
PubMed1991

Treatment of gallstones with piezoelectric lithotripsy and oral bile acids. A multicenter study.

The efficacy of the combination of piezoelectric lithotripsy and oral bile acids in the treatment of gallbladder stones was assessed. Three hundred and sixty-three patients with symptomatic radiolucent gallstones in functioning gallbladder were treated in five medical centers using the same protocol with the EDAP LT 01 lithotripter. No anesthesia, analgesia or sedation was used. After one session of lithotripsy, fragmentation was observed in 89% of the patients, and satisfactory fragmentation (fragments less than or equal to 5 mm) in 29%. The satisfactory fragmentation rate was higher in patients with solitary stones less than or equal to 20 mm than in patients with solitary stones 21-35 mm or multiple stones (p less than 0.001). After multiple sessions (mean 1.6 session/patient, range 1-5) the overall rate of satisfactory fragmentation was 50%. After 12 months on oral bile acid therapy, complete clearance of the gallbladder was observed in 69% of patients with solitary stones less than or equal to 20 mm, 25% of patients with solitary stones 21-35 mm and 37% of patients with multiple stones. No complication was observed during the lithotripsy. During follow-up under bile acid therapy, there were five complications (1.4%): four patients had acute cholecystitis and one had mild, self-limited pancreatitis. We conclude that piezoelectric lithotripsy with the EDAP lithotripter is a safe and effective treatment which can be performed in outpatients. Satisfactory fragmentation and rapid disappearance of stones are obtained mainly in patients with solitary stones less than or equal to 20 mm.

Administration, Oral↗
PubMed1990

[Treatment of gallbladder lithiasis by piezoelectric extracorporeal lithotripsy].

We report the results of extracorporeal piezoelectric lithotripsy of gallbladder stones, using the EDAP LT 01 device, in 60 patients treated without anaesthesia or analgesia. Fragmentation was satisfactory (i.e. with fragments less than 5 mm wide) in 31 patients (52 per cent) after multiple sessions (mean: 1.6). The satisfactory fragmentation rate was higher in patients with stones smaller than 20 mm (63 vs 8 per cent; P less than 0.01) and not different in patients with solitary or multiple stones (53 vs 50 per cent). After bile acid dissolution treatment during 3, 6 and 12 months, the stone-free rates were 23, 41 and 64 per cent respectively, and significantly better at 3 and 6 months in patients with satisfactory fragmentation (42 vs 4 per cent; P less than 0.05, and 71 vs 9 per cent; P less than 0.01). Fourteen patients (23 per cent) reported biliary colic, but only one required cholecystectomy. No severe complication was observed. Piezoelectric lithotripsy is safe, requires short hospitalization and gives interesting results when the stones are less than 20 mm wide.

Adult↗
PubMed1990

[Evaluation of decontamination procedures used at digestive endoscopy units in Gironde].

Decontamination procedures used for endoscopes were noted in 23 digestive endoscopy units, public and private, in the department of Gironde and compared to recommended procedures. Serial, bacteriological samples were obtained from one esogastroscope and one colonoscope in each unit, after upper endoscopy and colonoscopy diagnostic procedures at the end of the endoscopy session. Six units of 23 used complete decontamination procedures. In the 17 other units, principal errors of decontamination procedures were: inadequate cleaning of internal channel of scopes (12 units) and lack of utilization of glutaraldehyde between each endoscopy (8 units). Bacteriological samples were negative in 11/12 endoscopes after a complete decontamination procedure and in 8/39 after an inadequate procedure (p less than 0.01). Complete procedures are efficacious but not used often enough. Information and changes in endoscopic practices are necessary in digestive endoscopy units.

Bacterial Infections↗
PubMed1989

[Tissue effects of extracorporeal lithotripsy on a model of experimental biliary calculi in dogs].

Extracorporeal shock waves represent a new method to treat gallstones. This study was designed to evaluate: 1) the effectiveness of a recently available lithotripter (EDAP LT 01) for gallstone fragmentation; 2) adverse tissue reactions after treatment; 3) the optimum conditions for use of this apparatus in man. A human cholesterol stone was surgically implanted into the gallbladder of ten 20-25 kg mongrel dogs. One dog was used as a control. The other nine animals were divided into three groups (A, B and C). Two 60 min sessions of lithotripsy were carried out twice a week. Sonographic and CT examinations were performed 9 and 16 days after operation. The animals were killed 21 days after operation. Satisfactory fragmentation was obtained in 4 of the 9 animals, and in 2 dogs no stone fragments were detected. Fragments were found in the common bile duct in 5 dogs. In 2 animals a pathologic aspect of the papilla of Vater was observed. Marked hematoma was observed in the animals treated at 5 and 10 pulses/sec. In 5 cases, hematoma was observed in the gallbladder and in one case the gallbladder was ruptured. Hematoma was also noted in the hepatic vascular bed in 3 animals. Except for microscopic hemorrhagic lesions observed at the base of the right lung, no lesions were detected in any other organ. Shock waves produced by the EDAP LT 01 are effective for fragmentation of gallstones. However, in view of the tissue reactions observed at the higher pulse rates, the pulse rate should not exceed 2.5 pulses/s for use in man.

Animals↗