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Biomedical subjects

L Beaugerie

Publications and source records attributed to L Beaugerie.

At least 91 records · Page 5Linked to original sources
PubMed1988

[Lithiasis of the common bile duct in the aged subject treated with endoscopy (227 patients)].

One hundred and sixteen patients aged from 65 to 80 years (first group including 39 previously cholecystectomized patients) and 161 patients aged over 80 years (second group, including 31 previously cholecystectomized patients) underwent endoscopic papillotomy for choledocholithiasis. We compared clinical, biochemical and morphological features of choledocolithiasis with early results of endoscopic papillotomy. Clinical symptoms were not different between the old and very old patients, cholecystectomized or not. Charcot's triade was observed in one third of patients. Biochemical data just before endoscopic retrograde cholangiography were not different according to groups: 21 p. 100 of the 277 patients had a biological cholestasis without elevation of bilirubin and 10 p. 100 of the patients had no abnormality of the liver function. Diagnosis of choledocholithiasis was accurately suspected in 90 p. 100 of patients. Complete removal of gallstones after endoscopic papillotomy was obtained in 95 p. 100 of patients in the first group and 93 p. 100 of patients in the second group. Morbidity and mortality rates related to endoscopic papillotomy were not different between the 2 groups (6.9 and 0.8 p. 100 in the first group and 8.7 and 3.1 p. 100 in the second group, the first group and 8.7 and 3.1 p. 100 in the second group, respectively). These results suggest that clinical and biochemical features of choledocholithiasis, and early results of endoscopic treatment do not present any particularities in the elderly.

Aged↗
PubMed1987

[Extracorporeal lithotripsy. Preliminary results in 5 patients with calculi of the common bile duct].

Extracorporeal lithotripsy was performed in 5 patients whose stones in the main bile duct could not be extracted despite wide endoscopic sphincterotomy, conventional extraction techniques (basket and balloon catheter) and attempts at mechanical lithotripsy. Fragmentation of the stones was obtained in one session in 4 patients. The fragments were spontaneously expelled in 2 patients, while additional endoscopic manoeuvres (mechanical lithotripsy, extraction after installation of a temporary prosthesis) were necessary in the other 2 patients. Failure in the 5th patient was due to the impossibility to focus the point of convergence of the shock wave on the stones. No complication related to the technique was observed.

Aged↗
PubMedDate not supplied

The role of anatomic factors in nutritional autonomy after extensive small bowel resection.

BACKGROUND: It is difficult to predict which patients with a postsurgical short bowel will require long-term parenteral nutrition. METHODS: We performed a retrospective prognostic study for the time to home parenteral nutrition or death from malnutrition (nonautonomy), on the basis of 103 patients with a residual short bowel of 17 to 150 cm. The influence of anatomic variables was summarized through the use of Cox regression model. RESULTS: Of the 103 patients included, 24 lost nutritional autonomy. Three anatomic variables were identified as having independent predictive information; remaining small bowel length (measured on small bowel x-rays; p = .0001), and jejunoileal anastomosis (p = .01) promoted autonomy, whereas end jejunostomy (p = .002) increased the risk of losing nutritional autonomy. CONCLUSIONS: On the basis of these results and on the relative weight of these variables, high-risk patients for loss of nutritional autonomy were defined as those with jejunoileal anastomosis and a remaining small bowel length < 35 cm, patients with jejunocolic anastomosis and remaining small bowel length < 60 cm, and patients with an end jejunostomy and remaining small bowel length < 115 cm. This classification was thereafter validated on a prospective series of 32 patients.

Adolescent↗
PubMedDate not supplied

[Factors associated with hyperhomocysteinemia in Crohn's disease].

AIMS: The incidence of thromboembolic disease is increased in patients with inflammatory bowel disease. Hyperhomocysteinemia is one of the risk factors for thrombosis. The aims were: 1) to assess the prevalence of hyperhomocysteinemia in a large series of patients with Crohn's disease; 2) to search for clinical and biological factors associated with hyperhomocysteinemia. PATIENTS AND METHODS: One hundred seventy-one patients with Crohn's disease (64 males, 107 females), median age 31 years (range: 16-82), were studied. The median duration of the disease was 7 years. The concentrations of homocysteine, folate, cobalamin and C-reactive protein were measured in serum from blood sample of each patient. RESULTS: The mean concentration of seric homocysteine was 14.8 micromol/L (N: 4.4 - 12.4 micromol/L). Hyperhomocysteinemia was observed in 89 patients (52%). It was significantly associated with age, sex, smoking habit, serum cobalamin level and history of ileal surgical resection (P<0.05). In the group of operated patients, there was a statistically significant association between hyperhomocysteinemia and the length of small bowel resected. In multivariate analysis, sex and smoking were associated with hyperhomocysteinemia. CONCLUSION: More than half of the patients with Crohn's disease have hyperhomocysteinemia. This result stresses the need for preventing reversible factors associated with hyperhomocysteinemia, such as smoking and cobalamin deficiency, in order to lower the thrombotic risk of patients with Crohn's disease.

Adolescent↗
PubMedDate not supplied

Improvement in protein absorption with a small-peptide-based diet in patients with high jejunostomy.

We compared urinary and fecal excretions of fluid, electrolytes, and nutrients in six patients with a high jejunostomy during three randomized consecutive 3-day periods of total enteral nutrition with three diets differing only by the degree of hydrolysis of the protein moiety: whole proteins, their hydrolysate (63% nitrogen as small peptides with < 1000 M), and the two mixed together. Daily nitrogen absorption was significantly enhanced with the small-peptide and mixed diets (14.3 +/- 3.4 and 13.1 +/- 2 g, respectively) compared with the whole protein diet (10.9 +/- 2.4 g, p = 0.012). Concomitantly, blood urea nitrogen and urinary urea excretion increased with the small-peptide diet. Apparent absorption of fat and calories, fecal weight, and urinary and fecal excretions of sodium, potassium, calcium, and magnesium remained unchanged. We conclude that a small-peptide-based diet may be beneficial in patients with short-bowel syndrome.

Aged↗
PubMedDate not supplied

[The Fitz-Hugh-Curtis syndrome. Apropos of an unusual hepatic ultrasonic aspect].

A 22 year old woman was diagnosed as having a Fitz-Hugh and Curtis syndrome (FHCS) or venereal perihepatitis during laparoscopy for investigation of pain in right hypochondrium and fever. Abdominal ultrasonography images presented an unusual appearance suggestive of a perihepatic effusion and of thickening of Glisson's capsule, lesions that were confirmed on laparoscopy. This ultrasound image could not be formally distinguished from a normal variant, but ultrasonography is still a valid method of diagnosis of FHCS. An acute cholecystitis in a young woman should suggest the diagnosis; absence of a right renal, hepatic or gallbladder anomaly should lead to investigation by ultrasound of the possible presence of an abdominal effusion of fluid and pelvic inflammation. Perihepatitis is confirmed on laparoscopy, which also allows sampling for bacteriologic and serologic tests to identify the causal germ: gonococcus and particularly Chlamydia trachomatis. Treatment consists of administration of specific antibiotics (ampicillin or doxycycline).

Acute Disease↗
PubMedDate not supplied

[The clinical activity of Crohn's disease in the Paris area is maximal in the spring].

The aim of this study was to look for seasonal fluctuations in the clinical course of Crohn's disease. Eighty-three patients residing in the Paris area were included in the study and they had all undergone continuous clinical monitoring throughout the first three years of the disease. During this period, the clinical activity of the disease was ranked monthly on a semi-qualitative scale ranging from 0 to 4. The dates of corticosteroid treatment and of resection surgery carried out during the first three years of the disease were also recorded. The mean clinical score varied significantly (P < 0.0001) for different months of the year, the three highest scores being recorded during the three months of Spring-time (April, May and June). The number of months of corticosteroid treatment differed significantly (P < 0.05) for the various seasons, the six highest values being reported during Spring and Summer months. The number of intestinal resections differed significantly (p < 0.05) during different seasons, the highest incidence again being reported during Spring. This study demonstrates seasonal variations in the clinical course of Crohn' disease in the Paris area, with a peak occurring in the Spring.

Adrenal Cortex Hormones↗
PubMedDate not supplied

[Multifocal inflammatory leukoencephalopathy: a complication of chemotherapy by fluorouracil and levamisole].

Two female patients with an adenocarcinoma of the colon (Duke stages B and C) underwent colectomy followed by adjuvant chemotherapy combining 5 fluorouracil (5 FU) and levamisole. Secondary neurological manifestations occurred in both patients including vertigo, nausea and vomiting, dizziness with loss of balance, slow ideation, impaired memory, headache and, on one case, central origin facial paralysis. Symptoms appeared between the 11th and 34th week of treatment. The patients had received 9 to 30 g 5 FU and 2.7 to 7.6 g levamisole. CT scan and/or MRI first suggested cerebral metastases then demyelinisation. The clinical signs disappeared spontaneously in less than one month. The brain images were unchanged. The 5 FU/levamisole combination was undoubtedly responsible for the neurological manifestations. Levamisole may have potentialized the effect of 5 FU leading to demyelinisation. Whether chemotherapy should be stopped or not is debated.

Antineoplastic Combined Chemotherapy Protocols↗
PubMedDate not supplied

[HIV enteropathy].

HIV enteropathy is defined, according to authors, by intestinal histological anomalies presumed to be induced by HIV and/or the chronic diarrhea of AIDS progressing in the absence of any detectable intestinal infectious pathogen. HIV can certainly infect the mononuclear cells of the chorion of the intestinal mucosa, and probably certain colonocytes. The links between infection of these cells and HIV enteropathy remain very poorly understood. Certain authors attribute a preponderant role to possible abnormalities of enterocyte renewal induced by HIV, and others to intestinal mucosal inflammation induced by the infection and activation of lymphocytes of the mucosal chorion. Multifactorial, anatomical and functional, involvement of the mucosal barrier of the entire intestine is no doubt closest to the truth.

CD4-Positive T-Lymphocytes↗