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Biomedical subjects

M Delhaye

Publications and source records attributed to M Delhaye.

At least 55 records · Page 3Linked to original sources
PubMed1992

Factors related to early mortality in cirrhotic patients bleeding from varices and treated by urgent sclerotherapy.

Variceal haemorrhage in cirrhotic patients carries a high early mortality even when balloon tamponade or emergency sclerotherapy are applied. The aim of this study to identify patients dying within six weeks of their first variceal haemorrhage. One hundred and twenty one patients with parenchymal cirrhosis presenting with the first variceal bleeding episode between June 1983 and December 1988 were studied. Nineteen patients were excluded for various reasons. Emergency sclerotherapy was carried out in cases of active bleeding or where there were endoscopic signs of recent bleeding, and then regularly repeated afterwards. Of the 24 variables studied and included in a multivariate analysis using a logistic regression model, three had an independent prognostic value: encephalopathy, prothrombin time, and the number of blood units transfused within the 72 hours of time zero. The subsequent regression equation was able to predict 89% of the patients who will die and 97% of the patients who will still be alive six weeks after their first variceal haemorrhage treated by sclerotherapy. Pugh score was less discriminatory than these last three variables in terms of accuracy of adjustment, goodness of fit to the model, receiver operating characteristic curves, and percentage correct prediction. To measure the accuracy of the prediction rule, our model was applied to another series of 28 cirrhotic patients admitted with their first variceal bleeding during the next period (January 1989 to May 1990). Death and survival were correctly predicted in respectively 82% and 94% of the cases. The use of this score is recommended for the selection of patients with high early mortality after variceal bleeding despite sclerotherapy, and for the design of new therapeutic trials.

Acute Disease↗
PubMed1992

Stenting in severe chronic pancreatitis: results of medium-term follow-up in seventy-six patients.

Between January 1985 and September 1989, 75 patients presenting with severe chronic pancreatitis with distal stricture and upstream dilatation underwent stenting of the main pancreatic duct (MPD) through the major papilla (n = 54) or minor papilla (n = 21) in order to drain the predominant duct through a 10F plastic prosthesis. All patients had undergone biliary and pancreatic sphincterotomy with a few cases of complications, and the majority (84%) also ESWL in the period from October 1987 onwards without complications. Relief of pain (94%) occurred parallel to a decrease in the MPD diameter. In a mean follow-up period of 37 months improvement of the nutrition status and relief of pain was seen. Clogging of these large plastic stents was treated by replacement or by another endoscopic or surgical procedure. Complications were treated endoscopically. Further measures necessary due to failure of stenting consisted of laterolateral pancreatico-jejunostomy in 15% of patients and placement of self-expanding 18F metal mesh stents in 29%. There was no mortality due to surgery. It is concluded that stenting of distal strictures in the MPD can lead to rapid resolution of pancreatic pain due to ductal hypertension and is the best means for determining the cause of pain, providing an alternative to surgery. Significant improvement of a stricture by prolonged stenting is however unusual, and such patients treated endoscopically require close follow-up with stent replacement approximately once a year.

Adult↗
PubMed1991

Stenting in severe chronic pancreatitis: results of medium-term follow-up in seventy-six patients.

Between January 1985 and September 1989, 75 patients presenting with severe chronic pancreatitis with distal stricture and upstream dilatation underwent stenting of the main pancreatic duct (MPD) through the major papilla (n = 54) or minor papilla (n = 21) in order to drain the predominant duct through a 10 F plastic prosthesis. All patients had undergone biliary and pancreatic sphincterotomy with a few cases of complications, and the majority (84%) also ESWL in the period from October 1987 onwards without complications. Relief of pain (94%) occurred parallel to a decrease in the MPD diameter. In a mean follow-up period of 37 months improvement of the nutrition status and relief of pain was seen. Clogging of these large plastic stents was treated by replacement or by another endoscopic or surgical procedure. Complications were treated endoscopically. Further measures necessary due to failure of stenting consisted of laterolateral pancreatico-jejunostomy in 15% of patients and placement of self-expanding 18 F metal mesh stents in 29%. There was no mortality due to surgery. It is concluded that stenting of distal strictures in the MPD can lead to rapid resolution of pancreatic pain due to ductal hypertension and is the best means for determining the cause of pain, providing an alternative to surgery. Significant improvement of a stricture by prolonged stenting is however unusual, and such patients treated endoscopically require close follow-up with stent replacement approximately once a year.

Adult↗
PubMed1990

Enhanced expression of a 27 kD protein during diethylnitrosamine-induced hepatocarcinogenesis in rats.

Patterns of neosynthesized cellular proteins from normal rat liver and from diethylnitrosamine-induced neoplastic nodules and hepatocellular carcinomas were analyzed by radiolabeling and fluorography of two-dimensional gel electrophoregrams. Three proteins exhibited a significant and reproducible increase in labeling intensity in the nodules (n = 5) and in the tumors (n = 10) as compared to the normal liver (n = 10). Two of those proteins (MW 31 and 33 kD, pI of 5.25, 5.15 respectively) are secreted proteins and as yet, we have no clue as to their nature. The third one is an intracellular protein of 27 kD pI 5.5. Several similarities in physico-chemical properties (MW, pI, phosphorylated state, low methionine content) indicate that this 27 kD protein might be the 27 kD heat shock protein (27 HSP). This is further supported by our observation that the cadmium-induced 27 HSP comigrates with our 27 kD protein.

Animals↗
PubMed1990

Non-surgical management of severe chronic pancreatitis.

The observation that drainage of the MPD in selected cases of severe chronic pancreatitis has a radical benefit on pain reduction supports the hypothesis that pain is mainly due to obstruction of the MPD. Further follow-up study is needed to assess whether endoscopic management can prevent progression of the disease and especially postpone the onset of diabetes and steatorrhea. The iterative character of the endoscopic management is at least an advantage when compared with surgery, which, in principle, might be considered definitive in only one operation. The present excellent results of non-surgical management of chronic pancreatitis suggest that these new procedures will find a prominent role similar to that already achieved for biliary tract procedures. Therapeutic endoscopy of the pancreas and chronic pancreatitis has focused on the 'stone and stricture' nature of the disease, and techniques have developed accordingly.

Bile Ducts↗
PubMed1989

[Original survey and analysis method of the vestibulo-ocular transfer using the microcomputer. Contribution to the diagnosis of vestibular pathology].

This report presents a new and well-tolerated technique that quickly tests the labyrinthic system by moving the head, via a helmet mounted on a servo controlled torque motor, with a sinusoidal stimulus small enough (10 to 15 degrees of amplitude) to avoid the triggering of quick phases. A personal PC (Olivetti M24) digitizes the amplified and filtered eye and head movement data for storage and analysis. Compared to the low frequency patterns of stimulation by the sinusoidal acceleration test (SHA), our procedure, because of the reduced mass of inertia, investigates the bandwidth of frequencies corresponding to those normally incurred during natural movements. For each of 14 normal persons, 1 patient with Ménière's disease and 2 with a history of labyrinthic trauma, the phase difference of the eye position relative to the head and the gain are computed. The mean phase lag of 180 degrees, from 0.1 Hz to 2.5 Hz, in the normal group maintains steady gaze during head rotation in significant opposition to the phase lag, varying at 1 Hz from 264 to 354 degrees, of the patients with vestibular disorders. The phase lag is the most reliable parameter in detecting vestibular dysfunction and its correct determination can be made in a few minutes, at physiological frequencies, by our low-cost simplified method.

Acceleration↗
PubMed1988

A note on 'aging-pharmacodynamics' with application to the analysis of the age-dynamics of adipocyte response to epinephrine and insulin.

This note aims at clearing some semantic problems in the literature concerning the analysis of the effect of age on dose-response curves as well as standardize the way such data should be presented. In particular it is shown how to assess the age-dynamics (i.e. the pattern of change as a mathematical function of age) of the sensitivity of a receptor system to a given agent, of the quantitative overall changes of the cellular response apparatus which affect response capacity, and of the interaction between different simultaneously acting agents. The concepts and theory are illustrated using as an example the in vitro isolated rat fat cell (or adipocyte) which we have recently studied extensively with regards to the age-dynamics of its lipolytic response to epinephrine and insulin. This 'aging-pharmacodynamics' analysis has led to the surprising conclusion of a rebound effect of age (decrease at maturity followed by increase at old age) on the sensitivity of the fat cell to epinephrine and to its antagonist (with respect to lipolysis) insulin, as well as a negative correlation of these sensitivities with fat cell size.

Adipose Tissue↗
PubMed1987

Characterization of gamma-glutamyltransferase from neoplastic and non-neoplastic liver tissues in man and during rat liver hepatocarcinogenesis.

The activity and the affinity for concanavalin A-Sepharose (Con A) of liver gamma-glutamyltransferase (gamma GT) were investigated in man, under various clinical conditions and in rats during experimental hepatocarcinogenesis. In man, gamma GT activity was higher than normal in hepatomas and (except for 1 case of hemochromatosis) also higher in the surrounding cirrhotic liver. The proportion of gamma GT which did not bind to Con A (Con A- form) was also increased in the tumors and in the surrounding liver, yet (with the same exception as above) to a greater extent in the hepatomas. In rat, gamma GT activity was higher in fetal liver (15-fold) and in hepatocarcinomas (10-fold) than in normal adult liver; total liver gamma GT activity gradually increased during progression from foci of altered cells to neoplastic nodules and tumors. The proportion of the Con A- form of gamma GT in the early or late stage of the carcinogenic process did not significantly differ from that in normal adult or regenerating rat liver, i.e. about 20% of the total activity. By contrast, nearly all the gamma GT from fetal rat liver bound to Con A. This suggests that gamma GT expression in rat liver carcinoma does not correspond to so-called retrodifferentiation process.

Adolescent↗
PubMed1987

Increased plasma motilin concentrations in small cell carcinoma of the lung.

Plasma samples from 21 patients with small cell carcinoma of the lung were screened for pancreatic polypeptide, somatostatin, motilin, and vasoactive intestinal polypeptide. One patient had severe impairment of both renal and liver function. In the 20 remaining subjects vasoactive intestinal polypeptide concentrations were normal, and only two patients had increased concentrations of somatostatin. Increases in pancreatic polypeptide were detected more commonly (7/20), but these may have been non-specific age related increases. The major finding was high concentrations of motilin (greater than 496 pg/ml) in 17 of 20 patients. Plasma motilin was subsequently assayed in 16 more patients with lung cancer, including 10 patients with non-small cell carcinoma of the lung. At concentrations over 900 pg/ml plasma motilin appears to be a tumour marker for small cell carcinoma of the lung with acceptable sensitivity (59%) and specificity (78%). The origin of increased plasma motilin in small cell carcinoma of the lung was investigated. Bombesin (gastrin releasing peptide), a peptide known to stimulate the release of motilin in man, was, as in previous studies, detected in tumour but not in plasma, except in one patient out of 21. Immunohistochemical studies failed to detect motilin antigen in biopsy samples. Motilin tumour content was found to be low in tumour tissue from three patients with small cell carcinoma of the lung who had appreciable hypermotilinaemia and from three patients with non-small cell carcinoma of the lung who had either normal or slightly raised plasma motilin concentrations. The stimulus to motilin secretion in patients with small cell carcinoma of the lung remains unclear.

Adult↗
PubMed1987

Comparison of elastase-1 with amylase, lipase, and trypsin-like immunoreactivity in the diagnosis of acute pancreatitis.

Serum elastase-1, amylase, lipase, and trypsin-like immunoreactivity were measured in a group of 17 consecutive patients with acute pancreatitis. When assayed within 24 h of the onset of symptoms, all enzymes were found to be elevated, thus showing similar sensitivity. Elastase-1 did not improve the diagnostic score of the other enzymes studied. Owing to their much quicker and less expensive determinations, amylase and lipase should be considered the best initial markers of pancreatic injury. However, during the course of pancreatitis, amylase and in a lesser degree lipase returned to normal in more cases than elastase or trypsin; both were still elevated in 90% of the patients 10 days after the onset of the symptoms. Thus, trypsin and/or elastase-1 should be reserved for cases of doubtful or delayed diagnosis. The specificity and the positive predictive value of these enzymes need to be evaluated.

Acute Disease↗
PubMed1987

Hepatic vascular disease after kidney transplantation: report of two cases and review of the literature.

Severe hepatic vascular disease developed in two patients 4 and 8 years after kidney transplantation, while receiving combined immunosuppressive therapy with prednisone and azathioprine. Portal hypertension and marked liver failure were observed in both cases. The diagnosis was established by histological examination of liver biopsies showing typical veno-occlusive disease of the liver associated with peliosis in both cases. Azathioprine was discontinued. Two years later one patient was asymptomatic and liver function tests were normal. The second patient died 3 years later from liver failure. Early recognition of hepatic vascular disease arising in kidney transplant recipients would be of utmost importance, as substitution of another immunosuppressive agent for azathioprine could halt the process leading to portal hypertension.

Adult↗
PubMed1986

Pancreas divisum.

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Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1985

Muscarinic cholinergic receptors in pancreatic acinar carcinoma of rat.

The active enantiomer of tritiated quinuclidinyl benzilate (3H(-)QNB) was used as a ligand to evaluate the muscarinic receptors. The 3H(-)QNB binding characteristics of muscarinic cholinergic receptors obtained from normal and neoplastic tissues were studied to determine changes in receptor properties during neoplastic transformation. Saturable and stereospecific binding sites for 3H(-)QNB are present in homogenates of rat pancreatic adenocarcinoma. The proportions of high- and low-affinity agonist binding sites are similar for neoplastic and normal tissues. The density of muscarinic receptors is higher in neoplastic (200 femtomoles/mg protein) than in normal pancreatic homogenates (80 femtomoles/mg protein). The muscarinic binding sites of the neoplastic and fetal pancreas show similar KD values which are higher than those observed for normal pancreas.

Adenocarcinoma↗
PubMed1985

Modulation of rat pancreatic muscarinic cholinergic receptors by caerulein.

To evaluate the modulation of pancreatic muscarinic receptors in two states of pancreatic growth, hypertrophy and hyperplasia, caerulein, a cholecystokinin analog, (1 microgram/kg) was administered thrice daily for 2 and 4 days to adult rats. After 2 days of treatment, pancreatic hypertrophy was well established as evidenced by increases in pancreatic weight, cellular mass and protein content. Using an increase in DNA content as an index of hyperplasia, we demonstrated that pancreatic hyperplasia occurred only after 4 days of caerulein treatment. Caerulein increased the concentration of muscarinic receptors per DNA in pancreatic homogenate by 57% over control value after 2 days of treatment without modification of the receptor affinity for the ligand QNB. This increase involved mainly receptors in the low affinity state for carbamylcholine and their concentration returned to control levels after 4 days of treatment. The functional capacity of the acini was significantly increased after 2 days of caerulein as amylase release (U/mg DNA) was significantly increased but the sensitivity of these acini to carbamylcholine was significantly decreased. After 4 days of caerulein, the functional capacity has returned towards control values but the sensitivity to carbamylcholine remained decreased. The increase in muscarinic receptor concentration could be ascribed to a general increase in cellular proteins, as part of the hypertrophic effect of caerulein. This specific effect would also explain the increased functional secretory capacity of the caerulein-treated acini but the decreased sensitivity to carbamylcholine probably resulted in changes at a postreceptor loci since the affinities of the muscarinic receptors for carbamylcholine remained unaffected.

Amylases↗
PubMed1985

Pancreas divisum: congenital anatomic variant or anomaly? Contribution of endoscopic retrograde dorsal pancreatography.

The relationship between pancreas divisum and pancreatic disease has been studied in a series of 304 patients. This congenital anatomic variant, consisting of a separate pancreatic ductal system, was diagnosed by endoscopic pancreatography and dorsal duct opacification was achieved in 97 of these patients. This anatomic variation was observed with the same frequency in cases of pancreatitis (acute and chronic) (6.9%) and in the series of patients investigated by endoscopic pancreatography taken as a whole (5.7%). Moreover, incidences of pancreatic disease in patients with and without pancreas divisum were not statistically different when compared. These results show that pancreas divisum should not be regarded as an etiologic factor in pancreatitis but should be considered as a coincidental anatomic variant encountered in nearly 10% of the population. The results obtained herein do not support the hypothesis that stenosis of the accessory papilla occurs frequently in cases of pancreas divisum. We conclude that no further therapy should be systematically proposed for patients with pancreas divisum and pancreatitis.

Adult↗
PubMed1985

Changes in lipolytic activity of isolated adipocytes from rats throughout life span.

The lipolytic response of isolated adipocytes from 1 1/2-, 6-, 24- and 32-month-old rats to various doses of epinephrine was studied. Both the basal and the maximal stimulated glycerol release were largest in the mature rats (6 months old) which had the largest adipocytes. Expressing glycerol release per unit cell surface area (which was drastically reduced with age) eliminated the difference between mature and senescent rats both in absence of epinephrine and at high doses of the hormone. However, at low epinephrine doses the adipocytes of the very young and the very old rats showed an enhanced response per unit surface area. A simple pharmacodynamic analysis based on the occupancy theory of drug-receptor interaction suggests that the sensitivity of rat adipocyte receptors is increased during senescence; this increase may be related to the decreased surface of old adipocytes. On the other hand, the decreased maximal lipolytic response during senescence may be due in part to a reduced number of receptors and to a reduced sensitivity of the cellular enzymatic system underlying lipolysis.

Adipose Tissue↗