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Biomedical subjects

N Bourgeois

Publications and source records attributed to N Bourgeois.

At least 109 records · Page 6Linked to original sources
PubMedDate not supplied

[Use of diuretics in the treatment of ascites in patients with cirrhosis].

The cirrhotic patient with ascites has an increased tubular reabsorption of sodium. Diuretic therapy allows an urinary loss of sodium. The strongest diuretics which inhibit sodium reabsorption in the ascending limb of the loop of Henle (like furosemide) are not the most effective in cirrhotic patients; indeed the increased load of sodium arriving in the distal part of the tubule is reabsorbed because of hyperaldosteronism. Potassium-sparing diuretics, like spironolactone, which act beyond the sites of reabsorption of most of the filtered sodium, are mostly effective when combined with other diuretics which impair sodium reabsorption more proximally. We propose to treat ascites by: 1. Sodium restriction (maximum: 60 mmol per day); 2. Spironolactone 100 to 500 mg per day, combined with furosemide 40 to 200 mg per day if spironolactone does not induce a natriuretic effect.

Ascites↗
PubMedDate not supplied

[Selection of patients with parenchymal cirrhosis for hepatic transplantation].

The aim of our study was to design simple and practical quantitative scores or indices suitable for deciding a pre-liver transplantation work-up in patients with parenchymal cirrhosis. A Pugh score (combining five variables) superior to 8 or a p value inferior to 0.7 of a logistic regression equation containing only two variables (score of ascites and result of 14C aminopyrine breath test) were found to be highly effective for making this decision.

Aminopyrine↗
PubMedDate not supplied

Persistent active herpes virus infection associated with atypical polyclonal lymphoproliferation (APL) and malignant lymphoma.

This study focuses on lymphoproliferative diseases associated with persistent infection by Epstein-Barr virus (EBV) and human herpes virus 6 (HHV-6). A suggestive premalignant lymphoproliferative state is distinguished from malignant lymphoma and identified as "atypical polyclonal lymphoproliferation" (APL). Sixteen cases of herpes virus (HHV)-associated APL are compared with 21 cases of HHV-associated malignant lymphomas (ML), with 108 cases of EBV or HHV-6 related acute infections mononucleosis, with 14 cases of seronegative non-specific lymphoid hyperplasia and with 304 cases of HHV-unrelated ML. Six cases of APL and two ML occurred in AIDS patients, two cases in Sjogren's syndrome, one in a kidney allograft recipient, and the remaining cases had no identified underlying disease. APL was histologically reminiscient of excessive infectious mononucleosis, while other cases of Castleman's disease or even of malignant lymphoma. Seropositive APL and ML contained significantly more virus genome than is found in latent background infection. There was no histologic difference between HHV-6 or EBV-positive APL or ML, although both viruses infect different lymphocyte populations. From histology alone, seropositive ML cases were not distinguished from seronegative ones, yet persistent active EBV and HHV-6 appear to predominate in follicular center cell- and immunoblastic lymphoma and in HOdgkin's disease. Although no a direct oncogenic activity of these viruses could be observed in our cases, they may contribute to lymphomagenesis by inducing progressive lymphoproliferation.

Adolescent↗
PubMedDate not supplied

Bronchogenic cysts in children.

Three children with symptomatic bronchogenic cysts are presented. Because of the variability in clinical presentation and the shortcomings of diagnostic procedures, bronchogenic cysts present a diagnostical problem. In view of the risk of serious complications an aggressive attitude towards all congenital cystic lung lesions is advised, even when they are asymptomatic. Surgical excision assures an excellent outcome in most cases, and is therefore the treatment of choice.

Bronchogenic Cyst↗
PubMedDate not supplied

Surgical excision of pulmonary metastases from primary testicular cancer--case reports.

In disseminated nonseminomatous testicular cancer, chemotherapy is the first choice because this treatment can be curative. To illustrate the particular indications for surgical excision of pulmonary metastases from primary nonseminomatous testicular cancer three patients are presented who were operated on during the past two years. Surgery is recommended to ascertain the histologic nature of remaining metastases after chemotherapy, when there is no further response to chemotherapy or a partial response only. Histologic findings range from necrotic pulmonary lesions to benign transformation or viable tumor. These results should guide further therapy, particularly to decide whether chemotherapy should be continued or changed.

Adult↗
PubMedDate not supplied

Icterogenic hepatocellular carcinoma and polygonal cell carcinoma with fibrous stroma (fibrolamellar hepatocarcinoma).

Hepatocellular carcinoma (HCC) associated with obstructive jaundice by direct invasion or migration of tumor tissue into the biliary system has been described as icterogenic hepatocellular carcinoma (IHCC) or icteric type hepatoma. Fifty-eight such cases have been reported in literature since 1947. Curative treatment and prognosis depend directly on early appearance of icterus and its correct interpretation. Recently, attention has been paid to polygonal cell carcinoma with fibrous stroma (PCFS) as a well differentiated, low grade and transient type of HCC, probably distinguishable from classic HCC by etiological and epidemiological features. The combination of IHCC and PCFS is very rare; to our knowledge only one such case has been reported yet. We had the opportunity to observe and treat such a case, which will be reported in this article and will be compared with cases described in the literature.

Adult↗
PubMedDate not supplied

[Treatment of adenocarcinoma of Vater's ampulla].

We reviewed the records of 51 patients. In two-thirds of the cases the main symptom was icterus; one third presented with pain. The whole group underwent a retrograde choledocho-pancreatography. An abnormal papilla was found in 80% of the cases. This finding proved to be of sufficient diagnostic importance without the necessity of an associated choledocho-pancreatography for diagnostic confirmation. Although in the majority of the cases the choledochus proved to be dilated, pancreatic duct enlargment was only noted in 50%. The only treatment in the very elderly patient was endoscopic sphincterotomy. Younger patients underwent a duodeno-pancreatectomy preceded by an endoscopic sphincterotomy. The morbidity and mortality associated with endoscopic opacification of the biliary and pancreatic ducts and sphincterotomy in this setting is much higher than for all other indications in general. For this reason we propose to perform a choledocho-pancreatography only when indispensable for diagnostic purposes (nl. papilla) or when endoscopic sphincterotomy is the chosen treatment modality.

Adenocarcinoma↗
PubMedDate not supplied

[Complementarity and limits of the different technics of pancreatic morphologic investigation for the diagnosis of acute pancreatitis and complications (author's transl)].

The authors have previously proposed the endoscopic retrograde cholangio-pancreatography as a technic to be used systematically in acute pancreatitis; it offers a precise diagnosis of microlithiasis and a possibility of an immediate endoscopic treatment. They have studied the pancreatographic patterns in 355 cases of clinical acute pancreatitis; the pancreatogramm allows the diagnosis of chronic pancreatitis in acute phase in 1/3 of the patients; necrosis is present in 12% of the 240 patients without any radiological signs of chronic pancreatic disease. The computerized axial tomography gives a precise definition of the extra-pancreatic extension of the necrosis; the ultra-sound technic is better for the late complications of acute pancreatitis. The authors consider that these 3 examination technics must be performed at the admission or/and be part of the workup before surgery.

Acute Disease↗
PubMedDate not supplied

[Viral hepatitis].

Explore the source record for details and available documents.

Female↗
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Endoscopic varix ligation: a promising new technique?

Endoscopic varix ligation is a new promising endoscopic method which compete with endoscopic sclerotherapy both during acute bleeding and the chronic setting where the aim is to obliterate varices as soon as possible with minimal side effects.

Esophageal and Gastric Varices↗
PubMedDate not supplied

Long-term disease-free survival after liver transplantation for alveolar echinococcosis.

Alveolar echinococcosis of the liver is an uncommon and fatal disease resulting from hepatic infection by Echinococcus multilocularis. Liver transplantation has been proposed for unresectable cases with chronic complications, but up to now, no long-term follow-up has been reported. We report the case of a 29-year-old female who is disease-free more than six years after liver transplantation for a recurrent alveolar echinococcosis of the liver, confirming the place for liver transplantation in this disorder.

Adult↗
PubMedDate not supplied

Increased transaminases in psychiatry: a case report.

We report the case of a patient admitted to the hospital with psychiatric troubles. Soon after admission, he presented severe hepatitis of unknown origin. Careful review of the charts, transvenous liver biopsy, right heart and hepatic pressure measurements, negative toxicologic and viral screenings were highly suggestive of hypoxic hepatitis. Indeed, the patient had previously been treated for a decompensated cardiomyopathy and medications stopped prior to the current admission. Without clear clinical evidence of heart failure he presented a brief malaise two days before the increase in liver enzymes. Holter heart recording showed afterwards bouts of ventricular tachycardia. Treatment with Dobutamine and antiarrythmics led to a rapid decrease of transaminase levels and recovery in liver function. Unfortunately, he died three weeks later from his cardiomyopathy. This case illustrates the need for cardiovascular work-up in the context of hepatitis from unknown origin.

Adrenergic beta-Agonists↗