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Biomedical subjects

P Burtin

Publications and source records attributed to P Burtin.

At least 37 records · Page 2Linked to original sources
PubMed1998

Gastroesophageal endoscopic signs of cirrhosis: independent diagnostic accuracy, interassociation, and relationship to etiology and hepatic dysfunction.

BACKGROUND: The main objective of this prospective study was to evaluate the independent diagnostic accuracy of gastroesophageal endoscopic signs for cirrhosis. METHODS: Endoscopic signs were evaluated in vivo by one observer and on standardized videotape recordings by a consensus opinion of two endoscopists, with the stomach and esophagus examined both separately ("blind video") and together ("unblind video") in 168 consecutive patients with cirrhosis (n = 91), with non-cirrhotic liver disease (n = 29), and without liver disease (n = 48). The results were then tested in 149 different patients. RESULTS: Discriminant analysis of the "blind video" examination, considered to be the reference examination, showed that esophageal varices and portal hypertensive gastropathy had independent diagnostic accuracy (> or = 87%) for cirrhosis regardless of control group. However, in the "unblind video" and in in vivo examinations with different control groups, these results were altered. Prior knowledge of gastric patterns influenced the assessment of esophageal patterns. There was no independent association between portal hypertensive gastropathy or esophageal varices and the etiology of liver disease or the Child-Pugh score. CONCLUSIONS: When methodologic biases are eliminated, esophageal varices and portal hypertensive gastropathy have independent diagnostic accuracy for cirrhosis: esophageal varices had a diagnostic accuracy of 77% at the first step and increased to 89% with portal hypertensive gastropathy at the second step.

Adult↗
PubMed1998

Metastatic gastric cancer arising from breast carcinoma: endoscopic ultrasonographic aspects.

Linitis plastica of the stomach was diagnosed in four patients. Endoscopic ultrasonography (EUS) was performed in four cases; they were monitored by EUS and had their treatment adapted accordingly. According to the present study, the typical criteria of gastric linitis at EUS are: (a) rigidity of the gastric wall; (b) a wall thickness exceeding 6 mm; (c) a second enlarged layer marginally more echogenic than the fourth hypoechogenic layer (muscularis propria); (d) a third hyperechogenic enlarged layer; and (e) a poor demarcation between layers. Gastric linitis appears more likely to be specific metastasis from lobular breast carcinoma. In most of the follow-up cases, EUS showed correlation with a subsequent decrease of the CA15.3 level. At present, EUS seems to be the most effective and least invasive examination for clinical diagnosis and treatment surveillance of secondary gastric linitis arising from infiltrating lobular carcinoma (ILC) of the breast.

Aged↗
PubMed1998

Clinical relevance of therapeutic drug monitoring of digoxin and gentamicin in the saliva of children.

Digoxin and gentamicin are widely used in pediatric medicine, and therapeutic monitoring is mandatory because of their narrow margin of safety and wide interpatient and intrapatient pharmacokinetic variabilities. Saliva sampling may be of potential interest, especially in children, in whom blood sampling is often difficult. In 11 children treated with digoxin for various cardiac conditions, and in 24 children treated with gentamicin (14 patients were administered gentamicin three times a day, and 10 once-daily), drugs levels were measured in plasma and saliva. There was no correlation between plasma total or free digoxin concentrations and saliva levels, precluding the clinical use of the saliva test for digoxin. No correlation was found between plasma gentamicin concentrations and saliva levels when the drug was administered three times a day; however, good correlation was found when the drug was administered once-daily (r2 = 0.89, p < 0.0001). Saliva may be used as a noninvasive method of measuring gentamicin serum concentrations to guide dosage adjustments in patients administered the drug once-daily.

Anti-Bacterial Agents↗
PubMed1998

Long-term weekly treatment of colorectal metastatic cancer with fluorouracil and leucovorin: results of a multicentric prospective trial of fluorouracil dosage optimization by pharmacokinetic monitoring in 152 patients.

PURPOSE: A relationship between fluorouracil (5-FU) dose and response has been previously shown in advanced colorectal cancer. In a previous study with 5-FU stepwise dose escalation in a weekly regimen, and pharmacokinetic monitoring, we defined a therapeutic range for 5-FU plasma levels: 2,000 to 3,000 microg/L (area under the concentration-time curve at 0 to 8 hours [AUC0-8], 16 to 24 mg x h/L). The current study investigated 5-FU therapeutic intensification with individual dose adjustment in a multicentric phase II prospective trial. PATIENTS AND METHODS: Weekly high-dose 5-FU was administered by 8-hour infusion with 400 mg/m2 leucovorin. The initial dose of 5-FU (1,300 mg/m2) was adapted weekly according to 5-FU plasma levels, to reach the therapeutic range previously determined. RESULTS: A total of 152 patients entered the study from December 1991 to December 1994: 117 patients with measurable metastatic disease and 35 with assessable disease. Toxicity was mainly diarrhea (39%, with 5% grade 3) and hand-foot syndrome (30%, with 2% grade 3). Among 117 patients with measurable disease, 18 had a complete response (CR), 48 a partial response (PR), 35 a minor response (MR) and stable disease (SD), and 16 progressive disease (PD). Median overall survival time was 19 months. The 5-FU therapeutic plasma range was rapidly reached with a variable 5-FU dose in the patient population: mean, 1,803 +/- 386 mg/m2/wk (range, 950 to 3,396). Thirteen patients were immediately in the toxic zone, whereas 51 required a > or = 50% dose increase. CONCLUSION: Individual 5-FU dose adjustment with pharmacokinetic monitoring provided a high survival rate and percentage of responses, with good tolerance.

Adenocarcinoma↗
PubMed1998

[Prognostic value of Fürhman's grade in renal cell carcinoma. A study of 170 cases].

In order to evaluate the prognostic value of the anatomical stage (pTNM 1992) and of the histological factors (Führman's grade, cellular and architectural types), 170 renal cell carcinoma diagnosed between 1971 and 1991 were reviewed. In univariate analysis, the prognosis was correlated with the anatomical stage and Führman's grade: for the 125 patients without metastasis, grades 1 and 2 had a good prognosis, whereas grades 3 and 4 did poorly. The cellular type was not related to survival. Among architectural types, only the pseudo-sarcomatous type was correlated with prognosis. Multivariate analysis revealed that grade and metastasis at diagnosis were two independent predictors of survival; the grade was prognostically superior to metastasis. Führman's grade is essential in determining prognosis; its statistical value is superior to anatomical stage in multivariate analysis.

Adult↗
PubMed1998

[Evaluation of a new MRI cholangiography sequence with a half-Fourier acquisition technic].

PURPOSE: The aim of this study was to evaluate a new MR cholangiography sequence in which thick slices are obtained with half Fourier acquisition (SSFSE) in biliary obstructive diseases. PATIENTS AND METHODS: Fifty patients with suspected bile duct obstruction were prospectively investigated with MR cholangiography using SSFSE sequence with thick slices. The gold standard was ERCP (n = 40), percutaneous cholangiography (n = 1) or surgical findings (n = 9). According to this gold standard, 17 patients had bile duct lithiasis and 21 had neoplastic obstruction. RESULTS: The sensitivity and specificity of MR cholangiography were 100% and 94% for the diagnosis of lithiasis obstruction and 95% and 97% for neoplastic obstruction. Agreement between the MR cholangiogram and the gold standard was good whatever the site of obstruction (range of kappa values: 0.79-1). CONCLUSION: MR cholangiography with SSFSE sequence is a useful, precise and easy to use technique. Acquisition time for thick slices is short (< 2 sec) limiting cardiorespiratory artefacts and eliminating the need for post-treatment.

Adult↗
PubMed1997

Endoscopic detection of early esophageal cancer in a high-risk population: does Lugol staining improve videoendoscopy?

BACKGROUND: The aim of this study was to prospectively compare the diagnostic accuracy of videoendoscopy, with and without Lugol staining, for the detection of esophageal cancer in alcoholic or smoking patients older than 40 years. METHODS: Daily alcohol and tobacco consumption and overt and latent symptoms were noted. The 158 patients included were examined by videoendoscopy and with Lugol dye. RESULTS: The mean consumption of alcohol and tobacco was 86 +/- 49 gm/day for 26 +/- 11 years, and 30 +/- 18 pack-years, respectively. Twenty-five patients had no symptoms. Before Lugol staining, 12 patients had endoscopically identified cancerous lesions. After Lugol staining, 13 patients had 17 esophageal cancers, 3 of which were high-grade dysplasia. The prevalence of esophageal cancer was 8.2%: 95% CI [4,14]. Dye-free surfaces were significantly larger than the endoscopic patterns observed before Lugol staining (11.6 +/- 9.2 cm2 vs 1.4 +/- 1.7 cm2; p < 0.02). CONCLUSIONS: In an alcoholic smoking population, the prevalence of esophageal cancer detected by endoscopy is high and not related to symptoms described by patients. Lugol staining only moderately improves the diagnostic accuracy of videoendoscopy; its main advantage is the assessment of the mucosal extension of esophageal cancer.

Adult↗
PubMed1997

Interobserver agreement on endoscopic diagnosis of bleeding peptic ulcers.

BACKGROUND: The aim of this prospective study was to evaluate the interobserver agreement of stigmata of recent hemorrhage of bleeding peptic ulcers. METHODS: Sixty-one consecutive adult patients were enrolled in the study and nine (three junior and six senior) endoscopists reviewed standardized video recordings of endoscopic examinations. Interobserver agreement was evaluated using the kappa (kappa) index, intraclass correlation coefficient, and proportion of agreement. Observer bias and poorly trained observers were investigated. RESULTS: Interobserver agreement was very good for oozing (kappa = 0.68), good for clot (kappa = 0.51), poor for spurting (kappa = 0.29) and visible vessels (kappa = 0.33), and excellent for the absence of stigmata (kappa = 0.82). Observer bias sometimes occurred and the number of poorly trained observers was low. The kappa indexes were significantly better in senior than in junior investigators: 0.48 +/- 0.16 versus 0.37 +/- 0.26, respectively, p < 0.05. The agreement between the in vivo evaluation and video tape recordings (intraobserver agreement) was good (kappa = 0.60 +/- 0.19). There was no training phenomenon between the first and the second half of the patient group. CONCLUSIONS: The endoscopic classification of bleeding ulcers might be simplified by limiting grading to a few classes. Special attention should be paid to the training of endoscopists.

Adult↗
PubMed1997

Diagnostic strategies for extrahepatic cholestasis of indefinite origin: endoscopic ultrasonography or retrograde cholangiography? Results of a prospective study.

BACKGROUND AND STUDY AIMS: Due to its lower morbidity, it has been suggested that endoscopic ultrasonography (EUS) might replace endoscopic retrograde cholangiography (ERC) in the management of extrahepatic cholestasis of unknown origin. The present study aimed to compare the diagnostic accuracy of EUS and ERC in the management of cholestasis of unknown origin, taking into account the patient's general status and the necessity of endoscopic therapy. PATIENTS AND METHODS: Sixty-eight patients with cholestasis of unknown origin were studied prospectively. EUS followed by ERC was carried out on a blinded basis by two endoscopists; diagnostic and therapeutic suggestions were made after either examination. During the ERC procedure and before withdrawing the tube, the endoscopist provided the final conclusions and carried out appropriate endoscopic treatment. RESULTS: A correct diagnosis was obtained with EUS and ERC in 94% and in 92% of cases, respectively (not significant). After EUS, diagnostic ERC was necessary for diagnosis and therapy in 24% and 58% of cases, respectively. After ERC, EUS was requested in 41% of cases. The higher the American Society of Anesthesiologists (ASA) grade, the less it was necessary to perform a complementary investigation. In ASA grade 1 patients, endoscopic therapy was suggested in 38% of cases after EUS and in 33% after ERC (not significant); in ASA grade 3 patients, it was suggested in 93% of cases. CONCLUSIONS: The diagnostic sensitivities of EUS and ERC are similar for extrahepatic cholestasis. ERC is first indicated in poor candidates for surgery, since endoscopic therapy is frequently required. In good candidates for surgery, EUS should be carried out first in order to stage a tumor or identify choledocholithiasis.

Adult↗
PubMed1997

Interobserver agreement in the staging of rectal cancer using endoscopic ultrasonography.

BACKGROUND AND STUDY AIMS: In rectal tumors invasion of the rectal fat and perirectal lymph nodes are generally regarded as independent prognostic factors in most prospective series. There are no studies in the literature concerning interobserver agreement on the staging of rectal cancer by endorectal ultrasonography (EUS). The aim of the present study was to assess interobserver agreement using EUS in the TN staging of rectal cancer. PATIENTS AND METHODS: Thirty-seven patients with rectal cancer were investigated at two centers using EUS as part of the pretherapeutic staging (Olympus EUM-3 or EUM-20). All examinations were videotaped and reviewed six months later by four independent observers who assessed the stage of the tumor (from uT1 to uT4) and lymphatic invasion on a blinded basis. When the tumor was assessed as uT3, the observers specified the degree of involvement of the rectal fat (in millimeters). Interobserver agreement was estimated using the kappa coefficient (k) and the intraclass correlation coefficient (ICC). Agreement was classed as poor (k < 0.40), fair to good (0.40 < or = k < 0.75) or excellent (k < or = 0.75). RESULTS: Agreement was fair for uT1 tumors (k = 0.40) and poor for uT2 tumors (k = 0.20). Agreement was good (k = 0.58; CI 0.51 to 0.65) for uT3 tumors; there was a significant interobserver correlation for the exact measure of the extent of rectal fat (ICC = 0.65). The agreement was also good (k = 0.54, CI 0.47 to 0.61) for metastatic lymph nodes. CONCLUSION: As in the case of esophageal cancer, interobserver agreement on the staging of uT2 tumors is poor with EUS. The evaluation of rectal tumors with a poor prognosis shows good interobserver agreement.

Adenocarcinoma↗
PubMed1997

Is saliva suitable for therapeutic monitoring of anticonvulsants in children: an evaluation in the routine clinical setting.

Studies performed in the research setting suggested that saliva instead of blood may be used for therapeutic drug monitoring (TDM) of anticonvulsants in children. This is an attractive alternative because its collection is painless, and simpler and cheaper than blood drawing. Citric acid stimulation of saliva secretion facilitates sampling in the youngest patients. The aim of the study was to evaluate the suitability of saliva in routine TDM of anticonvulsants in infants and children with epilepsy. Blood and saliva samples were obtained simultaneously during routine TDM in 170 patients on chronic anticonvulsant drug therapy attending a neurology clinic. Saliva, plasma total, and plasma free concentrations of anticonvulsants were measured by high-performance liquid chromatography and enzyme multiplied immunoassay technique. Strong and highly significant correlations between saliva and plasma concentrations were found over a wide range of concentrations for carbamazepine, phenytoin, clobazam, and desmethylclobazam, and for phenobarbital in children > or = 8 years of age (r = 0.90 to 0.97; p < 0.001). Correlations between saliva and plasma concentrations were poor for phenobarbital in children < 8 years of age and for valproate. Correlations between saliva and plasma-free anticonvulsant concentrations were equal or only slightly better than between saliva and plasma total concentrations. Citric acid-stimulated saliva constitutes a convenient alternative for TDM of carbamazepine and phenytoin therapy in pediatric patients and of phenobarbital in children > or = 8 years of age.

Adolescent↗
PubMed1997

[Echoendoscopy and cancer of the esophagus].

Endoscopic ultrasonography is a major procedure for the staging of esophageal cancer. The staging given by the examination leads the treatment. We detail advantages and drawbacks of this technic.

Endosonography↗
PubMed1996

[Endoscopic retrograde cholangiography and endosonography. Respective indications in case of suspicion of common bile duct calculi].

The new methods for diagnosis and treatment of biliary lithiasis, including laparoscopic cholecystectomy, have encouraged work into new means of searching for a stone in the main bile duct. The management strategy for an individual patient can only be determined on the basis of the clinical situation and the relative expectations of the different diagnostic and therapeutic methods available. The current strategy does not take into consideration the contribution of magnetic resonance cholangiography which must be evaluated in comparison with endosonography. In general, when operative risk is moderate or low, endosonography is indicated, with or without sphincterotomy. In high-risk patients, endoscopic retrograde cholangiography would be indicated. Of course, this strategy depends on the facilities available and the experience of the surgical team. A self-assessment procedures will help determine the most cost-effective strategy.

Cholangiopancreatography, Endoscopic Retrograde↗
PubMed1996

Inhaled nitric oxide as an adjunct to pulmonary thromboendarterectomy.

In chronic pulmonary vascular thrombotic disease, pulmonary thromboendarterectomy has proved to be effective in reducing pulmonary hypertension and improving gas exchange. However, persistent pulmonary hypertension and unrelenting reperfusion edema are the main causes of death. We report a case of pulmonary thromboendarterectomy followed by an immediate unfavorable postoperative course with acute and persistent pulmonary hypertension, gas exchange impairment, and heart dysfunction. In this particular case, inhaled nitric oxide was successfully administered.

Administration, Inhalation↗