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Biomedical subjects

P Burtin

Publications and source records attributed to P Burtin.

At least 55 records · Page 3Linked to original sources
PubMed1996

Endoscopic ultrasonographic signs of portal hypertension in cirrhosis.

BACKGROUND: Endoscopic ultrasonography (EUS) has been suggested to investigate portal hypertension (PHT). We compared EUS and endoscopy in the exploration of PHT in cirrhosis. METHODS: In 58 patients with cirrhosis and 16 controls, the presence of esophageal varices and gastric varices was recorded by both endoscopy and EUS, peridigestive varices and perforating veins by EUS. Relationships of patterns with each other and with clinical and biologic data were evaluated. RESULTS: In patients with cirrhosis: esophageal varices were found by endoscopy and EUS in 88% and 55% of cirrhotic cases (p < 0.01), and gastric varices in 17% and 41%, respectively (p < 0.01). Perforating veins, below the gastroesophageal junction, were diagnosed by EUS in 40% of cases and never in controls. A significant relationship was found between perforating veins and the following patterns: peri-digestive varices, gastric varices at EUS, and esophageal varices at endoscopy. In patients with and without cirrhosis: after multivariate analysis, only esophageal varices at endoscopy were independently related to cirrhosis. However, in Child-Pugh class A patients, both esophageal varices and perforating veins were independently related to cirrhosis (diagnostic accuracy, 92%). CONCLUSIONS: EUS is of limited value in the diagnosis of cirrhosis because it gives little additional information to upper gastrointestinal endoscopy. The relationships between perforating veins, varices, and peridigestive varices support the hypothesis that perforating veins are important in the pathogenesis of esophageal and gastric varices.

Endoscopy, Gastrointestinal↗
PubMed1996

Interobserver agreement in endoscopic ultrasonography staging of esophageal and cardia cancer.

BACKGROUND: Endoscopic ultrasonography has been accepted as an accurate means of staging cardioesophageal cancer, but no study has focused on the variability of interobserver interpretation of images so obtained. METHODS: We compared interpretations recorded by five independent observers in 46 cases examined by endoscopic ultrasonography. One observer then reviewed a subset of 28 examinations 6 months later. RESULTS: Interpretations were in nearly full accord for uT0 and uT4 tumors (kappa = > or = 0.73), in good accord for uT1 and uT3 tumors (kappa = > or = 0.42), but in poor accord for uT2 tumors (kappa = 0.16). Agreement was generally good when pertaining to invasion of adjacent organs, but no agreement was noted for invasion of the pericardium. In assessment of lymph node involvement, agreement was good for intra-abdominal, subcarinal, right lower paratracheal, and paraesophageal nodes (kappa = > or = 0.49), but poor for left lower and upper paratracheal lymph nodes. Intraobserver agreement was excellent for extent of tumor infiltration (kappa = 0.91) and good for lymph nodes (kappa > or = 0.51). CONCLUSIONS: In staging cardioesophageal cancer by endosonographic ultrasonography, improvement is needed in cases of uT2 tumors and of tumors invading the pericardium, and in assessment of lymph nodes in the upper mediastinum.

Cardia↗
PubMed1996

Clinical pharmacokinetics of sedatives in neonates.

Sedation is currently administered to neonates experiencing pain and stress during intensive care for medical diseases, as well as postoperatively. Drugs commonly used for sedation in neonates include benzodiazepines (midazolam and lorazepam), chloral hydrate and opioids (fentanyl and morphine). Sedation protocols and dosage schedules are, in most cases, adapted from those which have been developed in children and even adults. The effectiveness and safety of the sedative agents remain underevaluated, however, due to the difficulties of quantifying pain and stress in neonates, and because of the limited use of validated scoring methods by practitioners. Among the benzodiazepines, midazolam is probably the drug of choice for continuous sedation. However, its elimination is delayed in the neonatal period and hypotension may occur when given as a bolus injection or when taken with opioids. Lorazepam requires further evaluation to exclude severe neurotoxicity. Chloral hydrate is administered orally, but because of its delayed elimination and risk of accumulation, a single administration for short term sedation is recommended. Among opioids, fentanyl (which was initially administered for postoperative analgesia) is now prescribed for sedation during mechanical ventilation. Tolerance and dependence may develop rapidly, limiting its usefulness for prolonged sedation. Although extensively studied in neonates, the efficacy and safety of morphine are not clearly determined, because of the limited number of patients included in individual studies. In addition, important interindividual differences in metabolism render dosage recommendations difficult. Alfentanil and sufentanil need further investigations to define their pharmacokinetic-pharmacodynamic properties in neonates. Although the choice of drug is important, the way the drug is used and monitored is equally important. All the drugs used for the sedation of neonates have large inter- and intraindividual differences in disposition, justifying specific pharmacological knowledge and individual dosage adjustments based on clinical evaluation of the patient and the monitoring of drug concentrations.

Humans↗
PubMed1996

[Mucinous ductal ectasia. Apropos of 2 cases].

Mucinous ectasia of the pancreas ducts is a recently described cystic lesion which usually occurs in acute pancreatitis. Endoscopic retrograde pancreatography provides diagnosis. Mucinous ductal ectasia is considered to be a precancerous lesion. Surgical exeresis is recommended. Our two cases emphasize the difficulties encountered for differential diagnosis with other cystic lesions of the pancreas.

Aged↗
PubMed1995

Colonic investigations in the elderly: colonoscopy or barium enema?

Colonoscopy (CS) is currently considered the best diagnostic procedure for colonic imaging. The objectives of this multicentric study were to assess whether CS or simple contrast barium enema (SCBE) has the best effectiveness and tolerance in the elderly (over 80 years old). Except in cases of emergency, 67 elderly patients from 3 centers were randomized among three diagnostic strategies: CS, SCBE or barium enema+rectosigmoidoscopy (BERS). CSs were generally carried out after polyethylene-glycol (PEG) cleansing, and barium enemas after enema cleansing. The diagnostic effectiveness of the three strategies was not significantly different: a colonic abnormality was found in CS, SCBE, BERS groups in 65, 56 and 71% of the cases, respectively. No other investigation was needed in 61 to 76% of cases, and, on the basis of the exploration, final therapy was modified in less than 22% of cases. Overall cleansing quality was significantly better with barium enema (84.1%) than with CS (57.0%; p < 0.05). This was explained by a poor tolerance to PEG intake, which led to 28.2% of adverse effects, compared with 7.1% after enema preparation (p < 0.05). This resulted in a significantly higher failure rate of complete colonic exploration with CS (48%) than with barium enema (9%; p < 0.001). In conclusion, the effectiveness of the three diagnostic strategies is similar in the elderly. However, due to a better acceptance of the enema preparation, and to a better success rate of complete exploration, SCBE should be preferred to investigate colonic symptoms when the above preparations are used.

Aged↗
PubMed1995

Safety of metronidazole in pregnancy: a meta-analysis.

OBJECTIVE: Our purpose was to determine from published experience in humans whether metronidazole exposure during the first trimester of pregnancy is associated with an increased teratogenic risk. STUDY DESIGN: All published articles reporting on metronidazole use during pregnancy were screened by two independent reviewers to select those including pregnant patients exposed during the first trimester and comparing the outcomes of their pregnancies with that of patients either not exposed to metronidazole or exposed only during the third trimester. The outcome under consideration was the occurrence of birth defects in live-born infants. The overall odds ratios of first-trimester exposure versus no first-trimester exposure was calculated by combining the selected studies in a meta-analysis according to the procedure of Mantel and Haenszel. RESULTS: From 32 identified studies, 7 met the inclusion criteria for meta-analysis. Six were prospective and included 253 women exposed to the drug in the first trimester of pregnancy; one was retrospective and reported on 1083 exposed women. The overall weighted odds ratio of exposure versus no exposure during the first trimester calculated by meta-analysis of the 7 studies was 0.93 (95% confidence interval 0.73 to 1.18). The odds ratio calculated from the 6 prospective studies was 1.02 (95% confidence interval 0.48 to 2.18). CONCLUSION: Metronidazole does not appear to be associated with an increased teratogenic risk.

Abnormalities, Drug-Induced↗
PubMed1995

[Corticosteroids: pharmacology and indications of short courses in pediatrics].

The principle of short courses of corticosteroids (SCC), ie, courses of less than 2 weeks, is to use the potent anti-inflammatory effect of corticosteroids. The pharmacological and pathophysiological basis of this anti-inflammatory effect are presented. Because they represent a very peculiar strategy of treatment, intravenous bolus dosages of methylprednisolone are not discussed. As compared to cortisol, the synthetic corticosteroids used in SCC (ie, mainly prednisone, prednisolone and betamethazone) have a more potent anti-inflammatory activity, a reduced mineralocorticoid effect and a longer biological half-life. The main indications of SCC are laryngitis and acute asthma. SCC are also indicated in bacterial meningitis, in addition to antibiotherapy. Other indications are Henoch-Schönlein purpura and intestinal inflammatory diseases. Adverse effects of SCC are uncommon. There are possible immunoallergic manifestations presenting mainly as skin reactions and sometimes as anaphylaxis. Abnormal psychological behaviour may be observed during the first 10 days of treatment. Few cases of ocular complications have been reported in adults, related to an increased intraocular pressure in patients with myopia or glaucoma. However, there is no evidence that SCC may cause gastric ulcer, nor that they may induce suppression of the adrenal function so that there is no need for a progressive decrease of the dosage when discontinuing the treatment.

Acute Disease↗
PubMed1995

Interobserver variation in tumor staging.

Interobserver agreement in cardioesophageal and rectal tumor evaluation is generally good, especially for uT1 and uT4 tumors. Diagnosis of a uT2 tumor is difficult and results in poor agreement. However, the proportion of agreement is satisfactory for distinguishing tumors that invade the mediastinal or the perirectal fat from those that do not, a situation that may be the most relevant from a therapeutic point of view. In cases of cardioesophageal tumor, agreement for metastatic LN is lower and depends on the sites involved, with the best agreement for intra-abdominal LN, which may indicate a worse prognosis. Lack of agreement in EUS images can be avoided by precise manipulation of the echoendoscope in the upper part of the mediastinum and by improving training and the definitions regarding EUS.

Endoscopy, Gastrointestinal↗
PubMed1995

[Evaluation of the teaching of echo-endoscopy. Application to the assessment of invasiveness of cancer of the esophagus and the cardia].

OBJECTIVES: Learning endosonography (EES) is known to be difficult, and the theory must be understood before performing EES routinely. The aim of the study was to evaluate the diagnostic indexes of EES in the staging of cardio-oesophageal cancer after a period of theoretical apprenticeship of EES and a learning period in a centre experienced in EES since 1989. METHODS: Five observers, having never used EES, followed to EES examinations for a 3-6 month period. They then reviewed the standardized records of 29 patients with cardio-oesophageal cancer. They had to evaluate the degree of tumour infiltration within oesophageal wall and the site of metastatic lymph nodes. Results were compared with the diagnosis of 5 experienced senior endoscopists. Interobserver agreement was estimated with kappa statistics and considered excellent for k > or = 0.75, good to moderate if 0.75 > k > or = 0.40, and poor if k < 0.40. RESULTS: Inter-observer agreement was poor for the topographic diagnosis of lymph nodes (kappa index from -0.09 to 0.33), lower to that of the 5 senior observers (0.33 to 0.77). It was satisfactory for degree of tumour infiltration (T1: k = 0.66; T2: k = 0.58; T3: k = 0.56; T4: k = 0.46). The individual sensitivities were weak according to lymph nodes site, but good for presence of lymph nodes (86 to 100%), with a specificity of 40 to 73%. CONCLUSIONS: After theoretical training of EES, agreement and diagnostic performances are good enough to diagnose pathological images (except for T4 tumors), and poor for localizing images in the mediastinum. This emphasizes the difficulties in learning echo-anatomy and gives useful guidelines for training programs in EES.

Cardia↗
PubMed1994

Placebo-controlled trial of midazolam sedation in mechanically ventilated newborn babies.

Although midazolam is used for sedation of mechanically ventilated newborn babies, this treatment has not been evaluated in a randomised trial. We have done a prospective placebo-controlled study of the effects of midazolam on haemodynamic variables and sedation as judged by a five-item behaviour score. 46 newborn babies on mechanical ventilation for respiratory distress syndrome were randomly assigned to receive midazolam (n = 24) or placebo (n = 22) as a continuous infusion. Doses of midazolam were calculated to obtain plasma concentrations between 200 and 1000 ng/mL within 24 h of starting treatment and to maintain these values throughout the study. Haemodynamic and ventilatory variables were noted every hour, as were complications and possible side-effects of treatment. Mean (SD) duration of inclusion was 78.7 (30.9) h. 1 patient in the treatment group and 7 in the placebo group were withdrawn because of inadequate sedation (p < 0.05). Midazolam gave a significantly better sedative effect than placebo, as estimated by the behaviour score (p < 0.05). Heart rate and blood pressure were reduced by treatment but remained within the normal range for gestational age and there was no effect on ventilatory indices. The incidence of complications was similar in the two groups. No midazolam-related side-effects were noted. Continuous infusion of midazolam at doses adapted to gestational age induces effective sedation in newborn babies on mechanical ventilation, with positive effects on haemodynamic variables. The course of the respiratory distress syndrome was not influenced by this treatment. Midazolam was given over only a few days and the limited effects on heart rate and blood pressure that we report should not encourage long-term administration.

Blood Pressure↗