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S Chaussade

Publications and source records attributed to S Chaussade.

At least 73 records · Page 4Linked to original sources
PubMed1997

Effects of lanreotide, a somatostatin analogue, on postprandial gastric functions and biliopancreatic secretions in humans.

AIMS: Lanreotide is a novel synthetic somatostatin analogue. A long-acting formulation of lanreotide has been shown to be effective for the treatment of gastroentero-pancreatic hormone-producing tumours but effects on postprandial digestive and absorptive functions remain obscure. The aim of the present study was to evaluate the effects of intravenous lanreotide on gastric and biliopancreatic secretions in man as well as the absorption of nutrients and the duodeno-caecal transit time after ingestion of an homogenized meal (500 kcal, 55% carbohydrates, 15% proteins, 30% lipids). METHODS: Eight healthy male volunteers were studied on two occasions within a 2 weeks interval, using a perfusion method. They received in single-blind and random order continuous i.v. infusion of either placebo or lanreotide (100 micrograms h-t after a bolus of 100 micrograms 15 min before the beginning of the study). RESULTS: Lanreotide significantly decreased gastric acid secretion (90%) for the initial 3 h period. Gastric emptying was not significantly modified by lanreotide infusion. Compared with placebo, lanreotide almost completely abolished both bile salts and lipase responses to the meal. It largely increased the duodeno-caecal transit time and decreased significantly the duodenal absorption of carbohydrates and triglycerides. CONCLUSIONS: Since lanreotide has powerful effects on gastrointestinal functions, it could be useful in the prevention or in the treatment of pancreatic and bowel fistulas as well as short bowel syndrome.

Adult↗
PubMed1997

Bone assessment in patients with ileal pouch-anal anastomosis for inflammatory bowel disease.

BACKGROUND: Patients with ulcerative colitis are at risk of low bone mineral density (BMD). Proctocolectomy with ileal pouch-anal anastomosis (IPAA) for ulcerative colitis diminishes the risk of bone disease. The aims of this study were to assess the mechanism of low BMD and to measure bone density changes after IPAA. METHODS: Twenty patients with IPAA for ulcerative colitis, of mean(s.d.) age 38(9) (range 21-58) years, had measurements of lumbar spine and femoral neck BMD by dual energy X-ray absorptiometry, a mean(s.d.) 28(23) (range 3-84) months after proctocolectomy. Serum levels of calcium, phosphate, parathyroid hormone, osteocalcin and 25-hydroxy vitamin D were determined. Fifteen patients were followed for 28(12) (range 8-50) months. RESULTS: At baseline, six patients had spine BMD more than two standard deviations below the normal value, and three had vertebral crush fractures. Mean vitamin D values were normal and no patient had osteomalacia. BMD increased with time elapsed since IPAA (spine: r = 0.71, P = 0.005). During follow-up, mean(s.d.) changes in bone density were +2.3(3.8) and +2.1(5.6) per cent per year at the spine and femoral neck respectively. CONCLUSION: These results suggest that in patients with IPAA for ulcerative colitis, low BMD is not associated with vitamin D malabsorption and may be reversible after surgery.

Adult↗
PubMed1997

In-situ endothelial cell adhesion molecule expression in ulcerative colitis. E-selectin in-situ expression correlates with clinical, endoscopic and histological activity and outcome.

BACKGROUND AND OBJECTIVES: Little is known of the in-situ expression of adhesion molecules in ulcerative colitis (UC) according to disease activity. In the present study we investigate the vascular expression of endothelial leucocyte adhesion molecule 1 (ELAM-1/E-selectin), vascular cell adhesion molecule (VCAM-1) and intercellular adhesion molecules (ICAM-1 and ICAM-3) on the rectal mucosa of patients with UC in order to identify links between in-situ expression of these adhesion molecules and clinical, endoscopic and histological parameters. DESIGN AND METHODS: At inclusion, 16 untreated patients with UC at different stages of disease activity were assessed clinically and endoscopically and underwent rectal biopsy. Ten patients had similar assessments during follow-up. Quantitative histological and immunohistochemical scores were established with anti-E-selectin, VCAM-1, ICAM-1, ICAM-3 and HLA-DR monoclonal antibodies on frozen biopsy specimens. RESULTS: (1) At inclusion, E-selectin in-situ expression correlated with clinical activity (r = 0.7, P = 0.05), endoscopic severity (r = 0.74, P = 0.04), the histological score (r = 0.57, P = 0.02) and in-situ expression of HLA-DR on epithelial cells (r = 0.74, P = 0.01). (2) After remission, there was a significant decrease in ELAM-1 in-situ expression (P = 0.04). (3) In patients with clinical, endoscopic and histological remission the level of residual E-selectin expression appeared to be predictive of clinical relapse. (4) Vascular expression of VCAM-1 and ICAM-1 did not correlate with clinical, endoscopic or histological parameters, or with changes in disease activity. (5) ICAM-3 was never detected on endothelial cells of the colonic mucosa of controls or patients with UC. CONCLUSION: In ulcerative colitis, E-selectin, but not VCAM-1, ICAM-1 or ICAM-3, appears to play a central role in leucocyte migration into the colonic mucosa. Elevated vascular expression of E-selectin after remission may be involved in clinical recurrence.

Adult↗
PubMed1996

Jejunal brake.

Explore the source record for details and available documents.

Adipose Tissue↗
PubMed1996

Endosonographic features of pancreatic metastases.

BACKGROUND: Pancreatic metastasis is a rare event. Surgical resection can provide long-term survival in selected cases. The aim of this study was to describe the endosonographic features of pancreatic metastases. METHODS: Among the 7000 endoscopic ultrasound (EUS) examinations of the pancreas performed between 1989 and 1993, 7 were performed in patients with pancreatic metastases that were histologically confirmed (6 by surgery, 1 by CT biopsy). Videotapes of the EUS procedures were re-examined. Metastases were from four renal cell carcinomas, one ovary carcinoma, one chondrosarcoma, and one neuroendocrine carcinoma of the gallbladder. RESULTS: A solitary lesion was imaged by EUS in six cases and 10 lesions were seen in one case. Fifteen of 16 lesions were slightly hypoechoic or isoechoic in comparison with the adjacent pancreas. They were homogeneous, round, well circumscribed and were associated with an enhancement of the ultrasonic beam. The association of these ultrasonographic patterns was different from that usually observed in cases of primary pancreatic carcinoma. In one case (ovary carcinoma), the lesion was hypoechoic, with heterogeneous infiltration and indistinct margins and with the marked attenuation of the ultrasonic beam that is commonly noticed in primary pancreatic carcinoma or in focal chronic pancreatitis. CONCLUSION: Endosonographic features of pancreatic metastasis are usually different from those observed in cases of pancreatic carcinoma.

Adult↗
PubMed1996

Biliary obstruction caused by portal cavernoma: a study of 8 cases.

BACKGROUND/AIMS: Biliary obstruction secondary to portal cavernoma is a rare and little-known entity. From 1985 to 1994, we observed eight cases of portal cavernoma compressing the biliary tract. We report here the features of biliary involvement in these cases of portal cavernoma including the circumstances of diagnosis, biliary tract morphology, liver pathology and the efficiency of various treatments. METHODS AND RESULTS: The causes of portal vein obstruction were portal vein thrombosis in one case, peritonitis in another, omphalitis in two cases, portal vein catheterization in one case and unknown in two cases. The portal cavernoma was revealed through esophageal varices ruptures in four patients. The mean time from portal cavernoma diagnosis to biliary involvement was 8 years (range 0-21). Six patients had acute cholangitis, one of whom revealed portal vein obstruction. All the patients had abnormal liver function tests. Imaging techniques (transparietal abdominal ultrasonography and abdominal computed tomography scan [n = 8], endosonography [n = 5] and endoscopic retrograde cholangiography [n = 7]) showed in all cases an extraluminal obstacle, laminating the common bile duct. Pathologic examination of the liver showed secondary biliary cirrhosis in one patient, periportal and perisinusoidal fibrosis in another and no abnormalities in three other cases. Three patients were treated by endoscopic sphincterotomy but cholangitis persisted in two cases, leading to death in one. One patient who underwent a splenorenal shunt was symptom-free 60 months after surgery. Balloon endoscopic dilatation of the common bile duct, performed in one case, led to normalization of liver biological tests. The patients with abnormal liver pathology were treated by propranolol and ursodesoxycholic acid. No complication had occurred after 6 and 24 months of follow-up. CONCLUSIONS: In conclusion, eliminating biliary obstruction seems to be essential in providing the best change of survival for patients when biliary obstruction becomes symptomatic. In cases of abnormal liver pathology, associating propranolol with ursodesoxycholic acid would seem to be useful.

Abdomen↗
PubMed1996

Could oral erythromycin optimize high energy continuous enteral nutrition?

BACKGROUND: Intravenous erythromycin has previously been reported to stimulate gastric emptying, to inhibit gastric acid secretion and to stimulate pancreatic secretion during continuous gastric infusion of a liquid diet in healthy volunteers. AIM: The aim of this study was to evaluate the effects of oral erythromycin (160 mg/h) on gastrointestinal function under these conditions in seven healthy subjects. METHOD: This randomized double-blind cross-over study measured the gastric emptying rate of nutrients, gastric acid secretion, gastric pH, jejunal flow rate as well as biliopancreatic secretion and duodeno-caecal transit time during a 19.9 kJ/min continuous infusion of a nutrient solution (4.18 kJ/mL) in the antrum over a 6-h period by a perfusion method. RESULTS: The nutrition was well tolerated except by one subject with placebo perfusion. During the 6-period, total gastric volume and gastric volume of nutrient decreased during erythromycin administration by 22 +/- 8 and 22 +/- 6%, respectively. Gastric acid secretion was not modified by erythromycin. Lipase and bile salt outputs were significantly higher with erythromycin. The duodeno-caecal transit time was not statistically different with drug and placebo (169 +/- 15 and 146 +/- 19 min, respectively). CONCLUSION: During continuous gastric infusion of a liquid diet, the effect of oral erythromycin on gastric emptying could be useful to optimize cyclic enteral nutrition or to enhance the tolerance of enteral nutrition.

Administration, Oral↗
PubMed1996

Multifocal stenosing ulcerations of the small intestine revealing vasculitis associated with C2 deficiency.

A patient with cryptogenic multifocal ulcerous stenosing enteritis characterized by repeated bouts of intestinal obstruction, ulcerative stenosis of the small bowel relapsing after surgical resection, and steroid sensitivity is described. Fourteen strictures of the jejunum were found at laparotomy. Despite resection, abdominal pain persisted. Steroid therapy was effective but led to dependence. In our patient, cryptogenic multifocal ulcerous stenosing enteritis was associated with fever, asthma, Raynaud's phenomenon, sicca syndrome, heterozygous type I C2 deficiency (28-base pair gene deletion), stenosis, and aneurysms in selective mesenteric angiography. It is hypothesized that cryptogenic multifocal ulcerous stenosing enteritis might be related to a particular form of polyarteritis nodosa with mainly intestinal expression or to a yet unclassified independent vasculitis.

Adult↗
PubMed1996

Omeprazole-amoxycillin versus omeprazole-amoxycillin-clarithromycin in the eradication of Helicobacter pylori.

AIM: To assess the effect of adding clarithromycin to the combination of omeprazole and amoxycillin for the eradication of H. pylori infection. PATIENTS AND METHODS: In an open, randomized, three-centre study 120 patients (69 men, mean age 47 years, caucasians 74%) with symptoms of dyspepsia had normal gastroscopic examination and a positive urease test. They underwent a 13C-urea breath test and received, for 14 days, either omeprazole 40 mg b.d. plus amoxycillin 750 mg b.d., or the same regimen plus clarithromycin 250 mg b.d. Compliance was assessed by returned tablet counts. H. pylori clearance at the end of treatment and eradication 4 weeks after finishing treatment were assessed by 13C-urea breath test. RESULTS: Results are expressed according to 'all patients treated analysis', excluding patients who did not receive treatment and patients who had no final 13C-urea breath test assessment. In the groups treated with omeprazole-amoxycillin or omeprazole-amoxycillin-clarithromycin good compliance (> or = 90%) was observed in 85% vs. 76% (N.S.) of patients but 25% vs. 34% (N.S.) experienced at least one adverse event. Adverse events were minor, and no patient reported a metallic taste. Four weeks after finishing treatment eradication rates were 26% (95% CI: 15-37%) vs. 93% (95% CI: 86-99%) (P < 0.001). CONCLUSION: These results show that dual therapy with omeprazole plus amoxycillin achieves an unacceptably low H. pylori eradication rate. Addition of clarithromycin at low dosage (250 mg b.d.) proved to be useful, achieving a high eradication rate without increasing side-effects.

Amoxicillin↗
PubMed1996

Risk factors of oesophageal perforation during pneumatic dilatation for achalasia.

BACKGROUND/AIMS: Pneumatic dilatation of the oesophagus is a well established treatment for achalasia. Oesophageal perforation is the most serious complication that occurs in 2% to 6% of cases. The aim of this retrospective survey was to identify predictive risk factors for perforation in a consecutive series of 218 patients with achalasia. METHODS: Between 1983 and 1993, 270 pneumatic dilatations were performed in 218 patients. A Witzel dilator was used in 58 cases and a Rigiflex dilator in 212. Eight oesophageal perforations occurred (3%). The clinical, radiological, endoscopic, manometric, and technical data for the eight perforated patients were compared with those of 30 patients randomly sampled among those without perforation. RESULTS: All perforations occurred during the first dilatation. Perforations were fewer during dilatations with the Rigiflex dilator than with the Witzel dilator (2.4% v 5.2%). Perforations were all located above the cardia, on the left side of the oesophagus. In a multivariate analysis, a small weight loss and a high amplitude of oesophageal contractions in the group of patients with perforations were predictive of complications (respectively, p = 0.001 and p = 0.026). A contraction amplitude higher than 70 cm H2O in the lower part of the oesophagus was observed in three of eight patients with perforations but was not seen in any of the 30 patients without perforation (p < 0.01). CONCLUSIONS: This identification of risk factors should facilitate the choice between pneumatic dilatation or a surgical approach.

Aged↗
PubMed1996

[Peritoneal mesothelioma revealed by episodes of recurrent spontaneous peritonitis].

A case of a malignant peritoneal mesothelioma revealed by recurrent episodes of peritonitis is reported. This presentation had never been described. A 54 year-old man presented successive episodes of appendicitis, cholecystitis and sigmoiditis associated with purulent aseptic peritonitis. There were no signs of immunodepression or vasculitis. Initial analysis of peritoneal biopsies showed non specific inflammation. Because of long-term asbestos exposure, these biopsies were reviewed. A diagnosis of peritoneal mesothelioma was made on subserous infiltration by mesothelioma cells, and confirmed by immunohistochemistry. The patient died ten months after the diagnosis of mesothelioma despite chemotherapy (cisplatine+interferon).

Antineoplastic Combined Chemotherapy Protocols↗
PubMed1996

Treatment of refractory diarrhoea in AIDS with acetorphan and octreotide: a randomized crossover study.

OBJECTIVE: To compare the efficacy and tolerance of acetorphan, an orally active enkephalinase inhibitor whose antidiarrhoeal properties derive from a purely antisecretory activity, to that of octreotide, a subcutaneously administered somatostatin analogue, in the treatment of refractory diarrhoea in AIDS patients. DESIGN: An open randomized crossover trial. SETTING: The inpatient medical units of three hospitals. PATIENTS: Thirteen adult inpatients with AIDS and refractory diarrhoea that lasted for 35 +/- 8 weeks despite use of traditional antidiarrhoeal agents and was characterized by 7.0 +/- 1.2 stools/day, weighing 1033 +/- 174 g/day with a lipid output of 18.8 +/- 3.5 g/day. INTERVENTIONS: Acetorphan (100-300 mg thrice daily) and octreotide (50-150 micrograms thrice daily) were given in random order during two 1-week periods. MAIN OUTCOME MEASURES: Response was defined as a reduction by at least one-third of both daily stool number and weight. RESULTS: The mean daily stool number was reduced to 4.6 +/- 1.1 with acetorphan (P < or = 0.05) but was 5.6 +/- 1.2 with octreotide (NS). Whereas two patients responded to both treatments, two responded to acetorphan alone and one to octreotide alone. Daily lipid output in faeces was reduced non-significantly with acetorphan (11.5 +/- 2.3 g) but was nearly doubled with octreotide (33.7 +/- 12.0 g). Acetorphan was very well tolerated. CONCLUSION: Enkephalinase inhibitors may be a useful alternative to somatostatin analogues in the management of refractory diarrhoea in AIDS.

Adult↗
PubMed1996

[Treatment with octreotide of stenosing cystic dystrophy on heterotopic pancreas of the duodenal wall].

Cystic dystrophy of the duodenal wall developing in heterotopic pancreas is a rare disease. Weight loss and painless vomiting due to duodenal stenosis where the main clinical manifestations of this entity in a chronic alcoholic patient. Diagnosis was made by using an ultrasonic-endoscope equipped with a miniprobe. Although surgical treatment is usually recommended in this situation, the clinical condition of this patient improved dramatically after subcutaneous injections of somatostatin analog (octreotide). This treatment was maintained during 9 months and no recurrence was observed during the follow-up period.

Adult↗
PubMed1995

[Myotomy of the upper esophageal sphincter in upper functional dysphagia. A series of 34 cases].

OBJECTIVES: Patients with disorders of the upper oesophagus often present with swallowing impairment. We evaluated our results in 34 patients treated with cricopharyngeal myotomy. METHODS: Etiologies were muscular in 11 patients, neurogenic in 10, cricopharyngeal achalasia in 7 and could not be ascertained in 6. A 4 to 6 cm myotomy of the cricopharyngeal muscle and the lower part of the oesophageal constrictor muscle was performed. Incision was made to the mucosa. Outcome was evaluated in terms of functional improvement, weight gain and post-operative mode of food intake. RESULTS: Favourable results were obtained in 19 patients. Incomplete improvement was achieved in 6 and the operation was unsuccessful in 11. CONCLUSION: The quality of residual pharyngeal propulsion appears to be the determining element in operative success and should be used in determining indications.

Adolescent↗