Search PubMed⌕ Search

Biomedical subjects

S Chaussade

Publications and source records attributed to S Chaussade.

At least 109 records · Page 6Linked to original sources
PubMed1993

[Deglutition disorders in Lyme disease with severe neurological involvement].

A 67-year old man consulted for dysphagia to solid food and weight loss. Four years earlier he had developed Lyme disease with severe neurological involvement. Magnetic resonance imaging showed, on T2-weighted sequences, multifocal high-intensity signals located in the periventricular white matter and the brain stem. The disorders of deglutition were evaluated by cineradiography and manometry which showed deficient relaxation of the superior esophageal sphincter and delayed initiation of the pharyngeal phase; intrapharyngeal propulsion was preserved. On the basis of these findings cricopharyngeal myotomy was performed with subsequent improvement of the disorders. Treatment with doxycycline was prescribed. The significance of these deglutition disorders as regards infection and neurology is discussed and it should have therapeutic implications.

Aged↗
PubMed1993

Antineutrophil cytoplasmic auto-antibodies in sera from patients with ulcerative colitis after proctocolectomy with ileo-anal anastomosis.

Presence of antineutrophil cytoplasmic auto-antibodies (ANCA) in ulcerative colitis could be an epiphenomenon related to colonic inflammation and/or may reflect a primitive disturbance of immune regulation. In this regard, study of ANCA status after the whole colorectal mucosa has been removed could favor one of these two hypothesis. We compared the prevalence of ANCA in a first group of 70 patients with non operated UC and in a second group of 32 patients with UC having had a proctocolectomy with ileoanal anastomosis. Perinuclear ANCA (p-ANCA) were found in 34/70 (49%) of the first group as compared to 11/32 (34%) in the second group (NS). Our results further support that the presence of ANCA in UC reflects an immune disturbance not linked to the presence of the target organ.

Adult↗
PubMed1993

Treatment of Crohn's disease recurrence after ileoanal anastomosis by azathioprine.

Ileoanal anastomosis is a surgical procedure performed in patients with ulcerative colitis. In a small number of patients operated on for ulcerative colitis, Crohn's disease occurs in the reservoir, mimicking pouchitis, and may lead to pouch excision and to a permanent terminal ileostomy. Two patients with recurrent Crohn's disease in the reservoir after ileoanal anastomosis were treated with azathioprine for 18 and 24 months, respectively. Azathioprine induced a complete clinical and endoscopic remission. These two observations suggested that immunosuppressive drugs were a good option for permanent ileostomy in cases of recurrence of Crohn's disease in the reservoir after ileoanal anastomosis.

Adolescent↗
PubMed1993

Alpha-chain disease: analysis of alpha-chain protein and secretory component in jejunal fluid.

BACKGROUND: It is unclear why different forms of alpha-chain disease protein appear in intestinal fluid. This was studied in a 23-year-old Mauritanian man in whom alpha-chain disease was diagnosed localized to the duodenum and jejunum, nasopharynx, and bone marrow. METHODS: The duodenal infiltrate was studied by immunohistochemistry. Forms of alpha chain-containing proteins in serum and jejunal fluid were analyzed by ultracentrifugation and radioimmunoassays. RESULTS: The infiltrating cells contained alpha-1 chain but no light chains, and approximately 66% showed variable expression of J chain. Serum contained a large fraction of monomeric alpha-chain disease protein, whereas both monomeric and heavier forms appeared in jejunal fluid. Some of the latter were bound to secretory component, and the fluid contained virtually no free component. CONCLUSIONS: Linkage of polymeric alpha-chain disease protein to secretory component depends on balanced synthesis of alpha chains and J chain in the proliferating B cells, giving rise to polymers with binding site for secretory component expressed as an epithelial receptor. Insufficient receptor-mediated transport capacity (either relative and/or because of intestinal crypt reduction) results in passive external transfer of polymers without bound secretory component along with leakage of serum-derived or locally produced monomeric alpha-chain disease protein, the latter presumably originating from immunocytes with little or no J-chain synthesis.

Adult↗
PubMed1993

Inhibitory effect of jejunal high caloric nutrient load on human biliopancreatic secretion. The role of atropine, naloxone and composition of nutrient solutions.

Our previous studies shown that a high caloric load in the jejunum decreases biliopancreatic output. However, the factors responsible for this inhibition have not yet been fully assessed. In this study, we have compared the effect of a high caloric load of either proteins or carbohydrates on stimulated pancreatic output and investigated the mechanism of this inhibition. The small intestine of 6 healthy volunteers was intubated 10 cm below the angle of Treitz, for 3 consecutive days, to infuse test solutions. After a 90 min period of stimulation, using a protein solution (0.6 kcal/min; solution A), one of the following 2 solutions was infused on for 90 min each day, in random order. In each instance, either a protein plus carbohydrate solution (3.5 kcal/min; solution B), or a protein solution (3.5 kcal/min; solution C) was administered. On the 3rd day, first solution A then solution B were infused with either IV atropine (17 mug/kg/h) in 3 subjects, or naloxone (40 mug/kg/hl) in 3 subjects. PEG 4000 was also added to solutions B and C and (14)C-PEG to solution A, as nonabsorbable markers. Intraluminal content was aspirated 25 cm below the infusion point and 50 cm distally to prevent unabsorbed nutrients from reaching the ileum. Solution B and C caused similar decreases in lipase, chymotrypsin and bile salt outputs. Neither atropine nor naloxone inhibited the jejunal-brake induced by solution B. However, naloxone, but not atropine, decreased the carbohydrate absorption rate of solution B. In conclusion, a high caloric load of proteins or carbohydrates infused into the human jejunum decreased the bilio-pancreatic output induced by a low caloric load of proteins. This mechanism is neither cholinergic nor opioid dependent. This effect, in relation to a jejunal brake, might explain functional pancreatic insufficiency after surgical procedures such as gastro-jejunostomy.

Journal Article↗
PubMed1993

Endoscopic ultrasonography in the local staging of primary gastric lymphoma.

Endoscopic ultrasonography (EUS) and endoscopy were prospectively performed and compared to the histopathologic findings of the resection specimens in 24 patients with primary gastric lymphoma (PGL). On EUS, three types of PGL could be differentiated, a superficial type (n = 10), an infiltrating type (n = 12) and a tumorous type (n = 2). In the correct assessment of surface extension of the tumors, endoscopy and EUS agreed in 37.5% of cases and EUS showed more extensive disease than endoscopy in 58% of cases. However, in comparison to the resection specimens, EUS still underestimated the tumor surface extension in 37.5% of cases; this was mainly in low grade malignant PGL. The depth of tumor infiltration was correctly determined on EUS compared to the resection specimens in 91.5% of cases. Sensitivity, specificity and accuracy of diagnosing lymph node metastases were 100%, 80% and 83%, respectively. We conclude that EUS is a useful pre-therapeutic staging tool for primary gastric lymphoma but there remain some problems in determining the longitudinal and circular tumor spread in order to accurately guide the extent of gastric resection.

Adult↗
PubMed1993

[Pancreatic endocrine tumors: contribution of ultrasound endoscopy in the diagnosis of localization].

Endoscopic ultrasonography is a new imaging technique which has previously demonstrated its accuracy in localization of small pancreatic cancers. The aim of this retrospective study was to report our experience of this new method for localization of small endocrine tumors of potential pancreatic origin. Thirteen patients with insulinoma and 17 patients with Zollinger-Ellison syndrome were studied. All were imaged in a reference center by ultrasound (US) and CT scan (CT) before endoscopic ultrasonography. Insulinomas: 78.5% of tumors were 15 mm or less in size. The endoscopic ultrasonography was more accurate (79%) than US (7%) and CT (14%) for localization of the 14 tumors removed in the 13 patients who underwent surgery. Gastrinomas: Endoscopic ultrasonography was able to image 7 to the 9 pancreatic gastrinomas, the 2 duodenal gastrinomas, and the 2 gastrinomas located in peripancreatic lymph nodes which were removed in the 9 patients who underwent surgery. US and CT were able to image only one of the two peripancreatic lymph nodes. We concluded that endoscopic ultrasonography is a highly accurate tool for localization of small pancreatic endocrine tumors and should be performed early in the management of these tumors.

Adult↗
PubMed1993

Systemic lupus erythematosus and chronic intestinal pseudoobstruction.

We describe the first case of a patient with systemic lupus erythematosus in which clinical and radiological features, small bowel manometry and histological studies were consistent with the diagnosis of chronic intestinal pseudoobstruction. Our patient developed a fatal form of lupus with cerebral angiitis and tubulointerstitial lupus nephritis, with no sign of progressive systemic sclerosis or dermatopolymyositis. Postmortem examination confirmed the presence of an extensive fibrotic process in the muscularis layers, whereas the muscularis mucosae and the innervation of the digestive wall were spared.

Adult↗
PubMed1992

Human papillomavirus infection in esophageal squamous-cell carcinoma in western countries.

Recent studies have suggested that esophageal HPV infection could be a risk factor for esophageal squamous-cell carcinoma. The aims of our study were to assess the presence of HPV esophageal infection among French patients with esophageal squamous-cell carcinoma and to compare the prevalence of this infection among control patients exposed to similar known risk factors (alcohol and tobacco) and among non-exposed control patients. All patients had the following investigations: serum immunoglobulin level, T-lymphocyte subsets, cutaneous anergy test and endoscopy with biopsies from tumoral and normal areas. Three different methods were used for HPV-infection diagnosis: histological score, in situ hybridization intended for detection of HPV types 6, 11, 16, 18, 31 and 33, and dot blot intended for detection of HPV types 6/11 and 16/18. Five out of 12 patients with esophageal carcinoma had HPV esophageal infection. This infection did not result from impaired immune status. The most frequently observed types are HPV 16/18. None out of 17 exposed controls and only 1 out of 7 nonexposed controls had HPV esophageal infection (p less than 0.01). HPV infection may be implicated in the development of esophageal squamous-cell carcinoma in association with known risk factors.

Age Factors↗
PubMed1992

Low bone mineral density in patients with inflammatory bowel disease.

To assess the prevalence and risk factors for low bone mineral density in inflammatory bowel disease, we studied 61 consecutive patients, mean age 36 +/- 11 years. Twenty-seven had a Crohn's disease and 34 ulcerative colitis (including 13 with ileoanal anastomosis). Three patients, two women and one man (32, 70, and 45 years old, respectively) had vertebral crush fractures. Bone mineral density measured by dual energy x-ray absorptiometry at spine and femoral level was more than 2 SD below normal values in 23% of the patients, all of them having received steroid therapy. Eighteen patients (29%) had never received steroid therapy; their bone mineral density was not different than those who had. Univariate analysis showed a positive correlation between bone mineral density and body weight or oral calcium intakes, and a negative correlation with steroid daily dose. After ileoanal anastomosis, bone mineral density was not different from other groups and showed a positive correlation with time elapsed since coloproctectomy. We concluded that bone mineral density is low in patients with inflammatory bowel disease and exposes them to the risk of bone fracture. Bone mineral density after ileoanal anastomosis may increase with time after surgery.

Absorptiometry, Photon↗
PubMed1992

PAF-acether and acetylhydrolase in stool of patients with Crohn's disease.

PAF-acether (PAF) is a phospholipid mediator with potent biological effects on the digestive tract. We report the presence of PAF in stool of patients with active Crohn's disease (39.1 +/- 13.5 ng/g of stool, mean +/- SEM, N = 19) and its absence in patients with irritable bowel syndrome with diarrhea and diarrhea with malabsorption. Fecal PAF acetylhydrolase activity was higher (P less than 0.04) in patients with Crohn's disease as compared to patients with irritable bowel syndrome with diarrhea and diarrhea with malabsorption. We also report a solid-phase extraction of fecal PAF using silica minicolumns, which yielded results highly correlated with those obtained with a high-performance liquid chromatography method (r = 0.86, P less than 0.001, N = 16). These findings may allow us to implicate PAF in the onset and perpetuation of digestive tract inflammatory symptoms observed during Crohn's disease. They would warrant to investigate the influence of various therapeutic agents, including PAF antagonists, on fecal PAF levels during inflammatory digestive ailments.

1-Alkyl-2-acetylglycerophosphocholine Esterase↗
PubMed1992

Effects of acetorphan, an antidiarrhoeal enkephalinase inhibitor, on oro-caecal and colonic transit times in healthy volunteers.

Acetorphan is a potent enkephalinase inhibitor displaying antidiarrhoeal activity attributable to its intestinal antisecretory action mediated by endogenous enkephalins. The effect of acetorphan on digestive motility was studied in 12 healthy volunteers. Oro-caecal transit time was evaluated using the sulphasalazine/sulphapyridine method and colonic transit times using radiopaque markers. These measurements were successively performed after one week treatment with an antidiarrhoeal dose of acetorphan (100 mg t.d.s.) or placebo. There was no significant modification in transit time linked to acetorphan treatment: total oro-caecal times were 303 +/- 32 min vs. 287 +/- 27 min and colonic transit times 25.8 +/- 5.8 h vs. 31.3 +/- 5.5 h after acetorphan and placebo, respectively (means +/- S.E.M.). There was no significant modification either in right colonic, left colonic or rectosigmoid segmental transit times, or in the mean number of stools. These results, consistent with those from animal studies, confirm that, unlike classical antidiarrhoeal mu opiate receptor agonists, which act by delaying intestinal transit, acetorphan does not affect the transit. Antidiarrhoeal activity not accompanied by a delayed intestinal transit could have beneficial therapeutic consequences in the management of infectious diarrhoea. In addition, we show that the sulphasalazine and radiopaque markers methods can be simultaneously applied in the same study.

Adult↗